CHAPTER I INTRODUCTION Introduction The body mass index

CHAPTER I
INTRODUCTION
Introduction
The body mass index (BMI) or Quetelet index is a fee derived from the mass (weight) and height of a character. The BMI is described because the body mass divided through the rectangular of the frame top and is universally expressed in gadgets of kg/m2, on account of mass in kilograms and height in meters.

The BMI will also be decided the usage of a table or chart which presentations BMI as a function of mass and height using contour strains or colorings for extraordinary BMI categories, and which may also use different gadgets of size (converted to metric devices for the calculation)
The BMI is an try and quantify the amount of tissue mass (muscle, fat, and bone) in an individual, and then categorize that man or woman as underweight, regular weight, overweight, or obese based on that fee. But, there may be a few debate approximately where at the BMI scale the dividing traces between categories have to be located.1 commonly frequent BMI stages are underweight: underneath 18.5 kg/m2, normal weight: 18.5 to 25, obese: 25 to 30, overweight: over 30. People of Asian descent have one-of-a-kind institutions among BMI, percentage of frame fat, and fitness risks than those of ecu descent, with a higher danger of type 2 diabetes and cardiovascular disorder at bmis decrease than the WHO reduce-off point for obese, 25 kg/m2, even though the cutoff for discovered chance varies amongst different Asian populations.2
Underweight is a term describing a person whose body weight is taken into consideration too low to be wholesome. The definition commonly refers to human beings with a body mass index (BMI) of underneath 18.5 or a weight 15% to twenty% underneath that every day for their age and peak organization.

Someone may be underweighting because of genetics, metabolism, drug use, loss of food (frequently due to poverty), or illness. Being underweight is related to certain medical situations, along with hyperthyroidism, cancer or tuberculosis. People with gastrointestinal or liver problems may be unable to take in nutrients properly. Human beings with certain eating issues can also be underweight due to lack of nutrients/over exercising.

Underweight might be secondary to or symptomatic of an underlying disorder. Unexplained weight loss might also require expert medical analysis.

Underweight also can be a number one causative circumstance. Seriously underweight people might also have poor bodily stamina and a vulnerable immune system, leaving them open to infection. Consistent with Robert E. Black of the Johns Hopkins college of Public health (JHSPH), “Underweight reputation … And micro-nutrient deficiencies also cause decreases in immune and non-immune host defenses, and should be categorized as underlying causes of demise if observed through infectious illnesses which can be the terminal associated causes.” people who are alterative underweight raise special issues, as now not most effective gross caloric intake can be inadequate, however also consumption and absorption of other important vitamins, particularly essential amino acids and micro-nutrients which includes vitamins and minerals.

In girls, being critically underweight due to an eating sickness, or because of immoderate strenuous workout can bring about amenorrhea (absence of menstruation), infertility and, if gestational weight advantage is too low, feasible complications all through being pregnant. Malnourishment also can reason anemia and hair loss.

Being underweight is an established chance factor for osteoporosis, even for young humans. This is seen in people affected by the lady athlete triad, while disordered consuming or immoderate workout motive amenorrhea, hormone changes at some point of anovulation results in loss of bone mineral density. After the prevalence of first spontaneous fractures the damage is frequently already irreversible.

Even though being underweight has been suggested to boom mortality at costs akin to that visible in morbidly obese people, the effect is lots less drastic while limited to non-people who smoke without a history of disease, suggesting that smoking and disease-associated weight loss are the leading causes of the determined effect.

Obesity is now a serious health trouble and its incidence has extended in an unexpected variety over the past two decades. Over 250 million human beings in low and center income nations be afflicted by weight problems. However globally multiple billion are overweight and of these 300 million are overweight.3 weight problems is regularly in reality described as a situation of odd or immoderate fats accumulation in adipose tissue, to the volume that fitness may be impaired.2 nearly all the growing and advanced international locations are experiencing a virulent disease of obesity but wonderful version is determined between and within international locations.5
The mechanism of obesity development isn’t always fully understood, and it is believed to be a sickness with multiple reasons. Environmental factors, life-style possibilities, and the cultural environment play pivotal roles within the rising occurrence of obesity global. In widespread, weight problems is believed to be the effects of an increase in caloric and fats consumption and feature extensive effect on both bodily and psychological health.6
Studies of obesity were frequently used weight for top measures as indicators of weight problems. These had many troubles and ought to be appeared as only approximating to the degree of fatness.6-7 In adults BMI (frame mass index) BMI (kg/m²) = weight in kilograms/ top in meters² has typically used. However, in childhood the index has been restricted use as it vary with age.

