RAJIV GANDHI UNITERSITY OF HEALTH SCINCES

BANGALORE, KARNATAKA
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION

UMA.H.M D/O Mr. H.P.

1. NAME OF CANDIDATE AND ADDRESS Mariswamy, # 216
GnanaMarga,
siddharthanagar, Mysore
-570011
THE OXFORD COLLEGE
2. NAME OF THE INSTITUTION OF PHYSIOTHERAPY
J.P.Nagar, 1st phase
Bangalore-78

MASTER OF
3. COURSE OF STUDY AND SUBJECT PHYSIOTHEREPY
(PHYSIOTHEREPY IN
PAEDIATRICS)

4. DATE OF ADMISSION
31st May 2008

5. TITLE OF THE STUDY:

“ ANTHROPOMETRIC INDICES OF HIGH SHOOL CHILDREN AND FAMILIAL
RISK FACTORS” – A CORRELATIONAL STUDY.
6. BRIEF RESUME OF THE INDEED WORK

6.1 NEED OF THE STUDY

Child hood obesity is a serious medical condition that affects children &
adolescents. It occurs when a child is well above the normal weight for his or her age &
height. ¹

Childhood obesity is particularly troubling because the extra pounds start kids
on the path to health problem that were once confined to adults, such as diabetes, high
blood pressure & high cholesterol.

There are some genetic & hormonal causes of childhood obesity. Most of the
excess weight is caused by children eating too much & exercising too little.

Children, unlike adults need extra nutrients & calories to fuel their growth &
development. So if they consume the calories needed for daily activities, growth &
metabolism, they add pounds in proportion to their weight beyond what is required to
support their growing bodies.1

Genetic diseases and hormonal disorders predispose a child to obesity. These

diseases, such as prader-willi syndrome & Cushing’s syndrome affect a very small
proportions of children. In the general population, eating & exercise habits play a much
larger role.1,2

Many factors increase the Child’s risk to become overweight. These factors are
diet and nutrition, inactivity, genetics, psychological factors, family factors, socio
economic factors.1
Anthropometric measurements provide a base line for measuring the physical
growth in terms of body composition & body fat distribution in children and several.
Studies considered anthropometry as an important parameter reflecting the pattern of
growth and development and nutritional status in community.3 ,4
Anthropometry is particularly use full as a practical approach for field method
measurement in children and adolescents. Using this techniques body mass index, waist
circumferences, hip circumferences, conicity index, skin fold thickness are assessed and
they help in identifying the individuals at risk for disease.4, 5

A BMI percentile >5th & <85th is considered normal weight for height, 85th to 95th
percentile is considered at risk for over weight & > 95th percentile is defined as over
weight.2,6

A recent report from the American institute of medicine has specially used the
term “obesity” to characterize BMI > 95th percentile in children and adolescents.2

Skin fold measures the thickness of subcutaneous adipose tissue fat. These
measurements estimate the regional fat distribution by determining the ratio of
subcutaneous fat on the trunk and extremities and establish anthropometrics profile.3

When the skin fold thickness > 85th percentile of weight for height, and for age
and sex , then such children are classified as obese / over weight.7

Studies have shown that the waist circumference had strong association with
blood pressure & prevalence of hypertension in men & BMI had the strong association
with blood pressure & hypertension in women .8

Conicity index is also anthropometric measurement having potential for

predicting fat distribution & disease risk.3
CI = waist circumference (in meters)
0.109 √(weight / height) in meters .

Early onset obesity was suggested as a risk factor for morbidity and mortality
later in life. The morbidity factors are diabetes, coronary heart disease, arteriosclerosis,
hip fracture, osteoarthritis, gout and colorectal cancer.9

Adolescent obesity has been found to be associated with increased risk of

developing Cardio vascular diseases diabetes in adulthood. 2

In western societies, machines, electronics & other technological advances have

supplemented virtually every physical activity that had been required by humans for
daily living. This minimizes the physical activity & energy expenditure. 10

In India, under nutrition attracted the focus of health workers as child hood
obesity was rarely seen. But over the past few years, child hood obesity is increasing
with the changing life style of families such as increased purchasing power, increasing
hours of inactivity due to television viewing, video games & computers which have
replaced the out door games & other social activities . 11

Extent of child hood obesity is increasing at an epidemic rate.

