obesity obesity research

8/17/2019 Obesity obesity Research

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Chapter I

THE PROBLEM AND ITS SCOPE

Introduction

Childhood obesity is a condition where excess body fat negatively affects a child's health

or wellbeing. As methods to determine body fat directly are difficult, the diagnosis of obesity is

often based on Body Mass Index (BMI. !ue to the rising "revalence of obesity in children and

its many adverse health effects it is being recogni#ed as a serious "ublic

health concern($i%i"edia.

Childhood obesity is one of the most serious "ublic health challenges of the & st century.

($orld ealth )rgani#ation. It is the most common nutritional "roblem among children in

develo"ed countries (*orof+ !aniels, &&. It is a com"lex, multifactoral and chronic condition

resulting from inter"lay between environment and genetics (*egal + *anche#, &. -he

"revalence of obesity has been growing at an alarming rate for decades in both children and

adults (iammattei et al., &/. )besity "revalence is 01&2 in industriali#ed countries, but

the fastest increases, "articularly in childhood obesity, are seen in develo"ing countries such as

Chile and China (3iner, &/. $orldwide, && million children under the age of five are

overweight (3iner, &/. -oday, among the affluent "eo"le around the world, including those in

develo"ing nations, obesity afflicts about &2 of children aging from 4 to , and more

alarmingly, about 2 of those aging from & to 5 are obese. Among those between the ages &

and 6, 72 are also obese (Chua, &&.

)besity is associated with significant morbidity and mortality, including cardiovascular,

res"iratory, ortho"edic, gastrointestinal, endocrine, and "sychosocial morbidities (*egal +

*anche#, &. As increasing numbers of overweight children and adolescents8 "rogress to

adulthood, these com"lications are ex"ected to reach e"idemic "ro"ortions (*egal + *anche#,

&.

Being an overweight child under / years of age does not "redict future obesity unless at

least one "arent is also obese. After the age of / years, the li%elihood that obesity will "ersist into

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adulthood increases with advancing age of the child and is higher in children with severe obesity

in all age grou"s. After an obese child reaches 4 years of age, the "robability that obesity will

"ersist into adulthood exceeds 52, and 92172 of obese adolescents will remain so as they

become adults (*egal + *anche#, &.

)besity in children not only affects their bodies but their mind as well. )bese children

are at higher ris% to develo" "sychological "roblems as the American Academy of Children +

Adolescent :sychiatry describes. )bese children tend to have much lower self;esteem,

de"ression, anxiety, obsessive com"ulsive disorder, and "oor body image. )bese children are

also most li%ely to be teased and bullied by other children that create more emotional damage.

$orldwide, the ado"tion of industriali#ed western society lifestyles (urbani#ation,

western foods, increased sedentariness, and car ownershi" is associated with increasing obesity.

-he shift towards a


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that the results of a survey conducted by the 3ood and >utrition @esearch Institute (3>@I of the

!e"artment of *cience and -echnology are more alarming. It was revealed that in 676, the

"revalence rate of obesity among 3ili"ino children was at 5.92. In 66/, it increased to 72 and

in 667, to 7.72.

A study conducted last une && by the school nurse of ABC, Ms. oanna B. auculan,

@> revealed that /.62 of the "o"ulation in elementary "u"ils is obese. Because of this, the

grou" would li%e to underta%e a study on the factors contributing to childhood obesity among

elementary "u"ils in ABC.


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Theoretical Frameor!

-his study is heavily anchored on the ealth Belief Model (BM develo"ed by Irwin

M. @osenstoc% in 644. -his Model is a health behavioral change and "sychological model that

will serve as the basis for the u"ta%e of health "romotional initiatives. -he BM is one of the

most commonly utili#ed theory in health education and health "romotion (lan# et al, &&.

-he Model was modified by Bec%er in 690, to include com"onents, such as individual

"erce"tion modifying factors and variables li%ely to affect initiating of action. It is a model based

on Motivation -heory which assumes that good health is an obective common to all "eo"le

(o#ier et alD &9.

3actors included in the BM are individual "erce"tions that would include "erceived

susce"tibility, seriousness, and threat. Intervening or modifying factors are also included such as

demogra"hics, structural variables, and cues to action. -he li%elihood for action will also de"end

on the "erceive benefit and barriers of action (o#ier et alD &9.


