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Eat well Program in Obesity : A study on obesity and eating well program outcome amongst professional college students in Kanpur District.    

 INTRODUCTION

Non-communicable diseases continue to be important public health problems in the world, being responsible for sizeable mortality and morbidity. Non-communicable diseases (NCDs). obesity are the leading causes of death and disability worldwide. In 2005 NCDs caused an estimated 35 million deaths, 60% of all deaths globally, with 80% in low income and middle-income countries and approximately 16 million deaths in people less than 70 years of age. Total deaths from NCDs are projected to increases by a further 17% over the next 10 years. The changing pattern of lifestyle leads to the development of obesity, stroke, stress, atherosclerosis, cancer and other NCDs. According to the WHO criteria there are three steps for screening of NCDs. Step 1: Estimation population need through assessing the current risk profile and advocate for action. Step 2: Formulate and adopt NCD policy. Step 3: Identify policy implementation steps. Management of NCDs should be to increased awareness among the public regarding the signs and symptoms of the disease and its complications. Health promotion strategies, with a strong focus on disease prevention, are needed to empower people to act both individually and collectively to prevent risky behavior, and to create economic, political and environmental conditions that prevent NCDs and their risks.[1]

Obesity is now so common within the world’s population that it is beginning to replace undernutrition and infectious diseases as the most significant contributor to ill health. In particular, obesity is associated with diabetes mellitus, coronary heart disease, certain forms of cancer, and sleep-breathing disorders. Obesity is defined by a body-mass index (weight divided by square of the height) of 30 kg m−2 or greater, but this does not take into account the morbidity and mortality associated with more modest degrees of overweight, nor the detrimental effect of intra-abdominal fat. The global epidemic of obesity results from a combination of genetic susceptibility, increased availability of high-energy foods and decreased requirement for physical activity in modern society. Obesity should no longer be regarded simply as a cosmetic problem affecting certain individuals, but an epidemic that threatens global wellbeing.[2]

Obesity, which broadly refers to excess body fat, has become an important public health problem. Its prevalence continues to increase worldwide. As the prevalence of obesity increases so does the burden of its associated co-morbidities. However, not only does the total body fat matter but also the pattern of distribution. Excess visceral fat, also referred to as central obesity, has a stronger association with cardiovascular disease than subcutaneous fat with is deposited mainly around the hips and buttocks. Central obesity produces a characteristic body shape which resembles an apple and thus is also referred to as “apple shaped” obesity as opposed to “pear shaped” obesity in which fat is deposited on the hips and buttocks circumference and Waist: Hip ratio (WHR), i.e. the ratio of the hip circumference to waist circumference.

Morbidities related obesity are -Impaired glucose tolerance test and diabetes mellitus, heart diseases, dyslipidemia, cerebro vascular diseases, metabolic syndrome, pulmonary abnormalities, osteoarthritis, gastrointestinal abnormalities, cancer, physic social problems, etc. [3]

Obesity, a multifaceted and prevalent health concern, arises from the intricate interplay of various risk factors that span genetic, environmental, and lifestyle domains. As societies undergo rapid transformations in diet, physical activity patterns, and overall living conditions, the prevalence of obesity has surged, constituting a significant global public health challenge. The etiology of obesity is complex, with numerous factors converging to influence body weight regulation and adipose tissue accumulation. This thesis aims to delve into the diverse risk factors contributing to obesity, unraveling the connections between genetics, environmental influences, lifestyle choices, and their collective impact on the escalating rates of obesity worldwide. Understanding the intricate web of contributors is imperative for developing targeted interventions and public health strategies to mitigate the burden of obesity and its associated health consequences.

To improve the public health in India and to combat negative nutritional trends to fight

lifestyle diseases, Food Safety and Standards Authority of India, (FSSAI) launched ‘The Eat

Right Movement’ on 10th July, 2018. The food industry, public health professionals, civil

society and consumer organizations, influencers and celebrities came together on a common

platform and pledged to take concrete steps to amplify ‘The Eat Right Movement’ in the

country. This movement is aligned with the government’s flagship public health programmes

such as POSHAN Abhiyaan, Anemia Mukt Bharat, Ayushman Bharat Yojana and Swachh

Bharat Mission.

