PREDICTORS OF OVERWEIGHT AND OBESITY AMONG SECONDARY SCHOOL STUDENTS IN PUCHONG SELANGOR, MALAYSIA. IJPHCS

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International Journal of Public Health and Clinical Sciences e-ISSN : 2289-7577. Vol. 6:No. 4 July/August 2019

Queen Esehi Ojo P., Suriani, I. , Huda, Z.Suhainizam M.S.

https://doi.org/10.32827/ijphcs.6.4.160

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Open Access: e-Journal

PREDICTORS OF OVERWEIGHT AND OBESITY AMONG SECONDARY SCHOOL STUDENTS IN PUCHONG

SELANGOR, MALAYSIA.

Queen Esehi Ojo P

²

, Suriani I

¹

*, Huda Z

¹

, Suhainizam MS

¹

1Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia

2Postgraduate Student, Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia

*Corresponding author: e-mail: si suriani@upm.edu.my https://doi.org/10.32827/ijphcs.6.4.160

ABSTRACT

Background: Childhood obesity is gaining a dramatic increase in developing as well as in developed countries. Childhood overweight and obesity in which adolescents are included have be known to have negative impact on both physical and psychological health.

Overweight and obese children are likely to stay obese into their adulthood and are more likely to develop non-communicable diseases. The objective of this study is to determine the occurrence and factors associated with overweight and obesity among secondary school students in Puchong Selangor Malaysia.

Materials and Method: A cross-sectional study design was employed. A self-constructed pretested questionnaire was used for the data collection. The questionnaire consists of six sections, which include: socio-demography characteristics, physical activity questionnaire, self-esteem scale, body parts satisfaction scale, body size perception scale and smoking status questionnaire. Weight and height were measured and converted to body mass index (BMI).

The study analysis was done using SPSS version 22. Basic descriptive analyses were carried out for the mean, median, frequency and percentage. Chi square test was used to test association between the variables. Multiple logistic regressions were used to determine the predictors of overweight and obesity among the respondents.

Result: The response rate was 100%. The respondents’ age was 13-17years and occurrence of overweight and obesity was 10% and 3.9% respectively. Out of the 281 students that participated in the study 164 were female (58.4%). Overweight and obesity was significantly associated with father’s education (χ2 = 9.697, df= 2, p=0.006), mothers education (χ2 = 7.448, df= 2, p= 0.023), body part satisfaction (χ2 =14.837, df= 1, p= 0.001) and body image (χ2 =6.745, df= 1, p= 0.009). Multiple logistic regression analysis showed that the predictors of obesity were age (AOR=2.049, 95% CL: 0.186, 0.835, p<0.007), body parts satisfaction (AOR=3.656, 95% CL: 1.729, 7.730, p<0.001) and body size perception (AOR=3.130, 95%:1.269, 7.718, p<0.014).

Conclusion: The significant predictors of overweight and obesity among study population were age, body parts satisfaction and body size perception.

Keywords: Overweight, obesity, association, predictors, secondary school, students.

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1.0 Introduction

Over the past century, there has been a dramatic increase in the prevalence of overweight and obesity levels both in developing and developed countries (Sahoo et al., 2015). Meanwhile the prevalence of overweight and obesity are becoming more of a health issue in developing countries than in developed countries (Hazreen et al., 2015). World Health Organization (WHO) reported that globally there are around 1.9 billion adults were overweight and 600 million were obese, while the prevalence of obesity among children has increased from 4.2%

in 90’s to 6.7% in 20th century(WHO, 2014). The prevalence of obesity among adolescents aged 12 to 19 years old had increased from 5% in 1980 to around 21% in 2012 (CDC, 2013).

Already 43 million children below the age of five were overweight in 2010 and this figure is projected to reach 60 million by 2020 (Garipagaoglu et al.,2009; de Onis et al.,2010).

