You are on page 1of 21

1

Introduction
Filipino children comprised about 31% of the total population of the Philippines
in 2001, and it is getting higher and higher every year (National Statistics Office, 2002).
One of the issues that Filipino children are facing is malnutrition, which means bad
nutrition (World Health Organization, 2011). In relation to this, Sen. Angara stated that
childhood obesity is being regarded as the newest form of malnutrition, which has
affected not only the affluent Western countries, but also the Asian countries like the
Philippines, as it poses numerous health risks, (January 2013).
Based on the study of Angeles-Agdeppa, Lana & Barba (2003), the Food and
Nutrition Research Institute, Department of Science and Technology, National Nutrition
Survey (1998) reported that 3.8% child-caregiver pairs were suffering from
undernutrition or overnutrition. Specifically, under/over nutrition prevalence in Metro
Manila was 4.6%.
In 2011, Espievidal stated in her article that undernourishment and malnutrition in
the Philippines, from years 1999- 2000, based on the data gathered from the NUTRISTAT
Protocol at St. Lukes Medical Center, 34% of the total admitted patients are
malnourished and about of them are obese. These results present credible evidence on
how obesity is certainly a serious problem even for our country... and more and more
Filipinos are becoming subjected to this, especially children.
Allen & Prkachin (2013), noted that recent studies have provided another
perspective by focusing on the influence of parental awareness and perception of their
childs weight. The same researchers also exclaimed that the explanation of the

misperception and underestimation of body sizes of parents on children is an effect of


change blindness, and that the growing prevalence of childhood obesity is due to the
parents identification of excess childhood weight as just nor- mal rather than seeing
excess weight as a potential problem.
Child obesity in the Philippines is not just a matter of nutritional problem but
also a cultural issue. For one, the older generation of Filipinos has the penchant of
indulging their babies and kids with food to be healthy. There is a prevailing
misconception among older generation Filipinos that a chubby child is cute and healthy.
This is also further reinforced by the inclination of parents to indulge their children with
food and material things that they were deprived when they were young. Thus, Filipino
parents tend to give everything that their children want, unconscious that they are actually
putting their children at risk. Aside from that, it is also caused by social factors, such as
the rampant use of computer and video games which consumes their whole time leaving
no space for exercise. Lastly, the existence of unhealthy food nowadays, such as, junk
food, and other instant meals contributed on the prevalence of obesity in the country ( All
About Diabetes, 2008).
It has been said in studies that parental perceptions towards childrens body sizes
are important because they are the one who mainly influences children. However, it was
also been implied in the study done by Sixsmith, Gabhainn, Flemming & OHiggins
(2007), that there is still a need to gain childrens perspectives rather than relying on
adult perceptions of childrens perspectives, in order to inform quality service, practice
and policy developments. The researchers of this study supported this, and decided to

study the effects of body sizes to the healthy perceptions of both Filipino mothers and
children.

Literature Review
Angeles-Agdeppa, Lana & Barba (2003) noted in their study that mothers
perception of their childs body is also related to childs nutritional status. They found out
that 39% of their participants which are obese mothers who have underweight child and
37% normal mothers with normal sized child in Metro Manila, preferred children who are
somewhat fat to very fat to be more attractive, while 16% of obese mothers with
underweight child and 17% of normal mothers with normal child group preferred
children who are either thin or somewhat thin. The incorrect perception of mothers of
their childs body size in the obese mothers with underweight child group and their
attraction to thin children might pose a greater risk of worsened nutrition condition of
their children because mothers might not provide extra childcare, especially on the
quality and quantity of food intake. These children might suffer from the negative
consequences of undernutrition, like poor school performance, stunted growth and
decreased immune response. On the other hand, normal mothers with normal child group
who perceived their childrens body size as thin (17%) might have the tendency to binge
feed their children that might cause them to become overweight.
In relation to the aforementioned study, the research of Yilmaz, Erkorkmaz,
Oscetin and Karaaslan (2013), stated that the different feeding styles given to children are
related to the maternal visual perception, and one of the influencing factors that

