RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / MS. THOUNAOJAM JOGABATI DEVI
1ST YEAR M. Sc. NURSING
THE OXFORD COLLEGE OF NURSING
1ST PHASE J.P.NAGAR
BANGALORE-560078
2. / NAME OF THE INSTITUTION / THE OXFORD COLLEGE OF NURSING,
1ST PHASE, J.P. NAGAR
BANGALORE-560078
3. / COURSE OF THE STUDY AND SUBJECT / MASTER DEGREE IN NURSING PSYCHIATRIC NURSING.
4. / DATE OF ADMISSION TO THE COURSE /
04-05-2007
5. / TITLE OF THE STUDY / ASSESSMENT OF KNOWLEDGE OF
SCHOOL TEACHERS ABOUT
PSYCHOLOGICAL IMPACT OF
OBESITY AMONG ADOLESCENTS.

6. BRIEF RESUME OF THE INTENTED WORK

“The first duty toward children is to make them happy. If you have not made

them happy, you have wronged them; no other good

they may get can make up for that.”
Charles Buxton


INTRODUCTION

Obesity is currently a major health problem in many parts of the world. What is most distressing is the rate in which the problem is growing. Industrialization, urbanization, globalization, and technological advancement have brought many changes in the lifestyle. These lifestyle changes have influenced the culture and normal activities of a childrens’ life in the way of play, study, eating habits, and social living.1

The advent of video games, computers, cable television, VCR’s, and public transportations that do not require great amount of physical exertion. Sprawling development has discourages physical activities and makes walking and biking difficult or dangerous. Changes in the food habits and lack of facilities to play especially in the urban area are causing obesity among children and adolescents. Young people are socialized to the importance of appearance early in life. Both boys and girls who perceive themselves to be different from recognized norms report dissatisfaction with themselves, and excess weight is a common reason for feeling different.

Children aged 9 to 12 years old who slept less than nine hours at night were more likely to gain weight than their more rested peers (University of Michigan’s center for Human Growth and Development). Insufficient sleep can negatively affect preteens’ metabolism as well as their exercise and eating habits, causing them to get fat. Many children are not getting enough sleep, and that lack of sleep may not only be making them moody or preventing them from being alert and ready to learn at school, it may also be leading to a higher risk of overweight (Julie Lumeng). Children should sleep 10 to 12 hours at night according to the National Sleep Foundation.2

When a child became obese their normal physical, psychological, and emotional development is altered. The most common psychological problems among children are distress, anxiety, depression, suicidal thought, and unhealthy weight control behaviors such as Bulemia. Added to these problems obese children are more often bullied and stigmatized by their peers in the school which is causing to social isolation. The degree of relationship between weight and self-esteem is greater in girls than it is in boys. In other words girls are more drastically affected by weight and perceived weight problems than boys.

Children attend school for more hours i.e. 5hours each day and more days i.e. 180 days each year.3 School is the arena for mental health promotion. The social processes that take place in the school affect behavioral development. Since the large portion of the child’s life is dominated by the school, the teachers are the best to handle psychological problem next to parent. The teacher through indirect processes can enhance self-esteem and self-effectiveness. Behavioral modification and group work were more effective than mental health consultant with teachers.4

6.1 NEED FOR THE STUDY

Obesity among children is becoming alarming issues in the modern lifestyle. Childhood obesity is the Top-3 major health concern of children in United States.5 By 2010; half of the all American children will be overweight (Wang and Lobstein, 2006). If the trends of childhood over-weightness continues, the current generation of children may be first in nation’s history whose life expectancy is shorter that that of their parents (Olshansky, 2005).6

The prevalence of overweight among children aged 6-11 is more than doubled in the past twenty years, going from 7% in 1980 to 18.8% in 2004. The rate among adolescents aged 12-19 more than tripled, increasing from 5% to 17.1%. Adolescent children have more knowledge and concern about their body image.7

In India, school based data demonstrates that, an obesity range of 4.6% to 25% for the children and adolescents. Obesity is a monumental dilemma affecting the health and well being of the world population. This is not a new problem, but rather a rapidly increasing one among children, adolescents, and adults. Obesity compounds a common adolescent problem of low self-esteem and can disrupt psychosocial development, interfering with the normal process of adolescence, a timeless journey that prepares the child for adulthood. Psychologically complications have been associated with obesity in adolescent, including depression, poor self-image, and difficulties in both at home and social environment (including school).8 Not surprisingly, guilt often accompanies obesity. Obese people are thought of as bringing the problem on themselves. They internalize these feelings and beat themselves up over their perceived gluttony. It is very unhealthy and unhelpful mindset.

