PhD

We live in an energy sparing society today. Changes in diet coupled with increasingly inactive life styles have sparked off overweight and obesity in several countries of the world including India and Kerala. Overweight is associated with the onset of major chronic diseases leading to complications and also psychosocial problems in children and adults. The greater concern is that the risks of overweight during childhood will persist into adolescence and adulthood. Hence close monitoring of overweight prevalence in children and adolescents and taking timely preventive measures will be an effective approach in dealing with the problem of obesity.
The study entitled “Contributing factors and problems associated with overweight among rural and urban school children” was undertaken with the major objective to assess the contributing factors and related problems due to overweight among rural and urban school going children and to find out the impact of diet counselling.
A total of 3886 children from the selected schools were screened for overweight and obesity using standard overweight/obesity indicators. The sample selected for the study comprised of a total of 840 school going children of which 720 belonged to the experimental group of overweight children and 120 belongs to the control group of normal weight children. The sample was selected from 10-15 years of age group with equal number of boys and girls from each of the six age groups selected from rural and urban areas of Thiruvananthapuram District. A comprehensive analysis of socio economic and demographic features, time utilization, activity pattern and dietary profile of the subjects were carried out to find out the contributing factors behind the development of overweight and obesity in school going children. A probe into the health, physical, academic, psychosocial and behavioural adjustment problems was also undertaken to get a picturesque and exhaustive information on the problems associated with overweight and obesity. A systematic and in-depth appraisal to understand the dietary adequacy, macronutrient intake, energy balance and impact of diet counselling and health education was also carried out on the micro sample of 120 children selected from the macro sample of 840 overweight and normal weight children. The data collected was statistically analysed to determine the significant difference between the overweight and normal weight children in the areas studied and also to give the relationship or association of the variables selected for the study.
The major findings of the study are:
From the total of 3886 children screened, the overall prevalence of childhood obesity was found to be 4.99 per cent, 17.73 per cent was overweight when only 58.67 per cent was normal weight, 16.16 per cent was under weight with a BMI less than 15, and 2.44 were severely malnourished with BMI less than 13. An interesting observation made was that the overall prevalence of overweight and underweight was comparable at 16 to18 percent. The study thus proved that even though the indicators of over nutrition like overweight and obesity are rising disturbingly, undernutrition is still a problem even in Kerala.
Region wise comparison of anthropometric measurements revealed that there was significant difference at 1 per cent level in body weight, BMI, body fat, waist circumference, waist:hip ratio and MUAC of overweight and normal weight children.
The sample as a whole form two homogeneous groups with most of the overweight children hailing from middle income and upper middle income whereas majority of the normal weight children were from lower middle income and middle income showing that income is a contributing factor for overweight and obesity. Majority of the children in both groups were from nuclear families with one or two siblings and with parents having good education and employment status. A greater majority of overweight children were living in own houses.
The dietary habits and preferences of the sample studied were in par with earlier studies done in this field with significant difference between overweight and normal weight children. Results revealed that snacking habits seen in overweight children could also be a contributing factor of obesity. The study also revealed that majority of the sample in both groups were non –vegetarians. The intake of cereals, meat group, snacks, hotel/canteen foods, and sweets were higher in overweight children. Similarly, the intake of macronutrients like carbohydrate, fat and protein were also significantly higher in overweight children.
The activities and time utilization pattern of the overweight and normal weight subjects were noted to have a significant contribution to their weight condition. The sedentary activities were significantly higher and heavy activities were significantly lower in overweight children confirming the proved fact that the lesser the energy spent, more is the gain in weight.
The evaluation of the energy balance computed from energy intake and energy expenditure revealed the following. The difference in energy intake and the positive energy balance was found to be significantly higher in overweight children compared to that of normal weight children indicating the need for maintaining an energy balance consistently for weight maintenance.
The knowledge, attitude and practices of the children were assessed in the areas of nutrition, diet related diseases, physical activity and weight reduction. The difference was found to be significant between overweight and normal weight groups in all the three areas with normal weight having higher scores indicating better knowledge, right attitude and correct practices.
When the problems associated with overweight and obesity were assessed, overweight children were noted to have more problems associated with puberty like early menarche, problems with menstrual bleeding in girls while early/late voice change and appearance of facial hair and secondary sex characteristics were seen in boys. The health and physical problems, though not very prominent in both weight groups, the percentage of overweight children having health and physical problems were higher. Similarly, the psycho social and behavioural adjustment and academic problems in overweight children were significantly higher than normal weight children.
On assessment of the impact of diet counselling, a significant difference at 1 per cent level was observed in the before and after values of weight, BMI and body fat of overweight children. Overweight children who received diet counselling and health education showed significant reduction in weight, BMI and body fat when compared to that of control group.
The study revealed that family history of obesity, high financial status, and dietary factors like faulty dietary habits and excessive intake of energy dense foods along with increased sedentary life style and significant reduction in physical activity or energy expenditure form the major contributing factors towards the development of overweight and obesity. Overweight and obese children are also found to have significantly higher pubertal problems, health, physical, academic, psychosocial and behavioural adjustment problems than normal weight children. However the study proved that, with proper dietary and behavioural interventions along with constant help, support, encouragement and motivation from all the family members and health care professionals, overweight children can definitely regain and maintain their ideal body weights and lead a normal healthy way of life.
The control of this epidemic is a challenge and requires strong social and political will in addition to medical management. The results obtained suggest the intervening role of socio-economic and demographic environment, knowledge, attitude and food habits, life style pattern, work load and psychosocial adjustments on the dietary profile of overweight children. This prompts for further researches to improve the nutrition related knowledge of children and to inculcate the importance of leading a healthy life style which incorporate ample physical activity with decreased work load and tension. Urgent measures to improve the food habits of school going children are also recommended. Parents are the key players when developing interventional programmes in children. Therefore interventional programmes should be planned in such way that will create awareness in parents about the importance of weight reduction in leading a healthy life with lesser physical, psychosocial and health problems through proper diet and adequate physical activity.