SURVEY REPORT

EFFECTS OF DIETARY HABITS OF HOUSE OFFICERS ON

THEIR BMI

Submitted by: Saleha Faisal

UHS Roll no. : 075565
Session: 2021-2025
Supervisor: Ms. Rimsha Fatima

Department of Nutrition

Institute of Allied Health Sciences

FMH College of Medicine and Dentistry, Lahore

INTRODUCTION

Healthcare professionals (HCP) differ from general population in regards to the nature of their
work, stress, burnout etc. which begs the need to have a robust state of health for the ones who
provide it to others. They include nurses, doctors, physicians and medical residents or “house
officers” (CMH Lahore, 2015).

A house officer is a resident physician and surgeon of a hospital (the "house") who is receiving
further training, usually in a medical or surgical specialty, while caring for patients under the
direction of an attending physician (Melissa Conrad Stoppler, 2024).

Interns and residents have always worked long hours in hospitals, and there has always been
much to admire about this. Beyond the educational benefits that accrue from observing the
natural history of disease and therapy, long hours help instill a sense of commitment to the
patient. House officers learn that becoming a doctor means learning to meet the needs of others.
This message has never been lost on them. However, it has also long been recognized that house
officers are routinely overworked. In the 1950s and 1960s, the hazards of sleep deprivation
became known, including mood changes, depression, impaired cognition, diminished
psychomotor functioning, difficulty with interpersonal relationships, and an increased risk of
driving accidents. This also results in unhealthy eating habits, and skipping their meals, which in
turn might affect weight and thus the BMI (M.Ludmerer, 2014).

Body Mass Index (BMI) is a person’s weight in kilograms divided by the square of height in
meters. A high BMI can indicate high body fatness. BMI screens for weight categories that may
lead to health problems, but it does not diagnose the body fatness of an individual (CDC, 2022).

The anthropometric indicator- body mass index (BMI) is most often used to assess the nutritional
and health status. BMI is directly related to eating habits. Consumption of plant-based foods and
fish is associated with lower BMI. Meat and foods rich in carbohydrates lead to increased BMI.
Skipping breakfast in the morning also affects BMI. According to scientists, skipping breakfast
leads to increased BMI. Late dinner also increases BMI. People who dine late and skip breakfast
are more prone to weight gain. According to WHO, BMI was developed as an indicator of health
status. As BMI increases, the risk of developing diabetes, obesity, cardiovascular, endocrine,
cancer, and other diseases increases (Department of Epidemiology, 2022).

Long work hours are associated with more frequent use of garage vending machines and higher
BMI. Long work hours may increase dependence upon food availability at the worksite, which
highlights the importance of availability of healthy food choices. Adequate nutrition and
hydration play important roles in the maintenance of health and well-being of all individuals.
Given the high prevalence of burnout in physicians, it is believed that in addition to issues
related to heavy workload, structure and length of shifts, the current status of physicians'
nutrition and hydration also effects their work performance and well-being (Maryam S Hamidi,
2016).

OBJECTIVES

Following are the objectives for this study:

 To evaluate the dietary habits of house officers

 To evaluate its effect on BMI of house officers

REVIEW OF LITERATURE

A study was conducted by Department of Community Health Sciences Bahria University

Medical and Dental College, Karachi at the June 2020 to July 2020. A total of 161 house officers
participated in the study, of which, most (73.9%) house officers were females, with a mean age
of 24.7± 2.2 years. An association between the officers’ junk food consumption and
psychological distress was found to be statistically significant, p < 0.05. Similarly, a significant
positive correlation was observed between dietary behavior and distress, p < 0.05. COVID-19
pandemic has increased the burden on healthcare professionals globally and to cope with the
situation the house officers are resorting to harmful behaviors such as consuming an unhealthy
diet in Karachi. If not addressed, these behaviors will last and deteriorate their overall health and
wellbeing in the long run (Khan, Haque, Siddique, Khan, & Mushtaq, 2022).

A cross-sectional study was conducted by analyzing secondary data from the 2019 annual
cardiovascular health screening program, which included information regarding all government
health-care workers in the east coast region of Peninsular Malaysia. The BMI was categorized
according to WHO criteria. Only 43% of the subjects had a normal BMI, while 33.1% were
categorized as overweight, and 21.1% were obese (Nor Akma Yunus, 2022).

