Blackwell Science, LtdOxford, UKOBRobesity reviews1467-78812005 The International Association for the Study of Obesity.
81310Review ArticlePrevalence of obesity K. O. Hajian-Tilaki & B. Heidari
obesity reviews
National Prevalence of Obesity
Prevalence of obesity, central obesity and the
associated factors in urban population aged
20–70 years, in the north of Iran: a population-based
study and regression approach
K. O. Hajian-Tilaki1 and B. Heidari2
1
Department of Social Medicine and Health,
Babol Faculty of Medicine, Babol University of
Medical Sciences, Babol, Iran; 2Department of
Internal Medicine, Shahid Beheshti hospital,
Babol Faculty of Medicine, Babol University of
Medical Sciences, Babol, Iran
Received 25 June 2005; revised 10 September
2005; accepted 14 September 2005
Address for correspondence: KO Hajian-Tilaki,
Department of Social Medicine and Health,
Babol Faculty of Medicine, Babol University of
Medical Sciences, Babol, Iran. E-mail:
drhajian@yahoo.com
© 2006 The International Association for the Study of Obesity. obesity reviews 8, 3–10
doi: 10.1111/j.1467-789X.2006.00235.x
Summary
Obesity is an undesirable outcome of changing of lifestyle and behaviours. It is
also reversible predisposing factor for the development of several debilitating
diseases. This study was aimed to determine the prevalence rate of obesity,
overweight, central obesity and their associated factors in the north of Iran. We
conducted a population-based cross-sectional study with a sample of 1800
women and 1800 men with respective mean ages of 37.5 ± 13.0 and
38.5 ± 14.2 years of urban population aged 20–70 years living in the north of
Iran. The demographic and lifestyle data, in particular, age, gender, marital status,
marriage age, family history of obesity, educational level, occupation, occupa-
tional and leisure time physical activity, duration of exercise per week, parity and
the number of children were collected with a designed questionnaire. Diagnosis
of obesity and central obesity were confirmed by the WHO standard recom-
mended method by determining of body mass index (BMI) and waist circumfer-
ence (WC). Logistic regression model was used to estimate the adjusted odds ratio
(OR) and its 95% confidence interval. Over half of the study subjects were at
educational levels of high school or higher; 79.4% of population was married
and 35.3% had a family history of parental obesity. The majority of subjects in
particular women had none or low levels of physical activity. The overall preva-
lence rates of obesity and overweight were 18.8% and 34.8% respectively. The
overall prevalence rate of central obesity was 28.3%. The rate of obesity in
women was higher than men (P < 0.0001). In both genders, particularly in the
women, the rate of obesity was raised by increasing age. There was an inverse
relation between the risk of obesity and marriage age, the high level of education
(OR = 0.19, P < 0.0001), severe occupational activity (OR = 0.44, P < 0.0001),
the level of exercise (in subjects with 3–4 h exercise per week, OR = 0.58,
P < 0.001) and leisure time activity. Marriage, history of parental obesity and
parity ≥5 were associated with increased risk of obesity (OR = 2.2, P < 0.001 and
OR = 2.43, P < 0.0001 and OR = 3.73, P < 0.0001 respectively). The results of
this study indicate an increased rate of obesity and overweigh in the north
population of Iran. With respect to these findings, low level of activity and
education, parity, family history of obesity, marriage at earlier age and ageing are
responsible for both obesity and central obesity in the north of Iran. Therefore,
a community-based multiple strategies are required to combat with increasing
rate of obesity and its subsequent complications such as diabetes, coronary artery
disease, hypertension and osteoarthritis.
3

