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ORIGINAL ARTICLE
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 80-85

Impact of nutrition clinic on obesity in Baghdad, Iraq: First year outcome


1 Iraqi Ministry of Health, Al-Yarmouk Teaching Hospital, Nutrition Clinic, Baghdad, Iraq
2 College of Medicine, Al-Mustansiriya University, Baghdad, , Affiliate Prof, Global Health, University of Washington, Seattle, WA, Iraq

Date of Web Publication13-Jan-2017

Correspondence Address:
Ali Hassan Hayyawi
Iraqi Ministry of Health, Al-Yarmouk Teaching Hospital, Nutrition Clinic, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-2618.197703

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  Abstract 

Background: Overweight and obesity are growing global health concerns. Strategies to control obesity focus on obesity management and weight reduction as well as obesity prevention.
Objective: The objective of this study was to summarize the impact of new nutrition clinic on obesity in Baghdad city, Iraq.
Methods: All patients who attended the clinic during the year 2015 were included in this case series study to describe the yield of work of the clinic in its first year. A complete examination was done by the researchers for every patient, including height, weight, BMI, and other relevant examinations according to the underlying health problem.
Results: The total number of patients that visited the clinic for the first time was 738 with a mean age of (32.9 ± 9.1 year) and mean BMI of (34.85 ± 7.84 kg/m2). The attendants who reported only one visit formed 71.5%, while 15% achieved two visits and only 13.5% could make it to achieve three visits, 10.5% of the sample did not show any loss in their weight, while 47.4 showed a loss of up to three kilograms after one month, and 42.1% lost more than three kilograms.
Conclusion: Most of the attendants to the nutrition clinic are females and morbid obese especially those with hypertension and diabetes mellitus. The compliance of the patients is still low. More health education is needed to increase their awareness about the problem of obesity.

Keywords: Baghdad, nutrition clinic, obesity, outcome


How to cite this article:
Hayyawi AH, Hasan KR, Lafta RK. Impact of nutrition clinic on obesity in Baghdad, Iraq: First year outcome. Saudi J Obesity 2016;4:80-5

How to cite this URL:
Hayyawi AH, Hasan KR, Lafta RK. Impact of nutrition clinic on obesity in Baghdad, Iraq: First year outcome. Saudi J Obesity [serial online] 2016 [cited 2019 Sep 16];4:80-5. Available from: http://www.saudijobesity.com/text.asp?2016/4/2/80/197703


  Introduction Top


Obesity could be defined as a disease process that results from excessive body fat accumulation[1] to the extent that impairs physical and psychosocial health and well-being.[2]

Overweight and obesity are growing global health concerns. Strategies to control obesity focus on obesity management and weight reduction as well as obesity prevention. Obesity is one of the ten most preventable health risks, yet, at least 300,000 deaths every year in the USA alone can be linked to obesity.[3]

Overweight and obesity are classified in some literature as: Normal body mass index (BMI) is 18.5–24.9 kg/m2, overweight is 25–29.9 kg/m2, moderately obese is ≥30 kg/m2, and morbidly obese is ≥40 kg/m2.[4]

The prevalence of obesity is increasing in both developed and developing countries and is considered to be a global pandemic.[5] Overweight and obesity rates have been increasing sharply over the recent decades in all industrialized countries, as well as in many lower-income countries, and has reached epidemic proportions, with over one billion adults worldwide estimated to be overweight and at least 300 million of those considered clinically obese.[6] The circumstances in which people have been leading their lives over the past 20–30 years, including physical, social, and economic environments, have exerted powerful influences on their overall calorie intake, on the composition of their diet, and on the frequency and intensity of physical activity at work, at home, and during leisure time.[7]

The reasons for the rising prevalence of obesity in the developed and undeveloped countries include urbanization of the world’s population, increased availability of food supplies, and reduction of physical activity. Many theories had been formulated to explain how and why obesity occurs; they include genetic factors, energy imbalance, fat cell theory, behavioral factors, and central regulation theory.[8]

The objective of this study was to summarize the impact of new nutrition clinic on obesity in Baghdad city, Iraq.


  Methods Top


This is descriptive study that represents a total year work yield in a nutrition clinic in Baghdad city. This clinic has recently been established in Al-Yarmouk Teaching Hospital (which is considered as the main hospital in the west half of Baghdad and its peripheries). The clinic work depends primarily on direct visits in addition to receiving referred cases of malnutrition (under and over-nutrition) from secondary clinics (general hospitals) and from the tertiary clinics in Al-Yarmouk Teaching Hospital, in addition to referrals from Primary Health Care Centers and private clinics. The main duties of the clinic are the management of obese patients, patients with chronic metabolic diseases of nutritional element such as diabetes mellitus, hypertension, thyroid, and renal diseases, also patients with underweight, and children with malnutrition.

The Nutrition Clinic in Baghdad started to work at the late 2014; its policy is primarily to assess the nutrition status of the attendants, then put a plan for management. Those confirmed to be overweight or obese are assigned for special management courses that include: A special program of calories intake restriction through diet control, correction of malpractice in dietary habits, and an education course to upgrade their awareness about increasing their physical activity as it is an important component of any weight management program. Although dieting is largely responsible for initial weight loss; making long-term changes to eating and activity behaviors is extremely difficult for most patients.[9] The attendants are then put under a long course of close follow-up and monitoring of their commitment to dietary programs and physical activities.

Once the patients attend the clinic; a medical file is opened and filled for them, full information about sociodemographic details are taken in addition to the complete history about the relevant health problem.

A complete examination was done by the researchers for every patient including height, body weight, and other relevant examinations according to the underlying health problem. BMI was measured by dividing the body weight (kg)/height (m2). Patients with BMI <18.5 were considered to be underweight, patients with BMI (18.5–24.9) are normal weight, 25- <30 are overweight, 30- <35 are obese, and 35 and more are labeled to have morbid obesity according to the WHO indices.[10] In the analysis stage, children age 19 years and less were excluded in respect to obesity for that nutrition status assessment in this age group needs to follow special curves forwarded by the WHO.

All patients who attended the clinic during the year 2015 were included in the study to describe the impact and workload of the clinic in its 1st year. The data were collected by well-trained community physicians that are working in the nutrition clinic and who have a long experience in the epidemiology of nutrition diseases in general and especially in problems of underweight and obesity.

Data from medical files entered into IBM Statistical Package for the Social Sciences (SPSS), version 20 for categorization, tabulation, and analysis. Mean and standard deviation were computed. Chi-square test was used to find out the significance of association; P = 0.05 was considered as a cutoff point regarding the level of significance.


  Results Top


The total number of patients that visited the clinic for the first time for different reasons was 738. The mean age of patients was (32.9 ± 9.1 year) and their mean BMI was (34.85 ± 7.84 kg/m2). After excluding those age 19 years or less (for the difference in BMI measurement), the total became 623. Those with high BMI (25 kg/m2 or more) were 568 (91.2%).

The age group of (31–45 years) formed the biggest group with 231 patient (31.3%) followed by the age group of (40–60) which constitutes 24.4% of the patients. Almost three-quarter of the patients were females, 34% with higher education level, and two-thirds (66.5%) of the patients were married as shown in [Table 1].
Table 1: Sociodemographic characteristics of the study sample

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Almost half of the study sample was morbid obese (47.5%) while 29.4% were obese, and 2.9% underweight [Table 2].
Table 2: Distribution of the study sample according to body mass index (n=623)*

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[Table 3] represents information about the presence of chronic diseases among the sample (23.7%). Hypertension (HT) (alone or with diabetes) (67.8%), diabetes alone 12.1%, thyroid gland disease (9.7%), and other diseases such as asthma, heart diseases, arthritis, cerebral accident, epilepsy, and irritable bowel syndrome formed (10.8%).
Table 3: Chronic diseases among the attendants of the clinic

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[Table 4] revealed that 72% of the attendants reported only one visit, 14.8% two visits, and only 13.2% came three times to clinic. The total patients who attended more than one visit were 159 (28%). The widow and divorced showed a good compliance with appointment. There was no significant association found between the different categories and number of visits.
Table 4: Number of visits achieved by different categories (n=568)

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In respect to weight loss, 15.1% of the sample did not show any loss in their weight while 44.7% showed a loss up to 3 kg after 1 month while 40.2% lost more than 3 kg after 1 month [Table 5].
Table 5: Kilograms lost after 1 month of follow-up (n=159)*

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  Discussion Top


The age group with the highest rate of attendance to the dietary clinic was (31–45 years). This is probably related to the fact that in this age group the physical activity starts to diminish keeping the same eating habits, this will lead to gaining more weight causing changes in body shape, and this alarming change urges most of them to seek medical advice. A study that was conducted in Baghdad in 2006 revealed that the peak occurrence of obesity was in the age group (40–49) years for both males and females.[11] Another study in Tehran (2013) showed that the highest rate of obesity was in the age group (40–49)[12] while in Vietnam, the prevalence of overweight and obesity was more than doubled between the young and old age groups (20–29 and 50–59 years).[13] The results of this study showed that out of the total sample, the least who were seeking medical help were those in the age group (>60 years), this agrees with Walls et al. study.[14]

Female was the dominant visitors to the clinic, may be because of more prevalent overweight and obesity among them (due to their lifestyle of less physical activity in our culture),[11] or because they are more concerned about their body shape for cosmetic reasons. This finding is similar to the Iranian study which showed higher prevalence of obesity in Iranian females compared to males,[12] and with many other studies in the regional countries such as Saudi Arabia,[15] Oman,[16] Lebanon,[17] and Turkey.[18] A previous study in Baghdad reported that only 25% of married obese women possess the desire to lose weight. This might be explained by the fact that a young female used to take care of her body, this usually wanes afterward although some middle-aged women keep on trying to lose weight.[11]

In the current study, about two-thirds of the attendants were graduated from secondary or higher schools; this goes with what Lafta and Hayawi stated that obesity in Baghdad was more frequent among highly educated people[11] while Moghimi-Dehkordi et al. in their study in Tehran observed that obesity is inversely related to education.[12]

Two-thirds of the attendants were married, maybe because they are older and more sedentary in their life. For females, there is an added precipitating factor that is related to pregnancy and to contraceptives. On the other hand, obesity before the age of marriage may lessen the chance of the female to get married as it affects her attractiveness.[19]

Our year work demonstrated that morbid obesity is not uncommon in our locality; this is probably attributed to the accelerated increase in the incidence of obesity in the whole community in the recent years and among different age groups as shown by many studies; Lafta and Kadhim found that prevalence of obesity and overweight is relatively high in children in central Iraq,[20] Musaiger et al. and El-Ghazali et al. concluded an increasing obesity prevalence among youth.[21][22] Badran and Laher concluded that the prevalence of obesity has increased at an alarming rate during the last three decades, and this appears to be more overwhelming in women.[23] There are many local factors that help increase this prevalence such as, bad eating habits like eating while watching television and screens using high calories traditional Iraqi meals, sedentary lifestyle, sustainable stress due to the continuous state of violence and insecurity, and the rapid multiplication of fast food places, El-Ghazali et al. reported similar factors for the increase in the prevalence of obesity.[22]

Another cause for attending the clinic was the complications of obesity or the concomitant chronic diseases. About quarter of the attendants gave a history of chronic diseases. HT is at the top of the list, followed by diabetes mellitus, and other diseases. Results of Díaz et al. study indicate that obesity is a significant factor in increasing comorbidity from diabetes, hypertension, and cardiovascular diseases, particularly in women, they found that more than 30% of obese have diabetes and that 50–80% of diabetic are obese.[24] Reis et al. study showed that prevalence of comorbidity in association with central distribution of adiposity is higher than the prevalence of comorbidity in association with overweight alone and obesity alone, this indicates that abdominal fat is a predictor variable for some chronic diseases.[25]

Some patients were not compliant and attended only once, probably because they were unsatisfied with the outcome of the first visit since the clinic urges the lifestyle modification and diet control as the first line of management while some patients believe only in medicines to ensure rapid weight loss. Besides slow weight loss strategies adopted by the clinic make some patients less enthusiastic for regular visits. Obese patients showed more desire to attend the clinic, widow and divorced had good compliance, probably because they have less family responsibilities, and hence, more free time.

In respect to weight loss during the follow–up, the young age category (<30 years) showed the highest percentage of more than 3 kg loss after 1 month. Males lost more weight than females probably because males in our society can (more easily than females) take some measures to increase their activity such as exercising outdoors or in the gyms than females. The married succeeded to lose weight more than the single, and the highly educated lost more weight, maybe because they are more understanding and responsive to the dietary advices.


  Conclusion Top


It can be concluded from this study that most of the attendants to the nutrition clinic are females and morbid obese, especially those with hypertension and diabetes mellitus. The compliance of the patients is still low. More health education is needed to increase their awareness about the problem of obesity, and more encouraging programs should be considered to motivate them use the clinic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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