Article Type: Research Article Article Citation: Augustina Araba
Amissah, Justice Mensah, and John Victor Mensah. (2021). PREVALENCE OF
CHILDHOOD OBESITY AND ITS SOCIO-PSYCHOLOGICAL EFFECTS ON PRIMARY SCHOOL
CHILDREN IN THE CAPE COAST METROPOLIS, GHANA. International Journal of Research
-GRANTHAALAYAH, 9(2), 216-228. https://doi.org/10.29121/granthaalayah.v9.i2.2021.3442 Received Date: 04 February 2021
Accepted Date: 28 February 2021 Keywords: Obesity Prevalence of
Obesity Childhood Obesity Socio-Psychological Primary Schools Childhood obesity is a major public health concern around the globe as it is associated with adverse consequences such as psychological problems, lower educational attainment, and a high risk of health challenges later in life. The study investigated the prevalence of obesity and its socio-psychological effects on primary school children in the Cape Coast Metropolis, Ghana. Interview schedule and interview guide were used to collect primary data from 317 pupils and 24 teachers respectively from public and private schools in 2018. Microsoft Excel software (version 2013) was used to analyse quantitative data while content analysis was used for qualitative data based on themes. The result indicated that the overall prevalence rate was five percent. Prevalence of obesity was higher in private schools than public schools while that among male pupils was higher than their female counterparts. Pupils of age 11 years were at higher risk than those at age nine years. The socio-psychological effects on the affected children included stigmatization, exclusion from taking part in some competitive activities, inactive and often slept during lessons. The school authorities should collaborate with the Metropolitan Directorates of Education and Health to manage obesity in the schools. They could invite health experts to educate school management, teachers, pupils, and parents on support systems for managing childhood obesity.
1. INTRODUCTIONChildhood is
developmental period during which individuals establish basics for their future
health through adolescence to adulthood (Morita et al., 2006). It is a
complicated path that
individuals take from dependency in childhood to independency in adulthood
(Arnett, 2014).
With the increasing prevalence in obesity, there is a corresponding number of youths
classified as obese. Childhood obesity has become a global health issue
due to its increasing prevalence and the consequences associated with it. Stigmatisation, low self-esteem
and economic burden of managing childhood obesity make it imperative to pay
particular attention to childhood obesity (Cunningham et al., 2014). An obese
child in two consecutive years has a $194 higher outpatient visit expenditure,
a $114 higher prescription drug expenditure, and a $12 higher emergency room
expenditure than a child with normal weight (Trasande
& Chatterjee, 2012). Globally, 41
million children under age five and over 340 million children and adolescents
aged 5–19 years were reported to be obese in 2016 (Akowuah, & Kobia-Acquah, 2020). Obesity used to
be considered a problem only in high-income countries
but the phenomenon is on the rise in low- and middle-income countries
(Pangani et al., 2016). Studies
show that obesity cases are being recorded even at faster rate in low- and
middle-income countries than the high-income countries (Dinsa et al., 2012). In Africa, the
number of obese children almost doubled within the period of 16 years;
increasing from 5.4 million in 1990 to 10.6 million in 2016 (Ganle et al., 2019). Childhood obesity is emerging as a major health
problem in Ghana, especially among the urban population. Ghana Statistical
Service (2014a) indicated that childhood obesity has grown at an alarming rate
of 3.1 percent in Ghana with Greater Accra, Central and Volta regions reporting
high levels of the incidence. Whyte et al. (2020) noted that about five percent
of school children in Cape Coast were obese and nine percent were at risk of
obesity. This is particularly important because childhood obesity can
negatively affect academic work of school children. Studies have shown
that overweight children tend to become overweight or obese adults (Biro
& Wien, 2010). Effective prevention and management of obesity
during childhood are critical to prevent the situation from becoming epidemic
in the society. Prevention and effective management of childhood obesity demand
the need to undertake an evidenced-based study to estimate its prevalence among
children in Ghanaian schools and disaggregate such information by sex and age (Atuahene et al., 2017). One key step in managing childhood obesity and its
attendant challenges is to undertake comprehensive studies of its prevalence
and causes. There is limited data on prevalence of childhood obesity
disaggregated by age and sex in Ghana (Ganle et al.,
2019). It is against this background that this study is undertaken. The study investigates the prevalence of childhood
obesity and its socio-psychological effects
on
primary school children in the Cape Coast Metropolis in Ghana. The specific
objectives of the study are to: (a) determine the prevalence of childhood obesity
among the primary school children; and (b) analyse
the effects of childhood obesity on socio-psychological aspects of school
children. The paper is structured into five sections,
beginning with introduction which captures the background to the paper. The
next section is literature review. The third section presents the methods used
for the study while the fourth section focuses on results and discussion. The
final section presents conclusion and the way forward. 2.
