1

Chapter I
THE PROBLEM AND ITS SCOPE
Introduction
Childhood obesity is a condition where excess body fat negatively affects a child's health
or wellbeing. As methods to determine body fat directly are difficult, the diagnosis of obesity is
often based on Body Mass Index (BMI). Due to the rising prevalence of obesity in children and
its

many

adverse

health

effects

it

is

being

recognized

as

serious

public

health concern(Wikipedia).
Childhood obesity is one of the most serious public health challenges of the 21 st century.
(World Health Organization). It is the most common nutritional problem among children in
developed countries (Sorof& Daniels, 2002). It is a complex, multifactoral and chronic condition
resulting from interplay between environment and genetics (Segal & Sanchez, 2001). The
prevalence of obesity has been growing at an alarming rate for decades in both children and
adults (Giammattei et al., 2003). Obesity prevalence is 1420% in industrialized countries, but
the fastest increases, particularly in childhood obesity, are seen in developing countries such as
Chile and China (Finer, 2003). Worldwide, 22 million children under the age of five are
overweight (Finer, 2003). Today, among the affluent people around the world, including those in
developing nations, obesity afflicts about 20% of children aging from 6 to 11, and more
alarmingly, about 10% of those aging from 2 to 5 are obese. Among those between the ages 12
and 19, 18% are also obese (Chua, 2012).
Obesity is associated with significant morbidity and mortality, including cardiovascular,
respiratory, orthopedic, gastrointestinal, endocrine, and psychosocial morbidities (Segal &
Sanchez, 2001). As increasing numbers of overweight children and adolescents progress to
adulthood, these complications are expected to reach epidemic proportions (Segal & Sanchez,
2001).
Being an overweight child under 3 years of age does not predict future obesity unless at
least one parent is also obese. After the age of 3 years, the likelihood that obesity will persist into

adulthood increases with advancing age of the child and is higher in children with severe obesity
in all age groups. After an obese child reaches 6 years of age, the probability that obesity will
persist into adulthood exceeds 50%, and 70%80% of obese adolescents will remain so as they
become adults (Segal & Sanchez, 2001).
Obesity in children not only affects their bodies but their mind as well. Obese children
are at higher risk to develop psychological problems as the American Academy of Children &
Adolescent Psychiatry describes. Obese children tend to have much lower self-esteem,
depression, anxiety, obsessive compulsive disorder, and poor body image. Obese children are
also most likely to be teased and bullied by other children that create more emotional damage.
Worldwide, the adoption of industrialized western society lifestyles (urbanization,
western foods, increased sedentariness, and car ownership) is associated with increasing obesity.
The shift towards a westernized dietary pattern has brought about a new nutrition scenario in
many developing countries. These countries are now faced with the twin problems of
malnutrition that is under nutrition among some segments of the communities and the problems
of obesity and associated disorders in other groups (Tee, 1999).
Changes in meal patterns are also evident: more families eat out, busy executives skip
meals, and younger generations miss breakfast and rely too much on fast food. In addition,
communities have become generally more sedentary (Tee, 1999). All these changes have brought
about undesired effects with significant proportions of the population being afflicted with various
non-communicable diseases associated with over nutrition namely obesity, hypertension,
coronary heart disease, type II diabetes, and cancers (Tee, 1999).
In the Philippines, studies on obesity among children show that the findings reveal a
pattern. The prevalence rate of obesity had been increasing through the years. The Philippine
National Health Evaluation and Survey (2004) has placed the prevalence rate of obesity among
Filipino children at 3.2%. This has increased to 4.9% in 2003. Opina (2005) claimed that the
gradual increase in the incidence of obesity was likewise noted by the National Nutrition Council
of the Philippines survey in 2003. Overweight children aging from 0 to 5 years rose from 0.4%
to 1.4%. The prevalence rate of overweight children aging from 6 to 10 years was almost
negligible in 1998 but had a significant increase to 1.3% in 2003. Mayuga (2005) however said

that the results of a survey conducted by the Food and Nutrition Research Institute (FNRI) of the
Department of Science and Technology are more alarming. It was revealed that in 1989, the
prevalence rate of obesity among Filipino children was at 5.7%. In 1993, it increased to 8% and
in 1998, to 8.8%.
A study conducted last June 2012 by the school nurse of ABC, Ms. Joanna B. Jauculan,
RN revealed that 13.09% of the population in elementary pupils is obese. Because of this, the
group would like to undertake a study on the factors contributing to childhood obesity among
elementary pupils in ABC.

