1. TOWARDS HEALTHY FOOD CHOICES,
FITNESS AND MENTAL HEALTH
AMONG WELL TO DO ADOLESCENTS
TO REDUCE DUAL BURDEN OF MALNUTRITION
IN SCHOOLS OF URBAN VADODARA
Presenting Author : Tripti Saxena
Research Guide : Prof. Shubhada Kanani
Department of Foods and Nutrition
M.S. University Vadodara Gujarat

2. Why the need to study dual burden of malnutrition
among well- to do school adolescents ?
 Developing countries: undernutrition and overnutrition among
wide sections of the population and in varying socioeconomic
environment ( FAO 2006) which lead to adverse consequences
(WHO 2005).
 Despite the reported high prevalence of undernutrition among
well to do school adolescents, most of the interventions in India
deal with adolescent obesity/overweight.
 There are gaps in our knowledge regarding determinants of over
& under nutrition among well to do adolescents.
Saxena & Kanani 2008

3. OBJECTIVES
• To assess the prevalence of dual burden of malnutrition
among well to do urban school adolescents of Vadodara in
terms of height, weight and waist circumference
• To understand the determinants of dual burden of
malnutrition as regards: food choices, fitness/ physical
activity patterns and stress coping abilities
• To study the school environment : teachers’ & principals’
views as regards adolescents food choices,fitness/physical
activities and stress coping abilities
• To study the home environment: parents’ views as regards
adolescents food choices, fitness/ physical activities and
stress coping abilities
Saxena & Kanani 2008

4. STUDY DESIGN
Purposive selection of urban schools (N=6)
Random Sample selection: Children from std. VIII & IX (N=1105)
Data collection
Children
Children Parents (N=40) Schools (N=6) Teachers (N=40)
• Ht. ,Wt. & (from PTA) Enabling Principals (N=6)
W.C (1105) Perceptions for factors Perceptions for
• Food patterns adolescent’s & adolescent’s
& P.A. (N=454) Food choices Meals at • Food choices
• Stress coping Physical activity School • Physical activities
abilities(N=335) Stress canteen • Stress coping

5. Classifying the children based on nutritional status
(WHO 2007 standards)
Normal Overweight and Obese Thin
Data was separated genderwise
and agewise for analysis
Cross tabulations: 3 categories by BMI with
Food patterns, physical activities and
stress coping
Saxena & Kanani 2008

6. Quality of data was ensured !

7. One to one interviews with
principals and teachers
Principals of selected schools
Teachers of selected schools

8. THE RESULTS
Kanani & Saxena 2007
KANANI & SAXENA 2007

9. THE PREVALENCE OF
DUAL BURDEN
OF MALNUTRITION

10. •Overall: Thinness was more than Ov-Ob
• Thinness was more in boys than girls
• Ov- Ob was similar in boys and girls
Prevalence by BMI
68.8
70 64.8
62.3
60
50
% ADOLESCENTS
40
THIN
30 NORMAL
21 24
20 16.5 14.7 Ov-Ob
14.1 13.7
10
0
Total Boys Girls
Saxena & Kanani 2008

11. • Prevalence of stunting was low
•Twice the number of boys were stunted
•Tallness was more in boys
Prevalence by Height for age
100 90.9
87.1 84.5
80
60 Stunted
%ADOLESCENT
S
40 Normal
Tall
20 12.2 14.5
8.8
0.7 1.1 0.2
0
Total Boys Girls
Saxena & Kanani 2008

12. THE CHANGING TRENDS IN DUAL
BURDEN OF MALNUTRITION BY AGE
90
80
70
60
%Adolescents
50
40 THIN
30 NORMAL
20
10 Ov-Ob
0
12- 13- 14- 15-
12.4 13.4 14.4 15.4
Age (years)
Saxena &Kanani 2008

13. FOOD PATTERNS
AND
FOOD CHOICES

14. General Food Patterns
3 meals & 3 snacks pattern: 10% adolescents
Twice more girls(14%) than boys(7%)
Breakfast Consumption: Daily by Majority (70%)
Similar in boys & girls
Quality of breakfast: Poor by majority
Milk, cereals & fruits by 3%
Similar in boys and girls
Snacking on Processed Packed munching snacks by 31% (e.g. Kurkure,
Chips, biscuits, chocolates ) and Snack intake was most common during
school hours by 50%
Intake of fruits at least once in a day : 10% adolescents
Saxena &Kanani 2008

15. Intake of vegetables at least once in a day : 90% adolescents
General Food Patterns………
Food frequency of vegetables
 Roots and tuber : Daily :Boys (30- 40)%
:Girls (30- 40)%
 GLVS : 2-3times :Boys (26-
27)%
(Spinach & fenugreek ) :Girls (21- 29)%
Amaranth & colocasia : Rarely :Boys (25-
33)%
:Girls (28- 41)%
 ‘Other’ vegetables : Rarely :Boys (23- 44)%
:Girls (21- 57)%
(Yellow Pumpkin, bitter gourd,
Bottle gourd, french beans,
Cowpeas, capsicum,
Clusterbeans ) Saxena & Kanani 2008

