Obesity Among Medical Students_nov08_final

Study on the prevalence of overweight / obesity among the medical students of AIMST University, Kedah, Malaysia. By

Dr.S.Gopalakrishnan. MD, DPH Senior Associate Professor, Community Medicine &

Dr.R.Arulmoli. MS Professor, Anatomy

Faculty of Medicine & Health Sciences, AIMST University Semeling, Kedah

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Summary Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used in classifying overweight and obesity in adult populations and individuals. A study was conducted to screen the medical students studying at AIMST University for overweight / obesity using BMI and to determine the prevalence among these medical students. Also to create an awareness among the medical students of AIMST University and the general public about the health effects of overweight / obesity and ways and means of preventing it. The study is an Institution based cross sectional observation conducted among 290 medical students using pre-designed and pretested questionnaire. Data was analyzed statistically by simple proportions. Out of 290 students participated in the study, male students were 131 [45.2%] and the female students were 159 [54.8 %]. 43 [14.8%] were found to be overweight; males 18 [13.7%] and females 25 [15.7%]. There were 46 [15.9%] pre-obese students: males 24 [18.3%] and females 22 [13.8%]. That means 32.0% of the males were overweight or pre-obese while only 29.5% females were overweight or pre-obese. 15 [5.2%] were found to be obese: males12 [9.2%] and females 3 [1.9%]. Also 43 [14.8%] were found underweight: males 16 [12.2%] and females 27 [17.0%]. In the study group there were 185 [63.8%] Indians, 94 [32.4%] Chinese and 11 [3.8%] Malays. The study reveals that the prevalence of overweight and obesity among the medical students of AIMST University is on the higher side, which is comparable to the findings of earlier studies conducted in Malaysia, reinforcing the need to encourage healthy lifestyle, healthy food habits and a physically active daily routine, among the adolescents and youth of this country. Key Words: Overweight, Obesity, Body mass index, Medical students

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Introduction Obesity is now a disease that affects nearly one-third of the adult population. The number of overweight and obese people has continued to increase since 1960, a trend that is not slowing down. Obesity is a chronic disease with a strong familial component. Obesity increases one's risk of developing conditions such as high blood pressure, diabetes (type 2), heart disease, stroke, gallbladder disease and cancer of the breast, prostate and colon. The tendency toward obesity is fostered by our environment: lack of physical activity combined with high-calorie, low-cost foods.1 Persons with obesity are victims of employment and other discrimination, and are penalized for their condition despite laws and policies. Obesity is the second leading cause of unnecessary deaths. According to the World Health Organization, there are over 300 million obese adults and 1.1 billion overweight people worldwide. Being underweight used to be much more common worldwide than obesity. Now the two conditions co-exist, with half of the world's population underweight and the other half overweight.1 The prevalence of overweight and obesity is increasing worldwide at an alarming rate in both developing and developed countries. Environmental and behavioral changes brought about by economic development, modernization, and urbanization has been linked to the rise in global obesity. Obesity is increasing in children and adults, and true health consequences may become fully apparent in the near future. Persons with obesity are at risk of developing one or more serious medical conditions, which can cause poor health and premature death. Obesity is associated with more than 30 medical conditions and scientific evidence has established a strong relationship with at least 15 of those conditions. Preliminary data shows the impact of obesity on various other conditions. Weight loss of about 10% of body weight, for persons with overweight or obesity, can improve some obesity related medical conditions including diabetes and hypertension. According to a recent study by the RAND organization, obesity is more damaging to health than smoking, high levels of alcohol drinking and poverty. Obesity affects all major body systems - heart, lung, muscle and bones. 2 The Global burden of overweight and obesity is increasing and is well documented by various studies conducted by different agencies at different locations. A similar effort is undertaken in Malaysia also but still a comprehensive picture is not available. There is a general perception that the incidence of overweight and obesity are on the rise. This study was designed to determine the magnitude of the problem in a microscopic level, since the target population identified for the study is representing the youths and young adults of this country. With the above background, this study was undertaken with the following objectives: 1. To screen the medical students study at AIMST University for overweight / obesity using BMI, to determine the prevalence among these medical students. 2. To create an awareness among the medical students of AIMST University and the general public about the health effects of overweight / obesity and ways and means of preventing it.

