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SYNOPSIS
PREVALENCE AND PROBLEMS OF OBESITY
AMONG THE URBAN WOMEN OF SAMBALPUR,
ORISSA WITH VARYING DEGREES OF HEALTH
CONSCIOUSNESS
2011
DOCTOR OF PHILOSOPHY
IN
HOME SCIENCE
SAMBALPUR UNIVERSITY
Supervisor:
Candidate:
Dr. (Mrs.) B.K.Mishra
Professor
P.G. Dept. of Home Science
Sambalpur University
Jyoti-Vihar
Dipika Kar
Regd. No.104/2006
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SYNOPSIS
Obesity is a condition in which there is an excess of body fat. Being too
fat, especially to the point of obesity is positively harmful to the health.
Obesity is associated with a number of health hazards like it increases
mortality and morbidity rates causing certain diseases such as cardiovascular
diseases, respiratory insufficiency, diabetes and hypertension. It also reduces
the life expectancy and it leads to mechanical disabilities. In women it
increases the risk of cancer of gall bladder, breast and womb.
A high prevalence of obesity has been reported in female sex in India.
Summary
comparison of two major studies conducted by National Family
Health Survey (NFHS-2) in 1988-1999 and NFHS-3 in 2005-2006 shows that the
prevalence of obesity among Indian women has elevated from 10.6% to 12.6%
(increased by 24.52%). The prevalence is more profound in the women of age
between 40-49 years (23.7%), residing in cities (23.5%), having high
qualification (23.8%), belonging to Sikh community (31.6%) and households in
the highest wealth quintile (30.5%). Highest percentage of obese women is
found in Punjab (29.9%). While the problem of under - nutrition still exists in
many parts of India, the additional burden of obesity due to increasing
sedentary life style, Junk food habi1ts in some Urban and economically sound
areas is really alarming. Prevention and control of this serious problem through
awareness programmes to adopt diversified nutritional food and healthy life
style are strongly recommended.
Awareness among the women about health, nutrition and obesity is the
only way to reduce the epidemic of overweight and obesity. There are a
number of Government and Non-government organizations in India that are
working to generate awareness among women about health and nutrition.
Nutrition education has an important role for promoting health and reducing
the risk of developing chronic diseases of life style. Various sources are
available for the communication of nutrition messages to the public, such as
mass media (articles in magazines, news paper, radio and television), health
education materials and books as well as through food labeling and food
packaging.
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On the basic of these theoretical consideration the present investigation
on “prevalence and problems of obesity among the urban women of
Sambalpur, Orissa with varying degrees of Health consciousness” was carried
out with the following objectives.
OBJECTIVES:
The present study was undertaken with the following objectives.

To assess the prevalence of obesity and type of obesity among the urban
women by using the criteria of body mass index (BMI) and waist hip ratio
(WHR).

To find out the degree of health consciousness present among the
women, on the basis of knowledge, attitude and practice on health.

To record dietary pattern and estimate the food and nutrient intake,
anthropometric measurements of the women and to observe the
influence of socio-economic variables, obesity and health awareness on
it.

To assess the metabolic aberration with respect to blood pressure,
blood glucose and blood lipid profile in obese subject.

To find out the morbidity pattern of the respondents and to ascertain
the factors influencing such morbidity incidences.
Review of relevant literature has been done to have a clear grasp of the
work already done.
Keeping the objectives of the study in mind data were collected from
the urban women of Sambalpur town with the help of an interview schedule.
The field work was carried out during 2007-2009 by the researcher through
personal interviews using pre-tested questionnaires. The Urban women in the
age group of 25 years and above in different parts of Sambalpur town i.e. Modipara, Cheruapara, Gopalmal, Housing Board colony, Baraipali, Labour
colony, station colony constitute the universe of the study. It was decided to
select a total numbered of 200 urban respondents by adopting the purposive
sampling method. The general information was collected by interviewing the
women personally. Besides, information about health awareness, causes of
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obesity, problems of obesity, dietary habits was also collected by asking few
direct and indirect questions to the women. A diet survey was conducted to
access the food and nutrient intake of respondents. Oral questionnaire method
(24 hours recall method) was followed to estimate the mean intake of food by
the urban women during the last 24 hours. The nutrients content of the diet
were estimated following the tables of nutritive value of Indian foods given by
ICMR. Information on morbidity pattern was also collected. Anthropometric
measurements of women were also recorded by the help of different
nutritional indices. Out of total 200 samples, only sub samples of 30 obese
subjects were selected for
collecting
information on various biochemical
analyses like lipid profile test, Blood pressure, Blood glucose and haemoglobin
level. A number of statistical methods like mean, standard deviation, S.E of
mean, chi-square test, ANOVAs, correlation and multiple regression analysis
have been used here to interpret the data and draw conclusions and
inferences. The data were also compared with the finding of other researchers
and the similarities and dissimilarities were explained properly.
