Background
Overweight and obesity are increasing worldwide [
1‐
4] and the prevalence of obesity has almost doubled since 1980s [
5,
6]. According to the World Health Organization (WHO) report of 2015, more than 1.9 billion adults (18 years and older) were overweight and among them, over 650 million were obese [
5]. The root causes of obesity are complex, including genetics, socio-economical, cultural, environmental, emotional, behavioral and lifestyle factors.
Obesity is a significant health alarm because it predisposes individuals to several co-morbidities, including hypertension, dyslipidemia, coronary heart disease, type 2 diabetes, stroke, cancer and osteoarthritis [
5,
7‐
9]. These co-morbidities shorten life expectancy while impairing quality of life [
10‐
12]. At the workplace, obesity has also been associated with symptoms of lower self-esteem, increased individual and employer healthcare costs, increased absenteeism and presenteeism at work and reduced employee productivity [
13‐
15]. Employees spend more than 50% of their time at the workplace [
16] therefore workplace may play a major role in predisposing people to obesogenic environment including physical inactivity and unhealthy diet [
16,
17].
In Tanzania, previous scholars have reported much information on generalized obesity [
18‐
26] among the general population [
21,
22,
24,
26,
27]. Nevertheless, previous studies have demonstrated that central obesity is the best predictor of cardiovascular risk factors particularly type 2 diabetes mellitus and hypertension rather than generalized obesity [
28,
29]. Recently studies have demonstrated that, Tanzania like other developing countries is also experiencing a higher burden of cardiovascular risk factors particularly diabetes and hypertension [
5,
24]. Furthermore, information on obesity that addresses specific occupational sector as well as central obesity in Tanzania is limited. Settings-based information on overweight and obesity are also recommended to help the stakeholders to plan for more appropriate interventions which are likely to be less costly and more effective as they reach individuals into their usual environment [
5]. Therefore, the current study aimed to determine the prevalence and correlates of central obesity among employees from the formal sector in Dodoma City, central Tanzania. Findings of this study will provide insight into the obesity situation among the formal sector employees population in Dodoma City. This will guide scholars and other stakeholders to plan for future research and appropriate interventions toward this group. Further, the use of waist circumference to assess obesity will add to the existing limited literature on central obesity in the country and help to identify people at increased risk of cardiovascular diseases.
Discussion
This study found high prevalence of central obesity in the formal sector employment at Dodoma City. Similar to the current finding, high prevalence of central obesity among employees has been reported from previous study conducted in Tanzania [
26]. On the other hand, the current prevalence is less than what was reported from the study conducted among primary school teachers in Dar es Salaam, Tanzania [
7]. This difference could be due to the fact that Dar es Salaam has been the city for more many years (> 40 years) and it is the most urbanized area in Tanzania compared to Dodoma City. Being highly urbanized, people living in Dar es Salaam are more likely to be exposed to higher risks of unhealthy eating and sedentary lifestyles compared to people living in Dodoma City. Furthermore, unlike the previous study that involved only one occupation, the current study involved different occupations. People from different occupations are likely to have mixture of different behaviors and lifestyles including healthy and unhealthy ones which may influence their health status in different ways including central obesity. On the other hand, people from one occupation are more likely to share common behaviors and lifestyles which might influence their health in a similar way including central obesity [
5]. Furthermore, the current prevalence is higher than the ones reported from previous studies conducted among the general population in Tanzania [
24,
27] and elsewhere [
1,
2]. The difference observed could be due to the differences in study population among these studies. This finding may suggest that formal sector employees might be at higher risk of central obesity compared to general population. However, the available evidences are still limited inorder to reach the conclusion hence we recommend more research in order to generate more evidences on the same.
Consistence with the previous studies [
1,
2,
24,
33], this study found that females were more likely to have central obesity than males. Furthermore, the current finding demonstrates higher difference in obesity levels between the two genders. A previous study from Italy, has demonstrated that occupational risk factors for obesity differ by sex [
17]. However, the current study could not find specific employment related factors to explain this finding therefore authors recommend future scholars to study more on this area. Nevertheless, previous studies conducted from general population have identified several factors associated with female obesity which could also partly explain the current finding including; physiological differences between males and females [
34], low physical activities in women compared to men [
33] and certain African traditions such as practice of resting and fattening girls in preparation for engagement and marriage, keeping indoor mothers during postpartum period [
35] and men’s preferences for overweight women [
36].
Many previous studies have reported that increased age is associated with risk of central obesity [
1,
2,
4,
37‐
39]. Similarly, this study found that the likelihood of having central obesity increased significantly with age. The possible explanation for this could be reduced basal metabolism and physical activities as a result of ageing.
Overweight and obesity is a result of energy imbalance between calories consumed and calories expended [
5]. It has been believed that ready to eat meals from restaurants, food vendors etc. contain high energy hence creates positive energy balance. Surprisingly in our study we found that, eating homemade meals at workplace was associated with higher chances of having central obesity among the respondents. However, lack of information on types of food and amount of food eaten could be a limitation to this finding [
20]. A few previous studies have demonstrated that a typical African meal is characterized by higher energy composition [
20,
40] while another study conducted among the employees at Kuwait Oil Company showed that meals from food vendors were healthier than the homemade meals [
40]. Therefore, this finding gives an opportunity for other scholars to explore more on dietary behavior and meal composition among employees at workplace.
Furthermore, the current finding continue to support the already known phenomenon that central obesity is threat as it predisposes people to hypertension [
5,
9,
41]. Intra-abdominal (visceral) fat deposition (central obesity) is linked to an increased risk for cardiovascular co-morbidities [
42]. However, obesity and its associated non-communicable diseases can be prevented. Targeted interventions to promote healthier food intake and regular physical activity need to be emphasized to help protect the population against obesity and related co-morbidities. Such approaches are affordable and effective in prevention of obesity.
Strengths and limitations
In the Tanzanian context this is the first study that involved employees from different occupations. It adds to the limited available evidences on central obesity. Also the study was conducted in Dodoma where there is limited information on obesity and is an urban environment that is rapidly transforming. The measurements for central obesity and hypertension were measured by qualified experts during the survey. However, this study had a number of limitations. The study was a cross sectional study, the study population were the employees from formal employment only sector hence the findings may not be generalized for all employees categories. Also, information on socio-demographic characteristics and other factors assessed were self-reported by the respondents which may be a source of information bias.
Conclusions
The present study had revealed a high prevalence of central obesity among the employees from formal sector in Dodoma City. Furthermore, this study demonstrates that obesity among this population is higher compared to the general population. This suggests that employees from the formal sector employment may be at higher risk of central obesity and its related consequences. As such, it is important to identify those factors that contribute to the problem in order to design appropriate interventions. The results from this study allow us to have an understanding of the current central obesity situation at the formal sector employment in Dodoma City, central Tanzania. This serves as initial step as we plan further studies to collect more detailed evidences to guide future interventions both locally and nationally. Regardless of the study limitations, the current findings can be used to plan targeted interventions for obesity and assess the effectiveness in reducing the prevalence of central obesity and its corresponding health consequences in this population.
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