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Chapter I THE PROBLEM AND ITS BACKGROUND Introduction The most important part of being a normal weight isn't looking a certain way - it's feeling good and staying healthy; having too much body fat can be harmful to the body in many ways. The number of people who are obese is rising. About 1.2 billion people in the world are overweight and at least 300 million of them are obese, even though obesity is one of the 10 most preventable health risks, according to the World Health Organization. In the United States, more than 97 million adults - that's more than half - are overweight and almost one in five adults is obese. Among teenagers and kids 6 years and older, more than 15% are overweight - that's more than three times the number of young people who were overweight in the 1970s. At least 300,000 deaths every year in the United States can be linked to obesity. A person with a Body Mass Index or BMI above the 95 th percentile (meaning the BMI is greater than that of 95% of people of the same age and gender) is generally considered overweight. A person with a BMI between

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the 85th and 95th percentiles typically is considered at risk for overweight. Obesity is the term used for extreme overweight. There are some exceptions to this formula, though. For instance, someone who is very muscular (like a bodybuilder) may have a high BMI without being obese because the excess weight is from extra muscle, not fat. People gain weight when the body takes in more calories than it burns off. Those extra calories are stored as fat. The amount of weight gain that leads to obesity doesn't happen in a few weeks or months. Because being obese is more than just being a few pounds overweight, people who are obese have usually been getting more calories than they need for years. But being obese and being overweight is not exactly the same thing. An obese person has a large amount of extra body fat, not just a few extra pounds. People who are obese are very overweight and at risk for serious health problems, such as, Cardiovascular Diseases. Obesity can run in families, but just how much is due to genes is hard to determine. Many families eat the same foods, have the same habits (like snacking in front of the TV), and tend to think alike when it comes to weight. All of these situations can contribute to weight gain, so it can be difficult to figure out if a person is born with a tendency to be obese or

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overweight or learns eating and exercise habits that lead to weight gain. Obesity is bad news for both body and mind. Not only does it make a person feel tired and uncomfortable, it can wear down joints and put extra stress on other parts of the body. There can be more serious consequences as well. Not all obese people are aware of the risks that come along with their current health status. Aside from abnormal respiratory-related conditions which are inevitable, and kidney malfunctioning where hyper-filtration occurs, and thus, tearing the kidneys apart, which is also a good indication of a disease, cardiovascular disease is also present, though perceived in a different manner.

BACKGROUND/ SETTING OF THE RESEARCH Maintaining a healthy weight, clean living and staying physically active are all important in preventing Cardiovascular Diseases. Some inactive people believe that maintaining a healthy weight is sufficient to prevent stroke from occurring. Other overweight people think

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that being physically active is enough to prevent the mentioned phenomenon. In one small study of men and women who had suspected heart complications who were maintaining a physically active lifestyle and a healthy diet, has normal blood pressure, not diabetic, and do not smoke were less likely to suffer from Cardiovascular Diseases. Reducing the risk of cardiovascular disease involves more than one factor. While maintaining a normal body weight and regular physical activity are both important in heart health, together they are a potent force in enabling people to live healthy lives. Obesity was barely recognized as a problem in the Philippines in the early part of the 90's; surely not because it is non-existent in this part of the world but because doctors & other health providers show not much interest in this issue. The incidence of clinically severe obesity --- or simply the state of exceeding the Ideal Body Weight (IBW) by 100 lbs. for males, or 80 lbs. for females, is rising among Filipinos. Severe obesity refers to a Body Mass Index (BMI) of >40 kg/m^2, the normal BMI being 19-25. Commonly called morbid obesity, it gives rise to a host of diseases such as high blood

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pressure, diabetes, joint disease, high cholesterol, heart disease, pulmonary problems, and reduced life expectancy. Morbid obesity could develop to be one of the major health problems in the Philippines unless serious steps are taken to arrest the rise of its incidence or, better, prevent it altogether. "There are an estimated 500,000 Filipinos suffering from clinically significant obesity. It is especially alarming to note that some of these patients are very young," says Dr. Hildegardes C. Dineros, main proponent, Asian Bariatrics, an advocacy group committed to create awareness on the problem of obesity. Is this obesity trend seen in the third world as well? National statistics on malnutrition show under nutrition as a major problem of developing countries like the Philippines. However, this is fast changing. As Filipinos adopt more of the western lifestyle and diet as reflected by the so-called “McDonald’s index”, a segment of our population inevitably becomes subject to the consequence of being overweight and finally obese. Based on the data gathered from the NUTRISTAT Protocol at St. Luke’s Medical Center (1999 – 2000), 34% of the total admitted patients are malnourished and yet surprisingly about one-fourth of them are obese. There was more

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overweight (2/3) than undernourished (1/3) patients. These data may give us an idea of how serious the problem is even in our country.

THEORETICAL FRAMEWORK Dorothea E. Orem's Self-Care Deficit Nursing Theory: The purpose of this paper is to inform the reader how Dorothea Orem’s nursing theory has been used in research. Orem began developing her theory in the 1950’s, a time when most nursing conceptual models were based on other disciplines such as medicine, psychology and/or sociology (Fawcett, 2000). Orem’s theory is a three-part theory of self-care. The three theories that make up the general theory are: Self-Care, Self-Care Deficit, and Nursing Systems. The Self-Care theory states that adults deliberately learn and perform actions to direct their survival, quality of life, and well-being. Self-Care Deficit theory states that nursing is required because of the inability to perform self-care as the result of limitations. Nursing Systems theory is the product of nursing in nursing system(s) by which nurses use the

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nursing process to help individuals meet their self-care requisites and build their self-care or dependent-care capabilities. These three theories form the overall Self-Care Deficit Theory. (Alligood & Tomey) Due to enumerable factors, obesity has come into a wide range due to people’s lack of sense of responsibility when it comes to handling their diet and maintaining a healthy lifestyle. Some tend to overeat without taking into consideration the nutrition that they acquire and the effects of the food they are eating to their bodies. They became prone to heart diseases, including cardiovascular disease, without being aware of it. This is due to lack of knowledge and discipline regarding such matters that affect their health and well being.

CONCEPTUAL FRAMEWORK It showed that obesity was a significant predictor of CVD, particularly among women. It also showed that weight gain in the young adult years produced an increased risk for CVD in both men and women. Some of the most interesting studies that show obesity itself cause an increase in the risk of CVD come from examining the hearts of obese people. The confusion

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that can occur in a discussion of obesity and CVD relates to the fact that poor fitness also increases the risk of CVD. Since poor fitness can often result in obesity, it is assumed by some that fitness is the overriding issue, and the association between CVD and obesity is, in reality, simply the association between poor fitness and CVD. Of course, unfit men as a whole were significantly more likely to die of CVD than fit men. Thus, even though a lack of fitness is clearly a risk factor for CVD, once fitness is taken into account, obesity still plays a role. In fact, the authors conclude that a lack of fitness represented only 39% of the CVD risk in obese men. A lack of fitness adds to overweight and obesity. In other words, fitness and obesity are independent risk factors.

