INTRODUCTION:

"Stress is not what happens to us. It's our response to what happens. And RESPONSE is something we can choose."

Anonymous

In medical terms stress is described as, "a physical or psychological stimulus that can produce mental tension or physiological reactions that may lead to illness". But there is not always necessary to say that stress in harmful as Hans Selye says, "stress is not necessarily something bad – it all depends on how person take it. The stress of exhilarating, creative successful work is beneficial, while that of failure, humiliation or infection is detrimental." Stress can be therefore negative, positive or neutral.¹

All human beings experience stress at one time or another. Without stress, there would be no life. However, excessive or prolonged stress can be harmful. Stress is unique and personal. Whenever body feels something not favorable, then it tries to defend itself. If this situation continues for a long time, then the body is working overtime.¹

Stress may be caused by a number of factors namely, stress at home, work and other. Causes of stress at work are to meet out the demands of the job, relationship with colleagues, to control staff, to train staff and take work from them, support from boss, colleagues and juniors, excessive work pressure to meet out deadlines etc³

“Eat breakfast like a king, Lunch like an ordinary person

And your dinner like a beggar”

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Body mass index (BMI), a measurement which compares weight and height, defines people as overweight (pre-obese) if their BMI is between 25 kg/m² and 30 kg/m², and obese when it is greater than 30 kg/m².⁵

Overweight and obesity lead to serious health consequences. Risk increases progressively as BMI increases. Raised body mass index is a major risk factor for chronic diseases such as: Cardiovascular disease, Musculoskeletal disorders especially osteoarthritis and some cancers like endometrial, breast, and colon.⁶

Several physical factors and emotional factors contribute to weight gain and obesity. The body becomes stressed due to fatigue, which causes levels of the hormone cortisol to be released at higher levels than normal. Elevated levels of cortisol encourage overeating, which leads to weight gain. Lack of sleep leads to decreased immune system function, which leads to more frequent illness where the body uses more energy than normal to heal itself. This further depletes energy and contributes to fatigue and stress (Fig.1). ⁷

Need for the study:

Stress Syndrome (SS) is a state of emotional strain often brought on by overwork, prolonged study, emotional pressure, or a host of other physiological or psychological factors. The connection between stress and disease is a topic that is researched extensively in the scientific literature. The human body is designed to handle temporary spikes of physical and emotional stress, but how much, in what degree and for what length of time it may affect human health varies from one person to another. ⁸

Evidence also suggests that stress is the major cause of turnover in organizations. With continued stress at the workplace, workers will develop psychological and physiological dysfunctions and decreased motivation in excelling in their position. ⁹

On the basis of research by the National Institute for Occupational Safety and Health and many other organizations, it is widely believed that job stress increases the risk for development of back and upper-extremity musculoskeletal disorders. High levels of stress are associated with substantial increases in health service utilization. Workers who report experiencing stress at work also show excessive health care utilization.⁸

Stress is very expensive and dangerous: it is recognized as the number one proxy killer disease today. The American Medical Association has noted that stress was the basic cause of more than 60% of all human illness and disease. Every week, 95 million Americans suffer some kind of stress related symptoms for which they take medication. ⁸

Before the 20th century, obesity was rare; in 1997 the WHO formally recognized obesity as a global epidemic. As of 2005 the WHO estimates that at least 400 million adults (9.8%) are obese, with higher rates among women than men. The rate of obesity also increases with age at least up to 50 or 60 years old and severe obesity in the United States, Australia, and Canada is increasing faster than the overall rate of obesity. ⁹

WHO latest projections indicate that globally in 2005: approximately 1.6 billion adults (age 15+) were overweight; at least 400 million adults were obese. At least 20 million children under the age of 5 years are overweight and also projects that by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese. ¹⁰

In India Obesity has reached epidemic proportions in the 21^st century, with morbid obesity affecting 5% of the country's population and the influence of other developing countries lifestyle. With considering to the data given by National Family Health Survey (NFHS, 2009), obesity is very common among both females and males. As per the data Punjab holds the first place in percentage of obesity i.e. 30.3% males and 37.5% females are obese. Similarly states like Kerala, Goa, Tamil Nadu, Andhra Pradesh and Maharashtra holds the 2, 3, 4, 5 and 9 ranks respectively. It is also important to notice that Karnataka state holds 9^th and 12^th rank among females and males in obesity respectively. ¹⁰

Statement of the problem:

“A correlative study on stress, obesity and other selected health problems among professionals in Belgaum city, Karnataka.”

