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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Endocrinol.</journal-id>
<journal-title>Frontiers in Endocrinology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Endocrinol.</abbrev-journal-title>
<issn pub-type="epub">1664-2392</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fendo.2025.1514308</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Endocrinology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Excessive body weight and its contributing factors in visually impaired patients in northwest Ethiopia, 2024</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Ashenef</surname>
<given-names>Baye</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>Yimenu</surname>
<given-names>Bayu Wondimneh</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>Osman</surname>
<given-names>Enatnesh Essa</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>Sinamaw</surname>
<given-names>Derese</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>Baye</surname>
<given-names>Gelagey</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>Teffera</surname>
<given-names>Zigale Hibstu</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>Engida</surname>
<given-names>Mamaru Getinet</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
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<contrib contrib-type="author">
<name>
<surname>Adugna</surname>
<given-names>Adane</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>Mengistu</surname>
<given-names>Enyew Fenta</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>Baylie</surname>
<given-names>Temesgen</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
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<contrib contrib-type="author">
<name>
<surname>Jemal</surname>
<given-names>Mohammed</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2604490/overview"/>
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<aff id="aff1">
<sup>1</sup>
<institution>Department of Biomedical Sciences, School of Medicine, Debre Markos University</institution>, <addr-line>Debre Markos</addr-line>, <country>Ethiopia</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Department of Medical Laboratory Sciences, College of Health Sciences, Debre Markos University</institution>, <addr-line>Debre Markos</addr-line>, <country>Ethiopia</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Wen-Hui Wu, Tongji University, China</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Siti Nurliyana Abdullah, Raja Isteri Pengiran Anak Saleha Hospital, Brunei</p>
<p>Fahad Alzahrani, Taibah University, Saudi Arabia</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Baye Ashenef, <email xlink:href="mailto:bayeashenafi77@gmail.com">bayeashenafi77@gmail.com</email>
</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>20</day>
<month>03</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="collection">
<year>2025</year>
</pub-date>
<volume>16</volume>
<elocation-id>1514308</elocation-id>
<history>
<date date-type="received">
<day>20</day>
<month>10</month>
<year>2024</year>
</date>
<date date-type="accepted">
<day>27</day>
<month>02</month>
<year>2025</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2025 Ashenef, Yimenu, Osman, Sinamaw, Baye, Teffera, Engida, Adugna, Mengistu, Baylie and Jemal</copyright-statement>
<copyright-year>2025</copyright-year>
<copyright-holder>Ashenef, Yimenu, Osman, Sinamaw, Baye, Teffera, Engida, Adugna, Mengistu, Baylie and Jemal</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<sec>
<title>Background</title>
<p>Excessive body weight are global health challenge affecting individuals across all age groups. They result from an imbalance between calorie intake and expenditure. Individuals with visual impairment are particularly vulnerable due to reduced physical activity, leading to higher rates of excessive body weight. This study assessed the prevalence and determinants of excessive body weight among visually impaired patients in northwest Ethiopia in 2024.</p>
</sec>
<sec>
<title>Method</title>
<p>A multi-centered institution-based cross-sectional study was done with 384 visually impaired patients selected using a simple random sample technique. An interviewer-administered structured questionnaire and physical assessments were used to gather data. The crude and adjusted odds ratios, as well as the 95% confidence intervals, were calculated. Bivariate and multivariate logistic regression analyses were performed. Variables having a p-value &lt; 0.05 were considered substantially associated with excessive body weight.</p>
</sec>
<sec>
<title>Results</title>
<p>The prevalence of excessive body weight was 27.9% (95% CI: 23.2&#x2013;32.8). Factors significantly associated with excessive body weight included being aged 65 or older (AOR = 5.43, 95% CI: 1.22&#x2013;24.1), urban residency (AOR = 4.84, 95% CI: 2.95&#x2013;7.95), and having visual impairment for five or more years (AOR = 3.33, 95% CI: 1.88&#x2013;5.89).</p>
</sec>
<sec>
<title>Conclusion</title>
<p>Excessive body weight affects nearly one-third of visually impaired patients in northwest Ethiopia, with significant associations found for older age, urban residence, and long-term visual impairment. Integrating weight management programs, physical activity promotion, nutritional education, and community support is essential to improve health outcomes. Future studies using prospective cohort designs are recommended to explore causal relationships.</p>
</sec>
</abstract>
<kwd-group>
<kwd>excessive body weight</kwd>
<kwd>visual impairment</kwd>
<kwd>northwest Ethiopia</kwd>
<kwd>overweight</kwd>
<kwd>obesity</kwd>
</kwd-group>
<counts>
<fig-count count="1"/>
<table-count count="5"/>
<equation-count count="1"/>
<ref-count count="84"/>
<page-count count="11"/>
<word-count count="3970"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Obesity</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<title>Introduction</title>
<p>Visual impairments often lead to reduced physical activity and difficulty managing food (<xref ref-type="bibr" rid="B1">1</xref>), contributing to unhealthy eating habits (<xref ref-type="bibr" rid="B2">2</xref>). Additionally, psychological issues such as depression, anxiety, and chronic stress can trigger hormonal changes and emotional eating, increasing their risk of excessive body weight (<xref ref-type="bibr" rid="B3">3</xref>)</p>
<p>Excessive body weight, defined by a BMI &#x2265; 25 kg/m&#xb2; (<xref ref-type="bibr" rid="B4">4</xref>), encompasses both overweight and obesity and is characterized by an abnormal accumulation of body fat, significantly increasing health risks for individuals of all age groups (<xref ref-type="bibr" rid="B5">5</xref>&#x2013;<xref ref-type="bibr" rid="B8">8</xref>). Excessive body weight arises mainly from an energy imbalance between calorie intake and expenditure (<xref ref-type="bibr" rid="B9">9</xref>). Contributing factors include reduced physical activity (<xref ref-type="bibr" rid="B10">10</xref>), insufficient sleep (<xref ref-type="bibr" rid="B11">11</xref>), abnormal physiological conditions (hypothyroidism, Cushing&#x2019;s syndrome, growth hormone deficiency, eating disorders) (<xref ref-type="bibr" rid="B12">12</xref>&#x2013;<xref ref-type="bibr" rid="B14">14</xref>), medications (like insulin, steroids, sulfonylureas, antidepressants, and hormonal contraceptives) (<xref ref-type="bibr" rid="B15">15</xref>), Genetic predisposition (<xref ref-type="bibr" rid="B14">14</xref>), and late-age pregnancy (<xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B17">17</xref>).</p>
<p>These conditions are major risk factors for a range of non-communicable diseases, including cardiovascular diseases (heart disease and stroke), type 2 diabetes, musculoskeletal disorders like osteoarthritis, and certain cancers (e.g., endometrial, breast, and colon cancers) (<xref ref-type="bibr" rid="B18">18</xref>&#x2013;<xref ref-type="bibr" rid="B20">20</xref>).</p>
