The Prevalence of Obesity Among Health Staffs in Muar Health District Office in 2018:

A Cross Sectional Study.

Norshazwani O1, Nor Fadilah MS1, Fiona BL1, Siti Khadijah AR1, Hanisah A1, Mohd Azhadi

O2, Noorhaida U1

1
Muar Health District Office, 2Institute of Public Health

ABSTRACT

Introduction: Obesity is a serious emerging global issue among healthcare personnel. Health

staffs are the front liners who are responsible to educate and act as role models to the

community. However, several studies of healthcare professionals have found that a

significant proportion are obese. The aim of this study is to report prevalence of obesity

among health staffs in Muar District Health Office and to describe the association of obesity

with selected socio-demographic profiles. Methods: This cross-sectional study studied Body

Mass Index (BMI) of health staffs in Muar Health Office except expectant mothers and

females in their first three months post-partum period. The respondent rate was 95.1%. Body

Mass Index (BMI:kg/m2) was calculated from measured weight and height, using calibrated

weighing scales and body meters. BMI was calculated and then classified into obese and non-

obese group based on Malaysia CPG on Management of Obesity 2004, which is obese BMI ≥

27.5 kg/m² and non-obese is < 27.5 kg/m². Binary logistic regression test was used to

determine the association between sociodemographic profile with obesity status. All P values

<0.05 were considered statistically significant. Results: Respondent rate was 95.1 %. There

were 602 total staffs in Muar District Health Office. Prevalence of obesity was 34.7%

(n=209). Among those are obese , 47.1% were aged 40 years old and above, 36.1% were

Malays, 39.9% were males and 36.7% had lower educational status. Conclusion: Prevalence

of obesity among health staffs in Muar District Health Office was higher than national
1
population. Healthy lifestyle promotion and education should be implemented to those who at

risk at obesity.

Keywords: Healthcare staffs, Obesity, BMI, Malaysia, Prevalence

INTRODUCTION

Obesity is described as excessive fat accumulation in the adipose tissues of the body

that is linked unequivocally to several health hazards1. Obesity is a complex chronic disease

with a multiple aetiology2 and is becoming a major clinical and public health concern.

Obesity is one of the most strongly associated risk factors liked to non-communicable

diseases such as diabetes and cardiovascular diseases3.

It is predicted that by 2030, about 573 million and 1.35 billion adults would have

problems with obesity and overweight, respectively 4. In Malaysia, based on Clinical Practice

Guidelines 2004 classification (Body Mass Index ≥ 27.5 kg/m 2), National Health and

Morbidity Survey (NHMS) reported that the national prevalence of obesity increased from

27.2 % in 2011 to 30.6% in 2016. Meanwhile based on WHO Obesity classification (BMI >

30 kg/m2), the national prevalence of obesity was 17.7% 5

Currently, obesity is a serious emerging global issue among healthcare personnel.

Health care staffs are the front liners who are responsible to educate and act as role models to

the community. The failure of health staffs to comply with healthy lifestyle and subsequently

fails to set good example will jeopardise the mission to educate the community. However,

based on WHO obesity classification, several studies on healthcare professionals have found

that a significant proportion are obese. The studies were as follows; Department of Health in

England has estimated that 21% healthcare professionals could be classified as obese 6.

Similarly, a study in Scotland found that 29% of nurses and 17% of other healthcare

professionals (including doctors, pharmacists, dentists and therapy professionals) were

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obese7. Regionally in Thailand, results found that almost 30% of the health workers were

overweight & obese8. In Malaysia, a study by Pejabat Kesihatan Daerah Kulaijaya showed

the prevalence of obesity among the health staff was 20.1% in 2012 9. Another study by

Pejabat Kesihatan Daerah Melaka Tengah demonstrated the prevalence of obesity among the

health staffs was 21.1%10. These local studies found a higher prevalence of

overweight/obesity among healthcare workers compared to the national population. The aim

of this study is to report prevalence of obesity among health staffs in Muar District Health

Office and to describe the association of obesity with selected socio-demographic profiles.

METHODOLOGY

Study Design, Setting & Study Population

This was a cross sectional study conducted in Muar District Health Office. The district is in

the northern Johor state and with a total of 634 healthcare workers. They were consist of 330

clinical health care staffs (doctors, paramedics and staff nurses), 30 non-clinical health care

staffs (rehabilitation therapist, radiology staffs, laboratory technicians, dietitians), 39

pharmacy staffs, 35 administrative staffs, 70 inspectorate and 130 support staffs. Health

facilities in this district comprise of one main administrative office, 11 health clinics, 40 rural

health clinics and 2 Klinik Komuniti. The respondents were all health staffs of Muar Health

District Office in 2018 aged between 20 to 60 years, except pregnant women, females in their

3 months postpartum period and incomplete Borang Saringan Status Kesihatan (Health Status

Screening Form).

Key definitions, Variables & Measurement.

