A STUDY TO ASSESS THE EFFECTIVENESS OF HYDROTHERAPY ON OBESITY AMONG OBESE WOMEN BETWEEN THE AGE GROUP OF 30 TO 50 YEARS IN SELECTED VILLAGES AT COIMBATORE.
By
30083231
DISSERTATION SUBMITTED TO THE TAMIL NADU Dr. M.G.R.
MEDICAL UNIVERSITY, CHENNAI. IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING.
MARCH – 2010.
CERITIFIED THAT THIS IS THE BONAFIDE WORK OF
30083231
CHERRAANS COLLEGE OF NURSING, COIMBATORE, TAMILNADU.
SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING TO THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI.
College Seal
Mrs. RANI IRUDAYARAJ, MSc(N)., Mphil., MBA., PRINCIPAL, CHERRAANS COLLEGE OF NURSING COIMBATORE.
A STUDY TO ASSESS THE EFFECTIVENESS OF
HYDROTHERAPY ON OBESITY AMONG OBESE WOMEN BETWEEN THE AGE GROUP OF 30 TO 50 YEARS IN
SELECTED VILLAGES AT COIMBATORE.
RESEARCH GUIDE :……….
Mrs. RANI IRUDAYARAJ, MSc(N)., Mphil., MBA., PRINCIPAL,
CHERRAANS COLLEGE OF NURSING COIMBATORE.
CLINICAL GUIDE : ………
Mrs. K.SUPRIYA, M.Sc (N)., ASSOCIATE PROFESSOR,
CHERRAAN’S COLLEGE OF NURSING COIMBATORE.
MEDICAL EXPERT : ………
Dr. ANANDHI VIJAYAKUMAR, M.B.B.S., MEDICAL OFFICER
SUNDAKKAMUTHUR PHC COIMBATORE.
A DISSERTATION SUBMITTED TO THE TAMIL NADU Dr. M.G.R.
MEDICAL UNIVERSITY, CHENNAI IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING.
MARCH- 2010.
ACKNOWLEDGEMENT
“ I praise and thank god for his abundant blessings, constant love and guidance”.
Several hand behind has given a shape to this thesis. While it would be impossible to mention all by name, there are some whom the researcher would particularly like to thank.
It is a great pleasure to express my sincere thanks to chairman, K.C.PALANISWAMY, BE (Agri), Charraan’s Institute of health science, who gave me this opportunity to carry out my study successfully.
It’s privilege to express thanks to Mrs.RANI IRUDAYARAJ. MSc(N) Mphil, MBA, Principal, Cherraans College of Nursing Coimbatore who has given precious advice, valuable suggestion for the completion of the thesis with in the stipulated period.
I express my gratitude to Mrs. MUTHUKARUPAYEE, M.Sc (N)., Vice Principal, Cherraan’s college of nursing, Coimbatore who encouraged to complete the thesis.
It gives me great pleasure to thank with deep sense of gratitude and respect to my guide Associate Prof. Mrs. K.SUPRIYA, M.Sc (N)., Cherraan’s college of nursing for taking a sincere interest and painstaking effort to mould this study into a systematic piece of work and spending her time throughout this entire endeavor for producing it proficiently.
I submit my sincere thanks to Associate Prof. Mr. R. SURESH, M.Sc (N)., class coordinator for his patience, affectionate, moral support and guidance throughout my study.
I would like to thank specially lecturer Mrs. LINDSIE, M.Sc (N)., for her guidance and moral support in the completion of this study.
I would like to thank specially Prof. Dr. RAVI SHANKER, Phd., in bio statistic and research, for this expert statistical guidance.
I also extend my thanks to lecturer Mrs. HEPZIBAH, M.Sc (N)., for her motivation, moral support and guidance for completing this study.
My heartful thanks to all faculty members of Cherraan’s college of nursing for their guidance and encouragement.
I owe my special thanks to all the women who have actively participated in this study without their cooperation, this study would not have materialized.
I express my sincere thanks to the experts, Prof. INDIRANI, Prof.
LAKSHMI, Prof. SARAMMA SAMUEL, Prof. ALAGESHUARI and Dr.ANANTHI who have done the content validity and given suggestions in the modification of the tool.
A word of appreciation to Mrs. Vasanthi, Librarian Cherraan’s college of nursing for lending her support and help in procuring the literature related to the study.
I express my sincere thanks to Mr. DEIVASIGAMANI , Array computers for his effortful help in preparing thesis in a form.
My friends are silent gift of nature stronger, more warm, more clear and more closer. My glad thank to my friend who induced and motivated me in a good way.
I express my grateful thanks to my beloved father Mr. VASUDEVAN who always wanted me to scale high rank academically.
I convey my special thanks to my beloved life mate Mr. PRABU for her lovable support and prayers.
My heart felt thanks to my brother, my sister and in-laws for their love and support.
Above all the investigator her success to almighty.
ABSTRACT
A study to assess the effectiveness of hydrotherapy on obesity among obese women in selected villages at Coimbatore was conducted by 30083231 as a partial fulfillment of requirement for the degree of Master of Science in nursing at Cherraan’s college of Nursing, Coimbatore under the Tamil nadu Dr. M.G.R. Medical University, Chennai during the year 2008 – 2010.
The objective of the study were
To assess the pre test level of obesity among obese women in experimental and control group.
To assess effectiveness of hydrotherapy on obesity among experimental and control group.
To assess the effectiveness of hydrotherapy on obesity among obese women in experimental group.
To associate the post test obesity with socio demographic variables among experimental group.
To associate the post test obesity with socio demographic variables among control group.
The following hypothesis were stated for the study:
H1 :- There will be a significant difference in post test level of obesity between experimental and control group
H2 :- There will be a significant difference in the before and after hydrotherapy among obese women in experimental group.
H3 :- There will be a significant association between post test obesity and back ground variables among experimental group.
H4 :- There will be a significant association between post test obesity and back ground variables among control group.
Conceptual frame work for the study was based on the modified Wiedenbach’s helping art of clinical nursing theory. Research design used for the study was a quasi experimental design. This study was conducted in selected villages
at Coimbatore. The population for this study consisted of obese women aged 30 – 50 years of age. Purposive sampling technique was used to select the sample.
Data collection tool consisted of demographic variables, check list to monitor the obesity of obese women.
The content validity of the tool was done by experts in different field reliability was obtained by test re-test method, the score was r=0.9, which was highly reliable. Try out conducted in Kulathupalayam village to find out the feasibility of conducting the study.
The collected data were tabulated analyzed and interpreted by using descriptive and inferential statistical methods.
Major findings:-
The mean score of obesity in post test was lesser than pre test among experimental group after hydrotherapy. The‘t’ value is significant at 0.05 level. Hence the stated hypothesis was accepted.
