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CHAPTER I: Introduction

1.1Background of the study:

Obesity is recognized as an important modifiable risk factor for ischemic heart


disease, stroke, diabetes and cancer, diseases that are leading causes of morbidity and
mortality. World Health Report 2002, approximately 58% of diabetes and 21% of
ischemic heart disease and 8-42% of certain cancers globally were attributable to a
BMI above 21 kg/m2. The WHO definition is: (1) A BMI greater than or equal to
25 is overweight (2) A BMI greater than or equal to 30 is obese. (3) A BMI
less than 18.5 are considered as underweight &(4) A BMI between 18.5 to 24.99 are
considered as normal weight1.

Overweight and obesity are defined as abnormal or excessive fat accumulation


that may impair health. BMI is a simple index of weight-for-height that is
commonly used to classify overweight and obesity in adults. It is defined as a
person's weight in kilograms divided by the square of his height in meters2.

Variables such as socioeconomic status (SES), ethno cultural background and place of
residence have been said to play a role in the development of obesity. various study
shown a mixed association between obesity and SES, with a similar number of
countries presenting positive and inverse associations or no association at all.
Preventive measures for obesity: a) Exercise regularly b.) Follow a healthy eating
plan. c) Know & avoid the food traps that cause you to eat. d.) Monitor your weight
regularly e) Be consistent3.

The studies have shown strong association of childhood obesity with family history,
sedentary life style, socioeconomic status, television watching and internets, computer
games, eating behavior, sleeping patterns etc4.

Most of Latin America has experienced rapid socio-economic growth, accompanied


by changes in nutrition characterized by increased consumption of energy-dense foods
with elevated contents of fat and sugars. Another significant change has been an
increase in urbanization, which has favored lifestyle modifications associated with
decreased physical activit5.

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Researchers showed an association between obesity in childhood and high prevalence
of blood pressure, diabetes, respiratory disease, and orthopedic and psychosocial
disorders. Overweight and obesity lead to adverse metabolic effects on blood
pressure, cholesterol, triglycerides and insulin resistance6.

The non-fatal, but debilitating health problems associated with obesity include
respiratory difficulties, chronic musculoskeletal problems, skin problems and
infertility. The likelihood of developing Type 2 diabetes and hypertension rises
steeply with increasing body fatness. Approximately 85% of people with diabetes are
type 2, and of these, 90% are obese or overweight. And this is increasingly becoming
a developing world problem7.

Raised BMI also increases the risks of cancer of the breast, colon, prostrate,
endometroium, kidney and gallbladder. Chronic overweight and obesity contribute
significantly to osteoarthritis, a major cause of disability in adults. Although obesity
should be considered a disease in its own right, it is also one of the key risk factors for
other chronic diseases together with smoking, high blood pressure and high blood
cholesterol8.

1.2 Statement of the problem:


Obesity is a worldwide accelerating public health problem. Overweight and obesity
are the fifth leading risk for global deaths. At least 2.8 million adults die each
year as a result of being overweight or obese. In addition, 44% of the diabetes
burden, 23% of the ischemic heart disease burden and between 7% and 41% of
certain cancer burdens are attributable to overweight and obesity2.
Nowadays, it also occurs in the developing countries. Since 1991, the percentage of
obese Americans has increased by 74%. More than 21 million US men and over 23
million women are obese. The most comprehensive data on the prevalence of obesity
worldwide are those of the WHO Monica project. The main conclusion drawn from
the project was that obesity prevalence is increasing worldwide at an alarming rate in
both developed and developing countries. In many developing countries, obesity co-
exists with under nutrition. Although still relatively uncommon in African and Asian

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countries, obesity is more prevalent in urban than rural populations. The childhood
obesity has now recognized as a global health problem because of its devastating
consequences and its prevalence is escalating at uncontrollable rate worldwide. In
2010, forty three million children (thirty five million in developing countries) were
estimated to be overweight and obese; ninety two million were at risk of overweight.
The worldwide prevalence of childhood overweight and obesity increased from four
percent in 1990 to six percent in the year 2010.This trend is expected to reach nine
percent or approximately sixty million, in 2020.Although, the prevalence is
comparatively lower in Asia (4.9% in 2010), the number of afflicted children is
greater. In developing countries, the prevalence of obesity has increased rapidly and
in some it is as high or even higher than the prevalence reported in developed
countries. In most countries, the prevalence of obesity is higher in women than in
men, and higher in urban than in rural areas. Females in Latin America have the third
highest prevalence rate of obesity following the Middle East and Africa2.
Some WHO global estimates from 2008 follow: More than 1.4 billion adults, 20
and older were overweight, Of these overweight adults, over 200 million men
and nearly 300 million women were obese . Overall, more than one 10% of the
world’s adult population was obese. Current worldwide estimates suggest that one
billion people are overweight or obese– and at least 300 million of them are clinically
obese and the World Health Organization (WHO) predicts that number will increase
1.5-fold by 20153.
An estimated 300,000 people die each year of illnesses related to obesity, more than
the number killed by pneumonia, motor vehicle accidents and airlines crashes
combined. Since 1991, the percentage of obese Americans has increased by 74%.
More than 21 million US men and over 23 million women are obese3.
The worldwide obesity rate increased from 2.3% to 19.6% between 1990 and 2000
.The International Day for Evaluation of Abdominal Obesity Study reported that
South Asians have the highest prevalence of abdominal obesity.Moreover, obesity
increased in women in other South Asian countries, including Nepal and Bangladesh,
between 1996 and 2006 (from 1.6% to 10% and from 2.7% to 8.9%, respectively.The
WHO estimates that obesity prevalence in children in such countries increased 28% in
only two years . In Europe, the prevalence of obesity (body mass index ≥ 30 kg/m2)

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in men ranged from 4.0% to 28.3% and in women from 6.2% to 36.5%.Obesity is a
major public health problem in developed countries especially in the United Status,
with one-third to one-half of adults affected3.
some regional studies conducted since 2000 have shown a prevalence of overweight
(between 20% & 34%), but prevalence of obesity varied widely (0.4% to 10.14%)3.
The adult prevalence rate of obesity in Nepal is 2.9%. Approximately 85% of people
with diabetes are type 2, and of these, 90% are obese or overweight4.
Our country Nepal is also one of the developing country facing most of the human
health problems due to obesity. Problems like: Diabetes, hypertension, ischemic
stroke, and heart disease, different types of cancers, Osteoarthritis and poor
reproductive health. Here is saying that "Problem is not a problem until showing some
effects on something". so in the same way due to its high risks & effects, Obesity is
considered as one of the leading factors of morbidity and mortality also7.

