CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 9, October 2012
512
AFRICA
Obesity and its health impact in Africa: a systematic
review
BRIDGET ADEBOYE, GIOVANNA BERMANO, CATHERINE ROLLAND
Abstract
Obesity and its association with co-morbidities in Africa
are on the rise. This systematic review examines evidence
of obesity and its association with co-morbidities within the
African continent. Comparative studies conducted in Africa
on adults 17 years and older with mean body mass index
(
BMI)
≥
28
kg/m
2
were included. Five electronic databases
were searched. Surveys, case–control and cohort studies from
January 2000 to July 2010 were evaluated. Of 720 potentially
relevant articles, 10 met the inclusion criteria. Prevalence of
obesity was higher in urban than rural subjects with signifi-
cant increases in obesity rates among women. Inflammatory
marker levels were significantly elevated among Africans
compared with Caucasians. The co-relationship between
obesity and chronic diseases was also highlighted. This
systematic review demonstrates that while obesity remains
an area of significant public health importance to Africans,
particularly in urban areas, there is little evidence of proper
diagnosis, treatment and/or prevention.
Keywords:
obesity, Africa, prevalence, cardiovascular risk
Submitted 11/11/11, accepted 3/5/12
Cardiovasc J Afr
2012;
23
: 512–521
DOI: 10.5830/CVJA-2012-040
Obesity has long been acknowledged as a significant contributing
factor in the development of various chronic diseases such as
cardiovascular disease, hypertension, type 2 diabetes mellitus,
stroke, osteoarthritis and certain cancers.
1-3
As a risk factor for
non-communicable diseases, obesity has become a global public
health concern with more than one billion adults estimated to be
overweight and over 400 million of them obese.
4,5
Recent global figures from the World Health Organisation
(
WHO) indicate that the prevalence of obesity is not just a
problem of the developed countries but is also on the increase
in the developing world, with over 115 million people suffering
from obesity-related problems.
5
This significant acceleration
in the incidence of obesity also indicates that low-income
countries are now confronted with a double burden where
both communicable and chronic non-communicable diseases
co-exist.
6-8
While the threat of communicable and poverty-related
diseases (such as malaria, malnutrition, cholera and infant
mortality) exists in several African countries, the prevalence
of chronic diseases continues unabated.
2,9-12
In fact, several
researchers predict that in many developing countries, the burden
of chronic diseases will equal the burden of acute infectious
diseases in the near future.
7,13,14
For instance, the WHO projects
by 2030 a doubling in mortality rates resulting from ischaemic
heart disease in the African region,
15
as well as a prediction by
2025
of the largest increase in prevalence of diabetes mellitus in
developing countries.
16
Despite this increasing need to tackle chronic diseases
with additional resources and effort,
17
under-nutrition and
communicable infectious diseases remain a core focus of
researchers and policy makers within the African continent,
11,18
with insignificant attention assigned to obesity and chronic,
non-communicable diseases.
2,6
The lack of attention given to
the obesity epidemic may have been spurred on by the earlier
misrepresentation of health information, which led to the
misperception of ‘healthy’ or ‘benign’ obesity.
19,20
This concept, widely propagated in places such as South
Africa from the 1960s until the late 1980s,
20,21
led to gross
neglect of the problem of obesity and treatment of the attendant
co-morbidities.
19,20
Although the misperception of ‘benign
obesity’ is being rectified by the increasing number of recent
studies that spell out the reality of obesity,
22,23
the threat of
diseases such as HIV/AIDS and the high economic toll it takes
on the continent make it increasingly difficult to divert resources
to tackling the obesity epidemic.
24-26
This systematic review focuses on epidemiological studies
(
surveys, case–control and cohort) with comparative subgroups.
It aimed to unearth the current evidence on obesity and
its association with increased co-morbidities among obese
individuals on the African continent. The pattern of obesity in
Africa was explored, comparing the differences in prevalence
between urban and rural subjects. General outcome, such as
prevalence of obesity among urban residents, was highlighted to
show the impact of urbanisation and Westernisation. The review
also highlights the impact of obesity on cardiovascular and
inflammatory bio-markers, comparing Africans and Caucasians.
Co-morbidities of obesity and their prevalence among the
obese in comparison with the non-obese population were also
evaluated.
Methods
A comprehensive electronic literature search of five databases
(
Cochrane library, Medline, EMBASE, CINAHL and Amed)
was conducted using both medical subject headings (MeSH)
and key text such as ‘obesity’, ‘overweight’, and ‘BMI’. Using
the appropriate Boolean operators, key search words were
combined with Africa, exploding searches to include West
Africa, East Africa, Africa sub-Sahara, South Africa, Central
Africa and North Africa. The search was restricted to studies
on human subjects published between January 2000 and July
2010.
Language restrictions were applied, limiting searches to
Centre for Obesity Research and Epidemiology (CORE),
Faculty of Health and Social Care, Robert Gordon
University, Aberdeen, Scotland
BRIDGET ADEBOYE, MSc
GIOVANNA BERMANO, PhD
CATHERINE ROLLAND, PhD,