There was a significant association between the obesity of obese women and their back ground variables like family type and marital status. Hence the stated hypothesis was accepted at 0.05 levels.
Above findings suggests that the hydrotherapy will help to reduce the obesity of obese women, there by it minimizing the complication due to obesity.
Based on the finding recommendation drawn for nursing service, nursing administration, nursing education and nursing research.
I dedicate this study to my beloved
mother in heaven, who is enlightening all the ways in my life.
Thank you MAA, for
being always with me.
TABLE OF CONTENTS
S.No. Content Page No.
I
II
III
INTRODUCTION
Background of the study Need for the study Statement of problem Objectives of the study Hypothesis
Operational definitions Assumption
Delimitations
Conceptual Framework REVIEW OF LITERATURE
Studies related to prevalence of obesity
Studies related to contributing factors for obesity Studies related to ill effects of obesity
Studies related to treatment of obesity
Studies related to drinking water for weight reduction RESEARCH METHODOLOGY
Research approach Research design Variables
Setting of the study Population of the study Sample and Sampling Tool and Tool Technique
1 – 8 1 3 5 5 6 6 6 6 7 9 – 18
9 11 13 14 17 19 – 27
19 19 20 22 22 22 24
S.No. Content Page No.
IV V VI
Validity & Reliability Tryout
Data collection procedure Plan for data analysis Ethical consideration
DATA ANALYSIS AND INTERPRETATION DISCUSSION
SUMMARY CONCLUSION, IMPLICATION,LIMITATION AND RECOMMENDATION
Summary of the study Major study findings Conclusion
Implications of the study Limitation
Recommendations
REFERENCES APPENDICES
25 – 26 26 26 27 27 28 – 45 46 – 48 49 – 52
49 50 51 51 52 52
LIST OF TABLES
S.No. Title Page No.
1.
2.
3.
4.
5.
6.
Frequency, percentage χ2 of back ground variables of obese women among experimental group.
Pre test level of obesity among obese women in experimental and control group.
Mean, standard deviation and ‘t’ value regarding difference in the post test obesity between experimental and control group.
Mean, standard deviation and ‘t’ value regarding effectiveness of hydrotherapy on obesity among experimental group.
χ2 on association between socio demographic variables and post test obesity among experimental group.
χ2 on association between socio demographic variables and post test obesity among control group.
30 34 35 37
39 42
LIST OF FIGURES
S.No. Title Page No.
1.
2.
3.
4.
Conceptual frame work on modified Wiedenbach’s helping art of Clinical Nursing Theory.
Schematic representation of research design.
Mean and Standard Deviation regarding effectiveness of
hydrotherapy on obesity among experimental and control group.
Mean and Standard Deviation regarding effectiveness of hydrotherapy on obesity among experimental group.
8 21 36 38
LIST OF APPENDICES
Appendix Title
A.
B C.
D.
E.
F.
G.
Letter seeking and granting permission to conduct study.
Name list of experts who validated the instruments.
Letter requesting expert’s opinion for content validity of the instruments.
Tool in English Tool in Tamil
Check list to ensure taking 4 liters of water per day Screening form
INTRODUCTION
1
CHAPTER -I
INTRODUCTION
“Fuel the body! Build the muscle! Burn the fat!”
BACK GROUND OF THE STUDY
This has been a century of great changes. In the 21st century, changes were noted not only in the science and technology but also in the lifestyle of its inhabitants.
Changes in the lifestyle made life easier and marked the beginning of certain chronic ailments such as osteoarthritis, cardiovascular disorder, hypertension and obesity.
Excessive deposition of fat in the body, which is usually referred as overweight or obesity in literature, is dangerous. Every individual needs a certain amount of body fat for stored energy, heat insulation, shock absorption and/ or other functions.
Overweight refers to en excess body weight compared to set standards.
Obesity specially refers to having an abnormally high proportion of total body fat (WHO 1998). As a rule, women have more body fat than men. Most health care providers agree that men with more than 25% total body fat and women with more than 30% total body fat should be considered obese.
Obesity can be defined as the “new world syndrome” characterized by an excess accumulation of fat and reflects an overall imbalance between energy intake and expenditure. Since1977 obesity is formally recognized as a global epidemic disease. Nowadays obesity has become a chronic disorder affecting the larger population than any other disease in the world. It mostly affects the adult population but children and adolescent are also prone to develop obesity. According to the world health organization (WHO), nearly 20% to40% of adult population and 10% to 20%
of the children are affected by obesity.
Obesity is considered global epidemic and the most rapidly growing form of malnutrition in the developed world as well as in developing countries. The economic cost of obesity and its associated co-morbidities is skyrocketing which is beyond the capacity of the best health care system in the world. Obesity is considered to be one of the most urgent public health problems and numerous studies have emphasized that obesity is a leading preventable cause of morbidity and mortality. Several
2
international and regional studies indicated that factors causing obesity are multi factorial in origin. These factors may include biological and non-biological factors such as hereditary, age, sex, education, socioeconomic level, physical activity, eating habits, and psychological factors.
Obesity, which made its presence felt first in the Northern Hemisphere, has now taken a pandemic look affecting practically almost all the countries of the globe. Obesity is not just limited to urban and affluent society but also affects the rural places and persons belonging to the lower socio-economic strata. Various epidemiological determinants have been responsible for the development of obesity, notably among them are dietary habits, physical inactivity, hereditary, etc.
WHO expert group estimate that obesity-related health risks increase among Asians from a lower BMI threshold. Asians have been found to be particularly vulnerable to obesity- related diseases, with rising rates of co-morbities from BMI 23.Thus, the WHO has recommended that the optimal BMI for Asian population be narrowed to 18.5 to23 kg/m2.compared with western populations. The percentage of body fat and the risk factors for cardiovascular disease, diabetes and hypertension at a given BMI are higher among Asian population. It is estimated that 3.6 billion Asian population already has BMI>23.
The prevalence of serious sequelae, e.g. Type2 diabetes, heart disease, hypertension, stroke, arthritis of weight bearing joint, many forms of cancer, poor quality of life, depression, premature death, etc, are prevented or reduced by weight loss-even by modest weight loss. The burden of the medical complications of
“globesity” threatens to over whelm health services, and the impact on health may soon overtake that of tobacco.
The WHO formally recognized obesity as a global epidemic in 1977, estimate that at least 400 million adults (9.8%) are obese with higher rate among women than men in the year 2005.Statistical data reveals that the problem of obesity has increased from 12-20% in men and from 16-25% in women over the last ten years.
In USA, adult obesity rates rose from 14.25% in 1978 to31% in 2000. In the UK, adult obesity rates rose from 6% of men and 8% of women in 1980 to 21% of men and 23.5% of women in 2001.the world health report 2002 estimated that
3
worldwide>2.5 million death per year are weight related-220,000 per year in Europe and >300,000 per year in USA.
