ABSTRACT

The study focused on “prevalence and risk factors associated with overweight among civil
servants in Imo State, Nigeria”. The general objective of this study was to determine the
prevalence and risk factors associated with overweight. A cross-sectional descriptive study
design was used for this study with a quantitative approach. The instruments used for the
study were semi-structured questionnaire, stadiometer, digital weighing balance, and
calibrated measuring tape. Data were analyzed using the Microsoft Excel 2007 and Statistical
Package for Social Sciences (SPSS) software version 20. The results showed that The result
the study shows that prevalence of overweight (34.0%) and obesity (22.6%) was high among
the respondents, and it affects both gender (males and females). The three major perceived
risk factors identified to be connected with overweight and obesity were; sedentary lifestyle
(322; 76.7%), consuming of foods high in fat and sugar (308; 73.3%) and consumption of
junks/fast foods (283; 67.4%). This study further revealed that racism/ethnicity (100; 23.8%)
is a perceived risk factor associated with respondent’s being overweight and obese. The study
recommended that those who are overweight or obese should be engaged in regular physical
activity to mitigate health hazards associated with overweight and obesity. Individuals should
avoid lifestyle (alcohol use, smoking, eating late at night, excessive consumption of foods
capable of exposing one to obesity) and adhere strictly to potentially good behavior.
 CHAPTER ONE

INTRODUCTION
1.1 Background of the study

Overweight can be explained as the imbalance between energy intake and expenditure

such that surplus energy is stored in fat cells (Heymsfield & Wadden, 2017).Overweight and

obesity are defined as irregular or excessive fat accumulation that may impair health (WHO,

2019). Overweight and obesity are disorders of energy metabolism involving excess adipose

tissues stored which may be associated with medical and psychological morbidity

(Heymsfield & Wadden, 2017). 

Worldwide, being overweight or obsessed has become public health problem in the

general population. Many determinants of overweight and obesity have been reported by

different scholars. Different biomarkers of obesity were identified for the guess of obesity.

Although researchers reflection the factors, biomarkers, consequences, and prevention

mechanisms, there is a lack of cumulative data about obesity. Although the factors differ

across regions and socioeconomic levels, socio-demographic, behavioral, and genetic factors

are prominent in the development of obesity. There are lot of biomarkers for obesity, of

which microRNA, adipocytes, oxidative stress, blood cell profile, nutrients, and microbiota

were promising biomarkers for determination of the occurrence of obesity. Since the

consequences of obesity are vast and interrelated, multidimensional prevention strategy is

mandatory in all nations (Melese & Gedefaw, 2020).

With the prevalence of overweight obesity among the workforce being the same to

that of the general population (Luckhaupt, Cohen, Li & Calvert, 2014), the occupational

safety and health discipline have revealed interest and effectively contributed to obesity

research. The effects of obesity on work performance, physical capacity, and physical and

cognitive function have been the research focus of many ergonomists, work analysts, and

occupational health experts. Consequently, employees who are obese have been found to
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have higher rates of sick leave (Neovius, Johansson, Kark & Neovius, 2009) and workplace

injuries (Pollack, Sorock, Slade, Cantley, Sircar, Taiwo, et al, 2007), along with increased

employer-paid healthcare costs (Schmier, Jones & Halpern, 2006).Most civil servants are not

spared the problems of overweight and obesity. Health-care workers who are directly

involved in the management of patients are seen to be either overweight or obese (Arojo &

Osungbade, 2013). This is taking a toll on the level of care rendered to the patients. Health-

care workers are faced with various complications of excessive weights thereby affecting

patients' confidence in their counsel or care (Arojo & Osungbade, 2013). The prevalence of

overweight and obesity has been reported to be high among Nigerians. A systematic review

revealed the prevalence of overweight as 20.3%–35.1%, and the prevalence of obesity as

8.1%–22.2% (Kana, 2009). Therefore, the need to assess the prevalence of overweight among

the civil servants.

A simple index of weight-for-height that is commonly used to classify overweight and

obesity in adults is the Body Mass Index (BMI). It is defined as a person's weight in

kilograms divided by the square of his height in meters (kg/m 2) (WHO, 2019). WHO defines

overweight and obesity for adults as BMI greater than or equal to 25 kilogram per meter

square; and obesity is a BMI greater than or equal to 30 kilogram per meter square (WHO,

2019).BMI offers the most useful population-level measure of overweight and obesity as it is

the same for both sexes and for all ages of adults. However, it should be seen as a rough

guide because it may not correspond to the same degree of fatness in different individuals. In

2016, about 13% of the world’s adult population (11% of men and 15% of women) were

obese.

In India, the prevalence of obesity among reproductive-age women was 5.1%, 15.7%

in Palestinian schoolchildren, and 34.8% among adult populations of Saudi Arabia. In

Kuwait, the prevalence of overweight and obesity was 40.9% among children aged 6–8 years

(Al-Raddadi, Bahijri, Jambi, Ferns &Tuomilehto, 2019). A systematic review done in Africa

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among primary school educators indicated that the continental figure of obesity has

increased. In this review, the magnitude of obesity was measured based on three international

standards, i.e., World Health Organization (WHO), Center for Disease Control (CDC), and

International Obesity Taskforce (IOTF) cutoff points. Based on the criteria stated above, the

prevalence of obesity was 6.1% (WHO criteria), 4.0% (IOTF criteria), and 6.9% (CDC

criteria).

Generally, the prevalence of obesity in Africa among adults and schoolchildren lies

between 4.4% and 21.2% (Adom, Kengne, De Villiers, &Puoane, 2019).Another critical

issue is currently the emerging sarcopenic obesity, which is defined as loss of skeletal muscle

and excess body fat accumulation. Clinically, it can be diagnosed through muscle biopsy,

computed tomography or magnetic resonance spectroscopy, bioelectrical impedance analysis

(BIA), and dual energy X-ray. Primarily, the consequence of sarcopenic obesity end is liver

cell damage either carcinogen or any abnormality (Baffy, 2019). It is highly prevalent in elder

population even though it did not get emphasis in majority of countries. Different scholars

reference a lot of predisposing factors which vary depending on geography, social conditions,

political and economic factors, and human genetics. In total, the commonest factors were

socio-demographic, behavioral, genetic, and living in obesogenic environment (Melese &

Gedefaw, 2020).

1.2 Statement of the problem

Obesity is a multifaceted chronic global disease affecting people worldwide across all

ages, sexes, ethnicities, and nationalities (De Luca, Angrisani & Himpens, 2016).Overweight

and obesity are the fifth leading risk of global death with at least 2.8 million adults’ deaths

each year from problems of overweight and obesity (WHO, 2018). The World Health

Organization mentioned that 1.9 billion of the world population is overweight while 650

million are obese as at 2016 (WHO, 2018). In addition, 44% of diabetes mellitus burden,

23% of ischemic heart diseases, and 7%–41% of certain cancer burden are attributable to

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overweight and obesity (WHO, 2018).Health risks associated with obesity include coronary

heart disease and other atherosclerotic cardiovascular diseases, stroke, type 2 diabetes

mellitus, high blood pressure, kidney disease, sleep apnea, osteoarthritis, gallstones, fatty

liver disease, stress incontinence, and other gynecological abnormalities (amenorrhea and

menorrhagia) and various cancers (National Institute of Health, 2018). 

Globally, obesity has reached epidemic proportion, with at least 2.8 million people

dying each year because of being overweight or obese. Once associated with high-income

countries, obesity is now also prevalent in low- and middle-income countries (WHO,

2020).More than 1.9 billion adults, 18 years and older, were overweight in 2016. Of these

over 650 million were obese. 39% of adults aged 18 years and over were overweight in 2016,

and 13% were obese (WHO, 2019).The prevalence of obesity is known to differ significantly

across the world (Balkau, Deanfield & Després, 2015).

In Africa, a systematic review by Ofori-Asenso fixed overweight and obesity

prevalence of Ghana at 42.5% (Ofori-Asenso, Agyeman, Laar & Boateng, 2016). The study

showed significant differences between Africa countries. In the latest survey, Egypt has the

highest prevalence of obesity by far. Two out of every five Egyptians (39%) are obese,

followed by Ghana at 22% (Dickson, 2018). Egypt and Ghana also experienced a significant

increase in obesity over the past 25 years — from 34% to 39% (13% increase) in Egypt and

8% to 22% in Ghana (65% increase). The increase in obesity has doubled in Kenya, Benin,

Niger, Rwanda, Ivory Coast and Uganda, while Zambia, Burkina Faso, Mali, Malawi, and

Tanzania experienced a three-fold increase (Dickson, 2018).According to Ono, Guthold &

Strong, (2012), among people aged 15 years and above, the WHO estimated that the

prevalence of overweight and obesity in 2010 was as high as 63.8% and 21.3% respectively,

for men, and 73.8% and 43.2% respectively, for women, in some Sub-Saharan Africa

countries. Eritrea, Ethiopia, Democratic Republic of the Congo, and Central African Republic

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had the lowest prevalence, while Seychelles, Lesotho, South Africa, and Mauritius had the

highest prevalence of overweight and obesity in Sub-Saharan Africa.

In Nigeria, based on the 2010 WHO survey data on Nigeria, the prevalence of

overweight was 26% and 37% in men and women respectively, while the prevalence of

obesity was 3% and 8.1% in men and women respectively. In Nigeria (Chukwuonye, Chuku,

John, Ohagwu, Imoh& Isa, 2013), the prevalence of obesity ranges from 8.1% to 22.2%.

1.3 Objectives of the study

1.3.1 General objective

The general objective of this study was to determine the prevalence and risk factors

associated with overweight among civil servants in Imo State, Nigeria.

1.3.2 Specific objectives

The specific objectives of this study were to:

1. Determine the prevalence of overweight among civil servants in Imo State State.

2. Determine the perceived risk factors of overweight and obesity among civil servants

in Imo State.

3. Assess the perceived preventive measures of overweight among civil servants in Imo

State.

1.3 Research hypothesis

Ho1: There is no statistically significant relationship of the prevalence of overweight with

socio-demographic characteristics of participants.

Ho2: There is no statistically significant association between known risk factors (smoking,

physical inactivity, consumption of food high in fat or sugar, family history, and sedentary

lifestyle) and overweight among the respondents.

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Ho4: There is no statistically significant association between known risk factors (smoking,

physical inactivity, consumption of food high in fat or sugar, family history& sedentary

lifestyle) and obesity among the respondents.

Ho5: There is no statistically significant association between BMI status with socio-

demographic characteristics of the respondents.

1.5 Significance of study

A study on overweight was needed because to the best of my knowledge there is

currently no study in Imo State that addresses the problem of overweight and among civil

servants. Hence, overweight and obesity among civil servants was not yet identified as a

problem in Imo State. Also, no established information on health implications of overweight,

as well as job consequences based on performance due to overweight among civil servants,

thus the need for this study.

The findings provided information on the prevalence and risk factors associated with

overweight among civil servants in Imo State. The findings also served as basis for further

studies by other researchers. The findings from this study are to be shared by the researcher

with relevant stakeholders for decision making in the interest of public health. The study also

aimed at providing information that could be useful in developing ways to avoiding diseases

that are derivatives of overweight and obesity thus improving their job performances.

1.6 Limitation of study

The study faced impediments caused by unwillingness of some of the respondents to

measure their body weight and height due to shyness and/or stigmatization especially, those

who perceived they were either overweight or obese.

To overcome this limitation, the researcher encouraged respondents who were shy

and/or stigmatized to measure their BMI, because their perception was not scientifically

based, and that their perception may be wrong. That not all who are seen to be fat by the

physical eyes are usually overweight or obese after anthropometric measurement.

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 Fortunately, a few who perceived were overweight/obese agreed to measure their BMI, and

some had normal weight to their amazement. This encouraged those respondents who were

unwilling to measure their weight and height participate fully in the study.

1.7 Operational definition of terms

i. Risk factors: This refers to those things that put Civil Servants in Imo State at risk of

developing overweight and obesity.

ii. Prevalence: Prevalence is the proportion of Civil Servants in Imo State who are overweight

and obese. Prevalence is a statistical concept referring to the number of cases of obesity that

are present in a particular population at a given time.

iii. Obesity: Obesity has been more precisely defined by the National Institutes of Health (the

NIH) as a Body Mass Index (BMI) of 30 and above. The BMI, a key index for relating

body weight to height, is a person’s weight in kilograms (kg) divided by their height in

meters (m) squared.

iv. Overweight: Overweight is BMI from 25 kilogram per meter squared to 29.9 kilogram per

meter squared.

v. Civil Servants: Civil Servants are those employed in the civil service for a Government

Ministry in Imo State.

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 CHAPTER TWO

LITERATURE REVIEW

The chapter looks at the review of the related literature which is an essential component of

research study as it provides a broad understanding of the research problem. The researcher

will make a thorough study on the available research sources, which has helped in projecting

the widened perspective of the study.

This chapter presents a review on assessment of determinants of cataract and shall be

reviewed under the following headings: Conceptual Review, Theoretical Review, Empirical

Review and Summary of Literature Review.

2.1: Conceptual Framework

2.1.1 Overview of the study

Being overweight (obese) is characterized by an excessive accumulation of body fat

that gives rise to significant comorbidities, such as diabetes, hypertension, dyslipidemia,

cardiovascular disease, and many cancers (Ortega & Lavie, 2018; Garg, Maurer, Reed &

Selagamsetty, 2014; Del Prato & Raz, 2013). Obesity is referred to as important public health

problem that requires urgent attention to prevent obesity-related health outcomes. In 2013, to

draw physicians’ attention to the condition, the American Medical Association classified

obesity as a disease (Addo, Nyarko & Sackey, 2015).

The prevalence of obesity is known to differ significantly across the world (Balkau,

Deanfield & Després, 2015). It is therefore important to design region-specific public health

policies, which requires the collection of epidemiological data relating to obesity from

different geographical areas. Overweight and obesity were previously regarded as the

problem of the high-income countries as two-third of the USA population are obese. They are

now on the increase in low- and middle-income countries, most especially in the urban

settings (Olufemi, 2013). According to Hruby and Hu, nutritional transition, sedentary

lifestyle, changing methods of transportation and increasing urbanization are fueling non-
8
communicable diseases (Hruby & Hu, 2015). Poor eating habit including increased

consumption of energy-dense food, high level of sugar, and saturated fats combined with

physical inactivity have led to increased prevalence of overweight and obesity in many parts

of the world (Kelly & Swinburn, 2015).