<p>Globally, the prevalence of excessive body weight is rising. In 2022, the WHO reported that 2.5 billion adults were overweight, and 890 million were obese, with this trend evident in both developing and developed countries (<xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B19">19</xref>). In Africa, overweight and obesity prevalence among adults ranges from 13.6% to 31%, while among children and adolescents, it ranges from 5% to 16.5% (<xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B21">21</xref>). In Ethiopia, the prevalence of overweight and obesity among adults was reported at 20.4% and 5.4%, respectively (<xref ref-type="bibr" rid="B22">22</xref>).</p>
<p>Among adults with visual impairments, the prevalence of excessive body weight varies significantly by country, 22.2% in Korea (<xref ref-type="bibr" rid="B23">23</xref>), 36% in the United States (<xref ref-type="bibr" rid="B24">24</xref>), and 38% in India (<xref ref-type="bibr" rid="B25">25</xref>). However, no studies have investigated the prevalence of excessive body weight among visually impaired adults in Ethiopia.</p>
<p>Excessive body weight significantly affects individuals with visual impairments and their families (<xref ref-type="bibr" rid="B26">26</xref>). These conditions can reduce the quality of life (QOL) (<xref ref-type="bibr" rid="B27">27</xref>), and contribute to physical inactivity, resulting in low socioeconomic status (<xref ref-type="bibr" rid="B28">28</xref>). They also increase the need for self-care assistance, adversely affecting mental health, social functioning, employment, and educational opportunities (<xref ref-type="bibr" rid="B27">27</xref>, <xref ref-type="bibr" rid="B29">29</xref>).</p>
<p>Evidence indicates that excessive body weight is associated with various factors including family history (<xref ref-type="bibr" rid="B30">30</xref>), age (<xref ref-type="bibr" rid="B31">31</xref>), sex (<xref ref-type="bibr" rid="B32">32</xref>), income (<xref ref-type="bibr" rid="B33">33</xref>), educational attainment (<xref ref-type="bibr" rid="B34">34</xref>), dietary type (<xref ref-type="bibr" rid="B35">35</xref>), length of sleep in a day (<xref ref-type="bibr" rid="B36">36</xref>), cigarette smoking (<xref ref-type="bibr" rid="B37">37</xref>), and alcohol consumption (<xref ref-type="bibr" rid="B38">38</xref>), khat chewing (<xref ref-type="bibr" rid="B39">39</xref>).</p>
<p>Despite these associations, no studies have explored the prevalence and risk factors of excessive body weight among visually impaired adults in Northwest Ethiopia. This study aims to fill that gap by investigating the prevalence and determinants of excessive body weight among visually impaired individuals attending follow-up visits in hospitals in Northwest Ethiopia. The findings emphasize the need to address excessive body weight within this population and implement targeted preventative strategies.</p>
</sec>
<sec id="s2" sec-type="materials|methods">
<title>Methods and materials</title>
<sec id="s2_1">
<title>Study setting and period</title>
<p>This study was conducted in hospitals located in Northwest Ethiopia from February 1 to March 30, 2024. These hospitals provide comprehensive care and support services to a population exceeding 25 million, including approximately 5,000 visually impaired patients who receive follow-ups and comprehensive healthcare services (unpublished data).</p>
</sec>
<sec id="s2_2">
<title>Study design and population</title>
<p>An institutional-based cross-sectional study was conducted among visually impaired patients attending hospitals in Northwest Ethiopia. The source population comprised all visually impaired patients on follow-up in the selected hospitals, while the study population included visually impaired patients on follow-up during the study period at randomly selected hospitals.</p>
</sec>
<sec id="s2_3">
<title>Inclusion and exclusion criteria</title>
<sec id="s2_3_1">
<title>Inclusion criteria</title>
<list list-type="bullet">
<list-item>
<p>Adults aged 18 years and above with documented visual impairment.</p>
</list-item>
<list-item>
<p>Residents of Northwest Ethiopia for at least six months.</p>
</list-item>
<list-item>
<p>Individuals who provided informed consent.</p>
</list-item>
</list>
</sec>
<sec id="s2_3_2">
<title>Exclusion criteria</title>
<list list-type="bullet">
<list-item>
<p>Patients with severe illnesses, pregnancy, or mobility disabilities.</p>
</list-item>
<list-item>
<p>Individuals with chronic conditions such as hypothyroidism, Cushing&#x2019;s syndrome, or other infections that could interfere with body weight.</p>
</list-item>
<list-item>
<p>Patients with severe cognitive impairments, acute psychiatric conditions, or those on weight-altering psychiatric medications.</p>
</list-item>
<list-item>
<p>Individuals with hearing impairments or those taking medications affecting body weight</p>
</list-item>
</list>
<p>Sample size determination</p>
<p>The sample size was determined using a single population proportion formula.</p>
<disp-formula>
<mml:math display="block" id="M1">
<mml:mrow>
<mml:mi>n</mml:mi>
<mml:mo>=</mml:mo>
<mml:mfrac>
<mml:mrow>
<mml:msup>
<mml:mrow>
<mml:mo stretchy="false">(</mml:mo>
<mml:mrow>
<mml:msub>
<mml:mtext>Z</mml:mtext>
<mml:mrow>
<mml:mtext>&#x3b1;</mml:mtext>
<mml:mo stretchy="false">/</mml:mo>
<mml:mn>2</mml:mn>
</mml:mrow>
</mml:msub>
</mml:mrow>
<mml:mo stretchy="false">)</mml:mo>
</mml:mrow>
<mml:mn>2</mml:mn>
</mml:msup>
<mml:mo>&#xd7;</mml:mo>
<mml:mtext>&#xa0;p</mml:mtext>
<mml:mo stretchy="false">(</mml:mo>
<mml:mrow>
<mml:mn>1</mml:mn>
<mml:mo>&#x2212;</mml:mo>
<mml:mtext>p</mml:mtext>
</mml:mrow>
<mml:mo stretchy="false">)</mml:mo>
</mml:mrow>
<mml:mrow>
<mml:mo>&#xa0;</mml:mo>
<mml:msup>
<mml:mtext>d</mml:mtext>
<mml:mn>2</mml:mn>
</mml:msup>
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</mml:mfrac>
<mml:mo>=</mml:mo>
<mml:mfrac>
<mml:mrow>
<mml:msup>
<mml:mrow>
<mml:mo stretchy="false">(</mml:mo>
<mml:mrow>
<mml:mn>1.96</mml:mn>
</mml:mrow>
<mml:mo stretchy="false">)</mml:mo>
</mml:mrow>
<mml:mn>2</mml:mn>
</mml:msup>
<mml:mo>&#xd7;</mml:mo>
<mml:mo stretchy="false">(</mml:mo>
<mml:mrow>
<mml:mn>0.5</mml:mn>
</mml:mrow>
<mml:mo stretchy="false">)</mml:mo>
<mml:mo stretchy="false">(</mml:mo>
<mml:mrow>
<mml:mn>0.5</mml:mn>
</mml:mrow>
<mml:mo stretchy="false">)</mml:mo>
</mml:mrow>
<mml:mrow>
<mml:msup>
<mml:mrow>
<mml:mo stretchy="false">(</mml:mo>
<mml:mrow>
<mml:mn>0.05</mml:mn>
</mml:mrow>
<mml:mo stretchy="false">)</mml:mo>
</mml:mrow>
<mml:mn>2</mml:mn>
</mml:msup>
</mml:mrow>
</mml:mfrac>
<mml:mn>384</mml:mn>
</mml:mrow>
</mml:math>
</disp-formula>
<p>Assumption:</p>
<p>n = sample size, P = proportion of excessive body weight = 50% since the study on excessive body weight among visually impaired patients was not conducted in the study area, d = Margin of sampling error tolerated- 5% (0.05), &#x3b1; = Critical value at 95% confidence interval of certainty (1.96).</p>
</sec>
</sec>
<sec id="s2_4">
<title>Sampling procedure</title>
<p>A combination of simple and systematic random sampling techniques was used to select participants. Three hospitals (Finote Selam General Hospital, Debre Markos Comprehensive and Specialized Hospital, and Mertulemariam Primary Hospital) were randomly selected using the lottery method. From the ophthalmic clinic records, a sampling frame of visually impaired patients was established. Systematic random sampling was applied, with every 2<sup>nd</sup> patient selected during data collection (sampling interval K=7, calculated by dividing the total number of visually impaired patients during the study period [2,500] by the sample size [384]). The starting point (patient number 2) was determined through the lottery method. A proportional number of participants were selected from each hospital to ensure representativeness.</p>
</sec>
<sec id="s2_5">
<title>Study variables</title>
<sec id="s2_5_1">
<title>Dependent variable</title>
<list list-type="bullet">
<list-item>
<p>Excessive body weight (Yes/No).</p>
</list-item>
</list>
</sec>
<sec id="s2_5_2">
<title>Independent variables</title>
<list list-type="bullet">
<list-item>
