TABLE 0F CONTENTS
Title page
Declaration i
Approval ii
Dedication iii
Acknowledgements iv
Table of contents v
List of appendices vi
List of tables vii-viii
List of abbreviations ix
Abstract x-xi
Chapter One: Introduction 1 – 5
Chapter Two: Literature Review 6 – 18
Chapter Three: Methodology 19 – 26
Chapter Four: Results and Analysis 27 – 49
Chapter Five: Discussion 50 – 59
Chapter Six: Conclusions / Recommendations 60 – 62
References 63 – 71
Appendices 72 – 85
vi
LIST OF APPENDICES
1. Sample of the Student’s Identification and Data Collection
Form Questionnaire. 72 -74
2. Sample of Informed Consent Form. 75 -76
3. Signed Informed Consent Letter from the Ministry
of Education. 77
4. Signed Informed Consent Letter from the principal of
Monsignor Maduka Memorial Secondary School Ekwulobia. 78
5. Signed Informed Consent Letter from the vice principal of
Girls High School Ekwulobia. 79
6. Signed Informed Consent Letter from the principal of
Aguata High School Aguata. 80
7. Clearance Letter from the Ethical Committee, Nnamdi
Azikiwe University Teaching Hospital. 81
8. CDC BMI-for-age growth chart for boys. 82
9. CDC BMI-for-age growth chart for girls. 83
10. BMI-for-age weight status categories table. 84
11. Map of Ekwulobia town in Aguata Local Government Area. 85
vii
LIST OF TABLES
1. Distribution of all subjects according to age and sex. 27
2. Distribution of subjects according to all weight categories 28
3. Gender differentials in all weight categories among the subjects 29
4. Classification of the weight categories of subjects according
to age 30
5. Classification of the weight categories of subjects according to
age group 31
6. Comparison of obese subjects with their normal weight
Counterparts 32
7. Comparison of overweight subjects with their normal weight
Counterparts 33
8. Comparison of underweight subjects with their normal weight counterparts 34
9. Classification of the weight categories of subjects according
to age and sex 35
10. Distribution of private and public school subjects by age and sex. 36
11. Prevalence of the weight categories among the private and public schools 37
12. Prevalence of the weight categories by gender among private
and public schools 38
viii
13. Occupation of parent or guardian and the various weight
categories 39
14. Relationship of overweight, obesity and underweight with soft
drink consumption among the subjects 40
15. Relationship of overweight, obesity and underweight with
meat pie consumption among the subjects 41
16. Relationship of overweight, obesity and underweight with
biscuit consumption among the subjects 42
17. Relationship of overweight, obesity and underweight with
bread consumption among the subjects 43
18. Relationship of overweight, obesity and underweight with
sweet consumption among the subject. 44
19. Relationship of overweight, obesity and underweight with
other pastries consumption among the subjects. 45
20. Relationship of overweight, obesity and underweight with
Television watching among the subject 46
21. Relationship of overweight, obesity and underweight with
exercise among the subjects 47
22. Relationship of overweight, obesity and underweight with
eating in restaurants among the subjects. 48
23. Correlation of various factors with the weight categories of
the subjects 49
ix
LIST OF ABREVIATIONS
1. CDC = Centers for Disease Control and Prevention.
2. IOTF = International Obesity Task Force.
3. NAFDAC = National Agency for Food and Drug Administration
and Control.
4. NGO = Non Governmental Organization.
5. OPCS = Office of Population Census and Surveys.
x
ABSTRACT
BACKGROUND: Childhood overweight and obesity is a health hazard and is an
emerging public health problem.
OBJECTIVE: The objective of this study is to determine the pattern of overweight and
obesity and influencing factors among secondary school students in Ekwulobia town in
Anambra state of Nigeria.
METHODS: This was a descriptive cross-sectional study. Subjects were selected
randomly using multistage sampling technique. 250 students aged 12-19 years from three
schools were studied. Calibrated mechanical weighing scale was used to measure their
weights. Heights were measured with rigid meter rule. A semi-structured, selfadministered questionnaire was used to collect data on their physical activities, dietary
habits and parent’s occupation.
