Health Should Mean a Rot More Than Escape From Death or for That Matter, Escape From Disease
Transcript of Health Should Mean a Rot More Than Escape From Death or for That Matter, Escape From Disease
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CHAPTER - I
INTRODUCTION
HEALTH SHOULD MEAN A ROT MORE THAN ESCAPE FROM
DEATH OR FOR THAT MATTER, ESCAPE FROM DISEASE.
BACKGROUND OF THE STUDY :-
Obesity is perhaps the moat prevalent from of malnutirition. As a
chronic disease , prevalent in both developed and developing countries,
and affecting children a well as adults. Early childhood overweight that
persists into adulthood is associated with more severe obesity among
adults. Among adolescents self image, communication problems and
difficulties both in school and home obesity:
Renstick etal. (1997) stated that having family members who are
emotionally available and appropriately involved in their lives has proved
to be a key-factor in the well being of adolescents.
Puberty marks the beginning of accelerated physical growth, which
can as much as double adolescents nutritional requirements for iron,
calcium, zinc & protein. At the same time, growing independence the
need for peer acceptability, concern physical appearance, and an active
lifestyle may affect eating habits, food choices, nutrient intake, and thus
nutritional status.
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Excess intake of calories, sugar, fat, cholesterol and sodium is
common among adolescents and if found in all income and social /ethnic
groups and both genders.
world health organization (WHO)(2008) described obesity as an
escalating epidemic and one of the neglected public health problems of
present time.
Mehta. M Bhasin. s. k. etal. (2007) cited that prevalence of
obesity and overweight among the study subjects was 5.3% and 15.27%
respectively.
Manuraj etal. (2007) reported that the proportion of overweight
children increased from 4.94% of the total students in 2003 to 6.57% in
2005. The increase was significant in both boys and girls. The proportion
of overweight children was significantly higher in urban regions and in
private schools.
The prevalence of overweight and obesity among children and
adolescents has increased significantly in the developed countries during
the past two decades and similar trends are being observed even in
developing world, through less rapidly.
The consequences that are associated with adolescent obesity both
during adolescence and adult life which include increased incidence of
coronary artery disease and hypertension, diabetes, obstructive sleep
apnea, esophageal reflux and gastric emptying disturbances, osteoarthritis
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and flat feet, psychological dysfunction, self-esteem and social isolation.
dyslipidemia and over all increase in morbidity and mortality in later life.
SIGNIFICANCE AND NEED FOR STUDY:-
National center for health statistics (NCHS) USA reported that
nearly 15% of adolescents in the united states were obese. A recent study
conducted among affluent public school children in new Delhi, revealed
prevalence of overweight (BMI >25-30) of about
25% and 75% respectively.
Abdellah described 21 nursing problems subsumed under one of
three categories, physical, social emotional need of a client. The second
problem is optimal activity. exercises, rest and sleep and nutrition for all
body cells. According to her theory proper exercise and balance diet for
the correction of existing obsesing. may be the most effective method to
curb the over fat condition.
Sumithra etal (2009), Stated that more cases of slipped femoral
epiphysis, joints problems in adolescents for excess weight bearing, over
weight girls have tendency to be glucose intolerant in their pregnancy
giving birth to bigger babies and in turns, girls babies amongst those
newborns are become pre-diabetic even before their pregnancy.
During the clinical experience the investigator found out that the
obese adolescent girls had problems like body image disturbance and
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complications like Diabetes, hypertension, & coronary artery disease. Due
to their sedentary life style and eating habits make them become obese.
A good counseling and motivation can go a long way in getting rid
of extra kilos and inches. Nurses being in close contact for long periods
while the patient is indoor can effectively do the job of a counselor.
Nurses could be involved in running weight management clinics. They
can provide the people with knowledge about obesity its risks and right
method of assessing obesity. They should encourage them to consume a
healthy diet and engage in regular physical activity. A through knowledge
of various parameters of assessing obesity is of paramount important to
nurses.
STATEMENT OF PROBLEM
A Descriptive study to Assess the Knowledge and life style factors on
Obesity Among Obese Children Age Between 12 15 Years at Selected
School
OBJECTIVES:-
Assess the knowledge of the School age children regarding the
obesity.
Assess the life style factors of School age children age between
12 15 years
To determine the association of knowledge on management of
obesity with selected demographic variables such as age,
educational status, sex , Fathers occupation , education of the
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parents, family income, Types of family, total no of children,
Food habits.. Religion, BMI.
OPERATIONAL DEFINITIONS
OBESITY:-
obesity is defined as an excess accumulation storage fat in the
body and is evidence when a person (he/she) having 20% more weight
over the maximum desirable weight for his ( or) her height and age. BMI
is more than 25.
KNOWLEDGE
Information acquired through experience or education.
In this study it refers to the understanding and the responses of the
respondents regarding obesity management as measured by knowledge
questionnaire.
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CHAPTER II
REVIEW OF LITERATURE
Kaneria.Y etal. (2006) undertaken a investigation to make a
comparative assessment of overweight and obesity in two different socio-
economic groups of school age children from udaipur city (Rajasthan),
ranging from 12 to 17 years, on the basis of 85th
and 95th
percentile of
body mass index (BMI). One group of children belonged to affluent upper
middle class society, while the other group was not so affluent. The first
group consisted of 268 children, and the second one comprised of 250
children. Result showed a significant increase in over weight (3.25%) in
the affluent group as compared to then non affluent group. Obesity in
the affluent group was 3.73% but no case of obesity (0%) was observed in
non-affluent group. Hence, the comparative data clearly delineates that
obesity is an increasing malady of affluent population.
Sharda Sidhu etal. (2004) conducted a study; an attempt has been
made to assess the prevalence of overweight and obesity in school
children (between 10 15 years of age) of the affluent families of
Amritsar district of Punjab, a state in rapid economic and epidemiological
transition. A total of 640 children (323 boys and 317 girls) were measured
for height and weight. Overweight and obesity were assessed using age
and sex-specific body mass index (BMI) cut-off points. 9.91% boys and
11.99% girls were overweight, and 4.95% boys and 6.31% girls were
obese. The prevalence of overweight and obesity among the affluent
children in Amritsar was as high or higher as in some industrialized
countries.