16 percent of children (more than 9 million) between the age of 6-9 years are over weight
& obese-a number that has tripled since 1980. 12

Over than past 3 decades , the child hood obesity rate has more than doubled for
pre school children aged 2-5year & adolescents aged 12-19 year & it has more than
tripled for children aged 6-11 year.12

Over weight adolescents have a 70% chance of becoming overweight or obese

adults. This increased to 80% if one or more parent is over weight or obese.13

Studies have identified family factors that place the child at risk for over weight
& obesity including family history, parental knowledge & values and family life style.14

Considering the prevalence of child hood obesity and the risk factors associated
with it, it becomes necessary to assess the anthropometric indices and family
predispositions to obesity, check for any relationship between the same, and also to
identify the children who are at risk.

6.2 REVIEW OF LITUATURE

1) PREVALENCE OF OBESITY IN CHILDREN AND ADOLESCENTS

 Dr. Kannan Pugahendi (2005)15 in his online edition sates that the
incidence of obesity in children and youth is very high all over the
world and is increasing at an alarming pace in India.

 S C Savva, Y Kourides (2000)16in their study estimated the prevalence

 of child hood and adolescents obesity from Cyprus. It was 10.3% in
males and 9.1% in females by using national health and nutrition’s
examination definition and International obesity task force definition.

 T. Agarwal, R C Bhatia (2007) 17 studied the prevalence of obesity and

overweight in adolescents in Punjab. They found the incidence of
obesity was 3.4% and over weight was 12.7%. A significantly greater
number of boys (15%) were over weight as compared to girls (10%).

 Berg I M, Simonson B (1997) 18 in their study found that prevalence of

our weight and obese was high in Sweden populations and it was high
is 15 years old boys.

 World health organization - Obesity (2004) estimated that more than

one billion adults and 17.6 million children are over weight and the
numbers are creasing.

2. CORELATIONS OF FAMILIAL FACTORS TO OBESITY

 M.A.A. Moussa ,A.A. Shaltout (1998)19 et al in their study showed that

family history of obesity , diabetes mellitus , respiratory and bone
disease are associated factory for children obesity after adjusting for
social and behavioral problem physical activity and parental social
class were not significant.

 D.R. Bharati, P.R. Deshmukh (2008)6 et al studied the magnitude of

over weight / obesity of 31 middle school and high school children of
warada city, India. The magnitude of over weight /obesity as been
found that 4.3%. He concluded that family characteristics play
important role in predisposing the children to over weight and obese.

 Scaglioni et al (2000) 21
in their study verified that prevalence of
overweight in five year old children and found it significantly higher
in those with over weight parents than in the ones whose parents did
 not present with over weight.

 Juliana farias de Novas et al (2007) 20

in their study, compared the
eutropic and obese children anthropametric relations with their
parental BMI and anthropometry. They have shown that there was a
difference concerning to the body fat distributions and lipid profile
among eutropic children and maternal obesity was influencing the
child’s obesity.

 Espostio – Rel Puente A et al (1998)22 in their survey on fourth grade of

primary school in Naples showed that there was a direct Correlations
between parental BMI and children anthropometric measurement.

 Abhijeet Dhoble M.D. MPH et al (2008)14 in their study concluded that

the genetic factor, cultural differences related to the nutritional habits,
level of physical inactivity and acceptance of weight among African
Americans plays a major role in the development of obesity.

 Strauss R S, Knight J (1999)23 in their study showed that the

standardized measures of home environment and house hold income
were also found to be important predictors of child hood obesity.

