Research Article :
The study
provides evidence that the school environment is an ideal setting for trained
educators to provide, unbiased, objective and appropriate information that
learners can relate to and apply in daily life. The nutrition programme in this
study was based on scientific evidence and proved to be very successful in that
a stable balance in the number of obese and overweight learners in session one
and two was maintained, despite the challenges and changes that the grade eight
learners were exposed to in a new environment. On the basis of this study,
recommendations are made for revising the national curriculum as it applies to
nutrition education, at all levels. An
ethical clearance application form was completed and submitted to the Ethics
committee for approval in October 2016. The Ethics Committee referred the
application to the Biomedical Research Ethics Committee at the University of
KwaZulu Natal (BREC). The application for Ethics from the Biomedical Research
Ethics Committee at the University of KwaZulu Natal was an extensive process
and involved an in-depth study of ethics and verification of field workers by
means of curricula vitarum, particulars and curriculum vitae of all co-authors.
In addition, the Biomedical Research Ethics requirements included the
completion of two time-limited, online examinations on ethics. This online
examination was completed on 14 November 2016. The results from both
examinations were successful and the necessary certifications (Annexure K-L)
were issued. The application was completed and acknowledged on the 21 November
2016. Permission to conduct the study was received on the 11 January 2017 from
BREC (Annexure J). Permission
was sought in writing from the school where the research was conducted. The
letter to the school principal outlined the aims and objectives, sample, data
collection methods, data analysis, ethical consideration as well as the value
of the study to the participants and the local community and requested
permission to conduct the study at the school (Annexure B). The principal
granted permission in writing to conduct the research at the school (Annexure
D). The
parents were briefed on the nature of the study on the 05 November at 8H30 in
the school hall during the grade eight information session. All the
parents/guardians of the grade eights that signed the consent forms were
present at the meeting at school. The parents and learners were briefed on the
aims and objectives of the researcher, data collection methods and procedure,
ethical consideration, value of the study and the intervention session to reinforce
healthy eating and healthy lifestyles. The parents and learners were also
briefed on the consent form that contains all the information about the data
collection and management of data. The proposed dates for data collection were
21 January 2017 and 20 May 2017. Parents were given an opportunity to ask
questions about the research in an open meeting. The principal researcher was
also available after the parent meeting to discuss any concerns that parents
had with regard to the research. This
was South African study conducted in KwaZulu–Natal that addressed the issue of
obesity, overweight and nutrient deficiency amongst grade eight girls in a
school in Durban Central. The learners at that school came from a diverse
cultural and racial background. This was a study in an urban area. The
sample group consists of learners
from grade eight attending a public secondary school in Durban Central. The
school was purposely selected for convenience of the research. The learner
enrolment in 2017 for grade eight was 210 learners; however, the learners
included in the study were only the learners who had completed both the
parent/guardian and learner informed consent forms. No restrictions on age were
placed on the learners from grade eight. The sample group consisted of 90
participants from a diverse cultural, religious and socioeconomic background
from the grade eight learners who were enrolled in 2017. The register for the
nutrition programme included only the 90 participants. The
main aim of quantitative research, according to given (2008, pp. 827-831), is
to cultivate and engage mathematical models, theories and hypotheses with
regard to a phenomena. Additionally, the process of measurement is key to
quantitative research, owing to the fact that it based on pillars of empirical
observation and mathematical expression such as statistics and percentages. The
characteristics of quantitative research identified above by given (2008, pp.
827-831) are relevant to my study because most of the data that I have worked
with is derived from measurements and the interpretation is represented in
tables, graphs and percentages. Food intake was
measured using the 24 hour food recall and the Quantified Food Frequency
Questionnaire (QFFQ). Anthropometric measurements were conducted to determine
overweight and obesity. 24
hour food recall questionnaire and QFFQ. The 24 hour food recall questionnaire
and the QFFQ was designed by the South African Medical Research Council and
compiled by Steyn & Senekal (1991) to gain data on food intake over a
period of time. The field workers had to complete the 24 hour food recall
questionnaires and the QFFQ questionnaires with the participants. The 24 hour
food recall questionnaire and QFFQ was completed in session one and session two. The
study made use of anthropometry measurements and structured questionnaires to
collect data (24 hour recall and Quantified Food Frequency Questionnaire).
According to Whati, Senekal, Steyn, Lombard, and Nel (2009, pp. 1839-1845),
these assessment strategies are effective in dietary assessment and nutrition
education. These key activities are part of determining the nutritional status
of individuals or groups. The outcomes of these activities are beneficial for
researchers as well as helping individuals deal with nutrition-related health
conditions. Anthropometry
was used to determine the prevalence of overweight and obesity amongst school
children in grade eight. Due to the fact that the BMI measurements had to be
taken once before the intervention and once after the intervention programme,
the same field workers were involved in conducting both sets of measurements.
