Obesity is a progressive problem among primary school children

O.R. Zekavat, 1 A.R. Makarem, *2 Z. Shayan, 3 M. Shojaee, 4 M.Y. Karami 5

1. Department of Pediatrics, Jahrom University of Medical Sciences, Jahrom, IR Iran.

2. Medical student research committee, Jahrom University of Medical Sciences, Jahrom, Iran.

3. Department of Biostatistics and Epidemiology, Shiraz University of Medical Sciences, Shiraz,

Iran.

4. Department of Cardiology, Jahrom University of Medical Sciences, Jahrom, Iran.

5. Department of Surgery, Mazandaran University of Medical Sciences, Sari, Iran.

Corresponding Author: A.R. Makarem

No 17, Siami Alley, Satarkhan Ave., Tohid Sq., Tehran, Iran

P.O. Box: 13185-1678, Tehran, Iran

Tel: +9821 66439463

Fax: +9821 66423304

Email: swt_f@yahoo.com

Running Title: Obesity & primary school children

Source of funding: None

Number of figures: 1

Number of Tables: 2

Total word count: 1881

Total number of pages: 15

Conflicts of interest: Authors declare any conflicts of interests.

Abstract

Objective: to describe the prevalence of overweight (pre obesity and obesity) during 7 to 13

year-old children.

Methods: A total of 1158 students (587 males and 571 females) aged 7-13 years were assessed

over a period of 12 months. Body mass index (kg/ m2) was measured for each subject. We

adopted the 5th, 85th and 95th centiles of the CDC as cut-off points for thin, overweight and

obese children, respectively, as generally accepted.

Results: Age of the children ranged from 7 to 13 years with a mean of 9.9 ± 1.6 years. A total of

58 boys (9.9%) and 57 girls (10%) were overweight, and the difference between them was not

statistically significant). However, obesity was less prevalent among girls (4.9%) compared to

boys (5.1%).

Conclusion: In this survey prevalence of obesity among girls and boys was 4.9% and 5.1%,

respectively. The scope of prevalence of obesity is remarkable enough for a mid-size semi-

industrialized society in comparison with heavy industrialized parts of Iran, thus there is an

urgent need to target younger ages for prevention and implementation of public educational

programs to curtail this rising trend of obesity in young men and women.

Key words: Body mass Index, adolescents, overweight

Introduction

Childhood obesity is nowadays considered as an epidemic of developed and industrialized

1
countries. It is a global health problem recognized by World Health Organization (WHO).

Children are the fastest-growing group of the overweight and obese population.2 Obesity is not a

single disease but is instead a syndrome with a multifactorial etiology that includes metabolic,

genetic, environmental, poor health behaviors, social, and cultural interactions.1, 3-6
Moreover, obesity is the result of an imbalance of energy intake and expenditure and its main

causes are linked to environmental factors, mainly the factors related to sedentary lifestyle which

is prevalent in children nowadays. Children’s modern lifestyles denote that their activities in their

extra time are mostly sedentary and unhealthy comprising screen watching including television,

handheld computer games, and using personal computers.1, 7-13

Prevalence of obesity has increased considerably over the last few decades and indications are

that these trends will continue.4, 7

Prevalence of obesity in school-aged children is likely to be 10% worldwide (Anonymous, 2005)

and is higher in industrialized and developed countries.3

From 1970 to 2000, the number of obese children in the USA tripled and 30.4% of children and

adolescents aged 2 through 19 years were overweight or obese in 2009-2010.14

In Asia, the prevalence of overweight children in Singapore was about 22.5%; and in Thailand,
15-16
7.9% of urban school children in the north-eastern part were overweight In Malaysia,

prevalence of overweight among primary school children in the state of Selangor was 7.8%. 17 In

Philippines, 24.9% of private and 5.8% of public school children were at risk of being

overweight.18

In Iran, comparable data indicate that in the year 2000, 21.1% and 7.8% of the 11- to 17-year-old

adolescents in Tehran were overweight and obese, respectively.19 In south of Iran, Fars

Provinence,The prevalence of obesity among healthy students aged 11- to 17-years-old was

7 %.20

Excess body weight in children is associated with type 2 diabetes, orthopedic and respiratory

problems, chronic inflammation, sleep apnea and cardiovascular disease risk factors. 19, 21-24

