ABSTRACT
Weight problems refers to the existence of either excess amounts of body fat for one’sheight or frame called overweight (or obese), or insufficient body fat called underweight. Anthropometry is the study of the measurement of the human body in terms of the dimensions of bone, muscle, adipose (fat) tissue wellness and weight status. Weight status of an individual is said to be overweight or obese when the weight of the person is higher than healthy weight and the weight of individual lower than healthy weight is considered underweight. This study assessed the socio-cultural factors affecting the weight status of young adults in urban and rural areas of Akwa Ibom State. A cross-sectional study design was adopted for the study. Multi-stage sampling techniques was used to select 300 respondents from six (6) wards of Uyo and Etimekpo Local Government Areas of Akwa-Ibom State. Data was collected from the respondents with the use of a well-structured and validated questionnaire. The anthropometry assessment of the respondents was done measuring their weight, height, waist circumference, hip circumference using weighing scale, standiometer, non-elastic stretchable measuring tape for the measurement and was used to determine their respective BMI and waist-hip ratio and comparing them with reference standard. The data collected was analysed using Statistical Package Service Software (SPSS) version 23.0. Descriptive statistical tools such as frequency table and inferential statistics (correlation analysis) was used to analyse the data so as to achieve the study objectives and the result of the analysis was presented in frequency and percentage, p-value (P<0.05) was statistically accepted. Findings of the study showed that majority (97.3%) of the respondents were Christian and 40.2% of the respondents were single adults. More than half (68.8%) of the respondents earn between N18, 000 - N54, 000 and few of the respondents had no formal education. The result showed that majority (97.0%) of the respondents claimed that belief/faith does not influence that dietary behaviour while many of them claimed that family income is a determinant of their food and dietary choices. More than half (52.2%) had normal body mass index, while prevalence of overweight and obesity among the respondents were 17.6% and 12.3%, respectively. About 56.8% of the respondents were at lower risk of developing central obesity with their waist circumference measurement and 49.5% of the respondents had lower risk of having health issues relating to abnormal waist-hip ratio. Findings of the study showed a significant relationship between preferred choice of food and BMI (0.254**). The result of the study further showed that there is a significant relationship between family income on food selection and BMI (0.019**) and WHR (0.160**). In conclusion, family income, beliefs/norms and knowledge have a great influence in food and nutrients consumption which directly affects weight status and overall body composition. Therefore, this study is recommended to nutritionist and dieticians to educate household on the link between food intake and loosing, gaining extra weight which contribute to prevalence of overweight and obesity in our society.
TABLE OF CONTENTS
TITLE PAGE I
CERTIFICATION II
DEDICATION III
ACKNOWLEDGEMENTS IV
TABLE OF CONTENTS V
LIST OF TABLES IX
ABSTRACT X
CHAPTER 1: INTRODUCTION
1.1 Background of the Study 1
1.2 Statement of the Problem 7
1.3 Objectives
of the Study 8
1.3.1
General Objective 8
1.3.2
Specific objectives 8
1.4 Significance of the Study 9
CHAPTER 2:LITERATURE REVIEW
2.1 Weight and Adiposity Distribution in
Nigeria 10
2.2 Social Context of Weight Status 13
2.3 Social
Determinants of Weight Status 25
2.3.1
Financial Stress 25
2.3.2
Posttraumatic Stress 26
2.3.3 Sleep 27
2.3.4 Marriage 30
2.3.5 Health literacy 31
2.4 Physical
Determinants of Obesity 33
2.4.1 Physical activity 33
2.4.2 Natural environment 34
2.4.3 Food environment 36
2.4.4 Worksite settings 39
2.4.5 Pregnancy 41
2.4.6 Genetics 43
CHAPTER 3:MATERIALS
AND METHODS
3.1 Study Design 45
3.2 Study Area 45
3.3 Population of the Study 46
3.4 Sampling
and Sample Size Determination 46
3.4.1 Sample Size determination 46
3.4.2 Sampling procedure 47
3.5 Preliminary
Activities 47
3.5.1 Training of the Research Assistant 47
3.5.2 Informed Consent 47
3.5.3 Ethical Approval 48
3.6 Data
Collection 48
3.6.1 Questionnaire 48
3.6.2 Anthropometric measurements 48
3.6.2.1 Height
measurement 48
3.6.2.2 Weight
measurement 49
3.6.2.3 Waist Circumference
(WC) 49
3.6.2.4 Hip
Circumference (HC) 49 3.7 Data Analysis 50
3.8 Statistical Analysis 51
CHAPTER 4:RESULTS AND
