Graduation project (2)

SULTANATE OF OMAN MINISTRY OF HEALTH OMAN COLLEGE OF HEALTH SCIENCEs SOUTH SHARQIYA BRANCH



CONTENTS Background Information The problem of statement Significance of Activity Objectives Literature Review Project Paradigm The Conceptual Framework Methodology Conclusion References

BACKGROUND INFORMATION: Obesity is defined as an excessive accumulation of body fat (MOH,2014). According to WHO over 340 million children and adults aged 5-19 were overweight or obese in 2016. Nationally, in 2017 we found in Oman the rate of obesity in men 20.6% and 36.9 % in women ( Yousuf ,2017).

BODY MAX INDEX Body mass index (BMI), which is weight in kilograms divided by height in meters squared, is one of the common ways used to measure obesity. For adults, when a BMI reaches 25.0 to 29.9 kg/m2 is defined as overweight and when a BMI is 30 kg/m2 or higher is defined as obese.

WHO OBESITY CHART The BMI for age between 5-19 years old the WHO prepared a special child chart to measure obesity for both boys and girls.

CAUSES OF Genetic/ Family History OBESITY Lifestyle Diseases Medications

EFFECT Economic Social and emotion Health condition

The effects of obesity are including health, mental, social, and economic. In the past, more than 3.4 million obese deaths in some countries globally. People who suffered obesity often worse than people who have normal weight. More than 20 medical conditions associated with obesity (Upadhyay et al., 2017). The life span of obese people is shorter than normal people.

Individuals who have obesity are likely to be socially excluded because of society's body norms, social withdrawal syndrome ,low emotional trust, low disclosure to close others, and being lonely are the most common issues related to obesity (Rotenberg et al., 2017).

PROBLEM STATEMENT The annual report of Ministry of Health in 2011 showed that the number of obese students in Oman was 2258 students. In 2018 the number increased dramatically to reach 3021. This indicates that problem of overweight and obesity is a serious issue.

SIGNIFICANCE OF ACTIVITY Our project is an initiative to raise the awareness of the target group of obesity. We aim, through the activities that the group will carry out, to shed light on the problem of obesity and encourage those who are overweight or obese to find appropriate health solutions to the problem. This project is the first of its kind in terms of the numbers of targets and the number of sectors involved.

OBJECTIVES: • Identify the magnitude of the problem among school-age grades (8-9) in Sur Wilayat. • Enumerate the number of students who suffer from obesity by calculating body mass index. • Increase awareness among the school students about obesity • Modify the unhealthy behaviors that are contributing to the obesity problem among the students. • Assist the students to find solutions for the lifestyle behaviors.

LITERATURE REVIEW: Definition: (WHO,2018) In the 21st century, obesity and overweight are becoming a more significant public health problem, especially among children. WHO has classified obesity as a disease in 2000.

Prevalence: According to Obesity Update Report in 2017 published by the Organization for Economic Cooperation and Development (OECD) show that nearly one in six children are overweight or obese in 2015. Study done by Suneel in 2016 which was about prevalence and awareness of obesity and its risk factors among adolescents in two schools, discovered that, the percentage rate of obesity in males (36%) is higher than in females (24%). Moreover, the percentages increased in private schools (8.3%) than in the government school (1.7%).

Obesity in the Gulf country Male Female According to study done by Al-Nohair in 48 2014, which was about obesity showed 44 that obesity rates are higher among women within the region than men. 36 28 17 8 Kuwait Saudia Oman Arabia

School Health Appraisal Report for the academic year 2018-2019 our region (Sur) showed that around 100 overweight and 60 obese female students in grade 7 in compare to 28 overweight and 51 obese male in same grade. This indicates that problem of overweight and obesity is a serious issue.

A study of obesity done by Al-Nohair in 2014, found that the reasons for the high obesity rate in women are due to traditional or cultural restrictions in lifestyle, limited access to sports and exercise activities, TV and internet as a main leisure activity and multiple pregnancies.

The Sultan Qaboos University medical journal in 2013 wrote an article about the westernization of lifestyle is related to a high incidence of obesity within the Gulf countries, including Oman. (Hashem Adnan, et al, 2013).

Medication may cause obesity 7% 30% Olanzapine 12% quetiapine Risperidone 14% Perphenazine Ziprasidone 16%

EFFECT: Economic According to Bellelli, 2015 found that there is increasing problem of weight and obesity has cost billions of people, not only their wellbeing but also the economy. Obesity is reported to be one of the top three socio-economic problems created by humans alongside smoking and armed violence , The economic impact of obesity is 2 trillion dollars per year .

PREVENTION The latest 2016 National Physical Activity Report Card in the United States found that most American children and teens don't have the required physical activity period of around 60 minutes a day. The study suggests revealed regulations and physical education policies.( Nihiser et al., 2013). According to Jonathan, 2018 eating nuts between primary meals. The study showed that persons who are eating nuts regularly have less body mass index rather than those who do not eat nuts regularly.

According to National Healthy Schools Program (2016). Said that School nurses should play a major role in enhancing nutrition and contributing to physical activity to help prevent obesity.

PARADIGM: A work breakdown structure (WBS) is a deliverable-oriented breakdown of a project into smaller components. The idea behind any work breakdown structure is to prepare several sections of a project into manageable sections that organizes the team's work.