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Ramachandran (2002) cited that the prevalence of diabetes
mellitus (DM) and cardiovascular disease (CVD) was increasing in urban
India. Overweight in adolescence was a marker of overweight in adult
age, and it shows an association with the above diseases. There had been
major data from India on the prevalence of childhood obesity. The
objective of the study was to quantify the prevalence of overweight and its
risk factors in adolescent children in urban India. School students in the
age group of 13 18 years (n=4700, M:F 2382:2318) were studied. Body
mass index (BMI) was measured. Data on physical activity, food habits,
occupation of parents
and their economic status, birth weight of the children and age at
menarche in girls were obtained by questionnaire. Age-adjusted
prevalence of overweight was 17.8% for boys and 15.8% for girls. It
increased with age and was higher in lower tertiles of physical activity
and in higher socio-economic group. Birth weight and current BMI were
positively associated. The study highlighted the high prevalence of
overweight in adolescent children in urban India. Life style factors
influenced BMI in adolescent age.
LITERATURE RELATED TO OBESITY AND ITS HEALTH RISK
AMONG SCHOOL CHILDREN.
Kolsgaard etal. (2008) conducted a study to identify differences in
the prevalence of metabolic syndrome between obese and overweight
Norwegian and immigrant children and adolescents. Two hundred and
three overweight and obese Norwegian, Pakistani, Tamil and Turkish
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patients aged 6-17 years living in Norway were included. Metabolic
syndrome was defined as the presence of at least three abnormal values of
waist circumference, blood pressure, fasting triglycerides fasting glucose
and HDL cholesterol results showed that the prevalence of metabolic
syndrome was significantly higher among immigrant compared to
Norwegian subjects. The prevalence of metabolic syndrome increased
with increasing severity of obesity and reached 50% in severely obese
immigrants and 30% in severely obese Norwegians.
Park. K (2008) stated that obesity was a health hazard and a
determinant to well being which is reflected in the increased morbidity
and mortality. Obesity is a positive risk factor in the development of
hypertension, diabetes, gall bladder disease and coronary heart disease,
especially the hormonally related and large bowel cancers. Varicose
veins, abdominal hernia, osteoarthritis of the kness, hips and lumbar
spine, flatfeet and psychological stresses particularly during adolescence.
Manuraj etal. (2007) conducted a study to determine the
relationship of obesity and blood pressure in Ernakulam, Kerala. They
used a stratified random cluster sampling method to select children. Blood
pressure and Anthropometric data were collected from 20,263 students
during 2005-2006. Gender, age and height were considered for
determining hypertension. Systolic incident of hypertension was found in
17.34% of over weight children versus 10.1% of the remaining students.
Choudhry. p (2005) cited that there has been a significant rise in
many adult diseases linked with obesity like Insulin resistance type 2
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diabetes, hypertension, coronary artery disease, hyperlipidemia and
stroke. These diseases have been shown to have their origin in
adolescence, especially in children who are getting bulkier relative to
themselves.
Stein AD etal. (2005) conducted a review of studies from countries
undergoing the nutrition transition. Five birth cohorts with measures of
child growth and outcome through adolescence were identified, from
china, India, Gualtemala, Brazil and the Philippines. Generally consistent
associations of growth failure in early childhood and development of
overweight in later childhood with the risk of elevated blood pressure,
glucose and serum lipids in adulthood were observed.
Bhatia V (2004) cited that type 2 diabetes mellitus (DM) has
traditionally being considered a disease of adults. However, in the last 2
decades, it is increasingly being reported in children and adolescents.
Obesity is a strong correlate, and the increasing prevalence of obesity and
poor physical activity is precipitating type 2 DM at younger ages in the
ethnic groups at risk. Indians and other south Asians are among the ethnic
groups.
William.D & Frank. T etal. (2003) obesity was associated with
several health risks such as hypertension, hyper lipidemia and coronary
artery disease. Obesity also can have an adverse effect on quality of life
by limiting mobility, impairing physical capacity and reducing an
individuals capacity to perform activities of daily living.
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Scott. K. power etal. (2001) stated that diseases or conditions in
which obesity is a primary contributing factor adult onset diabetes,
menstrual abnormalities, reproductive problems, heart size and function,
arthritis, gout and hypertension.
LITERATURE RELATED TO MANAGEMENT OF OBESITY BY
DIET AMONG SCHOOL CHILDREN:
Yuasa. K etal. (2008) conducted a cross sectional questionnaire
based survey was performed in elementary and junior high school
students in Tokushima, Japan, during the summer of 2004. The
questionnaire consisted of 30 items such as physique, sleep, eating habits
diet, exercise, free time, and attending after school lessons. The study
revealed that eating meals as a family every day is associated with a lower
rate of obesity as well as getting good life style habits such as eating
balanced meals and getting enough sleep. If the 3,291 students who
responded to the questionnaire, 2,688 (81.7%) reported that they eat meals
with their family every day.
Wilson LF (2007) conducted a study involved the development and
administration of a questionnaire to middle school their attitudes about
overweight/obesity and what they felt would work for them. Adolescents
are willing to exercise more, to change eating habits to include more fruits
and vegetables, drink more water, and eat less junk food. They are not
willing to give up soda, video/computer games and watching television to
improve their health.
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Hagarty, M.A. Submide, C et al. (2004) adolescent obesity has
been historically attributed to inappropriate diet and exercise. If left
untreated may result in metabolic complication. Practitioners should focus
on using new BMI national guidelines for early identification of obesity.
Bonnie spear (2002) stated that soft drinks represent the 6th
single
highest contribution of energy to the diets of adolescents. Between 12-
16% of the daily Caloric intake comes from soft drink alone. The number
of servings of soft drink increase, so does the risk of obesity.
D. LITERATURE RELATED TO MANAGEMENT OF OBESITY
BY EXERCISE AMONG SCHOOL CHILDREN.
