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Promoting Healthy Diet Through Peer Nutrition Counseling Posyandu Remaja

in Semarang City, Central Java, Indonesia

Article in Journal of Computational and Theoretical Nanoscience · April 2017

DOI: 10.1166/asl.2017.9117

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(2017) Advanced Science Letters, 23 (4), pp. 3424-3426. DOI: 10.1166/asl.2017.9117

Promoting Healthy Diet through Peer Nutrition Counseling

At Posyandu Remaja (Integrated Health Services of Adolescents)

Etika Ratna Noer 1*, Fillah Fithra Dieny2, Binar Panunggal 3

1,2,3
Department of Nutrition Science, Medical Faculty of Diponegoro University, Indonesia
1
email: etika.ratna.noer@gmail.com
2
email: fillahdieny@gmail.com
3
email : panunggalbinar@gmail.com

Abstract
Background: The increasing prevalence of obesity in adolescents contribute to chronic diseases both
developed and developing countries . Imbalance diet and physical activity will become obese.
Adolescents are very closely tied to the their peers, so it has a major influence on the behavior of
adolescents, especially in the selection of food. Peer group influence is stronger effect than the
parents. Closeness, openess is an opportunity to facilitate peer nutrition counseling. This study aimed
to identify the effectiveness of the nutrition peer counseling.
Method: Non randomized pre-post test control group design involving 30 adolescent at Porter’s
Posyandu Remaja as control group and Rosella’s Posyandu Remaja as intervention group. Nutrition
peer counseling was given in 6 times for 4 weeks. Peer counselors were selected and given training
before doing the counseling to the subjects. Dietary intake was measured by food recall 3x24 hours.
Data were analyzed with Mann-Whitney and Wilcoxon test.
Results: There was a significant difference between total energy, saturated fat, fiber, and natrium
intake before and after treatment (p<0.05). There was no a significant difference (p>0,05) in
physical activity before and after treatment for each group.
Conclusion: Nutrition peer counseling had an effect in the reduction of total energy, saturated fat,
natrium and increase fiber intake but it was not effectively increase physical activity in obese
adolescent 15-17 years old.
Keywords: adolescent, peer, nutrition counseling, posyandu remaja

1. INTRODUCTION
Obesity is a problem that occurs worldwide and
its prevalence has increased in both the
developed and developing countries.1 The
increasing prevalence of obesity in adolescents
contributes to chronic diseases. Obesity
becomes an important problem that should be
solved. It is because obesity has a bad effect for
healthiness or psychology. Cardiovascular,
diabetes and atherosclerosis are some of
degenerative disease which is caused by
obesity. Adolescence is marked as a crucial risk
period for the development of obesity and its
related consequences, tackling obesity at the
threshold of adulthood is critical 2
Obesity is commonly happen and it relates
to the unbalance of food provisions and the
output of the energy in the body. Obesity
adolescent has high provision of carbohydrate
and animal fat but low provisions of fruits and
vegetables.3
The behavior of eating is mostly affected
by their friends than their parents. Peer-group
counseling is a chance relates to the openness,
relation and same feeling as adolescent.
To target nutrition in adolescents, it has been
suggested that interventions have a behavioral
focus and use peer nutrition counseling. One of
the efforts of conducting the peer-group
counseling is by the implementation of
Posyandu Remaja (Integrated Health Services
of Adolescents).
2. METHOD
The study was conducted in IHSA of Senior
High School 1 and 2 Semarang from March to
August 2016. Non randomized pre-post test
control group design is used as a research
design. The independent variables is a peer
nutrition counseling about healthy eating. The
dependent variable in this research is the diet
quality of physical activity.
The population in this study were the
students of first grade class (class X) who met
the inclusion criteria. The inclusion criteria
used were adolescents aged 15-18 years who
are obese are marked with a BMI ≥ 95th
percentile of IMT/ U chart. The population who
meet the inclusion criteria of 30 boys and girls
are used as research subjects. The intervention
will involve peer nutritional counseling. The
control group was given leaflets and booklets.
Data on diet quality using the Healthy Eating
Index 2010, while physical activity using the
International Physical Activity Questionnary
(IPAQ). Food intake data is obtained through
interviews, by using a semiquantitative Food
Frequency Questionnary (FFQ). To test the
difference between the treatment group and
control (leaflets and booklets) the test used is
independent T test and Man Whitney. To test
the difference between before and after the
intervention used the Wilcoxon in each group
3. RESULT
The results of the screening in class X, it is
found that the prevalence of obesity in both
areas (SMA 1 and SMA 2 Semarang) by 21%.
With the 30 students who obese are willing to
participate in this study,proportion boys and
girls in equal numbers. In table 1 shows that in
both groups (control-intervention) have a high
dietary intake of energy, fat and low in fiber
and less physical activity (sedentary).

