BMC Public Health 2006, 6:228 http://www.biomedcentral.com/1471-2458/6/228 The anthropometric measurements except WHR were strongly correlated with each other. The correlation of indices of overall and central obesity is highly suggestive of an association between increased overall obesity (as measured by BMI) with increased visceral fat (WC in this case). We found that mean WC, more than WHR, increased across overall obesity (BMI) categories in both genders. Similar results were reported in the urban female population of Morocco by Belahsen et al [22], and by Sargeant et al in the urban adult population of Jamaica [23]. It is likely therefore that BMI and WHR provide dif- ferent measures of almost the same phenomenon. Visceral fat is more metabolically active than subcutane- ous fat, and hence may be more deleterious to health [9]. Several studies have found a strong association between visceral fat and cardiovascular risk factors [24-27]. WC is a practical measure of intra-abdominal fat mass [25] and recommendations have been formulated to use it in the identification of people in need of intervention for cardi- ovascular risk reduction [28-30]. In men and women adults of urban Cameroon, WC was strongly correlated with BMI (r ≈ 0.8 in men and women respectively) but showed moderate correlation with WHR (0.6 for men and 0.4 for women). These findings suggest that defining obesity on the base of waist circumference may be an equally or more valid and useful method for use in epide- miological research and clinical practice, though further research is needed to demonstrate this unequivocally Studies in developed countries show an inverse (negative) relationship between education and obesity, particularly among women: the lower the education or the social class, the higher the prevalence of obesity. However, in develop- ing societies, a strong positive relationship often exists between SES and obesity among men, women, and chil- dren [31]. In the present paper, the positive association between obesity and duration of education, as measured by the number of year of schooling was clearly seen in both genders when obesity was defined by BMI or WC. The same pattern was less evidence for WHR, particularly in women where there was some evidence of an inverse gradient. Number of years of education can be used as a proxy for socioeconomic status in this population; the greater the number of year of education, the higher the SES. It is likely that higher socioeconomic status in devel- oping countries is characterized by a westernization of the lifestyle, including reduced physical activity, more seden- tary life and adoption of higher energy, higher fat diets; all of which may lead to an increase in obesity. However, it is also possible that if westernization of diet and reduced physical activity becomes more general in developing country populations, the familiar inverse association of obesity with socioeconomic status will emerge. Conclusion The 2003 CamBoD Baseline Survey updates the preva- lence of obesity in the urban adult population of Cam- eroon. The findings suggest that waist circumference as a measure of central obesity is a useful indicator for use in epidemiological studies and clinical practice. The study provides insights into the relationship between age, sex, socioeconomic overweight and obesity using a range of anthropometric parameters. Based on BMI alone, the study showed a high prevalence of overweight and obesity and provides evidence to support the establishment of intervention programmes to prevent further increase in obesity-related disorders such as diabetes and hyperten- sion in urban Sub-Saharan African populations. Mean- while, further studies need to be carried out in the Cameroonian context and other Sub-Saharan African set- tings to provide appropriate cut-off points and identify which anthropometric parameter has the highest predic- tive value in the identification of subjects at risk of obes- ity-related disorders. Competing interests The author(s) declare that they have no competing inter- ests. Authors' contributions JCM, NU, RE, JSA participated in the design of the Cam- eroon Burden of Diabetes Project study protocol. JSA, RMK and ECK coordinated field data collection. RMK drafted the manuscript and performed all the statistical analysis. All authors provided comments on the draft manuscripts and read and approved the final manuscript. Acknowledgements The Cameroon Burden of Diabetes Baseline Survey was supported by a grant from the World Diabetes Foundation (grant WDF02-016). We would like to acknowledge the study participants, field workers and the Cameroon Ministry of Health for their commitment. References 1. (WHO) WHO: Obesity: Preventing and Managing the Global Epidemic. Report of WHO Consultation on Obesity, 3-5 June 1997. Geneva: WHO, 1998. Edited by: WHO . Geneva; 2006. 2. Delpeuch F, Maire B: [Obesity and developing countries of the south]. Med Trop (Mars ) 1997, 57:380-388. 3. Sowers JR: Update on the cardiometabolic syndrome. Clin Cor- nerstone 2001, 4:17-23. 4. Sobngwi E, Mbanya JC, Unwin NC, Kengne AP, Fezeu L, Minkoulou EM, Aspray TJ, Alberti KG: Physical activity and its relationship with obesity, hypertension and diabetes in urban and rural Cameroon. Int J Obes Relat Metab Disord 2002, 26:1009-1016. 5. Pasquet P, Temgoua LS, Melaman-Sego F, Froment A, Rikong-Adie H: Prevalence of overweight and obesity for urban adults in Cameroon. Ann Hum Biol 2003, 30:551-562. 6. Ribeiro-Filho FF, Faria AN, Azjen S, Zanella MT, Ferreira SR: Meth- ods of estimation of visceral fat: advantages of ultrasonogra- phy. Obes Res 2003, 11:1488-1494. 7. Stolk RP, Wink O, Zelissen PM, Meijer R, van Gils AP, Grobbee DE: Validity and reproducibility of ultrasonography for the meas- urement of intra-abdominal adipose tissue. Int J Obes Relat Metab Disord 2001, 25:1346-1351. Page 7 of 8 (page number not for citation purposes)