Background of the study: Obesity is becoming a major concern not only in developed countries but in developing countries aswell. Lack of physical activity among adolescents is the main reason for obesity among all age group especially adolescents. In addition they are not provided with adequate time to participate in games and other physical activities. The natural consequences of over-nutrition, sedentary lifestyles, unhealthy eating, and wrong choices of food preferences and lack of exercise will increase the childhood obesity in developing countries like India. Unfortunately obesity in childhood tracts in to their adult life resulting in an increased risk of morbidity and mortality in adulthood. The aim of this study was to assess the effectiveness of interventional program which consisted of structured training on obesity prevention and Zumba exercise for adolescents who attend school (both private and government) from randomly selected schools in Vellore.
Objectives of the Study wereto
Determine the prevalence of overweight and obesity in 10-18 year old school going adolescents in Vellore.
1. Assess the perception of the parent and the child about overweight/obesity, to study the effectiveness of a school based intervention program for 3 months in changing the BMI, body composition, fitness and health related behavior of adolescents aged 10-18 years as compared to the control group.
2. Determine the association between overweight, obesity and selected demographic features.
3. Determine the association between overweight, obesity and health related behavior, to reassess BMI, fitness and health related behavior of those adolescents who participated in the program (both study group and control group) 3 months after completion of the intervention.
Methods: The investigator after obtaining clearance from the College of Nursing, ethical committee and Institutional Review Board of C.M.C Vellore, sought permission from the Chief Educational Officer to conduct the study in the schools of Vellore city. The school principals were contacted to obtain permission and to learn the feasibility of the study methods. The prevalence of obesity among school adolescents was determined by measuring the weight, height and waist circumference. BMI was calculated from the recorded weight and height. Their body composition was assessed using a bioimpedance machine. The heart rate and blood pressure of the adolescents were assessed;physical fitness of the participants was also assessed with the assistance of the physical fitness teachers of the respective schools.The intervention which included structured training program (two sessions per month for two months and ‘Zumba exercise three days a week for three months was carried on.Post intervention BMI,Body fat, Physical fitness, nutritional assessments were carried on by another trained personnel and compared with the pre interventional data.
Data collection tools
The demographic details were filled by one of the parents(Appendix-1). The principal investigator measured the weight, height, waist circumferenceof the participants. Body mass index was calculated from that.The bioimpedence machine was used to assess BMI and the body fat composition. The participants’blood pressure and heart rate were measured. The intervention was measured and compared. A 24 hour dietary recall was done as a baseline for all study subjects by the nutritionist. To assess the health related factors, a questionnaire with 27 questions wereused, which was completed by the participants and one of the parent’s (Appendix-3a).To assess perception of over weight and obesity, a questionnaire consisting of 10 statements in Tamil and English was administered to participants and their parents. The school based intervention program (“Zumba exercise and structured teaching sessions) wasused for the experimental group and the primary outcomes (BMI) and secondary outcomes such as physical activity; eating, sleeping and sedentary behavior in children before and after the intervention was assessed.
Validity and reliability: The content validity of the tools had been already checked by the investigator who had done a study on obese children attending Child Health OPD in the year 2009, this study involved only teaching and no physical activity interventions. The validated tool was used for thestudy.(Content Validity score: 1)Reliability was checked by performing a pilot study.
Statistical analysis: The data was screened for outlier and extreme values using the histogram, Box-Cox plots. The prevalence of Obesity and overweight was described as percent with 95% CI based on gender and age of the participants. Perception of obesity by the adolescent and the parent was also expressed as a percentage. Independent-‘t’ test was used to assess the effectiveness of the intervention on the BMI, body fat, physical fitness and the risk factors including nutritional intake. Association of overweight, obesity and risk factors such as eating,sleeping and physical activity and also an association between overweight, obesity and demographic variables were assessed using chi square test.
Results: It was noted that the prevalence of overweight was8.4 % and obesity was 1.9%among the subjects studied. The mean overall perception of overweight and obesity was 70% for mothers and 68% for adolescents. The BMI of the participants reduced to 5% from the baseline after three months of intervention as hypothesized and to 2.5% after 6months of intervention(p <0.001).The systolic pressure was higher among the obese adolescents. There was a significant reduction in calorie and fat intake after the intervention(p<0.001). It was found the demographic features such as educational status of the mother and father, monthly family income, working status of both father and mother, eating pattern (vegetarian and non-vegetarian), area of residence and type of family had significant association(p<0.001). Association of overweight, obesity and risk factors such as physical activity, eating habits and sleeping habits was done and was found that there was association(p<001) in areas like –age of the adolescents, educational status of both parents, working status of both parents, eating pattern(Vegetarian/NonVegetarian intake), area of residence(urban/rural, number of siblings in the family.
Interpretation & Conclusion: Overweight and obesity continue to be a pressing issue among adolescents as the prevalence rate is 10.2 and 2% respectively among the school going adolescents of Vellore district. Interventional programs such as Zumba exercise and structured training was effective in reducing the BMI to 5% compared to the baseline BMI. This impact continued even 3monthsafter the intervention was discontinued (2.5% reduction at the 6th month after the intervention) which reveals that the school adolescents would have continued to do the Zumba exercise as instructed by the investigator. Therefore we propose that such interventions if introduced in all the schools in Vellore city atleast twice a week in addition to the regularly scheduled physical education at school will be very beneficial in maintaining the BMI and physical fitness of the adolescents at the optimum level or may be modified where physical education is made mandatory for all five to six days in a week.