Int J Adolesc Med Health 2016; 28(1): 31–37
Terence Babwah*
Exercise, bodyweight perception and related weight loss behavior among adolescents in Trinidad and Tobago Abstract Aim: This study attempted to evaluate the real and perceived body weight, exercise habits and weight-altering dietary supplement use by adolescents attending schools in Trinidad and Tobago. Methods: A de novo questionnaire was administered prospectively to 15–19-year-old to determine their exercise habits, their perceived body weights, and their use of any weight gain or weight loss supplements. A subset of students had their actual height and weights recorded and BMI calculated. Results: Five hundred and eighty-three students did the questionnaire (88% response rate), and 363 students had BMI calculated. Some 14.9% (54/363) of the students were overweight, and 15.4% (56/363) were obese, and more than 75% of the obese students had attempted weight loss in the past. These measures included exercise in the majority of the students and use of dietary supplements in the minority. Only 6% of the obese students exercised five or more times per week. About 28% of the students misclassified their body weights, and perception of body weight influenced weight loss behaviors more than actual body weights. Conclusion: Almost one third of the students were overweight or obese. Overweight students were motivated to lose weight, and these students need to have some structured health promotion program, which educates them on correct exercise habits, safe measures to lose weight, and which informs them of their actual body weight. Keywords: body image; dietary supplements; weight altering behavior.
*Corresponding author: Dr. Terence Babwah, MBBS, DM, MSc, MFSEM, Department of Para-Clinical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, Phone: +(868)6456741, E-mail: [email protected]; [email protected]
DOI 10.1515/ijamh-2014-0062 Received September 30, 2014; accepted November 22, 2014; previously published online January 23, 2015
Introduction Obesity in children and adolescents is associated with both medical and psychosocial problems. Medical problems include musculoskeletal problems (1) development of prediabetes, hyperlipidemia, endothelial dysfunction and hypertension (2), and metabolic syndrome (3). Interventions aimed at reducing BMI have been able to modify the risk factors for the metabolic syndrome (4). Psychosocial consequences of obesity include being victims of bullying in young males and increased substance use like marijuana and alcohol in females (5). In addition, overweight and obese adolescents are unfortunately seen by their peers as being lazy and lacking self-control (6). Physical inactivity has been strongly associated with the adolescent obesity epidemic, which the world is currently experiencing. Many studies have found strong positive associations between BMI and sedentary behaviors (7, 8). Activities like watching television, playing computer games, and using the Internet have decreased adolescent involvement in physical activities, and organized physical activities appear to assist in counteracting screen time participation (9). Children who partook in regular moderate-to-vigorous physical activity were positively associated with being normal weight (8) and had higher academic achievements (10) than obese adolescents. Male and female adolescents who exercise are more likely to take this habit into adulthood than those who do not exercise (11). Despite all this knowledge of the benefits of exercise, many adolescents do not seem to exercise regularly or adequately (12). It is recommended that children and adolescents partake in moderate-to-vigorous physical activity one or more hours daily and muscle and bone strengthening activities three or more times per week (13). Most studies looking at exercise in adolescents have been done in developed countries. However, there are geographical
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32 Babwah: Exercise, bodyweight perception and related weight loss behavior in adolescents differences in the exercise habits of adolescents, and cultural norms appear to influence exercise habits, so attempting to extrapolate exercise data from developed countries to developing countries is inappropriate. For example, whereas about 10% of adolescents in the UK were classified as being inactive, 57% of adolescents in Saudi Arabia were classified as inactive (7). The Caribbean adolescent population has also been affected by the obesity epidemic with rates of overweight and obesity together ranging from 13% to 35% with studies done in the last 10 years (14–16). The high rates of obesity have contributed to the high rates of diabetes, hypertension, and coronary heart diseases that are the leading causes of morbidity and mortality in the over 45-year-old population (17). Trinidad and Tobago (TT) is a multi-ethnic, developing Caribbean country with a population of 1.3 million people. The major races are East Indians, Africans, and mixed African and East Indian races. A previous study done in South Trinidad showed that many people did not exercise adequately or regularly, and exercise volume decreased with increasing age (18). Three quarters of adolescents in TT currently exercise but most exercise infrequently (19). No previous study in the Caribbean looked at exercise habits in adolescents as it relates to their body weight classification. Overweight and obese adolescents were found to be more likely to engage in a variety of behaviors in oDS to lose weight. These include: using dietary supplements (DS), diet and exercise, vomiting after eating, and using laxatives (20, 21). The use of DS and exercise to lose weight in TT adolescents is not known. The aims of this study were to determine the exercise habits of adolescents in TT, the prevalence of obesity in adolescents, and determine relationships between exercise habits and body weight classification. The current rates of obesity will be compared with work done previously (14), and the weight loss behavior of these adolescents as it relates to exercise habits and use of weight altering dietary supplement will be determined. The self-perceived body weights of these adolescents will also be determined. These baseline data obtained would be important in developing a health promotion plan to encourage exercise among adolescents in this country.
