Research Journal of Recent Sciences ______ ______________________________ ______ ____ ___ ISSN 2277 - 2502 Vol. 2 ( ISC - 2012 ), 304 - 307 (201 3 ) Res.J. Recent .Sci. International Science Congress Association 304 Obesity Assessment Based on B MI in the Young Adults of Haryana - A State of India Sangeeta C. Sindhu Deptt. of Foods and Nutrition, College of Home Science, CCSHAU Hissar, Haryana, INDIA Available online at: www.isca.in R eceived 13 th September 201 2 , revised 2 9 th December 201 2 , accepted 14 th January 201 3 Abstract Over the past 20 years a dramatic transition has altered the diet and health of hundreds of millions of people across the thi rd world. In India, like most deve loping nations, obesity has emerged as a more serious health threat than hunger. The change of lifestyle and dietary habits is leading to the global paradox of obesity and malnutrition. The present study was planned with the objective to assess the nutriti onal status of the youth (18 - 21 yrs.) of Haryana state (India) using BMI, body fat per cent and waist to hip ratio as indicating parameters. A questionnaire was developed and pretested on 100 respondents. Appropriate changes were made in consultation with Statistician and subject experts. Seven districts namely Karnal, Panchkula, Ambala, Sirsa, Hisar, Sonipat and Rohtak from the Haryana state of India were (n=1482) studied. Students from private and government colleges who volunteered for the study were cho sen as subjects. Of the total, 612 students mentioned family income below Rs. 30,000/ - per month, 742 students had family income between 30,000 – 1,00,000/ - month and 128 students had monthly family income above Rs.1,00,000/ - . Majority (61.74 per cent) of students were categorized as normal/healthy weight based on their BMI, 23.01 per cent were under weight, 12.35 per cent were overweight while only 43 students (2.90 per cent) were categorized as obese. When considered gender wise, 18.95 per cent of male an d 26.17 per cent of female students were underweight, while 16.64 and 14.16 per cent respectively were found to be overweight/obese. Body fat per cent correlated well with BMI categories but waist to hip ratio was contained within normal limits in all cate gories. . Keywords: Obesity, BMI, Young Adults, dramatic transition Introduction Obesity, a condition characterized by excess body fat, carries substantial health implications for both chronic disease and mortality. This fact and its increasing prevalen ce make obesity an important health problem. Obesity is usually defined in terms of the body mass index which is a measure of weight adjusted for height. Although numerous techniques are available for evaluating body fat, the variables for BMI are easy to measure. BMI has been shown to correlate closely with body fat content in adults and children 1 . Waist circumference and the waist - to - hip ratio are common adjuvant measures used to classify the distribution of body fat in people who are overweight, as obesi ty - related complications are most closely correlated with abdominal fat distribution 2 - 4 . Acc to WHO Obesity has reached epidemic proportions globally, with more than 1 billion adults overweight - at least 300 million of them clinically obese - and is a m ajor contributor to the global burden of chronic disease and disability. Often coexisting in developing countries with under - nutrition, obesity is a complex condition, with serious social and psychological dimensions, affecting virtually all ages and socio economic groups. As under nutrition decreases, over nutrition increases by about the same amount. India is one of the dual burdened countries. Haryana is amongst the richest states in northern India 5 and one of the preferred investment destinations in the country. In terms of the annual income of households — an important indicator of economic prosperity — Haryana ranks third amongst Indian states in terms of per capita income. Haryana’s economy has touched growth rate of 9.6 per cent in the gross state do mestic product during 2010 - 11.Also, advance estimates for the current financial year show the state’s per capita income to be US$ 2,029.60 at current prices. Haryana's GDP touched US$ 22.37 billion between 1999 – 00 and 2005 – 06 — an impressive 12.73 per cen t rise. Its per capita income in 2006 was US$ 862.90 — against the all - India average of US$ 573.10. There is a dearth of regional data when it comes to the nutritional status of young adults in the age group 18 - 21. Considering the high pace of development in Haryana and the fact that this is the age group that would form the main work force in near future, a surveillance of their status is important. Present study provides the much lacking data of youth presently studying in colleges of Haryana. Material s and Method Keeping in view the objectives of study, questionnaire was developed and pretested. Appropriate changes were made in consultation with Statistician and subject experts. A total of 1500 subjects were studied from seven districts of Haryana (nam ely Research Journal of Recent Sci ences ______ _ _ _______________________________ ______________ _ ________ ISSN 2277 - 2502 Vol. 2 ( ISC - 2012 ), 304 - 307 (201 3 ) Res.J.Recent.Sci International Science Congress Association 305 Karnal, Panchkula, Ambala, Sirsa, Hisar, Sonipat