Prevalence and related factors of overweight and obese older adults in two communes in the northern mountainous region of Vietnam

JOURNAL OF MEDICAL RESEARCH

PREVALENCE AND RELATED FACTORS OF OVERWEIGHT
AND OBESE OLDER ADULTS IN TWO COMMUNES
IN THE NORTHERN MOUNTAINOUS REGION OF VIETNAM
Vo Hoang Long, Bui Van Nhon, Nguyen Si Anh Hao,
Tran Minh Hien, Bui Van Tung, Vu Đang Khoi,
Pham Van Quyet, Nguyen Hoang Nguyen, Nguyen Thi Lien
Hanoi Medical University, Vietnam
A cross-sectional study was conducted on 354 people aged ≥ 60 in two communes in Chiem Hoa district,
Vietnam to describe the prevalence and various factors associated with being overweight or obese. A majority of the population (n = 218, 61.6%) was female . The median age was 67, with 60.4% of the population
between 60 - 69 years old. More than two-thirds were of the Tay ethnic group. Agriculture was the main occupation (88.4%). Half of the population had only primary education. The prevalence of overweight and obesity among the population was 28.2% and 43.8%, respectively. In a multivariate regression, abdominal overweight and obesity were associated with gender, ethnic group, and smoking (p < 0.05). Abdominal obesity
(obesity by waist-hip-ratio (WHR)) was positively associated with female gender (OR 43.64, 95%CI 13.15 144.86) and negatively associated with smokers and people in ethnic groups other than Kinh and Tay.

Keywords: overweight; obesity; older adults; Vietnam Northern Mountainous region

I. INTRODUCTION
Overweight and obesity have been increas-

2011 reported the prevalence of overweight

ing rapidly in many countries around the world,

and obesity in the population was 29.4% and

including Vietnam. According to the World

15.1% respectively, while Thailand was one of

Health Organization (WHO), overweight and

the countries with the highest prevalence of

obesity are defined as abnormal or excessive

obesity in the world (33% in men and 43% in

fat accumulation that may impair health [1].

women) in the past two decades alone [3].

The figures for overweight and obesity world-

In Vietnam, overweight and obesity among

wide were over 1.9 billion people and over

older adults accounted for approximately 25%

650 million people, respectively. In America,

of the population [4]. The Vietnam National

the prevalence of obesity in men and women

Institute of Nutrition reported that the propor-

aged above 65 years increased to 40.5% and

tion of obesity increases with age and that two

40.3% respectively between 1990 and 2010

-thirds of the overweight population is aged

[2]. The Malaysian Health and Disease Survey

over 45 years [4]. Although individuals with
obesity are evaluated according to their body

Corresponding author: Vo Hoang Long, Hanoi Medical
University

mass index (BMI), many previous studies

Email:

direct cause of morbidity and mortality. Hence,

Received: 08/3/2018

abdominal obesity (obesity by the waist-hip-

Accepted: 05/11/2018

ratio (WHR)) is more closely related to risk of

116

have reported that body fat distribution is the

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morbidity and death than gluteofemoral obe-

In which:

sity. WHR as an indicator of abdominal obesity

n is sample size;

may better predict risk for severe diseases
than BMI, including heart disease, diabetes
mellitus type 2, and Metabolic Syndrome [5].
WHR is also used to diagnose overweight and
obesity. WHR is calculated as waist circumference divided by hip circumference.
Kim Binh and Xuan Quang are two mountainous communes in northern Vietnam, located in Chiem Hoa district in Tuyen Quang
province. Overweight and obesity has not
been studied by WHR in this area, especially
in the elderly population aged ≥ 60 years. The
provision of information on overweight and
obesity in the elderly in these two communes
is necessary to suggest appropriate interventions and counseling. Therefore, this study
aims to describe the prevalence and related
factors of overweight and obesity by WHR
among older adults in two northern mountainous communes in the Tuyen Quang province
of Vietnam.

p is the expected proportion of overweight

and obesity among people aged 60 and older
(estimated p = 0.5);
ε: is the margin of error; α is the level of
statistical significance (to obtain a 95% confidence interval of the proportion, the α is set at
0.05, thus Z is 1.96). To estimate a proportion
of 0.5 with a margin of error of 0.11, the smallest sample size needed is 317. A total of 354
subjects were included in the study. A simple
random sampling technique was utilized to
ensure the representation of older adults living
in these communes. In the first stage of sampling, all the resident aged 60 and older living
in Kim Binh and Xuan Quang communes were
listed. The second stage consisted of selecting
354 objects randomly from a list of the elderly.
In the third stage, the appointment invitations
were sent for medical examination and data
collection.
3. Data Collection

II. METHODS

We collected the data through face-to-face

1. Study design and setting
We conducted a cross-sectional study in
two communes (Kim Binh and Xuan Quang) in
Chiem Hoa district, Tuyen Quang province.
People aged 60 or older residing in these two
communes were enrolled.

interviews using a structured questionnaire,

which included four main parts: personal characteristics, physical activity, smoking and alcohol drinking. For overweight and obesity, we
measured waist circumference and hip circumference.
4. Measures and Instruments

2. Sample size
The sample size of the study was calculated according to the following formula

4.1. Personal Characteristics
Information regarding gender (male and
female), age (60 - 69, 70 - 79, ≥ 80), ethnicity

(p.(1 - p)
n = Z2(1- α/2)

(p.ε)2

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(Kinh, Tay, others), occupation (farmer and
others) and education (none, primary, lower

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secondary and upper secondary and higher)

WHR < 0.85 among women were classified as

was collected.

overweight. (ii) Men with WHR ≥ 1.00 and

Physical Activity

women with WHR ≥ 0.85 were classified as
having abdominal obesity (obesity by WHR).

