INCIDENCE OF OVERWEIGHT AND OBESITY AMONG PRIMARY AND SECONDARY SCHOOL CHILDREN IN ABAKALIKI, EBONYI STATE.

2.5 Complications and Adverse Health Effects of Overweight and Obesity in Children 48

2.6.5 Parental and caregiver roles and responsibilities in obesity prevention in young children 53

4.6 Effects of Dietary Habits on the Prevalence of Overweight and Obesity among the Primary and Secondary School Children 132

2.2 BMI of children and adolescents age 5-19 years        32

4.4c Consumption pattern of grains                                       95

4.4f Consumption pattern of vegetables                       108

4.4j Consumption pattern of snacks among students of private and public schools in Abakiliki 124

Overweight and obesity are global public health problem because of their effect on individuals, families and communities. It is estimated that about one billion people are overweight and more than 300 million obese worldwide (WHO, 2012). The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been an increased intake of energy dense foods that are high in fat and an increase in physical inability due to the increasingly sedentary nature of many forms of work, changing modes of transportation and increasing urbanization (WHO, 2013).

The recent rapid increase in childhood overweight and obesity is attributed to the modern obesogenic environment. Obesogenic environments are defined as some of the influences that the surroundings, opportunities or conditions of life have on promoting obesity in individuals or populations (Swinburn and Egger, 2002).  Changes in dietary constituents including higher derivation of energy from nutritionally poor and energy dense foods, increased sweetened drink consumption, larger portion sizes, and more frequent intake of food outside the home have been associated with poorer diets and higher weights (Swinburn and Egger, 2002).

Childhood obesity has been called “one of the most serious public health challenges of the 21st century,” and with good reason (WHO, 2013). Obesity can harm nearly every system in a child’s body—heart and lungs, muscles and bones, kidneys and digestive tract, as well as the hormones that control blood sugar and puberty—and can also take a heavy social and emotional toll (Ebbeling et al., 2002).   Adolescents who are overweight or obese have substantially higher odds of remaining overweight or obese into adulthood, (Singh et al., 2008) increasing their risk of disease and disability later in life. There is evidence that the prenatal, early childhood, and adolescent periods are critical in the development of overweight and obesity but the mechanisms involved are yet to be elucidated. 

The effects of childhood obesity on morbidity and mortality indicate that effective prevention and treatment during childhood are likely to have a significant impact on immediate health, as well as adult disease (Dietz, 1996). It is well established that obesity in adults is difficult to treat. Programs aimed at treatment of overweight children, appear to have a substantial better long term success rate than similar programs in adults. Furthermore, because of the refractory nature of obesity, preventing childhood obesity may be an effective way to prevent adult obesity (Dietz, 1996).

The prevalence of overweight and obesity among children is increasing in high income, as well as in low and intermediate – income countries (Al-Haddad et al., 2005). In obese and overweight children, interventions rarely show satisfying long term results. Therefore, identifying children at risk are appropriate for possible prevention at an early age which is a major challenge (Cossrow and Falkner, 2004; Alberta, 2006).

American Heritage Dictionary of the English Language (2011), defines prevalence as the total number of cases of a disease in a given population at a specific time. Prevalence is also defined as the ratio (for a given time period) of the number of occurrences of a disease or event to the number of units at risk in the population.

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health (WHO, 2O13). Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters i.e kg/m2 (WHO, 2013).

Center for Disease Control and Prevention (CDC), USA, defines “overweight” as being at or above the 85th percentile of Body Mass Index(BMI) for age and “at risk of obesity” as being between the 85th and 95th percentiles of Body Mass Index(BMI) for age (CDC, 2004b; CDC, 2005b). The European Childhood Obesity Group classifies overweight as being at or above the 85th percentile of body mass index and obesity as being at or above the 95th percentile of body mass index. The International Obesity Task Force (IOTF), in their definition, used data from six national studies conducted in different countries and provided percentile curves that passed through the widely used cutoff points of 25 kg/m2 and 30 kg/m2 for adult overweight and obesity (Cole et al., 2000). These body mass index cutoff points are reported to be more internationally based than other definitions (Cole et al., 2000). There is no universal cutoff for waist circumference, but in some studies abdominal obesity has been defined as a waist circumference above the 75th percentile for age and sex in the population studied (Monzavi et al., 2006). Defining overweight and obesity in children have been difficult since assessing body fat is expensive and impractical. Body Mass Index (BMI), derived from weight and height, is used as a surrogate indicator in adults. In children, the consensus is to use BMI percentiles statistically derived from a reference population (Monzavi et al., 2006). 

