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Chapter I

THE PROBLEM AND ITS BACKGROUND

Introduction

The most important part of being a normal weight isn't looking a

certain way - it's feeling good and staying healthy; having too much body fat

can be harmful to the body in many ways.

The number of people who are obese is rising. About 1.2 billion

people in the world are overweight and at least 300 million of them are

obese, even though obesity is one of the 10 most preventable health risks,

according to the World Health Organization. In the United States, more than

97 million adults - that's more than half - are overweight and almost one in

five adults is obese. Among teenagers and kids 6 years and older, more than

15% are overweight - that's more than three times the number of young

people who were overweight in the 1970s. At least 300,000 deaths every

year in the United States can be linked to obesity.

A person with a Body Mass Index or BMI above the 95 th percentile

(meaning the BMI is greater than that of 95% of people of the same age and

gender) is generally considered overweight. A person with a BMI between

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the 85th and 95th percentiles typically is considered at risk for overweight.

Obesity is the term used for extreme overweight. There are some exceptions

to this formula, though. For instance, someone who is very muscular (like a

bodybuilder) may have a high BMI without being obese because the excess

weight is from extra muscle, not fat. People gain weight when the body

takes in more calories than it burns off. Those extra calories are stored as fat.

The amount of weight gain that leads to obesity doesn't happen in a few

weeks or months. Because being obese is more than just being a few pounds

overweight, people who are obese have usually been getting more calories

than they need for years.

But being obese and being overweight is not exactly the same thing.

An obese person has a large amount of extra body fat, not just a few extra

pounds. People who are obese are very overweight and at risk for serious

health problems, such as, Cardiovascular Diseases.

Obesity can run in families, but just how much is due to genes is hard

to determine. Many families eat the same foods, have the same habits (like

snacking in front of the TV), and tend to think alike when it comes to

weight. All of these situations can contribute to weight gain, so it can be

difficult to figure out if a person is born with a tendency to be obese or

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overweight or learns eating and exercise habits that lead to weight gain.

Obesity is bad news for both body and mind. Not only does it make a person

feel tired and uncomfortable, it can wear down joints and put extra stress on

other parts of the body. There can be more serious consequences as well.

Not all obese people are aware of the risks that come along with their

current health status. Aside from abnormal respiratory-related conditions,

which are inevitable, and kidney malfunctioning where hyper-filtration

occurs, and thus, tearing the kidneys apart, which is also a good indication of

a disease, cardiovascular disease is also present, though perceived in a

different manner.

BACKGROUND/ SETTING OF THE RESEARCH

Maintaining a healthy weight, clean living and staying physically

active are all important in preventing Cardiovascular Diseases.

Some inactive people believe that maintaining a healthy weight is

sufficient to prevent stroke from occurring. Other overweight people think

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that being physically active is enough to prevent the mentioned

phenomenon.

In one small study of men and women who had suspected heart

complications who were maintaining a physically active lifestyle and a

healthy diet, has normal blood pressure, not diabetic, and do not smoke were

less likely to suffer from Cardiovascular Diseases. Reducing the risk of

cardiovascular disease involves more than one factor. While maintaining a

normal body weight and regular physical activity are both important in heart

health, together they are a potent force in enabling people to live healthy

lives.

Obesity was barely recognized as a problem in the Philippines in the

early part of the 90's; surely not because it is non-existent in this part of the

world but because doctors & other health providers show not much interest

in this issue. The incidence of clinically severe obesity --- or simply the state

of exceeding the Ideal Body Weight (IBW) by 100 lbs. for males, or 80 lbs.

for females, is rising among Filipinos. Severe obesity refers to a Body Mass

Index (BMI) of >40 kg/m^2, the normal BMI being 19-25. Commonly

called morbid obesity, it gives rise to a host of diseases such as high blood
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pressure, diabetes, joint disease, high cholesterol, heart disease, pulmonary

problems, and reduced life expectancy.

Morbid obesity could develop to be one of the major health problems

in the Philippines unless serious steps are taken to arrest the rise of its

incidence or, better, prevent it altogether. "There are an estimated 500,000

Filipinos suffering from clinically significant obesity. It is especially

alarming to note that some of these patients are very young," says Dr.

Hildegardes C. Dineros, main proponent, Asian Bariatrics, an advocacy

group committed to create awareness on the problem of obesity.

Is this obesity trend seen in the third world as well? National statistics

on malnutrition show under nutrition as a major problem of developing

countries like the Philippines. However, this is fast changing. As Filipinos

adopt more of the western lifestyle and diet as reflected by the so-called

“McDonald’s index”, a segment of our population inevitably becomes

subject to the consequence of being overweight and finally obese. Based on

the data gathered from the NUTRISTAT Protocol at St. Luke’s Medical

Center (1999 – 2000), 34% of the total admitted patients are malnourished

and yet surprisingly about one-fourth of them are obese. There was more
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overweight (2/3) than undernourished (1/3) patients. These data may give us

an idea of how serious the problem is even in our country.

THEORETICAL FRAMEWORK

Dorothea E. Orem's Self-Care Deficit Nursing Theory:

The purpose of this paper is to inform the reader how Dorothea

Orem’s nursing theory has been used in research. Orem began developing

her theory in the 1950’s, a time when most nursing conceptual models were

based on other disciplines such as medicine, psychology and/or sociology

(Fawcett, 2000).

Orem’s theory is a three-part theory of self-care. The three theories

that make up the general theory are: Self-Care, Self-Care Deficit, and

Nursing Systems. The Self-Care theory states that adults deliberately learn

and perform actions to direct their survival, quality of life, and well-being.

Self-Care Deficit theory states that nursing is required because of the

inability to perform self-care as the result of limitations. Nursing Systems

theory is the product of nursing in nursing system(s) by which nurses use the
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nursing process to help individuals meet their self-care requisites and build

their self-care or dependent-care capabilities. These three theories form the

overall Self-Care Deficit Theory. (Alligood & Tomey)

Due to enumerable factors, obesity has come into a wide range due to

people’s lack of sense of responsibility when it comes to handling their diet

and maintaining a healthy lifestyle. Some tend to overeat without taking into

consideration the nutrition that they acquire and the effects of the food they

are eating to their bodies. They became prone to heart diseases, including

cardiovascular disease, without being aware of it. This is due to lack of

knowledge and discipline regarding such matters that affect their health and

well being.