Two field workers had to complete the BMI measurements: one field worker was
involved in consistently measuring and calling out the correct information,
while the other recorded the measurements that are called out. Weight: A
calibrated scale was used, balanced to within 50g (electronic) or 100g (if beam
balance). The field workers had to calibrate scale regularly to ensure accuracy
of the measurements. Subject had minimal clothing on, and no shoes or socks.
The scale was checked for a zero reading. Height: Standing height
(stretch stature) was used as a key measure and a stadiometer was used to
record height. The field workers ensured that they placed the SECA stadiometer
on a flat even surface, with the extension balanced against a wall. The
participants head had to be in the Frankfort horizontal plane, with heels,
buttocks and shoulder blades touching the back of the stadiometer. Subjects had
to take a deep breath and hold, then measurement was taken. Measurements was
read at eye level
and taken to the nearest 0.1 cm. Height: Standing height (stretch stature) was
used as a key measure and a stadiometer was used to record height. The field
workers ensured that they placed the SECA stadiometer on a flat even surface,
with the extension balanced against a wall. The participants head had to be in
the Frankfort horizontal plane, with heels, buttocks and shoulder blades
touching the back of the stadiometer. Subjects had to take a deep breath and
hold, and then measurement was taken. Measurements was read at eye level and
taken to the nearest 0.1 cm. The
intervention programme was designed by the principal researcher. It included a
series of lessons based on the SAFBDG and reflected on the South African Food
Pyramid to guide participants on changing their current habits of eating too
much unhealthy food.
The lessons were based on practical ways of preparing and eating the correct
amounts of food according to the South African Food Pyramid and the
implementation of SAFBDG in daily life. The purpose of this intervention was to
inform the participants about value of following the SAFBDG in making more
healthy food choices that are good for the body. Special attention was directed
to consumption of sugar and sugar sweetened beverages. According
to Vorster, Badham, and Venter (2013) the SAFBDG are short, positive,
science-based messages designed to assist with the process of eating a healthy
diet so that all the nutrient and energy requirements are met on a daily basis.
The intervention programme that the learners were exposed to from January to
end of May 2017 was based on the abovementioned revised SAFBDG. The time that
was allocated to these lessons was outside the academic programme of the
school. The interaction with the learners took place once a week during the
reading period (45 minutes) or during the second break (35 minutes). The
participants were called to the venue where the talks took place, discussion
followed and questions on the topic were asked by the learners. The environment
was unrestrictive; participants were encouraged to share their experiences and
report on their personal eating habits as a platform to find solutions to poor
eating practices and to inculcate healthy eating habits by the use of the
presentations and the discussions. Participants were very co-operative and
attended all the sessions. The
BMI measurements together with dietary intake from the 24 hour recall and QFFQ
was captured on Excel spreadsheets. Daily nutrient intake was determined using
the SAFOODS South African Food Composition Database (2016). Frequencies and
percentages were used to describe categorical data. The mean (with standard
deviation) was used to describe continuous data. The minimum, maximum and mean
intake of the participants were analysed and compared to 100% of the estimated
average requirement (EAR) and the daily recommended intake (encompassing
nutrient recommendations made by the Food and Nutrition Board of the National
Academy of Science, these include RDAs, EARs, AIs, and UILs) (Wardlaw, 2014, p.
