PREVALENCE AND RISK FACTORS FOR OBESITY AND OVERWEIGHT AMONG

ELEMENTARYSTUDENTS AT WEST VISAYAS STATE UNIVERSITY

INTEGRATED LABORATORY SCHOOL IN 2013

A Clinical based Research Paper

Submitted to the
Office of Research
West Visayas State University College of Medicine

Atas, Bryan
Altillero, Melchor Jr.
Albay, Shiela Mae
Hechanova April Rose
Pe, Clarisse Jane
Langurayan, Ma. Nerissa
Abelita, Monica Joanne
Yap, Jeremy Brian
Lim, MarijaMicah
Pedregosa, Lawrence
Sison, Angeli
Diamante, Daniel Ken

March 2014

PREVALENCE AND RISK FACTORS FOR OBESITY AND OVERWEIGHT AMONG

ELEMENTARY STUDENTS AT WEST VISAYAS STATE UNIVERSITY
INTEGRATED LABORATORY SCHOOL IN 2013

A Clinical based Research Paper

Submitted to the
Office of Research
West Visayas State University College of Medicine

Atas, Bryan
Altillero, Melchor Jr.
Albay, Shiela Mae
Hechanova April Rose
Pe, Clarisse Jane
Langurayan, Ma. Nerissa
Abelita, Monica Joanne
Yap, Jeremy Brian
Lim, MarijaMicah
Pedregosa, Lawrence
Sison, Angeli
Diamante, Daniel Ken

_______________________
JerushaComuelo, MD
Adviser

March 2014

INTRODUCTION
Background of the Study
Childhood obesity is one of the most serious public health challenges of the 21 st century.
The problem is global and is steadily affecting many low- and middle-income countries,
particularly in urban settings. The prevalence has increased at an alarming rate. The worldwide
prevalence of childhood overweight and obesity increased from 4.2 percent in 1990 to 6.7
percent in 2010.1Globally, in 2010 the number of overweight children under the age of five is
estimated to be over 42 million. Close to 35 million of these are living in developing countries. 2
The World Health Organization (WHO) predicts that by 2015 approximately 2.3 billion
adults will be overweight and more than 700 million will be obese. In 2005, at least 20 million
children under the age of 5 were overweight. Overweight is one of the leading causes of
lifestyle-related diseases such as hypertension, diabetes mellitus, strokes, muscle and bone
disorders, and certain cancers.3
The National Nutrition Survey (NNS) by the Food and Nutrition Research Institute of the
Department of Science and Technology (FNRI-DOST) revealed that 4.3 percent of children are
overweight for their age in 2011.4
The highest prevalence of childhood overweight is in the upper middle-income countries,
and, when taken as group, low-income countries have the lowest prevalence rate. However,
overweight is rising in almost all countries, with prevalence rates growing fastest in the lower
middle-income countries.5
The high prevalence of overweight and obesity has serious health consequences.
Children who are overweight or at-risk-for-overweight are at dramatically increased risk for
many chronic medical conditions. 6Elevated body mass index (BMI) is a major risk factor for
diseases such as cardiovascular disease, type 2 diabetes, liver disease and many
cancers 7 Menstrual abnormalities, impaired balance, orthopedic problems, asthma and
obstructive sleep apnea are also associated with obesity. 8 9 It not only causes premature
mortality, but also long-term morbidity.8
Children are a vulnerable age group in our society, and they are most particularly
affected by the ill-effects of this disorder, not only medically but also psychologically. Overweight
and obesity in children predisposes them to unhealthy behaviours due to psychological stress
like depression, limited mobility, decreased physical activity, low self esteem as well as social
discrimination.10 ,11,12,13 ,14
Childhood obesity has both immediate and long-term effects on health and well-being.
The most immediate consequence of overweight, as perceived by children themselves, is social
discrimination.15
Children and adolescents who are obese are at greater risk for social and psychological
problems, such as stigmatization and poor self-esteem.8For instance, overweight adolescents
are more likely than the non-overweight to engage in unhealthy disordered eating behaviors
such as binge eating and chronic dieting.16Majority of the researchers, academicians, and those

involved in health services agree that prevention should start in order to counteract the rise in
prevalence of obesity and diseases associated with obesity.17
Studies done in the prenatal period postulated a link between the severity of maternal
smoking during pregnancy and future development of childhood obesity.18 Children of mothers
who were overweight during pregnancy are known to be overweight in their early childhood.
Early studies on childhood obesity have reported that an overprotective dominant mother, a
timid father and lack of warmth within the family are all risk factors towards the development of
obesity in children.
Although no specific underlying factor or mechanism has been hypothesized to explain
the role of family factors in obesity, studies have proposed the lack of family cohesion, presence
of social isolation, conflicts and disorganization of family structure with role reversal as factors
that may contribute to the development of obesity in children.
There are a number of factors in the child that determine his tendency to be obese. It
has been noted that children who are obese tend to be more inactive, have increased energy
intake and decreased energy expenditure. It has been found that television viewing is a risk
factor for childhood obesity.
Increased consumption of soft drinks and sugary foods in childhood has also been linked
to overweight and obesity. It has been noted that children who sleep less are more prone to
childhood obesity and likewise children with obesity have disturbed sleep due to breathing
problems in sleep. The presence of fast food restaurants, school canteens that specialize in low
cost high fat meals and the relentless television marketing of foods high in sugar and fat
contribute to what has been described by some authors as a toxic food environment.19
The metabolic and physiologic changes in obesity are carried into adult life and
eventually predispose the individual to metabolic diseases, disability and death. 20 It is also
estimated that if current childhood obesity rates persist, children will live 3 to 4 years less than
todays adults due to obesity.21

Significance of the Study

Obesity is now reaching pandemic proportions across much of the world, and its
consequences are set to impose unprecedented health, financial and social burdens on global
society, unless effective actions are taken to reverse the trend.10,22Special focus must be given
to the children and adolescents. It is at the early ages that obesity must be controlled especially
because about half of overweight schoolage children become overweight as adults.
23,24
Apparently, primary or secondary prevention could be the key for controlling the current
epidemic of obesity and these strategies seem to be more effective in children than in adults. 25
Though at a young age, understanding the devitalizing effects of being overweight and
obese would create awareness in the child, initiating cooperation to the necessary lifestyle
changes imposed at school and at home.

This study would be of greatest importance to the family as they play a pivotal role in the
long term management of childhood obesity and in the successful management of weight.
Proper health habits especially that of diet, rest and activity should be started at home, and the
parents as well as the guardians should serve as stewards for a healthy lifestyle.
The results of this study would help school administrators and teachers in the creation of
a healthy environment for children, considering that majority of the childs time are spent at
school.
Even though the health consequences of obesity are most commonly seen during
adulthood, the underlying factors of these diseases could originate during childhood. It is
therefore vital to know exactly how early the health consequences and risk factors for these
serious diseases occur, and how early they can be detected if they are to be addressed
successfully. Prevention of obesity, therefore, is thought to be vital in decreasing morbidities
thought to be associated to obesity.
Numerous studies have been conducted worldwide with regards to monitoring childhood
obesity and the risk factors involved in developing it. It is however crucial that childhood obesity
in the local scenario must be monitored since society and local health protocols play a big factor
in its prevention.

General Objective
This study aimed to determine the prevalence of childhood overweight and obesity and
its association with risk factors among elementary students of West Visayas State University Integrated Laboratory School.

