Obesity has been reported to be a serious public health problem among children

and adolescents across the developed and developing country in recent years
[1]. In the developed country, obesity is the most common disease in children
and adolescents [1]. About 22 million of children worldwide are overweight
[2]. Based on the National Health and Nutrition Examination Survey
(NHANES III and NHANES 1999-2000), the prevalence of overweight among
US adolescents aged 12 to 19 years has increased from 10.5% in 1988-1994 to
15.5% in 1999-2000 [3]. On the contrary, the prevalence of underweight has
decreased from 5.5% in 1970s to 3.3% in 1990s [4]. These studies have
reported a rapid increase in prevalence of overweight and obesity as well as
decrease in prevalence of underweight among adolescents worldwide.
The high prevalence of overweight and obesity should be highlighted as one of
the priority health issues among adolescents, since overweight and obesity
during adolescence tend to persist till adulthood [5]. About 70% to 80% of
obese adolescents remained to be obese during adulthood [6]. In addition,
overweight and obesity are one of the independent risk factors for many noncommunicable chronic diseases [7]. There are several short term and long term
consequences of overweight and obesity in children and adolescents. In shortterm consequences, overweight and obese children and adolescents may
experience behavioral problems, low self-esteem, and clinical conditions such
as asthma, systemic inflammation, type 1 diabetes mellitus and cardiovascular
risk factors [8]. Meanwhile, long term consequences of obesity include adverse
social and economic outcomes, increased cardiovascular risk, diabetes,
hypertension, stroke, some types of cancer and premature mortality in future
adulthood [7,8].
Based on previous studies in western countries, dietary practices of adolescents
include eating large amounts of snack that are high in sugar and fat [9]. The
modern society's life style is increasingly sedentary and this problem has been

observed among adolescents too [10,11]. Adolescents tend to spend most of

their time playing computer games, doing homework and other relevant
activities instead of spending time on exercise and sports [11]. Levels of
physical activity tend to decline among adolescents, and physical inactivity
during adolescence might carry on towards adulthood [12]. Low level of
physical activity and unhealthy dietary practices are found to be predictors of
obesity among adolescents [13]. Furthermore, body image plays an important
role in determination of body weight status, particularly among adolescents
[14]. Adolescents who have negative body image are more likely to practice
dieting behaviors such as skipping meals, use of laxatives and vomiting [15].
Dieting is associated with binge eating behaviors that may lead to obesity
problem among adolescents [16].
Malaysia is also experiencing the similar situation where prevalence of
overweight and obesity among children and adolescents are increasing. The
prevalence of overweight among adolescents has increased from 9.5% in 1997
to 19.6% in 2007 [17,18]. On the other hand, the prevalence of underweight
has decreased from 14.8% in 2004 to 11.4% in 2006 [19,20]. As published
findings were limited, there is a need to determine the obesity-related behaviors
of Malaysian adolescents. Therefore, the present study aims to determine three
obesity-related behaviors that may associate with overweight and obesity
among Malaysian adolescents, namely dietary practices, physical activity and
body image.

Obesity is a medical term with a finite and specific meaning. It means someone
who is 30 pounds or more over their healthy weight. Thats all. Nothing more,
nothing less. But the term has taken on such a tremendous emotional charge,
such a negative connotation, that people naturally resist seeing themselves under
the classification of obesity, and as a result, fail to recognize themselves as being
among risk.
Number Of Obese Growing Bigger

About 50% of 13 million Malaysian adults could be overweight or obese, a

worrying trend that seems to be on the rise. Health Minister Datuk Liow Tiong Lai
said while the National Health and Morbidity Survey in 2006 revealed that 43.1%
of Malaysian adults were overweight or obese, which was double the figure from a
decade ago, the numbers could have already increased since then.
Malaysian Association for the Study of Obesity president Prof Dr Mohd Ismail
Noor later said that about 90% of overweight and obese adults in the country
were very likely to develop diabetes. What is worrying are younger people who
have diabetes and are also overweight. You do not have to wait until you are 40
to have this disease. They are now as young as 25, he said. He also said if one of
a persons parents was overweight or obese, the chances of his being in a similar
situation was 40%. The chances increased to 80% if both parents were either
overweight or obese, he added.
Genetic predisposition, he said, contributed to between 10% and 15% of those
who faced the weight problems.
Causes Of Obesity

Culture
Culture certainly has a big influence on behaviours leading to weight gain.
The concepts of personal well being such health, affluence, beauty,
strength and prosperity are modeled and learnt from society at large
(Matsumoto 1994). It is usual that people tend to eat the foods that are
eaten by their family and friends for reasons such as having a sense of
acceptance and belonging, compliance to authority (i.e. parents, teachers,
nutritionists, dietitians, etc.), as well as having consistencies in attitudes,
beliefs and habits of diet and nutrition formed through learning within the
community (Sobal 1995). One such cultural influence with regards to
socio-economic environment is eating out. Eating out has become popular
as it is highly convenient for todays modern household. Eating out at
restaurants and eating food prepared away from home has been found to
be increasing in trend in the past 20 years (French et al. 2001).

Personality Factors And Cognitive Style

Personality style as well as thinking patterns can help maintain behaviour
that leads to obesity. Feelings of hopelessness can demotivate individuals
from reducing and maintaining weight (Byrne 2002).

Non-Food-Related Behaviour
Non-food-related behaviour can also lead to obesity. These behaviours are
sedentary behaviours such as sitting or sleeping for long hours, using lifts
as compared to stair-walking, driving to places that are within walking
distance.

Food-Related Behaviour
The main behavioural factors that contribute to obesity include excessive
energy intake, diminished rate of physical activity or energy output,
greater responsiveness to stimuli associated to food (especially energy
dense food), large bites of food and rapid eating rapid eating allows

greater amount of food to beconsumed before satiety signals are

recognised.
Hunger And Appetite

Hunger is a physiological response to a need for food triggered by stimuli

acting on the brain (Liebowitz 1995). In a normal eating pattern hunger
begins after four to six hours after eating, when food has left the stomach
and much of it has been absorbed by thebody. This pattern is highly
influenced by psychophysiological factors such as smell, as well as
environmental interactions (French et al. 2001).
Effects Of Obesity
Obesity has a far-ranging negative effect on physical and psychological health of
a child. Former President of America, Bill Clinton (2005) acknowledged in an
article in the New York Post that Carrying around excess weight for years can
lead to high cholesterol, high blood pressure, type 2 diabetes, heart disease,
stroke, and premature death(p.5).
The health effects associated with obesity include, but are not limited to, the
following:

High blood pressure

If a child develops high blood pressure their heart works harder than
normal to pump blood to the extra fat tissues in the body, and the extra
circulation of blood causes pressure on artery walls. Having extra weight
raises the heart rate and reduces the bodys ability to transport blood to
the vessels.

Heart disease
Heart disease is also found in obese children and it is the hardening of
arteries. This reduces blood flow to the heart and can cause heart attacks.

Diabetes
The development of type 2 diabetes in so many children is extremely
frightening. This disease usually begins in adulthood but has become
common in obese children. Basically this form of diabetes occurs when the
body resists insulin allowing blood sugar levels to increase.

Sleep Apnea
Another common disease found in obese children is sleep apnea; this
disease causes people to stop breathing for periods while they are
sleeping.