SEARCHCROSS-SECTIONALendocrinology, cardiology

cross-sectional·endocrinology, cardiology, public_health, nutrition, internal_medicine·PMC10088635

Perception, environmental determinants, and health complications of excess weight in India: a mixed methods approach

Scientific Reports · 2 authors, 3 centres

AI SUMMARY

FIDELITY 88%

POPULATIONFemales and males aged 25–54 years with a BMI of 25 or higher and waist circumference of 80 cm (females) or 90 cm (males) living in the Kolkata metropolitan area for at least six months prior to the study.

INTERVENTIONNot applicable (observational mixed-methods study; no intervention was administered).

COMPARISONNot applicable (no comparison group; descriptive study).

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

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TL;DR

This mixed-methods study of 120 adults with excess weight in Kolkata, India, found that environmental factors such as lack of access to healthy foods, food advertising, and weather conditions promote obesity. Participants recognized that obesity increases the risk of diabetes, hypertension, cholesterol, and heart disease, with hypertension being the most common existing complication. The study highlights the need for health education, better food policies, and regulation of fast foods and sugary beverages to combat obesity in urban India.

Full summary

4,682 CHARS

**Background:** Obesity prevalence has increased threefold globally between 1975 and 2016, with an estimated 650 million individuals affected. In India, approximately 20% of adults aged 15–49 years have a BMI of 25 or higher. The Kolkata metropolitan area has one of the highest obesity rates in India, with around 43% of males and 41% of females aged 15–49 having a BMI of 25 or higher. Environmental factors such as food marketing, availability of healthy foods, and neighborhood walkability play a complex role in obesity risk. This study aimed to understand perceptions, environmental determinants, and health complications of excess weight among adults in Kolkata using a concurrent mixed methods approach.

**Methods:** The study employed a concurrent mixed methods design with data collected between November 2019 and October 2020. Purposive and snowball sampling were used to recruit 120 participants (60 females, 60 males) aged 25–54 years with a BMI of 25 or higher and waist circumference of 80 cm or higher (females) or 90 cm or higher (males). The principal investigator measured height, weight, and waist circumference for each participant. A quantitative survey with 28 items using a five-point Likert scale (Cronbach's alpha = 0.76), 4 items on level of importance (Cronbach's alpha = 0.73), and 5 dichotomous items (Cronbach's alpha = 0.37) was administered. Additionally, 18 in-depth semi-structured interviews (9 females, 9 males) were conducted, each lasting 20–25 minutes on average. Quantitative data were analyzed using descriptive statistics in Stata 14.0, and qualitative data were analyzed using inductive coding following Creswell's six-step approach. The Social-Ecological Model and Health Belief Model informed the development of field instruments.

**Key Results:** The average age of participants was 39 years. The mean BMI was 31.28, and the mean waist circumference was 106.44 cm. Among survey participants, 50.83% had a BMI of 30 or higher, and 57.5% had a waist circumference greater than 102 cm. Regarding environmental determinants, 53.33% of participants strongly agreed and 39.17% agreed that easy access to fast food increased obesity risk. Lack of accessibility to fresh produce was noted by 33.33% who agreed and 16.24% who strongly agreed. High-calorie food advertising was identified as a risk factor by 36.67% (agree) and 19.17% (strongly agree). However, 37.61% disagreed and 17.09% strongly disagreed that health awareness programs existed in their community. Most participants agreed (56.67% agree, 16.67% strongly agree) that parks, open spaces, and wellness facilities helped prevent obesity. Regarding health complications, 68.33% (n=82) of survey participants reported at least one health complication, and 17.5% (n=21) had three or more complications. Hypertension was the most common complication (37.5%, n=45), followed by thyroid issues (20.83%, n=25), cholesterol (20%, n=24), high blood sugar (16.67%, n=20), sleep apnea (21.67%, n=26), and asthma (10.83%, n=13). Among female participants, 13.33% (n=8) had PCOS. Participants reported difficulty with squatting and snoring as functional concerns. Qualitative findings expanded on these results, with interviewees expressing concerns about food adulteration, packaged foods, profit-driven food and medical industries, and the lack of nutrition education. Participants suggested interventions at institutional, community, and social/public policy levels, including raising awareness, promoting healthy food access, regulating fast foods and sugary beverages, and improving wellness programs.