Objectives of the study:

1. To assess the level of stress among professionals as measured by David Fontana’s Professional Life Stress Scale.

2. To assess the obesity and other selected health problems among professionals.

3. To correlate the stress, obesity and other selected health problems among professionals.

4. To find out the association between the level of stress, obesity and other selected health problems with selected demographic variables of professionals.

Operational definitions:

1. Stress: In this study stress refers to a physical, mental, or emotional response to events that causes bodily or mental tension.

2. Obesity: In this study obesity refers to a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems which is measured by BMI.

3. Selected health problems: In this study selected health problems refers to an abnormal or physiologically unbalanced state of the body or Impairment of normal physiological function affecting part or any system which includes sleep problems, hypertension, diabetes mellitus and heart related problems.

4. Professionals: In this study professional refers to a person who has obtained a degree in a professional field of nursing, banking, teaching and pharmacy and working under any settings of same profession.

· Nursing: Who completed B.Sc Nursing or M.Sc Nursing or higher qualification in nursing field with due registration in the council.

· Banking: Who completed Basic degree or above and undergone training to work in bank sector.

· Teaching: Who completed B.Ed or M.Ed or with higher qualification.

· Pharmacy: Who completed B.Pharmacy or above with license to practice.

Assumption:

The researcher assume that

1. Obesity is more common in all age groups and due to changing patterns of life styles and a leading cause for health problems.

2. Stress may cause obesity and vice versa.

3. Stress may also leads to life threatening health problems.

4. Stress is commonly seen in the professionals because of work load and sedentary life style.

Delimitation:

1. The sample size is limited to 300 professionals.

· Nusing professionals : 75

· Banking professionals : 75

· Teaching professionals : 75

· Pharmacy professionals : 75

2. Prescribed data collection is only 4-6 weeks.

3. Study design is limited to non experimental design.

REVIEW OF LITERATURE;

A study was conducted on overweight, obesity and influence of stress on body weight among undergraduate medical students at Midnapore Medical College. A total of 114 medical students (70 male and 44 female) were included in this study. The completed form was analyzed to obtain Perceived Stress Score Index (PSSI). Results shown that out of 114 students, 70 were male and 44 were female (M: F = 1.6:1) Out of 70 male students, 11 were overweight and four were obese whereas out of 44 female students, 9 were found to be overweight and none were obese. An overall prevalence of overweight was calculated to be 17.5%, prevalence of obesity was 3.4%. The study suggests that regular exercise and taking care of stress precipitating factors could improve the health of the medical students.¹¹

A study was under taken to assess the interaction of sleep quality and psychosocial stress on obesity among residents of metropolitan Atlanta in African Americans (AA). A sample of 1,515 AA, aged 30-65 years, was recruited by a random digit-dialing method in 2007-08. Among women, after multivariable adjustment that included age, gender, physical activity, smoking status, education, total family income, financial stress and history of hypertension, hypercholesterolemia, diabetes and myocardial infarction, obesity was associated with sleep quality as assessed by general sleep quality (GSQ). Among all participants, stress modified the association between obesity and sleep quality; there was an increased likelihood of obesity in the medium stress category, OR (95% C.I.): 1.09 (1.02 - 1.17). They concluded that Sleep quality was associated with obesity in women. ¹²

METHODOLOGY:

Research approach and Research design:

A Non-Experimental Design and Correlative approach was used in the study.

Setting:

The study was conducted in the Belgaum city where the subjects working under different organizations, institutions and hospitals

Population:

The population of the study was professionals of nursing, banking, teaching and pharmacy.

Independent Variable:

In this study the independent variables are age, sex, and area of residence, religion, educational, profession, working organization, and monthly income, and family type, pattern of diet, professional experience and habits.

Dependent Variable:

Dependent variables in this study are Level of Stress, Obesity and Selected Health Problems among professionals.