DISCUSSION
4.1 Socio-Demographic Characteristics of the respondents 52
4.2 Socio-Cultural influences on food
habits/weight status 56
4.3 Anthropometric Characteristics of the respondents
61
4.4 Relationship
between Socio-Cultural Factors and Weight
Status of respondents 63
CHAPTER 5: CONCLUSION
AND RECOMENDATION
5.1 Conclusion 65
5.2 Recommendation 66
REFERENCES 67
APPENDIX 72
LIST OF TABLES
Table Page
3.1: The
International classification of adult underweight, overweight and
obesity according to BMI 50
3.2: World
Health Organization cut-off points and risk of metabolic
complications 51
4.1a: Socio-demographic
characteristics of the respondents 54
4.1b: Socio-demographic
characteristics of the respondents 55
4.2a. Socio-cultural
influences on food habits/weight status 58
4.2b. Socio-cultural
influences on food habits/weight status 69
4.2c. Socio-cultural
influences on food habits/weight status 60
4.3. Anthropometric
characteristics of the respondents 62
4.4 Relationship
between socio-cultural factors and weight
status
of respondents 64
CHAPTER
1
INTRODUCTION
1.1 Background of the Study
Weight
problems refers to the existence of either excess amounts of body fat for
one’sheight or frame called overweight (or obese), or insufficient body fat
called underweight (Olaoye and
Oyetunde, 2012).Anthropometry is the study of the measurement of the
human body in terms of the dimensions of bone, muscle, adipose (fat) tissue
wellness and weight status (Chineduet al.,
2013; Chinedu and Emiloju, 2014).
Measures of subcutaneous adipose tissue are important because individuals with
large values are reported to be at increased risks for hypertension,
adult-onset diabetes mellitus, cardiovascular disease, gallstones, arthritis,
and other disease, and forms of cancer
(Emiloju, 2014).Body Mass Index, (BMI), indicates how much an
individual's body weight conforms or departs from what is normal, healthy or
desirable for a person of a specific height (Hernández-Yumaret al., 2018). Body weights are
generally classified into normal weight, underweight, overweight or obesity
using WHO cut-offs (WHO, 1995;Chinedu
and Emiloju, 2014). Weight status of an individual is said to be
overweight or obese when the weight of the person is higher than healthy weight
and the weight of individual lower than healthy weight is considered
underweight (National Institute of Health (NIH) 2013). Thus weight-status
management is not about weight loss only, but on the contrary, it covers all
aspects of attaining and maintaining optimum weight (ideal body weight) for a
healthy lifestyle (Inoue et al.,
2007). This is achieved by losing weight in the case of overweight or obesity,
and gaining weight in the case of underweight (Olaoye and Oyetunde, 2012).
Obesity
has become a major health problem worldwide, affecting people across all ages,
sex, ethnicities, and races. Obesity incidence is increased at an alarming rate
and is becoming a major public health concern (Singlaet al., 2010). Indeed, obesity facilitates the development of
metabolic disorders and cardiovascular diseases in addition to chronic diseases
(Singlaet al., 2010;Derdemezisetal.,2011). A body mass index (BMI)
value of 30.0kg/m2 or above is described as obesity and it has many
health consequences (Singlaet al.,
2010; Littleet al.,2007). Obesity is
further categorized as class I or mild obesity (BMI at 30.0-34.9kg/m2),
class II or moderate obesity (BMI at 35.0-39.9kg/m2) and class III
or extreme/morbid obesity (BMI at 40.0kg/m2 and above) (Singlaet al., 2010). In Asian populations, obesity cut off points
are lower. Asians have a higher tendency to development abolic syndrome, so
their BMI cut off for obesity is revised downwards to 25.0kg/m2
instead of 30.0kg/m2 according to published reports (Rubio et al., 2007). A simple way of
estimating obesity in a community or rural setting is to measure the waist
circumference with a tape measure as described later; a waist circumference
greater than 35 inches in women or greater than 40 inches in men is indicative
of obesity.Obesity has reached epidemic proportions in the developing countries
(Patelet al.,2013: Chandrasekaranet al.,2012). Obesity hasseveral causes,
some of which are obvious while others are hidden (Ortinauet al., 2013). Several efforts have therefore been made in curbing
obesity epidemic in other parts of the world(Chandrasekaranet al., 2012). Despite the obesity epidemic, some segments ofpeople
in some developed parts of the world(Chandrasekaranet al., 2012), and some developing countries experience
underweight, overweight and obesity in various segments of their populations
(Nazishet al., 2012).
