|Year : 2019 | Volume
| Issue : 12 | Page : 1685-1692
The prevalence of obesıty and related factors among prımary and secondary school students
S Deniz1, AF Oguzoncul2
1 Ministry of Health, Provincial Health Directorate of Malatya, Malatya, Turkey
2 Department of Public Health, Fırat University, Faculty of Medicine, Elazığ, Turkey
|Date of Submission||27-Mar-2019|
|Date of Acceptance||24-Jul-2019|
|Date of Web Publication||3-Dec-2019|
Dr. S Deniz
Malatya Provincial Health Directorate, Malatya
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives: Obesity was previously seen as a problem in high-income countries. It is also a problem in low and middle-income countries today. The sedentary lifestyle has made this situation more pronounced. Childhood obesity continues in adulthood. Adequate and balanced nutrition and mobile lifestyle have a great role in the prevention and treatment of obesity. The aim of this study was to determine the prevalence of obesity among primary and secondary school students and related factors. Methods: The sample size was calculated as 1278 (213 × 6) for the gender distribution to be appropriate and for the primary and secondary school students to be included in the district center and villages. Considering 15% of the students' non-response rate, the number of students planned to be reached is 1500. Selection was made after the students were ranked by class, gender and place of residence. Of the 1500 students who were sampled, 1298 (86.53%) were evaluated. Results: There was no difference in body mass index between gender and place of residence. The prevalence of being overweight or obesity among secondary school students (25.2%) was significantly higher than primary school students (20.5%).Conclusion: In the childhood age group; sedentary lifestyle, having breakfast and obesity in parents had a significant effect on obesity. It is considered important for children and family members to have proper nutrition and mobile life behaviors.
Keywords: Childhood, obesity, overweight, primary school, secondary school
|How to cite this article:|
Deniz S, Oguzoncul A F. The prevalence of obesıty and related factors among prımary and secondary school students. Niger J Clin Pract 2019;22:1685-92
| Background|| |
Overweight and obesity are defined as abnormal or excessive fat accumulation. At the same time risk for noncommunicable diseases increases with the increase in body mass index (BMI). BMI is calculated as a person's weight in kilograms, divided by height in meters squared. People with BMI values from 25 to 29.9 are considered overweight, and those with 30 or more are considered obese. In school-age children, the BMI is categorized according to the World Health Organization's (WHO) gender and age-specific BMI reference median values. Those with over 1 standard deviation (SD) of this value are overweight, over 2 SD are categorized as obese.,
Obesity was previously seen as a problem in high-income countries. Today, it is becoming a problem also in low and middle income countries. Urbanization creates a sedentary living environment and causes excessive feeding. However, it is known that children living in urban/central regions do not consume enough vegetables and fruits and they have easier access to high fat and sugar-based snacks and fast-foods. Change in lifestyle and transportation methods, disrupts the balance of energy intake and consumption in the body resulting in overweight and obesity.,,,,
In 2016, more than 340 million children (5–19 years) were overweight or obese in the world. While the prevalence of overweight and obesity in children and adolescents aged between 5 and 19 years was only 4% in 1975, it increased to 18% in 2016. According to gender, 18% of girls and 19% of boys were overweight. Similarly, the prevalence of obesity in children and adolescents aged between 5 and 19 years was lower than 1% in 1975. The prevalence of obesity increased to 8% in boys and 6% in girls in 2016.
Obese individuals are psychologically and physiologically disadvantaged. Obese children are at risk for many comorbidities and complications like Insulin resistance, type 2 diabetes mellitusdislipidemi, earlier menarche, hidden penis, hypertension, dyslipidemia, steatohepatitis, obstructive sleep apnea, fractures, pseudotumor cerebri, low self-esteem, and depression. Obesity in childhood increases the likelihood of higher levels of obesity, premature death and disability in adulthood. The risk of obesity likely to arise in adulthood increases with age. Obesity in older children is more likely to continue in adulthood. Healthy food usage and regular physical activity are effective in reducing overweight and obesity. In overweight and obesity prevention or treatment; consumption of fast food, fat, and sugar should be limited, consumption of fruits, vegetables, and cereals should be increased. In addition, regular physical activity of 60 minutes per day is recommended for children. Snacks after dinner should also be avoided. Children should be evaluated together with their families. In order to achieve these, it is important to develop population-based policies which can reach to the lowest socio-economic level in the community.,,
The aim of this study was to determine the prevalence of obesity among primary and secondary school students and related factors.