determine parental feeding style is parental perception of the weight status of the child.
They also indicated that focusing on achieving correct parental perception of the weight
status of their children is the most appropriate way to prevent their child to become
obese or underweight.
Furthermore, Mathieu, Drapeau &Tremblay (2010) stated in their study that
parental awareness of their childs body weight status is far from optimal, especially for
underweight and overweight-obese children. They stated that numerous differences in
eating habits exist between accurately perceived and inaccurately perceived children and
this fact may suggest that parents rely on body weight status perception to appreciate the
eating habits of their child. Comparison of parental perceptions and objective
measurements of fitness and physical activity levels support the fact that underweight and
overweight-obese children are poorly evaluated according to the parental perception of
their weight.In this study, it is found that children and parental characteristics
associated with misclassification are specific to the weight status group of the child and
that these specific considerations can be used to target a specific group at higher risks of
erroneous identification.
Lastly, it was found (2012) that many children underestimated their degree of
overweight. Their parents and even their attending physicians shared this misperception
(Chaimovitz, Issenman, Moffat & Persad). This study demonstrates the need to further
educate physicians to recognize obesity and overweight so that they can counsel children
and their families.

Theoretical and Conceptual Framework


Health Belief ModelRevised. Rosenstock, Stecher, & Becker (2008) revised
the Health Belief Model of Becker (1974) whereas it shows that the background (sociodemographic factors like education, age, sex, race, and ethnicity) has something to do
with the perception of threats (perceived susceptibility and perceived severity of ill-health
condition) and expectations (perceived benefits, barriers, and self-efficacy to perform
actions). It also indicates that what the mind perceived affects the action (behavior to
reduced threat based on expectations) of an individual.
In relation to this experiment, this theory shows that, since the parents of the child
has a different personal background, the background might affect how the parents think
about their child that will later affect their actions toward raising them. They aim to
provide all the needs of the child especially when it comes to making them healthy, but
there arise an established misconception, that when the child has a bigger body size, the
more it will be considered healthy; and the thinner the body size, the lesser it will be
considered healthy (American Heart Association, 2010).
Theory of Planned Behavior. Azjen (2002) stated that reasoned action which
posited intention to act as the best predictor of behaviour. Intention on the other hand,
was influenced by the behavior beliefs (attitude toward the behavior), normative beliefs
(subjective norm), and the control beliefs (perceived behavioral control).
In accordance to this study, this theory proves that intention seems to be the main
cause of bad nutrition among children. The parents intentions to make their child
healthy was also affected by their beliefs, such as, it is better for their child to be obese,

which they perceived as just nor-mal, (Allen & Prkachin, 2013) than to become a thinsized, that they perceived as weak and unintelligent.
Social Cognitive Theory. Bandura (2004) introduced self-efficacy as a key
component in social cognitive theory; he discussed human motivation primarily in terms
of outcome expectations or behavior. Other than the behavior, self- efficacy (perceived)
also affects ones outcome expectations in physical, social and self evaluate areas; goals;
socio-structural factors like facilitators and impediments. That outcome expectations,
goals, and socio-structural factors also has a big role in ones behavior.
In relation to the researchers experiment, this explains that ones perception and
behavior was affected by modeling. The childrens perceptions and behaviors might be an
adaptation from their parents, since they were the childs significant others. Evidence that
modeling by others strongly affects childrens eating behaviors; although we might
assume that the fact that obese parents tend to have obese children reflects inheritance,
Ray and Klesges(1993) have found that children are very likely to imitate adults food
choices and eating behaviors. In addition, they have observed that parents of children
who are obese not only encourage them to eat more than their non-obese siblings
(explaining that theyre bigger so they need more food!), but also offer such eating
prompts nearly two and a half times as often as parents of normal-weight children do.

Problem
In this study, the researchers wanted to know the effect of body sizes` to the
healthy perception of Filipinos. Aside from that, the researchers aimed to distinguish the

difference between the mothers perception and the childrens perception towards body
sizes.

Method
Design
The experiment made used of the Randomized Block Design or the Within Group
Design. All the participants in the experiment were exposed to the three treatment
conditions to describe the different health perceptions of Filipinos, specifically, Filipino
mothers and Filipino children.