The weight of respondents was measured in kilogram (kg) and the height was measured in

meter (m). Body Mass Index (BMI) was calculated using the formula published by World

Health Organization (1998): weight (kg) / height2 (m 2). Both height and weight were
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measured using a calibrated weighing scale with height attachment and measured to the

nearest 0.5cm and 0.1kg (not wearing shoes and light clothing). Body mass index (BMI,

kg/m²) was calculated and then classified into obese and non-obese group. The classification

of BMI is based on Malaysia CPG on Management of Obesity 2004, which is obese BMI ≥

27.5 kg/m² and non-obese is < 27.5 kg/m². The respondent professional grades represented

the educational levels and were divided into grade ≥ 41(tertiary educational level) and ≤40

(secondary and lower educational level). In this study, comorbid that considered was

hypertension, diabetes type 2 and dyslipidaemia.

Data Collection

Data collection was obtained from Borang Saringan Status Kesihatan (BSSK). BSSK is a set

of questionnaires, an early detection tools to screen for possible health condition among

respondents. BSSK comprised of questions on respondent’s demographic data,

anthropometric measurement (weight, height) and blood pressure readings, known comorbid

and blood test results (fasting blood sugar and cholesterol level). Muar Health District Office

has made it compulsory for the health staffs to answer this questionnaire and submit it

annually. The data from BSSK 2018 was collected and reviewed. Measures were extracted

from BSSK results including: BMI, gender, ethnic, age, professional grade, and co-morbid.

Sample size assumptions & Calculation.

Sample size was calculated using OpenEpi, Version 311. We expected the prevalence of

obesity among health staffs was 30.6% (national prevalence of obesity NHMS 2015 Volume

II) with 95% confidence interval, the minimum estimated sample size was 342.

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Ethics approval was obtained from the Ministry of Health, Malaysian Research Ethics

Committee (NMRR-19-2614-50650 (IIR)). Permission to conduct the study was also

obtained from the Muar District Health Office.

All data gained were extracted retrospectively from a resource which already available at

Muar Health District Office. Hence no consent needed.

Statistical methods

Analysis of the data was carried out using the IBM- Statistical Package for the Social

Sciences (IBMSPSS®) version 22 for Windows. Frequency table was used to describe the

social demographic data such as gender, age, ethnicity, grade and comorbid. Binary logistic

regression test was used to determine the association between sociodemographic profile with

obesity status. All P values <0.05 were considered statistically significant.

RESULTS

Socio-demographic and Occupational Profile

A total of 602 health staffs data from Muar District Office were analyzed in this

study, 209 from them were obese. The respondent rate was 95.1%. There was 62.1% of

respondents were female. There were 68.6% respondents aged less than 40 years old and

54.8% has comorbid. Most of the respondents attained secondary educational level and

14.8% respondents attained tertiary educational level. Out of 602 respondents, they were

Malay (94.4%) , Chinese 3.7% , Indian (1.2%) and others 0.8% .

Prevalence of obesity

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 Prevalence of obesity in Muar District Health Office in 2018 was 34.7%. Those who

were ≥40 years old had higher prevalence (47.1%) than respondents who were < 40 years old

(23.6%). There was higher prevalence of obesity among male respondents (39.9%) compared

to female respondents (31.6%). Malay respondents showed higher obesity prevalence

(36.1%) compared to other ethnicities. Respondents with secondary educational status had

higher prevalence of obesity than those with tertiary educational level (36.7% and 23.6%

respectively). The prevalence of obesity did not differ much between respondents with or

without comorbid disease (37.3% and 31.6% respectively).

Logistic regression test was used to search the significance correlation between

obesity and each socio-demographic and occupational factor. Malay has three times increased

risk (p=0.014) of developing obesity after control for age meanwhile respondents aged ≥40

years old has two times increased risk of developing obesity after control for ethnic

(p<0.001). Gender (p=0.12), education level (p=0.29) and comorbid (p=0.39) did not show

significant correlation with risk of developing obesity among health staffs in Muar Health

Office.

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Table 1 Socio-demographic and occupational characteristics of respondents (N = 602)

No of respondents %

Age

< 40 years old 413 68.6

40 and above 189 31.4

Gender

Male 228 37.9

Female 374 62.1

Ethnics

Malay 568 94.4

Chinese 22 3.7

Indian 7 1.2

Others 5 0.8

Educational level

Tertiary and above 90 15

Secondary and below 512 85

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 Comorbid

Yes 330 54.8

No 272 45.2

Table 2: Logistic Regression for each Socio-demographic Profiles.

