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The Prevalence of Obesity in School Children of Zahedan-Iran; Double Burden of Weight Disorders

AUTHORS

Fahimeh Soheilipour 1 , Atefeh Ghanbari Jolfaie 1 , Zeinab Pourzahabi 2 , Maryam Lotfi 2 , Maziar Moradi Lakeh 3 , *

1 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, IR Iran

2 Tehran University of Medical Sciences, Tehran, IR Iran

3 Gastro-intestinal and Liver Disease Research Center, Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, IR Iran

How to Cite: Soheilipour F, Ghanbari Jolfaie A, Pourzahabi Z, Lotfi M, Moradi Lakeh M. The Prevalence of Obesity in School Children of Zahedan-Iran; Double Burden of Weight Disorders, J Compr Ped. 2015 ; 6(3):e26641. doi: 10.17795/compreped-26641.

ARTICLE INFORMATION

Journal of Comprehensive Pediatrics: 6 (3); e26641
Published Online: August 24, 2015
Article Type: Research Article
Received: January 12, 2015
Revised: May 27, 2015
Accepted: June 16, 2015
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Abstract

Background: Obesity has a permanent effect on childrens’ health and acts as a major risk factor for chronic diseases. Therefore considering children BMI is a vital parameter at each visit.

Objectives: This study was performed to assess the prevalence of obesity and its determinants in school children of Zahedan in Iran. Zahedan is the capital of Sistan-and-Balouchestan province known to have the highest prevalence of underweight in Iranian children.

Patients and Methods: This cross-sectional study was performed on 3582 school children, among which 1786 were girls and 1796 boys in 2012. The students aged 6 to 13 years old and selected based on a stratified random method. The body mass index (BMI) was measured for each student and being overweight/obesity was determined based on CDC 2000 definitions. Prevalence proportions were estimated by weighing the sample. The study was performed at primary and guidance schools of Zahedan. Samples were stratified from two geographic regions of Zahedan (Zone 1 and 2).

Results: In the sample, 78.9% were under 85th percentile, 11.8% were overweight (85th - 95th percentile) and 9.3% were obese (> 95th percentile). Weighted estimate for the prevalence of obesity/overweight in girls, boys and all 6 - 13 years old students were 16.2%, 18.4% and 17.4%, respectively. Presence of overweight/obesity was related to school type (private to public schools OR = 2.13, 1.80 - 2.52) and increasing age (OR = 1.12, 1.04 - 1.20).

Conclusions: A high prevalence of obesity was found in Zahedan students. Concurrent high prevalence of obesity/overweight and underweight demonstrates amplitude of weight problems in school children. There is an urgent need for special health programs to conduct proper diagnosis and management of obesity in Zahedan.

Keywords

Overweight Obesity Prevalence Iran

Copyright © 2015, Iranian Society of Pediatrics. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

The prevalence of obesity in children and adolescents is increasing worldwide (1-3). Obesity in children and adolescents is gradually becoming a major public health problem in many developing countries, including Iran (4, 5). Approximately a half (42 to 63%) of obese school children become obese adults (6, 7). However, whether overweight persists until adulthood is a matter of concern; overweightness appears to increase the risk of subsequent morbidity (8-10). Overweight and obesity are major risk factors of a number of chronic diseases, such as diabetes, cardiovascular diseases and cancer (11-13). Comparison of cross-sectional data from the United States and 13 European countries has shown that the prevalence of overweight, based on BMI above the 85th percentile and below 95th percentile varied between 5.2% and 28.9% for boys and 8.1% and 31.0% for girls; and the prevalence of obesity, based on BMI above 95th percentile varied between 1.9% and 13.9% for boys and 1.1% and 15.1% for girls among adolescents (14). The prevalence of overweight and obesity (excess of the 85th and 95th percentiles) has been 21.1% and 7.8% among Iranian adolescents (15). Zahedan is the center of Sistan and Baluchestan province in south-east of Iran.

2. Objectives

Based on Iranian deputy for health studies, this province has the highest prevalence of underweight students (15%) among other provinces of Iran and also the lowest prevalence of overweight students (6%) (16, 17).

These statistics led us to examine this issue in Zahedan city, the capital of Sistan and Baluchestan to assess the prevalence of overweight and obesity based on BMI in 6 to 13-year-old children in Zahedan in 2012.