<p>Sociodemographic factors: Age, gender, residence, income, employment, education, marital status.</p>
</list-item>
<list-item>
<p>Health-related factors: Blood pressure, family history of diabetes, diabetes mellitus</p>
</list-item>
<list-item>
<p>Behavioral factors: Khat chewing, smoking, alcohol consumption, sleep duration, dietary habits, level of visual impairment</p>
</list-item>
</list>
</sec>
</sec>
<sec id="s2_6">
<title>Operational definitions</title>
<p>Excessive body weight: BMI &#x2265; 25 kg/m&#xb2; (<xref ref-type="bibr" rid="B4">4</xref>)</p>
<p>Diabetes Mellitus: a random plasma glucose level of &#x2265;200 mg/dL (<xref ref-type="bibr" rid="B40">40</xref>).</p>
<p>Visual impairment: Having presenting visual acuity less than 6/12 in the better eye (<xref ref-type="bibr" rid="B41">41</xref>).</p>
<p>Mild visual impairment: Having visual acuity worse than 6/12 but better than 6/18 in the better eye (<xref ref-type="bibr" rid="B41">41</xref>).</p>
<p>Moderate visual impairment: Presenting distance visual acuity (VA) worse than 6/18 but better than 6/60 in the better eye (<xref ref-type="bibr" rid="B42">42</xref>).</p>
<p>Severe visual impairment: Presenting distance VA worse than 6/60 but better than 3/60 in the better eye (<xref ref-type="bibr" rid="B42">42</xref>).</p>
<p>Blindness: Presenting VA worse than 3/60 (<xref ref-type="bibr" rid="B43">43</xref>).</p>
<p>Current smoker: An adult who has smoked 100 cigarettes in his or her lifetime and who currently smokes cigarettes (<xref ref-type="bibr" rid="B44">44</xref>).</p>
<p>Ever alcohol user: Use of alcohol, at least once in an individual&#x2019;s lifetime (<xref ref-type="bibr" rid="B45">45</xref>).</p>
<p>Current alcohol user: A person who consumed alcohol at least once within the last 30 days (<xref ref-type="bibr" rid="B45">45</xref>).</p>
<p>Duration of sleep: a short length of sleep of &#x2264;5 hours and long sleep of &#x2265;9 hours (<xref ref-type="bibr" rid="B46">46</xref>).</p>
</sec>
<sec id="s2_7">
<title>Data collection procedure and tools</title>
<p>Data collection occurred from February 1 to March 30, 2024, using a structured, interviewer-administered questionnaire developed from various validated sources (<xref ref-type="bibr" rid="B47">47</xref>, <xref ref-type="bibr" rid="B48">48</xref>). The questionnaire collected data on medical assessments, substance use, and sociodemographic characteristics, while blood pressure and body mass index (BMI) measurements were taken for patients with visual impairment. Two BSc clinical nurses were recruited at each hospital to collect and document data.</p>
</sec>
<sec id="s2_8">
<title>Examinations and measurements</title>
<sec id="s2_8_1">
<title>Anthropometric and blood pressure measurements</title>
<p>Weight and Height: Participants&#x2019; weight was measured using a standard balance scale, and height was recorded with a stadiometer. BMI was calculated by dividing weight (kg) by height squared (m&#xb2;). Blood Pressure: Blood pressure was measured using a calibrated sphygmomanometer, ensuring standard protocol adherence.</p>
</sec>
</sec>
<sec id="s2_9">
<title>Data analysis procedure</title>
<p>The collected data were checked for completeness and entered Epi data version 4.6. Then it was exported into SPSS version 26 for analysis. The crude and adjusted odds ratios were used to measure the association between study variables, and 95% confidence intervals were calculated. Descriptive measures such as median, interquartile range, and frequencies were calculated. Multicollinearity among selected independent variables was checked, and the variance inflation factor was found to be acceptable (less than 2) and model fitness was checked by the Hosmer and Lemeshow test at p-value &gt;0.05 (p=0.965). Both bivariable and multivariable binary logistic regression models were used to identify associated factors of excessive body weight. Those variables having a p-value of &lt;0.25 in the bivariable binary logistic regression analysis were selected for multivariable binary logistic regression. Those variables with a p-value of &#x2264; 0.05 in multivariable binary logistic regression were declared as having a statistically significant association with excessive body weight. Results were organized and presented by using frequency tables, graphs, and charts.</p>
</sec>
<sec id="s2_10">
<title>Data quality management</title>
<p>To ensure the data quality, high prominence was given in designing the data collection instrument. The questionnaire was pre-tested in a setup having similar socio-cultural characteristics with the 20 study participants at Bichena primary hospitals before the actual study begins. It helps to check its wording and sort out language barriers and contextual variations on the structured questionnaire. Training for both data collectors and supervisors regarding the study objectives, ethical considerations, data collection tools, interview techniques, measurement techniques, and strategies to ensure data quality and consistency was given for one day. Throughout the data collection, data collectors were supervised.</p>
</sec>
</sec>
<sec id="s3" sec-type="results">
<title>Results</title>
<sec id="s3_1">
<title>Socio-demographic, clinical, substance use, and behavioral characteristics of study participants</title>
<p>The study involved 384 visually impaired patients, achieving a 100% response rate. Participants ranged in age from 18 to 90 years, with a median age of 59 years (&#xb1; 17) and an interquartile range (IQR) of 49&#x2013;69 years. Among the participants, 225 (58.6%) were male, 243 (63.3%) were married, 203 (52.9%) resided in rural areas, and 289 (75.3%) were illiterate (<xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>).</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>Sociodemographic characteristics of visually impaired adult patients in selected hospitals of northwest Ethiopia, 2024 (n=384).</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" align="left">Variables</th>
<th valign="top" align="left">Frequency</th>
<th valign="top" align="left">Percentage (%)</th>
</tr>
</thead>
<tbody>
<tr>
<th valign="top" colspan="3" align="left">Age of participants (years)</th>
</tr>
<tr>
<td valign="top" align="left">&lt;40</td>
<td valign="top" align="left">13</td>
<td valign="top" align="left">3.39</td>
</tr>
<tr>
<td valign="top" align="left">40-64</td>
<td valign="top" align="left">167</td>
<td valign="top" align="left">43.49</td>
</tr>
<tr>
<td valign="top" align="left">&#x2265;65</td>
<td valign="top" align="left">204</td>
<td valign="top" align="left">53.13</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Sex of participants</th>
</tr>
<tr>
<td valign="top" align="left">Female</td>
<td valign="top" align="left">159</td>
<td valign="top" align="left">41.4</td>
</tr>
<tr>
<td valign="top" align="left">Male</td>
<td valign="top" align="left">225</td>
<td valign="top" align="left">58.6</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Marital status</th>
</tr>
<tr>
<td valign="top" align="left">Married</td>
<td valign="top" align="left">243</td>
<td valign="top" align="left">63.3</td>
</tr>
<tr>
<td valign="top" align="left">Divorced</td>
<td valign="top" align="left">27</td>
<td valign="top" align="left">7.0</td>
</tr>
<tr>
<td valign="top" align="left">Widowed</td>
<td valign="top" align="left">106</td>
<td valign="top" align="left">27.6</td>
</tr>
<tr>
<td valign="top" align="left">Single</td>
<td valign="top" align="left">8</td>
<td valign="top" align="left">2.1</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Residence</th>
</tr>
<tr>
<td valign="top" align="left">Urban</td>
<td valign="top" align="left">181</td>
<td valign="top" align="left">47.1</td>
</tr>
<tr>
<td valign="top" align="left">Rural</td>
<td valign="top" align="left">203</td>
<td valign="top" align="left">52.9</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Educational level</th>
</tr>
<tr>
<td valign="top" align="left">Unable to read and write</td>
<td valign="top" align="left">289</td>
<td valign="top" align="left">75.3</td>
</tr>
<tr>
<td valign="top" align="left">Primary</td>
<td valign="top" align="left">45</td>
