National Journal of Physiology, Pharmacy and Pharmacology

RESEARCH ARTICLE
Prevalence and determinants of overweight and obesity among medical
students

Evelyn Thomas1, Geethadevi M2

Department of Physiology, Government Medical College, Kottayam, Kerala, India, 2Department of Community Medicine, Government
1

Medical College, Kottayam, Kerala, India

Correspondence to: Evelyn Thomas, E-mail: evelynphysiology@gmail.com

Received: October 09, 2019; Accepted: November 01, 2019

ABSTRACT

Background: Obesity is one of the major lifestyle disorders in India and its incidence has rapidly increased during recent
decades. Medical students are more prone for obesity, due to, their sedentary lifestyle, lack of exercise, disordered eating
habits, increased stress, and vast topics to learn. Aims and Objectives: The objectives of the present study were to find
the prevalence of overweight/obesity among medical students, identify the contributing/associated factors, and assess the
risk of comorbidities in them. Materials and Methods: A cross-sectional study was done among 330 medical students
aged 18–25 years. Height, weight, and waist circumference were measured. Body mass index (BMI) was calculated.
International physical activity questionnaire was used to assess physical activity. Dietary habits such as regular/irregular
diet, vegetarian/non-vegetarian, eating speed, frequency of consumption of fried snacks, and fast food and sleep duration
were also assessed. Based on waist circumference, the risk of comorbidities was also assessed. Results: Increased prevalence
of overweight/obesity (30.6%) was obtained among medical students. Statistically significant increase in the prevalence
of generalized obesity was noted in males compared to females. However, waist circumference showed a statistically
significant increase in females. There was no significant association between dietary factors, sleep, and physical activity
with BMI. Conclusion: Medical students have a high prevalence of obesity and are thus more prone for obesity-related
risks. This study might create a self-awareness among the medical students to adopt healthy lifestyles such as regular
exercise, less frequent consumption of fast food, and thus assure that they have reduced cardiovascular risks.

KEY WORDS: Overweight; Obesity; Medical Students; Waist Circumference

INTRODUCTION obesity among adults ranges from 11.8% to 31.3% and 16.9%
to 36.3%, respectively. Kerala ranks second among Indian
Obesity is one of the major lifestyle disorders in India and states with the increased prevalence of obesity in females.
its incidence has rapidly increased during recent decades. Medical students are more prone for obesity, due to their
According to the Indian Council of Medical Research-India sedentary lifestyle, lack of exercise, disordered eating habits
Diabetes study 2015, the prevalence of obesity and central due to lack of leisure time, increased stress and vast topics
to learn. Thus, they are prone to overweight/obesity-related
Access this article online complications such as hypertension, dyslipidemia, and
Website: www.njppp.com Quick Response code impaired glucose tolerance. However, often it remains a
neglected problem despite its consequences. This study was
aimed at estimating the prevalence of overweight/obesity
DOI: 10.5455/njppp.2020.10.1035506112019 among medical students, determining the contributing/
associated factors and assessing the risk of comorbidities in
them.

National Journal of Physiology, Pharmacy and Pharmacology Online 2020. © 2020 Evelyn Thomas and Geethadevi M. This is an Open Access article distributed under the terms of the
Creative Commons Attribution 4.0 International License (http://creative commons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or
format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.

2020 | Vol 10 | Issue 01 National Journal of Physiology, Pharmacy and Pharmacology  42