The results and discussion has presented in various parts covering the
various important dimension of the study.
1. HEALTH CONSCIOUSNESS
It was observed that about 19 percent of the women had level-I (poor)
health consciousness. About 40 percent had average and 32 percent had good
health consciousness. Only 9 percent of the women had level-IV or excellent
level of health consciousness.
There was no distinct pattern observed in level of health consciousness
and age. Health consciousness was maximum in 30-34 years of age group and
minimum in 55 & above years of age. The level of health consciousness was
found to be almost equal in all educational level of women except one i.e.
Health consciousness was maximum at higher educational level. There was not
much difference in the level of health consciousness between employed and
unemployed urban women. There also not much difference in level of health
consciousness of joint and nuclear families. No distinct pattern observed
between the level of health consciousness and the total monthly income of the
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family. With the increase in educational level of the husbands the level of
health consciousness among the urban women also increases.
Generally the level of health consciousness has a direct impact on
calorie and protein intake of the women. In this present study with the
increase in health consciousness
from average to excellent level,
the
percentage of above average calorie intake among the women decreases. Out
of 80 women who had average level of health consciousness, 66.66 percent of
women had average calorie intake as against 27.77 and 5.55 percent among
good and excellent level of health consciousness. A strong association exists
between the level of health consciousness and calorie intake (2 = 6.97,
p<0.05). Similarly out of 80 urban women who had average level of health
consciousness 36.84 percent of women had average protein
intake as against
34.21 and 7.89 percent among good and excellent level of health
consciousness. Test of hypothesis on association of attributes revealed that the
level of health consciousness was not associated with protein intake (2=0.35).
The test of hypothesis on association of attributes revealed no
association exists between different socioeconomic variables and health
consciousness of urban women. Test of hypothesis revealed no association of
health consciousness and obesity (2 = 0.04).
2. DIETARY INTAKE
Observation of this present study indicates an excessive intake of
cereals, oils & fats, sugar & jaggery among the obese and overweight
individuals. Infrequent consumption of vegetables was also observed among
the obese and overweight women. The concept of vegetables offering as much
nutrients as fruits, if taken fresh seemed to be lacking among most of the
women. Foods which were liked and consumed by all the subjects during
normal physiological state included milk, curd, meat fruit, green vegetables,
pulses, salad & lemon. Many of these above items included in the diet because
they were believed to be nutritious. The obese and overweight, however,
reported in addition, a special liking for foods like cheese, potato, chowmin,
pizza, fast foods and snacks.
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The intake of cereal was found to be 7.75 percent more than the RDA.
Pulses intake was found to be 15.55 percent less than the RDA. The intake of
green leafy vegetables, other vegetables, and roots & tubers were found to be
13.34, 21.85 and 19.75 percent less than the RDA. The intake of fruits was
found to be 174.8 percent more than the RDA. The intake of Oils & fats and
milk were 65.84 and 68.25 percent more than the RDA. The intake of sugar &
Jaggery was 6.12 percent less than the RDA.
There is significant difference in the average intake of cereals and sugar
& Jaggery (P<0.05) in relation to age of the women. No significant difference
was observed in the average intake of cereals, pulses, green leafy vegetables,
other vegetables, roots & tubers, fruits, sugar & Jaggery, milk & fleshy foods
with respect to educational level of urban women, except the intake of oils &
fats. The difference in intake of oils & fats was significant (P<0.05). A
significant difference with regard to the average intake of sugar & Jaggery was
observed between unemployed & employed women (P<0.05) in urban area and
also in relation to caste of the urban women. No significant difference
observed in relation to type of family of the women.
There is significant difference in the intake of GLV (P<0.05) in relation
to size of family. The difference in the average intake of roots & tubers was
found to be significant (P<0.05) with total income of the family. The
difference in the average intake of cereals was found to be significant (P<0.05)
with per capita income of the family. There is significant difference in the
average intake of pulses (P<0.05) with education of husband. No significant
difference observed in relation to occupation of husband.
In the present study, the intake of cereals, oils and fats, sugar and
jaggery and milk are higher in case of obese groups than the non obese. The
intake of pulses, green leafy vegetables, fruits and fleshy foods are higher in
non obese groups. The difference in the average intake of cereals and pulses
were found to be significant, (P<0.05) with prevalence of obesity. Intake of
cereals & fleshy foods were higher among non-conscious women. Pulses, GLV,
roots & tubers, fruits and milk intake were higher among conscious urban
women. Along with this oils and fats, sugar & Jaggery consumption also found
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to be higher among conscious urban women. But the analysis of variance
showed
no significant difference
in the average intake of cereals pulses,
GLV, roots & tubers, other vegetables, fruits, oils & fats, sugar & Jaggery,
fleshy foods in relation to health conscious of the urban women.
