CHAPTER I

INTRODUCATION

BACKGROUND OF THE STUDY

"Children are the wealth of tomorrow, Take care of them if you wish to Have a strong India,
Ever ready to meet various challenges"

- Jawaharlal Nehru.

Good health is a prerequisite of human productivity and the developmental process. Health is
essential to all round development of the country. Health is a state of well being of individual and
community. School children face a determine in a society that values youthfulness and thinness but
encourages a lifestyle of sedentary convenience such a lifestyle includes a decrease is physical
activity, therefore energy expenditure, as well a fast foods high in calories, making adolescents
escapes obesity and ill health. Eating well, exercising regularly, encourage families to make
healthful food choices is very important for school children. Especially during the last few decades
the prevalence rate of childhood over weight and obesity has reached epidemic proportions
worldwide. Obese children face difficulties in their social life and run a substantially increased risk
of becoming our future generation of obese, chronically diseased adolescents and adults.1

Adolescent is the age of transition. The healthy adult hood has its origin from their adolescent
period. Healthy youth is more productive and contribute much to the development of the nation.
Healthy living needs food which helps them to grow and function actively. Many adolescents skip
breakfast by choice either because they do not have time to eat or in order to lose weight. The
Nutritional transition caused due to various factors like economic development and globalization
leads to rapid change in poor dietary habits combined with decreased physical activity. In addition
many school children depend on junk foods for nourishment and have inadequate intake of fruit,
vegetables and whole grains which have further led to an increase in overweight and obesity.2

Childhood obesity is a serious medical condition that affects the children and adolescents. It occurs
when a child is well above the normal weight for his or her age and height. Childhood obesity is
particularly troubling because the extra pounds often start children on the path to health problems

1
that were once confined to adults such as diabetes, high blood pressure and high cholesterol.
Childhood obesity can also leads to poor self-esteem and depression.2

Obesity now considered as a “killer lifestyle disease” an important cause of preventable death
worldwide. According to the world health organization 1.2 billion people worldwide are officially
classified as overweight. Obesity has so many affects on children and it can mess their lives up
dramatically.2

Children learn a lot from school, environment and more from experience. Whether a child is a
member of our family or not, it is our responsibility help the child to grow in a healthy way. Today's
children are tomorrow's citizen. Good health is everyone's right. As parents, teachers and much
more as care givers, we have great privilege and responsibility in bringing up children with adequate
knowledge and understanding. Understanding about obesity causes, treatment and prevention is one
of the best things that you can do for yourself. Over the course of last several decades, America has
suffered from an increase in obesity due to variety of factor. With more people eating fast food
regularly and not getting enough exercise, it’s no wonder that obesity has become a real epidemic.2

A bad diet is not only thing that cause obesity. If you eat food that contains things like fructose
corny syrup regularly you are putting your body at risk for obesity. In addition if you don't get
enough exercise on regular basis obesity may be in your future. There are some diseases like
hypothyroidism that can impact your weight.3

One of the best strategies to reduce childhood obesity is to improve the diet and exercise habits of
entire family. Treating and prevent childhood obesity helps to protect the health of your child now
and in the future.3

The increased rates of obesity among adolescents are dramatically reducing the quality of young
lives. Obesity in adolescents are associated with complications like, poor self-esteem, depressive
disorders, sleep apnea, hypertension, atherosclerosis, type II diabetes mellitus and the list goes on.
Obese parents are at greater risk of having obese children which is reflected by environment and
genetics. Other reasons contributing to obesity are psychological factors and child‘s body type. A lot
of research has been done regarding genetic and physiology of appetite control. Polymorphism is a
gene controlling appetite and metabolism which predispose individual to obesity, in spite of having
sufficient calories.4

Many children fail to exercise because they are spending time doing stationary activity such as
computer usage, playing video games or watching television. TV and other technology may be large

2
factors of physically inactive children. A randomized study showed that reducing TV, viewing and
computer use can decrease age adjusted BMI, reducing calorie intake also thought to be greatest
contributor to the BMI decrease.4

WHO states (2016) that it is estimated about 155 million children of 10-15 years of age are
overweight in world and 1228 children in India are obese according to journal of Medical
Nutrition.4

The World Health Organization has acknowledged that obesity is sweeping the world and is a major
public health problem of particular concern is the increasing incidence of child obesity. Obesity can
be seen as the first wave of a defined cluster of non-communicable disease called "New world
syndrome" creating an enormous socio-economic and public health burden in poor countries. The
World Health Organization has described obesity as one of today's most neglected public health
problems following the increase in adult obesity, the proportion of children and adolescents who are
overweight and obese have also been increasing. Being overweight or obese during childhood is a
health concern in itself, but can also lead to physical and mental health in later life such as heart
disease, diabetes, osteoarthritis, back pain, low self esteem and depression.5

Many people today, especially young people, are now living a hectic and stressful lifestyle. Because
they live this kind of life, they tend to eat comfort food to get rid of stress. Stress can make the
person feel hungry even though just ate. Because of this, they will tend to eat more portions over the
past two decades. Stress has increased in an alarming rate studies also found that along with
increase of stress, obesity also followed closely.5

The term obesity is derived from the Latin word "Obesus" which means having "eaten until fat". It
is usually defined as an excess of body fat and is often seen as an imbalance between energy intake
and expenditure. Obesity is a state in which there is generalized accumulation of excess fat in the
body leading to the body weight more than 20% of the required weight where as overweight is a
state in which there is generalized accumulation of excess fat in the body leading to the body weight
of more than 10% of required weight.1

Obesity is the consequence of a long term imbalance between energy intake and energy expenditure
determined by food intake, physical activity and influenced by biological, societal and
environmental factors. Obesity may have several short term consequences like social discrimination,
lower Quality of life, Increase cardiovascular risk factors and disease, like asthma and the long term
consequences are persistent of obesity, increased morbidity, and higher prevalence of cardiovascular
risk factors in adulthood and also cause important economic burden. Obesity should therefore be
3
prevented as early as possible. For establishing effective intervention, it is important to identify
major determinants in the early stage of life1.

Childhood obesity has been interpreted as compulsive overeating under the influence of brain
mediated through dopamine receptors. Children consume significantly more calories and products
having invisible salt, sugar and fat products, with taste thresholds adapted/changing with time –
depending upon the exposure, accessibility, availability and affordability of products in the market.
In the past two to three decades: national prevalence of prevalence of overweight and obesity
increased almost four times from 4% to 15% while type 2 diabetes among Indian adults increased
from 5.9% to 9.1% and hypertension prevalence increased from 17.2% to 29.2%, with significant
urban-rural differences.2

It is pertinent to point out that, most Indian studies are not comparable as difference exists in
methods, datasets, BMI cut offs, smoothening methods and using arbitrary assumptions; therefore
presently no reliable national level estimate in the prevalence of childhood obesity is available.
However a systematic review conducted by Gupta et al., (2012) reported that prevalence of
overweight, among 5 to 19 years children, ranges between 6.1 and 25.2% while that of obesity
ranges between 3.6 to 11.7%. Khadilkar et al., in 2010 have estimated the combined prevalence of
overweight and obesity as 19.6% as per IOTF classification while this was 27% when using WHO
standards.12 Among adolescence, between 10 to 17 years, the percentage was 22.3% (as per IOTF
cut off) and 29.8% (as per WHO cut off) – this age groups should be considered as most vulnerable
for adiposity.2

Childhood obesity is a global phenomena affecting all socio-economic groups, irrespective of age,
sex or ethnicity. Aetiopathogenesis of childhood obesity is multifactorial and includes genetic,
neuroendocrine, metabolic, psychological, environmental and socio-cultural factors. The treatment
of overweight and obesity requires a multidisciplinary, multi phase approach, which include dietary
management, physical activity enhancement, restriction of sedentary behaviour, pharmacotheraphy
and bariatric surgery.5

Schools should facilitate changes increase physical activity and parent teacher association can help
to educate parents as to the dangers of childhood obesity. Introduction of nutrition and physical
education in the school curriculum with there activities should become compulsory subject with
marks to be added to later grades. Parents are the role model. If parents will do exercise and eat
healthy, there child will follow them. Government should regulate fast food advertisements aimed at

4
children and insists on food labelling. Department can influence the food industry to reduce the
level of fat and sugar in foods targeted at children.6

NEED FOR THE STUDY

The nation’s prosperity always depends upon the quality of human resources. In current India
population structured, there significant percentage adolescents ranging from 10-19 were of age
represents the 22-8% (nearly 230 millions). This is almost 2/3 of the world adolescent population.
The transition period of Adolescence is from childhood to adulthood. Adolescent is frequently
exposed to rapidly- changing values, modern technology and communication and hostile culture
which affect their health. In Worldwide,the obesity trends are causing serious public health issues in
many countries, threatening the viability of basic health care delivery. It is an independent risk
factor for cardiovascular diseases and significantly increases the risk of morbidity and mortality.8

Obesity is among the easiest medical condition to recognize, but most difficult to treat.The health
consequences of obesity will have considerable effect on future burden on health cost and
services.The prevalence of childhood obesity is increasing rapidly worldwide. It is associated with
several risk factors for later heart disease and other chronic illness including hyper lipidaemia, hyper
insulinaemia, hypertension and early atherosclerosis. There risk factors may operate through the
association between child and adult obesity, but they may also act independently.7

A study done with school children in urban Chennai found that the number of overweight boys to be
17.8% and girls 15.8% .In affluent cities of India, the prevalence of obesity reaches the levels of
industrialized countries, with values increasing with socioeconomic class.6

Obesity rates are generally highest in communities with high levels of poverty and low levels of
income. Low income communities are often undeserved to grocery stores and frequently have fewer
places that are safe to play. A higher prevalence of obesity seen in urban areas in developing
countries is associated with the change from rural to urban life style causing decreased levels of
physical activity and increased intake of energy dense diet.8

Many countries in South East Asia including India are going through an economic and nutrition
transition. The nutrition transition is associated with a change in dietary habits, decreasing physical
activity and rising prevalence of obesity. Obesity in children and adolescents is gradually becoming
a major health problem in many developing countries, including India.8
5
countries, due to deaths from cardiovascular disease in people aged 35 - 64 years (9·2 million years
lost in 2000).

The department of community medicine reports that Obesity is arbitrarily considered to be present
when the fat content of the body is greater than 25% of body mass in men and 30% in women. Over
the past two decadesthere has been a dramatic rise in the prevalence of obesitythroughout the
world.It is estimated by the WHO that globally, over 1 billion (16%) adults are overweight and300
million of these (5%) are obese from their adolescent age.7

Adolescent obesity is affecting all socio-economic groups, irrespective of age, sex or ethnicity in
world wide. Aetiopathogenesis of adolescent obesity is multi-factorial and includes genetic,
neuroendocrine, metabolic, psychological, environmental and socio-cultural factors. Many co-
morbid conditions like metabolic, cardiovascular, psychological, orthopedic, neurological, hepatic,
pulmonary and renal disorders are seen in association with childhood obesity. The treatment of
overweight and obesity in children and adolescents requires a multidisciplinary, multi-phase
approach, which includes dietary management, physical activity enhancement, restriction of
sedentary behaviour, pharmacotherapy and bariatric surgery. A holistic approach to tackle the
adolescent obesity through influencing policy makers and legislation, mobilizing communities,
restructuring organizational practices, empowering providers, and community education.9

Prasad rajiv et.al (2018) conduct the cross sectional study to assess the prevalence of Obesity
among urban and rural school going adolescents in Surat India .The study show that the overall
prevalence of obesity is 7.4% and overweight is 9.9%. 65.22% of urban males & 62.26% females
were either obese or overweight as compared to 15.78% of rural males and 3.92%
females .Overweight and obesity was significantly associated with more expected calorie intake,
frequent restaurant visits, regular consumption of fast food/ junk food, sedentary activities, using
bus/car/auto as a transportation for going to school, upper and upper middle socioeconomic class,
family history of diabetes mellitus, obesity and hypertension (P value <0.001).10

Shete .S.Jagannatha et al (2018)A cross sectional study to estimate prevalence of obesity and its
risk factors in adolescent school children in Western Maharashtra, India. The sample size , About
207 adolescent school children from selected school were enrolled in the study. Research tool
comprised of questions about demographic characteristics, daily physical activity, frequency of
having junk food intake etc. Height and weight were measured on calibrated scales. The result show
among participants 58.9% were boys. 66.7% students were in the 13 to 14 years of age group. As

6
per body mass index, 46.9% children were underweight and 8.7% were obese. 77.3% participants
were eating junk food more than once in a week.11

T kowsalya, et al (2014) conducted a study on prevalence of overweight and obesity among

adolescent girls in Salem, India. The study was carried out at the Salem block in Salem District
from November 2012 to March 2013. Totally 6619 school going adolescents had been included,
their anthropometric measures include height (cm), weight (kg), waist (cm) and hip circumference
were measured. Body mass index (BMI) and waist-hip ratio (WHR) were calculated. Overweight
and obese adolescents were identified based on their BMI. For comparison, girls with normal weight
were selected by simple random sampling technique. All the selected girls were in the age group of
10-15 years, and they studied from 6th to 10th standard. The study show that overall rate of
prevalence of overweight/obese among adolescent girls was found to be 454 (6.86%). The highest
prevalence was observed at the age of 10-11 years (7.82). Mean anthropometric measures of
overweight/obese adolescents were higher than normal girls. Mean anthropometric measures of
normal and overweight/obese girls were significantly increased by age groups except hip
circumference. BMI was highly influenced by weight followed by age, height, hip circumference
and WHR of the overweight/obese girls.12

Edna sweenie,et.al (2013), Conducted a cross sectional study to assess the prevalence of
overweight and obese in Cuenca, Ecuador. Representative sample of n=74 school children aged 6-9
years with overweight and obesity were detected by using the International obesity task force
cutoffs according to body mass index, poverty, physical activity and eating habits were assessed
with validated questionnaire. The prevalence of obesity and overweight was 1.5 to 2 fold higher in 9
year old than in 6 year old children. Multivariate models demonstrated that higher BMI were
significantly related to low physical activity and non poverty. Eating breakfast and eating more than
3 meals/day were not related to prevalence of overweight and obesity. The high prevalence of
overweight and obesity in school children was associated with insufficient physical activity and non
poverty. promoting physical activity and fruit consumption in school snacks should be explored as
interventional measure to prevent overweight and obesity in Cuenca school children.13

Remesh Ambili (2012) conducted a descriotive cross-sectional study Prevalence of adolescent

obesity among high school students of Kerala, South India. A study questionnaire was administered
among the participants and their parents to understand the relationship of food intake, parental
obesity, and physical activity to obesity. The result show Of the 560 students enrolled, 49 (8.75%)
were overweight and 27 (4.82%) were obese. With this, the prevalence of obese is computed as
4.8%. The parental obesity posed a significant risk factor among the study population.14
7
.

As a consequence of the rising incidence of obesity, parents un awareness and over feeding is also a
cause for this condition. Parents role at home in promoting healthful eating practices and levels of
physical activity are so critical in preventing obesity. They should also take central to collective
efforts to combat the nation’s childhood obesity. Obesity may also increase the risk of serious
complications from H1N1 influences. A study in California showed about 25% of the people
hospitalized for H1N1 complication. A recent global survey by right speed research revealed that
nearly 3 out of 4 respondents blamed children spend much of their time in two places, home and
school which make their two most influential groups of people, parents and teachers9.

In worldwide controversy is going on regarding childhood obesity. Obesity is reportedly increasing

in India. The investigator had been seen many overweight and obese children among all the income
group peoples and wonder about the causes of obesity among them.so the investigator impressed on
the topic and interested to do this research in Kumbakonam as it was my native place.8

Therefore as a nurse, the researcher has a pivotal role in creating awareness among Adolescent
about the modification of lifestyle and prevention of future complications, which can help to
improve the quality of life by providing education and support. Today most of the research studies
among adolescents have focused on the nutritional problems, obesity and animia. Very little
information is available on knowledge and attitude of adolescents regarding obesity in urban and
rural areas. As an Investigator, I found children are spending more time on mobile phone, playing
video games, watching television and work on computers without doing any activity. Children have
lack of knowledge regarding obesity and were neglecting to take care of their health according to
their age group. Hence Investigator felt a strong need to conduct a study in a local setting. It is better
to prevent obesity and its complications in adolescent period by conducting health awareness
programme regarding lifestyle modification. The massive health education programme were
urgently needed both in urban & rural areas in India. The awareness and knowledge regarding
obesity is grossly inadequate among adolescents in India. Adolescent period may be the best time to
mount primary and secondary prevention programme against obesity, because this the age of which
individuals become.

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 PROBLEM STATEMENT

A pre-experimental study to assess the effectiveness of structured teaching programme on

knowledge regarding life style intervention as a management for obesity among adolescents in
selected schools of district. Kangra H.P.

AIM OF THE STUDY

To improve the knowledge regarding lifestyle intervention as a management for obesity among
adolescents in selected schools of district kangra, Himachal Pradesh.

OBJECTIVES

• To assess the pre-test knowledge scores regarding lifestyle intervention as a management for
obesity among adolescents.

• To assess the post-test knowledge scores regarding lifestyle intervention as a management for
obesity among adolescents.

• To compare the pre-test and post- test knowledge scores regarding lifestyle intervention as a
management for obesity among adolescents

• To find out the association of post-test knowledge scores regarding lifestyle intervention as a
management for obesity among adolescents with their selected socio demographic variables.

OPERATIONAL DEFINITION

The operational definitions are:

1.ASSESS: Assess refers to measure the level of knowledge regarding life style intervention as a
management for obesity among adolescents.

2. EFFECTIVENESS: In this study effectiveness refers to the extent to which the structured
teaching programme has achieved the desired effect of improving the knowledge as determined by
statistical difference between pre test and post test scores on knowledge regarding life style
intervention as a management for obesity.

3. STRUCTURED TEACHING PROGRAMME : In this study , structured teaching programme

refer to systematically developed instructional programme along with teaching aids, designed to
provide information on life style intervention as a management for obesity.

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4. KNOWLEDGE: In this study knowledge refers to the level of understanding of adolescents
regarding life style intervention as a management for obesity.

5. LIFE STYLE INTERVENTION: In this study life style intervention refers to

nutrition ,education, physical activity and stress management that is essential for management for
obesity.

6. ADOLESCENTS : In this study adolescents refers to students who’s age between 12-17 years .

7. OBESITY : In this study obesity refers to abnormal or excessive fat accumulation that leads to
further health problem among adolescents.

QUETELET’S INDE:

Weight in kg

QI= –––––––––––––––

Height (m2)

INTERPRETATION:

BMI Less than 18.5 Underweight

BMI 18.5-24.9 Normal weight
BMI 25-29.9 Overweight
BMI more than 30 Obese

ASSUMPTIONS

The proposed study assumes that:

 Adolescents may have some knowledge regarding life style intervention as a management
for obesity.

 Structured teaching programme will have some impact on level of knowledge of

adolescents regarding life style intervention as a management for obesity.

 Adolescents will provide reliable information.

 Knowledge questionnaire will help the researcher to collect the relevant information.

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 HYPOTHESIS

H1: There will be significant difference between mean pre-test and post-test knowledge

scores regarding life style intervention as a management for obesity among adolescents.

H01: There will be no significant difference between mean pre-test and post-test knowledge

scores regarding life style intervention as a management for obesity among adolescents.

H2: There will be significant association of post-test knowledge scores of adolescents with their
selected socio demographic variables.

H02: There will be no significant association of post-test knowledge scores of adolescents with
their selected socio demographic variable.

DELIMITATIONS

The study will be delimited to:

1. 60 adolescents aged between 12-17years.

2. Adolescents residing in District Kangra.

CONCEPTUAL FRAMEWORK

General System Model

System theory was proposed in the 1940’s by the biologist Ludwig Von Bertalanffy and furthered
studied by Ross Ashby (1964). Von Bertalanffy was reacting against both reduction and attempting
to revive the unity of science. He is considered to be the founder and principal author of general
systems theory. System concept include: input, process, output.

According to the general system theory a system is a set of components or units interacting with
each other within the boundary that filter the kind and the safe of blow of inputs and output to and
from the system. It provides a comprehensive systematic and continuously ongoing framework for
programme evaluation. The core value for present study is to assess the effectiveness of structure

11
teaching programme on knowledge regarding lifestyle intervention as a management for obesity
among adolescents.

INPUT : Input refers to target group with their socio demographic variable in the present study i.e.
age,gender, religion , education of father, education of mother ,occupation of father, occupation of
mother , type of family , Leisure time activity, Dietary habit,junk food practice,frequency of
consumption, previous knowledge, sources of knowledge.

THROUGHPUT : Throughput is an activity phase where a structure teaching programme of

knowledge regarding lifestyle intervention as a management of obesity among adolescents.

OUTPUT : It is any information, energy and material that leave the system and entera the
environment through system boundaries. Post-test is the output; it is end result or product of system
that is better knowledge of lifestyle intervention as a management of obesity among adolescents.

