Women are 2-3 times more likely than men to have obesity in low- and middle-income countries, with the disparity as much as 10-times higher among women in the Sub-Saharan region of Africa. Key factors believed to contribute to the higher obesity rates include weight gain during pregnancy and menopause, poor dietary habits, sedentary lifestyles, and sociocultural aspects such as beliefs that larger body types suggest high socioeconomic status and fertility.
A systematic review and meta-analysis of 345 studies involved 3.9 million people with data on associations between sex, obesity and cardiometabolic diseases.
Three hundred of the studies reported data on obesity in women and men in low- and middle-income countries.
Key metabolic diseases evaluated included type 2 diabetes, impaired glucose tolerance, dyslipidemia, and nonalcoholic fatty liver disease (now known as MASLD [metabolic dysfunction–associated steatotic liver disease].
Hypertension, coronary heart disease, myocardial infarction, and stroke were included as obesity-related cardiovascular diseases.
Obesity was defined as a body mass index (BMI) of ≥27.5 kg/m2 in studies in the South Asian community, and ≥30 kg/m2 in other populations.
Studies including children, adolescents, and those in high-income countries, as well as smaller studies and secondary analyses, were excluded.
Overall, the odds of obesity were 2.7-fold higher among women than men (odds ratio [OR] 2.72).
There were significant disparities in the differences between genders and obesity based on regions, with significantly higher odds for women in studies from Sub-Saharan Africa (OR, 3.91), followed by the Middle East and North Africa (OR, 2.69), and Latin America and Caribbean regions (OR, 2.17).
Studies from Sub-Saharan Africa reported odds that were 3-fold to as much as 10-fold higher in women than men.
The lowest differences between gender in terms of obesity odds were observed in studies from South Asia (OR, 1.43) and East Asia and Pacific (OR, 1.43).
Gender disparities were observed regardless of the country’s income status, setting and year of study being before or after 2000, as well as age.
Women had a slight decrease in the risk for hypertension vs men (OR, 0.95), and a slight increase in the risk for type 2 diabetes (OR, 1.07).
“To our knowledge, ours is the first meta-analysis to quantify the sex-related disparities in low- and middle-income countries for obesity, hypertension, and type 2 diabetes,” the authors report.
“Our findings are important as they call for urgent actions targeting obesity awareness, prevention, treatment, and control in women in low- and middle-income countries,” added first author Thaís Rocha MD, PhD, of the University of Birmingham, Birmingham, United Kingdom, in a press statement.
“Interventions require a woman-centered approach to treating obesity, considering the cultural, social, and behavioral barriers and facilitators uniquely faced by women in following the recommended diet-based and physical activity interventions and appropriate medical treatment.”
The study, led by joint first authors Rocha and Eka Melson, MB BCh, also from the University of Birmingham, was published online today in the Journal of Clinical Endocrinology & Metabolism.
There were differences in the studies in terms of the assessment of cardiometabolic diseases, with many studies, for instance, including patients with self-reported conditions. Causal relationships between obesity, type 2 diabetes, and hypertension could not be established because the study did not control for the timing of the diseases.
The authors report no relevant financial relationships.
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