ABSTRACT
This study was conducted to assess childhood obesity and eating behaviour among preschool children in Igbo- Etiti Local Government Area (L.G.A), Enugu State. Data for this report was obtained from a cross-sectional survey of 163 children aged 2-4 years from 7 seven schools. Simple random sampling was used in selecting the preschool children. A structured questionnaire was used to collect information on the background information of the preschool children, socioeconomic characteristics, lifestyle activities, and their eating behaviour. Anthropometric measurement was collected and grouped using WHO anthroPlus. Data collected were analyzed using statistical package for social science (SPSS) version 20.0 using descriptive statistics such as frequency and percentage, mean and standard deviation, regression and correlation . The results of the different variables collected reveals that half (50.9%) were male and (49.1%) were female. Majority (91.4%) were Christians. The study population was dominated by (96.9%) Igbo’s and (93.5%) were married. 53.4% completed secondary schooleducation and 37.4% were business men / traders. 47.9% earned #18,000-#29,999. 73.0% spent time at home after school hour. However, (73.6%) eat and play with their mates. More than half (54.0%) engage in football. About (52.8%) always trekked to school. Majority (74.2%) of children sometimes engaged in television viewing. 44.2% of the children often loved food. Less than half (42.3%) of the children do not eat more when annoyed. Less than half (43.6%) would often have a drink if given the chance. 41.1% always eats more when happy. 41.1% of the children sometimes leave food on the plate at the end of a meal. 31.9% of the children sometimes ate more and more slowly during the course of a meal. 32.5% of the children rarely decide a food to like even without tasting it. Weight-for-height status of the children some (38%) were normal while 25.8% were obese. The BMI-for-age showed that 38% were normal, 15.3% overweight and27.6% obese. Pearson correlation shows that there was no significance difference (P>0.05) between socioeconomic characteristics, lifestyle and eating behavior. The prevalence of overweight and obesity observed in this study was high, there is need for the parents to be educated on importance of adopting good eating habit and lifestyle pattern.
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGMENT iv
TABLE OF CONTENTS v
LIST OF TABLES vii
LIST OF FIGURES viii
ABSTRACT ix
CHAPTER 1
INTRODUCTION
1.1 Background of the Study 1
1.2 Statement of Problem 5
1.3 Objective of the Study 6
1.3.1 General Objective 6
1.3.2 Specific Objectives 6
1.4 Significance of the Study 7
CHAPTER 2:
LITERATURE REVIEW
2.1 Overview of Early Childhood Obesity 8
2.2 Assessment of Childhood Obesity 10
2.3 Implications of Early Childhood Obesity 11
2.4 Trends in Childhood Obesity 14
2.5.1 Behaviour factors 14
2.5.1.1 Dietary behaviour 14
2.5.1.2 Physical activity 16
2.5.1.3 Sedentary behaviour 18
2.5.2 Parenting style and family socio-demographic characteristics 19
2.5.3 Environmental factors 20
2.5.4 Genetic factors 21
2.6 Consequences of Obesity 23
2.6.1 Social effects 23
2.6.2 Health effects 23
2.6.3 Economic effects 24
2.7 Strategies towards Preventing Childhood Obesity 25
2.8 Childhood Eating Behaviour 27
2.8.1 Emotional eating 28
2.8.2 Fussy eating 28
2.8.3 Food responsiveness 29
2.8.4 Slowness in eating 30
2.8.5 Enjoyment of food 30
2.8.6 Satiety responsiveness 31
2.9 Early Taste and Experience with Food Flavors in Amniotic Fluid 31
2.10 Parenting Styles and Children's Eating Behaviour 32
2.11 Nutrition Assessment Methods 38
2.11.1 Anthropometric Measurements 39
2.11.1.1 BMI-for-Age 39
2.11.1.2 Mid-Upper Arm Circumference (MUAC) 40
2.11.1.3 Height-for-age (H/A) 41
2.11.1.4 Weight-for-height (W/H) 42
2.11.1.5 Weight-for-age (W/A) 42
CHAPTER 3
MATERIALS AND METHODS
3.1 Study Design 44
3.2 Area of Study 44
3.3 Population of Study 45
3.4 Sampling and Sampling Techniques 45
3.4.1 Sample Size 45
3.4.2 Sampling Procedure 47
3.5 Preliminary Activities 47
3.5.1 Preliminary visits 47
3.5.2 Informed consent letter 47
3.5.3 Training of research assistants 48
3.5.4 Inclusion and Exclusion Criteria 48
3.6 Data Collection 48
3.6.1 Questionnaire 49
3.6.2 Eating behaviour questionnaire 49
3.6.3 Anthropometric measurement 50
3.6.3.1 Height 50
