Shahjalal University of Science & Technology

Research Proposal on
PREVALENCE AND RISK FACTOR OF CHILDHOOD
OVERWEIGHT AND OBESITY IN PRIMARY SCHOOL
CHILDREN OF SYLHET CITY

Course Title: Advanced Data Analysis Lab

Prepared for:
Dr Md Azizul Baten
Professor,
Dept. of Statistics, SUST.

Prepared by:

Name Reg No.

Md Abdullah Al Mamun 2011134021
Farhad Ahmed 2011134035
M.A. Taleb 2012134083
Md Raisul Islam Khan 2012134088

Date: 28 January,2019

Department of Statistics
School of Physical Science
Shahjalal University of Science & Technology
PREVALENCE AND RISK FACTOR OF CHILDHOOD OVERWEIGHT
AND OBESITY IN PRIMARY SCHOOL CHILDREN OF SYLHET CITY

Background of the study and Statement of the problem:

Obesity is a major public health problem and becomes an important epidemic in both developed and
developing countries since an increase in the risky lifestyles. According to recent research 76% are
healthy weight, 13.3% overweight, 5.3% underweight and 5.3% obese, where girls have slightly higher
obesity rate than boys [1].
According to a WHO report, there are 1 billion overweight people in the world, of whom 300 million
are obese [2]. It has been declared an epidemic in many high-income countries. In the US, obesity is
considered a major health problem. Half the population is obese; among adults more than 60% are
overweight and more than 30% are obese; among children over 17% are obese [3,4]. In the UK, among
adults 23% of men and 25% of women are obese. Among children from 2 to 15 years 5.5% of boys and
7.2% of girls are obese and 22% of boys and 28% of girls are overweight [5]. Recent data on children
from North America suggest that 21.5 percent of African-Americans, 21.8 percent of Hispanics and
12.3 percent of non-Hispanic whites are overweight and this prevalence rapidly increased between 1986
and 1998 [6]. In Australia around 16% percent of boys and almost 20% percent of girls are overweight
[7].
The low-income countries are showing the same trend as the high-income countries in increasing rates
of obesity. Rapid urbanization and industrialization are changing the food habits resulting in socio-
economic, demographic and cultural changes leading to nutritional transition in low income countries
[8,9]. The National Health Survey of Pakistan in 1990–1994, found that the prevalence of obesity for
adults aged 25–64 from low; middle to high socioeconomic status (SES) was 9%, 15% and 27% for
rural areas and 21%, 27%and 42% for urban areas respectively [10]. Another study from Pakistan shows
that 6% was obese and 8% overweight. Of all obese children, 70% belonged to the higher socio-
economic status (SES) group, while of the underweight children, 63.3% were in the lower SES [11].
There are currently about 110 million people diagnosed with diabetes worldwide, the number is and this
projected to increase to 180 million by 2010 [12]. Being overweight or obese with an excessive
abdominal fat distribution probably accounts for 80-90% of all patients with type 2 diabetes [13].
The prevalence of obesity and overweight is alarming among the school aged children in Bangladesh. 6
to 15 years olds from both the urban and rural areas 3.5% were obese, 9.5% were overweight and 17.6%
were underweight. The proportion of obese and overweight students were greater among the students

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from urban schools (5.6%, 10.6%) compared to the students from rural schools (1.2%, 8.6%) (RD = 4.3,
95% CI = 3.6, 5.0; RD = 2.0, 95% CI = 0.1, 3.1). The proportion of underweight students were lower in
the urban schools (16.1%) compared to the rural schools (19.2%) (RD = −3.1; 95% CI = −4.6, −1.6).
[14] Obesity is also a risk factor for cardiovascular diseases. Another study it was showed that, obese
children had elevated blood pressures and elevated total cholesterol and decreased HDL cholesterol
relative to thinner children [15]. In many developing countries overweight and obesity are now so
common that they are replacing more traditional problems such as under nutrition and infectious disease
as the most significant causes of ill health [16]. In 1995, there were an estimated 200 million obese
adults worldwide and another 18 million under 5 years children classified as overweight. The obesity
epidemic was not restricted to industrialized societies; in developing countries, it was estimated that
over 115 million people suffer from obesity related problems [17]. In 1998, The World Health
Organization project monitoring of cardiovascular diseases (MONICA) reported Iran as one of the
seven countries with the highest prevalence of childhood obesity [18]. Though not all obese children
become obese adults, it is projected that a large proportion will be the continuing rise in childhood
obesity is likely to lead to a massive increase in the prevalence of those co-morbidities linked to obesity
[19].
Through this study, we would like to capture the current body weight status of school aged children in
Sylhet city.

