1

Chapter I

INTRODUCTION

A. Background of the Study The number of people who suffer from obesity has increased a lot, but things are sad as teen obesity has reached an incredible high level. Teen obesity causes are also hereditary, but without controlling what kids and teenagers eat, they will be more and more overweight. Teen obesity has multiple consequences that affect self-confidence and health. Teen obesity is the major cause of bulimia, blood flow and heart disorders, as well as hormonal problems. Fast-food courts transformed into a place where teenagers meet and have fun, but what they are eating is completely wrong and unhealthy for them. It is a trend to attend these places, but the effect is teen obesity that incorporates a lot of problem. The best thing is to educate, inform and explain to teenagers what is healthy for them and why. Use anything that may work as a demonstration to prove them that it is true and show them the effects. Adapt your language to their level of understanding and make sure they keep in mind the information and that apply it. A great tip is to let them pick the food, but only the healthy one, so you will know for sure if they got the point and make the right decisions. Beginning from an early age, during teenage and maybe all their lives, will have no problems. Here in the Philippines there are lots of herbal plants and also fruit that can be an alternative medicine to treat some illness, an example is the pomelo. Pomelo is distinguished from all other citrus fruits by its size namely it is the biggest of them all. Other commonly used names for this fruit are also Chinese grapefruit, lusho fruit, jabong, papanas, shaddock etc. Other quality that

differentiates it from its next of kin, i.e. the grapefruit, aside from the size has also a much thicker skin. When it comes to the size, it ranges anywhere from 15 to 25 cm in diameter, and the weight is approximately 1-2 kg. The rind is in most cases of pale green color, changing into yellow once the fruit becomes ripe. As far as the climate is concerned, the ones that best suit pomelo are tropical climates, with the fruit ripening in winter time. Pomelo can help you lose weight because it has fat burning enzymes. These enzymes absorb the sugar content in the body. The fruit can also be used as a remedy for diabetes, insomnia, fever and sore throat. Pomelo is often called the "Fat Melting Fruit" and fat-burning supplement, the theory being that the fruit's low glycemic index is able to support the body's metabolism to burn fat. Pomelo Seed contains the whole spectrum of the vitamin-B group, with a particularly high content of Biotin, which is responsible for the utilization of dietary body fats, facilitating the metabolism of carbohydrates, fats and proteins (and the utilization of other B-complex vitamins). Some studies have also shown that pomelo helps to lower cholesterol. According to 2010 data from Jerusalems Hebrew University and Massachusetts General Hospital, Naringenin, a compound derived from the pomelo was found to mimic the actions of some lipid-lowering pharmaceuticals in animal models and shows potential as a naturally occurring-dietary supplement to regulate lipid metabolism. It is on this premises that we should conducted an experimental research on the effectiveness of pomelo (Citrus Maxima) in order to have actual information on how to help to reduce the weight of an obese BSN Level 3 student.

B. Statement of the Problem This study aimed to determine the effectiveness of Pomelo (Citrus maxima) fruit in reducing weight among obese BSN Level 3 students in WMSU. Specifically, it seeks to answer the following queries: 1. Is there a significant difference in the weight of the BSN students before and after the introduction of Pomelo as an alternative weight reduction approach? 2. What are the evidences of effectiveness of Pomelo as a weight reduction alternative?

C. Significance of the Study Obesity can weaken physical health and well-being, and can shorten life expectancy. It can also lead to social disabilities and unhappiness, which may cause stress and even mental illness. We all know that the development of a personal identity and body image is an important goal for adolescents, but obesity becomes an obstacle in achieving this goal.

Nowadays, weight reducing products are available in the market. But surely, they are costly, at times ineffective and post health threats. Students even turn to unhealthy ways to save money to avail these products such as skipping meals.

This study that uses Pomelo (Citrus maxima) fruit aimed to help obese BSN Level 3 students to achieve their ideal weight and promoted a healthier body in a cheap and easy approach. This study even promoted losing weight without

altering the regular diet of the respondents. This study may also be a proof to the claims that the Pomelo fruit is an effective weight reducer.

