BUSINESS COMMUNICATION

Term Report

4/15/2013

PREPARED FOR
Irfan Sheikh
Business Communication
Institute Of Business Management

PREPARED BY
Hafiza Rabia Naz
Shazia Tabassum
Saba Salahuddin
Tasmia Billoo

April 15, 2013

ACKNOWLEDGEMENT
First and foremost, we would like to thank the Almighty Allah for His help and granting the
ability to undertake this project. It is His will that our team has been able to complete this
term report.
We would like to express our sincere gratitude to Mr Irfan Sheikh our teacher, for his
valuable guidance, constructive comments and continuous encouragement throughout the
course.
Special thanks the Institute of Business Management for providing us a platform and
enabling us to conduct this study.
Last but not the least we would like to thank our respondents who made the research possible.

Hafiza Rabia Naz

11506

Shazia Tabassum

11616

Saba Salahuddin

13153

Tasmia Billoo

14529

ii

LETTER OF AUTHORIZATION
April 15, 2013

Dear Reader
Here is a report of comparative analysis of obesity in patients of high and low socioeconomic
status in Karachi Pakistan. The report has been authorized by Irfan Sheikh, faculty of
Business Communication Department at the Institute of Business Management Karachi.

The content of this report reflects the practical life scenario and we have tried our level best
to justify the valuable information gathered.

Yours sincerely,

Hafiza Rabia Naz

Shazia Tabassum
Saba Salahuddin
Tasmia Billoo

iii

LETTER OF TRANSMITTAL
April 15, 2013

Sheikh Muhammad Irfan

Senior lecturer, Communication
Institute of Business Management
Korangi Creek
Karachi-75190

Dear Sir

Attached is the report requested by you as a term project for assessment in the subject
Business Communication. This report comments on the obesity that severely affects the
population of Pakistan these days. This study generated some interesting results about
obesity incidence and its association with non- communicable diseases.
We believe that you find this report useful for future evaluation of our performance in this
course. Moreover, we would please to discuss this report and its conclusions with you at
your request.
Yours sincerely,
Hafiza Rabia Naz
Shazia Tabassum
Saba Salahuddin
Tasmia Billoo

iv

ABSTRACT
Obesity is increasing worldwide. In the last few years obesity is increased in developed
countries due to modern lifestyle, increase intake of energy drinks, baked food and decrease
physical activity. Socioeconomic status is also considered a big factor for the rapid increase
of this disease. This study was directed to find trends of obesity in public and private sectors
of Karachi. A questionnaire was filled at two multi-disciplinary setups of hospitals and these
hospitals gave sample of patients of high and low socioeconomic class. Body Mass Index was
determined and its involvement with multiple factors like eating habits, qualification,
education, earnings, constancy of physical exercise and demonstration of non-communicable
diseases like hypertension and diabetes mellitus was evaluated
The result was found that 7% of patients in lower socioeconomic class were obese as
compared to 31% of patients in the higher socioeconomic class. There was a positive
correlation between obesity and associated co-morbidities.
Our study can be concluded by summarizing that obesity is not a disease of the affluent only.
There

are factors

besides socioeconomic

status

responsible for

this

globesity.

Table of Contents
ACKNOWLEDGMENT ................................................................................................................................ i
LETTER OF AUTHORIZATION ................................................................................................................... ii
LETTER OF TRANSMITTAL ...................................................................................................................... iii
ABSTRACT............................................................................................................................................... iv
CHAPTER 1: INTRODUCTION ................................................................................................................... 1
CHAPTER PREVIEW........................................................................................................................ 1
BACKGROUND ................................................................................................................................ 1
CHAPTER 2: LITERATURE REVIEW ........................................................................................................... 4
CHAPTER PREVIEW........................................................................................................................ 4
LITERATURE REVIEW ........................................................................................................................... 4
CHAPTER 3: METHODOLOGY .................................................................................................................. 6
CHAPTER PREVIEW........................................................................................................................ 6
Rationale ............................................................................................................................................. 6
Objectives ........................................................................................................................................... 6
Hypothesis .......................................................................................................................................... 6
Significance of Study .......................................................................................................................... 6
Methodology ....................................................................................................................................... 7
Study Design ....................................................................................................................................... 7
Study Setting ....................................................................................................................................... 7
Duration .............................................................................................................................................. 7
Sample Size By Statistical Formula .................................................................................................... 8
Sampling Technique ........................................................................................................................... 8
Research Tool ..................................................................................................................................... 8
Sample Selection................................................................................................................................. 8
Inclusion Criteria: ........................................................................................................................... 8
Exclusion Criteria ........................................................................................................................... 8
Data Collection Procedure .................................................................................................................. 8
Study Variables ................................................................................................................................... 9
Data Analysis Procedure ..................................................................................................................... 9
Limitations of the study ...................................................................................................................... 9
CHAPTER 4: DATA ANALYSIS ................................................................................................................. 10

CHAPTER PREVIEW...................................................................................................................... 10
DATA ANALYSIS: ................................................................................................................................ 10
RESULTS ............................................................................................................................................ 19
Table.1 .............................................................................................................................................. 19
CHAPTER 5: DISCUSSION....................................................................................................................... 21
CHAPTER PREVIEW...................................................................................................................... 21
DISCUSSION....................................................................................................................................... 21
Recommendations ............................................................................................................................. 26
REFERENCES .......................................................................................................................................... 27
Appendix A: QUESTIONNAIRE ............................................................................................................... 29
Appendix B: CONSENT FORM................................................................................................................ 31
Title of study ..................................................................................................................................... 31
Principal investigators ....................................................................................................................... 31
Introduction ....................................................................................................................................... 31
Procedure .......................................................................................................................................... 31
Possible risks or benefits ................................................................................................................... 31
Right of refusal to participate and withdrawal .................................................................................. 31
Confidentiality .................................................................................................................................. 32
Available Sources of Information ..................................................................................................... 32
Authorization .................................................................................................................................... 32
DISCLAIMER........................................................................................................................................... 33