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Materials & Methods Type of study: Institution based cross sectional observational study. Place of study: The present study was conducted among the medical students of AIMST University which is catering to the education needs of the young adult population from the peninsular Malaysia. Duration of Study: One month from15-5-07 to 15-6-07. Study population: The study subjects were the medical students in the age group of 19 to 25 yrs. The total number of students studied was 290. Study tool: A pre-designed pre-tested questionnaire Methodology: After getting permission from the University authorities, the batch leaders were explained the purpose and the whole process of the study. The students were briefed about the questionnaire and written consent was obtained via a consent form that stated the purpose of the study, procedures and the assurance of confidentiality of the results. Demographic data such as age, gender, ethnic origin and their present weight in kilograms and height in centimeters were collected by the self administered structured questionnaire. Students were given instructions on how to measure the weight and height correctly. The measurements were taken using a standardized weighing machine and a height measuring scale which was available in the Research laboratory of the Medical School. The measurements were recorded in the presence of the investigators. During the process the students were wearing normal clothing without their footwear. After collecting the questionnaire from the students, their queries were answered by the investigator. Statistical Analysis: Data obtained were collated and analyzed statistically by simple proportions. Body Mass Index (BMI) is a mathematical calculation used to determine whether a patient is overweight. BMI is calculated by dividing a person's body weight in kilograms by their height in meters squared (weight [kg] height [m]), 3 [This number can be misleading, however, for very muscular people, or for pregnant or lactating women]. Being obese and being overweight are not the same condition. A BMI of 30 or more is considered obese and a BMI 25 to 29.9 is considered overweight/pre-obese.

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Results: A total of 290 medical students participated in the study and the age range of the students is from 19 to 25 years. Male students were 131 [45.2%] and the female students were 159 [54.8 %]. Table 1 shows that, out of the 290 medical students studied, 43 [14.8%] were found to be overweight; males 18 [13.7%] and females 25 [15.7%]. There were 46 [15.9%] pre-obese students: males 24 [18.3%] and females 22 [13.8%]. That means 32.0% of the males were overweight or pre-obese while only 29.5% females were overweight or pre-obese. 15 [5.2%] were found to be obese: males12 [9.2%] and females 3 [1.9%]. From the Table 1, it can be found that 43 [14.8%] were underweight: males 16 [12.2%] and females 27 [17.0%]. Only 143 [49.3%] were found to be having normal weight: males 61 [46.6%] and females 82 [51.6%]. The remaining 104 [35.9%] were found to be above normal weight. Table 2 shows the ethnic origin wise distribution of the BMI status among the medical students. The whole batch of 290 students comprised of Indians, Chinese and the Malays which form the major ethnic groups in multi racial Malaysia. In the study group there were 185 [63.8%] Indians, 94 [32.4%] Chinese and 11 [3.8%] Malays. From the Table 2, it can be found that 31 [16.8%] Indians and 12 [12.8%] Chinese students were underweight. Normal weight group comprised of 83 [44.9%] Indians, 53 [56.4%] Chinese and 7 [63.6%] Malays students. Out of the 43 [14.8%] overweight students, 27 [14.6%] were Indians, 14 [14.9%] were Chinese and 2 [18.2%] were Malays. Out of the 46 [15.9%] Pre-obese students, 32 [17.3%] were Indians, 12 [12.8%] were Chinese and 2 [18.2%] were Malays. Among the 15 [5.2%] Obese students, 12 [6.5%] were Indians and the remaining 3 [3.2%] were Chinese and no Malay students were found to be obese.

