University of Perpetual Help - Dr. Jose G.

Tamayo Medical Center

Sto. Niño, Biñan, Laguna

ASSOCIATION OF SMOKING AND OBESITY AMONG RESIDENTS OF

ZONE 2 STO. DOMINGO, BIŇAN, LAGUNA

ON MAY 2016

In partial fulfillment of requirements in

The Department of Family and Community Medicine

Beverly Berceles
Apple Rose Untalan
Investigators

Dr. Romeo Andaya

Dr. Angelita Camacho
Dr. Winnie Siao

May 2016
 ACKNOWLEDGEMENT

We thank our colleagues from the University of Perpetual Help – Dr. Jose G.

Tamayo Medical Center who provided insight and expertise that greatly assisted the

research, although they may not agree with all the interpretation or conclusions of this

paper. We thank our advisers for the assistance and comments that greatly improved

the manuscript.

We would also like to show our gratitude to our residents for sharing their pearls

of wisdom with us during the course of this research. We are also immensely grateful to

our co-interns for their comments on an earlier version of the manuscript, although any

errors are our own and should not tarnish the reputations of these esteemed persons.

More acknowledgement may not redeem the debt we owe to our parents for their

direct/indirect support during the entire course of the project. Lastly, to God for providing

us knowledge, guidance from which we received fruitful and timely completion of this

work.
 ii

ABSTRACT

Heavy smokers tend to have greater body weight than do light smokers or

nonsmokers. In addition, smoking increases insulin resistance and is associated with

central fat accumulation. As a result, smoking increases the risk of metabolic syndrome

and diabetes, and these factors increase risk of cardiovascular disease.

The aim of this study is to determine the association of smoking and obesity

among residents of Zone 2 Sto. Domingo, Biñan, Laguna. Descriptive correlational

research design was used in the study. Universal sampling method was applied. The

researchers used descriptive statistics like frequency distribution and percentage to

determine the number of smokers and obese individuals. As for establishing the

relationship between obesity and smoking, the researchers utilized Chi Square. The

researchers found correlation between smoking and obesity. This indicates that people

who have weight problems are generally not aware of the possible risk of the unhealthy

lifestyle they practice. Therefore, the need to intervene such practice is found to be of

great importance and must be prioritized by community medicine specialists.

Keywords: Smoking, Obesity

 iii

Table of Contents

Acknowledgement…………………………………………………………………………..ii

Abstract ………………………………………………………………………………………iii

Chapter 1:

Introduction……………………………………………………………………………..….......1

Hypothesis……………………………………………………………………………………...2

Objectives………………………………………………………………………………………3

Scope and limitation of the study…………………………………………………………….3

Significance of the study………………………………………………………………………4

Chapter 2: Review of Related Literature……………………………………………………5

Chapter 3: Methodology………………………………………………………………………8

Chapter 4: Presentation, Interpretation and Analysis of data…………………………….10

Chapter 5: Conclusion, Recommendations………………………………………………..14

Appendix.......................................................................................................................16

References…………………………………………………………………………………….17
 CHAPTER 1

INTRODUCTION

Cigarette smoking is one of the leading causes of preventable morbidity and

mortality.[1-2] Several studies have indicated that smoking behavior is closely related to

body weight and obesity,[3] and shown that body weight of past smokers was heavier

than that of never smokers.[4] The mechanisms underlying the impact of smoking on

weight include varying energy intake, physical activity, metabolic rate, and inflammatory

status linked to smoking status.[5]

Importantly, associations between smoking and obesity have been extensively

investigated in large-scale studies of subjects of Western ethnicities, but not in Asian

populations.[6] This is of clinical importance because obesity-related complications,

such as diabetes and metabolic syndrome reportedly occur at a lower BMI in Asian

subjects compared with Western subjects.[7] Indeed, although obesity is now commonly

defined in adults as a BMI > 30 kg/m2,[8] the World Health Organization (WHO) western

pacific regions have provided a different cut-off level for obesity in Asians (BMI > 25

kg/m2).[9]

Smoking and obesity are the most important modifiable risk factors of non

communicable diseases (NCD).[10] Evidence is less clear for underweight.[11]

However, similarly to obese individuals and smokers, it was shown that underweight

individuals have an increased risk of premature death.[12] Investigations of the health

impact of extreme body mass index (BMI) combined with smoking found that obese and

underweight current smokers had the highest overall, cancer and cardiovascular

disease mortality risk.[13] Non-smoking and maintaining healthy BMI, but also related
risk factors such as healthy diet, low to moderate alcohol intake and physical activity

offer substantial potential for the reduction of premature death and NCD burden in the

population.[14-15]

Hypothesis

There is no association between smoking and obesity among residents of Zone 2

Sto. Domingo, Biñan, Laguna on May 2016.

