Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Indian Journal for the Practising Doctor

Prevalence of Obesity in an Urban Population - A Community based Study

Author(s): Khalid U. Khayyam, Shariqua Yunus Khan, Mohammad Yunus Khan, S. Muzammil

Vol. 5, No. 5 (2008-11 - 2008-12)

ISSN: 0973-516X

Khalid U. Khayyam٭, Shariqua Yunus Khan٭, Mohammad Yunus Khan٭٭, S. Muzammil٭٭٭

٭Department of Community Medicine, JNMC, Aligarh Muslim University, Aligarh; ٭٭ King Khalid University, Abha, Saudi Arabia; ٭٭٭ Department of Physiology, JNMC, AMU, Aligarh Correspondence: Dr. Shariqua Yunus Khan, Department of Community Medicine, Jawahar Lal Nehru Medical College, AMU, Aligarh.

Abstract:

Research Question: What is the prevalence of obesity in an urban population.
Objective: To study the prevalence of obesity in an urban population of Aligarh based on sum of skin fold thickness measured at four sites.
Study design: Cross sectional and community-based
Setting and participants: Urban population in and around Urban Health Training Center (UHTC), Department of Community Medicine, JNMC, AMU, Aligarh
Statistical Analysis: Mean value and T test
Results: The proportion of obese males having more than 40 mm of total skin fold thickness was 8.8% as compared to 14.1% obese females having more than 50mm of total skin fold thickness. A highly significant difference between males and females as regards biceps, triceps, subscapular and supra-iliac skin fold thickness was observed. Females had a higher mean value of skin fold thickness than males in each group.
Conclusion: Based on the total skin fold thickness measured at 4 sites, it was found that females were more obese than males. This difference was more evident in the age groups of 40-49 and 50-59 years.

Introduction

Obesity is an increasingly prevalent, costly and significant health problem throughout the world.1 Noteworthy is the curious fact that the prevalence of obesity is on the increase in both developed and developing countries.2-9 By definition obesity is a pathological condition characterized by an accumulation of fat in excess of its necessity for optimal body function.10 Research workers differ on the methods of estimating obesity; as a result there is no single method of choice. Skin fold thickness, which estimates the subcutaneous fat, is a good indicator of deep fat store in the body. Various sites for measurement have been suggested. Probably the best results are achieved by using 4 sites: biceps, triceps, subscapular and supra-iliac.11 Experts believe that skin fold thickness is the most convenient criterion for measurement of obesity, provided that the measurements are made exactly and at correct sites.12

Materials and methods

The present study was done in the urban population living in and around the Urban Health Training Center (UHTC), Department of Community Center, JNMC, AMU, Aligarh. All the 4162 individuals in the 15-65 year age group, forming 58.15% of the total population in the study area, were included in the study, of whom 3993 (96%) were screened. The remaining 169 (4%) individuals could not be screened either due to their non-availability (19; 0.45%) or because they belonged to one of the following categories: pregnant women, people suffering from debilitating disease, and having ascites or edema (150; 3.6%).

Skin fold thickness was measured at four sites (biceps, triceps, subscapular and suprailiac) to estimate the amount of subcutaneous fat in the body. For skin fold measurement, the standard Harpenden Skinfold Calipers with a jaw pressure of 10gm/mm2 was used and was standardized in the hospital OPD. The calipers had calibrations in mm with a maximum recordable reading of 56.6 mm and a minimum of 0.2 mm.

Skin fold measurement includes the thickness of the pinch of folded skin plus the attached subcutaneous adipose tissue. All the measurements were made with the subject in standing position and in accordance with Mayer et al.13

Triceps skin fold: The triceps skinfold was located at the mid point of a line between postero-lateral border of acromion process of the scapula and tip of olecranon process of the ulna, when the arm was flexed 900 at the elbow joint; it was called at the “Triceps Point”. During measurement arm was subjected to hang freely by the side.

Biceps skin fold: The “Biceps Point” was marked in front of the arm at the level of triceps point, to lie on a line drawn vertically upward from the middle of the cubital fossa.

Sub-scapular skin fold: Subscapular skin fold was located just below the angle of right scapula (shoulder and arm relaxed). The fold was pinched up in a line slightly inclined in the natural cleavage of skin. The subcutaneous fat was uniform in this region, precision location was less critical.14

Supra-Iliac skin fold: The supra-iliac skin fold was located at a point just above the iliac crest in mid-axillary line as recommended by other investigators.13,14,16

Results

Table I depicts the mean biceps skin fold thickness in males and females. The mean biceps skin fold thickness in males varied from 3 mm in the age group of 15-19 years to 8 mm in 50-59 years. In females, the mean biceps skin fold thickness also increased from 9 mm in the age group of 15-19 years to 14 mm in 50-59 years. Females had a higher mean value of skin fold thickness than males in each group, which was statistically significant. (P<0.001)

The mean triceps skinfold thickness in 15-19 year old males was 9 mm which increased to 13 mm in the 40-49 year age group, whereas the figures for the females in the respective age groups were 12mm and 21 mm. (Table II). Females, again, had a higher mean value of skin fold thickness than males in each age group which was statistically significant (P<0.001).

