2.4 Examples and results
2.4.4 Performance of the numerical method
61
Adolescents in Owerri were the control group. After collecting baseline data, a talk on the health risks of overweight and obesity was presented in the school assembly. No further intervention was implemented among this group.
Lifestyle changes and BMI were assessed immediately after the intervention at 5 monthsusing the same questionnaire used during the preliminary study91. A pretest of the study tool and procedure was carried out in Ihitte-Uboma Local Government Area to assess the following:
Suitability and understanding of the questionnaire.
Duration of the interview.
Appropriateness of the wording of the questionnaire.
Findings of the pretest were used to modify the study tool and procedure where necessary.
62
physical activity level was > 60 minutes were assumed to have met the WHO recommendation6. Furthermore, those with MET-minute < 600 were considered to be minimally active, those between 600 and 1,500 sufficiently active (there were only 10 adolescents with MET minute <
600, so they were grouped together with those considered to be sufficiently active) and those above 1500 and fitting into such criteria were considered to have achieved health enhancing physical activity level. The change in physical activity, screen time, sleeping time and BMI after the intervention was examined using the paired t test, while Wilcoxon rank test was used to assess dietary pattern and BMI. Level of significance was set at α ≤ 0.05. The study was powered at 80% to detect at least, a mean reduction of 0.35kg/m2 in the mean BMI score of adolescents involved in the intervention.
Limitations of the study:
The assessment of lifestyle was measured subjectively. This means that participants may exaggerate what they consider to be right answers in spite of the fact that while administering the questionnaire, students were told that there were neither right nor wrong answers. The socioeconomic classification of the family was regarded as a rough guide considering the fact that some students may not be in a position to answer correctly some of the questions that may aid in the assigning of such class. This was curtailed by asking students who were not so sure of the required answers to leave a blank and find out from their parents or guardians. They filled such gaps when they came to measure their weight and height the following day.
All adolescents with BMI of 25kg/m2 or greater were supposed to be recruited into the study for the intervention. Unfortunately, although the number of those eligible was 242 in the intervention arm of the study, only 60 of such received consent from their parents. Since the
63
intervention involved change in dietary pattern which meant changing the family diet, parents who declined consent did so on account of finance. This drastically reduced the number of participants in the study. To ensure equal representation, the same number of overweight and obese adolescents was chosen from the control through simple random sampling.
The study was not able to measure compliance of participants to the various recommendations.
To curtail this, participants were reminded on phone about particular activities or dietary patterns. Apart from this, involvement of parents is supposed to enhance compliance. Charts where participants were required to record meals and exercises were distributed and collected weekly.
64
CHAPTER FOUR RESULTS
A total of 2,250 in-school adolescents were recruited for the study between February 2015 and May 2015. Out of this, 2051 duly completed the questionnaire, giving a response rate of 91.2%.
One thousand and twenty six (1026) respondents were from the intervention while one thousand and twenty five (1025) were from the control group respectively. Thereafter, a subset of 120 overweight/obese students comprising 60 students each from intervention and control groups were involved in the intervention phase lasting for 5 months period (June 2015 to October 2015).
The findings of the study at baseline and post-intervention are as presented below.
65
Table I: Socio-demographic characteristics of participating adolescents Characteristic Intervention
N=1026 n(%)
Control N=1025
n(%)
χ2 P value
Sex
Male 559(54.5) 445(43.4) 25.14 <0.001
Female 467(45.5) 580(56.6)
Age (in years)
10-14 637(62.1) 651(63.5)
15-17 352(34.3) 353(34.4) 4.57 0.10
18-19 37(3.6) 21(2.0)
Mean ±SD 13.67±2.13 13.86±1.78 Type of school
Public 513(50.0) 511(49.9) 0.00 0.98
Private 513 (50.0) 514(50.1)
Number in household
2-5 376(36.6) 281(27.4)
6-9 600(58.5) 664(64.8) 23.90 <0.001
10+ 50(4.9) 80(7.8)
Socioeconomic Class
High 487(47.5) 489(47.7)
Middle 418(40.7) 399(38.9) 1.44 0.49
Low 121(11.8) 137(13.4)
Table I shows the socio demographic data of the adolescents. Age distribution of the students showed that the highest proportion of adolescents is from the 10-14years age group, followed by the group of 15-17 years. The mean age of the adolescents is 13.67±2.13 years in the intervention and 13.86±1.78 years in the control group. There is no significant difference in the
66
mean age P=0.10. Most of the adolescents in both groups belong to the high socio-economic status; 47.5% and 47.7% for intervention and control groups respectively, while the low social class accounted for the lowest proportion of the adolescents 121(11.8%) for intervention and 137 (13.4%) for the control. The difference in these proportions is not statistically significant (P >
0.05).
