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Quality of Life for Adult Clients with Obesity Who Attend Consultation Clinics at Teaching Hospitals in Al-Diwaniya City
Zainalabideen Yasser Jumaa Al-gharify1, Raad Kareem Faraj 2
1- M.Sc. Student, University of Baghdad, College of Nursing, Community Health Nursing Department, Email: [email protected]
2- Assist Prof (PhD), University of Baghdad, College of Nursing, Community Health Nursing Department.
Abstract
Obesity is a complex disease that involves the build-up of excess fat in the adipose tissue leading to deterioration in the state of health. Caused by multifactorial: genetic, behavioral, metabolic, cultural, and social and are associated with general declines in quality of life, be they physical, social, or psychological. The study aimed to assess quality of life for adult clients with obesity who attend consultation clinics at teaching hospitals in Al-Diwaniya City. A descriptive cross-sectional design used to identify quality of life level for adult clients with obesity for the periods of has been carried out from (December 5th, 2020 to April 20th, 2021). The convenience ‘’non-probability’’ sample used to select 262 adult clients with obesity who were recruited from teaching hospitals in Al-Diwaniya City, Iraq.
The study revealed that there is an effect of obesity on the quality of life, where reported less than half reported moderate level quality of life (n = 124 ؛47%), followed by those who reported poor level (n = 117؛ 45% ) and those who reported good level (n= 21 8؛ %).
Additionally, the results indicated that the domains most affected by obesity were self-esteem and sexual life. Furthermore, there are statistically significant between the quality of life and gender, occupation, Marital Status, family history of obesity. Also, the findings show that quality of life was highly associated with the client’s body mass index at (p-value =0.000).
The researchers recommends urging broadcasts of educational programs that limit the phenomenon of bullying on obese people by audiovisual and readable media.
Keywords: quality of life, adult clients, obesity.
Introduction
Frellick (2013) stated that Obesity is long recognized as a problem of public health and is widely characterized as an 'obesity epidemic' Because of recent drastic rises in prevalence rates over the past three decades around the world, especially in Canada. Until recently, obesity was recognized as a disease by the American Medical Association (Song et al.,2019).
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Overweight and obesity are defined by the WHO as an abnormal or exaggerated accumulation of fat that poses a health risk. Body Mass Index (BMI) is a simple scale used to determine the amount of increase or decrease in body weight. BMI can be calculated by dividing body weight in kilograms by the square of height in meters. Current directives from the US Centers for Disease Control and Prevention (CDC) and WHO for adults include a normal BMI range of 18,5 to 24,9 kg/m2, compared to a BMI of 25 to 29.9 kg/m2 classified as overweight, and BMI of 30 kg/m2 classified as obese, with severe obesity defined as a BMI of 40 kg/m2 (WHO,2020).
According to the World Health Organization (2016) that approximately 2 billion adults are overweight, 650 million of whom are considered to have obesity (BMI 30.0 kg/m2 or greater). This represents 39% of adults (39% of male, 40% of female) aged 18 and over being overweight, with a further 13% being obese. It is estimated that by the year 2025, over 2.7 billion adults will be overweight, over 1 billion will suffer from obesity and 177 million will suffer from extreme obesity by 2025 (World Obesity Federation,2019).
Al Tawil et al (2007) reported that 39% were overweight and 37% were obese among non-pregnant women attending outpatient clinics in Baghdad. While Mansour et al (2012) conducted a study between (2003-2010) in Basra, southern Iraq, it found 55.1% overweight and obese (38.9 percent of men and 61.1 percent of them women). The prevalence of obesity was 35.2 percent among women relatives of primary care attendants in Baghdad, Iraq (Al- Kaseer, et al.,2018). The survey conducted Iraq in 2015 showed the prevalence of overweight was 31.8 percent, obesity was 33.9 percent, while overweight and obesity were 65.7 percent (Pengpid & Peltzer,2020). In 2017, Erbil, overweight prevalence was 33,4 percent and obesity was 40,9 percent, and overweight and obesity were 74,3 percent.
(Shabu,2019).
