RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Ms.RAJILY.C.ROY1ST YEAR MSc. NURSING
THE OXFORD COLLEGE OF NURSING,
NO.6/9 & 6/11,1ST CROSS,
BEGUR ROAD, HONGASANDRA, BENGALURU -560068
2. / NAME OF THE INSTITUTION / THE OXFORD COLLEGE OF NURSING,
NO.6/9 & 6/11,1ST CROSS,
BEGUR ROAD, HONGASANDRA, BENGALURU -560068
3. / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING,
MEDICAL SURGICAL NURSING
4. / DATE OF ADMISSION TO THE COURSE / 09-05-2012
5. / TITLE OF THE
TOPIC / EFFECTIVENESS OF LEARNING MODULE ON AWARENESS AND PREVENTION OF OBESITY RELATED COMPLICATIONS AMONG YOUNG ADULTS IN SELECTED COMMUNITY AREA BEGUR, BENGALURU.
6. BRIEF RESUME OF THE INTENDED STUDY
INTRODUCTION
“Disease can rarely be eliminated through early diagnosis or good treatment but
prevention can eliminate disease’’.
Denis Burkitt
‘Health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.’ - World Health Organization1
Living a healthier life can not only extend your life, it can also improve the quality. Feeling physically better and having control over your own life can greatly increase your mental health as well. Although there are some aspects of physical and mental health that are beyond an individual's control, there are many things that people can do to improve their quality of life.2
Obesity is a leading preventable cause of death worldwide, with increasing prevalence in adults and children, and authorities view it as one of the most serious public health problems of the 21st century. Obesity is stigmatized in much of the modern world, though it was widely perceived as a symbol of wealth and fertility at other times in history, and still is in some parts.3
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. People are considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight in kilograms by the square of the person's height in meters, exceeds 30 kg/m2.3
Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications or psychiatric illness. Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited; on average obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body.3
Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, hypertension, stroke, sleep apnea and other sleeping problems,high LDL (“bad”) cholesterol,certain types of cancer, osteoarthritis, nonalcoholic fatty liver disease,asthma, gallbladder disease, complications of pregnancy, menstrual irregularitiesetc.3
Dieting and physical exercise are the mainstays of treatment for obesity. Diet quality can be improved by reducing the consumption of energy-dense foods such as those high in fat and sugars, and by increasing the intake of dietary fiber. Anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption together with a suitable diet. If diet, exercise and medication are not effective, a gastric balloon may assist with weight loss, or surgery may be performed to reduce stomach volume and or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from food.3
“In every region of the world, obesity doubled between 1980 and 2008,” says Dr Ties Boerma, Director of the Department of Health Statistics and Information Systems at WHO. “Today, half a billion people (12% of the world’s population) are considered obese.” The highest obesity levels are in the WHO Region of the Americas (26% of adults) and the lowest in the WHO South-East Asia Region (3% obese). In all parts of the world, women are more likely to be obese than men, and thus at greater risk of diabetes, cardiovascular disease and some cancers.4 The WHO projects that in 2015, the number of overweight adults will balloon to 2.3 billion, up from 1.6 billion in 2005. And the number of obese will rise to 700 million, up from 400 million.5
India is the second most populous country in the world that comprises 17% of the world's population and contributes to 16% of the world's deaths. Nutritional status of the Indian population varies significantly across the regions. Earlier, developing countries, including India, had focused scarce public health resources primarily on the high prevalence of under nutrition. However, these nations are currently facing the double burden of under nutrition as well as over nutrition. Data regarding the nutritional status of adults, as determined by body mass index (BMI), indicate that 50% of Indian adults suffer from different types of chronic energy deficiency, in that they have a BMI<18.5 kg/m 2 . In the same survey, it was observed that the BMI values were similar in men and women; however, there were more overweight/obese (BMI≥25 kg/m 2) women (6.6%) than men (3.5%). In certain regions, obesity and consequent diseases are posing an enormous public health problem.6
According to the National Family Health Survey (NFHS), the percentage of ever-married women aged 15-49 years who are overweight or obese increased from 11% in NFHS- 2 to 15% in NFHS-3. Under nutrition is more prevalent in rural areas, whereas overweight and obesity are more than three times higher in urban areas. This may be due to lesser physical activity in the urban areas. Furthermore, under nutrition and overweight/obesity are both higher for women than men. This dual disease pattern in women may have an endocrine basis, but more probably has its roots in societal and cultural mores, which prevent women from leading a healthy lifestyle. The percentage of women who are overweight or obese is highest in Punjab (30%), followed by Kerala (28%) and Delhi (26%), all of which are relatively richer states.6
A research study on prevalence of obesity in Bengaluru city conducted on 2010 by Dr Izharul Hassan. He designed this study with the objective to determine the prevalence of obesity and overweight among Bangalore of both gender, between the age of 30-70 years in rural as well as in urban communities over a 2-year period between 2006 and 2008.The prevalence of overweight was 36.9%.overweight is significantly more prevalent in males(42.4%) compared to 31.8%of females. The age adjusted prevalence of obesity was 35.5%in Bangalore with an overall prevalence of 35.6%. Female are significantly more obese with a prevalence of 44% than male 26.4%. Obesity and overweight are increasing in Bengaluruwith an overall obesity prevalence of 35.5%.reduction in overweight and obesity are of considerable importance to public health.7
