• Research Review
• Journal Summary

Author: AK Ziraba, JC Fotso, R Ochako

Reference: BMC Public Health 2009, 9:465 doi:10. 1186/1471-2458-9-465, http://www.biomedcentral.com/content/pdf/1471-2458-9-465.pdf (open access)

Summarized by: Eunice Mafundikwa, Health Communications Specialist, Danya International; ProCor guest editor

Africa is sitting on yet another time bomb-obesity--and the clock is ticking fast, especially among the urban poor. There is now a real threat that it will not be long before obesity among urban women reaches epidemic proportions in African countries.

Analysis of demographic and health survey data from seven African countries (Malawi, Senegal, Kenya, Ghana, Tanzania, Niger, and Burkina Faso) found that the number of overweight or obese people increased by almost 35 % between the early 1990s and early 2000s. The increase in obesity was higher among poor people, although wealthier and more educated individuals are still affected the most by obesity and overweight.

Cultural challenges
In a continent where being big is a symbol of status, the findings confirmed that women of higher socio-economic levels were more likely to be overweight or obese than their poorer counterparts. Similarly, women engaged in income-generating activities (working) were more likely to be overweight. A striking finding from this study was the increase in obesity among women of lower socioeconomic status. The speed of increase in obesity was found to be higher among the poorest group (+50%) as compared to the richest group (+7%). Most likely this is because of changing nutritional and lifestyle trends--people living in urban populations are consuming more refined and energy-dense foods and have very little physical activity.

"Results from this study can be considered an early warning that obesity, as a disease in its own right, and as a risk factor for other diseases, is on the increase among urban populations of sub-Saharan Africa, with a higher rate of increase among the "urban poor," researchers warn.

Systemic challenges
Despite the chronic nature of most diseases associated with obesity, and by extension the huge cost of treatment, research and investment in health care in Africa remains focused on infectious diseases. "The prospects look grim for the already under-funded and ill-equipped African health care systems to deal with a new epidemic alongside existing ones such as HIV/AIDS, tuberculosis, and malaria," the authors noted. Adding to the absence of prevention efforts are cultural attitudes that ignore the risks of being overweight. In most African cultures, big is considered beautiful and a sign of wealth.

"Like several other public health challenges, obesity should be tackled and prevented early before it gets worse, as indicated in the WHO Global Strategy on Diet, Physical Activity and Health, ensuring that people have access to healthy diets and get involved in physical activities," the study cautioned.

Rapid urbanization in poorly performing economies has resulted in huge populations of urban poor. As much as 20-50% of urban populations in Africa are classified as either overweight or obese. "In spite of rampant poverty in urban areas, access to cheap foods with large amounts of fat and sugar is higher among rural populations." Other factors associated with a higher risk of obesity include genetic predisposition, metabolic disorders, gender, and environmental factors, among others.

While poverty and social exclusion are likely to increase the risks of developing a chronic disease, the poor are also more likely to develop and die of complications from chronic diseases due to their inability to afford treatment and care.

Interestingly, the study found that while low socioeconomic status and living in poor neighborhoods has been associated with a higher prevalence of obesity and chronic diseases in developed countries, a contrast exists in Africa where there is a strong positive relationship between obesity and high socioeconomic status.

The study sheds light on the patterns of obesity in the sub-region, with special attention to the differences between the urban poor and the urban non-poor serving as a an early warning that obesity as a disease in its own right and a risk factor for many other diseases is increasing among urban populations.