Abstract
BackgroundHigh body mass index (BMI) is associated with stroke, ischemic heart disease (IHD), and type 2 diabetes mellitus (T2DM). An epidemiological analysis of the prevalence of high BMI, stroke, IHD, and T2DM was conducted for 16 Southern Africa Development Community (SADC) using Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study data.MethodsGBD obtained data from vital registration, verbal autopsy, and ICD codes. Prevalence of high BMI (≥25 kg/m2), stroke, IHD, and T2DM attributed to high BMI were calculated. Cause of Death Ensemble Model and Spatiotemporal Gaussian regression was used to estimate mortality due to stroke, IHD, and T2DM attributable to high BMI.ResultsObesity in adult females increased 1.54‐fold from 12.0% (uncertainty interval [UI]: 11.5–12.4) to 18.5% (17.9–19.0), whereas in adult males, obesity nearly doubled from 4.5 (4.3–4.8) to 8.8 (8.5–9.2). In children, obesity more than doubled in both sexes, and overweight increased by 27.4% in girls and by 37.4% in boys. Mean BMI increased by 0.7 from 22.4 (21.6–23.1) to 23.1 (22.3–24.0) in adult males, and by 1.0 from 23.8 (22.9–24.7) to 24.8 (23.8–25.8) in adult females. South Africa 44.7 (42.5–46.8), Swaziland 33.9 (31.7–36.0) and Lesotho 31.6 (29.8–33.5) had the highest prevalence of obesity in 2019. The corresponding prevalence in males for the three countries were 19.1 (17.5–20.7), 19.3 (17.7–20.8), and 9.2 (8.4–10.1), respectively. The DRC and Madagascar had the least prevalence of adult obesity, from 5.6 (4.8–6.4) and 7.0 (6.1–7.9), respectively in females in 2019, and in males from 4.9 (4.3–5.4) in the DRC to 3.9 (3.4–4.4) in Madagascar.ConclusionsThe prevalence of high BMI is high in SADC. Obesity more than doubled in adults and nearly doubled in children. The 2019 mean BMI for adult females in seven countries exceeded 25 kg/m2. SADC countries are unlikely to meet UN2030 SDG targets. Prevalence of high BMI should be studied locally to help reduce morbidity.
Highlights
High body mass index (BMI) is associated with stroke, ischemic heart disease (IHD), and type 2 diabetes mellitus (T2DM)
The increased vulnerability to obesity and attributable conditions in the 16 Southern Africa Development Community (SADC) countries shown in Figure 1 (Angola, Botswana, Comoros, Democratic Republic of Congo [DRC], Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, eSwatini [formerly Swaziland], Tanzania, Zambia, and Zimbabwe) has mainly been a result of populations adapted to traditional diets changing to rapid industrialization and urbanization, and thereby making people more susceptible to obesity, stroke, IHD, and T2DM, among other fast rising non‐communicable diseases (NCDs).[13]
While there was a significant reduction in the risk of stroke in all Global Burden of Disease (GBD) regions and high‐income countries, and in most countries between 1990 and 2015, there was a significant increase in the lifetime risk of stroke in seven SADC countries ranging from 4% to 32%, in three of the SADC countries, changes in the risk of stroke were not substantial.[14]
Summary
High body mass index (BMI) is associated with stroke, ischemic heart disease (IHD), and type 2 diabetes mellitus (T2DM). In the past few decades, the burden of obesity has increased in LMICs, and so far, no substantial reduction has been observed in developed countries as well.[2,3,4] A meta‐analysis of Demographic and Health Surveys (DHS) conducted between 2008 and 2019 across 33 countries in sub‐Saharan Africa (SSA) region of nearly 500,000 women 15 to 49 years of age revealed heterogeneity across the region in the prevalence of overweight/obesity ranging from 6.7% for Madagascar and up to 44.5% for Lesotho.[12] The increased vulnerability to obesity and attributable conditions in the 16 SADC countries shown in Figure 1 (Angola, Botswana, Comoros, Democratic Republic of Congo [DRC], Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, eSwatini [formerly Swaziland], Tanzania, Zambia, and Zimbabwe) has mainly been a result of populations adapted to traditional diets changing to rapid industrialization and urbanization, and thereby making people more susceptible to obesity, stroke, IHD, and T2DM, among other fast rising non‐communicable diseases (NCDs).[13]. The prevalence of T2DM, IHD, and cardiovascular disease (CVD) increased 10‐fold in SSA between 1988 and 2008.19 Between 2010 and 2030, the number of adults with T2DM in developing countries is projected to increase by 69%, compared to a 20% increase in developed countries.[20]
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