Conceptual Framework

CIGARETTE SMOKING OBESITY

Figure 1. Conceptual framework of the study showing the relationship between cigarette

smoking and obesity.

2
General Objectives

To determine the association between smoking and obesity among residents of

Zone 2 Sto. Domingo, Biñan, Laguna on May 2016

Specific Objectives

1) To determine the number of smokers among residents of Zone 2 Sto. Domingo,

Biñan, Laguna on May 2016

2) To determine the prevalence of obesity among residents of Zone 2 Sto. Domingo,

Biñan, Laguna on May 2016

3) To determine the association of smoking and obesity among residents of Sto.

Domingo, Biñan, Laguna on May 2016

Scope and Limitation of the Study

This research study was conducted primarily to determine the association

between obesity and smoking. In order for the researchers to attain this objective, the

smoking status and the body mass index of residents of Zone 2 Sto. Domingo, Biñan,

Laguna were determined. This study was limited to only two variables which were

smoking and obesity.

3
Significance of the Study

Health Practitioners

This research would allow medical doctors to look into the possibility if smoking does

cause obesity. This would give medical practitioners valuable ideas which they could

use as a basis for giving out medical counsel to their patients.

Researchers

This would give them an idea regarding the relationship of smoking and obesity. This

would serve as an instrument and reference in their future research.

Community

This research could assist the community in understanding the effects of smoking and

obesity in their over-all health.

Definition of Terms

The researchers defined the terms based on their usage and context in the

paper. In this line, operational definition of terms was used.

Body Mass Index. In this study this was used to identify who among the patients

are obese.

Smoking Status. In this study this refers whether the individual is a smoker or

non smoker.

Obesity. It is a condition where body weight is > 25kg/m2 (2000, WHO).

4
 CHAPTER 2

REVIEW OF RELATED LITERATURE

Unfavourable lifestyle factors are likely to occur with cigarette consumption.

Studies revealed educational level are driving factors for smoking.[16] In affluent

countries like Switzerland, obesity gained relevance as its prevalence was increased

over the past decades, whereas the prevalence of smoking decreased in the general

population.[17] However, it remains unknown whether this decrease occurred also in

those most at risk (i.e. obese individuals) or mainly in healthier and health conscious

people. Therefore we aimed to investigate the general lifestyle of obese individuals,

heavy smokers, and obese heavy smokers to get a better understanding of the

distribution of lifestyle risk factors.

These populations are already at high risk of NCD and the coincidence with

further unhealthy lifestyles would worsen their risk profile.[18] In the study of Lohse

et.al., (2016) it was found that in never and heavy smokers, the proportion of

underweight and overweight individuals was comparable in both sexes. However,

comparing male never with heavy smokers, the proportion of normal weight individuals

was smaller (never: 52 vs heavy: 45%) whereas the proportion of obese individuals was

larger (never: 10 vs heavy: 14%). This difference was smaller in females (61 vs 57%; 10

vs 9%). Sex differences also existed with respect to the prevalence of the combination

obesity plus heavy smoking. It was found to be 1.3% in men and 0.5% in women.[19]

Men were also more likely to be normal-weight heavy smokers. On the other hand,

women were more often obese never smokers, underweight never and heavy smokers,
respectively. Heavy smokers (referred as smokers in this section) were observed to be

more likely to have an unfavourable behaviour with respect to almost all modifiable

lifestyle proxy factors, regardless of BMI. In contrast, physical inactivity was the only

lifestyle factor that showed an association with being never smoker, except for

hazardous alcohol intake in male obese never smokers.

The association with the lifestyle factors was shown to be stronger in smokers

compared to never smokers. Smokers of both sexes (except for heavy smoking obese

women) were most likely to have a high alcohol intake. The results for smokers by the

investigated BMI categories are described in depth as follows. Male normal-weight and

obese smokers were likely to have an infrequent fruit and vegetable consumption, low

physical inactivity level, and high alcohol intake. For example in men, if an individual

reported a low fruit and vegetable consumption, the relative risk ratio for being an obese

smoker relative to normal-weight never smoker would be expected to be increased

compared to an individual having a high fruit and vegetable consumption.

In underweight smoking men, significant associations were found for physical

inactivity and high risk alcohol intake, despite the small stratum size and therefore wide

confidence intervals. Female normal-weight and underweight smokers were likely to

have an unfavourable behavior in all three lifestyle factors. Obese smoking women were

more likely to have infrequent fruit and vegetable consumption and high alcohol intake.

6
In contrast to men, women who smoked and/or were underweight or obese were more

likely to be physically inactive.

