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HEALTH AND WELLNESS 4/2014
WELLNESS AND SOCIETY
CHAPTER V
Department of Anatomy, Wrocław Medical University
Katedra i Zakład Anatomii Prawidłowej
Uniwersytetu Medycznego we Wrocławiu
2
Clinical and Dissecting Anatomy Students Scientific Club
Wrocław Medical University
Studenckie Koło Naukowe “Clinical and Dissecting Anatomy”
przy Uniwersytecie Medycznym we Wrocławiu
1
Department of Pathophysiology, Wrocław Medical University
Katedra i Zakład Patofizjologii
Uniwersytetu Medycznego we Wrocławiu
4
Department and Clinic of Internal
and Occupational Diseases and Hypertension
Wrocław Medical University
Katedra i Klinika Chorób Wewnętrznych
Zawodowych i Nadciśnienia Tętniczego
3
ZYGMUNT DOMAGALA1, LESŁAW RUSIECKI3, MACIEJ ORNAT2,
MARCIN CHOROSZY2, KAMIL LITWINOWICZ2, EDEL PYKE2,
ADRIAN PONA2, BEATA KACZMAREK-WDOWIAK4,
PAWEŁ DĄBROWSKI1, RYSZARD R. KACALA1,
MICHAŁ PORWOLIK1, BOHDAN GWORYS1.
Welfare and society – measured versus self-reported body
height and body mass in medicine students
of Wroclaw Medical University
Dobrostan i społeczeństwo – zmierzone a deklarowane wartości
wysokości ciała i masy ciała u studentów medycyny
z Uniwersytetu Medycznego we Wrocławiu
Key words: student awareness, BMI, body mass, body height, young adults, risk
factors
Wellness and society
The basic anthropometric parameters, such as body weight and body height, are
the data most frequently analyzed during a physical examination. Being aware of
one’s body weight and height not only allows the proper selection of material goods,
but also has great significance in leading a healthy life-style, inter alia in assessing
the degree of obesity. Being familiar with these basic anthropometric data is of great
significance in medical sciences. It allows the stratification of the cardio-vascular
risk in adults. Inappropriately high body weight is one of modifiable risk factors [1,
2]. Overweight and obesity increase the values of arterial pressure [3]. Inappropriately high body weight influences the incidence of lipid disorders [4]. Overweight
and obesity have a statistically relevant relationship with type 2 diabetes [5]. High
body weight is directly proportional to the risk of developing coronary artery disease
[6], and insignificantly influences the incidence of stroke among men in Northern
European countries [7].
The assessment of body fat in healthy subjects can be performed by direct measurement of body weight. The measurements can also be performed by measuring
waist circumference, or shoulder-to-hip ratio, or with a “pinch test” [8]. The assessment of body fat is one of the means of assessing the degree of obesity in patients,
which requires several anthropometric measurements. The easiest, most frequently
used and least consuming method of assessing the degree of obesity is based on BMI
(body mass index) [9]. Inappropriate, increased BMI is considered a significant
modifiable cardiovascular risk factor [10].
The available data indicate that there is a strong correlation between the data obtained from direct measurements and the data compiled from surveys conducted
among youths and young adults. The degree of correlation varies between 0.86 and
0.99, depending on the authors [11, 12, 13,14]. Krzyżanowska and Umławska show
that such a degree of correlation is enough to base the assessment of body weight
and height on subject-reported data [15]. The question remains, whether answers
based on the data obtained 10 years ago are still valid. In the last decade Poland has
joined the European Union, underwent great changes in the social sphere and in the
life-style of youth, all of which can have significant influence on the results of studies. Moreover, introducing BMI into the standards of assessing the degree of obesity
requires, according to the authors, gathering more precise anthropometric data. The
BMI is calculated according to the following simple formula:
Calculating BMI with this formula increases the results of possibly incorrect data
obtained in the survey. Therefore, there is a possibility that even slight, initially
insignificant statistical changes can cause the statistically significant differences in
the study results between subject-reported data and actual data.
