Answer :

Introduction

Obesity is a major problem and contributes to difficulties in prevention and management of chronic diseases in healthcare globally (Hruby & Hu, 2015). The high obesity cases are caused by industrialization, urbanization, mechanized transport systems, sedentary lifestyles, high calorie diets, and transition to consumption of processed foods. Therefore, obesity is a multifactorial, complex and preventable health condition that affects nearly a third of todays’ global population. It is estimated that if proper prevention measures are not taken, by the year 2030, approximately 20% of the global population will be obese and another 38% will be overweight (Kelly et al., 2008). Considering the case of the United States, it is projected that by the year 2030, more than 85% of the people will be obese and overweight (Wang et al., 2008). Obesity is described as increased body weight for height and is characterized by excess body adiposity, both in metabolism as well as body size. This condition increases the risks of morbidities such as disabilities, diabetes, depression and heart disease among others. This clearly indicates how high the economical and psychosocial costs linked to obesity are, while death might finally ensue. According to WHO reports, about 61.9% of people aged twenty years in the United States and Europe have a BMI of more than 25, indicating that they are obese (Khabazkhoob et al., 2017). However, if proper prevention programs are adopted, then the cases of obesity based on age and gender can be greatly lowered to achieve a good quality of life. Therefore, the purpose of this review is to evaluate various articles concerning obesity in middle aged adults, especially its prevalence, effects and prevention strategies.

Methods

In this review, an extensive literature search from various sources was carried in order to get top quality article based on this research topic. The following key words were used to create various meaningful phrase combinations based on medical subjects. These were: obesity, prevalence, overweight, lifestyle diseases, randomized controls, informed consent, and middle age. Moreover, online bibliographic searches were also conducted in various medical databases such as Medline, Tris, Pubmed and Embase. The literature searches were limited to English language as long as they included studies on obesity in middle aged adults. Therefore, all articles that contained one or more of the listed search words on the titles were retrieved for analysis. The inclusion criteria were the availability of the articles in English, published in peed journals and randomized clinical trials. On the other hand, the exclusion criteria were any articles published in a different language other than English, quantitative research, obesity in young children, and articles published before the year 2005.

Results

Having carried out a detailed review, 15 research articles were retrieved from the databases used.  Out of these reviewed research articles, only four of them were found to meet the inclusion criteria of being specific about obesity in middle age adults, and were thus considered for literature review.

Interventions

In a study by Khabazkhoob et al., (2017), the prevalence of overweight and obesity were determined as well as their associated factors among the middle aged people in Shahroud, in Iran. In this case, a population based cross sectional study using random cluster sampling method was carried out. There were 300 clusters which were randomly selected in Shahroud consisting of people aged between 40 to 64 years old. This study was done between the year 2009 and 2010 and during the initial enrollment process, the study participants had their weight and height taken on a weighing scale. In this case, obesity was described as whereby the BMI was more than 30kg/m². Out of the 6311 people who were selected to participate in this study, only 5190 of them representing 82.2% participated in the study. The obtained data was expressed as prevalence in form of percentages at 95 confidence interval. The BMI based on age and gender for the study participants were indicated that, while 74% were overweight, 31% were obese. Additionally, being obese and overweight was significantly higher in women with a p< 0.001. it was also noted that being a female with a higher economic status predisposed an individual to having a high BMI. Based on age, those people above the age of 54 years were more likely to have a high BMI as compared to those in the range of 40 to 44 years, with a p<0.001. In this study, obesity was common in women as compared to men and as WHO reports, it was high in people from 20 years of age and above, more so those between 40 to 60 years of age. This study also found out that the high obesity recorded was linked to low inequality such that most groups in the society were affected in a uniform manner.