67
Table II: Classification of participating adolescents by BMI BMI Class Intervention
N=1026 n(%)
Control N=1025 n(%)
χ2 P
Underweight 35(3.4) 23(2.2)
Normal 749(73.0) 740(72.2) 5.72 0.13
Overweight 180(17.5) 210(20.5)
Obese 62(6.0) 52(5.1)
Table II shows the BMI status of the adolescents. Most of the adolescents had normal BMI in both the intervention group– 749 (73.0%) and control group – 740 (72.2%). However, the proportion of overweight adolescents were 180(17.5%) and 210 (20.5%) in the intervention and control groups respectively; while those who were obese were 62(6.0%) and 52(5.1%) in the intervention and control groups respectively. There was no significant difference in the distribution of the adolescents by BMI status among the intervention and control groups.
68
Table III: Dietary practices of participating adolescents at baseline
Dietary practice Intervention
N=1026 n(%)
Control N=1025 n(%)
χ2 P
value Frequency of taking breakfast/week
Daily 666(64.9) 696(67.9) 2.50 0.29
Most days 138(13.5) 118(11.5)
Sometimes/never 222(21.6) 211(20.6)
Frequency of sweetened drinks consumption/week
Daily 154(15.0) 158(15.4) 0.08 0.96
Most times 233(22.7) 230(22.4)
Sometimes/never 639(62.3) 637(62.2)
Frequency of snacks consumption/week
Daily 312(30.4) 347(33.9) 2.87 0.24
Most times 254(24.8) 246(24.0)
Sometimes/never 460(44.8) 432(42.1)
Frequency of vegetables consumption/week
Daily 146(14.2) 109(10.6) 9.74 0.01
Most times 328(32.0) 302(29.5)
Sometimes/never 552(53.8) 614(59.9)
Frequency of fruits consumption/week
Daily 349(34.0) 324(31.6) 2.75 0.25
Most times 60(5.8) 50(4.9)
Sometimes 617(60.4) 651(63.5)
Table III shows the dietary practices of the adolescents at baseline. A greater proportion 696 (67.9%) of adolescents in the control take breakfast daily compared to 666 (64.9%) in the intervention. The proportions taking most times, sometimes or never are almost the same in the 2 groups. Among the intervention group, 146 (14.2%) takes vegetables daily compared to 109(10.6%) among the control. On the other hand, a greater proportion 614 (59.9%) among the control group compared to 53.8% among the intervention group do not take vegetable or only do so sometimes.
69
Table IV: Pattern of physical and sedentary activities of the adolescents at baseline.
Physical activities
Intervention Control t P value
N=1026 N=1025
MET/week 1613.35±350.43 1584.84±410.00 1.69 0.09
Physical
activity(min)/day 47.57±10.76 46.61±13.12 1.84 0.07
Time(hours) on
TV/day 1.41±0.92 1.42±0.97 -0.39 0.70
Sedentary time
(hours)/day 1.87±0.93 1.94±0.96 -1.70 0.09
Hours of
sleep/night 7.92±0.90 7.89±0.97 0.61 0.54
Table IV shows the pattern of physical and sedentary activities of the adolescents in the
intervention and control groups at baseline. Although adolescents in the intervention arm of the study appear to accumulate more MET/minute compared to the control, the difference is not statistically significant. There is no significant difference in the time spent on sedentary activities and in sleeping between the two groups.