In India obesity is becoming serious problem, despite the widespread presence of under nutrition obesity has reached epidemic proportion in India in the 21st century it affecting 5% the country’s population. Prevalence of obesity more in Punjab state for male 30.3% and for female 37.5%,Tamilnadu placed in fourth place for male 19.8
%, and for female 24.4%.
Body mass index (BMI) has been one of the transitions of an easiest ways to determine the transition of a person from normal weight to obesity. It is simple to calculate and its categorizes a person as underweight, normal, overweight and obese with its stages. So that timely measures could be taken for its correction, prevention and control persons and community as a whole. BMI of over 32 has been associated with a double mortality rate among women. Over a 16 year period obesity is estimated to cause an excess 111909 to 36500 death per year in the united states.
Obesity on average reduces life expectancy by six to seven years. A BMI of 30-35 reduces life expectancy by 20 years for men and 5 years for women.
Obesity is a chronic illness. Early detection of it can prevent various complications associated with it. BMI plays a crucial role in its early detection as it was simple to calculate and can even detect the pre-obesity stages in time.
NEED FOR THE STUDY
Obesity is the one of the leading preventable health problem worldwide. It affecting the productivity of the human. People who are overweight or obese have a greater chance of developing high blood pressure, high cholesterol, or other lipid disorders, type II diabetes mellitus, heart disease, stroke and certain cancers.
Statistical data shows that 80% of type II diabetes mellitus related to obesity, 70% of the cardio vascular disease related to obesity, 42% breast and colon cancers diagnosed among obese individual, 30% gall bladder surgery related to obesity, 26%
obese people having high blood pressure.
Care should be taken to reduce obesity and its complication. Even a small weight loss just 10% will help to lower risk of developing those diseases. It can be
4
reduced by diet modification, exercise, surgery and increasing intake of water.
Increasing intake of water having impact on obesity.
The most powerful healing substance known to man is the water. The human body is primarily composed of water. Water is not only beneficial but also vital to life.
Drinking water may be the most important piece to the weight loss puzzle.
Water contains no calories, fat or cholesterol and is low in sodium. It is nature’s appetite suppressant, and it helps the body to metabolize fat. Current research shows that low water intake; yield an increase in fat deposits. Conversely, a high water intake reduces the amount of fat deposits. Without enough water, the kidneys cannot function properly. As a result, some of their workload is pushed off onto the liver, in turn preventing the liver, from operating at peak levels. Because metabolizing fat is a primary function of liver, at peak levels when taking on the added work load from the kidneys, less body fat is metabolized and more is stored. This leads to weight gain.
When dieting, we restrict the calories we take less amount of food. By doing so, we lessen the total amount of water available to our body. Since about 30% of the average persons water intake comes from the food they eat. This gives us even more reason to raise our water intake.
All functions within the body require the presence of water. A well hydrated body enables the functions to occur quickly and efficiently. Drinking plenty of water will make us to feel more energetic and boost out metabolic rate, i.e. increased intake of water faster the metabolism there by it burning fat accumulation and providing energy to the body. It will reduce the food intake by feeling of fullness in the stomach.
There by it playing a role in weight reduction.
Increasing intake of water provides other benefits like, promoting the digestion and absorption of food; regulate body temperature and blood circulation, carries nutrients and oxygen to cells, it is necessary for the kidney to remove toxins and other wastes.
Stookey. JD.et.al (2008) conducted a experimental study, suggested that drinking water may promote weight loss by lowering total energy intake and/ or altering energy metabolism. Data collected from 173 premenopausal obese women (aged 25 to 50 years) by 24 hours diet recalls. Result shows that absolute and relative
5
increases in drinking water were associated with significant loss of body weight and fat over time.
Davy.BM. et.al (2008) conducted a experimental study suggested that water consumed before a meal has been found to reduce energy intake among obese and non obese older adults. Twenty four overweight and obese adults (body mass index=34.3+/-1.2),mean age 61.3+/-1.1 years, were given an ad libitum standardized breakfast meal on two randomly assigned occasions. Thirty minutes before the meal, subjects were given 500ml of water to pre load or no preload. Energy intake of each meal was correctly measured. Mean energy intake was significantly less in the water preload condition as compared with the no-preload condition (500+/-32 vs 574+/-38, respectively; p=0.004),representing an approximate 13% reduction in mean energy.
Nanci hellmach (2006) analyzed 240 overweight and obese women age group of 25 to 50 years those who drank more than 4 cups of water a day lost an additional 2 pounds more than dieters who did not drink that much.
STATEMENT OF THE RPOBLEM
A study to assess the effectiveness of hydrotherapy on obesity among obese women between the age group of 30 to 50 years in selected villages at Coimbatore.
OBJECTIVES
1) To assess the pretest levels of obesity among obese women in experimental group and control group.
2) To assess the effectiveness of hydrotherapy on obesity between experimental and control group
3) To assess the effectiveness of hydrotherapy on obesity among obese women in experimental group.
4) To associate the post test obesity with socio demographic variables among experimental group.
5) To associate the post test obesity with socio demographic variables among control group.
6 HYPOTHESIS
H1 – There will be a significant reduction in the post test level of obesity between experimental and control group.
H2 –There will be a significant difference in obesity before and after hydrotherapy among obese women in experimental group.
H3 – There will be a significant relationship between post test obesity and socio demographic variables among experimental group.
H4 – There will be a significant relationship between post test obesity and socio demographic variables among control group.
OPERATIONAL DEFINITION
1. Effectiveness – The outcome of hydrotherapy on obesity among obese women has achieved the desired effect on body weight as weight reduction.
2. Hydrotherapy – Intake of 4 liters of water measured by liter cane to reduce the obesity among obese women for a period of 1 month (30 days).
3. Obesity – Body weight more than 30% of BMI.
4. Obese women – Women who have weight more than 30% of BMI.
ASSUMPTION
1. Increased intake of water to 4 liters may reduce body weight among obese women.
2. Hydrotherapy on obesity may accept by the people in the selected villages.
3. Weight reduction may be measurable by weighing machine.
DELIMITATION
Study is delimited to obese women residing at selected villages at Coimbatore.
Samples selected by non-random method.
Obesity is measured only by calculating BMI.
7
CONCEPTUAL FRAME WORK
The present study is aimed to helping the obese women to prevent the complication of the obesity by reducing the weight and maintaining the normal body weight.
The conceptual framework of this study is based on “Modified Wiedenbach’s Helping Art of Clinical Nursing Theory”.
This theory views nursing as an art based on goal-directed care. According to this theory nursing practice consists of identifying a patient’s need for help, ministering the needed help and validating that the need for help was met.
