Introduction

Overweight and obesity represent a rapidly growing threat to the health of populations in an
increasing number of countries. Obesity was once considered as a problem only in high
income countries. Today, however, obesity is prevalent in both developed and developing
countries, and affecting children as well as adults. Indeed they are now so common that they
are replacing more traditional problems such as under nutrition and infectious diseases as the
most significant causes of ill-health.
Obesity comorbidity include coronary heart disease, hypertension and stroke, certain types of
cancer, non-insulin-dependent diabetes mellitus, gallbladder disease, dyslipidemia,
osteoarthritis and gout, and pulmonary diseases, including sleep apnea. These health
consequences range from increased risk of premature death, to serious chronic conditions
that reduce the overall quality of life.
The prevalence of overweight and obesity is commonly assessed by using body mass index
(BMI), defined as the weight in kilograms divided by the square of the height in metres
(kg/m2). A BMI over 25 kg/m2 is defined as overweight, and a BMI of over 30 kg/m2 as
obese. These markers provide common benchmarks for assessment, but the risks of disease
in all populations can increase progressively from lower BMI levels. According to WHO ,
adult mean BMI levels of 22-23 kg/m2 are found in Africa and Asia, while BMI levels of 2527 kg/m2 are prevalent across North America, Europe, and in some Latin American,North
African and Pacific Island countries. People with a BMI below18.5 kg/m2 tend to be
underweight.
Today, the distribution of BMI is shifting upwards in many populations worldwide. The
fundamental cause of obesity and overweight is actually due to an energy imbalance
between calories consumed and calories expended. Many studies had showed that obesity is
not a single disorder but a heterogeneous group of conditions with multiple causes each of
which is ultimately expressed as obese phenotype. Obesity involves complex etiological
links between genetic, metabolic framework on one hand and behavior, food habits, physical
activity, social and cultural factors on the other. However, recent studies suggest a
mechanistic link between lack of sleep and increasing body weight. A study conducted by
researchers at the University of Chicago had found out that sleep deprivation has impact on
the neuroendocrine control of appetite in human. This study had impressed us and raised our
group interest to further our research study on the relationship of sleep curtailment to obesity

1.2

Incidence/prevalence.

Overweight and obesity lead to adverse metabolic effects on blood pressure, cholesterol,
triglycerides and insulin resistance. Risks of other associated diseases such as coronary heart
disease, ischemic stroke and type 2 diabetes mellitus increase steadily with increasing body mass
index (BMI). Raised BMI also increases the risk of cancer of the breast, colon, prostate,
endometrium, kidney and gall bladder. Mortality rates increase with increasing degrees of
overweight.
Obesity is becoming one of the most concerned health problems nowadays. Prevalence of
obesity had increase for the past few years where according to World Health Organization (WHO),
the worldwide prevalence of obesity has nearly doubled between 1980 and 2008. In 2008, 10% of
men and 14% of women in the world were obese, compared with 5% and 8% for men and women
respectively in 1980.
The prevalence of overweight and obesity were highest in the WHO Regions of the
Americas (62% for overweight in both sexes, and 26% for obesity) and lowest in the WHO Region
for South East Asia (14% overweight in both sexes and 3% for obesity. In the WHO regions for
Africa, Eastern Mediterranean and South East Asia, women had roughly double the obesity
prevalence of men.
In the past, obesity is associated with high-income countries. Nowadays, the prevalence of
raised BMI increases with income level of countries up to upper middle income levels. The
prevalence of overweight in high income and upper middle income countries was more than double
that of low and lower middle income countries. Women's obesity was significantly higher than
men's, with the exception of high income countries where it was similar. In low and lower middle
income countries, obesity among women was approximately double that among men.

