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(Pakistan) 2015 CAUSES AND CONSEQUENCES OF OBESITY AMONG SCHOOL GOING CHILDREN: A COMPARATIVE STUDY OF RURAL AND URBAN AREAS OF PUNJAB BY Mohammad Amjad Registration No. 88-ag-1784 A thesis submitted in partial fulfillment Of the requirement for the degree of DOCTOR OF PHILOSOPHY IN RURAL SOCIOLOGY DEPARTMENT OF RURAL SOCIOLOGY FACULTY OF SOCIAL SCIENCES UNIVERSITY OF AGRICULTURE, FAISALABAD (PAKISTAN) 2015 The Controller of Examination University of Agriculture, Faisalabad We, the Supervisory Committee, certify that the contents and format of the thesis submitted by Muhammad Amjad, Regd. No. 88-ag-1784 have been found satisfactory and recommend that it be processed for the evaluation by the External Examiner (s) for the award of the degree. SUPERVISORY COMMITTEE Chairman: __________________________ (Professor Dr. M. Iqbal Zafar) Member: _____________________________ (Professor Dr. Ashfaq Ahmed Maan) Member: _____________________________ (Dr. Shoukat Ali) DECLARATION I hereby declare that contents of the thesis “Causes and Consequences of Obesity among School Going Children: A Comparative Study of Rural and Urban Areas of Punjab” are product of my own research and no part has been copied from any published source (except the references, some standard mathematical or genetic models/equations/protocols etc.). I further declare that this work has not been submitted for award of any other diploma/degree. The University may take action if the information provided is found inaccurate at any stage. (In case of any default, the scholar will be proceeded against as per HEC plagiarism policy). _______________________ Mohammad Amjad 88-ag-1784 DEDICATION All those who are sincere, dedicated, hardworking, industrious, Straight forward, patriots, honest, humble, submissive, Humanists, and bear an ideal conduct and character. Those who love Pakistan and can sacrifice anything for Pakistan. Those who have been martyred for this country; forefathers who struggled A lot for the independence of this country; and above all The Late and the Great – Quaid-e-Azam Muhammad Ali Jinnah The Curator of The Islamic Republic of Pakistan. i ACKNOWLEDGEMENT The author is thankful to Allah the Almighty, The Most Beneficent and The Most Merciful. Almighty Allah has given me the courage, strength and the opportunity to complete this dissertation successfully. The author is deeply indebted to his parents who have always been a source of help and encouragement throughout the life. The author cannot reciprocate their contributions. The author is much obliged to Professor Dr. Muhammad Iqbal Zafar, Chairman Supervisory Committee, Dean Faculty of Social Sciences, University of Agriculture Faisalabad, whose professional abilities and capabilities are matchless. He has always been a source of help, cooperation and encouragement throughout my PhD program. His advices will work as a beacon throughout my personal and professional life. He always guided me to the right direction and work very hard to get the work done by me. The author is also thankful to Professor Dr. Ashfaq Ahmed Maan, Member Supervisory Committee, and Chairman Department of Rural Sociology, University of Agriculture Faisalabad for his unparalleled support in finalizing the current dissertation. He always played the supportive role for me. The author is also thankful to Dr. Shoukat Ali, Member Supervisory Committee Associate Professor Department of Agri-Extension University of Agriculture Faisalabad who supported me through his valuable advices in the finalization of present dissertation. The author pays gratitude of thanks to Syed Kamal Ali, Director IGI Insurance who guided me throughout my professional life. He always plays a fatherly role for me. He is the one whom I idealize. May God bless him with eternal health. The author is also thankful to his colleague Mr. Pervaiz Nadir for his encouragement and moral support. The author is personally thankful to Mr. Tahir Masaud CEO IGI Insurance, and Mr. Moeez Karim GM Sales & Marketing; who extended fullest support and cooperation throughout the research work and accorded approval of leaves, when required, for the completion of PhD. Degree. The author is thankful to his wife, daughter, and two sons who always remained the sources of motivation for me throughout the research process. The author is deeply obliged for the cooperation extended by his colleagues Mohammad Akmal, M. Adnan Tariq, Khurram. S. Paul, Muhammad Hisham, Muhammad Hafeez, Muhammad Ejaz, Shakeel Ahmed, Mujib Ul Haq, Shabana Noreen, Asif Badar, Adil Khan, Faisal Qureshi, Faisal Khurshid and Tariq Mehmood. Last but not least, the author owes indebted to Mr. Tariq, DPU, and University of Agriculture Faisalabad who helped a lot in data analysis besides other contingencies support. Mohammad