Active men with high BMI had a 35% higher CVD hazard ratio than active men with low BMI. Of course, the active men and women all had lower CVD hazard ratios than the inactive men and women. This, of course, tells us that obesity and physical inactivity are both independent risk factors for CVD. This is why the authors note, “In conclusion, our study confirmed that both physical inactivity and obesity are important risk factors for CVD.”

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Although habitual physical activity is an effective strategy for preventing CVD, elevated body fatness is associated with an adverse CVD risk factor profile independently of aerobic fitness.” As you can see, then, obesity is an independent risk factor for CVD.

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RESEARCH PARADIGM INPUT Demographic Profile: • Age • Gender • Height • Weight • Religion Obese person handle their physical status with regards to: •

Exercise

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Daily Routine

Factors and how they contribute on development of obesity in terms of: •

Physiological factors

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Environmental factors

Obese person perceive their level of awareness with regards to: •

risk of having Cardiovascular Disease

Problems that an obese person may encounter with regards to: •

Daily Living

Preventive practices of obese person in regards to: •

Prevention of risk factors

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Health education to patient

PROCESS Analysis of input data Gathering of data • Questionnaire

Output Increase the level of awareness of health care management of obese person with the risk of having Cardiovascular Disease Figure 1: The Research Paradigm The level of awareness of the obese person with the risk of having Cardiovascular Disease

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STATEMENT OF THE PROBLEM

The purpose of this study is to determine the level of awareness of the obese person with the risk of having Cardiovascular Disease.

Specifically the study aims to find the answer to the following questions: 1. What is the profile of the respondent as to: 1.1 Age 1.2 Gender 1.3 Height 1.4 Weight 1.5 Religion 2. How do obese person handle their physical status with regards to: 2.1 Exercise 2.2 Daily routine 3. What are the factors and how they contribute on development of obesity in terms of: 3.1 Physiological factors 3.2 Environmental factors

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4. How do obese person perceive their level of awareness about the risk of having Cardiovascular Disease? 5. What are the problems that an obese person may encounter with their daily living? 6. What practices are the obese person do to improve their health status to prevent themselves of having Cardiovascular Disease?

IMPORTANCE OF THE STUDY This will be great relevance to the following person and entities:

Nursing Students: This study will help the nursing students to guide them in becoming prepared when dealing with obese person high risk in cardiovascular disease. This further helps them to improve their nursing process such as assessment, planning, intervention and evaluation. This study will also create awareness to the nursing students to be more participant with determination as the member of health care team. This will help to their performance in implementing possible health status. And help those obese persons to control cardiovascular disease.

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Families and Significant others: To the families of obese person, participation of health teaching will provide information they need actively participate or cooperate in such activities related to their health and daily a living. This will further help and guide them developing their skills for carrying themselves. And this study provides awareness to the public.

Obese Persons: The must benefited one of this study will be the obese person because improving themselves may hopefully realize they are those people who are high risk in cardiovascular disease. This study will help them to control and cope with the preventive measure and prioritize the aspect of care.

SCOPE AND LIMITATION This study focuses on the analysis of obese person high risk in cardiovascular disease. The respondent of this study are those twenty obese nursing students from Arellano University Legarda Street, Manila from second year to forth year ages between 15-23 years old. The aspect looked into were the severity of the obesity problem. The respondent will contribute to the study as they

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shared their ideas on what the present generation presumption about obesity. By the researcher would have an idea how obesity is a risk

DEFINITION OF TERMS Arteriosclerosis A disease process, commonly called hardening of the arteries, which includes a variety of conditions that cause artery walls to thicken and lose elasticity. Weight A measure of the heaviness of an object or the force with which a body is attracted to Earth or another celestial body, equal to the product of the object's mass and the acceleration of gravity. Height The distance from the base of something to the top. Body Mass Index (BMI) Indicates whether weight is appropriate for height. Cardiac Arrest The cessation of hearth function.

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Cardiovascular Disease Any abnormal condition characterized by dysfunction of the heart or blood vessels such as arteriosclerosis, rheumatic heart disease and systemic hypertension. Cardiac Output The amount of blood related by the heart with each ventricular contraction. Hypertension Blood pressure above the normal range. Hypotension Lowered blood pressure Obese Body (Obesity) Weight greater than 20% of ideal for height and frame. Overweight A body mass index of 26-30 kg/m Rheumatic Heart Disease Rheumatic Fever can lead to a condition known as rheumatic heart disease. This is usually a thickening and stenos is of one or more of the heart valves and often requires surgery, to repair or replace the involved valve

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Chapter II REVIEW OF RELATED LITERATURE AND STUDIES The rapid rise of degenerative diseases and health problems had brought a considerable change on the health status of different nations. These instances prompted the researcher to review and conduct studies about obesity to prevent the spreading problems over and within the countries.

Related Literature In this portion, local and foreign researchers had been reviewed to contribute on finding solution to solve the problem brought about by obesity in youngsters, as the situation and its consequences still prevail at present. Foreign Literature Literature 1 Obesity has reached epidemic proportions, says Davy, citing some very telling statistics. "Approximately 65 percent of the population is considered to be overweight and 31 percent is considered to be clinically obese." Individuals are considered to be clinically obese if they have a body mass index (BMI) of greater than 30. BMI is a measurement of body fat content found by dividing an individual's weight in kilograms by their height

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in meters squared. Overweight and obese individuals are at increased risk of developing heart disease, high blood pressure, stroke, diabetes, and many forms of cancer. However, there is considerable variability in the relationship between obesity and chronic disease. Individuals with an "apple," or abdominal, fat distribution pattern are at a substantially higher risk of developing cardiovascular and metabolic diseases compared with those with a "pear," or lower body, fat distribution pattern. Big hips are better than a big stomach. Davy initially became interested in obesity while conducting postdoctoral research at the University of Colorado in the area of aging and cardiovascular physiology. "We always excluded people who were overweight because it was our impression that they would somehow confound our understanding of how aging influenced the cardiovascular system. I became intrigued with understanding how the people we were excluding differed in their physiology." Since 1999, Davy's research has been focused on determining the role of body fat distribution patterns on the sympathetic nervous system (SNS), that part of the nervous system that speeds the heart, contracts blood vessels, and initiates other physiological reactions to mobilize the body for action in

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response to stress. The sympathetic nervous system plays a critical role in metabolism and cardiovascular physiology. Literature 2 Coronary heart disease (CHD) is the leading cause of mortality in the United States. Hypertension, diabetes mellitus, hypercholesterolemia, and smoking have all been directly related to CHD. Obesity is on the rise in the United States and has also been associated with CHD. This review clearly establishes obesity as an independent risk factor for CHD as demonstrated by the Framingham Heart Study, Nurses' Health Study, Buffalo Health Study, and the Cancer Prevention Study II. Morbid obesity was found to correlate with a significant risk of mortality from CHD, especially in young men. Prevention of obesity, and therefore reduction in risk from cardiovascular disease, is paramount in the management of obesity. New approaches to behavioral, medical, and surgical management of obesity are reviewed, including thalidomide, an antiangiogenic agent. A primary and secondary prevention model details a multidisciplinary approach to reducing risk in obesity. Cardiovascular disease (CVD), especially coronary heart disease (CHD), is the number one cause of mortality in the United States. During the

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years 1987-1994, mortality from CHD decreased, but the incidence of myocardial infarction has remained constant among whites and has increased in blacks, especially women. This suggests an improvement in treatment, but a decline in prevention. Obesity is on the rise in the United States and there is strong evidence to indicate obesity as a risk factor for CVD. This may be independent of or secondary to hypertension, diabetes, or hypercholesterolemia. This review considers obesity as an independent risk factor for CHD, and then compares morbid obesity vs. nonmorbid obesity as a risk factor for mortality in CHD. The studies used in this review include the Framingham Heart Study, Nurse's Health Study, Buffalo Health Study, and the Cancer Prevention Study II, which identify obesity as an independent risk factor for CHD. The Dusseldorf Study documents an increased risk of mortality in morbidly obese individuals. The sample population in the majority of these studies included only white Americans; although African Americans have an increased incidence of type 2 diabetes mellitus and hypertension, there was no statistically significant difference in mortality due to obesity when compared to whites.Therefore; this paper will concentrate on obesity as it relates to mortality from CHD.