70
Table V: Association between dietary practice and BMI in the intervention group
Dietary practice Thin/normal
N=784 n (%)
Overweight/obese N=242
n (%)
Χ2 P
Frequency of breakfast/week
Daily 522(66.6) 144(59.5) 5.43 0.07
Most days 105(13.4) 33(13.6)
Sometimes/never 157(20.0) 65(26.9)
Frequency of sweetened drinks consumption/week
Daily 119(15.2) 35(14.5) 0.25 0.88
Most times 180(22.9) 53(21.9)
Sometimes/never 485(61.9) 154(63.6)
Frequency of
snacks consumption/week
Daily 242(30.9) 70(28.9) 0.67 0.71
Most times 196(25.0) 58(24.0)
Sometimes/never 346(44.1) 114(47.1)
Frequency of consumption of vegetables/week
Daily 109(13.9) 37(15.3) 7.55 0.02
Most times 268(34.2) 60(24.8)
Sometimes/never 407(51.9) 145(59.9)
Frequency of fruits consumption/week
Daily 269(34.3) 80(33.1) 2.32 0.31
Most times 41(5.2) 19(7.9)
Sometimes 474(60.5) 143(59.1)
Table V shows the association between the BMI status and the dietary pattern of the adolescents in the intervention group at baseline. There are no differences in the frequency of consumption of sweetened drinks/week and snacks/week. The two BMI groups however differ in their frequency of taking breakfast and consumption of vegetables. Thus, a higher proportion of the thin/normal BMI group than the OW/OB group takes breakfast daily. Conversely, a higher proportion of the OW/OB than the thin/normal takes breakfast sometimes or not all.
71
Table V1: Association between dietary practice and BMI in the control group
Dietary practice Thin/normal
N=763(%)
Overweight/obese N=262(%)
χ2 p
Frequency of breakfast/week
Daily 530(69.5) 166(63.4) 4.70 0.10
Most days 88(11.5) 30(11.5)
Sometimes/never 145(19.0) 66(25.1)
Frequency of sweetened drinks consumption/week
Daily 118(15.5) 40(15.3) 2.47 0.29
Most times 180(23.6) 50(19.1)
Sometimes/never 465(60.9) 172(65.6)
Frequency of snacks consumption/week
Daily 273(35.8) 74(28.2) 5.11 0.08
Most times 180(23.6) 66(25.2)
Sometimes/never 310(40.6) 122(46.6)
Frequency of consumption of vegetables/week
Daily 78(10.2) 31(11.8) 0.79 0.67
Most times 229(30.0) 73(27.9)
Sometimes/never 456(59.8) 158(60.3)
Frequency of fruits consumption/week
Daily 239(31.3) 85(32.4) 0.89 0.64
Most times 40(5.2) 10(3.8)
Sometimes 484(63.4) 167(63.7)
Table V1 shows the association between dietary practice and BMI status in the control group.
Frequency of sweetened drinks and fruits consumption did not appear to be associated with BMI status. However, frequency of taking breakfast and snacks did. Thus, a higher proportion of those who are OW/OB (25.1%) than those who are thin/normal (19.0%) skip breakfast by taking sometimes or never. Similarly, a higher proportion of the thin/normal weight persons (35.8%) compared to 28.2% of those who are OW/OB take snacks daily.
72
Table V11: Association between physical and sedentary activity pattern and BMI status in the intervention group
Physical activities Thin/normal N=784
OW/OB N=242
t P
Total MET minute/week
1680.48±326.43 1395.87±337.57 11.76 <0.001
Physical activity
/week 49.29±9.91 42.19±11.57 9.54 <0.001
average hours of
TV per day 1.39±0.90 1.45±0.97 -0.76 0.45
Total sedentary
hours 1.87±0.90 1.87±1.00 0.04 0.97
Hours of sleep per
day 7.97±0.90 7.74±0.88 3.50 <0.001
Table V11 shows the association between physical and sedentary activities pattern and BMI status in the intervention group. The thin/normal BMI group is more active compared to the OW/OB group. This can be seen from the MET minute accumulated during the week and time spent on physical activity/day. Although the mean time spent by the OW/OB watching television is higher than the mean time spent by the thin/normal, the difference is not statistically significant. There is also no significant difference between the two groups in the total sedentary hours, but the OW/OB spend significantly less time sleeping compared to the thin/normal.
73
Table V111: Association between physical and sedentary activity pattern and BMI status in the control group.
