Chapter- I

INTRODUCTION

1.1

Background of the Study:

Sports have been part of human life almost since the time immemorial.
Be it a necessity for his survival i. e hunting for food, shelter and safety from
wild animals or other enemies, or as a pursuit of pleasure. The sports have
been indispensable to mankind, and have become a part of his culture.
Though the origin of sports is lost in antiquity, it is quite certain that physical
activity has been a part of the life of even primitive man.
Generally, physical education is misunderstood a physical activity or
merely drill. It is necessary to provide knowledge regarding true meaning and
scope of physical education. The aims and objectives of physical education
are also being stated in detail so as to enable the students to understand the
basic concept of the subject. It is also pertinent to deal with the controversy
whether physical education is an art or science. 1
Obesity and overweight has become a global epidemic. In 1997, the
World Health Organization (WHO) highlighted obesity as a major global health
problem. According to the WHO in 2005, throughout the world there were
about 1.6 billion overweight adults aged 15 years and older and approximately
400 million obese adults. WHO estimates that by 2015, 75% of adults will be
overweight and 41% will be obese A higher body weight is associated with an
increased incidence of a number of medical conditions, including type 2
diabetes mellitus, insulin resistance, cardiovascular disease, stroke, some
types of cancer, and nonalcoholic fatty liver disease. Obesity in childhood and
adolescence represents a serious health problem because it tends to continue
into adulthood2.Overweight and obesity is not only a health issue, but also has
economic consequences. Both direct costs related to medical expenditures
1Ajmer Singh (2003). Essentials of physical Education, Kalyani publishers,
Ludhina, New Delhi, pp. 13-15.

from obesity related diseases, and indirect costs related to reduced

productivity and disability3.
Data from the United States-National Health and Nutrition Examination
Survey (US-NHANES), estimated that the total cost of US healthcare related
2to overweight and obesity will increase from 7%, to about 17% by the year
20304.
A study by Finkelstein, Fiebelkorn and Wang, projected the annual
medical spending due to overweight and obesity approached $92.6 billion in
the United States (US) in 2002. On average, individual Americans whoare
considered obese pay yearly over $1,400 (42 percent increase) in health care
costs compared to normal-weight individuals. In addition, it is estimated that
the total spending of Medicare and Medicaid would be lower by 8.5% and
11.8%, respectively, in the absence of obesity5 .
Obesity costs are raising overall. For example, Cawley and
Meyerhoefer, found that per capita medical spending for obese US individuals
was $2,741 higher than for individuals who were not obese (150% increase).
Based on data from the Medical Expenditure Panel Survey for 2000-2005, the
estimated annual cost of obesity is $190 billion (in 2005 dollars) which
represents 20.6% of annual health care spending in the US.Globally direct
costs of obesity were estimated to account for between 0.7% and 2.8% of the
country's total healthcare expenditures. Moreover, obese people were found

2World Health Organization, Obesity and Overweight, retrieved on Sep 2015 from
online website http://www.who.int/mediacentre/factsheets/fs311/en/.
3Adair L. S. (2008). Child and Adolescent Obesity: Epidemiology and
Developmental Perspectives, Physiol Behav. pp.8-16.
4Trogdon J. G et al., (2008). Indirect costs of obesity: a review of the current
literature. Obes Rev. pp.489-500.
5Cawley J, Meyerhoefer C. (2012). The Medical Care Costs of Obesity: an
Instrumental Variables Approach, J Health Econ, pp.219-30.

