RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the candidate and address (in block letters) / DAYANAND. V. BELAGAVI
I YEAR M. Sc. NURSING
INDIRANURSINGCOLLEGE, FALNIR,
MANGALORE-575 002.
2. / Name of the Institution / INDIRANURSINGCOLLEGE, FALNIR,
MANGALORE-575 002.
3. / Course of Study and Subject / M. Sc. NURSING
PAEDIATRIC NURSING
4. / Date of Admission to the Course / 15.6.2009
5. / Title of the study
“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMMEREGARDINGIMPORTANCE OF EXERCISE IN PREVENTION OF OBESITY AMONG CHILDREN FROM SELECTED URBAN SCHOOLS AT MANGALORE”
6. / Brief resume of the intended work
6.1The need for the study
“Exercise is one of the best ways in preventing the rapid growth of obesity.”
-Lee Haney
A healthy and educated child of today is the active and healthy adult of tomorrow. Incidence of childhood obesity is on the rise since the last few decades and is still continuing to rise1. Childhood obesity has increased in both developed and developing countries, although the pace and patterns of spread of this global health problem differs from country to country2.
Obesity is a condition of abnormal or excessive fat accumulation in the adipose tissue to an extent that health may be impaired (WHO). In 1990, WHO noticed that obesity in general has become public health problem in North America and West Europe1.
The incidence of childhood obesity in USA has risen from 5% to 13.9% for the age group of 2-5 years and for the age group of 6-11 years the rise is from 6.5% to 17.4%, whereas the rise in incidence for adolescent is from 5% to 17.4%. WHO report (1998) pointed the same inclining trend in Middle East, Central, and Eastern Europe1.
According to the report of International Obesity Task Force (IOTF), in the year 2000 globally about 10% of young people aged 15-17years were overweight among which 2-3% were obese2. In India about 29% of school children in urban area were obese. A study carried out in Delhi found that obesity among school children had increased by 13% in the past three years3. A study in Indiaconducted in the private schools of Chennai showed that 22% of school children were overweight and obese in different schools, while the picture is only 4-5% in government schools1. In the year 2004, a study found that 16% of school children were obese and in the year 2008 the figure was 28.9%, which is very much disturbing3.
Obesity reflects untoward health sequelae, particularly among the children due to its latent effect in the formative years. Several studies have shown that it can lead to several health problems such as osteoarthritis, malignancy, heart attack, hypertension, Type II diabetes, stroke, sleep apnoea etc4. This shows that obesity is dangerous. Obesity is ultimately an insidiously divesting disease, a devastation that is almost guaranteed to occur in the future adults2.
Several factors account for the development of obesity such as eating habit, lack of exercise, socioeconomic variables, lifestyle changes, physiological alteration, and psychological disturbances5. Of these, lack of physical activity is the main factor. Evidence shows that falling levels of physical activity contributes to the obesity.
Thus, the increase in prevalence and its concomitant health risks justify widespread efforts towards prevention6. Promoting physical activity has becomes a priority because of its role in preventing childhood obesity which is a major public health problem in the current scenario7. Therefore, promoting and encouraging physical activity among children have a significant impact on the prevention of obesity.
The investigator had come across many obese children, who are dropped at urban schools by their parents. Even the review of the related literature and discussions with the experts also had motivated the investigator to select the topic for research.
6.2Review of literature
Obesity is an increasingly common problem affecting a significant proportion in developing and developed countries. The problem has become almost an epidemic and is also global8.
The prevalence of obesity in children ranges from 10-30%. According to the Bogalusa Heart Study, the prevalence of overweight children increased twofold between 1973 and 1994 with more drastic annual increase in last 10 years. Another study reported that over a period in Japan too, the prevalence of obesity (as indicated by more than 120% of standard body weight) in children aged 6-14years increased from 5 and 10%. United States records that 25% of children are overweight and 11% are obese9.
A comprehensive review of interventions related to obesity prevention in childhood was carried out on school-based studies. Three interventions were analysed, that is, physical education, nutritional education, and reducing TV viewing. Out of these three, physical education and reducing TV viewing have found to be successful in reducing BMI as well as skin fold measure. This concludes that physical education is a beneficial intervention in preventing childhood obesity10.
In developing countries the study findings have revealed that there has been an increase in the prevalence of childhood obesity. In Thailand, obesity in children between 6 and 12 years increased from 12.2% to 15.6% between 1991 and 199611. A similar prevalence
rate (15.8%) has been observed among Saudi Arabian adolescent girls’ age group between 16 and 18years. During the past 20 years, prevalence of obesity among children and adolescents has been doubled in America. The US National Centre for Health Statistics suggested that nearly 15% adolescent girls were overweight or obese12. Data from 5 National representative US health surveys covering the period starting 1960-1965 and ending 1988-1991 indicated that the prevalence of overweight had increased in age and sex groups. In the period starting from 1976-1980 and ending 1988-1999 indicated that the prevalence of overweight in children and adolescents was >20% at the end of this period13.
