“Overweight” adults think they are “underweight”: a household survey in rural Zambia Yukiko Tateyama

Cardiovascular diseases (CVDs) are recent public health challenges in Sub-Saharan Africa (SSA). In Zambia, 8% of all mortality in 2012 is related to CVDs. The national adult overweight prevalence was 26.4% in 2010. Further increase of CVDs is predicted to continue with economic development; however, researches on CVDs are limited in Zambia, particularly in rural areas where urbanization is outpacing. We, therefore, aimed to investigate the prevalence and perception of overweight in rural Zambia through a cross-sectional study that employs a rigorous probability sampling. We recruited 690 male and female residents (48.6% and 51.4%, respectively) of Mumbwa district (ages 25-64) through a multistage, clustered, household sampling for the questionnaire survey, anthropometric, and biological measurements during May-July 2016. Data analysis took into account of complex sampling design. Mean age was 41.9 ± 0.55 (SE), 74.3% had only primary education and 47.4% earned ≦50USD per month. The prevalence of overweight (BMI≧25) was 26.8%, of which, 58.4% and 14.2% perceived themselves as "normal" and "underweight", respectively. Among all, 13.8% responded that they prefer to be overweight; the main reasons included "attractive" (78.6%), "looks wealthy/avoids to be seen poor" (49.7%), and "fears to be seen ill/looks healthy" (39.6%), of which, "fear to be seen as having HIV' was ranked as the top reason. We found that more than half of overweight participants perceived that they were normal weight and more than 10% of all participants prefer to be overweight. Such preference of overweight appeared to have been influenced by the culture, socioeconomic, and HIV stigma. Future interventions for CVDs in Zambia should address these culturally appropriate contexts and the influence of HIV endemic. The findings may also be beneficial for other SSA countries that are experiencing the same epidemiological transition.

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