The Changes of Dietary Intake Patterns and Body Mass Indext of Overweight and Obesity Adolescent in Bulukumba:
Health Education Social Media-Based Approach
Dr. Asnidar,S.Kep.Ns,M.Kes¹, Dr. Muriyati,S.Kep,M.Kes² and Asdinar,S.Farm,M.Kes³
¹Nursing Departement, Panrita Husada Health College, Bulukumba
²Nursing Departement, Panrita Husada Health College, Bulukumba
³Midfery Departement, Panrita Husada Health College, Bulukumba E-mail : Asnidarnidar16@yahoo.com
Abstrack: This study aims to determine the differences between dietary intake patterns and body mass index (BMI) of overweight and obesity adolescents in each group and inter-groups. This research design is "Quasy Experiment", those are pre-test and post- test with control group design. Population was overweight and obesity adolescent in SMP 1, 2, 3 and 4, district of Bulukumba with purposive sampling method got sample equal to 91 respondent divided into 4 (four) groups. The analyses used were Friedman test, Krusskal Wallis, repeated anova, and one way anova. Research intervention was 6 months with the provision of health education through lecture by booklet media in groups 1 and 2, leaflets in group 3 and methods of non-media lectures in group 4.
Education was given through whatsapp application in group 1 and through sms in group
2. Periodic time series measurements were taken for 6 months on dietary intake patterns
and BMI. The results showed that there was a difference of dietary intake pattern on each group. In group 1,2 and 3 differs one to others while no difference in group 4.
There were differences between dietary intake patterns and BMI inter- groups. Moreover, an influence of health education on the basis of social media (whatsapp) in changing dietary intake patterns and BMI obesity adolescents exists. This research recommends health workers (nurses, nutritionists and health promotion) to use the booklets and utilize social media (whatsapp) in the provision of health education related to obesity.
Keyword: Health Education, social media, overweight, dietary intake patterns, and BMI
INTRODUCTION
Obesity is beginning to become a health problem worldwide, even WHO states that obesity has become a global epidemic, so it must be addressed.1The prevalence of Obesity continues to increase. According to the World Health Organization (WHO) in 2014 the highest prevalence of overweight and obesity is in the United States 61%
overweight and 27% obesity for all ages, while the lowest is in South Asia that is 22%
overweight and 5% for obesity for all age.
The prevalence of obesity in Indonesia is based on data from the Ministry of Health in 2013, in children aged 5-12 years by 18.8%
which consists of 10.8% overweight and 8%
obesity whereas in adolescents aged 13-15 years by 10.8 percent, consists of 8.3 percent overweight and 2.5 percent Obesity.2 Obesity is a state of overweight exceeding 20% of normal body weight. Obesity is characterized by excessive accumulation in various parts of the body, especially the waist, pelvis, and
upper arms.3 Obesity is caused by the interaction between genetic and environmental factors associated with lifestyle, activity, social economi and nutritional. 4.5The consumption of fast food and soft drinks can lead to overweight and obesity.6, 7, 8
Obesity in childhood will lead to high risk of obesity in adulthood. It has the potential to cause various major risks for some chronic diseases associated diet, including: type 2 of Diabetes mellitus, hypertension, stroke, cardiovascular disease, difficulty breathing, Obstructive Sleep Apnea (OSA), increased risk of fractures, hypertension, elevated blood cholesterol, early signs of cardiovascular disease, metabolic syndrome, dyslipidemia, , insulin resistance, polycystic ovary syndrome, cholangiasis9,10'11'12'13'14 and psychological effects such as lack of confidence, lack of self- confidence (self efficacy), and decreased quality of life.15 The management of obesity can be done with behavioral therapy in childhood namely diet and exercise combined with behavior modification through health education.16
Health education is a dynamic process of behavior change with the aim of altering or influencing human behavior that includes components of knowledge, attitudes, or
practices related to healthy living objectives in individually, group, and society, and is a component of the health program.17
Research on the effectiveness of health education on changes lifestyle behavior has been widely practiced. A study related to lifestyle interventions conducted by Nurkkala (2015) showed that intensive lifestyle counseling on dietary behavior was evaluated using TFEQ-18 and motivation related to weight loss in obese of adults.18
Research conducted by FlavioSarno, et all (2015) using mHealth technologies concluded that mHealth technology has the potential to be used as a tool for the prevention and treatment of overweight and obesity, especially with mobile phones and SMS, which has been used daily by most of people.19 Another study by Gemma floresmateo, et al (2015), suggests that mobile application-based interventions can be a useful tool for weight loss.20.Methods in the provision of health education continue to be developed through various media, both through print and electronic media. By the rapid development, information technology can be an alternative media in providing health information. Social media is one facility that can be used in providing information quickly and efficiently.
As a result, the provision of health education by utilizing print media (booklet, leaflet) and electronic media (sms and social media;whatsappaplication) can be an effective and efficient alternative intervention. This study aims to assess differences in dietary intake patterns and body mass index of obese adolescents after being given social media-based health education in each group and inter-groups.
The hypothesis in this research; there is difference of dietary intake pattern and body mass index of obeseadolescent after given health education based on social media in each group and inter-group.