G3) (DRI) (Institute of Medicine, 2005). Pearsons chi square test was used to
assess if BMI categories differed by sessions. ANOVA was used to compare
nutrient intakes between sessions one and two. Results were considered
significant for p < 0.05. Data was analysed using Stata version 14 (StataCorp.,
College Station, TX, USA). Most common
foods The
results revealed that within the study group of n = 90, there was a prevalence
of underweight, overweight and obesity at session one of 23.3%, 14.5% and 12.2%
at session one respectively. There was no significant change in underweight
(22.2%), overweight (15.6%) and obesity (12.2%) prevalence at session two (p =
0.996). Both
the 24 hour recall and QFFQ showed similar commonly consumed foods. In relation
to the SAFBDG Enjoy a variety of food, the percentage of learners that are
consuming protein rich food are as follows: 61.1% consumed beef patties, 37.8 %
show intake of grilled sausage, beef and pork/boerewors and 35.6% consumed
biltong game in session one in the QFFQ. In addition 64.4% of the sample
consumed apples and less than 20% consumed green vegetables. QFFQ
for starchy foods showed the percentage of participants that consumed white
bread and white bread rolls was 87.8% whereas 57.8% of the of the participants
showed intake of brown bread and brown bread rolls. The
QFFQ showed that 25.6% of the sample consumed beans canned in tomato sauce
(baked beans), 11.1% consumed sugar beans, 7.8% ate split peas with spices
fried in sunflower oil, 3.3% reported intake of white kidney beans, cooked with
potato, onion and hard margarine, 2.2% consumed soya mince and 2.2% consumed
lentils in biryani. According
to the results from the 24 hour recall in session one, 74.4% of the sample
consume white bread and white bread rolls whereas 15.6% of the sample group
consumed brown bread and brown bread rolls. Amongst
cereal products, 44.4% had consumed cereal in the form of savory snack/crisps
which are generally high in fat and salt and are not recommended as part of
healthy eating. Data from the 24 hour recall also revealed that 30% of the
sample consumed cornflakes and 28.9% potato crisps. Despite the recommendation
that wholesome, less processed grains form part of the diet, the learners in
grade eight consumed more refined food. Cereal and cereal
products in the form of cooked white rice was also a
popular choice with 38.9% of the participants consuming it. No participants
consumed brown rice. The
proportion of grade eight learners in the sample group who consumed apples,
according the 24 hour recall, was 24.4%. Raw plums and mangoes were consumed by
6.7% and grapes was eaten by 5.6% of the sample in the 24 hour recall. The
percentage of participants who consumed vegetables was generally lower compared
to fruit in the 24 hour recall with consumption of tomato by 5.6%, Greek salad
by 4.4% and mixed green salad and boiled mixed vegetables by 3.3% of the
participants. In
the 24 hour recall the following results were documented for legumes. The
percentage of participants that consumed legumes are as follows: 6.7% for
lentils in biryani, 2.2% beans canned in tomato sauce (baked beans) and 1.1%
each for white kidney beans cooked with potato onion and hard margarine, white
kidney beans cooked with potato, onion and polyunsaturated margarine, soya
mince, and sugar beans. On a daily basis only 15.4 % of the sample group (n =
90) consumed legumes, however, the percentage of participants that consumed
legumes was 26% reported in the QFFQ. Consumption
of milk, full
fat/whole fresh milk for the 24 hour recall and the QFFQ as 42.2% and 60.0%
respectively which was relatively high compared to other staple foods. In the
24 hour recall, and QFFQ 21.1% and 35.6% respectively consumed cheddar cheese.
Soft serve ice cream was consumed by 37.8% of the sample in the QFFQ and 6.7%
in the 24 hour recall. The
data collected from the QFFQ showed that 66.7% of the sample had salad
dressing, mayonnaise, 58.9% reported intake of sunflower oil, 52.2% reported
intake of peanut butter, 35.6% consumed polyunsaturated margarine and 28.9% ate
butter. Further results from the QFFQ were that, 8.9% of the sample had intake
of canola oil, 5.6% canned dessert cream and 1.1% of the sample consumed
homemade salad dressing. In the 24 hour recall the most commonly eaten fats and
oils was, hard brick margarine, mayonnaise, polyunsaturated margarine and peanut
butter at 17.8%, 14.4% and 7.8% and 6.7% respectively. Salt
rich foods were popular in the 24 hour recall with 44.4% and 28.9% of savoury
snacks in the form of chips being consumed. In the QFFQ the figures for savoury
snacks in the form of chips were 37.8% and 37.8%, indicating that salt rich
foods are very popular in food intake. Other salt rich foods in the QFFQ
included gravy prepared with water being consumed by 27.8% and biltong eaten by
35.6% of the sample. This
section addresses the changes in food intake after the intervention. The data
for cold drink, carbonated beverages was similar in the 24 hour recall and QFFQ
in session one compared to session two. In the 24 hour recall the following
statistics with regard to consumption of vegetables were noted: the percentage
of participants that consumed different vegetables was 5.6% or less in session
one and in session two was 8.9% or less of the sample was eating raw tomato. In
the QFFQ, the consumption of different vegetables increased from 20% or less to
38.9% or less. Nutrient intakes:
The
daily kilojoule intake dropped from 17209.24 (7417.83) kJ in session one to
13455.39 (5616.27) kJ in session two for the QFFQ (p = 0.0002). In general, the
total amount of carbohydrates decreased from session one compared to session
two, from 517.82 (228.95) g to 405.38 (181.20) g (p = 0.0003). The amount of
added sugar also significantly decreased from 41.18 (40.32) g to 27.63 (22.22)
g (p = 0.0058). DRI
in the QFFQ and the 24 hour recall in session one and session two The
data that was captured was analysed against the DRIs (Tables 1 and 2).