1.3 Rationale of study


 Obesity is one of the most serious emerging chronic public health problem and
challenges in 21st century worldwide in both developed and developing
countries as it is considered as one of the leading factors of morbidity and
mortality due to inadequate studies related to obesity in Nepal.
 This research will help to make plan & policy regarding obesity.
 This research will help to identify real situation of obesity.
 This study will help to change in behaviour of people.

1.4 Objectives:

1.4.1 General objective:


To identify the associated factors contributing to obesity among the school teachers of
Saptari Rajbiraj.

1.4.2 Specific objectives:


1) To find out the socio-demographic information.
2) To identify the life style of people.

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3) To find the relations between socio economic factors and body mass index.
4) To examine association between BMI and obesity.

1.5 Research Question:

What are the associated factors contributing to obesity among the school teachers of
Saptari Rajbiraj?

1.6 Study variables/conceptual framework

Independent variables Dependent variables


Socio demographic factor:
Age, Occupation, Religion, Education, Income,
Height Weight

Life style factors:


Physical exercise, Food taking pattern
OBESITY

Health Service factor:


Accessibility, Affordable,. Food availability

IEC Materials

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CHAPTER II: Literature Review
The study conducted in Ramkot VDC of Kathmandu district on obesity among adult
through cross-sectional descriptive method showed that the prevalence of obesity and
overweight is 24.5 and 1.8% respectively. 81.7% of respondents, who consumed
fruits more than five times a week had low BMI, whereas 44% of respondents, who
consumed fruits less than once a week in their diet had high BMI indicating
overweight and obesity2.
A study conducted by an expert committee convened by the WHO in 1997 showed
that one billion people are overweight or obese & predicts that number will increase
1.5-fold by 2015.The worldwide obesity rate increased from 2.3% to 19.6% between
1990 and 2000. In the Pacific Islands, the Middle East, and China, obesity has
increased at least threefold since 1980 , and the Western Pacific Islands of Nauru and
Tonga top the region with an adult obesity rate of around 90% . Almost 75% of adults
in Barbados, Mexico, Turkey, and Argentina are overweight3.
The study conducted on childhood obesity in 2010 showed that forty three million
children (thirty five million in developing countries) were estimated to be overweight
and obese; ninety two million were at risk of overweight. The worldwide prevalence
of childhood overweight and obesity increased from four percent in 1990 to six
percent in the year 2010.This trend is expected to reach nine percent or approximately
sixty million, in 2020. Although, the prevalence is comparatively lower in Asia (4.9%
in 2010), the number of afflicted children are greater4.
The cross-sectional study conducted in Panamanian adult(1982-2010) indicates that,
the prevalence in males of a body mass index (BMI) ≥ 30 kg/m2 was 3.8% and in
females 7.6% . In 2003, the prevalence in males increased to 14.4% and in females to
21.8%, in 2008, the prevalence in males was 16.9% and in females, it was 23.8%.
Nevertheless, in 2007, the national perception of being obese was only 4% among
males and 6.7% among females. The most recent nationally representative survey
performed in 2008 estimated that approximately 56.4% of adults were either
overweight or obese and that 21% were obese5.
The study conducted in Shahjahanpur district of India among school going children
through stratified random method showed that out of total 1484 boys, 16% boys lie in
over weight/obese group. The proportion is significantly higher in urban (22.5%) then

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in rural boys(1.1%) whereas Out of total 583 girls , 6.1% of girls are
overweight/obese but the proportion of urban girls is significantly higher in boys6.
The study conducted at Kathmandu among Nepalese of reproductive age (15-49)
attending a gynecological clinic at Kathmandu showed that out of 1000 women with
the various complaints;37.3% overweigh,10.1% obese, underweight 8% and 44.6%
healthy were found7.
The study conducted in Urban India among women by economic stratum showed
that prevalence of overweight and obesity is very high in urban areas, more noticeably
among the non-poor households. Furthermore, overweight and obesity increase with
age, education, and parity of women. The results of multinomial logistic regression
showed that non-poor women are about 2 and 3 times more at risk of being
overweight and obese respectively. Marital status and media exposure are the other
covariates associated positively with overweight and obesity8.
The study conducted among out patient in Qatar showed that the proportion of
obesity was higher among patients aged 40 years and over (62.5%) compared to
patients aged 20-39 years (56.7%). About 66% of women were obese, while the
percentage was 56.4% in men. In general older subjects (odds ratio, OR=1.27), and
female(OR=1.50) were more likely to be obese. However, there was no statistically
significant association between socio-demographic factors and obesity in our sample9.
The study conducted among Jordanian women of reproductive age in USA showed
that No major differences in mean BMI or the prevalence of obesity were observed
among women of reproductive age across the three examined surveys. The prevalence
of obesity for all women ranged from 26.3 percent in 2002 to 28.7 percent in 2012. In
the ever-married women sample, the lowest prevalence of obesity occurred in 2002, at
37.4 percent, and the highest in 2009, at 38.9 percent. The prevalence of obesity
ranged across the surveys from 8 percent to 13 percent for never married women and
from 37 percent to 39 percent for ever-married women10.
A survey conducted on prevalence & correlation of overweight & obesity among
older adults showed that Overall, 39% and 13% of Canadian older adults were
classified a overweight and obese, respectively. Some of the risk factors for
overweight were male gender, low education, being married, Canadian born,
residence in the Atlantic provinces, no use of alcohol, co-morbidity, physical

