|Year : 2021 | Volume
| Issue : 1 | Page : 143-148
Prevalence of obesity and overweight among type 2 diabetic patients in Bisha, Saudi Arabia
Mohammad S AlShahrani
Department of Family Medicine, College of Medicine, University of Bisha, Bisha, Saudi Arabia
|Date of Submission||04-Jul-2020|
|Date of Decision||13-Sep-2020|
|Date of Acceptance||12-Oct-2020|
|Date of Web Publication||30-Jan-2021|
Dr. Mohammad S AlShahrani
University of Bisha, Post Box 551, PC 61922 Bisha
Source of Support: None, Conflict of Interest: None
Context: Obesity is a significant worldwide public health issue and one of the significant risk factors for type 2 diabetes and cardiovascular diseases. Aims: This study aims to determine the prevalence of obesity and overweight among type 2 diabetic patients, and explore the association between Body Mass Index (BMI), social demographics and time since diagnosis. Settings and Design: This study followed a cross-sectional study design in Bisha, Saudi Arabia. Methods and Material: Participants were identified by convenience sampling from 6 Primary Health Care Centers (PHCC) over a period of two weeks from March 16 to March 28, 2020. Statistical Analysis Used: Frequency and percentage were used to report the obesity prevalence. Chi-Square test was used to test the association between social demographics and time since diagnosis with BMI. Results: Obesity and overweight prevalence was 85.8% (n = 525), among which 27.9% (n = 171) were overweight, 57.8% were obese (n = 354), and only 13.2% (n = 81) had normal weight. A statistically significant difference between BMI and age was observed (P = 0.01). Differences between BMI and time since obesity diagnosis were statistically significant (P < 0.0001). Differences between BMI and time since type 2 diabetes diagnosis were not found to be statistically significant. Conclusion: There is a high prevalence of obesity and overweight among type 2 diabetic patients in Bisha. Differences in BMI were found to be statistically significant according to age, gender, education level and time since obesity diagnosis. Patient education programs and public health awareness about diabetes and obesity are highly recommended.
Keywords: Diabetes mellitus, obesity, overweight, Saudi Arabia, type 2
|How to cite this article:|
AlShahrani MS. Prevalence of obesity and overweight among type 2 diabetic patients in Bisha, Saudi Arabia. J Family Med Prim Care 2021;10:143-8
|How to cite this URL:|
AlShahrani MS. Prevalence of obesity and overweight among type 2 diabetic patients in Bisha, Saudi Arabia. J Family Med Prim Care [serial online] 2021 [cited 2021 Feb 26];10:143-8. Available from: https://www.jfmpc.com/text.asp?2021/10/1/143/307893
| Introduction|| |
Over recent decades, obesity prevalence has flooded in numerous nations around the globe. The World Health Organization (WHO) characterizes obesity as the disease in which the abundance of body fat has become so much that health might be at odds.
Obesity is firmly connected with other metabolic disorders, including hypertension, diabetes, cardiovascular disease, dyslipidemia, and some cancers. It is a significant factor of the type 2 diabetes (T2DM) epidemic where almost 88% of those with T2DM are viewed as overweight or obese.
In spite of the expanded risk of poor clinical results and negative effect on the quality of life, just a single portion of people with diabetes and other chronic conditions get guiding on diet or potentially practice by their primary care provider.
For as far back as twenty years there has been a critical increment in obesity rates in Saudi Arabia and Gulf countries.,, A recent Saudi study found obesity and overweight among the high prevalence and risk factors of T2DM.
Bisha is a small town in the southern region of Saudi Arabia. Few studies have been conducted to report the prevalence of obesity in the province of Bisha, Saudi Arabia. This study aims to determine the prevalence of obesity and overweight among type 2 diabetic patients and explore the association between Body Mass Index (BMI), social demographics and time since diagnosis.
The results of this study will be reflected on better understating of the relation between obesity prevalence and T2DM, effective ways to tackle this issue and optimal practice for primary care physicians.
| Methods|| |
This study followed a cross-sectional study design. A total of 612 diabetic patients were identified by convenience sampling to participate in this study from 6 Primary Health Care Centers (PHCC) in Bisha, Saudi Arabia, over a period of two weeks from March 16 to March 28, 2020. Approval from the ethics committee was obtained on March 4, 2020.
Weight was measured using calibrated scales in PHCC, and height was taken in the same setting through experienced nurses using standard techniques. BMI was calculated according to person's weight in kilograms divided by the square of the person's height in meters, and World Health Organization's (WHO) classification of overweight and obesity was used.
