Dual burden of underweight and overweight/obesity among adults in Botswana: prevalence, trends and sociodemographic correlates: a cross-sectional survey

Objective To estimate the prevalence and trends in underweight, overweight/obesity and identify their sociodemographic correlates among adults in Botswana from 2007 to 2017. Design The study analysed cross-sectional and nationally representative data from 2007 to 2014 Botswana STEPS Surveys and the 2017 Botswana Demographic Survey. Setting Botswana. Participants Botswana adults aged 25-64 years (n=4003 in 2007, n=2983 in 2014 and n=11 550 in 2017). Primary outcome Underweight and overweight/obesity. Results The prevalence of underweight decreased from 18.1% (95% CI 12.0% to 26.3%) in 2007 to 11.6% (95% CI 9.5% to 13.9%) in 2014 and further dropped to 8.1% (95% CI 7.5% to 8.8%) in 2017. The prevalence of overweight/obesity increased slightly from 37.4% (95% CI 34.3% to 40.7%) in 2007 to 38.6% (95% CI 35.9% to 41.3%) in 2014 to 47.3% (95% CI 46.1% to 48.4%) in 2017. Underweight was more prevalent among males than females while overweight and obesity were more prevalent among females than males. The key risk factor for underweight was being male (adjusted OR (AOR) 2.21: 95% CI 1.80 to 2.72 in 2007, AOR 1.54: 95% CI 1.06 to 2.22 in 2014 and AOR 1.51: 95% CI 1.45 to 1.58 in 2017). For overweight/obesity, the main risk factors were being female (male AOR 0.23: 95% CI 0.15 to 0.35 in 2007, AOR 0.32: 95% CI 0.25 to 0.42 in 2014 and AOR 0.30: 95% CI 0.29 to 0.31 in 2017), being old (AOR 2.18: 95% CI 1.58 to 3.01 in 2007, AOR 2.37: 95% CI 1.71 to 3.29 in 2014) and AOR 2.10: 95% CI 1.94 to 2.27 in 2017 among those aged 55-64 years) and not working (AOR 1.70: 95% CI 1.20 to 2.42 in 2007, AOR 2.05: 95% CI 1.55 to 2.69 in 2014 and AOR 1.34: 95% CI 1.27 to 1.40 in 2017). Conclusions The findings presented in this study indicate coexistence of the double burden of underweight and overweight/obesity among adults aged 25-64 years in Botswana. Although underweight prevalence is on the decline, overweight/obesity is increasing over time. The problem of underweight and overweight/obesity needs immediate and effective interventions.