Specific Objectives
1. Determine the prevalence of overweight and obesity among elementary school students
when grouped according to:
a. General population of elementary students
b. Age
c. Sex
2. Determine the association between overweight and obesity and the following risk
factors:
a. paternal BMI
b. maternal BMI
c. parental educational level
d. household income
e. child birth weight
f. breast fed
g. number of children in the family
h. order of birth
i. physical activity
j. amount of sleep
k. passive entertainment
l. eating behavior
m. food preferences

Conceptual Framework
Independent Variables

Dependent Variables

parents' BMI
parents' educational level
household income
child birth weight
breast fed
number of children in the
family
order of birth

Childhood Overweight and

Obesity

physical activity

amount of sleep
passive entertainment
eating behavior
food preferences

METHODS
Study Design
This cross-sectional study aimed to determine the prevalence and risk factors of
overweight and obesity among elementary students of West Visayas State University Integrated Laboratory School (WVSU ILS) in Iloilo City.

Study Setting
This study gathered data from West Visayas State University Integrated Laboratory
School (WVSU-ILS), Gen. Luna St., Lapaz, Ilo-ilo City. The measurement of BMI was done in
the school clinic. Self administered questionnaires were sent to the parents.

Study Period
The gathering of data was done during the second semester of the academic school
year 2013 - 2014 in the months of November, December and January of the following year.

Study Population
This study measured the weight and height of elementary students from grade 1 to 6 in
WVSU ILS. Data were also gathered from the parents or guardians of the said students.

Inclusion Criteria
The study only gathered data from grade 1 to grade 6 elementary students of WVSU
ILS who are enrolled in the academic school year of 2013 2014 whose parents or guardians
have consented to their participation.

Exclusion Criteria
The study did not gather data from children who refused to participate, or whom parents
did not consent to their childs participation. Excluded also are those respondents who failed to
answer the questionnaires adequately or who were unavailable during the said study period.
Students with no birth weights in their respective student records at the Principals office were
also not included.
Children 12 years old or older who did not give their assent, despite the signed consent
forms from their parents, were not included in the study.

Sampling procedure
The study population comprised of those children who returned and adequately
answered the questionnaires and whose parents consented to the study.

Operational Definition of Terms

1. Obesity the state of being obese wherein the BMI is greater than 2 standard deviations
from the mean.26
2. Overweight the state of being overweight wherein the BMI is greater than 1 standard
deviations but less than 2 standard deviations from the mean. 59
3. Body Mass index (BMI) an assessment tool calculated as weight in kilograms divided
by the square of height (
).27
4. Parents' weight the self-reported weight of the parents in kilograms.
5. Parents height the self-reported height of the parents in meters.
6. Parents' educational level the level of education that the parents reached as to
elementary, high school, college, graduate course or etc.
7. Household income the self reported net income per month of the household which
supports the child. The monthly income was categorized into quintiles based on the
National Statistics Office (NSO) Family Income and Expenditure Survey (FIES) of
2012.28
Annual income cutoffs (Php)
Q1
Q2
Q3
Q4
Q5

110,986.5
156, 011
234, 423.5
500, 930.5

8. Child birth weight the childs weight at birth as reflected in the birth certificate of the
child.
9. Breast fed - the reception of nutrition from breast milk, either through direct contact with
the mothers breast or from expressed breast milk in a bottle.29
10. Number of children in the family the number of children which the parents or guardian
consider as part of their family regardless of biological parent.
11. Order of birth the order of the childs birth with respect to the birth of his or her
biological siblings.
12. Physical activity - any endeavor which results in expenditure of energy, which is done
outside and during school hours. These may include, but not limited to, walking to or
from school, sports, dancing, and swimming, among others. They may also include
physical education classes. 30
13. Amount of sleep - a self-reported total number of hours spent in sleeping, from the time
one lies down in bed to the time of awakening. 31
14. Passive Entertainment the amount of time spent watching television or playing video
games in hours per week.
15. Eating behaviour - defined as the attitude towards food as what and how to eat, the
selection of food, the way of getting food.32
16. Food preferences the selection of ones food or beverage

Maneuvers
The proposal of the study has undergone technical and ethical reviews. A verbal and
written explanation of the study and permission to conduct the study were obtained from the
concerned school authorities. Specifically, the researchers received permission from Dr. Emellie

G. Palomo, PhD, WVSU ILS Director, and Atty. Paulino Salmon, President of the ParentTeachers Association. The researchers also received permission from the WVSU ILS Office of
Director in obtaining the birth certificates of the children participants in their registry to obtain the
birth weight of the children.
A complete list of elementary students was obtained from the WVSU ILS Office of the
Director. On the card giving day of the elementary, informed consent forms were given and
explained personally to the parent(s) or guardian. After they had given consent, 2 self
administered questionnaires were given for them to answer for 15 20 minutes in the WVSU
ILS classrooms. An assent form was given and explained to children 12 years old or older. The
said children will only be included in the study after they have given their assent. Questionnaires
were allowed to be taken out and answered at home for the respondents convenience. The
researchers coordinated with the classroom advisers and school Guidance Office for the return
of the questionnaires.
Two self administered questionnaires were used as a tool for data gathering in the
study. The questionnaires were modified and adapted from a previous study. A permission to
use the adapted questionnaire has been given by the authors of the previous study. After the
approval, a pretest was done on selected elementary students of WVSU ILS to validate the
questionnaires. The data taken from the pretest were excluded from the official list of
respondents of the research study.
The first questionnaire was modified to assess the physical activity and food preference
of the child. The questionnaire contains questions pertaining to the parents' weight and height,
parents' educational level, household income, duration of breast feeding, number of children in
the family, childs age and sex, childs birth weight, order of birth of the child, physical activity of
the child, amount of sleep of the child, passive entertainment, eating behaviour of the child and
food preferences of the child.
The second questionnaire assessed the childs eating behaviour. It was adopted and
translated from the Child Eating Behaviour Questionnaire (CEBQ) by Wardle et al. It has 35
questions that evaluates Food Responsiveness (FR; 5 items), Enjoyment of Food (EF; 4 items),
Emotional Over Eating (EOE; 4 items), Desire to Drink (DD; 3 items), Slowness in Eating (SE;
4 items), Satiety Responsiveness (SR; 5 items), Food Fussiness (FF; 6 items) and Emotional
Under Eating (EUE; 4 items). Each item was answered in a Likerttype scale with scores from
1 to 5: Never=1, Rarely=2, Sometimes=3, Often=4, Always=5.33
The CEBQ assesses eating behaviour traits in children and may predict risks of eating
disorders and bodyweight related problems such as obesity. The data was used to assess
association between specific eating behaviour scores and childhood obesity.
The study measured the weight and height of the pupils included in the study on a
scheduled date approved by the principal. It was done inside the WVSU school clinic. During
the measurement, the participants were in their school uniform with their shoes removed and
their pockets emptied. A weigh beam weighing scale (Detecto) was used to measure the weight
of each participant. The height of the students will also be measured using the height rod in the
weigh beam scale. The participants stood straight with their back against the height rod. Each
participating child was then be classified whether they are thin, normal, overweight, or obese
based on the BMI-for-age chart of the World Health Organization.

The prevalence of obesity and overweight were then computed by dividing the number
of obese and overweight children over the total number of children involved in the study.
Statistical analysis was used to associate the risk factors in the questionnaires to childhood
obesity and overweight.
The classification of childrens BMI was based on the WHO charts of BMI-for-age of
boys and girls aged 5 to 19 years old. Parental BMI was based on the WHO standards for
adults.34 The monthly income was categorized into quintiles based on the National Statistics
Office (NSO) Family Income and Expenditure Survey (FIES) of 2012.35

Data Processing and Analysis

Statistical Package for Social Sciences (SPSS) version 20 (Chicago, Illinois) was used
to analyze the data. Multiple Regression Analysis was used to identify the risk factors that
influence obesity and overweight in the randomly selected elementary students.
Mean, frequency and standard deviation was computed to determine the obese,
overweight, normal or underweight children with respect to childrens age, and sex.

