PREVALENCE AND DETERMINANTS OF OBESITY AMONG ADOLESCENTS LIVING IN BOARDING SCHOOLS IN SOME SELECTED LOCAL GOVERNMENT AREAS OF ENUGU STATE

ABSTRACT

This cross sectional study aimed to determine the prevalence and determinants of obesity amongst adolescents in boarding schools in some selected Local Government Areas of Enugu state. A total of 380 adolescent students (183 males and 197 females) were randomly selected using multistage sampling techniques from thirty different secondary schools, out of which four were used. A self administered questionnaire was used to collect information on the socioeconomic status, dietary habits and frequency of consumption of different foods. Anthropometric measurements were taken using standard procedures. Data were analyzed using statistical package for social sciences (SPSS, Version 20) and WHO anthroplus package to assess their BMI-for-age and height-for-age status. Majority (75.8%) were within the age of 15-17 years, 36.8% and 28.4% were given N3000- N4999 and N5000-N6999, respectively as pocket money. Food habits of participants indicated that 69.4% skipped breakfast. The common provisions students took back to school were gala, cake, chin-chin (22%); biscuits (17.7%) and tea with milk (17.2%).  Only 53.9% were served fruits in the school refectory. Body mass index (BMI) for age of participants showed that 4.7% were underweight and 2.1% were overweight. Similarly, 5% were stunted while 1.6% was very tall. Sex of the students significantly determined their BMI-for-age (x2 =0.125; p=0.015). However, other variables such as age, parents’ educational status, occupation, frequent intake of provision and fruits were not significantly related to their height-for-age and BMI-for-age. Prevalence of overweight, underweight and stunting was low in this study. However, effort should be made to ensure that fruits and vegetable alongside healthy snacks and pastries are given to the students.

TABLE OF CONTENT

LIST OF TABLES

CHAPTER 1

                                                        INTRODUCTION

The World Health Organization (WHO) defined adolescence as the period from 10 to 19 years of age (Peter, 1999). It is the transitional period between childhood and adulthood (Chin and Mohd, 2009). However, the National Adolescent Health Policy in Nigeria viewed ages 10 to 24 years as a more appropriate range for adolescence (John and Catherine, 2003). It has been found that the rapid changes in physical growth and psychological development have placed adolescents as a nutritionally vulnerable group with unhealthy eating behavior (Peter, 1999; Shi et al., 2005 and WHO, 2000). The prevalence of obesity has continued to rise at an alarming rate worldwide to such an extent that it has been described as a global epidemic and it has even replaced under-nutrition as the most common public health concern for infants and children (WHO, 1998). This increased prevalence, which was initially more marked in developed countries,(Tremblay and Williams, 2000; Dietz, 1998), has become a global concern (De onis and Blossner, 2000; Schneider, 2000). Although the aetiology of obesity is rather complex, increased intake of fast foods, replacement of the traditional high fibre diet with Western diets with high sugar and fats and the tendency for a more sedentary lifestyle with the advent of cars are believed to contribute to this epidemic of childhood obesity.(Sallis and Glanz, 2006; Jelb and Moore, 1999). Obesity is a disease process associated with the development of serious medical complications and increased mortality in adulthood. Obesity is also a risk factor associated with cardiovascular disease, atherosclerosis, diabetes and breast, colonic, endometrial and prostate cancers, (Dietz, 1998; Ojofeitimi et al., and Freedman et al., 1999). Adolescent obesity is thought to be associated with some psychological problems like low self esteem, feeling of inadequacy, anxiety, social dysfunction, depression and moodiness; all of which affect the personality of the adolescents.(Whitaker, 1992; Wadden and Stunkard, 1985). A study reported that girls who are overweight or obese are prone to developing high-risk behaviours such as smoking and drinking alcohol, and are also less likely to engage in physical activities and exercise programmes that promote energy expenditure (Strauss, 2000).

