The European Journal of Public Health Advance Access originally published online on December 17, 2008
The European Journal of Public Health 2009 19(1):91-94; doi:10.1093/eurpub/ckn107
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Miscellaneous |
Obesity in adults in Turkey: age and regional effects
Ali
eri1 and
Nurullah Arslan2
1 Industrial Engineering Department, Fatih University, Istanbul, 34500 Turkey
2 Genetics and Bioengineering Department, Fatih University, Istanbul, 34500 Turkey
Correspondence: Ali eri, Industrial Engineering Department, Fatih University, Istanbul, 34500 Turkey, tel: +90 212 866 3375, fax: +90 212 866 3369, e-mail: aliiseri{at}fatih.edu.tr
Received March 24, 2008, accepted October 10, 2008
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Abstract |
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Background: In this study, the body mass index (BMI) of Turkish population is calculated using a sample of 4205 persons consisting of 2263 male and 1942 female individuals in 2007. The study contains data from all seven geographical regions (Aegean, Black Sea, Central Anatolia, Eastern Anatolia, Marmara, Mediterranean and Southeast Anatolia) of Turkey and from all age groups from 20 to 85 years. Method: In this study, height and weight data were measured and used for calculating the BMI of Turkish population accounting for age and regional effects. Results: This study's analysis found that age, region and gender are significant determinants on obesity of Turkish population. Also, Turkish population has higher obesity prevalence than most of the European countries. Overall, it was found that 56% of Turkish Population is overweight while 41% is in the normal range. Conclusions: This is the first study related to obesity in Turkey covering all seven regions and all age groups. Analyzing the differences of obesity prevalence between genders, geographical regions and age groups will be beneficial for better understanding the reasons behind obesity in Turkey.
Keywords: body mass index, obesity, anthropometry, Turkey
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Introduction |
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Obesity leads to many health problems worldwide. It is a major public health problem and the most common nutritional disorder.1 It is related with a host of health problems. Especially, abdominal obesity are associated with some serious problems, such as type 2 diabetes, cardiovascular and cerebrovascular diseases, hypertension, digestive disorders and cancer.2,3
In Turkey, 47.7% of all deaths have originated from cardiovascular diseases (most likely cerebrovascular and ischemic heart diseases)4 which are highly correlated with obesity. Thus, it is important to know the factors that affect obesity; since it is one of the main causes of cardiovascular problems. In this study, we have investigated obesity and tried to determine if age, gender and region are significant factors. Thus, our results can be one contribution to the studies to understand the reason of growing obesity and related cardiac problems in Turkey.
The body mass index (BMI) is a measure that expresses the relation between weight and height. It is calculated as BMI = Mass/Stature2 (measured in kg m–2). The World Health Organization (WHO) has introduced the graded classification system for BMI while paying attention to recent knowledge of health risks. According to this classification, persons who have a BMI lower than 18.5 are underweight, between 18.5 and 25 are normal, greater than 25 are overweight. The overweight category consists of four subcategories. Persons with a BMI between 25 and 30 are categorized as preobese, between 30 and 35 as obese class I, between 35 and 40 as obese class II and greater than 40 as obese class III.
There are previous studies concerning obesity in Turkey. However, these studies were generally related with some specific area, age or gender group. For instance; Aslan et al.5 investigated the elderly in Ankara. A
rbal et al.6 compared obesity in Ankara, Turkey with Bogalusa, Louisiana. Ersoy et al.7 investigated if socioeconomic status affects obesity prevalence in the city of Bursa and Erem et al.8 studied obesity in the city of Trabzon. Thus, our study is the only one to investigate the effects of geographical region, age and gender on obesity in Turkey. This study gives results for both genders, all age groups between 20 and 85 years and all geographical regions of Turkey and gives comparisons between them.
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Materials and methods |
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This study is based on the study done with 4205 individuals consisting of 2263 males and 1942 females from seven regions of Turkey. Individuals were selected from families of primary school children. A random cluster sampling frame was applied to select the study subjects. In every school that was associated with the study, three classes were selected randomly. Field workers who were guidance counselors in these schools received an appointment
1 week before visiting the household of the students who were in the selected classes. The response rate was, respectively, high with a mean of 77%. Field workers measured the height and weight of the household members who are greater than 20 with appropriate tools and recorded their ages.
This study was taken by the field workers from 18 different cities that are Denizli and Kütahya from Aegean region; Zonguldak from Black Sea region; Aksaray, Ankara, Kayseri and Konya from Central Anatolia region; Bitlis from Eastern Anatolia region; Adapazar, Balkesir, Bursa, stanbul and Kocaeli from Marmara region; Antalya and Mersin from Mediterranean region; Diyarbakr, Gaziantep and 
anlurfa from Southeast Anatolia region. The distribution of Turkish population was considered and 18 cities were selected accordingly. Therefore, the distribution of samples among regions is similar to the real regional distribution in Turkey.
Age is an important factor in anthropometry. Taking only younger people would lead us to overestimation of the measurements. In our survey, every age group is included between 20 and 85 years considering the real age distribution. Since individuals were selected from the families of primary school children, there is a small bias in age groups toward age of 40–44 years. However, this is not a large bias as can be seen in table 1, which shows the real distributions of individuals according to age and geographical region compared with the survey distributions.