Ethical Considerations
Informed consent forms were distributed and explained to the parents or guardians of
the elementary pupils to ensure that they understood the terms and conditions of the study.
Signed consent forms indicated the voluntary participation of the parents or guardians and
allowed their child as a participant. Failure of submission of signed consent forms implied that
both the child and the parent or guardian refused participation. An Assent form was also given
to children 12 years old or older whose parent(s) or guardians consented to their childs
participation in the study. A signed assent form indicated that the child agreed with the
parent(s)s or guardians decision to include him or her in the study.
Parents of students identified as obese/overweight will be sent a letter stating the
nutritional status (BMI) of the child. Parents will be advised for their childs consult to a pediatric
specialist concerning weight. Separate forums for children as well as parents will be organized.
Results of the study will be presented to the school principal and PTA officers for
necessary interventions to be initiated in cooperation with the research group. The results will
be discussed as well as measures in preventing and managing childhood obesity.
Confidentiality will be highly observed such that a serial number will be assigned to each
participant instead of their names. All participants in this study will be given utmost respect and
courtesy.

Scope and Limitations

This study did not look into the nutritional intake of the children. Some measurable risk
factors could not be measured or verified by the researchers; instead they will be self reported
by the parents or guardians. The said risk factors include: mothers height and weight, fathers
height and weight, and household income.

RESULTS
There were a total of 308 pupils from grade 1 to grade 6 that were officially enrolled in
West Visayas State University Integrated Laboratory School. This study managed to gather
data from 114 (37%) of the students and their parent(s) or guardian(s).
Out of the 114 respondents, 72(63.2%) are female, while 42(36.8%) are male. In terms
of age, 23(20.2%) are 11 years old while only 5(4.4%) are 6 years old. A greater number,
29(25.4%) belong to the 4th grade, while 6(5.3%) are from the 3rd grade.
Table 1. Student demographics (N=114)

Sex

Age (years)

Grade Level

No. of students

Percent (%)

Female

72

63.2%

Male

42

36.8%

4.4%

15

13.2%

14

12.3%

14

12.3%

10

18

15.8%

11

23

20.2%

12

18

15.8%

13

6.1%

19

16.7%

21

18.4%

5.3%

29

25.4%

18

15.8%

21

18.4%

Among the 228 parents (114 fathers and 114 mothers) of elementary students, 56.6%
(129) had a normal body mass index, 36.4% (83) were overweight, 4.4%(10) were obese and
2.6% (6) were thin.
Table 2. Parental BMI classification (N=114)
BMI classification
Obese
Overweight
Normal
Thin
Very thin

Father
4
48
58
4
-

Mother
6
35
71
2
-

Total
10
83
129
6
-

Percent (%)
4.4
36.4
56.6
2.6
-

Most of the parents, 191 (83.8%) were college graduates, 35(15.4%) post graduates,
and 2(0.9%) were high school graduates.
Table 3. Parental educational level classification (N=114)
Paternal education
100
14

Elementary graduate
High school graduate
College graduate
Post graduate

Maternal education
2
91
21

Total
2
191
35

Percent (%)
0.9
83.8
15.4

Obese children had the highest average household income (Php 51,916) followed by
children with normal BMI (Php 49,732). Interestingly though, the overweight children had the
lowest average household income at Php 35,662.
Half (57/114) of the study population were in the 5 th quintile. About one half (51%) of
those in the 5th quintile had normal BMI while only a quarter (24.6%) were obese.
Table 4. Monthly income profile per childrens BMI classification (N=114)
Children BMI
classification
very thin
thin
normal
overweight
obese

Q1

Q2
n

(Php)
.
.
6125
.
.

0
0
4
0
0
4

(Php)
.
.
10000
12000
10000

Q3
n
0
0
1
1
4
6

(Php)
.
18000
15250
18549
.

Q4
n
0
1
4
1
0
6

Q5
n

(Php)
.
20000
29727
30560
30714

0
2
22
10
7
41

(Php)
47152

1
7
29
6
14
57

56230
77049
50960
74494

mean
income
(Php)
47,152
45,161
49,732
35,662
51,916

47,565

Of the 114 households, 17.5% (20) only had one child, 41.2% (47) had two children and
30.7% (35) had three children.
Table 5. Number of children in the family of the study population (N=114)
No. of children
Frequency
Percent (%)
1
20
17.5
2
47
41.2
3
35
30.7
4
8
7.0
5
2
1.8
6
1
0.9
7
1
0.9
The average birth weight of the respondents were 3,003 grams.
Table 6. Childs birth weight descriptives (N=114)
Min
Max
Birth weight

1200

4173

Mean
3003.2

Standard
deviation
539.1

10

Out of the 114 students, there were 76 who were breastfed and 38 who were not
breastfed. Among those who were breastfed, 30 were males and 46 were females. On the other
hand, among those who were not breastfed, 12 were males and 26 were females.
Table 7. Frequency of breast fed respondents (N=114)
breastfed
Male
30
female
46
Total
76

not breastfed
12
26
38

Fifty percent of the students were 1st born, followed by 27% who were born second, 21%
who were born third, and 0.9% who were born 6 th and 7th each.
Table 8. Frequency of birth orders of children (N=114)
Birth order
Number
st
1
54
2nd
29
3rd
23
th
4
5th
th
6
1
7th
1

Percent (%)
50
27
21
0.9
0.9

Out of the 114 respondents, only 14 (12.3%) respondents spent at least 20 minutes
each day of the week for physical activities that resulted to sweating or breathing hard, and 8
(7%) of the respondents didnt spend any time for physical activities. Most of the respondents,
23(20%), only spent 1 day of at least 20 minutes physical activities in a week.
Table 9. Number of days in a week that the child spent in physical activities lasting for
at least 20 minutes each that resulted to sweating or breathing hard (N=114)
Days
Frequency
Percent (%)
0
8
7.0
1
23
20.2
2
10
8.8
3
15
13.2
4
5
4.4
5
16
14.0
6
2
1.8
7
14
12.3
dont know or unsure
21
18.4
Most of the respondents, 31 (27.2%), spent about 1 hour and 1.6 hours of the day
respectively for exercise. Only 1 (0.9%) of the respondents reported having spent 6-9 hours a
day for exercise, while 14 (12.3%) dont exercise at all.

11

Table 10. Number of hours of exercise the child spends per day (N=114)
Hours
Frequency
Percent (%)
0.0
14
12.3
0.3
2
1.8
0.4
1
0.9
0.5
5
4.4
1.0
31
27.2
1.5
1
0.9
1.6
31
27.2
2.0
15
13.2
3.0
6
5.3
4.0
3
2.6
5.0
2
1.8
6.0
1
0.9
7.0
1
0.9
9.0
1
0.9

The results showed that among 114 children, 107 (93.9%) had hours of sleep of 7-10
hours, 5 (4.3%) had less than 7 hours of sleep and 2 (1.8%) had more than 10 hours.
Table 11. Hours of sleep per day (N=114)
Number of hours
Number
less than 7
5
7 to 10
107
more than 10
2

Percent (%)
4.3
93.9
1.8

Of the total sample population, 22.8%(26) watched TV or played computer games for 4
hours during the weekdays, and 10.5%(12) for 1 hour and less. On the other hand, during the
weekends, 33,3%(38) watched TV or played computer games for 2 hours, 14.0%(16) for 3
hours, 8.8%(10) for 4 hours and another 5.3%(6) for 6 hours or more.
Table 12. Hours spent on tv or computer games during weekends and weekdays (N=114)
Weekdays
Weekends
Hours spent
Number
Percent (%)
Number
Percent (%)
0
2
1.8
4
3.5
12
10.5
35
30.7
1
2
17
14.9
38
33.3
3
21
18.4
16
14.0
4
26
22.8
10
8.8
5
13
11.4
3
2.6
21
18.4
6
5.3
6
Dont know/not sure
2
1.8
2
1.8
Out of the 114 respondents, only 2 (1.8%) were drinking carbonated beverages at a
frequency of three or more times a week, while 42 (36.8%) only had one. 34(29.8%) of the
respondents were not carbonated beverage drinkers.

