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ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 4  |  Page : 173-178

Prevalence and sociodemographic correlates of obesity and overweight in a rural and urban community of Delta State, Nigeria


1 Department of Medicine, Delta State University Teaching Hospital, P.M.B. 07, Oghara; Department of Medicine, Delta State University, P.M.B 01 Abraka, Nigeria
2 Department of Medicine, Delta State University Teaching Hospital, P.M.B. 07, Oghara, Nigeria
3 Department of Community Medicine, Delta State University Teaching Hospital, P.M.B. 07, Oghara, Nigeria

Date of Web Publication17-Apr-2018

Correspondence Address:
Dr. Ejiroghene Martha Umuerri
Department of Medicine, Delta State University Teaching Hospital, P.M.B. 07, Oghara
Nigeria
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DOI: 10.4103/1118-8561.230258

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  Abstract 


Introduction: Urbanization has been linked to increasing prevalence of obesity. Objective: To determine the rural–urban differences in the prevalence and sociodemographic correlates of obesity/overweight. Materials and Methods: A cross-sectional, descriptive study of adults in Jesse (rural) and Warri (urban). Weight and height were measured, and body mass index (BMI) was calculated. Results: A total of 866 respondents, 44.0% (rural) and 56.0% (urban) with a male: female ratio of 1:1 and 1:1.5; mean age (± standard deviation [SD]) was 47.1 (±19.0) years and 38.9 (±12.2) years, and mean BMI (±SD) was 22.64 (±3.52) kg/m2 and 24.89 (±5.14) kg for rural and urban populations, respectively. The overall prevalence of obesity and overweight was 10.9% and 20.9%, respectively, with urban (15.7% and 23.9%) being higher than rural (4.7% and 17.1%).Female respondents in both settings had a higher prevalence rate of overweight of 26.5% versus 19.9% (urban) and 17.3% versus 16.8% (rural) for females and males, respectively. The prevalence of obesity is highest among middle-aged (40–64 years) respondents in both settings. The difference in high BMI (≥25 kg/m2) between urban and rural setting in this age group was statistically significant (Chi-square [χ2] = 22.055, df = 1, P < 0.001). The urban–rural differences in the association between educational status and prevalence of obesity and overweight was significant (≤primary: χ2 = 18.970, df = 1, P < 0.001; secondary: χ2 = 9.064, df = 1, P = 0.003). Conclusion: The prevalence of obesity and overweight is high, being higher in the urban population. Obesity and overweight are more prevalent among females and middle-aged persons in both settings. The odds of having high BMI (≥25kg/m2) are highest among urban dwellers with a lower level of education.

Keywords: Body mass index, Nigeria, obesity, overweight, rural–urban


How to cite this article:
Umuerri EM, Ayandele CO, Eze GU. Prevalence and sociodemographic correlates of obesity and overweight in a rural and urban community of Delta State, Nigeria. Sahel Med J 2017;20:173-8

How to cite this URL:
Umuerri EM, Ayandele CO, Eze GU. Prevalence and sociodemographic correlates of obesity and overweight in a rural and urban community of Delta State, Nigeria. Sahel Med J [serial online] 2017 [cited 2018 Sep 24];20:173-8. Available from: http://www.smjonline.org/text.asp?2017/20/4/173/230258




  Introduction Top


The prevalence of overweight and obesity is on the increase worldwide.[1] The public health challenges posed by obesity is enormous, being risk factors for a number of noncommunicable diseases including cardiovascular disease, osteoarthritis, and cancers. Obesity has been linked to a higher mortality rate relative to normal weight.[2],[3] The burden is worse off in developing countries beset with weak health-care systems and prevalent existing communicable diseases and emerging noncommunicable diseases.[4] Urbanization and adoption of Western lifestyle have been hypothesized as factors contributing to increasing obesity and overweight in developing countries, especially with rural to urban migrants. Although the prevalence of obesity and overweight is more in urban than rural settings worldwide, the difference is narrow in developed countries [5] having a higher prevalence among people in the lower socioeconomic class compared with rural-based people in developing countries who are mostly lean and have a low prevalence of cardiovascular diseases.[6] Although previous studies in Nigeria have shown a rise in the incidence of overweight and obesity, as well as the metabolic syndrome due to the adoption of Western dietary and lifestyle patterns,[7],[8],[9],[10],[11] fewer comparative studies exist to provide evidence for the increasing effect of urbanization.[12],[13],[14] This study aimed at describing the rural–urban differences of overweight and obesity in two communities in Delta State, Nigeria.


  Materials and Methods Top


This is a cross-sectional, descriptive, community-based study in Delta State, Nigeria, located in the South-South geopolitical zone of Nigeria. Delta State covers a landmass of about 18,050 km 2, of which more than 60% is land and is one of the major oil-producing States in Nigeria. It is a culturally diverse state with multiethnic groups and a population of 4,098,291.[15] It is divided into three senatorial districts, namely Delta Central, Delta North, and Delta South each having eight, nine, and eight local government areas, respectively.