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Due to the rising trend of obesity and therefore life-threatening CHD in the United States, we will explore treatment options and new theories in prevention. A hypothetical model of the prevention and treatment of obesity is proposed. Literature 3 To assess obesity as a predictor of mortality, it is imperative to first establish obesity as an independent risk factor for CHD. The following are four large studies that document a strong association between obesity and CHD. Clearly, obesity is a problem that is reaching epidemic proportions in the U.S., with nearly 70% of adults being classified as overweight or obese compared with fewer than 25% 40 years ago. Although too often obesity is viewed as a cosmetic problem as opposed to a major health concern, there is no question that obesity places a "heavy" burden on the entire cardiovascular system, contributing to considerable overall morbidity and mortality, a fact that was even recognized by Hippocrates centuries ago. In fact, recent evidence indicates that obesity is associated with more morbidity than smoking, alcoholism, and poverty, and if current trends continue will

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account for over 300,000 deaths annually in the U.S., thus overtaking cigarette abuse as the leading preventable cause of death. Obesity has adverse effects on several coronary artery disease (CAD) risk factors. Obese patients are more likely to be hypertensive than lean patients, and weight gain is typically associated with increases in arterial pressure. However, independent of arterial pressure, obesity increases the risk of left ventricular hypertrophy (LVH), particularly of the eccentric type. Obesity also adversely affects plasma lipids, especially increasing triglycerides and decreasing the cardio protective levels of high-density lipoprotein cholesterol, and is the major contributor to adult-onset diabetes mellitus and the insulin resistance syndrome (now called metabolic syndrome), which are associated with high levels of inflammation and overall cardiovascular mortality . Despite adversely affecting these risk factors, including markedly increasing levels of high sensitivity C-reactive protein, data from both the Framingham Heart Study and a large cohort of U.S. nurses have indicated that obesity is an independent risk factor for major CAD events in men and, particularly, in women. In addition to increasing eccentric LVH and the propensity for more complex dysrhythmias, obesity also has adverse effects on cardiac function.

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Diastolic abnormalities occur with all types of LVH, with the most marked abnormalities occurring in those with both obesity and hypertension, especially in those with left atrial abnormality by electrocardiogram. Although preload dependent indices of systolic function (e.g., ejection fraction) remain preserved early in obesity, preload independent indices (e.g., end-systolic stress/end-systolic volume index) demonstrate reduced contractility early in obesity. Alpert et al. have confirmed the adverse effects of significant obesity on both diastolic and systolic ventricular function. In a study of 74 morbidly obese patients, Alpert et al. demonstrated that nearly one-third had clinical evidence of heart failure, and the probability of HF increased with increasing duration of morbid obesity. At 20 and 25 years of obesity duration, the probability of HF was 66% and 93%, respectively. A recent epidemiologic study from the Framingham Heart Study indicates that being overweight and obesity are potent predictors of subsequent clinical HF.

Literature 4 In an article written by Mike Adams, he argued that Diabetes and Obesity are diseases, thus, natural results in a person making extra poor decision about food choices and physical exercise. It's something that can be reverse in virtually 100% of the cases by changing these two simple things.

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As a result, it rests firmly under the control of the patient, especially if they are educated about health nutrition and to make intelligent choices about what kinds of food and grocery products they consume. To call obesity a disease as a "dumbing down" of the very idea if what a disease is. Unfortunately, it implies that the patient is helpless to do anything about it. This idea is reinforced by language of doctors and health care providers who say things such as "Oh, you are obese," which sounds like you've been afflicted with some external invader that took over your health and make you powerless in doing something about it.

In an article in the current policy of review, Mary Eberstad, a research fellow at the Hoover Institution at Stanford University, wrote, "Nothing is as firmly established in the at literature as the fact that watching TV and overweight children go hand and hand. The more TV a child watches, the more likely he is to get fat. "In a list of nine strategies set in 2000 to fight obesity, Surgeon General David Satcher listed, "Reduce time spent watching TV and other sedentary behaviors". (By the way, none of the strategies involved advocating fewer trips to fast food restaurants). After all, McDonald's offer such as grilled chicken Caesar salad with fat-free herb vinaigrette dressing: a total of 135 calories. The dinner makes the choice.

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A study of Minneapolis- St. Paul area published in the American Journal of Public Health described 93% of the a Carte School sold to students as "food to limit". In the school where they sold, students ate fewer fruits and vegetables and consumed more calories from fat and saturated fat than health guidelines encourage.

Local Literature Literature 1 In a article prepared by the Office of Secretary of Department of Health (2007). It was mentioned that the entire health sector has to face many challenges in the Philippines health situation. In appropriate health care delivery system, inadequate regulatory mechanism and poor health care health financing including the increasing the prevalence of cardiovascular disease, cancer and diabetes are the major problems faced by the health sector. A health sector reform agenda has been developed to address the need to institute changes in the way health care is delivered; regulated and financed that would bring the country towards its national goal and objectives for health and the realization of the common vision of health for the Filipinos.

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Literature 2 In the Philippines, Dr. Augusto D. Litonjua, stated a private group that in an informal survey of doctors, 25% of patients were overweight. He blamed what he called “malling”, which he defined as spending the day in shopping malls in eating at fast-food restaurants. Even as they eat, however, many of these people long to be slim. As in the west, the bloating of Asia has been accompanied by a slimming of the ideal of beauty. As American fastfood chains spread through Asia they were being followed by a proliferation of gyms, slimming programs, diet pills and liposuction.

Literature 3 In an article published recently in Lifestyle magazine, Dr. Sioksoan Chan-Chua, President of Philippine Society of Pediatric Metabolism and Endocrinology (PSPME), said that there is currently an epidemic of Type 2 Diabetes among children and adolescents and much of this is attributed to arise in number of obese children. "Type 2 Diabetes is no longer adult-onset only, the condition is becomingly common in young people below 2 years old and during pubertal years," she said.

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UP-PGH Medical Center, lead by Dr. Antonio Dads identifies obesity as one of the prevailing risk factors that contribute proportion on diseases as coronary heart disease and stroke.

