Rajive Gandhi University of Health Sciences

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

ANNEXTURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

Introduction.

“Nothing would be more tiresome than eating and drinking if God had not made them a pleasure as well as a necessity.”

Voltaire

Adolescents aged between 10 and 19 years account for 22.8 per cent of India's total population1.Adolescence marks a time of rapid and intense emotional and physical changes. There is an increased value placed on peer acceptance and approval, and a heightened attention to external influences. Body image and related self-concept emerge as significant factors associated with health and well-being during this developmental phase, as youths begin to focus more on their physical appearance. How adolescents formulate and define their body image ideals and subsequent self-comparisons is strongly influenced by personal, familial, and cultural factors.2

Eating disorders are complex illnesses that affect adolescents with increasing frequency. They rank as the third most common chronic illness in adolescent females, with an incidence of up to 5percentages, a rate that has increased dramatically over the past three decades. Two major subgroups of the disorders are recognized: anorexia nervosa, and bulimia nervosa. Both anorexia nervosa and bulimia nervosa can be associated with serious biological, psychological and sociological morbidity, and significant mortality.3

In the United States, as many as 10 million females and 1 million males are fighting a life and death battle with an eating disorder such as anorexia or bulimia. Millions more are struggling with binge eating disorder.4

Most people in India struggle to get enough to eat - one estimate is that 60percentages of India's women are clinically malnourished. But Delhi psychiatrist Sanjay Chugh says he has seen an explosion in anorexia cases over the past few years. He says a typical case could be a 17-year-old girl of around five feet six weighing just 30kg who is convinced she is overweight. The arrival of cable television and Western fashions and films has given today's teenagers the idea that thin is beautiful. Western fast foods have arrived too but as the young girls at Delhi's pizza and burger bars tuck in, they also say they want to lose weight.5

6.1 Need for the study.

Famous peoples can be inspirational - but in some cases, negatively also, Ana Carolina Reston, Brazilian fashion model, who died at age 21 from complications of anorexia in November of 2006. England's beloved Princess Diana, confessed self-harm and bulimia to the British media.6 Anna Freud, who was a psychotherapist, documented that she struggled with anorexia when she was younger.7

According to the National Institute of Mental Health, adolescent and young women account for 90 percent of cases. The number of adolescents with diagnosed anorexia nervosa or bulimia nervosa is growing and many adolescents with various eating disorders and disordered eating behaviors remain undiagnosed and untreated. Uncounted teenagers preparing to be models, entertainers, dancers, gymnasts, jockeys and other athletes who manipulate their weight also suffer from long-term effects of chronic malnutrition, whether they do or do not meet the criteria for anorexia nervosa or bulimia nervosa. They may be categorized as having an "Eating disorder not otherwise specified" when they have combinations of symptoms that do not fit the exact criteria of the other described eating disorders.8

Eating disorders are more common in cultures focused on weight loss and body image. Body dissatisfaction and dieting may lead to unhealthy and dangerous eating behaviors. Sometimes, these eating patterns can lead to eating disorders. Fortunately, there has been an increased awareness about these types of illnesses. Eating disorders are treatable.9

Eating disorders, particularly anorexia nervosa and bulimia nervosa, are significant causes of morbidity and mortality among adolescent females and young women. Eating disorders are associated with devastating medical and psychological consequences, including death, osteoporosis, growth delay, and developmental delay. Physical findings such as low body mass index, amenorrhea, bradycardia, gastrointestinal disturbances, skin changes, and changes in dentition can help detect eating disorders. Laboratory studies can help diagnose these conditions and exclude underlying medical conditions.10

Anorexia is thought to have the highest mortality rate of any psychiatric disorder, with approximately 10percentage of those who are diagnosed with the disorder eventually dying due to related causes. The suicide rate of people with anorexia is also higher than that of the general population and is thought to be the major cause of death for those with the condition. A recent review suggested that less than one-half recover fully, one-third improve, and 20percentages remain chronically ill.11

