Journal of Womens Health, Issues and Care ISSN: 2325-9795

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Research Article, J Womens Health Issues Care Vol: 5 Issue: 6

Perspective on Obesity Problems and Associated Factors to Reduce Weight among Overweight and Obese Housewives: A Qualitative Study

Nur Shahida Abdul Aziz*, Nor Azian Mohd Zaki, Noor Safiza Mohamad Nor, Rashidah Ambak and Cheong Siew Man
Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
Corresponding author : Nur Shahida Abdul Aziz
Centre for Nutrition Epidemiology Research, Institute for Public Health, Ministry of Health Malaysia, Jalan Bangsar, 50590 Kuala Lumpur, Malaysia
Tel: +603-22979400
Fax: +603-22823114
E-mail:
[email protected]
Received: July 22, 2016 Accepted: August 18, 2016 Published: August 23, 2016
Citation: Abdul Aziz NS, Mohd Zaki NA, Mohamad Nor NS, Ambak R, Cheong SM (2016) Perspective on Obesity Problems and Associated Factors to Reduce Weight among Overweight and Obese Housewives: A Qualitative Study. J Womens Health, Issues Care 5:6. doi: 10.4172/2325-9795.1000255

Abstract

Introduction: The World Health Organization has declared obesity a global epidemic. In Malaysia the prevalence of obesity has reached an upward trend. Findings from the National Health and Morbidity Survey 2011 indicated that obesity among women was higher as compared to men and mean Body Mass Index among housewives was highest compared to other job categories. The aim of this qualitative study was to explore perspective on obesity problems and to gain a better understanding on barriers and facilitators to reduce weight among housewives in order to develop a weight loss intervention package.
Methodology: This qualitative survey is part of the “My Body is Fit and Fabulous at Home” ([email protected]) which involved in-depth interviews with 28 overweight and obese housewives in low cost flats around Klang Valley. Housewives were sampled purposively and data were analysed using thematic analysis. Themes and subthemes were also coded, explored and refined using the NVIVO software.
Results: Five main themes associated with obesity problems emerge from the analysis that included ‘personal feelings, beliefs, lifestyles, life issues and effort to reduce weight’. Housewives perceived that their body size were big or too big and felt dissatisfied with their weight. Six main barriers were identified which included support, attitude, safety, environment, time and life issues such as finance and health problems. Self motivation, lifestyle, mindset, appealing figure, family and peer support were identified as facilitators to motivate housewives to reduce weight.
Conclusion: These findings provided tools useful to develop strategies to empower housewives to reduce and to sustain their weight loss over a period of time.

Keywords: Overweight and obesity; Housewife; Barrier and facilitator; Qualitative study

Keywords

Overweight and obesity; Housewife; Barrier and facilitator; Qualitative study

Introduction

Obesity is a major public health treat worldwide and is a known risk factor for a number of chronic diseases such as cardiovascular disease, hypertension, Type 2 Diabetes, dyslipidaemia and cancer [1- 2] Other health consequences of obesity include Osteoarthritis (OA) and knee pain [3-4] .
An increasing trend of overweight and obesity prevalence is seen among the Malaysian population. The National Health and Morbidity Surveys (NHMS) reported an upward trend of overweight and obesity prevalence for the past 15 years of which there was a 12.8% and 10.8 % increase in overweight obesity [5,6] respectively. Women showed a higher prevalence of obesity (15%) than men (10%) in the Malaysian population (MANS, 2003) [7]. In the NHMS 2015, the prevalence of obesity among females has increase (29.6 %), and this prevalence was also found to be higher than men (25.0%) [8]. In addition, the mean Body Mass Index (BMI) among housewives was also higher than other job categories (Mean BMI: 26.6 kg/m2) [8]. These findings have shown that overweight and obese female adults (including housewives) were also one of the high risk groups that require specific obesity intervention or weight reduction programme.
Although a considerable number of studies on overweight and obesity have been undertaken in Malaysia, there is little current information regarding the perception among overweight and obese housewives and their intentions on weight loss. Thus, before developing any weight reduction interventions for this high risk group, in-depth qualitative study was adopted to achieve a unique insight into the housewives behaviours, characteristics and their perspective on obesity and it management. This is important to promote self-efficacy so as to increase their capability to reduce as well as to maintain their weight loss. Perceived self-efficacy influences how they will behave based on how they feel, think and also their level of motivation [9].
Qualitative research method is effective in exploratory study because it is able to give detailed information about a person’s thoughts and to identify behavioural and social factors related to weight management [10]. Furthermore, the use of qualitative method allows the interviewer to deeply explore the respondent’s feelings and perspectives about body weight and provides deeper understanding of the barriers and facilitators of weight reduction [9,11]. It provides insights into the problems or helps to develop ideas or hypotheses for potential quantitative research.
The aims of this study were to explore in-depth understanding on obesity problems and weight management, barriers and facilitators of weight reduction among overweight or obese housewives in Klang Valley, Kuala Lumpur, Malaysia. This is the first phase of the research project of “My Body Fit and Fabulous at Home” ([email protected]). The findings of this qualitative study will be used to develop and design a weight reduction intervention package specifically for the targeted housewives.