Methodology A questionnaire was used to gather information from all the students involved in this study. A subset of these students had their weights and heights measured so
that their body mass indices (BMI) could be determined. Fifteen–19-year-old students were sampled from secondary schools in TT. This was done to target students in the middle and late adolescent period. School attendance is compulsory until 15 years of age. Secondary school attendance can be for up to 8 years’ duration.
Instruments As this was a pilot project looking at exercise habits in adolescents and their attempts to lose weight, a de novo questionnaire with 19 items was designed to collect data on secondary school students including DS use, actual and perceived body weight, and weight behaviors. Thirteen questions were directly related to this paper and are described here. Questions 1–7 looked at demographic information and exercise behavior. Factors like age, gender, ethnicity, type of secondary school attended, exercise and sport participation, and the individual’s perception of health status were explored. A question on self perception of body weight (normal weight, underweight, or overweight) was explored. Other questions related to attempts to lose weight, attempts to gain weight, and the use of weight-altering DS including anabolic steroids were explored. Six secondary school students aged 15–19 years of age attending a clinic (three boys and three girls) were asked to pretest the questionnaire for ease of understanding of the wording and layout of the original questionnaire. The questionnaire was re-administered to the six students a week later, and the test/retest ratio varied from 0.83 to 1.0 for the questions. The content validity was assessed by a primary care physician, a nutritionist, and a sociology teacher who reviewed the questions to determine the suitability of questions for the use in a primary care setting and suitability of content for students 15–19 years of age. Minor adjustments were made to the original questionnaire based on the recommendations of the reviewers.
Procedure Ethical Approval was obtained by the Ethics Committee of the University of the West Indies, St Augustine Campus. Institutional approval was obtained from the Ministry of Education of Trinidad and Tobago (MOE). Written informed consent was obtained from all the subjects. This study was cross-sectional in design. A proportionate,
Brought to you by | New York University Bobst Library Technical Services Authenticated Download Date | 2/17/16 7:30 PM
Babwah: Exercise, bodyweight perception and related weight loss behavior in adolescents 33
stratified sampling strategy was adopted based on the eight Educational Districts (EdD) in TT. Students who were
Terence Babwah*
Exercise, bodyweight perception and related weight loss behavior among adolescents in Trinidad and Tobago Abstract Aim: This study attempted to evaluate the real and perceived body weight, exercise habits and weight-altering dietary supplement use by adolescents attending schools in Trinidad and Tobago. Methods: A de novo questionnaire was administered prospectively to 15–19-year-old to determine their exercise habits, their perceived body weights, and their use of any weight gain or weight loss supplements. A subset of students had their actual height and weights recorded and BMI calculated. Results: Five hundred and eighty-three students did the questionnaire (88% response rate), and 363 students had BMI calculated. Some 14.9% (54/363) of the students were overweight, and 15.4% (56/363) were obese, and more than 75% of the obese students had attempted weight loss in the past. These measures included exercise in the majority of the students and use of dietary supplements in the minority. Only 6% of the obese students exercised five or more times per week. About 28% of the students misclassified their body weights, and perception of body weight influenced weight loss behaviors more than actual body weights. Conclusion: Almost one third of the students were overweight or obese. Overweight students were motivated to lose weight, and these students need to have some structured health promotion program, which educates them on correct exercise habits, safe measures to lose weight, and which informs them of their actual body weight. Keywords: body image; dietary supplements; weight altering behavior.