9
Overweight and obese youth are more likely to become obese adults and obese adolescents

have an increased risk of morbidity and mortality in adulthood. 2-3, 21, 25-33 In the US, excess weight
is responsible for about 300000 deaths each year, making it the second cause of death following

smoking.34

In the US, one-third of the overweight Americans are at an increased risk of developing chronic

diseases such as type 2 diabetes, cardiovascular diseases, gallbladder diseases, hypertension and

certain forms of cancer.34-36

Negative social and psychological ramifications of childhood obesity includes being liked to a

lesser extent by peers,12–13,19,21 being rejected by peers 19 and being the victim of various forms of

peer aggression such as bullying.37-38

There is a lack of data about prevalence of obesity in South of Iran after 1990 .Due to importance

of obesity as a common preventable cause of mortality and morbidity, current study were to

describe the prevalence of overweight (pre obesity and obesity) among 7 to 13 year-old children

in different parts of Jahrom City, southern Iran during 2008-2009.

Material and method:

The study was carried out between October 2008 and October 2009 on a random sample of 7- to

13-year-old primary (elementary) school children in Fars provenience, Jahrom City, southern

Iran. Schools were randomly selected in each district of the city, and the participating children

were selected using stratified randomization for age, with the aid of a table of random numbers.

In this study, people with systemic disorders were excluded.

A total of 1158 students (587 males and 571 females) aged 7-13 years were assessed over a

period of 12 months. Body weight and height were measured to the nearest 0.1 kg and 0.5 cm,

respectively. A questionnaire was filled providing information on sex, age, height, weight and

BMI. Body mass index, calculated as weight in kilograms divided by squared height in meters

(kg/ m2) 39, 40

was measured for each subject. We adopted the 5th, 85th and 95th centiles of the
 41
CDC as cut-off points for thin, overweight and obese children, respectively, as generally

accepted 42.

This study was conducted in accordance with the principles of the local Ethics Committee of

Jahrom University of Medical Sciences and Helsinki protocol. Prior consent for participation

was obtained from the children’s parents after description of the aims and methods of the study

in detail.

Measurement:

In each school, two trained individuals measured the children's height and weight using a

standardized procedure. Height was measured with a stadiometer (SECA 206, Germany), with

the head in the Frankfort horizontal plane (no shoes, heels together, and head touching the ruler

with line of aligned horizontally); while weight was measured with an digital lithium weighing

scale (Tanita 318, Japan) with a precision of 100 grams and taken twice per child. Weight

measurement was taken with the children lightly dressed and barefoot.

Statistical analyses were performed using SPSS software (version 11.5), Medcal 9 and Microsoft

Office Excel 2003. The tests used were trend and Chi-square.

In order to fit an appropriate model for BMI, the GROSTAT computer package (GROSTAT,

1988) was used.

Results

A total of 1158 students from different primary schools were eligible for the survey. The final

sample included 587 boys (50.7%) and 571 girls (49.3%). Age of the children ranged from 7 to

13 years with a mean of 9.9 ± 1.6 years. Table 1 presents age-related prevalence of obesity

among schoolchildren in Jahrom City by sex. A total of 58 boys (9.9%) and 57 girls (10%) were

overweight, and the difference between them was not statistically significant (p>0.05). However,
obesity was less prevalent among girls (4.9%) compared to boys (5.1%). Table 2 displays the

overall prevalence of obesity among boys and girls. Figure 1 shows percentile distribution of

body mass index among primary school children in Jahrom with gender distribution on the 2008

survey. The highest prevalence of obesity is seen between the ages of 11-12 years (11.6%) in

boys and between the ages of 12-13 years (14.5%) in girls. In Table 1, a significant change in

prevalence of obesity can be seen between the ages of 11-12 and 12-13 (from 3.6% to 14.5%) in

girls which can be the result of hormonal change. As depicted in Figure 1, difference in

prevalence of obesity in girls and boy is not significant till about the age of 8 years; but as the

children grow, the difference become significant and about the age of 12.5 years, prevalence of

obesity is more significant in boys than in girls.