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inactivity, and limited functional status. Risk factors for obesity were similar to those
for overweight except for being unmarried; American, European, and Australian born;
lower and higher levels of alcohol use; poor self-rated health; and psychological
distress11.
The study conducted among Jordanian women showed that, the overall prevalence of
overweight was 30% and obesity was 38.8% among Jordanian women aged 15–49
years. Results of multivariate analysis showed that age; residing in the south region of
Jordan, marriage at an early age, parity, wealth status and smoking were statistically
significant predictors of overweight and obesity among women in Jordan12.
The study conducted in Tanzania showed that, out of 1249 subjects recruited, 814
(65.2%) were females. The overall prevalence of obesity was 19.2% (240/1249).
However, obesity was significantly more prevalent in women (24.7%) than men (9%),
p < 0.001, among respondents with high socio-economic status (29.2%) as compared
to those with medium (14.3%) and low socio-economic status (11.3%), p value for
trend < 0.001, and among respondents with light intensity activities (26.0%), p value
for trend < 0.00113.
The study conducted among Nurses in the tamale Metropolis of Ghana showed that
the prevalence of overweight and obesity among the nurses were 26.4% and 16.9%
respectively. Physical inactivity and dietary habit especially skipping of meals was
found to be contributing factors to overweight and obesity among the nurses. Age,
gender and marital status had an influence on the level of obesity and overweight
among the nurses as the older nurses were more likely to be obese than the younger
ones, female nurses were significantly more likely to be obese than the males, whilst
those married had a higher tendency to be overweight and obese than the never
married, divorced and widowed respectively. Prevalence of overweight and obesity
among nurses in the Tamale metropolis is high and of public health significance14.
The study conducted among Saudi female Universiy students showed that
among the study participants, overweight and obesity reached 47.9%.
Marriage, presence of obesity among family members, frequency of drinking
aerated beverages increased the risk of obesity significantly. Misperception of
body image was reported by 17.4% and 54.2% of obese and overweight

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students respectively. Analysis of dietary habits and life styles indicated the
predominance of unhealthy behaviors15.
The study conducted in Cameroon and Gabon showed that an increase in the
proportion of overweight among women: nearly 2.77% between 2004 and 2011 (from
Cameroon) and nearly 13.22% between 2000 and 2012 (from Gabon)16.

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CHAPTER III: Methodology
3.1 Study design: Cross Sectional Descriptive study design was used.
3.2 Study area: Rajbiraj city, Saptari
3.3 Study population: School teachers
3.4 Sample size: According to standard formula of sample size:
Sample size=
4pq/d² where, 4= square of z value= (1.96) P= prevalence rate (unknown prevalence
rate therefore 50% is supposed)
q= 1-p= 100-50=50%, d=allowable error (10%) So, Sample size= 4 x 50 x 50/10² =
100
Therefore allowing 10% non response rate:
Sample size= 100 + 10=110
3.5 Sampling techniques: Non-probability, convenience-sampling technique was
used.
3.6 Technique of data collection: self-administered questionnaire with interview
technique was used.
3.7 Tools of data collection: Pre-tested semi structured questionnaire, weight
machine & measuring tape was used.
3.8 Data management analysis & interpretation procedure: SPSS 17 versions and
Microsoft excel was used for data analysis.
3.9 Reliability and validity:
Reliability: Reliability of the instruments was checked by pre-testing in 10% of total
sample. Tools like weight machine & measuring tape was used.
Validity:
The tools were developed by consulting with subject experts, research guide and
extensive literature review. According to their suggestion, modification was done in
the instruments to maintained validity.
3.10: Inclusion and exclusion criteria:
Inclusion criteria:
 Teachers of selected school of Rajbiraj city only were included in this study.
Exclusion criteria:
 Teacher who are not willing to participate in the study.
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 Except selected school, no one was included.
3.11 Ethical consideration:
The study was conducted strictly under the National Guidelines developed by the
Nepal Health Research Council (NHRC) as suggested by our research guide.
 Formal approval letter was obtained from the Campus TO conducting
research.
 After approval of KHSC, research committee
 Permission from School was taken for conducting study
 Both written consent was taken from the participants before collecting data.
 Privacy, confidentiality and anonymity were maintained throughout the study.
 Refusal rights of the participants were respected.
3.12 Limitation of the study:
The study was only limited to exploring associated factor contributing obesity among
teacher of selected school of Rajbiraj city, therefore the findings of this study could
not be generalized.
3.13 Operational definition:
Examine:
To observe or inspect carefully or critically the relations between healthy life
style practices adopted by the teacher and their body mass index
Health Related Behaviors:
Gochman(1982) defined health behavior as "those personal attributes such as beliefs,
expectations, motives, values, perceptions, and other cognitive elements; personality
characteristics, including affective and emotional states and traits; and overt behavior
patterns, actions, and habits that relate to health maintenance, to health restoration,
and to health improvement.
socio economic status & life style factors such as physical activity, eating behavior,
weight loss practices, health screening behaviors & stress management behavior are
used to examine the relation with obesity.
Physical activity: Any bodily movement produced by contraction of skeletal muscle
that substantially increases energy expenditure (Hawley, 2001).
Regular exercise: Exercise sessions of 3 times or more per week for 20 minutes or
longer each time.

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Association: Relationship between two data items where one is dependent on, or
causes, the other.
Body Mass Index: Body mass index is defined as the individual's body weight
divided by the square of his or her height. The formulae universally used in medicine
produce a unit of measure of kg/m2.
Overweight: Individuals with a body mass index (BMI) over 25 are considered
overweight.
Obese: Individual with a body mass index (BMI) over 30 are considered obese

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CHAPTER IV: Research Findings

This chapter deals with the analysis & interpretation of data obtained from
questionnaire. The data were collected from the school teacher of Rajbiraj, Saptari.
Total number of respondents was 111. Data analysis was done by SPSS 17 versions
and Microsoft excel.

