Health promotion survey in overweight and obese students of universiti

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Corresponding author: Atta Abbas E-mail address: bg33bdstudent.sunderland.ac.uk 64 IJAMSCR | Volume 2 | Issue 1 | Jan –Mar 2014 www.ijamscr.com Research article Health promotion survey in overweight and obese students of universities in North East England United Kingdom Atta Abbas 12 Arif Sabah 2 Sidra Tanwir 2 Farrukh Rafiq Ahmed 2 Anwar Ejaz Beg 2 Syed Ata Rizvi 3 . 1 Department of Pharmacy Health and Well Being University of Sunderland England United Kingdom. 2 Faculty of Pharmacy Ziauddin University Karachi Sindh Pakistan. 3 Faculty of Pharmacy Hamdard University Karachi Sindh Pakistan. ABSTRACT Overweight and obesity is one of the major health problems in the UK and worldwide. Approximately two-thirds of the population in the UK is either overweight or obese. Overweight and obesity is an important issue that causes distress to most women. Health promotion is the best method to educate overweight and obese women. It is defined as the process enabling people to increase control over and to improve their health by Ottawa Charter for Health Promotion. It is aimed to enhance the well-being of the individuals and their positive attitudes towards prevention of various diseases. In order to make any improvement to the health promotion for overweight and obesity the risk factors and the opinions from the public should first be identified and addressed. Cross-sectional survey design was selected with a questionnaire that consisted of 20 open and close ended questions. A sample size of 196 was determined. The data thus gathered was analyzed using SPSS V20 Statistical Package for Social Science version 20. Descriptive statistics fx and SD were used and Chi-square X 2 test for association was employed. Out of the total 196 responses only 40 of the students had normal weight SD 1.1 25 students had a good understanding of health promotion SD 1.6 half 50 appeared concerned about their weight SD 0.5 60 had an obese family member 0.5. The BMI of students was associated with the presence of an obese member in their family and their weight as a concern for them. P-value 0.05. The health promotion service is beneficial as it was found to have raised concerns in the mind of the students regarding over weight and obesity. However it was observed that the understanding of health promotion service was different among students and this is the root of the problem. Keywords:Health promotion obesity overweight England. INTRODUCTION Overweight and obesity is one tof the major health problems in the UK and worldwide. Approximately two- thirds of the population in the UK 1 is either overweight or obese. The department of Health DoH carried out a health survey for England in 2002 and found that the percentage of women who are overweight has risen from 32.2 to 22.8 in 2002.2 Obesity in England cost approximately £2.6 billion in 1998 and if it continues to rise till 2010 it would then cost about £3.6 million.3 As a result obesity is considered as a heavy burden to the economy of Great Britain. Overweight and obesity is an important issue that causes distress to most women. It can have an impact on both International Journal of Allied Medical Sciences and Clinical Research IJAMSCR

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Atta Abbas et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-21 2014 64-73 65 women’s physical and mental health. Obesity can increase risk of developing diabetes hypertention stroke certain cancers 4 osteoarthritis and sleep apnoea in women 5. It has been reported that a strong relationship was found BMI and type II DM and coronary heart disease CHD in women compared with men. 5 According to British Heart Foundation 1 obesity is the cause of death in 6 of women with CHD. Severly obese women may also face fertility problems and a higher risk of developing complications during pregnancy e.g. hypertention and gestational diabetes 6. Furthermore obese individuals tend to have psychological problems such as depression lower self- esteem or even anxiety. Hence obese women will be more likely to commit suicide compared with normal weight females. By maintaining their weight in the healthy range it does not only reduce the risk of certain chronic diseases 7 but also enhances their self- confidence 8. It is thus important to educate women regarding the significance of weight control. Health promotion is the best method to educate overweight and obese women. It is defined as the process enabling people to increase control over and to improve their health by Ottawa Charter for Health Promotion 9. It is aimed to enhance the well-being of the individuals and their positive attitudes towards prevention of various diseases. This is where all healthcare professionals especially the pharmacists have an important role to play. Women perception of ideal and desirable weight has changed dramatically over time. If this were the Renaissance period women were thought to be most beautiful if they were large in size. If this was the case now they would be considered as overweight or obese. In order to lose weight they are willing to try out any weight loss products. They are constantly seeking advice from pharmacists about any over the counter OTC or prescription products for losing weight quickly. Most products have low calorie contents i.e. less than 1000kcal/day9 and can be used only for a short period of time. Hence appropriate advice should be given by healthcare professionals to their patients. In 2006 the treatment for obesity accounted for nearly 1.06 million of prescription items.1 This amount is approximately eight times more than the prescription items in 1999. With the increasing number of overweight and obese women since 1980’s1 this raised a great concern to the government and the public. Different departments will have an important role in tackling this problem. For example the Department of Culture Sports and Media is responsible for promoting physical activities and reducing those for fast food can have an impact on the population’s perceptions as well as their awareness of healthy lifestyle. The local authorities should also ensure that streets are made safer so that the public can regularly walk to work or study rather than use the available transportation9. The impact of overweight and obesity on women’s health and the country’s economy is very significant. As a consequence it is crucial to reduce the percentage of women who are overweight or obese through health promotion. However there are not many health promotion studies designed specifically for the overweight and obesity in the UK. Health promotion on the healthy diet and active lifestyles mostly target the general public to improve their general health. For this reason more health promotion or campaigns for overweight and obesity should be implemented. In order to make any improvement to the health promotion for overweight and obesity the risk factors and the opinions from the public should first be identified and addressed. METHODS A cross-sectional survey was conducted in Sunderland and Gateshead areas of the North-East England United Kingdom during Jan 2013 to Jun 2013. The survey employed a questionnaire that consisted of 20 open and close ended questions was developed based on the current evidence. Content validity was checked by experts and it was validated. A sample size of 196 was determined using the approximate number of women in North-East England Sunderland and Gateshead for 95 confidence interval CI. A verbal consent was obtained prior to handing the questionnaire to the students in the region. The data thus gathered was analyzed using SPSS V20 Statistical Package for Social Science version 20. Descriptive statistics were used and Chi Square X 2 test for association was employed. The study complied with the Data Protection Act 1998 and the Freedom of Information Act 2000 of the United Kingdom. RESULTS The survey carried out in University of Sunderland included 196 students randomly selected. The results of the survey are explained in the following points: 1. Characteristics of Students

