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Effectiveness of a school-based pilot program on ‘diabesity’ knowledge scores among adolescents in Chennai, South India

  • T. S. Mehreen
  • N. Jagannathan
  • D. Pandiyan
  • Ranjit Mohan Anjana
  • Viswanathan Mohan
  • Harish RanjaniEmail author
Original Article
  • 8 Downloads

Abstract

Background

India has the 2nd largest number of children and adolescents living with diabetes in the world. Hence, the present study aimed to evaluate the knowledge on diabetes and obesity among school going adolescents in Chennai, south India.

Methods

Study participants were 3505 adolescents belonging to sixth and seventh grades of select private and government schools in Chennai. A school-based intervention consisting of five classroom activities were delivered to the intervention group participants. Teachers and peer leaders from intervention schools played a key role in program delivery. The control group received a one-time standard training program on diabesity. A self-administered questionnaire was used for the assessment of knowledge levels at baseline and follow-up. Overall, 3,263 students completed the program (response rate 93.1%).

Results

Mean age of the study participants was 11.1±0.8 years. The intervention group had a significant improvement in knowledge score with the overall mean score improving from 11.51 at baseline to 12.25 at follow-up (p<0.001). The mean composite score was higher in boys, compared to girls in both intervention (12.38 vs 12.08) and control (11.30 vs 10.99) groups. Participants in the intervention group were 1.31 (95%CI: 1.12-1.52 p value: <0.001) times more likely to have a good knowledge score about diabesity, compared to the control group.

Conclusions

School-based interventions are a successful way of reaching out to a large number of adolescents in order to increase awareness about diabetes and obesity.

Keywords

Knowledge Diabetes Obesity Adolescents School-based intervention 

Notes

Acknowledgment

The authors gratefully acknowledge Arogya World Inc., USA, and Bengaluru for the lesson plans offered for the intervention. We would like to thank the team from the Translational Research Department and Ms. Mridula Ayush Bhargava for the successful implementation of this project.

Author’s contributions

T.S.M. analysed the data, wrote the first draft and carried out corrections in all the consecutive drafts of the manuscript. H.R conceived and coordinated the study and helped in data analyses and revisions of the manuscript. RMA and VM contributed to critical revisions of the manuscript for intellectual content. T.S.M., N.J. and D.P performed the data collection. All authors read and approved the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Written informed consent from class teachers and assent from study participants were obtained prior to the study. This study was approved by the Institutional Ethics Committee of the Madras Diabetes Research Foundation (MDRF) with Registration no. ECR/194/Inst./TN/2013 with Clinical Trials Registry-India (CTRI) ID number CTRI/2016/09/007323.