Formative years refers back to the long transitional, developmental length among early life and adulthood, and to a maturational method related to most important bodily, mental, cognitive and social transformation.9 it’s miles defined via the WHO as someone between 10 and 19 years of age.10 The onset of it is marked through puberty, which is broadly speaking a bodily , maturational , hormonal and boom method. Nine One in each 5 people inside the global is a youngster, and out of 1.2 billion teens global about eighty five% stay in growing nations and the remainder within the industrialized international.10
Weight problems is now identified as a primary motive of children mortality and morbidity round the sector. Its incidence is growing dramatically irrespective of age and geographical variant. Round 1 in 6 persons in the global is a teenager: that is 1.2 billion humans aged 10 to 19. Maximum are healthy, but there may be nonetheless considerable death, infection and sicknesses among adolescents. The most important consequence of adolescence obese and weight problems is a extra chance of weight problems in maturity.11
In standard, overweight and weight problems are assumed to be the outcomes of a boom in caloric and fat intake and the overweight and weight problems in childhood are acknowledged to have massive effect on each bodily and psychological fitness. Obesity may be resulting from quantity of social, cultural, behavior, physiological metabolic and genetic factors which are beyond the characters manage. Symptoms of weight problems are breathing hassle, excess accumulation of fats, insulin resistance boom in length or wide variety of fats cells that upward thrust in blood stress, excessive cholesterol levels and so forth.12
Ailments can avert adolescent ability to grow and develop to their complete potential. Alcohol or tobacco use, lack of bodily hobby, unprotected sex and/or exposure to violence can jeopardize now not simplest their contemporary health, but frequently their health for years to come.13
In India amongst adolescent increased consumption of more electricity-dense, nutrient-negative ingredients with high degrees of sugar and saturated fat, mixed with decreased bodily pastime (because of multiplied use of automatic delivery, era in the domestic) and more passive. Spare time activities are suspected as essential members to growing stages of weight problems.7A large number of co-morbidities have been associated with obesity, however it became kind 2 diabetes that turned into most intently linked with increasing adiposity14 and even within the normal weight range diabetes incidence starts off evolved to upward push with growing adiposity.15-16
Weight problems is likewise a risk element for cardiovascular diseases. Some other look at it was confirmed that, overweight kids had increased blood pressures and elevated total ldl cholesterol and reduced HDL ldl cholesterol relative to thinner kids.17 Bangladesh faces a double burden of both of malnutrition with persistent energy malnutrition (CED) closing the dominant nutritional phenotype.18
In Bangladesh overweight and obesity should remember as a public health difficulty because obese adults may additionally have danger for mortality and morbidity with weight problems-associated persistent illnesses, which might be already a burden to the struggling fitness system in Bangladesh.
Therefore, the distance in know-how is growing dangers that necessitate the need to systematically look at the expertise of weight problems among adolescent.19
Based totally on the findings health schooling programmers can be performed in distinctive settings like schools, colleges, and the network. This challenged the researcher to discover the significance of expertise and attitudes of adolescent concerning weight problems, and to impart the expertise regarding weight problems and its outcomes. It’s also predicted that this have a look at can also growth recognition among adolescent concerning weight problems.20

1.2 Justification of the Study
Kids are the wealth of any nation as they constitute one of the vital segments of the populace. Kids inside the age institution of 10-19 years are regularly taken into consideration as adolescent length. The college age institution spans the duration among preschool years and grownup lifestyles. The foundation of properly health and sound thoughts is laid at some stage in the college age length. So, it’s far a primary milestone in the existence of an character and accountable for many modifications that take location at some point of later life. College age is considered as dynamic period of growth and improvement due to the fact youngsters go through bodily, intellectual, emotional and social changes.

In Bangladesh, weight problems is a new situation, however a grave challenge although. But much less records regarding know-how, mind-set and attention on weight problems the various adolescent of city area has been observed within the posted literature. Consequently, the present study has been undertaken to take a look at the understanding, mindset and practices about weight problems among faculty adolescents of Dhaka city.
In a study in India, the suggest understanding rating of the adolescent students turned into between 1- 14 and imply information rating of adolescent college students became five.sixty five ± 2.907, median changed into five and mean percent of information rating turned into 28.25. The ninety three% of the adolescent college students had underneath common know-how regarding weight problems observed with the aid of 6% of the adolescent college students had average knowledge and handiest 1% had had true understanding regarding weight problems.21
Consistent with a who file, there are 1 billion overweight people within the international, of whom three hundred million are obese.20currently, 14% of kids and young people inside the USA are obese and 20% are at threat for overweight. Twenty according to cent of grownup guys and 25% of grownup women within the united states are obese.23 in lots of growing nations overweight and weight problems are actually so not unusual that they are replacing extra conventional issues which include beneath vitamins and infectious disease as the most good sized reasons of unwell health.24the weight problems epidemic was not most effective a trouble of industrialized societies; in growing international locations, over a hundred and fifteen million human beings be afflicted by weight problems associated troubles.25
Within the initial effects of a nationwide examine lately carried out via icddr,b on weight problems occurrence and bodily activity among youngsters and young people in city regions of Bangladesh, it turned into seen that of kids aged 5-18 years, 10 in keeping with cent are obese at the same time as 4 in keeping with cent are obese.24 the figures are alarming, thinking about the size of our younger population. The studies diagnosed availability of high-calorie rapid/processed food, sedentary life-style, better transportation centers, much less out of doors leisure area and intake of extra food and beverages as end result of attractive media campaigns as some of the important factors contributing to childhood overweight and obesity among college-going youngsters of bangladesh.26
Bangladesh, a rustic with a big economic burden because of under vitamins, now must cope with over vitamins as nicely. In Bangladesh, almost forty% of youngsters <5 years are laid low with malnutrition.25 however, in current years, more than one elements along with fast urbanization, usually decreasing quantity of playgrounds, increasing buying strength, and easy access to new technological gadgets consisting of d1e51e9fa45a0b179488752ec4930123 pc toys probable have led to much less physical interest and more sedentary interest, and thereby have attributed to an rising overweight and obesity hassle amongst younger children in city settings, mainly among prosperous facilities in dhaka.28
Over the last few decades, there has been a chain of stories and advocacy files, declarations and milestone courses in instructional journals dedicated to the fitness and improvement of teenagers. There are international goals and goals directed to younger human beings, and youth and children are key to on-going and rising public health agendas, to the plans for the global conference on population and development (icpd) past 2014 and, increasingly more, to discussions about the post-2015 millennium development dreams (mdgs).there was interest to youngsters in international public health meetings, and younger humans were the point of interest of several current united international locations tasks and resolutions.29
This information is extremely vital to outline the trouble and to layout proper intervention strategies. However, the have a look at affords a baseline statistic at the understanding, mind-set and consciousness of youth obese and weight problems in addition to their associated chance elements within the Dhaka city. Therefore, the result of this study is probably capable of create primary recognition in popular populace, to address the future demanding situations to save you youth obese and weight problems.

