Abstract
IntroductionSouthern Mediterranean countries have experienced a marked increase in the prevalence of obesity whose consequences for gender related health inequities have been little studied. We assessed gender obesity inequalities and their environmental and socio-economic modifiers among Tunisian adults.MethodsCross-sectional survey in 2005; national, 3 level random cluster sample of 35–70 years Tunisians (women: n = 2964, men: n = 2379). Overall adiposity was assessed by BMI = weight(kg)/height(m)2 and obesity was BMI≥30, WHtR = waist circumference to height ratio defined abdominal obesity as WHtR≥0.6. Gender obesity inequality measure was women versus men Prevalence Proportion Odds-Ratio (OR); models featuring gender x covariate interaction assessed variation of gender obesity inequalities with area (urban versus rural), age, marital status or socio-economic position (profession, education, household income proxy).ResultsBMI was much higher among women (28.4(0.2)) versus men (25.3(0.1)), P<0.0001) as was obesity (37.0% versus 13.3%, OR = 3.8[3.1–7.4], P<0.0001) and abdominal obesity (42.6% versus 15.6%, 4.0[3.3–4.8], P<0.0001). Gender obesity inequalities (women versus men adjusted OR) were higher in urban (OR = 3.3[1.3–8.7]) than rural (OR = 2.0[0.7–5.5]) areas. These gender obesity inequalities were lower for subjects with secondary education or more (OR = 3.3[1.3–8.6]), than among those with no schooling (OR = 6.9[2.0–23.3]). They were also lower for those with upper/intermediate profession (OR = 1.4[0.5–4.3]) or even employees/workers OR = 2.3[1.0–5.4] than those not professionaly active at all (OR = 3.3[1.3–8.6]). Similar results were observed for addominal obesity.ConclusionThe huge overall gender obesity inequities (women much more corpulent than men) were higher in urban settings, but lower among subjects of higher education and professional activity. Reasons for gender inequalities in obesity and their variation with socio-economic position should be sought so that appropriate policies to reduce these inequalities can be implemented in Tunisia and similar settings.
Highlights
Southern Mediterranean countries have experienced a marked increase in the prevalence of obesity whose consequences for gender related health inequities have been little studied
In the context of global socio-economic changes and the epidemiological transition, the growing burden of non-communicable diseases (NCD) including overweight and obesity in low to middle income countries is widely acknowledged [1,2]; southern and eastern Mediterranean countries have been affected by this evolution [3,4]
(and often so on sub-national basis or with significant underrepresentation of men [3,10,11,12,13,14]). These health related gender issues are acute in this context [5], to our knowledge no specific assessment has ever focused on the magnitude of gender obesity contrasts using relevant quantitative measures of inequalities [15,16] nor the extent to which these gender inequities vary with socio-economic characteristics [17]
Summary
Southern Mediterranean countries have experienced a marked increase in the prevalence of obesity whose consequences for gender related health inequities have been little studied. Typical of emerging southern and eastern Mediterranean countries, in the last decades Tunisia has been undergoing an active epidemiological and nutritional transition This has resulted in a rapid increase in overweight and obesity and in the prevalence of co-morbidities such as diabetes and hypertension [11,18,19,20,21] whose prevention e.g. through targeted policies or interventions is a major public health issue. In this context the objectives of the present study were, using different anthropometric indicators, to quantify gender obesity inequalities at the national level using relevant quantitative measures and to assess, through appropriate modeling, variation of these inequities according to environment and socio-economic characteristics
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