Table of Figures
Figure 1: BMI Distribution at Public Hospital...................................................................................... 10
Figure 2: BMI Distribution at the Private Hospital ............................................................................... 11
Figure 3: BMI & Physical Activity ....................................................................................................... 12
Figure 4: BMI & Physical Activity ....................................................................................................... 13
Figure 5: Gender Distribution at the Public Hospital............................................................................ 14
Figure 6: Gender Distribution at the Private Hospital .......................................................................... 15
Figure 7: Household Income compared with BMI ............................................................................... 16
Figure 8: Household Income compared with BMI ............................................................................... 17
Figure 9: Co-morbidities compared to BMI ......................................................................................... 18
Figure 10: Co-morbidities compared to BMI ....................................................................................... 18

Obesity in Patients of High & Low Socioeconomic Status in Karachi

CHAPTER 1
INTRODUCTION
CHAPTER PREVIEW
The common perception in our part of the world is that obesity is a disease of the west.
However, recent results have revealed an alarming rise in the incidence of obesity globally
including in the developing world. This chapter gives a brief background of this dangerous
disease that affects very rapidly to the whole world

BACKGROUND
Obesity has increased worldwide. Infect a new phrase globesity is used to manifest the rise
in global obesity. This term has been introduced by the author at WHO in Feb 2011 .It is
referred by many health experts as a more alarming concern than smoking (Quinion, 2002).
According to WHO, obesity has extended wide-ranging sections globally greater than 1
billion adults overweight - no less than 300 million

clinically obese - and is a chief

contributor to the global encumbrance of chronic disease and disability. An elevated body
mass index (BMI) which is the weight in kilograms divided by the square of height in meters,
account for 16% of the global encumbrance of disease, expressed as a percentage of
disability-adjusted life years( WHO, 2006). In the urbanized world 2-7% of total health care
expenditures are attributable to obesity. In the United States, the seventh leading cause of
death is obesity, with 280,000 avertable deaths in 2005. The projected health care budgets are
at $117 billion which is greater than the revenue spent on cigarette smoking and alcoholism
collectively (CD & Coleman, 2005).
Often prevailing in unindustrialized countries with under-nutrition, obesity is revealed by
experts to be an intricate condition, with serious social and psychological issues, which
affects almost all groups and socioeconomic classes. . In the recent years, the unindustrialized

Obesity in Patients of High & Low Socioeconomic Status in Karachi

countries have perceived an increase in obesity due to embracing of a modern lifestyle,

because of intake of energy-rich food and decrease activity. Socioeconomic class is one
reason for this. Such lifestyle changes have also distressed children in these countries; the
pervasiveness of overweight among them ranges from 10 to 25%, and the dominance of
obesity ranges from 2 to 10%. The Asian Pacific, East and China demonstrate extreme threat
(Hossain, Kawar &Nahas, 2007) In the analysis of data from NHS Pakistan 1990-1994, range
of BMI was used to assess the ratio of overweight people in Pakistan .In rural areas (BMl
above 25) in middle age was 9% for men and 14% for women; in urban areas, it was 22% and
37% for men and women. For old age it was 11% for men and 19% for women in rural areas,
and 23% and 40% in urban areas. Thus obesity is associated with socioeconomic culture
regardless of residence. (Nanan, 2002)
Changes in cultural factors contribute less to incidence of overweight then environmental
(Hodge & PZ & ames, 1994 &1995). Enhancement, and changing family association, preset
and fast paced working environment all affect activity. Generally interaction between genetic
factors and an undesirable environment triggers the process of weight gain. Obesity results
from a disparity among caloric intake. Nutrition plays a direct part in caloric balance; it is the
only factor accountable for caloric intake while calorie expenditure depends on three things
activity, BMR and the energy generation of food. The rate of obesity reduces by increasing
exercise (Chin PL et al. 1996). Regardless of physical activity evidence indicate that indolent
trends such as desk work and and irregular eating habits lead to obesity (Levine, 2007).
Obesity is a foremost risk for severe diet-related chronic diseases, such as type II diabetes,
cardiovascular disease, hypertension and stroke, and certain forms of cancer (Cameron &
Ching et al, 1996, 99). Risks of premature death and serious chronic conditions reduce the
standard of health (Hossain et al, 2007). It increases the modifiable risk factors. Obesity leads
to HTN, CVS and CVA, along with these disease quality of life is also impaired.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

WHO states that the fat epidemic is usually considered a western problem but now it has
become a problem of un-industrialized world. Malnutrition and obesity lies within the same
countries (Levine, 2007). In the past decade obesity has joined underweight, malnutrition and
infectious diseases as major health problems threatening the developing world (Hamilton,
Hamilton & Zderic, 2007).
Association between obesity and socioeconomic class is complicated yet found in discrete
people. It is also linked too much co-morbidity because of under privileged condition (Pyle et
al, 2006). The association between obesity and socioeconomic class is complicated but
bidirectional: being poor in the world's most underprivileged countries ( [GNP] < $800 per
year) leads to underweight and malnutrition, but being poor in a less privileged country (
GNP of $3,000 per year) is leads to an increased risk of obesity (Hossain et al, 2007). Some
countries have underweight children and overweight adults, because of intrauterine growth
restriction leading to low birth weight predisposing to obesity in adulthood because of a
thrifty phenotype (Swallen et al, 2005). This hypothesis suggest that because of the
adaptation, to lack of nutrition in intrauterine life metabolic and endocrine changes occur that
will only be beneficial in underprivileged conditions. But in excess of nutrition, it predisposes
to obesity and metabolic syndrome and CVS diseases. There is a multi-factorial etiology
behind it, lack of self-esteem, depression and body image are the elements associated with it.
This is also seen in industrialized and developed nations. People from underprivileged class
are less health conscious. This in linked with unhealthy behavioral choices (WHO, 2010).
This study relates the trends associated with obesity and the different socioeconomic classes
in Karachi.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