High rate of paediatric obesity were reported in studies of several racial groups, including European, African American, Puerto Rican, Mexican, and Native Hawaiian subjects. Native American children and adolescent girls are at high risk of developing obesity.There is a notably elevated prevalence of obesity in tribes in the South-western US. In Canada, excessive paediatric obesity was reported in the Eastern James Bay Cree of Quebec and in the Mohawk community of Kahn awake. Even in Native Canadian community studies found that overall prevalence of overweight in subjects aged 2-19 years was significantly higher14. Among British, children between 7 and 19 years 15% of obesity was found15.
Asian countries are marked by an increasing number of overweight and obese cases. South Asians have at least 3-5% higher body fat when compared to Caucasians16. In Chennai, among 6 schools 22% of children were overweight17; in Delhi 31% of children were overweight12;in Pune, the findings showed 24%11. Now in India theproblem of obesity is increasing at a rapid pace16.
Due to unsafe roads (traffic, crime), children and adolescent girls are discouraged from walking and cycling to school. A study conducted among school children in Delhi, showed that lack of physical exercise is responsible for the rising prevalence of obesity12. Another similar study among Native Canadian children findings also revealed that low physical activity causes obesity14.
An interventional study was conducted among 6000 Indian school children at Hyderabad, Andhra Pradesh. This study finding revealed the degree of obesity (>30% body fat) in all subjects was 30.19%, where in affluent schools obesity percentage was 50.47 and in non- affluent schools it was 19.92%18. Another similar study was done among adolescent girls
at Delhi. The study findings revealed 7.4 percent of adolescent girls are obese12. A study conducted among college going adolescent girls at Ernakulam, 28% of them found to be overweight and out of them 12% were obese19. Another study at Avinashilingam Deemed University Coimbatore, found 16% of girls were having overweight and 14% were obese20. In Bangalore 15% of obesity was found among 1000 adolescent girls aged between 11 and 18years16.
Obesity is a growing problem every where and rampant among adolescent girls21. Many epidemiological studies have demonstrated that appropriate dietary restrictions and physical exercises improve in vivo insulin sensitivity, and thus are useful for the prevention and treatment of obesity and related diseases22. A study was conducted on 73 overweight children and was designed as four-phase physical activity intervention programme. Study findings showed significant weight loss and reduction in body fat, which was maintained at one year follow-up23.
The CATCH study (child and adolescent trial for cardiovascular health) in multi racial American school children and the ‘go girls’ community based study in African American girls showed that children can be taught to eat less fat and exercise more11. Most optimistic results have come from Singapore: an 8 years school based campaign with government support was successful in the implementation of physical-activity programme as well as reduction in prevalence of obesity from high of 16.6% in early 90s to less than 14.6% in 199811.
Traditionally, a fat child is considered as an attractive child, and is often referred to as a healthy child. However, the adverse and serious consequences of childhood obesity are now proved beyond doubt11. Consequences of childhood obesity will affect in adulthood. So nurses are having a vital role in providing health education regarding importance of exercise in prevention of childhood obesity.
6.3Statement of the problem
“A study to assess the effectiveness of planned teaching programme regardingimportance of exercise in prevention of obesity among children from selected urban schools at Mangalore”
6.4Objectives of the study
The objectives of the study are:
  1. To determine pre-test knowledge scores of school children regarding importance of exercise in prevention of obesity using a structured knowledge questionnaire.
  2. To evaluate the effectiveness of planned teaching programme regarding importance of exercise in prevention of obesity in terms of gain in post test knowledge scores.
  3. To associate the pre-test knowledge scores regarding importance of exercise in prevention of obesity and selected demographic variables.
  4. Operational definitions
  1. Effectiveness: In this study effectiveness refers to the extent to which the planned teaching programme regarding importance of exercise in prevention of obesity, has achieved the desired objectives.
  2. Plannedteachingprogramme: In this study it refers to a systematically developed teaching programme designed for school children to provide information regarding importance of exercise in prevention of obesity.
  3. Exercise: In this study it refers the activities which help the school children to keep away from obesity and its complications.
  4. Prevention: In this study it refers to the measures taken by the students to control obesity.
  5. Obesity: In this study it refers to an abnormal increase in the proportion of fat cells in the viscera and subcutaneous tissue of the body of school children.
  6. Children: In the present study it refers to the school students those who are aged between 11 to 13years, studying in the selected urban private schools at Mangalore.
6.6Assumptions
  1. Planned teaching programme is an approved strategy for improving the knowledge.
  2. School children have a little knowledge regarding importance of exercise in prevention of obesity.
  3. School children will sincerely answer the questions.

