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Analysis of “Body Mass Index” in MedicalAnalysis of “Body Mass Index” in Medical

Students at Nishtar Medical College, MultanStudents at Nishtar Medical College, Multan

byby

M. NadeemM. Nadeem**, A. Hanif, A. Hanif****, Sh.M. Faheem, Sh.M. Faheem******, ,

S. M. AwaisS. M. Awais********

** 22ndnd year medical student (Nishtar Medical college) year medical student (Nishtar Medical college)

** Biostatistician: Department of Orthopaedic Surgery,Biostatistician: Department of Orthopaedic Surgery,

King Edward Medical University/Mayo Hospital LahoreKing Edward Medical University/Mayo Hospital Lahore

****** Final year medical student (King Edward Medical University)Final year medical student (King Edward Medical University)

******** Sitar-e-Imtiaz & Sitar-e-Imtiaz & Pro-Vice Chancellor, and Prof. Orthopaedic

Surgery,King Edward Medical University, Lahore, Pakistan

ABTRACT: Obesity is an abnormal growth of the adipose tissue. Over weight is

usually due to obesity and causes a large number of diseases. It decreases the

pregnancy rates, low birth rates, low implantation rates, follicle development,

oocyte numbers and increases gonadotropin requirements. BMI is expressed in

term of weight divided by square of height on the basis of BMI, obesity is divided

into different classes; normal range (18.5-24.99), below normal range ( < 18.5 ),

pre-obesity (25-29.99), obesity class I (30-34.99), obesity class II (35-39.99),

obesity class III (above 40).STUDY DESIGN: It was a descriptive cross-sectional

study. RESULTS: 504 students were analyzed during February 2007 to May

2007, to assess the age group, sex distribution along with body mass index.

There were 269 males (53.4%) students and 235 female (46.6%) students. 67

students represented their age above or equal 20 years and 437 students were

below 20 years. Moreover we analyzed there were 102 (44 males and 58

females) students having BMI below normal range, 358 students (193 males and

165 females) of normal range and there were 44 students (29 males and 12

females) with obesity including all three classes.

INTRODUCTIONINTRODUCTION

Obesity is an abnormal growth of the adipose tissue. It is the

prevalent form of malnutrition. It affects children and adults. It is one of the

significant contributors to ill health. It is a key risk factor in natural history of other

chronic and non communicable diseases (1) Greater BMI, weight and body

surface area (BSA)associate with wider retinal venules, while greater BMI and

large waist circumference associate with narrower retinal arterioles(3) . BMI

associate with bacteria count (4). There is a weak correlation between BMI and

early complications following hip replacement surgery, and there also seems to

be a correlation between the operating surgeon and early complications (5).

Over weight is usually due to obesity and causes a large number of diseases.

Obesity is a detriment to human which is reflected in increased morbidity and

mortality. The Framingham Heart Study in United States showed a dramatic

increase in sudden death among men more than 20% over weight (1). It

decreases the pregnancy rates, low birth rates, low implantation rates, follicle

development, oocyte numbers and increases gonadotropin requirements (2).

Obesity is expressed in term of body mass index (BMI) (1). BMI is expressed in

term of weight divided by square of height. On the basis of BMI, obesity is

divided into different classes; normal range(18.5-24.99),below normal range( <

18.5 ), pre-obesity (25-29.99), obesity class I (30-34.99), obesity class II (35-

39.99), obesity class III (above 40).

Medical student population is considered the most ideal population all over the

world. It was expressed from the present study that they had also abnormal BMI.

Medical education may alter physicians' earlier stereotypes of obesity. Present

study was carried out at the Nishtar Medical College Multan during year 2007.