Participants
The participants of this study were composed of ninety-six participants which
were comprised of forty-eight (48) mothers whose ages range from twenty-five (25) to
thirty (30) years old (28 as the mean age and 1.77 for its Standard Deviation), and fortyeight (48) children whose ages range from seven (7) to eight (8) years old (7 as the mean
for age and 0.50 for the Standard Deviation) for a total of 96 participants. Participants
were chosen using a convenience sampling technique, but must be a resident of Bulacan,
precisely from the city of Malolos, and towns, like Sta. Maria, Paombong, Calumpit,
Hagonoy, and Baliwag.

Instruments/Measures
For the instrumentation, the researchers used pictures and Likert scale self-made
survey forms to know its effect on the perception of mothers and children towards body
sizes.
For the pictures, the researchers took a photo of three children from Sta.Maria,
Bulacan, who are all 7 years old. They were weighed, measured and classified as thin or
underweight, normal, fat or obese using the international standards of BMI. These three
different pictures were shown to the participants, for them to judge or rate the three
children based on their perception of who is the most intelligent and healthiest.
Likert-scale self-made survey forms were also used by the researchers in this
study. These forms were composed of six items which measures the area of perceived
intelligence (item numbers 1 and 2), and the area of perceived health (item numbers 3 to
6). Since it is a Likert-scale survey, the following numbers implies these meanings: 1 as
strongly disagree, 2 as disagree, 3 as not likely disagree, 4 as not likely agree, 5
as agree, and 6 as strongly agree.

Procedure
Participants in the experiment were given 3 pictures to look with, and each picture
has a corresponding questionnaire. The questionnaire for each picture has the same items,
to measure the different perceptions of the participants to the body size of the child in the
picture.

For the mothers, the first picture that was shown was a picture of the thin child,
they were also asked to look at the picture for ten (10) seconds so that they can clearly
see the image in themselves. After the picture was shown, the mother was asked to
answer the six items question about her perception with the thin child. Same procedure
was done to the other two treatment conditions, the only difference is the second picture
shown was the picture of the normal-sized child, and the last picture shown to the
participants was the picture of the obese-sized child.
For the children, the same procedure goes like with that procedure of the mother
showing pictures, from the thin-sized child to the normal-sized child up to the obesesized child. The only difference that was done between the procedures is that, the
children participants were aided by the experimenters in reading the questions to avoid
the children participants to just play along and pick-up the answer they just chose to
without judging the picture carefully.

Results
ANOVA TABLE FOR HEALTH
A. Within- Subjects Effects
Measure: MEASURE 1

Source

Type III
Sums of
Squares

Df

Mean
Square

Sig.

10
Picture
Picture*Participants
Error (Picture)

150.365

75.183

73.608

.000

6.737

3.369

3.292

0.39

192.023

188

1.021

Df

Mean
Square

Sig.

.001

.001

.977

94

1.045

B. Between- Subject Effects


Measure: MEASURE_1

Source
Participants
Error

Type III
Sums of
Squares
.001
98.227

The Within- Subject Effects Table shows that the Sums of Squares for Picture is
150.365. For the degree of freedom, the value is 2, since three treatment conditions were
used, minus 1. For the mean square, the value is 75.183. The frequency shows that its
value for picture is 73.608, and for the significant of Picture, it has a value of .000, which
is highly significant. For the Sums of Squares of Picture by participants, it resulted 6.737.
The degree of freedom is also 2. The value of the mean square for picture*participants is
3.369. For the frequency, the value that has been got was 3.292, which has a significant
value of 0.39 which is significant. Lastly, for the error, the resulted Sums of squares is
192.023. The degree of freedom resulted was 188, and a mean square of 1.021.

For the Between- Subject Effects, the Type III Sums of Squares of the participants
is .001. The degree of freedom is 1 since there were 2 participants, minus 1. The Mean
Square is also .001. For the Frequency, it resulted .001, which has a significance of .977.
For the Error, the Type III sums of squares is 98.227. The degree of freedom is 94, since

11

there were 96 participants minus 2, since there were 2 groups. For the mean square, the
value resulted is 1.045.