| Methods|| |
In this cross-sectional study, there were 2256 students in primary and secondary schools in the Akçadaǧ district of Malatya, Turkey. In the Epi Info program, the minimum sample size was determined to be 213, with a 95% confidence interval, 5% margin of error and the expected frequency of over weight or obesity 18.9%. The sample size was calculated as 1278 (213 × 6) for the gender distribution to be appropriate and for the primary and secondary school students to be included in the district center and villages. Considering 15% of the students' non-response rate, the number of students planned to be reached is 1500. Selection was made after the students were ranked by class, gender and place of residence. The age range of our study group was 66–179 months. The Ethics Committee approval and necessary permissions were obtained. Consent forms were distributed to the students who were selected. The children of the families who gave approval were included in the study. The weight and height measurements of the students were performed with the calibrated weighing instrument and length meter. Weights are measured in kilograms, lengths in meters. The questionnaires were applied to the parents of these students by face to face interview method. Two hundred two students' data couldn't evaluated because of absenteeism, refusal to participate in the research, not completing the questionnaire and continuing education in different districts. The study group consisted of 1298 (86.53%) participants.
The categorization of students' BMI values was made according to the age and gender specific categories of BMI in the 5–19 age group table recommended by the World Health Organization (WHO). The height and weight of the parents were evaluated according to their statements. BMI values of the parents were classified as thin (<18.5), normal (18.5–24.9), overweight (25.0–29.9), and obese (>30.0).
Statistical analysis was performed with SPSS 22.0 (Armonk, NY: IBM Corp.) packaged software. Mean values of continuous variables were given with standard deviations. Categorical variables were presented with percentages. Difference between the two groups mean was evaluated by t-test, difference between categorical variables was evaluated by Chi-square test. P < 0.05 was accepted as statistically significant.
| Results|| |
The mean age of our study group was 121.21 ± 28.23 months (min. 66, max. 179). The mean age of the boys (122.11 ± 28.46) and the mean age of the girls (120.29 ± 27.99) were similar (p = 0.247). Average time spent on TV and computer, except for lectures and assignments; Weekday: 1.68 ± 1.67 hours, weekend: 2.82 ± 2.22.
Of the study group, 51.5% (n = 668) were primary school students, 50.3% (n = 653) were boys, and 26.5% were living in the district centre. Descriptive characteristics of the study group is presented in [Table 1].
According to the parents' declaration, 19.3% (n = 250) of the mothers, 13.8% (n = 179) of the fathers were obese. The descriptive characteristics of the parents are given in [Table 2].
According to gender assessment; 22.2% (n = 145) of boys and 23.4% (n = 151) of girls were found to be overweight or obese (p = 0.791). According to place of residence assessment, 23.8% (n = 82) of the students in the district center, 22.4% (n = 214) of the students in the rural were overweight or obese (p = 0.425). In the evaluation according to the binary age groups (5-6, 7-8, 9-10, 11-12, 13-14); the prevalence of overweight or obese patients was 18.8% (n = 25), 20.3% (n = 73), 23.6% (n = 79), 27.2% (n = 79), 22.0% (n = 40) (p = 0.097), respectively. According to gender, place of residence and age groups, BMI categories were not found different (p > 0.05). The prevalence of overweight or obesity in secondary school students (25.2%, n = 159) was significantly higher than primary school students (20.5%, n = 137) (p = 0.005).
According to nutritional characteristics, it was found that there was a significant relationship between frequency of breakfast, frequency of consumption of fresh fruits and consumption of carbonated beverages and BMI categories (p < 0.05). The frequency of being overweight and obese was found to be 49.3% (n = 37) in those who had no breakfast (p = 0.001) and was found to be 55.7% (n = 39) who consume carbonated beverages every day (p = 0.001). There was no relationship between fast food consumption frequency and BMI categories (p > 0.05). The distribution of BMI categories according to nutritional characteristics is presented in [Table 3].