LITERATURE REVIEW
Literature is reviewed on obesity as a concept,
childhood obesity, prevalence of childhood obesity, causes of childhood
obesity, and socio-psychological
consequences of childhood obesity. 2.1. OBESITY AS A CONCEPT
Obesity refers to a physical condition characterized
by excessive deposition or storage of fats in the adipose tissues (Barkhru, 2006). It is an abnormal fat accumulation
resulting from energy imbalance between calories consumed and calories
expended. A person is considered obese when his/her body mass index (BMI)
exceeds 30kg/m2, with the range of 25-30kg/m2 defined as
overweight (Haslam & James, 2005). The Centre for Disease Control and
Prevention (2010) defines overweight as at or above the 95th percentile
of BMI for age and “at risk for overweight” as between 85th and
95th percentile of BMI for age (Himes & Dietz 1994; Flegal
et al., 2002). Obesity impedes the health of the individual and
can cause diseases and death that could be prevented. Therefore, it is
important to curb its prevalence. 2.2. CHILDHOOD OBESITYChildhood
is the period of the human lifespan between infancy and adolescence, extending
from ages 1–13 (Encyclopaedia Britannica). It is a
period during which individuals acquire foundation skills for their future
health, growth and development. Childhood obesity occurs when a child is well above
the normal weight for his/her age and height (Truswell,
2003). Many paediatricians classify a child as obese
when the child falls above the 95th percentile in weight for
height. A child whose BMI for age
percentile is greater than 95th percentile, is classified as obese.
However, a child’s BMI-for-age percentile between 85% and 95%, is classified as
overweight (WHO, 2007). Body
Mass Index is a simple calculation using a
person's height and weight.
The formula is BMI =
kg/m2 where kg is a person's weight in kilograms and m2 is their height in
square metres. A BMI of 25.0 or more is overweight, while the healthy range is
18.5 to 24.9. BMI applies
to most adults 18-65 years. Obesity is diagnosed when the BMI is 30 or higher. Table 1: Body mass index and weight status
Source: Diabetes Canada (2020) 2.3. PREVALENCE OF OBESITY AMONG SCHOOL CHILDRENThe prevalence of overweight and obesity
among males and females differs within and between countries but generally,
females are more obese than males in developing countries. Yet, in developed countries,
more males are overweight than females (Kanter & Caballero, 2012) Literature suggests that several
sociocultural dynamics throughout the world intensify gender disparities in
excess weight gain. The causes of overweight and obesity among girls and boys
may be different due to biological make-up, society
and culture (Kumanyika et al., 2002). Boys and girls differ in body composition,
patterns of weight gain, hormone biology, and the susceptibility to certain
social, ethnic, genetic, and environmental factors (Popkin, 2011). Understanding
gender differences in child overweight and obesity risk and associated
determinants is critical for the policy formulation and execution. Gender variations in prevalence of childhood
obesity have been noted in several countries. Some studies reported higher
prevalence in girls than in boys (Gortmaker, 2011)
while others have reported the contrary (McLaren, 2007). Muhihi et al. (2013)
observed that the overall incidence of childhood obesity among primary school
children in Dar es Salaam was 5.2%. Obesity was highlighted as higher among
girls (6.3%) than boys (3.8%). Similarly, the prevalence of overweight was
higher among girls (13.1%) than boys (6.3%). Pangani et al. (2016)
noted that prevalence of underweight, overweight and obesity among primary school
children aged 8–13 years in Dar es Salaam City were 5.5%, 18.7%, and
8.0% of females and 7%, 12.1%, and 4.9% of males
respectively. The result showed that more males were found to be underweight
(7%) than females (5.5%) while more females were found to be overweight or
obese (26.7%) than males (17%). Mohammed
and Vuvor (2012) observed that childhood obesity or
overweight ranked very high among the females in basic
schools in Accra. They observed 10.9% prevalence of child obesity with higher
prevalence in girls (15.0%) than boys (7.2%). The difference was statistically
significant (P-value = 0.001). The Ghana Statistical Service (2014a) revealed that
obesity among children was growing at the rate of 3.1%. Amidu
et al. (2013) reported that the overall prevalence of overweight and obesity
among the sampled children in Tamale drawn from the private and public schools
was 9.8% and 7.5% respectively. This suggests that the children from the
private schools were heavier than their counterparts from the public schools. Tuoyire et al. (2018) however, observed that obesity
is prevalent in Cape
Coast and appears to cut across all adult age groups. 2.4. CAUSES OF CHILDHOOD OBESITY
Genetics is one of
the causes of obesity. Some studies have found that BMI is 25–40% heritable (Anderson &
Butcher, 2006). Many
obese children grow to become obese adults, especially if one or both parents
are obese. However, hereditary
predisposition often needs to be coupled with contributing environmental and behavioural factors in order to
affect weight (Institute of Medicine (US),
2004). While genetics can play a role in the development of obesity, it is not
always the cause of the dramatic increase in childhood obesity. Metabolism has
also been identified as a potential cause of obesity. It is the body's
expenditure of energy for normal resting functions. Diet has been studied
extensively for its possible contribution to the increasing rates of obesity
among children. Several dietary factors examined include fast food consumption,
sugary beverages and snack foods. Increased fast food
consumption has been linked to obesity in the recent years (Niehoff, 2009). Fast food often
contains high calories with low nutritional values. Sugary drinks include soda,
juice and other sweetened beverages, which result in a
higher caloric intake (Chen et al., 2012). Sedentary
lifestyles coupled with lack of or inadequate physical
exercise also cause obesity (Anderson & Butcher, 2006). The increased amount of time devoted to inactive behaviours tends to decrease the amount of time spent in
physical activity. The number of hours children spend watching television
correlates with their consumption of the most advertised goods such as sweets,
sweetened cereals, sweetened beverages and snacks (Story et al., 2002). The use of electronic media and other environmental factors reduce the
opportunities for physical activity (Krushnapriya et.