to have medical costs that were about 30% greater than their normal weight
individuals.6
A country where 270 million people live below the 'poverty line', obesity
seems to be a distant issue, meant for the rich kids of first world. But India is
under siege: junk food, alcohol and sedentary lifestyle are leading us to silent
self-destruction, making one in every five Indian men and women either obese
or overweight. According to a study published in the noted journal Lancet,
India is just behind US and China in this global hazard list of top 10 countries
with highest number of obese people7.
The study - titled 'Global, regional, and national prevalence of
overweight and obesity in children and adults during 1980-2013: A systematic
analysis for the Global Burden of Disease Study 2013' - used data collected
by international bodies and organisations in various countries like India over
three decades. The US topped the list with 13 per cent of the obese people
worldwide in 2013, while China and India together accounted for 15 per cent
of the world's obese population, with 46 million and 30 million obese people,
respectively. According to the study, number of overweight and obese people
globally increased from 857 million in 1980 to 2.1 billion in 2013. This is onethird of the world's population8.
Overweight in adults is categorised as Body Mass Index of 25 kg/m2 to
30 kg/m2 and obesity as Body Mass Index of more than 30 kg/m2. In 2010,
overweight and obesity were estimated to cause 3 to 4 million deaths, 3.9 per
cent of years of life lost, and 3.8 per cent of disability-adjusted life-years
worldwide, the study said. And the problem is expected to get worse as
6world Health Organization, Obesity and Overweight, retrieved on Sep 2015 from
online website http://www.who.int/mediacentre/factsheets/fs311/en/.
7Withrow. D, and Alter. D. A. (2011). The economic burden of obesity worldwide: a
systematic review of the direct costs of obesity. Obes Rev. Vol: 12(2), pp.131-41.
8WHO Consultation, Obesity: Preventing and Managing the Global Epidemic. World
Health OrganizationTechnical retrieved on 16 Sep 2014 from online website
http://www.who.int/nutrition/topics/obesity/en/.

obesity is increasing and "no national success stories have been reported in
the past 33 years." According to Christopher Murray, director of the Institute
for Health Metrics and Evaluation (IHME) that conducted the analysis for the
study, "In the last three decades, not one country has achieved success in
reducing obesity rates, and we expect obesity to rise steadily as incomes rise
in low- and middle income countries in particular." Dr. Pradeep Chowbey,
director of the Institute of Minimal Access and Bariatric Surgery at Max
Healthcare Institute, said, "If we see the graph of obesity, from 1999 onwards
Indians started gaining weight due to urbanisation. There has been gradual
economical improvement in our status. The entrance of modern technology
and Internet has turned people lazy and stagnant. 9
With lifestyle disorders forcing more and more people to reel under
excess body weight, even relatively younger people are developing joint
disorders and knee pain. Excessive weight is associated with a series of
health problems, including blood pressure, diabetes, and cardiovascular
ailments. Yet another problem is that obesity puts people at an increased risk
of developing osteoarthritis. "Osteoarthritis, a degenerative joint disease,
involves degradation of the condition of joints mostly due to loss of cartilage
and may cause stiffness, locking or pain. Excess weight makes a person
more susceptible to osteoarthritis," said Dr. Rajeev K. Sharma, orthopedic
specialist and joint replacement surgeon at Indraprastha Apollo Hospital.
Obesity has also emerged as a major public health challenge in South Asian
countries. Experts say the prevalence of obesity is greater in urban areas, and
women are more affected than men10.
Further, obesity among children and adolescents too is rising rapidly.
The phenomenon in South Asians has characteristic features - high
prevalence of abdominal obesity, with more "intra-abdominal and truncal
9 Caballero. B (2007). The Global Epidemic of Obesity: an Overview. Epidemiol
Rev. Vol: 29, pp.15.
10 WHO Consultation, Obesity: Preventing and Managing the Global Epidemic.
World Health OrganizationTechnical retrieved on 16 Sep 2014 from online website
http://www.who.int/nutrition/topics/obesity/en/.

