ABSTRACT

Overweight and obesity is a health hazard and is an emerging public health problem. The objective of this study was to determine the pattern of overweight and obesity and influencing factors among University students in The North Central town in Anambra state of Nigeria. This was a descriptive cross-sectional study. Subjects were selected randomly using multistage sampling technique. 250 adults aged 12-19 years from three schools were studied. Calibrated mechanical weighing scale was used to measure their weights. Heights were measured with rigid meter rule. A semi-structured, self- administered questionnaire was used to collect data on their physical activities, dietary habits and parent’s occupation. Mean age of the adults was 15.6 years ± 1.75. Overall prevalence of overweight and obesity among them were 5.6 percent and 3.2 percent respectively. Females were more overweight than males (7.8% and 3.3% respectively), and also more obese (4.6% and 1.7% respectively). Prevalence of obesity was highest in the 18- 20 year age group (5.6%). Prevalence of overweight and obesity (combined) was higher in private school (10.7%) than in public schools (6.0%). Frequent consumption of soft drinks, meat pie, biscuit, sweet; and frequent television watching promoted obesity (P<0.001, P<0.001, P<0.05, P<0.05 and P<0.001 respectively). Occasional physical exercise, promoted overweight (P<0.05). Gradual increase in the prevalence of overweight and obesity was found. However these are still much lower than in developed countries. Faulty dietary eating habits and sedentary activities are major culprits. This constitutes a major public health challenge. The study recommended that Health education in schools, and media campaigns are needed. Policy makers, Health professionals, School authorities, Non Governmental Organizations (NGOs) and National. Agency for Food and Drug Administration and Control (NAFDAC) should be involved in primary preventive actions against childhood overweight and obesity.

CHAPTER ONE

INTRODUCTION

Background of the study

Obesity is the most common nutritional disorder in affluent societies. Obesity may be defined as a condition in which there is excessive amount of body fat ¹. It is an abnormal growth of the adipose tissue due to an enlargement of the fat cells (hypertrophic obesity) or an increase in the number of the fat cells (hyperplastic obesity) or a combination of both ². Excess fat accumulates because there is imbalance between energy intake and expenditure.

The significance of obesity requires constant emphasis because it is associated with increased morbidity and mortality. It predisposes to the development of important diseases and diminishes the efficiency and happiness of those affected. Obesity is a chronic disease, prevalent in both developed and developing countries, and affecting children as well as adults.

Obesity is now so common that it is replacing the more traditional public health concerns including Undernutrition ². It is now a global phenomenon.

It is extremely difficult to assess the size of the problem and to compare the prevalence rates in different countries as no exact figures are available and also because the definitions of obesity are not standardized. However it has been estimated to affect 10 to 20 percent of children and adolescents in developed countries ³.

Overweight may be defined as an excess of bodyweight but not necessarily body fat; a body mass index (BMI) of 25 – 29.9 ⁴. Body Mass Index (BMI) is acceptable for determining obesity for children two years and older ⁵. Although the BMI number is calculated the same way for children and adults, the criteria used to interpret the meaning of the BMI number for children and teens are different from those used for adults. BMI age- and sex- specific percentiles are used ⁶. The Centers for Disease Control (CDC), has published tables for determining this in children 7. Overweight (but not obese) is a BMI between the cut-off values for overweight and obesity, and obese is a BMI greater than the cut-off value for obesity⁷. For normal weight, the BMI is lower than the cut-off value for overweight⁷.

STATEMENT OF THE PROBLEM

Obesity is a health hazard and a detriment to well-being which is reflected in the increased morbidity and mortality ². It is a key risk factor in the natural history of other chronic and non communicable diseases. Due to the rising prevalence of obesity in adults and its many adverse health effects, it is now being recognized as a serious public health concern ⁸.

The incidence of chronic diseases is escalating much more rapidly in developing countries than in industrialized countries. There is strong evidence that childhood obesity is also becoming increasingly prevalent in low-and middle-income countries ^9,10. Malnutrition and obesity co-exist in many developing countries ¹¹.