So, we need to explore the present day level of knowledge, attitude and practices on weight problems among the adolescent of decided on urban place of Dhaka city. This observe will help to find out the information and preventive practices. The KAP section may also help to growth the participant’s attention toward weight problems, its attitudes, and practices. It’ll help the upcoming researchers on in addition study in this topic.
Furthermore, studies in this subject matter are poor in the study area in addition to countrywide and extra paintings want to be completed to discover the prevailing status concerning weight problems related understanding, mindset and exercise among faculty teenagers of Dhaka metropolis.

1.3 Operational Definitions
Obesity: obesity is defined as abnormal or excessive fat accumulation that may impair health.30
BMI: Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2).30

1.4 Research Question (s)
What are the sociodemographic, dietary and lifestyle factors associated with obesity?
What is the Prevalence of overweight or obesity in school going adolescents among English medium school?
CHAPTER II
LITERATURE REVIEW
In keeping with obesity Prevention source of Harvard faculty of Public fitness, South Asian nations like Bangladesh, India and Pakistan have low infant weight problems quotes in comparison to other nations. But the massive populations of these countries upload as much as huge numbers of children who’re overweight or obese.31
In each developed and growing countries there are proportionately extra girls overweight than boys, mainly amongst adolescent age.30,31,32 obesity prevention is a critical present day public fitness priority. Prevention entails addressing the principle chance elements of food regimen and less physical hobby and additionally involves a huge range of environmental elements along with get admission to to game and amusement, family life, food plan, schooling and records.
Know-how and mind-set regarding weight problems among adolescent students of Sikar, Rajasthan was conducted in 2014. The imply information rating of the adolescent students changed into among 1- 14 and mean know-how score of adolescent college students turned into 5.65 ± 2.907, median became five and imply percent of expertise rating became 28.25. The 93% of the adolescent students had below average knowledge regarding weight problems accompanied via 6% of the adolescent students had average know-how and handiest 1% had had true understanding regarding obesity.21
Weight problems is a rising problem in Pakistan. The authors sought to determine incidence of weight problems and malnutrition in school-going kids, from grades 6th to 8th of various colleges of Karachi and verify institutions that influence the weight of the kids. They located 52% have been underweight whereas 34% of all the youngsters were ordinary. Of the population, 6% became obese and 8% overweight. Of all overweight children, 70% belonged to the better socio-monetary repute (SES) group, while of the underweight youngsters, 63.3% had been in the decrease SES. Among obese children within the study, 65% ate meat each day, as compared to 33% of normal youngsters. Weight problems and below- nutrients co-exist in Pakistani faculty-kids. The look at showed that socio-monetary elements had been critical seeing that obesity and obese growth with SES. Higher SES businesses ought to be focused for overweight at the same time as underweight is a trouble of lower SES. Meat consumption and shortage of physical activity have been a number of the opposite factors that have been highlighted on that have a look at.35
Obesity in children and youngsters is rising alarmingly and coming near epidemic share in lots of economically advanced international locations, especially in united states of america, Canada, Australia and numerous ecu nations.36 Likewise in developing countries this difficulty is emerging as a public health crisis. According to a latest report, out of an expected 43 million overweight children international in 2010, approximately 81% have been from growing nations, 1/2 of which (18 million) had been pronounced to be living in Asia in spite ofof big burden of under-nutrients. By using 2020, it’s far expected that the global occurrence of early life obesity will attain approximately 60 million.37
WHO (2013) considers formative years weight problems as “one of the maximum critical public fitness challenges of twenty first century”.38 It money owed for a extensive variety of psychosocial and scientific outcomes.41 decrease 6ba8f6984f70c7ac4038c462a50eeca3, social isolation, terrible educational fulfillment and peer issues are the maximum apparent on the spot consequences in overweight children.40 obesity in children and children predisposes them to and is causally connected with aerobic-metabolic issues consisting of hypertension, dyslipidemia and insulin resistance that are well-mounted ailments.41 As overweight and obesity is probably to observe via into maturity, in the long run, there’s an extra threat of growing cardiovascular diseases.41,43 obesity at a young age appears to have vast effect on lowering existence expectancy.42 evidence additionally shows a hyperlink between obesity in young women with potential menstrual problems, hypertension in pregnancy and sub-fertility.45
This have a look at aimed to assess knowledge, mind-set and practices of youngsters in preparatory colleges in Ismailia town-Egypt in 2013. That is a school-based totally go sectional observe that changed into executed on 608 youngsters in some of the preparatory schools in Ismailia town in keeping with randomization. The strategies that have been used blanketed questionnaires to evaluate: (1) non-public history, (2) family socio-financial status, (three) knowledge of the child toward weight problems, healthy weight loss plan and significance of sports, (four) mindset of the child regarding eating habits, (5) the kid’s bodily pastime, (6) the child’s day by day screens’ watching hours, (7) mental effect of obesity on each the overweight child and his family. The BMI percentile of the studied adolescents was also measured.

