towards healthy food choices, fitness and mental health among well to do adolescents to reduce...
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Presenting Author : Tripti Saxena Research Guide : Prof. Shubhada Kanani Department of Foods and Nutrition M.S. University Vadodara Gujarat
TOWARDS HEALTHY FOOD CHOICES, FITNESS AND MENTAL HEALTH
AMONG WELL TO DO ADOLESCENTS TO REDUCE DUAL BURDEN OF MALNUTRITION
IN SCHOOLS OF URBAN VADODARA
Why the need to study dual burden of malnutrition among well- to do school
adolescents ?
Developing countries: undernutrition and overnutrition among wide sections of the population and in varying socioeconomic environment ( FAO 2006) which lead to adverse consequences (WHO 2005).
Despite the reported high prevalence of undernutrition among well to do school adolescents, most of the interventions in India deal with adolescent obesity/overweight.
There are gaps in our knowledge regarding determinants of over & under nutrition among well to do adolescents.
Saxena & Kanani 2008
OBJECTIVES• To assess the prevalence of dual burden of malnutrition among well to do urban school adolescents of Vadodara in terms of height, weight and waist circumference
• To understand the determinants of dual burden of malnutrition as regards: food choices, fitness/ physical activity patterns and stress coping abilities
• To study the school environment : teachers’ & principals’ views as regards adolescents food choices,fitness/physical activities and stress coping abilities
• To study the home environment: parents’ views as regards adolescents food choices, fitness/ physical activities and stress coping abilities Saxena & Kanani 2008
STUDY DESIGNPurposive selection of urban schools (N=6)
Teachers (N=40) Principals (N=6)Perceptions foradolescent’s• Food choices• Physical activities• Stress coping
ChildrenChildren• Ht. ,Wt. & W.C (1105)• Food patterns & P.A. (N=454)• Stress coping abilities(N=335)
Data collection
Schools (N=6)Enablingfactors
&Meals at School canteen
Random Sample selection: Children from std. VIII & IX (N=1105)
Parents (N=40)(from PTA)
Perceptions for adolescent’s Food choices
Physical activity Stress
Classifying the children based on nutritional status (WHO 2007 standards)
Normal Overweight and Obese Thin
Data was separated genderwise and agewise for analysis
Cross tabulations: 3 categories by BMI with Food patterns, physical activities and
stress coping
Saxena & Kanani 2008
One to one interviews with One to one interviews with principals and teachersprincipals and teachers
Principals of selected schools
Teachers of selected schools
•Overall: Thinness was more than Ov-Ob
2 1
6 4 . 8
1 4 . 1
2 4
6 2 . 3
1 3 . 71 6 . 5
6 8 . 8
1 4 . 7
0
1 0
2 0
3 0
4 0
5 0
6 0
7 0
% A
DO
LE
SC
EN
TS
T o t a l B o y s G i r l s
P r e v a l e n c e b y B M I
T H I NN O R M A LO v - O b
• Thinness was more in boys than girls• Ov- Ob was similar in boys and girls
Saxena & Kanani 2008
•Tallness was more in boys
1 2 . 2
8 7 . 1
0 . 71 4 . 5
8 4 . 5
1 . 18 . 8
9 0 . 9
0 . 20
2 0
4 0
6 0
8 0
1 0 0
%A
DO
LE
SC
EN
TS
T o t a l B o y s G i r l s
P r e v a le n c e b y H e ig h t f o r a g e
S t u n t e dN o r m a lT a l l
• Prevalence of stunting was low•Twice the number of boys were stunted
Saxena & Kanani 2008
THE CHANGING TRENDS IN DUAL BURDEN OF MALNUTRITION BY AGE
01 02 03 04 05 06 07 08 09 0
%A
do
les
ce
nts
1 2 -1 2 . 4
1 3 -1 3 . 4
1 4 -1 4 . 4
1 5 -1 5 . 4
A g e ( y e a r s )
T H I NN O R M A LO v - O b
Saxena &Kanani 2008
3 meals & 3 snacks pattern: 10% adolescents Twice more girls(14%) than boys(7%)
Breakfast Consumption: Daily by Majority (70%) Similar in boys & girls
Quality of breakfast: Poor by majority Milk, cereals & fruits by 3% Similar in boys and girls
Snacking on Processed Packed munching snacks by 31% (e.g. Kurkure, Chips, biscuits, chocolates ) and Snack intake was most common during school hours by 50%
Intake of fruits at least once in a day : 10% adolescents
General Food Patterns
Saxena &Kanani 2008
General Food Patterns………Intake of vegetables at least once in a day : 90% adolescents
Food frequency of vegetables Roots and tuber : Daily :Boys (30- 40)% :Girls (30- 40)% GLVS : 2-3times :Boys (26-
27)%(Spinach & fenugreek ) :Girls (21-
29)%Amaranth & colocasia : Rarely :Boys
(25- 33)% :Girls (28- 41)% ‘Other’ vegetables : Rarely :Boys (23- 44)%(Yellow Pumpkin, bitter gourd, Bottle gourd, french beans, Cowpeas, capsicum, Clusterbeans )
:Girls (21- 57)%
Saxena & Kanani 2008
Intake of Healthy Foods
Daily Milk Intake :
Less frequent intake of Probiotics
Curd : 2-3 times/wk :
Lassi and Shrikhand : Monthly once :
Boys: 82%Girls: 75%
Boys: 31%Girls: 32%Boys: 47%Girls: 47%