Variables Thin/normal N=763(%)
OW/OB N=262(%)
t p
MET minute
/week 1692.04±378.76 1272.67±330.56 15.96 <0.001 Time on physical
activity(mins)/day 49.92±12.02 36.98±11.33 15.25 <0.001 average hours of
TV per day 1.39±0.94 1.53±1.03 -2.06 0.04
Total sedentary
hours 1.87±0.93 2.15±0.99 -4.16 <0.001
hours of sleep per
day 7.93±0.96 7.78±0.98 0.91 0.03
Table V111 shows the association between physical and sedentary activity pattern and BMI status in the control group. All the variables are statistically significantly different between the two BMI groups. Those in the thin/normal BMI group are more active as shown by their higher total MET minute/week. The OW/OB spend more time on sedentary activities as seen in their higher television watching time and total sedentary hours than the thin/normal BMI group. The mean hours of sleep is also significantly less in the OW/OB than in the thin/normal BMI group.
74
Table 1X: Risk factors for overweight/obesity among all the adolescents
Independent variable Crude OR (95% CI) Adjusted OR (95%
CI)
Gender(1) female* 1.70(1.39-2.09) 1.33(1.06-1.67)
School type(1) public * 2.07(1.68-2.55) 1.79(1.32-2.42)
Socioeconomic status(1*) upper 2.26(1.58-3.24) 1.74(1.12-2.70)
Socioeconomic status (2) 1.40(0.96-2.04) 1.44(0.97-2.14)
Physical activity(1)* sufficiently active 0.11(0.08-0.16) 0.12(0.08-0.16) Time spent on sedentary activities(2)* 1.41(1.13-1.76) 1.31(1.02-1.67) Frequency of breakfast/week (1)* 1.47(1.16-1.87) 1.37(1.05-1.79) Frequency of breakfast/week (2) 1.11(0.81-1.51) 1.18(0.83-1.67) Frequency of snacks/week (1) * 1.29(1.02-1.63) 1.32(1.00-1.74) Frequency of snacks/week (2) 1.18(0.90-1.55) 1.22(0.89-1.68) Frequency of vegetables/wk (1) 0.97(0.80-1.24) 0.88(0.62-1.24) Frequency of vegetables/wk (2)* 0.74(0.53-1.03) 0.65(0.45-0.10)
*Statistically significant
Table 1X shows significant variables associated with overweight/obesity among all the adolescents as the following: Gender, school type, socioeconomic status, level of physical activity, time spent on sedentary activities, frequency of taking breakfast/week, frequency of snacks consumption/week and frequency of vegetable consumption/week. Female adolescents have the risk of being overweight/obese increased by 33%; AOR 1.33(1.06-1.67). Similarly, adolescents attending private schools have the risk increased almost two times; A OR
1.79(1.32-75
2.42). Adolescents whose parents belong to the high socioeconomic class have the risk increased by 74%; likewise those spending more time on sedentary activities especially watching TV or playing computer games > 2hours have an increased risk of 74%. Skipping of breakfast and frequent intake of snacks all increase the risks. On the other hand, adolescents who are sufficiently active have the risk reduced by 82%; AOR 0.12(0.08-0.16), so also those who consume vegetables regularly.
76
Table X: Risk factors for overweight/obesity among the intervention.
Independent variable Crude OR(95% CI) Adjusted OR(95% CI)
Gender(1) 1.84(1.37-2.46) 1.16(0.83-1.62)
School type(1) 1.90(1.41-2.55) 1.39(0.95-2.03)
Socioeconomic status(1)* 3.03(1.70-5.37) 3.26(1.71-6.23) Socioeconomic status (2) 1.70(0.94-3.07) 1.82(0.98-3.37) Physical activity(1)* 0.15(0.10-0.24) 0.14(0.09-0.23) Time spent on sedentary (2) 0.90(0.64-1.27) 0.85(0.58-1.24) Frequency of breakfast/week (1) 1.50(1.07-2.12) 1.35(0.92-1.97) Frequency of breakfast/week (2) 1.14(0.74-1.76) 1.18(0.73-1.91) Frequency of snacks/week (1) 1.14(0.81-1.60) 1.10(0.74-1.63) Frequency of snacks/week (2) 1.02(0.69-1.52) 1.00(0.64-1.59) Frequency of vegetables/week (1) 1.05(0.69-1.60) 1.13(0.71-1.80) Frequency of vegetables/week (2) 0.66(0.41-1.05) 0.73(0.44-1.21)
*Statistically significant
Table X shows risk factors for overweight/obesity among the intervention; socioeconomic status and level of physical activity. Those whose parents belong to the high socioeconomic class have the odds increased 3 times; AOR 3.26(1.71-6.23) and adolescents who are physically active have the odds reduced by 86%; AOR 0.14(0.09-0.23)
77
Table X1: Risk factors for overweight/obesity among the control.
