Frequency of overweight and obesity in students of medical college of Lahore
Muhammad Ashraf Chaudhry et al.
Original Article
Frequency of Overweight and
Obesity in Students of Medical
College of Lahore
Muhammad Ashraf Chaudhry*
Farrah Ahmad*
Muhammad Zeeshan Ashraf**
*Head of Department Community Medicine CMH Lahore Medical College, Lahore
**Department of Community
Medicine, CMH Lahore Medical
College, Lahore
Ittefaq Hospital, Lahore
Objective: To compare body mass index (BMI) in young adults and to find an association
between lifestyle behaviors and obesity.
Study design: Cross-sectional study
Place and Duration of Study: CMH Lahore Medical College, from first May 2011 to 31st
July 2011.
Materials and Methods: A cross-sectional study was conducted and a total of 404
medical students (123 males, 281 females) from 18 to 25 years of age participated in this
study. Students in this study were undergraduate students. Data was collected using a
structured self-administered questionnaire. All were questioned regarding gender, age,
class and lifestyle behaviours. Overweight and obesity were estimated by measuring Body
Mass Index (BMI). BMI ≥25.0 kg/m2 was taken as overweight and ≥30.0 kg/m2 as obese. Chisquare test of significance was used to see association between BMI and lifestyle behaviours with statistical significance taken as p<0.05.
Results: Out of 404 students, 76 (18.8%) were underweight, 285 (70.5%) had normal
weight, while the prevalence of overweight was found to be 8.2% and of obesity 2.4%. Overall 18.6% males and 7.4% females found to be overweight or obese. There was a statistical Address for Correspondence
Prof. Dr. Muhammad Ashraf
significance between obesity and gender (p = 0.001).
Conclusion: Nearly 10.6% participants were overweight or obese. There is an urgent need Chaudhry: Head of Department of
to educate medical students about optimum nutrition and physical exercise in order to pro- Community Medicine CMH Lahore
Medical College, Lahore
mote healthy lifestyles.
Email: [email protected]
Key Words: Medical students, overweight, obesity, physical exercise, body mass index
(BMI).
er that what is generally considered healthy for given
weight.3
Introduction
The weight of the person is the result of several interrelated factors; most important among these are genetic,
Obesity is a fast becoming a global health problem afenvironmental and behavioural. Modern life has signififecting the more and more people. Obesity is emerging
cantly affected daily life, by making both living and workin Pakistan as a public health problem. National Health
ing conditions more relaxed. People tend to spend hours
Survey of Pakistan, 1990-94, showed that prevalence of
sitting in front of televisions or computers, burning fewer
obesity (BMI≥25) (according to World Health Organizacalories, instead of engaging in healthy physical activition (WHO) Classification Scheme for Asians) in 25-44
ty.4
years old in rural areas was 9% for men and 14% for
Adverse health outcomes associated with overweight
women; in urban areas, prevalence was 22% and 37%
and obesity range from increased risk of mortality to
for men and women, respectively.1 What was once a
non-fatal debilitating disease.5 obesity is a major risk
problem seen in developed countries only, has now
factor for cardiovascular disease (CVD) and type-2 dispread around the globe, and affecting our young popuabetes mellitus (DM) and in the presence of other risk
lation as well, potentially shortening their lifespan.2
factors for non-communicable diseases (NCDs) such as
Overweight denotes the presence of excess body
smoking, hypertension, elevated blood cholesterol, has
weight. Obesity denotes the presence of excess body
a multiplicative effect.6
fat. All obese persons are overweight, but all overweight
In 1997, the WHO recommended the BMI for measurepersons are not necessarily obese. The Centers for Disment of overweight and obesity in adults owing to its :
ease Control and Prevention (CDC) defines overweight
validity in relation to morbidity and mortality outcomes,
as obesity as “labels for ranges of weight that are greatsimplicity, widespread acceptability, and robust nature.5
Ann. Pak. Inst. Med. Sci. 2012; 8(2):137-140
137
Frequency of overweight and obesity in students of medical college of Lahore
These attributes of BMI were determined largely from
studies in Europeans, and classified overweight as
BMI≥25 and obesity as BMI≥30. In February 2000, the
WHO Regional Office for the Western Pacific, the International Association for the study obesity, and International Obesity Task Force published provisional recommendations for adults for Asia-Pacific region: overweight
as BMI≥23 and obesity at BMI≥25.
