DOI: https://doi.org/10.21203/rs.3.rs-2077180/v1
Background: In recent decades, the significant increase in the prevalence of obesity, both in developing and developed countries, suggests that obesity is a complex health problem. Environmental factors such as lack of physical activity, excessive TV watching and sedentary lifestyle, consumption of high-calorie foods, and side effects of different drugs, can cause overweight and obesity. Obesity is associated with severe health problems such as diabetes, hypertension, hyperlipidemia, asthma, arthritis, and even reduced life expectancy. Obesity also has a profound effect on people's mental health.
Methods: After ethics committee approval from the Iran University of Medical Sciences (IR.IUMS.FMD.REC.1399.457), 395 healthy women between 20 to 50 years old entered the study. Questionnaires related to general information and assessment of individuals' status in terms of eating behaviors were completed on women from 20 to 50 years old who worked at the Iran University of Medical Sciences. Anthropometric variables including height, weight, body fat percentage, waist circumference, and hip circumference were measured and body mass index (BMI) and waist to hip ratio (WHR) were calculated. Then, a questionnaire related to perceived stress was completed by each participant. The 24-hour food recall questionnaire and the physical activity questionnaire were also conducted.
Results: In contrast to other studies, anthropometric indices (weight, height, BMI, waist circumference, and hip circumference) were reported higher in people who ate breakfast than in those who did not. There is no significant relationship between eating behaviors (speed rate, eating breakfast or not eating breakfast, and eating with or without a screen) and perceived stress levels. Anthropometric indices increase with increasing food intake and decreasing physical activity, while there is no relationship between dietary intake and physical activity with perceived stress levels.
Conclusion: Dietary behaviors and physical activity affect anthropometric indices, while, perceived stress levels do not affect dietary behaviors or anthropometric indices.
In recent decades, the significant increase in the prevalence of obesity, both in developing and developed countries, suggests that this issue is a complex health problem worldwide (1–3). Various factors such as increased food intake, decreased physical activity, prolonged cell phone use, sedentary lifestyle and also environmental and behavioral changes, especially nutritional behaviors, may contribute to population weight gain and obesity. (4, 5)
One of the issues that has been discussed is the frequency of meals and snacks consumption during the day and its role in causing overweight and obesity. Snacks can be as energetic as meals and can lead to obesity; however, they can also be used as diet modifiers by controlling the energy intake. (6)
Obesity is associated with serious health problems such as diabetes, hypertension, hyperlipidemia, asthma, arthritis and even reduced life expectancy (7). Obesity also has a wide range of effects on people's mental health, including behavioral problems, stress, depression, low self-esteem, social isolation and poor quality of life. (8)
Stress has been linked to obesity-related eating behaviors, such as higher energy intake, increased saturated fat and sugar intake, and poor diet quality. However, stress enhances some physiological responses that are independent of one's eating behaviors and diet. For example, physiological stress responses increase the activity of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, and subsequently increase cortisol secretion, which is then associated with increased lipogenesis and visceral fat accumulation. (9) Therefore, stress can affect the incidence of obesity in two ways, which include 1) dietary behaviors and diet quality, and 2) through biological processes.
Due to the difficulty of treating obesity and also due to the many serious cardio metabolic and psychological complications associated with it, it is necessary to identify the risk factors associated with overweight and obesity. Nutritional literacy is one of the important factors influencing the incidence of overweight and obesity. People who have stronger control over their eating instincts are up to 4 times less likely to be overweight and obese. Therefore, informing people about nutrition literacy can be a strong protective factor to prevent the occurrence of overweight and obesity in today's world (10).
Although several studies have been conducted on the relationship between behaviors and meal patterns with anthropometric indices and mental health status, the results of these studies have been inconsistent; therefore, this study was conducted to investigate the relationship between eating behaviors and anthropometric indices and perceived stress levels in healthy working adult women.
This study has been approved by the ethics committee of Iran University of Medical Sciences (IR.IUMS.FMD.REC.1399.457), adheres to the Declaration of Helsinki and informed consent was taken. The study was performed on 395 healthy women (based on previous similar studies) aged 20 to 50 years working under the supervision of Iran University of Medical Sciences, Tehran, Iran. Inclusion criteria included no acute or chronic disease, no use of steroidal and non-steroidal anti-inflammatory drugs, laxatives, and no use of drugs affecting weight status, no adherence to a special diet and no pregnancy and lactation (Fig. 1).
