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INTRODUCTION:
Health is a common theme in most cultures. In fact all communities
have their own concepts of health as part of their culture. Among the
definition still used probably the oldest is that health is the “absence of
disease”. But according to WHO “Health is the state of complete physical,
mental and social well being and not merely the absence of disease or
infirmity”. Good health is a vital part of great experience of living. So
attempts are being made to give every one a fair chance to lead a healthier
and fuller life. To maintain good health, a diet containing the essential food
and nutrient is very important. Adequate nutrition is necessary for vitality,
longevity and sound health. It has direct bearing on the work efficiency and
cultural productivity. Food is essential for human existence just like air we
breathe or the water we drink (Park, 2000: 1).
Health is not a static phenomenon, but a dynamic life process which
begins at birth and is governed by the genetic, nutritional and
environmental factors throughout life. The calorie and nutrient intake
affect work capacity and output and if the nutrient intake is either too
much or too low, it results in obesity and malnutrition. The word obesity
comes from a Latin word “Obesus” which originally meant “eaten away” or
wasted, but in a relative sense came to mean a person or even a bird that
had eaten fat. 17 to 38 percent of the Indian populations are obese.
(Thilakavathi and Vijayalakshmi, 2002: 153).
Obesity may be defined as a condition in which excessive
accumulation of fat in the adipose tissues has taken place. It arises when
the intake of food is in excess of physiological needs. Obesity is the most
common nutritional disorders in the western countries and among the high
income groups in the developing countries (Swaminathan, 1998).
An excess of twenty percent above the ideal body weight can be
termed as obesity. Maintenance of body weight within the limits of
facilitating optimum health is of prime importance for maintaining good
health. Obesity or excess fatness is the commonest problem of the affluent
and it is the night mare of every woman above twenty years and of middle
aged men. The prevalence of obesity in our country is high enough to make
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it a serious health problem. In strict terms, the diagnosis of this disorder
depends on the demonstration of an increased body fat content (Naidu and
Begum, 1992: 154).
The prevalence of obesity, aptly described as a genetic misfortune,
has reached epidemic dimension worldwide and is continuing to rise at an
alarming rate even in developing countries where human hunger is the other
side of the coin. It is estimated that more than 300 million people world
wide are obese. According to Koon the prevalence rates of overweight and
obesity in India are 12.8 and 10.3 percent respectively. Diet, eating pattern,
physical inactivity, sedentary life styles, environmental factors, alcohol
consumption and psychological factors contribute to obesity. This global
epidemic is related to increased mortality and morbidity rates with excess
body fat being a significant risk factor for a number of chronic disorders
such as cardiovascular diseases, gout, gall stones, intestinal blockage,
kidney disease, sleep apnea, hernia and arthritis. It also increases the
likelihood of backache and flat foot. So ways and means of reducing the
occurrence of this life threatening problem needs to be urgently explored.
(Vijaylakshmi and Anitha, 2003: 436).
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. Of late, obesity is emerging as one of the most prevalent metabolic
disorders. The voluminous researches have been carried out which revealed
that wide spread derangements in various metabolic and endocrine
functions are associated with obese state. It is associated with number of
health hazards like it increases mortality and morbidity rates causing certain
diseases such as cardiovascular and cerebrovascular diseases, respiratory
insufficiency, diabetes and hypertension. It also reduces the life expectancy
and it leads to mechanical disabilities. In women obesity increases the risk
of cancer of gall bladder, breast and the womb (Asthana and Gupta: 1999:
263).
The obesity epidemic moves through a population in a reasonably
consistent pattern over time and this is reflected in the different patterns in
low and high income countries. In low income countries, obesity is more
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common in people of higher socio economic status and in those living in
urban communities. It is often first apparent among middle aged women. In
more affluent countries, it is associated with lower socio-economic status
especially in women and rural communities. The sex differences are less
marked in affluent countries and obesity is often common amongst
adolescents and younger children. The standard definition of overweight
(BMI≥25 kg/m2) and obesity (BMI≥30kg/m2) have been mainly derived from
populations of European descent. However in population with large body
frames, such as Polynesians, higher cut-off points have been used. In
populations with smaller body frames, such as Chinese populations, lower
cut-off points have been proposed and studies are being undertaken to
separate appropriate cut off points for a variety of Asian populations
(Swinburn, et al, 2004: 124).
Obesity is prevalent in several developing countries, affecting
children, adolescents and adults particularly in those countries experiencing
rapid industrialization and urbanization, obesity is growing faster and
coexists with under-nutrition and infections diseases, becoming one of the
greatest public health problems (Ribeiro, et al, 2003: 659).
Obesity is a public health problem in the west. Its prevalence in
developing countries is generally believed to be low, but documented
information in this regard is scanty. In India, main emphasis has been placed
on under nutrition, but over-nutrition another profile of malnutrition has
not been investigated in much detail. The magnitude of the problems is not
known, but hospital experience has shown that a large number of obese
patients need management for obesity (Sood, et al., 1985: 42).
Obesity is essentially a disorder of energy balance characterized by
an excess of body fat. It is chronic in nature and often associated with a
wide range of metabolic abnormalities and degenerative diseases, some of
which could be life threatening. Further, it creates psychological problems
and reduces the quality of life. This complex condition of multifactorial
origin is considered to be the scourge of modern affluent societies, both in
developed and developing countries. The ability to store energy in the form
of adipose tissue can be considered as a survival strategy. This trait is, how -
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ever, not conducive to good health in case of affluent populations with
sedentary lifestyles and abundant availability of food. Even in situation in
which a genetic disposition to obesity exists, interactions between genetic
and environmental factors play a part in the development of obesity. The
body exerts a stronger defense against under nutrition and weight loss than
over -nutrition and weight gain. The primary form in which the potential
chemical energy is stored in the body is fat that is triglycerides. The amount
of fat in the adipose tissue is the sum total of the differences between
food/ energy intake and energy expenditure. Energy balance is controlled
by energy intake and expenditure mediated through endocrinal (hormonal),
nutrient, neuronal, gastrointestinal and metabolic signals which are all
processed by the central nervous system. Energy requirements of an
individual reflect the sum of the basal expenditure, thermo genesis and
physical activity. Thus there are several factors involved in energy balance.
The amount of body fat ultimately is influenced by age, gender, composition
of diet, and level of physical activity. In humans, obesity depends on a
variety of social, cultural and behavioral factors which act on physiological
and biochemical mechanisms that dictate food intake and energy
expenditure. Despite physiological regulation of body weight, small
deviations in total energy intake and expenditure over a period of time
could result in gain in body weight, with a new set point and physiological /
metabolic control for body weight regulation (Krishnaswamy, 1999: 1).
