THE PREVALENCE OF OBESITY AND THE KNOWLEDGE, ATTITUDE AND PRACTICE OF HEALTHY LIFESTYLE

AMONG THE ADULT POPULATION IN KAMPUNG BANYUK, KAMPUNG KERTO AND KAMPUNG LANGUP

YEAR 4 STUDENTS OF ROTATION 1 2013/2014

Supervisors Assoc Prof Dr Kamaluddin Bakar

Assoc Prof Dr Md Mizanur Rahman

Faculty of Medicine and Health Sciences UNIVERSITI MALAYSIA SARAWAK

Year 2013 RA 645 023 P944 2013

P at Khiomat lv(aJO:umal AKlideanik UNlVERSm MALAYSIA SARAWAK

Name list ofstudents involved

No. Name Matric number

I. Norhaslina bt Rosli 21840

2. Cbai Siew Pei 23256

3. Gerald Sim Lai Meng 23537

4. Lee Lian Thai 23826

5. Mariana anak Metaw 23958

6. Muhammad Izwan bin Azlin Shah 24213

7. Muhammad Najmi Na'imullah bin Rahim 24219

8. Norsuhaila binti Hazman 24502

9. Nurulhuda bt Azman Tan 24782

10. Arnold Lee Leong Chai 25924

II. Ashvini alp Sivabalan 25931

12. Bong Sing Kock 26006

13. Dinesh all Kerishnan 26179

14. Fatehah Izwani bt Idris 26285

15. Fidya bt Zamri 26313

16. Fung Mei Jiun 26334

17. HoTze Yung 26432

18. Hon Shu Ann 26436

19. LeeMei Funn 26685

20. Margeret Jong Shu Yi 26809

21. Muhd Zarif b Mohd Amin 27087

22. Noor Syafatin Azmin binti Abdul Safar 27336

23. Nor Atikah binti Mohamad 27382

24. Nur Edayah binti Ibrahim 27603

25. Nur Hazwani binti Abdul Rahman Sebli 27648

26. Siti Syuhada binti Rosman 28344

27. Sofina Azurin binti Soffian Chen 28363

28. Vivian Wong Chee Yien 28581

29. Wong Syn Hwan 28666 I

11

DECLARATION

We hereby declare that this project report is based on our original work except for

citations and quotations which have been duly acknowledged. We also declare that it

has not been previously and concurrently submitted for any other degree or award at

Universiti Malaysia Sarawak or other institutions.

111

ACKNOWLEDGEMENTS

No one walks alone and when one is walking on the journey of life just where

you start to thank those that joined you, walked beside you, and helped you along the

way. We have taken efforts in this research project. However, it would not have been

possible without the kind support and help of many individuals and organizations. We

would like to extend our sincere thanks to all ofthem.

First of all, we would like to acknowledge our Posting Coordinator, Dr

Cliffton Akoi Pangarah for his guidance, suggestions and encouragements during the

conduction of the research.

Besides that, we also would like to express our gratitude and appreciation to

our wonderful supervisors, Assoc Prof Dr Kamaluddin Bakar and Assoc Prof Dr Md

Mizanur Rahman for all their valuable guidance, advices, encouragements and

supports. They inspired us greatly throughout the progress in completing the research

effectively. Their willingness to motivate us contributed tremendously to our research.

We would like to extend our gratitude to them for showing some examples that related

to the topic of our research. Apart from that, we wish to express our deep sense of

gratitude to Assoc Prof Dr Md Mizanur Rahman for his guidance and useful

suggestions for helping our research team especially the parts of sampling methods,

statistical analysis and report writing.

Then, we would like to convey our special thanks to Dr Muhammad Rais

Abdullah, Sibu Divisional Health Officer for aiding us in correcting the research

proposal. We are very grateful for his guidance and the advices he shared in carrying

out the research.

Finally, yet importantly, we would like to express our heartfelt thanks to the

respondents for devoting their valuable time to participate in our research. Without

them, it is impossible for us to complete our research successes.

IV

ABSTRACT

Background Obesity has become a great public health concern and prevent!ive

measures need to be done.

Objective The objective of this research is to determine the prevalence of obesity and

their knowledge, attitude and practices (KAP) towards a healthy lifestyle among the

residents in Kampung Banyok, Kampung Kerto and Kampung Langup.

Methods A cross-sectional study was done among 126 randomly selected villagers

aged 18 years and above from the three selected villages. They were interviewed

based on a questionnaire and their body mass index (BMI) was calculated.

