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ORIGINAL ARTICLE
Year : 2013  |  Volume : 1  |  Issue : 1  |  Page : 14-17

Obesity among diabetic and hypertensive patients in Aseer region, Saudi Arabia


Joint Program of Family Medicine, Aseer Region, Saudi Arabia

Date of Web Publication8-Oct-2013

Correspondence Address:
Abdullah M AL-Shahrani
Family Medicine Consultant, Joint Program of Family Medicine, Aseer Region, P.O. Box 2653, Abha
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-2618.119470

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  Abstract 

Context: Saudi Arabians suffer from overweight and obesity, which contribute significantly to the poor control of diabetes mellitus (DM) and hypertension (HTN). Aim: To assess the effect of overweight and obesity on diabetes and HTN control in Aseer region, KSA. Materials and Methods: The study was conducted by the end of the year 2010. All medical records were assessed by trained doctors and nurses working in the Chronic Disease Clinic at each primary health care center (PHCC) using a check list derived from the quality assurance manual of PHC. The Chronic Disease Services were based on the recommendation of the relevant guidelines. Data entry and analysis was carried out using Statistical Package for Social Sciences. P-values less than 0.05 were selected for statistical significance. Results: The prevalence of obesity among diabetics and hypertensive patients was 46% and 54%, respectively. The diabetic patients with good control comprised 21% of the study population, while less than one-third of the patients had fair diabetic control and about half of the diabetics had poor diabetic control. About more than one-third of patients had good control of HTN and less than one-third suffered from overweight and more than half had obesity. Conclusion: This study demonstrated that most of DM and HTN patients in PHCCs, Aseer Region, KSA, suffered from overweight and obesity, which contribute significantly to the poor control of DM and HTN.

Keywords: Diabetes, hypertension, obesity, overweight, primary health care center


How to cite this article:
AL-Shahrani AM, Al-Khaldi YM. Obesity among diabetic and hypertensive patients in Aseer region, Saudi Arabia. Saudi J Obesity 2013;1:14-7

How to cite this URL:
AL-Shahrani AM, Al-Khaldi YM. Obesity among diabetic and hypertensive patients in Aseer region, Saudi Arabia. Saudi J Obesity [serial online] 2013 [cited 2019 Mar 23];1:14-7. Available from: http://www.saudijobesity.com/text.asp?2013/1/1/14/119470


  Introduction Top


Obesity and overweight affect more than 75% of the adult population in Saudi Arabia. [1],[2],[3] They are known to predispose to many health problems, including diabetes, hypertension (HTN), coronary heart diseases and some tumors. [4],[5]

Researches showed that reduction of weight improved control among diabetes and HTN patients. [6],[7]

In Saudi Arabia, the epidemiology of diabetes, HTN and obesity was studied during the past decade; most studies dealt with the prevalence of these disorders and the contributing factors such as physical activities and dietary behaviors. [3],[8],[9] In spite of the high prevalence of HTN, diabetes and obesity, there is no study conducted to determine the relationship of the impact of obesity on diabetes/HTN control.

The aim of the current study is to assess the prevalence of overweight/obesity among diabetics and hypertensive patients and to determine the association between the degree of weight and diabetes/HTN control among patients attending primary health care centers (PHCCs) in Aseer region, southwest of Saudi Arabia.


  Materials and Methods Top


This descriptive records based study was conducted by the end of the year 2010 in Aseer region, southwest of Saudi Arabia. The Aseer region is divided into 20 health sectors. Each sector consists of five to 12 PHCCs. Each center provides primary health care services including preventive and curative services for diabetic and hypertensive patients through primary health care physicians and nurses who are given special training in the management of diabetes and HTN.

In order to attain the objective of this study, the researchers designed a checklist derived from the quality assurance manual of PHC. [10] The checklist contained data related to patients socio-demographics, weight, height, blood pressure and fasting blood glucose (FBG). The medical records of all DM and HTN patients who attended in 2010 were assessed by the doctors and nurses working in the Chronic Disease Clinic at each PHCC using the above-mentioned checklist. The inclusion criteria for this study are records of adult patients that fulfilled the following: availability of two readings of weight, blood pressure and fasting blood sugar during 2010. Weight was graded according to the body mass index (BMI in kg/m 2 ) as follows: underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI = 18.5-24.9 kg/m 2 ), overweight (BMI = 25-29.9 kg/m 2 ), grade I obesity (BMI = 30-34.9 kg/m 2 ), grade II obesity (BMI = 35-39.9 kg/m 2 ) and morbid obesity (BMI ≥ 40 kg/m 2 ) based on the World Health Organization (WHO) classification.

Diabetes control was classified as follows based on the quality assurance manual in each PHCC [10] : good control if the average of the last two readings of the FBG level was ≤130 mg/dl, fair control if the FBG level was 131-179 mg/dl and poor control if the FBG was >179 mg/dl.

HTN control was considered good if the average of the two readings was less than 140/90 mmHg and less than 130/80 mmHg for hypertensive patients and diabetic patients, respectively, according to the Joint National Committee on High Blood Pressure (JNC-7).

