Central Journal of Family Medicine & Community Health

Cite this article: Diete-Spiff KO, Dienye PO (2017) Socio- Demographic Factors Associated with Overweight/Obesity in a Primary Care Clinic of a Tertiary Hospital in Nigeria. J Family Med Community Health 4(3): 1113.

Abstract

Objective: To determine the relationship between overweight/obesity and socio-demographic factors among patients attending the Family Medicine Clinic of the University of Port Harcourt Teaching Hospital, Nigeria.

Methods: This was a case control study in which 190 obese/overweight patients and non obese sex matched controls aged 18 - 64 years were recruited. Data on socio-demographic characteristics and anthropometric measurements was collected from them with the aid of a structured questionnaire. Descriptive analysis and pair wise comparison of data was done using Statistical package for Social Sciences version 16 (SPSS 16). All tests for statistical significance were two-tailed and performed assuming a type I error probability of <0.05.

Results: There were 190 overweight/obese respondents (56 males and 134 females) and an equal number of controls (54males and 136 females). Although the difference between the mean ages of the cases (37.35 ± 7.02years) and control group (for age and gender) (36.58 ± 5.45 years) was not statistically significant (P=0.23), significant difference was observed between the means of the weight, height and BMI in both groups (p<0.05), the mean BMI of the overweight/obese and controls being 26.15 ± 4.31kg/m2 and 23.64 ± 2.14kg/m2 respectively. Although overweight/obesity occurred more among the participants below tertiary education (97; 51.05%) and employed (108; 56.84%), the association between these factors and overweight/obesity was not significant. Significant association was only found between being married (142; 74.74%) and overweight/obesity (p=0.045). Married individuals were also more likely to be obese as compared with the unmarried (OR1.887; 95% CI 1.218-2.925)

Conclusion: Among the socio-demographic characteristics studied, only marital status was significantly associated with overweight/obesity.

*Corresponding authorPaul O. Dienye, Department of Family Medicine, University of Port Harcourt Teaching Hospital, Nigeria, Tel: 2348-03339-3806; Email:

Submitted: 01 March 2017

Accepted: 14 June 2017

Published: 16 June 2017

ISSN: 2379-0547

Copyright© 2017 Dienye et al.

OPEN ACCESS

Keywords•Overweight/obesity•Employment•Education•Marital status•Sociodemographic characteristics

Research Article

Socio- Demographic Factors Associated with Overweight/Obesity in a Primary Care Clinic of a Tertiary Hospital in NigeriaDiete-Spiff KO and Dienye PO*Department of Family Medicine, University of Port Harcourt Teaching Hospital, Nigeria

INTRODUCTIONThe continued rise in the global prevalence of overweight/

obesity [1] has made it an important public health problem. This rising global prevalence is mostly believed to be driven by the rising prevalence in developing countries [2], where unplanned urbanization with concomitant decrease in physical activity and adoption of unhealthy lifestyle in which the traditional diet rich in complex carbohydrate and fibre is abandoned giving way to more varied diets with a higher proportion of saturated fats and sugars [3]. As the prevalence of these conditions increase, so does the burden of their associated co-morbidities [4]. Overweight/obesity predispose to the development of chronic health conditions such as hypertension, type 2 diabetes mellitus, hypercholesterolemia and coronary heart disease and Africans are not immune to these risks [5]. Certain malignancies such as breast, colon, endometrium and prostate cancers are also

linked to overweight/obesity [6,7]. Degenerative disorders like osteoarthritis and psychological states such as depression have been found to positively correlate with overweight/obesity. According to the World Health Report 2002, approximately 58% of diabetes, 21 % of ischemic heart diseases and 8.42% of certain cancers were globally attributed to overweight/obesity [8]. In many developed countries, the annual health care costs of managing obese patients run into several billions of US dollars [9]. These costs include expenditure on prevention, as well as the investigation and treatment of overweight/obesity and its related problems. The annual health care cost of treating overweight/obesity in developing countries, including Nigeria, is currently unknown, but is likely to be enormous [10].

