RDN Sumanasekera RPJC Ramanayaka A Pathmeswaran Faculty of Medicine, University of Kelaniya, Sri Lanka 8/10/2015 1

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1 RDN Sumanasekera RPJC Ramanayaka A Pathmeswaran Faculty of Medicine, University of Kelaniya, Sri Lanka 8/10/2015 1

2 Obesity has become a global public health issue as it is associated with numerous adverse health outcomes (WHO Technical Report Series-894; Obesity: Preventing and Managing the Global Epidemic; 2000) Prevalence of overweight and obesity in Sri Lanka have been estimated to be 25.2 % and 9.2%, respectively (Katulanda P, Constantine GR, Mahesh JG, Sheriff R, Seneviratne RD, Wijeratne S, et al. Prevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka--Sri Lanka Diabetes, Cardiovascular Study (SLDCS). Diabet Med Sep;25(9): ) 8/10/2015 2

3 Introduction Female sex, urban living and being middle aged have been found to be associated with obesity in Sri Lanka (Arambepola C, Fernando D. Distribution and determinants of abdominal obesity in an adult population in the district of Colombo, Sri Lanka. International Union for the Scientific Study of Population, XXV International Population Conference July 18-23, 2005; Tours, France2005.) 8/10/2015 3

4 To explore the beliefs and expectations regarding bodyweight of middle class obese females attending an urban primary healthcare center in Sri Lanka 8/10/2015 4

5 Baseline data from an intervention study was used for this analysis. Fifty participants were selected randomly from obese females (BMI between kg/m2) registered with the University Family Medicine Clinic in Ragama and volunteered to participate in a lifestyle modification program for weight reduction. 8/10/2015 5

6 Participants demographic data and baseline anthropometric measurements were obtained. A focus group discussion (FGD) was conducted to identify the participants understanding on the factors leading to weight gain and to explore their myths and beliefs. 8/10/2015 6

7 Baseline characteristics of participants (n=50) Mean Minimum Maximum Age (years) Weight (kg) Body Mass Index (kg/m2) Waist circumference (cm) Would like to lose (kg). over 6 months /10/2015 7

8 Food habits Physical activity Perceived reasons for weight gain 8/10/2015 8

9 Food habits Eating out / Take-away meals especially when there are no children in the family regardless of whether it is a young couple or middle aged couple, they found it to be cheaper and easier to eat most meals from local shops. (fried rice, kottu, string hopper biriyani etc ) 8/10/2015 9

10 Food habits (continued) Carbohydrates many had meals consisting of rice together with starchy vegetables. They did not consider the yams, pumpkin or the jack fruit as a carbohydrate. Inadequate water/fruits/vegetables/fibre in the diet Green leaves difficult to prepare 8/10/

11 Physical activity Majority considered doing the daily household chores to be adequate None were currently doing any abdominal exercises Few infrequently went for a walk in the grounds 8/10/

12 Why do you put on weight? Aging process and childbirth I was very slim as a teenager. But after childbirth, I kept accumulating the weight. Even now, I am only fat in the abdomen.. Mainly.. I was very thin when I got married. But with age, I have gradually gained a lot of weight. I feel quite uncomfortable and heavy now Not like before. 8/10/

13 Why do you put on weight? Runs in the family Genes my mother s family are all a bit on the fat side. I take after them. I don t eat much and I do all the household work by myself. But still I keep on putting weight. 8/10/

14 Why do you put on weight? Eating leftovers in addition to meals When I feed my children, I eat whatever is left over on their plates. Also in the night when cleaning up, I eat up all the remaining food as I have to cook the next day anyways. That might be a reason.. (Most mothers with young children agreed) 8/10/

15 Unrealistically high targets for weight loss were common among participants Putting on weight after childbirth and with aging was perceived as the norm Many believed that they were eating sensibly and had adequate levels of physical activity Poor knowledge regarding nutrition Poor control over food 8/10/