Loman, D.G (2008) conducted a qualitative study using focus
groups and interviews with 28 girls (12-18years of age) recruited from
schools and neighborhood health centers in a Midwest metropolitan area,
USA. An interview guide with 15 open ended questions was used, and
data were analyzed using content analysis. Results showed most girls
preferred the phrase physical activity over exercise. The benefits most
frequently mentioned included positive physical attributes, mental health
benefits, and staying healthy. Three major themes were identified;
autonomy (ask them what they like to do and then provide choices) fun
(being with friends, variation and enjoyment), and body image (gaining
weight, appearance, and self-confidence).
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Tsiaris MD etal., (2008) examined the effectiveness of CBT
(Cognitive behavioral therapy) program for improving the body
composition, diet, physical activity in overweight and obese adolescents.
(16 male, 31 female; aged 14.5+/-1.6>: body mass index 30.9+/-4.2) were
block matched into 2 groups by age, sex, tanner stage, BMI and hip and
waist circumferences were randomly assigned to CBT or no treatment
(control). CBT consisted of 10 weekly sessions, followed by 5 fortnightly
telephone sessions. CBT showed greater reduction in intake of sugared
soft drinks as a percentage of total energy. (CBT, -4.0+/-0.9%; control-
0.3+/-0.9%) which was related to reduction in weight, BMI, and waist
circumference. Changes in soft drink consumption may have contributed
to this result.
Alm. M etal. (2008) conducted a qualitative assessment of barriers
and facilitators to achieving behavior goal among obese inner city
adolescents in a weight management program in minnea polis, USA.
Totally 18 adolescents were interviewed to identify barriers and
facilitators to reaching behavior goals. Data were analyzed using
descriptive statistic. Results showed that the rationale for weight control,
adolescent girls and boys reported a desire to improve physical
appearance and physical conditioning, respectively. Barriers to reaching
physical activity goals among girls include unsafe neighborhoods and a
negative body image. Overall, coaching provided support that helped the
obese teens feel more successful in the goat setting process and address
issues related to their disruptive environments.
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Dudas, R.A etal. (2008) conducted a survey together dietary and
activity practices in a cross sectional, convenience sample of 100 children
presenting to an urban hospital setting in Baltimore, Maryland, USA.
They chose to emphasize bicycling because it is a widely available
activity that requires sustained level of moderate energy expenditure
results showed that the mean age of our population was 11.8 years and
56% were ever weight. They found that approximately half of our
participants do not eat breakfast, fruits, or vegetables regularly. More than
half never ride a bike to school, walk to school, or participate in any
organized sport. Riding a bicycle atleast 2 or more days during the week
is associated with a decreased likelihood of being overweight during
childhood.
Kelly, G.A & Kelley, K.S (2008) used the meta analytic approach
to examine the effects of aerobic exercise on non high density
lipoprotein cholesterol in children and adolescents. Thirteen non HDL-C
out comes in 404 males and females (221 exercise, 183 control) were
available for pooling. A statistically significant decrease of 7% was found
for percent body fat (-2.1 +/- 0.5%) as well as 8% increase in aerobic
capacity, both secondary outcomes of the study.
Melynk, B.M.etal. (2007) cited that phase I and phase II clinical
trials were conducted with 23 overweight teens. The phases I trial used a
pre-experimental design with one group of 11 urban adolescent. The
phase 2 trial was conducted with 12 suburban teens using a randomized
controlled pilot study. COPE (creating opportunities for personal
empowerment) teens received a 15 session cognitive behavioural skills
building program that included physical activity. While the control group
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received an attention control program. Weight change and BMI were the
key out comes. Results showed cope teens experienced a significantly
greater reduction in weight and BMI than did teens in the control group,
who gained weight over time.
Kim, Y.H etal. (2005) conducted a study to determine the effects
of walking exercise training (WET) on metabolic syndrome risk factors
and body composition in obese middle school girls. A non equivalent
pretest post test experimental design was used. Twenty seven subjects
participated in this study from one womens middle school in Busan. The
participants were purposely allocated to an experimental group (n = 14)
and a control group (n=13). The experimental group participated in 30
60 minutes of WET with 55 to 75% of a maximal heart rate six days a
week for 12 weeks. Results showed that the prevalence of individual risk
factors on metabolic syndrome were improved in the experimental group
after the intervention. These results indicate that WET is effective in
decreasing risk factors of the metabolic syndrome and body compositioncomponents in obese middle school girls.
CONCLUSION
The above review of literature showed that there was a prevalence
of obesity among adolescent girls. Obesity was a positive risk factor in the
development of hypertension, cardiovascular disease and psychological
stress. Adolescents were changing their eating habits to include morefruits and vegetables, drink more water eats less junk food. Walking
exercise training (WET) was effective in decreasing risk factors of
metabolic syndrome and improves the body composition of adolescent
girls.
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CONCEPTUAL FRAME WORK
Conceptual frame work for a study is developed from the existing
theory and helps in defining the concepts of interests and proposing
relationship among them. The model give direction for planning, data
collection and interpretation of findings (Burns & Grove, 1995).
The frame work of present study was based on the modified Rosen
stocks health belief Model. (1996).
According to Rosen stocks health belief model, there are three
factors, individual perception, modifying factors and likelihood of taking
action which determines the individuals decision towards taking
preventive action. The model explains, a decision to take health action is
based on perception of susceptibility to conditions and the severity of the
consequences resulting from that condition. The preventing or reducing
the susceptibility to or severity of a sickness and the psychological as well
as the financial and other costs for pursuing a particular health action. The
model also includes cues to action that are internal or external stimuli to a
particular health behavior.
In this study, individual perception refers to the school children
perception of importance on prevention and management of obesity and
prevention of perceived susceptibility to get complications of obesity.
Modifying factors refer to knowledge and expressed practice of
School Children on management of obesity and demographic variables
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like educational status of school children, mothers education, fathers
occupation, type of family, familys monthly income and type of dietary
pattern.
Perceived threat of obesity is influenced by individual perception,
modifying factors and cues to action, which ultimately lead the individual
to take appropriate action.