Overweight children are at risk of developing medical problems that effect a child's present and future health and have direct impact on quality of life including: • High blood pressure, high cholesterol and abnormal blood lipid levels, insulin resistance, and type 2 diabetes. • Bone and joint problems • Shortness of breath that makes exercise, sports or any physical activity more difficult and may aggravate the symptoms or increase the chances of developing asthma. • Restless or disordered sleep pattern • Tendency to mature earlier (overweight kids may be taller and more sexually mature than their peers, raising expectations that they should act as old as they look, not as old as they are; overweight girls may have irregular menstrual cycle and have fertility problems in adulthood) • Liver and gallbladder disease

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• Depression

Risk factors present in childhood (including high blood pressure, high cholesterol, and diabetes) can lead to serious adult medical conditions like heart disease, heart failure and stroke. Preventing or treating obesity in children may reduce the risk of developing these conditions as they get older.

Literature 4 Endocrinologist, Agusto Litonjua, emeritus professor at the University of the Philippines College of Medicine (UPCM) says that the fat cells (adipocytes) in the intraabdominal area are not just storage sites for excess energy but constitute an active endocrine gland that responds to signals from higher centers in the brain through the autonomic nervous system and other endocrine tissues. He added, despite the anatomical similarities of adipocytes throughout the body, adipocytes in the intraabdominal location have a different function and are responsible for giving humans greater risk for chronic diseases. Prof. Cynthia Manabat of the UPCM, cited that there exist adiposity signals that are involved in a mechanism used by the body to know whether

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it is “fat” or “thin”. This model explains why despite irregular meals or irregular physical activity over time, the body has a mechanism for maintaining body weight. Through this process, energy intake is balanced with energy expenditure over time. If fat stores in the body decrease this change is sensed by adiposity signals that will inhibit catabolic and stimulate anabolic processes, decrease energy expenditure, and make the body increase food intake to maintain energy balanced. If the fat stores increase, this change will be sensed by adiposity signals telling the CNS, to initiate the catabolic and inhibit anabolic processes. This causes an increase in energy expenditure and the CNS will dictate the body to decrease food intake to restore energy balanced. Dr. Eva Cutiongco, assistant professor at the University of the Philippines-Philippine General Hospital, says recent data suggest that genotype and ethnicity affect the response of people to certain diets. Through nutrigenomics, the effects of molecular inputs like nutrients and their influence over a persons genes and gene formation expression are being studied. She also says nutrigenomics advances the view that under certain circumstances, diet may be a risk factor for disease and influence health and disease susceptibility depending on an individuals genetic make-up; dietary chemicals can alter gene expression and change the genome structure; diet

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genes regulated by diet also play a role in chronic diseases; and intelligent nutrition may prevent, mitigate, or even cure chronic diseases.

Related Studies

Many studies had been conducted both in local and foreign countries that are related to the problems brought by obesity. This portion provides information that is relevant and helpful to the different phase of the problem at hand.

Foreign Studies Study 1 According to the study, which has founded by the USDA's Agricultural Research Service, focused on the relationship between reading nutrition labels and percentage calorie intake from fat, 301 adolescents aged 10 to 19. Teen boys who actually do read the labels tend to eat more protein and fat than those who don't. Dietary fat intake in the U.S. adolescents has been found to be about 3.5% which is at the higher and if the recommended 20% to 35% range for daily fat intake (depending on a person's metabolism).

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In Berkley teenage study of 1961-65, Ruth Lois Huenemann studied the eating habits, body composition and physical fitness of nearly 1,000 students and found out that the tendency toward obesity begins well before adolescence. That study led her in 1969 to organize another longitudinal research effort, the Berkley Preschool Nutrition Study, which began with a group of 447 babies and tracked their development to the age of 6.

Huenemann sought "The key to understanding when obesity starts," said Leona R. Shapiro, a retired assistant professor of public health nutrition who helped design the teenagers study. "In her studies, particularly the two longitudinal studies, she got detailed information about how children eat and their physical exercise activity, their body composition, and their relationship with their parents. All kinds of details that had not been organized on that way. She got into details of how they lived," Shapiro said.

Shapiro recalled that one of the most surprising findings from the teenagers study was that adolescence was too late to study the onset of obesity. Children who tended to be overweight were already obese by 14. Signaling the encroachment of television and the growing dependence on cars for transportation, Hueneman found that physical inactivity in infancy

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and early childhood was a more critical factor for obesity that excessive calorie consumption. The studies also provided solid evidence that obesity was related to the income level. Prior to Huenemann's research, people commonly believed that obesity was a problem of the overfed rich, but she showed the inverse to be true. Among children and teenagers, the poor were far more likely to have serious weight problems.

Study 2 RA DeFronzo and E Ferrannini of the University of Texas Health Science Center, San Antonio (2006) said that; The reasons for the association of insulin resistance and essential hypertension can be sought in at least four general types of mechanisms: Na+ retention, sympathetic nervous system over activity, disturbed membrane ion transport, and proliferation of vascular smooth muscle cells. Physiological maneuvers, such as calorie restriction and regular physical exercise, can improve tissue sensitivity to insulin; evidence indicates that these maneuvers can also lower blood pressure in both normotensive and hypertensive individuals. Insulin resistance and hyperinsulinemia are also associated with an atherogenic plasma lipid profile. Elevated plasma insulin concentrations enhance verylow-density lipoprotein (VLDL) synthesis, leading to hypertriglyceridemia.

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Progressive elimination of lipid and apolipoproteins from the VLDL particle leads to an increased formation of intermediate-density and low-density lipoproteins, both of which are atherogenic. Last, insulin, independent of its effects on blood pressure and plasma lipids, is known to be atherogenic. The hormone enhances cholesterol transport into arteriolar smooth muscle cells and increases endogenous lipid synthesis by these cells. Insulin also stimulates the proliferation of arteriolar smooth muscle cells, augments collagen synthesis in the vascular wall, increases the formation of and decreases the regression of lipid plaques, and stimulates the production of various growth factors.

Study 3 Ralph S. Paffenbarger, Jr, MD, DrPH and Steven N. Blair, PED (2005) said that; overweight and obese men with baseline CVD or CVD risk factors were at higher risk for all-cause and CVD mortality compared with normal-weight men without these predictors. Using normal-weight men without CVD as the referent, the strongest predictor of CVD death in obese men was baseline CVD RR’s for obese men with diabetes mellitus, high cholesterol, hypertension, smoking, and low fitness were similar and ranged from 4.4 for smoking to 5.0) for low fitness. Relative risks for all-cause

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mortality in obese men ranged from 2.3 for men with hypertension to 4.7 for those with CVD at baseline. Relative risk for all-cause mortality in obese men with low fitness was 3.1 and in obese men with diabetes mellitus 3.1 and as slightly higher than the RR’s for obese men who smoked or had high cholesterol levels. Low fitness was an independent predictor of mortality in all body mass index groups after adjustment for other mortality predictors. Approximately 50% of obese men had low fitness, which led to a population-attributable risk of 39% for CVD mortality and 44% for all-cause mortality. Baseline CVD had population attribute risks of 51% and 27% for CVD and all-cause mortality, respectively.

