41 / 48
SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 14 NUMBER 2 • DECEMBER 2017
79
of current data,
10
these results tend to indicate that Tessekere is
also one of the rural areas in the sub-region that is least affected
by the obesity epidemic.
33-35
As indicated in the literature on West Africa,
10
problems
of excess weight affect the urban environment more than the
rural environment, therefore showing just how environmentally
dependent the nutritional transition is in Senegal. In Dakar, the
modern lifestyle
36
is combined with a decrease in physical activity
and a higher calorie content diet. In Tessekere, where there is
no running water or electricity, a pastoral lifestyle still protects
the population from the obesity epidemic, particularly by obliging
people to travel long distances daily to feed and water their
herds.
However, our results show that such differences between the
urban and rural environment may not last, as overweight and
obesity rates among women born after the great drought of
1973–1974,
hitande bonde
[the worst year in Pulaar], are now
approaching those of their urban counterparts. The gradual closing
of the gap between urban and rural populations is also borne out
by results concerning the ideal body size. In the rural environment,
the ideal body type for both men and women is in the overweight
category, whereas it is in the normal range in Dakar. The social
value placed on the overweight body undeniably acts as a factor
in the development of excess weight in rural areas.
16
At the same time, it is important to note the considerable
tolerance that both rural and urban Senegalese show toward
overweight. At a BMI of 27.5 kg/m², less than 40% of the men
in Dakar and Tessekere saw themselves as too fat, compared to
50% of urban women and 30% of rural women. By comparison,
in France, for the same BMI, 60% of the men and 85% of women
saw themselves as too fat.
29
Therefore, not only are body weight
norms higher in Senegal than in France, but they are also less strict,
which can only foster development of the obesity epidemic.
16
A
tightening of these body weight norms is conceivable in the years
to come, both pro-actively, through public health messages issued
by the Senegalese government, and also through globalisation
and the media, which convey beauty standards that emphasise a
slimmer body, particularly in the urban environment.
37,38
Our investigation has several limitations. First, the study design
was cross-sectional, which does not allow us to explore causation.
To overcome this limitation, it would be necessary to conduct
a longitudinal study in Dakar in the future. Second, due to
insufficient numbers of older adults in the study, we were unable
to survey the evolution of body weight after 50 years of age,
which should be analysed in the future, given the significant rise
in weight-related problems with age, and the aging population
on the continent.
39
Conclusion
This study shows that the prevalence of obesity is bound to rise
quickly among Senegalese women living in a rural environment,
partly due to high body weight norms and a large tolerance towards
overweight and obesity. To combat problems of obesity in Senegal
at present, public health messages should be geared towards the
population category most at risk, in other words mature women
living in urban areas. However, to limit the scope of the epidemic
over the entire country, health centres, which are the only local
health structures in rural areas, must begin to raise awareness of
the problems that arise with excess body weight.
The authors received funding for this research from the National
Center forScientific Research, France (PEPS ‘Ecological Health’).
References
1. World Health Organization.
Global status report on non-communicable diseases
2010.
Geneva: World Health Organization, 2011.
2. Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P,
et al
.
Obesity and the risk of myocardial infarction in 27000 participants from 52
countries: a case-control study.
Lancet
2005;
366
: 1640–1649.
3. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C,
et al.
Global,
regional, and national prevalence of overweight and obesity in children and
adults during 1980–2013: a systematic analysis for the Global Burden of Disease
Study 2013.
Lancet
2014;
384
: 766–781.
4. Chiolero A, Paccaud F. An obesity epidemic booga booga.
Eur J Public Health
2009;
19
: 568–569.
5. Roth J, Qiang X, Marbán SL, Redelt H, Lowell BC. The obesity pandemic: where
have we been and where are we going?
Obes Res
2004;
12
: 88S–101S.
6. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of
obesity in developing countries.
Nutr Rev
2012;
70
: 3–21.
7. Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML,
et al
.
The global obesity pandemic: shaped by global drivers and local environments.
Lancet
2011;
378
: 804–814.
8. Steyn NP, Mchiza ZJ. Obesity and the nutrition transition in sub-Saharan Africa.
Ann NY Acad Sci
2014;
1311
: 88–101.
9. Scott A, Ejikeme CS, Clottey EN, Thomas JG. Obesity in sub-Saharan Africa:
development of an ecological theoretical framework.
Health Promot Int
2013;
28
: 4–16.
10. Abubakari AR, Lauder W, Agyemang C, Jones M, Kirk A, Bhopal RS. Prevalence
and time trends in obesity among adult West African populations: a meta-
analysis.
Obes Rev
2008;
9
: 297–311.
11. Macia E, Duboz P, Gueye L. Prevalence of obesity in Dakar.
Obes Rev
2010;
11
:
691–694.
12. Popkin BM. Urbanization, lifestyle changes and the nutrition transition.
World
Dev
1999;
27
: 1905–1916.
13. Yako YY, Echouffo-Tcheugui JB, Balti EV, Matsha TE, Sobngwi E, Erasmus RT,
et
al
. Genetic association studies of obesity in Africa: a systematic review.
Obes Rev
2015;
16
: 259–272.
14. Popkin BM, Gordon-Larsen P. The nutrition transition: worldwide obesity dynamics
and their determinants.
Int J Obes
2004;
28
: 2–9.
15. Dinsa GD, Goryakin Y, Fumagalli E, Suhrcke M. Obesity and socioeconomic status
in developing countries: a systematic review.
Obes Rev
2012;
13
: 1067–1079.
16. Cohen E, Boëtsch G, Palstra FP, Pasquet P. 2013. Social valorisation of stoutness
as a determinant of obesity in the context of nutritional transition in Cameroon:
the Bamiléké case.
Soc Sci Med
2013;
96
: 24–32.
17. WHO.
Diet, nutrition and the prevention of chronic diseases.
Geneva: World
Health Organization, 2003.
18. Ziraba AK, Fotso JC, Ochako R. Overweight and obesity in urban Africa: a problem
of the rich or the poor?
BMC Public Health
2009;
9
: 465–473.
19. WHO Regional Office for Africa.
The health of the people: the African regional
health report (2006). Geneva: World Health Organization, 2006.
20. Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing
countries.
Circulation
1998;
97
: 596–601.
21. Brown PJ, Konner M. (1987). An anthropological perspective on obesity.
Ann NY
Acad Sci
1987;
499
: 29–36.
22. Brown P. Culture and the evolution of obesity.
Human Nature
1990;
2
: 31–57.
23. Renzaho A. Fat, rich and beautiful: changing sociocultural paradigms associated
with obesity risk, nutritional status and refugee children from sub-Saharan Africa.
Health Place
2004;
10
: 105–113.
24. Puoane T, Bradley H, Hughes G. Obesity among black South African women.
Human Ecology Special
2005;
13
: 91–95.
25. Holdsworth M, Gartner A, Landais E, Maire B, Delpeuch F. Perceptions of healthy
and desirable body size in urban Senegalese women.
Int J Obes
2004;
28
: 1561–
1568.
26. WHO.
Obesity: preventing and managing the global epidemic. Report of the
WHO consultation. WHO Technical Report Series 894.
Geneva: World Health
Organization, 2000.
27. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating
need for weight management.
Br Med J
1995;
311
:158–161.
28. Dobbelsteyn CJ, Joffres MR, MacLean DR, Flowerdew GA. Comparative evaluation
for waist circumference, wais to hip ration and body mass index as indicators of
cardiovascular risk factors, the Canadian Health Heart Survey.
Int J Obes
2001;
25
: 652–661.