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Introduction

Obesity was defined as excessive or abnormal fat accumulation that may impair health. A crude population measure of obesity is the body mass index, a person’s weight (in kilograms) divided by the sq. of his or her height (in meters). A person having a BMI of 30 or more is considered obese. A person with a body mass index equal to or more than 25 is considered overweight. For children, age needs to be considered when defining obesity. (WHO 16th February 2018)

Childhood obesity is predictive of adult obesity and is one of the most serious public health challenges of the 21st century. Lifestyle, nutritional status, and Food habits are the major contributors in childhood that determine the health of an adult. Lack of physical activity and an unhealthy diet during childhood are the leading risk factors accounting for the burden of non-communicable disease in adulthood (Bharati et al., 2008).

Worldwide, the prevalence of combined overweight and obesity rose by 27.5% for adults and 47.1% for youngsters between 1980 and 2013. In developing countries with rising economies (classified by the World Bank as lower- and middle-income countries) the speed of increase in childhood overweight and obesity has been quite 30% over that of developed countries (WHO, 2015).

Worldwide obesity has nearly tripled since 1975. Over 340 million kids and adolescents aged 5-19 were overweight or obese in 2016. (WHO 16th February 2018)

A child with a BMI at 85th or below 95th percentile for age and sex is considered at risk of being overweight, whereas a child with a BMI at or above 95th percentile is obese. Children with very high BMI are at greater risk of morbidity related to childhood obesity. Childhood obesity increases the risk of morbidity related to childhood obesity. Childhood obesity increases the risk of dyslipidemia, cardiovascular disease, impaired glucose tolerance, chronic inflammation, gall stones, non-alcoholic fatty liver diseases, pancreatitis, and many other musculoskeletal, and neurological alterations and consequently, the children are at higher risk of being obese as adults (Ekelund et al., 2006).

The role of physical activity in weight maintenance is very much evident. But nowadays it has become difficult for children to be physically active. Children consume a substantial proportion of their daily energy intake while watching television and TV commercials, which typically promote high sugar, high fat, and processed food and can, have a large impact on children’s food choices. In addition satiety cues and are therefore more likely to overeat (Susan & Jane 2008). Besides the obesogenic environment, there are some other variables that are associated with childhood obesity. Factors such as family history, high birth weight of the child, long sleeping hours, maternal employment, parental obesity, their own food eating behavior with regard to time of eating, food selection, and place of eating are correlated with the child’s food behavior (Moria et al., 2004).

Objective

    1. To find out the prevalence rate of childhood obesity in school-going children.
    2. To study the causes or causative factors of obesity in school-going children.
    3. To assess the dietary pattern and nutritional status of selected school-going children.
    4. To develop teaching aids to create awareness through nutrition education in years-old school-going children.
    5. To determine the impact of nutrition education on the prevention of obesity.

Review of literature

The available literature on the present investigation and related aspects have been thoroughly reviewed and presented under the following heads and subheads:

    1. Prevalence of childhood obesity
    2. Obesity and its complications
    3. Nutritional status of school-going children by anthropometry
    4. Anthropometric measurements
    5. Impact of nutrition education
    6. Prevention of childhood obesity

1. Prevalence of childhood obesity:

Siddique et al. (2015) conducted a study in a private school in Dhaka involving 140 students and reported that 50% of the students were either overweight or obese out of which 26.4% were obese. The majority of those found overweight and obese consumed fast foods and houses children from mostly middle to high-income families.

Dyson et al. (2014) reported that rates of hypertension, obesity and, overweight are high in school children in China, India and, Mexico. Obesity and overweight prevalence rates varied by country and were 16.6% in China, 4.1% in India, and 37.1% in Mexico. A cross-sectional study of hypertension (Badi et al., 2012) in relation to obesity and overweight among school children aged 6-16 years in Aden, Yemen done on 1885 children showed the prevalence of obesity as 8% and overweight 12.7%.

Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years (NCHS, 2012). The percentage of children aged 6-11 years within the United States who were obese, increased from 7% in 1980 to almost 18% in 2012. Similarly, the percentage of adolescents aged 12-19 years who were obese, increased from 5% to nearly 21% over the same period(Ogden et al., 2014)

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2. Obesity and its complications:

Leonard et al. (2004) studied the association between childhood overweight and adult disease. The relation between Body Mass Index (BMI) in childhood and adult cardiovascular mortality in a 57-year follow-up cohort study disclosed that cardiovascular mortality was related to higher childhood BMI. From the general public health perspective, ways geared towards reducing weight in childhood were important but may also affect adult health if such weight reduction persists into adulthood.

