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1.1 Background to the study
Obesity is an excessive or abnormal fat accumulation that may impair health if drastic actions are not taken. (Ellulu, Abed, Rahmat, Ranneh & Ali;(2014). It is a deadly non communicable disease which is gaining increasing importance globally and emanates as a result of excessive food intake containing fats, sugar dense meals and a reduction in physical activities. Also, obesity occurs as a result of an imbalance between energy intake and energy output leading to the accumulation of fats in the body (Thiam, Samba,& Lwanga;(2006). The World Health Organisation (WHO, 2014) states that Obesity is an abnormal or excessive fat accumulation that may impair health which occurs in individuals with body mass index (BMI) greater than 25 kilogram per metre square (kg/m2) for overweight individuals and a body mass index greater than 30 kilogram per metre square (kg/m2) for obese individuals. They went further to state that these cut-off points provide a bench mark for individuals assessment.
Studies carried out in Nigeria by (Abubakari, Lauder, Agymang, Jones, Kirk,& Bhopal 2008; Iloh, Amadi, Nwankwo, & Ugwu 2011; Chinedu, & Emiloju 2014; Onyechi,& Okolo;(2008) found out that a higher prevalence of obesity exist among women by 62.0% compared with men by 41.9% and Research carried out in the Western part of Nigeria also shows a higher obesity prevalence of 28% in women compared to 21% in men (Kadiri,& Salako 1997). The higher prevalence of obesity among the women may be attributed to physical inactivity than males, changes in the energy density of diets and sedentary life style. To buttress this claim, Wahab, Sani, Yusuf, Gbadamosi & Yandutse (2011) observed that women from the Northern part of Nigeria are engaged in sedentary life style, they also noted that there are women who never worked but preferred being full house wives and engagement in physical exercise is not a common activity in the general population of the North.
The prevalence of obesity has greatly affected the Nigerian economy as there are no adequate measures taken in creating awareness and reorientation programmes by health based action group in collaboration with the government to educate consumers on proper food intake and health maintenance thereby leading to a decrease in output per capital (Ekpenyong & Akpan 2013). Also, uneducated households belonging to the low socioeconomic class are not well informed,
unable to understand nutritional labels and make decisions on their diet, thereby making unhealthy product choices.
Obesity has been interpreted by many individuals especially the female folk as a sign of affluence in Nigeria; this has also led to a higher prevalence of obesity in women compared to the men in Nigeria. A study carried out by Ojofeitimi, Adeyeye, Fadiora, Kuteyi, Faborode, Adegbenro, Bakare, Setiloane, & Towobola, (2007) on the awareness of obesity and its health hazard among women in a university community found out that in spite of the higher level of education acquired by their respondents in a university community in the south western part of Nigeria, it is absurd to note that many of the respondents believed that being obese is a sign of good health, prestige and wealth. Oladapo, Falase, Salako, Sodiq, Soyinka, & Adedapo,(2010) in their findings on high prevalence of obesity in rural south western Nigeria argued that the prevalence of obesity increases with age while research carried out by Adediran, Okpara, Adeniyi, & Jimoh,(2012) on the same study found no relationship between age and obesity. Hughes, Frontera, Roubenoff, Evan, & Singh (2002) went further to state that an individual getting old is associated with changes in body composition resulting in increased body mass index.
1.2 Statement of the problem
In Nigeria, more than one in every five women was reported to be obese or overweight (University of Warwick, 2014). The level of obesity in Nigeria is capable of reducing the level of productivity as people with high body mass index tend to experience fatigue resulting to a decrease in productivity. To buttress this claim Popkin,(2006) and Adamu et al,(2014) argued that Nigeria is witnessing an ongoing demographic and epidemiologic transition such as rural to urban migration, changes in life style and socioeconomic factors such as income and culture could be some of the possible reasons why the prevalence of obesity is increasing as Nigerians preference for western diet, social and economic factors has led to a proportionate increase of fast foods and bolus meals (semolina, wheat, etc) intake. Report from Akarolo & Anthony (2012) states that changes in carbohydrate food such as imported rice, pounded yam, wheat and semolina (bolus meals) is now the major carbohydrate food eaten by most urbanized Nigerians, and is more consumed on weekdays rather than on weekend celebration and parties as was the custom four decades ago with most individuals eating three servings per meal. Such transition has been triggered by the availability of fast food restaurants whose major service is packed chicken and rice meals.
The ratio of independent individuals in the labour force have been identified as the group of individuals with the highest fast-food patronage as a result of work pressure, the easy mode of preparation and reduced time required for preparation not considering the effect on their health and income as consumption of such meals decreases the income and productivity of individuals seeking health care service thus having adverse effect on the Nigerian economy (Akarolo & Anthony (2012). A cross sectional study carried out in the western part of Nigeria by Ojofeitimi et al. (2007) found out that 21.2% of the respondents were obese while findings from Kadiri et al. (1997), shows that 21% of males and 28% of females were obese in a study of 146 middle-aged Nigerians respectively. The world health organisation (WHO, 2006) projected that by 2015 at least 2.3 billion and 700 million people aged 15 years and above will be overweight and obese unless drastic measures are taken.