Thomas and Geethadevi Overweight and obesity among medical students

In recent years, obesity has become very common and an Kokila and Sivaprakasam[2] have found a high prevalence
increasing health burden affecting both developed and of obesity and overweight among medical students in South
developing countries like India. Overweight and obesity India. They also concluded that sedentary lifestyle and
are the fifth leading risk for global deaths. The prevalence frequency of eating food were high among overweight and
of obesity has nearly doubled between 1980 and 2008.[1] obese individuals.
Obesity is one of the biggest challenges that Indians need to
overcome because we are genetically predisposed to weight Kamath and D’Souza[4] in their study on the prevalence of obesity
gain. There has been a nutritional transition from typical among medical students found a positive association between
carbohydrate diet to high-calorie fast food dietary habits eating speed and BMI. In another study by Gupta et al.,[5] a
particularly affecting young adults, like medical students.[2] high prevalence of obesity was found among medical students.
Another study Manojan et al.[6] conducted in medical students
Overweight and obesity are defined as excessive fat also found an increased prevalence of overweight and obesity.
accumulation that may impair health. Obesity is a complex They also found that increased prevalence of obesity was
multifactorial disease. It develops from the interaction among those who are using unhealthy lifestyle, including fast
of several factors such as social, behavioral, genetic, food and fried snack consumption.
psychological, and metabolic. The causes of adult obesity
include a variety of factors such as diet, genetic predisposition, Another study by Girish and Koppad[7] also found an
lack of physical activity, and other behavioral factors. The increased prevalence of obesity among the medical students
sedentary lifestyle includes watching television, playing and more in females. Furthermore, they found an increased
computer games, using mobile phones for long time, reading, prevalence of increased waist circumference which shows
talking over phone, and listening to music. that more number of medical students are at risk of developing
cardiovascular diseases. They also concluded an increasing
Indians have a more centralized distribution of body fat, need for awareness, motivation, and attitudinal change to eat
with thick trunk skin folds and markedly highest mean balanced diet and to incorporate physical activity in their daily
waist-hip ratios for a given level of body mass index (BMI) schedule. Ramesh[8] have found an increasing prevalence of
compared to Europids. Furthermore, in them, morbidity obesity among adolescent high school students of Kerala.
and mortality occur even with lower BMIs and smaller A community-based study has shown a high prevalence of
waist circumferences. Thus, they tend to accumulate overweight/obesity in urban population.[9]
intra-abdominal fat without developing generalized obesity.[3]
In India, abdominal obesity is one of the major risk factors As medical students are the future health-care providers for
for cardiovascular complications. BMI generally correlates the community, it is necessary to prevent overweight/obesity
highly with adiposity. among them by young adult based approaches such as changes
in lifestyle, regular exercise, healthy food habits, and health
The Western Pacific regional office of the World Health
education. This study was aimed at estimating the prevalence
Organization (WHO) has recommended lower BMI cut off
of overweight and obesity among the medical students of
values for Asian people.[3]
Government Medical College Kottayam, assessing the factors
influencing the development of obesity and overweight and
Obesity is a risk factor for hypertension, type II diabetes
assessing the risk of comorbidities in them.
mellitus, infertility, hyperlipidemia, coronary artery
disease, stroke, and arthritis. Evidences have suggested that
atherosclerosis also begins early, when cardiovascular risk MATERIALS AND METHODS
factors also begin. Moreover, the social implications of obesity
are often neglected. The obese, do less well academically, has A cross-sectional study was conducted among 330 medical
poorer job prospects and lower self-esteem.[3] students aged 18–25 years at Government Medical College

Table 1: Classification of weight by BMI in adult Asians

Classification BMI (kg/m 2)
Risk of comorbidities WC <90 cm Risk of comorbidities WC >90 cm (males)
(males) WC <80 cm (female) WC >80 cm (female)
Underweight <18.5 Low Average
Normal range 18.5–22.9 Average Increased
Overweight >23
At-risk 23–24.9 Increased Moderate
Obese I 25–29.9 Moderate Severe
Obese II >30 Severe Very severe
BMI: Body mass index, WC: Waist circumference

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Thomas and Geethadevi Overweight and obesity among medical students