Study 4 Beckley (2005) said that ; The idea of metabolic syndrome as a cluster of variables—such as obesity, hypertension, low HDL, high triglycerides, and impaired fasting plasma glucose—whose presence increases a person's risk of cardiovascular disease has attracted great interest but also raised many questions and controversy," says David Eddy, MD, PhD, medical director of Archimedes, Inc. ADA partnered with Archimedes last summer to build Diabetes PHD, a risk calculator that simulates the biology underlying diabetes as well as factors such as co-morbidity risks, medications, and

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treatments. ADA now has asked Eddy and his team to use the Archimedes model to develop the CMR Calculator, a new, interactive tool that by the end of the year will be available to help physicians evaluate the potential impact of variables related to CVD risk. Archimedes already includes factors such as body mass index, waist circumference ratio, fasting plasma glucose, blood pressure, HDL, and triglycerides, as well as age, sex, race/ethnicity, family history, tobacco use, LDL, apolipoprotein B, and C-reactive protein. Simulations of new clinical trials and epidemiological and cohort studies are used to validate the model and compare predictions with results.

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Study 5

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Scott M. Grundy, MD, PhD (2005) said that; it appears that 50% of children who are overweight are also overweight as adults, but it is not possible to identify any individual child who will become an overweight adult. CVD risk factors, such as elevated blood pressure, elevated total cholesterol and LDL cholesterol, and low levels of HDL cholesterol track from childhood, although less strongly than BMI. Overweight children also tend to have a cluster of risk factors. Risk factors tend to occur in families and are especially evident in children when an adult relative is obese. Children with a family history of CVD are heavier than those without family history of disease. All of this suggests that the obese child has an elevated risk of developing CVD in adulthood. Weight gain occurs differently in men and women. The greatest weight gain in men occurs in those with the highest BMI and those in the older age groups. Compared with women, men live longer and are obese later in life. In women, the greatest weight gain is in the younger age groups. Recent epidemiological studies have shown that in women, weight loss is also accompanied by bone loss. Another difference in weight gain between men and women is that as women's educational level rises, obesity decreases, for both white and black women, whereas in men, educational level appears not to be related to obesity.

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Local Studies Study 1 In the study conducted by FNRI in 1998, it was found out that among preschool age children (0-5 yrs. old) 9 of every 1000 are overweight for their height: 1 in every 1000 children are overweight: and 2 in every child, less than 1 year old are overweight for their height. Among children 6-10 years of age, prevalence of overweight is negligible among 6-9 year old children while 2 in every 1000 children are overweight. Among adolescents, 11-19 years old, the female adolescents are more at risk to overweight and obesity (4.7%) than their male counterpart (1.2%).

In the Philippines, Dr. Augusto D. Litonjua, who heads the Philippine Association for the Study of Overweight, a private group, said that in an informal survey of doctors, 25% of patients were overweight. He blamed what he called "malling", which he defined as spending the day in shopping malls and eating at fast food restaurants. Even as they eat, however, many of these people long to be slim. As in the west, the bloating of Asia has been accompanied by a slimming of the ideal of beauty. As American fast food

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chains spread through Asia, they were being followed by a proliferation of gyms, slimming programs, diet pills and liposuction. Study 2 Reyela (200) revealed that the common CVD for obese patient are hypertension which is a persistnt elevation of the arterial blood presure with a systolic blood pressure above 140 mmHg of the diastolic pressure above 90 mmHg, coronary artery disease, cerebrovascular accident and ischemic heart disease which is caused by occulation of the coronary arteries by thrombus formation in areas of narrowing and hardening in these arteries.

Study 3 The same view is held by Alcantara (2000) who emphasized that CVD have become the greatest threat to Filipino today.

Study 4 Bermudez (2001) study reveals that CVD have varied and multi causes and risk factors, ranging from infectious agents, environmental and constitutional causes, some inherited some acquired.

Study 5

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According to Dequina (2000), disease of the cardiovascular system are the most rapidly escalating disease problems of the country today. Study 6 Study of Janairo (2001) reveals that obese patients have a markedly increased evidence of CVD. it is suggested that the increased workload of the heart where obesity may be a significant factor

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Chapter III RESEARCH METHODOLOGY The descriptive method of research was used in this study. Descriptive method of research is a fact – finding study with adequate and accurate interpretation of findings. It describes with emphasis what actually exist such current conditions of group of persons, situations and involves analysis. Since the study was concerned on knowing the level of awareness of obese persons with the risk of having cardiovascular diseases, the descriptive method of research was the appropriate method used. This includes collection of data in order to answer questions concerning current status of the subject of the study.

METHOD USED The data for this study were gathered through the use of the questionnaire. This was supplemented by interview and observation of different computer classes.

Questionnaire

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The main instruments used in conducting the study and to collect data for the study were the questionnaires. This was used because it gathers data transfer than any other method. Besides, the respondents were students, and they are literate, they could read and answer the questions with ease.

Constructions The researchers gathered necessary details on literature and books including dictionaries, encyclopedia, articles, magazines, etc. which should be included in the study. These data are more convenient to use because they are already condensed and organized. The libraries make this data more easily accessible to researchers. Additional information was also gathered from other reliable sources as the internet, which enriched the questionnaires that was prepared.

Validation The data were gathered on selected representatives of College Nursing students of Arellano University through the used of survey questionnaires specifically for the study. Gathered information was analyzed and considered to arrive at accurate and reliable result of this study.

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Administration The researchers distributed the questionnaire to 20 obese nursing students of Arellano University. This was retrieved at a given time set and agreed by both the respondents and the researchers.

Interview Interview was one of the techniques used in gathering data for the study, a purposeful information interview was conducted to selected nursing students of Arellano University which are the respondent of the study. The researchers approached and interviewed the students to enable for them gain insights related to the study.

Observation To enable the researchers to gather sufficient data to supplement and verify information’s gathered through questionnaire and interview on obese nursing students of Arellano University, observation method was also used. This was employed using the senses to gather relevant information about obesity.

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RESPONDENTS OF THE STUDY The respondents of the conducted study regarding obesity awareness are twenty obese nursing students of Arellano University of school year 2006 – 2007.

SAMPLING PROCEDURE Twenty obese nursing students of Arellano University were taken for school year 2006 – 2007, with the use of Random sampling procedure.

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Chapter IV PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA Age 21 – 23 18 – 20 15 – 17 TOTAL

Number of Respondents 4 13 3 20

Percentage (%) 20.00 65.00 15.00 100 .00

Table I DISTRIBUTION OF RESPONDENTS IN TERMS OF AGE

As shown in Table I the distribution of respondents in terms of age, the majority of the respondents which is thirteen or sixty five percent belongs to 18 – 20 yrs. old, four or twenty percent belongs to 21 to 23 yrs. old, and three or fifteen percent respondents belongs to age bracket between 15 – 17 yrs. old.

Table II Gender Male Female TOTAL

Number of Respondents 10 10 20

Percentage (%) 50.00 50.00 100.00

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Table II shows the distribution of respondents in terms of gender, the male population is fifty percent which is a total of ten, and so in females. Gender in this case, has not been a very strong risk factor for obesity. People might be obese no matter what gender they do have.