Independent variable Crude OR (95% CI) Adjusted OR (95% CI)
Gender(1)* 1.56(1.16-2.08) 1.53(1.09-2.15)
School type(1)* 2.25(1.68-3.01) 3.94(2.22-6.99)
Socioeconomic status(1) 1.82(1.14-2-90) 0.65(0.33-1.28) Socioeconomic status (2) 1.24(0.76-2.02) 1.29(0.76-2.21) Physical activity(1)* 0.08(0.05- 0.14) 0.08(0.05-0.14) Time spent on sedentary (2)* 1.97(1.47-2.65) 1.80(1.27-2.54) Frequency of breakfast/week 1) 1.45(1.04-2.04) 1.38(0.93-2.04) Frequency of breakfast/week (2) 1.09(0.69-1.71) 1.23(0.73-2.07) Frequency of snacks/week (1)* 1.45(1.42-2.02) 1.66(1.11-2.48) Frequency of snacks/week (2) 1.35(0.92-2.00) 1.41(0.90-2.21) Frequency of vegetables/wk (1) 0.87(0.55-1.37) 0.63(0.37-1.09) Frequency of vegetables/wk (2)* 0.82(0.49-1.31) 0.51(0.28-0.91)
*Statistically significant
Table X1 shows risk factors among the control: Gender, school type, level of physical activities, time spent on sedentary activities, frequency of snacks and vegetables consumption. Females have the odds increased by 53%; AOR 1.53(1.092.15). Similarly, attending private school increased the odds almost 4 times; AOR 3.94(2.22-6.99). Spending more time on sedentary activities also increased the odds by 80%. On the other hand, being sufficiently active reduced the odds tremendously to an insignificant level; AOR 0.08(0.05-0.14), while frequent consumption of vegetables reduced the odds by 49%.
78
Table X11: Comparison of distribution of age, height, weight and mean BMI of the sub-set of overweight/obese at baseline.
Variable Intervention N=60 Mean±SD
Control N=60 Mean±SD
t P value
Age
Weight (kg)
14.15±2.12
72.58±12.59
13.95±1.87
65.96±9.97
0.55
3.21
0.59
<0.001
Height (m) 1.57±0.08 1.54±0.08 1.80 0.08
BMI (kg/m2) 29.40±3.83 27.81±2.64 2.65 0.01
Table X11 shows the age and anthropometric measures of the overweight/obese adolescents in the intervention and control groups at baseline. The mean age of the group is 14.05±2.00 years.
There is no statistically significant difference in their age distribution. The average weight in the intervention is 72.58±12.49kg as against 65.96±9.97kg in the control. The difference is
statistically significant. Again, the difference in the mean BMI of the intervention group (29.40±3.83kg/m2) and the mean BMI of the control group (27.81±2.64 kg/m2) is statistically significant. The difference in the mean height of the intervention group (1.57±0.08 m) and the mean height of the control group (1.54±0.08m) is not statistically significant.
79
Table X111: Comparison of the physical and sedentary activities pattern of the sub-set of overweight/obese at baseline.
Variable Intervention N=60 Mean±SD
Control N=60 Mean±SD
t P value
MET minute/week 1396.00±349.83 1298.00±321.49 1.60 0.11
Time on physical activity (min)/day
43.39±13.60 39.3±11.83 1.74 0.08
Time(hours) on TV/day
1.36±0.97 1.65±1.08 -1.55 0.12
Sedentary
time(hours)/day 1.81±1.03 2.19±1.07 -2.00 0.05
Hours of sleep 7.45±0.73 7.88±0.98 -2.67 0.01
Table X111 shows the physical and sedentary activities pattern of the overweight/obese at baseline. The pattern of activities between the two groups at baseline is similar, except hours of sleep which is more among the control.
