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An Intervention Programme Among Overweight Primary School Children
ABSTRACT
An Intervention Programme among Overweight Primary School Children
Shir-Ley Gui
1
, Saerah Shaharuddin
1
, Sheleaswani Inche Zainal Abidin
1
, Ainul Salhani Abdul Rahman
1
, Kulandaimmal Lourdusamy
1
, Amar-Singh HSS
2,5
, Sondi Sararaks
3
, Marina Kamaruddin
4
, Asmah Zainal Abidin
4
, Normah Mohd Zain
4
1 Kinta District Health Department 2 Clinical Research Centre Perak
3 Institute of Health Systems Research 4 Perak State Health Department
5 Department of Paediatrics, Hospital Raja Permaisuri Bainun Ipoh, Perak
Introduction and Objectives
Obesity is defined as an excessive accumulation of body fat. The onset of obesity may occur at any age. Five years’ data 2002-2006 obtained from the School Health Services, in
district of Kinta, Perak shows that the prevalence of obesity defined as weight-for-height in excess of 120 percent of the ideal, ranges from 6.30 to 8.90 among Year 1 students;
12.80 to 17.00 among Year 6 students and 8.50 to 13.30 among Form 3 students, respectively. The objective of this study is to evaluate an intervention programme among
overweight primary school children.
Methodology
SK Haji Mahmood was selected as the intervention school and SK Perpaduan was selected as the control school. Body mass indexes BMI for year 4 and 5 students were calculated
and those with BMI 19.84 were included in the study. A total of 70 and 83 students from intervention and control schools respectively were given consent by their parents
to be involved in this study. Subjects in both schools were given a self-administered questionnaire to assess dietary knowledge and habit, and physical activity and had
their BMI calculated, at baseline bl, pi-1 pi-1, after 3 months and post intervention 2 pi-2, after 6 months. Intervention group was seen monthly as part of the programme.
Subjects were given knowledge on dietary and physical aspects in seminars, small group discussion, quizzes and games. Control group was seen only during data collections.
Results
There was no significant difference in BMI between intervention and control group. There was an increment in percentage of intervention group having good nutrition knowledge
but it was not significant bl, p=0.357; pi-1, p=0.061; pi-2, p=0.152. There was also no significant difference in meal practice in both groups. As for food frequency habit, there
were significant difference at bl p=0.048 and pi-2 p=0.027. Intake of leafy vegetables, other vegetables, fruit, fish, chicken and pulses also showed no significant differences.
There were no significant differences in perception on family, except at pi-2 p=0.043
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An Intervention Programme Among Overweight Primary School Children
and psychological factor in both schools. As for physical activities that were tabulated in METs, significant differences were seen at pi-1 and pi-2. Both groups reported television
viewing as the most frequent activity. However in intervention group, the minutes spent on television viewing reduced from 137 minutes at bl to 101 minutes at pi-1 and 76
minutes pi-2 respectively. In other non-physical activities, significant differences were also found in playing computer games, and writing drawing at pi-2. In more vigorous
activities, it was found that the control group was having higher frequency in cycling, playing football and hockey.
Conclusion
In conclusion, the intervention programme was successfully carried out. A longitudinal study is needed for determination of success rate for the subjects that participated in
this programme. Parents should be encouraged to join and be involved actively in this programme to provide more supportive environment and effective behavioural changes.
Teachers and canteen operators should be empowered to run this programme for a better commitment and monitoring of subjects. The success of this intervention programme will
depend on all sectors: schools, canteen operators, parents and health staffs.
Keywords
Intervention programme, overweight, obese, primary school children, students
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An Intervention Programme Among Overweight Primary School Children
1.0 INTRODUCTION
Obesity is defined as an excessive accumulation of body fat. Obesity is present when total body weight is more than 25 percent fat in boys and more than 32 percent fat in
girls Lohman 1987. According to Dietz, 1983; Lohman, 1987 although childhood obesity is often defined as a weight for height in excess of 120 percent of the ideal, skin fold
measures are more accurate determinants of fatness. The onset of obesity may occur at any age, and is triggered by factors such as early weaning, eating disorders and problems
related to relationship, especially during growth spurts. Whitaker et al and Price showed that it is necessary to identify overweight children as soon as possible in order to prevent
them from becoming obese adult. Cutting et al. concluded that sedentary lifestyle and an inadequate family meal pattern may contribute towards early onset of obesity.
