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ORIGINAL ARTICLE
Year : 2022  |  Volume : 25  |  Issue : 6  |  Page : 801-808

Prevalence of obesity in women of reproductive age group and related factors. A study from Southeastern Turkey


1 Department of Midwifery, Faculty of Health Sciences, Adıyaman University, Adıyaman, Turkey
2 Department of Public Health, Faculty of Medicine, Erciyes University, Kayseri, Turkey

Date of Submission07-Jun-2021
Date of Acceptance26-Apr-2022
Date of Web Publication16-Jun-2022

Correspondence Address:
Dr. T Sahin
Adıyaman University, Faculty of Health Sciences Altınşehir Adıyaman
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_1587_21

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   Abstract 


Background: Obesity is an important public health issue with an increasing prevalence in Turkey as well as throughout the world. Aims: The purpose of this study is to identify the prevalence of obesity in women of reproductive age group living in Adıyaman which is located in southeastern Turkey and the factors related to it. Patients and Methods: This descriptive study was carried out with 1,100 women registered at Family Health Centers in the Adıyaman city center. Data were collected through a face-to-face survey method and evaluated on a computer. Chi-square and logistic regression evaluations were used in comparisons and P < 0.05 was considered statistically significant. Results: The mean age of the women was 32.94 ± 8.65; 78.3% of them were homemakers, and half were elementary school graduates or less educated; 57.6% of the women were overweight with 24.1% being obese. It was observed that women's body mass index increased with their age and decreased with higher levels of education. Also, the study showed that the risk of being overweight increased 3,2 times for married women and 2,0 times for unemployed women. Additionally, the rate of women being overweight was higher among the women with more number of previous pregnancies. Conclusion: Prevalence of obesity among women of reproductive age was high in the Adıyaman city center. Specific training should be planned, especially for women with low education levels, for fighting obesity.

Keywords: Prevalence of obesity, related factors, woman


How to cite this article:
Sahin T, Borlu A. Prevalence of obesity in women of reproductive age group and related factors. A study from Southeastern Turkey. Niger J Clin Pract 2022;25:801-8

How to cite this URL:
Sahin T, Borlu A. Prevalence of obesity in women of reproductive age group and related factors. A study from Southeastern Turkey. Niger J Clin Pract [serial online] 2022 [cited 2022 Jul 6];25:801-8. Available from: https://www.njcponline.com/text.asp?2022/25/6/801/347603




   Introduction Top


Obesity is a common health problem all over the world.[1] According to the World Health Organization (WHO), 39% of the adults (39% of men and 40% of women) were overweight and 13% (11% of men and 15% of women) were obese in 2016, worldwide.[2] The Organization for Economic Cooperation and Development (OECD), in which Turkey is also included, stated in its 'Obesity Update 2017 Report' that in 2015 the prevalence of obesity among the adult population across member countries was 19.5% and that the rate of obesity among women is higher than that of men in most of the OECD countries.[3] In a study investigating the relationship between obesity and gender and evaluating data from 56 countries, the obesity rate among women was found to be higher than obesity among men in 46 countries.[4] Results of various studies from Turkey considering women also point out that obesity is a major problem of public health among women.[5],[6],[7],[8],[9]

Some types of cancer and many chronic diseases are more common in obese people. Breast, ovarian, and endometrial cancer rates in women have been increasing in relation to obesity.[2],[10] High-risk pregnancies such as gestational diabetes, preeclampsia, and thromboembolism as well as high-risk births such as stillbirth, prolonged labor, and cesarean delivery are more common in obese women.[11] In addition to genetic factors, sociodemographic characteristics such as being a woman, sedentary lifestyle, bad eating habits, lower level of education, being married, or not working outside the home have been associated with obesity in the literature.[12],[13] In addition, although the mechanism of action has not been revealed, there are studies in the literature emphasizing that there are relationships between low vitamin B12 and vitamin D levels and obesity and these relationships are more pronounced in women.[14],[15],[16],[17] Cities in southeastern and eastern Anatolia Regions in Turkey are different in social, economic, and cultural terms than other regions.[18] Adıyaman, which is located in southeastern Turkey, is also one of the cities in which economic problems like lower income levels and unemployment are common, the birth rate is high and the level of education is low, especially among the women in the city.[18],[19] Revealing the sociodemographic determinants of obesity will be an important step in the fight against obesity. This research aims at determining the prevalence of obesity and its related sociodemographic factors in women of reproductive age living in the Adıyaman city center.