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 Adolescents (age between 12-17years )

INPUT PRE-TEST
OUTPUT
Administration of tool to the
sample before structured teaching
SOCIO – DEMOGRAPHIC programme in the form of self
VARIABLES structured knowledge questionnaire
LEVEL OF KNOWLEDGE
(Pre-Test)
 Age (in year) Inadequate Knowledge =
 Religion ≤33%
 Gender
 Education of father Moderate
Validity,tryout
Structured teaching
 Education of mother Knowledge = 34-66%
reliability of tools programme
 Father’s Occupation
and pilot study Adequate Knowledge =
 Mather’s Occupation
 Type of family ≥67%
POST-TEST
 Leisure time activity
 Dietary habits Administration of tool to the sample
 Junk food practice after structure teaching programme in
 Frequency of consumption the form of self-structured
knowledge questionnaire (Post-test)
 Previous knowledge
If yes, source of knowledge
 Self structured questionnaire
FEEDBACK

Figure1: conceptual framework based on General System Model by Von Bertalanffy.

13
 SUMMARY

Chapter-1 deals with the need of the study ,problem statement, aim of study, objective definition of
the term, assumption ,hypothesis, delimitations and conceptual framework of the study .

14
 CHAPTER -II
REVIEW OF LITERATURE
Review of literature is an important step in the development of any research project. It helps the
investigator to analyze what is already known about the topic and do describe methods of inquiry
used in earlier work including the success and short comings. This chapter deals with the collected
information relevant to the present study through the published and unpublished materials. These
publications were the foundation to carry out the research work.

Research literature were reviewed and organized under the following headings.

• Prevalence of obesity among adolescents.

• Studies related to knowledge regarding prevention of obesity.

• Studies related to Effectiveness of Information Education Communication (IEC) on knowledge

regarding prevention of obesity.

PREVALENCE OF OBESITY AMONG ADOLESCENTS

Seema S, Kusum K et al (2020) conducted a cross-sectional study on prevalence and contributing

factors for obesity in school adolescents of District Uttarakhand India . Same size include 385
students. A pre-test self-administered questionnaire was used to collect date . The result of study
shows that the prevalence of overweight and obesity in study population was 9% and 17.1% . it was
found that 6.8% of adolescents were obese and that about 17.1% were overweight. Remaining
53.8% percent had normal category of BMI and 22.3 percent were category of underweight.
Conclusion of the study ,Health care practitioners and policy makers need to be aware of the
prevalence and contributing factor to teenage obesity. Adolescents will embrace practices such as
healthy eating habits, avoiding smoking and physical inactivity. This obesity may increase their risk
of developing chronic illnesses in adulthood and later life stage.15

Adriana Paula da Silva et al (2018) conducted a descriptive study on prevalence of overweight

and obesity and associated factors in school children and adolescents in a medium- sized Brazilian
city. 1,125 children and adolescents between age of 5.6 and 18 years from public and private
schools were taken by the convenient sampling technique. The sample included 681 girls and 444
boys. Overall, 364 participants with excess weight were identified. 17.3 % were overweight, 15.0%
were obese. Among the girls, 18.0% were overweight, 12.5% were obese; among the boys 15.3%
were overweight and 18.0% were obese. 16

15
Jamunashree.B.,Kumar G. et all (2017) conduct a cross-sectional study of prevalence of obesity
and over weight among school going adolescents in the age group of 11-17 years of district
Kangra.10 school are selected by using simple random method and sample size include 1300
children included in the study, 669 (51.5%) children were males and 631 (48.5%) children were
female. Out of 1300 children 37(2.8%) were overweight and 10(0.8%) were obese, prevalence of
both overweight and obesity combined was 3.6%. The number of overweight children ranged from
2 to 10 with percentage ranging from 1.1% to 5.4%.The number and percentage of obese children
ranged from 0 to 4 and 0% to 2.2% respectively. In the present study 3% (20) and 1.5% (10) of
males were over-weight and obese respectively. Out of 631 females 2.7% (17) and 0% (0) of
females were over-weight and obese respectively. Out of 47 (3.6%) children identified either
overweight or obese, 4.5% being males (30 out of 669) and 2.7% being females (17 out of 631),
showed slight preponderance of males over females.17

Sadhu charan Panda (2017) conducted a comparative cross- sectional study to assess the
prevalence of overweight and obesity among adolescent in Sambalpur India . Sample size include
600 of class 6th to 10th of two government school and two private school with help systematic
sampling method. A comparative, cross-sectional study was conducted among 600 children of class
VI to X of two government and two private schools. Thirty students were chosen in each class using
systematic sampling method. For all the statistical tests,a p- value of<0.05 was considered as
statistically significantnt. The result show that the prevalence of overweight and obesity were 8.9%
and 3.4% respectively. Obesity was found more among girls (3.8%) and more children from private
school were obese. Association of fast food, physical inactivity with obesity was significant.
Conclusions of the study , Overall combined prevalence of childhood overweight and obesity was
12.3 per cent. Percentage of overweight and obese children studying in private schools was more as
compared to government school children. School health program should incorporate health
education of teachers, students, parents and a convergence of education and health sector can reduce
the modifiable lifestyle behaviours.18

Sunil Pathala, Meghavi Pandya et al (2017) conducted a cross-sectional study to assess the
prevalence of overweight and obese among urban and rural school going adolescent of Vododara ,
India. The study population 188 subjects. 188 rural and 99 urban school. The result of the study
17.6%(33), 20.2%(38), 59%(111) and 3.2%(6) children were obese, overweight, normal and
underweight respectively. 65.22% of urban males & 62.26% females were either obese or
overweight as compared to 15.78% of rural males and 3.92% females (p<0.0001). OR was 17.7
(95% CI of 7.6 to 40.7) in favor of urban residence.  Statistically significant (p<0.05) differences is
16
found in study result. Conclusions of the study  Obesity and overweight is more prevalent in urban
adolescent. There is no difference among male and female group. There is tendency of high
frequency of obesity and overweight among those adolescents who have higher annual family
income, frequency of restaurant and school canteen food and lesser frequency of physical training
sessions conducted in schools.19

Agrawal .P.Jagadish ,Gupta k. Virendra et al (2017) conducted a descriptive study to assess the
prevalence of obesity among school going adolescent in the age group of 10-18year of Jaipur city,
India .Sample size include 1000 student aged between 10 to 18 years from public and private
school were taken by the convenient sampling technique .The result of the study average age of the
study group was 15.20±2.60 years in government schools and 15.28±2.53 years in private schools.
The difference was statistically not significant (p=0.095). Among obese adolescents’ waist hip ratio
is 0.013 Significant, neck circumference is 0.018 Significant, BMI is <0.001 Significant.
Conclusions of study strategies for prevention of overweight, obesity, weight reduction, promotion
of healthy lifestyles and regular monitoring are necessary to prevent the onset and early detection of
adolescents health problems.20

Jacob K Jacob et al (2016) conducted a cross- sectional study to assess the prevalence of
overweight and obesity in adolescent children in Kochi (Kerala) India. Out of 254 girls of the rural
school, 6 were obese (8.74%) and 25 were overweight (42.66%) of these obesity and overweight
were more common among 12 years old girls, 6.06% and 12.12% respectively. Of the 220 girls of
urban schools, 6 were obese (11.08%) and 21 were overweight (49.9%) of these obesity or
overweight were more common in the 13 years old age group of 3 (5.56%) and 8 (14.81%),
respectively. Of the 191 boys of the rural schools, only 1 (1.27%) was obese and 12 (29.13%) were
overweight.21

Shukla Kaur Nirpal , Shukla Mukesh et al (2016) conducted a comparative study on prevalence
of overweight and obesity among adolescent of Hyderabad India. The study result shows that ,
overweight and obesity in adolescent ranged from 2.2 to 25.8% and 0.73 to 14.6 % respectively.
The prevalence was comparatively higher in urban areas than in rural areas and males were more
preponderate to get overweight/obese. Conclusions of study revealed towards rise in prevalence of
overweight and obesity especially in male adolescents belonging to urban area thereby indicating
the need to provide of immediate and comprehensive targeted intervention for adolescents.22

Prasad. R.Vishnu , Singh zile et al (2016) conducted a cross- sectional study to assess the
prevalence of obesity and overweight among school going adolescent in the age group of 12-17 year

17
of Pondicherry , India. Sample size include 2,465 student from 5 school of Pondicherry. The study
was conducted among 2,465 students from 5 schools and 2 polytechnic colleges.  Chi-square test
was used to identify statistical difference in proportions. The study results shows that the prevalence
of overweight and obesity in our study population was 9.7% and 4.3%, respectively. There was no
difference in prevalence between males and females. The prevalence of overweight/obesity
increased as the age advanced. Conclusions of the study , prevalence of overweight and obesity was
predominant among the students of private schools in the urban region in our study population.23

Gayathri , Syamily ,Kulanadaivel.M. (2016) conducted a cross-sectional study to assess the

prevalence of obesity and overweight among adolescents in the age group of 11-14 year of
Pondicherry, India. Sample size include 150 children. The study result show that, prevalence of
overweight and obesity shows that the prevalence of overweight is 18% (N=27) and Obesity is 6%
(N=9) based on BMI. Overweight and Obesity is an emerging major health problem in school
children in our Country. Conclusion of the study there is an increase in the prevalence of overweight
/obesity in school children.24

Anithas (2015) conducted a case control study on factors contributing to obesity/ overweight
among schools, Kumbakonam, Thanjavur district, Chennai. The sample for the present study
includes 100 school children inclusive of 30 obese male and 20 obese female and 23 normal male
and 27 normal female. The sample size was decided to 50 cases and 50 controls. The finding of
study showed that the majority 47 (94%) of school children in the cases and 3 (6%) in the control
had high risk of contributing to obesity and there was significant association with the cases group at
the level of p˂0.001. The risk for developing obesity in cases group was 15.6 times increased than
that of the controls.1

Yan zou, Ronghuazhang (2015) conducted a comparison study on the prevalence of obesity and
its associated factors among city, township and rural area adults in china. A stratified clusters
sampling technique used and randomly samples were selected as per 1770 city residence 2011 town
residence and 1736 rural area residence. The study result shows that prevalence of obesity was
10.1%, 7.3% and 6.5% among city, township and rural area adults, respectively. For rural area
residents, the daily intake of pork, fish and shrimp, vegetable oil and salt was positively correlated
with BMI (r=0.087, 0.122, 0.093, 0.112, p<0.05), Conclusions of study, the prevalence of obesity
was higher among city residents than among township and rural area residents. The findings of this
study indicate that demographic and dietary factors could be associated with obesity among adults.
Healthy dietary behaviour should be promoted and the ongoing monitoring of population nutrition
and health status remains crucially important.25
18
Jagadesan Sonya,Harish Ranjani et al (2013) conducted a cross- sectional study to determine the
prevalence of overweight and obesity among school children and adolescents in Chennai, India .
Study carryout 18,955 children (6-11 year) and adolescents age (12- 17 year) across 51 schools (31
private and 20 government) of Chennai. The study result shows that prevalence of
overweight/obesity was significantly higher in private compared to government schools both by the
IOTF criteria [private schools: 21.4%,government schools: 3.6%, (OR: 7.4, 95% CI:6.3-8.6;
P<0.001) and by Khadilkar criteria (private school: 26.4%, government schools: 4.6% OR: 6.9, 95%
CI:6.2-7.8; P<0.001). Overweight/obesity was higher among girls (IOTF: 18%, Khadilkar: 21.3%)
compared to boys (IOTF: 16.2%, Khadilkar: 20.7%) and higher among adolescents (IOTF: 18.1%,
Khadilkar: 21.2%) compared to children (IOTF: 15.5%, Khadilkar: 20.7%). Conclusions of the
study,the prevalence of overweight and obesity is high among private schools in Chennai.26

Edna sweenie,et.al (2013), Conducted a cross sectional study to assess the prevalence of
overweight and obese in Cuenca, Ecuador. Sample size for study is 74 school children aged 6-9
years. The study result show that the prevalence of obesity and overweight was 1.5 to 2 fold higher
in 9 year old than in 6 year old children. Multivariate models demonstrated that higher BMI were
significantly related to low physical activity and non poverty. Eating breakfast and eating more than
3 meals/day were not related to prevalence of overweight and obesity. The high prevalence of
overweight and obesity in school children was associated with insufficient physical activity and non
poverty. promoting physical activity and fruit consumption in school snacks should be explored as
interventional measure to prevent overweight and obesity in Cuenca school children.27

Ravi Rohilla, Meena Rajput et al (2013) conducted a cross sectional study to assess the
prevalence and Correlates of Overweight/Obesity Among Adolescents of Rohtak, India. Sample
size is 1900 adolescents and age group of 10–19 years were included in the study. Mean weight
increased from 34.7 to 55.09 kg from the age group 10–13 to 17–19 years. On binary logistic
regression analysis, female gender, bus as a mode of transport, not playing games, and single sibling
were found to have independent association with prevalence of being overweight. The study
conclude that prevalence of overweight and obesity is a problem of adolescent school going children
in this study area which shows comparable trends with other parts of the country. Using bus as the
mode of transport, not playing outdoor games, and sibling count more than two are independent
predictors for being overweight and obesity. School-based programs for lifestyle and behavioral
modification, motivation of school teachers, active participation in sports irrespective of the gender,
regular anthropometric examinations of students in schools and sensitization of parents are some of
the remedial measures to curb this rising menace.28
19
Marwah Ahish ,Marwah Poonam et al (2012 ) conduct a cross-sectional study to assess the
prevalence of obesity among affluent school children in Patiala, Punjab . Sample size include total
of 1250 school children in the age group of 6-15 years were selected using stratified random
sampling. Weight and height of each student was measured using standard measures and body mass
index (BMI) was calculated. A semi-structured questionnaire was filled evaluating risk factors like
family history of obesity, intake of high calorie including junk foods, physical inactivity and
television and/or computer viewing. The study results shows that Overall obesity was seen in 95
(7.6%) children with 61 (9.4%) girls and 34 (5.7%) boys affected (p=0.20). Family history of
obesity, intake of high calorie foods, physical inactivity and television or computer viewing for
more than 3 hours a day were found to be significant risk factors of obesity (p<0.001
respectively).Conclusion of the study obesity as an emerging health problem among affluent
children in Patiala, India due to an increasing sedentary lifestyle and faulty dietary habits.29

STUDIES RELATED TO KNOWLEDGE REGARDING PREVENTION OF OBESITY

Shycil Mathew, saldenha Prakash et al (2020) conducted a descriptive cross-sectional study to

assess the knowledge on prevention and control of obesity among adolescent at selected urban high
school of Mangluru, India. Sample size include 360 adolescents were screened to identify the
occurrence of overweight and obesity. Body Mass Index (BMI) was computed using the formula,
BMI=weight (Kg)/ height (m2 ). According to their BMI status, 9.7% of adolescents were
overweight and 8.3% of them were obese. Self -reported lifestyle practice scores depicted that most
(86.2%) of the overweight and obese adolescents follow unhealthy lifestyle practices. Majority
(66.1%) of the adolescents had only average knowledge on prevention and control of overweight
and obesity. Conclusion of the study Though a maximum number of adolescents had average
knowledge on prevention and control of overweight and obesity, unhealthy lifestyle practices are
major risk factors for overweight and obesity among growing adolescents. Overweight and obese
adolescents should strictly follow healthy lifestyle practices.30

Garggy Shaji, Aswathy mathu et al (2018) conducted a cross -sectional study to assess the
knowledge of adolescents towards obesity in private school in Thrissur district Kerala, India. This
was a cross sectional study conducted among students of 9, 10, 11 and 12 in Deva Matha public
school. In total there were 179 students. A pretested self administered questionnaire was used to
collect data. 46.4% of adolescents had low knowledge on obesity, 46.9% have moderate knowledge,
and only 6.7% of them had high knowledge on obesity. 24.6% of adolescents have negative attitude
towards obese individual, 68.2% had neutral attitude and only 7.3% had positive attitude towards

20
obesity. Conclusion of the study there is need for targeted activities to improve the knowledge and
attitude towards obesity.31

Praveen R, Gunagi et al (2018) conducted a cross-sectional study to assess the knowledge

regarding prevention of obesity among school children in the age group of 13-14 years of
Karnataka, India. Sample size of study 480 students .The result of study shows that 75% students
had correct knowledge of dietary factor associated with obesity and 51-75% students responded
correctly for the factor. Conclusion of the study students had knowledge regarding prevention of
obesity .only one third of the students knew preventive measure like adequate intake of fruits and
vegetable, limiting unhealthy snacks and limiting screen time to prevent obesity.32

Manjusha Samudre,Sunil M.kulkarni. (2016) conducted a exploratory study to assess the

existing knowledge regarding prevention of obesity among school children in selected school of
Miraj,Sangil and Kupwad corporation area, Maharashtra. The sample size was 160 selected by
simple random sampling method. Majority (91.34%) students performed exercise and (62.5%)
respondent correctly to the form of work which reduce obesity (62.01%) related to psychological
effect seen only (17.3%) of the subjects answer correctly to the item related to effective prevention
of obesity, (33.17%) of subjects knew how obesity effected the body. The study reveled that
(63.46%) of the subjects had knowledge about the measures need to treat obesity. This study
concluded that prevention may be achieved through a variety of intervention targeting built
environment, physical activity and diet.33

Anto Lincy (2016) conducted a descriptive study on assessment on quality of life among obese
children selected school of Chennai ,India . The researcher selected the obese children those who
were studying between 6th to 9th standarad. The sample size consists of 33 obese children with the
help of purposive sampling technique. The total numbers of students in L.M.S. higher secondary
school were 154. Out of 154, 20 (12.98%) children were found obese. In St. Joseph higher
secondary school total number of students 128. Out of 128 students (10.15%) were found as obese.
The prevalence of obesity among children was 12.17%. According to study the researcher concludes
that there was association between obese children and the quality of life. This study concluded that
there was association between obese children and the quality of life. 34

Swamy Narayana (2015) conducted a pre-experimental study to assess the knowledge regarding
prevention of obesity among high school students of Giddarth School, Koothanoor. 60 samples
taken. The samples were selected by using convenient sampling technique. The data were collected
from the samples by using structured teaching questionnaire method and rating scale method. The

21
study findings revealed that the prevalence majority of the respondents (66.7%) are having normal
body mass index followed by 18.3% are below normal 11.7% are overweight and 3.3% of
respondents are obese. 81.7% are not having previous information on obesity and remaining 18.3%
of respondents are having previous information about problems of obesity and how to be
prevented.35

Titi Xavier Mangalathil , Vikas Choudhary et al 2013 conducted a descriptive study to assess
knowledge and attitude regarding obesity among adolescent students of Sikar, Rajasthan. A sample
size is 100 adolescent students were selected and convenience sampling technique was used. The
tools used for data collection were structured knowledge questionnaires and attitude scale. The
study result shows that majority of the adolescent students 56% were in the age group of 17-18
years of age and with regard to educational 61% of the adolescent students were in senior secondary
level of education. Knowledge of the adolescent students ranged between 1- 14 and mean
knowledge score of adolescent students was found to be 5.65 ± 2.907.Range of attitude scores lies
between 65 -101, the mean attitude score of adolescent students 84.88 ± 8.346. Findings further
showed that coefficient of correlation between mean knowledge score and mean attitude score of
adolescent students regarding obesity (0.442) was found to be significant at 0.05 level of
significance.36

Studies related to Effectiveness of Information Education Communication (IEC)and Structure

teaching programme on level of knowledge

Dr. M. Vaijayanthimala,Dr. Maheswari Jaikumar (2019) conducted a Quasi Experimental

study to assess the effectiveness of Information, Education and Communication on Prevention of
Obesity in Young Adolescents in Meenakshi College of Nursing, MAHER, Chennai. .The sample
comprised of 50 students who were selected by purposive sampling technique. The tool comprises
of demographic profile and 30 multiple choice questionnaire. Reliability of the tool was checked by
using multiple choice questionnaire. The data were analyzed by using structured questionnaire. The
data was analyzed by using descriptive and inferential statistics. Obesity in adolescents and children
has raised to significant levels globally with serious public health consequences. The findings of the
study concluded that IEC was very effective in improving the knowledge of the students on
prevention of obesity.37

Shanthi M.,C.Kanniammal et al (2019) conducted a true-experimental study to assess the

effectiveness of Information, Education and Communication on Knowledge, Attitude, Practice
Regarding Obesity among Adolescents at Selected Government Schools in Kancheepuram India .

