RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Mrs. A.DEEPA REKHA,
No.5/1275, 48TH CROSS STREET, PHASE II, SATHUVACHARI,
VELLORE-632009.
2. / NAME OF THE INSTITUTION / NOOR COLLEGE OF NURSING,
NO.5, NOOR BUILDING,
BHOOPASANDRA MAIN ROAD,
RMV II STAGE, BANGALORE-94.
3. / COURSE OF STUDY & SUBJECT / M.SC.NURSING 1ST YEAR COMMUNITY HEALTH NURSING
4. / DATE OF ADMISSION / 01TH JUNE 2009
5. / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON THE KNOWLEDGE REGARDING PREVENTION OF OBESITY AMONG ADOLESCENT GIRLS IN R.T.NAGAR PUBLIC SCHOOL, BANGALORE”.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“ Women’s Health Is Universal Health”

Adolescent is the period of transition from childhood to adulthood. During this period they are physically more active and have greater metabolic rates, and also many changes take place in the body, like physical, biochemical and emotional and sexual growth due to the influence of different hormones. Formation of habits of daily living takes place in this period and persists into adult period. It is a period of greatly enhanced awareness and attention for changing body image.1

According to World Health Organisation had stated that obesity has turned out to be a major health problem in both developed and developing countries. It has reached epidemic proportions globally with more than one billion adults obese out of which 300 million are clinically obese. And also it affects 10-20% of children and adolescents in developing countries including India. The prevalence of overweight was 15.8% in girls aged between 14 to 19 years in urban southern India and since 1980 the number of overweight adolescents have been tripled.2

Childhood obesity is one of the major health issue of modern civilization. Research over the past four decades suggested that childhood is a period when dietary and life style patterns are initiated, that has implication on coronary heart diseases, and other morbidity risks in later adult life. It has been observed that the health problems of adult obesity can be prevented if obesity is controlled in childhood itself. National Health and Nutrition examination survey (1999-2000) had reported that 10 percent of children aged two to five years and 15 percent of children aged six to 19 years in the United States are overweight. The adolescents girls were less physically active than boys and had habits of fast eating, skipping meals frequently, irregular eating, desire towards junk food, spending time in watching television and computer, long hours of reading till late nights, and also they had stress often.3

The increased rates of obesity among adolescents are dramatically reducing the quality of young lives. Obesity in adolescents is associated with complication like, poor self-esteem, depressive disorders, and problem of sleep apnea, hypertension, atherosclerosis, type II diabetes mellitus and many more.4

Obesity and lack of physical activity during adolescent period contribute to one third of all type of cancers such as cancer of colon, breast, kidney, stomach and gall bladder disease.5

Balanced diet and physical activity would help in reducing obesity and related problems and prevent them from forming major health problems. Lifestyle modification plays an important role in reducing the incidence of overweight and obesity among adolescents and further reduces the risk of complicated diseases in later life. The treatment of obesity is very expensive and difficult as age advances. Hence it is better to prevent obesity and its complications in adolescent period by conducting health awareness programme regarding lifestyle modification.6

6.2 NEED FOR THE STUDY

Indian adolescents aged 15-19 years comprise 11% of total population. Adolescents females accounts for 22% of female population. So more attention should be paid in controlling overweight among adolescents, it is easier now a days to become overweight because high caloric foods such as fast foods and confectionary are heavily consumed by adolescents.7

Adolescents are spending much time in front of the television and computers without any activity. It is found that high fat diet and less physical activity and exercise will increase the risk of obesity. There is clear evidence of demographic, epidemiological and nutrition transition in India is fuelling the epidemic of overweight, obesity and chronic disease particularly in urban areas. With increasing levels of obesity there is corresponding increase in diabetes, cardiovascular diseases, hypertension and ultimately mortality rates.8

The massive health education programme were urgently needed both in urban & rural areas in India. Because the awareness and knowledge regarding obesity is grossly inadequate among adolescents in India. Adolescent period may be the best time to mount primary and secondary prevention programme against obesity, because this the age of which individuals become more independent in their food choices and also when many cases of chronic overeating begin.9

