The Prevalence of Childhood Overweight and Obesity in the Children of Noakhali City in Bangladesh

The prevalence of childhood obesity worldwide has increased significantly during the past two to three decades in developed countries. Obesity is now becoming widely common in developing countries as well, especially in urban areas (Wang & Lobstein, 2006). Childhood obesity is a burning topic worldwide because of its strong association with a variety of serious health problems, emerging in childhood and adulthood obesity. Their leads to various problems include psychosocial problems such as social discrimination and reduced selfAbstract


Introduction
The prevalence of childhood obesity worldwide has increased significantly during the past two to three decades in developed countries.Obesity is now becoming widely common in developing countries as well, especially in urban areas (Wang & Lobstein, 2006).Childhood obesity is a burning topic worldwide because of its strong association with a variety of serious health problems, emerging in childhood and adulthood obesity.Their leads to various problems include psychosocial problems such as social discrimination and reduced self- esteem, and physical health problems for instance diabetes mellitus (type 2) and different risk factors associated with cardiovascular diseases (Must & Strauss, 1999).A projected 300,000 people die every year of illnesses connected to obesity, more than the number killed by pneumonia, motor vehicle accidents and airlines crashes combined (Price, Danielle & Nicholas, 2000).
Obesity, the most prevalent health issue can be defined as an extreme accumulation of body fat (Lohman, 1987), and childhood obesity is defined as a weight-for-height intemperance of 120 percent of the principle (Dietz, 1983).Although, obesity development mechanism is not clearly understood but it is believed to be a disorder with various difficulties.The key factors such as environmental factors, daily life preferences and the civilizing surroundings play fundamental roles in the rising prevalence of obesity worldwide.Its occurrence is increasing dramatically in spite of age and geographical variation.A report of WHO states that, there were 1 billion overweight people in the world of whom 300 million are obese.A study from Bangladesh in Dhaka city reported that, the prevalence of obesity was considerably superior among the boys (56.8%) than the girls (43.2%) (Rahman et al., 2002).
Therefore, the purpose of the present study was to find out the prevalence of childhood overweight and obesity association with its risk factors in the primary school children of Noakhali City, a coastal region of Bangladesh.The findings of this study can present some baseline data on the enormity of this problem, with prominence on school going children in Noakhali, as well as recognize factors to spotlight on when addressing the problem of obesity among children.

Method
In a community-based, cross-sectional and randomized study carried out in all of Noakhali municipality, a coastal area of Bangladesh.A total of 500 students aged 6-16 years (277 boys and 223 girls) participated in the study.All the participants willingly joined this study and provided written informed consent.The sampling method was a stratified multistage sampling based on selected primary and secondary schools.The present study protocol was approved by the research ethics committee of Noakhali Science and Technology University, Bangladesh and also ethical informed consent was obtained from parents of all the participants prior to their inclusion into the study.

Detailed
information regarding demographic, socioeconomic information including name, sex, age, parent's education, parent's occupation, economic status, food habit etc, behavioral and health status was collected from each study subject.This study also conducted for their daily activities reported by the subjects with their parents in a questionnaire which include their school time, sleep time and free time.The questionnaire was administered by trained personnel.
The WHO criteria for obesity based on the BMI guiding principle were used in this study.BMI is calculated as a way of weight in kilograms divided by height in meters squared (BMI = kg/m 2 ).Using BMI chart, it is feasible to categorize the level of obesity by reference to internationally accepted ranges, beginning from underweight (BMI ˂ 18.5 kg/m 2 ), normal (BMI 18.5-24.9kg/m 2 ), overweight (BMI 25.0-29.9kg/m 2 ) and obese (BMI ≥30.0 kg/m 2 ) (Lima et al., 2000).In addition to this BMI chart, we redefined according to CDC BMI percentile growth chart (BMI for children and teens) and Cole established cut off points to define childhood overweight and obesity (Cole et al., 2000).

Statistical analysis
Descriptive statistics were calculated for all variables using SPSS package software (version 19) and the results were expressed as mean and standard deviations (SD).All values were also expressed in terms of percentage.All reported p values of <0.05 were considered as statistically significant.

Results
Total cohort included 500 subjects, out of which 55.4% (n=277) were boys and 44.6% (n=223) were girls.The mean age of the total study subjects was 9.68 years (SD 1.81 year; range 6-16).Table 1 presents the characteristics of the study subjects.Most of the participants were primary school students.Based on BMI classification of weight status, among the respondents 20.8% (n=104) students were underweight (BMI ˂ 18.5 kg/m 2 ), 40.6% (n=203) were normal (BMI 18.5-24.9kg/m 2 ), 15.6% (n=78) were overweight (BMI 25.0-29.9kg/m 2 ) and 23.0% (n=115) were obese (BMI ≥30.0 kg/m 2 ).On the other hand according to CDC BMI percentile growth chart, among the participants 17.6% (n=88) students were underweight (less than the 5 th percentile), 39.0% (n=195) were healthy weight (5 th percentile to less than the 85 th percentile), 18.4% (n=92) were overweight (85 th to less than the 95 th percentile) and 25.0% (n=125) were obese (equal to or greater than the 95 th percentile) (Fig. 1).In addition, we also try to fit the data according Cole's definition (Cole et al., to find out the prevalence of childhood overweight and obesity in the present study (Table 2).2), we show that a there is clear correlation between TV watching/juice intake/fast food intake and obesity.

Conclusion
The outcome of the present study concludes that, a high prevalence of overweight and obesity exists in primary school children in the southern coastal area of Bangladesh.The findings of this study provided obesity and overweight are most prevalent in boys from girls.Our data reveal that, positive energy balance with superior fat ingestion, lack of exercise and fast/processed food cultures to be along with the foremost fundamental factors for rising the prevalence of childhood obesity.
Further studies have to be done to evaluate the foremost causative factors coupled with obesity in primary school going children.

Figure 1 :
Figure 1: Nutritional status of study subjects.A total of 500 study subjects were evaluated for the prevalence of overweight and obesity according to CDC BMI percentile chart.

Figure 2 :
Figure 2: Daily activities of obese children.A total of 500 study subjects were interviewed to know their daily activities and the answers were recorded.