Gender disparities in central obesity in Cape Verde: analysis of the 2020 WHO STEPS survey

In Cape Verde, an archipelagic nation off the coast of West Africa, economic growth, urbanization, and nutritional transitions have led to shifts in lifestyle and dietary habits, contributing to a rising prevalence of obesity. However, limited research has examined the extent of central obesity in the Cape Verdean population. The study examines the prevalence of central obesity, its associated factors, and explore gender disparities in obesity patterns in Cape Verde. We used secondary data from the 2020 WHO STEPS survey conducted in Cape Verde. Central obesity was calculated as waist circumference divided by hip circumference, with sex-specific thresholds: ≥0.90 for men and ≥ 0.85 for women. Individuals meeting these criteria were classified as living with central obesity. A multivariable logistic regression model and a Fairlie decomposition analyses were performed in STATA version 18. Overall, 25.1% (95%CI: 22.4–28.0) of the participants were living with central obesity. After adjustment for covariates, the predicted probability of central obesity was 23.2% (95%CI: 20.2%–26.2%) among men and 39.4% (95%CI: 36.6%–42.1%) among women. The adjusted marginal effect indicated that women had a 16.15% point higher probability of central obesity compared with men (95%CI: 11.84%–20.46%; p < 0.001). The odds of central obesity were significantly high among older adults aged 60 years and above (Adjusted Odds Ratio [AOR] = 5.07, 95%CI: 3.34–7.68), those with primary/basic education (AOR = 2.13, 95%CI: 1.42–3.19), and those living with hypertension (AOR = 1.72, 95%CI: 1.36–2.18). Visiting a doctor was associated with increased odds of central obesity (AOR = 1.39, 95%CI: 1.12–1.74). The Fairlie decomposition analysis revealed that only 0.4% points of the observed 16.9%-point gender difference in central obesity were explained by the included covariates, with age, education, and hypertension emerging as the main contributors. Being female, older age, living with hypertension, and having lower educational attainment were key predictors of central obesity. Additionally, lower educational attainment, older age, and hypertension contributed significantly to gender disparities in central obesity. This implies that effective hypertension management could translate to reduced central obesity. Also, investing in higher education could contribute to a healthy lifestyle and reduced risk of central obesity.