Knowledge and Attitude of Overweight and Obesity Among the Residents of Eti-Osa East LGA Lagos State
Chapter One
Aims And Objectives of study
AIM
The aim of the study was to explore residents’ perceptions and attitudes about obesity in Eti-Osa East LGA, Lagos state.
Objectives
The objectives of the study were:
- To explore the knowledge of obesity and overweight among residents;
- To explore the attitudes towards behaviour change among residents;
- To identify the barriers to adopting a healthy lifestyle among residents in Eti-Osa East LGA medical metropolitan complex.
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
The literature reviewed was sourced through searches of electronic databases: Pubmed, Medline and Google scholar. The following key words were used in the search strategy: perceptions of obesity; perceptions of causes of obesity; attitudes about obesity; healthy lifestyle; prevalence of obesity; and health belief model. The search was conducted for studies published in English from 1990-2022. This chapter is divided into two sections. The first section presents a literature review on healthy lifestyle, prevalence of obesity and perceptions of obesity. The second section presents one theoretical perspective of the many theories that explain health-seeking behaviours. It highlights the challenges that prevent residents from controlling their weight, acting as role models and counselling their clients and communities in a more effective manner on overweight and obesity.
HEALTHY LIFESTYLE THEORY
According to Cockerham (2005: 55) “Healthy Lifestyle theory as a concept which combines the ideas of agency and structure to demonstrate that in modern society, not all individuals are provided equal opportunities to be healthy. The agency refers to an individual’s ability to choose a behaviour or action, and notes that there must be alternative options that the individual does not choose. Structure is defined as sets of mutually sustaining schemas and resources that empower or constrain social action and tend to be reproduced by that social action.”
People as individuals have the right to choose their own lifestyle to adopt under any circumstance. Nevertheless, social determinants play a major role in achieving and sustaining this lifestyle. Poor people struggle to adopt healthy lifestyles because of challenges such as non-availability of places to practise physical activities and lack of access to healthy affordable food.
Cockerham (2005) reported that healthy lifestyle theory emerged as a reaction to scholars trying to come to grips with changing disease burdens, modernity and social identities. The initial change occurred with the twentieth century epidemiological transition when disease profiles changed from acute to chronic diseases, which became a major contributor to human mortality globally (WHO, 2013). Modern medical treatment can relieve symptoms of chronic diseases to improve the quality of life of patients, but they are rarely cured.
Prentice (2006) added that the second change was social modernization, which came with the industrial revolution, which resulted in a massive increase in economic productivity, promoting general improvement in living standards and purchasing power. He argued that this pattern used to be common in high-income countries like the United States of America and Germany, but now, the situation has changed. Kelly, Yang, Chen, Reynolds and He (2008) reported that the situation in middle-income countries like Brazil and Nigeria has changed to be similar to that in the United States of America and Germany. These changes have been accompanied by an increased consumption of food high in refined oils and sugar. In addition, people’s lives are now more mechanized, resulting in some people’s becoming less physically active (Prentice, 2006). All of these factors increase the prevalence of obesity, which in turn is a main risk factor for all NCDs.
OBESITY
Obesity is the condition in which a person has excessive body fat that poses a risk of ill health (WHO, 2013b). The most commonly used measure for obesity is body mass index (BMI) which is a statistical measure comparing a person’s weight and height as earlier mentioned in the introduction in chapter 1. It is used to assess the degree of obesity in individuals. People who have a BMI of 30kg/m2 or more are considered obese (WHO, 2000). The WHO (2013 b) reported that 35% of the world adult population, 20 years and older, were overweight and 11% were obese in 2008, accounting for more than 1.4 billion overweight adults and more than 500 million people who were obese. Kelly (2005) reported that worldwide 33% of adults (1.3 billion people) were overweight or obese in 2005 and predicted the prevalence of obesity to go up to 57.8 % of the world’s adult population by 2030 if the trend towards obesity remains uncontrolled. The consequences of obesity as a risk factor have been considered in both high and low-income countries as the major contributory factor to the cause of disability and premature death due to NCDs (WHO, 2005).
CHAPTER THREE
RESEARCH METHODOLOGY
INTRODUCTION
This chapter describes the study design, study settings, study population and sampling, data collection, data analysis, rigour and ethics as applied in the current study.
RESEARCH DESIGN
An explorative and descriptive qualitative study was conducted in order to explore the understanding of residents’ knowledge about body weight, overweight and obesity. Malterud (2001: 483) describes the purpose of qualitative research as: “…the exploration of meanings of social phenomena, as experienced by individuals themselves in their natural context”. The qualitative approach was used to investigate the perceptions and attitudes of residents about obesity in Eti-Osa East LGA health metropolitan, as residents participating in the study were able to share their experiences with regard to obesity, as well as the barriers encountered to following a healthy lifestyle.