4 Prevalence of obesity K. O. Hajian-Tilaki & B. Heidari
Keywords: body mass index, central obesity, obesity, overweight, waist circum-
ference.
obesity reviews (2007) 8, 3–10
Introduction
Obesity is an undesirable outcome of changing in lifestyle
and behaviour. It is also a major risk factor for develop-
ment of diabetes, hyperlipidemia and osteoarthritis (1–7).
Obesity may lead to early disability and loss of job in the
majority of subjects because of osteoarthritis as well as
diabetes and coronary artery associated complications. The
medical expense of obesity associated conditions is esti-
mated to be about one hundred milliard dollars annually
in the USA (8,9). Although, the contribution of heredity
factor may account for about 30–70% of obesity (7), but
intake of high caloric diets and reduced expenditure of
energy in the form of low physical activities, changing
lifestyle and behaviours, particularly, in the modern societ-
ies, are also responsible for development of overweight and
obesity.
The prevalence of obesity varies significantly across the
world (10). The rate of obesity and overweight among
adults population ranges from 15 to 60%. It is usually
more common in women than men (10). According to
WHO report, obesity has become epidemic in the world
(11). Therefore, preventive measures are required to com-
bat with obesity and its associated complications.
Planning health programmes and preventive projects
require necessary information in the field of obesity for
different geographical areas. In the north of Iran, the prev-
alence of coronary artery diseases, hypertension, diabetes
and osteoarthritis is high. Despite the apparent affinity of
obesity with these conditions, there is no documented
information in relation to prevalence rate of obesity or
overweight in this region of Iran. For this reason the
present study was designed to determine the prevalence
rates of obesity, overweight, central obesity and their asso-
ciated factors in an urban population aged 20–70 years in
the north of Iran.
Methods and Materials
Study design, subjects and sampling techniques
We conducted a population-based cross-sectional study
with a sample of 3600 subjects (1800 women and 1800
men with respective mean ages of 37.5 ± 13 and
38.5 ± 14.3 years) of urban population aged 20–70 years
living in four cities in Mazandran, a province in the north
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obesity reviews
of Iran, situated at the Caspian see in 2004. With presump-
tion of 15% obesity rate, the sample size was calculated to
estimate an obesity rate in which, with a confidence level
of 95%, the maximum marginal error to be about 0.01.
Since the population of each city was roughly equivalent,
an equal sample size of 900 was allocated for each city. We
conducted a cluster sampling techniques with 30 clusters
of equal size of 30 subjects for each city. At first step of
sampling, the centres of 30 clusters were selected randomly
using systematic sampling technique based on cumulative
frequency of family health number under coverage of urban
health centres. In the second stage, around the centre of
each cluster, we selected 15 men and 15 women with rota-
tion from the right to the left of cluster centre. Thus,
on overall, the calculated total sample size was
4 × 2 × 15 × 30 = 3600 subjects for four cities.
We carried out indoor household survey, in subjects aged
20–70 years. The study population were residence of the
study areas and were apparently in good health with no
known systemic or debilitating conditions. Pregnant sub-
jects and those on weight loosing diets programmes were
excluded. The study proposal was approved by the ethical
committee of Babol University of Medical Sciences (Babol,
Iran). The written informed consent was obtained from all
subjects prior to their participation in the study.
Anthropometric measurements and data collection
After an interview and clinical examination, the anthropo-
metric measurement of height, weight and waist circumfer-
ence (WC) were measured by standard method. WC was
determined by measuring of waist diameter of the level of
midpoint between iliac crest and lower border of tenth rib.
The average of three measurements was considered as WC.
Body mass index (BMI) was calculated by weight in kilo-
gram divided to square of height in meter (kg m−2). The
demographic and lifestyle data, in particular, age, gender,
marital status, marriage age, family history of obesity, edu-
cational level, occupation, occupational physical activities,
the level of leisure time physical activities, the duration of
exercise per week by hours, the number of children and the
parity were collected with designed questionnaire. The
diagnosis of obesity was confirmed by the WHO standard
recommended method (11–13) in which a BMI 25–
29.9 kg m−2 was regarded as overweight; BMI ≥ 30 kg m−2
as obesity. Central obesity was diagnosed on the base of
 1467789x, 2007, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2006.00235.x by COMSATS Inst of Info Techn - I, Wiley Online Library on [12/05/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
obesity reviews Prevalence of obesity K. O. Hajian-Tilaki & B. Heidari 5