Table X1V: Comparison of the physical and sedentary activities pattern of the sub-set of overweight/obese after intervention.
80
Variable. Intervention
N=60 Mean±SD
Control N=60 Mean±SD
t P value
MET min/week 1767.00±296.92 1308±313.39 8.24 <0.001 Time(mins) spent on
physical activity /day
53.44±9.51 40.07±11.69 6.87 <0.001
Time(hours) spent watching TV/day
1.05±0.77 1.59±0.99 -3.38 0.001
Sedentary
time(hours)/day 1.46±0.82 2.15±0.94 -4.29 <0.001
Hours of sleep/day 7.73±0.51 7.94±0.73 -1.87 0.06
Table X1V shows the physical and sedentary activities pattern of the intervention and control groups post intervention. There is a significant difference in all the measures of physical activity between the two groups. Total MET minutes accumulated during the week is more in the intervention, compared to the control this difference is statistically significantly. Similarly, time spent on physical activity in the intervention is more than in the control. Time spent watching TV and total sedentary times are much lower in the intervention compared to the control. These differences are statistically significant. Hours of sleep per night are not different in the two groups.
81
Table XV: Comparison of the dietary practices of the sub-set of overweight/obese at baseline.
Dietary Practice Intervention
N=60 n(%)
Control N=60 n(%)
χ2 P
value Frequency of breakfast/week
Daily 31(51.7) 36(60.0) 1.09 0.58
Most days 9(15.0) 9(15.0)
Sometimes/never 20(33.3) 15(25.0)
Frequency of sweetened drinks consumption/week
Daily 10(16.7) 10(16.7) 0.51 0.78
Most times 10(16.7) 13(21.7)
Sometimes/never 40(66.6) 37(61.6)
Frequency of snacks consumption/week
Daily 16(26.7) 16(26.7) 0.51 0.78
Most times 13(21.7) 17(28.3)
Sometimes/never 31(51.6) 27(45.0)
Frequency of vegetables consumption/week
Daily 7(11.7) 6(10.0) 0.09 0.96
Most times 15(25.0) 15(25.0)
Sometimes/never 38(63.3) 39(65.0)
Frequency of fruits consumption/week
Daily 21(35.0) 13(21.7) 3.66 0.16
Most times 5(8.3) 3(5.0)
Sometimes 34(56.7) 44(73.3)
Table XV shows the dietary practice of the subset of overweight/obese in the intervention and control groups at baseline. There was no statistically significant difference in the dietary practices of the two groups at baseline.
82
Table XV1: Comparison of the dietary practice of the sub-set of overweight/obese after intervention.
Dietary practice Intervention
N=60 n(%)
Control N=60 n(%)
χ2 p
Frequency of breakfast/week
Daily 45(75.0) 32(53.3) 18.07 <0.001
Most days 14(23.3) 10(16.7)
Sometimes/never 1(1.7) 18(30.0)
Frequency of sweetened drinks consumption/week
Daily 0(0.0) 10(16.7) 16.8 <0.001
Most times 6(10.0) 14(23.3)
Sometimes/never 54(90.0) 36(60.0)
Frequency of snacks consumption/week
Daily 0(0.0) 12(20.0) 20.38 <0.001
Most times 10(16.7) 18(30.0)
Sometimes/never 50(83.3) 30(50.0)
Frequency of vegetables consumption /week
Daily 15(25.0) 6(10.0) 9.57 <0.001
Most times 25(41.7) 18(30.0)
Sometimes/never 20(33.3) 36(60.0)
Frequency of fruits consumption /week
Daily 26(43.3) 8(13.3)
Most times 23(38.3) 13(21.7) 27.99 <0.001
Sometimes 11(18.3) 39(65.0)
Table XV11 shows the dietary practice of the adolescents post intervention. Daily consumption of breakfast, vegetables and fruits, are all higher in the intervention. On the other hand, daily consumption of sweetened drinks and snacks are higher in the control. The proportion consuming breakfast daily in the intervention is 45(75.0%) while it is 32(53.3%) in the control.
