Chapter 3

METHODOLOGY

Study Setting : The present study was conducted in Raheemia Public School Bijnor City.

Period of study : Oct 2019 – Feb 2020

Study population : Students enrolled in Raheemia Public School of Bijnor City.

Sample frame : Selected students of Raheemia Public School Bijnor City.

Sample size : 50

Ethical consideration : Study was intiated after obtaining approval from the school
authority of Raheemia Public School of Bijnor City.

Inclusion criteria : Students of Raheemia Public School Bijnor City.

Exclusion criteria :

a. Study subjects who did not give consent to participate.

b. Childern who were not available in the school during two visits.
 Collection of data :

The present study was conducted in Raheemia Public School of Bijnor City from oct 2019 to
Feb 2020 students enrolled in 8th 10 th
standard of Raheemia Public School of Bijnor City
available at the time of study were included as study subjects.
The purpose of the study was explained and oral consent was obtained from the participants
before enrolling them in the study. A pretested semi structured questionnaire was used to
elicit the information of family characteristics and individual characteristics. The
questionnaire had four sections.

1. General information.
2. Physical activity
3. Dietary history
4. Examination

Clinical examination and anthropometric measurements of height, weight, waist and hip
circumference were taken using standard equipments (stadiometer weighing machine and
non-stretchable measuring tape respectively) to calculate Body mass index (BMI) and
Central obesity (waist-hip ratio). All the instruments used for the study were calibrated
daily. The anthropometric measurements were taken by the investigator. The data was
recorded n the questionnaire under the fourth section 'Examination' which was filled by a
team of interns. Interns were adequately trained before conducting the study. Two visits
were made to school to ensure complete coverage.

Heath education regarding the risk factors for overweight / obesity and other non-
communicable diseases and the preventive measures for these were given at the end of
filling the questionnaire and examination. Hand notes related to healthy habits about diet,
physical activity were distributed to students.
Study instruments: Questionnaire and Physical instruments.

Questionnaire

A pretested semi structured questionnaire was used to get information from the study
population. The variables studied included details regarding socio-demographic factors,
family history, physical activity, dietary history and anthropometric measurements like
weight, height, waist circumference and hip circumference.

Physical instruments

 Weight machine – Weight was recorded with bathroom scale weighing machine.
 Measuring Tape – Non stretchable measuring tape was used to measure waist and hip
circumference.
Measurement of height:

The height was measured with stadiometer. Subjects were made to stand barefoot on the flat
surface with weight distributed evenly on both feet and heels together, and the head
positioned so that the line of vision is perpendicular to the body (Frankfurt line). The arms
were hung freely by the sides, the head, back, buttocks, and heels in contact with the vertical
board. The individual was asked to inhale deeply and maintain a fully erect position. The
movable headboard was brought onto the topmost point on the head with sufficient pressure
to compress the hair. The height was recorded to the nearest 0.1 cm.
Measurement of weight:

The weight was measured in kilograms using standardized bathroom weighing machine with
the subject standing erect on centre of the platform, with the body weight evenly distributed
between both the feet with light clothing and looking straight. The same machine was used
throughout the study and was calibrated every day before using it. The weight was recorded
to the nearest 0.5 kg.
Measurement of waist circumference:

The subject was made to stand comfortably with his or her weight i evenly distributed on
both feet placed about 25-30 cm apart. The measurement was done at a level of midpoint
between the top of the iliac crest and the lower margin of the last palpable rib in the mid
axillary line. Measurements were taken with a non-stretchable tape that was wrapped
snugly around the subject, but not to the point that the tape was constricting. The tape
level was kept parallel to the floor at the point of measurement. The circumference was
measured to the nearest 0.1 cm at the end of normal expiration.

Measurement of Hip circumference:

The subject was made to stand comfortably with his or her weight evenly distributed on
both feet placed about 25-30 cm apart. The measurement was taken with a non-
stretchable tape that was held firmly around the point with the maximum circumference
over the buttocks but not to the point that the tape was constricting, ensuring its horizontal
position. 'The circumference was measured to the nearest 0.1 cm.

Body Mass Index (BMI)

It is also called Quetelet's index. It is used to assess obesity and is computed by weight in
kilograms divided by height in meters square. The classification is made according t0
proposed WHO Asia-Pacific guidelines. The cut off values for overweight and obesity
was obtained from WHO growth chart for 5-19 years age group. These values are
equivalent to the overweight cut-off for adults.
Case definition: According to WHO Asia-Pacific guidelines a subject is considered as
overweight if the BMI is >23 Kg/m2 and obese if the BMI is >25 Kg/m2.

BMI Categories

<18.5 Underweight

18.5 - 22.9 Normal Range

23 – 24.9 Overweight

25 – 29.9 Obese – I

> 30 Obese - II

Operational definitions

 Age: A completed year of the child on the date of examination.

 Illiterate: A person who cannot read and write in his/her language.
 Primary schooling: One who has studied up to 7" standard.
 High schooling: One who has studied up to 10 standard.
 Degree: One who has Obtained a undergraduate or post graduate degree and
above.
 Socio- economic status: All individuals were classified into various socio-
economic class according to Modified B. G. Prasad's classification 2013
 Nuclear family: Family consisting of married couples and their children while
they are still regarded as dependents.
  Joint family: Family in which number of married couples live together in same
household. All men are related by blood and property held in common.
 Definition of Obesity: Study subjects were categorized based on BMI category:
obese (>25 kg/m2), overweight (>23 kg/m2), Normal (18.5-22.9 kg/m2) and
Underweight (<18.5 kg/m2) using WHO Asia-Pacific guidelines.
 Urban area: A place satisfying the following 3 criteria: a minimum of 5000
population, at least 75% of male working population engaged in non-agricultural
pursuits and a density of population of at least 400 per sq km.
 Rural area: Those areas which do not fulfil the criteria for urban area.

Statistical analysis: Descriptive statistics like frequency, percentages, average

RECOMMENDATION

Based on the current study and search from the previous literature, we recommend regular
class hours on healthy food habits, nutritive values of different food items, lifestyle and
behavioural modification. Every student should be motivated to take part in outdoor games
and sports, irrespective of gender. The children as well l as parents should be advised about
obesity problems. Further, it is imperative that the government should take initiative and
adopt measures to restrict advertisements and availability of fast food which are poor in
nutritive quality.