Association of Sedentary Behavior with Obesity and Comorbities In Omani Women (Age 30-49 Years): A Cross-Sectional Study

any lower en-Abstract The alarming rise and increasing prevalence of abdominal obesity in developed as well as developing nations has made abdominal obesity as a major health concern globally. Abdominal obesity not only predisposes to life threatening conditions like hyperten -sion, cardiovascular diseases, diabetes mellitus, and cancer but also leads to premature mortality. Physical inactivity is a matter of grave concern globally as the whole world has switched from a demanding physically active life to a sedentary lifestyle exposing the populations to a of healthcomplications. Objective: The main purpose of this research was to study the association between sedentary lifestyle with obesity and comorbidities in Omani women. Method: The study was carried out during Aug 2019 to Jan 2020 and included a sample of total 398 obese Omani women aged 30-49 years from Muscat and Batina Governorates in Oman. Assessment of sedentary behavior and abdominal obesity associated comorbidities was performed using an IPAQ questionnaire allowing self-evaluation of diverse activities and self-report for the presence of hypercholesterolemia, hypertension, or diabetes mellitus. Result: The current data indicates that 47% of the women had grade 1 obesity, 32% had grade 11 obesity and 21 % of the women suffered from morbid abdominal obesity which is alarming. Further, 25% of the subjects suffered from hypertension and were on medication, 18% suffered from hypercholesterolemia, 23% suffered from diabetes and 16 % reported to have suffered from gestational diabetes. Conclusion: Sedentary lifestyles were common among the adult Omani women in the study sample. Lack of any kind of physical activity and sedentary behavior are commonly associated with high BMI, high WHR (abdominal obesity)and the associated diseases like high cholesterol, hypertension, and type 2diabetes.

ergy expenditures giving birth to lazier and physically inactive people worldwide [6]. TV viewing was closely linked to obesity not only because of decreased energy expenditure but also due to increased energy intake caused during this inactivity by fat and sugar laden food consumption [7].During the period of last forty years, most of the Gulf countries including Oman have undergone a remarkable change in the socioeconomic status and several studies reveal significant increase in adopting inactive lifestyle in the Gulf region.
This shift from a physically demanding life to a sedentary lifestyle have exposed people to high risk of diseases like obesity, hypertension, heart diseases, diabetes, cancer to name a few. Cultural differences and restrictions in lifestyle choices available to females in Arabic countries are the main reasons for increased rates of obesity: Females have restricted access to sporting/communal physical activities [8]. In Oman women may be at a greater risk of developing obesity and the associated morbidities due to their decreased physical activity and sedentary lifestyle. According to a study done in 2000 on Omani adults, approximately 17% of adult male and 24% of adult females were observed to have higher body weight [9]. It was also revealed in a research by the Health Ministry in Oman during 2011 that approximately 52% of 5,000 newly diagnosed cases of T2 diabetics, were female [10]. It was clearly postulated in a newly done study in Oman that metabolic syndrome related to the lifestyle and eating habits increases with the existence of causative risk factors like diabetes, cardio vascular disease and presence of extra fat in the body [11]. A very strong correlation between less physical activity, maximum hours spent sedentarily or sitting every day and increased prevalence of associated complications indicating an inverse relation between reduced activity and risk of getting more diseases [12]. Despite this, the studies indicating the sedentary lifestyle of Omani women are rare therefore the aim of the present study was to examine the association between sedentary behavior and obesity as well as the associated co morbidities.

Materials and Methods
The present cross-sectional study included obese women (aged 30-49 years) visiting Al Raffah Hospital. The subjects were enrolled between August 2019 and January 2020. The study was conducted after explaining the purpose of the study and obtaining informed consent from each participant.Pregnant women and those with any eating disorder were not included in the study. A total of 398 subjects with BMI above 30 aged 30-49 years were included. All the subjects were asked to complete a self-reported questionnaire (IPAQ) to assess physical activity and health status.
Subjects were asked questions in order to assess physical activity/ exercise and sedentary lifestyle levels on a weekly basis. BMI (Body Mass Index)=Weight (kg)/height (m^2)was used as an indicator of obesity. The weight was measured using commercial scale" Seca, Germany" with an accuracy of +_ 100 gm. Standing height of the participant was measured using a standardized measuring scale. Waist and hip circumference were measured using a flexible and inelastic tape measure and noted in cm. This ratio is calculated by dividing the waist circumference (cm) by the hip circumference (cm). The WHR above 0.85 in women is considered to be obese and risk of diseases rises steeply when the WHR rises above 0.8.