Rapidly changing diets, physical activity patterns, and lifestyles are
fueling the global obesity epidemic. Already, there are more than one
billion overweight people world wide and some 300 million of these are
estimated to be obese. In many developed countries obesity epidemic has
already reached crisis proportions. According to the 1999-2000 National
Health and Nutrition Examination survey (NHANES), the proportion of
overweight or obese adults in the United States has risen to 64%. Once
considered a problem related to affluence, obesity is now fast growing in
many developing countries and in poor neighborhoods of the developed
countries. In many developing countries with increasing urbanization,
mechanization of jobs and transportation, availability of processed and fast
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foods and dependence on television for leisure, people are fast adopting
less physically active lifestyles and consuming more “energy dense, nutrient
poor” diets. As a result, overweight and obesity and associated chronic
health problems, such as diabetes, hypertension, cardiovascular disease and
cancer, are increasing rapidly, particularly among the middle class, urban
populations. Even in countries like India, which are typically known for high
prevalence of under- nutrition, significant proportions of overweight and
obese now coexists with the undernourished.
1.1 WOMEN AND NUTRITION:
India constitutes one seventh (about 1000 millions) of the worlds
population of which about 406 millions are women and about 12 million girls
are born in India every year. India has the dubious distinction of being the
only country in the world where the ratio of women to men has been
declining and where the life expectancy of women is low than the men. In
1981, the number of female per 1000 males was 933 and in 2001 it was 929
(Cherian, 1994:32)
Women are more vulnerable to malnutrition for social and biological
reasons; as children they are often discriminated against in getting access to
health care, food and education, and as teenagers they have the risk of
early pregnancy and suffer from retarded growth, ill health and deprivation,
(ACC/SCN second report 1992:51)
Nutrition is one of the basic requirements of any living organisms to
grow and sustain life. But the quality and quantity of nutrition necessary to
keep an organism in good health during its life span vary not only with age
of the organisms but also with many other factors. Any major deviation in
quantity from its requirements can affect the growth and life span in a
number of ways.
The human being needs a wide range of nutrients to keep him healthy
and active and he must derive most of these nutrients through his daily diet.
Several of these nutrients are known to be quite essential since deficiencies
due to inadequate intake of these nutrients are often encountered in the
human subjects. The chief source of nutrient is food. It provides energy to
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keep the body warm and muscle active, supplies building material needed
for growth and development. Compensating for the loss incurred by daily
wear and tear, food also serves as the protective function. The food
requirement varies according to age, sex and activity of the individual.
Special demands are made during periods of stress such as pregnancy and
lactation. The amount of food requirement of women has been cited in the
table 1.1.
Table 1.1
Amount of food stuffs (g) required per day for women of different
activities groups
Food stuffs (g)
Sedentary work Moderate work Heavy work
Cereal
410
440
575
Pulses
40
45
50
Green leafy vegetables
100
100
100
Roots and tubers
40
40
100
Other vegetables
50
50
60
Fruits
30
30
30
Milk
100
150
200
Fats and oils
20
5
40
Meat, fish and egg
--
--
--
Sugar and Jaggery
20
20
40
(Source: ICMR 1980 and 1990)
Natural food stuffs contain nutrients in minute quantities and each
nutrient is responsible for a specific task in the body. The major nutrients
are energy, protein, calcium and iron and fat soluble vitamins like vitamin-A
and vitamin D and water soluble vitamins like ascorbic acid and B- Complex
vitamins like thiamine, riboflavin, nicotinic acid, pyridoxine, folic acid and
vitamin B12. The major nutrients like energy, protein and minerals like
calcium and iron are essential for growth and maintenance of the integrity
of the body tissues. The other nutrients namely vitamins and trace minerals
are required for the metabolisms of these major nutrients and to maintain
tissues at an optimum level of activity. Studies have been carried out on the
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quantitative requirements of these nutrients. The dietary requirement of
above nutrients depend upon the age, sex and quality of mans habitual diet.
The dietary allowance as recommended by ICMR (1990) for the Indian
women in different activity groups are presented in the table 1.2.
Table 1.2
Nutrient requirement per day for women of different activity groups
Nutrients
Sedentary work
Moderate work
Heavy work
Energy (Kcal)
1875
2225
2925
Protein (g)
50
50
50
Mineral Iron(mg)
30
30
30
Thiamine (mg)
0.9
1.1
1.2
Riboflavin (mg)
1.1
1.3
1.5
Niacin (mg)
12
14
16
Vitamin C(mg)
40
40
40
Vitamin-A (g)
2400
2400
2400
Folic Acid (g)
100
100
100
Vitamins
Nutrition plays a very important role in the physical, mental and
emotional development of human beings. The nutritional requirements of
females also follow the same pattern in males, but they differ from males in
certain important aspect during certain age periods. There is less difference
between men and women in nutritional requirements during infancy and
early childhood. During adolescent and adult periods, however the nutrients
of women’s are lower than men, since the growth rate during adolescence
and adult body weight attained are lower in women than in men. During
reproductive age period, due to blood loss during the menstrual period,
women’s need for certain nutrients concerned with blood formation (viz.
Iron, folic acid, vitamin B12) is much higher than in men.
The recommended dietary allowances for Indian women in general
are 1800 Kcal energy, 50 g protein, 400 mg calcium, 30 mg iron, 600 g
retinol (Vitamin A), thiamine 1.1 mg, riboflavin 1.3 mg and folic acid 100 g
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daily (Gopalan et al. 1996). A poor Indian mother’s calorie intake is 1400 –
1800 Kcal/ day and her protein intake is 40 g/ day or less. Studies in Gujarat
sowed that the proportion of women who consumed less than 2000 Kcal /
day was 43 percent (Srikantia, 1990:108)
1.2 WOMEN AND OBESITY:
Adolescents with special reference to girls are concerned about their
weight. Obesity occurring in adolescents tends to remain throughout life.
Storz and Greene state that above one third of adolescents studied were
obese and remained so as adults. In a developing country like India, obese
adolescent girls are common these days which may be attributed to changed
eating habits of adolescents. Excessive intake of energy and fat has adverse
effect on the body dimension and therefore may have an effect in their
blood cholesterol levels also. Studies on the prevalence of obesity among
Indian adolescent’s girls and blood cholesterol level are very few till now
(Sasirekha and Tamilarasi, 1990: 35).
