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Obesity represents a major health challenge and it
substantially increases the risk of many diseases and contributes to decline
both quality of life and life expectancy.
Objective: The
study aimed to investigate risk factors of overweight and obesity among high
school students in Abha city, 2019.
Methods:
Case-control study of 301 participants with the cases being overweight and
obese (100) and with control being normal (201) among high school students.
Weight, height were measured and BMI was calculated
to classified case and control. Information about risk factors obtained by
using a questionnaire girls’ High school were selected using simple random
sampling technique and data were analyzed by using SPSS version 22.
Results: The
results found childhood obesity and parents obesity were significant risk
factors for overweight and obesity (OR=1.922 (1.1783.135), OR=3.879
(2.067-7.279), respectively. Other risk factors were not found significant for
overweight and obesity.
Conclusion
and recommendation: Childhood obesity and parent’s obesity were
identified as risk factors for obesity and overweight. Therefore these risk
factors should be target for preventive program and polices in order to prevent
obesity in the future.
Keywords: Obesity,
Overweight, Risk factors, BMI
INTRODUCTION
Overweight and obesity are defined as
abnormal or excessive fat accumulation that may impair health. Overweight and
obesity are linked to more deaths worldwide than underweight. Globally there
are more people who are obese than underweight. The fundamental cause of
obesity and overweight is an energy imbalance between calories consumed and
calories expended [1]. Obesity is a major risk factor for illness and death. It
is associated with diabetes, hypertension, hyperlipidemia, obstructive sleep
apnea, osteoarthritis and causing more years of disability [2].
Obesity is a chronic and multifactorial
disease, genetic and environmental factors must also be considered, which are
reflected in specific populations with high or low rates, as well as in some
ethnic groups that denote more or fewer risks [3]. Obese parents have a higher
risk of having obese children as they provide both genetic and eating
environment [4]. Overweight and obese children are likely to stay obese into
adulthood and more likely to develop non-communicable diseases like diabetes
and cardiovascular diseases at a younger age. The transition in nutrition and lifestyle
by the popularity of fast foods, soft drinks, sedentary life style, and lack of
physical exercise, increased television watching and mobile phone usage are the
common trends adopted by children today. These may be the causes of overweight
and obesity seen in children of both rural and urban areas [5].
Worldwide, at least 2.8 million people die
each year as a result of being overweight or obese and an estimated 35.8
million (2.3%) of global DALYs are caused by overweight or obesity. Overweight
and obesity lead to
adverse metabolic effects on blood pressure, cholesterol, triglycerides and
insulin resistance. Risks of coronary heart disease, ischemic stroke and type 2 diabetes mellitus increase steadily with
METHODS
Study design
Case-control study
with the cases being overweight and obese and with control being normal among
high schools students in Abha City.
Study setting
High school girls
located in Abha city.
Study population
The population for
this study was girl students from high schools in Abha City
Sampling
Sample size: Sample size of 301 with the cases being overweight
and obese (100) and with control being normal (201) was calculated by using
online EPI Info version 7.0 with assumptions of 80% power, 95% confidence level
and controls to cases ratio of 2:1, to detect at least 2 odds ratio differences
between the cases and controls [8].
Sample methods: Two girl schools was randomly selected by
using simple random in Abha city, the age range of 16-18 years who satisfy the
definition of case and control
Methods of data collection
Risk factors was
assessed by using questionnaire structure close question through interview with
students to obtain information about socio-demographic characteristic, physical
activity, dietary habits, lifestyle and family history.
Anthropometric
measurements, height and weight of students were taken in the classroom
according to the standard procedures by using standard equipment, BMI is
calculated according to the formula (Weight (kg)/height (m2) then
categorized into to:
·
Normal (BMI 18.5-<24.9),
·
Overweight (BMI 25-<30),
·
Obese (BMI>30)
·
Underweight (BMI<18.5)
Inclusion criteria
Students who accept
to be involved in the study and classified as overweight or obesity (cases) and
normal (control).
Exclusion criteria
·
Students who reject getting involved in the study
·
Underweight students were excluded from this study
Study variables
Height, weight,
educational level, dietary habits parents obesity, exercise, sleep, childhood
obesity.
DATA ANALYSIS
The data coded,
checked and cleaned before entering and analyze by using the statistical
package for social science programmer (SPSS version22). Tables used to present
the results. Association of variables with obesity was assessed by comparing the
Obese (case) group against the Normal (control) group. The odds ratio (OR) and
its 95% confidence interval (CI) are computed for each factor, All p values are
based on two-tailed tests and compared to a significance level of 0.05. A risk
factors with an OR significantly (p<0.05) higher than 1.00 was taken as a
possible risk factor for obesity while OR significantly (p<0.05) less than
1.00 was considered as a protective factor.
ETHICAL CONSIDERATIONS
·
The research proposal was approved by ethics committee
of public health department at King Khalid University.
·
Consents were taken from school administration and
from students after explaining the purposes and nature of research.
RESULTS
A total of 301
students (100 cases and 201 controls) were participated in this study. Majority
of cases (94%) and control (92.5%) resided in urban area, regarding family size
2-5 siblings more in cases, (27%) than control (18.9%) and family size >6
siblings in control (81.1%) more than cases (73%). Regarding order of family majority
of cases are first orders (28%) and in control the middle-la of 1st order is
more (76.1%). According to education of father most of cases are no educated
(29%), while educated more in control (76.6%) (Table 1).
