ABSTRACT
This was a cross sectional study carried out to assess the prevalence of overweight and obesity among health practitioners. A total of 353 health workers (comprising 197 males and 156 females) were selected using simple random sampling technique. Data on socio economic characteristics and dietary habits were collected using a structured questionnaire, while physical activity levels were determined using IPAQ-SF questionnaire. Anthropometric measurements of weight, height, hip and waist circumferences were taken using standard measurements. Data were analyzed using frequencies, percentages, Chi-square, means and standard deviation with SPSS version 20.0. From the result, about 44.2% earned between N100,001-N200,000 a month. About 68.9% skipped breakfast due to time constraint. Pastries, carbonated drinks and alcoholic beverages were consumed by 61.8%, 54.9% and 41.9% twice a week, respectively. Many (45.3%) of them were moderately active. Prevalence of overweight and obesity according to BMI, waist height ratio, waist circumference and WHR classification were (41.1% and 20.7%, 64.3%, 34.6% and 39.7%) of the health practitioners. Females had significantly high waist circumference (χ2= 353.000; p=0.000), while males were significantly more obese than females (χ2= 353.000; p= 0.000) (p<0.05). Significant relationship was found between physical activity levels and sex (χ2=6.152; p=0.046), but no significant relationship was observed between the different health practitioners (χ2=4.755; p=0.313). Significant factors associated with BMI status were monthly income (χ2=18.560; p=0.005), ethnic group (χ2=14.136; p=0.028) and household size (χ2=10.374; p=0.035). It is important to maintain a healthy dietary habit and positive lifestyle pattern by engaging in regular physical activities at least 30 minutes a day.
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENTS iv
TABLE OF CONTENTS v
LIST OF TABLES viii
ABSTRACT ix
CHAPTER 1
INTRODUCTION 1
1.1 Statement of problem 5
1.2 Objectives 6
1.2.1 General objective 6
1.2.2 Specific objectives 6
1.3 Significance of the study 7
CHAPTER 2
LITERATURE REVIEW 9
2.1 Overweight and obesity 9
2.3 Measurement of overweight and obesity 10
2.3.1 Body Mass Index (BMI) 10
2.4 Classification of overweight and obesity 11
2.5Potential aetiological factors of overweight and obesity 11
2.5.1 Genetics 12
2.5.2 Diet 13
2.5.2.1 Fat 13
2.5.2.2 Portion size 14
2.5.2.3 Sugar 15
2.5.3 Exercise 16
2.5.4 Sleep 17
2.5.5 Depression 17
2.5.6 Office-work influences 19
2.6 Symptoms of overweight and obesity 19
2.7 Consequences of overweight and obesity 20
2.7.1 Physical/medical consequences 20
2.7.2 Psychological consequences 21
2.7.3 Social and economic consequences 21
2.8 Overweight and obesity among health practitioners 23
2.8.1 Health practitioners 23
2.8.1 Nutrition assessment of overweight and obesity 25
2.8.1.1 Nutrition knowledge 25
2.8.1.2 Nutritional status 25
2.8.1.3 Purpose of nutritional assessment 27
2.9 Anthropometric measurement 27
2.9.1 Height measurement 28
2.9.2 Weight measurement 29
2.9.3 Body Mass Index 29
2.9.4 Waist circumference (WC) 30
2.9.5 Hip circumference 30
2.9.6 Waist-hip Ratio (WHR): 31
2.10 Treatment/management of overweight and obesity 31
2.10.1 Weight loss Programs 32
2.10.2 Pharmacologic therapy 33
2.10.3 Surgery 33
2.10.4 Co-morbidities 33
2.10.5 Weight loss associated morbidity 34
2.10.6 Conventional diets 34
2.10.7 Reduced portion size diets and balanced, low-calorie diets 35
2.10.7.1 Reduced portion-sized diets 35
2.10.7.2 Low-calorie diets 36
2.10.7.3 Diets with different macronutrient compositions 37
2.10.8 Water drinking 37
2.10.9 Exercise programs 37
2.10.10 Behavioural changes 38
2.10.11 Anti-obesity medications 38
2.10 Barriers to the effectiveness of reduction of overweight and obesity 38
2.11 International Physical Activity Pattern Questionnaire (IPAQ) 40
CHAPTER 3
MATERIALS AND METHODS 43
3.1 Study design 43
3.2 Area of study 43
3.3 Population of the study 44
3.4 Sampling and sampling technique 44
3.4.1 Sample size determination 44
3.4.2 Sampling procedure 45
3.5 Preliminary activities 46
3.5.1 Preliminary visits 46
3.5.2 Informed consent 47
3.5.2 Training of research assistants 47
3.5.3 Questionnaire validation and pretesting 47
3.6 Data collection 48
3.6.1 Questionnaire administration 47
3.6.2 Anthropometric measurements 48
3.6.3.1 Weight measurement 48
3.6.3.2 Height measurement 48
3.6.3.3 Hip circumference measurement 49
3.6.3.4 Waist circumference measurement (WC) 49
3.7 Data analysis 49
3.8 Statistical analysis 52
CHAPTER 4
RESULTS AND DISCUSSION 54
4.1 Socio-demographic characteristics of the health practitioners 54
4.2 Distribution of health practitioners according to their job characteristics 57
4.3 Dietary habits of the health workers 59