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Individual perception Modifying factors Likelihood of Action
School age children knowledge
Regarding susceptibility to obesity
Age
Educational Status
Sex
Fathers occupation
Education of parents
Family income
Type of Family
Total number of children
Food habit
Religion
BMI
Perceived seriousness of disease
School age children knowledge
and expressed practice on
obesity management (pre test)
Demographic variables (School age
children education, Mothers
education,
Fathers occupation, familys
monthly income, type of family, type
of dietary pattern)
Perceived threat of obesity
Cues of action
Information, education and
communication package on
management of obesity after the data
collection
Perceived benefits
About life style changes, regular
exercise eating fat free diet
Likely hood of taking recommend
preventive health action
Gain knowledge on managemof obesity by diet and exercis
(post test)
change in expressed practice
towards management of obesi
(post test)
CONCEPTUAL FRAME WORK BASED ON ROSEN STOCHS HEALTH BELIEF MODEL
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CHAPTER- III
RESEARCH METHODOLOGY
Methodology of research refers to the investigations of the ways of
obtaining organizing and analyzing data. Methodological studies address
the development, validation and evaluation of research tools and methods.
This chapter deals with research design the setting sample and
sampling technique. It also deals with took and technique procedure for
data collection .The research approach used for this study was evaluative
approach .
Polit and Hunglel-2004
Research design
Descriptive Studies is to observe, describe, and document aspects
of a situation as or naturally occurs.Descriptive design was adopted for this study.
SETTING
The study was conducted at Dhanalakshmi Srinivasan Higher
Secondary school, Perambalur.
POPULATIONThe target Population of this study was School Children age
between 12-15 years
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SAMPLE
The Sample consisted of 50 school children who were having BMI
above 25-32 Studying at Dhanalakshmi Srinivasan higher secondary
school.
SAMPLING TECHNIQUE
Sampling technique used for this study was convenience sampling .
SAMPLE SIZE is 50
INCLUSION CRITERIA
School Children who were hawing BMI 25-30 studying in
Dhanalakshmi Srinivasan Higher Secondary School.
School Children who are Present at the time of data
collection.
EXCLUTION CRITERIA
School Children had any chronic systemic disease and renal
problems.
School Children had any endocrine disorders physical
deformities
School Children had any endocrine disorders
DESCRIPTION OF TOOLS
Demographic Data
Knowledge Questionnaire
Check list to assess life style factors.
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SECTION-I
Demographic characteristics of school age include age, educational
status, sex. Fathers occupation, education of the parents, family income,
types of family, total number of children food habits, Religion, BMI.
SECTION-II
Consisted of knowledge questionnaire to assess the knowledge
related to definition of obesity causes, assessment and complication
management of obesity.
SECTION-III
Check list to assess the life style factors of obese children.
SCORING PROCEDURE
The total score of multiple choice items on knowledge regarding
managements of obesity was 20. Each item was given one mark for
Correct answer and zero mark for wrong answer.
PART I;- II
The result score was ranged as follows
Level of knowledge Score
Adequate 76-100%
Moderately adequate 51-75%
Inadequate 0-50%
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PART III
Check list consistant of 20 items. 4 Point rating scale used for this
study.
(rare -1 , Sometimes -2 , Ofter-3 never-0)
VALIDITY
The tool was evaluated by 3 experts who were requested to give
their valuable suggestion about the content areas. Relevence clarity and
appropriate need of the items.
RELIABILITY
Reliability of the tool was assessed by split half technique using
spearman- brown formula (knowledge score r=0.8, expressed practice r-
o.9)
DATA COLLECTION PROCEDURE
The study was conducted from 07-08-2011 to 17-08-2011, 50samples were selected using non-probability convenience sampling
technique at Dhanalakshmi srinivasan higher secondary school. The data
collection was conducted after obtaining consent from the each participant
who fulfill the criteria. The demographic data, knowledge life style
practice of the participants were assessed by structured interview
Questionnaire.
PLAN FOR DATA ANALYS
Data analysis enables the researcher to organize summarize
evaluate interpret and communicate numerical information. The data
collected from the subject were complied and analyzed using descriptive
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statistic such as a number of percentage, mean and standard deviation. Chi
square test was used to associated the pretest knowledge with
demographic variables.
ETHICAL CONSIDERATION
Permission was obtained from headmistress of Dhanalakshmi
Srinivasan Higher Secondary School to conduct the study. Participants
were informed about the study and written consent was obtained from the
individual participant. None of the subject were denied from their routine
and participant were told that they were under no obligation to participate
in the study and his data will be kept confidentially.
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CHAPTER IV
DATA ANALYSIS AND INTERPRETATION
This chapter deals with the analysis and interpretation of the data
collected. Analysis is the method for rendering, quantitative, meaningful
and providing intelligible information. So that, the research problem can
be studied and tested including the relationship between the variables.
The data collected were analyzed using appropriate statistical methods
and the results are presented in
Section 1 : Distribution of Demographic Variables
Section II : Distribution of level of knowledge of the Subjects
regarding the obesity
Section III : Checklist to assess lifestyle factors.
Section IV : To associate the knowledge with selected
demographic variables such as age, educational
status , sex, Fathers occupation, education of
the Parents, family income, Types of
family, total no of children, Food habits,
Religion, BMI.
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SECTION I
TABLE I
FREQUENCY DISTRIBUTION OF SAMPLE ACCORDING TO
THEIR DEMOGRAPHIC VARIABLES
S.
No.
