OVERWEIGHT AND OBESITY; SOCIO-DEMOGRAPHIC FACTORS AND DISEASES CAUSING OVERWEIGHT AND OBESITY AMONG 25-60 YEARS WOMEN IN LAHORE, PAKISTAN

…. Objectives: To investigate socio-demographic factors and diseases causing overweight and obesity among 25 to 60 years women. Study Design: Descriptive cross-sectional study. Duration & Setting: Comprised of five months (January 2016 to May 2016); concerning household survey i.e. door to door sampling method was carried out in Lahore, Pakistan. Material and Methods: Multistage sampling technique was used and 3239 women aging 25 to 60 years; of which 1684 (52%) females were normal weight (excluded from the research) and 1555 (48%) overweight/obese women i.e. 1106 (34%) were overweight and 449 (14%) women were obese (included in the analysis).Descriptive statistics and Bivariate logistic regression was applied on the achieved data through IBM SPSS Statistics Version 21. Results: Socio-demographic factors and diseases were found significantly associated with overweight and obesity; includes age (p=0.001), marital status (p<0.000), level of education (p=0.000), occupation (p=0.000), father/husband occupation (p=0.000) and monthly income (p=0.001); whereas, diseases such as hypothyroidism (p=0.001), polycystic ovarian syndrome (p=0.000), menstrual period (p=0.001) and depression/stress (p=0.000)as their p-values were less than 0.05 (significant). Conclusion: The research findings points out notable explanation of socio-demographic factors and diseases causing overweight and obesity among 25 to 60 years women with respect to which the study can definitely summarized to countless extent.


INTRODUCTION
In modern eras, the increased pervasiveness of overweight and obesity poses noteworthy threats to both health and well-being of many inhabitants; thus signifies a major challenge for health facilities. 1 In United States, the pervasiveness of obesity increased from 15.0% to 30.9% between 1980 and 2000 2 in which 40% males and 28% females 20-74 years of age were overweight whereas, 21% males and 22% females were found as obese. 3 Several studies had also revealed that high occurrence of obesity occurs in women above 50 years of age. 4,5,6 Similarly, obesity and socioeconomic status was also evaluated at different levels of education. 7,8 Females in low and high income groups were found more obese i.e. 31.8% and 13.6% as compared to 30.5% and 7.4% low and high income groups overweight females. 9 After marriage weight gain is obvious; 10,11 and high body mass index was found among married women as compared to females living alone. 12,13,14 According to Gunderson 15 abnormal weight was also witnessed among woman's reproductive age. Furthermore, women education, residence, gravid and parity were also found considerably allied with an amplified menace of overweight and obesity. 16,17 Among diseases such as hypothyroidism 18 also causes increase gain of body weight. Polycystic ovarian syndrome 19 causes infertility among females at reproductive age. Menopause is also one of the critical periods in the life of woman causing overweight and obesity but the manifestation of obesity was more than overweight women. 20 A notable association was also found between depression, anxiety and obesity among 3004 women aged 25-74 years having history of using antidepressants. 21

MATERIALS AND METHODS
Descriptive cross-sectional study concerning household survey i.e. door to door sampling method was carried on overweight and obese women 25 to 60 years in Lahore, Pakistan. The research adopted multi-stage sampling technique and was completed in five months (from January 2016 to May 2016). Lahore is divided into ten towns which was further grouped into several union councils and from each union council two neighboring localities were randomly selected and explained as follows; A structured questionnaire was prepared in English language which was further translated into Urdu (local) language. In questionnaire, women (25 to 60 years of age) were asked about their socio-demographic profile which includes name, age, marital status, women education, women occupation, father/husband occupation and monthly income with their weight and height using weighing scale and retractable steel measure tape ruler as well as diseases causing overweight and obesity such as hypothyroidism, polycystic ovarian syndrome, menstrual period and depression/stress. Before commencement of data collection, pretesting of questionnaire was also done in order to know whether questions are comprehensible to respondents and they could reply them completely.
Normal weight, pregnant and lactating women falling between 25 to 60 years age group as well age of women below 25 and above 60 years were excluded from our study whereas; overweight and obese were observed thoroughly after random sampling. Due to allocation of time 128 houses were visited from one town among which 1-2 women per house were interviewed for the result tabulation. Therefore, visited 1280 houses from 10 towns; the estimated women should range from 1280 to 2560 but, study findings found only 1555 overweight/obese (1106 overweight and 449 obese) women. Formerly written informed consent was taken from all the overweight and obese women (25 to 60 years) after providing sufficient information related to the study. During study it was also ensured that privacy and anonymity of all participated women was maintained and will remain confidential in future.

RESULTS
Socio-demographic factors and diseases with overweight and obesity among 25 to 60 years women.
The socio-demographic factors (age of women, marital status, women level of education, women occupation, father/husband occupation and monthly income) as well as diseases (hypothyroidism, polycystic ovarian syndrome, menstrual period and depression/stress) with overweight and obesity among 25 to 60 years women were presented in Table- 4 Among marital status, 646 (58%) overweight and 249 (55%) obese women were married respectively, 164 (15%) overweight and 61 (14%) obese women were unmarried, 180 (16%) overweight and 84 (19%) obese women were widowed and 116 (10%) overweight and 55 (12%) obese women were divorced. Maximum rate of overweight and obesity was in married women and lowest rate of overweight and obesity in divorced women.
The resources of food intake for a businessman's family were more and least for an unemployed person. Therefore, overweight 526 (48%) and obesity 170 (38%) were seen more in women of businessman father/husband and least in women (overweight 31 (3%) and obese 43 (10%)) of unemployed father/husband as compared to overweight and obese women whom father/ husband were government employees (224 (20%) and 95 (21%)) and private employees (325 (29%) and 141 (31%)) respectively.
Maximum number of overweight 489 (44%) and 188 (42%) obese women had regular menstrual period whereas, 464 (42%) overweight and 163 (36%) obese women reported irregular menstrual period and 251 (16%) overweight/obese women had stopped menstrual period. Depression/ stress was divided into three categories, 568 (37%) women said that they often felt stress, of which 411 (37%) women were overweight while 157 (35%) were obese, 753 (48%) women said that they sometimes felt stress, of which 542 (49%) women were overweight while 211 (47%) were obese and 234 (15%) women said that they never have stress or felt stress, of which 153 (14%) women were overweight while 81 (18%) were obese. In the second category women, watch TV to forget their worries or troubles for some time at least. In addition, in the state of depression, person eats more which ultimately lasts in overweight/ obesity. Association of socio-demographic factors and diseases with overweight and obesity among 25 to 60 years women.
The association of socio-demographic factors and diseases with overweight and obesity were shown in Table- The results concluded from above Table-II, that significant associations were found between socio-demographic factors and diseases with overweight and obesity. Among sociodemographic factors such as marital status, level of education, occupation and father/husband occupation have p-values 0.000, whereas, age group and monthly income have p-values 0.001; whereas, diseases such as polycystic ovarian syndrome and depression/stress have p-values 0.000; thyroid imbalance (hypothyroidism) and menstrual period have p-values 0.001.

DISCUSSION
Clearly, socio-demographic factors are related to overweight and obesity in many populations, 22,23 thus the findings in this study show significant associations between age, marital status, level of education, occupation, father/husband occupation as well as monthly income with overweight/obesity and goes to buttress this point. Age has been established as a very important predictor of overweight and obesity among 25 to 60 years old women. The study findings were confirmed by Abdeen and authors 24 that the percentages for overweight and obesity increase with age. This is consistent with several studies that have showed a similar relationship between increasing prevalence of weight gain and obesity with age. 25,26 Among marital status, statistical significant relationship was observed with overweight and obesity having p<0.000 in which 895 (58%) overweight/obese women were found as married as compared to unmarried (225 (14%)), divorced (171 (11%)) and widowed (264 (17%)), which may imply that marital status of women was likely to have an influence on their body mass index. This finding conforms from study conducted in Multan 27 who found a high degree of overweight and obesity among married women as compared to single women (unmarried, divorced and widowed). The positive relationship between marital status and overweight, obesity can be explained by the fact that people, after marriage have less physical activities, change their dietary pattern, may be less focused on being attractive, have more social support, or may be exposed to other environmental factors whereas, unmarried women may intentionally manage their weight in an effort to be more attractive to potential marital partner.
The study also showed that socio-economic status of the women was based on her level of education, occupation (women and father/ husband occupation) and monthly income; consistent with the finding of other studies that women social class and father/husband social class were much stronger predictors of overweight and obesity. 28,9 Further research was carried out and interest was focused on factors that may explain the relationship of socio-economic status with overweight and obesity and found similar findings with the research study. 29 Among diseases causing overweight and obesity; hypothyroidism was significantly associated with increase body weight. Various researchers have studied the effect of the thyroid hormones on body mass index and it has been demonstrated that explicit thyroid dysfunction affects body weight. 30,31 Overweight and obesity also showed significant association with polycystic ovarian syndrome. Variation in body weight between polycystic ovarian syndrome populations in USA and Europe attributed to genetic and lifestyle factors have also been reported recently. 32 The evidence also showed that even normal weight subjects suffered from polycystic ovarian syndrome have increased intra abdominal fat. 33 Interestingly, the proportion of women with regular menstrual cycles also suffered from overweight and obesity. Some investigators reported higher rates of menstrual disorders in overweight/obese patients, 34 and others did not identify differences in body mass index between women with regular, irregular/stopped menstrual cycles 35 and in other reports that women with regular menustral cycles were more obese than those with irregular mensutral cycles. 36 Several cross-sectional studies suggested a positive association of depression/stress with individual weight gain 37 and others observed either inverse or null relationships. 38 The study also revealed a similar finding which coordinately links depression/stress with overweight and obesity in the study subjects. In the study, weight gain was also observed in women who were on medications. The findings were well-supported by study conducted in Canada 21 that weight gain is obvious among individuals, thus accompanied reduced metabolic rate, increased consumption of calories and dwindled physical doings.

CONCLUSION
Overweight and obesity is an important public health problem. The study on socio-demographic factors of overweight and obese women revealed that the prevalence of being overweight and obese increases with age and most vulnerable age group observed was 52-60 years. Diseases such as hypothyroidism, polycyclic ovarian syndrome, imbalance of menstrual period and depression/ stress were also the risk factors of overweight and obesity among 25 to 60 years women. Thus, the study concluded the relationship of sociodemographic factors as well as diseases with overweight and obesity.