Chapter 1 Introduction to the Study

Background of the Study Obesity is not just the mere outrageous physical problem of a person who has it, but it is a concern that must be talked about because it can predispose and precipitate a more serious, and probably life-threatening, disease. Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. Once considered a problem only in high income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings (http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/, 2010) Previous studies have reported regarding several factors that can contribute to obesity and overweight, such as, lifestyle choices (e.g., lack of exercise), medical conditions (e.g., hypothyroidism), and genetics (e.g, heredity). When a person takes in more calories than he or she uses, overweight may result; and if not intervened, it may lead to obesity. These excess calories are stored in the body as fat, and unless weight-control strategies are put into place, more and more weight is gained (Larson and Swierzewski, 2006). According to Dr. Mia C. Fojas report obesity was not a problem five decades ago. In this 21st century however, systematic studies by the World Health Organization (WHO) predict that there will be 2.3 billion overweight adults

worldwide by 2015, and more than 700 million of them will be obese. Way back 2003,with the use of non-adjusted BMI guidelines for Asians, the WHO Global Databas on BMI reported that the Philippines has a rate of 23.5% overweight and obese population with the female adults having higher obesity prevalence rates than male adults. However, in 2003 the Philippine National Nutritional Health Evaluation and Survey showed that there are 19.6% overweight and 4.9% obese Filipinos, indicating that there is certainly an increase in the rate of obesity in the country. (http://www.obesity.org.ph/?p=article2-wellness, 2008) With the advocacy of the Philippine Association for the Study of Overweight and Obesity (PASOO), the First Wellness Summit entitled Bawas Timbang, Dagdag Buhay (Lose Weight, Gain Life) was held at the SM Megatrade Hall dated on August 29, 2007. A total gathered data of 187, 31% of whom were males, and 12 (6%) of whom were from pediatric age group (<18 years old). More than half were overweight based on body mass index of 24kg/m2. Among the males, only 8% were obese based on waist circumference of >90 cm, while among females, 32% had a waist circumference of >80 cm. Waist:Hip ratio was 0.9 among males, and 0.8 among females. Mean random blood glucose was above normal at 162 mg/dL, meaning most of the respondents were either insulin resistant or poorly controlled diabetics. Mean blood pressure was normal. More than half of the respondents learned that they were obese with cardiovascular risk factors. Only 87 (45%), however specified the specific disease, 26% of whom wrote down diabetes and hypertension (Fojas, 2008). In addition, even children may also have increased blood

pressure, heart rate and cardiac output, type 2 diabetes, sleep apnea, and hyperlipidemia and other health problems; obese children have an 85% chance of becoming obese adults if they are obese after the age of 10 (Huang, 2008) This research study described the eating behaviors and lifestyle factors of identified obese students of Xavier University Main Campus. To point out, eating behaviors included binge eating, eating when stressed out, and skipping meals while lifestyle factors will only include activity level, alcohol consumption, and smoking habits. Therefore, the study attempted to portray the relationship of eating behaviors and lifestyle factors to obesity among selected respondents.

Conceptual Framework People are becoming obese nowadays for a number of reasons. Among these are: consumption of too much calories, living a sedentary lifestyle, emotional disturbances, eating habits, smoking. In line with this, the primary result of being obese is an alteration in body image, and a potential damage to a persons self esteem. One of the identified factors contributing to obesity is binge eating. Eating disorders and obesity are usually seen as very different problems but actually share many similarities. Body dissatisfaction and unhealthy dieting practices are linked to the development of eating disorders, obesity, and other problems. Binge eating is common among people with eating disorders and people who are obese (http://www.athealth.com/consumer/disorders/obesityeatingdis.html, 2008). Binge eaters can consume a very large number of calories in one meal. While some

binges consist of a normal amount of food, as much as 20,000 calories may be consumed at a time. Constant episodes of compulsive overeating may lead to a person becoming overweight or even obese (http://www.casapalmera.com/ articles/compulsive-overeating-and-eating-disorder-treatment/, 2009). The major complications of binge eating disorder are the diseases that accompany obesity. These include diabetes, high blood pressure, high cholesterol levels, gallbladder disease, heart disease, and certain types of cancer. People with binge eating disorder are extremely distressed by their binge eating. Obese people with binge eating disorder often feel bad about themselves, are preoccupied with their appearance, and may avoid social gatherings. Most feel ashamed and try to hide their problem. Often they are so successful that close family members and friends don't know they binge eat (http://www.athealth.com/Consumer/disorders /Bingeeating.html, 2009). Another identified risk factor is skipping meals. Skipping meals is perhaps the most common reason for people to get hungry. The meals most likely to be skipped are breakfast and lunch, resulting in the evening binge. Skipping meals leads to low blood sugar. This can cause sudden hunger pangs which can cause bingeing and/or food cravings (http://www.annecollins.com/dieting/skippingmeals.htm, 2009). In a recent study, researchers found that skipping meals during the day and eating one large meal in the evening resulted in potentially risky metabolic changes. The meal skippers had elevated fasting glucose levels and a delayed insulin response conditions that, if they persisted long term, could lead to diabetes (Pope, 2010).