We used the International Physical Activity

(iii) The individuals were classified as normal

Questionnaire (IPAQ) to measure physical

for men with a WHR < 0.90 and women with a

activity. The individuals were considered capa-

WHR < 0.80 [6; 7]. Hence, the subjects with

ble of physical activity if they reported partici-

criteria (i) and (ii) were considered as abdomi-

pation in moderate-intensity physical activity

nal overweight and obesity.

and vigorous-intensity physical activity for at
least 60 minutes for 7 days per week.

Smoking and Alcohol Use
The status of current smoking or drinking
was reported.

5. Data Analysis
Data entry was performed by Epidata 3.1
(EpiData Association). After data cleaning,
statistical analyses were performed using
Stata 12.0 (StataCorp). Qualitative variables

Overweight and Obesity
Measurement of waist circumference, hip
circumference: Stand up straight and breathe
out. Use a tape measure to check the distance
around the smallest part of the waist, just
above the belly button (waist circumference).
Then measure the distance around the largest

were described in percentage, and quantitative

variables

were

described

in

mean

(standard deviation) and median (min–max)
where appropriate. Multivariate logistic regression was used to examine the factors associated with overweight and obesity. A p-value of
< 0.05 was considered statistically significant.

part of the hips to the widest part of the but-

6. Research ethics

tocks (hip circumference).

All subjects received an explanation about

Overweight and obesity: WHR was calcu-

the purpose of the study. Personal information

lated as waist measurement divided by hip

of the subjects was kept confidential and

measurement (same unit of measurement). (i)

coded. Individuals with overweight or obesity

0.90 ≤ WHR < 1.00 among men and 0.80 ≤

were provided with consultation.

III. RESULTS
Table 1. Personal characteristics of the research subjects (n = 354)

Characteristics

n

%

Women

218

61.6

Men

136

38.4

214

60.4

Gender

Age Group
60 - 69
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Characteristics

n

%

70 - 79

83

23.5

≥ 80

57

16.1

Age Group

Median (min –max)

67 (60 - 90)

Mean±SD

69.5 ± 8.1

Ethnic Group
Kinh

59

16.7

Tay

244

68.9

Others*

51

14.4

313

88.4

41

11.6

None

44

12.4

Primary

178

50.3

Lower secondary

102

28.8

Upper secondary or higher

30

8.5

Job
farmers
Others

**

Education

*Others: Muong and Nung ethnic;

**Others: Officials, workers, retirees and freelance occupation.
The characteristics of the study sample are described in Table 1. The proportion of women
was 61.6%. The figure for the elderly aged 60 to 69 years was the highest, at 60.4%. The Tay
ethnic groups constituted 68.9% of the elderly. The main occupation was agriculture (88.4%). The
figure for older adults with primary education was the highest, at 50.3%.

Figure 1. The prevalence of overweight and obesity in the elderly (n = 354)
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As shown in Figure 1, the prevalence of abdominal obesity among older adults was the highest, at 43.8%. The figures for overweight and normal were 28.2% and 28.0% respectively. The
figure for average WHR was 0.89 ± 0.07.
Table 2. Factors associated with prevalence of overweight and obesity
by WHR in the elderly (n = 354)

Associated factors

Overweight and obesity (n,%)

Multivariate
OR

95%CI

Gender
Men

65 (47.8)

1

-

Women

189 (85.7)

4.60*

2.27 - 9.33

60 - 69

152 (71.0)

1

-

70 - 79

60 (72.3)

1.05

0.55 - 2.00

≥ 80

42 (73.7)

0.96

0.44 - 2.07

Kinh

38 (64.4)

1

-

Tay

181 (74.2)

1.84

0.91 - 3.70

Other

35 (68.6)

1.16

0.47 - 2.89

Yes

67 (69.1)

1

-

No

187 (72.8)

1.06

0.57 - 1.96

No

231 (79.9)

1

-

Yes

23 (35.4)

0.38*

0.19 - 0.78

No

231 (79.93)

1

-

Yes

23 (35.38)

0.95

0.47 - 1.95

Age group

Ethnic groups

Physical activity

Smoking

Drinking alcohol

*: The significance level was set at p < 0.05; OR: Odds ratio; CI: Confidence interval.
Table 2 shows association with the overall prevalence of overweight and obesity. The odds
ratio of overweight and obesity among women was higher than among men (ORs: 4.60). The
odds of overweight and obesity among older adults smoking was less than that of non-smokers
(ORs: 0.38). These factors were statistically significant.

