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ORIGINAL ARTICLE
Year : 2017  |  Volume : 3  |  Issue : 3  |  Page : 140-145

Prevalence of Obesity and Overweight Among Second Year Students in a Malaysian Medical University and Their knowledge and Perception of Obesity


1 Division of Family Medicine, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia
2 Division of Basic Medical Sciences, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia

Date of Web Publication24-Oct-2017

Correspondence Address:
Reshma M Ansari
Division of Basic Medical Sciences, Cyberjaya University College of Medical Sciences, Cyberjaya 63000
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_27_17

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  Abstract 

Introduction: Obesity is a lifestyle disease that has been significantly increasing in the recent years. Body mass index (BMI) is recommended by the WHO to classify obesity and is used as a tool to identify patients or individuals at risk for adverse health outcomes. Waist circumference (WC) is also an important risk factor for lifestyle diseases and it can also be used to measure body fat distribution. Our study, therefore aims to determine the prevalence of overweight and obesity among the preclinical students in a Malaysian medical university, correlate the relationship of BMI and WC and evaluate the knowledge and perception of obesity of obese and overweight students. Method: A descriptive cross sectional study was performed involving 93 second year medical students. The BMI and WC were recorded of all the participants. The obese and overweight participants were identified and asked to answer a close-ended self-administered questionnaire. Results: Out of 93 students who participated in the study, 23 (25%) were overweight and 21 (22%) were obese. Pearson correlation analysis between BMI and WC values showed that the two variables strongly correlate with each other. The questionnaire identified gaps in the knowledge of the students and poor perception among overweight students. Conclusion: Hence, our study concludes that the prevalence of obese and overweight individuals is on the rise and there a gap in the knowledge. Based on our study results it is recommended that appropriate measures are taken to address the issue.

Keywords: Knowledge, medical students, obesity, overweight, perception


How to cite this article:
Sivashunmugam L, Ansari RM. Prevalence of Obesity and Overweight Among Second Year Students in a Malaysian Medical University and Their knowledge and Perception of Obesity. MAMC J Med Sci 2017;3:140-5

How to cite this URL:
Sivashunmugam L, Ansari RM. Prevalence of Obesity and Overweight Among Second Year Students in a Malaysian Medical University and Their knowledge and Perception of Obesity. MAMC J Med Sci [serial online] 2017 [cited 2017 Nov 21];3:140-5. Available from: http://www.mamcjms.in/text.asp?2017/3/3/140/217117


  Introduction Top


Obesity is a lifestyle disease that has been significantly increasing in the current scenario. It is a global epidemic and is an important risk factor for developing cardiovascular diseases, including diabetes, hypertension, and dyslipidaemia.[1] Overweight (OW) and obesity are defined as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is recommended by the World Health Organization (WHO) to classify obesity and is used as a tool to identify patients or individuals at risk for adverse health outcomes.[1] Waist circumference (WC) is an important risk factor for lifestyle diseases, and it can also be used to measure body fat distribution.[1] The corrected WHO guidelines categorizes Asians according to their BMI as underweight <18.5, normal 18.5 to 22.9, OW 23 to 27.5, and obesity >27.5.[2]

The National Health and Morbidity Survey 2011 (NHMS 2011) reported that the prevalence of OW and obesity among adults aged 18 years and above was 33.3 and 27.2%, respectively.[3] Obesity was found to be more prevalent among Malaysian females (13.8%) than males (9.6%).[4] A study done in International Medical University in the year 2012 among medical students in the clinical years showed that the prevalence of OW and obesity was 30.1%.[5] A latest study carried out in UniKL Royal College of Medicine, Perak, Malaysia, noted that there is a growing trend of OW and obesity among medical students.[6]

Seidell reported that apart from BMI, WC, and waist–hip ratio (WHR) are strongly predictive of obesity in young and middle-aged adults compared to older people and WC alone could replace WHR and BMI as a single risk factor for all‐cause mortality.[7] Therefore, our study aims to determine the prevalence of OW and obesity using both BMI and WC among the preclinical medical students in a Malaysian Medical school, correlate the relationship of BMI and WC, and assess the knowledge and perception of the students regarding obesity.