The mean subscapular skin fold thickness in males varied from 10 mm (15-19 years) to 14 mm in the 40-49 year group. Among the females, the lowest mean value for subscapular skin fold thickness of about 12 mm was observed in the age group of 15-19 years while the highest mean value of 19 mm was found in 40-49 year age group (Table III). Females had a higher mean value than males which was significant. (P<0.001)

Table IV shows the mean supra-iliac skin old thickness in males and females; in the 15-19 year males it was 11mm which increased to 16mm in those aged 40-49. Females had a minimum mean value of 13mm (15-19 year) and a maximum of 20 mm in the 40-49 years age group. Thus, females again showed a higher mean value in each age group. Which was statistically significant when compared to that in the male counterparts (P<0.001)

Table V shows the distribution of males into two groups based on the sum of mid-triceps, biceps, sub-scapular and supra-iliac skin fold thickness, The total number of males with more than 40mm of total skin fold thickness was 177 (8.8%) which was statistically significant. (P<0.001)

Table VI depicts the distribution of females into two groups of those having total sum of skin fold thickness <50mm and those with >50 mm. The total number of females having sum of skin old thickness >50 mm was 281 (14.1%), which was statistically significant. (P<0.001)

Discussion

Sood15 observed that the proportion of males and females with obesity was 9.4% and 19.4%, respectively, which was higher than that in the present study. However, the variation in mean values of biceps and triceps skin fold thickness, observed in this study in both male and female population, was similar to that reported by him.

Durvin and Womersly11 in their study at Glasgow (UK) reported a highest mean value of 17 mm in males and 24 mm in females in the age group of 40-49 years. The observed differences may be attributable to the fact that the present study was conducted in a developing country while the referred study was conducted in a developed country, where both men and women are well-nourished.

Jones et al16 found differences between the proportions of subcutaneous fat in Europeans, Gurkhas, Rajputs and South Indians. Probably, there are some ethnic differences in the distribution of subcutaneous fat.

Conclusion

Based on the skin fold thickness measured at four sites, it was inferred that females were more obese than males which was more evident in the age group of 40-49 years and 50-59 years.

Table I: Comparison of Mean Biceps Skin fold Thickness by Age and Sex

Age (years) Males Females t-value Significance
N Mean SD N Mean SD
15-19 420 3 3.28 315 9 5.66 240 P < 0.001
20-29 594 4 5.12 567 10 5.47 333.3 P < 0.001
30-39 372 5 4.25 407 11 5.86 230.8 P < 0.001
40-49 244 7 2.65 384 13 5.29 201.4 P < 0.001
50-59 252 8 3.82 187 14 7.4 115.4 P < 0.001
60-69 120 6 3.27 131 11 6.50 60.2 P < 0.001
Total 2002     1991        

Table II: Comparison of Mean Triceps Skin fold Thickness by Age and Sex

Age (years) Males Females t-value Significance
N Mean SD N Mean SD
15-19 420 9 6.56 315 12 10.44 127.6 P < 0.001
20-29 594 10 6.59 567 15 10.95 187.5 P < 0.001
30-39 372 11 9.46 407 17 14.75 93.75 P < 0.001
40-49 244 13 7.96 384 21 14.70 72.3 P < 0.001
50-59 252 12 8.90 187 19 9.04 72.3 P < 0.001
60-69 120 11 13.2 131 17 15.05 22.0 P < 0.005
Total 2002     1991        

Table III: Comparison of Mean Sub-scapular Skin fold Thickness by Age and Sex

Age (years) Males Females t-value Significance
N Mean SD N Mean SD
15-19 420 10 5.74 315 12 6.20 60.6 P < 0.001
20-29 594 11 7.81 567 14 7.62 100 P < 0.001
30-39 372 13 7.53 407 16 7.27 78.9 P < 0.001
40-49 244 14 5.62 384 19 8.43 100 P < 0.001
50-59 252 13 8.19 187 18 5.34 74.6 P < 0.001
60-69 120 11 5.61 131 17 5.02 70.6 P < 0.001
Total 2002     1991        

Table IV: Comparison of Mean Supra-iliac Skin fold Thickness by Age and Sex

Age (years) Males Females t-value Significance
N Mean SD N Mean SD
15-19 420 11 6.36 315 13 6.55 55.5 P < 0.001
20-29 594 13 8.30 567 14 9.99 35.7 P < 0.001
30-39 372 15 6.95 407 17 8.48 50.0 P < 0.001
40-49 244 16 4.99 384 20 9.41 74.1 P < 0.001
50-59 252 14 8.39 187 18 8.08 51.9 P < 0.001
60-69 120 12 4.51 131 16 5.81 47.6 P < 0.001
Total 2002     1991        