WC with cut-off points of WC > 88 cm for women and
WC > 102 cm for men.
Statistical analysis
In statistical analysis, we used SPSS software and chi-
square test used for bivariate data analysis and also we
applied the logistic regression analysis to estimate the crude
and age-adjusted odds ratio (OR) of obesity and central
obesity risks for different levels of demographic and life-
style factors. We also estimated the 95% confidence inter-
val of OR. The P-value less than 0.05 was considered as
statistical significant level.
Results
The characteristics of the study population who enrolled in
the study are shown in Table 1. Regarding the levels of
education, over half of the study subjects were at educa-
tional levels of high school or higher. Only 9% of subjects
were illiterate; 79.4% of population were married and
35.3% had a family history of obesity. The majority of
subjects, in particular, women had none or low levels of
physical activity as exercise, occupational activity or leisure
time activity. Low level occupational activity was also com-
mon in men.
Among women the number of previous pregnancies var-
ied from none to higher than five; 19.9% of women had ≥ 5
and 33.8% had 1–2 and the remainder had no history of
pregnancy (22.6%) or no parity (22.9%).
The prevalence rates of obesity and overweight are pre-
sented in Table 2. The overall prevalence of obesity and
overweight were 18.8% and 34.8% respectively. The over-
all prevalence rate of central obesity by WC criteria was
28.3% (women 46.2% and men 10.6%). The rate of obe-
sity in women was roughly three times greater than men

Table 1 The distribution of demographic characteristics and lifestyle-related factors with respect to gender

Characteristics Male (n = 1800*) Female (n = 1800*) Total (n = 3600*)

n (%) n (%) n (%)

Age (years)
20–29 620 (34.0) 608 (33.8) 1228 (34.1)
30–39 392 (21.8) 447 (24.8) 839 (23.3)
40–49 347 (19.3) 373 (20.7) 720 (20.0)
50–59 245 (13.6) 254 (14.1) 499 (13.9)
60–70 196 (10.9) 118 (6.6) 314 (8.7)
Education
Illiterate 100 (5.6) 227 (12.6) 327 (9.1)
Primary level 233 (30.0) 338 (18.8) 571 (15.9)
Elementary level 311 (17.3) 326 (18.1) 637 (17.7)
High school and college 778 (43.3) 655 (36.4) 1433 (39.8)
University level 377 (21.0) 254 (14.1) 631 (17.5)
Marital status
Single 451 (25.1) 289 (16.1) 740 (20.8)
Married 1348 (74.9) 1511 (83.9) 2859 (79.4)
Parental obesity
Absent 1211 (67.3) 1116 (62.0) 2327 (64.7)
Present 588 (32.7) 683 (38.0) 1271 (35.3)
Exercise (h week−1)
None 942 (52.4) 1172 (65.8) 2114 (59.1)
1–2 h 352 (19.6) 367 (20.6) 719 (20.1)
3–4 h 209 (11.6) 140 (7.9) 349 (9.8)
≥5 h 294 (16.4) 103 (5.8) 397 (21.1)
Occupational activity
Low 1072 (59.6) 1241 (69.0) 2314 (64.3)
Moderate 618 (34.3) 529 (29.4) 1147 (31.9)
Severe 110 (6.1) 29 (1.6) 139 (3.9)
Leisure time physical activity
Very low 927 (52.0) 1101 (61.2) 2026 (56.6)
Low 450 (25.2) 435 (24.2) 885 (24.7)
High 290 (16.3) 211 (11.7) 501 (14.0)
Very high 117 (6.6) 53 (2.9) 170 (4.7)

*lack of corresponding of sum of frequencies of subgroups with sample size was due to the missing data.

