Assessment of the Psycho Social Problems Related with Obese Juveniles in Actual Government School at Chennai

To evaluate the level of obesity, associated psychosocial problems and comparison with demographic variables in a selected government school at Chennai. Stock (1974) health belief Theory, a non-experimental study design, was used as the conceptual frame work in the present study. The students were randomly selected for the study Semi structured interview questions and questionnaire were used to assess the psychosocial problems of adolescents and demographic data of the students, respectively. The results revealed that psycho social problems were found among 50 obese adolescents, majority of them are 15-18 years of age, females, nuclear family, Hindus and non-vegetarian. It was also exclusively observed that obese adolescents had high level of psycho social problems.


INTRODUCTION
Overconsumption of food coupled with sedentary lifestyle and genetic factors leads to obesity. Around the world, in spite of the differences, obesity is steadily increasing [1]. Obesity has grown to epidemic proportions with 4 million people deaths per year. Not just the absence of disease but a state of complete physical, mental, and social well-being is termed as healthy by World Health Organization (WHO). Prevention is always better than cure. In regard to obesity, eating right, exercise and sleep together helps a person to stay fit. WHO states that a Body Mass Index (BMI) above 30 is considered obese? Apart from food, exercise and sleep selfconfidence, support from friends or family and an urge to follow a healthy lifestyle is important overall wellbeing. Obesity seems to psychologically affect the young more than the other age groups. Adolescence, puberty to adulthood, is marked by characteristic changes, sexual feelings, identity construction, and formation of life-affecting views/thoughts. Obese adolescents are more likely than their peers to have high blood pressure and type2 diabetes.
In addition to Genetics, obesity usually is a result of improper diet and minimal physical activity. Obesity was twice as common among adolescents as it was 30 years ago. Most of the youngsters who are obese in their early ages remain the same in adulthood too.
According to WHO the Worldwide 65% of the worlds population lives in countries where the mortality rate due to obesity and related disorders is high. Nearly 43 million adolescents under the age of twenty were overweight in 2010. In India too, obesity seems to pose a major threat to public health. Its prevalence continues to increase in many segments of the Indian population, including children and adolescents. Apart from the psychological damage it does, it also leads to many complications in adulthood. Obese individuals, particularly youth, are often stigmatized in their own societies [2]. As a result of this bias and prejudice, it has been hypothesized that obese children and adolescents are at increased risk for poor body image, low self-esteem, and psychological disorders, especially depression. Hitchcock et al. (1986) found that children of lower social rank and those with a southern European background made most of the overweight category (greater than the 90th percentile for BMI), particularly in adolescence [2]. Another study states that the distribution of BMI was more in the children of US (12-14 years) when compared to Australians [3]. The results of studies among adolescents from parts of Punjab, Maharashtra, Delhi, and South India revealed that the prevalence of overweight and obesity was high (11% to 29%) [4].
The overweight and the obesity is are of two important problems of current modernized life style and their impacts are spanning from the socio, familial to psychological roots. Many of the obese persons have deepened psycho disturbances related to their mood, self-esteem, quality of life, and body image. A kind of emotional distress is existing between them and seeking for alternatives in case of treatment and cure against the obesity. The psychological harmony is remained to be a hard challenge for those individuals until achieving the adequate weight loss and increase the risk of unwanted psychological issues [1][2][3][4].
Although many studies have been made in this light, findings have been inconsistent, and associations seen cross-sectionals cannot distinguish whether obesity is a consequence of, a contributor to, or a correlate of psychological disorders. For youth, the most immediate consequences are thought to be psychosocial, but whether adolescent overweight increases the risk for psychological disorders remains poorly understood. Hence the present study is framed to assess the association between obesity and psychosocial problems among adolescents.

METHODOLOGY
The research approach used for the study is qualitative and quantitative research to assess the level of psycho social problems of obese adolescents in selected government higher secondary schools in Chennai.

Research Design
Non-experimental descriptive design helps assess, describe and document the aspect of psycho social problems.
Setting is the physical location and conditions in which data collection takes place in a study (Polite and Beck, 2004). The selection of the Centre for the present study is on the Availability of subjects, Feasibility of conducting the study and Economy of time and money.

Sample and Sampling Technique
The sample size for the present study is 50. The samples are selected by simple stratified random sampling method in selected schools at Chennai.
The sample size was calculated by the formula, formula [n = {Zα 2 × P (1 -P)/d 2 }]. Considering an expected population parameter [12] (p = 5.9%) with 95% confidence level, 2% absolute error (d), a non-response rate of 10% and a design effect of 2 due to cluster sampling, the sample size was calculated to be 50. The list of schools was prepared and a student was selected using the simple random sampling; students from each stratum were selected using a proportionate allocation technique based on the number of students in each stratum. A complete enumeration of students from classes 10-12 was considered for the study.

Inclusion criteria
 Individual of between 13-18 years of age  Both boys and girls between the age group of 13-18 years  Students who are studying 8 th to 12 th standard.

Development of the Instrument
The research instrument was developed after extensive review of literature and expert opinion. A semi structural questionnaire was prepared to assess the level of psychosocial problems of the adolescents. The tool consists of 2 parts -1: demographic variables (age, religion, sex, and marital status, and educational status, occupational status socio economic status type of family and area of residence), 2: psychosocial problem questionnaires (true or false type with response pattern: sometimes/always/never questionnaires to assess the level of psychosocial problems).

Content Validity
The tool was submitted to experts of the department of mental health Nursing. Based on experts opinion tool was modified. The 30 items of questions are used to assess the level of psychosocial problems of obese adolescents these are all the modifications and suggestions about the content of the tool. Modifications were made as per the experts incorporated in the final preparation of the tool [3][4].

Reliability
Test and retest method was used to find out the reliability of tool and found that the tool was reliable.

Pilot Study
We conducted a pilot study at Chennai. The duration for pilot study the investigators selected total of 10 participants who were randomly assigned the study purpose was explained to the sample when analysed the result gave evidence that the tools were found reliable and feasible No further changes were made in the tool after the pilot study. The investigators proceeded for the main study.

Data Collection Procedure
The permission obtained from concerned higher authority. The data collection was done for the period 1 month the investigators introduced themselves the confidentiality of the subjects was assured and the purpose of the interview was explained to all the participants and informed consent was obtained from the participants the sample was randomly assigned. Appropriate explanation was given to all the participants about the aim of the study and nature of the tool. The data was collected from each sample as follows the investigators personally visited each student for data collection. Nearly 20 to 25 minutes were spent for each participant the investigators visited (10 samples) 5 -6 hours daily.

Statistical Analysis
The data related to demographic variable were analysed by using descriptive measures (Frequency and percentage). The level of psychosocial problems of obese adolescents were analysed by using descriptive statics (Mean, standard derivation). The association between selected demographic variables was analysed by using inferential statistics (chi square test). The frequency and distribution of obese adolescents age shows that the majority of the mentally challenged children were belongs to the age group of 12-14 years 25(50%) and equally distributed 25(50%) by 15-17 years. Regarding gender of obese adolescents highly from females 33(66%) comparatively by males 17(34%). Next category is type of family 22(44%) were attached with joint family and remaining living with nuclear family 28(56%).

Section: I Frequency and percentage distribution of demographic variables of obese adolescents
The above table reveals that how many of them are living in the family. Normally 3-4 members were show the percentage by 7(14%) from 5 members shows 2(4%) & >6 members respectively shows high percentage by 34(68%). The frequency of religion measured that majority of the obese adolescents comes under the Hindu 37(74%), remaining 13(26%), belongs to Muslim category. Christians and other categories are not having the psychosocial problem. The analysis of educational status of student, assessed that high level of 20(40%) obese adolescents belongs to 10 th standard and 17(34%) belongs to 9 th standard and 13(26%) belongs to 8 th standard.
Educational status of father shows high level of 33(66%) belongs to illiterate and 11(22%) belongs to middle school and 6(12%) belongs to secondary level of education. In graduate nobody is having the particular problems. Regarding the Educational status of mother shows that high level belongs to 22(44%) belongs to primary education and 12(24%) belongs to graduate and 8(16%) belongs to illiterate and 1(2%) belongs to graduate. The father occupational status shows that highly occupied by 35(70%) other category 6(12%) were occupied to private employee, 5(10%) self-employed and government employee were 4(8%). The mother occupational status highly shows house makers 28(56%) and 22(44%) belongs to working category.
The frequency and distribution of obese adolescents age shows that the majority of the mentally challenged children were belongs to the age group of 12-14 years 25(50%) and equally distributed 25(50%) by 15-17 years and nobody in 18-20 years.
In type of family 22(44%) were attached with joint family and remaining living with nuclear family 28(56%).
The Table 2.4 reveals that how many of them are living in the family. Normally 3-4 members were show the percentage by 7(14%) from 5 members shows 2(4%) & >6 members respectively shows high percentage by 34(68%). The analysis of educational status of student, assessed that high level of 20(40%) obese adolescents belongs to 10 th standard and 17(34%) belongs to 9 th standard and 13(26%) belongs to 8 th standard and nobody in 11 th and 12 th standard.  Educational status of father shows high level of 33(66%) belongs to illiterate and 11(22%) belongs to middle school and 6(12%) belongs to secondary level of education. In graduate nobody was present.
Regarding the Educational status of mother shows that high level belongs to 22(44%) belongs to primary education 12(24%) belongs to graduate and 8(16%) belongs to illiterate and 12(24%) belongs to graduate 1(2%) belongs to middle school.
The father occupational status shows that highly occupied by 35(70%) other category 6(12%) were occupied to private employee and 5(10%) working as self-employee and government employee were 4(8%).
The analysis of living area highly shows that 31(62%) highly occupied rural area and 10(38%) comes under urban area.
The Table 3 shows that 34(68%) of adolescents having high level of psychosocial problems and 16(32%) of people had moderate level psychosocial problems.

