Open Journal of Gastroenterology, 2017, 7, 75-88
http://www.scirp.org/journal/ojgas
ISSN Online: 2163-9469
ISSN Print: 2163-9450
DOI: 10.4236/ojgas.2017.72009
February 20, 2017
Prevalence and Correlates of Overweight and
Obesity among School Children in Sohag, Egypt
Soumaya El Sayed Ahmed Hadhood
1
, Rasha Abd Elhameed Ali
2
, Montaser Mohamed Mohamed
1
,
Eman Soliman Mohammed
1
1
Faculty of Medicine, Pediatrics Department, Sohag University, Sohag, Egypt
2
Faculty of Medicine, Public Health and Community Medicine Department, Sohag University, Sohag, Egypt
Abstract
Background:
Continually rising prevalence of obesity and overweight
in
children and adolescents is a major public health concern. This is due to
its
various and serious health hazards on one side and its preventable nature
on
the other side. This study aims at identification of prevalence of
overweight
and obesity and its risk factors among children between 6 - 14 years of age
in
Sohag, Egypt.
Method:
A cross sectional study was conducted on 711
school
children between 6 - 14 years in four months’ period from February to
May
2016.
Weight and height of the studied children were measured to
calculate
BMI, which was compared with standard Egyptian growth charts for dete
r-
mining overweight and obesity. Then a questionnaire containing data
about
socio demographic, parental obesity, early life and dietary risk factors w
as
completed by the children’s parents
. Result:
Out of 711 studied children,
117
(16.5%) were overweight and 104 (14.6%) were obese. Residing in urban
area,
having an obese parent or both of them, low level of maternal education, b
e-
ing on formula feeding during early life and lack of fresh vegetables and
fruits
in diets were significant risk factors for overweight and obesity in the
studied
children (P value < 0.05).
Conclusion
: Improperly educated mothers
together
with sedentary life style manifested in obesity among the parents and lack
of
sport practice among children constituted the majors risk factors for chil
d-
hood obesity. This emphasizes the need for increased health awareness of
the
community about the importance of proper nutrition and physical activity.
Keywords
Childhood Overweight and Obesity
1. Introduction
Obesity is a form of malnutrition that often results from an imbalance between
How to cite this paper:
Hadhood,
S.E.S.A.,
Ali,
R.A.E., Mohamed, M.M. and Moham-
med
, E.S. (2017) Prevalence and Corre
lates
of Overweight and Obesity among School
Children in Sohag, Egypt
.
Open Jour
nal of
Gas
troenterology
,
7
, 75-88.
https://doi.org/10.4236/ojgas.2017.72009
Received:
January 12, 2017
Accepted:
February 17, 2017
Published:
February 20, 2017
Copyright © 201
7 by authors and
Scientific
Research Publishing Inc.
This work is licensed under the Creative
Commons Attribution
International
License (CC BY
4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access
S. El S. A. Hadhood et al.
76
food intake and energy utilization. Overweight and obesity in children and ado-
lescents are considered global epidemic. Recent statistics show that, 16% of
children, 6 - 11 years old, are overweight [1]. In actual numbers, the estimate
suggested that 150 - 160 million school-age children worldwide were overweight,
of which, 35 - 40 million were obese [2]. Statistics also show that, prevalence of
overweight continues to increase during the school age and adolescent stages [3].
Obesity in childhood increases the risk of development of metabolic syn-
drome, diabetes mellitus, cardiovascular and even fatty liver in later life. Asthma,
shortness of breath and sleep apnea are common respiratory problems asso-
ciated with obesity. Children who are obese also have a negative body-image,
which leads to lower self-esteem. In Egypt, obesity among school age children
constitutes an emerging concern; the Egyptian Medical Association for the Study
of Obesity in early 2010 estimates that 15 percent of Egyptian (school-age)
children are obese, in comparison with its 1990’s estimate of only six percent.
The rapid increase in prevalence of overweight and obesity signals that devel-
opment of strategies to face such problem is a health
priority [4].