DEMOGRAPHIC
VARIABLES
CATEGORYRESPONSE
FREQUENCYNO
PERCENTAGE%
1. Age a) 12
b) 13
c) 14
d) 15
5
7
23
15
10
14
46
30
2. Educational Status a) 6
b) 7
c) 9
d) 10
1
5
29
15
2
10
58
30
3. Sex a) boys
b) girls
23
27
46
54
4. Fathers occupation a) Farmer
b) Cooliec) Private employee
d) Government
employee
21
1212
5
42
2424
10
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5. Education of the
parents
a) illiteracy
b) Primary
education
c) Higher education
d) Graduate
2
14
24
10
4
28
48
20
6. Family income a) Rs. 5000
b) Rs. 5000-7000
c) Rs. 7000
d) Rs. 7000 above
21
9
9
11
42
18
18
227. Type of family a) Nuclear
b) Joint
35
15
70
30
8. Total Number of
Children
a) 1
b) 2
c) 2 above
10
30
10
20
60
20
9. Food habits a) Vegetarian
b) Non-vegetarian
10
40
20
80
10. Religion a) Hindu
b) Muslim
c) Christian
d) Others
46
4
0
0
92
8
0
0
11. BMI Calculation a) 25-27
b) 27-30
c) above 30
34
12
4
68
24
8
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RESULT:-
Table 1 show that out of 50 samples 5 (10%) of respondents were
between of 12 yrs, 7 (14%) of were 13 years, 23(46%) of were 14years and 15(30%) of were 15 years.
Regarding their educational status 5(10%) of them of 7th
std, 29
(58%) at 9th
std, and 15(30%) at 10th
std.
In relation Regarding the sex of their student, 23 (46%) among
them were girls and 27(54%) among them were boys.
In relation to their parents occupation 21(42%) of them were
farmers, 12(24%) of them were coolie, 12(24%) of them were
working as private employers, and 5(10%) is government
employers.
Regarding the family income 19(38%) of them having Rs. 5000 /
month, 10 (20% of them having Rs. 5000-7000/ month, 11(22%) of
them having Rs 7000/ month 10(20%) of them having Rs 7000
above income per month.
Table 6 shows out of 50 samples 14(28%) of respondent werebelongs to joint family and 36 (72%) of them belongs to nuclear
family.
Out of 50 samples the 10(20%) respondent having no brothers and
sisters 29(58%) of respondent having either one brother/sister and
11(22%) of respondent having 2(or) more brothers / Sisters).
Regarding history of food habit (10(20%) of their were vegetarian
and 40 (80%) of them were non vegetarian.
Table a shows that out of 50 samples 46(92%) belongs to the Hindu
and 4(8%) belongs to Muslims.
Among 50 samples BMI of 21-27, 34(68) respondent were 27-30%
and 4(8%) were > 30.
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AGE DISTRIBUTION OF OBESITY
10%
14%
46%
30%
0%
5%
10%
15%
20%
25%
30%
35%40%
45%
50%
Percentage
12 yrs 13 yrs 14 yrs 15 yrsAge
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SEX DISTRIBUTION OF OBESITY
boy, 46%
girl, 54%
boy
girl
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OBESITY CHILDREN FATHERS OCCUPATION
42%
24% 24%
10%
0%
5%
10%
15%
20%
25%
30%
35%
40%45%
Percentage
Farmer Cooley Private
Employee
Government
Employee
Father's Occupation
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OBESITY CHILDREN FAMILY INCOME
38%
20%22%
20%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Percentage
Rs.5000 Rs.5000-7000 Rs.7000 Rs.7000 above
Family Income
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TYPES OF FAMILY OF OBESITY CHILDREN
Joint Family,
28%
Nuclear Family,
72%
Joint Family
Nuclear Family
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TOTAL NUMBER OF CHILDREN IN OBESITY
CHILDREN FAMILY
20%
58%
22%
0%
10%
20%
30%
40%
50%
60%
Percentage
1No. 2 Nos. 2andabove
Total Number of Children
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FOOD HABITS OF OBESITY CHILDREN
Vegetarian, 20%
Non-Vegetarian,
80%
Vegetarian
Non-Vegetarian
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RELIGION OF OBESTIY CHILDREN
92%
8%
0% 0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage
Hindu Muslim Christian Others
Religion
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SECTION II
TABLE 2
LEVEL OF KNOWLEDGE OF THE SUBJECTS REGARDING
OBESITY
Level of knowledge frequency Percentage
1)
2)
3)
Inadequate knowledge (75%)
7
37
6
14%
74%
12%
Table show the level op knowledge of the subjects regarding obesity. Out
of 50 samples, 7 (14%) pf them had inadequate knowledge and 37 (74%)
of them moderate knowledge and 6 (12%) of them adequate knowledge.
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SECTION III
TABLE 3
ASSOCIATION BETWEEN KNOWLEDGE AND SELECTED
DEMOGRAPHIC VARIABLES OF THE SUBJECTS
S.
No.
Demographic
Variables
Frequency Mean Df Chi-
Square
value
P- value
1. Age
a) 12 years
b) 13 years
c) 14 years
d) 15 years
5
7
23
15
13.2
12.85
12.34
12.26
1 41.11 *0.001
2. Educational Status
a) 6th
Std
b) 7th
Std
c) 9th
Std
d) 10th
std
1
5
29
15
2
13
12.68
11.8
1 44*
0.05
3. Sex
a) boys
b) girls
23
27
12.56
12.49 1 21 0.10
4. Fathers Occupation
a) Farmer
b) Coolie
c) Private employee
d) Government
employee
21
12
12
5
12.95
12.22
12.41
12.8
1 8.24 0.01
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5. Family Income
a) Rs 5000
b) Rs. 5000-7000
c) Rs. 5000
d) Rs. 7000 above
21
9
9
11
13.14
12.77
11.22
11.81
1 15 0.02
6. Types of family
a)Joint family
b) Nuclear family
15
35
12.53
12.51 1
33.80*
0.05
7. Total No of Children
a) 1
b) 2
c) 2 above
10
30
10
12.2
12.6
12.4
1 160.85
*0.001
8. Religiona) Hindu
b) Muslim
c) Christian
d) Other
46
4
0
0
12.4
13
-
-
1 4.53 0.02
9. Food habits
a)Vegetraian
b)Non-Vegetraian
10
40
12.6
12.45
1 4 0.02
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10. BMI Calculation
a) 25 27
b) 27- 30
c) >30
34
12
4
68
24
8
1 34.48
*0.05
Table 2 shows
Age (12-15 ) Years : P Value = 0.001
Educational Status ( 7th
to 10th
) : P Value = 0.05
Types of family : P Value = 0.05.
