Background: Obesity is now reported as an epidemic in many developed countries, and it is an emerging public health concern in developing, transitional, and newly developed countries. The incidence of obesity increases during adolescence and persists into adulthood and becomes irreversible. In addition to biological causes like inheritance, cultural factors (such as dietary knowledge, attitudes and behaviours), socio-demographic factors may also play a central role in the etiology of obesity. The aim of the study was to describe young adults’ knowledge and perceptions about obesity, with a focus on comprehensibility and meaningfulness of obesity in their daily lives and its health implications. Methods: A cross-sectional descriptive design was used with 96 participants aged 18 - 35 years. The respondents’ body mass indices (BMI) were calculated from self-reported weights and heights. Descriptive analytical, statistical methods were used for data analysis. Results: The youths had good knowledge about obesity, its causes and associated complications. Generally, negative attitudes toward obesity were reported. Some perceived obesity as the ideal body image among today’s youths while others perceived obesity as something that was beyond their control. Identified knowledge gaps were in the area of obesity and nutrition knowledge, food preferences and implications to health. Knowledge deficit about obesity might lead to poor health-related behaviours with its associated complications. Conclusion: There is a need to intensify community-focused health education as a preventive strategy to empower the youths to take charge of their health and change their perceptions about obesity.
Obesity has reached epidemic proportions in many countries around the world. It is now an epidemic health problem in many developed countries, and it is an emerging public health concern in developing, transitional, and newly developed countries [
The increase in the prevalence of diabetes parallels that of obesity and both are emerging pandemics in the 21st century. Some experts call this dual epidemic “diabesity” [
Obesity arises from an energy imbalance whereby energy intake exceeds energy expenditure. Increased intake of foods that are high in energy and fat, low physical activity and high levels of inactivity are suspected to be major contributors to rising levels of obesity [
Body Mass Index (BMI), a measure commonly used to define obesity and assess adiposity, is an indicator of relative weight for height (weight in kilograms divided by the square of height in meters = kg/m2). It is frequently used as a surrogate for the crude assessment of excess body fat and to classify underweight, overweight and obesity in adults. Obesity is defined as a BMI ≥ 30.0 kg/m2 [
Throughout most of human history, weight gain and fat storage have been viewed as signs of health and prosperity [
Obesity is therefore a global epidemic that is associated with increased morbidity and mortality and imposes an enormous burden on individuals and public health. The emerging problems of obesity and associated chronic diseases are exacerbated as increasingly urbanized populations adopt diets with higher saturated fat in addition to lower fruit and vegetable intakes than was consumed traditionally. Healthy eating, exercise habits and a positive body image need to be developed and nurtured at younger ages across ethnic groups [
In the United States, the prevalence of obesity has increased dramatically in the last decades both in children and adults and is now considered a major health problem. It has been reported that over 60% of the adult population is overweight or obese [
The rate of increase of obesity in the US population has led many to label this public health threat as an epidemic. This is supported by data from the National Health and Nutrition Examination Surveys [
The prevalence of childhood and youth overweight/obesity has also increased considerably in recent years in the sub-Saharan region [
Although perceptions about obesity differ from country to country, it has been reported that an appropriate perception of one’s own weight is important for improved weight control behavior [
Health risk knowledge has been identified as a key to making informed decisions regarding healthy lifestyle choices [
The results of a study to determine whether obesity was a problem in Zimbabwe suggested that obesity was not a problem in adult Black Africans of Zimbabwe. Women, however, were overweight (BMI = 25 - 30 kg/m2) and had larger mean waist circumferences, posing a greater risk of health problems associated with abdominal adiposity [
This study therefore investigated the youths’ knowledge and perceptions about obesity, with a focus on comprehensibility and meaningfulness of obesity in their daily lives and its health implications. It is hoped that an understanding of this selected group of people’s knowledge and perceptions about obesity will help in designing appropriate preventive and promotive health education programmes that address obesity and other related chronic non-communicable diseases in Zimbabwe.