Extra than three fourth (87.2%) of the studied populace falls below the regular weight categorization whilst 7.7% of them are obese and 5.1% are obese. Statistically enormous members of the family were proved among weight problems and: illiterate mothers, high mom’s educational stage, adolescent’s attitude concerning consuming conduct, practice of sports and physical state of no activity. Psychological effects of weight problems had been evident amongst obese teens as in 33.3% of the subjects there has been a extreme impact of weight problems on their psychological repute.

Associated with adjustments in life style in current years, obesity has been improved gradually amongst kids and teenagers. On this move sectional observe; adolescent’s mind-set regarding eating behavior and his/her practices regarding bodily hobby are relatively affecting obesity. However, weight problems significantly affect the psychological country of overweight youngsters.46
Prevention and management of weight problems largely relies upon on affected person motivation and training and these, in flip, can be significantly facilitated through good enough baseline facts on the know-how, attitude and practice (KAP) of sufferers. The intention of this have a look at is to assess KAP on obesity amongst Bangladeshi type 2 diabetics. Below pass-sectional design a hundred and sixty type 2 diabetics had been selected from outpatient department of Bangladesh Institute of research and Rehabilitation in Diabetes, Endocrine & Metabolic disorders. A standard questionnaire turned into built in nearby language and interview was administrated. Age and frame mass index (BMI) of the respondents had been 45.17±5. 68 years and 25.6 ±four kg/m2 respectively. Amongst them 45% have been male, 38% had number one schooling, 25% belonged to normal weight, half of them were obese and rest had been obese. KAP rating of the respondents become mean ±SD(%) 60.03±thirteen.eighty two, seventy nine.30±eight.27, 55.50±19.21 respectively. Majority have been unaware approximately best body weight, electricity requirement and the burden measurement techniques. A great proportion of the respondents considered rapid meals, soft liquids, mayonnaise as healthier meals. Majority of them agreed on willingness to follow proper weight loss program, maintaining ideal body weight, nutritional management and exercising. More than half of the regular weight and overweight respondents did workout >45 min, while 1/3 overweight did now not do workout (35%). KAP rating were drastically associated with respondents’ level of education (P=zero.0001, P=0.007, P=0.05 respectively) practice rating became substantially related to sex (P=zero.0001), career (P=0.003) and BMI (P=0.0001). There’s a need for elevated effort closer to growing and making schooling applications specializing in empowering the people to convert their understanding and attitude into exercise.47
A chain of recognition organizations became used to study the understanding, attitudes and practices of college students (ages 11-18 years) toward obesity in Jamaica. Specifically, the study sought to: apprehend whether weight problems is considered a nutritional sickness or ailment among secondary school college students in Jamaica. Describe any problems between city and rural attitudes in the direction of obesity. Provide statistics to assist the improvement of public health messages that can be maximum useful for fitness programs to utilize, for secondary faculty students in combatting the issues of obesity. Fifteen recognition agencies with a total of a hundred and eighty college students were drawn from a total of one thousand and twenty- (1,022) students, from colleges: one positioned within the urban place of Kingston, St. Andrew; and the opposite positioned inside the rural location of Ewarton, inside the parish of St. Catherine. Samples of college students from the two faculties had been divided into three categories: younger-for-Grade; common-for-Grade and antique-for-Grade. College students have been similarly grouped into all boys, all women, and mixed organizations of boys and women. Institution interviews had been taping recorded, and all recordings have been transcribed verbatim. Notes had been additionally made at some stage in every session. Following the standard procedures outlined in grounded methods of grouped interviews, open coding of the transcriptions become executed. Standards were recognized and evolved in terms in their homes and dimensions. Comparable questions had been categorized and grouped to shape categories referring to every studies query. Analysis of the sessions confirmed that there was no extensive difference inside the expertise of causes of weight problems among college students in extraordinary grades. The public of male college students confirmed a bad mindset or feeling toward being obese. But many desired ladies who were heavier or had a lower body distribution of adipose tissue which became known as a “Coca-Cola bottle form” (gyneacoid weight problems), as opposed to girls with an upper-body or abdominal distribution of adipose tissue (android obesity). Most people of female students expressed a high-quality mind-set closer to gyneacoid weight problems, however disliked android weight problems. Further, the various girl students expressed their dislike for overweight guys. College students’ knowledge about the causes of obesity and prevention measures was now not very constant with their nutritional styles. Most of the scholars who participated inside the consciousness institution classes did not consider weight problems as a dietary disorder, however rather regarded it as a signal of wealth, precise living, or get admission to an abundance of meals (AU).48
Overweight and obesity are the 5th leading hazard for international deaths. The goal of the look at is to evaluate the information of medical college students bearing on weight problems.

