ORCP-431; No. of Pages 9
ARTICLE IN PRESS
Obesity Research & Clinical Practice (2015) xxx, xxx—xxx
ORIGINAL ARTICLE
Misperception of weight status and associated factors among undergraduate students Victor Mogre a,∗, Samuel Aleyira b, Rauf Nyaba b a
Department of Human Biology, School of Medicine and Health Sciences, University for Development Studies, P.O. Box TL 1883, Tamale, Ghana b Department of Allied Health Sciences, School of Medicine and Health Sciences, University for Development Studies, P.O. Box TL 1883, Tamale, Ghana Received 14 December 2014 ; received in revised form 10 March 2015; accepted 16 March 2015
KEYWORDS Weight status misperception; Ghana; University students; Young adults
∗
Summary Problem: We compared participants’ self-perception of their weight with the World Health Organisation (WHO) definition for BMI categories among undergraduate university students undertaking health related academic programmes in Ghana. Also, we investigated factors associated to the underestimation of weight status in this sample. Methods: This cross-sectional study was conducted among a sample of 368 undergraduate students. Anthropometric measurements of weight and height were measured with appropriate tools and computed into Body Mass Index (BMI) categorised based on WHO classifications. Waist and hip circumferences were also measured appropriately. Participants’ self-perception of weight status was assessed by the question: How do you perceive your weight? (a) Underweight, (b) normal weight, (c) overweight, and (d) obese. The BMI-measured weight status was compared to the self-perceived weight status by cross-tabulation, Kappa statistics of agreement and 2 for trend analysis. Factors associated with misperception of weight status was measured using univariate and multivariable analysis. Results: Thirteen percent (n = 48) of the participants were overweight/obesity (BMI) and 31.5% had central obesity. Overall, 20.6% of the participants misperceived their weight status in which 78.9% of them underestimated it. Among overweight/obese participants, 41.7% self-perceived themselves accurately. Whereas 10.6% of normal weight participants underestimated their weight status, over half (58.3%) of overweight/obese participants did so. Factors that were associated with underestimation of weight status were having overweight/obesity (BMI) and central obesity.
Corresponding author. Tel.: +233 208442438. E-mail address: [email protected] (V. Mogre).
http://dx.doi.org/10.1016/j.orcp.2015.03.002 1871-403X/© 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Mogre V, et al. Misperception of weight status and associated factors among undergraduate students. Obes Res Clin Pract (2015), http://dx.doi.org/10.1016/j.orcp.2015.03.002
ORCP-431; No. of Pages 9
ARTICLE IN PRESS
2
V. Mogre et al. Conclusion: Underestimation of weight status was frequent. Health professionals and related government agencies should develop intervention programmes to empower young people to have accurate weight status perception. © 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
Introduction The prevalence of overweight/obesity continues to rise steadily in both developed and developing countries [1]. In the United States (US) the prevalence of obesity has increased from 12.0% to 34.9% [2—5] and half of its adult population, 20 years and older is either overweight or obese [5]. Young adults are not left out of the overweight/obesity epidemic. A study among University students in Nigeria reported an obesity prevalence of 21.0% [6]. An overweight/obesity prevalence ranging from 2% to 40% has been reported among young adults in Greece [7], Slovakia [8], India [9], and the US [10]. The causes, prevention and outcomes associated with obesity are complex [11]. Leading experts in obesity have emphasised the need for more interdisciplinary research into this condition [1]. An area in need of further research is that of the psychosocial influences on, and self-perceptions of, body weight and health [1]. Misperception of weight status, a distortion between actual and self-perceived body weight, places underweight, normal weight and overweight/obese individuals at risk [12]. Eating disorders and unhealthy weight control practices are associated with normal weight/underweight individuals, self-perceiving themselves as overweight [13,14]. Conversely, overweight and obese individuals underestimating their weight status are unlikely to engage in weight control practices or seek medical attention and are also at risk of obesity-related diseases [15]. In the transtheoretical model stage of precontemplation, there is no intention by the individual to change behaviour in the foreseeable future, and individuals are unaware or underestimate their problems [16]. It is pertinent that the issue of excess weight or weight gain is recognised by the individual to enable him/her chart on a pathway of achieving healthy weight. Several studies have reported misperception of weight status in adults and the youth [12,17—21].
