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ORIGINAL ARTICLE

Prevalence of overweight/obesity among primary school

pupils in Urban Centre, Nigeria
Elizabeth Onazahi Ajayi, Hassan Abdullahi Elechi1, Mohammad Arab Alhaji1

Department of Paediatrics, Lagos University Teaching Hospital, Idi‑Araba, Surulere, Lagos, 1Department of Paediatrics,
University of Maiduguri, Maiduguri, Nigeria

ABSTRACT

Background: Overweight and obesity, initially thought to be the problem of the developed countries, are rapidly
rising in the developing countries constituting a high proportion of nutritional problems in these countries.
Several factors, including changing lifestyle and improved economic power, are believed to contribute to this
trend. This pattern if unchecked is known to lead to several medical complications. We thus aim to assess and
compare the prevalence of overweight/obesity among primary school pupils from the public and private schools
as well as determine factors contributing to the rising trend. Materials and Methods: Four hundred and
twenty primary school children from public and private schools were selected using multistage stratified random
sampling. Relevant information was obtained using a questionnaire, and anthropometric indices were recorded.
Data obtained were analyzed using EPI INFO version 3.5.1. and frequencies were compared using Chi‑square.
Results: Seventy‑three (17.4%) of the 420 pupils studied were found to be overweight/obese. Pupils from private
school accounted for the majority of these cases with 28 (13.3%) and 29 (13.8%) of them being overweight
and obese, respectively. High socioeconomic class and consumption of energy‑dense diet were significantly
associated with high prevalence of overweight/obesity (P < 0.001). In contrast, regular physical activity was
significantly associated with low prevalence (P < 0.001). Conclusion and Recommendations: Prevalence
of overweight/obesity among primary school pupils is quite high in Lagos, Nigeria. High socioeconomic class,
consumption of energy dense food, and lack of adequate physical activities appear to be major factors contributing
to this high prevalence. Introduction of daily school meal and mandatory physical activity in all the schools would
go a long way in imbibing healthy eating and lifestyle pattern into these children. Public nutritional education
and campaign on the importance of healthy lifestyle and complications associated with overweight and obesity
would probably reverse the trend.

Key words: Childhood, malnutrition, obesity, overweight

Address for correspondence: Dr. Hassan Abdullahi Elechi,

Department of Paediatrics, College of Medical Sciences, University of
Maiduguri, P. M. B. 1069, Maiduguri, Nigeria.
E‑mail: h2elechi@gmail.com This is an open access article distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows
Access this article online others to remix, tweak, and build upon the work non‑commercially, as long as
the author is credited and the new creations are licensed under the identical
Quick Response Code: terms.
Website:
www.saudijobesity.com For reprints contact: reprints@medknow.com

DOI: How to cite this article: Ajayi EO, Elechi HA, Alhaji MA. Prevalence
10.4103/2347-2618.171959 of overweight/obesity among primary school pupils in Urban Centre,
Nigeria. Saudi J Obesity 2015;3:59-65.