subcutaneous adiposity," experts say. "Dietary guidelines for prevention of

obesity and diabetes, and physical activity guidelines for Asian Indians are
now available. Intervention programmes with emphasis on improving
knowledge, attitude and practices regarding healthy nutrition, physical activity
and stress management need to be implemented," said Dr. AnoopMisra,
chairman of the National Diabetes, Obesity and Cholesterol Foundation 11.
According to Dr. Prabal Roy, senior bariatric surgeon at the Asian
Institute of Medical Science, Indians had faced undernutrition for a long time
and are now being exposed to the "overnutrition of the modern world through
globalisation". "India is currently witnessing rising numbers of people in the
middle-class who are obese. A lot of the Indian population has started relying
on processed foods that contain a huge percentage of trans-fat, sugars, and
other unhealthy and artificial ingredients. Obesity is considered the core of
many diseases. Increased weight carries significant health risks for some
cancers, diabetes, heart diseases and strokes," Roy said. And yet, we seem
to do nothing to counter the menace, allowing ourselves to be controlled by a
"pandemic",

happily

shrugging

off

the

dangers

with

unpardonable

nonchalance.12
In recent years obesity has reached pandemic proportions. In the
world, half of the whole population lack food, the other half in the
industrialized prosperous Western Countries fight against the consequences
of overfeeding. 20-30% of the adult population is affected by obesity and
obesity conditions. The World Health Organization Regional Office for Europe
recently stated that 300 million people in the world are obese. The prevalence
of obesity has increased by 25,0% in the last 20 years. In Europe 14 million
people are overweight, 6 million obese: 27,0% of men, 38,0% of women. In
many European countries 15,0-20,0% of adults are overweight or obese [3].
11Finkelstein. E. A et at., (2004). State-level Estimates of Annual Medical
Expenditures Attributable to Obesity. Obes Res, vol: 12, pp.1824.
12Wang Y, et al., (2008). Will all Americans become overweight or obese?
Estimating the progression and cost of the US obesity epidemic. Obesity.vol:16,
pp.23232330.

Obesity has a positive trend in the Italian population: the Italian National
Institute of Statistics, (ISTAT) reported that in the preceding five years (200005), obesity has increased at a rate of 9,0%, with about 4.700.000 affected
people. Statistics show 30% of the population are overweight, 10,0% are
obese, with only about half the population being of a normal weight. Health
costs linked to obesity equate to 7,0% in the European Union, and up to
10,0% in Italy; with the inclusion of cardiovascular conditions the proportion
raises to 30,0-35,0% . A similar figure was also reported for children. In recent
years childhood obesity has become a serious health problem in the world, an
exacting challenge for public health authorities, raising great concern in
families and communities. Investigations reported that 1 out of 3 children are
overweight, 4,0 /6,0 % are obese. Over the past 3 decades prevalence of
obesity has more than tripled for youth aged 6-11 and more than doubled for
youth aged 12-19. 18,8% of children 6-11 years old and 17,4% of adolescents
12-19 years old were reported being over the 95 th percentile for age and
gender, 37,0% and 34,0%, respectively, over the 85th percentile, being at risk
of obesity. The International Obesity Task Force (IOTF), in Europe, reported in
the northern European regions from 10,0% to 20,0% prevalence of obesity,
compared with higher rates (20,0-30,0%) in the southern regions.Surveys
conducted in Italy by the Italian National Institute for Research on Nutrition
(INRAN) assessed that obesity, concerning children, had higher rates in 6 to
13 years old, males were fatter than females and reported percentages of
overweight between 12,0% and 34,0%, and of obesity from 4,7% to 22,3%. A
series of surveys conducted in different Italian regions reported about 20,0%
of children 6- 11 being overweight and 4,0% obese. A survey on a sample of
primary school children in Pavia, northern Italy, reported that 31,3% of the
pupils did not practice any organized physical activity. Prevalence of obesity in
this group was nearly double. Obesity is considered a risk factor for many
chronic diseases as hypertension, carbohydrate metabolism or type 2 diabete,
hyperlipaemia, atherosclerosis. Obesity was also linked to increased children
morbidity and adult mortality rates. Many studies indicate, in fact, that children
who are severely overweight have an increased risk of death from
cardiovascular disease in adulthood. Since overweight in childhood persists
into adulthood and an obese child will have high probability of becoming an