A descriptive study was conducted in Sweden to identify the Psychological problems in adolescents and young women with eating disturbances. Samples used are adolescent and young adult girls from the general population with or without self-reported eating problems. Results showed that girls with eating disorder reported more psychological problems. Patients with bulimia nervosa scored higher than both patients with anorexia nervosa. 12

A descriptive study was conducted in Tamilnadu, on 210 medical students examined, 31 subjects were found to have distress relating to their eating habits and body size not amounting to criterion-based diagnosis of eating disorders. The characteristics of this eating distress syndrome are described in relation to the major eating disorders.13

Adolescents with eating behaviors associated with anorexia (fasting, frequent exercise to lose weight, and self-induced vomiting) are at high risk for anxiety and depression in young adulthood. Some studies estimate that 12 – 18percentages of people who are anorexic also abuse alcohol or drugs. Even worse, suicide has been estimated to account for as many as half the deaths in anorexia. In one study, 22percentages of anorexic patients attempted suicide.14

In people who suffer from Eating Disorders it is not uncommon to find other associated psychological disorders that co-exist with their Anorexia, Bulimia and/or Compulsive Overeating. In some cases, their Eating Disorder is a secondary symptom to the Eating Disorder. Men and women may also suffer from both an Eating Disorder and other psychological disorders that completely co-exist with one another, or they can suffer from an Eating Disorder and have little or no signs of an additional psychological disorder. It is important to the recovery process and treatment that all these issues about eating disorders addressed, and that a proper diagnosis is determined. 15

In the light of these observations, the researcher felt the need for generating awareness regarding eating disorders among adolescent girls through an educational approach.

6.2 Review of literature.

A cohort study conducted on ‘Onset of adolescent eating disorders’ in Australia. To study the patterns of new eating disordersin an adolescent. The design used was Cohort study over 3years with sixwaves. The subjects are Students, initially aged 14-15years, and from44secondary schools in the state of Victoria. The result of the study revealed that at the start of the study, 3.3percentages (29/888) offemale subjects and 0.3percentages (2/811) of male subjects had partialsyndromes of eating disorders. The rate of development of neweating disorder per 1000person years of observation was 21.8in female subjects and 6.0in male subjects. Female subjects whodieted at a severe level were 18times more likely to developan eating disorder than those who did not diet, and female subjectswho dieted at a moderate level were five times more likely todevelop an eating disorder than those who did not diet. Psychiatricmorbidity predicted the onset of eating disorder independentlyof dieting status so that those subjects in the highest morbiditycategory had an almost sevenfold increased risk of developingan eating disorder. 16

A comparative study conducted on ‘Eating attitudes in a diverse sample of Israeli adolescent females’. The study estimates the eating attitudes in Israeli Jewish female adolescents. A representative sample of 1270 females in grades 7–12 from five different Israeli schools from five different residential areas were assessed by EAT-26. The result of the study shows that of the total sample, 19.5percentages were identified as having abnormal eating attitudes. In terms of age, the 16 year olds were found to have the significantly highest rate of total and positive EAT-26 scores. 17

A longitudinal study conducted on ‘Risk Factors for the Onset of Eating Disorders in Adolescent Girls: Results of the McKnight Longitudinal Risk Factor Study’ in America. This study examined the importance of potential riskfactors for eating disorder onset in a large multiethnic samplefollowed for up to 3 years, and a structured clinical interviewused to make diagnoses. Participants were 1,103 girlsinitially assessed in grades 6–9 in school. Of the 1,358 girls, 34 (2.5percentages) already had a full-or partial-syndrome eating disorder. There were higher scores on a factor measuring thin body preoccupationand social pressure in predicting onset of eating disorders.An increase in negative life events also predicted onset ofeating disorders in this sample.18