According to the WHO survey in 2010, Malaysia was ranked sixth in Asia with the highest
adult obesity rate. . The survey also showed that 60% of Malaysians aged 18 and up, had a BMI
over 25 which indicate overweight. In 2007, Universiti Putra Malaysia (UPM) did a nationwide, all
Malaysian states study on obesity, on Malaysians aged 15 years old and above. The UPM
researchers found that females were more likely to be obese at 13.8% while men were at 9.6%.
Malays and Indians had higher case of obesity at 13.6% and 13.5% respectively, while Chinese
came in 8.5% of their populations in groups. Sarawak natives had 10.8% cases of obesity while the
Sabah natives had the lowest at 7.3%.
In 2008, Universiti Kebangsaan Malaysia (UKM) did a research on the prevalence of
obesity among children and the results show an increase of obesity of 30% in the 6 to 12 years old
age group. These studies highlight a need for more active, inter-sectorial participation on advocating
a health-promoting environment in order to combat obesity in this country.

1.3

RISK FACTORS

In a nutshell, obesity is driven by two main factors; too much food and too little exercise. Living in
a fast-paced modern world, we tend to opt for the faster choices in food as well. With fast food
chains rapidly blooming and poor nutritional habits such as skipping breakfast and intake of highcalorie foods, gaining weight is incredibly easy with noticeable results in a short period of time.
Consumption of high-calorie diet combined with physical inactivity simultaneously leads to
extra calories that will be preserved as fat in the body, thus obesity. There are also a number of other
factors that increases the risk of obesity. For example, an individuals lifestyle choice or influence
from his or her surrounding can affect his diet and physical activity. There could be a myriad causes
why an individual has a higher risk of obesity compared to another. For example, choice of
transportation (walking, cycling, or driving) or work environment (office job vs. manual labour) has
an effect on a persons physical activity.
Although its not the major cause to obesity, genetics increases the chance of a person to be
obese although to a much lesser degree. A healthy lifestyle, however, can countervail this effect.
Apart from genetics, obesity tends to run in families. Family members tend to have similar eating,
lifestyle and activity habits. Therefore, if one or both of your parents are obese, your risk of being
obese is very likely.
Obesity can occur at any age, even in young children. But as you age, hormonal changes and
a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body
tends to decrease with age. This reduced muscle mass leads to a decrease in metabolism. These
changes also reduce calorie needs and can make it harder to keep off excess weight. If you don't
control what you eat as you age, you're likely to gain weight.
Since the past two decades, obesity is not only a public health concern to the western
countries but has increasingly becoming a worldwide epidemic. Due to globalization, the world is
getting wealthier, and as countries start to move up the income scale, obesity rates climb, too. Farm
workers and poor city-dwellers may now have enough money to pick up modern habits associated
with obesity buying processed foods at supermarkets, and eating more food away from home,
for example. But they dont yet have the healthcare and knowledge about healthy foods and
physical activity that would help them keeping their weight down. When countries move further up
the scale to middle- and high-income, and people have better access to health care and education,

obesity rates tend to flatten and fall off.

Another lifestyle habit worth mentioning that increases the risk of obesity would be lack
of sleep. Research shows that sleep deprivation may alter the hormones that control hunger, thus
increases hunger and therefore higher food intake.

1.6 Justification
Through this research, we want to study the relation on how an individuals sleeping hours
may affect the development of obesity on that said individual. The aspects that are taken into
account are the range of sleeping hours, age and gender.
Several previous studies by researches showed that obesity may be linked to inadequate
sleep duration. Those studies have indicated that overweight and obese person has less sleeping
hours than a normal weight person. Another study has showed that for sleep that lasted for less than
8 hours, the increase in body mass index (BMI) was proportional to the amount of decreased sleep.
This research is conducted on randomized people in Kulim aged 18 to 55 years old in order
to better understand the association of sleeping hour with the potential of adolescent and adult to
become affected by overweight and obesity.

1.5 Conclusion
In the light of issues noted above, obesity is not a social condition but is a rampant disease.
Obesity cannot be overviewed as just a matter of overeating and lack of will power but must
be considered as a major genetic aetiology modified by environment . A recent research from
University of Chicago stated sleep-curtailment condition resulted in decreased leptin levels
m increased ghrelin levels and markedly elevated hunger and appetite ratings have proven to
be on the right tracks . Thus, a keen of interest of increase the quantity and quality of sleep in
individuals provide a basis for future studies on weight control intervention With the
increasing awareness and ongoing research in this area there is a considerable reason for
optimism that the next coming years will bring better treatment for the obese.