Thus, prior to commencing a big project on the state of students’ awareness of
cardiovascular disease risk factors, an assessment of the students’ awareness of their
body weight was carried out. In our opinion, detailed knowledge of one’s body
weight and height is highly desirable, especially among those from the medical
62
Zygmunt Domagala, Lesław Rusiecki, Maciej Ornat, Marcin Choroszy,
Kamil Litwinowicz, Edel Pyke, Adrian Pona, Beata Kaczmarek-Wdowiak,
Paweł Dąbrowski, Ryszard R. Kacala, Michał Porwolik, Bohdan Gworys
Welfare and society – measured versus self-reported body height
and body mass in medicine students of Wroclaw Medical University
profession, who should place special care on the prevention of civilization diseases.
A medical doctor should know their body weight and height in order to be able to
calculate their own BMI. Knowing their actual BMI will allow a doctor to intervene
when the result is inappropriate. For how can a medical doctor, who is obese, does
not know their own BMI and does nothing to change their life-style, credibly motivate their patients to change their life-styles and start a diet. Therefore, we believe
that such a simple study, conducted among medicine students carries both scientific
and, more importantly, educational significance, as it teaches to pay attention to
easily modifiable civilization diseases risk factors.
MATERIAL AND METHODS
We analyzed a group of 88 healthy individuals, 39 women (mean age about
19.97 years) and 49 men (mean age about 19.87 years), students of the 1st year of
the Faculty of Medicine, Wroclaw Medical University. The study has been conducted between February and March 2014. The mean age of the participants was 19.92
years.
Persons with ailments influencing body height (e.g. amputations) and persons
with conditions that could in a short period of time affect the current body weight
(e.g. uncompensated heart failure, renal failure, thyroid gland condition) have been
excluded from the study.
The participants were assessed based on a survey, especially prepared for this
study. The participants answered on their own, if they had any doubts they consulted
one of the investigators. The gathered data have been coded to ensure anonymity
and confidentiality. The respondents were asked to give their body height and
weight.
Furthermore, a three-person study team comprising of trained students from student scientific club “Clinical and Dissecting Anatomy,” working under the supervision of a member of the Department of Anatomy, has verified the self-reported data.
Measurement of body height and weight were performed before noon. Body weight
was measured with certified scales, Radwag, with measurement accuracy up to
0.00001kg. Body height was measured with certified anthropometer, Holtain, with
measurement accuracy up to 0.0001m. Each measurement was performed three
times and the mean of all three measurements was used for statistical analysis. The
instruments used in the study are CE certified and in accordance with directive
MDD93/42EEC on medical instruments and appliances.
Body mass index (BMI) was calculated as the patient’s weight in kilograms divided by the squared height in metres. The following WHO classes were used for
classification: normal range, defined as BMI <24.9kg/m2; overweight, defined as
BMI 25–29.9kg/m2, and obesity, defined as BMI ≥30kg/m2 [16].
Statistica 11 PL software was used for statistical analysis. The basic statistical
parameters were calculated for the studied group. Student – T test for dependent
63
means and Yates’ chi square test were used. Analysis of variance was used for some
of the parameters.
The study was approved by the Bioethics Committee of Wroclaw Medical University.
RESULTS
Collected data of self-reported and actual measurements of body weight and
height are presented in Table 1.
Table 1. The mean self-reported and measured base anthropometric values in the
studied group of medicine students
N – number of participants, SD – standard dev
N Mean
Age [in years]
88 19,92045
self-reported mass [kg] 88 68,11364
self-reportedheight [m] 88 1,73886
Measured mass [kg] 88 69,73580
Measured height [m] 88 1,73131
Minimum
18,00000
41,50000
1,52000
42,30000
1,52600
Maksimum
25,0000
106,0000
1,9500
123,4000
1,9230
SD
1,07449
13,79004
0,09827
14,92905
0,09564
Table 2 contains the data for female participants.
Table 2. The mean self-reported and measured base anthropometric values among
the females from the studied group of medicine students
N Mean
Age [in years]
39 19,97436
self-reported height [m] 39 1,65641
Measured height [m] 39 1,65238
Minimum
19,00000
41,50000
1,52000
42,30000
1,52600
Maksimum
25,00000
92,00000
1,86000
93,30000
1,84200
SD
1,180704
8,768811
0,068662
9,145969
0,063856
Table 3 contains the data for male participants.