Kottayam, Kerala. Ethics Committee Clearance was overweight/obesity and various factors was done using
obtained. Informed consent was obtained after introducing the Chi-square test Table 1.
objectives of the study. Each student was given a pre-tested
questionnaire, which included name, age, sex, year of
RESULTS
admission, type of diet (vegetarian/non-vegetarian), dietary
habits (regular/irregular), speed of eating, consumption of
Of the 330 students enrolled in the study, there were
fried snacks and fast food, and duration of sleep. Physical
118 males and 212 females. The BMI categories were those
activity was scored according to international physical activity
underweight (<18.5), those who were normal (18.5–22.9),
questionnaire (IPAQ) (short past 7 days self-administered
and those who were overweight (>23). The overweight group
version of the IPAQ. Revised August 2002). Anthropometric
includes three subcategories, at risk (23–24.9), obese Grade I
measurements were taken which include weight, height, and
(25–29.9), and obese Grade II (>30) [Table 2]. Thus, overall
waist circumference. The height was measured on a vertical
prevalence of overweight/obesity which includes at risk and
scale with heels, buttocks, and occiput against the wall. The
obesity Grade I and II was found to be 101 (30.6%).
weighing machine was checked with known weights every
day before starting the survey. The participants were made Of the total boys, 11% were underweight, 49.2% were normal,
to stand still on the weighing machine, and the weight in and 39.8% were overweight/obese. Of the girls, 20.3%
kilograms was recorded. For waist circumference, the subject were underweight, 54.2% were normal, and 25.5% were
was made to stand with feet 25–30 cm apart, weight evenly overweight/obese. The percentage of boys with overweight/
distributed. Measurement was taken midway between the obesity was more when compared to girls, and this increase
inferior margin of the last rib and the crest of the ileum in was found to be statistically significant (P = 0.009) [Table 3].
a horizontal plane. BMI was calculated using Quetelet’s
index (BMI = Weight in kg divided by Height in m2). The According to the waist circumference measured, 207 (62.7%)
participants were categorized on the basis of BMI (criteria had normal waist circumference and 123 (37.3%) had
for Asian people) into underweight (BMI <18.5), normal increased waist circumference. Of the total 123 with increased
(BMI 18.5–22.9), and overweight (BMI >23). The overweight waist circumference, only 29 were males and 94 were females.
group was further divided into at risk (BMI 23–24.9), obese This increase in the number of females with increased waist
Grade I (BMI 25–29.9), and obese Grade II (BMI >30). circumference was found to be highly statistically significant
Furthermore, each group will be subdivided based on cutoff (P = 0.000) [Table 4].
values of waist circumference (<90 cm [men], >90 cm [men],
<80 cm [women], and >80 cm [women]) to assess their risk Of the 207 with normal waist circumference, 52 (25.1%) were
of comorbidities. All those who were absent during the time underweight, 121 (58.5%) were of normal, and 34 (16.4%)
of study and were physically challenged were excluded from were overweight/obese. Of the total 123 with increased waist
the study. circumference, 4 (3.3%) were underweight, 52 (42.3%) were
normal and 67 (54.5%) were overweight and obese. Out of
All data were entered into Microsoft Excel Sheet and the total 101 overweight students, only 67 had abdominal
statistical analysis was done using SPSS version 21. P < 0.05 obesity. Rest 34 had normal waist circumference [Table 4].
was considered statistically significant. Association between Furthermore, the risk of comorbidities was assessed as per
the WHO classification for Asian population [Table 5].
Table 2: Frequency distribution of study subjects based on
BMI categories Various contributing or associated factors were also assessed
BMI categories No. of students/percentage (%) using questionnaire. Of the total population, majority,
i.e., 277 (83.9%) had a regular diet and some, i.e., 53 (16.1%)
Underweight 56 (17)
had diet at irregular timings. Furthermore, majority (304) were
Normal 173 (52.4)
non-vegetarians and only very few (26) were vegetarians. The
Overweight – At risk 62 (18.8) total percentages of students consuming maximum amount of
Obesity Grade I 32 (9.7) food during breakfast, lunch, and supper were 68 (20.6%),
Obesity Grade II 7 (2.1) 158 (47.9%), and 104 (31.5%), respectively. Furthermore,
BMI: Body mass index the frequency of consumption of junk foods such as fried

Table 3: Distribution of study subjects based on BMI categories and gender

Gender BMI categories (%) Total (%) P value
Underweight Normal Overweight/obese
Males 13 (11) 58 (49.2) 47 (39.8) 118 (100) 0.009
Females 43 (20.3) 115 (54.2) 54 (25.5) 212 (100)
*For the purpose of analysis overweight at risk, obese I and obese II were clubbed together, BMI: Body mass index