IDENTIFYING THE NEED FOR HELP
It involves, determining the patient’s need for help based on the existence of a need. Whether the patient realizes the need and what prevents the patient from meeting the need.
MINISTERING NEEDED HELP
This includes provision of needed help to the patient. And also it requires an identified need and a patient who wants help.
VALIDATING THAT A NEED FOR HELP WAS MET.
It refers to a collection of evidence that shows patient’s needs have been met and that has functional ability has been restored as a direct result of the nurses action.
8
FIG.1. CONCEPTUAL FRAME WORK BASED ON MODIFIED WIEDENBACH’S HELPING ART OF CLINICAL NURSING THEORY
EXPERIMENTAL GROUP
STEP II MINISTERING THE
NEEDED HELP Maintaining checklist
in order to assess the intake of water.
Increasing the intake of water to 4 litters/day for one month (3days).
Regular intake water for one month (30 days).
STEP I
IDENTIFYING THE NEED FOR HELP
Pre test:
Identifying the obesity by weight. Assessing obesity by the weight
of the women.
STEP III VALIDATING THE
NEED OF HELP Post test: Assessing the weight to identify the reduction of obesity.
CONTROL GROUP
Negative Outcome:
No change in the obesity
Positive Outcome:
Reduction of obesity
REVIEW OF
LITERATURE
9
CHAPTER II
REVIEW OF LITERATURE
Review of literature is an important step in the development of any research project. It helps the investigator to analyze what is known about the topic and to describe methods of inquiry used in earlier work including their success and shortcoming. It gives a board understanding of the problem. Keeping these aspects in mind the investigator and studies related to prevalence and treatment regarding obesity among adults.
Literatures relevant for this study were reviewed and have been organized in the following sequence:
1. Studies related to prevalence of obesity.
2. Studies related to contributing factors of obesity.
3. Studies related to ill effects of obesity.
4. Studies related to treatment for obesity.
5. Studies related to drinking more amount of water for weight reduction.
1. STUDIES RELATED TO PREVALENCE OF OBESITY
Indian journal of community medicine (2009) Ranjan Tiwari, et.al, A cross sectional study to determine prevalence of obesity in high income group colonies of Gwalior city. Information regarding socio-demographic profile, eating habits and current health status, family type was recorded. Anthropometric data regarding height, weight and blood pressure was also taken. The data was collected and analyzed using statistical software and chi-square and proportional statistical test were applied. The study showed that 34.4% of male and 31.3% of female both aged 30 years and above were either obese or over weight. There was a statistically significant difference noted in the likening of freed food and fast food between obese and over weight persons and persons family type with normal body mass index.
Journal of biological sciences (2009) Ahamad. A. Sulaiman, et.al, conducted a cross sectional survey to determine prevalence of factors associated with overweight and obesity among university students. Using a multistage stratified sampling technique a total of 1219 students aged 17 to 28 years were selected. A self
10
administered questionnaire was used for data collection. Height and weight were self reported to calculate the body mass index (BMI) and to categories it normal, overweight and obese according to WHO (1997) classification. The over all prevalence rates of overweight and obesity among university students were 28.5% and 10.2% respectively, biological factors significantly associated with overweight and obesity were increasing age, being female and parental obesity (p<0.05). Obesity is a problem among university students. Factors behind overweight and obesity among university students were increasing age, being female, parental obesity, physical inactivity, non-healthy diet and lower family monthly income.
Kumar S., et.al, (2007) conducted a study to know the prevalence of obesity in Davangere city, Karnataka. A cross sectional study followed by case control study was conducted in two affluent villages of Davangere city. A total of 1496 samples were enrolled and data on family history of obesity, diet, snaking habits and physical activity was collected. Prevalence of obesity was 15.74%, prevalence of obesity was more in women (18.82%) than men (14.42%) prevalence of obesity increased with increase in age in both men and women. Family history of obesity, type of family, snaking of high energy food, lake of physical activity and marital status were the important influencing factors of obesity.
Hidustan Times New Delhi(2007)A study conducted by leading diabetologist Dr.Anoop Misra, showed that 16-18% of children were overweight/obese in 2004,which increased to 28% in 2006”. Nearly 50-70% of these children will become obese adults, and will suffer not only from diabetes but also stroke, liver disease, infertility, hypertension, arthritis and cancers. Unhealthy eating habits and a sedentary life style with no active sport activity are the major reason for obesity which is fast becoming an epidemic in India.
Youfa Wang, et.al (2007) conducted a systematic review and meta-regression analysis to assess the epidemics of obesity in United States. This review of the obesity epidemic provides a comprehensive description of the current situation, time trends, and disparities across gender, age, socioeconomic status, racial/ethnic group, and geographic regions in the United States based on national data. The authors searched studies published between 1990 and 2006. Adult overweight and obesity were defined by using body mass index. Among adults, obesity prevalence increased from 13% to
11
32% between the 1960s and 2004. Currently, 66%of adults are overweight or obese;
16% of children and adolescents are overweight and 34% are at risk of overweight.
By 2015, 75% of adults will be overweight or obese, and 41% will be obese. They reported that obesity has increased at an alarming rate in the United States over the past three decades. The associations of obesity with gender, age, ethnicity, and socioeconomic status are complex and dynamic. Related population-based programs and policies are needed.
M. Deepa et.al (2006) conducted a study on prevalence and significance of generalized and central body obesity in an urban Asian Indian population. Subjects were recruited from the Chennai urban rural epidemiology study carried out between 2001 and 2004. Anthropometric measurements, lipids, and oral glucose tolerance tests were carried out. Generalized obesity and abdominal obesity were defined using WHO Asia pacific guidelines. Result shows that isolated generalized obesity (normal waist circumference, increased BMI) was present in 12.7%, 8 men and 6.1 of women isolated abdominal obesity (increased waist circumference, normal BMI) was presented in 4.7% of men and 14.7% of women. They reported that combine obesity was present in 32.6% of men and 43.3% of women. In Asian Indian, the prevalence of combined obesity is high among both sexes.
Dhurandhar, et.al (2002) studied the prevalence of obesity in 1784 adults of Bombay, found lowest prevalence (11%) of obesity in students and highest (53%) in female medical doctors. Prevalence was highest in the age group of 31-50 years. Most of them are having mild obesity.
2. STUDIES RELATED TO CONTRIBUTING FACTORS OF OBESITY
Penny Gordon-Larsen(2008) A matched-pairs study was conducted with 32 stature- and age-matched pairs of obese and non-obese female African American were compared on the following measures: physical activity, inactivity, dietary intake, eating attitudes, health behavior knowledge, body image, self-esteem, and maturation status.Result shows that physical activity, inactivity, and perception of ideal body size emerged as the most important contributory factors to obesity status. There were no statistically significant matched-pair differences in macronutrient and micronutrient intakes, self-esteem, eating attitudes, health behavior knowledge, or maturation status
12
of these adolescents. Obese adolescents had significantly lower levels of physical activity, higher inactivity, and a larger perception of ideal body size than non-obese adolescents. These findings suggest that future intervention strategies should pay particular attention to physical activity, inactivity, and body image attitudes.
