PROFORMA FOR REGISTRATION OF SUBJECTFOR

DISSERTATION

MS. DIBYASHWORI LAKHE

FIRST YEAR M. Sc. NURSING

COMMUNITY HEALTH NURSING

YEAR 2011-2013

PADMASHREE COLLEGE OF NURSING

GURUKRUPA LAYOUT, NAGARBHAVI,

BANGALORE - 560072

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / Ms. DibyashworiLakhe
1st Year M.Sc Nursing
Padmashree College of Nursing
Gurukrupa Layout, Nagarbhavi,
Bangalore -560072
2. / NAME OF THE INSTITUTE / Padmashree College Of Nursing
Bangalore – 560072
3. / COURSE OF THE STUDY AND SUBJECT / 1st Year M.Sc Nursing
Community Health Nursing
4. / DATE OF ADMISSION / 30-05-2011
5. / TITLE OF THE STUDY / A study to assess the knowledge and practices of menopausal women on weight reduction measures with a view to develop an informational booklet in selected rural area, Bangalore.

6. BRIEF RESUME OF THE INTENDED WORK.

6.1. INTRODUCTION:

“Maintaining a healthy body weight is beneficial for menopausal women”.
Health is the most important aspect for the well being of a person. The attainment of health is also fundamental right of every human being as enriched in the constitution. Status of the health awareness and access to hospitals or services indicates the status of a family, society and nation in regards of development.1
The total world population during earlier last century was about 10 million per year. It is increasing in the same pace; the projected population would be 8000 million by 2025. India, with a population of 989 million, is the world's second most populous country. Of that number, 120 million are women who live in poverty. Current population of Karnataka in 2011 is 6,11,30,704 in which females population is 3,00,72,962 with the sex ratio in 1000 males for every 968 female.2
The prevalence of obesity is increasing worldwide and is reaching epidemic proportions. 8.3 million population is forecasted to be obese in age of 50 years or older in 2010. The prevalence of obesity is increasing most rapidly in post menopausal women. Postmenopausal women have an increased tendency for gaining weight.3
Health issues in India are always on a large scale and menopause is no exception. As one of the worlds’s most populated countries, India faces a variety of challenges dealing with menopause for several decade. India’s population currently sits just over 1 billion and the number of menopausal women comes in around 43 million and would include between the age of 40 to 60.4
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries, the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining. Menopause typically (but not always) occurs in women in midlife, during their late 40s or early 50s, and signals the end of the fertile phase of a woman's life.5
Menopause goes with aging. Weight gain during menopause is a natural process of aging. We cannot totally avoid weight gain during menopause because this phenomenon is natural and inevitable.6
According to investigators from NCI and Columbia University Mailman School of Public Health (2007), obesity is mainly caused due to the hormonal change, metabolic disorder, hereditary, dietary intake, less exercise, stress. Due to increase in weight, there is more risk of having breast cancer. Research also indicates that belly fat also increases the risk of cardiovascular disease, diabetes mellitus, certain cancers like breast cancer and colorectal cancer, even premature death.7
Menopause is one of the critical periods of a women’s life during which weight gain and obesity are favoured. Women classified as obese, with a BMI of at least 30 kg/m2, had a 45 percent increased overall mortality rate. At this time most women (2/3rd) experience weight gain or difficulty in maintaining their usual weight. Most women will gain above 10-15 pounds of weight during their menopausal year.
Menopause is unavoidable, but some of the condition associated with it is avoidable. Weight gain is one of those conditions that can be controlled in certain extent. Thus to avoid these complications, and to maintain the weight different activities had to be carried out like active exercise, diet control, good psychological balance and water therapy.

6.2 NEED FOR THE STUDY:

According to the United Nation (2010), the world population had already exceeded 7 billion. India with a population of 989 million is the world’s second most populous country. Of that number 120 million are women who live in poverty. 92% of women in India suffer from gynaecological problems. Menopause is diagnosed as one of major problem seen in at elder women. 8

Menopause is one of the critical periods in women's life during which weight gain and onset or worsening of obesity is favoured. It is at this period when obesity prevalence is the highest. There are several causes for this disorder, ones clearly related with hypo-oestrogenism and others depend on age favouring increased, food intake and decreased energy waste.