  Materials and Methods Top


A descriptive cross-sectional study was performed involving 93 second year medical students from the Faculty of Medicine. The participants were selected as per nonrandom quota sampling method. The sample size was calculated using the one proportion formula N = (Z/m)2 × p (1−p) based on the prevalence of 19.5% obesity amongst young Malaysians,[3] N is the sample size required, Z will be 1.96 for confidence level of 95%, and p is the estimated prevalence of 19.5. The calculated sample size was 240. The corrected sample size for known population was calculated using the formula N0N/N0 + (N−1). Where N0 = 240, Number of second year students N = 100. So the corrected sample size for known population was 71. Number of nonrespondents was expected to be 14 (20%). But 93 students were willing to participate in the study. All respondents were informed of the objectives of the study and their written consent was obtained prior to participation in this research. The students were selected according to the inclusion and exclusion criteria as mentioned below. All respondents were informed of the objectives of the study and their consent was obtained prior to participation in this research. Ethical approval was obtained from the University Research Ethics Review Committee, and identity of participants was kept anonymous.

The inclusion criteria were as follows:
  1. Second year medical students
  2. Age from 19 to 25 years


The exclusion criteria were as follows:
  1. Students diagnosed with diabetes
  2. Students on treatment for diabetes
  3. Pregnant


Nonrespondents were as follows:
  1. Respondents who refused to participate in this study
  2. Respondents who did not complete the questionnaire


The tools used to measure the weight and height were a standardized weighing scale and measuring rod. The weighing scale was calibrated at the beginning of every session of measurement. Measuring tape was used to measure the WC. Participants were weighed in their light clothing without shoes. The height was measured without the footwear with the participants standing straight and looking forward. The participants’ height was recorded at the point where the arm of the measuring rod resting on the head, following which the BMI was calculated as weight in kilograms divided by height in square meters (kg/m2). The students were categorized as per WHO guidelines, as underweight <18.5, normal 18.5 to 22.9, OW 23 to 27.5, and obesity >27.5.[2]

WC was measured in centimeters (cm) midpoint between the lowest ribs and anterior superior iliac spine at the end of normal expiration in a relaxed state. Each measurement was repeated twice, and if the measurements were within 1 cm of each other, the average was calculated. If the difference between the two measurements exceeded 1 cm, the two measurements were repeated and rerecorded.[8] As per WHO guidelines, the WC cutoff points for Asians was taken as 90 and 80 cm for males and females, respectively.[8] All data were kept confidential using a password-protected laptop, and all paper documents were kept under lock and key. The obese and OW participants were identified according to their BMI. They were asked to answer a close-ended self-administered questionnaire in English. A questionnaire comprising three sections was developed based on literature review[9],[10],[11] and consensus among research team members. It was pilot tested and amended accordingly. The three sections of the questionnaire were as follows:
  • Section 1: This section covers the sociodemographic and clinical profile data which includes age, gender, race, and marital status.
  • Section 2: To assess the knowledge of obesity.
  • Section 3: To assess the perception and attitude on obesity.
  • The data collected were analyzed using SPSS version 21 (IBM Corp. Released 2012, IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp).



  Results Top


The results are given in percentage values as below. Out of 93 students who participated in the study, 33% (n = 31) were males and 67% (n = 62) were females. The major 87% (n = 81) of students were Malays, 10% (n = 9) were Indians, 2% (n = 2) were Chinese, and 1% (n = 1) was others. The total percentage of OW and obese students was 47% (n = 44), which comprised 15 male students and 29 female students. Out of this number, 25% (n = 23) were OW and 22% (n = 21) were obese. [Figure 1] depicts the breakdown of the participants according to their BMI.
Figure 1: The breakdown of participants according to their BMI