Table 3. The mean self-reported and measured base anthropometric values among
the males from the studied group of medicine students
N Mean
Age [in years]
49 19,87755
self-reportedheight [m] 49 1,80449
Measuredheight [m] 49 1,79413
64
Minimum
18,00000
51,00000
1,68000
50,90000
1,66400
Maksimum
23,0000
106,0000
1,9500
123,4000
1,9230
SD
0,99232
11,87061
0,06205
12,93927
0,06527
The analysis of body weight values for the study population revealed statistically
significant differences between the self-reported data and actual measurements (Figure 1). The differences occurred during the analysis of all results, as well as during
separate analyses for particular sexes (Figure 2 and Figure 3).
110
100
90
80
70
60
50
40
30
self-reported mass
measured mass
Średnia
Średnia±Odch.std
Średnia±1,96*Odch.std
Figure 1. The differences between self-reported and measured mean body weight
(p=0.0000)
110
100
90
80
70
60
50
self-reported mass
Measured mass
Średnia
Średnia±Odch.std
among females (p=0.000003)
65
80
75
70
65
60
55
50
45
40
35
self-reported mass
Measured mass
Średnia
Średnia±Odch.std
among males (p=0.002143)
It has been proven that the students from the studied group report body weight
significantly lower than their actual weight reported from measurements (Table 1),
(Figure 1). Furthermore, the analysis of mean body height and weight values showed
a statistically significant difference between the self-reported and actual values for
the study population. The collected data are illustrated on Figure 4.
1,95
1,90
1,85
1,80
1,75
1,70
1,65
1,60
1,55
1,50
self-reported height
Measured height
Średnia
Średnia±Odch.std
Figure 4. The differences between self-reported and measured mean body height
(p=0.000776)
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The abovementioned difference was reported for male participants (Figure 5).
1,94
1,92
1,90
1,88
1,86
1,84
1,82
1,80
1,78
1,76
1,74
1,72
1,70
1,68
1,66
1,64
Measured height
Średnia
Średnia±Odch.std
among males (p=0.002270)
No statistically significant differences were reported for the analysis of mean
body height values among females (Figure 6). Thus, it has been shown that male
medicine students declare body height values that are statistically significantly higher than actual data.
1,82
1,80
1,78
1,76
1,74
1,72
1,70
1,68
1,66
1,64
1,62
1,60
1,58
1,56
1,54
1,52
1,50
Measured height
Średnia
Średnia±Odch.std
among females (p=0.144)
67
The comparison of BMI calculated on the basis of data obtained from surveys
BMIdek and direct measurements BMIreal – showed statistically significant differences
between these values (Figure 7). The differences were reported for both male
(p=0.000) and female students (p=0.000891).
32
30
28
26
24
22
20
18
16
14
Self -reported BMI
Measured BMI
Średnia
Średnia±Odch.std
Figure 7. The difference between self-reported and measured mean BMI
While analyzing the data, we also assessed the education level of the participants’ parents. Most of the participants came from higher education background.
Figure 8. illustrates the education data for the fathers and Figure 9. the education
data for the mothers.
Figure 8. The education level of the participants’ fathers
(Description: podstawowe = primary; zawodowe = vocational; średnie = secondary; wyższe
= higher).
68
Figure 9. The education level of the participants’ mothers
(Description: podstawowe = primary; zawodowe = vocational; średnie = secondary; wyższe
= higher)
Statistical analysis did not show any relationship between the education level and
BMI of the participants.
Even though the percentage for parents with higher medical education (medical
doctor, pharmacist, nurse, paramedic) was calculated, no relationship was shown
between the parents’ medical education and overweight or obesity among the participants (Table 4).
Table 4. The number of parents with medical education
Medical
Medical
Education [No] Education [%]
Mother
32
36,4%
Father
19
21,6%
Additionally, while conducting the study, we assessed the number of participants
declaring to be active smokers and the number of people declaring drug use. The
percentage for smoking students ia illustrated on Figure 10.