A cross-sectional descriptive study changed into performed among first-year clinical college students in March of 2013 in Kancheepuram district, Tamil Nadu about, evaluation of know-how approximately obesity amongst students in a medical college in. A normal sampling method changed into hired, and all first-12 months college students have been blanketed as subjects in the take a look at. The overall pattern protected 138 college students. After acquiring informed consent, a pre-tested semi-structured questionnaire turned into administered to each of the individuals. Utmost care was taken to hold privatenes and confidentiality. Statistical analysis became carried out the use of SPSS model 17. Frequency distributions and percentages have been calculated for all the variables. A lack of physical pastime and the presence of pressure had been identified as the most commonplace risk factors for weight problems improvement. Approximately, 73(52.9%) students had been of the incorrect opinion that gynaecoid obesity changed into more dangerous than android weight problems. The most not unusual method referred to via 107(77.5%) respondents for prevention of weight problems changed into ordinary workout.

The observe discovered that even though the general public of the medical students have been privy to the risk factors of weight problems, many gaps, which want to be bridged, had been recognized in their knowledge. Those medical college students might be actively worried in recognition campaigns for delaying the onset of lifestyle sicknesses.49
This preliminary observe is carried out in Pulau Pinang, Malaysia to evaluate the general public information regarding weight problems. A self-evolved questionnaire was used to behavior this survey most of the individuals over the age of 18 years. The questionnaire consisted of 17 questions protecting socio-demographic elements and understanding approximately the reasons, symptoms, headaches and remedy. Convenient sampling method turned into utilized and facts become analyzed via the usage of SPSS version 19.0. A complete number of 33 questionnaires have been disbursed and out of this 30 have been again.
The response charge turned into 90.90%. Demographics show that 53.3% of them have been Malay, 36.7% Indian, 6.7% Chinese language and 3.3% others participated in the survey. Out of this 60.66 % were females and 40.44% had been adult males. Approximately 93.3% of respondents cited that they have got heard about the weight problems, 46.7% realize exactly that it’s far endocrine and metabolic sickness and 6.7% haven’t any concept about it at the same time as 6.7% do not understand both it is sickness or normal situation. Concerning the records approximately elements and symptoms associated with the weight problems, fatty meals alternatives, sedentary lifestyle, eating conduct, physical state of no activity, sleep apnea, high cholesterol, shortness of breath, daytime sleepiness and ache in joints have been fantastically stated by using majority of the individuals. Many of the results of obesity, heart disorder, diabetes mellitus, osteoarthritis and metabolic syndrome were mentioned more often than not by using the contributors. People have moderate information approximately obesity in Pulau Pinang.60
Teenagers is length of important section of boom. Youth is a particularly inclined time for the development of weight problems. An overweight Adolescent is related to improved morbidity and mortality in their adulthood. Consequently, the investigator felt the need to have a look at to evaluate the expertise and attitude of children in the direction of weight problems. The have a look at followed Descriptive layout and conducted at decided on Senior Secondary colleges in Amritsar. A complete of a hundred teenagers age group among 15 and 18 years was decided on via handy sampling technique. A established understanding questionnaire and A dependent mindset Scale on obesity used.
Information analysis is completed through Descriptive and Inferential records. The results showed that (67%) samples are having inadequate understanding, (32%) samples are having moderately ok knowledge and (1%) are having good enough expertise on weight problems. With appreciate to mind-set (6%) samples are having negative mind-set, (94%) samples are having reasonably favorable attitude and (0%) are having effectively favorable mind-set concerning obesity. The correlation coefficient (r) showed that terrible correlation between information and mind-set. The association of know-how with socio demographic variables such as intercourse, education reputation, circle of relative’s profits, place of house, form of circle of relatives, dietary conduct, hobbies found sizeable while age, education of mom are not widespread. Association with attitude and socio demographic characteristics along with age, intercourse, circle of relative’s income, place of house, form of own family, nutritional behavior, whereas training reputation, education of mom, pastimes are not substantial. Comparable look at may be performed on large samples at exclusive areas for generalize findings. An experimental have a look at may be undertaken with manipulate organization to analyze the effectiveness of STP in the direction of obesity among the teens. A comparative has a look at may be performed by means of comparing the understanding and mindset of early life and maturity human beings toward weight problems.51

CHAPTER III
RESEARCH METHODOLOGY
3.1 Study Objectives
3.1.1 General Objective
To identify the factors associated with obesity among school going students.

3.1.2 Specific Objectives
To measure the prevalence of obesity among school going students.

To measure the socio-demographic ,dietary and lifestyle factors for obesity
To identify the association between socio demographic factor and obesity.