Food frequency of milk and milk products
Food frequency of iron rich foods• Dried Peas and Bajra : 2 -3 times/ wk Rajmah, Dried cowpeas, green onions : Rarely Moth beans, Colocasia leaves (Monthly once or Never)
Boys: 20- 30% Girls : 20- 30%
Boys: 20- 30% Girls : 20- 30%
Saxena &Kanani 2008
School tiffins: Not brought by more than half (54%), more boys(66%) than
girls(38%)
Types of food brought in school tiffins 30% :Traditional fried foods( puri, pakoda, parantha) 27% :Ready to eat/ convenience food (biscuits, maggie,
wafers)
6% :Traditional fermented foods(dhokla, muthia, khaman )
12% :Whole some meals ( pulav, dal-chawal, chana, roti sabji)
DeterioratingFood patterns in
schools
HIGH
Saxena & Kanani 2008
School canteens: 54% : More than half eat in school canteens 33% : Common frequency: 2-3 times/week Purchases from school canteen: 34% :Processed and packed munching snacks 31% :Puff 17.4% : Samosa
By chi-square no significant association of the undesirable food patterns with BMI was seen (Thin, normal, Ov-Ob).
DeterioratingFood patterns in schools…………..
HIGH
Saxena & Kanani 2008
Salient findings• 30% :daily engagement in vigorous play/ exercise (such that they breathe rapidly or start sweating)
• Spot observations : Decreased participation in school exercise/ play, more in girls than boys : Decreased participation in mass drill in schools• Parents : 4hrs/ day involvement in sedentary behaviors (T.V. watching, video games, computer) •Teachers & principal : Escape from exercise but like to play. Interested in learning yoga but not do it regularly
Conclusion: Over reporting of physical activity by adolescents since in reality, adolescents are physically inactive
Dual burden of malnutrition in relation to exercise/play and
fitness
By chi-square : Significantly higher proportion of adolescents who
were involved in outdoor games had normal BMI (66%).
More Ov-Ob adolescents (21%) played indoor games
Boys: Similar trends Girls: By chi- square no significant differences in
various BMI categories (Thin, normal, Ov-Ob) Saxena & Kanani 2008
Categories of stress coping abilityTotal (N = 355) High stress
coping ability (>=70% scores)
Low stress coping ability(< 70%scores)
r Value
n % n %1 Nutrition** 86 24.2 269 75.8 1vs 5 0.4
2 Exercise-Fitness** 92 25.9 263 74.1 1vs 5 0.53 Mental health** 203 57.2 152 42.8 1vs 5 0.94 Art of relaxation** 159 44.8 196 55.2 1vs 5 0.75 Overall stress coping 158 44.5 197 55.5 1vs 5
Out of the 4 aspects studied which contributed Out of the 4 aspects studied which contributed to overall stress coping ability?to overall stress coping ability?
Correlation was significant at p <= o.o1 Saxena & Kanani 2008
Dual burden of malnutrition in relation to stress coping ability
Higher proportion of adolescents with normal BMI ( 11%) had ‘very good’ stress coping compared to thin(7%) or Ov-Ob( 4%)
‘Problem behaviours’ Poor food choices/ food practices were seen among stressed adolescents whether thin/ Ov-Ob Irregular exercise- fitness patterns were seen among stressed adolescents whether thin/ Ov-Ob, more so in girls than boys Saxena & Kanani 2008
Reasons for stress by principals and teachers: Increased competition, search of their identity No time to relax : Tution- an unnecessary stressor Parents’ expectation to obtain more marks Lengthy syllabus Parents are busy: children cannot share their problems
Views of Teachers and Parents regarding Views of Teachers and Parents regarding stress among adolescentsstress among adolescents
82% parents reported that Adolescents are
not stressed Saxena & Kanani 2008
Home Environment
Cyclic Menu signed by principal
Dal Rice
School lunch offered wholesome healthy food with variety in diet
Pulav
Integrated approach including : Adolescents The school environment Teachers Parents……. …….will result in holistic nutrition interventions
to reduce dual burden among well to do adolescents .
Conclusion
Saxena & Kanani 2008
Unified interventions for underweight and Overweight :
Nutrition friendly schools initiative
Recommendations
Unified interventions for controlling both underweight and Overweight :
Nutrition friendly schools initiative
Over- and undernutition are not simply a problem of rich or poor,
respectively. On the contrary, often these problems overlap
and coexist. Currently, strategies to tackle
this dual burden of malnutrition are often
pursued and promoted independently, as if
the two problems were independent of each other. This
will need to change, and policies and programs
developed that address both issues in an integrated
manner.
Mercedes de Onis( WHO)
Saxena & Kanani 2008
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