Neck circumference as a tool

1. Prevalence of obesity among the
young girls (18-22 yrs) of Dawoodi
Bohra Community in Central
Mumbai.
Ms. Sakina A Ratlamwala
Guided by- Mrs. Anuradha Shekhar

2. Introduction
• Obesity is a chronic disorder of energy imbalance.
It exists all over the world and is increasing at an
alarming rate in developed and developing
countries . Obesity may be defined as a condition
in which excessive accumulation of fat in adipose
tissue has taken place. According to WHO obesity
is caused when BMI is greater than 25kg/m2 and
on the other hand if the percentage of the body
fat in males is greater than 25 percent and in
females is greater than 30 percent
www. apps.who.int/bmi/index.jsp?introPage=intro_3.html

3. Aim
• To find the prevalence of obesity among the
young girls of Dawoodi Bohra community.

4. Objectives
• To determine the prevalence of overweight and
obesity among young Bohri girls of age (18-22 yrs).
• To assess the anthropometric measurements and to
compare their BMI to their nutritional status.
• To assess the body composition using skin fold
measurements.
• To establish the neck circumference and foot length
measurements as markers of obesity.
• To evaluate the nutritional status and eating pattern
of the obese individuals using one day dietary recall.
• To analyze the clinical symptoms using a
questionnaire

5. Methodology
Distribution of pamphlets
Saifee mohalla husaini kutbi fatemi
405 sample of 18-22 year old girls
study conducted in a community hall
Using a questionaire background information
obtained

6. Cont..
1. Anthropometric assessment
• Height
• Weight
• Calculation of BMI
• Circumference measurements-waist
circumference, Hip circumference, WHR, mid
upper arm circumference.
• Skin fold measurements-bicep, tricep,
subscapular, suprailiac.
• Foot length and neck circumference.

7. Cont..
2. Clinical assessment
3. Dietary assessment
4. Family history
5. Medical history
Followed by calculation of body density, body fat%, fitness score
based on body fat %
Identification of overweight and obese subjects from the sample
(using WHO cut offs for BMI)
Subsample of 58 overweight and obese selected and nutritional
assessment using 24 hr dietary recall was done

8. Results and discussions
Background information
• Educational status- Maximum number of subjects (n=202) 49.9%, had obtained a
higher secondary certificate.
• Marital status- Maximum of (n=321) 79.3% were unmarried
• Type of family- nuclear family system was predominant in the community (n=250)
• Work related information- 18 % (n=73) of the total sample were working from
which 16.8% of subject had a desk job and a very minute percentage (1.2%) had a
field job.
• Family monthly income- a majority (45.4%) of the subjects fell in the highest
income range of above 15000 Rs per month

9. Anthropometric details
• BMI classification- the prevalence of Obesity
underweight
32%
normal
48%
overweight
15%
obese
5%
BMI classification

10. Cont..
• Fitness Classification based on body fat %
21%
15.6%
25.2%
26.4%
11.9%
fitness scale as per body fat percentage
excellent: 9-18.9
good: 19-22.1
fair: 22.2-25
poor: 25.1-29.6
very poor:
>29.6
Sen Ray K., Iqbal R., Body Composition: Terms And Techniques,2010: 1; 1-5, In: Methodologies For Fitness
Assessment, Anne Books Pvt. Ltd.

11. Co-relation of BMI and Fitness scores
0
10
20
30
40
50
60
70
80
90
100
underweight normal overweight obese
excellent
good
fair
poor
very poor
significant correlation at p=0.001

12. Neck circumference and foot length
• Significant correlation between foot length and obesity (p=0.002) as well as neck
circumference and obesity (p=0.000) was found
• Best cut-off of Neck Circumference is ≥33.35cms to predict obesity with sensitivity=89.5%
and specificity=90.9% for the present study.
• A study done in Israel among 979 subjects, for screening obesity using neck circumference
on the same lines reported NC 37 cm for men and 34 cm for women were the best cut off
levels for determining the subjects with BMI 25.0 kg/m2 using the receiver output curve
analysis with a 98% sensitivity, 89% specificity and NC 39.5 cm for men and 36.5 cm for
women were the best cut off levels for determining the subjects with BMI 30 kg/m2 with
93% sensitivity, 90% specificity. Similarly in Chinese subjects Receiver operating
characteristic analysis showed a neck circumference of ≥38 cm for men and ≥35 cm for
women was the best cut off point for determining overweight subjects
Noun B. ; Neck Circumference as a Simple Screening Measure for Identifying Overweight and Obese Patients, Obesity Research (2001) 9,
470–477
Yang G.R., Neck circumference positively related with central obesity, overweight, and metabolic syndrome in Chinese subjects with type
2 diabetes: Beijing Community Diabetes Study 4, Diabetes care 2010 Nov;33(11):2465-7. Epub 2010 Aug 19

13. Comparison of Obese and Non obese
as per BMI and neck circumference
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
obese non obese
4.70%
95.30%
12.80%
87.20%
As per
BMI
As per
NC

14. Comparison of obesity as per BMI and
Foot length
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Obese Non Obese
4.70%
95.30%
64.90%
35.50%
As per
BMI
As per FL
The result of ROC analysis reported a cut off of 22.9cm for foot
length measurement to identify obesity with a specificity =33.7%
and sensitivity =36.8%.