22
The sample size was 6 government schools and age between 12-15year children with help of
purposive sampling technique. The data collection instrument was the Structured Interview
questionnaire..The result shows that , total of 1496 children (975 boys, 521 girls ).Among them 86
were obese (boy 40,521girls.).Prevalence was 5.74%..more in girl (8.82%) than boys (4.10%).The
unpaired ‘t’ test value was t 6.12,t=2.52 and t=2.14 which was greater than the table value at
p=0.001, p=0.01 and p=0.03 for all three components and revealed that there was a high signficant
difference between the experimental and control group.. The finding of study concluded that there
was a significant cant improvement in the level of knowledge attitude and practice among
adolescent children in the study group after the administration of Information Education
Communication Package.38

N Kumar, Rawat Alok (2019) conducted a pre-experimental study to assess the effectiveness of
structured Teaching Programme on Knowledge regarding healthy habits in prevention of obesity
among students in selected senior secondary schools of Jaipur, Rajasthan. Sample size 60
student .Results of the study, highest percentage (90%) of students had average knowledge
regarding healthy habits in prevention of obesity and others comes under poor (3.33%) and
remaining students having good knowledge(6.67%)about healthy habits in prevention of obesity.
The total mean percentage of knowledge scores of the pre-test was 48.22 with total mean +_SD of
14.466+_8.3942. This reveals that knowledge of students regarding healthy habits in prevention of
obesity was average in all the area. The findings of the study concluded that STP was very effective
in improving the knowledge regarding healthy habits in prevention of obesity.39

Thresiamma Antony(2019) conduct a quasi experimental study was conducted to assess the
effectiveness of a structured teaching programme on the knowledge and attitude of adolescents
regarding junk food in selected high schools at Ernakulam,karala,India. A total of 100 samples
were selected using convenience sampling of which 50 students were included each in experimental
and control group respectively. The mean post-test knowledge score (20.30) regarding junk food
among adolescents in the experimental group was significantly higher (p=0.001) than the pre- test
score (11.08). Similarly the mean post-test (20.30) knowledge score regarding junk food among
adolescents in the experimental group was significantly higher (p=0.001) than the mean post- test
knowledge score (11.90) of control group(t=14.371,p=0.001) . Conclusion: Majority of the samples
had poor and average knowledge regarding junk food. There was improvement in the knowledge
score of the samples in the experimental group after intervention. There was association between
knowledge score and age of children and type of family.The effectiveness of structured teaching
programme measured by pre test and post test score of samples and research hypothesis was tested.
23
The finding shows that structured teaching programme is more effective in improving
knowledge and attitude on junk foods among adolescents.40

Esater mery Pappiya, Sumathi ( 2018 ) conducted a true-experimental study to assess the
effectiveness of information, Education and communication on knowledge regarding obesity among
adolescents at selected school in Chenni, Tamil Naddu , India .The sample size include 200 students
of 4 government school and age between 12 to 18 year with help of random sampling
technique .The resuxlt of study shows that significant difference between the pre-test and post-test
knowledge score (124.4 + 1.3 ) and post-test (118.6 + 0.7) ( p < 0.0001). Study concludes that there
was information education communication (IEC) was effective in improving knowledge regarding
obesity.41

Sherin John , Prof .Sheela Williams et al (2018)conduct a pre-experimental study to assess the
effectiveness of Planned Teaching Programme on knowledge regarding lifestyle modification on
prevention of overweight among adolescents in selected schools in Mysuru. A sample size 100
adolescents and sample technique is Probability random sampling technique. Data were collected
using a structured knowledge questionnaire. A planned teaching programme was conducted from
adolescents. The result of the study reveals that the significance of difference between the mean pre
test and mean post test knowledge scores which was statistically tested using paired ‘t’ test and it
was found to be significant at 0.05 level of significance’t’=22.54, p. ,The study concluded the
planned teaching programme was effective in enhancing knowledge regarding lifestyle modification
on prevention of overweight among adolescents. Therefore, the study reinforces the need to
organize health campaigns and teaching programs which sensitize the adolescents to enhance the
knowledge regarding lifestyle modification on prevention of overweight among adolescents.42

Isha (2017) conducted a pre- experimental study to assess the effectiveness of planned teaching
programme on knowledge and attitude regarding prevention of obesity among adolescent girls in
selected schools of Joginder Nagar, Mandi, Himachal Pradesh. 60 randomly selected (lottery
method) student from the selected schools. The result of study shows that significant difference
between the mean pre- test and post- test knowledge scores (t59= 15.363, p˂ 0.001) and attitude
score (t59= 9.861, p˂ 0.001). The significant difference was found the different area. There were
association between the pre- test knowledge and attitude scores and selected demographic variables.
Hence it can be concluded that planned teaching programme was effective in improving knowledge
and changing attitude regarding prevention of obesity among adolescent girls, which was evident in
post- test knowledge score and attitude score.43

24
Priscillal.J(2017) conducted a pre-experimental Study to assess the effectiveness of Information
Education and Communication (IEC) on knowledge regarding prevention of obesity among students
in selected high school at Kanyakumari. A pre-experimental one group pre-test post-test design was
adopted and Non-probability convenient sampling technique was chosen for this study. The total
number of samples 60 students(11-16years)by using non-probability convenient sampling
technique. Study concludes that there was information education communication (IEC) was
effective in improving knowledge regarding obesity.8

Geeta.C.Jeyalakshmi et al 2017conduct a pre-experimental study to assess the effectiveness of

education programme on knowledge regarding obesity among school children in selected school,
Punducherry The sample size of present study was 148 school children studying 8th and 9th
standard in selected school Puducherrry children in selected school Puducherry. Non-Probability
convenient sampling technique was used to select the samples Out of 148 samples boys are majority
gender 79(53.4%)and girls are 69 (46.6%).With regard to father education 107 (72.3%) had an
education up to 10th standard and mothers To evaluate the effectiveness of educational programme
on knowledge regarding obesity among school children. The results indicates the mean in pre test
was 8.98 with a standard deviation of 3.67 and in the post test was 17.74 with Frequency and
percentage distribution of Pre test and Post test knowledge among school children regarding obesity.
N=148 Pre Test Post Test a standard deviation of 2.95.The t value was which was highly significant
at p<0.001 level which can be attributed to the effectiveness of educational programme. The study
concluded The most important strategies for preventing obesity are healthy eating behaviours,
regular physical activity and reduced sedentary activity. Education and awareness regarding obesity
are the vital part to prevent Non communicable disease in adulthood period.44

Narayan swami M.(2016) conducted the study pre-experimental study to assess the effectiveness
of planned teaching programme on knowledge and practice regarding prevention of obesity among
adolescent in selected school of Bangalore ,Karnataka .India. Sample size include 60, selected by
convenient sampling technique. Result of study, mean practice score in the pre test is 31.92whereas
in the post test is 65.68%. In the area wise practice mean percentage of 46.05% observed in the area
of practice related to Diet, activity and lifestyle mean practice score in pre-test and 71.15% in the
area of practice related to Diet, activity and lifestyle during post-test And knowledge score in the
pre-test in 48.33% where as in the post-test in 83.33%. Knowledge is assessed using translated self-
administered questionnaire with 18 items. Overall mean knowledge score in the pre-test is 48.78%
where as in the post test is 82.33%.The results of ‘t’ test shows that the improvement of mean value
of knowledge scores of post test when compared to a lesser values of pre-test are not by chance but
25
due to the gain in knowledge because planned teaching programme at a level of significance of
0.05%.45

SUMMARY

Chapter-II deals with the review of literature related to the present study . the literature reviewed
pertained to lifestyle intervention as a management for obesity among adolescents. Review of
literature is divided into tree section: section 1 : Prevalence of obesity among adolescents. Section
2 : Studies related to knowledge regarding prevention of obesity. Section 3 : Studies related to
Effectiveness of Information Education Communication (IEC) on knowledge regarding prevention
of obesity. The literature reviewed enabled to investigator to broaden her understanding and gain
insight to establish the need for the study, develop the conceptual framework, adopt the research
design, develop tool and decide to plan the data analysis.

26
 CHAPTER -III

METHODOLOGY

Research methodology is a significant part of any research which enables the researcher to
organize the procedure of collecting reliable data for the problem under study or investigation. This
chapter deals with the description of methodology and the various steps adopted to collect and organize
data for the study.

Polit and Beck (2004) research methods are the techniques used by researcher to structure a study
to gather and analyze information relevant to research question.

The methodology section includes the research approach, research design, variables, settings,
population, sample, sample size, sampling technique, sampling criteria, development of the tool,
description of the tool, validity, reliability, pilot study, data collection procedure, plan for analysis and
ethical consideration.

RESEARCH APPROACH

A research approach tells the researcher what data to collect and to analyze. It is the overall plan
chosen to carry out the study. It also suggests the possible conclusion to be drawn from the date.

According to Suresh K. Sharma (2011) the research approach involves the description of the plan
to investigate the phenomenon under study in a quantitative, qualitative or a combination of the two
methods. Furthermore, it helps to decide whether the presence or absence as well as manipulation and
control over variables. Also, it helps to identify the presence or absence of and comparison between
groups.

A quantitative research approach was considered to be appropriate for the present study used to
assess the effectiveness of structured teaching programme on knowledge regarding lifestyle
intervention as a management for obesity among adolescents.

27
 RESEARCH DESIGN :

Research design defines the study types, the research question, hypothesis, variables and data
collection methods. The selection of research design is the most important step as to provide the
framework for the study.

Polit and beck states that experiments are the most powerful method available for testing the
hypothesis of cause-and-effect relationships between variables.

Pre-experimental “One – group pretest – post-test design”.

A SCHEMATIC PLAN OF THE STUDY

GROUP PRETEST INTERVENTION POSTTEST

Adolescents O1 X O2

KEY :

O1 = Pre-test assessment of knowledge scores of adolescents of selected schools of district kangra

regarding lifestyle intervention as a management for obesity.

X = Structured teaching programme regarding lifestyle intervention as a management for obesity.

O2 = Post-test assessment of knowledge scores of adolescents of selected schools of district kangra

regarding lifestyle intervention as a management for obesity.

28
 RESEARCH APPROACH
(Quantitative research approach)

RESEARCH DESIGN :One group pre-test post-test Research Design

RESEARCH SETTING : Selected school of district Kangra (H.P.)

Govt.Sr.Sec.School, Govt.Sr.Sec.School,Palampur Govt.Sr.Sec.School,Nagrota

Bhawarna,Distt.Kangra ,Distt..kangra Bagwan Distt.Kangra
(H.P) Deogran

POPULATION: Adolescents

TARGET POPULATION :Adolescents of age group 12-17years

ACCESSIBLE POPULATION : Adolescents of age group 12-17 years

of selected schools of district Kangra (H.P.)

SAMPLE SIZE AND SAMPLING TECHNIQUE

60 samples and Non - probability purposive sampling technique

TOOL AND METHOD OF DATA COLLECTION

PART 1: - Section A. Socio demographic variables
Section B. Self -structured knowledge questionnaire

PART 2:- Structure teaching programme

ANALYSIS AND INTERPRETATION OF DATA

DESCRIPTIVE STATSTICS INFRENTIAL STATSTICS

Frequency, percentage, mean, median and standrad t-test, correlational coefficient and chi-square test
deviation

Figure- Schematic presentation of methodology

29
 RESEARCH VARIABLES

Burns and Grove stated that variables are qualities, properties, or characteristics of person, things
or situations that change or vary, are manipulated or measured in research.

Burns and Grove stated that independent variable is the treatment or experimental activity that is
manipulated or varied by the researcher to cause effect on the dependent variable.

Burns ad Grove stated that dependent variable is the response behavior or outcome that is
predicted or explain in research; changes in dependent variables are presumed to be cause by the
independent variables

• In present study

Independent variable: Structured teaching programme on knowledge of adolescents regarding

lifestyle intervention as a management for obesity.

Dependent Variable: Knowledge of adolescents regarding lifestyle intervention as a management for

obesity.

RESEARCH SETTING

The present study was conducted at following schools of District Kangra, Himachal Pradesh.

 Govt.Sr.Sec.School, Palampur Distt.Kangra,(H.P)

 Govt.Sr.Sec.School (boy),Nagrota Bagwan, Distt.Kangra ( H.P)

 Govt.Sr.Sec.School,Bhawarna ,Distt. Kangra ,(H.P)

POPULATION

Adolescents.

Target population :

The target population of the study was adolescents of age group of 12-17 years.

30
Accessible population :

The accessible population of the study was adolescents of age group of 12-17 years of selected schools
of District Kangra (H.P.).

 Govt.Sr.Sec.School, Palampur Distt.Kangra,(H.P)

 Govt.Sr.Sec.School(boy),Nagrota Bagwan, Distt.Kangra ( H.P)

 Govt.Sr.Sec.School,Bhawarna ,Distt. Kangra ,(H.P)

SAMPLE AND SAMPLING TECHNIQUE

SAMPLE

Burn and Grove states that sample is the upset of population selected to participate in research study

Polit and Beck state the a sample is small portion of population selected to participate in research
study.

The sample of present study consisted of 60 adolescents of age group of 12-17 years of selected schools
of district Kangra (H.P).

SAMPLING TECHNIQUES

Sampling is the process of selecting unit (people or organization) from a population of

interest. It is the process of selecting a portion of population. The process of sampling makes it possible
to accept a generalization to the intended population on the basis of careful observation of the variable
with in the relatively small portion of the population.

Non probability purposive technique was used in the present study to select the samples.

CRITERIA FOR SAMPLE COLLECTION

A. Inclusion Criteria:

This study includes adolescents :

31
  Who were in the age group of 12-17 years of selected schools of district kangra.
 Who understand and speak in Hindi and English language.
 Who were willing to participate in the study.
 Who were present on the day of data collection.

B. Exclusion Criteria :

This study excludes adolescents:

• Who were not willing to give consent.

• Who were not present on the day of data collection.

SELECTION AND DEVELOPMENT OF THE TOOLS

A tool is vehicle that could obtain data pertinent to the study and the same time adds to the body
of general knowledge in the discipline. The tool was selected and developed according to the objective
to the study, previous review of literature like books, journals, unpublished research studies, mass
media and by discuss with guide and co- guide. The developed tool was refined and validated by
subject experts and the guides.

The structured knowledge questionnaire was developed to evaluate the effectiveness of

structured teaching programmer on knowledge regarding lifestyle as a management of obesity among
adolescents.

DESCRIPTION OF TOOL

The self-administered questionnaire is a structured questionnaire which consist of questions

regarding demographic characteristics and knowledge. It consists of two parts:

PART-I: SOCIO DEMOGRAPHIC VARIABLES

The first part of the tool consist of some items for obtaining an information about the selected
background factor such as age, gender, religion, education of father, education of mother, occupation of
father, occupation of mother, type of family, leisure time activity, dietary habits , junk food practices,
frequency of consumption, previous and source oof knowledge.

32
Part-II

SECTION-A: Self structure knowledge questionnaire

Self-structured questionnaire is to assess the previous knowledge and effectiveness of structured

teaching program on knowledge regarding lifestyle intervention as a management for obesity among
adolescents. It consists of 30 items of multiple-choice questions where total score is 30.

SECTION-B: Structured teaching program.

It consist of systematically designed structured teaching programme regarding lifestyle intervention

as a management for obesity among adolescents

SCORING PATERN

The self-structured knowledge questionnaire consisted of 30 questions. In which right answer was
documented as correct one mark and wrong were documented were as zero marks. The complete range
was 0-30

Knowledge score % Score

Inadequate knowledge ≤ 33% 0-10

Moderately adequate knowledge 34-66% 11-20

Adequate knowledge ≥67 % 21-30

CONTENT VALIDITY

It was validated d by obtaining the experts opinion from different fields.

To ensure content validity of the tool regarding the relevance of item, the tool was submitted to 10
experts of different fields of nursing. Experts are requested to judge the items of tool for clarity,
relevance, appropriateness, relatedness and meaningfulness for the purpose of the study and give their

33
opinion and suggestion on the content, its coverage, organization. There was almost 100% agreement of
the items in the questionnaire; however, there were few suggestions to modifying some of the
questions, and they were incorporated in final draft.

LANGUAGE VALIDITY

The developed tool was given to an English and Hindi language expert for the corrections. As per
the suggestions, the modification were implemented.

ETHICAL CONSIDERATION

• A written permission was obtained from Principal, Netaji Subhash College of Nursing ,Palampur.

• Ethical clearance was taken from ethical clearance committee of Netaji Subhash College of Nursing.

• Written permission was taken from Principal of selected schools of District Kangra.

• Written informed consent was taken from each study sample anonymity and confidentiality of each
sample will be assured and maintained throughout the study.

PILOT STUDY

Burns and Grove stated that pilot study is the smaller version of a proposed study conducted to
develop and refine the methodology, such as the treatment instrument or data collection process to be
used in the larger study.

After obtaining the administrative approval ,pre-testing of structured questionnaire was done by
administering it to 6 adolescent in Government Senior Secondary School ,Rajapur Distt.Kangra (H.P.)
in the 1st week of august. The subjects chosen were similar in the charteristics to those of the population
under study to check the items for the clarity , relevance of items and nature of response .It was found
that participants took 30-35 minutes to complete the structured questionnaire . The items of the
structured questionnaire were clear and unambiguous.

RELIABILITY OF THE TOOTL

34
 Burns and Grove stated that reliability is the extent to which an instrument consistently
measure a concept, three type of reliability is stability, internal consistency and equivalence.

Reliability of tool was computed by applying split-half methods with Karl Pearson’s correlation
coefficient formula. The reliability was found (0.85) and tool was reliable.

PROCEDURE OF DATA COLLECTION

Burns and Grove states that data collection is the identification of subjects and precise, systematic
gathering of information (data) relevant to research purpose or the specific objective, questions or
hypothesis of the study.

After obtaining formal administrative approval from the Govt. Senior Secondary School, Palampur
Distt.Kangra,(H.P),Government. Senior Secondary School(boy),Nagrota Bagwan,Distt.Kangra (H.P.)
and Government Senior Secondary School,Bhawarna Distt.Kangra (H.P), Final study was conducted in
month of august 2022. The aim of study was to evaluate the effectiveness of structured teaching
programme on knowledge regarding lifestyle intervention as a management for obesity among
adolescents. .After obtaining permission from concerned authorities , the investigator develops rapport
and take consent from school going children. Total 60 sample were selected by non-probability
purposive sampling technique. After getting consent from the sample who met the inclusion criteria.

1. Pre-test : On 1st day pre-test was administered to adolescents in the form of self-structured
knowledge questionnaire regarding the lifestyle intervention as a management for obesity.

2. Self structured teaching programme.

3. Post-test : post-test was conducted on the 7 th day of pre-test with the same set of self-structured
knowledge questionnaire.

The data were compiled and analysis was done by using descriptive and inferential statistics.

DATA ANALYSIS

It includes descriptive and inferential statistics

• Descriptive statistics: the statistical analysis includes frequency, percentage, mean, median and
standard deviation.
35
• Inferential statistics:-

 Paired t-test was used to find out the significant difference between pre-test and post-test
knowledge scores.
 Chi square test was used to find out the association of post-test knowledge scores of adolescents
with their selected socio – demographic variable.
 Probability p-value of less than 0.05 was considered as statistically significant.SPSS (Stattistical
Package For Social System) version-18 software was used for analysis of data.

SUMMARY

Chapter-III deals with methodology adopted for the study. It included research approach ,research
design, research setting, target population, sample and sampling technique, inclusion and exclusion
criteria, selection and development of tool, description of tool, validity of tool, reliability of tool, pilot
study and procedure of data collection, ethical consideration and plan of data analys.

36
 CHAPTER- IV

ANALYSIS AND INTERPRETATION OF DATA

This chapter deal with analysis and interpretation of data collected to evaluate the effectiveness
of structured teaching programme on knowledge regarding lifestyle intervention as a management
for obesity among adolescents in selected school of district Kangra.

Burns and Grove state that data analysis is the technique used to reduce organize and giving
meaning to data.

The other purpose of data analysis , regardless of the type of data one has, is to impose some
order on large body of information so that can be synthesized, interpreted and communicated.

Analysis and interpretation of data collected through self-structured knowledge questionnaire

tool to assess the effectiveness of structure teaching programme on knowledge regarding lifestyle
intervention as a management for obesity among adolescents in selected schools of district Kangra.

Analysis and interpretation of data were based on objectives of the study and hypothesis. The
objectives of the study were to assess the effectiveness of structure teaching programme on
knowledge regarding lifestyle intervention as a management for obesity among adolescents.

The data and finding have been organized and presented under the following objective:

1. To assess the pre-test knowledge scores regarding lifestyle intervention as a management for
obesity among adolescents.
2. To assess the post-test knowledge scores regarding lifestyle intervention as a management
for obesity among adolescents.
3. To compare the pre-test and post- test knowledge scores regarding lifestyle intervention as a
management for obesity among adolescents.
4. To find out the association of post-test knowledge scores regarding lifestyle intervention as a
management for obesity among adolescents with their selected socio demographic
variables.

The result of analysis of data have been organized and presented under following section :

SECTION- 1

Description of socio-demographic variable of study participants,

37
 SECTION - II

Assess the pre-test knowledge scores regarding lifestyle intervention as a management for
obesity among adolescents.

SECTION – III

Assess the post-test knowledge scores regarding lifestyle intervention as a management for
obesity among adolescents.

SECTION – IV

Compare the pre-test and post- test knowledge scores regarding lifestyle intervention as a
management for obesity among adolescents.

SECTION – V

Association of post-test knowledge regarding lifestyle intervention as a management for

obesity among adolescents.

SECTION – I

DESCRIPTION OF SOCIO-DEMOGRAPHIC VARIABLES OF STUDY PARTICIPANTS

This section describes the frequency and percentage distribution of socio-demographic variables
life age, gender, religion , education status of father, education status of mother, father’s
occupation, mother’s occupation, type of family, leisure time activity ,dietary habits, junk food
practices, frequency of consumption ,previous knowledge and sources of knowledge.

