| Summary: | 碩士 === 國立陽明大學 === 臨床暨社區護理研究所 === 102 === Abstract
Background: Taiwan gets the second place of childhood obesity in Asia. Poor implementation of health behavior, the childhood obesity more likely to cause psychosocial problems of children, as well as obesity in adulthood and the vast majority easily lead to many chronic diseases. According to the 2007 cross-sectional survey of health behavior and obesity of students: the rate of over eight hours of sleep a day was 25% ; the rate of eat three servings of vegetables daily was 13.1%; the rate of screen time less than two hours a day was 48.1%; the rate of over 210 minutes of physical activity a week was 52.9%. therefore, childhood obesity is a topic which must be solved.
Aim: management strategies of student obesity based on prior evidences: full eight hours of sleep a day, eating all vegetables of lunch every day, using four electric equipment less than two hours a day (watching TV, playing video games, playing on the computer, using the phone), engaging physical activity 30 minutes every day (physical activity 210 minutes per week), drinking water (drinking 1500 cc every day) and eating breakfast every day. Based on healthy promoting school model and providing health behavior intervention for 24 weeks, we track record of student achievement rate of health behavior and body weight by week, and examine its effectiveness.
Methods: This study as a longitudinal study, the schools used the results of “Study of Aid Student to Fit” to develop strategies. The investigators used questionnaires of "healthy self-management of students" between September 2012 to September 2013 by the internet or on paper to track the behavior of 95,767 junior high and elementary school students with the height and weight. Hierarchical Linear Modeling (HLM) analyze the impact of long-term intervention of health behavior for students Z values of BMI; mean while Cox regression and Kaplan-Meier analyze relation of health behavior reaching or not with obesity-related risk.
Results: After promotion “Study of Aid Student to Fit” in the junior high and elementary schools in Taiwan. Student achievement rate of healthy behavior increased significantly. After 24- week intervention of healthy behavior, the ratio of students’ normal bodyweight increased from 44.6 % to 48.3 %; overweight ratio decreased from 24.4% to 23.5%; obesity ratio decreased from 16.5% to 13.9%. The cross - sectional analysis based on mean effect of HLM showed the students to full eight hours sleep a day, to use four - electric equipment less than two hours a day, to engage physical activity 30 minutes every day, and to eat breakfast every day. Their BMI Z value is significantly lower than which people not reached (p <0.001). However, the analysis of interaction of time and healthy behaviors based on HLM shown the time increases, eat all vegetables of lunch every day (p <0.004) and drinking water 1500 cc/day (p <0.001) of healthy behavior change will significantly reduce BMI Z values. Based on the Cox analysis, reached a full eight- hour sleep a day, HR: 0.72 (95% CI = 0.705-0.736); eating vegetables of lunch, Hazard Ratio (HR): 0.76 (95% CI = 0.741-0.77); using four electric equipment less than two hours a day, HR: 0.61 (95 % CI = 0.598-0.623); engaging physical activity 30 minutes every day, HR: 0.77 (95% CI = 0.754-0.788); daily drinking water, HR: 0.88 (95% CI = 0.866-0.900); eating breakfast every day , HR: 0.68 (95% CI = 0.662-0.694), the risk of obesity can reduces the most by eating breakfast every day.
Conclusion: Full sleeps, reducing screen time, more physical activity, eating breakfast are antecedents of obesity. Eating enough lunch vegetables in school, and drinking plenty of water to reduce the sugar drinks reduce consequently obesity rate.
Suggest: In the past, eating less and exercise more can reach effective weight loss, however children still grows, children eating less may affect their growth and development, but it is also difficult to implement. So the contribution of this study is in addition to diet control, looking to school level that could be implemented to prevent obesity intervention strategies; full eight- hour sleep a day, eating all vegetables of lunch, using four electric equipment less than two hours a day, engaging physical activity 30 minutes every day, daily drinking enough water and eating breakfast every day can reduce the risk of obesity, it is worth on campus implementation; especially four electric equipment less than two hours a day can effectively reduce sedentary behavior and increase physical activity to reduce childhood obesity. For this generation of children, it is a very important intervention.
Keywords: Children, overweight, obesity, health behavior, intervention, self-monitoring, school
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