The etiology of childhood obesity is poorly understood. Obesity is not a single
disorder but a heterogeneous group of conditions with multiple causes. Body
weight is determined by an interaction between genetic, environmental and psy-
chosocial factors acting through the physiological mediators of energy intake
and expenditure. Although genetic differences are of undoubted importance, the
marked increase in the prevalence of both overweight and obesity is best ex-
plained by behavioral and environmental changes that are results of technologi-
cal advances [5]. These changes had resulted in increased intake of large quanti-
ties of foods high in sugar and energy-rich foods combined with lack of physical
exercise. Sedentary lifestyle resulting from spending most of the day watching
television, or playing computer or video games is considered a serious factor for
obesity. Role of environmental effects on body weight is well noticed in various
settings such as at home, in school, and in the community. At home, parents can
improve children’s food choices and motivate them to practice and have a heal-
thy lifestyle. School also should promote healthy food choices and physical activ-
ity among students who spend most of their times
in it. As regards communities
in the absence of accessible and affordable choices of healthy food and facilities
for physical activities as safe side walks, bike paths, and safe parks obesity is a
must [4].
2. Patients and Method
2.1. Study Design and Setting
This is a cross sectional study to determine the prevalence of obesity and its risk
factors among children between 6 - 14 years in Sohag, Egypt. Sohag governorate
is an agricultural rural region, which produces sugar cane, grains and clover for
animal husbandry (United Nations Development Program (UNDP) & Institute
of National Planning Egypt 2010). The total number of population of Sohag, ac-
cording to Egypt developmental indicator was 4,769,000 citizens. The study was
S. El S. A. Hadhood et al.
77
conducted in five public primary and two preparatory schools which were se-
lected randomly from public primary and preparatory schools of Sohag city and
three nearby villages. It was conducted through a period of four months from
February to May 2016.
2.2. Sample Size
The sample size was calculated using the EPI-INFO 2002 software (Centers for
Disease Control and Prevention (CDC), Atlanta, Georgia, USA; on the basis of a
prevalence rate of 13.3% for obesity among primary school children that was
reported by Nora El Saied Badawi, 2012 in Port Said city [6]. With a precision of
3%, a confidence level of 95%, and an error of 0.05, a minimum sample of 450
students were required.
This sample was increased to 700 for proper representa-
tion of different age groups in the selected schools.
2.3. Sampling Technique and Procedures
Stratified and clustered random sampling technique was employed to select
study subjects. Stratification was based on type of school (primary or preparato-
ry), the locality (urban or rural) and grades in each school. Based on the propor-
tion between rural and urban inhabitants in Sohag governorate two schools in
Sohag city and five schools in three nearby villages were selected. 200 students
were selected from the preparatory schools and 500 from primary schools. As
regard the gender all the selected primary and preparatory schools included both
girls and boys. Every school was divided into strata based on the grade and in each
grade a clustered sample of one class was selected. All students aged between 6 to
14 years were included, while students less than 6 years or more than 14 years were
excluded. Also children with chronic illness as well as those on corticosteroid the-
rapy or growth hormone replacement therapy were excluded
.
2.4. Data Collection Procedure
After agreement of the head of educational directorate of Sohag governorate on
conducting this research, data were collected from February to May 2015.
In the first visit to each school, the researcher invited children to participate in
the study, sampled them and gave them consent letter for their parents that in-
cluded basic information about aim of the study, the planned physical examina-
tion of the study participants and the questionnaire. This visit took place a day
before the second visit in which data were collected. On arrival of the second
visit, consent letters from the parents were collected from the children and those
who were allowed to participate in the research were gathered in class for mea-
surement of anthropometric then they were given the questionnaire and were
asked to take it home to be filled by their parents and give it back to the re-
searcher on the next day.