Frequency and percentage distribution were calculated to describe the socio demographic variable.
The finding were presented in table-1

38
 TABLE -1

FREQUENCY AND PRECENTAGE DISTRIBUTION OF SELECTED SOCIO

DEMOGRAPHIC VARIABLE OF ADOLESCENTS

N=60

Sr.no. Sociodemographic Variable % F

12-13 years 33.3% 20

1. 14-15 years 41.7% 25

Age (in year)
25.0%
16-17 years 15

100.0%

55.0%
a ) Male 33
Gender
2.

b) Female 45.0% 27

100.0%

3. No formal education 8.3% 05

Education status Primary education 8.3% 05

of father Higher secondary education 36.7% 22

Graduate / equivalent 46.7% 28

100%

Education status No formal education 31.7% 19

of mother
4. Primary education 35.0% 21

Higher secondary education 26.7% 16

39
 Graduate / equivalent 6.7% 04

100.0%

Government Employee 11.7% 07

5 Father's Private Employee 38.3% 23

occupation Self Employed 40.0% 24

Un Employed 10.0% 06

100.0%

Government Employee 5.0% 03

6 Mother's Private Employee 10.0% 06

occupation Self Employed 43.3% 26

Un Employed 41.7% 25

100.0%

Nuclear family 81.7% 49

Type of family
7 Joint family 18.3% 11

100.0%

Outdoor games 23.3% 14

8 Watching TV 38.3% 23

Indoor Games 23.3% 14

Exercise 15.0% 09

100.0%

9 Vegetarian 50.0% 30
Dietary habits
Non vegetarian 50.0% 30

100.0%

Junk Food

40
 10 Yes 95.0% 57
Practice
No 5.0% 03

100.00%

Daily 23.3% 14
Frequency of
11 Once in a week 56.7% 34
consumption
Once in a month 20.0% 12

100.0%

12 Previous Yes 100.0% 60

knowledge No 0.0% 00

100.0%

Health professional / social

31.7% 19
worker
Sources of
13. T.V and radio 31.7% 19
knowledge
Newspaper / magazine 15.0% 09

Friends / Relative 21.7% 13

100.0%

Table 1 : This depicts the socio demographic variable of adolescents in age between 12-17 years .

According to age group majority of adolescents 41.7%were age group of 14-15 years ,33.3% of
adolescent were age group of 12-13years,25% of adolescent were age group of 16-17 years.

According to gender ,majority of adolescents 55% were male and 45% were female.

According to education status of father ,majority of adolescents 46.7 % father were having
graduate 36.7 % father were having higher secondary education and above, 8.3 % father were
having primary education and 8.3% father were having no formal education.

41
 According to education of mother, majority of adolescents 35.0 % mother were having primary
education, 31.7% mother having no formal education and above, 26.7% mother were having higher
secondary education and 6.7% mother were having graduate.

According to occupation of father , majority of adolescents 40.0 % self -employed and 38.3 %
father were in private sector,11.7% father were government employee and 10.0% father were
unemployed.

According to occupation of mother, majority of adolescents 43.3% mother were self-

employed ,41.7% mother were unemployed,10.0% mother were private employee and 5.0% mother
were government employee.

According to type of family, 81.7% families were nuclear families and 18.3% families were joint
families.

According to leisure time activity, majority of adolescents 38.3% spend leisure time activity
watching TV and 23.3% spend leisure time activity outdoor games and above, 23.3%spend leisure
time activity indoor game and 15.0% spend leisure time activity exercise .

According to dietary habits, majority of adolescents 50.05% were vegetarian and 50.0 % were
non-vegetarian.

According to junk food practice, majority of adolescents 95.0% were having junk food practice
and 5.0 %were not having junk food practice.

According to frequency of consumption ,majority of adolescents 56.7% were having junk food
consumption once in week ,20.0% were having junk food consumption once in month,23.3% were
having junk food consumption daily.

According to previous knowledge regarding lifestyle intervention as a management of obesity,

majority of adolescents 100.0% were having previous knowledge regarding lifestyle intervention as
a management for obesity.

According to sources of knowledge, majority of adolescents 31.7%received information from

health professional/social worker, 31.7% received information from T.V and radio , 21.7% received
information from friends / relative , 15.0% received information from newspaper.

42
 Age in year
41.7%
45.0% 33.3%
40.0%
35.0% 25.0%
Percentage%

30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
12-13 years 14-15 years 16-17 years
Age

Figure 3: Cone diagram representing the description of respondent by

percentage distribution based on age (in year).

60.0% GENDER
55.0%
50.0%
45.0%
40.0%
Percentage%

30.0%

20.0%

10.0%

0.0%
Male Female
Gender

Figure 4: Cone diagram representing the description of respondent by percentage

distribution based on gender

43
 Education status of father

46.7%
50.0%
45.0% 36.7%
40.0%
35.0%
30.0%
25.0%
Percentage%

20.0%
15.0% 8.3% 8.3%
10.0%
5.0%
0.0%

Graduate
Higher
Primary

ondary

/ equiva-
educa-
ucation

educa-
mal ed-
No for-

tion
sec-
tion

lent
Education Status Of Father

Figure 5: Cone diagram representing the description of respondent by

percentage distribution based on education status of father .

Education status of mother

35.0%
31.7%
35.0%
26.7%
30.0%

25.0%

20.0%
Percentage%

15.0%
6.7%
10.0%

5.0%

0.0%
Graduate
Higher
Primary

ondary

/ equiva-
educa-
ucation

educa-
mal ed-
No for-

tion
sec-
tion

lent

Education Status Of Mother

Figure6: Cone diagram representing the description of respondent by percentage distribution

based on education status of mother.

44
 Father's occupation
40.0%
38.3%
40.0%

35.0%

30.0%

25.0%

20.0%
Percentage%

11.7%
15.0% 10.0%

10.0%

5.0%

0.0%
Government Private Employee Self Employed Un Employed
Employee
Father's Occupation

Figure7: Cone diagram representing the description of respondent by percentage distribution

based on father’s occupation .

mother's Occupation
43.3%
41.7%
45.0%
40.0%
35.0%
30.0%
25.0%
Percentage%

20.0%
10.0%
15.0%
5.0%
10.0%
5.0%
0.0%
Government Private Employee Self Employed Un Employed
Employee
Mother's Occupation

Figure8: Cone diagram representing the description of respondent by percentage distribution

based on Mother’s occupation

45
 Type of family

81.7%

90.0%
Percentage%

80.0%
70.0%
60.0%
50.0%
18.3%
40.0%
30.0%
20.0%
10.0%
0.0%
Nuclear family Joint family
Type of family

Figure9 : Cone diagram representing the description of respondent by percentage distribution

based on type of family.

Leisure time activity

38.3%
40.0%

35.0%

30.0% 23.3% 23.3%

Percentage%

25.0%
15.0%
20.0%

15.0%

10.0%

5.0%

0.0%
Outdoor Games Outdoor Games Indoor Games Exercise
Leisure Time Activity
Fi
gure10: Cone diagram representing the description of respondent by percentage distribution
based on Leisure time activity.

46
 Dietary habits
50.0% 50.0%

50.0%
45.0%
40.0%
Percentage%

35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Vegetarian Non vegetarian
Dietary habits

Figure11 : Cone diagram representing the description of respondent by percentage

distribution based on Dietary habits.

Junk food practice

95.0%

100.0%
90.0%
Percentage%

80.0%
70.0%
60.0%
50.0%
40.0%
30.0% 5.0%
20.0%
10.0%
0.0%
Yes No
Junk Food Practice

Figure12: Cone diagram representing the description of respondent by percentage

distribution based on Junk food practice.

47
 Frequency of consumption
56.7%
60.0%

50.0%

40.0%

23.3%
30.0% 20.0%
Percentage%

20.0%

10.0%

0.0%
Daily Once in a week Once in a month
frequency of consumption

Figure13: Cone diagram representing the description of respondent by percentage

distribution based on frequency of consumption of junk food .

Previous knowledge
100.0%

100.0%
90.0%
80.0%
70.0%
60.0%
Percentage%

50.0%
40.0%
30.0%
20.0% 0.0%
10.0%
0.0%
Yes No
Previous knowledge

Figure14: Cone diagram representing the description of respondent by percentage

distribution based on previous knowledge.

48
 Sources of knowledge

35.0% 31.7% 31.7%

30.0%

25.0% 21.7%

20.0%
15.0%

15.0%
Percentage%

10.0%

5.0%

0.0%
Health professional / T.V and radio Newspaper / magazine Friends / Relative
social worker
Sources Of Knowledge

Figure15 : Cone diagram representing the description of respondent by percentage

distribution based on sources of knowledge.

49
 SECTION -II

Assess the pre-test knowledge scores regarding lifestyle intervention as a management for
obesity among adolescents .

This section describes the finding related to the frequency, percentage distribution and mean,
median, standard deviation, maximum, minimum and mean percentage of pre-test knowledge scores
regarding lifestyle intervention as a management for obesity among adolescents obtained through
self-structured knowledge questionnaire. The data is represented in the form of frequency
percentage distribution according to knowledge score.

Table 2

Frequency and percentage distribution of pre-test knowledge scores regarding lifestyle

intervention as a management for obesity among adolescents.

N= 60

Pre-test knowledge score % range f %

Inadequate knowledge 33% 0-10 24 40%
Moderate knowledge 34-66% 11-20 36 60%
Adequate knowledge 67% 21-30 00 00%

Maximum score =30 Minimum score = 0

Table 2: show frequency and percentage distribution of pre-test knowledge scores regarding
lifestyle intervention as a management for obesity among adolescent.

The majority of adolescent i.e.60 % moderate knowledge ,40% were having inadequate knowledge
regarding lifestyle intervention as a management for obesity during their pre-test.

50
 Pre-test KNOWLEDGE SCORE)
60 PRE TEST (%)

60

50

40

40

30

20

10

0
INADEQUATE MODERATE ADEQUATE
KNOWLEDGE.(0-10) KNOWLEDGE.(11-20) KNOWLEDGE.(21-30)

Figure 16: cylindrical diagram representing Pre-test knowledge scores regarding lifestyle
intervention as a management for obesity among adolescents.

51
 TABLE -3

MEAN, MEDIAN, STANDARD DEVIATION, MAXIMUM, MINIMUM AND MEAN

PERCENTAGE OF PRE-TEST KNOWLEDGE SCORES.

This table describe the mean, median, standard deviation, maximum, minimum and mean
percentage of pre-test knowledge score through self-structured knowledge questionnaire regarding
lifestyle intervention as a management for obesity among adolescents.

Pre-test Mean Median S.D. Maximu Minimum Range Mean%

knowledge score m
Pre-test 12.45 12.5 2.795 17 8 9 41.50
knowledge score

The data depicted in table -3 shows the mean, median, stander deviation, maximum, minimum
and mean percentage of pre-test knowledge score regarding lifestyle intervention as a management
for obesity among adolescents. The knowledge of mean pre-test score was 12.45, stander deviation
score was 2.795, median score was 12.5, maximum was17, minimum was 8, range was 9, and mean
% was 41.50% through self-structured knowledge questionnaire regarding lifestyle intervention as a
management for obesity among adolescents.

52
 MEAN,MEDIAN ,S.D. ,MAMIMUM,MININUM AND MEN% OF PRE-TEST
KNOWLEGES

18.00
17.000 PRETEST KNOWLEDGE

16.00

14.00
12.450 12.500
12.00

10.00
9.000
8.000
8.00

6.00

4.00
2.795

2.00

0.00
Mean S.D. Median Score Maximum Minimum Range

Figure 17: Bar diagram representing mean, median, standard deviation, maximum, minimum and
mean percentage of pre-test knowledge score.

53
 SECTION – III

Assess the post-test knowledge scores regarding lifestyle intervention as a management for
obesity among adolescents.

This section describes the finding related to the frequency, percentage distribution and mean,
median, standard deviation, maximum, minimum and mean percentage of post-test knowledge
scores regarding lifestyle intervention as a management for obesity among adolescents obtained
through self-structured knowledge questionnaire. The data is represented in the form of frequency
percentage distribution according to knowledge score.

Table : 4

Frequency and percentage distribution of post-test knowledge scores regarding lifestyle

intervention as a management for obesity among adolescents.

N= 60

Post-test knowledge score % Range f %

Inadequate knowledge ≤33% 0-10 00 00%

Moderate knowledge 34-66% 11-20 13 21.7%

Adequate knowledge ≥67% 21-30 47 78.3%

Maximum score=30 Minimum score =0

Table – 4 show the finding related to frequency and percentage distribution of post-test knowledge
scores regarding lifestyle intervention as a management for obesity among adolescents.

The majority of adolescent i.e. 78.3% were having adequate knowledge , 21.7% were having
moderate knowledge and 0% were having inadequate knowledge through self-structure knowledge
questionnaire regarding lifestyle intervention as a management for obesity among adolescents.

54
 POST-TEST KNOWLEDGE SCORE

78.3
80 POST TEST (%)

70

60

50

40

30
21.7

20

10
0
0
INADEQUATE MODERATE ADEQUATE
KNOWLEDGE.(0-10) KNOWLEDGE.(11-20) KNOWLEDGE.(21-30)

Figure 18 : Cylindrical diagram representing post-test knowledge score regarding lifestyle

intervention as a management for obesity among adolescents.

55
 TABLE -5

MEAN, MEDIAN, STANDARD DEVIATION, MAXIMUM,MINIMUM AND MEAN

PERCENTAGE OF POST-TEST KNOWLEDGE SCORES

This table describe the mean, median, standard deviation, maximum ,minimum and mean
percentage of post-test knowledge score through self-structured knowledge questionnaire regarding
lifestyle intervention as a management for obesity among adolescents.

Post-test Mean Median S.D. Maximu Minimum Range Mean%

knowledge score m

Post-test 25.08 26.5 3.038 28 18 10 83.60

knowledge score

Maximum score =30 Minimum =00

The data depicted in table -5 shows the mean, median, stander deviation, maximum, minimum and
mean percentage of post-test knowledge score regarding lifestyle intervention as a management for
obesity among adolescents. The knowledge of mean post-test score was 25.08, stander deviation
score was 3.038, median score was 26.5, maximum was 28, minimum was 18, range was 10, and
mean % was 83.60% after structure teaching programme regarding lifestyle intervention as a
management for obesity among adolescents.

56
 Mean,Median,S.D,Maximum,Minimum and Mean% of post-
test Knowledge score

POSTTEST
KNOWLEDGE
30.00
28.000
26.500
25.080
25.00

20.00
18.000

15.00

10.000
10.00

5.00
3.038

0.00
Mean S.D. Median Score Maximum Minimum Range

Figure.19 Bar diagram representing mean, median, standard deviation ,maximum ,minimum and
mean percentage of post-test knowledge scores .

57
 SECTION – IV

COMPARISON BETWEEN PRE-TEST AND POST-TEST KNOWLEDGE SCORE

This section describe the significant difference between mean of pre-test and post-test knowledge
score among adolescents .In order to find out the significant difference between knowledge score
among adolescent following hypothesis was tested.

H1: There will be significant difference between mean pre-test and post-test knowledge scores
regarding life style intervention as a management for obesity among adolescents.

H01: There will be no significant difference between mean pre-test and post-test knowledge scores
regarding life style intervention as a management for obesity among adolescents

TABLE –6

Comparison between pre-test and post-test knowledge regarding lifestyle intervention as a

management for obesity among adolescents.

Knowledge Mean S.D Mean Paired t test df P value Table

score differenc value 0.05
e
Pre-test 12.45 2.795 12.630 29.484 59 <0.001 2.00
knowledge
Post-test 25.08 3.038
knowledge
P value <0.05= significant , < 0.01 = highly significant ; <0.001 = very highly significant

Table-6 show the finding related comparison between pre-test and post-test knowledge scores
regarding lifestyle intervention as a management for obesity among adolescents.

The data depicts in table-6, effectiveness of structure teaching programme regarding lifestyle
intervention as a management for obesity among adolescents. The mean post-test knowledge score (
25.08)was higher than mean pre-test knowledge score 12.45 and obtained ‘t’ value has been found
statistically very highly significant 29.484at p< 0.001 level of significance which shows the
significant difference between mean pre-test and post-test knowledge score regarding lifestyle
intervention as a management for obesity among adolescents.

Hence, the research hypothesis H1 was accepted and null hypothesis H02 was rejected .

58
 Comparison between pre-test and post-test knowledge

PRETEST (%) POSTTEST (%)

78.3
80.0

70.0
60.0
60.0

50.0
Percentage%

40.0
40.0

30.0 21.7

20.0

10.0
0.0 0.0
0.0
INADEQUATE MODERATE KNOWLEDGE. ADEQUATE KNOWLEDGE.
KNOWLEDGE.(0-10) (11-20) (21-30)

Figure 20: Cylindrical diagram representing comparison of pre-test and post-test knowledge scores
among adolescents.

Comparison between mean,median,standard deviation,maximum,minimum and

mean percentage of post-test and pres-test knowledge score
28.000

30.00
26.500
25.080

KNOWLEDGE PRETEST
25.00
KNOWLEDGE POST TEST
18.000

20.00
17.00

15.00
12.50
12.45

10.000
9.00

10.00
8.00
3.038

5.00
2.80

0.00
Mean Score S.D Median Score Maximum Minimum Range

Figure 21. Bar diagram representing the comparison of mean, median, standard
deviation ,maximum, minimum and mean percentage of pre-test and post-test knowledge score
regarding lifestyle intervention as a management for obesity among adolescents.

59
 SECTION-V
Association of post test knowledge score among adolescents with their selected socio
demographic variables
This section deals with the finding related to the association of post-test knowledge scores
among adolescents with their selected socio-demographic variable. The chi-square test was used to
determine the association between the knowledge scores and selected demographic variable .
H2: There will be significant association of post-test knowledge scores of adolescents with their
selected socio demographic variables.
H02: There will be no significant association of post-test knowledge scores of adolescents with
their selected socio demographic variable.
OBJECTIVES:
 To determine the association of post-test knowledge score among school going children with
their selected socio-demographic variable was calculated and it is presented in table 7.

60
 TABLE-7
CHI SQUARE SHOWING ASSOCIATION OF POST TEST KNOWLEDGE
SCORE AMONG ADOLESCENTS WITH THEIR SELECTED SOCIO
DEMOGRAPHIC VARIABLES

Socio-demographic Adequate Moderate Inadequate Df 2 P value

variable knowledg knowledge knowledge
e
AGE( in year )

12-13 year 09 O1 00 2 1.052NS 0.591

14-15year 27 08 00
16-17 11 04 00
Gender

Male 25 08 00 1 0.287NS 0.592

Female 22 05 00
Education status of
father

No formal education 05 00 00
Primary education 04 01 00 3 5.090NS 0.165
Higher secondary 14 08 00
Graduate/equivalent 24 04 00
Education of mother

No formal education 13 06 00
Primary education 18 03 00 3 1.880NS 0.598
Higher secondary 13 03 00
Graduate/equivalent 03 01 00
Father’s occupation

Government 06 01 00
Employee
Private Employee 19 04 00 3 1.356NS 0.716
Self Employed 17 07 00
Un Employed 05 01 00

Mother’s occupation

Government 01 02 00 3 8.030NS 0.045

Employee
Private Employee 03 03 00
Self Employed 23 03 00
Un Employed 20 05 00

61
 Type of family
Nuclear family 39 10 00 1 0.249NS 0.617
Joint family 08 03 00
Leisure time activity

Outdoor Games 11 03 00
Watching TV 20 03 00 3 3.760NS 0.289
Indoor Games 11 03 00
Exercise 05 04 00
Dietary habits

Vegetarian 24 06 00 01 0.098NS 0.754

Non-vegetarian 23 07 00
Junk food practice
Yes 45 12 00 01 0.253NS 0.615
No 02 01 00
Frequency of
consumption of junk
food

Daily 10 02 00 02 3.118NS 0.210

Once in a week 24 10 00
Once in month 13 01 00
Pervious knowledge

Yes 47 13 00
No 00 00 00
Sources of
knowledge
Health professional / 18 01 00
social worker
T.V and radio 16 03 00 03 11.332* 0.010
Newspaper / magazine 07 02 00
Friends / Relative 06 07 00

*= SIGNIFICANT NS = NOT SIGNIFICANT

Table 7: Show the association between post-test knowledge score among school going children
with their selected socio-demographic variable regarding lifestyle intervention as a management for
obesity among adolescents.
Data given in table 7 shows association of level of knowledge with selected demographic
variable which calculated by using chi test. It concluded that , there was non- significant association
of level of knowledge with socio-demographic variable i.e. age, gender, education status of
father ,education status of mother , father’s occupation, mother’s occupation , type of family ,leisure
time activity ,dietary habits ,junk food practice, frequency of consumption of junk food, frequency
of consumption ,previous knowledge and sources of knowledge . therefore, selected socio

62
demographic variable had no impact on knowledge regarding lifestyle intervention as a management
for obesity among adolescents.
Hence, the research hypothesis H2 is rejected and null hypothesis H02 was accepted as research
hypothesis.
SUMMARY OF THE CHAPTER
Chapter-IV deals with the analysis and interpretation of date collected to assess the
knowledge regarding lifestyle intervention as a management for obesity among adolescents.
Descriptive and inferential statistics were used to analyze the data. The analyzed data interpretation
and presented in the form of table and bar graph.
The structure teaching programme was found effective to improve knowledge regarding lifestyle
intervention as a management for obesity among adolescents.