Amjad ii TABLE OF CONTENTS Page # Dedication I Acknowledgement II Table of contents III List of tables VII Abstract IX Chapter Title Page # I INTRODUCTION 1 1.1: Obesity 2 1.2: World and South Asian Perspective 3 1.3: Pakistan’s Perspective 10 1.4: Need for Study 13 1.5: Objectives 14 1.6: Conceptual Framework 14 II REVIEW OF LITERATUTRE 17 2.1: Theoretical Models of Health Behaviors 17 2.2: Obesity and Body Mass Index (BMI) 22 2.3: Obesity, self-esteem, stigmatization, discrimination and 23 implications 2.4: Parental factors and obesity of children 25 iii 2.5: TV Watching, video games, internet and obesity 27 2.6: Physical activities and obesity 30 2.7: Eating patterns, life patterns, junk food and obesity 31 2.8: Knowledge, education, intervention and obesity 36 2.9: Asthma and implications of obesity 41 2.10: Obesity and other diseases 42 2.11: Genetic factors, family history and obesity 45 2.12 Obesity and other factors 47 2.13: Obesity and sleep 48 2.14: Obesity and socio-economic factors 48 2.15: Obesity, culture and environment 50 III RESEARCH METHODOLOGY 53 3.1: Study Design 53 3.2: Study Area 52 3.2.1: Faisalabad District 53 3.2.2: Rawalpindi District 54 3.2.3: Map of Punjab Province 56 3.2.4: Sample Selection Scheme 57 3.3: Sample Size 58 3.4: Pre-testing 58 3.5: Measures to enhance data quality 58 3.6: Construction of the Measurement Instrument 58 3.7: Statistical techniques 59 iv 3.7.1: Frequency distribution 59 3.7.2: Bivariate analysis 59 3.7.2.1: Chi-square test statistics 59 3.7.2.2: Gamma statistics 60 3.7.3: Reliability 61 3.7.4: The Pearson’s Correlation 61 3.7.5: Index construction 62 3.7.6: Multivariate analysis (Multiple Linear Regressions) 62 3.7.7: Measures of obesity 63 IV RESULTS - DESCRIPTIVE ANALYSIS 65 4.1: Demographic characteristics of the respondents 65 4.2: School related characteristics 73 4.3: BMI related characteristics 75 4.4: Importance of playing facilities 77 4.5: Life patterns 80 4.6: Fast Food/Junk Food definitions 86 4.7: Cultural elements in anthropological and sociological accounts 87 of food in Pakistan 4.8: Cooking oil, Banaspati Ghee and Butter oil (desi ghee) 97 4.9: Obesity, perceptions and feelings 99 4.10: Family history 106 4.11: Researcher’s perception about respondents’ health 108 V TESTING OF HYPOTHESES: EXPLORING RELATIONSHIPS 113 v VI MULTIVARIATE ANALYSIS: EXAMINATION OF 136 RELATIVE SIGNIFICANCE OF INDEPENDENT VARIABLES 6.1.1: Regression coefficients of socio-economic and demographic 139 characteristics 6.1.2: Regression coefficients of physical characteristics 139 6.1.3: Regression coefficients of eating characteristics 139 6.1.4: Regression coefficients of health characteristics 140 6.2.1: Regression coefficients of socio-economic and demographic 141 characteristics (rural areas) 6.2.2: Regression coefficients of physical characteristics (rural areas) 142 6.2.3: Regression coefficients of eating characteristics (rural areas) 142 6.2.4: Regression coefficients of health characteristics (rural areas) 142 VII SUMMARY, FINDINGS, CONCLUSION, AND 146 RECOMMENDATIONS 7.1: Important dimensions 146 7.2: Main findings 147 7.3: Implications of obesity 153 7.4: Conclusion 154 7.5: Policy recommendations 155 7.6: Recommendations for future study 157 LITERATURE CITED 159 APPENDIX-I (implications of obesity – Regression Analysis) 174 APPENDIX-II (MBI Scores of aged-Boys 178 APPENDIX-III (questionnaire) 187 vi LIST OF TABLES Table Title Page # 4.1 Percentage distribution of the respondents according to their socio- 65 economic and demographic characteristics 4.2 Percentage distribution of the respondents according to their school 73 related characteristics 4.3 Percentage distribution of the respondents according to their BMI 75 related characteristics 4.4 Percentage distribution of the respondents according to their responses 78 regarding playing and sports related characteristics 4.5 Percentage distribution of the respondents according to their life 81 patterns characteristics 4.7 Percentage distribution of the respondents according to their and their 88 families eating characteristics 4.8 Percentage distribution of the respondents according to material 98 characteristics in homemade foods 4.9 Percentage distribution of the respondents according to their 99 perception related characteristics 4.10 Percentage distribution of the respondents according to their family 107 history related characteristics 4.11 Percentage distribution of the respondents according to their health 111 status and researcher’s perception about their health characteristics 5.1 The values of Chi-Square, Gamma and Pearson’s Correlation 115 Coefficients of different independent variables with dependent variable (Obesity) for both rural and urban areas 5.2 The values of Chi-Square, Gamma and Pearson’s
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