Presenting Author : Tripti Saxena Research Guide : Prof. Shubhada Kanani Department of Foods and Nutrition M.S. University Vadodara Gujarat

TOWARDS HEALTHY FOOD CHOICES, FITNESS AND MENTAL HEALTH

AMONG WELL TO DO ADOLESCENTS TO REDUCE DUAL BURDEN OF MALNUTRITION

IN SCHOOLS OF URBAN VADODARA

Why the need to study dual burden of malnutrition among well- to do school

adolescents ?

Developing countries: undernutrition and overnutrition among wide sections of the population and in varying socioeconomic environment ( FAO 2006) which lead to adverse consequences (WHO 2005).

Despite the reported high prevalence of undernutrition among well to do school adolescents, most of the interventions in India deal with adolescent obesity/overweight.

There are gaps in our knowledge regarding determinants of over & under nutrition among well to do adolescents.

Saxena & Kanani 2008

OBJECTIVES• To assess the prevalence of dual burden of malnutrition among well to do urban school adolescents of Vadodara in terms of height, weight and waist circumference

• To understand the determinants of dual burden of malnutrition as regards: food choices, fitness/ physical activity patterns and stress coping abilities

• To study the school environment : teachers’ & principals’ views as regards adolescents food choices,fitness/physical activities and stress coping abilities

• To study the home environment: parents’ views as regards adolescents food choices, fitness/ physical activities and stress coping abilities Saxena & Kanani 2008

STUDY DESIGNPurposive selection of urban schools (N=6)

Teachers (N=40) Principals (N=6)Perceptions foradolescent’s• Food choices• Physical activities• Stress coping

ChildrenChildren• Ht. ,Wt. & W.C (1105)• Food patterns & P.A. (N=454)• Stress coping abilities(N=335)

Data collection

Schools (N=6)Enablingfactors

&Meals at School canteen

Random Sample selection: Children from std. VIII & IX (N=1105)

Parents (N=40)(from PTA)

Perceptions for adolescent’s Food choices

Physical activity Stress

Classifying the children based on nutritional status (WHO 2007 standards)

Normal Overweight and Obese Thin

Data was separated genderwise and agewise for analysis

Cross tabulations: 3 categories by BMI with Food patterns, physical activities and

stress coping

Saxena & Kanani 2008

Quality of data was ensured !Quality of data was ensured !

One to one interviews with One to one interviews with principals and teachersprincipals and teachers

Principals of selected schools

Teachers of selected schools

Kanani & Saxena 2007 KANANI & SAXENA 2007

THE RESULTS

THE PREVALENCE OF DUAL BURDEN

OF MALNUTRITION

•Overall: Thinness was more than Ov-Ob

2 1

6 4 . 8

1 4 . 1

2 4

6 2 . 3

1 3 . 71 6 . 5

6 8 . 8

1 4 . 7

0

1 0

2 0

3 0

4 0

5 0

6 0

7 0

% A

DO

LE

SC

EN

TS

T o t a l B o y s G i r l s

P r e v a l e n c e b y B M I

T H I NN O R M A LO v - O b

• Thinness was more in boys than girls• Ov- Ob was similar in boys and girls

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•Tallness was more in boys

1 2 . 2

8 7 . 1

0 . 71 4 . 5

8 4 . 5

1 . 18 . 8

9 0 . 9

0 . 20

2 0

4 0

6 0

8 0

1 0 0

%A

DO

LE

SC

EN

TS

T o t a l B o y s G i r l s

P r e v a le n c e b y H e ig h t f o r a g e

S t u n t e dN o r m a lT a l l

• Prevalence of stunting was low•Twice the number of boys were stunted

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THE CHANGING TRENDS IN DUAL BURDEN OF MALNUTRITION BY AGE

01 02 03 04 05 06 07 08 09 0

%A

do

les

ce

nts

1 2 -1 2 . 4

1 3 -1 3 . 4

1 4 -1 4 . 4

1 5 -1 5 . 4

A g e ( y e a r s )

T H I NN O R M A LO v - O b

Saxena &Kanani 2008

FOOD PATTERNS AND

FOOD CHOICES

3 meals & 3 snacks pattern: 10% adolescents Twice more girls(14%) than boys(7%)

Breakfast Consumption: Daily by Majority (70%) Similar in boys & girls

Quality of breakfast: Poor by majority Milk, cereals & fruits by 3% Similar in boys and girls

Snacking on Processed Packed munching snacks by 31% (e.g. Kurkure, Chips, biscuits, chocolates ) and Snack intake was most common during school hours by 50%

Intake of fruits at least once in a day : 10% adolescents

General Food Patterns

Saxena &Kanani 2008

General Food Patterns………Intake of vegetables at least once in a day : 90% adolescents

Food frequency of vegetables Roots and tuber : Daily :Boys (30- 40)% :Girls (30- 40)% GLVS : 2-3times :Boys (26-

27)%(Spinach & fenugreek ) :Girls (21-

29)%Amaranth & colocasia : Rarely :Boys

(25- 33)% :Girls (28- 41)% ‘Other’ vegetables : Rarely :Boys (23- 44)%(Yellow Pumpkin, bitter gourd, Bottle gourd, french beans, Cowpeas, capsicum, Clusterbeans )