Methodology

Study Design
This study employed a qualitative approach using semi-structured face-to-face interviews to explore in-depth understanding on obesity problems and weight management among overweight or obese housewives. Their intention to lose weight was obtained by using Trans- theoretical Model of Change (TTM) Algorithm. Thus their opinion would then help the researchers to develop and refine the items for the intervention package for Phase II (intervention phase).
Interviews were conducted in any of the five languages Malay, English, Mandarin, Cantonese or Tamil depending on the understanding and preference of the respondents. A set of predetermined open-ended questions interview guidelines were used including other questions that emerged during the interviews. Development of interview guideline was based on literature review and a qualitative study by Chang et al, (2007). Pre-test questionnaires have been done by researches among volunteers (women aged 18- 59 years old) and questionnaires were finalized based on feedback prior to the actual interviews. This interview lasted between 20 to 60 minutes.
Setting
Respondents were recruited from three low cost flats in Klang Valley namely Cheras Baru, Bandar Tun Razak and Lembah Pantai. Besides that, active search and contact list from the State Health Department of Wilayah Persekutuan and Family Medicine Specialists at three Health Clinics located in Klang Valley (Cheras Baru, Cheras, Pantai) were done.
Subjects
Housewife was defined as a married/single/widowed female who has been staying at home for at least 6 months with no fixed income. Inclusion criteria were overweight and obese housewives aged 18-59 years old, living in apartments or low cost flats, and without any comorbidities of diabetes, severe hypertension, heart disease and renal dysfunction. Overweight was classified as Body Mass Index between 25-29.9 kg/m2 and obesity was classified as Body Mass Index >30kg/ m2 (WHO1998). Housewives with BMI of 25.0 to 39.9 kg/m2 were included in this study.
Recruitment
Research team members sought for potential respondents who were living in apartments or flats and filtered it through contact list provided. Researchers contacted the housewives, explained on the study and written consent was acquired prior to starting of the interview. Respondents were interviewed at the nearest health clinics or at their house based on their convenience. During the interview session, respondent were briefed on the onset that no opinion or ideas were considered right or wrong. All interviews were recorded using a tape recorder and then transcribed into the Malay language.
Data analysis
Data were analysed in two stages. The first stage of the analysis started during the data collection involving a combination of pre-defined codes and new codes, which emerged from each transcription. Based on the questions, each code was defined to indicate the detailed aspects of the code. Further analysis involved both ‘coding up’ (inductive) and ‘coding down’ (deductive) activities using all transcripts. All codes were defined as themes, subthemes and compiled into two key areas which include:
Obesity problems and weight management
Barriers and facilitators of weight reduction
In the second stage of the analysis, all themes that emerged from the first stage of analysis were categorised and coded using NVIVO 10 software. The categories were obesity and its management as well as facilitators and barriers to weight loss. Based on the analyses, key data were analysed by the research team members who collected and transcribed the data. The researchers also rechecked the appropriate themes and subthemes through a peer review process. Potential biases were reflected and discussed to improve the credibility of the analysis.