This fruit is widely available in Zamboanga city. Most homes also have this tree on their backyards.

D. Scope and Delimitations This study focused on the use of Pomelo (Citrus maxima) fruit as an effective weight reducing alternative. This study is delimited to BSN Level 3 students in the Western Mindanao State University with ages 15- 20 years old and who are considered Obese Grade I to Grade III according to the Body Mass Index (BMI) WHO Classification.

This study was conducted to include all weighing sessions for 6 weeks. It utilized accurate monitoring for the whole duration of the experiment.

This study recommends for a better, cheaper and safer way for reducing weight among obese BSN Level 3 students.

Chapter II

THEORETICAL FRAMEWORK

A. Review of Literature POMELO The pomelo (Citrus maxima) fruit is the largest of all citrus fruits with a very thick rind and filled with a sweetish yellow or pink flesh. The pomelo tree is about 5 to 15 meters tall. Pomelo is big (larger than grapefruits), 10-25 cm in diameter, with a thick spongy rind. At maturity the fruits are handpicked. They can be stored for several months. According to Hein Bijlmakers, an agricultural development adviser, pomelo is originally found in Thailand and Malaysia. Some pomelos can be found in the Mediterranean, tropical America and Australia, but its main distribution is in South-East Asia and some other Asian countries. For growth, it prefers hot and humid climate.

There are many uses of pomelo. As a food, the pomelo fruit is eaten fresh or processed into juice. The rind is candied or used in jams. Malays boil the rind in syrup. For cooking purposes, it is sometimes used in place of grapefruit. Furthermore, pomelo can be also be used as a medicine. The Chinese eat the sweet and sour fruit is eaten to fortify the lungs and the spleen. They make various medicaments from the seeds, flowers, mature peel, and slices of young fruit by usually drying them up. It is used in treating cough, swellings, vomiting, indigestion, in removing phlegm and resolving alcohol toxins and hangover. The Malays eat the fruit to treat abdominal pains, oedema and phlegm. The leaves are

boiled into a lotion and applied on swellings and ulcers (Thulaja, 2003). Pomelo is an excellent source of Vitamin C and potassium.

Food Uses. The skinned segments can be broken apart and used in salads and desserts or made into preserves. The extracted juice is an excellent beverage. The peel can be candied. Food Value Per 100 g of Edible Portion* Calories Moisture Protein Fat Carbohydrates Fiber Ash Calcium Phosphorus Iron Vitamin A Thiamine Riboflavin Niacin Ascorbic Acid *Analyses made in China and the United States. Toxicity. Like that of other citrus fruits, the peel of the pummelo contains skin irritants, mainly limonene and terpene, also citral, aldehydes, geraniol, cadinene and linalool, which may cause dermatitis in individuals having excessive 25-58 84.82-94.1 g 0.5-0.74 g 0.2-0.56 g 6.3-12.4 g 0.3-0.82 g 0.5-0.86 g 21-30 mg 20-27 mg 0.3-0.5 mg 20 I.U. 0.04-0.07 mg 0.02 mg 0.3 mg 30-43 mg