Theoretical Framework
This study is heavily anchored on the Health Belief Model (HBM) developed by Irwin
M. Rosenstock in 1966. This Model is a health behavioral change and psychological model that
will serve as the basis for the uptake of health promotional initiatives. The HBM is one of the
most commonly utilized theory in health education and health promotion (Glanz et al, 2002).
The Model was modified by Becker in 1974, to include components, such as individual
perception modifying factors and variables likely to affect initiating of action. It is a model based
on Motivation Theory which assumes that good health is an objective common to all people
(Kozier et al; 2007).
Factors included in the HBM are individual perceptions that would include perceived
susceptibility, seriousness, and threat. Intervening or modifying factors are also included such as
demographics, structural variables, and cues to action. The likelihood for action will also depend
on the perceive benefit and barriers of action (Kozier et al; 2007).

Biological Factors:

Physical factor:

Genetics

Physical activities

Environmental Factors:

Personal Factors:

Easy access to foods

Lifestyle
Dietary habits

Mediating Variables:
Parental Factors
Age
Civil Status
Educational Background
Gender
Monthly Income
Religion

Childhood Obesity

Fig. 1.Schematic Diagram of Study

Figure 1. describes the paradigm of the factors contributing to childhood obesity which shows
the relationship of the independent variables which are the biological, physical, environmental,
and personal factors as well the mediating variables (age, civil status, educational background,
gender, monthly income, religion), these factors can either worsenor lessen the risk to childhood
obesity(dependent variable).
There are many factors that contribute to childhood obesity. These are biological,
psychological, social and personal factors. Children with obese parents have double risk of
becoming obese and have many of same references in diet and lifestyle. Genetics cannot be
changed. Once the parents are obese, the child will possibly inherit it thats why limit intake of
high calorie foods and regular exercise are very important. Also, there are other factors like
personality and peer pressure. Obese children are sometimes taunted by playmates and may
become loners or have difficulty relating to peers. Obese children have reduced physical activity
including sports participation, watching television, using computer and playing video games
occupy a large percentage of children leisure time. Poor lifestyle choices, increase in daily
snacking, decline in consumption of 3 principal meals, lack of access to healthy foods and easy
access to junk foods has greatly contributed to children obesity.
Parents also have a major role in the childs growth and development which serves as
mediating variables, these factors can either worsen or lessen the risk of the child to become
obese. Parental factors like age, civil status, educational background, gender, monthly income
and religion may affect them. Elementary pupils need their parents for guidance with regards to
their nutrition.

Statement of the Problem

This study aims to determine the factors contributing to childhood obesity among
elementary pupils at ABC.
Specifically, it seeks to answer the following questions:
1. What is the respondents profile in terms of:
1.1 Age
1.2 Gender
1.3 Civil status
1.4Religion
1.5 Educational background
1.6 Monthly income
2. What are the factors contributing to childhood obesity among elementary pupils with
regards tobiological, physical, environmental, and personal aspects?

Hypothesis
The null hypothesis will be formulated and tested at the alpha 0.05 level of significance
with utilization of appropriate statistical tools:
Ho1

There are no significant differences in the factors contributing to childhood obesity

among elementary pupils when grouped according to age, gender, height, weight, and lifestyle.

Significance of the Study

Parents
For the parents, this will help them understand more about the nutritional status of their
children since we know that most of the time, it is already enough to them seeing their
child in their weight without knowing whether their child is on the appropriate weight to
their age or not. This will also encourage them to be a good role model for children's
nutrition through Buying fruits and vegetables rather than snacks. This shows that if
parents emphasize how important these are in the diet, children will eat them more often.
Health Care Professionals
This study will help the Health Care professionals in developing plans that are evidencebased practice.

