Factors contributing to the evolution of the prevalence of overweight and obesity among adults in Burkina Faso : a multivariate decomposition analysis of data from the 2013 and 2021 Burkina Faso STEPS surveys

Abstract

Background : The alarming increase in overweight and obesity on a global scale now affects low-income countries, with significant health and economic implications. In Burkina Faso, the prevalence of these health issues has risen between 2013 and 2021. However, few studies have analyzed the underlying factors of this trend.

Objectives : to identify the factors associated with the rise in overweight and obesity prevalences using data from the Burkina Faso 2013 and 2021 STEPS (Survey on the STEPSwise Approach to Surveillance of Risk Factors for NCDs) surveys.

Methods : This was a study using repeated cross-sectional survey data for analytical purposes, utilizing the data from the STEPS Surveys of 2013 and 2021 in Burkina Faso. The study population consisted of the adult population included in the first two STEPS surveys in Burkina Faso. Overweight and obesity were the study variables. A decomposed multivariate logistic regression model was employed to identify the contributive share of each determinant in the evolution of overweight and obesity prevalences over the study period.

Results : Between 2013 and 2021, the prevalence of overweight increased significantly from 13.4% to 17.1% (+3.7 pp, p<0.001), and obesity from 4.5% to 8.6% (+4.1 pp, p<0.001). Decomposition analysis revealed that changes in population characteristics accounted for the majority of this increase: 77.5% for overweight and 73.1% for obesity. The main contributing factors to this "composition effect" were urbanization (contributing ~30-31% to the rise), followed by hypercholesterolemia, and having no formal education. Changes in behaviours (coefficient effect) played a smaller role. Notably, increased engagement in moderate physical activity was the only behavioural change that significantly mitigated the rise in obesity (-11.9%).

Conclusion : The significant increase in overweight and obesity in Burkina Faso between 2013 and 2021 poses a major public health challenge. To reverse this trend, interventions should target dietary habits, sedentary lifestyles, as well as changing socio-economic and demographic factors. Addressing gender disparities, education levels, blood pressure, place of residence, type of fat consumed, tobacco consumption, physical activity, cholesterol levels, and fasting blood glucose should be a priority.