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Fi"# $#*chematic !iagram of *tudy

Ph%&ical 'actor(

:hysical activities

Biolo"ical Factor&(

enetics

Per&onal Factor&(

Eifestyle

• !ietary habits

En)ironmental Factor&(

?asy access to foods

Mediatin" *aria+le&(

:arental 3actors

• Age

• Civil *tatus

• ?ducational Bac%ground

• ender

• Monthly Income

• @eligion

Childhood )besity


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3igure . describes the "aradigm of the factors contributing to childhood obesity which shows

the relationshi" of the inde"endent variables which are the biological, "hysical, environmental,

and "ersonal factors as well the mediating variables (age, civil status, educational bac%ground,

gender, monthly income, religion, these factors can either worsenor lessen the ris% to childhood

obesity(de"endent variable.

-here are many factors that contribute to childhood obesity. -hese are biological,

"sychological, social and "ersonal factors. Children with obese "arents have double ris% of

becoming obese and have many of same references in diet and lifestyle. enetics cannot be

changed. )nce the "arents are obese, the child will "ossibly inherit it that8s why limit inta%e of

high calorie foods and regular exercise are very im"ortant. Also, there are other factors li%e

"ersonality and "eer "ressure. )bese children are sometimes taunted by "laymates and may

become loners or have difficulty relating to "eers. )bese children have reduced "hysical activity

including s"orts "artici"ation, watching television, using com"uter and "laying video games

occu"y a large "ercentage of children leisure time. :oor lifestyle choices, increase in daily

snac%ing, decline in consum"tion of / "rinci"al meals, lac% of access to healthy foods and easy

access to un% foods has greatly contributed to children obesity.

:arents also have a maor role in the child8s growth and develo"ment which serves as

mediating variables, these factors can either worsen or lessen the ris% of the child to become

obese. :arental factors li%e age, civil status, educational bac%ground, gender, monthly income

and religion may affect them. ?lementary "u"ils need their "arents for guidance with regards to

their nutrition.


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Statement o' the Pro+lem

-his study aims to determine the factors contributing to childhood obesity among

elementary "u"ils at ABC.

*"ecifically, it see%s to answer the following Fuestions=

. $hat is the res"ondents8 "rofile in terms of=

. Age

.& ender

./ Civil status

.0@eligion

.5 ?ducational bac%ground

.4 Monthly income

&. $hat are the factors contributing to childhood obesity among elementary "u"ils with

regards tobiological, "hysical, environmental, and "ersonal as"ectsG

H%pothe&i&

-he null hy"othesis will be formulated and tested at the al"ha .5 level of significance

with utili#ation of a""ro"riate statistical tools=

o -here are no significant differences in the factors contributing to childhood obesity

among elementary "u"ils when grou"ed according to age, gender, height, weight, and lifestyle.

Si"ni'icance o' the Stud%


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:arents

3or the "arents, this will hel" them understand more about the nutritional status of their

children since we %now that most of the time, it is already enough to them seeing their

child in their weight without %nowing whether their child is on the a""ro"riate weight to

their age or not. -his will also encourage them to be a good role model for children's

nutrition through Buying fruits and vegetables rather than snac%s# -his shows that if

"arents em"hasi#e how im"ortant these are in the diet, children will eat them more often.

ealth Care :rofessionals

-his study will hel" the ealth Care "rofessionals in develo"ing "lans that are evidence;

based "ractice.

*tudents

As a su""orting effort to the school environment, school nutrition "lays a significant role

in bettering the health of students. -he *chool Canteen ensures that "artici"ating students

receive foods that are based on nutritional standards, limits certain nutrients for sale, and

"rovides nutrition materials and "rofessional growth o""ortunities to school nutrition

staff. -hrough this study, they could use the results as an evidence regarding the

elementary "u"ils are at ris% of develo"ing obesity thereby they can im"lement

interventions such as selling at the school canteen low;calorie foods (e.g. boiled beans,

boiled "otatoes, broccoli, etc. or by eliminating un% foods as one of the foods they sell.


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Scope and Delimitation

-his study is focused on the factors contributing to childhood obesity that affect

elementary "u"ils in ABC. It involves /.62 of the res"ondent "arents of elementary "u"ils

enrolled at ABC. -he study consists of res"ondents in elementary de"artment of ABC who are

both male and female. -he researchers limit this study to ABC for the reason that it is the survey

conducted by the school nurse of ABC, Ms. oanna B. auculan, @>. -his study is also limited to

the effects of cause to childhood obesity among elementary "u"ils. -he study does not cover the

as"ects of child develo"ment such as "sychological, social and intellectual.

