ABSTRACT
The transition from traditional diets to more refined foods and calorie dense snacks has led to the emergence prevalence of childhood obesity in developing countries. The study was designed to assess childhood obesity among school age children between 6 – 12 years old in Nsukka L.G.A in Enugu state. A total of 250 children were selected using simple random sampling. A structured questionnaire was used to elicit their personal and socio-economic characteristics of their parents, their dietary patterns and physical activity opportunities. World Health Organization (WHO) child growth standard charts and FANTA 2006 dietary diversity scale were used to categorize their anthropometric and dietary diversity indices, respectively. Results revealed that there were more males (58.4%) than female (41.6%) children. The mothers were mainly civil servants (70.8%) and traders/business (15.6%). The same was observed for the occupational status of the fathers (Civil servants – 70.0%, traders/business – 14.0%). Family income status revealed that most of the children household earned between N40,000 – N60,000 (64.4%) while some of them earned either between N19,000 – N39,000 (13.6%) or above 40,000 (19.6%). Also the children household comprised mostly of 1 – 3 (21.6%) or 4 – 6 (71.6%) persons. Pit toilet (30.0%) and water cistern (68.4%) were found to be the commonly utilized toilet facilities. Tap (19.6%) and borehole (76.8%) water were the major sources of drinking water. Meals were consumed three times by majority (90.0%) of the children. A little proportion (6%) of the children skipped breakfast (2.4%), lunch (5.2%) or dinner (2.0%). Snacks were consumed by virtually all (98.0%) of the students. Dietary diversity rating score revealed that almost all (97.6%) of the children had a high dietary diversity rating while a few of them had an average (1.6%) and low (0.8%) dietary diversity score. All (100%) of the children acknowledged that break time was given during school periods. Majority (74.0%) of the children noted that the break lasted for 30 minutes. Weight for age indices showed that majority (93.5%) of the children were normal, while a few of them were either wasted (3.7%) or overweight (2.8%). Wasting was observed only amongst the female children (8.3%). High dietary diversity scores ensuredietary adequacy which will in turn positively affect nutrition outcomes as low prevalence of obesity and other malnutrition indices were observed in this study.
TABLE OF CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgement iv
Table of contents v
List of tables viii
Abstract ix
CHAPTER 1
INTRODUCTION
1.1 Statement of the Problem 3
1.2 Objectives of the Study 4
1.3 Significance of the Study 5
CHAPTER 2
LITERATURE REVIEW
2.1 Definition of Obesity 6
2.1.1 The Effects of Childhood Overweight and Obesity 6
2.2 Factors Influencing Overweight and Obesity in Children 7
2.2.1 Genetic Factors 7
2.2.2 Breast-Feeding 8
2.2.3 Energy Balance 9
2.2.4 Sedentary Behaviour 11
2.2.5 Media 12
2.2.6 Family 12
2.3 Childhood Obesity: A Global Concern 13
2.3.1 Co-Morbidities 13
2.3.2 Persistence into Adulthood 13
2.3.3 Psycho-social consequences including eating disturbances 14
2.4 Socioeconomic Impact of Obesity 16
2.5 Determinants of Childhood Obesity 18
2.6 Causes of Childhood Obesity 23
2.7 Intervention for Childhood Obesity 25
2.7.1 Diet 26
2.7.2 Television viewing 28
2.7.3 Physical activity 28
2.7.4 Behavioural approaches 30
2.7.5 Family interventions 31
2.7.6 School-based interventions 32
2.7.7 The child’s wellbeing 33
2.7.8 Social and political influences 33
CHAPTER 3
MATERIALS AND METHODS
3.1 Study Design 35
3.2 Area of Study 35
3.3 Population of the Study 35
3.4 Sampling and Sampling Techniques 35
3.4.1 Sample Size 35
3.4.2 Sampling Techniques 36
3.5 Preliminary Activities 36
3.5.1 Informed Consent 36
3.5.2 Training of Research Assistants 37
3.6 Data Collection 37
3.6.1 Questionnaire Administration 37
3.6.2 Anthropometric Measurements 37
3.7 Data Analysis 38
3.8 Statistical Analysis 38
CHAPTER 4
RESULTS AND DISCUSSION
4.1 Personal and Socio-Economic Characteristics of the Children and their
Parents 39
4.2 Food Consumption Pattern of the Children 42
4.3 Weekly Frequency of Food Consumption 45
4.4 24 Hours Dietary Recall of the Children 49
4.5 Dietary Diversity Scores of the Children 53
4.6 Physical Activity Opportunities of the Children 56
4.7 Anthropometric status of the Children 59
CHAPTER 5
CONCLUSION AND RECOMMENDATIONS
5.1 Conclusion 63
5.2 Recommendations 63
REFERENCES
APPENDIX
LIST OF TABLES
4.1a Personal and socio-economic characteristics of the children and their parents 40