A longitudinal study conducted on’ Eating Disorders during Adolescence and the Risk for Physical and Mental Disorders during Early Adulthood’ in New York. Method used to collect data was Psychosocial and psychiatric interviews administeredto a representative community sample of 717 adolescents andtheir mothers from 2 counties in the state of New York in 1983,1985 to 1986, and 1991 to 1993. In 1983, the mean age of theyouths was 13.8 years. The result of the study shows that Adolescents with eating disorders were at a substantiallyelevated risk for anxiety disorders, cardiovascular symptoms,chronic fatigue, chronic pain, depressive disorders, limitationsin activities due to poor health, infectious diseases, insomnia,neurological symptoms, and suicide attempts during early adulthoodafter age, sex, socioeconomic status, co-occurring psychiatricdisorders, adolescent health problems, body mass index, andworries about health during adulthood were controlled statistically.Problems with eating or weight during adolescence predictedpoor health outcomes during adulthood, regardless of whetheran eating disorder had been present. 19

An epidemiological study was conducted on ‘A two-stage epidemiologic study on prevalence of eating disorders in female university students in Mexico’. This study investigated the prevalence of eating disorders in women.Two samples of university students (1995, n=522; 2002, n=880) completed the Eating Attitudes Test and the Bulimia Test .The results showed a prevalence rate of 0.49percentages for eating disorder in 1995 (0.14percentages for bulimia nervosa) and a prevalence rate of eating disorder of 1.15percentages in 2002 (0.24percentages for bulimia nervosa). Anorexia nervosa was not found in either of the evaluated periods. Nevertheless, the results must be taken with reservation since there was a high rate of loss to follow-up.20

6.3 Statement of the problem.

Effectiveness of planned teaching programme on eating disorder of adolescent girls in selected colleges at Mangalore.

6.4 Objective.

The objectives of the study are to,

1. determine the pre-existing knowledge on eating disorder among adolescent girls as measured by structured questionnaire.
2. design and provide a planned teaching programme.
3. find the effectiveness of planned teaching programme on eating disorder among adolescent girls as measured by same structured questionnaire.

6.5 Operational definitions

Effectiveness: in this study it refers to the difference in percentage of correct responses and mean knowledge score of pre-test and post test conducted for the sample.

Planned teaching programme: in this study it refers to a systematically organized teaching plan to assimilate information to adolescent girls in selected colleges regarding eating disorder.

Eating disorder: eating disorders are psychiatric illness with psychosocial and biological consequences. There are two important types are described; anorexia nervosa and bulimia nervosa.

Adolescent:adolescence is the time between the age group of 11- 20.

Adolescent girls: in this study, it refers to girls who are in late adolescent group, with in an age limit of 16-19 years.

Selected college: in this study it refers to a group of adolescent girls who attend regular classes at selected colleges in Mangalore.

6.6 Assumptions.

The investigator assumes that,

1. the adolescent girls from selected college will have some knowledge regarding eating disorders.
2. planned teaching programme will enhance the knowledge of adolescent girls regarding eating disorders.

6.7 Delimitations

The study is delimited to adolescent girls,

1. Attending a regular class in a selected colleges.
2. With in an age limit of 16-19 years.

6.8 Hypothesis

The mean post test knowledge scores of adolescent girls from selected college regarding eating disorder will be significantly higher than their mean pre test scores.

7. Materials and methods.

7.1 Source of date:

Data will be collected from 50 adolescent girls from selected colleges at Mangalore.

7.1.1 Research design: the research design for the study will be one group pre -test post- test design.

7.1.2 Settings: this study will be conducted in selected colleges at Mangalore.

7.1.3 Population: the population will include adolescent girls attending regular class in a selected colleges at Mangalore.

7.2 Method of data collection.

7.2.1 Sampling procedure: non-probability sampling using purposive technique will be appropriate to select 50 adolescent girls from selected colleges at Mangalore.

7.2.2 Sample size: a sample of 50 adolescent girls will be selected from the selected colleges at Mangalore.

7.2.3 Inclusion criteria

1. Adolescent girls those who are attending regular classes will be selected from the selected colleges.
2. With in late adolescent period.
3. Available at the limit of data collection.
4. Willing to participate in the study.

7.2.4 Exclusion criteria

1. Adolescent girls those who are in early and mid adolescent stage.
2. Not willing to participate
3. Attending evening classes and doing distance education.

7.2.5 Instruments used.

Self administered structured questionnaire will be used to collect data.