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The number of both male and female participants and the percentage with their BMI is shown in [Figure 2].
Figure 2: A bar chart depicting the number and percentage of male and female participants categorized according to their BMI

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There were no students with high WC in the underweight and normal group. As of the OW students, 42.5% males (n = 3 out of 7) and 18.7% females (n = 3 out of 16) had high WC. All of the obese students had high WC as shown in [Figure 3].
Figure 3: The number of participants with high WC among the OW and obese group

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Pearson correlation analysis was performed between BMI and WC values ([Table 1]). The result of the coefficient is found to be more than 0.75 and the P value is less than 0.05, which denotes that the two variables strongly correlate with each other. The association is positive, denoting WC is directly proportional to BMI values [Figure 4] [Table 2].
Table 1: The variables taken for correlation using the Pearson correlation coefficient

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Figure 4: The positive correlation between BMI and WC

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Table 2: The data collected from the questionnaires of all OW and obese respondents

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  Questionnaire Analysis Top


The questionnaire analysis of OW students (n = 23) revealed that 61% of them lack knowledge about the normal BMI, and only 35% scored it right for the cutoff values for WC. However, all 23 of them (100%) were aware of the causes of obesity, namely, inappropriate diet and lack of exercise. Regarding perception, 52% of OW students identified themselves as “too heavy”. However, 57% were willing to participate in a weight reduction program. The questionnaire analysis of obese students (n = 21) revealed that 29% of them had knowledge about the normal BMI, and only 10% scored it right for the cutoff values for WC. However, all 95% of them were aware of the causes of obesity.

Regarding perception, 86% of obese students identified themselves as “too heavy”. But only 81% of OW students were willing to enroll in a weight reduction program.


  Discussion Top


The results show, out of 93 students who participated in the study, the prevalence of OW and obesity is 25 and 23%, respectively. Our results are in accordance with a recent study in Trivandrum, Kerela, India, which reported a prevalence of 24.57% of OW and 25.71% of obesity, respectively.[12] Our data show that there is an increase in OW and obesity among young adults compared to a Malaysian study performed in 2010, which reports 30% prevalence of BMI over 23 kg/m2.[2] Asians are at risk for metabolic syndrome, and its complications even at low BMI, and hence, new Asia Pacific guidelines for assessing BMI were developed.[2] The high prevalence rate encountered in these studies is due to the adoption of the new Asia Pacific guidelines. Our study has produced similar results as predicted by the NHMS 2006 that the rate of OW students would increase to 26.5% by the year 2015.[13]

Among the cohort in our study, female medical students were more OW and obese than their male counterparts. But males had higher WC compared to the females. All of the obese students had high WC. Pearson correlation analysis between BMI and WC values denote that the two variables strongly correlate with each other and the association is positive. In Asians, the body fat distribution represented by visceral adipose tissue results in higher insulin resistance which predisposes them to a myriad of diseases. Studies have shown that measurements of WC with BMI are of high predictive value rather than BMI only.[14] Hence, even if Asians have a lean BMI, measurement of their body fat distribution is mandatory to ascertain their risk for diabetes and cardiovascular diseases.[15]

High WC values pose a greater health risk compared to normal WC values within each BMI category.[15] Females are 3.6 times at higher risk of developing high WC, as they tend to have larger abdominal subcutaneous adipose tissue area.[16] However, men with high WC are five times more likely and women with high WC are three times more likely to develop complications like diabetes. BMI measurement is a measure of body fat, and it may be distorted by high muscle mass necessitating the correlation between BMI and WC to assess the obesity-related risk of an individual.[17] Our study analysis of the BMI and WC correlation shows a positive association.