   Materials and Methods Top


The study is cross-sectional descriptive research. The data were collected in the Adıyaman city center between March and August 2016. The population of the study consisted of 77 873 women 15–49 years old (reproductive age) who lived in Adıyaman according to the Turkish Statistical Institute.[20] The sample size was calculated by assuming the prevalence of obesity as 26.8% in women, with a tolerance value of 0.03 and a confidence interval of 0.95, and 1,100 women were contacted within the study.[21] There were 14 Family Health Centers (FHC) in the Adıyaman city center. The FHCs where the research would be conducted were determined by the cluster sampling method. The FHCs were grouped into three and one FHC from each of these three groups was included in the study by the random sampling method.

Women of reproductive age who applied to FHC for any reason were included in the research. Women who were pregnant and puerperal, those who did not live in the city center, those who did not volunteer for the study, and those having problems with communication were excluded from the study.

The data were collected using the face-to-face interview technique by the researcher. A questionnaire form containing sociodemographic characteristics of women, some of their habits, and their obstetric characteristics was used to collect the data and anthropometric measurements were recorded on the form. The anthropometric measurements include weight and height. The height was measured in cm in a standing upright position, with bare feet, with the heels together, the head upright, and the eyes facing forward, using a plastic portable height gauge. Bodyweight was taken in kilograms using a bioelectric impedance device (Tanita BC-418).

According to the WHO, women in the study were classified into two groups “underweight or normal weight” including those with a BMI below 25 kg/m2 and “overweight/obese” including those with a BMI over 25 kg/m2.[22],[23],[24]

SPSS 22.0 (SPSS Inc, Chicago, IL) was used to evaluate data. Descriptive statistics, Chi-square test, and logistic regression analyzes were used for statistical evaluation. The statistical significance level was accepted as P < 0.05.

The approval of the ethics committee of Erciyes University Faculty of Medicine, the administrative permission from the Adıyaman Provincial Directorate of Public Health, and written consent from the participants were obtained for the research.


   Results Top


The mean age of women is 32.9 ± 8.6 years and their descriptive characteristics are given in [Table 1].
Table 1: Some of the descriptive characteristics of the women in the study group

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The BMI average of the women in the study was 26.6 ± 5.5; 25.2% of the participants in the study group were found to have gone on a diet in some period of their lives, and 43.5% to have done physical activity in some period of their lives [Table 2].
Table 2: BMI values and WHRs of the women in the study group, their perception of their weight, and their characteristics regarding diet and physical activity

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A statistically significant difference was found between BMI groups and the age groups, educational status, marital status, employment status, perception of their weight, and previous pregnancy status (P < 0.001). In the study, 35.4% of those who perceive their weight as normal have a BMI value of 25 kg/m2 and above, while 97.1% of those who perceived themselves as fat have a BMI value of 25 kg/m2 and above [Table 3]. The consistency between BMI determined by measurement and perceived body weight was found to be 16.2%.
Table 3: Some descriptive characteristics of women in the research group, distribution of BMI groups by pregnancy status

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The independent effects of possible predictors determined as a result of previously paired comparisons in predicting being overweight or obese were evaluated by multivariate logistic regression analysis. In the analysis phase, being overweight or obese was accepted as the dependent variable, while age groups, family type, marital status, educational status, employment status, and previous pregnancy status were accepted as independent variables. According to the results of the analysis, these variables were found to be effective in predicting being overweight or obese (P < 0.05) [Table 4].
Table 4: Independent effects of some possible predictors in predicting the BMI to be 25 kg/m2 or more (Multivariate Logistic Regression Analysis)

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   Discussion Top


In this study, which aims to determine the prevalence of obesity and related sociodemographic factors in 15–49 age group women living in the city center of Adıyaman, 24.1% of the women were found to be obese [Table 2]. The prevalence of obesity among women of reproductive age varies in studies conducted in different cities of Turkey. In the studies carried out in Artvin, Istanbul, and Izmir, the obesity prevalence of women (22.8, 24.1, and 24.4%, respectively) was found to be similar to the results in the study.[25],[26],[27] In the studies conducted in Antalya, Elazığ, and Adana, the frequencies of obesity (27.1, 27.3, and 28.3%, respectively) were found to be slightly higher than the women's obesity rate at the study.[6],[7],[28] Women's obesity rates were found higher in studies conducted in Tokat, Konya, Manisa, Kayseri, and Bilecik (33.6, 33.9, 37.4, 52.5%, and 62.0% respectively).[8],[13],[29],[30],[31] There were also studies in the literature showing women's obesity rates were lower in Denizli and Konya (5.9 and 12.0%).[32],[33] Differences between studies may be due to differences in the place, time, and the groups covered by the studies. According to the data from the Turkey Demographic and Health Survey (TDHS) 2018, the prevalence of obesity in women aged 15–49 was detected to be 30.0% throughout Turkey and 30.7% in the southeast Anatolian region,[34] which was higher than the rate in the research.