3.2 Conceptual Framework
Dependent Variables
Independent Variables

Socio-Demographic Factors
Student’s Age
Student’s Sex
Student’s Education
Education of Mother
Monthly family income
Education of Father
Occupation of Father
Area of living

Sedentary Lifestyles
Hours spending on watching TV or study/reading books
computing, video games
Using Internet
Sleeping
Transportation school/home
Physical Activities
Exercise – walking, bicycling
Sports
Health related factors-(Physical, Mental)
Medication
Depression
BMI
1. Underweight (BMI >18.5)
2. Normal (BMI<=25)
3. Overweight/ Obesity (BMI>25)
Dietary Habits
Meals – Rice, Meat, Fish
Vegetables, Fruits
Milk
Fast food/ Junk food
Soft Drinks/beverages
Sweets

3.3 Study Design
School based cross-sectional study.
3.4 Target Population
All students of class 6-8 who are attending schools currently.

3.5 Study Site & Area
The study will be conducted at Mastermind School and Sunny Dale School, Dhanmondi, Dhaka City
3.6 Study Period
The study will be conducted during April 2018 to May 2018
3.7 Inclusion Criteria
All the students from class 6-8
Those who will participate in the study
Those who will be present in the data collection days.

3.8 Exclusion Criteria
Those who will be absent in the data collection day.

Those who will not willing to give consent.

3.9 Data Collection Tools
Data collection tools will be developed by combination of structured & semi-structured questionnaire according to the objectives & variables of the study. The questionnaire will be pretested & checked for expected results & then finalized.
3.10 Data Management & Analysis Plan
Data collection tools will be developed by combination of structured & semi-structured questionnaire according to the objectives & variables of the study. The questionnaire will pretested & checked for expected results & then finalized.

3.11 Quality Control & Quality Assurance
Quality will be assured by the following steps:
Question pretest.

Cleaning of the data.

Re-checking of the data collected
Editing of the data
3.12 Ethical Considerations
Ethical approval from the study protocol will be obtained from the North South University Review Committee and a written informed consent will be taken from all participants.

CHAPTER IV
Result
4.1 Socio demographic analysis:
Variables Measures Total Response (n)
Sex Male 56%
Female 44%
Age 12 to 13 35%
14 to 15 65%
BMI Underweight 20%
Normal 47%
Overweight 33%
Family Member 3 to 4 85%
5 and above 15%
Father’s Education BSc. 28%
MSc. 73%
Mother’s Education HSC and Diploma 80%
Bachelors and above 92%
Monthly Family Income 50K to 80K 3.5%
80K to 100K 20%
100K and above 78.4%
Pocket money 50 to 100 82%
110 and above 15%
No money 2%
Transport Walk, bicycle or rikshaw 6.4%
Motor vehicle 93.6%
Smart phone availability Yes 83%
No 17%
4.2 X2 Square test result analysis:
The data was collected from 139 students with the age range of 12 to 15. The variables which were considered was sex, family member, mother’s working status, mother’s education, eating habit of fast food and soft drinks, involvement with exercise or outside sports activity, TV hours, regular transportation habit and availability of smart phone. Compared to female students, the sample had more number of male students but the p value doesn’t say that it has any effect on obese or overweight. The family member present in each sample has also no impact of overweight or obesity as the p value for this is not significant. In one hand the working status of mother doesn’t have any contribution to the problem but on the other hand the education of mother has a huge impact on the adolescent overweight or obesity. The p value of mother education is 0.01387 which defiantly says that mother’s education has direct involvement with obesity and overweight. Again from the table 1 we can see that the habit of eating fast food and drinking soft drinks is not associated with the overweight and obesity but doing regular physical exercise or involving into different outdoor sports activity have an effect on overweight or obesity. From the table 1 we can see that the number of obese and overweight children is more under the irregular activity of physical exercise or outdoor sports. The p value for this variable is 0.003064 which certainly says that the regular involvement of physical exercise or outdoor sports have a massive impact on overweight and obesity. Watching TV for long period of time and using smart phone for long time doesn’t have any impact on overweight and obesity because none of the variable has a significant p value. From the table 1 we can see that the transportation of the students has an effect on overweight and obesity. The p value for transportation is 0.03557 which makes it significant. The table 1 also says that most of the students who are having overweight or obese are used to travel by car on a regular basis.
Table 2: X2 Square test result
Variables Categories Compliance Level X2 Square p- value
Normal Overweight/ Obese Underweight Sex Male 37 25 16 0.087582 0.9572
Female 28 21 12 Family Member <=4 54 40 24 0.3346 0.8459
>=5 11 6 4 Mother Working Employed 27 26 16 3.2085 0.201
Housewife 38 20 12 Mother Education Below grad 53 36 15 8.5568 0.01387
Graduation 12 10 13 Fast Food,
Soft Drinks Irregular 19 15 13 2.6308 0.2684
Regular 46 31 15 Exercise,
Outdoor sports Irregular 35 39 18 11.576 0.003064
Regular 30 7 10 TV <=2 hrs 30 19 8 2.5034 0.286
>2 hrs 35 27 20 Transport Car 56 44 21 6.6725 0.03557
Others 9 2 7 Smartphone No 12 5 6 1.7295 0.4212
Yes 53 41 22 4.3 Odd ratio test analysis:
Another analysis was done about OR between normal weight vs. underweight and normal weight vs. overweight/obese. For the analysis the CI value was 95%. The upper limit of confidence interval was 95% and the lower limit of confidence interval was 5%.