4.1: Socio-economic & demographic information

Table 1: Distribution of respondents according to their age group


Age (years) Frequency Percent
15-19 4 3.6
20-24 29 26.1
25-29 20 18.0
30-34 27 24.3
35-39 11 9.9
40-44 10 9.0
45-49 8 7.2
50-54 1 0.9
55-59 1 0.9
Total 111 100
Mean=31.02, Median=30, Mode=23, Standard deviation=8.614, Minimum=18 &
Maximum=58.

Table1: Shows that among the 111respondents, 26.1% belongs to the age group20-24
years, followed by 24.3% in the age group 30-34 years & very few respondents are
from the age groups 50-54 & 55-59years i.e. only 0.9. The mean age was 31.02,
median was 30, minimum age is 18 & maximum age is 58.

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Table 2: Distribution of respondents according to religion
Frequency Percent
Hindu 109 98.2
Muslim 0 0
Buddhist 2 1.8
Christian 0 0
Total 111 100

Table 2: Shows that out of 111 respondents, the majority of respondent's i.e.98.2 %
(109) were Hindu and lowest percent 1.8% (2) were from Buddhist.

Table3: Distribution of respondents according to Educational attainment


Frequency Percent
Secondary 8 7.2
Higher secondary 26 23.4
Graduates 48 43.2
Master degree & above 29 26.1
Total 111 100

Table3: Shows that among total (111) respondents, 43.2 %( 48) of respondents were
graduates, 26.1 %( 29) had received master degree, 23.4 %( 26) had received higher
secondary & 7.2 %( 8) had received secondary education.

Table 4: Distribution of respondents according to marital status


Frequency Percent
Married 83 74.8
Unmarried 28 25.2
Total 111 100.0

Table4: Shows that out of 111 respondents, 74.8 %( 83) were married and 25.2(28)
were unmarried.

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Table 5: Distribution of respondents according to monthly Income
Frequency Percent
5000-9000 49 44.1
10000-14000 30 27
15000-19000 13 11.7
20000-24000 9 8.1
25000-above 10 9
Total 111 100
Mean=13309.01, Median=11000, Mode=9000, Standard deviation=6913.933,
Minimum=5000 & Maximum=40000.

Table5: Shows that among the 111respondents, 44.1 %( 49) had monthly income
between 5000-9000 and 8.1 %( 9) had monthly income between 20000-24000. The
minimum monthly incomes of respondents were 5000 & maximum monthly incomes
of respondents were 40000.

Table6: Distribution of respondents according to Level of teaching


Frequency Percent
Primary level 48 43.2
Lower Secondary level 31 27.9
Secondary level 32 28.8
Total 111 100

Table6: Shows that out of 111 respondents, 43.2 %( 48) were teaching in primary
level, 27.9 %( 31) were teaching in lower secondary level & rest 28.8% (32) were
teaching in secondary level.

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4.2: Question related to lifestyle & dietary habits leading to obesity

Figure1: Distribution of respondents by the Physical Exercise

Figure1: Shows that out of 111 respondents, the majority of respondent's i.e.87.4%
(97) were involved in doing physical exercise followed by very few i.e.12.6 %( 14)
who were not involved in physical exercise.

Figure 2: Distribution of respondents according to time period of doing physical


exercise

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Figure 2: Shows that out of 97 respondents. , 70.2 %( 68) were doing physical
exercise regularly & 29.8 %( 29) were doing physical exercise irregularly

Figure 3: Distribution of respondents according to the sleeping hour/day

Figure3: Shows that out of 111 respondents, 93.7% (104) of them sleep less than 8
hours per day & 6.3 %( 7) of them sleep more than 8 hours per day.

Figure 4: Distribution of respondents according to type of tea they prefer

Figure4: Shows that out of 111 respondents, the majority of respondents i.e. 53.2 %(
59) had preferred milk tea & very few of respondents i.e.5.4 %( 6) had preferred
green tea.

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Figure5: Distribution of respondents according to breakfast they take

Figure5: Shows that among 111 respondents, 99.1 %( 110 respondents) used to take
breakfast.

Figure6: Distribution of respondents according to type of breakfast they usually


takes

Figure6: Shows that out of 110 respondents, the majority of respondent's i.e.58% (64)
had taken fruits in their breakfast.

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Figure7: Distribution of respondents according to time period of meals/day

Figure7: Shows that out of 111 respondents, the majority of respondent's i.e.60.4%
(67) took two times meals/day.

Figure8: Distribution of respondents according to dinner taken

Figure 8: Shows that 98.2 %( 109) of the respondents ate dinner whereas only few
i.e.1.8 (2) do not ate dinner among the 111 respondents.

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Table 7: Distribution of respondents according to kinds of food they take usually
Frequency Percent
Rice 33 30.27
Bread 24 22.01
Less vegetables more rice 15 13.77
Less rice more vegetables 37 33.95
Total 109 100

Table7: Shows that among the 109 respondents who eat dinner,33.95% of them
usually take less rice more vegetables, 13.77% of them take less vegetable more rice,
30.27%of them take rice & 22.01% of them take bread.

Figure9: Distribution of respondents according to type of diet they take

Figure9: Shows that out of 111 respondents, the majority of the respondent's i.e.73%
were non-vegetarian & remaining 27% of them were vegetarian.

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Table 8: Distribution of respondents according to time period of non-veg items
they take
Frequency percent
Daily 1 1.23
Alternative day 11 13.59
Twice in a week 35 43.20
Once a week 34 41.98
Total 81 100

Table8: Shows that among 81 respondents, the majority of respondents i.e.43.20 %


(35) ate meet in twice a week.

Figure10: Distribution of respondents according to type of cooked food they


prefer more

Figure10: Shows that out of 111 respondents, the majority of respondent's i.e.44%
used to preferred gravy cooked food & very few respondents used to preferred
readymade food.

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Figure11: Distribution of respondents according to alcohol with meat they take

Figure11: Shows that out of 111 respondents, very few i.e.17.1% (19) of them used to
take alcohol with meat.

Figure12: Distribution of respondents according to time period of alcohol with


meat they take

Figure12: Shows that out of 19 respondents, the majority of them i.e.78.95% (15)
were social drinkers & remaining i.e.21.05 %(4) used to take regularly.