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6 Prevalence of obesity K. O. Hajian-Tilaki & B. Heidari obesity reviews

Table 2 The prevalence of obesity and overweight based on the distribution of BMI and central obesity with respect to age groups and gender

BMI Age groups (years) Total

n (%)
20–29 30–39 40–49 50–59 60–70
n (%) n (%) n (%) n (%) n (%)

Male gender
Underweight (BMI < 18.5) 27 (4.4) 5 (1.3) 4 (1.2) 5 (2.1) 7 (3.6) 48 (2.7)
Normal (18.5 ≤ BMI < 24.9) 397(64.1) 177 (45.3) 148 (42.7) 104 (42.4) 96 (49.0) 922 (51.3)
Overweight (25 ≤ BMI < 29.9) 151 (24.4) 166 (24.4) 152 (43.8) 107 (43.7) 74 (37.8) 650 (36.2)
Obesity (BMI ≥ 30) 44 (7.1) 43 (11.0) 43 (12.4) 29 (11.8) 19 (9.7) 178 (9.9)
Central Obesity 31 (5.0) 45 (11.5) 36 (10.4) 45 (18.4) 33 (16.8) 190 (10.6)
Inappropriate WC (WC > 102 cm)
Female gender
Underweight (BMI < 18.5) 56 (9.2) 15 (3.4) 2 (0.5) 3 (1.2) 1 (0.8) 77 (4.3)
Normal (18.5 ≤ BMI < 24.9) 328 (53.9) 135 (30.3) 48 (18.9) 48 (18.9) 33 (28.0) 619 (34.5)
Overweight (25 ≤ BMI < 29.9) 150 (24.7) 173 (38.8) 141 (37.9) 100 (39.4) 39 (23.1) 600 (33.5)
Obesity (BMI ≥ 30) 74 (12.2) 123 (27.4) 154 (41.4) 103 (40.6) 45 (38.1) 499 (27.8)
Central Obesity 150 (24.7) 208 (46.5) 232 (62.2) 169 (66.5) 72 (61.0) 831 (46.2)
Inappropriate WC (WC > 88 cm)

BMI, Body mass index; WC, Waist circumference.

(P < 0.0001). The age distribution of BMI was also signif-
icantly different between two genders. In both genders, the
rates of obesity raised by increasing age. The lowest obesity
rates in women and men were 12.2% and 7.1% for age
groups of 20–29 years and the highest rates were 41.9%
and 12.4% for age group of 40–49 years respectively. The
elevated rates persisted up to 60 years for both genders.
However, the rate of obesity was consistently higher in
women compared with men in all age groups.
In Table 3, the estimated OR (with 95% CI) of obesity
are presented. With respect to results derived from logistic
regression model compared with age group of 20–29 years,
the OR has increased to 2.32, 3.55, 3.38 and 2.41 for age
groups of 30–39, 40–49, 50–59 and 60–70 years respec-
tively. The age-adjusted estimates of OR for female subjects
was 3.64 times greater than male subjects (P < 0.0001).
There was an inverse relation between the risk of obesity
and the levels of education particularly at university levels
(OR = 0.19, P < 0.0001). Similarly, the risk of obesity was
decreased by 56% in subjects with severe occupational
activity (OR = 0.44, P < 0.001). Additionally, by increasing
the levels of exercise, the risk of obesity was decreased.
There was a significant decrease in OR for subjects with 3–
4 h exercise weekly compared with subjects with no exer-
cise (OR = 0.58, P < 0.0001). Leisure time activity was also
associated with non-significant decreased risk of obesity.
Marriage and history of parental obesity were associated
with increased risk of obesity (adjusted OR = 2.2,
P < 0.0001 and OR = 0.43, P < 0.0001 respectively). In
contrast, there was an inverse relationship between the
marriage age and risk of obesity. Compared with marriage
at 20 years of age or lower, the risk of obesity decreased
by 78% with marriage at 30 years of age or higher
(Adjusted OR = 0.22, P < 0.0001). Parity was also associ-
ated with increased risk of obesity. In women with five or
more pregnancies, the risk was increased by 3.73
(P < 0.0001).
Regarding to central obesity, factors such as age, female
gender, having five or more pregnancies, parental obesity
were associated with increased risk of central obesity as
well. Whereas physical activity, occupational, exercise; or
leisure time activity as well as higher educational levels and
marriage age at 30 years of old or older were associated
with decreased risk of central obesity. The adjusted OR for
central obesity for women (compared with men) was 8.47
(P < 0.0001). The risk of central obesity was significantly
lower at marriage age of 30 years or higher compared with
20 years or less (OR = 0.18, P < 0.0001).
Discussion
The findings of the present study indicate an overall prev-
alence rate of 18.8% for obesity and 34.8% for overweight
and 53.6% for both obesity and overweight in population
of Iranian aged 20–70 years who are living in north of Iran.
The mean ages of both genders in the study population are
lower than expected. However, this sample truly reflects the
general population of Iran. Because, over the half of the
adult Iranian population are younger than 40 years, owing
to lack of birth control over the first decade after Islamic
revolution. Both obesity and central obesity were more
prevalent in women than men by age adjusted OR of 3.64
and 8.47 for female gender. In general, 61.3% of women
and 46.1% of men were fat or overweight.
With respect to results derived from logistic regression
analysis, risk factors for obesity and central obesity are

