Prevalence of overweight and obesity and their associations (PDF)

An-Najah National University Faculty of Graduate Studies Prevalence of overweight and obesity and their associations with dietary habits among students from An-Najah National University: A cross-sectional study By Bassam Ali Abdel Raheem Abu Shanab Supervisor Dr. Haleama Hasan Al -Sabbah This thesis is Submitted in Partial Fulfillment of the Requirements for the Degree of Master in Public Health, Faculty of Graduate Studies, An- Najah National University, Nablus, Palestine. 2011   iii Dedication I dedicate this work especially to my family; Wife, sons, daughters Parents, bropthers, sisters Nieces, nephews And friends with love and respect Bassam Ali Abu Shanab  iv Acknowledgement First of all, I would like to express my Special thanks and Sincere gratitude to my family; wife, sons, daughters and also to my friends for their encouragement, and support, to finish this study. Sincere gratitude also goes to Dr. Haleama Al –Sabbah; my supervisor, for her guidance, highly efforts, and useful suggestions and advises in order to carry out this research study. Appreciations and Sincere gratitude also goes to Dr. Ali Barakat, and Dr. Hassan Abu Qaoud, who helped me with their knowledge and experience to fulfill this thesis. I do highly appreciate the cooperation of Mr. Sami Budair for his help in data collection. Many thanks and appreciations are also expressed to Roaia Melhem, Yasmeen Eisa, Rasha Dweekat, Moataz Kabha, Hadeel Mohtadi, Ahmed, Helal and Heba Borini for their help in data collection. Many thanks to all the Students who participated in this study Finally, I would like to express my special thanks to An-Najah National University Administration that gave me the chance to accomplish this work.  v : Prevalence of overweight and obesity and their associations with dietary habits among students from An-Najah National University: A cross-sectional study : . Declaration The work provided in this thesis, unless otherwise referenced, is the researcher’s own work and has not been submitted elsewhere for any other degree or qualification. : Student's name: : Signature: : Date:  vi TABLE OF CONTENTS No. Content Page Dedication iii Acknowledgment iv Declaration v Table of Content vi List of Table vii List of Figures viii List Of Appendices ix Abstract X Chapter 1: INTRODUCTION 1 1.1 Background information 2 1.2 The significance of the study 4 1.3 Study objectives 5 1.4 The questions of this study 6 Chapter 2: LITERATURE REVIEW 7 Chapter 3:METHODOLOGY 12 3.1 Study design 13 3.2 Study Sample 13 3.3 Inclusion criteria 14 3.4 Measures 14 3.5 Data Collection 18 3.6 Data analysis 19 3.7 Ethical considerations 20 Chapter 4:RESULTS 21 4.1 Characteristics of the participants 22 4.2 Anthropometric measurments of the participants 23 4.3 Percentages of physical activity and smoking among university students 23 4.4 Dietary habits among university students 24 4.5 Prevalence of overweight and obesity among university students and their associations 29 4.6 Prevalence of anaemia among university students and its associations 33 Chapter 5:DISCUSSION 39 5.1 Limitations of the study 47 5.2 Conclusions and Recommendations 47 References 50 Appendices 59  vii List of tables No. Table Page Table (4.1.1) Socio- demographic characteristics of the participants 22 Table (4.2.1) Mean and standard deviation of the anthropometric measurements of the participants by gender 23 Table (4.3.1) Percentage of physical activity & smoking among university students by gender 24 Table (4.4.1) Meal pattern of university students by gender 25 Table (4.4.2) Food habits of university students by gender 28 Table (4.5.1) Prevalence of overweight and obesity among university students based on BMI by gender. 30 Table (4.5.2) Meal pattern by BMI status among university students 31 Table (4.5.3) Prevalence of abdominal obesity among university students by gender 32 Table (4.5.4) Prevalence of overweight and obesity among university students by faculty 32 Table (4.5.5) Prevalence of overweight and obesity among university students by study year level 33 Table (4.6.1) Prevalence of anaemia among university students by gender 34 Table (4.6.2) Prevalence of anaemia among university students by residency 34 Table (4.6.3) Percentage of overweight and obesity by anemia among university students 35 Table (4.6.4) Meal pattern by anemia among university students 36 Table (4.6.5) Food habits by anemia among university students 37  viii List of Figures No. Figure Page Figure (1) Variables influencing overweight and obesity 17 Figure (2) Conceptual framework for the causes of overweight & obesity 18  ix List Of Appendices No. Annex Page Annex (1) The questionnaire of the study (English & Arabic version) 60 Annex (2) Table1: WHO standard classification of obesity 72 Annex (3) Table 2: Sex-specific waist circumferences 73 Annex (4) 74 Annex (5) IRB Approval letter 75 Annex (6) / 76 Annex (7) A picture for drawing blood sample from a participant 78  x Prevalence of overweight and obesity and their associations with dietary habits among students from An-Najah National University: A cross-sectional study By Bassam Ali Abdel Raheem Abu Shanab Supervisor Dr. Haleama Hasan Al - Sabbah Abstract Background Overweight and obesity are major public health problems and the most common nutritional disorders. The prevalence of overweight and obesity is rising at an alarming rate in both developing and developed countries. The main objective of this study is to assess the prevalence of overweight and obesity and their associations with dietary habits among students from An-Najah National University in Palestine. Methodology A cross-sectional study was conducted on 304 Students (50% males and 50%females), who have been chosen by convenient sampling method from An-Najah National University campus of two faculties; Faculty of Arts (152 students) and