Students
As a supporting effort to the school environment, school nutrition plays a significant role
in bettering the health of students. The School Canteen ensures that participating students
receive foods that are based on nutritional standards, limits certain nutrients for sale, and
provides nutrition materials and professional growth opportunities to school nutrition
staff. Through this study, they could use the results as an evidence regarding the
elementary pupils are at risk of developing obesity thereby they can implement
interventions such as selling at the school canteen low-calorie foods (e.g. boiled beans,
boiled potatoes, broccoli, etc.) or by eliminating junk foods as one of the foods they sell.

Scope and Delimitation

This study is focused on the factors contributing to childhood obesity that affect
elementary pupils in ABC. It involves 13.09% of the respondent parents of elementary pupils
enrolled at ABC. The study consists of respondents in elementary department of ABC who are
both male and female. The researchers limit this study to ABC for the reason that it is the survey
conducted by the school nurse of ABC, Ms. Joanna B. Jauculan, RN. This study is also limited to
the effects of cause to childhood obesity among elementary pupils. The study does not cover the
aspects of child development such as psychological, social and intellectual.
The study conducted last June 2012 by the school nurse of ABC, Ms. Joanna B. Jauculan,
RN, revealed that 13.09% out of 336 elementary pupils in ABC, 44 are identified as obese. Due
to limited time frame to conduct frequent interviews necessary to accomplish this study,
questionnaires will be designed instead for respondent parents to accomplish. Since parents
refer to the father or the mother of the elementary pupils, the agreement of both would have been
written as answers to the given questionnaire to make possible accurate and unbiased data
collection. Because of this, the researchers would like to commence a study on the factors
contributing to childhood obesity among elementary pupils in ABC.

10

Operational Definition of Terms

Andres Bonifacio College - it is a non-sectorial school institution in Dipolog City wherein the
research study will be conducted.
Health - it pertains to the good condition of elementary pupils in ABC in terms of their nutrition
and activities.
Lifestyle - refers to how the elementary pupils of ABC perform their activities of daily living and
their recreational activities during vacant hours.
Nutrition - pertains to eating the right kind of foods providing balanced diet with regards to their
age bracket.
Obesity - is a term used to describe the elementary pupils in ABC with excessive fat
accumulation that presents a risk to health; refers to elementary pupils in ABC with a BMI
greater than or equal to 30 kg/m2.
Pupils - are those individuals, aging from 4 to 12 years old who are studying at ABC.

11

Chapter 2
REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the selected related literature and studies written by local and
foreign authors which have relevance to the study. These data have been used as one of the
sources to support the study.

Related Literature
The incidence of overweight and obesity among children is slowly becoming a worldwide problem. Developed and developing countries are not spared from this health concern. The
World Health Organization (2006) has made this problem a priority and is currently drawing up
programs to improve the prevention and management of obesity among children and adults. The
organization has recognized the impact of such problem on the future health as well as on the
level of productivity and economic growth retardation of communities and nations. Several
countries in the world have reported an alarming prevalence of obesity among children. In the
United States (US),it was claimed that while the incidence of obesity in children is less than in
adults, the rate of increase appears to be higher for children (Dehghan e.t al., 2005).
The focus on childhood obesity is clinically significant as the problem contributes to the
marked decrease in childrens health. The effects of obesity are usually seen later during adult
life. Cardiovascular complications such as coronary heart disease (CHD) and stroke are common
among obese adults with history of childhood obesity. The relationship of cardiovascular disease
and obesity was clearly shown in a study conducted by Pavel (2004).
Childhood obesity has reached epidemic levels in developed countries. Twenty five
percent of children in the US are overweight and 11% are obese. Overweight and obesity in
childhood are known to have significant impact on both physical and psychological health. The
mechanism of obesity development is not fully understood and it is believed to be a disorder with
multiple causes. Environmental factors, lifestyle preferences, and cultural environment play