The result as shown in the table says that the Picture, or the used material for the
treatment condition is significant since it has a significant value of .000which is highly
significant. For the Picture*Participants result, it showed that there is an interaction
effect. Interaction Effect is "the differing effect of one independent variable on the
dependent variable, depending on the particular level of another independent variable"
(Cozby, 1997; p. 314). So the interaction effect here, was shown through the simple main
effect of Picture over Participants. This may mean that the pictures, might influences
the Filipinos perception regarding health, but in some ways, the Participants may also
be a factor on their own perception towards body sizes. For the between- subject effects,
the participants is not highly significant when it comes to the health perception of
Filipinos.

ANOVA TABLE FOR INTELLIGENCE


A. Within- Subjects Effects
Measure: MEASURE 1

Source
Picture
Picture*Participants
Error (Picture)

Type III
Sums of
Squares

Df

Mean
Square

Sig.

43.674

21.837

21.183

.000

9.694

4.847

4.704

.010

193.799

188

1.031

12

B. Between- Subject Effects


Measure: MEASURE_1

Source
Participants

Type III
Sums of
Squares
.834

Error

118.373

Df

Mean
Square

Sig.

.834

.662

.418

94

1.259

For this ANOVA table for Intelligence, the Type III sum of squares of Picture is
43.674. The degree of freedom is 2, since there were 3 levels minus 1. The mean square
is 21.837. The F value is 21.183 which has a significant of .000highly significant. For
the Picture*Participants, the Type III Sums of is 9.694. The degree of freedom is also 2.
The mean square is 4.847. The value of F is 4.704, which has a highly significant value of
.010. For the Error, the type III Sums of squares is 193.799. The degree of freedom is
188, and the Mean square is 1.031.

For the Between Subject Effects, the Type III Sums of squares is .834. The degree
of freedom is 1, since there were 2 groups of Participants minus 1. The mean square is .
834. The Frequency is .662 which has a significant value of .418. For the Error, the type
III Sums of squares is equal to 188.373. The degree of freedom is 94, since 96(no of
participants) minus 2 groups. The value of Mean square is 1.259.

Again, in the Within Subject Effects, there is a significant interaction effect


between the Picture and the Participants. A change in the picture might affect the
participants perception in intelligence. For the Between Subject effects, the participant is
not a factor that significantly affects the Filipinos perception regarding intelligence.

13

TABLE FOR MEAN AND STANDARD DEVIATION


5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0

Mean
Standard Deviation

Axis Title

This table shows the mean deviation (MD) and the standard deviation(SD) of the
three treatment conditions in the areas of Intelligence and health perception of both the
participant 1 (mothers) and the participant 2 (children).
For the mothers perception towards the intelligence level of the thin sized child in
the picture, it resulted that the mean is 3.7812 which is in between the scale of 3, which is
not likely disagree , and 4, which is not likely agree. Although the mean is in
between the two scale, it is nearer to the not likely agree which may imply that there is
an agreement that the child was intelligent, but maybe because of their thin sized body,
they doubt if the child was really intelligent. For the second condition, which is a normal
sized child in the picture, the mean is 4.1771 which is in between 4, which is again not
likely agree and 5 which is agree. The mean for normal sized children in the picture is

14

4.1771, which is nearer to the not likely agree, again there is a slight agreement here
that the normal child was intelligent, but still there is a doubt that is why they did not
agree completely. For the last picture, which is the picture of an obese sized child, the
mean is 4.2500. The mean was again between the scale of 4 and 5, and also nearer to the
4th scale, but this third treatment scored the highest which may imply that for the mothers,
the child with an obese sized body is the most intelligent among the three, while for the
lowest mean 3.7812 for the thin child might be the least intelligent as perceived by the
mothers.
For the participant children perception towards the intelligence of the thin sized
child in the picture, it resulted that the mean is 3.3750 which is in between the not likely
disagree and not likely agree. That may mean that the participant children do not
believe or agree that the thin sized child was intelligence. For the picture of the normal
sized child, the mean resulted is 4.4792 which is between not likely agree and agree.
Unlike to the mean of the picture of the thin sized child, the mean here is somehow near
to the agree scale which may imply that the participant children believed or thinks that
the normal sized child in the picture was somehow intelligent. For the last picture shown,
the picture of an obese sized child, the mean is 4.6771 which is also between the not
likely agree and agree but this time, the mean is nearer to the agree scale. Since the
last has the highest mean, that may imply that the participant children thinks that the
obese child is more intelligent than the other two who has a normal and a thin body sized.
If you are to combine the result of the perception of both the mothers and the
participant children, you can see that there is an interaction effect, whereas the bigger the
size of the body, the more they believe that it is more intelligent. Result of the means in