Socio-demographic characteristics are important determinants of health and well-being because they track economic progress, social change, experiences and exposure to

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several health risk factors [11,12]. Diseases, regardless of whether it is infectious, genetic, metabolic, malignant, or degenerative have been found to be associated with socio-demographic factors [13]. Overweight/obesity is one of Nigeria’s major health problems [14,15]. Studies on the prevalence of overweight/obesity in Nigeria reported prevalence range of 8.1%– 26% depending on the location of the study [10,16]. Such studies are few in Rivers state of Nigeria [17,18]. Moreover, cross sectional design was used in most of the studies and this predisposed them to associated limitations. In an attempt to address some of these limitations, this case control study was designed to determine the association of overweight/obesity and socio-demographic factors among patients attending a primary care clinic of a tertiary centre in Port-Harcourt, Rivers State of Nigeria. We hypothesized that overweight/obesity is not associated with socio-demographic indices. It is envisaged that the results of this study will enlighten the primary care physicians on the need for appropriate intervention to prevent the deleterious effect of overweight/obesity.

MATERIALS AND METHODSStudy setting

The study was conducted in the Family Medicine Clinic of the University Of Port Harcourt Teaching Hospital (UPTH). This is a general primary care clinic attending to undifferentiated patients. University of Port Harcourt Teaching Hospital is the apex health care institution in Port Harcourt, the capital of Rivers state and centre of the oil and gas industry in the Niger delta region. This hospital is one of the major tertiary health institutions and referral centre in this region hence attracts a wide variety of clientele.

Study design and population

This was a case control study among patients aged 18 years to 64 years attending the Family Medicine Clinic of the University of Port Harcourt Teaching Hospital.

Inclusion criteria: 1) All patients between the age of 18 years and 65 years presenting to the clinic for any health reason who met the criteria for overweight/obesity (BMI ≥ 25 kg/ m2) and consented to the study.

2). Controls consisting of all patients presenting to the clinic for any health reason who were not obese (BMI between 18.5 kg/ m2 and 24.9 kg/m2) and consented to the study.

Exclusion Criteria:

1) All pregnant patients

2) All patients who were very sick and required urgent medical care.

3) Patients with physical deformity of the spine or legs that will prevent actual measurements of weight or height to be taken due to difficulty in standing.

4) Patients with as cites or gross pedal edema

Sample size determination

A sample size of 362 (181 cases and 181 controls) was calculated using the formula:

2/2

21 2

( )(1 )( Z )1( )(p )

p p Zrnr p

β α− ++=

−

n = Sample size in the case group, r = ratio of controls to cases, p = A measure of variability in which a prevalence of 24.5% (0.25) was used, Zβ = Represents the desired power (typically .84 for 80% power). p1–p2 = the difference in proportions, Zα/2 = the desired level of statistical significance (typically 1.96). It was increased to 380 to give room for attrition.

Sampling method

The study was planned to span through a period of three months made up of 60 working days since the clinic functions five days in a week. Routinely patients attending the family medicine clinic are screened for different disease conditions such as hypertension, diabetes mellitus and overweight/obesity. All patients attending the clinic were consecutively weighed, their height measured and their Body Mass Index calculated. Within the period of this study, patients who were identified by the researchers as overweight/ obese during the screening process were selected for the study.

From the clinic records, it was discovered that about 15 of the 150 patients who presented to the clinic daily were overweight/obese and these formed the target population. From an average population of 15 overweight/obese patients seen daily in the clinic (75 weekly) approximately 900 overweight/obese patients will be seen in 60 working days.

A systematic sampling method was employed in the recruitment of the patients. Using the balloting technique, the first overweight/obese patient for the day was recruited from the selected overweight/obese patients who attended the clinic. With a sampling frame of 900 and sample size of 190, the calculated sampling interval was 900/190 which is approximately 5, implying that every 5th overweight/obese patient presenting to the clinic and consented to the study was recruited until the sample size was reached. A suitable age (± 2 years) and sex matched non overweight/obese control was recruited by the researchers for every overweight/obese patient recruited from among patients who presented to the clinic for any reason.

Data collection: The data collection tool used for this study was a specially designed, interviewer administered and structured two-part questionnaire. The first part was the socio-demographic characteristics and the second part was determination of overweight/obesity. Sociodemographic data was collected from the respondents by the researcher and trained assistants using this questionnaire. Informed written consent was sought and obtained from each study subject recruited by the researchers. The names of participants were concealed and only serial numbers were allocated to the participants, who were assured that their responses would be kept confidential. The questionnaires were kept safely and data entered on the computer were protected and made accessible to the researchers only. The participants were assured that their discontinuation with the study at any stage will not affect their treatment.

Determination of overweight/obesity was done by measuring the height and weight with a stadiometer and weighing scale.