Schulze et al. 2004 revised the evidence on the diet and nutrition causes of obesity and recommended strategies to reduce obesity prevalence. The protection issue against obesity was considered to be regular physical activity, a high intake of dietary non-starch polysaccharides /fiber, supportive home and school environments for children, and breastfeeding. Risk factors for obesity were thought of to be sedentary lifestyles, a high intake of energy-dense, micronutrient-poor food, significant selling of energy-dense foods and nourishment shops, sugar-sweetened soft drinks and fruit juices, adverse social and economic conditions in developed countries, especially in women. Strategies suggested to cut back obesity prevalence included influencing the food offered to make selections easier, reducing the selling of energy-dense foods and beverages to children, influencing urban environments and transport systems to promote physical activity, increasing communications about healthy eating and physical activity, and improved health services to promote breastfeeding and manage current overweight or obese people.

3. Nutritional status of school-going children by anthropometry:

Sharma et al. (2017) designed a study to assess and compare the nutritional status of government and private school children in Muzaffarnagar city. A total of 1960 (980 each from private and government schools) schoolchildren of class 6-12 were studied for socio-epidemiological details, dietary habits, and physical activity. Information on education status, occupation, and monthly income of their parents was also collected. Required anthropometric measurements were taken. Out of 980 children from private schools, 90 (9.18%) were underweight, 138 (14.08%) were overweight, and 137 (13.97%) were obese. The majority of children from government schools were underweight 215 (21.94%) except for 24 (2.45%) overweight children. This study shows the dual nature of nutritional problems and under-nutrition among the lower socioeconomic class of govt. school at one side and the worrisome epidemic of obesity among the affluent of private schools.

Deren et al. (2018) evaluated the prevalence of overweight, obesity, and underweight in children from Ukraine. The measuring of body weight was performed with medical scales and height was measured employing a stadiometer. Based on the results obtained, body mass index (BMI) was calculated. The combined prevalence of obesity, and overweight among children aged 6-18 years old was 12.1%, 17.6%, and 12.6% based on the IOTF reference, WHO growth standard, and the CDC, respectively. Obesity was 2.1%, 4.2%, and 3.6% respectively. Significantly more girls were underweight than boys.

4. Anthropometric measurements:

Menon et al. (2007) conducted a study on 36 children (26 boys and 10 girls, age 1.5 to 15 years) and 37 adults (21 men and 16 women, age 25 to 69 years) with obesity and 29 non-obese (15 children and 14 adults). All anthropometric parameters were higher in obese subjects compared to non-obese. BMI was >28 kg/m2 in all obese children and >31 kg/m2 in eight.

Mehta et al. (2007) reported that twenty-one out of 22 obese girls (95.4%) were centrally obese (waist circumference > 80 cm). out of the 21 girls whose waist circumference was> 80 cm, 10 girls had a waist circumference greater than 100 cm, and even among the rest, it was just below 100 cm for 5 girls. Twelve (54.6%) girls among the 22 obese were found to be having central obesity (waist-hip ratio > 0.85).

5. Impact of nutrition education:

Shin et al. (2004) reported that a well-designed nutrition education program for obese children and their parents can be an effective approach to help them improve their nutrition knowledge and establish desirable food habits and eating behaviors. Nutrition education based on decreasing portion sizes, decreasing sugared drinks, lowering fat intake, and increasing lean meats and fish, fruit, whole grains, and vegetables imparted to the parents showed a gain in their knowledge level (Engels et al., 2005).

Nutrition education, behavioral interventions, and exercise are the mainstay of treatment for obese parents (adults) and at risk for obese or obese children (Wadden and Stunkard, 2002) and are aimed at improving nutritional choices, decreasing sedentary activity, and increasing physical activity. Children and adults may be targeted separately or together (Berry et al., 2004).

Omar (2000) studied meal planning and its relation to the nutritional status of preschool children aged 2-4 years in Egypt. Special emphasis was given to the socioeconomic status and education level of the families. The results and nutritional quality of meal planning by housewives.

6. Prevention of childhood obesity:

According to Berge et al. (2014), there is a significant association between positive family and parent-level interpersonal dynamics (i.e., parental positive reinforcement, warmth, and group enjoyment) at family meals and reduces the risk of childhood obesity. In addition, vital associations were found between positive parental and family-level food-related dynamics (i.e., food communication, warmth of food, parental food positive reinforcement) and reduced risk of childhood obesity.

