Obesity in Developing Countries

Obesity in Developing CountriesOverweight and Obesity The emerging Trend of childhood Mal sustenance in Urban digest in NigeriaAbstractBackground Overweight and corpulency initially thought to be the problem of the developed countries is rapidly rising in the developing countries constituting a graduate(prenominal) proportion of nutritional problem in these countries. Several factors, including changing life style and improved economic power are believed to contribute to this trend. This pattern if uncurbed is known to lead to several medical complications and hence the need to assess the burden of this condition, factors contributing to the rise and possible ways of reversing the trend.Method Four century and twenty primary school children from state-supported and clandestine schools were selected development multistage stratified random sampling. Relevant information were obtained using a questionnaire, and anthropometric indices were recorded. Data obtained were analysed us ing SPSS version 16, and frequencies were compared using Chi square.Result Seventy three (17.4%) of the pupils were found to be hard/obese. Pupils from privy school accounted for majority of these fictitious characters with 28 (13.3%) and 29 (13.8%) of them being gruelling and obese respectively. High socioeconomic class and consumption of faculty dense diet were importantly associated with high prevalence of lowering/obesity (P last and Recommendation Prevalence of stoutness/obesity among primary school pupils is quite high in Lagos, Nigeria. High socioeconomic class, consumption of energy dense pabulum and lack of adequate physical activities appear to be major factors contributing to this high prevalence. insane asylum of cursory school meal and mandatory physical act in all the schools would go a long way in imbibing healthy eating and life style pattern into these children. Public discernment and campaign on the importance of healthy life style and complications a ssociated with overweight and obesity would probably reverse the trend.Key Words Overweight, Obesity, Primary School PupilsIntroductionMalnutrition is a serious globe health problem that is caused by either deficient or excess intake of nutrients in relation to requirements. Under nutrition (Nutrient deficiency) has been the prevalent pillow slip of malnutrition in developing countries like Nigeria.1-3 This has been attributed to the synergistic interaction between several factors, most importantly, inadequate nutrient intake and infection.4-6 This is non the case with developed countries like the United States of America (USA), where over-nutrition is a major challenge amongst the school aged children. Studies done in the USA on the overweight situation and eating patterns among adolescents showed that the prevalence of over-nutrition was higher amongst those from a low socio-economic class.7-9Recently, overweight thought to be the problem of the developed world is spreading to the developing world.10 Several studies in Africa and other developing countries stick documented an emerging trend of malnutrition with overweight and obesity increasing at an alarming rate in comparison to below nutrition.10-12 However, in these developing countries, contrary to the determination in USA, overweight and obesity appear to be commoner among the high socioeconomic class.13-15 The effect of urbanization and the associated sort in life style have been shown to contribute immensely to the current trend of malnutrition in the developing countries.16,17 However, children of low socioeconomic status from much(prenominal) urban centres remain strongly associated with under nutrition rather than over nutrition.18 This further underscores the central role of socioeconomic status in malnutrition.The increasing rate of overweight/obesity entertains that obesity-related chronic diseases are likely to become common among the children. Being overweight is known to significa ntly increase the risk of asthma, Type 2 diabetes, gallstone, heart disease, high blood pressure and several other diseases.19 This will further impose a great challenge to the already over stretched health care system in the developing countries.We thus aim to assess and compare the prevalence of overweight/obesity among primary school pupils attending universe and close schools, in Ikeja Local administration area of Lagos and to identify common factors associated with overweight. The information generated would be useful in guiding the concerned authorities in designing appropriate interventions in the various schools.Materials and MethodsStudy area The ruminate was carried out in usual and private primary schools in Ikeja Local Government Area (LGA) of Lagos State Nigeria. Ikeja is the capital city of Lagos state, the most populated and urbanized state in Nigeria with over 10million residents.20There are 114 immortaliseed private primary schools and 32 in the public eye(pr edicate) primary schools in Ikeja Local Government Area.Study design It is a field-based cross-sectional descriptive studyStudy Population This consists of pupils in public and private primary schools in Ikeja LGA.Sample Size determination Calculated minimum sample size for each group of school is 200 pupils.Sampling regularity Multistage stratified random sampling was used. Based on the numbers of schools, three Private and two public primary schools were selected. Participants were selected randomly using the class register as a template in each of the classes of the schools selected.Exclusion criteria children whose parents denied con direct, children with obvious skeletal deformity and those with known chronic medical conditions like Chronic renal failure, heart disease etc.Ethical consideration Ethical clearance was sought and