4.4 Mean anthropometric variables of the health practitioners 64
4.6 Assessment of the nutritional status of health workers, using anthropometric
measurements 66
4.3 Physical activity level of the respondents, using IPAQ-SF questionnaire 69
4.6 Factors associated with obesity among the health practitioners 72
CHAPTER 5
CONCLUSION AND RECOMMENDATION 77
5.1 Conclusion 77
5.2 Recommendations 77
REFERENCES 79
APPENDIX I 89
APPENDIX II 94
LIST OF TABLES
Table 2.1: Classification of Body Mass Index (BMI) 11
Table 4.1: Socio-demographic characteristics of the health practitioners 55
Table 4.2: Distribution of health practitioners according to their job
characteristics 57
Table 4.3a: Dietary habits of the health practitioners 61
Table 4.3b: Dietary habits of the health practitioners 63
Table 4.4: Mean anthropometric variables of the health workers 65
Table 4.5: Prevalence of obesity among health practitioners, using
anthropometric measurements 67
Table 4.6a Physical activity level of the respondents, using IPAQ-SF
questionnaire 69
Table 4.6b: Physical activity levels based on their professions 72
Table 4.7a: Dietary factors associated with obesity among the health
Practitioners 73
Table 4.7b Association between socio-demographic characteristics and
obesity among the health practitioners 75
Table 4.6c Association between physical activity level and obesity among
the health practitioners 76
CHAPTER 1
INTRODUCTION
The World Health Organization (WHO) states that non-communicable diseases (NCDs) make the largest contribution to mortality, both globally and in the majority of low and middle income countries (WHO, 2009). Overweight and obesity, which are remarkable non-communicable diseases, refer to the abnormal or excessive fat accumulation that may impair or pose a health risk (WHO, 2009).
Worldwide, obesity has more than doubled since 1980, and according to the WHO (2014), more than 1.9 billion adults (18 years and above) are overweight, out of which over 600 million are obese. Furthermore, a study carried out by Mannan et al. (2013) explained that obesity has been expressed by the World Health Organization as a disease, and also one of the growing threats to populations and countries alike. It is in fact replacing the traditional health concerns of undernutrition and infectious diseases (Mannan et al., 2013). Ogden (2006) also noted that “there has been a dramatic rise in the incidence and prevalence of obesity in both developed and developing parts of the world over the past decade, which is as a result of inadequate eating habits, lack of physical exercise, industrialization and unhealthy lifestyle modifications.”
A report given by the United Nations Standing Committee on Nutrition (UNSCN), states that “the dramatic increase in the incidence of obesity and overweight have been attributed to the nutrition transition, which constitutes a departure from a traditional diet to a western diet with high intakes of saturated fat, sugar and refined carbohydrates, and low fibre intake, together with a sedentary lifestyle due to urbanization and technological advances” (UNSCN, 2006 and Popkin, 2006).
In Nigeria and some African countries, overweight and obesity are socially acceptable as a sign of affluence (Okafor et al., 2014), whereas, in others, obesity is admired and seen as a symbol of beauty and virility (Iwuala et al., 2015). Ogunjimi et al. (2010) revealed that some “fattening” ceremonies have been reported in various parts of the world, such as among Massa men of northern Cameroon and Chad. These ceremonies are also seen in Tahiti, Nauru, among Japanese Sumo wrestlers (Oliver et al., 1974; Ogunjimi et al., 2010) and among the Anang tribe of Calabar, Nigeria (Oliver et al., 1974; Ogunjimi et al., 2010). It is also seen among affluent business executives and in middle-aged females with sedentary lifestyles according to Okafor et al. (2014). Besides, Ebele et al. (2009) noted that work patterns in Africa, including Nigeria are becoming sedentary due to improvement in technology and civilization. Adegun and Konwea (2009) also supported that view by saying that most jobs in the civil service are sedentary and basically involve spending hours seated at the office.
According to current researches, it is believed that obesity also has implications at the work place. For instance, the study by Gate et al. (2008) and Capadaglio et al. (2010) explained that obesity is associated with weight discrimination, increased rate of absenteeism, presenteeism, occupational injury, short term disability, as well as reduced productivity rate. The work environment has also been discovered to contribute to the obesity epidemic. Such “obseogenic” environment includes shift work, job stress and long work hours (Zhao et al., 2011; Buss et al., 2012).