CHAPTER 2
LITERATURE REVIEW
CHAPTER PREVIEW
The common perception in the mind of every individual about obesity had it is a disease of
developed countries or more affluent people in developing countries. Many writers had done
a lot of researches on this major issue and revealed that it is not the disease of only developed
countries but also equally affected the people of developing countries like Pakistan. The
major findings and results of their studies are discussed in this chapter.

LITERATURE REVIEW
1. In their article, Hossain et al, has looked in the recent rise in obesity .It is a
threatening problem to health, in addition to malnutrition and infection. Diabetes,
CVS disease, and cancers are linked to excess weight. This burden is high in averageincome citizens. Obesity is 5th in disease burden after underweight.
2. This data has been collected from NHS Pakistan in 1990-1994. In this study the range
of BMI was used to assess the ratio of overweight people in Pakistan .In rural areas
BMl more than 25 in middle age was 9% for men and 14% for women; in urban areas,
it was 22% and 37% for men and women respectively. For old age it was 11% for
men and 19% for women in rural areas, and 23% and 40% in urban areas. Thus
obesity is associated with socioeconomic culture regardless of residence.
3. In the industrialized world, opposing relation has been seen in women with respect to
obesity and economic class. Obese females were less paid and were living in
hardship, were less qualified and were mostly single. Same views were found for
men. This was compared with disability and chronic illness. The results reviewed that
being overweight is a greater disability then having some chronic illness.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

4. The authors monitored kids of school going age to look at the understanding of
children about eating habits and body mass .The BMI of teenagers was calculated
along with an evaluation form. 17% people were underweight, 18% were overweight
and 65% were of normal weight. 90% of the people were aware that being obese is
detrimental to health and 96% enumerated workout as the means of losing weight.
The writer suggested mild physical activity as part of routine and more survey should
be conducted to establish good guidelines for health status for Pakistan.
5. The Sources scrutinized the liaison relating income and education along with body
mass index and waist circumference to apprehend the relationship amid
socioeconomic class and obesity, also

to detect manifestation of any sex

differences.7962 sample of 20 year old individuals conferred data about their stature,
physique, waist circumference, qualification and remunerations level. They ascertain
considerable association between income and obesity and abdominal circumference.
However this co-relation was not seen in female participants. Socio economic level
does effects the level of obesity but differently between the two sexes.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

CHAPTER 3
METHODOLOGY
CHAPTER PREVIEW
In this chapter we will be going to discuss the rational, objectives, hypothesis and
significance of study. In addition to these this chapter also discussed the methodology like
study design, setting, duration, sampling technique, sample size, study variables, data
collecting procedures, data analysis and limitation of study. The detail of all headings is
discussed below.

Rationale
Obesity is a global challenge with serious psychosocial and economic implications. It is
associated with a host of diseases, in addition to severely affecting the quality of life. The
economic burden resulting from the management of obesity and its associated complications
is quite substantial. Preventive interventions and successful management is associated with a
favorable impact on the associated medical conditions and also reduces the associated costs
in addition to improving the quality of life. The education of its ill effects and the importance
of healthy habits need to be encouraged to ensure a proper understanding of the problem.

Objectives
To compare the incidence of obesity in the adult population of Karachi by analyzing the
Body Mass Index (BMI) of patients from high and low socioeconomic status.

Hypothesis
Ho: There is no association between obesity and socioeconomic status.
HA: There is an association between obesity and socioeconomic status.

Significance of Study
Obesity is now considered a global epidemic. Obesity is still considered an issue of the west,
afflicting the affluent but recent years have seen an alarming rise in the incidence of obesity

Obesity in Patients of High & Low Socioeconomic Status in Karachi

in the developing countries as well. Recent changes of globalization and a more mechanized
way of living has ushered an era of sedentary lifestyle. This results in reduced physical
activity that in turn contributes to the development of obesity and an unhealthy lifestyle. The
issue of westernization of diet in the developing world further adds to the etiology of obesity.
In addition to its ill effects on an individuals health, there is a high cost associated with
obesity and its associated medical conditions. Successful management is associated with a
favorable impact on the associated medical conditions, besides improving the quality of life
and thus reducing the disease burden. There is abundant literature about preventive strategies
and guidelines regarding nutrition and obesity for developed countries. However, since
obesity is a burgeoning issue in the developing world, more local data is needed to tailor
strategies according to the local customs and dietary patterns. This study will help in raising
awareness in our society about obesity and its outcomes.

Methodology
The BMI of patients coming to government and private hospitals was calculated and
compared.

Study Design
This is a descriptive group comparison of obese patients from high and low socioeconomic
status.

Study Setting
The study was conducted in a government hospital (Jinnah Postgraduate Medical CentreJPMC) and a private hospital (South City Hospital-SCH).

Duration
This study was conducted over a period of one month from 1st April 2012-1st May 2012.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

Sample Size By Statistical Formula

n = (Z/2)2 p (q)/ (d)2
= (1.96) 2 *0.891-0.8) /(0.05)2
=3.84* 0.16/0.0025
=245
Convenient sample size of 100 patients due to lack of time

Sampling Technique
Rule of thumb would be applied.