<td valign="top" align="left">11.7</td>
</tr>
<tr>
<td valign="top" align="left">Secondary and preparatory</td>
<td valign="top" align="left">22</td>
<td valign="top" align="left">5.70</td>
</tr>
<tr>
<td valign="top" align="left">College and university</td>
<td valign="top" align="left">28</td>
<td valign="top" align="left">7.30</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Occupation</th>
</tr>
<tr>
<td valign="top" align="left">Farmer</td>
<td valign="top" align="left">150</td>
<td valign="top" align="left">39.10</td>
</tr>
<tr>
<td valign="top" align="left">Civil servant</td>
<td valign="top" align="left">16</td>
<td valign="top" align="left">4.20</td>
</tr>
<tr>
<td valign="top" align="left">Merchant</td>
<td valign="top" align="left">32</td>
<td valign="top" align="left">8.30</td>
</tr>
<tr>
<td valign="top" align="left">Housewife</td>
<td valign="top" align="left">118</td>
<td valign="top" align="left">30.7</td>
</tr>
<tr>
<td valign="top" align="left">Unemployed</td>
<td valign="top" align="left">13</td>
<td valign="top" align="left">3.40</td>
</tr>
<tr>
<td valign="top" align="left">Retire</td>
<td valign="top" align="left">55</td>
<td valign="top" align="left">14.3</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Income (Ethiopian Birr)</th>
</tr>
<tr>
<td valign="top" align="left">&lt;2000</td>
<td valign="top" align="left">234</td>
<td valign="top" align="left">61</td>
</tr>
<tr>
<td valign="top" align="left">2000-5000</td>
<td valign="top" align="left">90</td>
<td valign="top" align="left">23.4</td>
</tr>
<tr>
<td valign="top" align="left">&gt;5000</td>
<td valign="top" align="left">60</td>
<td valign="top" align="left">15.6</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>Of the participants, 244 (63.5%) had experienced visual impairment for less than five years. About half of the respondents (51.8%) reported sleeping between 5 and 8 hours per night. The majority, 232 (60.4%), were non-vegetarians. Additionally, 331 participants (86.2%) had consumed alcohol at some point in their lives, but only 47 (12.2%) reported drinking alcohol within the past 30 days, primarily traditional beverages such as <italic>tela</italic> or <italic>tej.</italic> Among the respondents, 63% had elevated systolic blood pressure, while 48.2% showed elevated diastolic blood pressure. Of the visually impaired respondents, 17.7% had diabetes mellitus (<xref ref-type="table" rid="T2">
<bold>Table&#xa0;2</bold>
</xref>).</p>
<table-wrap id="T2" position="float">
<label>Table&#xa0;2</label>
<caption>
<p>Clinical and behavioral characteristics of visually impaired adult patients in selected hospitals of northwest Ethiopia, 2024 (n=384).</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" align="left">Variables</th>
<th valign="top" align="left">Frequency</th>
<th valign="top" align="left">Percentage (%)</th>
</tr>
</thead>
<tbody>
<tr>
<th valign="top" colspan="3" align="left">Duration for visual impairment</th>
</tr>
<tr>
<td valign="top" align="left">&lt;5 years</td>
<td valign="top" align="left">244</td>
<td valign="top" align="left">63.5</td>
</tr>
<tr>
<td valign="top" align="left">&#x2265;5 years</td>
<td valign="top" align="left">140</td>
<td valign="top" align="left">36.5</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Duration of sleep per day</th>
</tr>
<tr>
<td valign="top" align="left">&lt;5 hours</td>
<td valign="top" align="left">3</td>
<td valign="top" align="left">0.80</td>
</tr>
<tr>
<td valign="top" align="left">5-8 hours</td>
<td valign="top" align="left">199</td>
<td valign="top" align="left">51.8</td>
</tr>
<tr>
<td valign="top" align="left">&#x2265;9 hours</td>
<td valign="top" align="left">182</td>
<td valign="top" align="left">47.4</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Dietary types</th>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Vegetarians</td>
<td valign="top" align="left">152</td>
<td valign="top" align="left">39.6</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Non-vegetarians</td>
<td valign="top" align="left">232</td>
<td valign="top" align="left">60.4</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Chewing chat</th>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Yes</td>
<td valign="top" align="left">1</td>
<td valign="top" align="left">0.3</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;No</td>
<td valign="top" align="left">383</td>
<td valign="top" align="left">99.7</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Ever alcohol drinker</th>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Yes</td>
<td valign="top" align="left">331</td>
<td valign="top" align="left">86.2</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;No</td>
<td valign="top" align="left">53</td>
<td valign="top" align="left">13.8</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Current alcohol drinker</th>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Yes</td>
<td valign="top" align="left">47</td>
<td valign="top" align="left">12.2</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;No</td>
<td valign="top" align="left">337</td>
<td valign="top" align="left">87.8</td>
</tr>
<tr>
<td valign="top" align="left">SBP (mmHg)&lt;140</td>
<td valign="top" align="left">142</td>
<td valign="top" align="left">37.0</td>
</tr>
<tr>
<td valign="top" align="left">&#x2265; 140</td>
<td valign="top" align="left">242</td>
<td valign="top" align="left">63.0</td>
</tr>
<tr>
<td valign="top" align="left">DBP (mmHg)&lt; 90</td>
<td valign="top" align="left">199</td>
<td valign="top" align="left">51.8</td>
</tr>
<tr>
<td valign="top" align="left">&#x2265; 90</td>
<td valign="top" align="left">185</td>
<td valign="top" align="left">48.2</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Body mass index (kg/m<sup>2</sup>)</th>
</tr>
<tr>
<td valign="top" align="left">&lt; 18.5</td>
<td valign="top" align="left">11</td>
<td valign="top" align="left">2.90</td>
</tr>
<tr>
<td valign="top" align="left">18.5-24.99</td>
<td valign="top" align="left">266</td>
<td valign="top" align="left">69.3</td>
</tr>
<tr>
<td valign="top" align="left">25-29.99</td>
<td valign="top" align="left">96</td>
<td valign="top" align="left">25.0</td>
</tr>
<tr>
<td valign="top" align="left">&#x2265;30</td>
<td valign="top" align="left">11</td>
<td valign="top" align="left">2.90</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Family history of DM</th>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Yes</td>
<td valign="top" align="left">11</td>
<td valign="top" align="left">2.9</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;No</td>
<td valign="top" align="left">373</td>
<td valign="top" align="left">97.1</td>
</tr>
<tr>
<th valign="top" colspan="3" align="left">Diabetes mellitus</th>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Yes</td>
<td valign="top" align="left">68</td>
<td valign="top" align="left">17.7</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;No</td>
<td valign="top" align="left">316</td>
<td valign="top" align="left">82.3</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s3_2">
<title>Prevalence of excessive body weight</title>
<p>The overall prevalence of excessive body weight among visually impaired patients was 27.9% (95% CI: 23.2- 32.8) (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref>). Among the respondents, 13.28% with mild visual impairment, 8.6% with moderate visual impairment, and 5.99% with severe visual impairment were found to have excessive body weight (<xref ref-type="table" rid="T3">
<bold>Table&#xa0;3</bold>
</xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Prevalence of excessive body weight among visually impaired adult patients in selected hospitals of northwest Ethiopia, 2024 (n=384).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fendo-16-1514308-g001.tif"/>
</fig>
<table-wrap id="T3" position="float">
<label>Table&#xa0;3</label>
<caption>
<p>Distribution of excessive body weight among visually impaired adult patients by level of visual impairment in selected hospitals of northwest Ethiopia, 2024 (n=384).</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" rowspan="2" align="left">Level of visual impairment</th>