CONCEPTUAL FRAMEWORK

It showed that obesity was a significant predictor of CVD, particularly

among women. It also showed that weight gain in the young adult years

produced an increased risk for CVD in both men and women. Some of the

most interesting studies that show obesity itself cause an increase in the risk

of CVD come from examining the hearts of obese people. The confusion
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that can occur in a discussion of obesity and CVD relates to the fact that

poor fitness also increases the risk of CVD. Since poor fitness can often

result in obesity, it is assumed by some that fitness is the overriding issue,

and the association between CVD and obesity is, in reality, simply the

association between poor fitness and CVD. Of course, unfit men as a whole

were significantly more likely to die of CVD than fit men. Thus, even

though a lack of fitness is clearly a risk factor for CVD, once fitness is taken

into account, obesity still plays a role. In fact, the authors conclude that a

lack of fitness represented only 39% of the CVD risk in obese men. A lack

of fitness adds to overweight and obesity. In other words, fitness and obesity

are independent risk factors.

Active men with high BMI had a 35% higher CVD hazard ratio than

active men with low BMI. Of course, the active men and women all had

lower CVD hazard ratios than the inactive men and women. This, of course,

tells us that obesity and physical inactivity are both independent risk factors

for CVD. This is why the authors note; “In conclusion, our study confirmed

that both physical inactivity and obesity are important risk factors for CVD.”
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Although habitual physical activity is an effective strategy for

preventing CVD, elevated body fatness is associated with an adverse CVD

risk factor profile independently of aerobic fitness.”

As you can see, then, obesity is an independent risk factor for CVD.
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RESEARCH PARADIGM

INPUT
Demographic Profile:
• Age
• Gender
• Height
• Weight
• Religion
Obese person handle their physical status with regards to:
• Exercise
• Daily Routine
Factors and how they contribute on development of obesity in terms of:
• Physiological factors
• Environmental factors
Obese person perceive their level of awareness with regards to:
• Risk of having Cardiovascular Disease
Problems that an obese person may encounter with regards to:
• Daily Living
Preventive practices of obese person in regards to:
• Prevention of risk factors
• Health education to patient

PROCESS
Analysis of input data
Gathering of data
• Questionnaire

OUTPUT
Increase the level of awareness of health care management of obese person with the risk
of having Cardiovascular Disease

Figure 1: The Research Paradigm

The level of awareness of the obese person with the risk of having Cardiovascular
Disease
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STATEMENT OF THE PROBLEM

The purpose of this study is to determine the level of awareness of the

obese person with the risk of having Cardiovascular Disease.

Specifically the study aims to find the answer to the following

questions:

1. What is the profile of the respondent as to:

1.1 Age

1.2 Gender

1.3 Height

1.4 Weight

1.5 Religion

2. How do obese person handle their physical status with regards to:

2.1 Exercise

2.2 Daily routine

3. What are the factors and how they contribute on development of

obesity in terms of:

3.1 Physiological factors

3.2 Environmental factors

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4. How do obese person perceive their level of awareness about the risk

of having Cardiovascular Disease?

5. What are the problems that an obese person may encounter with their

daily living?

6. What practices are the obese person does to improve their health

status to prevent themselves of having Cardiovascular Disease?

IMPORTANCE OF THE STUDY

This will be great relevance to the following person and entities:

Nursing Students:

This study will help the nursing students to guide them in becoming

prepared when dealing with obese person high risk in cardiovascular disease.

This further helps them to improve their nursing process such as assessment,

planning, intervention and evaluation. This study will also create awareness

to the nursing students to be more participant with determination as the

member of health care team. This will help to their performance in

implementing possible health status. And help those obese persons to control

cardiovascular disease.
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Families and Significant others:

To the families of obese person, participation of health teaching will

provide information they need actively participate or cooperate in such

activities related to their health and daily a living. This will further help and

guide them developing their skills for carrying themselves. And this study

provides awareness to the public.

Obese Persons:

The must benefited one of this study will be the obese person because

improving themselves may hopefully realize they are those people who are

high risk in cardiovascular disease. This study will help them to control and

cope with the preventive measure and prioritize the aspect of care.

SCOPE AND LIMITATION

This study focuses on the analysis of obese person high risk in

cardiovascular disease.

The respondent of this study are those twenty obese nursing students

from Arellano University Legarda Street, Manila from second year to forth

year ages between 15-23 years old. The aspect looked into were the severity

of the obesity problem. The respondent will contribute to the study as they
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shared their ideas on what the present generation presumption about obesity.

By the researcher would have an idea how obesity is a risk

DEFINITION OF TERMS

Arteriosclerosis

A disease process, commonly called hardening of the arteries, which

includes a variety of conditions that cause artery walls to thicken and lose

elasticity.

Weight

A measure of the heaviness of an object or the force with which a

body is attracted to Earth or another celestial body, equal to the product of

the object's mass and the acceleration of gravity.

Height

The distance from the base of something to the top.

Body Mass Index (BMI)

Indicates whether weight is appropriate for height.

Cardiac Arrest

The cessation of hearth function.

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Cardiovascular Disease

Any abnormal condition characterized by dysfunction of the heart or

blood vessels such as arteriosclerosis, rheumatic heart disease and systemic

hypertension.

Cardiac Output

The amount of blood related by the heart with each ventricular

contraction.

Hypertension

Blood pressure above the normal range.

Hypotension

Lowered blood pressure

Obese Body (Obesity)

Weight greater than 20% of ideal for height and frame.

Overweight

A body mass index of 26-30 kg/m

Rheumatic Heart Disease

Rheumatic Fever can lead to a condition known as rheumatic heart

disease. This is usually a thickening and stenosis of one or more of the heart

valves and often requires surgery, to repair or replace the involved valve
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Chapter II

REVIEW OF RELATED LITERATURE AND STUDIES

The rapid rise of degenerative diseases and health problems had

brought a considerable change on the health status of different nations.

These instances prompted the researcher to review and conduct studies about

obesity to prevent the spreading problems over and within the countries.

Related Literature

In this portion, local and foreign researchers had been reviewed to

contribute on finding solution to solve the problem brought about by obesity

in youngsters, as the situation and its consequences still prevail at present.

Foreign Literature

Literature 1

Obesity has reached epidemic proportions, says Davy, citing some

very telling statistics. "Approximately 65 percent of the population is

considered to be overweight and 31 percent is considered to be clinically

obese." Individuals are considered to be clinically obese if they have a body

mass index (BMI) of greater than 30. BMI is a measurement of body fat
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content found by dividing an individual's weight in kilograms by their height

in meters squared. Overweight and obese individuals are at increased risk of

developing heart disease, high blood pressure, stroke, diabetes, and many

forms of cancer. However, there is considerable variability in the

relationship between obesity and chronic disease. Individuals with an

"apple," or abdominal, fat distribution pattern are at a substantially higher

risk of developing cardiovascular and metabolic diseases compared with

those with a "pear," or lower body, fat distribution pattern. Big hips are

better than a big stomach.

