Abstract
Obesity is a significant global health issue. Despite the availability of published data on the epidemiology of overweight and obesity in African countries, relatively few studies have been conducted in Sudan, the third-largest African country. This study aims to estimate the prevalence of obesity and central obesity among adults in Northern Sudan and identify associated factors. A multistage community-based survey was conducted in River Nile State, Northern Sudan. The adult’s sociodemographic and clinical data were collected through a questionnaire. Waist circumference was measured, and body mass index (BMI) was computed from the weight and height. Multivariate multinomial and binary analyses were performed. Of 470 adults, 242 (51.5%) were males, and their median age was 45 years. Forty-four (9.4%) adults were underweight, 154 (32.8%) were normal weight, 145 (30.9%) were overweight, 127 (27.0%) were obese, and 205 (43.6%) adults had central obesity. In the multivariate multinomial analysis, being female (adjusted odds ratio [AOR] = 2.34, 95.0% confidence interval [CI] = 1.22–4.49) and married (AOR = 2.18, 95.0% CI = 1.20–3.96) were associated with obesity. In multivariate binary analysis, increasing age (AOR = 1.04, 95.0% CI = 1.02–1.05) and female sex (AOR = 7.09, 95.0% CI = 3.90 − 12.91) were associated with central obesity. This study showed that obesity is a health problem in this region of Sudan, especially among females and adults with increasing age.
Introduction
Obesity is one of the main global health problems, ranking as the fifth leading cause of mortality worldwide1. The World Health Organization (WHO) defines overweight and obesity based on body mass index (BMI): overweight is a BMI of 25.0 kg/m2 or greater, and obesity is a BMI of 30.0 kg/m2 or greater2. As of 2022, approximately 1 in 8 people globally were living with obesity, totaling around 890 million adults. Since 1990, the prevalence of obesity in adults has more than doubled, and adolescent obesity has quadrupled3. Obesity is a chronic, complex-acquired disease characterized by excessive fat accumulation; obesity is heavily influenced by lifestyle factors such as low physical activity and excessive caloric intake, in addition to genetic and epigenetic influences4. Obesity can lead to an increased risk of chronic diseases such as asthma, cancer, dyslipidemia, and cardiovascular diseases1,3,5, stroke6, hypertension7 and diabetes mellitus8.
Central obesity, as defined by the WHO, is a waist circumference (WC) exceeding 94 cm and 80 cm for males and females, respectively9. It has recently been shown that in some regions of the world, WC is a better predictor of hypertension than BMI10. Recently, central obesity has been identified as a significant factor worsening cardiometabolic risk and contributing to type 2 diabetes mellitus8. It is linked to various co-morbidities and an increased risk of premature death. Notably, abdominal fat accumulation is directly associated with higher cardiovascular morbidity and mortality, independent of overall obesity11,12.
Obesity crises were once viewed as primarily affecting affluent populations, but are now alarmingly increasing in developing countries, particularly in Africa, where the epidemic is escalating rapidly13,14.
Risk factors such as female sex are associated with obesity7,15. Specifically, central obesity has been linked to advancing age and female sex15. Studies indicate that overweight and obesity rates are rising across all African regions, particularly in Northern and Southern Africa16. Women experience higher rates than men, and urban areas are more affected than rural ones, though rural rates are increasing quickly. Several factors, such as age, parity, marital status, socioeconomic status, physical inactivity, and higher energy intake, are associated with overweight and obesity in sub-Saharan Africa17.
Despite the availability of published data on the epidemiology of overweight and obesity in African countries18,19,20,21,22,23, there are relatively few studies in Sudan15,24,25. Accurate data on the prevalence of overweight and obesity are essential for formulating effective public health interventions. Thus, this study aims to estimate the prevalence of obesity and central obesity among adults in Northern Sudan and identify associated factors. Understanding the diverse causes and determinants of obesity is vital for developing effective policies and prevention strategies to tackle this complex health issue26.
Methods
Sampling
A multistage cross-sectional sampling survey was conducted in Almatamah in Northern Sudan from July to September 2022. Almatamah is in the River Nile state, one of the 18 Sudanese states, each composed of localities27. Almatamah was selected randomly (simple random sampling) out of the seven localities (the lowest administrative units in Sudan) in the River Nile state. Then, four villages (Hajer Alteer, Athawra Kabota, Alkoumer, and Wadi Alshohda) were randomly selected from 22 villages in the Almatamah locality. Both male and female adults (≥ 18 years of age) in households in this survey are based on the population size in each village. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement standard checklists were adopted for the selection28.
Inclusion and exclusion criteria
All the Sudanese adults (≥ 18 years of age) from the selected households in these villages who agreed to participate were enrolled in this survey. Exclusion criteria included adults on a restricted diet, pregnant women, congenital deformities, chronic disease (renal failure) or malignancy, liver failure, and those using steroids.
