Obesity

CHAPTER 1 INTRODUCTION

1.0 Introduction

Obesity among students has become a national phenomenon. It becomes a concern among the public and school personnel - including teachers, school psychologists, and counselors, as to the effects of student obesity. With the numbers of student obesity on the rise, it is important to see how school personnel, teachers, as well as other students perceive this situation. Overweight and obese students have a higher risk of continuing to become overweight adolescents and they are more likely to experience serious long term morbidity, including coronary heart disease, diabetes mellitus, hypertension, and some cancers. Current physical activity levels among Malaysian adolescents remain low, together with unhealthy dietary practices and a passive lifestyle, these lead to obesity and being overweight. Lack of or minimal physical activities at home and at work, have resulted in increased morbidity and mortality from cardiovascular disease, which it becomes one of the important causes of premature death in the Southeast Asia region. Such sedentary lifestyles and unhealthy eating habits of adolescents may well lead to an increase in the prevalence of obesity today (Low W J, 2006).

1.1 Background of study

Obesity is the term used for people who are extremely overweight. Obese people have excessive weight where it will increase their risk of having serious health problems. To determine if someone is obese, doctors and other health care professionals often use a measurement called Body Mass Index (BMI). A person with a BMI between the 85 th and 95 th percentiles typically is considered at risk for overweight. Results of the 2003 Youth Risk Behavior Survey (YRBSS) in 2003 showed that 13.5% of high school students were overweight. Overall, the prevalence of being overweight was higher among male (17.4%) than female (9.4%) students; higher among white male (16.2%) and Hispanic male (21.7%) than white female (7.8%) and Hispanic female (11.8%) students. Overall, the prevalence of being overweight was higher among black (17.6%) than white (12.2%) students and higher among black female (15.6%) than white female(7.8%) students.(* Body Mass Index (BMI) greater than the 85th percentile.) Among American children ages 6-11, using the 95th percentile of body mass index (BMI) values on the CDC 2000 growth chart, the following are overweight, for non-Hispanic (NH) whites, 14.0 percent of boys and 13.1 percent of girls, for NH blacks, 17.0 percent of boys and 22.8 percent of girls, and for Mexican Americans, 26.5 percent of boys and 17.1 percent of girls. (NHANES [1999-2002], CDC/NCHS.

According to the American Obesity Association (2003), teaching healthy behaviours at a young age is important. Why? This is because change becomes more difficult when the age increases. The AOA teaches that families and schools are the two most critical links in providing the foundation for behaviours involving physical activity and nutrition. Parents play the most critical role. An AOA survey of parents shows that almost 30% said that they are “somewhat” or “very” concerned about their children’s weight, 12% of parents considered their child overweight and 27% of parents say their children eat less nutritionally than they did when they were children; 24% say their children are less physically active.

1.2 Statement of problem

On the whole, these studies have generally report obesity among primary school students from the perspective of age and possible factor to associate with. Results of a 1999 national survey shows that 16 percent of high school students were obese and overweight (Body Mass Index (BMI) greater than the 85 th percentile and below the 95 th percentile) and nearly 10 percent were obese (BMI more than or equal to the 95th percentile). Self-reported height and weight was used. The survey, called the Youth Risk Behavioral Surveillance System (YRBSS) 2003, is conducted by the Centers for Disease Control and Prevention (CDC), and uses a nationally representative sample of students in grades 9 to 12. The Center for Health and Health Care in Schools (2004) states that approximately 50% of children and adolescents who are obese will become obese adults. The problem of obesity affects mainly girls because they increasingly become preoccupied with their body image and their developing body during adolescence; body image and self esteem tend to be intertwined. Obese girls may resort to drinking, smoking, and getting drunk and they try to lose weight through dieting (Dixey, 1998). Obese children are also subjected to stereotypes and size prejudices. They are not considered best friends; are described as dirty, sloppy, lazy, and stupid by other children according to Levine (as cited in Loewy, 1998); and are subjected to name calling and teasing (Neumark-Sztainer, Falkner, Story, Perry, & Hannan, 2002).Thus, the purpose of this study is to know why it occurs and what the perceptions of student on this issue are.

