Do lifestyle choices influence the development of overweight and obesity in the South African Air Force?

doi:10.21203/rs.3.rs-40841/v1

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Do lifestyle choices influence the development of overweight and obesity in the South African Air Force?

https://doi.org/10.21203/rs.3.rs-40841/v1

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posted 10 Jul, 2020

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Background: An increase in the prevalence of overweight and obesity has been reported globally amongst the general public as well as military populations around the world. No information about the prevalence of overweight and obesity as well as the lifestyle choices that influence the development is available for the South African military population. The aim of this study was too determine the prevalence of overweight and obesity at Air Force Base Bloemspruit in Bloemfontein, Free State, South Africa, as well as the dietary and lifestyle factors and physical activity which may play a role in the development thereof.

Methods: A descriptive cross-sectional study was performed on active military personnel, by taking anthropometric measurements and collecting data using a self-administered questionnaire.

Results: A high prevalence of overweight (38.6%) and obesity (36.1%) was identified in the study population. No significant associations were detected between lifestyle factors or physical activity and body mass index (BMI). The majority of participants (59.6%) consumed three meals per day. Meal frequency did not differ between different BMI categories, and no associations were found between meal frequency and being overweight or obese. Inadequate intakes of fruit and vegetables were observed.

Conclusion: A high prevalence of overweight and obesity was observed in this study, which calls for urgent intervention. No associations were, however found between dietary and lifestyle factors and the presence of overweight and/or obesity. Further investigation is required to identify the causes of overweight and obesity and effective ways to address this health challenge.

Preventive Medicine

overweight

obesity

dietary intake

physical activity

military

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TABLE 1: Classification of adult weight status according to body mass index (BMI).²⁹

Classification	BMI	Risk of co-morbidities
Underweight	< 18.5 kg/m²	Low (but the risk of other clinical problems increases)
Normal range	18.5 – 24.9 kg/m²	Average
Overweight	25.0 – 29.9 kg/m²	Increased
Obesity class 1	30.0 – 34.9 kg/m²	Moderately increased
Obesity class 2	35.0 – 39.9 kg/m²	Severely increased
Obesity class 3	≥ 40.0 kg/m²	Very severely increased

TABLE 2: Risk of metabolic complications with respect to waist circumference (WC).²⁹

Risk of metabolic complications	Waist circumference (cm)
Risk of metabolic complications	Men	Women
Low risk	< 94 cm	< 80 cm
Increased risk	≥ 94 cm	≥ 80 cm
Substantially increased risk	≥ 102 cm	≥ 88 cm

TABLE 3: Frequency of consumption of different fat sources during the past 12 months in relation to body mass index (BMI) categories.