In India, women constitute about 48 percent of all human resources
and work force. Thus, their good health is of paramount importance.
Obesity, a world wide problem, associated with a reduced life span, has
been extensively documented in the western countries. A high prevalence
has been reported in the female sex (Dua and Seth, 1988: 338).
Obesity is an established risk factor for post-menopausal, but not
premenopausal, development of breast cancer. Evidence for a positive
association between obesity and breast cancer mortality is mounting.
Avoiding adult weight gain and maintaining a healthy body weight may
contribute importantly to decreasing breast cancer risk and mortality,
especially in postmenopausal women. The relationship between obesity and
breast cancer incidence and mortality is complex and especially difficult to
interpret (Petrelli, et al., 2002: 325)
The relationship between weight status and the occurrence of breast
cancer is complex. Nonetheless; overweight and obesity have been
implicated as risk factors for breast cancer in postmenopausal women
(Barnett, 2003; Connolly et al, 2002; Stephenson and Rose, 2003). Connolly
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and colleagues, in their Meta analysis of 19 studies, suggested that the risk
of breast cancer increased as waist to hip ratio increased. This risk was
independent of general obesity (overall BMI), as well as other known breast
cancer risk factors. Further more obesity and poor breast cancer outcomes
are more prevalent in African American women than in Caucasian women”.
(Blackburn, Copeland, Khaodhiar, and Buckley, 2003 :185).
Evidence shows that dietary fat intake may play a significant role in
the development of breast cancer (Blackburn et al., 2003). Diets low in
saturated fats and high in fruits, vegetables and whole grains may protect
against breast cancer. Furthermore, the type of fat ingested, specifically
marine fatty acids has been found to inhibit the proliferation of breast
cancer cells in animals and in vitro studies (Terry, Rohan and Wolk, 2003).
However, similar findings have not been obtained in studies using human
participations. Terry and associates (2003) in their review of 7 prospective
cohort studies and 19 case control studies concluded that evidence to
support this assertion remains unclear. Consumption of fish and marine fatty
acids was not associated with a decrease in the incidence of breast cancer.
As with cardiovascular health, a diet high in fruits, vegetables and high-fiber
carbohydrates and low in fats seem to offer protection against breast
cancer. Women who followed the dietary guide liens and ate in this manner
decreased their risk of breast cancer by 15% (Blackburn et al., 2003). These
investigators concluded that lifestyle modifications, including diet, protect
middle aged and older women from breast cancer. There does not seem to
be an association between intake of foods high in dietary carotenoids such
as lycopene and protection against breast cancer (Terry, Jain, Miller, Howe
and Rohan, 2002), unlike the possible association between lycopene and
decreased risk for cardiovascular disease (Sesso et al., 2004).
Current age adjusted data from the National Health and Nutrition
Examination survey 1999-2000 indicate that 64.5% of a U.S. Sample of 4115
men and women are overweight (Body mass index 25) and 30.5% are obese.
When one consider the data specifically in relation to women, the incidence
of obesity is even more alarming. Almost 62% of women over the age of 20
years are overweight, of these, 33.4% are obese.
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The incidence of obesity is even greater is non Hispanic black and
Mexican American women. Canadian women are not immune to increasing
weight. The proportion of overweight women (Defined as BMI>27) increased
from 14% to 23% from 1985 to 1996-1996 (Health Canada, office of nutrition
policy and promotion, 2003).
Nutritional challenges are particularly relevant to women. Almost 62%
of women are overweight; of these women 33% are obese. The incidence of
obesity is even greater in non Hispanic black and Mexican American women.
Women who are overweight or obese experience a greater number of
adverse health outcomes, including an increased incidence of cardiovascular
disease and breast and colon cancer. Dietary patterns influence health
outcomes, with a heart healthy pattern having the most positive health
outcomes. Health care providers should encourage women to consume a diet
high in fruits and vegetables and low in total and saturated fats (Morin, et
al, 2004: 823)
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 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%). Although this number seems small in the
international perspective, it is significant because of the sheer size of
population in India. While the problem of under- nutrition still exists in
many parts of India, the additional burden of obesity
due to increasing
sedentary lifestyle, junk food habits 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 (Garg, et al, 2009).
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1.3 OBESITY AND ASSOCIATED FACTORS:
Considering the health hazards of obesity, researchers have tried to
identity the factors which lead to the development of obesity. Broadly
speaking, the biological, nutritional, social and psychological factors have
been identified. Since obesity is predominantly a metabolic disorder the
role of biological and nutritional factors are more important in its
development than the other factors. Biological factors may be described in
terms of heredity, age, sex, marital status and also in terms of certain event
in life of women such as pregnancy, use of contraceptive, and menopause
which may be associated with weight gain (Asthana and Gupta, 1999: 263).
Demographic profile which also increases the incidence of obesity
consists of mean age, marital status, occupation, family size, educational
level, caste and culture etc. Food behavior denotes the aspects of type of
diet consumed and daily intake of nutrients of obese adults (Naidu and
Begum, 1992: 154).
There is an association between obesity with food behavior and some
related factors like parity, duration of lactation, physical activity pattern
and familial traits. Food behavior denotes the different aspects of food
consumption like selection and preparation, dietary intake, eating patterns,
food likes, dislikes and habits and food intake in response to socio-cultural,
environmental and physiological pressures (Dua and Seth, 1988: 338).
Socio–economic status (SES) is a characteristic of an individual (often
measured by personal income or educational attainment), its underlying
determinants are closely linked to the wider environment, especially to
social, economic employment and educational policies. The relationship
between obesity and socioeconomic status is complex. The patterns are
more exaggerated in women compared to men and children and generally
show that in low income countries obesity is more prevalent in high
socioeconomic status individuals and in affluent countries it is more
prevalent in low socioeconomic status individual. The change in obesity
prevalence patterns can be seen in some countries that have monitored
obesity prevalence rates over a period of economic transition. It seems that
in developed countries, the relationships may be bi directional (i.e. low SES
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promotes obesity and obesity promotes low SES) as well as both obesity and
low SES being independently influenced by other common factors such as
intelligence. The mechanisms by which high SES in developed countries
provides some protection against have not been well characterized and are
likely to be multiple, including behaviors such as restrained eating practices
and increased levels of recreational activity, living in less obesogenic
environments with greater opportunities for healthy eating and physical
activity and a greater capacity to manipulate their micro-environments to
suit their needs. People living at low SES circumstances may be more at the
mercy of the increasingly obesogenic environment and end up taking the
default choices on offer. Poorer neighborhoods tend to have fewer
recreation amenities, be less safe and have a higher concentration of fast
food outlets. Overall, there is consistent support for the concept that, in
affluent countries, a low SES is risk factors for obesity in women and part of
that effect is likely to be related to environments that are relatively
deprived of healthier for choices and opportunities for physical activity.