According to Lehmann (2004), a health worker is defined as a healthcare provider who is not a medical doctor or physician, but who provides clinical care in the community or at the primary care facility or hospital (Lehmann et al., 2004). Health workers, which are also known as the health service providers, are one of the most important group of workers facing such obseogenic work environment or setting (skaal et al.,2010. These include the doctors, nurses, pharmacists etc (Caban et al., 2005; Suija et al., 2010). Generally, it is well known that doctors and nurses play a vital role in the health and welfare of the people of a nation (Frank, 2004), and the health of the doctors and nurses especially, is of paramount importance because they themselves must be healthy to perform their jobs optimally under challenging work environments (Skaal et al., 2011). Additionally, evidence suggests that there is a strong and consistent relationship between a physician’s health choices and the recommendations he or she makes to his or her patients (Frank, 2004). With further elaboration, it simply means that a physician must stay healthy in order to provide healthy recommendations to his patients. However, there are conflicting reports about the prevalence of obesity among these health workers who are perceived or seen as role models of healthy behaviour in the society (Caban et al., 2005). Certain studies found the prevalence of obesity to be lower among health workers, compared to the general population (Caban et al., 2005 and Temporelli et al., 2013). For instance, a study carried out in the United States, among 41 professional groups showed that the health practitioners (persons of the health-diagnosing profession) had the lowest obesity rates, being 6.2% in men, and 4.3% in women (Skaal et al., 2011; Ordinioha, 2013). Conversely, other studies, especially from developing countries, have reported higher rates of obesity among health practitioners, compared with the general population (Ordinioha, 2013; Skaal et al., 2011).For instance, a study carried out by Skaal et al. (2011) revealed that the prevalence of overweight and obesity among 100 black medical healthcare workers in South Africa was 60.5% and 76.5% in the male and female health workers, respectively, while the prevalence of overweight/obesity was 49% in black men and 75% of black women in the general population.
Unfortunately, some of these health workers seem to be comfortable with their weights, despite the fact that they are overweight or obese (Skaal et al., 2011). A study carried out among medical health workers in South Africa found that, although 73.5% were overweight/obese, 56% were satisfied with their weight (Skaal et al., 2011).
According to the 2010 WHO survey data on Nigeria, the prevalence of overweight was 26% and 37% in men and women, while the prevalence of overweight was 3% and 81% in men and women, respectively (WHO, 2010). Furthermore, it is important to note that there have been limited studies about the prevalence of obesity among health practitioners in Nigeria. These studies have mostly been carried out among health workers. For instance, according to Ojomu et al. (2013), prevalence of overweight or obesity was found to be 72% among the health workers. Furthermore, in researches among single professional groups such as the doctors, Aghaji (2009) found a higher prevalence of overweight (68.1%) among males than females (57.6%). Similarly, a study carried out by Ogunjimi et al. (2010), in a study among 500 nurses in Akwa Ibom State, Nigeria found a high prevalence (62.2%) of obesity among the nurses. A combined prevalence of overweight and obesity was also found among women aged 15 – 49 years of about 34.8%, both in Akwa Ibom state (Ogunjimi et al., 2010).
Studies have also further indicated early retirement among obese workers, as compared to non-obese workers (Houston et al., 2009) as its presence can create certain functional disabilities or cause other health problems. Therefore, it would be useful and fundamental to carry out this research among health care practitioners, not just to identify the rate of prevalence among them, but also to help instigate corrective measures which can be taken against improper feeding, sedentary lifestyle practices and any erroneous attitudes or misinformation about obesity, which they may have been involved in or acquired, if found necessary.
1.1 STATEMENT OF PROBLEM
Overweight and obesity are emerging as serious health problems throughout the world. Not only is it found among the adults, children and teenagers, but also, it has been identified among health workers who are also known as the healthcare providers, such as doctors, nurses, pharmacists, etc (Jayara et al., 2014).
Indeed, many disorders have been shown to occur with greater frequency in overweight and obese individuals than among others, which indicates that obesity predisposes an individual to hypertension, type II diabetes mellitus, hyperlipidemia, coronary artery diseases, etc (McDermott, 2006;Baron, 2007), and this is as a result of environmental adaptation and nutrition transition which could equally be referred to as “changes in lifestyle”(;UNSCN, 2006 and Okafor et al., 2014).
Obesity is gradually penetrating into the health sector, and this goes to show a gradual loss of knowledge on the adequate diets to consume, increase in unhealthy behaviours such as alcoholism, smoking and sedentary lifestyle practices on the part of the health workers.
Hence, it has become important to find out the prevalence of overweight and obesity among health practitioners and make recommendations based on findings.
1.2 OBJECTIVES
1.2.1 General objective:
The general objective of this research is to determine the prevalence of overweight and obesity among health practitioners.
1.2.2 Specific objectives:
The specific objectives of this study are to:
i. assess the nutritional status of health practitioners, using anthropometric measurements.
ii. assess dietary habits of the respondents.
iii. determine the physical activity level of the respondents, using the International Physical Activity Questionnaire short-form(IPAQ-SF).
iv. determine the factors associated with obesity among the health practitioners.
1.3 SIGNIFICANCE OF THE STUDY
This study will create an impact to the body of knowledge on overweight and obesity in Nigeria, thereby increasing awareness to the health practitioners and the general public about the dangers or health implications of being obese, as well as how their weight could be controlled.
Furthermore, results from this research would also help them to identify the importance of consuming adequate diets and carrying out physical exercise, which would improve their health condition.
The study would also be useful to nutritionists, corporate bodies and professional bodies by providing sufficient information which would serve as a medium or basis for further researches to be carried out in the near future.
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