‘The Eat Right Movement’ is built on two broad pillars of ‘Eat Healthy’ and ‘Eat Safe’. It is a

collective effort to make both the demand and supply side interventions through engagement

of key stakeholders.

The main objectives of the study were to integrate “Eat Right Movement” campaign into the school environment and to improve the awareness of the students about nutrition and health. The sub objectives of the study are i) to assess the nutritional status of the school students, ii) to study the knowledge of school students about nutrition, iii) to improve eating habits of students through teaching nutrition and iv) to sensitize the parents about the “Eat Right Movement” [3]

 

           

                        Review of literature

  • Global overview

 

Plotnikoff RC et al; (2015) did descriptive study on effectiveness of intervention targeting   physical activity, nutrition and healthy weight for university and college students.

 

To examine the effectiveness of interventions aimed at improving physical activity, diet, and/or weight-related behaviors amongst university/college students. Five online databases were searched (January 1970 to April 2014). Experimental study designs were eligible for inclusion. Data extraction was performed by one reviewer using a standardized form developed by the researchers and checked by a second reviewer. Data were described in a narrative synthesis and meta-analyses were conducted when appropriate.

 

Forty-one studies were included; of these, 34 reported significant improvements in one of the key outcomes. Of the studies examining physical activity 18/29 yielded significant results, with meta-analysis demonstrating significant increases in moderate physical activity in intervention groups compared to control. Of the studies examining nutrition, 12/24 reported significantly improved outcomes; only 4/12 assessing weight loss outcomes found significant weight reduction.

 

Overall, 41 studies targeting improvements in student health outcomes (physical activity, diet,       weight loss) within tertiary education settings met the inclusion/exclusion criteria. Study characteristics (i.e., country, target sample and size, age, duration, intervention and retention) and risk of bias scores are summarized. Risk of bias assessment indicated eight studies had a negative rating (high risk of bias), 30 were considered neutral, and the remaining four had a positive rating (low risk of bias).[10]

 

  • Indian overview

 

Ameena RN et al;(2020) conducted ‘Eat Right Movement Campaign ‘into the school environment, study sample consisted of 100 adolescents of age 11-13 years among them 50 each were from a government school and a private school. It was aimed to improve nutritional knowledge, attitude towards food and to inculcate good eating practices amongst school going adolescents so as to enhance their quality of life. The results of the study showed that by incorporating age appropriate fun activities, the students were able to imbibe knowledge with regard to nutrition and make positive changes in attitudes and practices. This study was able to create positive nutritional awareness amongst the adolescents and their parents. Thus, this study proved that Eat Right Movement can be successfully integrated across the schools of the State and Nation.[4]

 

 

PENGPID S et al;(2014 NOV) conducted study on Prevalence of overweight/obesity and central obesity and its associated factors among a sample of university students in India. Obesity research & clinical practice.

 

The study found a high prevalence of overweight/obesity and central obesity. Several gender specific health risk practices were identified including lack of dietary risk knowledge, shorter sleep duration, living away from parents or guardians, tobacco use and lack of social support and religiousness that can be utilized in health promotion programs.

37.5% were overweight or obese, 26.8% overweight (≥23–27.4 BMI) and 10.7% obese (≥27.5 kg/m2), 11.7% underweight (<18.5 kg/m2) and 16.4% central obesity (WC ≥90 cm for men and ≥80 cm for women). In multivariate analysis among men lack of non-organized religious activity (odds ratio = OR 0.85, confidence interval = CI 0.77–0.95), lower dietary risk knowledge (OR = 0.64, CI = 0.41–0.99), tobacco use (OR = 2.23, CI = 1.14–4.38), and suffering from depression (OR = 1.59, CI = 1.00–2.47) were associated with overweight/obesity, and younger age (OR = 0.32, CI = 0.12–0.90), lives away from parents or guardians (OR = 1.79, CI = 1.04–3.07), healthy dietary practices (OR = 1.95, CI = 1.02–3.72) and 9 or more hours sleep duration (OR = 0.28, CI = 0.09–0.96) were associated with central obesity. In bivariate analysis among women, lack of social support, lower dietary risk knowledge, tobacco use, and 9 or more hours sleep duration were associated with overweight/obesity and lives away from parents or guardians and abstinence from alcohol associated with central obesity.[9]

 

 

Gangwar V et al; (2019 Jan) conducted study on Study of Overweight and Obesity and Associated Factors among Undergraduate Medical Students in North India.