Table 3: Normal vs. Underweight Odd ratio with 95% CI
Variable Reference Estimate OR LCL UCL p Value
Age
-0.25 0.78 0.40 1.50 0.44
Sex-
Male Female 0.23 1.25 0.47 3.62 0.54
Family Member
>=5 4=> -0.54 0.59 0.13 2.31 0.45
Mother-
Housewife Working -0.22 0.80 0.29 2.30 0.66
Mother Education- Graduation Below Graduation 1.12 3.07 1.00 9.72 0.04
Fast food/Soft drinks-
Regular Irregular -0.72 0.50 0.17 1.36 0.16
Exercise/Outdoor Sports-
Regular Irregular -0.33 0.72 0.25 2.03 0.53
TV time-
>2 hrs 2hrs< 0.57 1.79 0.66 5.35 0.29
Transport-
Others Car 0.26 1.31 0.32 5.37 0.71
Smart phone-
Yes No 0.23 1.26 0.31 5.56 0.74
From the table of normal weight vs. underweight says us that if we consider the age as a factor then the odd ration is 0.78 that means the number of normal weight is more that the number of underweight. In the term of sex, the OD of being underweight of male students are less likely than female students. That means females are 1.26 times more likely to be underweight than male students but this cannot be agreed because the p value is not significant. Again if we consider the family member more than 5 people with equal or less than 4 members, we can see that the students who have 5 or more family members are 0.43 times more chances to be underweight. The mothers who are working outside of house have 0.79 times less likely to have underweight child. When we will take the factor of mother’s education, from the table we will see that the children of the mother who are below graduation are 3.06 times more likely to be underweight than the mothers who are completed their graduation. This is significant because the p value is less than 0.05. So we can say that the education of mother has a positive effect in the children’s being underweight. In terms of eating fast food and soft drinks and doing exercise regularly, from the table we can say that they do not have any significant value for being underweight. Other factors like, watching TV, mode of transport and owning a smart phone doesn’t have any relation of being underweight.

Table 4: Normal vs. Overweight/Obese Odd ration with 95% CI
Variable Reference Estimate OR LCL UCL p Value
Age
-0.02 0.98 0.56 1.69 0.91
Sex-
Male Female 0.13 1.15 0.48 2.73 0.73
Family Member
;=5 4=; -0.24 0.79 0.21 2.51 0.67
Mother-
Housewife Working -0.52 0.60 0.22 1.48 0.29
Mother Education- Graduation Below Graduation -0.09 0.91 0.28 2.82 0.85
Fast food/Soft drinks-
Regular Irregular -0.15 0.86 0.34 2.10 0.73
Exercise/Outdoor Sports-
Regular Irregular -1.48 0.23 0.08 0.56 0.002
TV time-
;2 hrs 2hrs; 0.15 1.18 0.49 2.88 0.72
Transport-
Others Car -0.92 0.40 0.09 1.99 0.27
Smart phone-
Yes No 0.40 1.50 0.45 6.01 0.54
From the table of normal weight vs. overweight/obese says us that if we consider the age as a factor then the odd ration is 0.97 that means the number of normal weight is more that the number of overweight/obese. In the term of sex, the OD of being overweight/obese of male students are less likely overweight/obese than female students. That means females are 1.14 times more likely to be overweight/obese than male students but this cannot be agreed because the p value is not significant. Again if we consider the family member more than 5 people with equal or less than 4 members, we can see that the students who have 5 or more family members are 0.78 times more chances to be overweight/ obese. The mothers who are working outside of house have 0.59 times less likely to have overweight/obese child. When we will take the factor of mother’s education, from the table we will see that the children of the mother who are below graduation are 0.90 times more likely to be overweight/obese than the mothers who are completed their graduation. This is not significant here because the p value is not less than 0.05. So we can say that the education of mother has a negative effect in the children’s being overweight/ obese. In terms of eating fast food and soft drinks regularly, from the table we can say that they do not have any significant value for being overweight/obese. But doing exercise in a regular basis has a significant effect on being overweight and obese. The table says us that the students who do not play outside have a positive effect on their body weight. The table says that the student who plays regularly outside is 0.78 times less likely to be overweight or obese. Other factors like, watching TV, mode of transport and owning a smart phone doesn’t have any relation of being overweight/obese.

CHAPTER V
DISCUSSION
Obese and obesity mostly depends at the physical interest of a baby. Mom of a child is tending to feed him greater meals by using questioning that extra food will bring greater health which is incorrect. Meals ought to be suitable thinking about the age and bodily hobby of a child. For better improvement of health a infant ought to have some physical activity in regular basis. Bodily exercising no longer handiest allows an infant to broaden his fitness however additionally helps him in brain development. Now an afternoon’s maximum of the child used to stay at domestic and watch tv and play video games in their laptop or on smart phone. They handiest go out while the ought to cross to school and returned to domestic. This practice is making them lazier each day and lack of hobby in physical activity. In this have a look at the result that has been determined is 3.3% of the adolescent women had been underweight and 32.7% were obese or obese. And for adolescent boys, 20.5% have been underweight and 27% overweight or obese.