In this study, data on general information, age, marital status and level of education were collected using a checklist. Anthropometric data including weight, height, and percentage of body fat mass, waist circumference and hip circumference were measured and body mass index and waist to hip ratio were calculated. To assess the amount of food intake (calories, fat, carbohydrates, protein and fiber), a 2-day food recall questionnaire (1 day off and 1 non-holiday day) was used and related data including energy intake and macronutrients and dietary fiber by means of N4 (Nutritionist4) software was calculated. The amount of physical activity was recorded based on the International IPAQ questionnaire as Met-min / week. Perceived stress levels were also assessed by a perceived stress questionnaire.
SPSS software version 22 was used for data analysis. Descriptive statistics including mean and standard deviation for quantitative normal variables, median and quadratic amplitude for skew variables and number and percentage for qualitative data will be reported. To examine the relationship between quantitative and qualitative or quantitative variables shortly after checking the normality of the data with Kolmogorov-Smirnov test, parametric tests such as t-test, analysis of variance and Pearson correlation coefficient or their nonparametric equivalents such as Mann-Whitney and Kruskal-Wallis or correlation coefficient or correlation coefficient will be used. Chi-square test will also be used to examine the relationship between qualitative and qualitative variables. Logistic regression model will be used to determine the factors affecting obesity, and overweight.
According to the statistical analysis, the speed of eating meals is significantly related to the ratio of waist to hip circumference and this ratio is higher in those who have a fast consumption speed than those who have a slow and medium speed (P1 = 0.04). Other anthropometric indices have no significant relationship with the speed of eating meals (Table 1).
| Anthropometric indices/Eating breakfast | P-Value | |
|---|---|---|
| Height | Speed | 0.93 |
| Weight | Speed | 0.39 |
| BMI | Speed | 0.41 |
| WC | Speed | 0.27 |
| HC | Speed | 0.06 |
| WHR | Speed | 0.04 |
| BFC | Speed | 0.42 |
According to the results, there is a significant relationship between consumption and non-consumption of breakfast with weight (P1 = 0.01), body mass index (P1 = 0.03), hip circumference (P1 = 0.000), and waist to hip ratio (P1 = 0.005); thus, the mentioned indicators have been reported higher in people who consume breakfast than those who do not. There is no significant relationship between height, waist circumference, and body fat composition with having breakfast or not. There is no significant relationship between consuming meals while watching TV and using a mobile phone with anthropometric indicators (Table 2, 3).
| Anthropometric indices/Eating breakfast | P-Value | |
|---|---|---|
| Height | Breakfast | 0.90 |
| Weight | Breakfast | 0.01 |
| BMI | Breakfast | 0.03 |
| WC | Breakfast | 0.26 |
| HC | Breakfast | < 0.001 |
| WHR | Breakfast | 0.005 |
| BFC | Breakfast | 0.07 |
| Anthropometric indices/Eating with screen | P-Value | |
|---|---|---|
| Height | screen | 0.40 |
| Weight | screen | 0.27 |
| BMI | screen | 0.98 |
| WC | screen | 0.25 |
| HC | screen | 0.09 |
| WHR | screen | 0.29 |
| BFC | screen | 0.32 |
According to the results, there is no significant relationship between the perceived stress level with the speed of eating meals, consumption or non-consumption of breakfast and consumption or non-consumption of meals while watching TV or using a mobile phone (Table 4).
| Stress level/Eating behaviors | P-Value | |
|---|---|---|
| Speed | Stress | 0.72 |
| Breakfast | Stress | 0.37 |
| Screen | Stress | 0.06 |
According to the results, there is a significant relationship between dietary intakes (total energy, fat, carbohydrates, protein and fiber intake) with anthropometric indices (except height and waist-to-hip ratio) (P1 = 0.000). The higher the total energy and other micronutrient intake during the day, the higher the anthropometric indices. There is no significant relationship between dietary intake (total energy, fat, carbohydrate, and protein and fiber intake) and perceived stress levels (Table 5, 6).
| Anthropometric indices/Dietary intake (Kcal) | P-Value | |
|---|---|---|
| Height | intake | 0.90 |
| Weight | intake | < 0.001 |
| BMI | intake | < 0.001 |
| WC | intake | < 0.001 |
| HC | intake | < 0.001 |
| WHR | intake | 0.07 |
| BFC | intake | < 0.001 |
| Stress level/Dietary intake (Kcal) | P-Value | |
|---|---|---|
| Stress | intake | 0.51 |
According to the results of Pearson correlation test, all anthropometric indices except height have a significant relationship with the amount of physical activity (P1 = 0.000); in such a way that with the increase of physical activity, all the desired anthropometric indices have decreased. There is no significant relationship between physical activity and perceived stress levels (Table 7).
