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Abstract
Obesity is now the most common medical condition of childhood, with the prevalence having doubled over the past 20 years. It is defined as an excessive accumulation of body fat. The problem of children obesity is global and increasingly extends into the developing world. As with adult-onset obesity, childhood obesity has multiple causes centering around an imbalance between energy in (calories obtained from food) and energy out (calories expended in the basal metabolic rate and physical activity).
Childhood obesity most likely results from an interaction of nutritional, psychological, familial, and physiological factors. Because of change of children lifestyles, they are eating a lot more snacks, therefore getting more calories because they are eating different kinds of foods that are more energy dense. Declining physical activity of children at school and at home is recognized as one of the primary factors that lead to obesity in childhood. Increasing physical activity alone has been found to prevent overweight in children. Watching television and playing video games appear to be major factors in reducing the amount of physical activity and are strong predictors of obesity in children. Children who are obese are at high risk of becoming obese adults with a greater risk factor for cardiovascular disease; insulin resistance, abnormal lipid profile, hypertension, and adult morbidity and mortality. The psychosocial consequences of overweight are also significant.
Pediatric obesity management programs are often multidisciplinary and long term, involving clinicians, dietitians, exercise physiologists, health educators, and social workers or psychologists; in a primary care sitting, the clinician’s support staff should include at least an experienced and highly motivated dietitian. Family involvement is an essential component. However, obesity is easier to prevent than to treat, and prevention focuses in large measure on parent’s education and behavior modification. This should include proper nutrition, selection of low-fat snacks, good exercise/activity habits, and monitoring of television viewing.
The general aim of the present study is to assess the prevalence of obesity and at risk of obesity among primary school children in Damanhour city in EI Beheira governorate and to identify the contributing factors of the problem. More specific objective is to define the role of dietary fuctors and eating patterns in relation to obesity.
The study was conducted during the scholastic year of 2004-2005. The first study was the cross-sectional study. Ten schools were randomly selected; two from within each district (one governmental and one private) using probability proportionate to the size of the students in the different districts, then students were randomly selected from the different educational grades from within each school to from the target population of the study. All students, boys and girls, were interviewed to answer a prestructured interviewing questionnaire concerning personal and family information. Anthropometric measurements in the form of weight and height were taken, and BMI was then calculated Overweight and obesity was diagnosed according to the Cole et al reference standards. The
sample was then divided into tour categories; underw”eight, normal weight, ovenveight and obese.
The second study, a case-control one, was conducted on 100 cases (obese) and 100 controls (nonnal weight) identified from the cross-sectional study and matched for age, sex and socioeconomic level. The sample was chosen after exclusion of students with a history of chronic disease or under chronic drug therapy. The 200 students were interviewed to answer a prestructured interviewing questionnaire covering personal and family history of obesity, meal patterns and dietary habits, history of feeding during infancy as well as physical activity patterns. Dietary intake data was collected using a selective foodfrequency questionnaire and a 24-hour dietary recall questionnaire.
The collected data was fed to the computer for tabulation and analysis.
Anthropometric data was presented in the form of mean, median and standard deviation tor weight and height. The calculated BMI was presented in the fonn of mean, median and standard deviation. The t-test was used for comparison between means and X2 - test for comparison between categories. Univariate and multivariate analyses was used to identifY significant associations between obesity and the studied factors. Dietary intake data was presented as mean and median intakes of energy and macronutrients.
Results of the current study have revealed that overweight and obesity were prevalent among primary school children in Damanhour city where 19.8% of the samples were obese and 17.2% overweight; and that prevalence was higher among females and younger age groups. The sociodemographic factors associated with increased risk of obesity were earlier order among live births, smaller family size, higher level of father’s education and occupation, ”higher level of mother’s education and positive employment status and higher family income.
Through the case-control study, it was found that the peak onset of obesity was in the earlier years of childhood period and a strong relationship exists between obesity in parent and offsprings. Increased sedentariness and decreased activity is associated with a higher risk of overweight and obesity. Delayed weaning till six months is associated with a lower risk of overweight and obesity.
Assessment of dietary patterns and nutritional intake showed that:
- Certain dietary habits are associated with increased risk of obesity. These included skipping the breakfast meal, eating more than three meals, snacking between meals and frequent intake of meals away from home.
- Certain energy dense foods were commonly consumed by the overweight and obese on regular basis.
From the current study we were able to conclude that the problem of overweight and obesity is prevalent among primary school children in Damanhour city, being higher in girls and in earlier years of childhood Therefore, we came to the following
recommendations aiming at the prevention of obesity rather than its management, which can be implanted through 4 approaches:
-Increasing knowledge and awareness of obesity as a serious problem.
-Promoting healthy eating habits.
-Promoting regular physical activity and an active lifestyle.
Increasing awareness and identification of obesity in the primary care setting, especially among younger children and those with mild obesity with a special attention to high risk individuals: children at increased risk for future obesity and those with related medical problems.
- Increasing the activity levels of the students through encouragement of physical educational classes.
- Incorporating nutrition education as apart of the curriculum.
- Making only healthy foods sold in the school canteen.
- Routine medical check up to identify obese students early which should be
targeted with more attention and education.
- Providing economic incentives for production and distribution of vegetables and fruit.
As regards the role of Ministry of Health: Training of healthcare workers in the field of obesity through primary healthcare and MeH centers, intensifying community development programs concerning women and children and supporting school programs for education and feeding.