-he study conducted last une && by the school nurse of ABC, Ms. oanna B. auculan,

@>, revealed that /.62 out of //4 elementary "u"ils in ABC, 00 are identified as obese. !ue

to limited time frame to conduct freFuent interviews necessary to accom"lish this study,

Fuestionnaires will be designed instead for res"ondent "arents to accom"lish. *ince H"arents

refer to the father or the mother of the elementary "u"ils, the agreement of both would have been

written as answers to the given Fuestionnaire to ma%e "ossible accurate and unbiased data

collection. Because of this, the researchers would li%e to commence a study on the factors

contributing to childhood obesity among elementary "u"ils in ABC.


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Operational De'inition o' Term&

Andre& Boni'acio Colle"e , it is a non;sectorial school institution in !i"olog City wherein the

research study will be conducted.

Health , it "ertains to the good condition of elementary "u"ils in ABC in terms of their nutrition

and activities.

Li'e&t%le ; refers to how the elementary "u"ils of ABC "erform their activities of daily living and

their recreational activities during vacant hours.

Nutrition ; "ertains to eating the right %ind of foods "roviding balanced diet with regards to their

age brac%et.

O+e&it% , is a term used to describe the elementary "u"ils in ABC with excessive fat

accumulation that "resents a ris% to healthD refers to elementary "u"ils in ABC with a BMI

greater than or eFual to / %gJm&.

Pupil& ; are those individuals, aging from 0 to & years old who are studying at ABC.


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Chapter -

RE*IE. OF RELATED LITERAT/RE AND ST/DIES

-his cha"ter "resents the selected related literature and studies written by local and

foreign authors which have relevance to the study. -hese data have been used as one of the

sources to su""ort the study.

Related Literature

-he incidence of overweight and obesity among children is slowly becoming a world;

wide "roblem. !evelo"ed and develo"ing countries are not s"ared from this health concern. -he

$orld ealth )rgani#ation (&4 has made this "roblem a "riority and is currently drawing u"

"rograms to im"rove the "revention and management of obesity among children and adults. -he

organi#ation has recogni#ed the im"act of such "roblem on the future health as well as on the

level of "roductivity and economic growth retardation of communities and nations. *everal

countries in the world have re"orted an alarming "revalence of obesity among children. In the

Knited *tates (K*,it was claimed that while the incidence of obesity in children is less than in

adults, the rate of increase a""ears to be higher for children (!ehghan e.t al., &5.

-he focus on childhood obesity is clinically significant as the "roblem contributes to the

mar%ed decrease in children8s health. -he effects of obesity are usually seen later during adult

life. Cardiovascular com"lications such as coronary heart disease (C! and stro%e are common

among obese adults with history of childhood obesity. -he relationshi" of cardiovascular disease

and obesity was clearly shown in a study conducted by :avel (&0.

Childhood obesity has reached e"idemic levels in develo"ed countries. -wenty five

"ercent of children in the K* are overweight and 2 are obese. )verweight and obesity in

childhood are %nown to have significant im"act on both "hysical and "sychological health. -he

mechanism of obesity develo"ment is not fully understood and it is believed to be a disorder with

multi"le causes. ?nvironmental factors, lifestyle "references, and cultural environment "lay


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"ivotal roles in the rising "revalence of obesity worldwide. In general, overweight and obesity

are assumed to be the results of an increase in caloric and fat inta%e. )n the other hand, there are

su""orting evidence that excessive sugar inta%e by soft drin%, increased "ortion si#e, and steady

decline in "hysical activity have been "laying maor roles in the rising rates of obesity all around

the world. ConseFuently, both over;consum"tion of calories and reduced "hysical activity are

involved in childhood obesity (!ehghan e.t al., &5.

Childhood obesity has become America8s new tobacco. -hey, li%e many other "ublic

health administrators, fear the obesity e"idemic America currently faces will only get worse

before it starts to get better. $ith one in three American children being overweight or obese, the

issue has risen to monumental "ro"ortions (lein + !iet#, &.

-he "roblem did not ust a""ear out of thin air, however. )ver the "ast / years the rise

in obesity rates have steadily increased, and Hthe fact that the increase in obesity during this

"eriod cannot be ex"lained by genetics, and has occurred among all socioeconomic grou"s

"rovides su""ort for a broad set of social and environmental ex"lanations (Christa%is, &9.

