THE WEIGHT OF OBESITY: A HEALTH ISSUE IN PERUMUGAI, INDIA

The University of Kansas School of NursingKelley Sharp

PERUMUGAI, TAMIL NADU - INDIA

Small semi-rural village located in Southern India in Tamil Nadu, just 7 km outside of Vellore

Total Population: 4,094 (2037 male, 2057 female)

Religion: Majority Hindu, but there is a Muslim and Christian presence as well

Top 5 Health Concerns:• Ischemic Heart Disease• Hypertension• Diabetes• Stroke• Anemia

Who was Ida Scutter?• American physician who recognized

the need for community healthcare in Vellore and founded Christian Medical Center in 1928.

DESCRIPTION OF CLINICAL SITE

• Founded by Dr. Ida Scutter, Christian Medical Center is one of India’s foremost hospital that provides acute, primary, and population-based care to locals and travelers alike.

• Perumugai is a site that CMC’s nurse-run program, College of Nursing Community Health (CONCH) oversees care for.

• The community health nurses assigned to this community visit every home at least once a month.

• The main hospital campus is located 9 km down the road, but CONCH is a unique service CMC facilitates that allows individuals in more rural settings to receive much needed preventative and maintenance health care.

OBJECTIVES

• Identify a key preventable health concern for a targeted population• Obesity epidemic in the villagers of Perumugai

• Design interventions customized to the community’s unique cultural beliefs and learning styles

• Villagers respond best and engage well with art-based interventions. Wrote song to convey benefits of exercise and health risks of obesity

• Improve long-term health outcome for target population related to the key health concern.

• Inspire community to embrace exercise through music-based educational tool

BACKGROUND INFORMATION• Obesity is a key health concern for the

community of Perumugai.

• In India, the culture for structured exercise (especially for women) is virtually non-existent(Sadan, personal communication, 2018).

Obesity in Perumugai vs. Tamil Nadu vs. India

• Perumugai = 50% of women overweight/obese(Sharp, Green, Bessent, Gibbs, & Miller, 2018).

• Tamil Nadu = 30.9% of women are overweight/obese

• India = 20.7% of women are overweight/obese(Ministry of Health and Family Welfare, 2016).

THINGS TO CONSIDER• Knowledge:

• Community baseline knowledge about health complications linked to obesity• Community knowledge about what causes obesity• Community knowledge about how to prevent obesity

• Attitudes:• Attitudes of the target population regarding obesity and exercise• Strong family and peer dynamics contributing to group-workout mentality

• Skills:• Past strategies implemented for health education in the community • How physically capable community is to do exercise

OVERALL DESCRIPTION OF TOPIC

Although not one of the top 5 nationally recognized health issues, obesity can be declared as a major health concern for this population, given the common comorbidities linked to this health condition, and per the recommendation of local nursing staff. (Sadan, personal communication, 2018)

Obesity is connected to…• Hypertension• Diabetes• Joint Pain

Christian Medical Center mandates that CONCH nurses track community heights, weights, and BMI’s to monitor unhealthily weight gain as well as weight loss.

INDIVIDUAL INTERVENTIONS• Individual

• Stakeholders (villagers) acknowledge how obesity has negatively affected their health • Teach exercise routine to each woman in village• Teach exercise song to each woman in village• Educate about healthy eating habits

COMMUNITY INTERVENTIONS• Community

• Cultivate a sense of community through promotion of exercise with an emphasis on group activity

• Teach song to the village leaders and common folk alike to further disseminate the information. Allow insiders to begin teaching the song to their peers