Obesity has many health complications. The first problems to occur in these obese children are usually emotional or psychological ¹². Childhood obesity can also lead to serious conditions such as diabetes mellitus, high blood pressure, heart disease, sleep problems and cancer ¹³. Other disorders include liver disease, early puberty or menarche, eating disorders such as anorexia, skin infections, asthma and other respiratory problems ¹⁴. Studies have shown that overweight children are more likely to grow up to be overweight adults ¹³. Obesity during adolescence has been found to increase mortality rates during adulthood¹⁵. In schools, obese adults often suffer from teasing, harassment and ridicule from their peers ¹⁶. At home they may also suffer harassment, discrimination and name-calling from their own family members and neighbours. These may lead to anxiety, depression ¹⁷, low self esteem, frustration and even withdrawal. A study¹⁸ has shown that college obesity is increasing, and that physical inactivity, disordered eating perceptions, and disordered behaviours are associated with increased rates of overweight and obesity. A 2008 study has found that children who are obese have carotid arteries which have prematurely aged by as much as thirty years, as well as abnormal levels of cholesterol. This emerging public health issue of increasing incidence of childhood obesity in developing countries will likely create an enormous socioeconomic and public health burden for poorer nations in the near future ²¹. Nigeria is a poor developing nation.

JUSTIFICATION FOR THE STUDY

Since it has been shown that interventions are not usually successful once overweight and obesity have occurred ²², it becomes important to generate and provide research information for policy makers, health care providers, parents and the general population, so that the problem could be identified in childhood and appropriate attention given at that early age. The developing trends in the factors that influence childhood overweight and obesity among our adults are definite health risks that require definite studies and data for planning interventions.

In Nigeria (as also in other developing countries) little is known about the prevalence of childhood overweight and obesity because of the limited number of studies available, particularly in the North Central States of Nigeria.

Nigeria needs more studies and data for reliable assessment of the problem of childhood overweight and obesity in Nigeria and for comparison of its prevalence with those of other regions of the world. Studies such as this research project are therefore necessary to further reveal this apparently hidden but important public health problem. The prevalence of childhood overweight and obesity and their association with chronic diseases in adulthood are still under appreciated in Nigeria because of inadequate studies, data and publicity. The college years are highly influential in shaping adult behaviours, particularly with regard to diet, physical activity, and other lifestyle habits. Interventions aimed at the college population may help reduce overweight and obesity during the transition from adolescence to adulthood and thereby prevent some of the long-term health consequences of obesity, which include coronary heart disease, hypertension, type 2 diabetes, and dyslipidemia ¹⁸. Identification of, and a clearer understanding of these risk factors may prove useful in the treatment of adolescent obesity by helping in the development of multifaceted interventions that not only address weight loss but also target the associated disordered behaviours ¹⁸.

Up to now, most national public health programs and policies, as well as national level research on children and adolescents in Nigeria appear to have focused mainly on under nutrition and its effects on survival, mortality, and development, in mothers and children. Since childhood overweight and obesity and their co-morbidities will continue to increase the impact of a number of risk factors for adult diseases, it is reasonable and important to increase knowledge and awareness about the prevalence of these disorders in Nigeria, which is still grappling with the public health effects of malnutrition and micronutrient deficiencies. This study will be an additional stimulus and contribution to these efforts.

In this period of Health Sector Reform, this study can equip stakeholders to make policies that will recognize and address the emerging challenges of childhood overweight and obesity in Nigeria in general. In particular, seminars could be organized with evidence of this research data in The North Central town, for adults and parents to initiate and stir up voluntary preventive health measures for themselves against these emerging childhood problems.

AIM OF THE STUDY

To determine the pattern of overweight and obesity among University students in the North Central of Nigeria.

SPECIFIC OBJECTIVES

1. To determine the prevalence of overweight and obesity among the secondary school

adults in the North Central.

2. To determine the age and gender differentials in the prevalence of overweight and obesity among these University students in the North Central town.

3. To identify factors influencing overweight and obesity among these adults.

4. To suggest ways of preventing overweight and obesity among the adults.