6.7Hypotheses
The hypotheses will be tested at 0.05 level of significance.
H1:The mean post test knowledge score of school children will be significantly higher than mean pre-test knowledge score.
H2:There will be significant association between pre-test knowledge score and selected demographic variables.
6.8Delimitations
This study will be delimited to:
  • School children who are aged between 11-13years of selected urban private schools at Mangalore.
  • Those who can read and write English.
  • Those who are present at the time of teaching programme.

7. / Material and Methods
7.1Source of data
The data will be collected from urban school childrenat Mangalore.
7.1.1Research design
Quasi experimental design will be used for the study.
One group pre-test, post test design will be selected for the study.
Subjects / Pre-test / Treatment / Post test
School children / O1 / X / O2
R= O1 X O2
R= Sample
O1= Pre-test assessment of school children knowledge regarding importance of exercise in Prevention of obesity.
X= Treatment (planned teaching programme regarding importance of exercise in Prevention of obesity).
O2= Post effect of planned teaching programme among school children regarding importance of exercise in prevention of obesity.
7.1.2Setting
The study will be conducted in selected urban private schools at Mangalore.
7.1.3Population
The population in this study comprises of school children in selected urban schools, Mangalore.
7.2Methods of data collection
7.2.1Sampling procedure
The sample for the present study will be selected by simple random sampling technique.
7.2.2Sample size
In this study the sample size consists of 100 schoolchildren.
7.2.3Inclusion criteria for sampling
  • School children who are willing to participate.
  • School children who are present at the time of teaching programme.
  • Age group of school children between 11-13years.

7.2.4Exclusion criteria for sampling
  • School children who are less than 11years and more than 13 years.

7.2.5Instruments intended to be used
The tools used for this study are:
  • Baseline proforma.
  • Structured questionnaire regarding importance of exercise in prevention of obesity.

7.2.6Data collection method
  1. Permission will be obtained from the principals of urban schools.
  2. Purpose and need for the study will be explained to the school children.
  3. Written consent will be obtained from the concerned authority of the schools and from school children.
  4. Pre-test will be conducted on Day 1, planned teaching programme on Day 2 and post test will be conducted on Day 9.

