Prevalence of obesity among the young girls (18-22 yrs) of Dawoodi Bohra

Community in Central Mumbai.

Ms. Sakina A RatlamwalaGuided by- Mrs. Anuradha Shekhar

Introduction

• Obesity is a chronic disorder of energy imbalance. It exists all over the world and is increasing at an alarming rate in developed and developing countries . Obesity may be defined as a condition in which excessive accumulation of fat in adipose tissue has taken place. According to WHO obesity is caused when BMI is greater than 25kg/m2 and on the other hand if the percentage of the body fat in males is greater than 25 percent and in females is greater than 30 percent www. apps.who.int/bmi/index.jsp?introPage=intro_3.html

Aim

• To find the prevalence of obesity among the young girls of Dawoodi Bohra community.

Objectives • To determine the prevalence of overweight and

obesity among young Bohri girls of age (18-22 yrs).• To assess the anthropometric measurements and to

compare their BMI to their nutritional status.• To assess the body composition using skin fold

measurements. • To establish the neck circumference and foot length

measurements as markers of obesity.• To evaluate the nutritional status and eating pattern

of the obese individuals using one day dietary recall.• To analyze the clinical symptoms using a

questionnaire

Methodology

Distribution of pamphlets Saifee mohalla husaini kutbi fatemi

405 sample of 18-22 year old girls study conducted in a community hall

Using a questionaire background information obtained

Cont..

1. Anthropometric assessment• Height• Weight• Calculation of BMI• Circumference measurements-waist circumference, Hip

circumference, WHR, mid upper arm circumference.• Skin fold measurements-bicep, tricep, subscapular,

suprailiac.• Foot length and neck circumference.

Cont..2. Clinical assessment3. Dietary assessment4. Family history5. Medical history Followed by calculation of body density, body fat%, fitness score based on

body fat %

Identification of overweight and obese subjects from the sample (using WHO cut offs for BMI)

Subsample of 58 overweight and obese selected and nutritional assessment using 24 hr dietary recall was done

Results and discussions

Background information• Educational status- Maximum number of subjects (n=202) 49.9%, had obtained a

higher secondary certificate.

• Marital status- Maximum of (n=321) 79.3% were unmarried

• Type of family- nuclear family system was predominant in the community (n=250)

• Work related information- 18 % (n=73) of the total sample were working from

which 16.8% of subject had a desk job and a very minute percentage (1.2%) had a

field job.

• Family monthly income- a majority (45.4%) of the subjects fell in the highest

income range of above 15000 Rs per month

Anthropometric details• BMI classification- the prevalence of Obesity

underweight32%

normal48%

overweight15%

obese5%

BMI classification

Cont..• Fitness Classification based on body fat %

21%

15.6%

25.2%

26.4%

11.9%

fitness scale as per body fat percentage

excellent: 9-18.9 good: 19-22.1

fair: 22.2-25 poor: 25.1-29.6

very poor: >29.6

Sen Ray K., Iqbal R., Body Composition: Terms And Techniques,2010: 1; 1-5, In: Methodologies For Fitness Assessment, Anne Books Pvt. Ltd.

Co-relation of BMI and Fitness scores

underweight normal overweight obese 0

10

20

30

40

50

60

70

80

90

100

excellentgood fair poorvery poor

significant correlation at p=0.001

Neck circumference and foot length• Significant correlation between foot length and obesity (p=0.002) as well as neck

circumference and obesity (p=0.000) was found

• Best cut-off of Neck Circumference is ≥33.35cms to predict obesity with sensitivity=89.5%

and specificity=90.9% for the present study.

• A study done in Israel among 979 subjects, for screening obesity using neck circumference

on the same lines reported NC 37 cm for men and 34 cm for women were the best cut off

levels for determining the subjects with BMI 25.0 kg/m2 using the receiver output curve

analysis with a 98% sensitivity, 89% specificity and NC 39.5 cm for men and 36.5 cm for

women were the best cut off levels for determining the subjects with BMI 30 kg/m2 with

93% sensitivity, 90% specificity. Similarly in Chinese subjects Receiver operating

characteristic analysis showed a neck circumference of ≥38 cm for men and ≥35 cm for

women was the best cut off point for determining overweight subjects

Noun B. ; Neck Circumference as a Simple Screening Measure for Identifying Overweight and Obese Patients, Obesity Research (2001) 9, 470–477 Yang G.R., Neck circumference positively related with central obesity, overweight, and metabolic syndrome in Chinese subjects with type 2 diabetes: Beijing Community Diabetes Study 4, Diabetes care 2010 Nov;33(11):2465-7. Epub 2010 Aug 19

Comparison of Obese and Non obese as per BMI and neck circumference

obese non obese0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

4.70%

95.30%

12.80%

87.20%

As per BMI

As per NC

Comparison of obesity as per BMI and Foot length

Obese Non Obese0.00%

10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

4.70%

95.30%

64.90%

35.50%

As per BMI

As per FL

The result of ROC analysis reported a cut off of 22.9cm for foot

length measurement to identify obesity with a specificity =33.7%

and sensitivity =36.8%.