According to Esmaili, Bahreynian & Qorbani, (2015), obesity is now a worldwide

epidemic, with an estimated 57.8% of adults worldwide expected to be classified as obese by

2030 according to figures released by the World Health Organization (WHO). In the last 30

years, obesity increased globally. Surprisingly, it is also rising in low- and middle-income

countries due to absence of controlled urbanization and nutrition transition (shifting dietary

habit from traditional to westernized diet) (Ford, Patel, & Narayan, 2017). Data from the

WHO Global InfoBase regarding individuals aged 30 years and above, shows that the

prevalence of overweight and obesity together increased by 23% in men and 18% in women,

which totals 41%.

Globally, obesity has reached epidemic proportion with at least 2.8 million people

dying each year because of being overweight or obese. Once associated with high-income

countries, obesity is now also prevalent in low- and middle-income countries (WHO, 2020).

In 2016, more than 1.9 billion adults, 18 years and older were overweight. Of these, over 650

million were obese. 39% of adults aged 18 years and over were overweight in 2016, and 13%

were obese (WHO, 2019). The prevalence of obesity is known to differ significantly across

the world (Balkau, Deanfield & Després, 2015).

Regionally, overweight was heterogeneous in low- and middle-income countries

based on the trend. In the meantime, the prevalence of obesity in children aged 2–4 years has

increased moderately. In 1975, children with obesity aged 5–19 years were relatively

uncommon, but it becomes highly prevalent in 2016 (Assari & Bazargan, 2019). According

to WHO, (2019) obesity has been cited as a contributing factor to approximately 100,000–

400,000 deaths in the United States per year (including increased morbidity in car
9
accidents) and has increased health care use and expenditures, costing society an estimated

$117 billion in direct (preventive, diagnostic, and treatment services related to weight) and

indirect (absenteeism, loss of future earnings due to premature death) costs.

2.1.2 Predisposing Factors of Overweight and Obesity

Some scholars have mentioned a lot of predisposing factors which vary based on

geography, social conditions, political and economic factors, and human genetics. On

average, the commonest factors were socio-demographic, behavioral, genetic, and living in

obesogenic environment (Melese & Gedefaw, 2020).

i. Socio-demographic Factor

Based on United Nations Children’s Fund (UNICEF) three causes of malnutrition

analysis were identified. According to the framework, the basic causes including poverty,

social condition, political, economic, ecological, and other factors were the main reason for

any form of malnutrition (UNICEF, 1990). Different literature studies clearly identified

socio-demographic factors that were highly associated with obesity, for example; older age,

married (marital status) and low wealth index (Al Kibria, Swasey, Hasan, Sharmeen, & Day,

2019), urban residency, being female, learning in private schools, easy accessibility of junk

and fired or energy-dense foods and packed animal source foods due to free trade policy,

rural to urban migration, replacement of local agribusiness with food retail (Popkin,

Corvalan, & Grummer-Strawn, 2020) higher education level, and being pregnant are also

factors associated with obesity. In variance to the previous findings, a study which was

conducted among French women indicated that having a higher income, a higher

occupational class, and a higher educational level and having hot water at home decrease the

occurrence of obesity although the pathophysiology of hot water at home and obesity

occurrence was not yet studied (Auguste, Julien, Gwenn, Barul, Richard & Luce, 2019).

ii. Physical inactivity

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 Sedentary people expend fewer calories than people who are active. The National

Health and Nutrition Examination Survey (NHANES) showed a strong correlation between

physical inactivity and weight gain in both sexes (Jerry, 2019).

iii. Overeating

Overeating leads to weight gain, especially if the diet is high in fat. Food high in fat or

sugar (for example, fast food, fried food, and sweets) have high energy density (foods that

have a lot of calories in a small amount of food). Epidemiologic studies have shown that diets

high in fat contribute to weight gain (Jerry, 2019).

iv. Genetics (family background)

According to WHO (2019) &Jerry (2019) a person is more likely to develop obesity if

one or both parents are obese. Genetics also affect hormones involved in fat regulation. For

example, one genetic cause of obesity is leptin deficiency. Leptin is a hormone produced in

fat cells and in the placenta. Leptin controls weight by signaling the brain to eat less when

body fat stores are too high. If, for some reason, the body cannot produce enough leptin or

leptin cannot signal the brain to eat less, this control is lost, and obesity occurs. The role of

leptin replacement as a treatment for obesity is under exploration.

v. A diet high in simple carbohydrates

Carbohydrates increase blood glucose levels, which in turn stimulate insulin release

by the pancreas, and insulin promotes the growth of fat tissue and can cause weight gain.

Some scientists believe that simple carbohydrates (sugars, fructose, desserts, soft drinks, beer,

wine, etc.) add to weight gain, because they are more rapidly absorbed into the bloodstream

than complex carbohydrates (pasta, brown rice, grains, vegetables, raw fruits, etc.) and thus

cause a more pronounced insulin release after meals than complex carbohydrates. This higher

insulin release, some scientists believe, contributes to weight gain (WHO, 2019; WHO, 2018;

Jerry, 2019).

vi. Frequency of eating

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 According to Jerry (2019), the associated between frequency of eating (how often you

eat) and weight is somewhat contentious. There are many reports of overweight people eating

less often than people with normal weight. Scientists have observed that people who eat small

meals four or five times daily, have lower cholesterol levels and lower and/or more stable

blood sugar levels than people who eat less frequently (two or three large meals daily). One

possible explanation is that small frequent meals produce stable insulin levels, whereas large

meals cause large spikes of insulin after meals.

vii. Medications

According to WHO (2019), some medications associated with weight gain include

antidepressants (medications used in treating depression), anticonvulsants (medications used

in controlling seizures such as carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol)

and valproate (Depacon, Depakene), some diabetes medications (medications used in

lowering blood sugar such as insulin, sulfonylureas, and thiazolidinediones), certain

hormones such as oral contraceptives, and most corticosteroids such as prednisone.

Some high blood pressure medications and antihistamines cause weight gain. The reason for

the weight gain with the medications differs for each medication. If this is a concern for you,

you should discuss your medications with your physician rather than discontinuing the

medication, as this could have serious effects. Antihistamines (used for allergies),

particularly cyproheptadine, Steroids, including corticosteroids and birth control pills,

Psychotherapeutic medications, including lithium, antipsychotics, and antidepressants,

Anticonvulsant drugs (used for epilepsy and some other conditions), such as sodium

valproate and carbamazepine (Ingrid, 2015).

viii. Psychological factors

Emotions influence eating habits for some people. Most persons eat excessively in

response to emotions such as boredom, sadness, stress, or anger, while majority of

overweight people have more psychological disturbances than normal weight people. About

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30% of the people who seek treatment for serious weight problems have difficulties with

binge eating (Jerry, 2019&WHO, 2019).

a. Diseases

Diseases such as hypothyroidism, insulin resistance, polycystic ovary syndrome, and

Cushing's syndrome also contribute to obesity. Also, disease such as Prader-Willi syndrome,

can lead to obesity.

b. Social issues

There exists a link between social issues and obesity. Lack of money to purchase

healthy foods or lack of safe places to exercise can increase the risk of obesity (WHO, 2019).

2.1.3 Measurement and Assessment Methods of Obesity

The World Health Organization defines obesity as “abnormal or excessive fat

accumulation that may impair health” (WHO, 2017). This definition should serve as the basis

for measurement selection, while underwater weighing and dual energy x-ray absorptiometry

(DEXA) directly measure body fat, many indirect measures of adiposity have been used to

measure obesity status. Anthropometric measures such as the weight-for-height index, BMI,

waist circumference (WC), waist–hip ratio (WHR), and body fat percentage estimated by

skin fold thickness (ST) are widely accepted indirect measures. Since the 1990s, BMI has

been widely used to classify overweight and obesity, both in adults and children. BMI has

been suggested as an ideal measure of adiposity since it is easy to measure and is closely

associated with obesity related health risks (Wang, 2004). The question is what is the best

way to determine whether a body is fat or fit? Body fat can be measured in several ways, with

each body fat assessment method having strength and limitation thus:

I. Body Mass Index (BMI)

Body Mass Index (BMI) is the ratio of weight to height, calculated as weight

(kg)/height (m2) (Hu, 2008).

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 Strengths

1) It is easy to measure

2) Inexpensive

3) The standardized cutoff points for overweight and obesity: Normal weight is a BMI

between 18.5 and 24.9; overweight is a BMI between 25.0 and 29.9; obesity is a BMI

of 30.0 or higher.

4) It is strongly correlated with body fat levels, as measured by the most accurate

methods.

5) Most of the studies show that a high BMI predicts higher risk of chronic disease and

early death (Hu, 2008 & WHO, 2017).

Limitations

1. Indirect and imperfect measurement-does not differentiate between body fat and lean

body mass.

2. It is not as accurate a predictor of body fat in the elderly as it is in younger and

middle-aged adults.

3. At the same BMI, women have, on average, more body fat than men, and Asians have

more body fat than whites (Hu, 2008).

II. Waist Circumference

Waist circumference is the simplest and commonest way to measure “abdominal

obesity”-the extra fat found around the middle that is an important factor in health, even

independent of BMI. It’s the circumference of the abdomen, measured at the natural waist (in

between the lowest rib and the top of the hip bone), the umbilicus (belly button), or at the

narrowest point of the midsection (WHO, 2017 & Hu, 2008).

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 Strengths

1) Easy to measure

2) Inexpensive

3) Strongly correlated with body fat in adults as measured by the most accurate methods.

4) Studies show that waist circumference predicts development of disease and death

(WHO, 2017; WHO, 2019 & Hu, 2008).

Limitations

1. The procedure of measurement has not been standardized.

2. Absence of good comparison standards (reference data) for waist circumference in

children.

3. It may be difficult to measure and less accurate in individuals with a BMI of 35 or

higher (Hu, 2008).

III. Waist-to-Hip Ratio

As the waist circumference, the waist-to-hip ratio (WHR) is also used to measure

abdominal obesity. It is calculated by measuring the waist and the hip (at the widest diameter

of the buttocks), and then dividing the waist measurement by the hip measurement (Wang,

2004 & Hu, 2008).

Strengths

1) There is good correlation with body fat as measured by the most accurate methods.

2) It is inexpensive.

3) Studies have shown that waist-to-hip ratio predicts development of disease and death

in adults (WHO, 2017 & Hu, 2008).

Limitations

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 1. It is more prone to measurement error because it requires two measurements.

2. It is more difficult to measure hip than it is to measure waist.

3. It is more complex to interpret than waist circumference since increased waist-to-hip

ratio can be caused by increased abdominal fat or decrease in lean muscle mass

around the hips.

4. Turning the measurements into a ratio can lead to a loss of information: Two people

with very different BMIs could have the same WHR.

5. It may be difficult to measure and less accurate in individuals with a BMI of 35 or

higher (WHO, 2017 & Hu, 2008).

IV. Skinfold Thickness

Here, researchers use a special caliper to measure the thickness of a “pinch” of skin

and the fat beneath it in specific areas of the body (the trunk, the thighs, front and back of the

upper arm, and under the shoulder blade). Equations are usually used to predict body fat

percentage based on these measurements (Hu, 2008).

Strengths

1) It is convenient.

2) Safe.

3) Inexpensive.

4) Portable.

5) Fast and easy (except in individuals with a BMI of 35 or higher) (WHO, 2017 & Hu,

2008).

Limitations

1) It is not as accurate or reproducible as other methods.

2) It is very hard to measure in individuals with a BMI of 35 or higher (Hu, 2008).

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V. Bioelectric Impedance (BIA)

BIA apparatus sends a small, imperceptible, safe electric current through the body,

measuring the resistance. The current then faces more resistance passing through body fat

than it does passing through lean body mass and water. Equations are used to estimate body

fat percentage and fat-free mass (Hu, 2008 & WHO, 2017).

Strengths

1. It is convenient.

2. Safe.

3. Relatively inexpensive.

4. Portable.

5. Fast and easy

Limitations

1. It is hard to calibrate.

2. The ratio of body water to fat may be changed during illness, dehydration, or weight

loss, decreasing accuracy.

3. It is not as accurate as other methods, especially in individuals with a BMI of 35 or

higher (WHO, 2017 & Hu, 2008).

VI. Underwater Weighing (Densitometry)

Individuals are often weighed in airwhile submerged in a tank. Researchers use

formulas to estimate body volume, body density, and body fat percentage. Fat is more

buoyant (less dense) than water, so someone with high body fat will have a lower body

density than someone with low body fat. This method is typically only used in a research

setting (Wang, 2004 & Hu, 2008).

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 Strengths

1. It is accurate

Limitations

1) It is time consuming.

2) It requires individuals to be submerged in water.

3) Generally, not a good option for children, older adults, and individuals with a BMI of

40 or higher (Hu, 2008).

VII. Air-Displacement Plethysmography

This method uses similar principle to underwater weighing but can be done in the air

instead of in water. The individual sit in a small chamber wearing a bathing suit; one

commercial example is the “Bod Pod.” The machine estimates body volume based on air

pressure differences between the empty chamber and the occupied chamber (WHO, 2017 &

Hu, 2008).

Strengths

1) It is relatively quick and comfortable.

2) It is accurate.

3) Safe.

4) Good choice for children, older adults, pregnant women, individuals with a BMI of 40

or higher, and other individuals who would not want to be submerged in water (Wang,

2004 & Hu, 2008).

Limitations

1) It is expensive

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VIII. Dilution Method (Hydrometry)

For this method, individuals drink isotope-labeled water and give body fluid samples.

Researchers analyze these samples for isotope levels, which are then used to calculate total

body water, fat-free body mass, and in turn, body fat mass (Wang, 2004 & Hu, 2008).

Strengths

A. It is relatively low cost.

B. Accurate.

C. It is safe.

D. Can be used in individuals with a BMI of 40 or higher, as well as in children and

pregnant women (WHO, 2017 & Hu, 2008).

Limitations

A. The limitation is that the ratio of body water to fat-free mass may change during

illness, dehydration, or weight loss, decreasing accuracy (WHO, 2017; Wang, 2004 &

Hu, 2008).

IX. Dual Energy X-ray Absorptiometry (DEXA)

X-ray beams pass via different body tissues at different rates. So DEXA uses two

low-level X-ray beams to develop estimates of fat-free mass, fat mass, and bone mineral

density. DEXA is typically used for this purpose in research settings (WHO, 2017 & Hu,

2008).

Strengths

It is accurate

Limitations

19
 (1) The equipment is expensive and cannot be moved

(2) It cannot accurately distinguish between different types of fat (fat under the skin, also known

as “subcutaneous” fat vs. fat around the internal organs, or “visceral” fat)

(3) It cannot be used with pregnant women, since it requires exposure to a small dose of radiation

(4) Most of the current systems cannot accommodate individuals with a BMI of 35 or higher

(Hu, 2008).

X. Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI)

These two imaging techniques areconsidered to be the most accurate methods for

measuring tissue, organ, and whole-body fat mass as well as lean muscle mass and bone

mass. CT and MRI scans are typically only used for this purpose in research settings (Wang,

2004 & Hu, 2008).

Strengths

(1) It is accurate.

(2) It allows for measurement of specific body fat compartments, such as abdominal fat and

subcutaneous fat (Hu, 2008).

Limitations

(1) The equipment is extremely expensive and cannot be moved.

(2) The CT scans cannot be used with pregnant women or children, due to the high amounts

of ionizing radiation used

(3) Some MRI and CT scanners may not be able to accommodate individuals with a BMI of

35 or higher (WHO, 2017 & Hu, 2008).

20
2.1.4 Nutritional Assessment Methods

In nutritional science, there are four basic nutritional assessment methods, i.e.,

anthropometric, biochemical, clinical, and dietary methods. Similarly, obesity can also be

assessed through these methods. In this review, two nutritional assessment methods

(anthropometric and biochemical) are discussed in detail (Gibson, 2005).

2.1.5 Anthropometric assessment

According to Hu, Huang, & You, (2017), obesity can be assessed through BMI, waist

circumference (WC), body fat percentage (BFP), and skin fold thickness (SFT). As evidenced

in the literature, the anthropometric method shows a correlation between the factors. The

classification of obesity was reevaluated and validated again recently with the consideration

of morbidity and mortality at population level. Lorenzo, (2016) further classified obesity into

four categories: (1) normal weight obese (NWO), (2) metabolically obese normal weight

(MONW), (3) metabolically healthy obese (MHO), and (4) metabolically unhealthy obese

(MUO). The present approach is more reliable than the previous approach to predict obesity

and its correlated disorders since using only BMI gives gross data which are difficult to

interpret (Melese & Gedefaw, 2020).

2.1.6 Biochemical Methods

The biochemical method is objective and more reliable among the nutrition

assessment methods. There are two types of biochemical methods such as functional and

static methods. The functional method is used when there is a deficiency or an excess of

nutrient which leads to functional impairment. Unexpectedly, obese children have

significantly lower ability to identify taste types and qualities correctly due to lesser number

of fungi form papillae in the tongue (Mameli, Cattaneo & Panelli, 2019).

21
22
2.1.7 Classification of Body Mass Index

The World Health Organization uses classification system using the BMI to define

overweight and obesity thus:

a) BMI of 25 to 29.9 is defined as a "pre-obese or overweight"

b) BMI of 30 to 34.99 is defined as "obese class I."

c) BMI of 35 to 39.99 is defined as "obese class II."

d) BMI of or greater than 40.00 is defined as "obese class III." (WHO, 2018).

Below is a table showing the risk of associated disease according to BMI and waist size.
TABLE 1: Classification of overweight and obesity by BMI, waist circumference, and associated
disease risk.

Disease risk* relative to normal weight and waist circumference

BMI Obesity Men 102cm (40 in) or Men > 102cm (40
(kg/m2) Class less in)
Women 88cm (35 in) Women > 88cm (35
or less in)
Underweight < 18.5
Normal 18.5 - 24.9
weight
Overweight 25.0 - 29.9 Increased High
Obesity 30.0 - 34.9 I High Very High
Obesity 35.0 - 39.9 II Very High Very High
Extreme 40.0 + III Extremely High Extremely High
Obesity

Source: (Jerry, 2019; Jonathan, 2018).

2.1.8 Health risks or implications associated with being overweight

Being overweight is associated with array of comorbidities, including diabetes

mellitus, dyslipidemia, hypertension, cardiovascular disease, obstructive sleep apnea, chronic

obstructive pulmonary diseases, cancer, chronic disease morbidity and mortality, premature

23
death, and a trial fibrillation. Hypertension was also strongly associated WC, BMI, and waist

hip ratio (WHR) (Hingorani, Finan, & Schmidt, 2019; Chaudhary, Din, & Chaudhary, 2019).

According to Jerry (2019), obesity is not just a cosmetic consideration; it is harmful to

one's health as it is a risk factor for many conditions. In the United States, roughly 112,000

deaths per year are directly related to obesity, and most of these deaths are in patients with a

BMI over 30. Patients with a BMI over 40 have a reduced life expectancy. Obesity also

increases the risk of developing a number of chronic diseases, including the following.

i. Insulin resistance: Insulin is essential for the transport of blood glucose (sugar) into

the cells of muscle and fat (which the body uses for energy). By transporting glucose

into cells, insulin keeps the blood glucose levels in the normal range. Insulin

resistance (IR) is the state whereby there is diminished effectiveness of insulin in

transporting glucose (sugar) into cells (Jerry, 2019). Fat cells are more insulin

resistant than muscle cells; therefore, one significant cause of insulin resistance is

obesity. The pancreas initially responds to insulin resistance by producing more

insulin. If the pancreas can produce sufficient insulin to overcome this resistance,

blood glucose levels remain normal. This insulin resistance state (characterized by

normal blood glucose levels and high insulin levels) can last for years. Once the

pancreas can no longer keep up with producing high levels of insulin, blood glucose

levels begin to rise, resulting in type 2 diabetes, thus insulin resistance is a pre-

diabetes condition (WHO, 2019 & Jerry, 2019).

ii. According to Jerry(2019), Type 2 (adult-onset) diabetes: The risk of type 2

diabetes increases with the degree and duration of obesity. Type 2 diabetes is

associated with central obesity; a person with central obesity has excess fat around

his/her waist (apple-shaped figure).

24
iii. High blood pressure (hypertension): Hypertension is commonly found among obese

adults. A Norwegian study revealed that weight gain tended to increase blood

pressure in women more significantly than in men (WHO, 2019 & Jerry, 2019).

iv. Heart attack: A prospective study showed that the risk of developing coronary artery

disease increased three to four times in women who had a BMI greater than 29. A

Finnish study revealed that for every 1 kilogram (2.2 pounds) increase in body

weight, the risk of death from coronary artery disease increased by 1%. In patients

who have already had a heart attack, obesity is associated with an increased likelihood

of a second heart attack (Jerry, 2019).

v. Cancer: Obesity can lead to the development of different cancers; therefore, cancer

epidemiology abruptly increased worldwide. Obesity also encourages breast cancer

formation and formation of Barrett’s esophagus (BE). BE has been defined as a

pathological condition in which the stratified squamous epithelium of the distal

esophagus has been replaced by the metaplastic columnar epithelium with goblet

cells. The formation of BE predisposes patients to esophageal adenocarcinoma (EAC)

(Melese & Gedefaw, 2020). Obesity is a risk factor for cancer of the colon in men and

women, cancer of the rectum and prostate in men, and cancer of the gallbladder and

uterus in women. Obesity may also be associated with breast cancer, particularly

in postmenopausal women. Fat tissue is important in the production of estrogen, and

prolonged exposure to high levels of estrogen increases the risk of breast cancer

(Jerry, 2019).

vi. Osteoarthritis (degenerative arthritis) of the knees, hips, and the lower back (Jerry,

2019).

vii. Other health risks of obesity include: High cholesterol (hypercholesterolemia),

Stroke (cerebrovascular accident or CVA), Congestive heart failure & Sleep apnea

(WHO, 2019 & Jerry, 2019).

25
 Blomberg (2013) maintained that high BMI and accumulation of body fat mass are an

important predictor for metabolic disorders. Obesity during pregnancy leads to adverse

neonatal outcomes (skeletal muscle injury, respiratory distress syndrome, injury to peripheral

nervous system, bacterial sepsis, convulsion, hypoglycemia). Additionally, it increases the

rate of cesarean section and morbidity for the women.

A review carried out in the USA population reveals that the magnitude of obesity among

coronary heart disease patients was increased. The effect of obesity varies in different age

groups; a systematic review identified that students with obesity in tertiary education have

low academic performance and poor achievements either due to weight gain bias stigma or

metabolic disorder (Hill, Lopez & Caterson, 2018). A 25-year longitudinal study from 1986

to 2011 carried out in America revealed that baseline obesity better predicts long-term risk of

cerebrovascular death in black individuals as compared to white people. More research

should explore factors that explain why racial differences exist in the effects of obesity on

cerebrovascular outcome. Findings also have consequences for personalized medicine (Assari

& Bazargan, 2019).

Central obesity is highly associated with kidney injury. It also has significant correlation

with urinary incontinency. Specifically, central obesity correlates with intra‐abdominal

pressure, which exerts forces in the pelvic floor. Polycystic ovary syndrome (POS) was

highly correlated with obesity which is emphasized in different clinical and epidemiological

studies (Barber, Petra, Martin & Franks, 2019). Obesity also leads to anatomical deformity; a

study carried out in Egypt among schoolchildren explicitly reveals that the occurrence of flat

foot was high among obese children. The presence of flat foot leads to foot pain which is

significantly displayed with increased level of adipocyte cytokines, as well as adiponectin,

leptin, resistin, Il-6, and TNF-α, compared to subjects with normal BMI. Physical inactivity

like slow waking/decreased velocities and mental comorbidities were also other

consequences of obesity (Skea, Aceves-Martins, Robertson, Bruin & Avenell, 2019).

26
 According to Melese & Gedefaw (2020),obesity has significant effect on the reproduction

of human. Sexual dysfunction is highly prevalent in men with severe with erectile

dysfunction in diabetic patients was likely a significant contributing factor for sexual

dysfunction in obese population. The impact of obesity varies based on the trait and

biological differences like sex. Also, it has an etiological role in the death of most people

globally. In general, the public health significance of obesity is highly integrated with

country’s economic, social, and political affairs

2.1.9 WHO Response

Adopted by the World Health Assembly in 2004 and recognized again in 2011

political declaration on non-communicable diseases, the "WHO Global Strategy on Diet,

Physical Activity and Health" describes the actions required to support healthy diets and

regular physical activity. The Strategy calls upon all stakeholders to act at global, regional,

and local levels to improve diets and physical activity forms at the population level (WHO,

2019).

According to WHO (2019), the 2030 Agenda for Sustainable Development recognizes

NCDs as a major challenge for sustainable development. As part of the Agenda, Heads of

State and Government committed to develop ambitious national responses, by 2030, to

reduce by one-third premature mortality from NCDs through prevention and treatment (SDG

target 3.4) (WHO, 2019). The "Global action plan on physical activity 2018–2030: more

active people for a healthier world" provides effective and feasible policy actions to increase

physical activity globally. WHO published ACTIVE a technical package to assist countries in

planning and delivery of their response. New WHO guidelines on physical activity, sedentary

behavior, and sleep in children under five years of age were launched in 2019.

27
 2.1.10 Conceptual framework

This Conceptual framework was formulated to serve as a guide for the study of the

prevalence and risk factors of overweight and obesity among civil servants in Cross River

State, and its health risk and preventive mechanisms.

Risk factors of Preventive measures

Assessment of
overweight and of overweight and
overweight and
obesity obesity
obesity

Physical inactivity, overeating, Nutritional education, physical

family history, use of activity, healthy food
BMI, Waist contraceptive, disability, socio- subsidization and taxation of
circumference economic status, age, gender, junk food, surgery
stress, racism/ethnicity.

Morbidly obese ≥
40kg/m2

Severely obese Health risk: diabetes mellitus,

35-39.9kg/m2 hypertension, CVDs, obstructive
sleep apnea, cancer osteoarthritis,
chronic morbidity and mortality,
Mildly obese premature death, heart attack
30-34.9kg/m2

Overweight
25-29.9kg/m2

Normal
≥ 18.5-24.9kg/m2

Health risk: vulnerable to disease

Underweight infection, poor mental development, death
< 18.5 kg/m2

Figure I: conceptual framework

Source: As conceptualized by the researcher

28
2.2 Theoretical Framework
The theoretical framework underlying this research study is informed from the Health

Belief Model (HBM).The HBM is a social psychological health behavior change model

formulated to elucidate and predict health-related behaviors, particularly in regard to the

uptake of health services (Siddiqui, Ghazal, Bibi, Ahmed & Sajjad,2016; Janz & Marshall,

1984). “The HBM was developed in the 1950s by social psychologists at the U.S. Public

Health Service and remains one of the best known and most widely used theories in health

behavior research” (Carpenter, 2010; Glanz & Bishop, 2010). The HBM submits that people's

beliefs about health problems, perceived benefits of action and barriers to action, and self-

efficacy explain engagement (or lack of engagement) in health-promoting

behavior. A stimulus, or cue to action, must also be present in order to trigger the health-

promoting behavior (Janz & Marshall, 1984).The HBM is one of the first theories of health

behavior, which was developed in 1950s by social psychologists Irwin M. Rosenstock,

Godfrey M. Hochbaum, S. Stephen Kegeles, and Howard Leventhal at the U.S. Public Health

ServiZce (Carpenter, 2010).

2.2.1 Theoretical Constructs

The theoretical constructs of the HBM originate from theories in Cognitive

Psychology (Glanz, 2015). Cognitive theorists in early twentieth century believed that

reinforcements operated by affecting expectations rather than by affecting behavior straightly

(Lewin,1951). “Mental processes are severe consists of cognitive theories that are seen

as expectancy-value models, because they propose that behavior is a function of the degree to

which people value a result and their evaluation of the expectation, that a certain action will

lead that result. In terms of the health-related behaviors, the value is avoiding sickness. The

expectation is that a certain health action could prevent the condition for which people

consider they might be at risk” (Glanz, 2015).

29
The following constructs of the HBM are anticipated to differ between individuals and

predict engagement in health-related behaviors (Janz & Marshall, 1984).

1. Perceived susceptibility
Perceived susceptibility has to do with subjective assessment of risk of developing a

health problem (Barbara & Viswanath, 2008). The HBM predicts that individuals who

perceive that they are susceptible to a particular health condition will engage in behaviors to

minimize their risk of developing the health problem. Individuals with low perceived

susceptibility may argue that they are at risk for contracting a particular illness. Others may

recognize the possibility that they could develop the illness, but believe it is unlikely

(Rosenstock, 1974). Individuals who believe they are at small risk of developing an illness

are more likely to involve in unhealthy, or risky, behaviors. Individuals who perceive a high

risk that they will be personally affected by a particular health problem are more likely to

involve in behaviors to decrease their risk of developing the condition.

2. Perceived Severity
Perceived severity refers to the subjective assessment of the cruelty of a health

problem and its potential consequences (Barbara & Viswanath, 2008). “The HBM proposes

that individuals who perceive a given health problem as serious are more likely to engage in

behaviors to prevent the health problem from occurring (or reduce its severity). Perceived

seriousness encompasses beliefs about the disease itself (e.g., whether it is life-threatening or

may cause disability or pain) as well as broader impacts of the disease on functioning in work

and social roles” (Barbara & Viswanath, 2008). For instance, an individual may perceive

that obesity and overweight are not medically serious, but if he or she perceives that there

would be serious financial implicationsbecause of being absent from work for several days,

then he or she may perceive obesity to be a particularly serious condition.