4.1b Continuation of Personal and socio-economic characteristics of the Children and their parents 41
4.2a Food consumption patterns of the children 43
4.2b Continuation of Food consumption patterns of the children 44
4.3a Weekly frequency of food consumption of the children 46
4.3b Continuation of Weekly frequency of food consumption of the children 47
4.4a 24 hours dietary recall of the children 49
4.4b Continuation of 24 hours dietary recall of the children 50
4.4c Continuation of 24 hours dietary recall of the children 51
4.5a Categorized dietary diversity scores of the children 53
4.5b Individual dietary diversity scores of children 55
4.6 Physical activity opportunities of the children 57
4.7 Anthropometric status of the children 59
CHAPTER 1
INTRODUCTION
Childhood obesity has been described by Kimm (2003) as an ‘emerging pandemic of the new millennium’.Ruxton (2004) and Asayama et al. (2003) defined obesity as an excess of body fat, with overweight being seen as a less severe excess of body fat than obesity.
Childhood overweight and obesity are now considered to be major public health problems (Thaibault and Rolland-Cachera, 2003; Knehans, 2002). In 2006, 30-45 million children and adolescents (aged 5-17) were obese, or 2-3% of the world population. Approximately 150 million children/adolescents were either overweight or obese, or 7-8% worldwide (Bouchard, 2006). By 2012, more than 40 million children under the age of 5 were overweight or obese (World Health organization, (WHO), 2014). Even low income countries are increasingly affected. Obesity is an underlying risk factor in numerous chronic diseases. Overweight and obesity now rank as the fifth highest global risk factor for mortality and are the cause of an estimated 35.8 million (2.3%) of global disability-adjusted life years (DALYs) lost (WHO, 2010).
The galloping rate of obesity in a short amount of time in fairly stable populations suggests that a genetic origin is most unlikely, even though genes have a permissive role in the sense that some individuals may be genetically more susceptible to the obesogenic influences of the environment. The obesity pandemic reflects the widening gap between biology and lifestyle.
Kail (2011) described school age children as children between the ages of 6-12years of age. Childhood obesity is not only a daily problem for most pediatricians and parents in most economically developed countries but also it is becoming a burden for developing countries as well (Wang et al., 2000). The increased burden of childhood obesity in these last year’s involves both its prevalence and development at an earlier ages with increased occurrence of its co-morbidities such as diabetes mellitus type2, cardiovascular diseases and hypertension (Bauer and Maffeis, 2002). Significantly obesity is increasing rapidly in developing countries undergoing rapid nutrition and lifestyle transition and it often exists with under nutrition. The rising prevalence of obesity in developing countries is largely due to rapid urbanization and mechanization which has led to reduction in the energy expenditure along with an increase in energy intake due to increasing purchasing power and availability of high fat and energy dense fast foods (Wang et al., 2000).
Rates of obesity generally increase with age and the prevalence of overweight and obesity among adults continues to rise (Statistics, 2013). Prevention and treatment interventions are most likely to be successful when implemented pre-puberty (at childhood) (Paterson et al., 2012). Obesity develops from a sustained positive energy imbalance and a variety of genetic, behavioural, cultural, environmental and economic factors. The interplay of these factors is complex and has been the focus of considerable research (Waters et al., 2011).
Childhood obesity has immediate and long term physical and psychosocial consequences. Physical consequences can include obstructive sleep apnoea, fatty liver, indigestion and oesophagitis, orthopaedic problems, polycystic ovaries in adolescent females, type 2 diabetes and cardiovascular disease risk factors including hypertension, dyslipidaemia, chronic inflammation, increased blood clotting tendency, endothelial dysfunction and hyperinsulinemia (Freeman et al., 1999; Ford et al., 2001; Ferguson et al., 1998; Tounian et al., 2001; Srinivasan et al., 2002). More immediate physical consequences include; heat intolerance, increased sweating, chafing skin, shortness of breath on exertion, and musculoskeletal discomfort which can all have a major impact on lifestyle and mental wellbeing (National Health and Medical Research Council, 2013).
