CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

2. 5 Stress Cause Obesity

Research concludes that acute psychological stress is associated with eating in the
absence of hunger (Rutters el al 2009).Furthermore, many epidemiological studies have
also reported that obesity is associated with short sleep duration, which may also be
caused by emotional stress (Vgontzas ciÍJ/2008). In light of this evidence, healthcare
professionals should explore both the physical and mental health status of patients (Metz
ci j/2009).
Obesity today is so common that young people are also suffering from this kind of
disease. Normally, obesity is diagnosed during middle age. However today, normally
hear that young people in their 20's are now suffering from this kind of disease. The main
cause of obesity is overeating. However, not many people know the causes of overeating.
And, the answer to this question is stress. Many people today, especially young people,
are now living a hectic and stressful lifestyle. Because they live this kind of life, they tend
to eat comfort foods to get rid of stress. Stress can make you feel hungry even though you
just ate. Because of this reason, you will tend to eat more portions and fast food chains
are serving food portions that are high in fat, sugar and salt 700 percent larger than what
is recommended by dietitians and nutritionists. (Albert).
 The older adults who are obese are more likely than those who are not obese to
report symptoms of depression, such as feelings of sadness, worthlessness, and
hopelessness (Center on an Aging Society, 2003). Older adults are more likely than
younger adults to experience functional limitations associated with chronic illnesses that
may begin a stress-pain-depression cycle that can result in lifestyle patterns leading
obesity (Lorig et al., 2006).
Stress experienced at work significantly increases a person's risk of obesity in
general and central obesity in particular, according to a study published in the American
Journal of Epidemiology. According to lead researcher Dr. Eric J. Brunner of the Royal
Free and University College London Medical School, the study provides "firm evidence
that high psychological workload, together with lack of social support at work, acts as a
causal factor for obesity."
Prior studies have linked chronic stress to heart disease as well as metabolic
syndrome, a combination of medical disorders tied to an increase in a person's risk of
cardiovascular disease and diabetes. The researchers monitored 3,413 women and 6,895
men for 19 years, questioning them several times about their levels of job strain, which
was defined as having heavy demands, little decision-making power and little social
support at work.
All participants were between the ages of 35 and 55 at the beginning of the study.
Regardless of sex, people who reported job strain on one occasion were 17 percent more
likely to develop obesity or central obesity than those who reported none. Those who
reported stress on two occasions were 24 percent more likely to become obese and 41
percent more likely to develop central obesity. Those who reported job strain on three or
more occasions had a 73 percent higher chance of developing obesity and a 61 percent
higher chance of developing central obesity.
2.6 Awareness from the Adults Regarding Obesity Problems

Our society has a weight problem. Flegal et al. reported that 61% of US adults were
overweight or obese in 1999. The number of quick fixes like fad diets and expensive exercise
equipment has also increased. Americans spend about $30 billion a year on weight-loss products
and service. However, most people make promises to change, but immediately revert back to
their old habits.

2.6.1 Concern on practice regular exercise

The prevalence of obesity is rising. Because obesity is positively associated with

many health related risks and negatively associated with life expectancy this is a threat to
public health. Physical exercise is a well known method to lose fat mass. Due to shame of
their appearance, bad general condition and social isolation, starting and continuing
physical exercise tends to be problematic for obese adults. A supervised training program
could be useful to overcome such negative factors. In this study we hypothesized that
offering a supervised exercise program for obese adults would lead to greater benefits in
body fat and total body mass reduction than a non-specific oral advice to increase their
physical activity. A supervised exercise program in a peer group may provide an adequate
environment to maintain motivation for physical activity. A 12-week program of
supervised exercise showed a significant decrease in body mass in obese elderly.9 Also,
when compared with a sedentary life style, 16-months supervised exercise program
showed major effects on weight in obese young adults (S P A Nicolaï, L M Kruidenier, P
Leffers, R Hardeman, 2009).
2.6.2 Healthy diet