15

the three conditions of both the mothers and the child were slightly the same since the
mean of the picture of a thin child both started in 3- 3.7812 and 3.3750. Together with the
normal (4 as the value)- 4.1771 and 4.4792, and the obese (4 also)- 4.2500 and 4.6771.
For the mothers perception of healthiness towards the thin sized child in the
picture, the mean scored 3.0781 which is in between most likely disagree and most
likely agree. Though it is between those scales, it is nearer to most likely disagree
wherein they dont see the thin child in the picture as a healthy child. For the normal
sized child, the mean is 4.0625 which is between most likely agree and agree. This
may imply that they may see the child in the picture as in good condition, but not fully
healthy. For the last picture, which is the obese sized child, the mean is 4.5052 which is
also between most likely agree and agree, but unlike from the mean of the picture of
the normal sized child, the mean of the picture of the obese child, it is nearer to the agree
scale. With that we can say that for the mothers, the greater the size of a child, the healthy
she is while the thinner the size, the lesser the healthiness.
For the participant children perception towards the thin sized childs healthiness,
the mean scored 2.6771, which is between disagree and not likely disagree. Since the
mean is in between the disagree, it may signify that the participant children do not see
the thin sized child in the picture as healthy. For the mean of the picture of the normal
sized child, it scored 4.4010 which is between not likely agree and agree. In that, we
can say that though there was hesitation, the participant children see the normal sized
child as healthy. For the last picture, the child with an obese size, the mean scored 4.5781
which is also between not likely agree and agree. There is only a small difference
between the means of the second and the third treatment condition, which may imply that

16

though the participant children see the obese sized child as a healthy one, still there is a
hesitation that having a greater body size is healthy.
For the combination of the result of the mother and the child participant, still there
is an interaction effect whereas the participants saw that the greater the body size, the
greater they believe that it was healthy. For the thin childs healthiness perception of the
child, it implies that the participant child does not really think her as healthy, but for the
mothers, they have hesitation if the child is really healthy or not.

Significance
This study is of importance to many peopleparents, children, school, Filipino
government, to the future researchers and especially to the future parents and their
children.
It will be of importance to the parents because it will correct their misperception
about an obese child being healthy; also it will encourage them to engage their children to
activities that will help them maintain a healthy body. Aside from that, the parents of the
children will also provide their children a balanced diet and proper nutrition, and that the
wrong feeding styles that they are used to, will be eventually eradicated, hopefully, to
decrease the prevalence of malnutrition in our country, specifically, obesity.
Filipino children is said to be the hope of our society, and this so-called hope of
society is on the verge of improper nutrition as well as misconception. This study will
provide them the correct information about their mistakenly perceived perception. It will

17

enable them to realize that being fat or being thin at a glance does not clearly signify
intelligence and health.
It has been figured out in the study of Chaimovitz, Issenman, Moffat & Persad
(2012) that many children underestimated their degree of overweight. Their parents and
even their attending physicians shared this misperception. It demonstrates the need to
further educate physicians to recognize obesity and overweight so that they can counsel
children and their families.In this study, the medical practitioners will be more open to
the issue that Filipinos experience. With that, they can set-up seminars that they will
provide to the pregnant mothers that will give them the correct information about a
healthy child.
The Filipino government and all the Filipino citizensthe future parents and their
children, will gain through this study, since obesity and undernourishment is one of the
issues that Philippines faces. This will enable them to come up with new ideas to stop the
widespread misperception of Filipinos. Also, this might catch their attention to conduct
deeper studies on this area.
Lastly, future researchers may use this study as a springboard and basis of further
researches that may include larger populace, and at different locale.

