Nutrition in AfricaPhysical inactivity is the major determinant of obesity in black women in the North West province, South Africa: the THUSA study☆
Introduction
There is an exceptionally high prevalence of obesity among black South African women.1, 2 The reasons for this phenomenon are not well understood. It seems that many black South African women do not want to lose weight because obesity is culturally and esthetically looked upon with far less disfavor in black women than in white women.3 Factors such as higher parity and lower levels of physical activity may contribute to the tendency of black women to gain weight.4 Increased body mass index (BMI) among women is associated with chronic diseases, especially coronary heart disease. Results from the coronary artery risk development in young adults (CARDIA) and atherosclerosis risk in communities (ARIC) studies have shown that black and white women should avoid excess adiposity.5 To prevent and treat obesity in black women, more should be known about the underlying causes of obesity among these women to develop appropriate and culturally accepted interventions.
The Transition and Health During Urbanisation of South Africans (THUSA) study assessed the relation between stratum of urbanization and measures of health status in the black population of the North West Province. This part of the study investigated the association between measures of obesity and factors contributing to obesity such as socioeconomic factors, dietary intakes (total energy, total fat, percentage of energy from fat, total carbohydrate, and sugar), and level of physical activity.
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Subjects
Strata of urbanization had to be defined to plan the drawing of a sample from the study population. The definitions of urban and rural used in epidemiologic research should be determined by the aim of the study.6 Given the aim of the THUSA study, subjects who stayed only temporarily in the city or a rural area were not included in the study sample. In addition to two rural strata (people living in tribal areas and on farms), three different strata of urbanization were distinguished for urban
Demographic data
The demographic data of the subjects showed that most spoke Setswana (75.7%), with a low level of school education (53.7% primary school or less), a high unemployment rate (64.3%), and a low household income (77.4% less than R1000, or US $130, per month). There were no significant differences between the demographic profiles of subjects in the 1996 and the 1998 surveys.
Socioeconomic data
There were significant differences between the BMI, TSF, SSF, and WHR of subjects in the different income groups (P < 0.01).
Discussion
We assessed the association between measures of obesity and socioeconomic factors, dietary intakes, and physical activity. The prevalence of obesity (BMI > 30) in the THUSA study sample was slightly lower than that reported for black South African women in the Cape Peninsula1 and the Free State.2 The mean BMI values of the three study samples are compared in Table V.
It was not possible to measure the skinfold thicknesses of grossly obese subjects with calipers because such measurements were
Conclusion
The subjects most at risk of being obese were those from the higher income categories and habitual low physical activity. These findings are consistent with the results of Paeratakul et al.17 in a Chinese population. Weak, but statistically significant, positive correlations between total energy and fat intakes and BMI were found. The highest fat intakes in this study were in subjects living in urban areas. A high fat intake and a high energy intake may be among the contributing factors to the
Acknowledgements
The authors gratefully acknowledge the assistance of all members of the THUSA research team, especially Dr. A Kruger, for drawing of blood samples, Professor J. H. de Ridder for supervision of the anthropometrical measurements, and Dr. U. E. MacIntyre for supervision of the dietary assessment. Support with statistical analyses was received from Professor H. S. Steyn, DSc, of the Statistical Consultation Service, Potchefstroom University for CHE, who was responsible for drawing the sample. The
References (24)
- et al.
The 10-y incidence of obesity and major weight gain in black and white US women aged 30–55 y
Am J Clin Nutr
(1991) - et al.
Implications of obesity for cardiovascular disease in blacksthe CARDIA and ARIC studies
Am J Clin Nutr
(1991) - et al.
Urbanisation and healthmethodological difficulties in undertaking epidemiological research in developing countries
Soc Sci Med
(1990) - et al.
A short questionnaire for the measurement of habitual physical activity in epidemiological studies
Am J Clin Nutr
(1982) Dietary fat and obesityan unconvincing relation
Am J Clin Nutr
(1998)- et al.
Dietary fat intake does affect obesity
Am J Clin Nutr
(1998) Dietary fat and obesityan epidemiological perspective
Am J Clin Nutr
(1998)- et al.
Coronary heart disease risk factors in a rural and urban Orange Free State black population
S Afr Med J
(1995) - et al.
Risk factors for coronary heart disease in the black population of the Cape Peninsula. The BRISK study
S Afr Med J
(1991) - et al.
Obesity in African hypertensive womenproblems in treatment
S Afr J Food Sci Nutr
(1994)
The development and testing of a food portion photograph book for use in an African population
J Hum Nutr Dietet
A standardised physical activity questionnaire for a population in transitionthe THUSA study
Afr J Phys Health Educ Recreat Dance
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Editor: Demetre Labadarios, MB, ChB, PhD, FACN
This project was supported by research grants from the South African Sugar Association, the National Research Foundation of South Africa, and the Research Fund of the Potchefstroom University for Christian Higher Education.