contact with the oil of the outer peel. Harvesters, workers in processing factories, and housewives may develop chronic conditions on the fingers and hands. Other Uses. The flowers are highly aromatic and gathered in North Vietnam for making perfume. The wood is heavy, hard, tough, fine-grained and suitable for making tool handles (Morton, 1987). Medicinal Uses: Pomelo is also used as a medicine. In the Philippines and Southeast Asia, decoctions of the leaves, flowers, and rind are given for their sedative effect in cases of epilepsy, chorea and convulsive coughing. The hot leaf decoction is applied on swellings and ulcers. The fruit juice is taken as a febrifuge. The sarcocarps are employed against coughs, dyspepsia and lumbago. Gum that exudes from declining trees is collected and taken as a cough remedy in Brazil. An essence prepared from the flowers is taken to overcome insomnia, also as a stomachic and cardiac tonic. The pulp is considered an effective aid in the treatment of urinary disorders. Leaf extractions have shown antibiotic activity (Admin, 2009). Pomelo can help you lose weight because it has fat burning enzymes. These enzymes absorb the sugar content in the body. Pomelo is often called the "Fat Melting Fruit" and fat-burning supplement, the theory being that the fruit's low glycemic index is able to support the body's metabolism to burn fat. Pomelo Seed contains the whole spectrum of the vitamin-B group, with a particularly high content of Biotin, which is responsible for the utilization of dietary body fats, facilitating the metabolism of carbohydrates, fats and proteins (and the utilization of other B-complex vitamins). Some studies have also shown that pomelo helps to lower cholesterol. According to 2010 data from Jerusalems Hebrew University and Massachusetts General Hospital, Naringenin, a compound derived from the pomelo was found to mimic the actions of some lipid-lowering pharmaceuticals in

animal models and shows potential as a naturally occurring-dietary supplement to regulate lipid metabolism. According to Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998) biotin plays a key role in the metabolism of lipids, proteins and carbohydrates. It acts as a critical coenzyme of four carboxylases (enzymes): acetyl-CoA carboxylase (involved in the synthesis of fatty acids from acetate) propionyl-CoA carboxylase (involved in gluconeogenesis, i.e. the generation of glucose from lactate, glycerol, and amino acids) b-methylcrotonyl-CoA carboxylase (necessary for the metabolism of leucin, an essential amino acid) pyruvate carboxylase (involved in energy metabolism, necessary for the metabolism of amino acids, cholesterol, and odd chain fatty acids) Biotin also plays a special role in enabling the body to use blood glucose as a major source of energy for body fluids.

Citrus fruits include grapefruit, lemons, limes, tangerines, and oranges. They are best eaten fresh and are high in vitamin C as well as a wide range of nutrients and protective phyto-chemicals like pectin and naringenin. When eaten raw they are a good source of soluble and insoluble fiber. By adding Citrus Fruits to the daily diet, one can greatly increase metabolism, increase ability to get rid of fat and, hence, citrus fruits can be called as an effective weight-loss weapon. It has been shown that people can actually eat large quantities of food without consuming too many calories by choosing foods high in fiber and water content. Besides being a refreshing source for the mind and body, citrus fruits have been also recognized for their numerous other health benefits.

According to researchers, Vitamin C & naringenin, found abundantly in all citrus fruits, have a fat burning quality. Vitamin C Vitamin C reduces the effectiveness of fat. It reduces its content and can liquefy or dilute fat. By diluting the fat, it makes it less effective, and easier to flush out of your system. Vitamin C also works on cholesterol deposits. Vitamin C can help burn out the cholesterol, hence, making it difficult for cholesterol deposits to form in blood vessels. Naringenin A phytonutrients present in citrus fruits Citrus fruits mainly consist of various water-soluble plant pigments collectively called as flavonoids. Of all the flavonoids, the most abundant one is naringenin, a naturally occurring alkaline compound in all citrus fruit, but most significantly in grapefruit, orange and tomato. Naringenin has a significantly positive bioactive effect on human health as a fat blaster (weight loss agent), antioxidant, anti-inflammatory agent, carbohydrate metabolism promoter and immunity system modulator. (Mulvihill et al., Diabetes journal, July 10, 2009). OBESITY

Overweight and obesity, as defined by the World Health Organization, are abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), a persons weight (in kilograms) divided by the square of his or her height (in metres). A person

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with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight. Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. Once considered a problem only in high income countries, overweight and obesity are now dramatically on the rise in lowand middle-income countries, particularly in urban settings. Overweight and obesity are the fifth leading risk for global deaths. At least 2.8 million adults die each year as a result of being overweight or obese. In addition, 44% of the diabetes burden, 23% of the ischaemic heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity (WHO, 2011). In the Philippines, 19% of the population is overweight and 4% are obese, as reported by Jessica Soho in a television show.