Total No of Children : P Value = 0.001
B.M.I. Calculation : P Value = 0.05
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CHECK LIST ON LIFE STYLE PRACTICES OF OBESITY
S.
NO
QUESTIONS
NO OF
STUDENTSHAVING THE
HABITS
PERCENTAGE
1. Habits of taking non-vegetarian per week 36% 72%
2. Habits of taking hotel foods per week 37% 74%
3. Habits of taking chocolates & snacks per
day.
44% 88%
4. Habits of taking sweet drinks (Fruits juices)
per day
37% 74%
5. Habits of taking Fried foods 38% 76%
6. Habits of taking more amount of milk per
daily (500ml)
26% 52%
7. Habits of taking Ice creams per day 23% 46%
8. Habits of taking packed Juices per day 25% 50%
9. Habits of taking any snacks in morning
instead of taking foods
23% 46%
10. Habits of taking pizza (or) Noodles 22% 44%
11. Habits of taking snacks while watching TV. 40% 80%
12. Habits of doing exercise per day 35% 70%
13. Habits of indoor games 35% 70%14. Habits of outdoor games 41% 82%
15. Habits of taking heavy foods after exercise 16% 32%
16. Habits of taking TV& playing videogames 39% 78%
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17. Habits of spending excess time spending in
computer
44% 88%
18. Habits of going parties along with the
parents
35% 70%
19. Will the parents get all the snacks what willyou ask
43% 86%
20. Will you parents restrict you while eating
snacks
35% 70%
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CHAPTER V
DISCUSSION
This chapter deals with the discussion of the study findings
This study was done to determine the management & prevention of
obesity among school children. A pre-experimental study was used to
conduct the study knowledge and expressed practice were assessed by self
administrated questionnaire non-probability purposive sampling techniquewas used. The study sample consisted of 50 school children, between 12-
16 years of age using the above tool, data were collected and analyzed and
the study findings revealed the following.
Table 1 shows that out of 50 samples 5 (10%) of respondents were
at 12Yrs 7 (14%) of were 13 years, 23 (46%) of were 14 years and
15 (30%) of were 15 years.
Regarding their educational status 5 (10%) of them at 7th
std 29
(58%) at 9th
std and 15 (30%) at 10th
std
Regarding the sex of their student 23 (46%) among them were gets
and 27 (54%) among them were boys.
In relation to their parents occupation 21 (42%) of them farmers 12
(24%) of them were coolie, 12 (24%) of them were working as
private employers and 5(10%) is government employers.
Regarding the family income 19 (38%) of them having
Rs.5,000/month, 10 (20% of them having Rs5000-7000/month, 11
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(22%) of them having Rs.7000/month 10 (20%) of them having
Rs.7000 above income per month.
Table 6 shows out of 50 samples 14 (28%) of respondent were
belongs to joint family and 36 (72%) of them belongs to nuclear
family.
Out of 50 sample the 10 (20%) respondents having no
brothers/sisters and 29 (58%) of respondent having either one
brother/sister and 11 (22%) of respondent having 2 (or) more
brothers/sisters)
Regarding history of food habits 10 (20%) of them were vegetarian
and 40 (80%) of them were non-vegetarian.
Table 9 shows that out of 50 samples 46 (92%) belongs to the
Hindu and 4 (8%) belongs to Muslims.
Among 50 samples BMI of 34 (68%) respondents were 26-30%
and 4 (8%) were >30.
The first objective of the study was to assess the knowledge
regarding prevention and management of obesity among school children.
The level of knowledge of the subjects regarding obesity out
of 50 samples 7 (14%) of them had inadequate knowledge and 37 (74%)
of them moderate knowledge and 6 (12%) of them adequate knowledge.
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CHAPTER VI
SUMMARY AND CONCLUSION
This chapter represents the summary, findings, conclusions
implications and recommendations which create a base for the researcher
for evidence based practice.
SUMMARY
The purpose of the study to assess the knowledge regarding obesity
among obese children Age between 12-16 years at selected school
ROSENTOCHS (1974)BECKER AND MAIMANS (1975) health belief
model was adopted for conceptual frame work. Descriptive design was
adopted for the study.
The study was conducted from 07-08-2011 to 17-08-2011 samples
of 50 children were using Non-probability convenience sampling
technique. The investigator applied both descriptive and inferential
statistics to analyze the data collected from the subjects to find out the
knowledge on obesity.
THE MAJOR FINDINGS OF THE STUDY
Most of the participants about 7 (14%) of them had inadequate
knowledge and 37(74%) of them moderate knowledge and 6 (12%) of
them adequate knowledge of obesity.
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There was a significant association between knowledge and
demographic variables such as Age, Educational Status, Type of family,
Total number of children, BMI at P level > 0.005.
The present study assess the knowledge of obesity among obese
child and found that the majority of the subjects had inadequate
knowledge regarding obesity.
Considering the study findings an efforts was made by the
investigator and conducted awareness programme by using posters was
giving to the subjects and an awareness was treated regarding obese.
NURSING IMPLICATION
Nursing practice
The field of community health nursing has great responsibility to
protect the health of the children
Community health Nursing need to take up the responsibility to
create awareness among the obese children to improve their
knowledge by giving health education there by reduces the majority
of obesity rate.
Nursing practice in community should focus on the prevention of
illness and the promotion of health.
NURSING EDUCATION
This study emphasizes the need for developing good teaching skill
among student nurses on obese
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Nurse educator should plan and implement the workshops and
service education as these will update the knowledge of nurses who
plays a key role in assessing and managing children with obese.
NURSING RESEARCH
Evidence based nursing practice must take higher profile in order to
increase an awareness among obese children. The study findings can be
utilized for the development of research based policies and programmes.
The study provide scope for further studies.
NURSING ADMINISTRATION
Nurse Administrator efficient in organizing programme regarding
obese children to create awareness.
The administrator organize in service education programme among
nurses to update their knowledge on obese children.
The nurse administrated in hospital and community health centre
should develop guidelines for conducting descriptive on obese child
and create an awareness among obese children.