Kishi et al., 2014 studied the relationship between the BMI and the effects on the structure and functions of the left ventricles. This was following the observation that a longlisting obesity causes heart disease and failure. Therefore, this study evaluated the effects if obesity on cardiac functions among the young adults and middle aged people. In this study, the Coronary Artery Risk Development in Young Adults enrolled both White and Black study participants aged 18-30years of age in the years 1985 to 1986. Out of the 3,498 surviving participants from an overall of 5,115 recruited people, various tests were conducted to determine the effects of obesity on cardiac functions. At the twenty-fifth year, the cardiac tests were carried out in these patients and was accessed by the use of echocardiography and tissue dropper imaging methods. This change over the course of twenty-five years was split into groups namely: The low-low, high-low, low-high and eventually high-high. The common covariates measured in this study were age, height, weight, blood pressure, smoking, level of education and physical activities amongst many more. Then the BMI was measured with normal BMI values being set as between 18.5 to 25 kg/m2. The obtained data obtained was analyzed and presented in form of descriptive statistics such as means and standard deviations. The twenty-five years’ follow-up indicated that there was a positive correlation with tracking deformity indices which reflect a low ability to contract and less contracting behaviors. The measurement of BMI for the participants aged between 18-30 years as well as the change over a period of 25 years was consistent to dysfunction of the left ventricles. Obesity causes the development of myocardial remodeling through various mechanisms. This is because high amounts of adipose is linked to hemodynamic volume overload causing the left ventricle dilation and hypertrophy. Generally, a high level of BMI in young and middle adulthood causes reduced diastolic and systolic roles of the left ventricles.

A research was conducted by Kirunda et al., 2015 to determine the factors associated with obesity and overweight in peri-urban and rural regions of Uganda. This is due to the observation that obesity and overweight are a major problem to non-communicable disease which co-exist high under nutrition. Globally, the cases of obesity and overweight are on the rise, while undernutrition still continues to be a major threat. In this analysis, a cross sectional study was carried out on 1210 randomly selected participants who were adults of eighteen years and above in Iganga Mayule Health and Demographic Surveillance site in the year 2013. The study population consisted of both men as well as non-pregnant women aged eighteen years and above. Therefore, a semi structured questionnaire was administered to collect quantitative data on some variables such as sex, age, place of residence, education level, monthly earnings in order to understand the sociodemographic characteristics. Then the anthropogenic characteristics like height, and weight were collected for each participant and recorded. This research found that being a female of above thirty-five years, living in peri-urban areas and having a high social economic status was associated with obesity and overweight. Moreover, the study participants in the age of 35-44, 45-54, 55-64 were more prone to developing obesity as compares to those aged 18-24 years. Moreover, the highest obesity prevalence was recorded among men (5.4%) in the age range of 55-64 years, while it was high in women aged between 45-54 years. Moreover, the mean BMI was found to be highest among the middle ages. This study therefore demonstrated that truly, obesity and overweight are high among females and middle aged adults and thus the need to put appropriate measures to control these non-communicable diseases.

Muhihi et al., (2012) carried out a research in which obesity, overweight and perceptions concerning body weight occurs among the middle aged adults in Dar es Salaam in Tanzania. This research was conducted bearing in mind the fact that while obesity and overweight are increasing at a high rate globally, the manner in which people view their own bodies determines their weight control and health improvement process. The design used by the researches was a cross sectional study which was quantitative in nature. A total of two hundred and fifty people were randomly selected to participate in the stud but only two hundred and nine were enrolled in the study. The social economic status of the participants was collected using structured questionnaires and the following information was gathered: income, and education among other information. Then anthropogenic data was collected concerning weight, height, hip circumference, waist circumference, and eventual calculation of BMI so as to classify the participants as either under or overweight. The prevalence of obesity and overweight among the middle aged adults in this study based on BMI was 32.54 and 23.44% respectively. It was reported that more than a third of the people reported that their body weight had increased within one year.  While a total of 19% of the middle aged adults perceived themselves as being either obese or overweight, the proportion of men and women with this perception was zero and 2 respectively. This study found that there are gender differences on obesity prevalence which affected the perceptions. It was commonly observed that the overweight men would underestimate their body weight

Discussion

Obesity is caused by the increased accumulation of body fat in various tissues and is associated with increased BMI. The prevalence of this condition is always on the increase and hence causes significant global public health problems to people (Seburg et al., 2017). The increase in the prevalence of obesity is caused by urbanization, and changes in lifestyles such as inactivity leading to a high burden related to co-morbidities (Biro & Wien, 2010). The non-communicable diseases including obesity require sophisticated technologies for accurate assessments. Therefore, the BMI has been selected as a measure of obesity and overweight levels among patients (Banack et al., 2018). The BMI gives a very good correlate of the proportion of body fat in middle aged people because this is the age bracket where obesity is very common. In obesity, the problem is not the amount of fats in the body but rather the manner of distribution to various parts of the body. In central obesity, there is high amounts of visceral fats and causes cardiac diseases (Rahmani et al., 2018). An individual with central obesity presents with a body shape which is similar to that of an apple. In subcutaneous obesity, the fats are deposited around the hips and buttocks and can be observed by assessing the waist circumference and waist hip ratio. There are a number of morbidities related to the development of obesity and these cause negative effects to the patients. For instance, obesity is known to cause impaired glucose tolerance otherwise known as type 2 diabetes (American Diabetes Association, 2017).