Faculty of Science (152 students). Data collection was carried out during the period between March and April 2011. Students were asked to fill in a standard questionnaire. Food habits of the participants were assessed by using the food frequency questionnaire for selected food items. Body Mass Index (BMI) was used for the assessment of overweight and obesity. Also waist  xi circumference (WC) was measured to assess abdominal obesity. In addition, hemoglobin level in blood (Hb%) was tested. Statistical analysis was conducted using the Statistical Package for Social Sciences software (version 15.0). Informed consent was taken from all participants. Results The majority of the sampled students (70.4%) were of normal weight (78.9% of females and 61.8% of males). The prevalence rates of overweight and obesity among students from An-Najah national University were 20.1% and 4.6%, respectively. Furthermore, overweight and obesity were more common among male students compared to females (27.0%and 5.9% vs. 13.2% and 3.3%, respectively). The prevalence of abdominal obesity among students was 17.8% and was more common among female students (23.0%) compared to males (12.5%). The prevalence of anaemia among university students was 13.8%. Anaemia was more common among females (18.4%) than males (9.2%), (P< 0.05). In addition, about 5.3% of male students were underweight compared to 4.6% of females. The majority (68.4%) of students reported that they take meals irregularly. There were significant differences between males and females in meal patterns, (P< 0.05). Also there were significant differences between males and females in physical activity (69.1% of males and 55.9% of females practiced sports), and smoking (51.3% of males and 91.4% of females never smoked, while 48.7% of males and 8.6% of females were current smokers), (P< 0.05).  xii A total of 58.2 % (57.2% of females and 59.2% of males) and 43.4% (40.8% of females and 46.7% of males) reported daily intake of vegetables and fruits, respectively. Conclusions According to results obtained, the author concluded that overweight and obesity are a problem among Arts and Science students of An-Najah National University, despite the low prevalence of overweight and obesity in the studied sample as compared to prevalence in neighboring countries. Overweight and obesity were more common among male students compared to females. The prevalence of abdominal obesity was more common among female students compared to males. Prevalence of anaemia was more common among females than male students. Results indicated that university students would benefit from nutritional and health promotion programs to reduce the tendency of overweight and obesity, particularly males, and to improve students' eating habits through educational programs which encourage increased consumption of fruits and vegetables for a good health. Keywords Obesity, Overweight, Dietary habits, Anemia, An-Najah National University students, Nablus, Palestine.  1 Chapter 1 Introduction  2 Chapter 1 Introduction 1.1 Introduction Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems [1]. Obesity is a leading but preventable cause of death worldwide, with increasing prevalence in adults and children, and it is one of the most serious public health problems of the 21st century [2]. Some contributing factors are said to include a global shift in diet towards increased calories, fat, salt, and sugar intake, a trend towards decreased physical activity due to the sedentary nature of modern work, transportation, and increasing urbanization [3]. Dietary habits are the major aspects of people's lifestyles that influence health, morbidity, and mortality for a range of conditions [4]. Overweight and obesity are major public health problems and the most common nutritional disorders [5], therefore, both overall and abdominal obesity are associated with non-communicable chronic diseases such as type 2 diabetes, cardiovascular and cerebrovascular diseases, digestive disorders, and cancer [6]. As obesity is one of the major health challenges worldwide, it is rapidly reaching epidemic proportions [7, 8]. Disorders related to obesity are a growing epidemic in both developing and developed countries [9- 11].  3 The World Health Organization (WHO) classifies adults as overweight when Body Mass Index (BMI) is 25 -29.9 kg/m2, obese when BMI is >30 kg/m2, and have abdominal obesity when waist circumference (WC) > 94 cm for men and >80 cm for women, and Waist –to-Hip Ratio (WHR) of > 0.90 in men and > 0.85 in women [12]. Overweight is generally defined as having more body fat than is optimally healthy [13, 14]. The estimates in 2005 showed that more than 1 billion people worldwide were overweight and more than 300 million were obese. Prevalence is expected to increase further in almost all countries, with 1.5 billion people expected to be overweight in 2015 [15]. Several studies indicated that causes of obesity are multifactorial [16-18]. These factors may include biological and non-biological factors such as heredity, age, sex, occupation, socio-economic level, physical inactivity, eating habits and physiological factors [9, 10, 16-18]. Complications are either directly caused by obesity or indirectly through mechanisms sharing a common cause such as poor diet or a sedentary lifestyle. The strength of the association between obesity and specific conditions varies. One of the strongest is the link with Type 2 diabetes. Obesity is responsible for a large proportion of the total burden of chronic diseases, 65% of the obesity and overweight in the European region is associated with growing rates of chronic diseases such as heart disease, diabetes and cancers [8- 19]. The condition is thus affecting longevity, and in particular trends in childhood obesity are widely expected to lead to shorter life expectancy for today’s children [8- 19]. In the United States,