Data regarding consecutive 504 students was analyzed. Obesity causes a lot of

health problems. So, it is necessary to overcome its causes, so that it can be

reduced. It's necessary to foment preventive ways against overweight in young

adult life because in this age it's possible to revert the higher blood pressure

levels and other disorders

LITERATURE REVIEW

Bakr EM, Ismail NA, Mahaba HM ( 2002): described that this cross sectional

study was carried out to assess the nutritional status of medical students and to

determine its relation to their life style. The study involved 317 students at, Am

Shams University. Anthropometric measurements such as weight, height, mid-

arm circumference, triceps skin fold thickness and body mass index were

measured. The study revealed that 41.3% of the students were of normal weight

while 9.5% of the sample was underweight, 36.9% were overweight and 12.5%

were obese. The mean mid upper arm circumference (MUAC) and mid arm

muscle circumference (MAMC) of males was significant higher than that of

females, while the mean triceps skin fold (TSF) of females was significant higher

than that of males. Obese individuals eat more during watching television and

during feeling of stress compar ed to non-obese. We concluded that about half of

medical students were overweight and obese. The most important life style

factors responsible for obesity were longer time spent using computer, eating

more during time of stress and snacking between meals. Also, genetic factors

played an important role in development of obesity.

Nieradko-Iwanicka B (2005): described that this work was concerned with an

approach to teaching of obesity as a civilization-related disease to medical

students. Brainstorming, snowball discussion, careful reading of medical texts,

evidence-based medicine, and practicals on how to measure BMI and WHR were

exploited. Analysis of medical histories to disclose risk factors of ischemic heart

disease and polymetabolic syndrome X are proposed.

Chow VT, Phoon MC (2003): described that, leptin is a peptide hormone that

plays a key role in the regulation of body weight and composition. Overweight

individuals generally demonstrated higher circulating leptin concentrations than

healthy-weight and underweight participants. The differences in mean leptin

levels between underweight and overweight males (P = 0.006), as well as

between healthy-weight and overweight males (P = 0.011) were statistically

significant. Comparison tests of leptin levels between healthy-weight and

underweight females were highly significant (P = 0.001). Highly significant linear

correlations between BMI and the logarithm of leptin concentration were

observed in the female (r = 0.44) and male (r = 0.36) groups. The findings also

corroborate evidence that adiposity determines leptin levels.

Rasheed P, Abou-Hozaifa BM, Khan A (1994): described that The prevalence of

obesity was examined among Saudi female medical and nursing students. The

analysis was made on 222 students whose ages ranged from 18-25 years. The

prevalence rate of obesity by body mass index was found to be 30.6% with more

girls falling in the Grade I (26.1%) than the Grade II (4.5%) category. Using the

skin fold measurement as a standard, a smaller proportion (16.8%) of students

was observed to be obese indicating variation in the sensitivity of the two indices

as measures of body fatness. The prevalence of obesity in these young Saudi

women was notably high.

Wiese HJ, Wilson JF, Jones RA, Neises M (1992): described that the purpose of

this study was to develop and evaluate an educational intervention designed to

modify the stigma held by first-year medical students towards obese patients...

Analysis of students' attitudes toward obese patients five weeks and one year

after the course indicates that the intervention was effective.. One year after the

course, the intervention group was significantly more likely to rate genetic factors

as important in obesity and less likely to blame the obese for their conditions.

Cowan GS, Smalley MD, Defibaugh N, Cowan KB, Hiler ML, Sehnert W, James

S (1991): described that cultural indoctrination throughout childhood largely

defines adult value systems including stereotypic attitudes towards the obese. It

is possible that medical education may alter physicians' earlier stereotypes of

obesity. We conclude that obesity appears to carry a burdensome degree of

societal prejudice, as reflected by negative stereotypes, which is largely

unaffected by undergraduate or postgraduate medical education.

Gümez-Sandoval JC, Moreno-Altamirano L, Méndez-Vargas R, Alba-Leonel A,

Argotte-Roumagnere A, Aparicio-Cabrera A (1990): described that there is

evidence of an association between obesity and hypertension.. We found that in

males, the 21.89% was overweight or obese and in females, the 25.98% was in

this range. The blood pressure was greater in males. The prevalence ratio was

greater than 1 in all cases. The observations founded suggest that the

mechanism that protect females in young adult life are nulified by the overweight.

It's necessary to foment preventive ways against overweight in young adult life

because in this age it's possible to revert the higher blood pressure levels..

McClamrock HD (2007): described that excess weight is associated with

decreased pregnancy rates, lower birth rates, lower implantation rates, and the

possibility of decreased follicle development and oocyte numbers as well as an

increased gonadotropin requirement in patients undergoing in vitro fertilization or

intracytoplasmic sperm injection.

