Epidemiology of adult obesity
DOI:
https://doi.org/10.7196/SAMJ.2025.v115i9b.3616Keywords:
Epidemiology, Obesity, Guideline, South AfricaAbstract
RECOMMENDATIONS
1. Healthcare providers should recognise and treat obesity as a chronic disease, caused by abnormal or excess body fat accumulation (adiposity) that impairs health, with increased risk of premature morbidity and mortality (Level 2b, Grade B).
2. The development of evidence-informed strategies at the health system and policy level should be directed at managing obesity in adults (Level 2b, Grade B).
3. Continued longitudinal national and regional surveillance of obesity that includes self-reported and measured data (i.e. heights, weights, waist circumferences) should be conducted on a regular basis (Level 2b, Grade B).
References
1. World Health Organization. Obesity and overweight. 2024. http://www.who.int/news-room/fact-sheets/ detail/obesity-and-overweight (accessed 7 May 2025).
2. Statistics Canada. Table 13-10-0096-20: Body mass index, overweight or obese, self-reported, adult, age groups (18 years and older). 2007. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009620 (accessed 25 January 2025).
3. Twells LK, Gregory DM, Reddigan J, Midodzi WK. Current and predicted prevalence of obesity in Canada: A trend analysis. CMAJ Open 2014;2(1):E18-E26. https://doi.org/10.9778/cmajo.20130016
4. Global BMI Mortality Collaboration; di Angelantonio E, Bhupathiraju S, Wormser D, et al. Body-mass
index and all-cause mortality: Individual-participant-data meta-analysis of 239 prospective studies in
four continents. Lancet 2016;388(10046):776-786. https://doi.org/10.1016/s0140-6736(16)30175-1
5. Prospective Studies Collaboration; Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies. Lancet
2009;373(9669):1083-1096. https://doi.org/10.1016/s0140-6736(09)60318-4
6. Sutin AR, Stephan Y, Terracciano A. Weight discrimination and risk of mortality. Psychol Sci
2015;26(11):1803-1811. https://doi.org/10.1177/0956797615601103
7. ChenY,MaL,HanZ,XiongP.Theglobalburdenofdiseaseattributabletohighbodymassindexin204
countries and territories: Findings from 1990 to 2019 and predictions to 2035. Diabetes Obes Metab
2024;26(9):3998-4010. https://doi.org/10.1111/dom.15748
8. Bradshaw D, Joubert JD, Abdelatief N, et al. Estimating the changing burden of disease attributable
to high body mass index in South Africa for 2000, 2006 and 2012. S Afr Med J 2022;112(8b):583-593.
https://doi.org/10.7196/SAMJ.2022.v112i8b.16488
9. James WPT. WHO recognition of the global obesity epidemic. Int J Obes (Lond) 2008;32(Suppl 7):S120-S126. https://doi.org/10.1038/ijo.2008.247
10. WorldObesityFederation.WorldObesityAtlas2024.London:WorldObesityFederation,2024.https:// data.worldobesity.org/publications/WOF-Obesity-Atlas-v7.pdf (accessed 7 May 2025).
11. Gupta S, Richard L, Forsythe A. The humanistic and economic burden associated with increasing body mass index in the EU5. Diabetes Metab Syndr Obes 2015;8:327-338. https://doi.org/10.2147/DMSO.S83696
12. GoettlerA,GrosseA,SonntagD.Productivitylossduetooverweightandobesity:Asystematicreviewof
indirect costs. BMJ Open 2017;7(10):e014632. https://doi.org/10.1136/bmjopen-2016-014632
13. Okunogbe A, Nugent R, Spencer G, Powis J, Ralston J, Wilding J. Economic impacts of overweight and obesity: Current and future estimates for 161 countries. BMJ Glob Health 2022;7(9):e009773. https://doi.
org/10.1136/bmjgh-2022-009773
14. Boachie MK, Thsehla E, Immurana M, Kohli-Lynch C, Hofman KJ. Estimating the healthcare cost of overweight and obesity in South Africa. Glob Health Action 2022;15(1):2045092. https://doi.org/10.10 80/16549716.2022.2045092
15. Discovery Vitality. The Vitality ObeCity Index 2023. 2023. https://www.discovery.co.za/wcm/ discoverycoza/assets/vitality/benefit-guides/obecity-2023-digital-version.pdf (accessed 3 January 2025).