and Rohtak) during 2010 - 2012. Students from private and government colleges who volunteered for the study were chosen as subjects. College students in the age group 18 - 21 were assessed for their body wei ght, BMI and body fat per cent using Digital weighing scale (Omron HN 283), BMI and body fat monitor (Omron HBF 306, based on hand to hand BIA method) respectively. Height was measured in cm using the standard height measuring rod. Consent from the Princip al of the concerned colleges was taken. Colleges were visited with prior intimation. The students were briefed about the study through organized lectures. Only the students who themselves volunteered were included in the study. The physically challenged (d ifferently abled) students were excluded. Subjects who did not provide complete information were also excluded from the study and thus the final data was available for 1482 subjects. The collected data were analyzed separately for boys and girls and tests of significance were applied wherever applicable. The software SPSS 7.5 was used for statistical analysis. Results and Discussion Table 1 presents the background characteristics of the subjects. The subject population comprised of 56.25 per cent females a nd 43.79 per cent males. Seventy six per cent of the respondents (n=1482) belonged to nuclear families. Majority of subjects (50.1) belonged to middle income groups (Rs. 30,000/ - to 100,000/ - per month) while only 8.6 per cent belonged to higher income gro up (monthly income �100,000/ - ). Majority of subjects had parents educated up to at least high school while 46 (3.10 per cent) students had both parents professionally qualified (above graduate). When asked whether the subjects were satisfied with their pre sent physical appearance regarding body weight, 55 per cent were satisfied while 48 per cent said they wanted to add/ lose weight. Table - 1 Background characteristics of the study population (n= 1482) Characteristics Frequency Per cent Sex Male Female 6 49 833 43.79 56.21 Family type Joint Nuclear 354 1128 23.9 76.1 Income Low income group (s.10,000/ - pm) Middle income group(Rs.10,000 - 60,000/ - pm) High income group (� 60,000/ - pm) 612 742 128 41.3 50.1 8.6 Father education Uneducated Upto High Sch ool High School to Graduate Professionally qualified 154 715 466 147 10.39 48.25 31.58 9.92 Mother education Uneducated Below graduate Graduate Professionally qualified 444 608 351 79 29.96 41.03 23.68 5.33 Body Image Satisfied un satisfied 790 692 53.31 46.69 Table - 2 Mean anthropometric measurements of subjects BMI kg/m 2 Body fat% Waist/Hip Body Weight (Kg) Height (cm) Male 21.24±4.06 18.97 * ± 6.08 0.82 * ±0.08 59.33 * ±11.04 167.09 * ±7.47 Female 20.72± 4.09 24.85 * ±7.07 0.75 * ±0 .09 49.74 * ±9.98 156.50 * ±6.17 Total N=1482 20.94 ± 4.09 22.34±7.27 0.77±0.09 53.94±11.49 161.13±8.56 Values are mean ± standard deviation , * Difference is significant (p.001) Research Journal of Recent Sci ences ______ _ _ _______________________________ ______________ _ ________ ISSN 2277 - 2502 Vol. 2 ( ISC - 2012 ), 304 - 307 (201 3 ) Res.J.Recent.Sci International Science Congress Association 306 Table - 3 Health status of subjects based on BMI (n=1482) Obesity category Mal e Female Total Underweight BMI≤18.5 123 (18.95) 218 (26.17) 341 (23.01) Normal BMI 18.5 - 24.9 418 (64.41) 497 (59.66) 915 (61.74) Overweight BMI 25 - 29.9 89 (13.71) 94 (11.28) 183 (12.35) Obese ≥30 19 (2.93) 24 (2.88) 43 (2.90) Classification of obesity is based upon WHO, 1998 , Figures in parenthesis indicate per cent subjects Table 4 Mean BMI, Waist to hip ratio and body fat per cent of subjects in different obesity categories Obesity categories Male (n=649) Female (n=833) BMI waist/Hip Fat % BMI waist/Hip Fat % Under weight 16.96±1.04 0.78±0.08 14.06±4.19 16.50±0.99 0.76±0.11 16.80±4.08 Normal weight 20.75±1.85 0.79±0.09 19.87±4.90 20.71±1.83 0.76±0.07 25.39±5.41 Overweight 26.95±1.47 0.80±0.06 29.87±4.50 26.86±1.38 0.78±0.07 33.91±4.98 Obese 33.60±2.93 0.80±0.06 35.23±3. 43 34.90±4.54 0.80±0.07 37.96±4.06 Mean BMI was 20.72 kg/m 2 for females and 21.24 kg/m 2 for males (table 2). The body fat per cent ranged from 18.97 in males to 24.85 in females. Mean waist /hip ratio was 0.75 in females and 0.82 in males. Mean height o f male subjects was 167.09 cm while that for female subjects was 156.50 cm. The body weight ranged from 49.74 kg in females to 59.33 kg in males. Independent sample t - test depicted significant difference (p0.001) in fat per cent, waist /Hip ratio, body w eights and height between the two sexes. When assessed for obesity categories based on BMI, 23.01 per cent of the subjects were underweight, 12.35 per cent were overweight and only 2.90 per cent were categorised as obese. Per cent of underweight females w as 26.17 as against 18.95 per cent of males. At the same time, 13.71 per cent of male students and 11.28 per cent of female students were assessed as overweight. About three per cent of both were categorised as obese. Figure 1 presents the gender wise prev alence of underweight against combined overweight - obese category. Waist to hip ratio for males should be less than 1.00 and those of females should be less than 0.8 6 . Acceptable range for body fat per cent is 25 - 31% for female and 18 - 25% for males. In male subjects waist