7.2.7Plan for data analysis
The data will be analyzed using both descriptive (mean, median, mean percentage and standard deviation) and inferential statistics (Chi square test and t-test).
7.3Does the study require any investigations or interventions to be conducted on patients, or other animals? If so please describe briefly.
Yes, in present study, the investigator plans to use a structured questionnaire to assess the knowledge of school children regarding importance of exercise in prevention of obesity.
7.4Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance will be obtained from the ethical committee of this institution.
8. / References
  1. Chakraborhty S. Childhood obesity – A Neglected Vital Issue. The Nursing Journal of India. 2009 Aug;8:180-1.
  2. Measurementand determinants of childhood obesity: an INCLEN-McMaster collaborative programme in 30 countries. [online]. Available from: URL:
  3. 29 percent urban school children are obese in India. [online]. Available from: URL:
  4. SuskindRM. Recent advances in the treatment and prevention of childhood obesity. [online]. Available from: URL:
  5. Goran MI, Reynolds KD, Lindquist CH. Role of physical activity in the prevention of obesity in children. Int J Obes Relat Metab Disord 1999 Apr;23 Suppl 3:S18-33.
  6. Naylor PJ, McKay HA. Prevention in the first place: schools are setting for action on physical inactivity. Br J Sports Med. 2009 Jan;43(1):10-3.
  7. Epidemic proportions. The Hindu,2.8.2004;6.
  8. Birach LL, Fisher JO. Mother’s child feeling practices influences daughter’s eatingand weight. American Journal of Clinical Nutrition 2000;71(5):1054-61.
  9. Doak CM, Visscher TL, Renders CM, Seidell JC. The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes. Obes Rev2006Feb;7(1):111-36.
  10. Bhave S, Bavadekar A, Otiv M., IAP National Task Force for childhood prevention ofadult diseases. Child obesity. Indian Paediatrics 2004; 41: 550-75.

  1. Kapil U, Singh P, Pathak P, Dwivedi SN, Bhasin S. Prevalence of obesity amongst affluent adolescent school children in Delhi. Indian Paediatrics 2002;39:449-52.
  2. Troiano RP, Flegal KM, Kuczmarki RJ, Campbell SM, Johnson C. Overweight prevalence and trends for children and Adolescents. Arch Paediatric Adolesc Med 1995;149:1085-90.
  3. Hanley AJG, Harries SB, Gittelesohn J, Wolever. Overweight among children and adults in a Native Canadian community: prevalence and associated factors. Am J Clin Nutr 2000;71:693-706.
  4. Rudolf M CJ, Sahota P, Barth JH, Walker J. Increasing prevalence of obesity in primary school children: cohort study. BMJ 2001;322(5):1094-9.
  5. A weighty crisis. Health and Environment 2005;3(2):1-6.
  6. Subramanyam V., Jayashree R., Mohamad R. Prevalence of overweight and obesity in affluent adolescent girls in Chennai in 1981 and 1998. Indian Paediatrics 2003; 40:332-6.
  7. Park K. Textbook of preventive and social medicine. 17th ed. Jablapur: Banarsidas Bharat Publishers; Jabalpur; 2002.
  8. Choudhary B., Kishore A. Are we making school children sedentary and obese? Intervention study of 6000 Indian school children. The Ind JNutrDietet2004;41:250-255.
  9. Prabhakaran S. Nutritional status of adolescent girls residing in a University Hostel. Ind J Nutr Dietet 2003;40:274-9.
  10. Going on a teenage diet. New Indian Express 21.12.2004. Pg. 3.
  11. Sato Y. Practical aspect of exercise therapy for obesity 2005;48(2):59-63.
  12. Sother MS, Hunter S, Suskind RM, Brown R, Udall. Motivating the obese child to move: the role of structured exercise in paediatric weight management. South Med J 1999;92(6):577-84.

9. / Signature of the candidate
10. / Remarks of the guide
11. / Name and designation of (in block letters)
11.2 Guide / PROF. (MRS.) SUJATHA R.
PRINCIPAL
INDIRANURSINGCOLLEGE
FALNIR
MANGALORE-575 002.
11.2 Signature
11.3 Co-guide (if any)
11.4 Signature
12. / 12.1 Head of the department / PROF. (MRS.) SUJATHA R.
PRINCIPAL
INDIRANURSINGCOLLEGE
FALNIR
MANGALORE-575 002.
12.2 Signature
13. / 13.1Remarks of the Chairman and Principal
13.2Signature

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