16. Burkhauser RV, Cawley J. Beyond BMI: The value of more accurate measures of fatness and obesity in
social science research. J Health Econ 2008;27(2):519-529. https://doi.org/10.1016/j.jhealeco.2007.05.005
17. Rush EC, Freitas I, Plank LD. Body size, body composition and fat distribution: Comparative analysis of European, Maori, Pacific Island and Asian Indian adults. Br J Nutr 2009;102(4):632-641. https://doi.
org/10.1017/s0007114508207221
18. Sumner AE, Micklesfield LK, Ricks M, et al. Waist circumference, BMI, and visceral adipose tissue in white women and women of African descent. Obesity (Silver Spring) 2011;19(3):671-674. https://doi. org/10.1038/oby.2010.201
19. World Health Organization Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363(9403):157-163. https://doi. org/10.1016/s0140-6736(03)15268-3
20. National Department of Health, Statistics South Africa, South African Medical Research Council, ICF. South Africa Demographic and Health Survey 2016. 2019. https://www.dhsprogram.com/publications/ publication-fr337-dhs-final-reports.cfm?cssearch=16620_1 (accessed 17 December 2024).
21. National Department of Health, South African Medical Research Council. South Africa Demographic and Health Survey 1998. 2002. https://dhsprogram.com/pubs/pdf/FR131/FR131.pdf (accessed 17 December 2024).
22. National Department of Health, South African Medical Research Council. South Africa Demographic and Health Survey 2003. 2007. https://dhsprogram.com/pubs/pdf/fr206/fr206.pdf (accessed 17 December 2024).
23. Human Sciences Research Council. The South African National Health and Nutrition Examination Survey (SANHANES-1) [Dataset]. 2014. https://www.hsrc.ac.za/uploads/pageNews/72/SANHANES- launch%20edition%20(online%20version).pdf (accessed 17 December 2024).
24. NationalIncomeDynamicsStudy(NIDS).http://www.nids.uct.ac.za/(accessed3December2024).
25. Simelane T, Mutanga S, Hongoro C, et al. National Food and Nutrition Security Survey: National Report. Pretoria: Human Sciences Research Council, 2023. https://repository.hsrc.ac.za/
handle/20.500.11910/23338 (accessed 17 December 2024).
26. Public Health Agency of Canada. Obesity in Canada – snapshot. Figure 1. 2012. https://www.canada.
ca/en/public-health/services/reports-publications/obesity-canada-snapshot.html (accessed 25 January
2025).
27. Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each
other in their body mass index/body fat per cent relationship. Obes Rev 2002;3(3):141-146. https://doi.
org/10.1046/j.1467-789x.2002.00065.x
28. Heymsfield SB, Peterson CM, Thomas DM, Heo M, Schuna Jr JM. Why are there race/ethnic differences in adult body mass index-adiposity relationships? A quantitative critical review. Obes Rev 2016;17(3):262- 275. https://doi.org/10.1111/obr.12358
29. Caleyachetty R, Barber TM, Mohammed NI, et al. Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: A population-based cohort study. Lancet Diabetes Endocrinol 2021;9(7):419-426. https://doi.org/10.1016/s2213-8587(21)00088-7
30. Snehalatha C, Viswanathan V, Ramachandran A. Cutoff values for normal anthropometric variables in Asian Indian adults. Diabetes Care 2003;26(5):1380-1384. https://doi.org/10.2337/diacare.26.5.1380
31. Tham KW, Abdul Ghani R, Cua SC, et al. Obesity in South and Southeast Asia – a new consensus on care and management. Obes Rev 2023;24(2):e13520. https://doi.org/10.1111/obr.13520
32. World Health Organization. The Asia-Pacific perspective: Redefining obesity and its treatment. Health Communications Australia, 2000. https://iris.who.int/bitstream/handle/10665/206936/0957708211_eng. pdf (accessed 27 March 2025).