Davy initially became interested in obesity while conducting

postdoctoral research at the University of Colorado in the area of aging and

cardiovascular physiology. "We always excluded people who were

overweight because it was our impression that they would somehow

confound our understanding of how aging influenced the cardiovascular

system. I became intrigued with understanding how the people we were

excluding differed in their physiology."

Since 1999, Davy's research has been focused on determining the role

of body fat distribution patterns on the sympathetic nervous system (SNS),

that part of the nervous system that speeds the heart, contracts blood vessels,
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and initiates other physiological reactions to mobilize the body for action in

response to stress. The sympathetic nervous system plays a critical role in

metabolism and cardiovascular physiology.

Literature 2

Coronary heart disease (CHD) is the leading cause of mortality in the

United States. Hypertension, diabetes mellitus, hypercholesterolemia, and

smoking have all been directly related to CHD. Obesity is on the rise in the

United States and has also been associated with CHD. This review clearly

establishes obesity as an independent risk factor for CHD as demonstrated

by the Framingham Heart Study, Nurses' Health Study, Buffalo Health

Study, and the Cancer Prevention Study II. Morbid obesity was found to

correlate with a significant risk of mortality from CHD, especially in young

men. Prevention of obesity, and therefore reduction in risk from

cardiovascular disease, is paramount in the management of obesity. New

approaches to behavioral, medical, and surgical management of obesity are

reviewed, including thalidomide, an antiangiogenic agent. A primary and

secondary prevention model details a multidisciplinary approach to reducing

risk in obesity.
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Cardiovascular disease (CVD), especially coronary heart disease

(CHD), is the number one cause of mortality in the United States. During the

years 1987-1994, mortality from CHD decreased, but the incidence of

myocardial infarction has remained constant among whites and has

increased in blacks, especially women. This suggests an improvement in

treatment, but a decline in prevention. Obesity is on the rise in the United

States and there is strong evidence to indicate obesity as a risk factor for

CVD. This may be independent of or secondary to hypertension, diabetes, or

hypercholesterolemia. This review considers obesity as an independent risk

factor for CHD, and then compares morbid obesity vs. nonmorbid obesity as

a risk factor for mortality in CHD.

The studies used in this review include the Framingham Heart Study,

Nurse's Health Study, Buffalo Health Study, and the Cancer Prevention

Study II, which identify obesity as an independent risk factor for CHD. The

Dusseldorf Study documents an increased risk of mortality in morbidly

obese individuals. The sample population in the majority of these studies

included only white Americans; although African Americans have an

increased incidence of type 2 diabetes mellitus and hypertension, there was

no statistically significant difference in mortality due to obesity when

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compared to whites. Therefore; this paper will concentrate on obesity as it

relates to mortality from CHD.

Due to the rising trend of obesity and therefore life-threatening CHD

in the United States, we will explore treatment options and new theories in

prevention. A hypothetical model of the prevention and treatment of obesity

is proposed.

Literature 3

To assess obesity as a predictor of mortality, it is imperative to first

establish obesity as an independent risk factor for CHD. The following are

four large studies that document a strong association between obesity and

CHD.

Clearly, obesity is a problem that is reaching epidemic proportions in

the U.S., with nearly 70% of adults being classified as overweight or obese

compared with fewer than 25% 40 years ago. Although too often obesity is

viewed as a cosmetic problem as opposed to a major health concern, there is

no question that obesity places a "heavy" burden on the entire cardiovascular

system, contributing to considerable overall morbidity and mortality, a fact

that was even recognized by Hippocrates centuries ago. In fact, recent

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evidence indicates that obesity is associated with more morbidity than

smoking, alcoholism, and poverty, and if current trends continue will

account for over 300,000 deaths annually in the U.S., thus overtaking

cigarette abuse as the leading preventable cause of death.

Obesity has adverse effects on several coronary artery disease (CAD)

risk factors. Obese patients are more likely to be hypertensive than lean

patients, and weight gain is typically associated with increases in arterial

pressure. However, independent of arterial pressure, obesity increases the

risk of left ventricular hypertrophy (LVH), particularly of the eccentric type.

Obesity also adversely affects plasma lipids, especially increasing

triglycerides and decreasing the cardio protective levels of high-density

lipoprotein cholesterol, and is the major contributor to adult-onset diabetes

mellitus and the insulin resistance syndrome (now called metabolic

syndrome), which are associated with high levels of inflammation and

overall cardiovascular mortality. Despite adversely affecting these risk

factors, including markedly increasing levels of high sensitivity C-reactive

protein, data from both the Framingham Heart Study and a large cohort of

U.S. nurses have indicated that obesity is an independent risk factor for

major CAD events in men and, particularly, in women.

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In addition to increasing eccentric LVH and the propensity for more

complex dysrhythmias, obesity also has adverse effects on cardiac function.

Diastolic abnormalities occur with all types of LVH, with the most marked

abnormalities occurring in those with both obesity and hypertension,

especially in those with left atrial abnormality by electrocardiogram.

Although preload dependent indices of systolic function (e.g., ejection

fraction) remain preserved early in obesity, preload independent indices (e.g.,

end-systolic stress/end-systolic volume index) demonstrate reduced

contractility early in obesity. Alpert et al. have confirmed the adverse effects

of significant obesity on both diastolic and systolic ventricular function. In a

study of 74 morbidly obese patients, Alpert et al. demonstrated that nearly

one-third had clinical evidence of heart failure, and the probability of HF

increased with increasing duration of morbid obesity. At 20 and 25 years of

obesity duration, the probability of HF was 66% and 93%, respectively. A

recent epidemiologic study from the Framingham Heart Study indicates that

being overweight and obesity are potent predictors of subsequent clinical HF.

Literature 4
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In an article written by Mike Adams, he argued that Diabetes and

Obesity are diseases, thus, natural results in a person making extra poor

decision about food choices and physical exercise. It's something that can be

reverse in virtually 100% of the cases by changing these two simple things.

As a result, it rests firmly under the control of the patient, especially if they

are educated about health nutrition and to make intelligent choices about

what kinds of food and grocery products they consume. To call obesity a

disease as a "dumbing down" of the very idea if what a disease is.

Unfortunately, it implies that the patient is helpless to do anything about it.

This idea is reinforced by language of doctors and health care providers who

say things such as "Oh, you are obese," which sounds like you've been

afflicted with some external invader that took over your health and make

you powerless in doing something about it.

