Abstract
Obesity is now of such epidemic proportions that its impact threatens the capacity of health services in the richest countries. The main objective of the study was to investigate the prevalence and associated factors of obesity among adults at a level 4 health facility in Nigeria. The study was conducted at Obio Akpo community, in Rivers state, between February 2023 and March 2023.
The study design was cross-sectional, descriptive and analytic in nature. The study population comprised 275 outpatients aged above 18 years (excluding those with physical deformities) seeking health care at Obio Akpo community. Data was collected on socio demographic characteristics (age, sex, marital status, education, occupation, individual monthly income, and wealth status), nutrition status (Body Mass Index, Waist Circumference and Waist hip ratio), meal and food consumption frequency and level of physical activity. The sampling procedure was purposeful sampling of Obio Akpo community and exhaustive sampling in selection of respondents.
The overall prevalence of obesity was 67.2%, with the specific prevalence of overweight being 36.7% (n=101) and obesity 30.5% (n=84). The prevalence of obesity was higher in females (71.9%, n=84) than in males (62%, n=101). There was a significant difference in mean Body Mass Index between males and females (p=0.001). The factors that were significantly associated with obesity included sex (p=0.021), education (p=0.001), wealth (p=0.003), marital status (p=0.004) and age (p=0.000). Meal and food consumption frequency and physical activity level were not significantly associated with obesity (p>0.05).
Over half (54.5%) of the overweight and obese respondents did not consume the main meals regularly (breakfast, lunch and dinner). The average daily energy intake was high at 3505 kilocalories. In addition, majority (58.9% n=109) of the overweight and obese respondents were engaged in physical activity but not as per the WHO recommendations. Logistic regression analysis picked age (18-37 years) and sex as the predictors of overweight/obesity, among the participants. The null hypothesis for this study was rejected that there is no significant association between socio demographic characteristics and obesity as results show that there was a significant association.
In conclusion, there was a high prevalence of obesity found in this study, sex and age being the most predictive factors of being obesity. Food and meal frequency and physical activity levels were not associated with obesity. Recommendations from this study is the need for nutrition and health education by health professionals among patients at Obio Akpo community on ensuring frequent meal consumption of all meals and engaging in physical activity on a regular basis within recommended time and intensity levels. In addition more research is needed on obesity in Nigeria for informed timely interventions.
CHAPTER ONE
INTRODUCTION
• Background of the Study
Globally, nearly one billion people are classified as overweight, 300 million of them being clinically obese (WHO, 2002). Nearly one third of the adult American population is obese, while in South Africa, more than one in two adult women are overweight or obese. In Morocco, 40% of the population is overweight (Lichtarowicz, 2004). The Nigeria Demographic and Health Survey of 2009 show that the national prevalence rate of obesity for women (15- 49 years old) is 23% (NDHS, 2009).
The proportion of overweight and obese women is higher in urban areas than in the rural areas, with Abuja having the highest prevalence (41% and 39%) (NBS, 2010). Numerous factors lead to obesity. Key among them is urbanization which brings with it a reduction in daily energy expenditure through reduction of physical activity and a shift to a higher caloric content diet (BeLue, et al., 2009). According to Nigerian medical experts, Nigerians today are eating an oilier diet than ever before, even as they rely more on personal and public vehicles to move even the shortest of distance. In urban areas, conveniences such as lifts and escalators have become a standard feature in all shopping malls making it unnecessary to walk up and down the stairs (Kimani and Okwemba, 2007).
The current obesity pandemic reflects the profound changes that have taken place in the society over the last 20-30 years that have created an environment that promotes a sedentary lifestyle and the consumption of a high fat, energy dense diet (Popkin, 2006) and (WHO, 2003). Worldwide, more than 60% of adults do not engage in sufficient levels of physical activity which is beneficial to their health. Lack of physical activity in leisure time, which leads to people spending increasing amount of time on sedentary behaviors such as television viewing, computer use, and excessive use of “passive” modes of transport (cars, buses and motorcycles) has also contributed (albeit partly) to problem of obesity (WHO, 2003). Physical inactivity is more prevalent among women, older adults, individuals from low socio-economic groups (especially in developed countries), and the disabled (WHO, 2003).
Urbanization has accelerated the spread of rapid motorization and the development of road networks in densely population urban areas. Developments of highly concentrated residential areas with little open spaces for people to engage in physical activity (Morisugi, 1992). White collar workers have more sedentary jobs than blue collar workers which could increase their risk of obesity (Kirk and Rhodes, 2011).
Obesity, recognized as a disease for more than 60 years, is now of such epidemic proportions that its impact threatens the capacity of health services even in the richest countries. Obesity accounts for 2-6% of total health care costs in several developed countries; some estimates put the figure as high as 7%. The true costs are undoubtedly much greater as not all obesity-related conditions are included in the calculations (WH0, 2004).
Although indirect costs to society can be substantially higher, they are often neglected. They relate to income lost from decreased productivity, reduced opportunities and restricted activity, illness, absenteeism and premature death (IOTF, 2010). In addition, there are high costs associated with the numerous infrastructure changes that societies must make to cope with obese people i.e. reinforced beds, operating tables and wheel chairs; enlarged seats in sports-grounds, and modifications to transport safety standards (IOTF, 2010).
