Weight Control And Healthy Eating for Women in Singapore

2,753 views
2,627 views

Published on

Research conducted for Health Promotion Board, Singapore.

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
2,753
On SlideShare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Weight Control And Healthy Eating for Women in Singapore

  1. 1. WEIGHT CONTROL & HEALTHY EATING  1    09    NOV  Topic: Weight Control & Healthy Eating  NM 3220 Group Project  DW 3    Presented By:    Chang Yi Ping Hilda                           U071902L  Lim Xiu Yan Jacqueline                     U072097W  Md Khairul Azmi B Suhaimi             U071772M  Tan Soo Huay                                     U072688Y  Teo Qi Ling                                          U072726X   
  2. 2. WEIGHT CONTROL & HEALTHY EATING  2      Table of Contents  1. INTRODUCTION  3  2. LITERATURE REVIEW  4  3. METHOD & RESEARCH DESIGN  7  3.1 JUSTIFICATION OF RESEARCH DESIGN AND METHOD SELECTION    3.2 SUBJECTS            3.3 SAMPLING  3.4 DATA COLLECTION PROCESS  3.5 MEASURES  4. RESULTS / ANALYSIS  10  5. DISCUSSION  13  6. REFLECTIONS  15  7. BIBLIOGRAPHY  16         
  3. 3. WEIGHT CONTROL & HEALTHY EATING  3    1. Introduction: Define the problem Extensive research has suggested that obesity may not be the only cause of experiencing negative psychological effects of weight status (Spitzack, 1987). People of normal weight or self- classified overweight experienced body dissatisfaction may equally perceive prejudicial treatment (Annis, Cash, & Hrabosky, 2004; Cash & Hicks, 1990) and want to lose weight (Navia et al., 2003). Hence, weight consciousness, which leads to weight control, is becoming a prevalent trend. Weight control is the act of trying to lose or maintain weight (Serdula et al., 1999). This phenomenon is especially true for women, as many are generally more concerned than men over their body weight and are also more inclined to control their weight. (Serdula et al., 1993) Changes in diet and physical activity are the most prevalent methods of weight control. Changing diets include consuming fewer calories and fat (Serdula et al., 1999). These are the components that constitute healthy eating according to HPB. Healthy eating is selecting a balanced diet that is high in dietary fibre and low in fat, cholesterol, sugar and salt. It also means having different types of food in the right amounts and not over-eating any one type (HPB, 2007). Previous researchers have found that people are eating healthily to control their weight but these studies are western-centric. This paper thus aims to find out if the relationship between healthy eating and weight control can be generalized to the local context.
  4. 4. WEIGHT CONTROL & HEALTHY EATING  4    2. Literature Review More females than men have the desire to be thinner in Singapore. While only 28% of Singaporean men want to be thinner, more than half (53%) of Singaporean women want to be thinner (Wang et al., 1999). Weight control has also been identified as a major motivation behind females selecting food carefully (Steptoe, Pollard & Wardle, 1995). Therefore discovering whether there is an intention for female undergraduates in National University of Singapore (NUS) to control their weight may present an opportunity for Health Promotion Board (HPB) to reinforce the healthy eating lifestyle (refer to SWOT analysis of HPB). This paper thus seeks to find out if female undergraduates are controlling their weight and what are the methods employed. The first research question is hence derived. RQ1: Are female undergraduates in NUS controlling their weight? If so, how are they controlling their weight? Are they satisfied with their methods of weight control? The theory of planned behavior suggests that behaviour is mainly predicted by intention, which constitutes three main factors. “As a general rule, the stronger the intention to engage in behaviour, the more likely should be its performance.” (Verbeck & Vackier, 2004) Behavioural intention is determined by behavioural attitudes, subjective norms and perceived behavioural control (Rah, Hasler, Painter & Chapman-Novak, 2004). Behavioural attitude is defined as a positive or negative evaluation of performing behaviour of interest. Subjective norm is social pressure implied by important referent individuals’ or groups’ approval or disapproval of engaging in a given behavior. Perceived behavioural control (PBC) is defined as the perceived
  5. 5. WEIGHT CONTROL & HEALTHY EATING  5    ease or difficulty of performing a behaviour (Pawlack, Malinauskas & Riveria, 2009). However, Armitage and Conner (1999) have separated self-efficacy with PCB. This is because self- efficacy is defined as confidence in one’s own ability to carry out a behaviour, and relates to internal resources such as motivation. PCB on the other hand measures external factors, such as availability. For this study, self-efficacy is chosen over PCB, as recommended by Armitage and Conner (1999). Thus, the theory of planned behavior is modified and implemented to understand weight control intention and behaviour among female undergraduates in NUS. (Refer to Appendix C for modified theory) This leads to the second research question. RQ2: How does the Theory of Planned Behaviour help us understand weight control intention among female undergraduates? Three hypotheses were formulated to find out if a correlation exists between these variables in the modified theory. H1: There is a positive relationship between attitude towards weight control and intention to control weight. H2: There is a positive relationship between subjective norms and intention to control weight. H3: There is a positive relationship between perceived self-efficacy and intention to control weight. Furthermore, researchers have found a link between weight control and the adopting of healthy dietary habits like increasing intake of fruits and vegetables (Lowry et al., 2000; Georgiou et al.,