Children are a relevant group as childhood lifestyle may track into adulthood and tend to influence weight status later in life, with almost 70% of obese children or adolescent becoming obese adults (Reilly, 2007). Prevalence of childhood obesity for developing countries in 2010 was 6.1% and is predicted to reach 8.6% in 2020 while for developed countries it was 11.7% in 2020 and predicted to be 14.1% by 2020 (de Onis et al., 2010).

Children and adolescents are experiencing an increase in non-communicable disease risk factors due to overweight and obesity and in addition, its consequence of chronic non- communicable diseases and disability ((WHO, 2011, Deren et al., 2018). These chronic conditions such as hypertension, diabetes and cancer require long term treatment, and are commonly associated with morbidity and mortality. Over 2.5 million deaths each year are attributed to obesity and its associated disease conditions; a figure which is likely to double by 2030 (WHO,2013)

In some regions of the world, Asia for example, the prevalence of obesity in 2010 was 4.9%

and is predicted to reach 6.8% by 2020 (de Onis et al., 2010). In South East Asia where Malaysia is located, about 300,000 deaths due to overweight and obesity where reported at the year 2011 (WHO, 2011). In Malaysia, the Third National Health and Morbidity Survey (NHMS III) in 2006 showed the prevalence of obesity to be 14% in adult 18 years and above while in children below 18 years was 5.4%. In 2017 NHMS III reported that about 44% of adolescents were overweight and 14% were obese in Malaysia (MOH, 2010 & MOH, 2017).

In the year 2016, the number of overweight children under the age of five has increased and was estimated to be over 41 million. Almost half of all overweight children under 5 lived in Asia while one quarter lived in Africa (WHO, 2016).

The history of overweight and obesity is not really understood and thought to be complex.

The factors that can be associated with overweight and obesity among adolescents or its contributing factors include diet, adequate physical activity, heredity, social factors, behavioural cultural, environmental or socioeconomic status (Crawford et al., 2012; CDC, 2016). The well-established causes of overweight and obesity are low physical activity, unhealthy diet, heredity factors, lack of awareness of the effects of health consequences of the problem or a combination of these factors (CDC, 2016). Health consequences of overweight and obesity specifically in childhood include non-insulin dependent diabetes, heart diseases (breathing difficulties), cardiovascular diseases and cancer which can be harmful and have a negative impact well into adulthood (Sahoo et al., 2015; Krushnapriya, 2019) WHO, 2016).

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In summary, overweight and obesity trauma can affect the quality of life and reduce good health, which also can cause substantial social, cultural and economic problems in developing and newly industrialized countries. The purpose of this study is to look at sociodemographic and psychological factors associated with and predictors of overweight and obesity among secondary school children in Puchong, Selangor.

2.0 Materials and Methods

This study was conducted at four secondary schools in Puchong district, Selangor, Malaysia.

A cross-sectional study design was used. The study population was the students attending the four selected secondary schools. The list of all students at the four secondary schools were used, which formed the sampling frame. The sample size calculated using the formula for hypothesis testing of two group comparisons (Lemeshow et al., 1990) was 281 after taking into account the design effect. Probability proportional to size sampling technique was used for the selection of respondents. Inclusion criteria were Malaysia citizen age 13-17 while those who refused to have their height and weight taken were excluded.

Data was obtained using a pretested structured self-administered questionnaire. Calculation of BMI was done using the formula of weight (kg) / height (m²). The BMI was then classified according to BMI cut-off points for children and adolescents according to WHO standard, namely; Severe thinness (< -3SD), Thinness-(3SD to < -2SD), Normal (-2SD to ≤ +1SD), Overweight (> + 1SD to ≤ +2SD) and obese (> + 2SD), which were later categorised into two groups namely ‘overweight and obese’ and ‘not overweight or obese’.

Data was analysed using IBM SPSS version 22. Descriptive analysis such as frequencies and percentages are presented. Chi square was used to determine the associations. Simple and multiple Logistic regression analysis were deployed to determine the predictors of

‘overweight and obesity’ among respondents using the ‘ENTER’ method. Significant variables at p < 0.05 were then selected and entered into the final model.