Ethical Considerations
Permission was obtained from the Ethical Review Board of Al Raffah Hospital, Muscat before commencing the interviewing and measurements and the subjects were given a brief orientation.

Discussion
The increasing burden of diseases globally is a major health concern. As per the WHO, the obesity related morbidities account for approximately 61% of the deaths and 49% of the disease burden across the world and if this alarming trend continues, roughly 70% of total global deaths and 56% of the disease burden worldwide will be attributable to these diseases by 2030 [14]. Like many Gulf countries, Oman is also facing new health challenges due to increasing trends in lifestyle related diseases thus increasing the incidence of the disease in the country. Women may be more prone to adopting sedentary lifestyle; thus becoming obese and at higher risk of developing associated health disorders due to lack of physical activity. The current data indicates that 47% of the women had grade 1 obesity, 32% had grade 11 obesity and 21 % of the women suffered from morbid obesity which is alarming. The WHR calculations indicated that majority of the subjects i.e. 70% had abdominal obesity and were at a very high risk of developing co morbidities, 28% of the subjects were at moderate risk while only 2% of the women had low risk of developing obesity associated diseases. Though BMI has been consistently linked with an increased risk of cardiovascular diseases and type 2 diabetes [15], abdominal obesity assessed through WHR is associated with higher risk for obesity related morbidities and mortalities than overall adiposity [16,17] .25% of the women were having high blood pressure and were regularly taking medication and these findings are in agreement with several other studies where age, obesity, and sedentary lifestyle were significant factors for hypertension [18][19][20][21]. 23% of the participants reported to have type 2 diabetes and were on medications. Studies indicate that sedentary lifestyle like spending long hours on screen, TV, reading (encourages overeating), driving etc. are strongly linked to excessive weight gain further leading to type2 diabetes [22]. According to a survey conducted by International journal of behavioral nutrition and physical activity in 2013, 90% of type 2 diabetes in women can be strongly linked to obesity, unhealthy eating habits and physical inactivity i.e. sedentary behaviors [23,24]. 18% of the subjects had high cholesterol levels. A positive correlation has been found between sedentary lifestyle and higher chances of developing heart diseases through raised blood triglycerides and reduced HDL cholesterol, as indicated by a recent meta-analysis [25,26]. The ATTICA study showed that physically active women had significantly lower levels of total cholesterol, LDL-cholesterol, triglycerides, and higher levels of HDL-cholesterol, compared to sedentary women [27]. 16---% of the women reported that they had gestational diabetes and were on medication throughout the pregnancy. A myriad of studies done globally suggest that GDM is prevalent in almost 17.8% of the pregnancies [28]. which is strongly associated with a greater risk of complications and developing type 2 diabetes later in life both for mother and baby [29]. Reports indicate an inverse correlation between GDM and regular exercise during pregnancy as well as the BMI at the time of conception [30,31]. independently associated with obesity and its associated diseases like type 2 diabetes [35]. Normal weight women need at least 1 hour of moderate-to-vigorous physical activity for maintaining a steady weight as reported by The Women's Health Study done on 34,000 middle aged women [36].The results of another study indicate that any kind of vigorous activity is more effective than slow walking for weight loss and it was reported that those women who increased their physical activity by 30 minutes/day gained less weight than those with steady activity levels [37][38][39]. Furthermore , recent research done on a control group of obese middle-aged women suggested that 45minutes of moderate-to-vigorousaer obicactivity, 4-5days/week significantly reduced the body weight and the abdominal fat as compared to those who did not exercise [40].

Conclusion
Such changes are essential to make physical activity an integral