INTRODUCTION:

“God gives us children for a time, to train them in his way love them and to show them how, to follow and obey. Our children are a gift from God, on loan from heaven above, to train and nourish in the Lord, and show to them his Love.”

Speer (1995)

Nutrition is the cornerstone of socio economic development and nutrition problems are not just problem, but are “multi factorial” with roots in many other sectors of rural development. The old concept that the health sector alone is responsible for all nutritional illness of the community has faced away. It is now realized that a broad intersectoral and integrated approach of sectors development is needed to tackle nutritional problem. World Health Organization (WHO) defines health as a state of complete physical, mental, social and spiritual well being, not merely an absence of any disease or infirmity.

The adverse effects of overweight include the likelihood of lifelong physical and emotional health problem as well as diminished quality of life. (Bungum and Jackson 2003)

Malnutrition is a man-made disease. It is a disease of human societies. It is pathological state resulting from a relative or absolute over nutrition or under nutrition. The basic cause of obesity is over nutrition. Obesity is an emerging major public health problem throughout the world and its prevalence has largely increased over the last decade in both developed and developing countries. This global epidemic is well described in the adult as well as children.

There is a general tendency among parents of obese children, to relate obesity with parental weight especially that of the mother. Many studies reveal that mother’s over weight and diet during the pregnancy has an influence in child’s obesity and often has a direct association between maternal and child weight.(Birch and Fisher 2000)

Obesity is a key risk factor in natural history of other chronic and non-communicable disease, the typical time sequence of emergency of chronic disease following the increased prevalence of obesity is important in public health planning. The first adverse effects of obesity are hypertension, hyperlipidemia and glucose intolerance, while coronary heart disease and long term complication of diabetes.

The number of overweight children in the United States is increasing and may be approaching epidemic status. In the 1999-2000 National Health and Nutrition Examination Survey data indicated that 15% of children and teens between 6 and 19 years were overweight. The prevalence of childhood obesity in the United States is estimated to be 25% to 30%. Although obesity occurs across gender, raceal, ethnic, and socio-economic lines. Obesity rates are higher among low-income youths and among African, American, Hispanic population groups. Increases in the number of overweight children and adolescence pose serious problems for society. Obesity is associated with numerous physical complications including type 2 with diabetes mellitus, coronary artery disease, pulmonary dysfunction, arthritis ischemic stroke, and some forms of cancer. (Binns and Ariza 2004)

Obesity is increasing among both children and adolescents in the United States. The obesity currently seen is not a result of metabolic disturbances, but of poor dietary habits and increasingly sedentary lifestyles. Childhood obesity often results in obesity in adulthood. The last two decades have revealed an increase in the overall portion size of foods. The largest portions for most foods are found at fast-food restaurants. However, portion sizes for desserts and hamburgers are the largest at home. (Nielsen and Poplcin, 2003)

Few problems in childhood and adolescence are so obvious to others, so difficult to treat and have such long-term effects on health as obesity. The Body Mass Index (BMI) measurement is strongly associated with subcutaneous and total body fat and also with skin fold thickness measurements. The Centre of disease control (CDC) standards available for tracking children’s body mass index from 2-20 years of age. Children with a BMI between the 85^th and 95^th percentiles are considered overweight, and obesity is defined by a BMI greater than the 95^th percentile.

In developing societies, being this has been equated with poor health and at bring high risk of developing illness. Weight gain after marriage and the presence of well-nourished children in some communities reflect positively on a man’s ability to be a good provider and the woman as a good mother. As developing societies industrialized and urbanized and as standards of living continue to rise, undue weight gain and obesity are now beginning to pose a growing threat to the health of citizens. Obesity has become a global epidemic and a prevalent problem event in developing countries including India, affecting both children and adults. This has now become a public health concern similar to under nutrition and infectious disease. It is a significant contributor to the health of people in developing countries. (Shelly,2000)

In India the problem of obesity has been scantily explored even in the affluent population groups. Despite the growing numbers of adolescent school girls and the overall increasing obesity over the year. Effective prevention of adult obesity will require the prevention and management of childhood obesity. WHO as also emphasized an urgent need of understanding the prevalence trend, factors contributing and developing strategies for effective intervention.

Children learn a lot from school environment and more from experience. Whether a child is a member of our family or not, it is our responsibility to help the child to grow in a healthy way. Today’s children are tomorrow’s citizens. Good health is everyone’s right. As parents, teachers and much more as caregiver, we have great priviledge and responsibility in bringing-up children with adequate knowledge and understanding.

NEED FOR THE STUDY:

Childhood obesity was considered a problem in affluent countries. Today the problem is started appearing even in developing countries. Globally the prevalence of childhood obesity varies from over 30% in USA to less than 2% in sub-saharan Africa. Currently prevalence of obese school children in 20% in UK and Australia, 15.8% in Saudi Arabia, 5.6% in Thailand, 10% in Japan and 7.8% in Iran.

The prevalence of obesity in children is difficult to ascertain. According to a survey conducted by Tershakevor and Weller, (2001) the prevalence of childhood obesity ranges from 10%-30% whereas in Herrandez Etal, (2000) stated that prevalence estimates range from 25%-30%.

According to the study out of 1496 children, 8 were obese. Prevalence of obesity was 5.74%. Prevalence of obesity was more in girls 8.82% than boys 4.42%. Prevalence of obesity is increased with an increase in ages in both boys and girls. Family history of obesity, snacking of high-energy foods and lack of physical activity were the important influencing factors of obesity.

A study found that increase in the prevalence of childhood obesity is also seen in developing countries. In Thailand obesity in children between 6-12 years old children is increased from 12.2% to 15.6% between 1991and 1996.

Several countries in the developing world show a prevalence rate of over 2% which include Brazil, Zautria, Venezuela and Peru. Other such as, Bolria, Iran have more than 4% prevalence. While Jamaica and China top in this last with a 10% or more prevalence rate of obesity in preschool child (0-4.99 yrs).

The prevalence of obesity in school children covering over 4000 students with similar anthropometric measurements. Of this subject studied, 22% were overweight and 6% are obese. Only 6% of these children had low birth weight. The prevalence of obesity is rising among the children because of this changes in lifestyle and nutritional education and associated complication.

According to this study, prevalence and trends in overweight and in three cross sectional studies among Indian children at department of public health science, Mumbai. It reports that the trends in overweight or obesity was increased from 5.4% to 9% in boys and 9.3-13.5% in girls.

Natural representative data for childhood obesity in India is unavailable, however available studies of Chennai and Delhi show the prevalence of 6.2% and 7.4% respectively. The factors causes for obesity are over eating less physical activity, watching television, etc.

The prevalence of overweight was 6.1% among boys and 8.2% among girls: (6% of males and 1% of females were obese respectively). The prevalence was significantly higher among adolescents who watched television and belong to high socio-economic background and lower among those participating regularly in outdoor games and households activities.

In addition if said prevalence of overweight was four times higher among the adolescents of higher socio economic status, 3 times higher in those not participating in outdoor games and 1.92 times higher in those watching TV, respectively. The prevalence of obesity and overweight amongst the study was 5.3% and 15.2% respectively. The prevalence of obesity in Australian girls aged 16-18 years to be 6%. The prevalence of Grade II and Grade III obesity to be 8.32% in females above the age of 15 years.

Child obesity is an emerging major public health problem throughout the world. The researcher has noticed with her clinical experiences some of the school children obese due to changes in food habits.

Clearly, something must be done now to assist the overweight children. Interventions designed to reduce or eliminate future generations of overweight children are needed as well as strategies to assist the overweight children of today.

Now government of Tamilnadu also undertaken a project related to child obesity in Sivagangai district to find out the prevalence and risk factors of childhood obesity. Hence, I decided to continue the project.

MATERIALS AND METHODS:

Research Design

A descriptive design was used to determine the prevalence of childhood obesity and its influencing factors among school children.

