Prevalence, Associated Factors and Psychological Determinants of Obesity among Adults in Selangor, Malaysia

Cervical length screening among low-risk women; relationship of body mass index on cervical length and risk of preterm birth

BACKGROUND

Preterm birth (PTB) contributes to nearly 11% of all deliveries in the world. The majority of spontaneous preterm birth (sPTB) remains unexplained. Risk factors include abnormal body mass index (BMI), short cervical length, comorbidities and many more. However, there is limited study on the association between body mass index, cervical length and preterm birth in Malaysia among low-risk women. Hence, we aim to examine the relationship between body mass index, cervical length and the risk of spontaneous preterm birth.

METHOD

In this prospective cohort study, pregnant women between 16 and 24 weeks who fulfilled the criteria were recruited. Women with history of preterm birth were excluded. Demographic and clinical data (age, BMI, ethnicity, education level and parity) were obtained. Cervical length was measured using transvaginal scan. Patients were then followed up till delivery to determine their delivery gestation and outcome of delivery.

RESULTS

Out of 153 women who participated in this study, 146 women had cervical length of more than 30 mm, six had cervical length between 25 mm and 30 mm and one had cervical length of 24 mm. There were nine (9) cases of sPTB, with all of them being late preterm with normal midtrimester cervical length. Almost half of them (44%) were overweight/obese. A significant association was found between age, cervical length, and parity compared to BMI. Nevertheless, no significant association was seen between the BMI and risk of sPTB.

CONCLUSION

This study demonstrates a higher BMI is associated with longer cervical length, but it is not necessarily protective against sPTB. Hence, we concluded there is a limited role in cervical length screening among low-risk women regardless of their BMI in predicting sPTB.

A Qualitative Exploration of Weight Loss Experiences through Hypnotherapy

Hypnotherapy has been gaining recognition as an alternative treatment for excess weight problems. This qualitative study aims to explore individuals' experiences of losing weight through hypnotherapy and their perceived barriers and facilitators for healthy lifestyle changes. Semistructured interviews were conducted with 15 participants (11 women and 4 men; mean age of 23 years) who recorded having lost ≥5% weight after undergoing 3 hypnotherapy sessions previously at a public university in Terengganu, Malaysia. Each interview was audiotaped, transcribed, and analyzed using thematic analysis. The themes that emerged were the usefulness of hypnotherapy, barriers, and facilitators of healthy lifestyle changes. All participants contended that hypnotherapy played a role in their weight-loss journey through increased mindful eating and enhanced motivation to make lifestyle modifications. Barriers to healthy lifestyle changes included high costs of healthy foods and lack of support for healthy food sources in social and family settings. Hypnotherapy is essential as an adjunct tool in assisting weight loss. However, additional efforts are needed to improve support in the weight management journey.

Obesity and Its Association with Undiagnosed Diabetes Mellitus, High Blood Pressure and Hypercholesterolemia in the Malaysian Adult Population: A National Cross-Sectional Study Using NHMS Data

This study aimed to report the prevalence of obesity, classified using Asian cut-off, and its relationships with undiagnosed diabetes mellitus, high blood pressure, and hypercholesteremia. We analyzed the nationally representative data from 14,025 Malaysian adults who participated in the NHMS 2015. The relationship between obesity and undiagnosed diabetes mellitus, high blood pressure, and hypercholesteremia was determined using multivariable logistic regressions, and lifestyle risk factors and sociodemographic characteristics were adjusted. The undiagnosed high blood pressure group showed the highest proportionate of overweight/obese (80.0%, 95% CI: 78.1-81.8) and central obesity (61.8%, 95% CI: 59.3-64.2). Inverse association was observed between underweight with undiagnosed high blood pressure (aOR: 0.40, 95% CI: 0.26-0.61) and hypercholesterolemia (aOR: 0.75, 95% CI: 0.59-0.95) groups. In contrast, positive relationships were shown between overweight/obese and risk of undiagnosed diabetes mellitus (aOR: 1.65, 95% CI: 1.31-2.07), high blood pressure (aOR: 3.08, 95% CI: 2.60-3.63), and hypercholesterolemia (aOR: 1.37, 95% CI: 1.22-1.53). Likewise, central obesity was positively associated with a risk of undiagnosed diabetes mellitus (aOR: 1.40, 95% CI: 1.17-1.67), high blood pressure (aOR: 2.83, 95% CI: 2.45-3.26), and hypercholesterolemia (aOR: 1.26, 95% CI: 1.12-1.42). Our findings indicated the importance of periodical health examinations to assess the risk of non-communicable diseases among the general and abdominal obese Malaysian adults.