The relevant data were coded, entered and analyzed by using Statistical Package for the Social Sciences, version 15. Descriptive statistics (mean, standard deviation and percentage) were used to quantify the study and outcome variables. Chi-square test was used to find out the association between the categorical variables. A P-value of less than 0.05 was considered as statistically significant.


  Results Top


The total number of diabetic and hypertensive records that were assessed were 23,156 and 15,942, respectively. The records that satisfied the inclusion criteria were 14,252 for diabetes and 10,997 for HTN. The overall prevalence of obesity among diabetics and hypertensive patients was 46% and 54%, respectively. [Table 1] shows the socio-demographic characteristics and the grade of obesity among the patients in this study.
Table 1: Demographic characteristics of diabetics and hypertensives at the PHCC, Aseer region, 2010

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Diabetes and obesity

[Table 2] shows that 21% of the diabetics have good diabetes control, while less than one-third had fair diabetes control and about half of the diabetics had poor diabetes control. Studying the association between diabetic control and grade of obesity showed no difference (P-value = 0.05).
Table 2: Association between BMI categories and diabetic control among diabetics at the PHCC, Aseer region, 2010

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Hypertension and obesity

[Table 3] shows that more than one-third of the patients had good control of HTN, less than one-third suffered from overweight and more than one half had obesity. [Table 3] shows the association between grade of obesity and hypertension control. It is obvious that those hypertensive patients with overweight and obesity had poor hypertension control compared with those patients with underweight and normal weight (P-value less than 0.05).
Table 3: Association between BMI categories and hypertension control among hypertensive patients at the PHCC, Aseer region, 2010

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  Discussion Top


The current study that included most of diabetics and hypertensive patients attending PHCC showed that more than 80% of the patients suffered from overweight and obesity. Previous studies from Saudi Arabia showed that overweight and obesity are common morbidities among diabetics and hypertensive patients. Khattab et al. mentioned that about 45% of diabetics in Aseer region had overweight/obesity. [11] Al-Alfi et al. reported that about one-third and one half of the diabetics in Qassim region suffer from overweight and obesity, respectively. [12] Another study from Aseer region revealed that one-fourth of the hypertensive patients had overweight and 47% had obesity of different grades. [13] These findings are slightly lower than that reported by Barrimah et al. (81%) and are higher than that reported by AlZahrani et al. (59%) and Al-Humaidi et al. (68%). [8],[9],[14]

This difference between the current study and the above-mentioned studies might be explained by a trend in increasing the prevalence of obesity and overweight that was observed during the last decade due to sedentary life and intake of diet rich in simple carbohydrate and fat.

Regarding diabetic control, this study found that only 21% had good diabetic control. This figure is not differ from the figures reported from Aseer region (20-24%) and that reported from Qassim region, Saudi Arabia (21%). [11],[12],[15]

Statistical analysis could not prove a relationship or association between poor diabetic control and overweight/obesity (P-value greater than 0.05). These findings might be explained by the fact that diabetic control depends on many factors such as compliance to drugs/diet/life styles, which were not explored in this study. Another important factor that should be considered is using "fasting blood glucose" to assess the grade of diabetic control, which is known to be not accurate for assessing the degree of control compared with glycosylated hemoglobin (HbA1C), which is not available in the PHCCs in Aseer region.

Good HTN control was reported among 36% of hypertensive patients. This figure is lower than that reported from Aseer region (58%) [16] and Riyadh (40%) [17] and those reported by Al- Homrani et al. (63%) [18] and Onwukwe from South Africa (57%) [19] and Al-Shidhani et al. from Oman (55%). [20] However, the HTN control reported in this study is similar to that reported in a national survey (37%) [21] and by Al-Khaldi from the Aseer region (35%), [13] but it is higher than that found by Hajjar and Kotchen from USA (31%). [22] These big differences could be explained by differences of sample size, different methods used and definition of cut point of HTN control. In spite of the real reasons for such variation, it is mandatory to reach optimal target of good HTN control to prevent long-term serious complications of HTN through intensive health education of patients and to comply to practical guideline of HTN care.

Concerning the relationship between degree of overweight/obesity and HTN control, it was found that there is a strong association between poor control of HTN and high BMI (P-value less than 0.05). Such an association should be taken in consideration during management of HTN through concentrating on health education about life styles and weight reduction programs for those high-risk groups of HTN patients.


  Conclusion Top


This study revealed that most of the DM and HTN patients in the PHCCs in Aseer region, Saudi Arabia, suffer from overweight and obesity that could contribute significantly to the poor control of DM and HTN. Obesity and overweight should be given more attention during management of DM and HTN patients. Intensive health education regarding life styles and behavioral therapy are mandatory to reduce weight and to improve metabolic control. DM and HTN patients with obesity should be counseled about the benefits of bariatric surgery, which could be a good option of management if life styles/behavioral and medical therapies fail to achieve good metabolic control.