The Body Mass Index (BMI) also known as Quetelet Index is considered as the best body mass index for adult population groups. It measures body fatness and adiposity. (Santos, et al. 2009) BMI (WHO Classification) Category
CED (Chronic Energy Deficiency) LOW OBESE Grade III Grade II Grade I Normal Normal Grade I Grade II Grade III

BMI Range
Less than 16 16.0 16.9 17.0 18.4 18.5 19.5 20.0 24.9 25.0 29.9 30.0 39.9 40 and over

The World Health Organization also recommends the following guidelines for determining obesity for certain age groups; (Tienboon et al, 1992, p21).

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Age (years) <14 15 >16

BMI(kg/m) 19-20 25 28

Growth charts, such as weight-for-age and weight-for-height, are more frequently used to determine if children are overweight/obese rather than using BMI.

Obesity is a multi-factorial disorder with major contribution from the environment and the genome. The maintenance of a large number of genetic variants within the genome that give rise to increased adipose tissue mass may be explained by the process of natural selection. It has been hypothesised that during human evolution there was selection for any genotype that favours energy storage because this would enhance survival during periods of famine. Famine is known to be an important and consistent occurrence during the evolution of the human species. However, this genotype is only advantageous under conditions of food scarcity and is deleterious in conditions where food availability is high and energy expenditure is low i.e. the prevailing environment! Thus, obesity is the result of an unfavourable interaction between our current environment and our ancient genome. The process of natural selection is not fast enough to modify our genome in response to rapid changes in environmental conditions. This genomic inertia has led to many mass extinction events during the life course of planet Earth. The only solution to the problem of the obesity epidemic is therefore a rapid change in environmental conditions to better match our present genetic make-up. Such changes must occur at the individual level and be encouraged by changes at the population level. However, societal inertia is a major stumbling block and it is therefore possible that the ultimate demise of the human species will be the result

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of a clash between a highly evolved genome, sculpted by millennia of fine tuning and a human-built, change-resistant environment crudely cobbled into existence over mere decades (Crowther, 2009).

Stated in the official website of Stanford Hospitals and Clinics, the health effects associated with obesity include, but are not limited to, the following: high blood pressure, diabetes, heart disease, joint problems including osteoarthritis, sleep apnea and respiratory problems, cancer, and metabolic syndrome. For instance, being overweight/obese tends to raise blood levels of LDL cholesterol and VLDL cholesterol which is generally considered to be a mild indicator of heart disease risk (Conopio, 1990). Obesity also has psychosocial effects. In a culture where often the ideal of physical attractiveness is to be overly thin, people who are overweight or obese frequently suffer disadvantages. Overweight and obese persons are often blamed for their condition and may be considered to be lazy or weak-willed. It is not uncommon for overweight or obese conditions to result in persons having lower incomes or having fewer or no romantic relationships. Disapproval of overweight persons expressed by some individuals may progress to bias, discrimination, and even torment.

Dr. Sidney Wolfe, director of the Health Research Group, said that "the possibility that the drug will only do the good things like lose weight and not have myriad effects on the body -- is zero" (Park, CNN 2011). Moreover, natural or herbal weight loss drugs and supplements are equally dangerous as synthetic weight loss drugs because they are contaminated with materials that are not tolerated by the human body and may cause debilitating side effects, even death, says Trisha Torrey.

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B. Related Studies A 2010 study by the Institute of Nutrition, Mahidol University, Thailand, discovered that pomelo is a better source of flavonoids than a number of other tropical fruits like guava, durian and papaya. The research also demonstrated that pomelo is an excellent source of dietary fiber (Bilton, 2011).