According to de Paz et al. 2006; Sharma et al. 2008, theprevalence of overweight and obesity amongpostmenopausal women of United Kingdom hasbeen reported as 41% (24/59) and 36% (21/59)respectively where as less than half of thepremenopausal women (48.27% ,14/29) of U.K.were observed as overweight/ obese. This figure is higher than statisticsreleased by WHO in 2006 (WHO global infobase)which stated that the prevalence of overweightand obesity among postmenopausal women ofU.K. was 30-40% and 25-31%, respectively.9

The prevalence of obesity is rising dramatically, impacting adversely on health and well being at the menopause and across the life span. With menopause, abdominal adiposity selectively increases. The impact of obesity and abdominal adiposity on chronic disease, including diabetes and cardiovascular disease, is significant and quality of life is adversely affected. Yet accurate perception of the weight related health risk profile is lacking and there is inadequate focus on prevention and treatment of obesity and its complications. Research aimed at prevention and management of obesity at menopause is limited. Accurate risk perception, education and translation programs highlighting obesity risks and supporting sustainable lifestyle changes are needed, particularly around menopause.10

A descriptive study conducted by Women’s Nutrition Research Program (2003) in Louisiana State University, explained that menopause tends to be associated with an increased risk of obesity and a shift to an abdominal fat distribution with associated increase in health risks. Changes in body composition at menopause may be caused by the decrease in circulating oestrogen, and, for fat distribution shifts, the relative increase in the androgen-oestrogen ratio is likely to be important. Clinicians need to be aware of the likelihood of weight gain during the perimenopausal and postmenopausal years because behavioural strategies for weight loss can be effectively used in this population. Weight loss or prevention of weight gain is likely to have significant health benefits for older women.11

Menopause and the aging process itself cause many physiologic changes, which explain the increased prevalence of chronic diseases observed in postmenopausal women. Exercise and nutrition play important roles in the prevention and treatment of cardiovascular disease, cancer, obesity, diabetes, osteoporosis, and depression.12

An article state that the consequences of menopause are threatened by lack of knowledge regarding it. Early management related to menopause helps to make women healthier and happier. It is a field of great social importance and impact, nationally and globally in developed as well as developing countries. Menopause is a normal event in a woman’s life. Unhealthy diet is one culprit in the rural obesity problem. Rural residents in some areas eat a higher fat and calorie diet. People in rural areas are often faced with limited selection and higher cost for fresh fruit and vegetables than consumers in more urban areas. Due to distance and limited transportation options, shopping for healthy food can prove difficult for those living in areas not served by a major grocery chain. People in rural areas may also lack nutrition information that would help them to choose a healthier diet. Nutritionists tend to be less available in rural areas, and fewer school and community nutrition education opportunities exist, compared with what may be available in larger communities.13

An article states that rural residents experience higher rates of obesity and overweight than people living in urban areas. Rural demographics may play some role in this difference. Rural residents tend to be older, less educated and have lower income than urban residents, and all of these factors are related to higher obesity levels. Even with other factors held equal, however, rural residents of every racial/ethnic group are at higher risk for obesity.14

India is one of the developing countries and its population is largely rural based (72%). India also has one of the highest illiteracy rates especially for women (54.16% based on the 2001 census). Due to the lack of knowledge and education different problems are being created. As menopause is unavoidable but the consequences like obesity during menopause can be controlled in some extent by exercise, maintaining diet etc. 15

Obesity and overweight is increasing in Bangalore city particularly among females. Data were obtained by examining 2000 Bangalore subjects from selected households who participated in the study. Obesity and overweight are increasing in Bangalore with an overall obesity prevalence of 35.5%. Reduction in overweight and obesity are of considerable importance to public health. Therefore it is recommended a state level obesity prevention program at community level to be implemented sooner to promote leaner and consequently healthier community.16

During the community posting, the researcher found that the menopausal women have inadequate knowledge regarding prevention of menopausal obesity. This motivated the researcher to select this study so that she will be able to prevent in some extent the different problems that are arise due to menopausal obesity.