The collected data were entered into the computer (MS-Office, Excel), after which was subjected to statistical analyses using SPSS Version 22. Frequency and percentage were used to report the obesity prevalence. Chi-Square test was used to test the association between social demographics and time since diagnosis with BMI.
A P value of less than 0.05 was considered to represent statistical significance.
Prior to data collection, an official ethical and institutional approval was obtained. An informed consent was provided to all participants. Collected data were kept fully confidential and were used only for research purposes. The study was self-funded. Some participations were not complete, with frequent missing responses.
| Results|| |
[Table 1] shows socio demographic data of participants. A total of 612 type 2 diabetic patients participated in this study. Male participants were 298 (48.7%) and females were 314 (51.3%). Almost half participants were among the 41-60 years age group (49.5%, n = 303). A quarter of participants were illiterate (25%, n = 153), while 28.1% (n = 172) had acquired primary level education and 22.7% (139) had university level education.
[Table 2] shows the time since each participant was diagnosed with obesity and type 2 diabetes. For obesity, almost a quarter of participants were not obese (24.7%, n = 151), 152 participants (24.8%) were diagnosed between 3 to 5 years ago, and 156 (25.5%) were diagnosed between 6 to 10 years ago.
For type 2 diabetes, fifty-three participants (8.7%) were diagnosed less than two years ago, 115 participants (18.8%) were diagnosed between 3 to 5 years ago, 194 (31.7%) were diagnosed between 6 to 10 years ago, while 250 (40.8%) were diagnosed more than 10 years ago.
[Table 3] shows the BMI distribution among participants. A total of 171 participants (27.9%) were overweight and 354 participants (57.8%) were obese. A third of participants (n = 206) were classified as class I obese, 105 participants (17.2%) were class II obese, and 43 participants (7%) were class III obese.
[Table 4] shows the BMI distribution according to age group. Differences between BMI and age group were statistically significant (P = 0.01).
[Table 5] shows the BMI distribution according to Gender. Differences between BMI and gender were statistically significant (P < 0.0001).
[Table 6] shows the BMI distribution according to education level. Differences between BMI and education level were statistically significant (P = 0.004).
[Table 7] shows the BMI distribution according to time since obesity diagnosis. Differences between BMI and time since obesity diagnosis were statistically significant (P < 0.0001).
[Table 8] shows the BMI distribution according to type 2 diabetes diagnosis.
| Discussion|| |
This study aimed to determine the prevalence of obesity and overweight among type 2 diabetic patients, and explore the association between BMI, social demographics, and time since diagnosis.
The current study results revealed an obesity and overweight prevalence of 85.8% (n = 525), among which 27.9% (n = 171) were overweight, 57.8% were obese (n = 354), and only 13.2% (n = 81) had normal weight. Moreover, the number of overweight and obese females (47.1%, n = 288) was significantly higher than its corresponding number in males (38.7%, n = 237, P < 0.0001).
These findings are in line with a number of Saudi studies. A study by Mugharbel and Al-Mansouri reported high prevalence of overweight and obesity among type 2 diabetics (71.1%, n = 271). Findings by Bakhotmah also reported high prevalence of obesity among type 2 diabetics (76.6%, n = 572), with a number of obese females (34.1% n = 195) that is more than double its corresponding number in males (14.3%, n = 82). In a study by Alqurashi et al., a statistically significant higher prevalence of obesity among type 2 diabetic females was observed (83.1%, P = 0.008).
Moreover, similar findings were observed globally. In Tanzania, Damian et al. reported high prevalence of overweight and obesity among type 2 diabetics (85%), and a higher prevalence among females (92.2%) than males (69.9%). Similar findings were reported in the United States, United Kingdom, Nepal, Iran, Yemen and Ghana.,,,,,,
There exists a high prevalence of overweight and obesity among type 2 diabetics which might be explained by the vast junk food market in Saudi Arabia, as well as the continuous modernization and development of infrastructure which encourages fewer physical activity such as drive-thru automated teller machines (ATM), online groceries and food delivery.
The significant gender difference in the prevalence of overweight and obesity among diabetics might be caused by physiological and genetic factors. Other factors could also be attributed to differences in eating behavior and lifestyle between males and females in Saudi Arabia.
In the current study, the highest numbers of obese and overweight participants were observed among the 41–80 age groups (71.6%, n = 438) with a statistically significant difference between BMI and age groups (P = 0.01).
