Epidemiology of obesity among primary school children (6–12 years), Menoufia Governorate

Mahmoud E. A. Salem; Omaiyma A Fateh Mahrous; Hewaida M El Shazly; Zeinab A Aziz Kasemy; Sally Abdel-Wanees Mehesin

doi:10.4103/1110-2098.202529

ORIGINAL ARTICLE

Year : 2016 | Volume : 29 | Issue : 4 | Page : 1000-1004

Epidemiology of obesity among primary school children (6–12 years), Menoufia Governorate

Mahmoud E. A. Salem, Omaiyma A Fateh Mahrous, Hewaida M El Shazly, Zeinab A Aziz Kasemy, Sally Abdel-Wanees Mehesin MBBCh
Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Al-Menoufia, Egypt

Date of Submission	12-Feb-2015
Date of Acceptance	06-Apr-2015
Date of Web Publication	21-Mar-2017

Correspondence Address:
Sally Abdel-Wanees Mehesin
Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Gamal Abdel Nasser Street, Shebin Al-Kom, Al-Menoufia 32511
Egypt

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1110-2098.202529

Abstract

Objectives
The aim of the study was to estimate the prevalence and identify possible risk factors for obesity in a representative sample of primary school children (6–12 years) in Menoufia Governorate.
Background
Childhood obesity has more than tripled in the past 30 years.
Patients and methods
A case–control study nested in a cross-sectional study was carried out in Menoufia Governorate. It was conducted in El-Bagour district. The sample consisted of 306 students (148 boys and 158 girls). Children were asked to fill a predesigned questionnaire, and anthropometric measures were taken.
Results
The prevalence of obesity and overweight was 19.6%. It was significantly higher among girls (24.7%) than among boys (14.2%) and among urban participants (22.1%) than among rural ones (11.3%). The prevalence of obesity among children from families with sufficient income was significantly higher (22.4%) than that in children from families without sufficient income (9.2%), and in children with a positive family history of obesity (27.3%) than in those with a negative family history (14.6%). Obesity prevalence was significantly higher among children with intake of fast food more than three times per week (81.2%) than in children who consume fast food less than three times per week (1.7%). It was significantly higher among those who take high-calorie snacks like sweets or chips (30.9%) than in those who take low-caloric snacks like vegetables and fruits (13.3%). The prevalence of obesity among children who exercise for less than 2 h per day was significantly higher (34.6%) than that among those who exercise more than 2 h per day (8.9%).
Conclusion
Obesity is a serious health problem. To face this, there should be programs initiated by the government, especially by Ministries of Education and Health, targeted at both children and parents through different public media. Programs should focus on the nutritional needs and feeding habits of these children.

Keywords: epidemiology, obesity, school children

How to cite this article:
Salem ME, Fateh Mahrous OA, El Shazly HM, Aziz Kasemy ZA, Mehesin SA. Epidemiology of obesity among primary school children (6–12 years), Menoufia Governorate. Menoufia Med J 2016;29:1000-4

How to cite this URL:
Salem ME, Fateh Mahrous OA, El Shazly HM, Aziz Kasemy ZA, Mehesin SA. Epidemiology of obesity among primary school children (6–12 years), Menoufia Governorate. Menoufia Med J [serial online] 2016 [cited 2023 Dec 4];29:1000-4. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/1000/202529

Introduction

Childhood obesity is a serious medical condition where excess body fat negatively affects a child's health or well-being ^[1]. Healthcare professionals define obesity as increased adiposity on the basis of BMI, which is an excellent proxy for more direct measurement of body fat. BMI = weight (kg/) height (m ²). Consequently, obesity and overweight in children younger than 2 years is defined as BMI more than or equal to the 95^th percentile ^[2]. In 2010 more than one-third of children and adolescents were overweight or obese worldwide ^[3]. Rates of childhood obesity have increased greatly between 1980 and 2010. It has more than doubled in children and tripled in adolescents in the past 30 years. The causes of obesity are multifactorial and include genetic predisposition, sedentary lifestyle, overeating, fast food diet, lack of adequate nutritional education, the school environment, and advertising and marketing of unhealthy foods ^[4]. Available studies in Eastern Mediterranean countries indicate that obesity has reached an alarming level among both children and adults. In Egypt, previous studies indicated that obesity is an important public health problem among school children ^[5]. Salem et al. ^[6] found that the prevalence of obesity among Egyptian children was 14.7 and 15.08% in boys and girls, respectively.

Abou Ghazy et al. ^[7] found an incidence of 20.4% for obesity in school children in Qalubia Governorate, and El-Ghadban et al. ^[8] and Shaheen et al. ^[9] found an incidence of 13.1%.

