Factori legaţi de stilul de viaţă pentru obezitatea infantilă în preadolescenţă

Introduction

Lifestyle is the designative pattern and manner of living that an individual or group uses to meet their biological, economical, emotional and social needs that typically reflects their attitudes, believes and values. Childhood is the period of human lifespan between infancy and adolescence, extending from the ages of 1 to 2 years old, and from 2 to 13 years old. Obesity is defined as an abnormal or excessive fat accumulation that presents a risk to health⁽²⁾. Childhood obesity is a serious and a rising public health issue that has affected the health of people in developed and developing countries⁽⁴⁾. In 2019, 108 million children were estimated as obese around the world. The majority of them are found in Asian countries⁽³⁾.

Most of evidence-based research done on childhood obesity reveals that lack of physical activities and dietary factors are associated with childhood obesity. Also, deficiency of healthy foods and poor quality of diet influence childhood obesity⁽⁸⁾. Obesity is a major health problem worldwide, and it is recognized as a key risk factor for coronary heart disease, hypertension, diabetes, and many other health problems⁽⁶⁾. Obesity prevalence varies among girls and boys between 8 to 10 years old in Sri Lanka, reaching 4.3% and 3.1%, respectively⁽⁵⁾. Lifestyle changes towards healthy diet, increasing physical activities and reducing sedentary activities are helpful for preventing and treating obesity, as this has become a major health problem⁽¹⁷⁾.

When considering the European countries, the national health and the nutritional survey databa­ses offer alarming statistics. A rapid increase in the prevalence of obese children is also noticed in the United States of America. In 2020, nearly 8% of children 4 to 5 years old and 10% of preschool children were obese in the US⁽¹⁵⁾. Regarding the prevalence of childhood obesity in developing countries, it varies between 41.8% in Mexico, 22.1% in Brazil, and 19.3% in Argentina⁽⁶⁾.

In Asian countries, previous studies showed that the frequency in obese school children aged 6 to 14 years old increased from 5% to 10% in Japan⁽¹²⁾. Also, a Chinese study revealed that physical activity, sleep patterns, screen time and eating habits are four modifiable lifestyle behaviors that are related with childhood obesity⁽¹³⁾. Another study, performed by Wang et al., showed that unhealthy dietary behaviors and sedentary lifestyle were significantly associated with obesity in China⁽¹⁶⁾. A recent study was done in Sri Lanka, by Gunawardhana et al., in 2021, on physical and psychological quality of life in children with obesity. According to their findings, obesity appeared to have a higher impairment on the physical quality of life. Furthermore, this study found a lack of regular exercises relatively affecting the quality of life⁽⁵⁾.

Childhood obesity has reached “epidemic levels” in developed as well as developing countries. The global prevalence of childhood obesity is over 41 million in children under the age of 5 years old in 2020. Also, 124 million children, aged between 5 and to 19 years old, were estimated as obese by WHO in 2019, and 108 million children worldwide were estimated to be obese, the majority of them from Asia⁽⁶⁾. Obesity is a risk factor for many non-communicable diseases, such as cardiovascular diseases, hypertension, atherosclerosis and diabetes. These diseases impact the children’s physical and psychological health. Obesity and its related diseases can be largely preventable. The causes of these are a major issue in the present society, and they can be successfully preventable.

This study is conducted to examine the related factors for childhood obesity. Obesity and its related diseases can be largely preventable. Thus, obese children can improve their health by preventing further complications by using the knowledge of obesity prevention. Researchers are able to uplift the knowledge of children and parents regarding obesity, its prevalence, the related factors, complications and management. Further steps can be taken to modify children’s dietary habits and physical activities through teaching sessions. By encouraging children to improve their levels of physical activities and healthy dietary habits, the overall health of children can be enhanced.