12

pivotal roles in the rising prevalence of obesity worldwide. In general, overweight and obesity
are assumed to be the results of an increase in caloric and fat intake. On the other hand, there are
supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady
decline in physical activity have been playing major roles in the rising rates of obesity all around
the world. Consequently, both over-consumption of calories and reduced physical activity are
involved in childhood obesity (Dehghan e.t al., 2005).
Childhood obesity has become Americas new tobacco. They, like many other public
health administrators, fear the obesity epidemic America currently faces will only get worse
before it starts to get better. With one in three American children being overweight or obese, the
issue has risen to monumental proportions (Klein & Dietz, 2010).
The problem did not just appear out of thin air, however. Over the past 30 years the rise
in obesity rates have steadily increased, and the fact that the increase in obesity during this
period cannot be explained by genetics, and has occurred among all socioeconomic groups
provides support for a broad set of social and environmental explanations (Christakis, 2007).
According to the Robert Wood Johnson Foundations 2011F as in Fat report, more than two
out of every three states have obesity rates above 25 percent. Twenty years ago, no state had a
rate above 15 percent (Levi et al., 2011). Only one state in the nation currently has a childhood
obesity rate below 10 percent (Oregon), and the Robert Wood Johnson Foundation found that 16
states significantly increased their obesity rates in just one year from 2010-2011. The prevalence
of obesity among children from lower-income families is also on the rise as families struggle to
afford high-priced healthy foods. From 1999 to 2009, obesity rates for lower SES children
increased from 12 percent to 15 percent (Levi et al., 2011). Across all populations in every state,
the childhood obesity epidemic has undoubtedly reached an all time high.
A childs obesity level is determined using their body mass index, or BMI. BMI is an
individuals weight divided by their height, and children are defined as being obese when their
BMI is at the ninety-fifth percentile or higher. Also, when documenting childhood obesity, the
common categories are children ages 5-9, and youth aged 10-17 (Lobstein et. al., 2004).
Research shows that children who have a higher BMI and are considered overweight or obese,
not only have a significantly greater chance of being overweight adults, but are also at a much

13

greater risk of having asthma, joint problems, diabetes, liver disease, cardiovascular disease and
an array of other problems later in life (Klein & Dietz, 2010).
Today, children have become the group in which the

obesity rates are increasing

the fastest. This growing population is also starting to impact the country as a whole, transferring
their weight of problems onto the rest of the American public. Experts report that direct medical
costs from obesity-related health issues are as high as $150 billion a year (Cawley, 2010). These
health care expenditures are starting to burden the rest of America, and are costing the
government a surplus of expenses todays economy cannot afford to handle. The overweight
American is simply more expensive to care for, and it is beginning to show as more of them fall
into a tailspin of health problems.
From an increase in daily snacking and a decline in the consumption of three principal
meals, to the lack of access to healthy foods and the school lunch program, the causes for
childhood obesity are endless (Piernas, 2010). With no one actions causing the problem,
recommendations to reverse the epidemic are confusing, contradictory and forever changing.
Individual responsibility is continuously emphasized into the nations treatment for obesity, but
with the ever-increasing number of overweight individuals in the United States, it is imperative
to examine environmental contributors to obesity (Wang & Brownell, 2005).
Overweight and obesity in childhood have significant impact on both physical and
psychological health; for example, overweight and obesity are associated with hyperlipidemia,
hypertension, abnormal glucose tolerance, and infertility. In addition, psychological disorders
such as depression occur with increased frequency in obese children. Overweight children
followed up for 40 and 55 years were more likely to have cardiovascular and digestive diseases,
and die from any cause as compared with those who were lean (Dehghan et. al., 2005).
There are three forms of prevention: primary, secondary, and tertiary. Primary prevention
is tailored towards reducing the occurrence of the disease before it results. Secondary prevention
is geared towards reducing the progress of a disease once it begins. Tertiary prevention is related
to reducing the limitations of disability from the disease (Fris& Sellers, 2009). It should be
noted that overweight and obesity lead to many other symptoms, such as sleep problems,
respiratory problems, gastrointestinal problems, endocrine disorders, menstrual irregularities,

