10

Chapter- IINTRODUCTION

1.1 Background of the Study:Sports have been part of human life almost since the time immemorial. Be it a necessity for his survival i. e hunting for food, shelter and safety from wild animals or other enemies, or as a pursuit of pleasure. The sports have been indispensable to mankind, and have become a part of his culture. Though the origin of sports is lost in antiquity, it is quite certain that physical activity has been a part of the life of even primitive man.Generally, physical education is misunderstood a physical activity or merely drill. It is necessary to provide knowledge regarding true meaning and scope of physical education. The aims and objectives of physical education are also being stated in detail so as to enable the students to understand the basic concept of the subject. It is also pertinent to deal with the controversy whether physical education is an art or science.[footnoteRef:2] [2: Ajmer Singh (2003). Essentials of physical Education, Kalyani publishers, Ludhina, New Delhi, pp. 13-15.]

Obesity and overweight has become a global epidemic. In 1997, the World Health Organization (WHO) highlighted obesity as a major global health problem. According to the WHO in 2005, throughout the world there were about 1.6 billion overweight adults aged 15 years and older and approximately 400 million obese adults. WHO estimates that by 2015, 75% of adults will be overweight and 41% will be obese A higher body weight is associated with an increased incidence of a number of medical conditions, including type 2 diabetes mellitus, insulin resistance, cardiovascular disease, stroke, some types of cancer, and nonalcoholic fatty liver disease. Obesity in childhood and adolescence represents a serious health problem because it tends to continue into adulthood[footnoteRef:3].Overweight and obesity is not only a health issue, but also has economic consequences. Both direct costs related to medical expenditures from obesity related diseases, and indirect costs related to reduced productivity and disability[footnoteRef:4]. [3: World Health Organization, Obesity and Overweight, retrieved on Sep 2015 from online website http://www.who.int/mediacentre/factsheets/fs311/en/. ] [4: Adair L. S. (2008). Child and Adolescent Obesity: Epidemiology and Developmental Perspectives, Physiol Behav. pp.8-16.]

Data from the United States-National Health and Nutrition Examination Survey (US-NHANES), estimated that the total cost of US healthcare related 2to overweight and obesity will increase from 7%, to about 17% by the year 2030[footnoteRef:5]. [5: Trogdon J. G et al., (2008). Indirect costs of obesity: a review of the current literature. Obes Rev. pp.489-500.]

A study by Finkelstein, Fiebelkorn and Wang, projected the annual medical spending due to overweight and obesity approached $92.6 billion in the United States (US) in 2002. On average, individual Americans whoare considered obese pay yearly over $1,400 (42 percent increase) in health care costs compared to normal-weight individuals. In addition, it is estimated that the total spending of Medicare and Medicaid would be lower by 8.5% and 11.8%, respectively, in the absence of obesity[footnoteRef:6] . [6: Cawley J, Meyerhoefer C. (2012). The Medical Care Costs of Obesity: an Instrumental Variables Approach, J Health Econ, pp.219-30.]

Obesity costs are raising overall. For example, Cawley and Meyerhoefer, found that per capita medical spending for obese US individuals was $2,741 higher than for individuals who were not obese (150% increase). Based on data from the Medical Expenditure Panel Survey for 2000-2005, the estimated annual cost of obesity is $190 billion (in 2005 dollars) which represents 20.6% of annual health care spending in the US.Globally direct costs of obesity were estimated to account for between 0.7% and 2.8% of the country's total healthcare expenditures. Moreover, obese people were found to have medical costs that were about 30% greater than their normal weight individuals.[footnoteRef:7] [7: world Health Organization, Obesity and Overweight, retrieved on Sep 2015 from online website http://www.who.int/mediacentre/factsheets/fs311/en/.]

A country where 270 million people live below the 'poverty line', obesity seems to be a distant issue, meant for the rich kids of first world. But India is under siege: junk food, alcohol and sedentary lifestyle are leading us to silent self-destruction, making one in every five Indian men and women either obese or overweight. According to a study published in the noted journal Lancet, India is just behind US and China in this global hazard list of top 10 countries with highest number of obese people[footnoteRef:8]. [8: Withrow. D, and Alter. D. A. (2011). The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev. Vol: 12(2), pp.131-41.]