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Atta Abbas et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-21 2014 64-73 66 2. Lifestyle of Students 3. Students perceptions of health promotion services 4. Associations of students’ perception and their socio- demographics 1. CHARACTERISTICS OF STUDENTS In terms of characteristics the survey incorporated students from all races and ethnicity i.e. White 30 Asian South 25 Black 10 and other ethnicities 35 SD 1.277. The students were asked about their age body mass index marital and living status. The survey found out that the students are usually young adults in the age range of 16-25 years 65 some are between 26-35 years 20 and few lie in the range of 36-45 years 15 SD 0.761 and the marital status is single in case of most of the student 85 SD 0.366. However less than half of the students maintain a healthy weight and have a normal BMI40 most of the students are unhealthy and were found to be over weight 25 obese 15 and extremely obese 20 SD 1.182. Table 1 highlights the characteristics of the students. TABLE 1. STUDENTS CHARACTERISTICS Characteristics SD Age Group 0.761 16-25 yrs 65 26-35 yrs 20 36-45 yrs 15 BMI 1.182 Normal 40 Overweight 25 Obese 15 Extreme Obese 20 Marital Status 0.366 Single 85 Married 15 Divorced 0 Other 0 Ethnicity 1.277 White 30 South Asian 20 Black 10 Other 35 Living Status 1.276 Alone 55 With Partner 5 With Family 20 Other 20 Studying 0.308 Yes 90 No 10 Working 0.444 Yes 30 No 70 Education 0.000 Yes 5 No 95 Healthcare 0.224 Yes 5 No 95 Retail 0.224 Yes 5 No 95 Other 0.366 Yes 15 No 85 Unemployed 0.224 Yes 70 No 30

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Atta Abbas et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-21 2014 64-73 67 GRAPH 1. EDUCATIONAL STATUS OF STUDENTS GRAPH 2. EMPLOYMENT STATUS OF STUDENTS GRAPH 3. WORKING SECTORS OF STUDENTS 2. LIFESTYLE OF STUDENTS The students with regards to their lifestyles appeared concerned about their body weight 50 SD 0.513 and most had an obese member in their family 60 SD 0.503 as shown in table 2. 90 10 Educational status Studying Not Studying 30 70 Employment of Student Employed Unemployed 16 17 17 50 Working Sectors of Student Education Healthcare Retail Other