Limitations

18

The limitations for this study, is that the participants only came from Bulacan.
Aside from that, the researchers saw that preferring mothers as a participant, and not
having fathers as participants also limited the study. The socio-economic status and the
educational background of the participants especially to the mothers had become a
limitation because it can also affect their perception. (Angeles-Agdeppa, Lana & Barba,
2003). Another limitation is the span of time that this study was conducted. Lastly, the
few literatures done in the country also served as a limitation because it contributed less
information compared to the studies done abroad.

Implications of the Study


Based on the results, this study implies that Filipino mothers and children had that
certain misconception about body sizes, and that they perceive a fat or obese child to be
healthier and more intelligent; more so, an underweight or thin child to be weak, and
doesnt have good health compared to their normal and obese playmates. This established
misperception proved to be one of the causes of childhood obesity in the Philippines, and
this phenomena started prevailing itself in the country and, is the new form of
malnutrition, according to the World Health Organization.
It is quite alarming that both mothers and children perceived that the obese child
is healthier and more intelligent. The mothers who perceived that the thin and normal
child is unintelligent and unhealthy might binge feed their child, while those children
who perceived the thin and normal child like what the mother participants had perceived
might allow their mothers to binge feed them or that, they binge feed themselves just to

19

be healthy and intelligent on their own perceptions. These perceptions that both mother
and children share is an implication why child obesity is prevalent in the country.
It demonstrates how important the perceptions of the mothers towards body sizes
are because they are the one responsible for feeding their child, and if they have that
misperception towards body sizes, it might be a factor that they will prefer their children
to be fat, and that the child might suffer from obesity.
The perception of the children is also important, rather than just merely relying on
the adults perception, because they are the one who is mostly affected by the
misperception towards body sizes. The way they think and the way they perceived body
sizes, might also affect the next generation and their generation. The next generation
because these children will also soon be parents, and if that misperception will not stop in
their generation, it would be safe to assume that the next generation would still be under
that improper perception towards body sizes.
According to Cruz, Himsa, Imson & Mang-usan (2009), the focus on childhood
obesity is clinically significant as the problem contributes to the marked decrease in
childrens health. The effects of obesity are usually seen later during adult life.
Cardiovascular complications such as coronary heart disease (CHD) and stroke are
common among obese adults with history of childhood obesity. The relationship of
cardiovascular disease and obesity was clearly shown in a study conducted by Pavel
(2004).
This study also implies that Filipinos must conduct more studies so that they can
be more aware and will be able to understand this rampant predicament that the society
faces. Other than that, Filipinos must start now having a healthy lifestyle, and that the

20

future parents must be well-educated on how to handle proper feeding styles to their
children.

Conclusion
Both the participantsmothers and children, in this study, perceived that the
obese child is the healthiest and the most intelligent among the three treatment
conditions. According to the results, the participants also perceived that the thin child is
neither healthy nor intelligent, while the normal-sized child remains to be have normal
results.
Aside from that, it was also observed by the researchers that the size of the
participants also affects their perception. Majority of the mothers who are fat, perceived
that the fat child is the healthiest and most intelligent. Some thin mothers perceived that
the thin child is the most intelligent and healthiest, yet majority of them choose the obese
child. In the case of the child participants, some of the children participants who are fat,
perceived that the thin child is the healthiest but not the most intelligent.
Generally, majority of the participants perceived the obese child being the
healthiest and most intelligent among the three body sizes that were shown to them.

21

Recommendation
For the future researchers who will use this study, the researchers recommend that
they must widen the range of the age bracket of the child participants. They must
equalized the age, from seven (7) years old to ten

(10) years old so that they can

clearly see the difference between their perceptions. The gender must also be considered
as well as the body size, because it was observed that it also affects the perception.
Moreover, the socio-economic status that the child is in must also be considered.
It would be better if the future researchers also add fathers as participants. The age
bracket of the mothers and fathers that would participate in the study must also be
regarded, like that of the children. Their occupation, the educational background and the
socio-economic status, and even their body size must be looked upon their future
experiment.
Bigger locale, longer time and more items on the survey is suggested by the
researchers. A bigger locale would provide the future researchers to compare the
perception of those who live in the urban areas and those of whom who live in the rural
areas like Bulacan. Longer span of time would give the future researchers to have a more
in-depth study towards this, and lastly, adding of items in the questionnaire would also be
better because they will be able to gather more data and information about the
perceptions of their participants.

References: