1.

0 INTRODUCTION

1.1 PROBLEM BACKGROUND

Obesity in children is a serious public health problem and the prevalence is increasing
dramatically (Ng et al. 2014). Demonstrating that this upward trend has reached a plateau
(Wabitsch et al. 2014). In Malaysia, prevalence of overweight and obesity among urban children
aged 7 to12 years was reported at 14.4% and 20.1%, respectively (Poh et al. 2013).

Childhood obesity has been associated with short and long-term effects on physical and
psychosocial health in both child and adult life (Bray & Bouchard 2014). Several studies found
that overweight and obese children are more likely to remain obese into adulthood and more
likely to develop non-communicable diseases later in life (Li et al.2011). According to Wee et al.
(2011), overweight and obese Malaysian children aged 9 to 12 years were at 16.3 times higher
risk of developing metabolic syndrome compared to their normal weight counterparts.

Obesity is a complex issue and it is the result of interactions between multiple factors.
Etiology of childhood obesity can be divided into two main categories: modifiable factors
(socioeconomic status, diet, physical activity, sleep and parental determinants) and un-
modifiable factors (genetics, ethnicity, intrauterine factors) (Ang et al. 2013). The increase in the
percentage of overweight and obesity among primary schoolchildren in Malaysia was mainly
caused by the type of foods consumed, which mostly were high in fat, sugar and calories.
Moreover, a majority of Malaysian children did not meet the recommended daily pedometer step
counts and exceeded the recommended maximum screen time of 2 hours per day (Lee et al.
2015).

Considering the increasing prevalence of overweight and obesity among children,

effective interventions to prevent this epidemic in Malaysia are urgently needed and should
target modifiable health-related behaviours. The essential behavioural components of a
childhood obesity intervention are likely to include dietary intake, physical activity and active
parental involvement (Kirk et al.2005).

This paper provides an overview of the rationale and study of a school-based nutrition
education program aimed at managing childhood obesity. The aim of the Sihat Minda & Badan

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program is to assess the effectiveness of a one month nutrition education program in improving
knowledge, attitude and practice (KAP) of nutrition, eating habits and physical activity among
overweight and obese primary schoolchildren aged 9 to 11 years.

1.2 OBJECTIVE OF INVESTIGATION

The main objectives of these investigations are:

 To give exposure to students about the danger of obesity

 To improve student’s daily dietary intake
 To get obese students involve in physical activity

1.3 POPULATION

For this investigation, 3 Tamil schools in Johor Baru area were selected. From each school a total
of 20 obese students aged between 7 to 11 years old were selected randomly. The reason for
schools in Johor Baru chosen is because, it is known that parents in city are busy with their work
and this phenomenon contribute to unhealthy eating patter among their children. Hence, this
school sounds reasonable to conduct the investigation. Since year 6 students (aged 12) involves
in UPSR exam preparation, they were not included in this study.

1.4 INSTRUMENTS

Each selected students were given a checklist form and a questionnaire with few simple
questions. In that checklist form, their age and body mass index (BMI) were recorded. For the
duration of one month of the study, students have to tick their eating and exercise habits. They
only have to tick whether they eat healthy meal and do exercise. Before the study was conducted,
students were asked few questions regarding their eating habit through questionnaire. With the
help of the school physical teacher, students will be given basic exercise every morning during
their physical lesson. After the study, their BMI recorded again and the same question asked

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before the study asked again to see whether students have clear picture of healthy eating. The
success of the program will be based on the latest BMI of the respondents.

2.0 FINDINGS

2.1 PRESENTATION OF ANALYSED DATA

Pre-Study Post-study
85th-95th 97th-99.9th >100th <85th 85th-95th 97th-99.9th >100th
percentile percentile percentile percentile percentile percentile percentile
BMI 3 12 5 4 9 3 4
100m
35 70 110 < 20 20-30 40-50 < 100
running
seconds seconds seconds seconds seconds seconds seconds
time
Push-ups 2 1 0 5 4 3 2
Knowledge
of healthy Poor Good
foods

The BMI for the children is calculated based on the range given by Canadian Dietitian
Organization. From that chart, below 85th percentile is considered healthy weight, 85th-95th
percentile is overweight, 97th-99.9th percentile is obese and more than that is severe obesity.
Before the study, 3 of the students are overweight, 12 are obese and 5 of the students are
extremely obese. Physical test to evaluate their fitness were conducted, they are 100m running
and push-ups. On average students in overweight category ran 100 m distance within 35 seconds,
followed by 70 seconds for obese group and 110 seconds for extreme obese group. Overweight
students did 2 pushups while students in obese group did 1 pus-up on average. Students in
extreme obese group were unable to do any pus-ups. Before the study all of the respondents
show very poor knowledge of healthy eating. Post-test reveals that 4 of the total respondents are
now in healthy weight group followed by 9 students in overweight group, 3 in obese group and 4
are extremely obese. Students in healthy weight group can sprint 100m in less than 20 seconds

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on average. Overweighed students finish the 100m run in between 20-30 seconds on average
followed by obese students within 40-50 seconds while extremely obese students managed to
finish the run in less than 100 seconds. 5 of the students of healthy weight can do 5 push-ups,
overweight students can do 4 push-ups on average followed by 3 for obese group and 2 for
extreme obese group. Post study shows that all the 20 participants shows good knowledge of
healthy eating on average.

