Prevalence of overweight and obesity for urban adults in Cameroon

Abstract

The emergence of a nutrition transition in developing countries might lead to higher prevalence of obesity and related adverse health effects. In Cameroon,urbanization growth rate is one of the highest in sub-Saharan Africa. Such dramatic demographic change favours important modifications, notably in nutritional patterns.
In this paper we examine the current prevalence of overweight and obesity in Yaounde,the capital city of Cameroon and search for possible causal factors. Detrimental consequences of overweight are also discussed.
Samples of adults (519 women, 252 men) of all ages in all districts of Yaounde were subjected to anthropometric and body composition measurements, blood pressure and resting heart rate determination, and interviewer-administered questionnaires on socio-demography, smoking habits, physical activity, self-perception of body weight and health status.
In both sexes body mass index (BMI) increases with age and peaks in the years of maturity. These changes are related to changes in adiposity. Prevalence rates of overweight(BMI >or= 25) and obesity (BMI > or = 30) increase from 20 to 29 years and peak at 40-49 years in men and at 50-59 years in women before starting to decline. One woman in two is overweight and one woman in five is obese, whereas one-third of men are overweight and only 5% are obese. Obese subjects have a larger age-adjusted waist to hip ratio(WHR) than their non-overweight counterparts, attesting that fat gain is oriented towards a more abdominal fat mass distribution. The length of residence in Yaounde, increasing education level, occupation, ethnicity, physical inactivity and smoking practices appear to influence early overweight and/or obesity. No parity effect is observed in women. From the present study, it appears that obesity, and especially obesity in women, could be less benign than that described in other studies in Africa.
Research is needed in Cameroon, including aetiological and cohort studies aimed at the quantification of morbidity and mortality risks associated with overweight and obesity.

Full text

Prevalence of overweight and obesity for urban adults in Cameroon
P. Pasquety,L.S.Temgouaô,F.Melaman-Segoô,A.Fromentz
and H. Rikong-Adie
¤
}
y Centre National de la Recherche Scientifique, UPR 2147, Paris, France
z Institut pour la Recherche en de
´
veloppement (IRD), Orle
´
ans, France
} Institut de la Medecine et des Plantes Me
´
dicinales, Centre de Recherches
sur l’Alimentation et la Nutrition, Yaounde
´
, Cameroon
ô Faculte
´
de Me
´
decine, Universite
´
de Yaounde
´
I, Yaounde
´
, Cameroon
Received 4 September 2002; in revised form 14 April 2003; accepted 1 May 2003
Summary. Background: The emergence of a nutrition transition in developing countries
might lead to higher prevalence of obesity and related adverse health effects. In Cameroon,
urbanization growth rate is one of the highest in sub-Saharan Africa. Such dramatic
demographic change favours important modifications, notably in nutritional patterns.
Aim: In this paper we examine the current prevalence of overweight and obesity in Yaounde
´
,
the capital city of Cameroon and search for possible causal factors. Detrimental
consequences of overweight are also discussed.
Material and methods: Samples of adults (519 women, 252 men) of all ages in all districts of
Yaounde
´
were subjected to anthropometric and body composition measurements, blood
pressure and resting heart rate determination, and interviewer-administered questionnaires
on socio-demography, smoking habits, physical activity, self-perception of body weight and
health status.
Results: In both sexes body mass index (BMI) increases with age and peaks in the years of
maturity. These changes are related to changes in adiposity. Prevalence rates of overweight
(BMI 5 25) and obesity (BMI 5 30) increase from 20 to 29 years and peak at 40–49 years
in men and at 50–59 years in women before starting to decline. One woman in two is
overweight and one woman in five is obese, whereas one-third of men are overweight
and only 5% are obese. Obese subjects have a larger age-adjusted waist to hip ratio
(WHR) than their non-overweight counterparts, attesting that fat gain is oriented towards
a more abdominal fat mass distribution. The length of residence in Yaounde
´
, increasing
education level, occupation, ethnicity, physical inactivity and smoking practices appear to
influence early overweight and/or obesity. No parity effect is observed in women. From the
present study, it appears that obesity, and especially obesity in women, could be less benign
than that described in other studies in Africa.
Conclusion: Research is needed in Cameroon, including aetiological and cohort studies
aimed at the quantification of morbidity and mortality risks associated with overweight
and obesity.
1. Introduction
In many developing countries overweight, obesity and obesity-related morbidity
are becoming a problem of increasing importance. For several decades profound
demographic and economic changes that create completely new conditions in terms
of lifestyle have been observed. With urbanization and economic development has
emerged a nutritional transition characterized by a shift to an higher caloric content
of diet and/or to the reduction of physical activity, and whose consequences are
changes in the body composition of the individuals (Popkin 1994). This transition
implies and accompanies the current transition towards the development of the
so-called non-communicable diseases: obesity and more generally chronic degenera-
tive diseases (Shetty 1997).