The present study was conducted to examine the extent
of overweight and obesity in young population of medical college.
Materials and Methods
This cross-sectional study was conducted at the department of Community Medicine, CMH Lahore Medical
College from May to July 2011. A total of 404 students
(123 males, 281 females) of five classes from first year
to 5th year MBBS, aged 18 to 25 years, participated in
the study. Written informed consent was taken from
each subject and the study was approved by CMH Lahore Medical College Ethical Committee. All the subjects were asked to fill out a questionnaire regarding
gender, class, age, height (in cms), weight (in kg) and
lifestyle behaviours such as physical exercise and eating habits. Body Mass Index (BMI) was calculated as
weight (Kg) divided by height squared (m2) The WHO
definition of overweight as BMI of 25-29.9 kg/m2 and
obesity as a BMI of 30 or greater was used.
Statistical Analysis: Descriptive statistics such as frequencies and percentages were calculated for categorical data. Chi-square test of significance was used to
evaluate association of overweight/obesity and gender,
class, exercise and food habits. P-value <0.05 was considered statistically significant.
Results
A total of 404 subjects in the age group 18 to 25 years
were included in the study. Majority of them were girls
(69.6%; n = 281). Using BMI as an index of Obesity, the
subjects were classified into four groups: underweight,
normal weight, overweight and obese. Out of 404 students, 76(18.8%) were overweight, 285(70.5%) had
normal weight, while the prevalence of overweight was
found to be 8.2 percent and of obesity 2.4 percent.
The percentages of males and females in these categories were as follows: males 8.1%, 73.1%, 17% and 1.6%
respectively; females 23.1%, 69.3%, 4.6% and 2.8%
respectively (table I). The prevalence of obesity in female students and the prevalence of overweight in male
students were found high and this difference was statistically highly significant (P=0.001).
Comparisons were also made between various classes
and on BMI and there were more overweight students
(n=10) in 4th year MBBS class and more obese students
(n=8) in final year MBBS class as compared to other
Ann. Pak. Inst. Med. Sci. 2012; 8(2):137-140
Muhammad Ashraf Chaudhry et al.
classes and this difference was statistically significant (p
=0.013) (table II). Some of the healthy lifestyle behaviours that help in maintaining normal weight of a person
include taking fruits and vegetables and doing physical
exercise. There were less overweight/obese students
(n=11) in exercise group as compared to non-exercise
group (n=33) but this difference was statistically not significant (p=0.28).
Association was also evaluated between BMI and
fruits/vegetables intake. More students were taking
fruits/vegetables daily (n=132) as compared to not all
(n=12) and this difference was statistically highly significant (p = 0.001) (table III).
