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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
74
VOLUME 14 NUMBER 2 • DECEMBER 2017
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
Correspondence to: Enguerran Macia
Emmanuel Cohen, Lamine Gueye, Gilles Boetsch
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
e-mail:
enguerranmacia@gmail.comEmmanuel Cohen
Department of Eco-Anthropology and Ethnobiology, National
Museum of Natural Science, University of Paris, France
Francois Lepira Bompera
Department of Anthropology, Ethics and Health, Santé,
Aix-Marseille University, Marseille, France
Previously published in
Cardiovasc J Afr
2017;
28
: 324–330
S Afr J Diabetes Vasc Dis
2017;
14
: 74–80
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
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 nowwell 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
In Pikine,
a suburb of Dakar, these positive perceptions of stoutness have
been observed among women.
25
However, no study has been
conducted from this perspective among urban men, or among
the rural population.
Therefore, the objectives of this study were (1) to assess and
compare the prevalence of obesity, general and central, in Dakar and