Setting of the study

The study was conducted in St.Justin Matriculation High school in Sivagangai, situated 20 km away from the Matha College of Nursing, Manamadurai. The total students strength of this school is 1200. The school comprises of various section from L.K.G–10^th Standard. There is a separate classroom for each section. 7 – 10 standard have 8 sections. Each section consisted of 40 students and above. Totally there are 400 students.

Population

The population of this study was the students who were between the age group of 12-15 years.

Sample and sample size

Sample consisted of 200 school children in the age group between 12-15 years, to determine the prevalence of childhood obesity from that selected 50 obese children based on BMI calculation to identify the influencing factors for childhood obesity who are studying in St. Justin Matriculation High school, Sivagangai District.

Sampling technique

In this study 200 school children were selected by random sampling technique and BMI was worked out for all the selected 200 children and 50 school children were selected as sample based on BMI > 25.

Description of the tool

The tool consist of 3 division

Tool I: Deals with Demographic Data of school going children such as age, sex, parents education, parents occupation, family type, family income and Religion.

Tool II: Formula for calculating the Body mass Index or Qutelet’s Index

BMI = Weight (Kg)

Height (M²)

Tool III: Rating scale for assessing the influencing factors.

It consist of four sections, those are; Section I – Dietary pattern; Section II – Physical activity; Section III – Sleep pattern; Section IV – Pattern of watching TV.

Scoring procedure

Tool II

Prevalence classified as

Interpretation of Body mass Index (or) Qutelet’s Index is calculated by a formula given by WHO

BMI = Weight (Kg)

Height(M²)

Interpretation of BMI

Weight Status	BMI Range
Over weight	25 – 29.9
Obese	30-39.9
Severely obese	>40

Tool III:

Tool III consist of four sections such as, dietary pattern, physical activity, sleep pattern and pattern of watching T.V. Each section carries different score which is stated below in detailed. 5 point Rating Scale type 44 questions were prepared by the investigator on the influencing factors of childhood obesity. The questions were The maximum score of question is 4 and minimum score is 0.

Plan for data analysis

Data was collected, tabulated and analysed by using statistical methods with numbers, percentages, Karl Pearson’s correlation ‘r’, multiple regression and analysis of Chi- Square.

S. No

Data analysis

Methods

Remarks

Descriptive statistics

· Frequency

· Percentages

Used for the distribution of sample characteristics.

Inferential statistics

Karl Pearson’s ‘ r’

Multiple regression

Chi Square

Used to find out the relationship between the prevalence and influencing factors.

Used to determine the effectiveness of influencing factors, influencing the prevalence of childhood obesity.

Used to find out the association between the prevalence and demographic variables.

Used to find out the association between the influencing factors and demographic variables

DATA ANALYSIS:

Table I shows that regarding age of the children 9 (18%) were 12 years, 10 (20%) were 13 years, 16 (32%) were 14 years and 15 (30%) were 15 years. Regarding sex 16 (32%) were males and 34 (68%) were females. Regarding family type 3 (64%) were Nuclear family, 18 (36%) were joint family. Regarding family income 8 (16%) were below 5000, 23 (46%) were 5000 – 10000, 19 (38%) were above 10,000. Parents education revealed that 28 (36%) were below graduate, 22 (44%) were above graduate. Regarding parent’s occupation 7 (14%) were labourer, 28 (56%) were private, 15 (30%) were Government. Regarding religion 23 (46%) were Hindu, 12 (24%) were Muslim and 15 (30%) were Christian.

