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In the context of rapid nutritional transitions in Africa, few studies have analyzed the etiology of obesity by considering the driver pathways that predict body mass index (BMI). The aim of this study is to innovatively identify these driver pathways, including the main sociodemographic and socioecological drivers of BMI. We conducted a rural-urban quantitative study in Cameroon ( n = 1106; balanced sex ratio) to explore this issue. We recruited participants and reported several sociodemographic characteristics (e.g., marital status, socioeconomic status (SES), and ethnicity). We then assessed three main socioecological drivers of BMI (body weight perception, dietary intake, and physical activity) and conducted bioanthropometric measurements. We identified several driver pathways predicting BMI. In Cameroon, Bamiléké ethnicity, higher SES, being married, and older age had positive effects on BMI through overweight valorization and/or dietary intake. Accordingly, we found that being Bamiléké, married, and middle-aged, as well as having a higher SES, were factors that constituted at-risk subgroups overexposed to drivers of obesity. As such, this study highlights the necessity of investigating the complex driver pathways that lead to obesity. Therefore, better identification of the subgroups at risk for obesity will help in developing more targeted population health policies in countries where this burden is a major public health issue.

Owing to nutritional transition in Cameroon, one in two adults is overweight and one in five is obese, and 8·1% of children are overweight and 2·1% are obese. Given this phenomenon, dietary intake assessment is needed to establish appropriate preventive nutrition-sensitive strategies. Our aim was to develop and test the validity of two food portion photograph books (FPPB) to be used as visual aids for adults and children taking part in a 24-h dietary recall. To design FPPB, interviews and focus group discussions were undertaken with women to obtain consensus on the local categorisation of foods. For each cooked and weighed food, three photographs of the average small, medium and large serving portion sizes were taken, and four intermediary portion sizes were calculated. To validate the FPPB, a sample of adults (361) and children (224) were asked, at meal times, to self-serve a food portion prepared in the household and the portion sizes were weighed; 24 h after the measurement, the same subjects were shown the appropriate FPPB and were asked to indicate the food and the portion they consumed. In adults, of the 821 portions tested, 77% were accurately estimated, whereas in children 74% of the 556 portions tested were accurately estimated. For both groups, the small- and medium-sized portions were frequently selected and accurately estimated (>70%). Our findings suggest that the adult and children's FPPB can be used in Cameroon to estimate food portion sizes, and thus nutritional intake in the frame of the 24-h dietary recall.

Background: The social valorisation of overweight in African populations could promote high-risk eating behaviours and therefore become a risk factor of obesity. However, existing scales to assess body image are usually not accurate enough to allow comparative studies of body weight perception in different African populations. This study aimed to develop and validate the Body Size Scale (BSS) to estimate African body weight perception., Methods: Anthropometric measures of 80 Cameroonians and 81 Senegalese were used to evaluate three criteria of adiposity: body mass index (BMI), overall percentage of fat, and endomorphy (fat component of the somatotype). To develop the BSS, the participants were photographed in full face and profile positions. Models were selected for their representativeness of the wide variability in adiposity with a progressive increase along the scale. Then, for the validation protocol, participants self-administered the BSS to assess self-perceived current body size (CBS), desired body size (DBS) and provide a "body self-satisfaction index." This protocol included construct validity, test-retest reliability and convergent validity and was carried out with three independent samples of respectively 201, 103 and 1115 Cameroonians., Results: The BSS comprises two sex-specific scales of photos of 9 models each, and ordered by increasing adiposity. Most participants were able to correctly order the BSS by increasing adiposity, using three different words to define body size. Test-retest reliability was consistent in estimating CBS, DBS and the "body self-satisfaction index." The CBS was highly correlated to the objective BMI, and two different indexes assessed with the BSS were consistent with declarations obtained in interviews., Conclusion: The BSS is the first scale with photos of real African models taken in both full face and profile and representing a wide and representative variability in adiposity. The validation protocol proved its reliability for estimating body weight perception in Africans.