Regarding education most of mothers of cases were not
educated (46%) while were educated more in control (58.7%). Regarding
occupation of father more than half of cases and controls were employees. In
the living situation most of cases (94%) and control (93.5%) live with both
parents (94%) and few of cases and controls did not live with both parents (6%,
6.5%, respectively).
The Table 2 show socio-demographic factors
are not significant risk factors for overweight and obesity in adolescents
participated in the study.
The table show childhood obesity (p-value=0.000) and parents obesity (p-value=0.009) are significant risk factors for overweight and obesity.
The childhood obesity
odds in cases was 3.879 times higher than odds childhood obesity in control
(AOR=3.879; 95% CI; 2.067-7.279) and parents obesity odds in cases was 1.9
times higher than odds parents obesity in control (AOR=1.922; 95% CI; 1.178-3.135).
The result also show
all other factors like lifestyle and dietary habit were not significant risk
factors for overweight and obesity in students participated in the study.
DISCUSSION
This study found
Place of birth and family size were not significant risk factors of overweight
and obesity. The findings of case-control study conducted on Southern Ethiopia
adolescents in 2017 by Bereket et al. support the current results [9].
Regarding the order
of family, the first order child is more in cases, while middle-last order is
more in controls and not risk factors for overweight and obesity. Study
conducted in Kenya in 2013 reported effect of birth order, on overweight and
obesity in adolescence [10], which was reverse of this study.
The present study
found that father education and mother education were not risk factor for
overweight and obesity in high school students. This finding is in line with
study in Southern Ethiopia 2017 [9]. Other study in Morocco in 2018 found
positive correlation between obesity and fathers or mothers having with higher
education [11]. This is not in agreement with our study. Uneducated parents
were more in cases while educated parents were more in controls that explained
low educated mothers may not have enough information about healthy food.
The current study
found the living situation is not significant risk factors for overweight and obesity;
this may be due to some students avoided answering the question. They are
ashamed and trying to hide it from their friends.
Our study found
parents obesity is significant risk factors for obesity and overweight, odds of
parent’s obesity in cases were 3.8 times higher than odds of control not
exposed to obesity in childhood. Case control study in Brazil 2006 found same results
[12]. Study by van der Sande et al. showed a family history of hypertension,
obesity, diabetes or stroke was a significant risk factor for obesity and
hyperlipidemia [13].Other study by Corica et al. showed BMI was positively
associated with family history for obesity [14]. These studies support our
current result.
The current study
found childhood obesity is significant risk factor for overweight and obesity; odds
of childhood obesity in cases were 3.8 times higher than odds of control not
exposed to obesity in childhood.
Study by Harrell et
al. [15] showed obesity, or overweight, in childhood is a major risk factor for
the metabolic syndrome in adolescence. According to WHO [16], overweight and
obese children are likely to stay obese into adulthood and more likely to
develop non-communicable diseases like diabetes and cardiovascular diseases at
a younger age. These support our current study.
Study about sleep
duration and adolescent obesity found increasing sleep from 7.5 to 10.0 hours
per day at age 18 predicted a reduction in the proportion of adolescents >25
kg/m2 by 4%. Each additional hour of sleep was associated with
decreases in BMI at the 10th [17]. This does not support our study.
Free time exercise
per day was not seen as a risk factor for overweight and obesity. This finding
is not in line with the report from a cross sectional study conducted in KSA
2013 [2]. According to previous studies exercise reduces body weight and
affects body fat distribution by promoting regional fat loss especially at the
abdomen. [18].
This study found
transport type to school not significant risk factors. Study in Morocco in 2018
reported the motorized transport to school was correlated with an increased
risk for overweight and obesity [11]. This does not support our study.
This study found
watching TV and video games are not risk factors. Barr-Anderson and colleagues
found that adolescents, who watched television for more than 5 hours a day, ate
fewer fruits and vegetables and consumed more sugar [19].
Study by Campbell in 2011
reported video games may not boost teenage obesity [20]. This finding is in
line with current study.
This study did not
find use of social media to be risk factors for obesity. The literature in this
area is scarce. This is may be attributed to sitting for long periods on social
media it can lead to bad lifestyle. Skipping breakfast wasn’t found to be a
risk factor for overweight and obesity This is not in agreement with the report
from Brazil in 2009 [21]. According to previous studies skipping breakfast has
been linked with obesity [22].
Regarding to previous
studies there are facts about eating out and fast food is associated with
higher body mass index, less successful weight-loss maintenance and weight gain
[23]. This was not supported by our study.
LIMITATION OF STUDY
·
This study was conducted in two Government Girls High
Schools in Abha city.
·
The study did not investigate all possible factors
that may have effect on obesity.
·
In this study, the information collected by the
questionnaire was prone to recall bias and may have effect on our findings.
CONCLUSION AND RECOMMENDATION
The study concluded
that childhood obesity and parent’s obesity are significant risk factors for
overweight and obesity. Other important risk factors like dietary habits,
lifestyle and socio-demographic factors were not found to be significantly
related to overweight and obesity in this study. The study recommended that it
necessary to encourage healthy eating habits among all family members and
screening obesity in childhood should be promoted in schools to identify and
track children at risk of developing into overweight adults.
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