to hip ratio varied from 0.78 in underweight categories to 0.80 in obese categories. In female subjects the ratio varied from 0.76 in underweight categories to 0.80 in obese categories. Female subjects had higher fat per cent as compare d to their male counterparts in all weight categories. The waist to hip ratio for all subjects was contained within acceptable limits. Body fat per cent was beyond acceptable limits in underweight as well as overweight / obese subjects. Obese male and fema le had fat per cent as high as 35.23 and 37.96 per cent respectively. Results and Discussion Obesity is globally on a rise. Data from the National Centre for Health Statistics show that, in 40 years, obesity prevalence increased from 13% to 27% of the U.S. adult population 7,8 . Obesity prevalence is higher in women; overweight is more common in men 8 . Kim and Kim in 2005 9 investigated the Body Mass Index among 266 Korean girls (M age= 16.6 yr., SD= .9). Based on Body Mass Index, 73.7% were normal weight, 22.9 % were underweight, and 3.4% were overweight. In India, the issue of overweight/obesity was not even addressed during National Family Health Survey - 1 in 1992 - 1993. In 1998 - 99, NFHS - 2 depicted 16.6 per cent women in Haryana as underweight and 25.9 per cen t as overweight/ obese. As per NFHS - 3 in 2005 - 2006, Haryana had 27.8 per cent of its women and 26.8 per cent male below normal weight 10 . At the same time the survey indicated prevalence of overweight/obesity in 21 per cent of females and 14.4 per cent male s. The survey included female subjects in the age 15 - 49 and male subjects in the age 15 - 54. Subramanian et al 11 used the NFHS data and calculated a ratio of the number of underweight women to overweight women in India. They concluded that although the rati o of underweight to overweight women decreased from 3.3 in 1998 – 1999 to 2.2 in 2005 – 2006, there were still considerably more underweight women than overweight women. Chatwal et al 12 determined the prevalence of obesity in pre - adolescent and adolescent ch ildren of northern India. Using WHO references, overall prevalence of obesity and overweight was 11.1% and 14.2% respectively. The prevalence of obesity as well as overweight was higher in boys as compared to girls (12.4% vs 9.9%, 15.7% vs 12.9%). Our stu dy indicates Research Journal of Recent Sci ences ______ _ _ _______________________________ ______________ _ ________ ISSN 2277 - 2502 Vol. 2 ( ISC - 2012 ), 304 - 307 (201 3 ) Res.J.Recent.Sci International Science Congress Association 307 existence of dual problem in young adults with 23.01 per cent of total subjects in under weight and 15.25 per cent in overweight/obese categories. Obesity is a risk factor for major causes of death, including cardiovascular disease, some canc ers and diabetes. Obesity has also been linked with many sources of morbidity, including osteoarthritis, gall bladder disease; sleep apnea, and respiratory impairment. It is also associated with concerns of quality of life, including diminished mobility an d social stigmatization 13, 14 . Considering the alarming rise in overweight/obesity in developed as well as developing countries, the situation warrants urgent attention. A WHO expert consultation 15 addressed the debate about interpretation of recommended body - mass index (BMI) cut - off points for determining overweight and obesity in Asian populations They reviewed scientific evidence which suggested that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation however agreed that the WHO BMI cut - off points should be retained as international classifications. Dudeja et al 16 studied appropriate cut - off levels of the BMI for defining overweight, considering percentage body fat in healthy Asian Indians in northern India as the standard and concluded that the conventional cut - off level of the BMI underestimates overweight and obesity when percentage body fat is used as the standard to define overweight. However in present stu dy, body fat per cent correlated well with BMI cut off points. These preliminary findings, if confirmed in a larger number of subjects and with the use of instruments having a higher accuracy of body fat assessment, would be crucial for planning, preventio n and treatment of various obesity - related metabolic diseases in the Asian Indian population. Conclusion The present study was conducted in one of the most progressive states of Northern India as per the WHO guidelines and is probably the only one other t han NFHS, reporting obesity prevalence in the age group of 18 - 21 of this region using these guidelines. The results indicate coexistence of underweight and overweight/obese subjects. There is a need to assess obesity prevalence by conducting wider, nationa lly representative studies and also create awareness regarding the emerging trend. Such studies would be instrumental in policy formulation for handling the malnutrition. Acknowledgement The study was part of a major research project funded by University Grants Commission, New Delhi, India. References 1. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Alexandria, Virginia: International Medical Publishing, Inc., 219 - 229 (1996) 2. Lapidus L., Bengtsson C., Larsson B., Pennert K., Rybo E. and Sjostrom L,. 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