Overweight and obesity prevalence in North Africa: A systematic review and meta-analysis

North Africa is experiencing an accelerating obesity epidemic driven by nutrition transition, urbanization, and changing lifestyle patterns. Overweight and obesity are now leading risk factors for NCDs across all five target nations. No contemporary PRISMA-compliant systematic review has synthesized country-level adult prevalence data. This review aimed to estimate pooled and country-specific prevalence of overweight (OW, BMI 25 - 29.9 kg/m²) and obesity (OB, BMI ≥ 30 kg/m²) among adults (≥ 18 years) across Libya, Egypt, Tunisia, Algeria, and Morocco from 2018 to 2026; to examine temporal trends, sex-based disparities, urban/rural gradients, and socioeconomic determinants; and to assess heterogeneity, study quality, and publication bias. This study was carried out through systematic searches of PubMed/MEDLINE, EMBASE, CINAHL, WHO IRIS, and grey literature; eligible studies reported BMI-based obesity/overweight prevalence in community-dwelling adults, and quality was assessed using the JBI Prevalence Checklist (9-item). Pooled prevalence estimated using Der Simonian-Laird random-effects meta-analysis. Heterogeneity quantified via I² and Cochran’s Q. Subgroup analyses by country, sex, setting, and measurement method. Publication bias assessed by funnel plots and Egger’s test. Analyses in R 4.3 (meta, metafor). The findings revealed 34 studies (representing > 72 million screened/surveyed individuals) included after screening 1,847 records. Pooled obesity prevalence: 33.7% (95% CI: 28.9 - 38.7%). Pooled overweight: 31.4% (27.2 - 35.8%). Egypt recorded the highest obesity (39.8%; n = 49.6 million, national screening 2018 - 2019). Libya had the highest combined OW plus OB burden (75.3%). Female obesity (42.1%) consistently exceeded male (21.3%) in all countries; pooled F: M ratio = 1.98. High heterogeneity: I² = 91.4% (Q = 382.4; p < 0.001). Female sex, urban residence, age 40 - 59 years, physical inactivity, and low educational attainment were detected. Overweight and obesity have reached epidemic proportions across all five North African countries. The burden disproportionately affects women, urban dwellers, and middle-aged adults.