obtained from the Ikeja LGA Education Authority. The head teachers of the selected schools also gave well informed expressive laudation after receiving appropriate information. All the selected pupils were given consent form and introductory note to the study to their parents for their signature or thumb print. There was no consequent for the pupil if he or she refused to participate or parents denied assess. Data obtained were treated with confidentiality and only for the purpose of this research.Study procedure A structured questionnaire was used in collection of relevant information required to meet the objective of the study. All the participating pupils were interviewed at school, piece of music the section to be completed by the parents were sent through their wards and were returned the following day. Information obtained included socio-demographic data like age, sexual activity, parents occupation, average monthly income and educational attainment. Information on dietary intake include type of diet, frequency and 24 hours dietary recall. Involvement in exercise and physical activity were also sought. Socioeconomic statu s was assessed using the model by Ogunlesi et al 21, while the dietary pattern of the child was assessed using food frequency questionnaire (FFQ). Weight was measure using a bathroom weighing scale with sensitivity of 0.5KG while height was measure using a stadiometer. Nutritional status was determined using the Z- score system in accordance with National Centre for Health Statistics/ World Health Organization (WHO) reference value.22Data analysis The data obtained were entered into and analysed using EPI INFO version 3.5.1. Tables were used in data presentation. Chi square and Fishers Exact test were used in comparing frequencies.RESULTSA total of 420 children were studied, 210 pupils from each group. The children from the private schools were younger with a mean age of 7.71.9 years as against 10.32.6 years for those in public school (t=11.58, p=2=305.34, p=The dietary pattern among the two study groups were significantly different 90 (42.9%) pupils from the private school consumed beef daily as against 49(23.3) from the public schools. Similarly, approximately half 103(49.1) of the pupils from the private school eat white prick daily as against 45 (21.4%) from the public schools. Seventy five (35.7%) and 29 (13.8%) eats eggs while 44(21.0) and 11(5.2%) eat fried plantain and yam for public and private schools respectively. Again 25 (11.9%) and 13(6.2%) from private and public schools consume at least a can of coke/Fanta daily. These differences were all statistically significant P= Regarding extracurricular activity, the pupils in public schools engaged more in physical activity compared to those in private schools. One hundred and thirteen (53.9%) pupils from the public schools trek daily for a distance of at least one kilometre as against 8 (3.8%) pupils from the private schools. Similarly, 77(36.7%) pupils from the public schools engage in competitive sports daily as against 33(15.7%) from the private. The difference between the two groups regarding phys ical activity was statistically significant P= Table II shows the distribution of the study population by BMI percentile. The nutritional status varied significantly between the pupils from the public and private school. While under-nutrition was the predominant form of malnutrition in the public schools 33(15.7%), overweight and obesity predominated in the private schools 57(27.1%).Table III below show the effect of various studied variable on BMI percentile. The highest frequency of overweight was observed among those aged 5-6years while the least frequency was among those aged 11 and above. This pattern was statistically significant (X2=21.90, p= 0.01). Although more female pupils when compared to male pupils, were found to be overweight, but this was not statistically significant. More than half (50.9%) of the pupils of low socioeconomic class were undernourished while majority of overweight children (76.7%) were of high socioeconomic class. This pattern was statistically signi ficant (X2=150.0, p=DiscussionThe overall prevalence of 17.4% for overweight and obesity in this study is quite alarming though similar to the conclusions from previous studies.6, 12, 23 Owa et al12 reportage from Nigeria in 1997 found a prevalence of 18% for obesity among children aged 5-15 years using fat mass percentage and body mass advocator based on the US standard. Similarly, Mogre et al23 reported a prevalence of 17.4% for overweight and obesity from Ghana in 2013 among school aged children (5-14 years). This finding from this study and the others above further support the rising trend of overweight and obesity among children in developing countries and that the burden of the problem might not be different from that in the developed countries.24 However, other studies have found much lower prevalence for overweight/obesity. Adegoke et al 14 in 2009 reported a prevalence of 3.1% for overweight/obesity from Ile-Ife South West Nigeria using anthropometry, while Alkali et al 1 5 in 2015 reported a prevalence of 6.5% from Gombe in North eastern Nigeria. These lower prevalence reported by Adegoke et al(14) and Alkali et al15 may be due to the difference in socioeconomic status between the study-populations, while greater than 86% of our study population were either of middle or upper socioeconomic class, 48.2% of those studied by Adegoke et al14 were of low socioeconomic class with only 19.6% belong to the upper class. Although Alkali et al15 didnt give socioeconomic distribution of their study population but Gombe located in the North East of Nigeria is a diminutive town with small scale businesses and subsistence farming as major occupation compared to Lagos which