15. Correlations of anthropometric measurements with
dietary nutrient intakes.
• A strong positive correlation (p=0.000)
between oil consumption and the weight of
the subjects.
• Similarly oil consumption of the subjects had
positive correlations at a significance of
(p<0.001) with other anthropometric indices
like BMI, waist circumference, hip
circumference, WHR, MUAC and Neck
circumference.
• The body density had a significant negative
correlation at (p<0.05)

16. Correlation between BMI and other
anthropometric parameters
• A significant correlation (p<0.01) between
WHR and BMI, WC and BMI, HC and BMI, and
MUAC and BMI was obtained. Thus these may
be successfully used in the determination of
obesity and its associated co-morbidities.

17. Dietary pattern details
• Regularity of meals- The overweight and obese group had
66.1% and 52.6% regular meal eating habits respectively.
Maximum meal regularity was seen among the normal BMI
group (71.4%).
• Meals per day- four meals a day by each of the BMI
categories was the trend observed.
• Obesity and eating out pattern- highly significant relationship
(χ2=73.864, p=0.0001) with the BMI of the sample in relation
to their eating out patterns . The overweight and obese
individuals displayed the maximum frequencies of eating out
i.e. 39% and 36.8% respectively every alternate day.

18. Diet recall
• Energy: The average energy intake of the subsample was 1981kcal ±309.449kcal.
This average intake is 4.3% higher than the recommended caloric intake of
1899kcal for a young adult lady having reference weight 55kg as per (ICMR, 2010)
• CHO: The mean CHO intake of the subsample as depicted in was 65.19% ±8.77% of
the total caloric intake. This was in accordance to the recommended CHO
requirement as per the recent RDA.
• Protein: The average per day protein intake of the subsample (n=58) was 8.7% ±
2.14% of the total energy intake. As per ICMR daily protein intake calculated for as
per 0.8g/kg B.W is 9.2%of total calorie intake.
• Fat: The recommended fat intake is 20% of the total recommended energy intake.
The obese and overweight subsample demonstrated a mean fat intake of 26%
±8.5% which was significantly higher than the RDA requirements.

19. Clinical assessment
• There were 2.46% (n=10) subjects exhibiting
dryness of skin and 5.18% (n=21) showing
pale inner eyelids. Specific clinical symptoms
like bleeding of gums, pallor, deformities in
nails and teeth, eczema, inflammation of
tongue etc were not observed among the
subjects.

20. Menstrual details
• Age of menarche- The present study data illustrates that the mean
ages of menarche for Underweight, normal, overweight and obese
were 13.24,12.34, 10.76, 11.32 respectively . The relationship test
carried out between obesity and early age of menarche for the
present study showed a significant co-relation (p=0.00) Thus, as
BMI increased age of menarche decreased.
• Regularity of menses- The menstrual irregularity was prominent
among the obese subjects (n=19) with 78.9% . These results
support that obesity influences the menstrual cycle irrespective of
the fat distribution and can cause many reproductive disorders in
women

21. Family history
• Co-relation between obesity and family history of obesity.
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Not obese Obese
36.30%
(n=140)
94.70%
(n=18)
63.70%
(n=246)
5.30%
(n=1)
No
Yes
obesity of the subjects in relation to their familial history of obesity
showed a very strong significance (p=0.000) of positive co-relation

22. Medical history
• Medication for PCOS was reported to be
consumed by a total of 24 subjects
• Co-relation between PCOS and BMI
.The test result reported a significant co-relation
(χ2=33.357, p=0.000) between increase BMI
and PCOS

23. Physical activity
• Physical activity pattern
n=64
15.81%
n=341
84.19%
physical activity
Exercising
Not exercising
The co-relation analysis between Physical exercise and BMI
reported a significant correlation at (p<0.05).

24. Summary and conclusion
• Prevalence of Obesity and overweight subjects were 5%
and 15%
• The fat percentages of normal BMI subjects were highly fair
and poor pointing to the thin fat phenomenon
• The obese and overweight subjects had increased calorie
and fat consumption as compared to the RDA.
• Best cut-off of Neck Circumference is ≥33.35cms to predict
obesity(≥30kg/m2) with sensitivity=89.5% and
specificity=90.9%. Thus Neck circumference proved to be a
good anthropometric marker of overweight and obesity.
• Finally the dietary and physical activity patterns on a whole
reported increased need to improve the dietary pattern
and eating behaviours of the youth and encourage energy
expenditure by engaging in an exercise regime and active
lifestyle behaviour.

25. Thank you