Obesity was linked to impairments to a healthy quality of life, in addition to its medical consequences, particularly one's ability to perform day-to-to-day activities, to a variety of other also a few issues related to bodily functioning and mental well-being. The obese population faces a greater risk of health issues such as shortened life expectancy and death due to their poor health, just as poor health issues shorten a person's life (Laxy et al.,2018).
According to findings in the literature, adult life-experience research in Iraq, the need to know the domains of quality of life most affected by obesity necessitates further study.
This study aims to assess the quality of life for adult clients with obesity who attend
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consultation clinics at teaching hospitals in Al-Diwaniya City and, determine the difference between the adult client's body mass index and their quality of life.
Methodology
A descriptive cross-sectional study design was used to guide this study. The study was conducted for the period from (December 5th, 2020 to April 20th, 2021). A non-probability convenience sample of (262) adult clients with obesity who were recruited from Al-Diwaniya Teaching Hospital, and Maternity and Children Teaching Hospital at consultation clinics in Al-Diwaniya City
.
Study Instrument
The study instrument is a questionnaire designed according to the study objectives to assess the quality of life among adult clients with obesity. It is composed of three parts which include
:
Part I: Socio-demographic data: (age, gender, Marital Status, Occupation, Family members suffering from obesity, chronic diseases)
.
Part II: Measure Body Mass Index (BMI)
.
Part III: Quality of life for adult clients with obesity
.
Through the researchers review of the study conducted by Duval et al (2006), related to an overview of obesity quality of life questionnaires. The researcher used a questionnaire a 31-item, short form of the IWQOL (IWQOL Lite) was developed in order to be used to measure the quality of life for obese and minimize response burden to the subject (Kolotkin et al.,1995). The researcher modified and developed the (IWQOL Lite) questionnaire to suit the research objectives
.
The IWQOL Lite is a 31-item self-assessment questionnaire with five QoL dimensions; physical function (11 items), self-esteem (7 items), sexual life (4 items), public distress (5 items), and work are the subjects addressed (4 items). An instrument was performed using (3) levels from the Likert scale for assessing the quality of life for adult clients with obesity (Hauber et al.2010)
.
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The questionnaire has been scored and rated on three levels Likert scale, (1) point for always, (2) points for sometimes, and (3) points for the never which assessed by cutoff point (0.66) due to scores (1, 2, & 3) respectively. Scores of responses are categorized according to the following
:
(1-1.66) = poor level, (1.67-2.33) = moderate level, (12.34-3.00) = good level.The instrument's score and rating (1) always, (2) sometimes, and (3) never. A panel of experts in various areas of specialty (20) shall determine the validity of the instrument. The pilot study was done using the split-half Cronbach technique to identify the reliability of the instrument. The coefficient of correlation (r=0.84) indicates the tool's reliability
.
Theresearcher met the clients with obesity at a hall in the clinic's department to get their agreement to participate in the study and to clarify the study questionnaire. The data collection process started from (14th February 2021 to 4th April 2021) in order to achieve the objectives of the study. The interview time for each client took (15-25) minutes
.
The data analyzed by using the Statistical Package for Social Sciences (SPSS) version 25 application of statistical analysis system.Results
Table 1: Overall Obesity Clients their Quality of Life
No Domains N MS SD Ass.
1 Physical Function Domain 11 1.81 0.705 M
2 Self-esteem Domain 7 1.44 0.633 P
3 Sexual Life Domain 4 1.49 0.726 P
4 Public distress Domain 5 1.70 0.591 M
5 Work Domain 4 1.98 0.802 M
Overall Main Domains 31 1.68 0.6914 M
"N =number of items, %= Percentage, M.s.= Mean of score, cut off point (0.66), poor (mean of score 1-1.66), moderate (mean of score 1.67-2.33), good (mean of score ≥2.34), S. d= Stander deviation"
This table shows the statistical distribution and client’s quality of life associated with obesity of main domains, the table reveals that domains of the study within the (moderate ) level of quality of life for all domains except (Self-esteem and Sexual Life Domain) which reveal ( poor) level of quality of life among all study domains, while the level of quality of life overall main study domains with ( Moderate; mean +S.d.= 1.68+ 0.6914 ) level of client’s quality of life associated with obesity.