According to the @obert $ood ohnson 3oundation8s &H3 as in 3at re"ort, more than two

out of every three states have obesity rates above &5 "ercent. -wenty years ago, no state had a

rate above 5 "ercent (Eevi et al., &. )nly one state in the nation currently has a childhood

obesity rate below "ercent ()regon, and the @obert $ood ohnson 3oundation found that 4

states significantly increased their obesity rates in ust one year from &;&. -he "revalence

of obesity among children from lower;income families is also on the rise as families struggle to

afford high;"riced healthy foods. 3rom 666 to &6, obesity rates for lower *?* children

increased from & "ercent to 5 "ercent (Eevi et al., &. Across all "o"ulations in every state,

the childhood obesity e"idemic has undoubtedly reached an all time high.

A child8s obesity level is determined using their body mass index, or BMI. BMI is an

individual8s weight divided by their height, and children are defined as being obese when their BMI is at the ninety;fifth "ercentile or higher. Also, when documenting childhood obesity, the

common categories are Hchildren ages 5;6, and Hyouth aged ;9 (Eobstein et. al., &0.

@esearch shows that children who have a higher BMI and are considered overweight or obese,

not only have a significantly greater chance of being overweight adults, but are also at a much


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greater ris% of having asthma, oint "roblems, diabetes, liver disease, cardiovascular disease and

an array of other "roblems later in life (lein + !iet#, &.

-oday, children have become the grou" in which the obesity rates are increasing

the fastest. -his growing "o"ulation is also starting to im"act the country as a whole, transferring

their weight of "roblems onto the rest of the American "ublic. ?x"erts re"ort that direct medical

costs from obesity;related health issues are as high as L5 billion a year (Cawley, &. -hese

health care ex"enditures are starting to burden the rest of America, and are costing the

government a sur"lus of ex"enses today8s economy cannot afford to handle. -he overweight

American is sim"ly more ex"ensive to care for, and it is beginning to show as more of them fall

into a tails"in of health "roblems.

3rom an increase in daily snac%ing and a decline in the consum"tion of three "rinci"al

meals, to the lac% of access to healthy foods and the school lunch "rogram, the causes for

childhood obesity are endless (:iernas, &. $ith no one actions causing the "roblem,

recommendations to reverse the e"idemic are confusing, contradictory and forever changing.

Individual res"onsibility is continuously em"hasi#ed into the nation8s treatment for obesity, but

with the ever;increasing number of overweight individuals in the Knited *tates, Hit is im"erative

to examine environmental contributors to obesity ($ang + Brownell, &5.

)verweight and obesity in childhood have significant im"act on both "hysical and

"sychological healthD for exam"le, overweight and obesity are associated with hy"erli"idemia,

hy"ertension, abnormal glucose tolerance, and infertility. In addition, "sychological disorders

such as de"ression occur with increased freFuency in obese children. )verweight children

followed u" for 0 and 55 years were more li%ely to have cardiovascular and digestive diseases,

and die from any cause as com"ared with those who were lean (!ehghan et. al., &5.

-here are three forms of "revention= "rimary, secondary, and tertiary. :rimary "revention

is tailored towards reducing the occurrence of the disease before it results. *econdary "revention

is geared towards reducing the "rogress of a disease once it begins. -ertiary "revention is related

to reducing the limitations of disability from the disease (3ris+ *ellers, &6. It should be

noted that overweight and obesity lead to many other sym"toms, such as slee" "roblems,

res"iratory "roblems, gastrointestinal "roblems, endocrine disorders, menstrual irregularities,


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ortho"edic "roblems, mental health "roblems, genitourinary "roblems, and s%in conditions

(rebs, &9. 3or this reason, a variety of current research on obesity is dedicated towards

"rimary "revention of obesity.

As "hysicians, research indicates that education may be the best form of overweight and

obesity "revention among children and adults (rebs, &9. owever, it is im"ortant to

understand the difficulty of treating obesity. Children of obese "arents have double the ris% of

becoming obese and have many of the same "references in diet and lifestyles (lot, &9. -his

not only "redis"oses children to obesity genetically, but it ma%es it increasingly difficult as the

environment they live in is rich with the tem"tations of an obese lifestyle. -here are 9, fast

food restaurants and three million soft drin% vending machines in the Knited *tates (Cho"ra,

&&. -oday8s children will be tomorrow8s adults. -his obective reality "oses a very real threat

to our nation8s health.


