Muhammad Waseem Tufail, Rahmattullah Khan, Md. Azman Shahadan, Muhammad Saleem


Central obesity reduction through effective treatment is desirable everywhere in the world including Pakistan. The current study intends to provide effective intervention programs to reduce central obesity among Pakistani women. Through randomized control trial study fourteen females (N= 14, WHR= .897 ± .030) were recruited by employing penal data technique with simple randomization. The sample distributed into two equal groups from online randomization. The experimental group received 10-week sessions of modified cognitive behavior therapy (CBT) along with supervised and unsupervised exercise execution, plus supervised diet management plan. As a contrast, the control group received 10-week sessions without offering standard treatment. The results found that the intervention group or experimental group significantly reduced waist circumference (-2.33 inches) while control group reduced (-0.36 inches) within 10 weeks, F=42.82, p<.001***, 2p=0.781. Likewise, the experimental group reduced hip circumference (-0.75 inches), and control group reduced only (-0.07 inches), F=69.75, p<.001***, 2p =0.853 respectively. Finally, the experimental group reduced waist to hip ratio (-0.042) but control group reduced only (-0.007) within 10 weeks, F=27.0, p<.001***, 2p=0.692.  Conclusively, the combination of CBT with an exercise regimen and diet plan is effective to reduce waist circumference, hip circumference, and waist to hip ratio among obese women. The limitations and future directions are also discussed that can be a good contribution in the body of knowledge concerning obesity research. 

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Aftab, H., Ambreen, A., Jamil, M., Garred, P., Petersen, J. H., Nielsen, S. D., ... & Christensen, D. L. (2017). High prevalence of diabetes and anthropometric heterogeneity among tuberculosis patients in Pakistan. Tropical Medicine & International Health, 22(4), 465-473.

Akatsu, H., & Aslam, A. (1996). Prevalence of hypertension and obesity among women over age 25 in a low income area in Karachi, Pakistan. Journal-Pakistan medical association, 46, 191-193.

Amin, F., Fatima, S. S., Islam, N., & Gilani, A. H. (2015). Prevalence of obesity and overweight, its clinical markers and associated factors in a high-risk South-Asian population. BMC obesity, 2(1), 16.

Ashwell, M., & Hsieh, S. D. (2005). Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. International journal of food sciences and nutrition, 56(5), 303-307.

Ashwell, M., Lejeune, S., & McPherson, K. (1996). Ratio of waist circumference to height may be better indicator of need for weight management. BMJ: British Medical Journal, 312(7027), 377.

Beevers, D. G., & Prince, J. S. (1991). Some recent advances in non-communicable diseases in the tropics: 1. Hypertension: an emerging problem in tropical countries. Transactions of the Royal Society of Tropical Medicine and Hygiene, 85(3), 324-326.

Chan, J. M., Rimm, E. B., Colditz, G. A., Stampfer, M. J., & Willett, W. C. (1994). Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes care, 17(9), 961-969.

Church, T. S., Earnest, C. P., Skinner, J. S., & Blair, S. N. (2007). Effects of different doses of physical activity on cardiorespiratory fitness among sedentary, overweight or obese postmenopausal women with elevated blood pressure: a randomized controlled trial. Jama, 297(19), 2081-2091.

Church, T. S., Martin, C. K., Thompson, A. M., Earnest, C. P., Mikus, C. R., & Blair, S. N. (2009). Changes in weight, waist circumference and compensatory responses with different doses of exercise among sedentary, overweight postmenopausal women. PloS one, 4(2), e4515.

Despres, J. P. (2001). Health consequences of visceral obesity. Annals of medicine, 33(8), 534-541.

Eriksson, K. M., Westborg, C. J., & Eliasson, M. C. (2006). A randomized trial of lifestyle intervention in primary healthcare for the modification of cardiovascular risk factors The Björknäs study. Scandinavian Journal of Social Medicine, 34(5), 453-461.