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Atta Abbas et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-21 2014 64-73 68 TABLE 2. LIFESTYLE ATTRIBUTES OF STUDENTS Lifestyle attributes SD Weight as a concern 0.513 Yes 50 No 50 Any obese family member 0.503 Yes 60 No 40 Possible Causes SD Imbalanced Diet 0.489 Yes 65 No 35 Overeating 0.444 Yes 75 No 25 Lack of Exercise 0.444 Yes 75 No 25 Taking Medication 0.410 Yes 20 No 80 Smoking 0.336 Yes 15 No 85 Alcohol 0.444 Yes 25 No 75 Family history/Genetics 0.336 Yes 85 No 15 Lifestyle attributes SD Eat 5 portions of fruits and vegetables a day 0.513 Yes 50 No 50 Prepare own meal 0.444 Yes 75 No 25 Preference of buying fresh frozen or both food 0.887 Fresh Food 25 Frozen/Preheated 5 Both 70 Frequency of consuming fast food in a month 0.470 1-4 times per month 70 5-10 times per month 30 Smoking 0.447 Yes 15 No 80 Quit 5 Alcohol 0.503 Yes 40 No 60 Any health related problem 0.308 Yes 10 No 90 Taking any medicine 0.308 Yes 10 No 90 Exercise 0.503 Yes 40 No 60 Travel by SD Car 0.444 Yes 25 No 75 Bus 0.503 Yes 40 No 60 Cycling 0.000 Yes 0 No 100 Walking 0.489 Yes 65 No 35 Other 0.410 Yes 20 No 80

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Atta Abbas et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-21 2014 64-73 69 GRAPH 4. MEANS OF TRANSPORT OF SUNDERLAND’S STUDENT 3. STUDENTS’ PERCEPTION OF HEALTH PROMOTION SERVICE In the survey the student were asked about their observation and what they understand and perceive about the health promotion services. We found out that a small number of students 5 understood health promotion service to the fullest a third of the students 35 were not sure while only quarter had a good understanding 25 one fifth of the students surveyed 20 had an average understanding some had little understanding 10 and very few did not understand 5 SD 1.609. The results summarized and illustrated in table 3.1 and graph 3.1.1 respectively: TABLE 3. STUDENTS’ UNDERSTANDING OF HEALTH PROMOTION SERVICES Understand Choice SD Health promotion 1 Least 2 Little 3 Average 4 Good 5 Excellent 6 Not sure 1.609 Least 5 Little 10 Average 20 Good 25 Excellent 5 Not sure 35 Car Bus Cycling Walking Other Yes 25 40 0 65 20 0 10 20 30 40 50 60 70 N Means of transport

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Atta Abbas et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-21 2014 64-73 70 Source of information Choice SD By Leaflets 1 Yes 2 No 0.503 Yes 40 No 60 Counseling 1 Yes 2 No 0.510 Yes 45 No 55 By Poster 1 Yes 2 No 0.489 Yes 35 No 65 Other sources 1 Yes 2 No 0.308 Yes 10 No 90 Combination 1 Yes 2 No 0.447 Yes 15 No 85 Source Choice SD Television 1 Yes 2 No 0.513 Yes 50 No 50 Magazines Newspaper 1 Yes 2 No 0.513 Yes 50 No 50 By GP 1 Yes 2 No 0.366 Yes 15 No 85 Other Sources 1 Yes 2 No 0.366 Yes 15 No 85 Source Choice SD Pharmacy 1 Yes 2 No 0.410 Yes 20 No 80 GP 1 Yes 2 No 0.510 Yes 55 No 45 Hospital 1 Yes 2 No 0.308 Yes 10 No 90 Other 1 Yes 2 No 0.470 Yes 30 No 70 How useful 1 Useful 2 Not useful 3 Not sure 0.933 Useful 50 No t useful 15 Not Sure 35

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Atta Abbas et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-21 2014 64-73 71 GRAPH 5. SOURCE OF HEALTH INFORMATION FOR STUDENTS GRAPH 6. USEFULNESS OF INFORMATION FOR STUDENTS 4.ASSOCIATIONS OF STUDENTS’ LIFE STYLE AND THEIR SOCIO-DEMOGRAPHIC DATA An association between BMI of students and their concern for body weight was investigated and statistical test i.e. Chi-square and cross tabulation was carried out. The cross tabulation and chi-square test yield significant results P-value 0.01 and showed that an association exist between BMI of students and their concern for bodyweight Phi and Cramer’s V P-value 0.01. Similarly the association between BMI of students with any obese member in their family was investigated and chi-square and cross tabulation was carried out. The cross tabulation and chi-square test done to investigate BMI of students with presence of any obese member in family found out significant results P-value 0.05 and confirmed the association Phi and Cramer’s V P-value 0.04. DISCUSSION The study conducted in the North-East England Sunderland and Gateshead was aimed at finding out the characteristics and lifestyle of students with regards to overweight and obesity their perception about health promotion services and detection of any association that might exist. A survey questionnaire was formulated in light of literatures reviewed from Health Committee of United Kingdom1 and various reports from the UK government departments23. In terms of personal characteristics questions related to age BMI living and employment issues race etc were asked based on guideline59 the participants were given choices from which they can choose an 0 10 20 30 40 50 60 Pharmacy GP Hospital Other of Students Source of information 50 15 35 Usefulness of information Useful Not useful Not sure