Negative psychosocial effects of childhood obesity include depression, social isolation, poor social functioning, negative physical self-perceptions and increased risk of mental health problems in later life (National Health and Medical Research Council, 2013).
Obesity occurs across all demographics and sub-populations, however of particular risk in Australia are Aboriginal people, people from Pacific Islander and middle eastern/Arabic backgrounds, and to a lesser extent general social-economic disadvantage is a risk factor for obesity (National Health and Medical Research Council, 2013).
1.1 STATEMENT OF THE PROBLEM
Obesity has been a global health problem for decades (Spruijt-Metz, 2011). In 1997, the World Health Organization declared obesity to be an international epidemic, and since then, numerous organizations have made efforts to decrease the rates of obesity worldwide (Spruijt-Metz, 2011). Despite these efforts, rates of obesity have continued to grow exponentially in adults and children, thus creating a global health crisis that has resulted in devastating individual health outcomes and increasing costs to the public (Spruijt-Metz, 2011). In the year 2020, approximately 70% of deaths will be due to chronic diseases, and 80% of the burden will be observed in developing countries (WHO, 2010).Obesity is a multifactoral disease, and major risk factors include genetic predisposition, overweight or obesity during childhood and adolescence, poor diet and insufficient regular physical activity (Smith et al., 2011). The consequences of obesity are great, and in addition to increasing the individual risk of numerous health conditions, including diabetes, dyslipidaemia, hypertension, heart disease, stroke and certain cancers, obesity is one of the leading causes of preventable, premature death in the U.S. (Biro and Wien, 2010; Smith et al., 2011). When obesity occurs in childhood, the atherosclerotic process is accelerated and almost every organ system can be adversely affected, resulting in serious medical and psychosocial complications (Han et al., 2010).
Globally it is estimated that 155 million children are obese. The prevalence rate worldwide is put at 25%, with America (37%), Europe (35%), Middle East (25%), and Asia (15%) and in Africa it is estimated to be 8.4%. Studies conducted among the pre-school children from several African countries indicated that South Africa had a prevalence rate of 31.9%, Algeria 21.6%, Seychelles 25%, Malawi 8.4%, Mauritius 5.6% and Kenya 4.6%. However, there are limited representative data available from African countries for studying the trends on childhood obesity (International Obesity Task Force, 2002).
A study conducted by Ene-Obong et al.(2012) in Nigeria identified overweight, obesity and thinness prevalence of 11.4%, 2.8% and 13.0%,respectively among children aged 5-18 years. Similar findings have been reported in South Africa, Tanzania, Pakistan, Mexico, Australia and Brazil (De Assis et al., 2005; Mosha and Fungo,2010; Mushtaq et al., 2011; Renzaho et al., 2008). As a result both diseases related to under nutrition, infectious diseases coexist with obesity-related diseases contributing substantially to the burden of disease (WHO, 2002).
Data on childhood overweight/obesity and thinness in Sub-Saharan Africa including Nigeria is limited and probably scarce. The issue of childhood obesity is less recognised in developing countries, making less information available (McDonald et al., 2008). This study would therefore be carried out to assess childhood obesity among school age children in Nsukka, Enugu State.
1.2 OBJECTIVES OF THE STUDY
General objective
The general objective of this study is to assess childhood obesity among school age children in Nsukka LGA of Enugu state.
Specific objectives
The specific objectives includes to:
1. Determine the socio-economic characteristics of the parents of school aged children in Nsukka LGA of Enugu state.
2. Assess the dietary pattern and availability of healthy food choices for school aged children in Nsukka LGA of Enugu state.
3. Assess opportunity for physical activity available to school age children in Nsukka LGA of Enugu state.
4. Obtain data on the prevalence of childhood obesity among school aged children in Nsukka LGA of Enugu state using anthropometric measurements.
1.3 SIGNIFICANCE OF THE STUDY
The results from this study will contribute a great deal to the study carried out by other researchers in the same field and to policy makers in the entire world more so in countries with a high prevalence of obesity. They will be able to come up with an appropriate nutrition policy which will help mitigate this problem before it reaches epidemic proportions in our country. Thus the result of this study will benefit the policy makers such as the Government, Non-governmental organizations and foreign agencies to identify the possible causes and extent of the problem and also formulate and implement intervention programmes with the help of the nutrition educators, health professionals and school authorities who will monitor and evaluate the impact of the programmes aimed at benefiting the general public by reducing childhood obesity among school aged children.
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