69
Figure 10. The number of smoking male and female students in the study population
Questions about drug use provided information about reported occasional use of
the so called recreational drugs, i.e. marijuana and ecstasy. Among the persons
using, the number of males was significantly higher than the number of females
(Figure 11).
Figure 11. Gender differences between using and not-using students from the study
population
OVERVIEW OF OUR OWN RESEARCH RESULTS
The mean body height of 2014 medicine students amounted to 1.73 [m], which is
higher than in the population of peers, who are not students [17]. Krzyżanowska et
70
al. suggest that one of the reasons of this finding is that students possess better genes
than their peers [15].
The relationship between BMI, body height or weight and parents’ level of education is not clearly defined. Many Polish authors point out that higher education of
parents corresponds to greater stature of children [18,19]. Charzewski points to the
relationship between the father’s higher education and the children’s greater height
[20]. The presence of a higher educated parent is believed to contribute to a more
varied family diet, more regular mealtimes and higher level of hygiene. We did not
show any relation between body weight, height and BMI and the level of education
of the parents of our participants. Krzyżanowska et al. suggest that the student population is in some way privileged and thus more homogenous, and that is why the
relationships between basic anthropomorphic parameters and social factors are not
as clearly visible in this group[15].
The comparison between the self-reported and actual data for body weight has
revealed the presence of underestimation of weight among the studied population,
on the level of 1.62kg. Stewart et al. have published similar results. They have assessed a group of 1,598 residents of Australia in the 1980s, reporting an underestimation of weight at a level of 2.4kg [11]. On the other hand, researchers from Sweden have shown only 1kg difference between the self-reported and actual data, while
analyzing, inter alia, a group of young adults living near Stockholm [21]. The difference between self-reported and measured data for body weight are therefore varied
and population specific. In the Wroclaw study population, a markedly higher difference in body weight data was shown for males (ca. 2.5kg), rather than females (ca.
1.0kg). This finding is very interesting and requires further research, as in the available data world-renowned authors, such as Mc Adams at al. present contrary reports.
In their analysis, women are the ones who misrepresent their body weight [22]. The
reasons of this discrepancy are unknown.
The analysis of data concerning body height of the participants revealed that only men, medicine students, overestimate their height. The analysis of data for female
students did not yield any statistically significant differences between self-declared
and measured data. Interestingly, in her 2000 study on a group of students, Krzyżanowska et al. has shown that women report data on their height that are statistically
significantly overestimated, while men give accurate data [23]. One of the interesting unproven hypothesis, which could explain this phenomenon, is discontinuing
mandatory military service in Poland. Previously, young men, ca. 18-19 years old,
were examined in detail by the draft board. Therefore they were more aware of their
precise body weight and height than women, who were not subject to mandatory
military service. Since 2014, such detailed examinations are no longer taking place,
as there no longer is a mandatory military service. What is also interesting is that the
height of the male and female students in Wroclaw did not change between 2000
and 2014, and oscillates around ca. 165cm for women and ca. 179-180cm for men.
71
Even though the students from the study population have overestimated their
height and underestimated their body weight, and even though the differences between self-reported and measured data are statistically significant, surprisingly the
comparison of BMIreal and BMIdekl did not yield such big discrepancies. They are
statistically significant, however the WHO-classification-based comparison of selfreported and actual data did not significantly affect the classification of obesity (Table 5).
Table 5. Clinical classification of the degree of obesity
Self-reported Measured
categories categories
Normal
71
64
Overweight
14
22
Obese
3
2
TOTAL
This finding is even more clear if we do a separate comparison for the data for
males and females (Figure 12 and 13).
Figure 12. Comparison of the self-reported and actual data on the degree of obesity
in females
72
Figure 13. Comparison of the self-reported and actual data on the degree of obesity
in males
The data from our observations correspond to those of other authors [21,22].