33. Haam JH, Kim BT, Kim EM, et al. Diagnosis of obesity: 2022 update of clinical practice guidelines for obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr 2023;32(2):121-129. https:// doi.org/10.7570/jomes23031
34. Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD. Body mass index, waist circumference and waist-hip ratio: Which is the better discriminator of cardiovascular disease mortality risk? Evidence from an individual-participant meta-analysis of 82 864 participants from nine cohort studies. Obes Rev 2011;12(9):680-687. https://doi.org/10.1111/j.1467-789x.2011.00879.x
35. HamerM,O’DonovanG,StenselD,StamatakisE.Normal-weightcentralobesityandriskformortality. Ann Intern Med 2017;166(12):917-918. https://doi.org/10.7326/l17-0022
36. Peters SAE, Bots SH, Woodward M. Sex differences in the association between measures of general and central adiposity and the risk of myocardial infarction: Results from the UK Biobank. J Am Heart Assoc 2018;7(5):e008507. https://doi.org/10.1161/jaha.117.008507
37. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120(16):1640-1645. https://doi.org/10.1161/circulationaha.109.192644
38. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health 2009;9:88. https://doi.org/10.1186/1471-2458-9-88
39. Aune D, Greenwood DC, Chan DS, et al. Body mass index, abdominal fatness and pancreatic cancer risk: A systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol 2012;23(4):843-852. https://doi.org/10.1093/annonc/mdr398
40. Aune D, Navarro Rosenblatt DA, Chan DS, et al. Anthropometric factors and endometrial cancer risk: A systematic review and dose-response meta-analysis of prospective studies. Ann Oncol 2015;26(8):1635- 1648. https://doi.org/10.1093/annonc/mdv142
41. Aune D, Navarro Rosenblatt DA, Chan DS, et al. Anthropometric factors and ovarian cancer risk: A systematic review and nonlinear dose-response meta-analysis of prospective studies. Int J Cancer 2015;136(8):1888-1898. https://doi.org/10.1002/ijc.29207
42. StatisticsSouthAfrica.CancerinSouthAfrica(2008-2019).ReportNo.03-08-00.28March2023.https:// www.statssa.gov.za/publications/03-08-00/03-08-002023.pdf (accessed 8 April 2025).
43. Statistics South Africa. Non-communicable diseases: Findings from death notifications, 2008-2018. Report No. 03-08-01. 17 October 2023. https://www.statssa.gov.za/publications/Report-03-08-01/ Report-03-08-012018.pdf (accessed 8 April 2025).
44. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA 2003;289(2):187-193. https://doi.org/10.1001/jama.289.2.187
45. Wolin KY, Carson K, Colditz GA. Obesity and cancer. Oncologist 2010;15(6):556-565. https://doi. org/10.1634/theoncologist.2009-0285
46. Abdullah A, Peeters A, de Courten M, Stoelwinder J. The magnitude of association between overweight and obesity and the risk of diabetes: A meta-analysis of prospective cohort studies. Diabetes Res Clin Pract 2010;89(3):309-319. https://doi.org/10.1016/j.diabres.2010.04.012
47. AuneD,NoratT,VattenLJ.Bodymassindex,abdominalfatnessandtheriskofgallbladderdisease.Eur J Epidemiol 2015;30(9):1009-1019. https://doi.org/10.1007/s10654-015-0081-y
48. AuneD,NoratT,VattenLJ.Bodymassindexandtheriskofgout:Asystematicreviewanddose-response meta-analysis of prospective studies. Eur J Nutr 2014;53(8):1591-1601. https://doi.org/10.1007/s00394- 014-0766-0
49. Bliddal H, Leeds AR, Christensen R. Osteoarthritis, obesity and weight loss: Evidence, hypotheses and horizons – a scoping review. Obes Rev 2014;15(7):578-586. https://doi.org/10.1111/obr.12173
50. Blagojevic M, Jinks C, Jeffery A, Jordan KP. Risk factors for onset of osteoarthritis of the knee in older adults: A systematic review and meta-analysis. Osteoarthritis Cartilage 2010;18(1):24-33. https://doi. org/10.1016/j.joca.2009.08.010
51. Gadalla TM. Association of obesity with mood and anxiety disorders in the adult general population. Chronic Dis Can 2009;30(1):29-36.