12

Table 13. Frequency of drinking carbonated beverage per week (N=114)

Frequency
Number
Percent (%)
None
34
29.8
Once
42
36.8
Twice
24
21.1
Three or more times
2
1.8
Dont know/not sure
12
10.5

Out of the 114 respondents, almost half 53(46%) of them drink sweetened beverages
once a day and about a third 35(31%) drinks twice a day. Ten percent(11) were not sure, 8(7%)
dont drink and 7(6%) drink three or more times a day of sweetened beverages.
Table 14. No of frequency of drinking sweetened beverage per day (N=114)
Frequency
Number
Percent (%)
None
8
7
Once
53
46
Twice
35
31
Three or more times
7
6
Dont know/not sure
11
10
The result showed that among 114 children, 53 (46.5%) had fast food once a week, 9
(7.9%) had less than a week, 28 (24.6%) had twice a week, 16 (14.0%) had 3-5 times a week,
and only 1 (0.9%) had more than 5 times a week.
Table 15.Frequency of eating fast foods (N=114)
Times per week
Number
Less than once per week
9
Once
53
Twice
28
Three to five times
16
More than five times
1
Dont know not sure
7

Percent (%)
7.9
46.5
24.6
14.0
0.9
6.1

The results showed that 27(23.7%) of the respondents drink 1 glass of milk per day.
Almost a fifth, 24(21.1%) of the parents reported that they are unsure how much glasses the
child drinks per day. Only 2(1.8%) of the children drink 4 or more glasses of milk per day.
Table 16. Amount of milk the child typically drinks in a day (N=114)
Glasses of milk drank per day
Number
Percent (%)
None
6
5.3
Less than 1
14
12.3
1
27
23.7
2
21
18.4
3
16
14.0
4 or more
2
1.8
Dont know/not sure
24
21.1

13

The most frequent milk type that is consumed by children is flavoured low-fat or skim
milk (35.1%) followed by low-fat (24.6%) and skim or non-fat (12.3%). Seven percent reported
that they their children do not drink milk.
Table 17. Type of milk the child usually drinks (N=114)
Type of milk
Number
None
8
Skim or non-fat
14
Flavored low-fat or skim
40
Low fat (1/2 - 1%)
28
Flavored 2% or whole
13
Reduced fat (2%)
1
Whole
7
Dont know/not sure
3

Percent(%)
7.0
12.3
35.1
24.6
11.4
0.9
6.1
2.6

Among the 114 children, 51 (44.7%) ate chips once a day, 25 (21.9%) ate chips twice a
day, 10 (8.8%) ate chips three or more times a day, 19 (16.7%) do not eat chips at all.
Table 18. Amount of chips consumption (N=114)
Times per day
Number
None
19
Once
51
Twice
25
Three or more times
10
Dont know/not sure
9

Percent (%)
16.7
44.7
21.9
8.8
7.9

Of the study population, 9.7% of the students dont eat vegetables. 52.6% of them had 1
serving a day; 28.1% had 2 servings a day; 7% had 3 servings or more. 2.6% either did not
know or were not sure. Of the study population, 7.1% of the pupils dont eat fruits. 48.2% had 1
serving a day; 26.3% of them had 2 servings a day; 12.3% had 3 or more servings a day. 6.1%
of the students were either not sure or did not know.

Table 19. Amount of vegetable and fruit consumption per day (N=114)
Vegetables
Fruits
No. of servings
Number
Percent (%)
Number
Percent (%)
None
11
9.7
8
7.1
1
60
52.6
55
48.2
2
32
28.1
30
26.3
3 or more
8
7.0
14
12.3
Dont know/not sure
3
2.6
7
6.1

14

Prevalence of obesity
The overall prevalence of childhood obesity in the study was 21.9%. Almost half (52.6%) had
normal BMI while 15.8% were overweight. The average BMI of the pupils were 19.99.
Table 20. Prevalence of childhood obesity in WVSU-ILS (N=114)
BMI classification
Frequency
Obese
25
Overweight
18
Normal
60
Thin
10
Very thin
1
Total
114

Percent (%)
21.9
15.8
52.6
8.8
0.9
100.0

Table 21. Body-Mass Index profile of study participants (N=114)

Min
Max
Mean
BMI

11.8

33.6

Standard
deviation
4.0

20.00

When Body Mass Index (BMI) was categorized as to age in years, results showed that 64.3% (9
students) of 9 years old students, 28.6%(4 students) of 8 year old students and 26.1%(6
students) of 11 years old students were obese. While 27.8% (5 students) of 10 year old
students, 26.1% (6 students) of 11 years old students, 16.7%(3 students) of 12 years old
students were overweight.
Table 22. BMI classification of children per age (N=114)
Age
6
7
8
9
10
11
12
13
Total

Obese
n
4
9
4
6
1
1
25

%
28.6
64.3
22.2
26.1
5.6
14.3
21.9%

Overweight
n
%
2
14.3
1
7.1
5
27.8
6
26.1
3
16.7
1
14.3
18
15.8%

Normal
n
4
6
8
3
9
11
14
5
60

%
80.0
40.0
57.1
21.4
50.0
47.8
77.8
71.4
52.6%

Thin
n
1
8
1
10

%
20.0
53.3
7.1
8.8%

n
1
1

Very thin
%
0.0
6.7
0.9%

Total
5
15
14
14
18
23
18
7
114

When BMI was categorized as to the respondents sex, of the 72 females, 13.9% were
obese (10 students), and 15.3% (11 students) were overweight. Of the 42 males, 35.7% (15
students) belong to the obese category while 21.9% (25 students) were in the overweight
category.

15

Table 23. BMI classification per sex (N=114)

sex

Obese

BMI classification
Normal
n
%

Overweight
n
%

Female

10

13.9%

Male

15

35.7%

25

21.9%

11

Thin
n

Very thin
n
%

15.3%

44

61.1%

8.3%

16.7%

16

38.1%

9.5%

18

15.8%

80

52.6%

10

8.8%

Total

1.4%

72

42

0.9%

114

Only 25% of the obese fathers also had an obese child while 50% of those fathers had
an overweight child. Among the fathers who were overweight, 20.8% had an obese child and
12.5% had an overweight child.
Table 24. Distribution of childrens BMI with respect to paternal BMI (N=114)
Childrens BMI
Obese

Overweight

Normal

Thin

Very thin

Obese

25.0%

50.0%

25.0%

Overweight

10

20.8%

12.5%

28

58.3%

8.3%

Normal

14

24.1%

13.8%

29

50.0%

10.3%

1.7%

Thin

50.0%

50.0%

Very thin

25

21.9%

18

15.8%

60

52.6%

10

8.8%

0.9%

Paternal BMI

Total

A third (33.3%) of the obese mothers also had an obese child. Among the mothers who
were overweight, 34.3.8% had an obese child and 11.4% had an overweight child.
Table 25. Distribution of childrens BMI with respect to maternal BMI (N=114)
Childrens BMI
Obese