After properly explaining their role and the aim of the study, each participant signed an informed consent form. Four general practitioners (two males and two females) conducted individual face-to-face interviews. A questionnaire was then used to collect sociodemographic and clinical (age, marital status, education level, and alcohol consumption), weight, and height. The WHO three-level stepwise questionnaire was adopted for data collection29. According to local tradition in this region of Sudan, smoking and drinking are not female habits; hence, we intentionally avoided asking females to encourage female cooperation.
Weight and height measurements
The adults’ weights were measured in kilograms using a well-calibrated Seca 874 weighing scale (Seca, Deutschland, Germany), which, and was adjusted to zero before each measurement. A Seca stadiometer (Shorr Board, Olney, MD, USA) was used to measure the height, following standard procedures to minimize movement after removing their shoes and excess clothing. The participants were asked to stand straight with their backs against the wall and their feet together, which allowed for measuring their heights to the nearest 0.1 cm. BMI was computed by dividing the adults’ weight in kilograms (kg) by their height in meters squared (m²). After that, BMI was grouped as per the WHO classification as underweight (< 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), or obese (≥ 30.0 kg/m2)2.
The adults were directed to fold their arms across their chests to ensure they adopted a relaxed standing position. A stretch-resistant tape providing a constant 100 g tension was obtained for the WC. WC was measured at the end of the regular expiration at the midpoint between the lower margin of the least palpable chest rib and the superior border of the iliac crest. Central obesity is indicated by waist circumference measurements exceeding 94 cm for males and 80 cm for females25.
Sample size calculation
A sample size of 470 adults was calculated based on previous reports on the prevalence (28.0%) of obesity in eastern Sudan25. It was assumed that 30.0% of the adults in the community in North Sudan would be obese. Moreover, it was assumed that 25.0% ad 40.0% would be females of normal weight and obese adults, respectively. The calculated sample size would have to detect a difference of 5% at α = 0.05, with a power of 80%.
Statistic
The collected data were analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 22.0 (SPSS Inc., New York, United States). Descriptive statistics were computed, including frequencies and percentages for categorical variables and medians with interquartile ranges for continuous variables, following a normality assessment using the Shapiro–Wilk test, which indicated non-normal distribution. The chi-square test was used to compare proportions between two or more groups. Kruskal-Wallis H test was used to compare the median of the non-normally distributed data between more than two groups (underweight, normal, overweight, and obese). Variables with a significance level of 0.2 or lower in univariate analysis were included in multivariate analyses to adjust for confounders. The dependent variables are overweight and obesity in multinomial analysis, and it was central obesity in binary analysis. Independent variables included age, sex, education, marital status, occupation, and alcohol use. Due to a small sample size, underweight and normal weight categories were combined and treated as reference categories. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, and a two-sided P-value of < 0.05 was considered statistically significant.
Results
General characteristics
Table 1 presents the sociodemographic characteristics of 470 adults. The median (IQR) age was 45.0 (33.0‒56.0) years. Of 470, 242 (51.5%) were male participants, and 323 (68.7%) had education beyond secondary school. Around three-quarters (74.3%) of the adults were married, and more than half (53.6%) were unemployed. Only 49 (10.4%) currently or previously consume alcohol. Forty-four (9.4%) adults were underweight, 154 (32.8%) were normal weight, 145 (30.9%) were overweight, and 127 (27.0%) were obese. Of 470, 205 (43.6%) adults had central obesity.
Factors associated with overweight and obesity
The median (IQR) of the age and WC were significantly higher among obese adults. Significantly higher numbers of obese adults were females, married, unemployed, and alcohol-consuming. There was no difference in education level between BMI groups (Table 2). In the multivariate multinomial analysis, alcohol consumption was associated with overweight (AOR = 2.40, 95.0% CI= (1.02–5.67), and the other variables (age, sex, education, marital status, and employment) were associated with overweight. Being female (AOR = 2.34, 95.0% CI = 1.22− 4.49, P = 0.011) and married (AOR = 2.18, 95.0% CI = 1.20−3.96, P = 0.010) were associated with obesity. Alcohol consumption was not associated with obesity. Age was borderline associated with obesity (Table 3).
Factors associated with central obesity
Of 470, 205 (43.6%) adults had central obesity. Table 4 shows the association between participants’ general characteristics and central obesity. Similar to the results of obesity, the median (IQR) of age was significantly higher among adults with central obesity [50.0 (37.0‒60.0) years versus 41.0 (30.0 ‒55.0), P < 0.001].
Significantly higher numbers of adults with central obesity were females, married, unemployed, and non-alcohol-consuming. There was no difference in the level of education between adults with and without central obesity. Moreover, in univariate analysis, these variables (age, sex, education level, marital status, and alcohol consumption) were associated with central obesity. In multivariate analysis, increasing age (AOR = 1.04, 95.0% CI = 1.02–1.05, P < 0.001) and female sex (AOR = 7.09, 95.0% CI = 3.90 − 12.91, P < 0.001) were associated with central obesity (Table 5).