63
 CHAPTER – V
DISCUSSION
The purpose of study was to assess the effectiveness of structure teaching programme on
knowledge regarding lifestyle intervention as a management for obesity among adolescents in
selected school of district Kangra Himachal Pradesh. This chapter relates the finding of the present
study in accordance with the studies done earlier.
Analysis of the indicated the significant effect the structure teaching programme on lifestyle
intervention as a management for obesity among adolescents. The present study show structure
teaching programme is effective in improving the knowledge scores among adolescents i.e. from
mean pre-test knowledge score ( 12.45) to post-test mean knowledge score (25.08 ). These findings
were consistent with the finding of ‘t’ value obtained was (29.484) at P < 0.001 level of significance
which was very highly significant. The post-test score was high as compare to pre-test score ,which
show the effectiveness of structure teaching programme .Hence , the research hypothesis H 1 was
accepted and H01 was rejected.
Similar finding had been found by Sherin John , Prof .Sheela Williams et al (2018) the
finding show that the mean post-test knowledge score 26.08 of the subject was higher than the
mean pre-test knowledge score 17.07 and was significant t=22.54, P <0.05 , which shows that
planned teaching programme was effective in improving knowledge.
Similar finding had been found by Geeta.C.Jeyalakshmi et al 2017 the finding show that the
mean post-test knowledge score 17.74of the subject was higher than the pre-test knowledge score
8.98 and t= 21.20, P < 0.001, which show that planned teaching programme was effective in
improving knowledge.
Similar finding had been found by Narayan swami M. (2016) the finding show that the mean
post-test knowledge score 65.68 of the subject was higher than the mean pre-test knowledge score
31.92 and significant t= 10.003, P< 0.05 , which show that planned teaching programme was
effective in improving knowledge.
Similar findings had been found by Prashanth K. and Uma Rani, (2013) who conducted an
experimental study to assess the effectiveness of structured teaching programme on knowledge and
attitude regarding prevention of obesity among adolescent girls of 50 samples in New Delhi. The ‘t’
value computed between pre-test and post-test knowledge scores is statistically significant at 0.05
level of significance. The calculated ‘t’ value (t=10.57) is greater than the table Value (t=2.0096).
This indicates that the teaching program on prevention of obesity was effective in improving the
knowledge of adolescents.
Study finding of the present study revealed that chi-square value show non-significant
association of post-test knowledge score with their selected demographic variables i.e age, gender,
religion, education status of father, education status of mother ,occupation of father, occupation of
mother, type of family, deity habits ,practice of junk food ,previous knowledge regarding prevention
of obesity, sources of knowledge.

64
Similar finding had been found by Thresiamma antony (2019) that there was no significant
association between knowledge score of student and the selected demographic variables.

Similar finding had been found by Isha (2017) that there is no significant association between
post- test knowledge and demographic variables.
SUMMARY
Chapter – V deal with the purposes of the study which shows paired t-test had significant effect of
structure teaching programme on knowledge regarding lifestyle intervention as a management of
obesity among adolescent And chi-square value show non-significant association of post-test
knowledge scores with their selected socio demographic variable.

65
 CHAPTER VI
SUMMARY, CONCLUSION AND RECOMMENDATION
This chapter deals with brief account of the study undertaken including the conclusion drawn from
findings, implication of the study and recommendation for future research. The study was
undertaken study to assess the effectiveness of structure teaching programme on knowledge
regarding lifestyle intervention as a management for obesity among adolescent in selected school of
district Kangra ,Himachal Pradesh .
SUMMARY
The present study was undertaken by the investigator to assess the effectiveness of structure
teaching programme on knowledge regarding lifestyle intervention as a management for obesity
among adolescent in selected school of District Kangra, Himachal Pradesh.
AIM OF STUDY
To improve the knowledge regarding lifestyle intervention as a management for obesity among
adolescent in selected school of District Kangra ,Himachal Pradesh.
OBJECTIVE OF STUDY
1.To assess the pre-test knowledge scores regarding lifestyle intervention as a management for
obesity among adolescents.
2. To assess the post-test knowledge scores regarding lifestyle intervention as a management for
obesity among adolescents.
3. To compare the pre-test and post- test knowledge scores regarding lifestyle intervention as a
management for obesity among adolescents.
4.To find out the association of post-test knowledge scores regarding lifestyle intervention as a
management for obesity among adolescents with their selected socio demographic variables.
HYPOTHESIS
H1: There was significant difference between mean pre-test and post-test knowledge
scores regarding life style intervention as a management for obesity among adolescents.
H2: There was significant association of post-test knowledge scores of adolescents with their
selected socio demographic variables.
The conceptual framework adopted for the present study was based on General system model
by Von Bertalanffy, the model was characterized by input, process and output. The literature review

66
for the present study had been divided into three section, Literature related to prevalence of obesity
among adolescents, literature related knowledge regarding prevention of obesity, literature related to
effectiveness of information education communication (IEC) And structure teaching programme on
knowledge regarding prevention of obesitya mong adolescents.
The methodology adopted for study includes a quantitative research approach and pre-
experimental research design was adopted to conduct study. The non-probability purposive
sampling technique was used to selected 60 adolescent of selected school of District Kangra
(H.P)..The sample for present study consisted of 60 school adolescents of the age group 12-17
years at selected school of District Kangra (H.P) .Non-probability purposive sampling techniques
had been employed in the present study to select a sample. The tool was formulated after an
extensive review of literature and discussion with experts and guides. The tool was consisting
Socio-demographic variable,Self-structure knowledge questionnaire and structure teaching
programme regarding lifestyle intervention as a management for obesity among adolescent. Pilot
study was conducted in 1st week of august 2022.Finding of pilot study reveald that it was feasible to
conduct the study and criteria measure were found to be reliable.After that final study was
conducted in mid of august 2022 among adolescent of selected school of district kangra (H.P) i.e.
Govt.Sr.Sec.School, Palampur Distt.Kangra,(H.P) Govt.Sr.Sec.School(boy),Nagrota Bagwan,
Distt.Kangra ( H.P) Govt.Sr.Sec.School,Bhawarna ,Distt. Kangra ,(H.P) with the help of self-
structure knowledge questionnaire and after the structure teaching programme was used as
intervention. The data was calculated by using descriptive and inferential statistics. Descriptive
statistics used were frequency, percentage , mean& stander devision. Inferential statistics were
calculated by using paired ‘t’ test and chi-square. Tables and bar diagram were used to depict the
finding.
Finding related to pre-test knowledge score: About 40% adolescent were having inadequate
knowledge, 60% moderate adequate knowledge regarding lifestyle intervention as a management
for obesity among adolescents.
Finding related to post-test knowledge score- About 78.3% adolescents having adequate
knowledge and 21.7% having moderate knowledge through self-structure knowledge questionnaire
regarding liestyle intervention as a management for obesity among adolescents.
Finding elated to comparison of pre-test and post-test knowledge score regarding lifestyle
intervention as a management for obesity among adolescents: mean of pre-test score was 12.45
whereas mean of post-test was 25.08 and t value has been found statistically very highly significant
29.484 at p<0.001 level of significance. The mean of post-test score was high as compared to mean
of pre-test score which show that structure teaching programme was effective in improving the
knowledge regarding lifestyle intervention as a management for obesity among adolescents. Hence,
the research hypothesis H1 was accepted and null hypothesis H01 was rejected as research
hypothesis.
Finding related to the association of post-test knowledge score among school going children
with their selected demographic variable: From the above results and discussion clearly shows
that chi-square value had non- significant association of level of knowledge with socio-demographic
variable i.e. age, gender,education status of father ,education status of mother , father’s occupation,
mother’s occupation , type of family ,leisure time activity ,dietary habits ,junk food practice,
frequency of consumption of junk food, frequency of consumption ,previous knowledge and sources
of knowledge . therefore, selected socio demographic variable had no impact on knowledge

67
regarding lifestyle intervention as a management for obesity among adolescents. Hence, the research
hypothesis H2 is rejected and null hypothesis H02 was accepted as research hypothesis.
CONCLUSION
The result from this study reveals that implementation of structure teaching programme to assess
the knowledge regarding lifestyle intervention as a management for obesity was adequate. And chi-
square value had non-significant association between knowledge score of students regarding
lifestyle intervention as a management for obesity with selected demographic variable.

NURSING IMPLICATION
The research had derived the following implication from the study results which are of vital concern
to field as :
1. Nursing practices
2. Nursing education
3. Nursing administration
4. Nursing research
NURSING PRACTICE :
 Nurse should be knowledgeable regarding lifestyle intervention as a management for
obesity.
 Nursing should promote and encourage the adolescents regarding lifestyle intervention
for obesity,
NURSING EDUCATION :
 The nurse educators need to be equipped with adequate knowledge regarding lifestyle
intervention as a management for obesity.
 Nursing personnel working in various health setting should be given in service education
to update the knowledge and abilities in identifying the learning needs of the clients
with obesity regarding prevention of obesity and planning for appropriate intervention.
 Conduct workshop or conference for student regarding the lifestyle intervention as a
management for obesity.
NURSING ADMINISTRATION
 The nursing administrator should take an initiative in creating health policy making and
developing protocols in providing education to the students during their schooling and
involve patients in the promotion of their health.
 Nurse administrators should review the institutions policies and practices related to diabetic
diet of patients. They should develop dietary meal plans and guidelines to be followed for
management of obesity.
 The Nurse administrator should plan for the budget and utilize the resources for training of
staff, health education of patients and providing regular education, Training and follow up
for students attending schools and colleges.
 This study suggests that nurse administrators should conduct in service education for the
nursing staff regarding obesity and its prevention measures

68
  These findings will help the administrator to implement health education programmed on
prevention of obesity during school health emphasize the nurse administrator to conduct
various mass awareness programmers focusing on obesity.

NURSING RESEARCH

 Nurse should conduct research to further clarify regarding the lifestyle intervention as a
management for obesity among adolescents.
 Encourage further research to be conducted regarding the lifestyle intervention as a
management for obesity among adolescents.
 The finding of present study help to expand the studies on lifestyle intervention as a
management for obesity .
 The result study can be published in nursing journals with the recommendation which will
be beneficial to upcoming researchers.
 Disseminate the finding of research through conference, seminars and publishing in nursing
journals.

LIMITATIONS
 Information collected from the students was based on the self reported responses only.
 The study was confined to 60 students only.
 The study was limited to assessment of knowledge regarding obesity among students of
12-17 years only.
RECOMMENDATIONS
 In the light of the above findings and personal experience of the investigator the following
recommendations are offered.
 The study can be replicated on a larger sample; thereby findings can be generalized for a
larger population.
 A Self instructional module can be prepared to enhance the knowledge of students
regarding prevention of obesity.
 Regular educational programme scan be conducted for students on importance of diet;
monitoring body mass index and management of prevention of obesity thereby ensuring an
active live for type 2 diabetes mellitus.
 A comparative study can be done between effectiveness of self instructional module versus
planned teaching programme.
 The study can be done in the community area.
 A similar study can be conducted to compare the knowledge level of students between
urban and rural communities.

69
 REFERENCES

1. Anithas.Ms.(2015). A case control study on factors contributing to obesity/overweight

among school children at selected schools Kumbakonam Thanjavur District. Tamil Nadu. Dr
MGR Medical University.pp.122.

Avaliable from: http://repository-tnmgrmu.ac.in › 3002278anithas

2. Ancy Paul. (2012). Prevalence of obesity among school children. Kerala Nursing
Forum.Vol. 7(1) pp.36-43

3. Beg .(2013).Obesity. Current Medical Journal of India, Vol. XIX(5).pp.44-52

4. Theena xavier (2011).Tv viewing and obesity.Journal of obesity.Vol.20(15)Pp. 1-7.

5. Edna Sweerie. (2013). Effectiveness of educative supportive intervention on prevention of

childhood obestiy among school children. TNNMC .Vol.1(2). pp.16-18.

6. Kotian Shasidhar.M.(2007).Prevalance of obesity and overweight among school

children.Indian Journal of Community Medicine.Vol.16(4). pp.18-22.

7. Sweenie Edna J.(2013) .Effectiveness of Educative supportive interventions on prevention

of childhood obesity among school children .Journal of Pediatric Nursing. Vol.1(2) pp. 16-
18

8. J.priscillal. (2017) .Effectiveness of information education and communication on

knowledge regarding prevention of obesity among students in selected high school at
kanyakumari. Reg.No.301515751Date Deposited:05 Nov 2018 19:27

Available from : http://repository-tnmgrmu.ac.in/id/eprint/10072

9. Anto Lincy (2016) quality of life among obese children selected school of Chennai ,India.
Tamil Nadu Dr MGR Medical University.March2016.volume 4

Available from : http://repository-tnmgrmu.ac.in/2092/

70
 10. Prasad rajiv ,Yogesh (2018) prevalence of obesity in adolescent in Surat ,India.National
journal of community medicine volume 9 .Published online Feb.2018

Available from : https://njcmindia.com/index.php/file/article/view/640

11. Shete .S.Jagannatha et al (2018) prevalence of obesity and its risk factors in adolescent
school children in Western Maharashtra, India. International journal of research in medical
science Vol.6 No.9 .

Available from: https://www.msjonline.org/index.php/ijrms/article/view/5234.

12. T kowsalya, et al (2014) prevalence of overweight and obesity among adolescent girls in
Salem, India.Indian journal of health science and biomedical research
KLEU.Volume7.issue2.

Availablefrom:https://www.ijournalhs.org/article.asp?
issn=25426214;year=2014;volume=7;issue=2;spage=73;epage=77;aulast=Kowsalya

13. Edna sweenie,et.al (2013), prevalence of overweight and obese in Cuenca, Ecuador. Octuber
2015 Dr. MGR Medical University, Chennai.Volume2.

Available from: http://repository-tnmgrmu.ac.in/513/1/3002278anithas.pdf.

14. Remesh Ambili (2012) Prevalence of adolescent obesity among high school students of
Kerala, South India. Archives of Pharmacy Practice Vol. 3 Issue 4 Oct-Dec 2012.

Availablefrom:rchivepp.com/storage/models/article/
Oc1Imtdqela3J4BvsKExyZwebNIRIDUSsFUuCt5SFsTc2uRytuVQUtWX4YWF/
prevalence-of-adolescent-obesity-among-high-school-students-of-kerala-south-india.pdf.

15. Seeema S,kusum K et al (2020) A cross-sectional study on prevalence and contributing

factors for obesity in school adolescents of District Uttarakhand India.Date deposited: 31
may, 2021.

Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208200/

16. Adriana Paula da Silva,I. (2017).Prevalence of overweight and obesity and associated factors
in school children and adolescents in a medium-sized Brazilian city.Published online 2018
Nov 16. Volume 3.
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238815

71
17. B. Jamunashree. Kumar G.(2017).A Cross sectional study of prevalence of obesity and over
weight among school going adolescents in the age group of 11-17 years of Kangra (H.P). .Int
J Pediatric Research volume 5.Issue 3.Anuscript received: 24th February 2018. Reviewed:
4th March 2018. Author Corrected: 10th March 2018. Accepted for Publication: 15th March
2018.Available from: https:pediatrics.medresearch.in/index.php/ijpr/article/view/369/736

18. Sadhu charan Panda (2017) A comparative cross- sectional study to assess the prevalence
of overweight and obesity among adolescent in Sambalpur India. International Journal Of
Research In Medical Sciences, Vol 5, No 11 Date of deposited : 29 September 2017.
Available from:https://www.msjonline.org/index.php/ijrms/article/viewFile/4092/3431

19. Sunil Pathala, Meghavi Pandya et al (2017) conducted a cross-sectional study to assess
the prevalence of overweight and obese among urban and rural school going adolescent of
Vododara , India.int J Pediatrics .vol 5.no.4 date of desposited : 2018-06-22.

Available from :https://www.ijpediatrics.com/index.php/ijcp/article/view/1792

20. Agrawal .P.Jagadish ,Gupta k. Virendra et al (2017) A descriptive study to assess the
prevalence of obesity among school going adolescent in the age group of 10-18year of
Jaipur city, India. International Journal of Contemporary Pediatrics Vol 4 Issue 4 date:
July-August 2017 .

Available from : https://www.ijpediatrics.com/index.php/ijcp/article/viewFile/864/787

21. Jacob K Jacob.(2016).A Cross Sectional study of prevalence of Overweight and Obesity in
Adolescent Children. International Journal of Scientific Study .September. 2016 .Vol 4 .

Available from : http://www.ijss-sn.com/uploads/2/0/1/5/20153321/ijss_sep_oa09.pdf

22. Nirpal Kaur Shukla.Mukesh Shukla et al .(2016). Prevalence of overweight and obesity
among adolescentsin India. A systematic review J Cur Res Rev .Vol 8 .Issue 18 September.
Available.from:https://www.researchgate.net/publication/317304489_PREVALENCE_OF_
OVERWEIGHT_AND_OBESITY_AMONG_ADOLESCENTSIN_INDIA_A_SYSTEMA
TIC_REVIEW.

23. Prasad. R.Vishnu , Singh zile et al (2016) conducted a cross- sectional study to assess the
prevalence of obesity and overweight among school going adolescent in the age group of 12-
17 year of Pondicherry , India. International journal of nutritional Volume 6.Issue.2016

72
 AvailableFrom:https://www.ijnpnd.com/article.asp?
issn=22310738;year=2016;volume=6;issue=2;spage=72;epage=75;aulast=Prasad

24. Gayathri , Syamily ,Kulanadaivel.M. (2016) prevalence of obesity and overweight among
adolescents in the age group of 11-14 year of Pondicherry, India. International journal of
medical research and review volume 8.issue6 November,2016 available from :
https://ijmrr.medresearch.in/index.php/ijmrr/article/view/1226

25. Yan zou, Ronghuazhang (2015) prevalence of obesity and its associated factors among
city, township and rural area adults in china.BJM Journal volume5 issue 7 available from :
https://bmjopen.bmj.com/content/5/7/e008417

26. Jagadesan Sonya,Harish Ranjani et al (2013) prevalence of overweight and obesity

among school children and adolescents in Chennai, India .National library of medicine.

Available from: https://pubmed.ncbi.nlm.nih.gov/25031132/

27. Edna sweenie,et.al (2013), prevalence of overweight and obese in Cuenca,.Natioanl library
of medicine.november 2013. Available from : https://pubmed.ncbi.nlm.nih.gov/24605689/

28. Ravi Rohilla, Meena Rajput et al (2013) prevalence and Correlates of

Overweight/Obesity Among Adolescents of Rohtak, India .J Family Med Prim Care. 2014
Oct-Dec; 3(4): 404–408.

Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311352/

29. Marwah Ahish ,Marwah Poonam et al (2012 prevalence of obesity among affluent
school children in Patiala, Punjab.Pediatric Oncall Journal Volume 9, Issue 4 View Issue
October-December 2012 Pages: 93-95.

Availablefrom:https://www.pediatriconcall.com/pediatric-journal/view/fulltext
articles/525/J/0/0/72/0

30. Shycil Mathew, saldenha Prakash et al (2020) prevention and control of obesity among
adolescent at selected urban high school of Mangluru, India. October 2022 Journal of
Health and Allied Sciences NU DOI:10.1055/s-0042-1755587 License CC BY-NC-ND 4.0

Availablefrom:https://www.researchgate.net/publication/
364214045_Prevalence_of_Overweight_and_Obesity_among_Adolescents_A_School-
Based_Preliminary_Cross-Sectional_Study

73
31. Garggy Shaji, Aswathy mathu et al (2018) knowledge of adolescents towards obesity in
private school in Thrissur district Kerala, India. june 2019International Journal of
Community Medicine and Public Health .Volume 6.Issue 3.