Results It was found that more than half of the respondents are obese. Among the

respondents, for the healthy lifestyle component, the level of good KAP is 69.2%,

46.8% and 60.3% respectively. As for obesity component, the level of good KAP is

60.3%, 54% and 54.8% respectively. Among the obese respondents, the level of

knowledge and attitude on healthy lifestyle and obesity is better. Obese respondents

have better obesity preventive practice while the non-obese respondents have better

practice on healthy lifestyle. The only significant correlation noted was between

knowledge and practice on obesity albeit a negative one.

Conclusion The level of knowledge and attitude and practice on healthy lifestyle

among the obese respondents are encouraged but more effort in the preventive

practice ofobesity shou1d be done to reduce the prevalence.

v

KELAZIMAN OBESITI DAN TAHAP PENGETAHUAN, SIKAP

DAN AMALAN CARA HIDUP SIHAT DALAM KALANGAN

POPULASI ORANG DEWASA DI KAMPUNG BANYUK,

KAMPUNG KERTO DAN KAMPUNG LANGUP

ABSTRAK

Latar belakang Masalah kegemukan telah menjadi masalah kesihatan utama dan

langkah-Iangkah untuk menangani masalah ini harus dilakukan.

Objectif Objektif kajian ini ialah untuk menentukan tahap kelaziman obesiti dan

pengetahuan, sikap dan amalan (KAP) gaya hidup sihat dalam kalangan penduduk kampung

Banyok, Kerto dan Langup.

Cara pelaksanaan kajian 'Cross-sectional study' telah dijalankan terhadap 126

penduduk kampong dari kampung-kampung terpilih. Mereka telah diinterviu

berdasarkan borang soal selidik dan pengiraan 'body mass index (BMI)' telah

dijalankan.

Basil kajian Secara keseluruhannya, lebih daripada setengah responden adalah obes.

Dalam kalangan respond en, untuk komponen cara hidup sihat, tahap KAP yang baik

adalah 69.2%,46.8% and 60.3% manakala untuk kompenen obesity, tahap KAP yang

baik adalah 69.2%, 46.8% and 60.3%. Dalam kalangan responden yang obes, tahap

pengetahuan, sikap untuk komponen cara hidup sihat dan obesity adalah lebih baik.

Responden yang obes mempunyai amalan pencegahan obesity yang lebih baik

manakala respond en yang bukan obes mempunyai amalan cara hidup sihat yang lebih

baik. Berdasarkan hasil kajian, satu-satunya kebarangkaitan yang didapati adalah di

antara pengetahuan dan amlan pencegahan obesity dan ia adalah kebarangkaitan yang

negatif.

Kesimpulan Tahap pengetahuan, sikap dan amalan untuk cara hidup sihat dalam

kaJangan responden obes adaah menggalakkan tetapi amalan pencegahan obesity

haru dipertingkatkan untuk mengurangkan kelaziman obesity.

VI

Plisat Khldmat MikJ",mat Akadtmik UNlVERSrn MALAYSfA SARAWAK

Table of Contents

DECLARATION ............................................................................................................... iii

ACKNOWLEDGEMENTS ............................................................................................... iv

ABSTRACT ........................................................................................................................ v

ABSTRAK ................................................................................................vi

List of Abbreviations ...........................................•.............................................................. x

List of Tables ...............................................................................•........•............................. xi

List of Figures ...........•............••..................•.........................................•••......................... xiii

CHAFfER 1: INTRODUCTION....................................................................................... 1

1.1 Background lnfonnation .. ... .. ........... ......... ... ..... .. ............... ....... ............ ... ... ..... ... .. ... ....... 1

1.2 Problem Statement ... .............. ... ....... ... ...... .. ............... .................. ...... .. .. ......... ................ 2

1.3 Significance of the study ... .... .............. .... ...... ........................ .... ................ .... ..... ............ . 4

1.4 Objectives of Study ................... .. ................. ..... ............... ............. .... .................. ...... ...... 5

1.4.1 General objective .. .. .... ............ ... .... .............. ... .. .. .. ............ ..... ...... ....... .... ......... 5

1.4.2 Specific Objectives ... ... .......... ... .. ... ..... ..... ... ............ ... ..... ................ ... .. .. .......... 5

1.5 Research Questions .... .... ... .............. .. .............. ..... ................ .... ...... .... .. .. .. ... ............. ..... .. 5

1.6 Hypothesis ............... ....... .......................... .. ... ................... ... ............ .... .... . .... ....... .. ......... 6

