http://doi.org/10.33698/NRF0060Sukhpal Kaur, Indarjit Walia
Abstract : A descriptive study to determine the prevalence of obesity by measuring body mass index, waist circumference and waist hip ratio was undertaken. This study was carried out on 189 nursing students aged 17-23 years. About one third were non vegetarian and 94.17% were in the habit of consuming junk food. Approximately half of them were doing regular exercises. Body weight, height, waist circumference and hip circumference of all the participants were taken. Based upon these values body mass index and waist-hip ratio was calculated. Eleven (5.82%) participants were over weight and 4 (2.12 %) were obese as per Body Mass Index. Almost similar finding were indicated by waist circumference. The percentage of over weight and obese was 23.28 and 7.84 respectively while the classification was based on waist hip ratio. Markers of central obesity i.e. waist-hip ratio appeared to be the most sensitive indicators of obesity followed by waist circumference and body mass index respectively as it indicated over weight and obesity four times as compared to other indicators.
Key words :Body mass Index, obesity, waist circumference, waist hip ratio.Correspondence at :Sukhpal Kaur Lecturer, National Institute of Nursing Education , PGIMER, Chandigarh.
With the improvement in standards of living, decrease in physical activities, dependence of men on machine, dietary changes and other life style changes people are putting on extra weight. This gain in body weight and obesity is posing a real threat to health both in children as well as adults all over the world. Obesity has become a serious health problem in the developed as well as developing countries. In US current estimates have put the prevalence of over weight in adults at 61 % and of obesity at 26%. Similar patterns have been observed in majority of developing nations also.1 Globally the prevalence of obesity in women exceeds that in men.2 Over weight and obesity are risk factors for cardiovascular diseases, certain types of cancers, type 2 diabetes, hypertension, osteoarthritis, gall stones, dislipidemia and musculoskeletal problems.3- A study conducted on nurses’ health highlighted over weight/obesity as the single most predictors of diabetes.6 Children display the same co-morbid disease risk markers as for adults. As many as 75% of obese adolescents go on to become obese adults and carry the same risk of co-morbid disease in adulthood too.7 Simple anthropometrical measurements are taken to rule out obesity and are more practical both in the clinical practice and for large scale epidemiological studies. Body mass index (BMI) which is calculated as weight in kilograms divided by the square of height in meters is the most widely used and is a simple measure of body size.8 However this measurement does not account for variation in body fat distribution and abdominal fat mass. Excess intra-abdominal fat is associated with greater risk of obesity related morbidity than in overall adiposity.9 Waist circumference (WC) and waist-hip ratio (WHR) are the measures of visceral or abdominal fat mass. These measures are independent of height and muscle mass, have emerged as important predictors of risk of obesity related diseases and are thus very useful indicators of excess body fat and increased health risk.IO Measurements of WC and WHR are relatively simple and easier to calculate. It has been reported that WC and WHR showed significant association with myocardial infarction as compared to BMI. 11,12 The purpose of present study was. to evaluate body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) as predictors of health risk for being over weight amongst the nursing students.
The study was conducted at National Institute of Nursing Education, Post Graduate Institute of Medical Education Research Chandigarh in the month of September 2005. This institute is one of the premier institutes of the country offering graduate and post graduate degree courses in nursing. In the present study a total of 189 B.Sc. Nursing (4years) students were included.
Body weight, height, waist and hip circumference and waist-hip ratio were measured by the following procedures: Weight was measured after removal of shoes while wearing light clothing. Height was measured without shoes in the standing position with the shoulders in relaxed position and arms hanging freely. BMI was calculated as weight (kg)/height in meter2. The classification of BMI was as follows: 13
Less than 18.5-under weight 18.5-24.9 – healthy weight range 25.0-29.9 – over weight
More than 30.0-obese.
Waist circumference was measured using a measuring tape over the unclothed abdomen, with measurements made halfway between the lower border of the ribs and the highest point of iliac crest (at the umbilicus level) in the standing position. Participants with waist circumference of 80-87.9 cm were classified as over weight and with >88.0 cm were classified as obese. 13 Hip circumference was measured over light clothing at the widest point over the buttocks when viewed from the side. Waist hip ratio was obtained by dividing the waist circumference by hip circumference. The participants with WHR 0.80-0.84 were classified as over weight and with WHR >0.85 were classified as obese.13 Data is analysed by descriptive statistics.
