Obesity matters but is not perceived: A cross-sectional study on cardiovascular disease risk factors among a population-based probability sample in rural Zambia

RESEARCH ARTICLE Obesity matters but is not perceived: A crosssectional study on cardiovascular disease risk factors among a population-based probability sample in rural Zambia Yukiko Tateyama ID1*, Teeranee Techasrivichien1, Patou Masika Musumari1, S. Pilar Suguimoto1,2, Richard Zulu3, Mubiana Macwan’gi ID3, Christopher Dube4, Masako Ono-Kihara1, Masahiro Kihara1 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 2 Medical Education Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 3 Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia, 4 Ndola District Health Office, Ndola, Zambia * OPEN ACCESS Citation: Tateyama Y, Techasrivichien T, Musumari PM, Suguimoto SP, Zulu R, Macwan’gi M, et al. (2018) Obesity matters but is not perceived: A cross-sectional study on cardiovascular disease risk factors among a population-based probability sample in rural Zambia. PLoS ONE 13(11): e0208176. https://doi.org/10.1371/journal. pone.0208176 Editor: Sabine Rohrmann, University of Zurich, SWITZERLAND Received: February 9, 2018 Accepted: November 13, 2018 Published: November 29, 2018 Copyright: © 2018 Tateyama et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This work received support from the following: United Nations University, Institute for the Advanced Study of Sustainability (Global Leadership Training Programme in Africa),Award Number: None | Recipient: Yukiko Tateyama; InterGraduate School Program for Sustainable Abstract Background Sub-Saharan Africa, including Zambia, has experienced an increase in overweight and obesity due to rapid lifestyle changes associated with recent economic growth. We explored the prevalence and correlates of overweight and obesity in rural Zambia. We also investigated the role of self-perception of body weight in weight control given the local socio-cultural context. Methods In this cross-sectional study, we recruited 690 residents of the Mumbwa district aged 25–64 years through a multistage, clustered, household random sampling. We administered a questionnaire and collected anthropometric and bio-behavioral data from May to July 2016. Factors associated with body mass index (BMI) �25 kg/m2 and underestimation of body weight were assessed using multiple logistic regression. Results Of the weighted sample of 689 participants (335 men and 354 women), 185 (26.8%) had BMI �25 kg/m2. In multivariate analyses, female gender, age 45–64 years, tertiary education, higher fruit and vegetable intake, high blood pressure, abnormal blood lipid profile, and Hemoglobin A1c �5.7% were significantly associated with BMI �25 kg/m2. Among participants with BMI �25 kg/m2, 14.2% and 58.2% perceived themselves as being underweight and normal weight, respectively. Age 45–64 years was the only factor significantly associated with body weight underestimation. Preference for obesity was reported by 17.5% and 3.6% of respondents with BMI <25 kg/m2 and BMI�25 kg/m2, respectively; “looks attractive” and “fear of being perceived as HIV-positive” were the main reasons. PLOS ONE | https://doi.org/10.1371/journal.pone.0208176 November 29, 2018 1 / 19 Obesity matters but is not perceived: Cardiovascular disease risk factors in rural Zambia Development and Survivable Societies, Kyoto University Award Number: None | Recipient: Yukiko Tateyama;2016 Kyoto University School of Public Health Super Global Course’s travel scholarship, Award Number: None | Recipient: Yukiko Tateyama. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Conclusion In rural Zambia, overweight and obesity are prevalent and significantly associated with alterations in blood pressure, blood lipid profile, and glucose metabolism. However, most subjects with BMI �25 kg/m2 underestimated their body weight; some preferred obesity, in part due to cultural factors and HIV-related stigma. A health promotion program that addresses such perceptions and body weight underestimation should be urgently introduced in Zambia. Introduction The epidemic of overweight and obesity is an important global health concern. The prevalence of overweight and obesity among adults has doubled since 1980 worldwide [1], and it has increased in many low- and middle-income countries (LMICs). Cardiovascular diseases (CVDs), diabetes, musculoskeletal disorders, and some types of cancers that are associated with overweight and obesity are the leading causes of mortality worldwide [2]. Accordingly, the increase in overweight and obesity can pose a huge burden on healthcare systems. In fact, it has been projected that the burden of chronic diseases will become comparable to the burden of acute infectious diseases in the near future in many LMICs [3,4]. Sub-Saharan Africa (SSA), including Zambia, has also been experiencing an accelerating rate of overweight and obesity [5–7]. Obesity-related diseases currently represent 3.8% of disability-adjusted life years (DALYs) [8]. Although Zambia is still greatly affected by epidemics of infectious diseases, especially HIV, with a prevalence of 13.1% in 2013–2014 [9], the estimated national prevalence of overweight and obesity in Zambia was 29.2% in 2014, compared with 26.4% in 2010 [10]. The rapid increase of overweight and obesity in Africa has been ascribed to changes in diet and lifestyle brought on by economic growth, rapid urbanization, and globalization [5,11–13]. In the SSA context, perceptions surrounding body weight should be explored as a moderator. In many SSA societies, obesity is culturally accepted or even desirable, particularly for women [14–16]. However, research on overweight and obesity remains scarce both in amount and depth in many SSA countries, including Zambia [5]. In Zambia, prevalence studies have been conducted only in a few districts including the capital city, with the results already outdated in view of rapid social changes [6,17,18]. There have been no studies that involved biological measurements to assess the metabolic effects of overweight and obesity or have evaluated the perception of overweight and obesity in consideration of the local cultural context in Zambia. Thus, we designed a sequential mixed methods study. The initial qualitative phase was conducted in August–September 2014 with 67 rural residents of Zambia participating to explore their lifestyle, particularly dietary habits and perception about body w (...truncated)