Availablefrom:https://www.researchgate.net/publication/
334106799_A_study_to_assess_the_knowledge_and_attitude_of_adolescents_towards_obes
ity_in_a_private

32. Praveen R, Gunagi et al (2018) knowledge regarding prevention of obesity among school
children in the age group of 13-14 years of Karnataka, India. 2019International Journal of
Community Medicine and Public Health volume7.no.1

Available From: https://www.ijcmph.com/index.php/ijcmph/article/view/5781

33. Manjusha Samudre, Sunil M. Kulkarni, "Knowledge on Prevention of Obesity among the
Students from Selected High Schools", International Journal of Science and Research
(IJSR), Volume 5 Issue 3, March 2016, pp. 682-687,

Available From : https://www.ijsr.net/get_abstract.php?paper_id=NOV161975

34. Anto lincy (2016) descriptive study to assess the quality of life among obese children
selected school of Chennai ,India.Tamil Nadu Dr MGR Medical University.Volume 6 .
Available from: http://repository-tnmgrmu.ac.in/2092/
35. Narayana swamy (2015) effectiveness of planned teaching programme regarding prevention
of obesity among adolescents of Bangalore. Karnataka. International Journal Of
research .Volume 1
Available from : https://www.academia.edu/6872604/4-

36. Titi Xavier Mangalathil , Vikas Choudhary et al 2013 knowledge and attitude regarding
obesity among adolescent students of Sikar, Rajasthan. IOSR Journal of Nursing and Health
Science (IOSR-JNHS) e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 3, Issue 2 Ver. I
(Mar-Apr. 2014), PP 44-48

Available from: : http://repository-tnmgrmu.ac.in/2092/

37. Dr. M. Vaijayanthimala,Dr. Maheswari Jaikumar (2019) effectiveness of Information,

Education and Communication on Prevention of Obesity in Young Adolescents in
74
 Meenakshi College of Nursing, MAHER, Chennai. International Journal of Health Sciences
and Research Mar: 2019 | Month: March | Volume: 9 | Issue: 3 | Pages: 159-163 Available
from: https://www.ijhsr.org/IJHSR_Vol.9_Issue.3_March2019/IJHSR_Abstract.022.html

38. Shanthi M., C. Kanniammal .2019. The Effectiveness of Information, Education and
Communication on Knowledge, Attitude, Practice Regarding Obesity among Adolescents at
Selected Government Schools in Kancheepuram. Indian Journal of Public Health Research
& Development,January2019.Vol.10.
Avilablefrom:https://www.researchgate.net/publication/
331255849_The_Effectiveness_of_Information_Education_and_Communication_on_Knowl
edge_Attitude_Practice_Regarding_Obesity_among_Adolescents_at_Selected_Government
_Schools_in_Kancheepuram_District.
39. N Kumar, Rawat Alok (2019) effectiveness of structured Teaching Programme on
Knowledge regarding healthy habits in prevention of obesity among students in selected
senior secondary schools of Jaipur, Rajasthan. ISSN NO:2236-6124 Volume VIII, Issue XII,
December/2019
Available from: http://ijrpublisher.com/gallery/14-ijr-december-1547.pdf
40. Thresiamma Antony(2019) effectiveness of a structured teaching programme on the
knowledge and attitude of adolescents regarding junk food in selected high schools at
Ernakulam,karala,India. International journal of research culture SOCIETY I Volume -
3, Issue - 9, Sept – 2019 Monthly, Publication Date: 30/09/2019.
Available from: https://ijrcs.org/wp-content/uploads/IJRCS201909020.pdf
41. Sherin John , Prof .Sheela Williams et al (2018) effectiveness of Planned Teaching
Programme on knowledge regarding lifestyle modification on prevention of overweight
among adolescents in selected schools in Mysuru. Journal of Emerging Technologies and
Innovative Research (JETIR) November 2018, Volume 5, Issue 11
Available from: file:///C:/Users/lenovo/Downloads/JETIR1811716%20(1).pdf
42. Esater mery Pappiya, Sumathi ( 2018 ) effectiveness of information, Education and
communication on knowledge regarding obesity among adolescents at selected school in
Chenni, Tamil Naddu , India. Journal Of emerging technologies and innovative research.
Volume: 9 | Issue: 3.
AvilableFrom:https://www.ijhsr.org/IJHSR_Vol.9_Issue.3_March2019/
IJHSR_Abstract.022.html
43. Ms. Isha .2017. Effectiveness of Planned Teaching Programme on Knowledge and Attitude
Regarding Prevention of Obesity among Adolescent Girls in Selected Schools of Joginder
Nagar. Mandi District.Himachal Pradesh.Akal College of Nursing.Eternal University. Baru
Sahib.H.P.India International Journal of Health Sciences & Research.page no.182 Vol.7.
Avilable From :https://www.ijhsr.org/IJHSR_Vol.7_Issue.7_July2017/27.pdf
44. Priscillal .j. (2017) effectiveness of Information Education and Communication (IEC) on
knowledge regarding prevention of obesity among students in selected high school at

75
 Kanyakumari Item Type:Thesis (Masters) Additional
Information. .Reg.No.3015157.Depositing User: Subramani R Date Deposited:05 Nov 2018
Avilable from:http://repository-tnmgrmu.ac.in/10072
45. Geeta.C.Jeyalakshmi et al 2017effectiveness of education programme on knowledge
regarding obesity among school children in selected school, Punducherry International
Journal of Current Advanced Research.volume 6. Available from : http
://journalijcar.org/issues/study-assess-effectiveness-educational-programme-knowledge-
regarding-obesity-among-school
46. Narayana Swamy. (2015). Effectiveness Of Planned Teaching Programme OnKnowledge
And Practice Regarding Prevention Of Obesity Among Adolescents In Selected Schools Of
Bangalore. Karnataka. International journal of research and engineering .Volume1.
Available.from:https://www.academia.edu/6872604/
A_Study_To_Evaluate_The_Effectiveness_Of_Planned_Teaching_Programme_On_Knowle
dge_And_Practice_Regarding_Prevention_Of_Obesity_Among_Adolescents_In_Selected_S
chools_Of_Bangalore_District?auto=download

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 ANNEXURES-1
LETTER SEEKING PERMISSION FROM PRICIPLAL OF NETAJI SUBHASH COLLEGEG OF
NURSING, PALAMPUR TO CONDUCT RESEARCH STUDY

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 APPENDIX-II
LETTER SEEKING PERMISSION FOR CONDUCT PILOT STUDY

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APPENDIX-III

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LETTER SEEKING PERMISSION FROM PRINCIPAL OF NETAJI SUBHASH COLLEGE OF
NURSING ,PALAMPUR TO CONDUCT RESERCH STUDY

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 APPENDIX – IV
LETTER SEEKING PERMISSION TO CONDUCT FINAL STUDY

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LETTER SEEKING PERMISSION TO CONDUCT FINAL STUDY

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LETTER SEEKING PERMISSION TO CONDUCT FINAL STUDY

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 APPENDIX-V
CERTIFICATE OF ENGLISH EDITING

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CERTIFICATE FOR HINDI

85
 APPENDIX-VI
LETTER REQUESTIONG SUBJECT EXPERT OPINION TO ESTABLISH CONTENT
VALIDITY FOR RESEARCH TOOL
From,
Ms. Robin Sayasha
M.Sc. Nursing 2nd year,
Netaji Subhash Nursing college, Palampur.
To:
...... .......................................
..............................................

SUBJECT: Requesting regarding content jvalidity of tool.

Respected Sir/Madam

This is to inform you that I am a student of Master of Science in Nursing in Netaji Subhash Nursing
college, Palampur. I have selected the below mentioned topic for research project to be submitted to
the Himachal Pradesh University (Deemed to be University), Shimla as a partial fulfilment of
university requirement for the award of Master of Science Nursing degree. The topic of the research
project is: “A PRE-EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING
LIFESTYLE INTERVENTION AS A MANAGEMENT FOR OBESITY AMONG
ADOLESCENTS IN SELECTED SCHOOLS OF DISTRICT KANGRA ( H.P) ”.
In this regard, I have developed demographic profile, self-structured knowledge questionnaire. I
request you to go through the tool and give your opinion for any modification and improvement
needed. Your esteemed opinion and critical comments will provide and contribute immensely to the
quality and content of my final research.
I shall be grateful to you for your valuable remarks and suggestions. Thanking you,
Yours faithfully,
Miss. Robin Sayasha

86
 APPENDIX-VII

PERFORMA FOR EXPERT’S OPINION AND SUGGESTION FOR

THE CONTENT VALIDITY OF TOOLS

INSTRUCTIONS- Kindly go through the content of Intervention Protocol.

NAME AND SIGNATURE OF EXPERT: -

DESIGNATION: -

Section Highly relevant Quiet relevant Somewhat Not relevant

relevant
Section A
Demographic
variable

Section B
Self-Structured
Knowledge
Questionnaire

87
 APPENDIX- VIII
LIST OF EXPERTS
LIST OF EXPERTS CONSULTED FOR CONTENT VALIDITY
1.Dr.Ajay Vaid M.D.Pediatrics
Dr.RPGMC,Kangra(H.P)
2.Dr.Nitesh Joshi M BBS,Pediatric
Kullu Valley Hospital,Kullu (H.P)
3.Mrs.kanta ajay kumar Principal
M.Sc. in Child Health Nursing
Nursing traning Institute,Kakira,Distict
Chamba (H.P)

4.Dr.Arvin kumar Vice Principal

M.Sc in Child Health Nursing
Sukhmani College Of Nursing,Punjab

5.Mrs.Navjeet kaur Vice principal

M.Sc. in Child Health Nursing
Ratten Professional Education College,Punjab

6.Ms.shalini thakur Associate professor

Department of Child Health Nursing
Guru Dronaharya College Of Nursing ,Yol,
(H.P)

7.Ms.Upma sharma Assistant professor

Department of child health nursing
Murari Lal Memorial School & College Of
Nursing ,Solan(H.P)

8.Mrs.Bandna kumari Assistant professor

Department of Child Health Nursing
Gautam College of Nursing,Hamirpur
9.Mrs. Ritika Jamwal Assistant professor
Department Of Child Health Nursing
Chamunda Institute Of Medical Science and
Nursing College,Mohal,Kullu
10.MrsSapna kumari Assistant professor
Department Of Child Health nursing
Kol Yallay Institute Of Nursing,Naihar H.P.
APPENDIX-VIII

88
 LETTER TO PARTICIPANTS,SEEKING CONSENT TO PARTICIPATE IN
RESERCH STUDY
Letter to participant, seeking consent to participate in research study

I Robin Sayasha student of M.Sc Nursing 2nd year from department of Child Health Nursing in Neta
Ji Subhash College of Nursing, Palampur. Himachal Pradesh as a part of programme, I am doing
research study on below mentioned topic:
‘‘A PRE-EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING
LIFESTYLE INTERVENTION AS A MANAGEMENT FOR OBESITY AMONG
ADOLESCENTS IN SELECTED SCHOOLS OF DISTRICT KANGRA ( H.P) ”.
The information given by you will be used for research purpose only and will be kept confidential.
The successful completion of study largely depends on your active cooperation and participation.
Thanking you
Yours Sincerely
Robin Sayasha
CONSENT FORM
Here I give, consent for the above said study knowing that all the information provided by me will
be treated with utmost confidentiality by the investigator.

Date:
Place:
Participant Signature

89
 APPENDIX- IX
DESCRIPTION OF TOOL
The tool used for the study consisted of three parts. these are as follow :

Section A: Socio-demographic variable to obtain personal and general information of adolescents.

Section B: Self-structure knowledge questionnaire to assess the knowledge regarding lifestyle

intervention as management for obesity among adolescents.

Section C : Structure Teaching Programme regarding lifestyle intervention as a management for

obesity among adolescents.

Scoring procedure : a score of one point has given fir correct response and zero for incorrect
response. The knowledge level has classified to :

Sr.no. knowledge score % Range

1. Inadequate knowledge ≤33% 0-10

2. Moderate knowledge 34-66% 11-20

3. Adequate knowledge ≥67% 21-30

90
 A. Demographic Characteristics
1. Age in years: ……………….

2. Gender
a.. Male ( )
b. Female ( )

3 . Educational status of Father’s.

a. No formal education
b. Primary education ( )
c. Higher secondary education ( )
d. Graduate / equivalent ( )

4. Educational status of Mother’s.

a. No formal education ( )
b. Primary education ( )
c. Higher secondary education
d. Graduate / equivalent ( )

5. Father’s Occupation
a. Government Employee ( )
b. Private Employee ( )
c. Self Employed ( )
d. Un Employed ( )

6. Mother’s occupation
a.. Government Employee ( )
b. Private Employee ( )
c. Self Employed ( )
d. Un Employed ( )

7. Leisure Time Activity

a. Outdoor Games ( )
b. Watching TV ( )
c. Indoor Games ( )
d. Exercise ( )

8. Type of family
a. Nuclear family ( )
b. Joint family ( )

9) Dietary habits
a) Vegetarian ( )
b) Non vegetarian ( )

10. Practice of consuming fast & junk foods

(packed items, beverages, pizzas &bugers)
a) Yes ( )
b) No ( )
11) If yes, the frequency of consumption
a) Daily ( )

91
b) Once in a week ( )
c) Once in a month ( )

12. Previous exposure to knowledge regarding prevention of obesity

a. Yes ( )
b. No ( )

13. If yes, sources of knowledge :

a. Health professional / social worker ( )
b. T.V and radio ( )
c. Newspaper / magazine ( )
d. Friends / Relative ( )

92
 SECTION – B
STRUCTURED KNOWLEDGE QUESTIONNAIRE TO ASSESS THE OF KNOWLEDGE
REGARDING LIFE STYLE INTERVENTON AS A MANAGEMENT FOR OBESITY AMONG
ADOLESENTS

1. In obesity the accumulation of ………….in body

a. Excessive Fat ( )
b. Excessive Protein ( )
c. Excessive Mineral ( )
d. Excessive Energy ( )

2. Physiological response to the body need for food is :

a. Satiety ( )
b. Thermogenesis . ( )
c. Hunger ( )
d. Salivation ( )

3 . The expansion of BMI

a. Basal metabolic index ( )
b. Basal mass index ( )
c. Body mass influence ( )
d. Body mass index ( )

4. Normal range of BMI

a) 18.5 – 24.9 ( )
b) 25-29.9 ( )
c) 30- 34 ( )
d) 35- 39 ( )

5. BMI .Range classification for over weight:

15 to 19.9 ( )
20 to 24.9 ( )
25 to 29.9 ( )
30 to 35.9 ( )

6. Obesity can be
a. Untreatable ( )
b. Preventable ( )
c. Unpreventable ( )
d. Not curable ( )

7. Obesity can be caused by

a. Exogenous factor ( )
b. Political factor ( )
c. Chemical factor ( )
d. Environmental factor ( )

93
8. The common exogenous cause of obesity is
a. Balanced diet intake ( )
b. Regular walking ( )
c.. Lack of physical activity ( )
d. less intake of cookies ( )

9. Obesity may be due to

a. Over intake of water ( )
b. Hormonal imbalances ( )
c. Healthy diet ( )
d. Birth defects ( )

10. Excessive intake of carbohydrate leads to :

a. Obesity ( )
b. Growth retardation ( )
c. Muscle weakness ( )
d. Mental retardation ( )

11. Obesity lead to :

a. Skin problem ( )
b. Heart diseases ( )
c. lung disease ( )
d. Blindness ( )

12. All are the cause of obesity except :

a. Genetics ( )
b. Medicine ( )
c. Age ( )
d. Hormonal ( )

13. Risk factor of obesity :

a. Sedentary lifestyle ( )
b. Moderate activity ( )
c. Regular exercise ( )
d. Yoga ( )

14. Obesity is the common cause of :

a. Mumps ( )
b. T.B ( )
c Hepatitis B ( )
d. Diabetes mellitus

15.The contributing factors associated with obesity is

a. Excessive use of Video games ( )
b. Excessive exercises ( )
c. Excessive consumption of juice and fruits ( )
d. Excessive water consumption ( )

94
16.The emotional effect of obesity is
a. Happiness ( )
b. Self – depressed ( )
c. Relaxed ( )
d. Peaceful ( )

17. White Rice contributes to weight gain because it contains

a. High Protein ( )
b. Low protein ( )
c. Low calorie ( )
d. High calories ( )

18.Daliy requirement of calories among adolescent:

a. 2000 calories per day ( )
b. 2500 calories per day ( )
c. 2,800 calories per day ( )
d. 3000 calories per day ( )

19.Junk foods includes

a. . Grapes ,pomegranates ( )
b Soft drinks ,French fries ( )
c) . Boiled potatoes ,milk. ( )
d. vegetable juices, curd ( )

20. Daily Consumption of fiber helps

a. To reduce weight ( )
b. Treating cancer ( )
c. Doing heavy works ( )
d. Controlling diabetes ( )

21. Food component rich in fiber is :

a. Meat ( )
b. Fish ( )
c. Eggs ( )
d. Vegetable ( )

22. The food which effectively helps in reducing obesity except

a. Salads ( )
b. Cabbages ( )
c. Potatoes ( )
d. . Tomatoes ( )

23. . Preventive measure of obesity

a. Unhealthy nutrition and weight management ( )
b. Healthy nutrition and weight management ( )
c. Vigorous exercise and fatty foods ( )
d. Sedentary life style and fatty foods ( )

95
24 Drink plenty of water to
a. Decrease obesity ( )
b. Increase obesity ( )
c. Burn more calories ( )
d. Maintain obesity ( )

25. Food component rich in fat is:

a. Broccoli ( )
b. Bread ( )
c. Cucumber ( )
d. Butter ( )

26.Benefits of balance diet are :

a. Support healthy growth and boosts immunity ( )
b. Affect the digestive system ( )
c. Support the risk of infection ( )
d Affect the muscle development

27 The important measures to prevent the stressful life

a. Unhealthy diet ( )
b. Medication ( )
c. Yoga and meditation ( )
d. Alcohol intake ( )

28 .The excess body weight can be reduced by

a. Balancing food intake and exercises ( )
b. Intake of carbohydrate rich food ( )
c. Consumption of junk food ( )
d. Low intake of protein. ( )

29.Physical activity expected for healthy life

a. 15 minutes/day of moderate intensity physical activity ( )
b. 30 minutes/day of moderate intensity physical activity ( )
c. 40 minutes/day of vigorous intensity physical activity ( )
d. 60 minutes/day of moderate intensity physical activity ( )

30. Mild and moderate obesity can be managed by

a. eating spicy food ( )
b . sedentary life style ( )
c. reduce physical activity ( )
d. Modification in dietary habits ( )

96
ANSWER KEY

QUES. ANS. QUES ANS.

1. a. 16. b.
2. c. 17. d.

3. d. 18. c.

4. a. 19. b.

5. c. 20. a.

6. b. 21. d.

7. a. 22. c.

8. c. 23. b.

9. b. 24. c

10. a. 25. d.

11. b. 26. a

12. c. 27. c

13. a. 28. a

14. d. 29. b

15. a. 30. d

97
किशोरों में मोटापे के प्रबंधन के रूप में जीवनशैली हस्तक्षे प के संबंध में ज्ञान से संबंधित उपकरण

उद्दे श्य :

इसमें दो खंड होते हैं :

खं ड ए: इसमें प्रतिभागियों के जनसां ख्यिकीय चर से सं बंधित प्रश्नावली शामिल है ।

खं ड बी: इसमें ज्ञान से सं बंधित प्रश्नावली शामिल है ।

खंड- एक प्रतिभागी कोड संख्या ……

सामाजिक जनसांख्यिकी यतिथि पत्रप्रोफार्मा

निर्देश:

-प्रतिभागी निम्नलिखित शीट आपकी व्यक्तिगत जानकारी से सं बंधित है ।

-कृपया उन सभी मदों का उत्तर दें जो आपकी व्यक्तिगत जानकारी से सं बंधित हैं ।

-यह जानकारी गोपनीय रखी जाएगी। सही विकल्प के आगे (√) का निशान लगाएं ।

1. आयु (वर्षमें) …………………

2. लिंग

क ) पु रुष
( )

ख ) महिला ( )

98
2. पिता की शैक्षिक स्थिति

क ) कोई औपचारिक शिक्षा नहीं ( )

ख) प्राथमिक शिक्षा ( )

ग ) उच्च माध्यमिक शिक्षा ( )

घ) ( )

ङ ) स्नातक / समकक्ष ( )

3.. माता की शैक्षिक स्थिति

क )कोई औपचारिक शिक्षा नहीं ( )

ख ) प्राथमिक शिक्षा ( )

ग ) ) उच्च माध्यमिक शिक्षा ( )

घ ) ) स्नातक / समकक्ष ( )

4. पिता का व्यवसाय

क )सरकारी कर्मचारी ( )

ख ) निजी कर्मचारी ( )

ग ) स्व नियोजित ( )

घ ) बेरोजगार ( )

5. माता का पेशा

क ) सरकारी कर्मचारी ( )

ख ) निजी कर्मचारी ( )

ग ) स्व नियोजित ( )

घ ) बेरोजगार ( )

6 आराम के समय की गतिविधि

क )घर के बाहर खेले जाने वाले खेल ( )

ख ) टीवी देखना ( )

ग )घर के अंदर खेले जाने वाले खेल ( )

घ ) व्यायाम ( )

7. परिवार का प्रकार

99
क ) एकल परिवार ( )

ख ) संयुक्त परिवार ( )

8) आहार संबंधी आदतें

क ) शाकाहारी ( )

ख )) मांसाहारी ( )

9. फास्ट और जंक फू ड खाने का अभ्यास

(पैक किए गए आइटम, पेय पदार्थ, पिज्जा और बगर्स)

क ) हाँ ( )

ख ) नहीं ( )

10. यदि हाँ, तो उपभोग की आवृत्ति

दैनिक

क) सप्ताह में एक बार ( )

ख ) महीने में एक बार ( )

11 मोटापे की रोकथाम के संबंध में ज्ञान का पिछला परिचय

क ) हां ( )

ख ) नहीं ( )

12. यदि हां, तो ज्ञान के स्रोत :