6.3STATATEMENT OF THE PROBLEM:

A study to assess the knowledge and practices of menopausal women on weight reduction measureswith a view to develop aninformational booklet in selected rural area, Bangalore.

6.4 OBJECTIVES:

  1. To assess the knowledge of menopausal women regarding weight reduction measures.
  2. To assess the practices of menopausal women regarding weight reduction measures.
  3. To correlate the knowledge and practices of menopausal women regarding weight reduction measures.
  4. To associate the knowledge and practices of menopausal women with the selected demographic variables.

6.5 OPERATIONAL DEFINITIONS:

  1. Knowledge:

It refers to the understanding or awareness of menopausal women regarding weight reduction measures.

  1. Practices:

It refers to the daily activities that are carried out by menopausal women regarding weight reduction measures.

  1. Weight Reduction Measures:

In this study it refers to the:

  • Simple exercises: This refers to the activities such as brisk walking, stretching the larger muscles of the bodies like hands and legs in sitting position etc for 15-30 minute daily.
  • Diet control: In this study, it refers to the restriction of food items containing more calorie and fat like milk products (butter, cream, and cheese), ghee, red meats, roasted peanut, coconut oil, wheat flour, maize flour etc.
  • Water therapy: In this study it refers to the type of treatment adopted by obese women in which the women have to drink daily 1.5 litre (1500ml) of water early in the morning.
  1. Menopausal Women:

In this study, menopausal women refer to women who are between the age group of 44-49 years and whose menstrual cycle is stopped.

  1. Informational booklet:

This refers to a thin book which contains information about menopausal obesity, predisposing factors, complication and preventive measures on weight reduction measures.

6.6 ASSUMPTIONS:

  • Rural menopausal women may have an inadequate knowledge regarding weight reduction measures.
  • Rural menopausal women may go for less practicetowards weight reduction measures.
  • Selected demographic variables of menopausal women may have an influence on weight reduction measures.

6.7 HYPOTHESIS:

H1: There will be a significant relationship between the knowledge and practices of rural menopausal women regarding weight reduction measures.

H2: There will be a significant association between knowledge and practices with the selected demographic variables

6.8 REVIEW OF LITERATURE:

Review of literature is a key step in research process. The review of literature is an extensive, systematic selection of potential sources of previous work, acquired fact-findings after securitizations and location of reference to the problem under study. It is helpful in understanding and developing insight into the selected problem and also to develop a conceptual framework for the study.17

It is divided into three sections:

  1. Reviews related to knowledge on menopausal obesity
  2. Reviews related to practices on prevention of menopausal obesity
  3. Reviews related to complications of menopausal obesity

Reviews related to knowledge on menopausal obesity:

A cross-sectional study conducted in USA (2006) by Division of Clinical Pharmacology and Metabolic Research on effect of menopausal status on body composition and abdominal fat distribution on total and regional body composition by dual energy X-ray absorptiometry and abdominal fat distribution by computed tomography. The sample are fifty-three healthy, middle-aged, premenopausal women (mean+/-SD; 47+/-3 y) and 28 early-postmenopausal women (51+/-4 y). The result suggest that total body fat mass was 28% higher and abdominal subcutaneous fat 17% higher in postmenopausal women compared with premenopausal women. Postmenopausal women had a 49% greater intra-abdominal and a 22% greater abdominal subcutaneous fat area compared to premenopausal women.18

A descriptive study was conducted by J Natl Black Nurses Assoc. 2003 to describe and compare the knowledge, attitudes, perceptions and health practices related to menopausal health among African-American women (N= 106) from diverse SES levels, between 40 to 65 years of age. The mean age of menopause was 49 years of age, 60.7% were college graduates, 45.8% were married, 85% employed full-time and 88% had medical insurance. The result shows that African women were knowledgeable about the process of menopause. Thus it concluded that women and their physicians should be encouraged to discuss menopausal health. Culturally appropriate materials should be provided in all women's health settings, through media and places where women gather including churches, beauty parlour, community centers.19