Obesity management at a younger age may have a greater effect for several reasons, including:

    • Motivation may be easier to generate and maintain, for both the child and other family members while the child is small;
    • There may be more frequent opportunities for medical observations during earlier childhood compared with later years;
    • It can be easier to modify and control behavior in younger individuals; there may be less resistance to treatment stigmatization and greater influence of the family on the child;
    • Longitudinal growth and an increase in lean body mass occur during childhood so that children can grow into their weight (Lobstein et al., 2004).

References

    1. Bharati, D. R., Deshmukh, P. R. and Garg, B. S., 2008. Correlates of overweight and obesity among school-going children of Wardha city, Central India. Indian Journal of Medical Research. 127: 539-543.
    2. Eklund U, Ken Ong, Yvonne Linne, Martin Neovius, Soren Brage, David B Dunger, Nicholas J Wareham and Stephan Rossner 2006 upward weight percentile crossing in infancy and early childhood independently predicts fat mass in a young adult: the Stockholm Weight Study (SWEDES) Am J Clin Nutr 83: 324-30.
    3. Moria Golan, Ph.D., and Scott Crow, MD 2004 Parents are key players in the prevention and treatment of weight-related problems Nutrition Reviews 62(1) 1-7.
    4. Susan Carnell and Jane Wardle 2008 Appetite and adiposity in children: evidence for a behavioral susceptibility theory of obesity Am J Clin Nutr 88:22-9.
    5. Leonard M B, Shults J, Wilson B A, et al. 2004 Obesity during childhood and adolescence augments bone mass and bone dimensions. American J. Clinical Nutrition, Vol. 69: 608-1.
    6. Schulze M B, Liu S, Rimm E B, et al. 2004 Glycemic index, Glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. American J. Clinical Nutirion, 80: 348-56.
    7. Deren K, Nyankovskyy S, Nyankovska O, Luszczki E, Wyszynska J, Sobolewski M and Mazur A. 2018. The prevalence of underweight, overweight and obesity in children and adolescents from Ukraine, Scientific Reports, 8(3625):1-7.
    8. Sharma S, Muzammil K, Singh R, and Siddiqui S. 2017. Assessment and comparison of nutritional status of government and private secondary school children of Muzaffarnagar, Indian Journal of Community Health, 29(3): 265-270.
    9. Menon, P.S.N., Dubey, S., Kabra, M., Bajpai, A., Pandey, R.M., Hasan, M. and Gautam, R.K. 2007. Serum leptin levels in obese Indian children: Relation to clinical and Biochemical Parameters. Indian Pediatrics, 44: 257-262.
    10. Mehta, M., Bhasin, S.K., Agarwal, K. and Dwivedi, S. 2007. Obesity amongst affluent adolescent girls. Indian Journal of Pediatrics. 74 (7): 619-622.
    11. Siddique, L.S., Nahar, S and Parvin, T. 2015. Frequency of High Body Mass Index in School-going Children in Dhaka City. University Heart Journal. 10(1): 23-26.
    12. Dyson, P.A., Anthony, D., Fenton, B., Matthews, D.R and Stevens, D.E. 2014. High rates of child hypertension associated with obesity: a community survey in China, India, and Mexico. Pediatrics and International Child Health. 34(1): 43-49.
    13. Ogden, C.L., Carroll, M.D., Kit, B.K and Flegal, K.M.. 2014. Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association. 311(8): 806-814.
    14. Berge, J.M., Rowley, S., Trofholz, C., Rueter, M., MacLehouse, R.F and Neumark-Sztainer, D. 2014. Childhood Obesity and Interpersonal Dynamics during Family Meals. Pediatrics. 134(5): 923-32.
    15. Shi, E.K., Lee, H.S. and Lee, Y.K. 2004. Effect of Nutrition Education Program on Obese Children and Their Parents(2): Focus on Nutrition Knowledge, Eating Behaviors, Food Habits, and Nutrient Intake. Korean Journal of Community Nutrition. 9)5): 578-588.
    16. Engels, H.J, Gretebeck, R.J., Gretebeck, K.A. and Jimenz, L. 2005. Promoting healthful diets and exercise: efficacy of a 12-week after-school program in urban African Americans. Journal of the American Dietetics Association. 105(3): 455-4599.
    17. Wadden, T.A and Stunkard, A.J. 2002. Handbook of Obesity Treatment. New York: The Guilford Press; 2002.
    18. Berry, D., Sheehan, R., Heschel, R., Knafl, K., Melkus, G. and Grey, M. 2004. Family-based interventions for childhood obesity: A review. Journal of Family Nursing. 10:429-449.
    19. Omar, K.O.A. 2000. Meal planning and its relation to the nutritional status of preschool children. Roczniki Panstwowego Zakladu Higieny. 51(2): 163-166.

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