ABSTRACT
Overweight and obesity are public health problems all over the world because of their devastating health, economic and social consequences. In recent years, developing countries like Nigeria have been experiencing a nutritional transition in food choices from the typical starchy (mainly carbohydrate diets) to the fast food pattern and as a result of this, the dietary habits and lifestyle of young adults have being affected. Thus, overweight and obesity are increasingly being observed among young adults. This study assessed the prevalence of overweight and obesity amongst young adults in Coal Camp, Enugu State, Nigeria. A total of 325 young adults were randomly selected for this survey. A validated questionnaire was used to collect information on the socio-economic characteristics of the subjects. Weight and height measurements were taken alongside waist circumference and hip circumference. Body mass index and waist/hip ratio were calculated. Overweight and obesity were defined according to WHO cut-off for BMI. The data were analysed using descriptive statistics, cross tabulations and chi-squared tests. The percentage of females (53.5%) was slightly higher than that of the males (46.5%). All the respondents were between 18-21 (26.8%), 22-25 (42.5%) and 26-29 (30.8%) years of age. Occupational status of young adults revealed that majority of the respondents were students (63.4%), artisans (12.9%) and unemployed (11.4%). Results on lifestyle pattern of young adults showed that only a few (31.4%) of them regularly indulged in physical activity compared to the majority (68.6%) of the youths who either do not exercise regularly or do not exercise at all. Furthermore, regular pastries (48.3%) and poor fruit (76.8%) consumption was observed among most of the respondents. Prevalence of overweight and obesity based on body mass index status of respondents were 11.4% and 3.7%. More females(6.2%) and (3.1%) than males (5.2%) and (0.6%) were overweight and obese (p< 0.05). Most(72.9%) of the respondents had normal BMI while some (12.0%) of them were underweight. Results on waist/hip ratio of the respondents showed that majority (82.8%) of the young adults were normal, while only 17.2% were at an increased risk of obesity. The low prevalence of overweight and obesity in this study is encouraging though efforts needs to be made to encourage these and other young adults to strive for and maintain healthy weights as they grow into full adulthood.
TABLE OF CONTENTS
| TITLE PAGE CERTIFICATION DEDICATION ACKNOWLEDGEMENT TABLE OF CONTENTS LIST OF TABLES ABSTRACT | i |
| ii |
| iii |
| iv |
| v |
| vi |
| vi |
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| CHAPTER 1 | |
1.1 1.2 1.2.1 1.2.2 1.3 2.1 2.1.1 2.2 2.2.1 2.3 2.3.1 2.3.2 2.3.3 2.3.4 2.3.5 2.3.6 2.3.7 2.3.8 2.4 2.5 2.6 2.7 2.8 2.9 2.9.1 2.9.2 2.9.3 3.1 3.2 3.3 3.4 3.4.1 3.4.2 3.5 3.5.1 3.5.2 3.5.3 3.6 3.7 3.8 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5.1 5.2 Table 2.2.1 Table 2.4 Table 4.1 Table 4.2 Table 4.3 Table 4.4a Table 4.4b Table 4.5a Table 4.5b Table 4.6 Table 4.7 Table 4.8a Table 4.8b Table 4.9a Table 4.9b Table 4.9c | INTRODUCTION Statement of problem Objective of the study General objectives Specific objectives Significance of the study CHAPTER 2 LITERATURE REVIEW Nutritional status Anthropometric measurements Overview of overweight and obesity Classification of overweight and obesity Measurements of body fat composition Waist circumference Waist-to-hip ratio Skinfold thickness Dual energy x-ray absorptiometry Near-infrared interactance Hydrostatic (underwater) weighing Air displacement plethysmography Bioelectric impedance analysis Diseases related to obesity Causes and aetiology of overweight and obesity Other factors influencing obesity Genetic defects, endocrine factors, trauma and obesity Effects of obesity on human health Control and treatments of obesity Physical exercise and dietary advice Tested and potential drugs treating obesity Surgical treatment of obesity CHAPTER 3 MATERIALS AND METHODS Study design Area of study Population of study Sampling and sampling techniques Sample size Sampling techniques Preliminary activities Preliminary visits Training of research assistants Informed consent Data collection Data analysis Statistical analysis CHAPTER 4 RESULTS AND DISCUSSIONS Demographic and socio-economic status of young adults Lifestyle pattern of young adults Family medical/health history of young adults Dietary habits of young adults Snacks, fruits and beverage consumption pattern of young adults Nutritional status of young adults using anthropometric measurements Cross tabulation of BMI and sex of young adults 24 hours dietary recall of young adults Weekly food frequency of young adults CHAPTER 5 CONCLUSION AND RECOMMENDATIONS Conclusion Recommendation REFERENCES LIST OF TABLES BMI classifications of overweight and obesity Common causes of morbidity and mortality due to obesity Demograghic and socio-economic status of young adults Lifestyle pattern of young adults Family medical/health history of young adults Dietary habits of young adults Dietary habits of young adults Snacks, fruits and beverage consumption pattern of young adults Snacks, fruits and beverage consumption pattern of young adults Anthropometric status of young adults Cross tabulation of sex and BMI status of young adults 24 hours dietary recall of young adults 24 hours dietary recall of young adults Weekly food frequency of young adults Weekly food frequency of young adults Weekly food frequency of young adults | 5 8 8 8 9 10 11 14 15 16 16 17 18 19 20 21 22 24 25 27 28 28 30 30 33 34 36 36 36 36 36 38 38 38 38 39 39 41 42 43 46 50 52 59 64 67 69 72 76 77 78 16 24 45 49 51 57 58 62 63 66 67 70 71 74 75 76 |
`CHAPTER 1
INTRODUCTION
According to Wardlaw and Kessel (2002), food is a part of everyday life and it provides both the energy and the nutrients to build and maintain all body cells. Nutrition as defined by Ajala (2005) is the process of taking in food and how these food nutrients are used by the body for growth, repair and maintenance of tissues. Furthermore, he stated that prolonged poor nutritional practices and heightened levels of stress are strongly linked with nutritional problems like overweight and obesity.
