Our study findings show that the overall prevalence of overweight & obesity was 46% (overweight- 27.8% and obesity- 18.2%). This was lower than the prevalence observed in the Ugandan general population (overweight- 14.5% and obesity- 4.6%) (21).Our findings are similar with those of a study done in South Africa where prevalence of overweight and obesity combined was 45.7% (58.7% in women and 15.9% in men) (10).
On the contrary, the prevalence of overweight & obesity combined was 10.6% in men and 22.6% in women in western Kenya (22), which was lower than that in our findings. Similarly, another study done among HIV patients in Tanzania found that the prevalence of overweight and obesity was 8% and 2% in men, and 16% and 7% in women, respectively (23), which was also lower than the prevalence observed among in our study. The prevalence of overweight & obesity surpassed that of undernutrition in the overall study population (46% vs 6.2%). The same results were reported in a study done in Addis Ababa where prevalence of overweight & obesity was 22.1% compared to that of undernutrition which was 15.1% (7).
The reason for the high prevalence of overweight & obesity could be due to lifestyle changes which include poor dietary patterns and sedentary living which lead to increased weight gain (15). Secondly, because wasting syndrome linked to AIDS is associated with stigma (24), PLWH tend to embrace weight gain through adoption of poor eating patterns like high caloric diets so as to avoid being stigmatised.
Our study findings show that overweight & obesity was almost twice in women than in men while obesity alone was thrice in women than in men. This was similar to the findings of the Uganda National NCDs risk factors STEPS survey where the prevalence of overweight & obesity was twice as much among the females than males (21). Our findings were also comparable with other studies where overweight and obesity were more prevalent among females than males (7, 10, 22, 23). This could be explained by the tendency for women to take up sedentary work or jobs with low physical demand thus increasing their risk of overweight & obesity as well as cultural values that favour larger body sizes as a sign of prosperity and responsibility (25, 26).
We also observed that overweight & obesity were more prevalent among the older patients, with the middle-aged adults (25-59 years) having the highest risk. This was similarly observed in the study done in Tanzania where older patients were more likely to be overweight or obese(23). This we presume to be due to the decrease in physical activity as well as the decreased metabolism associated with aging (27).
In our findings, duration of ART ranging from 6-10 years was positively associated with overweight & obesity. Interestingly, duration of more than ten years on ART was negatively associated with overweight and obesity. This we hypothesised to possibly be due to lipoatrophy caused by drugs like stavudine (d4T) which were used in ART regimens in the earlier days of HIV management (28). Secondly, we presumed that most of the patients that had been on ART for more than ten years are now elderly and hence more likely to be undernourished (29).
Our findings also showed that patients that had at least one NCD were more likely to have overweight and obesity. Evidence shows that overweight and obesity are some of the known cardio-metabolic risks for NCDs (16). On the contrary, presence of some NCDs is likely to limit physical activity. Similar findings were observed in other studies done among HIV patients in Kenya and South Africa (10, 22). Our findings highlight the imminent need to create awareness among health workers and policy makers in designing of nutrition care packages which include weight management programs, prevention of NCDs as well as act as a baseline for larger studies on nutrition in HIV/AIDS.
There were some limitations in conducting this study; this was a retrospective analysis of routinely collected clinical data therefore some variables of interest were not routinely measured for example dietary intake, level of physical activity, tobacco use, alcohol use, education level and employment status among others. Secondly, it is not possible to determine causal relationships between the risk and outcome variables.