Ethics approval was obtained from Universiti Putra Malaysia Ethics Committee for Research Involving Human Subject (JKEUPM Ref No: FPSK(EXP16)P109) and permission to carry out the study was obtained from Ministry of Education Malaysia, Selangor Education Department, Principals of the selected schools and permission from their parents prior to data collection.

3.0 Result

Of the 281 respondents selected, all participated and completed the questionnaires, giving an overall response rate of 100%. Table 1 describes the socio-demographic characteristics of respondents. Highest percentages of the respondents belong to the age group of 16 to 17 years old (65.5%), female (58.4%), Chinese ethnic group (46.3%), Buddha religion (38.4%), father and mother with tertiary education (50.5%and 48.4% respectively). The median monthly

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income was RM 3000 with 33.5% having income of ≥ MYR6000. Regarding psychological factors, although majority (98.2%) had normal self-esteem but most were dissatisfied with body part and body size (79.1% and 60.5% respectively).

Table 1: Distribution of respondents by socio-demographic characteristics and psychological factors of respondent (N= 281)

Socio-demographic Frequency (n) Percentage (%) Median (IQR) Age

13 – 15 16 – 17

97 184

34.5 65.5

16.14 (2.04)

Gender

Male 117 41.6

Female 164 58.4

Ethnicity

Malay 95 33.8

Chinese 130 46.3

Indian 48 17.1

Others 8 2.8

Religion

Islam 94 33.5

Buddha 108 38.4

Hindu 36 12.8

Christian 34 12.1

Others 4 1.4

No religion 5 1.8

Father’s Education Level

No formal education 3 1.1 Primary education 12 4.3 Secondary education 124 44.1 Tertiary education 142 50.5 Mother’s Education Level

No formal education 10 3.6 Primary education 13 4.6 Secondary education 122 43.4 Tertiary education 136 48.4 Household income Range

(MYR)

3000 (4000)

≤ MYR1499 51 18.1

MYR1500 – 2299 85 30.2

MYR2300 – 5999 51 18.1

≥ MYR6000 94 33.5

Self Esteem

Low Self Esteem 5 1.8

Normal Self Esteem 276 98.2

Body part satisfaction

Dissatisfied 202 71.9

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Socio-demographic Frequency (n) Percentage (%) Median (IQR)

Satisfied 79 28.1

Body size Perception

Dissatisfaction 170 60.5

Satisfaction 111 39.5

Table 2 presents the percentage of respondents according to BMI classification. About 10% of the respondents were overweight and 3.9% were obese.

Table 2: Percentage of respondents according to BMI classification (N=281)

BMI by age Classification Frequency (n) Percentage (%)

z > +2 SD (Obesity) 11 3.9

+1SD < z < +2SD (Overweight) 28 10.0

-2SD < z < +1SD (Normal Weight) 214 76.2

-3SD < z < -2SD (Thinness) 25 8.9

z < -3SD (Severe thinness) 3 1.1

Tables 3 shows the association between socio-demographic characteristics and psychological factors with overweight and obesity. There are significant association between ‘overweight and obesity’ with age (χ²=11.981, p=0.001), fathers level of education (χ²=9.697, p=0.006), mothers education level (χ²=7.448, p=0.023), body part satisfaction (χ²=14.837, p=<0.001) and part size perception (χ²=5.112, p=0.033).

Table 3 Association between socio-demographic characteristics and psychological factors with overweight and obesity

Overweight & Obesity

Variables Yes

n (%) 39 (13.9)

No n (%) 242 (86.1)

χ² Df p- value

Age 13 - 15

16 - 17 Gender

23(23.7) 16(8.7)

74(76.3) 168(91.3)

11.981

2.778

1

0.001*

0.096

Male 21(17.9) 96(82.1)

Female 18(11.0) 146(89.0)

Ethnicity 0.344 2 0.826

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Malay 12(12.6) 83(87.4)

Chinese 20(15.4) 110(84.6)

