Determinants of obesity and perception of weight in hypertensive patients in rural South Africa

Objective: The objective of the study was to identify factors associated with being overweight or obese, and perceptions of weight byhypertensive patients living in rural South Africa.

Design: This was a nested cross-sectional study.

Setting: The setting was primary healthcare clinics close to Manguzi Hospital, KwaZulu-Natal.Subjects: Subjects were 109 males and 391 females, prescribed at least one antihypertensive medication aged ≥ 18 years.

Outcome measures: The primary outcome measure was body mass index (BMI) ≥ 25 kg/m2. The secondary outcome measure was recognitionof being overweight by those with a BMI ≥ 25 kg/m2.

Results: The mean age was 58 years. Three hundred and ninety-one (78%) participants were female, and the majority had never been toschool or had attended primary school only. Three hundred and eleven (62%) participants were overweight or obese, with a BMI ≥ 25 kg/m2.Factors associated with being overweight or obese included having high cholesterol [adjusted odds ratio (OR) 10.62, 95% confidence interval(CI): 1.22-92.4, p-value 0.032], and having never smoked (adjusted OR 3.22, 95% CI: 1.38-7.52, p-value 0.007. Human immunodeficiencyvirus (HIV) was associated with a lower risk of being overweight or obese (adjusted OR 0.52 for BMI ≥ 25, 95% CI: 0.31-0.89, p-value< 0.0001). Only 12% of participants who were overweight or obese perceived that they were overweight. Participants with a BMI ≥ 25 kg/m2were most likely to recognise they were overweight if they had high cholesterol, diabetes or HIV.

Conclusion: Almost two thirds of participants were overweight or obese, and of these, only 12% perceived that they were overweight.Educating patients about obesity, particularly when they have other cardiovascular risk factors such as hypertension, is of public health importance.