A cross sectional survey based on sample of convenience was conducted at outpatient department of Isra university hospital, from 1st January 2005 to 31st December 2006. Total 863 women in age group of 42 to 80 years were interviewed. A semi structured questionnaire was used to collect data. Data analysis done by computer software statistical program for social sciences (SPSS) version 11.0. Results shows that 680 (78.79%) women had little knowledge about menopause, while 137 (15.8%) women knew about effects and symptom of menopause and study was concluded that majority of women were unaware of menopausal symptoms and its health effects. Most of them considered it as a natural process of aging, though bothered by symptoms but did not go for consultation due to lack of awareness and poverty.20

A cross-sectional study was conducted (2010) in 595 women (330 premenopausal and 265 postmenopausal) about prevalence of obesity in working premenopausal and postmenopausal women of Jalandhar, district and were selected by personal interview. A questionnaire was filled to know the required reproductive history of the subject. Obesity was assessed according to Body Mass Index, Waist-Circumference and Waist-Hip-Ratio. The prevalence of obesity was found more in postmenopausal women as compared to premenopausal women. According to Body Mass Index, the prevalence was 70.30% and 75.09% in pre- and postmenopausal women, respectively. Similarly the prevalence of central obesity according to Waist Circumference was 75.15% and 89.05% in pre- and postmenopausal women, respectively whereas according to Waist-Hip Ratio this prevalence was 74.54% in premenopausal women and 87.92% in postmenopausal women.21

A descriptive study conducted in outpatient clinics of obstetrics and gynaecology department of Dr TMA Pai Hospital (2008), a tertiary care Hospital in South India, with 352 post menopausal women with the Menopause-Specific Quality of Life (MENQOL) questionnaire on prevalence of menopausal symptoms and quality of life after menopause in women and data were presented as percentages for qualitative variable. The findings revealed that the mean age at menopause was 48.7 years and most frequent menopausal symptoms were obesity, aching in muscle and joints, feeling tired, poor memory, lower backache and difficulty in sleeping. The age at onset of menopause in southern Karnataka (India) is 48.7 years which is four years more than the mean menopause age for Indian women.22

A community based state level epidemiological health survey was conducted by examining 2000 Bangalore subjects in the age group of 30-70 years on prevalence of obesity of selected households over a 2 year period between 2006 and 2008. Data were obtained from body mass index (BMI) and were analyzed to classify individuals with overweight (BMI=25-29.9kg/m2), obesity (BMI more than 30 kg/m2 andsevere (gross) obesity if BMI is more than 40kg/m2. The findings revealed that prevalence of overweight was 36.9%. Females are significantly more obese with a prevalence of 44% than males 26.4%. Obesity and overweight are increasing in Bangalore and reduction is considerable importance to public health. Thus, it is recommended a state level obesity prevention program at community level to implemented sooner to promote leaner and consequently healthier community.23

Review of literature related to practices for prevention of menopausal obesity:

A longitudinal study was conducted by the Study of Women's Health Across the Nation (SWAN) in 2001 to examined the relations of aging, menopausal status, and physical activity to weight and waist circumference in 3,064 racially/ethnically diverse women aged 42-52 years . Over 3 years of follow-up (1996-1997 to 1999-2000), mean weight increased by 2.1 kgand mean waist circumference increased by 2.2 cm. A one-unit increase in reported level of sports/exercise (on a scale of 1-5) was longitudinally related to decreases of 0.32 kg in weight (p < 0.0001) and 0.10 cm in waist circumference. Similar inverse relations were observed for daily routine physical activity (biking and walking for transportation and less television viewing). These findings suggest that, although midlife women tend to experience increases in weight and waist circumference over time, maintaining or increasing participation in regular physical activity contributes to prevention or attenuation of those gains.24