Study on the prevalence of overweight /

obesity among the medical students of

AIMST University, Kedah, Malaysia.
By

Dr.S.Gopalakrishnan. MD, DPH

Senior Associate Professor, Community Medicine
&
Dr.R.Arulmoli. MS
Professor, Anatomy

Faculty of Medicine & Health Sciences,

AIMST University
Semeling, Kedah

1
Summary

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair
health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used in
classifying overweight and obesity in adult populations and individuals. A study was conducted
to screen the medical students studying at AIMST University for overweight / obesity using BMI
and to determine the prevalence among these medical students. Also to create an awareness
among the medical students of AIMST University and the general public about the health effects
of overweight / obesity and ways and means of preventing it. The study is an Institution based
cross sectional observation conducted among 290 medical students using pre-designed and pre-
tested questionnaire. Data was analyzed statistically by simple proportions. Out of 290 students
participated in the study, male students were 131 [45.2%] and the female students were 159 [54.8
%]. 43 [14.8%] were found to be overweight; males 18 [13.7%] and females 25 [15.7%]. There
were 46 [15.9%] pre-obese students: males 24 [18.3%] and females 22 [13.8%]. That means
32.0% of the males were overweight or pre-obese while only 29.5% females were overweight or
pre-obese. 15 [5.2%] were found to be obese: males12 [9.2%] and females 3 [1.9%]. Also 43
[14.8%] were found underweight: males 16 [12.2%] and females 27 [17.0%]. In the study group
there were 185 [63.8%] Indians, 94 [32.4%] Chinese and 11 [3.8%] Malays. The study reveals
that the prevalence of overweight and obesity among the medical students of AIMST University
is on the higher side, which is comparable to the findings of earlier studies conducted in
Malaysia, reinforcing the need to encourage healthy lifestyle, healthy food habits and a
physically active daily routine, among the adolescents and youth of this country.

Key Words: Overweight, Obesity, Body mass index, Medical students

2
Introduction

Obesity is now a disease that affects nearly one-third of the adult population. The number of
overweight and obese people has continued to increase since 1960, a trend that is not slowing
down. Obesity is a chronic disease with a strong familial component. Obesity increases one's
risk of developing conditions such as high blood pressure, diabetes (type 2), heart disease, stroke,
gallbladder disease and cancer of the breast, prostate and colon. The tendency toward obesity is
fostered by our environment: lack of physical activity combined with high-calorie, low-cost
foods.1 Persons with obesity are victims of employment and other discrimination, and are
penalized for their condition despite laws and policies. Obesity is the second leading cause of
unnecessary deaths.

According to the World Health Organization, there are over 300 million obese adults and 1.1
billion overweight people worldwide. Being underweight used to be much more common
worldwide than obesity. Now the two conditions co-exist, with half of the world's population
underweight and the other half overweight.1 The prevalence of overweight and obesity is
increasing worldwide at an alarming rate in both developing and developed countries.
Environmental and behavioral changes brought about by economic development, modernization,
and urbanization has been linked to the rise in global obesity. Obesity is increasing in children
and adults, and true health consequences may become fully apparent in the near future.

Persons with obesity are at risk of developing one or more serious medical conditions, which can
cause poor health and premature death. Obesity is associated with more than 30 medical
conditions and scientific evidence has established a strong relationship with at least 15 of those
conditions. Preliminary data shows the impact of obesity on various other conditions. Weight
loss of about 10% of body weight, for persons with overweight or obesity, can improve some
obesity related medical conditions including diabetes and hypertension. According to a recent
study by the RAND organization, obesity is more damaging to health than smoking, high levels
of alcohol drinking and poverty. Obesity affects all major body systems - heart, lung, muscle and
bones. 2

The Global burden of overweight and obesity is increasing and is well documented by various
studies conducted by different agencies at different locations. A similar effort is undertaken in
Malaysia also but still a comprehensive picture is not available. There is a general perception that
the incidence of overweight and obesity are on the rise. This study was designed to determine the
magnitude of the problem in a microscopic level, since the target population identified for the
study is representing the youths and young adults of this country.

