Background: Obesity in children is universal affecting all ethnicities, ages, gender and social classes. Public school children consist mainly of the less affluent strata of society, and consequently may not be opportuned to avail themselves of necessary public health interventions as their private school counterparts. Objective:This study aimed to determine the prevalence of obesity using various anthropometric indices and association of certain factors with obesity among public secondary school students.
Methods:A cross-sectional school-based questionnaire and physical assessment of 593 students aged 10 – 17 years in public schools in Nnewi, Southeast Nigeria was carried out.
Results: There were 289 boys and 304 girls, giving an approximate ratio of 1:1. Most of the students were from the middle and lower socio-economic levels. Girls were physically less active and consumed more junk food than the boys. The mean weight and height varied significantly with age in males, females and both sexes combined together (p <0.001). In general, girls were heavier than boys, while the boys were slightly taller than the girls. Age varied significantly with BMI (P<0.001 for girls and boys), WC (P<0.001 for girls and boys) and WHtR (p=0.034 for boys and 0.024 for girls). BMI performed better than WC and WHtR in identifying children with obesity. When compared with BMI, WC had a sensitivity of 5.2% and a specificity of 100.0% with a positive predictive value of 100.0% and a negative predictive value of 90.7%. WHtR had a sensitivity of 31.0% and a specificity of 99.8% with a positive predictive value of 94.7% and a negative predictive value of 93.0%. BMI had a strong correlation with both WC and WHtR although correlation was stronger with WC (R=704) compared to WHR (R=641). Among the students 9.8% were in the obese/overweight group, made up of 96.6% females, out of which 64.1% were older adolescents aged 15-17 years. Reduced physical activity played a major role in enhancing obesity/overweight, while socio-economic level and diet did not. After logistic regression analysis, age and sex remained significantly associated with being overweight or obese. The odds of being overweight or obese was 32 times in females compared to males and twice in in late adolescence compared to early adolescence.
Conclusion: The obesity/overweight of older adolescent public secondary school girls buttress the importance of physical exercises in curbing obesity. Although easier to perform and very specific, WC and WHtR seemed to miss many adolescents with obesity when compared to BMI. Therefore, a combination of these indices is recommended while screening adolescents for obesity.
World Health Organization. Report of the Commission on Ending Childhood Obesity. WHO 2016.
Falkner B, Gidding SS, Ramirez-Garnica G, Wiltrout SA, West D, Rappaport EB. The relationship of body mass index and blood pressure in primary care pediatric patients. J Pediatr 2006; 148(2): 195 – 200.
Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, Ethnicity, and the Prevalence of Hypertension in School-Aged Children. Pediatrics 2004; 113 (3): 475 – 482. Doi: 10.1542/peds.113.3.475
Riley M, Bluhm B. High blood pressure in children and adolescents. American Family Physician 2012; 85 (7): 693 – 700.
Ugochukwu EF, Onubogu CU, Ofora VC, Okeke KN, Uju CM. Blood pressure profiles and determinants of hypertension among public secondary school students in Nnewi, Southeast Nigeria. European Journal of Medical and Health Sciences 2020; 2(3). DOI: https://doi.org/10.24018/ejmed.2020.2.3.298.
World Health Organization. Global Recommendations on Physical Activity for Health. WHO 2010.
World Health Organization. Waist Circumference and Waist-Hip Ratio. Report of a WHO Expert Consultation. Geneva, 8-11 December 2008. World Health Organization 2011.
Children’s Hospital Research Institute of Manitoba, Canada: Waist:Height Ratio percentile charts for Boys and Girls 5-19 years and Waist percentile charts for Boys & Girls 5-19 years. Available at: https://cpeg-gcep.net>upload.pdf; https://cpeg-gcep.net>bookfiles
Oyedeji GA. Socio-economic and cultural background of hospitalized children in Ilesha. Nigerian Journal of Paediatrics 1985; 12: 111 – 117.
Oduwole AA, Ladapo TA, Fajolu IB, Ekure EN, Adeniyi OF. Obesity and elevated blood pressure among adolescents in Lagos, Nigeria: a cross-sectional study. BMC Public Health 2012; 12: 616. http://www.biomedcentral.com/1471-2458/12/616. Doi: 10.1186/1471-2458-12-616.
