PREVALENCE OF OBESITY AMONG MALE AND FEMALE HYPERTENSIVE PATIENTS IN IJEBU-ODE AND IJEBU EAST LOCAL GOVERNMENT

CHAPTER ONE

INTRODUCTION

Background to the study

Obesity has become a major public health concern worldwide and it is now recognized by major health promotion bodies as a major cardiovascular risk factor as cardiovascular disease continues to become a major cause of morbidity and mortality even in the developing countries where it has been estimated that up to 75% of the expected increase in the cardiovascular disease burden will come by 2020 (Adebiyi, 2006). The increase in obesity worldwide will have an important impact on the global incidence of cardiovascular disease and type 2 diabetes mellitus (Ifatade, 2009). Obesity is excessive accumulation of adipose tissue, while overweight represents a body weight exceeding the normal for a person's gender, age, height and build. The National Cholesterol Education program (Adult Treatment Panel III) recognized obesity, physical inactivity, and atherogenic diet as major risk factors for Cardiovascular disease (Manson; Colditz, and Stanmper, 2009)

In the opinion of Opadijo Akande and Jimoh (2004), obesity is associated with increased morbidity and mortality due to hypertension, diabetes, dyslipidemia, and cardiovascular and renal diseases. The prevalence of obesity and obesity-related disease is increasing worldwide, the prevalence of obesity increases with age predominantly in men and scarcely in women. The Centers for Disease Control and Prevention estimated that obesity cost the United States at least $147 billion in 2008. Consequently, strategies for preventing and treating obesity have become political as well as health-care issues.

In both adults and children, obesity rates have increased over the past several decades in the United States (Koh, 2008).  Obesity rates have increased in both genders, and among all racial, ethnic, and socioeconomic groups. Approximately 68% of US adults are either overweight or obese  which could be accounted for by their lack of physical exercise and hefty fatty constituted diets they consume. (Cali, 2005).  Based on National Health and Nutrition Examination Survey data, the prevalence of obesity in 2007–2008 was 32.2% among adult men and 35.5% among adult women (Steinberg, 2004). Among adults, the prevalence of obesity increases with age in men. The prevalence of obesity among African Americans is approximately1.5 times  in whites, and Mexican Americans have an intermediate prevalence (Meyers, 2007). During the past three decades, prevalence rates of childhood and adolescent obesity (body mass index (BMI) >95th percentile for age and sex) have more than doubled in the United States. In 2006, 16.3% of children and adolescents were reportedly obese, and approximately 32% of children are either overweight or obese. Childhood obesity frequently persists into adulthood, with up to 80% of obese children reported to become obese adults (Serdula, 2003). Among adolescents, the prevalence of obesity is approximately twice as high among African Americans and Mexican Americans as among non-Hispanic whites (Cali, 2008).

Because of the increasing prevalence of obesity in the United States, it has been projected that the steady increase in life expectancy during the past two centuries will soon end (Olshanky, 2003).

However, recent reports from the Centers for Disease Control and Prevention suggest that obesity rates may be stabilizing. Obesity rates have remained constant for 5 years in men and closer to 10 years in women and children. The prevalence of obesity is increasing not only in the United States, but also globally (Misra, 2008). Socioeconomic and demographic transitions occurring in many developing countries are contributing to the escalation of obesity despite continuing nutritional deficiencies. This double burden poses health and economic challenges in resource-constrained populations. In 1998, the prevalence of obesity in the developing world had increased from 2.3 to 19.6% over a 10-year period (Adebiyi, 2006). Obesity rates have increased threefold or more since 1980 in the Middle East, the Pacific Islands, Australasia, and China. Additionally, the prevalence of childhood overweight has increased in almost all countries for which data are available (Oghagbon and Okesina 2006). Obesity in the developing world is no longer a disease of higher socioeconomic status groups; the burden of obesity is shifting toward groups with lower socioeconomic status as the country’s gross national product increases. The increasing prevalence of obesity is related to urbanization, major changes in the food supply, diet, and a reduction in physical activity (Vantallie, 2009 )

Obesity is a component of the metabolic syndrome which represents a cluster of risk factors for cardiovascular disease. This cluster of risk factors includes type 2-diabetes mellitus, elevated triglyceride level, elevated low density lipoprotein (LDL), low high-density lipoprotein, elevated blood pressure and obesity. Obesity is thought to be the primary substrate in its development by various international bodies such as World Health Organization (WHO), American Diabetes Association (ADA) and the International Diabetes Federation (IDF).