1.3 Research Question

This study will seek to answer the following research question
1. What are the perceptions of primary school students about obesity in Teluk Intan area?
2. What are the factors that contribute to obesity among primary school students in Teluk Intan area?

1.4 Research Objectives

1. To investigate what are the perceptions of primary school students about obesity in Teluk Intan area.
2. To examine what are the factors that contribute to obesity among primary school students in Teluk Intan area.

1.5 Significant of study

This study will give a contribution towards the new knowledge about obesity for primary school students in Teluk Intan area. They will know much more about obesity and the effects of obesity that bring to their future life. Student must know what the types of food for their life are. In the class, teachers must explain to their student about obesity, what factor can lead to obesity, how to prevent and what activity can help student reduce obesity. Teachers also can arrange new programme concerning obesity in class or school such as motivation, and campaign.

As for school administrators, they can determine what kind of food that the canteen should provide to the students. The school administrators also must do inspection on the kind of food served to the students every day. This research also will raise the awareness to the school administrators on the importance of providing a better and more nutritious food to the student. The Government needs to determine the standard for canteen management to increase the quality of nutrition in school. The Government can stop the canteen manager if they do not follow the rules and regulations that have been stated. The Government also can suggest all schools in Malaysia to hold morning exercise before entering the class.

1.6 Limitation The limitations that occur in this research are due to:
The cooperation:-
The cooperation from the school administrator, teachers and students may also become a barricade for the researcher to get the data. So, I must be prepared to solve the problem if there is any limitation arises during doing this study.
Financial factor:-
The fund for this study is too limited during doing this study because there is no budget and sponsor. So I have to use my money to do this study.
Time constraint:-
The short time frame given to the researcher for completing the study becomes the time constraint. Because of this limitation, only one school will be involved in this study.

1.7 Definitions of terms

Phenomenon – An occurrence, circumstance, or fact that is perceptible by the senses.
- Something that can be seen or experienced; a natural happening that is interesting or unusual.
Morbidity
- The quality of being morbid; morbidness.
- The rate of incidence of a disease.
Hispanic
- Of or relating to Spain or Spanish-speaking Latin America.
- Of or relating to a Spanish-speaking people or culture.
Surveillance
- Close observation of a person or group, especially one under suspicion.
- The act of observing or the condition of being observed.
- A close watch on someone; especially by the policy
Prejudices
- An adverse judgment or opinion formed beforehand or without knowledge or examination of the facts.
- The act or state of holding unreasonable preconceived judgments or convictions.

CHAPTER 2
LITERATURE REVIEW
2.1. Introduction

This review of literature will elaborate on childhood obesity, and perception of childhood obesity. Topics to be covered include the definition of obesity, causes of obesity, effects of childhood obesity, stereotypes about childhood obesity, and childhood obesity in the schools. Obesity has become a national epidemic. In the last twenty years, the number of people who suffer from obesity has steadily risen. There are approximately 13% of children and adolescents who are seriously overweight. Recent surveys by the National Examination Survey (1999), shows that approximately 61% of the adults in the United States are either overweight or obese.

2.2. What is obesity?

Berg (1997) reports that obesity is not well understood in today’s society. There are combinations of factors that come into play when defining obesity. These factors include genetics, food supply, physical activities, cultural factors, socioeconomic status, and psychological factors. These six factors combined to have an effect on a person’s appetite and how the calories are used and stored as fat. Berman and Fromer (1997) defined overweight as being heavier than average. This could be attributed to bone structure, large muscles, and /or excess fat. Strauss and Miller (2001) have a narrower description of being overweight, defining it as someone who is approximately 25 pounds above their ideal body weight.