obese adult , increased prevalence of overweight and obesity in children will

certainly led to an exacerbation of obesity related chronic diseases among
adults . This is considered a public health threat as, in fact, obesity is
associated in adults with the development of many pathological conditions as
coronary heart disease, ictus, sleep apnea, osteoporosis and premature
mortality. Causes of obesity are associated with certain life style factors such
as sedentary habits and decreased physical activity. Important life style
modifications in young people, particularly, have seen a decrease of time
dedicated to organized physical exercise and an increase in hours spent
watching TV, playing video games or using PCs. Sedentary habits and
decrease physical activity, in turn, have been reported to be associated with
unhealthy food consumption. The influence of childhood diet may influence
the persistence of obesity and the development of diseases later in life.
Reports indicate that only 20,0% of children and adolescents eat five or more
servings of fruit and vegetables per day. In the States, American children do
not consume the recommended servings and about 50,0% boys and girls 1219 consume less than one serving of fruit and vegetables per day. Most
students (11,0% to 28,0%) skip breakfast, with 86,0% having hyper caloric
snacks. Students in middle and high school have access to snack bars and
school food stores selling foods high in fat and calories. In addition, low milk
consumption and increasing soft drink consumption is of increasing concern,
beside obesity, in respect to the risk of osteoporosis. It is necessary to prevent
or treat obesity in childhood since behaviors that lead to obesity are
established in this period of life: this should be done in order to reduce the risk
of adult obesity.13
Increasing the proportion of children meeting alimentary and physical
guidelines with education interventions from childhood, in fact, reinforces
prevention of obesity in adulthood. Results reported by different authors
indicate that individual behaviors in nutrition and sedentary or active physical
engagement are largely influenced by different variables such as age, gender,
social, economical, cultural factors and different settings. Understanding the
13 Fri J, and Finley. W (2005). The prevalence and costs of obesity in the EU.
Proceedings of the Nutrition Society, pp.359-62.

determinants of life style and behaviors in youth and attempting to change

childrens habits with the long term goal of establishing healthy life style
patterns to prevent chronic diseases in adulthood is considered a key strategy
in the primary prevention of obesity.14
According to WHO estimates, by 2020, non communicable diseases
(NCD) will account for approximately three quarters of all deaths in the
developing world.15
Interest in childhood precursors to chronic diseases is increasing
because the behavioral and biological risk factors for chronic diseases persist
from childhood into adulthood. Declining levels of physical activity (PA) as well
as nutrition transition (i.e. the trend towards increased consumption of a diet
high in saturated fat, sugar and refined foods, and low in fiber) among
communities are thought to be partly responsible for the rising rate of such
risk factors worldwide.In this regard, a potential emerging public health
concern in developing countries is likely to be the increasing incidence of
childhood overweight, which in the future is likely to create an enormous
public health burden.In recent years, in addition to problems in adults, the
epidemiological transition has made Iranian young people prone to chronic
diseases in later life.16
Although previous studies have determined the associations between
PA and dietary habits in relation to overweight in developed countries, it is not
clear if their findings can be generalized to other ethnic groups with very
different cultures and lifestyles. Consequently, for the first time in the Islamic
Republic of Iran, and to our knowledge for the first time in the WHO Eastern
Mediterranean Region, a national-level baseline survey has been performed
14 Wang Y and Lobstein.T (2006). Worldwide trends in childhood overweight and
obesity. Int J Pediatr Obes, pp.11-25.
15 Bescianini. S et al., (2002). Excess of weight in infancy and adolescence. ISTAT
Conference, Rome.