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Using the anthropometric survey data, BMI for every individual is calculated. To understand if age, region and gender have an effect on BMI, ANOVA analyses were done using Minitab statistical software. According to ANOVA results; gender, age and region affect BMI significantly (P < 0.000 for gender and age; P < 0.025 for region) in the stated significance order.
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Results |
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The results show that only 41% of the Turkish population is in the normal range and only 3% is underweight. Most of the population (56%) is overweight: preobese (40%), obese class I (12%), obese class II (3%) and obese class III (1%). Thus, according to classification of WHO,9 most of the Turkish population is under high risk of cardiac problems. According to UHY-ME 20044 study, in Turkey, 43% of all male and 52% of all female deaths are originated from cardiovascular diseases (most likely cerebrovascular and ischemic heart diseases). The diabetes prevalence is also high in Turkey with 8.1% in men, 8.9% in women.10
The reasons for high prevalence of obesity in Turkey may be an increasing sedentary life-style in the cities and dietary habits in Turkey. Other factors may also be effective, such as societal changes and technological developments. The results also show that the Turkish population has a higher rate of obesity relative to European countries where overweight rates range from 25% to 75%,11 however, similar to the United States where 59% of American men and 49% of women have BMI's over 25.12 Compared with the study of BMI done in the city of Trabzon,8 our study showed similar results in the same region. Erem et al.8 stated that 61% is overweight (BMI > 25 kg m–2) and 24% is obese (BMI > 30 kg m–2) in Trabzon while we state that 61.6% is overweight and 22.1% is obese in Black Sea region.
BMI values differ from region to region. Table 2 enlisting the prevalence of obesity by regions shows these differences. Women in Aegean and Marmara regions—which are economically more developed regions—have lower obesity prevalence than women in Black Sea, Central Anatolia and Southeast Anatolia. Whereas men in Aegean, Eastern Anatolia and Mediterranean regions have lower BMI values than men in Black Sea, Marmara and Southeast Anatolia. In regions where education level is higher women have lower obesity prevalence. However there is not such an effect for men. These results can be seen in table 2.
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It is clearly seen from table 3 that BMI increases until the age of 40 years for men and 55 years for women, and then it diminishes. Health complaints and decreasing ability of the body to gain weight can be among the main reasons. Also another reason could be that the overweight have already died, and only the thin survive. Turkish BMI range for Turkish men according to age is about ±2 kg m–2, however, this range is ±4.5 kg m–2 for women. So the rate of increase in BMI through aging is greater and lasts longer for women. Turkish women between age 20 and 45 years are thinner than men, however, this changes after age 45 years because of the greater rate of gaining weight of women.
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As it is seen from table 3, most of the young Turkish women are underweight or normal; however, most of the middle aged women are overweight or obese. There is also an age effect for men, however, this is not as great as in women.
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Discussion |
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BMI is an important and quick way of assessing the body fat. BMI of every individual that is involved in the survey is calculated and obesity map of Turkey is generated with respect to gender, age and region. According to our research, gender, age and region have a significant effect on BMI. The effects of these factors can be used to better understand the reasons of the growing obesity trend.
To truly represent Turkish population whose parameters, such as mean and standard deviation are unknown, we were forced to imitate the characteristics of the population that could bias the study in our sample set. These characteristics are age and region. Associated cities were selected according to the real regional distribution which is shown in table 1. For the age, we assume we would get an unbiased age distribution using the households of primary school children. However as can be seen in table 1, there is a small bias toward age of 40–44 years. Another bias can be that the subjects were chosen from the urban population, so this study represents only the urban Turkish population. Sampling methodology and response rate can also be important for the representativeness of the sample. These are explained in details in the Material and methods section.
Only 41% of the Turkish population is in the normal range and only 3% is underweight. Most of the population (56%) is overweight, especially preobese. This can be mostly because of the sedentary life-style and dietary habits in Turkey. Other factors can be also effective, such as societal changes and technological developments.
Age significantly affects BMI of Turkish population for both genders. However, this effect is much greater in Turkish women than in Turkish men. Being an average marriage age of 23.2 years13 for women in Turkey, main factors for this great trend can be marriage and child birth. Also another important factor can be that most of the Turkish women are housewives whose activity level is low compared with the mostly working Turkish men. According to the data of Turkish Statistics Institute on January 2007,14 there are 16 130 000 working men while there are only 5 619 000 working women. In the study of Erem et al.8, obesity rate of housewives is 33% whereas it is only 14% for workers.
Until recently, all studies related with obesity prevalence in Turkey used a specific region or a specific age group such as children or elders. There is no study covering 18 different cities and all seven regions and all age groups as in our study. We used a sample size of 4205 (1942 female, 2263 male) and compared seven geographical regions and different age groups in Turkey.
In this study, we only stated probable reasons for the differences. Further studies can be done to understand the differences in obesity prevalence of different geographical regions and age groups.
The results show that Turkish population has a higher rate of obesity relative to European countries,11 however, it is similar to the United States.12 Although obesity is a secular trend in developed and developing countries, attention should be paid to this growing trend in Turkey since BMI is a measure of body fat and body fat has been statistically linked to cardiac problems.
Conflict of interest: None declared.
Key points
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References |
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