In addition, 15(25.0%) and 26(43.3%) among the intervention consume vegetables and fruits
83
daily while 6(10.0%) and 8(13.3%) respectively do so among the control. Among the intervention, there was no one consuming neither sweetened drinks nor snacks daily, but in the control, 10(16.7%) and 12(20.0%) were still doing so. Similarly, 54(90.0%) and 50(83.3%) among the intervention had either stopped consuming sweetened drinks and snacks daily or were only doing so sometimes.
84
Table XV111: comparison of the physical and sedentary activities pattern of the overweight/obese adolescents before and after intervention using paired t-test.
variable Intervention
N=60
Control N=60
Baseline Post intervention Baseline Post intervention MET/week 1396.00±349.83 1775.59±291.84 1298.00±321.49 1308±313.39
t = 11.80 p<0.001 t = -0.43 p= 0.67 Time spent on
physical
activity(mins/day)
43.39±13.66. 53.44±9.51 39.3±11.83 40.07±11.69 t= 9.28 p= <0.001 t = -0.61 p=0.55
Daily TV time 1.36±0.97 1.05±0.77 1.65±1.08 1.56±0.99
t = 4.15 p= <0.001 t = 1.99 p= 0.05 Daily Sedentary
time (hours/day) 1.81±1.03 1.46±0.82 2.19±1.07 1.93±0.84
t = 3.47 p= 0.001 t = 1.09 p= 0.28 Hours of
sleep/night 7.45±0.73 7.73±0.51 7.88±0.98 7.94±0.73
t = -4.74 p= <0.001 = -0.79 p=0.42 Table XV111 shows the paired t test for the physical activity pattern. There was a change in all the measures of physical and sedentary activities in the intervention, but not so in the control.
The increase in total metabolic equivalent for the week is 371 MET minute for the intervention, while for the control the increase is just 10 MET minute. Time spent watching television reduced in both the intervention and control, though the difference is more in the intervention. Total sedentary hours reduced in the intervention significantly, but in the control the change was not much. Hours of sleep also increased significantly in the intervention by more than 30 minutes.
85
Table X1X: Comparison of the dietary practice of the overweight/obese adolescents before and after intervention.
Variable Intervention
N=60 n (%)
Control N=60 n (%) Baseline post
intervention
Baseline Post
intervention Frequency of
breakfast/week
Daily 31(51.7) 45(75.0) 36(60.0) 32(53.3)
Most times 9(15.0) 14(23.3) 9(15.0) 10(16.7)
Sometimes/never 20(33.3) 1(1.7) 15(25.0) 18(30.0)
Wilcoxon test = -4.82 p=<0.001 Wilcoxon test = -1.73 p= 0.08 Frequency of
sweetened drinks consumption/week
Daily 10(16.7) 0(0.0) 10(16.7) 10(16.7)
Most times 10(16.7) 6(10.0) 3(21.7) 14(23.3)
Sometimes/never 40(66.6) 54(90.0) 37(61.6) 36(60.0) Wilcoxon test= -4.02 p=<0.001 Wilcoxon test= -1.00 p=0.32 Frequency of
snacks
consumption/week
Daily 16(26.7) 0(0.0) 16(26.7) 12(20.0)
Most times 3(21.7) 10(16.7) 17(28.3) 18(30.0)
Sometimes/never 31(51.6) 50(83.3) 27(45.0) 30(50.0)
Wilcoxon test =-4.64 p=<0.001 Wilcoxon test= -1.10 p= 0.06 Frequency of
vegetables
consumption/week
Daily 7(11.7) 15(25.0) 6(10.0) 6(10.0)
Most times 15(25.0) 25(41.7) 15(25.0) 18(30.0)
Sometimes/never 38(63.3) 20(33.3) 39(65.0) 36(60.0)
Wilcoxon test= -4.25 p= <0.001 Wilcoxon test= -1.73 p=0.08 Frequency of
fruits
consumption/week
Daily 21(35.0) 26(43.3) 13(21.7) 8(13.3)
Most times 5(8.3) 23(38.3) 3(5.0) 13(21.7)
Sometimes/never 34(56.7) 11(18.3) 44(73.3) 39(65.0)
Wilcoxon test= -3.19 p= 0.001 Wilcoxon test= -0.14 p=0.089
86
Table X1X shows a comparison of the dietary practice of the intervention and control groups at baseline and after the intervention. All the measures of dietary practice changed significantly in the intervention, but not so in the control. Post intervention, the proportion taking breakfast in the intervention increased. At baseline, equal proportions 10(16.7%) of adolescents were consuming sweetened drinks daily, post intervention, no adolescent in the intervention group was still taking sweetened drinks daily. In addition, the proportion not taking sweetened drinks at all or doing so sometimes had increased from 40(66.6%) to 54(90.0%) in the intervention, but in the control it remained the same. A similar scenario is depicted in the consumption of snacks. The proportion of adolescents in the intervention consuming vegetables daily had increased from 11.7% at baseline to 25.0% post intervention. Daily consumption of fruits had increased from 35.0% to 43.3.0% among the intervention but reduced from 21.7% to 13.3% among the control.
