Vol.5, No.12, 1983-1992 (2013) Health
Association between obesity and self-reported
diseases: Population-based study among
adults in southern Brazil
Frederico Manoel Marques1, Marco Aurélio Peres2, Giana Zarbato Longo3,
Patricia Alves de Souza1
1Universidade do Planalto Catarinense (UNIPLAC), Lages, Brazil; passpb@gmail.com
2Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
3Universidade Federal de Viçosa (UFV), Viçosa, Brazil
Received 15 October 2013; revised 21 November 2013; accepted 2 December 2013
Copyright © 2013 Frederico Manoel Marques et al. This is an open access article distributed under the Creative Commons Attribu-
tion License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
Introduction: There are few population-based
studies conducted in Brazil outside the major
urban centers, the prevalence of overweight,
obesity and associated factors in the up country
cities remains not noticed. Particularly, the cha-
racteristics of this phenomenon are unknow n in
the mountain regions of Santa Catarina (state of
the southern region), which concentrate the
lowest economic and social development of the
state, where culture, dietary habits and climate
are quite peculiar. Objective: To estimate the
prevalence of nutritional status and its associa-
tion with self-reported diseases in adult s of Lages,
Santa Catarina. Methods: A cross sectional study
including adults was conducted (n = 2022). De-
mographic information was collected as well as
anthropometric measurements, through a num-
ber of interviews and physical examinations.
The outcome of the study was the body mass
index (BMI). The descriptive statistic was per-
formed, as well as simple associations between
BMI and the independent variables by sex. Cor-
relations between BMI, abdominal circumfer-
ence and self-reported diseases for men and
women were tested separately. Results: The pre-
valence of normal weight, overweight and obe-
sity among men was 41%, 39% and 19% respec-
tively. Among women, the prevalence rates w ere
43%, 31% and 26%. It was observed that the
obesity increase is correlated with low levels of
education. The greater the BMI the more nega-
tive was the self-assessment of health. It was
found a positive correlation between BMI and
abdominal circumference, with diabetes mellitus
and high blood pressure levels. Conclusions:
There was a high prevalence of overweight and
obesity in Lages, SC. Strategies involving the
various sectors of the community should be
considered to reverse this process.
Keywords: Nutritional Assessment; Ri sk Factors;
BMI; Population Surveys; Epidemiology
Obesity is being considered the most important nutria-
tional disorder in developed and developing countries [1]
and represents a significant change in the profile of
health and disease in the world in recent years. In the
most-recently published statistics, over one-third of the
US population and 10% of the population in poor coun-
tries are currently classified as overweight. In the Ameri-
cas, research shows a high level of obesity for both sexes.
Obesity is less prevalent in African countries. In Asia,
the prevalence is higher in urban population. In econo-
mically more advanced regions, the prevalence patterns
of obesity may be as high as in industrialized countries
The increasing prevalence of obesity at preschool age,
the early occurrence of adiposity and a rapid weight gain
are some risk factors that can increase the development
of obesity in more advanced ages [3].
In Brazil, there are studies demonstrating the clearly
decline in malnutritionespecially in children under five
years, and a significant increase in overweight and obe-
sity in all age groups. Historically, malnutrition was the
Copyright © 2013 SciRes. OPEN ACCESS
F. M. Marques et al. / Health 5 (2013) 1983-1992
condition of nutritional status that caused most concern
on Public Health, especially among children.
The population-based health data are widely recogni-
zed tools for gathering information actions, and they also
make possible the describing and monitoring of the dif-
ferences between subgroups and the analysis of the dif-
ferentials of income concentration in health as well as the
investigating of interventions in different aspects. The
monitoring of the trend in the health status, the behaviors
related to health, and the access and use of services by
the population require the use of regular health surveys
which most appropriate elements do identify temporal
changes in the risk factors and in the frequency of
chronic diseases in populations. This search strategy has
been used internationally for a few decades and more
recently also in Brazil in order to collect information to
assess the various dimensions of population health, ena-
bling the monitoring of fluctuations and historical trends
of the epidemiological pattern among different commu-
nities considered at the same period or from the same
population at different periods. In the area of health, na-
tional experiences regarding the comparison of data from
periodic health surveys are still recent [4].