Intuitive Eating Behaviour among Young Malay Adults in Malaysian Higher Learning Institutions

Despite the significance of dietary knowledge interventions, there is a lack of established studies on intuitive eating behaviour among young Malay adults in Malaysia. This cross-sectional study aimed to determine the intuitive eating score, identify the intuitive eating factors, and determine the association of intuitive eating with weight-control behaviours and binge eating. A total of 367 respondents completed self-administered questionnaires on sociodemographic characteristics, namely the Intuitive Eating Scale (IES-2) and The Diabetes Eating Problems Survey (DEPS). The findings reported IES-2 mean scores of 3.52 ± 0.32 and 3.47 ± 0.35 for both men and women. No difference in total IES-2 scores was found between genders for Unconditional Permission to Eat (UPE) and Reliance on Hunger and Satiety Cue (RHSC) subscales (p > 0.05). However, among all four subscales of IES-2, there was a gender difference in the mean EPR and B-FCC subscale scores (p < 0.05). A statistically significant difference was found in intuitive eating, which refers to a belief in one's body's ability to tell one how much to eat, in women across living areas (p < 0.05). The result shows that there is a relationship between weight-control behaviour and binge eating and dieting, with the coefficient of the relationship (R²) of 0.34. As a result, intuitive eating throughout young adulthood is likely to be related to a decreased prevalence of obesity, dieting, poor weight-management behaviours, and binge eating.

Practical Strategies for Improving Sustainability and Scale-up of Noncommunicable Disease-related Public Health Interventions: Lessons from the Better Health Program in Southeast Asia

Introduction

The Better Health Program has been addressing key health system issues in the prevention and control of noncommunicable diseases (NCDs) in Malaysia, Thailand, Vietnam, and the Philippines. As the program comes to an end, the sustainability and scaling-up of issues have assumed importance.

Objectives

The objective is to assess how well sustainability and scale-up strategies have been integrated into the design and implementation of a 3-year multicountry technical program; to explore enablers and barriers of sustainability and scaling up; and to identify practical strategies that can improve sustainability and scale-up of Better Health Program interventions.

Methods

We applied a staged approach to explore barriers and enablers and to identify practical strategies to improve sustainability and scale-up of four NCD interventions: community-based obesity prevention, front-of-pack labeling, local learning networks (LLNs), and NCD surveillance. We extracted evidence from peer-reviewed literature and local documents. We also conducted in-depth interviews with the implementation teams and key stakeholders. We conducted a thematic synthesis of the resulting information to identify practical strategies that improve sustainability and scale-up of the four interventions.

Results

Strong engagement of stakeholders at higher levels of the health system was identified as the main enabler, while limited funding and commitment from local governments were identified as a key barrier to sustainability and scale-up. Strengthening the social and institutional anchors of community health volunteers, enhancing evidence-based advocacy for front-of-pack labeling, trailblazing the LLN innovation, and securing the commitment of local governments in the implementation of NCD surveillance were among the key strategies for improving sustainability and scale-up of Better Health Program interventions in Malaysia, Thailand, Philippines, and Vietnam, respectively.

Conclusions

This study identified practical strategies for improving sustainability and scale-up of NCD-related interventions. Implementation of the strategies that had high priority and feasibility will improve the sustainability of critical elements of the program in the respective countries.