The study sites were Jesse and Warri. They are approximately 47 km apart.

Jesse, the rural study area, is located within the Delta Central senatorial district. It occupies an area of 500 km 2, lying between latitudes 5°.15' and 6°00' N and longitudes 5°.40' and 6°.25' E. Although an oil-rich land, the major occupation in Jesse community is farming, which is mainly subsistence and commercial in nature. The urban study area, Warri, is the largest cosmopolitan city and commercial hub in Delta State. It is located in Delta South senatorial district with coordinates between 5° 31' N and 5° 45' E.

Participants aged 18 years and above who had lived in their current location for at least 1 year were recruited using the cluster sampling. Those who have lived <1 year in the study area, visitors, pregnant women, and persons unwilling to participate in the study were excluded from the study. Ethical approval was obtained from the Health Research and Ethics Committee of Delta State University Teaching Hospital, Oghara, Nigeria, before the commencement of the study which was conducted according to the tenets of the Helsinki Declaration.

Trained research assistants used an adapted World Health Organization (WHO) STEPS instrument [16] to obtain data. Participants had their anthropometric indices measured and documented. Weight was measured to the nearest 0.1 kg using the Detecto PD300DHR Digital-ProDoc (USA) weighing scale, with participants standing upright on the scale without footwear and having heavy outer clothing removed and pockets emptied. Height was measured to the nearest 0.1 m using the Prestige HM0016D (India) stadiometer, also without footwear and head dressing off. The body mass index (BMI) was then calculated by dividing the weight in kilogram by the square of the height in meter squared.

Using the WHO classification, BMI was categorized as:[17]

  • Underweight: BMI <18.5 kg/m 2
  • Normal weight: BMI 18.5–24.9 kg/m 2
  • Overweight: BMI 25.0–29.9 kg/m 2
  • Obesity: BMI ≥30 kg/m 2.


Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA). Comparison of means between two groups was done using the independent Student's t-test. Chi-square (χ2) test was used to find associations between categorical variables and to test for differences in proportion. The level of statistical significance was put as P < 0.05.


  Results Top


A total number of 866 adults were studied, comprising 485 (56.0%) and 381 (44.0%) urban and rural dwellers, respectively. The sociodemographic characteristics of the study participants are as shown in [Table 1].
Table 1: Sociodemographic characteristics of respondents

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The age distribution of respondents from the urban and rural populations differed significantly; rural dwellers were significantly older than the urban dwellers (P < 0.001).

The mean age (±standard deviation [SD]) was 38.9 (±12.2) years and 47.1 (±19.0) years for urban and rural population, respectively. This difference in mean age was statistically significant (t = −7.332, P < 0.001, 95% confidence interval [CI] = −10.396–−6.004).

The male: female ratio was 1:1.5 and 1:1 for urban and rural populations, respectively (χ2 = 9.525, df = 1, P = 0.002).

Although majority of the respondents from both urban and rural populations were married, the marital status of respondents from urban and rural populations still differed significantly (P < 0.001) as the proportion of single and married persons was more in the urban population while the proportion of separated/divorced, cohabiting, and widowed persons were more among rural population.

The level of education differed significantly between the urban and rural cohorts with 82% of the urban population having attained a higher educational level, using completed secondary education as the benchmark, compared with the rural population where the majority (66.4%) of the respondents had only primary education or less.

Majority of the respondents were self-employed, being higher in the rural (83.8%) than urban (53.1%) population. The unemployed accounted for 7.7% and were predominately in the urban setting.

The distribution of BMI category using the WHO classification for both urban and rural population is as shown in [Figure 1]. Majority of the respondents had normal BMI, being higher among rural population (70.1% versus 52.6%). The overall prevalence of obesity and overweight was 10.9% and 20.9%, respectively, with urban (15.7% and 23.9%) being higher than rural (4.7% and 17.1%). The differences in BMI distribution were statistically significant (χ2 = 39.219, df = 3, P < 0.001).
Figure 1: Urban–-rural distribution of body mass index categories using the World Health Organization classification. BMI: Body mass index

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The mean BMI (±SD) for urban and rural population was 24.89 (±5.1) kg/m 2 and 22.64 (±3.5) kg/m 2, respectively. This difference in mean BMI was statistically significant (t = 7.322, P < 0.001, 95% C1 = 1.650–2.859).

