Impact of a multidimensional weight-management programme on the weight status and associated factors of first-year female students

Cilliers, Janetta (2004-03)

Thesis (MSc Nutrition Science)--Stellenbosch University, 2004.

Thesis

ENGLISH ABSTRACT: First-year female students (FYFS), studying at the University of Stellenbosch were previously identified as a high-risk group for gaining weight. A four-year follow-up of these female students indicated that a large percentage experience weight fluctuations throughout their university careers. The unique weight management needs of the FYFS were also identified in the longitudinal study. The integration of these results with an extensive search and assessment of the weight management literature led to the development of a multidimensional weight-management paradigm for application in the development of weight-management interventions for female students. Subsequently, a self-help weight-management manual, which follows the multidimensional approach proposed in the mentioned paradigm, was developed to address the unique weight-management needs of female students. The aim of the current study was to evaluate the impact of the multidimensional self-help weightmanagement manual (the Manual) on the weight status and associated factors of FYFS at the University of Stellenbosch over an eight-month period. For this purpose a non-randomized quasi-experimental design was used, including purposively selected experimental and control groups. Data were obtained during February (Baseline), May (three months after baseline = Follow-up I) and October 2002 (eight months after baseline = Follow-up 2). All students in the experimental group received the Manual at Baseline for use during the eight-month study period. Because this was a low-intensity intervention programme, no further contact was made with either group during the study period, except when Followup I data were obtained. Measures that were taken and instruments that were completed include the following: weight, height, triceps skinfoid, mid-upper ann circumference, hip circumference, waist circumference, Adolescent Self-Concept Scale (self-concept), Body Shape Questionnaire (body shape concerns), Eating Attitudes Test (eating attitudes and behaviours), General Health Questionnaire (general psychological well-being), 90-item Semi-quantified Food Frequency Questionnaire (dietary intake from nine food groups), and the Baecke Questionnaire of Habitual Physical Activity (physical activity). Additional questions on weight related perceptions and practices, dissatisfaction with body parts, reasons for eating and socio-demographic factors were also included. The Baseline characteristics of the FYFS involved in this study, which did not differ between the experimental and control groups for all key variables, identified them as a typical group of young female adults who are healthy but are not realistic about their weight status and who experience numerous problems related to their weight status. The implementation of the Manual was found to be significantly effective in limiting weight gain among the FYFS in the experimental group. The control group experienced almost a full unit increase in BMI (0.93 kg/m²), while the increase found for experimental group was 0.53 kg/m² (p=0.004). Although the weight of both groups increased initially the experimental group went on to lose weight, while the control group continued to gain weight during the last five months of the intervention. The impact of the Manual is further illustrated by the fact that the FYFS in the experimental group who indicated that they did Lise the Manual extensively experienced a significantly lower rise in their weight (change in BMI over study period = 0.37 kg/m²) than those in the experimental group who indicated that they did not use the Manual (change in BMI over study period = 0.89 kg/m²). Factors that are possibly linked to the success attained with the Manual were identified and include more reasonable weight goals; the use of sound weightreduction methods such as a balanced diet and physical activity; improvements in self-concept; maintenance of physical activity levels, especially during the first three months at university; improvement in general psychological well-being; decreased intake of foods from the "other" (includes mainly high fat, sugar based foods such as doughnuts, cookies, cake, tart), beverage and grains food groups; and possibly less concerns with body shape from the start. Factors for which no link with weight management success could be established include changes in body composition; perceptions of own weight; weight loss attempts; foods from the vegetables, fruit, milk and cheese, meat, fish and chicken, fats and fast foods food groups; physical activity over the total eight-month period; reasons for eating; eating attitudes and behaviour; dissatisfaction with body parts; and body shape concerns. It is recommended that the implementation of the Manual on the campus of the University of Stellenbosch to prevent weight gain of FYFS should be considered, bearing in mind some of the recommendations formulated by the FYFS in the experimental group.