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Discussion This study shows that 43 [14.8%] medical students out of the 290 studied were found to be overweight, 46 [15.9%] were pre-obese and 15 [5.2%] were found to be obese. In other words, when the overweight group and the pre-obese group are combined, it amount to 30.7%, which is much higher than the findings of other studies conducted earlier in Malaysia. The 5.2% obese group shows a similar trend shown in the earlier studies. The National Health Morbidity Survey data reveal that in adults, 20.7% were overweight and 5.8% obese.1 This study also showed that the prevalence of obesity was clearly greater in women than in men. In women, obesity rates were higher in Indian and Malay women than in Chinese women, while in men the Chinese recorded the highest obesity prevalence followed by the Malay and Indians.1 This study also shows that 32.0% of the males were overweight to pre-obese while it is 29.5% for the females. This shows that males were found to be slightly more overweight when compared to the females, while most of the other studies showed that prevalence of overweight to pre-obese status as well as obesity was clearly greater in females. Similarly of the 15 [5.2%] found to be obese: males were 12 [9.2%] and females were 3 [1.9%]. In a study conducted in Kelantan by the Department of Medicine, Universiti Sains Malaysia, the height and body weight were measured in 2,284 subjects over 20 years old. The overall prevalence of overweight [BMI (kg/m2) > or = 25-< or = 30] and obesity (BMI > 30) was 21.3% and 4.5% respectively.4 Another study measured the body mass index (BMI), and assessed attitudes and knowledge about obesity, of 197 male and 217 female patients aged 20-59 years attending the primary care clinic of the University Hospital in Kelantan, Malaysia. There was no significant difference between the mean BMI of males (23.7) and females (24.2). In the overweight group (BMI 2529.9) were 60 men (30%) and 66 women (30%). In the obese group (BMI 30 and above) were 12 men (6%) and 22 women (10%).5 This study also shows that 59 [31.9%] Indians, 26 [27.7%] Chinese and 2 [36.4%] Malays were in the overweight to pre-obese stage, while 12 [6.5%] Indians and 3[3.2%] Chinese were obese. There were no Malay students in the obese category. This high ethnic distribution among the Indian students may be a reflection of the highest number of Indian students [63.8%] among the study group when compared to the Chinese and Malay groups. The findings of this study and that of the earlier studies shows that the prevalence of overweight to obesity among the Malaysian population is much lower when compared to the American adults. Among 2007 Behavioral Risk Factor Surveillance System [BRFSS] respondents in US Adults: 25.6% were obese. [26.4% of men and 24.8% of women were obese], The obesity prevalence ranged from 19.1% for men and women aged 18--29 years to 31.7% and 30.2%, respectively, for men and women aged 50--59 years.6

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Another observation found in this study was that out of the 290 studied, 43 [14.8%] were underweight: males 16 [12.2%] and females 27 [17.0%]. Ethnic origin wise, 31 [16.8%] of the Indians and 12 [12.8%] Chinese were found to be underweight. No Malay students were found to be underweight. This study shows that there is a higher prevalence of underweight problem among the female students studying in the university when compared to the male students. In an Indian study conducted among adolescents in Punjab, obesity was 3.4% and overweight was 12.7%(15% of boys were overweight as compared to 10% of girls). 7 A study conducted among medical students at Ain Shams University,Cairo,Egypt, revealed 12.5% obesity and 36.9% overweight. 8 The Iranian study conducted among medical students at Iran University of Medical Sciences, Tehran, showed 10% were underweight while 12.4% were obese and overweight (7.9% of males versus 22.5% females). 9

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Conclusion The prevalence of various medical conditions increases with overweight and obesity for men and women. Being overweight or obese increases the risk of many diseases and health conditions, including hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, some cancers (endometrial, breast, and colon) etc. Diabetes, hypertension and other obesity-related chronic diseases that are prevalent among adults have now become more common in youngsters. The percentage of children and adolescents who are overweight and obese is now higher than ever before. Poor dietary habits and inactivity are reported to contribute to the increase of obesity in youth. Today's youth are considered the “most inactive generation” in history caused in part by reductions in school physical education programs and unavailable or unsafe community recreational facilities. This study reveals that the prevalence of overweight and obesity among the medical students of AIMST University is on the higher side, which is comparable to the findings of earlier studies conducted in Malaysia. Another revelation of this study is the sizeable proportion of students who are underweight among the medical students, particularly among the female students. Thus the .findings of the study reinforces the need to encourage healthy lifestyles, healthy food habits and a physically active daily routine, among the adolescents and youth of this country, so that the dangers of the risks of developing chronic degenerative diseases earlier in life can be prevented. This can be achieved by proper awareness creation about healthy lifestyles among the youth of this country.

