Date Published: January 19, 2017
Publisher: Public Library of Science
Author(s): Aude Lagarrigue, Soufiane Ajana, Lucile Capuron, Catherine Féart, Marie-Pierre Moisan, Yvonne Böttcher.
Inmates, notably women, are at greater risk for obesity and metabolic complications than the general population according to several studies from high income countries. Data regarding French correctional institutions are lacking so far. To fill this gap, we have assessed in a sample from a French prison (33 females and 18 males) the gender-specific effect of incarceration on weight and body mass index (BMI) and examined their current metabolic status. Furthermore, to reveal the possible determinants of increased obesity, we analyzed emotional vulnerability, eating behavior and physical activity using self-reported questionnaires.
In this sample, obesity (BMI≥30 kg/m2) was already frequent in women (18.2%) but rather scarce for men (11%) at prison entry. Incarceration worsened the rate of obesity in both genders (21.2% and 16.7% respectively). At the time of study, abdominal obesity estimated through waist circumference was particularly prevalent in women (69.7%) versus men (27.8%) and metabolic syndrome was detected in 33% of female against none in male inmates. Abdominal obesity was associated with female sex (p<0.03), low physical activity (p<0.05) and eating disorder (p = 0.07) in univariate analyses. Low physical activity remained significant as an explanatory factor of higher abdominal obesity in multivariate analysis. A marked difference between genders was found for practice of physical activity with a higher proportion of women compared to men being inactive (37.9% vs. 11.8%) and fewer women being very active (17.2% vs. 41.2%). This study revealed that a significant proportion of women of this correctional institution combined established obesity, a metabolic syndrome and very little practice of physical activity which put them at high risk of cardiovascular disease. Thus, obesity should be better surveyed and treated in prison, especially for female inmates. Increased physical activity, adapted to obese women, would be the first mean to decrease obesity and gender differences.
Among the most prevalent non-communicable diseases, obesity and diabetes are reported as major problems for the general population and represent thus important public health issues. Unhealthy diets and inadequate physical activity are the main factors contributing to overweight, obesity and type 2 diabetes . Some populations are particularly vulnerable to these disorders. For instance, inmates are often mentioned, especially women. A recent systematic review including 13 studies with a total of 46711 prisoners (39631 [85%] men and 7080 [15%] women) reported that male prisoners were less likely to be obese than males in the general population (prevalence ratio ranged from 0.33 to 0.87, except one study in USA 1.02) whereas female prisoners were more likely to be obese than non-imprisoned women (prevalence ratio 1.15 to 1.18 except one study in UK 0.70) .
This study shows that at entry into prison, women and men are frequently diagnosed as obese, as already reported by Herbert et al, 2012  for high-income countries. At the time of study the prevalence of obesity had increased for both women and men. These data underline that the issue of obesity was already present in these women before entering prison and that incarceration worsens the prevalence of obesity, especially in men. Our data also show that participants underweight at prison entry gained weight following imprisonment pointing to a positive effect of incarceration on these subjects’ weight. A significant proportion of women lost weight (21.2%). Among those, 2 were obese and 2 others had a high WC (≥80), the rest lost little weight (2 or 3 kg) and none become underweight, again suggesting that incarceration improved the weight status of some subjects. Potential reasons may be a better balanced diet through the provided meals and limited snacking outside the meals for these subjects.