Research Tool
Predesigned questionnaire filled by doctors

Sample Selection
Inclusion Criteria:
1. Adults between the ages of 18-60 years were included
2. Patients having at least one earning member in the family were included
Exclusion Criteria
1. Pregnant women were not included.
2. Mentally challenged patients were note included
3. Non-cooperative patients were not included
4. Children/adolescents under the age of 18 years were not included

Data Collection Procedure

Weight and height of patients was measured using height scale/measuring tape and calibrated
weighing scale at the two hospitals. Height was recorded in meters and weight in kilograms
and BMI calculated by using the formula weight/height2. Socioeconomic status was the other
variable and was measured in terms of overall family income, occupation and education
level.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

A predesigned questionnaire attached with this report was the data collection instrument. The
questionnaires were filled out by interview and translated to Urdu for patients who did not
understand English.

Study Variables
The following variables were studied:
1. BMI
2. Gender
3. Age
4. Socioeconomic status
5. Income
6. Education
7. Occupation
8. Co-morbidities
A predesigned questionnaire attached with this synopsis was the data collection instrument.
The questionnaires were filled out by us and translated to Urdu for patients who cannot
understand English.

Data Analysis Procedure

BMI of patients was used to calculate the obesity status of these two populations of patients.
Statistical Package for Social Sciences (SPSS) was used to analyze our data.

Limitations of the study

1. Time was an important limiting factor in our stud. Our sample size was 245 but due to
lack of time convenient sample size of 104 patients was done.
2. Due to ease of accessibility the study was limited to only two hospitals. A bigger
sample can be offered by involving other hospitals, educational institutes and other
public areas.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

10

CHAPTER 4
DATA ANALYSIS
CHAPTER PREVIEW
This chapter explained the major findings of our research. This research was conducted in
two major hospitals of Karachi as we had already mentioned in chapter three. SPSS is used to
analyze different variables like BMI, gender, age, socioeconomic status, income, education,
occupation and Co-morbidities. The detail of these variables findings are discussed below.

Figure 1: BMI Distribution at Public Hospital

DATA ANALYSIS:
Figure 1 depicts the prevalence of the overall BMI ranges and their frequency distribution
within the sample acquired from the public hospital representing the lower socioeconomic
class. It is clear that the most prevalent of all BMI ranges is the <23 group i.e. Underweight.
This is an alarming statistic and suggests that a huge proportion of our lower socioeconomic
society is malnourished. Upon calculating percentages, we find that approximately 46% of our
lower socioeconomic representative sample is Underweight.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

11

The ranges 23-25 i.e. Normal and 25-30 i.e. Overweight have similar frequency
distributions, however, upon looking closely we can see that we have slightly more
Overweight people than those of Normal BMI. Statistically, 22% Normal and 23%
Overweight were found in our Public Hospital sample. This suggests an increasing proportion
of Overweight individuals in our lower socioeconomic class succeeding from the Normal
weight range.
The range >30 of Obese turned out to be approximately 8%. Considering the lower
socioeconomic status, according to our assumptions for this study was the sector earning
anywhere less than Rs 20,000 monthly household income, this is a crucial figure. With the
cost of living so high, these patients dont earn enough to spend on high quality healthy food
choices, therefore, this 8% rate of obesity is most likely due to use of unhealthy, high calorie
high cholesterol foods and lack of physical activity.

Figure 2:

BMI Distribution at the Private Hospital

Figure 2 shows the frequency distribution of BMI from the Private Hospital. We see almost
22% of our Private Hospital patients as underweight which is almost 50% less than that of the
Public sector, signifying the predominance of underweight individuals in the lower
socioeconomic status.
BMI range 23-25 Normal weight is only 4%. Now this is another crucial figure. Private
sector has individuals earning more than Rs 150,000 household monthly income, they are

Obesity in Patients of High & Low Socioeconomic Status in Karachi

12

assumed to be at the Education level of Bachelors, of not higher, and are supposedly more
aware of healthy life choices. Yet, this class shows at least 12% lesser Normal BMI patients
compared to those of the lower socioeconomic class.
BMI range 25-30 Overweight is at a 30% and those of the Obese category BMI range >31
at a stupendous 39%. These are alarming statistics and show a dangerously unhealthy life
style by the representatives of our upper socioeconomic class.

Figure 3: BMI & Physical Activity

Figure 3 shows the cross-tabulation of BMI ranges and weekly exercise patterns of patients
from Public Hospital. Here the blue bar represents zero times weekly exercise and the green
bar represents once in a week exercising practices. It is obvious that a complete lack of
weekly physical exercise patterns exist in the representatives of lower socioeconomic class.
None of BMI ranges have any weekly exercising preferences, only the Normal Weight
individuals seem to follow once a week exercises pattern with a very low percentage of only
3%. This suggests a major lack of awareness of physical activity among the representatives of
the lower socioeconomic class.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

13

Figure 4: BMI & Physical Activity

Figure 4 show the cross-tabulation of BMI ranges and exercising pattern from the Private
Hospital. Just to point out, here the blue color is representative of once a week exercise and
green is twice a week exercise pattern. This graph seems better in terms of awareness of
physical activity as we see more and higher green bars on each BMI range, suggesting a
predominant pattern of twice a week exercise. It may seem confusing that the Obese and
Overweight group has the highest count of twice a week exercise. This may suggest that,
since these patients are attending a private hospital, they are being explained of the
importance of physical activity in order to lose weight.
It is interesting to notice that even the <23 Underweight individuals have a relatively high
frequency of weekly exercising pattern. This may suggest that either they are exercising too
much for their desired physical needs.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

