Group 9

1. EFRIYANTI ( PO7131123038 )
2. RISKA MARMALIYANTI ( PO7131123054 )
3. SALIMA ATHIYA FAHRIYAH ( PO7131123076 )
4. NURAINI ZABELITA ( PO7131123086 )
5. NIMAS AYU RAHMAWATI ( PO7131123100 )

The influence of heal the education through short message service

(SMS) and booklets about obesity in overweightand obese
adolescent

A. Background

Adolescence is a transition period between children and adults that is very

important to pay attention to. Problem nutrition in adolescents along with decreased
physical activity, adolescents in general have larger appetites so that often looking for
additional food outside meal times in the form of energy-dense, sweet and high-fat foods
which are at risk of causing overweight and obesity. Therefore, one effort to overcome
nutritional problems is through providing education health for teenagers .

B. Introduce

In the past, a fat body was considered a symbol prosperity due to the general
problem of obesity often found in rich countries such as the United States and
European countries that are classified as prosperous. This opinion is now no longer
correct. Formerly poor and developing countries such as China, several countries in
Africa, India, and Indonesia, apart from being found in many children and adults
skinny and short due to malnutrition, also started Obesity is often found due to excess
nutrition (1). Prevalence of obesity in children aged 2 to 19 years in the United
Statesinthelast3decadeshasincreasedfrom27.5%to31.1%(2).Prevalenceofobesityin
hildren aged 6-12 years in Bangkok increased from 12.2% to 15.6% and the
prevalence rate in Japan in children 6-14 years from 5% to 10% (3). Riskesdas results
2013 shows that the prevalence of overweight and obesity in Indonesia at the age of 18
years and over nationally at 13.5% and 15.4%. While prevalence obesity in teenagers
aged 16 – 18 years 7.3% consisting of 5.7% overweight and 1.6% obesity. Yogyakarta
Special Region Province (DIY) is one of the provinces with the prevalence of obesity
above the national prevalence (4). The research results conducted on school children in
2004 in Yogyakarta found cases of obesity of 7.9% in adolescents in cities and 2% in
villages (5).
 Adolescence is very important to pay attention to because is a transition period
between childhood and adulthood. Adolescent nutrition problems are in line with the
decline physical activity,teenagers generally have anappetite larger so they of ten look
for additional food, for example, snacks outside meal times. Teenagers love it energy
dense, sweet, and fatty foods, even though If consumed frequently, these foods are risky
causes obesity. Obesity is closely related with some serious illnesses suchas pressure
high blood pressure, coronary heart disease,diabetes mellitus,and respiratory tract
disease(6).Research on midwiferya cademy students about health promotion for
prevention overweight and obesity through transparency and booklet succeeded in
increasing knowledge, attitudesand treatment group behavior (7). Same as research
results in Korea that utilize features short service message on mobile to modify
behavior in weight control shows that the majority of participants were satisfied with
SMS messages (8). However, the research is not yet conclusive appropriate and
effective health education media in behavior modification to overcome nutritiona
lproblems especially the problem of obesity inteenagersItis known that this problem
will cause dangerous impact on future health. Therefore, researchers are interested in
doing so research with the aim of knowing the influence of education health about
obesity through short message service (SMS) and booklets on knowledge and index
body mass (BMI) of overweight and obese adolescents in Yogyakarta City High
School.

C. Method

Analytical research with research types quasi-experimental and pre-test research

design and post-test. In the intervention group, a pre-test was carried out and post-test
on knowledge and mass index body (BMI) of each group. Treatment given are divided
into three groups, namely providing intervention via SMS (X1); giving intervention
via bookle t(X2); and providing interventions via a combination of SMS plus booklet
(X3). Study implemented in May-July 2014 in three City High Schools Yogyakarta,
namely SMA Negeri 2, SMA Negeri 6, and Public High School 10. The population is
all high school students in Yogyakarta City while the sample was selected based on
inclusion and exclusion criteria. The inclusion criteria are students who are overweight
and obese; own cell phone even if not brought to school; and willing to take part in
research (informed consent) while the exclusion criteria is undergoing the program
fitness or athlete and undergoing a special diet or consumption slimming medicine.