3. Perceived benefits
The reality is that health-related behaviors are also influenced by the perceived

benefits of acting (Barbara & Viswanath, 2008). Perceived benefits refer to an individual's

30
assessment of the value or efficacy of involving in a health-promoting behavior to reduce risk

of disease (Janz & Marshall, 1984). If an individual believes that a particular action will

reduce susceptibility to a health condition or decrease its seriousness, then he or she is likely

to involve in that behavior regardless of objective facts based on the effectiveness of the

action (Rosenstock, 1974). For example, individuals who believe that engaging in physical

activity or exercise prevents obesity and overweight are more likely to start physical activity

than individuals who believe that engaging in physical activity will not prevent the

occurrence of obesity and overweight.

4. Perceived barriers
Health-related behaviors are similarly a function of perceived barriers to acting

(Barbara & Viswanath, 2008). Perceived barriers refer to an individual's assessment of the

impediments to behavior change. Even if an individual perceives a health problem as

threatening and believes that a particular action will effectively reduce the threat, barriers or

obstacles may prevent engagement in the health-promoting behavior. That is, the perceived

benefits must outweigh the perceived barriers for behavior change to take place (Barbara &

Viswanath, 2008). Perceived barriers to actingare the perceived inconvenience, expense,

danger (e.g., side effects of a medical procedure) and discomfort (e.g., pain, emotional upset)

involved in engaging in the behavior. For instance, lack of access to affordable health

serviceand the perception that a surgery will result to a significant pain may act as barriers to

receiving the medication.

5. Cues to action

The HBM speculates that a cue, or trigger, is important to prompting engagement in

health-promoting behaviors. Cues to action can be either internal or external. Physiological

cues (e.g., pain, symptoms) are examples of internal cues to action. External cues include but

not limited to events or information from close others, the media, (Carpenter, 2010) or health

care providers promoting engagement in health-related behaviors. Some of the examples of

31
cues to action include a reminder postcard from a dentist, the illness of a friend or family

member, mass media campaigns on health issues, and product health warning labels. The

intensity of cues needed to prompt action varies between individuals by perceived

susceptibility, seriousness, benefits, and barriers (Siddiqui, Ghazal, Bibi, Ahmed & Sajjad,

2016). For example, individuals who believe they are at high risk for a serious illness

(obesity) and who have a well-known relationship with a primary care doctor may be easily

convinced to get screened for the illness after seeing a public service announcement, whereas

individuals who believe they are at low risk for the same illness and do not have reliable

access to health care may require more intense external cues to get screened.

6. Self-efficacy

Self-efficacy was included to the four components of the HBM (i.e., perceived

susceptibility, severity, benefits, and barriers) (Barbara & Viswanath, 2008; Rosenstock,

Strecher & Becker, 1988). Self-efficacy refers to an individual's perception of his or her

ability to successfully perform a behavior. Self-efficacy was included to the HBM to better

explain individual variances in health behaviors (Barbara & Viswanath, 2008). “The model

was originally developed to explain engagement in one-time health-related behaviors such as

being screened for cancer or receiving an immunization. Eventually, the HBM was applied to

more substantial, long-term behavior change such as diet modification, exercise, and

smoking. Developers of the model recognized that confidence in one's ability to effect change

in outcomes (i.e., self-efficacy) was a key component of health behavior change” (Barbara &

Viswanath, 2008).

32
 Figure 2: Health belief Model

Source: https://en.wikipedia.org/wiki/Health_belief_model#/media/File:

%E6%96%B0%E5%BB%BA%E9%A1%B9%E7%9B%AE.jpg

2.3 Empirical Framework

2.3.1 Prevalence of overweight (Obesity)

A country known as Nauru has the highest obesity prevalence in the world at 61.0%

(WHO, 2021). Nauru is a Pacific Island nation with roughly 10,000 inhabitants, and their diet

comprises mostly of noodles, rice, soda, and food from tins, likely attributed to the island’s

economic decline making it difficult to access healthy food. Type 2-diabettes is a large

concern among the Nauru people (WHO, 2021).According to Development Initiative, Global

Nutrition Report (2017), the 2017 global nutrition report revealed that 2 billion adults are

overweight and obese, and 41 million children are overweight worldwide.

A systematic review by Ofori-Asenso Agyeman, Laar & Boateng (2016)fixed

overweight and obesity prevalence in Ghana at 42.5% . The study identified significant

differences between Africa countries. In the latest survey, Egypt has the highest prevalence of

obesity. Two out of every five Egyptians (39%) are obese, followed by Ghana at 22%

33
(Dickson, 2018). Egypt and Ghana also saw a significant increase in obesity over the past 25

years — from 34% to 39% (13% increase) in Egypt and 8% to 22% in Ghana (65% increase).

The increase in obesity has doubled in Kenya, Benin, Niger, Rwanda, Ivory Coast and

Uganda, while Zambia, Burkina Faso, Mali, Malawi, and Tanzania experienced a three-fold

increase (Dickson, 2018). Among those aged 15 years and above, the WHO estimated that

the prevalence of overweight and obesity in 2010 was as high as 63.8% and 21.3%

respectively, for men, and 73.8% and 43.2% respectively, for women, in some Sub-Saharan

Africa countries. Eritrea, Ethiopia, Democratic Republic of the Congo, and Central African

Republic had the lowest prevalence, while Seychelles, Lesotho, South Africa and Mauritius

had the highest prevalence of overweight and obesity in Sub-Saharan Africa (Ono, Guthold &

Strong, 2012).

According to Ono, Guthold & Strong, (2012), the prevalence of obesity only is

increased by 47% in men and 39% in women, between 2002 and 2010, in Nigeria. The

prevalence of overweight and obesity in Abuja, the capital city of Nigeria is high, compared

to other cities in Nigeria (Olatunbosun, Kaufman & Bella, 2011). It is similar to the

prevalence in developed countries like the United Kingdom, where a higher part of men than

women (42% compared with 32%) were classified as overweight and 26% of the adults were

classified as obese in 2010 (The NHS, Information Centre LS, 2012). In Nigeria, according to

the 2010 WHO survey data on Nigeria, the prevalence of overweight was 26% and 37% in

men and women respectively, while the prevalence of obesity was 3% and 8.1% in men and

women respectively. In Nigeria (Chukwuonye, Chuku, John, Ohagwu, Imoh & Isa, 2013), the

prevalence of obesity ranges from 8.1% to 22.2%.

2.3. 2 Perceived risk factors of overweight

The major cause of obesity and overweight is an energy imbalance between calories

consumed and calories expended (WHO, 2019). The balance between calorie intake and

energy expenditure determines a person's weight. If a person consumes more calories than he
34
or she burns (metabolizes), the person gains weight (the body will store the excess energy as

fat). If a person eats fewer calories than he or she metabolizes, he or she will lose weight.

Therefore, the most common causes of obesity are overeating and physical inactivity.

(a) Age

Sabir, Balarabe, Sanni, Isezuo, Bello & Jimoh, (2017) reported that obesity and

increasing age are the major risk factors enhancing increased prevalence of type 2 diabetes

mellitus among Nigerians. Another study also reported high prevalence of overweight and

obesity among tertiary hospital workers in Northern Nigeria (Dankyau, Shu'aibu, Oyebanji &

Mamven, 2016). High prevalence of hypertension was reported among health-care workers in

Nigeria despite their awareness of the disease (Owolabi, Owolabi, OlaOlorun & Amole,

2015). It has also been reported that increased body mass index (BMI) predisposes to certain

cancers (Zhu, Caulfield, Hunter, Roland, Payne-Wilks & Texter, 2005).

(b) Behavioral Factors (feeding habit and lifestyle)

Dietary lifestyle is a fundamental determinant factor for our health, not only to obesity

(Melese & Gedefaw, 2020). Scientifically, eating energy-dense food, such as confectionaries,

sugars, soft drinks, fats, and alcohol, have been found to be highly correlated with obesity

and chronic diseases (Yoon, Kim &Doo, 2016). Some researchers stated that feeding habit

culture, consuming pastry foods, consuming ultra-processed food (refined carbohydrate),

excess alcohol consumption, and poor diet quality increase the occurrence of obesity

(Ngaruiya, Hayward, Post, & Mowafi, 2017). According to Narciso, Silva &

Rodrigues(2019), consuming breakfast and fruit reduce the occurrence of obesity. In other

words, evening snack induces obesity. Also, food store environment and school food

environment for school age expose children to obesity.

Many studies largely identified that either irregular physical activity (Addo, Nyarko,

Sackey, Akweongo, & Sarfo, 2015) watching television or lengthy screen time, short sleep

period or shift work, stress, urbanization and industrialization, smoking, and regular use of a

35
taxi for transportation were determinant factors for overweight/obesity (Cinteza & Cintez,

2018).Watching electronic screens for more than 2 hours increases the occurrence of obesity

because during simple observation, the brain does not use glucose and as a result, the

metabolism of carbohydrate to glycogen and fat increased consistently. The association

between stress and the development of obesity has different scientific perspectives. Most

researchers therefore conclude that hormonal variation may be a cause. The cortisol levels

rise during stress which is a cause for excess production of abdominal fat by increasing

appetite (daily intake) (van der Valk, Savas, & van Rossum, 2018; Boniecka, Wileńska,

Jeznach-Steinhagen, Czerwonogrodzka-Senczyna, Sekuła & Paśnik, 2017).

(c) Genetic factors

The study conducted by Narciso, Silva, & Rodrigues (2019) revealed that a family

history of obesity and different genetically arranged genes were a risk for obesity. Genome-

wide association studies (GWAS) identified that more than 250 genes/loci were associated

with obesity. Of these genes, the fat mass- and obesity-associated gene (FTO) revealed an

important role for development of the obesity and type 2 diabetes. A study conducted among

adults specifically recognizes the correlation between these genes and a higher body mass

index (BMI), fat mass index (FMI), and leptin concentrations (Choquet & Meyre, 2011).

(d) Ethnicity

According to Jerry (2019), ethnicity may influence the age of onset and the quickness

of weight gain. African American women and Hispanic women tend to experience weight

gain earlier in life than Caucasians and Asians, and age-adjusted obesity rates are higher in

these groups. Non-Hispanic black men and Hispanic men have a higher obesity rate then non-

Hispanic white men, but the variance in prevalence is significantly less than in women.

(e) Childhood weight

A person's weight during childhood, teenage years, and early adulthood may also

influence the development of adult obesity. Consequently, decreasing the prevalence

36
 of childhood obesity is one of the areas to focus on in the fight against overweight and

obesity. For example, being mildly overweight in the early 20s was connected to a substantial

incidence of obesity by age 35; being overweight during older childhood is highly predictive

of adult obesity, especially if a parent is also obese; being overweight during the teenage

years is even a greater predictor of adult obesity (Jerry, 2019).

Other risk factors associated with being overweight

I. Disability, inability to engage in physical activity (e.g walking, swimming, running,

visiting of gyms).

II. Age: Obesity increases with increasing age.

III. Illiteracy: Obesity increases with decrease in educational level.

IV. Gender: Females are more exposed to obesity and overweight than males based on

predisposing factors.

V. Stress: In a few ways, stress contributesto obesity: People who are stressed tend to

make bad food choices and to eat too much. Stress causes the release of stress

hormones including cortisol, which activates the release of triglycerides (fatty acids)

from storage and transfers them to fat cells deep in the abdomen. Cortisol also

increases appetite (Ingrid, 2015).

VI. Racism/ Ethnicity (WHO, 2009).

2.3.3 Perceived preventive measures of being overweight

Being overweight is a condition which occurs due to individual behaviors and the living

environment. As a result of this, to prevent obesity, both legal and voluntary counseling

services are required. Overweight can be prevented or treated based on the following

approach (Melese & Gedefaw, 2020).

i. Nutrition education
According to Flannery, Fredrix, Olander, McAuliffe, Byrne, & Kearney (2019), nutrition

education is one of the common authorized approaches practiced at schools to reduce obesity

37
in the USA. Spreading health education and developing dietary consumption standards at

organization level also have significant impact; weight loss programs and diabetes prevention

approaches were effective programs to reduce obesity which is reported elsewhere.

Interventional studies which are entitled as “Healthy Primary School of the Future” applied in

Dutch are primarily focused on lunch health education, healthy diet approach, and physical

activity session, lowering children’s BMI z-scores.

Another program conducted in Brooklyn entitled as “Live Light Live Right program” is a

lifestyle intervention that uses medical assessment, nutritional education, access to physical

fitness classes, and behavioral change to reduce BMI Z-Scores. Even moderate physical

activity is effective to control overweight/obesity among pregnant women (Flannery et al,

2019). Overweight and obesity, as well as their related non-communicable diseases, are

largely preventable. Supportive environments and communities are important in shaping

people’s choices, by making the choice of healthier foods and regular physical activity the

easiest choice (the choice that is the most accessible, available, and affordable), and therefore

preventing overweight (WHO, 2019).

At the individual level, people can: limit energy intake from total fats and sugars;

increase eating of fruits and vegetables, as well as legumes, whole grains, and nuts; and

engage in regular physical activity (60 minutes a day for children and 150 minutes spread

through the week for adults) (WHO, 2019). Individual’s duty can only have its full effect

where people have access to a healthy lifestyle. Therefore, at the societal level, it is important

to support individuals in following the recommendations, through sustained implementation

of evidence based and population-based policies that make regular physical activity and

healthier dietary choices available, affordable, and easily accessible to everyone, particularly

to the poorest individuals. An example of such a policy is a tax on sugar sweetened beverages

(WHO, 2019).

38
 The food industry can play a significant role in promoting healthy diets by reducing fat,

sugar and salt content of processed foods; ensuring that healthy and nutritious choices are

available and affordable to all consumers; limiting marketing of foods high in sugars, salt and

fats, especially those foods intended for children and teenagers; and ensuring the availability

of healthy food choices and supporting regular physical activity practice in the workplace

(WHO, 2019).

ii. Developing non-sedentary lifestyle plan

Physical activity, reducing sedentary time, reducing fast food consumption, sleeping 7–9

hours per day, avoiding smoking, and moderate alcohol drinking habit were effective

interventions to reduce obesity (WHO, 2019). All too often, obesity prompts a strenuous diet

in the hopes of reaching the "ideal body weight." Some amount of weight loss may be

accomplished, but the lost weight usually quickly returns. Most people who lose weight

regain the weight within five years. A more effective, long-lasting treatment for obesity must

be found. We need to learn more about the causes of obesity, and then we need to change the

ways we treat it. When obesity is accepted as a chronic disease, it will be treated like other

chronic diseases such as diabetes and high blood pressure. The treatment of obesity cannot be

a short-term "fix" but must be an ongoing lifelong process (WHO, 2019).

