Prevalence of obesity and associated socioeconomic factors among Tunisian women from different living environments

Adult Tunisian women aged 20-59 (national random sample, n = 1849), were assessed with respect to environmental and socioeconomic factors associated with obesity (body mass index >= 30 kg m(-2)) and abdominal obesity (waist circumference >= 88 cm). At the national level, prevalence of obesity and abdominal obesity were, respectively, 22.6% and 29.2%, but varied markedly (both P < 0.0001) among living environments classified as big cities (30.2% and 36.6%), other cities (25.9% and 32.4%), rural clustered (19.4% and 24.8%) and rural dispersed (9.5% and 16.5%). Adjusted prevalences of both types of obesity increased with age, parity and economic level of the household, while educationally, the risk was greatest in women with intermediate schooling. Differences between the four environments were accounted for by socioeconomic factors, mostly household wealth, except for most rural environment; socio-cultural factors were possibly influential. Observed differences between rural areas confirmed that finer measures of urbanization are necessary for the drivers of obesity prevalence at the national level. Obesity was still more prevalent in wealthy than in poor women, but given the high prevalence in all the environments, actions are needed at the national level before highly prevalent obesity extends into those of lower socioeconomic status and thereby increases health inequities.