 Polley DC et al (2005)24 in their study showed that there was significant

correlations between children BMI and parent’s BMI, weekly
television viewing hours and a trend for percent energy from fat.

 Akhil Kanth singh et al (2006)25 in their study on 12-18 years age group
student showed that there was a association between BMI, systolic and
diastolic blood pressure among children and other life style factors.

3. RELIABILITY AND VALIDITY OF ANTHROPOMETRIC

MEASURMENT.
 Vivan H Heyward and Lisa M – Stalarzysk (1996) 3 states the
body mass index is the ratio of body weight in kilo grams divided
 by height squared in meter.

 M. Mamtani, H Kulkarni (2003)26 in their study concluded that

waist circumference is simple non invasive and accurate predictor
of the risk of type 2 diabetes that can potentially be used in
screening program in developing countries.

 Asif Z Khan et al4 studied the anthropometric measurements of

rural school children. He considered that anthropometry is an
early and convenient method of assessing nutritional and socio
economic status of growing children.

 A Must, GE Dallal and W H Dietz (1991)27 states that the 85th

and 95th percentile of BMI and Triceps skin fold are often used
operationally to define obesity and super obesity respectively.

 Pamela J Schrenier et al (1996)28 in their study concluded that

when the waist circumference or body mass index is used as a
surrogate for intra abdominal fat area in man, a quadratic term
should be included in the analysis as a predictor variable

 Masaru Sakuri et al (2005)8 in their study conclude that the

waist circumference had strongest association with blood pressure
and prevalence of hypertension in men and BMI had the strong
association with blood pressure and hypertension in women.

4. RISK FACTORS ASSOCIATED WITH OBESITY

 M.J.Muller et al (1999)29 in their study showed that over weight,

physical inactivity and unhealthy eating habits were seen more
frequently in children from low socio-economic background.

 J. Kennard Fraley et al (2004)30 in their study found that children

 who watch television and played videogames more frequently,
who have over weight parents and come from families of lower
socio economic background are at increased risk of obesity.

 H. Mozaffari et al (2006) 31 in their study found the prevalence

of over weight and obesity in young Iranian girls was high.
Advanced age, lack of physical activity, low economic factors and
maternal educational status could be risk factors for obesity in
children.

6.3 OBJECTIVE OF THE STUDY

1. To find out the prevalence of obesity in high school children by anthropometric
measurements.
2. To correlate the familial risk factors with anthropometric indices of high school
children.
3. To identify the children at risk of developing obesity.

6.4 RESEARCH HYPOTHESIS

A. Null hypothesis
Familial risk factors may not be associated with
anthropometric indices of high school children.

B. Alternative hypothesis
Familial risk factors may be associated with
anthropometric indices of high school children.

6.5 VARIABLES
A. Independent variable
- Familial risk factors
- Height
- Weight
- Blood Pressure
 B. Dependent variables
Anthropometric indices of school children
- Skin fold measurements
- Age
- Gender
- Waist circumference
- Hip circumference

MATERIALS & METHODS

7.1 STUDY DESIGN & SETTING.

7.1.1 Research design
Non-experimental cross sectional correlation study will be done to examine
the relationship between anthropometric indices of high school children &
associated familial risk factors.
7.1.2 Source of data
 Oxford School J.P.Nagar, Bangalore
 JSS Public School, Bangalore
 JSS Public School, Mysore
7.  Arabindo School, Bangalore

7.2 METHODOLOGY
7.2.1 Population
All high school children aged between 13-16 years from various
schools.
7.2.2 Selection criteria
1. Inclusion criteria
- All high school children’s of age group between 13-16 years
- Both genders will be included as samples.
2. Exclusion criteria
- Those who are not willing to participate in the study
 3. Withdrawal criteria
- Those who fail to return the questionnaire duly filled.
7.2.3 Sampling
A. Sampling method
Convenient sampling
B. Sampling size
Total 300 high school children.