Moreover, emotional eating has also been identified as a factor leading to obesity. Emotional eating is when people use food as a way to deal with feelings instead of other means to satisfy hunger. (http://kidshealth.org/teen/ diseases _conditions/obesity/emotional_eating.html, 2010). Many people turn to food for comfort when facing a difficult problem, alleviating boredom and stress, or suppressing or soothing difficult emotions, such as anger, anxiety, sadness, helplessness and loneliness. Emotional eaters keep their compulsive eating a secret from others although it can take place in a variety of circumstances. Some people eat when they are home alone or get up in the middle of the night to eat. The compulsion to eat is intense and the need to perform the behavior so compelling that if they are not able to do it they experience both real physical and emotional pain (http://annedranitsaris.com/eating_article.html, 2009). It is commonly believed that some people overeat because of depression, hopelessness, anger, boredom, and many other reasons that have nothing to do with hunger. It is always not necessary that overweight and obese people have more emotional problems than other people. (http://obesity.ygoy.com/ emotional-causes-of-obesity/, 2009). Also, a persons alcohol consumption may predispose him / her to being obese. The body mass index (BMI) of individuals who drink alcohol may be related to how much, and how often, they drink. Alcohol is a significant source of calories, and drinking may stimulate eating, particularly in social settings (http://alcoholism.about.com/od/health/a/blniaaa050222.htm, 2005). People who consume too much alcohol have good chance of making it to the obesity chart.

Pure alcohol contains 7 calories per gram. And if that is complimented with excessive drinking, it wont take much time before you find yourself in a severe life threatening problem of obesity (http://www.buzzle.com/editorials/8-26-200575508.asp, 2010). Furthermore, physical activity has also been identified to be one of the factors leading to obesity. It can be thought of that the lesser physical activity a person is able to perform, he / she is at a greater risk to develop metabolic disorders, and ultimately, obesity (http://www.eurekalert.org/pub_releases/200204/ajoc-dpa041902.php, 2009). Also, smoking has been correlated with obesity. This claim is due to the possibility that the influence of nicotine or other cigarette components may predispose a person to having a highly oxidative metabolism, leading to malabsorption, and ultimately, to obesity. Statement of the Problem This study described the eating behaviors and lifestyle factors of selected respondents of Xavier University Main Campus and described its implication to health and wellness. Figure 1 illustrates the relationship between the two factors:

Independent Variables Eating Behaviors Skipping meals Binge Eating Emotional Eating

Dependent Variable

Lifestyle Factors Activity Level Alcohol Consumption Smoking Habits

Classes of Obesity Class I Class II Class III

Figure 1. Relationship between Eating Behaviors and Lifestyle Factors with the Classes of Obesity

Specifically, this study aimed to answer the following questions: 1. What is the profile of the respondents in terms of: 1.1 age; 1.2 sex; 1.3 civil status? 2. What are the eating behaviors of the respondents in terms of: 2.1 skipping meals;

2.2 binge eating; 2.3 emotional eating? 3. What are the lifestyle factors of the respondents in terms of: 3.1 activity level; 3.2 alcohol consumption; 3.3 smoking habits? 4. What class of obesity, as to the Body Mass Index, do respondents belong? 5. Is there a significant relationship between eating behaviors and lifestyle factors when respondents are grouped as to profile? 6. Is there a significant relationship between the eating behaviors and lifestyle factors of the respondents and their classes of obesity as to the BMI? 7. Is there a significant relationship between the class of BMI, eating behaviors and lifestyle factors when grouped according to profile? Hypotheses 1. There is no significant relationship between eating behaviors and lifestyle factors when respondents are grouped as to profile. 2. There is no significant relationship between the eating behaviors and lifestyle factors of the respondents and their classes of obesity as to the BMI. 3. There is no significant relationship between the class of BMI, eating behaviors and lifestyle factors when grouped according to profile?