RESULTS: Mean age of the students was 15.6 years ± 1.75. Overall prevalence of
overweight and obesity among them were 5.6 percent and 3.2 percent respectively.
Females were more overweight than males (7.8% and 3.3% respectively), and also more
obese (4.6% and 1.7% respectively). Prevalence of obesity was highest in the 18- 20 year
age group (5.6%). Prevalence of overweight and obesity (combined) was higher in
private school (10.7%) than in public schools (6.0%). Frequent consumption of soft
drinks, meat pie, biscuit, sweet; and frequent television watching promoted obesity
(P<0.001, P<0.001, P<0.05, P<0.05 and P<0.001 respectively). Occasional physical
exercise, promoted overweight (P<0.05).
CONCLUSION/RECOMMENDENTIONS: Gradual increase in the prevalence of
overweight and obesity was found. However these are still much lower than in developed
countries. Faulty dietary eating habits and sedentary activities are major culprits. This
constitutes a major public health challenge. I therefore recommend the following:
Health education in schools, and media campaigns are needed. Policy makers, Health
professionals, School authorities, Non Governmental Organizations (NGOs) and National
xi
Agency for Food and Drug Administration and Control (NAFDAC) should be involved
in primary preventive actions against childhood overweight and obesity.
1
CHAPTER ONE
INTRODUCTION
Obesity is the most common nutritional disorder in affluent societies. Obesity may be defined as
a condition in which there is excessive amount of body fat
1
. It is an abnormal growth of the
adipose tissue due to an enlargement of the fat cells (hypertrophic obesity) or an increase in the
number of the fat cells (hyperplastic obesity) or a combination of both 2
. Excess fat accumulates
because there is imbalance between energy intake and expenditure.
The significance of obesity requires constant emphasis because it is associated with increased
morbidity and mortality. It predisposes to the development of important diseases and diminishes
the efficiency and happiness of those affected. Obesity is a chronic disease, prevalent in both
developed and developing countries, and affecting children as well as adults.
Obesity is now so common that it is replacing the more traditional public health concerns
including Undernutrition 2
. It is now a global phenomenon.
It is extremely difficult to assess the size of the problem and to compare the prevalence rates in
different countries as no exact figures are available and also because the definitions of obesity are
not standardized. However it has been estimated to affect 10 to 20 percent of children and
adolescents in developed countries 3
.
Overweight may be defined as an excess of bodyweight but not necessarily body fat; a body mass
index (BMI) of 25 – 29.9 4
. Body Mass Index (BMI) is acceptable for determining obesity for
children two years and older 5
. Although the BMI number is calculated the same way for children
2
and adults, the criteria used to interpret the meaning of the BMI number for children and teens
are different from those used for adults. BMI age- and sex- specific percentiles are used 6
. The
Centers for Disease Control (CDC), has published tables for determining this in children
7
.Overweight (but not obese) is a BMI between the cut-off values for overweight and obesity, and
obese is a BMI greater than the cut-off value for obesity7
. For normal weight, the BMI is lower
than the cut-off value for overweight7
.
STATEMENT OF THE PROBLEM
Obesity is a health hazard and a detriment to well-being which is reflected in the increased
morbidity and mortality 2
. It is a key risk factor in the natural history of other chronic and non
communicable diseases. Due to the rising prevalence of obesity in children and its many adverse
health effects, it is now being recognized as a serious public health concern 8
.
The incidence of chronic diseases is escalating much more rapidly in developing countries than in
industrialized countries. There is strong evidence that childhood obesity is also becoming
increasingly prevalent in low-and middle-income countries 9,10
. Malnutrition and obesity co-exist
in many developing countries 11
.
Obesity has many health complications. The first problems to occur in these obese children are
usually emotional or psychological 12
. Childhood obesity can also lead to serious conditions such
as diabetes mellitus, high blood pressure, heart disease, sleep problems and cancer 13
. Other
disorders include liver disease, early puberty or menarche, eating disorders such as anorexia, skin
infections, asthma and other respiratory problems 14
. Studies have shown that overweight
children are more likely to grow up to be overweight adults 13
. Obesity during adolescence has
3
been found to increase mortality rates during adulthood15
. In schools, obese students often suffer
from teasing, harassment and ridicule from their peers 16
. At home they may also suffer
harassment, discrimination and name-calling from their own family members and neighbours.
