Background of the study
Obesity is said as the excess amount of fat accumulated in the body that causes an impact on health which is negative (WHO 2014), which is the result of an imbalance between the amount of energy intake and expenditure. Obesity is generally measured by Body Mass Index (BMI). BMI is obtained by dividing the weight in Kg by height in m2. Adolescents whose BMI is greater than 95 percentile for age are regarded as obese. There are also field methods to measure obesity which include the waist circumference, waist-hip ratio, skinfold thickness, and bioelectrical impedance – used in clinical, community settings, and large research studies. Obesity is one of the most common health problems in the world which is mostly preventable.
Statistical overview
In 2010 over 300,000 deaths have been estimated each year due to obesity, 3.9% of years of life lost, and 3.8% of DALY’s globally. The rising prevalence of obesity in many countries has been described global pandemic. International Obesity Task Force (IOTF) surveyed in the year 2000 was about 10% (a total of 155 million) of children and Adolescents of 5-17 years globally were overweight; out of which 2-3% (30-45 million) were obese, even more, 22 million younger children are also affected according to previous IOTF global estimates based on WHO data for under-fives [1].WHO reports stated that 1 in 5 children and Adolescents are obese. In 2016 around 41 million infants and young children were obese and overweight. According to a report from urban South India, 21.4 % of boys and 18.5% of girls aged 13-18 years were overweight or obese.
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Causes:
Evidence indicates that genetic background, is an important role in determining the risk of obesity, though there are many genes found to be associated with obesity, it is believed that not a single type of gene could be a cause for epidemic results, studies are being done to have a good understanding on the interrelation between the gene variation for the cause of obesity. Factors such as dietary intake of excess caloric and fat, increased consumption of sugar by soft drinks, physical activity, and sedentary behavior, which moderated by factors such as age, gender, race, and economic status [2]. Environmental risk and lifestyle preferences for obesity are very high and interrelated.
A wide variety of government policies and programs have been implemented, which includes the development of national clinical guidelines, nutrition labeling on packaged foods, education and social marketing efforts, and more recently, calorie labeling on food products and federal efforts to increase access and financing for fresh fruits and vegetables.
Complications
Obesity plays a risk factor for many non-communicable diseases such as diabetes, cardiovascular diseases, hypertension, hyperlipidemia, cancer, and early atherosclerosis which has its early origin in adolescence. Adolescents who are obese are at an increased risk of orthopedic conditions such as slipped capital femoral epiphysis, genu valgum, and musculoskeletal pain [4] and are also susceptible to fractures because of reduced bone mass compared to the body’s size [5]. In obesity, disordered breathing is most common which includes hypoventilation in obesity syndrome characterized by poor alveolar exchange and obstructive sleep apnea. In female adolescents who are overweight and obese abnormal uterine bleeding with reports of amenorrhea, heavy bleeding, anovulation due to immaturity of the hypothalamic-pituitary-ovarian axis, and elevated level of free estrogen. Hence a healthy weight is essential for adolescents as they grow into healthy adults.
Obesity is a common cause of insulin resistance in adolescents. Studies have revealed that obese adolescents with impaired glucose tolerance are significantly more insulin resistant than those with normal glucose tolerance [3]. This is due to the increased deposition of lipids in the visceral and intramyocellular compartments (IMCL).
Psychological risks in adolescent obesity
Obese adolescents tend to become obese adults, of these obese female adolescents face medical, psychological, and reproductive health challenges. Obese adolescents are at a risk of being stigmatized, teased, bullied, and medically compromised, so they avoid situations that give rise to such pressure and heed to safe places, such as their homes [1]. In addition, adolescents who are overweight tend to have fewer friends than normal-weight adolescents, which may result in decreased social participation and play leading to increased time in sedentary life. Obese children are excluded from activities, particularly competitive activities that require physical activity. It is often harder for overweight adolescents to participate in physical activities as they tend to be slower than adolescents of their age and contend with shortness of breath. These negative social problems give rise to low self-esteem, depression, anxiety, low self-confidence, and a negative body image in adolescents and can also affect academic performance.
Social participation
Social participation is an organized pattern of behavior that is characteristic and expected of an individual or a given position within the social system or the extent of involvement and interaction of people with others in their local communities and neighborhood. There are many factors that influence social participation, including the facilities and resources available in the community or neighborhood and the ease by which people can access them. It includes connecting electronically through text, voice chat, and virtual chat, interacting with friends, family, and co-workers for various purposes. Cultural practices, assets, and expression play an important role in social participation. It improves happiness, health, and well-being. The social participation frame of reference emphasizes the power of emotion to motivate and engage. Early relationships with parents provide the foundation for further social participation.