Table V: Distribution of Obesity among Male Population based on Total Skin fold thickness (Biceps, Triceps, Sub scapular and Supra-iliac)

Age (years) <40 mm (N1) % > 40 mm (N2) % Total (N)
15-19 420 100 420
20-29 582 98.0 12 2.0 594
30-39 345 92.7 27 7.3 372
40-49 186 76.2 58 23.8 244
50-59 191 75.8 61 24.2 252
60-69 101 84.2 19 15.8 120
Total 1825 91.1 177 8.8 2002

X2 = 1682.1 , df 5, P<0.001 Highly significant

Table VI: Distribution of Obesity among Female Population based on Total Skin fold thickness (Biceps, Triceps, Sub scapular and Supra-iliac)

Age (years) <50 mm (N1) % > 50 mm (N2) % Total (N)
15-19 299 94.9 16 5.1 315
20-29 530 93.5 37 6.5 567
30-39 353 86.7 54 13.3 407
40-49 287 74.7 97 25.3 384
50-59 124 66.3 63 33.7 187
60-69 117 89.3 14 10.7 131
Total 1710 85.9 281 14.1 1991

X2 = 1568.5, df 5, P<0.001 Highly significant

References:

  1. Thomas P.R.Weighing the Options: Criteria for Evaluating Weight Management Programs; D.B Allison and F.X Pi-Sunyer, Eds. Obesity treatment; Establishing Goals, Improving Outcomes and reviewing the Research Agenda; Food and Nutrition Board, Institute of Medicine, National Academy Press, Washington DC, 1995
  2. Prentice, AM, Jebb SA. Obesity in Britain: Gluttony or sloth? Br Med J 1995; 311:437
  3. Flegal KM, Caroll MD, Kuezmarski RJ, Johnson CL; Overweght and obesity in the United States; Prevalence and Trends, 1960-1994. Int J Obes Relat Metab Disord 1998; 22:39-47
  4. Musaiger AO, Al Mannai MA, Weight, height, body mass index and prevalence of obesity among the adult population in Bahrain. Ann. Hum Biol 2001; 3:346-350
  5. Sorkhou El, Al-Qallaf B, Al Namash HA, Ben-Nakhi A, Al-Batish MM, Habiba SA. Prevalence of metabolic syndrome among hypertensive patients attending a primary clinic in Kuwait. Med Princ Pract 2004; 13:39-42
  6. Guttierez-Fisac JL, Lopez E, Banegas JR, Graciani A, Rodriguez-Artalejo F. Prevalence of overweight and obesity in elderly people in Spain. Obes Res 2004; 12: 710-715
  7. Al-Nuaim AA, Bamgboye AA, Al-Rubean KA, Al-Mazrou Y. Overweight and obesity in Saudi Arabian adult population, role of socio-demographic variables. J Community Health 1997; 3:211-223.
  8. Al- Nozha MM, Al-Mazrou YY. Al-Maatouq MA, Arfah MR et al. Obesity in Saudi Arabia. Saudi Medical J 2005; Vol. 26(5): 824-829
  9. Musiager A., Overwieght and Obesity in the Eastern Mediterranean Region: Canwe control it? East Mediterr Health J 2004: 10:789-793
  10. Mayer Mendelson: Psychological Aspects of obesity. Med Clin Nor Am, Vol. 48: 1373-1385, 1964
  11. Durvin J.V.G and Womersley J. Body fat assessment from total body density and it’s estimation from skin fold thickness; measurements on 481 men and women aged from 16-72 years. Brit. J. Nutr. 32: 77-79, 1974
  12. Garrow J.S, Ames W.P.T and Ann Rolph: Obesity: Human Nutrition and dietetics p. 16-20 Ninth Edition; 1993, Churchill Livingstone
  13. Meyr J, Roy P, Mitra K.P. Relation between calorie intake, body weight and physical work studies in an industrial male population in West Bengal, Am. J Clin. Nutr. 1966; 4: 169,
  14. Seltzer CC, Mayer J: A Simple Criterion of Obesity. Post Grad Med. 1965 38A;101-107,
  15. Sood K Ajay: An epidemiological study of obesity in an urban community of Malviya Nagar, South Delhi, Dikshot Library AIIMS, 1982
  16. Jones PRM, Bhardwaj H, Nhatia MR, Malhotra MS: Differences between ethnic groups in relationship of skin fold thickness to body density. In: Bhatia B, Chhina GS, Singh B. Selected Topics in Environmental Biology Interprint Publications, N Delhi pp 373-376, 1976
Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica