Prevalence and determinants of overweight and obesity in the workers of Shiraz hospitals

Obesity is a medical condition where extra body fat has accrued to the degree that it may have an adverse effect on health, leading to decreased life expectancy and/or increased health complications 1. Since 2008 the World Health Organization (WHO) declared that more than 1.4 billion adults, 20 and older, were overweight and of whom over 200 million men and almost 300 million women were obese2. WHO introduced obesity as a worldwide epidemic and called for a harmonious effort in the managing and prevention of that state of health3. Obesity raises the probability of several diseases, mainly heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis1 .In order that is a most important preventable cause of global death and with growing prevalence that is one of the most critical public health problems in the 21 century4 .Obesity is projected to cause an above 111,909 to 365,000 deaths for every year in the United States1,5 as 1 million (7.7%) of deaths in the European are associate with extra weight6 .Although in the beginning of 20th century, obesity was a public health problem in the developed countries , mainly in the United States and Europe but in developing countries such as Mexico, China, and Thailand increased too7.In developing countries more than 115 million people suffer from obesity associated with health status8 .Risk factors for obesity include: 1) Caloric intake (kind of diet and eating habits) 2) Genetic factors (more than 300 genes, markers, and chromosomal regions have been known that are related to different obesity of human phenotypes) 3)Socio-economic status, cultural conditions and level of education 5.aging 6.pregnancy 7) Lack of sleep 8)Decreasing or Quitting smoking ( as appetite put down by smoking) 9 ) Certain medications 10) Old maternal age 11) Endocrine disruptors (environmental contaminants that obstruct lipid metabolism) 12) Psychological factors (Psychological status can affect eating habits, as


Introduction
Obesity is a medical condition where extra body fat has accrued to the degree that it may have an adverse effect on health, leading to decreased life expectancy and/or increased health complications 1 .Since 2008 the World Health Organization (WHO) declared that more than 1.4 billion adults, 20 and older, were overweight and of whom over 200 million men and almost 300 million women were obese 2 .WHO introduced obesity as a worldwide epidemic and called for a harmonious effort in the managing and prevention of that state of health 3 .Obesity raises the probability of several diseases, mainly heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis 1 .In order that is a most important preventable cause of global death and with growing prevalence that is one of the most critical public health problems in the 21 century 4 .Obesity is projected to cause an above 111,909 to 365,000 deaths for every year in the United States 1,5 as 1 million (7.7%) of deaths in the European are associate with extra weight 6 .Although in the beginning of 20th century, obesity was a public health problem in the developed countries , mainly in the United States and Europe but in developing countries such as Mexico, China, and Thailand increased too 7 .In developing countries more than 115 million people suffer from obesity associated with health status 8 .Risk factors for obesity include: 1) Caloric intake (kind of diet and eating habits) 2) Genetic factors (more than 300 genes, markers, and chromosomal regions have been known that are related to different obesity of human phenotypes) 3)Socio-economic status, cultural conditions and level of education 5.aging 6.pregnancy 7) Lack of sleep 8)Decreasing or Quitting smoking ( as appetite put down by smoking) 9 ) Certain medications 10) Old maternal age 11) Endocrine disruptors (environmental contaminants that obstruct lipid metabolism) 12) Psychological factors (Psychological status can affect eating habits, as most of people eat more in reaction to negative emotions.)and 13) Lack of physical activity 9, 10 .So far no study conducted about the survey of obesity in Shiraz hospitals staff , hence conducting this survey seems necessary.The aim of this study is the survey of prevalence and determinants of overweight and obesity in the workers of Shiraz hospitals.

Materials & methods
The survey was conducted 2006 between staff of 24 hospitals of Shiraz that had at least, one year record of service.A random sample of 1027(20%) of hospitals personnel population was chosen.The method of sampling was categorical and carried out systematically .The categories included nursing workers (nurses, health workers and obstetricians) official workers and the menial workers.Data collected by questionnaire and body measurement examinations.Questionnaire included demographical, occupational and General Health Questions (GHQ28) that assessed mental conditions.A face to face interview was conducted for answering to questionnaire.All survey participants were eligible for the body measurement component.There were no medical, safety, or other exclusions for the body measurements protocol but the pregnant women were excluded from the analysis.The body measurement data were collected by trained health technicians.Body mass index (BMI) was used for measuring of underweight, overweight and obesity.BMI was calculated by dividing the subject's weight in kilograms by the square of his or her height in meters (BMI = kilograms / meters 2 ).By WHO definition a BMI less than 18.5 is considered as underweight, a BMI greater than 25.0-29.9 is considered overweight and above 30 is considered obese 10 .BMI measurements: height was measured without shoes and by a safe metal ruler and weight was measured in light clothing using calibrated scales.BP was measured after 6 minute rest in the sitting position and recorded by trained researchers, according to WHO (World Health Organization) standardized criteria 26 .The mean of two reading from right arm was used in the analysis.High BP was defined according to the JNC 7 (The Seventh Report of the Joint National Committee) and WHO Guideline criteria 11.This Study was approved by local ethical Committee.