References

  1. 1.
    International Diabetes Federation. IDF Diabetes Atlas, 8th ed.; International Diabetes Federation: Brussels, Belgium, 2017. Available online: http://www.diabetesatlas.org/resources/2017-atlas.html (accessed on 13 December 2017).
  2. 2.
    Jagadesan S, Harish R, Miranda P, Unnikrishnan R, Anjana RM, Mohan V. Prevalence of overweight and obesity among school children and adolescents in Chennai. Indian Pediatr. 2014;51:544–9.  https://doi.org/10.1007/s13312-014-0444-6.CrossRefGoogle Scholar
  3. 3.
    Kaufman FR. Diabesity. The obesity-diabetes epidemic that threatens America - and what we must do to stop it. New York: Bantam Books; 2006.Google Scholar
  4. 4.
    The “Diabesity” epidemic: let’s rehabilitate America Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1785206/. Accessed September 17 2010
  5. 5.
    DalyA. Diabesity: the deadly pentad disease. DiabetesEduc1994, 20: 156-8. Wang Y, Lim H. The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. International review of psychiatry (Abingdon, England) 2012;24(3):176–188. doi: https://doi.org/10.3109/09540261.2012.688195.
  6. 6.
    Ranjani H, Pradeepa R, Mehreen TS, Mohan Anjana R, Anand K, Garg R, et al. Determinants, consequences and prevention of childhood overweight and obesity: an Indian context. Indian J Endocrinol Metab. 2014;18(7):17–25.  https://doi.org/10.4103/2230-8210.145049.CrossRefGoogle Scholar
  7. 7.
    Kar SS, Kar SS. Prevention of childhood obesity in India: way forward. J Nat SciBiol Med. 2015;6(1):12–7.  https://doi.org/10.4103/0976-9668.149071.Google Scholar
  8. 8.
    Divakaran B, Muttapillymyalil J, Sreedharan J, Shalini K. Lifestyle risk factors of noncommunicable diseases: awareness among school children. Indian J Cancer. 2010;47(Suppl 1):9–13.  https://doi.org/10.4103/0019-509X.63864.CrossRefGoogle Scholar
  9. 9.
    School health guidelines to promote healthy eating and physical activity. Available online: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6005a1.htm (Accessed on December 2017).
  10. 10.
    Khandelwal S, Siegel KR, Narayan KV. Nutrition research in India: underweight, stunted or wasted? Glob Heart. 2013;8(2):131–7.  https://doi.org/10.1016/j.gheart.2013.05.003.CrossRefGoogle Scholar
  11. 11.
    Tojo R., Leis R. Obesity in childhood and adolescence. In: Moreno B., Charro A Nutrition, physical activity and the prevention of obesity. NAOS strategy. Madrid: Editorial Pan American Medical; 2007. p. 69–112.Google Scholar
  12. 12.
    The World Health Organization. Population-based approaches to childhood obesity prevention. WHO Document Production Services, Geneva, Switzerland, 2012, 13, 46. Available online: http://www.who.int/dietphysicalactivity/childhood/WHO_new_childhoodobesity_PREVENTION_27nov_HR_PRINT_OK.pdf (accessed on 8 August 2017).
  13. 13.
    Kameswararao AA, Bachu A. Survey of childhood diabetes and impact of school level educational interventions in rural schools in Karimnagar district. Int J Diabetes Dev Ctries. 2009;29:73.CrossRefGoogle Scholar
  14. 14.
    Shah P, Misra A, Gupta N. Improvement in nutrition-related knowledge and behaviour of urban Asian Indian school children: findings from the ‘medical education for children/adolescents for realistic prevention of obesity and diabetes and for healthy aGeing’ (MARG) intervention study. Br J Nutr. 2010;104:427–36.CrossRefGoogle Scholar
  15. 15.
    Singhal N, Misra A, Shah P, Gulati S. Effects of controlled school-based multi-component model of nutrition and lifestyle interventions on behavior modification, anthropometry and metabolic risk profile of urban Asian Indian adolescents in North India. Eur J Clin Nutr. 2010;64:364–73.CrossRefGoogle Scholar
  16. 16.
    Singhal N, Misra A, Shah P, Gulati S, Bhatt S, Sharma S, et al. Impact of intensive school-based nutrition education and lifestyle interventions on insulin resistance, β-cell function, disposition index, and subclinical inflammation among Asian Indian adolescents: a controlled intervention study. Metab Syndr Relat Disord. 2011;9:143–50.CrossRefGoogle Scholar
  17. 17.
    Aravindalochanan V, Rengarajan M, Kumpatla S, Rajan R, Viswanathan V. Impact of awareness program on prevention of childhood obesity among school children in a metropolitan city – Chennai slim and fit program. J Educ Pract. 2012;3:88–95.Google Scholar
  18. 18.