These findings are in concordance with several studies which reported a significant effect of age on the occurrence of diabetes., However, other studies reported an inverse linear relationship between BMI and age groups., Difference in study settings and population may account for the difference in results. In addition, most participants in the current study were above 40 years, and therefore the age range and sample size limitation might contribute to different findings.
In this study, differences between BMI and education level were statistically significant (p = 0.004). Similar findings were reported by Sánchez et al. where low education level was independently associated with the presence of obesity. Another study by Seiglie et al. found that greater level of educational attainment was associated with higher diabetes risk.
However, while obesity and overweight are considered factors contributing to the expanding diabetes epidemic, several studies have concluded that higher BMI is not the sole contributor to the relationship between education level and risk of diabetes.,
In the present study, differences between BMI and time since obesity diagnosis were statistically significant (P < 0.0001). However, differences between BMI and time since type 2 diabetes diagnosis were not found to be statistically significant.
Several studies report a diagnosis driven lifestyle, behavior change and physical activity. In a study conducted by Schneider et al., it was found that participants who received a diabetes diagnosis were more likely to increase their physical activity. Another study by Penn et al. reported the diagnosis as a motivational factor for participants to exercise and follow a healthy diet. Findings by Chong et al. report changes in participants lifestyle after receiving their diagnosis.
These findings may be explained by the knowledge of diagnosis acting as a threat or call to action, and therefore contributing to a change in lifestyle, behavior and habits. Differences between our findings and other study findings may be due to the limited sample size and population, as well as the study setting.
However, it is important to note that the practice of primary care physicians can affect prevalence of obesity. Physicians often overlook obesity by under coding it. Findings by Mattar et al. suggest that physicians usually document obesity in patients' records for those with morbid obesity. Patients with slightly lower BMI scores are often undocumented.
Therefore, findings of the current study can be concluded in the following conclusion.
| Conclusion|| |
There is a high prevalence of obesity and overweight among type 2 diabetic patients in Bisha, with higher prevalence among females than males. Differences in BMI were found to be statistically significant according to age, gender, education level and time since obesity diagnosis. Patient education programs, public health awareness, and trainings and seminars for primary care physicians on how to deal with obesity and overweight patients are highly recommended for effective primary care practice and better public health. Further research is required to further understand the prevalence of obesity among type 2 diabetic patients and its health implications.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pradeepa R, Anjana RM, Joshi SR, Bhansali A, Deepa M, Joshi PP, et al
. Prevalence of generalized and abdominal obesity in urban and rural India--the ICMRINDIAB Study (Phase-I) [ICMR- NDIAB-3]. Indian J Med Res 2015;142:139-50.
] [Full text]
Vasanthakumar J, Kambar S. Prevalence of obesity among type 2 diabetes mellitus patients in urban areas of Belagavi. Indian J Health Sci Biomed Res 2020;13:21-7. [Full text]
Shubrook J, Brannan G, Wapner A, Klein G, Schwartz F. Time Needed for Diabetes Self-Care: Nationwide Survey of Certified Diabetes Educators. Diabetes Spectrum. 2018;31:267-271.
Alhyas L, Mckay A, Balasanthiran A, Majeed A. Prevalences of overweight, obesity, hyperglycaemia, hypertension and dyslipidaemia in the Gulf: Systematic review. JRSM Short Rep 2011;2:1-16.
Aljaadi A, Alharbi M. Overweight and Obesity Among Saudi Children: Prevalence, Lifestyle Factors, and Health Impacts. Handbook of Healthcare in the Arab World. 2020;:1-25.
Gezawa ID, Uloko AE, Gwaram BA, Ibrahim DA, Ugwu ET, Mohammed IY. Pattern of obesity among patients with type 2 diabetes at a tertiary healthcare center in Northern Nigeria. Diabetes Metab Syndr Obes 2019;12:2785-90.
Al Mansour M. The prevalence and risk factors of type 2 diabetes mellitus (DMT2) in a semi-urban Saudi population. Int J Environ Res Public Health 2019;17:7.
Mugharbel KM, Al-Mansouri MA. Prevalence of obesity among type 2 diabetic patients in Al-khobar primary health care centers. J Family Community Med 2003;10:49-53.
Abed Bakhotmah B. Prevalence of obesity among type 2 diabetic patients: Non-smokers housewives are the most affected in Jeddah, Saudi Arabia. Open J Endocr Metab Dis 2013;3:25-30.