14

orthopedic problems, mental health problems, genitourinary problems, and skin conditions
(Krebs, 2007). For this reason, a variety of current research on obesity is dedicated towards
primary prevention of obesity.
As physicians, research indicates that education may be the best form of overweight and
obesity prevention among children and adults (Krebs, 2007). However, it is important to
understand the difficulty of treating obesity. Children of obese parents have double the risk of
becoming obese and have many of the same preferences in diet and lifestyles (Zlot, 2007). This
not only predisposes children to obesity genetically, but it makes it increasingly difficult as the
environment they live in is rich with the temptations of an obese lifestyle. There are 170,000 fast
food restaurants and three million soft drink vending machines in the United States (Chopra,
2002). Todays children will be tomorrows adults. This objective reality poses a very real threat
to our nations health.

15

Related Studies
Children who eat too many carbohydrates and become obese may develop motor skills
more slowly than the other children because physical movement is more tiring for them. Obese
children are sometimes taunted by their playmates and may become loners or have difficulty
relating to their peers because of behavior problems or depression about their weight (Pillitteri,
2010).
A study by Miller, J.; Rosenbloom, A. & Silverstein, J. (2004) yielded that the increased
incidence of childhood obesity cannot be blamed on either environment or genetics alone.
Changes in the environment like nutrition and lifestyle are primarily responsible because it is not
possible for the gene pool to change in less than a generation.
The cause of obesity is high because many studies concluded on current lifestyles have
drawn a number of conclusions. It is generally accepted that a combination of poor lifestyle
choices has greatly contributed to children who are obese.
A study conducted by the Center for Disease Control (CDC) revealed that from 1976 to
2000, the incidence of obesity among American children aging from 6 to 11 years has doubled
and those ages 12 19 years has tripled (Girandola& Chin, 2004). The prevalence of childhood
obesity in other parts of North America, Europe and some parts of Asia is also high. According to
Prentice (2006), Canada has 15% prevalence rate while Germany has 21%. In Asia, Iran has
prevalence rate of 10% with children making up most of the obese population while Bahrain has
29%. In the United Kingdom (UK), a study conducted by Stamatakis (2002) revealed that the
prevalence of overweight and obesity among children is increasing at alarming rates across
social classes. They concluded that overweight and obesity are now common across social
classes in the UK with overweight being widely accepted as a norm.
In Cyprus, a study to determine the prevalence of childhood and adolescent obesity and
its associated factors was conducted by Savva (2002). Their study revealed that the prevalence of
obesity in males was 10.3% and in females 9.1%. The percentages presented a decreasing trend
with age. It was also found in their research that physical activity and parental obesity on the
other hand had more significant roles in the obesity of the subjects. Most obese children had

16

reduced physical activity including sports participation, as compared to those who are not obese.
Likewise, most obese subjects have one or both parents who were obese.
In the Philippines, studies on obesity among children show that the findings reveal a
pattern. The prevalence rate of obesity had been increasing through the years. The Philippine
National Health Evaluation and Survey (2004) has placed the prevalence rate of obesity among
Filipino children at 3.2%. This has increased to 4.9% in 2003. Opina (2005) claimed that the
gradual increase in the incidence of obesity was likewise noted by the National Nutrition Council
of the Philippines survey in 2003. Overweight children aging from 0 to 5 years rose from 0.4%
to 1.4%. The prevalence rate of overweight children aging from 6 to 10 years was almost
negligible in 1998 but had a significant increase to 1.3% in 2003. Mayuga (2005) however said
that the results of a survey conducted by the Food and Nutrition Research Institute (FNRI) of the
Department of Science and Technology are more alarming. It was revealed that in 1989, the
prevalence rate of obesity among Filipino children was at 5.7%. In 1993 it increased to 8% and
in 1998 to 8.8%.
A study conducted by Gonzalez-Suarez C. B., Lee-Pineda K., Zamora M. T. G., Sibug E.
O., Velasco Z. F. & Grimmer-Somers K. last 2012 revealed that there is an alarming increase in
the prevalence of childhood obesity. This study examines the joint association of cardiovascular
fitness and nutritional intake in Filipino pre-adolescents. Grade 4 to 6 students from an
elementary school in Manila were included. Data were obtained from August 2009 to March
2010. Outcome measures were BMI, cardiovascular fitness using 20m multistage shuttle run and
24h dietary food recall utilizing a face-to-face interview. For males, the odds of being overweight
compared to having normal weight were significantly elevated in those who had low
cardiovascular fitness and high caloric intake. Comparing those who were obese with those with
normal BMI, the odds of being obese were very high for those who had low cardiovascular
fitness and low caloric intake. However, the odds of being obese increased even more when
males had low cardiovascular fitness and high total caloric intake. For females, the odd of being
overweight and obese was significantly higher for those with high caloric intake and low
physical fitness compared to those with high physical fitness and low total caloric intake. The
findings emphasize the importance of increasing cardiovascular fitness through involvement in