Social participation in adolescents
Social participation in adolescents facilitates the development of self-identity. Social participation is an important component of the education process because it can support or hinder learning outcomes. Social participation was found to be a better predictor of academic success and school readiness than mental abilities. Thus, addressing the social participation of students is important to promote academic success within the classroom. Social participation reduces the likelihood of behavioral and emotional problems (Murray & Greenberg, 2006), and promotes a better subjective health status (Gerich, 2003), all of which lead to a more conducive learning environment. Knowledge of the compact relationship among the adolescents and their engagement in valuable occupations, and the need to organize occupation-based intervention plans that cause a change or growth. (AOTA 2014). Obesity in adolescence not only affects the individuals but also society.
Occupational therapists play an important role in obesity by providing a meaningful and health-building occupation, and involve participation in physical activity, intake of a nutritionally balanced diet, and engaging in healthy lifestyle behavior. Occupational therapy can enable participation in an occupation that helps in preventing and treating obesity as well as occupations that are meaningful to persons with obesity (CAOT 2015). Compensatory training in ADL and IADL, recommendations of home modifications, adaptations, and equipment, and also an education program. Healthy occupations in the obesity prevention framework refer, to participation in physical activity and the intake of a balanced diet.
Occupational therapy interventions are effective in fostering the use of virtual reality technology to increase physical activity for patients living in a mental health residential facility, engaging adolescents in increased physical activity. Occupational therapy practitioners give appropriate strategies that facilitate the participation of the adolescent by modifying daily habits, roles, and patterns that contribute to obesity and other chronic condition.
1.2 Need for the study
- According to recent studies, it was concluded that obesity in childhood has its effects on participation, mental health, and psychosocial development due to victimization, and weight bias, studies also showed that adolescent obesity leads to low self-esteem, so this study is done to find the impact of obesity on adolescents in social participation by correlating the social participation of obese and non-obese adolescents.
Review of literature
This chapter explains the following:
- 2.1 Influence of obesity in adolescence
- 2.2 Influence of social participation
- 2.3 Adolescent Obesity affecting social participation
2.1 Influence of obesity in adolescence
Michael A. Pizzi and Kerryellen Vroman 2013 April did their study on Childhood Obesity to find if obesity had caused an impact on children’s participation, and psychosocial and mental wellbeing. Their study aimed and investigated the psychosocial issues due to obesity, the variant sequelae of psychosocial factors have been revealed with childhood obesity which includes the children being targeted and marginalized and being discriminated on weight bias and that these children deserve the same opportunities for participation. Children who are bullied, and teased often undergo depression and low self-esteem Occupational therapists view the issues from all perspectives and use a model of practice that defines the relation between occupational performance and an individual’s personal system to remove all that obstructs healthy psychosocial development.
Canadian association of occupational therapy in obesity and healthy occupation (2015) was done regarding obesity which is one of the chronic diseases treated with lifestyle modification, pharmacotherapy, and surgery. Occupational therapists are, as in other areas of chronic disease prevention and management, key members of the healthcare team for persons with obesity. It does not need a new skill for them to meet the needs of obesity, rather Occupational therapists must be informed about obesity, treatment, and participation experiences to determine, clarify and advocate for the application of occupational therapy in the area of obesity prevention, treatment, and management. Everyday life’s occupation provides good health and wellness for all populations. Occupational therapy thus has a role in helping people individually, in groups, and in communities to participate in an occupation that has a positive impact on their health.
Salles-Jordan, Katie, OTD, OTR 2007, in her position paper on obesity and occupational therapy pointed out the importance of occupational therapy interventions in childhood obesity, explained the role of occupational therapists in addressing the impact of obesity on people’s ability to engage in daily activities. Interventions not only facilitate weight loss but also enable clients to make changes to performance in multiple areas of life, including incorporating appropriate productive and social activity as well as physical activity, to address obesity, thus improving health outcomes and maintaining long-term wellness. Through their knowledge of psychosocial, physical, environmental, and spiritual factors, as well as cultural traditions and perspectives that influence performance, occupational therapy practitioners help consumers develop and implement an individualized, structured approach to lifestyle change.
