Exploring the risk and protective factors associated with obesity amongst Libyan adults (20 -65 years)

A thesis submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Doctor of PhilosophyBackground Obesity is a highly complex, chronic disorder with a multifactorial aetiology that includes biological, psychosocial and cultural factors. Since the discovery of oil in 1959, Libya has been undergoing a nutrition transition. Despite obesity reaching epidemic proportions in Libya, there is a lack of information about obesity in Libyan adults. Aims The aims of this study were to investigate the risks and protective factors associated with obesity among adult men and women in Libya; to estimate gender differences in the prevalence of obesity among Libyan adults; and to explore key informants’ views about obesity within the context of Libyan culture. Design of study An adapted mixed-methods sequential explanatory design was used, consisting of two phases: a quantitative study in the form of a cross-sectional design, and a qualitative study in the form of semi-structured interviews, which followed up on the findings of the first phase. Method A multi-stage cluster sampling technique was used to select participants from the Benghazi electoral register. With a response rate of 78%, the sample consisted of 401 Libyan adults, aged 20-65 years, who have lived in Benghazi for over ten years; 63% were female. A survey questionnaire was used to examine the relationship between Body Mass Index (BMI) and the following four-predictor variables, derived from the Socio-Ecological Model (SEM): socioeconomic status; unhealthy eating habits; physical activities and sedentary lifestyle; and neighbourhood environment. Anthropometric measurements were collected from participants in their homes. For the qualitative phase, 9 Libyan healthcare professionals and 12 Libyan community leaders (key informants) were individually interviewed. A mixed-methods approach to study obesity has not previously been used in Libya. Results The prevalence of obesity among Libyan adults was found to be 42.4%, whereas that of being overweight was 32.9%. A significant positive association was found between obesity and two SES components (education level and income) in Libyan adults of both genders, while occupational status was significantly positively associated with obesity in women only. Obesity was significantly positively associated with fast-food consumption, and the consumption of large food portion sizes, in Libyan adults of both genders. In contrast, the consumption of sugar-sweetened beverages was significantly positively associated with obesity in Libyan women but not in men. A significant inverse association was found between breakfast consumption and obesity in Libyan adults. Obesity was significantly negatively associated with physical activity in Libyan women, while significantly positively associated with sedentary behaviour in Libyan women but not in Libyan men. Finally, a significant association exists between the BMI of Libyan adults in 6 of the 12 neighbourhood environment attributes. For Libyan men and women these were: street connectivity, ‘unsafe environment and committing crimes at night’, and neighbourhood aesthetics. For men only, these were: access to public transport, access to recreational facilities, and ‘unsafe environment and committing crimes during the day’. Finally, ‘residential density zones’ was significant for women but not for men. Three main risk factors were identified from the qualitative study. The first concerned the heavy subsidisation of staple food commodities in Libya; the second is Libya’s deteriorating health sector performance; and the third is the effect of the neighbourhood environment on physical activity and food, including the current political and economic instability in Benghazi which is potentially fuelling the obesity epidemic. These themes and additional sub-themes were categorised as belonging to one of the five spheres of the SEM (individual; interpersonal; institutional and organisational; community and physical environment; and public policy), resulting in the final conceptual framework of this study. Some of the qualitative results contradicted the quantitative results, resulting in some inconclusive findings. Conclusion These findings could inform Libyan health policies and the interventions that are urgently needed for preventing or controlling the obesity epidemic in Libya. Key recommendations are that an electronic health information system needs to be implemented and awareness about obesity and its causes and consequences needs to be raised among the public in order to dispel the many myths and misconceptions held by Libyans about obesity

Prevalence of overweight and obesity among Libyan men and women

Libya is following the trend observed in developing countries of steadily becoming more obese, such that obesity in Libya has reached epidemic proportions in the twenty-first century. The prevalence of obesity in Libya has more than doubled in the last three decades, with the numbers of overweight and obese adults being continuing to grow. Therefore, this study aimed to estimate and describe the prevalence of overweight and obesity among Libyan men and women. A cross-sectional survey was conducted to examine the prevalence of overweight and obesity among the Libyan population. A multistage sampling technique was employed to select 401 Libyan adults randomly from the Benghazi electoral register. Qualified nurses were allocated to take anthropometric measurements (including visceral fat and Body Mass Index (BMI)) from participants using the Segmental Body Composition Analyser and a portable Stadiometer. The response rate achieved in this cross-sectional study was 78%. Four hundred and one Libyan adult, aged 20-65 years, participated; 253 were female (63%). The prevalence of obesity, overweight, and normal weight among Libyan adults was 42.4%, 32.9%, and 24.7%, respectively. The results also revealed that approximately 75.3% of Libyan adults were overweight and obese, and the prevalence of overweight and obesity in women was significantly higher than that in men (the prevalence of overweight was 33.2% in women compared to 32.4% in men, while the prevalence of obesity was 47.4% in women compared to 33.8% in men, respectively). The findings of this study confirmed that obesity and overweight are the fastest growing issues and have become one of the most serious public health challenges confronting the Libyan authorities. As the obesity epidemic in Libya continues to escalate, with a complete absence of prevention interventions to reduce obesity, more research is desperately needed to follow the trend of gender difference in the prevalence of overweight and obesity among Libyans adults across the Libyan state to improve the effective interventions for preventing obesity