  6. 6. WEIGHT CONTROL & HEALTHY EATING  6    1997), especially in women (Wardle et al., 2004). A review of young people’s views on healthy eating revealed that their attitudes towards healthy eating were generally positive and concerns over weight was motivation for choosing healthier food. This suggests that young people who are practicing weight control have a more positive attitude towards healthy eating (Shepherd et al., 2005). Therefore, the third aim of this paper is to find out the relationship of weight control intentions and healthy eating frequency among female undergraduate students in NUS. RQ3: What is the relationship between healthy eating and weight control intentions among female undergraduates? The research question is further broken down into two hypotheses. H4: There is a positive relationship between intention to control weight and the attitude towards healthy eating. H5: There is a positive relationship between intention to control weight and the frequency of healthy eating practices.
  7. 7. WEIGHT CONTROL & HEALTHY EATING  7    3. Method/Research Design A questionnaire was formulated for 150 participants (see Appendix B). The data collected from the survey were then analyzed using the Statistical Package for the Social Sciences, SPSS. 3.1 Justification of Research Design and Method Selection Survey is well suited to answering the research questions and hypotheses, as it can be used to evaluate attitudes, intentions, subjective norms, self-efficacy and past behaviors of respondents in a statistical significant way. It enables identification and gathering of descriptive and inferential data about the target audience. Survey findings were the basis for the development of strategies to promote healthier eating habits among tertiary students. 3.2 Subjects Respondents were all female undergraduates from NUS, aged between 18 to 25 years old, with the mean age being 21.1 (SD 1.14). It is recognized that female tertiary students are usually more inclined towards weight control (Wang et al). They are also more prone to adopt alteration to their dietary habits to control their weight (Serdula et al., 1993). As such, they make a suitable sampling frame. 3.3 Sampling Non-probability purposive sampling was employed. To achieve a variety of opinions, participants were recruited from each faculty (Appendix A Table 1).
  8. 8. WEIGHT CONTROL & HEALTHY EATING  8    3.4 Data Collection Process A pretest ascertained the reliability of the questionnaire. Data collection was conducted through emails and recruitment on campus. Respondents were informed about the purpose of the study and participation was voluntary. 3.5 Measures Standard-scaled statements related to behavioral intention, attitude, subjective norms, and self- efficacy were adopted from Armitage and Conner (1999) and tailored to the targeted behavior (weight control) of the survey. Intention. Intention to practice weight control was assessed using three items, each on a 7- point Likert scale measured at interval level, anchored from definitely do not (1) to definitely do (7). These were: “ I intend to control my weight over the next month,” “ I plan to control my weight over the next month,” and “I want to control my weight over the next month.” The mean of these items produced a composite scale with a Cronbach’s alpha coefficient of .963. Attitude. Attitude to practise weight control was assessed using six items, each on a 7- point Likert scale measured at interval level, anchored from strongly disagree (1) to strongly agree (7). These were: “I think that controlling my weight is good," "...pleasant,""...beneficial," "...enjoyable," "...wise," "...necessary." The mean of the six scales were taken as a composite score, with a Cronbach alpha coefficient .875. Subjective norm. A global measure of subjective norm was measured with a composite score,
  9. 9. WEIGHT CONTROL & HEALTHY EATING  9    derived from four items: "People who are important to me think I (should not control my weight/should control my weight)," "People who are important to me want me to control my weight (strongly disagree/strongly agree)", "People who are important to me would (disapprove of my weight control/approve of my weight control),"I feel under social pressure to control my weight (strongly disagree/ strong agree)." All were measured on 7-point likert scales measured at interval level. The Cronbach's alpha coefficient for this scale is .946. Self-efficacy. This is assessed using six items, each on a 7-point likert scale, anchored from strongly disagree (1) to strongly agree (7). These were: " ...control my weight is entirely up to me.," "...I have personal control over controlling my weight...," "... I have the ability to control my weight...," " I am capable to control my weight ...," " ...confident to control my weight". The Cronbach's alpha coefficient for this scale is .710. Behaviour. Two behavior measures were included in the questionnaire: “I have practiced weight control in the last month (strongly disagree/strongly agree),” and “How often did you practice weight control in the last month? (never/frequently).” The Cronbach's alpha coefficient for this scale is .897. Attitude of healthy eating. Attitude of healthy eating was assessed using six items, each on a 7- point likert scale measured at interval level, anchored from strongly disagree (1) to strongly agree (7). These were: “I think that healthy eating is a good way to control my weight," "...pleasant way to control my weight,""... beneficial way to control my weight," "...enjoyable way to control my weight," "...wise to control my weight," "...necessary to control my weight."
