[ad_1]
Descriptive statistics of the survey participants
A total of 120 people participated in the study, 60 of whom were females and 60 of whom were males. Table 1 shows the descriptive statistics of study participants aged 25 to 54, with an average age of 39. The sampled participants were more present between the ages of 25 and 34. Half of the respondents had obtained their diplomas or graduated. Most participants had a monthly family income between 40,001 and 80,000 INR, mostly employed, with a household size of around four persons. Most survey participants believed in Hinduism, belonged to the General or OBC social group, and spoke Bengali as their first language. The majority of the participants were married with children. Further, more participants had a BMI greater than 30, a waist circumference greater than 102 cm, and were nonsmokers. The sampled participants had a mean BMI of 31.28 and a waist circumference of 106.44 cm. Also, 45.83% of the survey participants never drank alcohol, and one-fifth had thyroid problems.
Descriptive statistics of the in-depth interviewees
A total of 18 people, nine males and nine females, volunteered to participate in the interview. (Table 2). The average age of the interviewees was 39 years, and they were between 27 to 52 years. Most participants were graduates and employed, with a monthly family income of more than 80,000 INR, and lived in households with an average of four people. Hinduism was the most prevalent religious belief among the sampled interviewees, who primarily belonged to the ‘General’ social category and spoke Bengali. The majority of those interviewed were married with children. In addition, most of the interviewees in the sample had a BMI of more than 30 and a waist circumference of more than 102 cm. The sampled participants had a mean BMI of 32.87 and a waist circumference of 109.28 cm. Furthermore, nearly half of the participants said they had never smoked, only drank alcohol occasionally, had a minimum of one health problem or were on medication.
Themes
Five broad themes based on participants’ perception, knowledge and health behaviours emerged from the qualitative data: 1) risk factors; 2) benefits of healthy behaviours; 3) physical activity behaviour; 4) dietary behaviour; 5) obesity prevention.
Risk factors
Obesity
Survey participants felt that obesity was a health condition (82.91%), disease (61.67%), the result of lifestyle change (85%) and not a lifestyle choice (68.64%).
Interview participants confirmed lifestyle as one of the most important reasons for obesity. The view of having excess weight as unhealthy was high among young adults and females. Participant 8 claimed, “At this time, the influence in your generation and the later generation, for them lifestyle is the culprit, which is deadly.”
Conversely, Participant 3 shared her views on obesity and opined, “It is like a disease, something we are unable to fix. I think obesity is a concern more than a disease. It is not a disease. It is like sitting on a time bomb.”
Differently, Participant 14 stated, “Obesity, to an extent, is an illness as it affects both physical and mental health.”
An interviewee emphasised the beauty industry’s impact on how obesity is perceived, further expanding the understanding. He shared, “I don’t have a medical understanding of obesity. What my personal understanding is that the cosmetic industry, the styling industry and the fashion industry have brought in a lot of perceptions of how you would look to others. And one of the key factors here is obesity. So I feel there are two kinds of obesity – one is obesity which is normal and healthy. You could still be healthy and be obese, and other is when you are not normal and healthy, and you are obese. That needs medical intervention.”
Family
As per the survey respondents, family’s eating habits (56.67% agree; 27.50% strongly agree) and family history of obesity (60% agree; 13.33% strongly agree) influenced the risk of obesity.
Participant 3 confirmed, “Family plays an important role. Only if we were told to eat fruits every day. We don’t eat fruits. A healthy diet should consist of fruits, leafy vegetables, and fibre rich. These things were not imbibed. So those food habits stayed on. When hungry, often, I go for instant noodles.”
On family history, participant 6 confirmed, “I have never seen my parents slim and trim. Most of my family members – they are apparently not the healthy perfect that we understand. We should be. It is more than slightly what is required we have always carried. It could be genetic reasons.”
Behavioural factors
Two of the most critical risk factors of obesity were eating foods with too much fat and sugar (42.50% agree; 54.17% strongly agree) and lack of physical activity (40.83% agree; 53.33% strongly agree). The survey participants also revealed a lack of sleep (42.50% agree; 19.17% strongly agree) as the other risk factor.
According to the interview participants, a lack of physical activity is another significant cause of obesity. Participant 10 expanded, “People are not engaged in any physical activity. After eating, what people should do regarding physical activity but are not doing or are unable to do so. People are availing Ola or Uber. Rapido is new now, and many people are availing that for transportation. Therefore, what is happening is that the calorie that they should burn with some physical activity, but hardly people are engaging in physical activity.”
