The Risk Factors of Obesity Among Elderly in Sintang, Indonesia

. Body Mass Index problem is becoming a double burden in Indonesia, including among older people. Nowadays, the elderly face a high index of BMI due to some risk factors and it is leading to other non-communicable diseases. This research aimed to examine the correlation between some determinants and obesity among older people in Sintang Regency, West Kalimantan. 358 elderly aged 46 to 65 years participated in this study selected by the total sampling method. The independent variables in this study were knowledge, activity, food intake, sex, attitude, age, the history of obesity, and obesity breeds, type contraception, and the duration of sleep. The multivariate analysis was found that knowledge, activity, food intake, age, and duration of sleep were significantly associated with obesity among the elderly. The preventive and promotive approach is needed to treat the obesity prevalence.


III. RESULTS AND DISCUSSION The Univariate Results
The univariate analysis was done to describe each variable. Table 1 below describes that more than half of the respondents were obese in type 1. In terms of knowledge, more than half of them did not have enough knowledge related to obesity. The physical activity was also found that more than half of them did http://ijstm.inarah.co.id not have sufficient physical activity. Regarding food intake, the majority of the respondents did not have adequate food intake. The majority of the respondents were female. About 55% of them did not practice a good attitude, and mostly they were in the aged range 46-55 years. Most of them also had a history of obesity and genetic factor was taking the large part. In terms of contraception, most of them did not use any contraception method and they mostly had less than 7 hours of sleep duration. The Chi-square analysis in this study was present in table 2 below. The results were revealed that knowledge and sleep duration significantly had a mid relationship with obesity. For other variables, it was also found that physical activity, food intake, sex, attitude, age, history of obesity, genetic, and use of contraception significantly had a weak relationship with obesity. Furthermore, the attitude did not have any association with obesity. The multivariate analysis in this study took five variables based on bivariate results. They were knowledge, physical activity, food intake, age, and sleep duration. After adjusted with other independent variables, it was found that knowledge, physical activity, and food intake had a mid relationship with obesity. Particularly, those who had insufficient knowledge were 7.6 times more likely to be obese (p = 0.002, OR 7.6, CI 95% 5.219-8.613), for those who did not practice enough physical activity were 6.9 times more likely to be obese (p = 0.006, OR 6.9, CI 95% 5.435-7.039), and for those who did not have an adequate intake of food was 8.2 times more likely to be obese (p = 0.008, OR 8.2%, CI 95% 6.364-10.054). In term of weak relationship, it was found that those aged 46 to 55 years were 6.7 times more likely to be obese (p = 0.012, OR 6.7, CI 95% 5.993-8.335) and for those who had sleep duration less than 7 hours were 5.2 times more likely to be obese (p = 0.014, OR 5.2, CI 95% 3.983-6.354).

Discussion
The literature review article observed the elderly in Malaysia was found three contributory factors for obesity such as socio-demographic factors, medical history, and dietary factors, and environmental factors [7]. These results supported the finding of this study which found that some sociodemographic and dietary factors were significantly associated with obesity. One study in Padang, West Sumatera Province, Indonesia did not find the same result as this study which revealed the negative association between knowledge and obesity [8].
Physical activity in this study was significantly associated with obesity. Supporting this study, the previous study in Brazil and Padang Indonesia also found that lower in physical activity in the leisure time had an association with obesity [9]. Additionally, one study in Sweden also found that physical activity and mobile activity was found a significant association with [10].
In terms of food intake, this study found that food intake was significantly associated with obesity. One study in Sharpeville, South Africa brought specific nutrients of food, namely Fe. The result revealed differently with this current study which found the Fe status was not significantly associated with obesity [11]. Indonesia is a country with rice as a staple food. The study in China revealed that the rice staple pattern was associated with abdominal obesity in men elderly, but not in women [12]. It describes that http://ijstm.inarah.co.id rice intake could be the risk of obesity. A study in Korea also supports this current study, particularly a concern in protein intake, that study found the lower protein intake the higher risk for being obese [13]. Studies in Sweden and Brazil found that the intake of fruit and vegetable was associated with obesity [14]. On the other hand, the study conducted in Purwosari Indonesia did not find the relationship between food intake especially for energy, carbohydrate, and far with obesity among older people [15].
The study in Brazil also found the same result as this study, which found age was inversely associated with abdominal obesity [9]. The prevalence of obesity based on a study in Sweden and Padang Indonesia found that aged 65-75 years were the higher risk and it decreases after aged 75 years [10]. One study in Brazil also found that aged 60-79 years was a high risk of being obese [16].
In the line with this study, a study among the Korean elderly also found that short sleep duration (less than 6 hours) was the risk of being obese [17]. Doo also found that the risk of being obese tended to be higher with those who had a short sleep duration compared with those who had a proper sleep duration [18]. Opposite with current findings, the study in Greece found a negative association between sleep quality and obesity [19].
The study conducted in Brazil found different risk factors of obesity which revealed that having hypertension, dyslipidemia, and the female gender was a strong association with overweight and obesity [20]. In the line with another study in China, overweight was associated with a decreased risk of cognitive impairment, and abdominal obesity was associated with an increased risk of cognitive impairment (sociodemographic, lifestyle, comorbid factors) [21]. Another study in Brazil found that sex, marital status, the presence of disease, and smoking behavior were significantly associated with BMI and waist circumference [22]. These results did not support this current study. Another result was shown by a study in Padang Indonesia that found a significant association between the history of obesity and the prevalence of obesity among the elderly [8]. The prevalence of obesity was affected by the loss of muscle mass regarding the study in Salatiga Indonesia [23].
Additionally, obesity is also leading to non-communicable diseases as found in the study conducted in Indonesia that found obesity as a risk factor for diabetes mellitus [24].

IV. CONCLUSION
The strong predictors for being obese among the elderly were knowledge, physical activity, and food intake. Additionally, age and sleep duration had a weak association with obesity. Familial factors are associated with aderly obesity, dietary intake, physical activity and weight control behaviors. The role of family members is needed to prevent and treat obesity among older people.

V. ACKNOWLEDGMENTS
The authors are grateful to the elderly in Sintang district who have been willing to become respondents. We also thank the Sintang District Health Office for their support and for their permission to collect data on elderly people.