Document Type : Original Article


1 Departments of Health Education and Promotion and Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences

2 Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences

3 Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran


INTRODUCTION: In developing countries, there is an increased risk of incidence of noncommunicable
diseases due to general and abdominal obesity. Therefore, this study aimed to assess socioeconomic
determinants of excess weight and central obesity among women in Tehran city based on information
motivation behavioral skills model (IMB).
MATERIALS AND METHODS: A cross‑sectional study was conducted among 260 women aged
between 20 and 49 years old using cluster sampling. A skilled interviewer completed socioeconomic
status (SES), food insecurity, and IMB questionnaires. Analysis of variance, Chi‑square tests, and
regression model were used for statistical analysis. The multiple logistic regression analysis was
used to identify independent predictors of the excess weight and central obesity using SPSS 21.
RESULTS: The mean and standard deviation of participants’ age was 34.7 (±7.59) years old. The
prevalence of overweight and obesity in adult women was estimated 35% and 21.2%, respectively.
The prevalence of abdominal obesity was 34.6%. Independent predictors of overweight/obesity in
women were age (odds ratio [OR] =1.09, 95% confidence interval [CI] =1.03–1.14), educational
level (OR = 2.35, 95% CI = 1.05–5.27), and total expenditure (OR = 3.14, 95% CI = 1.06–9.37).
Whereas, independent predictors for increased the likelihood of central obesity were age
(OR = 1.12, 95% CI = 1.06–1.18), marital status (OR = 6.44, 95% CI = 1.94–21.40), low education
(OR = 0.38, 95% CI = 0.16–0.91), number of rooms (OR = 1.19, 95% CI 1.03–3.45), and self‑regulation
score (OR = 0.94, 95% CI = 0.88–1.00).
CONCLUSIONS: The socioeconomic determinants, especially age, level of education, and
expenditure, as well as self‑regulation, play an important role in excess weight and central obesity
among women. Therefore, further research is needed to reach women in different SES groups with a
variety of interventions through concurrent triangulation of longitudinal studies and qualitative research.


1. Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden
of obesity in 2005 and projections to 2030. Int J Obes (Lond)
2. Prospective Studies Collaboration, Whitlock G, Lewington S,
Sherliker P, Clarke R, Emberson J, et al. Body‑mass index and
cause‑specific mortality in 900 000 adults: Collaborative analyses
of 57 prospective studies. Lancet 2009;373:1083‑96.
3. Panagiotakos DB, Pitsavos C, Skoumas Y, Lentzas Y,
Papadimitriou L, Chrysohoou C, et al. Abdominal obesity, blood
glucose and apolipoprotein B levels are the best predictors of the
incidence of hypercholesterolemia (2001‑2006) among healthy
adults: The ATTICA study. Lipids Health Dis 2008;7:11.
4. Hirani V, Zaninotto P, Primatesta P. Generalised and
abdominal obesity and risk of diabetes, hypertension and
hypertension‑diabetes co‑morbidity in England. Public Health
Nutr 2008;11:521‑7.
5. Rahmani A, Sayehmiri K, Asadollahi K, Sarokhani D, Islami F,
Sarokhani M, et al. Investigation of the prevalence of obesity in
Iran: A systematic review and meta‑analysis study. Acta Med
Iran 2015;53:596‑607.
6. Hossain P, Kawar B, El Nahas M. Obesity and diabetes in
the developing world – A growing challenge. N Engl J Med
7. Ghassemi H, Harrison G, Mohammad K. An accelerated nutrition
transition in Iran. Public Health Nutr 2002;5:149‑55.
8. Barzin M, Keihani S, Hosseinpanah F, Serahati S, Ghareh S,
Azizi F, et al. Rising trends of obesity and abdominal obesity in
10 years of follow‑up among Tehranian adults: Tehran lipid and
glucose study (TLGS). Public Health Nutr 2015;18:2981‑9.
9. Hajian‑Tilaki KO, Heidari B. Prevalence of obesity, central obesity
and the associated factors in urban population aged 20‑70 years, in the north of Iran: A population‑based study and regression
approach. Obes Rev 2007;8:3‑10.
10. Prättälä R, Sippola R, Lahti‑Koski M, Laaksonen MT,
Mäkinen T, Roos E, et al. Twenty‑five year trends in body mass
index by education and income in Finland. BMC Public Health
11. Devaux M, Sassi F. Social inequalities in obesity and overweight
in 11 OECD countries. Eur J Public Health 2013;23:464‑9.
12. Compernolle S, De Cocker K, Abbott G, Verloigne M, Cardon G,
De Bourdeaudhuij I, et al. Do sedentary behaviors mediate
associations between socio‑demographic characteristics and
BMI in women living in socio‑economically disadvantaged
neighborhoods? Int J Behav Nutr Phys Act 2015;12:48.
13. Jalali‑Farahani S, Amiri P, Karimi M, Gharibzadeh S, Mirmiran P,
Azizi F, et al. Socio‑behavioral factors associated with overweight
and central obesity in Tehranian adults: A structural equation
model. Int J Behav Med 2017;24:110‑9.
14. James W, Schofield E. FAO Human Energy Requirement:
A Manual for Planners and Nutritionists. Oxford: Oxford
University Press; 2005.
15. Mohammadi‑Nasrabadi F, Omidvar N, Khoshfetrat MR,
Kolahdooz F. Household food insecurity in the Islamic republic
of Iran: A systematic review and meta‑analysis. East Mediterr
Health J 2014;20:698‑706.
16. Kalantari N, Ghaffarpour M. National Comprehensive Study on
Household Food Consumption Pattern and Nutritional Status. IR
Iran, 2001‑2003: Tehran: Nutrition Research Department, National
Nutrition and Food Technology Research Institute, Shaheed
Beheshti University of Medical Sciences, Ministry of Health; 2005.
17. Mohammadi F, Omidvar N, Harrison GG, Ghazi‑Tabatabaei M,
Abdollahi M, Houshiar‑Rad A, et al. Is household food insecurity
associated with overweight/obesity in women? Iran J Public
Health 2013;42:380‑90.
18. FisherJD, Fisher WA. Changing AIDS‑risk behavior. Psychol Bull
19. DiClemente RJ, Crosby RA, Kegler MC. Emerging Theories in
Health Promotion Practice and Research. San Francisco, CA:
Jossey‑Bass; 2009.
20. Clinical guidelines on the identification, evaluation, and treatment
of overweight and obesity in adults – The evidence report.
National Institutes of Health. Obes Res 1998;6 Suppl 2:51S‑209S.
21. Azizi F, Khalili D, Aghajani H, Esteghamati A, Hosseinpanah F,
Delavari A, et al. Appropriate waist circumference cut‑off points
among Iranian adults: The first report of the Iranian national
committee of obesity. Arch Iran Med 2010;13:243‑4.
22. Mohammadi F, Omidvar N, Houshiar‑Rad A, Khoshfetrat MR,
Abdollahi M, Mehrabi Y, et al. Validity of an adapted household