| Anthropometric indices/Physical activity (Met) | P-Value | |
|---|---|---|
| Height | PA | 0.21 |
| Weight | PA | < 0.001 |
| BMI | PA | < 0.001 |
| WC | PA | < 0.001 |
| HC | PA | < 0.001 |
| WHR | PA | < 0.001 |
| BFC | PA | < 0.001 |
| Abbreviations: Body Mass Composition (BMI), Waist Circumference (WC), Hip Circumference (HC), Waist to Hip Ratio (WHR), Body Fat Composition (BFC), Physical Activity (PA). | ||
In this study, with the aim of determining the relationship between dietary behaviors and anthropometric indices and perceived stress levels in working women, promising results have been obtained.
Among working women under the supervision of Iran University of Medical Sciences, the results regarding food behaviors are promising due to the higher educational level than the general public. A significant percentage of participants eat their meals at a moderate speed, and breakfast is included in their food basket. However, due to the large amount of time they spend in the workplace, these working populations are forced to spend their free time to eating meals and also using social media such as watching TV and using mobile phones.
According to the study population, the average number of snacks consumed is less than the main meals. Working women have less free time to eat snacks, especially healthy home-made snacks.
The average of anthropometric indices measured among the participants in this study is in the range of healthy and ideal individuals, which is to be expected given the activity in the field of health and the level of higher education. Therefore, educating the general population about nutrition literacy and self-awareness can help improve nutritional indices and the obesity trend in the society.
In this study, no significant relationship was found between the number of meals and snacks consumed with anthropometric indices, which was expected according to previous studies in this field (11, 12). In some studies, snack consumption, especially high-volume and high-calorie ingredients, has been cited as a reason for increased abdominal obesity (13), while in our study, no relationship was found between the number of snacks consumed and abdominal obesity.
In our study, the simultaneous consumption of meals and snacks using a mobile phone or watching TV was not associated with anthropometric indices and abdominal obesity, which has been found in other studies (11).
Despite the results of previous studies on the reduction of abdominal obesity in people who eat breakfast (14), in this study, breakfast consumption has increased many anthropometric indicators, including weight. According to the study population, participants in this study used corporate breakfast prepared at work. Breakfasts served in hospitals and other centers under the auspices of Iran University of Medical Sciences contain high-calorie and low nutritional value substances such as jams containing preservatives, sugar halva and bran-free lavash bread; Therefore, it can be concluded that due to the consumption of this important meal in the workplace and the incompatibility of this meal with the necessary standards, an increase in anthropometric indices among employees at this university can be expected.
In this study, there was no relationship between perceived stress levels and eating behaviors including the speed of eating meals, whether or not to eat breakfast, and eating meals while watching TV or using a cell phone. Other studies have shown the effect of perceived stress on the increase of abdominal obesity, however, the effect of this factor on eating behaviors is still unknown (7).
As it has been found from other studies, increasing energy intake and micronutrients during the day increases anthropometric indices (15). In our study, except for height, other anthropometric indices increased with increasing daily food intake and calories. According to the results obtained in this study, there is no relationship between perceived stress levels and food intake and daily energy. This means that people with higher stress levels have not increased their food intake. According to the study population, it can be inferred that a significant amount of perceived stress was justified by their job and did not affect their eating behavior and energy intake.
As in other studies, in our study, anthropometric indices decreased with increasing physical activity (16, 17). As physical activity increases, so does the body's metabolism, which justifies a reduction in nutritional indexes. Unlike anthropometric indices, the amount of physical activity had no effect on the level of perceived stress among our participants.
Dietary behaviors and the amount of physical activity can change and improve anthropometric indices in different ways. Anthropometric indices also increase with increasing food intake, while there is no relationship between food intake and physical activity with perceived stress levels.
Ethics approval and consent to participate: This study has been approved by the ethics committee of Iran University of Medical Sciences (IR.IUMS.FMD.REC.1399.457), adheres to the Declaration of Helsinki and informed consent was taken.
Consent for publication: The authors confirm that written consent has been obtained from the participants for submission and publication. A copy of the participants’ consent for publication is available for review by the editor of the journal.
Availability of data and materials: Not applicable
Competing interests: The authors declare that they have no competing interests.
Funding: Not Applicable
Authors’ contributions: M.V conceived of the presented idea, developed the theory, and performed the computations. M.M wrote the manuscript with support from B.A, B.T, P.S and M.V helped supervise the project.
Acknowledgments: Not applicable