Table 1: Frequency distribution and percentage of samples according to the demographic variables. N = 50

S. No	Demographic variables	Frequency	Percentage
1.	Age
	12 years	9	18%
	13 years	10	20%
	14 years	16	32%
	15 years	15	30%
2.	Sex
	Male	16	32%
	Female	34	68%
3.	Family Income
	Below 5000	8	16%
	5000 – 10000	23	46%
	Above 10000	19	38%
4.	Family type
	Nuclear	32	64%
	Joint	18	36%
5.	Parents Education
	Below Graduate	28	56%
	Above graduate	22	44%
6.	Parent’s occupation
	Labourer	7	14%
	Private officer	28	56%
	Government officer	15	30%
7.	Religion
	Hindu	23	46%
	Muslim	12	24%
	Christian	15	30%

Table II : Frequency distribution and percentage of prevalence of childhood obesity among school children

N = 50

S. No	Prevalence	Frequency	Percentage
1.	Overweight	43	86%
2.	Obese	7	14%
3.	Severely Obese	-	-

Table II shows that prevalence of childhood obesity among school children in that 43 (86%) children were overweight, 7 (14%) children were obese and there is no prevalence of severely obese.

Percentage distribution of Prevalence of Childhood obesity

Table III : Frequency distribution and percentage of samples according to level of influencing factors which leads to childhood obesity. N = 50

S. No	Influencing Factors	Mild Influencing		Moderate influencing		Severe influencing
S. No	Influencing Factors	F	P	F	P	F	P
1.	Dietary pattern	14	28%	29	58%	7	14%
2.	Physical activity	9	18%	20	40%	21	42%
3.	Sleep pattern	22	44%	18	36%	10	20%
4.	Pattern of watching T.V	16	32%	23	46%	11	22%

Table III shows the influencing factors of childhood obesity, in that Dietary pattern 14 (28%) were mild influencing, 29 (58%) were moderate influencing and 7 (14%) severe influencing. Regarding physical activity 9 (18%) were Mild influencing 20 (40%) were moderate influencing and 21 (42%) were severe influencing. Sleep pattern revealed that 22 (44%) were Mild influencing, 18 (36%) were moderate influencing and 10 (20%) were severe influencing. Regarding pattern of watching T.V, 16 (32%) were mild influencing, 23 (46%) were moderate influencing and 11 (22%) were severe influencing.

Percentage distribution of samples according to their levels of Influencing factors

Table IV : Multiple regression Analysis of prevalence of childhood obesity on influencing factors. N = 50

S.No	Influencing factors (Variables)	Coefficient	Multiple Correlation ®	R²
1	Dietary pattern	0.07 ^**	0.48 ^*	0.23*
2	Physical Activity	0.07 ^NS
3	Sleep Pattern	0.06 ^NS
4.	Pattern of Watching T.V	- 0.05 ^NS

** : Significant at 1% level

* : Significant at 5% level

NS : No Significant

The data presented in the table IV, shows that the multiple regression analysis of prevalence of childhood obesity on influencing factors.

The regression co-efficient of the independent variables were 0.07, 0.07, 0.03 and - 0.05 respectively. It indicates that 1% increase in X₁ will cause 0.07% increase in Y and also significant

R² = 0.23^* it indicates that the contribution of the independent variables (X₁, X₂, X₃) is 23% and also significant.

Y = 21.48 + (0.07 X₁ + 0.07 X₂+ 0.06 X₃ – 0.05 X₄

Hence, the dietary pattern is effectively influencing the prevalence of childhood obesity than other factors.

Table V : Relationship between the prevalence and influencing factors of childhood obesity N = 50

S.No	Prevalence of childhood obesity Vs Influencing factors	Co-efficient correlation ‘r’	Significantly value
1.	Prevalence of childhood obesity vs Dietary pattern	0.41	3.124^**
2.	Prevalence of childhood obesity vs Physical activity	0.2	1.414^NS
3.	Prevalence of childhood obesity vs sleep pattern	0.29	2.113^*
4.	Prevalence of childhood obesity vs pattern of watching T.V	0.12	0.84^NS

** : Significant at 0.01 level

* : Significant at 0.05 level

NS : No Significant

To find out the relationship between prevalence and influencing factors co-efficient correlation was used. The computed ‘r’ value is 0.41 for dietary pattern, 0.2 for physical activity, 0.29 for sleep pattern and 0.12 for pattern of watching TV. The positive correlation was found between prevalence and influencing factors. Hence it was interpreted that children who had obese they are influenced by certain factors.