Table III DISTRIBUTION OF RESPONDENTS IN TERMS OF HEIGHT Height 5’6” – 5’11” 5’0” – 5’5” 4’6” – 4’11” 4’0” – 4’5” TOTAL

Number of Respondents 2 16 1 1 20

Percentage (%) 10.00 80.00 5.00 5.00 100.00

Table III exhibits that sixteen or eighty percent of the total number of respondents, which is evidently the majority, belongs to 5’0” – 5’5” height bracket. Ten percent or two of which are 5’6” – 5’11” in height, while those who belong to the height bracket of 4’6” – 4’11” and 4’0” – 4’5” are equally five percent. Height is a crucial factor for getting the Body Mass Index of a person, and therefore being able to determine if a person is obese or not. But in this case, people of normal height range still became susceptible to having

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weight problems, and this concludes that physical appearance is not enough in determining a health condition per se.

Table IV DISTRIBUTION OF RESPONDENTS IN TERMS OF WEIGHT

Weight (kg) 99 - above 89 – 98 79 - 88 69 – 78 59 – 68 TOTAL

Number of Respondents 2 6 4 4 4 20

Percentage (%) 10.00 30.00 20.00 20.00 20.00 100.00

This table presents the weight of the respondents, that six or thirty percent of them belongs to the weight bracket of 89 – 98 kilograms which is considered to be the highest, while the rest of them which have four or twenty percent belongs to the weight bracket 79 – 88 kilograms, 69 – 78 kilograms and 59 – 68 kilograms that have the same number and percentage. According to the BMI weight status categories, anyone with a BMI over 25 would be classified as overweight and anyone with a BMI over 30 would be classified as obese. Although some people with a BMI in the overweight range (from 25.0 to 29.9) may not have excess body fatness,

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most people with a BMI in the obese range (equal to or greater than 30) will have increased levels of body fatness. And thus, may be concluded that obesity may not be definite unless clinically diagnosed even after physical assessment.

Table V DISTRIBUTION OF RESPONDENTS IN TERMS OF RELIGION

As shown in the table above, it shows the distribution of religion of the respondents, that majority of them are Roman Catholic which have Religion Number of Respondents Percentage (%) Roman Catholic 19 95.00 Iglesia ni Kristo 1 5.00 TOTAL 20 100.00 nineteen or ninety five percent of the total number of the respondents while only one or five percent for Iglesia ni Kristo. Regardless of religion, obese still have a high risk of having cardiovascular disease.

Table VI DISTRIBUTION OF RESPONDENTS IN TERMS OF PHYSICAL ACTIVITY

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According to table VI it shows that twelve or sixty percent of the respondents are performing exercise while only eight or forty percent of Regularity Number of Respondents Exercise Number of Respondents Once a day 4 Yes 12 Once a week 3 No 8 Twice a week 3 TOTAL 20 Once a month 2 TOTAL 12 them do not engage in any physical activity.

Percentage (%) Percentage (%) 33.00 60.00 25.00 40.00 25.00 100.00 17.00 100.00

Physical inactivity has been known to contribute in obesity. When food energy intake exceeds energy expenditure, fat cells throughout the body take in the energy and store it as fat. In all individuals, the excess energy utilized to generate fat reserves is minute relative to the total number of calories consumed. This means that very fine perturbations in the energy balance can lead to large fluctuations in weight over time. And thus, hesitance to perform exercises could increase the amount of excess energy inside the body system.

Table VII DISTRIBUTION OF RESPONDENTS IN TERMS OF REGULARITY OF PHYSICAL ACTIVITY

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Table VII, regularity of exercise shows that thirty three percent or four are used of having exercise daily, while there are twenty five percent or three for once a week and twice a week regularity of exercise, and only two or seventeen percent for the rest of them who are having exercise once a Form Number of Respondents Percentage (%) Aerobic 9 75.00 Anaerobic 3 25.00 TOTAL 12 100.00 month. Exercising daily produces healthy life to an individual, exercising once or twice a week is not bad considering the routine and time management of an individual. Once a month is not quite adequate for their intake whether solid or liquid, but at least it’s better than nothing.

Table VIII DISTRIBUTION OF RESPONDENTS IN TERMS OF EXERCISE PREFERENCE

The exercise preferences of the respondents has a greater choice of aerobic exercise having seventy five percent or a frequency of nine, while

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three or twenty five percent out of twelve respondents choose anaerobic exercise. This table shows that few of the respondents give special time for their exercise; some of them go to a gym or a sports complex. It means that only a small number of them is willing to spend much of their time to burn their calories, live a healthy life, and promote well being by considering exercise as part of their routine. While most of them only depend on their daily activities like walking and do not focus on burning calories.

Table IX DISTRIBUTION OF RESPONDENTS ACCORDING TO SMOKING PREFERENCE Smoking Yes No TOTAL

Number of Respondents 14 6 20

Percentage (%) 70.00 30.00 100.00

Table IX shows that the majority, which is seventy percent of the respondent population do smoke or have tried smoking at least once, and the remaining thirty percent of which, don’t.

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Table X DISTRIBUTION OF RESPONDENTS ACCORDING TO SMOKING FREQUENCY Frequency Everyday Weekly Occasionally TOTAL

Number of Respondents 6 0 8 14

Percentage (%) 43.00 0.00 57.00 100.00

As shown in Table X, shown that the distribution of respondents in terms frequency of their smoking, eight or seventy percent, which is the majority of the respondents, only smoke occasionally, while the remaining six or forty three percent of which, habitually smokes everyday.

Table XI DISTRIBUTION OF RESPONDENTS ACCORDING TO ALCOHOL DRINKING FREQUENCY Frequency Everyday Weekly Occasionally TOTAL

Number of Respondents 1 4 15 20

Percentage (%) 5.00 20.00 75.00 100.00

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Table XI presents how often do the respondents consume alcoholic drinks. It is evident that fifteen or seventy-five percent of the total number of subjects asked drink alcohol occasionally, four people or twenty percent drink weekly, and the remaining individual, which is five percent of the total, drinks everyday. As presented, most of the respondents only drink alcoholic beverages as their way of socializing or when other matters permit them to. Drinking alcohol has not been a part of their daily routine, and thus, only consume them for purposes as exhibited by some circumstances. We can assume that the subjects, which in this case are nursing students, are somehow aware of the health complications that alcohol-over-consumption may cause.

Table XII PHYSIOLOGICAL FACTORS AFFECTING OBESITY Physiological Factors Slow Metabolism Excess Starch Diet Food Intolerance TOTAL

Number of Respondents 8 4 8 20

Percentage (%) 40.00 20.00 40.00 100.00

The tabulated data shows some physiological factors that influence the population's eating and health conditions, and thus, making them

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susceptible to increasing their risk for being obese. These factors are often preventable, and manageable, that's why it is extremely important that the people are aware of these things. As presented, slow metabolism and food intolerance exhibited the equally greater percentage of the physiological factors, which is forty percent of the total. These aspects are self-manageable, and could be treated without any help from the health service providers. Since that is the case, it can be concluded that it could be all up to the patient alone if slow metabolism and .food intolerance are solely considered, when ruling out other health problems that may lead to obesity. While some respondents say that excess starch in their diet probably contributes to obesity problems, which in any circumstance, is preventable and depends much on the food preference in eating, and on the body's capability to metabolize starch of any form.