The statistically significant differences between self-reported and actual data do not
pertain to false classification of the degree of obesity among students. We believe
that the reason for the reported phenomenon is simple. Medicine students are mostly
slim or only slightly overweight. Therefore even statistically significant discrepancies in self-assessment of body weight and height do not carry any clinical significance. Thus, we believe that when conducting a study that does not require exact
data for body weight and height for medicine students, performing objective measurements of anthropomorphic data is not necessary. The observed differences can,
however, have clinical significance in older age groups.
CONCLUSIONS
1. Medicine students in Wroclaw do not know their body weight and height. A
comparison of self-reported and actual data reveals statistically significant differences.
2. The students have overestimated their body height and underestimated their body
weight.
3. The differences between BMIdekl and BMIreal calculated based on self-reported
data are statistically significant. However, they carry no clinical significance.
4. When conducting a study among medicine students, self-reported data for body
weight and height are sufficient for analysis and there is no need for objective
measurements.
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LIMITATIONS
1. Insufficient volume of the study group.
2. Carrying out the study on only one Faculty.
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14. Nakamura K, Hoshino Y, Kodama K, Yamamoto M. Reliability of self-reported
body heigth and weight of adult Japanese women. J Biosoc Sci, 1999,31:555558.
15. Krzyżanowska M, Umlawska W. The relationship of polish students height,
weight and BMI with some socioeconomic variables. J Biosoc Sci, 2010,
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MiPa, 188, 95: 81-106
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ABSTRACT
The basic anthropometric parameters, such as body weight and body height, are
the data most frequently analyzed during a physical examination. Being aware of
one’s body weight and height not only allows the proper selection of material goods,
75
but also has great significance in leading a healthy life-style, inter alia in assessing
the degree of obesity. Being familiar with these basic anthropometric data is of great
significance in medical sciences. It allows the stratification of the cardio-vascular
risk in adults. Inappropriately high body weight is one of modifiable risk factors. .
The aim of the study was to assess the correct knowledge of these parameters in a
group of students of the Faculty of Medicine. We analyzed a group of 88 healthy
individuals, 39 women (mean age 19.97 years) and 49 men (19.87 years). We
proved that participants do not know their body weight and height. A comparison of
self-reported and actual data reveals statistically significant differences. The students
have overestimated their body height and underestimated their body weight.The
differences between BMIdekl and BMIreal calculated based on self-reported data
are statistically significant. However, they carry no clinical significance.When conducting a study among medicine students, self-reported data for body weight and
height are sufficient for analysis and there is no need for objective measurements.
STRESZCZENIE
Podstawowe parametry antropometryczne jakimi są masa ciała i wysokość ciała
to jedne z najczęściej analizowanych danych podczas badania fizykalnego. Wiedza
o własnej masie ciała i wzroście umożliwia nie tylko prawidłowy dobór dóbr materialnych ale ma ogromne znaczenie w prowadzeniu przez poszczególnych osobników zdrowego stylu życia. Celem pracy było określenie stopnia znajomości własnej
masy ciała i wzrostu przez studentów medycyny. Analizie poddano grupę 88 zdrowych ochotników, studentów I roku Wydziału Lekarskiego Uniwersytetu Medycznego we Wrocławiu. Średni wiek uczestników wyniósł 19,92 lat. W badaniu uczestniczyło 39 kobiet (średni wiek 19,97 lat) oraz 49 mężczyzn (średni wiek 19,87 lat).
Analiza wartości masy ciała oraz wysokości ciała w badanej grupie studentów
ujawniła obecność istotnie statystycznych różnic pomiędzy danymi deklarowanymi
a rzeczywistymi pomiarami. Porównanie obliczonego wskaźnika BMI na podstawie
uzyskanych danych z ankiet oraz pomiarów bezpośrednich – dla danych uzyskanych
z bezpośrednich pomiarów wykazało znaczne, istotne statystycznie różnice pomiędzy tymi wartościami. Szczegółowa analiza ujawniła jednak że wykazane różnice
nie mają jednak istotnego znaczenia klinicznego. W przypadku prowadzenia badań
na grupie studentów medycyny można zatem odstąpić od pomiaru ich masy ciała i
wzrostu i ograniczyć się tylko do danych deklarowanych.
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