INTRODUCTION:

Childhood obesity is a major emerging public health issue in developing countries, whereas it has reached epidemic proportions in industrialized nations (Freedman et al., 2001). In Indian children, overweight and obesity are common among middle- and low-income groups; however, in the developed nations, a higher prevalence of childhood obesity can be seen in the low socioeconomic group (Fezeu et al., 2006; Goyal et al., 2010; WHO Report, 2003). Moreover, there is an increasing trend in the prevalence of obesity among both adults and children throughout India with certain urban and rural differences (Reddy et al., 2002).

MAGNITUDE OF THE PROBLEM

Studies conducted in Chennai, among school children aged below 15 years have shown the increasing prevalence of obesity, from 6.8% in 1998 (Subramanyam et al., 2003) to 12% in 2009 (Shabana and Vijay, 2009). These studies have also reported that the prevalence was higher in the schools catering to children from affluent families compared to those from poor economic status, and overweight was more common among girls than boys (Ramachandran et al., 2002).

Economic growth has made developing countries such as India more prone to lifestyle disorders (Asian Development Bank, 2010). This is due to physical inactivity and intake of calorie dense food associated with urbanization, rural-to urban migration and mechanization, finally resulting in obesity (Allender et al., 2010; Ebrahim et al., 2010). This has resulted in nutrition transition, which in turn contributes to the prevailing increasing trend in childhood obesity. A study from India reported that awareness levels about childhood obesity among school children are generally poor (Shabana and Vijay, 2009). Increasing trends in obesity seen among urban Indian children combined with the poor awareness levels have led to initiation of many interventional strategies throughout the country. The WHO has emphasized on promotion of healthy behaviors such as eating right and involving in regular physical activity as a strategy for the primary prevention of non-communicable diseases (WHO Technical Report Series, 2010). Hence, a concerted effort from policy makers and food industry will be an effective intervention; yet educating the high risk group on this major public health issue can influence the attitude and physiologic and social behavior of people, particularly in India. In view of these and obesity being a modifiable risk factor, an awareness programme is being conducted in the Central Board of Secondary Education (CBSE), schools in Chennai for prevention of childhood obesity.

OBJECTIVES OF THE STUDY:

1.To create awareness on the prevention of childhood obesity among school children.

2. To sensitize the school administration, teachers and parents on childhood obesity.

3.To evaluate the effectiveness of ESI on prevention of childhood obesity among school children.

MATERIAL AND METHODS:

An awareness programme on “Prevention of childhood obesity” was conducted in five CBSE schools in Chennai and 2,476 students in the age group of 9–13 years belonging to the high-income group participated in this programme.ESI consisted of educational programme emphasizing the benefits of consumption of balanced diet and enhancing physical activity to maintain an ideal BMI, in a simple language with pictorial representations using PowerPoint presentation. It also included the benefits of certain habits like nutritional label reading in this programme. Pre-experimental research design was chosen and the Educative Supportive Intervention on prevention of childhood obesity was administered to 25 students of fifth grade in each school and a subsample of 125 children in the age group of 9 to 10 years were included for pre- and post-test evaluation. Fifth grade children were selected for evaluation to maintain uniformity in the age group for knowledge assessment and also because it is the ideal age to inculcate awareness on issues such as healthy eating and lifestyle behavior. BMI was calculated using the formula weight in kilograms divided by squared height in meters. The researcher plotted the BMI in age-gender-specific WHO charts and categorized the children with BMI between 85^th and 95^th percentiles as overweight and more than 95^th percentile as obese (WHO Growth Reference Chart, 2007).

RESULTS:

Out of 125 selected children, there were 54 boys and 71 girls in the study. The findings show that there was no significant difference in the mean age of boys and girls. The mean BMI between boys and girls remained similar (17.6±4.1 vs 17.5±3.3; p=0.812). The overall prevalence rates of overweight and obesity in the study subjects were 14.9% and 17.2%, respectively. The obesity rate was higher among boys than that of overweight (Overweight vs. obesity; 13.9% vs. 22.2%). The mean pre-test scores for girls in the three domains remained higher than boys but the difference was not statistically significant. However, on considering the overall pre-test score, the awareness levels were higher among girls compared to boys and it was statistically significant (p=0.029). The mean score of the post-test in each domain of the questionnaire was significantly higher than the pre-test scores secured by all the children (p<0.001). The results of the study emphasized that there was a significant increase in the knowledge levels of the children after attending the ESI on prevention of childhood obesity(Fig- 1).

Fig-1: Pre-test and Post-test scores of study subjects in different nutritional grades

DISCUSSION:

The results of the present study have highlighted that knowledge regarding the hazards of obesity was generally low prior to the ESI. The higher pre-test score among the obese group showed that the children were probably aware of this issue only after developing the problem. There was a significant increase in the awareness levels of the children regarding obesity after attending the ESI. Similarly, a recent study reported a 4% reduction in BMI in students of 6^th to 8^th grades due to national-level awareness creation on childhood obesity (Kaufman et al., 2011). Consistent with these findings, the ESI also had increased the awareness levels of children on the prevention of childhood obesity. Empowering the high-risk group with adequate knowledge and sustained motivation to adopt a healthy lifestyle is effective and can result in weight reduction. Hence, creating mass awareness on prevention of obesity at the community level could be possible through such programmes, which is one of the components of intervention strategies, the other component being involvement of stakeholders in implementing regulatory approaches in food industries, which could modify the prevailing obeso-genic environment in India. These might include leverage of additional taxes on fats and sweets that may indirectly encourage children to consume more of fruits and vegetables and conventional foods. Modelled estimates have shown that a considerable reduction in the prevalence of childhood obesity could be achieved by restricting advertisements on high-calorie and unhealthy food (Veerman et al., 2009; Haby et al., 2006). Since children are the targeted group by the food-related advertisements, they must be sensitized and made aware of this issue through such mass educational programmes as the present one, especially in countries like India.

CONCLUSION:

This research study revealed that there was a significant increase in the level of knowledge among normal and overweight children followed by a mass education programme. However, the obese children had higher awareness levels in the pre-test, which showed a non-significant increase in post-test. This finding denotes that special intervention strategies are needed besides the educational programmes, such as promoting the production of nutrition-focused foods/snacks rather than calorie-dense food products, and regulatory actions for food-related advertisements are also required to address this issue. Further reinforcement by including the core concept of obesity and health in their educational curriculum and sustained motivation with the assistance of parents and school administration would have long-term benefits. In general, implementing mass awareness programmes to sensitize various high-risk groups would be a cost-effective measure in preventing the impending epidemic of noncommunicable diseases such as cardiovascular disorders and diabetes in middle- and low-income countries.

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Received on 31.07.2013 Modified on 25.08.2013

Asian J. Nur. Edu. and Research 3(4): Oct.- Dec., 2013; Page 216-218