1.7 List of Variables ................... ....... ........... ... ............ ... .. .. ............ ........ .. ........... ... ... ............ 6

1.8 Conceptual Framework ... .... .. ............. .... .. ............. ............. ... .. .. ................. ... ... ........... .. . , 7

1.9 Operational Definitions .............. .. .............. .. .... ....... .. ....... ... ....... ......... ... .. ......... .. ...... ...... 7

CHAFfER 2: LITERATURE REVIEW ......................................................................... 10

2.1. Prevalence of Obesity ... .... .... ............... .... .. .. ....... .... ............... ... ...... .......... .. ... .... ... ....... . 10

2.2. Causes of obesity .... .. ..... .......... ... .. .... ............... ..... .. ... ..... .... ............ ... .... .... ......... ...... ... 11

2.3. Knowledge and attitude towards obesity ... ................. .. .. ..... ............. .... ..... ..... ............... 14

2.4. Health -related problems in obesity ... ... ................ ... ... ................ ..... .. ............. ... ...... .... . 19

2.5. Impact of obesity...... ... ...... .. ........... ....... .......... .. .............. ... ... .............. ... ............... ....... 20

2.6. Knowledge of healthy lifestyle ................. .. ....... ... ...... ..... ... ......... ....... ................. ..... .... 22

2.7. Attitude towards healthy lifestyle .... ... ... .................. .. .. ..... ..... ..... ......... ... ...... ... ........... .. 28

2.8. Practice of healthy lifestyle .... ....... ... ............... ...... .. .............. ... .... ............ .... ..... .... ..... .. 32

CHAFfER 3: METHODOLOGy.................................................................................... 34

3. 1 Study Design .. ... .. ................ .................. ..... .............. .... ..... ..... ....... ............ ...... .............. 34

VII

3.2 Study Population and Place of Study ............................................................................. 34

3.3 Sample Size Determination and Sampling Procedure ..................................................... 35

3.4 Data Collection Instrument. .... ....................................................................................... 37

3.5 Data Collection Procedure ............................................................................................. 38

3.6 Intervention.................................................................................................................... 39

3.7 Statistical analysis ......................................................................................................... 39

3.8 Ethical issues ................................................................................................................ 40

3.9 Duration of study .......................................................................................................... 40

CHAPTER 4: RESULTS .................................................................................................. 41

4.1 Introduction .............................................................. '" ................................................. 41

4.2 Socio-demographic characteristics ................................................................................. 42

4.3 Nutritional status ........................................................................................................... 45

4.4 Levels of Knowledge on Healthy Lifestyle and Obesity ................................................ .49

4.5 Attitude towards Healthy Lifestyle and Obesity ............................................................. 56

4.6 Practice towards Healthy Lifestyle and Preventive Practice towards Obesity .................. 65

4.7 Relationship between Knowledge, Attitude and Practice on Healthy Lifestyle and Obesity

........................................................................................................................................... 80

CHAPTER 5: DISCUSSION ............................................................................................ 82

5. 1 Introduction .................................................................................................................. 82

5.2 Knowledge .................................................................................................................... 83

5.2.1 Knowledge of healthy lifestyle ....................................................................... 83

5.2.2 Knowledge on obesity .................................................................................... 84

5.3 Attitude ......................................................................................................................... 85

5.3.1 Attitude on Healthy Lifestyles .............................................................. .......... 85

5.3.2 Attitude on Obesity ........................................................................................ 86

5.4 Practice ...................................................................................................... ................... 88

5.4.1 Practice Towards Healthy Lifestyle ................................................................ 88

5.4.2 Preventive Practice towards Obesity .............................................................. 90

5.5 Correlation between knowledge, attitude and practice .................................................... 92

5.5.1 Relationship between knowledge, attitude and practice on healthy lifestyle .... 92

5.5.2 Relationship between knowledge, attitude and practice on obesity .................. 93

5.6 Limitation of the study .................................................................................................. 94

Vlll

CHAYfER 6: CONCLUSION & RECOMMENDATION ............................................. 95

6.1 Conclusion .. ... .... .... ...... ................ .... ..... .... ...... .... .... .. ........ .. .... ... ...... .... ..... .. .. .. ... ....... ... . 95

6.2 Recommendations ... ..... ..... ........... ... ... .... .... .... ....... .... .... .. ..... ... ........ ..... .. ...... .... .... .. ..... .. 96

References ......................................................................................................................... 98

Appendix .............................................................................................................................. i

Appendix t: Timeline for study ........................................................................................... i