Mays and Pope (1995) argue that an understanding of participants’ experiences and constructed meanings about particular issues within their natural settings is one of the most important aspects of qualitative research. In line with Mays and Pope, all participants were interviewed in their respective hospitals. The qualitative approach is most suitable to explore perceptions, attitudes and challenges about obesity as it allows the researcher to explore and understand residents’ perceptions on susceptibility to NCDs, severity of NCDs, benefits of leading a healthy lifestyle, barriers to following a healthy lifestyle, cues to action and self-efficacy.
STUDY POPULATION AND SAMPLING
The study population was constituted of residents from the above-mentioned hospitals which are part of the Eti-Osa East LGA medical metropolitan complex. The inclusion criteria for eligible participants were residents who:
- Have been working for more than one year;
- Are permanently employed at one of the selected areas ;
- Have at least three years of professional training;
- Are working closely with overweight or obese
This study included relatively small sample sizes that were purposefully selected, as the researcher’s primary concern was quality of data and not statistical representation (Mays & Pope, 2000). In qualitative studies, selected participants grant access to information on a particular phenomenon under study and, as such, they represent a perspective rather than a population, thus providing the researcher with more detailed and richer data.
Six residents from each hospital site were recruited for data collection. Physiotherapy managers informed various component managers about the proposed study, who then assisted in recruiting suitable participants from their respective components. The researcher included two obese residents from each institution, allowing these individuals to share perceptions surrounding obesity, thus making the study more inclusive. All participants were recruited using purposive sampling, with the intention of ensuring representation from as many of the professional categories as possible.
CHAPTER FOUR
DATA ANALYSIS AND RESULTS
INTRODUCTION
This chapter will discuss the results of the study starting with a description of the study participants. The chapter will then present the findings using the predetermined themes.
CHAPTER FIVE
DISCUSSION OF FINDINGS, CONCLUSION AND RECOMMENDATIONS
DISCUSSION OF FINDINGS
PERCEIVED SUSCEPTIBILITY TO NON-COMMUNICABLE DISEASES
Residents are aware of the negative consequences of increased weight or obesity. The study reported that participants know that being obese can predispose them to NCDs and eventually lead to health complications. Some residents have realised that the chances of their suffering from these conditions are high and they are now involving themselves in health promoting programmes such as modifying their eating habits and doing physical exercise. The results of the current study are consistent with studies that were done in the USA (Kim, Harrison & Kagawa-Singer, 2007; Agne, 2012).
Studies conducted in Nigeria also show the same trend. Puoane et al. (2005) similarly found that more than half of community residents tried to reduce weight by reducing food consumption or taking slimming tablets in order to reduce the chances of suffering from NCDs. These finding are supported by other Nigerian studies (Skaal & Pengpid, 2011; Dalais, 2013; Phiri et al., 2014).
In addition, the study reported that few residents bring cooked food from home to avoid unhealthy food. The consumption of unhealthy food over a prolonged period of time can increase their chances of becoming obese. Home cooked meals are the best because a health conscious person can regulate the amount of additives they add to the meal, like salt and cooking oil.
Consumption of oily food and refined sugar is unhealthy as it contributes to a person’s becoming overweight or obese (Prentice, 2006).
PERCEIVED SERIOUSNESS OF OBESITY
This study found certain obese residents find it difficult to interact physically with their clients, as their size limits their mobility and their ability to handle patients. This was in agreement with Agne (2012) who reported that Latin-Americans associated weight gain with the presence of multiple physical symptoms of obesity, discomfort, and reduced physical capability, such as breathlessness, fatigue, and low energy. This was further supported by Dalais (2013) in the study on educators.
This study also reported that participants are aware of obesity’s being a major risk factor for NCDs. These diseases have severe consequences on individual performance at work possibly due to depression or stress. A person who is sickly fails to work effectively and efficiently and this impacts negatively on other members of staff. This study’s results are similar to Phiri and colleagues’ findings (Phiri et al., 2014).
PERCEIVED BENEFITS OF LEADING A HEALTHY LIFESTYLE
This study reported that residents who lead a healthy lifestyle have enhanced self-esteem, are physically flexible and they are able to manoeuver around patients easily. They are usually more productive and do their work more effectively. These results are similar to the findings from previous studies in Nigeria (Mvo & Steyn, 1999; Puoane et al, 2005; Puoane et al, 2012; Dalais, 2013).
This study also reported that participants who keep fit and follow a healthy diet are unlikely to get sick from NCDs. This is consistent with Agne’s (2012) findings that Latin- Americans considered weight loss as a way to improve personal health and wellbeing. This is supported by local Nigerian studies (Mvo & Steyn, 1999; Puoane et al., 2005; Puoane et al., 2012; Dalais, 2013).