In an article in the current policy of review, Mary Eberstad, a research

fellow at the Hoover Institution at Stanford University, wrote, "Nothing is as

firmly established in the at literature as the fact that watching TV and

overweight children go hand and hand. The more TV a child watches, the

more likely he is to get fat. "In a list of nine strategies set in 2000 to fight

obesity, Surgeon General David Satcher listed, "Reduce time spent watching
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TV and other sedentary behaviors". (By the way, none of the strategies

involved advocating fewer trips to fast food restaurants). After all,

McDonald's offer such as grilled chicken Caesar salad with fat-free herb

vinaigrette dressing: a total of 135 calories. The dinner makes the choice.

A study of Minneapolis- St. Paul area published in the American

Journal of Public Health described 93% of the a Carte School sold to

students as "food to limit". In the school where they sold, students ate fewer

fruits and vegetables and consumed more calories from fat and saturated fat

than health guidelines encourage.

Local Literature

Literature 1

In a article prepared by the Office of Secretary of Department of

Health (2007). It was mentioned that the entire health sector has to face

many challenges in the Philippines health situation. In appropriate health

care delivery system, inadequate regulatory mechanism and poor health care

health financing including the increasing the prevalence of cardiovascular

disease, cancer and diabetes are the major problems faced by the health

sector. A health sector reform agenda has been developed to address the need
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to institute changes in the way health care is delivered; regulated and

financed that would bring the country towards its national goal and

objectives for health and the realization of the common vision of health for

the Filipinos.

Literature 2

In the Philippines, Dr. Augusto D. Litonjua, stated a private group that

in an informal survey of doctors, 25% of patients were overweight. He

blamed what he called “malling”, which he defined as spending the day in

shopping malls in eating at fast-food restaurants. Even as they eat, however,

many of these people long to be slim. As in the west, the bloating of Asia has

been accompanied by a slimming of the ideal of beauty. As American fast-

food chains spread through Asia they were being followed by a proliferation

of gyms, slimming programs, diet pills and liposuction.

Literature 3

In an article published recently in Lifestyle magazine, Dr. Sioksoan

Chan-Chua, President of Philippine Society of Pediatric Metabolism and

Endocrinology (PSPME), said that there is currently an epidemic of Type 2

Diabetes among children and adolescents and much of this is attributed to

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arise in number of obese children. "Type 2 Diabetes is no longer adult-onset

only, the condition is becomingly common in young people below 2 years

old and during pubertal years," she said.

UP-PGH Medical Center, lead by Dr. Antonio Dads identifies obesity

as one of the prevailing risk factors that contribute proportion on diseases as

coronary heart disease and stroke.

Overweight children are at risk of developing medical problems that

effect a child's present and future health and have direct impact on quality of

life including:

• High blood pressure, high cholesterol and abnormal blood lipid levels,

insulin resistance, and type 2 diabetes.

• Bone and joint problems

• Shortness of breath that makes exercise, sports or any physical

activity more difficult and may aggravate the symptoms or increase

the chances of developing asthma.

• Restless or disordered sleep pattern

• Tendency to mature earlier (overweight kids may be taller and more

sexually mature than their peers, raising expectations that they should
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act as old as they look, not as old as they are; overweight girls may

have irregular menstrual cycle and have fertility problems in

adulthood)

• Liver and gallbladder disease

• Depression

Risk factors present in childhood (including high blood pressure, high

cholesterol, and diabetes) can lead to serious adult medical conditions like

heart disease, heart failure and stroke. Preventing or treating obesity in

children may reduce the risk of developing these conditions, as they get

older.

Literature 4

Endocrinologist, Agusto Litonjua, emeritus professor at the University

of the Philippines College of Medicine (UPCM) says that the fat cells

(adipocytes) in the intraabdominal area are not just storage sites for excess

energy but constitute an active endocrine gland that responds to signals from

higher centers in the brain through the autonomic nervous system and other

endocrine tissues.
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He added, despite the anatomical similarities of adipocytes throughout the

body, adipocytes in the intraabdominal location have a different function and

are responsible for giving humans greater risk for chronic diseases.

Prof. Cynthia Manabat of the UPCM, cited that there exist adiposity

signals that are involved in a mechanism used by the body to know whether

it is “fat” or “thin”. This model explains why despite irregular meals or

irregular physical activity over time, the body has a mechanism for

maintaining body weight. Through this process, energy intake is balanced

with energy expenditure over time. If fat stores in the body decrease this

change is sensed by adiposity signals that will inhibit catabolic and stimulate

anabolic processes, decrease energy expenditure, and make the body

increase food intake to maintain energy balanced. If the fat stores increase,

this change will be sensed by adiposity signals telling the CNS, to initiate

the catabolic and inhibit anabolic processes. This causes an increase in

energy expenditure and the CNS will dictate the body to decrease food

intake to restore energy balanced.

Dr. Eva Cutiongco, assistant professor at the University of the

Philippines-Philippine General Hospital, says recent data suggest that

genotype and ethnicity affect the response of people to certain diets.

Through nutrigenomics, the effects of molecular inputs like nutrients and

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their influence over a persons genes and gene formation expression are being

studied. She also says nutrigenomics advances the view that under certain

circumstances, diet may be a risk factor for disease and influence health and

disease susceptibility depending on an individuals genetic make-up; dietary

chemicals can alter gene expression and change the genome structure; diet

genes regulated by diet also play a role in chronic diseases; and intelligent

nutrition may prevent, mitigate, or even cure chronic diseases.

Related Studies

Many studies had been conducted both in local and foreign countries

that are related to the problems brought by obesity. This portion provides

information that is relevant and helpful to the different phase of the problem

at hand.

Foreign Studies

Study 1
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According to the study, which has founded by the USDA's

Agricultural Research Service, focused on the relationship between reading

nutrition labels and percentage calorie intake from fat, 301 adolescents aged

10 to 19. Teen boys who actually do read the labels tend to eat more protein

and fat than those who don't. Dietary fat intake in the U.S. adolescents has

been found to be about 3.5% which is at the higher and if the recommended

20% to 35% range for daily fat intake (depending on a person's metabolism).

In Berkley teenage study of 1961-65, Ruth Lois Huenemann studied

the eating habits, body composition and physical fitness of nearly 1,000

students and found out that the tendency toward obesity begins well before

adolescence. That study led her in 1969 to organize another longitudinal

research effort, the Berkley Preschool Nutrition Study, which began with a

group of 447 babies and tracked their development to the age of 6.