Appendix 2: Research Questionnaire (English) ................................................................. ii

Appendix 3: Research Questionnaire (Malay Language) ................................................ .ix

Appendix 4: Photos of the villages ................................................................................. xviii

IX

I

List of Abbreviations

CDC Centers for Disease Control and Prevention

ePG Clinical Practice Guidelines

CSTF Canadian Standardized Test ofFitness

MASO Malaysian Association for the Study ofObesity

MOH Ministry of Health

NHMS National Health and Morbidity Survey

NSP-NCD National Strategic Plan for Non-communicating Disease

WHO World Health Organization

x

List of Tables

Table 4. I Percentage distribution of the respondents by age (n= 126) .. ... .... ... .. .. ... ... .......... .. 42

Table 4. 2 Percentage distribution of the respondents by gender (n= 126) ............ .. ..... ..... ... .. 43

Table 4. 3 Percentage distribution of the respondents by race (n= 126) ............... .. ............. .. . 43

Table 4. 4 Percentage distribution of the respondents by educational level (n= 126) ............. 44

Table 4. 5 Percentage distribution of respondents by occupation (n= 126) ................. .. ......... 44

Table 4. 6 Monthly income of the respondents (n= 126) ......................... .. ..... ....................... 45

Table 4. 7 Percentage distribution of the respondents by marital status (n= 126) ...... .. ........... 45

Table 4. 8 Percentage distribution of the respondents by height (n= 126) ...... .. ..... .. ............... 46

Table 4. 9 Percentage distribution of the respondents by weight (n= 126) ............................. 46

Table 4. 10 Percentage distribution of the respondents by BMI (n= 126) .............. .. .............. 47

Table 4. II Percentage distribution of the respondents by nutritional status and socio­demographic characteristics ........... ... .... .. ... .. ... .. ..... ... .. ..... .... .... ... ..... ... ... .. ... ....... .. .. ...... .... ... 48

Table 4. 12 Percentage distribution of respondents by knowledge of healthy lifestyle .......... 49

Table 4. 13 Percentage distribution of the respondents by level of Knowledge on healthy lifestyle ... .. ............. ..................... ...... .. ..... ... .. ............ .... .......... ....... ........... .. .............. .... ...... 50

Table 4. 14 Percentage distribution of the respondents by knowledge of Health Lifestyle and sooio-demographic characteristics ........................... .... .... ..... .. .. .......... ... .. ... ... .. .................... 51

Table 4. 15 Percentage distribution of the respondents by knowledge of Health Lifestyle and nutritional status ....................................................... ......... .. .. ...... ... ..... ... .. .. ...... ....... ... .. .. ... . 52

Table 4. 18 Percentage distribution of the respondents by knowledge on Obesity and socio-

Table 4. 19 Percentage distribution of the respondents by knowledge on obesity and

Table 4. 21 Percentage distribution of the respondents by level of attitude towards Healthy

Table 4.22 Percentage distribution of the respondents by attitude towards Healthy Lifestyle

Table 4. 16 Knowledge on obesity among the respondents .... .. ............. .. ............................. 53

Table 4. 17 Percentage distribution of the respondents by level of Knowledge on obesity ... . 54

demographic characteristics .. ... ... .. .. .. .................... ..... ......... ... .. ... ... ... .. ... .. .. .. ... .......... ... ... .... 55

nutritional status ............... ......................... ........................................... .. .. ... ... .. ... .. ... .. ....... . 56

Table 4. 20 Attitude towards healthy lifestyle among the respondents ...... .. ......................... . 58

Lifestyle ... ... .. ... ... .. ........... ............. .......... .. .......... ... ..... .. ... .................... .......... .................... 59

and socio-demographic characteristics .. ....... ... ........ ..... ....... .... .. .... ........... .... .. ......... ........ ..... 60

Xl

Table 4. 23 Percentage distribution of the respondents by attitude towards Healthy Lifestyle and nutritional status ........ ... ............ ................................ ... .... .. ... ....... ........... ...... .... .... .... .... 61

Table 4. 24 Attitude towards obesity among the respondents .... ................ .... ............ .. .. ....... 62

Table 4. 25 Percentage distribution of the respondents by level of attitude towards obesity .. 63

Table 4. 26 Percentage distribution of the respondents by attitude towards obesity and socio­demographic characteristics ......................... .... ............. ........ ..... ...... ............ ... .... .. .... .. ........ 64