The study - titled 'Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study 2013' - used data collected by international bodies and organisations in various countries like India over three decades. The US topped the list with 13 per cent of the obese people worldwide in 2013, while China and India together accounted for 15 per cent of the world's obese population, with 46 million and 30 million obese people, respectively. According to the study, number of overweight and obese people globally increased from 857 million in 1980 to 2.1 billion in 2013. This is one-third of the world's population[footnoteRef:9]. [9: WHO Consultation, Obesity: Preventing and Managing the Global Epidemic. World Health OrganizationTechnical retrieved on 16 Sep 2014 from online website http://www.who.int/nutrition/topics/obesity/en/. ]

Overweight in adults is categorised as Body Mass Index of 25 kg/m2 to 30 kg/m2 and obesity as Body Mass Index of more than 30 kg/m2. In 2010, overweight and obesity were estimated to cause 3 to 4 million deaths, 3.9 per cent of years of life lost, and 3.8 per cent of disability-adjusted life-years worldwide, the study said. And the problem is expected to get worse as obesity is increasing and "no national success stories have been reported in the past 33 years." According to Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) that conducted the analysis for the study, "In the last three decades, not one country has achieved success in reducing obesity rates, and we expect obesity to rise steadily as incomes rise in low- and middle income countries in particular." Dr. Pradeep Chowbey, director of the Institute of Minimal Access and Bariatric Surgery at Max Healthcare Institute, said, "If we see the graph of obesity, from 1999 onwards Indians started gaining weight due to urbanisation. There has been gradual economical improvement in our status. The entrance of modern technology and Internet has turned people lazy and stagnant.[footnoteRef:10] [10: Caballero. B (2007). The Global Epidemic of Obesity: an Overview. Epidemiol Rev. Vol: 29, pp.15.]

With lifestyle disorders forcing more and more people to reel under excess body weight, even relatively younger people are developing joint disorders and knee pain. Excessive weight is associated with a series of health problems, including blood pressure, diabetes, and cardiovascular ailments. Yet another problem is that obesity puts people at an increased risk of developing osteoarthritis. "Osteoarthritis, a degenerative joint disease, involves degradation of the condition of joints mostly due to loss of cartilage and may cause stiffness, locking or pain. Excess weight makes a person more susceptible to osteoarthritis," said Dr. Rajeev K. Sharma, orthopedic specialist and joint replacement surgeon at Indraprastha Apollo Hospital. Obesity has also emerged as a major public health challenge in South Asian countries. Experts say the prevalence of obesity is greater in urban areas, and women are more affected than men[footnoteRef:11]. [11: WHO Consultation, Obesity: Preventing and Managing the Global Epidemic. World Health OrganizationTechnical retrieved on 16 Sep 2014 from online website http://www.who.int/nutrition/topics/obesity/en/.]

Further, obesity among children and adolescents too is rising rapidly. The phenomenon in South Asians has characteristic features - high prevalence of abdominal obesity, with more "intra-abdominal and truncal subcutaneous adiposity," experts say. "Dietary guidelines for prevention of obesity and diabetes, and physical activity guidelines for Asian Indians are now available. Intervention programmes with emphasis on improving knowledge, attitude and practices regarding healthy nutrition, physical activity and stress management need to be implemented," said Dr. AnoopMisra, chairman of the National Diabetes, Obesity and Cholesterol Foundation[footnoteRef:12]. [12: Finkelstein. E. A et at., (2004). State-level Estimates of Annual Medical Expenditures Attributable to Obesity. Obes Res, vol: 12, pp.1824.]

According to Dr. Prabal Roy, senior bariatric surgeon at the Asian Institute of Medical Science, Indians had faced undernutrition for a long time and are now being exposed to the "overnutrition of the modern world through globalisation". "India is currently witnessing rising numbers of people in the middle-class who are obese. A lot of the Indian population has started relying on processed foods that contain a huge percentage of trans-fat, sugars, and other unhealthy and artificial ingredients. Obesity is considered the core of many diseases. Increased weight carries significant health risks for some cancers, diabetes, heart diseases and strokes," Roy said. And yet, we seem to do nothing to counter the menace, allowing ourselves to be controlled by a "pandemic", happily shrugging off the dangers with unpardonable nonchalance.[footnoteRef:13] [13: Wang Y, et al., (2008). Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity.vol:16, pp.23232330.]