Calculation results using the sample size formula at least based on paired
analytical- numerical 35respondents were obtained for each group treatment so that the
total sample is 105 respondents. 38 Indonesian Journal of Clinical Nutrition, Vol. 12,
no. 1, July 2015: 36-44 The sampling method is carried out using simple random
sampling technique (simple random sampling) namely after status screening nutrition
in students at the three high schools later Simple random sample selection was carried
out towards students who have nutritional status overweight or obese as many as 35
respondents at each school. Teenagers are categorized overweight if BMI measurement
is based on age (BMI/U) is at ≥ 85th percentile, meanwhile obeseifat ≥ 95 th
percentile.

The independent variable in this research is education health via SMS and
booklets, the dependent variable is knowledge and BMI, and the intermediate variable
is intake energy and physical activity. SMS service sent via mobile phones with a
maximum of 160 messages sent characters and the SMS sending process takes 2
month with a frequency of once every 2 days. The contents of the message sent created
by researchers by modifying the SMS material on Joo and Kim's research (8) while the
contents of the booklet were created by researchers from the results of modifications to
the book let material about obesity in previous research conducted by Saragih (7). The
booklet contains the definition of obesity and measurement, causes of obesity, impacts
of obesity, and tips for dealing with obesity. Booklets are given only once, namely
after conducting a pre-test on the subject.
The knowledge variable is measured using Knowledge questionnaire about
obesity and variables BMI is measured using scales (body weight) and microtoise
(body height). Energy intake is known as 3x24 hour recall carried out on 2 school days
and 1 holiday. Meanwhile physical activity is measured using International Physical
Activity Questionnaire (IPAQ) which has been modified by research (9).
Questionnaire knowledge in the form of 20 closed questions questions about obesity
(7). Knowledge assessment done by giving a score based on the answers, if it is wrong
it is given ascore of 0and correct it is given a score of 1 so Minimum total scoreis 0
and maximum is 17. Test validity and reliability indicate that the question on the
questionnaire and booklet used as The research instrument is valid and reliable.

Data analysis using paired t-test to see pre-test and post-test changes in each
treatment group, then analysis was also carried out of variance (ANOVA) to see
difference betweentreatment groups followed by multiple comparison test (MCA).
Apart from that, it's done also test the correlation to see the relationship between
energy intake and physical activity on body mass index (BMI). This research has
received ethical suitability information from the Medical and Health Research Ethics
Commission Gadjah University Faculty of Medicine Society Mada Yogyakarta with
number KE/FK/648/EC.

E.Disscusion
The influence of health education on knowledge

Based on the research results, it is known that health education has a

significant influence
Towards increasing knowledge in each treatment group. Next, after Comparisons were
made between the three treatment groups shows that statistically there is a difference
the influence of media on knowledge in adolescents overweight and obesity.
Intervention uses SMS media canincreaseteenagers'knowledgeabout obesity.In line
with the research results previously(13) that cell phones are one type of effective and
effective communication technology It is feasible to provide information via delivery
fillin the SMS as a reminderin your efforts public health promotion .Research in
Iran(43)shows the effectiveness of interventions using SMS via cell phone to internal
knowledge management of type 2diabetes mellitus. There is an increase knowledge can
be caused by the advantages of the media SMS, including messages, can be sent within
a certain time fast, read at the right time, there is communication two-way, and SMS
ischeaper than media other prints (15).

Health education through booklets on This research is also able to increase

knowledge overweight and obese adolescents. Research results on teenagers in
Tasikmalaya (16) showed that knowledge in the treatment group that received health
education through experience booklets enhancement. Research conducted on nursesin
The hospital results also showed that there was a difference significant increase in
prior knowledge and after giving the booklet (17). Mentioned That health education
using booklet media role in increasing knowledge, this media can make the process of
delivering material content more effective teaching given (18

Health education intervention via SMS plus The booklet in this study also shows
that The combination of two media has an effect on increasing Adolescents'
knowledge about obesity. As It is stated that combining several media can increase
one's knowledge. Fusion SMS media plus booklet will be easy to learn and it is
understood, this is because they can read and look at the contents of the material in the
booklet, too Get additional information via SMS sent to them every two days.
According to Previous research also found that there was an influence health education
using the lecture method accompanied by with booklets to increase knowledge,namely
before intervention, it was 26.67%,in creasing to 90% after intervention(19)

The results of the analysis also show that group the combination of SMS plus booklet
is more effective in increasing knowledge compared to SMS group and group
booklet.Effective SMS plus booklet media can be caused by providing material about
obesity simultaneously through combination of media namely print media and
electronic media so more interesting and easy to
readandunderstand.InlinewithresearchconductedinBandaAcehCityaboutnaturaldisaster
preparedness, research results shows that health promotion with using short message
services and leaflets effectively to increase the knowledge of junior high school
students (20)