Indian 7(14.6) 41(85.4)

Religion Islam Buddha Hindu Christain Others

12(12.8) 15(13.9) 3(8.3) 7(20.6) 2(22.2)

82(87.2) 93(86.1) 33(91.7) 27(79.4) 7(77.8)

2.828 4 0.587

Father’s Education 9.697 2 0.006*

No formal/ Primary education

2(13.3) 13(86.7) Secondary/ Tertiary

education

37(13.9) 229(86.1)

Mother’s Education 7.448 2 0.023*

No formal/ Primary education

2(8.7) 21(91.3) Secondary/ Tertiary

education

37(14.3) 221(85.7)

Household income 1.286 3 0.732

≤ MYR1499 45(88.2) 6(11.8)

MYR1500 – 2299 75(88.2) 10(11.8) MYR2300 – 5999 44(86.3) 7(13.7) ≥ MYR6000

Self esteem Low self-esteem Normal self-esteem Body Parts Satisfaction Dissatisfied

Satisfied

Body Size Perception Dissatisfied

Satisfied

78(83.0) 1(20.0) 38(13.8) 21(26.6) 18(8.9) 30(17.6) 9(8.1)

16(17.0) 4(80.0) 238(86.2) 58(73.4) 184(91.1) 140(82.4) 102(91.9)

14.837

5.112

1

0.529

<0.001*

0.033*

*significant at p value <0.05

Table 4 shows that the odds of being ‘overweight or obese’ were 3 times higher among respondents who are within the age group of 16-17, respondents who were dissatisfied with their body parts and dissatisfied with their body size perception. These three variables were entered into the final model. Results show that age, body size perception and body parts satisfactions are the predictors of overweight and obesity among the study population. The odds of being ‘overweight or obese’ were 4 times higher among respondents who were dissatisfied with their body parts, 3 times higher among respondents who were dissatisfied with their body size perception and 2 times higher among age group 16 -18 year old.

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Tables 4: Simple & Multiple Logistic Regression model showing predictors of overweight &

obesity (N=281)

Simple Logistic Regression Multiple Logistic Regression

Variables

Crude Odds Ratio

95% CI

Lower Upper p- value

Crude Odds Ratio

95% CI

Lower Upper

p- value

Ages group

[13 - 15] 1

16 -17 3.264 1.630 6.534 0.001 2.049 0.186 0.835 0.007 Father’s Education

[No formal/ Primary] 1

Secondary/ Tertiary 1.050 0.228 4.844 0.950 Mother’s Education

[No formal/ Primary] 1

Secondary/ Tertiary 1.758 0.396 7.813 0.459 Body Satisfaction

[Satisfied] 1

Dissatisfied 3.701 1.847 7.418 <0.001 3.959 1.901 8.246 < 0.001 Body size perception

[Satisfied] 1

Dissatisfied 3.016 1.270 7.163 0.015 2.977 1.216 7.718 0.014

4.0 Discussion

This study shows that there is still need to pay attention to the prevalence and factors associated with overweight and obesity particularly in Puchong, Selangor, Malaysia. When comparing the obtained results to the national prevalence of obesity report, the overall prevalence of overweight and obesity obtained in this study among secondary school students were 10% and 3.9% respectively, which is low as compared to that reported by the National Health and Morbidity Survey (MOH, 2017) in Malaysia, where overweight and obesity was 44% and 14% respectively. A slightly similar result was reported from an earlier study on prevalence of overweight among secondary students aged 13 -17 in Klang district which showed the prevalence of 11.4% overweight and 8.2% obesity (Rampal et al, 2007). However the result is lower than a study in Malaysia among adolescents in an Arabic secondary school which showed 21.3% for overweight and 6.9% for obesity (Eltayeb, Salmiah & Suriani 2016). A systematic review on the prevalence of overweight and obesity among adolescents in Malaysia 1990-2014 revealed that the prevalence of overweight ranges between 4.5 to 69.0% and obesity ranges between 3.5 to 16.0% for both genders (Hazreen et al., 2015). The difference could be attributed to different sociodemographic characteristics distribution such as ethnic group distribution.