- Alan J. Zametkin, M.D., Christine K. Zoon, B.S., Hannah W. Klein, B.S., and Suzanne Munson, B.A. conducted research on psychiatric aspects of child and adolescent obesity and highlighted information on prevention, diagnosis, and treatment. Health care professionals must take into account goals that provide significant health benefits. The most effective treatments involve that parental involvement in taking care of the child’s health. Mental health professionals must aid in developing obese children and adolescents in building self-esteem to help them live their life without concern about the weight
- Gregory John Jarvie, Benjamin Lahey, William Graziano, and Edwards Frame
His study on childhood obesity and social stigma reviewed the evidence for the social stigma associated with body image in childhood in obesity. A relation between facial attractiveness, body image, situation context, and obesity stage was examined and discussed. It also aimed to investigate the evidence for inter-relation between physical appearances involving the body and face and social growth. It was said that unattractiveness seemed to be influencing a child’s social interaction resulting from the way he/she is treated, though an unattractive child has equal skills as that attractive child they are not recognized. Thus obese children assume that they look at themselves with handicaps even when others don’t look at them that way.
Praveen Agarwal, Kamala Gupta, Vinod Mishra, and Su tapa Gupta in 2015 did a study to explain the psychosocial factors among obese, and overweight morbidity in women from Delhi, where they interviewed women of age 20-54 years who were selected from the national family health survey samples 1998-1999 a re-interview had been done after four years 2003, day to day issues were collected, not satisfied with body image and sexual needs, discrimination and stigma. They found that psychosocial & behavior issues were found to be highly present which lead to anxiety, depression, and low self-esteem.
Blanchard in 2006 in his study to determine the interrelation between obesity and age, education and socioeconomic status, and depression and obesity in African- Americans. Information was collected by a direct interview for an American health survey. Higher rates of obesity along with depression were found.
Mary A Forhan, Mary C Law, Brenda H. Vrkljan et al in 2014 in their study described that obesity had a great impact of quality of life in regard to their health, but was unclear on the influence of participation in a different occupation. This study explains class 3 obesity and its impact on daily living occupations. Adults who were undergoing treatment for obesity were interviewed.
Data were collected in descriptive methods where the people participating were scored under tensions, barriers, and coping strategies in different occupations. Participation in different daily living occupations has described the level and quality of occupations that were affected by barriers perceived in the surrounding environment. Participation was greatly affected for these class3 obesity individuals. The treatment in providing meaningful participation in life’s everyday activities for obesity must involve adaptations to the surrounding environment.
Obesity and social participation
Ketteridge and Boshoff in 2008 did a study to evaluate the participation of adolescents in physical activity and their perception for participation and the strategies that encourage the involvement. Using three focus groups an interpretive design was formed in which a cross-sectional study has been done. The reasons were found to be the benefits in areas like physical health, emotional, psychological, and self-development. The factors that encouraged the participation were fun and interesting where they could have their own choices and not of the competitive type. The adolescents who participated were from private schools. Reduced results were found in adolescents who were less active.
The impact of obesity not only affected individuals directly but also indirectly by job absenteeism (Bungum et al., 2003). Obesity indirectly reduced education and employment services (Puhl & Brownell, 2001); reduced access of the available healthcare and wellness services provided for everyone (Wallis, 2004); due to portrayals in television regarding obesity in which the obese women were less attractive and preferred by everyone which lead to the limited social participation (Greenberg, Eastin, Hofschire, Lachlan, & Brownell, 2003; Moloney, 2000). these ill effects and consequences cause a great deal of damage to their participation throughout their entire life, reducing their interest and performance in their desired activities.
Occupational therapy in obesity
Kristi Haracz, Susan Ryan, and Michael Hazelton et al 2013 did a study to describe obesity is a health concern globally. It usually leads to lower physical & mental health along with wellness and hindrances in performing occupation. The interrelation between health and wellness with occupation, where an occupational therapist can describe the causative factors and the consequences of obesity.
This study with evidence-based support described the function of occupational therapy in obesity. It comprises eight theoretical bases of which are two qualitative studies and twelve quantitative studies. Occupational therapy treatment plans were based on certain categories such as in preventing issues and promoting health, increasing participation in physical activities, changing dietary patterns, and decreasing the effects of obesity. The interventional categories were identified as evaluation, environmental modifications, health educating, and adapting occupations according to needs. However, studies were needed to provide a strong evidence base for the practice of occupational therapy.
Position paper in occupational therapy published a paper to explain to people working in professions other than occupational therapists how obesity impacts an individual from performing their everyday events of life. For individuals with obesity occupational therapist evaluates and considers all the needs of the individual and sets goals and works on implanting them, they also work with individuals in designing the intervention plan according to their interests and needs in areas affected due to obesity Occupational therapy programs put to action the personal preferences of the client, their medical regimen a plan an intervention. Occupational therapy also does community programs by changing their lifestyles and through education programs, introducing new healthy routines and habits, recommendation of certain modifications at home to reduce laziness and adaptive equipment to improve the effort in occupations, retraining ADL and IADL, good wellbeing program for adolescents and children, play and education program in schools regarding healthy lifestyle and social participation.
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