According to Sean Nokes, Pomelo is a great food content. It provides us with all the kinds of things that we need. We should know that we are required to get foods that mean health to our body. Pomelo is highly upheld due to its nutritional value that makes it a good pick for anyone who want to ensure that the foods are going to do no harm to the body. The scientific research carried on the pomelo shows that it can help the body to increase its resistance towards infection. It contains vitamin C which has the power to detoxify the blood and make the skin glow. If you are trying to lose some pounds, then, pomelo is a good choice. It contains no fat yet it will ensure that your body is strong as you try to go through the weight loss regime. If you have problem with controlling your blood pressure, you should consider taking the pomelo as it is rich in potassium. Even though it does not take the place of the hypertension drugs, it will help you to control the condition effectively. You have to talk to your doctor about and once you get a go ahead to use the pomelo, then you can do so. It will protect you from strokes and other conditions that can result from high blood pressure. With an increased immunity, you can be sure that you will be able to feel better as there are no opportunistic infections that can come your way. You have to be aware of the things that you have to avoid. They include other unhealthy foods such fats or alcohol and tobacco. The choice of foods will enhance the

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functioning of the pomelo. If you are on the right diets, it will promote the absorption of the calcium in the foods. However, medics advice us not to take too much of the pomelo as it can result to a liver condition. If the pomelo has a weird taste, then you should not consume it. It can be counterproductive. It is the same case if you overuse it. Some of the signs that you see are vomiting and nausea. This is a pointer to the fact that pomelo has be taken beyond the recommendable limit (Nokes, 2011). Since pomelo is a fiber-rich fruit, it can probably help people lose some pounds. According to Kathleen M. Zelman, MPH, RD, LD, author of High-fiber Diets and Weight Loss, Eating healthy high-fiber foods makes you feel full, so you can resist eating more food than you need. Fibrous foods also can take longer to chew, giving your brain time to get the signal that you have had enough to eat. Fiber also moves fat through our digestive system faster so that less of it is absorbed. US study Naringenin, a key to fighting obesity In 2006, a scientific study was performed by the Florida Department of Citrus at the California Scripp's Clinic. It was found that by adding 4 ounces of grapefruit juice or half a grapefruit to meals, participants had an average weight loss of 3 1/2 pounds a week without altering their diet in any other way. Researchers believed a compound, naringenin, in the grapefruit helped the liver lower cholesterol and also helped regulate insulin levels. Both of these factors had a significant impact on overall weight reduction of the subjects. It should be noted that obesity constitutes the main part of the metabolic syndrome that is also characterized by hypertension, elevated blood cholesterol and disturbed glucose and insulin metabolism.

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Canadian study Naringenin, as an effective weight reducer and maintainer In another study performed at the Roberts Research Institute at the University of Western Ontario, the study mice were divided into four groups. They fed one group a normal, healthy diet. The second group received a high-fat, high-calorie diet. The third and fourth groups received a high-fat, high-calorie diet along with a naringenin supplement. After just four weeks, the mice on the highfat, high-calorie diet became obese. In addition, they became insulin and glucose intolerant. On the other hand, the two groups who received the naringenin supplement fared much better. Despite the same high-fat, high-calorie diet, these mice did not gain weight like their counterparts. In addition, the naringenin mice did not develop key health factors linked to Metabolic Syndrome. In fact, they lowered their triglyceride and cholesterol levels. They also continued to metabolize glucose normally and they never developed a resistance to insulin. At the end of the study, it was found that naringenin had marked lipid- and lipoprotein-lowering potential, without affecting caloric intake or fat absorption. It was also found that naringenin, in concentrations far above levels found naturally, makes the liver burn fat instead of storing it. These effects were independent of caloric intake as the mice ate exactly the same amount of food and the same amount of fat. There was no suppression of appetite or decreased food intake, which are often the basis of strategies to reduce weight gain and its metabolic consequences. As a conclusion, it was suggested that naringenin metabolizes hepatic VLDL (very low density lipoprotein) production, improves glucose tolerance and insulin sensitivity and prevents obesity associated with high-fat diet (Mulvihill et al., Diabetes journal, July 10, 2009).

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C. Conceptual Framework Pre-Intervention Weight Before Pomelo As Weight Reduction Approach Experimental Phase Post-Intervention
Weight After

Evidence of Effectiveness Figure 1. A One-Group Pretest- Post-test Design of the Study

In the Pre-Intervention phase, it involved the weighing of the subject before the introduction of Pomelo.