 
  References Top

1.Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Arafah MR, Khalil MZ, Khan NB, et al. Obesity in Saudi Arabia. Saudi Med J 2005;26:824-9.  Back to cited text no. 1
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2.AL-Othaimeen AI, AL-Nozha M, Osman AK. Obesity: An emerging problem in Saudi Arabia. Analysis of data from national nutrition survey. Eastern Med Health J 2007;13:441-8.  Back to cited text no. 2
    
3.Al-Daghri NM, Al-Attas OS, Alokail MS, AlKharafy KM, Yousef M, Sabico SL, et al. Diabetes Mellitus type 2 and other chronic non-communicable disease in central region, Saudi Arabia (Riyadh cohort 2): A decade of an epidemic. BMC Med 2011;9:76.  Back to cited text no. 3
    
4.Guh DP, Zhang W, Bansback N, Amaris Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: A systematic and Meta-analysis: BMC Public Health 2009;9:88.  Back to cited text no. 4
    
5.Kannel WB. Effect of weight on cardiovascular disease. Nutrition 1997;13:157-8.  Back to cited text no. 5
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6.Aucott L, Poobalan A, Smith WC, Avenell A, Jung R, Broom J. Effects of weight loss in overweight/obese individuals and long-term hypertension outcomes: A systematic review. Hypertension 2005;45:1035-41.  Back to cited text no. 6
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7.Williamson DA, Rejeski J, Lang W, Van Dorsten B, Fabricator AN, Toledo K. Impact of a weight management program on health related quality of life in overweight adults with type 2 diabetes. Arch Intern Med 2009;169:163-71.  Back to cited text no. 7
    
8.Barrimah IE, Mohaimeed A, Midhat F, Al-Shobili HA. Prevalence of Metabolic Syndrome among Qassim University Personnel in Saudi Arabia. Int J Health Sci (Qassim) 2009;3:133-42.  Back to cited text no. 8
    
9.AlZahrani A, Karawagh AM, AlShahrani FM, Naser TA, Ahmed AA, Alsharef EH. Prevalence and predictors of Metabolic Syndrome among healthy Saudi adults. Br J Diab Vasc Dis 2012;12:78-80.  Back to cited text no. 9
    
10.The Scientific Committee of Quality Assurance in Primary Health Care. Quality Assurance in Primary Health Care Manual. WHO/EM/PHC/81-A/G/93: DAR AL-HILAL, Printing Press, Riyadh, KSA, 1994. Pages:145-64 and 197-223.  Back to cited text no. 10
    
11.Khattab M, Abolfotouh M, Alakija W, Humaidi M, Al-tokhy M, Al-Kaldi Y. Audit of diabetic care in an academic family practice center in Asir, Saudi Arabia. Diab Res 1996;31:243-54.  Back to cited text no. 11
    
12.Al-Alfi MA, Al-Saigal AM, Saleh MA, Surour AM, Riyadh MA. Audit of structure, process and outcome of diabetic care at Alasyah primary health care center, Qassim region, Saudi Arabia. J Fam Community Med 2004;11:89-96.  Back to cited text no. 12
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13.Al-Khaldi YM. Quality of hypertension care in family practice center, Aseer region, Saudi Arabia. J Fam Community Med 2011;18:45-8.  Back to cited text no. 13
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14.AL-Humaidi MA, Suleiman SA, Abolfotouh MA, Khattab MS, AL-Kadoumi OF, AL-Khaldi Y. Hypercholesterolemia and other risk factors of coronary heart disease among Primary health care Centers in southwest Saudi Arabia. J Bahrain Med Soc 1999;11:15-22.  Back to cited text no. 14
    
15.Al-Khaldi YM. Foot care among male diabetics in family practice center, Abha, Saudi Arabia. J Fam Community Med 2008;15:103-6.  Back to cited text no. 15
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16.AL-Menawar HA. Non-compliance among hypertensive patients. Med J Cairo Univ 2007,75 suppl. III:387-93.  Back to cited text no. 16
    
17.Al-Tuwijri AA, Al-Rukban MO. Hypertension control and comorbidities in Primary Health care Centers in Riyadh. Ann Saudi Med 2006;26:266-71.  Back to cited text no. 17
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18.Al-Homrany MA, Khan MY, Al-Khaldi YM, Al-Gelban KS, Al-Amri HS. Hypertension care of Primary Health care Center: A report from Abha, Saudi Arabia. Saudi J Kidney Dis Transpl 2008;19:990-6.  Back to cited text no. 18
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19.Onwukwe SC, Omole OB. Drug therapy, lifestyle modification and blood pressure control in a primary care facility, South of Johannesburg, South Africa: An audit of hypertension management. Afr Fam Pract 2012;54:156-61.   Back to cited text no. 19
    
20.Al-Shidhani TA, Bhargava K, Rizvi S. An audit of hypertension at university health center in Oman. Oman Med J 2011;26:248-52.  Back to cited text no. 20
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21.Saeed AA, AL-Hamdan NA, Bahnassy AA, Abdalla AM, Abbas MA, Abuzaid LZ. Prevalence, awareness, treatment and control of hypertension among Saudi adult population: A national survey. Int J Hypertens 2011;2011:174135.  Back to cited text no. 21
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22.Hajjar I, Kotchen T. Trends in prevalence, awareness, treatment and control of hypertension in United States; 1988-2000. JAMA 2003;290:199-206.  Back to cited text no. 22
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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