A survey was conducted involving 114 EM programs participated (54%). The primary teaching
site included 43 community hospitals, 23 county hospitals, and 48 university hospitals. Resident
access to an onsite hospital cafeteria was most common (97%); other onsite options were
vending machines (87%), fresh food fridges (34%), national chains (32%), local restaurants
(25%), food trucks (30%), and farmer's markets (11%). More than one-third (38%) reported that
onsite options did not include healthy food, 26% reported being dissatisfied with onsite food, and
35% rarely or never purchased food onsite (Amy V. Kontrick, 2023).

A study was conducted among three groups of healthcare professionals (Doctors, Dentists and
Nurses) across the province Punjab after their consent. 1,319 healthcare professionals took part
in the study (response rate of 87.35). A total of 1,190 healthcare professionals formed the final
sample with doctors and nurses forming the major proportion. Out of 1,190 participants only one
healthcare professional was found who eat according to USDA Dietary Guidelines; others ate
more of protein group and less of fruits, dairy and vegetable groups. 76% did not perform any
exercise. 71.5% worked >48 h/week. More than 50% of healthcare professionals were sleeping
<7 h/day (CMH Lahore, 2015).

A cross-sectional survey was conducted at four medical colleges of Lahore, Pakistan between
March and June 2012. A total of 244 medical students (85 males, 159 females) of the median age
of 20 years (range: 18–25) were randomly included in the study. Approximately, 30.5% males
and 16% females had BMI ≥25.0 kg/m2 overall affecting 21% of total medical students. Central
obesity was found in 46% of male and 31.4% of female students. Central obesity was associated
with a higher total daily caloric intake, studying at private medical college and male gender.
Overall, 197 of 244 (80.7%) students played no sports in college. Median time to watch
television or work on the computer was 120 min a day (range: 30–420). Only 70 (28.7%)
students had regular walk or jogging (Department of Medicine, High prevalence of preobesity
and obesity among medical students of Lahore and its relation with dietary habits and physical
activity, 2016).
A study was conducted, including 72 resident physicians (52 women and 20 men) who
underwent the following assessments: nutritional assessment, anthropometric variables, fasting
metabolism (lipids, cortisol, high-sensitivity C-reactive protein), physical activity level, sleep
quality, and sleepiness. We observed a high frequency of residents who were overweight or obese
(65% for men and 21% for women; p = 0.004). Men displayed significantly greater body mass
index (BMI) values (p = 0.002) and self-reported weight gain after the beginning of residency (p
= 0.008) than women. Poor diet was observed for both genders, including the low intake of
vegetables and fruits and the high intake of sweets, saturated fat, cholesterol, and caffeine.
Women had significantly higher mean high-density lipoprotein cholesterol (Maria Carliana Mota,
2013).

A study was conducted to examine the relationship between chronotype and food intake, physical
sleep and activity in 72 resident physicians (52 women and 20 men). It showed that the
chronotype score was negatively associated with cholesterol (coefficient = −0.24; p = 0.04),
sweets (coefficient = −0.27, p = 0.03) and vegetables (coefficient = −0.26; p = 0.04) intakes. We
concluded that most issues related to nutrition problems and unhealthy lifestyle was associated
with scores indicative of eveningness. These findings emphasize the importance of assessing an
individual’s chronotype when examining feeding behavior (Maria Calarina Mota, 2016).

A study was conducted to describe body mass index (BMI), blood pressure, eating habits, and
physical activity during postgraduate training. BMI and blood pressure were objectively
measured, and an eating and exercise habits recall was obtained for 375 enrolled medical and
surgical residents (93 longitudinally) at the onset of each postgraduate year (PGY) in 2006, 2007,
and 2008. Nearly half (43%) of overweight residents described themselves as normal weight.
Residents were more likely to be overweight (BMI ≥25) at the beginning of PGY-3 than at the
beginning of PGY-1 (Maya Leventer Roberts, Overweight physicians during residency: a cross-
sectional and longitudinal study, 2013).

METHODOLOGY

Sampling technique
The sample was collected by convenient sampling technique

Sample size

The sample included 60 house officers to determine their dietary habits and its effect on their
BMI

Inclusion criteria

On duty house officers who don’t have any diagnosed chronic disease

Exclusion criteria

On duty house officers who have diagnosed chronic disease

Study population

The target population was on-duty house officers

Data collection tool

The data from participants was collected by self-made questionnaire

Study site

The data was collected from on-duty house officers at Fatima Memorial Hospital

Study design

The cross-sectional observational method was used to collect data

Statistical analysis

For data analysis, Excel (2013) was used. The results were represented by pie charts and bar
graphs.

RESULTS AND DISSCUSION

The study aimed to evaluate the impact of house officers' dietary habits on their BMI. The results
revealed a noteworthy contrast, as 11% of house officers were classified as underweight, 66%
fell within the healthy weight range, and 21% were categorized as overweight. This incongruity

suggests a divergence between their BMI classifications and their dietary patterns.