<th valign="top" colspan="2" align="left">Excessive body weight</th>
<th valign="top" rowspan="2" align="left">Total (%)</th>
</tr>
<tr>
<th valign="top" align="left">Yes (%)</th>
<th valign="top" align="left">No (%)</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Mild</td>
<td valign="top" align="left">51(13.28)</td>
<td valign="top" align="left">106(27.6)</td>
<td valign="top" align="left">157(40.89)</td>
</tr>
<tr>
<td valign="top" align="left">Moderate</td>
<td valign="top" align="left">33(8.6)</td>
<td valign="top" align="left">100(26.04)</td>
<td valign="top" align="left">133(34.63)</td>
</tr>
<tr>
<td valign="top" align="left">Severe</td>
<td valign="top" align="left">23(5.99)</td>
<td valign="top" align="left">71(18.49)</td>
<td valign="top" align="left">94(24.48)</td>
</tr>
<tr>
<td valign="top" align="left">Total</td>
<td valign="top" align="left">107(27.9)</td>
<td valign="top" align="left">277(72.1)</td>
<td valign="top" align="left">384(100)</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s3_3">
<title>Determinant factors of diabetes mellitus among hypertensive patients</title>
<p>In the bivariate analysis, factors such as age, marital status, family size, residence, education level, occupation, duration of visual impairment, dietary habits, current alcohol consumption, and isolated diastolic blood pressure were associated with excessive body weight. However, the multivariate analysis, which adjusts for potential confounders, revealed that age (65 years or older), residence, and the duration of visual impairment were significantly associated with excessive body weight.</p>
<p>Respondents aged 65 years or older were significantly more likely to have excessive body weight, with 5.43 times higher odds compared to those under 40 years (AOR = 5.43, 95% CI: 1.22&#x2013;12.1). Similarly, individuals residing in urban areas had 4.84 times higher odds of excessive body weight compared to those living in rural areas (AOR = 4.84, 95% CI: 2.95&#x2013;7.95). Furthermore, individuals with visual impairment lasting five or more years were 3.33 times more likely to have excessive body weight compared to those with a shorter duration of impairment (AOR = 3.33, 95% CI: 1.88&#x2013;5.89) (<xref ref-type="table" rid="T4">
<bold>Table&#xa0;4</bold>
</xref>).</p>
<table-wrap id="T4" position="float">
<label>Table&#xa0;4</label>
<caption>
<p>Bivariable and multivariable binary logistic regression analysis of factors associated with excessive body weight among visually impaired adult patients in selected hospitals of northwest Ethiopia, 2024 (n=384).</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" align="left">Variables</th>
<th valign="top" colspan="2" align="left">Excessive body weight</th>
<th valign="top" rowspan="2" align="left">AOR (95% CI)</th>
<th valign="top" rowspan="2" align="left">p-value</th>
</tr>
<tr>
<th valign="top" align="left"/>
<th valign="top" align="left">Yes (%)</th>
<th valign="top" align="left">No (%)</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Age &#x2003;&lt;40</td>
<td valign="top" align="left">2(15.4)</td>
<td valign="top" align="left">11(84.6)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left"/>
</tr>
<tr>
<td valign="top" align="center">40-64</td>
<td valign="top" align="left">37(22.16)</td>
<td valign="top" align="left">130(77.84)</td>
<td valign="top" align="left">1.9(0.34-10.75)</td>
<td valign="top" align="left">0.13</td>
</tr>
<tr>
<td valign="top" align="center">&#x2265;65</td>
<td valign="top" align="left">68(33.3)</td>
<td valign="top" align="left">136(66.7)</td>
<td valign="top" align="left">5.43(1.22-12.1)</td>
<td valign="top" align="left">0.001</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Marital status</th>
</tr>
<tr>
<td valign="top" align="center">Single</td>
<td valign="top" align="left">2(25)</td>
<td valign="top" align="left">6(75)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left"/>
</tr>
<tr>
<td valign="top" align="center">Married</td>
<td valign="top" align="left">78(32.1)</td>
<td valign="top" align="left">165(67.9)</td>
<td valign="top" align="left">2.12(0.24-8.51)</td>
<td valign="top" align="left">0.216</td>
</tr>
<tr>
<td valign="top" align="center">Widowed</td>
<td valign="top" align="left">19(17.92)</td>
<td valign="top" align="left">87(82.08)</td>
<td valign="top" align="left">0.45(0.13-1.50)</td>
<td valign="top" align="left">0.346</td>
</tr>
<tr>
<td valign="top" align="center">Divorced</td>
<td valign="top" align="left">8(29.63)</td>
<td valign="top" align="left">19(70.37)</td>
<td valign="top" align="left">0.66(0.22-1.95)</td>
<td valign="top" align="left">0.462</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Number of families</th>
</tr>
<tr>
<td valign="top" align="center">&lt;3</td>
<td valign="top" align="left">18(19.35)</td>
<td valign="top" align="left">75(80.65)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left"/>
</tr>
<tr>
<td valign="top" align="center">3-5</td>
<td valign="top" align="left">72(30.25)</td>
<td valign="top" align="left">166(69.75)</td>
<td valign="top" align="left">1.7(0.66-4.38)</td>
<td valign="top" align="left">0.5514</td>
</tr>
<tr>
<td valign="top" align="center">&gt;5</td>
<td valign="top" align="left">17(32.07)</td>
<td valign="top" align="left">36(67.93)</td>
<td valign="top" align="left">1.3(0.64-2.70)</td>
<td valign="top" align="left">0.527</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Residence</th>
</tr>
<tr>
<td valign="top" align="left">Urban</td>
<td valign="top" align="left">79(43.65)</td>
<td valign="top" align="left">102(56.35)</td>
<td valign="top" align="left">4.84(2.95-7.95)</td>
<td valign="top" align="left">0.003</td>
</tr>
<tr>
<td valign="top" align="left">Rural</td>
<td valign="top" align="left">28(13.8)</td>
<td valign="top" align="left">175(86.2)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left"/>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Educational level</th>
</tr>
<tr>
<td valign="top" align="left">Unable to read and write</td>
<td valign="top" align="left">61(21.1)</td>
<td valign="top" align="left">228(78.9)</td>
<td valign="top" align="left">0.5(0.1-2.65)</td>
<td valign="top" align="left">0.247</td>
</tr>
<tr>
<td valign="top" align="left">Primary<break/>Secondary and</td>
<td valign="top" align="left">21(44.4)</td>
<td valign="top" align="left">24(55.6)</td>
<td valign="top" align="left">0.98(0.19-5.20)</td>
<td valign="top" align="left">0.413</td>
</tr>
<tr>
<td valign="top" align="left">Preparatory</td>
<td valign="top" align="left">12(54.55)</td>
<td valign="top" align="left">10(45.45)</td>
<td valign="top" align="left">2.13 (0.39-11.62)</td>
<td valign="top" align="left">0.966</td>
</tr>
<tr>
<td valign="top" align="left">College</td>
<td valign="top" align="left">9(56.25)</td>
<td valign="top" align="left">7(43.75)</td>
<td valign="top" align="left">2.0(0.38-11.17)</td>
<td valign="top" align="left">0.382</td>
</tr>
<tr>
<td valign="top" align="left">University</td>
<td valign="top" align="left">4(33.33)</td>
<td valign="top" align="left">8(66.67)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left"/>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Occupation</th>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Civil servant</td>
<td valign="top" align="left">6(37.5)</td>
<td valign="top" align="left">10(62.5)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left"/>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Farmer</td>
<td valign="top" align="left">36(24.00)</td>
<td valign="top" align="left">114(76.00)</td>
<td valign="top" align="left">5.18(0.99-17.06)</td>
<td valign="top" align="left">0.777</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Housewife</td>
<td valign="top" align="left">28(23.73)</td>
<td valign="top" align="left">90(76.27)</td>
<td valign="top" align="left">2.4 (0.45-12.6)</td>
<td valign="top" align="left">0.200</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Merchant</td>
<td valign="top" align="left">15(46.88)</td>
<td valign="top" align="left">17(53.12)</td>
