Differing Patterns of Overweight and Obesity among Black Men and Women in Cape Town: The CRIBSA Study

Objectives: To ascertain the prevalence and determinants of overweight/obesity in the 25–74-year-old urban black population of Cape Town and examine the changes between 1990 and 2008/09. Methods: In 2008/09, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Data were collected by questionnaires, clinical measurements and biochemical analyses. Gender-specific linear regression models evaluated the associations with overweight/obesity. Results: There were 1099 participants, 392 men and 707 women (response rate 86%) in 2008/09. Mean body mass index (BMI) and waist circumference (WC) were 23.7 kg/m2 (95% confidence interval (CI): 23.1–24.2) and 84.2 cm (95% CI: 82.8–85.6) in men, and 33.0 kg/m2 (95% CI: 32.3–33.7) and 96.8 cm (95% CI: 95.5–98.1) in women. Prevalence of BMI ≥25 kg/m2 and raised WC were 28.9% (95% CI: 24.1–34.3) and 20.1% (95% CI: 15.9–24.9) in men, and 82.8% (95% CI: 79.3–85.9) and 86.0% (95% CI: 82.9–88.6) in women. Among 25–64-year-olds, BMI ≥25 kg/m2 decreased between 1990 (37.3%, 95% CI: 31.7–43.1) and 2008/09 (27.7%, 95% CI: 22.7–33.4) in men but increased from 72.7% (95% CI: 67.6–77.2) to 82.6% (95% CI: 78.8–85.8) in women. In the regression models for men and women, higher BMI was directly associated with increasing age, wealth, hypertension and diabetes but inversely related to daily smoking. Also significantly associated with rising BMI were raised low-density lipoprotein cholesterol and being employed compared to unemployed in men, and having >7 years of education in women. Conclusions: Overweight/obesity, particularly in urban black women, requires urgent action because of the associations with cardiovascular disease risk factors and their serious consequences.