BMI of house officers

1
21% 1
%

under weight
healthy weight
over weight

67%

Figure1.1. BMI ranges of house officers

The findings reveal that, considering BMI ranges, 11% of house officers were categorized as
underweight, 67% fell within the healthy weight range, and 22% were classified as overweight.
 How has house job affected your weight?

18 3% 25
% %

increased
decreased
no change
don’t know

53%

Figure1.2. Effect of house job on weight of house officers

The house job has had an impact on the weight of house officers, with the following outcomes:
53% experienced a decrease in weight, 25% saw an increase in weight, 18% reported no change,
and 2% were unsure whether their weight had changed or not.

Intake of different empty caloric products in a week

60

50

40 rarely(never or 1 time/week)
sometimes(1-2 times/week)
30 often(3-4 times/week)
always(6-7 times/week)
20

10

0
junk food carbonated tea/coffee bakery items
drinks

Figure1.3. Intake of different empty caloric products in a week

This indicates that a majority of individuals during their duty consumed empty-calorie products
3-4 times a week, with nearly daily intake of caffeine. A small number only indulged in these
empty-calorie items once a week, but even among them, caffeine consumption was almost a
daily occurrence.

Food frequency questionnaire

fats and nuts

vegetables
>4 times/day
2-3 times/day
fruits
1 time/day
2-4 times/week
protein(meat,egg) 1 time/week

bread and cereals

dairyproducts

0 10 20 30 40 50 60
Figure
1.4. Food frequency questionnaire

Figure 1.4 showed that, the dietary habits of house officers are deficient in daily consumption
across all six food groups. The majority of individuals tend to consume higher quantities of dairy
items, moderate amounts of cereals and protein, with limited servings from vegetables.
Additionally, fruits are consumed only 2-3 times per week, and nuts are the least frequently
consumed, occurring only once per week.

CONCLUSION

The survey findings lead to the conclusion that, while the majority of house officers fall within
the healthy BMI range, their dietary habits do not align with a balanced diet. A significant
number of participants are not consuming the recommended servings from each food group.
Additionally, many house officers have experienced weight loss, often attributed to daily meal
skipping due to their demanding job routines. Furthermore, the consumption of empty calories is
prevalent throughout the week. Notably, a few house officers fall into the overweight category
based on their BMI, indicating unhealthy dietary habits within this subgroup.

RECOMMENDATIONS

House officers are advised to adopt a more balanced diet by incorporating recommended
servings from all six food groups into their daily meals. It is recommended that they steer clear
of empty-calorie foods such as junk foods, bakery items, and carbonated drinks. Additionally,
limiting caffeine intake is advisable. Choosing healthy options from available food sources and
opting for home-cooked meals are also encouraged practices.

REFERENCES

Amy V. Kontrick, M. D. (2023). Do emergency medicine residents have access to healthy food
options during work hours?

CDC, d. o. (2022). Body Mass Index (BMI).

CMH Lahore, S. a. (2015). Diet, exercise and mental-wellbeing of healthcare professionals

(doctors, dentists and nurses) in Pakistan.

Department of Epidemiology, m. c. (2022). Dependence of Body Mass Index on Some Dietary

Habits: An Application of Classification and Regression Tree.

Department of Medicine, A. N.-e.-G. (2016). High prevalence of preobesity and obesity among
medical students of Lahore and its relation with dietary habits and physical activity.

Khan, M., Haque, A., Siddique, S., Khan, M., & Mushtaq, S. (2022). Pandemic, Association of
Dietary Behavior with Psychological Distress among House Officers in Karachi during
Coronavirus Disease.

M.Ludmerer, K. (2014). The origin of work-hour regulations for house officers.

Maria Calarina Mota, J. W.-S. (2016). Association between chronotype, food intake and physical
activity in medical residents.

Maria Carliana Mota, D. A.-S. (2013). Dietary Patterns, Metabolic Markers and Subjective Sleep
Measures in Resident Physicians.

Maryam S Hamidi, M. K. (2016). Running on empty: a review of nutrition and physicians' well-
being.
Maya Leventer Roberts, M. R. (2013). Overweight physicians during residency: a cross-sectional
and longitudinal study.

Melissa Conrad Stoppler, M. (2024). definition of house officer. Retrieved 2024, from rxlist

Nor Akma Yunus, G. R.-E. (2022). The perceptions of healthcare practitioners on obesity
management in Peninsular Malaysia: a cross-sectional survey.