The study showed high prevalence of overweight (30.2%) and obesity (3.9%). Obesity was significantly associated with non-vegetarian diet (p0.05). The importance of healthy eating habits and healthy life style needs to be emphasized. We created awareness for healthy living among medical students during the study.

The present study was conducted on 129 medical students, out of them 65 (50.4%) were males and 64 (49.6%) were females. Out of total students, 85 (65.9%) were normal weight, 39 (30.2%) were overweight and 5 (3.9%) were obese according to BMI. Nobody was underweight in our study group. 87 (67.4%) students had normal waist-hip ratio and 42 (32.6%) were obese. Waist-hip ratio was significantly higher in male students than the female students (p0.05) . We also observed that 45 (34.9%) students were vegetarian and rests (65.1%) were non-vegetarian. Prevalence of obesity was significantly higher in nonvegetarian than vegetarian students (p< 0.05)

33.3% students were exercising regularly while 66.7% were not exercising at all (table III). History of endocrine disorders were only in 7 (5.4%) students and history of menstrual disorders was present in 6.3% (n= 4) female subjects only. 13.2% students had family history of overweight/obesity while 34.9% had family history of diabetes mellitus. There was no significant difference in the prevalence of obesity/ overweight and family history of diabetes/ obesity. 76% students had normal sleep duration. 16% students slept for 8 hours. There was no significant difference between sleep duration and BMI (P> 0.05). There was no significant difference in the prevalence of obesity and duration of sleep. Prevalence of overweight and obesity was highest in students with blood group B (12.4%) and least in blood group AB (0%). Prevalence of obesity was 1.6% in students with blood group A and B [7]

 

  • State overview

 

Tiwari HC et al. (2014) conducted cross sectional study in 2014 Jan on Overweight & obesity and its correlates among school going adolescents of district Allahabad. The magnitude of overweight/obesity among school going adolescents of Allahabad was found to be 7.7%. Regular participation in household activities &outdoor games and healthy eating habit should be emphasized at individual level, family level & school level to curb this problem. A total of 940 students were included in this study. Among these 50.5% belonged to urban & 49.5% belonged to rural area. Males were 53.7% while 46.3% were females with mean age-15.5 years ±1.25 SD. Overall prevalence of overweight & obesity was found to be 6.6% & 1.1% respectively. Prevalence of overweight was maximum in late adolescence (8.3%). The prevalence of overweight was found higher among female students (7.4 %) as compared to male students (5.9%) (Table-1). Prevalence of overweight & obesity was found significantly higher among urban students (10.1% and 1.7%) than rural students (3.0% and 0.4%) respectively. Among urban students, prevalence of overweight & obesity was found to be 13.0% & 2.1% among female students and 8.2% and 1.4% among male students. Among rural students, 3.1% males were overweight and no obese male was found. The prevalence of overweight and obesity among female students was 2.9% and 0.8% respectively. Prevalence of overweight & obesity was found higher in students belonging to socioeconomic class I (11.7% & 2.2%) followed by socioeconomic class II (overweight 7.4% & obesity 1.1%)

Majority (45.3%) had participated in outdoor games for >6 hour/week, while (32.0%) did not participate at all. Only 14.6% participated in household activity for >3 hrs./day while 52.7% participated in household activity for 1-3 hrs./day. Majority of the students (67%) did not go for walks and only 10.8% walked regularly for more than 1hr/day.

Prevalence of overweight/obesity was found to be significantly higher among the students who did not participate in various physical activities like outdoor games, household activities and were watching television daily for longer durations. Prevalence of overweight/obesity was significantly higher among those students who were taking fast foods & junk drinks frequently (≥3 times/week).