Omuemu VO, Omuemu CE. The prevalence of overweight and its risk factors among adolescents in an urban city in Edo State. Niger J Clin Pract 2010; 13 (2): 128 – 133. PMID: 20499742.
Ben-Bassey UP, Oduwole AO, Ogundipe OO. Prevalence of overweight and obesity in Eti-Osa LGA, Lagos, Nigeria. Obes Rev 2007; 8 (6): 475 – 479. https://doi.org/10.1111/j.1467-789X.2007.00408.x
Kimani-Murage EW, Kahn K, Pettifor JM, Tollman SM, Dunger DB, Gomez-Olive XF, et al. The prevalence of stunting, overweight and obesity, and metabolic disease risk in rural South African children. BMC Public Health 2010; 10: 158 – 70. http://www.biomedcentral.com/1471-2458/10/158.
Kimani-Murage EW, Kahn K, Pettifor JM, Tollman SM, Klipstein-Grobusch K, Norris SA. Predictors of adolescent weight status and central obesity in rural South Africa. Public Health Nutr 2011; 14 (6): 1114 – 1122. Doi: 10.1017/S1368980011000139.
Otitoola O, Oldewage-Theron W, Egal A. Prevalence of overweight and obesity among selected schoolchildren and adolescents in Cofimvaba, South Africa. South African Journal of Clinical Nutrition 2020. Doi:10.1080/16070658.2020.1733305. Available at https://doi.org/10.1080/16070658.2020.1733305.
Stigler MH, Arora M, Dhavan M, Shrivastav R, Reddy KS, Perry CL. Weight-related concerns and weight-control behaviors among overweight adolescents in Delhi, India: A cross-sectional study. International Journal of Behavioral Nutrition and Physical Activity 2011; 8: 9. http://www.ijbnpa.org/content/8/1/9. Doi: 10.1186/1479-5868-8-9.
Ip P, Ho FKW, So H-K, Chan DF-y, Ho M, Tso W, et al. Socioeconomic gradient in childhood obesity and hypertension: A multilevel population-based study in a Chinese community. PLoS ONE 2016; 11(6): e0156945. Doi: 10.1371/journal.pone.0156945.
Al-Rethaiaa AS, Fahmy AA, Al-Shwaiyat NM. Obesity and eating habits among college students in Saudi Arabia: a cross sectional study. Nutrition Journal 2010; 9: 39 – 48. http://www.nutritionj.com/content/9/1/39.
Mahfouz AA, Shatoor AS, Khan MY, Daffalia AA, Mustafa OA, Hassanein MA. Nutrition, physical activity, and gender risks for adolescent obesity in Southwestern Saudi Arabia. Saudi J Gastroenterol 2011; 17: 318 – 22. www.saudijgastro.com. PubMed ID: 21912058. Doi: 10.4103/1319-3767.84486.
Duncan S, Duncan EK, Fernandes RA, Buonani C, Bastos KD-N, Segatto AFM et al. Modifiable risk factors for overweight and obesity in children and adolescents from Sao Paulo, Brazil. BMC Public Health 2011; 11: 585 – 93. http://www.biomedcentral.com/1471-2458/11/585.
Silva DAS, Pelegrini A, de Lima e Silva JMF, Petroski EL. Epidemiology of abdominal obesity among adolescents from a Brazilian State. J Korean Med Sci 2011; 26: 78 – 84. http://jkms.org. doi: 10.3346/jkms.2011.26.1.78.
Garza JR, Perez EA, Prelip M, McCarthy WJ, Feldman JM, Canino G, et al. Occurrence and correlates of overweight and obesity among island Puerto Rican youth. Ethn Dis 2011; 21 (2): 163 – 169.
Guedes DP, Rocha GD, Silva AJRM, Carvalhai IM, Coelho EM. Effects of social and environmental determinants on overweight and obesity among Brazilian schoolchildren from a developing region. Rev Panam Salud Publica 2011; 30 (4): 295 – 302.
Athanasopoulos DT, Garopoulou AI, Dragoumanos VP. Childhood obesity and associated factors in a rural Greek island. Rural and Remote Health 2011; 11: 1641. Available: http://www.rrh.org.au.