Obesity treatment must acknowledge that even modest weight loss can be beneficial. For

example, a modest weight loss of 5%-10% of the initial weight, and long-term maintenance

of that weight loss can bring significant health gains, including: lowered blood pressure;

reduced blood levels of cholesterol; reduced risk of type 2 (adult-onset) diabetes (In the

Nurses’ Health Study, women who lost 5 kilograms [11 pounds] of weight reduced their risk

of diabetes by 50% or more.);decreased chance of stroke; decreased complications of heart

disease and decreased overall mortality (WHO, 2018).

It is not necessary to achieve an "ideal weight" to derive health benefits from obesity

treatment. Instead, the goal of treatment should be to reach and hold to a "healthier weight."

The emphasis of treatment should be to commit to the process of lifelong healthy living,

39
including eating more wisely and increasing physical activity. In sum, the goal in dealing

with obesity is to achieve and maintain a "healthier weight." (WHO, 2019).

The role of physical activity and exercise in overweight

The National Health and Examination Survey (NHANES I) showed that people who

engage in partial recreational activity were more likely to gain weight than more active

people. Other studies have shown that people who engage in regular tireless activity gain less

weight than sedentary people (Jerry, 2019). Physical activity and exercise help burn calories.

The number of calories burned depends on the type, duration, and intensity of the activity. It

also depends on the weight of the person. A 200-pound person will burn more

calories running 1 mile than a 120-pound person, because the work of carrying those extra 80

pounds must be factored in. But exercise as a treatment for obesity is most effective when

combined with a diet and weight-loss program (WHO, 2018). Exercise alone without dietary

changes will have a limited effect on weight because one must exercise a lot to simply lose 1

pound. However regular exercise is an important part of a healthy lifestyle to maintain a

healthy weight for the long term. Another benefit of regular exercise as part of a weight-loss

program is a greater loss of body fat versus lean muscle compared to those who diet alone

(WHO, 2019).

Other profits of exercise include: improved blood sugar control and increased insulin

sensitivity (decreased insulin resistance), reduced triglyceride levels and increased

"good" HDL cholesterol levels, lowered blood pressure, a reduction in abdominal fat,

reduced risk of heart disease and release of endorphins that make people feel good.

Remember, these health benefits can occur independently (with or without) achieving weight

loss. Talk to a doctor about the type and intensity of the exercise program before starting an

exercise program, (WHO, 2020).

2.4 Gap in Review

The following gap in knowledge have been identified thus:

40
 i. No study has been conducted on prevalence and risk factors of overweight and

obesity among civil servants in Imo State. As such, there is no mechanism put

forward to establish the risk factors associated with overweight and obesity among

civil servants and work performances.

ii. Little is known about the risk factors of overweight and obesity among civil servants

in Imo State.

iii. There are also contradicting ideas on who is more vulnerable to overweight and

obesity between the rich civil servants and the poor ones.

2.5 Summary of Review

This chapter under review dealt with the overviews of literature that supported the

study. The chapter considered the conceptual reviews of the various variables that form the

study, theoretical literature related to risk factor associated with overweight, empirical

literature related to the study was also reviewed. Lastly, the chapter was summarized.

41
 CHAPTER THREE

MATERIALS AND METHODS

This chapter discussed the research methods that were use in carrying out the study. The

study area where the study would be conducted, the study design and the population and

sample will be described. The instrument used to collect the data, including methods

implemented to maintain validity and reliability of the instrument will also be stated

according.

3.1 Research Design

A cross-sectional descriptive study design with quantitative approach was used to determine

the prevalence and risk factors associated with overweight among civil servants in Imo State,

Nigeria. It consisted of mainly Anthropometric measurements of weight, height, and

abdominal girth. The cross sectional descriptive study design was appropriate for this study

because it helped to analyze data of a group of subjects in a point of time and was deemed

basic when one tried to determine the economic, social burden of health condition (being

overweight) in a population of a given time.

3.2 Study Area

This study was conducted in Imo State Nigeria. Imo State is a state in the South-East

geopolitical zone of Nigeria bordered to the North by Anambra State, River State to the West

and South and Abia to the East. The state got its name from the Imo River which flows along

the state’s Eastern border. The state capital is Owerri and its State’s Nickname is the Eastern

Heartland. Imo state has an estimated population of 5.4 million people as of 2016. Imo is

inhabited by various ethnic groups but primarily by the Igbo people speaking Igbo language.

3.3 Scope of the Study

42
 This research work was focused on prevalence and risk factors associated with

overweight among Civil Servants in Imo State, Nigeria. This study also assessed the various

measures taken by the respondents to prevent the chances of becoming overweight.

3.4 Study population

The study populations were Civil Servants (both male and female) aged eighteen to

Sixty years in Imo State.

3.5 Sample size determination

Sample size for this study was determined or calculated using (Lwanga & Lemeshow,

1991) formula which is given as follows:

n= Z2PQ
d2
Where; n = Sample size

Z = The alpha level at 95% level of confidence = 1.96

P = Estimated proportion of obesity prevalence = 41% (0.41).

Source:(Ono, Guthold & Strong, 2012).

Q = Estimated proportion of non-prevalence of obesity (i.e 1-P) = 59% (0.59).

d = Margin of error = 5% (0.05).

Substituting into the formula above we have that;

n = Z2PQ
d2
n = (1.96)2*0.41*0.59
(0.05)2

n = 3.8416*0.41*0.59
0.0025

n= 0.9358
0.0025

n = 374.32, n = 374 (to a whole number).

If you consider non-response rate as 10%, the adjusted sample size is then calculated thus:
43
Estimated proportion of response = 10% = 0.1

Final sample size, n = Sample size (n)

1-estimated proportion of response

= 374
1-0.1

= 374
0.9

N = 415.55.

Therefore, n = 415 (adjusted to 420)

3.6 Sampling procedure

The researcher made use of multi-stage sampling technique to select 420 respondents

from State Ministries, instead of 415 respondents as calculated. This is because 420

respondents divide by the 20 Ministries that were selected for the study, gave a whole

number.

Stage one: Selection of Ministries

Simple random sampling technique was used to select twenty (20) Ministries out of

thirty-nine (39). The Ministries’ names were written on pieces of paper separately, which

folded into a container and vigorously shaken by the researcher. A volunteer was asked to

pick at random from the container, the first twenty (20) Ministries without replacement. The

Ministries randomly selected was used for the study.

Stage Two: Selection of Departments

Three (3) departments were randomly selected from each of the Ministry, making a

total of 60 departments from the 20 Ministries selected. The names of the Departments were

also written separately on parts of paper, which folded into a container and vigorously shaken

by the researcher. A volunteer was asked to pick at random from the container, the first three

(3) Departments without replacement.

44
Stage three: Selection of respondents

In each of the three (3) Departments randomly selected, seven (7) respondents were

selected for the study.The names of the Civil Servants present at work at the time of study

werealso written separately on pieces of paper, which were crumpled into a container and

vigorously shaken by the researcher. A volunteer was asked to pick at random from the

container, the first seven (7) respondents without replacement.

Questionnaire administration

After the selection of respondents, a simple semi-structured questionnaire was

administered to the respondents.

3.7 Instruments for data collection

The instruments that were used for the study include:

(a) Stadiometer: A well calibrated stadiometer with model number/name: Mi20, which

measures from 0.0cm up to 200cm as scores. To manage the scores, the stadiometer was

calibrated with least count of 0.1cm, to assess the height of participants. Before the

measurement of height of each participant, the researcher ensured that the stadiometer scale

was at 0.0cm, and after repeating the measurement for each participant to be sure of accuracy,

the final reading was then written.

(b) Digital weighing balance: A digital weighing balance with model number/name: MIFW,

which measures from 0.0kg up to 180 kg as scores. To manage the scores, the weighing

balance was calibrated with least count of 0.1kg, to assess the weight of participants. Before

the measurement of weight of each participant, the researcher ensured that the weighing

balance scale was at 0.0kg, and after repeating the measurement for each participant to be

sure of accuracy, the final reading was then written.

45
(c) Questionnaire: Well planned and pretested set of semi-structured questionnaire to collect

data from the study participants was used by the researcher. Each questionnaire was

numbered to enable the researcher to detect missing questionnaire, if any, during sorting. The

questionnaire comprises of four (4) major segments; socio-demographic characteristics, risk

factors, prevalence, and preventive measures of overweight and obesity.

(d) Tape: A well calibrated measuring tape to measure the waist circumference (abdominal

girth), which measures from 0.0cm up to 152cm or 60 inches as scores was used. To manage

the scores, the tape was calibrated with least count of 0.1cm, to assess the waist

circumference of participants. Before the measurement of waist circumference of each

participant, the researcher ensured that the tape scale was at 0.0cm, and after repeating the

measurement for each participant to be sure of accuracy, the final reading was then written.

3.8 Method of collection of data

Data collection was spread over two phases viz: initial contact with the study

participants completing the semi structured questionnaire and in second phase,

anthropometric measurements were taken. Anthropometric measurements were carried out by

measuring ‘height’ with the help of stadiometer, “abdominal girth” given the used of tape,

and ‘weight’ given the use of weighing balance.

Weight: Weight was measured to the nearest 100 grams (0.1kg) using a weighing scale after

calibrating it to zero with the capacity of 180 kg, and after removal of excess clothing and

shoes. Both height and weight were taken twice. The weighing scale was calibrated before

measuring of weight every day and after every five measurements during the data collection

time to ensure quality data.

Height: Stadiometer with the capacity of 197 cm and to the nearest 0.1cmwas used measured

height. The participant was told to stand (without shoes) on a horizontal platform with his

heels together and with the Frankfurter plain horizontal. The participant drew himself to full

46
height without raising the shoulders with arms and hands relaxed and with the feet flat on the

ground.

Tape: The waist circumference (abdominal girth) was measured using a well calibrated

measuring tape. The respondent was told to stand vertically with his heels together. The

respondent drew himself to full height with hands and armsstretched out, and with the feet

flat on the ground.

BMI: BMI of the respondent was measured by respondent’s weight in kilograms divided by

the square of height in meters.

3.9 Pre-testing of instruments

The sets of questionnaire and anthropometric instruments were pre-tested among civil

servants in State Ministries of Abia State, with 10% of the total sample size of similar

characteristics like the ones that were used in the main study. Pre-testing was carried out to

ensure accuracy and clarity of questionnaire, to check the consistency in interpretation of

questions by respondents and to identify unclear item (s). The questionnaire was then tested

for reliability using Cronbach Alpha Test in SPSS. Test results gave a value of 0.701 for the

questionnaire, 0.756 for measuring tape, 0.721 for digital weighing balance, and 0.783 for the

stadiometer (Appendix 2).George & Mallery (2003) maintained that this value indicates a

good level of internal consistency of the items/variables used in the questionnaire. By

comparing the data that were provided by the weighing balance with standard weights,

validity of instrument was ascertained. The tape used for measurement was calibrated against

standard stadiometer. To validate the data, the instruments were checked and reset daily. The

questionnaire was pretestedbefore data collection to ensure content validity. Efficiency and

work performance of the Research Assistant were determined during the pretest. Where

necessary, modification of the instruments was done.

3.10 Method of data analysis

47
 A total of 420 participants were enrolled in this study. Using the Microsoft Excel

2007 and Statistical Package for Social Sciences (SPSS) software version 20, data were

analyzed and the analysis took into cognizance frequency distribution of variables, graphical

representations, and tables. Standard deviation and mean were considered for continuous

variables and Chi Square (χ 2) test was then used to measure the level of association of

categorical variables. Alpha level of P less than or equal to 0.05 was used for chi-squared

test.

3.11 Selection criteria

3.11.1 Inclusion criteria

Civil servants in the State’s ministries aged from 18 to 60 were included in the study.

3.11.2 Criteria for exclusion

(a) Civil Servants below 18 years and above the age of60.

(b) Civil servants seriously ill, mentally unfit, pregnant and lactating women.

3.12 Ethical considerations

From the Department of Public Health, Imo State University, a letter of introduction

was obtained which enabled the investigator to obtain certificate of ethical approval from the

Chairman, Imo State Health Research Ethics Committee, and Ministry of Health, to facilitate

access in the selected Ministries to carry out research. From the study participants, informed

verbal consent was obtained who were assured of anonymity and confidentiality and given

information to enable them to make informed decision. Participants in the study were free

from coercion, as they participated very voluntarily. The researcher told the participants that

there were very free to withdraw participation at any time of the study without negatively

impacting on their participation in future study or the current study.

48
 CHAPTER FOUR
RESULTS
The semi-structured questionnaires were administered to respondents and all (four hundred

and twenty copies), one hundred percent (100%) were properly filled, retrieved, and used for

entry of data and analyzed by the researcher.

4.1 Socio-demographic characteristics of respondents

Most of the respondents who participated in the study were adults aged 32-45 years

(158; 34.5%), about the same proportion 145 (37.6%) were younger adults aged 18-31 years,

while those older than 45 years were the fewest (117; 27.9%). The Mean age of participants

recorded was 37.98±11.51. The ratio of male (167; 39.8%) to female (253; 60.2%)

participants in the study was about 2:3. Respondents’ religious affiliation were sought, and it

was observed that more than three-quarter of them were Christians (312; 84.3%), followed by

traditional worshippers (57; 13.6%) and Muslims (51; 12.1%). Of all the civil servants who

participated in the study, more than a third of them were married (164; 39.1%). Others were

single (133; 31.7%), divorced (64; 15.2%), separated (40; 9.5%), and widowed (19; 4.5%).

Half of the participants had attained tertiary level of education by far (225; 53.6%). 169

(40.2%) had attained secondary while 19(4.5%) have had primary education. The mean

number of children of participants was 1.35±1.98, with most of the civil servants having

about five children (403; 96.0%). This result showed that about two in every five civil

servants earned less than N50,000 (173; 41.1%) as monthly income compared to a very few

who indicated that they earned more than N200,000 (21; 5.1%) monthly.