The aim of present study was to determine the prevalence of childhood obesity and it’s influencing factors among school children at St.Justin Matriculation High School, Sivagangai. The sample size was 50.

RESULTS CONCLUSION:

Major findings of the study

Sample characteristics:

· Totally 18% were 12 years of age, 20% were 13 years of age, 32% were 14 years of age and 30% were 15 years of age.

· Regarding gender 32% were male; 68% were female.

· Regarding family income 16% were come under below 5000, 46% were come under 5000 – 10000 and 38% were come under above 10000.

· In family type 64% were belonged to the nuclear family and 36% were belonged to Joint family.

· Regarding parents education (56%) children’s parents were below graduate, (44%) were above graduate.

· In parents occupation (14%) children’s parents were labourers (56%) were private officer and 30% were government officer.

· Regarding religion 46% were Hindus, 24% were muslims and 30% were Christians.

Prevalence of childhood obesity:

Regarding prevalence 86% were overweight and 114% were obese. (0%) were severe obese.

Influencing Factors (Level)

· Dietary pattern is influencing (28%) mildly, 58% moderately and 14% severely.

· Physical activity is influencing 18% mildly 40% moderately 42% severely.

· Sleep pattern 44% mildly, 36% moderately, 20% severely.

· Pattern of watching T.V. is influencing 32% mildly, 46% moderately and 22% severely.

Effectiveness

The dietary pattern more effectively influences the prevalence of childhood obesity than other factors such as, physical activity, sleep pattern, pattern of watching T.V.

Relationship

There was a positive correlation between the prevalence and influencing factors of childhood obesity.

Association

There was a significant association between the prevalence of childhood obesity and age.

· There was a significant association between the Dietary pattern and religion.

· There was a significant association between the physical activity and sex.

· There was a significant association between the sleep pattern and sex.

· There was a significant association between the pattern of watching TV and sex.

NURSING IMPLICATION:

The findings of the study have implication to nursing practice, nursing education, nursing administration and nursing research.

Implication for nursing practice

It is known fact that lack of knowledge about childhood obesity often leads to some health problems among childrens.

The findings would help the nurses in planning, organizing, implementing the measures to reduce the childhood obesity.

Nurse can query parents on how their individual perception is about childhood obesity.

Nurses can prepare teaching modules and learning materials for the parents to handle the children with childhood obesity.

In the light of study findings, measures and interventions to minimize the prevalence of childhood obesity is prepared by the investigation for use of nurse and other health team members in pediatric field.

Implication for nursing education

Findings of the study have some implications for nursing education too.

« Nurse educators can encourage students to conduct health educational program and exhibition to school children.

« Nurse educators can encourage creative instinct of students nurse to prepare pamphlets on various aspects of healthy habits.

Findings of the study can be used for updating the knowledge of nursing personnel. It would provide a broad frame work in which further research can be conducted.

Implication for nursing administration

« Nurse administrator can disseminate the research knowledge into practice, so that school children can be benefited.

« Nurse administrator can conduct seminars on life style practice of school children.

« Nurse administer can use Mass media to create awareness of needs and problems of the destitute children.

« Nurse administrator can encourage peripheral nurse to conduct health visit regularly for school children.

Implication for nursing research

« Extensive research can be conducted to find out the health problems of obese children.

« The study can be a base line for future studies to build up.

« Nursing research contributes professional development of child health nurse.

CONCLUSION:

Based on the results, the investigator felt that there is a need for good childhood care to prevent the occurrence of childhood obesity. Interactive method of teaching that is question and answer with instructional module is an effective method of increasing the knowledge of the children regarding control to intake of fried food items, way of increase the physical activity, reduce a time of watching T.V. and control the intake of snacks while watching T.V. This will be helpful to prevent the prevalence and risk factors of childhood obesity.

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Received on 15.05.2014 Modified on 04.06.2014

Asian J. Nur. Edu. and Research 4(4): Oct.- Dec., 2014; Page 481-488