food insecurity access scale in urban households in Iran. Public
Health Nutr 2012;15:149‑57.
23. CNSTAT, CoNS. Food Insecurity and Hunger in the United States:
An Assessment of the Measure. Washington, DC: U.S Department
of Agriculture’s Measurement of Food Insecurity and Hunger,
National Research Council; 2006.
24. Salarkia N, Abdollahi M, Amini M, Eslami‑Amirabadi M.
Validation and use of the HFIAS questionnaire for measuring
household food insecurity in Varamin. Iran J Endocrinol Metab
25. Mohammadi‑Nasrabadi M, Sadeghi R, Rahimiforushani A,
Shojaeizadeh D, Montazeri A, Mohammadi‑Nasrabadi F. An
educational intervention to promote healthy nutritional behavior
in women. Design and the Framework. Tehran, Iran: Tehran
University of Medical Sciences; 2017.
26. Mirzazadeh A, Sadeghirad B, Haghdoost A, Bahreini F,
Rezazadeh‑Kermani M. The prevalence of obesity in Iran in recent
decade; a systematic review and meta‑analysis study. Iran J Public
Health 2009;38:1‑11.
27. Esteghamati A, Meysamie A, Khalilzadeh O, Rashidi A,
Haghazali M, Asgari F, et al. Third national surveillance of risk
factors of non‑communicable diseases (SuRFNCD‑2007) in Iran:
Methods and results on prevalence of diabetes, hypertension,
obesity, central obesity, and dyslipidemia. BMC Public Health
28. Azizi F, Azadbakht L, Mirmiran P. Trends in overweight, obesity
and central fat accumulation among Tehranian adults between
1998‑1999 and 2001‑2002: Tehran lipid and glucose study. Ann
Nutr Metab 2005;49:3‑8.
29. Hosseinpanah F, Barzin M, Eskandary PS, Mirmiran P, Azizi F.
Trends of obesity and abdominal obesity in Tehranian adults:
A cohort study. BMC Public Health 2009;9:426.
30. Chipman A, Koehring M. Confronting Obesity in the Middle East:
Cultural, Social and Policy Challenges. London: The Economist
Intelligence Unit Limited; 2016.
31. Shariff ZM, Khor GL. Obesity and household food insecurity:
Evidence from a sample of rural households in Malaysia. Eur J
Clin Nutr 2005;59:1049‑58.
32. Albawardi NM, Jradi H, Al‑Hazzaa HM. Levels and correlates of
physical activity, inactivity and body mass index among Saudi
women working in office jobs in Riyadh city. BMC Womens
Health 2016;16:33.
33. Rezazadeh A, Omidvar N, Eini‑Zinab H, Ghazi‑Tabatabaie M,
Majdzadeh R, Ghavamzadeh S, et al. Food insecurity,
socio‑economic factors and weight status in two Iranian ethnic
groups. Ethn Health 2016;21:233‑50.
34. TroyLM, MillerEA, OlsonS. Hunger and Obesity: Underestanding
a Food Insecurity Paradigm. Washington, DC: National Academy
of Sciences; 2011.
35. Hurst L, Grundleger J, Stewart K, Abruzzese L. The Burden of
Obesity: Its Relationship with Food Security. USA: The Economist
Intelligence Unit; 2014.
36. Esfarjani F, Hosseini H, Mohammadi‑Nasrabadi F, Abadi A,
Roustaee R, Alikhanian H, et al. Development of a home food
safety questionnaire based on the PRECEDE model: Targeting
Iranian women. J Food Prot 2016;79:2128‑35.
37. Karam Soltani Z. The Study of Association between Obesity
and Food Insecurity Among Primary School Students in
Yazd [Dissertation]. Tehran: Tehran University; 2004.
38. Dastgiri S, Mahboob S, Tutunchi H, Ostadrahimi A. Determinants
of food insecurity: A cross‑sectional study in Tabriz. J Ardabil
Univ Med Sci 2006;6:233‑9.
39. Gholami A, Sani TR, Askari M, Jahromi ZM, Dehghan A. Food
insecurity status and associated factors among rural households
in North‑East of Iran. Int J Prev Med 2013;4:1018‑24.
40. Ramesh T, Motlagh A, Abdollahi M. Prevalence of food insecurity
on urban household in Shiraz city and its related socioeconomic
factors. Iran J Nutr Food Tech 2010;4:53‑64.
41. Annesi JJ, Gorjala S. Relations of self‑regulation and self‑efficacy
for exercise and eating and BMI change: A field investigation.
Biopsychosoc Med 2010;4:10.
42. Razavi NS, Majlessi F, Mohebbi B, Tol A, Azam K. Assessing
the effect of educational intervention on treatment adherence
based on AIM model among patients with type 2 diabetes. Iran
J Diabetes Lipid Disord 2017;16:173‑82.
43. Tol A, Baghbanian A, Mohebbi B, Shojaeizadeh D, Azam K,
Shahmirzadi SE, et al. Empowerment assessment and influential
factors among patients with type 2 diabetes. J Diabetes Metab
Disord 2013;12:6.