3.6.3.2 Weight 50
3.6.3.3 Body Mass Index (BMI) 51
3.7 Data Analysis 51
3.8.1 Statistical Analysis 52
CHAPTER 4
RESULTS AND DISCUSSION
4.1 Background Information Preschool Children 54
4.2 Socioeconomic Characteristics of their Parents 56
4.3 Lifestyle of the Preschool Children 58
4.4 Eating Behaviour of the Preschool Children 62
4.5 Anthropometric Status of the Preschool Children 69
4.6 Effect of Socioeconomic Characteristics, Lifestyle and Eating Behaviour of the Preschoolers on their BMI-For-Age 71
CHAPTER 5
CONCLUSION AND RECOMMENDATIONS
5.1 Conclusion 73
5.2 Recommendations 73
REFERENCES 75
Appendix I 92
LIST OF TABLES
Table 4.1: Background information of the preschool children 55
Table 4.2: Socioeconomic characteristics of their parents 57
Table 4.3a: Lifestyle of the preschool children 59
Table 4.3b: Lifestyle of the preschool children 61
Table 4.4a: Eating behaviour of the preschool children 63
Table 4.4b: Eating behaviour of the preschool children 65
Table 4.4b continuation: Eating behaviour of the preschool children 66
Table 4.4c: Eating behaviour of the preschool children 68
Table 4.5: Anthropometric status of preschool children weight-for-height and BMI-for-age 70
Table 4.6: Effect of socioeconomic characteristics of the parents, lifestyle and eating behaviour of preschoolers on their body mass index for age 72
LIST OF FIGURES
Fig. 2.1: Conceptual Framework 22
Fig. 3.1: Map of Enugu State showing Igbo Etiti LGA 45
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
The world, including developing countries, is facing a global epidemic of obesity, according to a recent report from the World Health Organization (WHO, 2011). Obesity is an adverse health condition characterized by an excessive increase in body fat caused by a sustained positive energy balance over time (Santos et al, 2005). It is defined as a condition of excess body fat which creates increased risk for morbidity and/or premature mortality and the adult BMI thresholds 25 and 30 kg/m2 for overweight and obesity respectively are based on prospective associations between BMI in middle to late-aged adults in relation to their subsequent mortality (WHO, 2002). In contrast, there is little consensus as to the best way to operationalize this definition in children (Rajalakshmi et al., 2013).
Childhood obesity epidemic is fueled, in part, by excess childhood weight gain. Dramatic increases in childhood obesity foreshadows serious health consequences (that is, early risk for much of adult morbidity and mortality (Biro and Wien, 2010) and premature death, type 2 diabetes (Goran et al., 2003; Van Vliet, 2010) hypertension and - lipidemia, cardiovascular disease, asthma and sleep apnea, lower self-esteem, and psychological and social stress. Obesity tracks from childhood into adulthood and is difficult to treat successfully in the long term (Gordon-Larsen et al., 2004).
Nigeria, like other developing countries, currently experiences obesity. This does not bode well for any economy that seeks to attain "industrial and economic development", and therefore calls for urgent public health action (Ejike, 2014). There are many reports in the literature on the prevalence of overweight and obesity in Nigerian children and adolescents (Eke et al., 2015).
Poor diet and lack of physical activity are major contributors to obesity. The preschool years are a critically important period for developing healthy food preferences and motor skills (Skinner et al., 2002; Hagan et al., 2008). As such, experts suggest that obesity-prevention efforts begin in early childhood and have identified preventing obesity among young children as an important strategy for reversing the epidemic (Ogden et al., 2008). All-time high rates of obesity are evident among the nation’s youngest children more than 21 percent of preschool children are overweight or obese (Ogden et al., 2008). The consequences of obesity for young children and the economic toll of this epidemic are serious. Children who are obese have a greater likelihood of being obese in adulthood and developing heart disease, diabetes, and other chronic conditions (Guo, 2002; Daniels, 2009). Effective strategies to reduce and prevent obesity among preschool children are needed to protect children from these health consequences and avoid the future financial burden of health care expenditures (Encinger, 2015).