Table 4. 27 Percentage distribution of the respondents by attitude towards Obesity and nutritional status ... ... ....... ... ..... ............. ... .... ......... .. ............. ..... ............. ........ .. ... ... ........... ... 65

Table 4.28 Percentage distribution of experiences of the respondents by depression .. ....... .. 67

Table 4.29 Percentage distribution of experience of the respondents by communication problem .... .... ... ... ..... .............. ..... .............. .. .............. .. .................. .... ....... ............. .. .... ........ 67

Table 4. 30 Percentage distribution of factors preventing physical exercise among the respondents .... .... ............ .... , ............... ............................... ........ .... ...... ............. ... ............. ... 68

Table 4. 31 Percentage distribution of the respondents by level of practice towards Healthy Lifestyle ..... .. ............. .... .. ........................ ............................. .... ... ........... .. ....... ... ... ...... ....... 69

Table 4. 32 Percentage distribution of the respondents by level of practice towards Healthy Lifestyle and socio-demographic characteristics ............... ... ............... .. ...... .. ...... ............. .... 70

Table 4. 33 Percentage distribution of the respondents by level of practice towards Healthy Lifestyle and nutritional status .. .. ............... ................ .... ........... ... ....... .. ... .. .............. .... .. .... . 71

Table 4. 34 Percentage distribution of the respondents by weight monitoring practice ......... 72

Table 4. 35 Percentage distribution of the respondents by practice of preventing weight gain ............... ....................... .. .... .. ........ .. ........ .. ... .... .............. .... ... .. ..................... ..... ............ ... .. 72

Table 4. 36 Percentage distribution of the respondents by experience of weight losing in the past ....................... ... .... ... .... .... ............. .... ............... .. ..... ..... ..... .... ......... ..... ............ .... ......... 72

Table 4. 37 Percentage distribution of daily home-prepared meals practice among the respondents ...... ....... ......................... ................ ... ......... .. ... ............ .. ...... ..... ..... ............. ....... 74

Table 4.38 Percentage distribution of the respondents by habit of taking breakfast (n=126)

Table 4. 39 Percentage distribution of the respondents by level of preventive practice towards

76

Obesity .............. ........... ...... ................ ... .......... .... .. ............. ................ ...... ..... ... .................. 77

Table 4. 40 Percentage distribution of the respondents by level of preventive practice towards obesity and socio-demographic characteristics ............................................. .... ............ ... .... . 79

Table 4. 41 Percentage distribution of the respondents by levd of preventive practice towards Obesity and nutritional status .............. .. ............................................ .. ...... .. ....... .. ............ ... 80

Table 4. 42 Correlation matrix ofknowkdge, attitude and practice on healthy lifestyle .. .. .... 81

Table 4. 43 Correlation matrix of knowledge, attitude and practice on obesity .......... .... ...... . 81

xii

List of Figures

Figure 4. 1 Percentage distribution of the respondents by smoking .......... ... ............. ......... ... 66

Figure 4. 4 Percentage distribution of presence of medical conditions preventing exercise

Figure 4. 6 Percentage distribution of the respondents by high calorie foods/drinks intake in a

Figure 4. 7 Percentage distribution of the respondents by snack eating habit in between meals

Figure 4. 2 Percentage distribution of the respondents by drinking habit ......... ...... .. .. .. ....... . 66

Figure 4. 3 Percentage distribution of the respondents by exercise practice ... ............ .. .. ....... 73

among the respondents ............. ..... .. .... ....... .......... ... .. .... ..... .... ... ............ ............ ..... ........ .... . 73

Figure 4. 5 Percentage distribution of the respondents by eating outside practice ..... ..... .... ... 74

week ......... ..... .............. .... ... ..... ....... ........... ........ .. ..... ... ........ ..... .. .... ......... ........... ..... .. ........ . 75

........... ... ...... ... ...... .. ....... .... ..... .......... ... ....... ... ..... .. ......... ... ...... ..... ... .. .......... ...... .............. ... . 76

figure 4. 8 Percentage distribution of the respondents by daily fruit or vegetables intake .. ... 77

xiii

CHAPTER 1: INTRODUCTION

1.1 Background Information

Obesity is a worldwide challenge as prevalence of this problem in both developed

countries and developing countries is increasing. In 2009-2010, 33.7% of U.S. adults were

obese (Ogden et ai., 2012). However, in Malaysia a survey regarding body mass index (BMI)

of adults was carried out and it revealed 12.1% were obese (Azmi et ai., 2009). National

Health Survey and Morbidity III in Malaysia (2008) reported that 2.9% of adult males were

obese while 5.7% adult females were obese. Based on WHO (1998) classification of BMI,

BMl ~ 30kglm2 is classified as obese and BM! ~ 25-29.9 kglm2 is overweight. It was also

reported that there was a difference between rural and urban populations and Malays and

Indians were more obese as compared to Chinese (NHMS, 1996). Obesity was not only

confined to one age group as it may affect children as well. Globally, in 2010 the number of

overweight children under 5 is estimated to be over 42 million (WHO, 2010).