17

moderate to vigorous physical activity and improving dietary patterns in order to reduce the
increasing prevalence of childhood obesity.
Another study on the role of nutritional factors on obese children conducted by Weker, H.
(2006) shows that excessive amount of adipose tissue in children and simple obesity in particular
constitute a growing health problem throughout the world. Adverse health effects of obesity of
children justify the need to look for efficient treatments and among them the dietary treatment.
The aim of the study was to examine the effectiveness of dietary treatment in children with
simple obesity on the basis of thorough analysis of their state of nutrition, method of nutrition,
and eating habits, and the impact of other environmental factors. Four research hypotheses were
formulated: (1.) Simple obesity of children is influenced by selected environmental factors such
as parents' level of education, familial inclination to obesity, and health habits; (2.) Chosen and
accepted by the child and/or its mothers/parents programme of dietary treatment in the form of
low-energy diet with elements of low glycemic index results in the loss of body mass in children;
(3.) Implemented dietary treatment translates into the modification of basic anthropometric
features--body mass, body height, thickness of skin, and adipose folds on arm, below shoulder
blade (scapula), on abdomen as well as arm circumference and anthropometric parameters of
examined children-- BMI, waste-hip ratio, and body fat content; (4.) Implemented dietary
treatment has an impact on modification of certain biochemical indicators--lipid profile of
children with increased indicators of lipid metabolism.
Several studies conducted by the National Health and Nutrition Examination Survey
(NCHS), CDC in 2000 have been published that attempt to link childrens diets with the onset of
obesity. However, none have been able to show a causal link between diet and obesity. Two such
studies include the Bogalusa Heart Study and a USDA Economic Research Service study.
The Bogalusa Heart Study analyzed childrens eating patterns over two decades (19731994) using a series of seven cross-sectional surveys given to 1,584 ten-year old children. The
study discovered changes in childrens eating patterns over this 20-year period including:
increased incidence of missed breakfasts, increased numbers of children eating dinners outside
the home, and increased snacking. No causal associations were found between changes in meal
patterns and overweight status.

18

The USDA Economic Research Service study on fruit consumption indicated that higher
fruit consumption is linked with a lower BMI in both adults and children. A large cohort of 3,064
children between the ages of 5 and 18 years were surveyed between 1994 and 1996 using the
USDAs Continuing Survey of Food Intakes by Individuals (CSFII). The study hypothesized that
people who incorporate nutrient-dense, low-fat foods into their diets like those found in fruits
and vegetables will have a healthier BMI. However, the study only found a weak correlation
between body weight and vegetable consumption.
Moreover, the research above indicates that a decrease in daily energy expenditure
without a concomitant decrease in total energy consumption may be the underlying factor for the
increase in childhood obesity. Physical activity trend data for children are limited, but, cross
sectional data indicates that one third of adolescents are not getting recommended levels of
moderate or vigorous activity, 10% are completely inactive and physical activity levels fall as
adolescents age. This situation may actually be worse than these data described. Activity
measured by physical activity monitors tends to be significantly lower than what is reported on
surveys.
Watching television, using the computer, and playing video games occupy a large
percentage of childrens leisure time influencing their physical activity levels. It is estimated that
children in the United States are spending 25% of their waking hours watching television and
statistically, children who watch the most hours of television have the highest incidence of
obesity. This trend is apparent not only because little energy is expended while viewing
television but also because of the concurrent consumption of high-caloric snacks.
A study conducted by de Onis, M., Blossner, M. &Borghi, E. (2010) shows that even
though child hunger remains the most pressing nutritional concern for much of Asiain South
Asia, for example, one in three preschool children is underweightthe region has also seen
dramatic increases in child obesity. Overall in Asia (excluding Japan), nearly 5% of preschoolers
were estimated to be overweight or obese in 2010, a 53% increase in prevalence since 1990 that
translates into 17.7 million Asian preschoolers being overweight or obese. Theres quite a bit of
diversity from region to region, however. While South Asian countries like Bangladesh, India,
and Pakistan have low obesity rates, their large populations add up to large numbers of children