The aim of the study was to determine the youths’ knowledge and perceptions about obesity and its health implications and further, to identify the youths’ needs for education in prevention and control of obesity.
The revised Health Belief Model (RHBM) was used to underpin this study because it attempts to predict health-related behavior in terms of certain belief patterns. The model is an example of a Prevention Model that explores why some people who are free from illness take actions to avoid illness while on the other hand some people fail to do so [
Therefore, empowerment of the youths using acceptable health promotion strategies will be expected to change behaviour leading to adoption of healthy life-styles in relation to obesity prevention. Supportive environments and communities are fundamental in shaping the youths’ choices, making healthier choices of food stuffs and regular physical activity the easiest choice which is available, accessible and affordable and therefore, preventing obesity.
A descriptive cross- sectional study was conducted using a self-report questionnaire with 96 respondents aged 18 - 35 years and mean age of 23 years. The design enabled the disclosure of information on the different perspectives about obesity and further, to make inferences about possible relationships between the respondents’ socio-demographic and obesity-related characteristics and their knowledge and perceptions about overweight and obesity.
The study population comprised of students from a selected state owned university in Zimbabwe. The sample consisted of 96 youths, 49 females and 47 males aged 18 - 35 years and obtained through convenience sampling. The inclusion criteria required that the respondent be university students who were mentally sound to give informed consent and were conversant with English. Body size was not a limiting factor for eligibility to participate in the study.
Data were collected using a self- report questionnaire, developed by the investigator after a review of relevant literature and adoption of some questions from a validated (ORK-10) Obesity Risk Knowledge-10 scale questionnaire [
The questionnaire was divided into two sections. Section A elicited the respondents’ socio-demographic characteristics that included age, sex and level of education. Respondents were also asked to record their current heights and weights. A bathroom scale was also used to verify the respondents’ weights in case they were not sure. Section B examined the respondents’ knowledge on; obesity, nutrition and obesity-associated complica- tions by ticking either (True/False) in appropriate boxes up to 61 items. Food preferences, food-related behaviours and their implications on health plus the respondents’ perceptions towards their body images in relation to overweight and obesity were also elicited. The respondents’ perceptions and attitudes towards their own weights were assessed using the following questions:
1) How do you feel about your own body weight?
2) If you were obese, would it affect you in any way? (Yes/No. Please explain your answer)
3) Does obesity affect your self-esteem? (Yes/No. Please explain your answer)
4) If you were obese, would it affect your social life? (Yes/No. Please explain your answer)
5) There is no need to worry about overweight or obesity as long as it is not causing any health problems. (True/ False)
6) If you were obese, would you make an effort to lose weight? (Yes/No). Explain your answer.
Data were collected between March and July 2015 by the investigators and two trained research assistants. The self-report questionnaire used in the study was piloted on six university students, after which minor modifications to the question arrangement, wording and meanings were made before being used on a larger sample described above. The questionnaire was in English (one of the three official languages in Zimbabwe) and it required 15 to 20 minutes to complete. The completed questionnaires were checked for completeness and collected soon after completion.
The study was approved by the Ethics committee of the university that was used for the study. Written informed consent was obtained from each respondent in accordance with the Helsinki Declaration.
Data were analyzed using SPSS (Version 20). Prior to analysis, all the data were assessed and screened for missing values before applying appropriate parametric and non-parametric statistics on the useable responses. (Chi squared and t-tests were used to statistically compare the data).Pearson’s correlation was used to determine the association between the respondents’ knowledge and BMI, body image, self perception and to analyze the strength and significance of the associations.