al., 2015). For example, in the past, most children either walked or rode their
bicycles to school but today, most affluent parents drive their children to
school, even in developing countries. Anderson and Butcher (2006) noted that 53% of the parents drove their children to
school, thereby making their wards to be physically inactive and exposing them
to the risk of obesity and overweight. Psychological factors
such as depression and anxiety can also cause obesity (Goldfield et al., 2010). In a clinical study of obese adolescents, a higher life-time prevalence
of anxiety disorders was reported compared to non-obese controls
(Britz et al., 2000). In contrast, Tanofsky-Kraff
et al. (2004) reiterated that some
studies demonstrate no significant relationship between increased BMI and
increased anxiety symptoms. 2.5. SOCIO-PSYCHOLOGICAL CONSEQUENCES
OF CHILDHOOD OBESITY
Childhood obesity is an austere medical
condition that affects children because the extra kilograms often start
children on the path to poor health conditions that were hitherto considered
adult problems such as diabetes, high blood pressure and high cholesterol (Cote
et al., 2013). It can also lead to poor self-esteem and depression. Childhood obesity
has several consequences as it can affect children's physical health, social,
and psychological well-being including emotions and self-esteem, and academic
performance (Krushnapriya et al., 2015). It has been
connected to various health conditions such as fatty liver disease, sleep
apnea, Type 2 diabetes, asthma, hepatic steatosis, cardiovascular disease, high
cholesterol, gallstones, glucose intolerance and insulin resistance, skin
conditions, menstrual abnormalities, impaired balance, and orthopaedic
problems (Niehoff, 2009). Until
recently, many of the above health conditions had only been found in adults;
now they are extremely prevalent in obese children. Most of the physical health
conditions related to childhood obesity are preventable and can disappear when
a child attains a healthy weight while some continue to have negative effects
during adulthood (American
Academy of Pediatrics, 2019). Some of
these poor health conditions may lead to death. Childhood obesity
also affects children's social and emotional health. It is one of the most
stigmatizing and least socially acceptable conditions (Schwimmer et al., 2003). Overweight
and obese children are often teased and/or bullied. They also suffer miseries
such as negative labels, discrimination and social
marginalization (Budd & Hayman, 2008). Obese children are frequently excluded from
competitive activities that require smartness. The above-mentioned negative
effects can be devastating to children and adolescents, especially when they
are in school. The negative
social effects of obesity may contribute to long-term difficulty in weight
management. Obese children often safeguard themselves from stigmatization by
withdrawing from interacting with friends and other people (Cornette, 2008). Childhood obesity has negative
effect on academic performance. According to Schwimmer et al. (2003), overweight
and obese children are four times more likely to report having problems at
school than their normal weight peers. In addition, they are more probable to miss school
often particularly, those with chronic diseases such as diabetes and asthma. 3. STUDY AREA AND METHODSThe study was conducted in the Cape Coast
Metropolis which is the capital of the Central Region of Ghana (Figure 1). The
Metropolis shares boundary to the South by the Gulf of Guinea, to the West by
Komenda-Edina-Eguafo-Abrem Municipality,
to the East by the Abura-Asebu-Kwamankese
District and to the North by the Twifo Heman Lower Denkyira District.
Its location is on the longitude of 1°14' -1°15ˈW and latitude 5°05'- 60.00’N
and occupies an area of approximately 122 square kilometres.
The population of the Cape Coast Metropolis was 169,894 in 2010, representing
7.7% of the total population of the Central Region. The population constituted
48.7 percent males and 51.3 percent females, among which the proportion of
children below 15 years was 28.4 percent. The economic activity status of the
entire population is very high with about 54.7% of children age
15 and above being economically active. There were about 21,178 primary school
pupils in the Metropolis in 2010 (Ghana Statistical Service, 2014b). The
Metropolis was chosen for the study because it is considered as the citadel of
education in Ghana. It has many schools ranging from basic to tertiary level.
Records obtained from the Cape Coast Metropolitan Education Office in 2018 showed
120 primary schools (80 public and 40 private). Figure 1: Map
of Cape Coast Metropolis Source:
Cartography Unit, Department of Geography and Regional Planning, UCC (2018). The study adopted the mixed method approach.
Both quantitative and qualitative data were used. The target population was all school-aged pupils between
the age range of 9 and 15 years. For this study, pupils from primary four to
six were selected from 12 schools in the Metropolis. This is because it was
assumed that they were old enough and more likely to understand the
requirements for the study. The inclusive criteria for the study were all
primary four to six pupils who were available, willing and had their
parents/guardians’ consent for their participation. It excluded pupils whose
parents or guardians did not give their consent for their participation and
those with physical deformities that could affect the accuracy of the
anthropometric measurements. For representativeness, reliability and
flexibility in the study, a justified sample size was obtained. Cohen, Manion
and Morrison (2007) are of the opinion that sample size can be obtained in two
ways; the researcher can either carefully ensure that the sample is a good
representation of the wider population or by using a table which forms a
mathematical formula. Based on this, the
Krejcie and Morgan (1970) table for determining
sample size was used. As laid down by them, for a population between 20,000 and
30,000, a sample size of about 379 is appropriate for a study. However, a
sample size of 317 was obtained and used because of availability and approval
of parents or guardian to participate in the study. These comprised 169 (53%)
females and 148 (47%) males. Both males and females were selected because of the
differences in their physiological and genetic make-up. These differences were
perceived to possibly affect their tendency of acquiring or accumulating excess
body fat. In addition, 136 out of these 317 pupils, representing 42.9%, were
selected from private schools and 181 also representing 57.1% were selected
from public schools. This was also done to make it possible to compare the
prevalence of obesity among the pupils from both clusters. The multi-stage sampling procedure was
adopted to select participants for the study. The procedure involved four steps. First, the
total number of all primary schools was obtained from the six circuits in the
Cape Coast Metropolitan Education Directorate. Second, a sampling frame was
made using the list of schools based on their categories: private and public.