The home and family environment is undoubtedly the most important
setting in relation to shaping children’s eating and physical activity
behaviors, but surprisingly, very little is known about the specific home
influences. A recent review by Campbell and Crawford, however, has
highlighted a number of elements in the home environment that are likely
to be influential. The availability, accessibility and exposure to arrange
fruits and vegetables in the home was correlated with consumption and at
least two studies showed that repeated exposure to new foods seemed to
reduce the propensity for young children to rejects them. Some aspects of
the mother’s nutrition knowledge, attitudes and behaviors are also
significant predictors of a child’s consumption of fruits, vegetables and
confectionery. Fast food restaurants and energy dense foods and drinks are
among the more advertised products on television and children are often
the targeted market. The fat, sugar and energy content of foods advertised
to children is very high compared to their daily needs and most of the foods
advertised fall into the ‘eat least’ or ‘eat occasionally’ sections of the
recommended dietary guidelines. The prevalence of overweight and obesity
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is higher among children who watch more television and the increased
energy intakes of these children may be partly responsible. Advertised
products are more often requested for purchase and consumed by children.
There are a wide variety of settings in which people gather and that involve
food and eating. Most of the evidence for their impact on eating patterns
comes from cross sectional surveys or intervention studies. Restaurants,
workplaces, super markets, and a variety of other settings probably each
provide modest influences on dietary intakes and obesity but good evidence
is either limited or non existent. (Swinburn, et al., 2004: 133-134).
Several authors have demonstrated a positive association between
the time spent in watching TV, reduced physical activity, and obesity in
children and adolescents. According to Gortmaker et al time of TV viewing
during childhoods is associated positively with obesity prevalence and
incidence. According to Neutzling et al environmental factors represent
important risk factors for overweight and obesity. At a given stage of
development better socio-economic condition favour nutrition and health
aspects and contribute to the rise of obesity in the population (Ribeiro, et
al., 2003: 659).
The relationship between social factors and childhood obesity
remains equivocal and poorly understood. Physical factor for example,
region, season and population density and social factor for example,
ethnicity, family size, excessive television viewing, short sleep duration,
and rearing conditions have all been associated with adiposity in children
and risk of overweight in young adult-hood. The role of socioeconomic
status has probably been studied the most extensively, but the associations
with childhood obesity are inconsistent. However, data from the 1946
British birth cohort show that low socioeconomic background in child hood
and a high relative weight at age of 14 years are associated with higher
mean BMI throughout adult life. Moreover, this is only partially confounded
by educational attainment and by adult socioeconomic status, suggesting a
long term impact of biological and behavioral processes on BMI.
At present, it is not clear whether obesity develops because of an
excess energy intake (EI) relative to energy expenditure (EE), a reduced EE
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relative to EI or most likely a combination of both. While young children
appear quite capable of self regulating their EI under unsupervised
conditions, this regulatory capacity appears to be easily undermined by a
variety of factors including the degree of parental control and attitude
towards the children intake. The pressures on children to eat and the
opportunities for them to eat may be greater than ever before. However
considerable caution needs to be applied when scrutinizing EI data sets as a
basis for explaining the origins and development of pediatric obesity.
Epidemiological studies of food habits and dietary intake in children and
adolescents face a number of measurement difficulties which are more or
less specific to these age groups (Livingstone, 2004: 111-113).
Considerable data indicate that energy from beverages does not
displace energy from other foods throughout the day, often leading to
energy imbalance, and numerous studies have documented that beverages
are a leading contributor to energy intake among Native Americans.
Prevention programs that target pregnant women and parents of infants and
very young children are necessary to halt the epidemic of obesity among
Native Americans. Across all age groups and ethnicities, the well recognized
epidemics of overweight and obesity grow worse with each passing year.
The majority of adults in the United States are overweight or obese based
on body mass index (BMI (Kg/m2) and between 10 and 15% of U.S. children
are overweight. Preventing and treating overweight and obesity are high
priorities because these conditions are associated with an increased risk for
chronic diseases, including cardiovascular diseases, diabetes, hypertension,
pulmonary stress and orthopedic problems (Wharton, et al, 2004; 153).
Data from the 1994-1996 Continuing survey of Food intakes by
Individuals (CSFIT) show that Americans frequently choose beverages,
especially colas, as snacks. Chanmugam et al, compare the dietary intakes
between 1989-1991 and 1994-1996 and showed that soft drink intake
increased significantly (P<0.05) and that this change was responsible for
most of the increase in energy intake from beverages. Of all the food groups
assessed, whole milk and soft drink intakes changed the most during the
brief time interval. Whole milk intake decreased by ~100 g/day and soft
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drink intake increased by ~90 g/day. An increase of approximately 85g/day
in reduced fat milk consumption was noted in these data as well. This was
nearly enough to offset the large decrease in whole milk consumption.
Other
findings by Mrdjenovic and Levitsky,
however showed
that
consumption of sugary beverages displaced milk in children’s diets, leading
to significantly lower intakes of protein, calcium, magnesium and vitamin A
(Heaten, et al., 2003, 3).
Risk factors may vary amongst and within societies exposed to
different environmental influences. Demographic, epidemiological and
nutritional transition processes have different characteristics in different
countries. In Latin America, the social, economic and demographic
transformations that have taken place during the last decades coincided
with modifications in the regions epidemics, logical profile and dietary and
physical activity patterns (Neutzling, et al., 2003: 743).
For many individuals depressed physical activity is the main cause of
calorie imbalance. Modern living patterns require less of physical mobility
while eating patterns remain of excessive calories. Currently, obesity is
viewed as an outcome of multiple etiological factors. The factors
influencing the food intake and energy expenditure have social, economic,
somatic, emotional and genetic elements. Numerous studies have been
conducted in the field of obesity and psychiatry. It has been indicated that
obese individuals respond to their environment in a manner quite different
from that of persons having normal weight. Obese persons are frequently
found to be frustrated, hostile, and often depressed. It is also agreed that
persistence in overeating is an emotional problems (Lakhanpal, 1978: 8384).