Body size perceptions were assessed among members of the Bamiléké, an ethnic group in an urban setting in Cameroon with high rates of obesity, but also a positive perception of stoutness in its social representations. We first implemented a qualitative study (April 2007) to identify local representations of body weight among Bamiléké using semi-structured interviews. We then quantitatively assessed body size perceptions among a representative sample of Bamiléké (May to June 2007), employing a body image assessment scale and a questionnaire that included declarative body weight self-satisfaction, health status, and attempts to reduce weight. Results indicate Desired Body Size (DBS) for women, and particularly for men, was situated in the overweight category. Qualitative analyses show that overweight is considered as a normal and healthy body size in the Bamiléké. On the other hand, the quantitative study reveals that high rates of obesity, especially in women (40.8% obese), are associated with high blood pressure. Moreover, subjects who had a negative perception of their health status wanted to lose weight (p < 0.01). Unlike males, females have a DBS lower than their Current Body Size (p < 0.001). In addition, subjects (particularly males) who felt they were too lean, were older than those who felt too fat. We therefore conclude that the social valorisation of stoutness exposes Bamiléké, particularly males, to obesity. Although the women stated a desire to lose weight and present aesthetic criteria more oriented towards slimness, the attitude of the Bamiléké remained oriented toward stoutness appreciation. This preference can help protect against body image disturbances identified in Western societies, but may also increase of the incidence of obesity and its associated pathologies in this part of the world., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Recent studies suggest that early modifications in metabolic pathways and behaviour, leading to energy conservation and reduced linear growth, could represent adaptations to nutritional constraints during foetal life and infancy. Impaired fat oxidation, low resting energy expenditure and reduced physical activity, resulting from these adaptations, could facilitate fat storage and development of overweight in growth-retarded children that consume more energy-dense food. This study aims at assessing whether: (1) dual-burden preschool children (simultaneously stunted and overweight) of Yaounde (Cameroon) have low birth-weight (indicator of foetal undernutrition) and reductions in fat oxidation, resting energy expenditure (REE) and physical activity, (2) fat oxidation, REE and physical activity are associated with foetal growth., Methodology/principal Findings: 162 children (24-72 months) were considered: 22 stunted-overweight (SO), 40 stunted (S), 41 overweight (O), and 59 non stunted-non overweight (NSNO). Nutritional status and body composition were assessed using anthropometry and multifrequency bioimpedance analysis. Fasting respiratory quotient (RQ) and REE were measured by indirect calorimetry. Physical activity was determined using accelerometers, food questionnaires were used for diet assessment and birth-weight was noted. Mean RQs and REE (weight adjusted) did not differ between stunted children (SO and S) and non-stunted children (O and NSNO). SO and S children spent more time in sedentary activities than O children (p = 0.01 and p = 0.02, respectively) and less time in moderate-to-vigorous activities than NSNO children (p = 0.05 and p = 0.04, respectively). SO children's diet was less diverse (p = 0.01) with less animal products (p = 0.006). Multiple linear regressions model revealed that birth-weight is predictive of RQ (β = 0.237, p<0.01, R(2) = 0.08)., Conclusions/significance: This study showed that growth retardation in stunted-overweight children could be associated with postnatal nutritional deficiencies. Overweight in stunted children could be associated with reduced physical activity in the context of nutrition transition. High birth-weight was a predictor of reduced lipid oxidation, a risk factor of fat deposition.

Objective: Develop and validate body image scales (BIS) presenting real human bodies adapted to the macroscopic phenotype of urban Cameroonian populations., Design: Quantitative and qualitative analysis., Setting: Yaoundé, capital city of Cameroon., Participants: Four samples with balanced sex-ratio: the first (n=16) aged 18 to 65 years (qualitative study), the second (n=30) aged 25 to 40 years (photo database), the third (n=47) and fourth (n=181), > or =18 years (validation study)., Main Outcome Measure: Construct validity, test retest reliability, concurrent and convergent validity of BIS., Results: Body image scales present six Cameroonians of each sex arranged according to main body mass index (BMI) categories: underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity class I (30-34.9 kg/m2), obesity class II (35-39.9 kg/m2), and obesity class III (> or =40 kg/m2). Test-retest reliability correlations for current body size (CBS), desired body size and current desirable discrepancy (body self-satisfaction index) on BIS were never below .90. Plus, for the concurrent validity, we observed a significant correlation (r=0.67, P<.01) between measured BMI and CBS. Finally, the convergent validity between BIS and a female African American silhouettes scale, for different dimensions of body size perceptions, is acceptable., Conclusions: Body image scales are adapted to the phenotypic characteristics of urban Cameroonian populations. They are reliable and valid to assess body size perceptions and culturally adapted to the Cameroonian context.

