Diet culture and obesity in Northern Africa

The etiology of obesity in North Africa is not well understood and few stud ies shed any light on its development among women. This study compiles what is known about the prevalence of obesity and its determinants in Morocco a nd Tunisia. Results from the authors' two surveys on nutrition-related dise ase among reproductive-age women (sample size: 2800) and their children (12 00 children under 5 y and 500 adolescents) were combined with data from fou r national income and expenditure surveys (dating from 1980) to assess obes ity trends and development in Morocco and Tunisia. Overall levels of obesit y, identified by body mass index (BMI) greater than or equal to 30 kg/m(2), were 12.2% in Morocco and 14.4% in Tunisia. Obesity is significantly highe r among women than among men in both countries (22.7% vs. 6.7% in Tunisia a nd 18% vs. 5.7% in Morocco) and prevalence among women has tripled over the past 20 y. Half of all women are overweight or obese (BMI > 25) with 50.9% in Tunisia and 51.3% in Morocco. Overweight increases with age and seems t o take hold in adolescence, particularly among girls. In Tunisia, 9.1% of a dolescent girls are at risk for being overweight (BMI/age greater than or e qual to 85th percentile). Prevalence of overweight and obesity are greater for women in urban areas and with lower education levels. Obese women in bo th countries take in significantly more calories and macronutrients than no rmal-weight women. The percentage contribution to calories from fat, protei n and carbohydrates seems to be within normal limits, whereas fat intake is high (31%) in Tunisia and carbohydrate intake (65-67%) is high in Morocco. These are alarming trends for public health professionals and policy maker s in countries still grappling with the public health effects of malnutriti on and micronutrient deficiencies. Health institutions in these countries h ave an enormous challenge to change cultural norms that do not recognize ob esity, to prevent significant damage to the public's health from obesity.