MATERIALS AND METHODS
The design of this study was "Quasy Experiment", ie pre-test and post-test with control group design. Total sample was 91 participants with purposive sampling technique. The study group in this study was divided into 4 (four) groups consisting of 2 (two) treatment groups and 2 (two) control groups. The first group (25 participants) were given a health education through a lecture with a booklet andwhatsapp application, the second group (22 participants) were given a health education through a lecture with a booklet andsms, a third group (22 participants) was given a health education with a leaflet and
fourth group (22 participants) were given only health education through lectures without media.
Group 1 was given health education for 1 month by giving material about obesity, dietary intake pattern and calculation of BMI alternately every week by using booklet. During the next six- month period, education is provided, through the transmission of information related to obesity material, dietary intake patterns and BMI calculations through whatsapp application.
The submitted materials were text with pictures.
In the second (second) group, health education was given as well as the first group, but the information provided was sent bysms via. The submitted material was text only. Group 3 (third) was given 1 month of health education as well by giving the material in turn each week through leaflet. While in group 4 (fourth), health educationwas given through lectures without media every week for a month. There was no repetition of given education within six months for each group.
After giving intervention, the assessment of changes in dietary intake patterns and BMI per month for 6 (six) months were conducted.
Collected data from children include sex, age, weight, height, BMI and dietary intake patterns
whereas data of parents included parental education, family income, overweight history and family obesity, family health history, and family structure.
Weight measurements used 150 Kg stepped scales with 0.1 Kg accuracy of footlessness, whereas the height measurement usedmicrotoise scale 200 cm with 0.1 cm accuracy, and then determine the IMT of children by WHO Antrho Plus software. Children and parents usedbiodata form. Food intake was measured using a 2x24 hour Food Recall and analyzed by using the software nutrisurvey2007.
The result of this research was processed by using SPSS program. The used statistic test was friedman and repeated anova test for each group analysis, cruciate wallis test and one way anova for inter-group whilemanova analysis for simultaneous analysis in all groups, with 95%
confidence level (CI) and significance value α was 0 , 05.21,22
RESULTS
The characteristics of the participants indicated that in group I are more female (52%), low father education (64%), low maternal education (60%), high family income (72%), core family
structure (72%), family support for obesity (100%), obese parents' risk (52%) and family health risk (80%). Participants in group II are more female (63.6%), low father education (63.6%), low maternal education (72.7%), high family income (81.8%), core family structure (72.7%), family culture of obesity (90.9%), history of parents’obese at risk (50%) and family health history at risk (59.1%).
Participants in group III are more female (59.1%), low father education (72.7%), low maternal education (95.5%), high family income (63.6%), core family structure (81.8%), family culture of obesity (100%), obesity history of the elderly are not at risk (59.1%) and family health history at risk (63.6%).
Participants in group IV are more female (16%), low father education (95.5%), low maternal education (95.5%), high family income (72.7%), core family structure (68.2%), family culture of obesity (100%), obesity history of risky parents (59.1%) and family health history at risk (72.3%). Homogeneity test (leneve's test) response characteristics include: gender (0.048), parental education (0.000), family income (0.064), family structure (0.162), family culture (0.398), obesity history of parents (0.702) and family health history (0.008) indicates the existence of sample equality in all groups. (table 1)
The results show that at the beginning of the measurement, the mean score of participants’
energy intake is131.3-182.4. The mean final score of the child's energy intake is approximately 114.2-160.2. (figure 1). At the beginning of the measurement, the meanscoreof carbohydrate intake of participantsis 87.72- 170.3. The mean final score of children's energy intake is approximately 73.9-169.1. (figure 2). In the final measurement, all the participants experienced a decrease in the mean score of energy and carbohydrate intake compared with the initial measurement. This shows that there is adifference of meanscoresbetween the energy and carbohydrate intake at the initial measurement compared with the second, third,
fourth, fifth, sixth and seventh measurements.
Friedman test results obtained p = <0.001 in groups of 1.2 and 3. This shows that there are differences in energy and carbohydrate intake of children in groups of 1.2 and 3. While in group 4 obtained p value = 0.008 on energy intake and value p = 0.270 on carbohydrate intake, it shows that there is no difference of energy and carbohydrate intake in group 4. The result of KristkalWallis test obtained p value = <0.001 of inter-groups. It indicates that there is a difference of energy and carbohydrate intakeof children between groups. The decrease of highest mean score of energy and carbohydrate intake is in group 1, then group 2, and group 3.
The lowestscore one is in group 4. (Table 2).
The results indicate that in initial measurement, the mean of BMI score for primary school children is 1.89-SD 3.06. The mean of final score of children’s BMI is approximately SD 1.61 - SD 2.81. (figure 3). In the final measurement of BMI,the mean score decreasescompared with initial measurement in all groups. Test results repeated anova got p value of groups 1 and 2 = <0.001, group 3=
0.034, group 4 = 0.140. This shows that there is difference of children’s BMI in group 1,2 and 3 while in group 4 there is no difference. One way anova test results obtained p value <0.001. This suggests that there is a difference children’sBMIof inter-group. The highest
increase meanscoreof BMI is in group 1, and then group 3, group 2 and lowest score is in group 4. (Table 3).