Correlations of anthropometric measurements with dietary nutrient intakes.

• A strong positive correlation (p=0.000) between oil consumption and the weight of the subjects.

• Similarly oil consumption of the subjects had positive correlations at a significance of (p<0.001) with other anthropometric indices like BMI, waist circumference, hip circumference, WHR, MUAC and Neck circumference.

• The body density had a significant negative correlation at (p<0.05)

Correlation between BMI and other anthropometric parameters

• A significant correlation (p<0.01) between WHR and BMI, WC and BMI, HC and BMI, and MUAC and BMI was obtained. Thus these may be successfully used in the determination of obesity and its associated co-morbidities.

Dietary pattern details

• Regularity of meals- The overweight and obese group had 66.1% and 52.6% regular meal eating habits respectively. Maximum meal regularity was seen among the normal BMI group (71.4%).

• Meals per day- four meals a day by each of the BMI categories was the trend observed.

• Obesity and eating out pattern- highly significant relationship (χ2=73.864, p=0.0001) with the BMI of the sample in relation to their eating out patterns . The overweight and obese individuals displayed the maximum frequencies of eating out i.e. 39% and 36.8% respectively every alternate day.

Diet recall

• Energy: The average energy intake of the subsample was 1981kcal ±309.449kcal. This

average intake is 4.3% higher than the recommended caloric intake of 1899kcal for a young

adult lady having reference weight 55kg as per (ICMR, 2010)

• CHO: The mean CHO intake of the subsample as depicted in was 65.19% ±8.77% of the

total caloric intake. This was in accordance to the recommended CHO requirement as per

the recent RDA.

• Protein: The average per day protein intake of the subsample (n=58) was 8.7% ± 2.14% of

the total energy intake. As per ICMR daily protein intake calculated for as per 0.8g/kg B.W

is 9.2%of total calorie intake.

• Fat: The recommended fat intake is 20% of the total recommended energy intake. The

obese and overweight subsample demonstrated a mean fat intake of 26% ±8.5% which was

significantly higher than the RDA requirements.

Clinical assessment

• There were 2.46% (n=10) subjects exhibiting dryness of skin and 5.18% (n=21) showing pale inner eyelids. Specific clinical symptoms like bleeding of gums, pallor, deformities in nails and teeth, eczema, inflammation of tongue etc were not observed among the subjects.

Menstrual details

• Age of menarche- The present study data illustrates that the mean

ages of menarche for Underweight, normal, overweight and obese

were 13.24,12.34, 10.76, 11.32 respectively . The relationship test

carried out between obesity and early age of menarche for the

present study showed a significant co-relation (p=0.00) Thus, as BMI

increased age of menarche decreased.

• Regularity of menses- The menstrual irregularity was prominent

among the obese subjects (n=19) with 78.9% . These results support

that obesity influences the menstrual cycle irrespective of the fat

distribution and can cause many reproductive disorders in women

Family history

• Co-relation between obesity and family history of obesity.

Not obese Obese0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

36.30%(n=140)

94.70%(n=18)

63.70%(n=246)

5.30%(n=1)

NoYes

obesity of the subjects in relation to their familial history of obesity showed a very strong significance (p=0.000) of positive co-relation

Medical history

• Medication for PCOS was reported to be consumed by a total of 24 subjects

• Co-relation between PCOS and BMI.The test result reported a significant co-relation

(χ2=33.357, p=0.000) between increase BMI and PCOS

Physical activity

• Physical activity pattern

n=6415.81%

n=34184.19%

physical activity

ExercisingNot exercising

The co-relation analysis between Physical exercise and BMI reported a significant correlation at (p<0.05).

Summary and conclusion• Prevalence of Obesity and overweight subjects were 5% and 15%• The fat percentages of normal BMI subjects were highly fair and

poor pointing to the thin fat phenomenon• The obese and overweight subjects had increased calorie and fat

consumption as compared to the RDA.• Best cut-off of Neck Circumference is ≥33.35cms to predict

obesity(≥30kg/m2) with sensitivity=89.5% and specificity=90.9%. Thus Neck circumference proved to be a good anthropometric marker of overweight and obesity.

• Finally the dietary and physical activity patterns on a whole reported increased need to improve the dietary pattern and eating behaviours of the youth and encourage energy expenditure by engaging in an exercise regime and active lifestyle behaviour.

Thank you