The influence of health educationon BMI

Research results in the three treatment groups shows that the average BMI for
each group experienced a decline after it was given intervention, although the results of
the comparison betweenthe threegroups did notshow anydifferences significant.
Differentresults areshown by research in Korea (8) about weight loss programs via
mobile phone short message service for behavior modification carried out for 12 weeks
showed that post-intervention the mean circumference Waist decreased by 4.3 cm and
BMI of 0.6 kg/m2. Some subjects were satisfied with sent messages and SMS maybe
effective method in behavior modification for weight control. Possible differences in
results this research with research in Korea (8) can caused by differences in the length
of research, As is known, in this research only carried out for 8weeks while in the
research This was done for 12 weeks. As well with overweight and obese teenagers in
the group getting health education through booklets, no shows a decrease in the average
BMI. This is possible due to the frequency of giving booklets in research This is only
given once so it doesn't give away maximum effect. Apart from that, it may also be
caused because booklet media has weaknesses, including: that is, it is difficult to
display movement, the printing costs are expensive if want to show illustrations, color
photos, processes printing takes a long time, and if not maintained well quickly
damaged or lost (18).
However, the results of this study show health education through a combination
of SMS plus booklet has an effect on reducing BMI in overweight and obese
adolescents. In line with research conducted on female students about health
promotion to overcome overweight and obesity, the study proves it exists reduction in
obesity status to overweight (p=0.04) in the treatmentgroupatthetimeofthepre-
testwerecomparedwithpost-test(7).Furthermore,the research states that health education
uses booklets combined with other media can reduce the weight of teenagers who
experience obesity, this could be due to the media being able to increase adolescent
knowledge about obesity so that it will indirectly influence attitudes and behavior
towards weight control

After making a comparison between the three health education media groups
either through
SMS, booklet or a combination of SMS plus booklet apparently nothing is more
effective in reducing BMI. This is possible because although knowledge has increased,
but para Teenagers do not change their behavior especially in consumption patterns or
eating habits and physical activity
soitdoesn'thavealoweringeffectweight.Apartfromthat,asweknowthatLosingweighttakes
time relatively long and requires strong motivation. On In this study, only health
education was provided through print and electronic media for two months can be
categorized as preventive and promotive efforts as well as the absence of direct
treatment, for example in the form of providing certain foods or supplements as a
curative measure so there is no immediate effect in reducing BMI in adolescents who
experience it overweight and obesity
After making a comparison between the three health education media groups
either through
SMS, booklet or a combination of SMS plus booklet apparently nothing is more
effective in reducing BMI. This is possible because although knowledge has increased,
but para Teenagers do not change their behavior especially in consumption patterns or
eating habits and physical activity so it doesn't have a lowering effect weight. Apart
from that, as we know that Losing weight takes time relatively long and requires
strong motivation. On In this study, only health
educationwasprovidedthroughprintandelectronicmediafortwomonthscanbecategorizeda
s preventive and promotive efforts as well as the absence of direct treatment, for
example in the form of providing certain foods or supplementsas a curative measure so
there is no immediate effect in reducing BMI in adolescents who experience it
overweight and obesity
The relationship between energy intake and physical activity overweight and obesity

The results of correlation analysis show a significant relationship not significant