Two schools (one private and one public) from each circuit were then selected
from the six circuits in the Metropolis using the simple random (lottery)
method. Third, the lottery method with replacement was used to select the
sample of 32 pupils from each selected school. This was done by compiling the
list of all primary four to six pupils using their class registers. During data
collection, a sample size of 317 pupils were available and approved by their
parents for use for the study. Fourth, two teachers from each of the 12
selected schools (i.e., 24 teachers) were involved in the in-depth interview to
provide information on the effects of childhood obesity on
socio-psychological aspects of the school children. For the purpose of
this study, anthropometric measurements were used for data collection. A standardised UNICEF electronic scale produced by SECA (a German company that develops, produces
and sells weighing scales and measuring instruments) and a height rod
were used to take weight and height measurements of the school pupils
respectively following standard procedures outlined by Gibson (2005). Heights
were recorded to the nearest 0.1 centimetre while
weights were recorded to the nearest 0.1 kilogram. An in-depth
interview guide was developed to collect qualitative data from teachers in the
selected schools. Two research assistants were recruited and trained to assist
in the data collection. During the training, they were briefed on appropriate
data collection (weight and height measurements procedures) and ethics. A
pre-test of the instruments for data collection was carried out in three
primary schools using five pupils from each school who did not form part of the
sample for the main study. This was to test the procedures outlined above and
to check the reliability of the weighing scale and the height rod used. A letter of
introduction was sent to school authorities to seek permission from the Ghana
Education Service as well as various heads of schools selected. After the
school authorities agreed for the study to be undertaken, consent letters were
sent to parents/guardians of all selected pupils in classes four to six through
their children. Children whose parents granted consent were included in the
study. Data collection took place from 17th
September to 25th October, 2019. The pupils
were refreshed with biscuits and yoghurt by way of compensation for
participation. Social scientists observe ethical
considerations and cannot carry out research that involves people without an
informed consent (Israel & Hay, 2006). An introductory letter was sent to
the authorities of the Cape Coast Metropolitan Assembly to seek clearance to
conduct the study as well as to the Educational Unit. Ethical approval was
sought from the University of Cape Coast Institutional Review Board (UCCIRB)
before conducting the studies. The researchers adhered to all the ethical
issues that supported research work. All respondents were given much
information needed to make an informed decision about whether
or not they wished to participate in the study. Moreover, respondents
were assured that, information provided would be treated as confidential as
possible. Also, as part of exercising a high level of confidentiality, anonymity
was highly addressed to ensure that the research was devoid of the names of the
participants. The
anthropometrical measures were taken in the mornings on the school premises.
The research team ensured that though participants were in their usual school uniform,
they were without foot wear, socks, watches, and items
in their pockets or any heavy clothing like jacket or sweater. Body weight was
measured using a weighing scale. The scale was placed on a flat surface and
stepped on for it to display 0.0 kg. Participants’ data such as age, height and
sex were recorded. Each participant stepped onto the scale with one foot on
each side of the scale. They were also asked to stand still, face forward,
place arms on the side and wait until asked to step off. Weight and BMI figures
that appeared on the screen were recorded. Height was measured
using a height rod fixed appropriately to a wall. They were then asked to stand
with their backs straight, and arms hanging loose by their sides with feet
flat, buttock, shoulder blades and head touching the wall. The height rod was
aligned to the vertex of the head and readings recorded. The data were
coded, entered into computer and analysed
using the Microsoft Excel software (version 2013) to generate tables and graphs
using frequency and percentage distributions. Microsoft Excel was used to
calculate the BMIs using the heights and weights of the pupils to confirm the
readings from the weighing scale. 4.