Obesity and its associated disorders are a growing epidemic across the world.
Many genetic, physiological, and behavioral factors play a role in the etiology of obesity.
Diet and exercise are known to play a valuable role in the treatment and prevention of
obesity and associated disorders such as hypertension, heart disease, and diabetes.
Treatment of people who are already obese is difficult; however, systematic reviews in
recent years have shown that diet, exercise, and behavioral approaches, used in
combination, are effective management strategies, at least in the short term. Therefore,
the purpose of this review is to examine the prevalence, etiology, consequences, and
treatment of obesity. Journal of the International Society of Sports Nutrition. 2(2):4-31,
2005.
Many patients who are dealing with being overweight or obese accomplish weight
loss with diet, exercise and lifestyle changes. Some patients may require physician
supervised dietary management. The greatest loss in body weight, especially of body fat
within a definite period of time is achieved by diets that provide only 400-800 kcals per
day. Efforts to reduce fast-food consumption may be a useful strategy in improving diet.
Results indicated that fast-food intake was positively associated with intake of energy and
sodium as well as total fat and saturated fat as a percentage of calories. ( W. Colin, B.
Jacqueline, C. Bill, H. Travis, G. Melyn, L. B. Paul, N. Erika, W. Jennifer , and K.
Richard, 2005).
Healthy eating is defined by the eating behaviors that can enable the person to
achieve “a state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity” (World Health Organization, 2007). The current study
found that a balanced diet and eating at regular time intervals were perceived as healthy
by respondents. In other words, the contents of the diet and the frequency of food
consumption matters most to the respondents (C. Kara, P.Gerard, G. Alice and B. Tino,
2009).
2.6.3 Get knowledge and information regarding obesity

There is need for more public awareness on the effect of obesity on people's
health through information, education and communication. It would be of great
importance if such interventions were introduced at early age of life, for example by
inclusion in school curricula. Four aspects of awareness concerning obesity were
examined from the study February 2003 EAST AFRICAN MEDICAL JOURNAL 71
subjects. The four aspects were; knowledge about harmful effects of obesity; knowledge
about the association between excess body weight and certain chronic diseases; concern
about body weight, and preference of body type.
Results of the study revealed that only about one half of the study subjects were
aware of the harmful effects of obesity, and among them, the greater proportion were old
individuals. It is really a great concern that the majority of the young individuals, who
hold much of the future of the nation, were not aware. Given the fact that any effort to
control the situation can only be successful if people are aware, there is a need to take
deliberate action to raise awareness. However, the fact that one is knowledgeable about
the effects of obesity may not provide full guarantee that the person might not become
obese (C.N.M. Nyaruhucha, J.H. Achen, J.M. Msuya, N.B. Shayo and K.B.M. Kulwa,
2003).
The study has investigated the awareness of the health risks of overweight and
understanding of measures overweight among people in rural area in central Queensland.
It was found that most people in this study were appropriately aware that regardless of
their degree of physical activity, overweight is associated with increase risk of heart
disease, type 2 diabetes and stroke.
The wide spread knowledge among participants that overweight poses a risk to
health may reflect the increase burden of obesity related illness in these community.
Then, knowledge of health risks of overweight were generally consistent across the BMI
spectrum with similar belief expressed by those who were classified overweight and
obese for those who were not (FR. Coulson, VA. Ypinazar, and SA. Margolis, 2006).
3.2 Research Design

Research design can be defined as a plan to decide on the best way to gather the
information in order to provide the best answers to the research objectives. There are three types
of research design that includes exploratory, descriptive, and causal research.
Therefore, in this study will be using the causal research that the main goal is to identify cause
and effect relationship among variables. Experimental or causal designs are used when it is
necessary to establish causal relationships. Causal designs generally take the form of an
experiment that can be carried out either in a laboratory setting or in a field setting.
This study will measures whether the causes such stress, bad eating, and behaviors have
increase the obesity among adults. Besides that, in this study also we want to determine the risk
effect such have
Lastly, by using causal research, we can determine whether people get awareness about
through balanced diet, get obesity knowledge, and practice good exercises.
Besides that, we also will use the descriptive research that describes the characteristic of
a population or phenomenon. Descriptive research seeks to determine the answers to who, what,
when, where, and how questions. In this survey, we want to identify the characteristics of genetic
group that cause to obesity problem.
3.6 Data analysis

Data analysis can be defined as analyzing of data is a process of inspecting, cleaning,

transforming, and modeling data with the goal of highlighting useful information, suggesting
conclusions, and supporting decision making. Data analysis has multiple facets and approaches,
encompassing diverse techniques under a variety of names, in different business, science, and
social science domains (Wikipedia). In this study, we will use descriptive analysis which it is
refers to the transformation of raw data into a form that will make them easy to understand and
interpret. The data will be gathering and we will put all the data into the Microsoft Excel.

