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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 137-142

Overweight and obesity among elderly in an urban slum of Puducherry: A facility-based descriptive study


1 Department of Community Medicine, SVMCH and RC, Puducherry, India
2 Department of Community Medicine, JIPMER, Puducherry, India
3 Department of General Surgery, JIPMER, Puducherry, India

Date of Web Publication9-Apr-2018

Correspondence Address:
Sitanshu Sekhar Kar
Department of Community Medicine, JIPMER, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_110_17

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  Abstract 


Background: Overweight and obesity are important addendum to the pool of risk factors for noncommunicable disease (NCD) among the elderly. Objectives: The objectives of this study were to find (1) the proportion of overweight and obesity and (2) the distribution of overweight and obesity based on sociodemographic characteristics and four major risk factors for NCDs (smoking, alcohol consumption, unhealthy diet, and physical inactivity) among the elderly attending the out-patient department/NCD clinic of a Urban Health and Training Centre (UHTC). Materials and Methods: This facility-based descriptive study was conducted among 181 elderly attending one UHTC, in Puducherry during June and July 2015. A pretested interview schedule was used to obtain information on sociodemographic details and history of NCD risk factors after obtaining verbal informed consent. Anthropometric measurements were taken as per standard procedures prescribed by the World Health Organization. Body mass index (BMI) was calculated and classified using BMI classification for the Asian population. Results: Among the elderly, 18% were overweight and 51% were obese. The proportion of obesity was more among females than males. Obesity was found to be decreasing with increase in age. Overweight and obesity were found to be significantly inversely related to chronic disease status. Overweight and obesity were proportionately more among elderly who were consuming alcohol and doing less physical activity than prescribes. However, the proportion of overweight/obees elderly with no tobacco use and not having unhealthy diet was found to be more than their counterpart. Conclusion: Overweight and obesity are important public health problems in the study population. Hence, interventions should be implemented targeting elderly as well as the adult to decrease the obesity and overweight among the elderly.

Keywords: Body mass index, elderly, obesity, overweight


How to cite this article:
Naik BN, Kar SS, Majella MG, Nachiappan DS. Overweight and obesity among elderly in an urban slum of Puducherry: A facility-based descriptive study. CHRISMED J Health Res 2018;5:137-42

How to cite this URL:
Naik BN, Kar SS, Majella MG, Nachiappan DS. Overweight and obesity among elderly in an urban slum of Puducherry: A facility-based descriptive study. CHRISMED J Health Res [serial online] 2018 [cited 2019 Mar 21];5:137-42. Available from: http://www.cjhr.org/text.asp?2018/5/2/137/229580




  Introduction Top


Despite obesity being preventable, it has doubled since 1980. According to the World Health Organization (WHO), about 39% and 13% of adults, aged 18 years and above, were overweight and obese, respectively, in 2014.[1] Overweight and obesity result due to increase in the proportion of unhealthy diet and physical inactivity. Elderly individuals are prone to overweight and obesity as a result of more sedentary lifestyles and increase in physical inactivity.[1]

Elderly individuals are more prone to age-related diseases such as noncommunicable diseases (NCDs), impairment of cognitive skills, sexual dysfunction, and disorders of skeletal system which increase with age per se.[2],[3],[4] Although negative impact of obesity declines with the advancement of age, still obesity remains an important addendum to other behavioral risk factors in the development of age-related morbidities and mortality among elderly individuals.[5] Overweight and obesity lead to significant decline in physical performance and other activities of daily living among the elderly.[6] The increase in morbidities among the elderly increases the burden on the health-care delivery system. Provision of preventive health services among the elderly will reduce the demand for healthcare and thereby the burden on the health system.[7]

Developing countries like India face the double menace of communicable diseases and NCDs.[8] According to the Indian Council of Medical Research, NCDs accounts for more than half of all-cause mortality in India. The proportion of elderly population in India is expected to increase from 5.8% (1961), 8.2% (2011), to 10.7% (2021). The elderly population has increased slowly from 1901 (12.3 million) to 1991 (57 million) but is projected to increase multi-fold to 326 million by 2050.[9],[10]

It is postulated that nearly 10% of the elderly in India are suffering from physical morbidity and same proportion being admitted in hospital for some health problem or other at any point of time.[11] More than 50% of the elderly aged 70 years are suffering from at least one chronic condition such as diabetes, hypertension, cancers, and physical disability.[11] The prevalence of risk factors for NCDs could be even higher among elderly individuals.