Fawwad, A., Siddiqui, I. A., Basit, A., Zeeshan, N. F., Shahid, S. M., Nawab, S. N., & Siddiqui, S. (2016). Common variant within the FTO gene, rs9939609, obesity and type 2 diabetes in population of Karachi, Pakistan. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 10(1), 43-47.

Fox, C. (2004). British Heart Foundation and NHS publication. Heart disease and South Asians (delivering the National Service Framework for Coronary Heart Disease). Retrieved from Department of Health website: http://www.dh.gov.uk/assetRoot/04/09/89/19/04098919.pdf

Ghafoor, M. U., Mahmood-ur-Rehman, & Irshad, F. (2016). Screening tools for obesity; evaluation of waist hip ratio, waist circumference and BMI among hypertensive patients in a tertiary care hospital. Professional Medical Journal, 23(7), 844-857.

Goulet, J., Nadeau, G., & Lemieux, S. (2003). Effect of a nutritional intervention promoting the Mediterranean food pattern on plasma lipids, lipoproteins and body weight in healthy French-Canadian women. Atherosclerosis, 170(1), 115-124.

Hayashi, T., Boyko, E. J., Leonetti, D. L., McNeely, M. J., Newell-Morris, L., Kahn, S. E., & Fujimoto, W. Y. (2003). Visceral adiposity and the prevalence of hypertension in Japanese Americans. Circulation, 108(14), 1718-1723.

Janssen, I., Katzmarzyk, P. T., & Ross, R. (2004). Waist circumference and not body mass index explains obesity-related health risk. The American journal of clinical nutrition, 79(3), 379-384.

Khan, A., Haq, F. U., Pervez, M. B., Saleheen, D., Frossard, P. M., Ishaq, M., ... & Ahmad, U. (2008). Anthropometric correlates of blood pressure in normotensive Pakistani subjects. International journal of cardiology, 124(2), 259-262.

Khan, I. A., & King, H. (1999). Pakistan National Diabetes Survey Prevalence of Glucose Intolerance and Associated Factors in North West Frontier Province (NVVFP) of Pakistan. JPMA-Journal of the Pakistan Medical Association, OPMA, 49, 206.

Klein, S., Allison, D. B., Heymsfield, S. B., Kelley, D. E., Leibel, R. L., Nonas, C., & Kahn, R. (2007). Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; American Society for Nutrition; American Diabetes Association. Waist circumference and cardiometabolic risk: a consensus statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Am J Clin Nutr, 85, 1197-1202.

Koster, A., Leitzmann, M. F., Schatzkin, A., Mouw, T., Adams, K. F., van Eijk, J. T. M., ... & Harris, T. B. (2008). Waist circumference and mortality. American journal of epidemiology, 167(12), 1465-1475.

Kumar, B. N., Meyer, H. E., Wandel, M., Dalen, I., & Holmboe-Ottesen, G. (2006). Ethnic differences in obesity among immigrants from developing countries, in Oslo, Norway. International journal of obesity, 30(4), 684.

Larsson, B., Svärdsudd, K., Welin, L., Wilhelmsen, L., Björntorp, P., & Tibblin, G. (1984). Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J (Clin Res Ed), 288(6428), 1401-1404.

Lean, M. E. J., Han, T. S., & Morrison, C. E. (1995). Waist circumference as a measure for indicating need for weight management. Bmj, 311(6998), 158-161.

Lopatynski, J., Mardarowicz, G., & Szczesniak, G. (2003). A comparative evaluation of waist circumference, waist-to-hip ratio, waist-to-height ratio and body mass index as indicators of impaired glucose tolerance and as risk factors for type-2 diabetes mellitus. In Annales Universitatis Mariae Curie-Sklodowska. Sectio D: Medicina, 58(1), 413-419.

McKeigue, P. M., Shah, B., & Marmot, M. G. (1991). Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. The Lancet, 337(8738), 382-386.