3. Patients and Methods

The study was performed at the primary and guidance schools of Zahedan in 2012. We assessed a sample of 3582 school children (1786 girls and 1796 boys) aged 6 - 13 years in a cross-sectional study.

Subjects were selected through stratified sampling from two geographic regions of Zahedan (Zone 1 and 2). According to grade, sex and educational class, 16 strata were obtained. In Iran, for usual students, grades 1 to 5 of primary schools are normally equivalent to ages 6 to 10 years and grades 1 to 3 of guidance school are equivalent to ages 11 to 13. Each stratum contained 220 students. In each stratum, schools were selected with cluster random method separately from public and private schools. Students with known cardiac, renal and thyroidal diseases were excluded from the study because of their known relationship with weight.

3.1. Instruments

Weight and height were measured to calculate body mass index (BMI). Measurements were performed by trained health teachers of schools. Body weight and height were measured and rounded to the nearest 0.1 kg and 0.5 cm using digital scales (Seca, Germany) and a non-stretch tape fixed to a flat vertical wall, respectively. BMI values were calculated based on the following Equation.

(1)

kg stands for kilogram and m stands for meter.

Overweight was defined using age and sex specific charts for BMI released by the center for disease control (CDC) (18, 19). BMI between the 85 - 95th percentile was considered as overweight and a BMI greater than the 95th percentile as obesity (20, 21). Measurements were performed in the morning (10 - 12 AM) in all schools. Digital scales were checked before the measurements with the standard device.

3.2. Data analysis

The data was analyzed using SPSS software version 16 for windows (Inc. Chicago, IL). For reporting and analysis purposes, we used real ages of students instead of their grades. After determining the prevalence of obesity and overweight in each age-sex stratum, the prevalence of obesity and overweigh was estimated by weighting each stratum based on the size of the same stratum in student population of Zahedan.

We also performed a logistic regression analysis to assess the effect of gender, age and type of school on obesity and overweight as a dependent variable.

4. Results

Weight and height of children were recorded. From all 3582 children, 78.9% were under 85th percentile, 11.8% were overweight (85th - 95th percentile of BMI) and 9.3% (95th percentile of BMI) were obese.

In our sample, 7.7% of girls and 10.9% of boys were obese, while 12.8% of girls and 10.8% of boys were overweight. Table 1 shows the weighted prevalence of obesity/overweight in each sex-age stratum. Weighted estimate for prevalence of obesity/overweight in girls, boys and all 6 - 13 years old students were 16.2%, 18.4% and 17.4%, respectively.

Table 1 shows the prevalence of obesity and overweight in different age-sex-school type strata and also weighted prevalence of overweight/obesity in age-sex strata. The prevalence of overweight/obesity was obviously higher in guidance schools (11 - 13 years) compared with 6 - 10 years old children of elementary schools (Table 1).

Table 1. Prevalence of Obesity and Overweight in 6 - 13 Years Old Students of Zahedan (2012)
Age, yNumber (City)Number of SampleObesity PrevalenceOverweight PrevalencePrevalence of Obesity/Overweight
PublicPrivatePublicPrivate(Weighted for School Type)
Girls
661662205.311.43.013.610.8
756032163.011.19.64.913.0
853212325.66.56.47.512.2
952902141.87.710.017.313.4
1050042162.012.25.917.410.7
1146002177.613.919.315.327.1
1240782237.68.114.719.422.8
13349723913.38.512.828.827.2
Boys
667732123.310.93.314.19.5
760542264.012.05.39.311.2
860252246.913.97.610.116.0
957672239.319.37.913.319.3
1055102108.314.010.09.019.0
11594821714.811.112.919.028.1
1251512236.323.89.825.021.0
13457121414.321.67.928.426.7
Figure 1. An Increasing Trend of Obesity/Overweight With Age in Both Sexes and Both School Types
An Increasing Trend of Obesity/Overweight With Age in Both Sexes and Both School Types

A concurrent decrease is also observed in the prevalence of underweight (BMI < 3rd percentile).