Fig. 4. Correlation between height and weight of obese adolescents
The above figure shows that the correlation between height and weight of the adolescents it shows that the correlation value is significant.
The P value is 0.01. The height and weight of the adolescents shows they are comes under the obese category II.   The above table shows that there was a significant association between the levels of psychosocial problems of obese adolescents with their age group. The p value is 0.000. Here the age group of 12-14 years adolescents was having 32% moderate level of psychosocial problems and 18% having high level of psychosocial problems.
In 15-17 years of adolescents 50% having the high level of psychosocial problems and nobody having moderate level of psychosocial problem. The above table shows that there was a highly significance between the levels of psychosocial problems of obese adolescents with their age group. So the respective age group peoples are had the psychosocial problems.  The above table represent that there is an association between the sex and psychosocial problems of the obese adolescents. The chisquare value is 37.434. So the p value is 0.000.
Here 30% of adolescents having moderate level of psychosocial problems and 2% of female having the moderate psychosocial problems. Only 4% male having high level of psychosocial problems but 64% females has high level of psychosocial problems.  The educational status of the student shows that there is association between the educational status of the student and the psychosocial problems. The chi-square value is 16.396 and 0. The p value is 000. here students of 8 th standard 16% having moderate level of psychosocial problems and 10% having high level of psychosocial problems and 40% of 9 th standard having high level of psychosocial problems and 4% of adolescents having moderate level of psychosocial problems and 16% of 10 th standard having the moderate level of psychosocial problems 18% having high level of psychosocial problem.    The educational status of father shows that there is significance link between the psychosocial problems of obese adolescents with their fathers educational status. Here the chi-square value is 12.121 and the p value is 0.002.   The Table 5.7 reveals that there is association between the psychosocial problems and food habits of the obese adolescents. Here the chisquare value is 17.297 so the p value is 0.000. In this the vegetarian adolescents had 14% moderate level of psychosocial problems and nobody had the high level problems. The nonvegetarian adolescents had 68% high level psychosocial problems and 18% had moderate level of psychosocial problems.

DISCUSSION
The frequency and distribution of obese adolescents age shows that the majority of the children psychologically affected due to Wight gain in childhood belonged to the age group of 12-14 years 25(50%) and equally distributed 25(50%) from 15-17 years. Obesity related issues were seen predominantly in most of the females -33(66%) when compared to males 17(34%). 44% were from a joint family and 56% were from a nuclear family. 14% had 3-4 members in their family, 4% had a 5 member family and around 68% had >6 family members. Most of the Hindus (74%) were obese, followed by Muslims (26%). In terms of education, high level of 20 (40%) obese adolescents belongs to 10 th standard and 17(34%) belongs to 9 th standard and 13(26%) belongs to 8 th standard. Educational status of father shows high level of 33(66%) belongs to illiterate and 11(22%) belongs to middle school and 6(12%) belongs to secondary level of education. Educational status of mother shows that high level belongs to 22(44%) belongs to primary education and 12(24%) belongs to graduate and 8(16%) belongs to illiterate and 1(2%) belongs to graduate. Most (70%) of the fathers belonged to the others category (unemployed, studying, etc.); 12% worked in private firms, 10% were selfemployed and 8% were government employees. The analysis of mother occupational status highly shows that 28(56%) belongs to non-working and 22(44%) belongs to working category. The analysis of income highly shows that 30(60%) belongs to income, Rs 3000-7000/-and 16(32%) belongs comes under below Rs 1000-3000/-and 4(8%) comes under the Rs 7000-9000 category. The analysis of food habits highly shows that 43(86%) comes under non-vegetarian and 7(14%) comes under the vegetarian category. The analysis of living area highly shows that 31(62%) comes under rural area and 10(38%) comes under urban area. This shows that 34(68%) of adolescents having high level of psychosocial problems (36-50) and 16 (38%) of people having moderate level of psychosocial problems (24-36). Most of the adolescents are comes under the obese class 1. This shows that there was a highly significant association between the level of psychosocial problems of obese adolescents and their selected demographic variables like age, sex, educational status of the family, religion and food habits. Here the p value is <0.01. In accordance with the present study, Eric Robinson (2020) reported similar results [5].

CONCLUSION
In conclusion, most of the obese adolescents having the high level of stress. The present study has helped in identifying the psychosocial problems among adolescents. Similar kind of study can be conducted among different populations in different settings and in large group. Awareness about the problems they face will help in better understanding obesity and its management in youngsters.

CONSENT
The purpose of the interview was explained to all the participants and informed consent was obtained from the participants.

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).