Effects of Ambient Particulate Matter (PM2.5) Exposure on Calorie Intake and Appetite of Outdoor Workers

Malaysia has been experiencing smoke-haze episodes almost annually for the past few decades. PM2.5 is the main component in haze and causes harmful impacts on health due to its small aerodynamic size. This study aimed to explore the implications of PM2.5 exposure on the dietary intake of working individuals. Two phased 13-weeks follow-up study was conducted involving 440 participants, consisting of two cohorts of outdoor and indoor workers. Ambient PM2.5 concentrations were monitored using DustTrakTM DRX Aerosol Monitor. Data on Simplified Nutritional Appetite Questionnaire (SNAQ) and 24 h diet recall were collected weekly. The highest PM2.5 concentration of 122.90 ± 2.07 µg/m3 was recorded in August, and it vastly exceeded the standard value stipulated by US EPA and WHO. SNAQ scores and calorie intake were found to be significantly (p < 0.05) associated with changes in PM2.5 exposure of outdoor workers. Several moderate and positive correlations (R-value ranged from 0.4 to 0.6) were established between SNAQ scores, calorie intake and PM2.5 exposure. Overall findings suggested that long hours of PM2.5 exposure affect personal dietary intake, potentially increasing the risk of metabolic syndromes and other undesired health conditions. The current policy should be strengthened to safeguard the well-being of outdoor workers.

Type D Personality and Health Behaviors in People Living with Obesity

BACKGROUND

Considering that health behaviors and personality traits play an important role in the formation of health attitudes, the main objective of this study was to evaluate the relations that occur between type D personality and health behaviors in a group of obese patients.

METHODS

443 adult patients with BMI ≥ 30 kg/m2, who had been hospitalized in selected hospital facilities in the Silesian Voivodeship (Poland), participated in the study. Respondents completed three standardized questionnaires-the Multidimensional Health Locus of Control Scale, version A (MHLC-A), the Inventory of Health Behaviors (IZZ), and the Type D Scale (DS-14).

RESULTS

Patients with type D personality were characterized by the least effective mental attitudes and preventive behaviors, and differed significantly from the other personality types (intermediate and non-type D). Type D personality increased the risk of initiating improper health behaviors by more than five times. Regarding the sense of health control, patients with type D personality had significantly lower scores for the Internal Dimension subscale (21.3 ± 3.1) and higher for the Powerful Others Dimension subscale (24.0 ± 2.6), compared to patients with intermediate and non-type D personality. Proper health behaviors correlated with an internal sense of health control; the strongest correlation, defined as a medium, was with Preventive Behaviors (R = 0.42; p < 0.0001).

CONCLUSIONS

Type D personality was associated with poorer attitudes towards health. Among obese respondents with a type D personality, there was a significantly higher prevalence of those who believed that their health status was a consequence of chance events.

Fermented Black Tea and Its Relationship with Gut Microbiota and Obesity: A Mini Review

Fermentation is one of the world’s oldest techniques for food preservation, nutrient enhancement, and alcohol manufacturing. During fermentation, carbohydrates such as glucose and starch are converted into other molecules, such as alcohol and acid, anaerobically through enzymatic action while generating energy for the microorganism or cells involved. Black tea is among the most popular fermented beverages; it is made from the dried tea leaves of the evergreen shrub plant known as Camellia sinensis. The adequate consumption of black tea is beneficial to health as it contains high levels of flavanols, also known as catechins, which act as effective antioxidants and are responsible for protecting the body against the development of illnesses, such as inflammation, diabetes, hypertension, cancer, and obesity. The prevalence of obesity is a severe public health concern associated with the incidence of various serious diseases and is now increasing, including in Malaysia. Advances in ‘omic’ research have allowed researchers to identify the pivotal role of the gut microbiota in the development of obesity. This review explores fermented black tea and its correlation with the regulation of the gut microbiota and obesity.