 In Nigeria, data on the prevalence of being overweight and of obesity are few and scattered. The adolescents, however, are considered as the age group with the least mortality (Woodruff, 2000). Despite increased concerns for adolescent health worldwide, adolescence has not been considered to be a high priority stage for nutritional needs and intervention (Peter, 1999 and WHO, 2005).

1.1 STATEMENT OF THE PROBLEM

The coexistence of under nutrition and over nutrition within a population also referred to ‘double burden of malnutrition’ has enormous consequences among which are childhood mortality and chronic diseases at later age (Shrimpton, 2013).

In the United States of America (USA), the incidence of obesity in adolescents rose from11% in 1984 to 25% in 1998, with African-American girls having a 50% greater prevalence than White girls (Dietz, 1998; Troiano and Flegal, 1998).In Australia, at least one in five children and adolescents are obese or overweight, with a continuous rise in prevalence (Baur, 2002).The prevalence of being overweight and of obesity in Canadian children aged 7 to 13 years has also doubled and tripled, respectively, since 1981 (Tremblay and Willms, 2000). In the United Arab Emirates(UAE), recent research suggested that the prevalence of childhood obesity is increasing dramatically, already surpassing the high levels of obesity found among children and adolescents in the USA and Europe (Westerbeek and Smith, 2005; Al-hadded et al., 2005). In 2004, the global prevalence of overweight and obesity among children and adolescents (5 to 17 years) was estimated by the International Obesity Task Force (IOTF) to be 10% (Lobstein et al., 2004). A national survey conducted in South Africa in 2003 found that the prevalence of overweight (including obesity) among older adolescents (15-19 years) was over 19%, with boys less commonly overweight (14%) than the 25% of girls (South African Medical Research Council and OrcMacro, 2007). In Nigeria, data on the prevalence of being  overweight and of obesity are few and scattered. A study by Omolola et al., (2009) in south western Nigeria reported no adolescent to be neither overweight nor obese among the rural dwellers studied. Furthermore, the prevalence rates of obesity and being overweight in a study carried out in Cross River, Nigeria were 1.7% and 6.8%, respectively (Victor et al., 2008).In Nigeria, the prevalence of obesity among adolescents in urban and rural areas of Lagos State was reported as 3.0% and 0.0%, respectively (Ben-Bassey, 2007). A total of 18% of Nigerian children and adolescents (5 to 15 years) were reported to be obese in a study carried out in 1997 by Owa and Adejuyigbe (Owa and Adejuyigbe, 1997). The prevalence rate of overweight, obesity and thinness among school-aged children and adolescents in Southern Nigeria were recorded as 11.4%, 2.8% and 13.0%, respectively (Ene-Obong et al., 2012). Trends in overweight and obesity in adolescents have been studied in only a few developing countries and sub-groups; this study was therefore conducted to assess the prevalence and determinant of obesity among in-school adolescents in selected local government areas of Enugu State, Nigeria.

1.2  OBJECTIVES

1.2.1 General objectives

The general objective of this study was to assess the prevalence and determinants of obesity among in-school adolescents in selected local government areas of Enugu State, Nigeria.

1.2.2        Specific objectives

Specific objectives were to:

        i.            determine the socio-demographic characteristics of in-school adolescents

      ii.            assess the anthropometric status of the adolescents

    iii.            determine the prevalence of obesity among in-school adolescents in  selected Local Government Areas of Enugu State.

    iv.            identify the determinants of obesity among the in-school student.

1.3      SIGNIFICANCE OF THE STUDY

The study will provide necessary information on the state of prevalence of adolescents in selected Local Government Area of Enugu State and also to know the likely causes of obesity among in school adolescents in Enugu State. The information will help nutritionists, parents, community health workers, older persons, care givers on possible intervention for the adolescents to prevent obesity among them. It will help to advice the adolescents on the need for consumption of adequate of diets to maintain their normal weight if found to be necessary.

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