क ) स्वास्थ्य पेशेवर / सामाजिक कार्यकर्ता ( )

ख ) टीवी और रेडियो ( )

ग ) समाचार पत्र / पत्रिका ( )

घ ) दोस्त / रिश्तेदार ( )

खंड - बी

स्व-संरचित प्रश्नावली

निर्देश: कृ पया निम्नलिखित विकल्पों को पढ़ें और (√) उत्तर लिखें।

100
1. मोटापे में शरीर में ………. का सं चय हो जाता है

क ) अत्यधिक वसा ( )

ख ) अत्यधिक प्रोटीन ( )

ग ) अत्यधिक खनिज ( )

घ ) अत्यधिक ऊर्जा ( )

2. भोजन के लिए शरीर के लिए आवश्यक शारीरिक प्रतिक्रिया है :

क ) बहुतायत ( )

ख ) थर्मोजेनेसिस। ( )

ग । भूख ( )

घ ) राल निकालना ( )

3. बीएमआई . का विस्तार :

क )बे सल मे टाबोलिक इं डेक्स ( )

ख ) बे सल मास इं डेक्स ( )

ग ) बॉडी मास प्रभाव ( )

घ ) बॉडी मास इं डेक्स ( )

4. बीएमआई की सामान्य सीमा :

क) 18.5 - 24.9 ( )

ख ) 25-29.9 ( )

ग) 30- 34 ( )

घ) 35- 39 ( )

5. अधिक वजन के लिए बीएमआई श्रेणी वर्गीकरण :

क) 15 से 19.9 ( )

ख )20 से 24.9 ( )

ग ) 25 से 29.9 ( )

घ ) 30 से 35.9 ( )

101
6. मोटापा हो सकता है

क )लाइलाज ( )

ख) रोके ( )

ग ) अप्रतिरोध्य ( )

घ ) इलाज योग्य नहीं ( )

7. मोटापा किसके कारण हो सकता है

क ) बहिर्जात कारक ( )

ख ) राजनीतिक कारक ( )

ग ) रासायनिक कारक ( )

घ ) पर्यावरणीय कारक ( )

8. मोटापे का सामान्य बहिर्जात कारण है

क ) सं तुलित आहार का से वन ( )

ख ) नियमित चलना ( )

ग) शारीरिक गतिविधि की कमी ( )

घ )कुकीज़ का कम से वन ( )

9. मोटापा किसके कारण हो सकता है

क ) पानी का अधिक से वन ( )

ख ) हार्मोनल असं तुलन ( )

ग) स्वस्थ आहार ( )

घ) जन्म दोष ( )

10. सूक्ष्म पोषक तत्वों के अत्यधिक से वन से होता है :

क ) मोटापा ( )

ख ) विकास मं दता ( )

ग) मांसपे शी में कमज़ोरी ( )

घ ) मानसिक मं दता ( )

102
11. मोटापे की ओर ले जाता है :

क) त्वचा की समस्या ( )

ख ) दिल के रोग ( )

ग ) फेफड़ों की बीमारी ( )

घ ) अं धापन ( )

12. मोटापे के सभी कारण हैं सिवाय :

क ) आनु वंशिकी ( )

ख )दवा ( )

ग ) आयु ( )

घ) हार्मोनल ( )

13. मोटापे का जोखिम कारक :

क ) आसीन जीवन शै ली ( )

ख )मध्यम गतिविधि ( )

ग )नियमित व्यायाम ( )

घ )योग ( )

14. मोटापा इसका सामान्य कारण है :

क) मम्प्स ( )

ख टी.बी ( )

ग हेपेटाइटिस बी ( )
घ ) मधु मेह ( )

15.मोटापे से जु ड़े योगदान कारक हैं :

क ) वीडियो गे म का अत्यधिक उपयोग ( )

ख ) अत्यधिक व्यायाम ( )

103
ग) जूस और फलों का अत्यधिक से वन ( )

घ )अत्यधिक पानी की खपत ( )

16.मोटापे का भावनात्मक प्रभाव है

क) ख़ु शी ( )

ख) स्वयं उदास ( )

ग )ढील ( )

घ )शां तिपूर्ण ( )

17. सफेद चावल वजन बढ़ाने में योगदान दे ता है क्योंकि इसमें होता है

क) उच्च प्रोटीन ( )

ख ) कम प्रोटीन ( )

ग) कम कैलोरी ( )

घ) उच्च कैलोरी ( )

18.किशोरावस्था में कैलोरी की दै निक आवश्यकता:

क) प्रति दिन 2000 कैलोरी ( )

ख )प्रति दिन 2500 कैलोरी ( )

ग )प्रति दिन 2,800 कैलोरी ( )

घ)प्रति दिन 3000 कैलोरी ( )

19. जं क फू ड में शामिल हैं

क ) अं गरू , अनार ( )

ख) शीतल पे य, फ् रें च फ् राइज़ ( )

ू ।
ग )उबले आलू, दध ( )

घ )सब्जियों का रस, दही ( )

20. फाइबर का दै निक से वन मदद करता है

क ) वजन कम करने के लिए ( )

ख ) कैंसर का इलाज ( )

ग )भारी काम करना ( )

104
घ) मधु मेह को नियं त्रित करना ( )

21. रे शे से भरपूर खाद्य घटक है :

क ) मांस ( )

ख )मछली ( )

ग) अं डे ( )

घ) सब्ज़ी ( )

22. वह भोजन जो मोटापे को कम करने में प्रभावी रूप से मदद करता है सिवाय

क) सलाद ( )

ख )पत्तागोभी ( )

ग) आलू ( )

घ ) टमाटर ( )

23. मोटापे की रोकथाम के उपाय

क )अस्वास्थ्यकर पोषण और वजन प्रबं धन ( )

ख )स्वस्थ पोषण और वजन प्रबं धन ( )

ग ) जोरदार व्यायाम और वसायु क्त भोजन ( )

घ) गतिहीन जीवन शै ली और वसायु क्त भोजन ( )

24 ……………………..के लिए खूब पानी पिए

क ) मोटापा कम करें ( )

ख ) मोटापा बढ़ाएं ( )

ग ) अधिक कैलोरी बर्न करने ( )

घ ) मोटापा बनाए रखें ( )

25. वसा से भरपूर खाद्य अवयव है

क ) ब्रॉकली ( )

ख ) रोटी ( )

ग) खीरा ( )

105
घ) मक्खन ( )

26. संतलि
ु त आहार के लाभ हैं:

क स्वस्थ विकास का समर्थन और प्रतिरक्षा को बढ़ाता है ( )

ख पाचन तंत्र को प्रभावित ( )

ग संक्रमण के जोखिम का समर्थन ( )

घ मांसपेशियों के विकास को प्रभावित करता है ( )

27 . तनावपूर्ण जीवन को रोकने के महत्वपूर्ण उपाय

क ) सं तुलित आहार ( )

ख )दवाई ( )

ग )योग और ध्यान ( )

घ )शराब का से वन ( )

28. शरीर के अतिरिक्त वजन को किसके द्वारा कम किया जा सकता है

क ) भोजन के सेवन और व्यायाम को संतुलित करना। ( )

ख ) कार्बोहाइड्रेट युक्त भोजन का सेवन। ( )

ग ) जंक फू ड का सेवन। ( )

घ ) प्रोटीन का कम सेवन। ( )

29. स्वस्थ जीवन के लिए अपे क्षित शारीरिक गतिविधि

क ) 15 मिनट / दिन मध्यम तीव्रता की शारीरिक गतिविधि के ( )

ख ) 30 मिनट/दिन मध्यम तीव्रता की शारीरिक गतिविधि के ( )

ग ) 40 मिनट/दिन जोरदार तीव्रता वाली शारीरिक गतिविधि ( )

घ ) 60 मिनट/दिन की मध्यम तीव्रता वाली शारीरिक गतिविधि ( )

30. हल्के और मध्यम मोटापे को किसके द्वारा प्रबं धित किया जा सकता है

क ) मसाले दार खाना खाना ( )

ख ) आसीन जीवन शै ली ( )

ग) शारीरिक गतिविधि को कम करें ( )

106
घ ) आहार की आदतों में सं शोधन

107
LESSON PLAN ON LIFESTYLE INTERVENTION AS A MANAGEMENT FOR OBESITY

108
KNOWLEDGE REGARDING LIFESTYLE INTERVENTION AS A MANAGEMENT FOR OBESITY AMONG
ADOLESCENTS IN SELECTED SCHOOLS OF DISTRICT KANGRA
Name of the student : Robin Sayasha

Group : school students

Place of instruction : Kangra

Topic : lifestyle intervention as a management for obesity among adolescents in selected school of district Kangra

Medium : English

Duration : 35 minutes

Method of teaching : Lecture Cum Discussion

Teaching aids : PPT, pamphlet

109
CENTRAL OBJECTIVE:

The Students will acquire adequate knowledge regarding lifestyle intervention as a management for obesity.

SPECIFIC OBJECTIVES:
The Students will be able to,
• define obesity
• list down the causes of obesity
• enumerate the effects on health
• describe the classification of obesity
• explain the BMI calculations
• narrate the management of obesity
• recognize the preventive measures of obesity

110
SELF INTRODUCTION:

GOOD MORNING! I am Miss.Robin Sayasha student of M.Sc nursing 2nd year in Netaji Subhash College of Nursing , Palampur,District Kangra
(H.P). I am doing a research on “A Study to Assess the Effectiveness of Structured Teaching Programme On Knowledge Regarding Lifestyle
Intervention As A Management For Obesity among students in selected high schools at Kangra ”. Now I am going to give health talk on obesity and its
causes, treatment, preventive measures etc. I request your co- operation and active participation to complete this health education.

INTRODUCTION TO THE TOPIC:

Life style related diseases are having few common risk factors which can be prevented if early measures are adopted by the individuals .obesity is the
most common nutritional disorder in the western countries and among the higher income groups in developing countries. Obesity now considered as a
killer life style disease is an important cause of preventable death world wide .Adolescent obesity also known as new world syndrome is a global health
challenge of the 21st century, with morbidity obesity affecting 5% of the country’s population.

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SR.NO TIM SPECIFIC CONTENT Lecture- A.V.aids EVALUATION
E OBJECTIVE cum-
discussion
1. 2mint The students Basic k Lecture- PPT What is obesity ?
will be able to DEFINITION: cum-
know the Obesity is the excessive accumulation of fat in the subcutaneous discussion
definition tissues and other body parts.
ofobesity.

5mint The students PPT What are the

2. will be able to CAUSES OF OBESITY: Lecture- causes of obesity?
describe the Obesity cum
causes of discussion
obesity.

Endogenous causes Exogenous obesity

[A] ENDOGENOUS OBESITY

- causes related to our own body GENETIC CAUSE:
Genetic cause that may include, a child
born into a family of overweightpeople. Family having high caloric
diet habit also parents being a role model for excessive eating.

112
ENDOCRINAL CAUSE:
So many hormonal deficiencies occur and lead to hypothyroidism,
Cushingsyndrome,
hormonaldeficiencies, polycystic ovaries, pseudohypoparathyrodism,
and these imbalances leads to obesity.

HYPOTHALAMIC
OBESITY:Postencephalitic obesity,post menegitic obesity.

INADEQUATE SLEEPING PATTERN;

[B] EXOGENOUS OBESITY:

Causes related to external.
Constitutional, excessive dietary consumption or over eating due to
psychogenicfactors, poor energy expenditure, fat cell hyperplasia,
etc..

DIETARY PATTERNS :
Unhealthy lunch habits
-High calories food intakes
-Fast food intakes
-Cookies Baked
-foods Soda
Candies chips
-Vending machine snacks

PSYCHOLOGICAL FACTORS:

113
Some children’s may turn to food as a coping mechanism for dealing
with problems or negative emotions like stress,anxiety or boredom.
Children struggling to cope with a divorce or death in the family
may eat more as a result.

SOME MORE CAUSES OF OBESITY:

Obesity caused by fast life style:

In our fast and hurried life style we do not have time to sleep well,
no time to eat well or work out. All work and no play is making our
bodies lazy and weak. No calories burn as there is no active work
done by our bodies leads to obese.

Obesity caused by fast food:

We tend to rely heavily on fast food items like hotdogs, pizzas,
and burgers. There is no doubt its tasty but it is nothing but empty
calories. They completely lack any essential nutrients and vitamins
that our body requires.

Lecture- PPT
Lack of exercise leads to overweight and obesity: cum-
Exercise plays a very vital role in maintance of body physique. discussion
Hence lack of exercise, keeps all these fat cells building their
homes in our body as long as we continue.

Weight gain by high calorie consumption:

When energy intake is higher than energy loss, fat cells
accumulation in our body tissues this resulting in obesity. Lecture-
cum- PPT
Laziness- The mother of obesity: Lowering of body activity discussion

114
 levels for daily energy expenditure and increase calorie intake
definitely leads to obesity.

Obesity due to Hormones:

Hormonal changes during teenage, pregnancy and menopause
tend to gain weight.
Obesity due to Genes or Heredity:
Obesity flows through genes from generations to generations in
a few cases of dietary patterns and excessive food energy intake
leads to obesity.

3. 2mint The student EFFECTS ON HEALTH: Lecture- PPT What are the effect
will be able to Obesity cause ill effects on both physically and psychological cum- of obesity on health
explain the health. discussion ?
effects on PHYSICAL EFFECTS:
health
Physically obesity causes so many illness like accumulation of
fat under the skin and leads to physical problems like diabetes
mellitus, high blood pressure, heart diseases, sleep problems and
some sort of cancers. If sugar lever increases and leads to
diabetes, stress level, salt intake through junk foods etc leads to
high blood pressure in adolescents and also heart diseases. The
accumulation of cholesterol or fats undigested stores in the
blood arteries and veins leads to heart diseases.
Sleep inadequate sleep duration leads to stress and restlessness
can be a cause of obesity.

PSYCHOLOGICAL EFFECTS
Obese children develop low self esteem
and emotional problems leading to isolation, excessive appetite
and more food intake causing further obesity.

115
4. 2mint Student will CLINICAL MANIFESTATIONS: Lecture- What are the
be able to There is a fat deposition all over the body. Excessive fat cum- clinical
explain the deposition over the neck gives double look chin. Fat deposition discussion manifestation of
clinical found in gluteal region, thighs, abdomen and around breast. obesity ?
manifestation.
External genitalia, hands and feet appears small, knocked knee,
slipped femoral epiphysis present. Emotional disturbances also
present.

DIAGNOSIS: What is BMI ?

2mint Student will The method use to identity obesity is BMI. Body Mass Index is
5. be able to acceptable for determining obesity for children of two years of
explain the age and older. It is determined by the ratio of weight to height.
BMI.
The normal ranges for BMI in children vary with age and sex.
BMI- Body Mass Index is a number calculated by dividing a
person’s weight in kilograms by his or her height in meter
squared.

If a BMI is above 85th percentage its called over weight and if it

is above or equal to 95th percentage its called obesity.
age in years x 7 -5

Body weight= ______ _ _ _ _ _

2
Height = age in years x 6 + 77

Weight
BMI = ___ _ _ __
(height m2)

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 Normal weight = 18.5 – 24.9
Over weight = 25 – 29.9 Class I Obesity = 30 – 34.9 Class II
Obesity = 35 – 39.9 Class III Obesity = >40
6. 5mint Student will OTHER EFFECTS OF OBESITY: Lecture- What are the effect
know Obesity endangers an individual body in many ways. Because of cum- of obesity ?
its association with several diseases, obesity decreases life discussion
expectancy.

Obesity result in humiliation and discomfort-

Distorted shape or abnormal shape leads in humiliation and
discomfort

Joint pain due to obesity-

Many obese people complain of joint
pains. In many people joint pain many develop arthritis

(osteoarthritis) because obese people have overburdened theirs

knees and joints with their excess body weight.

Obese individuals suffer from various life threatening health

problems-
Obesity increases levels of lipids or fats and cholesterol in the
blood leading to narrowing of blood vessels due to deposition of
fats in coronary arteries. This in turn causes the blood pressure
level and increases the risk of heart attacks and strokes.

Diabetes is also a side effect of

Obesity
- Obesity increases the risk of diabetes. It increases insulin

117
 resistance leading to glucose intolerance weight reduction helps
many diabetic patients in controlling diabetes.
Obese individuals have high risk of cancer-
Obese individuals have a risk of developing cancers such as
cancer of gall bladder, endo martial ovary, breasts and cervix in
women and cancer of the colon and prostate in men.

Obesity causes sudden death-

Obesity cause individuals to suffer from respiratory
insufficiency and may even result in sudden death during sleep.

7. 8mint To explain 2.Healthy eating habits : Lecture- What are the healty
about the - Adapt family meals to loose extra weight Instead of eating outside cum- eating habits
healthy eating home, try simple preparation of food and reduce as much oils and fats discussion
habits. as you can. Encourage your family members and friends to support
your diet program.
-Proper calorie intake for weight loss Since calorie intake is required
by body to function properly, do not stop taking calories completely,
instead balance your calorie intake diet. Consult dieticians that can
help you to develop a diet plan that suits your age.
-Challenge yourself to lose that extra flab
- Challenge yourself by setting short term and long-term goals and
celebrate every success. Do not rust to lose 10kg at once. Stick to 1 or
1.5kgs a week.
- Change your eating habits to beat obesity
- Drink lots of water throughout the day. Increase fruits intake such as
papaya pineapple and apples as they contain many beneficial vitamins
and avoid fruits like banana that provides fats to your body.
-Food to avoid to lose weight : Eat salads, vegetables and fruits that Lecture-
have natural benefits to body, eg; wheat barley, maize and seghum cum-
can be included in your diet in heavy quantities. Consuming salads disussion

118
that contain many tomatoes and mint leaves, especially cabbage and
be included. It is very important to avoid foods that are rich in
carbohydrates such as rice and potatoes as well as avoiding sweets
and candies, chocolates, refined flour.
-Drink water to fight with obesity : It is very necessary to keep your
body hydrated by nourishing it with water from time to time. Loads
of water intake helps to pass out all unwanted harmful materials
outside the body through sweat etc.
-Oats help to lose weight :Oats for breakfast with 2tsb sugar, add
some apples to enhance taste.
-Avoid sugar if you want to lose that extra fat
-Avoid sugar intake but do not stop its intake completely. Sugar is
also a need of our body, so try to take asper need and avoid extra Lecture-
consumption cum-
-Avoid tea and coffee to get rid of obesity discussion
-Avoid taking tea and coffee more than twice a day. Try to avoid
sugar in it
-Do not over eat :Instead of three big meals, take small 5-6 meals a
day. Do not over eat spread food throughout the day to meet energy
needs. Make breakfast the larger and dinner the smallest.
- Never skip meals.
-Select simply prepared items while eating outside. Avoid fried food, Lecture-
select fruits as desserts rather than ice-creams, puddings etc. cum-
-Eating a rainbow of fruits and vegetables discussion
-Pay attention to add five to seven servings daily ranging from leafy
greens to straw berries to tomatoes to sweet potatoes to promote
health.
-Discourage eating meals or snacks while watching TV. Eating in
front of the TV may make it difficult to pay attention to feelings of
fullness and may lead to overeating.
-Avoid labeling foods as "good" or "bad." All foods in moderation
can be part of a healthy diet.

119
To explain 1. Balance diet : balanced diet comprises vital nutrients like Lecture- PPT
the balance carbohydrates, fats, vitamins, minerals, proteins, and fibre. cum-
diet for Sufficient and nutritious food that ensures good health is discussion
adolescent included in a balanced diet. A healthy and balanced diet helps
to reduce the risk of diseases and improves overall health.
Benefits of a balanced diet
 Vitamins and minerals in the diet are vital to boost immunity
and healthy development,
 A healthy diet can protect the human body against certain
types of diseases,
 Healthy diets can also contribute to adequate body weight.
 Better mood and energy levels.
 Improved memory and brain health.