16. Intake of Healthy Foods
Food frequency of milk and milk products
 Daily Milk Intake : Boys: 82%
Girls: 75%
 Less frequent intake of Probiotics
Boys: 31%
Curd : 2-3 Girls: 32%
times/wk : Boys: 47%
Girls: 47%
Lassi and Shrikhand :
Food frequency of iron rich foods
Monthly once :
• Dried Peas and Bajra : 2 -3 times/ wk Boys: 20- 30%
Girls : 20- 30%
Rajmah, Dried cowpeas, green onions : Rarely Boys: 20- 30%
Moth beans, Colocasia leaves (Monthly once Girls : 20- 30%
or Never) Saxena &Kanani 2008

17. Deteriorating
Food patterns in
schools
School tiffins:
 Not brought by more than half (54%), more boys(66%) than
girls(38%)
 Types of food brought in school tiffins
 HIGH
30% :Traditional fried foods( puri, pakoda, parantha)
 27% :Ready to eat/ convenience food (biscuits, maggie,
wafers)
 6% :Traditional fermented foods(dhokla, muthia, khaman )
 12% :Whole some meals ( pulav, dal-chawal, chana, roti
sabji)
Saxena & Kanani 2008

18. Deteriorating
Food patterns in
schools…………..
School canteens:
 54% : More than half eat in school canteens
 33% : Common frequency: 2-3 times/week
 Purchases from school canteen:
 34% :Processed and packed munching snacks
 31% :Puff HIGH
 17.4% : Samosa
By chi-square no significant association of the undesirable
food patterns with BMI was seen (Thin, normal, Ov-Ob).
Saxena & Kanani 2008

19. Exercise/Play
And
Fitness Patterns

20. Salient findings
• 30% :daily engagement in vigorous play/ exercise (such that
they breathe rapidly or start sweating)
• Spot observations : Decreased participation in school
exercise/ play, more in girls than boys
: Decreased participation in mass drill in
schools
• Parents : 4hrs/ day involvement in sedentary
behaviors (T.V. watching, video
games, computer)
•Teachers & principal : Escape from exercise but like to play.
Interested in learning yoga but not
do it regularly
Conclusion: Over reporting of physical activity by adolescents
since in reality, adolescents are physically inactive

21. Dual burden of malnutrition in
relation to exercise/play and
fitness
 By chi-square :
 Significantly higher proportion of adolescents who
were involved in outdoor games had normal BMI
(66%).
 More Ov-Ob adolescents (21%) played indoor
games
 Boys: Similar trends
 Girls: By chi- square no significant differences in
various BMI categories (Thin, normal, Ov-Ob)
Saxena & Kanani 2008

22. Stress Coping Abilities

23. Out of the 4 aspects studied which contributed
to overall stress coping ability?
Categories of stress coping ability
Total (N = 355) High stress Low stress r Value
coping ability coping ability
(>=70% scores) (< 70%scores)
n % n %
1 Nutrition** 86 24.2 269 75.8 1vs 5 0.4
2 Exercise-Fitness** 92 25.9 263 74.1 1vs 5 0.5
3 Mental health** 203 57.2 152 42.8 1vs 5 0.9
4 Art of relaxation** 159 44.8 196 55.2 1vs 5 0.7
5 Overall stress coping 158 44.5 197 55.5 1vs 5
Correlation was significant at p <= o.o1
Saxena & Kanani 2008

24. Dual burden of malnutrition in relation
to stress coping ability
 Higher proportion of adolescents with normal BMI ( 11%)
had ‘very good’ stress coping compared to thin(7%) or
Ov-Ob( 4%)
 ‘Problem behaviours’
Poor food choices/ food practices were seen among
stressed adolescents whether thin/ Ov-Ob
Irregular exercise- fitness patterns were seen among
stressed adolescents whether thin/ Ov-Ob, more so in
girls than boys
Saxena & Kanani 2008

25. Home Environment
Views of Teachers and Parents regarding
stress among adolescents
Reasons for stress by principals and teachers:
 Increased competition, search of their identity
 No time to relax : Tution- an unnecessary stressor
 Parents’ expectation to obtain more marks
 Lengthy syllabus
 Parents are busy: children cannot share their problems
82% parents reported that
Adolescents are not stressed
Saxena & Kanani 2008

26. School Environment: School canteens

27. School lunch offered wholesome
healthy food with variety in diet
Dal Rice
Cyclic Menu signed
by principal
Pulav

28. Conclusion
Integrated approach including :
 Adolescents
 The school environment
 Teachers
 Parents…….
…….will result in holistic nutrition interventions
to reduce dual burden among well to do
adolescents .
Saxena & Kanani 2008

29. Recommendations
Unified interventions for controlling both
Unified interventions underweight and
Overweight :
underweight and Overweight :
Nutrition friendly schools initiative
Nutrition friendly schools initiative

30. Over- and undernutition are not simply a problem of
rich or poor, respectively. On the contrary, often these
problems overlap and coexist.
Currently, strategies to tackle this dual burden
of malnutrition are often pursued and promoted
independently, as if
the two problems were independent of each other.
This will need to change,
and policies and programs developed that address
both
issues in an integrated manner.
Mercedes de Onis
( WHO)
Saxena & Kanani 2008