AFRIKAANSE OPSOMMING: Eerstejaar damestudente wat aan die Universiteit van Stellenbosch studeer is voorheen geïdentifiseer as 'n hoë risiko groep vir gewigstoename. 'n Vier-jaar opvolg van hierdie damestudente het aangedui dat 'n groot persentasie vir die duur van hul universiteitsloopbane gewigsfluktuasies ondervind. Die unieke gewigshanteringsbehoeftes van die eerstejaar damestudente is ook tydens die longitudinale studie geïdentifiseer. Die integrasie van hierdie resultate met 'n uitgebreide soektog en ontleding van die literatuur wat betrekking het op gewigshantering het aanleiding gegee tot die ontwikkeling van 'n multidimensionele gewigshanteringsparadigma wat gebruik kan word tydens die ontwikkeling van gewigshanteringsintervensies vir damestudente. As 'n volgende stap is 'n self-help gewigshanterings handleiding, wat die multidimensionele benadering voorgestel in die genoemde paradigma volg, ontwikkelom die unieke gewigshanteringsbehoeftes van damestudente aan te spreek. Die doel van die huidige studie was om die impak van die multidimensionele self-help gewigshanteringshandleiding (die Handleiding) op die gewigstatus en geassosieerde faktore van eerstejaar damestudente aan die Universiteit van Stellenbosch oor 'n tydperk van agt maande, te evalueer. Vir hierdie doeleinde is 'n nie-gerandomiseerde kwasi-eksperimentele ontwerp gebruik, wat doelbewus geselekteerde eksperimentele en kontrole groepe ingesluit het. Data is gedurende Februarie (Basislyn), Mei (drie maande na basislyn = Opvolg-I) en Oktober (agt maande na basislyn = Opvolg-2) 2002 versamel. Alle studente in die eksperimentele group het die Handleiding tydens Basislyn ontvang vir gebruik tydens die agt maande studieperiode. Omdat dit 'n lae-intensiteit intervensie program was, is geen verdere kontak gedurende die studieperiode met beide die groepe gemaak nie, behalwe tydens die versameling van Opvolg-I data. Metings wat geneem is en instrumente wat voltooi is, sluit die volgende in: gewig, lengte, triseps velvou, mid-bo-armomtrek, heupomtrek, middelomtrek, "Adolescent Self- Concept Scale" (self-konsep), "Body Shape Questionnaire" (besorgdheid oor liggaamsvorm), "Eating Attitudes Test" (eetgedrag en -houding), "General Health Questionnaire" (algemene sielkundige welstand), 90-item semi-gekwantifiseerde voedselfrekwensievraelys (dieetinname van nege voedselgroepe), en die "Baecke Questionnaire of Habitual Physical Activity" (fisieke aktiwiteit). Addisionele vrae aangaande gewigsverwante persepsies en praktyke, ontevredenheid met liggaamsdele, redes vir eet en sosio-demografiese faktore is ook ingesluit. Die Basislyn eienskappe van die eerstejaar damesstudente wat aan hierdie studie deelgeneem het, het nie tussen die eksperimentele en kontrole groepe vir alle sleutelveranderlikes verskil nie. Hierdie inligting het ook daarop gedui dat die studente 'n tipiese groep jong vroulike volwassenes is wat gesond is maar, onrealisties is oor hul gewigstatus en baie gewigstatusverwante probleme ondervind. Die resultate toon dat die implementering van die Handleiding beduidend effektief was om die gewigstoename by eerstejaar damestudente in die eksperimentele groep te beperk. Die gewig van die kontrole groep het byna 'n volle LMI eenheid (0.93 kg/m²) toegeneem terwyl die toename vir die eksperimentele groep 0.53 kg/m² was. Alhoewel die gewig van beide groepe aanvanklik toegeneem het, het die eksperimentele groep daarna gewig verloor terwyl die kontrole groep se gewig gedurende die laaste vyf maande van die intervensie verder toegeneem het. Die impak van die Handleiding word verder geïllustreer deur die feit dat die eerstejaar damesstudente in die eksperimentele groep wat aangedui het dat hul wel die Handleiding ekstensief gebruik het, 'n beduidend laer toename in gewig (LMI verandering gedurende studieperiode = 0.37 kg/m²) ondervind het as die studente in die eksperimentele groep wat aangedui het dat hul nie die Handleiding gebruik het nie (LMI verandering gedurende studieperiode = 0.89 kg/m²). Faktore wat moontlik gekoppel kan word aan die sukses verkry met die Handleiding is geïdentifiseer en sluit die volgende in: meer redelike gewigsdoelwitte; die gebruik van veilige gewigsverlies metodes soos 'n gebalanseerde dieet and fisieke aktiwiteit; verbetering van self-konsep; handhawing van fisieke aktiwiteitsvlakke, veral gedurende die eerste drie maande op universiteit; verbetering van algemene sielkundige welstand; verlaagde inname van voedsel van die "ander-" (sluit hoofsaaklik hoë vet, suiker gebasseerde voedsels soos oliebolle, koekies en tert in), drankies- en graanvoedselgroepe; en moontlik minder besorgdheid oor liggaamsvorm van die begin af. Faktore waarvoor geen verband met sukses met gewigshantering gevind is nie sluit die volgende in: liggaamsamestelling; persepsies van gewig; gewigsverliespogings; voedselinname uit die groente-, vrugte-, melk en kaas-, vleis, vis en hoender-, vette- en kitskosse-voedselgroepe; fisieke aktiwiteit gedurende die totale agtmaande periode; redes vir eet; eetgedrag en -houding; ontevredenheid met liggaamsdele; en besorgdheid oor liggaamsvorm. Dit word aanbeveel dat die implementasie van die Handleiding op die kampus van die Univérsiteit van Stellenbosch oorweeg word om gewigstoename van eerstejaar damesstudente te voorkom. Dit word ook aanbeveel dat die aanbevelings van die studente in die eksperimentele groep in hierdie verband, in ag geneem moet word.

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