Question and options		Underweight and normal weight		Overweight		Obese		p-value
Question and options		n	%	n	%	n	%	p-value
1. Do you use full cream milk, 2% fat milk or fat-free milk at home?
	Full cream milk (n = 126, 75.9%)	35	27.8	49	38.9	42	33.3	0.3604
	2% fat milk (n = 23, 13.8%)	3	13.0	7	30.4	13	56.6
	Fat-free milk (n = 10, 6.0%)	3	30.0	5	50.0	2	20.0
	I do not use milk (n = 7, 4.2%)	1	14.4	3	42.8	3	42.8
2. How often do you eat foods cooked in margarine, butter, or oil?
	Never (n = 6, 3.6%)	1	16.7	2	33.3	3	50.0	0.9496
	1 – 2 times per week (n = 58, 34.9%)	13	22.4	21	36.2	24	41.4
	3 – 4 times per week (n = 49, 29.5%)	14	28.6	21	42.8	14	28.6
	5 – 6 times per week (n = 20, 12.0%)	6	30.0	7	35.0	7	35.0
	At least once per day (n = 33, 19.9%)	8	24.2	13	39.4	12	36.4
3. How often do you eat sausage, ham, salami, viennas, Russians, polony or bacon?
	Never (n = 14, 8.4%)	6	42.9	5	35.7	3	21.4	0.3324
	1 – 2 times per week (n = 93, 56.0%)	17	18.3	38	40.9	38	40.9
	3 – 4 times per week (n = 36, 21.7%)	13	36.1	12	33.3	11	30.6
	5 – 6 times per week (n = 9, 5.4%)	3	33.3	2	22.2	4	44.4
	At least once per day (n = 14, 8.4%)	3	21.4	7	50.0	4	28.6
4. How often do you use margarine or butter on bread or rolls?
	Never (n = 38, 22.9%)	10	26.3	17	44.7	11	28.9	0.2557
	1 – 2 times per week (n = 39, 23.5%)	6	15.4	20	51.3	13	33.3
	3 – 4 times per week (n = 36, 21.7%)	10	27.8	14	38.9	12	33.3
	5 – 6 times per week (n = 21, 12.6%)	8	38.1	5	23.8	8	38.1
	At least once per day (n = 32, 19.3%)	8	25.0	8	25.0	16	50.0
5. How often do you use cheese or cheese spread?
	Never (n = 32, 19.3%)	10	31.2	10	31.2	12	37.5	0.1788
	1 – 2 times per week (n = 78, 47.0%)	13	16.7	38	48.7	27	34.6
	3 – 4 times per week (n = 37, 22.3%)	14	37.8	11	29.7	12	32.4
	5 – 6 times per week (n = 10, 6.0%)	2	20.0	2	20.0	6	60.0
	At least once per day (n = 9, 5.4%)	3	33.3	3	33.3	3	33.3
6. How often do you eat “slap” chips or “vetkoek”?
	Never (n = 33, 19.9%)	7	21.2	13	39.4	13	39.4	0.8709
	1 – 2 times per week (n = 107, 64.4%)	27	25.2	43	40.2	37	34.6
	3 – 4 times per week (n = 15, 9.0%)	4	26.7	5	33.3	6	40.0
	5 – 6 times per week (n = 3, 1.8%)	2	66.6	0	0	1	33.3
	At least once per day (n = 8, 4.8%)	2	25.0	3	37.5	3	37.5
7. How often do you add margarine, butter or oil to vegetables when cooking?
	Never (n = 34, 20.5%)	10	29.4	12	35.3	12	35.3	0.4521
	1 – 2 times per week (n = 70, 42.2%)	15	21.4	29	41.4	26	37.1
	3 – 4 times per week (n = 33, 19.9%)	9	27.3	11	33.3	13	39.4
	5 – 6 times per week (n = 15, 9.0%)	5	33.3	3	20.0	7	46.7
	At least once per day (n = 14, 8.4%)	3	21.4	9	64.3	2	14.3
8. How often do you use mayonnaise, salad dressing or salad cream?
	Never (n = 34, 20.5%)	9	26.4	14	41.2	11	32.4	0.6848
	1 – 2 times per week (n = 96, 57.8%)	21	21.8	39	40.6	36	37.5
	3 – 4 times per week (n = 25, 15.1%)	8	32.0	7	28.0	10	40.0
	5 – 6 times per week (n = 5, 3.0%)	3	60.0	1	20.0	1	20.0
	At least once per day (n = 6, 3.6%)	1	16.7	3	50.0	2	33.3
9. How often do you use sauces or gravy on rice, samp, or pasta?
	Never (n = 21, 12.6%)	4	19.0	8	38.1	9	42.8	0.4872
	1 – 2 times per week (n = 70, 42.2%)	17	24.3	26	37.1	27	58.7
	3 – 4 times per week (n = 46, 27.7%)	11	23.9	20	43.5	15	32.6
	5 – 6 times per week (n = 17, 10.2%)	7	41.2	3	17.6	7	41.2
	At least once per day (n = 12, 7.2%)	3	25.0	7	58.3	2	16.7
10. When you eat meat or chicken do you cut the fat from the meat or take the skin off the chicken?
	Yes, I cut it off before cooking (n = 53, 32.0%)	12	22.6	18	34.0	23	43.4	0.7301
	Yes, I cut it off after cooking (n = 41, 24.7%)	12	29.3	16	39.0	13	31.7
	No, I don’t remove it at all (n = 72, 43.4%)	18	25.0	30	41.7	24	33.3
11. How many times a week do you use frying as a cooking method when preparing food?
	Never (n = 25, 15.1%)	6	24.0	11	44.0	8	32.0	0.3406
	1 – 2 times per week (n = 88, 53.0%)	21	23.9	37	42.0	30	34.1
	3 – 4 times per week (n = 39, 23.5%)	9	23.1	11	28.2	19	48.7
	5 – 6 times per week (n = 9, 3.0%)	5	55.6	2	22.2	2	22.2
	At least once per day (n = 5, 3.0%)	1	20.0	3	60.0	1	20.0
12. How many times a week do you use coffee creamers such as Ellis Brown or Cremora?
	Never (n = 116, 69.9%)	25	21.5	46	39.7	45	38.8	0.4870
	1 – 2 times per week (n = 19, 11.4%)	6	31.6	7	36.8	6	31.6
	3 – 4 times per week (n = 14, 8.4%)	6	42.8	3	21.4	5	35.7
	5 – 6 times per week (n = 5, 3.0%)	2	40.0	1	20.0	2	40.0
	At least once per day (n = 12, 7.2%)	3	25.0	7	58.3	2	16.7
13. How often do you eat baked products such as pies, cakes, muffins, rusks and cookies?
	Never (n = 27, 16.3%)	4	14.8	14	51.9	9	33.3	0.2778
	1 – 2 times per week (n = 110, 66.3%)	28	25.4	43	39.1	39	35.5
	3 – 4 times per week (n = 20, 12.0%)	5	25.0	5	25.0	10	50.0
	5 – 6 times per week (n = 3, 1.8%)	2	66.7	0	0	1	33.3
	At least once per day (n = 6, 3.6%)	3	50.0	2	33.3	1	16.7