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Figure 1: Overall Quality of Life Assessment among Clients with Obesity
The findings presented the overall client’s quality of life associated with obesity. Finding reveals that the majority of (47.3%) were moderate quality of life (Figure1).
Table 2: Relationship between Quality of Life for Adult Clients with Obesity and their Demographic Characteristics
Poor (M.s=1- 1.66)
45%
Moderate (M.s.=1.67-2.33)
47%
Good (M.s.≥2.34)
8%
Poor (M.s=1-1.66) Moderate (M.s.=1.67-2.33) Good (M.s.≥2.34)
Age
Rating QOL
Total d.f Sig.
Poor Moderate Good
<20years
old 6 10 3 19
8
χ2obs.= 6.055 χ2 crit.= 15.507
P-value=0.641 NS 20-30years
old 33 41 4 78
31-40years
old 38 37 5 80
41-50 years
old 31 28 6 65
51 and older 9 8 3 20
Total 117 124 21 262
Gender
Male 45 49 19 113
2
χ2obs.= 20.892 χ2 crit.= 5.991 P-value=0.000
HS
Female 72 75 2 149
Total 117 124 21 262
Marital Single 27 30 13 70
6 χ2obs.= 15.788
Married 72 72 6 150
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"χ2obs. = Chi-square observer, χ2crit. = Chi-square critical, D. f= Degree of freedom, P-value= Probability value, S= significant, NS= non-significant, S= significant, HS= high significant"
Table 3: Mean differences between the overall client’s quality of life and their BMI BMI VS QOL
d.f. Mean
Square F Sig.
Between Groups 2 9.817
18.210 0.000
Within Groups 259 0.539 HS
Total 261
By ANOVA test, findings shows that quality of life (QOL) were highly associated with adult clients’ body mass index (BMI) at p-value <0.01.
Discussion
Through table (1), related to the physical function domains of obese adult clients. The finding indicated that the obese adult clients have a moderate level of quality of life in the physical function at the mean (1.81). While the finding indicated that the obese adult clients have a poor level of quality of life in the self-esteem at the mean (1.44). Also, the finding indicated that the obese adult clients have a poor level of quality of life in the sexual life at
Status Widowed 14 15 2 31 χ2 crit.= 15.507
P-value=0.015 S
Separated 4 7 0 11
Total 117 124 21 262
Occupa tion
Unemploye
d 38 38 2 78
6
χ2obs.= 33.603 χ2 crit.= 15.507
P-value=0.000 HS Self-
employment 33 36 19 88
Student 11 12 0 23
Employee 35 38 0 73
Total 117 124 21 262
Family membe
rs sufferin
g from obesity
Yes 68 67 2 137
2
χ2obs.= 17.140 χ2 crit.= 5.991 P-value=0.000
HS
No 49 57 19 125
Total 117 124 21 262
Chronic disease
s
Non 83 85 13 181
6
χ2obs.= 1.700 χ2 crit.= 15.507
P-value=0.945 NS Hypertensio
n 16 18 4 38
D.M. 13 13 2 28
Heart
diseases 5 8 2 15
Total 117 124 21 262
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the mean (1.49). Additionally, the finding indicated that the obese adult clients have a moderate level of quality of life in the public distress at the mean (1.70). Also, the finding indicated that the obese adult clients have a moderate level of quality of life in the work at the mean ((1.98). These findings indicate disturbance of body image, and people view to obese man may affect negatively on obese adult feeling and emotion may decrease their self- esteem. Also finding related to an increase in weight may increase the risk of various body systems complications like the endocrine system and effect on the action of some hormone and increase the chance of diabetes mellitus and cardiovascular diseases and effect on sexual function.
Through table (1), related to the overall quality of life of obese adult clients. The finding indicated that the obese adult clients have a moderate level of quality of life at the mean (1.68). This mean is slightly higher than the poor quality of life (1-1.66). Also, figure (1) shows less than half (47%) reported a moderate level of quality of life, followed by those who reported poor levels (45%), and those who reported good levels (8%). Obesity is associated with a negative effect on self-esteem, and sexual life aspects of quality of life, and to a lesser extent with physical functions, work, and general distress.
Rozjabek et al., in the United States (2020) reported the most significant declines were found between classes 2 and 3 obesity in mental and physical function domains.