Yuca SA, Yilmaz C, Cesur Y, Dogan M, Kaya A, Basaranoglu M. Prevalence of overweight and obesity in children and adolescents in Eastern Turkey. J Clin Res Pediatr Endocrinol 2010; 2 (4): 159 – 163. Doi: 10.4274/jcrpe.v2i4.159. PMID: 21274316.
Bereket A, Atay Z. Current status of childhood obesity and its associated morbidities in Turkey. J Clin Res Pediatr Endocrinol 2012; 4 (1): 1 – 7. Doi: 10.4274/jcrpe.506. PMID: 22394698
Eagle TF, Sheetz A, Gurm R, Woodward AC, Kline-Rogers E, Leibowitz R, et al. Understanding childhood obesity in America. Linkages between household income, community resources, and children’s behaviors. Am Heart J 2012; 163 (5): 836 – 843.
Isasi C, Whiffen A, Campbell E, Florez Y, Freeman K, Wylie-Rosett J. High prevalence of obesity among inner-city adolescent boys in the Bronx, New York: Forgetting our boys. Preventing Chronic Disease 2011; 8 (1). http://www.cdc.gov/pcd/issues/2011/jan/10_0009.htm. Accessed May 23, 2020.
Oh I-H, Cho Y, Park S-Y, Oh C, Choe B-K, Choi J-M, et al. Relationship between socioeconomic variables and obesity in Korean adolescents. J Epidemiol 2011; 21 (4): 263 – 70. Doi:10.2188/jea.JE20100099
Jain S, Pant B, Chopra H, Tiwari R. Obesity among adolescents of affluent public schools in Meerut. Indian Journal of Public Health 2010; 54 (3). www.ijph.in. doi: 10.4103/0019-557X.75740.
Morgen CS, Mortensen LH, Rasmussen M, Andersen AN, Sorensen TIA, Due P. Parental socioeconomic position and development of overweight in adolescence: longitudinal study of Danish adolescents. BMC Public Health 2010; 10: 520 – 30. http://www.biomedcentral.com/1471-2458/10/520.
Perez A, Hoelscher DM, Springer AE, Brown HS, Barroso CS, Kelder SH, et al. Physical activity, watching television, and the risk of obesity in students, Texas, 2004-2005. Preventing Chronic Disease 2011; 8 (8). http://www.cdc.gov/pcd/issues/2011/may/10_0007.htm. Accessed May 23, 2020.
Khoury M, Manlhiot C, McCrindle BW. Role of the Waist/Height Ratio in the cardiometabolic risk assessment of children classified by body mass index. Journal of American College of Cardiology 2013; 62 (8): 742 – 51. http://dx.doi.org/10.1016/j.jacc.2013.01.026 .
Jensen NS, CamargoTdeF, Bergamaschi DP. Body mass index and waist circumference are good indicators for classifying children’s nutritional status. Ciencia & Saude Coletiva 2016; 21 (4): 1175 – 1180. Doi: 10.1590/1413-81232015214.138712015. PMID: 27076016
Li C, Ford ES, Mokdad AH, Cook S. Recent trends in waist circumference and waist-height ratio among US children and adolescents. Paediatrics 2006; 118(5): e1390 – e1398. www.pediatrics.org/cgi/doi/10.1542/peds.2006-1062.
Savva SC, Tornartis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. International Journal of Obesity 2000; 24: 1453 – 1458. www.nature.com/ijo.
Schwandt P, Haas G-M. Waist circumference in children and adolescents from different ethnicities. Childhood Obesity, Dr. Sevil Ari Yuca (Ed.) 2012. ISBN: 978-953-51-0374-5, In Tech, Available from: http://www.intechopen.com/books/childhood-obesity/waist-circumference-in-children-and-adolescents-from-different-ethnicities.
Bacopoulou F, Efthymiou V, Landis G, Rentoumis A, Chrousos GP. Waist circumference, waist-to-hip ratio and waist-to-height ratio reference percentiles for abdominal obesity among Greek adolescents. BMC Pediatrics 2015; 15: 50. Doi: 10.1186/s12887-015-0366-z.
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