  10. 10. WEIGHT CONTROL & HEALTHY EATING  10    The mean of the six scales were taken as a composite score, with a Cronbach alpha coefficient of .854. Practice of healthy eating. This is assessed using five items, each on a 7-point likert scale (never/frequently) measured at interval level. These were: " I have been skipping meal to control my weight. ," "...avoiding one type of food...," "...gone without food for more than 24hr...," "...only eating food from one food group...," " ...replacing meals with alternatives...". The mean of the five scales were taken as a composite score, with a Cronbach alpha coefficient of .762. 4. Results/Analysis Out of 150 survey respondents, 67.3% of female undergraduates are controlling their weight. Of those, 61.9% engage in physical activities to control their weight including “aerobics”, “gym on a regular basis” and “jogging twice a week”. 77.6% who are controlling their weight alter their eating habits for example “avoiding fried and oily food”, “reduce carbohydrate intake” and “eating less snacks”. 1.4% of them go to slimming centres or take slimming pills (Appendix A, Table 9). Some weight-controlling females have expressed dissatisfaction with their weight control methods. They commented that “weight is only maintained but not decreased” and “it takes a long time, so it does not really work”. 70.1% of female undergraduates trust dietitians as a source of weight control advices, followed by sports instructors (58.5%), general practitioners (54.4%) and immediate friends (50.1%). 74.1% of them also trust weight control advices from newspaper articles and editorials, followed
  11. 11. WEIGHT CONTROL & HEALTHY EATING  11    by magazine articles (73.5%), medical journals (27.9%) and the HPB website (26.5%). When the frequency of their healthy eating practices was measured, weight-controlling females are eating more unhealthily (M=4.27, SD=1.23) than those not controlling their weight (M=3.54, SD=1.21, Appendix A Table 9). There is a moderate correlation between intention and behaviour (r=.542, p<.01) and positive correlations between intention and its direct antecedents (rs= .659 to .760, all ps < .01). This supports H1,H2, and H3. However, compared to “attitude to weight control” and “self-efficacy”, “subjective norms” have the strongest relationship with intention (r=.760). The strongest component for attitude towards weight control is "I think that controlling my weight is good" with a correlation of (r=.592, p<.01). The weakest component of that is "I think that controlling my weight is an enjoyable experience" with a correlation of (r=489, p<.01, Appendix A Table 3). For H2, the strongest component for subjective norms is "people important to me would approve of my weight controlling" with a correlation of (r=.723, p<.01). The weakest component for subjective norms is "I feel under social pressure to control my weight" with a correlation of (r=.403, p<.01, Appendix A Table 4). In H3, the strongest component for self-efficacy is "to what extent do you see yourself as being capable of controlling your weight in the next month" with a correlation of (r=.619, p<.01). However, the weakest component for self-efficacy is found to be "whether or not I control my weight in the next month is entirely up to me" with a correlation of (r=.348, p<.01, Appendix A Table 5).
