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Is overweight still a problem of rich in sub-Saharan Africa? Insights based on female-oriented demographic and health surveys
Authors: Bertille Daran, Pierre Levasseur
Source: World Development Perspectives, Volume 25; DOI:
Topic(s): Nutrition
Wealth Index
Country: Africa
  Multiple African Countries
Published: MAR 2022
Abstract: To most people, sub-Saharan Africa (SSA) is synonymous with hunger and starvation. However, overweight and obesity are currently also a major public health concern in this region, sometimes even more than the prevalence of underweight. Despite the significant increase in the average body mass index (BMI) in SSA, the existing literature still considers a positive association between household socioeconomic status (SES) and individual BMI, suggesting that excess weight is a symbol of wealth while thinness is linked to poverty. This article aims to update this traditional and probably outdated perception by investigating potential nonlinearities and heterogeneity in the relationship between SES and BMI in SSA. First, we pool several cross-sectional female adult-oriented demographic and health surveys that are representative of a large number of SSA countries from 1990 to 2019. Second, we implement both ordinary least-squares (OLS) and instrumental variables (IV) regressions. Once a comprehensive set of observed characteristics was controlled for, OLS estimates suggest a nonlinear association between SES indicators and female BMI, taking a U-inverted shape. IV corrections controlling for reverse causality and unobserved heterogeneity reveal similar trends, confirming the overrepresentation of excess weight in intermediate levels of wealth and education. Furthermore, this study dates the social shift of the obesity burden in SSA: changing from positive to curvilinear from the end of the 1990s, including for countries currently classified as lower middle income. To conclude, this article contributes to the literature demonstrating the ongoing nutrition transition in SSA and the role of an emergent middle class in the rise of the obesity epidemic. This result has important implications for public health policies.