Obesity is defmed as abnormal or excessive fat accumulation that presents a risk to

health (WHO, 2006). A crude population measure of obesity is the body mass index (BMI), a

person's weight (in kilograms) divided by the square of his or her height (in meters) (CDC,

2011). Obesity is related to age, sex, social class and cultural background (O'Dea, 2008). In

developed countries, obesity is more prevalent in lower than higher income groups (CDC,

2009). Prevalence rates therefore will vary with methodology, population characteristics and

obesity definitions. There are abundant of causes which may eventually lead to obesity.

Genetics, lifestyle including exercise, smoking and diet, health conditions such as

hypothyroidism and Cushing syndrome, medicines can lead to increase in BMI index and the

most often causes of overweight and obesity is lack of energy balance (National Heart, Lung

and blood Institute, 2012). The main principles to maintain a healthy weight is to have a

balance calories in and calories out.

Besides that, obesity is a complex medical problem which will increase the risk of

various health conditions including hypertension, adverse lipid concentrations, cancer and

type 2 diabetes mellitus (Wilborn et at., 2005). The health risks associated with obesity is

estimated by the Relative Risk (RR) (CPO, 2003). The relative risk of developing Type 2

Diabetes Mellitus, Hepatobiliary disease, Dyslipidemia, Metabolic syndrome, breathlessness

and sleep apnea is more than 3 (RR >3) whereas the relative risk of developing coronary

artery disease, cerebrovascular disease and cardiac failure are moderately increased (RR 2-3).

Moderate weight loss (10% to 15% of body weight) has been shown to decrease health risks

and medical problems in obese patients (Newman, 2009). It was explained that this is due to

improvements of their heart function, blood pressure, glucose tolerance and lipid profiles, as

well as decreased requirements for medication and decreased postoperative complications.

1.2 Problem Statement

Obesity represents a state of excess storage of body fat. However, because differences

in weight among individuals are only partly the result of variations in body fat, body weight is

a limited, although easily obtained, index of obesity. Although several classifications and

definitions fur degrees of obesity are accepted, the most widely accepted are those from the

WHO, based on BMI. The WHO designations include the following grade I overweight

(commonly and simply called overweight) in which BMI of 25-29.9 kg/m2 , grade 2

overweight (commonly called obesity) in which BMI of 30-39.9 kg/m2 and lastly grade 3

overweight (commonly called severe or morbid obesity) in which BMI greater than or equal to

4Okglm2 .

2

Obesity is also associated with host potential comorbidities that significantly increase

the risk of morbidity and mortality in obese individuals. There are also several diseases that

risk towards the obese individuals such as metabolic syndrome, type 2 diabetes, dyslipidemia,

coronary heart disease, osteoarthritis, stroke, depression, non-alcoholic fatty liver disease,

infertility (women) and erectile dysfunction.

The aetiology of obesity is far more complex than simply an imbalance between

energy intake and energy output. Possible factors in the development of obesity include the

follo wing metabolic factors, genetic factors, level of activity, endocrine factors, race, sex, and

age factors, ethnic and cultural factors, socioeconomic status, dietary habits, smoking

cessation, pregnancy and menopause, psychological factors, history of gestational diabetes

and lactation history in mothers.

Globally, obesity is recognized as the 6th most important risk factor contributing to the

overall burden of disease. Ismail et aI., (2002) found that Malaysia has been experiencing a

rapid phase of industrialization and urbanization in recent decades and has often been

recognized as a role model for developing economies. At the population level, a high

prevalence of obesity results from a complex interaction between changes in the population's

lifestyle. A study was undertaken to assess the recent data on Malaysian adult body weights

and associations of ethnic differences in overweight and obesity with comorbidity risk factors,

and to examine measures of energy intake, energy expenditure, basal metabolic rate (BMR)

and physical activity changes in urban and rural populations of normal weight. The NHMS

data revealed that in adults, 20.7% were overweight and 5.8% obese, the prevalence ofobesity

was clearly greater in women than in men. In women, obesity rates were higher in Indian and

Malay women than in Chinese women, while in men the Chinese recorded the highest obesity

rebalances followed by the Malay and Indians. Studies on normal healthy subjects indicated

that the energy intake of Indians was significantly lower than that of other ethnic groups. In

3

women, Malays recorded a significantly higher energy intake than the other groups. Urban

male subjects consumed significantly more energy than their rural counterparts, but this was

not the case in women. In both men and women, fat intakes were significantly higher in

Chinese and urban subjects.