Rationale of the study:

Children are becoming increasingly vulnerable to overweight and obesity around the world. It is among the
easiest medical conditions to recognize but the most difficult to treat and now a day’s one of the most
alarming public health issues. It also leads to adult obesity along with chronic health problems such as
diabetes, asthma, sleep apnoea, gallbladder disease, elevated blood pressures and elevated total cholesterol.
Obesity is the main cause of chronic illness and risk of being obese is increasing in children so this study
will help to find out the prevalence and contributing factors about obesity so that problems will be
addressed.

This study will help to find out the prevalence and contributing factors of obesity among the children which
will be significant as
 It will help the children and the other members of the society to adopt healthy lifestyle.
 It will help the nation to minimize obesity and thus helps in reducing chronic illness.
 It will help different NGO’s and INGO’s working in health sectors to plan a programme related to
healthy life style.

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Objective of the Study:
The main objective of the study is to determine the prevalence of childhood overweight and obesity and its
risk factors in primary school children of Sylhet city. In order to achieve the main objective, there are some
specific objectives that have to be fulfilled, which are:
 To measure height, weight and other anthropometric indices (MUAC) in primary school children.
 To investigate the risk factors of overweight and obesity among in primary school children.
 To analyse the influence of socioeconomic and demographic factors on the anthropometric indices
of the children.

Methodology:
Description of Methodology:
This study will be used three approaches of Descriptive statistical analysis, Weight for Height and
Multinomial regression analysis.
Weight for height Approach
Weight for height measures body weight relative to height. High weight for height in children will be termed
overweight and arises from gaining excess weight relative to height or from gaining insufficient height
relative to weight (WHO,1995). Weight for height of the subjects will be calculated using standard formula
(20):
Weight of subjects
Weight for height ( % )= ∗100
Weight of normal child of same hight

Multinomial Logistic Regression Approach

The general form of a logistic regression is:

Where x 1 ¿ x k are theindependent variables .

For the study, we will use
 Sex, Age (years), Income, Parents Education, Physical Activities as independent variables
 BMI categories (Underweight, Normal, Overweight, Obese) as dependent variables
Multinomial logistic regression is used to predict categorical placement in or the probability of category
membership on a dependent variable based on multiple independent variables. The independent variables

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can be either dichotomous (i.e., binary) or continuous (i.e., interval or ratio in scale) (Dr. Jon Starkweather
and Dr. Amanda Kay Moske, 2011).
Univariate multinomial regression models will be used to estimate the odds ratios (ORs) and the 95%
confidence intervals (95% CI) for the three categories of weight-for-height (underweight, overweight and
obese). Multivariate multinomial regression models will be used to estimate adjusted OR and the 95% CI for
the three categories of weight-for-height.
We will use logistic regression analyses to quantify the individual effects of sex, age, income, parent’s
education and physical activities, with weight for height in obese, overweight and underweight group.
Study design: a cross-sectional study, which will be focused on the prevalence of childhood obesity in
primary school children of Sylhet city in Bangladesh. This epidemiological survey will be conducted to find
out the prevalence of childhood overweight and obesity.
Study area: Sylhet City Corporation.
Study population: an epidemiologic study involving primary school children of Sylhet city. In Sylhet City
Corporation, there are 37 Government Primary schools, 77 Kindergarten schools (pre-schooling), 47
NGO schools. The study population will both children boys and girls aged 6 to 12 years old be included in
this study. About 400 students from class I to V will be selected as a sample for the study.
Tools and techniques of data collection: semi structured questionnaires will be used. data will be collected
by interview and measurement. Weighing scale and measuring tape will be used to calculate BMI.