Underweight
however has been a perennial problem of many developing countries and is a
result of many causes including diarrhea, poor sanitation and hunger (Black, et al., 2013). It is however ironic that
underweight, diet relate anemia and obesity can co-existin the same country,
but in different segments of the populations in both developed and developing
regions of the world (Caballero,2005;Caballero, 2007; Reese, 2008;Uzogara,2016)
In
many populations, overweight is described as a BMI value between 25.0
and 29.9(Jensenet al., 2013). For Asians,
overweight is described as a BMI value between 23.0 and 24.9 (Caballero, 2005).
There are other methods of estimating overweight in the field and community
settings. Such methods involve using a simpletape measure to measure waist
circumference (WC), hip circumference (HC) and a person’s height (Ht) in an
upright position. From these measurements, one can calculate the waist-to- hip
ratio (WHR) and waist-to-height ratio (WHtR). Both WC, WHR, are good estimates
of fat distribution in the body according to the World Health Organization
WHO., 2008) and high WHR correlates positively with many metabolic diseases
such as Type 2 Diabetes mellitus (T2DM), stroke, infertility, hypertension and
cardiovascular diseases (Reese, 2008).Anecdotal reports however claim that low
WHR is directly correlated with fertility and female attractiveness. Waist
circumference is the measurement of distance round the abdomen just above the
belly button while hip circumferenceis distance round the hip through the
widest part of the buttocks. Waist-to-hip ratio (WHR) is the ratio of waist
circumference (WC) to the hip circumference (HC). (Thus WHR=WC/HC). Both WC and
HC must be measured in the same units before deriving the ratio (WHR). If the
waist to hip ratio is greater than 0.9 in men, or greater than 0.8 in women, it
is indicative of overweight and obesity and high risk of metabolic diseases
(WHO, 2008). High WHR and WC correlated positively with high rates of
overweight and obesity as well as higher risk of cardio-metabolic diseases
(Reese, 2008).
The
waist-to-height ratio (WHtR) is another good estimate of fat distribution in
the body. The WHtR is the ratio of waist circumference to height, both measured
in same units. (ThusWHtR=WC/Ht). The WHtR can be used to estimate overweight
and obesity and predict risk of metabolic diseases better than BMI according to
recent reports. If the WHtR is less than 0.50, it is indicative of low risk of
metabolic diseases. If the ratio is around 0.50 or higher than 0.50, it
indicates overweight and obesity and increased risk of metabolic diseases like
T2DM, stroke, infertility, CVD and others. Recent studies indicate that keeping
WHtR below 0.50 (i.e. keeping a person’s waist circumference at less than half
of the person’s height) is one good way of reducing risk of metabolic disease
and increasing life expectancy (Ashwellet
al.,2012).
Overweight
is very common in many developed countries and some developing countries where
overweight can coexist with obesity and underweight (Reilly et al.,2012; Caballero,2007;
Caballero,2005).
In
many populations, overweight is described as a BMI value between 25.0%
and 29.9%(Jensen et al.,2014).If
overweight in an adult is not well controlled by physical activity, behavior
modification and diet, it can result into obesity. Similarly an overweight
child without early intervention to control excess weight can grow up living
with overweight and obesity and these conditions may continue into adulthood.