A similar sort of look at was performed in north Ethiopia by means of gebregyorgis t, tadesse t, atenafua in 2015.the prevalence of thinness become 21.4%. Age of adolescent aor = 2.15 (1.14,4.03), mother’s academic reputation AOR = 2.34 (1.14,4.80), eating less than 3 meals in step with day AOR = 1.66 (1.12,2.46), having family size >5 AOR = 2.53 (1.66,3.86) were notably related to thinness most of the adolescent ladies. 52
Bulbul t, Hoque m. Has executed a observe named, occurrence of childhood weight problems and obese in Bangladesh: findings from a countrywide epidemiological observe. They have found amongst 6 to 15 yrolds from both the urban and rural areas three.5% have been overweight, 9.5% had been overweight and 17.6% had been underweight. The percentage of overweight and obese college students have been greater a number of the students from city schools (5.6%, 10.6%) compared to the students from rural schools (1.2%, eight.6%) (RD=4.3, 95% ci?=?3.6, 5.0; RD?=?2.0, 95% ci?=?zero.1, three.1). The proportion of underweight college students were decrease inside the urban colleges (sixteen.1%) as compared to the agricultural faculties (19.2%) (RD?=??3.1; 95% ci?=??4.6, ?1.6)53
Alam n, roysk, ahmed t, ahmedams. Has accomplished a study named dietary fame, dietary intake, and relevant knowledge of adolescent women in rural Bangladesh. They inquired mothers approximately age of their daughters and possessions of long lasting assets to divide households into asset quintiles. Effects found out that 26% of the women were thin, with body mass index (BMI)-for-age <15th percentile), 0.3% obese (bmi-for-age >95th percentile), and 32% stunted (height-for-age ?2sd). Risks of being skinny and stunted were better if girls had trendy morbidity in the last fortnight and foul-smelling vaginal discharge than their friends. Consumptions of non-staple correct-satisfactory food objects within the ultimate week had been less frequent and correlated nicely positively with the family asset quintile.54
Akhter n, Sandhya fy. Studied, dietary popularity of youth in Bangladesh: evaluation of intense thinness repute of a low–profits circle of relatives’ youngsters among urban and rural Bangladesh. 1.Results found out that economic fame had a considerable impact on nutritional popularity. Nutritional fame of low-profits households’ adolescent was low each in urban and rural adolescents, but excessive thinness price consistent with the who of urban (22.4%) kids turned into tons better than rural (10.3%) young people (chi-square = 4.9 and p-price = 0.01), and turned into additionally better at an earlier age of their life. In food consumption distribution and meals intake fame, the identical consequences were seen. The percentage of never eat meat and fish of low-earnings households adolescent women have been (29.7%, 11.4%) in city organization and (24.4%, 6.8%) in rural group. The primary food rice consumption of city young people become also approximately half of that of rural youngsters in step with day. The examiner also suggests that intake of strength, protein, carbohydrate and fats were substantially exclusive among urban and rural women. Best 53% energy was included of the endorsed daily power consumption in urban kids.55
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QUESTIONNAIRE
Date:
Part I: Background
Name of School: ………………………………………………………………….

Class: ………………
Part II: Socio-Demographic Factors
Student’s Age: ……….

Student’s Sex:(1) Male (2) Female
Body Weight: ……….Kg
Height: ………. Feet and ……….cm
Family members: ……………….

Father’s Education: (1) No education (2) Primary school (3) Secondary school (4) Diploma (5) Bachelor (6) Masters (7) PhD
Father’s Height: __________________, Weight: _____________________.

Father’s Occupation: (1) Working (2) Not working
Mother’s Occupation: (1) Working (2) Not working
Mother’s Height:___________________, Weight:______________________.

Mother’s Education: (1) No education (2) Primary school (3) Secondary school (4) Diploma (5) Bachelor (6) Masters (7) PhD
Monthly Family Income:
(1) 40000-50000 (2) 50,000- 80000 (3) 80000-100000 (4) more than 100000
Area of living: ………………………….

Part III: Dietary Habits
How often do you eat Fast food?
Never
Sometimes
Often
Everyday
How often do you have soft drinks?
Never
Sometimes
Often
Everyday
How often do you eat sweets (chocolates, ice-cream, cake, pastry etc.)?
Never
Sometimes
Often
Everyday
What time do you usually have the last meals of the day?
<7 pm
7-8 pm
9-10 pm
>10 pm
How much do you usually have per day from your parents as pocket money (mention in tk)
……………………
Part IV: Physical Activities
Do you have regular physical activities at school or home? (it includes sports also)
1. Yes
2. No
Duration of physical activities each day- option hours
30 minutes
1 hours
More than 1 hour
Part V: Sedentary Lifestyles
What do you think about how many hours do you estimate to sit and watch TV or video games/ reading books, computing on an average in a school day?
Less than 1 hour
1-2 hours
3-4 hours
5 or more hrs
None
Don’t know
Others
How do you usually go to school/ back from school to home every day?
By car/bus
By motorbike
By Bicycle
On foot
Do you own a smart phone?
Yes
No
Part VI: Health Related Factors
Did you have any chronic disease like diabetes, asthma, for which you have to take medicine regularly?
Yes
No
Sometimes
Never
Do you often feel depressed (about study, family problem, problems with friends, etc.)?
Yes
No