A. D. Patel and M. Albrizio (2006): described that the purpose of this study was to

evaluate the relationship between body mass index and early complications

following total hip replacements. Out of Five hundred and fifty patients, fifty-six

patients (10.2%) had an early complication following hip replacement surgery.

Forty-four patients (8%) had a major local complication. Overall, there did seem

to be a weak correlation between BMI and the rate of complications, with a p

value of 0.104. A correlation was also found between the surgeon and presence

of complications with a p value of 0.736. There is a weak correlation between

BMI and early complications following hip replacement surgery, and there also

seems to be a correlation between the operating surgeon and early

complications,

Ohe K, Hachiya Y, Takahashi Y, Oda S, Takahara K. (1992): described that for

the purpose of evaluating the significance of obesity in a young population as a

risk factor toward various chronic diseases. The following results were obtained.

(1) The average obesity index of the students showed a progressive and

significant increase in the past 13 years from 1979 to 1991. (2) A close

correlation between the obesity index and serum GPT was recognized This

finding was intensified in 142 obese students with an obesity index of over 10%,

but it was not seen in the remaining non-obese students. (3) The correlation

between the obesity index and serum GPT was found solely in the group of

students with constant obesity; (4) Systolic blood pressure was related to the red

blood cell count rather than to the obesity index. (5) No particularly close

correlation to serum cholesterol was found with any of 10 representative items

examined in this physical checkup, From the above findings, it can be concluded

that constant obesity in students is related to liver dysfunction,

AIM AND OBJECTIVE

To study the medical student’s population in Nishtar Medical College Multan

during February through May, 2007 for the following aims and objectives

1- Gender distribution

2- Age distribution

3- Frequency of different obesity classes

4- Frequency of different obesity classes with sex

5- Frequency of different obesity classes with age and sex

MATERIAL AND METHODS:

STUDY SAMPLE

504 medical students of 1st year, 2nd years, 3rd years and house officers of both

sexes were included in this study of BMI

PLACE OF STUDY

This study was conducted in Nishtar Medical College Multan during, February to

May 2007.

STUDY DESIGN

A descriptive cross-sectional study.

ANALYSIS

SPSS 11.5 for analysis.

METHODS

1. Classification of BMI used in this study (Mushtaq Ahmad. Esstials of

Medical Biochemistry, 7th edition 2001.Merit Publishers;110-115.)

1- Below normal range (less than 18.5)

2- Normal range (18.5 to 24.5)

3- Pre-obesity or overweight (25 to 29.9)

4- Obesity (equal and more than 30)

2. Weight was measured using kg weight scale.

3. Height was determined using a length measuring tape in cm.

4. The BMI calculating formula was weight in kg divided by square of height

in meter.

RESULTS:

Table 1: Gender Frequency Distribution

Frequency Percent

Male 269 53.4

Female 235 46.6

Total 504 100.0

The above table shows that the ratio of male students is more than that of

the female students i.e. 53.4% and 46.6% respectively.

Table 2: Frequency Distribution for age

Gender Total Percent

Male Female

Age Above 20 53 14 67 13.3

Below= 20 216 221 437 86.7

Total 269 235 504 100

According to the table 2 there are 437 students i.e. 86.7% with age below or

equal 20 years and the rest of the students i.e. 13.3% have age above 20 years.

Table 3: Frequency Distribution for BMI

Frequency Percent

Below Normal Range 102 20.3

Normal Range 358 71.0

Above Normal Range 44 8.7

Total 504 100.0

71% people investigated as normal, 20.2% having range below 18.5 and the rest

of the people are above normal range (showing over weight).

Table 4: Cross tabulation for AGE vs. Gender

Gender Total Percent

Male Female

AGE <18.5 44 58 102 20.3

18.5-24.5 193 165 358 71

More than 24.5 32 12 44 8.7

Total 269 235 504 100

There are 71% persons between the ranges of 18.5-24.5 in which males are

more i.e. 193.