1.3 Significance of the study

Obesity is a growing nationwide problem and of deep concern. It has developed and

become a major public health problem, in Malaysia. In order to curb this problem, the

prevalence of obesity must be studied in relation to the knowledge, attitude and practice of a

healthy lifestyle among us.

Based on the MASO 2009 Conference, WHO has indicated that obesity, is a chronic

disease that does not exclude all age groups. Furthermore, the prevalence of obesity is moving

upwards in Malaysia and much more serious in comparison to other surrounding countries.

Based on the statistics obtained from the study by MASO, the trend of obesity is increasing

and is something to be looked heavily upon. The NHMS revealed that in 1996, 1 in 5 adults

were either overweight or obese and in 2006, this figure increased to 2 in 5 adults. A number

from I to 2 might seem small, but when converted to a percentage, it is a significant increase

of22%. Hence this is something serious to be looked upon (MASO, 2009).

In conclusion, this study is important to curb the prevalence of obesity, and also to

assess the kn wledge, attitude and practice of a healthy lifestyle in Kampung Banyok, Langup

and Kerto to counter against the up growing obesity trend.

4

Pus»t Khidmat Maklumat Akademik UNNERSm MALAYSiA SARAWAK

1.4 Objectives of Study

1.4.1 General objective

The objective of this research was to detennine the prevalence of obesity and their

knowledge, attitude and practices towards a healthy lifestyle among the residents in Kampung

Banyok, Kampung Kerto and Kampung Langup.

1.4.2 Specific Objectives

The specific objectives ofthis study were to:

1.4.2.1 Assess the socio-demographic characteristics of the villagers m Kampung

Banyok, Kampung Kerto and Kampung Langup;

1.4.2.2 Assess the prevalence of obesity among the villagers in Kampung Banyok,

Kampung Kerto and Kampung Langup;

1.4.2.3 Assess the level of knowledge, attitude and practice towards a healthy lifestyle

among the villagers in Kampung Banyok, Kampung Kerto and Kampung

Langup.

1.4.2.4 Detennine the relationship between obesity and their level of knowledge,

attitude and practice of a healthy lifestyle.

1.4.2.5 Detennine the relationship between socio-demographic characteristics and

prevalence ofobesity

1.5 Research Questions

• What is the prevalence of obesity among the adult population in Kampung Banyok,

Rumah Panjang Kerto and Rumah Panjang Langup?

• What is their level ofknowledge, attitude and preventive practice towards obesity?

• What is their level ofknowledge, attitude and practice towards a healthy lifestyle?

5

1.6 Hypothesis

• There is a significant relationship between Knowledge, Attitude and Practice of

healthy lifestyles in relation towards the prevalence ofobesity.

1.7 List of Variables

1.7.1 Independent Variables

• Age

• Gender

• Ethnic group

• Highest educational level

• Occupation

• Household income

• BMI

1.7.2 Dependent Variables

• Knowledge

• Attitude

• Practice

• Prevalence ofobesity

6

1.8 Conceptual Framework

Socio-demographic factors: 8MI: • Height• Age ---,• weight• Gender

• Ethnic group

• Education level

Knowledge Attitude

~____p_ra_c_ti_c_e____~I'- _____________________ J

1.9 Operational Definitions

Obesity: An increase in body weight due to excessive accumulation of fat.

Healthy lifestyle: A way ofliving that helps to enjoy life by being healthy physically.

Knowledge: The state or fact of knowing, or familiarity, or awareness, or understanding

gained through experience or study. It can also be said as specific information about

something.

(a) Good knowledge: Grade for respondents who score equal to or above the mean level of

knowledge.

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(b) Poor knowledge: Grade for respondents who score below the mean level of

knowledge.

Attitude: The way of thinking, which influence one's behavior towards a disease.

(a) Positive attitude: Grade for respondents who score equal to or above the mean level of

attitude.

(b) Negative attitude: Grade for respondents who score below the mean level of attitude.

Practice: The behaviour and action taken by respondents in response to the desire to seek

knowledge, diagnosis and treatment ofdiabetes, and steps taken for the prevention of diabetes.