The prevalence varies by race, age, ethnicity, and socio-economic status (Anderson and Whitaker, 2009; Ogden, et al., 2014; Center for Disease Control, 2014). Obesity earlier considered a problem of high income countries is now on the rise in most low and middle income countries particularly in urban settings (Bloomgarden, 2003). According to the Centers for Disease Control and Prevention (CDC, 2014), approximately 13 million children and adolescents, aged 2-19 years, in the United States are obese. Understanding children’s eating attitudes and behaviour is important in terms of children’s health. Children’s eating behaviours have been found to contribute to weight status and some may also be potential risk factors for childhood obesity. Obese children tend to demonstrate particular eating behaviours that contribute to higher weight status compared to children of healthy weight status. A variety of eating behaviours have been found to contribute to overweight and obesity status in children. Obese children typically have decreased satiety responsiveness, increased food responsiveness, increased eating speed, and have a tendency to engage in emotional eating more often than children of healthy weight status (Moens and Braet, 2007; Llewellyn et al., 2008; Jahnke and Warschburger, 2008; Webber et al., 2009).
Children’s obesity occurs as a result of over-consumption of calories and low physical activity (Dehghan et al., 2005). The preschool age is a time when distinct eating behaviours are formed (Ashcroft et al., 2008). Studies have suggested that there are genetic predispositions for some obesity related appetitive traits such as food preferences (Fildes et al., 2015) speed of eating (Llewellyn et al, 2008) eating in the absent of hunger (for boys) (Faith et al., 2006; Hill et al., 2008) satiety responsiveness and food responsiveness (Faith et al., 2013). However, children’s eating behaviours are also significantly influenced by social and environmental factors such as role modeling (Fisher et al., 2002; Wardle et al., 2005) availability of food in the home (Matheson et al., 2006; Gregory et al., 2010) and parenting practices (Kral et al., 2007). Thus, understanding how and why parents respond to children’s different eating behaviours is key to framing childhood obesity interventions (Anna et al., 2016).
Obesity reflects a complex condition which is influenced by a wide range of genetic, metabolic, cultural, environmental, socioeconomic, and behavioural factors. It is the convergence of these forces, biological and technological that has produced the current obesity epidemic (Dong et al., 2003). Caloric intake, physical inactivity and genetics lie at the distant level and reflect the health behaviours most directly related to obesity while the environment modifies how the genes are expressed, placing genetics inside the causality continuum that produces obesity in humans (Scott et al., 2012).
1.2 STATEMENT OF PROBLEM
Childhood obesity has become an area of public health concern because children are at an increased risk of carbohydrate intolerance, increased insulin, coronary heart diseases, hypertension and orthopedic problems (Strauss and Pollack, 2001). Obesity is becoming a public health concern in Nigerian children. This is attributed to the changes in lifestyle for example individuals have shifted from active to sedentary, changes in dietary habits; foods consumed are mostly carbohydrates and fats which provide more calories than what is expected. (Malla, 2004).
Although effective action to prevent obesity epidemic requires an evidence base of early-life risk factors, unfortunately, this evidence base is still very incomplete. Despite the increasing prevalence of obesity in preschool children, researchers have focused on risk factors in school-age children (Lytle et al., 2006). Further, few studies have tried to capture the complete picture of childhood obesity risk factors. Most studies have included fewer predictors of overweight, such as parental obesity, breastfeeding duration (Harder et al., 2005). However, these risk factors often do not occur in isolation.
It is well accepted that there is no single cause of childhood obesity, but co-actions at multiple levels (e.g. genetic, cellular, physiological, psychological, social and cultural) determine outcomes (Birch and Anzman, 2010). Due to the rising prevalence of obesity, its consequent health implications and cost associated with this prevalence, the present study aims to critically assess childhood obesity and eating behaviour in preschool children aged 2-4 years in some selected primary school in Igbo-Etiti Local Government Area in Enugu State.
1.3 OBJECTIVE OF THE STUDY
1.3.1 General objective
The general objective of this study was to assess childhood obesity and eating behaviour of pre-school children aged (2-4 years) in some selected primary school in Igbo-Etiti Local Government Area, Enugu State, Nigeria.
1.3.2 Specific Objectives
The specific objectives were to:
1. compile the background information of the children and the socio-economic characteristics of their parents.
2. evaluate the lifestyle and eating behaviour of the pre-school children.
3. assess the nutritional status using anthropometric measurement (weight and height) of the children.
4. ascertain the effects of socio-economic status of their parents, eating behaviour and life style of the children on their anthropometric status.
1.4 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. The findings of the study will encourage care givers to establish a healthy lifestyle and good feeding habit of their children. It will be useful in creating awareness about the risk factors and long term effects of obesity and also be beneficial to the government as a health policy formulation tool to curtail the 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 the country.
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