Table 5: Cross tabulation for BMI vs. Gender vs. Age

Gender

TotalMale Female

Below or equal 20

Years of age

Range <18.537 56 93

18.5-24.5 157 153 310

Pre Obesity 22 12 34

Obesity 0 0 0

Total 216 221 437

Above 20 years

of age

Range <18.57 2 9

18.5-24.5 36 12 48

Pre Obesity 10 0 10

Obesity 0 0 0

Total 53 14 67

Grand Total 269 235 504

According to the above table, male students were more in both groups, (Age

below and equal 20 i.e. 437 and above 20 i.e. 67).

No female complaints as pre obesity in group of age above 20. While the normal

ranges are more than the other categories.

DISCUSSION

Obesity is due to abnormal distribution of fat. It affects adults more than children.

Male adults are sensitive as compare to the female adults. Due to the improper

and less information we are unable to represent the age, height and weight in

form of mean and standard deviation. The other important statistics have been

calculated and represented in the form of percentages and frequencies.

Moreover in the study of Bakr EM, Ismail NA, Mahaba HM ( 2002), 41.3% of the

students were the normal weight while 9.5% of the sample were underweight,

36.9% were overweight and 12.5% were obese, but present study showed that

71% were normal while 20.2% were below normal range and 8.75 were above

normal range. Female were more below normal range i.e. 11.5% than the male

i.e. 8.7%. Male were more in normal range i.e. 38.29 than that of female i.e. 32.7.

Above the normal range, male were 6.4% and female were 2.4% but obesity is

0% in both sex. Lastly, pre-obesity is more in male than female which is the first

step to be obese.

CONCLUSIONS:

The ratio of Pre-obesity was more in male students than that of

female. Present study included 53.4% male,46.6% female students below and

equal 20 years of age, BMI was normal in 71%, below normal in 20% and above

normal in 9%. The occurrence of BMI less than normal was more than two times;

as compared to BMI more than normal. In present study not a single case of

obesity was identified. Abnormal BMI occurs due to food factor, genetic factor

and hormonal factor. Abnormal BMI range in medical students indicates that their

food is not good. They are not provided balance diet in hostels.

RECOMMENDATIONS:

1.It is recommended to develop nutritional education and physical activities

programs to face the problem of increasing the rate of overweight and obesity.

2. Preventive programs for weight control and a healthy lifestyle among medical

students should be emphasized from young adulthood or perhaps earlier. Thus it

is necessary to foment preventive ways against overweight in young adult life

because in this age it is possible to revert the higher blood pressure levels and

other disorders. Federal, Provincial, Medical College and Hospital administration

need to acknowledge for more explicitly than ever before, the need to prevent the

overweight causes and to effective treatment of it.

3. It is important to note that in this study 20.3%students are underweight and

therefore need supplementation in their diet

4. Finally all of the level mentioned earlier is expected to improve their policies,

because obesity is a stair for causing the others severe diseases.

REFERENCE:

1. J.E. Park. Preventive & Social Medicine, 28th edition 2005-06.M/s

BANARSIDAS BHANOT; 298-300

2. Mc Clamrock HD. The great weight debate: Do elevations in body

mass index (BMI) exert a negative extraovarian effect on in vitro

fertilization outcome? Fertil Steril; 2007 Jun 29

3. Taylor B, Rochtchina E, Wang JJ,Wong TY, Heikal S,Saw SM,Mitchell P.

Body mass index and its effects on retinal vessel diameter in 6-year-

old children. Int J Obes (Lond); 2007 Jul 3.

4. Vagstrand K, Karin Lindross A, Birkhed D, Linne Y. Associations

between salivary bacteria and reported sugar intake and their

relationship with body mass index in women and their adolescent

children. International Journal of Obesity; 3 July 2007.

5. A. D. Patel and M. Albrizio. Relationship of body mass index to

early complications in hip replacement surgery

International Orthopaedics Journal, 8 September 2006.

6. Mushtaq Ahmad. Esstials of Medical Biochemistry, 7th edition

2001.Merit Publishers;110-115.

Author’s Group Photo

Left to Right: Prof. S. M. Awais, Sh. M. Faheem, M. Nadeem, Asif Hanif and Asim Butt