  12. 12. WEIGHT CONTROL & HEALTHY EATING  12    Thus, the moderate correlation between intention and behaviour, with 'intention' amalgamating the variables of 'attitude', 'self-efficacy' and 'subjective norms' adequately answers RQ2 through the quantitative instruments utilized. There is a positive correlation between intention to control weight and the variable ‘attitude towards healthy eating’ (r=.391, p<.01), which supports H4. The variable ‘frequency of healthy eating practices’ was found to have a negative relationship with intention to control weight (r= - .240, p<.01, Appendix A Table 2), which contradicts H5. In addition, from the open-ended questions in question 1 of the survey (Appendix D), there were respondents who commented that they have practiced "liquid diets" and "starving myself when I don't feel like eating". The strongest component contributing to the attitude towards healthy eating is the extent respondents agree on the item "I think that healthy eating is a pleasant method of weight control" with correlation r=.829 (p<.01). The weakest component contributing to the attitude towards healthy eating is "I think that healthy eating is a beneficial method of weight control" with correlation r=.707 (p<.01). The most frequent unhealthy behavior practiced is "I have been skipping meals to control my weight" and "I have been replacing meals with alternatives like water to control my weight".
  13. 13. WEIGHT CONTROL & HEALTHY EATING  13    5. Discussion The aims of the present study were three-fold: to understand if female undergraduates in NUS are controlling their weight and how; to apply the modified theory of planned behavior to understand weight control intentions and behavior; and to identify the relationship between the frequency of healthy eating practices and weight control intentions which may contribute to the understanding of dietary habits among female undergraduates in NUS. Social factors are more influential in Asian context in affecting weight control behavior among female undergraduates than in Western context. The modified TPB is applicable to the Singapore context, specifically towards NUS female undergraduates, as it had effectively predicted both weight control intentions and behavior. However, in contrast with findings by Armitage and Conner (1999) and Oygard and Rise (1996), which indicates that 'attitude towards weight control' is the strongest predictor and 'subjective norms' the weakest predictor, we found that 'subjective norms' has the strongest correlation with intention to control weight. This suggests the strong influence of social factors leading to weight control behaviour among female NUS undergraduates. This could probably be due to differences in context between the West and East. Women in general are found to be more collectivistic than men (Triandis & Singelis 1998). People from East Asian backgrounds are also more collectivistic than those from European backgrounds (Singelis, T. M., Triandis, H. C., Bhawuk, D. S., & Gelfand, M. 1995). Asian cultures emphasize "selfless subordination to family and community, which may decrease
  14. 14. WEIGHT CONTROL & HEALTHY EATING  14    levels of personal control". Thus Asians have lower levels of self-control than non-Asians (Ross & Sastry 1998). Female tertiary students seem to value the opinions of the people important to them and they are more inclined to seek approval than feel pressure when it comes to social factors in influencing them to control their weight. This finding is useful in assisting the formulation of messages if the tactic of persuading female undergraduates' social groups to influence them is utilized. Thus people important to the undergraduates intending to control their weight should be influential in referring them to health professionals such as weight loss dietitians or nutritionists to ensure that they do not use extreme methods to control their weight. Female undergraduates who are intending to control weight do not necessarily practice healthy eating. Weight-controlling female undergraduates appear to expect instant results and become dissatisfied with their weight control methods though the methods are healthy. This probably led them to exploring more methods of weight control, which turned out to be unhealthy. Although earlier studies suggested a positive relationship between the "intention to control weight" and the "frequency of healthy eating practices", findings of this study suggested otherwise and left H5 unsupported. This paper attributes this discrepancy to insufficient theories explaining the relationship between the frequency of healthy eating practices and the intention to control weight. Furthermore, the definitions of healthy eating differ between previous studies and that of this study. For example, Pawlak, Malinauskas & Rivera's (2009) definition of healthy eating refers to a diet that includes whole grains, fruits, and vegetables and is moderate in fat, sugar, and sodium. However, HPB's definition of healthy eating is more detailed. On top of eating
  15. 15. WEIGHT CONTROL & HEALTHY EATING  15    whole grains, fruits, and vegetables and moderate fat, sugar, and sodium intake, one also has to eat different types of food in the right amounts and not over-eat any one type of food. 6. Reflections The findings of the present study must be interpreted in light of certain limitations. The results presented here are based on a purposive sampling of female undergraduates. Moreover, findings of this research are based on self-reported data. The authors have also not assessed the actual weight control behaviors of female undergraduates included in the sample are unable to assess how well the behavioral intention and components of the theory of reasoned action predicts the actual weight control behavior. This study thus reveals the methods of weight control undertaken among female undergraduates. Coupled with circumstances like packed schedules and busy days and experiencing irregular meals as a result, these undergraduates are placed in high risk for future health problems. There is thus a need to educate female undergraduates on the correct methods of weight control. Studying weight control methods and alterations to dietary habits to maintain or reduce weight should be a focus of researchers and health authorities like HPB. This area is worth exploring in future studies.