7.2.4 Procedure

Informed consent will be taken from parents. There explain the

objectives as well as the method of the study to the school authorities.

All the high school children’s age group between 13-16 years of class 8 th,
9th & 10th standard are selecting for the study.

Subjects would be instructed previously about the procedure & for their
co-operation through out the study. All the children will be screened for
anthropometric measurements.

Initially height (in certain meters) & weight (in kilograms) will be
measured by using height board & weighing machine respectively. This height
& weight will be taken to calculate the body mass index (BMI).

Skin fold thickness measurements will be taken by caliper at 2 regions of

the body i.e. one is at triceps and another is at calf regions.

Using the skin fold caliper grasp a skin fold, which is held between the
testers thumb and finger to provide a measurement in millimeters for a double
fold of skin and subcutaneous tissue fat.

Body circumferences will be measured by standardized inch tape,

circumferences will be measured at two levels one is at waist circumference and
 another one is at hip circumference. Waist to hip ratio and Conicity index will
be calculated.

Blood pressure of the children will be measured by sphygmomanometer

and values will be recorded.

Physical activity of the children including hours of time spending in

television viewing and out door games will be recorded by the family reported
questionnaire filled by the parents of the children.

A family reported questionnaire will be used to collect the information

about family compositions family history and lifestyle. This questionnaire will
be send to parents through their children.

The questionnaire will be pre-tested on five parents of the school children

each from five schools to check the reliability. Necessary modifications will be
done in the questionnaire before start of study.

A. Duration of the study: - single time study.

B. Materials used
- Sphygmomanometer
- Skin fold caliper
- Stethoscope
- Height board
- Weighing machine
- Inch tape
- Calculator
- Pen and paper
7.3
 7.3.1 OUTCOME MEASURES.
- BMI
- Skin fold thickness measurement
- Waist to hip ratio
- Conicity index
- Blood pressure
- Family reported questionnaire

7.3.2 DATA MANAGEMENT

Formulae
a) Body mass index
= weight in Kilograms
(Height) ² in meters

b) Waist to hip ratio

= Waist circumference in meters
Hip circumference in meters

c) Conicity index

= Waist circumference in meters

0.109 √ (weight / height) in meters

d) Skin fold measurement = ΣSKF

e) Blood pressure = SBP mm Hg

DBP
7.3.3 STATISTICAL ANALYSIS
Pearson product moment correlation co-efficient will be used to correlate the
data.
7.4
a. Does the study require any investigations or interventions to be conducted on
patients or other humans or animals?
Yes, it requires an investigation i.e. Anthropametric Measurements is to be done on high
school children

b. Has ethical clearance been obtained from you institutions?

Yes, ethical clearance has been obtained from my institution. ethical clearance form
attached.

REFERENCES
1.www.myoclinic.com child hood obesity.

2. Stephen.R.Daniels et al. “Over weight in children and adolescents”. AHA

circulation, 2005; 111: 1999-2012.

3. vivan H Heyward and Lisa M-Stalarzyk “ Body composition assessment”. USA.

Human kinetics, PP 79.
4. Asif. Z. Khan et al “Anthropometric measurements in rural school children”.
 www.google.com

8. 5. colleen Keller “ child hood obesity ; measurement & risk assessment”. 1996;82-85.

6. DR. Bharathi, P.R Deshmukh and B S Garg. “Correlates of over weight and obesity
among school going children of wardha city, central India”. Indian J M edres 127,
June 2008; pp 539-543.

7. Freed man DS, Harsha DW et al “Relationship of changes in obesity to serum lipid &
lipoprotein changes in child hood & adolescence”. JAMA 1985; 254:512-20

8. Masaru sakurai , Katsuyki MIURA et al. “Gender difference in the associations

between Anthropometric Indices of obesity & blood pressure in Japanese”. HYPRES:
Vol 29 (2006), pp 75-80.

9. Willam H. Dietz. “Child hood weight affects Adult morbidity & mortality”. American
society for Nutritional sciences 1998.