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Ajayi, et al.: Childhood overweight and obesity
INTRODUCTION
Malnutrition is a serious public health problem that is
caused by either deficient or excess intake of nutrients
in relation to requirements. Undernutrition (Nutrient
deficiency) has been the prevalent type of malnutrition
in developing countries such as Nigeria.[1,2] This has been
attributed to the synergistic interaction between several
factors, most importantly, inadequate nutrient intake and
infection.[3,4] This is not the case with developed countries
such as the USA, where overnutrition is a major challenge
among the school‑aged children. Studies done in the
USA on the overweight status and eating patterns among
adolescents showed that the prevalence of overnutrition
was higher among those from a low socioeconomic class.[5‑7]
Recently, overweight thought to be the problem of the
developed world is spreading to the developing world.[8]
Several studies in Africa and other developing countries
have documented an emerging trend of malnutrition with
overweight and obesity increasing at an alarming rate
in comparison to undernutrition.[8,9] However, in these
developing countries, contrary to the finding in the USA,
overweight and obesity appear to be more common among
the high socioeconomic class.[10‑12] The effect of urbanization
and the associated change in lifestyle have been shown to
contribute immensely to the current increasing trend of
malnutrition in the developing countries.[13,14] However,
children of low socioeconomic status from such urban
centers remain significantly associated with undernutrition
rather than over nutrition,[15] further underscoring the
central role of socioeconomic status in malnutrition.
The increasing rate of obesity means that obesity‑related
chronic diseases are likely to become common among
the children. Being overweight is known to significantly
increase the risk of asthma, type 2 diabetes, gallstone,
heart disease, high blood pressure, and several other
diseases.[16] This will further impose a great challenge
to the already overburdened health care system in the
developing countries.
We thus aim to assess and compare the prevalence
of overweight/obesity among primary school pupils
attending public and private schools, in Ikeja Local
Government Area (LGA) of Lagos and to identify
common factors associated with overweight/obesity.
The information generated would be useful in guiding
the concerned authorities in designing appropriate
interventions in the various schools.
MATERIALS AND METHODS
Study area
The study was carried out in public and private primary
schools in Ikeja LGA of Lagos State Nigeria. Ikeja is
60
the capital city of Lagos state, the most populated
and urbanized state in Nigeria with over 10 million
residents.[17] There are 114 registered private primary
schools and 32 public primary schools in Ikeja LGA.
Study design
It is a cross‑sectional survey.
Study population
This consists of pupils in public and private primary
schools in Ikeja LGA.
Sample size determination
Minimum sample size for each type of school was
determined using the formula:
(za + zb)2 (p1 q 1 + p 2 q 2 )
(N ) =
P1 - P2
The values for P1 and P2 were taken from a previous
study.[18] A minimum sample size of 146 pupils for each
type of school was obtained, but to increase the power
of the observation, 210 pupils were studied from each
type of school as resources allowed.
Sampling method
Multistage stratified random sampling was used.
Based on the numbers of schools, three private and two
public primary schools were selected. Participants were
selected by simple random sampling method using the
class register as a template in each of the classes of the
schools selected.
Exclusion criteria
Children whose parents refused consent, children with
obvious skeletal deformity, and those with known
chronic medical conditions such as chronic renal failure
and heart disease were excluded.
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
approval 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 thumbprint. There was no consequence for
the pupil if he or she refused to participate or parents
refused consent. Data obtained were treated with
confidentiality and only for the purpose of this research.
Data collection method
A structured questionnaire was used in the collection of
relevant information required to meet the objective of
the study. All the participating pupils were interviewed
at school and sent home with the section of the
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Ajayi, et al.: Childhood overweight and obesity