Childhood obesity and its related diseases are a significant burden on healthcare system. Increased mortality and morbidity are associated with obesity, due to its impact on type 2 diabetes and cardiovascular diseases. More recent research has found that, in addition to changes in physical activity and caloric intake, emotional, social and psychological factors must be addressed in order to provide effective treatment to obese children. The primary prevention and control of obesity are based on the identification of risk factors contributing to the rapid increase of obesity. In order to promote a holistic approach to obesity treatment, it is necessary to examine the existing evidence and compile it, in a form that is easily accessible, as well as informative for the use of medical healthcare professionals.

This study aimed to examine lifestyle-related factors for childhood obesity. It is very important and necessary to modify lifestyle factors in preventing obesity. The general objective of this study is to examine lifestyle-related factors for childhood obesity among 9 to 11 years old obese children in a nutrition clinic in Teaching Hospital Kurunegala, Sri Lanka.

Methodology

The research approach and design

This study is based on a quantitative research approach and descriptive design.

Research setting

The study was performed in a nutrition clinic from the Teaching Hospital Kurunegala (THK) in Sri Lanka. The hospital is under the supervision of Ministry of Health and the direct purview of the line ministry in Sri Lanka. THK is classified as a tertiary care hospital and is the only one of its kind in the North Western Province. This hospital has 72 wards and 2300 beds. THK provides many types of medical services such as medical, surgical, cardiology, pediatric, gynecology, obstetrics, orthopedic, ENT, nutrition clinic, etc. In the nutrition clinic, there are five nursing officers, four medical officers, and 150 registered obese children. Lifestyle-related factors for childhood obesity can be assessed due to a large number of people coming to the nutrition clinic in Teaching Hospital Kurunegala and cover most of the area in the Kurunegala district. Also, no such study has been conducted in this area before. Therefore, the researchers selected this area.

Population and sample

The study was performed on a pediatric population aged between 9 and 11 years old, diagnosed with obesity and who were admitted to the University Hospital Kurunegala. The total registered children were 200. Sample calculation was done with a confidence level of 95% and error rate considered as 5%. The sample was chosen from the target population by using convenience sampling technique. The study sample of 131 resulted from the sample calculation method of registered obese children among 9 to 11 years old from the nutritional department of the Clinical Hospital Kurunegala. The inclusion criteria of this study were represented by obese children between 9 and 11 years old who were registered in the nutrition clinic of THK. The exclusion criteria were represented by children who had disabilities, hormonal problems, diabetes mellitus, or used steroid medications.

Data collection method

The self-administered questionnaires including eleven questions were handed over to each child admitted in the nutritional department. Before distributing the research questionnaire, the authors explained the research study and the data collection procedure to the children and their parents. Then, the informed consent was obtained from all participant’s parents. Children were asked to complete the questionnaire with the help of their parents. Each child was identified by a code number to protect privacy and confidentiality of the participants and their given information.

Description of the tool

The questionnaire had main three sections: demo­gra­phic data, dietary habits, and physical activity in­volve­ment. Information regarding age, physical acti­vity (including sports participation, modes of travel to school, regular exercises), dietary habits (inclu­ding consumption of snacks and consumption of sugar sweetened beverages) and self-reported height and weight were collected. The used international standard age adjusted Body Mass Index (BMI=weight/height, weight in kilograms, and squared height in meters) information about physical activities were collected by asking how long the child used to spend on exercises and sport activities. The responses regarding exercises were classified as 10 minutes per day, 15 minutes per day, and 20 minutes per day. The responses regarding sports participation were classified as two hours per day, two to three hours per day, equal or more than three hours per day. Children’s modes of travel to school were recorded as active transport (walking or cycling) and inactive transport (public transport or private vehicle). Information about student’s dietary habits and patterns were collected with their help of their parents. Frequency of snacks was recorded as one to two times per day, three to four times per day, five times per day, and more than five times per day. Sugar sweetened beverage consumption was classified as less than two cups per day, two to five cups per day, five to seven cups per day, and more than seven cups per day. Reliability and validity were checked before the questionnaire was disseminated among participants.