Overweight

Normal

Thin

Very thin

Obese

33.3%

66.7%

Overweight

12

34.3%

11.4%

16

45.7%

8.6%

11

15.5%

14

19.7%

38

53.5%

9.9%

1.4%

Thin

100.0%

Very thin

25

21.9%

18

15.8%

60

52.6%

10

8.8%

0.9%

Maternal BMI Normal

Total

16

Of the children with college graduate fathers, 22% were obese, while 17% were
overweight. For those with fathers having completed post-graduate education, 21.4% were
obese, while 7.1% were overweight.
Table 26. Distribution of BMI based on fathers educational level (N=114)
Childrens BMI
Obese
n
college graduate

Overweight
n

Normal
n

Thin

Very thin

Total

%
100
100

22

22.0

17

17.0

51

51.0

9.0

1.0

100

21.4

7.1

64.3

7.1

14

Fathers
education

Completed postgraduate
course

Of the children with college graduate mothers, 22% were obese, while 16.5% were
overweight. For those having mothers having post graduate degrees, 23.8% had children who
were obese, while 14.3% were overweight.
Table 27. Distribution of BMI based on mothers educational level (N=114)
Childrens BMI
Obese

Highschool

Overweight

Normal

Thin

Very thin

Total

100.0%

100.0%

20

22.0%

15

16.5%

47

51.6%

8.8%

1.1%

91

100.0%

23.8%

14.3%

11

52.4%

9.5%

21

100.0%

graduate
Mothers
College graduate
education
Postgraduate
course

Twenty percent of families with only 1 child, had obese children and overweight children,
respectively. For families with 3 children, 28.6% had obese children while 17.1% had overweight
children. For families having 4 children, 25% of them had obese children, while 12.5% had
overweight children.

17

Table 28. Distribution of BMI with respect to no. of children in the family (N=114)
Childrens BMI
Obese

Overweight

Normal

Thin

Very thin

Total

20.0%

20.0%

11

55.0%

5.0%

0.0%

20

100.0%

17.0%

12.8%

27

57.4%

10.6%

2.1%

47

100.0%

10

28.6%

17.1%

17

48.6%

5.7%

35

100.0%

25.0%

12.5%

50.0%

12.5%

100.0%

50.0%

50.0%

100.0%

100.0%

100.0%

100.0%

100.0%

Number of
children in
the
family

Breastfed and non-breast fed children showed close values in terms of obese children,
22.4% and 21.1% respectively. Meanwhile 13.2% of breastfed children and 21.1% of nonbreastfed children were overweight.
Table 29. Distribution of BMI in terms of breastfeeding history (N=114)
Childrens BMI
Obese

Not
Breastfeeding

Overweight

Normal

Thin

Very thin

Total

21.1%

21.1%

16

42.1%

15.8%

38

100.0%

17

22.4%

10

13.2%

44

57.9%

5.3%

1.3%

76

100.0%

breastfed
breastfed

Among the first borns, 20.4% were obese while 16.7% were overweight. Meanwhile,
22.9% of second borns were obese while 11.4% were overweight. Among the 3 rd borns, 26.1%
were obese while 17.4% were overweight.

18

Table 30. Distribution of BMI with respect to birth order (N=114)

Childrens BMI
Obese

Overweight

Normal

Thin

Very thin

Total

st

11

20.4%

16.7%

26

48.1%

13.0%

1.9%

54

100.0%

nd

22.9%

11.4%

22

62.9%

2.9%

35

100.0%

rd

26.1%

17.4%

11

47.8%

8.7%

23

100.0%

th

100.0%

100.0%

th

100.0%

100.0%

1
2
Birth order 3
6
7

Among the obese children, only 12% dont exercise, while 16% were reported to
exercise for at least 20 minutes everyday. Among the overweight children, same values of
11.1% were reported for those who dont exercise and for those exercising everyday.
Table 31. Distribution of BMI with respect to no. of days of in a week of exercise (N=114)
BMI category
Obese

Exercise
days

Overweight

Normal

Thin

Very thin

No.

No.

No.

No.

No.

12.0%

11.1%

5.0%

16.0%

16.7%

15.0%

70.0%

16.7%

11.7%

16.0%

11.1%

15.0%

4.0%

5.6%

3.3%

10.0%

12.0%

22.2%

13.3%

10.0%

3.3%

16.0%

11.1%

13.3%

Dont know

24.0%

5.6%

12

20.0%

10.0%

100.0%

All obese children and almost all (94.4%) of overweight children sleep 7-10 hours a day.

19

Table 32. Distribution of BMI with respect to sleeping hours (N=114)

BMI category
Obese

less than 7
hours
Sleeping

7 to 10 hours

hours

per day
more than 10
hours per day

Overweight

Normal

Thin

No.

No.

No.

No.

5.6%

6.7%

25

100.0%

17

94.4%

54

90.0%

10

3.3%

Very thin
%
-

100.0%

No.

100.0%

Among the obese children, 44% played computer games/watched television for 2 hours
during weekends while 8% for 6 hours or more. Among the overweight, 33.3% played computer
games/watched television for 2 hours while 16.7% for 6 hours or more.
Table 33. Distribution of BMI with respect to passive entertainment during weekends
(N=114)
BMI
Obese

Passive

Overweight

Normal

Thin

Very thin

No.

No.

No.

No.

No.

N%

4.0%

5.6%

3.3%

28.0%

22.2%

21

35.0%

30.0%

11

44.0%

33.3%

17

28.3%

40.0%

8.0%

11.1%

10

16.7%

20.0%

5.6%

13.3%

100.0%

4.0%

3.3%

6 or more

8.0%

16.7%

10.0%

Don't know

4.0%

5.6%

entertainment
(hours)

Among the obese children, 20% played computer games/watched television for 3, 4 and
6 hours and more respectively during weekdays. Among the overweight, 27.8% played
computer games/watched television for 5 hours while 5.6% for both 1 hour, and those not
engaging in passive entertainment, respectively.

20

Table 34. Distribution of BMI with respect to passive entertainment during weekdays
(N=114)
BMI category
Obese
No.

Passive
Entertainment
(hours)

Overweight

Normal

Thin

Very thin

No.

No.

No.

No.

5.6%

1.7%

12.0%

5.6%

13.3%

16.0%

22.2%

10.0%

30.0%

20.0%

22.2%

11

18.3%

10.0%

20.0%

16.7%

16

26.7%

20.0%

8.0%

11.7%

30.0%

100.0%

6 or more

20.0%

27.8%

10

16.7%

10.0%

Dont know

4.0%

1.7%

Forty percent of the obese respondents drink carbonated drinks once a day, while only
4%(1) drinks three or more times a day. Among the overweight, 38.9%(7) drink once a day
while 22.2%(4) drink carbonated beverages twice a day.
Table 35. Distribution of childrens BMI with respect to carbonated drinks consumption
(N=114)

Carbonated
drinks
consumption
frequency
(a day)

None
1 time
2 times
times
Don't know

n
4
10
6
1
4

Obese
%
16.0%
40.0%
24.0%
4.0%
16.0%

Overweight
n
%
6
33.3%
7
38.9%
4
22.2%
1
5.6%

BMI category
Normal
n
%
21
35.0%
19
31.7%
13
21.7%
7
11.7%

n
3
5
1
1
-

Thin
%
30.0%
50.0%
10.0%
10.0%
-

n
1
-

Very thin
%
100.0%
-

44% (11) among the obese respondents drink sweetened beverages twice a day, while
only 4% (1) drinks three or more times a day. Among the overweight, 50% (9) drink once a day
while 16.7% (3) drink sweetened beverages three times or more a day.

21

Table 36. Distribution of childrens BMI with respect to Sweetened drinks consumption
(N=114)
BMI category
Obese

Sweetened drinks
consumption
frequency

Overweight

Normal

Thin

Very thin

No.

No.

No.

No.

No.