The Center for Disease Control (2000) defines overweight as in increased body weight in relation to height. Overweight may or may not be due to increased body fat. It appears to be difficult to define what an overweight child is because unlike adults, children are still growing and developing, so they may grow out of that childhood or “baby fat,” where as adults are already developed and are not going to grow out of that “baby fat.” Despite this ambiguity, Birch and Fisher (1998) say there is still a great focus on overweight children because they might become an obese child or adult. Lohman (1987) defines obesity as an excessive amount of body fat. Obesity is perceived when the Body Mass Index is more than 25 percent for males and 32 percent for females. Strauss and Miller (2001) say that obesity for a child refers to a child that is 40 to 50 pounds above their ideal body weight. According to them, obesity often follows when a child has a persistent overweight problem. According to the Center for Disease Control (2000) obesity refers to an excessively high amount of body fat in relation to lean body mass. The amount of body fat includes the distribution of the fat throughout the body as well as the tissue deposits of body fat. In sum, the term obesity is quite hard to define accurately because of the subjectivity of everyone’s perception.

2.3. Childhood Obesity in the Schools

For a child, the school is supposed to be a happy and safe place to learn and explore their identities. Ideka (1995) reports that school are the most important institution in a child’s life. Schroer (1985) finds that teachers and counsellors have many of the same biases as parents and children do towards obesity and children who are obese.

He finds in a study of 200 pre-service and in-service teachers that characteristics such as attractiveness, energy level, self-esteem, and sociability were perceived more negatively in obese or overweight children than that of an average child. In a study by Neumark- Sztainer (1999), school staff reported that obesity is largely behavioral; however they also reported that obesity had some genetic component as well. As teachers hold these conflicting, often-negative views, they often filter down to the students. The National Education Association (1995) finds that at the elementary level, children learn that it is acceptable to dislike fatness. From nursery school through college, fat students experience ostracism, discouragement, and sometimes violence. Often ridiculed by their peers and discouraged by well-meaning education employees, fat students develop low self-esteem and have limited horizons. They are deprived of places on honor rolls, sports teams, and cheerleading squads and are denied letters of recommendation (Healthy Weight Journal, 1995, p.113). Ideka (1995) reports that school staff and teachers can take an active role in establishing a positive environment that supports size diversity. She goes on to say that rules can be put into place for both students and teachers in order to establish a bias-free school. In order for this to take place, it is important for the teachers to look at their own bias about weight, so that they do not model discrimination and size bias.

2.4. Prevalence
Childhood obesity is not a phenomenon that has taken place overnight. Since the past 20 years, there has been a significant increase in the number of people as well as children who are reportedly obese.

Dietz (1983) reports that 5-25% of the children and teens in the United States are obese. Approximately 10 years later, the Centers for Disease Control (1994) report that 21% of children ranging in ages 12-19 years old as overweight. The Centers for Disease Control (1999) report that 13 % of children are seriously overweight and the number is rising. Foyet and Goodrick (1995) find that 5-10% of preschoolers are obese. Mithers (2001) says that one out of every ten preschoolers is now overweight. Although it seems that obesity is starting at such a young age, it continues to take an extreme rise at the age of 10 or during pre-puberty (Lassle, Wurmser, & Pirke, 1997). Mithers (2001) reports that the number of children who are overweight has more than tripled in a generation. In 1960, 4% of children of the age of 6-11 were overweight, by 1980, 7%, and by 1999 13% of all children in the United State were seriously overweight. Obesity is not just a problem in America. It appears to be spanning the globe. A survey of Australian students in a 1995 reports the prevalence of girls who are overweight has risen from 11.8% in 1985 to 12.3% in 1995. A similar survey done in Britain shows children of the age of four years old and younger are being classified as obese at a rate of 23.6 % in 1998 compared to just 14.7% in 1989. These numbers appear to be comparable to the United States. The former US Surgeon General, David Satcher, has declared youth obesity as “one of the top ten United States health priorities” (NEA, 2001). Obesity also crosses ethnic boundaries in varying ways. The Office of Maternal and Child Health (1989) reports that 5-7% of Caucasian and African American children are obese while 12% of Hispanic boys and 19% of Hispanic girls are obese. Some research indicates that people of different ethnic backgrounds may also assume that a child may be obese when this is not the case at all.

Berg (1997) finds that it is common for preschoolers to carry their weight on their arms and legs, making those areas look chubby. African American preschoolers, on the other hand, often carry their excess weight in the middle of their body, giving them a fuller stomach area. This may cause one ethnic group to appear to be more obese than another, when this is not the case.