Only a selection of the smoking/BMI combination groups is shown. To briefly

summarize the results for the remaining 14 outcome categories, we found that

individuals in these categories were less likely to have low fruit and vegetable

consumption, high alcohol intake, and physical inactivity, compared to those individuals

in the categories with heavy smoking and extreme BMI Only overweight heavy smokers

showed similar poor behaviour in the three lifestyle variables investigated. In addition,

we observed that the lifestyle tended to deteriorate, the more an individual smoked.

Socio-demographic adjustment variables were strongly associated with the combination

of heavy smoking and obesity or underweight. In general, individuals with lower

educational level were more likely to have an extreme BMI and being a smoker.

However, this association was reversed in underweight women. Male foreign nationals

were more likely to be normal-weight or obese smokers and obese never smokers,

respectively.

Being female Swiss national was associated with being normal-weight smoker or

underweight never smoker, whereas foreign nationals were more likely to be obese

never smokers. A significant impact of language region was observed mainly in women.

Compared to women living in the German speaking part, women from the French and

Italian speaking region were more likely to be underweight and less likely to be obese.

Moreover, those from the French speaking part were more likely to be underweight

smokers.

7
 CHAPTER 3

METHODOLOGY

Research Design

Descriptive correlational research design was used in the study. This research

method was used since the researchers determined the association of obesity and

cigarette smoking among participants at Zone 2 Barangay Sto. Domingo Binan Laguna.

This research model was used in this study due to the nature of the objective declared

herein.

Participants of this Study

This study included the members of the community of Zone 2 Barangay Sto.

Domingo Binan Laguna. The participants are smokers and non smokers who have

given the researchers their permission to recruit them for this study. The participants

were found in the age categories of 18 years old to 60 years of age. These are Filipino

citizens, consenting adults, and are capable of basic skills such as reading and writing.

Sampling Technique

Universal sampling method was applied in this study. This was done to ensure

that all samples needed for analysis were included. The researchers utilized this

sampling technique due to the fact that there was a perceived low number of

participants in this undertaking.

Data Collection

House-to-house survey was performed. The survey form contained participants’

age, gender, weight, height, and smoking status. The researchers measured the weight

and height of the participants to compute for their BMI in order to determine their weight

classification.

Statistical Analysis

The researchers used descriptive statistics like frequency distribution and

percentage to determine the number of smokers and obese individuals. As for

establishing the relationship between obesity and smoking, the researchers utilized Chi

Square.

Ethical Consideration

The researchers did not include participants who have not given their approval to

participate in the study. The researchers did not give money to those who participated in

the study. Bribery in any form was not done just to encourage the community from

participating in the study. This was not encouraged by the researchers nor being

initiated by the community.

9
 CHAPTER 4

PRESENTATION, INTERPRETATION AND ANAYSIS OF DATA

Table 1. Smoking Status of Participants at Zone 2 Barangay Sto. Domingo Binan

Laguna on May 2016

Status N %

Smoking 75 80.6

Non-Smoking 18 19.4

Total 93 100%

Table 1 shows the smoking status of participants at Zone 2 Barangay Sto.

Domingo Binan Laguna. The majority of the population was said to be smokers. There

were 75 in this group which comprised the 80.6% of the population. On the other hand,

there were 18 who were non smoker. This comprised the 19.4% of the population.

The data disclosed signifies that there is indeed a growing number of smoking

individuals in the community. This means that the possibility of acquiring smoking

related diseases is high. The assumptions noted in this study was augmented by a

study conducted by Center for Disease Control. In their analysis, the researchers have

declared that smoking has several ill health effects. The research found out that

smoking increases the risk of developing coronary heart disease and the like.[21]

Table 2. Distribution of Participants at Zone 2 Barangay Sto. Domingo Binan

Laguna According to Body Mass Index

on May 2016
 Body Mass Index N %

Underweight 27 29.1

Normal 15 16.1

Overweight 15 16.1

Obese 36 38.7

Total 93 100

In this table, it was found that the majority of participants were in the obese

weight category. There were 36 of them in this group. This corresponds to 38.7% of the

population. The least in rank were the 15 participants (16.1%) found in both the normal

and overweight categories.

The results indicate that most obese people understudied were inclined to

smoking. Though this needs further evaluation for this to be declared valid, still the

researchers consider the possibility that most obese people do not take care of their

personal health. This assumption was supported by Badheka et.al., who have declared

that obese people are at higher risk of heart problems due to their poor lifestyle.[20]

11

Table 3. Association between Cigarette Smoking and Obesity among the

Participants at Zone 2 Barangay Sto. Domingo Binan Laguna

on May 2016

Cigarette Smoking

Yes No Total p value Conclusion

Body Mass Index N(%) N(%)

 Overweight 6(40) 9(60) 15

Obese 36(100) 0(0) 36 .000 Significantly Correlated

Table 7 shows that there is a positive correlation between cigarette smoking and

body mass index specifically on the areas of being overweight and obese. This was

based on the p value gathered when Chi square was performed by the researchers. In

the study, a p value of .000 was obtained. The researchers concluded that there is a

significant correlation between the variables understudied.