The Experimental Phase was the treatment of Pomelo as a weight reduction approach.

The Post- Intervention Phase was the weighing of the subjects after introduction of Pomelo. Also, this includes evaluation for effectiveness of Pomelo as a weight reduction approach.

D. Assumption 1. Pomelo is effective for weight reduction

2. There is a significant difference in the weights of the subjects before and after introduction of Pomelo as an alternative weight reduction approach.

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E. Definition of Terms

Body Mass Index (BMI)- A weight-to-height ration, calculated by dividing ones weight in kg by the square of ones height in meters and used as an indicator of obesity and underweight.

Ideal weight- a weight that is believed to be maximally healthful for a person, based chiefly on height but modified by factors such as gender, age, build, and degree of muscular development.

Obesity- is an abnormal accumulation of body fat usually 20% or more oven an Individuals ideal body weight. Obesity is associated with increased risk of illness, disability and death. Regular Diet of the Respondents- is the respondents normal daily intake of food, with no alteration in amount or in the number of times of eating.

Weight Loss- A decrease in body weight resulting from either voluntary (diet, exercise) or involuntary (illness) circumstances. Most instances of weight loss arise due to the loss of body fat, but in cases of extreme or severe weight loss, protein and other substances in the body can also be depleted.

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Chapter III

METHODOLOGY

A. Research Design This study utilized an Experimental Design specifically Pre-experimental type wherein the respondents was randomly assigned to 3 groups A, B and C and underwent treatment of Pomelo fruit at different amounts. There was no control group. The pretest was the weighing of respondents before treatment of Pomelo and the post-test was the weighing of respondents after treatment of Pomelo fruit.

This study proved the hypothesis mathematically utilizing statistical analysis. And the only variable tested and manipulated in this study is the amount of the Pomelo taken by the respondents.

B. Sampling Design a. Research Locale This study conducted in 2 settings: The actual weighing and the selection of target respondents done at Western Mindanao State University- College of Nursing. Subsequently, the treatment with Pomelo fruit conducted in the respondents respective houses.

b. Sampling Technique

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This study utilized a non-probability sampling technique specifically the Purposive sampling method wherein the 9 willing obese respondents among the BSN Level 3 students selected.

c. Samples The respondents for this study are the BSN students, aging 15-20 years old belonging to the obese group in the classification of Body Mass Index.

From the 9 respondents, there were 3 groups namely Group A, B and C. Group A received 100 grams of Pomelo, Group B 200 grams and Group C 300grams. This was done to determine if the amount of Pomelo taken affected the total weight loss. There was a weekly weighing to monitor the weight loss and it was totaled at the end of 6 weeks.

C. Research Instrument The study utilized the Body Mass Index (BMI) Chart as basis of the classification of the weights of respondents. It also utilized an Interview Guide for the pre-assessment of the subjects for the study.

D. Reliability and Validity Each weighing scale used in this study was subjected to a Pretest, ensured the reliability and validity of results.

The 3 weighing scales for Pomelo are tested by weighing 1 Pomelo using each weighing scale. The weight readings did not exceed 2 grams below or above each weight to be considered reliable.

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For the single weighing scale used to weigh the respondents, 1 researcher was weighed 3 times. The weight readings did not also exceed 5 grams below or above each weight considered reliable.

E. Plan for Data Gathering

Prior to the data gathering, the respondents was oriented about the study, emphasized the duration of the research, the amount of Pomelo taken after lunch everyday and the weekly monitoring of weights. For the baseline data, the respondents was weighed before the treatment of Pomelo. In this study, the recommended amount of Pomelo fruit per group was prepared. These was packed and distributed to each respondent, received packed Pomelo good for 3 days. They were instructed to take 1 pack of Pomelo anytime after lunch without altering their regular diet. It was also be advised that taking pomelos after dinner may yield better result.

Weights were taken weekly, every Saturday morning with each respondent wearing the same clothing every weighing session. The clothing was provided to ensure the validity and reliability if the weights to be taken. This was done for a total of 6 weeks.