A total of 189 respondents participated in the study. The mean age ± S.D. was 19.8±1.66 with the range of 17-23 years. All were female. About one third i.e. 32.3% were non-vegetarian. Most of them (94.18%) were in the habit of consuming junk and fried foods like chips, noodles, patties, hot dogs, chocolates and pastries etc. About half of the respondents were doing regular exercises in the form of walking, yoga, outdoor games, cycling and skipping. (Table 1)Table 1: Characteristics of respondents N=189
|Age (yrs) Mean±S.D.||19.8±1.66|
|Non vegetarian||61 (32.3)|
|Consumption of junk food|
|Type of exercise|
|Others *||08 (8.9)|
* Outdoor games, cycling, skipping
Type and frequency of junk food consumption
Table 2 depicts the type and frequency of consumption of junk food by the participants. Samosa was the most preferred and was consumed one per week. Patties and
cold drinks were preferred two to four times and more than four times a week by 29.21 % and 10.11% of the subjects respectively. However one fourth of the subjects (24.15% preferred cold drinks once a week and one third (30.33%) preferred chips once a week.
Table 2 : Type and frequency of junk food consumption
|Item||Once / week n(%)||2-4 times / week n(%)||>4 times / week n(%)|
T.V. Wathching by the paricipants
About half of the subjects were watching TV rarely or less than an hour daily
while one third of them were watching daily for 1-2 hours. Rest of them i.e. (10%) were watching for 2-3 hours daily and even more than 3 hours (1.6%) daily. (Table 3)
Table 3 : T.V. Watching by the participants N=189
|T. V. watching||n (%)|
|Occasionally or rarely
1-2 hours/day 2-3 hours / day
Prevalence of obesity as per BMI, WC, WHR
Table 4 shows the prevalence of obesity as per BMI, WC, and WHR. Out of the total respondents two third i.e. 67.7% had normal BMI (18.5-24.9kg/m2). Eleven (5.82%) participants had BMI in the range of 25.0 to 29.99 kg/m2 which is considered to be overweight. Only 4(2.12%) were obese with BMI>30 kg/m2. Almost similar findings were observed by the measurements of waist circumference i.e. 6.87% subjects were over weight and 2.65% were obese. However the percentage of over weight and obese raised to almost four times i.e. 23.28% and 7.94% respectively when classified as per waist-hip ratio.
Table 4. Prevalence of obesity as per BMI, WC, WHR
|Over weight||11 (5.82)||13(6.87)||44(23.28)|
Over weight and obesity are common health conditions. Body mass index, waist circumference are the commonly used parameters to evaluate obesity. The influence of high values of all these parameters on various metabolic and cardiovascular diseases is multiplicative, so weight loss should be urged to all those who are falling in the above said category. The present study was an attempt to identify over weight and obese nursing students by body mass index, waist circumference and waist-hip ratio. As indicated by BMI about 8% were over weight and obese, however this figure increased to 10% when waist circumference was considered as a parameter. However the percentage of obese and over weight increases four folds when the classification was based on waist hip ratio. That means central obesity as per waist-hip ratio is more prevalent than general obesity. The importance of central distribution of fat has been known since decades. Waist circumference has become the preferred measure for abdominal obesity. Han has also repor ted that the larger waist circumference helps in identification of people at increased cardiovascular risks14. In the INTERHEART study, it was very clear that out of different anthropometric measures waist- hip ratio shows the strongest relation with the risk of myocardial infarction. More over thisratio was the strongest predictor of MI irrespective of age, sex, smoking status, diabetes, lipid levels and blood pressure.15,16 One more study also confirmed waist hip ratio as an important risk factor for death from coronary heart diseases.17 Thus waist-hip ratio is the best of all parameters in anthropometery while assessing obesity. The incidence of obesity as per WHR in our study is fairly high and merits intervention for reduction of abdominal circumference. Although not much data is available on over weight / obesity in adolescent, but there is growing concern about these problems. The National Health and Nutrition Examination Surveys (NHANES Cycle I,II,III) have been surveying the prevalence of obesity in American children and youth since 1971. The 1988-91 NHANES cycle III study identified 21 % of adolescents with 12-19 years of age as being over weight.18 Currently 35% of American college students are now over weight. The prevalence of over weight and obesity in Indian school based data demonstrates an obesity range of 5.6% to 24% for the children and adolescents respectively. 19-20 In one of the studies conducted at China it was reported that the prevalence of over weight and obesity in young adults had moved up from 10% to 15% for urban areas, and from 6%-8% in rural areas over a ten year period (1982-1992).