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Table 3. Factors associated with prevalence of abdominal obesity in
the elderly (n = 354)

Associated factors

Multivariate

Abdominal obesity (n,%)

OR

95%CI

6 (4.4)

1

-

149 (68.4)

43.64*

13.15 - 144.86

60 - 69

91 (42.5)

1

-

70 - 79

36 (43.4)

1.08

0.55 - 2.14

≥ 80

28 (49.1)

1.49

0.66 - 3.34

Kinh

27 (45.8)

1

-

Tay

113 (46.3)

1.19

0.57 - 2.50

*

Gender
Men
Women
Age group

Ethnic group

15 (29.4)

0.35

0.13 - 0.91

Yes

36 (37.1)

1

-

No

119 (46.3)

1.44

0.76 - 2.73

No

153 (52.9)

1

-

Yes

2 (3.1)

0.53

0.09 - 3.09

No

147 (54.0)

1

-

Yes

8 (9.8)

1.16

0.34-3.90

Other
Physical activity

Smoking

Drinking alcohol

*: The significance level was set at p < 0.05; OR: Odds ratio; CI: Confidence interval.
Table 3 shows the association with the prevalence of abdominal obesity among older adults.
The odds ratio of abdominal obesity among women was higher than that among men (ORs:

43.64). The odds of abdominal obesity among others ethnic groups was less than that for Kinh
ethnic group (ORs: 0.35). These factors were statistically significant.

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IV. DISCUSSION
This is the first study to assess the prevalence of overweight and obesity by WHR
among older adults in two communes of the
northern mountainous areas in Vietnam. The
results indicated the prevalence of abdominal
obesity was the highest, at 43.8%, while the
figures for overweight and normal people were
similar (28.2% and 28.0% respectively). The
overall prevalence of overweight and obesity
in our study (72.0%) was much higher compared to the figure in Mo Cay Bac district of
Ben Tre province (28.2%) [8]. The obesity
classification between BMI and WHR might
contribute to this difference. The explanation
for this may be due to the fact that more than
three quarters of the elderly adult population
belongs to an ethnic minority with an agricultural job. The proportion of the elderly with
primary school education was the highest, at
50.3%. In particular, Kim Binh and Xuan
Quang are two poor communes in the northern mountainous area, therefore, awareness
of the locals is not only low but access to

health care services for them is also difficult.

ings among Malaysian and Indian populations
[9; 10]. The prevalence of overweight and obesity in older adults who smoke was less than
that of non-smokers. This may be explained
because smoking is associated with lower
weight and smoking cessation is associated
with weight gain [11; 12]. Reductions in smoking prevalence have been suggested as one
of the factors associated with an increase in
obesity [11; 12]. There is a statistically significant impact of the above factors on the overall
prevalence of overweight and obesity among
older adults.
Particularly, factors associated with abdominal obesity in the elderly, including gender, ethnic group and smoking were statistically significant. The prevalence of abdominal
obesity was higher among women than among
men. The prevalence of abdominal obesity of
other ethnic groups including Muong and
Nung was 0.35 times less than that of Kinh
ethnic group. The explanation for this may be
becaause the customs and the habits between
Kinh and ethnic minorities are different. A
report of the Vietnam Committee on Ethnic
Minority Affairs showed the general poverty

In this study, the prevalence of abdominal

concentrated on ethnic majorities such as

obesity among women was significantly higher

Muong and Nung, hence the malnutrition rate

than among men, at 68.4% and 4.4% respec-

among Tay and Muong people remains high

tively. The figures for a study among an Indian

even in recent years. Hence, the prevalence of

population were about 12% in men and 68% in

non-communicable

women [9]. Our result was also consistent with

ethnic majorities are much less than that of the

a study among a Malaysian population which

Kinh ethnic group [13]. The prevalence of

found a higher prevalence of abdominal

abdominal obesity in older adults who smoke

obesity among female respondents, at 6.2% in

is less than that of non-smokers. This is con-

males and 54.2% in females [10].

sistent with the results of a study in the United

disease

among

these

In general, the overall prevalence of over-

States that the probability of abdominal

weight and obesity has been found to be

obesity in nonsmokers was higher than that in

significantly higher among women than among

smokers [14]. A study from data of the 2002

men. This result was consistent with the find-

Swiss

122

Health

Survey indicated

that ex-

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smokers had higher ORs of being overweight

and obesity. The results of our study also sug-

or obese with respect to non-smokers [15]. A

gest that there is a need for further research in

national survey in Brazil found a higher preva-

other areas among older adults in Vietnam.

lence of abdominal obesity in adolescents who

ACKNOWLEDGMENTS

smoke than in nonsmokers [16]. It is likely that
these studies are conducted on the working

The authors would like to thank the Hanoi

age population and the prevalence of over-

Medical University and Hospital for recom-

weight and obesity is based on BMI, while our

mending the physicians who examined the

findings only focus on overweight and obesity

patients in this study, especially the elderly in

by WHR in the elderly aged 60 and older.

the two communes of Kim Binh and Xuan

This is the first study in an area of Viet-

Quang who participated in this study.

nam’s northern mountainous region. However,

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