Childhood overweight and obesity are important public health issue due to its rapidly increasing prevalence and the associated adverse medical, economic and social consequences. The number of adolescents who are overweight have tripled since 1980 and the prevalence among younger children has more than doubled. Obesity contributes about 2.8 million deaths each year, risk of heart diseases, strokes and diabetes increase steadily with increasing body mass index (WHO, 2011). For instance in Nigeria, presently about eight million people are suffering from hypertension, 4 million are diabetic and 100,000 new cases of cancer are diagnosed each year (Chukwu, 2011). 

Children in low and middle income countries are more vulnerable to inadequate pre-natal, infant and young child nutrition.  At the same time, they are exposed to high-fat, high-sugar, high-salt, energy-dense, micronutrient-poor foods, which tend to be lower in cost but also lower in nutrient quality. These dietary patterns in conjunction with lower levels of physical activity, result in sharp increases in childhood obesity while under nutrition issues remain unsolved (WHO, 2013).

Globally, an estimated 43 million preschool children (under age 5) were overweight or obese in 2010, a 60 percent increase since 1990 (De-Onis et al., 2010).  The problem affects both rich and poor countries and by sheer numbers, places the greatest burden on the poorest.  Of the world’s 43 million overweight and obese preschoolers, 35 million live in developing countries, by 2020, if the current epidemic continues unabated, 9 percent of all preschoolers will be overweight or obese (De-Onis et al., 2010).

Obesity rates are higher in adults than in children. But in relative terms, the U.S., Brazil, China, and other countries have seen the problem escalate more rapidly in children than in adults (Popkin et al., 2006). Of course, some regions still struggle mightily with child hunger, such as Southeastern Asia and sub-Saharan Africa (UN, 2012).  But globalization has made the world wealthier, and wealth and weight are linked. As poor countries move up the income scale and switch from traditional diets to Western food habits, obesity rates rise (Popkin et al., 2012). One result of this so-called “nutrition transition” is that low- and middle-income countries often face a dual burden: the infectious diseases that accompany malnutrition, especially in childhood and increasingly, the debilitating chronic diseases linked to obesity and Western lifestyles (Popkin et al., 2012).

According to the World Health Organization (WHO) 2002, the societal change and nutritional transition are driving the high prevalence of obesity worldwide. Economic growth, modernization, urbanization and the globalization of the food market are just some of the forces thought to underline the increasing trend of overweight and obesity (Drewnowski and Popkin, 1997). Obesity has reached epidemic proportion globally with more than 1.6 billion adults being overweight and at least 400 million of them clinically obese and is a major contributor to the global burden of chronic diseases and disability (WHO, 2002; 2006). At the other end of malnutrition scale, overweight and obesity are some of today’s most blatantly visible-yet most neglected public health problems (WHO, 2002). The scourge of overweight and obesity are not restricted to developed societies alone, in developing countries, it is estimated that over 775 million people suffer from obesity related problems (WHO, 2006).

The general objective of the study was to determine the incidence of overweight and obesity among  primary and secondary school children in Abakaliki, Ebonyi State.

The specific objectives of the study were;

1. to determine the personal characteristics of primary and secondary school children in public and private schools in Abakaliki,

2. to determine the socioeconomic characteristics of their parents,

3. to determine the dietary habits of primary and secondary school children in public and private schools in Abakaliki,

4. to determine the food frequency of primary and secondary school children in public and private schools in Abakaliki,

5. to measure anthropometric status of the children using anthropometric indicators, example weight for age, height for age and BMI for age among the public and private schools and

6. to determine the effect of dietary habits on the incidence of overweight and obesity among the primary and secondary school children in Abakaliki.

The findings of this research would enlighten the public on the causes and prevention of overweight and obesity complications in children and adolescents in order to safeguard long term good health for the population in the world. This study would create awareness to parents on the need to make healthy lifestyle choices of food which can make families to reduce risk of overweight and obesity. 

This study shows current statistics on incidence of overweight and obesity in primary and secondary school children in Abakaliki so that government will start to implement special school meal programs and effective nutrition education programs in our schools. Through this work schools will be able to know the benefit of combination of classroom health education, physical education programs, food service and health service as well as employing qualified personnel such as nutritionists and dietitians. This will make school a viable forum for providing obesity intervention in a cost effective manner which will help to prevent potential long term effects of childhood overweight and obesity which include hypertension, diabetes mellitus, cancers, disability in adulthood, breathing difficulties, cardiovascular disease and premature death.