## 4 Discussion
This is in addition to the socioeconomic (e.g., income), occupational (i.e., driving for long hours), and behavioral factors (i.e., alcohol use) [8; 14; 45]. This could justify the alarming prevalence and the variations of prevalence of overweight and obesity among studies, including the present study. In addition, abdominal obesity by WC (59%), WHR (65%), and WHtR (80%) were prevalent. Literature documents that BMI has a strong correlation with gold standard body fat, while WC, WHR, and WHtR are better indicators for assessing abdominal obesity [21; 22; 23; 62]. The findings of this study classify truckers as being at a high or very high cardio-metabolic risk. This is consistent with a study of [PERSON] et al. [9], who reported 89% of abdominal obesity among truckers, and further indicated that it is a valid measure of abdominal adiposity predisposing to cardio-metabolic risk. The concept of cardio-metabolic risk encompasses the increased likelihood of vascular events, and comprehends risk factors, such as hypertension, dyslipidemia, and smoking [63]. The current study further showed that the prevalence of diabetes was 14%. Prominent cardio-metabolic risk factors, in addition to overweight/obesity, included smoking (29%) and consuming alcohol (57%), were observed in the present study, which were high compared to 11% and 9%, respectively, in addition to physical inactivity reported among truck drivers in South Africa [36]. We found an alarmingly high prevalence of hypertension (57%) among truck drivers in this study. A similar prevalence of 57% has been reported among commercial drivers in South Africa [43], while [PERSON] et al. [36] reported a 36% of hypertension among truckers in other South African provinces (i.e., Gauteng and Free State) between 2016 and 2017. The prevalence of hypertension recorded in this study is comparable to two studies in Hong Kong (57%) [64] and Taiwan (56%) [65] reported among commercial drivers, but higher than studies in Africa (9% to 33%) [37; 66; 67] and several developing countries [68; 69]. In addition, the current study reported a prevalence of 14% for diabetes, which is almost similar to the 16% prevalence among commercial drivers [44] in South Africa, but too high compared to <3% reported among truckers in the country [36]. In addition, this prevalence is almost double compared to 8.3% overall prevalence of diabetes in the general population in South Africa [70]. Compared to developing countries, such as Hong Kong [64], Iran [68; 71], and Brazil [72; 73], the prevalence of diabetes among truckers in this study is higher, while [PERSON] et al. [11] reported an almost similar finding (16.4%) among commercial taxi drivers in South Brazil. Uncontrolled and poorly controlled diabetes among truck drivers have been implicated to an increased risk of road accidents [74; 75]. Both the prevalence of hypertension and diabetes among truck drivers in the current study may be related to their unhealthy lifestyle and illicit health behaviours associated with their job, similar to the suggestions of other researchers [43; 67]. In the present study, hypertension was significantly associated with all obesity indicators. Studies have found direct associations of hypertension with BMI, WC, WHR, and WHtR [23; 76; 77]. An upward trend in the incidence of hypertension with increasing BMI, WC, and WHtR has been reported in literature [78]. Obesity increases the risk of developing hypertension [79] due to the activation of the sympathetic nervous system, renin-angiotensin system, and sodium retention among other abnormalities [33; 80]. Meanwhile, the current study further showed that diabetes was substantially related with abdominal obesity by WC and WHR. WC has been reported as a stronger anthropometric predictor of diabetes than BMI [81]. In addition, WHR has been reported as the mutual indicator for diabetes, subsequent to BMI, and correlates weakly with BMI compared to the correlation with WC [82; 83].