RESULTS AND DISCUSSION
This section presents the analysis and discussion
of data on prevalence of obesity among primary school children based on sex,
age and the type of school children attended as well as the effects of
childhood obesity on socio-psychological aspects of school children. 4.1. PREVALENCE OF CHILDHOOD OBESITY
The overall prevalence
of obesity among the sampled primary pupils was 4.7 percent of the total number
of pupils
as presented in Figure 2. Fifteen
(4.7%) pupils were obese. Pupils at risk of obesity (overweight) were 29 (9.2%)
representing almost twice the number of obese pupils. The implication is that the combined
prevalence of obesity and overweight was 13.9 percent. The results are in line
with other studies on the prevalence of obesity among children. Child obesity
is growing in the Central Region at the rate of 4.6 percent (Ghana Statistical
Service, 2014a). Amidu et al. (2013) revealed that
the combined obesity and those at risk of obesity among basic school pupils in
the Tamale metropolis was 17.6 percent. Aduama (2004)
noted that the prevalence of obesity and overweight among primary school pupils
in the Greater Accra Region was 5% and 10.2% respectively, thereby giving a
combined prevalence of obesity and risk of obesity as 15.2 percent. Nicklas et
al. (2001) indicated that 25
percent and 11 percent of children in the USA were overweight and obese
respectively and about 70 percent of the obese children grow up to become obese
adults. Figure 2: Overall prevalence of obesity Source: Field data, 2019 4.2. PREVALENCE OF OBESITY BY SEX
The sample for the study
comprised 169 (53.3%) females and 148 males (46.7%). The result indicates
obesity prevalence rates of 6.1% and 3.6% among the males and females
respectively as presented in Table 2. This shows that the prevalence rate of
obesity among the males was almost twice as that of females. Table 2: Prevalence of obesity by sex
Note: Figures in parentheses are row
percentages; Significance level = 0.05 Source: Field data, 2019 Table 2 indicates that
there was no statistical difference between the obese pupils from both sexes
and the overweight pupils, although those at risk of obesity or overweight was
at an alarming rate of 10.8% males and 7.7% females. However, the
difference in weight by sex was statistically insignificant as indicated by
chi-square value of 2.199 with p-value = 0.33, which is higher than 0.05. Our finding is consistent with that of Ng et al. (2014) that there
were more obese males than females in developed countries. However, it is
inconsistent with that of Mohammed and Vuvor (2012)
who observed a higher prevalence of obesity of 15% among females than 7.2% among
males in Accra. Mohammed and Vuvor (2012) concluded
that the higher prevalence rate among females may be due to hormonal changes
and other factors. 4.3. PREVALENCE OF OBESITY BY AGE
The age of
the sampled pupils ranged from 9 to 15 years. The prevalence of obesity by age of the pupils is presented in Figure 3. The prevalence of
obesity was high among pupils of age 11 (2.2%) for both sex classifications and
was also very low at age nine (0.32%). However, there were more pupils at the
age of 10 (3.2%) who were overweight and at risk of being obese. This implies
that obesity and risk of obesity were highly seen among pupils within the age
range of 10-12 years. The result suggests that the
difference in weight of children by age was statistically insignificant as
shown by chi-square value of 8.214 (p-value = 0.41). The results corroborate Muhihi et al.’s (2013)
finding that, children aged 10 years and above were three times more likely to
develop obesity. This is also confirmed by the American Heart Association
(2009) that when children entered kindergarten (mean age 5.6 years), 12.4% were
obese and 14.9% overweight but as they entered eighth grade (mean age
14.1years), 20.8% were obese and 17.0% were overweight. McLaren et al.
(2003) studied the relationship between past body size and current body
dissatisfaction among 933 middle-aged women and found out that, women who were
dissatisfied at mid-life were found to have been overweight at age seven and
showed a more rapid increase in BMI with age. Obese children are more likely to become obese adolescents or adults (Barkhru, 2006). Figure 3: Prevalence based on age Source: Field data, 2019 4.4. PREVALENCE BASED
ON TYPE OF SCHOOL CHILDREN ATTENDED
The prevalence of
childhood obesity based on type of school children
attended is illustrated in Table 3. There were more
obese pupils in the private schools 9 (2.8%) than those found in the public
schools 6 (1.9%). In terms of those overweight and at risk of obesity, the
results showed higher prevalence among private schools 16 (5%) than those found
in the public schools, 13 (4.1%). This finding is in line with the assertion of
Amidu et al. (2013) that the mean percentage of body
fat among the pupils in the private schools was significantly higher than those
from the public schools. This may be due to differences in the socio-economic
backgrounds of parents of private schools and those of public schools.
Literature suggests that variations in factors such as lifestyle, dietary behaviours and standard of living occasioned by socio
economic status could explain an individual’s social environment, physical
environment and macro-level environments all of which interact to impact energy
intake and physical activity behaviours (American
Heart Association, 2009). Chi-square analysis emerging from our study shows
that the difference in weight of children by type of school
children attended was statistically insignificant as indicated by chi-square
value of 4.133 with p-value = 0.13. Table 3: Prevalence based on type of school children attended
Note: Figures in
parentheses are row percentages; Significance level = 0.05 Source: Field data, 2019 4.5. EFFECTS OF CHILDHOOD OBESITY ON
SOCIO-PSYCHOLOGICAL ASPECTS OF SCHOOL CHILDREN
Interactions with the teachers and the
children revealed that overweight and obese children face socio-psychological
problems which included stigmatization, teasing, bullying, marginalisation, negative stereotyping, discrimination,
absenteeism, poor academic performance, poor health conditions and unhappiness.
For example, a 43-year-old female teacher reported that: Some children tease their obese friends but
the teachers have warned them against that. I even punished some pupils for
teasing their obese friends (Private school teacher, 19th September, 2019). This statement confirms the assertion of Schwimmer et al. (2003) that obese and
overweight children are often teased, bullied and stigmatized. Another teacher reported that some obese
children were marginalized as they were often excluded from taking part in some
competitive activities such as soccer and athletics. One of the teachers
remarked that: Some of the obese children are not happy
about not being selected to take part in sporting activities
(Public school teacher, 25th September, 2019). This
corroborates the findings of Schwimmer et al. (2003), American
Academy of Paediatrics (2019)
and Budd and Hayman (2008) that obese and
overweight children suffer negative stereotypes, discrimination and marginalization.