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obesity reviews Prevalence of obesity K. O. Hajian-Tilaki & B. Heidari 7

Table 3 The estimated crude odds ratio (OR) of the risk of obesity and age adjusted odds ratio with different levels of demographic and lifestyle-related
factors with 95% confidence interval (CI) using logistic regression model

Variables Crude OR(95% CI) Age adjusted OR(95% CI)

Age group (years)

20–29 1.0 (–) –
30–39 2.32 (1.80, 2.99) –
40–49 3.55 (2.76, 4.56) –
50–59 3.38 (2.57, 4. 45) –
60–70 2.41 (1.73, 3.55) –
gender
Male 1.0 (–) 1.0 (–)
Female 3.5 (1.73, 3.55) 3.64 (3.01, 4.40)
Education
Illiterate 1.0 (–) 1.0 (–)
Primary level 1.07 (0.79, 1.43) 0.98 (0.72, 1.32)
Elementary level 0.59 (0.44, 0.80) 0.60 (0.43, 0.84)
High school and college 0.38 (0.29, 0.50) 0.41 (0.30, 0.56)
University level 0.16 (0.11, 0.24) 0.19 (0.12, 0.29)
Marital status
Single 1.0 (–) 1.0 (–)
Married 3.69 (2.75, 4.96) 2.20 (1.56, 3.09)
Parental obesity
Absent 1.0 (–) 1.0 (–)
Present 2.14 (1.80, 2.53) 2.43 (2.04, 2.90)
Occupational activity
Low 1.0 (–) 1.0 (–)
Moderate 0.92 (0.77, 1.10) 0.91 (0.75, 1.09)
Severe 0.46 (0.26, 0.81) 0.44 (0.25, 0.77)
Exercise hour/w
None 1.0 (–) 1.0 (–)
1–2 h 0.81 (0.65, 1.01) 0.90 (0.72, 1.12)
3–4 h 0.58 (0.42, 0.81) 0.67 (0.48, 0.93)
≥5 h 0.68 (0.51, 0.92) 0.85 (0.63, 1.16)
Leisure time physical activity
Very low 1.0 (–) 1.0 (–)
Low 0.82 (0.66, 1.00) 0.87 (0.71, 1.07)
High 0.79 (0.61, 1.02) 0.86 (0.66, 1.12)
Very high 0.67 (0.43, 1.04) 0.71 (0.45, 1.10)
Parity
None 1.0 (–) 1.0 (–)
1–2 2.52 (1.73, 3.67) 1.92 (1.27, 2.88)
3–4 6.18 (4.26, 8.97) 3.44 (2.15, 5.49)
≥5 6.82 (4.61, 10.11), 3.73 (2.22, 6.27)
Marriage age (years)
<20 1.0 (–) 1.0 (–)
20–24 0.45 (0.37, 0.55) 0.46 (0.27, 0.56)
25–29 0.23 (0.23, 0.40) 0.28 (0.21, 0.37)
≥30 0.25 (0.15, 0.42) 0.22 (0.13, 0.37)

