Prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children

Abstract

Background: Childhood obesity is becoming an equally challenging, yet under-recognized, problem in developing countries including Pakistan. Children and adolescents are worst affected with an estimated 10% of the world's school-going children being overweight and one quarter of these being obese. The study aimed to assess prevalence and socioeconomic correlates of overweight and obesity, and trend in prevalence statistics, among Pakistani primary school children.

Methods: A population-based cross-sectional study was conducted with a representative multistage cluster sample of 1860 children aged 5-12 years in Lahore, Pakistan. Overweight (> + 1SD) and obesity (> + 2SD) were defined using the World Health Organization child growth reference 2007. Chi-square test was used as the test of trend. Linear regression was used to examine the predictive power of independent variables in relation to BMI. Logistic regression was used to quantify the independent predictors for overweight and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were obtained. All regression analyses were controlled for age and gender and statistical significance was considered at P < 0.05.

Results: Seventeen percent (95% CI 15.4-18.8) children were overweight and 7.5% (95% CI 6.5-8.7) were obese. Higher prevalence of obesity was observed among boys than girls (P = 0.028), however, there was no gender disparity in overweight prevalence. Prevalence of overweight showed a significantly increasing trend with grade (P < 0.001). Children living in the urban area with high socioeconomic status (SES) were significantly at risk for being overweight and obese (both P < 0.001) as compared to children living in the urban area with lower SES and rural children. Being in higher grade (aOR 2.39, 95% CI 1.17-4.90) and living in the urban area with higher SES (aOR 18.10, 95% CI 10.24-32.00) independently predicted the risk of being overweight.

Conclusion: Alarmingly rapid rise in overweight and obesity among Pakistani primary school children was observed, especially among the affluent urban population. The findings support the urgent need for National preventive strategy for childhood obesity and targeted interventions tailored to local circumstances with meaningful involvement of communities.

Figure 1

Grade- and gender- specific prevalence (with confidence interval bars) of overweight among primary school children in Lahore, Pakistan (n = 1860)

Figure 2

Grade- and gender- specific mean BMI among primary school children in Lahore, Pakistan (n = 1860)

Figure 3

Gender-specific prevalence (with confidence interval bars) of overweight by area and socioeconomic status among primary school children in Lahore, Pakistan (n = 1860).

Figure 4

Trend in prevalence of overweight among urban primary school children in Pakistan; (a) shows over-all trend, and (b) shows age-specific trend. Note: US CDC 2000 child growth reference (defining overweight as >85^th percentile BMI-for-age) was used in the previous studies, and results from urban sample in the present study are presented with respect to the same reference for purpose of trend analysis.