The National Household Sample Survey (PNAD) from
the Brazilian Institute of Geography and Statistcs
(IBGE)a population-based survey with national cov-
erage in Brazil, whose data are collected from probabil-
istic samples of the populationincluded the first health
supplement in 1981. Since 1998 these supplements have
been applied systematically, at every five years, enabling
the monitoring of trends identified from various indica-
tors [4].
In Brazil, the challenges involving the population to
reach a great level of nutrition are many. The complexity
of dietary problems, resulted from the nutritional transi-
tion occurring currently in the country, is imposing ur-
gent rewards in healthcare, in order to respond the new
nutritional demands. The nutritional transition can be
conceptualized as a phenomenon in which changes occur
in the distribution patterns of eating problems in a certain
population. In general, it refers to the passage of under
nutrition to obesity. In Brazil, nutritional transition as-
sumed a singular profile. As such, the inefficiency in
resolving satisfactorily the dietary problems associated
with the absolute shortage of food, the country lives with
distinct nutrient profiles, sometimes overlapped. The ten-
dency of malnutrition evolution is noticeable, as well as
the permanence of nutritional anemia and the increase in
obesity and the diseases related to it [5].
Nutritional changes take different aspects depending
on the geographic region studied; factors such as family
income, education, lifestyle, number of children per fam-
ily will determine different prevalences. There are few
population-based studies that are conducted outside the
major urban centers, therefore, the prevalence of obesity
and overweight remains unknown even as the factors as-
sociated with it in the interior municipalities of the coun-
try. Particularly, the characteristics of this phenomenon
are unknown in the mountain regions of Santa Catarina,
regions with the lowest economic and social develop-
ment of the state, where culture, dietary habits and cli-
mate are quite peculiar [6].
In adults, the prevalence of malnutrition has fallen to
low levels as 3.6% among men and 1.6% among wo-
men (urban area of southern Brazil) [7].
Obesity imposes high costs on health’s systems of a
number of countries. About 1.6 billion adults (above 15
years) are considered over the ideal weight and 400 mil-
lion are considered obese [8]. There is evidence that half
of the adult population in Brazil were overweight be-
tween the years 2008 and 2009 [9].
This change in body mass is reputed as a participant
on the range of chronic non-communicable diseases,
which has the prolonged natural history with multiple
complex risk factors as characteristics. The clinical ma-
nifestations are usually chronic, of long latency period
and asymptomatic course, with periods of remission and
exacerbation, evolving for the emergence of disability or
even death. Its importance resides not only in the extent
of physical damage, but also in the social and psycho-
logical impact that they cause, with a reduction in quality
of life as one of its consequences [10].
In Europe, there has been an increase between 10 and
40% of obesity in most countries, in a period of 10 years,
mainly in England. Australia, Japan, Samoa and China
also presented an increase in the prevalence of obesity,
although China and Japan still present the lowest pre-
valence. Studies on secular trends in the body mass index
(BMI) of adults are found with some frequency in de-
veloped countries [1].
Evidence shows an increase of the relative risk of
death by different causes according to the increase in the
body mass index (BMI) [11], correlating it also the de-
velopment of various diseases such as cardiovascular,
diabetes mellitus, among other [12-14]. Anthropometry
stands out as being a low-cost tool with quick and effec-
tive results in diagnosing obesity. Some measures such
as abdominal circumference, in addition to evaluating
obesity, are related to increased risk of developing com-
plications, as cardiovascular and metabolic diseases [15].
Knowing the behavior of overweight and diseases as-
sociated with it is critical to developing for more effec-
tive strategies in healthcare [10]. The body mass index
and abdominal circumference are currently the most fre-
quently used data and easy applications that are used in
population studies. Although weight is the variable most
directly related to the metabolic and osteoarticular chan-
ges, overweight can only be assessed in relation to height.
Copyright © 2013 SciRes. OPEN ACCESS
F. M. Marques et al. / Health 5 (2013) 1983-1992 1985
The BMI has emerged as a method to have these two
aspects in a single measurement [16]. It is the most
commonly used indicator to assess the nutritional status
in population-based studies. The strong correlation be-
tween BMI and the body composition, the ease of its
measurement and its relation to morbidity and mortality
are enough reasons for its use in epidemiological studies,
in association or not with other anthropometric measure-
ments [17]. However, BMI has some limitations as: cor-
relation to its stature, to fat-free mass especially in men
and to body proportionality (relative size of the legs/
trunk). Therefore, it is not appropriate for some situa-
tions where the information about the body fat is not
correct, such as elderly persons and athletes. In the eld-
erly there is a reduction of lean body mass and an in-
crease of body fatness, but BMI can remain stable in the
course of these changes [16]. Athletes have increased
lean mass, which may overestimate the BMI.
The purpose of this study was to evaluate the anthro-
pometric profile (weight, height and abdominal circum-
ference) of the adult population and its association with
self-reported diseases of the urban area of Lages, SC.
Lages is located in the mountainous region of the state,
176.5 kilometers distant of Florianópolis, the capital of
the State. In the year 2005, the population of the city was
166,733 inhabitants, and 97.4% of them belong to urban
area [18].
It was conducted a cross sectional population-based
study. On a population of adults, 20 to 59 years of age,
completed when the study, both sexes, living in the urban
area of Lages. This age group covers approximately 52%
of the total population in the municipality, accounting
around 86.998 people [18], for the sample it was used the
formula for the estimation of the prevalence. The calcu-
lation of the sample size was performed through the pro-
gram Epi Info [19]. The final sample consisted of 2.051
adults. The sampling process was conducted across con-
glomerates from the geographical distribution. 60 census
sectors were randomly selected among the 186 existing
in Lages [20,21]. The simple sampling random was used
to the draw, without replacement, through tables of ran-
dom numbers [22].
Were not included in the sample, being considered as
missing, the households visited at least four times, in-
cluded at least, one visit on weekend and one visit at
night, where the examiner/interviewer could not locate
the person to be interviewed or if there was refusal in
participating. Were excluded from the sample: pregnant
women, amputees, bedridden, patients with casts, carri-
ers of psychiatric disorders and those who for some rea-
son had no conditions to stay in the proper position of
The socio-demographic information were collected
through interviews and anthropometric measurements,
both were performed at home. The outcome of the pro-
ceedings was the BMI index, obtained by dividing the
weight (in kilograms) and height (in meters) squared.
The categorization adopted was in accordance with the
criteria established by the World Health Organization
(WHO) [2]. This study considered as eutrophic individu-
als those with a BMI between 18.5 and 24.9 kg/m2, over-
weight BMI between 25.0 and 29.9 kg/m2 and obesity
BMI 30 kg/m2. The body weight was measured with
individuals wearing light clothing, without shoes, stand-
ing position, feet together, arms positioned along the
body, with the palm facing leg [23]. Portable digital
scales with a variation of 0.1 kg and capacity up to 150
kg were used for measuring weight. The participants
were weighed only a single time, and the measures were
recorded. The measurement of height and waist was per-
formed using a non-elastic tape. Height was estimated by
fixing the tape measure on a vertical surface without base
boards a 100 centimeters from de floor with the aid of an
adhesive tape. The individuals were without shoes or
head adornments, in a standing position, with heels to-
gether. These, gluteus, shoulders and head should touch
the vertical surface of the wall. The line of vision at the
moment of inspiration was horizontal [23]. The pattern
adopted was performed according to the normative stan-
dards of the Brazilian Society for Nutrition. The meas-
urement of abdominal circumference was made through
a non-elastic tape, with a capacity of 1.5 meters, with
subdivisions of 1 millimeter. The individual was in the
standing position. The tape surrounded the higher ab-
dominal circumference. The record proceeded at the time
of expiration [19]. The values defined as cut off points
were: 94 centimeters for men and 80 for women, rec-
ommended by the World Health Organization (WHO)
[2]. During the interviews pressure levels were measured
with pressure monitoring device, in two stages, at the
beginning and the end of the process, and the second
measurement was considered. The high blood pressure
levels were defined with values of BP 140/90 mmHg
[24]. Concerning the self-reported diseases, the individ-
ual has been asked if the doctor had said that he has
chronic obstructive pulmonary disease (COPD), cerebral
vascular accident, diabetes, hypertension or tuberculosis.
Information concerning the level of satisfaction of health
were collected through Likert-type scale and subse-
quently categorized into positive, regular and negative.
The socio-demographic information collected included
sex, age in years, and per capita incomes (in Brazilian
currency—Real) based on the previous month the study
was conducted, subsequently analyzed according to
quartiles of the distribution and the number of years of
completed education (<4, 4 to 8 years, 9 to 11 and >11).
