title: Gender obesity inequities are huge but differ greatly according to environment and socio-economics in a North African setting: a national cross-sectional study in Tunisia.
abstract: BACKGROUND
  Southern Mediterranean countries have experienced a marked increase in the prevalence of obesity whose consequences for gender related health inequities have been little studied. We assessed gender obesity inequalities and their environmental and socio-economic modifiers among Tunisian adults.
  
  
  METHODS
  Cross-sectional survey in 2005; national, 3 level random cluster sample of 35-70 years Tunisians (women: n = 2964, men: n = 2379). Overall adiposity was assessed by BMI = weight(kg)/height(m)(2) and obesity was BMI≥30, WHtR = waist circumference to height ratio defined abdominal obesity as WHtR≥0.6. Gender obesity inequality measure was women versus men Prevalence Proportion Odds-Ratio (OR); models featuring gender x covariate interaction assessed variation of gender obesity inequalities with area (urban versus rural), age, marital status or socio-economic position (profession, education, household income proxy).
  
  
  RESULTS
  BMI was much higher among women (28.4(0.2)) versus men (25.3(0.1)), P<0.0001) as was obesity (37.0% versus 13.3%, OR = 3.8[3.1-7.4], P<0.0001) and abdominal obesity (42.6% versus 15.6%, 4.0[3.3-4.8], P<0.0001). Gender obesity inequalities (women versus men adjusted OR) were higher in urban (OR = 3.3[1.3-8.7]) than rural (OR = 2.0[0.7-5.5]) areas. These gender obesity inequalities were lower for subjects with secondary education or more (OR = 3.3[1.3-8.6]), than among those with no schooling (OR = 6.9[2.0-23.3]). They were also lower for those with upper/intermediate profession (OR = 1.4[0.5-4.3]) or even employees/workers OR = 2.3[1.0-5.4] than those not professionaly active at all (OR = 3.3[1.3-8.6]). Similar results were observed for addominal obesity.
  
  
  CONCLUSIONS
  The huge overall gender obesity inequities (women much more corpulent than men) were higher in urban settings, but lower among subjects of higher education and professional activity. Reasons for gender inequalities in obesity and their variation with socio-economic position should be sought so that appropriate policies to reduce these inequalities can be implemented in Tunisia and similar settings.
authors.affiliation: INNTA (National Institute of Nutrition and Food Technology), Tunis, Tunisia.
authors.forename: Jalila
authors.initials: J
authors.lastname: El Ati
authors.forename: Pierre
authors.initials: P
authors.lastname: Traissac
authors.forename: Francis
authors.initials: F
authors.lastname: Delpeuch
authors.forename: Hajer
authors.initials: H
authors.lastname: Aounallah-Skhiri
authors.forename: Chiraz
authors.initials: C
authors.lastname: Béji
authors.forename: Sabrina
authors.initials: S
authors.lastname: Eymard-Duvernay
authors.forename: Souha
authors.initials: S
authors.lastname: Bougatef
authors.forename: Patrick
authors.initials: P
authors.lastname: Kolsteren
authors.forename: Bernard
authors.initials: B
authors.lastname: Maire
authors.forename: Habiba
authors.initials: H
authors.lastname: Ben Romdhane
mesh_terms: D050154:Adiposity; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology*; D015995:Prevalence; D012424:Rural Population; D012737:Sex Factors; D012959:Socioeconomic Factors; D014416:Tunisia / Q000453:epidemiology; D014505:Urban Population