3. NUTRIENT INTAKE
The average intake of protein and calories were found to be 45.88 and
47.96 percent higher than the RDA. The intake of iron was found to be 19.06
percent less than the RDA. The intake of calcium was 112.18 percent higher
than the RDA. The high energy intake was contributed mainly by a higher fat
intake and high carbohydrate intake. The excess calories intake by the urban
women was mainly due to the inclusion of different types of cereal products in
breakfast and also in evening tiffins. In Urban areas it was found that every
family are using more amount of ghee and cooking oil in food preparation
which are very rich sources of fat. Iron intake was observed to be less in urban
areas because of less inclusion of pulses and green leafy vegetables in their
diets. The excess calcium intake by the urban women was mainly due to the
inclusion of more amounts of milk and milk products, fruits like bananas and
other pulses, groundnuts, egg & fish in their daily diets, which are very rich
sources of calcium.
With the increase in educational status of women the intake of protein
increases, but the intake of calcium and fat decreases. The average intake of
proteins, calories, fat, carbohydrate, iron were recorded to be higher in
unemployed urban women, where as only the intake of calcium was more in
employed women. The average intake of protein & calcium were higher in
women belonging to nuclear families where as the intake of calories,
carbohydrate and fat were higher in women belonging to joint families in
urban area. With the increase in per capita income level the intake of protein
also increases gradually. The intake of calories, fat, and carbohydrate were
found to be in an increasing order with the increase in percapita income level
of women, except one where the income level was above 5000. Education of
husbands also influenced the intake of different nutrients by the urban
women. The intake of protein was found higher when the education of husband
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was higher. But the intake of other nutrients like calories, fat, carbohydrate &
iron decreases with the increase in educational level of the husband.
There was no significant difference in average intake of all the nutrients
in relation to age, educational level, caste, type and size of family of the
women. A significant difference in average fat intake by the urban women was
found between the employed and unemployed groups (P<0.05). There is also
significant difference in average calcium intake (P<0.05) with percapita
income of the family. There was no significant difference in relation to
education and occupation of husband.
In the present study, intake of calories, fat and carbohydrate were
found higher in obese women than the non obese. These three nutrients are
the major cause for obesity among women. The difference in the average
intake of calories and fat were observed to be significant, (P<0.05) with
prevalence of obesity. Analysis of Variance showed no significant difference
with other nutrients. The intake of nutrients like calories, carbohydrates and
calcium were found higher among non-conscious women. But protein and fat
intake were higher among conscious urban women. Iron intake was found to be
similar in both the groups. No significant difference observed in nutrient intake
of urban women in relation to their health consciousness on the basis of
analysis of variance.
4. NUTRITIONAL ANTHROPOMETRY
There was no significant difference in anthropometric measurement in
relation to age, education, occupation, caste, type of family, and percapita
income of the urban women. There was significant difference in mean weight
and waist measurement in relation to size of the family (P<0.05). There was no
significant
difference
in
anthropometric
measurement
except
hip
circumference in relation to total income of the family (P<0.05). No significant
difference was found in relation to education and occupation of husbands.
There was no significant difference observed
in BMI level in relation to
different socio-economic variables. But significant difference was observed in
WHR in relation to size of the family and percapita income of the family
(P<0.05).
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A significant association was observed between age and BMI level among
the Urban women (2 = 31.12, P<0.05). The test of hypothesis on association of
attributes revealed no association exists in relation to education, occupation,
caste, type & size of family, total income, education and occupation of
husband with BMI level of women. A significant association was observed
between percapita income and BMI level (2 = 41.95, P<0.01). A significant
association was also observed between employment status of women & WHR
(2 = 9.24, P<0.01). No association observed in relation to age, education
caste, size & type of family, income level, occupation of husband with WHR
level of women. But a significant association observed between education of
husband and WHR (2 = 6.32, P<0.05).
Both BMI and WHR of the women increase with the increase in age of
the urban women. Education is directly related to the increase in BMI and
WHR. With the increase in educational level of women BMI and WHR also
increases. Both BMI & WHR were found more for unemployed or housewives
than the employed urban women. There was not much difference between the
BMI & WHR of the nuclear and joint families. No distinct pattern was observed
in BMI &WHR in relation to their income level. As the educational level of
husband increases the BMI value decreases. It was also observed that as the
occupational level of human decreases the BMI value also decreases.
Comparison of mean height, weight and body mass Index of urban
women with ICMR and NNMB data of women indicates that the mean height,
weight, and BMI of women of present study were higher than the mean of
urban women of India (NNMB (1980), ICMR (1980)). Calorie intake has a direct
impact in BMI and WHR level of women. With the increase in calorie intake
both BMI and WHR value increases. .