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Related Studie&

Children who eat too many carbohydrates and become obese may develo" motor s%ills

more slowly than the other children because "hysical movement is more tiring for them. )bese

children are sometimes taunted by their "laymates and may become loners or have difficulty

relating to their "eers because of behavior "roblems or de"ression about their weight (:illitteri,

&.

A study by Miller, .D @osenbloom, A. + *ilverstein, . (&0 yielded that the increased

incidence of childhood obesity cannot be blamed on either environment or genetics alone.

Changes in the environment li%e nutrition and lifestyle are "rimarily res"onsible because it is not

"ossible for the gene "ool to change in less than a generation.

-he cause of obesity is high because many studies concluded on current lifestyles have

drawn a number of conclusions. It is generally acce"ted that a combination of "oor lifestyle

choices has greatly contributed to children who are obese.

A study conducted by the Center for !isease Control (C!C revealed that from 694 to

&, the incidence of obesity among American children aging from 4 to years has doubled

and those ages & 1 6 years has tri"led (irandola+ Chin, &0. -he "revalence of childhood

obesity in other "arts of >orth America, ?uro"e and some "arts of Asia is also high. According to

:rentice (&4, Canada has 52 "revalence rate while ermany has &2. In Asia, Iran has

"revalence rate of 2 with children ma%ing u" most of the obese "o"ulation while Bahrain has

&62. In the Knited ingdom (K, a study conducted by *tamata%is (&& revealed that the

"revalence of overweight and obesity among children is increasing at alarming rates across

social classes. -hey concluded that overweight and obesity are now common across social

classes in the K with overweight being widely acce"ted as a norm.

In Cy"rus, a study to determine the "revalence of childhood and adolescent obesity and

its associated factors was conducted by *avva (&&. -heir study revealed that the "revalence of

obesity in males was ./2 and in females 6.2. -he "ercentages "resented a decreasing trend

with age. It was also found in their research that "hysical activity and "arental obesity on the

other hand had more significant roles in the obesity of the subects. Most obese children had


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reduced "hysical activity including s"orts "artici"ation, as com"ared to those who are not obese.

Ei%ewise, most obese subects have one or both "arents who were obese.

In the :hili""ines, studies on obesity among children show that the findings reveal a

"attern. -he "revalence rate of obesity had been increasing through the years. -he :hili""ine

>ational ealth ?valuation and *urvey (&0 has "laced the "revalence rate of obesity among

3ili"ino children at /.&2. -his has increased to 0.62 in &/. )"ina (&5 claimed that the

gradual increase in the incidence of obesity was li%ewise noted by the >ational >utrition Council

of the :hili""ines survey in &/. )verweight children aging from to 5 years rose from .02

to .02. -he "revalence rate of overweight children aging from 4 to years was almost

negligible in 667 but had a significant increase to ./2 in &/. Mayuga (&5 however said

that the results of a survey conducted by the 3ood and >utrition @esearch Institute (3>@I of the!e"artment of *cience and -echnology are more alarming. It was revealed that in 676, the

"revalence rate of obesity among 3ili"ino children was at 5.92. In 66/ it increased to 72 and

in 667 to 7.72.

A study conducted by on#ale#;*uare# C. B., Eee;:ineda ., amora M. -. ., *ibug ?.

)., Nelasco . 3. + rimmer;*omers . last && revealed that there is an alarming increase in

the "revalence of childhood obesity. -his study examines the oint association of cardiovascular

fitness and nutritional inta%e in 3ili"ino "re;adolescents. rade 0 to 4 students from an

elementary school in Manila were included. !ata were obtained from August &6 to March

&. )utcome measures were BMI, cardiovascular fitness using &m multistage shuttle run and

&0h dietary food recall utili#ing a face;to;face interview. 3or males, the odds of being overweight

com"ared to having normal weight were significantly elevated in those who had low

cardiovascular fitness and high caloric inta%e. Com"aring those who were obese with those with

normal BMI, the odds of being obese were very high for those who had low cardiovascular

fitness and low caloric inta%e. owever, the odds of being obese increased even more when

males had low cardiovascular fitness and high total caloric inta%e. 3or females, the odd of being

overweight and obese was significantly higher for those with high caloric inta%e and low

"hysical fitness com"ared to those with high "hysical fitness and low total caloric inta%e. -he

findings em"hasi#e the im"ortance of increasing cardiovascular fitness through involvement in


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moderate to vigorous "hysical activity and im"roving dietary "atterns in order to reduce the

increasing "revalence of childhood obesity.