|Table 3: Comparison of BMI categories according to nutrition characteristics|
Click here to view
The prevalence of overweight and obesity in children, who were walking or cycling to school (19.8%) and who had sport and physical activity for longer periods (18.8%), was significantly lower (p < 0.05). The assessment of parents according to BMI categories 28.2% (n = 203) of the overweight or obese mothers', and 27.2% (n = 209) of the overweight or obese fathers' children were overweight or obese. The categories of BMI according to the characteristics of the parents and children are presented in [Table 4].
|Table 4: Comparison of BMI categories according to the characteristics of parents and children|
Click here to view
| Discussion|| |
The mean age of our study was 121.21 ± 28.23. Boys were 50.3% of the students. 15.9% of the group were overweight and 6.9% were obese. According to similar studies, overweight and obesity prevalences were found as follows; in a study conducted by Savaşhan et al. 11.1% and 7.5%, in Karahan's study 17.6% and 5.7%, in Ozilbey's study 5.0% and 20.0%, in the study of Ozurk and Akturk 12.4% and 6.5%, in Ceylan and Turan's study 6.9% and 6.4%.
In our study, there was no difference in terms of overweight and obesity between boys (22.2%) and girls (23.4%). Öztürk and Aktürk (20.3% and 17.5%), Ceylan and Turan (12.9% and 13.8%), Şimşek et al. (4.1% and 5.5%) did not find any difference in BMI categories between boys and girls in the same way as our study. However, Karahan (27% and 18.9%), Özilbey (30.6% and 19.6%) and Çınar (only obese: 26.9% and 14.6%) stated that overweight and obesity were more common in boys.
In the evaluation made according to age groups, the highest overweight or obese prevalence was found in the 11–12 age group (27.2%). However, no significant difference was found between BMI categories according to age groups. In Karahan's research on the 10 years age group (35.0%), Öztürk and Aktürk's research on the 5–8 years age group (25.4%), research of Şimşek et al. on the 12–17 years age group (only obese 5.4%) it is found a significantly higher frequency than other age groups.
The prevalence of overweight or obesity was higher in secondary school students (25.2%) than in primary school students (20.5%). In Karahan's research 23.3% of secondary school students and in Özilbey's research 25.0% of primary school students were overweight or obese.
Prevalence of overweight or obese people in the district center and villages (23.8% and 22.4%) were similar. Participants who went to school by walking or cycling constitute 31.5% of our study group and 64.6% used motor vehicle, 19.8% of those who go to school by walking or cycling, 24.3% of those who used motor vehicle were overweight or obese. Access to school by walking or cycling and exercising had a positive effect on the BMI category. There was a significant difference in terms of being overweight and obese between those who did not do sports or physical activity (24.1%) and those who had 4 and over hours of physical activity every week (18.8%). The relationship between sport and exercise and BMI category; it is also supported by the literature reviewed.,,
The prevalence of obesity was found to be 49.3% in children who did not have breakfast on any day of the week. In our study, the prevalence of being overweight or obese was decreasing with the increasing frequency of having breakfast. The consumption of carbonated beverages had a negative impact on the BMI category. In Karahan's study, the prevalence of overweight or obese was found to be 38.9% in children who skipped breakfast meals. In the same study, it was found that those who consumed fast food had higher rate than those who did not consume (36.2% of overweight and obese). As the frequency of fast food consumption increased, the frequency of obesity increased. According to Çınar's research, there was no difference in the prevalence of obesity according to the food groups they consumed at breakfast and before bedtime. The frequency of obesity was found to be 41.2% in those who never had breakfast. In the same study, it was found that obesity was more common among those who consumed fast food, chocolate, candy, chips, cookies and ready drinks every day. There was no relation between the frequency of weekly fast food intake and the prevalence of obesity in the study of Savaşhan et al. However, the prevalence of obesity was higher in children who had more habit of fast food such as hamburgers and toast.
There was no difference between BMI categories according to the time spent on TV and computer. Similarly, in Karahan's research, no difference was found between BMI categories according to the time spent on TV and computer. In the research of Savaşhan et al. and Özilbey; It has been observed that the prevalence of obesity is higher in research group who spend more time on television and computer.
In our study, it was determined that the BMI categories of the parents affected the BMI categories of children. 28.2% of children whose mother is overweight or obese, 27.2% of the children whose father is overweight or obese were overweight or obese. In studies conducted by Savaşhan et al., Karahan, Ceylan and Turan, Çınar and Nasreddine et al., obesity has also been shown to increase in children, if there was obesity in mother, father, or other family members. Dekkaki et al. found that parents' BMI and obesity status did not significantly affect children.