Even though misperception of weight status among adults has been reported elsewhere [17,22], studies on self-perception of weight status among young adults in Ghana and the rest of sub-Saharan Africa are limited. With a predominant culture that considers being overweight/obese as a sign of well-being and beauty, coexisting with emerging trends of young women being concerned about their weight and specific body parts and young men worrying about their height, strength and overall physical condition [12], it is pertinent to investigate the prevalence of weight status misperception among young adults in Ghana, a developing country undergoing nutrition transition. This will help in designing weight management programmes to curb the rising prevalence of overweight and obesity. Firstly, we intended to compare selfperception of weight status with the World Health Organisation’s (WHO) definition for BMI categories. Secondly, we investigated factors (socio-demographic, anthropometric and weight management behaviours) that are associated with underestimation of weight status.
Methods Ethics statement All data collection methods complied with the guidelines of the Ethics Committee of the University for Development Studies, School of Medicine and Health Sciences, Ghana, which subsequently approved the study. Each participant signed an informed consent form included in the questionnaire. All informed consent procedures were approved by the Ethics Committee of the University for Development Studies, School of Medicine and Health Sciences, Ghana.
Study design and participants From January to July, 2013, this cross-sectional survey was undertaken with a sample of 368
Please cite this article in press as: Mogre V, et al. Misperception of weight status and associated factors among undergraduate students. Obes Res Clin Pract (2015), http://dx.doi.org/10.1016/j.orcp.2015.03.002
ORCP-431; No. of Pages 9
ARTICLE IN PRESS
Misperception of weight status among undergraduate students students attending the University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS), Tamale, Ghana. All students of the UDS-SMHS were eligible to participate in the study. From the eligible student population of 1809, the participants of the study were selected using a random number statistical table that yielded a proportionate random sample of 450 students that included more participants from academic programmes that had larger student populations. Three hundred and seventy-five students were approached and agreed to participate in the study, yielding a participation rate of 83.3%. Seven questionnaires were incomplete leaving 368 questionnaires yielding a response rate of 98.1%. Participation in the study was voluntary and informed consent was sought from each participant. Potential participants who self-reported pregnancy or breast-feeding were excluded from the study because of the possible impact of these conditions on their perceived body weight. The administration of the questionnaire and all anthropometric measurements were done by SA and RN.
Questionnaire A self-administered 12-item close-ended questionnaire was designed to collect data on demographic variables, self-perceived weight status, weight management behaviours, coffee, alcohol drinking and smoking status. In order to minimise bias in reporting self-perceived weight status, the questionnaire was administered to the participants before taking their anthropometric measurements.