Results

All 28 housewives aged 18 to 59 were interviewed, where the majority were Malays (64%) followed by Chinese and Indians (18%) respectively. Approximately 54% of them were obese with BMI above 30 kg/m2 while the rest were overweight (BMI = 25 -29.9 kg/m2). Most of the housewives had achieved secondary level education at 71%, had 1 to 5 children and only 36% of all housewives had a part time job (Table 1).
Table 1: Socio-demographic profile of the housewives.

Obesity problems and weight management

Five themes emerged from the analysis of the first six questions of part one of the semi-structured which were include personal feeling, lifestyle, beliefs and efforts to reduce weight and life issue (Table 2).
Table 2: Obesity problems and weight management.
The perceptions and feeling of being overweight or obese are closely linked. The majority of housewives felt that they were too fat, their body sizes were big or too big and they did not like their body shape. Among the body parts that the housewives disliked were their stomachs, hips, thighs, arms and chest. Most of them reported that they gained a lot of weight after child birth, marriage or after taking contraceptive pills. They believe that some of their food, water, culture and fate make them being overweight or obese.
Some of the housewives commented that they have busy days and prioritize their family above their own. Besides that, there were a few life issues raised by respondents to reduce weight such as stress in term of family and friends as well as economic and health issues.
Majority of the housewives have tried losing weight before but but they did not successful due to inappropriate weight loss methods. Among the reasons for weight regained were lack of exercise, overeating although some of housewives agreed that eating too much can lead to this obesity problems and discontinued use of traditional or products for weight loss.
In general, the methods used for weight loss were fasting, exercising and taking weight loss products. Most of them were aware that excessive weight may lead to health complications such as diabetes and stroke while some mentioned that they were already experiencing knee pain due to their heavy weight. Besides health complications, other implications of obesity mentioned were poor self-image and self-esteem as well as poor quality of life.
However, there were some issues or barriers that prevent them from trying to reduce weight. A total of six main barriers which included time, attitude, safety, environment and life issues such as finance and health problems.
Barriers of weight reduction
Lack of time, support from family, friends and environment surrounding them was the most frequent barrier identified in this interview. Besides that, they also faced problems in managing their finances which most of them spend more on family rather than themselves. Some of them think for weight reduction they must spent their money to buy weight loss product. Although fewer housewives raised safety issue but it should be highlighted in this study. They perceived that it was not safe to perform outdoor exercise due to safety issues (Table 3).
Table 3: Barrier of weight reduction.
Facilitators of weight reduction
Most housewives agreed that strong facilitators of weight reduction include self-motivation, support from family members and friends, mind-set, image and beauty (Table 4).
Table 4: Facilitator of weight reduction.