Mefferd, K., Nichols, J. F., Pakiz, B., & Rock, C. L. (2007). A cognitive behavioral therapy intervention to promote weight loss improves body composition and blood lipid profiles among overweight breast cancer survivors. Breast cancer research and treatment, 104(2), 145.

Mogre, V., Aleyira, S., & Nyaba, R. (2015). Misperception of weight status and associated factors among undergraduate students. Obesity research & clinical practice, 9(5), 466-474.

Neeland, I. J., Turer, A. T., Ayers, C. R., Powell-Wiley, T. M., Vega, G. L., Farzaneh-Far, R., ... & de Lemos, J. A. (2012). Dysfunctional adiposity and the risk of prediabetes and type 2 diabetes in obese adults. Jama, 308(11), 1150-1159.

Newby, P. K., Muller, D., Hallfrisch, J., Qiao, N., Andres, R., & Tucker, K. L. (2003). Dietary patterns and changes in body mass index and waist circumference in adults. The American journal of clinical nutrition, 77(6), 1417-1425.

Parveen, Z., Ali, A., Ali, T. M., & Hasnain, A. (2016). Association of dietary patterns with anthropometric, lifestyle and socio-economic factors among women of selected communities from Karachi, Pakistan. JPMA. The Journal of the Pakistan Medical Association, 66(10), 1249-1257.

Qiao, Q., & Nyamdorj, R. (2010). Is the association of type II diabetes with waist circumference or waist-to-hip ratio stronger than that with body mass index?. European journal of clinical nutrition, 64(1), 30.

Rogers, R. J. (2012). The comparison of a technology-based system and in-person behavioral weight loss intervention in the severely obese (Doctoral dissertation, University of Pittsburgh).

Ross, R., Janssen, I., Dawson, J., Kungl, A. M., Kuk, J. L., Wong, S. L., ... & Hudson, R. (2004). Exercise‐induced reduction in obesity and insulin resistance in women: a randomized controlled trial. Obesity, 12(5), 789-798.

Safdar, N. F., Bertone-Johnson, E. R., Cordeiro, L., Jafar, T. H., & Cohen, N. L. (2015). Dietary patterns and their association with hypertension among Pakistani urban adults. Asia Pacific journal of clinical nutrition, 24(4), 710-719.

Sowers, J. R. (2003). Obesity as a cardiovascular risk factor. The American journal of medicine, 115(8), 37-41.

van der Kooy, K., Leenen, R., Seidell, J. C., Deurenberg, P., & Hautvast, J. G. (1993). Effect of a weight cycle on visceral fat accumulation. The American journal of clinical nutrition, 58(6), 853-857.

Williams, E. D., Tillin, T., Richards, M., Tuson, C., Chaturvedi, N., Hughes, A. D., & Stewart, R. (2015). Depressive symptoms are doubled in older British South Asian and Black Caribbean people compared with Europeans: associations with excess co-morbidity and socioeconomic disadvantage. Psychological medicine, 45(9), 1861-1871.

World Health Organization. (2011). Waist circumference and waist-hip ratio: Report of a WHO expert consultation, Geneva, 8-11 December 2008.

Zafar, J., Bhatti, F., Akhtar, N., Rasheed, U., Bashir, R., Humayun, S., ... & Nazar, M. (2011). Prevalence and risk factors for diabetes mellitus in a selected urban population of a city in Punjab. JPMA-Journal of the Pakistan Medical Association, 61(1), 40.

Zafar, J., Nadeem, D., Khan, S. A., Jawad Abbasi, M. M., Aziz, F., & Saeed, S. (2016). Prevalence of diabetes and its correlates in urban population of Pakistan: A Cross-sectional survey. J Pak Med Assoc, 66, 922-927.

Zahid, N., Meyer, H. E., Kumar, B. N., Claussen, B., & Hussain, A. (2011). High levels of cardiovascular risk factors among Pakistanis in Norway compared to Pakistanis in Pakistan. Journal of obesity, 2011.


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