2.5. Causes of Childhood Obesity

Jalong (1999) reports that most experts feel childhood obesity is affected by various factors such as: emotional factors, inappropriate interventions, heredity, and activity levels. Strauss and Miller (2001), however, feel that childhood obesity is the result of the interaction between psychological, familial, and physiological factors. As there is some dispute as to the causes of childhood obesity, it resounds that familial and emotional or psychological factors play a large part. Birch and Fisher (1998) report that obesity shows a familial course; the risk of childhood obesity is significantly higher when both of the child’s parents are obese themselves. This may point to a genetic component to childhood obesity, although it is not the only factor. “Heredity has recently been shown to influence fatness, regional fat distribution, and response to over feeding” (Bouchard, Tremblay, Despres, Lupien, Theriault, Dussault, Morrjani, Pinault, & Fournier 1990, p. 1480). Although there are some people who use hereditary as part of this equation as to why today’s children are so obese, not everyone is in agreement. Strauss and Miller (2001) report that over the past generations, there is strong evidence that heredity was the most important determiner of a person’s weight.

However, genetics cannot explain why obesity has almost doubled in the past thirty years. The activity level of a child may also play a part in obesity. Strauss and Miller (2001) report that an American child spends several hours watching television each day on the average. In previous years, they might have been devoted to physical pursuits and activities. Robinson, Hammer, Killen, Kraemer, Wilson, Hayward, and Taylor (1993) report that according to the Nielsen Company, 6-11 years old children in the United States watch more than 23 hours of television per week and 12- 17 years old watch an average of 21 hours per week. The American Psychological Association estimates that children and adolescents spend 22-28 hours per week watching television (Smith, 1993). They engage in television watching more than any other activity except sleeping. Smith (1993) reports that by the time an individual reaches the age of 70, they will have spent 7- 10 years watching television. Ikeda (1995) states that the primary factor that contributes to childhood obesity is lack of physical activity, not overeating. Another contributor could be the food and drinks being consumed by children. Mithers (2001) reports that school aged children are consuming more soft drinks and fruit juices that those of the children in the past two decades. Parents who give their child fruit juice could be contributing to their child’s weight problem. Children should only have 4- 6 ounces of fruit juice a day. Older children may be drinking soft drinks. Mithers (2001) reminds us that fruit juices and soft drinks should be a once-in-awhile treat.

2.6. Effects of Childhood Obesity

There are two major areas in a child’s life that are affected when obesity is an issue, that of their health and of their emotional well-being. Summerfield (1990) reports that childhood obesity increases the risk of adult obesity. In addition, childhood obesity is also the leading cause of pediatric hypertension, type II diabetes, the increased risk of coronary failure at a very young age, as well as excess pressure on the child’s joints. Berenson, Bonura, Hunter, Webber, Myers, and Johnson (1997) report that obesity is a cardiovascular risk factor that is related to blood pressure. Mithers (2001) reports that overweight children reach puberty sooner. For females, this could mean a longer exposure to estrogen, which could lead to a higher risk of breast cancer. She also reports that obesity is a chronic disease that kills approximately 300, 000 Americans each year. Stunkard (1993) gives 19 physical ailments that are an increased risk for those individuals who are overweight or obese. High blood pressure, high blood cholesterol, type 2 diabetes, insulin resistance, hyperinsulinemia, coronary heart disease, angina pectoris, congestive heart failure, stroke, gallstones, cholescystitis and cholelithiasis, gout , osteoarthritis, obstructive sleep apnea and respiratory problems, Some types of cancer (breast, prostate and colon), complications during pregnancy, poor female reproductive health, bladder control problems and uric acid nephrolithiasis. Childhood obesity can also have negative effects on a child’s emotional well being. A study done by Strauss and Forehand (1985) finds that obese children often reported that they suffer from depression more often than non obese children, as well as have lower self-esteem than those children who do not suffer from obesity. Most experts appear to believe that childhood obesity is much more of a social and psychological problem than a health risk (Berman & Fromer 1997).