 Carbohydrates : Carbohydrates are the main source of energy

for the human body. It is formed by the chemical composition
of Carbon, Hydrogen, and Oxygen. Carbohydrates are of two
types- Simple Carbohydrates and Complex Carbohydrates.
a. Simple carbohydrates are quick-energy food and are easy to
digest. Sources of simple carbohydrates are milk and milk
products, natural fruits, and vegetables, including potatoes and
carrots. They are also present in processed and refined food PPT
items like candy, sugar syrup, soft drinks, table sugar, etc. PPT
b. Complex carbohydrates are better sources of energy than
simple carbs since they are released slowly. They take time to
digest. Sources of complex carbohydrates are bread, cereals
(rice, wheat, bajra, corn, barley, ragi, etc.), legumes, pasta,
starchy vegetables, whole grains, etc. 
 Protein: Proteins are called the building blocks of our body
because they are essential for the growth and repair of muscle
and other body tissues.
2. About 20% of the whole body weight comes from Protein.
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  Fat: Teens need about a quarter of their calories as fat. It helps
with growth. Fat also helps the body take in vitamins and keep
the skin healthy. Your teen should eat healthy fats, such as
those found in vegetable oils, nuts, avocados, olives, and fatty
fish.
Vitamins and Minerals :Many teens, mainly girls, do not get enough
vitamins and minerals. Ask the doctor if your teen should take
vitamins.
Here are some vitamins and minerals that teens often do not get
enough of:
Vitamin or Role Good Sources
Mineral

Calcium Helps to build Milk, cheese, yogurt, tofu, orange juice with
strong bones and
teeth
calcium, cereal with calcium, and canned

salmon

Folate Helps with growth Orange juice, breakfast cereals with folate, PPT
PPT
bread, milk, dried beans, and lentils

Iron Needed to carry red Meat, chicken, fish, and breakfast cereal
blood cells; not
getting enough from
the foods you eat with iron
can lead to iron-
deficiency anemia

Zinc Helps with growth Chicken, meat, shellfish, whole grains,

and sexual
maturation

121
 and breakfast cereal with zinc

Vitamin A Needed for eyesight Carrots, breakfast cereal with vitamin A,

and growth and to
help the immune
system work milk, and cheese

Vitamin D Needed for the Milk with vitamin D, salmon, and egg
body to use the
calcium that your
teen eats yolks—the sun lets your body make vitamin D, but be aware of the dangers
of getting too much sun

Vitamin E Helps protect the Nuts, seeds, whole grains, spinach, and
body from harm

breakfast cereal with vitamin E

PPT

PPT
Magnesium Helps keep the Whole grains, green veggies, and legumes
heart in rhythm,
builds strong bones,
and keeps blood
pressure within a
normal range

Exercise /physical activity :

122
Physical activity is any activity that involves moving your body. It
includes everyday activities as well as organised sports and exercise. PPT
Light physical activity includes everyday activities like leisurely PPT
walking, standing to do artwork or playing a musical instrument.
Moderate activities make your child huff and puff a bit. These could
include brisk walking, dancing, bike riding, swimming laps and
jogging. Even helping out with some of the more active chores inside
and outside your home can be good.
Vigorous activities increase your child’s heart rate and make him
huff and puff a lot. Vigorous activities can happen in any game with
lots of running. They’re often a big part of sports like soccer, cycling,
hockey and football, and some forms of dance.

Children and adolescents aged 5-17 years

 should do at least an average of 60 minutes per day of
moderate-to-vigorous intensity, mostly aerobic, physical

123
 activity, across the week.
 should incorporate vigorous-intensity aerobic activities, as
well as those that strengthen muscle and bone, at least 3 days
a week.
 should limit the amount of time spent being sedentary,
particularly the amount of recreational screen time

To explain Avoid sedentary life-style : Lecture- PPT

about avoid cum-
sedentary life discussion
style

Lecture- PPT
cum-
discussion

124
People can reduce the amount of time they spend being sedentary by:
 standing rather than sitting on public transport

 walking to school

 taking walks during lunch breaks

PPT
 setting reminders to stand up every 30 minutes when working Lecture-
cum-
at a desk
discussion
 investing in a standing desk or asking the workplace to
provide one

 taking a walk or standing up during coffee or tea breaks

 spending more time doing chores around the house, especially

DIY or gardening

 making excuses to leave the office or move around the PPT

125
 building

 taking phone calls outside and walking around at the same

time

 spending some free time being active rather than watching

television or playing video games

 getting up and walking around during television commercials

 taking the stairs instead of using the elevator

2mint To explain BEHAVIOUR MODIFICATION Lecture- PPT
the behaviour Intensive behavioral therapy can work very well. It targets poor habits cum-
modification that lead to obesity. These Pecifically, you may learn how to: discussion
 Track your eating
 Change your environment to avoid overeating
 Increase your activity level
 Create an exercise plan
 Set realistic goals
You will learn how to gain control over the times in which you
overeat. For instance, you may need to keep all unhealthy foods out
of your home. You may also need to use smaller plates. Your
therapist may also ask you to focus on eating without distractions.
This means turning off the TV or your phone.  
Your plan may also include:
 Learning how to eat more slowly and notice when you are full
 Setting realistic weight-loss goals Lecture- PPT
 Using small rewards to motivate yourself cum-
 Learning about nutrition. This may include making meal discussion
plans.
 Being more active. You may set up a formal fitness plan.

126
  Getting social support. Your spouse or family members may
be involved.
 Learning how to think more positively
 Reducing stress. This may decrease stress eating.
 Identifying and overcoming weight-loss obstacle
 Self – monitoring may involve keeping a record of the type and
time food was consumed and how the person was feeling when the
eating.
 Stimulus control is aimed at separating event that trigger eating
from the act of eating.

PROMOTION OF SLEEP Lecture- PPT

Adolescents and Adults: adolescents (12-18 years): 9-10 hours) cum-
• Avoid caffeinated beverages after lunchtime discussion
• Plan to be in bed with lights off at least 7 hours before the time to
get up
• Avoid activities that may be arousing around bedtime (e.g. playing
computer games, texting)
• Establish relaxing activities such as writing in a journal, listening to
relaxing music, stretching
• Create a quiet, dark, and relaxing bedroom environment
1. Stick to a sleep schedule
2. Pay attention to what you eat and drink
3. Include physical activity in your daily routine

Stress management : Lecture- PPT

 Exercise and eat regularly. cum-
 Get enough sleep and have a good sleep routine. discussion
 Avoid excess caffeine which can increase feelings of anxiety
and agitation.
 Avoid illegal drugs, alcohol, and tobacco.
 Learn relaxation exercises (abdominal breathing and muscle

127
 relaxation techniques).
 Develop assertiveness training skills. For example, state
feelings in polite, firm, and not overly aggressive or passive
ways: ("I feel angry when you yell at me.” "Please stop
yelling.”)
 Learn practical coping skills. For example, break a large task
into smaller, more attainable tasks.
 Learn to feel good about doing a competent or "good enough”
job rather than demanding perfection from yourself and
others.
 Take a break from stressful situations. Activities like listening
to music, talking to a friend, drawing, writing, or spending
time with a pet can reduce stress.
 Build a network of friends who help you cope in a positive
way.
These techniques cope with stresses one may find themselves
withholding.:
 Social activity
 Cognitive therapy
 Getting a hobby
 Meditation
 Music as a coping strategy
 Deep breathing PPT
 Reading novels

 Prayer
 Relaxation techniques PPT
 Physical exercise
 Spending time in nature
 Stress balls
 Time management
 Planning and decision making

128
  Listening to certain types of relaxing music
 Spending quality time with pets
3mint To do SUMMARIZATION : Verbal Summarization is
summarizatio Today we have discussed about the topic “life style done
n
intervention as a management for obesity”
- Defination, cause, symptom of obesity
- Healthy eating habits

REFERENCE:

•Swaminathan,M.(2005) Principles Nutrition,

Dietics.Second edition, Bapco Publishing, Bangalore.
• Bellize,M.C(2001) .Standard definition for childhood
overweight and obesity.Br med.
• Wongs (2001) wongs essentials of pediatric nursing(2nd
edition) missorimos by publications.
• Steinberger J Morgan A,HongCP,Jacobs DR Jr.Sinaiko
AR(2001) Adiposity in childhood predicts obesity and
insulin resistance in young adulthood. JPediatr.
• Parthasarathy.A (2009)IAP text book of pediatrics (4th
edition)newdelhi publications.
NET REFERENCES
• American Academy of Pediatrics Policy Statement (2007)
Prevention of Pediatric Overweight and Obesity, Pediatrics
Vol. 12, No 2, viewed online 2/21/2008 at
http://aappolicy.aappublications.org/cgi/content/full/
pediatrics;112/2/424
• Americas children viewed online 2-21-07@

129
www.childstats.gov/americaschildre

130
 APPENDIX - X
LIST OF STATISTICAL FORMULA

SR.NO. METHODS FORMULA

1. MEAN

2. Split half methods

3. Median

4. Stander deviation

5 Paired t-test

6 Chi square

131
 APPENDIX – XI
Master Data Sheet - Socio Demographic Variables

VARIABLES Age Gender Education Education Father's Mother's Type Leisure Dietary Junk frequency Previous Sources of
status of status of occupation occupation of time habits Food of knowledge knowledge
father mother famil activity Practic consumption
y e
SAMPLE  
1 14 1 3 1 2 4 1 1 2 1 3 1 2
2 13 1 3 2 2 2 1 3 2 1 2 1 3
3 13 2 4 2 1 3 1 2 1 1 2 1 2
4 14 1 4 1 3 1 1 4 2 1 2 1 2
5 14 1 3 2 4 4 2 3 2 1 3 1 2
6 13 2 4 4 2 3 1 2 1 1 3 1 2
7 14 1 4 3 3 4 1 2 2 1 2 1 2
8 13 2 1 1 1 3 1 2 1 1 1 1 3
9 13 1 4 1 2 2 1 3 2 1 2 1 2
10 14 1 3 3 3 4 2 1 2 1 2 1 2
11 13 1 1 2 2 3 1 4 2 1 1 1 1
12 13 1 4 2 1 3 1 3 2 1 2 1 2
13 14 2 3 1 3 4 1 2 1 1 2 1 1
14 14 2 4 1 2 3 1 2 1 1 2 1 4
15 13 2 3 1 3 3 1 3 1 1 2 1 1
16 14 1 4 2 2 4 2 3 2 1 2 1 1
17 14 1 4 2 2 3 1 2 2 1 2 1 1
18 13 1 3 2 3 4 1 1 2 1 2 1 3
19 13 2 3 1 3 3 1 2 1 1 1 1 1

132
20 14 1 3 1 2 4 2 1 2 1 2 1 4
21 16 2 4 2 2 4 1 4 2 1 3 1 1
22 16 2 4 1 1 4 1 1 1 1 2 1 2
23 15 2 5 2 2 3 1 4 1 1 2 1 3
24 15 2 4 2 4 3 2 1 1 1 2 1 1
25 15 2 2 3 2 4 1 1 2 2 3 1 1
26 15 2 4 3 2 4 1 4 2 1 2 1 3
27 16 2 2 3 2 3 1 3 2 1 1 1 1
28 16 2 1 1 1 3 2 2 1 1 2 1 1
29 15 2 3 2 3 2 1 2 2 1 2 1 4
30 15 2 4 1 3 3 1 3 2 1 2 1 1
31 15 2 4 1 3 4 1 3 1 1 1 1 3
32 16 2 4 2 2 3 1 2 2 1 3 1 1
33 15 2 4 2 3 2 2 1 1 1 2 1 1
34 16 2 4 2 2 4 1 2 1 1 3 1 1
35 16 2 4 3 1 3 1 2 2 1 3 1 4
36 16 2 4 3 2 3 1 2 2 1 2 1 1
37 15 2 3 2 3 4 1 2 2 1 1 1 1
38 16 2 3 2 3 2 1 1 1 1 1 1 4
39 16 2 1 3 2 3 2 4 1 1 2 1 4
40 15 2 4 3 4 4 1 3 2 1 3 1 1
41 12 1 4 3 3 2 1 2 2 1 2 1 2
42 12 1 3 1 3 4 1 2 1 1 3 1 2
43 12 1 4 4 3 3 1 1 1 1 1 1 2
44 12 1 3 2 3 4 1 1 2 1 2 1 2
45 12 1 4 3 2 3 1 3 1 2 1 1 4
46 12 1 3 1 3 4 2 2 1 2 2 1 4
47 12 1 3 4 3 4 1 2 1 1 2 1 2
48 12 1 4 3 3 3 1 3 1 1 2 1 2

133
49 12 1 3 1 4 4 1 1 2 1 3 1 3
50 12 1 2 3 3 3 1 1 1 1 2 1 1
51 15 1 3 1 3 4 1 2 1 1 3 1 2
52 15 1 4 3 2 3 2 4 1 1 1 1 4
53 15 1 3 1 3 3 1 2 1 1 1 1 4
54 16 1 3 1 4 4 1 4 2 1 3 1 4
55 16 1 4 2 2 1 1 2 1 1 2 1 3
56 15 1 3 2 2 3 1 2 1 1 3 1 3
57 15 1 1 3 4 4 1 3 2 1 2 1 4
58 16 1 4 4 3 3 1 4 1 1 2 1 4
59 16 1 3 2 2 4 2 1 2 1 2 1 2
60 16 1 2 3 1 1 1 3 1 1 1 1 2

134
 MASTER SHEET OF PRE-TEST

variable Q Q. Q. Q Q. Q. Q Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q.
. . .
1 2 3 4 5 6 7 8 9 10 1 12 13 14 1 16 17 18 19 2 21 22 23 2 25 26 27 28 2 30

Total
1 5 0 4 9
sample  
1 1 0 0 0 0 1 0 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 o 0 0 0 9
2 1 1 0 1 0 0 0 0 0 1 0 1 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 0 0 0 12
3 1 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 0 1 1 1 0 0 1 0 0 0 0 0 0 10
4 1 0 0 1 0 0 0 1 1 1 0 1 0 0 1 1 0 0 1 0 0 0 0 1 0 0 0 0 0 0 10
5 1 0 0 1 0 0 0 0 0 1 0 1 0 0 1 1 0 0 1 1 1 1 0 0 0 0 1 1 0 1 13
6 1 1 0 0 1 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 1 1 0 0 1 1 1 1 1 0 15
7 1 0 0 1 0 0 0 0 0 1 0 1 0 0 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 10
8 1 0 0 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 10
9 1 0 0 1 0 0 0 0 1 1 0 1 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 10
10 1 0 0 0 1 0 0 1 0 1 1 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 9
11 1 0 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 12
12 1 0 0 0 0 1 0 0 1 1 1 0 1 1 0 0 0 0 1 1 1 1 1 1 0 0 1 0 1 0 15
13 1 1 0 0 0 1 0 0 1 0 0 0 1 1 1 0 1 1 0 0 1 0 1 1 0 0 1 0 0 0 13
14 1 0 0 0 0 1 0 0 1 0 1 0 0 1 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 9
15 1 1 0 0 1 0 1 0 1 1 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 10
16 1 1 0 0 1 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 10

135
17 1 1 0 0 1 0 0 0 1 1 0 1 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 12
18 1 1 0 0 1 0 1 0 0 1 0 1 0 0 1 1 1 0 1 1 1 1 0 0 1 0 1 0 0 0 15
19 1 1 0 0 1 0 1 0 0 1 1 0 1 1 1 0 1 0 0 1 1 1 1 1 0 0 0 0 0 1 16
20 1 1 0 0 0 1 0 1 1 1 0 1 0 0 1 1 0 0 1 1 1 0 0 0 1 0 0 0 0 0 13
21 1 1 0 0 0 1 0 0 1 0 0 1 0 0 1 1 0 0 1 1 1 0 0 0 1 0 1 1 0 1 14
22 1 0 0 1 0 0 1 1 0 1 0 0 1 0 1 0 1 1 0 1 1 0 1 1 1 0 0 0 0 0 13
23 1 1 0 0 1 1 0 0 0 1 0 1 0 0 0 1 0 0 1 1 1 1 0 0 1 0 0 0 0 1 13
24 1 1 0 1 0 0 0 1 1 1 0 1 0 0 1 1 0 0 1 1 1 0 0 1 1 0 0 0 0 0 14
25 1 0 0 0 1 0 0 1 0 1 0 1 0 0 1 1 1 0 1 1 1 0 0 0 1 0 1 1 0 1 15
26 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 8
27 1 1 0 0 1 0 0 1 0 1 0 0 0 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 0 0 15
28 1 0 0 1 0 1 0 0 0 1 0 1 0 0 0 1 0 1 1 1 1 1 0 0 1 0 1 0 0 1 14
29 1 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 0 1 0 1 1 0 0 14
30 1 1 0 1 0 1 0 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 0 0 15
31 1 1 0 0 1 1 0 0 0 1 0 1 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 1 0 0 16
32 1 1 0 1 0 1 0 0 0 1 0 0 1 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 0 1 10
33 1 1 0 0 1 1 0 0 0 1 0 1 0 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 0 1 10
34 1 1 0 1 0 1 0 1 0 1 0 1 0 0 0 1 0 0 1 1 1 1 0 0 1 1 1 1 0 0 16
35 1 1 0 0 1 0 0 0 0 1 0 1 0 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 0 0 15
36 1 1 0 1 0 1 0 0 0 1 0 1 0 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 0 0 16
37 1 1 0 0 1 0 1 0 0 1 0 0 1 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 0 0 17
38 0 0 0 1 0 0 0 0 1 1 0 1 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 8

136
39 1 1 0 0 0 1 0 0 1 1 0 1 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 0 0 0 15
40 1 0 0 1 0 1 0 0 1 1 0 1 0 0 0 1 0 0 1 1 1 1 0 0 1 0 0 0 0 0 12
41 1 1 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 1 1 1 1 1 0 1 1 1 1 0 0 14
42 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 1 1 0 0 1 1 1 1 0 1 15
43 1 1 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 1 1 1 1 0 0 1 1 1 1 0 1 16
44 0 0 0 1 0 1 0 0 0 1 0 1 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 9
45 1 0 0 0 0 1 0 0 1 1 0 1 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 10
46 0 0 0 1 0 1 0 0 1 1 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 10
47 0 0 0 0 1 1 0 0 1 1 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 8
48 1 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 1 0 0 0 0 12
49 0 0 0 0 1 0 0 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 0 0 0 9
50 1 0 0 0 0 1 0 0 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 10
51 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 1 1 1 1 0 0 1 0 1 0 0 0 10
52 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 1 0 0 0 9
53 1 1 0 0 1 0 0 0 1 1 0 1 0 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 0 1 16
54 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 0 1 0 0 0 9
55 1 1 0 1 0 0 0 0 1 1 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 1 0 1 0 0 10
56 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 0 1 15
57 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 1 1 0 0 1 0 0 0 0 0 10
58 1 1 0 0 1 0 0 0 0 1 0 1 0 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 0 1 16
59 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 0 0 0 9
60 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 1 1 1 0 0 1 10

137
138
 MASTER SHEET POST-TEST

Variabl Q. Q Q. Q. Q. Q Q. Q. Q Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q. Q.
e . . .
1 2 3 4 5 6 7 8 9 10 1 12 1 14 1 16 17 1 19 2 21 2 23 2 25 2 27 2 29 3

total
1 3 5 8 0 2 4 6 8 0
sample  
1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 26
2 1 1 0 1 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 0 0 0 0 0 0 20
3 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 27
4 1 0 0 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 1 1 1 0 1 0 0 0 0 0 19
5 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 26
6 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 27
7 1 1 1 0 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 1 0 1 25
8 1 1 0 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 26
9 1 1 1 0 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 27
10 1 1 0 1 0 0 1 1 0 1 1 1 1 1 0 1 0 1 1 1 0 1 1 0 1 1 1 0 1 0 20
11 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 27
12 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 1 1 1 1 1 27
13 1 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 26
14 1 1 0 1 0 1 1 0 0 1 0 1 0 1 1 0 1 1 0 1 1 1 0 1 1 0 1 1 0 1 19
15 1 0 1 0 1 0 1 1 0 1 1 1 1 0 1 1 0 0 1 1 1 1 1 1 0 1 1 0 1 0 20
16 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 20

139
17 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 0 1 1 1 1 1 1 0 1 1 1 1 1 1 26
18 1 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 27
19 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 27
20 1 1 1 0 1 1 0 1 1 1 0 1 1 0 1 0 1 0 1 1 0 1 1 0 1 0 1 1 0 1 20
21 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 27
22 1 1 0 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 26
23 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 26
24 1 1 0 1 0 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 27
25 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 1 1 1 1 1 26
26 1 1 1 0 1 1 0 1 0 1 1 0 0 1 1 1 1 0 1 1 1 1 0 1 0 1 0 1 1 0 20
27 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 1 27
28 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 27
29 1 1 0 0 1 1 1 0 1 1 0 1 1 0 1 1 0 1 0 1 1 0 1 1 1 0 1 1 0 0 19
30 1 1 1 1 0 1 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 26
31 1 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 27
32 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 27
33 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 1 27
34 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 26
35 1 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 26
36 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 1 27
37 1 1 1 1 0 1 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 27
38 1 0 0 1 0 1 1 1 0 1 1 0 1 1 0 1 1 0 1 1 1 0 1 1 1 0 0 1 1 1 20

140
39 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 27
40 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 1 1 1 1 1 27
41 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1 0 1 26
42 1 1 1 1 0 1 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 26
43 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 1 27
44 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 27
45 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 1 27
46 1 0 0 1 0 1 1 1 0 0 1 1 1 0 1 1 0 1 0 1 1 0 1 1 1 1 0 1 1 0 19
47 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1 0 1 26
48 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 26
49 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 27
50 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 26
51 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 27
52 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 1 1 1 0 1 26
53 1 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 27
54 1 0 1 0 0 1 1 1 0 1 0 1 0 1 1 1 0 1 1 0 1 0 1 0 1 1 1 0 1 0 18
55 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 27
56 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 27
57 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 27
58 1 0 1 0 0 1 1 0 1 1 0 1 1 1 1 0 1 1 1 0 1 1 1 1 0 0 1 0 0 1 19
59 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 27
60 1 0 1 1 0 1 1 0 1 0 1 1 1 0 1 1 1 0 1 1 1 1 0 1 1 0 1 0 1 0 20

141
142
143
144
145
146
147
148
149
150
151
152
153