In the study, 33.5% of the women were found to be overweight [Table 2]. The prevalence of being overweight were found to be 15.7 and 23.3% in the studies conducted in Denizli and Konya, respectively, among women.[32],[33] In the studies conducted in Elazig and Artvin, on the other hand, it was found to be 37.6 and 32.5%, respectively, similar to the study.[6],[25] According to the data from TDHS 2018, 29% of the women aged 15–49 were noted to be overweight throughout Turkey.[34]

When we consider the studies conducted in different countries, the frequency of being overweight was found to be 15.7% in a study conducted with women in Bangladesh,[35] and 31.3% in Germany.[36] In a study carried out with women aged 15–49 in Finland, 19.9% of the Finnish turned out to be overweight and 9.8% to be obese; 18.5% of the Russians were overweight and 8.0% were obese; 32.9% of the Somalians were overweight and 30.9% were obese.[37] In another study conducted with women of reproductive age in Tehran, 28.3% of the women were found to be overweight and 15.6% obese.[38] Another study carried out in India showed that 37.0% of the women had a BMI >25.[39] When the results of the study were compared with other studies, it can be said that the obesity rate among women was high in Adıyaman.

The most common method used by the women participating in the study for weight control was physical activity. About 43.5% of the women in the study group reported engaging in physical activity at some period in their lives [Table 2]. In a study involving women attending gymnasiums in Konya, it was stated that 54.7% of the participants had the habit of playing sports regularly.[33] The results in that study are higher than the ones in ours. A higher incidence of regular physical activity is an expected outcome among women attending gymnasiums. In the studies conducted in Manisa and Konya, the rates of regular physical activity of women were found to be 31.1 and 33.6%, respectively, which were lower than the rates in our study.[29],[31] However, the physical activity status at any time of life was questioned in this study, while other studies focused on the current situation.

The second most frequently used method for weight control was diet. The study showed that one-fourth of women had been on a diet at some time in their lives [Table 2]. About 52.7% of the participants in a study done with 150 adult women in Konya reported ever consciously trying to lose weight by dieting.[33] A study in İzmir indicated that 49.2% of the women preferred dieting to lose weight.[27] In a study by Aslan, it was found that 39% of the women went on a diet to lose weight.[40] Another study in Konya indicated that 41.7% of the women who wanted to lose weight tried only dieting;[29] 35.4% of the women were shown to have been on a diet in a study conducted in Iran[41] in which the frequency of dieting was found to be high in line with other studies. In the study, the type of diet that the women followed was not questioned, but in the literature review, it has been seen that diets such as intermittent fasting had positive effects on the metabolism and were beneficial for women in overcoming the problems of obesity, type 2 diabetes, and polycystic ovarian syndrome.[42],[43],[44] Diet is a method that is frequently preferred by women for reasons such as being costless, under one's control, and not having any undesirable consequences.

The study set forth that the older the woman, the higher her risk of being overweight or obese was [Table 3]. Also, in a study carried out with women in the 15–49 age group in Afyonkarahisar, it was found that obesity increased as the age got older.[45] The rate of obesity at the age of 30 and over was reported to increase 2.2 times in a study conducted with 676 housewives in Konya.[29] The prevalence of obesity among women over 30 years of age was found to be even higher in another study including 246 women in İzmir.[27] A study involving women between the ages of 20 and 64 in Adana indicated that the prevalence of obesity was lower at younger ages whereas it increased with age.[7] Also, in different studies in Bangladesh, Canada, and Iran, it has been determined that increasing age of women is an efficient cause of increasing obesity.[35],[41],[46] TDHS and population-based obesity studies in Turkey demonstrate that the prevalence of obesity increases with increasing age.[24],[34] Similar to the study, other studies show a relationship between age and obesity as well. Deceleration of basal metabolism with age and adopting a more sedentary lifestyle may be factors serving the development of obesity.