They state that being fat can be damaging to a child’s self-concept. A negative body image may cause children to feel embarrassed about participating in physical activities or may even contribute to eating disorders later in life. Berenson et. al (1997) in Bloedow W.J article reports that children who suffer from obesity may also develop learned helplessness behaviour. This behaviour is characterized by the lack of motivation and passivity in a performance task. They report that this learned helplessness behaviour could contribute to lower academic scores for these children, and possibly lower self-esteem.

2.7. Stereotypes about Childhood Obesity

Powers (1996) reports that attitudes towards obesity vary from culture to culture, and in the United States being thin is very important. He goes on to report that attitudes about obesity have changed dramatically over the years. In the early nineteenth century, most societies equated weight with wealth; the heavier one was the wealthier they were. This view changed during the twentieth century, where thin was in for most developed countries. Most people in less-developed countries still today believe that heaviness is better and more prestigious (Powers, 1996). Negative attitudes about obesity and obese children permeate throughout society. These negative thoughts, beliefs, and attitudes held by society are then filtered down though the news, other television, books, and magazines. Farrington (1997) reports that our views on prejudice, racism, and discrimination are affected not only by the good and bad news on the television, radio, and print media, but people are more affected by family and friends.

Neumark-Sztainer (1999) report that physicians, medical students, and nurses have negative attitudes towards obese individuals. Many negative attitudes and bias are overlooked. Brown (1994) reports that harsh statements about those who are overweight are often tolerated because it is assumed that this type of diversity is the result of character flaws, such as being lazy. However, most individuals’ hostile reaction is fear. For example, Ikeda (1995) says that for individuals who are overweight, it “may seem like the worst possible fate. However, it isn’t. A worse fate is feeling rejected and unloved because one is overweight”. Obese children are the target of ridicule, prejudice, teasing, and disgust by their peers and possibly adults in their lives, including parents and teachers. Obesity has such a negative connotation that many people do not even realize that they harbor bias against obese people. They may have hidden feelings. “Fat has become the “bogeyman” -the monster that terrorizes our children” (Ikeda, 1995, p 110). Pinkwater (1995) reports that in public, obese individuals, especially women, are often subjected to vile remarks, pointing and mockery. He goes on to say that it is at least six times harder to get hired if you are overweight. This is because of the beliefs that overweight people are greedy, lustful, stupid, lazy, dishonest, and weak.

A child’s biggest source of support is through his/her family, mainly his/her parents. Ikeda (1995) reports that many parents are aware of the social stigmatism that goes along with being overweight because many of them themselves have experienced this discrimination themselves. Parents of overweight or obese children often subject their children to common weight loss programs and strategies that are often used by adults. Benett and Gurin (1982) found that most of these weight loss attempts resulted in short-term success.

Lowey (1998) stresses that it is important for parents to deal with their own dissatisfaction with their bodies, rather than projecting that dissatisfaction on to their children.
Once a child goes to school, the obesity issue shifts from being a home issue to be a social one. Rothblum (1992) finds that children as young as preschool age had biases against obesity. When they were given a chance to play with an average looking doll and an obese doll, all of the children, regardless of their body size, chose the average looking doll. A year later, Rothblum (1993) replicated the study using pictures. The pictures were of children in a wheel chair, missing a limb, on crutches, facially disfigured, and obese. The least likely child to get played with was the obese child. According to Rothblum (1993) childhood obesity bias starts at a young age, but then the bias increases, as children get older. Levine (1987) finds that by elementary school, children are referring to obese individuals as fat, stupid, lazy, and ugly. Staffieri (1967) reports that boys aged 6-10 report that fat children are the most likely to be teased in school. These feelings about obesity do not improve over time, but appear to intensify each year.

2.8. Treatment of Childhood Obesity Ikeda (1995) reports that families that have children who suffer from obesity need extra time from health professionals. Ikeda (1995) reports that one of the most common actions parents take when their children are becoming overweight restricting the child’s food. Parents of overweight children may have their children go into therapy. Ikeda (1995) says that often therapists who are seeing overweight children report that if that child’s food is being restricted those children are often begging, scavenging, and stealing food to rid themselves of the hunger.