With the above background, this study was undertaken with the following objectives:

1. To screen the medical students study at AIMST University for overweight / obesity using
BMI, to determine the prevalence among these medical students.
2. To create an awareness among the medical students of AIMST University and the general
public about the health effects of overweight / obesity and ways and means of preventing it.

3
Materials & Methods

Type of study: Institution based cross sectional observational study.

Place of study: The present study was conducted among the medical students of AIMST
University which is catering to the education needs of the young adult population from the
peninsular Malaysia.

Duration of Study: One month from15-5-07 to 15-6-07.

Study population: The study subjects were the medical students in the age group of 19 to 25
yrs. The total number of students studied was 290.

Study tool: A pre-designed pre-tested questionnaire

Methodology: After getting permission from the University authorities, the batch leaders were
explained the purpose and the whole process of the study. The students were briefed about the
questionnaire and written consent was obtained via a consent form that stated the purpose of the
study, procedures and the assurance of confidentiality of the results. Demographic data such as
age, gender, ethnic origin and their present weight in kilograms and height in centimeters were
collected by the self administered structured questionnaire.

Students were given instructions on how to measure the weight and height correctly. The
measurements were taken using a standardized weighing machine and a height measuring scale
which was available in the Research laboratory of the Medical School. The measurements were
recorded in the presence of the investigators. During the process the students were wearing
normal clothing without their footwear. After collecting the questionnaire from the students, their
queries were answered by the investigator.

Statistical Analysis: Data obtained were collated and analyzed statistically by simple
proportions.

Body Mass Index (BMI) is a mathematical calculation used to determine whether a patient is
overweight. BMI is calculated by dividing a person's body weight in kilograms by their height in
meters squared (weight [kg] height [m]), 3 [This number can be misleading, however, for very
muscular people, or for pregnant or lactating women]. Being obese and being overweight are not
the same condition. A BMI of 30 or more is considered obese and a BMI 25 to 29.9 is considered
overweight/pre-obese.

4
Results:

A total of 290 medical students participated in the study and the age range of the students is from
19 to 25 years. Male students were 131 [45.2%] and the female students were 159 [54.8 %].

Table 1 shows that, out of the 290 medical students studied, 43 [14.8%] were found to be
overweight; males 18 [13.7%] and females 25 [15.7%]. There were 46 [15.9%] pre-obese
students: males 24 [18.3%] and females 22 [13.8%]. That means 32.0% of the males were
overweight or pre-obese while only 29.5% females were overweight or pre-obese. 15 [5.2%]
were found to be obese: males12 [9.2%] and females 3 [1.9%].

From the Table 1, it can be found that 43 [14.8%] were underweight: males 16 [12.2%] and
females 27 [17.0%]. Only 143 [49.3%] were found to be having normal weight: males 61
[46.6%] and females 82 [51.6%]. The remaining 104 [35.9%] were found to be above normal
weight.

Table 2 shows the ethnic origin wise distribution of the BMI status among the medical students.
The whole batch of 290 students comprised of Indians, Chinese and the Malays which form the
major ethnic groups in multi racial Malaysia. In the study group there were 185 [63.8%] Indians,
94 [32.4%] Chinese and 11 [3.8%] Malays.

From the Table 2, it can be found that 31 [16.8%] Indians and 12 [12.8%] Chinese students were
underweight. Normal weight group comprised of 83 [44.9%] Indians, 53 [56.4%] Chinese and 7
[63.6%] Malays students. Out of the 43 [14.8%] overweight students, 27 [14.6%] were Indians,
14 [14.9%] were Chinese and 2 [18.2%] were Malays. Out of the 46 [15.9%] Pre-obese students,
32 [17.3%] were Indians, 12 [12.8%] were Chinese and 2 [18.2%] were Malays. Among the 15
[5.2%] Obese students, 12 [6.5%] were Indians and the remaining 3 [3.2%] were Chinese and no
Malay students were found to be obese.

5
Discussion

This study shows that 43 [14.8%] medical students out of the 290 studied were found to be
overweight, 46 [15.9%] were pre-obese and 15 [5.2%] were found to be obese. In other words,
when the overweight group and the pre-obese group are combined, it amount to 30.7%, which is
much higher than the findings of other studies conducted earlier in Malaysia. The 5.2% obese
group shows a similar trend shown in the earlier studies.

The National Health Morbidity Survey data reveal that in adults, 20.7% were overweight and
5.8% obese.1 This study also showed that the prevalence of obesity was clearly greater in women
than in men. In women, obesity rates were higher in Indian and Malay women than in Chinese
women, while in men the Chinese recorded the highest obesity prevalence followed by the
Malay and Indians.1

This study also shows that 32.0% of the males were overweight to pre-obese while it is 29.5%
for the females. This shows that males were found to be slightly more overweight when
compared to the females, while most of the other studies showed that prevalence of overweight
to pre-obese status as well as obesity was clearly greater in females. Similarly of the 15 [5.2%]
found to be obese: males were 12 [9.2%] and females were 3 [1.9%].

In a study conducted in Kelantan by the Department of Medicine, Universiti Sains Malaysia, the
height and body weight were measured in 2,284 subjects over 20 years old. The overall
prevalence of overweight [BMI (kg/m2) > or = 25-< or = 30] and obesity (BMI > 30) was 21.3%
and 4.5% respectively.4

Another study measured the body mass index (BMI), and assessed attitudes and knowledge
about obesity, of 197 male and 217 female patients aged 20-59 years attending the primary care
clinic of the University Hospital in Kelantan, Malaysia. There was no significant difference
between the mean BMI of males (23.7) and females (24.2). In the overweight group (BMI 25-
29.9) were 60 men (30%) and 66 women (30%). In the obese group (BMI 30 and above) were 12
men (6%) and 22 women (10%).5

This study also shows that 59 [31.9%] Indians, 26 [27.7%] Chinese and 2 [36.4%] Malays were
in the overweight to pre-obese stage, while 12 [6.5%] Indians and 3[3.2%] Chinese were obese.
There were no Malay students in the obese category. This high ethnic distribution among the
Indian students may be a reflection of the highest number of Indian students [63.8%] among the
study group when compared to the Chinese and Malay groups.

The findings of this study and that of the earlier studies shows that the prevalence of overweight
to obesity among the Malaysian population is much lower when compared to the American
adults. Among 2007 Behavioral Risk Factor Surveillance System [BRFSS] respondents in US
Adults: 25.6% were obese. [26.4% of men and 24.8% of women were obese], The obesity
prevalence ranged from 19.1% for men and women aged 18--29 years to 31.7% and 30.2%,
respectively, for men and women aged 50--59 years.6

6
Another observation found in this study was that out of the 290 studied, 43 [14.8%] were
underweight: males 16 [12.2%] and females 27 [17.0%]. Ethnic origin wise, 31 [16.8%] of the
Indians and 12 [12.8%] Chinese were found to be underweight. No Malay students were found to
be underweight. This study shows that there is a higher prevalence of underweight problem
among the female students studying in the university when compared to the male students.

In an Indian study conducted among adolescents in Punjab, obesity was 3.4% and overweight
was 12.7%(15% of boys were overweight as compared to 10% of girls). 7

A study conducted among medical students at Ain Shams University,Cairo,Egypt, revealed

12.5% obesity and 36.9% overweight. 8

The Iranian study conducted among medical students at Iran University of Medical Sciences,
Tehran, showed 10% were underweight while 12.4% were obese and overweight (7.9% of males
versus 22.5% females). 9

7
Conclusion

The prevalence of various medical conditions increases with overweight and obesity for men and
women. Being overweight or obese increases the risk of many diseases and health conditions,
including hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder
disease, osteoarthritis, sleep apnea and respiratory problems, some cancers (endometrial, breast,
and colon) etc.

Diabetes, hypertension and other obesity-related chronic diseases that are prevalent among adults
have now become more common in youngsters. The percentage of children and adolescents who
are overweight and obese is now higher than ever before. Poor dietary habits and inactivity are
reported to contribute to the increase of obesity in youth. Today's youth are considered the “most
inactive generation” in history caused in part by reductions in school physical education
programs and unavailable or unsafe community recreational facilities.

This study reveals that the prevalence of overweight and obesity among the medical students of
AIMST University is on the higher side, which is comparable to the findings of earlier studies
conducted in Malaysia. Another revelation of this study is the sizeable proportion of students
who are underweight among the medical students, particularly among the female students. Thus
the .findings of the study reinforces the need to encourage healthy lifestyles, healthy food habits
and a physically active daily routine, among the adolescents and youth of this country, so that the
dangers of the risks of developing chronic degenerative diseases earlier in life can be prevented.
This can be achieved by proper awareness creation about healthy lifestyles among the youth of
this country.

8
References

1. Fact Sheet about Obesity. American Obesity Association 2007 [www.obesity.org]

2. RAND Organization. [www.rand.org]

3. Shashikiran U, Sudha V, Jayaprakash B .What is Obesity? The Medical Journal of Malaysia

2004;59 :10-14.

4. Mohamad WB.Prevalence of obesity and overweight in northeastern peninsular Malaysia and

their relationship with cardiovascular risk factors. Southeast Asian J Trop Med Public Health.
1996 27(2):339-42.

5. Jackson A , Cole C, Esquiro J, Edwards M. Obesity in primary care patients in Kelantan,

Malaysia: prevalence, and patients' knowledge and attitudes. Southeast Asian J Trop Med Public
Health.1996;27(4):776-9.

6.Obesity Statistics: American Obesity Association 2007

[www.obesity.org/information/factsheets.asp]

7. Aggarwal T, Bhatia RC, Singh D, Sobti PC . Prevalence of Obesity and Overweight in

Affluent Adolescents from Ludhiana, Punjab. Indian Pediatr. 2008 ; 45(6):500-502.

8. Bakr EM, Ismail NA, Mahaba HM Impact of life style on the nutritional status of medical
students at Ain Shams University.J Egypt Public Health Assoc 2002; 77(1-2):29-49.

9. Nojomi M, Najamabadi S Obesity among university students, Tehran, Iran.

Asia Pac J Clin Nutr 2006; 15(4):516-20.

9
 Appendix:

Table -1: Sex wise distribution of BMI among medical students

Classification BMI ( kg / m² ) Male Female Total

No % No % No %

Underweight < 18.4 16 12.2 27 17.0 43 14.8

Normal weight 18.5 - 22.9 61 46.6 82 51.6 143 49.3

Overweight 23.0 - 24.9 18 13.7 25 15.7 43 14.8

Pre - Obese 25.0 - 29.9 24 18.3 22 13.8 46 15.9

Obese > 30 12 9.2 3 1.9 15 5.2

Total 131 100.0 159 100.0 290 100.0

Figure -1: Sex wise distribution of BMI among medical students

60

51.6
50 49.3 Male %
46.6
Female %
40
Total %
30

20
17 18.3
14.8 15.714.8 15.9
12.2 13.7 13.8
10 9.2
5.2
1.9
0

Underweight Normal weight Overweight Pre - Obese Obese

BMI classification

10
Table -2: BMI and ethnic origin of medical students

Ethnic origin
Indian Malay Total
Classification Chinese
No % No % No % No %

Underweight 31 16.8 12 12.8 0 .0 43 14.8

Normal weight 83 44.9 53 56.4 7 63.6 143 49.3

Overweight 27 14.6 14 14.9 2 18.2 43 14.8

Pre - Obese 32 17.3 12 12.8 2 18.2 46 15.9

Obese 12 6.5 3 3.2 0 .0 15 5.2

Total 185 100.0 94 100.0 11 100.0 290 100.0

Figure -2: BMI and ethnic origin of medical students

70

63.6
60
56.4 INDIAN %
50 49.3 CHINESE %
44.9
MALAY %
40
TOTAL %

30

20
16.8 18.2 17.3 18.2
14.8 14.9 14.8
14.6 15.9
12.8 12.8
10
6.5 5.2
0 3.2 0
0

Underweight Normal weight Overweight Pre - Obese Obese

BMI classification

11
Figure-3: BMI Classification of all Medical Students

Obese
5.2%

Under weight
Pre - Obese 14.8%

15.9%

Over weight
14.8% Normal weight
49.3%

12
13