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ORIGINAL ARTICLE
Year : 2014  |  Volume : 7  |  Issue : 3  |  Page : 279-283  

Study regarding overweight/obesity among medical students of a teaching hospital in Pune, India


Department of Community Medicine, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, India

Date of Web Publication18-Mar-2014

Correspondence Address:
Samir Anil Singru
Flat No 4, Plot No 7, Parveen Palace, Sector 25 (SDC), PCNTDA, Nigdi, Pune - 411 044
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.128950

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  Abstract 

Context: Obesity is found to be the strongest risk factor for persistent hypertension, which is an important risk factor for the coronary artery disease and stroke. Urbanization, unhealthy eating patterns and reduced physical activity are the important reasons. Prevention of obesity is always better than its treatment. Aims: The aim of this study was to determine the proportion of overweight/obesity among medical student and to identify various correlates associated with it. Settings and Design: Cross-sectional study conducted in medical students in Pune. Methods: A validated, pre-designed, and pre-tested questionnaire was used. Overweight/obesity was assessed on the basis of body mass index (BMI) for age using gender specific Centre for Disease Control (CDC) charts. Statistical Analysis: Proportions, ANOVA, and unpaired t-tests were used to find any statistical significant association of mean BMI for age with various correlates. Results: Total 159 students including 66 (41.5%) female and 93 (58.5%) male took part in the study. The proportion of overweight/obesity was 13.2% (C.I: 7.84-18.5%). Daily calorie intake, lack of daily physical activity, daily consumption of Tea/Coffee/Fruit juices, playing outdoor games, socio-economic status, and family history of obesity were found to have statistically significant association with overweight/obesity. Conclusions: The problem of obesity/overweight is on the rise.

Keywords: Body mass index for age, medical students, overweight/obesity


How to cite this article:
Fernandez K, Singru SA, Kshirsagar M, Pathan Y. Study regarding overweight/obesity among medical students of a teaching hospital in Pune, India. Med J DY Patil Univ 2014;7:279-83

How to cite this URL:
Fernandez K, Singru SA, Kshirsagar M, Pathan Y. Study regarding overweight/obesity among medical students of a teaching hospital in Pune, India. Med J DY Patil Univ [serial online] 2014 [cited 2019 Feb 18];7:279-83. Available from: http://www.mjdrdypu.org/text.asp?2014/7/3/279/128950


  Introduction Top


Obesity is a multi-factorial disorder, which is often associated with many other significant diseases such as diabetes, hypertension, other cardiovascular diseases, osteoarthritis and certain cancers. Obesity is found to be the strongest risk factor (relative risk, 3.3; 95% confidence interval (C.I), 2.5-4.2%) for persistent hypertension, which is an important risk factor for coronary artery disease and stroke. [1]

Obesity is emerging as a serious problem throughout the world not only among adults, but also children, teenagers, and young adults. Of the factors contributing to obesity, stress seems to be particularly important as stressful condition leads to irregularity in diet, lack of exercise and addiction, each being considered independent factors leading to obesity. [2] Medical education is stressful throughout the course of training. The amount of material to be absorbed, social isolation, pressure of examination, discrepancies between expectation and reality all can be anticipated to bring psychological stress. [3] However, stress will remain part and parcel of every medical student, which cannot be modified as college level. Other modifiable factors such as increased fast food consumption, increased soft drinks, watching television and playing games on the computer and lack of outdoor games are more important from prevention point of view. [4] Prevention of obesity is always better than its treatment. College can plays a significant role in encouraging healthy behavior in students. There are few studies on the problem of overweight/obesity in college going students. Medical students are exposed to various factors, known, unknown for overweight/obesity. Therefore, this study was undertaken with the objective to find the proportion of overweight/obesity among medical students and to identify various correlates associated with it.


  Materials and Methods Top


This was a cross-sectional study and Ethical clearance was obtained from Institutional or Ethical Committee. The sampling universe was all students of 2 nd year M.B.B.S. (Bachelor of Medicine and Bachelor of Surgery) course in the tertiary care teaching Hospital. Inclusion criteria were all students who gave informed consent. Validated pre-designed and pre-tested questionnaire were used to interview the students. Daily calorie intake was measured based on 24 h recall method. Regarding daily calorie intake from diet, a cut off of 2640 Kcal for males and 2060 Kcal for females was used as per Indian Council of Medical Research (ICMR) (1990) guidelines. [5] Physical activity was assessed based on the hours spent on the playground for outdoor games, membership of any gymnasium, hours spent per week for brisk walking/jogging, use of vehicle for routine travel in campus or commuting to college. Similarly, hours spent watching television, internet and working on computer/laptop were also used to assess physical activity. Adequate daily physical activity was defined as moderate to severe the physical activity of at least 60 min/day as recommended by Global recommendations on physical activity for Health, World Health Organization publication 2010. [6]