2.5. Instrument of the Study: Questionnaire
A semi-structured, self-administered questionnaire was used. The questionnaire
S. El S. A. Hadhood et al.
78
had two sections; the first section includes personal information: age, grade,
gender, school name in addition to anthropometric measurements. This section
was filled in the school by the researcher. The second section which is a reliable
questionnaire was filled by one of the parents. This section was concerned about
the suggested risk factors of overweight and obesity including maternal educa-
tion and job, maternal or parental obesity (documented by the mother herself),
birth weight of the child, and type of feeding during infancy (whether breast,
formula feeding or both). Data about the current dietary habits of the child are
also collected including frequency of eating fast food, frequency of drinking su-
gary fruit juice daily, frequency of eating fresh vegetables and fruits in addition
to information about the weekly practice of physical exercises.
2.6. Anthropometric Measurements
• Height was measured using stadiometer (Leicester-21400, CECA, UK). Par-
ticipants were asked to remove shoes before stepping on stadiometer placed
on a flat floor along the wall. The students were advised to hold the breath,
and maintain an erect anatomical posture. Height measurement was then
carefully read to the nearest 0.1 cm.
• Weight was determined using a digital
weighing. Measurements were taken
with each student in light clothing and without shoes and socks. Weight was
carefully read when the point readings stabilized and was recorded to the
nearest 0.1 kg.
• The BMI (Body Mass Index) was calculated (body weight in kg/height in m
2
).
• By plotting BMI against standard percentile Egyptian curves for each sex,
over weight was defined as BMI more than 85th and less than 95th for age
and sex, and obesity was defined as BMI more than 95th percentile for age
and sex compared to standard Egyptian growth charts.
2.7. Etical Consideration
The study protocol was approved by ethical committee of the Faculty of Medi-
cine of Sohag University. A prior consent for the study was taken from the
school administration. At the time of the study the parents of each participant
were informed about the study protocol and a written consent was obtained to
their child’s participation and confidentiality was assured.
2.8. Statistical Analysis
The statistical analysis was carried out using SPSS software for Windows (ver-
sion 18.0, Chicago, IL, USA). Sample characteristics were summarized using the
mean and the standard deviation (SD) for continuous variables and percentage
for categorical variables.
Overweight and obesity prevalence rates were calcu-
lated using descriptive data, along with corresponding 95% confidence interval
(CI). Chi square test was used to compare distributions of characteristics be-
tween overweight, obese and normal and underweight children as appropriate
and P value below 0.05 was considered significant.
S. El S. A. Hadhood et al.
79
3. Results
711 students were successfully enrolled in this study, 323 boys (45.4%) and 388
girls (54.6%). The mean age of the studded sample was 10.36 years and the stan-
dard deviation was 1.92 years, 36.8% of the participants were from urban areas
while 63.2% were from rural areas, as shown in
Table 1.
Table 2 presents distribution of the studied children as regard prenata, pa-
rental, early life and life style factors, about one fifth of the mothers of the stu-
died sample were obese (19.8%), received high level of education (21.2%) while
more than 84% were house wives. 92% of the studied children were full term at
birth and 85.5% had average birth weight. As regard practice of sport more than
72% of them did not practice sport regulary.
Figure 1 Shows distribution of the studied primary school children as regard
BMI. By plotting BMI against standard percentile Egyptian curves, 117 (16.5%)
were overweight and 104 (14.6%) were obese.
Table 3 shows that high significant association (P value = 0.004) presents be-
tween residing in urban areas and both overweight and obesity, as 19.9% and
13% of urban school children were obese and overweight respectively compared
to 11.6% and 18.5% of the rural children. Significant association also presents
between overweight and obesity in school children and obesity of one or both
parents. More than 20% children with obese parents were obese compared to
10% of children with normal weight parents’. More than 25% of children whose
mothers’ finished primary level of education only were obese compared to 10.5%
of those finished faculty indicating significant association (P value < 0.05). As
regard type of feeding in infancy 31% of the obese children were on formula
feeding compared to 13% of those who were breast fed either exclusively or with
formula and the difference is significant (P value < 0.05).
Table 4 indicates presence of very high statistically significant association
between not consuming fresh fruits and vegetable daily and overweight and
Figure 1. Distribution of the studied children as regard BMI by plotting BMI against
Standard Percentile Egyptian Curves.
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Normal or
underweight
Overweight
Obese
Percentage