Logistic regression analysis was performed on obesity/overweight as the dependent variable and covariates of age, gender and type and level of school with different models. Age and school type were significantly related to overweight/obesity in Model 1. In Model 2, school level had a significant association with overweight/obesity independent to age (Table 2). We performed subgroup analysis for private and public schools; while age was similarly related to obesity/overweight in both public and private schools, sex was related just in private schools.

Table 2. Factors Related to Overweight/Obesity in Primary and Guidance Schools of Zahedan, Iran (2012)
Model 1 (All Schools)BS.E.WaldP ValueOdds Ratio95.0% C.I
LowerUpper
School type (Private to Public)0.7330.08574.70.0002.0811.7632.457
Sex (M to F)0.1390.0842.70.0991.1490.9741.355
Age, y0.1760.01987.00.0001.1921.1491.237
Constant-3.4220.206276.60.0000.033
Model 2 (All schools)
School type (Private to Public)0.7560.08677.90.0002.1291.8002.518
Level (Guidance to Elementary)0.3400.1654.20.0401.4041.0161.941
Sex (M to F)0.1390.0842.70.1001.1490.9741.355
Age, y0.1120.0369.60.0021.1191.0421.201
Constant-2.9520.30494.10.0000.052
Model 3 (Public schools)
Sex (M to F)0.0060.1150.0030.9581.0060.8031.261
Age, y0.1840.02552.90.0001.2021.1441.262
Constant-3.4310.275155.20.0000.032
Model 4 (Private schools)
Sex (M to F)0.3060.1256.00.0141.3581.0641.734
Age, y0.1590.02930.50.0001.1721.1081.240
Constant-2.6060.28981.30.0000.074

5. Discussion

In the current study, the prevalence of obesity was higher in private schools than public schools and in older students than younger ones. Regarding the fact that Zahedan has had the lowest human development index (HDI) in Iran in the recent studies (22) and is known for its highest rates of stunting and underweight among Iran provinces (16, 23), obesity seems a common problem in students, especially around the puberty age in Zahedan. The prevalence of obesity and overweight in Zahedan children is similar to many other places of Iran as shown in Table 3.

Table 3. The Prevalence of Obesity and Overweight in Zahedan Children Compared to Other Places of Iran
AuthorsCityYearSexSample SizeAgePrevalence of Obesity, aPrevalence of Overweight, a
Sohailifar and Sadri (24)Hamedan1998Girls/Boys20007 - 112.5-
Asar and Asghari (25)Ahwaz2001Girls/Boys47937 - 142.26.0
Karajibani et al. (26)Zahedan2002Girls/Boys20677 - 111.41.5
Gheibi et al. (27)Orumiyeh2002Girls45811 - 144.010.4
Mozafari and Nabaei (28)Tehran2002Girls18006 - 107.713.3
Beigi et al. (29)Neyshabour2005Girls/Boys14716 - 124.6-
Taheri et al. (30)Birjand2005-6Girls/Boys60937 - 181.84.8
Haeri Behbahani et al. (31)Sabzevar2008Girls/Boys18006 - 114.87.9
Nabavi et al. (32)Semnan2010Girls/Boys4007 - 1214.318.8

a Data are presented as %.

Maddah et al. studied a random sample of 1079 students in Zahedan and reported overweight and obesity in 8.9% of boys and 10.3% of girls in 2010 (33). Another study by Mortazavi et al reported 12.9% overweight, similar to our study and 1.3% obesity (39.5% of female and 3.1% of male students with central obesity) in 720 students in Zahedan in 2004 (23). In our sample, 9.3% of the students were obese, which can be due to increased obesity rate in the recent decades (20). As far as we are concerned, there has been no recent study in Zahedan with similar sample size. Therefore, the results of these studies might not be statistically comparable.

Relationship of socio-economic level of school and overweight/obesity, independent of age, found in our study, needs more exploration, which can be due to unfair dropout of children at the end of primary school and entrance to a more special group of students to guidance school.

Higher prevalence of obesity in students of private schools might be correlated with better socio-economic levels of their families. In developing countries, lifestyle risk factors such as overweight and obesity are usually higher in people with higher socioeconomic status, while in more developed countries, such risk factors are mainly the problem of poor people (34).

In this cross-sectional study, we were not able to discriminate the effect of age with respect to cohort and time period (35).