The teachers also reported that some obese
children often sleep in class and the children concerned do not benefit from
the lessons being taught. For example, a teacher highlighted that: I have two obese children in my class. They
are not active at all. They are always sleeping during lessons. Although some
other children sometimes sleep in the class, I suspect that for these two obese
children it is due to their condition. They are also not academically good
(Public school teacher, 9th October, 2019). In one of the schools, it was indicated that
there was an obese child who frequently absented herself from school due to ill
health. The class teacher lamented that: The child’s performance was not good but she
could have done better as she was not dull but she has been missing classes
(Private school teacher, 14th
October, 2019). This result corroborates the finding of Krushnapriya et al. (2015) that
overweight and obese children are likely to miss school more frequently,
especially those with health conditions such as diabetes and asthma. One female obese child reported that: My friends have given me a nickname ‘Obolo’ which means I am too big or fat. I have told them I
do not like it but they still call me by the nickname
(A female private school child, 14th
October, 2019). The child’s report was corroborated by two
teachers in the school and three in other schools that: School children have nicknames for their
obese counterparts. Most obese school children do not like such names. But some
school children are stubborn as they continue to harass them in one way or the
other with the nicknames. However, the teachers do not spare the offenders when
reports reach them. It is important to note that some obese children do not
mind their friends calling them by the nicknames (Private
school teacher, 14th
October, 2019). In another school, a male obese child
reported that: When the friends are playing soccer and he
wants to join them, they do not allow him because they say he is too big and
heavy as he might hurt someone. (Public school child, 26th
September, 2019). Three teachers confirmed the boy’s report
indicating that they had punished two boys on this issue after advising them a
couple of times to no avail to refrain from that behaviour. Besides, all the teachers confirmed that
obese children usually had one challenge or the other due to their condition
but they (the teachers) were doing their best to contain the situation. The foregoing reports are consistent with the
findings of Budd and Hayman (2008) and Krushnapriya
et al. (2015) that some obese children face hardships including negative
stereotypes, discrimination and social marginalization. These negative effects
can be devastating to children and adolescents, especially when they are in
school. 5. CONCLUSION AND THE WAY FORWARDThe paper has provided evidence that the
prevalence rate of obesity among primary school children in the Cape Coast
Metropolis was 4.7 percent. The prevalence of obesity was almost twice among
males than females. Overweight was also higher among males (10.6%) than females
(7.7%). In terms of age, pupils within 10-12 years were found to be most highly
at risk of obesity. For both sex, pupils of age 11 were highly at risk (2.2%)
while those at age nine were found to be at low risk. Prevalence of obesity was higher among
primary school children in private schools than their public-school
counterparts. Overweight was also higher in private schools than the public
ones. The socio-psychological effects on obese children in the schools include
stigmatization, marginalization and exclusion from taking part in some
competitive activities. Additionally, some obese children were not active and often slept during
lessons, thereby making them not good academically. The findings of
this study suggest that obesity and overweight among school children in the
Cape Coast Metropolis were high. These
could pose challenges to both pupils and teachers in academic work. However,
chi-square results show that there was no statistically significant difference
in weight of school children by sex, age and type of school children attended. As a way forward, the schools should collaborate with the Metropolitan Directorate of Education and parents to find ways of reducing the incidence of obesity among pupils in the schools. They should collaborate with health experts to educate the teachers, parents and pupils on both reducing and managing obesity among pupils. Since this case study used a relatively small sample, there is need for a nation-wide study on obesity and overweight among school children to guide national policy and obesity management. SOURCES OF FUNDINGThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. CONFLICT OF INTERESTThe authors have declared that no competing interests exists. ACKNOWLEDGMENTNone. REFERENCES [1] Aduama, S. (2004). Obesity in primary school
children in Accra Metropolis. Dissertation submitted to the School of Public
Health, University of Ghana, Legon, for the award of Master of Public Health
http://ugspace.ug.edu.gh/bitstream/handle/123456789/5103/
Svitlana%20Aduama_Obesity%20in%20primary%20school%20children%20in%20Accra%20Metropolis_2004.pdf?sequence=3&isAllowed=y [2] Akowuah, P. K., & Kobia-Acquah,
E. (2020). Childhood Obesity and Overweight in Ghana: A Systematic Review and
Meta-Analysis. Journal of Nutrition and Metabolism, Article ID 1907416,
11 pp., 2020. https://doi.org/10.1155/2020/1907416. [3] American
Academy of Pediatrics (2019). About childhood obesity. Itasca: American Academy
of Pediatrics, Available from: http://www.aap.org/obesity/about.html. [4] American
Heart Association (2009). Understanding childhood obesity, Texas:
National Center. [5] Amidu, N., Owiredu,
W., Saaka, M., Quaye, L., Wanwan,
M., Kumibea, P., Zingina,
F., & Mogre, V. (2013). Determinants of childhood
obesity among basic school children aged 6–12 years in Tamale Metropolis. J
Med Biomed Sci. 2(3):26–34. [6] Anderson
P. M., & Butcher, K. E. (2006). Childhood obesity: trends and potential
causes. Future Child, 16(1), 19-45.
