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Indian Journal of Community Medicine

Body Mass Index Status and Some Obesity Promoting Dietary Factors Among Students of Nursing Training School, Bankura

Author(s): A. Sinhababu

Vol. 31, No. 2 (2006-04 - 2006-06)

Introduction

Overweight and obesity are becoming serious problem in India despite the widespread presence of undernutrition1. While examining the body mass index (BMI) distribution of various adult population worldwide, a WHO Expert group2. has observed that as the proportion of population with low BMI decreases, there is an almost symmetrical increase in the proportion with BMI above 25. The same report has shown the overall prevalence figure of overweight (BMI > 25) among adult population in India around 10%, which is suggestive of early stage of the epidemic.

Table - I: Frequency of consumption of energy dense foods from outside in different BMI categories (n =176)

Food item
& frequency of
consumption
BMI < 18.5
(Kg/m2)
Underweight
(n = 59)
BMI 18.5 - 24.9
(Kg/m2)
Normal weight
(n = 108)
BMI 25 & above
(Kg/m2)
Overweight
(n = 9)
Total (n = 176)
No. % No. % No. % No. %
1. Fast food: daily 23 39 34 31.5 2 22.2 59 33.5
Weekly 13 22 21 19.4 2 22.2 36 20.5
Occasionally 23 39 53 49.1 5 55.6 81 46.0
  X2 =1.81 P > 0.1
2.Sweets: daily 17 28.8 18 16.7 4 44.4 39 22.2
Weekly 19 32.2 51 47.2 2 22.2 72 40.9
Occasionally 23 39.0 39 36.1 3 33.4 65 36.9
  X2 = 3.46 P > 0.1
3. Butter: daily 11 18.6 12 11.1 0 0 23 13.1
Weekly 18 30.5 39 36.1 7 77.8 64 36.4
Occasionally 30 50.9 57 52.8 2 22.2 89 50.5
  X2 =2.98 P > 0.1
TOTAL 59 33.5 108 61.4 9 5.1 176 100

There is convincing evidence that increase in the energy density of the diet by fat or sugar together with concomitant eating behaviours like snacking, binge eating and eating out promote unhealthy weight gain through passive overconsumption of energy.1,2 Consequent upon the economic development and market globalization, traditional energy dilute foods are being replaced by widely advertised highly processed energy dense foods. There has also been a steady increase in the consumption of foods prepared outside the home.1 Therefore, there is an imperative need for restriction of consumption of energy dense foods both at home and outside home setting in order to check further progress of the epidemic. Since educational institutions, particularly the residential ones, can play an important role in this regard, the present study was undertaken among the students of Nursing Training School, Bankura with the objective of finding out the relative proportion of underweight and overweight among study subjects on the basis of BMI and the influence of some selected obesogenic dietary factors on BMI status.An institution based cross-sectional study was carried out in the month of July, 2004 among all the 176 students of Nursing Training School, Bankura, located in the campus of Bankura Sammilani Medical College. All of them belonged to 19 - 24 year age group. Height and weight of the study subjects were measured using the standard procedure suggested by Jellife.3 WHO grading of BMI1,2 was used for determination of relative proportion of underweight and overweight. Obesogenic dietary factors that were studied include frequency of consumption of energy dense foods from outside, and some concomitant eating behaviours as shown in table II. Energy dense food in this study was defined as processed foods that are high in fat and / or sugar in contrast to energy dilute foods like whole grain cereals, fruits and vegetables that are high in dietary fibre and water.1,2 The relevant information were collected by a selfadministered questionnaire prepared for this purpose and put to the respondents in a class room. Absentees were covered on subsequent dates to ensure complete coverage.

Results

The proportion of overweight (5.1%) among study subjects (Table - I) was far less than the proportion of underweight (33.5%). Mean, median and mode of the BMI values were 20.24, 19.96 and 19.4 respectively. These findings pointed towards the BMI distribution being skewed to the right and reflective of early stage of transition.

The daily consumption rates of different energy dense foods were found to vary from 13.1% for butter to 33.5% for fast food while the rates of daily and weekly consumption together varied between 49.5% for butter and 63.1% for sweets. All these were indicative of degree of exposure to energy dense foods. The differences in frequency of consumption of various energy dense foods among different BMI categories however were not statistically significant.