Table XIII ENVIRONMENTAL FACTORS AFFECTING OBESITY Environmental Factors Number of Respondents Physical Inactivity 8 Stress 12 TOTAL 20

Percentage (%) 40.00 60.00 100.00

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Table XIII exhibits some of the environmental factors that relatively affect or often lead to or become a cause of the obesity of a person. Lack of physical activity demonstrated got the percentage of forty-three percent, and for which is considered as a very significant controlling factor for those suffering from obesity. Stress, sixty percent, which nowadays is experienced by majority of the population, increases greatly the predisposal of people to overeat and worsen their metabolic abnormality - which in effect, could cause obesity.

Table XIV DISTRIBUTION OF RESPONDENTS IN TERMS OF AWARENESS THAT OBESITY COULD LEAD TO CARDIOVASCULAR DISEASE Awareness Yes No TOTAL

Number of Respondents 16 4 20

Percentage (%) 80.00 20.00 100.00

Table XIV illustrates that sixteen of twenty chosen respondents, eighty percent of which do believe that their weight problem could definitely predispose their health to other complications such as Cardiovascular

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Disease. And while the other twenty percent are not yet aware of the health, problems that they could suffer from due to their condition. Greater risk awaits obese individuals who are not at all aware of the complications, it is manifested in such a way that they tend to overlook their indifference and continue to disregard important health concerns, as long as they feel confident that they are not ill. Table XV DISTRIBUTION OF RESPONDENTS IN TERMS OF COMPLICATIONS AS MANIFESTED BY HEALTH-RELATED PROBLEMS Complications Yes No TOTAL

Number of Respondents 2 18 20

Percentage (%) 10.00 90.00 100.00

As presented in the table above, ten percent of the obese respondents are suffering from health-related problems which resulted into such as a complication of their abnormal BMI status. The remaining ninety percent appeared not to be suffering from any health problem; although in this case, it is not easily determined as such. They might be unconsciously experiencing troubles that they just ignore, or presume not to be serious at all to be considered an obesity complication.

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Table XVI DISTRIBUTION OF RESPONDENTS ACCORDING TO THEIR VIEW ABOUT LIFESTYLE MODIFICATION

Lifestyle Modification Number of Respondents Yes 15 No 5 TOTAL 20

Percentage (%) 75.00 25.00 100.00

As represented by the table above, only fifteen respondents, seventyfive of the total, in terms of their lifestyle activities prefer to modify their daily routine and engage into physical activities much more often in order to decrease their risk of developing health-related complications.

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Chapter V SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

The study aimed to assess the knowledge of Obese Arellano Nursing Students with regard to their awareness of the risk of having Cardiovascular Diseases. Involved in the study were 20 Obese Nursing Students of Arellano University. A questionnaire prepared by the researcher was utilized. Interview and observation were also employed to supplement the data collected from the questionnaire. SUMMARY OF FINDINGS

Through the procedure described above, the following questions have been answered:

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Specific Problem Number 1 Respondent’s Profile

1.

1.1 Sixty five percent of the total respondents belonged to age bracket 18 – 20 yrs. old. 1.2 The respondents were equally divided among men and women. 1.3 Majority of the total number of respondents belonged to 5’0” – 5’5”

height bracket. 1.4 Thirty percent of the respondents belonged to the weight bracket of

89 – 98 kilograms. 1.5 Ninety five percent of the respondents were Roman Catholic. 2. Physical Status 2.1 Sixty percent of the respondents were performing exercise.

2.1.1. Majority of the respondents were used of having exercise daily. 2.1.2. The exercise preferences of the respondents had a greater choice of aerobic exercise having seventy five percent. 2.2.

Seventy percent of the respondent population did smoke or had tried smoking at least once.

2.2.1. Seventy percent was the majority of the respondents only smoke occasionally.

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2.2.2. It was evident that Seventy-five percent of the total number of subjects asked drink alcohol occasionally.

Factors Affecting Obesity

3.

Slow metabolism and food intolerance exhibited the equally

3.1.

greater percentage which was forty percent in total. 3.2.

Stress, the leading factor which nowadays was experienced by majority of the population, increased greatly the predisposal of people to overeat and worsen their metabolic abnormality - which in effect, could cause obesity.

4. Respondent’s Awareness 4.1 Do you consider yourself obese? – 4.2 Eighty percent of which did believed that their weight problem could

definitely predispose their health to other complications such as Cardiovascular Disease. 5. Complications 5.1 Most of the respondents appeared not to be suffering from any health

problem.

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6. Lifestyle Modification 6.1 Seventy-five percent of the total, in terms of their lifestyle activities

preferred to modify their daily routine and engaged into physical activities much more often.

CONCLUSIONS Based on the analysis and findings, the following conclusions were drawn: 1. That there are more obese on the age of 18-20 year old. 2. There are same number of men and women in terms of gender. 3. The most common height of the obese is 5’0”-5’5”. 4. Majority of the obese gaining 89-98 kilogram in weight. 5. Almost every one of the obese is Roman Catholic. 6. Most of the obese are performing exercise. 7. Daily exercising is practice by more number of the obese. 8. Aerobic exercise is the choice of the obese. 9. There are more obese that are smokers than non-smokers. 10.Obese take cigarette smoking occasionally. 11.Most of the obese drink occasionally.

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12.Both slow metabolism and food intolerance are considering the physiologic factor affecting their obesity. 13.Stress is the most common factor in the environment of the obese. 14.Almost every on of the obese are aware that they have the high risk of having Cardiovascular Disease. 15.Few of the obese is suffering from any health disturbances. 16.Modifying daily routine and engaging into physical activities are the positive perception of the obese in their lifestyle.

RECOMMENDATIONS Having a fit and healthy body keeps an individual in living a normal life. It is one's most prized possessions, and thus, truly deserves to be taken care of. A bright future and positive outlook in life beings here and continues thereon. The following recommendations towards developing a healthy lifestyle are hereby offered by the researchers in order to promote obesity awareness:

1. Teenagers nowadays are also prone in developing healthrelated problems, so as early as they could, teenagers should watch what they eat, and engage devotedly in physical and

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recreational activities in order to keep or further improve their healthy lifestyle. With this, health diseases, as well as obesity, could be prevented as early as possible. 2. Parents should also be aware of their children's environment, and its influence to them. They should properly educate and habituate their children in doing the right things in order to preserve their health. Proper food nutrition and discipline are important factors that must be implemented by the parents in or out of their home. Prevention, as always mentioned, is way better than cure. 3. Schools, as teenagers' second home should provide proper education, and hence, a good working environment to students in order to improve their health awareness and practice. Physical education must be administered to students as part of the school's curriculum so that the children could explore the environment and go beyond the theoretical side. Engagement into sports and practicing discipline in eating are just some of the recommendations. 4. The government must place a higher emphasis on foods' nutritional values in public assistance programs, and also,

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determine control upon the products sold in the market. They should implement programs in order to increase public awareness and to encourage people to maintain a healthy lifestyle. Some of which are: obesity screening, and obesityrelated disease management that bolsters preventive care. 5. As the greatest influence to the public people, television stations must inculcate health improvement and awareness thru production of good-to-know advertisements regarding health. 6. To the public, it is important that they are aware and disciplined enough to execute health improvement processes. They should take advantage of the knowing that obesity has a great role on the development of different chronic diseases. 7. Further study on determining the prevention measures to impart in order to reduce obesity epidemic to its lowest possible range. 8. A further study using much broader scope, and a higher or increased number of respondents as one community, etc.