None

5.6%

8.3%

20.0%

1 time

32.0%

50.0%

32

53.3%

30.0%

100.0%

2 times

11

44.0%

22.2%

15

25.0%

50.0%

4.0%

16.7%

5.0%

20.0%

5.6%

8.3%

3 or more
times
Don't know

60% (15) among the obese respondents eats fast food once a week, while only 4%(1)
eat more than five times a week. Among the overweight, 44.4% (8) respondents eat fast food
once a week, while only 11.1% (2) eat less than once a week, or twice a week respectively.
Table 37. Distribution of childrens BMI with respect to fast food consumption (N=114
BMI category
Obese

Thin

Very thin

No.

No.

No.

No.

4.0%

11.1%

8.3%

10.0%

Once a week

15

60.0%

44.4%

25

41.7%

40.0%

Twice a week

20.0%

11.1%

19

31.7%

30.0%

12.0%

27.8%

11.7%

10.0%

4.0%

5.6%

6.7%

10.0%

100.0%

a week

consumption

Normal

No.
Less than once

Fastfood

Overweight

3 to 5 times a
week
More than 5
times a week
Don't know

Among the obese respondents, 28%(7) consume 2 glasses of milk a day while only
4%(1) consumes 4 or more glasses. Among the overweight, 33.3%(6) consume 1 glass of milk
a day while 16.7%(3) consume 3 glasses.

22

Table 38. Distribution of childrens BMI with respect to milk consumption (N=114)
BMI category
Obese
No.

4.0%

16.0%

1 glass

20.0%

2 glasses

3 glasses

None
Less than
1 glass
Milk consumption
(a day)

Overweight

4 or more
glasses
Dont know

No.

Normal
No.

8.3%

22.2%

8.3%

33.3%

13

28.0%

22.2%

8.0%

4.0%

12.0%

Thin
No.

Very thin
%

No.

10.0%

21.7%

30.0%

15.0%

10.0%

16.7%

13.3%

30.0%

1.7%

5.6%

17

28.3%

20.0%

100.0%

Most of the obese respondents(32%) consume low fat milk while most of the overweight
respondents(38.9%) consume flavoured low fat or skim milk.
Table 39. Distribution of childrens BMI with respect to type of milk consumed (N=114)
BMI category
obese
No.

overweight

No.

normal
No.

thin
No

very thin

No.

.
None

12.0%

8.3%

Skim or non-fat

12.0%

16.7%

11.7%

10.0%

20.0%

38.9%

25

41.7%

30.0%

32.0%

11.1%

13

21.7%

40.0%

100.0%

16.0%

22.2%

8.3%

Reduced fat (2%)

10.0%

Whole

8.0%

6.7%

10.0%

Don't know

11.1%

1.7%

Flavored low-fat
or skim
Milk type
consumed

Low fat (1/2

1%)
Flavored 2% or
whole

Among the obese respondents, 48%(12) consume one serving of chips a day while only
8%(2) consumes none at all, or 3 times or more serving, respectively. Among the overweight,
44.4%(8) consume one serving of chips a day while only 5.6%(1) consume none at all, or two
servings, respectively

23

Table 40. Distribution of childrens BMI with respect to chips consumption (N=114)
BMI Category
Obese

Chips
consumption

Overweight

Normal

Thin

Very thin

No.

No.

No.

No.

No.

None

8.0%

5.6%

11

18.3%

50.0%

Once

12

48.0%

44.4%

27

45.0%

30.0%

100.0%

2 times

36.0%

27.8%

10

16.7%

10.0%

8.0%

5.6%

11.7%

16.7%

8.3%

10.0%

3 or more
times
Don't know

Among the obese respondents, 56%(14) consume one serving of vegetable a day while
only 8%(2) consume none at all, or 3 times or more serving, respectively. Among the
overweight, 44.4%(8) consume one serving of vegetable a day while only 5.6%(1) consume
none at all, or not sure respectively.
Table 41. Distribution of childrens BMI with respect to vegetable consumption (N=114)
BMI category
obese

None
1 serving per
day
2 servings per
Vegetables

day

overweight

normal

thin

very thin

No.

No.

No.

No.

No.

8.0%

5.6%

10.0%

10.0%

100.0%

14

56.0%

44.4%

32

53.3%

60.0%

24.0%

33.3%

19

31.7%

10.0%

8.0%

11.1%

3.3%

20.0%

4.0%

5.6%

1.7%

3 or more
servings per
day
Don't know

Among the obese respondents, 44%(11) consume one serving of fruit a day while only
8%(2) consumes none at all, or are not sure, respectively. Among the overweight, 38.9% (7)
consume one serving of fruit a day while only 5.6% (1) consume none at all, or not sure,
respectively

24

Table 42. Distribution of childrens BMI with respect to Fruit consumption (N=114)
BMI category
Obese
No.
None
1 serving per
day
2 servings per
day
Fruits

Overweight

Normal

Thin

Very thin

No.

No.

No.

No.

8.0%

5.6%

5.0%

10.0%

100.0%

11

44.0%

38.9%

33

55.0%

40.0%

28.0%

33.3%

16

26.7%

10.0%

12.0%

16.7%

8.3%

30.0%

8.0%

5.6%

5.0%

10.0%

3 or more
servings per
day
Don't know

Child Eating and Behaviour Questionnaire

The mean (3.72) of enjoyment of food (EF) had the highest average CEBQ score in the
respondents. It was followed by emotional under eating (EUE) and food responsiveness (FR)
with means of 3.04 and 2.96 respectively. Emotional over eating (EOE) and by Slowness in
eating (SE) were the lowest mean CEBQ scores at 2.42 and 2.65 respectively.
Table 43. Average CEBQ scores per sub category of the respondents (N=114).
Food responsiveness (FR)
Enjoyment of food (EF
Emotional Over Eating (EOE)
Desire to Drink (DD)
Slowness in Eating (SE)
Satiety Responsiveness (SR)
Food Fussiness (FF)
Emotional Under Eating (EUE)

N
114
114
114
114
114
114
114
114

Range
4.0
3.0
2.8
4.0
4.0
3.0
4.0
3.8

Minimum
1.0
2.0
1.0
1.0
1.0
1.4
1.0
1.3

Maximum
5.0
5.0
3.8
5.0
5.0
4.4
5.0
5.0

Mean
3.0
3.7
2.4
2.9
2.6
2.9
2.9
3.0

Most of the obese respondents had higher mean scores in the eating behaviors such as
Enjoyment of food, Food Responsiveness and Desire to drink while among the overweight,
higher mean scores were found to be in Enjoyment of Food, Emotional under eating and Satiety
responsiveness.

25

Table 44. Distribution of childrens BMI with respect to child eating behaviors (N=114)
BMI category
Obese

Overweight

Normal

Thin

Very thin

Mean

Mean

Mean

Mean

Mean

FR

3.7

2.7

2.8

2.9

2.8

EF

4.2

3.8

3.6

3.4

2.8

EOE

2.7

2.1

2.4

2.3

2.0

DD

3.3

2.8

2.8

3.1

1.7

SE

2.4

2.4

2.7

3.3

5.0

SR

2.6

2.9

2.9

3.2

3.8

FF

2.9

2.9

2.9

3.3

3.5

EUE

3.1

3.2

3.0

2.9

3.0

Multiple Regression analysis

Multiple regression analysis showed that only frequency of sweetened beverage
(OR=2.140), eating behaviors such as food responsiveness (OR=4.677), enjoyment of
food(OR=7.313) and emotional over eating(OR=2.47) had strong positive associations with
obesity while satiety responsiveness(OR=0.298) had a negative association with obesity.
Frequency of sweetened beverages, Food responsiveness, Enjoyment of food and emotional
overeating are therefore predictors for childhood obesity, while satiety responsiveness as a
protective factor. None of the factors had any association with being overweight.