Chukwunonye, Abali, Ikechi, Okechukwu, Madukwe, Chukwuebuka & Ogah (2013) noted that the incidence of obesity is associated with certain medical cost known as direct and indirect cost. Among the direct costs are preventive, diagnostic and treatment services related to obesity while the indirect costs are associated with the value of income lost from decreased productivity, absenteeism, restricted activity, days of receiving treatment in the hospital and income lost as a result of premature death by obese patients.
Obesity in Nigeria has also been attributed to the low socioeconomic status of citizens. Chukwunonye et al. (2013) carried out a research on the association between socioeconomic status and obesity in south eastern Nigeria, findings from the study shows that the prevalence of obesity has a direct relationship with income and that individuals with higher socioeconomic status (the rich) are less susceptible to being obese because they have greater abilities of affording rich nutritional intake than the poor. Similarly, a study carried out by the North Carolina Institute of Medicine (NCIM, 2009) found that individuals with higher income, higher level of education on average have better health outcomes because they are well informed on the access to health care facilities which is more accessible with monetary resources, they reside in a healthy safe environment, afford quality education, have access to purchase healthy foods, fruits and vegetables and afford time and resource to partake in physical activity through recreational facilities. Also, findings from Benjamin,(2012), Pickett, Kelly, Brunner, Lobstein, & Wilkinson (2005), Wilkinson, & Pickett,(2009) on the effects of income inequality on BMI and obesity states that income inequality is an economic factor whose contribution to general health and mortality has caused a great increase to the prevalence of obesity.
Another socioeconomic factor that has led to the prevalence of obesity in Nigeria is the sedentary life styles of Africans and particularly in Nigeria. (Raheem, Ali, & Adekeye, 2010; Sharma, Cade, & Jackson,1996; Mennen, Mbanya, and Cade, 2000). A study carried out by (Raheem et al 2010), on the life style of the urban and rural dwellers in Kaduna state, found that sedentary life style was found among the urban residents of Kaduna state unlike their rural counterparts as the use of automobiles, telephone facilities and household gadgets have reduced the physical activity of urban residents thereby causing an increase in obesity.
The role of socio cultural beliefs have also led to the prevalence of obesity among the female gender in Nigeria as obesity is likened to physical attractiveness, strength, fertility and prestige (Adienbo, Hart, & Oyeyemi, (2012), (Powdermaker,1997). Caballero (2007) states that the socio-cultural practice of fattening rooms among the Kalabari people of Ijaw in the Niger delta region of Nigeria known as “Iria” has increased obesity prevalence as women in the pre marital age group are confined to a secluded area for the period of 2-3 months, fed with elaborate meals rich in starch and carbohydrates to enable them grow fat and are also restricted from partaking in domestic activities. Similarly, according to Phillip, (2013), this practice also exists amongst the Ibibio people of Akwa Ibom state, the efiks of Cross River state, the Ogonis and the Ikwerres of Rivers state with variations in their ceremonies. Findings from Adienbo et al. (2012) shows that diet and socio-cultural life styles influences obesity.
Previous studies dealing with obesity in Nigeria have been carried at micro-level using states and local government as case studies (Okafor, Gezawa, Sabir, Raimi, & Enang (2014), Anthony-Akarolo et al. (2014), Iloh, et.al 2015, Raimi, Odusan & Fasanmade, (2015). This study on the socioeconomic determinants of obesity in Nigeria departs from previous studies efforts by utilising a nationally representative survey, the Demographic and health Survey DHS 2013 so as to capture the socioeconomic determinants of obesity in a wider spectrum. This study filled a methodological gap by utilising a simultaneous equation model so as to control for identification problem that may arise in the model.
This study justified its relevance by providing information on the geopolitical zone in Nigeria with the highest prevalence of obesity. Generally the socioeconomic factors that make people susceptible to obesity will be explored. This study provides policy recommendations that will help Nigerians adjust their lifestyle if they are susceptible to obesity.
Obesity, as observed in literature brings about high health care costs, absenteeism from places of work, decrease in workers‟ productivity, thus leading to decrease in national productivity. If these menaces are not tackled among Nigerians, high health costs, absenteeism from places of work and a decrease in national productivity may be unavoidable. It is on this basis that this study will investigate the socioeconomic determinants of obesity in Nigeria.
1.3 Research Questions
This study seeks to address the following research questions:
1. What are the socioeconomic factors that determine obesity in Nigeria?
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