The first complications to occur in obese children are usually emotional or psychological. Also endocrine and cardiovascular abnormalities are among the well-documented health factors associated with being overweight in children; these include insulin resistance, hypertension, and hyperlipidemia ^[10].

Patients and Methods

This study was conducted from April 2013 to December 2014 in Menoufia Governorate primary schools. Data were collected and then analyzed from the first of March to the end of December 2014. The study protocol was approved by the local ethics committee. All participants gave written consent.

In this study, one district (El-Bagour) out of 10 was chosen randomly. One urban primary school (El-Salam) and another rural (El-Ibrahemya) were chosen randomly and then one class from each grade was chosen randomly.

All participants were subjected to a predesigned questionnaire and anthropometric measures were taken.

Weight was measured on a digital electronic scale. Height was measured using a tape measure permanently fixed to a wall or door frame. BMI was calculated as follows: BMI = weight (kg)/height (m ²).

The data were tabulated and analyzed with the statistical package for the social science (SPSS, version 11, IBM SPSS inc., Chicago.IL, USA), using a personal computer. Qualitative data were expressed as number and percentage and analyzed using the χ²-test. Quantitative data were expressed as mean ± SD and analyzed using the t-test.

Results

The present study included 306 primary school children. The prevalence of obesity and overweight among them was 19.6%. They were further classified into class 1 (overweight) (11.7%), class 2 (obese) (43.3%), and class 3 (severe obese) (45%) ([Table 1]).

Table 1 Distribution of the studied participants regarding their body mass index and its Z-score class

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Prevalence of obesity in the older age group of 10–12 years was higher than that in the lower age group of 6–9 years. Prevalence of obesity among the female participants was significantly higher (24.7%) than that among male participants (14.2%). Obesity prevalence among urban residents (22.1%) was significantly higher than that among rural residents (11.3%), and prevalence in children from families with high income (22.4%) was significantly higher than that in children from families with low income (9.2%). Other sociodemographic data such as parent education and parent occupation were studied but were not significant ([Table 2]).

Table 2 Comparison between obese and nonobese participants regarding their sociodemographic characteristics

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Obesity was significantly higher in children with a positive family history of obesity (27.3%) than in those with a negative family history (14.6%) ([Table 2]).

The total caloric intake (TCI) in the obese group was significantly higher than that in the nonobese group. Basal and resting metabolic rates (BMR and RMR) in obese children were significantly higher than those in nonobese children (P < 0.001) ([Table 3]).

Table 3 Comparison between obese and nonobese participants regarding energy measurements

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The prevalence of obesity was significantly higher among children with intake of fast food more than three times per week (81.2%) than in those with intake less than three times, and was significantly higher among those who take high-calore snacks like sweets or chips (30.9%) than in those who take low-caloric snacks like vegetables and fruits (13.3%). Obesity was highly significantly more among those who take soft drinks more than three times per week (56.3%) than among those who take it less than three times (6.6%) ([Table 4]).

Table 4 Comparison between obese and nonobese participants regarding their answers to healthy and unhealthy food habits

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The prevalence of obesity among children who exercise for less than 2 h per day was significantly higher (34.6%) than that in those who exercise for more than 2 h (8.9%) ([Table 5]).

Table 5 Comparison between obese and nonobese participants regarding duration of rest and exercise

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Discussion

One of the most important developments in pediatrics in the past two decades has been the emergence of a new chronic disease – obesity – during childhood and adolescence ^[11].

In this study, the prevalence of obesity was 19.6%. The prevalence of overweight and obesity in this study was higher than that reported in a previous Egyptian study by Hafez et al. ^[12], which showed a prevalence of 11% among children of governmental schools in Cairo. Among the 306 participant children we found the prevalence of overweight and obesity among girls to be significantly higher than that among boys. This could be due to reduced activity levels of girls in the school and outside. This finding is in agreement with those of most previously conducted studies in Egypt, which showed a significant increase in female percentage of obesity compared with boys ^[6],[13]. In contrast, Abou Ghazy et al. ^[7] found that the prevalence of obesity among 7–15-year-old Egyptian school children living in Qalubia was higher among boys than among girls. The different age groups between the two studies might be the cause of the different results.

Regarding BMI Z-score classes we found that the percentage of overweight and obesity among the total participants in the urban center was significantly higher than that among rural children. This could be explained by the variation in the diet between urban and rural children. This finding concurs with that of Jackson et al. ^[14], who compared the relationship between body weight body image in a convenience sample of rural and urban girls in Egypt. Using the Centers for Disease Control and Prevention reference standards, it was found that overweight was more prevalent in urban girls than among rural girls and in those with higher income than in lower-income girls.