49
Variables Group Frequency (n = 420) Percentage (%)
Age (in years) 18-31 145 34.5
32-45 158 37.6
> 45 117 27.9
Mean age (in years) 37.98 ± 11.51

Sex Male 167 39.8

Female 253 60.2

Religion Christianity 312 84.3

Muslim 51 12.1
Traditional 57 13.6

Marital status Married 164 39.1

Single 133 31.7
Divorced 64 15.2
Separated 40 9.5
Widowed 19 4.5

Educational level Informal 7 1.7

Primary 19 4.5
Secondary 169 40.2
Tertiary 225 53.6

Number of children 0-5 403 96.0

6-12 17 4.0

Income level (N) < 50,000 173 41.1

51,000-100,000 149 35.5
101,000-200,000 77 18.3
> 200,000 21 5.1

Location Mba ise 147 35.0

Mbaitoli 119 28.3
Oru 49 11.7
Ngorkpala 31 7.4
Orlu 11 2.6
Orsu 24 5.7
Oweri west 39 9.3
Table 2: Socio-demographic characteristics of the respondents

50
4.2 Prevalence of being overweight among civil servants

Results displayed in Figure 3 show that prevalence of overweight among participants

was seen to be 34.0% and 22.6% respectively. The assessment of theassociation of the

prevalence of overweight with socio-demographic characteristics of participants indicated

that in terms of age, most persons that were overweight and obese were those aged 32-45

years (70; 44.3%) and more than 45 years old (40; 34.2%) respectively. Females (90; 35.6%)

were more overweight compared to the males (53; 31.7%), however, obesity was recorded

more in males (42; 25.1%) than females (53; 20.9%). Christians (114; 36.5%) and Traditional

worshippers (15; 26.3%) were more overweight and obese respectively. Participants who

were mostly overweight were those that were married (62; 37.8%), divorced (24; 37.5%) and

widowed (7; 36.8%). Similarly, married (42; 25.6%), divorced (21; 32.8%) and widowed (5;

26.3%) were obese. Furthermore, participants that had attained primary level of education

recorded the highest level of overweight (7; 36.8%) and obesity (5; 26.3%). In terms of

monthly income, participants who earned between 51,000-100,000 were the most overweight

(59; 39.6%) persons while those that earned more than N200,000 were the most obese (9;

42.9%) participants. The Mean weight, mean height and mean BMI were recorded as

75.30±12.35, 1.69±5.85, and 26.12±4.14 respectively.

51
 172 (41.0%)
180
143 (34.0%)

Number of respondents
160
140
120 95 (22.6%)

100
80
60
40 10 ( 2.4%)
20
0
Undeweight Normal Overweight Obese

BMI Status

Figure 3: Prevalence of obesity and overweight

52
 Table 3: Association of socio-demographic characteristics with BMI status of
respondents
Variables BMI Status (%) Total (%) χ2 df p-value
Age (in years) Underweight Normal Overweight Obesity
18-31 8(5.5) 84(57.9) 37(25.5) 16(11.0) 145(100.0) 49.16 6 <.001*
32-45 1(0.6) 48(30.4) 70(44.3) 39(24.7) 158(100.0)
> 45 1(0.9) 40(34.2) 36(30.8) 40(34.2) 117(100.0)

Sex 3.07 3 .381

Male 6(3.6) 66(39.5) 53(31.7) 42(25.1) 167(100.0)
Female 4(1.6) 106(41.9) 90(35.6) 53(20.9) 253(100.0)

Religion 6.69 6 .351

Christianity 9(2.9) 120(38.5) 114(36.5) 69(22.1) 312(100.0)
Muslim 0(0.0) 27(52.9) 13(25.5) 11(21.6) 51(100.0)
Traditional 1(1.8) 25(43.9) 16(28.1) 15(26.3) 57(100.0)

Marital status 27.80 12 .006*

Married 2(1.2) 58(35.4) 62(37.8) 42(25.6) 164(100.0)
Single 6(4.5) 73(54.9) 37(27.8) 17(12.8) 133(100.0)
Divorced 1(1.6) 18(28.1) 24(37.5) 21(32.8) 64(100.0)
Separated 0(0.0) 17(42.5) 13(32.5) 10(25.0) 40(100.0)
Widowed 1(5.3) 6(31.6) 7(36.8) 5(26.3) 19(100.0)

Educational level 9.43 9 .398

Informal 1(14.3) 4(57.1) 1(14.3) 1(14.3) 7(100.0)
Primary 0(0.0) 7(36.8) 7(36.8) 5(26.3) 19(100.0)
Secondary 4(2.4) 77(45.6) 55(32.5) 33(19.5) 169(100.0)
Tertiary 5(2.2) 84(37.3) 80(35.6) 56(24.9) 225(100.0)

Income LEVEL 22.84 9 .007*

(N)
< 50,000 4(2.3) 91(52.6) 50(28.9) 28(16.2) 173(100.0)
51,000-100,000 5(3.4) 46(30.9) 59(39.6) 39(26.2) 149(100.0)
101,000-200,000 1(1.3) 29(37.7) 28(36.4) 19(24.7) 77(100.0)
> 200,000 0(0.0) 6(30.0) 6(30.0) 9(42.9) 21(100.0)

Location 12.56 18 .817

Mba ise 6(4.1) 57(38.8) 47(32.0) 37(25.2) 147(100.0)
Mbaitoli 3(2.5) 43(36.1) 43(36.1) 30(25.2) 119(100.0)
Oru 0(0.0) 25(51.0) 17(34.7) 7(14.3) 49(100.0)
Orlu 0(0.0) 14(45.2) 10(32.3) 7(22.6) 31(100.0)
Ngorkpala 0(0.0) 4(36.4) 3(27.3) 4(36.4) 11(100.0)
Orsu 0(0.0) 12(50.0) 8(33.3) 4(16.7) 24(100.0)
Owerri west 1(2.6) 17(43.6) 15(38.5) 6(15.4) 39(100.0)
*Significant at 0.05 level of significance.

53
4.3 Perceived risk factors of being overweight among respondents.

Respondents were asked to identify perceived risk factors of overweight and obesity

engaged in for at most four weeks preceding the period of the survey. Results show that the

three major perceived risk factors of overweight (asself-reported) were; sedentary lifestyle

(322; 76.7%), foods consumption high in sugar and fat (308; 73.3%) and consumption of

junks/fast foods (283; 67.4%). On the other hand, drug use (79; 39.5%) was observed to be

mostly associated with overweight while family history (126; 30.0%) was more associated

with obesity compared to other risk factors identified.

The risk factors of obesity and overweight among civil servants were identified,

where most participants reported that they were more involved in walking (255; 60.7%) than

jogging (176; 41.9%), swimming (105; 25.0%) and gym (87; 20.7%) as forms of physical

activity. It was further noted that participants who were least overweight and obese were

those that engaged in gym (24; 27.6%) and swimming (15; 14.3%) activities respectively.

Chi-squared test statistics at 95% Confidence level, showed that drug use (p= .025) and

alcohol consumption (p=.042) were statistically significantly associated with overweight

status of the respondents (Table 11). Similarly, results showed that drug use (p= .003),

smoking (p=.017) and family history (p=.016) were statistically significantly associated with

obesity status of the respondents (Table 12).

Table 5 showed that the frequency of physical activity engaged by respondents were

mostly daily (229; 54.5%) as reported by more than half of the respondents. About a third of

the participants reported that they engage in physical activity monthly (139; 33.1). More so,

more than half of the respondents engaged in physical activity for a period of less than 20

minutes (215; 51.2%).

54
 Table 4: Perceived risk factors of overweight and obesity among respondents
Risk factors No. of No. of overweight No. of obese
participants n = participants n = participants n
420, % 143, % = 95, %
Physical activity*
Walking 255(60.7) 83(32.5) 53(20.8)
Jogging 176(41.9) 52(29.5) 36(20.5)
Swimming 105(25.0) 33(31.4) 15(14.3)
Gym 87(20.7) 24(27.6) 14(16.1)

Drug use 200(47.6) 79(39.5) 58(29.0)

Smoking 166(39.5) 64(38.6) 48(28.9)

Consumption of junks/fast 283(67.4) 104(36.7) 68(24.0)

foods

Consumption of food high in 308(73.3) 113(36.7) 73(23.7)

fat or sugar

Family history 126(30.0) 45(35.7) 38(30.2)

Sedentary lifestyle 322(76.7) 110(34.2) 78(24.2)

Alcohol consumption 203(48.3) 79(31.1) 47(18.5)

55
 Table 5: Frequency and duration of physical activity of the respondents

Variables Frequency (n = 420) Percentage (%)

Frequency of physical activity
Daily 229 54.5
Weekly 139 33.1
Monthly 51 12.1
Yearly 1 0.2

Duration of physical activity (in

minutes)
<20 215 51.2
20-40 134 31.9
> 40 71 16.9

Duration of physical activity (in

minutes) per:
Day 164 39.1
Week 198 47.1
Month 55 13.1
Year 3 0.7

56
4.3.1 Perceived factors associated with respondents’ overweight status

R
Factors e s u l
Frequency t = 420)s
(n Percentages (%) h o w

Boredom 183 43.6

Sadness 82 19.5
Stress 115 27.4
Anger 67 16.0
Age 255 60.7
Socioeconomic status 182 43.3
Gender 119 28.3
Physical inactivity 101 24.0
Racism/ethnicity 100 23.8
overweight status were age (225; 60.7%) and boredom (183; 43.6%). Other factors that were

perceived to associate with overweight and obesity were: socio-economic status (182;

43.3%), gender (119; 28.3%), stress (115; 27.4%), physical inactivity (101; 24.0%),

racism/ethnicity (100; 23.8%), sadness (82; 19.5%) and anger (67; 16.0%)(Table 6).

Table 6: Perceived factors associated with respondents’ overweight and obesity status

*Multiple responses, percentages do not sum up to one hundred

57
4.3.2 Perceived health risks associated with respondents’ overweight and obesity
status
Results displayed as frequencies and percentages indicate that, Type-2 diabetes (188;

44.8%), High Blood Pressure (186; 44.3%) and Stroke (169; 40.2%) were the three major

health risks that were perceived to be associated with overweight and obesity. Others are high

cholesterol (144; 34.3%), insulin resistance (124; 29.5%), osteoarthritis (105; 25.0%), heart

attack (104; 24.8%), sleep apnea (102; 24.3%), and some cancers (67; 16.0%)

58
 Table 7: Perceived health risk associated with respondents’ overweight and obesity
status
Health risk* Frequency (n = 420) Percentage (%)
Type II diabetes 188 44.8
High Blood Pressure 186 44.3
Insulin resistance 124 29.5
Heart attack 104 24.8
Some cancers 67 16.0
Osteoarthritis 105 25.0
Sleep apnea 102 24.3
High cholesterol 144 34.3
Stroke 169 40.2
*Multiple responses, percentages do not sum up to one hundred

59
4.4 Perceived preventive measures of overweight among respondents

Results presented in Table 8 show that measures perceivedby the respondents to

prevent obesity and overweight include majorly; limiting energy intake from sugars and fats

(386; 91.9%) increased fruits consumption, legumes, whole grains, vegetables, and nuts (335;

79.8%), avoiding the use of drugs to gain weight (260; 61.9%) and avoiding oral

contraceptives (259; 61.7%). Other preventive measures were limiting stress (160; 38.1%),

avoiding sedentary lifestyles in workplace (148; 35.2%), and surgery (104; 24.8%).

60
 Table 8: Perceived preventive measures of overweight among respondents
Measures* Frequency (n = 420) Percentage (%)
Limiting energy intake from fats and sugars 386 91.9
Increased consumption of fruits, vegetables, 335 79.8
legumes, whole grains, and nuts.
Avoiding the use of drugs to gaining weight 260 61.9
Engaging in physical activity 259 61.7
Avoiding oral contraceptives 252 60.0
Limiting stress 160 38.1
Avoiding sedentary lifestyles in workplaces 148 35.2

Surgery 104 24.8

*Multiple responses, percentages do not sum up to one hundred

61
4.5 Test of Hypotheses

Ho1: There is no statistically significant relationship of prevalence of overweight with socio-

demographic characteristics of participants.

Chi-squared test statistics at 95% Confidence level showed that sex (χ 2 = 0.659, df = 1, p

= .417), religion (χ2 = 3.432, df = 2, p = .180), marital status (χ 2 = 2.777, df = 4, p = .437),

educational level (χ2 = 7.372, df = 3, p = .061), income level (χ 2 = 4.548, df = 3, p = .208) and

location (χ2 = 1.135, df = 6, p = .980) of respondents were not statistically significant with

prevalence of overweight among the respondents except for, age(χ 2 = 12.66, df = 2, p = .002)

of respondents (Table 9).

Ho2: There is no statistically significant relationship of the prevalence of obesity with the

socio-demographic characteristics of participants.

Chi-squared test statistics at 95% Confidence level showed that sex (χ 2 = 1.014, df = 1, p

= .317), religion (χ2 = 0.522, df = 2, p = .770), educational level (χ 2 = 4.310, df = 3, p = .230),

and location (χ2 = 5.785, df = 6, p = .448) of respondents were not statistically significant

with prevalence of obesity among participants except for age (χ2 = 20.45, df = 2, p = <.001),

marital status (χ2 = 12.269, df = 4, p = .015) and income level (χ 2 = 10.268, df = 3, p = .016)

of respondents (Table 10).

Ho3: There is no statistically significant association between known risk factors (physical

inactivity, smoking, consumption of junks/fast foods, consumption of food high in fat or

sugar, family history, and sedentary lifestyle) and overweight among the respondents.

Chi-squared test statistics at 95% Confidence level showed that physical activity (χ 2 = 0.447,

df = 3, p = .930), smoking (χ 2 = 2.483, df = 1, p = .115), consumption of junks/fast foods (χ 2 =

2.820, df = 1, p = .093), consumption of food high in fat or sugar (χ 2 = 3.587, df = 1, p

= .058), family history (χ2 = .223, df = 1, p = .637), sedentary lifestyle (χ 2 = 0.008, df = 1, p

= .929) of respondents were not statistically significant with prevalence of overweight among

62
participants except for drug use (χ2 = 5.055, df = 1, p = .025), alcohol consumption (χ2 =

4.147, df = 1, p = .042), and fattening room practice (χ2 = 5.746, df = 1, p = .017) (Table 11).

Ho4:There is no statistically significant association between known risk factors (physical

inactivity, smoking, consumption of junks/fast foods, consumption of food high in fat or

sugar, family history, and sedentary lifestyle) and obesity among the respondents.

Chi-squared test statistics at 95% Confidence level showed that physical activity (χ 2 = 2.413,

df = 3, p = .491), consumption of junks/fast foods (χ 2 = 1.355, df = 1, p = .244), consumption

of food high in fat or sugar (χ 2 = 0.773, df = 1, p = .379), sedentary lifestyle (χ 2 = 2.030, df =

1, p = .154) and alcohol consumption (χ 2 = 0.064, df = 1, p = .800) of respondents were not

statistically significant with prevalence of obesity among participants except for drug use (χ 2

= 8.882, df = 1, p = .003), smoking (χ2 = 5.714, df = 1, p = .017) and family history (χ2 =

5.846, df = 1, p = .016) (Table 12).