Excess weight gain is ranked the third greatest risk factor after smoking and high blood pressure for all premature deaths and disabilities in the affluent world (IASO, 2010). Yet the situation is even worse in poorer countries: widespread fetal and childhood malnutrition increases the impact of even modest weight gain on the development of diabetes and other chronic diseases. Poorer nations have 4-5 times more adults with overweight-induced illness than the Western world. The result is catastrophic medical costs for hundreds of millions. The epidemic of obesity in children is affecting every continent. The resulting social handicaps, inferior academic and employment prospects, and early medical complications are increasingly evident (IASO, 2010).
Obesity lead to adverse metabolic effects on blood pressure, cholesterol, triglycerides and insulin resistance. The non-fatal, but debilitating health problems associated with obesity include respiratory difficulties, chronic musculoskeletal problems, skin problems and infertility. The more life-threatening problems fall into four main areas: CVD problems; conditions associated with insulin resistance such as type 2 diabetes; certain types of cancers, especially the hormonally related and large-bowel cancers; and gallbladder disease (WHO, 2003).
Obesity in developing countries has been neglected as most attention is concentrated on famine and under nutrition or malnutrition of children [(Popkin, 2006); (Schmidhuber, 2005); (WHO, 2000)]. If preventive measures are not put in place, the problem may escalate and overburden the health care system in these areas. Hence there is need to put measures in place to arrest the problem of obesity and prevent the negative consequences.
• Statement of the Problem
Obesity is becoming one of the main public health problems in Nigeria. Most of the data available is on women with limited data on other groups. The Nigeria Demographic and Health surveys show that the national prevalence rate of obesity for women is 23% (NDHS, 2009). The proportion of overweight and obese women is higher in urban areas than in the rural areas, with Abuja having the highest prevalence of 41% (NDHS, 2009). Through the development of various diseases caused by obesity, being overweight reduces life expectancy and shortens lifespan by three to seven years for an individual aged 40 and with a BMI of 30 or more (Fontaine, 2003. )The global burden of the diseases that are related to obesity makes it a priority.
Chronic diseases have been noted to strain household incomes as families in Nigeria bear the burden of caring for loved ones ailing from non-communicable diseases. They further contribute to household poverty, as less income is channeled to investment, thereby stifling economic growth. This is compounded by the lack of social health insurance as well as lack of access to adequate health infrastructure, to care for those affected by non-communicable diseases (Chuma and Maina, 2012). Understanding factors associated with obesity is crucial for informing and developing effective prevention efforts, nutrition education and proper planning. The choice of a hospital setting is because of the chronic diseases that patients present which could be attributed to obesity.
• Justification of the Study
Obesity are risk factors for a variety of chronic conditions which lead to increased burden and mortality (WHO, 2003). In Nigeria and Africa in general, there is limited up-to-date data on prevalence of obesity as priority has always been on under nutrition. Studies that have been done have largely been concentrated in the capital and major cities while neglecting other urban settlements (Amegah, et al., 2011).
With recent statistics putting Nigeria’s urban growth rate at 21 percent, with nearly one out of every four Nigerians now living in urban areas (Barasa, 2007), there is need to address the issues that accompany such changes, lifestyle change being one of them. Failure to do so would mean that no action might be taken in the near future, thus the problem is likely to escalate. Tackling the problem in its early stages may lead to reduction in its occurrence thus reducing the costs eventually. This can only be achieved if data is available to quantify the magnitude of the problem, hence the need to carry out the study.
• The Aim of the Study
The study aimed at contributing towards improved understanding of obesity in rural Nigeria.
• The Purpose of the Study
The purpose of the study was to generate data on the prevalence of obesity in Rivers state, Nigeria. The information can be used to plan for interventions for prevention of obesity and overweight in rural Nigeria.
• Objectives of the Study
• General objective
To investigate the prevalence and associated factors of obesity among a rural population in Rivers state, Nigeria.
Specific objectives
• To determine the socio-demographic characteristics of adults in Obio Akpo community.
• To determine the prevalence and associated factors of obesity among adults in Obio Akpo community.
• To determine the food and meal consumption frequency of adults in Obio Akpo community.
• To determine the physical activity level of adults in Obio Akpo community.
• Study hypothesis
Obesity is associated with socio demographic characteristics, irregular food and meal consumption frequency and low physical activity levels.
1.8 Operational Definition of Terms
Adult Any person aged 18 years and above
BMI in this study BMI was computed by dividing an individual’s weight in kilograms by the square of his/her height in meters to identify obesity among study participants.
Obesity in this study obesity was considered as a condition in which the body is above a standard acceptable weight (BMI>29.9).
Overweight in this study overweight was considered a condition in which the body is above a standard acceptable weight (BMI>24.9).
Rural in this study rural was used to refer to the study location which is outside the city but has areas that are densely populated and others that are sparsely populated.
Income in this study income referred to how much money the respondent receives from wages, salaries or other investments made.
Education in this study education was used to refer to the highest level of schooling the respondent has reached.
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