Behavioural risk factors for NCDs among elderly individuals are extensively studied; but there is a paucity of literature on the prevalence of overweight and obesity among the elderly.[12],[13],[14],[15] Obesity can independently influence the morbidities of elderly. Earlier studies from Southern India have studied elderly obesity as a part of NCD risk factors profile and have used unrevised body mass index (BMI) classification. In this background, this study was conducted with the aims to find out (1) the proportion of overweight and obesity and (2) the distribution of overweight and obesity based on sociodemographic characteristics and four major risk factors for NCDs (smoking, alcohol consumption, unhealthy diet, and physical inactivity) among the elderly attending the Out-patient Department/NCD clinic of a Urban Health and Training Centre (UHTC) in Puducherry.


  Materials and Methods Top


We conducted this facility-based descriptive study in an urban slum of Puducherry in an UHTC during June and July 2015. The health facility, an Urban Health cum Training Centre (UHTC), is located in the urban field practice area of a tertiary healthcare institution and is attached to the Department of Preventive and Social Medicine. The UHTC provides family folder-based comprehensive health care to a population of approximately 9000 residing in four urban wards of Puducherry. Preventive, promotive, and rehabilitative health care is provided to the people at the facility as well as in the community by the staffs and internship trainees. Apart from providing routine outpatient care, emergency and outreach services, clinic-based specialty care on specified day and referral services are provided to the patients. On every Wednesday, health-care services which include follow-up services as well are provided for patients NCDs.

We approached all the elderly individuals attending the UHTC during the data collection period. Using OpenEpi version 2.3 (Emory University, Atlanta, GA), the sample size for the present study was calculated to be 181 considering the proportion of elderly with overweight to be 36.2%[12] and with the assumption of the alpha level at 0.05 and absolute precision 7%. Due to feasibility reasons, all consecutive elderly attending the UHTC were included until the sample size was achieved. Prospective participants were included in the study after obtaining verbal informed consent. The participants were ensured of confidentiality of identity and data, and same was maintained throughout the study. An individual with age more than or equal to 60 years was considered as the elderly. Elderly refusing to give verbal consent or not able to communicate properly were excluded from the study. Using a pretested questionnaire, information on sociodemographic details, history of known NCDs and selected risk factors for NCDs (tobacco use, harmful alcohol consumption, unhealthy diet, and physical inactivity) were collected. Anthropometric measurements (height and weight) were measured using standard procedures as prescribed by WHO. For the current study, the NCDs included cardiovascular diseases, diabetes, and cancers.

All the data collected were entered into MS Excel and descriptive analysis was performed using SPSS Version 20.0 (SPSS Statistics for Windows, Armonk, NY: IBM Corp). An individual was considered to have consumed unhealthy diet if (s) he has taken vegetables and fruits <5 days a week/junk food more than 3 days a week/has the habit of taking extra salt in any combination. Tobacco use or alcohol consumption in the previous 1 month were captured and considered as current use. An individual is said to be physically inactive if (s) he is not performing leisure time the physical exercise of 150 min a week. The BMI calculation and classification were done as per BMI classification for Asian population. BMI 23–24.9 and more than or equal to 25 were classified as overweight and obese, respectively.[16],[17]


  Results Top


Out of the total of 183 elderly, majority were females (70%) and belonged to the age group of 60–69 years (51%). Nearly three-fourth of the elderly belonged to the nuclear family and about 55% were housewives. More than half of the elderly had no formal education. About 90% of the elderly belong to low socioeconomic status (SES) (modified BG Prasad's SES Class 4 and 5) [Table 1].
Table 1: Socio-demographic details of the study population. (n=183)

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Nearly one-fifth of the study population were reported to be current tobacco user. About 10% of the study population were consuming alcohol. Nearly 90% of the study population each were having unhealthy diet and not doing the adequate physical activity [Table 2].
Table 2: Presence of obesity/overweight, major behavioural risk factors for NCDs and chronic disease among study population (n=183)

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Based on WHO BMI classification for Asian population, about 18% (33/183) and 51% (94/183) were found to be overweight and obese, respectively [Table 2]. Higher proportion of elderly females was obese compared to elderly males. Proportion obesity among study participants showed inverse relationship with age. Elderly studied up to class 10th had the highest proportion of obesity. High BMI was significantly more common among elderly with chronic disease than those without chronic disease. High BMI was also found to be proportionately more among elderly with no tobacco use, no unhealthy diet, having adequate physical activity and consuming alcohol. Obesity was also found to be more common among elderly consuming alcohol (62.5%) than their counterpart. However, proportion of obesity was found to be more common among elderly who were not using tobacco (54.5%), eating healthy diet (76.9%) and doing adequate physical activity (60%) than their counterpart [Table 3].
Table 3: Distribution of overweight/obesity based on socio.demographic characteristics, presence of chronic diseases and behavioural risk factors for NCDs among the study population#