Copyright © 2013 SciRes. OPEN ACCESS
F. M. Marques et al. / Health 5 (2013) 1983-1992
The construction of the database and the double entry
were performed thorugh the statistical package Epi Info
version 6.0 [19]. Descriptive statistics with the use of
averages and proportions was performed. Simple asso-
ciations between BMI and the independent variables for
each sex were tested through the Pearson Qui-squared
test for linear tendency. The Pearson’s linear correlation
was used to assess the level of correlation between BMI
and abdominal circumference according to sex and self-
reported diseases. The value of p < 0.05 was considered
for statistical significance. All analyzes were performed
with STATA 9 [25]. The project was submitted and ap-
proved by the Ethics in Research Committee of UNI-
PLACnumber 001 - 007. If it were any health prob-
lems observed with the respondent, the interviewers sub-
mitted them to the nearest Health Care Unit.
A total of 2.022 adults aged between 20 and 59 years
which corresponds to a response rate of 98.6% were in-
terviewed. The sample consisted of 61.4% females and
38.6% males.
Regarding to the nutritional state, most of the respon-
dents were eutrophic in both sexes; however, among
those with excess weight, there was a prevalence of over-
weight among men and the opposite occurred regarding
obesity demonstrating a higher percentage among wo-
Comprehensive data come from national health and
nutrition surveys performed in the United States between
1960 and 1994. These surveys documented a progressive
increase in the prevalence of obese adults, and in the
period of 1976 to 1994 there was an increase in obesity
among men, in the proportion of 12.3% to 19.9%, and
among women from 16.9% to 24.9% [2].
Most eutrophic belonged to the lower age groups,
those with overweight in intermediate ages between 30
and 39 years, while the obese were distributed more fre-
quently in the higher age groups (Table 1). It was ob-
served in this study, a frequency of BMI below 18.5; less
than 2%, indicating the absence of energy deficits adult
population in urban Lages. As a result, the group of un-
derweight was added to those with normal weight status
in all analyzes.
The highest frequency of eutrophic was in the third
income quartile, while those with excess weight were in
the lowest quartiles. The lower the BMI, the more posi-
tive was the perception of health (Table 1). It was ob-
served a linear relation between obesity and the levels of
education (p < 0.001).
In respect of the self-reported diseases, diabetes mel-
litus showed a higher distribution for male and among
those overweight, followed by the obese (p = 0.001). For
females there was a positive relation of diabetes with
BMI, with the highest prevalence observed among obese
individuals (p < 0.001). In men, it was found a larger
percentage in high tension levels (blood pressure above
the normal settings), among those overweighed, followed
by the obese (p < 0.001). For females, the higher the
BMI, the higher the incidence in high blood pressure (p <
0.001). The prevalence of cerebral vascular accident was
1.43%. The greatest distribution was found among the
overweighed in both sexes, but without statistical sig-
nificance (p = 0.496). With reference to bronchitis, to
both sexes, the highest prevalence was found among eu-
trophic individuals, with p = 0.849, also not statistically
significant (Table 2).
Figure 1 shows the positive correlation between BMI
and abdominal circumference for both sexes (p < 0.001).
Studies conducted in several centers have shown a cor-
relation between BMI and abdominal or visceral fat (ab-
dominal circumference). The abdominal fat has its im-
portance on cardiovascular diseases because of its fre-
quently association with dyslipidemia, hypertension and
insulin resistance [26]. Although abdominal circumfer-
ence was classified, according to cut-off points suggested
by the World Health Organization as 94 cm for men and
80 cm for women, as a measure of metabolic risk in-
creased, few studies in Brazil evaluated the appropriate-
ness of the use of this indicator, as well as the most ap-
propriate cut-off points for the Brazilian population [27].
Study conducted in Cuiabá, Mato Grosso—Brazil, shows
that these cut-off points as measures of metabolic risk are
lower than that recommended by the World Health Or-
ganization [19]. The results of this study are quite statis-
tically consistent, but further researches are needed to
better define the cut-off points for the Brazilian popula-
tion and rather in different age groups. It is possible that
in the future it may have only one single measure, using
a very low cost solution as the tape measure, a high ac-
curacy tool as a predictor of metabolic diseases.