According to the data that was generated from session one and two, there is a
clear indication that nutrition intervention at school level was extremely
beneficial to all the participants. The
BMI statistics of this study are indicative of the phenomena of obesity,
overweight and nutritionaldeficiency that are prevalent. The post intervention results regarding food
intake suggest that the intervention programme aided in creating awareness
amongst the sample group in mainly areas of good nutrition in particular the
decrease in fat consumption and encouraging the consumption of more vegetables. These
results concur with other recent studies that obesity, overweight and
nutritional deficiency is a problem that must be addressed. These results
concur with results of a study by Winkvist et al. (2016, p. 41) that there is a
problem with overweight, obesity and nutritional deficiency amongst children at
school. The
total numbers of minutes that a learner that completes grades R to 12 at school
is exposed to in nutrition education is 1757 minutes, equivalent to roughly 29
hours for the 13 years that a child is at school. This averages to 2.2 hours a
year. There is no repetition of basics that can help with reinforcing nutrition
education, progression and consistency in nutrition education content in the
Life Orientation curriculum. The
controversy that surrounds Life Orientation is highlighted by Van Deventer
(2009, pp. 130-140), who identifies the following as drawbacks to the success
of Life Orientation: the indifferent attitude of the school principals towards
the learning area; guidance teachers are tasked with the responsibility to
teach the Life Orientation component as well as the Physical Education
component; Life Orientation is taught by a wide spectrum of educators who are
often not trained in the field. In addition, Van Deventer (2009, p. 140) cites
the problem of lack of support from the Department of Education as a
contributing factor because of the appointment of unqualified educators who
compromise the teaching and learning in Life Orientation. According
to the National School Nutrition Programme, one guideline that must be
highlighted is the need to support nutrition education
through the curricular activities in Life Orientation. Referring to the
evidence from the CAPS documents from grades R to 12, the content is extensive
and time is limited therefore the support of curricular activities is
compromised. The
main reason for using the grade eight learners was to assess the BMI and food
intake when they entered the secondary school phase and to implement the
intervention so that some positive influence over the food intake can be
encouraged. We have argued and shown that poor nutritional intake, obesity and
overweight are prevalent amongst the learners at grade eight level. Reflecting
on the results of the BMI, we do have a problem with underweight,
overweight and obesity. The transition from primary school to secondary school
comes with a lot of challenges, with the onset of puberty and physical changes.
In addition peer pressure and adjusting to the new environment are amongst the
challenges that these learners need to overcome. However, with intervention, some
improvements in food
intake are evident that would assist learners in maintaining a healthy body and
mind. The
intervention programme was for a short period; however a longer period of
intervention would have shown greater changes in eating habits. The study was
conducted using from only grade eight and limited the intervention to only
grade eight learners, however, all learners would benefit from nutrition
intervention. The
study results clearly indicate that nutrition intervention has positive effects
on the eating habits of learners. The current curriculum does not contain
adequate content on nutrition education to equip learners to follow healthy
eating. The recommendation based on the results of this study indicates that
the Life Orientation curriculum should have more content based on the South
African Food Based Dietary Guidelines. Nutrition
education of learners according to a school policy on nutrition and nutrition
education should be based on a new curriculum with the objective of improving
the nutrition- related behaviour and attitudes towards nutrition and healthy
eating, should include: •
Commitment from the educators to support the nutrition policy and deliver on
the new curriculum requirements. •
Skills development for all educators so that all educators are equipped to
teach nutrition within their respective learning areas. •
Education on eating healthily and healthy food choices so that informed choices
on correct food choice are made at all times. •
Provision of healthy options of fruit, vegetables and protein food to learners. •
Provision of one nutritious meal a day for all learners at all schools. •
Provision of knowledge and skills for healthy living which includes: healthy
eating, hygienic and healthy food preparation and storage methods. •
The South African Food Based Dietary Guidelines should form the core of
nutrition education. •
Portion sizes for each meal and snack should be part of teaching correct
nutrition Department of
Basic Education, (2011a) Curriculum and Assessment Policy Statement Life
Orientation. Grades 10, 12. Pretoria: Department Basic Education. *Corresponding
author: Thilavathy Naidoo, School of Education, University of KwaZulu-Natal, South Africa, E-mail: roshenkanaidoo@gmail.com Citation:
Naidoo T, LR Maharajh, and Yusentha Balakrishna. Is the
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and Ega. Impact of nutrition education on nutrition knowledge of public school
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HC, Pretorius B, and Hall N. The impact of animal source food products on human
nutrition and health (2013) South Afri J Animal Sci 43: 394-412. http://dx.doi.org/10.4314/sajas.v43i3.11 South African
Food Database System (SAFOODS). Food Composition Database, Version 2016. South
African Medical Research Council, Parow Valley, Cape Town, South Africa. Takeda Y, Yoneda
T, Demura M, Furukawa K, Miyamori I, et al. Effects of high sodium intake on
cardiovascular aldosterone synthesis in stroke-prone spontaneously hypertensive
rats (2001) J hypertension 19: 635-639. Van Deventer K.