    Sreevatsava M, Narayan KM, Cunningham SA. Evidence for interventions to prevent and control obesity among children and adolescents: its applicability to India. Indian J Pediatr. 2013;80(1):S115–22.  https://doi.org/10.1007/s12098-012-0881-y.CrossRefGoogle Scholar
  19. 19.
    Panuganti P, Mehreen TS, Anjana RM, Mohan V, Mayer-Davis E, Ranjani H. Influence of socioeconomic status on knowledge of obesity and diabetes among adolescents in Chennai, South India. Children. 2017;4(8):61.  https://doi.org/10.3390/children4080061.CrossRefGoogle Scholar
  20. 20.
    Glanz K, Rimer BK. Theory at a glance: a guide for health promotion practice. 2nd ed. Bethesda, MD: National Institute for Health, National Cancer Institute; 1995.Google Scholar
  21. 21.
    Reynolds CR, Livingston RB. A psychometric primer for school psychologists. In: Harrison P, Thomas A, editors. Best Practices in School Psychology: Foundations. Bethesda, MD: National Association of School Psychologists; 2014. p. 281–300.Google Scholar
  22. 22.
    Marchetti D, Fraticelli F, Polcini F, Lato R, Pintaudi B, Nicolucci A, et al. Preventing adolescents’ diabesity: design, development, and first evaluation of “Gustavo in Gnam’s Planet”. Games for Health Journal. 2015;4(5):344–51.  https://doi.org/10.1089/g4h.2014.0107.CrossRefGoogle Scholar
  23. 23.
    Wang Z, Xu F, Ye Q, Tse LA, Xue H, Tan Z, Leslie E, Owen N, Wang Y. Childhood obesity prevention through a community-based cluster randomized controlled physical activity intervention among schools in China: the health legacy project of the 2ndworld summer youth Olympic games (YOG-obesity study). Int J Obes 2017 doi:  https://doi.org/10.1038/ijo.2017.243. [Epub ahead of print], 42, 625, 633.
  24. 24.
    Gamage AU, Jayawardana PL. Knowledge of non-communicable diseases and practices related to healthy lifestyles among adolescents, in state schools of a selected educational division in Sri Lanka. BMC Public Health. 2017;18(1):64.  https://doi.org/10.1186/s12889-017-4622-z. CrossRefGoogle Scholar
  25. 25.
    Xu F, Wang X, Xiang D, Wang Z, Ye Q, Ware RS. Awareness of knowledge and practice regarding physical activity: a population-based prospective, observational study among students in Nanjing. China. PLoS One. 2017;12:e0179518.  https://doi.org/10.1371/journal.pone.0179518.CrossRefGoogle Scholar
  26. 26.
    Thomas AS, Greene LF, Ard JD, Oster RA, Darnell BE, Gower BA. Physical activity may facilitate diabetes prevention in adolescents. Diabetes Care. 2009;32(1):9–13.  https://doi.org/10.2337/dc08-0780.CrossRefGoogle Scholar
  27. 27.
    Safari M, Dalilhoush N, Abbaslou P, Abbaszadehzouri N, Torabi R, Sharbati SA, et al. Assessment of diabetes knowledge among adolescents in selected Iranian schools in UAE. Gulf Med J. 2013;2(S2):S11–7.Google Scholar
  28. 28.
    Mohan D, Raj D, Shanthirani CS, Datta M, Unwin NC, Kapur A, et al. Awareness and knowledge of diabetes in Chennai - The Chennai Urban Rural Epidemiology Study. J Assoc Physicians India. 2005;53:283–6.Google Scholar
  29. 29.
    Al-Mahrooqi B, Al-Hadhrami R, Al-Amri A, et al. Self-reported knowledge of diabetes among high school students in Al-Amerat and Quriyat, Muscat Governate, Oman Sultan Qaboos. Med J. 2013;13(3):392e8.Google Scholar
  30. 30.
    Bassi S, Gupta VK, Chopra I, Ranjani H, Saligram N, Arora M. Novel school based health intervention program—a step toward early diabetes prevention. Int J Diabetes Dev Ctries. 2015;35:460–8.  https://doi.org/10.1007/s13410-015-0315-2.CrossRefGoogle Scholar
  31. 31.
    Ubangha LO, Odugbemi TO, Abiola AO. Diabetes mellitus: identifying the knowledge gaps and risk factors among adolescents attending a public school in Lagos state. J Clin Sci. 2016;13:193–8.CrossRefGoogle Scholar
  32. 32.
    Eskicioglu P, Halas J, Sénéchal M, Wood L, McKay E, Villeneuve S, et al. Peer mentoring for type 2 diabetes prevention in first nations children. Pediatrics. 2014;133(6):e1624–31.  https://doi.org/10.1542/peds.2013-2621.CrossRefGoogle Scholar

Copyright information

© Research Society for Study of Diabetes in India 2019

Authors and Affiliations

  1. 1.Department of Translational Research, Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention & ControlIDF Centre for EducationChennaiIndia
  2. 2.Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention & ControlIDF Centre for EducationChennaiIndia

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