Sample and Sampling Size:

300 professionals were selected from various professionals like: Nursing – 75, Banking – 75, Teaching – 75 and Pharmacy – 75 who fulfill the inclusion criteria.

Sampling Technique :

In this study non-probabilty, purposive and Snow-ball sampling technique was used.

Description of the Tool:

The tools were divided into three parts,

Part A: Demographic data consists of 14 items.

Part B: David Fontana’s Professional Life Stress Scale to assess the level of Stress.

Part C: Structured questionnaire to assess the other health problems such as sleep problems, hypertension, and diabetes mellitus and heart related problems which consists of 34 items

Ethical clearance:

Ethical clearance was obtained.

Reliability:

· Reliability was established from data of 30 samples by split half method.

· The reliability was found by using Karl Pearson correlation co-efficient

· The ‘r’ value for The Professional Life Stress Scale was found reliable (r =0.77)

· The ‘r’ value of Structured Questionnaire to assess the other selected health problems was also found reliable (r = 0.79).

· Hence the tool was highly reliable.

RESULTS:

Major findings of the study:

With regard to their age majority (47.7%) of the professionals (Fig 3) were between 25-30 years(Fig 3). Considering the sex of professionals majority (60.3%) were a males. Considering their areas of residence majority (71.3%) of the professionals were belongs to urban area and majority (63%) of the samples belongs to Hindu religion. Regarding the educational status majority (73.7%) of the professionals was graduates and from each profession (Nursing, Banking, Teaching and Pharmacy) (Fig 4) equal number 75 (25%) of samples have been selected for the study. While considering their working organization majority (45.6%) of the professionals were belongs private organization (Fig 5). Considering the monthly income majority (40.3%) was between Rs. 5,001 – 10,000 per month and majority of the samples (56.3%) were from nuclear family.

Considering the occupation of family members’ majority (63%) was employed and their monthly family income was 30.3% between Rs. 10,001 – 15,000 (Fig 6). With regards to pattern of diet of professionals majority (56%) were vegetarian (Fig 7). Majority of the professionals (52.4%) were having the experience of < 5 years at work. Considering the habits majority (94%) of the professionals had habits.

Fig. 4: Percentage Distribution of Profession of Professionals

Table 1. Mean and Standard Deviation of Level of Stress among the Professionals (overall), level of obesity and health problems. (N=300)

Statistics	Stress Score	Level of Obesity	Health Problems
Mean score	23.86	23.18	74.73
Standard deviation	6.24	3.13	20.15

Above table shows that the professionals had a mean score of 23.86 with standard deviation 6.24, the professionals had a mean BMI of 23.18 with standard deviation of 3.13 and mean score (74.73) and standard deviation (20.15) of Selected Health Problems among Professionals.

Assessment of level of stress among professionals:

Table 2. Distribution of Level of Stress among Professionals (overall)

(N=300)

Sl. No.	Category	Score	Frequency	Percentage
1.	No stress	0 – 15	38	12.7
2.	Mild	16 – 30	229	76.3
3.	Moderate	31 – 45	33	11
4.	Severe	46 – 60	0	0

Table 2 describes that 229(76.3%) professionals were having mild level of stress and 33(11%) of them had moderate level of stress. (Fig. 8)

Table 3. Distribution of Level of Stress among Professionals (category wise)

(N=300)

Sl. No.	Category	Score	Frequency	Percentage
NURSING (N = 75)
1.	No stress	0 – 15	9	12
2.	Mild	16 – 30	56	74.7
3.	Moderate	31 – 45	10	13.3
4.	Severe	46 – 60	0	0
BANKING (N=75)
1.	No stress	0 – 15	13	17.3
2.	Mild	16 – 30	56	74.7
3.	Moderate	31 – 45	6	8
4.	Severe	46 – 60	0	0
TEACHING (N=75)
1.	No stress	0 – 15	5	6.7
2.	Mild	16 – 30	65	86.6
3.	Moderate	31 – 45	5	6.7
4.	Severe	46 – 60	0	0
PHARMACY (N=75)
1.	No stress	0 – 15	11	14.7
2.	Mild	16 – 30	52	69.3
3.	Moderate	31 – 45	12	16
4.	Severe	46 – 60	0	0

Fig 9: Percentage Distribution of Level of Stress among of Professionals (category wise)

Assessment of Obesity among Professionals.