DISCUSSION
Provision of health education by using media can decrease the energy and carbohydrate intake continuously and the use of booklet media added by re-education through application of whatsapp shows higher change compared to other media. This is in line with Bullet Theory reveals that the effectiveness of messages using the media can directly target the intended target.23In the provision of health education can use a variety of media. The used technics and media stated by Edgar Dale (1964) include text, images / audio only, audio and other audio media. The level of media involvement on retention percent includes: reading 10%, listening 20%, seeing 30%, listening and seeing 50%, saying by self70%, saying and doing by self 90%. Theory of memory argued that memory is the ability to be able to receive and enter (learning), retention (retention) and re- create what ever happened (remembering).
Associated with the problem of retention and forgetfulness, there is one important thing, namely the interval or time between insert and re-create. The length of the interval relates to the length of time of inserting the material (act of remembering). The length of the interval relates to the retention power. The longer of the interval is, the less of the retention
strengthoccurs. It is also related to the theory of interference that focuses on the contents of the interval.24
Involvement of children in the provision of care will have a positive effect on their health.
Provision of information or health education, especially in children should use an interesting media. The use of technology can be another interesting alternative in the provision of health information to children.25 This study is in line with research conducted by Kinard (2016), in his research related to the influence of healthy food posting to the weight of consumers revealed that obeseindividuals are encouraged to build and maintain social networks relationship with others who routinely post healthy food pictures on their social media.26 Eating behaviors such as fast food habits which commonly contain fat, soft drinks which contain high sugars and early solid feeding for infant.4,5'27Parents affect food selection by controlling food availability, acting as role model and encouraging children to consume certain foods.28 Unhealthy eating behavior of mothers such as eating sweet foods or high- energy drinks can affect children's food intake of similar foods. The knowledge of the nutrition of parents affects the choice of food as well.29
This, when viewed from the family culture of participants related to the provision of food, found that in all major groups have a culture that supports the obesity distributed to group 1 (100%), group 2 (90.9%), group 3 (100%) and groups 4 (100%). Thus, through health education by utilizing social media such whatsappapplications, the researchers provide positive stimulation about the pattern of healthy food intake, so it is embedded in the minds of students how to choose food intake with the givenprovision of knowledge. Therefore, this study shows the results of differences energy and carbohydrates intakepatterns before and after intervention of inter-groups.
The results showed that on the final measurement of participants’weightin groups 1 and 2 experience a decrease of the mean score while in groups 3 and 4 get the increasing mean score compared to the initial measurement.
Final height measurements showe an increase of mean score compared with initial measurements in all groups. Final measurements of BMI experience decreased mean score compared with initial measurements in all groups. The results showed by giving health education,children's BMI becomes more decreased. Health education is able to change the knowledge of children and affects the
attitude and behavior especially in the pattern of dietary intake. The existence of changes in dietary intake patterns will affect BMI as a measurement of nutritional status of children, because the pattern of dietary intake is part of the cause of overweight and obesity in children.
Selection of different media will result different changes. The frequent reminders of children will provide sustained motivation in children. It can be seen from the re-education using social media with whatsappapplicationin group 1 so that the BMI decrease higher than other group.
The decrease of IMT is higher in group 3 than in group 2, although group 2 is given re- education but this occurs due to the initial measurement of the mean score of IMT where group 3 is lower than group 2. The difference results of groups and inter-groups present that in the test of each group,only group 4 shows no diffenrence whereas in inter-group test all groups show the difference. Based on the results of analysis of each group in group 4 found no difference because the change of mean score on the initial measurement compared with the final measurement is very small (-0.19).The data show that in the initial measurement of the mean score of IMT in group 4 is 2.02 and at the final measurement became 1.83.
Nikolaou Ck, et al. (2015) The use of supporting advertising and social media may decrease the obesity epidemic.30 Hales (2014), in a study aimed at testing whether different types of postings through social media differently influence the involvement of participants in increasing weight loss proved that the use of social media during the intervention can lose weight.31
Shin (2014) Social network analysis is used to see whether peer influences from one's social network moderate the effects of obesity prevention programs on obesity-related behaviors (healthy and unhealthy behaviors).
The results show that peer exposure is positively related to a person's healthy and unhealthy behavior. The effect of program participation indicates peer influence through social networking in obesity prevention programs.32 Erika (2016), there is an influence of family empowerment modified models on family self-reliance in controlling lifestyle and physical activity of overweight and obese children.33-35
The results of those studies support this research, which can be concluded that the provision of health education through social media can change the pattern of dietary intake and BMI in obese adolescents.
CONCLUSION
Provision of health education by using bookletmedia andre-education through whatsappapplication shows the changes of energy intake, carbohydrates intake, and BMIpatternsis greater than the provision of health education by using other media.
SUGGESTION
This research recommends to the health workers (nurses, nutritionists and health promotion) to use othis booklet in the provision of health education about obesityand also re-education by the use of social media;whatsapp applications REFERENCES
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