THE CONCEPTUAL FRAMEWORK Initial Phase: Planned Activity Intended Outcome 1. Meeting with the officials: A. To know the number of students enrolled in cycle two • Directorate General of schools. Education. B. To know number of obese • Directorate General of students in grade 7 in these Health Services schools according to the department of: annual screening oStatistical o School Health

Second Intended Outcome Phase: Planned Activity 1. Screening of grade 8-9 A. To demonstrate to the students student how to calculate the BMI 2. Planning the biggest loser competition for 10 students B. To enumerate the number and the competition will of students who suffer from last for six weeks. The obesity by in Al-Marrwah completion will be under Girls School. supervision of obese clinic, with coordinating of C. To encourage students to school schools health and reduce the weight. our team.

Third Phase: Planned Activity Intended Outcome 1. Conducting the proposed A. To increase awareness among health exhibition the school students about obesity B. To help students and their parents to find healthy food alternatives. C. To illustrate to the students how they can maintain their weight. D. To modify the unhealthy behaviors that are contributing to the obesity problem among the students.

METHODOLOGY

PROJECT DESIGN ( HEALTH EXIHIBITION): We decided we choose the clinical nursing practice track in which we are planning to conduct a health exhibition titled as “obesity among school students’ from detection to prevention”. The health exhibition will target cycle two schools (grades 5-9) aged between 11- 15 years old. The health exhibition will be implemented in 9th of April and it will be carry out in a special event tent in the front area of our college.

CONT. Sectors Involved: Exhibition Sections: •School Health Nurses •Sur City Project 1. Detection section •Dietitian and Obesity Clinic 2. Statistics and facts •Youth Complex and a Gym 3. Nutrition and diet and center alternatives healthy food 4. prevention

TARGET AUDIENCE: Our main target audience will be cycle two school students grades 5-9 in Sur. According to statistics this group age is having the highest number of overweight and obese students with 12.5% of students in grade 7 are obese, and 14.5% are overweight. The total numbers of students in these schools are around 5600 and we are aiming to reach 1000 Visitors

PROJECT PLAN Prevention better than cure. In health promotion, prevention aim to avoid diseases and maintain health. Initial Phase Semester weeks •Know the number of students 1-5 enrolled in cycle two schools in Sur, •Identify our target group Second Phase 6-7 •Screening of 170 students in Al- Third Phase 7-12 Marawah Girls School grades 8 -9 female •Start the biggest loser competition •Organize the health exhibition for our target group

SUGGESTED TIMETABLE FOR THE HEALTH EXIHIBITION ACTIVITIES Copy of the time table provided in the proposal •The exhibition day will start from 7:30 to 8:00 • The day will start with morning walk for 30 min •The opening ceremony and the rest of the activities will be carried on as planned in the timetable •Activities in the exhibition sections will be inactive section in which we will practice and teach some of our nursing skills like measuring of BMI, food calories, daily activities using some apps.

SUGGESTED TIMETABLE FOR THE HEALTH EXIHIBITION ACTIVITIES: The opening ceremony the health exhibition will organized in the conference hall of our college under patronage of the member of Al-Shura Council. Participants •School health nurses, •School principles of targeted schools and students representatives •Officials from both Directorate General of Health Services and Directorate General of Education, •Teachers and colleagues from our college.

ETHICAL CONSIDERATION We will obtain all formal approval to do the planned body mass index screening in Al-Marrwah Girls School grades 8 to 9. We will obtain inform consent of participants and their parents as whether to participate in biggest loser competition. Additionally, all needed official letter and communication will be kept and use only for this project proposes

CONCLUSION we can say that there is increase in the prevalence of overweight and obesity among school- age students which need collaboration between the policy makers, health care providers, school health nursing, children’s parents and students themselves

REFERENCES 1. Yousuf, K. (2017) . Alarming rise in obesity rate in region. Retrieved, from https://www.omano bserver.om/alarming-rise-obesity-rate-region/ 2. Komaroff, M. (2016). For Researchers on Obesity: Historical Review of Extra Body Weight Definitions. Journal Of Obesity. http://downloads.hindawi.com/journals/jobe/2016/2460285.pdf 3. Hales, E . (2020). Prevalence of Obesity Among Adults and Youth: United States, 015-2016 . Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29155689 4. . Caroline ,M.(2016). Obesity: Definition, Comorbidities, Causes, and Burden Retrieved from https://www.ajmc.com/journals/supplement/2016/impact- obesity- interventions-managed-care/obesity-definition-comorbidities-causes-

5. Alnohair, S. (2014). Obesity in Gulf Countries. International Journal Of Health Sciences, 8(1) p. 79-83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039587 6. PMC, E. (2014). Obesity in Gulf Countries Retrieved , from http://europepmc.org/articles/PMC4039587 7. Jonathan, Q. (2018).Obesity Archives Retrieved from https://www.endotext.org/section/obesity 8. Bellelli, S. & Turchetti, G. (2015). Economic Impact of Employment Status on The Social Cost of Morbid Obese Patients Submitted to Bariatric Surgery. Value In Health, 18(7), P.664-665. https://www.investopedia.com/articles/personal- finance/041715/

9. Zhao, D., & Zhang, Y. (2015). Body mass index (BMI) predicts percent body fat better than body adiposity index (BAI) in school children. , 72(3), P. 257-262. https://www.cancer.org/cancer/cancer-causes/diet-physical-activity/body-weight- and-cancer-risk/adult-bmi.html 10. Jung, F., & Luck-Sikorski, C. (2019). Overweight and Lonely? A Representative Study on Loneliness in Obese People and Its Determinants. Obesity Facts, 12(4),P. 440-447. https://www.karger.com/Article/FullText/500095