ANNALS OF HUMAN BIOLOGY
SEPTEMBER–OCTOBER
2003, VOL. 30, NO. 5, 551–562
Annals of Human Biology ISSN 0301–4460 print/ISSN 1464–5033 online # 2003 Taylor & Francis Ltd
http://www.tandf.co.uk/journals
DOI: 10.1080/0301446032000112652

In sub-Saharan Africa overweight and obesity were not considered a major public
health issue until recently. The emphasis was on under-nutrition and food security
rather than on overweight and obesity, so that there is little data on current prev-
alence. However given the current structural changes and more specifically the
rapidly growing urbanization which affect these countries, overweight is likely to
become a matter of growing concern (Delpeuch and Maire 1997).
Cameroon, in Central Africa, has one of the highest urbanization rate growth in
sub-Saharan Africa—the urbanization rate was 9.8% in 1950 and 40.8% in 1990;
previsions for 2025 give the figure of 67% (United Nations 1993). In the past decade
we have conducted nutritional anthropometry surveys on random samples of adults
from populations living in various contrasted ecological and economical settings in
Cameroon. These have shown a clear dramatic rural to urban trend towards increas-
ing adiposity in this country (Pasquet et al. 1994). No prevalence studies have been
carried out in the main cities of the country but studies among civil servants and in a
peripheral district of Yaounde
´
—the capital city—suggests high rates of overweight
among women (Rotimi et al. 1995, Sobngwi et al. 2002).
In this paper we present the results of a prevalence study on overweight and
obesity for Yaounde
´
adults, conducted in all districts of the city, including the
search for possible causal factors. Detrimental consequences of overweight are
also discussed.
2. Material and methods
2.1. Population
The survey was conducted from June 1998 to March 1999. For every district,
quarters were selected at random in a number proportional to the number of
inhabitants in the district according to the last National Census of 1987 (RGPH
and MINPAT 1992). Subjects were recruited by volunteering and the measurement
sessions were done at the headquarters’ house on Saturdays, when most of the
inhabitants are present. Each participant was informed on the bio-statistical and
anthropometrical nature of the survey, including the description of the measure-
ments, but the overweight and obesity-oriented goals of the study were not empha-
sized. Delivery of medicines, and possibly medical follow up, were provided in
compensation for participating, at the end of each individual session.
The study concerns all men and women at or above 20 years of age but excluding
pregnant and lactating women.
2.2. Measurements
A set of anthropometric measurements was taken by the same trained fieldworker,
using standardized procedures (Weiner and Lourie 1981). The height was measured
to the nearest millimetre using a portable stadiometer (Siber Hegner, Zurich,
Switzerland). The weight of each participant was measured, in very light clothing,
to the nearest 100 g, using a digital scale (Tanita, Tokyo, Japan). Body mass index
(BMI) was calculated by dividing weight in kilograms by the square of height in
metres. Overweight was defined as a BMI of 25 and more, and obesity as an index of
30 and more (WHO 2000).
Mid-arm, hip and waist circumferences were measured with the subject in a
standing position, to the nearest millimetre, using a non-stretchable tape measure.
Waist circumference was measured mid-way between the lowest rib and the iliac
crest, at the end of a gentle expiration, and hip circumference was measured at the
552 P. Pasquet et al.

greater trochanters. The waist to hip ratio (WHR) was calculated to assess body
fat distribution. WHR values above 1.0 and 0.85 were used to identify subjects
with abdominal obesity for men and for women, respectively (WHO 2000). Waist
circumference gender-specific cut-points of 102 cm and 88 cm, for men and women,
respectively, were used to distinguish subjects at increased cardiovascular risks
(Lean et al. 1995).
Skinfold thickness measurements were taken at four sites: biceps, triceps, sub-
scapular and suprailiac using an Holtain Tanner/Whitehouse skinfold caliper
(Holtain Ltd, Crosswell, UK). Fatness (per cent fat), was derived from the sum of
the four skinfolds (or the three when the suprailiac skinfold was not measured),
according to Durnin and Womersley (1974). Fat mass and fat free mass were derived
from body weight and estimated fatness. Body composition was also estimated, on
a subsample, by using bioelectrical impedance analysis (BIA), according to Segal
et al. (1988), with a BIA 101 50 Hz analyser (RLJ, Detroit, MI, USA) in standard
conditions after a 15 min rest lying.
An average of two diastolic and systolic blood pressure (BP) readings were taken
with the subjects in a seated position, according to standard procedures (WHO
1978), after a 15 min rest. Mean blood pressure was defined as: diastolic BP þ 1/3
(systolic BP – diastolic BP). Mean BP was dichotomized by the third upper tercile
of its distribution in the total study sample, in order to distinguish subjects with
high mean BP. Persons who reported taking hypertensive medication were also
considered as having high BP.
Resting heart rate was assessed by pulse counting, during 3 min, after the last
blood pressure measurement.
2.3. Questionnaires
In addition to measurements all participants filled a set of questionnaires on
socio-demography, smoking habits, physical activity, self-perception of body
weight and attempts to lose weight, health status and current medication.
2.4. Ethics
All measurements and questionnaires in this study were in accordance with the
Code of Ethics of the World Medical Association (Declaration of Helsinki).