14

Figure 5: Gender Distribution at the Public Hospital

Figure 5 shows cross-tabulation among BMI ranges of males (blue) vs. females (green) at the
public hospital setting. It is seen that almost 22% of males and 24% females are underweight
in the lower socioeconomic class. This is not surprising as these individuals do not have the
access to resources or buying power as well as the awareness of healthy lifestyle choices.
The Normal weight range of 23-25 is more predominant in males (19%) compared to females
(3%). The reason to this is probably that the cultural set up of Pakistan is so that mothers,
daughters, wives tend to eat after the sons, brothers and husbands have had their meals.
Women usually tend to eat the left-over and hence might not be getting required meal
portions. This is a more common observation in the lower socioeconomic class.
Tables turn back at the Obesity and Overweight ranges of BMI. Females, again, tend to be on
the high end of weight scales (6% Obese and 16% Overweight). This is probably due to lack
of physical exercise, and sedentary lifestyles. Males are found to be at 1.5% Obese and 8%
Overweight. These are rather alarming statistics for Overweight and Obese males and
females from a low socioeconomic class. This suggests that there is a prevalence of Obesity
and being overweight even in our lower socioeconomic class.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

15

Figure 6: Gender Distribution at the Private Hospital

Figure 6 shows cross-tabulation among BMI ranges of males (blue) vs. females (green) at the
Private Hospital setting. The trends are similar to that of the Public Hospital with respect to
Obese and Overweight groups of BMI ranges. However, there are a strikingly higher number
of females in the Obese group of Private Hospital (29%) compared to that of the males (10%)
as well as the females in the Public Hospital (6%). Another important fact to notice is the 0%
males being in the Normal weight range at the Private Hospital. This could possibly mean
that our randomly selected sample missed out of any of the males who fall in the Normal
weight range of BMI. Despite that, the figure suggests a very low incidence of healthy males
in the upper socioeconomic status which is a matter of high concern, as in our society males
are still considered as the sole providers of their family.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

16

Figure 7: Household Income compared with BMI

Figure 7 is a cross-tabulation of BMI ranges and the monthly household income of patients at
the Public Hospital, depicting the lower socioeconomic class. The monthly household ranges
are defined in the legend; blue is <Rs. 10,000, green is between Rs. 10,000-20,000 and Beige
is Rs. 20,000-50,000.
It is surprising to see the prevalence of Overweight as well as Obesity in the lower
socioeconomic class. Approximately, 8% of individuals earning a monthly household income
of Rs. 10,000-20,000 are obese. None of the two other income groups are found to be obese
in our sample. However, all three income groups are found to be over weight: <Rs.10, 000 at
8%, Rs. 10,000-20,000 at 13% and Rs. 20,000-50,000 at 6.35%. These income groups are
economically lower socioeconomic groups, yet they all coincide in the Overweight range of
BMI. This suggests, yet again, a low awareness of healthy eating habits and lack of physical
activity.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

17

Figure 8: Household Income compared with BMI

Figure 8 is a cross-tabulation of BMI ranges and the monthly household income of patients at
the Private Hospital. Although at the beginning of our study we assumed that the Private
Hospitals would represent the upper socioeconomic class, but as we analyzed our data on
SPSS 17.0 we came to find that our selected Private Hospital serves a mix of Karachi
residents from all socioeconomic strata. Figure 8 then depicts a list of colored legends and
respective monthly household income ranges for all socioeconomic patients visiting the
Private Hospital.
It is strange to see that the highest incidence of Obesity, Overweight and Underweight
individuals fall in the highest monthly household income of more than Rs. 150,000; 12% for
Obese, 5% for Overweight and 7% for Underweight, as well do those in the second highest
range of Rs. 100,000-150,000, 5%, 10% and 2% respectively.
Another striking observation is the prevalence of the lower socioeconomic status in the
Obesity and Overweight groups with 10% and 7% respectively. It is rather unfortunate to
notice no prevalence of any of the upper or lower socioeconomic groups in the Normal BMI
range.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

18

Figure 9: Co-morbidities compared to BMI

Figure 9 is a cross tabulation of co-morbidities associated with BMI at the public hospital.
Surprisingly 1.6 % of patients had hypertension and diabetes mellitus irrespective of their
BMI. But where at normal BMI 36.5% patients had no co-morbidities, there were no patients
without any co-morbidity at BMI above 30.

Figure 10: Co-morbidities compared to BMI

Figure 10 is a cross tabulation of co-morbidities associated with BMI at the private hospital.
Again the probability of finding patients with no co-morbidities declines with rising BMI.

19

Obesity in Patients of High & Low Socioeconomic Status in Karachi

2.4% patients had both hypertension and diabetes mellitus at normal BMI while 22% of
patients with BMI more than 30 had these diseases. This figure illustrates the association
between high BMI and co-morbidities better than the data from the public hospital although
the patient pool from here was significantly lower (41 patients). Despite the low number, the
positive association of co-morbidities with high BMI is again illustrated.