Variables Obese n (n%) Non obese n (n%) X2 statistical (df) P value

Age

≤ 40 years old 120 (29.1%) 293 (70.9%) 18.61 (1) <0.001

> 40 years old 100 (47.1%) 89 (52.9%)

Gender

Male 91 (39.9%) 137 (60.1%) 4.37 (1) 0.037

Female 118 (31.6%) 256 (68.4%)

Ethnic

Malay 205 (36.1%) 363 (63.9%) 12.35 (3) 0.006

Non Malay 4 (11.8%) 30 (88.2%)

Education level

Tertiary & above 21 (23.6%) 68 ( 76.4%) 5.76 (1) 0.016

Secondary & below 188 ( 36.7%) 324 (63.3%)

Comorbid

Yes 123 (37.3%) 207 (62.7%) 2.10 (1) 0.147

No 86 (31.6%) 186 (68.4%)

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Table 3: P value each Socio-demographic and Profiles.

Variables Adjusted OR (95% CI) P value

Age

≤ 40 years old 1.00 <0.001

> 40 years old 2.12 (1.48,3.03)

Ethnic

Malay 3.78 (1.30, 10.95) 0.014

Non Malay 1.00

Gender

Male 1.00 0.12

Female 0.76 (0.53, 1.18)

Education level

Tertiary & above 0.74 (0.42, 1.3) 0.29

Secondary & below 1.00

Comorbid

Yes 0.17 (0.82, 1.66) 0.39

No 1.00

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DISCUSSION

The prevalence of obesity (BMI ≥ 27.5kg/m2) among the health staffs in Muar District

Health Office was 34.7% which was higher than the national obesity prevalence (30.6%) as

reported by NHMS 20153. This finding is similar with other studies conducted elsewhere that

revealed a high prevalence of obesity among healthcare workers in comparison with general

population. For example, a study in Kulaijaya District Health Department among 189

healthcare workers showed that obesity (WHO Classification BMl>30kg/m2) among the

health staff was 20.1%9. In another study which involved 702 healthcare workers in Melaka

Tengah District Health Department, the prevalence of obesity (WHO Classification

BMl>30kg/m2) was 21.1% 10. Based on WHO Obesity classification, these two local studies

showed that the prevalence of obesity among health staffs was higher than the national

prevalence (17.7%).

According to a study done among staffs in a military hospital in Melaka, there was a

significant relationship between obesity and habitual physical activity in the workplace12. As

for Muar Health Office health staffs, the high prevalence of obesity may be due to lack of

physical activity and sedentary lifestyle. Most of the working nature involves “sitting” for

long hours before lunch break and time for home. For examples, medical officers spend most

of time take history and perform routine clinical examination while sitting and administrative

and support staffs spend long hours sitting at desks. As for staffs who work outside the clinics

for examples inspectorate officers and home visit staff nurses, they commute by motor-

vehicles even between short distance destinations due to local hot climate.

Besides that, age forty-year-old and above was found to be a significant factor of

obesity in our study (p<0.001). This study finding is similar with NHMS report where the

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prevalence of overweight and obesity were more than doubles to a peak in middle age 3. This

finding is consistent with the local study conducted in Pejabat Kesihatan Daerah Melaka

Tengah which reported that staffs aged forty and above was found to be a significant factor of

overweight/obesity10.This condition might be attributed by combination of few factors such

as decrease in metabolic rate and less of physical activity, in which both factors are strongly

associated with ageing13.

Malay ethnicity was also found to be associated with obesity in our study. Prevalence

of obesity among Malay ethnicity was 36.1% compared to other races. Local studies on the

prevalence of obesity have shown higher prevalence among Malays and Indians compared to

Chinese14,15. Cultural factors appear to influence dietary and lifestyle behaviours differently 16.

A study in Kelantan showed Malay adolescents had significantly higher scores for the

Western-based food pattern (characterised by high intakes of animal‐based and processed

foods, which were high in fat, salt and sugars) and local-based food pattern (characterised

based on higher factor loading of several common habitual foods consumed in these

populations such as white rice, condensed sweetened milk, tea, seasoning fish sauce “budu”,

banana fritter and white bread) compared to the Chinese participants who showed higher

scores for healthy food based pattern 17. Besides that, Malaysian Chinese, were found to be

more physically active than Indian and Malay ethnicity18.

The strength of our study include its large representative sample from multiple

occupational and socio-demographic profiles. Minimum sample size required is 342 while we

managed to collect 602 respondents. This large sample size formula can reflect the real

prevalence of obesity among health staffs.

However, this study has a few limitations. Since our study design was a cross-

sectional, the causal relationship between overweight/obesity and listed risk factors could not

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be established. Besides that, we did not assess other relevant factors that may be contributing

to obesity such as physical activity, dietary pattern and marital status.

CONCLUSION

In conclusion, the prevalence of obesity among health staffs in Muar District Health Office is

higher compared to the general population. Healthy lifestyle promotion and education should

be implemented to those who at risk at obesity.

ACKNOWLEDGMENT

The authors are grateful to the Director General of Health Malaysia, Ybhg. Dato’ Dr Noor

Hisham bin Abdullah and Muar District Health Officer, Dr NoorHaida binti Ujang, for the

continuous help throughout the publication.

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