In recent years obesity has reached pandemic proportions. In the world, half of the whole population lack food, the other half in the industrialized prosperous Western Countries fight against the consequences of overfeeding. 20-30% of the adult population is affected by obesity and obesity conditions. The World Health Organization Regional Office for Europe recently stated that 300 million people in the world are obese. The prevalence of obesity has increased by 25,0% in the last 20 years. In Europe 14 million people are overweight, 6 million obese: 27,0% of men, 38,0% of women. In many European countries 15,0-20,0% of adults are overweight or obese [3]. Obesity has a positive trend in the Italian population: the Italian National Institute of Statistics, (ISTAT) reported that in the preceding five years (2000-05), obesity has increased at a rate of 9,0%, with about 4.700.000 affected people. Statistics show 30% of the population are overweight, 10,0% are obese, with only about half the population being of a normal weight. Health costs linked to obesity equate to 7,0% in the European Union, and up to 10,0% in Italy; with the inclusion of cardiovascular conditions the proportion raises to 30,0-35,0% . A similar figure was also reported for children. In recent years childhood obesity has become a serious health problem in the world, an exacting challenge for public health authorities, raising great concern in families and communities. Investigations reported that 1 out of 3 children are overweight, 4,0 /6,0 % are obese. Over the past 3 decades prevalence of obesity has more than tripled for youth aged 6-11 and more than doubled for youth aged 12-19. 18,8% of children 6-11 years old and 17,4% of adolescents 12-19 years old were reported being over the 95th percentile for age and gender, 37,0% and 34,0%, respectively, over the 85th percentile, being at risk of obesity. The International Obesity Task Force (IOTF), in Europe, reported in the northern European regions from 10,0% to 20,0% prevalence of obesity, compared with higher rates (20,0-30,0%) in the southern regions.Surveys conducted in Italy by the Italian National Institute for Research on Nutrition (INRAN) assessed that obesity, concerning children, had higher rates in 6 to 13 years old, males were fatter than females and reported percentages of overweight between 12,0% and 34,0%, and of obesity from 4,7% to 22,3%. A series of surveys conducted in different Italian regions reported about 20,0% of children 6- 11 being overweight and 4,0% obese. A survey on a sample of primary school children in Pavia, northern Italy, reported that 31,3% of the pupils did not practice any organized physical activity. Prevalence of obesity in this group was nearly double. Obesity is considered a risk factor for many chronic diseases as hypertension, carbohydrate metabolism or type 2 diabete, hyperlipaemia, atherosclerosis. Obesity was also linked to increased children morbidity and adult mortality rates. Many studies indicate, in fact, that children who are severely overweight have an increased risk of death from cardiovascular disease in adulthood. Since overweight in childhood persists into adulthood and an obese child will have high probability of becoming an obese adult , increased prevalence of overweight and obesity in children will certainly led to an exacerbation of obesity related chronic diseases among adults . This is considered a public health threat as, in fact, obesity is associated in adults with the development of many pathological conditions as coronary heart disease, ictus, sleep apnea, osteoporosis and premature mortality. Causes of obesity are associated with certain life style factors such as sedentary habits and decreased physical activity. Important life style modifications in young people, particularly, have seen a decrease of time dedicated to organized physical exercise and an increase in hours spent watching TV, playing video games or using PCs. Sedentary habits and decrease physical activity, in turn, have been reported to be associated with unhealthy food consumption. The influence of childhood diet may influence the persistence of obesity and the development of diseases later in life. Reports indicate that only 20,0% of children and adolescents eat five or more servings of fruit and vegetables per day. In the States, American children do not consume the recommended servings and about 50,0% boys and girls 12-19 consume less than one serving of fruit and vegetables per day. Most students (11,0% to 28,0%) skip breakfast, with 86,0% having hyper caloric snacks. Students in middle and high school have access to snack bars and school food stores selling foods high in fat and calories. In addition, low milk consumption and increasing soft drink consumption is of increasing concern, beside obesity, in respect to the risk of osteoporosis. It is necessary to prevent or treat obesity in childhood since behaviors that lead to obesity are established in this period of life: this should be done in order to reduce the risk of adult obesity.[footnoteRef:14] [14: Fri J, and Finley. W (2005). The prevalence and costs of obesity in the EU. Proceedings of the Nutrition Society, pp.359-62. ]

Increasing the proportion of children meeting alimentary and physical guidelines with education interventions from childhood, in fact, reinforces prevention of obesity in adulthood. Results reported by different authors indicate that individual behaviors in nutrition and sedentary or active physical engagement are largely influenced by different variables such as age, gender, social, economical, cultural factors and different settings. Understanding the determinants of life style and behaviors in youth and attempting to change childrens habits with the long term goal of establishing healthy life style patterns to prevent chronic diseases in adulthood is considered a key strategy in the primary prevention of obesity.[footnoteRef:15] [15: Wang Y and Lobstein.T (2006). Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes, pp.11-25.]

According to WHO estimates, by 2020, non communicable diseases (NCD) will account for approximately three quarters of all deaths in the developing world.[footnoteRef:16] [16: Bescianini. S et al., (2002). Excess of weight in infancy and adolescence. ISTAT Conference, Rome.]

Interest in childhood precursors to chronic diseases is increasing because the behavioral and biological risk factors for chronic diseases persist from childhood into adulthood. Declining levels of physical activity (PA) as well as nutrition transition (i.e. the trend towards increased consumption of a diet high in saturated fat, sugar and refined foods, and low in fiber) among communities are thought to be partly responsible for the rising rate of such risk factors worldwide.In this regard, a potential emerging public health concern in developing countries is likely to be the increasing incidence of childhood overweight, which in the future is likely to create an enormous public health burden.In recent years, in addition to problems in adults, the epidemiological transition has made Iranian young people prone to chronic diseases in later life.[footnoteRef:17] [17: Must A et al., (1999). The Disease Burden Associated with Overweight and Obesity. JAMA, pp.23-29.]