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Figure13: Distribution of respondents according to the habit of using junk food

Figure13: Shows that out of 111 respondents, the majority of them i.e. 68.5 %( 76)
didn't had habit of using junk food & remaining of them i.e.31.5 %( 35) had habit of
using junk food.

Figure14: Distribution of respondents by the general means of transportation


used

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Figure14: Shows that out of 111 respondents, the maximum respondent's i.e.41.4%
(46) means of transportation were by-walking & minimum of them i.e.4.5 %( 5) used
Scooter as means of transportation.

4.3: Other question related to factor associated with obesity


Figure15: Distribution of respondents according to Self-rated health status

Figure15: Shows that out of 111 respondents, the majority of respondent i.e.84%
health status was good.

Figure16: Distribution of respondents according to types of disease they suffered

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Figure16: Shows that out of 111 respondents, the majority of them 80.2% had none
of these diseases.

Figure17: Distribution of respondents according to any medication with


Preventive measures they taken

Figure17: Shows that among 111 respondents, the majority of them i.e.74.8% (83)
were not taking any medication with preventive measures.

Figure18: Distribution of respondents according to weight they measured

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Figure18: Shows that among 111 respondents, the majority of them i.e.50.5% (56)
were measuring their weight irregularly.

Figure19: Distribution of respondents according to time period of weight they


measured

Figure19: Shows that out of 55 respondents, the majority of them i.e.71% were
measuring their weight in a month.

Figure20: Distribution of respondents according to way of modifying dietary


pattern when weight increases

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Figure20: Shows that out of 111 respondents, the majority of them i.e.49.5 %( 55)
used to focus in exercise when their weight increases.

Figure21: Distribution of respondents according to habit of eating when weight


decreases

Figure21: Shows that out of 111 respondents, the majority of them i.e.65.8 %( 73)
used to taking same pattern of food when their weight decreases.

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Table9: Distribution of respondents according to Weight (in kg)
KG Frequency Percent
35 1 0.9
38 1 0.9
40 3 2.7
43 2 1.8
44 1 0.9
45 9 8.1
46 4 3.6
47 1 0.9
48 3 2.7
49 4 3.6
50 7 6.3
52 1 0.9
53 2 1.8
54 2 1.8
55 8 7.2
56 2 1.8
57 1 0.9
58 5 4.5
59 1 0.9
60 6 5.4
62 2 1.8
63 1 0.9
64 3 2.7
65 9 8.1
67 1 0.9
68 4 3.6
70 5 4.5
72 5 4.5
73 1 0.9
75 6 5.4
77 1 0.9
78 5 4.5
80 3 2.7
120 1 0.9
Total 111 100
Mean=59.42, Median=58, Mode=45, Standard deviation=12.877, Minimum=35 &
Maximum=120

Table9: Shows that out of 111 respondents, the highest frequency is 9 which belong to
the weight of respondents i.e. 45 & 65 kg. The maximum weight of respondent is 120
kg & the minimum weight of respondent is 35kg.

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Table 10: Distribution of respondents according to Height (in feet)
Height Frequency Percent
4’ 2 1.8
4’10” 1 0.9
4’3” 1 0.9
4’5” 2 1.8
4’6” 2 1.8
4’9” 1 0.9
5’0’’ 16 14.4
5’1” 4 3.6
5’2” 9 8.1
5’3” 16 14.4
5’4” 9 8.1
5’5” 12 10.8
5’6” 7 6.3
5’7” 9 8.1
5’8” 2 1.8
5’9” 2 1.8
6’0” 12 10.8
6’1” 1 0.9
6’2” 1 0.9
6’5” 2 1.8
Total 111 100
Mean=5.3811, Median= 5.4, Mode=5.0, Standard deviation=0.45, Minimum=4 feet &
Maximum=6.5 feet.

Table10: Shows that out of 111 respondents, , the highest frequency is 16 which
belong to the height of respondents i.e. 5 feet & 5.3 feet. The maximum height of
respondents is 6.5 feet & the minimum height of respondent is 4 feet.

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Table11: Distribution of respondents according to BMI

Mean 22.19
Median 21.76
Mode 17.24
Standard deviation 4.46
Minimum 13.45
Maximum 37.67

Table11: Shows that out of 111 respondents, the maximum BMI of respondent is
37.67kg/m2 & the minimum BMI of respondents is 13.45kg/m2.

Figure22: Distribution of the respondents according to the BMI

Figure22: Shows that out of 111 respondents, 20.73 %( 23) were underweight,
58.55% (65) were normal, 14.42 %( 16) were overweight & 6.3% (7) were obese.

30
Table 12: Association between BMI and Physical Exercise
BMI Categorization Total p value
Underweight Normal Overweight Obese
Physical yes 20 59 13 5 97 .417
exercise No 3 6 3 2 14
Total 23 65 16 7 111

Table 12: shows that there is no association between BMI and physical exercise as the
p-value is 0.417 that is not less than 0.05.

Table 13: Association between BMI and Monthly Income


BMI Categorization Total p
Underweight Normal Overweight Obese value
5000- 12 28 6 3 49
Monthly 9000
Income 10000- 7 16 4 3 30 0.817
14000
15000- 1 10 1 1 13
19000
20000- 1 6 2 0 9
24000
25000 2 5 3 0 10
&
above
Total 23 65 16 7 111

Table 13: Shows that there is no association between BMI and monthly income as the
p-value is 0.817 that is not less than 0.05.

31
Table 14: Association between BMI and Education Status

BMI Categorization Total p


Underweight Normal Overweight Obese value
Secondary 2 5 1 0 8
Higher 7 15 4 0 26
Education secondary 0.573
Graduates 10 25 7 6 48
Master 4 20 4 1 29
degree &
above
Total 23 65 16 7 111

Table 14: Shows that there is no association between BMI and education status as the
p-value is 0.573 that is not less than 0.05.

Table 15: Association between BMI and type of tea they preferred
BMI Categorization Total p
Underweight Normal Overweight Obese value
Milk tea 12 32 11 4 56
Type of Green 1 1 3 1 6
tea they tea 0.081
Preferred Lemon 5 18 2 2 27
tea
None 5 14 0 0 19

Total 23 65 16 7 111
Table15: Shows that there is no association between BMI and type of tea they
preferred as the p-value is 0.081 that is not less than 0.05.