G L Burke et al (2004)conducted a study to assess the differences in obesity between Blacks and Whites are well documented in adult women. The association between behavioral and demographic factors and body size was assessed in 2801 Blackand White women aged 18 to 30 years. Results shows that black women had significantly higher age-adjusted mean body mass index and sub scapular skin fold thickness than white women. Obesity had different associations with age and education across racial groups. Apositive relationship between age and obesity was seen in Black women but not in White women, whereas a negative association between education and body size was noted only in White women. Potential contributing factors to the increased prevalence ofobesity in Black women include a more sedentary lifestyle, higher energy intake, earlier menarche, and earlier age at first childbirth .Further investigation is needed to develop interventional strategiesto prevent or reduce excess levels of obesity in Black women.
Michael G et al (2001) To examine the association between common mental disorders andobesity (body mass index 30 kg/m2) across the adult life course.The participants, 6820 men and 3346 women, aged 35–55were screened four times during a 19-year follow up. Each screening included measurements of mental disorders(the General Health Questionnaire), weight and height.Result shows that the excess risk of obesity in the presence of mental disorders increased with age (P = 0.004). The estimated proportion of people who were obese was 5.7% at age 40 both in the presenceand absences of mental disorders, but the corresponding figures were 34.6%
and 27.1% at age 70. They suggested that the association between common mental disorders and obesitybecomes stronger at older ages.
13
3. STUDIES RELATED TO ILLEFFECT OF OBESITY
Rosenberg.L, et.al (2009).conducted a study on obesity and poor breast cancer prognosis. High body mass index and use of hormone replacement therapy (HRT) increase the risk of post menopausal breast cancer. It has been shown that BMI modifies the effect of hormone replacement therapy, as its influence is most pronounced in lean women. They investigated the influence of BMI and HRT on prognosis in 2640 post menopausal women diagnosed with breast cancer, taking into account HRT and mammography before diagnosis. In non-users of HRT, obese women (BMI>30) compared with normal weight women (BMI<25) had a similar prognosis (hazard ratio (HR) 1.1, 95% confidence interval (CI) 0.8-1.6) despite larger tumors found in obese women. Obese HRT users had less favorable tumors characteristics and poorer prognosis compared with normal weight women (HR 3.7, 95%CI 1.9-7.2).
Tricia Y.LI, MD; et.al (2005) compared the obesity with physical activity in risk of coronary heart disease in women. Here they followed 88393 women, 34 to 59 years of age. These participants did not have cardiovascular disease and cancer at baseline. Documented 2358 incident major CHD events (including nonfatal myocardial infarction and fatal CHD) during 20 years of follow-up, including 889 cases of fatal CHD and 1469 cases of non fatal myocardial infarction. In a multivariate model adjusting for cardiovascular risk factors, overweight and obesity were significantly associated with increased risk of CHD, where as increasing levels of physical activity were associated with a graded reduction in CHD risk (p<0.001).Even a modest weight gain (4 to 10kg) during adulthood was associated with 27% (95% CI, 12% to 45%) increased risk of CHD compared with women with a stable weight after adjusting for physical activity and other cardiovascular risk factors. They reported that obesity and physical activity independently contribute to the development of CHD in women. These data underscore the importance of both maintaining a healthy weight and regular physical activity in preventing CHD.
Peeters A, et.al (2003) conducted a prospective cohort study life-table analysis.
Assessed the obesity in adulthood and its consequences for life expectancy.
Overweight and obesity in adulthood are linked to an increased risk for death and disease. 3457 Framingham heart study participants who were 30 to 49 years of age at
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baseline. Life expectancy and the probability of death before 70 years of age were analyzed by using life tables. Large decreases in life expectancy were associated with overweight and obesity. Forty-year-old female non smokers lost 3.3 years and 40 year-old male non-smokers lost 3.1 years of life expectancy because of overweight.
They suggested that obesity and overweight in adulthood are associated with large decreases in life expectancy and increases in early mortality. These decreases are similar to those seen with smoking. Obesity in adulthood is a powerful predictor of death at older ages. Because of the increasing prevalence of obesity, more efficient prevention and treatment should become high priorities in public health.
4. STUDIES RELATED TO TREATMENT FOR OBESITY
Yin Ll, et.al (2008) observed the therapeutic effect of acupoint sticking therapy on simple obesity. One hundred and eight cases were randomly divided into an acupoint sticking group (n=58) and an acupuncture group (n=50).The acupoint sticking group treated with TCM plaster sticking. The acupuncture group was treated with simple acupuncture. Their therapeutic effects were observed after 3 therapeutic courses. The total effective rate was 84.5%in the acupoint sticking group,86%in the acupuncture group with no significant difference between the two groups(p>0.05);after treatment, the body weight, body mass index, waist circumference, hip circumference decreased and the cumulative score of clinical symptoms decreased in the two groups with no significant difference between the two groups.
Szygutea Z, et.al (2006) studied the influence of diet and physical activity therapy on body’s composition of medium obesity women and men. In 56 women and 15 men the efficiency of two weeks diet and physical activity therapy was evaluated.
The following before and after therapy were measured: BM, BMI, LBM, WHR and the fat mass (fat kg and fat%).The subjects were divided into four groups depending on sex:(group of men and group of women), and value of BMI (group of persons with BMI lower than 27 and group of persons with BMI higher than 27).Both, body mass, content of fat and BMI decreased in all groups after two weeks.
Nichola J. Davis, et.al (2006) conducted study on obesity management. The purpose of the study was to assess inner-city clinic patient attitudes about weight loss counseling and to assess practice behaviors of primary care physicians in residency
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training. A chart was evaluated using 2 analyses and odds ratios. Chart reviews (n=84) indicated that 80% of patients were either obese or overweight; 21% of obese patients and 11% of overweight patients had the diagnosis documented. Of the (n=42), 17% had dietician referrals and 36% had an indication of physician weight loss recommendation. A patient survey indicated that 86% of obese patients wanted to lose weight, 64% wanted to dietician referral, and 62% felt that their physician could help with weight loss recommendations than were overweight patients, but frequency of visits and the diagnosis of diabetes did not increase the likelihood that weight would be addressed. Physicians need to address how to manage obesity including assessing patient attitudes about making lifestyle changes and using dietician and other referrals for weight reduction counseling.