Figures 2 and 3 show a positive correlation with ab-
dominal circumference with self-reported diabetes mel-
litus and high blood pressure for males and females, re-
spectively (p < 0.001).
The results of this study show the high percentages of
overweight and obesity, but it would be precipitate to say
that overeat is replacing the food shortage problem, as
this study has a cross-sectional design and was the only
one held in the region, not satisfying the requirement of
temporality between the possible cause and the presumed
effect so that it can make such an inference. The high
prevalence of overweight is not unique to Lages, as
found by the process of nutritional transition, taking
place throughout the country and also in other develop-
ing countries, especially Latin America and China,
whose transformation phenomenon closely resembles the
Brazilian one [28].
Copyright © 2013 SciRes. OPEN ACCESS
F. M. Marques et al. / Health 5 (2013) 1983-1992
Copyright © 2013 SciRes. OPEN ACCESS
Table 1. Distribution of nutritional status according to socio-demographic and health perception in adults (n = 2.022). Lages, Santa
Catarina, 2007.
Nutritional status
Variables Eutrophia Overweight Obesity
N % N % n %
Sex (N = 1.969)
Male 318 41.4 302 39.3 148 19.3 <0.001*
Female 517 43.1 370 30.8 314 26.1
Age (years) (N = 1.965)
20 - 29 384 63.4 145 23.9 76 12.7 <0.001**
30 - 39 180 41.9 167 38.8 83 19.3
40 - 49 170 32.9 199 38.6 147 28.5
50 - 59 99 23.9 159 38.4 156 37.7
Education (years) (N = 1.942)
0 - 4 40 26.9 55 36.9 54 36.2 <0.001**
5 - 8 189 38.4 162 32.9 141 28.7
9 - 11 151 38.4 159 40.4 83 21.8
12 e mais 446 49.1 284 31.2 178 19.7
Per capita income (Real)*** (quartis) (N = 1.934)
1˚ (0.26 - 0.51) 191 39.1 170 38.4 127 26.5 0.07**
2˚ (0.52 - 0.88) 209 43.0 166 34.1 111 22.9
3˚ (0.89 - 1.58) 221 43.9 163 32.4 119 23.7
4˚ (1.59 - 19.74) 199 43.5 164 35.8 94 20.7
Health (self-evaluation) (N = 1.974)
Positiva 654 45.1 493 34.2 296 20.7 <0.001**
Regular 162 35.9 155 34.3 134 29.8
Negativa 24 30.0 24 30.0 32 40.0
*Pearson qui-squared test; **Linear tendency; ***A US dollar is worth R$2,20 reais (Brazil), a minimum wage is equal R$640,00 reais.
Factors such as low physical activity, ingestion of high
caloric density food associated with other sociocultural,
environmental and genetic factors contributed to high
prevalence of overweight and obesity found on this
search. Concerning the association between age and BMI,
with a prevalence of overweight between 30 and 39 years
and of obese in over 50 years; it is important to point that
the incidence of cardiovascular diseases and diabetes
mellitus type 2 are more common at these ages. These
sort of disorders are often serious and may be fatal at this
period of life, coinciding with the period of individual’s
greatest productivity.
The WHO MONICA study (Monitoring of Trends and
determinants in Cardiovascular Diseases) has revealed
significant data about the worldwide prevalence of obe-
sity, BMI values between 25 and 30 are responsible for
most of the impact of overweight on certain co-morbid-
ities associated with obesity. About 64% of men and
77% of women with diabetes mellitus, non-insulin de-
pendent diabetes could, theoretically, prevent the disease
if they have a BMI less than or equal to 25. Among the
population of 35 to 64 years of age, the prevalence is of
50% to 75% of overweight and obesity, with the preva-
lence in female population [2].
Concerning schooling variable, the results indicate an
inverse association between educational level and obe-
sity, similarity to what occurs in developed countries
F. M. Marques et al. / Health 5 (2013) 1983-1992
Table 2. Association between nutritional status and self-reported diseases in the adult population in Lages, Santa Catarina, 2007.