26

Table 45. Odds ratio of factors evaluated for childhood overweight or obesity. (N=114)
Factors
paternal BMI
maternal BMI
household income
birth order
breastfed
number of children in the
family
exercise days
hours of sleep
weekday passive
entertainment
weekend passive
entertainment
carbonated drinks frequency
sweetened beverages
frequency
fast food
chips
milk type
skim/nonfat

Overweight
OR
0.977
0.937
0.799
0.657
0.561
1.08

Obesity
p-value
0.769
0.447
0.259
0.524
0.284
0.745

OR
1.053
1.106
1.116
1.075
0.954
1.167

0.985
0.710
1.23

0.902
0.710
0.270

1.024
1.602
0.999

0.840
0.628
0.994

0.931

0.636

1.026

0.844

1.012
1.526

0.973
0.240

1.612
2.140

0.127
0.048

1.133
1.386

0.687
0.304

1.039
1.471

0.889
0.150

0.990

3.333

0.344

0.990
0.990
0.991
0.992
0.928
0.236
0.300
0.759
0.169
0.122
0.853
0.123
0.480
0.552
0.224

1.563
3.500
0.909
5.000
0.750
1.062
1.090
1.098
4.677
7.313
2.47
1.641
0.579
0.298
0.758
1.442

0.712
0.297
0.943
0.368
0.819
0.705
0.786
0.756
<0.0005
<0.0005
0.025
0.056
0.073
0.007
0.482
0.344

5188729.000
flavoured low fat or skim
2917679.000
low fat
3112269.000
flavoured 2% or whole
2121762.000
reduced fat
whole
389050.200
milk amount
0.982
vegetables
1.527
fruits
1.408
CEBQ food responsiveness
0.904
CEBQ enjoyment of food
1.871
CEBQ emotional over eating
0.533
CEBQ desire to drink
0.948
CEBQ slowness in eating
0.5663
CEBQ satiety responsiveness
0.715
CEBQ food fussiness
0.776
CEBQ emotional under eating
1.625
significant with p-value <0.05

p-value
0.511
0.164
0.510
0.893
0.925
0.484

It was revealed thru multiple regression that only birthweight (0.004), FR (0.002), EF
(0.003) and SE (<0.0005) were significant (p value<0.05) predictors of high BMI among
elementary children in WVSU-ILS. Birthweight, FR and EF are therefore positive predictors
while SE is a negative predictor of high BMI.

27

Table 46. Multiple regression analysis of factors as predictor for high BMI. (N=114)
Factors
Parental factors
paternal BMI
maternal BMI
paternal education
maternal education
household monthly income
number of children in the family
order of birth
Birth and prenatal factors
birth weight*
breastfeed
Physical activity factors
exercise (days/week)
exercise (hours/day)
passive entertainment during weekdays (h)
passive entertainment during weekend (h)
hours of sleep
Food preference factors
frequency of drinking carbonated drinks
frequency of drinking sweetened beverage
eating at fast food
chips
type of milk
amount of milk
vegetables
fruits
*significant at p value <0.05

Beta

t-value

Sig.

0.101
0.094
-0.069
-0.019
-0.044
-0.095
-0.087

1.318
1.187
-0.885
-0.243
-0.577
-1.231
-1.110

0.190
0.238
0.378
0.809
0.565
0.221
0.269

0.002
0.000

2.929
-0.002

0.004
0.999

-0.009
-0.009
0.099
0.077
0.150

-0.121
-0.118
1.292
0.999
1.967

0.904
0.907
0.199
0.320
0.052

0.006
0.076
-0.121
-0.022
-0.140
0.052
0.051
0.003

0.075
0.966
-1.521
-0.291
-1.854
0.679
0.660
0.042

0.940
0.336
0.131
0.771
0.066
0.498
0.511
0.967

Table 47. Multiple regression analysis of CEBQ scores as predictors for high BMI (N=114)
Food responsiveness (FR)*
Enjoyment of food (EF)*
Emotional Over Eating (EOE)
Desire to Drink (DD)
Slowness in Eating (SE)**
Satiety Responsiveness (SR)
Food Fussiness (FF)
Emotional Under Eating (EUE)
*significant at p-value <0.05
**significant at p-value<0.0001

Beta
.280
.271
-.012
-.052
-.308
-.030
.048
-.054

t-value.
3.193
3.084
-0.134
-0.557
-3.988
-0.333
0.593
-0.669

Sig.
0.002
0.003
0.893
0.579
0.000
0.740
0.555
0.505

28

DISCUSSION
Prevalence of obesity
The prevalence of overweight and obesity in developed countries is about double that in
developing countries (11.7% and 6.1%, respectively) in which a vast majority of affected
children (35 million) live in developing countries. In addition, the relative increase in the past 2
decades has been higher in developing countries (+65%) than in developed countries (+48%).
Marked differences were observed across regions. In Africa, the prevalence of childhood
overweight and obesity in 2010 is 8.5%, and it is expected to increase to 12.7% in 2020a
relative increase of 49%. In Asia, the estimated prevalence is lower than in Africa (4.9% in 2010,
increasing to 6.8% in 2020); however, in absolute numbers, Asia has the highest number of
overweight and obese children, because more than half (18 million in 2010) of the affected
children from developing countries live in this region.36
According to the Regional Coordinator of the Asia-Pacific International Obesity
Taskforce of Australia, in the report in 2008, 1% of young children (0-10 years) and 3% of
adolescents (11-17 years) were overweight in the Philippines. Among Chinese youth and young
urban Thai children, the rate of overweight and obesity was as high as 23%. Also, in Taipei,
Taiwan, 28% of boys, were either overweight or obese, as compared to only 21.3% of the girls
between 12-15 years of age. Even Vietnam, which is just beginning the process of economic
transition, 14-16% of the children were overweight. 37
In the Philippines, a survey by the National Statistics Coordination Board (NSCB)
revealed that in 2008, the number of overweight Filipinos has increased to 26.6% from 16.6% in
1993.38 Overweight and obesity had affects 7 out of 10 women and about 1 out of 10 men,
according to 7th National Nutrition Survey conducted by the Food and Nutrition Research
Institute of the Department of Science and Technology (FNRI-DOST), thus this has become an
increasing problem of the country.39 In this study, 35.7% of males were obese and 16.7% of
males were overweight while 13.9% of females were obese and 15.3% of females were
overweight.
The National Nutrition Survey (NNS) by the Food and Nutrition Research Institute of the
Department of Science and Technology (FNRI-DOST) revealed that 4.3 % or about 4 in every
100 of children, (newborns to 5 year olds) are overweight for their age. The survey results
further revealed that 8 in 100 (7.5%) of school children 6-10 years old are overweight. Although
the prevalence of overweight children belonging to this age group is still low, it has been steadily
increasing since 1989.
Some of the regions with the highest prevalence of overweight children aged five years
and below include Ilocos (or Region 1) with 6.3 %, the National Capital Region (NCR) with 6.2
percent, and Calabarzon (or Region IV-A) with 5.9 %. 40 Meanwhile the National Nutrition
Council- Region 6 stated that 3 out of 10 persons in Western Visayas are obese based on
records covering 1998 to 2011.41
In this study, the prevalence of obesity and overweight among elementary students in
WVSU ILS are 21.9% and 15.8% respectively while 52.6% are normal. Theaverage BMI of the
pupils is 19.99.A table below shows the comparison of the prevalence of obesity in this study
with other studies with conducted in almost the same age group. 42

29

Table 48. Prevalence of childhood obesity according to different studies.