3.6.1 Bar Chart

Example of bar chart:

 Bar chart or bar graph is a chart with rectangular bars with lengths
proportional to the values that they represent. The bars can also be plotted
horizontally. Bar charts are used for plotting discrete (or 'discontinuous') data i.e.
data which has discrete values and is not continuous. Some examples of
discontinuous data include 'shoe size' or 'eye color', for which you would use a bar
chart. In contrast, some examples of continuous data would be 'height' or 'weight'.
A bar chart is very useful if you are trying to record certain information whether it
is continuous or not continuous data (Wikipedia).

Therefore, in this study, we will use bar chart in order to get the
meaningful data from the questionnaires that we will contribute to our
respondents. All the questions that will be ask in the questionnaires, we will
evaluate the answers and then we will construct the bar chart to reach our
objectives. For example, we want to know the BMI level among the adults based
on their height and weight, and then we will construct the bar chart.

Other than that, we also can know the result regarding the number of
respondents that get obesity from the causes such genetic, stress and bad healthy
lifestyles. Beside that, we also can get the number of respondents that really
aware about obesity problem.
3.6.2 Pie Chart

A pie chart (or a circle graph) is a circular chart divided into sectors,
illustrating proportion. In a pie chart, the arc length of each sector (and
consequently its central angle and area), is proportional to the quantity it
represents. When angles are measured with 1 turn as unit then a number of
percent is identified with the same number of centiturns. Together, the sectors
create a full disk. It is named for its resemblance to a pie which has been sliced.
The earliest known pie chart is generally credited to William Playfair's Statistical
Breviary of 1801.

The pie chart is perhaps the most ubiquitous statistical chart in the
business world and the mass media. However, it has been criticized, and some
recommend avoiding it, pointing out in particular that it is difficult to compare
different sections of a given pie chart, or to compare data across different pie
charts. Pie charts can be an effective way of displaying information in some cases,
in particular if the intent is to compare the size of a slice with the whole pie, rather
than comparing the slices among them.
 Pie charts work particularly well when the slices represent 25 to 50% of
the data, but in general, other plots such as the bar chart or the dot plot, or non-
graphical methods such as tables, may be more adapted for representing certain
information. It also shows the frequency within certain groups of information
(Wikipedia).

Therefore, in this study, we will use pie chart in order to get the
meaningful data from the questionnaires that we will contribute to our
respondents. All the questions that will be ask in the questionnaires, we will
evaluate the answers and then we will construct the pie chart to reach our
objectives. For example, we want to know the percentage of respondents that
practice healthy diet and physical activity.

Other than that, we also can know the result regarding the percentages of
respondents that get risk affect such diabetes, blood pressure, and after being
identified as obese people.
3. 7 Hypotheses

Hypothesis can be defined as unproven proposition that is empirically testable. In other

word, when one states a hypothesis, it should be written in a manner that can be supported or
shown to be wrong an empirical test. A hypothesis is a formal statement explaining some
outcomes. Therefore, in its simplest form, a hypothesis is a guess. Below is our hypothesis
regarding the adult obesity:

H1: Unhealthy lifestyles will have positively effect to the obesity rather than genetic
factor and stress factor.

H2: The more information people get about obesity, the more people will aware about
obesity rather than practice physical activity and healthy diet.

H3:
 CONCLUSION

As conclusion, we have chosen to make some research about adult obesity among
Segamat residents because we want to know about the causes of obesity, the risk effect, and the
awareness among Segamat residents.
Chapter one includes the introduction about obesity, background of the obesity. Then,
we also stated the research objectives, problem definition, scope of research, and the limitation.
The research objectives are to determine the causes of obesity, to determine risk effect, and
explore the awareness among Segamat residents.
After that, in Chapter two there are analysis and summarize the journal that is secondary
data. We summarize journal about the topic such genetic, stress, healthy lifestyles, awareness
about obesity, and risk affect from obesity.
Lastly, in Chapter three provides the frame work for the researcher, the important aspects
of the research design namely methodology, questionnaire and the development, data collection
and analysis, research question, and hypothesis. We will provide 384 questionnaires to our
respondents in Segamat residents. After that, we will make analysis about the answers and will
reach the research objectives.
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