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This study revealed a higher percentage of overweight and obesity among the younger age group of 13 ≤ 15 (23.7%) compared to those within the category of 16 < 18 (8.7%), and it was statistically significantly associated with overweight and obesity in this study. The result agrees with the study done by Rampal et al., (2007) in Malaysia among secondary school students in Klang district which showed that obesity decreases as age increases from childhood, but it disagrees with other reported results in Malaysia which show no association (Eltayeb, Salmiah & Suriani, 2016). The variation in the prevalence of overweight and obesity with age may be in line with the fact that there are physiological changes during the early pubertal ages (Siervoge et al, 2003). Further analysis shows that age was a significant predictor of overweight and obesity in this study.

A higher percentage of overweight and obesity was found among males compared to females.

This finding agrees with a survey in Indonesia which showed higher prevalence rates in boys compared to girls among children, but higher in females in the adolescent and adult age groups. (Rachmi et al., 2017), as well as a recent national survey in United States among which showed that the trend of differences in prevalence between men and women are diminishing in the period between 1999–2000 and 2009–2010, with the prevalence of obesity among men reaching the same level as that of women. Age differences in obesity prevalence varies between men and women (Ogden et al., 2012). However, there is no significantly association between gender with overweight and obesity in this study and further analysis showed that gender is not a significant predictor of overweight and obesity among the respondents after logistics regression was done. This finding corresponds with a similar results of a study among secondary school students in Slemani City Kurdistan Region, Iraq which reported higher prevalence overweight and obesity among males but no significant gender associations (Qadir et al ,2015), also seen following a review of prevalence in five Arab countries ie. Kuwait, Libya, Palestine, Syria and United Arab Emirates (Musaiger et al., (2013).

This study revealed that psychological factors (self-esteem, body part satisfaction and body size perception) have a strong relation with overweight and obesity. Based on this study, respondents with low self-esteem were found to have higher prevalence of overweight and obesity. However, there were no significant association between self-esteem level with overweight and obesity. Body image dissatisfaction is divided into body parts satisfaction and body size perception. The result also reveals that those dissatisfied with both body parts satisfaction and body size perception was found to have highest percentage of overweight and obesity compared to those who are satisfied. It tallies with the findings of a study carried out among adolescents in Kajang, Malaysia (Rezali et al, 2012) which is a district near this study location. It is also similar to the results of a study among adolescents in United States (Ali et al., 2010).

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5.0 Conclusion and recommendation

The prevalence of overweight and obesity found in this study among secondary school students in Puchong is still high. The study also showed that the predictors of overweight and obesity were age, body parts satisfaction and body size perception. Intervention programs should be employed to inform adolescents on how to appreciate their body parts and body size perception at all age in other to reduce this public health epidemic of overweight and obesity.

Acknowledgement

The authors would like to thank the Ethical Committee for Research involving Human Subjects of the Universiti Putra Malaysia for ethical approval and all the schools for their support and contribution in carrying out this study.

Ethical approval was sought and obtained from the Medical Research Ethics Committee of Faculty of Medicine and Health Sciences, UPM; Jawatan Kuasa Etika Universiti Untuk Penyelidikan Melibatkan Manusia (JKEUPM Ref No:FPSK(EXP16)P109) . Approval and permission to conduct the study was obtained from Ministry of Education Malaysia, Selangor Education Department and Principals of the schools. The consent forms were also obtained from the parents through parents/guardian consent form, and the researcher gave each participant a clear verbal explanation on the purpose and procedures of the study.

Declaration

Author(s) declare that this article is our original work and has never been published before now.

Authors contribution

Author 1: research concept and design, preparing research proposal, data collection, data analysis and writing the manuscript.

Author 2: research concept and design, supervising the research process, actively involved in the data analysis and reviewing the manuscript and final editing.

Author 3: supervising the research, reviewing the manuscript.

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