Huenemann sought "The key to understanding when obesity starts,"

said Leona R. Shapiro, a retired assistant professor of public health nutrition

who helped design the teenagers study. "In her studies, particularly the two

longitudinal studies, she got detailed information about how children eat and

their physical exercise activity, their body composition, and their

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relationship with their parents. All kinds of details that had not been

organized on that way. She got into details of how they lived," Shapiro said.

Shapiro recalled that one of the most surprising findings from the

teenagers study was that adolescence was too late to study the onset of

obesity. Children who tended to be overweight were already obese by 14.

Signaling the encroachment of television and the growing dependence on

cars for transportation, Hueneman found that physical inactivity in infancy

and early childhood was a more critical factors for obesity that excessive

calorie consumption. The studies also provided solid evidence that obesity

was related to the income level. Prior to Huenemann's research, people

commonly believed that obesity was a problem of the overfed rich, but she

showed the inverse to be true. Among children and teenagers, the poor were

far more likely to have serious weight problems.

Study 2

RA DeFronzo and E Ferrannini of the University of Texas Health

Science Center, San Antonio (2006) said that; The reasons for the

association of insulin resistance and essential hypertension can be sought in

at least four general types of mechanisms: Na+ retention, sympathetic

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nervous system over activity, disturbed membrane ion transport, and

proliferation of vascular smooth muscle cells. Physiological maneuvers, such

as calorie restriction and regular physical exercise, can improve tissue

sensitivity to insulin; evidence indicates that these maneuvers can also lower

blood pressure in both normotensive and hypertensive individuals. Insulin

resistance and hyperinsulinemia are also associated with an atherogenic

plasma lipid profile. Elevated plasma insulin concentrations enhance very-

low-density lipoprotein (VLDL) synthesis, leading to hypertriglyceridemia.

Progressive elimination of lipid and apolipoproteins from the VLDL particle

leads to an increased formation of intermediate-density and low-density

lipoproteins, both of which are atherogenic. Last, insulin, independent of its

effects on blood pressure and plasma lipids, is known to be atherogenic. The

hormone enhances cholesterol transport into arteriolar smooth muscle cells

and increases endogenous lipid synthesis by these cells. Insulin also

stimulates the proliferation of arteriolar smooth muscle cells, augments

collagen synthesis in the vascular wall, increases the formation of and

decreases the regression of lipid plaques, and stimulates the production of

various growth factors.

Study 3
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Ralph S. Paffenbarger, Jr, MD, DrPH and Steven N. Blair, PED

(2005) said that; overweight and obese men with baseline CVD or CVD risk

factors were at higher risk for all-cause and CVD mortality compared with

normal-weight men without these predictors. Using normal-weight men

without CVD as the referent, the strongest predictor of CVD death in obese

men was baseline CVD RR’s for obese men with diabetes mellitus, high

cholesterol, hypertension, smoking, and low fitness were similar and ranged

from 4.4 for smoking to 5.0) for low fitness. Relative risks for all-cause

mortality in obese men ranged from 2.3 for men with hypertension to 4.7 for

those with CVD at baseline. Relative risk for all-cause mortality in obese

men with low fitness was 3.1 and in obese men with diabetes mellitus 3.1

and as slightly higher than the RR’s for obese men who smoked or had high

cholesterol levels. Low fitness was an independent predictor of mortality in

all body mass index groups after adjustment for other mortality predictors.

Approximately 50% of obese men had low fitness, which led to a

population-attributable risk of 39% for CVD mortality and 44% for all-cause

mortality. Baseline CVD had population attribute risks of 51% and 27% for

CVD and all-cause mortality, respectively.

Study 4
 34

Beckley (2005) said that; The idea of metabolic syndrome as a cluster

of variables—such as obesity, hypertension, low HDL, high triglycerides,

and impaired fasting plasma glucose—whose presence increases a person's

risk of cardiovascular disease has attracted great interest but also raised

many questions and controversy," says David Eddy, MD, PhD, medical

director of Archimedes, Inc. ADA partnered with Archimedes last summer to

build Diabetes PHD, a risk calculator that simulates the biology underlying

diabetes as well as factors such as co-morbidity risks, medications, and

treatments. ADA now has asked Eddy and his team to use the Archimedes

model to develop the CMR Calculator, a new, interactive tool that by the end

of the year will be available to help physicians evaluate the potential impact

of variables related to CVD risk. Archimedes already includes factors such

as body mass index, waist circumference ratio, fasting plasma glucose, blood

pressure, HDL, and triglycerides, as well as age, sex, race/ethnicity, family

history, tobacco use, LDL, apolipoprotein B, and C-reactive protein.

Simulations of new clinical trials and epidemiological and cohort studies are

used to validate the model and compare predictions with results.

 35

Study 5

Scott M. Grundy, MD, PhD (2005) said that; it appears that 50% of

children who are overweight are also overweight as adults, but it is not

possible to identify any individual child who will become an overweight

adult. CVD risk factors, such as elevated blood pressure, elevated total

cholesterol and LDL cholesterol, and low levels of HDL cholesterol track

from childhood, although less strongly than BMI. Overweight children also

tend to have a cluster of risk factors. Risk factors tend to occur in families

and are especially evident in children when an adult relative is obese.

Children with a family history of CVD are heavier than those without family

history of disease. All of this suggests that the obese child has an elevated

risk of developing CVD in adulthood. Weight gain occurs differently in men

and women. The greatest weight gain in men occurs in those with the highest

BMI and those in the older age groups. Compared with women, men live

longer and are obese later in life. In women, the greatest weight gain is in the

younger age groups. Recent epidemiological studies have shown that in

women, weight loss is also accompanied by bone loss. Another difference in

weight gain between men and women is that as women's educational level

rises, obesity decreases, for both white and black women, whereas in men,

educational level appears not to be related to obesity.

 36

Local Studies

Study 1

In the study conducted by FNRI in 1998, it was found out that among

preschool age children (0-5 yrs. old) 9 of every 1000 are overweight for their

height: 1 in every 1000 children are overweight: and 2 in every child, less

than 1 year old are overweight for their height. Among children 6-10 years

of age, prevalence of overweight is negligible among 6-9 year old children

while 2 in every 1000 children are overweight. Among adolescents, 11-19

years old, the female adolescents are more at risk to overweight and obesity

(4.7%) than their male counterpart (1.2%).

In the Philippines, Dr. Augusto D. Litonjua, who heads the Philippine

Association for the Study of Overweight, a private group, said that in an

informal survey of doctors, 25% of patients were overweight. He blamed

what he called "malling", which he defined as spending the day in shopping

malls and eating at fast food restaurants. Even as they eat, however, many of

these people long to be slim. As in the west, the bloating of Asia has been

accompanied by a slimming of the ideal of beauty. As American fast food

chains spread through Asia, they were being followed by a proliferation of

gyms, slimming programs, diet pills and liposuction.