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F. Plan for Data Presentation, Analysis and Interpretation The result of this study was presented in a combination of textual, tabular and graphical forms; this showed the relationship of results accurately. The data gathered also was subjected to t-test to prove the significant difference of the respondents weights before and after the treatment of Pomelo fruit.

G. Ethical Considerations In all countries, research works that involve human subjects and animals should be carried out in accordance with high ethical standards set by various ethics committee. The privacy and dignity of every individual to be involved in this research will be protected. The respondents will be assured of confidentiality and anonymity through identification coding and reports of aggregate data. The respondents will be notified of the aims, methods, expected outcome, benefits and potential hazards of this study.

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BIBLIOGRAPHY Journal/Manual: Conopio, Flor , et.al. (1990). The National Journal of Better Living: Health & Home. page 20, July-August edition. Santos, Leah B, et.al. (2009). Readings and Laboratory Manual in NuDiet 101 (Nutrition with Diet Therapy) for Nursing and Allied Courses. WMSU. CHE. pg 17. Websites: Chinapomelo. (2009). Chinese Pomelo. Retrieved February 15, 2012, from http://www.chinapomelos.com/index.php/pomelo-otheruses.html Annadurai, G., Arubachalam, R., Jayarajan, M. (2011). Research Journal Of Environmental Sciences 5:434-443. Use of Low Cost Nanoporous Materials of Pomelo Fruit Peel Wastes in Removal of Textile Dye. Retrieved February 13, 2012, from http://scialert.net/abstract/?doi=rjes.2011.434.443 Bijlmakers, H. (nd). Pomelo. . Retrieved February 10, 2012, from http://www.bijlmakers.com/fruits/pomelo.htm

Bilton, P. (2011, July 2). The Tropical Fruit Pomelo: Its Nutrition and Culinary Uses. Retrieved February 10, 2012, from http://foodnutrition.factoidz.com/the-tropical-fruit-pomelo-its-nutrition-andculinary-uses-1/ Crowther, NJ., Ali AT., (2009). Journal of Endocrinology, Metabolism and Diabetes of South Africa Vol. 14, No. 2. Factors Predisposing to Obesity: A Review of Literature. Retrieved February 17, 2012, from http://www.ajol.info/index.php/jemdsa/article/view/50350 Jamilah, B., Keshani, S., Luqman Chuah, A., Nourouzi, M. M., Russly A.R. (2010). International Food Research Journal 17: 733-742.

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Optimization of Concentration Process on Pomelo Fruit Juice Using Response Surface Methodology (RSM). Retrieved February 15, 2012, from: http://www.ifrj.upm.edu.my/17%20(03)%202010/IFRJ-2010-733742%20Keshani%20Malaysia%20ok.pdf Morton, J. (1987). Fruits of Warm Climates. p. 147151. Pummelo. Retrieved February 17, 2012, from http://www.hort.purdue.edu/newcrop/morton/pummelo.html#Other %20Uses Nokes, S. (2011, April 29). Nutritional Benefits of Pomelo. Retrieved February 17, 2012, from http://healthy-diet.maxupdates.tv/nutritional-benefits-of-pomelo/ Park, M. (2011, April 15). Why isn't there a safe weight-loss pill?. Retrieved February 17, 2012, from http://edition.cnn.com/2011/HEALTH/04/15/diet.drugs.fail/index. html Rutishauser I., Tienboon P., Wahlqvist M. (1992). ) Asia Pacific J Clinic Nutr, 1. pp 21-22. Early Life Factors Affecting Body Mass Index and Waist-Hip Ratio in Adolescence. Retrieved February 17, 2012, from http://www.healthyeatingclub.com/info/articles/infant child/childhood-obesity.htm#Tienboon,P Kaewsarn, P., Saikaew, W., Saikaew, W. (2009). World Academy of Science, Engineering and Technology 56 2009 pg 287-291. Pomelo Peel: Agricultural Waste for Biosorption of Cadmium Ions from Aqueous Solutions. Retrieved February 17, 2012, from http://www.waset.org/journals/waset/v56/v56-56.pdf Thulaja, N. (2003, December 3). Pomelo. Retrieved February 17, 2012, from http://infopedia.nl.sg/articles/SIP_207_2005-01-09.html Torrey, T. (2010, May 2). Natural or Herbal Weight Loss Drugs and Supplements - Contaminated and Dangerous. Retrieved February 17, 2012, from http://patients.about.com/od/patientempowermentissues/a/weightlo ssdrugs.htm