questionnaire to be completed by their parents and Table 1: Sociodemographic features of the studied
were returned the following day. Information obtained population
included sociodemographic data such as age, gender, Variable Public Private P
parents’ occupation, average monthly income, and (n=210) n (%) (n=210) n (%)
educational attainment. Information on dietary intake Age
includes type of diet, frequency, and 24 h dietary recall. 5-6 14 (6.7) 63 (30.0) <0.001*
Involvement in exercise and physical activity were also 7-8 46 (21.9) 59 (28.1)
sought. Socioeconomic status was assessed using the 9-10 50 (23.8) 81 (38.6)
model of Ogunlesi et al.,[19] whereas the dietary pattern of 11-12 59 (28.1) 7 (3.3)
the child was assessed using a pretested food frequency >13 41 (19.5) 0 (0)
questionnaire. Weight was measured in kilogram to one Sex
decimal place using a bathroom weighing scale with Male 97 (46.2) 99 (47.1) 0.850**
sensitivity of 0.5 kg. The weighing scale was adjusted to Female 113 (53.8) 111 (52.9)
the zero reading before each weighing, and a standard Socioeconomic status
20 kg weight was used to revalidate the scale at regular Low 49 (23.3) 6 (2.9) <0.001**
intervals and adjustment made as required. Height Middle 157 (74.8) 28 (13.3)
was measured in meters to two decimal places using a High 4 (1.9) 176 (83.8)
stadiometer. Nutritional status was determined using *Student t‑test, **Chi‑square
body mass index (BMI) percentile in accordance with the
National Centre for Health Statistics/Center for Disease compared to those in private schools. One hundred
Control and Prevention.[20] BMI for age of ≥95th centile is and thirteen (53.9%) pupils from the public schools
classified as obesity, ≥85th to <95th centile as overweight, trekked daily for a distance of at least one kilometer
≥5th to <85th as normal and <5th centile as underweight. as against 8 (3.8%) pupils from the private schools.
Similarly, 77 (36.7%) pupils from the public schools
Data analysis engaged in competitive sports daily versus 33 (15.7%)
The data obtained were entered into and analyzed from the private. The difference between the two groups
using  EPI INFO version 3.5.1 (developed by Centers for regarding physical activity was statistically significant
Disease control and Prevention (CDC), Atlanta, Georgia P ≤ 0.001. In contrary, pupils from private schools
(USA)). Tables were used in data presentation. Chi‑square engaged significantly more in nonphysical activity,
and Fisher’s exact test were used in comparing frequencies. 150 (71.4%) and 34 (16.2%) of them watch television
and play computer game daily as against 122 (58.1%)
RESULTS and 20 (9.5%) from the public schools, respectively, for
television and computer games. Again the difference
A total of 420 children were studied, 210 pupils from each regarding nonphysical activity was significant P ≤ 0.001.
school type. The children from the private schools were
younger with a mean age of 7.7 ± 1.9 years as against Table 3 shows the distribution of the study population by
10.3 ± 2.6 years for those in public school (t = 11.58, BMI percentile. The nutritional status varied significantly
P ≤ 0.001). The female pupils were slightly more than between the pupils from the public and private school. While
the male with M: F ratio ≈ 1:1.1 in both groups. Majority undernutrition was the predominant form of malnutrition
176 (83.3%) of the pupils from the private schools in the public schools 33 (15.7%), overweight/obesity
were of high socioeconomic class whereas those from predominated in the private schools 57 (27.1%). The overall
public schools were predominantly of the middle prevalence of overweight/obesity is 17.4%.
socioeconomic class (χ2 = 305.34, P ≤ 0.001). Table 1 shows
the sociodemographic features of the study sample. Table 4 shows the effect of various studied variables on
BMI percentile. The highest frequency of overweight/
The dietary pattern among the two study groups was obesity was observed among those aged 5–6 years
significantly different across all the common food items whereas the least frequency was among those aged 11
studied (P ≤ 0.001) [Table 2]. The frequency of daily and above. This pattern was however not statistically
consumption of all the food items considered were significant (P = 0.05). Although more female pupils, when
higher among the pupils from private schools except compared to male pupils, were found to be overweight/
for two locally made beverages (Zobo and Kunu), which obese, this was not statistically significant. More than
had higher daily frequency of consumption among the half (50.9%) of the pupils of low socioeconomic class were
public school pupils. undernourished, whereas the majority of overweight/
obese children (76.7%) were of high socioeconomic
Regarding extracurricular activity, the pupils in class. This relationship showed a strong positive
public schools engaged more in physical activity correlation between these two variables (P ≤ 0.001).
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Ajayi, et al.: Childhood overweight and obesity