The children may also feel guilty for eating. Ikeda (1995) reports that health professionals should assist parents in having realistic weight goals for their children. A daughter that is born of a tall father and a short mother may not look like the short mother but the father. Health professionals have to help parents see this, and accept their children for who they are. Garrow (1992) reports that many doctors feel that the treatment of obesity is unsatisfactory. Astwood (1962) reports that nothing can be done for people who are born fat. Others believe that there is a diet out there that could work. Garrow (1992) reports that more women than men seek help for being overweight - a five to one ratio. Garrow (1992) states that taller patients can achieve more rapid weight loss than shorter ones, and younger individuals can lose weight more quickly than older individuals. He goes on to discuss three principles of weight reducing diets. The first is that, one must provide less energy than that required to maintain the body weight of the individual. The second component is consuming low fat foods rather than high fat foods. The third competent is the diet needs to be agreed on by the patient. If the individual does not want to lose weight or agree to the plan, then the plan will fail. Another treatment that is being talked about more readily in weight loss circles is drugs. Garrow (1992) reports that drugs in the treatment of obesity are designed to do three things. First, they inhibit absorption of nutrients into the stomach. Next, the drugs are to increase the energy expenditure of the individual. Finally, the drugs reduce hunger of the individual. Smith (1995) reports that weight loss gimmicks have been around since the 1800s but recently it has become a multi-billion dollar industry.

Other options for an obese person to lose weight are jaw wiring and gastric stapling. This is when the jaw is wired shut so that the person cannot open their mouth, making it impossible for individual to consume solid foods. A person may also opt for gastric stapling; this is when the stomach is stapled to make the stomach smaller. Garrow (1992) says that jaw wiring and gastric stapling are options for obese individuals who choose to reduce their weight. Once a person is obese, there are numerous possible treatments available. However there are fewer treatments for children who are obese than there are for adults. Summerfield (1990) lays out the three major forms of treatment for obesity.

1. Physical Activity. This could include a formal exercise program or it could be just increasing the activity at a small amount each day.
2. Diet management. Where adults may be able to fast or eliminate foods out of their diets, this method is not recommended for children. Parents should teach their children “normal” eating habits using food groups. Children should also consume fewer carbohydrates because they produce fat.
3. Behavior Modification. This technique can be used with older children and they can keep a journal as to how they are doing on their food intake and exercise routine. This helps the child see exactly what they are doing to their bodies, and hopefully they will want to make some changes in their lives.

2.9. Creating a Healthy Eating Environment in Schools

Recommended daily servings of fruits and vegetables are not being met by today's youth. According to the Centers for Disease Control and Prevention (1999), "51 percent of children and adolescents eat less than one serving a day of fruit, and 29 percent eat less than one serving a day of vegetables that are not fried." According to the U.S. Department of Agriculture (USDA), children drink 16 percent less milk now than in the late 1970's, and 16 percent more of carbonated soft drinks. The consumption of non-citrus juices such as grape and apple mixtures increased by 280 percent. A coalition of five medical associations and the USDA proposed a "Prescription for Change: Ten Keys to Promote Healthy Eating in Schools" to be used for guidance in school nutrition programs. Their prescription is:

1. Students, parents, food service staff, educators and community leaders will be involved in assessing the school's eating environment, developing a shared vision and an action plan to achieve it.
2. Adequate funds will be provided by local, state and federal sources to ensure that the total school environment supports the development of healthy eating patterns.
3. Behavior-focused nutrition education will be integrated into the curriculum from pre-K through grade 12. Staffs that provide nutrition education will have appropriate training.
4. School meals will meet the USDA nutrition standards as well as provide sufficient choices, including new foods and foods prepared in new ways, to meet the taste preferences of diverse student populations.