2.5. Data analysis
All data analysis and statistical calculation were done using the STATISTICA
software, version 5 (Statsoft, Inc., Tulsa, OK, USA). Descriptive results are pre-
sented as means SD. Group comparisons were performed using the t-test, analysis
of variance and analysis of covariance for age-adjusted comparisons. The logistic
regression model was used to examine the relationship (adjusted odds ratios)
between overweight, obesity and possible causal factors.
3. Results
Table 1 presents the sex-specific values for the anthropometric and physiological
variables. The distribution of the study participants by age group reflects the distri-
bution of ages in the various districts of Yaounde
´
. However the male subjects were
under-represented, probably as a consequence of the use of a volunteering sampling
strategy and of the lower motivation for males to participate in health-related
Overweight and obesity in Cameroon 553

surveys. Given the small number of subjects, the two oldest age classes of men were
grouped into a single group of subjects aged 50 years and more.
Significant differences were observed for most of the anthropometric measure-
ments between men and women. The later exhibited lower mean values for the body
size-related variables, including arm circumference, but they were fatter and had a
larger mean hip circumference than men. No significant gender differences were
observed for waist circumference and blood pressure measurements.
High and significant ( p<0.001) correlation levels were observed between BMI
and the various indicators of body composition in both sexes. The correlation
between BMI and estimated per cent fat were 0.71 in women and 0.78 in men.
Higher correlations were observed with fat mass: 0.91 in women and 0.88 in men
and while lower. The correlations between BMI and skinfold thickness were 0.77,
0.72, 0.78 and 0.73 in women and 0.73, 0.70, 0.78 and 0.78 in men for triceps, biceps,
subscapular and suprailiac skinfold, respectively. High correlation levels were also
observed between BMI and the components of body composition as calculated by
BIA (r ¼ 0.96 and r ¼ 0.88 for fat mass in women and men, respectively). Lower
correlation levels were found concerning estimated fat free mass: 0.68 in women
and 0.63 in men. WHR and BMI were moderately correlated—indicating the differ-
ent aspects of fatness measured by these indicators—but with an higher correlation
level in men (r ¼ 0.42, p<0.001) than in women (r ¼ 0.21, p<0.001).
Table 2 presents the means of BMI, estimated fat and fat free mass, and fat
distribution assessed by WHR, by age group and by gender. Given the small
number of subjects the two oldest age classes of men were grouped into a single
group of subjects aged 50 years and more.
554 P. Pasquet et al.
Table 1. Age, and anthropometric and physiological characteristics of the study subjects.
Men Women
n Mean SD n Mean SD
Age (years) 252 40.44 15.07 519 41.13 14.74
Height (cm) 252 171.45 6.12 519 160.62 } 6.40
Weight (kg) 252 69.81 11.77 519 67.05 } 14.46
BMI* 252 23.70 3.52 519 25.96 } 5.25
Waist circumference (cm) 237 83.40 10.14 508 84.11 12.95
Hip circumference (cm) 237 93.24 7.53 508 100.00 } 11.85
WHR 237 0.894 0.06 508 0.843 } 0.08
Arm circumference (cm) 252 28.58 3.39 519 29.47 } 4.50
Triceps skinfold (mm) 252 8.10 3.77 519 17.98 } 8.48
Biceps skinfold (mm) 252 4.62 1.79 519 8.53 } 5.29
Subscapular skinfold (mm) 252 11.80 6.61 519 17.27 } 8.56
Suprailiac skinfold (mm) 248 13.50 8.73 517 17.40 } 8.41
Body fat (%) y 252 17.75 6.93 519 31.00 } 7.47
Fat mass (kg) y 252 12.94 6.97 519 21.55 } 9.23
BIA resistance () 112 448.05 73.22 223 503.55 } 79.06
Resting heart rate (beats/min) 233 71.21 8.37 497 74.80 } 7.53
Diastolic pressure (mmHg) 233 75.92 10.46 497 74.49 11.63
Systolic pressure (mmHg) 233 114.29 20.16 497 114.34 25.10
Mean blood pressure (mmHg) z 233 88.71 13.03 497 87.77 15.62
* Weight/staturey
y From skinfold thickness, according to Durnin and Womersley (1974).
z Diastolic BP þ 1/3  (systolic BP  diastolic BP).
} t-test of the differences between means of men and women: p<0.01.

In both sexes, BMI increased with age and peaks in the years of maturity (men:
F(3,248) ¼ 8.96, p<0.001; women: F(4,514) ¼ 24.9, p<0.001). This increase was
related mainly to an increase of the degree of fatness (men: F(3,248) ¼ 38.6,
p<0.001; women: F(4,514) ¼ 34.2, p<0.001). Fat free mass tended to decrease
in both sexes after 30–39 years. In parallel a clear trend towards the development
of central adiposity was apparent (men: F(3,232) ¼ 32.2, p<0.001; women:
F(4, 496) ¼ 49.0, p<0.001).