Alqurashi KA, Aljabri KS, Bokhari SA. Prevalence of diabetes mellitus in a Saudi community. Ann Saudi Med 2011;31:19-23.
] [Full text]
Damian D, Kimaro K, Mselle G, Kaaya R, Lyaruu I. Prevalence of overweight and obesity among type 2 diabetic patients attending diabetes clinics in Northern Tanzania. BMC Res Notes 2017;10:515.
Hillier TA, Pedula KL. Characteristics of an adult population with newly diagnosed type 2 diabetes: The relation of obesity and age of onset. Diabetes Care 2001;24:1522-7.
Daousi C, Casson IF, Gill GV, MacFarlane IA, Wilding JP, Pinkney JH. Prevalence of obesity in type 2 diabetes in secondary care: Association with cardiovascular risk factors. Postgrad Med J 2006;82:280-4.
Basukala A, Sharma M, Pandeya A. Prevalence of overweight and obesity among patients with type 2 diabetes mellitus in Kathmandu. Age (years) 2014;3:60–4.
Marjani A. Prevalence of obesity among type 2 diabetes mellitus in Gorgan (South East of Caspian Sea), Iran. J Chin Clin Med 2011;6:85-92.
Al-Sharafi B, Gunaid A. Prevalence of obesity in patients with type 2 diabetes mellitus in Yemen. Int J Endocrinol Metab 2014;12:e13633.
Obirikorang Y, Obirikorang C, Odame Anto E, Acheampong E, Dzah N, Akosah C, et al
. Knowledge and lifestyle-associated prevalence of obesity among newly diagnosed type II diabetes mellitus patients attending diabetic clinic at Komfo Anokye teaching hospital, Kumasi, Ghana: A hospital-based cross-sectional study. J Diabetes Res 2016;2016:1-10.
Wild S, Roglic G, Green A, Kng H. Global prevalence of Diabetes. Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.
Alhazmi RS, Ahmed AAB, Alshalan MH, Alfuhigi ZD, Alhazmi SF, Aldughmi AN, et al
. Prevalence of diabetes mellitus and its relation with obesity in Turaif (Saudi Arabia) in 2017. Electron Physician 2017;9:5531-5.
Chen Y, Zhang X-P, Yuan J, Cai B, Wang X-L, Wu X-L, et al
. Association of body mass index and age with incident diabetes in Chinese adults: A population-based cohort study. BMJ Open 2018;8:e021768.
Atique SM, Shadbolt B, Marley P, Farshid A. Association between body mass index and age of presentation with symptomatic coronary artery disease. Clin Cardiol 2016;39:653-7.
Sánchez CN, Maddalena N, Penalba M, Quarleri M, Torres V, Wachs A. Relación entre nivel de instrucción y exceso de peso en pacientes de consulta externa. Estudio transversal [Relationship between level of education and overweight in outpatients. A transversal study]. Medicina (B Aires) 2017;77:291-6.
Seiglie J, Marcus M, Ebert C, Prodromidis N, Geldsetzer P, Theilmann M, et al
. Diabetes prevalence and its relationship with education, wealth, and BMI in 29 low- and middle-income countries. Diabetes Care 2020;43:767-75.
Steele C, Schöttker B, Marshall A, Kouvonen A, O'Doherty M, Mons U, et al
. Education achievement and type 2 diabetes—what mediates the relationship in older adults? Data from the ESTHER study: A population-based cohort study. BMJ Open 2017;7:e013569.
Williams E, Tapp R, Magliano D, Shaw J, Zimmet P, Oldenburg B. Health behaviours, socioeconomic status and diabetes incidence: The Australian diabetes obesity and lifestyle study (AusDiab). Diabetologia 2010;53:2538-45.
Schneider K, Andrews C, Hovey K, Seguin R, Manini T, LaMonte M, et al
. Change in physical activity after a diabetes diagnosis. Med Sci Sports Exerc 2014;46:84-91.
Penn L, Moffatt SM, White M. Participants' perspective on maintaining behaviour change: A qualitative study within the European diabetes prevention study. BMC Public Health 2008;8:235.
Chong S, Ding D, Byun R, Comino E, Bauman A, Jalaludin B. Lifestyle changes after a diagnosis of type 2 diabetes. Diabetes Spectr 2017;30:43-50.
Mattar A, Carlston D, Sariol G, Yu T, Almustafa A, Melton G, et al
. The prevalence of obesity documentation in primary care electronic medical records. Appl Clin Inform 2017;8:67-79.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]