Perspectives of teachers on the implementation of Life Orientation in Grades
R-11 from selected Western Cape schools (2009) South Afri J Edu 29: 127-145. Vorster HH,
Badham JB, and Venter CS. An introduction to the revised food-based dietary
guidelines for South Africa. South African (2013) J Clin Nutr 26: 5-12. Wardlaw GM, Smith
AM, and Collene AL. Contemporary nutrition: a functional approach (2014)
McGraw-Hill Higher Education 4th edition. Winkvist
A, Hultén B, Kim JL, Johansson I, Torén K, et al. Dietary intake, leisure time
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study (2016) Nutr j 15: 41. https://doi.org/10.1186/s12937-016-0160-2 Overweight, Obesity, Under nutrition
Is the CAPS School Curriculum in Life Orientation Doing Justice in Educating South African Children on Overweight, Obesity and Under Nutrition?
Naidoo T, Maharajh LR and Balakrishna Y
Abstract
Aim: Measure nutritional intake of grade eight
learners in a purposively selected public school using 24 hour food recall and
the Quantified Food Frequency Questionnaire to identify the food that the
participants are consuming and compare the food intake to the South African
Food Based Dietary Guideline.
Objectives: 1. Measure nutritional intake of grade eight learners in a purposively
selected public school using 24-hour food recall and Quantified Food Frequency
Questionnaire. 2. Measure the BMI of grade eight learners in a purposively
selected public school to determine overweight and obesity. 3. Analyse levels
of obesity, overweight and nutritional deficiency among grade eight learners in
a purposively selected public school and draw comparison with the nutrition
education in the CAPS curriculum in Life Orientation and develop a possible new
curriculum in Life Orientation to address the problem of obesity, overweight
and nutritional deficiency.
Method: This
was a South African study conducted in KwaZulu–Natal that addressed the issue
of obesity, overweight and nutrient deficiency amongst grade eight girls in a
school in Durban Central. The learners at that school came from a diverse
cultural and racial background. This was a study in an urban area. The participants
that were included was a small percentage from the general population of grade
8 learners in the area. Ninety learners in Grade 8 were assessed before and
after an intervention of nutrition education in terms of their body mass index
(BMI) and food intake. Two of the instruments used for data collection were the
24 hour food recall questionnaire, and the Quantified Food Frequency
Questionnaire (QFFQ), designed by the South African Medical Research Council
and compiled by Steyn & Senekal (1991) to gain data on food intake over a
period of time. Nutrient intake was determined using the South African Food
Data System (SAFOODS) Food Composition Database (2016). ANOVA tests were used
to determine significant differences in food intake between the first and second
set of measurements.
Results: The
prevalence of underweight, overweight and obesity during session one was
respectively 23.3%, 14.5% and 12.2%, with no significant change in session two.
The daily kilojoule intake dropped from 17209.24 kJ in session one to 13455.39
kJ in session two for the QFFQ (p = 0.0002). The total amount of carbohydrates
decreased from session one compared to session two, from 517.82 to 405.38 (p =
0.0003). Although the intervention was successful in reducing the kilojoule
intake of the participants, the kilojoule intake remains higher than the
recommended Dietary Reference Intake (DRI) of 8665 kJ for the age group of the
participants.
Conclusion: Full-Text
Introduction
Despite
the various research studies in the field of obesity and overweight globally,
there is a lack of commitment to the integration of nutrition knowledge into
the curriculum, and activities and plans to promote healthy eating initiatives
by all stakeholders (Oldewage-Theron & Egal, 2011). Any intervention
strategy that educators embark on to prepare learners for healthy eating and
healthy lifestyles must be directly
related to the South African Food Based Dietary Guidelines (SAFBDG). This
SAFBDG was designed with the primary purpose of informing, educating and
empowering South Africans to change their eating behavior. Permission from
the humanities and social sciences research ethics committee
Permission from
the school principal
Permission from
the parents and learners
Methods
Anthropometry
Intervention in
keeping with SAFBDG
Data analysis
Results
Comparison of
food items in the first and second session
Discussion
Limitations
Conclusion
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