As indicated in table 3 overweight and obesity were associated with age in both
sexes (women: 
2
¼ 52.3 and 36.3, p<0.001; men: 
2
¼ 21.8 and 10.7, p<0.01, for
overweight and obesity, respectively). The prevalence rates increased from 20 to 29
years and peaked at 40–49 years in men and at 50–59 years in women then declined.
Women, as a group, were more overweight (
2
¼ 21.1, p<0.001) and more obese
than men (
2
¼ 30.9, p<0.001): one woman in two was overweight and one woman
in five was obese whereas one-third of men were overweight and only 5% were obese.
Moreover massive obesity (BMI 5 40) was observed only in women (1.8%).
Differences in fat mass explained some 60% of the age-adjusted body weight differ-
ence between obese and non-overweight male or female (men: F(1,183) ¼ 506,
p<0.001; women: F(1,361) ¼ 1078, p<0.001). Moreover, obese subjects had a
larger age-adjusted WHR than their non-overweight counterparts (men:
Overweight and obesity in Cameroon 555
Table 2. Age trends of BMI, per cent fat, fat mass (FM), fat free mass (FFM) and WHR by gender
among Yaounde
´
adults.
Age group
(years) n BMI (kg m
2
) % fat FM (kg) FFM (kg) WHR
Women
20–29 150 (145) 23.4 SD 3.4 24.9 SD 5.4 15.5 SD 5.8 45.1 SD 5.1 0.800 SD 0.057
30–39 110 (109) 26.7 SD 5.5 29.9 SD 5.8 21.5 SD 8.2 48.2 SD 7.2 0.818 SD 0.067
40–49 105 (103) 26.9 SD 5.1 33.7 SD 5.9 24.6 SD 8.9 46.1 SD 7.0 0.845 SD 0.066
50–59 88 (87) 27.8 SD 5.5 37.1 SD 5.6 27.2 SD 9.1 44.4 SD 6.6 0.877 SD 0.082
60þ 66 (64) 26.6 SD 6.0 34.3 SD 8.1 23.2 SD 10.5 40.8 SD 8.6 0.931 SD 0.071
Men
20–29 87 (74) 22.5 SD 2.3 12.7 SD 4.0 8.7 SD 3.7 58.1 SD 5.7 0.847 SD 0.037
30–39 51 (49) 24.1 SD 3.4 18.0 SD 5.3 13.5 SD 5.8 59.4 SD 7.7 0.885 SD 0.050
40–49 46 (46) 25.6 SD 4.5 21.1 SD 6.6 16.9 SD 8.1 59.2 SD 7.0 0.916 SD 0.055
50þ 68 (68) 23.6 SD 3.6 21.7 SD 7.3 15.3 SD 7.5 51.8 SD 5.9 0.935 SD 0.070
In parentheses: subjects with WHR measurements.
Table 3. Age-specific prevalence rates of overweight and obesity in Yaounde
´
adults.
(Overweight and obesity are defined as a BMI above 25 kg m
2
and 30 kg m
2
,
respectively.)
Women Men
Age group
(years)
Overweight
(%)
Obesity
(%)
Age group
(years)
Overweight
(%)
Obesity
(%)
20–29 26.7 4.7 20–29 13.8 1.0
30–39 54.6 25.5 30–39 35.3 5.9
40–49 63.8 24.8 40–49 50.0 13.1
50–59 67.1 34.1 50–76 38.2 5.9
60–75 54.6 24.2
20–75 50.3 20.5 20–76 31.4 5.2

F(1,167) ¼ 17.9, p<0.001; women: F(1,344) ¼ 6.8, p<0.001), attesting that fat gain
was oriented towards a more abdominal fat mass distribution.
To examine the possible causal factors for the development of overweight and
obesity in Yaounde
´
adults, the relationships between overweight, obesity and
various ecological variables are presented in table 4.
Most of the variables entered in the logistic regression were risk factors for over-
weight and obesity as attested by the level of the adjusted odds ratios. Increasing age,
the female sex and increasing educational level were important risk factors. Ethnicity
was also predictive as well as occupation and smoking practice (notably for obesity
in former smokers). The length of residence in Yaounde
´
and physical inactivity
appeared to influence early overweight. Conversely, there was no adjusted-parity
effect on the development of overweight and obesity in women.
556 P. Pasquet et al.
Table 4. Risk factors for overweight and obesity adjusted by logistic regression analysis.
(Significant adjusted odds ratios: 95%, þ95% confidence limits.)