5. All students will have designated lunch periods of sufficient length to enjoy eating healthy foods with friends. These lunch periods will be scheduled as near the middle of the school day as possible.
6. Schools will provide enough serving areas to ensure student access to school meals with a minimum of wait time.
7. Space that is adequate to accommodate all students and pleasant surroundings that reflect the value of the social aspects of eating will be provided.
8. Students, teachers and community volunteers who practice healthy eating will be encouraged to serve as role models in the school dining areas.
9. If foods are sold in addition to National School Lunch Program meals, they will be from the five major food groups of the Food Guide Pyramid. This practice will foster healthy eating patterns.
10. Decisions regarding the sale of foods in addition to the National School Lunch Program meals will be based on nutrition goals, not on profit making.

2.10 Summary

Obesity in childhood as well as in adults is rising at an alarming rate. The causes of obesity are genetic factors, activity levels, emotional factors, and inappropriate interventions. The treatment for childhood obesity is difficult because most treatments are for adults. The physical effects of childhood obesity are numerous and often times negative. In addition, the emotional effects of childhood obesity are negative due to the beliefs about obesity form society. It is not clear however, what teachers’ attitudes and perceptions of obesity are. It appears however that attitude about obesity is negative whether those attitudes are coming from other students or teachers.

In the final section of this paper, a critical analysis of the previously reviewed literature will be presented. Criticisms of the research connecting of treatments, and perceptions of childhood obesity will be discussed. Finally, implications for school psychologists and counselors will be provided.

CHAPTER 3
RESEARCH METHODOLOGY
3.0 Introduction

This chapter describes the methodology used in the study that has been done on primary school student about obesity. In this chapter, there will be a detail explanation about the research method, place method, procedure method and how to collect data analysis.

3.1 Research Design

This research is done to find out what the perceptions of primary school students about obesity are. Therefore, to find out the results of the study, the method used is by distributing questionnaires according to populations, sample and sample selection. For this research, I have chosen questionnaire because it is easy to obtain adequate data, to enable the researcher answers the research question.

3.2 Research Population and Sampling

This study uses a probability sampling. That means each member in the population has an equal and same chance of being selected. Because of this study uses an experimental design, the sample of students for this study is selected by using Cluster sampling. So, the researcher has a group already in existence. Using this method, researcher specifies the minimum number of sampled units in each category. Researcher does not concern with having numbers that match the proportions in the population. In this study, the target population will be a school in Teluk Intan Area. The sample for this research was taken from 6 schools in Teluk Intan area

1. Sek. Keb Dato' Yahya Subban
2. Sek Keb Pekan Rabu
3. Sek Keb Pengkalan Ara
4. Sek Keb Langkap
5. Sek Keb Sultan Idris I
6. Sek Keb Sultan Idris II

Every school provides 20 students from Year 6. The total number of Year 6 students in this experiment is 120 students/respondents.

3.3 Data Collection
3.3.1 Instrument

For the purpose of data collection, one data gathering instrument is used to obtain the data for this research. The instrument is a question to investigate what are the perceptions of primary school students about obesity and to examine what is the factor that contributes to obesity among primary school students. (Refer appendix B).

The questionnaire containing:
Yes or No
True or False and
Likert type scale questions
1 = Strongly disagree
2 = Disagree
3 = Undecided

4 = Agree
5 = Strongly agree

This is because the limitation of the time for doing this research. Besides that, the tests are made up of 25 questions that have been chosen from related to topic.

3.3.2 Procedure of data collection

The questionnaires, consisted of 25 questions will be answered by 20 students of each school during the Health Education class at around 10.30 a.m. after the recess. Each student will be given approximately 20 minutes to answer the questions. All questionnaires given to year 6 students will be collected on the day the questionnaires are given to them. The questionnaires will be distributed to them by their class representative.

3.4 Data Analysis

The data from the questionnaire will be evaluated by used SPSS programme. The data is analysed to get their mean, mode and median. After the information is analysed, the perception and factor that contribute to the obesity among primary school students in 6 schools will be made. This way, we can differentiate obesity perception among primary school students in Teluk Intan area. The Microsoft Excel Programs will be used to analyse the percentage and get the graph for the conclusions.

Method

Independent Variable
Factor and how to overcome obesity
Dependent Variable
Physical and health education students