10. Bevan C Grant, Stan Bassin “The challenge of paediatric obesity: more rhetoric than
actions”. The Newzealand medical Journal 2007, vol 120.

11. Sing M, Sharma M. “Risk factor for obesity in children “. Indian paediatr 2005; 42 :
183-5.
12. Centers for disease control and prevention (2004). “Prevalence of over weight and
obesity among children and adolescents”. United States. 1999-2002.
13. U.S. Department of health and human services (2007)
htpp://www.surgeongeneral.gov/topics/obesity/calltoaction/fact adolescents.htm.

14) Abhijeet Dhoble M.D et al. “Familial and Behavioral determinants of obesity in
black childrens and preventive strategies”. International journal of health 2008, volume
7 Number 2.

15) Dr.Kannan pugazhendi. “Emphasizing health elated fitness from school will keep be
active, stress free and promote life long fitness”.
16) S. C. Savva, Y. Kourides et al. “obesity in children and divestments is Cyprus.
Prevalence and predisposing factors”. International Journal of obesity (2002) 26, 1036-
1045.

17) T. Agrawal, R C Bhatia et al. “Prevalence of obesity and over weight in Affluent
Adolescents from Ludhiana, Panjab”. Indian pediatrics; vol 45; 2008.

18) Berg IM , Simons son B et al “prevalence of over night and obesity is children and
adolescents in a country is Sweden”
http://www.ncbi.nlm.nih.gov/pubmed/11440102

19) M.A.A. Maussa et al. “Factors associated with obesity is Kuwaiti Children”. Springs
link –Journal article: 1998

20) Juliana Farias de Novaes et al. “Comparison of the anthropometric and biochemical
variables between children and their parents”. www.alanrevista.org/edicjones:2007.

21) Scaglioni S. Agostoni C et al. “Early macronutrient intake and over weight at five
years of age”. Int J obes 2000; 24:777to81.

22) Esposito - Del Puente A et al. “Familial and environmental influences on body
composition and body fat distribution in childhood in southern Italy”. Int J obes Relat
Metab Disord .1.

23) Strauss R.S, Knight J. et al. “Influence of the home environment on the development
of obesity in children. American Academy of Paediatrics.1999 ; 103(6):e 85.

24) Polley D C, Spicer MT et al. “Intra-familial correlates of over weight and obesity in
African and American and Native American grand parents , parents and children in
rural Oklahoma”. Journal of American Dietic Association. 2005; 105(2):P262-5.

25) AKhil Kanth singh et al. “Life style Associated Risk factors in Adolescents”. Indian
Journal of Pediatrics, Vol 73; 2006.
 26) M.Mamtani, H Kulkarni. “Predictive Performance of Anthropometric Indexes of
central obesity for the risk of Type 2 Diabetes”. Archives of Medical research 2003, Vol
36, Issue 5, page 581-589.

27) A Must, G E Dallal et al. “Reference data for obesity: 85th and 95th Percentiles of
body mass index (Wt/Ht²) and triceps skin fold thickness”. American Journals of clinical
nutrition, 1991; Vol 53, 839-846.

28) Pamela J Schrenier et al. “The Atherosclerosis Risk in Community study”. Am J

Epidomol 1996; 144:335-45.

29) M.J.Muller et al. “Physical activity and diet in 5 to 7 years old children”. Public
health nutrition 1999; 2:443-444.

30) J.Kennard Fraley et al. “Risk Factors for childhood obesity in an urban public school
population”. Journal of children’s Health, 2004; Vol 2, Issue 2, pages 159-169.

31) H.Mozaffari et at. “Obesity and Related Risk Factors”. Indian Journal of Pediatrics,
2007; Vol 74.