<td valign="top" align="left">1.95 (0.36-10.15)</td>
<td valign="top" align="left">0522</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Retire</td>
<td valign="top" align="left">20(36.36)</td>
<td valign="top" align="left">35(63.64)</td>
<td valign="top" align="left">1.14(0.26-5.08)</td>
<td valign="top" align="left">0.678</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Unemployment</td>
<td valign="top" align="left">2(15.38)</td>
<td valign="top" align="left">11(84.62)</td>
<td valign="top" align="left">1.17(0.1-13.53)</td>
<td valign="top" align="left">0.829</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Duration of VI</th>
</tr>
<tr>
<td valign="top" align="left">&#x2003;&lt;5 years</td>
<td valign="top" align="left">47(19.26)</td>
<td valign="top" align="left">197(80.74)</td>
<td valign="top" align="left"/>
<td valign="top" align="left"/>
</tr>
<tr>
<td valign="top" align="left">&#x2003;&#x2265;5 years</td>
<td valign="top" align="left">60(42.86)</td>
<td valign="top" align="left">80(57.14)</td>
<td valign="top" align="left">3.33(1.88-5.89)</td>
<td valign="top" align="left">0.005</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Dietary type</th>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Vegetarians</td>
<td valign="top" align="left">53(35.1)</td>
<td valign="top" align="left">98(64.9)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left"/>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Non-vegetarians</td>
<td valign="top" align="left">54(23.18)</td>
<td valign="top" align="left">179(76.82)</td>
<td valign="top" align="left">1.01(0.57-2.17)</td>
<td valign="top" align="left">0.810</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Current alcohol drinking</th>
</tr>
<tr>
<td valign="top" align="center">Yes</td>
<td valign="top" align="left">20(42.55)</td>
<td valign="top" align="left">27(57.45)</td>
<td valign="top" align="left">0.49 (0.22-1.08)</td>
<td valign="top" align="left">0.086</td>
</tr>
<tr>
<td valign="top" align="center">No</td>
<td valign="top" align="left">87(25.82)</td>
<td valign="top" align="left">250(74.18)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left"/>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Diastolic BP</th>
</tr>
<tr>
<td valign="top" align="left">&lt;90mmhg</td>
<td valign="top" align="left">51(25.63)</td>
<td valign="top" align="left">148(74.37)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left"/>
</tr>
<tr>
<td valign="top" align="left">&#x2265;90mmhg</td>
<td valign="top" align="left">(5630.27)</td>
<td valign="top" align="left">129(69.73)</td>
<td valign="top" align="left">0.65(0.37-1.14)</td>
<td valign="top" align="left">0.166</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>COR, Crude odds ratio; AOR, Adjusted odds ratio; CI, Confidence interval; VI, visual impairment; DBP, diastolic blood pressure.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</sec>
</sec>
<sec id="s4" sec-type="discussion">
<title>Discussion</title>
<p>This study aimed to assess the prevalence of excessive body weight and its associated factors among visually impaired patients in hospitals in northwest Ethiopia in 2024. The prevalence of excessive body weight among these patients was found to be 27.9%, which is higher than the 22.2% reported in a Korean population-based study (<xref ref-type="bibr" rid="B23">23</xref>). This discrepancy might be due to this study having a smaller sample size compared to the Korean study, which included 8,435 participants. Additionally, the higher illiteracy rate among participants in this study likely contributed to lower levels of physical activity, potentially leading to an overestimation of excessive body weight prevalence. Furthermore, differences in study design may have influenced the results. While the Korean study employed a population-based prospective cohort design, this research used an institution-based cross-sectional approach. The hospital-based nature of this study might also have inflated the prevalence estimate compared to the broader, community-based Korean survey.</p>
<p>In contrast, the prevalence of excessive body weight in this study was lower than findings from studies conducted in the United States (36%) (<xref ref-type="bibr" rid="B24">24</xref>) and India (38%) (<xref ref-type="bibr" rid="B25">25</xref>). This discrepancy may stem from variations in participant age ranges. While both the U.S. and Indian studies focused on individuals aged 60 years and older, this study included participants aged 18 and above. Aging is often linked to decreased physical activity, resulting in reduced total energy expenditure and disturbances in energy balance, both of which can contribute to weight gain (<xref ref-type="bibr" rid="B49">49</xref>). Lifestyle differences between study populations may explain the observed variation. In the U.S. study, most participants were current alcohol drinkers and smokers, while in this study; the majority did not consume alcohol or smoke. Alcohol consumption, particularly binge drinking, significantly contributes to excessive body weight due to its high caloric content (7 calories per gram) (<xref ref-type="bibr" rid="B38">38</xref>). It reduces fat oxidation, promotes fat storage (especially abdominal), disrupts appetite-regulating hormones (leptin and ghrelin), impairs sleep, and lowers physical activity due to fatigue and hangovers (<xref ref-type="bibr" rid="B50">50</xref>, <xref ref-type="bibr" rid="B51">51</xref>, <xref ref-type="bibr" rid="B52">52</xref>&#x2013;<xref ref-type="bibr" rid="B54">54</xref>). Smoking contributes to weight gain through metabolic dysregulation, including insulin resistance and altered fat metabolism, especially abdominal fat accumulation (<xref ref-type="bibr" rid="B55">55</xref>, <xref ref-type="bibr" rid="B56">56</xref>). It disrupts appetite regulation via dopamine changes, increases cravings for high-calorie foods, and can lead to weight gain during cessation due to increased hunger and slower metabolism (<xref ref-type="bibr" rid="B57">57</xref>&#x2013;<xref ref-type="bibr" rid="B61">61</xref>). Smoking is further linked to leptin resistance and chronic inflammation, exacerbating fat accumulation (<xref ref-type="bibr" rid="B62">62</xref>).</p>
<p>Our results revealed that 13.28%, 8.6%, and 5.99% of those with mild, moderate, and severe visual impairment respectively had excessive body weight. This discrepancy might be due to persons with severe visual impairment experiencing mobility difficulties that limit access to high-calorie diets, while reduced physical activity in mild cases may encourage weight gain (<xref ref-type="bibr" rid="B63">63</xref>). Additionally, individuals with advanced visual loss may adopt healthier diets due to caregiver support, while socioeconomic constraints might further reduce caloric intake (<xref ref-type="bibr" rid="B64">64</xref>).</p>
<p>Older adults (aged 65 and above) are significantly more likely to have excessive body weight, as supported by studies conducted in Ethiopia (<xref ref-type="bibr" rid="B65">65</xref>), Tanzania (<xref ref-type="bibr" rid="B66">66</xref>), Malaysia (<xref ref-type="bibr" rid="B67">67</xref>), and Norway (<xref ref-type="bibr" rid="B68">68</xref>). This association may be attributed to the close link between aging, vision impairment, and excessive body weight, which creates a cycle that negatively impacts health and quality of life in older individuals (<xref ref-type="bibr" rid="B69">69</xref>). Aging contributes to weight gain through a combination of metabolic, hormonal, and lifestyle changes (<xref ref-type="bibr" rid="B70">70</xref>). Sarcopenia, the age-related loss of muscle mass, lowers the basal metabolic rate, reducing calorie expenditure and increasing fat storage (<xref ref-type="bibr" rid="B71">71</xref>). Hormonal changes, such as reduced levels of growth hormone, testosterone, and estrogen, further promote fat accumulation and increase insulin resistance, exacerbating weight gain (<xref ref-type="bibr" rid="B72">72</xref>). Additionally, physical activity often declines with age due to mobility challenges, leading to fewer calories burned (<xref ref-type="bibr" rid="B73">73</xref>). Meanwhile, many older adults maintain their existing eating habits, often preferring high-calorie, low-nutrient foods, which further elevates the risk of weight gain (<xref ref-type="bibr" rid="B74">74</xref>).</p>
