Discussion: such as standing, performing household chores, out-door activities

Discussion:

Obesity is a major public health challenge across the globe. The prevalence of overweight and obesity in the study was found to be 38.9% and 21.2% respectively. Since the study is conducted in the urban area the findings were consistent to the recent findings of NFHS-4 where prevalence of women having BMI above 25.00kg/m2 in Maharashtra was 32.4% in urban area1. Similar finding were reported by studies conducted in Ludhiana (obesity 58.1%) and Chennai (obesity 19.8%) 2,3. Studies focusing on obesity among women during midlife are scarce in India. In the present study, the percentage of obesity was highest among women in the age groups of 55-59(25.7%) followed by 45-49 (23.6%). The findings were similar to the study done by Anuradha R et al., where the percentage of obesity in the age group of 50-59 was 27.3%4. Misra et al also found a significantly increasing trend of obesity with advancing age, the highest being above 50 years of age5.

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Considering waist circumference (p=0.000), study participants were at increased risk of being obese. Increase in BMI may be explained by sedentary lifestyle, faulty dietary practices which cause increased accumulation of abdominal fat, decreased basal metabolic rate and decreased energy expenditure6. In the current study, 41.1% of overweight and 23.3% of obese women were non- working.  Sedentary lifestyle and physical activities was assessed using various activities such as standing, performing household chores, out-door activities such as walking down to market or nearby place, sitting hours at work place and spending time in leisure activities such walking, performing exercises etc. and sleeping. Majority of women did not engage in any outdoor activities. Based on the physical activity level, 64.7% women were leading a sedentary lifestyle and only 39.4% women reported to perform some physical activities, commonly being performing household chores, working as domestic helps and maids and walking. Walking was the most commonly reported leisure time activity; however this walking can be compared to that of strolling.  Similar findings were reported by a study done in slums of Mumbai in which the relationship between obesity and low level of physical activity was statistically significant at p value 0.0277. A comparative study between rural and urban women in south India shows that about 39.9% women who engaged in low physical activity were overweight/obese. The study also reveals that the odds of the urban women being overweight/obese are 5.555 times than that of the rural women and the odds of the women who engage in moderate physical activity  are 3.87 times obese than that of the women who engage in high physical activity8.  Moderate physical activity, like brisk walking may be beneficial for the improvement of quality of life. Interventions to increase physical activity should be recommended to prevent increase in BMI.

The relationship between obesity and hypertension is said to be a two way9. Obesity is being recognized as one of the most important risk factors for the development of hypertension.Thus, in this study, we examined the relationship between obesity and hypertension among women between 45 to 60 years. The current study shows that obesity is significantly associated with hypertension. Out of the 125 women who reported to be hypertensive, 44.8% were overweight and 28% were obese (p=0.013). The analysis showed that odds of having high blood pressure were 1.8 times in overweight women.  In a study conducted in China by Wang S et al, significant differences in the prevalence of central obesity and hypertension was found between 50-59 age group(p=0.001)10. A study conducted in Pune, found that hypertension was significantly higher in females with BMI more than 25(P<0.001)11.One of the probable reasons behind this positive relation between obesity and hypertension could be that increased weight increases cardiac output and increased peripheral resistance of arterioles. Other than that, urbanization is also a cause of changes in dietary habits and reduced physical activity which leads to obesity and subsequently results in hypertension.There are few studies which have studies the associations between Obesity and Knee pain. The current study shows that a high number of women reported of knee pain and obesity was significantly associated with knee pain. Out of the 235 women who complained of knee pain, 36.6% were overweight and 28.5% were obese (p=0.029). In a longitudinal study conducted by Bindawas SM, it was found that obese individuals experience frequent and higher levels of knee pain as compared to their non-obese counterparts.In a cross-sectional study, Vincent et al found an association between Knee Pain, obesity, and fear of movement12, 13. The relation between obesity and knee pain can be explained that the knee joint is exposed to high compressive loads of body weight during walking and other activities adults thus causing pain, discomfort and ultimately functional limitation. Thus, multicomponent weight loss interventions can be introduced to demonstrated effective benefits in terms of reducing knee pain. Overall 351 women reported to have difficulty to perform 1 or more activities. It was seen that percentage of women who were obese had more difficulty in performing activities than those who were not obese. The finding was found to be statistically true with p –value 0.002. Further the data was analyzed using individual activities. It was found that the percentage of overweight and obese women had more difficulty in performing activities such as squatting, walking, climbing stairs and rising from chair. The odds of having difficulty in squatting and difficulty in walking were 1.5 times and 1.9 times higher in overweight women. In the same way, the odds of having blood pressure and difficulty in walking were 1.8 times and 2.4 times higher in women who were obese.   Similar finding was reported by Agarwal P et al. Day-to-day activities such asdifficulty in walking was reported by morbidly obese women (58 %; p values < .0001). Difficulty in squatting was reported by 17% and 28 % (p < .0001) of the overweight, obese women14, 15. Studies have indicated that the extent to which daily functioning is affected is positivelyrelated to BMI. A study conducted by Daviglus ML et al. titled body mass index in middle age and health-related quality of life in older age showed that bad outcomes in lifting or carrying groceries, climbing stairs and walking several blocks were associated with higher BMI (P<0.001)16.   India and other developing countries are undergoing rapid urbanization and changes in lifestyle. There is a shift in the pattern of morbidity from infectious diseases to NCDs. This epidemiological transition is more so in the south Asian region. In a population survey of risk factors for NCD's done in north India, it was found that rural women were 7 times more physical active than urban and urban slum dwelling women. Obesity was also highest for urban women followed by urban slums and lastly rural women. Urbanization leads to a greater prevalence of risk factors for NCD's, the effect being much greater among women than men.(ref) Thus, the findings of the current study, which correspond to the theme of high BMI and other factors such as Chronic diseases, low physical activity, and functional limitation are very much relevant. Majority of the women in the current study had the notion that physical exercise like walking, jogging, skipping etc.,are not so important for reducing overweight and obesity, as they feel that the household activities like, cooking, washing clothes and cleaning etc., involves lots of physical stamina and is equivalent to any other physical exercise. Besides, majority of the women in this slum were unemployed, which limits their mobility. This study was consistent with another study done in Delhi, where it showed that the prevalence of obesity is more common in females who had lighter physical activity. The findings of this study suggest that women living in urban slums have high prevalence of obesity, low levels of physical activity, faulty dietary pattern which puts them at high risk for non-communicable diseases. This indicates a need for specific interventions targeted to urban slum women. Heath education and lifestyle change motivation intervention should be targeted for these women.