Ho5: There is no statistically significant association between BMI Status with socio-

demographic characteristics of the respondents.

Using the Chi-squared test statistics to test for association between socio-demographic

characteristics with the BMI status of participants at 95 percent confidence level, results

displayed in Table 3 indicate that BMI status of participants were all not statistically

significantly different with sex (χ2 = 3.07, df = 1, p = .381), religion (χ 2 = 6.69, df = 6, p

= .351), educational level (χ2 = 9.43, df = 9, p = .398) and location (χ 2 = 12.56, df = 18, p

= .817) except for age (χ2 = 41.96, df = 6, p = <.001), marital status (χ 2 = 27.80, df = 12, p

= .006) and income (χ2 = 22.84, df = 9, p = .007) of participants which were statistically

significant.

63
Table 9: Association of overweight with socio-demographic characteristics of participants

Variables No. of participants, No. of overweight χ2 Df p-value

n = 420, % participants, n = 143, %
Age (in years) 12.66 2 .002*
18-31 145(34.5) 37(25.5)
32-45 158(37.6) 70(44.3)
> 45 117(27.9) 36(30.8)

Sex 0.659 1 .417

Male 167(39.8) 53(31.7)
Female 253(60.2) 90(35.6)

Religion 3.432 2 .180

Christianity 312(84.3) 114(36.5)
Muslim 51(12.1) 13(25.5)
Traditional 57(13.6) 16(28.1)

Marital status 3.777 4 .437

Married 164(39.1) 62(37.8)
Single 133(31.7) 37(27.8)
Divorced 64(15.2) 24(37.5)
Separated 40(9.5) 13(32.5)
Widowed 19(4.5) 7(36.8)

Educational level 7.372 3 .061

Informal 7(1.7) 1(14.3)
Primary 19(4.5) 7(36.8)
Secondary 169(40.2) 55(32.5)
Tertiary 225(53.6) 80(35.6)

Income level (N) 4.548 3 .208

< 50,000 173(41.1) 50(28.9)
51,000-100,000 149(35.5) 59(39.6)
101,000-200,000 77(18.3) 28(36.4)
> 200,000 21(5.1) 6(30.0)

Location 1.135 6 .980

Mba ise 147(35.0) 47(32.0)
Mbaitoli 119(28.3) 43(36.1)
Orlu 49(11.7) 17(34.7)
Oru 31(7.4) 10(32.3)
Ngorkpala 11(2.6) 3(27.3)
Owerri west 24(5.7) 8(33.3)
*Significant at 0.05 level of significance.

64
 Table 10: Association of being overweight with socio-demographic characteristics of
participants

Variables No. of participants, No. of obese participants, χ2 Df p-value

n = 420, % n = 95, %
Age (in years) 20.45 2 <.001*
18-31 145(34.5) 37(25.5)
32-45 158(37.6) 70(44.3)
> 45 117(27.9) 36(30.8)

Sex 1.014 1 .314

Male 167(39.8) 53(31.7)
Female 253(60.2) 90(35.6)

Religion .522 2 .770

Christianity 312(84.3) 114(36.5)
Muslim 51(12.1) 13(25.5)
Traditional 57(13.6) 16(28.1)

Marital status 12.269 4 .015*

Married 164(39.1) 62(37.8)
Single 133(31.7) 37(27.8)
Divorced 64(15.2) 24(37.5)
Separated 40(9.5) 13(32.5)
Widowed 19(4.5) 7(36.8)

Educational level 4.310 3 .230

Informal 7(1.7) 1(14.3)
Primary 19(4.5) 7(36.8)
Secondary 169(40.2) 55(32.5)
Tertiary 225(53.6) 80(35.6)

Income level (N) 10.268 3 .016*

< 50,000 173(41.1) 50(28.9)
51,000-100,000 149(35.5) 59(39.6)
101,000-200,000 77(18.3) 28(36.4)
> 200,000 21(5.1) 6(30.0)

Location 5.785 6 .448

Mba ise 147(35.0) 47(32.0)
Mbaise 119(28.3) 43(36.1)
Oru 49(11.7) 17(34.7)
Orlu 31(7.4) 10(32.3)
Ngorkpala 11(2.6) 3(27.3)
Orsu 24(5.7) 8(33.3)
Owerri west 39(9.3) 15(38.5)

*Significant at 0.05 level of significance.

65
 Table 11
Association of risk factors with the prevalence of overweight among participants
Risk factors No. of participants No. of overweight χ2 Df p-value
n = 420, % participants n = 95, %
Physical activity# 0.447 3 0.930
Walking 255(60.7) 83(32.5)
Jogging 176(41.9) 52(29.5)
Swimming 105(25.0) 33(31.4)
Gym 87(20.7) 24(27.6)

Drug use 200(47.6) 79(39.5) 5.055 1 0.025*

Smoking 166(39.5) 64(38.6) 2.483 1 0.115

Consumption of 283(67.4) 104(36.7) 2.820 1 0.093

junks/fast foods

Consumption of food 308(73.3) 113(36.7) 3.587 1 0.058

high in fat or sugar

Family history 126(30.0) 45(35.7) 0.223 1 0.637

Sedentary lifestyle 322(76.7) 110(34.2) 0.008 1 0.929

Alcohol consumption 203(48.3) 79(31.1) 4.147 1 0.042*

*Significant at 0.05 level of significance;

#
Multiple response

66
 Table 12
Risk factors No. of participants No. of obese χ2 Df p-value
n = 420, % participants n = 95, %
Physical activity# 2.413 3 0.471
Walking 255(60.7) 53(20.8)
Jogging 176(41.9) 36(20.5)
Swimming 105(25.0) 15(14.3)
Gym 87(20.7) 14(16.1)

Drug use 200(47.6) 58(29.0) 8.882 1 0.003*

Smoking 166(39.5) 48(28.9) 5.714 1 0.017*

Consumption of 283(67.4) 68(24.0) 1.355 1 0.244

junks/fast foods

Consumption of food 308(73.3) 73(23.7) 0.773 1 0.379

high in fat or sugar

Family history 126(30.0) 38(30.2) 5.846 1 0.016*

Sedentary lifestyle 322(76.7) 78(24.2) 2.030 1 0.154

Alcohol consumption 203(48.3) 47(18.5) 0.064 1 0.800

Association of risk factors with the prevalence of being overweight among participants

*Significant at 0.05 level of significance;

#
Multiple response

67
 CHAPTER FIVE

DISCUSSION, SUMMARY, CONCLUSION AND RECOMMENDATION

5.1 Discussion

5.1.1 Prevalence of overweight.

The results from this study indicate that the prevalence of overweight among

participants was 34.0% and 22.6% respectively. This agrees with the findings from

Chukwuonye, Chuku, John, Ohagwu, Imoh & Isa (2013) that in Nigeria the prevalence of

obesity ranges from 8.1% to 22.2%.Further association of prevalence of overweight with

socio-demographic characteristics of participants indicated that in terms of age, most of the

respondents (70; 44.3%) that were overweight and obese were those aged 32-45 years; as

well as those aged 45 years and above (40; 34.2%). This study is in line with data from the

WHO Global InfoBase, that individuals aged 30 years and above, showed that the prevalence

of overweight and obesity is increased by 23% in men and 18% in women.

This study further reveals that Females (90; 35.6%) were more overweight compared

to their male (53; 31.7%) counterparts. This is supported by 2010 WHO survey data on

Nigeria that the prevalence of overweight was 26% and 37% in men and women respectively.

Findings from this study, however, indicates that obesity was more in males (42; 25.1%) than

females (53; 20.9%), which is at variance with the findings by 2010 WHO survey data on

Nigeria that the prevalence of obesity was 3% and 8.1% in men and women respectively.

5.1.2 Risk factors of overweight among civil servants

This study identified some major risk factors associated with overweight at 95%

significance level such as alcohol consumption (p=.042) and drug use (p=.025) (Table 11).

Also, the study identified major risk factors related to obesity such as drug use (p=0.003),

smoking (p=0.017) and family history (p=0.016) (Table 12). This finding is supported by

Yoon, Kim & Doo, (2016) that consumption of energy-dense food, consuming sugars and
68
soft drinks, fats, smoking, alcohol consumption, etc have been found to be highly correlated

with obesity and overweight. Similarly, some studies have also stated that feeding habit

culture, consumption of pastry foods, and ultra-processed food (refined carbohydrate),

consumption of excess alcohol, and monotonous consumption of diet or poor diet quality

consumption increase the occurrence of obesity (Ngaruiya, Hayward, Post, & Mowafi, 2017).

This study also identified sedentary lifestyle as a risk factor related to being overweight

(322; 76.7%). This finding is supported by Addo, Nyarko, Sackey, Akweongo, & Sarfo

(2015) that engaging in sedentary lifestyle for two hours or more increases the occurrence of

obesity, because during simple observation, the brain does not use glucose, and as a result,

the breakdown of carbohydrate to glycogen and fat increased constantly.

The study also showed that the risk factors of obesity and overweight among the

respondents were participants who were involved in walking (255; 60.7%) than jogging (176;

41.9%), swimming (105; 25.0%) and gym (87; 20.7%) as forms of physical activity (as self-

reported). This is in variance with the findings by Cinteza & Cintez, (2018) that either

irregular physical activity, prolonged watching of television, and regular use of taxi for

transportation were determinant factors for overweight/obesity.

5.1.3 Perceived factors associated with respondent’s overweight status

This study showed that stress (115; 27.4%) is a perceived factor associated with

respondent’s being overweight. This finding is however, supported by van der Valk, Savas, &

van Rossum, (2018); Boniecka, Wileńska, Jeznach-Steinhagen, Czerwonogrodzka-Senczyna,

Sekuła & Paśnik, (2017) that during stress, the cortisol level rises, which is a reason for

surplus production of abdominal fat by increasing appetite (daily intake).

This study further revealed that racism/ethnicity (100; 23.8%) is a perceived risk

factor associated with respondent’s being overweight and obese. This agrees with the

findings by Jerry (2019) that ethnicity may influence the speediness of weight gain. African-

American women and Hispanic women seem to experience weight gain earlier in life than

69
Caucasians and Asians, and age-adjusted obesity rates are more among these groups. Non-

Hispanic black men and Hispanic men have more obesity rate than non-Hispanic white men,

but the variance in prevalence is significantly lower than in women.

This study also showed that socio-economic status (182; 43.3%) and physical

inactivity (101; 24.0%) are factors perceived by the respondents to be associated with

overweight and obesity. This is supported by WHO (2019) that there is a relationship

between social issues and obesity, and that having no money to buy healthy foods or, lack of

harmless places to walk or exercise can increase the risk of obesity. This study further

showed that age (p=.001), marital status (p = .015) and income level (p = .016) are factors

associated with respondent’s overweight. This is clearly supported by WHO (2009) that

obesity and overweight/obesity increases with age, marital status, and income level.

5.1.4 Perceived health risk associated with respondent’s overweight status

This study revealed that the respondents perceived Type-2 diabetes (188; 44.8%) and high

blood pressure (186; 44.3%) to be the major health hazards that are linked to overweight and

obesity. These findings are supported by Sabir, Balarabe, Sanni, Isezuo, Bello &

Jimoh, (2017) that obesity and overweight are the major risk factors fueling increased

prevalence of type 2 diabetes mellitus among Nigerians. This finding is also supported by

Owolabi, Owolabi, OlaOlorun & Amole (2015) that obesity and overweight contribute to

high prevalence of hypertension (high blood pressure) among workers in Nigeria despite their

awareness of the disease.

5.1.5 Preventive measures of becoming overweight among respondents

The findings from the study regarding the measures taken by respondents to prevent

obesity and overweight are majorly; reducing energy intake from fats and sugars (386;

91.9%) increased fruits consumption, as well as vegetables and legumes, whole grains, and

nuts (335; 79.8%), avoiding the use of drugs to gain weight (260; 61.9%) and avoiding oral

contraceptives (259; 61.7%). Other preventive measures were limiting stress (160; 38.1%), as

70
well as avoiding sedentary lifestyles in workplace (148; 35.2%). These findings are supported

by WHO (2019) that individuals can limit energy consumption from total fats and sugars;

increase consumption of fruit and vegetables, as well as legumes, whole grains, and nuts; and

engaging in regular physical activity.

Furthermore, according to the WHO report (2019) “some diabetes

medications (medications used in lowering blood sugar such as insulin, sulfonylurea as, and

thiazolidinediones), certain hormones such as  oral contraceptives, and

most corticosteroids such as prednisone, some high blood pressure medications

and antihistamines cause weight gain.”Additionally, the findings are equally supported by

Ingrid (2015) that antihistamines (used for allergies), particularly cyproheptadine, Steroids,

including corticosteroids and birth control pills, psychotherapeutic medications,

including lithium, antipsychotics, and antidepressants, anticonvulsant drugs (used

for epilepsy and some other conditions), such as sodium valproate and carbamazepine

contribute to overweight and obesity.

5.2 Summary

The study focused on “prevalence and risk factors associated with overweight and among

civil servants in Imo State, Nigeria”. Overweight and obesity can be explained as the

imbalance between energy consumption and expenditure such that more than required energy

is stored in fat cells. Overweight are defined as excessive accumulation of fat that may be

harmful to health. They are also disorders of energy metabolism involving excess adipose

tissues stored which may be associated with medical and psychological morbidity. Obesity

and overweight have become public health problems disturbing people world-wide. The

general objective of this study was to determine the prevalence and risk factors associated

with overweight and obesity among civil servants in Imo State, Nigeria.

A cross-sectional descriptive study design was used for this study using a quantitative

approach. The study population were civil servants aged between 18 and 60 (males and
71
females) that were physically present at the time of study. It consisted of Anthropometric

measurements of weight, height, and abdominal girth. The descriptive cross sectional study

design was appropriate for this study because it helped to analyze data of a group of subjects

at a point of time and was deemed basic when one tries to assess the burden of health

condition (obesity & overweight) in a population at a given time. Multi-stage sampling

technique was used to select 420 participants from State Ministries as sample size. Simple

random sampling technique was used to select twenty (20) Ministries out of thirty-nine (39).

Three (3) departments were randomly selected from each of the Ministry, making a total of

60 departments from the 20 Ministries selected. In each of the three (3) Departments

randomly selected, seven (7) respondents were selected for the study. The instruments that

were used for the study include stadiometer, digital weighing balance, questionnaire, and

calibrated measuring tape.