2.2 DISCUSSION

Before the study conducted, the selected students are overweight, obese and extremely
obese. All of them have poor eating habits and sedentary lifestyle. Major factor for these
scenario are because, all of their parents are working and they seldom eat at home. The students
also show poor knowledge of healthy eating habits. Almost all of them prefer fast foods and
carbonate drinks as their favorites. Their sedentary lifestyle is shown in their inability to perform
physical test at optimum level. All of them scored below average. Apart from that, students in
extreme obese group have health complications such as diabetes, asthma and limited mobility.
This hinders them from performing better during physical examination.

After lecture about healthy living for them in school, it can be assumed that they are
beginning to aware of the danger of obesity and healthy living. Students now prefer fruits and
vegetables to be included in their meals. And they also begin to gradually limit intake of fast
foods and sugary drinks. Their parents also cooperate in realising this program. Students
beginning to lose weight. It can be seen in BMI findings after the study. 4 out of 20 students are
now in healthy weight category. Overweight students are increased from 3 to 9. But obese
students dramatically reduced to from 12. 4 students still remain in extreme obese category as it
may require more advanced intervention to reduce their weight. Their overall fitness levels also
increased. This shows the intervention carried out is working. Everyday the selected students
required to do exercise ranging from light to medium difficulty. At the final stage of the study,
the students shows dramatic improvement considering their long sedentary lifestyle, this includes
extreme obese students. Although their results are still lower than average, it shows improvement
compared to results obtained before the program conducted.

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3.0 CONCLUSION

3.1 CONCLUSION BASED ON FINDINGS

The Sihat Minda & Badan program targets to improve healthy nutrition practices and
physical activities, as well as to reduce sedentary lifestyles among overweight and obese primary
schoolchildren. It is believed that this nutrition education program could have significant positive
impact on weight status and behavioral intentions of the children. It is anticipated that Sihat
Minda & Badan program could be a pioneer that can be implemented by the government and
private sectors, as well as policy makers in formulating childhood obesity intervention in
Malaysia, particularly. Besides that, this study will provide the much needed information for the
planning and implementation of future childhood obesity intervention programs. We hope it will
be beneficial to researchers, public health professionals and other parties seeking to develop
similar prevention programs.

3.2 RECOMMENDATION

The components of obesity management in children and adolescent recommended in this study
are:

 Reduction of energy intake by dietary modification, and using conventional foods

 Increased energy expenditure by increasing physical activities and decreasing
physical inactivity
 Behaviour modification associated with eating habits and activity pattern
 Involvement of the family in the process of change

Parents also play important role in preventing obesity among children. They are the one that
spend most of time with their children. Busy working should never be an excuse for them to
neglect their children’s health. Parents can:

 Respect the child’s appetite: children do not need to finish every bottle or meal
 Avoid pre-prepared and sugared foods when possible
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 Limit the amount of high calorie foods kept in the home
 Provide a healthy diet, with 30 percent or fewer calories derived from fat
 Provide ample fiber in the child’s diet
 Do not provide food for comfort or as a reward
 Do not offer sweets in exchange for a finished meal
 Limit hours of television viewing and computer games
 Encourage active play
 Establish regular family activities such as walks, ball games and other outdoor activities

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REFERENCE

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of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the
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Wabitsch, M., Moss, A. & Kromeyer-Hauschild, K. (2014). Unexpected plateauing of childhood

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Poh, B.K., Ng, B.K., Haslinda (2013). Nutritional status and dietary intakes of children aged 6
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Bray, G.A. & Bouchard, C. (2014). Handbook of Obesity: Epidemiology, Etiology and
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Li, L., de Moira, A.P. & Power, C. (2011). Predicting cardiovascular disease risk factors in mid-
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Wee, B.S, A. Ismail, M.N. Ruzita, (2011). Risk of metabolic syndrome among children living in
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Ang, y.N., Wee, B.S., (2013). Multifactorial influences of childhood obesity. Current Obesity
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Lee, S.T., Wong, J.E., (2015). Daily physical activity and screen time, but not other sedentary
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Kirk, S., Scott, B.J. & Daniels, S.R. (2005). Pediatric obesity epidemic: treatment options.
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