**Clinical Implications:** The study demonstrates that adults with excess weight in Kolkata are generally aware of obesity-related health complications, particularly diabetes, hypertension, cholesterol, and heart disease, but less aware of links to cancer and sleep apnea. Hypertension was the most prevalent complication, affecting over a third of participants. The findings underscore the need for health education programs, improved food safety regulations, and policies addressing the obesogenic environment. The authors note that India does not classify obesity as a disease and that government support for obesity treatment is limited. They recommend rigorous food safety inspections, regulation of pesticide usage, improved healthcare services, and policies governing the sale and marketing of junk foods. The study highlights that environmental factors—particularly the food environment—play a critical role in obesity and that interventions must address social, environmental, and commercial determinants of obesity rather than focusing solely on individual responsibility.

PICO

PPOPULATION

Females and males aged 25–54 years with a BMI of 25 or higher and waist circumference of 80 cm (females) or 90 cm (males) living in the Kolkata metropolitan area for at least six months prior to the study.

IINTERVENTION

Not applicable (observational mixed-methods study; no intervention was administered).

OOUTCOME

Perceptions of obesity, environmental determinants (e.g., food access, advertising, neighborhood safety), and self-reported health complications (e.g., hypertension, diabetes, cholesterol, difficulty squatting).

STUDY TYPE

cross-sectional

SPECIALTY

endocrinology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

88% · B

ORIGINAL PAPER

PMC10088635

Perception, environmental determinants, and health complications of excess weight in India: a mixed methods approach

Scientific Reports

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ABSTRACT

In light of the high and rising prevalence of obesity, we studied females and males aged 25–54 years with excess weight in the Kolkata metropolitan region, one of India's main cities, to understand the perception, environmental determinants and health complications of obesity. We resorted to primary fieldwork. The close-ended quantitative survey questionnaire was designed to capture the perception and health complications of the sampled population, while a semi-structured interview guide comprising open-ended questions was prepared to capture the target population’s in-depth views. Following the WHO guidelines on BMI and WC cut-off for Asian adults, the sampled population comprised females and males aged 25–54 with a waist circumference of 80 cm and 90 cm or higher, respectively, and a BMI of 25 or higher in the Kolkata metropolitan area. Using a concurrent mixed methods approach, we collected and analysed quantitative and qualitative data separately using descriptive statistics and inductive coding before combining them. In the study area, we completed 120 surveys and 18 in-depth interviews. Some environmental factors promoting obesity were the lack of access to healthy, fresh foods, lack of health awareness programmes, advertisements, and weather conditions in Kolkata. Interview participants also extended their concerns about food adulteration and the food industry. Participants confirmed that obesity could increase the risk of developing diabetes, hypertension, cholesterol and heart disease. Further, participants felt squatting was challenging for them. Hypertension was the most common existing health complication found among the study participants. Participants suggested raising awareness, promoting and making access to healthy food and wellness programs more accessible, and regulating fast foods and sugary beverages at institutional, community and social/public policy levels to prevent obesity. Health education and better policies are required to combat obesity and related complications.

CITATION EXPORT

Somdutta Barua, Nandita Saikia. Perception, environmental determinants, and health complications of excess weight in India: a mixed methods approach. Scientific Reports. (2023). https://doi.org/10.1038/s41598-023-31016-w

AUTHORS

2 · 3 CENTRES

Somdutta Barua, Nandita Saikia

1grid.10706.300000 0004 0498 924XJawaharlal Nehru University, New Delhi, India
2grid.473700.70000 0004 0499 4356National Institute of Urban Affairs, New Delhi, India
3grid.419349.20000 0001 0613 2600Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India