The frequency of being overweight/obese was reported to decrease with higher educational levels. The greatest difference is between having a bachelor's or master's degree versus primary school graduation. It was found that having a bachelor's or master's degree reduced the risk of being overweight or obese 3.5 times compared to being a primary school graduate [Table 3] and [Table 4]. The study by Aslan also showed that obesity decreased as the educational level of women increased.[40] In the study conducted on women in Malatya, the effect of educational status on obesity was not detected.[47] Obesity was detected 2.7 times more among primary school graduates and below in the study with women in Konya.[29] In the study carried out on 246 women in İzmir, the frequency of obesity was found to be higher in participants with secondary school and lower educational levels.[27] TDHS and Population-Based Obesity Studies in Turkey demonstrate that the prevalence of obesity decreases as the educational level goes up.[24],[34] A study aimed at determining the prevalence of obesity among adult women in Turkey revealed an inverse relationship between education and obesity using logistic regression analysis; and it was shown that as education increases, obesity decreases.[48] Another study carried out in Canada also displayed similar results to the study.[39] The results of the studies show similarities. They suggested a decrease in the risk of being overweight as the level of education increases, which can be explained by the fact that women build awareness of personal health and develop healthy dietary habits with the increase in educational level.

The frequency of being overweight/obese was higher in married women in our study [Table 3]. According to the results of the logistic regression analysis, not being married reduces the risk of being overweight by 3.2 times in women [Table 4]. In the study conducted in Afyonkarahisar, the prevalence of obesity was found to be higher in married women.[45] The study among women in Malatya showed that marital status did not have any effect on obesity.[47] In the study conducted on women in İzmir, the prevalence of obesity was found to be higher in married/widowed or divorced individuals.[27] The logistic analysis results of two different studies with women in Canada and Bangladesh were similar to the study.[46],[49]

The study revealed that unemployed women were more overweight or obese than employed women [Table 3]. This finding is compatible with the literature.[13],[25],[40]

The study showed that the frequency of obesity increased in accordance with the number of previous pregnancies [Table 3]. In a study conducted in Afyonkarahisar, a significant relationship was found between the number of previous pregnancies and obesity, and the BMI values of those who experienced five or more pregnancies were found to be higher than those who had one to four pregnancies.[45] According to a study involving 676 housewives in Konya, three to four pregnancies increased the obesity frequency by 2.9 times, while the frequency was increased 6.3 times when the number of pregnancies was five or more.[29] The frequency of obesity was reported to be higher in those who gave birth to four or more in a study conducted with women in İzmir.[27] Another study aiming at finding out the incidence of obesity in adult women in Turkey revealed a higher frequency of obesity in women giving birth to four or more.[48] The results of the study show similarity with others. When they do not have enough information about nutrition, women may make the mistake of overeating during pregnancy and breastfeeding periods, and thus, may end up gaining too much weight.

In the study, 35.4% of those who perceive their weight as normal have a BMI value of 25 kg/m2 and above, while 97.1% of those who perceive themselves as fat have a BMI of 25 kg/m2 and above [Table 3]. The consistency between the BMI values of women determined by measurement and self-perceived body weight was found to be 16.2%. In the study with women in Konya, a consistency rate of 59.4% was observed between the BMI values determined by measurement and self-perceived body weight.[29] The study conducted on women of reproductive age in İzmir indicated a good significance level of consistency between the measured BMI values and the ones calculated using the weight and height reported by the women themselves.[27] In a study carried out by Aslan in Community Health Center it was reported that the vast majority of women who rate their current weight much more than it should be were in the group of obese participants; and the vast majority of women who rate their current weight as ideal were in the group of participants with normal weight, which is similar to the findings of our study.[40] Studies in the literature show that women's perception of their weight is consistent with their real weight. Contrary to other studies, women's consistency between their BMI values and self-perceived body weight was lower.

As a result, the prevalence of being overweight/obese among women of reproductive age was high in a southeast Anatolian city center. Studies should be conducted on combating obesity in women.

The risk of having a BMI higher than 25 is higher in women with a low education level, married, having a high number of pregnancies, and being unemployed. These risky groups should be especially taken into consideration in studies on the fight against obesity. Women mostly applied physical activity, and then, dieting methods for weight control. Women should be made aware and encouraged about weight control. Women were unsuccessful in assessing their weight status. The first thing to do in weight control should be to teach women the definition of normal weight and to convince them to follow their own weight.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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