RESULTS

Table.1
Demographics

Public

Private

63
42years

41
43years

Gender
Mean Weight
Overweight (BMI>25)

Male:32;Female:33
73.34kg
23%

Male:13;Female:28
67.5kg
27%

Obese
Gender Distribution of
Obesity

7%

33%

M=3%; F=12%

M=31%; F=43%

Association with
Co-morbidities

7.9%

39%

Education Level

Bachelors & Above: Nil

Bachelors & Above:

10,000-20,000(7%)

>150,000 (31%)

Total Respondents
Mean Age

Household Income (monthly)

Table 1: Results

Our results are summarized in the table above. We were able to fill out 63 questionnaires at
JPMC and 41 at SCH. 7% of patients from JPMC were found to be obese and 23% of them
were overweight. 33% of patients from SCH were obese and 27% were overweight. 3% of
males from JPMC were obese while 12% of females constituted the obese segment. In SCH
31% of males and 43% of females were obese. 7.9% of patients from JPMC had associated
non-communicable diseases like hypertension and diabetes mellitus while 39% of patients

Obesity in Patients of High & Low Socioeconomic Status in Karachi

20

from SCH had these diseases. The segment of patients who were obese (7%) in JPMC
belonged to the lower socioeconomic status with a monthly household income of less than
Rs.20, 000 while in SCH the obese (31%) had a monthly household income of more than
Rs.150, 000.
.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

21

CHAPTER 5
DISCUSSION
CHAPTER PREVIEW
At the start of this study we think that obesity is a disease of only high socioeconomic class.
But after the results of this research we concluded that it is not only the disease of high
socioeconomic class but also affect the low socioeconomic class of Pakistan as well. This
chapter is a brief discussion of the findings of this study.

DISCUSSION
Obesity is a chronic condition that is prevalent worldwide. Pakistan being a developing world
is not exempted. In fact the probability of malnourishment (underweight and obesity) is found
in all strata irrespective of the socioeconomic status. Cheap energy dense foods are as big a
culprit as expensive calorie laden food. This study has illustrated the incidence of obesity in
all strata.
- Figure 1 depicts the prevalence of the overall BMI ranges and their frequency distribution
within the sample acquired from the public hospital representing the lower socioeconomic
class. It is clear that the most prevalent of all BMI ranges is the <23 group i.e. underweight.
This is an alarming statistic and suggests that a huge proportion of our lower socioeconomic
society is malnourished. Upon calculating the percentages, we find that approximately 46%
of our lower socioeconomic representative sample is Underweight.
The ranges 23-25 i.e. Normal and 25-30 i.e. Overweight have similar a frequency
distribution, however, upon looking closely we can see that we have slightly more
overweight people than those of Normal BMI. Statistically, 22% Normal and 23%
Overweight were found in our Public Hospital sample.

This suggests an increasing

proportion of overweight individuals in our lower socioeconomic class succeeding from the
Normal weight range.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

22

The range >30 of Obese turned out to be approximately 8%. Considering the lower
socioeconomic status, according to our assumptions for this study was the sector earning
anywhere less than Rs 20,000 monthly household income, 8% is a crucial figure. With the
cost of living so high, these patients dont earn enough to spend on high quality healthy food
choices, therefore, this 8% rate of obesity is most likely due to use of unhealthy , high calorie
high cholesterol foods and lack of physical activity.
-Figure 2 shows the frequency distribution of BMI from the Private Hospital. We see almost
22% of our Private Hospital patients as Underweight which is almost 50% less individuals in
the lower socioeconomic status.
BMI ranges 23-25 Normal Weight is only 4%. Now this is another crucial figure. Private
sector has individuals earning more than Rs 150,000 household monthly income, they are
assumed to be at the Education level of Bachelors, of not higher, and are not supposedly more
aware of healthy life choices. Yet, this class shows at least 12% lesser Normal BMI patients
compared to those of the lower socioeconomic class.
BMI range 25-30 Overweight is at 30% and those of the Obese category BMI range >31
at a stupendous 39%. These are alarming statistics and show a dangerously unhealthy life
style by the representatives of upper socioeconomic class.
-Figure 3 shows the cross-tabulation of BMI ranges and weekly exercise patterns of patients
from Public Hospital. Here the blue bar represents zero times weekly exercise and the green
bar represents once in a week exercising practices. It is obvious that a complete lack of
weekly physical exercise patterns exist in the representatives of lower socioeconomic class.
None of BMI ranges have any weekly exercising preferences, only the Normal Weight
individuals seems to follow once a week pattern with a very low percentage of only 3%. This
suggests a major lack of awareness of physical activity among the representatives of the
lower socioeconomic class.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

23

-Figure 4 shows the cross-tabulation of BMI ranges and exercising pattern from the Private
Hospital. Just to point out, here the blue color is representative of once a week exercise and
green is twice a week exercise pattern. This graph seems better in terms of awareness of
physical activity as we see higher green bars on each BMI range, suggesting a predominant
pattern of twice a week exercise. It may seem confusing that the Obese and Overweight
group has the highest count of twice a week exercise. This may suggest that, since these
patients area attending a private hospital, they are being explained of the importance of
physical activity in order to lose weight. It is interesting to notice that even the < 23
Underweight individuals have a relatively high frequency of weekly exercising pattern. This
may suggest that either they are exercising too much for their desired physical needs.
-Figure 5 shows cross-tabulation among BMI ranges of males (blue) vs. females (green) at
the public hospital setting. It is seen that almost 22% of males and 24% females are
underweight in the lower socioeconomic class. This is not surprising as these individuals do
not have the access to resources or buying power as well as the awareness of healthy lifestyle
choices.
The normal weight range of 23-25 is more predominant in males (19%) compared to females
(3%). The reason to this is probably that the cultural set up of Pakistan is so that mothers,
daughters, wives tend to eat after the sons, brothers and husbands have had their meals.
Women usually tend to eat the left-over and hence might not be getting required meal
portions. This is more common observation in the lower socioeconomic class.
Tables turn back at the obesity and overweight ranges of BMI. Females, again, tend to be on
the high end of weight scales (6% Obese and 16% Overweight). This is probably due to lack
of physical exercise, and sedentary lifestyles. Males are found to be at 1.5% Obese and 8%
Overweight. These are rather alarming statistics for Overweight and Obese males and