 37

Study 2

Reyela (200) revealed that the common CVD for obese patient are

hypertension which is a persistnt elevation of the arterial blood presure with

a systolic blood pressure above 140 mmHg of the diastolic pressure above

90 mmHg, coronary artery disease, cerebrovascular accident and ischemic

heart disease which is caused by occulation of the coronary arteries by

thrombus formation in areas of narrowing and hardening in these arteries.

Study 3

The same view is held by Alcantara (2000) who emphasized that CVD

have become the greatest threat to Filipino today.

Study 4

Bermudez (2001) study reveals that CVD have varied and multi

causes and risk factors, ranging from infectious agents, environmental and

constitutional causes, some inherited some acquired.

Study 5

According to Dequina (2000), disease of the cardiovascular system is

the most rapidly escalating disease problems of the country today.

 38

Study 6

Study of Janairo (2001) reveals that obese patients have a markedly

increased evidence of CVD. it is suggested that the increased workload of

the heart where obesity may be a significant factor

 39

Chapter III

RESEARCH METHODOLOGY

The descriptive method of research was used in this study. Descriptive

method of research is a fact – finding study with adequate and accurate

interpretation of findings. It describes with emphasis what actually exist

such current conditions of group of persons, situations and involves analysis.

Since the study was concerned on knowing the level of awareness of

obese persons with the risk of having cardiovascular diseases, the

descriptive method of research was the appropriate method used. This

includes collection of data in order to answer questions concerning current

status of the subject of the study.

METHOD USED

The data for this study were gathered through the use of the

questionnaire. This was supplemented by interview and observation of

different computer classes.

Questionnaire

The main instruments used in conducting the study and to collect data

for the study were the questionnaires. This was used because it gathers data
 40

transfer than any other method. Besides, the respondents were students, and

they are literate, they could read and answer the questions with ease.

Constructions

The researchers gathered necessary details on literature and books

including dictionaries, encyclopedia, articles, magazines, etc. which should

be included in the study. These data are more convenient to use because they

are already condensed and organized. The libraries make this data more

easily accessible to researchers.

Additional information was also gathered from other reliable sources

as the internet, which enriched the questionnaires that was prepared.

Validation

The data were gathered on selected representatives of College Nursing

students of Arellano University through the used of survey questionnaires

specifically for the study. Gathered information was analyzed and

considered to arrive at accurate and reliable result of this study.

 41

Administration

The researchers distributed the questionnaire to 20 obese nursing

students of Arellano University. This was retrieved at a given time set and

agreed by both the respondents and the researchers.

Interview

Interview was one of the techniques used in gathering data for the

study; a purposeful information interview was conducted to selected nursing

students of Arellano University which are the respondent of the study. The

researchers approached and interviewed the students to enable for them gain

insights related to the study.

Observation

To enable the researchers to gather sufficient data to supplement and

verify information’s gathered through questionnaire and interview on obese

nursing students of Arellano University, observation method was also used.

This was employed using the senses to gather relevant information about

obesity.
 42

RESPONDENTS OF THE STUDY

The respondents of the conducted study regarding obesity awareness

are twenty obese nursing students of Arellano University of school year

2006 – 2007.

SAMPLING PROCEDURE

Twenty obese nursing students of Arellano University were taken for

school year 2006 – 2007, with the use of Random sampling procedure.
 43

Chapter IV

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

Table I

DISTRIBUTION OF RESPONDENTS IN TERMS OF AGE

Age Number of Respondents Percentage (%)

21 – 23 4 20.00
18 – 20 13 65.00
15 – 17 3 15.00
TOTAL 20 100 .00

As shown in Table I the distribution of respondents in terms of age,

the majority of the respondents which is thirteen or sixty five percent

belongs to 18 – 20 yrs. old, four or twenty percent belongs to 21 to 23 yrs.

old, and three or fifteen percent respondents belongs to age bracket between

15 – 17 yrs. old.

Table II
 44

DISTRIBUTION OF RESPONDENTS IN TERMS OF GENDER

Table II shows the distribution of respondents in terms of gender, the

Gender Number of Respondents Percentage (%)
Male 10 50.00
Female 10 50.00
TOTAL 20 100.00
male population is fifty percent which is a total of ten, and so in females.

Gender in this case, has not been a very strong risk factor for obesity.

People might be obese no matter what gender they do have.

Table III

DISTRIBUTION OF RESPONDENTS IN TERMS OF HEIGHT

 45

Table III exhibits that sixteen or eighty percent of the total number of

respondents, which is evidently the majority, belongs to 5’0” – 5’5” height

Weight
Height (kg) Number of Respondents Percentage (%)
5’6”
99 -–above
5’11” 2 10.00
5’0”
89 – 98
5’5” 16
6 80.00
30.00
4’6”79 –- 4’11”
88 41 20.00
5.00
4’0”
69 –– 78
4’5” 41 20.00
5.00
59 – 68
TOTAL 20 4 20.00
100.00
TOTAL 20 100.00
bracket. Ten percent or two of which are 5’6” – 5’11” in height, while those

who belong to the height bracket of 4’6” – 4’11” and 4’0” – 4’5” are equally

five percent.

Height is a crucial factor for getting the Body Mass Index of a person,

and therefore being able to determine if a person is obese or not. But in this

case, people of normal height range still became susceptible to having

weight problems, and this concludes that physical appearance is not enough

in determining a health condition per se.

Table IV

DISTRIBUTION OF RESPONDENTS IN TERMS OF WEIGHT

 46

This table presents the weight of the respondents, that six or thirty

percent of them belongs to the weight bracket of 89 – 98 kilograms which is

considered to be the highest, while the rest of them which have four or

twenty percent belongs to the weight bracket 79 – 88 kilograms, 69 – 78

kilograms and 59 – 68 kilograms that have the same number and percentage.

According to the BMI weight status categories, anyone with a BMI

Religion Number of Respondents Percentage (%)
Roman Catholic 19 95.00
Iglesia ni Kristo 1 5.00
TOTAL 20 100.00
over 25 would be classified as overweight and anyone with a BMI over 30

would be classified as obese. Although some people with a BMI in the

overweight range (from 25.0 to 29.9) may not have excess body fatness,

most people with a BMI in the obese range (equal to or greater than 30) will

have increased levels of body fatness.

And thus, may be concluded that obesity may not be definite unless

clinically diagnosed even after physical assessment.