Overweight Obesity
Sex** (**)
Male y
Female 3.0 (1.9–4.7) 11.1 (4.8–25)
Age** (**)
20–29 y
30–39 3.2 (1.5–5.2) 7.3 (2.9–18.2)
40–49 6.6 (3.8–11.4) 10.2 (3.4–26.8)
50–59 8.0 (4.3–14.7) 19.2 (7.0–52.8)
5 60 10.6 (5.2–21.4) 20.1 (6.5–62.3)
Education level** (**)
Illiterate y
Primary 1.8 (1.1–3.4) 2.7(1.3–5.6)
Secondary 2.1 (1.2–4.7) 2.3 (1.1–5.3)
High 4.0 (1.5–10.2) 6.0 (1.6–22.8)
Occupation** (**)
No activity y
Agriculturalist 0.1 (0.04–0.3) 0.1 (0.02–0.9)
Trader 2.0 (1.2–3.4) 1.9 (1.1–3.6)
Executive/professional
Other occupation
Length of residence in Yaounde
´
** (NS)
<5 years y
5 5 years 2.0 (1.1–3.8)
Ethnicity** (**)
Beti-Fang y
Bamileke 3.2 (2.0–5.2) 3.2 (1.7–5.6)
Other ethnicities 3.0 (1.9–4.8) 2.4 (1.3–4.4)
Parity** (**)
<4 children y
5 4 children
Smoking practice* (NS)
Never smoked y
Stopped smoking 6.2 (2.3–17.1)
Currently smoking 0.5 (0.3–0.8)
Physical activity pattern** (*)
Regular sport and/or more than 2 h walking per day y
No sport and less than 2 h walking per day 1.5 (1.1–2.2)
*, ** Crude analysis significant effect ( p<0.05 and p<0.01, respectively); in parentheses for obesity.
y Category taken as reference.

4. Discussion and conclusion
The results of this prevalence study in Yaounde
´
confirm the existence of a
clear rural–urban trend towards increasing overweight and overfat in Cameroon
(figure 1a and b). However the prevalences in some rural areas are not negligible.
This is the case, in particular, of the hilly areas of west Cameroon (Grassfields) in
which prevail strong economic dynamism and satisfactory sanitary conditions
(Temgoua Takam 1997).
Overweight and obesity prevalence rates in Yaounde
´
are high, particularly among
women, while chronic energy deficiency (CED) is no longer prevalent (only 2.5%
of women and 3.5% of men present BMI values lower than 18.5). The percentage of
women overweight and obese are within the upper range of the figures reported in
developed countries (WHO 2000). The high overweight sexual dimorphism observed
in Yaounde
´
could reflect an early nutrition transitional situation, during which
women are more affected by obesity, as observed in other studies (Beltaifa et al.
2001).
As underlined by committees of international experts (IDECG 1993), factors
associated with obesity in Africa, its aetiology and its health, psychological, social
Overweight and obesity in Cameroon 557
0
2
4
6
8
10
12
14
16
18
20
%
(b)
%
Yaoundé
(n=519)
Urban
(middle
sized)
(
n=334
)
Rural
south
(n=518)
Rural
north
(n=550)
Women
0
2
4
6
8
10
12
14
16
18
20
Yaoundé
(n=237)
Urban
(middle
sized)
(n=317)
Rural
south
(n=459)
Rural
north
(n=445)
Men
Figure 1. (a) Age-adjusted prevalence rates of overweight for adults in various ecological settings in
Cameroon. (b) Age-adjusted percentages of excess fat for adults in various ecological settings
in Cameroon. Excess fat was calculated from the sum of triceps þ subscapular skinfold thickness
and defined as a value 5 52 mm in women and 5 38 mm in men, according to van Itallie (1985).
The non-Yaounde
´
data were collected between 1985 and 1996 and come from the Anthropologie
Alimentaire des Populations Camerounaises project (Pasquet et al. 1994, Froment et al. 1996, Koppert
1996).
0
10
20
30
40
50
60
%
(a)
Yaoundé
(n=519)
Urban (middle
sized) (n=662)
Rural (high
income)
(n=530)
Rural south
(n=946)
Rural north
(n=1340)
Women
Grade III (BMI: 40 +)
Grade II (BMI: 30-39.9)
Grade I (BMI: 25-29.9)
0
10
20
30
40
50
60
%
Yaoundé
(n=252)
Urban
(middle
sized)
(n=549)
Rural (high
income)
(n=305)
Rural south
(n=803)
Rural north
(n=1006)
Men
Grade II (BMI: 30-39.9)
Grade I (BMI: 25-29.9)

and economic consequences are not necessarily of the same nature as those which
were identified in the developed countries.
The importance of the nutritional transition itself (increased energy content of the
diet, and/or reduced habitual energy expenditure) remains to be quantified in the
main cities of Cameroon. However, in the present study, using indirect assessment
(a questionnaire) of physical activity, we showed that walking less than 2 h a day and
or not practising sports activity is significantly related to the occurrence of over-
weight in Yaounde
´
(table 4). This is particularly true for women who walk less and
practise less sport than men. In the same vein, a recent study (Sobngwi et al. 2002)
has shown that a low activity energy expenditure is an important determinant of
overweight in Yaounde
´
and a study among Nigerians (Luke et al. 2002) has shown
that low activity energy expenditure is related to increased weight gain in women.
As far as food consumption is concerned, the result of food weighing surveys
conducted over the past years in various ecological settings in Cameroon (Koppert
et al. 1996, Sajo Nana et al. 1996) suggest the existence of a rural–urban trend
towards an increased lipid content of the diet: the percentage of calories from
lipids varies from 16% in the northern savannas to 22% in the southern rural
areas up to 27% in the middle sized urban areas.