Albani G, et.al (2005) Assessed the safety and efficacy of therapy with botulinum toxin in obesity was assessed in eight subjects median age, 46 years;
range, 35-57years with severe obesity median body mass index (BMI), 47.1kg/m;
range 38.2-56.7kg/m and multiple dietary treatment failures No clinically significant side effects were observed. In all patients, despite their not being on a specific diet, a reduction of body weight was observed at 1 month (median baseline weight 124.4kg vs. 121.8kg at 1 month; p<0.05).Two treatment-unrelated dropouts were observed. At 4 month, three of the six patients had a further weight loss. The treatment effect was apparently independent of changes in hunger or satiety, or of changes in fasting and postprandial plasma ghrelin and serum leptin, thus suggesting a different pharmacological mechanism. They reported that BTX-A treatment appears to be safe and well tolerated by obese patients, while its short-term efficacy varied widely.
Melinda A. et.al (2005) Conducted Meta analysis on surgical treatment of obesity. Back ground of the study was controversy exists regarding the effectiveness of surgery for weight loss and the resulting improvement in health-related outcomes.
They assessed 147 studies. Of these, 89 contributed to the weight loss analysis, 134 contributed to the mortality analysis, and 128 contributed to the complications analysis. The authors identified 1 large, matched cohort analysis that reported greater weight loss with medical treatment in individuals with an average body mass index (BMI) of 40 kg/m2 or greater. Surgery resulted in a weight loss of 20 to 30 kg, which was maintained for up to 10 years. Gastric bypass procedures result in more weight
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loss than gastroplasty. Bariatric procedures in current use have been performed with an overall mortality rate of less than 1%. Adverse events occur in about 20% of cases.
A laparoscopic approach results in fewer wound complications than an open approach. They suggested that surgery is more effective than non surgical treatment for weight and control of some co morbid conditions in patients with a BMI of 40 kg/m2 or greater.
Samper M, et.al (2004) conducted a study on Meal replacement as a dietary therapy for weight control. Assessment in males and females with different degrees of obesity. The goal of this project was to identify the efficacy and safety of the dietary product, a meal replacement, within the setting of a balanced hypo caloric diet established for weight loss. Total of 47 volunteers of both the sexes between the ages of 23 and 58,in which 11 of them acted as the a “control group “and ate only the low calorie diet while the rest formed a “problem group “and replaced one meal with a 200calorie meal replacement. Those individual with highest body mass index showed great weight loss than those with lower index. The volunteers did not note any hunger pangs until 3 hours after consumption of the meal replacement and health status parameters analyzed did not show any anomalous values. They reported that the replacement product studied allows controlled weight loss over 3 weeks when accompanied by a balanced low calorie diet and also produces a sensation of fullness in those consuming it.
Wozniak P, et.al (2003) Compared the efficacy of low calorie diet and low calorie diet applied with laser acupuncture in the therapy of visceral obesity in post menopausal women. The study population consisted of 74 menopausal females with visceral obesity who was divided in two groups according to an employed 2 months slimming procedure. In the first group (n=36) a low calorie diet was applied, while women in the second group (n=38) were on the same kind of diet, having additionally one cycle of laser acupuncture therapy at the same time. At baseline at the end of the study, body weight, body mass index, waist to hip ratio were determined in all women. After 6trial months both the group exhibited a statistically significant drop in body weight, body mass index and waist-to-hip ratio. The mean reduction of body weight, body mass index and waist-to-hip ratio was significantly higher in the second group of women (Laser acupuncture plus low-calorie diet). They reported that the
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combination of low calorie diet and laser acupuncture is characterized by a higher efficacy than a low-calorie diet alone in lowering body weight, body mass index and waist-hip-ratio. Laser acupuncture is an additional useful healing method in the therapy of visceral postmenopausal obesity.
Baltasar A, et.al (2001) Conducted a study on effectiveness of duodenal switch for a treatment of morbid obesity. The duodenal switch is a variant of the biliopancreatic diversion (BPD), with a vertical subtotal gastrectomy and pylorus preservation. Duodenal switch was used to treat morbid obesity in 125 patients, with a mean BMI 50, with 65% of the patient super obese. Patients have been followed for an intermediate period. The percentage of excess weight loss was >70%at one year, and reached 81.4%at 5 years when 97% of the patients had a excess weight loss>50%.Comorbidities were cured or improved in all patient. Duodenal switch was effective for the treatment of the morbid obesity in the severe obese patient.
Sindler BH (2001) assessed the effectiveness and safety of two herbal therapies for weight reduction. A non randomized group of 128 patients who had received one of two herbal treatments for obesity were retrospectively analyzed for their weight loss response. Of 128patients,90 were treated with the herbal product Biolean, and 38 were treated with the combination of prescription phentermine and the herbal product satiete. Result shown that 79% of the Bio lean-treated patients and 87% of the phentermine and satiete-treated patients lost a mean of at least 0.5 Ib/wk. Herbal products for weight reduction in motivated patients may be effective in helping to treat clinically significant obesity, which is an important public health problem. He reported that consistency and safety of a bio available active product for weight reduction, as well as its efficacy, remain important factors in the consideration of such therapy for weight reduction.
5. STUDIES RELATED TO DRINKING WATER FOR WEIGHT REDUCTION
Stookey JD.et.al (2008) conducted a experimental study, suggested that drinking water may promote weight loss by lowering total energy intake and or altering energy metabolism. Data collected from 173 premenopausal obese women (aged 25 to 50 years) by 24 hours diet recalls. Result shows that absolute and relative increases in
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drinking water were associated with significant loss of body weight and fat over time (p=0.05) level.
Davy BM.et.al (2008) conducted a study, suggested that water consumed before a meal has been found to reduce energy intake among obese and non obese older adult. Twenty four over weight and obese adult (body mass index = 34.3 + 1.2), mean age 61.3+1.1years, where given an ad libitum standardized break fast meal on two randomly assigned occasions. Thirty minutes before the meal subjects were 500 ml of water to pre load or no preloaded. Mean energy intake was significantly less in the water preload condition as compared with no preload condition (500 +32 Vs 574+38, respectively (p=0.004)),; representing an approximately 13% reduction in mean energy.
Nanci Hellmich (2006) analyzed 240 overweight women age group of 25 to 50 years, those who drank more than 4cups of water a day lost an additional 2 pounds more than dieters who did not drink that much.
Flood JE.et.al (2006) examined the impact of increasing beverage portion size on beverage and food intake. The result shows that increasing beverage portion size significantly increased the weight of beverage consumed, regardless of the type of beverage served(p<0.05).This study concludes that serving a large portion of beverage resulted in an overall increase in energy consumption and increased energy intake from the beverage when a caloric beverages was served. Serving caloric beverages resulted in an overall increase in total energy consumed at lunch. There fore replacing caloric beverages can be effective strategy for decreasing energy intake.
