Significant Gender/Obesity Imbalance in Tunisia

tunisia_women_weightIn Tunisia, the smallest country in North Africa, one out of four inhabitants over the age of 35 is obese — translating to nearly a million people.  Tunisian women of this age group are much more affected, with nearly 40 percent suffering from obesity, compared to less than 15 percent of the men. Obesity is tied with several health risks, including diabetes, cardiovascular diseases, cancer, high blood pressure, and even early death.

To examine this gender disparity, and hopefully find clues to understanding more about the complexities of obesity, researchers conducted a representative sample study of more than 5000 Tunisians between the ages of 35 and 70, from all social categories, urban and rural. They found that the national rate of overweight inhabitants (BMI of 25 to 30) was as high as 60 percent.  More than 50 percent of men in the country are overweight, and as much as 70 percent of women suffer from excess weight.  Further, more than three times as many women in Tunisia are affected by obesity (BMI 30 or greater) than their male counterparts. This is different than what has been observed in other areas, where more men tend to be overweight. For example, in the United States, the overweight & obesity rate for men is approximately 22% greater than the rate for women.

The researchers point to urban living as one of the contributing factors to Tunisia’s obesity disparity. More than two-thirds of Tunisian people live in cities. The urban environment holds particular dangers to body weight, with a more sedentary lifestyle, supermarkets that offer a variety of rich, fatty foods and the prevalence of fast-food chains.  Women have a metabolism that makes them even more vulnerable to an energy imbalance that causes weight gain, making them more vulnerable to the dangers of overeating that come with an urban lifestyle, say the researchers.

Separate from urban versus rural living, but also contributing to women’s growing waistlines are socio-economic factors. The study found that the difference between men and women’s BMI declined with the number of years of schooling and study, and with holding a higher qualified job. The findings also showed that working women are less prone to this disparity than those who stay at home. More than anything, it is women’s traditional role in society that influences factors associated with obesity and is still widely prevalent, said the researchers. For example, three quarters of the women in the study group were 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 and/or food intake, which are major causes of obesity.

We spoke with New Jersey bariatric surgeon, Dr. Val Andrei, about the study. He said, “living in an urban environment invites people to make food decisions based on convenience instead of nutritional value. A sedentary lifestyle ultimately leads to weight gain and risk of poor self-image.  The negative emotional connotation of obesity leads to increased incidence of isolation, depression and significant health issues. In my practice, we encourage pre-planning meals to include lean protein and fewer processed food items as well as introducing physical activity to control weight and increase one’s self esteem.”

As Dr. Andrei pointed out, aside from the dangerous health issues associated with an overweight society, carrying excess weight can have emotional and social implications, as well. Worldwide, attitudes toward overweight people are shifting. According to a recent cross-cultural study, stigma against overweight people is becoming a cultural norm around the world. People from nine diverse areas–Mexico, Argentina, Paraguay, the United States, United Kingdom, American Samoa, Puerto Rico, and Tanzania—were asked about body size. The study found that negative attitudes toward overweight people existed in all of the cultures surveyed, even those that had previously valued larger body size. “The global growth in obesity isn’t just a concern because it can undermine health.  We also need to be as concerned about the profound emotional suffering that comes with these types of prejudicial ideas about big bodies taking hold,” said the study author, Dr.  Alexandra Brewis.  You can read more about the study here.

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