TABLE 4: Frequency of consumption of sugary foods and drinks in relation to body mass index (BMI) categories.

Question and options		Underweight and normal weight		Overweight		Obese		p-value
Question and options		n	%	n	%	n	%	p-value
1. How often do you drink sugary drinks or soft drinks such as Coke, Fanta, Stoney, Iron Brew or flavoured water or ice teas?
	Never (n = 13; 7.8%)	3	23.1	7	53.8	3	23.1	0.1128
	1 – 2 times per week (n = 72, 43.4%)	13	18.1	28	38.9	31	43.0
	3 – 4 times per week (n = 31, 18.8%)	14	45.2	9	29.0	8	25.8
	5 – 6 times per week (n = 17, 10.2%)	2	11.8	9	52.9	6	35.3
	At least one glass (250 ml) per day (n = 17, 10.2%)	6	35.3	7	41.2	4	23.5
	More than one glass (250 ml) per day (n = 16, 9.6%)	4	25.0	4	25.0	8	50.0
2 How often do you eat sweets or chocolates?
	Never (n = 25, 15.1%)	3	12.0	12	48.0	10	40.0	0.3151
	1 – 2 times per week (n = 105, 63.2%)	25	23.8	44	41.9	36	34.3
	3 – 4 times per week (n = 20, 12.0%)	7	35.0	4	20.0	9	45.0
	5 – 6 times per week (n = 8, 4.8%)	4	50.0	2	25.0	2	25.0
	At least once per day (n = 8, 4.8%)	3	37.5	2	25.0	3	37.5
3. How many times per week do you drink caffeine-containing energy drinks such as Red Bull, Monster or Play?
	Never (n = 107; 64.4%)	28	26.2	35	32.7	44	41.1	0.4671
	1 – 2 times per week (n = 40, 24.1%)	11	27.5	18	45.0	11	27.5
	3 – 4 times per week (n = 12, 7.2%)	2	16.7	7	58.3	3	25.0
	5 – 6 times per week (n = 4, 2.4%)	0	0	3	75.0	1	25.0
	At least once per day (n = 3, 1.8%)	1	33.3	1	33.3	1	33.3
4. How many teaspoons of sugar do you drink in your coffee or tea?
	None (n = 45, 27.1%)	8	17.8	20	44.4	17	37.8	0.8376
	One teaspoon (n = 25, 15.1%)	7	28.0	10	40.0	8	32.0
	Two teaspoons (n = 41, 24.7%)	10	24.4	16	39.0	15	36.5
	Three teaspoons (n = 46, 27.7%)	13	28.3	15	32.6	18	39.1
	More than three teaspoons (n = 9, 5.4%)	4	44.4	3	33.3	2	22.2