Rodin .J (1990) conducted a study using a within subject design. He gave overweight and normal weight subjects a 500ml drink of fructose, glucose or aspartame diluted in lemon-flavored water or plain water in a randomized fashion at about weekly intervals. Food intake was assessed at a buffet lunch that began 38minute after the preload was completed. When subjects drank the fructose preload, they subsequently ate fewer overall calorie and fewer grams of fat than when drank any of the other preload. The effects of the oxidation of fructose as a possible mechanism for the reduction in food intake there by it reducing the weight of the individual.
METHODOLOGY
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CHAPTER - III
RESEARCH METHODOLOGY
Research methodology is a way to systematically solve the research problem.
It is a science of studying how research is done scientifically. Methodology is a significant part of the research under which the researcher is able to project a blue print of the research undertaken.
This chapter includes research design, variables, setting, population, and sample size, sampling technique, development of tool, data collection procedure and ethical consideration. The problem stated in this study was “A study to assess the effectiveness of hydrotherapy on obesity among obese women in experimental and control group”.
RESEARCH APPROACH
The research approach used for this study was a evaluative approach, without random selection of sample by manipulating the variables to assess the effectiveness of hydrotherapy on obesity.
RESEARCH DESIGN
The term research design refers to the plan of a scientific investigation.
Research design helps the researcher in the selection of the subject. Identification of variables, then manipulation, control, observations to be made and types of statistical analysis to interpret the data.
Pre test post test experimental design
In this design, the dependent variable is measured at two points in time before and after the intervention. This scheme permits us to examine what changes were produced as a result of intervention which is our independent variable. This design, because of its two measurements points is referred to as a before after design or a pre test – post test design.
Considering all the above factors and availability of the time and sample the researcher has selected “the pre test post test control group design”, i.e. – the 2 groups, experimental and control group. Pre and post test with random selection of the sample.
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Randomization is applied in selecting the villages from panchayat. 14 villages are in sundakkamuthur panchayat. Among these 3 villages are selected randomly by simple random sampling for the study. Then subjects are selected based on the obesity score.
The entire subjects are taken by weight analysis before the treatment of hydrotherapy. Hydrotherapy is given only to experimental and control group remain the same. After one month of hydrotherapy again both the groups will be taken for post test and the findings has to be analyzed for difference.
The diagrammatic representation of pre test post test control group design is given below:
Group Pretest Treatment Post test
Experimental O1 X O2
Control O3 - O4
Key:
O1 – Assessing the weight of the obese women before hydrotherapy among experimental group.
O2 – Assessing the weight after hydrotherapy among experimental group.
O3 – Pre test to assess the weight of obese women in control group.
O4 – Post test to assess the weight of obese women in control group X – Manipulation (hydro therapy for one month).
VARIABLES
Three categories of variables discussed in the present study were:
Independent Variable : Hydrotherapy i.e., increasing the intake of water into 4 liters.
Dependent Variable : Obesity i.e.,body weight of the obese women that is measured by reliable weighing machine.
Socio demographic Variable : Age Education, income, type of work, dietary pattern, religion, marital status, type of family hereditary, menstrual history, under any treatment, and related to reproduction.
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Fig – 2: SCHEMATIC PRESENTATION OF RESEARCH DESIGN ACCESSIBLE POPULATION
Women between age of 30 to 50 yrs. weighs more than 30% of their BMI
Residing at selected villages at Coimbatore SAMPLE AND SAMPLING TECHNIQUE 60 obese Women and purposive sampling
PRE TEST DATA COLLECTION
Assessing Weight By
Weighing machine EXPERIMENTAL GROUP
30 obese women
CONTROL GROUP 30 obese women
INTERVENTION Increasing intake of
Water 4 liters/ day for one month (30
days)
POST TEST
ANALYSIS AND INTERPRETATION Inferential and descriptive analysis
Findings
REPORT / THESIS TARGET POPULATION
Women between age of 30 to 50 yrs. weighs more than 30% of their BMI
PRE TEST
POST TEST
CRITERION MEASURES Weight score
22 SETTING OF THE STUDY
Research setting is the specific place where data collection is to be made; the selection of setting was done on the bases of feasibility of conducting the study, availability of subjects and permission from authorities. The present study was conducted in the Sundakamuthur, Ramachettipalayam, and Sugunapuram at Coimbatore.
POPULATION
Bler and Hungler (2004) referred population as the entire set of individuals (or) subjects having common characteristics, sometimes referred to as universe.
Population may be of two types, target population and accessible population. In this study two populations were described.
Target population
It refers to the population that the researcher wishes to make generalization. In this research the target population was the obese women between the age group of 30 to 50 years, whose weight more than 30 % of their BMI.
Accessible population
It refers to the aggregate of cases which conform to the designed criteria and which is accessible to the researcher as the pool of subjects (or) objects. In this research the accessible population was the obese women between the age group of 30 to 50 years, whose body weight more than 30% of their BMI, residing at Sundakamuthur, Ramachettipalayam, and Sugunapuram at Coimbatore.
SAMPLE & SAMPLING Sample
Sample consists of the subject of the population selected to participate in the research study.
The sample selected for the present study decided to be 60 obese women between the age group of 30 to 50 years, weight more than 30% of their BMI, who were residing at Sundakamuthur, Ramachettipalayam, and Sugunapuram at Coimbatore were selected.
23 Sample size
The sample size is determined based on the type of precision required, level of significance, type of variables, type of study, availability of sample and feasibility of conducting the study. The sample size for the present study is decided to be 60 obese women 30 in experimental and 30 in the control group.
Sampling technique
The purpose of using a sampling technique is to increase representatives and to decreases bias of sampling error. In this study purposive sampling technique is used to select subjects as they fulfilled the inclusion criteria.
Simple random sampling
Randomization is applied in selecting the villages from panchayat. 14 villages are in sundakkamuthur panchayat. Among these 3 villages are selected randomly by simple random sampling for the study. Then subjects are selected based on the obesity score.
A purposive sampling is based on the belief that a researcher’s knowledge about the population can be used to hand pick the cases to be included in the sample.
The researcher decided purposively to select the widest possible variety of respondents or chosen subjects who are judged to be a typical of obese population having more than 30% of BMI are selected for the study, who are coming under the inclusion criteria.
Criteria for selection of sample
In sampling criteria the researcher specifies the characteristics of the population under the study by detailing the inclusion and exclusion criteria. Inclusion criteria are characteristics that each sample elements must possess to be included in the sample. Exclusion criteria are characteristics that conformed or contaminate the results of the study, therefore such participates are excluded from the study.
Inclusion Criteria
The women who were having weight more than 30% of their BMI between the age group of 30 to 50 years.
The women who were willing to participate in the study.