19

who are overweight or obese. Its important to note that in Asian adults, the health complications
associated with overweight and obesity start at a lower BMI than seen in the U.S. and Europe.
Therefore, many of these estimates of child obesity prevalence in Asia likely underestimate the
true public health burden of obesity in Asia.
The bottom line is that it is never too early to start preventing obesity even among the
youngest of children. It is clear that obesity rates are rising across the globe. Equally clear is that
it is very hard for anyone who becomes overweight to lose weight, at any age. Preventing obesity
in a childs earliest years (and even before birth, by healthy habits during pregnancy) confers a
lifetime of health benefits. It is the most promising path for turning around the global epidemic.

20

CHAPTER 3
RESEARCH METHODOLOGY
This chapter specifies the research design, research environment, the respondents of the
study, research instrument, sampling plan, and statistical treatment.

Research Design
This study employs a descriptive-comparative research study. It involves a description of
the factors contributing to childhood obesity among elementary pupils in ABC as well as
relationship between them. The researchers considered this as the appropriate research design. It
will discuss and compare the different factors that contribute to childhood obesity from the
viewpoint of the parents. A researcher-made questionnaire will be used in gathering the data. The
parents of the identified obese children from the elementary department of ABC will be
considered as the studys prospective respondents.

Research Environment and Setting

This study was conducted in ABC which is situated in a 25 hectare sprawling campus
along Barangay Miputak, Dipolog City, Zamboanga del Norte, Philippines with several buildings
surrounding its panorama views of the College Park. The Elementary Department of the school
has well-built concrete building with 10 rooms conducive for learning at the side of the schools
Administrative Building. This school has Basic Elementary education from grades I to VI and
currently has 336 of total population.

21

Respondents of the Study

Respondents of the study are the parents or the guardians currently taking care of their
children who are currently studying Elementary students of ABC, Dipolog City and who were
previously identified by the school nurse as among the group that are obese. The respondents
age, civil status, educational background, gender, monthly income, and religion will be taken
into consideration.
All respondents must be 18 years old and above, living in Dipolog City and their children
must be studying at ABCs Elementary Department and whose child must have been identified
by the school nurse as obese for his or her current age.
Research Instruments
Data of the study will be collected utilizing a questionnaire as the main data gathering
tool. The questionnaire covers three important areas. The first part consists of a profile of the
respondents as to the age, gender, religious affiliation, educational attainment, occupation, and
relationship with the obese children. The second part assesses the knowledge about giving care
which includes growth and development concepts, hygiene, nutrition, activities, educational
attainment and social aspects. The third part determines the common practices of the caregivers
in relation to their knowledge on health practices which includes growth and development
concepts, hygiene, nutrition, activities, educational and social aspects.
To interpret the data that will be gathered from the respondents, the following continuum
will be utilized.
Continuum for PART II
Weight

Responses

Continuum

Strongly Agree

4.50 - 5.00

Seldom Agree

3.50 4.59

Disagree

2.50 3.49

Strongly disagree1.00 2.49

22

Sampling Plan
The researchers select the respondents of the study who are the parents or the guardians
of elementary pupils from Kinder I to Grade 6, aging from 4 to12 years old, studying at ABC,
Dipolog City. The sampling designs that will be used are the convenient and purposive sampling
design where Ms. Joanna B. Jauculan, RN conducted an initial survey at ABC, Dipolog City and
identified those elementary pupils who are considered as obese with a BMI greater than or equal
to 30.
The statistical instruments that will be used to gather relevant data are the researchermade questionnaires and structured interview to clarify. The data then will be analyzed using the
frequency, percentage, and weighted mean, and with the use of Minitab statistical software to
determine whether or not significant relationship between the knowledge and practices of
elementary pupils that are consider as obese exist.