Table 2: Dietary pattern among the two study groups

Food item Public (n=210) n (%) Private (n=210) n (%) P
Daily Often ST Never Daily Often ST Never
Fruits 17 (8.1) 62 (29.5) 129 (61.5) 2 (1.0) 51 (24.3) 19 (9.0) 140 (66.7) 0 (0.0) <0.001*
Vegetable 23 (11.0) 83 (39.5) 104 (49.5) 0 (0.0) 42 (20.0) 25 (11.9) 141 (67.2) 2 (1.0) <0.001*
White bread 45 (21.4) 75 (35.7) 88 (42.0) 2 (1.0) 103 (49.1) 25 (11.9) 79 (37.6) 3 (1.4) <0.001*
Wheat bread 5 (2.4) 24 (11.4) 71 (33.8) 110 (52.4) 13 (6.2) 7 (3.3) 102 (48.6) 88 (41.9) <0.001*
Fried yam/plantain 11 (5.2) 57 (27.1) 122 (58.1) 20 (9.5) 44 (21.0) 28 (13.3) 123 (58.6) 15 (7.1) <0.001*
Milk 31 (14.8) 71 (33.8) 104 (49.6) 4 (1.9) 103 (49.1) 18 (8.6) 84 (40.0) 5 (2.4) <0.001*
Egg 29 (13.8) 57 (27.1) 112 (53.3) 12 (5.7) 75 (35.7) 18 (8.6) 110 (52.4) 7 (3.3) <0.001*
Fish 49 (23.3) 80 (36.1) 75 (35.7) 6 (2.9) 67 (31.9) 18 (8.6) 115 (54.8) 10 (4.8) <0.001*
Beef/meat 49 (23.3) 67 (31.9) 89 (42.4) 5 (2.4) 90 (42.9) 20 (9.5) 95 (45.3) 5 (2.4) <0.001*
Chicken/Turkey 13 (6.2) 60 (28.6) 126 (60.0) 11 (5.2) 63 (30.0) 19 (9.0) 125 (59.5) 3 (1.4) <0.001*
Beans/moi‑moi 18 (8.6) 65 (31.0) 120 (57.2) 7 (3.3) 21 (10.0) 17 (8.1) 165 (78.6) 7 (3.3) <0.001*
Butter/magerine 22 (10.5) 61 (29.0) 102 (48.6) 25 (11.9) 65 (31.0) 18 (8.6) 108 (51.5) 19 (9.0) <0.001*
Biscuit/cake 49 (23.3) 62 (29.5) 93 (44.3) 6 (2.9) 92 (43.8) 22 (10.5) 94 (44.8) 2 (1.0) <0.001*
Chocolate/sweets 23 (11.0) 52 (24.8) 109 (52.0) 26 (12.4) 32 (15.2) 12 (5.7) 149 (71.0) 17 (8.1) <0.001*
Beverages 13 (6.2) 44 (21.0) 118 (56.2) 35 (16.7) 25 (11.9) 14 (6.7) 14167.2 () 30 (14.3) <0.001*
Zobo 12 (5.7) 58 (27.6) 111 (52.9) 29 (13.8) 3 (1.4) 1 (0.5) 39 (18.6) 167 (79.5) <0.001*
Kunu 9 (4.3) 56 (26.7) 126 (60.0) 19 (9.0) 2 (1.0) 1 (0.5) 36 (17.1) 171 (81.5) <0.001*
Yogurt 9 (4.3) 51 (24.3) 123 (58.6) 27 (12.9) 26 (12.4) 6 (2.9) 124 (59.1) 54 (25.7) <0.001*
*Chi‑square. ST: Some times

Table 3: Study population by BMI percentile in the developed countries.[22] However, other studies
BMI Public Private χ2 df P have found much lower prevalence for overweight/
percentile (n=210) n (%) (n=210) n (%) obesity. Adegoke et al.[11] in 2009 reported a prevalence
<5th 33 (15.7) 10 (4.8) 41.55 3 <0.001 of 3.1% for overweight/obesity from Ile‑Ife South West
5th-<85th 161 (76.6) 143 (68.1) Nigeria using anthropometry, while Alkali et al.[12] in
85th-<95th 14 (6.7) 28 (13.3) 2015 reported a prevalence of 6.5% from Gombe in
≥95 th
2 (1.0) 29 (13.8) North East Nigeria. These lower prevalence reported
BMI: Body mass index by Adegoke et al.[11] and Alkali et al.[12] may be due to the
difference in socioeconomic status between the study
Daily consumption of selected high‑calorie food items populations whereas >86% of our study population
was associated with significantly higher frequencies of were either of middle or upper socioeconomic class,
overweight/obesity when compared to other pupils who 48.2% of those studied by Adegoke et al.[11] were of low
do not consume such food items regularly. In contrast, socioeconomic class with only 19.6% belonging to the
physical activity was associated with significantly low upper class. Although Alkali et al.[12] did not give the
frequency of overweight/obesity. socioeconomic distribution of their study population
but Gombe located in the North East of Nigeria is a
DISCUSSION small town with small scale businesses and subsistence
farming as major occupation compared to Lagos, which
The overall prevalence of 17.4% for overweight/ is the most industrialized city in Nigeria. Furthermore,
obesity in this study is quite alarming though similar we studied children in primary schools alone but
to the findings from previous studies.[4,9,21] Owa et al.[9] Adegoke et al.[11] as well as Alkali et al.[12] studied both
reporting from Nigeria in 1997 found a prevalence of primary and secondary school children. It has been
18% for obesity among children aged 5–15 years using remarkably documented that prevalence of overweight/
fat mass percentage and BMI based on the US standard. obesity decreases in children with advancing age.[23,24]
Similarly, Mogre and Abukari[21] reported a prevalence
of 17.4% for overweight and obesity from Ghana in In contrast to the developed countries where
2013 among school‑aged children (5–14 years). The overweight/obesity is more common among the
finding from this study and the others above further low socioeconomic class, [5‑7] majority 56 (76.7%) of
support the high prevalence of overweight and obesity these overweight children in this study were of high
among children in developing countries and that the socioeconomic class. This pattern is similar to findings
burden of the problem might not be different from that from other studies from other developing countries.[10‑12,25]

