Jan. 7, 2013 Men and women in Tunisia are not equal before the scales. Tunisian women are three times as likely to suffer from obesity as their male compatriots. This great inequality was revealed in a study by IRD and its partners (1), and differs from what nutritionists have observed in the North, where more men tend to be overweight. The disparity is even greater in cities: a sedentary lifestyle, temptations offered by mass-market retail… Their role in society makes women particularly vulnerable to risk factors in an urban environment.
Body mass index (BMI) is also increasing among those with a lower education level and without employment, further broadening the difference from their masculine counterparts. A BMI above 25 increases health risks: cardiovascular diseases, diabetes, cancer, high blood pressure… The latter already affects nearly a third of all Tunisians above the age of 35, of which almost a million are obese today. Prevention is better than cure: healthcare authorities must aim their actions at the population segment that is most at risk, namely women.
In Tunisia today, one out of four inhabitants over the age of 35 is obese, in other words nearly a million people. Urbanisation, a sedentary lifestyle, temptations offered by mass-market retail… Tunisians are seeing the waistlines thickening. Or Tunisian women, to be more specific: women in this age category are much more affected, with nearly 40% suffering from obesity, compared to less than 15% of the men. This great disparity has been brought to light by IRD researchers and their partners (1). Nutritionists are noticing this trend in the majority of emerging and developing countries. The opposite is true in industrialised countries in the Global North where men and women are more or less equal before the scales, or where men even tend to be more corpulent (2). Until now, little research has been done regarding gender inequality in terms of overweight. Tunisia is one of the countries where this trend in appears to be the strongest.
Women, a population segment at risk
Researchers have studied a representative sample of more than 5,000 Tunisian men and women between the ages of 35 and 70 from all social categories, urban as well as rural. They evaluated their body mass index (BMI) which, if above 25, qualifies the person as overweight. Anything over 30 is considered as obese. According to scientists' calculations, the national prevalence of overweight in the studied age group in Tunisia is above 60%. The rate is relatively high among men, of whom more than 50% are overweight. But it is even higher among the women, of whom more than 70% suffer from excess weight. The difference increases as the needle climbs on the scale: when it comes to obesity, more than three times as many women in Tunisia are affected than their male compatriots. While the phenomenon is not insignificant among the men, with a rate of just over 13%, it concerns 37% of their fellow countrywomen. Whereas extreme obesity -- a BMI of over 40 -- is rare among the men, it is slightly more frequent among the women.
Rising inequality in cities
Globally speaking, the risk of corpulence is greater in cities than in rural areas. An urban environment holds particular dangers, with a more obviously sedentary lifestyle, supermarkets that offer a variety of rich, fatty foods, fast-food chains, etc. Two thirds of Tunisia's inhabitants live in cities and are therefore exposed to these risks. The research team has pointed out that city life also accentuates gender inequality when it comes to overweight. With a metabolism that makes them even more vulnerable to an energy imbalance that causes weight increase, women are more susceptible to the dangers of overeating that come with an urban lifestyle.
The weight of socio-economic factors
Independent from the fact of living in town or in the countryside, there are two other weighty factors: the level of education, and socio-professional category. The difference between men and women's BMI in fact diminishes with the number of years of schooling and study, and with doing a higher qualified job. Among Tunisian women who have never been to school or who left school at a relatively young age, the contrast with their male counterparts is even more noticeable. Regardless of their qualifications, working women are less prone to this disparity than those who stay at home. Lastly, the difference between women and men in higher socio-professional spheres is also smaller.
The traditionally positive perception of corpulence is often stated as an aggravating factor. But this is changing, particularly among the more educated population segments. It is above all women's traditional role in society that influences factors associated with obesity. This is still widely prevalent: for instance, three quarters of the women in the studied age group are not professionally employed, and the preparing of meals is a task that traditionally befalls women. This has an impact on their level of physical activeness or food intake, which are major causes of obesity.
Health hazard alert
The WHO has declared obesity as a "global epidemic." All regions appear to be affected, including emerging and developing countries of which most will now have to deal with a double burden: while a large part of their population is still struggling in the grips of famine, overweight is spreading in big cities. And with it, the accompanying load of serious health consequences such as cardiovascular diseases, diabetes, cancer or high blood pressure. In Tunisia today, the latter for example affects 30% of the studied age group. Looking at the harmful effects that are already visible on Tunisians' state of health, the Ministry of Healthcare recently launched a programme to fight against obesity. One of the best preventative measures is physical exercise. But researchers have observed that it is not customary for women to do sport in public, which is a real obstacle and makes it even more difficult for them to control their weight.
Actions that are implemented must take this gender disparity into account, which until now has been absent from debates, and must consider women as a priority target in the prevention of obesity.
(1) These studies were done in cooperation with researchers from INNTA (Tunisia's national institute for nutrition and food technology) and INSP (Tunisia's national public health institute) as part of the TAHINA (Transition and Health Impact in North Africa) project financed by the European Union.
(2) Men seem to be less subject than women to social pressure regarding their weight.
(3) BMI = weight (kg) / height² (m)
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- Jalila El Ati, Pierre Traissac, Francis Delpeuch, Hajer Aounallah-Skhiri, Chiraz Béji, Sabrina Eymard-Duvernay, Souha Bougatef, Patrick Kolsteren, Bernard Maire, Habiba Ben Romdhane. Gender Obesity Inequities Are Huge but Differ Greatly According to Environment and Socio-Economics in a North African Setting: A National Cross-Sectional Study in Tunisia. PLoS ONE, 2012; 7 (10): e48153 DOI: 10.1371/journal.pone.0048153
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