Determinants of Obesity among Basic School Pupils in the Ga-East Municipality

Abstract

Background: Overweight and obesity among children is a major public health concern globally. Childhood obesity is likely to persist into adulthood. Little is known about the prevalence and determinants of overweight and obesity among school-age children in Ghana. Knowing the determinants of overweight/obesity among basic school pupils is important for obesity intervention design. Objective: To determine overweight and obesity prevalence and its risk factors among basic school pupils in the Ga-East Municipality of Ghana. Methods: A cross-sectional study involving 24 private and public basic schools in the Ga-East Municipality; 487 pupils aged 9 - 15 years and 340 parents. Data collection involved interviews with pupils, parents and head teachers, a school environmental scan and an audit of school feeding and physical activity facilities. Dietary data was collected using a one-time 24 – hour meal recall and a 7–day Food Frequency assessment. Body weight and height of pupils and their parents were measured. Physical activity level of pupils was determined using the physical activity questionnaire for children. Associations between home and school food environments and child BMI and overweight status were tested using linear and logistic regressions respectively. Results: Total overweight prevalence among basic school pupils in the Ga-East Municipality was 17.7%; 8% were obese. Overweight prevalence among parents was 59.2%. Frequency of beverage consumption (p<0.01), least physical activity level (p<0.01) and being in the middle household wealth tertile (p=0.03) significantly predicted higher child BMI after controlling for parental BMI, age, sex, and calories consumed. None of the schools assessed had a written policy on eating at school and physical activity of pupils. Over 77% of all pupil purchases made during break time were from within the school compound. Foods associated with obesity formed 46.6% of all purchases. Schools which highly promoted healthier food options had over 5 times increased odds of child overweight [AOR=5.55; 95% CI = 1.430 – 21.511, p=0.013] than schools that least promoted. Schools‘ exerting moderate control over the food options available to pupils compared to those who had least control had 84.3% reduced odds of having overweight pupils. Parental use of snacks and sweetened drinks as reward from the least to the moderate category was associated with reduced odds of child overweight (AOR = 0.282, 95% CI = 0.105 – 0.759, p<0.05). High provision of a supporting environment for physical activity (open spaces, sports field) in a school was associated with an 80.2% reduced likelihood of pupils being overweight compared to the least provision. Conclusions: The school and home environments have significant influences on child weight status beyond the individual child behavioural and background factors. The school environment offers an opportunity to reach a large child population and changes made to improve physical activity and access to healthy food can have positive impacts on child weight status.