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WHO. (2011). Obesity and Overweight. Retrieved February 15, 2012, from http://www.who.int/mediacentre/factsheets/fs311/en/index.html Zelman, K. (2010, October 29). High-fiber Diets and Weight Loss. Retrieved February 17, 2012, from http://www.webmd.com/diet/fiber-health-benefits-11/fiber-weightcontrol?page=2 Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998) National Academy of Sciences. Institute of Medicine. Food and Nutrition Board. Retrieved March 1, 2012, from http://www.vitamin-basics.com/index.php?id=53 Mulvihill et al., (2009) Diabetes journal, July 10. Retrieved March 1, 2012, from http://www.fat-diet.com/citrus-fruits-weight-loss

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APPENDIX A INTERVIEW GUIDE NAME:______________________________________ ADDRESS:_______________________________________________________ YEAR LEVEL:________ SEX:_____ SECTION:_____ AGE:______

QUESTIONS: 1. What is your regular diet? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2. Why do you want to lose weight? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 3. What methods did you take to lose weight? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 4. Are they successful? Why or why not? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 5. Is this your first time to hear that Pomelo can help you reduce weight? What do you think about this? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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APPENDIX B Republic of the Philippines WESTERN MINDANAO STATE UNIVERSITY College of Nursing Zamboanga City

LETTER OF CONSENT

To whom it may concern:

I,______________________________ , _____ years of age and resident of ___________________________, voluntarily submit myself and express my willingness to participate in the research to be conducted by the Western Mindanao State University Level 3 SY 2010-2011 BSN students on the study titled EFFECTIVENESS OF POMELO (Citrus maxima) AS A WEIGHT REDUCTION STUDENTS. My signature affixed below signifies my full cooperation and participation in all activities that the group is planning to undertake. ALTERNATIVE AMONG OBESE BSN LEVEL III

_________________________
Signature over Printed Name

_____________________
Date

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Republic of the Philippines WESTERN MINDANAO STATE UNIVERSITY College of Nursing Zamboanga City

BEHAVIORAL CONTRACT

I,______________________________ , _____ years of age agree to make the following behaviors:

Take the prescribed amount of Pomelo given by the researchers anytime after lunch but before sleep for the whole duration of the research. Not make any alterations in my regular diet, exercise or activity to help the researchers gather valid and reliable results. Not take any diet pills, drinks and the likes to achieve a valid and reliable result of my weight loss through the use of Pomelo. Immediately notify the researchers of any unusual effects when taking pomelo.

Signed: ______________________________
Signature over Printed Name

_____________________
Date

Researchers:
Aldrich B. Arquiza Sarah Merdan C. Bensali Lorelee Ninia O. Espaldon Hanna Joy H. Hirang Kathleen Mona R. Napao Christopher Philip M. Pelayo Kharren A. Reyes Marlo Rene D.R. Solis Chrissele Joyce P. Tacurian _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________

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APPENDIX C INTERVIEW GUIDE NAME:______________________________________ ADDRESS:_______________________________________________________ YEAR LEVEL:________ SEX:_____ SECTION:_____ AGE:______

QUESTIONS: 1. What effects did you experience when eating pomelo? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2. Do you think it had been an effective weight reduction alternative for you? Why or why not? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 3. Does eating pomelo affect your daily life? If yes, how does it affect you? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 4. For you, is pomelo safe for loosing weight? Why? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 5. What would you recommend for this research to be more effective? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________