Discussion

The in-depth interviews were able to gain deeper insight about the obesity problems and associated factors that influence individual housewives to reduce weight. Most of them have raised multiple issues regarding obesity problems and perceived that problems were caused by several factors related to their personal feeling, level of knowledge and behavioural factor of housewives.
Personal feeling
Based on the finding, they expressed their feeling, they were not confident with their body size. They did not like their body shape because it was not attractive. Among the body parts that the housewives disliked were their stomach, hip, thigh and chest. The changes of body shape were expressed in terms of difficulty in choosing appropriate clothes. Obese/overweight housewives in the rural area of Kelantan, Malaysia also expressed dissatisfaction of their body shape [12]. Other studies , also showed that many of adult overweight or obese feel ashamed and frustrated with their altered body shape as they perceived as being ugly[13-14]. However this finding was in contrast with a study among the African women. They accepted and perceived large body size as healthy and attractive. Some of them related the attractiveness with self-esteem and even though they knew they were obese but they can still be positive about themselves [15]. Other study also expressed that being healthy did not associate with overweight/obese, in fact they mentioned being underweight also can be unhealthy [15]. Interestingly, most of the overweight/obese women thought that they were in a great health condition, and did not have problem with their body weight [12]. Other studies also expressed that being healthy does not depend on certain body size in fact they also mention being underweight also can be unhealthy [14]. Some overweight women was proud of their body curve but other people see it in different way and it make them feel confusion and frustrating with what other people said [15]. Although there were different perspective in different culture but most of the women were aware of effect being obese to their health.
Attitude
As shown in the result section, most of them expressed negative attitudes towards their own body and regular exercise. Based on the findings, they reported negative behavior at home, such as less likely to be active and love to spend free time by sitting in front of television. This condition was also highlighted in other studies. Housewives demonstrated attitude towards physical inactivity to be the most reason for weight gain, beside time constraint and support to reduce weight [14,16]. It appeared that lack of time was the most popular barrier highlighted by the respondent to performed exercise in their daily life. Besides that, other reasons such as not having fun with exercise and not quick result also have been expressed by some of the women [16]. This important finding need to be considered in planning a good health intervention for reducing weight related to housewives.
Lifestyles
Majority of the housewives have tried losing weight before but they gained it back. Low physical activity, having a heavy meal at night , unhealthy cooking methods, stress with too much house work and discontinued use of traditional supplement or products for weight loss were the most common reasons for being overweight or obese among housewives. According to study done among the African American women, many of the women perceived that bad eating behaviour and, lack of physical activity were also causes of weight gain [14]. Hence it is very important to increase knowledge regarding healthy eating habits and how to lead a healthy and active lifestyle. Other study also reported similar findings those being knowledgeable and confident with what they eat and practice in their daily life seem to be more helpful in body weight management [18].
Despite various issues raised by the housewives, other barriers identified in this study were lack of time to perform exercise and to get support from family members and friends. Housewives were occupied with house works and responsibility to the family is the most important thing for them. Other study also showed similar result of external barriers such as lack of time to be physically active, burden of housework, no support from relative and friends, and too old to do exercise[17,19-21]. Other barrier raised in this study that should be highlighted was safety to perform outdoor exercise. Fear of crime and feel unsafe were the reasons not to be physically active. Safety during an exercise activity was the most important factor effect on community level of physical activity [20]. These important finding needs to be highlighted for any weight intervention program related to housewives especially women.
In general, the methods used for weight loss were fasting, exercising and taking weight loss supplement. Although there were similarities in opinions but the Singaporean Malay housewives did not agree with spending money in a weight loss centre or consumed weight loss supplement. They commented of a few friends or relatives of those who have tried to lose weight by going to the weight management center or consuming weight loss products but did not get optimum results [16,20]. Most of housewives agreed that consistently exercise will increase their stamina and these will help them in managing routine housework. Many studies have shown that exercise will increase our basal metabolic rate (BMR), which will be increase our fat-free mass and decrease fat mass [22]. In addition, exercise also has inversely related to body weight and body mass index (BMI) [23]. Therefore, this should be highlighted to motivate overweight and obese housewives in regular exercise consistently.
There were several factors that influence or facilitate them for reducing weight and most often factor were strong self-motivation, more support from other family member and friends, body image and beauty. Previous study also documented that strong social support from family and friends and positive mindset of their weight status or their effort to lose weight was most common facilitator [14-15].
The present study has its own limitations. One of the limitations is that the majority of the respondents were Malay compared than other ethnicity group. Some information among the other ethnic group on barriers, facilitator and also strategies to reduce weight among housewife could not been captured in detail. Other limitation in this study is that we do not have specific question on the role of the spouse or family member of the respondent in supporting the weight reduction program. This aspect can be exploring in the future research.

Conclusion

The objectives of the study were met. The housewives in Klang valley have arisen many issues, with the personal attitude toward exercise and maintaining the momentum and lifestyle modification as their main concern. They also identified lack of self-motivation and discipline as their main problem in reducing body weight. Others also expressed lack of time and lack of support from family members and environment as the reason they were less likely to do regular exercise to reduce their body weight. They perceived their role as housewife in doing housework chores and manage child as their utmost priority, hence neglecting their health. The present study mainly explored their feelings and opinions; therefore more research is needed to narrow the knowledge gap on their family members and social perceptions toward obesity problems especially among women. Future study should also consider the psychology component in motivating and maintaining them to achieve healthy body weight.

Acknowledgments

The authors would like to thank the Director General, Ministry of Health Malaysia, the permission to publish this paper. Appreciation to Sackler Institute for Nutrition Science and Malaysian Industry-Government Group for High Technology(MiGHT) for providing the technical and financial support in this study and also to Dr.Tahir Aris, Director of the Institute for Public Health for his support and supervision. We also thank all individuals who directly or indirectly contributed to the success of this study.

Author Disclosure

The author declared no potential conflicts of interest with respect to the research,authorship or publication of this article.

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