7.2.6 Data collection method.

The researcher will obtain permission from the concerned authority. The purpose of the study will explain to all adolescent girls and consent will be obtained from them. The structured questionnaire will be administered to determine the knowledge of the subjects. A planned teaching programme will be prepared based on the knowledge of the subjects. After administering the planned teaching programme, post-test will be conducted using the same structured questionnaire to evaluate its effectiveness.

7.2.7 Data analysis plan.

Collected data will be analyzed by using descriptive and inferential statistics. Mean standard deviation and mean percentage will be used to describe the pre test knowledge of adolescent girls from selected college. Statistical significance of the effectiveness of planned teaching programme will be analyzed using paired‘t’ test. Data will be presented in form of tables, graphs and diagrams.

7.3Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so, please describe briefly.

Yes, the study requires a planned teaching programme to be conducted among adolescent girls attending selected college regarding eating disorders.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance has been obtained from the ethical committee of the institution; consent from the sample will be taken at the time of data collection.

8. REFERANCES

1. J. Niti,‘Go Now here Adolescent Programs’, women’s future service,March 17, 2002
2. National Association of Social Workers, Volume 2, Number 4, November 2001 .(online)available from
3. Canadian Pediatric Society (CPS) ‘Eating disorders in adolescents: Principles of diagnosis and treatment’ 1998;volume 3:page no;189-192
4. Crowther , Fairburn, Gordon, National Eating Disorders Association's Information, (online) available from
5. Jill McGivering ,BBC Asia analyst , Tuesday, 17 June, 2003, 11:45 GMT12:45UK(online) available from
6. Maddie Ruud,Celebrities with Eating Disorders(online) available from
7. Eating disorder referral and information center, (online) available from
8. Jane Mitchell Rees, ‘Document on Eating Disorders during Adolescence’ ;
   Maternal Child Health and Adolescent Medicine,University of Washington, Seattle, WA 98195 01/05/2007.
9. Center for Young Women's Health, Children's Hospital Boston (online) available from
10. SARAH D. PRITTS, JEFFREY SUSMAN, ‘Diagnosis of Eating Disorders in Primary Care’American Family PhysicianVolume. 67;No. 2 ;January 15, 2003.
11. Birmingham CL, Hlynsky JA, Goldner EM, ‘The mortality rate from anorexia nervosa’. International Journal of Eating Disorders, 2005,volume 38 number 2, page no:143-1466.
12. Ekeroth, Kerstin ‘ Psychological problems in adolescents and young women with eating disturbances’,Goteborg’s university, Doctoral Dissertation 154, (online) available from
13. Srinivasan TN; Suresh TR; Jayaram V; Fernandez MP; Vasantha Jayaram ; ‘Eating disorders in India’.Indian J Psychiatry. 1995 Jan; 37(1)page no: 26-30
14. University of MarylandMedicalCenter (UMMC). (online) available from
15. (online) available from
16. G CPatton, RSelzer, CCoffey, J BCarlin, RWolfe, ‘Onset of adolescent eating disorders: population based cohort study over 3years’ BMJ 1 Apr 1999
17. Y. Latzer O. Tzischinsky ‘Eating attitudes in a diverse sample of Israeli adolescent females: a comparison study’ , Journal of Adolescence
    Volume 28, Issue 3, June 2005, Pages 317-323
18. ‘The McKnight Investigators Risk Factors for the Onset of Eating Disorders in Adolescent Girls’ American journal of Psychiatry volume160:page no 248-254, February 2003
19. Jeffrey G. Johnson, Patricia Cohen, Stephanie KasenJudith S. Brook, ‘Eating Disorders During Adolescence and the Risk for Physical and Mental Disorders During Early Adulthood’ Archives of General Psychiatry Vol. 59 No. 6, June 2002, page no 545-552.
20. Karina Franco, Rosalia Vazquez, Xochitl Lopez, Georgina L. Alvarez ‘ A two-stage epidemiologic study on prevalence of eating disorders in female university students in Mexico’ , interscience Wiley , Volume 15, Issue 6 , Pages 463 - 470

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