16 Must A et al., (1999). The Disease Burden Associated with Overweight and Obesity.
JAMA, pp.23-29.

as part of the Childhood & Adolescence Surveillance and Prevention of Adult

Non-communicable disease: CASPIAN Study. The current paper used the
baseline data from this large study to examine the associations between
dietary and PA patterns, as well as their relation to the body mass index (BMI)
among a nationally representative sample of children and adolescents. 17

1.2 The Problem and its Social Relevance:

One of every three people or almost 2.1 billion of the worlds population
is either obese or overweight, according to the Global Burden of Disease
study published in Lancet medical journal on Thursday which analyses data
from 188 countries between 1990 and 2013. Almost 37% of the worlds men
are overweight or obese, up from 29% in 1980. And almost 38% of the worlds
women are, up from 30% in 1980. According to the study, 13% of the obese
people in the world are in the US and 15% in China and India an indication
of how economic progress has wreaked havoc on waistlines in developing
economies. In 2010, obesity (and being overweight) caused the death of 3.4
million people, according to study conducted by the Seattle-based Institute for
Health Metrics and Evaluation. Most of the deaths were caused by
cardiovascular conditions. Obesity is an issue affecting people of all ages
and incomes, everywhere, said Christopher Murray, director of Institute of
Health Metrics and Evaluation, in a press release. In the last three decades,
not one country has achieved success in reducing obesity rates, and we
expect obesity to rise steadily as incomes rise in low- and middle-income
countries in particular, unless urgent steps are taken to address this public
health crisis, added Murray who is one of the co-founders of the study.
17 Must A, and Strauss R.S. (1999). Risks and Consequences of Childhood and
Adolescent Obesity. Int J Obes Relat Metab Disord , pp.2-11.

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According to the study between 1980 and 2013, the prevalence of overweight
or obese children and adolescents increased by nearly 50%. In 2013, more
than 22% of girls and nearly 24% of boys living in developed countries were
found to be overweight or obese. Developing countries also recorded high
levels of childhood obesity, where nearly 13% of boys and more than 13% of
girls are overweight or obese. Hence keep this data in her mind researcher
selected this topic to find out the status of the university students of Bharati
Vidyapeeth.

1.3 Statement of the Problem

The statement of the research problem was to find out Comparison
of Eating Behavior with Physical Activity Characteristics and BMI from
the Students of Different Region.

1.4 Objectives of the Study:

The objectives of the study are as follows:

To find out physical activity of the students from different region.

To find out the eating behaviour of the students from different region.
To find out the BMI of the students from different region.
To find out the relationship between physical activities, eating behavior and
BMI of the students from different region.

1.5 Hypothesis:
H1 1: There would be significant difference between the north east region and
west region student of eating behavior.
H1 2: There would be significant difference between the north east region
and west region student of physical activity.

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H1 3: There would be significant difference between the north east region

and west region student of BMI.

1.6 Delimitation of the Study:

The study was delimited to students of only Bharati Vidhyapeeth

University.
The age of the subjects was ranging from 18-25yrs.
The study was delimited to both male and female students.
The study was delimited to students of 2 different region: north east region
(Nagaland, Manipur, Tripura ,Assam) and West (Maharashtra, Goa).

1.7 Limitation of the Study:

The researcher assumed that the information provided by the students

would be valid.
Questionnaire research has its limitation. As such any bias that might have
crept into the subjects response on this account may be considered as a
limitation of this study.

1.8 Operational Definition of the Terms Used

Physical activity:
Physical exercise is any bodily activity that enhances or maintain
physical fitness and overall health. It is performed for many different reasons.
These include strengthening muscles and the cardiovascular system, honing
athletic skills, weight loss or maintenance and for enjoyment.
Behavior:
It is the range of actions and mannerisms made by organisms,
systems or artificial entities in conjunction with themselves or their
environment, which includes the other systems or organisms around as well
as the (inanimate) physical environment. It ia response of the system or

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organism to various stimuli or inputs, whether internal or external, conscious

or subconscious, overt or covert and voluntary or involuntary.
BMI:
Body mass index (BMI) is the ratio between the height and weight to
check the obesity level.
BMI = weight (kg) / [height (m.)]2
Measurement of BMI is necessary for prediction of obesity and also
useful to assess health risk of heart.

1.9 Significance of the Study:

The result of the study was highlighting the students physical activity and

eating behaviour.
The study yield beneficial information about personal physical activity and
nutritional habits.