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Stadiometer: A portable, collapsible stadiometer (Leicester Height Measure-Seca, Ltd Birmingham, UK) placed on a firm level surface was used. Participants were asked to remove head gears and foot wear, and to stand on the stadiometer platform with their heels together touching the back stop to ensure that their spine is at pelvis and shoulder level. The head was held erect with the external auditory meatus and the lower border of the orbit in a horizontal plane. The back of the head should touch the upright rod of the stadiometer. The measuring arm of the stadiometer was lowered onto the patients head without forcing their head down. The patient was then asked to move away from the stadiometer and the measurement read by the examiner to the nearest 0.1cm.

Weighing scale: Participants were weighed bare feet, wearing light clothing and using a UC-321 Precision Health scales (A&D Medical). The scale was placed on a flat surface and with the pointer at zero mark. The patient was then asked to step on the scale and stand with their feet firmly on the scale without moving. The weight was then recorded to the nearest 0.1kg. The weighing scale was calibrated daily with a known 10kg equivalent mass.

From the height and weight measurements, their body mass index (BMI) was calculated.

Definitions: Body mass index (BMI) is recognized as the measure of overall overweight/obesity. The criteria for underweight, desirable weight, overweight and obesity used in this study were based on BMI (weight/height2 (kg/m2)) and were consistent with the definitions set forth by the World Health Organization (WHO) and the National Heart, Lung, and Blood Institute (NHLBI) as follows: underweight <18.5 kg/m2, desirable weight 18.5 – 24.9, overweight 25 – 29.9, and obese ≥ 30.0 [19,20].

For the purpose of this study, educational status and employment status were collapsed into dichotomous measures to facilitate statistical calculations. Educational status was grouped as below tertiary education level and tertiary education level. This grouping was adopted based on the fact that educational status below the tertiary level cannot guarantee any reasonable employment [21]. Marital status was classified into two categories: married and not married and employment status as employed and unemployed.

Data analysis: Data on socio-demographic characteristics and anthropometric measurements was collected from the patients with the aid of a structured questionnaire. Descriptive analysis and pair wise comparison of data was done using Statistical package for Social Sciences version 16 (SPSS for Windows; SPSS Inc., Chicago, IL, USA). All tests for statistical significance were two-tailed and performed assuming a type I error probability of <0.05.

Ethical consideration: Ethical approval of this study was obtained from the Ethical Committee of the University of Port Harcourt Teaching Hospital Port Harcourt Nigeria.

RESULTSThere were 190 overweight/obese respondents (56 males

and 134 females) and an equal number of controls (54males and 136 females).The personal characteristics of the overweight/

obese subjects and the controls are shown in Table (1). Their ages ranged from 18years to 65 years in both groups. Although the difference between the mean ages of the obese group (37.35 ± 7.02years) and control group (36.58 ± 5.45 years) was not statistically significant (P=0.23), significant difference was observed between the means of the weight and height in both groups (p<0.05). Overweight/obesity occurred more among the participants without tertiary education (97; 51.05%), employed (108; 56.84%) and Christians (184; 96.84%), the association between these factors and overweight/obesity was not significant. Significant association was only found between marital status (142;74.74%) and overweight/obesity (p=0.045). Married individuals were also more likely to be obese as compared with the unmarried (OR1.887; 95% CI 1.218-2.925) (Table 2).

DISCUSSIONThe increased occurrence of overweight/obesity in the

developing countries has immensely contributed to the spread of non communicable diseases such as diabetes, cardiovascular disease, and cancer hence demanding the implementation of control measures. In the current study we aimed to determine the association of some socio-demographic factors with overweight/obesity among patients attending the Family Medicine Clinic of the University of Port Harcourt Teaching Hospital, Nigeria. Of the socio-demographic factors considered, significant statistical association was found only between overweight/obesity and marital status. Overweight/obesity was about two times more likely to occur among the married respondents than the unmarried. This finding corroborates the reports by other researchers in other parts of the world [12-14,22-24] but disagrees with some other authors who reported either no association [25] or inverse relation [26]. Although the exact mechanism linking overweight/obesity and marital status is not fully understood, several authors have made some hypotheses explaining BMI increase during marriage. These are related to increased social support [27] and include: a) The social obligation of marriage, which states that couples are led to eat more regular meals and richer and denser foods with less emphasis on the much valued eating and exercise behaviors for slimness. Couples spend more time together building up their homes and rearing their children. b) The marriage market hypothesis, which suggests that unmarried subjects especially women intentionally lose weight in an effort to be more attractive to potential marital partners [28,29], but after marriage are no longer concerned about attracting a mate. This may predispose to rise in BMI. c) The selection hypothesis which states that individuals especially women with a lower BMI are more likely to be selected into marriage [24]. d) It is also known that, in women, excessive weight gain during pregnancy and postpartum retention of pregnancy weight gain are significant risk factors for later overweight/obesity [30]. However, in this study, data on gender, pregnancy and parity to investigate the association between overweight/obesity and gender and childbearing was not collected. e) The culture in which women, in some parts of Sub-Saharan Africa, are primarily responsible for farming in order to produce food for their families [31], contributes significantly to the male sedentary lifestyle with resultant overweight/obesity.