Contrary to what was observed for some other urban areas in sub-Saharan africa
(Maire et al. 1992), recent migration in Yaounde
´
is associated with a significant
risk of overweight (table 3). Measures need to be developed to determine whether
psychosocial and psychocultural factors (stress, changes in the structure and cohe-
sion of family and communities, etc.), associated with living in an urban area, play a
significant and separate role on the prevalence of overweight.
Cultural perception of body weight may influence the prevalence of obesity in
Yaounde
´
since only 46% of obese men and 54% of obese women perceive themselves
as overweight. As a comparison, 87% of African American obese women and 95%
of white US obese women consider themselves overweight (Dawson 1988). In addi-
tion, only 4% of men and 30% of women that perceive themselves overweight
are actually trying to lose weight (the figure among US women is 68%). Such
divergences between medical and social/cultural weight valuations might contribute
to the extensive prevalence of obesity, notably in women. They have to be taken
into account when designing programmes aimed at reducing overweight in this
population.
Data on the income level were not available in this study. However overweight
and obesity rates are positively linked with higher educational level and are more
prevalent among occupational categories such as traders. This suggests that excess
weight is more common in individuals with an higher socio-economic status, accord-
ing to a model generally observed in the less developed countries. However, such a
model could not prevail any more given the current trend towards the uncoupling of
the diet–income relationship, as a characteristic of the actual worldwide nutrition
transition (Drewnowski and Popkin 1997).
Adverse sequelae of obesity have been identified. They concern health as well
as psychology of individuals and economy (WHO 2000). However, the extent of
detrimental consequences of African obesity (or in people of African origin) is not
clearly established and is a controversial issue (Kumanyika 1987, Solomon and
Manson 1997), which sustains the current debate on health and ethnicity (Hames
and Greenlund 1996).
558 P. Pasquet et al.

Some authors observing the high prevalence of overweight among African
Americans, concluded that ‘race is an independent predictor of overweight’ (Van
Itallie 1985) and that central adiposity—linked to many obesity-related metabolic
disorders (Kaplan 1989)—is more frequent among black than among white
(Freedman et al. 1995).
Some studies in women suggest that excess health risk in African-American
is proportionate to their excess weight (Kumanyika 1987), whereas other studies
found less obesity-related risks among black than among white (Stevens et al.
1992). However, the results of more recent investigations suggest that a given
amount of central adiposity (intra-abdominal adipose tissue) confers the same
risks for both white and African-American women, but that for any given amount
of total body fat African-Americans may have less intra-abdominal fat (Lovejoy
et al. 1996).
As far as Africa is concerned, a South African report (Walker et al. 1990) found a
minimal effect of obesity on hypertension, hyperlipidaemia and hyperglycaemia, and
overall morbidity in black women, presumably in relation to the morphological
characteristics of the South African woman in whom gluteofemoral fat deposition
is common (Cameron 1997).
In Cameroon, it appears, at least on the basis of the available anthropometric
indicators in the present study (table 5), that obesity, and more specifically obesity in
women, could be less benign than that described in South African studies.
Arguments for the necessity of weight management in Yaounde
´
adults are: (i) the
orientation of fat gains in the obese towards a more abdominal fat mass distribution,
(ii) the high proportion of subjects with large waist circumference (iii) the high
proportion of obese women with elevated blood pressure compared with non-
overweight women (odds ratio: 2.1, 95% CI: 1.21–3.62, age adjusted).
Further research is needed in Cameroon, including aetiological and cohort studies
aimed at the quantification of morbidity and mortality risks associated with over-
weight and obesity. However the results of the present study highlight the need to
develop plans for adequate prevention and management of obesity, taking into
account environmental, social and genetic background interactions.
Overweight and obesity in Cameroon 559
Table 5. Health-risk indicators among obese and non-overweight adults (age-adjusted means
and percentages).
Men Women
Non-overweight
(n ¼ 158)
Obese
(n ¼ 14)
Non-overweight
(n ¼ 247)
Obese
(n ¼ 106)
WHR (mean  SD) 0.88  0.05 0.94  0.05 ** 0.84  0.06 0.86  0.06 **
Subjects with android obesity 2.4% 14.2% NS 38.0% 56.1% **
Waist circumference
(cm, mean  SD)
78.2  6.0 102.8  5.9 ** 74.9  8.1 99.5  8.1 **
Subjects with waist
circumference >102 cm in men,
>88 cm in women
0.1% 93.5% ** 21.0% 97.1% **
Mean blood pressure
(mmHg, mean  SD)
87.5  0.11.4 95.7  11.1 * 85.4  13.2 92.4  13.1 **
Subjects with elevated blood
pressure (mean BP 5 96 mmHg)
17.2% 21.4% NS 19.1% 33.0% **
* p<0.05; ** p<0.01.

Acknowledgement
This study was supported by grants from the Groupe d’Etude des Peuples des
Foreˆ ts Equatoriales (GEPFE).