Considering the association between childhood and adult overweight and deleterious consequences of overweight on health, special attentions should be made regarding prevention and management of childhood obesity.

Acknowledgements

Footnotes

References

  • 1.

    Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity G, 3-5 June,1997. 1998;

  • 2.

    Kelishadi R. Childhood overweight, obesity, and the metabolic syndrome in developing countries. Epidemiol Rev. 2007; 29 : 62 -76 [DOI][PubMed]

  • 3.

    Ells LJ, Hancock C, Copley VR, Mead E, Dinsdale H, Kinra S, et al. Prevalence of severe childhood obesity in England: 2006-2013. Arch Dis Child. 2015; [DOI][PubMed]

  • 4.

    Jafari-Adli S, Jouyandeh Z, Qorbani M, Soroush A, Larijani B, Hasani-Ranjbar S. Prevalence of obesity and overweight in adults and children in Iran; a systematic review. J Diabetes Metab Disord. 2014; 13(1) : 121 [DOI][PubMed]

  • 5.

    Kasmini K, Idris MN, Fatimah A, Hanafiah S, Iran H, Asmah Bee MN. Prevalence of overweight and obese school children aged between 7 to 16 years amongst the major 3 ethnic groups in Kuala Lumpur, Malaysia. Asia Pac J Clin Nutr. 1997; 6(3) : 172 -4 [PubMed]

  • 6.

    Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med. 1993; 22(2) : 167 -77 [DOI][PubMed]

  • 7.

    Mayfield CA, Suminski RR. Addressing obesity with pediatric patients and their families in a primary care office. Prim Care. 2015; 42(1) : 151 -7 [DOI][PubMed]

  • 8.

    Cote AT, Phillips AA, Harris KC, Sandor GG, Panagiotopoulos C, Devlin AM. Obesity and arterial stiffness in children: systematic review and meta-analysis. Arterioscler Thromb Vasc Biol. 2015; 35(4) : 1038 -44 [DOI][PubMed]

  • 9.

    Flynn J. The changing face of pediatric hypertension in the era of the childhood obesity epidemic. Pediatr Nephrol. 2013; 28(7) : 1059 -66 [DOI][PubMed]

  • 10.

    Anderson AD, Solorzano CM, McCartney CR. Childhood obesity and its impact on the development of adolescent PCOS. Semin Reprod Med. 2014; 32(3) : 202 -13 [DOI][PubMed]

  • 11.

    Koskinen J, Magnussen CG, Sabin MA, Kahonen M, Hutri-Kahonen N, Laitinen T, et al. Youth overweight and metabolic disturbances in predicting carotid intima-media thickness, type 2 diabetes, and metabolic syndrome in adulthood: the Cardiovascular Risk in Young Finns study. Diabetes Care. 2014; 37(7) : 1870 -7 [DOI][PubMed]

  • 12.

    Park MH, Sovio U, Viner RM, Hardy RJ, Kinra S. Overweight in childhood, adolescence and adulthood and cardiovascular risk in later life: pooled analysis of three british birth cohorts. PLoS One. 2013; 8(7)[DOI][PubMed]

  • 13.

    Dabelea D, Harrod CS. Role of developmental overnutrition in pediatric obesity and type 2 diabetes. Nutr Rev. 2013; 71 Suppl 1 -7 [DOI][PubMed]

  • 14.

    Lissau I, Overpeck MD, Ruan WJ, Due P, Holstein BE, Hediger ML, et al. Body mass index and overweight in adolescents in 13 European countries, Israel, and the United States. Arch Pediatr Adolesc Med. 2004; 158(1) : 27 -33 [DOI][PubMed]

  • 15.

    Mohammadpour-Ahranjani B, Rashidi A, Karandish M, Eshraghian MR, Kalantari N. Prevalence of overweight and obesity in adolescent Tehrani students, 2000-2001: an epidemic health problem. Public Health Nutr. 2004; 7(5) : 645 -8 [PubMed]

  • 16.

    Khosravi A, Najafi N, Rahbar M. Health profile indicators in IRI Center for Health Network Development and health promotion. 2009;

  • 17.

    Goudarzi S, Kameli ME, Hatami H. Improvement in health indicators of islamic republic of iran in the years 2004 and 2008. Iran Red Crescent Med J. 2011; 13(8) : 574 -7 [PubMed]

  • 18.