All the health professions have role in the treatment and prevention of obesity and an integrated approach is essential which include general practitioners, exercise specialist, psychologists, nutritional lists and dieticians. Nurses were ideally placed with in the health service to promote diet and life style changes and prevention of obesity with in the community. Investigator observed that adolescents are more attracted towards junk foods compared to other age groups. Many research studies and media reveal that the incidence of obesity is more common among early adolescent girls in urban area. So, personally the investigator felt the need to evaluate the structured teaching programme on lifestyle modification to avoid obesity among adolescent girls. 10

6.2  REVIEW OF LITERATURE

Review of literature is a systematic identification, location, selection and summary of written material that contains information on research problems. Literature review is based on the extensive survey of books, Journals, audio visual aids, and international nursing indices. It provides books for future investigations, justifies the need for study of scientific knowledge in a profession discipline from which valid and pertinent theories may be developed.

A study was conducted to assess the prevalence of obesity. It estimated that one billion adults world wide were overweight and at least 300 million of these were clinically obese. And also 17.6 million children were estimated to be overweight11.

A study was conducted to determine the prevalence of obesity, it has been increased among the US population over the past 30 years. Data collected from 1999-2002 and estimated that nearly 1/3 of adults were obese in which 27.6% of men and 33.2% of women12.

A study was conducted to investigate the prevalence of obesity in Indian population and their findings show the prevalence of underweight as 24.9% overweight (BMI 23-25) 20.8% and obesity (BMI > 25) 50.9% and the incidence of obesity is more in women than men 13.

A study was conducted to assess on obesity among pre adolescents and adolescents of a developing country’s (India). This cross sectional study was carried out in 2008 among school – children who were aged 9-15 years. The results showed that the overall prevalence of obesity and overweight was 11.1% and 14.2% respectively. Children from higher Socio-economic status were obese and overweight than those from lower socio-economic status14.

A study was conducted to monitor women of higher socioeconomic status in Karnataka, India. They were more likely to be overweight. The study found that the prevalence of under nutrition was high for rural women (48%) and for overweight prevalence was high in large urban areas (44%).15

A study was conducted to assess the prevalence of obesity in US. It is estimated that 15% of children and adolescents aged 6-19 years are overweight.16

A study was conducted prevalence of obesity, it estimated that 25% of all children in the United States are overweight or at risk of becoming overweight. 17

A study was conducted on existing obesity. It estimated that 20-25% of children and adolescents were overweight or obese and 4.9% of boy’s and 5.4% of girls are obese. Rates of obesity have increased significantly in Australia with the prevalence of overweight doubling and obesity trebling.18

A study was conducted to find out the prevalence of obesity and its causes such as the macronutrient content of the diet, meal patterns, physical activity, and sedentary behaviours. He concluded that the obesity is occurred due to long time watching, TV, lack of physical activity and intake of fast food. Soft drinks are also examined as potential contributing factors in the obesity epidemic.19

A study on association between the soft drinks and obesity was done. He concluded that obesity is occurred due to soft drinks because of increased intake of additional calories in the diet. 20

A study was conducted to determine on obesity and its causes. Factors that may contribute to children being overweight may be attributed to larger food portion sizes, fast foods and an increasingly sedentary lifestyle. He concluded that low frequency of physical activity was found to be the main reason for obesity. The aim of the study was to find out the relationship between the obesity and parental attitudes and practices required for the adoption of healthy eating habits of children. It has been found that the role of parents is central to obesity reduction efforts among children it has been found that parental obesity more than doubles the risk adult obesity among both obese and non - obese children under 10 years of age. 21

A study was done on the use of a low calories diet. That generates an initial deficit of 500-1000k.cal/ day and supplies 1000-1200 kcal day for women to treat obesity and recommended 30-45 minutes of moderate intensity aerobic physical activity (40-60% of maximum oxygen uptake, or 50-70% of maximum heart rate) 3-5 days / weak initially and then a gradual increase in the duration and frequency of the activity for long term weight loss.22