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Atta Abbaset al / Int. J. of Allied Med. Sci. and Clin. Research Vol-21 2014 64-73 www.ijamscr.com 72 appropriate answer. Similar to this they were also asked about their lifestyle and what they perceive about the health promotion services with regards to overweight and obesity. The survey showed that the students are of different ethnicities mostly young and single. Almost all of them are engaged in studies and unemployed. Majority lives alone and are unhealthy in terms of BMI. The students appeared concerned about their body weight and most of them had an obese member in their family. Furthermore they viewed it as a major cause of obesity along with other cause such as imbalanced diet and over eating. The students were active and most of them prepare their own meals and take part in house hold activities. Few consumed alcohol but majority never smoked. In terms of health and wellbeing most of the students had no health related problem and neither did they take any medication but only half of them exercise and care about the health by eating fresh fruits vegetables and minimizing fast food consumption. The students mostly travel by walking. When asked about their understanding of health promotion services some of them were not sure however many had understood but not quiet complete. Many students use leaflets and undergo counseling to get the information about health promotion and normally hear about by the help of television and newspaper. However majority tries to seek information from the GP and finds it useful. The association of students’ BMI with concern for their body weight and presence of any obese family member was investigated and we found out statistical significance between them. It is obvious that an unhealthy BMI is always a cause of concern for everyone and it was evident that the students understood the issue the presence of an obese member in the family of those students with unhealthy BMI hints at the genetic predisposition of obesity which is already established in many studies conducted in different points in time.6 CONCLUSION The health promotion service is beneficial as it was found to have raised concerns in the mind of the students regarding over weight and obesity similar to findings of a study conducted in Kingston upon Hull48. The students were aware of the consequences of obesity and concerned about their health. They tried to take appropriate action by modifying their dietary social and living habits based on their understanding and available guidelines5. However it was observed that the understanding of health promotion service was different among students. A large proportion of students were not able to understand the health promotion service some did understand but not quiet complete and this is the root of the problem. The investigator finds it absolutely crucial to take appropriate action to improve the understanding of health promotion service regarding obesity and to screen the genetically predisposed individuals as early as possible and devise a care plan specifically for them and also recommends such activities to be routinely carried out in other parts of the world. STATEMENT OF CONSENT Verbal consent was obtained prior to administering the questionnaire. CONFLICT OF INTEREST The authors declare that no conflict of interest exists. AUTHOR’S CONTRIBUTION AA conceived the idea and wrote the introduction and collected the data the literature review was carried out by AS ST and the methods were formulated by the AR and SA. The discussion and conclusion were written by FR and AA. The final editing was done by AA and AEB. SOURCE OF FUNDING None. REFERENCE 1 House of Commons Health Committee. Obesity: third report of session 2003-04. London: The House of Commons: volume 1 2004. Available: http//www.publications.parliament.uk/pa/cm200304/cmhealth/23/23/pdf. 2 Department of Health. Health survey for England 2002 trend data. London: Department of Health: 2002. Available: http//www.publications.doh.gov.uk/stats/trends1.htm 3 National Audit Office. Tackling obesity in England. London: NAO 2001. Available: http//www.nao.org.uk/publications/nao_reports/0001/0001220.pdf.

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Atta Abbaset al / Int. J. of Allied Med. Sci. and Clin. Research Vol-21 2014 64-73 www.ijamscr.com 73 4 Halen W. etal. Participants perceptions of a lifestyle approach to promoting physical activity: targeting deprived communities in Kingston-Upon-Hull. BMC Public Health 2006 6:202 doi:10.1186/1471-2458-6-202 5 National Health Service. Preventing obesity and staying a healthy weight. London: NHS 2006. Available: http://www.nice.org.uk/nicemedia/pdf/CG43publicinfo2.pdf 6 Pi-Sunyer FX. Obesity: criteria and classification. 2000 Nov594:505-9.PMID: 11115784. Available: http://www.ncbi.nlm.nih.gov /pubmed/11115784 7 Clinical Resource Efficiency Support Team. Guidelines for the management of obesity in secondary care. Belfast: Crest 2005.Available: http//www.crestni.org.uk/obesity-guidelines-reports.pdf 8 Sharma AM Kushner RF. A proposed clinical staging system for obesity. Int J Obes Lond. 2009 Mar333:289- 95. doi: 10.1038/ijo.2009.2. Review. Epub 2009 Feb 3. PMID:19188927 9 Gill T Chittleborough C Taylor A Ruffin R Wilson D Phillips P. Body mass index waist hip ratio and waist circumference: which measure to classify obesity. Soz Praventivmed. 2003483:191-200. PMID:12891871. Available: http://www.ncbi.nlm.nih.gov/pubmed/12891871

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