1.1 The Onset of Obesity
In Malaysia, rapid and marked socio-economic advancement over the past two decades has brought about significant changes in the lifestyles of communities. These
include significant changes in dietary patterns e.g. an increase in consumption of fats, oils, and refined carbohydrates and a decrease intake of complex carbohydrates.
As a result there was a decline in the proportion of energy from carbohydrates, while an increase in the percentage contribution of fat has been observed Tee, 1999.
The National Health and Morbidity Study of 1996 showed that in Malaysia, the prevalence of obesity in adults by body mass index was 4.4, overweight 16.6
and underweight 25.2. A study done by Prof Mohd Ismail Noor Head of Nutrition and Dietetic on 1,026 schoolchildren aged 7 to 10 years revealed that childhood
obesity was a result of uncontrolled diet, lifestyle changes and other factors. The same study revealed that 12.5 of male children were obese compared to 5 of
female children; and Malay male children had the highest obesity rate 16.8 whilst Chinese females had the lowest at 4.1. JP Judson and P Kavitha did a survey in
2004 on 309 students, aged 7 to 11 years old and found out that the prevalence for overweight and obese were 11.7 and 10.7 respectively.
1.2 Obesity and Health Problems
Obesity is the most common nutritional problem among children in developed countries Sorof Daniels, 2002. It is a complex, multifactorial and chronic condition
resulting from interplay between environment and genetics Segal Sanchez, 2001. The prevalence of obesity has been growing at alarming rate for decades in both
children and adults Giammattei et al., 2003.
Overweight and obesity are currently regarded as public health problem that affects both young people and adult. They have become a global epidemic
WHO consultation on obesity, 3
rd
-5
th
June 1997 and are increasing rapidly in
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An Intervention Programme Among Overweight Primary School Children
both childhood and adolescence Will, Beata; Zeeb, Hajo; Baune, Bernhard 2005. Obesity presents numerous problems for the children. It is associated with significant
morbidity and mortality. In addition to increasing the risk of obesity in adulthood, childhood obesity is the leading cause of pediatric hypertension, is associated with
type 2 diabetes mellitus, increases the risk of coronary heart disease, increases stress on the weight – bearing joints, lower self esteem, and affects relationship with peers.
Some authorities feel that social psychological problems are the most significant consequences of obesity in children.
Being an overweight child under 3 years of age, does not predict future obesity unless at least one parent is also obese. After the age of 3 years, the likelihood that
obesity will persist into adulthood increases with advancing age of the child and is higher in children with severe obesity in all age groups. After an obese child reaches
6 years of age, the probability that obesity will persist into adulthood exceeds 50 , and 70-80 of obese adolescents will remain so as adults Segal Sanchez,
2001.
1.3 Prevalence of Obesity in Perak, Malaysia
There is no single data on the prevalence of obesity among schoolchildren in the state of Perak. However, individual data gathered from the various districts school
health teams showed that apart from Kerian district, the rest of the districts had low prevalence of obesity. Review of five years data from Kerian district showed
prevalence of obesity ranging from 4.45 to 6.30 among Year 1 students; 7.60 to 16.80 among Year 6 students and 5.0 to 13.90 among Form 3 students
respectively. A study done in Hilir Perak district by Pon Lai Wan et al 2004 revealed that 8.5 from 558 students were found to be overweight and obese. Five years’
data obtained from the School Health Services showed that the prevalence of obesity defined as weight-for-height in excess of 120 percent of the ideal in the district of
Kinta, ranges from 6.30 to 8.90 among Year 1 students; 12.80 to 17.00 among Year 6 students and 8.50 to 13.30 among Form 3 students respectively.
It is thus felt that there is a need for an intervention programme for young schoolchildren so as to reduce future morbidity and mortality, and further help to
decrease the economic burden on the health system.