*Corresponding author: Dr. Terence Babwah, MBBS, DM, MSc, MFSEM, Department of Para-Clinical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, Phone: +(868)6456741, E-mail: [email protected]; [email protected]
DOI 10.1515/ijamh-2014-0062 Received September 30, 2014; accepted November 22, 2014; previously published online January 23, 2015
Introduction Obesity in children and adolescents is associated with both medical and psychosocial problems. Medical problems include musculoskeletal problems (1) development of prediabetes, hyperlipidemia, endothelial dysfunction and hypertension (2), and metabolic syndrome (3). Interventions aimed at reducing BMI have been able to modify the risk factors for the metabolic syndrome (4). Psychosocial consequences of obesity include being victims of bullying in young males and increased substance use like marijuana and alcohol in females (5). In addition, overweight and obese adolescents are unfortunately seen by their peers as being lazy and lacking self-control (6). Physical inactivity has been strongly associated with the adolescent obesity epidemic, which the world is currently experiencing. Many studies have found strong positive associations between BMI and sedentary behaviors (7, 8). Activities like watching television, playing computer games, and using the Internet have decreased adolescent involvement in physical activities, and organized physical activities appear to assist in counteracting screen time participation (9). Children who partook in regular moderate-to-vigorous physical activity were positively associated with being normal weight (8) and had higher academic achievements (10) than obese adolescents. Male and female adolescents who exercise are more likely to take this habit into adulthood than those who do not exercise (11). Despite all this knowledge of the benefits of exercise, many adolescents do not seem to exercise regularly or adequately (12). It is recommended that children and adolescents partake in moderate-to-vigorous physical activity one or more hours daily and muscle and bone strengthening activities three or more times per week (13). Most studies looking at exercise in adolescents have been done in developed countries. However, there are geographical
Brought to you by | New York University Bobst Library Technical Services Authenticated Download Date | 2/17/16 7:30 PM
32 Babwah: Exercise, bodyweight perception and related weight loss behavior in adolescents differences in the exercise habits of adolescents, and cultural norms appear to influence exercise habits, so attempting to extrapolate exercise data from developed countries to developing countries is inappropriate. For example, whereas about 10% of adolescents in the UK were classified as being inactive, 57% of adolescents in Saudi Arabia were classified as inactive (7). The Caribbean adolescent population has also been affected by the obesity epidemic with rates of overweight and obesity together ranging from 13% to 35% with studies done in the last 10 years (14–16). The high rates of obesity have contributed to the high rates of diabetes, hypertension, and coronary heart diseases that are the leading causes of morbidity and mortality in the over 45-year-old population (17). Trinidad and Tobago (TT) is a multi-ethnic, developing Caribbean country with a population of 1.3 million people. The major races are East Indians, Africans, and mixed African and East Indian races. A previous study done in South Trinidad showed that many people did not exercise adequately or regularly, and exercise volume decreased with increasing age (18). Three quarters of adolescents in TT currently exercise but most exercise infrequently (19). No previous study in the Caribbean looked at exercise habits in adolescents as it relates to their body weight classification. Overweight and obese adolescents were found to be more likely to engage in a variety of behaviors in oDS to lose weight. These include: using dietary supplements (DS), diet and exercise, vomiting after eating, and using laxatives (20, 21). The use of DS and exercise to lose weight in TT adolescents is not known. The aims of this study were to determine the exercise habits of adolescents in TT, the prevalence of obesity in adolescents, and determine relationships between exercise habits and body weight classification. The current rates of obesity will be compared with work done previously (14), and the weight loss behavior of these adolescents as it relates to exercise habits and use of weight altering dietary supplement will be determined. The self-perceived body weights of these adolescents will also be determined. These baseline data obtained would be important in developing a health promotion plan to encourage exercise among adolescents in this country.
Methodology A questionnaire was used to gather information from all the students involved in this study. A subset of these students had their weights and heights measured so
that their body mass indices (BMI) could be determined. Fifteen–19-year-old students were sampled from secondary schools in TT. This was done to target students in the middle and late adolescent period. School attendance is compulsory until 15 years of age. Secondary school attendance can be for up to 8 years’ duration.
Instruments As this was a pilot project looking at exercise habits in adolescents and their attempts to lose weight, a de novo questionnaire with 19 items was designed to collect data on secondary school students including DS use, actual and perceived body weight, and weight behaviors. Thirteen questions were directly related to this paper and are described here. Questions 1–7 looked at demographic information and exercise behavior. Factors like age, gender, ethnicity, type of secondary school attended, exercise and sport participation, and the individual’s perception of health status were explored. A question on self perception of body weight (normal weight, underweight, or overweight) was explored. Other questions related to attempts to lose weight, attempts to gain weight, and the use of weight-altering DS including anabolic steroids were explored. Six secondary school students aged 15–19 years of age attending a clinic (three boys and three girls) were asked to pretest the questionnaire for ease of understanding of the wording and layout of the original questionnaire. The questionnaire was re-administered to the six students a week later, and the test/retest ratio varied from 0.83 to 1.0 for the questions. The content validity was assessed by a primary care physician, a nutritionist, and a sociology teacher who reviewed the questions to determine the suitability of questions for the use in a primary care setting and suitability of content for students 15–19 years of age. Minor adjustments were made to the original questionnaire based on the recommendations of the reviewers.
Procedure Ethical Approval was obtained by the Ethics Committee of the University of the West Indies, St Augustine Campus. Institutional approval was obtained from the Ministry of Education of Trinidad and Tobago (MOE). Written informed consent was obtained from all the subjects. This study was cross-sectional in design. A proportionate,
Brought to you by | New York University Bobst Library Technical Services Authenticated Download Date | 2/17/16 7:30 PM
Babwah: Exercise, bodyweight perception and related weight loss behavior in adolescents 33
stratified sampling strategy was adopted based on the eight Educational Districts (EdD) in TT. Students who were