Data Collection Procedures:

Several research assistants will be recruited and trained up for the field work of the study which includes
sample selection, collection of data by reviewing the questionnaire through teamwork with the researcher.
About five days training will be provided to the assistants focused on the demonstration of the questionnaire
selection process of subjects, interview, using the research tools and data collection prior to the
commencement of the study.

Questionnaire:
The questionnaire will be composed of some general information; like the demographic and socioeconomic
information, including name, sex, age, parent’s education, parent’s occupation and economic status etc in
the same language Bangla. The participants will be asked for their food habit. They will be also asked for
their daily activities which include with their school time, sleep time and free time that will be reported by
the subjects with their parents in a questionnaire.
All the subjects and their parents were interviewed for their demographic and socioeconomic information. It
includes name, sex, age, parental education, occupation and economic status etc.

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Statistical Analysis:
All of the collected data will be entered into computer for analysis. All statistical analyses will be performed
by using statistical package for social science (SPSS) 22.0 version.
 Student’s t tests will be used to compare two independent group means for continuous
variables.
 Univariate Multinomial Regression models will be used to estimate the odds ratios (ORs)
and the 95% confidence intervals (95% CI) for the three categories of weight-for-height
(underweight, overweight and obese).
 Multivariate Multinomial Regression models will be used to estimate adjusted OR and the
95% CI for the three categories of weight-for-height.
Ethical Consideration:
 All necessary ethical and administrative approvals will be obtained by the responsible authorities
before the study was took place.
 All the personal information will be maintained confidentially.

Work Plan:
Gantt Chart of Research Activities (Jan 2019 –Jul 2019):

Activity

Name of Months Jan Feb Mar Apr May Jun Jul

Need assessment & preparation for the study, Literature xxx

review

Data collection and editing xxx xxx

Data entry and preliminary analysis xxx xxx

Draft report preparation along with the research findings xxx

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Report finalization and submission X
xx

* The star indicates the duration of each activity.

Budget (in taka)

Transportation 20,000
Communication 5,000
Refreshment 12,000
Stationary 2,000
Photocopy 5,000
Printing 5,000
Internet 5,000
Report preparation cost 10,000
Expert cost 25,000
Editor 6,000
Principle investigator 30,000
Co-investigator 20,000
Miscellaneous 15,000
total budget 1,50,000

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References:
1. Ullah MO, Hasan MA, Rahman MM, Chowdhury AH, Das NC, Uddin MJ, Uddin MT: Obesity of Primary
School Children: A Crosssectional Study in Bangladesh ,2014 . International Journal of Scientific &
Engineering Research, 5(12)
2. World Health Organization GSoD, Physical Activity and Health (2008) Obesity and Overweight.
3. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM: Prevalence of overweight and
obesity among US children, adolescents, and adults, 1999–2002. JAMA: J Am Med Assoc 2004, 291(23):2847–
2850.
4. Ogden CL, Carroll MD, Kit BK, Flegal KM: Prevalence of obesity in the United States, 2009–2010. NCHS
data brief, no 82. Hyattsville, MD: National Center for Health Statistics: US Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2012
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14. Bulbul T, Hoque M: Prevalence of childhood obesity and overweight in Bangladesh: findings from a
countrywide epidemiological study
15. Berenson, G.S.: Cardiovascular Risk Factors in Children: The Early Natural History of Atherosclerosis and
Essential Hypertension. New York, Oxford University Press, 1980.
16. https://www.who.int/nutrition/publications/obesity/en/.
17. McTigue KM, Garrett JM and Popkin BM. The natural history of the development of obesity in a cohort of
young U.S. adults between 1981 and 1998. Ann Intern Med 2002; 136: 857-64.

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18. World Health Organization project monitoring of cardiovascular diseases (MONICA), 1998.
19. Kotani K, Nishida M, Yamashita S et al. Two decades of annual medical examination in Japanese obese
children: do obese children grow into obese adults? Int J Obes 1997; 21: 921-21.
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81

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