A study was designed to find out the extent of the problem of obesity and people's awareness about risk factors and complications of obesity. A cross sectional survey was conducted in Coimbatore district between March and September 2003 in which 537 urban women and 661 rural women aged 20 years and older in Coimbatore were randomly selected, interviewed and the BMI was assessed. The prevalence of overweight in urban area was 43.9% and in rural area was 23.6%. 43% of women failed to recognize that obesity can lead to Diabetes and 37% failed to do so regarding its contribution to Heart attack. When asked about the causes, being happy was suggested as a cause by 60%, whereas 30% failed to mention excess eating and 26% failed to mention lack of exercise. Among the overweight women a large proportion of them (36%) did not consider themselves to be overweight. The concordance between Self-perception and BMI using Kappa index was 0.552 corresponding to only a moderate degree of agreement. The percentage of misperceived as not overweight was higher for those having BMI less than 30 kg/m2.8
Five important conclusions can be derived from the present study. First a considerable proportion of persons do not recognize the complications of overweight and obesity. Second, the population groups with lowest level of knowledge about the complications of overweight were younger females, women with elementary education, skilled laborers, those with low standard of living and people residing in rural areas. Third, the concordance between self-perception and BMI showed that there is only a moderate degree of agreement. Hence a considerable proportion of persons do not recognize a certain level of overweight as being a matter of concern, a necessary condition to becoming conscious of the need for healthy weight reduction. Fourth, a substantial group, do not relate overweight to diet or lack of exercise. Fifth, the prevalence of misperceived as not overweight was higher in the moderate levels of overweight. It is in these levels of overweight that a treatment based on moderate dietary restriction and increased physical activity can more effectively reduce the prevalence of overweight. Hence programs on weight reduction should also focus on improving consciousness of perception of "normal weight" together with the risks associated with overweight as well as on the importance of recognizing overweight.8
A study conducted onto prevalence of overweight and obesity among urban & rural adolescents in Surat (Gujarat, India). The data were derived from cross-sectional sampling of children, 176 in rural and 213 in urban, aged 14–16 years doing study in government schools in year of 2009. Age, gender and body mass index (BMI) were used todefine overweight and obesity. The prevalence of obesity increased significantly from 12.8% in rural to 14.6% in urban (p<0.01), whereas underweight decreased from 13.6% to 4.6% (p<0.001). There was a significantly higher risk of being overweight andobese in urban than rural, after adjusting for age, gender. Urban Males had significantly higher increase in prevalence and risk of being overweight and obese. This study showed an increasing in prevalence of overweight and obesity in urban adolescents especially with male gender, calling for an urgent need for immediate and targeted preventive measures In conclusion, we report that the prevalence of obesity has increased in urban adolescents .In addition, male gender and higher socioeconomic status is associated with a significant risk of being both overweight and obese. Countrywide awareness programs to spread healthy messages on good nutrition and good health for the prevention of obesity and its consequences need to be initiated. These shall not only promote good health, but shall also help in the prevention of non-communicable diseases as diabetes, heart problems, and other related diseases. On the long run, such programs shall act to reduce the burden on economic growth of the nation.9
6.1. NEED FOR THE STUDY
“That’s an important finding, because it tells us that weight control at a younger age is really important if we want to reduce the risk of this disease.”
Donghui Li
Obesity is increasing at an alarming rate throughout the world. Today it is estimated that there are more than 300 million obese people world-wide. Obesity is defined as a condition of excess body fat and is associated with a large number of debilitating and life-threatening disorders. The prevalence of obesity is increasing in most part of the world, affecting men, women and children. Furthermore, obesity is no longer just a concern for developed countries, but it is becoming an increasing problem in many developing countries. In order to prevent obesity, it is important to be aware of its prevalence. Obesity in the young adult population has increased significantly in the past thirty year.10
For thousands of years obesity was rarely seen. It was not until the 20th century that it became common, so much so that in 1997 the World Health Organization (WHO) formally recognized obesity as a global epidemic. As of 2005 the WHO estimates that at least 400 million adults (9.8%) are obese, with higher rates among women than men. As of 2008, The World Health Organization claimed that 1.5 billion adults, 20 and older, were overweight and of these over 200 million men and nearly 300 million women were obese. The rate of obesity also increases with age at least up to 50 or 60 years old. Once considered a problem only of high-income countries, obesity rates are rising worldwide. These increases have been felt most dramatically in urban settings. The only remaining region of the world where obesity is not common is sub-Saharan Africa.11
Obesity has reached epidemic proportions in India in the 21st century, with morbid obesity affecting 5% of the country's population. Urbanization and modernization has been associated with obesity. In Northern India obesity was most prevalent in urban populations (male = 5.5%, female = 12.6%), followed by the urban slums (male = 1.9%, female = 7.2%). Obesity rates were the lowest in rural populations (male = 1.6%, female = 3.8%). Socioeconomic class also had an effect on the rate of obesity. Women of high socioeconomic class had rates of 10.4% as opposed to 0.9% in women of low socioeconomic class. With people moving into urban centers and wealth increasing, concerns about an obesity epidemic in India are growing.11
BBC news reported that the World Health Organization predicts there will be 2.3 billion overweight adults in the world by 2015 and more than 700 million of them will be obese It is predicted that the levels of obesity will continue to rise unless action is taken now. WHO has warned “the growth in the number of severely overweight adults to double that of underweight during 1995-2025” (WHO 1998). From existing data it has been projected that by the year 2030 levels of obesity could be as high as 50-80% in the USA, between 30-40% in Australia, England and Mauritius and over 20% in some developing countries. Once it occurs it is difficult to treat. Prevention of weight gain offers the most effective means of controlling obesity. This means we need to start with children and young people.12