Adult obesity can have many consequences such as diabetes, hypertension,
cardiovascular and other diseases (Reilly et
al.,2012).
Given
the current obesity epidemic and its projectedconsequences, identifying
effective population based interventions has become a public health priority in
sub-Saharan Africa (WHO, 2005; Steyn and Damasceno, 2006;Oyeyemiet al., 2012). The problem of obesity is
multi-factorial, and prevention of weight gain can theoretically be achieved by
altering the imbalance between energy consumed and expended (Oyeyemiet al., 2012). However, complex behavioral
and social factors including environments that promote unhealthy food choices
and discourage physical activity are thought to be contributing to the
imbalance driving the epidemic of population wide obesity (Swinburnet al., 2005; Boehmeret al., 2006; Oyeyemiet al., 2012).
An
unhealthy lifestyle among young adults is a serious and often unnoticed problem
which contributes to increase in body weight both in the rural and urban areas
(Ostrowskaet al., 2007). Studies have
shown that there are differences in the lifestyle of young adults from rural
and urban areas such as dietary pattern and physical activity (Ostrowskaet al., 2007).
To
date, research focusing on the relation of the built environment to overweight
and obesity has rarely been conducted anywhere in Africa. Africa-specific
studies on the environment-overweight association are needed to guide evidence
and develop effective population based interventions that can be tailored to
the unique African context.
1.1 STATEMENT OF PROBLEM
Children and young
adults who are obese are more likely to have a clustering of cardiovascular
risk factors such as dyslipidemia, hypertension and type-2 diabetes mellitus,
which persist into adulthood (Vercozaet
al., 2009).Many studies have opined the relationship between the dietary
lifestyle of youths and its risk factors for overweight and obesity. All over
the world, the prevalence of overweight and obesity has been on the increase
(WHO, 2008). In 2008, more than 1.4 billion adults (20
years and above) were overweight, and of these over 200 million men and nearly
300 million women were obese (WHO, 2012). This data is alarming considering the
health burden associated with these medical conditions. In addition, research
have shown that the increasing trend of obesity in the world is even more
pronounced in developing countries of the world (Chukwuonye et al., 2013).Although it had
been projected that by 2030, there will be 2.16 billion overweight and 1.12
billion obese individuals globally, results from trend analysis suggest that 2
or more billion people worldwide are currently overweight or obese (Kellyet al., 2008; Popkinet al., 2012). High blood pressure and high fasting plasma glucose
were leading risk factors for disease worldwide in 2010 and are in part caused
by obesity (Limet al., 2013). The
global disease burden attributable to high body-mass index increased from 52
million in 1990 to 94 million disability-adjusted life-years in 2010 (Limet al., 2013).
Among
people aged 15 years and above, the WHO estimated that the prevalence of
overweight and obesity in 2010 was as high as 63.8% and 21.3% respectively, for
men, and 73.8% and 43.2% respectively, for women, in some Sub-Saharan Africa
countries (Ono et al., 2012).
Eritrea, Ethiopia, Democratic Republic of the Congo and Central African
Republic had the lowest prevalence, while Seychelles, Lesotho, South Africa and
Mauritius had the highestprevalence of overweight and obesity in Sub-Saharan
Africa (Ono et al., 2012).
In
general, the countries with lower prevalence of overweight and obesity tend to
be those with low gross domestic product per capita and vice versa, suggesting
that socio-economic status may be a determinant of overweight and obesity in
some African countries(Ono et al.,
2012). According to Innocent et al.,
(2013), prevalence of overweight individuals in Nigeria ranged from
20.3%-35.1%, while the prevalence of obesity in Nigeria ranged from 8.1%-22.2%,
respectively.
Data
from the WHO Global InfoBase, based on individuals aged 30 years and above,
shows that the prevalence of overweight and obesity together increased by 23%
in men and 18% in women, while the prevalence of obesity alone increased by 47%
in men and 39% in women, between 2002 and 2010, in Nigeria (Ono et al., 2012). Previous studies have
shown that several factors including age, gender, marital and socio-economic
statuses, occupation, urban residence, dietary intake and physical activity are
associated with overweight and obesity (McLaren, 2007; Abubakari et al., 2008; Olatunbosun et al., 2011).Inequalities in obesity
vary by ethnic group, with children and adults from some ethnic-minority groups
at increased risk. For instance, Asian children are more likely to be obese
than white children and in the United Kingdom, rates of adult obesity are lower
in men of minor ethnicity, however, higher among black Africans, Black
Caribbean, and Pakistani women (Law et al.,
2007).