:Girls (21- 57)%

Saxena & Kanani 2008

Intake of Healthy Foods

Daily Milk Intake :

Less frequent intake of Probiotics

Curd : 2-3 times/wk :

Lassi and Shrikhand : Monthly once :

Boys: 82%Girls: 75%

Boys: 31%Girls: 32%Boys: 47%Girls: 47%

Food frequency of milk and milk products

Food frequency of iron rich foods• Dried Peas and Bajra : 2 -3 times/ wk Rajmah, Dried cowpeas, green onions : Rarely Moth beans, Colocasia leaves (Monthly once or Never)

Boys: 20- 30% Girls : 20- 30%

Boys: 20- 30% Girls : 20- 30%

Saxena &Kanani 2008

School tiffins: Not brought by more than half (54%), more boys(66%) than

girls(38%)

Types of food brought in school tiffins 30% :Traditional fried foods( puri, pakoda, parantha) 27% :Ready to eat/ convenience food (biscuits, maggie,

wafers)

6% :Traditional fermented foods(dhokla, muthia, khaman )

12% :Whole some meals ( pulav, dal-chawal, chana, roti sabji)

DeterioratingFood patterns in

schools

HIGH

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School canteens: 54% : More than half eat in school canteens 33% : Common frequency: 2-3 times/week Purchases from school canteen: 34% :Processed and packed munching snacks 31% :Puff 17.4% : Samosa

By chi-square no significant association of the undesirable food patterns with BMI was seen (Thin, normal, Ov-Ob).

DeterioratingFood patterns in schools…………..

HIGH

Saxena & Kanani 2008

Exercise/Play And

Fitness Patterns

Salient findings• 30% :daily engagement in vigorous play/ exercise (such that they breathe rapidly or start sweating)

• Spot observations : Decreased participation in school exercise/ play, more in girls than boys : Decreased participation in mass drill in schools• Parents : 4hrs/ day involvement in sedentary behaviors (T.V. watching, video games, computer) •Teachers & principal : Escape from exercise but like to play. Interested in learning yoga but not do it regularly

Conclusion: Over reporting of physical activity by adolescents since in reality, adolescents are physically inactive

Dual burden of malnutrition in relation to exercise/play and

fitness

By chi-square : Significantly higher proportion of adolescents who

were involved in outdoor games had normal BMI (66%).

More Ov-Ob adolescents (21%) played indoor games

Boys: Similar trends Girls: By chi- square no significant differences in

various BMI categories (Thin, normal, Ov-Ob) Saxena & Kanani 2008

Stress Coping Abilities

Categories of stress coping abilityTotal (N = 355) High stress

coping ability (>=70% scores)

Low stress coping ability(< 70%scores)

r Value

n % n %1 Nutrition** 86 24.2 269 75.8 1vs 5 0.4

2 Exercise-Fitness** 92 25.9 263 74.1 1vs 5 0.53 Mental health** 203 57.2 152 42.8 1vs 5 0.94 Art of relaxation** 159 44.8 196 55.2 1vs 5 0.75 Overall stress coping 158 44.5 197 55.5 1vs 5

Out of the 4 aspects studied which contributed Out of the 4 aspects studied which contributed to overall stress coping ability?to overall stress coping ability?

Correlation was significant at p <= o.o1 Saxena & Kanani 2008

Dual burden of malnutrition in relation to stress coping ability

Higher proportion of adolescents with normal BMI ( 11%) had ‘very good’ stress coping compared to thin(7%) or Ov-Ob( 4%)

‘Problem behaviours’ Poor food choices/ food practices were seen among stressed adolescents whether thin/ Ov-Ob Irregular exercise- fitness patterns were seen among stressed adolescents whether thin/ Ov-Ob, more so in girls than boys Saxena & Kanani 2008

Reasons for stress by principals and teachers: Increased competition, search of their identity No time to relax : Tution- an unnecessary stressor Parents’ expectation to obtain more marks Lengthy syllabus Parents are busy: children cannot share their problems

Views of Teachers and Parents regarding Views of Teachers and Parents regarding stress among adolescentsstress among adolescents

82% parents reported that Adolescents are

not stressed Saxena & Kanani 2008

Home Environment

School Environment: School canteens

Cyclic Menu signed by principal

Dal Rice

School lunch offered wholesome healthy food with variety in diet

Pulav

Integrated approach including : Adolescents The school environment Teachers Parents……. …….will result in holistic nutrition interventions

to reduce dual burden among well to do adolescents .

Conclusion

Saxena & Kanani 2008

Unified interventions for underweight and Overweight :

Nutrition friendly schools initiative

Recommendations

Unified interventions for controlling both underweight and Overweight :

Nutrition friendly schools initiative

Over- and undernutition are not simply a problem of rich or poor,

respectively. On the contrary, often these problems overlap

and coexist. Currently, strategies to tackle

this dual burden of malnutrition are often

pursued and promoted independently, as if

the two problems were independent of each other. This

will need to change, and policies and programs

developed that address both issues in an integrated

manner.

Mercedes de Onis( WHO)

Saxena & Kanani 2008