Confidentiality and privacy was maintained. Appropriate training to the investigators was given regarding measuring height, weight so as to reduce measurement error. All the instruments were standardized to reduce instrument error. Body weight was measured (to the nearest 0.5 kg) with the subject standing motionless on the weighing scale with feet 15 cm apart, and weight equally distributed on each leg. Height was measured (to the nearest 0.5 cm) with the subject standing in an erect position against a vertical scale of portable stadiometer and with the head positioned so that the top of the external auditory meatus was in level with the inferior margin of the bony orbit. Overweight/obesity was assessed on the basis of body mass index (BMI) for age using gender specific Centre for Disease Control (CDC) charts. BMI values at or above the 95 th percentile of the gender-specific BMI growth charts were categorized as obese. [7]

Statistical methods

Proportion with a confidence interval (C.I) was used to measure obesity/overweight. ANOVA and unpaired t-tests were used to find out any statistically significant association of mean BMI for age with various correlates. P value of lesser than 0.05 was considered to be of statistically significant. Data were analyzed using epi_info2002 software.


  Results Top


Out of the 182 available students at the time of the study, 159 gave consent for participation in the study. The response rate was thus 87.3%. No sampling (Purposive sampling) was carried out, and all the 159 students who consented for the study were included in the study. Out of the 159 students, 66 (41.5%) were female, and 93 (58.5%) were male. The mean age and standard deviation for age for female students was 19 years and 0.76 years and for male were 19.12 years and 0.86 years respectively. In the present study, the proportion of overweight/obesity was 13.2% (C.I: 7.84-18.5%). In female students, it was 16.6% (C.I: 10.7-22.5), and male students was 10.75% (C.I: 5.84-15.6%). No obese/overweight student was found to be suffering from any metabolic disorder as confirmed by appropriate biochemical laboratory investigations. The associations of various correlates are summarized in [Table 1].Thus daily calorie intake, amount of daily physical activity, amount of daily consumption of tea/coffee/fruit juices, habit of playing outdoor games, socio-economic status, and family history of obesity were found to have statistically significant association with overweight/obesity.
Table 1: Association of various correlates with BMI for age (n =159)

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  Discussion Top


India is currently in a transitional phase between developing countries and developed countries. Overweight/obesity among college going students is an important issue as height by this age is stabilized. This age group is very important to inculcate the importance of physical exercise and healthy eating.

In the present study, the proportion of overweight/obesity was 13.2% (C.I: 7.84% to 18.5%). In female students, it was 16.6% (C.I: 10.7-22.5), and male students was 10.75% (C.I: 5.84-15.6%). This gender difference; however was not found to be statistically significant. (x 2 = 1.017, df = 1, P = 0.313). One of the limitations of our study was a small sample size. However, this can be resolved by calculating the C.I and taking the lowest value found out from the C.I. Even if one considers the lowest proportion as per the present study, it clearly reflects the increase in the proportion of obesity/overweight than school going children as studied by Ramachandran et al. [8] in six schools from Chennai, two each from high, middle and lower income groups and which was found to be in the range from 22% in better off schools to 4.5% in lower income group schools. Although there is the difference in the age group in the present study and Chennai study, it is assumed that these factors are also important in the present study age group. In a study conducted by Gupta et al. [9] among medical students studying in Midnapore Medical College, India, overall prevalence of 17.5% and 3.4% for overweight and obesity respectively was found. Another study conducted by Chhabra et al. [10] reported prevalence of 11.7% overweight and 2% obesity among medical students of Delhi. This clearly indicates that the prevalence of overweight/obesity in India is on a rise. The importance of socio-economic status, family history of obesity, daily physical activity, daily calorie consumption, and playing outdoor games are well-known facts. Our study has also found out statistically significant association with the above mentioned parameters. Similar results were also seen by Goyal et al. [11]

In the present study, the proportion of students not undertaking adequate physical activity was 47.7%. This proportion is very high. Various reasons for this as identified from our questionnaire were staying in hostel, less leisure hours, avoiding walking, and instead using vehicles for travel even for short distances. Similar findings were also seen by Banerjee and Khatr [12] in their study regarding physical activity habits among medical students of Pune. Our study found out a statistically significant association of decreased physical activity with overweight/obesity. Similar results were also seen in by Gupta et al. [9] At the College level compulsory, physical exercise in the form of jogging, gymnasium, aerobics should be undertaken. The students should be counseled and encourage to undertake such activities.

In the present study, socio-economic status was found to be significantly associated with overweight/obesity. However, no statistical association was seen with source of breakfast/lunch/dinner whether house made or from mess/canteen with overweight/obesity. Similarly, no association was seen with hostel stay or with the type of family. There was no significant association seen with the type of diet whether mixed or pure vegetarian and also with the amount of non-vegetarian items consumed as calculated by once/twice/thrice or more non-vegetarian items with overweight/obesity. In the present study, we could not authentically derive information regarding consumption of junk food or snacking. Socio-economic status is closely associated with the amount and type of diet consumed. Consumption of junk foods and snaking is associated with overweight/obesity as seen by various investigators. [2],[13],[14] The students should be educated regarding the adverse effects of junk food and all the complications associated with overweight/obesity.