The results indicate that smoking could lead into obesity and other weight related

issues. This was based on the data gathered by the researchers. Coexistence of both

pro- and anti-obese impacts of smoking on obesity in male smokers deserves

discussion.[22] Previous studies have suggested that cigarette smoking itself, in

particular nicotine, could decrease body weight by appetite suppression and/ or

12

increased energy consumption. In addition, comorbid chronic obstructive pulmonary

disease or malignant disease might contribute to decreased BMI.

Alternatively, smoking may be associated with obesity through, for example, an

unhealthy diet and low physical activity that is often present in heavy smokers.[23]

Interestingly, there may be inter-race differences in the response of obesity to smoking

duration because current smokers who had smoked for more than 20 years were more

likely to be overweight in a Scottish population.

The result also showed that most obese people understudied were inclined to

smoking. Though this needs further evaluation for this to be declared valid, still the
researchers consider the possibility that most obese people do not take care of their

personal health. This assumption was supported by Badheka et.al., who have declared

that obese people are at higher risk of heart problems due to their poor lifestyle.[20]

13

CHAPTER 5

CONCLUSION AND RECOMMENDATIONS

Conclusions

Based on the findings of the study, the following conclusions are drawn

1. In the community, a large number of individuals have been found to be

smoking as compared to the non smoking group. This suggests that there is an

increasing trend of smoking individuals in the community. This is quite interesting since
the government specifically DOH has been very vocal of the ill effect of cigarettes

smoking.

2. The researchers found correlation between smoking and weight related

problems such as overweight and obesity. This indicates that people who have weight

problems are generally not aware of the possible risk of the unhealthy lifestyle they

practice. Therefore, the need to intervene such practice is found to be of great

importance and must be prioritized by community medicine specialists.

RECOMMENDATIONS

Based on the conclusions drawn from the study, the following conclusions are

drawn

For the Department of Community Medicine

1. Information dissemination with regard to the health effects of cigarette smoking

must be prioritized. This was based on the growing number of smoking individuals in the

community.

2. Since obesity and overweight are considered serious issues in the study, the

need to provide information about healthy eating must be done. This is important to

ensure that people in the community obtain important ideas on how to properly maintain

their weight.

For the Smoking Community

1. Smoking should be completely stopped at the soonest possible time before

any ill health effects emerge.

 2. Diverting to healthy lifestyle should be done. It is important that people should

become physically active to maintain their ideal weight

For Future Researchers

1. Analysis on the correlation between smoking and hypertension must be

explored. This is essential in order to see whether smoking could aggravate potential

cardiovascular disease.

2. Correlating body mass index to lifestyle practices is strongly suggested. This

could give valuable information with regard to understanding the effects of the variables

to each other.

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APPENDIX

A. Survey Form

Lagyan ng check (√) ang

Family Age Gender Height Weight iyong sagot
Member (Edad) (Kasarian) (Taas) (Timbang) Naninigarilyo Hindi
Naninigarilyo
1
2
3
4
5
 B. Measurement of height and weight

MEASURING HEIGHT

1) Remove shoes, bulking clothing and hair ornaments and unbraid hair that interferes with

the measurement

2) Take the height measurement on flooring that is not carpeted and against a flat surface

such as a wall with no molding

3) Have the patient stand with feet flat, together and against the wall

4) Make sure the patient is looking straight ahead and that the line of sight is parallel with

the floor

5) Take the measurement while the patient stands with head, shoulders, buttocks and

heels touching the flat surface. Depending on the overall body shape of the patient, all

points may not touch the wall

6) Use a flat headpiece to form a right angle with the wall and lower the headpiece until it

firmly touches the crown of the head

7) Make sure the measurer’s eyes are at the same level as the headpiece

8) Lightly mark where the bottom of the headpiece meets the wall. Then, use a metal tape

measure from the base on the floor to the marked measurement on the wall to get the

height measurement

9) Accurately record the height

MEASURING WEIGHT

1) Use a digital scale (Brand: Dowell). Avoid using bathroom scales that are spring-loaded.

Place the scale on firm flooring rather than carpet

2) Have the patient remove shoes and heavy clothing such as sweaters
 3) Have the patient stand with both feet in the center of the scale

4) Record the weight

16

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