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Ajayi, et al.: Childhood overweight and obesity

Table 4: The association between various variables and BMI percentile

Variable BMI percentile, n (%) Total P
<5th 5th-<85th ≥85th
Age
5-6 6 (7.8) 46 (59.7) 25 (32.5) 77 0.0512*
7-8 19 (18.1) 66 (62.9) 20 (19.0) 105
9-10 8 (6.1) 99 (75.6) 24 (18.3) 131
11-12 6 (9.1) 58 (87.9) 2 (3.0) 66
>13 4 (9.7) 35 (85.4) 2 (4.9) 41
Sex
Male 18 (9.2) 147 (75.0) 31 (15.8) 196 0.531**
Female 25 (11.2) 157 (70.1) 42 (18.7) 224
Socioeconomic class
Low 28 (50.9) 25 (45.5) 2 (3.6) 55 <0.001*
Middle 13 (7.0) 157 (84.9) 15 (8.1) 185
High 2 (1.1) 122 (67.8) 56 (31.1) 180
Daily dietary consumption pattern
Beef 3 (2.2) 95 (68.3) 41 (29.5) 139 <0.001**
White bread 5 (3.4) 95 (64.2) 48 (32.4) 148 <0.001**
Egg 2 (1.9) 80 (76.9) 22 (21.2) 104 0.004**
Fried yam/plantain 2 (3.6) 30 (54.5) 23 (41.8) 55 <0.001**
Beverages 1 (2.6) 19 (50.0) 18 (47.4) 38 <0.001**
Daily extracurricular activities
Trekking 10 (8.3) 109 (90.1) 2 (1.7) 121 <0.001**
Sports 6 (5.5) 104 (94.5) 0 (0.0) 110 <0.001**
Watching television 25 (9.2) 202 (74.3) 45 (16.5) 272 0.469**
Computer games 1 (1.9) 50 (92.6) 3 (5.6) 54 0.002**
*Gamma correlation, **Chi‑square test. BMI: Body mass index

This fact was further confirmed by the significantly
higher prevalence of overweight/obesity among pupils
from private schools compared to those from public
schools. In Nigeria, private schools, particularly in the
urban centers, 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 private schools were of high socioeconomic
class as against 1.9% of those in public schools.
Several factors could be responsible for this high
prevalence of overweight/obesity among the affluent
class in the developing countries. In the first place, the
parents of these children are likely of the working class
with little or no time to plan and prepare healthy food
for them. [26] 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. [27]
Nutritional habits and patterns have been shown to
influence the nutritional status of the society.[28] These
are further driven by aggressive advertising practices,
relatively low cost of energy‑dense food, and improved
purchasing power which are now most prevalent in
developing countries and leading to the development of
overweight and obesity and subsequently the associated
morbidities.[29] 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, when compared to those from the public
and low socioeconomic status.
Sedentary lifestyle has been well‑documented as a cause
of overweight and obesity[27,30,31] 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 activities
such as television watching and computer games. Similar
to previous studies, this practice 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 either
driven in car to school by their parents or use the school
bus. This is in contrast to the public school where more
than half (53.9%) of the pupil trekked to school daily
as observed in this study. Second, while most public
schools are usually sited in a planned location with
enough space for sporting activity, the same cannot be
said for the majority of the private schools in Nigeria