Obesity in Patients of High & Low Socioeconomic Status in Karachi

24

females from a lower socioeconomic class. This suggests that there is a prevalence of Obesity
and being overweight even in our lower socioeconomic class.
-Figure 6 shows cross-tabulation among BMI ranges of males (blue) vs. females (green) at
the Private Hospital setting. The trends are similar to that of the Public Hospital with respect
to Obese and Overweight groups of BMI ranges. However, there are a strikingly higher
number of females in the Obese group of Private Hospital (29%) compared to that of the
males (10%) as well as the females in the public hospital (6%). Another important fact to
notice is the 0% males being in the Normal Weight range at the Private Hospital. This could
possibly mean that our randomly selected sample missed out of any of the males who fall in
the Normal weight range of BMI. Despite that, the figure suggests a very low incidence of
healthy males in the upper socioeconomic status which is a matter of high concern, as in our
society males are still considered as the sole providers of their family.
-Figure 7 is a cross-tabulation of BMI ranges and the monthly household income of patients
at the Public Hospital, depicting the lower socioeconomic class. The monthly household
ranges are defined in the legend; blue is < Rs 10,000, green is between Rs. 10,000-20,000 and
Beige is Rs. 20,000-50,000.
It is surprising to see the prevalence of Overweight as well as Obesity in the lower
socioeconomic class. Approximately, 8% of individuals earning a monthly household income
of Rs. 10,000-20,000 are obese. None of the two other income groups are found to be obese
in our sample. However, all three income groups are found to be overweight: Rs. 10,000 at
8%, Rs. 10,000-20,000 at 13% and Rs. 20,000-50,000 at 6.35%. These income groups are
economically lower socioeconomic groups, yet they all coincide in the Overweight range of
BMI. This suggests, yet again, a low awareness of healthy eating habits and lack of physical
activity.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

25

-Figure 8 is a cross-tabulation of BMI ranges and the monthly household income of patients
at the Private Hospital. Although at the beginning of our study we assumed that the Private
Hospitals would represent the upper socioeconomic class, but as we analyzed our data on
SPSS 17.0 we came to find that our selected Private Hospital serves a mix of Karachi
residents from all socioeconomic strata. Figure 8 then depicts a list of colored legends and
respective monthly household income ranges for all socioeconomic patients visiting the
Private Hospital.
It is strange to see that the highest incidence of Obesity, Overweigh and Underweight
individuals fall in the highest monthly household income of more than Rs. 150,000; 12% for
Obese, 5% for Overweight and 7% for Underweight, as well do those in the second highest
range of Rs. 100,000-150,000, 5%, 10% and 2% respectively. It is rather unfortunate to
notice no prevalence of any of the upper or lower socioeconomic groups in the Normal BMI
range.
In addition to severely impairing the quality of life, obesity is also associated with a host of
illnesses that are detrimental to health. As analyzed in our study as well, the chances of
developing co-morbidities increase with a rising BMI. The successful treatment of obesity
also has a favorable impact on these diseases. Hence a better awareness and aggressive
approach to the treatment of obesity is the need of the hour.
-Figure 9 is a cross tabulation of co-morbidities associated with BMI at the public hospital.
Surprisingly 1.6% of patients had hypertension and diabetes mellitus irrespective of their
BMI. But where at normal BMI 36.5% patients had no co-morbidities, there were no patients
without any co-morbidities declines with rising BMI. 2.4% patients had both hypertension
and diabetes mellitus at normal BMI while 22% of patients with BMI more than 30 had these
diseases.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

26

Figure 10illustrates the association between high BMI and co-morbidities better than the data
from the public hospital although the patient pool from here was significantly lower (41
patients). Despite the low number, the positive association of co-morbidities with high BMI
is again illustrated.

Recommendations
1. Obesity is prevalent everywhere threatening to assume the importance of an epidemic.
There is a dire need to educate our masses about the significance of harmful effects of
obesity especially in female.
2. Healthy eating pattern need to be encouraged with healthy emphasis on regular
exercise. The eating patterns at home need to be changed with minimizing the intake
of oily and fried food.
3. The habit of eating should be curtailed and there should be stress on the nutritional
value of food.
4. The importance of regular exercise should be stressed and encouraged.
5. These changes should be especially instilled in our children, educating them about the
importance of healthy food and inculcating the habit of regular exercise in them.
6. Regular seminars should be organized and importance of health and healthy living
emphasized.

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Obesity in Patients of High & Low Socioeconomic Status in Karachi

REFERENCES
The world health organizationreport, W.H.O., (2006), working together for health. Geneva:
Rutt CD,R.C.D, Colmen KJ, K.J.K.( 2005) Examining the relationships among built
environment, physical activity and body mass index in El Paso, TX. Preventive Medicine;
40(6):831-841
Hamilton, H.M.T., Hamilton DG, H.D.G., Zderic TW, Z.T.W., (2007) Role of low energy
expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular
disease. Diabetes, 56(11):2655-2667.

Rehman T, R.T et al. (2003) Obesity in Adolescents of Pakistan. JPMA, 53(7): 315

Quinion, M.Q., (2002) Globesity: worldwidewords.org, Int J. Obes. and Metab;19( 3): S34145
Hossain H.P, Kawar,K.B. & Megui, N.M., (2007) Obesity and Diabetes in the Developing
World A Growing Challenge, N Engl J Med 356:213-215
Nanan DJ, N.D.J., (2002), The obesity pandemic--implications for Pakistan, J Pak Med
Assoc.; 52(8):342-6
Alam Khan, A.K., et al (2003) Prevalence of Obesity in the Employees of Universities, Health
and Research Institutions of Peshawar, Pakistan Journal of Nutrition 2 (3): 182-188,
Hodge AM,H.A.M., Zimmet PZ. Z.P.Z (1994), The epidemiology of obesity,
Clinical Endocrinology and Metabolism; 8:577-99

Bailleres

Levine JA, L.J.A.,(2007) Non-exercise activity thermogenesis - liberating the life-force. J

Intern Med, 262:273-287..
Pyle SA. P.S.A., (2006) Fighting an epidemic,The role of schools in reducing childhood
obesity. Psychology in the Schools; 43(3): 361-376.