RECOMMENDATIONS
In the light of the findings of the study the following
recommendations are put forth.
A similar Study can be conducted in the school
A study can be under taken to evaluate the knowledge after an
awareness programme.
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A comparative study can be conducted to find out the similarity and
differences between knowledge of obese children in 400 settings.
periodical re inforcement can be done using various type of audio
visual aids.
Health Education on obese can be given at the School children.
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BIBLOGRAPHY
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22.Melynk BM, (2007) The COPE Healthy life styles TEEN program
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23.Michele gronder et al. (1996)Foundation and clinical applications
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DEMOGRAPHIC VARIABLES
1. Age
a) 12 yearsb) 13 years
c) 14 years
d) 15 years
2. Educational Status
a) 6th
Std
b) 7th
Std
c) 9th
Std
d) 10th
std
3. Sex
a) boys
b) girls
4. Fathers Occupation
a) Farmer
b) Coolie
c) Private employee
d) Government employee
5. Family Income
e) Rs 5000
f) Rs. 5000-7000g) Rs. 5000
h) Rs. 7000 above
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6. Types of family
a)Joint family
b) Nuclear family
7. Total No of Children
d) 1
e) 2
f) 2 above
8. Religion
e) Hindu
f) Muslim
g) Christian
h) Other
9. Food habits
a)Vegetraian
b)Non-Vegetraian
10. BMI Calculation
d) 25 27
e) 27- 30
f) >30
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Knowledge Question on Obesity
1. What is obesity ?
1. Increased Calcium 2. Increased fat
3. Increased Carbohydrate 4. Increased protein2. What is the reason for obesity ?
1. Decreased intake of food 2. Over Eating
3. Disease Condition 4. Fasting.
3. What is the dietary pattern of obesity ?
1. Vegetables 2 Water & Carbohydrate foods
3. Fatty and tinned food 4. Fruits & Fruit juices
4. Who are all more prone to get obesity ?
1. Childhood 2. Old age
3. Women 4. Men
5. Except dietary pattern what are all the other factors that you think as a
cause
of obesity ?
a. Running b. Studying
c. Not doing exercise d.. Travelling
6.What is the risk to get obesity ?
a. Water b. Watching TV
c. Reading Books d. Drugs
7.What are all the factors you will consider to calculate obesity ?
a. Height only b. Weight only
c. Both height & Weight d. Muscle strength
8.What is the formula to calculate BME ?1. Weight 2. Weight
Height in metre (Height)2
in M
3. Weight2
4. Height2
9. What is the abbreviation of BMI ?
A. Bare Mass Index B. Body Mass Index
C. Body Mass Instrument D. Bare Mass Instrument
10. How Will you reduce the weight?1. Exercise of controlled diet 2. Medication
3. Deceased intake of food 4. Increased intake of food
11. What is the signs of obesity ?
1. Very active 2. Palpitation of less activity
3. Happiness 4. Anemic
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12. How does the Mentality of obesity / overweight child ?
1. Active 2. Happy
3. Stress 4. Palpitation
13. What is the complication of obesity ?
a. Increased morbidity rate b. Loss of Appetitec. Eye disease d. Malnutrition
14.What is the simple method to calculate the obesity ?
a. Height b. Weight
c. BMI d. Muscle Strength
15. How does the obesity calculate other tan BMI ?
a. Skin fold thickness & waist circumference
b. Height only c. Weight only
d. Muscle strength
16.What is the normal weight of school going student?
a. 50-60 kg b. 16.5 to 37 Kgc. 35-45 Kg c. 10-15 Kg
17. How will you prevent obesity ?
a. Excessive sleeping b. Exercise and dietary control
c. Taking Medications d. Excess intake of food
18. What is the normal weight of school going adolescence?
a. 40-45 b. 30-35
c. 60-70 d. 50-60
19.What are all the disease condition caused by obesity ?
a. Bone & heart disease b. Head ache
c. Visual deficit d. Hearing deficit20. What is the incident rate of obese among school going student?
a. 1-10% b. 80-90 %
c. 10-20% d 50-60 %
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APPENDIX III
AWARNESS PROGRAMME ON OBESITY
Place : Dhanalakshmi Srinivasan Higher Secondary
School.
Group : School age Children between 12 15 Years.
Teaching Method : Lecture cum Discussion.
A.V.Aids : Poster.
Teacher : Ms. A. Anis Fathima Kani,
Ms. J. Anne Grace,
Ms. S. Aruna,
Ms. Aswathy Prasad,
Ms. D. Baby Santhiya.
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CONTENT
INTRODUCTION
Obesity is perhaps the most prevalent form of malnutrition. As a
chronic disease, prevalent in both developed and developing countries,
and affecting children as well as adults. Early childhood overweight that
persists into adulthood is associated with more severe obesity among
adults. Among adolescents self image communication problems and
difficulties both in School and home obesity.
DEFINITION OF OBESITY
Obesity is defined as a high percentage of body fat, usually >25%
for men and >32% for women.
INCIDENCE
Obesity has been estimated to affect 20 to 40 percent of the adults
and 10 to 20 percent of children and adolescents in developed countries
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Subramanian etal have reported that the prevalence of overweight and
obesity among the affluent adolescent school children in Chennai,
Tamilnadu was about 15% There are evidences that children and
adolescents of affluent families are increasingly becoming
overweight/obese in recent times, because of decreased physical activity.
Secondary lifestyle and changes in dietary habits.
Epidemiological determinants of obesity.
a) Age : Obesity generally occurs at any age and increases with age.
b) Sex: Women generally have higher rate of obesity than men
c) Genetic factors: There is a genetic Components in the etiology of
obesity. Twins Studies have shown a close correlation between the
weights of identical twins even when they are reared in dissimilar
environments.
d) Physical inactivity : Regular Physical activity is protective against
unhealthy weight gain. Physical inactivity may cause obesity which
in turns restricts activity.
e) Socio economic States: Obesity has been found to be more
prevalent in the lower socio economic groups.
f) Eating habits: Eating habits (eg: Eating in between meals,
preference to sweets, refined foods and fats/ are established in early
life. The Composition of the diet, the periodicity with which it is
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eaten and the amount of energy derived from at are all relevant to
the etiology of obesity.
g) Psychosocial factors: Psychosocial factors (eg, emotional
disturbances are deeply involved in the etiology of obesity.