In the pediatric age group, the presence of a sedentary lifestyle, obesity in parents and breakfast habit status had a significant effect on obesity. When assessing the status of children being overweight or obese, the status and lifestyles of parents should be considered. It is considered important that parents to have proper nutrition and active life behaviors together with the children.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gupta N, Goel K, Shah P, Misra A. Childhood obesity in developing countries: Epidemiology, determinants, and prevention. Endocr Rev 2012;33:48-70.
Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: Public-health crisis, common sense cure. Lancet 2002;360:473-82.
Buscemi S, Barile A, Maniaci V, Batsis JA, Mattina A, Verga S. Characterization of street food consumption in palermo: Possible effects on health. Nutr J 2011;10:119.
Koyuncuoǧlu Güngör N. Overweight and obesity in children and adolescents. J Clin Res Pediatr Endocrinol 2014;6:129-43.
Boutelle KN, Rhee KE, Liang J, Braden A, Douglas J, Strong D, et al.
Effect of attendance of the child on body weight, energy intake, and physical activity in childhood obesity treatment: A randomized clinical trial. JAMA Pediatr 2017;171:622-8.
Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, et al.
Pediatric obesity—Assessment, treatment, and prevention: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2017;102:709-57.
Öztürk A, Aktürk S. Obesity prevalence and associated risk factors in school-aged children. TAF Prev Med Bull 2011;10:53-60.
Savaşhan Ç, Sarı O, Aydoǧan U, Erdal M. Obesity frequency in school children and related risk factors. Turk J Fam Pract 2015;19:14-21.
Karahan FF. The Investigation of Obesity Prevelance and Affecting Factors in the 10-14 Age Group Students at Secondary School in the City Center Erzincan [Master thesis]. [Ezrzurum]: Ataturk University; 2015.
Özilbey P. Determining the Prevalance of Obesity in Primary School Students and Examination of Eating Habits [Master thesis]. [İzmir]: Dokuz Eylul University; 2013.
Ceylan SS, Turan T. Obesity prevelance and influencing factors in a primary school students who were 11-14 years old. J Anatolia Nurs Health Sci 2008;11:76-84.
Şimşek F, Ulukol B, Berberoglu M, Gülnar SB, Adıyaman P, Öcal G. Obesity prevalence in a primary school and a high school in Ankara. J Ank Univ Fac Med 2005;58:163-6.
Çınar S. Research on Obesity for Children between the Ages of 7-14 and from Different Socio-Economic Levels [Master thesis]. [Ankara]: Hacettepe University; 2013.
Nasreddine L, Mehio-Sibai A, Mrayati M, Adra N, Hwalla N. Adolescent obesity in Syria: Prevalence and associated factors. Child Care Health Dev 2010;36:404-13.
Dekkaki IC, Mouane N, Ettair S, Meskini T, Bouklouze A, Barkat A. Prevalence of obesity and overweight in children: A study in government primary schools in Rabat, Morocco. Arch Med Res 2011;42:703-8.
[Table 1], [Table 2], [Table 3], [Table 4]
|This article has been cited by|
||An investigation of anthropometric measurements of early adolescents and determination of BMI-for-age-based neck circumference and BMI-for-age-based mid-upper-arm circumference cut-off points
| ||Yeliz Mercan, Gokce Cakmak Kafadar, Sunbul Hulya Arikan, Nuket Pancar |
| ||Clinical Nutrition ESPEN. 2022; |
|[Pubmed] | [DOI]|
||The Arkansas Active Kids Study: Identifying contributing factors to metabolic health and obesity status in prepubertal school-age children
| ||Shasha Bai,Anthony Goudie,Elisabet Børsheim,Judith L Weber |
| ||Nutrition and Health. 2021; 27(2): 273 |
|[Pubmed] | [DOI]|
||Angiotensin-(3–4) normalizes blood pressure, decreases Na+ and energy intake, but preserves urinary Na+ excretion in overweight hypertensive rats
| ||Rafael Luzes,Thuany Crisóstomo,Paulo A. Silva,Roxane Iack,Virgínia Genelhu de Abreu,Emílio A. Francischetti,Adalberto Vieyra |
| ||Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease. 2020; : 166012 |
|[Pubmed] | [DOI]|