A study by Hu et al., (2001) used a cohort of female nurses, 84941 in number for sixteen years and found that there was the development of diabetes mellitus in 3300 participants. Obesity has also been linked with increased cases of hypertension and possible gain in weight. For instance, the BMI has been reported to have a positive correlation with hypertension for people aged between eighteen years and middle adults (Segula et al., 2014). In the process of fighting conditions of the cardiovascular system, the existing policies recommend the maintenance of body weight. This is because high amount of BMI in middle adults causes a risk to the emergence of heart diseases, hypertension and diabetes among other comorbidities (Alidu et al., 2017). According to Muhihi et al., (2012), obesity cases are on the increase and most people especially men underestimate this fact. This means that most overweight people have a high likelihood of gaining more weight and becoming obese since no strategies can be taken to control a person’s own behavior. Sometimes, culture could have a role in the development of obesity and overweight. For instance, culture determines how people view themselves with respect to weight gain and obesity and hence the commitment to control obesity (Meldrum et al., 2017). However, in most cities, no culture is predominant since people come from all spheres of a country leading to the adoption of an urban lifestyle.

Lack of proper parental guidance is another cause of increased cases of obesity because parents have a very busy lifestyle. Busy lives make parents lack time to educate their children about proper nutrition and balanced diet. Most people also consume fast foods from fast restaurants which are fatty (Berry et al., 2017). Once obesity develops among the middle aged adults, various spheres of their lives are affected negatively (Kelly et al., 2008). For instance, they are bullied and hence develop low self-esteem and consequently depression. People should thus take time to prepare healthy foods which have less fat calories and also engage in physical activities. Obesity is considered to be the main cause of premature deaths in the United States especially among the middle age adults. While the relative risks of the BMI rise as age increase, the obesity and overweight have been on the rise in the middle age adults. The body weight reflects the eventual health condition of a person and may lead to the development of other heath conditions causing comorbidities. The actual effects of the development of obesity and overweight as well as deaths can be obscured by confounding factors (Osher & Stern, 2009). An example is a situation whereby there is a reverse causation as a result of the prior existence of chronic diseases and habits like smoking, which could expose them to non-BMI related mortalities.

As the world continues to develop, so does health treatment options for various diseases also advance. The main approach is in engaging in activities which can reduce the body fat such as physical exercises (Biro & Wien, 2010). There are indoor exercising machines that are available which help in the reduction of sore shins. These indoor machines are economical because they save people from spending so much in attending the gym. Thus, the physical exercise machines can be programmed to reach varied exercise levels. When people fail to engage in physical activities and aerobics, they stand a high risk of high accumulation of fats in the adipose tissues and thus high fat mass. Physical inactivity also has some effects on the metabolism in the skeletal muscles whereby it causes high lean body mass and high volume of muscles (Osher & Stern, 2009). It is also worth noting that obesity in some lesser instances can be caused by an interaction between the environment and genes. There is an expression of genes that favor the excess storage of fats in some individuals. Some of these genes have been selected across a long period of time and thus they are maladaptive in a constantly changing environment.

Limitation

This review carried out an investigative search on previous and recent research related to obesity in middle age adults. However, this review did not consider any unpublished work or thesis, which in real sense could have substantial information about the topic. Moreover, the review was limited to scholarly articles published in English language. This means that it was biased since there is a possibility of better articles published in different languages which could be a source of rich information about the research topic. Moreover, there was age limits in terms of the type of articles to be used for review. This was initially aimed at getting recent information concerning middle age adult suffering from obesity. This was in order to limit the research to recent development and findings in causes, management and recommendations in this non-communicable disease.

Conclusion

It is evident that obesity, which goes hand in hand with overweight are on the increase globally. The major causes are socioeconomic status which are closely influenced by the demographic characteristics. It is thus necessary for people especially the middle age adults to adopt healthy living styles like eating a balanced diet and engaging in regular physical activities. The most commonly observed form of obesity is the abdominal obesity and it’s still the most predictive form. It could therefore be possible that the abdominal obesity promotes insulin resistance in the genetically proposed people. This is activated by an increased flux of the sugars and fatty acids leading to low glucose clearance in blood. With a high prevalence of metabolic syndrome, there has been an observed hypertension, high fats and high waist circumference