Variables Eutrophic Overweight Obesity Values
Male Female Male Female Male Female
N˚ % N˚ %n˚ %n˚ % n˚ % n˚ %
Diabetes (N = 1.959)
Negative 312 42.9 50045.4 282 38.8 335 30.4133 18.3 266 24.2 0.001*<0.001
Positive 5 13.4 14 14.9 19 51.3 32 34.0 13 35.3 48 51.1
Pressure levels (N = 1.968)
Não elevado 240 47.7 45849.5 189 37.6 280 30.4 74 14.7 184 20.1 <0.001<0.001
Elevado 77 29.1 61 21.8 113 42.8 88 31.5 74 28.1 130 46.7
Cerebral vascular acident (N = 1.965)
Negative 317 41.7 50843.2 297 39.0 360 30.6 147 19.3 308 26.2 0.3540.496
Positive 1 16.7 7 31.8 4 66.6 9 40.9 1 16.7 6 27.3
Chronic bronchitis (N = 1.955)
Negative 301 41.4 48843.2 286 39.3 345 30.6 139 19.3 295 26.2 0.9770.849
Positive 16 41.0 25 40.3 15 38.4 21 33.88 20.6 16 25.9
*Teste do qui-quadrado de pearson.
r = +0.797r = +0.906
Significant correlation p < 0.001
Figure 1. Scatter plot between body mass index and waist circumference according
to self reported diabetes. Lages, Santa Catarina, 2007.
Considering the surveys from the Estudo Nacional da
Despesa Familiar (ENDEF), Pesquisa Nacional sobre
Saúde e Nutrição (PNSN) e Pesquisa sobre Padrões de
Vida (PPV 1996-1997)all performed in Brazil [30], it
was observed that the risk of obesity was growth in all
levels of education, tending to be higher for men and
women with greater schooling, however, it was reported
a stability or even decrease in female rates in woman
with high or medium schooling in the second period. For
males there was still a positive trend, but with less inten-
sity than in the first period.
Comparing the results with studies conducted by Mon-
teiro [7] and Gigante [31], even in the case of a unique
and cross-sectional study, there was a high prevalence of
overweight among those with low education [7,31].
Probably those with higher schooling level should
Copyright © 2013 SciRes. OPEN ACCESS
F. M. Marques et al. / Health 5 (2013) 1 98 3-1992 1989
r = +0.797
Significant correlation p < 0.001
r = +0.906
Figure 2. Scatter plot between body mass index and waist circumference according to ac-
cording to self reported diabetes in males and females. Lages, Santa Catarina, 2007.
Body mass index
Significant correlation p < 0.001
20 40 60 20 40 60 20 40 60 20 40 60
r = +0.776 r = +0.880r = +0.735r = +0.776
Male Female
ormal blood pressure levels High blood pressure levels
50 100 15 200
ormal blood pressure levels High blood pressure levels
Figure 3. Scatter plot between body mass index and waist circumference according to pressure levels increased in male and female
sexes. Lages, Santa Catarina, 2007.
better understand the adverse effects of obesity that are
advertised through various means of communication and
have a greater chance of acquiring and consuming lower-
calorie foods and practice regular physical activity.
The tendency to overweight among people belonging
to the poorest groups of the urban population has been
corroborated by several studies [22,33]. In the study of
the distribution of malnutrition and obesity, based on
data obtained by PNSN [34], occurred high prevalence of
overweight in the lower-income classes, especially among
women, in groups of up to 0.25 minimum wages per
capita, 13% of them, approximately, had a BMI above
27.7 kg/m2, corresponding to the 95th percentile. In the
period between 1975 and 1989 [35] the rate of obesity
among men and women increased 92% and 63%, respec-
tively, and this increase was higher in the lower income
group. In the second period between 1989 and 2003 [35],
an increase in obesity among men remained higher for
the poorest class. For the female population, however,
the obesity rate has remained stable as a whole, however,
increased by 26% among women belonging to the two
lowest income quintiles and decreased by 10% among
women belonging to the three highest income quintiles.
In Brazil, according to the above data, in 4 decades, it
occurred a nutritional transition (from malnutrition to
obesity), where in the developed countries of Europe this
Copyright © 2013 SciRes. OPEN ACCESS
F. M. Marques et al. / Health 5 (2013) 1 98 3-1992
nutritional transition took a century.
Despite uncertain causes that justify the world’s in-
crease in obesity, three hypotheses are objects of study.
