50 / 74
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017
324
AFRICA
Prevalence of obesity and body size perceptions
in urban and rural Senegal: new insight on the
epidemiological transition in West Africa
Enguerran Macia, Emmanuel Cohen, Lamine Gueye, Gilles Boetsch, Priscilla Duboz
Abstract
Background:
The objectives of this study were to assess the
prevalence of obesity in Dakar and in Tessekere, a rural
municipality in northern Senegal, and to compare ideal body
size between these populations.
Methods:
A cross-sectional survey was carried out in 2015 on
a representative sample of 1 000 adults, aged 20 years and
older in Dakar, and 500 adults of the same age in Tessekere.
Results:
The prevalence of obesity and overweight was higher
in Dakar than in Tessekere. However, overweight and obesity
rates of young women living in this rural area were close to
those of young women in Dakar. At a body mass index of
27.5 kg/m², less than 40% of the men in Dakar and Tessekere
found themselves too fat, compared to 50% of urban women
and 30% of rural women.
Conclusion:
This study explains how and why obesity is
becoming a rural health problem in Senegal.
Keywords:
Africa, biological anthropology, epidemiological tran-
sition, nutrition transition, overweight
Submitted 4/11/16, accepted 13/7/17
Published online 25/10/17
Cardiovasc J Afr
2017;
28
: 324–330
www.cvja.co.zaDOI: 10.5830/CVJA-2017-034
Overweight and obesity are important risk factors for
cardiovascular disease.
1,2
The increasing prevalence of obesity
during the last few decades in a number of countries
3
has been
reported as a global pandemic and a major public health issue
worldwide.
4-7
Sub-Saharan Africa (SSA) is not immune to this
epidemic.
8,9
In urban West Africa, the prevalence of obesity
more than doubled from 7.0% in 1990–94 to 15.0% in 2000–04.
10
However, over this 15-year period, Abubakari and colleagues
noted that obesity rates seemed to remain unchanged in rural
West Africa, possibly due to the small number of studies
retrieved from these populations.
10
Despite the threat posed by obesity in West Africa, there are
very few studies addressing this issue in Senegal and none in the
rural areas. To our knowledge, few studies have evaluated the
prevalence of obesity among both men and women in Dakar,
11
the political and economic capital of the country. In terms
of body mass index (BMI), the prevalence of overweight and
general obesity in 2009 was 22.3 and 8.3%, respectively, in Dakar,
whereas using waist circumference (WC), the prevalence of
central obesity was 21.2%.
11
Only by monitoring prevalence over
time can the evolution of the obesity epidemic in the Senegalese
capital be understood.
1
Various factors contribute to the high prevalence of obesity in
SSA.
8,9
More precisely, numerous macrosocial (e.g. urbanisation,
12
globalisation
9
), genetic,
13
behavioural (mainly diet and physical
activity
14
), sociodemographic,
15
and culturally underlying
16
factors have been reported as determinants of obesity in West
Africa. In the context of this comparative urban–rural study
in Senegal, a focus on urbanisation, sociodemographics and
perception of body size is fundamental.
It is now well established that urbanisation is a major driving
force in obesity, by reducing physical activity and increasing
consumption of energy-dense diets.
17
In West Africa, urban
residents have three times the odds of being obese than rural
residents.
10
Among sociodemographic factors, age and gender
have regularly been shown to be associated with obesity in SSA
8
and West Africa.
10
Beyond these recurrent and robust predictors, the role of
socio-economic status (SES) seems more complex in SSA.
Indeed, while studies regularly report that obesity is significantly
more likely to occur in the highest SES group,
8
Ziraba and
colleagues observed that the increase in obesity was higher
among the poorest than among the richest African urban dwellers
during the period 1995 to 2005.
18
In line with the epidemiological
transition occurring in SSA,
19,20
the relationship between obesity
and SES is likely to change in the coming years and gradually
affect the lowest SES groups more than the highest.
In SSA, positive traditional representations of stoutness –
the social validation of the big belly for men and large hips for
women
21
– may also contribute to the gradual development of
obesity. Obesity is a concept that is viewed differently across
cultures.
22
In SSA, where HIV and other diseases associated
with wasting away are prevalent, overweight and obesity have
been associated with health.
16,23
Moreover, once married, extra
weight is seen as an indicator that the spouse is well cared for.
24
Faculty of Medicine, Pharmacology and Odontology,
University of Cheikh Anta Diop, Dakar, Senegal; National
Centre for Scientific Research, University of Bamako,
Mali; and National Centre for Scientific and Technological
Research, Burkina Faso
Enguerran Macia, PhD,
enguerranmacia@gmail.comEmmanuel Cohen, PhD
Lamine Gueye, PhD
Gilles Boetsch, PhD
Department of Eco-Anthropology and Ethnobiology, National
Museum of Natural Science, University of Paris, France
Emmanuel Cohen, PhD
Department of Anthropology, Ethics and Health, Santé,
Aix-Marseille University, Marseille, France
Priscilla Duboz, PhD