Although previous studies have determined the associations between PA and dietary habits in relation to overweight in developed countries, it is not clear if their findings can be generalized to other ethnic groups with very different cultures and lifestyles. Consequently, for the first time in the Islamic Republic of Iran, and to our knowledge for the first time in the WHO Eastern Mediterranean Region, a national-level baseline survey has been performed as part of the Childhood & Adolescence Surveillance and Prevention of Adult Non-communicable disease: CASPIAN Study. The current paper used the baseline data from this large study to examine the associations between dietary and PA patterns, as well as their relation to the body mass index (BMI) among a nationally representative sample of children and adolescents.[footnoteRef:18] [18: Must A, and Strauss R.S. (1999). Risks and Consequences of Childhood and Adolescent Obesity. Int J Obes Relat Metab Disord , pp.2-11.]

1.2 The Problem and its Social Relevance:One of every three people or almost 2.1 billion of the worlds population is either obese or overweight, according to the Global Burden of Disease study published in Lancet medical journal on Thursday which analyses data from 188 countries between 1990 and 2013. Almost 37% of the worlds men are overweight or obese, up from 29% in 1980. And almost 38% of the worlds women are, up from 30% in 1980. According to the study, 13% of the obese people in the world are in the US and 15% in China and India an indication of how economic progress has wreaked havoc on waistlines in developing economies. In 2010, obesity (and being overweight) caused the death of 3.4 million people, according to study conducted by the Seattle-based Institute for Health Metrics and Evaluation. Most of the deaths were caused by cardiovascular conditions. Obesity is an issue affecting people of all ages and incomes, everywhere, said Christopher Murray, director of Institute of Health Metrics and Evaluation, in a press release. In the last three decades, not one country has achieved success in reducing obesity rates, and we expect obesity to rise steadily as incomes rise in low- and middle-income countries in particular, unless urgent steps are taken to address this public health crisis, added Murray who is one of the co-founders of the study. According to the study between 1980 and 2013, the prevalence of overweight or obese children and adolescents increased by nearly 50%. In 2013, more than 22% of girls and nearly 24% of boys living in developed countries were found to be overweight or obese. Developing countries also recorded high levels of childhood obesity, where nearly 13% of boys and more than 13% of girls are overweight or obese. Hence keep this data in her mind researcher selected this topic to find out the status of the university students of Bharati Vidyapeeth. 1.3 Statement of the ProblemThe statement of the research problem was to find out Comparison of Eating Behavior with Physical Activity Characteristics and BMI from the Students of Different Region.

1.4 Objectives of the Study:The objectives of the study are as follows: To find out physical activity of the students from different region. To find out the eating behaviour of the students from different region. To find out the BMI of the students from different region. To find out the relationship between physical activities, eating behavior and BMI of the students from different region.

1.5 Hypothesis:H1 1: There would be significant difference between the north east region and west region student of eating behavior. H1 2: There would be significant difference between the north east region and west region student of physical activity.H1 3: There would be significant difference between the north east region and west region student of BMI.1.6 Delimitation of the Study: The study was delimited to students of only Bharati Vidhyapeeth University. The age of the subjects was ranging from 18-25yrs. The study was delimited to both male and female students. The study was delimited to students of 2 different region: north east region (Nagaland, Manipur, Tripura ,Assam) and West (Maharashtra, Goa).1.7 Limitation of the Study: The researcher assumed that the information provided by the students would be valid. Questionnaire research has its limitation. As such any bias that might have crept into the subjects response on this account may be considered as a limitation of this study.

1.8 Operational Definition of the Terms UsedPhysical activity: Physical exercise is any bodily activity that enhances or maintain physical fitness and overall health. It is performed for many different reasons. These include strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance and for enjoyment. Behavior: It is the range of actions and mannerisms made by organisms, systems or artificial entities in conjunction with themselves or their environment, which includes the other systems or organisms around as well as the (inanimate) physical environment. It ia response of the system or organism to various stimuli or inputs, whether internal or external, conscious or subconscious, overt or covert and voluntary or involuntary.BMI: Body mass index (BMI) is the ratio between the height and weight to check the obesity level. BMI = weight (kg) / [height (m.)]2Measurement of BMI is necessary for prediction of obesity and also useful to assess health risk of heart.

1.9 Significance of the Study: The result of the study was highlighting the students physical activity and eating behaviour. The study yield beneficial information about personal physical activity and nutritional habits.