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BIBLIOGRAPHY A. Book Smeltzer, Suzane C. and G Bare Medical, Surgical Nursing Volume II, J.B Lippincott Company, Philippines Atkinso, Lucyjo and Nancy Marie Fortunato, Berry and Kohn’s Operating room Technique And Edition, Nancy L. Coon, Mosby- Year Book Incorporation 11830, Industrial West line Drive St. Louis, Missouri 63146 Kozier, Barbara, and Glenora Erb, and Audrey Berman and Shirlee Snyder, Fundamentals of Nursing, Seventh Edition, Pearson Education South Asia PTELTD, Philippines 2004.

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B. Periodicals Office of the Secretary Department of Health Sector Reform Agenda, Health Beat, January - February 2000, Sprinoer Publishing Company Inc. New York C. Others Dela Cruz O, Nursing Care Management of Patient with cardiovascular disease Basis for an action Plan, March 2004, Master Thesis, Arellano University Victor, Lucio C., Obesity bring forth many chronic Disease, January 2006, Peter G. Kopelman, Obesity as a medical problem, Nature 404, 635 - 643 (2000). Hubert HB,and M Feinleib, and PM McNamara, and WP Castelli, Obesity as an independent risk factor for cardiovascular disease: a 26-year followup of participants in the Framingham Heart Study, Circulation, 67(5):96877 (1983) Berg, Anders H.,and Philipp E. Scherer, Adipose Tissue, Inflammation, and Cardiovascular Disease, Circulation Research 96:939 (2005). Licata, G. et al., Effect of obesity on left ventricular function studied by radionuclide angiography, Int. J. Obesity 15, 295-302 (1991).

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APPENDIX A LETTER OF PERMISSION TO CONDUCT THE RESEARCH ARELLANO UNIVERSITY SCHOOL OF NURSING LEGARDA, MANILA, PHILIPPINES

29 January 2007 Rosita B. Bulanadi R.N.,M.A.N. DEAN, School of Nursing Arellano University Legarda, Manila Thru: Loida A. Arias R.N.,M.A.N. Level-III Chairman Dear Madam,

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The undersigned, Group four (IV) Level three (III) section twenty five (25) nursing students of Arellano University is currently undertaking a research study entitled “Level of Awareness of Obese Persons on the Risk of Having Cardiovascular Diseases”. In view thereof, the researchers would like to request your permission to undertake the study in this University with at least twenty (20) respondents. Rest assured that all information derived will be treated with utmost confidentiality. Thank you very much for your kind support and assistance. Respectfully Yours, Group IV Level III-25 APPENDIX B SURVEY QUESTIONNAIRE FOR ARELLANO NURSING STUDENTS Direction: Please check the proper information corresponding to your answer. 1. Respondent’s Profile 1.1.Age ___ 15 – 17 yrs. Old ___ 18 – 20 yrs. Old ___ 21 – 23 yrs. Old 1.2.Gender ___ Male

___Female

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1.3.Height ___ 4’0” – 4’5” ___ 4’6” – 4’11”

___ 5’0”– 5’5” ___ 5’6”– 5’11”

1.4. Weight Please indicate your weight in pounds (lbs.) or in kilograms

(kg.). ____________ 1.5.Religion ___Roman Catholic

___Islam

___Jehovah’s Witness

___Protestant

___Iglesia ni Kristo

Others please specify

___________

2. Physical Status 2.1.Do you exercise? ___ Yes

___ No

2.1.a. If Yes, how often? ___ Once a day

___ Twice a week

___ Once a week

___ Once a month

Others please specify ____________ 2.1.b. What form of exercise? ___ Aerobic (walking, jogging, biking, etc.) ___ Anaerobic (weight-lifting, and the like) 2.2.Do you smoke or at least have tried to? ___ Yes

___ No

2.2.a. If Yes, how often? ___ Everyday

___ Occasionally

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___ Weekly 2.2.b. Do you drink alcoholic beverages? ___ Everyday

___ Occasionally

___ Weekly 3. Factors affecting Obesity 3.1.What physiological factor/s you think has/have mostly influenced your diet? ___ Slow metabolism ___ Food intolerance ___ Excess starch diet Others please specify _______________ 3.2.What environmental factor/s you think has/have mostly influenced your diet? ___ Physical Inactivity ___ Stress Others please specify ________________ 4. Respondent’s Awareness 4.1.Do you consider yourself obese? ___ Yes

___ No

4.2.Are you aware that obesity could lead to Cardiovascular Disease? ___ Yes

___ No

5. Complications 5.1.Are you presently suffering from any health-related problems? ___ Yes

___ No

5.2.If Yes, please specify. ________________________________________________________

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6. Lifestyle Modification 6.1.Are you planning of modifying your lifestyle in order to improve your health and promote wellness? ___ Yes

___ No

6.2.If yes, how? ________________________________________________________

CURRICULUM VITAE 1. Name: Sanchez, Donnabelle C. Course: Bachelor of Science in Nursing Address: Lot 23 blk 12 Alfalfa St. Robinson Homes Brgy. Dalig Antipolo City 1870 2. Name: Sanchez, Kates Endee M. Course: Bachelor of Science in Nursing Address: Lot 1 blk 6 Jasmin St. Ts Cruz Las Pinas 3. Name: Santos, Ana Margarita D. Course: Bachelor of Science in Nursing Address: 56 k 13th avenue Murphy Cubao Quezon City 4. Name: Santos, Angel Lynn Course: Bachelor of Science in Nursing Address: 2050 B Legarda St. Quiapo, Manila 5. Name: Santos, Christian Robert M. Course: Bachelor of Science in Nursing

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Address: 218 Kanlaon St. Laloma Quezon City 6. Name: Santos, Joren Alfaro Course: Bachelor of Science in Nursing Address: 1021 C Dagupan St. Tondo Manila 1012 7. Name: Santos, Lord Izon O. Course: Bachelor of Science in Nursing Address: 27 Int. Herrera St. Malabon City 8. Name: Santos, Maria Carolina A. Course: Bachelor of Science in Nursing Address: Blk 9 Lot 13 Phase 2 Peace Village Antipolo City 9. Name: Simundac, Ronald Course: Bachelor of Science in Nursing Address: 3934 Araro St. Palonan Makati City 10. Name: Subropena, Carolyn C. Course: Bachelor of Science in Nursing Address: Blk 149 lot 2 Katatagan St. Karangalan Village Cainta Rizal 11. Name: Yu, Ian Vincent Course: Bachelor of Science in Nursing Address: 450 Makisig St. Bacood Sta. Mesa Manila

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