between energy intake and physical activity on the incidence of overweight and obesity
based on BMI. Direction of relationship between energy intake and BMI is positive,
namely if there is an increase in intake energy, the BMI value will also increase. On the
contrary 42 Indonesian Journal of Clinical Nutrition, Vol.12,no.1,July 2015:36-44 with
the direction of the relationship between physical activity and BMI is negative which
means that if activity If your physical condition decreases, your BMI value will increase.
Results This is supported by previous research in America states that there is an increase
in the percentage size portions and energy intake in fast food and Sweet foods go hand
in hand with increasing body weight (obesity) children and adolescents (21).
Furthermore, providing health education via SMS, booklet, and a combination
of SMS plus booklet In this study it did not have any influence significant effect on
energy intake.Energy intake does not experienced a decline in both of them group or
after comparis on between groups. In contrast to that statement stated that there was
adecrease in energy intake compared to the
needs likely to be caused there was an increase in respondents' knowledge after
get health education through booklets. Matter This happens because health education is
an attempt to change someone's behavior carried out with an educational approach
aimed at foster positive attitudes of individuals and society on nutritional intake which
will influence habits eat to achieve improved nutrition (22). Another factor which may
result in no effect health education on energy intake is due to limited research on there
call method 24 hours which is very dependent on memory, both from identify the food
consumed and the size or portion. Several studies prove that food consumption that is
not properly reported by 20-25% of research subjects, especially femalesubjects,
individuals who are overweight, and individuals who sensitive to weight problems.
Likewise with physical activity does not have a significant effect (p>0.05)
after being given health education through the media SMS, booklet or a combination
of SMS plus booklet. This lack of influence could be due to by various factors, as
stated in previous research (23) that variousfactorswhich caninfluenceadolescents'
physicalactivity includingthe supportof family and friends. Meanwhile, in this study,
the intervention provided was: health education that is only given to respondents only
or in other words there is no intervention towards their family or friends as a group
supporter. Apart from that, it might also be caused by the habits of teenagers who
rarely exercise and accustomed to using motorbikes, cars or buses as tools
transportation. The direction of the relationship between physical activity and BMI is
negative, meaning that if activity If your physical condition decreases, your BMI will
increase, likewise Conversely, if activity increases, BMI will decrease. There is a
negative relationship between physical activity with this BMI shows that people those
who are overweight or obese have activities less compared to slender people or norm
Physical activity of overweight and obese adolescents in this study it is known
that it falls into this category light. The results of this research are in line with
Riskesdas data that most of the population is teenagers in Indonesia have physical
activity in the light category. The study conducted in the Netherlands stated that
teenagers were overweight have light physical activity and psycho social problems
 associated with physical activity compared with adolescents who have normal weight
status(23).Besides That,based on the results of research in the United States(24)
showed that physical activity increased able to reduce obesity status by 0.06 kg/ m2 for
women and 0.22kg/m2for men. Every an increase of one hour of television watching
activity or videos or playing games (play station or games computer) provides a
weight-increasing effect of 0.05 kg/m2
especially for women

Evidence suggests that exercise intensity has the potential to be an effective tool
and economical in reducing body fat mass in individuals who are overweight and
obese (25). Therefore, teenagers are advised to do so high intensity exercise (sports)
and doing useful and healthy physical activity, such as cleaning his bedroom,
gardening, walking some distance from the parking lot, sweep or mop while sports are
healthy for teenagers for example football, basketball, volleyball, badminton, cycling,
jogging and skipping (26). Furthermore, efforts to increase physical activity among
teenager sistopromotepositiveattitudestowardsphysical activity it self and
needsencouragementfrom members families tosupport adolescents'effortsto become
more active (27)

Thus, it can be concluded that health education media through a combination

of SMS plus booklets are the most effective mediain in creasing knowledge in
overweight adolescents and obesity. However, health education through none of these
three media is more effective for reducing the BMI value of overweight and obese
adolescents. This shows that the media is a short message service (SMS) and booklets
are not suitable for use in lowering BMI so it is necessary to provide real interventions
that have direct benefits in losing weight

D. CONCLUSION

Health education about obesity uses SMS media and booklets have a deep
influence increase knowledge in adolescents who experience it overweight and obese.
Thus, SMS media and booklets can be used to increase knowledge, but the frequency
of giving booklets should be done more than once, for example 3 times in stages
during research to have an impact the maximum. Apart from using SMS media and
booklets, further research can use audio visual media and the use of smartphones
through social media for example Facebook, BlackBerry Messenger (BBM),
WhatsApp, Line, Instagram, and so on so that more health education is provided
interesting.

E.Bibliograpy

Lanita, U., Sudargo, T.,& Huriyati, E. (2015). Lanita, U., Sudargo, T., & Huriyati, E.
(2015). Pengaruh pendidikan Kesehatan Melalui short message service (SMS) dan
booklet Tentang Obesitas Pada remaja overweight Dan obesitas. Jurnal Gizi
Klinik Indonesia, 12(1), 36. https://download.garuda.kemdikbud.go.id/article.php?
article=689197&val=5019&title=Pengaruh%20pendidikan%20kesehatan%20melalui
%20short%20message%20service%20sms%20da n%20booklet%20tentang
%20obesitas%20pada%20remaja%20overweight%20dan%20obesits