Many
childhood diseases achieve their worse effect in poverty, socially deprived
homes and it would be surprising if protein energy malnutrition were an
exception (Center for Disease Control and Prevention, 2008). It is not
necessarily the poorest children who become the most malnourished. Some
families do manage by ingenious self-help schemes and economies to stave off
malnutrition but in general; it is the case that malnutrition is primarily a
problem of poor countries and of the poorest sections of the community within
these countries (Levison, 2011).Lucas and Gilles (2010) noted that poverty is
the main determinant of energy and nutrient malnutrition. Many surveys
undertaken in rural areas of developing countries have emphasized that poor
families are more likely to have malnourished children (Lucas and Gilles,
2010). This is in agreement with Nigeria living standards survey, 39.1% of
Nigerians lived below the international poverty line of $1.90 per person per
day while 40.1% of Nigerians lived below Nigeria’s national poverty line (NPP,
2011).
However,
it has been suggested that individuals who live in impoverished regions have
poor access to fresh food which leads to diminished access to healthy food.
Nutrition basically can be described as the process of taking food to carry out
different functions of the body needed for the survival of the organisms which
is about eating a healthy and balanced diet (WHO, 2008). The socio-cultural
factors bearing on food and nutrient range from material technologies to
implicit ideologies and symbol, and are inter-related in an original pattern.
This cultural influences lead to difference in the habitual consumption of
certain foods and in traditions of preparation, and in certain cases can lead
to restriction such as exclusion of meat and milk from the diet which leads to
the consumption of insufficient required food (Kuczmarski et al.,2017).
Wage earners are forced to buy cheap food in
order to make ends meet, leading to over reliance on few high yielding staples
that are usually cheap to procure (Obionu, 2007). Everywhere, protein energy
malnutrition is clearly more common in the less affluent members of the
population (Obionu, 2007). Even though the prevalence of overweight and obesity
in Nigeria continues to increase, there are few studies of its correlates with socio-cultural factors. It
is in view of these identified problems that this study seeks to assess the
weight status and socio-cultural factors of young adults in urban and rural
areas of Akwa Ibom State.
1.2 OBJECTIVES OF THE STUDY
1.2.1 General objective
The general objectives of the study are to determine the
socio-cultural factors affecting the weight status of young adults in urban and
rural areas of Akwa Ibom State.
1.2.2 Specific
objectives
The
specific objectives of the study is to:
i.
Determine the
socio-economic characteristics of young adults in urban and rural areas of Akwa
Ibom State.
ii.
Assess their weight
status
iii.
Identify the
socio-cultural factors of the respondents
iv.
Determine the
relationship between socio-cultural factors and weight statusof the respondents
1.3 SIGNIFICANCE OF THE STUDY
The
result from this research will help young adultsexpose socio-cultural factors
which affect weight status and help them see the need to develop good eating
pattern and food choice, so as to have better weight status and reduce the risk
caused by poor food choice such as under-nutrition and over nutrition.
Result will also assist young adults who have
a sedentary lifestyle to observed correct nutritional practices. It will also
improve the knowledge of young adults on nutrition education, most especially
those in the rural community and then urban areas.
This
study will also be of uttermost significance to people in the rural community
whereby they will be aware of socio-cultural influences on food choice and know
their stance in regards to healthy eating.Through this study researchers will
know the weight statues of young adults in the area of study as well as their
dietary habits and socio-cultural factors affecting them.
The
study will also be of importance to the government/policymakers by given them a
broad knowledge of the effect of some of the cultural practices thereby setting
up a better standards to promote healthy living and food consumption.
In
addition, the result will also be an eye opener to public health
professionals/health workers/nutritionist in designing nutrition program for
young people with limited resources. Professionals could draw from this
research as they carry out further research in community nutrition.
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