Skip to main content
    • Aa
    • Aa

Predictors of adolescent weight status and central obesity in rural South Africa

  • Elizabeth W Kimani-Murage (a1) (a2), Kathleen Kahn (a1) (a3) (a4), John M Pettifor (a5), Stephen M Tollman (a1) (a3) (a4), Kerstin Klipstein-Grobusch (a6) and Shane A Norris (a5)...

To investigate predictors of adolescent obesity in rural South Africa.


Cross-sectional study. Height, weight and waist circumference were measured using standard procedures. Overweight and obesity in adolescents aged 10–17 years were assessed using the International Obesity Taskforce cut-offs, while the WHO adult cut-offs were used for participants aged 18–20 years. Waist-to-height ratio of >0·5 defined central obesity in those at Tanner stages 3–5. Linear and logistic regression analysis was used to evaluate risk factors.


Agincourt sub-district, rural South Africa.


Participants (n 1848) were aged 10–20 years.


Combined overweight and obesity was higher in girls (15 %) than boys (4 %), as was central obesity (15 % and 2 %, respectively). With regard to overweight/obesity, fourfold higher odds were observed for girls and twofold higher odds were observed for participants from households with the highest socio-economic status (SES). The odds for overweight/obesity were 40 % lower if the household head had not completed secondary level education. For central obesity, the odds increased 10 % for each unit increase in age; girls had sevenfold higher odds v. boys; post-pubertal participants had threefold higher odds v. pubertal participants; those with older mothers aged 50+ years had twofold higher odds v. those whose mothers were aged 35–49 years; those in highest SES households had twofold higher odds v. those in lowest SES households.


