Association between obesity with physical activity, eating behavior, sleep quality, general health, and the incidence of hypertension among women: a study in rural and nomadic population of western, Iran.

backgroundObesity is a global health issue, particularly among women. This study aimed to investigate the relationship between obesity and physical activity, eating behavior, sleep quality, general health, and the incidence of hypertension among women in rural and nomadic areas of Iran.

methodsThis cross-sectional study was conducted from August to December 2020 among 2,581 rural and nomadic women aged 18 years and older in Kermanshah, western Iran. A multi-stage cluster sampling method was used to ensure a representative sample. Data were collected using a structured sociodemographic questionnaire, anthropometric measurements, and validated self-report instruments. Participants' age, marital status, educational level, occupational status, smoking history, and hospitalization in the past year were recorded. Body weight, height, and blood pressure were measured using standardized protocols. Body Mass Index (BMI) was calculated and categorized according to WHO criteria: underweight (< 18.5 kg/m²), normal weight (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), and obese (≥ 30.0 kg/m²). Physical activity level (PAL) was assessed using the International Physical Activity Questionnaire (SF-IPAQ), eating behavior with the Three-Factor Eating Questionnaire (TFEQ-R18), general health with the General Health Questionnaire (GHQ-28), and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics are presented as mean ± SD or percentage. Inferential analyses were performed using non-parametric tests (Chi-square, Kruskal-Wallis) for group comparisons. To evaluate the association between health-related behaviors and BMI categories, multinomial logistic regression models were fitted with normal weight as the reference category, and results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant.

resultsThe mean age of participants was 50.17 ± 13.49 years. The prevalence of obesity was 44.98%, and 29.99% were overweight. Significant differences were observed across BMI categories in age, marital status, education, occupation, smoking, and hospitalization (all p < 0.05). Women with obesity had significantly lower physical activity levels, poorer sleep quality, worse general health, and higher rates of hypertension compared to those with normal weight (p < 0.001 for all). Multinomial logistic regression analysis revealed that low physical activity was strongly associated with higher odds of obesity (aOR = 4.32; 95% CI: 3.41-5.48) and overweight (aOR = 2.14; 95% CI: 1.68-2.73). Similarly, hypertension, poor sleep quality, and impaired general health were significantly associated with increased odds of obesity (aOR = 3.21, 95% CI: 2.54-4.06; aOR = 2.47, 95% CI: 1.88-3.24; and aOR = 2.95, 95% CI: 2.23-3.90, respectively). No significant association was found between PAL and eating behavior (p = 0.705). A sensitivity analysis using binary logistic regression confirmed that obesity was significantly associated with hypertension (aOR = 3.21; 95% CI: 2.54-4.06, p < 0.001).

conclusionsThese findings highlight that low physical activity, poor sleep quality, and impaired general health are significantly associated with obesity and hypertension among rural and nomadic women in western Iran. While a strong inverse relationship was observed between physical activity and obesity, no significant association was found with eating behavior, suggesting that these lifestyle factors may be independently influenced. Public health strategies should prioritize community-based interventions to promote physical activity and improve sleep and mental health in this high-risk population. Future research should focus on longitudinal and interventional studies to develop targeted, culturally appropriate policies for obesity and hypertension prevention.