Anthropometric measures Anthropometric measurements of body weight and height were measured without shoes on and with light clothing. Weight was measured to the nearest 0.1 kg using a UNICEF electronic scale manufactured by seca. Height was measured using a wall-mounted microtoise and recorded to the nearest 0.5 cm. BMI was calculated as weight (kg)/height2 (m2 ). Based on the WHO Expert Consultation guidelines [23], BMI was categorised as underweight (BMI < 18.5), normal body weight (BMI 18.5—24.9), overweight (BMI 25.0—29.9) and obesity (BMI ≥ 30). Waist circumference (WC) was measured midway between the inferior angle of the ribs and the suprailiac crest [24]. Hip circumference was measured as the maximal circumference over the buttocks in centimetres. Both measurements were measured to the nearest 0.5 cm using a nonstretchable fibre-glass measuring tape (Butterfly,
3
China). During both measurements, participants stood in an upright position, with arms relaxed at the side, feet evenly spread apart and body weight evenly distributed in accordance with the WHO expert consultation report on waist circumference and waist-to-hip ratio (WHR) [24]. WHR was calculated by dividing the waist circumference (cm) by the hip circumference (cm). Men with WHR
ARTICLE IN PRESS
Obesity Research & Clinical Practice (2015) xxx, xxx—xxx
ORIGINAL ARTICLE
Misperception of weight status and associated factors among undergraduate students Victor Mogre a,∗, Samuel Aleyira b, Rauf Nyaba b a
Department of Human Biology, School of Medicine and Health Sciences, University for Development Studies, P.O. Box TL 1883, Tamale, Ghana b Department of Allied Health Sciences, School of Medicine and Health Sciences, University for Development Studies, P.O. Box TL 1883, Tamale, Ghana Received 14 December 2014 ; received in revised form 10 March 2015; accepted 16 March 2015
KEYWORDS Weight status misperception; Ghana; University students; Young adults
∗
Summary Problem: We compared participants’ self-perception of their weight with the World Health Organisation (WHO) definition for BMI categories among undergraduate university students undertaking health related academic programmes in Ghana. Also, we investigated factors associated to the underestimation of weight status in this sample. Methods: This cross-sectional study was conducted among a sample of 368 undergraduate students. Anthropometric measurements of weight and height were measured with appropriate tools and computed into Body Mass Index (BMI) categorised based on WHO classifications. Waist and hip circumferences were also measured appropriately. Participants’ self-perception of weight status was assessed by the question: How do you perceive your weight? (a) Underweight, (b) normal weight, (c) overweight, and (d) obese. The BMI-measured weight status was compared to the self-perceived weight status by cross-tabulation, Kappa statistics of agreement and 2 for trend analysis. Factors associated with misperception of weight status was measured using univariate and multivariable analysis. Results: Thirteen percent (n = 48) of the participants were overweight/obesity (BMI) and 31.5% had central obesity. Overall, 20.6% of the participants misperceived their weight status in which 78.9% of them underestimated it. Among overweight/obese participants, 41.7% self-perceived themselves accurately. Whereas 10.6% of normal weight participants underestimated their weight status, over half (58.3%) of overweight/obese participants did so. Factors that were associated with underestimation of weight status were having overweight/obesity (BMI) and central obesity.
Corresponding author. Tel.: +233 208442438. E-mail address: [email protected] (V. Mogre).
http://dx.doi.org/10.1016/j.orcp.2015.03.002 1871-403X/© 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Mogre V, et al. Misperception of weight status and associated factors among undergraduate students. Obes Res Clin Pract (2015), http://dx.doi.org/10.1016/j.orcp.2015.03.002
ORCP-431; No. of Pages 9
ARTICLE IN PRESS
2
V. Mogre et al. Conclusion: Underestimation of weight status was frequent. Health professionals and related government agencies should develop intervention programmes to empower young people to have accurate weight status perception. © 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
Introduction The prevalence of overweight/obesity continues to rise steadily in both developed and developing countries [1]. In the United States (US) the prevalence of obesity has increased from 12.0% to 34.9% [2—5] and half of its adult population, 20 years and older is either overweight or obese [5]. Young adults are not left out of the overweight/obesity epidemic. A study among University students in Nigeria reported an obesity prevalence of 21.0% [6]. An overweight/obesity prevalence ranging from 2% to 40% has been reported among young adults in Greece [7], Slovakia [8], India [9], and the US [10]. The causes, prevention and outcomes associated with obesity are complex [11]. Leading experts in obesity have emphasised the need for more interdisciplinary research into this condition [1]. An area in need of further research is that of the psychosocial influences on, and self-perceptions of, body weight and health [1]. Misperception of weight status, a distortion between actual and self-perceived body weight, places underweight, normal weight and overweight/obese individuals at risk [12]. Eating disorders and unhealthy weight control practices are associated with normal weight/underweight individuals, self-perceiving themselves as overweight [13,14]. Conversely, overweight and obese individuals underestimating their weight status are unlikely to engage in weight control practices or seek medical attention and are also at risk of obesity-related diseases [15]. In the transtheoretical model stage of precontemplation, there is no intention by the individual to change behaviour in the foreseeable future, and individuals are unaware or underestimate their problems [16]. It is pertinent that the issue of excess weight or weight gain is recognised by the individual to enable him/her chart on a pathway of achieving healthy weight. Several studies have reported misperception of weight status in adults and the youth [12,17—21].