(a) Good practice: Grade for respondents who score equal to or above the mean level of

practice.

(b) Poor practice: Grade for respondents who score below the median level ofpractice.

Monthly income: It refers to the monthly income of the respondent.

(a) Low household income: Total income ofRM500 or less in a month's time.

(b) Moderate household income: Total income from RM501 to RMIOOO in a month's

time.

(c) High household income: Total income ofRMlOOl or more in a month's time.

Level of education: Categorization of respondents' knowledge level.

(a) Illiterate: Never been to any school

(b) Primary education: Standard I - 6

(e) Secondary education: Fonn I - 6 and matriculation

(d) Tertiary education: College, university, graduate and postgraduate

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Risk factor: The possibility of suffering harm or loss; danger or to expose to a chance of loss

or damage; hazard.

Sign & Symptom

(a) Sign: an objective evidence of disease especially as observed and interpreted by the

physician rather than by the patient

(b) Symptom: sUbjective evidence of disease or physical disturbance observed by the

patient

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CHAPTER 2: LITERATURE REVIEW

2.1. Prevalence of Obesity

In this 21 51 century, as standards of living continue to rise globally; weight gain and

bcsity have become the issues of concern for the nation as it pose a growing threat to health

in countries all over the world. Indeed, the escalating prevalence of obesity in the world has

replaced the more traditional public health concerns. According to Khor (2012), it is estimated

that more than 1.1 billion adults worldwide are overweight, and 312 million of them are obese.

In addition, at least 155 million children worldwide are overweight or obese (Khor, 2012).

WHO (2003) also stated that it is estimated, 35.8 million (2.3%) are overweight or obese.

Unfortunately, there are at least 2.8 million people in the world who die each year as a result

ofbeing overweight or obese.

Unfortunately, countries in Asia are not spared of this social issue, obesity. Khor

(2012) showed the prevalence of obesity in Singapore is 6.9%; 2.4% in the Republic of Korea

_ Indonesia. In addition, according to Tee (2002), his study on the prevalence ofoverweight

8IId obesity in five Asian cities which include Beijing, Hong Kong, Kuala Lumpur, Manila

aod Bangkok was found to be more than 23%. Furthermore, the prevalence of overweight and

ity in Japanese males is 24.5% and 2.3% respectively whereas overweight women are

7.8% and obese women are 3.4%.

As for Malaysia, has also become one of the countries with rapid rise of obesity as the

He has a dramatic change in their lifestyle, regardless of the resultant changes in food and

. ion as well as the presence of awareness of health concern in the society. Khor (2012)

eel that there is a three-fold increase in obesity prevalence among adults, surging from

14% over the 10-year period. Furthermore, the prevalence of overweight and obesity

IJJ'~aysla studied by Tee (2002) showed 20.7% and 5.8% respectively.

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Apart from that, the overall national prevalence of obesity among Malaysians aged 15

years and above was 11.7% whereby females showed a significantly higher prevalence of

obesity compared to males (Rampal et aI., 2007). Rampal et aI., (2007) stated the prevalence

of obesity was highest amongst the Malays (13.6%) and Indians (13.5%) followed by the

iDdigenous group of Sarawak Bumiputera (10.8%) and the Chinese (8.5%). Azmi et aI.,

(2009) showed that there is no significant difference in the prevalence of obesity in rural or

urban areas.

2.2. Causes of obesity

It is important to know the causes of obesity to prevent it and avoid further

complications associated. In the guideline for the prevention of obesity (MASO, 2005), the

cause ofobesity can be divided into the imbalance of energy expenditure, poor eating habits,

lade ofphysical activity, psychosocial factors and cultural background.

According to Bouchard (2008), energy imbalance refers to the difference between the

calorie intake and output on the same day. It can be divided into positive energy balance when

the energy intake is higher than output and negative energy balance when the energy output is

JR8ler than the input. This concept had been explained in the work of Hill (2006). Therefore,

an increase in weight gain is indicated as a positive energy balance due to the interaction

between the behavioural and environmental factors that affect the energy intake and

expenditure. Behaviour pattern such as diet and physical activity were the main causes of

daily fluctuations in energy balance while an obesigenic environment such as increased food

N'ailability, high energy-rich food supply and decreased need for physical activity encouraged

a positive rather than negative energy balance (Hill et aI., 2003).

There is also an association between food availability and the upward shift in the

pulation dietary pattern that lead to an increase in the obesity rate in Malaysia (Khor, 2012).

11