Data Gathering Procedures

The researchers will submit a letter signed by the Dean of the School of Nursing. The
said letter contains information regarding the need for approval of the principal of the elementary
department in ABC, Mr. William T. Pinili, allowing the researchers to conduct the study.
Moreover, it includes the permission of inquiring as to how many obese pupils are enrolled. The
researchers will identify who among those obese pupils with characteristics that meet the
eligibility criteria of the study. After identifying the prospective participants, they will be
approached and will be given an informed consent.
The researchers will meet first as a group to come up with a plan on how to approach the
respondents. During the actual data gathering, the researchers will be using questionnaires that
are phrased in Cebuano. The researchers will confirm the semantic equivalents in the Cebuano
-phrased questionnaire by back-translation, that is, by back-translating the Cebuano -phrased
questionnaire into English and then comparing the back-translation with the original
questionnaire.

23

The questionnaire consists of three parts (1) the profile of the respondents (2) the factors
contributing to childhood obesity among elementary pupils with regards to physical, social,
emotional, physiological, and mental aspects (3) the significant differences in the factors
contributing to childhood obesity among elementary pupils. Before the Cebuano-phrased
questionnaires will be disseminated to the respective participants, they will be submitted to the
research adviser for validation and revision until they will be ready and will be distributed to the
study respondents. An initial draft of the questionnaires will be presented to the adviser, research,
and grammar consultants to correct the errors in the sentences, grammars, and to identify
appropriate questions for the study.
The effectiveness and appropriateness of the questionnaires will be tested through
conducting a pilot study consisting of at least 20 respondents at St. Vincents Basic Education
Campus. The researchers will be divided by pair and will go to the said respondents and conduct
the pilot study through using the researcher-made questionnaires. The researchers will first
explain the content of the questionnaire to the respondents, guide them in answering the
questionnaires and answer their questions or clarifications. After conducting the pilot study, the
researchers will then analyze the results and make any necessary changes and revision on the
questionnaires. The revised questionnaires will be checked and approved by the adviser, research
and grammar consultant before giving the research instrument to the respondents in the actual
study.
On the pilot study and actual data gathering, the study participants will be informed about
their rights to refuse or terminate cooperation at any point. The researchers will address questions
from the respondents and thoroughly discuss and clear details.

24

Statistical Method

The researchers will utilize the following statistical methods and procedures namely:
frequencies and percentage, a weighted average, t-test and Pearson Product-Moment Correlation
Coefficient r.
Frequency count and percentage will be utilized to describe the profile of the
respondents. As illustrated below:
Where:
Formula:
P(%)=

P = Percentage
f X 100
N

f = Frequency
N = Total Respondents

Weighted average will be utilized to ascertain the respondents responses on the questions
fielded by the researchers. The Weighted Mean Formula is illustrated below;

Formula:

Where:
x = weighted mean
X

fw
N

f = frequency
w = weight
N = number of cases

The Chi-Square will measure observed behaviors from expected behavior and establish if
there is significant differences between them. Chi-square (2) procedures measures the
differences between observed (O) and expected (E)frequencies of nominal variables, in which
the subjects are grouped in categories or cells. This study will use the Goodness of Fit Test type
of chi-square analysis. The Goodness of Fit Test is applied to a single nominal variableand

25

determines whether the frequencies we observe in k categories fit what we might expect. Some
textbooks call this procedure the Badness of Fit Test because a significant 2 value means that
Observed counts do not fit what we Expect. The Goodness of Fit Test can be applied with equal
or proportional expected frequencies.
Where:

Formula:
2 =

_0 -- E_

= Summation

O = Observed Value
E = Expected Value

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