Causes of becoming Overweight /Obese

If the weight of an in divid ual goes above a certain level, the person is referred to as being
overweight / obese. This is defi ned as having too m uch body fat in the body, which can
lead to health proble ms.

The m ain causes of beco ming overweight / obese are:

 Fa mily history (or having a ten dency of beco ming overweight / obese)
 Eating an u n healthy diet
 Lack of p hysical activity/low p hysical activity
 Presence of psychological factors- Depression, anxiety, stress, an d low estee m can
result in over eating
 Hor m on al im balance in the body
 Over-feeding d uring infancy, child hood an d adolescence predisposes to overweight /
obesity d uring ad ulthood

Risks Associated with being Overweight /Obese

Being overweight / obese can result in health proble ms, such as:
 Cardiovascular diseases (heart diseases) an d cerebrovascular diseases (stroke)
 High levels of har mful blood fat / Hyperlipide mia
 Hypertension
 Diabetes
 Musculoskeletal disorders (especially osteoarthritis – a disabling, degenerative
disease of the joints)
 Sleep Disorder
 Cancer –cancer of breast, cervix, ovary, liver, gallbladder, kid ney, colon, rectu m an d
prostrate
 Diseases of the joints
 Lu ng Disorders
 For m ation of gallstones

Diagnosing Overweight /Obesity in individuals

In this section, you will learn how to diagnose an overweight / obese in divid ual by
calculating Body Mass In dex (BMI) an d m easuring Waist Circu mference (WC). Both
BMI an d WC should be used together (with equal im portance) to identify in divid uals at
risk at the co m m u nity level an d in the clinics. The risk for Non-Co m m u nicable Diseases
increases, with increases in BMI an d WC.

1. Body Mass Index (BMI)

This is used as a screening tool for estim ating the total body fat content in a person’s body.
It is calculated by dividing a person’s weight in kilogra ms by his or her height in m eters
squared (kg / m 2).

24 Module for Multi-Purpose Workers (MPW) - Female/Male on Prevention, Screening and Control of Common Non Communicable Diseases
BMI is calculated by m easuring:
Weight (kgs)- You already have a weighing scale an d have been recording weight of
pregnant wo m en in the su b-centre.

Height (m eters)- A wall- m ou nted stadio m eter or non-stretchable tape m easuring height
u p to 2 m eters can be used.

BMI can be calculated by using the for m ula:

BMI = Weight (in kg)
Height (in m eter 2)

By using this method, u nderweight, norm al, overweight and obese individuals can be
identifi ed. Based on observational studies it has been suggested that the norm al BMI values
in Asian Indian adults to be between 18 – 22.9 kg/ m 2.

Table 4: Classification of Overweight /Obesity by Body Mass Index in Asian

Indians8
Weight Status BMI Range/Cut-off
Un derweight Less than 18.0 kg / m 2
Nor m al 18.0-22.9 kg / m
Overweight 23.0-24.9 kg / m 2
Obesity More than or equal to 25 kg / m 2

Metric Conversions- Conversions for height into m eters

 1 cm = 0.01m
 1 foot = 0.30m
 1 inch = 0.02m
Exa m ple- Sachin, is a 45-year- old m an, weighs 65 kgs with height 5 feet 10 inches.
Step 1- Convert the height in m eters. Using the m etric conversion, convert the
height given in feet an d inches to m eters.
So, as given in exa m ple, convert feet into m eters- 5 feet= 5X0.30= 1.5 meters (1
foot=0.30m)
Step 2- Square the answer fro m step 1 (the m eters)
Height in Meter X Height in Meter = 1.5 X 1.5 = 2.25 (m 2 )
Step 3- Using the BMI for m ula
BMI = Weight in Kilogra m / (Height in Meter x Height in Meter)
BMI= 65 (kgs)/ 2.25 (m 2 ) = 28.88 kg/ m 2
Sachin 's BMI is 28.88 kg / m 2 who is OBESE according to the BMI cut-off.

8
Source: Consensus Grou p. Consensus State m ent for Diagnosis of Obesity, abdo minal Obesity an d
the Metabolic Syn dro m e for Asian In dians an d Reco m m en dations for Physical Activity, Medical an d
Surgical Manage m ent-Misra et al, 2009.

Health Promotion 25
 2. Waist Circumference (WC)

Two in divid uals m ay have the sa m e BMI, b ut m ay differ in the a m ou nt of fat arou n d the
waist. People who develop excess body fat especially arou n d the waist are m ore likely to
develop Non-Co m m u nicable Diseases even if they have no other risk factors. It is best
m easured by taking waist circu mference in centim eters (cms). It should be less than or
equal to 90 cm in m en an d less than or equal to 80 cm for wo m en (See below Figure).

Classification of Overweight /Obesity by Waist Circumference

Less than or Less than or

equal to 90 cm equal to 80 cm
in men in women

The steps to m easure Waist Circu mference is given in An nexure- 4.