is the most industrialized City in Nigeria. Furthermore, we studied children in primary schools only if but Adegoke et al14 as well as Alkali et al15 studied both primary and secondary school children. It has been severally documented that prevalence of overweight/obesity decreases in childre n with advancing age.25,26In contrast to the developed countries where overweight/obesity is commoner among the low socioeconomic class7-9, majority 56 (76.7%) of these overweight children in this study were of high socioeconomic class. This pattern is similar to findings from other studies from other developing countries13-15,27. This fact was further confirmed by the significantly higher incidence of overweight/obesity among pupils from Private schools compared to those from public schools. In Nigeria, Privates schools particularly in the urban centres charge exorbitant fees affordable only to the rich while public schools are usually free and attended by the low socioeconomic class. In this study, 83.8% of the pupil in public schools were of high socioeconomic class as against 1.9% of those in public schools.Several factors could be responsible for this increasing pattern of overweight/obesity among the affluent class in the developing countries. In the original place, the paren ts of these children are likely of the working class with little or no time to plan and prepare healthy food for them.28 It is also known that such parents in an effort to compensate for the deficient care constantly provide junk food and snacks for these children.29 Nutritional habit and pattern have been shown to influence the nutritional status of the society.30 These are further driven by aggressive advertising practises, relatively low cost of energy dense food and improved purchasing power which are now most prevalent in developing countries and conducive for the development of overweight and obesity and subsequently the associated morbidities.31 This is in agreement with the finding in this study from Lagos, the most urbanized State in Nigeria, in which Children from the private schools and of high socioeconomic status significantly consumed food of high energy density such as soft drink, egg, white bread, etc when compared to those from the public and low socioeconomic stat us.Sedentary life style has been well documented as a cause of overweight and obesity29,32,33 in children. Pupils from the private schools were significantly less involved in physical activities when compared to those from the public schools but engaged more in indoor(prenominal) activities like television viewing and computer games. Similar to previous studies, this practise was significantly associated with overweight and obesity. The low level of physical activity among those in private schools could be due to several reasons. Most of these children are usually driven in car to school by their parents or use the school bus. This is in contrast to the public school which lack school bus and majority, 53.9%, of the pupils trek to school daily. Secondly, while most public schools are usually sited in a planned location with enough berth for sporting activity the same cannot be said of the private schools which do not have enough space for outdoor activities with only 15.7% of the pupils engaged in competitive sports. Pressure on the pupils from affluent society for good academic performance including regular extra lessons at home after school hours could also contribute to lack of outdoor activities at home.In this study, overweight and obesity were higher among the younger age groups compared to the sr. pupils with the highest frequency of 18.2% among those aged 5-6years. Similar pattern of decreasing incidence with advancing age among children less than 13 years was also observed in a study from India25 and Saudi Arabia26. However, other studies have found a contrary pattern increasing incidence with advancing age34. The reason for this variability in finding is not clear.Females had slightly higher prevalence of overweight and obesity when compared to the male, though this difference was not significant. This is similar to the finding of Mohana et al 35 from India. The effect of gender on overweight and obesity in children remains inconclusive, while sev eral studies have found significantly higher prevalence among the female gender 34,36-38 others have reported significantly higher prevalence among the males.39-41 The reason for this variability is not clear but studies with higher female prevalence have suggested cultural factors as a possible explanation as female children in certain society mostly engage in indoor activities.Conclusion and RecommendationsThe prevalence of overweight and obesity among children living in urban centres in developing countries like Nigeria is quite high and is comparable to that in the developed country. This problem is mainly a problem of children from high socioeconomic status. Dietary pattern and sedentary life style are important factors contributing to the high prevalence among these group of children. In contrast, under-nutrition has remain a major problem among the low socioeconomic status. We recommend introduction of school meal program in both the public and private school to augment calor ie intake among the public school children and modulate same for those in private schools. Provision of sporting facilities must be do mandatory requirement for registering of private school and if already a requirement must be enforced on new and existing private schools. Finally, public enlightenment on the medical implications of overweight/obesity in children should be aggressively pursued by the relevant agencies before the complications begin to set in. interlocking of InterestThe authors had no conflict of interest whatsoever to declare