The aim of this study was to determine the prevalence of obesity and overweight and also the predictors of BMI among women in Ramian city of Golestan province. Ordinal logistic regression analysis was used to determine BMI predictors. The BMI was considered as a dependent variable in three categories: normal (25-29.9), overweight (30-34.9), and obese (35 and above). The variables of age, occupation and education years of woman, socioeconomic status of the family, body image in three groups: normal, overweight and obese, body preference in both normal and overweight groups, women attitude, and intention(intrinsic motivation), and perception of husband opinion(extrinsic or controlled motivation), and activity levels were entered the model as the independent variables. Among the demographic variables, age, education years (12 years and less), women employment (not having a job) and among psychological variables: intention and attitude, and perception of the spouse opinion about weight control through eating and behavior of stretching activities were predictors of women BMI ranks.
Age is a known determinant of women's body mass index (BMI) . The prevalence of obesity in women 40 years and older (43.5%) was more independent of education years and economic status than other age groups. Contrary to the findings [30, 31, 32] of women's BMI levels based on education level, the economic status did not show a significant difference.
The age as a dominate variable showed a 2% increase in women falling in different ranks of BMI as a predictor of overweight or obesity. That is, increasing age in women was associated with increasing obesity. No significant difference was observed between physical activity levels and women's age, except for the intense physical activity in which a slight and increasing difference was observed in the levels of physical activity of women 40 years and older compared to women 25–39 years. In this study, age is not considered as a critical factor affecting the BMI of women. Probably factors other than age affect the BMI of women in the region.
Socioeconomic status is known to be a distinguishing factor between overweight and obesity . Contrary to the global trend report , the prevalence of overweight and obesity among women with low and moderate economic status was lower. It seems that improving the economic situation of women in Golestan region increases their chances of becoming obese and overweight. One of the reasons for the low ratio of overweight and obesity in women with low and moderate economic status can be related to the levels of physical activity, eating behaviors and economic and social conditions of their living environment. Due to the special conditions of the region and the high proportion of nomadic population, women with low and medium economic status are more likely to be physically active due to heavy labor load.
Another reason for low overweight and obesity prevalence among women with low economic status is likely to be due to their degree of awareness , motivation and perceptions [35, 36]. Women intrinsic motivations due to attitude towards weight and body shape, eating less or avoiding unhealthy, high-calorie, high-fat foods such as sweets, as well as prepared and processed foods reduced women possibility of falling into the upper BMI rank. According to the research[34, 35], increasing the score of women's attitude towards eating more than physical activity increases the chances of overweight and obesity among women. Increasing the awareness of healthy eating behaviors, identifying eating motivations and physical activity, strengthening attitude towards eliminating or avoiding unhealthy foods such as high-calorie, high-fat foods and processed foods can be effective solutions in controlling overweight and obesity among women
External motivations resulting through perceiving the opinion and support of the spouse (Perceived spouse support) to change body shape, control and lose weight, reduce the chances of women falling into the upper BMI ranks. Decreased BMI in women, regardless of women's eating behaviors, also applies to controlling weight through physical activity. It is likely that women with a high perception of the husband attitude follow his recommendations more readily, and in turn, maintain an optimal BMI. Conversely, external motivations (spouse's recommendations) related to a woman's eating and eating habits did not reduce BMI, but rather increased a woman's chances of falling into the upper BMI ranks. There are times that spouse's recommendations may render opposite consequences. It means, women eat extra amount of food instead of watching their weight through controlling food intake. Women with a high BMI who appear to have unhealthy eating behaviors, perceived more advice and support from their husbands to control their weight through dieting. These findings, while indicating high food intake and inadequate nutritional literacy of women, leave unanswered the role of husband as a factor of external motivation in controlling women's eating behaviors to lose weight, which requires in-depth studies. Gast et al., believe that in order to achieve optimal health status in women, it is more beneficial to identify and pay attention to women's eating and physical activity motives than to prescribe and promote dietary restrictions and physical activity .
Among the cognitive and psychological factors, BI perception was one of the strongest predictors of a woman's chances of falling into the upper BMI ranks. Women with normal weight were less likely to consider themselves be in the upper BMI ranks than both overweight and obese women. Actually, BI is the perception of a woman of her BMI. In the present study, 83% of obese women and 58% of overweight women found themselves obese or overweight. About 3.4% of women had a normal perception of their body weight. In other words, the perception of women's body weight was in accordance with their BMI.
Physical preferences or dissatisfaction with one’s BMI status is one of the motivating factors in the success of lifestyle modification programs. This kind of dissatisfaction was higher among women with high BMI. Nearly three-quarters of all women (72.08–73.33%) were dissatisfied with their weight and BMI status. In the study by Von Lengerk et al., the dissatisfaction with one’s body weight among German men and women varied according to economic status. The present study comes to agreement with Von Lengerke and et al., who believed the highest dissatisfaction was observed among well-educated obese women . That is, low-educated women (less than 12 years) had high BMI. The low chances of uneducated/ illiterate women falling into the upper BMI ranks are likely to be due to unfavorable economic status, unemployment, low physical activity and improper eating habits.
The importance of physical and stretching activities along with healthy food selection and eating behaviors is well known not only in overall body health, but also in healthy weight control and general body structure . According to the new version, the index for measuring the four levels of physical activity and the state of stretching movements was determined as sitting behaviors; light, moderate and intense activities. To analyze the data and to estimate OR, data related to the levels of physical activity, i.e. sitting behaviors and light activities were combined in one group, and moderate and intense activity in another.
Findings on women's physical activity levels varied based on BMI. Women with high BMI had moderate to vigorous physical activity. Women with sitting behaviors and light physical activity had lower BMI compared to women with moderate to severe physical activity. On the other hand, women's physical activity and stretching movements based on their BMI levels also showed significant differences. Although women with very low BMI or normal weight, had very low moderate and intense physical activity, their score of stretching movements was high. These findings contradicted the findings of Coelho et.,al.. Although many psychological and environmental factors play a role in physical activity , the role of a person's inner motivations in maintaining and sustaining behavior is also well known [13, 14]. Obese women are more likely to do more intense physical activity with the intention of losing weight, and normal-weight women are more likely to do stretching exercises to strengthen their muscles and to maintain their body shape.
Although the chances of women with intrinsic motivation (intention) to change weight and body shape in the upper BMI ranks were high, more than three-quarters of women with intrinsic motivation (intention) to change weight, body shape and weight control with physical activity had a high BMI. In women of normal weight, with increasing the score of stretching movements, the chances of women falling into the upper BMI ranks showed a significant decrease of nearly fifty percent.
The aim of this study was to investigate the predictors of obesity for the first time among the women population of Golestan region. However, there were some limitations, such as not measuring women's food intake, husband eating behaviors, and other external sources of motivations- family physician, health care personnel, and friends- which should be investigated in future researches considering psycho-behavioral factors, such as women self-efficacy.
To access the desired health status of women, health authorities and practitioners should design and launch educational programs with the purpose of recognizing the women perception of their own body shape, their ideal /desired body shape, and the kind of motivations they have to access that desired body shape. At the end the committee may be able to offer appropriate solutions