The silent epidemic of obesity in The Gambia: evidence from a nationwide, population-based, cross-sectional health examination survey

Abstract

ObjectivesNon-communicable diseases account for 70% of global deaths; 80% occur in low-income and middle-income countries. The rapid increase of obesity in sub-Saharan Africa is a concern. We assessed generalised and abdominal obesity and their associated risk factors among adults in The Gambia.DesignNationwide cross-sectional health examination survey using the WHO STEPwise survey methods.SettingThe Gambia.ParticipantsThis study uses secondary analysis of a 2010 nationally representative random sample of adults aged 25–64 years (78% response rate). The target sample size was 5280, and 4111 responded. Analysis was restricted to non-pregnant participants with valid weight and height measurements (n=3533).Primary and secondary outcome measuresThe primary outcome variable was generalised obesity, using WHO body mass index (BMI) thresholds. Analyses used non-response weighting and adjusted for the complex survey design. We conducted multinomial logistic regression analysis to identify factors associated with BMI categories. The secondary outcome variable was abdominal obesity, defined as high waist circumference (using the International Diabetes Federation thresholds for Europeans).ResultsTwo-fifths of adults were overweight/obese, with a higher obesity prevalence in women (17%, 95% CI 14.7 to 19.7; men 8%, 95% CI 6.0 to 11.0). 10% of men and 8% of women were underweight. Urban residence (adjusted relative risk ratio 5.8, 95% CI 2.4 to 14.5), higher education (2.3, 1.2 to 4.5), older age, ethnicity, and low fruit and vegetable intake (2.8, 1.1 to 6.8) were strongly associated with obesity among men. Urban residence (4.7, 2.7 to 8.2), higher education (2.6, 1.1 to 6.4), older age and ethnicity were associated with obesity in women.ConclusionThere is a high burden of overweight/obesity in The Gambia. While obesity rates in rural areas were lower than in urban areas, obesity prevalence was higher among rural residents in this study compared with previous findings. Preventive strategies should be directed at raising awareness, discouraging harmful beliefs on weight, and promoting healthy diets and physical activity.

Prevalence of Metabolic Syndrome and its Components in Kanifing Municipality, The Gambia

“…In using the harmonized definition, the prevalence of MetS in our study rose to 64.0%, and that of the females to 67.2%. The very high prevalence in our participants, and the high increase in prevalence compared to that from the study conducted 21 years ago, though published in 2015 ( 6 ), could be attributed to the over years exponential increase in obesity prevalence in The Gambia ( 8 , 15 ); given the rising prevalence of the syndrome in the world being largely attributed to increasing prevalence of obesity ( 3 , 16 ).…”

“…And with the prevalence of obesity having more than doubled in the country in that time period ( 7 , 8 ), there is need for evaluating the prevalence of MetS and MetS components in the country.…”

High level of co-occurrence of risk factors for non-communicable diseases among Gambian adults: A national population-based health examination survey

“…Table S1 is a summary of the unweighted characteristics of participants included in this study. The size of the analytical sample (N=3000) is lower than the samples used in our previous publications using the same data set (Cham et al, 2018, Cham et al, 2020, because 1111 participants did not have complete information on all the risk factors considered. However, the distribution of the socio-demographic characteristics is similar to those described previously.…”

“…This study is based on secondary analysis of data from the 2010 WHO STEPS survey, which is the most recent nationally representative population-based health examination survey conducted among adults (25-64 years) in The Gambia. A detailed description of the data has been published elsewhere (Cham et al, 2018, Cham et al, 2020, Cham et al, 2019. Briefly, data were collected from January to March 2010 using STEPS, a standard population-based health examination survey approach to NCD surveillance (World Health Organization, 2003, Cham et al, 2018.…”

“…One third of Gambian adults (aged 25-64 years) were hypertensive in 2010 (Cham et al, 2018) and one in every ten adults were overweight or obese (Cham et al, 2020). The risk of premature mortality from NCDs among adults aged 30-70 years in The Gambia is 20% (World Health Organization, 2018).…”