Awareness of Body Mass Index and Its Associated Factors: A Cross-Sectional Study

This study explores the correlates of sociodemographic factors, smoking and caloric knowledge to body mass index awareness with a focus on Malaysia. Logistic regressions were estimated to examine sociodemographic factors associated with body mass index awareness. More than half of respondents were unaware of their body mass index (54.8%). Age was negatively associated with body mass index awareness (aOR: 0.993, 95% CI: 0.984, 1.001). Adults without formal education were less likely to know their body mass index than those with tertiary-level education (aOR: 0.279, 95% CI: 0.170, 0.457). Adults were less likely to be aware of their body mass index if they engaged in smoking (aOR: 0.779, 95% CI: 0.594, 1.023). Adults with knowledge of the definition of calories were more aware of their body mass index than others (aOR: 2.224, 95% CI: 1.805, 2.742). The findings emphasise the urgent need for a forthcoming sociodemographic factors-specific policy directed towards improving body mass index awareness to lower the prevalence of obesity in Malaysia.

Dietary habits, shopping behavior and weight gain during COVID-19 pandemic lockdown among students in a private university in Selangor, Malaysia

Background

Due to the global surge in COVID-19 cases, numerous countries have enforced lockdowns of varying stringency. Social isolation and stay-at-home orders have detrimental effects on one's lifestyle and dietary habits. This study aimed to assess the dietary patterns, food preferences, shopping behavior and weight gain during the lockdown among students in a private university in Malaysia.

Design and Methods

We conducted a cross-sectional study among 426 students using convenience sampling method one-month after initiating the Conditional Movement Control Order (November 15-30, 2020), using a validated self-administered web-based survey. Chi-square test with post-hoc and planned comparison procedures were performed.

Results

Of the 426 participants, more than half were females (55.9%). Over half of the surveyed students reported increased eating (51.2%), snacking (55.2%) and online food ordering (71.1%) during the lockdown. Meat products and sweet drinks (both >90%) were the most consumed food among individuals with higher BMI. 45.5% of the participants reported weight gain (mean 3.36, SD 1.61kg) one month after the lockdown. Female, youth (aged 19-24), working remotely, increased eating, snacking, cooking, and online food ordering were positively associated with weight gain.

Conclusions

Findings suggested that unintended consequences of lockdown have negative impacts on dietary habits and food preferences among university students. Advocacy and public health measures for nutritional support amidst the pandemic are crucial, especially for at-risk groups such as overweight and obese individuals.

Does hypnosis result in greater weight loss compared to conventional approach?

Hypnosis has been increasingly used in recent years as an alternative treatment to maintain well-being. Yet, limited evidence is available regarding its role in weight management, especially in Malaysia. Hence, this quasi-experimental study was conducted to evaluate the effectiveness of hypnosis on weight loss and body composition (body mass index, waist circumference and body fat percentage) among staff and students of a public university in Terengganu, Malaysia. Participants with body mass index (BMI) ≥ 25.0 kg/m² were randomly assigned to either intervention group (IG = 53) or control group (CG = 54), for 12 weeks. All participants received health education (diet + exercise + behavioral recommendations) with those in IG had additional three hypnotherapy sessions, once a month. Body weight was measured at week 1, 7, and 12 while body compositions were measured at weeks 1 and 12. Descriptive, univariate, and repeated-measures analysis of covariance (ANCOVA) were utilized. A total of 104 participants completed the trial (mean age = 26.28 ± 8.01; female = 82.2%; BMI = 31.39 ± 4.89). A significant weight loss was observed in the intervention (-4.61%) and control (-3.04%) groups (mean difference = -1.57; 95%CI: -2.59, -0.54; p = .003) after 12 weeks. Participants that frequently practiced self-hypnosis lost more weight (-6.27%; t(50) = -5.331, p < .001). Body fat percentage and waist circumference did not significantly change from baseline in both groups. Essentially, the positive outcomes indicated the promising potential of hypnosis as an alternative tool in facilitating weight loss efforts for those in need.