In India, it was basically under nutrition which attracted the focus of health workers and childhood obesity was rarely seen. But over the past few years this entity is increasingly being observed. The changing lifestyle of families with an imitation of western culture in the so called modernized India with increased purchasing power, easy availability, more comfortable and luxurious living, improved technology has all attributed to this problem. Increased hours of inactivity due to increased academic pressure, spending time in front of television, computer, and video games have replaced all outdoors games and other social activities.9 Quite often fatty girls and boys have many problems especially in girls like menstrual problems which can lead infertility and impotence in males. These persons will have psychological impact.10

From the above fact, it is clear that obesity among adolescent lead to many psychological problems. These problems are likely to affect the academic performance also. To minimize the impact of obesity on psychological aspect among adolescent the main and first preference is to teachers, who are always dealing with the children at school than the parent at home. Teacher is not only act as evaluators but also spend a good portion of their time as disciplinarians, counseling, and social model. The mentioned psychological problems due to obesity shall be handled appropriately by the teachers. Hence, the researcher felt

the need of assessing the knowledge of school teachers.

6.2. REVIEW OF LITERATURES


”Be ever gentle with the children God has given you; watch over them constantly; reprove them earnestly, but not in anger. In the forcible language of Scripture, "Be not bitter against them." "Yes, they are good boys," I once heard a kind father say. "I talk to them very much, but do not like to beat my, children--the world will beat them." It was a beautiful thought not elegantly expressed.”
- Elihu Burritt

In this the researcher has reviewed the literature to have information regarding psychological impact of obesity among adolescents at school and is focused mainly on knowledge of the school teachers about psychological problems among obese children. The literatures are classified into following categories:

6.2.1. Studies related to the psychological impact of obesity among adolescents at school.

6.2.2. Studies related to the knowledge of school teachers about psychological problems of obese adolescents at school.

6.2.1. Studies related to the psychological impact of obesity among adolescents at school.

The Pupa’s health information team (2007) published an article on ‘Avoiding Childhood Obesity’. It said that being overweight as a child can also cause psychological distress. Teasing about their appearance affects a child’s confidence and self-esteem, and can lead to isolation and depression. The number of overweight and obese children in the UK has risen steadily over the past 20 years. The obesity epidemic is now a major health concern. Very few children become overweight because of an underlying medical problem. Research indicates that children are more likely to be obese if their parents are obese. It isn't known whether this is because of genetic factors which the child inherits, if it’s because families tend to share eating and activity habits, or a combination of them both. According to the National Diet and Nutrition survey (2000), 4 out of 10 boys and 6 out of 10 girls do not do the minimum one hour a day of physical activity recommended by the Health Education Authority.11

Francine Ratner Kaufmam (2005) published an article on ‘Obesity Side Effects on the Rise’. He said that, poor quality of life and low self-esteem are endemic among obese children. The prevalence of psychological problems in obese children may depend on the degree to which obesity is accepted by the family members and the culture in which the child lives. The likelihood that a severely obese child or adolescent will have impaired health related quality of life is 5.5 times higher than that of a normal weight child and similar to that of a child with cancer. Moderate to severe depressive symptoms (48%) and high level of anxiety (35%) are reported in severely obese adolescents. As a result, obese girls are more likely to have attempted suicide than non obese girls. Other high risk behavior is also frequent among overweight compared with their non-overweight peers, including alcohol consumption, cigarette smoking and binge eating.12