One important finding of our study was the significant statistical association of daily consumption of tea/coffee/fruit juice with the overweight/obesity. Students consuming these items on more than five total items daily were having significantly more BMI for age. Total quantity in ml per day could not be assessed as the students could not exactly tell the amount in each serving. The role of tea/coffee/fruit juice/soda based soft drinks as found out by systematic review by Malik et al. [15] show strong evidence for weight gain. The busy schedule of college hours with less time for lunch/breakfast contributes to the habit of drinking tea/coffee/fruit juices more frequently throughout the day. These items contribute significantly to the daily calorie consumption. Hence, there is a need to educate students regarding consumption of fresh fruits rather than fruit juices and limiting the frequency of tea/coffee. Because of a smaller sample size the role of individual beverage could not be assessed. Further, study on a larger sample size is recommended.

In the present study, family history of obesity was significantly associated with overweight/obesity. This is a well-known fact and therefore, such students should be aggressively counseled on life-style and diet modification.

In the present study, overweight/obesity was not associated significantly with watching TV/using computer or internet. Similar results were also observed in a study conducted in South India although the age group was different. [16] Further, research is needed to confirm findings in the study age group. Similarly, the gender, habit of daily taking breakfast, occasional alcohol consumption, watching TV, and computer/internet usage, regular membership of gymnasium, playing outdoor games were not found to have statistical significance with overweight/obesity.


  Conclusion Top


The problem of obesity/overweight is on the rise, and there is a definite need to inculcate good habits of healthy eating and regular physical exercise.


  Acknowledgments Top


The authors are thankful to the participants of the study, Medical Social Workers, Lab Technicians of the institute.

 
  References Top

1.Stabouli S, Kotsis V, Papamichael C, Constantopoulos A, Zakopoulos N. Adolescent obesity is associated with high ambulatory blood pressure and increased carotid intimal-medial thickness. J Pediatr 2005;147:651-6.  Back to cited text no. 1
    
2.Kumar S, Mahabalaraju KD, Anuroopa MS. Prevalence of obesity and its influencing factor among affluent school children of Devanagere city. Indian J Community Med 2007;32:15-7.  Back to cited text no. 2
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3.Srinivasan K, Vaz M, Sucharita S. A study of stress and autonomic nervous function in first year undergraduate medical students. Indian J Physiol Pharmacol 2006;50:257-64.   Back to cited text no. 3
    
4. Kapil U, Singh P, Pathak P, Dwivedi SN, Bhasin S. Prevalence of obesity amongst affluent adolescent school children in delhi. Indian Pediatr 2002;39:449-52.   Back to cited text no. 4
    
5. ICMR. Recommended Dietary Intakes for Indians. New Delhi: ICMR publications; 1990.  Back to cited text no. 5
    
6.Global Recommendations on Physical Activity for Health. WHO Publications; 2010. ISBN: 9789241599979. Available from: http://www.who.int/dietphysicalactivity/publications/9789241599979/en/index.html. [Last accessed on 2012 December].  Back to cited text no. 6
    
7.Overview of the CDC growth charts. Available from: http://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module2/text/page1a.htm. [Last accessed on 2012 December].  Back to cited text no. 7
    
8.Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CK, Sheeba L, et al. Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract 2002;57:185-90.   Back to cited text no. 8
    
9. Gupta S, Ray TG, Saha I. Overweight, obesity and influence of stress on body weight among undergraduate medical students. Indian J Community Med 2009;34:255-7.   Back to cited text no. 9
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11. Banerjee A, Khatri S. A study of physical activity habits of young adults. Indian J Community Med 2010;35:450-1.   Back to cited text no. 11
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12. Goyal RK, Shah VN, Saboo BD, Phatak SR, Shah NN, Gohel MC, et al. Prevalence of overweight and obesity in Indian adolescent school going children: Its relationship with socioeconomic status and associated lifestyle factors. J Assoc Physicians India 2010;58:151-8.  Back to cited text no. 12
    
13.Vadera BN, Yadav SB, Yadav BS, Parmar DV, Unadkat SV. Study on obesity and influence of dietary factors on the weight status of an adult population in Jamnagar city of Gujarat: A cross-sectional analytical study. Indian J Community Med 2010;35:482-6.  Back to cited text no. 13
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14.Goyal JP, Kumar N, Parmar I, Shah VB, Patel B. Determinants of overweight and obesity in affluent adolescent in Surat City, South Gujarat region, India. Indian J Community Med 2011;36:296-300.  Back to cited text no. 14
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15.Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: A systematic review. Am J Clin Nutr 2006;84:274-88.   Back to cited text no. 15
    
16. Komal W, Jaipanesh K, Seemal M. Association of leisure time physical activity, watching television, obesity & lipid profile among sedentary low-income south Indian population. East Afr J Public Health 2010;7:225-8.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1]


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