Another study on the role of nutritional factors on obese children conducted by $e%er, .

(&4 shows that excessive amount of adi"ose tissue in children and sim"le obesity in "articular

constitute a growing health "roblem throughout the world. Adverse health effects of obesity of

children ustify the need to loo% for efficient treatments and among them the dietary treatment.

-he aim of the study was to examine the effectiveness of dietary treatment in children with

sim"le obesity on the basis of thorough analysis of their state of nutrition, method of nutrition,

and eating habits, and the im"act of other environmental factors. 3our research hy"otheses were

formulated= (. *im"le obesity of children is influenced by selected environmental factors such

as "arents' level of education, familial inclination to obesity, and health habitsD (&. Chosen andacce"ted by the child andJor its mothersJ"arents "rogramme of dietary treatment in the form of

low;energy diet with elements of low glycemic index results in the loss of body mass in childrenD

(/. Im"lemented dietary treatment translates into the modification of basic anthro"ometric

features;;body mass, body height, thic%ness of s%in, and adi"ose folds on arm, below shoulder

blade (sca"ula, on abdomen as well as arm circumference and anthro"ometric "arameters of

examined children;; BMI, waste;hi" ratio, and body fat contentD (0. Im"lemented dietary

treatment has an im"act on modification of certain biochemical indicators;;li"id "rofile of

children with increased indicators of li"id metabolism.

*everal studies conducted by the >ational ealth and >utrition ?xamination *urvey

(>C*, C!C in & have been "ublished that attem"t to lin% children8s diets with the onset of

obesity. owever, none have been able to show a causal lin% between diet and obesity. -wo such

studies include the Bogalusa eart *tudy and a K*!A ?conomic @esearch *ervice study.

-he Bogalusa eart *tudy analy#ed children8s eating "atterns over two decades (69/;

660 using a series of seven cross;sectional surveys given to ,570 ten;year old children. -he

study discovered changes in children8s eating "atterns over this &;year "eriod including=

increased incidence of missed brea%fasts, increased numbers of children eating dinners outside

the home, and increased snac%ing. >o causal associations were found between changes in meal

"atterns and overweight status.


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-he K*!A ?conomic @esearch *ervice study on fruit consum"tion indicated that higher

fruit consum"tion is lin%ed with a lower BMI in both adults and children. A large cohort of /,40

children between the ages of 5 and 7 years were surveyed between 660 and 664 using the

K*!A8s Continuing *urvey of 3ood Inta%es by Individuals (C*3II. -he study hy"othesi#ed that

"eo"le who incor"orate nutrient;dense, low;fat foods into their diets li%e those found in fruits

and vegetables will have a healthier BMI. owever, the study only found a wea% correlation

between body weight and vegetable consum"tion.

Moreover, the research above indicates that a decrease in daily energy ex"enditure

without a concomitant decrease in total energy consum"tion may be the underlying factor for the

increase in childhood obesity. :hysical activity trend data for children are limited, but, cross

sectional data indicates that one third of adolescents are not getting recommended levels of moderate or vigorous activity, 2 are com"letely inactive and "hysical activity levels fall as

adolescents8 age. -his situation may actually be worse than these data described. Activity

measured by "hysical activity monitors tends to be significantly lower than what is re"orted on

surveys.

$atching television, using the com"uter, and "laying video games occu"y a large

"ercentage of children8s leisure time influencing their "hysical activity levels. It is estimated that

children in the Knited *tates are s"ending &52 of their wa%ing hours watching television andstatistically, children who watch the most hours of television have the highest incidence of

obesity. -his trend is a""arent not only because little energy is ex"ended while viewing

television but also because of the concurrent consum"tion of high;caloric snac%s.

A study conducted by de )nis, M., Blossner, M. +Borghi, ?. (& shows that even

though child hunger remains the most "ressing nutritional concern for much of AsiaOin *outh

Asia, for exam"le, one in three "reschool children is underweightOthe region has also seen

dramatic increases in child obesity. )verall in Asia (excluding a"an, nearly 52 of "reschoolers

were estimated to be overweight or obese in &, a 5/2 increase in "revalence since 66 that

translates into 9.9 million Asian "reschoolers being overweight or obese. -here8s Fuite a bit of

diversity from region to region, however. $hile *outh Asian countries li%e Bangladesh, India,

and :a%istan have low obesity rates, their large "o"ulations add u" to large numbers of children


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19

who are overweight or obese. It8s im"ortant to note that in Asian adults, the health com"lications

associated with overweight and obesity start at a lower BMI than seen in the K.*. and ?uro"e.

