Evidence of an Overweight/Obesity Transition among School-Aged Children and Youth in Sub-Saharan Africa: A Systematic Review

Abstract

BackgroundPrevalence of childhood overweight/obesity has increased considerably in recent years. The transition to higher rates of overweight/obesity has been well documented in high income countries; however, consistent or representative data from lower income countries is scarce. It is therefore pertinent to assess if rates of overweight/obesity are also increasing in lower income countries, to inform public health efforts.ObjectiveThis systematic review aimed to investigate the evidence for an overweight/obesity transition occurring in school-aged children and youth in Sub Saharan Africa.MethodsStudies were identified by searching the MEDLINE, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases. Studies that used subjective or objective metrics to assess body composition in apparently healthy or population-based samples of children and youth aged 5 to 17 years were included.ResultsA total of 283 articles met the inclusion criteria, and of these, 68 were used for quantitative synthesis. The four regions (West, Central, East, and South) of Sub Saharan Africa were well represented, though only 11 (3.9%) studies were nationally representative. Quantitative synthesis revealed a trend towards increasing proportions of overweight/obesity over time in school-aged children in this region, as well as a persistent problem of underweight. Weighted averages of overweight/obesity and obesity for the entire time period captured were 10.6% and 2.5% respectively. Body composition measures were found to be higher in girls than boys, and higher in urban living and higher socioeconomic status children compared to rural populations or those of lower socioeconomic status.ConclusionsThis review provides evidence for an overweight/obesity transition in school-aged children in Sub Saharan Africa. The findings of this review serve to describe the region with respect to the growing concern of childhood overweight/obesity, highlight research gaps, and inform interventions.PROSPERO Registration NumberCRD42013004399

Childhood obesity in low- and middle-income countries

“…21 A review of 68 studies of overweight/ obesity in school-children in sub-Saharan Africa found evidence of a transition towards increasing overweight/ obesity, but there was no attempt to assess the validity of the BMI recorded in references as indicative of excessive fatness for the children in these studies. 23 Large longitudinal studies are required to show how international growth references do or do not match the growth patterns of children of different nationalities and racial groups, what this means in terms of the proportions and distribution of body fat and lean tissue, and how these relate to later outcomes for children. Simple, non-invasive but reliable methods are also required to determine the amount of fat and its distribution within bodies.…”

A cross sectional analysis of eating habits and weight status of university students in urban Cameroon

“…A study among sub-Saharan African children and youth demonstrated that this increase is similar to that of developed countries [1], while another has indicated a higher relative increase (+65%) in developing countries than developed countries (+48%) [2]. In Cameroon, the numbers of individuals affected is on the rise and also remains a challenge.…”

Relationships between active school transport and adiposity indicators in school-age children from low-, middle- and high-income countries

“…1 Many low-and middle-income countries (LMIC) have shown similar or even more rapid increments of childhood obesity compared with highincome countries (HIC). 2,3 Although the increment of obesity in some HIC seems to be leveling off, the prevalence remains very high. 1 Unfortunately, the data for time trends in physical activity (PA) and sedentary behaviors among children and adolescents from LMIC are extremely sparse.…”