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Zusammenfassung. Hintergrund: Das Auftreten einer Erna
¨
hrungsumstellung in Entwicklungsla
¨
ndern
ko
¨
nnte zu einer ho
¨
heren Adipositaspra
¨
valenz und damit verbunden zu nachteiligen Gesundheitseffekten
fu
¨
hren. Kamerun hat eine der ho
¨
chsten Urbanisationswachstumsraten in Sub-Saharan Afrika. Solche
drastischen demographischen Vera
¨
nderungen begu
¨
nstigen umfassende A
¨
nderungen, vornehmlich in den
Erna
¨
hrungsmustern.
Ziel: In dieser Arbeit wird die aktuelle Pra
¨
valenz von U
¨
bergewicht und Adipositas in Yaounde
´
, der
Hauptstadt von Kamerun untersucht und nach mo
¨
glichen Ursachen dafu
¨
r gesucht. Des weiteren werden
nachteilige Folgen des U
¨
bergewichtes diskutiert.
Material und Methoden: Bei einer Erwachsenenstichprobe (519 Frauen, 252 Ma
¨
nner) aller Altersgruppen
in allen Bezirken von Yaounde
´
wurden anthropometrische und Ko
¨
rperbaumaße, Blutdruck und
Ruhepuls bestimmt. Außerdem wurden durch Intervier Befragungen zur Sozio-Demographie, zu den
Rauchgewohnheiten, zur ko
¨
rperlichen Aktivita
¨
t, zur Selbstwahrnehmung von Ko
¨
rpergewicht und
Gesundheitszustand durchgefu
¨
hrt.
Ergebnisse: Bei beiden Geschlechtern stieg der Body Masse Index (BMI) mit dem Alter an und erreicht im
Erwachsenenalter seinen Ho
¨
chstwert. Diese A
¨
nderungen stehen im Zusammenhang mit A
¨
nderungen des
Fettes. Die Pra
¨
valenzraten fu
¨
rU
¨
bergewicht (BMI 5 25) und Adipositas (BMI 5 30) steigen von 20-29
Jahren an und erreichen ihr Ho
¨
chstmaß mit 40-49 Jahren bei Ma
¨
nnern und 50-59 Jahren bei Frauen.
Danach sinkt die Pra
¨
valenz wieder. Eine von zwei Frauen ist U
¨
bergewichtig und eine von fu
¨
nf Frauen ist
adipo
¨
s, wa
¨
hrend ein Drittel der Ma
¨
nnern U
¨
bergewichtig ist, sind nur 5% adipo
¨
s. Adipo
¨
se Personen haben
eine gro
¨
ßere WHR fu
¨
r ihr Alter als nicht U
¨
bergewichtige. Dies deutet darauf hin, dass die Fettzunahme
zu einer mehr abdominalen Fettmassenverteilung fu
¨
hrt. Dauer des Wohnsitzes in Yaounde
´
, Zunahme
des Ausbildungsniveaus, berufliche Ta
¨
tigkeit, ethnische Herkunft, ko
¨
rperliche Inaktivita
¨
t und
Rauchgewohnheiten scheinen einen Einfluss auf ein fru
¨
hzeitig Auftreten von U
¨
bergewicht und/oder
Adipositas zu haben. Bei Frauen wurde kein Einfluss der Parita
¨
t gefunden. Es scheint, dass in der vorlie-
genden Untersuchung Adipositas, besonders Adipositas bei Frauen schwerwiegender ist, als in anderen
Studien aus Afrika beschrieben.
Zusammenfassung: In Kamerun sind Untersuchungen notwendig – einschließlich a
¨
tiologischer und
Kohortenstudien -, die das Morbidita
¨
ts- und Mortalita
¨
tsrisiko im Hinblick auf U
¨
bergewicht und
Adipositas quantifizieren.
Overweight and obesity in Cameroon 561

Re
´
sume
´
. Arrie
`
re-plan: l’apparition d’une transition nutritionnelle dans les pays en de
´
veloppement
pourrait conduire a
`
une plus forte pre
´
valence de l’obe
´
site
´
ainsi que de ses conse
´
quences sur la sante
´
.
Le rythme de l’urbanisation au Cameroun est l’un des plus rapides de toute l’Afrique sub-saharienne,
il s’accompagne de changements de
´
mographiques qui favorisent des modifications importantes des profils
nutritionnels.
But: Cet article examine la pre
´
valence actuelle du surpoids et de l’obe
´
site
´
dans la ville de Yaounde
´
, capitale
du Cameroun et en recherche les causes possibles. Il discute e
´
galement des conse
´
quences du surpoids sur la
sante
´
.
Mate
´
riel et me
´
thodes: Des mensurations anthropome
´
triques, de composition corporelle, de tension arte
´
r-
ielle et de rythme cardiaque au repos, ainsi que des enqueˆ tes par questionnaire comprenant des rubriques
de socio-de
´
mographie, de tabagisme, d’activite
´
physique et d’auto-perception du poids et de l’e
´
tat de sante
´
,
ont e
´
te
´
re
´
unies sur des e
´
chantillons d’adultes (519 femmes et 252 hommes) de tous aˆ ges et de tous les
quartiers de Yaounde
´
.