9 Signature of candidate

10. Remarks of the guide

11 NAME AND DESIGNATION OF

THE GUIDE

11.1 Guide Mr.Pruthvi raj. R. MSPT

Assistant Professor
 11.2 Signature

11.3 Co-guide

11.4 Signature

Mr. K.G. Kirubakaran., MPT

11.5 Head of the Department

11.6 Signature

12. 12.1 Remarks of chairman and

principal

Mr. K.G. Kirubakaran., MPT

12.2. Signature

APPENDIX –I

THE OXFORD COLLEGE OF PHYSIOTHERAPY

I PHASE, J.P.NAGAR, BNGALORE – 560078.

Review Board on Ethics for Research

We here by declare that the project titled,

Carried out by Ms. Uma H.M. of I Year M.P.T. has been brought forward for scrutiny to
the board members. After analyzing the Objectives, subjects involved and the
methodology of the project, the following conclusions were drawn.

The project does not have nay mental or physical harm to the subjects involved
and there is no risks involved by mean as mental or physical harm to the subjects and
there is no risks involved with the study. The performance of the study procedure will
not cause nay injury to the subjects. The board has evaluated and confirmed that the
experimenter is trained and qualified in giving the intervention and / or measuring
outcome. The informed consent form prepared ensures that, the experimenter explains
the procedure of the study to the subjects, their voluntary participations is confirmed and
the identification of subjects is maintained confidential.

Further more the finding of the study will benefit similar subjects, the profession
and the society.

Hence the review board has no objections on the conduct of the above mentioned
study.

Chairman of Departmental Review Board Project Guide

Principal

APPENDIX II
CONSENT FORM

TITLE: “Anthropometric indices of high School children and familial risk factors” – A
Co relational study.

INVESTIGATOR: Ms. Uma H.M( M.P.T 1st Year)

PURPOSE OF THE RESEARCH

PARENTAL PERMISSION:
I ……………………. PARENT/GUARDIAN of master/miss……………… have been
informed that this will reveal the relation between anthropometric indices of high school
children and familial risk factors .

PROCEDURE

I have been explained that this study is conducted by physical examination in which I
will be assessed by anthropometric measurements, which is easy to perform and clear
instructions are given to me about the procedure.

MEDICAL CONSENT

I also assure that my ward is fit for this assessment and in not having any health
problems, which can induce complication to this assessment. My ward is physically,
mentally and socially sound.
He /she is under no medications.

RISKS/ DISCOMFORTS

I understand that this study will not produce any harm to me by anthropometric
measurements and does not hurt the subject in any manner. I am aware that I have to
follow the instruction that has been told to me. I understand that there wont be any
discomfort throughout the study, I am aware that Ms. Uma H.M. will help me for better
understanding of the procedure

BENEFITS

I understand that the record values, its interpretations and its result will help to
find out the prevalence of obesity in high school children and associated familial risk
factors.
ALTERNATIVES

I understand the procedure being studied is the standard way than compare to
other studies which can be conducted by using other measures

CONFIDENTIALITY

I understand that the medical information produced by this study will be

confidential. If the data are used for publication in the medical literature or for teaching
purpose no names will be used.

PHOTOGRAPHY CONSENT DOCUMENT

I…………………………………….have been explained by Ms. Uma H.M. that

photographs are required in order to illustrate various aspects of the study for the thesis
and other articles, and at presentations and conferences . These images may also be
converted to electronic formats for use in multimedia presentations and documents
accessible to others by computer for the purpose of sharing the results of the study and
for promoting this research. By giving my consent authorize her to use any of the
photographs taken of my ward in printed format, in slides for presentations, and in
electronic format. If the photograph is used the face will be taped to prevent
identification.

REQUEST FOR MORE INFORMATION

I understand that I/ my ward are encouraged to discuss any concerns regarding

this study at any time. Ms. Uma H.M is available to answer my questions to the best of
her knowledge. A copy of this consent form will be given to me for my careful reading.