Obesity was defined using body mass indices (BMI) which were calculated from the respondents’ self-re- ported weights and heights. Obesity was defined and graded on a scale according to WHO Classification of adult obesity (2000). Underweight (BMI < 18.5 kg/m2); overweight (BMI ≥ 25 kg/m2); Pre-obese (25 - 30 kg/m2); class I obesity (BMI 30 - 35 kg/m2); class II obesity (BMI 35 - 40 kg/m2); class III obesity (BMI ≥ 40 kg/m2). Normal BMI (18.5 - 24.9 kg/m2).
Knowledge levels were obtained by scoring the respondents’ responses. Correct responses scored a point while incorrect and “don’t know” responses scored zero points. Operationally, the total possible knowledge score was 61.A score of <30.5 was rated as poor knowledge; 30.5 - 37 (average knowledge); 38 - 45 (Good knowledge) and ≥46 (very good knowledge).Knowledge gaps were identified by recording the questions that were incorrectly answered or where the respondent indicated “I don’t know”.
Overall, 73.3% ± 11.1% of the respondents correctly answered the items on the obesity knowledge test, mean of 48.4 ± 4.6. Three percent had “average” knowledge, 12 (13%) had ‘good’ knowledge while the majority, 81 (84%) had “very good” knowledge about obesity, its causes and related complications (see
Variable | Frequency n (%) |
---|---|
Sex | |
Male | 47 (49) |
Female | 49 (51) |
University Educational level | |
First year | 58 (60) |
Second year | 19 (20) |
Final year | 19 (20) |
Body Mass Index categories | |
18.5 - 24.9 kg/m2 (Normal BMI) | 53(55) |
<18.5 kg/m2 (Underweight) | 7 (7) |
≥ 25 kg/m2 (Overweight) | 9 (9) |
25.00 - 29.99 kg/m2 (Pre obese) | 14 (15) |
30.00 - 34.99 kg/m2 (Obese class I) | 12 (13) |
35.00 - 39.99 kg/m2 (Obese class II) | 1 (1) |
Knowledge scores (out of 61) | Frequency n (%) | Description |
---|---|---|
<30.5 | 0 | Poor |
30.5 - 37 | 3 (3) | Average |
38 - 45 | 12 (13) | Good |
≥46 | 81 (84) | Very good |
Knowledge deficit (incorrectly answered items + “don’t know” with a score above 50%) was noted in questions related to the following: Definition of obesity (90%); Causes of obesity (child birth = 68%, family planning pills = 61%, hot dogs = 60%, craving = 53%); Obesity-related complications (diabetes mellitus = 56%, infertility = 54%, gout = 54%, arthritis = 51%) (see
The majority of the respondents, 85 (89%) knew that low physical activity and high levels of inactivity increased the risk of obesity. Identified knowledge gaps were in the area of obesity and its predisposing factors, diet and food preferences and obesity?related complications.
Pearson’s Chi-square test showed that knowledge about obesity was significantly associated with age (p = 0.002, 95% CI) and one’s BMI (p = 0.012, 95% CI) while feeling about one’s weight was significantly associated with the BMI (p = O.038, 95% CI). No other associations were found between obesity-related knowledge and the other demographic and obesity-related characteristics of the respondents.