Final model of binary logistic regression analysis revealed that risk of overweight and obesity was 2.4 times higher among the adolescents who belonged to socioeconomic status class I, as compared to socioeconomic class III and below. The risk of overweight and obesity was 2.6 times higher among adolescents who either did not participate in any household activity or participated for less than 1 hour/day compared to who participated for more than 3 hours/day, 2.3 times higher among adolescents who did not participate in outdoor games and sports as compared to those who participated for >6 hour/week. It was 2.6 times higher among adolescents who watched television ≥3hrs/day in comparison to those who either did not watch or watched it for less than 1 hour. The risk of overweight & obesity was 1.8 times higher among adolescents who consumed fast foods frequently [8]

 

 

Alpana Saxena (2015) conducted study on 260 college students. The information such as name, age, gender, present weight (Kg) and height (m) was measured. All subjects were subjected to BMI and was calculated by dividing a person’s body weight by their height (weight [kg] / height [m²].

Obesity is increasing in students. The most common reason is frequent use of fast food, alcohol, soft drink and lack of exercise.

Subjects underweight were (males- 15, females- 20), normal weight (males- 50, females- 74), over weight (males- 17, females- 22), pre- obese (males- 20, females- 22) and obese (males- 8, females- 11). The difference was non- significant (P > 0.05). the prevalence of obesity was 7.27% in males and 7.33% in female.

Risk factor were soft drink, fast food and alcoholism. [11]

 

Rationale of Study

  • Obesity is public health problem in India and it leads to many non-communicable diseases like Cancer, Diabetes, etc.
  • Its importance to know risk factor (Dietary, Physical, Inactivity related, substance abuse, etc.)
  • This study is an attempt to eating healthy foods amongst college students.
  • The study will look at the nutrition knowledge, attitude and practices followed by a selected group of students and introduced interventions to improve their existing nutritional awareness.
  • A standardized questionnaire method is developed and used to collect the relevant data of the students which included socio-economic, personal, health profile, diet profile and lifestyle particulars data (N=380).
  • To collect information regarding demographic characteristics.
  • To evaluate data pertaining to lifestyle sugar, salt and fat consumption among college students.

 

Lacunae in existing knowledge

  • No recent study from Kanpur Region.
  • Eat right campaign finding not done in Kanpur region.

 

                                   Limitation of study

  • It cannot be done generalized to whole Indian population.
  • This is longitudinal study which have own limitation, further multicentric study is needed to know the exact quantum of problem so that obesity can be prevented at the earliest.

 

 

Research question and hypothesis

  • What is the prevalence of overweight in college student?
  • What is risk factor associated (junk food, in activity, smoking, alcohol).
  • Effect of eat well programme in them after 6 months of time?

 

 Aim:  To find out Obesity & “Eating well program” outcome in professional college.

 

Objectives:

1) To study the prevalence of obesity & overweight in college of Kanpur.

2)To study risk factor related to obesity & overweight.

3) To Measure outcome of eating well program among students.

 

MATERIAL AND METHODS

  • Study Design:    Longitudinal study
  • Study setting: ITI College, Sarvodaya Nagar, Kanpur
  • Study population: Students 18 years to 22 years of age
  • Study Period:2 years from March 2024 to February 2026
  • Study tool: Predesigned questionnaire
  • Inclusion: –
  • 1) 18-22 years age group.
  • 2) Students Found at that time of two visit
  • Exclusion Criteria: –

Students not willing to participate in the study

Sample Size Estimation:

Based on the prevalence rate of morbidity (38%) as per study done by Gangwar V et al; (2019 Jan) [7], the required sample size has been calculated by using the formula;

[n= z²pq/d²]

Where ‘n’ is the minimum sample size; ‘z’ denotes the level of confidence according to the normal standard distribution that corresponds to the 95% confidence interval (z= 1.96); ‘p’ stands for the prevalence; ‘q’ is the complement of p (q= 1-p); and ‘d’ pertains to the desired degree of accuracy or tolerated margin of error/ absolute error.

Based on the prevalence of rate of morbidity (38%)

The required sample size is:

As p= 38%, z= 1.96, q= 100-38= 62,

d=absolute error= 5%

n= (1.96) ² x 38 x62/ 2²

n= 362

Taking into consideration non-response of 5%,

Estimated sample size, n= 380.

 

 

Definition used for study purpose

 

Obesity-Obesity can be defined as an excessive amount of fat that increases the risk of medical illness and premature death.