World Health Organization (WHO) (2000) defined overweight and obesity as medical conditions in which excess body fat has accumulated to the extent that it may have an adverse effect on health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. . WHO (2000) went further to define Body mass index (BMI) as a person's weight in kilograms divided by the square of the persons height in meters (kg/m2). They classified overweight as a BMI greater than or equal to 25kg/m2 while obesity is a BMI greater or equal to 30kg/m2.BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals (WHO, 2000). Obesity according to Sweeting (2007) is also defined by Body Mass Index (BMI) and further evaluated in terms of fat distribution through the waist-hip ratio and total cardiovascular risk factors. Findings from Olusanya (2008) pointed that overweight and obesity are the most common nutritional disorders in infants, children and adults in affluent societies. He also defined overweight and obesity as abnormal accumulation of fat in the adipose tissues throughout the body. Young adults are reportedly prone to overweight and obesity in the transition from childhood/adolescence to adulthood (Gordon-Larsen et al., 2009 and Singh et al., 2008). Thomas (2005) described young adults as people who are in their early stage of adulthood and they fall within the age bracket of 20-30 years.
Young adulthood is the period in which good health and financial independence may be experienced, resulting from financial success. Memory and thinking abilities (cognitive) abilities are at their peak at this stage. The social development and personality development for the young adults can be identified with a desire to be socially independent and with a high ambition to succeed (Devine, 2005). Young adults typically have enormous appetites, and unfortunately, the foods popular with them are often empty calorie foods, such as chips, soft drinks and sweets. These foods provide mainly carbohydrates and fat, and very few proteins, vitamins and minerals (Townsend, 1994). Ene-Obong (2001) stated that young adults have been shown to have poor food habits. They are characterized by skipping of meals, eating in-between meals, snacking on “junk foods”, having a wide range of likes and dislikes, and, above all, dieting to maintain shape or figure (especially among girls). This often leads to inadequate and sometimes bizarre dietary intakes, and may result in anorexia nervosa (willful starvation). Food habits established during this stage of life can have an enormous impact on health and wellbeing, as well as the risk for developing obesity, diabetes, heart disease and cancer (Townsend, 1994).
Haslam and James (2005)reported that the fundamental cause of overweight and obesity is an energy imbalance between calories consumed and calories expended and other causes are a combination of an increased intake of energy-dense foods that are high in fat, an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, increasing urbanization and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications and psychiatric illness. Furthermore, they stated that overweight and obesity increases the likelihood of various noncommunicable diseases, particularly cardiovascular diseases (mainly heart disease and stroke), type 2 diabetes mellitus, musculoskeletal disorders (especially osteoarthritis - a highly disabling degenerative disease of the joints), some cancers (endometrial, breast, and colon) and breathing difficulties during sleep. The risk for these noncommunicable diseases increases, with an increase in BMI.
WHO (2012) emphasized that overweight and obesity, as well as their related noncommunicable diseases are largely preventable. Supportive environments and communities are fundamental in shaping people’s choices, making the healthier choice of foods and regular physical activity the easiest choice (accessible, available and affordable) and therefore preventing overweight and obesity.At the individual level, people can limit energy intake from total fats and sugars, increase consumption of fruit and vegetables as well as legumes, whole grains and nuts, engage in regular physical activity (60 minutes a day for children and 150 minutes per week for adults).
Individual responsibility can only have its full effect where people have access to a healthy lifestyle. Therefore, at the societal level it is important to support individuals in following the recommendations above, through sustained political commitment and the collaboration of many public and private stakeholders, make regular physical activity and healthier dietary choices available, affordable and easily accessible to all especially the poorest individuals.
The food industry can play a significant role in promoting healthy diets by reducing the fat, sugar and salt content of processed foods, ensuring that healthy and nutritious choices are available and affordable to all consumers, practicing responsible marketing especially those aimed at children and teenagers, ensuring the availability of healthy food choices and supporting regular physical activity practice in the workplace.