32
Table 16: Association between BMI and type of diet they had taken
BMI Categorization Total p
Underweight Normal Overweight Obese value
type Vegetarian 8 18 4 0 30
of Non- 15 47 12 7 81 0.342
diet vegetarian
they
had
taken
Total 23 65 16 7 111

Table 16: Shows that there is no association between BMI and type of diet they had
taken, as the p-value is 0.342 that is not less than 0.05.

Table 17: Association between BMI and alcohol with meat they had taken
BMI Categorization Total p
Underweight Normal Overweight Obese value
Alcohol Yes 3 11 5 0 19
with No 20 54 11 7 92 0.265
meat
they
had
taken
Total 23 65 16 7 111

Table17: Shows that there is no association between BMI and alcohol with meat they
had taken as the p-value is 0.265 that is not less than 0.05.

33
Table 18: Association between BMI and habit of using junk food
BMI Categorization Total p
Underweight Normal Overweight Obese value
Yes 3 21 8 3 35
Habit No 20 44 8 4 76 0.086
of
using
junk
food
Total 23 65 16 7 111

Table18: Shows that there is no association between BMI and habit of using junk
food as the p-value is 0.086 that is not less than 0.05.

Table 19: Association between BMI and Means of transportation they used
BMI Categorization Total p
Underweight Normal Overweight Obese value
Scooter 2 2 0 1 5
Means of Bi- 12 14 5 1 32
transportation cycle 0.132
they used By- 7 30 6 3 46
walking
Bike 2 19 5 2 28

Total 23 65 16 7 111

Table 19: Shows that there is no association between BMI and means of
transportation they used as the p-value is 0.132 that is not less than 0.05.

34
Table 20: Association between BMI and marital status
BMI Categorization Total p
Underweight Normal Overweight Obese value
marital Married 12 52 13 6 83
status Unmarried 11 13 3 1 28 0.047
Total 23 65 16 7 111

Table20: Shows that there is association between BMI and marital status as the p-
value is 0.047 that is less than 0.05.

Table 21: Association between BMI and religion


BMI Categorization Total p
Underweight Normal Overweight Obese value
Religion Hindu 23 64 15 7 109
Buddhist 0 1 1 0 2 0.5
Total 23 65 16 7 111

Table21: Shows that there is no association between BMI and religion as the p-value
is 0.5 that is not less than 0.05.

35
Table 22: Association between BMI and weight
BMI Categorization Total p
Underweight Normal Overweight Obese value
35 1 0 0 0 1
38 1 0 0 0 1
40 2 1 0 0 3
43 0 1 1 0 2
44 1 0 0 0 1
45 6 3 0 0 9
46 1 2 1 0 4
47 0 1 0 0 1
48 1 2 0 0 3
49 2 2 0 0 4
50 2 5 0 0 7
52 0 1 0 0 1
53 0 2 0 0 2
54 0 2 0 0 2
weight 55 2 5 1 0 8 0.038
56 0 1 0 1 2
57 0 1 0 0 1
58 1 3 0 1 5
59 0 1 0 0 1
60 1 5 0 0 6
62 0 2 0 0 2
63 0 1 0 0 1
64 0 0 3 0 3
65 0 7 2 0 9
67 0 0 1 0 1
68 0 3 1 0 4
70 1 3 1 0 5
72 1 3 0 1 5
73 0 1 0 0 1
75 0 4 1 1 6
77 0 0 1 0 1
78 0 1 2 2 5
80 0 2 1 0 3
120 0 0 0 1 1
Total 23 65 16 7 111

Table 22: Shows that there is association between BMI and weight as the p-value is
0.038 that is less than 0.05.

36
CHAPTER V: Discussion
This Descriptive cross sectional study shows the prevalence and associated factor
contributing to obesity among the schoolteachers of Rajbiraj, Saptari.
This study demonstrates that out of 111 respondents, 20.73 %( 23) were underweight,
58.55% (65) were normal, 14.42 %( 16) were overweight & 6.3% (7) were obese. A
few studies have been reported in Nepal. So there no more data for comparison on a
National level. However, one of study conducted in Nepal shows that prevalence of
overweight and obesity among adult women was 24.5% and 1.8% respectively
associated with vegetarian and non-vegetarian factors2.But this study shows that there
is no association between BMI and type of diet they had taken (vegetarian and non-
vegetarian).
The results on prevalence of overweight (14.42%) as similar at National level (24.4%)
but the prevalence of obesity was not high in comparison at National level (6.3%).
98.2% were Hindu; this study shows that there is no association between BMI and
religion. But the similar study was conducted in Urban India among women by
economic stratum showed that there is association between BMI and religion8.
43.2 % of respondents were graduates, 26.1 %( 29) had received master degree, 23.4
%26) had received higher secondary & 7.2 %( 8) had received secondary education
but this study shows no association between BMI and education as the p-value is
0.573 that is not less than 0.05.The similar study was conducted in Panamanian adults
also shows no association between BMI and education status5.
This study shows no association between BMI and sleeping hour/day. However, the
similar study was conducted among Jordanian women of Reproductive age shows
association between BMI and sleeping hour/day10.
The majority of respondent's 87.4% were involved in doing physical exercise
followed by very few i.e.12.6 % who were not involved in physical exercise but this
study shows that there is no association between BMI and physical exercise as the p-
value is 0.417 that is not less than 0.05. However, the similar was study conducted
among adult shows association between BMI and physical exercise13.
The majority of the respondent 73% were non-vegetarian but this study shows no
association between BMI and type of diet they had taken (Vegetarian or Non-

37
vegetarian). However, the similar study was conducted among adults of Tanzania
Department shows association between BMI and type of diet they had taken
(Vegetarian/ Non-vegetarian) 13.
44.1 % had monthly income between 5000-9000 and 8.1 % had monthly income
between 20000-24000 but this study shows no association between BMI and monthly
income as the p-value is 0.817 that is not less than 0.05. The similar study was
conducted among Panamanian also shows no association between BMI and monthly
income5.
74.8 % were married. This study shows the association between BMI and marital
status as the p-value is 0.047 that is less than 0.05. The similar study was conducted
among Jordanian women that also show the association between BMI and marital
status10.
This study shows that out of 111 respondents, the highest frequency is 9 which belong
to the weight of respondents i.e. 45 & 65 kg. The maximum weight of respondent is
120 kg & the minimum weight of respondent is 35kg. Hence, this study shows the
association between BMI and weight as the p-value is 0.038 that is less than 0.05. The
similar study was conducted among older adults that also show the association
between BMI and weight11.