Table I. Comparison of overweight/obesity in male
and female students
ClassifiBMI (ref- Results
Results
Pcation of
erence
Males
FeValue
BMI
values
(n=123)
males
k/m2)
(n=281)
Under<18.5
10
65
0.001
weight
(8.1%)
(23.1%)
Normal
18.5-24.9 90
195
weight
(70.1%)
(69.3%)
Over25-29.9
21
13
weight
(17%)
(4.6%)
Obese
≥30
02
8
(1.6%)
(2.8%)
Table II. Matching of overweight/obesity with classes
Weight
Class
P-value
0.013
3rd
4th
5th
First 2nd
year
year year year year
Under10
17
19
10
19
weight
Normal
63
61
55
59
47
Over7
2
5
13
7
weight
obese
0
1
1
1
4
Table III. Association of overweight/obesity with dietary fibre
Weight
Fruit Eating
Pvalue
0.001
Daily Twic Thrice Occa- Not
ea
a
sionally all
week week
Under26
7
10
31
1
weight
Normal 90
33
69
86
7
Over13
5
7
8
1
weight
Obese
3
0
0
4
3
Total
132 45
86
129
12
138
Frequency of overweight and obesity in students of medical college of Lahore
Discussion
Obesity is increasing in developing counries.7 Once
considered a problem only in high income countries,
overweight and obesity are now dramatically on the rise
in low and middle income countries particularly in urban
setting.8 Supporting this statement studies from countries such as India 9, Srilanka10, also show the high prevalence of overweight and obesity in their population
and more so in urban, affluent settings. According to
WHO these global increases in overweight and obesity
are attributable to a number of factors including a global
shift in diet towards intake of energy-dense foods that
are high in fat and sugars but low in vitamins, minerals
and other micronutrients and a trend towards decreased
physical activity due to sedentary lifestyles.8
In this study we investigated the presence of overweight
and obesity in young adults from middle to high socioeconomic classes, correlating with their gender, dietary
habits and physical activity. The prevalence of obesity
was found to be 2.4% and that of overweight was 8.2%.
Prevalence of obesity in male students was 1.6% and in
female students was 2.8% respectively. This is in contrast to data from the National Health Survey of Pakistan, 1990-94,1 which found prevalence of obesity in 2544 years olds urban areas as 22% and 37% for men and
women respectively. The lower figures in our study
might be due to the fact that study population being
medical students was more conscious about their
weights and moreover they were comparatively younger
(18-25 years) as compared to National Health Survey of
population. However, high prevalence of obesity in female students (2.8%) as compared to males (1.6%) is
similar to that of National Health Survey of Pakistan.1
In our study 18.6% males and 7.4% females were found
to be either overweight or obese. This is also in contrast
to the study carried out by Qureshi MA et al in dental
college of Karachi where they found a large number of
subjects (60.8% females and 44.4% males) either overweight or obese in study population.11 This is also in
contrast to a previous study done in Pakistan where
they found 13.8% females and 12.4% males, in a similar
age group, to be overweight or obese.12 Another study
carried out by Yabanci N and et al in Turkish adults
found obesity prevalence 9.7%, whereas overweight
prevalence was found higher (41.0%) in men, 28.8%) in
women).14 The prevalence rate of obesity in many
Western countries is 22-23%.15 Moreover, obesity considered much lower than compared to industrial countries such as Unites States where the obesity rate is
35%.16
Decrease in physical activity due to increased dependence on transportation even for short distances, is one
of the causative factors for the development of overweight. Our study demonstrated that students regularly
engaged in physical activity were less overweight/obese
Ann. Pak. Inst. Med. Sci. 2012; 8(2):137-140
Muhammad Ashraf Chaudhry et al.
as compared to those students who were not carrying
out 30 minutes of physical exercise at least five days a
week, although this difference was statistically not significant (p = 0.28).
In our study, more students (n=32) were taking
fruits/vegetables daily as compared to not all (n = 12)
and this difference was statistically highly significant
(p=0.001). This is in contrast to the study carried out by
Aziz S and et al among children and adolescents of affluent schools of Karachi13 which found that the food
provided by the parents to their younger children was
not according to the food pyramid, but comprise of less
intake of vegetables and fruits.
In conclusion, important factors promoting obesity is a
change in lifestyle towards lack of physical activity and
taking less fruits and vegetables in daily diet. Awareness
has to be created among the general population regarding obesity, especially targeting our young adults, in
whom the process of weight gain is in its early stages
and would be more easily reversible.
Limitations of Study: This study had limitations. First,
the sample used in this study was a convenience sample and thus findings need to be interpreted with caution. Second, self-reported weight is likely to be an underestimation in the overweight and an overestimation in
the underweight sample.
