The current cross-sectional study was conducted to assess the magnitude of central obesity and associated factors among adults attending public health facilities in Adama town.
The overall magnitude of central obesity among adults attending public health facilities in Adama town was 40%. The result reported in this study is comparable with the finding from the studies done in India (46.6%), central Tanzania (41.8%), Gonder, and Dabat town (37.6%), South East Ethiopia (39%) [25–28], but higher than the studies conducted in Burkina Faso (22.5%) [6], Nekemte town, West Ethiopia (28.4%) [17], Woldia town, Northeast Ethiopia (16.5%) (29), and Dilla town South Ethiopia (24.4, %) [30]. Differences in the cutoff value for waist circumferences could be a possible reason for variations in the magnitude of abdominal obesity between studies [6, 30]. Moreover, discrepancies in the findings could be explained by differences in the age distributions [6, 17].
On the other hand, our finding is lower than that of studies done in Portugal (50.5%) [31] South Africa (67%) [32], Eastern Sudan (67.8%) [33], and Dire Dawa city, Eastern Ethiopia (76.1%) [18], The possible variations of the obesity prevalence could be explained by methodological differences, sociocultural background, and the set up in which the study was conducted. Furthermore, institutional-based studies may also contribute to a higher magnitude of central obesity.
In this study, female adults had higher odds of central obesity compared to men. This finding is supported by studies in China and South Africa [32, 34] and various studies in different parts of Ethiopia [26, 29, 30]. The association between being female and central obesity can be explained by the fact that females usually have higher fat distribution than males, particularly with a larger area of subcutaneous adipose tissue in the abdomen [20]. The other possible explanation could be that, in the Ethiopian cultural context, men mainly engaged in activities that require higher energy expenditure than women.
In this study, the odds of abdominal obesity increased with age, a finding that is consistent with the study done in China, Tanzania, and Ivory Coast. [11, 34–36]. This association might be explained by the gradual decline in the majority of physiological functions, body metabolism, physical activities, and exposure to a more sedentary way of life among older adults as age increases. Furthermore, as age increases the distribution and accumulation of fat shifts into the abdominal region, and older age individuals will have a chance to develop central obesity [35].
In this study, there was a statistically significant association between marital status and increased risk of central obesity. Hence, married participants had higher odds of being centrally obese as compared to those who were never married. Similar findings were reported from the studies done in Argentina, Uganda, and South Africa [32, 36, 37]. The reason could be because of a possible change in dietary patterns where married people are more likely to have stable eating patterns and social support that comes from the responsibility of eating together [38].
The odds of central obesity were higher for individuals who had a higher average monthly income than those with a lower monthly income. The finding is in line with a study done on Indian adults and another study in Indonesia [39, 40]. The finding is plausible because people with higher incomes may change their lifestyles and consume high-energy meals with limited variety. Besides, higher monthly income may increase the use of motorized modes of transportation. On the contrary, individuals with lower incomes may engage in increased physical activity, and consume low-energy, high-fiber foods that are less preferred and less expensive in developing countries [41].
In this study, the odds of central obesity were lesser for individuals with high consumption of milk and milk products as compared to those with low consumption. This finding is supported by studies done in Sweden, the US, and India [42–44]. The association has been hypothesized that calcium in dairy foods lower levels of body fat through its effects on lipogenesis [45]. Milk is also an important source of protein and protein-rich diets that have been shown to promote satiety and a rich source of the essential amino acid leucine that is involved in the partitioning of dietary energy [45].
This study also found that the odds of being centrally obese were higher for adult patients with a family history of obesity as compared to those who had no family history of obesity. This is alike to the study findings in Iran, Italy, and southwest Ethiopia [46–48]. Though the exact mechanism connecting the family history with the occurrence of obesity is not completely understood, it could be influenced by genetic, environmental factors, and, shared family lifestyle characteristics.
Strength and limitations of the study
As a major strength, this study tried to address a neglected but important public health issue by collecting data from primary sources. This study only included four of the eight governmental health institutions, and the private health facilities in Adama Town were not included, hence generalization was limited to the study area. The cross-sectional nature of the study design. Hence, the issue of temporal relationships is questionable. Dietary intake was assessed by using a qualitative food frequency questionnaire, which does not account for absolute intake of specific nutrients and there could also be a potential for recall and social desirability bias in the frequency of dietary habits, physical activity, and health risky habits that may have been resulting in results different from actual behavior because it is prone to recall and social desirability bias.