Results:
Of 1027 eligible subjects 313 subjects(30.5%)were male and 417subjects(69.5%)were female that were over 19 years and the Mean age of male and female were 35.37 and 33.27 years, respectively .The overall Prevalence of underweight, overweight and obesity was 5.5 %( 56 case), 27.8 %( 286) and 7.0 %( 72 case).The prevalence of underweight, overweight and obesity in the male staff was 5.1%, 28.8% and 6.7% respectively and in the female staff was 5.6%, 27.5% and 7.1% respectively (Table 1).The prevalence of BMI status based Socio-demographic and clinical characteristics are presented in Table1.The proportion of Overweight (37.2%) and obesity (17.9%) in collegiate staff was higher than the other education groups (Table 1).In married status; widow (er) & died spouse staff had a much higher proportion of obesity and Overweight than Married and Single staff (Table 1).In job groups, the highest prevalence of overweight and obesity followed by menial workers, Clerical & Managerial workers and Nurses and the highest proportion of underweight followed by Nurses, Clerical & Managerial workers and menial workers (Table 1).In work status, the prevalence of obesity in seating status was the highest (9.8%) (Table 1).Respondents that drank tea and those who had second job and who had any chronic disease had a higher proportion of obesity and overweight compared to their having tea, having second job and having any chronic disease counterparts (Table 1).Respondents who didn't drink coffee had a higher proportion of obesity (7.3% vs.4.5%) and underweight (5.6%vs.4.5%) than those who drank coffee.None of the subjects that smoked was obese and the prevalence of overweight and underweight in smoking staff was 22.0% (13 subjects) and 8.5% (5 subjects) respectively (Table 1).
Respondents who did not exercise had a high proportion of obesity than their counterparts who did exercise (7.6%vs.5.6%) (Table1).Subjects who didn't have shift works had a higher prevalence of obesity than Subjects who had shift works.(9.2% vs. 3.8%) (Table1).The proportion of obesity and underweight in subjects that had tension headache was greater than who didn't have tension headache (5.5% vs.3.9 and 11.1 vs. 5.8%) (Table1).About shift work, the highest prevalence of obesity followed by fixed night, fixed evening, morningevening, fixed morning, regular rotation and irregular rotation (Table1).The proportion of obesity and overweight followed by systolic hypertensions (23

Discussion:
In present study the prevalence of underweight, overweight and obesity was 5.5 %, 27.8 % and 7.0 % respectively in Shiraz hospitals staff.In comparison with the general population in Shiraz, the prevalence of overweight and obesity in staff was lower.
(Overweight: 37.1% and obesity: 17.9%) 12 .Males had highest proportion of Underweight (5.6% vs. 5.1%) and obesity (6.7% vs. 7.1%) while females had highest proportion of Overweight (28.8% vs. 27.5%)However, this difference was not statistically significant.In Tohidi studies, the prevalence of overweight and obesity in males was about twice compared to the present study (42.7% and 10.5%) also for women similar result was obtained (34.1% and 21.9%) 12 , However the prevalence of overweight in male staff Ahvaz university ( 2005) was almost equal to our study, (26%) but the prevalence of obesity(52%) was much more 13 , also in female staff of Shahid Beheshti Tehran university (1999), the prevalence of overweight(39%) and obesity (11% ) was higher than present study 12 .
Compared with workers in other countries, the proportions of our study were less, such as Mexico(1996) that the prevalence of overweight and obesity in a staff general hospital was 37.45% and In headache effect on BMI, subjects with tension headaches showed higher levels of BMI.While the relationship between migraine headaches or mixed with BMI was not significant.In most studies, there was a significant relationship between migraine headaches and BMI levels 38,39 .These results were inconsistent with the present study's findings that probably because of type of studding model and con-trol of different variables.
In the current study, with the presence of possible confounding variables, subjects with Irregular sleep had lower BMI levels, but there was no significant relationship between sleep hours and BMI levels.While in some studies, an inverse relationship had been observed between sleep hours and BMI levels 22,40,41,42 .In multiple linear regressions analysis of present study, there was no significant relationship between smoking and level BMI.Previous Studies Provided Conflicting results in this field 21,23,24 .However, consistent with the results of some studies in single variable linear regression, an inverse relationship between education level and BMI level were observed 21,24 but this relationship was not maintained in multiple linear regression in present study.Unexpectedly, in our study, physical activity did not show any effect on the BMI level.Whereas most studies found that people with physical activity showed a lower level of BMI 8,21,23 .In the multiple regressions, having shift work showed no effect on the BMI level.While some studies had reported people with shift work had a higher level of BMI that still was being unrevealed 43 that further studies are needed in this area.

Conclusion:
Although our findings suggested that the prevalence of overweight and obesity within the hospital staff in Shiraz, in comparison with other groups and the general population was lower, but the prevalence ratio, is significant and requires consideration.While obesity is easily preventable, if not controlled, chronic and irreversible complications, it would have.This study was estimated on the multiple linear regression models, and showed new findings of determining factors associated with BMI.In addition to the factors of age, systolic and diastolic blood pressure had direct relationship with BMI; there was an indirect relation to BMI and irregular sleep and widow(er) status.In other words, poor living conditions had the negative impact of the increase in BMI level.This is required to justify that unlike other studies, physical activity in this study didn't have any effect on BMI levels.Consequently, for improve the physical activity, intervention programs appears to be necessary.
17.2% 14 , among the Employees of Universities, Health and Research Institutions of Pakistan ( 2003), the overall prevalence of underweight, overweight and obesity was 5.4%, 29.6 and 8% respectively 15 , In the Kuwait Oil Company employees, the overall