similar. Increasing age, marriage age, presence of parental
obesity, lack of exercise or having low level of physical
activities and low level of education were the major respon-
sible factors for both obesity and central obesity in women
and men in north of Iran. However, the association of
marriage, parental obesity and parity with obesity was
stronger than central obesity.
The results of the present study are somewhat different
from the results reported from other geographical areas of
Iran. In a study of Tehranian population living in 17th
district of Tehran, the overall prevalence rate of obesity and
overweight were 30.5% and 37.8% respectively (14). The
higher prevalence rate of obesity in the latter study may be
attributed to lower level of activity in particular occupa-

© 2006 The International Association for the Study of Obesity. obesity reviews 8, 3–10

8 Prevalence of obesity K. O. Hajian-Tilaki & B. Heidari
tional physical activity in Tehranian population than north
population who frequently do agricultural activity.
In another study of Iranian population living in central
part of country (Arak and Isfahan) the prevalence rate of
obesity and overweight were similar to ours. In the latter
study the respective prevalence rates of obesity and over-
weight in the female and male subjects were 27.1% and
10.4%; and 35.2% and 35.4% (15).
In another study of Tehranian adult population living in
low socioeconomic area in south of Tehran during 1999–
2001, Azarbakht et al. have reported an obesity rate of
29.1% for women and 14.2% for men (16). In the latter
study, the prevalence rate of obesity in Tehranian male
population was higher than north population whereas
the rate of obesity in female population were similar. In
another study of Iranian population, living in an urban area
in south of Iran, the prevalence rates of obesity and over-
weight were 12.5% and 36.5% respectively (17). The
higher rate of obesity in the north may be explained by
higher socio-economic condition in the north population,
as well as the local eating habits in the north who custom-
arily use high carbohydrate diets. Furthermore, jobs with
severe physical activity are more frequent in the south
rather than in the north of Iran.
The prevalence of obesity in other parts of the worlds
varies according to geographical regions. The data from
the present study are comparable to those studies that
included similar ethnic population or was performed in the
geographical areas similar to north of Iran. In the Euro-
pean countries the lowest rate (7%) was reported from
France. In general, the overall prevalence rate varies from
10 to 20% in men to 15–25% in women (18,19). The
prevalence rates of obesity and overweight in Spain were
40.6% and 56.6% respectively; however, there is a trend
for raising (20). In Irish and Brazilian population, the prev-
alence rates of obesity were 18% and 32.8% respectively
(21,22). In the USA, the prevalence of obesity and over-
weight were 21.2% and 36% respectively (23,24). In a
study of Canadian population, 27% of women and 35%
of men were found to have a BMI > 27 kg m−2 (25). The
respective prevalence rates of obesity in adult women and
men in a number of Middle East neighbouring countries,
such as Lebanon (26), Saudi Arabia (27), and Bahrain (28),
were 18.8% and 14.4 5, 26. 6% and 17.8%, 47.7% and
21.2%.
The association between lifestyle and obesity as shown
in this study was also observed in studies from other coun-
tries (22,26,27). The negative association between educa-
tion and obesity has been also shown in other studies from
Iran (29,30) and Oman (31). The association between low
level of physical activity and obesity was also shown in a
study from Iran (29) as well as in other countries (32,33).
The higher prevalence of obesity in female subjects in our
study can be explained by higher marriage rate particularly
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obesity reviews
at younger age in women, compared with men. Because, in
female population, marriage around the 20 years of age are
usual in the north of Iran. Additionally, sex hormone asso-
ciated factors may be also responsible in female obesity.
Because, body weight and BMI are inversely related to sex
hormone binding globulin concentrations, both in pre-
menopausal and post-menopausal women (34).
In this study we have also determined the prevalence rate
as well as the risk factors for central obesity. Since substan-
tial evidences indicate that increased WC or waist to hip
ratio (WHR) independently predict obesity associated
comorbidities and mortality (4,12). In this study we deter-
mined central obesity based on WC criteria. In our study
the prevalence rate of central obesity by WC criteria was
lower than those with WHR criteria used in Tehran Lipid
Study (66.1% and 32.1% for women and men respectively)
(29). However, in our study, the WC indices were corre-
sponded to those reported by Ghaderipor et al. in a study
of Isfahan population in central part of Iran (35).
The association between central obesity and parity as
shown in our study was also observed by Kau et al. (36).
In this study abdominal obesity was observed in 50.7% of
women aged ≥35 years who had ≥ 2 children (36). The
overall prevalence rate of abdominal obesity in a study by
Ramos et al. was 39.2% (22). In another study be Riyami
et al. in adult population of Oman country (31), 64.4% of
women and 31.5% of men had abdominal obesity (31).
The results of this study, in accordance with the previous
published studies, confirm an epidemic of obesity and over-
weight in both developed and developing countries
(24,37,38). In the USA, the prevalence of severe obesity
(BMI ≥ 40 kg m−2) has increased from 1 in 200 to 1 in 50
subjects during 1986–2000. Furthermore, the prevalence
rate of obesity (BMI ≥ 30 kg m−2) has roughly increased by
two times (24). In the developing countries, because of
transition of population from rural to urban areas and
owing to changing in lifestyles, there is a trend for increas-
ing of obesity rate. For example, over a period of less than
5 years, there was a significant trend in increasing of obe-
sity and overweight in adult population of Tehran Lipid
Study (29).
In comparison to world wide statistics, the obesity rate
in north of Iran is slightly lower than those reported from
neighbouring countries such as Saudi Arabia (27), Bahrain
(28), as well as from Venezuela (37) and the USA (23,24).
The different prevalence rates of obesity in different parts
of the world may explained by changes in lifestyle pattern,
nutritional status, physical activity and local eating habits
of different population.
In this study, the pattern of obesity and overweight has
significantly increased by age. Similar patterns were
observed in other studies from Iran (15,29,35). Further-
more, age has been considered as a prognostic factor for
obesity in a setting of published studies (26–28,36).