It was found that children from families with sufficient income have significantly more positive deviation from mean BMI for age Z-score compared with other children (P = 0.018). The results of the present study were consistent with those of Abou Ghazy et al. ^[7], who found that obesity in Qalubia is more among the high socioeconomic classes, which may be explained by the excessive intake of processed meat, processed cheese, rice, artificial juices, and soda drinks (coca) among high-income classes in addition to more idle hours at home playing video and computer games and watching television advertisements of fattening food.

Regarding family history of obesity we found that obesity was significantly higher among those with a positive family history than among those with a negative family history.

This agrees with the results of van der Sande et al. ^[15], who stated that subjects who reported a family history of obesity had significantly higher mean BMI (P < 0.001) than those who reported no such history.

Another study carried out by Ochoa et al. ^[16] showed that carriers of the polymorphism Pro12Ala of the PPARg2 gene had a significantly higher obesity risk compared with noncarriers [odds ratio (OR): 2.18, 95% confidence interval (CI): 1.09–4.36] when we adjusted for sex, age, and physical activity. Moreover, the risk for obesity was higher (OR: 2.59, 95% CI: 1.17–5.34) when family history of obesity was also taken into account in the model. The OR for obesity linked to both polymorphisms (PPARg2 and ADRb3) was 5.30 (95% CI: 1.08–25.97) when we adjusted for sex, age, and physical activity. After adjustment for family history of obesity, the OR for carriers of both polymorphisms was 19.5 (95% CI: 2.43–146.8).

It was recently proposed that increased energy intake is the major driver of the increasing prevalence of overweight and obesity observed in the USA, whereas physical activity is one of the moderators that influence the steepness of the trajectory of weight gain ^[17].

Overweight and obesity are the result of 'caloric imbalance' – too few calories expended for the amount of calories consumed – and are affected by various genetic, behavioral, and environmental factors ^[18].

For energy intake, 24-h diet recall was obtained from the participants. Conversion of food into nutrients was carried out using a computerized program based on Egyptian food composition tables to calculate TCI. Also, BMR and RMR were assessed to compare energy input with energy expenditure. A significant increase in TCI, BMR, and RMR was found in obese participants compared with nonobese participants.

This agrees with the findings of Ravussin et al. ^[19], who found that both BMR and RMR were significantly higher in obese subjects when compared with normal-weight subjects. The RMR was 7592 ± 351 kJ/day in the obese, 6652 ± 242 kJ/day in the moderately obese, and 6118 ± 405 kJ/day in the controls. Mean BMR values were 10 043 ± 363, 9599 ± 277, and 8439 ± 432 kJ/day in the obese, moderately obese, and controls, respectively. The larger BMR and RMR in the obese were mainly due to a greater VO₂ during the daylight hours and other factors such as the increased cost of moving the extra weight of the obese.

Beverages are major components of the daily diet, and may affect our health through various pathways ^[20]. Patterns of beverage consumption have changed dramatically in the past several decades ^[21]. There is growing evidence that intake of sugar-sweetened beverages is associated with an elevated risk for obesity and weight gain ^[22]. In the present study we found that obesity was significantly higher among those who consume beverages greater than and equal to three times per week than among those who consume it less than three times per week (P < 0.001).

Regarding fast food intake we found that obesity was significantly higher among those who consume more than three times per week than among those who consume less than three times per week (P < 0.001). This agrees with multiple hierarchal regressions that revealed that square miles per fast food restaurants and residents per restaurant accounted for 6% of the variance in state obesity rates after controlling for population density, ethnicity, age, sex, physical inactivity, and fruit and vegetable intake. The entire model explained 70% of the total variance in state obesity rates ^[23].

Another study by Jeffery et al. ^[24] reports the association between BMI and frequency of eating at restaurants. As has been reported by others, we found a significant positive association between BMI and frequency of eating at 'fast food' restaurants.

Sedentary behaviors such as excess television watching and excess computer use were all associated with increased prevalence of obesity among the studied children. We found that the prevalence of obesity among those who watch television or computer for more than 2 h was 20%, whereas it was 12.5% among those who watch it for less than 2 h.

Most studies of children that examined the relationship between sedentary behavior and prevalence of overweight and obesity found a positive relationship between television watching and overweight ^[25].

El-Gilany and El-Masry ^[26] found that physical inactivity and sedentary behaviors such as excess television watching and excess computer use were associated with increased risk for overweight/obesity among adolescents.

Conclusion and Recommendations

On the basis of the findings from the present study, we can conclude that the prevalence of obesity and overweight was 19.6% among children aged 6–12 years. Sex, family history of obesity, fast food, soft drinks, and decreased activity (as contributing factors of obesity) were studied in the chosen group.