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Thomas and Geethadevi Overweight and obesity among medical students

snacks, fast foods such as pizzas and burgers was more than in them. Furthermore, the overall prevalence of abdominal
once per day for 137 students (41.5%), once per day for 40 obesity in medical students was 37.3%. Among the total
students (12.1%), only once per week for 99 students (30%), 101 overweight/obese students, 66.3% had increased waist
and only once per month for 54 students (16.4%). Of the total, circumference too which substantially increased their risk of
182 students (55.15%) had their meals in <15 min, while 139 comorbidities. Although there was no significant association
students (42.12%) had eating speed between 15 and 30 min between the contributing/associated factors such as dietary
followed by 30–45 min for 8 (2.42%) of them and only one habits, sleep, and physical activity with BMI, we found that
(0.30%) had eating speed between 45 and 60 min [Table 6]. majority of students (41.5%) ate junk foods such as fried
snacks, fast food items more than once per day and majority
The IPAQ questionnaire showed that majority of the study (55.15%) had eating speed <15 min for meal. Furthermore,
population, i.e., 199 students (60.3%) were of low physical 60.3% of total medical students were having low physical
activity group, followed by 96 students (29.1%) coming under activity score in IPAQ questionnaire.
moderate physical activity and less students, i.e., 35 (10.6%)
were of high physical activity group. Furthermore, regarding Results similar to ours, showing high prevalence of
the duration of sleep, 26 (7.9%) students slept only for overweight/obesity, were also obtained in studies
only <6 h, while, 131 (39.7%) students slept for 6–8 h, and conducted in medical students.[10-12] Another study done by
majority, i.e., 173 (52.4%) slept for more than 8 h [Table 7]. Fernandez et al.,[13] on medical students in Pune, also showed
an increased prevalence of overweight/obesity. However,
There was no significant association between BMI categories their study showed an increased prevalence in female students
and other factors such as diet, sleep duration, frequency of than male students, whereas we had obtained an statistically
consumption of junk foods, and physical activity. significant increase in prevalence in male students than in
female students. In a study done by Priya et al.,[14] in female
DISCUSSION medical students, it was found that females perceived their
body image correctly and attempted to change their body
In the present study, the overall prevalence of overweight/ weight toward normal.
obesity was found to be 30.6% in medical students. In males,
it was 39.8% and in females, it was 25.5%. This increased Similar to our results, Kokila and Sivaprakasam also found
prevalence of overweight/obesity in male students than that among medical students, females were more abdominal
female students was also statistically significant. However, obese than males.[2] Furthermore, 66.3% of total overweight/
to the contrary, when the waist circumference was measured obese students in the present study had moderate to very
to assess the abdominal obesity due to visceral fat deposition severe risk of comorbidities due to coexistence of abdominal
it was seen that 44.3% of females had abdominal obesity, obesity in them. This is because; evidence has shown that
whereas only 24.6% of males had abdominal obesity. This abdominal obesity is associated with cardiovascular risks
female preponderance in abdominal obesity was found to such as dyslipidemia, hypertension, and type II diabetes.
be statistically significant. Hence, due to the increased waist Hence, it is not only the amount of fatness that is important
circumference, the risk of comorbidities also will be more but also its distribution that determines the risks associated
with it. Furthermore, in a study done by Debnath[15] on
female students of 16–22 years, he found a positive
Table 4: Distribution of study subjects based on WC
correlation between waist circumference and systolic
categories and gender
blood pressure, diastolic blood pressure and mean blood
Gender Normal Increased Total (%) P value pressures. Furthermore, a significant correlation between
WC (%) WC (%)
BMI and systolic and diastolic hypertension also has been
Males 89 (75.4) 29 (24.6) 118 (100) 0.000 noted.[16] In another study conducted by Vikram et al.,[17]
Females 118 (55.7) 94 (44.3) 212 (100) even C-reactive protein (CRP) levels were also found to be
Total 207 (62.7) 123 (37.3) 330 (100) higher in subjects with obesity and in subjects with increased
WC: Waist circumference waist circumference. CRP is found to be associated with

Table 5: Distribution of study subjects based on BMI categories and waist circumference categories
BMI category Normal waist circumference Increased waist circumference
No. of students (%) Risk of comorbidities No. of students (%) Risk of comorbidities
Underweight 52 (25.1) Low 4 (3.3) Average
Normal 121 (58.5) Average 52 (42.3) Increased
Over weight/obese 34 (16.4) Increased to severe 67 (54.5) Moderate to very severe
Total 207 123
BMI: Body mass index

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Thomas and Geethadevi Overweight and obesity among medical students