Sedentary activities [TV, computer, mobile, etc.] and stress
As per the survey respondents, hours of TV watching, phone browsing, indoor gaming (44.17% agree; 22.50% strongly agree) and constant stress (40% agree; 22.50% strongly agree) influenced the risk of obesity.
Participant 4 confirmed and summarised a few important risk factors of excess weight, “Our lifestyle – previously we used to walk for hours, spend time at playgrounds but now our life has become restricted. TV, mobile, gadgets, all these affect our health too much. Obesity is, therefore, caused due to junk food and lifestyle. People in a job sitting on a chair for the entire day. People who are at home watch TV or browse the phone. Due to the building, there is less space. Stress is also the most important thing for obesity. And also not eating timely.”
Time-poor
Lack of time and work pressure were risk factors since participants were discouraged from engaging in physical activity (48.33% agree; 20.83% strongly agree).
Participant 14, who was already diagnosed with Type 2 diabetes and hypertension before the age of 41 and ran his own business, confirmed and explained, “For surviving, the earning you need, to earn that money, the middle class are the worst sufferer. Maximum problems belong to the middle class. The lower and upper classes have fewer fat people, comparatively, and rich people can manage their working hours accordingly. They can manage their time to go to the gym for an hour. For me, that is not possible, leaving my shop unattended. If I go to the gym, I have to keep a worker to whom I got to pay a certain amount of money.”
Wealth
Survey participants mostly disagreed that excess weight is a sign of prosperity (27.50% disagree; 27.50% strongly disagree) influencing the risk; and that the lack of money increased obesity risk (42.50% disagree; 35.83% strongly disagree).
Interview participant 10 expanded, “So there is an entirely low-income group who may have had sources to different kinds of food, may not have access to those foods anymore. Obesity is for all classes. But if we do an analysis, particularly in the slum areas, there is an entire baby who is obese in that sense. People could be undernourished and obese at the same time.”
Urbanisation
Urbanisation in Kolkata (41.67% agree, 13.33% strongly agree) influenced the risk of obesity.
Participant 15 confirmed, “Young generations are also taking escalators now. Instead, if they take stairs, that can also be an exercise. Small changes can bring a bigger impact. It is becoming difficult after getting extra benefits. In villages transport facility is poor, so people walk. They have to take the stairs. But in the urban city, getting extra advantages is becoming problematic, I think. And these junk fried, oily foods are not there in villages.”
Furthermore, qualitative interviews expanded the understanding that technology, digital marketing of food, lack of knowledge and self-care influenced the risk of obesity. During the field visit, the PI observed that generally, people lived a busy life and were reliant on technology and app-based marketing, takeaway and readymade foods were popular, and people lacked awareness and health care. For example, participant 13 stated, “Yes, now our country has developed a lot, therefore, swiggy, uber eats, all kinds of home delivery and free services. So I think with more passing days, the consumption of these free services are affecting health. Our heads do not think twice about what these free services do to our bodies. People are very excited to order, but we don’t understand how unhealthy that is. That’s the problem.”
Benefits of healthy behaviours
Table 3 compares quantitative and qualitative findings on the benefits of healthy behaviours in a joint display. The first column shows the qualitative results, the second column shows the quantitative findings, and the last column suggests the fit of data integration, whether the findings are confirming, discording or expanding. When we use the terms “concordance” and “expansion,” we mean that the two data forms agree, suggesting the same thing and that the knowledge of the subject is expanding, respectively.
Physical activity behaviours
Table 4 shows a side-by-side display of quantitative and qualitative findings on physical activity. The green colours denote agreement, the blue colours denote disagreement, and the grey ones denote inconclusive survey participants’ responses.
Dietary behaviour
Calorie consumption
Survey participants frequently disagreed about being aware of their calorie consumption (45.83% disagree & 15% strongly disagree) and did not track their food or liquid intake (45% disagree & 16.67% strongly disagree).
Interview participants confirmed that they seldom had an idea of their calorie consumption. Participant 3 expanded, “When I referred a nutritionist, they said I should consume 1500-1700 calories and eventually lessen it. Then I went till 1300. Now at least I consume 2500 calories per day. So no calorie deficit is there.”
Read nutritional labels
More than half of the survey participants agreed to read nutritional labels (43.33% agree or strongly agree). However, 39.17% of the participants disagreed with not consulting dietary labels.
Conversely, interviewees recalled that they did not consult dietary labels.