 

Body Mass Index (BMI)- Methods of estimating body composition include measuring weight and weight for height, body mass index (BMI), waist circumference. Of these, perhaps the most convenient is BMI, which can be calculated according to the following formula: BMI = weight (kg)/(height) (m2) Body Mass Index (BMI), a measurement which compares weight and height, defines people as underweight, normal weight, overweight (pre-obese) and obese. The WHO regards a BMI of less Underweight: BMI less than 18.5

WHO Guidelines for Asian

Normal weight: BMI 18.5 to 22.9 Asian

Overweight: BMI 23 to 25

Obesity: BMI >25 or greater.

 

The measurement of height, a fundamental anthropometric parameter, follows standardized procedures outlined by the World Health Organization (WHO) to ensure consistency and accuracy. The following steps are employed:

 

1.Equipment: Utilize a calibrated stadiometer, a vertical measurement device with a flat base and a sliding headpiece. Ensure the stadiometer is positioned on a level and flat surface.

2.Preparation: Request the participant to remove shoes and any headgear that might interfere with the accuracy of the measurement. Instruct the participant to stand erect with heels together, feet flat on the ground, and the back straight against the stadiometer.

3.Measurement Process: The participant’s back should be in contact with the stadiometer, with the heels, buttocks, and the back of the head making firm contact. Lower the headpiece gently until it touches the crown of the head without compressing the hair. Ensure that the eyes are in the Frankfurt horizontal plane, maintaining a natural posture without leaning.

4.Reading the Measurement: Record the height measurement to the nearest completed millimeter.

Overweight-Overweight is defined as a body mass index (BMI) of 23 or higher. Obesity is defined as a BMI of 25 or higher.

Waist Circumference >=80 for Female and   >=90 cm for Male

 

                                     METHODOLOGY

 

      Sampling method:

  1. This Longitudinal study will be done among students of ITI College in Kanpur.
    b. Study participants will be selected by simple random technique.
    c. Predesigned questionnaire will be used to gather information (General information,anthropometry)

Study tools: –

  1. Demographic characteristics.
  2. Obesity related characteristics.
  3. Behavior related characteristics

 

Outcome Measures

 

  • To find out prevalence of obesity.
  • To identify the cause of obesity and overweight in college students.
  • To educate students about eat well programme.
  • To encourage overweight students to implement eat well programme in lifestyle.
  • To measures changes in weight after 6month sessions of programme.

 

                              Statistical Methods

 

  • Descriptive statistics will be generated to determine the distribution

of socio-demographic variable.

  • Frequencies and percentages will be shown for categorical

variables.

  • Mean and SD values will be used for quantitative parameters

Appropriate statistical tests will be used for data analysis.

 

 

                          ETHICAL ISSUES?

 

  • Ethical clearance will be obtained from Institutional Ethics and Research Advisory Committee RMCHRC
  • Informed consent will be taken from study subjects.
  • Anonymity of study subjects will be maintained.

 

                                   REFERENCES

  • Habib SH, Saha S. Burden of non-communicable disease: global overview. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2010 Jan 1;4(1):41-7.
  • Kopelman PG. Obesity as a medical problem. Nature. 2000 Apr;404(6778):635-43.
  • Segula D. Complications of obesity in adults: a short review of the literature. Malawi Medical Journal. 2014 Jun 9;26(1):20-4.
  • Ameena RN, Joseph M. Integrating ‘Eat Right Movement Campaign’ into the school environment. Int. J. Home Sci. 2020; 6:332-5.
  • Tripathi S, Pathak VK, Lahariya C. Key findings from NFHS-5 India report: Observing trends of health indicators between NFHS-4 and NFHS-5. Journal of Family Medicine and Primary Care. 2023 Sep 1;12(9):1759-63
  • Siddiqui Z, Donato R. The dramatic rise in the prevalence of overweight and obesity in India: Obesity transition and the looming health care crisis. World Development. 2020 Oct 1;134:105050.
  • Gangwar V, Gahlot A, Gahlot SK, Verma MK. Study of Overweight and Obesity and Associated Factors among Undergraduate Medical Students in North India. International Journal of Physiology. 2019 Jan;7(1):103.
  • Tiwari HC, Dwivedi S, Bali S, Parveen K. Overweight & obesity and it’s correlates among school going adolescents of district Allahabad-a cross sectional study. Indian J Prev Soc Med. 2014 Jan;45(1-2):77-82.
  • Pengpid S, Peltzer K. Prevalence of overweight/obesity and central obesity and its associated factors among a sample of university students in India. Obesity research & clinical practice. 2014 Nov 1;8(6): e558-70
  • Plotnikoff RC, Costigan SA, Williams RL, Hutchesson MJ, Kennedy SG, Robards SL, Allen J, Collins CE, Callister R, Germov J. Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity. 2015 Dec;12(1):1-0.
  • Saxena A. Assessment of Risk Factors of Obesity among the College Students. Journal of Advanced Medical and Dental Sciences Research. 2018 Dec 1;6(12):12-5.