1.1 Statement of problem
Overweight and obesity have been considered serious health problems worldwide since 1997 (WHO, 2000). Adeogun and Ligali (2013) emphasized that both developed and developing countries are experiencing increasing rates of overweight and obesity. Overweight and obesity are the fifth leading risk for global deaths, at least 2-8 million adults die each year as a result of being overweight or obese. In addition, 44% of the diabetes burden, 23% of the ischemic heart disease burden, between 7% and 41% of certain cancer burdens are attributable to overweight and obesity (Adeogun and Ligali, 2013). Furthermore (WHO, 2012) noted that although overweight and obesity were once considered high-income country problem, they are now on the rise in low – and middle-income countries, particularly in urban settings. Close to 35 million overweight children are living in developing countries and 8 million in developed countries.
Overweight and obesity are linked to more deaths worldwide than underweight. For example, 65% of the world’s population live in countries where overweight and obesity kill more people than underweight (this includes the high income and most middle-income countries) (WHO, 2012). In Europe, overweight affects 30% to 80% of European adults (Pieniak et al., 2009). In Brazil and Columbia, the figure of overweight is about 40% comparable with a number of European countries and in all regions, obesity appears to escalate as income increases. In France, obesity rate increased from 5% in 1981 to 10% in 2003 among its French adults aged 18-65years (Khlat et al., 2009). Swiss men and women of Geneva, Switzerland are now 44% and 24% overweight and 13% and 9% obese, respectively. Spanish Ministry of Health stated that one out of every two individuals in Spain is overweight (Costa-font and Gil, 2008). The prevalence of obesity among Spanish men and women has risen to 20.2% and 25.6%, respectively (Andreyeva et al., 2007).
In the West African countries such as Ghana and Republic of Benin, obesity is found in 13.6% and 18% respectively among adults (Amoah, 2003 and Sodjinou et al., 2008) while Abubakari et al. (2008) reported prevalence of 10% in the West African sub-region with the odd of being obese being 3.2% among urban women compared to men. Overweight and obesity are becoming more prevalent in many Africans and other developing countries with nutritional transition as a result of urbanization, adoption of western lifestyles and demographic transition being implicated for the upsurge (Ojofeitimi et al., 2007). Adeogun et al. (2010) also observed that obesity epidemic is especially evident in industrialized nations where many people live sedentary lives and eat more convenience foods, which are typically high in calories and low in nutritional value. Barness et al. (2007) noted that overweight and obesity are the leading preventable causes of death worldwide, with increasing prevalence among adults and children and authorities view them as being among the serious public health problems of the 21stcentury.World health organisation estimates that at least 1 billion people are overweight and 3 hundred million people are obese (Haslam, 2005). Ezzati (2005) reported that overweight and obesity prevalence are increasing in developing countries and mean Body Mass Index (BMI) levels are highest in middle income countries. In Nigeria, a 2008 WHO report puts the prevalence of overweight and obesity at 26.8% and 6.5% respectively (WHO, 2011). Adeyemo et al. (2003) reported that Nigeria is witnessing both demographic and epidemiologic transitions and these could be some of the possible reasons why the prevalence of non-communicable diseases is increasing. They also noted that there is a general misconception in Nigeria that obesity is a sign of affluence. Ojofeitimi et al. (2007) found that 21.2% of their respondents were obese while Kadiri and Salako (2007) and Adeogun (2011) also found obesity in 21% and 28% of males and females respectively in a study of 146 middle-aged Nigerians.
Ben-Bassey et al. (2007), observed that in many of the urban centres of the developing Countries, a change in lifestyle due to increased affluence has been observed, and this change in lifestyle is an important factor in the global epidemic of overweight and obesity. However, Olusanya and Omotayo (2011) reported that overweight and obesity are increasingly being observed among young adults. They further stated that many researches have been done on nutritional status of children (school-age), infants and the elderly because they are believed to be among the groups at risk or the vulnerable group, but young adults are not believed to be part of these vulnerable groups, and so little attention is paid to this group in relation to nutrition (Olusanya and Omotayo, 2011).
Given the lack of much information on overweight and obesity in young adults in Nigeria and the possible impact of these disorders on the health system and the economy of any nation, this study is therefore designed to fill that gap by examining the prevalence of overweight and obesity amongst young adults, using different anthropometric measurements.
1.2 Objectives of the study
1.2.1 General objective
The general objective of this study was to determine the prevalence of overweight and obesity amongst young adults in Coal camp, Enugu State, Nigeria.
1.2.2 Specific objectives
The specific objectives of this study were to:
i. determine the demographic and socio-economic status of young adults.
ii. determine the lifestyle pattern of young adults.
iii. ascertain the dietary habits of young adults using food frequency questionnaires and 24 hour dietary recall.
iv. assess the nutritional status of young adults, using anthropometric measurements.
1.3 Significance of the study
Findings from this study will constitute useful information for the World Health Organization and other international and local health and nutrition agencies and non-governmental organizations, to aid in compiling data on the prevalence of overweight and obesity in Nigeria. In addition, this study will provide valuable insight to nutritionists and other health professionals concerning the problem of overweight and obesity in Nigeria, particularly as it affects young adults.
Furthermore, this study will contribute to existing researches concerning the problem of obesity in Nigeria and also provide a useful background for further researches on the subject. Finally, everyone that will take part in this research will be able to know their state of nutrition and wellbeing.
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