Another study, conducted by Malik et al., (2019)discovered low HRQoL in Pakistan between overweight and obese. The most effective field was emotional, body pain, and physical role due to emotional problems among obese adults. These findings supported the present study finding.
Busutil et al., (2017) in the study among the Spain population found that obesity increases the problem of mobility, self-care, usual activities, and pain/discomfort in comparison to ordinary peers.
Kolotkin and Crosby, (2002) found that the increase of weight (obesity) has negative impacts on the physical function, sexual life, auto-establishment, public distress, work, and overall quality of life in the studying (psychometric assessment of weight impact on quality of life-lite questionnaire (IWQOL-lite).
The finding in table (2) regarding the relationship between adult clients with obesity and their age indicated that there is no significant statistical relationship between the age of
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obese adults’ clients and quality of life (at p-value=0.641). This finding is supported by the study done by Malik et al., (2019), which found that there is no significant relationship between the age of obese adults’ clients and quality of life. While this result disagrees with the result conferred by the study done by Ghazala and Farhood (2016), found there is a statically significant relationship between age and quality of life.
The study, as in table (2), showed there is a highly significant statistical relationship between the gender of obese adult clients and quality of life (at p-value = 0.000). This finding is consistent with the Korean study (Song et al., 2010). While this result disagrees with the result conferred by the study done by Almojarthe et al., (2020) found that there is no significant statistical relationship between gender. This can be explained because most of the sample are females and women's nature are more interested in their look and image than men and thus obesity has an influence on their psychology and self-confidence and is afraid of rejection.
Regarding the marital status as in table (2), the study showed that there was a significant relationship between the marital status of obese adults’ clients and quality of life (at p-value=0.015). This finding may be associated with sexual problems in a married person who is obese. This result disagrees with the result conferred by the study done by Almojarthe et al., (2020) found that there is no significant statistical relationship between marital status.
The finding in the table (2) regarding to the relationship between adult clients with obesity and their occupation indicated that there is a highly significant statistical relationship between the occupation of obese adults’ clients and quality of life (at p-value=0.000). This result supported with the study done by Malik, et al (2019), found that there is a significant relationship between the occupation of obese adult clients and quality of life.
Analysis of the study data (table (2)) showed that there was a highly significant statistical relationship between family history of obese adult clients and quality of life. (at p- value=0.000). This finding relates to the family play role in the transmission of diseases across the family members and most of the sample have a family history of obesity.
The finding in the table (2) regarding to the relationship between adult clients with obesity and their chronic diseases indicated that there is no significant statistical relationship between chronic diseases of obese adult clients and quality of life (at p-value=0.945). This finding related to most of the sample have not chronic diseases. This result disagrees with the
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result conferred by the study done by Ghazala and Farhood (2016), which found that there is a significant relationship between chronic diseases of obese adult clients and the quality of life.
The study, as in table (3), indicated that there is a highly significant statistical difference between three groups of obesity (obese class I, obese class II, & obese class III) in the quality of life (at p-value= 0.000). Many previous studies were in agreement with this result, Ramasamy et al., (2020) found that there is a significant statistical relationship between BMI and quality of life. This result agrees with other studies (Taylor et al., 2013) and (Hassan et al.,2003), as well as (Kearns, et al 2013) .
This finding indicates the obesity has negative health impacts, physically, obesity is associated with numerous health problems such as DM type 2, coronary artery diseases, hypertension, and several types of cancers. Psychologically, obesity is related to lower self- esteem, and decreased self-image. Socially, obese people are susceptible to discrimination and teasing by others, which have further negative social and economic implications. So, obesity is inversely related to all aspects of quality of life, so the higher the BMI, the lower the quality of life.
Conclusion
The researchers concluded that the quality of life of the participants is low in the domains of (self-esteem and sexual life). While, they have a moderate quality of life in the areas (physical function, public distress, work, and overall quality of life).
Recommendations
The researchers recommends an Emphasis on public health departments in the Ministry of Health or primary health care sectors on the need to prepare educational programs about obesity, its consequences, and methods of prevention to reduce its risks and improve the quality of life of adults who suffer from obesity.
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