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Ajayi, et al.: Childhood overweight and obesity
where over 70% of private schools were found to be
sited either in private homes or a makeshift buildings
with no capacity for expansion.[32] 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/obesity was higher among
the younger age groups compared to the older pupils
with the highest prevalence of 18.2% among those aged
5–6 years. However, this relationship was not statistically
significant. Similar pattern of decreasing prevalence
with advancing age among children <13 years was also
observed in a study from India[23] and Saudi Arabia.[24]
However, other studies have found a contrary pattern:
Increasing prevalence with advancing age.[33] 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 Mohan et al. [34] from India. The effect of
gender on overweight and obesity in children remains
inconclusive whereas several studies have found
significantly higher prevalence among the female
gender,[33,35‑37] others have reported the reverse.[38‑40] 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 RECOMMENDATIONS
The prevalence of overweight and obesity among
children living in urban centers in developing countries,
such as 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 lifestyle are important
factors contributing to the high prevalence among
this group of children. In contrast, undernutrition
has remained a major problem among the middle
socioeconomic status. We recommend the introduction
of school meal program in both the public and private
school to augment calorie intake among the public
school children and modulate same for those in private
schools. Provision of sporting facilities must be made
mandatory requirement for registering of private
school and if already a requirement must be enforced
on new and existing private schools. Finally, public
nutritional education and campaign on the medical
implications of overweight/obesity in children should
be aggressively pursued by the relevant agencies before
the complications begin to set in.
64
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Florêncio TM, Ferreira HS, de França AP, Cavalcante JC,
Sawaya AL. Obesity and undernutrition in a very‑low‑income
population in the city of Maceió, Northeastern Brazil. Br J Nutr
2001;86:277‑84.
2. Pai M, Alur M, Wirz S, Filteau S, Pagedar S, Yousafzai A.
A pilot study of the nutritional status of disabled and
non‑disabled children living in Dharavi, Mumbai. Indian Pediatr
2001;38:60‑5.
3. Krebs NF, Primak LE. Pediatric undernutrition. In: Marcdante KJ,
Kliegman RM, Jenson HB, Behrman RE, editors. Nelson
Essentials of Pediatrics. 6th ed. Philadelphia: Saunders; 2011.
p. 111-3.
4. Schaible UE, Kaufmann SH. Malnutrition and infection:
Complex mechanisms and global impacts. PLoS Med
2007;4:e115.
5. Neumark‑Sztainer D, Story M, Hannan PJ, Croll J. Overweight
status and eating patterns among adolescents: Where do youths
stand in comparison with the healthy people 2010 objectives?
Am J Public Health 2002;92:844‑51.
6. Wang Y, Beydoun MA. The obesity epidemic in the
United States – Gender, age, socioeconomic, racial/ethnic,
and geographic characteristics: A systematic review and
meta‑regression analysis. Epidemiol Rev 2007;29:6‑28.
7. Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and
socioeconomic status in children and adolescents: United States,
2005‑2008. NCHS Data Brief 2010;51:1-8.
8. Popkin BM, Adair LS, Ng SW. Global nutrition transition and
the pandemic of obesity in developing countries. Nutr Rev
2012;70:3‑21.
9. Owa JA, Adejuyigbe O. Fat mass, Fat mass percentage, body
mass index, and mid-upper arm circumference in a healthy
population of Nigerian Children. J Trop Paediatr 1997;43:13-9.
10. Lobstein T, Baur L, Uauy R; IASO International Obesity
TaskForce. Obesity in children and young people: A crisis in
public health. Obes Rev 2004;5 Suppl 1:4‑104.
11. Adegoke SA, Olowu WA, Adeodu OO, Elusiyan JB, Dedeke IO.
Prevalence of overweight and obesity among children in Ile‑ife,
south‑western Nigeria. West Afr J Med 2009;28:216‑21.
12. Alkali YS, Ambe JP, Sabin M, Zacharin M. Socio‑economic
status, lifestyle and childhood obesity in Gombe. Niger J Paediatr
2015;42:107‑10.
13. Mendez MA, Monteiro CA, Popkin BM. Overweight exceeds
underweight among women in most developing countries. Am
J Clin Nutr 2005;81:714‑21.
14. Zhang YX, Zhao JS, Chu ZH. Prevalence of overweight
and obesity among children and adolescents is associated
with urbanization in Shandong, China. Int J Cardiol
2014;176:1212‑3.
15. Ojiako IA, Manyong VM, Ikpi AE. Determinants of nutritional
status of preschool children from rural household in Kaduna
and Kano States, Nigeria. Pak J Nutr 2009;8:1497‑505.
16. Daniels SR. The consequences of childhood overweight and
obesity. Future Child 2006;16:47‑67.
17. National Population Commission of Nigeria. 2006 National
Population Census. Maiduguri, Nigeria: National Population
Commission of Nigeria; 2006.
Saudi Journal of Obesity | Volume 3 • Issue 2 • Jul-Dec 2015
[Downloaded free from http://www.saudijobesity.com on Wednesday, September 5, 2018, IP: 41.216.170.34]

