Women in the developing world are increasingly suffering from obesity. Experts aren’t exactly sure why – or what to do about it.

One in three people in the world are overweight or obese, but in the developing world women are disproportionately affected, causing diet-related diseases and, in some cases, maternal and infant deaths. In African countries including Ghana, Kenya, Niger, Sierra Leone, Tanzania and Zimbabwe, the prevalence of overweight and obesity among women is approaching 50 percent, according to a 2017 review published in Public Health Nutrition

The results can be devastating. The Lancet published research in 2013 that found that overweight and obesity among pregnant women is linked to higher rates of maternal death and infant mortality. The study highlighted that the prevalence of maternal overweight has steadily increased since 1980 and now exceeds that of underweight in all regions.

“The struggle now will be to make sure women and children are not victims of obesity – and the only way to ensure this is to have policies that are inclusive, and that will do no harm – either now or in the future,” Marie T. Ruel, the director of the International Food Policy Research Institute’s poverty, health and nutrition division, told News Deeply.

Though the trend appears to be exacerbated in developing countries, the situation is global. According to the 2017 Global Nutrition Report, 15 percent of women are obese, compared to 11 percent of men. Women are also more likely than men to be affected by adult hypertension and diabetes – illnesses linked to overweight and obesity.

The problem is that officials have not identified a single successful strategy for reducing obesity in women that can be replicated and scaled.

Lack of Research

“There is no data to look at the exact causes of rising obesity among women,” said Dr. Ashkan Afshin, an assistant professor of global health at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. “Even though many interventions have been evaluated, there is little evidence on their effectiveness. Because we don’t know the causes, we don’t know what works either.”

That doesn’t mean researchers don’t have any ideas about what’s driving this problem, though.

Experts have recognized the nutrition transition – changes in lifestyle and diets due to the economic transition of countries – as a significant cause of obesity. For women especially, this means a shift in the use of time and resources, including away from preparing healthier food choices and toward faster, less nutritious options. At the same time, a cultural acceptance of heaviness as a sign of wealth and success sometimes also contributes.

Dr. Saskia Osendarp, a nutrition consultant at the University of Wageningen, said there is also the problem of female disempowerment to address.

“Overweight and obesity amongst women are tied to women’s roles and decision-making powers in the household,” she said. “Changing behaviors with interventions that seek to change these roles has been explored to reduce undernutrition. It’s time to utilize the same techniques for obesity as well.”

Programs that encourage women to eat more nutritious food have challenged traditional practices in some countries where women don’t eat at the same time as men, and often receive leftovers. A similar approach could be adopted to address obesity.

Addressing the Double Burden

Such initiatives are particularly important in households that are grappling with both undernutrition and obesity.

Research has shown that increased consumption of unhealthy food leads to obesity among mothers, which in turn has a detrimental effect on the children. Children of obese mothers don’t get adequate nutrients and run the risk of being undernourished.

In these cases, nutrition interventions will have to balance this double burden – addressing obesity, while not pulling attention away from undernutrition, according to Dr. Jenny Cresswell, an epidemiologist and an assistant professor at the London School of Hygiene and Tropical Medicine.

“Efforts to reduce overnutrition amongst mothers will have to be introduced in existing structures,” she told News Deeply. That includes screening for signs of overweight and obesity at antenatal clinics and altering food environments to encourage healthy eating.

In a paper highlighting maternal obesity in neonatal death in sub-Saharan Africa, Cresswell and her co-authors point out that early identification of obese women who might have a high-risk pregnancy is one potential low-cost intervention. Because women are more likely to seek health services during a pregnancy, it offers a window for counseling to expectant mothers about the importance of losing weight, while also improving the health of the newborn.

Experts are also pushing governments to put more emphasis on the issue in their national nutrition plans. Kenya is one of the few countries to have done so. The government is improving nutrition in schools to ensure obesity does not set in at an early age. Officials are also looking to scale up community screening of body mass index and waist circumference in women for early detection of obesity.

One thing is clear – the fight against obesity cannot succeed without prioritizing women’s health.