In general the factors known to predispose to obesity are common to
both children and adults. At a fundamental level it is necessary to have an
excess of energy intake over expenditure, and ever a small excess may, over
a number of years, lead to very considerable obesity. The excess may come
about through overeating or though reduced energy expenditure or a
combination of both. The situation in child-hood differs somewhat from that
found in adult life. Eating habits of school children are the subject of
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continued pressure from the peer groups, especially in the type and
frequency of between-meal snacks, many of which have a high energy
density. Adolescence also presents particular problems in that there may be
a disturbance of body image, especially in girls and in that the sexual
connotations of body shape are very intrusive at this age. Growth hormone
deficiency is associated with relative overweight and the combination of
shortness and fatness should ring alarm bells. ‘Normal’ obese children are
usually above average in height. There is no doubt that genetic factors are
important and this has been demonstrated both in general population
studies and in studies of identical twins reared apart. From the available
data, it appears that heritability is particularly important in fat children
over 10 years of age, while in children fewer than 10 environmental factors
are probably more important. It has however, been shown that the children
of obese parents, through not yet themselves obese, have lower daily
energy expenditure than the children of thin parents. So genetic factors
may have greater influence than has been indicated by population surveys
of established obesity. The first factor usually considered when faced with
an obese individual is food intake. In infancy there is more definite
association between over feeding and obesity, than there is in older
children. It is very difficult to measure energy intake in children accurately,
but to measure energy expenditure accurately over a long enough period to
mean anything is virtually impossible with present techniques. Even so there
is good circumstantial evidence that variations in energy expenditure are
important. For example in situations where expenditure is reduced because
of physical inactivity, obesity is common, and the wide variation in energy
intake which is known to occur in normal children could not be
accommodated without gross changes in body fatness unless there were
equivalent and compensating alternations in energy expenditure. A
proportion of fat children (but not all) will have important emotional
difficulties which may contribute to, or ever be the original cause of, the
obesity. Eating is quite often a coping mechanism, helping the children to
deal with stress. Overeating may be a symptom of depression and depressed
children tend to be lethargic, increasing the likelihood of obesity. There
16
may be complex psychological undercurrents in adolescence, especially in
girls who may overeat to avoid being too thin or alternatively to make
themselves less attractive, there by postponing the threat of sexuality. As
soon as obesity is established it becomes a psychological factor in its own
right, leading to peer group decision and initiating a vicious cycle. (Brooke
and Abernethy, 1985:304-308)
1.4 OBESITY AND DISEASES:
Obesity is a major risk factor for high morbidity and mortality its
association with hyperlipidaemia, hyperglycemia and insulin resistance are
well established. Diseases such as coronary artery disease, cerebrovascular
accident, hypertension, diabetes, certain cancers, cholelithiasis and
reproduction problems such as polycystic ovarian syndrome and muscular
skeletal problems are more often associated with a body mass index greater
than 30 kg/m2. The detrimental effects are related to body weight, body
fat, and magnitude overweight gain during adulthood and sedentary
lifestyles.
More recently, regional distribution of fat within the body has been
the focus of attention. Excess abdominal fat or ‘android’ obesity or ‘central
obesity’ appears to be far more deleterious than ‘gynoid’ obesity where fat
is distributed peripherally around the body. Further, the X syndrome of
hyperglycemia, hyperlipidaemia (elevated triglycerides) and dense LDL and
hyperinsulinaemia (insulin resistance) and hypertension, is more often
associated with abdominal obesity which is believed to be more common in
south Asians (Krishnaswamy, 1999: 1).
Obesity, or the over-nutrition associated with obesity, causes an
increase in height growth during childhood. Obese children thus tend to be
taller than average. However, puberty also occurs earlier, and the halting of
growth which follows may result in an adult height which is below average
(Lloyd et al, 1961), since the whole process of skeletal maturation has been
accelerated without leaving enough time for full genetic height potential to
be realized. Impaired glucose tolerance occurs in about 25 percent of obese
children (Martin and Martin, 1973). Since hyper insulinaemia also occurs
17
after oral glucose, it must be assumed that insulin resistance develops. This
is reversible on weight loss. Frank diabetes is not usually found. The
distribution of adipose tissue in obesity may give a false impression of
gonadal abnormalities in boys, since fat on the chest may mimic breast
enlargement and since the penis may be partly buried in pubic fat and
therefore appear small. In fact there are no major disturbances of sex
hormone function. Young infants with obesity are more prone to respiratory
infections than thin infants (Hutchinson- Smith, 1975). The reason for this
are not understood. Extreme obesity in children and adolescents may result
in a state of chronic hypoventilation, particularly severe during sleep, and
causing respiratory failure with CO2 retention and hypoxemia. The CO2
retention results in a drowsiness so often seen in this syndrome, which has
been named ‘Pickwick syndrome’ after Dickens’s fat boy. If the situation is
allowed to persist heart failure and death can occur. Hypertension is seven
times more frequent among obese than non obese children (Brooke and
Abernethy, 1985: 309).
Few studies have assessed the relationship between obesity and
breast cancer mortality. Obesity has been shown to increase the breast
cancer mortality in women after menopause in the nurse’s health study by
Huang et al and in a large Norwegian study by Treetli. The recently
published study in cancer causes and control by Petrelli et al strongly
supports these findings. The association between obesity and breast cancer
mortality may be attributed to co morbidity issues that come with increased
obesity. The evidence for the relationship of obesity to a number of co
morbidity such as diabetes, hypertension, cardiovascular disease, gall
bladder disease, and some cancers is strong. In addition higher frequency of
large tumors, lymph node metastases and poorer prognosis in obese
compared with lean breast cancer patients have been observed. Obese
women with breast cancer have been found to have decrease survival rates
and increases recurrence. According to Petrelli et al., the higher death rate
found in their study may be due to a true biologic effect of obesity or to
delayed diagnosis in heavier women which are 50 to 100% higher among
heavy than in leaner women. Estradiol levels in post -menopausal women
18
have been reported to increase with increasing BMI. In addition, the level of
unbound or loosely bound biologically available estrogen is higher in obese
than in lean women because sex hormone binding globulin level is lower in
obese women. Estrogen sensitive tissues in obese women are therefore
exposed to more stimulation, which leads to more rapid growth of metastatic tissues, than those of leaner women. Breast cancer is also more likely
to be detected later in obese women. This is because detection of breast
tumor is more difficult in obese than in lean women. Late stage tumors have
been associated with poor prognosis (Barnett, et al, 2003: 73).
Obesity is associated with a number of health hazards like it increases
morbidity and mortality rates causing certain diseases such as cardiovascular
and cerebrovascular diseases, respiratory insufficiency, diabetes and
hypertension. It also reduces the life expectancy and it leads to mechanical
disabilities. In women obesity increases the risk of cancer of gall bladder,
breast and the womb (Asthana and Gupta, 1999: 263).
Overweight among children carries heavy individual and public health
consequences and is on the rise in the United States. In less than 30 years,
the rates of overweight among children and adolescents have more than
doubled. In the year 1999-2000 National Health and Nutrition Examination
Survey (NHANES III), 15.5% of adolescents aged 12-19 years and 15.3% of
children aged 6-11 years were overweight compared with 10.5% and 11.3%
respectively in 1988-1994 (NHANES III). Reports from the centers for disease
control and prevention (CDC) indicate that overweight is occurring in
children as early as preschool age, with NHANESIII (1999-2000) reporting
that 10.4% of children aged 2-5 years are overweight.
Overweight children not only suffer from negative psychosocial
interaction and repercussions from their peers, sleep apnea and orthopedic
complications, but older overweight children and adolescents are now also
presenting with type II diabetes mellitus and hypertension, which are
normally seen in the obese adult and / or the elderly. The overweight child
is also at much higher risk for becoming an overweight adult. Approximately
30% of overweight children become overweight adults. The persistence of
overweight into adult-hood results in more extreme overweight as an adult,
19
with higher morbidity and mortality than experienced in adults whose
overweight began in adulthood. Therefore, programmes to promote healthy
life styles need to start early in life, to prevent overweight in childhood and
subsequently adulthood. (Slusser, et al., 2005: 141).
Several studies have shown that abdominal obesity, independent of
general obesity is associated with a high risk of developing non-insulindependent diabetes, CHD and Stroke (Walker et al., 1996; Rexrode, et al.,
1998, 2001; Lakka, et al., 2002) and of mortality (Bigaard, et al., 2003 and
Halkjaer et al., 2004: 735).
The evidence of a relationship between obesity and asthma is not
conclusive; however, several studies find a relationship between obesity and
asthma in females but not in males. Others have found no relationship
between obesity and asthma. Still others have concluded the reverse
relationship that asthma is a risk factor for obesity.
The evidence for the adverse effects of obesity on women’s health is
overwhelming and indisputable. Obesity, especially abdominal obesity is
central to the metabolic syndrome and is strongly related to polycystic
ovary syndrome (PCOS) in women. Obese women are particularly susceptible
to diabetes and diabetes, in turn, puts women at dramatically increased risk
of cardiovascular disease (CVD). Obesity substantially increases the risk of
several major cancers in women, especially postmenopausal breast cancer
and endometrial cancer. Overweight and obesity are associated with
elevated mortality from all cases in both men and women and the risk of
death rises with increasing weight. Curbing the two epidemics of obesity
and diabetes calls for not only changes in the diet and life style at individual
levels, but also changes in physical and social environments, and cultural
norms.
1.5 PREVENTION OF OBESITY:
In discussing preventing measures for obesity in a community, the
first important step is in locating the individuals at risk. To detect early
cases of obesity screening procedures are suggested. Several types of
screening programmes depending on available resources and priorities can
20
be designed in order to offer proper guidance and care to the needy.
Prevention is more effective if obesity is detected at an early stage, and
this is particularly emphasized for childhood obesity. Weight reduction
efforts exerted by individuals on their own initiative or under the direction
of their physicians have been widespread for many years. However, many of
these measures do not seem to reach a sufficient number people because of
expense
involved.
Other
group
efforts
in
dealing
with
medically
uncomplicated and moderate obesity have more hope of success in reaching
the millions of persons who require some kind of expert support and
guidance. Dwyer and his associates have suggested approaches for more
effective prevention and treatment of obesity including group’s efforts,
establishment of middle aged clubs, particularly for men, to encourage
physical exercise and dieting through organized classes and other facilities.
‘Weight watchers’ and health spa’s are other ideas where group’s therapies
and groups techniques are used in the prevention of obesity. Many persons
are using such facilities gainfully, where a combination of ‘low calories’ diet
and a programme of physical exercise is instituted in a social atmosphere
and comradeship. Success in weight reduction program through such clubs
and spas will necessitate the education of instructors in the rudiments of
scientific nutrition, energy balance, energy metabolism and weight control.
This type of education is needed in order to reduce chances of
dissemination of common misconceptions about foods, facts and fads. The
health clubs and spas do not entirely serve the purpose of controlling
obesity in a community, and there is an ever present need for designing
weight control programmes tailored to the requirements of the community.
This may calls for nutrition education of the particular population and
collaboration between nutritionists and health workers of others disciplines.
No one kind of diet can be said to be best for all individuals. Also, dieting is
difficult to adhere to for a successful weight regulation programme because
of several social and economic factors. Modern food technology will
probably help to develop a low calorie, high nutritive value foods which are
inexpensive, tasty, safe and socially acceptable. This product will allow
21
dieters to loose weight and at the same time to avoid the monotony of
dieting and yet maintain good nutrition status.
Since obese children usually become obese adults, measures in
preventing obesity in children should begin at an early age. Also, it must be
recognized that a well established obesity is difficult to cure. Further, our
knowledge of predisposing factors in childhood obesity remains fragmentary.
It is believed that obesity in childhood may be an outcome of environmental
situations or psychological traumas. The factors that greatly affect obesity
in childhood are obesity in parents or siblings, unwanted pregnancies, family
setup or physical handicaps that limit mobility. These and other factors such
as body image disturbances underline the need for efficient psychiatric,
diagnostic and therapeutic services. For any meaningful programme to be
effective in prevention of obesity, adequate facilities for exercise and
opportunities for the development of physical activity programmes, for both
adults and children must be provided in the community. This is because
physical activity plays an important role in maintaining the desired energy
balance. Furthermore, counseling in foods, and nutrition and other health
care matter must also be available to the community. Prevention rather
than treatment of obesity is by for the best course (Lakhanpal, 1978: 88-90).
Reducing energy intake is simple in principle, but very hard in
practice. It is very difficult to eat less than you want to and a great deal of
support is necessary for the maintenance of a low energy intake. Adults
probably get most help from self-help groups, but such groups do not
normally allow children to attend. If there is any other members of the
family who is even mildly overweight, he or she should be encouraged to
join the child in dieting, since this provides support and an element of mild
competition.
A pediatric dietitian should be involved from the start wherever
possible. There is no particulate magic in the type of diet used, although
strong claims have been made for very high fiber diets and diet containing
high concentration of protein. In practice it is difficult to persuade children
to make major changes in the quality of their diets, and it is usually best to
organize a low energy intake within the framework of the child’s normal
22
dietary pattern, while ensuring that it is of adequate nutritional quality and
given in a satisfactory meal pattern. There of course no harm in combining
diet with a bit of health education, but it may be very hard to get working
class children to eat whole-meal bread, fresh salad or cooked vegetables.
There may well be an advantage in attempting to provide a higher protein
energy ratio than normal because post prodigal thermo genesis is greater
with such diets and the increased energy expenditure will contribute to
weight loss. Regular weighing and clinic visits are important. Thrice weekly
weighing and charting on a wall-chart are aids to compliance as well as
indicators to the dietitian or physician that compliance has failed. Ketonuria
should occur during weight loss as depot fat is metabolized. Exercise should
be encouraged vigorously, not merely as an adjunct to the more important
measure of reduced food intake, but also to maintain muscle mass and
reduce the tendency towards loss of lean tissue which occurs to some extent
on weight losing regimens. Exercise alone, however, has much less effect
on energy balance than reduced energy intake. Energy output can be
increased by the use of thermogenic drugs and there is abundant evidence
in animals that they will produce weight loss in all types of experimental
obesity (Dulloo and Miller, 1984). The majorities which have been tested are
 adrenergic stimulant drugs and are likely to have side effects if given in
dosages sufficient to cause weight loss in humans. Thyroid hormones
produce increased thermo genesis and thyroxin and T2 have been used as
adjuncts in the treatment of obesity (Bray, 1976). We occasionally use T3 in
particularly refractory cases in older children, but only on the basis of
carefully controlled assessment during hospital admission, giving just
sufficient to increase the sleeping pulse rate. The place of such agents is at
present uncertain and they should only be used for short periods of time.
Long term results are no more satisfactory than dietary treatment alone.
Psychiatric help is often necessary. Behavior disturbance may be obvious or
there may be evidence of depression. In either case psychiatric referral
forms part of the management, class cooperation being maintained with the
psychiatrist
to
ensure
a
consistent
approach.
Proper
psychological
management will help to resolve conflicts within the home but rarely results
23
in an improvement in the prognosis for the obesity. The role of psychiatric
treatment in the primary management of obesity, by modification of eating
behavior, is not well evaluated in children but has been successfully applied
in adults (Brownell and Stunkard, 1978). If a fat child can not manage to
lose weight as an out patient or if obesity is so severe as to impair health,
hospital admission must be considered. With adequate supervision all obese
children will lose weight in hospital and although a very expensive form of
treatment it does have the advantages of demonstrating to the family that
weight loss is possible and of allowing a leisurely psychological evolution of
the family situations (Brooke Abernethy, 1985: 310-312).
As obesity is a life threatening problem, giving rise to various
complications, ways and means of reducing the occurrence of obesity needs
to be explored. Naturopathy is one of the systems that provide a positive
solution for the problem of obesity, as exercise has been the major element
of the system. Exercise not only facilitates weight loss through direct energy
expenditure but burns fat both during and after exercise. Exercise can tilt
energy balance towards negative and enhance a weight loss programme. In
addition exercise tones up the muscles, reduces appetite and improves the
psychological outlook in life. Yogasana is another recognized and practiced
health tool which is a powerful way for physical fitness. Since gradual
weight reduction can be achieved by means of naturopathic treatment
without any side effects, this method is becoming popular among people
who would like to reduce weight (Vijayalakshmi, et al., 2003: 1).
A common treatment for obesity is weight reduction. Although short
term weight loss programmes have proved to be successful, long term
weight maintenance is a major problem (Kramer, et al., 1989). Successful
weight maintenance is of importance for lowering risk factors for
cardiovascular and other diseases. To improve the metabolic profile, it is
not necessary to achieve the ideal body weight. A weight reduction of 5-10%
is often sufficient to induce a clinically relevant effect (Goldstein, 1992). To
preserve these beneficial effects of weight reduction, an improvement in
long term weight maintenance is necessary. Pasman et al (1999) showed
that weight regain was slower when the body composition of the weight
24
regained consisted of a greater but fat free mass (FFM) due to physical
activity. There is a hypothesis that weight regain may be limited if the
inevitable increase in body weight consists of a larger FFM, for instance
achieved by the consumption of an appropriate substrate.
For this, there is suggestion for an increased protein intake, because
of its potential to increase FFM (Jean et al., 2001). Furthermore, it is known
that of all the macronutrients, protein seems to be the most satiating.
Protein consumption suppresses short term food intake more than that of
fats or carbohydrates and even more than is expected from its energy
content alone (Anderson, 1994). Several studies have shown that a high
protein lunch decreases later food intake more than a lunch low in proteins.
(Booth et al., 1970; Barkeling et al., 1990; Latner and Schwartz, 1999).
Westerterp Plantenga et al., (1999) showed an increased satiety effect of a
high protein diet despite similar energy intake. Finally, protein has also
been shown to have low energy efficiency during overfeeding, a situation
that is comparable to a weight regain situation. Although the effect of
dietary protein has been examined in weight-loss studies, the effect of
additional protein intake on weight maintenance has not yet been studied
(Manuela, et al., 2005: 281).
1.6 OBESITY AND HEALTH CONSCIOUSNESS:
Obesity has now become an important health problem in developing
countries particularly in India which is currently experiencing a rapid
epidemiological transition. Available data on prevalence of obesity from
different published studies suggest that the prevalence ranged from 10 to 50
percent (Parimalavalli et al, 2009). Obesity is considered to be the link
between insulin resistance and metabolic abnormalities inclusive of
diabetes, hypertension and dyslipidaemia, all of which are risk factor for
coronary artery disease (Mohan et al, 2001).
Many developing countries including India today face the dual burden
of diseases of poverty as diseases of affluence. Some of the reasons for this
change among many are urbanization and adaptation of westernized life
style (Popkin 1994; Drewnowski and Popkin; 1997). India is passing through a
25
transitional phase of socioeconomic development. There is an increase in
women’s employment due to economic pressure. The gainful employment of
women, which ensures increase in income, may lead to better nutrition for
themselves. (D’ souza and Bhujza 1982; Gulati 1982;). Improved health
facilities, increase in income, availability of food and decrease in physical
activity have contributed to this epidemic form of overweight and obesity
especially in the urban areas of the developed and developing countries.
(Vijaylakshmi et al, 2005). According to the published data, during the last
30 years, along with the increase in consumption of fast foods, the
incidence of obesity, diabetes and circulatory system diseases has rose up
rapidly (Bowman 2004; Cheng 2003; Ebbeling et al 2004; Isganaitis and lustig
2005; zwierzyk 2005). With rapid urbanization in recent years, there is a
boom in fast foods in India, majority of fast foods contain high amount of
saturated and trans fatty acids and less dietary fiber, which is the main
cause of obesity (Kumar et al, 2007).
From National Family Health Survey (NFHS) it was found that Indian
women are more obese than Indian men. Moreover, as per the NFHS data
there is not a single state in India where more number of men are obese
than women. Only Tripura is one state where this difference is small of 0.1%
(in Tripura number of obese male 5.2% & number of obese female 5.3%),
while in rest of state this difference is very significant. Whereas Punjab tops
overall obese people chart with 30.3% obese male and 37.5% obese female.
Overall, India results are 12.1% obese male and 16% obese female. From this
data, we can clearly conclude that women are more obese than men in
India. In recent years obesity has increased significantly in India and it looks
that this trend has affected Indian women more than Indian men. It is
difficult to define exact reason between these trends and why Indian women
are more obese than Indian men, however, it looks that Indian women are
enjoying life more comfortably than Indian men because comfortable life is
mostly associated with obesity. Overall, this is not a good sign for health
conscious women, because chances of numbers of health related problems
increases significantly.
26
Awareness among the women about health and 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.
CHETNA (Centre for Health Education, Training and Nutrition
Awareness) is a unique resource agency which provides support to
Government and civil society organizations; which raises health and
nutrition
consciousness
among
women,
youth
and
children
from
disadvantaged social sections. It strives to bring about comprehensive
gender sensitive polices at the state, national, regional and international
levels and networks globally to build strategic partnerships. CHETNA
activities were initiated in 1980 as an activity of the Nehru Foundation for
Development, which is registered under the Bombay public trust Act 1950.
MASUMs (Mahila Sarvangeen Utkarsha Mandal) women’s health
programme is unique in the sense that it focuses on women’s health
concerns with a feminist perspective and works with a rights based approach
to health care. It enables the most deprived sections in the community to
get access to basic health services. The women’s health programme is built
on the self help principle, which aims to empower women with knowledge
of their own bodies and addresses unequal relationship between the
provider and receiver because of the possession of knowledge and skills with
the provider, by sharing information. It recognizes the emotional, social &
environmental factors that affect health and works towards addressing
these issues. It assists women to recast their self image and confidence by
validating their experiences and knowledge and creates a space for women
to ventilate their problems and share their feelings.
Awareness of women’s risks for diabetes and cardiovascular diseases
must be promoted by health care professionals. Vulnerable times for weight
gain during a woman’s life cycle include early adulthood, the child bearing
years and menopause. Thus, healthy diet and exercise behaviors must be
particularly emphasized during these years. Foods comprising diets
associated with reduced cardiovascular disease and type-II diabetes risks
27
tend to be unrefined plant foods (vegetables, legumes, fruits, whole grains,
nuts, and seeds), low fat dairy products, fish rich in omega-3 fatty acids and
lean sources of protein. A balance of micro nutrients and fiber should be
obtained from wholesome food sources rather than supplements. Dietary
counseling for women should consider the context in which they live (Ryan,
2007:S3-S7).
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 & television),
health education materials and books as well as through food labeling and
food packaging (Charlton, et al, 2004; 809).
1.7 SIGNIFICANCE OF THE PRESENT STUDY:
Good health is a vital part of great experience of living. So attempts
are being made to give every one a fair chance to lead a healthier and fuller
life. To maintain good health, a diet containing the essential food and
nutrient is very important. The nutrients and other substances in their
action, interaction and balance are related to health and diseases.
Nutritional balance is very essential to maintain health and to prevent major
diseases like diabetes coronary heart diseases, stroke, cancer, overweight
and obesity. Overweight and obesity is most common among all. Both
overweight and obesity affect health of an individual and favour the
development of secondary conditions. As obesity is strongly associated with
the main causes of morbidity and mortality, its reduction is a necessary
health goal.
Obesity is a global health problem. The magnitude of the problem
appears to be increasing with affluence, urbanization and mechanization. It
is now estimated that, world-wide there are over 100X106 obese subjects.
The results of current methods of treatment are disappointing and of
limited value. Obesity and weight cycling are now recognized as important
risk factors for several diseases with high morbidity and mortality. Body
mass index provides the most useful population measured of obesity. In an
28
average man, the percentage body fat is in the order of 15-20 percent while
in women, it vary between 25-30 percent. In spite of the problems
magnitude, however little is known about the factors that contribute to the
world wide obesity epidemic. It is therefore urgent to evaluate the factors
that determine this process in every different culture (Neutzling et al,
2003).
India is passing through a transitional phase of socio economic
development. While acute infectious diseases are on the decline, chronic
non- communicable diseases like cardiovascular diseases, diabetes and
cancers are becoming major contributors to the disease burden. While the
country has still to overcome problems arising from under-development and
poverty, it is also likely to increasingly face problems related to affluence,
generally seen in developed countries, in the years ahead. With
industrialization, urbanization and economic betterment, more individuals
survive to enter middle age. With increasing affluence, several undesirable
life styles, like alterations in the form of diets rich in saturated fats, salt
and excess calories; decreased physical activity; addictions like tobacco and
alcohol; and the augmentation of psychosocial stress, come into play. The
chain of slimming centers, which claim to promise rapid weight reduction,
cannot solve the problem of obesity at the public health level. The
deleterious effects of repeated loss and gain of fat are now well reported.
So the answer lies in the prevention.
Sambalpur is one of the under developed district of Western Orissa. In
spite of the rapid increase in the knowledge and awareness on health
through the mass media and health centers, most of the people do not know
the hazardous effect of overweight and obesity in life. No detailed study has
been made on the health awareness, obesity; its causative factors and
problems related to it. With this background the proposed study will be a
modest attempt to find out the prevalence and problems of obesity among
the urban women of Sambalpur, Orissa, with varying degree of health
consciousness.
29
1.8 OBJECTIVES:
The present study was undertaken with the following objectives.

To find out the degree of health consciousness present among the
women, on the basis of knowledge, attitude and practice on health.

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 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.
30