Regarding the knowledge on obesity, 66% of OW and obese participants were unaware of the normal BMI range and 77.5% were unsure of the normal WC values for males and females. The gaps in knowledge are due to mismatch between the skills acquired through education and practice. This feature was also noted by researchers who conducted a study in Ipoh, Malaysia and Mumbai, India.[18],[19] However, 98% of the respondents in our study had fairly good understanding of the causes of obesity in comparison to another study conducted in Malaysia, whereas only 80% respondents were aware of the causes of obesity.[20] This can be attributed to the fact that our study population is from the medical fraternity. Similarly, a study conducted on medical students in Mumbai revealed that their knowledge about the causes of obesity is sufficient, further ascertaining the advantage of being medical students.[19]

Data analysis of the perception shows 86% (n = 18 out of 21) of obese and 52% (n = 12 out of 23) of OW respondents identified themselves as “too heavy”. According to our observation, OW individuals have a problem of identifying themselves compared to the obese group. In a study conducted in Selangor Malaysia, 74% of OW respondents perceived themselves correctly, and in contrast, only 52% of our OW group perceived themselves correctly.[21] Almost 86% of our obese subjects have a correct perception compared to a previous study performed in 2014, where 77% respondents only were aware of being obese.[21] This information highlights the fact that the obese students in our study have a better insight of their body image.

The analysis of data shows that only 57% of OW and 81% of obese students are willing to participate in weight reduction program. This clearly points out that the willingness among the OW group is insufficient. This is also evidenced in another study which shows a discrepancy between knowledge and practice among medical students.[19]


  Conclusion and Recommendation Top


Our study concludes that the prevalence of obese and OW individuals is on the rise. The main factors for the rising trend of OW and obesity among medical students can be attributed to unhealthy diet, lack of physical activity, and probably psychological stress due to the nature of curriculum.[10] Although our study population showed adequate knowledge about obesity, there are gaps in areas of perception and attitude that were identified through this study. Most of the obese students have a good insight of body perception and positive attitude toward weight-loss program. However, OW students are still lacking in their perception and are unwilling to enroll into the program.

The gaps in knowledge could be addressed by emphasizing the importance of obesity implications and actively involving the medical students in awareness campaigns of lifestyle diseases. The possible reasons for weight gain among medical students are long study hours, less time for exercise, using vehicles for travel even for short distances, and eating fast food, and these factors need to be addressed to incorporate healthy lifestyle changes.

Our study results also show that there is a definite need to inculcate good habits of healthy eating and regular physical exercise among the OW and obese students. Life style changes are the mainstay of reducing the incidence of obesity and related complications. There are currently no evidence-based interventions to promote or facilitate weight loss or obesity prevention among medical students. “My Weight My Health” program was initiated by the Malaysian Pharmaceutical Society in 2012 to tackle weight issues experienced by Malaysians.[22] It has a call center which consists of pharmacists, nutritionists, and dieticians to provide counseling, education, and also resources for appropriate physical exercises for obese Malaysians. It is recommended that as a pilot study, our potentially high risk OW, and obese students are enrolled into such programs, observed for 6 months by the researchers. Any changes in parameters, perception and attitude will be evaluated at the end of the period. The effectiveness of the intervention, if beneficial can be adopted as a strategy for the management of weight-related problems among our medical students.


  Limitations of Our Study Top


The limitation of our study is a small and unequal sample size comprising more female participants. The students in the medical school are majority of Malay ethnicity, and therefore, Chinese and Indians are not proportionally represented in our study sample. Convenience sampling employed in our study is another limitation as some high-risk students may have opted out of the study due to implications of identification of obesity. Another shortcoming is the use of self-reported data and the assumption that participants responded honestly and accurately.

Acknowledgement

The authors would like to acknowledge and thank the second year MBBS students for participating in the study and CGSRC (Center for Graduate Studies, Research and Commercialization) for funding this project.

Financial support and sponsorship

The study is funded by CGSRC, Cyberjaya University College of Medical Sciences (CUCMS), Grant No: CRG/02/01/2015.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Seidell JC. Waist circumference and waist/hip ratio in relation to all-cause mortality, cancer and sleep apnea. Eur J Clin Nutr 2010;64:35-41.  Back to cited text no. 7
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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