This study reported that residents following a healthy lifestyle are in a better state of health and appear healthier than those who do not follow healthy practices. These workers also have enhanced self-image. This can be seen in the way they conduct themselves at work and when they are in public. These findings are supported by Puoane et al. (2010) in their Cape Town study among residents.
This study also reported that clients and patients who are being attended to by residents who look physically healthy become motivated to look like them. They assume that the health worker knows what they are doing and, as such, they are more willing to be assisted. This is consistent with the study by Oberg and Frank (2009) and Frank et al. (2000).
PERCEIVED BARRIERS TO LEADING A HEALTHY LIFESTYLE
Participating African residents believe that people who are healthy are not supposed to be skinny. This belief is very strong among African respondents who usually associated being skinny with poverty and ill health. In many cases, a thin person is suspected of illnesses such as TB and HIV/AIDS. Some Nigerian studies support these findings. Puoane et al. (2007) reported that residents preferred to be overweight because of the stigma associated with thinness. This was also supported by other studies conducted in Africa (Mvo et al., 1999; Puoane et al., 2002; Puoane et al., 2005; Matoti-Mvalo, 2006; Puoane et al., 2010; Devanathan et al., 2013).
This study also found that certain participants believe that when people have enough food, they should eat as much as possible as this is a reflection that they have enough money to spend on food and, as such, they are considered to be doing well. This belief encourages some people to overeat, thus ending up being obese. This belief discourages residents from adopting a healthy lifestyle. This is consistent with local Nigerian studies (Matoti-Mvalo, 2006; Puoane et al., 2010; Devanathan et al., 2013).
This study reported that institutions are utilizing physiotherapy departments for physical exercise in these hospital but these departments are not ideal because they have limited operational times. Physiotherapy departments are primarily to serve patients, therefore, the departments are open to members of staff only at times when there are few patients. Staff can only access this service during those times. This limits access to the facility. This is consistent with local studies (Skaal & Pengpid, 2011; Dalais, 2013; Phiri et al., 2014).
CONCLUSIONS
This study explored residents’ perceptions and attitudes about obesity in Eti-Osa East LGA, Lagos state. A description of these aspects related to residents may be vital in the development of guidelines for the Department of Health (DOH) to empower residents on proper counselling of patients and adopting a healthy life style.
Despite residents having knowledge of obesity, they cannot act without institutional support. Workplace health promotion programmes focusing on increasing opportunities for physical activities and availability of healthy food choices should be established to encourage long-term health worker well-being. The hospitals need to enable residents to access physical exercise facilities and provide affordable healthy food options. Physical activities facilities should be built so that they are ideal for all residents. This involves building health gymnasiums within the institutions and not modifying the physiotherapy departments. These facilities should be accessible at any time.
Healthy food should also be made accessible and affordable by the hospital management, facilitating discussions and agreements between hospital cafeteria operators and food suppliers so that healthy food can be made available at affordable prices. The infrastructure or system should enable residents to pursue a healthy lifestyle. Mandatory health-behaviour promotion programmes on obesity and other NCDs should be instituted in institutions. This will assist in combating older cultural norms which advocate overweight body size as desirable because of positive cultural connotation accorded to it.
As an important limitation to the study, it needs to be recognised that the results of this study cannot be generalised to all residents in S.A. due to the small sample size and the local nature of the region studied.
RECOMMENDATIONS
The high burden of overweight and obesity among residents in this study calls for concern and action. Residents in Nigeria need to be sensitized and empowered to be roles models of healthy weight in the society. Based on the findings of the study the following recommendations are made.
Firstly, the DOH should be responsible for and involved in the development and implementation of a sustainable wellness and health programme for residents. The DOH should have policies which are related to the promotion of healthy behaviours. Residents should be encouraged to practise health-behaviour changes, through the provision of gymnasiums in the institutions. The current policy on healthy lifestyle initiation (Appendix 7) should be supported by hospital management so that it can be implemented effectively. The programme should be aimed at health- behaviour change on weight control and maintaining a healthy lifestyle. This should include proper diet and the provision of physical activities centres within the hospitals.
Secondly, time was mentioned as a very important consideration; therefore, shift duration and structures should be modified to enable residents to exercise at work. The health and wellness programme should be incorporated into the hospital programme or be made part of staff development or a team building programme where the buddy system is encouraged and specific time is set aside for residents monthly for these activities.
Thirdly, heavy workloads and work burnout should be reduced by involving the institutional management in the wellbeing of residents. Heavy workloads and burnouts can be attributed to staff shortages and absenteeism. Absenteeism can be reduced by improving staffing of residents by filling all vacant posts and effectively training section managers to implement effective leave management.
Lastly, the assessment tool which is used for evaluating hospital performance both for clinical and managerial capabilities (Core standards assessment tool) should include the health promotion of residents. This will encourage health institutions to hold the executive management accountable for the health of their workers.
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