• Implement a walking club in the community

• Ensure entire community has access to health food source

SYSTEM INTERVENTIONS

• System• Teach the community health nurses, students, and faculty of the college of nursing the song

to pass along to villages across Tamil Nadu• Encourage Christian Medical Center to implement the song in their obesity curriculum and

encourage music therapists to perform it for inpatients.• Establish a normalized culture of exercise in Perumugai, Vellore, and all of Tamil Nadu

through promotion of the song

EXERCISE SONGChorus: Exercise, exercise, it’s so healthy for you to take a walk outside. Obesity can be beat if you exercise regularly. Go with your friends, husband, children too. Exercise is good for you. Exercise, exercise, you’re just steps away, from a healthy life! Verse: It doesn’t take long, 30 minutes a day and you’ll be feeling great! Do it with you friends and it will be fun. You’ll have more energy! And people will tell by the smile on your face, that you’re healthy...let’s all sing along! Chorus!Verse: Obesity leads to sugar (diabetes) and BP (hypertension). Eating foods high in fat is not good for your body. Being obese makes it hard to move, hurts your joints and your knees. So let’s exercise, C’mon everybody! One, two, three, four…Chorus!Bridge: You can do it, let’s get to it! C’mon and exercise! Now you’re movin’, really groovin’ towards a healthy life! *Will include an MP3 hyperlink of the song on final version of presentation

CONCLUSIONS• Music is a universal teaching tool that spans cultural and international barriers and

boundaries

• Aerobic exercise is a fun and accessible way to prevent and treat obesity

• When implementing a health intervention in a specific community it is important to take into account the attitudes, knowledge, and skill level of the population at hand

• Long-term change is multifactorial and implementation of one song is not enough to prevent or cure all obesity; however, it is a foundation to get the conversation started in hopes of building a culture of increased awareness of the importance of exercise

PROFOUND ACADEMIC EXPERIENCEA highlight of my clinical experience in Vellore, India was the ability to conduct independent research.

• identified a health concern & proposed an intervention to improve health outcomes

• Interviewed 88 participants

• Analyzed meaningful trends in the data

• Created a scholarly poster presentation for collegiate faculty and BSN nurses

This project seemed daunting at first, but was actually an incredible learning experience that fostered my interest in research and gave me an enhanced sense of confidence in my own academic capabilities!

PROFOUND CULTURAL EXPERIENCE Throughout my time spent visiting with the villagers of Perumugai, my heart and mind were opened in ways I could never have imagined. Each day I experienced a level of hospitality, joy, and love that is hard to describe. Although there was a language barrier between myself and the patients I interacted with, I felt a certain and powerful kinship and connection to the people of Perumugai. During my time there, I had the opportunity to enter many homes and upon my arrival I was always offered food and water. I discovered that in Indian culture, a common morning greeting is, “have you eaten yet”? This sentiment represents this culture’s belief that before one can start his or her day, he or she must nourish his or her physical body. This simple phrase encompasses a beautiful sentiment of compassion for one’s fellow man, as well as a genuine concern for his or her wellbeing. My entire community health clinical rotation was one profound cultural experience after another. Above all else, I feel as though I am kinder and more aware of the energy I am putting out into my surrounding environment. Upon returning home, I have strived to start each day as the villagers of my beloved Perumugai do, with thoughts of gratitude, a glass of water, and a substantive breakfast to feed my mind, body, and soul.

REFERENCES Healthy People 2020 [Internet]. Washington, DC: U.S. Department of Health and

Human Services, Office of Disease Prevention and Health Promotion. Retrieved February 1, 2018 from https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status

India, Government of India , Ministry of Health and Family Welfare. (2016). National FamilyHealth Survey-4, District Fact Sheet, Vellore, Tamil Nadu (p. 4-6). Retrieved February 3,

2018, from http://rchiips.org/nfhs/FCTS/TN/TN_FactSheet_605_Vellore.pdf

Sadan, V. (January, 2018) Personal Communication

Sharp, K., Green, B., Bessent, A., Gibbs, S., & Miller,R (2018, February). Implementation of an Exercise Program for Housewives in the Indian Village of Perumugai. Poster presented at The UMKC School of Medicine 2018 International Medicine Poster Session, Kansas City, MO.