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  Discussion Top


Elderly obesity is an important public health issue. First, it adds to the age-related risk of developing morbidities and mortalities. Second, with the increase in a number of elderly and improvement in life expectancy, the morbidities and mortalities related to overweight and obesity among elderly individuals will have enormous economic impact on the health system and society alike. With socioeconomic improvement and technology advancement, the level of physical activity is in declining trend. Physical inactivity is directly associated with sedentary lifestyles and obesity.[18],[19]

About 70% of the elderly were found to be overweight or obese in our study. This is higher than the prevalence of overweight and obesity reported by other studies from India which varies from nearly 20%–50%. We have taken BMI of 23 as the cutoff point for estimating overweight and obesity. WHO expert consultation group has suggested BMI of 23 as the cutoff points for public health actions.[20] Since Asian population are at higher risk of diabetes or cardiovascular diseases or other NCDs even at lower BMI than that internationally accepted, the prevention of obesity and metabolic syndrome group developed a consensus on lowering the BMI cutoff points to 23 for overweight classification.[16],[17] A similar study from Puducherry using STEP questionnaire have reported the prevalence of overweight and obesity to be 46%.[15] Another study from New Delhi found nearly 36% of the elderly to be overweight and obese.[12] Kritika et al. found the prevalence of obesity and overweight to be 15.4% and 7.6%, respectively.[21] Singh et al. from Lucknow found nearly 38% of the elderly population to be overnourished.[14] A study from Belgaum reported the prevalence of overweight and obesity among elderly to be 34%.[22] Saxena et al. have found 18% of the elderly to be overweight and obese.[23] Swami et al. from Chandigarh have reported the prevalence of elderly overweight and obesity to be 33% and obesity alone 7.5%.[24] A study from Turkey reported about 60% of the elderly to be overweight or obese.[25]

We found higher proportion of female to be overweight and obese compared to males. Females are more prone to obesity due to higher levels of sex hormones and also lesser intensity of work.[24] Similar results were reported by Rajkamal et al., Singh et al., Shukla et al., and Swami et al.[14],[15],[24],[26] However, a Canadian study has reported male to be at higher risk of developing overweight and obesity than females. The same Canadian study also reported low education, no use of alcohol and physical inactivity to be risk factors for obesity. Consistent with the findings from a study in Turkey, we found decrease in proportion of elderly obesity with increase in age.[25]

People with higher education were found to have higher proportion of overweight and obesity in our study concurrent to a study by Shukla et al.[26] However, Erem et al. from Turkey reported inverse relation between obesity and level of education.[25]

Elderly people with chronic diseases were found to be more obese in our study. The overweight and obesity was more common among elderly who do not use tobacco, eat healthy diet and engaged in physical activity. However, alcohol user were found to be more overweight or obese similar to that reported by Thankappan et al. from Kerala.[27] Erem et al. from Turkey also have reported similar finding to ours with respect to smoking and alcohol consumption. However, Erem et al. found inverse relation between obesity and physical activity.[25] Rajkamal et al. also reported a higher proportion of elderly who does not smoke to be overweight and obese compared to who smokes.[15] The findings in our study could be because people tend to modify their behaviors after being aware of some morbidity or risk behaviors after developing some illness/diseases.

The occurrence of high BMI among elderly with the reverse of risk factors was a contrasting observation. First, the overweight and obese people would have adopted the changed behavior with respect to NCD risk factors. Secondly, it was not statistically significant and could be due to a small sample.

Overweight and obesity among the elderly increase the financial burden on the family.[28] A study from the US reported 6%–17% increase in lifetime health-care expenditure among elderly individuals with obesity than their normal counterpart.[28] Overweight and obesity is becoming more common among people from low SES. People from low SES will be trapped and pushed into poverty due to the economic burden associated with overweight/obese. Hence, it is of utmost important to address the issues of obesity in general and elderly obesity in particular, targeting the adult population.

We have used revised BMI classification for the Asian population. Being hospital-based study, the overweight and obesity estimate might be slightly higher. Hence, it should be interpreted carefully while making comparison with the community-based study. Despite ensuring privacy and confidentiality, recall bias and social desirability bias might have played an important role in ascertaining the tobacco use and alcohol consumption status as reported by elderly.


  Conclusion Top


A very high proportion of elderly was found to be overweight and obese in the study population. Elderly overweight and obesity is an important public health problem in the study area. Public health interventions need to be instituted targeting the adults as well as elderly to reduce the overweight and obese proportion, burden on family and health care delivery system, and health consequences among the elderly community.

Acknowledgment

We would like to thank all the interns and staff of urban health and training center, where study was conducted, for the co-operation extended in conducting the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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