Even though misperception of weight status among adults has been reported elsewhere [17,22], studies on self-perception of weight status among young adults in Ghana and the rest of sub-Saharan Africa are limited. With a predominant culture that considers being overweight/obese as a sign of well-being and beauty, coexisting with emerging trends of young women being concerned about their weight and specific body parts and young men worrying about their height, strength and overall physical condition [12], it is pertinent to investigate the prevalence of weight status misperception among young adults in Ghana, a developing country undergoing nutrition transition. This will help in designing weight management programmes to curb the rising prevalence of overweight and obesity. Firstly, we intended to compare selfperception of weight status with the World Health Organisation’s (WHO) definition for BMI categories. Secondly, we investigated factors (socio-demographic, anthropometric and weight management behaviours) that are associated with underestimation of weight status.
Methods Ethics statement All data collection methods complied with the guidelines of the Ethics Committee of the University for Development Studies, School of Medicine and Health Sciences, Ghana, which subsequently approved the study. Each participant signed an informed consent form included in the questionnaire. All informed consent procedures were approved by the Ethics Committee of the University for Development Studies, School of Medicine and Health Sciences, Ghana.
Study design and participants From January to July, 2013, this cross-sectional survey was undertaken with a sample of 368
Please cite this article in press as: Mogre V, et al. Misperception of weight status and associated factors among undergraduate students. Obes Res Clin Pract (2015), http://dx.doi.org/10.1016/j.orcp.2015.03.002
ORCP-431; No. of Pages 9
ARTICLE IN PRESS
Misperception of weight status among undergraduate students students attending the University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS), Tamale, Ghana. All students of the UDS-SMHS were eligible to participate in the study. From the eligible student population of 1809, the participants of the study were selected using a random number statistical table that yielded a proportionate random sample of 450 students that included more participants from academic programmes that had larger student populations. Three hundred and seventy-five students were approached and agreed to participate in the study, yielding a participation rate of 83.3%. Seven questionnaires were incomplete leaving 368 questionnaires yielding a response rate of 98.1%. Participation in the study was voluntary and informed consent was sought from each participant. Potential participants who self-reported pregnancy or breast-feeding were excluded from the study because of the possible impact of these conditions on their perceived body weight. The administration of the questionnaire and all anthropometric measurements were done by SA and RN.
Questionnaire A self-administered 12-item close-ended questionnaire was designed to collect data on demographic variables, self-perceived weight status, weight management behaviours, coffee, alcohol drinking and smoking status. In order to minimise bias in reporting self-perceived weight status, the questionnaire was administered to the participants before taking their anthropometric measurements.
Anthropometric measures Anthropometric measurements of body weight and height were measured without shoes on and with light clothing. Weight was measured to the nearest 0.1 kg using a UNICEF electronic scale manufactured by seca. Height was measured using a wall-mounted microtoise and recorded to the nearest 0.5 cm. BMI was calculated as weight (kg)/height2 (m2 ). Based on the WHO Expert Consultation guidelines [23], BMI was categorised as underweight (BMI < 18.5), normal body weight (BMI 18.5—24.9), overweight (BMI 25.0—29.9) and obesity (BMI ≥ 30). Waist circumference (WC) was measured midway between the inferior angle of the ribs and the suprailiac crest [24]. Hip circumference was measured as the maximal circumference over the buttocks in centimetres. Both measurements were measured to the nearest 0.5 cm using a nonstretchable fibre-glass measuring tape (Butterfly,
3
China). During both measurements, participants stood in an upright position, with arms relaxed at the side, feet evenly spread apart and body weight evenly distributed in accordance with the WHO expert consultation report on waist circumference and waist-to-hip ratio (WHR) [24]. WHR was calculated by dividing the waist circumference (cm) by the hip circumference (cm). Men with WHR