One of them proposes the possibility of populations pre-
sent themselves genetically more susceptible to obesity,
which associated with certain environmental factors,
should increase the chances of this happens. This hy-
pothesis would explain the rise in obesity in low-income
populations, linked to a supposed “economic genotype”,
it means that in cases of food shortages the genes related
to obesity would be a guarantee of survival, however, in
periods of excess, such genes would become would be-
come detrimental. The second hypothesis, the most stud-
ied, attributes the increasing trend of obesity in devel-
oped and developing countries to the decline of energy
expenditure of individuals. The lower energy expenditure
would be associated with occupations that would require
less physical efforts. Dietary factors such as lower fiber
intake and increased consumption of fats and sugars
would also be considered [36]. A third hypothesis would
result in a protein-energy malnutrition in early life stages,
in this case, obesity would be a sequel of malnutrition.
The energy and protein restriction would cause changes
in the central nervous system in order to facilitate pri-
marily the accumulation of body fat, causing a tendency
to positive energy balance, when the easy access to food
occurred [37].
The presence in this search of a high prevalence of
overweight in low-income populations is very similar to
other population-based studies conducted in other re-
gions of the country [27,31].
Facing this reality that affects adults from impoveri-
shed segments of society, deprived by the assistance of
the private sector and depending on the public health
system, constitutes a new challenge to public health,
changing olds paradigms which showed the highest pre-
valence of obesity among people with greater incomes.
The health’s satisfaction variable shows how those
with higher BMI have difficulty in perceiving their
health. It is possible that eating disorders may influence
the perception of health, but it is plausible that the con-
cern with body image also assisted in its evaluation. In
this aspect, there is the influence of the means of com-
munication that emphasize thinness as the ideal model of
social representation to be achieved.
A significant association between BMI and self-re-
ported diabetes mellitus and blood pressure levels was
identified. These values, however, must be interpreted
with caution, not eliminating the possibility of reverse
causation bias, inherent in cross-sectional studies. Even
though, the biological plausibility as well as the magni-
tude of the results suggests that the results may be inter-
preted as potential causal factors. This association per-
sisted regardless of the genre.
Undoubtedly, the overcoming of eating problems in
the country involves intricate aspects. In this context, the
proposal of health promotion suggests a promising path
for food and nutrition areas. Primarily because it is a
strategy that articulates different sectors and social indi-
viduals where there are issues such as: health model un-
der the approach of completeness; articulation of techni-
cal and popular knowledge; empowering and enabling
individuals, partnerships in action; sectors division of
public and private agencies, strengthening of community
action; popular education; citizenship; public ethics;
among others [5].
With these results, the multiplication of initiatives that
are still incipient in the country is proposed, focusing on
the nutritional reality aiming to reverse this process in-
terrupting the cycle of a high prevalence of overweight
and its association with chronic non-communicable dis-
eases. Suggestions among other measures are: optimizing
health activities in essential care (a free service to the
public by the Unified Health System (SUS—is the health
care system that is free to the entire population of Bra-
zil)), providing nutritional counseling training to all
members with more effective participation of health
agents; implementation of community gardens, creating
awareness of the importance of micronutrients and fiber
in healthy eating; incorporating these programs with their
local university courses in health, social sciences and
technology, integrating them in a multidisciplinary, but
mostly interdisciplinary; using the space in schools and
health unities for the construction of gyms with extended
hours of use, including weekends and school holidays,
aimed at all ages, with monitors and adequate health care.
Associated with those, the use of all means of mass com-
munication in the country for disseminating educational
actions that reproduce the harmful consequences of obe-
sity can help people realize the importance of changing
eating habits and increasing physical activity.
This search showed that Lages has a high prevalence
of overweight in adults in the urban region, associated
with high blood pressure and self-reported diabetes. Fur-
ther epidemiological studies are needed for monitoring
this population of nutritional risk, aiming at an adequate
caring, offering scientific topics for both public and pri-
vate sectors, based on their reality.
Also, it defines the priorities of the population. Taking
into consideration regional aspects and providing health
education actions are important steps for successful pre-
vention and control of obesity [10].
This apparent “health status”, with high prevalence
rates of overweight and obesity, hides a new challenge to
public health that could jeopardize the entire health sys-
tem, damaging the society, family and the individual
Copyright © 2013 SciRes. OPEN ACCESS
F. M. Marques et al. / Health 5 (2013) 1 98 3-1992 1991
which may have lower quality and life expectancy.
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