The current epidemic of obesity is caused largely by an environment that promotes excessive food intake and discourages physical activity. Urban populations in different countries have changed their diets increasing fat and sugar consumption and decreasing fiber intake leading to overweight, obesity and more cardiovascular deaths. There is a complex link between poverty and obesity which may be responsible for the increasing numbers of obese people even among the poorer segments of the society. Low educational attainment, which is a strong predictor of health behaviour, is a major link between them. Therefore, primary prevention of obesity is needed among youths and women, particularly among those from lower socio-economic backgrounds (Davis, 2008).

It is also known that the age of obesity onset may have a significant influence in the persistence of obesity and adverse consequences in adult life Treatment of obesity and other risk factors for cardiovascular diseases should be initiated as early as possible.

Strategies given to address the problem of obesity among ethnic minorities include increasing physical activity, reducing television viewing and the adoption and maintenance of healthy lifestyle practices for the entire family. The World Heart Federation recommends that obesity prevention programs should be high on the scientific and political agenda of both industrialized and industrializing countries. Promoting healthy lifestyles should be national priorities and international priority, beginning in schools and carried over into work places, communities and the health care system as a whole.

Statement of the problem

The relevance of both hypertension and obesity, as important public health challenges, is increasing worldwide. Compared with the year 2000, the number of adults with hypertension is predicted to increase by approximately 60% to a total of 1.56 billion by the year 2025 (Kearney, 2005). The growing prevalence of obesity is increasingly recognized as one of the most important risk factors for the development of hypertension. This epidemic of obesity and obesity-related hypertension is paralleled by an alarming increase in the incidence of diabetes mellitus and chronic kidney disease. According to Popkin (2008), a small amount of weight loss in overweight hypertensive individuals is associated with a decrease in arterial pressure. Indeed, over the last decade, most studies have demonstrated that treatment of hypertension with weight loss resulted in a lower blood pressure. This suggests that a decrease in intra-abdominal fat reduces blood pressure in hypertensive patients and supports the use of waist circumference. It is against this background that this study is poised to assess the prevalence of obesity among male and female hypertensive patients.

Justification of the Study

This study would help to determine the prevalence of obesity among male and female hypertensive patients. This will improve awareness of the modalities for further educating the male and female adults on the need to engage in physical activities and attend regular health seminars related to obesity-related hypertension. Health workers will also find it a useful diagnosis to the quest for healthy population in Nigeria.  This study is also significant in the sense that it contributes to the body of knowledge about obesity-related hypertension.  It is also significant because it gives the researcher a sense of fulfillment and also serves as a reference point for students writing research on related topics.

Research Questions

1.                  Is there any difference in the prevalence of obesity among male and female hypertensive patients within the study area?

Research Hypotheses

H01:     There is no significant difference in the prevalence of obesity among male and female hypertensive patients within the study area

General Objectives

The general objective of this study is to assess the prevalence of obesity among male and female hypertensive patients

Specific Objectives

Specific objectives are:

a) To determine the prevalence of obesity among male and female hypertensive patients using height and weight measurement and waist circumference.

b) To determine the Body Mass Index (BMI) for male and female hypertensive patients.

c) To measure the waist circumference of the respondents

Scope of the Study

The study is delimited to hypertensive patients attending general hospital in Ijebu-ode.

A cross section of the patients will constitute the coverage of the study

Operational Definition of Terms

Obesity: is medical condition characterized by storage of excess body fat. The human body naturally stores fat tissue under the skin and around organs and joints (Manson, 2009 ).

Prevalence: rate of occurrence of a particular phenomenon (Encanta, 2009)

Nurses: Professional saddled with the responsibility of assisting doctors in a health care delivery centre (Akinniyi, 2011)

Cholesterol : this is a substance found in blood fat and most tissues of the body, i.e too  much cholesterol can cause heart disease (CDC, 2004)

Body mass Index: Body Mass Index (B.M.I): It is a simple index of weight for height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in metres (WHO 2004).