Table 1. Baseline characteristic subjects by sex, energy, Fat, fiber Intake and physical activity
Variable Control Intervention
n=15 % n=15 %
Sex
Male 9 (60%) 8 (53%)
Female 6 (40%) 7 (47%)
Fat
Low (≤80% AKG) 6 (40%) 2
(13%)
High (≥100% AKG)
9 (60%) 13 (87%)
Fiber
Low (≤80% AKG) 11 (73%) 9
(60%)
Sufficient (80-100% AKG)
4 (27%) 6 (40%)
Energy intake
Sufficient (80-100% AKG) 6 (40%) 5 (33%)
High (≥100% AKG) 9 (60%) 10
(67%)
Physical activity
Sedentary 10 (67%) 11 (73%)
Moderate 5 (33%) 4
(27%)

Table 2 shows that in the intervention group, and fat intake before and after the intervention
there are the difference between energy, fiber (p<0.05)

Tabel 2. Difference test by energy fiber, and fat intake in control and intervention group
Variable Control Sig Intervention Sig
Mean ± SD (p) Rerata ± SD (p)
Pre Post Pre Post
Energy intake (Kal) 2886,01±733,07 2436,01±925,13 0,07 2636,01±913,24 1836,21±516,12 0,04
Fiber intake (g) 12,23±4,24 13,70±5,49 0,56 10,70±5,25 22,90±6,08 0,02
Fat intake (g) 50,88±1,00 44,13±0,07 0,59 48,88±8,55 25,84±7,03 0,01
Physical activity 1246,33 ± 1234,95 1735,81 ± 2044,57 0,26 1326,63±1497,69 1806,04±1294 0,18
(MET-minute/week)

Table 3 shows that the change in average
energy, fiber and fat intake between before
and after the intervention had significant
difference (p <0.05) between the control and
intervention groups. The average change in
physical activity between before and after the
research there were no significant differences
(p >0.05) between the control and intervention
groups. A decrease in energy and fat intake is
greater in the intervention than the control
group. An increase fiber intake is greater in the
intervention than the control group
 Table 3. Delta Energy, fat, fiber intake and physical activity pre-post intervention between control
and intervention group
Variable
Control
∆ Energy intake (Kal) -450,01±5,21
∆ Fiber intake (g) 1.47,01±0,07
∆ Fat intake (g) -6,75±1,07
∆ Physical activity (MET- 489,48±45,03
minute/week)
4. DISCUSSIONS
The age of the subjects are relatively
homogeneous, ranging from 15-17 years which
were included in the category of middle teens.
The proportion of sex research subject were
equals.
Peer counseling is a form of counseling
assistance given by peers (friends with the
same ages) that have already been trained. In
this study, peer nutritional counseling was
applied as an intervention in adolescent obesity
problems, namely excessive intake of energy,
fat and lacking in fiber intake and low physical
activity. Selection of peer counselor was
motivated by factors of adolescent attachment
with peers. Ordinary, teenage compare themself
with friends in choosing foods. Overweight
adolescents who have friends were overweight
consume more calories than the overweight
adolescents who have friends not overweight.4
Nutritional counseling peers which is
done 6 times was expected to be able to change
eating behavior of adolescents, increasing fiber
intake and decreasing saturated fat. It was
based on previous research, the study by
Prahastuti showed that counseling and peer
education were effective in improving
knowledge and attitudes of girl teenager if
prevention of anemia.5 In this research,
nutritional peer counseling were effective to
reduce energy intake, fat and fiber, yet, it was
not successful to improve physical activity.
The availability and motivation of
parents to provide fruit and vegetables at home
has an important role in the daily fiber
consumption. Availability and access to food
sources of fiber are positively related to the
intake of fiber.4 Most subjects asked the parents
to prepare vegetables and fruit at home after
getting counseling. The subject was also stated
that the fruit juice or fruit soups are common in
the pavement hawkers.
Rerata ± SD
Intervention Sig (p)
-800,21±45,07 0.001*
12,2±5,07 0.001*
-23,45±15,20 0.001*
479,±25,07 0.078
Other factors that affect eating
behavior of adolescents is their role model and
the role of electronic media and masses.
Physical activity is estimated to adolescents
aged 13-17 years spent 4.5 hours watching
television, 2.5 hours listening to the radio, 1.5
hours using the computer, playing video games
1,2, and 18 minutes reading magazines, as well
as technological advances makes almost every
teenager use a gadget now. Figure idol is an
important figure in adolescent eating behavior
change. In the cognitive development of
adolescents, their own thoughts and wishes to
identify themselves according to their figures
idol.
Saturated fats contained in animal
products such as fatty meat, cream, cheese,
butter, and palm oil. Junk food and fast food is
a product of processed foods containing
saturated fats. Both have a delicious flavor that
makes teenagers like to eating them, especially
on weekends. After being given counseling,
adolescent knowledge about foods that contain
saturated fat increases so that adolescents are
more selective in choosing food, in addition,
the teen was able to reduce the intake of food
with high saturated fat content by reducing the
frequency and amount of consumption of these
foods.
Less physical activity and a low quality
diet were contributing factors in the obesity
development. Today's lifestyles change the role
of food, not only as a primary need in the
fulfillment of nutrients needed by the body but
also as a lifestyle. This led to the rapid
development in the construction of fast food
restaurants in urban areas. Fast food restaurants
usually presents a high carbohydrate, high fat,
high sodium and low fiber.
 5. CONCLUSION
Peer counseling of nutritional is one method
that can be used as an effort to raise
awareness in order to change eating behavior
in obese adolescents. The interaction from the
various components of the complex behaviors
cause the behavior change process takes a
6. ACKNOWLEDGMENTS
The Authors would like to acknowledge The
Ministry of Research, Technology and Higher
Education Indonesia for funding of this
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