The results showed that the respondents had mixed perceptions and feelings towards overweight, obesity and their own body weight as summarized in
Question | Incorrectly answered (%) | Don’t know (%) |
---|---|---|
1. A person is considered to be obese when their BMI is… | 19 | 71 |
False | Don’t know | |
2. Causes of obesity include the following: a) Childbirth b) Family planning c) Foods like hot dogs d) Craving | 66 59 32 43 | 2 2 28 10 |
3.Obesity related complications include: a) Diabetes mellitus b) Arthritis c) Infertility d) Gout | 53 44 48 52 | 3 7 6 2 |
Explanations to Questions | Frequency n (%) |
---|---|
1. If you were obese, how would it affect you? a) Activities like sports and outings, daily activities b) No need to worry because that is the way I am c) It causes diseases e.g. heart diseases d) Makes me uncomfortable (Self stigmatization) e) No explanations | 6 (6) 39 (41) 28 (29) 8 (8) 15 (16) |
2. How would obesity affect your self esteem? a) It makes me uncomfortable and less confident b) Overweight/Obesity is the ideal body weight from an African perspective c) Stigmatization by others d) No explanations | 37 (39) 32 (33) 21 (22) 6 (6) |
3. How would obesity affect your social life? a) Stigmatization b) Won’t be attracted to the opposite sex c) Inability to participate in social activities d) Clothes won’t fit well e) No need to worry, I like it that way f) No explanations | 29 (30) 11 (11) 21 (22) 2 (2) 25 (26) 6 (8) |
4. If you were obese, would you make an effort to lose weight? a) Obesity is not a problem b) There is need to exercise and have a low fat diet c) Obesity is a problem that needs to be addressed d) Obesity leads to stigmatization e) No comments | 33 (34) 7 (7) 13 (14) 7 (7) 36 (38) |
Obesity constitutes a major public health problem and a risk factor for many debilitating diseases that are a main cause of mortality and morbidity around the world. Weight control initiatives should attempt to influence people’s weight-related knowledge as well as their perceptions and attitudes towards weight control. The main findings of this study showed that the majority (90%) of the respondents did not know the minimum BMI for defining obesity, despite good knowledge about the comorbid conditions associated with obesity.
Over fifty percent of the youths in this study failed to recognize such chronic and debilitating diseases like diabetes mellitus and arthritis as possible obesity- related complications. Diabetes mellitus, particularly type 2 has been reported to be on the increase globally, reaching pandemic levels in low-income countries in sub- Saharan Africa [
Furthermore, most of the youths failed to appreciate that obesity is caused by lifestyle factors like smoking and alcohol use and poor eating habits like food cravings and hot dogs that most university students commonly prefer to eat. This finding shows that the youths need to have a better understanding of the life-style causative factors of obesity which they can easily control through the adoption of healthy behaviours e.g. refraining from eating fatty foods while increasing active physical activity.
Previous studies have reported that the incidence of obesity increases during adolescence [
Despite a high prevalence of obesity among the youths who participated in this study, there was a tendency towards underestimation of overweight and obesity, similar to findings from other African countries [
Although the cross-sectional design used in this study enabled the investigator to make inferences about possible relationships between the respondents’ demographic characteristics and their knowledge and perceptions about overweight and obesity, it was not possible to draw inferences on the direction of the association and causal relationships. Moreover, the small sample size in this study is not representative of the youths in Zimbabwe as a whole, making it rather difficult to generalize the findings. The same study could be conducted using a bigger sample size. The assessment of body weight by relying on self-reported values of weights and heights can be under or overestimated and anthropometric techniques could have been included to evaluate weight status and body fat content [
The findings in this study have highlighted areas worthy of intervention in the battle against obesity. However, the impact of long term low self-esteem and stigmatization among some Zimbabwean youths with high BMI deserves further study. Additional research is also needed to define the most effective role of primary care providers including health education on prevention of obesity, diagnosis of cases, counseling and referral to specialists for further management.
This study has shown strong findings for the association of knowledge about obesity and age and one’s BMI, while feeling about one’s weight was associated with their BMI. Future health promotion efforts should therefore be aimed at strengthening obesity prevention education during pre-adolescence period, taking into account, the attitudes and health behaviours of the communities. The obesity-related knowledge gaps highlighted in this study can be used to formulate appropriate intervention strategies in this and other population groups.
The authors thank Precious, Nombulelo Mzizi and Likwa Dube (BSc. Nursing students at Bindura University of Science Education) for their assistance with data collection.
Esther Mufunda,Lynah Makuyana, (2016) Obesity: A Potential Pandemic for the 21st Century among the Youths in Zimbabwe. Journal of Diabetes Mellitus,06,136-145. doi: 10.4236/jdm.2016.62014