TABLE 5: Meal frequency during the past 12 months in relation to body mass index (BMI) categories.

Question and options		Underweight and normal weight		Overweight		Obese		p-value
		n	%	n	%	n	%
1. How many meals do you consume per day?
	One meal per day (n = 6, 3.6%)	2	33.3	2	33.3	2	33.3	0.7269
	Two meals per day (n = 48, 28.9%)	10	20.8	20	41.7	18	37.5
	Three meals per day (n = 99, 59.6%)	25	25.3	36	36.4	38	38.4
	More than three meals per day (n = 13, 7.8%)	5	38.5	6	45.2	2	15.4
2. How often do you eat breakfast during the week?
	Never (n = 14, 8.4%)	3	21.4	6	42.9	5	35.7	0.4099
	Once per week (n = 10, 6.0%)	5	50.0	4	40.0	1	10.0
	Twice per week (n = 18, 10.8%)	4	22.2	9	50.0	5	27.8
	Three times per week (n = 20, 12.0%)	2	10.0	7	35.0	11	55.0
	Four times per week (n = 14, 8.4%)	5	35.7	4	28.6	5	35.7
	Five or more times per week (n = 90, 54.2%)	23	25.6	34	37.8	33	36.7
3. How often do you eat lunch during the week?
	Never (n = 4, 2.4%)	1	25.0	1	25.0	2	50.0	0.4493
	Once per week (n = 5, 3.0%)	3	60.0	1	20.0	1	20.0
	Twice per week (n = 7, 4.2%)	0	0	5	71.4	2	28.6
	Three times per week (n = 15, 9.0%)	3	20.0	5	33.3	7	46.7
	Four times per week (n = 20, 12.0%)	3	15.0	8	40.0	9	45.0
	Five or more times per week (n = 115, 69.3%)	32	27.8	44	38.3	39	33.9
4. How often do you eat supper during the week?
	Never (n = 0, 0%)	0	0	0	0	0	0	0.4213
	Once per week (n = 2, 1.2%)	1	50.0	0	0	1	50.0
	Twice per week (n = 3, 1.8%)	2	66.7	0	0	1	33.3
	Three times per week (n = 2, 1.2%)	0	0	2	100.0	0	0
	Four times per week (n = 7, 4.2%)	2	28.6	2	28.6	3	42.8
	Five or more times per week (n = 152, 91.6%)	37	24.3	60	39.5	55	36.2
5. How many times per day do you eat anything in between meals?
	Never (n = 21, 12.6%)	5	23.8	8	38.1	8	38.1	0.9770
	Once per day (n = 76, 45.8%)	17	22.4	29	38.2	30	39.5
	Twice per day (n = 33, 19.9%)	9	27.3	14	42.4	10	30.3
	Three times per day (n = 17, 10.2%)	6	35.3	5	29.4	6	35.3
	Four times per day (n = 8, 4.8%)	3	37.5	3	37.5	2	25.0
	Five or more times per day (n = 11, 6.6%)	2	18.2	5	45.5	4	36.4
6. How often do you eat takeaways or fast food?
	Never (n = 25, 15.1%)	8	32.0	6	24.0	11	44.0	0.2623
	Once per month (n = 117, 70.5%)	26	22.2	46	39.3	45	38.5
	Twice per month (n = 18, 10.8%)	7	38.9	8	44.4	3	16.7
	1 – 2 times per week (n = 4, 2.4%)	0	0	3	75.0	1	25.0
	3 – 4 times per week (n = 2, 1.2%)	1	50.0	1	50.0	0	0
7. How often do you eat in a restaurant?
	Once per month (n = 30, 18.1%)	11	36.7	13	43.3	6	20.0	0.3143
	Twice per month (n = 69, 41.6%)	14	20.3	24	34.8	31	44.9
	1 – 2 times per week (n = 41, 24.7%)	10	24.4	16	39.0	15	36.6
	3 – 4 times per week (n = 22, 13.2%)	7	31.8	8	36.4	7	31.8
	5 – 6 times per week (n = 4, 2.4%)	0	0	3	75.0	1	25.0