Discussion

In this survey of 1158 school-aged children aged 7 to 13 years from 2008 to 2009 in Jahrom

(south of Iran), prevalence of obesity among girls and boys was found to be 4.9% and 5.1%,

respectively. This study population consisted of 587 boys and 571 girls. Overall 85.06 % of the

children had normal BMI values (boys, 85%; girls,85.11 %). We found that girls aged 12 years

old were most likely to be obese. Puberty changes in this age group might be a reason.the

aouthor study Showed that there is no significant difference in the prevalence of obesity between

boys and girls.43

Similarly, Bong and Safurah found the overall prevalence of obesity in the district of Kuala

Selangor to be 8.7% based on the 1983 WHO criteria of weight-for-height. 44 Kasmini et al.

reported the overall prevalence of obesity to be 9.6% among children and adolescents aged 7 to

16 years in schools of Kuala Lumpur based on weight-for height cut-off points from the 1976

NCHS growth charts.45

In previous studies, overweight and obesity were higher among boys (Bong & Safurah, 1996;

Kasmini et al., 1997). In Bong & Safurah's study, there was no discernible difference between

urban and rural obesity rates, in contrast with an earlier study. Obesity is more prevalent in urban

areas of China but in rural areas of Russia.46 in N-F Chu's study, the prevalence of obesity has

steadily increased from 12.4% in 1980 to 16.4% in 1994 among boys; and from 10.1% to 11.1%

among girls. The Naidu and et.al Study47 results showed that the overall prevalence of

overweight children in Malaysia was 19.9%.

The prevalence of overweight was 12.4 % Cameron 48 and also Overweight prevalence was 9.5%

including 2.2% of obesity in 5–7-yearold children and 15.6% including 2.9% of obesity in 7–11-

year-old children in French primary-school children.49

The highest prevalence of overweight in middle east was reported from Bahrain (38.5%),50

followed by Kuwait with a rate of 31.8% among girls. 51 The lowest prevalence of obesity was

reported from Iran (2% to 3%),18 followed by Lebanon (3.2% among 3- to 19-year-old girls).52

The increasing prevalence rate of obesity may be due to changes in children’s lifestyle and shifts

in their nutritional patterns, attributed to industrialization and substitution of high-fat, refined

carbohydrate, and low-fiber diets.53 Childhood and adolescent obesity has become a global health

problem and is no longer limited to industrially developed countries; the implementation of

western lifestyles, especially the intake of attractive energy-dense food with undesirable

composition, increased consumption of animal fats and sugars and reduced consumption of

dietary fiber, along with a lack of sufficient physical activity has resulted in an increasing

prevalence of obesity in many countries.43

Although the overall prevalence of obesity among primary school children of Jahrom was lesser

than the aforementioned study; but the scope of prevalence is remarkable enough for a mid-size

semi-industrialized society in comparison with heavy industrialized parts of Iran, thus there is an
urgent need to target younger ages for prevention and implementation of public educational

programs to curtail this rising trend of obesity in young men and women.47

We conducted this study and recommend researchers to conduct extensive and comprehensive

studies on prevalence of obesity and its side effects in other parts of Iran during specific period

of time; as it can help us to recognize the increasing prevalence of obesity and determine the

related factors for designing novel health programs which can change school-aged children’s

lifestyle and nutritional pattern.

Acknowledgment

We would like to express our sincere gratitude to Farzan Institute for Research & Technology for

technical assistance.

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Table 1
Age-related prevalence of obesity among schoolchildren in Jahrom by sex, 2008-2009
*

Age and Sex Normal Overweight Obese Total

< 85% 85% to 95% (> 95%)

n(%) n(%) n(%)

7 Female 60(100%) 0 0 60
Male 79(94.04%) 5(6%) 1(1.2%) 84
8 Female 88(96.70%) 3(3.3%) 0 91
Male 100(93.45%) 4(3.7%) 3(2.8%) 107
9 Female 103(91.15%) 9(8%) 1(9%) 113
Male 124(91.17%) 10(7.4%) 2(1.5%) 136
10 Female 90(84.11%) 10(9.3%) 7(6.5%) 107
Male 87(79.81%) 14(12.8%) 8(7.3%) 109
11 Female 70(84.33%) 10(12%) 3(3.6%) 83
Male 95(73.64%) 19(14.7%) 15(11.6%) 129
12 Female 75(64.10%) 25(21.4%) 17(14.5%) 117
Male 15(68.18%) 6(27.3%) 1(4.5%) 22
Total Female 486(85.11%) 57(10%) 28(4.9%) 571
Male 499(85%) 58(9.9%) 30(5.1%) 587
*Values are absolute numbers (percent).

Table 2

Overall prevalence of obesity among schoolchildren in Jahrom by sex, 2008-2009

Sex Frequency Percent

Underweight 19 3.2
Normal 480 81.8
Male Overweight 58 9.9
Obese 30 5.1
 Total 587 100

Underweight 28 4.9
Normal 458 80.2
Female Overweight 57 10
Obese 28 4.9
Total 571 100

Figure Legends

Figure 1. Comparison of BMI of boys and girls, Jahrom, 2008 -2009