doi: 10.1353/foc.2006.0001. [7] Arnett,
J. J. (2014). Emerging adulthood: The winding road from the late teens
through the twenties. New York: Oxford University Press. [8] Atuahene M., Ganle,
J. K., Adjuik, M., Atuahene,
N. F., & Kampitib, B. G. (2017). Overweight and
obesity prevalence among public servants in Nadowli
district, Ghana, and associated risk factors: a cross-sectional study. BMC
Obesity. https://doi.org/10.1186/s40608-017-0153-5. [9] Barkhru, H. K. (2006). Nature cure for
children's diseases. http://www. HealthLibrary.com. [10]
Biro, F. M., & Wien, M. (2010). Childhood
obesity and adult morbidities, The American Journal of Clinical Nutrition.
91(5), 1499S–1505S. [11]
Britz,
B., Siegfried, W., Ziegler, A., Lamertz, C, Herpertz-Dahlmann, B.M., Remschmidt,
H., et al. (2000). Rates of psychiatric disorders in a clinical study group of
adolescents with extreme obesity and in obese adolescents ascertained via a
population-based study. Int J Obes Relat Metab Disord,
24:1707–14. [12]
Budd, G.M., & Hayman, L.L. (2008).
Addressing the childhood obesity crisis. Am J Matern
Child Nurs. 33:113–7. [13]
Center for Disease Control and Prevention.
(2010). Contributing factors. Available from: http://www.cdc.gov//obesity/childhood/contributing_factors.html
[14]
Chen, S. E., Raymond J., Florax,
R. J., & Snyder, S. D. (2012)
Obesity and fast food in urban markets: A new approach using
geo‐referenced micro data. Health Economics, 22(7),
835-856.https://doi.org/10.1002/hec.2863 [15]
Cohen L, Manion, L. & Morrison, K.
(2007). Research Methods in Education, (6th ed.), London: Routridge [16]
Cornette,
R. (2008). The emotional impact of obesity on children. Worldviews Evid
Based Nurs. 5,136–41. [17]
Cote, A.T., Harris, K. C., Panagiotopoulos, C., et al. (2013). Childhood obesity and
cardiovascular dysfunction. J Am Coll Cardiol;
62 (15):1309–1319. [18]
Cunningham, S. A., Kramer, M. R., &
Narayan, K. M. V. (2014). Incidence of
childhood obesity in the United States. N Endl J
Med, 11 370-403. [19]
Desalew,
A., Mandesh, A., & Semahegn,
A. (2017), Childhood overweight, obesity and associated factors among primary
school children in dire dawa, Eastern Ethiopia; A
cross-sectional study. BMC Obes. doi: 10.1186/s40608-017-0156-2. [20]
Diabetes Canada (2020). Body Max Index
(BMI) Calculator, Toronto: National office. [21]
Dinsa,
G. D., Goryakin, Y., Fumagalli,
E., & Suhrcke, M. (2012). Obesity and
socioeconomic status in developing countries: A systematic review. Obesity
reviews, 13(11), 1067-1079. [22]
Flegal,
K.M., Wei, R., & Ogden, C. (2002). Weight-for-stature compared with body
mass index-for-age growth charts for the United States from the Centers for
Disease Control and prevention. Am J Clin Nutr,
75,761–766. [23]
Ganle, J. K., Boakye, P. P., & Baatiema,
L. (2019). Childhood obesity in urban Ghana: evidence from a cross-sectional
survey of in-school children aged 5–16 years. BMC Public Health
19, 1-12. 1561 https://doi.org/10.1186/s12889-019-7898-3. [24]
Ghana Statistical Service (2014a). Ghana
demographic and health survey. Accra: GSS and ICF Macro. [25]
Ghana Statistical Service (2014b). Population
and housing census of Ghana. Analysis of Districts Data and Implications for
Planning, Accra: Ghana Statistical Service. [26]
Gibson, R. S. (2005). Principles of
nutritional assessment. Oxford, UK: Oxford University Press. [27]
Goldfield, G. S., Moore, C., Henderson, K.,
Buchholz, A., Obeid, N., & Flament, M. F. (2010).
Body dissatisfaction, dietary restraint,
depression, and weight status in adolescents. J Sch Health, 80, 186–92. [28]
Gortmaker,
S. L., Swinburn, B., Levy, D., Carter, R., Mabry, P. L., Finegood,
D., Huang, T., Marsh, T., & Moodie, M.
(2011). Changing the future of obesity: Science, policy and action.
Lancet. 27, 838–847. doi:
10.1016/S0140-6736(11)60815-5. [29]
Haslam, D. W., & James, W. P. (2005).
Obesity. National Library of Medicine, 366(9492), 1197-209. doi: 10.1016/S0140-6736(05)67483-1. PMID: 16198769. [30]
Himes, J. H. $., & Dietz, W. H. (1994).
Guidelines for overweight in adolescent preventive services - Recommendations
from an Expert Committee. The Expert Committee on Clinical Guidelines for
Overweight in Adolescent Preventive Services. Am J Clin Nutr.