Table V

DISTRIBUTION OF RESPONDENTS IN TERMS OF RELIGION

As shown in the table above, it shows the distribution of religion of

the respondents, that majority of them are Roman Catholic which have
 47

nineteen or ninety five percent of the total number of the respondents while

only one or five percent for Iglesia ni Kristo.

Regardless of religion, obese still have a high risk of having

cardiovascular disease.
Exercise Number of Respondents Percentage (%)
Yes 12 60.00
No 8 40.00
TOTAL 20 100.00

Table VI

DISTRIBUTION OF RESPONDENTS IN TERMS OF

PHYSICAL ACTIVITY

According to table VI it shows that twelve or sixty percent of the

respondents are performing exercise while only eight or forty percent of

them do not engage in any physical activity.

Physical inactivity has been known to contribute in obesity.

When food energy intake exceeds energy expenditure, fat cells throughout
 48

the body take in the energy and store it as fat. In all individuals, the excess

energy utilized to generate fat reserves is minute relative to the total number

of calories consumed. This means that very fine perturbations in the energy

Regularity Number of Respondents Percentage (%)

Once a day 4 33.00
Once a week 3 25.00
Twice a week 3 25.00
Once a month 2 17.00
TOTAL 12 100.00
balance can lead to large fluctuations in weight over time. And thus,

hesitance to perform exercises could increase the amount of excess energy

inside the body system.

Table VII

DISTRIBUTION OF RESPONDENTS IN TERMS OF REGULARITY OF

PHYSICAL ACTIVITY

Table VII, regularity of exercise shows that thirty three percent or four

are used of having exercise daily, while there are twenty five percent or three

for once a week and twice a week regularity of exercise, and only two or

seventeen percent for the rest of them who are having exercise once a

month.
 49

Exercising daily produces healthy life to an individual; exercising

once or twice a week is not bad considering the routine and time

management of an individual. Once a month is not quite adequate for their

intake whether solid or liquid, but at least it’s better than nothing.
Form Number of Respondents Percentage (%)
Aerobic 9 75.00
Anaerobic 3 25.00
TOTAL 12 100.00

Table VIII

DISTRIBUTION OF RESPONDENTS IN TERMS OF

EXERCISE PREFERENCE

The exercise preferences of the respondents has a greater choice of

aerobic exercise having seventy five percent or a frequency of nine, while

three or twenty five percent out of twelve respondents choose anaerobic

exercise.

This table shows that few of the respondents give special time for

their exercise; some of them go to a gym or a sports complex. It means that

only a small number of them is willing to spend much of their time to burn

their calories, live a healthy life, and promote well being by considering
 50

exercise as part of their routine. While most of them only depend on their

daily activities like walking and do not focus on burning calories.

Table IX

DISTRIBUTION OF RESPONDENTS ACCORDING TO

SMOKING PREFERENCE

Smoking Number of Respondents Percentage (%)

Yes 14 70.00
No 6 30.00
TOTAL 20 100.00

Table IX shows that the majority, which is seventy percent of the

respondents population do smoke or have tried smoking at least once, and

the remaining thirty percent of which, don’t.

 51

Table X

DISTRIBUTION OF RESPONDENTS ACCORDING TO

SMOKING FREQUENCY

Frequency Number of Respondents Percentage (%)

Everyday 6 43.00
Weekly 0 0.00
Occasionally 8 57.00
TOTAL 14 100.00

As shown in Table X, shown that the distribution of respondents in

terms frequency of their smoking, eight or seventy percent, which is the

majority of the respondents, only smoke occasionally, while the remaining

six or forty three percent of which, habitually smokes everyday.

 52

Table XI

DISTRIBUTION OF RESPONDENTS ACCORDING TO

ALCOHOL DRINKING FREQUENCY

Frequency Number of Respondents Percentage (%)

Everyday 1 5.00
Weekly 4 20.00
Occasionally 15 75.00
TOTAL 20 100.00

Table XI presents how often do the respondents consume alcoholic

drinks. It is evident that fifteen or seventy-five percent of the total number of

subjects asked drink alcohol occasionally, four people or twenty percent

drink weekly, and the remaining individual, which is five percent of the

total, drinks everyday.

As presented, most of the respondents only drink alcoholic beverages

as their way of socializing or when other matters permit them to. Drinking

alcohol has not been a part of their daily routine, and thus, only consume

them for purposes as exhibited by some circumstances. We can assume that

 53

the subjects, which in this case are nursing students, are somehow aware of

the health complications that alcohol-over-consumption may cause.

Table XII

PHYSIOLOGICAL FACTORS AFFECTING OBESITY

Physiological Factors Number of Respondents Percentage (%)

Slow Metabolism 8 40.00
Excess Starch Diet 4 20.00
Food Intolerance 8 40.00
TOTAL 20 100.00

The tabulated data shows some physiological factors that influence

the population's eating and health conditions, and thus, making them

susceptible to increasing their risk for being obese. These factors are often

preventable, and manageable, that's why it is extremely important that the

people are aware of these things.

As presented, slow metabolism and food intolerance exhibited

the equally greater percentage of the physiological factors, which is forty

percent of the total. These aspects are self-manageable, and could be treated

without any help from the health service providers. Since that is the case, it

can be concluded that it could be all up to the patient alone if slow

metabolism and food intolerance are solely considered, when ruling out
 54

other health problems that may lead to obesity. While some respondents say

that excess starch in their diet probably contributes to obesity problems,

which in any circumstance, is preventable and depends much on the food

preference in eating, and on the body's capability to metabolize starch of any

form.

Table XIII

ENVIRONMENTAL FACTORS AFFECTING OBESITY

Environmental Factors Number of Respondents Percentage (%)

Physical Inactivity 8 40.00
Stress 12 60.00
TOTAL 20 100.00

Table XIII exhibits some of the environmental factors that

relatively affect or often lead to or become a cause of the obesity of a

person. Lack of physical activity demonstrated got the percentage of forty-

three percent, and for which is considered as a very significant controlling

factor for those suffering from obesity. Stress, sixty percent, which

nowadays is experienced by majority of the population, increases greatly the

predisposal of people to overeat and worsen their metabolic abnormality -

which in effect, could cause obesity.

 55

Table XIV

DISTRIBUTION OF RESPONDENTS IN TERMS OF AWARENESS

THAT OBESITY COULD LEAD TO CARDIOVASCULAR DISEASE

Awareness Number of Respondents Percentage (%)

Yes 16 80.00
No 4 20.00
TOTAL 20 100.00

Table XIV illustrates that sixteen of twenty chosen respondents,

eighty percent of which do believe that their weight problem could definitely

predispose their health to other complications such as Cardiovascular

Disease. And while the other twenty percent are not yet aware of the health,

problems that they could suffer from due to their condition.