Consumption of high-calorie food
Generally, survey participants agreed that they limited their consumption of high-calorie food (50% agree; 11.67% strongly agree) and limited their eating portions (58.33% agree/strongly agree).
In discordance, interview participants recalled eating high-calorie and low-nutrient-dense foods.
“After that in the evening, I crave for something some bad stuff – snacks” – Participant 10.
Occasionally interviewees stated that they ate small portions. For example, participant 7 stated, “Intention towards my weight is eating less. Not to eat much. I intend to lose weight. Only one intention. If that makes me sad, that is okay. One or two days I can eat good food, most days bad food.”
Dietary pattern and food knowledge
More survey participants agreed that they consumed low-fat meals (52.50% agree; 13.33% strongly agree), low-carbohydrate meals (55% agree/ strongly agree) and high-fibre foods (56.67% agree/ strongly agree); monitored their consumption of butter, cream and cheese (47.50% agree; 12.50% strongly agree); opted drinking water over sugary drinks (46.67% agree & 16.67% strongly agree) to prevent obesity.
However, the dietary recalls of the interview participants were contrary. For example, interview participants skipped their daily intake of fruits and vegetables.
“My biggest drawback is I do not eat vegetables and fruits because of that the way to start eating it is very difficult.” – Participant 8.
The PI observed that individuals tended to understand food and nutrition poorly. For an, e.g., one survey participant mentioned that she did not eat fruits so to avoid sugar intake.
Additionally, the qualitative interview provided more detail and shed light on the lack of dietary knowledge, high sugar and low protein consumption. Seldom interview participants were aware of low-fat, low-carbohydrate meals and high-fibre foods. As per those participants, vegetables were low-fat foods; less rice and roti, protein-rich diet were considered low carbohydrate meals; while high-fibre foods were mainly multi-grains. On the other hand, Participant 9 said with the sentiment, “I really don’t know because previously, we used to hear not to eat eggs. Now the new fad is ‘keto’. Now keto is based on eggs, good fats. Previously there was a saying not to eat ghee. Now it’s a superfood. Butter was not suggested; now it’s another kind of a superfood. ‘Cholesterol is bad’, now I hear cholesterol is good for you. You should not be lowering cholesterol below your level because it has its benefits to break down this and that. Previously it was the HDL is good, LDL is bad. Now I don’t hear that as well. Now they are saying if your LDL decrease to a low level, it creates a problem with your digestion. So I don’t know.”
Participant 4 felt people were the “culprit” for their health. She added, “I like noodles. It’s my favourite, but when I conceived, I was asked to quit as it is made of refined wheat, and it takes four days to digest. These are wax coated. We do not know all these. But it is totally unhealthy. Only taste!”
While Participant 14 reasoned, “Our understanding is all made up of what is healthy food. Some are made up by doctors and some by media advertisement.”
Frequency of eating outside
Most survey participants agreed that they avoided eating outside and preferred eating at home (42.50% agree; 19.17% strongly agree) to prevent obesity.
In contrast, interviewees repeatedly recalled eating at least 4–5 days a month outside their homes.
“Typically I eat one meal at home and rest outside” – Participant 3.
The PI observed that outside eateries and food deliveries were highly prevalent, roadside shops were filled with ready-made instant food items, and people tended to meet over food. The qualitative interviews contribute to a better understanding of how the food environment has changed, possibly due to the convenience of ready-made food.
“The foodscape has changed in different ways, and the restaurant industry has boomed across the city. So for a long time, I remember going to the restaurants was a kind of most discussed affair in the family. Now it is not a matter; you can go and have everyday food.” – Participant 10.
“It is because of ease. As people are cooking less now that restaurants and food chains have increased a lot. Within the last 21 years, there has been a huge difference.” – (Participant 2).
Similarly, qualitative interviews expanded the understanding that socialisation took place around food. Participant 10 referred to a fascinating insight related to food and diet, “my obesity is not simply about me. It’s the food culture that we have adapted so easily. We are made to imbibe through socialisation. Nowadays a typical socialising point will be a fast food centre or a restaurant which I remember not to be. Rather it used to be a friend’s place earlier, or it could be a playground for a long time because we could not afford to get priced expensive food. But now the typical socialising point would be KFC, Mc Donald’s. There is so much promotion around most of these foods rather than any organic food market. Only burgers and all. Even what we call healthy food also to be contested.”
Obesity prevention
Table 5 shows another side-by-side display of quantitative and qualitative findings on obesity prevention. Green colours indicate agreement, and blue colours indicate disagreement.
[ad_2]
Source link