The collection of data was spread over two phases, thus: initial contact with the

participants finishing the semi-structured questionnaire, and in second phase, anthropometric

measurements were taken. The organized sets of questionnaire and anthropometric

instruments were pre-tested with a few civil servants in State Ministries of Abia State,

corresponding to 10 per cent of the total sample size of the same characteristics as the ones

that were used in the study. A total of 420 respondents were enrolled in this study. Data were

analyzed with the use of Microsoft Excel 2007 and Statistical Package for Social Sciences

(SPSS) software version 20 and the analysis took cognizance of frequency distribution of

variables, charts, and tables. Mean and standard deviation (SD) were calculated for

continuous variables and Chi Square (χ 2) test was used to measure the association of

categorical variables. Alpha level of P less than or equal to 0.05 was used for chi-squared

test.

The results showed that most civil servants who participated in the study were adults

aged 32-45 years (158; 34.5%), about the same proportion of the respondents were younger
72
adults aged 18-31 years (145; 37.6%) while those older than 45 years were the fewest (117;

27.9%). Mean age of participants was recorded as 37.98±11.51. The ratio of male (167;

39.8%) to female (253; 60.2%) participants in the study was about 2:3. Of all the civil

servants who participated in the study, more than a third of them were married (164; 39.1%).

Others were single (133; 31.7%), divorced (64; 15.2%), separated (40; 9.5%), and widowed

(19; 4.5%). More than half of the respondents had achieved tertiary level of education (225;

53.6%). About two in every five civil servants reported that they earned less than N50,000

(173; 41.1%) as monthly income compared to a very few who said that they earned more than

N200,000 (21; 5.1%) monthly.

The results further showed that the prevalence of being overweight among

participants was observed to be 34.0% and 22.6% respectively . Females (90; 35.6%) were

more overweight compared to their male (53; 31.7%) counterparts, however, obesity was

recorded more in males (42; 25.1%) than females (53; 20.9%).The three major perceived risk

factors identified to be connected with overweight and obesity were; sedentary lifestyle (322;

76.7%), consuming of foods high in fat and sugar (308; 73.3%) and consumption of

junks/fast foods (283; 67.4%). On the other hand, drug use (79; 39.5%) was observed to be

mostly associated with overweight while family history (126; 30.0%) was more associated

with obesity compared to other risk factors identified. Further results showed that perceived

measures taken by respondents to prevent overweight, and obesity include majorly; reducing

energy intake from fats and sugars (386; 91.9%) increased fruits consumption, as well as

vegetables and legumes, whole grains, and nuts (335; 79.8%), avoiding the use of drugs to

gain weight (260; 61.9%) and avoiding oral contraceptives (259; 61.7%). Other perceived

preventive measures were limiting stress (160; 38.1%), avoiding sedentary lifestyles in

workplace (148; 35.2%), and surgery (104; 24.8%).

Chi-squared test statistics at 95% Confidence level showed that sex (p = .417),

religion (p = .180), marital status (p = .437), educational level (p = .061), income (p = .208)

73
and location (p = .980) of respondents were not statistically meaningfully associated with

prevalence of overweight among participants except for age (p = .002) of respondents.

Furthermore, Chi-squared test statistics at 95% Confidence level showed that sex (p = .317),

religion (p = .770), educational level (p = .230), and location (p = .448) of respondents were

not statistically significantly connected with prevalence of obesity among participants except

for age (p = <.001), marital status (p = .015) and income (p = .016) of respondents.

Also, Chi-squared test statistics at 95% Confidence level showed that physical activity (p

= .930), smoking (p = .115), consumption of junks/fast foods (p = .093), consumption of food

high in fat or sugar (p = .058), family history (p = .637), sedentary lifestyle (p = .929) of

respondents were not statistically significantly related with prevalence of overweight among

participants except for drug use (p = .025), and alcohol consumption (p = .042).Chi-squared

test statistics at 95% Confidence level showed that physical activity (p = .491), consumption

of junks/fast foods (p = .244), consumption of food high in fat or sugar (p = .379), sedentary

lifestyle (p = .154) and alcohol consumption (p = .800) of the respondents were not

statistically significantly linked with prevalence of obesity among participants except for

drug use (p = .003), smoking (p = .017) and family history (p = .016). Also, using the Chi-

squared test statistics to test for association between socio-demographic characteristics with

the BMI status of participants at 95 percent confidence level, results indicate that BMI status

of participants were all not statistically significantly related with sex (p = .381), religion (p

= .351), educational level (p = .398) and location (p = .817) except for age (p = <.001),

marital status (p = .006) and income (p = .007) of participants which were statistically

significant.

5.3 Conclusion

` In the course of the study, the researcher discovered that prevalence of overweight

(34.0%) and obesity (22.6%) were high among the respondents, and it affects both gender

(males and females). Majority of the respondents were both obese and overweight, and this

74
may increase rate of co-morbidities and mortality. The prevalence of overweight was higher

than those who were obese. Also, majority of the respondents were obese and overweight

based on age group (in years). The age with the highest prevalence of overweight and obesity

were those between 32-45 years and more than 45 years respectively. This implies that

obesity and overweight increase with increasing age. Based on gender and marital status,

those exposed to being overweight were mostly females, while those obese were mostly

males, and married woman respectively.

Majority of the respondents indicated that increased consumption of vegetables, fruits,

legumes, and nuts can prevent overweight and obesity. The respondents also observed that

less consumption of fats, sugar, salt, carbohydrate, and engagement in regular physical

activity prevent overweight and obesity. Majority of the respondents who were overweight

and obese have attained both secondary and tertiary education. Majority of the respondents

observed that their routine work restricts them to a sitting position which promotes sedentary

lifestyle leading to the prevalence of obesity and overweight (self-reported).

Perceived health danger linked with overweight, and obesity wereType-2 diabetes,

High Blood Pressure and Stroke. Others are high cholesterol, insulin resistance, osteoarthritis,

heart attack, sleep apnea, and some cancers. The preventive measures taken by respondents to

avoid getting overweight was majorly; reducing energy intake from fats and sugars increased

fruits consumption, as well as vegetables and legumes, whole grains, and nuts, avoiding the

use of drugs to gain weight, and avoiding oral contraceptives. Other preventive measures

were limiting stress, avoiding sedentary lifestyles in workplace, and surgery.

5.4 Recommendations
Based on the findings and conclusion from the study, the followings are
recommended:

1. Those who are overweight or obese should be engaged in regular physical activity to
mitigate health hazards associated with overweight and obesity.
75
2. Individuals should avoid lifestyle (alcohol use, smoking, eating late at night, excessive

consumption of foods capable of exposing one to obesity) and adhere strictly to

potentially good behavior.

3. Individual should take more of fruits, vegetables, legumes, and nuts to prevent obesity

and its co-morbidities.

4. Individuals should ensure that body weight and height are checked regularly to

determining their Body Mass Index (BMI).

5. Individuals should avoid sedentary lifestyle and excess consumption of food that could

expose them to the disease condition.

6. Health Care Providers should educate individuals on the need to avoid the use of anti-

depressant drugs to gain weight, and/or potentially bad behavior to reducing drastically,

overweight and obesity and its co-morbidities and mortality.

7. There should be health education/promotion on obesity and prevention.

8. Stakeholders (Government, NGOs, etc.) should provide facilities and recreational

canters to facilitate physical activity and reduction in morbidity and mortality rates

among civil servants in Cross River State.

9. Food industry should play significant role in encouraging healthy diets by; limiting fat,

sugar and salt content of processed foods, ensuring that healthy and nutritious choices

are made available and affordable to all consumers.

5.5 Contribution to knowledge

1. To the best of my knowledge, this study has provided information on prevalence and

risk factors associated with obesity and overweight among civil servants in sImo

State, Nigeria which were previously unavailable

2. This study also offered a conceptual framework as conceptualized by the researcher,

which can be used for further studies. The framework showed the linkages between

76
overweight, obesity, normal weight and underweight, and the risk factors of obesity

and overweight, and the preventive measures of overweight and obesity.

77
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 APPENDIX I

RESEARCH QUESTIONNAIRE

Dear respondent,
I am Ozioma Cynthia Obianuju, a Masters Student of the department of Public Health, Faculty of
Health Sciences, Imo State University Owerri. I am carrying out a research on “Prevalence and risk
factors associated with overweight and obesity among Civil Servants in ImoState, Nigeria.”
Please assist this research by filling the information required on the questionnaire. Data produced
from this study will be used for academic purpose only. All participants in this study are guaranteed
of confidentiality. Your answers that will be provided in filling the questionnaire will be considered
correct. This research has received ethical approval from the State Ministry of Health, Imo State.
Kindly spare a few minutes to sincerely fill this questionnaire. Please, tick ( √ ) in the appropriate box
or fill in your answers where necessary.
Many thanks for your cooperation!

SECTION A: SOCIO-DEMOGRAPHIC DATA OF RESPONDENTS

1. What is your age (in years) ……………………..
2. Gender: Male [ ] Female [ ]
3. Religion: Christianity [ ] Muslim [ ] Traditional [ ] Others, please specify……………….
4. Marital Status: Married [ ] Single [ ] Divorced [ ] Separated [ ] Widowed [ ]
5. Highest educational level: Informal [ ] Primary [ ] Secondary [ ] Tertiary [ ]
6. Number of Children ………………………………….
7. Monthly Income: Less than N50,000 [ ] N51,000-100,000 [ ] N101,000-200,000[ ]
More than N200,000[ ]
8. Location of residence: Mbaitoli [ ] Owerri Municipal [ ] Ikeduru [ ] Owerri North [ ]

SECTION B: PREVALENCE OF OVERWEIGHT AND OBESITY

1. Are you overweight or obese? Yes [ ] No [ ] Don’t know [ ]
2. When last did you measure your body weight and height? This month [ ] Last month [ ] Last 3 months
[ ] Last six month [ ] Last one year [ ] Above one year [ ] I have never measured at all [ ]
3. Do you know your Body Mass Index (BMI)? Yes [ ] No [ ]
Please, skip question 4 and 5 below
4. Respondent’s body weight and height: Weight……………….. Height…………………….
5. Respondent’s BMI: Underweight [ ] normal [ ] overweight [ ] obese [ ]

SECTION C: RESPONDENT’S RISK FACTORS OF OVERWEIGHT AND OBESITY

1. Do you engage in any of these physical activities like: walking Yes [ ] No[ ]; jogging Yes[ ]
No[ ]; swimming Yes[ ] No[ ] or gym? Yes [ ] No [ ].
2. If “yes”, for how long? < 20mins [ ] 20-40mins [ ] More than 40mins.[ ].
3. If “yes”, how often? Daily [ ] Weekly [ ] Monthly [ ] Yearly [ ]
4. If “No”, what are your reasons for not engaging in physical activity? Disabled [ ] Other health
conditions [ ] Don’t have time [ ] Security reasons [ ] I see it as a stress [ ] No reason [ ]
Others please specify:………………………………………
5. Have you been eating junks/fast foods? Yes [ ] No [ ]
6. Do you eat food high in fat or sugar (for example; fried food, sweets)? Yes [ ] No [ ].
7. If “yes”, how often? Daily [ ] Weekly [ ] Monthly [ ] Yearly [ ].
8. Does your routine work expose you to sedentary lifestyle (that is, sitting position)? Yes [ ] No [ ]
84
9. If “yes”, how long on daily basis? < 20minutes [ ] 20-40minutes [ ] More than 40minutes [ ].
10. Is any of your parents or relations overweight or obese? Yes [ ] No [ ] Don’t know [ ]
11. Which of the simple carbohydrates below do you consume regularly? Sugars Yes[ ] No[ ] soft
drinks Yes[ ] No[ ] beer Yes[ ] No[ ] wine Yes[ ] No[ ] garri Yes[ ] No[ ]
yam Yes[ ] No[ ]
12. Do you smoke cigarettes/tobacco? Yes [ ] No [ ]
13. If “Yes”, how often? Daily [ ], Weekly [ ], Monthly [ ], Yearly [ ]
14. Do you consume alcohol? Yes [ ] No [ ]
15. If “Yes”, how often? Daily[ ], Weekly[ ], Monthly[ ], Yearly[ ]
16. Is there a medication you take to either make you: gain weight Yes [ ] No[ ] or lower high
blood pressure Yes[ ] No[ ] or lower blood sugar Yes[ ] No[ ], or do you take oral
contraceptives? Yes [ ] No [ ]

17. Which of these psychological or emotional factors commonly influence your excessive eating
habits?
Instruction: Please, respond by ticking as appropriate ‘Agree’ or ‘disagree’ or ‘Do not know’
below.
Agree Disagree Do not know
Boredom (a state of being bored)
Sadness
Stress
Anger

18. Which of the following is associated with your current weight?

Instruction: Please, respond by ticking as appropriate ‘Agree’ or ‘Disagree’ or ‘Do not know’ below.
Agree Disagree Do not know
Age
Socioeconomic status
Gender
Physical inactivity
Stress
Racism/ethnicity
19. The followings are health risks of obesity and overweight, which of them is currently
associated with your state of health?

Instruction: Please, respond by ticking as appropriate ‘Agree’ or ‘Disagree’ or ‘Do not know’ below.
Agree Disagree Donot know
Type 2 diabetes
High blood pressure
Insulin resistance
Heart attack
Some cancers
Osteoarthritis
Sleep apnea
High cholesterol
Stroke

85
 SECTION D: PREVENTIVE MEASURES OF OVERWEIGHT AND OBESITY

1. Which of the followings prevents obesity?

Instruction: Please, respond by ticking as appropriate ‘Agree’ or ‘Disagree’ or ‘Do not know’ below.

Agree Disagree Donot know

Limiting energy intake from total fats and Sugar
Increasing consumption of fruits, vegetables, legumes, whole
grains and nuts
Engaging in physical activity
Avoiding sedentary lifestyles in work places
Avoiding fatty-room practices
Surgery
Limiting stress
Avoiding the use of drugs to gaining weight
Avoiding oral contraceptives

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 APPENDIX 2
RELIABILITY TESTS OF THE INSTRUMENTS (CRONBACH ALPHA TEST)

Test 1: Reliability statistics (questionnaire)

Cronbach’s Alpha Cronbach’s Alpha based on Number of items

standardized items

0.701 0.762 15

Test 2: Reliability statistics (measuring tape)

Cronbach’s Alpha Cronbach’s Alpha based on Number of items

standardized items

0.756 0.782 20

Test 3: Reliability statistics (digital weighing balance)

Cronbach’s Alpha Cronbach’s Alpha based on Number of items

standardized items

0.721 0.742 15

Test 4: Reliability statistics (stadiometer)

Cronbach’s Alpha Cronbach’s Alpha based on Number of items

standardized items

0.783 0.738 24

87