Significance of the Study This study described the specific factors that may have predisposed the respondents to obesity. This study is expected to be beneficial to the following: To the nursing students, that they may be able to include the inputs of this study as part of their health teachings to their clients. To the clinical instructors, that they may include the results of this study as part of their discussions, lectures and other forms of enhancement activities during classes and duties to their students. To the members of the health care team- the physicians who have obese, overweight and non-obese clients in their care, that they may be able to impart as health teachings the varying factors which influence the levels of obesity so as to prevent the incidence of obesity as well as progression to a higher level of obesity. To the nutritionists, that they may be able to disseminate updated and valuable information regarding the relationship between eating habits, lifestyle factors and the classes of obesity. To the personal training/exercise instructors, that they may know what kind of activity level will they recommend to the obese and non-obese clients so as to halt the progression to a higher obesity level or decrease its incidence. To the respondents of this study, they may be able to be in full awareness of the possible factors that had generally affected them and, in turn, be able to

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avoid further use as a step towards achieving a good state of health and wellbeing. To the students of Xavier University Ateneo de Cagayan Main Campus that they may be informed of the numerous possible risk factors for obesity. By being knowledgeable of these risk factors, the non-obese population may be able to avoid the development of obesity. Furthermore, this descriptive study may provide future researchers with ideas, facts and information on the factors that influence obesity so they may use it in their studies in the event that they may want to pursue a similar but more in depth study.

Scope and Limitations This descriptive correlational study described the eating behaviors and lifestyle factors of selected male and female obese of Xavier University Ateneo de Cagayan Main Campus. The Body Mass Index (BMI) of the respondents were obtained to identify their corresponding class of obesity. The weighing scale and height chart at the university clinic were used as instruments in taking the weight and height of the respondents. In this study, the BMI was the sole description for the identification of the obesity state of the respondents. Criteria for inclusion of respondents included the following: a bona fide student of the College of Nursing of Xavier University enrolled at XU Main Campus, diagnosed by a physician and/ or is an obese basing on his/ her BMI as taken by the researchers, must be at least 18 to 45 years of age and has no

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other known medical condition that may have a distinct relationship with obesity as verbally spoken by the respondent. Furthermore, whether or not the respondents were honest in their response/s, other medical conditions and previous diagnosis of the respondents and underlying conditions not mentioned were considered to be the limitation of the study. This study was conducted from March 2010, upon the approval of the Research Proposal, to December 2010.

Definition of Terms: Eating Behaviors These are behavioral responses or sequences associated with eating including modes of feeding, rhythmic patterns of eating, and time intervals. (http://www.find-health-articles.com/msh-feedingbehavior.htm, 2010). In this study, this pertain to the eating habits which are manifested or done by the respondents that have an influence on obesity particularly skipping meals, binge eating and emotional eating. Skipping Meals These are a behavioral response that involve missing out on one or more of the common meals taken in a day, whether it be breakfast, lunch, and/ or dinner. (http://www.annecollins.com/dieting/skippingmeals.htm, 2009)

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In this study, this pertains to whether or not the respondents are missing out on one or more than one meal (breakfast, lunch and/or dinner) in a day. Binge Eating This is a behavioral response where one consumes a very large number of calories in one meal, and wherein as much as 20,000 calories may be consumed at a time. (http://www.casapalmera.com/articles/ compulsive-overeating-and-eating-disorder-treatment/, 2009). In this study, it refers to whether or not the respondent is not able to control eating more than the usual portion of food in one sitting. Eating when Stressed or Emotional Eating This is a behavioral response when people use food as a way to deal with feelings instead of other means to satisfy hunger. (http://kidshealth.org/teen/diseases_conditions/obesity/ emotional_eating.html, 2010) In this study, it refers to whether or not the respondents consumption of food is done to relieve stress and anxiety. Lifestyle Factors This refers to a bundle of behaviors that make sense to both others and oneself in time and place, including social relations, consumption and entertainment. (http://www.mypersonalimprovement.com/definition oflifestyle.html, 2009) In this study, this pertains to practices or habits of the respondent that contribute or have an influence on obesity such as: Activity Level This refers to the amount of physical activity that a person undertakes each day which is used in calculating their daily requirements.

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(http://www.sports medicinedictionary.com/definition/physical-activitylevel.html, 2009) In this study, it pertains to the number of hours multiplied to the number of times a respondent exercises in a week. Alcohol Consumption This refers to drinking beverages containing ethyl alcohol. (http://www. britannica.com/EBchecked/topic/13398/alcoholconsumption, 2008) In this study, it pertains to the number of bottles of alcoholic beverages the respondent can consume in a week. Smoking Habits These are practices wherein a substance, most commonly tobacco, is burned and the smoke is tasted or inhaled. (http://www.britannica.com/ EBchecked/topic/13398/alcohol-consumption, 2008) In this study, this pertains to the number of sticks a respondent can consume in a week.