    Nieto FJ, Szklo M, Comstock GW. Childhood weight and growth rate as predictors of adult mortality. Am J Epidemiol. 1992; 136(2) : 201 -13 [PubMed]

  • 19.

    Mostafavi H, Dabagh Manesh MH, Zare N. [Prevalence of obesity and overweight in adolescents and adult population in Shiraz]. Iran J Endcorinol Metab. 2005; 7(1) : 57 -66

  • 20.

    Lewis CE, Jacobs DJ, McCreath H, Kiefe CI, Schreiner PJ, Smith DE, et al. Weight gain continues in the 1990s: 10-year trends in weight and overweight from the CARDIA study. Coronary Artery Risk Development in Young Adults. Am J Epidemiol. 2000; 151(12) : 1172 -81 [PubMed]

  • 21.

    Childhood obesity The APGNN Clinical Handbook of Pediatric Gastroenterology. 2008;

  • 22.

    Olyaee Manesh A, Haghdoost AA, Beheshtian M, Tehrani Banihashemi A, Motlagh M. Progress towards Health Equity in I.R. of Iran through Last Three Decades. Iran J Pub Health. 2009; 38 : 130 -5

  • 23.

    Mortazavi Z, Shahrakipour M. Prevalence of general and central obesity in Zahedan university of medical sciences students, Iran. Asia Pacific J Clin Nutr. 2004; 13(3) : 145

  • 24.

    Sohailifar J, Sadri GH. Prevalence of obesity in Hamadan primary schools' students in 1998. Sci J Hamadan Univ Med Sci. 2000; 7 : 15 -20

  • 25.

    Asar S, Asghari S. Prevalence of obesity & overweight among 7-14 years old students in the city of Ahwaz. Sci Med J Ahvaz Univ Med Sci. 2005; 44 : 11 -20

  • 26.

    Karajibani M, Montazerifar F, Mohammadi M, DASHIPOUR AR. The prevalence of obesity and wasting in primary school girls in the city of Zahedan. Tabib-e-Shargh. 2005; 6(4) : 289 -96

  • 27.

    Gheibi S, Fakoor Z, Alizadegan M. The prevalence of obesity among girl students in Urmia in 2002-3. Iran J Pediatr. 2003; 13 : 1 -8

  • 28.

    Mozafari H, Nabaei B. [Prevalence of obesity and overweight 13. in Tehranian girls' student of primary schools]. Univ Jahad Q Pub Health Sci. 2002; 1(4) : 15 -9

  • 29.

    Beigi F, Dorosty AR, Mehran L. The Prevalence of Childhood Obesity and Some Biological-Environmental Associated Factors in Neishabour-Iran. Iran J Diabetes Obes. 2006; 2(2)

  • 30.

    Taheri F, Kazemi T, Sharifzadeh G, Student Research C. Prevalence of overweight and obesity in preschool children (2-5 year-olds) in Birjand, Iran. BMC Res Notes. 2012; 5 : 529 [DOI][PubMed]

  • 31.

    Haeri Behbahani B, Dorosty AR, Eshraghian MR. Assessment of obesity in children: Fat mass index versus body mass index. Tehran Univ Med J. 2009; 67(6) : 408 -14

  • 32.

    Nabavi M, KARIMI B, Ghorbani R, Mazloum Jafarabadi M, Talebi M. Prevalence of obesity and some related factors among students aged 7 to 12 in Semnan, Iran. Payesh. 2010; 9(4) : 443 -51

  • 33.

    Maddah M, Shahraki T, Shahraki M. Underweight and overweight among children in Zahedan, south-east Iran. Public Health Nutr. 2010; 13(10) : 1519 -21 [DOI][PubMed]

  • 34.

    Monteiro CA, Moura EC, Conde WL, Popkin BM. Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ. 2004; 82(12) : 940 -6 [PubMed]

  • 35.

    Moradi Lakeh M, Montazer M, Moradi M, Mahmoodi SMH, Alemzadeh Bahreini SAP, Askari S. Stunting Trends in under 6 year old children living in rural area of Robat-Karim from 1997 to 2007: An Age-Period-Cohort effect analysis. Iran J Epidemiol. 2009; 5(3) : 27 -34

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