Conclusion
Most of the cases of acute pancreatitis in our setup are
idiopathic in nature but gallstones continue to be the
second most common cause of AP. By investigating
patients with Multi Detector Computed Tomography
scan abdomen without and with contrast for AP will give
information regarding severity of pancreatitis as well as
the causative factor i.e. gall stone in CBD. This will
guide appropriate management.
References
1.
2.
3.
4.
5.
6.
National Healthy Survey of Pakistan, 1990—94.
World Health Organization. Nutrition-Controlling the global obesity
epidemic (on line) Updated 2009 Jan (Cited 2009 Feb 7). Available
from URL: http://www.who.int/nutriton/topics/obesity/en/index.html.
CDC-Centers for Disease Control and Prevention. Overweight and
Obesity- Defining Overweight and Obesity. Updated 2008 Jan 20
(Cited
2008
Oct
4)
Available
from
URL:http//www.cdc.gov/nccdphp/dnpa/obesity/defining.htm.
Chang PC, Li TC, Wo MT, Lin CS, LiCI, Chancc, e al. Association
between television viewing and the risk of metabolic syndrome in a
community-based population. BMC Public Health 2008; 8:193.
World Health Organization – Obesity: Preventing and managing the
global epidemic. Report of a WHO consultation on Obesity. Geneva.
WHO, 1998.
Blackburn H, Luepker R. Heart Disease. In: Last, SM (ed). MaxcyRosenau public health and preventive medicine. 12th ed. Norwalk,
Conn. Appleton Century – Crofts, 1986, pp.1159-93.
139
Frequency of overweight and obesity in students of medical college of Lahore
7.
Kooti RI, Panagiotakos BD. The epidemic of obesity in children and
adolescents in the world. Cent Eur J Public Health Nutr. 2005; 23:2508.
8. World Health Organization Fact Sheet September 2006.
www.who.int/medicalcentre/factsheets/fs311/en/index.html. Accepted
August 8, 2008.
9. Sharma A, Sharma K, Mathur KP. Growth pattern & prevalence of
obesity in affluent school children of Delhi. Public Health Nutr. 2007;
10:485-91.
10. Wickramasinghe VP, Lamabadusuriya SP, Attapttu N, Sathyadas G,
Kuruparanantha S, Karunarathne P. Nutritional status of school children in urban areas of Srilanka. Ceylon Med J 2004; 49:114-8.
11. Hingorjo MR, Syed S, Qureshi MA. Overweight and obesity in students
of a Dental College of Karachi: lifestyle influence and measurement by
an appropriate anthropometric index. J Pak Med Assoc August 2009;
59(8): 528-532.
Ann. Pak. Inst. Med. Sci. 2012; 8(2):137-140
Muhammad Ashraf Chaudhry et al.
12. Jafar TH, Chaturvedi N, Pappas G. Prevalence of overweight and
obesity and their association with hypertension and diabetes in in IndoAsian population. CMAJ 2008; 175:1071-7
13. Aziz S, Noorulain W, Zaidi U, Hossain K, Siddiqui IA. Prevalence of
overweight and obesity among children and adolescents of affluent
schools in Karachi. J Pak Med Assoc January 2009; 59(1): 35-38.
14. Yabanci N, Gocgeldi E, Simseh IKillic S. Prevalence of obesity, abdominal obesity and the associated factors among a group of Turkish
adults. Pak J Med Sci 2010; 26(1):21-25.
15. Sheikh MA, Kumar R, Ghori RA, Shaikh D. Comparison of frequency of
obesity in high risk non diabetic young individuals with low risk non diabetic young individuals. J Pak Med Assoc. June 2011; 61(6):522-524.
16. Lowry R, Galuska DA, Fulton JE, Wechsler H, Kan L, Collins JL. Physical activity, food choice and weight management goals and practices
among US college students. Am J Clin Nutr 2000; 71:44-53.
137