Ajayi, et al.: Childhood overweight and obesity

18. Oninla SO, Owa JA, Onayade AA, Taiwo O. Comparative study
of nutritional status of urban and rural Nigerian school children.
J Trop Pediatr 2007;53:39‑43.
19. Ogunlesi TA, Dedeke IO, Kuponiyi OT. Socio‑economic
classification of children attending Specialist Paediatric Clinic
in Ogun State, Nigeria. Niger Med Pract 2008;54:21‑5.
20. Centers for Disease Control and Prevention/National Center
for Health Statistics. 2000 CDC Growth Chart for the United
States: Methods and Development. Vital and Health Statistics,
Series 11, No. 246; 2002.
21. Mogre V, Abukari RN. Overweight, obesity and thinness and
associated factors among school aged children (5‑14 years) in
Tamale, Northern Ghana. Eur Sci J 2013;9:160‑75.
22. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of
childhood and adult obesity in the United States, 2011‑2012.
JAMA 2014;311:806‑14.
23. Premanath M, Basavanagowdappa H, Shekar MA, Vikram SB,
Narayanappa D. Mysore childhood obesity study. Indian Pediatr
2010;47:171‑3.
24. El‑Hazmi MA, Warsy AS. The prevalence of obesity and
overweight in 1‑18‑year‑old Saudi children. Ann Saudi Med
2002;22:303‑7.
25. Dinsa GD, Goryakin Y, Fumagalli E, Suhrcke M. Obesity and
socioeconomic status in developing countries: A systematic
review. Obes Rev 2012;13:1067‑79.
26. Manson JE, Skerrett PJ, Greenland P, VanItallie TB. The
escalating pandemics of obesity and sedentary lifestyle. A call
to action for clinicians. Arch Intern Med 2004;164:249‑58.
27. Popkin BM. The nutrition transition and obesity in the
developing world. J Nutr 2001;131:871S‑3S.
28. Misra A, Khurana L. Obesity and the metabolic syndrome
in developing countries. J Clin Endocrinol Metab
2008;93 11 Suppl 1:S9‑30.
29. Gupta N, Goel K, Shah P, Misra A. Childhood obesity in
developing countries: Epidemiology, determinants, and
prevention. Endocr Rev 2012;33:48‑70.
30. Kuriyan R, Bhat S, Thomas T, Vaz M, Kurpad AV. Television
viewing and sleep are associated with overweight among
urban and semi‑urban South Indian children. Nutr J
2007;6:25.
31. Al‑Hazzaa HM, Al‑Rasheedi AA. Adiposity and physical
activity levels among preschool children in Jeddah, Saudi Arabia.
Saudi Med J 2007;28:766‑73.
32. Agi UK. The challenges and prospects of managing private
school system in River State. Afr Res Rev 2013;7:340‑51.
33. Misra A, Shah P, Goel K, Hazra DK, Gupta R, Seth P, et al. The
high burden of obesity and abdominal obesity in urban Indian
schoolchildren: A multicentric study of 38,296 children. Ann
Nutr Metab 2011;58:203‑11.
34. Mohan B, Kumar N, Aslam N, Rangbulla A, Kumbkarni S,
Sood NK, et al. Prevalence of sustained hypertension and obesity
in urban and rural school going children in Ludhiana. Indian
Heart J 2004;56:310‑4.
35. Wasir JS, Misra A. The Metabolic Syndrome in Asian Indians:
Impact of nutritional and socio‑economic transition in India.
Metab Syndr Relat Disord 2004;2:14‑23.
36. Armstrong ME, Lambert MI, Sharwood KA, Lambert EV.
Obesity and overweight in South African primary school
children – The Health of the Nation Study. S Afr Med J
2006;96:439‑44.
37. Kaur S, Sachdev HP, Dwivedi SN, Lakshmy R, Kapil U.
Prevalence of overweight and obesity amongst school children
in Delhi, India. Asia Pac J Clin Nutr 2008;17:592‑6.
38. Jabre P, Sikias P, Khater‑Menassa B, Baddoura R, Awada H.
Overweight children in Beirut: Prevalence estimates and
characteristics. Child Care Health Dev 2005;31:159‑65.
39. Tee ES, Khor SC, Ooi HE, Young SI, Zakiyah O, Zulkafli H.
Regional study of nutritional status of urban primary
schoolchildren 3. Kuala Lumpur, Malaysia. Food Nutr Bull
2002;23:41‑7.
40. Wickramasinghe VP, Lamabadusuriya SP, Atapattu N,
Sathyadas G, Kuruparanantha S, Karunarathne P. Nutritional
status of schoolchildren in an urban area of Sri Lanka. Ceylon
Med J 2004;49:114‑8.

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