Ethical consideration

Ethical approval was obtained from the ethics review committee of THK. The permission letter for data collection was obtained by in charge nurse of the nutrition clinic. Voluntary participation was expected. Participants’ invitations were displayed on the notice board. The reason for the study was explained, and the participants were informed that there were no financial benefits. Written consent was obtained from the participants, and they were explained that they had no obligation to join. The participants were free from any harm or exploitation. Also, the participants were free to refuse or withdraw at any time without any risk. The protected privacy of human subjects while collecting, analyzing and reporting data was assured. A code number was given to research participants to maintain them anonymous. The information is available only to researchers and supervisors. All information was destroyed after the study. Research findings are shared with participants and used for educational purposes.

Data analysis

A total of 131 obese children were examined for the study, each of them included in the 9 to 11 years old age category. The quantitative data were collected by using self-administered questionnaire from children who registered in the nutrition clinic in Teaching Hospital Kurunegala. The data were analyzed by using SPSS (statistical package for the social sciences) software 25^th version. This software package is a widely used program for statistical analysis in social sciences. The quantitative data analysis was carried out using frequency tables and charts. Under the quantitative data analysis, each variable was examined, and we discussed the distribution of those variables such as age, BMI, physical factors and dietary factors. Finally, the researcher analyzed the physical factors and the dietary-related factors for childhood obesity.

Results

A total of 150 obese children were selected, but only 131 fully responded. Therefore, the response rate was 86.6%. The findings of the study were categorized according to demographic data and meeting the specific objectives such as dietary factors and physical factors related to childhood obesity.

The classification for Body Mass Index (BMI), according to the national standards, is the following: underweight (<18.50), normal weight (18.50 to 22.90), overweight (23 to 26.90), and obesity (≥27). The sample population’s age distribution and BMI are disclosed by the descriptive statistics. According to the sample’s average BMI of 29.26, most of the people were considered overweight. Roughly half of the sample group had a BMI below this value, while the other half had a BMI beyond it, according to the median BMI of 29. Values comparatively close to the mean, the variance of 1.34 and a standard deviation of 1.15 demonstrate the degree of dispersion or variability in the BMI data. Regarding age, the standard deviation of 0.78 and a mean of 10.28 years old show a reasonably stable age distribution with the average, falling between 9 and 11 years old. These findings offer valuable insights into the BMI and age characteristics of the sample population, facilitating further analysis and understanding of health-related trends or interventions within this demographic category.

Dietary factors related to childhood obesity

Table 2 shows the frequency distribution of children’s weekly habits of consuming instant meals, broken down by the quantity of cups consumed. Among the 131 participants in the sample, 3% reported using between two and five cups of instant food per week, 27.5% reported drinking between five and seven cups, and the majority (70.5%), reported consuming more than seven cups. The aforementioned data offer valuable insights into the diverse consumption patterns of the sample population. Noteworthy, a notable proportion of the population exhibited a high frequency of consuming fast food, which may suggest an important dietary pattern within this group.

Regarding the mode of transportation to school, presented in Table 2, just 3.8% of the respondents said they used to walk to school, compared to the overwhelming majority (96.2%) who said they used a vehicle. This suggests that a sizable proportion of the population polled relied heavily on cars for mobility, which may be explained by elements like accessibility, the distance to school, or cultural preferences that affect travel choices.

Also, 95.4% of the respondents did not report participating in sports, whilst 4.6% of respondents said they did. Comparably, of those who answered questions on how many hours they played, 95.4% said they didn’t play, and only 4.6% said they played for two hours. Concerning exercise participation, 92.4% of the respondents did not exercise, whilst 7.6% of respondents said they did. These results point to areas that could be targeted for boosting physical activity and health awareness, because they indicate a low level of sports, play and exercise involvement among the studied population. It was found that only 7.6% of the children used to participate in exercises, while 92.4% did not participate. There were only 10 children who used to participate in exercises, but they also spent less time (Table 2).