WHO estimates that globally 60% of deaths are due to unhealthy diets and physical inactivity, with 79% of these deaths in developing countries.13 There are many factors that contribute to obesity in our modern culture. The change in diet and physical activity contribute to the increased prevalence of obesity in youth. Dietary pattern in adolescence not only influence their immediate well being but also have an impact on their long term health. Some of these behaviors may be compromised in adolescents because they are less dependent on their parents for meals, spend more time away from home and consume greater quantity of fast foods and snacks. In the current study it was observed that many participants were in the habit of consuming junk food in the form of samosa, patties, hot dogs, chocholates, pastries, cold drinks and chips etc. Junk food is basically a slang term used for food with high calories and limited nutritional values. While working on computers, watching television and playing video games snacks are consumed and physical exertion is reduced which adds up to calorie intake. In the present study it was observed that 42% of the participants were watching TV for 1-2 hrs/day and 1. 6% admitted to watch for more than 2 hours / day which is quite long. It has been mentioned that watching TV more than 2 hours / day increases adolescents chances of being over weight.
Thus to conclude it is emphasised that adolescence is a unique intervention point in the life cycle and the knowledge regarding optimal nutrition can be acquired during this period that could prevent or delay adult-onset diet related illnesses later on. Further, it is during adolescent years that most people develop life style habits that are likely to become the foundations of their adult behaviors.
- Reilly JJ, Dorosty Epidemic of obesity in UK children. Lancet 1999; 354: 1874-75.
- Kumanyika Obesity in minority population: an epidemiologic assessment. Obes Res 1994;2: 166-83.
- Manson JE, Colditz GA, Stampfer A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med 1990; 322: 882-89.
- Colditz GA, Willett WC, Stampfer Weight as a risk factor for clinical diabetes in women. Am J Epidemiol1990; 132: 501-13.
- Carman WJ, Sowers M, Hawthorne VM, Weissfeld Obesity as a risk factor for osteoarthritis of the hand and wrist: a prospective study. Am J Epidemiol 1994; 139: 119-29.
- Hu FB, Manson JE, Stampfer Diet, life style and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001; 345: 790-97.
- Campbell IW, Haslaw Obesity. Churchill Living Stone. Reed Elsevier India Private Limited. New Delhi.
- Coldiz G, willett W, Rotnitzky A, Manson
- Weight gain as a risk factor for clinical diabetes mellitus in Ann Intern Med 1995; 122: 481-86.
- Ho SC, Chen YM, Woo JL, Leung SS, Lam TH, Janus Association between simple anthropometric indices and cardiovascular risk factors, Int Obes Relat Metab Disord 2001; 25: 1689-97.
- Folsom AR, Kushi LH, Anderson KE, Mink PJ, Olson JE and Hong CP et Association of general and abdominal obesity with multiple health outcomes in older women. Arch Intern Med 2000; 160: 2117-28.
- usuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MJ and Commerford Obesity and the risk of myocardial infarction in 27000 participants trom 52 countries: a case-control study. Lancet 2005; 366: 1640-49.
- Welborn TA, Dhaliwal SS, Bennett SA. Waist-hip ratio is the dominant risk factor predicting cardiovascular death in Australia. Medical Journal of Australia 2003; 179: 580-85.
- World Health Organization. Obesity- preventing and managing the Global Epidemic: Report of a WHO cosultation on Geneva: World Health Organization, 1998.
- Han van Leer E, Seidell J, Lean M. Waist cicumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. BMJ 1995; 311: 1401-05.
- Yusuf S, Hawken S, Ounpuu Effects of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937-52.
- Ounpuu S, Negassa, Yusuf INTER- HEART: a global study of risk factors for acute myocardial infarction. Am Heart J 2001; 141: 711- 21.
- Prineas RJ, Folsom AR, Kaye Central adiposity and increased risk of coronary artery disease mortality in older women. Ann Epidemiol 1993; 3: 35-41.
- Zhu SK, Wang ZM, Heshka S. Waist circumference and obesity-associated risk factors among whites in the third National Health and Nutrition Am J Clin Nutr 2002; 76: 743-49.
- Yadav Obesity: An increasing problem in the developing countries. Indian J Practical Pediatr 2001; 4: 293-99. Kapil U, Singh P, Pathak P, Dwivedi SN, Bhasin S. Prevalence of obesity amongst aflluent school children in Delhi. Ind Pediatr 2002; 39: 449–52.