In case of obese women weight, waist circumference and MUAC are
higher than the non obese in the present study. The difference in
anthropometric measurements like height, weight, MUAC, waist circumference
were found to be highly significant, (P<0.05) with prevalence of obesity on the
basis of analysis variance. The anthropometric measurements like height,
weight, MUAC and waist circumference were found similar in both conscious
and non-conscious urban women, expect hip circumference. There is no
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significant difference observed in anthropometric measurements of the urban
women in relation to their health consciousness.
5. MORBIDITY PATTERNS
India is one of the many developing countries, which have high level of
morbidity. The morbidity in different population groups may have different
implications on the national development. Various morbidity patterns
prevalent in urban women are cold, headache, fever, diarrhoea, joint pain,
arthritis, digestive disorder and reproductive problems. Thus the prevalence of
diseases among the urban women was in the order of Headache > diarrhoea >
cold > digestive disorder > fever > reproductive problem > joint pain >
Arthritis.
It was found that with the increase in age of the urban women the
occurrence of arthritis, joint pain, and digestive disorder found to be
increasing. Headache is a common problem and it was found to be almost
equally prevalent in all age group. The morbidity episodes related to
reproductive problems was observed to be very less and thus it could not be
taken into consideration to observe the association with age.
Incidence of cold, diarrhoea & digestive disorder found to be at highest
level where the educational level is also higher. The morbidity episodes
related to joint pain and arthritis were observed to be very less and thus it
could not be taken into consideration, to observe the association with
educational status.
Occurrences of cold, fever, diarrhoea, joint pain, arthritis, digestive
disorder were found to be higher in case of unemployed women in comparison
to the employed women in urban area. But reproductive problem was observed
more in employed women compared to unemployed urban women.
The occurrence of cold, diarrhoea, joint pain, arthritis, digestive
disorder and respiratory problem were reported to be higher in women
belonging to joint families, than the nuclear families. Headache is a common
problem in both nuclear and joint families.
The occurrence of cold, fever and diarrhoea were found higher in those
women whose total monthly income was also high. The morbidity episodes
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related to joint pain and arthritis shows no distinct pattern in relation to total
monthly income of the family.
The morbidity episodes related to join pain and arthritis were found
higher among the urban women, where the husbands education was also at
higher level (above post graduation).
6. BIOCHEMICAL EXAMINATION
Though a total of 200 urban women were selected purposively from
different area of Sambalpur for studying the prevalence and problems of
obesity, only a sub sample of 30 obese subjects were used for biochemical
analysis, as it is not possible to take the biochemical analysis of all the
subjects because of the time, energy and financial constraints. The mean value
of the lipid profile of the selected obese subjects revealed that there was no
abnormality in fractions, though the subjects were obese which indicate that
their overweight is of recent origin. The systolic and diastolic pressure was
more than the normal value in all 30 obese women, which clearly means that
they were all high blood pressure patients.
SUGGESTION AND RECOMMENDATION
Positive strategies that could be adopted to retard the escalation of
obesity among urban Indians could include the following.
(1)
To use a low calorie and low carbohydrate diet regarded as more
suitable to avoid obesity.
(2)
Regular physical exercise should be encouraged to reduce weight.
(3)
A major factor in effective fat loss is high psychological motivation. The
victim of obesity must deeply want to become and remain lean. He must
firmly aware of the hazards that obesity can inflict upon quality and
length of his life.
(4)
An intensive programme of health education through media on the
problem of overweight/obesity, designed to promote healthy dietary
practices and regular physical exercise.
(5)
The provision of facilities for dietary counseling and short periods of
daily physical exercise/training in large establishments (public/private
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sector) employing a large number of people for sedentary occupations.
In the long run, investments on this some what innovative approach may
prove valuable and cost-effective, benefiting both the management and
the members of the staff.
(6)
Improvement of nutrition education programs with regard to obesity
through in service courses in nutrition for teachers with special
emphasis on weight control in the context of adolescence.
(7)
Soft drinks, fruit juices and sports drinks are loaded with sugar; drink
fat free or low fat milk or water instead.
(8)
Eat at least five servings of fruits and vegetables a day.
(9)
Avoid fast-food restaurants.
(10)
Eat a healthy breakfast everyday.
(11)
Don’t eat meals or snacks while watching.
(12)
A simple and very effective strategy in the prevention of obesity is
walking and cycling. Encourage walking to near destinations instead of
driving a short distance.
Last but not the least the bibliography section presents a list of all the
literature, which were referred, cited and quoted in the text. Appendix
provides the demographic analysis and the questionnaire (interview scheduled)
of the present study.
Supervisor
Candidate:
Dr. (Mrs.) B.K. Mishra
Dipika Kar
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