Discussion

Researchers can take a significant step towards preventing obesity by studying and analyzing the factors that influence the occurrence of childhood obesity. Dietary habits and physical activities are major related factors for childhood obesity. The majority of children have an unhealthy diet and they engage less in physical activities. Previous studies revealed a regular sugar sweetened beverage consumption among children over the recent decades. Several epidemiological studies have found a positive link between sugar sweetened beverage consumption and long-term weight gain and obesity­. According to our findings, 65% of obese children used to have sweetened drinks more than seven cups per week, and 27.5% of obese children used to have five to seven cups per week. Only 3.1% of children used to have sweetened drinks two to five cups per week. Also, according to a study performed in China about fast food consumption and its associations with obesity, it was found that 50% of the included children reported having consumed western fast food and Chinese fast food at least one time per week over the past three months. The study found that 11.1% of those children were obese, while 26.2% were overweight or obese⁽⁷⁾. Compared with our study, the majority (71%) of obese children used to consume fast food more than five times per week. Only 5.4% of the sampled children used to eat fast food for only three or four times per week⁽¹⁰⁾.

When taking a step towards searching how physical activities influence childhood obesity, most of obese children were less physically active. In this study, three types of physical activities were examined: the mode of traveling to school, the level of activities, and exercise involvement.

This is one of the factors that are most significantly linked to childhood obesity. Regarding sedentary behaviors, each additional hour of watching television per day increase the prevalence of obesity⁽¹⁾. A Canadian study reports that active play levels are insufficient, and children spend less time in outdoors than children of previous generations. The findings of the paper imply that a lack of activity contributes to the childhood obesity crisis⁽⁹⁾. Watching television was also associated with obesity in children who spent more than 11 hours per week in front of the television⁽¹⁾. Sedentary beha­vior patterns increase the risk of being obese – more than 60% of obese incidence can be linked to excess television viewing time⁽¹⁴⁾. Compared to our study, it was found that most of obese children (94%) did not use to participate in any sports at any time. In summary, the overall findings of this study revealed that children who have bad dietary habits and less physical activity are more prone to being obese⁽¹⁾.

The findings of our study align with those from other international studies performed on the same issue.

Conclusions

This study explored how eating habits and lack of physical activity influenced childhood obesity.

The die­tary habits were examined investigating snacks or fast foods consumption per week and sugar sweetened beverages consumption per week by the obese children from the nutrition clinic from the Teaching Hospital Kurunegala. Also, their physical activity level was examined investigating the mode of transport to school, the participation for sports activity, and engaging in regular exercises.

The study findings revealed that most of the obese children went to school by public and private transportation. Only a few used to walk to school.

Furthermore, the majority of the obese children did not participate in any sports activity. According to our findings, most of the obese children seem to be physically less active during the day time.

When exploring their dietary habits, the majority of obese children used to eat snacks and fast food more than seven times per week. Most of them used to consume sugar beverages much more times per week.

However, the findings of this study showed that bad dietary habits and being less active in childhood lead to being obese or overweight.

Limitation of the study

The nutrition clinic was not functioning well, and the attendance of the participants was low. Also, the sample size was dropped down from 150 to 131. Due to these reasons, the researchers were unable to collect and analyze the data within the allocated time plan.

Recommendations of the study

Uplift the knowledge of healthcare professionals and health education programs can be launched to prevent childhood obesity. This has the potential to lead to lifestyle changes and dietary modifications. Assisting the Ministry of Health in its efforts to prevent and control childhood obesity and use for prospective researchers are able to be recommended by this study.  

Funding: No funding to declare.

Corresponding author: Faiz M.M.T. Marikar E-mail: faiz@kdu.ac.lk

Conflict of interest: none declared.

Financial support: none declared.

This work is permanently accessible online free of charge and published under the CC-BY licence.