Background: Nutrition transition in developing countries has been associated with higher prevalence of overweight., Aim: The study aimed to identify the factors associated with concurrent stunting and overweight in urban preschool children of Yaounde, Cameroon., Subjects and Methods: 169 preschool children of both sexes were recruited according to their nutritional status: Stunted, overweight, stunted-overweight, and non-stunted-non-overweight. Factors associated with concurrent stunting and overweight were investigated through interviewer-administered questionnaires. A binary logistic regression model was used to determine the relation between nutritional statuses and associated factors., Results: A low-income family and a low maternal educational level are independent risk factors for a child to be stunted-overweight [odds ratios (95% CI): 3.81 (13.32-1.08), 2.90 (7.82-1.07), respectively]. Mother under-evaluation of child's weight is a factor associated with stunting-overweight and overweight in children [odds ratios (95% CI): 3.42 (8.72-1.33), 6.52 (18.09-2.34), respectively]. Being overweight is also related to higher birth weight. Unlike stunted children, stunted-overweight children live with both their parents and have an older mother. Short maternal stature and mother's over-evaluation of her child's height are independent factors associated with stunting., Conclusion: Poor preschool children of Yaounde are facing concomitant stunting and overweight. More studies are needed to better assess the impact of maternal factors.

Background: The emergence of a nutrition transition in developing countries might lead to higher prevalence of obesity and related adverse health effects. In Cameroon,urbanization growth rate is one of the highest in sub-Saharan Africa. Such dramatic demographic change favours important modifications, notably in nutritional patterns., Aim: In this paper we examine the current prevalence of overweight and obesity in Yaounde,the capital city of Cameroon and search for possible causal factors. Detrimental consequences of overweight are also discussed., Material and Methods: Samples of adults (519 women, 252 men) of all ages in all districts of Yaounde were subjected to anthropometric and body composition measurements, blood pressure and resting heart rate determination, and interviewer-administered questionnaires on socio-demography, smoking habits, physical activity, self-perception of body weight and health status., Results: In both sexes body mass index (BMI) increases with age and peaks in the years of maturity. These changes are related to changes in adiposity. Prevalence rates of overweight(BMI >or= 25) and obesity (BMI > or = 30) increase from 20 to 29 years and peak at 40-49 years in men and at 50-59 years in women before starting to decline. One woman in two is overweight and one woman in five is obese, whereas one-third of men are overweight and only 5% are obese. Obese subjects have a larger age-adjusted waist to hip ratio(WHR) than their non-overweight counterparts, attesting that fat gain is oriented towards a more abdominal fat mass distribution. The length of residence in Yaounde, increasing education level, occupation, ethnicity, physical inactivity and smoking practices appear to influence early overweight and/or obesity. No parity effect is observed in women. From the present study, it appears that obesity, and especially obesity in women, could be less benign than that described in other studies in Africa., Conclusion: Research is needed in Cameroon, including aetiological and cohort studies aimed at the quantification of morbidity and mortality risks associated with overweight and obesity.

Status quo data on the age at menarche were obtained on samples of Cameroonian girls living in urban (Yaoundé) (n = 205), suburban (n = 505) and rural areas (n = 201). Mean ages at menarche, estimated by probit analysis, are 13.18 years (SD 1.08) in Yaoundé, 13.98 years (SD 1.55) in the suburban area, and 14.27 years (SD 1.65) in the rural area. The early menarcheal age observed in Yaoundé girls attending 'privileged schools' (12.72 years, SD 1.18) substantiates the hypothesis that in good environmental conditions Africans are as early-maturing as Asiatic or Mediterranean populations. Comparison with retrospective data on age at menarche during previous decades reveals the presence of a clear secular trend towards earlier maturation, at a rate of 2.5-3.2 months per decade, only in the main cities of the country (Yaoundé/Douala) and a lack of temporal variation in rural areas. The degree of urbanization influences maturational age and its evolution, probably through improvements in the nutritional standards.

To verify the existence of a set point for body mass, the spontaneous evolution of body weight and composition after massive overfeeding was observed in nine lean young Cameroonian (Massa) men participating in a 4-6 mo traditional fattening session (Guru). Anthropometry (skinfold thicknesses) was used to estimate body composition. Peak weight and fat gains were found to be 19 +/- 3.2 (mean +/- SD) kg and 11.8 +/- 2.5 kg, respectively. Two and one-half years after cessation of fattening and a return to daily life and food habits, there was a spontaneous return to initial body weight and body composition of the overfed subjects. Because the subjects were not under social or other stimuli to lose weight, this finding argues in favor of the existence of a biological control of energy balance at a "preferred" level in nonobese individuals.