The prevalence of overweight was higher in females than males in both urban and rural settings (Urban: 26.5% versus 19.9%; Rural: 17.3% versus 16.8%) as shown in [Table 2]. Differences in BMI categories between urban and rural settings were found only among females (females: χ2 = 33.490, df = 3, P < 0.001; males: χ2 = 6.191, df = 3, P = 0.103). The prevalence of obesity was higher among urban respondents; female (18.7%) and male (11.0%), respectively. The odds of a high BMI (≥25 kg/m 2) among males living in urban versus rural settings are 1.575 (95% CI = 0.994–2.495) while it were 3.022 (95% CI = 1.996–4.576) for females.
Table 2: Urban-rural body mass index categories by sociodemographic variables

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Urban dwellers had a significantly higher BMI across all age groups such as young, middle-aged, and elderly as shown in [Table 2]. The prevalence of obesity was highest among middle-aged (40–64 years) respondents in both settings. The difference in high BMI (≥25 kg/m 2) between urban and rural setting in this age group was statistically significant ([χ2 = 22.055, df = 1, P < 0.001], [odds ratio [OR] = 3.044; 95% CI = 1.898–4.883]).

Urban dwellers were significantly weightier than rural dwellers across all educational levels as shown in [Table 2]. The prevalence of overweight decreased among urban dwellers with an increase in educational status. The trend was not the same among rural dwellers. The prevalence of overweight was higher among rural participants with the secondary education than those with the primary or no formal education. The urban–rural differences in the association between educational status and prevalence of obesity and overweight are significant (≤primary: [χ2 = 18.970, df = 1, P < 0.001, OR = 3.411, 95% CI = 1.930–6.030]; secondary: [χ2 = 9.064, df = 1, P = 0.003, OR = 2.161, 95% CI = 1.301–3.589]).

Overweight and obesity were the most prevalent among urban dwellers who were government and nongovernment employees. Overweight and obesity were least prevalent among the unemployed and student urban dwellers [Table 2].


  Discussion Top


This study has shown that obesity and overweight are not uncommon in Delta State, Nigeria; being higher in urban than rural population. The proportion of obese persons in the urban setting was over three times those in the rural setting; (15.7% versus 4.7%). The overall prevalence rates for obesity and overweight in this study were within the range of 8.1%–22.2% and 20.3%–35.1%, respectively, obtained by Chukwuonye et al.[11] in a systematic review of Nigerian studies on obesity. On the other hand, a higher prevalence of obesity and overweight (49.34% and 22.04%, respectively) was obtained among indigenous Kalabaris living in the Niger-Delta region of Southern Nigeria.[18] The high prevalence obtained by Adienbo et al.[18] may be adduced to the cultural lifestyles and dietary choices of the Kalabaris, especially as it relates to the practice of sending women to a fattening room.

There were significant differences in the sociodemographic between the urban and rural populations in this study. The rural population was older, less educated, and engaged in more physically demanding occupations. Similarly, Adediran et al.[19] compared the distribution of BMI as a measure of adiposity in rural and urban communities with similar extraction but a different sociodemographic profile. Like this study, Adediran et al.,[19] the prevalence of obesity was higher among the urban population compared with the rural population. It is likely that the variations in the anthropometric profile of the two populations may be due to the disparity in their lifestyles and dietary choices, as well as their vocation.

In this study, rural respondents were significantly older than urban respondents. Loss of muscle mass occurs with aging and BMI depends not only on adiposity but also on muscle mass. The age difference may be an important contributory factor to the urban population having a higher mean BMI than the rural population.

The urban dwellers in this study were mainly traders and civil servants who were less physically active than their rural counterparts who were majorly peasant farmers and unskilled manual workers.

In this study, overweight and obesity were more prevalent among females and middle-aged persons (40–64 years) in both settings. The proportion of overweight and obese persons was highest among urban females. It appears that obesity is a problem of the urban women as affirmed by other studies done in Nigeria [7],[18],[19],[20],[21] and among Africans around the world.[22],[23] This might be due to complex behavioral and hormonal factors since both sexes are exposed to the same environmental factors.[22]

A broadly linear relationship between the number of years spent in full-time education and the probability of obesity, with the most educated individuals displaying lower rates of the obesity have been described.[24] The odds of having a high BMI ≥25 kg/m 2 were highest among urban dwellers with the lower level of education compared with rural dwellers. A similar finding has also been reported in other studies in Nigeria.[14],[25] This may be due to acquired knowledge and awareness of the risk of unhealthy lifestyle choices among those with higher education. Cutler and Lleras-Muney [26] found that those with more years of schooling are less likely to smoke, drink a lot, to be overweight, or obese. This is also corroborated by Ogden et al.[27] who found that obesity prevalence increases as attained educational status decreases more especially among women. The desire to lose weight is higher among the educated than the less educated obese; hence, the possible high prevalence of obesity among those of the low-socioeconomic status.[28]

Obesity is a lifestyle disease, and high BMI has been associated with cardiovascular disease and Type 2 diabetes. As lifestyle choices can be modified, it is necessary that an ecological approach that embraces all stakeholders be adopted in reducing the scourge of obesity for better results.


  Conclusion Top


This study has shown that obesity and overweight are common in Nigeria; being higher in urban compared with rural population. High BMI is more prevalent among females and middle-aged persons in both settings. The odds of having high BMI are highest among urban dwellers with the lower level of education compared with rural dwellers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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