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Table 1: Mean of personal characteristics of respondents and matched controls at UPTH at the time of the study.

Characteristics Overweight/obesity(N=190)

Control group(N=190) p-value 95% CI

Mean age (years) 42.35 ± 8.72 41.95 ± 5.48 0.593 0.593 -1.069-1.869

Height (cm) 156.8±1.15 157.2±0.07 <0.0001 0.236 - 0.564

Weight (kg) 64.45±6.37 58.26±3.42 <0.0001 3.159 - 5.221

BMI 26.15±4.31 23.64±2.14 <0.0001 1.824- 3.196

Table 2: Demographic characteristics of respondents and matched controls at UPTH at the time of the study.

Characteristics Overweight/obesity [N=190(%)] Controls [N=190(%)] P-value OR (95%CI)

Educational Level

< Tertiary 97(51.05) 90(47.37) 0.473 1.160(0.775-1.733)

≥Tertiary 93(48.95) 100(52.63)

Employment Status

Unemployed 82(43.16) 67(35.26) 0.115 1.394(0.922-2.108)

Employed 108(56.84) 123(64.74)

Marital Status

Married 142(74.74) 116(61.05) 0.045 1.887(1.218-2.925)

Unmarried 48(25.26) 74(38.95)

Religion

Others 6(3.16) 1(0.53) 0.097 6.163(0.735-51.693)

Christianity 184(96.84) 189(99.47)

In our study, when we analysed data in our population as a whole we observed that overweight/obesity was commoner among those with below tertiary educational level, employed and Christians but we did not find any significant association between these factors and overweight/obesity. Educational level is used in many epidemiological studies as a valuable indicator of socioeconomic position. The findings of this study indicate that education level is inversely related with overweight/obesity even though the association was not significant. This is similar to findings in other studies [32-34]. This could be due to the fact that educated individuals are more likely to engage in preventive health behavior such as regular exercise and better diet compared with their counterparts and the women less likely to have high parity that is associated with overweight and overweight/obesity [35]. The predisposition of the Christians to overweight/obesity in this study could be related to the location of the study where the inhabitants are predominantly of this religious faith. .

The main strength of the present study is its design, in which the selection of the controls was very stringent manifesting in the comparison of their ages and sex which are variables that influence the occurrence of overweight/obesity.

LIMITATIONS OF THIS STUDYOur study may have several limitations. 1) The study did

not include a comparison of the sexes and the effect of parity on overweight/obesity. 2) We used WHO criteria but not African cutoff values for overweight/obesity. It will be necessary in a future study to define African cutoff values. 3) Lack of data regarding dietary habits, which may be an important factor

concerning overweight/obesity and weight gain. 4) Considering the fact that an overwhelming majority of the study population were of Christian faith, the findings from it might not be easily generalized to the whole country. 5) Although some limitations of BMI as a suitable method of determining body fatness have been recognized, such as failure to be able to differentiate individuals with pronounced muscular build, patterns observed in the studies that examined BMI concurrently with waist circumference and waist: hip ratio did not show any difference in patterns of obesity among people from developing countries [36].

CONCLUSIONOf the sociodemographic characteristics studied, marital

status has significant statistical association with overweight/obesity.

RECOMMENDATIONSWe recommend that BMI estimation should be included as

one of the ‘vital signs’ during consultations.

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Diete-Spiff KO, Dienye PO (2017) Socio- Demographic Factors Associated with Overweight/Obesity in a Primary Care Clinic of a Tertiary Hospital in Nigeria. J Family Med Community Health 4(3): 1113.

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