Greater risk awaits obese individuals who are not at all aware of

the complications, it is manifested in such a way that they tend to overlook

their indifference and continue to disregard important health concerns, as

long as they feel confident that they are not ill.

 56

Table XV

DISTRIBUTION OF RESPONDENTS IN TERMS OF COMPLICATIONS

AS MANIFESTED BY HEALTH-RELATED PROBLEMS

Complications Number of Respondents Percentage (%)

Yes 2 10.00
No 18 90.00
TOTAL 20 100.00

As presented in the table above, ten percent of the obese respondents

are suffering from health-related problems, which resulted into such as a

complication of their abnormal BMI status. The remaining ninety percent

appeared not to be suffering from any health problem; although in this case,

it is not easily determined as such. They might be unconsciously

experiencing troubles that they just ignore, or presume not to be serious at

all to be considered an obesity complication.

 57

Table XVI

DISTRIBUTION OF RESPONDENTS ACCORDING TO THEIR VIEW

ABOUT LIFESTYLE MODIFICATION

Lifestyle Modification Number of Respondents Percentage (%)

Yes 15 75.00
No 5 25.00
TOTAL 20 100.00

As represented by the table above, only fifteen respondents, seventy-

five of the total, in terms of their lifestyle activities prefer to modify their

daily routine and engage into physical activities much more often in order to

decrease their risk of developing health-related complications.

 58

Chapter V

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

The study aimed to assess the knowledge of Obese Arellano Nursing

Students with regard to their awareness of the risk of having Cardiovascular

Diseases.

Involved in the study were 20 Obese Nursing Students of Arellano

University.

A questionnaire prepared by the researcher was utilized. Interview and

observation were also employed to supplement the data collected from the

questionnaire.

SUMMARY OF FINDINGS

Through the procedure described above, the following questions have

been answered:

Specific Problem Number 1

1. Respondent’s Profile

1.1 Sixty five percent of the total respondents belonged to age bracket

18 – 20 yrs. old.
 59

1.2 The respondents were equally divided among men and women.

1.3 Majority of the total number of respondents belonged to 5’0” – 5’5”

height bracket.

1.4 Thirty percent of the respondents belonged to the weight bracket of

89 – 98 kilograms.

1.5 Ninety five percent of the respondents were Roman Catholic.

2. Physical Status

2.1 Sixty percent of the respondents were performing exercise.

2.1.1. Majority of the respondents were used of having exercise daily.

2.1.2. The exercise preferences of the respondents had a greater choice of

aerobic exercise having seventy five percent.

2.2. Seventy percent of the respondent population did smoke or had

tried smoking at least once.

2.2.1. Seventy percent was the majority of the respondents only

smoke occasionally.

2.2.2. It was evident that Seventy-five percent of the total number of

subjects asked drink alcohol occasionally.

 60

3. Factors Affecting Obesity

3.1. Slow metabolism and food intolerance exhibited the equally

greater percentage, which was forty percent in total.

3.2. Stress, the leading factor that nowadays was experienced by

majority of the population, increased greatly the predisposal of

people to overeat and worsen their metabolic abnormality - which

in effect, could cause obesity.

4. Respondent’s Awareness

4.1 Do you consider yourself obese? –

4.2 Eighty percent of which did believed that their weight problem could

definitely predispose their health to other complications such as

Cardiovascular Disease.

5. Complications

5.1 Most of the respondents appeared not to be suffering from any health

problem.

6. Lifestyle Modification

6.1 Seventy-five percent of the total, in terms of their lifestyle activities

preferred to modify their daily routine and engaged into physical

activities much more often.

 61

CONCLUSIONS

Based on the analysis and findings, the following conclusions were

drawn:

1. That there are more obese on the age of 18-20 year old.

2. There are same number of men and women in terms of gender.

3. The most common height of the obese is 5’0”-5’5”.

4. Majority of the obese gaining 89-98 kilogram in weight.

5. Almost every one of the obese is Roman Catholic.

6. Most of the obese are performing exercise.

7. Daily exercising is practice by more number of the obese.

8. Aerobic exercise is the choice of the obese.

9. There are more obese that are smokers than non-smokers.

10.Obese take cigarette smoking occasionally.

11.Most of the obese drink occasionally.

12.Both slow metabolism and food intolerance are considering the

physiologic factor affecting their obesity.

13.Stress is the most common factor in the environment of the obese.

14.Almost every on of the obese are aware that they have the high risk of

having Cardiovascular Disease.

15.Few of the obese is suffering from any health disturbances.

 62

16.Modifying daily routine and engaging into physical activities are the

positive perception of the obese in their lifestyle.

RECOMMENDATIONS

Having a fit and healthy body keeps an individual in living a normal

life. It is one's most prized possessions, and thus, truly deserves to be taken

care of. A bright future and positive outlook in life beings here and continues

thereon. The following recommendations towards developing a healthy

lifestyle are hereby offered by the researchers in order to promote obesity

awareness:

1. Teenagers nowadays are also prone in developing health-

related problems, so as early as they could, teenagers should

watch what they eat, and engage devotedly in physical and

recreational activities in order to keep or further improve their

healthy lifestyle. With this, health diseases, as well as obesity,

could be prevented as early as possible.

2. Parents should also be aware of their children's environment,

and its influence to them. They should properly educate and

habituate their children in doing the right things in order to

 63

preserve their health. Proper food nutrition and discipline are

important factors that must be implemented by the parents in or

out of their home. Prevention, as always mentioned, is way

better than cure.

3. Schools, as teenagers' second home should provide proper

education, and hence, a good working environment to students

in order to improve their health awareness and practice.

Physical education must be administered to students as part of

the school's curriculum so that the children could explore the

environment and go beyond the theoretical side. Engagement

into sports and practicing discipline in eating are just some of

the recommendations.

4. The government must place a higher emphasis on foods'

nutritional values in public assistance programs, and also,

determine control upon the products sold in the market. They

should implement programs in order to increase public

awareness and to encourage people to maintain a healthy

lifestyle. Some of which are: obesity screening, and obesity-

related disease management that bolsters preventive care.

 64

5. As the greatest influence to the public people, television

stations must inculcate health improvement and awareness thru

production of good-to-know advertisements regarding health.

6. To the public, it is important that they are aware and disciplined

enough to execute health improvement processes. They should

take advantage of the knowing that obesity has a great role on

the development of different chronic diseases.

7. Further study on determining the prevention measures to impart

in order to reduce obesity epidemic to its lowest possible range.

8. A further study using much broader scope, and a higher or

increased number of respondents as one community, etc.

65