Overeating may be a symptom of depression, anxiety, frustration
and loneliness in childhood as it is in adult life.
h) Familial Tendency: Obesity frequently seen in families Obese
parents frequently having obese children.
i) Alcohol: The relationship between alcohol consumption and
adiposity was generally positive for men and negative for women.
j) Education: There is an universe relationship between educational
level and prevalence of obesity.
k) Drugs : Use of certain drugs, Eg: Cortico Steroids, contraceptives,
insulin, beta adrenergic blockers etc., can promote weight gain.
ASSESSMENT OF OBESITY
Body mass index
Skin fold thickness
Waist circumference and Waist Hip ratio (WHR)
Others
Body mass index = Weight in Kilograms
(Height in meter)2
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Normal BMI 18 to 24.9
Over Weight 25 to 27.9
Obese >30
2) Skin fold thickness
It is a rapid and non invasive method for assessing body fat.
Several varieties of calipers (eg:- Harpenden skin calipers) are available
for the purpose. The measurement may be taken at all four sites-mid
triceps, biceps, subscapular and suprascapular regions. The sum of the
measurements should be less than 40mm in boys and 50mm in girls.
3. Waist circumference and waist: Hip ration (WHR)
Waist circumference is measured at the mid point between the
lower border of the ribcage and the iliac crest. It is a convenient and
simple measurement that is unrelated to height. Correlates closely with
BMI and WHR and is an approximate index on intra abdominal fat mass
and total body fat. A change in waist circumference reflects changes in
risk factor for cardio vascular disease.
4. Others:
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In addition to the above, three well established and more accurate
measurements are used for estimation of body fat. They are measurement
of total body water, of total body potassium and of body density
Obesity Associated disorders:
i.Cardiovascular Disease: Childhood obesity has been associated
with the development of risk factors for cardio vascular disease.
ii. Hyper tension:
Obesity is related to hypertension, increased heart rate and
increased cardiac output.
iii. Diabetes and carbohydrate metabolism: There is an increased
level of insulin and abnormal glucose tolerance tests in the obese. Further
insulin resistance is present in the obese and may increase renal sodium
retention, also increasing blood pressure of obese adolescents.
iv. Respiratory and sleep disorders: Obesity is believed to alter
respiratory function so that abdominal and thorasic fat are mechanical
obstacles to breathing.
v. Skeletal disorders: Slipped capital femoral epiphysis, which
occurs in adolescence as a result of increased stress at the growth plate.
vi. Mortality: The mortality risk of adolescent obesity was greater
than that of adult obesity.
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vii. Psychological and social distress; Severely obese adolescents
suffer from greater level of depression, low self concept and binge eating
disorder.
ii. Nutritional Counseling: Green foods: Foods low in fat and
calories, which may be eaten at reasonable quantities.
Yellow foods: are low in fat and moderate in calories (yellow means eat
but with moderation)
Red foods: are high in calories and fat. (Red means limi t these and eat
just a few red foods a week, usually outside the home). For example, an
adolescent would be prescribed a naturally balanced menu plan of 1200 to
1500 calories per day.
Protein: 20% of the total kilocalories from protein. (50 to 60 gm). Fat:
Minimum of 20% fat of total kilocaloricdiet (27 to 33gm) Carbohydrate:
Minimum of 20% of the kilocalories from carbohydrate.
Fibers: Another strategy to increase satiety is through high fiber intake.
(0.7 gm/kg of body wt). This provides bulk with low caloric density
foods.
A weight reduction die should satisfy the following criteria
i. Meet all nutrient needs except energy
ii. Suit clients tastes and habits
iii. Minimum hunger and fatigue
iv. Be accessible and Socially acceptable
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v. Encourage a change in eating pattern
Favor improvement in overall health.
Role of exercise: The effectiveness of regular exercise in achieving
weight loss is linked to ones degree of obesity. Generally, persons who
are obese lose weight and fat more readily with exercise then their
counterparts of normal weight.
Aerobic exercise: even without dietary restriction, provider a significant
positive.
When exercise: is used for weight loss, factors such as frequency,
intensity, duration, and the specific form of exercise must be considered.
Continuous, big muscle, aerobic: activities having moderate to high
caloric costs, such as walking, running, rope skipping, stair stepping,
cycling, and swimming, are ideal. Aerobic exercises also: stimulate lipid
metabolism, establish favorable blood pressure responses, and generally
promote cardiovascular fitness.
There generally is no selective: effect of running, walking of bicycling,
each is equally effective in promoting fat loss. An extra 300 kcal daily
caloric expenditure induced by moderate jogging for 30 minutes, for
example causes a 0.45 kg fat loss in about 12 days.
General guidelines for an exercise weight loss program:
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i. Start slowly: The initial stage of an exercise weight loss
program for a previously sedentary, over fact person
should be developmental in nature and should not include
an initial high total energy output.
ii. During the initial stage: the individual should be urged
to adopt long term goals, personal discipline and a
restructuring of both eating and exercise behavior.
iii. Regal city is the key: exercise frequency is important
when using exercise for weight reduction. It appears that
at least 3 days of training per wells is required to bring
about meaning feel changes in body composition through
exercise and more frequent exercise is even more
effective.
Diet flues exercise: the ideal combination benefits of adding exercise to
dietary restriction for weight loss.
i. Increases the overall size of the energy deficit
ii. Facilitates lipid mobilization and oxidation, especially
from visceral adipose tissue depots.
iii. Increases the relative loss of body fat by preserving the
fat free body mass.
iv. Contributes to the long term success of the weight loss
effort.
v. Provides unique and significant health related benefits.
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Summary & Conclusion:
Till now, we have seen about meaning of obesity definition,
etiology, measurement of obesity, compilation, management by diet
exercise. I hope you all have gained knowledge on obesity management
& you will apply this in practice.
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