Analysis of “Body Mass Index” in Medical Students at Nishtar Medical College, Multan by

M. Nadeem*, A. Hanif**, Sh.M. Faheem***, S. M. Awais****

* **

2nd year medical student (Nishtar Medical college) Biostatistician: Department of Orthopaedic Surgery, King Edward Medical University/Mayo Hospital Lahore

*** ****

Final year medical student (King Edward Medical University) 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.

INTRODUCTION
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) associate with bacteria count
(4)

.

BMI

. 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 (3539.99), 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, midarm 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 2- Normal range (less than 18.5) (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 Male Female Total
269 235 504

Percent
53.4 46.6 100.0

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 Age Total
Above 20 Below= 20 Male 53 216 269 Female 14 221 235

Total
67 437 504

Percent
13.3 86.7 100

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
Below Normal Range Normal Range 102 358

Percent
20.3 71.0

Above Normal Range

44 504

8.7 100.0

Total

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
Male

Total
102 358 44 504

Percent
20.3 71 8.7 100

AGE

<18.5 18.5-24.5 More than 24.5

44 193 32 269

Female 58 165 12 235

Total

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
Male Female 56 153 12 0 221 2

Total
93 310 34 0 437 9

Below or equal 20 Years of age

Range

<18.5 37 18.5-24.5 Pre Obesity Obesity 157 22 0 216 7

Above 20 years

Total Range

<18.5

of age 18.5-24.5 Pre Obesity Obesity Total 36 10 0 53 269 12 0 0 14 235 48 10 0 67 504

Grand Total

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-yearold 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