59: 307–16. [31]
Institute of Medicine (US) Subcommittee on
Military Weight Management. Weight Management: State of the Science and
Opportunities for Military Programs. Washington (DC): National Academies Press
(US); 2004. 3, Factors That Influence Body Weight. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK221834/ [32]
Israel, M., & Hay, I. (2006). Research
Ethics for Social Scientists, London: Sage Publications Ltd. [33]
Krejcie,
R. V., & Morgan, D. W. (1970). Determining sample size for research
activities. Educational and Psychological Measurement, 30, 607-610. [34]
Krushnapriya,
S., Bishnupriya, S., & Ajeet, S. B. (2015).
Childhood obesity: causes and consequences. J Family Med Prim Care,
4(2), 187–192. [35]
McLaren, L. (2007). Socioeconomic status and
obesity, Epidemiol Rev, 29:29-48 DOI: 10.1093/epirev/mxm001 [36]
Mohammed, H., & Vuvor,
F. (2012). Prevalence of childhood overweight/obesity in basic schools in
Accra. Ghana Med Journal, 46(3):124-7. [37]
Morita, Y., Iwamoto, I., Mizuma,
W., Kuwahata, T., Matsuo, T., Yoshinaga, M., & Douchi, T. (2006). Precedence of the shift of body-fat
distribution over the change in body composition after menopause. Journal of
Obstetrics and Gynecology, 32, 513-516. [38]
Muhihi,
A.J., Mpembeni, R.N.M Njelekela,
M.A., Anaeli, A., Sulende,
O.C., Lujani, K.B., Maghembe,
M., & Ngarash, D. (2013). Prevalence and
determinants of obesity among primary school children in Dar es Salaam,
Tanzania. Archives of Public Health; 71:26 http; /www/archives of public
health.com/content71/1/26. [39]
Ng, M., Fleming, T., Robinson, M., Thomson,
B., Graetz, N., Margono,
C., & Abera, S. F. (2014). Global, regional, and
national prevalence of overweight and obesity in children and adults during
1980–2013: A systematic analysis for the global burden of disease study 2013. The
lancet, 384(9945), 766-781. [40]
Nicklas, T. A., Baranowski, T., Baranowski,
J. C., Cullen K., Rittenberry, L., & Olvera, N. (2001). Family and
child‐care provider influences on preschool children's fruit, juice, and
vegetable consumption. Nutrition Reviews, 59(7), 224-235. [41]
Niehoff,
V. (2009). Childhood obesity: A call to action. Bariatric Nursing and
Surgical Patient. Care, 4:17–23. [42]
Pangani,
I, N., Kiplamai, F, K., Kamau, J, W. & Onywera, V. O. (2016). Prevalence of overweight and obesity
among primary school children aged 8–13 years in Dar es Salaam City, Tanzania, Advances
in Preventive Medicine, https://doi.org/10.1155/2016/1345017 [43]
Popkin, B.M. (2011). Contemporary nutritional
transition: determinants of diet and its impact on body composition; Proc Nutr Soc, 70(1):82-91. [44]
Sahoo, K., Sahoo, B., & Bhadoria, S. B. (2015). Childhood obesity: Causes and
consequences; J Family Med Prim Care. 4(2), 187–192. [45]
Schwimmer, J. B., Burwinkle, T. M., & Varni, J. W. (2003). Health-related quality of life of
severely obese children and adolescents. JAMA. 289, 1813–9. [46]
Smith, J. D., Fu, E., & Kobayashi, M.
(2020) ... Prevention and management of childhood obesity and its psychological
and health comorbidities. Annu Rev Clin
Psychol, doi:
10.1146/annurev-clinpsy-100219-060201 [47]
Story, M, Neumark-Stainzer.
D., & French, S. (2002). Individual and environmental influences on
adolescent eating behaviours. J Am Diet Assoc.
2002 102: S40–51. [48]
Tanofsky-Kraff,
M., Yanovski, S. Z., Wilfley, D. E., Marmarosh, C., Morgan, C. M., Yanovski,
J. A. (2004). Eating-disordered behaviours, body fat,
and psychopathology in overweight and normal-weight children. J Consult Clin
Psychol, 72, 53–61. [49]
Trasande,
L., & Chatterjee, S. (2012). The impact of obesity on health service
utilization and costs in childhood. Obesity, 17(9), 1749-1754. [50]
Truswell,
A. S. (2003). ABC of nutrition (4th ed. Vol. 92), London: BMJ Books. [51]
Tuoyire,
D. A., McNair, S., Debrah S, A., & Duda, R.B. (2018). Perception of risk for hypertension and
overweight/obesity in Cape Coast, Ghana. Ghana Med J. 52(3): 140–146. doi:
10.4314/gmj. v52i3.6 [52]
Whyte, N. S., Amissah, A. A., & Mensah,
J. (2020). Strategies for managing childhood obesity in primary schools in the
Cape Coast Metropolis of Ghana. Asian Journal of Contemporary Education.
4(1) 41- 56. [53]
World Health Organization (2007). Reference
Curves
ebook.ecog-obesity.eu/chapter-growth-charts-body-composition/world-health-organization-referencecurves.
This work is licensed under a: Creative Commons Attribution 4.0 International License © Granthaalayah 2014-2020. All Rights Reserved. |