Cameron A, C.A., & Ching, C. et al.( 2003 ) Overweight and obesity in Australia: the 19992000 Australian Diabetes, Obesity and Lifestyle Study (Aus Diab). Med J 178:427-432.
Yeong, Y. (2006) Socioeconomic Status in Relation to Obesity and Abdominal Obesity in
Korean Adults: A Focus on Sex Differences Obesity, 14:909-919

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Stunkard & Sorensen, S.S, (1993) Obesity and socioeconomic status a complex relation.
New Engl J Med; 329: 1036 1037.

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Appendix A
QUESTIONNAIRE
Serial #:_____________

Hospital: __________________

Demography
Name (optional):______________________________
Age (yrs):______________ Gender: Male ________Female________
Weight (kg): __________ Height (m): _____________ BMI (kg/m2): _____________
Area of Residence: ______________________________Occupation: _________________

Education Level: Uneducated_______ Primary_______ Matriculation/ O-Level __________

Intermediate_______ Bachelors______ Masters_______

PhD_________

Marital Status: Single ________ Married ________ Divorced ________Widower _______

Parity:__________
Monthly Salary Range: Less than Rs. 10,000________ Rs. 10,000 19999________
Rs. 20,000 49999 _________ Rs. 50,000 74,999 _______
Rs. 75,000 99,999 _________Rs. 100,000 149,999_____
Rs. 150, 000 and above _______
Monthly Household Income:
Less than Rs. 10,000________ Rs. 10,000 19999________
Rs. 20,000 49999 _________ Rs. 50,000 74,999 _______
Rs. 75,000 99,999 _________Rs. 100,000 149,999_____
Rs. 150, 000 and above _______
No. of earning members in family: __________No. of dependent members: __________
House Characteristics: Rented______ Own house: _______
Number of proper meals in a day:

2 _______ 3______ More _____

Do you snack between meals: Yes ______ No _____

Do you take any carbonated drinks every day? (one who is consuming drink in a week will
mark it as no):

Yes

No

If yes, how many:

Do you eat out? ______Number of times in a week? _______
Medical History

30

Obesity in Patients of High & Low Socioeconomic Status in Karachi

Do you think obesity is harmful to your health? Yes ______ No ______

Do you have any of the following diseases?
_____Hypertension
_____Diabetes Mellitus
_____Asthma
_____Joint diseases
_____ Other

Is there a history of obesity in your family? Yes ______ No ______

How many times do you exercise in a week: Once ______ Twice ______ More ______
How does your weight affect your daily activities? _____________________________
Do you want to lose weight? Yes ____ No ______
If

not,

then

why

not?

____________________________________________________________
If yes, why do you want to lose weight? _________________________________________
How do you think you can lose weight? _____________________________
Have you tried losing weight in the past?
What do you hope to accomplish by losing weight?

Questionnaire filled out by: ___________

THANK YOU FOR PARTICIPATION

Obesity in Patients of High & Low Socioeconomic Status in Karachi

31

Appendix B
CONSENT FORM
Title of study
Comparative analysis of obesity in patients of high and low socioeconomic status in Karachi

Principal investigators
Dr. Talat and Hafiza Rabia Naz

Introduction
We are MBA students at IoBM and are conducting a research on obesity and its relevance to
socioeconomic status among patients. We want to compare the two variables to depict if
obesity is also predominant in lower and middle class families of Karachi, or is it just a
disease of the affluent. Since your socioeconomic status fits our criteria for this research, we
would like to invite you to participate in this research.

Procedure
In this study we will ask few questions about your demographics, social health and general
health practices including diet preferences and exercise routine. This will take about 15
minutes of your time.

Possible risks or benefits

There is no risk involved in this study except that we will be taking some of your valuable
time. There is no direct benefit to you also. However, you might feel more aware of how
obesity is or might affect you.

Right of refusal to participate and withdrawal

You have the right to participate or withdraw from the study without any loses or benefits.
You may also refuse to answer some or all the questions if you dont feel comfortable.

Obesity in Patients of High & Low Socioeconomic Status in Karachi

32

Confidentiality
The information that you provide will remain confidential. Nobody except the principal
investigators and the research coordinator will have an access to it. This is an anonymous
process so your name will not be asked or disclosed at any time.

Available Sources of Information

If you have any further questions you may contact the Principal Investigator.

Authorization
I have read and understand this consent form, and I volunteer to participate in this research
study, but I understand that my consent does not take away any legal rights in the case of
negligence or other legal fault of anyone who is involved in this study. I further understand
that this research does not include my name and other legal information and that it is not
intended to replace any applicable Federal, state, or local laws.

Participants Name (Printed or Typed):

Date:

Participants Signature or thumb impression:

Date

Principal Investigators Signature:

Date:

Obesity in Patients of High & Low Socioeconomic Status in Karachi

33

Appendix C
DISCLAIMER
The information provided by you will remain confidential. Nobody except the principle
investigator will have access to it. Your name and identity will not be disclosed at any time.
However, the data may be seen by ethical review committee and may be published in journals
elsewhere without disclosing your identity.