Table 6: Distribution of study subjects based on dietary factors, duration of sleep, and physical activity against body mass
index categories
Variable Underweight (%) Normal (%) Overweight/obese (%) P value
Diet (n=330) regular 47 (17) 143(51.6) 87(31.4) >0.05
Irregular 9 (17) 30 (56.6) 14 (26.4)
Diet (n=330) vegetarian 7 (26.9) 12 (46.2) 7 (26.9) >0.05
Non-vegetarian 49 (16.1) 161 (53) 94 (30.9)
Time during which more food is consumed (n=330)
Break fast 7 (10.3) 37 (54.4) 24 (35.3) >0.05
Lunch 28 (17.7) 84 (53.2) 46 (29.1)

Dinner 21 (20.2) 52 (50) 31 (29.8)

Speed of eating (n=330) min

<15 22 (12.1) 100 (54.9) 60 (33) >0.05
15–30 32 (23) 66 (47.5) 41 (29.5)
30–45 2 (25) 6 (75) 0
45–60 0 1 (100) 0
Consumption of fast food/fried snacks (n=330)
>Once per day 27 (19.7) 70 (51.1) 40 (29.2) >0.05
Once per day 2 (5) 23 (57.5) 15 (37.5)
Once per week 15 (15.2) 53 (53.5) 31 (31.3)
Once per month 12 (22.2) 27 (50) 15 (27.8)
Duration of sleep (n=330) (h)
<6 7 (26.9) 13 (50) 6 (23.07) >0.05
6 23 (17.55) 69 (52.67) 39 (29.77)
>6 26 (15.02) 91 (52.60) 56 (32.36)
Physical activity according to the international physical activity questionnaire (n=330)
Low 42 (21.1) 104 (52.3) 53 (26.6) >0.05
Moderate 9 (9.4) 51 (53.1) 36 (37.5)
High 5 (14.3) 18 (51.4) 12 (34.3)

Table 7: Distribution of study subjects based on physical activity groups and waist circumference categories
Physical activity as per international Normal waist Increased waist circumference P value
physical activity questionnaire circumference (%) (abdominal obesity) (%)
Low 126 (63.32) 73 (36.68) >0.05
Moderate 57 (59.38) 39 (40.62)
Severe 24 (68.57) 11 (31.43)
There was no significant association between physical activity and waist circumference

endothelial dysfunction and increased risk of coronary and performed physical exercise. Hence, from this, we can
heart disease. Studies.[18] have even shown that obese had assume that eating junk foods, low levels of physical activity
high levels of major cardiovascular risk factors such as could be few probable causes for obesity among our medical
hypertension and dyslipidemia. In a community-based students also, though we could not establish a positive
study done in adolescents by Harikrishnan and Kumar[19] in
statistical correlation. Another study[20] has even proved
Chennai, he had found that low levels of physical activity,
consuming junk foods and watching television are associated that high burden of obesity is influenced by prevalent outlet
with high prevalence of obesity. They have also proved that density of food in the environment. Reports have also shown
prevalence of obesity was found to be lower in adolescents that due to the long-term consequences, overweight/obesity
who performed household chores, played outdoor games poses enormous[21] financial burden to the health-care system.

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Thomas and Geethadevi Overweight and obesity among medical students

The present study has taken the WHO criteria for overweight/ medical students: A cross sectional study in a south Indian
obesity for Asians and could estimate accurately the actual medical college. Al Ameen J Med Sci 2013;6:93-5.
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Our study suggests that primary prevention of obesity in of overweight and obesity among the medical students at Kannur,
young adults could be possible only by improving their Kerala. J Evol Med Dent Sci 2014;3.Available from: https://www.
lifestyle by initiating awareness in them, providing facilities go.gale.com/ps/ anonymous?id= GALE%7CA467680367&sid
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This study concludes that the prevalence of overweight/ study on prevalence of obesity among urban population of
obesity is very high among medical students. Although Shivamogga, Karnataka, India. Int J Community Med Public
males showed increased prevalence of overweight/obesity Health 2017;4:96-9.
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the medical students. Thus, this study could create a self- 12. Mehmood Y, Al-Swailmi FK, Al-Enazi SA. Frequency of
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13. Fernandez K, Singru SA, Kshirsagar M, Pathan Y. Study
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ACKNOWLEDGMENT
medical students at mangalore. Indian J Community Med
2010;35:316-20.
I am grateful to all the students who have wholeheartedly 15. Debnath S. BMI is a better indicator of cardiac risk factors,
participated in this study and to all the staff of Department as against elevated blood pressure in apparently healthy
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