As for eating behaviour (Table II) snacking, a known accompaniment of exposure to modern marketing practices of energy dense foods1,2 was prevalent among 43.8% of respondents but the differences in this behaviour among different BMI categories were not statistically significant. The practices of 'eating until plate is finished' and 'eating more fried food' showed wide variation among different BMI categories. The differences were statistically highly significant.

Table - II: Eating behaviour among different BMI categories (n =176)

Eating behaviour BMI < 18.5
(Kg/m2)
Underweight
(n = 59)
BMI 18.5 -424.9
(Kg/m2)
Normal weight
(n = 108)
BMI > 25 (Kg/m2)
Overweight
(n = 9)
Total (n =176)
No. % No. % No. % No. %
1. Snacking (Eating while doing some other activity):
Yes 26 44.1 49 45.4 2 22.2 77 43.8
No 33 55.9 59 54.6 7 77.8 99 56.2
  X2 =1.75 P > 0.5
2. Eating until plate is finished:
Yes 02 3.4 25 23.1 5 55.6 32 18.2
No 57 96.6 83 76.9 4 44.4 144 81.8
  X2 =18.36 P < 0.001
3. Eating more fried food:
Yes 04 6.8 40 37.1 2 22.2 46 26.1
No 55 93.2 68 62.9 7 77.8 130 73.9
  X2 2 d.f =18.19 P < 0.001

Discussion

The relative proportion of underweight and overweight in a population depends on the degree of exposure to energy dense foods. With the increasing exposure to energy dense foods and concomitant changes in eating behaviour, mean population BMI gets increased, population distribution of BMI is shifted to the right with increased skewness and more flattening of the curve indicating a rise in the prevalence of high BMI and proportionate fall in the prevalence of low BMI. The rate of increase in the prevalence of high BMI is slow at mean population BMI 23 or below, but when the mean BMI goes above 23, the rate of increase becomes much faster.

Rose found a 4.66% increase in the prevalence of high BMI (> 30) for every single unit increase in the mean population BMI above 232. Different regions and population groups are in different stages of transition. Augustine et al4 in their study on urban college girls of Ernaculum had found the prevalence of underweight and overweight as 21.5% and 10.5% respectively. Kapil et al5 had obtained 7.4% prevalence of obesity among affluent adolescents in Delhi. High prevalence of underweight (33.5%), relatively much lower prevalence of overweight (5.1%) and mean BMI of 20.24 in the present study were indicative of early stage of transition from energy dilute to energy dense foods. Frequency of consumption of energy dense foods from outside and the prevalence of eating behaviour like 'snacking' (43.8%) and 'eating more fried food' (26.1%) provided supportive evidence in favour of early stage of transition.

Since the institution did not provide any extra meal other than lunch and dinner, the students had to take extra food from outside. But the frequency of 'consumption of energy dense foods from outside' and 'snacking', though of considerable magnitude among all BMI categories, did not seem to influence the BMI status of study subjects. This may be because of inadequate amount of eating out. The relatively much lower prevalence of 'eating until plate is finished' and 'eating more fried food' among underweight, compared to other BMI categories appear to be the main reason for the high prevalence of underweight and also the disparity in BMI status among study subjects. This can be corrected through appropriate nutrition education. Provision of extra meals as breakfast and afternoon snacks from the hostel can obviate the need for eating out and help minimize consumption of energy dense foods and thus go a long way in preventing further progress of overweight while taking care of the problem of prevailing undernutrition.

References

  1. WHO. Report of a Joint WHO/FAO Expert consultation. Diet, Nutrition and the prevention of chronic diseases, WHO Technical Report series, 2003, 916.
  2. WHO. Report of a WHO consultation. Obesity: Preventing and managing the global epidemic, WHO Technical Report Series, 2000, 894.
  3. Jellife BD. The assessment of the nutritional status of the community. WHO 1966, 63 - 78.
  4. Augustine LF, Poojara RH. Prevalence of obesity, weight perception and weight control practices among urban college going girls. Indian J. of community medicine 2003; 28: 187 -190.
  5. Kapil U, Singh P, Pathak P, Dwibedi SN, Bhasin S. Prevalence of obesity among affluent adolescent school children in Delhi. Indian paediatrics 2002; 39:449 -452.

Deptt. of Community Medicine, B. S. Medical College, Bankura, West Bengal.
Received: 18.12.2004

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