  16. 16. WEIGHT CONTROL & HEALTHY EATING  16    7. Bibliography 1. Georgiou, C.C., Betts, N.M., Hoerr, S.L., Keim, K., Peters, P.K., Stewart, B. & Voichick, J. (1997) Among young adults, college students and graduates practised more healthful habits and made more healthful food choices that did nonstudents. Journal of the American Dietetic Association, 97 (7), 754-759. 2. Lowry, R., Galuska, D.A., Fulton, J.E., Wechsler, H., Kann, L. & Collins, J.L. (2000) Physical Activity, Food Choice, and Weight Management Goals and Practices Among U.S. College Students. American Journal of Preventive Medicine, 18 (1), 18-27. 3. Navia, B., Ortega, R.M., Requejo, A.M., Mena, M.C., Perea, J.M. & López-Sobaler, A.M. (2003) Influence of the desire to lose weight on food habits, and knowledge of the characteristics of a balanced diet, in a group of Madrid university students. European Journal of Clinical Nutrition, 57 (1), S90-S93. 4. Oygard, L. & Rise, J. (1996). Predicting the intention to eat healthier food among young adults. Health Education Research, 11 (4), 453-461. 5. Pawlak, R., Malinauskas, B. & Rivera, D. (2009) Predicting Intentions to Eat a Healthful Diet by College Baseball Players: Applying the Theory of Planned Behaviour. Journal of Nutrition Education and Behaviour, 41 (5), 334-339.
  17. 17. WEIGHT CONTROL & HEALTHY EATING  17    6. Rah, J.H., Hasler, C.M., Painter, J.E. & Chapman-Novakofski, K.M. (2004) Applying the Theory of Planned Behaviour to Women's Behavioral Attitudes on and Consumption of Soy Products. Journal of Nutrition Education and Behaviour, 36 (5), 238-244. 7. Sastry, J., Ross C. E. (1998) Asian Ethnicity and the Sense of Personal Control. Social Psychology Quarterly, 61 (2), 101-120. 8. Serdula, M.K., Collins, M.E., Williamson, D.F., Anda, R.F., Pamuk, E., & Byers, T.E. (1993) Weight Control Practices of U.S. Adolescents and Adults. Annals of Internal Medicine, 119 (7), 667-671. 9. Serdula, M. K., Mokdad, A. H., Williamson, D. F., Galuska, D. A., Mendlein, J. M., & Heath, G. W. (1999). Prevalence of attempting weight loss and strategies for controlling weight. Journal of American Medical Association, 282, 1353-1358. 10. Sheperd, J., Harden, A., Rees, R., Brunton, G., Garcia, J., Oliver, S., & Oakley, A. (2005). Young people and healthy eating: a systematic review of research on barriers and facilitators. Health Education Research, 1-19. 11. Singelis, T. M., Triandis, H. C., Bhawuk, D. S., & Gelfand, M. (1995). Horizontal and vertical dimensions of individualism and collectivism: A theoretical and measurement refinement. Cross-Cultural Research, 29, 240-275.
  18. 18. WEIGHT CONTROL & HEALTHY EATING  18    12. Singelis, T. M., Triandis, H. C. (1998). Training to recognize individual differences in collectivism and individualism within culture. International Journal of Intercultural Relations, 22 (1), 35-47. 13. Spitzack, C. (1987). Confession and significance: the systematic inscription of body consciousness. Journal of Medicine and and Philosophy, 12, 357-369. 14. Verbeke, W. & Vackier, I. (2004) Individual determinants of fish consumption: application of the theory of planned behaviour. Appetite, 44 (1), 67-82. 15. Wang, M. C., Ho, T.F., Anderson, J. N., Sabry, Z. I. (1999). Preference for thinness in singapore - a newly industrialised society. Singapore Medical Journal, 40, 502-507. 16. Wardle, J., Haase, A.M., Steptoe, A., Nillapun, M., Jonwutiwes, K. & Bellisle, F. (2004) Gender Differences in Food Choice: The Contribution of Health Beliefs and Dieting. Annals of behavioural medicine, 27 (2), 107-116.

×