 

 

 

A- SOCIO-DEMOGRAPHIC INFORMATION

1- Name of the child-

2-Age in years-

3- Sex –   M        F

4-Types of family -a) nuclear b) joint c) extended

5-Total no. of family members-

6-Educational status of parents

  1. Father -1) illiterate 2) primary 3) middle 4) high school 5) intermediate 6) graduation 7) post graduation and above
  2. Mother -1) illiterate 2) primary 3) middle 4) high school 5) intermediate 6) graduation 7) post graduation and above

7-Occupational status of parents

a.Father –

b.Mother-

8-Total monthly income of family –

9-Social class-a)Upper  b)Upper middle  c)Middle  d)Lower middle  e)Lower

 

ANTHROPOMETRIC  EXAMINATION

 

  1. Weight(kg) –
  2. Height/length (cm)-
  3. BMI –
  4. Neck circumference
  5. Waist circumference.

 

Behaviour related characterstics

  • How many times a do you eat fast/fried food/or packaged snacks high in fat/salt/or sugar?
  • How often do you consume green leafy vegetables?
  • How often do you consume food from all the food groups in your daily diet?
  • How often do you exercise or participate in physical activity?
  • How often do you eat home cocked food?
  • How often do you consume fruits?
  • How often do you consume fruits, salad, cooked vegetables without sprinkling salt?

 

 

Eat  Right India tool has been used is provided by fssai, its material will be used in study, there is no copyright issue in using it.

 

PATIENT INFORMATION SHEET

This must be bilingual both in English and in Hindi. State the purpose of study, how the participant stands to benefit out of the study, procedures and tests that will be done, how will they be done, what would be their potential side effects or risks, if any, etc. State your name and contact number and your supervisor’s name and contact number. You must state clearly if any ethical issues exist.

 

CONSENT FORM

A study on obesity and eating well program outcome amongst professional college students in Kanpur District

 

Consent:

I have been informed about the procedures of the study. The possible risks too have been explained to me as stated in the information. I have understood that I have the right to refuse my consent or withdraw it any time during the study without adversely affecting my/my ward’s treatment. I am aware that by subjecting to this investigation, I will have to give more time for assessments by the investigating team and that these assessments do not interfere with the benefits.

I,………………………………………………………………. , the undersigned, give my consent to be a participant

of this investigation / study program/clinical trial.

 

 

Signature of the patient/guardian                                                                                            Signature of the witness (Name and address)                                                                                                                                          (Name and address)

 

 

 

Signature of the Doctor/investigator:                  Name and Designation Date:                                       Place:

 

 

“I have been explained the contents of the informed consent form in a language understandable to me and I am signing this document on my own”.

 

 

Name of the Patient/Subject/Participant:

Signature/Thumb Impression:

 

Address:

 

 

 

CERTIFICATE OF TRANSLATION

 

 

This informed consent form in Hindi version (mention language) is translated by

 

……………………………………………… (indicate name of the translator) and it is true/correct with

respect to English (original) version.

 

 

 

 

 

Translator Signature with date Translator Name:

Address:

 

                                               CANDIDATE’S CHECK LIST

 

Certificates incorporated in synopsis

Content

1.Introduction

2.review of literature

3.Aims and objective

4.Rationale of the study

5.Research question

6.Material and methods

7.Methodology.

8.Outcome measures

9.Flow chart.

10.Statistical methods

11.References

12.Annexures

  • Performa
  • Consent form
  1. Candidate checklist.

 

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