REFUSAL FOR WITHDRAWAL OF PARTICIPATION

 I understand that my wards participation is voluntary and I may withdraw consent
and discontinue participation any time without fear of prejudice. My decision whether or
not to participate will not affect relationship with ( agency , health care provider, school
etc.
I also understand that she may terminate my participation in the study after she has
explained the reason for doing so.

INJURY STATEMENT

I understand that in the unlikely event of injury resulting directly from the participation in
the study, medical treatment would be available , but no further compensation will be
provided. I understand my wards agreement to participate in the study and I am not
waiving any of the legal rights for the same .

I have explained to …………………………parent/guardian of …………….the purpose

of the research, the procedures required and possible risks and benefits associated , to the
best of my ability.

PRINCIPAL PERMISSION (SUBJECTS SCHOOL)

I…………………………… PRINCIPAL of the school of master/miss

……………………………… been informed to let the subject involve in the study.
According my knowledge, as told by the investigator this study is simple, safe and
accurate. Assuring potential benefits to the society and with this test.

INVESTIGATOR DATE

I confirm the Ms. Uma H.M. has explained me the purpose of this research, the study
procedure and the possible risks and benefits associated that I may experience . I have
read and understood this consent form to let my ward participate as a subject in this
research project and I am giving the consent willfully.

PARENTS/GUARDIAN DATE

PRINCIPAL OF THE
SUBJECTS SCHOOL DATE

SUBJECT DATE

SIGNATURE OF WITNESS DATE

 APPENDIX III

DATA PROFORMA:

Serial No. --------------------

Name : Date of Assessment:…………………

Age :

Sex :

Address :

Phone No: Source:

Anthropometric measurements

Family reported questionnaire:

……………………………. ……………………………………….

Signature of the subject/ guardian Signature of the investigator

 APPENDIX IV

FAMILY REPORTED QUESTIONNIRE

I . FAMILY COMPOSTION

 Parents Name
 Father -

 Mother -

 Address and phone number

 Date
 Age
 Father -
 Mother -
 Height
 Father -
 Mother -
 Weight
 Father -
 Mother -
1) How many members are there in your family?

2) How many children are there in your family?

3) What is the age of children?

Son __________________

Daughter______________
 II. FAMILY HISTORY [ Please select all that apply]

Father Mother Siblings

1) Heart attack or
Surgery prior to age 55

2) Stroke prior to age 50

3) Congenital heart disease or

left ventricular hypertrophy

4) Hypertension

5) Osteoporosis

6) Arthritis

7) High Cholesterol

8) Diabetes

9) Obesity

10)Asthma / respiratory
Disorders

11) Leukemia or cancer

Prior to age 60

12) Other - Specify ________

III FAMILY LIFE STLYE

1) Diet habits (please select all that apply)

[ ] I seldom consume red or high fat meats

[ ] I prefer a low- fat diet

[ ] My diet includes many fiber foods

[ ] I eat at least _____ servings of fruits per day

[ ] I eat at least ______ servings of vegetables per day.

[ ] I almost always eat something for break fast

[ ] I really eat high sugar or high fat desserts

2) Are you alcoholic?

[ ] Yes

[ ] No

3) Are you smoker?

[ ] Yes

[ ] No
4) Do you exercise regularly? If yes, how many hours?

[ ] Yes

[ ] No

_______

5) What is the nature of your work?

[ ] Sedentary

[ ] Non Sedentary

6) How many hours do you work in a day?

_________

7) Do you have any high stress level?

[ ] Yes

[ ] No

8) Do you engage in any of the sports activity?

[ ] Yes

[ ] No

9) How many hours do you watch television?

________
 10) Do you participate in any other recreational activity?

[ ] Yes

[ ] No

11) How many hours do you sleep in a day? Is that enough?

________
[ ] Yes

[ ] No

12) Do your children participate in indoor or outdoor games?

[ ] indoor

[ ] outdoor

13) How many hours your children will watch television?

_______________________

14) How many hours does your children play outdoor games and indoor
Games
- Outdoor games
- Indoor games.