<p>Living in urban areas was significantly linked to excessive body weight, as observed in studies from Switzerland (<xref ref-type="bibr" rid="B75">75</xref>), Algeria (<xref ref-type="bibr" rid="B76">76</xref>), Bangladesh (<xref ref-type="bibr" rid="B77">77</xref>), and Ethiopia (<xref ref-type="bibr" rid="B78">78</xref>). Living in cities may contribute to excessive body weight due to several reasons (<xref ref-type="bibr" rid="B75">75</xref>). Urban dwellers often lead sedentary lifestyles, with jobs that require long periods of sitting and the use of cars or public transportation, which limits opportunities for physical activity (<xref ref-type="bibr" rid="B79">79</xref>). additionally, urban areas tend to have fewer safe spaces for exercise (<xref ref-type="bibr" rid="B80">80</xref>),, and the easy availability of unhealthy, high-calorie foods from fast food outlets and convenience stores encourages poor dietary habits (<xref ref-type="bibr" rid="B81">81</xref>). Collectively, these factors increase the likelihood of weight gain and make weight loss more challenging, contributing to higher rates of excessive body weight among urban populations.</p>
<p>A duration of visual impairment lasting five years or more is associated with excessive body weight. This could be attributed to the long-term effects of visual impairment, particularly when it persists for over five years, leading to an increase in body weight. Reduced physical activity often results from mobility issues, safety concerns, and reliance on others for assistance, which limit opportunities for exercise (<xref ref-type="bibr" rid="B82">82</xref>). This, in turn, fosters a more sedentary lifestyle, with individuals spending more time indoors and engaging in less physical movement. Emotional eating may also arise from stress, anxiety, or sadness linked to visual impairment, and difficulties in assessing food quantities or preparing meals can result in poor nutritional choices, typically favoring convenient or calorie-dense foods (<xref ref-type="bibr" rid="B83">83</xref>). These changes in physical activity and diet, combined with reduced overall energy expenditure, contribute to the risk of weight gain. Furthermore, limited access to healthcare resources and exercise programs tailored for individuals with visual impairments can make it challenging to effectively manage weight (<xref ref-type="bibr" rid="B84">84</xref>).</p>
<p>In this study, many of the questions in the data collection instrument relied on participants&#x2019; recall, which may introduce recall bias. Additionally, as a cross-sectional study, it does not allow for the establishment of a cause-and-effect relationship. Given that this study was conducted in a hospital setting, its findings on the prevalence of excessive body weight cannot be generalized to the broader community.</p>
</sec>
<sec id="s5">
<title>Conclusions and recommendations</title>
<p>This study found a 27.9% prevalence of excessive body weight among visually impaired patients in northwest Ethiopia. Factors such as older age, urban residency, and long-term visual impairment were significantly associated with higher rates of excessive body weight. To manage excessive body weight, promoting physical activity, nutritional education, specialized healthcare, weight monitoring, lifestyle counseling, and emotional support are crucial. Additionally, conducting a prospective cohort study would be valuable in establishing a cause-and-effect relationship. Future studies should also ensure the inclusion of individuals with mobility disabilities. Furthermore, the causes of visual impairment and obesity-related complications in patients with visual impairment such as insulin resistance, T2DM, lipid disorders, and hyperuricemia, should be included in future studies.</p>
</sec>
</body>
<back>
<sec id="s6" sec-type="data-availability">
<title>Data availability statement</title>
<p>The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/supplementary material.</p>
</sec>
<sec id="s7" sec-type="ethics-statement">
<title>Ethics statement</title>
<p>The studies involving humans were approved by Institutional Review Committee (IRC) of the Amhara Institution of Public Health (APHI) (ref. no. APHI 3/1082). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required from the participants or the participants&#x2019; legal guardians/next of kin in accordance with the national legislation and institutional requirements.</p>
</sec>
<sec id="s8" sec-type="author-contributions">
<title>Author contributions</title>
<p>BA: Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. BY: Conceptualization, Formal Analysis, Methodology, Validation, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. EO: Conceptualization, Formal Analysis, Software, Supervision, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. DS: Conceptualization, Data curation, Formal Analysis, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. GB: Investigation, Software, Supervision, Validation, Visualization, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. ZT: Formal Analysis, Investigation, Methodology, Project administration, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. ME: Investigation, Software, Supervision, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. AA: Formal Analysis, Methodology, Validation, Visualization, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. EM: Conceptualization, Data curation, Formal Analysis, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. MJ: Conceptualization, Data curation, Investigation, Methodology, Supervision, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. TB: Conceptualization, Data curation, Software, Supervision, Validation, Visualization, Writing &#x2013; review &amp; editing.</p>
</sec>
<sec id="s9" sec-type="funding-information">
<title>Funding</title>
<p>The author(s) declare that no financial support was received for the research and/or publication of this article.</p>
</sec>
<ack>
<title>Acknowledgments</title>
<p>We would like to acknowledge the study participants, data collectors, and supervisors for their willingness, valuable support, and assistance during this work.</p>
</ack>
<sec id="s10" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s11" sec-type="ai-statement">
<title>Generative AI statement</title>
<p>The author(s) declare that no Generative AI was used in the creation of this manuscript.</p>
</sec>
<sec id="s12" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<fn-group>
<title>Abbreviations</title>
<fn fn-type="abbr" id="abbrev1">
<p>AOR, Adjusted Odds Ratio; BMI, Body Mass Index; COR, Crude Odds Ratio; DBP, Diastolic Blood Pressure; Kg, Kilogram; Kg/m2, Kilogram per meter square; SBP, Systolic Blood Pressure; WHO, World Health Organization.</p>
</fn>
</fn-group>
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<app-group>
<app id="app1">
<title>Appendix</title>
<table-wrap id="T5">
<label>Table&#xa0;1</label>
<caption>
<p>Bivariable and multivariable binary logistic regression analysis of factors associated with excessive body weight among visually impaired adult patients in selected hospitals of northwest Ethiopia, 2024 (n=384).</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" align="left">Variables</th>
<th valign="top" colspan="2" align="left">Excessive body weight</th>
<th valign="top" rowspan="2" align="left">COR (95% CI)</th>
<th valign="top" rowspan="2" align="left">AOR (95% CI)</th>
</tr>
<tr>
<th valign="top" align="left"/>
<th valign="top" align="left">Yes (%)</th>
<th valign="top" align="left">No (%)</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Age &lt;40</td>
<td valign="top" align="left">2(15.4)</td>
<td valign="top" align="left">11(84.6)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left">1.00</td>
</tr>
<tr>