Table 5: Distribution of Obesity among Professionals (overall) (N=300)

Sl. No.	Category	Score	Frequency	Percentage
1.	Normal	18.5 – 25	211	70.3
2.	Over Weight	25.1 – 30	87	29
3.	Obese	> 30.1	2	0.7

Table 5 shows the assessment of obesity and its percentage. Majority of professionals are having normal (70.3%) BMI, 29% are overweight and have a risk of becoming obese and 0.7% are obese. (Fig. 10)

Fig.10 : Percentage Distribution of Obesity among Professionals (overall)

Table 6: Distribution of Obesity among Professionals (category wise).

(N=300)

Sl. No.	Category	Score	Frequency	Percentage
NURSING (N = 75)
1.	Normal	18.5 – 25	69		92
2.	Over Weight	25.1 – 30	4		5.3
3.	Obese	> 30.1	2		2.7
BANKING (N=75)
1.	Normal	18.5 – 25	45	60
2.	Over Weight	25.1 – 30	30	40
3.	Obese	> 30.1	0	0
TEACHING (N=75)
1.	Normal	18.5 – 25	57	76
2.	Over Weight	25.1 – 30	18	24
3.	Obese	> 30.1	0	0
PHARMACY (N=75)
1.	Normal	18.5 – 25	40	53.3
2.	Over Weight	25.1 – 30	35	46.7
3.	Obese	> 30.1	0	0

Fig 11: Percentage Distribution of Obesity among of Professionals (category wise)

Assessment of Selected Health Problems among Professionals.

Table 7: Distribution of Selected Health Problems among Professionals (overall) (N=300)

Sl. No.	Category	Score	Frequency	Percentage
1.	Normal	0 – 40	0	0
2.	Mild	41 – 80	189	63
3.	Moderate	81 – 120	111	37
4.	Severe	121 - 160	0	0

Table 7 describes that 189(60%) professionals were having mild degree of selected health problems and 111(37%) had moderate degree of selected health problems. (Fig.22)

Fig.12 : Percentage Distribution of Selected Health Problems among Professionals (overall)

Table 8: Distribution of Selected Health Problems among Professionals (category wise)

(N=300)

Sl. No.	Category	Score	Frequency		Percentage
NURSING (N= 75)
1.	Normal	0 – 40		0	0
2.	Mild	41 – 80		59	78.7
3.	Moderate	81 – 120		16	21.3
4.	Severe	121 – 160		0	0
BANKING (N=75)
1.	Normal	0 – 40		0	0
2.	Mild	41 – 80		46	61
3.	Moderate	81 – 120		29	39
4.	Severe	121 – 160		0	0
TEACHING (N=75)
1.	Normal	0 – 40		0	0
2.	Mild	41 – 80		44	58.7
3.	Moderate	81 – 120		31	41.3
4.	Severe	121 – 160		0	0
PHARMACY (N=75)
1.	Normal	0 – 40		0	0
2.	Mild	41 – 80		40	53.3
3.	Moderate	81 – 120		35	46.7
4.	Severe	121 – 160		0	0

Fig 13: Percentage Distribution of Selected Health Problems among Professionals (category wise)

Table 9: An Overall Comparison of Mean Score of Stress, Obesity and Selected Health Problems among Professionals (Category wise) (N=300)

Category	Stress	obesity	Selected Health Problems
Nursing	24.4	21.72	70.23
Banking	22.69	24.32	72.59
Teaching	23.98	22.6	78.7
Pharmacy	24.36	24.07	77.39

Table 9 denotes that professionals of teaching and pharmacy have equal stress score and slightly higher than nursing and banking professionals. Obesity score of banking and pharmacy professionals are higher than nurses and teachers. Selected health problems are more among teaching and pharmacy professionals comparing to nursing professionals. (Fig.14)

Correlation between Level of Stress, Obesity and Selected Health Problems among Professionals:

Table 10: Correlation co-efficient between level of stress, obesity and selected health problems

(N=300)

Variables	Level of stress (r)	Level of obesity (r)	Selected health problems (r)
Level of stress	1	-0.026	0.5495***
Level of obesity	-0.026	1	0.026
Selected health problems	0.5495***	0.026	1

*** Indicates highly significant at p<0.001

Table 10 denotes that there is a positive correlation between level of stress and selected health problems (r= 0.5495). There is a very low positive correlation between level of obesity and selected health problems (r= 0.026) and there is a negative correlation between level of stress and obesity (r= -0.026).