52. Zheng W, McLerran DF, Rolland B, et al. Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med 2011;364(8):719-729. https://doi.org/10.1056/nejmoa1010679 53. Kitahara CM, Flint AJ, Berrington de Gonzalez A, et al. Association between class III obesity (BMI of 40-59 kg/m2) and mortality: A pooled analysis of 20 prospective studies. PLoS Med 2014;11(7):e1001673.
https://doi.org/10.1371/journal.pmed.1001673
54. Manne-Goehler J, Baisley K, Vandormael A, et al. BMI and all-cause mortality in a population-based cohort in rural South Africa. Obesity (Silver Spring) 2020;28(12):2414-2423. https://doi.org/10.1002/ oby.23005
55. Micklesfield LK, Lambert EV, Hume DJ, et al. Socio-cultural, environmental and behavioural determinants of obesity in black South African women. Cardiovascular J Afr 2013;24(9):369-375. https:// doi.org/10.5830/cvja-2013-069
56. Micklesfield LK, Kolkenbeck-Ruh A, Mukoma G, et al. The Healthy Aging Adult South Africa report card: A systematic review of the evidence between 2013 and 2020 for middle-aged South African men and women. Cardiovasc J Afr 2022;33(4):200-219. https://doi.org/10.5830/cvja-2022-015
57. Sartorius B, Veerman LJ, Manyema M, Chola L, Hofman K. Determinants of obesity and associated population attributability, South Africa: Empirical evidence from a National Panel Survey, 2008-2012. PLoS ONE 2015;10(6):e0130218. https://doi.org/10.1371/journal.pone.0130218
58. OkopKJ,LevittN,PuoaneT.WeightunderestimationandbodysizedissatisfactionamongblackAfrican adults with obesity: Implications for health promotion. Afr J Prim Health Care Fam Med 2019;11(1):e1- e8. https://doi.org/10.4102/phcfm.v11i1.2022
59. McHiza ZJ, Goedecke JH, Lambert EV. Intra-familial and ethnic effects on attitudinal and perceptual body image: A cohort of South African mother-daughter dyads. BMC Public Health 2011;11:433. https:// doi.org/10.1186/1471-2458-11-433
60. Case A, Menendez A. Sex differences in obesity rates in poor countries: Evidence from South Africa. Econ Hum Biol 2009;7(3):271-282. https://doi.org/10.1016/j.ehb.2009.07.002
61. MfenyanaK,GriffinM,YogeswaranP,etal.Socio-economicinequalitiesasapredictorofhealthinSouth Africa – the Yenza cross-sectional study. S Afr Med J 2006;96(4):323-330.
62. Kruger HS, Venter CS, Vorster HH. Obesity in African women in the North West Province, South Africa is associated with an increased risk of non-communicable diseases: The THUSA study. Br J Nutr 2001;86(6):733-740. https://doi.org/10.1079/bjn2001469
63. McLaren L. Socioeconomic status and obesity. Epidemiol Rev 2007;29:29-48. https://doi.org/10.1093/ epirev/mxm001
64. Roskam AJR, Kunst AE, van Oyen H, et al. Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries. Int J Epidemiol 2010;39(2):392-404. https://doi.org/10.1093/ije/dyp329
65. Kruger HS, Venter CS, Vorster HH, Margetts BM. Physical inactivity is the major determinant of obesity in black women in the North West Province, South Africa: The THUSA study. Nutrition 2002;18(5):422- 427. https://doi.org/10.1016/s0899-9007(01)00751-1
66. Mvo Z, Dick J, Steyn K. Perceptions of overweight African women about acceptable body size of women and children. Curationis 1999;22(2):27-31. https://doi.org/10.4102/curationis.v22i2.719
67. Vorster HH, Venter CS, Wissing MP, Margetts BM. The nutrition and health transition in the North West Province of South Africa: A review of the THUSA (Transition and Health during Urbanisation of South Africans) study. Public Health Nutr 2005;8(5):480-490. https://doi.org/10.1079/phn2005784
68. Mchiza ZJ, Steyn NP, Hill J, et al. A review of dietary surveys in the adult South African population from 2000 to 2015. Nutrients 2015;7(9):8227-8250. https://doi.org/10.3390/nu7095389
69. Bourne LT, Lambert EV, Steyn K. Where does the black population of South Africa stand on the nutrition transition? Public Health Nutr 2002;5(1A):157-162. https://doi.org/10.1079/phn2001288
70. Puoane T, Matwa PN, Hughes GD, Bradley HA. Socio-cultural factors influencing food consumption patterns in the black African population in an urban township in South Africa. Hum Ecol 2006;Special Issue 14:89-93.
