Prevalence of overweight and obesity among medical students and their knowledge, attitude and practices about obesity

INTRODUCTION

Overweight and obesity are the fifth leading cause for global deaths. At least 2.8 million adults die each year as a result of being overweight or obese.¹

The prevalence of obesity has nearly doubled between 1980 and 2008. 65% of the world’s population lives in a country where overweight and obesity kills more people than underweight.² A variety of factors, including diet, genetic predisposition, physical activities, physiological and behavioural factors, are implicated as contributing factors to obesity.^3,4

It is a major risk factor for type 2 diabetes, hypertension, stroke, coronary heart diseases, gall bladder diseases, arthritis, colon cancer, psychological problems and so on. The social implications of obesity are a major problem area that is often neglected. The obese, do less well academically, have poorer job prospects and lower self-esteem.⁵

Overweight and obesity are defined as abnormal or excessive fat accumulation in the body but is impracticable for epidemiological use. The body mass index (weight/height²) is widely used in adult populations to assess overweight and obesity. World Health Organization (WHO) defines overweight as a BMI equal to or more than 25, and obesity as a BMI equal to or more than 30.¹ The Western Pacific Regional Office of the World Health Organization (WHO) has recommended lowering the BMI cut off levels for Asian people to 23.0 for overweight and 25.0 for obesity.⁶

Medical students are more prone to obesity due to their lifestyle with less physical activity and disordered eating habits and thereby are prone to obesity related health hazards. Medical student was the target group of particular interest for this study as they are future physicians and if they are overweight or obese they would carry wrong impression on general population. With this background present study was conducted with objectives to study prevalence of obesity among medical students and to assess their knowledge, attitude and practices about obesity.

METHODS

A cross sectional study was conducted in 305 medical students from all batches of MBBS course i.e. I^st, II^nd, IIIrd and final MBBS in Feb 2009 to March 2009 in Grant Medical College Mumbai.

All students ranged in the age group of 18-23 years. Out of 305, 80 were from 1^st year, 95 were from 2^nd year and 130 were from final MBBS part I and part II. Five refused to participate in the study, so actual population which participated in the study was 300.

No specific sampling technique was used, the students which were present at time of data collection and had given informed consent were included in study.

Data collection: A structured pretested questionnaire was given to each student which included questions about knowledge, attitude and practices about obesity. Weight and height were measured by standard techniques. Weight was measured using normal weighing scale with no shoes. Height was recorded using a measuring tape, with the individual standing straight next to the wall, with the heels, buttocks, shoulders and occipit touching the wall without shoes. The Body Mass Index was calculated using the formula

BMI = weight (Kg)/Height² (m²)

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 2010.⁷

Informed consent was obtained from the participants and ethical approval obtained from institutional ethical committee.

Statistical analysis was done using SPSS-16. Mean, Standard Deviation (SD), Standard Error (SE), 95% confidence intervals were calculated. Normality of the data was checked by Kolmogorov Smirnov test. As the underlying distribution was non-normal Chi square test of significance was used, P value of <0.05 was taken as statistically significant. BMI was associated with sociodemographic variables, dietary and lifestyle factors.

RESULTS

Table 1 shows sociodemographic characteristics of study population. Out of 300 medical students, 60% (182) were males and 40% (118) were females. Majority (53.3%) were in the age group of 18-20 years and 46.7% were in the age group of 21-23 years. 25% (75) were day scholars and 75% were hostellers. 26.7% were from first MBBS, 30% were from second MBBS and 43.3% were from final MBBS.

Table 2 shows prevalence of overweight and obesity among medical students. According to WHO international classification prevalence of overweight and obesity was 14.33% and 3.34% respectively and according to Asia-Pacific guidelines it was 9.67% and 17.66% respectively.

When assessed about knowledge about obesity, all students scored 5 and above out of 10 with mean of 9.1 ± 1.06 SD.

Out of 300 students, 14% (42) were purely vegetarian and 86% (258) consumed mixed diet. 5.7% consumed non-veg daily, 55% consumed non-veg weekly, 12.7% consumed it once a month and 12.7% consumed it twice a month. 26% students didn’t have fixed timing of meals.

Only, 23.3% (70) students carry tiffin to college and 76.7% (230) eat in canteen daily of which 17% eat weekly, 5.3% eat once a month. 63% (189) skip their breakfast 2-3 times a week while 37% (111) never skip their breakfast. 27.7% (83) skip lunch/dinner once a week, 0.7% (2) skip it twice a week and 71.7% (215) never skip lunch or dinner.

13.3% (40) consumed junk food and carbonated soft drinks daily, 80.3% (241) consumed it sometimes, 6.3% (19) never consumed junk food. 67.3% (202) drink 1-2 cups of tea or coffee per day, 27.3% (82) drink 2-4 cups per day 3.3% (10) drink >4 cups per day, 2% (6) never drink tea or coffee.