<td valign="top" align="left">40-64</td>
<td valign="top" align="left">37 (22.16)</td>
<td valign="top" align="left">130(77.84)</td>
<td valign="top" align="left">1.94(0.35-10.86)</td>
<td valign="top" align="left">1.9(0.34-10.75)</td>
</tr>
<tr>
<td valign="top" align="left">&#x2017;65</td>
<td valign="top" align="left">68(33.3)</td>
<td valign="top" align="left">136(66.7)</td>
<td valign="top" align="left">7.43(1.4-19.40)</td>
<td valign="top" align="left">5.43(1.22-12.1)*</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Marital status</th>
</tr>
<tr>
<td valign="top" align="left">Single</td>
<td valign="top" align="left">2(25)</td>
<td valign="top" align="left">6(75)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left">1.00</td>
</tr>
<tr>
<td valign="top" align="left">Married</td>
<td valign="top" align="left">78(32.1)</td>
<td valign="top" align="left">165(67.9)</td>
<td valign="top" align="left">2.17(1.23-3.8)</td>
<td valign="top" align="left">2.12(0.24-8.51)</td>
</tr>
<tr>
<td valign="top" align="left">Widowed</td>
<td valign="top" align="left">19(17.92)</td>
<td valign="top" align="left">87(82.08)</td>
<td valign="top" align="left">1.53(0.286-8.15)</td>
<td valign="top" align="left">0.45(0.13-1.50)</td>
</tr>
<tr>
<td valign="top" align="left">Divorced</td>
<td valign="top" align="left">8(29.63)</td>
<td valign="top" align="left">19(70.37)</td>
<td valign="top" align="left">1.93(0.74-5.05)</td>
<td valign="top" align="left">0.66(0.22-1.95)</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Number of families</th>
</tr>
<tr>
<td valign="top" align="left">&lt;3</td>
<td valign="top" align="left">18(19.35)</td>
<td valign="top" align="left">75(80.65)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left">1.00</td>
</tr>
<tr>
<td valign="top" align="left">3-5</td>
<td valign="top" align="left">72(30.25)</td>
<td valign="top" align="left">166(69.75)</td>
<td valign="top" align="left">1.97(.9-4.26)</td>
<td valign="top" align="left">1.7(0.66-4.38)</td>
</tr>
<tr>
<td valign="top" align="left">&gt;5</td>
<td valign="top" align="left">17(32.07)</td>
<td valign="top" align="left">36(67.93)</td>
<td valign="top" align="left">1.8(1.00-3.24)</td>
<td valign="top" align="left">1.3(0.64-2.70)</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Residence</th>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Urban</td>
<td valign="top" align="left">79(43.65)</td>
<td valign="top" align="left">102(56.35)</td>
<td valign="top" align="left">6.41(2.94-14.00)</td>
<td valign="top" align="left">4.84(2.95-7.95)**</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Rural</td>
<td valign="top" align="left">28(13.8)</td>
<td valign="top" align="left">175(86.2)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left">1.00</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Educational level</th>
</tr>
<tr>
<td valign="top" align="left">Unable to read and write</td>
<td valign="top" align="left">61(21.1)</td>
<td valign="top" align="left">228(78.9)</td>
<td valign="top" align="left">0.53(0.15-1.8)</td>
<td valign="top" align="left">0.5(0.1-2.65)</td>
</tr>
<tr>
<td valign="top" align="left">Primary<break/>Secondary and</td>
<td valign="top" align="left">21(44.4)</td>
<td valign="top" align="left">24(55.6)</td>
<td valign="top" align="left">1.75(0.46-6.65)</td>
<td valign="top" align="left">0.98(0.19-5.20)</td>
</tr>
<tr>
<td valign="top" align="left">Preparatory</td>
<td valign="top" align="left">12(54.55)</td>
<td valign="top" align="left">10(45.45)</td>
<td valign="top" align="left">2.89(0.66-12.57)</td>
<td valign="top" align="left">2.13 (0.39-11.62)</td>
</tr>
<tr>
<td valign="top" align="left">College</td>
<td valign="top" align="left">9(56.25)</td>
<td valign="top" align="left">7(43.75)</td>
<td valign="top" align="left">2.57(0.54-12.17)</td>
<td valign="top" align="left">2.0(0.38-11.17)</td>
</tr>
<tr>
<td valign="top" align="left">University</td>
<td valign="top" align="left">4(33.33)</td>
<td valign="top" align="left">8(66.67)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left">1.00</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Occupation</th>
</tr>
<tr>
<td valign="top" align="left">Civil servant</td>
<td valign="top" align="left">6 (37.5)</td>
<td valign="top" align="left">10(62.5)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left">1.00</td>
</tr>
<tr>
<td valign="top" align="left">Farmer</td>
<td valign="top" align="left">36(24.00)</td>
<td valign="top" align="left">114(76.00)</td>
<td valign="top" align="left">6.35(1.1-27.27)</td>
<td valign="top" align="left">5.18(0.99-17.06)</td>
</tr>
<tr>
<td valign="top" align="left">Housewife</td>
<td valign="top" align="left">28(23.73)</td>
<td valign="top" align="left">90(76.27)</td>
<td valign="top" align="left">1.64(0.35-7.76)</td>
<td valign="top" align="left">2.4 (0.45-12.6)</td>
</tr>
<tr>
<td valign="top" align="left">Merchant</td>
<td valign="top" align="left">15(46.88)</td>
<td valign="top" align="left">17(53.12)</td>
<td valign="top" align="left">3.3(0.54-20.26)</td>
<td valign="top" align="left">1.95 (0.36-10.15)</td>
</tr>
<tr>
<td valign="top" align="left">Retire</td>
<td valign="top" align="left">20(36.36)</td>
<td valign="top" align="left">35(63.64)</td>
<td valign="top" align="left">1.77(0.37-8.47)</td>
<td valign="top" align="left">1.14(0.26-5.08)</td>
</tr>
<tr>
<td valign="top" align="left">Unemployment</td>
<td valign="top" align="left">2(15.38)</td>
<td valign="top" align="left">11(84.62)</td>
<td valign="top" align="left">3.14(0.63-15.64)</td>
<td valign="top" align="left">1.17(0.1-13.53)</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Duration of VI</th>
</tr>
<tr>
<td valign="top" align="left">&lt;5 years</td>
<td valign="top" align="left">47(19.26)</td>
<td valign="top" align="left">197(80.74)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left"/>
</tr>
<tr>
<td valign="top" align="left">&#x2017;5 years</td>
<td valign="top" align="left">60(42.86)</td>
<td valign="top" align="left">80(57.14)</td>
<td valign="top" align="left">3.14(1.98-4.99)</td>
<td valign="top" align="left">3.33(1.88-5.89) <sup>**</sup>
</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Dietary type</th>
</tr>
<tr>
<td valign="top" align="left">Vegetarians</td>
<td valign="top" align="left">53(35.1)</td>
<td valign="top" align="left">98(64.9)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left">1.00</td>
</tr>
<tr>
<td valign="top" align="left">Non-vegetarians</td>
<td valign="top" align="left">54(23.18)</td>
<td valign="top" align="left">179(76.82)</td>
<td valign="top" align="left">1.79(1.14-2.82)</td>
<td valign="top" align="left">1.01(0.57-2.17)</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Current alcohol drinking</th>
</tr>
<tr>
<td valign="top" align="left">&#x2003;Yes</td>
<td valign="top" align="left">20(42.55)</td>
<td valign="top" align="left">27(57.45)</td>
<td valign="top" align="left">2.13(1.4-3.99)</td>
<td valign="top" align="left">0.49 (0.22-1.08)</td>
</tr>
<tr>
<td valign="top" align="left">&#x2003;No</td>
<td valign="top" align="left">87 (25.82)</td>
<td valign="top" align="left">250(74.18)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left">1.00</td>
</tr>
<tr>
<th valign="top" colspan="5" align="left">Diastolic BP</th>
</tr>
<tr>
<td valign="top" align="left">&lt;90mmhg</td>
<td valign="top" align="left">51(25.63)</td>
<td valign="top" align="left">148(74.37)</td>
<td valign="top" align="left">1.00</td>
<td valign="top" align="left">1.00</td>
</tr>
<tr>
<td valign="top" align="left">&#x2017;90mmhg</td>
<td valign="top" align="left">5630.27)</td>
<td valign="top" align="left">129(69.73)</td>
<td valign="top" align="left">1.26(0.8-1.97)</td>
<td valign="top" align="left">0.65(0.37-1.14)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>***Extremely significant association at p-value &lt;0.001 **Very significant association at p-value &lt;0.01, COR, Crude odds ratio; AOR, Adjusted odds ratio; CI, Confidence interval; VI, visual impairment; DBP, diastolic blood pressure.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</app>
</app-group>
</back>
</article>