Perceived environmental factors associated with obesity in Libyan men and women

Background: There is a lack of research pertaining to the links between built environment attributes and obesity in adults in the Eastern Mediterranean Region. In the Libyan context, no previous studies have been conducted to investigate this relationship. Therefore, the aim of this study was to examine associations between perceived neighbourhood built environmental attributes and obesity among Libyan men and women. The prevalence of overweight and obesity was also assessed. Methods: A cross-sectional study design was used for the population-based survey in Benghazi, Libya. A multi-stage cluster sampling technique was used to select Libyan adults from the Benghazi electoral register. The Physical Activity Neighbourhood Environment Scale (PANES) was used to measure participants’ perception of neighbourhood environmental factors. Using the Tanita BC-601 Segmental Body Composition Monitor and a portable stadiometer, anthropometric measurements were taken at a mutually agreeable place by qualified nurses. Results: Four hundred and one Libyan adults were recruited (78% response rate). Participants were aged 20–65 years, 63% were female, and all had lived in Benghazi for over 10 years. The prevalence of obesity and overweight was 42.4% and 32.9% respectively. A significant association was found between BMI and 6 neighbourhood environment attributes, specifically: street connectivity, unsafe environment and committing crimes at night, and neighbourhood aesthetics. For men only, these were: access to public transport, access to recreational facilities, and unsafe environment and committing crimes during the day. The attribute ‘residential density zones’ was only significant for women. Conclusions: The study suggests that Libyan people are at risk of living in neighbourhoods with unsupportive environmental features of physical activity, which are likely to promote obesity of both genders. The findings of this study could inform Libyan health policies about interventions in the obesogenic environments that might slow the obesity epidemic and contain the public health crisis. This study suggests that further research is needed, within the Libyan context, to explore the impact of the neighbourhood environment attributes on contributing to increased obesity

Investigating the Association between Unhealthy Dietary Habits and Obesity among Libyan Adults

Background: Although an increasing number of studies have reported on nutrition transition and unhealthy eating habits (UEHs) worldwide, there is a paucity of studies on UEHs in the Arab region, particularly in Libya. Aim: This study investigated the associations between obesity among Libyan adults and UEHs. Methods: A cross-sectional survey was conducted at the five major districts in Benghazi, Libya. A multistage cluster sampling strategy was implemented to choose and recruit Libyan adults. Anthropometric measurements were gathered by highly qualified nurses, using the Segmental Body Composition Monitor and a portable Stadiometer. The study used and adapted the two Self-administered questionnaires: the WHO STEPS Instrument and eating behaviors linked with obesity questionnaire. Results: Among a total of 401 participants who were successfully recruited in this study, 253 (63%) were female (aged 20–65 years), the response rate achieved was 78%. The prevalence of obesity amongst Libyan adults was estimated to be 42.4%. The results revealed the presence of a significant association between obesity (BMI ≥ 30 kg/m2) and five UEHs for Libyan men and six UEHs for Libyan women. For Libyan men, an association was found between obesity and the following five explanatory factors: fast food intake in a day and a week, which were (OR: 2.52, 95% CI: 4.04–12.32) and (OR: 4.65, 95% CI: 1.04–9.46), respectively; large food portion sizes consumed at one sitting (OR: 19.54, 95% CI: 1.41–27.74); a high frequency of skipping breakfast either in a typical day or a week, which were (OR: 0.02, 95% CI: 0.01–0.77) and (OR: 0.03, 95% CI: 0.01–0.24), respectively. For Libyan women, a significant association was found between obesity and the following six explanatory factors: fast food intake in a day and a week, which were (OR: 2.14, 95% CI: 3.32–11.12) and (OR: 5.5, 95% CI: 1.88–16.11), respectively; intake of sugar-sweetened beverages in a typical week (OR: 4.02, 95% CI: 1.35–11.99); and large food portion sizes consumed at one sitting at one sitting (OR: 3.40, 95% CI: 1.18–9.84); and a high frequency of skipping breakfast either in a typical day or a week, which were (OR: 0.11, 95% CI: 0.03–0.43) and (OR: 0.12, 95% CI: 0.08–0.63), respectively. Conclusions: The findings of the study reveal areas of action for Libyan researchers, clinicians, policymakers, and government officials about UEHs in the Libyan context. This could inform establishing and developing new interventions for preventing and controlling the obesity epidemic through food system improvements