87
Table XX: Comparison of the pre and post intervention anthropometric data using paired t test
Variable Intervention N=60 n(%)
Control N=60 n(%)
Baseline Post intervention Baseline Post intervention Weight (kg)
Height(m)
72.58±12.59 t= -7.46 1.57±0.08
t= -15.45
75.20±12.60 p<0.001 1.61±0.08 p<0.001
65.96±9.96 t= -10.21 1.54±0.81 t=-15.55
70.60±10.90 P<0.001 1.59±0.08 p<0.001 BMI (kg/m2) 29.40±3.80
t=3.11
29.02±3.90 p<0.01
27.81±2.60 t=0.61
27.90±3.0 p<0.55 Post intervention difference in
BMI= -0.38kg/m2
Post intervention difference in BMI=
+0.09kg/m2 Table XX shows the pre and post intervention weight, height and BMI for the 2 groups.
Weight: Although both groups showed increase in weight, 2.62kg for the intervention and 4.64kg for the control, the increase was more among the control.
Height: The height of adolescents in both groups increased.
BMI: For the intervention, BMI reduced from 29.40kg/m2 to 29.02 kg/m2 (a reduction of 0.38kg/m2), while for the control, it increased from 27.81 kg/m2 to 27.90kg/m2 (an increase of 0.09kg/m2). The reduction in mean BMI was significant.
88
Table XX1: proportion of adolescents whose BMI was < 25kg/m2 post intervention.
Variable Intervention N=60 n (%)
Control N=60 n (%)
χ2 p
Post intervention
BMI
<24.99 19(31.7) 8(13.3) 5.78 0.02
>24.99 41(68.3) 52(86.7)
Table XX1 shows the proportions of adolescents who post intervention were no longer overweight/obese. Among the intervention, 19 adolescents (31.7%) were no longer overweight, while among the control 8(13.3%) were no longer obese.
89
CHAPTER FIVE DISCUSSION
The prevalence of overweight and obesity for the intervention was 17.5% and 6.0% and for the control 20.5% and 5.1% respectively with no significant difference. The similarity in the prevalence is expected as the intervention and control groups did not differ much at baseline, since the two samples were drawn from the capital cities of the two states. Previous studies have recorded varied prevalence with most in Nigeria recording much lower prevalence especially for obesity; Ene-Obong et al recorded 2.8% for obesity and 11.4% for overweight in their study carried out in Port Harcourt. A study in Benue had 1.8% and 9.7% and Ahmad et al 1.4% and 3.3% respectively12, 13, 59. But, it did not differ remarkably from 4.1% recorded by Ani et al24. This variation may be explained by the varied methods of classifying and assessing obesity in the various studies. The wider implication is that overweight and obesity are no longer issues neither of adult nor of the developed countries, but that just as the prevalence has been increasing globally, a similar picture is portrayed by the results in this study. In addition, the culture and disposition of the various tribes that make up the country may explain the variations4, 8. Nevertheless, in Ivory Coast, Kramoh et al56 recorded 5.0% for obesity which is not very different from what was obtained in this study, but the combined prevalence of overweight and obesity as in this study was 24.6%; which is not very different from what studies in South Africa and Sudan found9, 34, but rather very low in comparison to 48.5% by Al-Haifa in Kuwait47. In addition, when only the prevalence of obesity is compared with the general prevalence of 13.4%
for developing and 24.7% for the developed countries, and studies in other continents, the figures are on the low side4, 50. The low prevalence may due to the fact that IOTF classification of obesity was used in this study and this method has been known to give lower prevalence