In rural South Africa, adolescent females are most at risk of obesity which increases with age and appears to be associated with higher SES. To intervene effectively, it is essential to understand how household factors influence food choice, diet and exercise.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Predictors of adolescent weight status and central obesity in rural South Africa
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Predictors of adolescent weight status and central obesity in rural South Africa
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Predictors of adolescent weight status and central obesity in rural South Africa
      Available formats
Corresponding author
*Corresponding author: Email;
Hide All
1. Popkin BM & Gordon-Larsen P (2004) The nutrition transition: worldwide obesity dynamics and their determinants. Int J Obes Relat Metab Disord 28, Suppl. 3, S2S9.
2. World Health Organization (2002) The World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva: WHO; available at
3. Bibbins-Domingo K, Coxson P, Pletcher MJ et al. (2007) Adolescent overweight and future adult coronary heart disease. N Engl J Med 357, 23712379.
4. Dietz WH (1998) Childhood weight affects adult morbidity and mortality. J Nutr 128, Suppl 2, S411S414.
5. Department of Health, Medical Research Council & ORC Macro (2007) South African Demographic and Health Survey 2003. Pretoria: Department of Health; available at
6. Jinabhai CC, Reddy P, Taylor M et al. (2007) Sex differences in under and over nutrition among school-going Black teenagers in South Africa: an uneven nutrition trajectory. Trop Med Int Health 12, 944952.
7. Labadarios D, Swart R, Maunder EMW et al. (2008) National Food Consumption Survey–Fortification Baseline (NFCS-FB-I): South Africa, 2005. S Afr J Clin Nutr 21, Suppl. 2, 245300.
8. Kimani-Murage E, Kahn K, Pettifor J et al. (2010) The prevalence of stunting, overweight and obesity, and metabolic disease risk in rural South African children. BMC Public Health 10, 158.
9. Griffiths PL, Rousham EK, Norris SA et al. (2008) Socio-economic status and body composition outcomes in urban South African children. Arch Dis Child 93, 862867.
10. Davison KK & Birch LL (2001) Childhood overweight: a contextual model and recommendations for future research. Obes Rev 2, 159171.
11. Kruger R, Kruger HS & Macintyre UE (2006) The determinants of overweight and obesity among 10- to 15-year-old schoolchildren in the North West Province, South Africa – the THUSA BANA (Transition and Health during Urbanisation of South Africans; BANA, children) study. Public Health Nutr 9, 351358.
12. Hargreaves JR, Collinson MA, Kahn K et al. (2004) Childhood mortality among former Mozambican refugees and their hosts in rural South Africa. Int J Epidemiol 33, 12711278.
13. Dolan CG, Tollman SM, Nkuna VG et al. (1997) The links between legal status and environmental health: a case study of Mozambican refugees and their hosts in the Mpumalanga (Eastern Transvaal) Lowveld, South Africa. Health Hum Rights 2, 6284.
14. Gelb S (2003) Inequality in South Africa: nature, causes and responses. (accessed February 2010).
15. Collinson MA, Tollman SM & Kahn K (2007) Migration, settlement change and health in post-apartheid South Africa: triangulating health and demographic surveillance with national census data. Scand J Public Health 35, Suppl. 69, S77S84.
16. Collinson MA, Tollman SM, Wolff B et al. (2006) Trends in internal labour migration from rural Limpopo Province, male risk behaviour, and implications for the spread of HIV/AIDS in rural South Africa. J Ethn Migr Stud 32, 633648.
17. Kahn K, Tollman SM, Collinson MA et al. (2007) Research into health, population and social transitions in rural South Africa: data and methods of the Agincourt Health and Demographic Surveillance System. Scand J Public Health 35, Suppl. 69, S8S20.
18. Lohman TG, Roche AF & Martorell R (1991) Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books.
19. Tanner JM (1962) Growth at Adolescence. Oxford: Blackwell.
20. Norris SA & Richter LM (2005) Usefulness and reliability of Tanner pubertal self-rating to urban black adolescents in South Africa. J Res Adolesc 15, 609624.
21. Filmer D & Pritchett LH (2001) Estimating wealth effects without expenditure data – or tears: an application to educational enrollments in states of India. Demography 38, 115132.
22. World Health Organization (2009) WHO AnthroPlus for Personal Computers Manual: Software for Assessing Growth of the World's Children and Adolescents. Geneva: WHO.
23. Cole TJ, Bellizzi MC, Flegal KM et al. (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320, 12401243.
24. Ashwell M (2009) Obesity risk: importance of the waist-to-height ratio. Nurs Stand 23, 4954.
25. World Health Organization (1995) Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series no. 854. Geneva: WHO.
26. Kelishadi R (2007) Childhood overweight, obesity, and the metabolic syndrome in developing countries. Epidemiol Rev 29, 6276.
27. Reilly JJ, Methven E, McDowell ZC et al. (2003) Health consequences of obesity. Arch Dis Child 88, 748752.
28. Reddy S, Resnicow K, James S et al. (2009) Underweight, overweight and obesity among South African adolescents: results of the 2002 National Youth Risk Behaviour Survey. Public Health Nutr 12, 203207.
29. Neutzling MB, Taddei JA, Rodrigues EM et al. (2000) Overweight and obesity in Brazilian adolescents. Int J Obes Relat Metab Disord 24, 869874.
30. de Onis M & Blossner M (2000) Prevalence and trends of overweight among preschool children in developing countries. Am J Clin Nutr 72, 10321039.
31. Hardy LL, Bass SL & Booth ML (2007) Changes in sedentary behavior among adolescent girls: a 2.5-year prospective cohort study. J Adolesc Health 40, 158165.
32. Lindquist CH, Reynolds KD & Goran MI (1999) Sociocultural determinants of physical activity among children. Prev Med 29, 305312.
33. Wisniewski AB & Chernausek SD (2009) Gender in childhood obesity: family environment, hormones, and genes. Gend Med 6, Suppl. 1, S76S85.
34. Reddy SP, Panday S, Swart D et al. (2003) Umthenthe Uhlaba Usamila – The South African Youth Risk Behaviour Survey 2002. Cape Town: South African Medical Research Council; available at
35. Neumark-Sztainer D, Paxton SJ, Hannan PJ et al. (2006) Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. J Adolesc Health 39, 244251.
36. le Grange D, Telch CF & Tibbs J (1998) Eating attitudes and behaviors in 1,435 South African Caucasian and non-Caucasian college students. Am J Psychiatry 155, 250254.
37. Collinson MA (2009) Striving against adversity: the dynamics of migration, health and poverty in rural South Africa. PhD Thesis, Umeå University.
38. Kursmark M & Weitzman M (2009) Recent findings concerning childhood food insecurity. Curr Opin Clin Nutr Metab Care 12, 310316.
39. Amuna P & Zotor FB (2008) Epidemiological and nutrition transition in developing countries: impact on human health and development. Proc Nutr Soc 67, 8290.
40. Drewnowski A (2003) Fat and sugar: an economic analysis. J Nutr 133, Suppl. 3, S838S840.
41. Wang Y (2001) Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status. Int J Epidemiol 30, 11291136.
42. Sobal J (1991) Obesity and socioeconomic status: a framework for examining relationships between physical and social variables. Med Anthropol 13, 231247.
43. Wang Y & Zhang Q (2006) Are American children and adolescents of low socioeconomic status at increased risk of obesity? Changes in the association between overweight and family income between 1971 and 2002. Am J Clin Nutr 84, 707716.
44. Matijasevich A, Victora CG, Golding J et al. (2009) Socioeconomic position and overweight among adolescents: data from birth cohort studies in Brazil and the UK. BMC Public Health 9, 105.
45. Vorster HH, Venter CS, Wissing MP et al. (2005) The nutrition and health transition in the North West Province of South Africa: a review of the THUSA (Transition and Health during Urbanisation of South Africans) study. Public Health Nutr 8, 480490.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 4
Total number of PDF views: 122 *
Loading metrics...

Abstract views

Total abstract views: 175 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd October 2017. This data will be updated every 24 hours.