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References 1. Fact Sheet about Obesity. American Obesity Association 2007 [www.obesity.org] 2. RAND Organization. [www.rand.org] 3. Shashikiran U, Sudha V, Jayaprakash B .What is Obesity? The Medical Journal of Malaysia 2004;59 :10-14. 4. Mohamad WB.Prevalence of obesity and overweight in northeastern peninsular Malaysia and their relationship with cardiovascular risk factors. Southeast Asian J Trop Med Public Health. 1996 27(2):339-42. 5. Jackson A , Cole C, Esquiro J, Edwards M. Obesity in primary care patients in Kelantan, Malaysia: prevalence, and patients' knowledge and attitudes. Southeast Asian J Trop Med Public Health.1996;27(4):776-9. 6.Obesity Statistics: American Obesity Association 2007 [www.obesity.org/information/factsheets.asp] 7. Aggarwal T, Bhatia RC, Singh D, Sobti PC . Prevalence of Obesity and Overweight in Affluent Adolescents from Ludhiana, Punjab. Indian Pediatr. 2008 ; 45(6):500-502. 8. Bakr EM, Ismail NA, Mahaba HM Impact of life style on the nutritional status of medical students at Ain Shams University.J Egypt Public Health Assoc 2002; 77(1-2):29-49. 9. Nojomi M, Najamabadi S Obesity among university students, Tehran, Iran. Asia Pac J Clin Nutr 2006; 15(4):516-20.

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Appendix: Table -1: Sex wise distribution of BMI among medical students Classification

BMI ( kg / m² )

Male

Female

Total

No

%

No

%

No

%

< 18.4

16

12.2

27

17.0

43

14.8

Normal weight

18.5 - 22.9

61

46.6

82

51.6

143

49.3

Overweight

23.0 - 24.9

18

13.7

25

15.7

43

14.8

Pre - Obese

25.0 - 29.9

24

18.3

22

13.8

46

15.9

12

9.2

3

1.9

15

5.2

131

100.0

159

100.0

290

100.0

Underweight

Obese

> 30 Total

Figure -1: Sex wise distribution of BMI among medical students 60

51.6 49.3 46.6

50

Male % Female %

40

Total %

30

20

17 12.2

15.714.8 13.7

14.8

18.3 15.9 13.8 9.2

10

1.9

0

Underweight

Normal weight

Overweight

Pre - Obese

5.2

Obese

BMI classification

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Table -2: BMI and ethnic origin of medical students Ethnic origin Classification

Indian

Total

Malay

Chinese

No

%

No

%

No

%

No

%

Underweight

31

16.8

12

12.8

0

.0

43

14.8

Normal weight

83

44.9

53

56.4

7

63.6

143

49.3

Overweight

27

14.6

14

14.9

2

18.2

43

14.8

Pre - Obese

32

17.3

12

12.8

2

18.2

46

15.9

Obese

12

6.5

3

3.2

0

.0

15

5.2

Total

185

100.0

94

100.0

11

100.0

290

100.0

Figure -2: BMI and ethnic origin of medical students 70

63.6 60

56.4

50

44.9

INDIAN %

49.3

CHINESE % MALAY %

40

TOTAL %

30

20

18.2 14.9 14.8 14.6

16.8 14.8 12.8

17.3 18.2 15.9 12.8

10

0

6.5 5.2 3.2 0

0 Underweight

Normal weight

Overweight

Pre - Obese

Obese

BMI classification

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Figure-3: BMI Classification of all Medical Students

Obese 5.2%

Pre - Obese

Under weight 14.8%

15.9% Over weight 14.8%

Normal weight 49.3%

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