Increasing awareness about obesity, its consequences, and ways and means of prevention, especially among the young and their families, through the promotion of healthy eating and physical activities is recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Kopelman PG, Caterson ID, Dietz WH. Clinicalobesity in adults and children. Vol. 493. Blackwell Publishing, Quebec; 2005:pp. 1672–1675.
2.	Kliegman RM, Stanton BF, Behrman RE. Overweight and obesity. In: Kliegman RM, editor. Nelson textbook of pediatrics [Chapter 44]. 19^th ed. Philadelphia, PA: Saunders, an imprint of Elsevier Inc.; 2011. 44:p. 179-183.
3.	Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents.JAMA 2010; 303:242–249.
4.	Hassink SG. Childhood obesity: and over view. In, editor. Pediatric obesity: prevention, intervention, and treatment strategies for primary care. Vol. 1. ElkGroove Village, IL: American Academy of Pediatric; 2007:pp. 22–25.
5.	El-Shafie AM, Hogran HH, Mohamed Dphein AH. Prevalence of obesity in primary school children living in Alexandria governorate. Menouf Med J 2014; 27:529–532.
6.	Salem MA, El Samahy M, Monier E, Tash F, Zaki M, Farid S. Prevalence of obesity in school children and its link to type 2 diabetes mellitus. Egypt J Pediatr 2002; 19:397–416.
7.	Abou Ghazy HS, Ezzat AM, EL-Gendy MF, Soliman DR. Body mass index as anassessmenttool for overweight and obesity in school children in El-Qalubia Governorate. J Am Sci 2011; 7:8.
8.	El-Ghadban HM, Gamal AN, Yamamah GN. Prevalenceand risk factors of obesity in primary school children living in Cairo: East Mediterr Health J. 2005;15:1513-1524.
9.	Shaheen F, Hathout M, Tawfik AA. Prevalenceof obesity in Egypt. Abstract book of the 13^th international scientific congress of the Egyptian Medical syndicate. 'Major health problem in Cairo, Egypt. Problem solving for better health'. Al Azhar International Conference Center. 2002; Vol. 14: p. 111.
10.	Freedman DS, Mei A, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr 2007; 150:12–17.
11.	Sokol RJ. The chronic disease of childhood obesity: the sleeping giant has awakened. J Pediatr 2000; 136:711–713.
12.	Hafez AS, EI-Awady MY, Hassan NE. Obesity profile among primary school children in Cairo. Egypt J Community Med 2000; 18:99–119.
13.	Ismail G. Study of the problem of obesity among primary school children in Alexandria there. Alexandria: High Institute of Public Health Alexandria; 1998.
14.	Jackson RT; Rashed M; Saad-Eidin R. Nutrition and food science. Int J Food Sci Nutr 2003; 54:1–11.
15.	van der Sande MA, Walraven GE, Milligan PJ, Banya WA, Ceesay SM, Nyan OA, McAdam KP. Family history: an opportunity for early interventions and improved control of hypertension, obesity and diabetes. Bull World Health Organ 2001; 79:321–328.
16.	Ochoa MC, Marti A, Azcona C, Chueca M. Gene–gene interaction between PPARc2 and ADRb3 increases obesity risk in children and adolescents. Int J Obes 2004; 28:37–S41.
17.	Swinburn B, Sacks G, Ravussin E. Increased food energy supply is more than sufficient to explain the US epidemic of obesity. Am J Clin Nutr 2009; 90:1453–1456.
18.	Daniels SR, Arnett DK, Eckel RH. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005; 111:1999–2002.
19.	Ravussin E, Burnand B, Schutz Y, Jéquier E. Basal metabolic rate and resting metabolic rate in obese, moderately obese, and control subjects. Am J Clin Nutr1982;35:566–573.
20.	Wolf A, Bray GA, Popkin BM. A short history of beverages and how our body treats them. Obes Rev 2008; 9:151–164.
21.	Nielsen SJ, Popkin BM. Changes in beverage intake between 1977 and 2001. Am J Prev Med 2004; 27:205–210.
22.	Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006; 84:274–288.
23.	Maddock J. The relationship between obesity and the prevalence of fast food restaurants: state-level analysis. Am J Health Promot2004; 19:137–143.
24.	Jeffery RW, Baxter J, Mc Guire M, Linde J. Are fast food restaurants an environmental risk factor for obesity? Int J BehavNutr Phys Act 2006; 3:2.
25.	Andersen LF, Lillegaard IT, Overby N. Overweight and obesity among Norwegian school-children: changes from 1993 to 2000. Scand J Public Health 2005; 33:99–106.
26.	El-Gilany A, El-Masry R. Overweight and Obesity among adolescent school students in Mansoura, Egypt. Child Obes 2011; 7:3.