These may lead to anxiety, depression 17
, low self esteem, frustration and even withdrawal. A
study18
has shown that college obesity is increasing, and that physical inactivity, disordered
eating perceptions, and disordered behaviours are associated with increased rates of overweight
and obesity. A 2008 study has found that children who are obese have carotid arteries which have
prematurely aged by as much as thirty years, as well as abnormal levels of cholesterol. A 15 year
old obese child will have the carotid artery of a 45 year old person 19
. According to World Health
Organization estimates, by the year 2020, non communicable diseases will account for
approximately three quarters of all deaths in the developing world 20
, and adolescent obesity will
likely be a major risk factor contributing to this. This emerging public health issue of increasing
incidence of childhood obesity in developing countries will likely create an enormous socioeconomic and public health burden for poorer nations in the near future 21
. Nigeria is a poor
developing nation.
JUSTIFICATION FOR THE STUDY
Since it has been shown that interventions are not usually successful once overweight and obesity
have occurred 22
, it becomes important to generate and provide research information for policy
makers, health care providers, parents and the general population, so that the problem could be
identified in childhood and appropriate attention given at that early age. The developing trends in
4
the factors that influence childhood overweight and obesity among our students are definite
health risks that require definite studies and data for planning interventions.
In Nigeria (as also in other developing countries) little is known about the prevalence of
childhood overweight and obesity because of the limited number of studies available, particularly
in the South Eastern States of Nigeria.
Nigeria needs more studies and data for reliable assessment of the problem of childhood
overweight and obesity in Nigeria and for comparison of its prevalence with those of other
regions of the world. Studies such as this research project are therefore necessary to further reveal
this apparently hidden but important public health problem. The prevalence of childhood
overweight and obesity and their association with chronic diseases in adulthood are still under
appreciated in Nigeria because of inadequate studies, data and publicity. The college years are
highly influential in shaping adult behaviours, particularly with regard to diet, physical activity,
and other lifestyle habits. Interventions aimed at the college population may help reduce
overweight and obesity during the transition from adolescence to adulthood and thereby prevent
some of the long-term health consequences of obesity, which include coronary heart disease,
hypertension, type 2 diabetes, and dyslipidemia 18
. Identification of, and a clearer understanding
of these risk factors may prove useful in the treatment of adolescent obesity by helping in the
development of multifaceted interventions that not only address weight loss but also target the
associated disordered behaviours 18
.
Up to now, most national public health programs and policies, as well as national level research
on children and adolescents in Nigeria appear to have focused mainly on under nutrition and its
5
effects on survival, mortality, and development, in mothers and children. Since childhood
overweight and obesity and their co-morbidities will continue to increase the impact of a number
of risk factors for adult diseases, it is reasonable and important to increase knowledge and
awareness about the prevalence of these disorders in Nigeria, which is still grappling with the
public health effects of malnutrition and micronutrient deficiencies. This study will be an
additional stimulus and contribution to these efforts.
In this period of Health Sector Reform, this study can equip stakeholders to make policies that
will recognize and address the emerging challenges of childhood overweight and obesity in
Nigeria in general. In particular, seminars could be organized with evidence of this research data
in Ekwulobia town, for students and parents to initiate and stir up voluntary preventive health
measures for themselves against these emerging childhood problems.
AIM OF THE STUDY
To determine the pattern of overweight and obesity among secondary school students in
Ekwulobia town, in Anambra state of Nigeria.
SPECIFIC OBJECTIVES
1. To determine the prevalence of overweight and obesity among the secondary school
students in Ekwulobia town.
2. To determine the age and gender differentials in the prevalence of overweight and obesity
among these secondary school students in Ekwulobia town.
3. To identify factors influencing childhood overweight and obesity among these students.
4. To suggest ways of preventing overweight and obesity among the students
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