Rickard L. Sjoberg, Kent W. Nilsson, and Jerzy Leppert ( Sweden, 2005) conducted a study on ‘Obesity, Shame, and Depression in School- aged Children’, to investigate an association between adolescent obesity and depression in a non clinical population and whether psychosocial and economic status and subjective experiences of shame may account for such an association. The study was performed on a sample of 4703 adolescents (71% of the target population of 15- and 17-year-old students). The study was resulted that the obesity was significantly related to depression and depressive symptoms among 15 and 17 year olds. Obesity was also significant related to experiences of shame. Adolescents who reported many experiences of shame had an increased risk (odds ratio: 11.3; confidence interval: 8.3–14.9) for being depressed. Clinical treatment of obesity may sometimes not just be a matter of diet and exercise but also of dealing with issues of shame and social isolation.13

Ian Janssen, Wendy M. Craig, William F. Boyce, and William Pickett (2004) were conducted a study on ‘Association between Overweight and Obesity with Bullying Behavior in School age Children’. The researchers examined the associations between bullying behaviors (physical, verbal, relational, and sexual harassment) with overweight and obesity status in a representative sample of 5749 boys and girls (11-16 years old). In this study, 15- to 16-year-old boys’ relationships were observed between BMI category and peer victimization, such that overweight and obese youth were at greater relative odds of being victims of aggression than normal-weight youth. Strong and significant associations were seen for relational (e.g., withdrawing friendship or spreading rumors or lies) and overt (e.g., name-calling or teasing or hitting, kicking, or pushing) victimization but not for sexual harassment. The study was revealed that, that there were no associations between BMI category and bully-perpetrating in 11 to 14 years olds. However, there were relationships between BMI category and bully-perpetrating in 15 to 16 years boys and girls.14

VV Khadilkar and AV Khadilkar (2004) published an article on ‘Prevalence of Obesity in Affluent School Boys in Pune’. It shows that the prevalence of childhood obesity is rising around the world including India. Over the last decade or so the overall BMI of children is increasing suggesting a worrying trend of a whole adolescent population shifted towards higher weights and BMI.15

Meg H. Zeller, Brian E. Saelens, Helment Roehrig, kirk Shelly and Stephen R. Daniels (2004) conducted a study on ‘Psychological Adjustment of Obese Youth Presenting for Weight Management Treatment.’ In the study anthropometrics, demographics (race, sex, insurance status), measures of youth psychological adjustment (self and mother report; Behavioral Assessment System for Children), and maternal self-report of psychological distress (Symptom Checklist 90-Revised) were collected from 121 obese children and adolescents (55% white, 45% black) and their mothers. The researcher found that appropriately one-third of youths self-reported some psychological maladjustment, but two-thirds of youths were described by the mothers as experiencing some degree of psychological maladjustment. Adjustment difficulties were specific to social functioning, low self-esteem, and internalizing symptoms. 41% of mothers of child participants and 56% of mothers of adolescent participants reported clinically significant psychological distress.16

Samuel L. Friedlander, Emma K. Larkin, Carol L. Rosen, Tonya M. Palermo, and Susan Redline (2003) were conducted a study on the ‘Decreased Quality of Life Associated with Obesity in School age Children’. The study is conducted on preadolescent school-aged children to examine the association between health related quality of life and body mass index (BMI). A cross sectional analysis of 371(50% female; 32%minority) children from a community based sample of 8-11 years old participated. Using BMI percentiles for age and sex, 17.5% of the children were considered overweight (BMI 95th percentile), 12.4% were at risk for overweight (BMI 85th-94th percentile), 8.1% were relatively underweight (BMI <20th percentile), and the remaining 62.0% were of normal weight (BMI 20th-84th percentile). The study reveals that the overweight children have increased odds of low scores of several health related quality of life domains. Overweight children were compared with normal weight children scored lower on the Psychosocial Health Summary (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.6) and on subscales measuring self-esteem (OR, 3.5; 95% CI, 1.9-6.3), physical functioning (OR, 2.8; 95% CI, 1.7-6.8), and effect on the parent's emotional well-being (OR, 2.0; 95% CI, 1.1-3.6).17

A study on ‘Health related Quality of Life (QOL) of Severely Obese Children and Adolescents’ was conducted by JB Schwimmer and TM Bur winkle (2003). The researchers found that severely obese children and adolescents have lower health related QOL than children and adolescents who are healthy and similar QOL as those diagnosed as having cancer. Physicians, parents, and teachers need to be informed of the risk impaired health related QOL among obese children and adolescents to target interventions that could enhance health outcomes.18