38
CHAPTER VI: Conclusion and Recommendation
6.1 Conclusion
Overweight or obese sets in when there is a successive increase in body mass. Obesity
is quantified or measured using body mass index (BMI) which is calculated using the
weight & size of an individual. If the BMI is greater than or equal to 25kg/m2, a
person is considered as overweight, which is a condition associated with excessive fat.
The study shows, 70.2 % were doing physical exercise regularly & 29.8 % were doing
physical exercise irregularly. This study shows that there is no association between
BMI and physical exercise as the p-value is 0.417 that is not less than 0.05. 93.7% of
the respondents sleep less than 8 hours per day & 6.3 % of them sleep more than 8
hours per day. The majority of respondents i.e. 53.2 % had preferred milk tea & very
few of respondent's 5.4% had preferred green tea. This study shows no association
between BMI and type of tea they preferred, as the p-value is 0.081 that is not less
than 0.05.
99.1% used to take breakfast. The majority of respondent's 58% had taken fruits in
their breakfast. 33.95% of them usually take less rice more vegetables, 13.77% of
them take less vegetable more rice, 30.27%of them take rice & 22.01% of them take
bread. The majority of the respondent's 73% were non-vegetarian & remaining 27%
of them were vegetarian. This study shows no association between BMI and type of
diet they taken, as the p-value is 0.342 that is not less than 0.05. The majority of
respondent 44% used to preferred gravy cooked food & very few respondents used to
preferred readymade food. Only 17.1% of them used to take alcohol with meat and
the majority of them78.95percentage were social drinkers & remaining i.e.21.05%
used to take alcohol regularly. This study shows no association between BMI and
alcohol with meat they had taken, as the p-value is 0.265 that is not less than 0.05.
This study shows that the majority of them i.e. 68.5 % did not had habit of using junk
food & remaining of them 31.5% had habit of using junk food. This study shows that
there is no association between BMI and habit of using junk food, as the p-value is
0.086 that is not less than 0.05. 41.4% means of transportation were by walking & 4.5
% used Scooter as means of transportation. This study shows that BMI was not
associated with means of transportation they used, as the p-value is 0.132 that is not

39
less than 0.05. This study shows that 84% of respondent's health status was good. The
study shows that the majority of respondents 50.5% were measuring their weight
irregularly. 71% were measuring their weight in a month. 49.5% used to do exercise
when their weight increases. This study shows that 20.73 % were underweight,
58.55% were normal, 14.42 % were overweight & 6.3% were obese.
This study shows that there is no association between BMI and monthly income as the
p-value is 0.817 that is not less than 0.05. This study shows that there is no
association between BMI and education as the p-value is 0.573 that is not less than
0.05
This study shows the association between BMI and marital status as the p-value is
0.047 that is less than 0.05. This study shows no association between BMI and
religion as the p-value is 0.5 that is not less than 0.05. This study shows the
association between BMI and weight as the p-value is 0.038 that is less than 0.05.
The study concluded that majority of respondents were of normal weight and has
maintained healthy lifestyle.

6.2 Recommendation
 There is need to empower teachers to take decision that help to avoid obesity.
 A national program to prevent and control overweight and obesity with multi-
component interventions should be considered.
 There is need to increase the awareness of decision makers of the
consequences of overweight and obesity in order to promote legislation and
regulation that help to control and prevent overweight and obesity.
 A similar type of the study can be conducted in large scale to draw
generalization.

40
References/Bibliography

1) WHO, Obesity and Overweight 2012, May,


http://www.who.int/mediacentre/factsheets/fs311/en/(Cited in 20
December,2016)
2) Mandira shahi,laxmi rai, Raj Devi Adhikari, Muma Sharma, Prevalence and
factors associated with obesity among adult women of nepal, Global journal of
medicine and public health,2013;2(4).
www.gjmedph.com/uploads/O1-Vo2No4.pdf cited in 25 December,2016
3) Abhinav Vaidya,Suraj Shakya and Alexandra Krettek; "Obesity prevalence in
nepal:Public health challenges in low-income nation during alarming
worldwide trend". International journal of environmental research and public
health;2010 https://www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed
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4) Aryal M; Childhood obesity unrecognized public health challenge in nepal,
Kathmandu University Medical Journal,2010;(32):358.
www.kumj.com.np/issue/32/358-359.pdf cited in 10th Jan, 2017
5) Morris Sasson, Marcos Lee, Carmen Jan,Flavia Fontes,Jorge Matta;
Prevalence and associated factors of obesity among Panamanian adults, 2010.
journals.plos.org/plosone/article?id=10.1371/journal.pone.0091689 Cited in
15th feb,2017
6) Padhye SM: A study of BMI of Nepalese women attending Gynecology clinic.
J. Nepal Med Assoc 2007:46(168):185-188
https://www.ncbi.nlm.nih.gov/pubmed/18340371 cited in 20th Feb, 2017.
7) Department of Obstetrics and Gynaecology,KTM medical College Teaching
Hospital, KTM,Nepal.2007-oct-dec;46(168):185-188.
www.njcmindia.org/home/issue_download/4/1 cited in 23rd Feb, 2017
8) Jitendra Gouda and Ranjan kmar Prusty;Overweight and obesity among
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nutrition,2014 march;32(1):79-88.