Benefi ts of reducing weight

 The red uction of weight lowers the risk of-

 Cardiovascular diseases (Heart diseases) an d Cerebrovascular diseases(stroke)
 Type-2 diabetes
 Am ou nt of Har mful blood fats / Hyperlipidae mia
 Hypertension
 Sleeping disorders

The role of ANM in helping an individual reduce weight (The

following steps can be undertaken with support of ASHA)
 Help her / him identify an d overco m e the challenges faced in red ucing
weight

 Encourage the fa mily m e m bers an d frien ds to provide su p port an d

m otivation to the overweight / obese in divid ual

 Motivate the in divid ual who is overweight / obese to m ake a fi r m decision

to lose weight an d change lifestyle to beco m e healthier

 Life-style m anage m ent-Eating a healthy diet, an d being p hysically active

 Explain that they should not resort to misleading m easures that pro mise
weight loss in a short ter m; pills, ch uran, mixtures, surgeries etc.

 Regular follow-u p with the in divid ual is required to m onitor changes in

their weight or any related health con ditions

26 Module for Multi-Purpose Workers (MPW) - Female/Male on Prevention, Screening and Control of Common Non Communicable Diseases
3.3.3. Physical Activity
Physical activity is any body m ove m ent that involves the use of m uscles of the body, an d
requires energy. Regular p hysical activity helps in m aintaining a healthy body weight,
healthy bones, m uscles an d joints an d protects against the develop m ent of heart diseases,
stroke, hypertension, diabetes, joint proble ms an d so m e cancers. Exa m ples: Walking,
ru n ning, jogging, cycling, playing a sport, dancing, swim ming, clim bing the stairs, yoga,
work like far ming, lifting an d m oving heavy objects as in construction, household work
like sweeping, cleaning, washing, d usting, etc.

How Much Physical Activity is needed for an

adult?
Ad ults should u n dertake at least 150 min utes of
m oderate exercise per week. This can be spread
throughout the week e.g. 30 min utes of activity 5 tim es
per week. 10 min utes of m oderate activity can be done
three tim es a day, that will add u p to the 30 min utes
of p hysical activity per day. Exa m ples of exercises are
brisk walking (walking fast), clim bing stairs, jogging,
cycling, dancing, playing sports an d ga m es, yoga,
carrying / m oving m oderate loads (<20kg), etc.

Exercise should increase the heart rate. Household activities like sweeping, cleaning,
washing, d usting, etc. do contrib ute to p hysical activity. However, doing only such
household work alone m ay not m eet the daily require m ents. Advise on p hysical activity
should be given according to the occu pation an d life style of in divid uals. For exa m ple,
those who spen d long hours in stren uous p hysical work such as working in the fi elds or
as labourers, or carrying heavy loads m ay not need to engage in further p hysical activity.

Please Note- People suffering fro m heart proble m, person with disabilities,
pregnant wo m en, or lactating wo m en, an d people suffering fro m other
health issues m ay need to do different a m ou nt an d types of exercises to suit
their con dition. They will need advice fro m a m edical practitioner.

Enabling adequate and regular physical activity in your community

Given below are so m e ideas that can be given to people who do not engage in regular
p hysical activity:

 Choose an activity that fi ts into daily routine. Inclu de exercise into routine
work along with developing a habit of walking e.g. to school, m arket, frien d’s
house, workplace etc. exercise at ho m e, at work or d uring leisure / relaxing
tim e.

 Exercising in grou ps im proves m otivation to exercise

 30 min utes of p hysical activity per day for a minim u m of five days a week.

 Yoga an d m editation both have gained m uch im portance in the past years as
they pro m ote health by im proving control of min d an d body for the overall
well-being of a person.

Health Promotion 27
 Annexure 4
Steps of Waist Circumference Measurement

Tool
 Non-stretchable fl exible m easuring tape

Important point to keep in mind

 WC should be taken on stan ding posture

Process steps
 Re m ove any layers of clothing blocking the waist. If the in divid ual
is u nwilling to re m ove clothing the m easure m ent can be taken
over the thin nest layer of clothing.

 The in divid ual stan ds straight looking in front with abdo m en

(sto m ach) relaxed, ar ms at side an d their feet fairly close together
(about 12- 15 cm) with their weight equally distrib uted across
both feet

 You will stan d in front, facing the su bject. Fin d the mid point between the lowest rib /
bony point in front an d top of hip bone in back. Waist circu mferences can also be
m easured across the u m bilical line (at the naval).

 The person should be asked to breathe nor m ally. At the tim e of the reading of the
m easure m ent she / he asked to breathe out gently

 Place the tape fi r mly in a horizontal position m aking sure the m easuring tape is
parallel to the fl oor an d not folded or twisted

 Record the reading at the end of the normal expiration/breathing

 The tape should be loose enough to allow to place one fi nger between the tape an d
the person’s body b ut the tape should fi t fi r mly b ut co mfortably arou n d the waist. The
tape should not squeeze the skin

 Look at the place on the tape where the zero en d m eets the other en d of the tape
m easure. The location of this m eeting point is the waist m easure m ent.

 Record the m easure m ent in cms to the nearest 0.0 or 0.5 cm in the in divid ual’s card or
your register. Exa m ple- If the exact m easure m ent is 85.7 cm, it should be recorded as
85.5 cm an d if it is 85.9 cm, then record the reading as 86 cm

Annexures 77