Re
´
sultats: L’indice de masse corporelle (IMC) s’accroıˆ t avec l’aˆ ge dans les deux sexes, pour culminer au
cours des anne
´
es de maturite
´
. Ces changements sont lie
´
s aux changements d’adiposite
´
. Les taux de
pre
´
valence du surpoids (IMC > 25) et de l’obe
´
site
´
(IMC > 30) augmentent a
`
partir de l’aˆ ge de 20-29
ans et culminent entre 40-49 ans chez les hommes et entre 50-59 ans chez les femmes avant de commencer
de de
´
cliner. Une femme sur deux est en surpoids et une femme sur cinq est obe
`
se, tandis qu’un tiers des
hommes sont en surpoids et seulement 5% sont obe
`
ses. Les sujets obe
`
ses ont un rapport poids/taille par
aˆ ge plus e
´
leve
´
que leurs homologues de poids normal, ce qui indique que les gains d’adiposite
´
sont plus
oriente
´
s vers une distribution abdominale de la masse graisseuse. Le surpoids ou l’obe
´
site
´
pre
´
coces
semblent influence
´
s par le temps de re
´
sidence a
`
Yaounde
´
, par un niveau e
´
ducatif croissant, par la profes-
sion, par l’appartenance ethnique, par l’inactivite
´
physique et par les habitudes tabagiques. On n’observe
pas un effet de la parite
´
chez les femmes. Cette e
´
tude indiquerait que l’obe
´
site
´
, notamment fe
´
minine,
pourrait eˆ tre moins be
´
nigne qu’il n’a e
´
te
´
de
´
crit a
`
propos d’autres e
´
tudes africaines.
Conclusion: Le Cameroun a besoin que soient effectue
´
es des recherches comportant des e
´
tudes e
´
tiologiques
et de cohortes qui viseraient a
`
quantifier les risques de morbidite
´
et de mortalite
´
associe
´
s au surpoids et a
`
l’obe
´
site
´
.
Resumen. Antecedentes: La aparicio
´
n de una transicio
´
n nutricional en los paı
´
ses en vı
´
as de desarrollo
podrı
´
a conducir a una mayor prevalencia de obesidad y efectos relacionados adversos para la salud.
En Cameru´ n, la tasa de incremento de la urbanizacio
´
n es una de las ma
´
s elevadas del Africa
Subsahariana. Un cambio demogra
´
fico tan dra
´
stico propicia importantes modificaciones, sobre todo en
los patrones nutricionales.
Objetivo: En este artı
´
culo examinamos la actual prevalencia de sobrepeso y obesidad en Yaounde
´
, la capital
de Cameru´ n, y buscamos posibles factores causales. Tambie
´
n se discuten las consecuencias perjudiciales
del sobrepeso.
Material y me
´
todo: Se tomaron medidas antropome
´
tricas y de composicio
´
n corporal, la presio
´
n sanguı
´
nea,
y se determino
´
la tasa cardiaca en reposo, en muestras de adultos (519 mujeres, 252 varones) de todas
las edades y en todos los distritos de Yaounde
´
; el entrevistador realizo
´
una encuesta que incluı
´
a datos
sociodemogra
´
ficos, sobre el ha
´
bito de fumar, actividad fı
´
sica, la propia percepcio
´
n del peso corporal y el
estado de salud.
Resultados: En ambos sexos, el ı
´
ndice de masa corporal (BMI) aumenta con la edad y presenta picos en la
madurez. Estos cambios esta
´
n relacionados con cambios en la adiposidad. Las tasas de prevalencia de
sobrepeso (BMI 5 25) y obesidad (BMI 5 30) aumentan desde los 20-29 an
˜
os y presentan un pico a los
40-49 an
˜
os en los varones y a los 50-59 an
˜
os en las mujeres, antes de comenzar a declinar. Una mujer de
cada dos presenta sobrepeso y una de cada cinco es obesa, mientras que un tercio de los hombres tiene
sobrepeso y solo el 5% es obeso. Los sujetos obesos tienen un mayor WHR ajustado para la edad que sus
homo
´
logos sin sobrepeso, lo que confirma que el aumento de grasa se orienta hacia una distribucio
´
ndela
masa grasa ma
´
s abdominal. El tiempo de residencia en Yaounde
´
, el incremento en el nivel educativo,
la ocupacio
´
n, la etnicidad, la inactividad fı
´
sica y el consumo de tabaco parecen influir en la aparicio
´
ndeun
sobrepeso y/o una obesidad precoces. No se ha observado ningu´ n efecto de la paridad en mujeres. Segu´ n
este estudio parece que la obesidad, y especialmente la obesidad en mujeres, podrı
´
a ser menos benigna de
lo que se habı
´
a descrito en otros estudios realizados en Africa.
Conclusio
´
n: Se precisan investigaciones en Cameru´ n, que incluyan estudios etiolo
´
gicos y de cohortes,
destinadas a cuantificar los riesgos de morbilidad y mortalidad asociados con el sobrepeso y la obesidad.
562 P. Pasquet et al.