69.3% (208) takes meals while watching T.V. of which 18.7% (56) daily take meal while watching T.V., 55% (166) take it occasionally and 26.3% (79) never take it while watching T.V.

60% replace vegetables with pickles or chutney occasionally. 66% (198) eat chocolate/sweets/desserts after food, of which 8.3% (25) eat it daily, 57.3% (173) eat it occasionally, while 34% (102) don’t eat it. 51.7% (155) have habit of munching between meals, of which 5% munch daily, 46.3% munch occasionally, while 48.3% (145) don’t have this habit.

91.3% (274) don’t participate in outdoor activity and only 8.7% (26) students participate in outdoor activity as walking (1%), swimming (1.3%), sports (3.7%) or gymnasium (2.7%). frequency: daily - 19 (6.3), occasionally - 3 (1%), weekly - 4 (1.3%). All 300 students were concerned about their weight, 96% were concerned about their weight for lifestyle aerobics, exercise should be practiced for maintaining weight but only 7% were actually practicing it.

Only 23 out of 300 agreed that they smoke, 10 started smoking since 1 year, 9 started it since 2 years and 4 students smoke since 3 years. 20 students smoke 3-4 cigarettes per day, 3 student smoke >4 cigarettes per day.

Only 9 out of 300 agreed that they consume alcoholic beverages, of these 7 consume beer occasionally, 2 consume wine occasionally. 80.3% take 6-8 hours of sleep, 19.7% take 8-10 hours of sleep.

Table 3 and 4 shows association of BMI with sociodemographic, dietary and life style factors.

When BMI was associated with various factors like age, sex, religion, place of residence (hostel/home), year of MBBS, type of food (veg/non-veg/mixed), timing of meals, eating in the canteen, skipping breakfast, eating junk food or carbonated soft drinks, drinking coffee, taking meals while watching T.V., eating chocolate/sweets/desserts after food, munching between the meals, participation in outdoor activity, smoking and alcohol consumption significant association was found between BMI and sex (P = 0.000), skipping breakfast (P = 0.016), eating junk food or carbonated drink (P = 0.001), drinking coffee (P = 0.000), taking meals while watching T.V. (P = 0.007), eating chocolates/sweets/desserts after food daily (P = 0.000), munching between meals (P = 0.000).

*Statistically significant

*Statistically significant

DISCUSSION

Prevalence of overweight and obesity according to WHO international classification was 14.33% and 3.34% respectively and according to WHO classification for Asian population 9.67% and 17.66% respectively. Study conducted by Manojan KK et al. reported prevalence of 24.57% overweight and 25.71% obesity using Asia Pacific guidelines among medical students of Trivandrum district of Kerala, India.⁸ In the study⁹ the prevalence of overweight and obesity among medical students based on Asia-Pacific guideline was (31.10%) and 11 (5.26%) respectively. This clearly indicates that the prevalence of overweight/obesity in India is on a rise. Compared to these studies our study reported lesser prevalence. In our study BMI was significantly associated with sex, skipping breakfast, eating junk food or carbonated drink, drinking coffee, taking meals while watching T.V., eating chocolates/sweets/desserts after food daily, munching between meals. In our study proportion of obesity was significantly higher among males as compared to females this may be because of females are more cautious about their weight status than males, due to society perceptions which encourage females to be slender. This finding is consistent with Gupta S et al.¹⁰ study wherein 21.43% of males and 20.45% of females were overweight and obese. The role of tea/coffee/fruit juice/soda based soft drinks as found out by systematic review by Malik et al.¹¹ 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. Our findings also correlate with the studies.^8,11,12 Lack of physical activity is known risk factor for obesity but in our study no significant association was found this may be because majority (91.3%) were having sedentary life style may be because of busy medical curriculum and the examination pattern and only 8.7% students participated in outdoor activity like walking (1%), swimming (1.3%), sports (3.7%) or gymnasium (2.7%) but in those students who participated in outdoor activity BMI was significantly associated with frequency of outdoor activity. Boo NY et al.¹³ in their study also observed that physical exercise and outdoor sports did not have a significant influence on body weight.

When assessed about knowledge, attitude and practices about obesity, study revealed that majority of the medical students were aware about the risk factors of obesity but there were many gaps identified in their knowledge which needs to be bridged. Regular exercise was cited as the most common measure for prevention of development of obesity. Similar results were obtained from other studies.^14,15 Our study has limitations also, it was an institution-based study. We have not measured the lipid profile, Waist/Hip ratio of the participants.

CONCLUSIONS

Prevalence of overweight and obesity according to WHO classification was 14.33% and 3.34% respectively and according to Asia-pacific guidelines prevalence of overweight and obesity is 9.67% and 17.66 % respectively.

Students have good knowledge and positive attitude but lack of appropriate behaviour and practices. The study reinforces the need to encourage healthy lifestyle, healthy food habits and a physically active daily routine, among medical students to prevent obesity related disease epidemic.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the institutional ethics committee

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