-herefore, many of these estimates of child obesity "revalence in Asia li%ely underestimate the

true "ublic health burden of obesity in Asia.

-he bottom line is that it is never too early to start "reventing obesity even among the

youngest of children. It is clear that obesity rates are rising across the globe. ?Fually clear is that

it is very hard for anyone who becomes overweight to lose weight, at any age. :reventing obesity

in a child8s earliest years (and even before birth, by healthy habits during "regnancy confers a

lifetime of health benefits. It is the most "romising "ath for turning around the global e"idemic.


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20

CHAPTER 0

RESEARCH METHODOLO12

-his cha"ter s"ecifies the research design, research environment, the res"ondents of thestudy, research instrument, sam"ling "lan, and statistical treatment.

Re&earch De&i"n

-his study em"loys a descri"tive;com"arative research study. It involves a descri"tion of

the factors contributing to childhood obesity among elementary "u"ils in ABC as well as

relationshi" between them. -he researchers considered this as the a""ro"riate research design. It

will discuss and com"are the different factors that contribute to childhood obesity from the

view"oint of the "arents. A researcher;made Fuestionnaire will be used in gathering the data. -he

"arents of the identified obese children from the elementary de"artment of ABC will be

considered as the study8s "ros"ective res"ondents.

Re&earch En)ironment and Settin"

-his study was conducted in ABC which is situated in a &5 hectare s"rawling cam"us

along Barangay Mi"uta%, !i"olog City, amboanga del >orte, :hili""ines with several buildings

surrounding its "anorama views of the College :ar%. -he ?lementary !e"artment of the school

has well;built concrete building with rooms conducive for learning at the side of the school8s

Administrative Building. -his school has Basic ?lementary education from grades I to NI and

currently has //4 of total "o"ulation.


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21

Re&pondent& o' the Stud%

@es"ondents of the study are the "arents or the guardians currently ta%ing care of their

children who are currently studying ?lementary students of ABC, !i"olog City and who were

"reviously identified by the school nurse as among the grou" that are obese. -he res"ondents8

age, civil status, educational bac%ground, gender, monthly income, and religion will be ta%en

into consideration.

All res"ondents must be 7 years old and above, living in !i"olog City and their children

must be studying at ABC8s ?lementary !e"artment and whose child must have been identified

by the school nurse as obese for his or her current age.

Re&earch In&trument&

!ata of the study will be collected utili#ing a Fuestionnaire as the main data gathering

tool. -he Fuestionnaire covers three im"ortant areas. -he first "art consists of a "rofile of the

res"ondents as to the age, gender, religious affiliation, educational attainment, occu"ation, and

relationshi" with the obese children. -he second "art assesses the %nowledge about giving care

which includes growth and develo"ment conce"ts, hygiene, nutrition, activities, educational

attainment and social as"ects. -he third "art determines the common "ractices of the caregivers

in relation to their %nowledge on health "ractices which includes growth and develo"mentconce"ts, hygiene, nutrition, activities, educational and social as"ects.

-o inter"ret the data that will be gathered from the res"ondents, the following continuum

will be utili#ed.

Continuum for :A@- II

$eight @es"onses Continuum

0 *trongly Agree 0.5 ; 5.

/ *eldom Agree /.5 1 0.56

& !isagree &.5 1 /.06

*trongly disagree. 1 &.06


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22

Samplin" Plan

-he researchers select the res"ondents of the study who are the "arents or the guardians

of elementary "u"ils from inder I to rade 4, aging from 0 to& years old, studying at ABC,

!i"olog City. -he sam"ling designs that will be used are the convenient and "ur"osive sam"ling

design where Ms. oanna B. auculan, @> conducted an initial survey at ABC, !i"olog City and

identified those elementary "u"ils who are considered as obese with a BMI greater than or eFual

to /.

-he statistical instruments that will be used to gather relevant data are the researcher;

made Fuestionnaires and structured interview to clarify. -he data then will be analy#ed using the

freFuency, "ercentage, and weighted mean, and with the use of Minitab statistical software to

determine whether or not significant relationshi" between the %nowledge and "ractices of

elementary "u"ils that are consider as obese exist.