71. Odunitan-Wayas FA, Faber M, Mendham AE, et al. Food security, dietary intake, and foodways of urban low-income older South African women: An exploratory study. Int J Environ Res Public Health 2021;18(8):3973. https://doi.org/10.3390/ijerph18083973
72. Okop KJ, Lambert EV, Alaba O, et al. Sugar-sweetened beverage intake and relative weight gain among South African adults living in resource-poor communities: Longitudinal data from the STOP-SA study. Int J Obes (Lond) 2019;43(3):603-614. https://doi.org/10.1038/s41366-018-0216-9
73. Hofman KJ, Stacey N, Swart EC, Popkin BM, Ng SW. South Africa’s Health Promotion Levy: Excise tax findings and equity potential. Obes Rev 2021;22(9):e13301. https://doi.org/10.1111/obr.13301
74. Cook I, Alberts M, Lambert EV. Relationship between adiposity and pedometer-assessed ambulatory activity in adult, rural African women. Int J Obes (Lond) 2008;32(8):1327-1330. https://doi.org/10.1038/ ijo.2008.26
75. Muti M, Ware LJ, Micklesfield LK, et al. Physical activity and its association with body mass index: A cross-sectional analysis in middle-aged adults from 4 sub-Saharan African countries. J Phys Act Health 2023;20(3):217-225. https://doi.org/10.1123/jpah.2022-0539
76. Joubert J, Norman R, Lambert EV, et al. Estimating the burden of disease attributable to physical inactivity in South Africa in 2000. S Afr Med J 2007;97(8 Pt 2):725-731.
77. Mlangeni L, Makola L, Naidoo I, et al. Factors associated with physical activity in South Africa: Evidence from a national population based survey. Open Pub Health J 2018;11(1):516-525. https://doi. org/10.2174/1874944501811010516
78. Micklesfield LK, Westgate K, Smith A, et al. Physical activity behaviors of a middle-age South African cohort as determined by integrated hip and thigh accelerometry. Med Sci Sports Exerc 2022;54(9):1493- 1505. https://doi.org/10.1249/mss.0000000000002940
79. Mendham AE, Goedecke JH, Kufe NC, et al. Physical behaviors and their association with adiposity in men and women from a low-resourced African setting. J Phys Act Health 2022;19(8):548-557. https:// doi.org/10.1123/jpah.2022-0032
80. Malambo P, de Villiers A, Lambert EV, Puoane T, Kengne AP. Associations of perceived neighbourhood safety from traffic and crime with overweight/obesity among South African adults of low-socioeconomic status. PLoS ONE 2018;13(10):e0206408. https://doi.org/10.1371/journal.pone.0206408
81. Cook I, Alberts M, Brits JS, Choma SR, Mkhonto SS. Descriptive epidemiology of ambulatory activity in rural, black South Africans. Med Sci Sports Exerc 2010;42(7):1261-1268. https://doi.org/10.1249/ mss.0b013e3181ca787c
82. Assah FK, Ekelund U, Brage S, Mbanya JC, Wareham NJ. Urbanisation, physical activity, and metabolic health in sub-Saharan Africa. Diabetes Care 2011;34(2):491-496. https://doi.org/10.2337/dc10-0990
83. Draper CE, Tomaz SA, Bassett SH, et al. Results from South Africa’s 2018 report card on physical
activity for children and youth. J Phys Act Health 2018;15(S2):S406-S408. https://doi.org/10.1123/
jpah.2018-0517
84. Levine JA. Nonexercise activity thermogenesis – liberating the life-force. J Intern Med 2007;262(3):273- 287. https://doi.org/10.1111/j.1365-2796.2007.01842.x
85. Keith SW, Redden DT, Katzmarzyk PT, et al. Putative contributors to the secular increase in obesity: Exploring the roads less traveled. Int J Obes (Lond) 2006;30(11):1585-1594.
86. Wharton S, Lau DC, Vallis M, et al. Obesity in adults: A clinical practice guideline. CMAJ 2020;192(31):E875-E891. https://doi.org/10.1503/cmaj.191707
87. National Department of Health, South Africa. Strategy for the prevention and management of obesity in South Africa, 2023-2028. Pretoria: NDoH, 2023. https://www.health.gov.za/wp-content/ uploads/2023/05/Obesity-Strategy-2023-2028_Final_Approved.pdf (accessed 28 May 2025).
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