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https://www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)
Cited in 2nd March, 2017
9) Abdulrahman O. Musaiger, DrPH,Ahmed A.AL-Mulla,DrPH, MaryamA.AL-
Mannai,PhD;Social lifestyle and health factors associated with obesity among
out patients in Qatar, 2016.
https://www.researchgate.net/.../265521496 Cited in 8thMarch,2017
10) Mohannad A1-Nsour,Ali Arboji;Obesity and related factors among Jordanian
women of Reproductive age based on three DHS surveys,2000-2012.ICF
International Rockville,Maryland,USA..
apps.who.int/iris/bitstream/10665/200009/1/9789241565110eng.pdf cited in
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and Joan Lindsay. ‘Prevalence and correlates of overweight and obesity
among older adults:Findings from the Canadian National population health
survey’.Journal of gerontology:medical science,2003,58A,(11): 1018-1030.
biomedgerontology.oxfordjournals.org/content/58/11/M1018.abstract cited in
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12) N.AL. Nsour,Gh.AL Kayyali and S.Naffa;Overweight and obesity among
Jordanian women and their social determinants.Eastern Mediterranean health
Journal,2013; 19(12).
www.emro.who.int/...vol-19 Cited in 23rd April, 2017
13) Grace A. Shayo and Ferdinand M.Mugusi;Prevalence of obesity and
associated risk factors among adult in Kinondoni municipal district,Dar es
salaam Tanzania.Department of internal medicine Muhimbili University of
health and allied sciences.BMC Public Health,2011
bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-365.Cited
in 25th April, 2017
14) P.A. Aryee, G.K. Helegbe, J.Baah,R.H.Sarfo-Asante and R.Quist-
therson;Prevalence and risk factors for overweight and obesity among Nurses
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https://www.ajol.info/index.php/jmbs/article/view/101910 Cited in 26th
April,2017
15) Norah N.AL.Qauhiz; obesity among Saudi female university students:Dietary
Habits and Health Behaviors. J Egypt Public Heath Association,2010; 8(1).
Cited in 2010 www.ncbi.nlm.nih.gov/pubmed/21073847 Cited in 27th
April,2017
16) Henock Blaise Nguendo Yongsi,Olivier Abondo Ngwa;Trends and risk factors
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Cited in 29th April,2017

43
Appendix

Consent form
Namaste! I am Ruby Das. I am student of Bachelor In Public Health from Koshi
Health and Science campus. I am going to do research on the topic-associated factors
contributing to obesity among the schoolteachers of Saptari Rajbiraj.The information
given by you will be strictly treated as confidential. All the mentioned information
will be used only for the research purpose. It depends on your wish to participate in
this survey or not. Would you be willing to participate?

1. Yes 2. No
….............
Signature

Annex 2: Questionnaire
Socio-economic & demographic information

1. Age
a. 15 to 19 b. 20 to 24 c. 25 to 29
d. 30 to 34 e. 35 to 39 f. 40 to 44
g. 45 to 49 h. 50 to 54 i. 55 to 59

2. Religion
a. Hindu b. Muslim c. Buddhist d. Christian

3. Education
a. Secondary b. Higher secondary
c. Graduates d. Master degree & above

4. Marital status
a. Married b. Unmarried

44
5. Monthly income status
a. 5000 to 9000 b.10000 to 14000 c.15000 to 19000
d. 20000 to 24000 e.25000 to above

6. At which level are you teaching?


a. Primary level b. Lower secondary level
c. Secondary level

Questions related to lifestyle & dietary habits leading to obesity

7. Are you doing physical exercise?


a. Yes b. No

8. If yes, how often do you do physical exercise?


a. Regular b. Irregular

9. How long time do you sleep a day?


a. Less than 8 hour’s b. More than 8 hours

10. What kind of tea do you prefer?


a. Milk tea b. Green tea
c. Lemon tea d. None

11. Do you take breakfast?


a. Yes b. No

12. If yes, then what do you take usually?


a. Carbohydrate b. Fruits

13. How many times do you take meals/day?


a. 1 b. 2 c. 3

45
14. Do you eat dinner?
a. Yes b. No

15. If yes, then what kind of food do you take usually?


a. Rice b. Bread
c. Less vegetables more rice d. Less rice more vegetables

16. Are you vegetarian or non- vegetarian?


a. Vegetarian b. Non- vegetarian

17. If you are non-vegetarian then how often do you eat meat in a week?
a. Daily b.Alternative day
c. Twice in a week d.Once a week

18. Which type of cooked food you prefer more?


a. Gravy b. Boiled c.Oily d.Readymade food

19. Do you take alcohol with meat?


a. Yes b. No

20. If yes, in what way do you take?


a. Regular Basis b. Social Drinker

21. Do you have habit of using junk food?


a. Yes b. No

22. General means of transportation using


a. Scooter b. Bi- cycle c. By- walking d. Bike

46
Other question related to factor associated with obesity

23. Self- rated health status.


a. Good b. Poor c. Unhealthy

24. What diseases are you suffering from?


a. Diabetes mellitus b. Obesity
c. Respiratory disease d. Hypertension e. No any

25. Are you taking any medication with preventive measures?


a. Yes b. No

26. Are you measuring your weight?


a. Regular b. Irregular

27. If regular, then how often do you measures your weight?


a.In a week b. In a month c. In a year

28. If your weight increases then in what way you modify dietary pattern?
a. Dieting b. Taking more veg items c. Taking junk food
d. Focus in exercise e. No any medication

29. If your weight decreases then what do you do in your eating habit?
a. Taking same pattern of food b. Taking more non-veg items

30. Weight of respondents in kg

31. Height of respondents in feet

32. BMI of Respondents

47
Work Plan

Activity Month (2073/74)

Poush

Magh

Falgun

Chaitra

Baisakh

Jestha

Ashardh
Literature review

Proposal
development

Proposal presentation
and finalization

Pre- testing
,Finalization of
questionnaire

Data collection

Data entry and


analysis

Report writing

Report submission

48
MAP OF NEPAL

MAP OF SAPTARI

49
MAP OF RAJBIRAJ

STUDY AREA

50
51
52
53
54
55
56

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