Discussion
This study aimed to evaluate the prevalence and associated factors of adult obesity and central obesity in Northern Sudan. It found that the rates of overweight, obesity, and central obesity were 30.9%, 27.0%, and 43.6%, respectively. The prevalence of overweight and obesity in the current study is comparable to findings from eastern Sudan, which showed that 26.8% and 32.2% of the adults were overweight and obese, respectively25,30,31. Our findings (30.9% and 27.0% of the adults were overweight and obese, respectively) are comparable to the pooled prevalence of overweight (25.0%) and obesity (14.3%) recently reported in Nigeria in a meta-analysis that included 35 studies and enrolled 52,81632. Our results of the prevalence of overweight and obesity were higher than the pooled prevalence of overweight (25.4%) and obesity (17.1%) that was reported in the meta-analysis of 43 studies, 48,966 sampled in Ghana23. The prevalence of central obesity in this study (43.6%) was comparable to a facility-based study conducted in Ethiopia18. However, the prevalence of central obesity was lower than that previously reported in eastern Sudan (67.8%)25. On the other hand, the prevalence of central obesity in this study was higher than the pooled prevalence (37.31%) of central obesity reported in the meta-analysis, which included 20 studies and enrolled 12,603 people in Ethiopia7. Likewise, the prevalence of central obesity was higher than the pooled prevalence (39.0%) of central obesity reported in a meta-analysis of 18 studies and 21,859 individuals in Nigeria22. Moreover, the prevalence of central obesity in this study was higher than the pooled prevalence reported in a systematic review, which reported a global prevalence (41.5%) of central obesity, with the highest rates observed in South America (55.1%), Central America (52.9%), and Africa (49.6%). Additionally, the prevalence of central obesity was higher in high-income countries (41.2%) compared to low-income countries (27.8%)33. The difference between our results and those of others could be explained by sociodemographic characteristics, physical activity, genetics, and the methods used to diagnose central obesity. Other potential drivers of the BMI, such as urbanization, dietary patterns, or access to health services, could have their effects34. The current study showed that females were at 2.34- and 7.09-times higher risk for obesity and central obesity, respectively. This finding aligns with reports from various studies indicating that abdominal obesity is more prevalent in women than in men in Sudan25. Moreover, several studies in African countries have shown that females were at higher risk for obesity and central obesity, e.g., Ethiopia7, Nigeria22, Ghana23, and South Africa35. One possible explanation for this gender disparity is that higher levels of steroid hormones in women may predispose them to obesity36. In addition to pregnancy and less physical activity35. Moreover, cultural factors could play a role. We have observed that central obesity increases significantly with age. This goes with the results of a study in eastern Sudan25 and the results of a recent meta-analysis that included 20 studies in Ethiopia reported that adults aged 55 and above were at higher risk for central obesity7. Furthermore, several previous studies have shown that increasing age is a risk factor for central obesity13,25. This trend may be attributed to decreased basal metabolism and reduced37 physical activity as individuals age, poor eating habits, and decreased nutritional needs37.
In this study, married participants have double the odds of obesity. Other studies in Sudan24,25 and other countries18 reported the same findings of the association with marriage; obesity was reported more among married than unmarried individuals.
The study’s findings showed no significant association of education with obesity or central obesity, which opposes findings from other studies38. Recognizing individuals with obesity using straightforward anthropometric measurements should be a key focus for swift interventions, helping to prevent health complications and lower associated healthcare and economic expenses.
Conclusion
This study showed a high prevalence of obesity and central obesity, especially among females and adults with increasing age.
Data availability
The datasets generated and/or analyzed during the current study are not publicly available (because the manuscript is still under the peer review process) but are available from the corresponding author on a reasonable request.
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Acknowledgements
The authors would like to thank all the participants who participated in this study.
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Contributions
AOB and IA conceived the study; AOB, OEO, and IA supervised the work, guided the analysis and critically reviewed the manuscript; OEO, and IA prepared the analysis plan, performed the data analysis and wrote the first draft of the manuscript. All authors reviewed and approved the final manuscript.
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Ethical approval and consent to participate
This study complies with the Declaration of Helsinki. The Ethics Committee of the Health Authority in Almatamah, Sudan, provided ethical approval of the study (reference number # 03/2021). A signed written informed consent was collected from each participant.
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Bashir, A.O., Osman, O.E. & Adam, I. Prevalence and associated factors of overweight, obesity, and central obesity among adults in Northern Sudan: a community-based cross-sectional study. Sci Rep 15, 29162 (2025). https://doi.org/10.1038/s41598-025-15097-3
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DOI: https://doi.org/10.1038/s41598-025-15097-3