TABLE 6: Fruit and vegetable intake during the past 12 months in relation to body mass index (BMI) categories.

Question and options		Underweight and normal weight		Overweight		Obese		p-value
Question and options		n	%	n	%	n	%	p-value
1. How many fruits do you consume in a day?
	One fruit per day (n = 109, 65.7%)	30	27.5	35	32.1	44	40.4	0.2815
	Two fruits per day (n = 42, 25.3%)	9	21.4	21	50.0	12	28.6
	Three fruits per day (n = 11, 6.6%)	2	18.2	5	45.5	4	36.4
	Four or more fruits per day (n = 4, 2.4%)	1	25.0	3	75.0	0	0
2. How many vegetables do you consume in a day?
	One vegetable per day (n = 71, 42.8%)	19	26.8	32	45.1	20	28.2	0.3650
	Two vegetables per day (n = 58, 34.9%)	12	20.7	17	29.3	29	50.0
	Three vegetables per day (n = 25, 15.1%)	7	28.0	11	44.0	7	28.0
	Four vegetables per day (n = 5, 3.0%)	2	40.0	1	20.0	2	40.0
	Five or more vegetables per day (n = 7, 4.2%)	2	28.6	3	42.8	2	28.6

TABLE 7: Stress, sleep and smoke patterns during the past month in relation to body mass index (BMI) categories.

Question and options		Underweight and normal weight		Overweight		Obese		p-value
Question and options		n	%	n	%	n	%	p-value
1. On a scale from 1 – 10 how stressed would you say you normally are?
	1 – 3 (Low stress levels) (n = 23, 1.2%)	6	26.1	6	26.1	11	47.8	0.5076
	4 – 6 (Medium stress levels) (n = 66, 39.7%)	17	25.8	26	39.4	23	34.8
	7 – 10 (High stress levels) (n = 77, 46.4%)	19	24.7	32	41.5	26	33.8
2. On average how many hours of sleep do you get in a 24-h period?
	Less than 7 hours of sleep per day (n = 33, 19.9%)	7	21.2	11	33.3	15	45.5	0.9123
	Equal to or more than 7 hours of sleep per day (n = 133, 80.1%)	35	26.3	53	39.8	45	33.8	0.9123
3. Do you currently smoke? (n = 165)
	Yes (n = 52, 31.5%)	15	28.8	21	40.4	16	30.8	0.6308
	No (n = 113, 68.1%)	27	24.0	43	38.0	43	38.0	0.6308

TABLE 8: Physical activity during the past 7 days according to BMI categories.

Moderate physical activity in minutes per week
BMI category	n	Median	Minimum	Maximum	p-value
Under and normal weight	29	120	10	840	0.4891
Overweight	46	127	15	2520
Obese	38	202	10	1440
Vigorous physical activity in minutes per week
BMI category	n	Median	Minimum	Maximum	p-value
Under and normal weight	27	180	10	720	0.9879
Overweight	44	180	30	2520
Obese	36	180	10	840

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Do lifestyle choices influence the development of overweight and obesity in the South African Air Force?

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