24 Exclusion Criteria
Obese women who had any medical complication.
Obese women who underwent any surgery.
Obese women who had mental illness at the time of data collection.
TOOL & TECHNIQUE Selection of tool
Data collection tool is an instrument that gathers information needed to address a research problem accurately, precisely and sensitively (polit 1999).The investigator used a standardized weighing machine to assess the weight of the women.
Development of tool
The research instrument is developed after extensive review of literature and expert opinion. An instrument in research refers to the tool used for collecting data. A standardized weighing machine was used to assess the level of obesity among obese women. Here the investigator used a standardized weighing machine to assess the weight among 60 obese women between the age group of 30 to 50 years.
Description of the tool
The study tool consisted of 3 sections.
SECTION I: Screening form using BMI.
SECTION II: Back ground factors of obese women between the age group of 30 to 50 years.
SECTION III: Weight score by using weighing scale.
SECTION I:
Obese women BMI will be calculated by using weight and height.
Weight in kg BMI = ---
Height in (meter2)
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CLASSIFICATION OF ADULT ACCORDING TO BMI
Classification BMI Risk of Co morbidities
Under Weight Normal range Over weight :
Pre Obese Obese Class I Obese Class II Obese Class III
<18.50 18.5 – 24.99
>25.00 25.00 – 29.99 30.00 – 34.99 35.00 – 39.99
>40.00
Low (but risk of other clinical problems increased) Average Increases Moderate Severe Very Severe
SECTION II: Information on socio demographic factors.
This section consisted of items seeking general information about obese women like age, education, type of work, dietary pattern, type of family, religion, income, marital status hereditary, menstrual history, treatment, and reproduction.
It was a self administered questionnaire. Instructions were given to the obese women before administering the questionnaire.
SECTION III: Weight score i.e. reduction of body weight after 1 month of hydrotherapy.
Mild: 0 to 0.5 kg, Moderate: 0.6 to 1 kg, Good: 1.1 to 1.5 kg, Very good: 1.6 and above.
VALIDITY & RELIABILITY Validity of the tool
In the present study, five expert including one PHC medical officer and 4 nursing experts validated the entire section of the tool. The experts were suggested on relevance, sequence, and adequacy of the items in the tool.
Validity of the instrument
In the present study the tool for measuring the weight was weighing machine.
The validity of the instrument was checked by checking the weight of the same person by 2 weighing machine i.e. used for the study. The two weighing machines have to
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give the same exact weight. Validity is tested by checking the body weight of a person whose weight is known by checking in other standardized weighing machine.
Both readings are same then it is concluded that the weighing machine was valid to check the weight of the samples.
Reliability of the tool
The reliability of the tool was established by test retest method among 6 obese women. The post test was conducted 10 days after the pre test, to the same group of obese women. Then the score obtained were correlated. Reliability was computed using Karl Pearson’s correlation co-efficient and it was found, r = 0.9. the tool was found to be highly reliable for the study.
TRY OUT
The tool was administered and checked for the feasibility and appropriateness.
The subjects chosen were similar in characteristics to those of the population under the study. The tool prepared by the investigator was administered to 6 obese women.
It was found that the items were clear and reliable.
DATA COLLECTION PROCEDURE
The present study was conducted in Sundakamuthur, Ramachettipalayam, and Sugunapuram at Coimbatore. The data collected for four weeks.
Prior permission from the authorities obtained. Individual informed consent will be taken from the study sample.
The study samples selected by purposive sampling technique based on sample selection criteria.
All the obese women will screen to assess the obesity. Obese women who were satisfying the selection criteria will be included for the study. The objectives and purpose of the study will be explained and confidentiality has maintained.
The samples will be divided into 2 group i.e. experimental and control group.
Hydrotherapy (Drinking water 4 liters/ day) is explained to the experimental group and they are motivated to follow the instruction for 4 weeks. During that period samples has to be followed by the investigator daily. After 4 weeks weight has to be checked for both experimental and control group using same weighing scale and findings has to be recorded.
27 PLAN FOR DATA ANALYSIS
The investigator has to edit the tool, code the data and enter the data into excel sheet. Statistical analysis has to be done by SPSS packages version10. The significance at 0.05 levels is used to reject the null hypothesis.
The plan for data analysis is as follows:
Descriptive statistics
Frequency and percentage distribution will be used analyze socio demographic variables.
Mean and standard deviation will be used to analyze the pre test and post test scores of obesity.
Inferential statistics
Paired‘t’ test, mean score will be used to find out the effectiveness of hydrotherapy among experimental group.
Unpaired‘t’ test, mean score will be used to find out the effectiveness of hydrotherapy among experimental group and control group.
Chi square will be used to find out the relationship between post test score of and socio demographic variables.
ETHICAL CONCIDERATION
The study objective, intervention and data collection procedures will be approved by the research and ethical committee of the institution. Informed consent will be obtained from the individual obese woman in oral form. The obese women will have the freedom to leave the study at their own will without assigning any reason. The benefits of hydrotherapy, ill effects of obesity, were explained to the obese women involved in the study.
ANALYSIS AND
INTERPRETATION
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CHAPTER-IV
DATA ANALYSIS AND INTERPRETATION
This chapter deals with the analysis and interpretation of the collected data from 60 samples of obese women with reference to their weight reduction after the hydrotherapy.
The purpose of analysis was to identify the pre and post test variables. So that the relation of the research problem can be studied and tested.
According to Polit and Hungler (2005) analysis is the method of organizing, sorting and scrutinizing data in such a way that research question can be answered.
The analysis and interpretation of data collected through weight and height check list of obese women and the result were computed by using descriptive (mean, frequency, percentage and standard deviation) and inferential(co-relation co-efficient, chi-square, ‘t’ test and paired ‘t’ test) statistics and the result were computed, based on the objective of this study. The major objectives in the present study were:
1. To assess the pre test level of obesity among obese women in experimental and control group
2. To assess the effectiveness of hydrotherapy on obesity among obese women in experimental and control group.
3. To assess the effectiveness of hydrotherapy on obesity among obese women in experimental group.
4. To associate the post test obesity with background variables among experimental group.
5. To associate the post test obesity with background variables among control group.
The data collected were edited, tabulated, analyzed, interpreted and the findings were presented in the form of tables and diagrams under the following section;
Section –I: Data on frequency, percentage and χ2 of socio demographic variables of obese women among experimental and control group.
Section –II: Data on pre test level of obesity among obese women in experimental and control group.
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Section –III: Data on effectiveness of hydrotherapy between experimental and control group.
Section –IV: Data on effectiveness of hydrotherapy on obesity among experimental group.
Section – V: Data on association of post test obesity with socio demographic variables among experimental group.
Section – VI: Data on association of post test obesity with socio demographic variables among control group.