A study was conducted to assess the knowledge recording obesity in children among school teachers. An educational seminar was conducted for teachers and an interactive session talk and several activities were used to educate the children about the importance and method of leading healthy life style and to serve as reinforcement sessions. Pre and post intervention questionnaires were used to assess improvement in knowledge. Teachers showed increases in knowledge about obesity (89%) and its prevention (92%). 23

A study was conducted on effect of fruits and vegetables on chronic diseases such as obesity in Flurida, US. The study participants were recommended to consume five to nine servings of fruits and vegetables. The results revealed that the fruits and vegetables had a beneficial effect on weight reduction at P<0.05 level.

A study was conducted on effects of dieting and physical activity among adolescent girls in USA. The study participants were recommended to high levels of physical activity and the consumption of low calore, portion controlled meals, including liquid meal replacements. The results revealed that the high levels of physical activity and the consumption of low caloric diet including liquid meal replacements also helps to maintain weight loss. 25

A study was conducted on obesity and its complication. They conducted that in childhood and adolescents obesity may be associated with a range of medical and psychological complications and can predispose individuals to serious health problems in adult life, including type two diabetes, hypertension, dislipidemia. Prevention of obesity in children and adolescents require a range of stratigies involving changes in lifestyle and behaviour.26

A study was conducted on consequences of obesity, they concluded that the major health consequences associated with obesity and are Non Insulin Dependent Diabetes Mellitus (NIDDM) Coronary Heart Disease (CHD), hypertension, gall bladder diseases, psychological disturbances, infertility and certain types of cancer. 27

A study was conducted on consequences of obesity. They concluded that the more immediate health risks including cholesterol levels, abnormal glucose tolerance and several other health problems occurring during childhood. 28

A study was conducted on obesity to assess its complication. Obesity has been significantly associated with several chronic diseases, including type II diabetes, hypertension hypercholesterolemia, asthma, arthritis and poor health status. In addition to ischemic heart diseases, stroke hypertensive heart disease, osteoarthritis, postmenopausal breast cancer, colon cancer, endometrial cancer and

renal cancer. Respiratory problems, gall bladder disease and sleep apnea are additional health problems found to be associated with obesity. He concluded that obesity is strongly associated with these chronic diseases. 29

STATEMENT OF THE PROBLEM

“ A study to assess the effectiveness of self instructional module on the knowledge of prevention of obesity among adolescent girls in RT Nagar Public School, Bangalore”

6.3  OBJECTIVE OF THE STUDY

·  To assess the level of knowledge on prevention of obesity among adolescent girls.

·  To determine the effectiveness of self instructional module on the knowledge of prevention of obesity among adolescent girls.

·  To find out the association between the level of knowledge with selected demographic variables among adolescent girls.

6.4. OPERATIONAL DEFINITION

Assess: It refers to gathering the information on knowledge regarding prevention of obesity among adolescent girls.

Effectiveness: It refers to the out come of Self instructional module in improving the knowledge of prevention of obesity among adolescent girls.

Self instructional module: It refers to the knowledge of prevention of obesity among adolescent girls.

Knowledge: It refers the response of the adolescent girls to the questions stated in the questionnaires, regarding prevention of obesity among adolescent girls in R.T. Nagar Public School, at Bangalore.

Prevention : It refers to prevention of obesity among adolescent girls.

Obesity : It refers to adolescent girls in the age group of 12-15 years.

Adolescent: it refer to the people of age group between 12-15 years who are studying in R.T. Nagar Public School, at Bangalore.

SELF INSTRUCTIONAL MODULE

It refers the planned teaching which include the measures preventing overeating, taking foods while watching television, psychological factors like emotional disturbances, depression, anxiety, frustration, loneliness, endocrine factors like thyroid deficiency , growth hormone deficiency, increase adrenal hormones, sleeping less than 5 hours per day.

HYPOTHESIS