Data 1atherin" Procedure&

-he researchers will submit a letter signed by the !ean of the *chool of >ursing. -hesaid letter contains information regarding the need for a""roval of the "rinci"al of the elementary

de"artment in ABC, Mr. $illiam -. :inili, allowing the researchers to conduct the study.

Moreover, it includes the "ermission of inFuiring as to how many obese "u"ils are enrolled. -he

researchers will identify who among those obese "u"ils with characteristics that meet the

eligibility criteria of the study. After identifying the "ros"ective "artici"ants, they will be

a""roached and will be given an informed consent.

-he researchers will meet first as a grou" to come u" with a "lan on how to a""roach the

res"ondents. !uring the actual data gathering, the researchers will be using Fuestionnaires that

are "hrased in Cebuano. -he researchers will confirm the semantic eFuivalents in the Cebuano

;"hrased Fuestionnaire by bac%;translation, that is, by bac%;translating the Cebuano ;"hrased

Fuestionnaire into ?nglish and then com"aring the bac%;translation with the original

Fuestionnaire.


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23

-he Fuestionnaire consists of three "arts ( the "rofile of the res"ondents (& the factors

contributing to childhood obesity among elementary "u"ils with regards to "hysical, social,

emotional, "hysiological, and mental as"ects (/ the significant differences in the factors

contributing to childhood obesity among elementary "u"ils. Before the Cebuano;"hrased

Fuestionnaires will be disseminated to the res"ective "artici"ants, they will be submitted to the

research adviser for validation and revision until they will be ready and will be distributed to the

study res"ondents. An initial draft of the Fuestionnaires will be "resented to the adviser, research,

and grammar consultants to correct the errors in the sentences, grammars, and to identify

a""ro"riate Fuestions for the study.

-he effectiveness and a""ro"riateness of the Fuestionnaires will be tested through

conducting a "ilot study consisting of at least & res"ondents at *t. Nincent8s Basic ?ducation

Cam"us. -he researchers will be divided by "air and will go to the said res"ondents and conduct

the "ilot study through using the researcher;made Fuestionnaires. -he researchers will first

ex"lain the content of the Fuestionnaire to the res"ondents, guide them in answering the

Fuestionnaires and answer their Fuestions or clarifications. After conducting the "ilot study, the

researchers will then analy#e the results and ma%e any necessary changes and revision on the

Fuestionnaires. -he revised Fuestionnaires will be chec%ed and a""roved by the adviser, research

and grammar consultant before giving the research instrument to the res"ondents in the actual

study.)n the "ilot study and actual data gathering, the study "artici"ants will be informed about

their rights to refuse or terminate coo"eration at any "oint. -he researchers will address Fuestions

from the res"ondents and thoroughly discuss and clear details.


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24

Stati&tical Method

-he researchers will utili#e the following statistical methods and "rocedures namely=

freFuencies and "ercentage, a weighted average, t;test and :earson :roduct;Moment CorrelationCoefficient r.

3reFuency count and "ercentage will be utili#ed to describe the "rofile of the

res"ondents. As illustrated below=

Formula(

P3456 7 ' 8 $99

N

$eighted average will be utili#ed to ascertain the res"ondents8 res"onses on the Fuestions

fielded by the researchers. -he $eighted Mean 3ormula is illustrated belowD

-he Chi;*Fuare will measure observed behaviors from ex"ected behavior and establish if

there is significant differences between them. Chi;sFuare (P 2 "rocedures measures the

differences between observed (O and ex"ected (EfreFuencies of nominal variables, in which

the subects are grou"ed in categories or cells. -his study will use the oodness of 3it -est ty"e

of chi;sFuare analysis. -he oodness of 3it -est is a""lied to a single nominal variableand

$here=

: Q :ercentage

f Q 3reFuency

> Q -otal @es"ondents

Formula(

8 6 7 '

N

$here=

x Q weighted mean

f Q freFuency

w Q weight

> Q number of cases


25/27

25

determines whether the freFuencies we observe in k categories fit what we might ex"ect. *ome

textboo%s call this "rocedure the Badness of 3it -est because a significant P 2 value means that

Observed counts do not fit what we E xpect. -he oodness of 3it -est can be a""lied with equal

or proportional ex"ected freFuencies.

Formula(

P 2 = Σ

REFERENCES

$here=

Σ = Summation

O = Observed Value

E = Expected Value

_ 0 -- E_

E


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