obesity reviews
During the two recent decades a significant transition of
rural population to urban areas has occurred in the geo-
graphical areas of the present study because of economical
problems. Although, there was no baseline data in this
study area for comparison. It seems that this migration
resulted to lifestyle changes and subsequent increasing of
obesity rate in recent decades. On the other hand, changes
in lifestyles may affect as well as physical activity and result
to lower physical and occupational activities in urban com-
pared with rural population.
Hence, in the north population of Iran, local eating habits,
lifestyle pattern and utilizing high caloric foods should be
also considered as predisposing factors of obesity. Because,
high carbohydrate containing foods such as rice and bread
are customarily utilized almost by the majority of popula-
tion in north of Iran. Therefore, in addition to above factors,
intake of high carbohydrates containing foods should be
also considered as a cause of obesity in the north of Iran.
In conclusion, the results of this study indicate an
increased rate of obesity and overweigh in the north pop-
ulation of Iran. With respect to these findings, several vari-
ables such as low level of physical activities and education,
parity, family history of obesity, and marriage at earlier age
are associated with obesity. Therefore, a community-based
multiple strategies are required to combat with increasing
rate of obesity and its subsequent complications such
as diabetes, coronary artery disease, hypertension and
osteoarthritis.
Conflict of Interest Statement
No conflict of interest was declared.
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