Diagram showing the Correlation of Stress and Health Problems

ociation between the Level of Stress and Selected Demographic Variables of Professionals:

There is no association between level of stress and demographic variables such as age, sex, area of residence, religion, education, profession, working organization and occupation of family members. But monthly income, type of family, occupation of family members, monthly family income, pattern of diet, years of experience at work and habits has significant association with level of stress.

Association between the Obesity and Selected Demographic Variables of Professionals:

There is no association between obesity and demographic variables such as area of residence, religion, working organization, monthly income, type of family, occupation of family members, monthly family income, pattern of diet and habits. But age, sex, education, profession and years of experience at work has significant association with obesity.

Association between the Selected Health Problems and Selected Demographic Variables of Professionals:

There is no association between selected health problems and demographic variables such as age, sex, area of residence, religion, education, profession, working organization, type of family, occupation of family members, monthly family income, years of experience at work, pattern of diet and habits. But monthly income has significant association with selected health problems.

Implications for Nursing Education:

The present study emphasizes on stress, obesity and health problems among professionals, which encourage the health team member to educate and guide the professionals, seek appropriate health care. In order to achieve this, the Diploma, Degree & Master Degree curriculum should include topics on stress, obesity and health problems, its affects on day today routine of an individual in a daily life.

The student nurses from School of Nursing and College of Nursing should be encouraged to attend specialized courses and seminars regarding stress, obesity and health problems, and its affects on physical, psychological and social life of an individual.

Nursing schools, colleges and teachers should come forward and encourage the students to provide information on stress, obesity and health problems with the help of audio visual aids.

Implications for Nursing Practice:

Nurses are key persons in the health care team, they play a major role in health promotion and maintenance in the clinical as well as in community setup; it is a practicing profession, hence, the researchers generally integrate findings into practice.

Nurses can provide information about the stress, obesity and health problems, its causes, effect of yoga and exercise on stress, obesity and health problems and treatment modalities available and help them to cope with the condition which will help in improvement of knowledge for both nurses and professionals in hospital and in community area.

Implications for Nursing Administration:

The study assists the nursing administrative authorities to initiate and carry out health education program in health care settings which includes clinical and community by utilizing advanced technologies.

Professional interaction between the nurses and the public will help to improve professional standards and creates better image in the community.

· Teaching program can be given to hospital people using various channels of communication regarding stress, obesity and health problems and how they are interrelated.

· Specialized teaching package in specific topic create interest among public and serves as reference material.

Implications for Nursing Research:

· The study helps the investigator to develop insight regarding stress, obesity and health problems among professionals.

· This study will serve as a valuable reference material for future investigators.

· In-depth research studies can be conducted by including all the three domains i.e. knowledge, attitude and practice.

RECOMMENDATIONS

· A similar study can be under taken on large scale.

· A comparative study may be conducted among different professionals.

· An experimental study may be conducted on effect of yoga, exercise on reducing stress, obesity and health problems.

· A descriptive study may be conducted on knowledge on life style modifications to reduce stress, obesity and its related health problems.

CONCLUSIONS OF STUDY:

On the basis of the findings, the investigator concluded that the professionals will have mild level of stress and selected health problems

REFERENCES:

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3. Basavantappa B T. Psychology for nurses. Jaypee Brothers Medical Publication private limited, New Delhi. 2010.

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6. David Gutierrez, staff writer. Work stress found to promote obesity. American Journal of Epidemiology. 07; 2007.

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8. Elizabeth Scott, M.S. Stress and Health: How It Affects Your Body and How You Can Stay Healthier. Medical Review Board. 2009.

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Received on 27.02.2013 Modified on 22.04.2013

Asian J. Nur. Edu. and Research 3(3): July-Sept., 2013; Page 154-163