Prevalence(%)
Age range
Country
Year
Study
35
6-12
Spain
199-1996
Moreno43
10
6-14
Japan
1993
Kotani44
20
7-11
UK
1998
Lobstein45
31.2 boys
6-12
Greece
2011
Tzotzas46
26.5girls
15
6-11
USA
1999-2000
NCHS47
18
6-11
USA
2009-2010
Ogden48
Studies have shown that the prevalence of overweight and obesity also varied between
the sexes. In a study conducted by Jackson from more than 1,700 sixth-grade students from 20
schools in Michigan between 2004 and 2011 revealed that more than 37% of boys and about
31% of the girls were overweight or obese.49A study on Greek children also revealed that there
is higher percentage of boys that are obese. 45A statistics report in Canada in 2009 to 2011 finds
that 19.5% of boys aged 5 to 11 are obese, compared to 6.3 % of girls of the same ages. The
same survey further stated that its long been recognized that obesity tends to occur in higher
rates in boys than girls, but the numbers were three times as much in boys than in girls. 50
In this study, the total elementary student population including those who did not
participate in the study was 376. From the total population, 40.7% (153) were boys and 59.3%
(223) were girls. Among those who participated in the study, 35.7% of the boys are obese while
only 13.9% of the girls are obese. Among the boys, 52.4% are overweight or obese while only
29.2% are overweight or obese among the girls. The sample population that participated in this
study was composed predominantly of females which could have affected the percent of obese
and overweight among boys and girls when compared.

Risk Factors for obesity

Parental BMI
A study conducted in the United Kingdom by Reilly et al identified parental obesity as
one of the risk factors in early-life obesity in children.51 This was supported by another study
from Hong Kong involving 6 and 7 year olds concluding that paternal and maternal obesity were
independently associated with childhood overweight. A stronger association for maternal obesity
than for paternal obesity was also found.52Another study also reported that a combination of
independent risk factors including parental obesity resulted in the highest risk of overweight in 57 year old children.53
Parental obesity may increase the risk of obesity through genetic mechanisms or by
shared familial characteristics in the environment such as food preferences. 54 Even when only
1 of the parents was obese, the risk of obesity at age 7 was increased. The risk was higher
when both parents were obese. 50However, in our study, these associations were not found. Our
data showed that both the paternal BMI and the maternal BMI have no significant relationship to
a childs BMI.

30

Parental educational level

In this study, multiple regression analysis showed that the parental education was not a
significant predictor for obesity and overweight among elementary students. This was contrary
to several studies which revealed that parental education was one of the significant predictors
and has a negative or inverse relationship with childhood obesity.
Children of mothers with no school degree had an almost three times higher risk to be
obese than children of mothers with 13 years of school. Stratified analysis by BMI of the parents
revealed that paternal and maternal education was particularly strongly associated with
overweight in children in the subsample of both parents being overweight. 51
Nonetheless, 9 or less years of education of either of the parents were the highest risk
factor for childhood obesity. However, children of self-employed mothers, in spite of high
educational levels, also had a high risk of being obese. Self-employed mothers who work more
hours outside their homes might probably spend less time with their children and, hence, will
have less control over food intake, eating habits, and physical activity levels of their children. 51
A representative cross-sectional survey on 1979 children and casecontrol study on 367
children in the German City of Aachen have also convincingly demonstrated that social status is
inversely associated with childhood obesity as early as age 6. There was a significant
relationship between parents years of education and childhood obesity, and among the many
other ascertained socioeconomic status (SES) variables, parental education was the most
important SES variable that accounts for the SES-obesity association. Children of the lowest
social status had a 3.3-fold higher risk to be obese than children of the highest social status.55
Differences in cultural and social norms between parents of high and low education
might be another reasonable explanation. Adverse economic circumstances, marital conflict and
negative life events seem to be much more frequent in families with a lower SES. These parents
might be less involved in the lives of their children, which might then lead to more overeating. 54

Monthly family income

In this study, monthly income was not a significant factor in affecting the childrens BMI.
This is in contrast with the study by Danielzik which reported that low socioeconomic status,
along with other independent risk factors, resulted in the highest risk for overweight in 5 to 7
year old children.52Children of the lowest social status had a 3.3-fold higher risk to be obese
than children of the highest social status. 54However in a study done byWang which gathered
data from children of ages 6 to 18 and compared the effect of income on the risk for obesity.
The study reported that in China and Russia, the risk for obesity is higher for high income
groups while; in the United States of America the low income entails a higher risk for obesity.56
A systematic review of cross sectional studies looked into the association of income
indices and obesity. In the said study, 3 out of 11 showed no association, 4 of the studies
showed an inverse association and the remaining 4 showed varying associations. 57

Child birth weight

A study by AtulSinghal et al have concluded that there was a positive correlation
between birth weight indicative of fetal growth and lean body mass in adulthood as measured by

31

body mass index, implicating early factors for obesity and cardiovascular diseases.58 Hill et al
have further indicated that birth weight has a positive correlation to the individual BMI as a
measure of obesity in contrast to the body fat percentage.59
Another study by Salsberry et alhave elaborated further into other prenatal factors that
have an effect on the childs early weights as having an influence towards overweight and
obesity which increased as the child grew older. Such factors would include race, ethnicity,
maternal smoking and prepregnancy obesity. This study suggests that overweight and obesity
may well have its origins not only in childhood but also during pregnancy and prepregnancy
periods.60
A systematic review and meta-analysis by Yu et al, comprising of 33 studies suggest
that high birth weight was associated with high risks of obesity and serves as a mediating factor
between prenatal factors and obesity risk. The study showed that high birth weights (>4000 g)
was associated with higher risks for obesity (odds ratio [OR], 2.07)compared with birthweights
of 4000 g. Further, birth weights <2500 g were associated with decreased obesity risks (OR,
0.61) compared with to birth weights 2500 g. Also, a subgroup analysis of pre-school children,
school children, and adolescents showed a positive association of high birth weights with high
risks of obesity from childhood extending to early adulthood.61
A study in Buenos Aires, Argentina by Hirschler et al explored the relationship between
birth weight (BW) and childhood overweight and obesity (OW/OB) and metabolic syndrome
(MS) in 10 elementary schools at 9 years of age. They concluded that low birth weights did not
have an association with either obesity or metabolic syndrome in children; however, high birth
weight was positively correlated with obesity and metabolic syndrome in children. 62 High birth
weight in combination with other independent risk factors such as parental obesity and low SES
was also reported to high risk of overweight in 5 to 7 year old children. 52In a cohort study of 7
year old children, birth weight was shown to be associated with the risk for obesity. 50In line with
our study, multiple regression showed birth weight as one of the significant factors that
predicted the childs BMI.

Breastfeeding
Though in this study, breast feeding has no association with obesity; it was
recommended by the American Academy of Pediatrics that breast feeding mildly protects
against later obesity. 63 A study among German children and adolescents also showed no
significant association between obesity and breast feeding.64

Order of birth and Number of children

A study on Portuguese children revealed that obesity and overweight was associated
with being a single child in the family, belonging to large or small families, and being born later
than other siblings.65

Physical activity
This study showed that physical activity had no significant relationship with childhood
obesity. However, it has been hypothesized that a steady decline in physical activity among all
age groups has heavily contributed to rising rates of obesity all around the world. Numerous

32

studies have shown that sedentary behaviours like watching television and playing computer
games are associated with increased prevalence of obesity. Increased proportions of children
who are being driven to school,and low participation rates in sports and physical education,
particularly among adolescent girls, were also associated with increased obesity prevalence. 66It
has also been cited by another study that children who watched at least 4 hours of television per
day were also less likely to participate in vigorous physical activity, thus they also had greater
BMIs and skinfold measurements than those who watched <2 hours of television per day. It also
pointed out that restriction of television viewing resulted to improvement in BMI. 67

Amount of sleep
There were 29 studies conducted in 16 countries about sleeping hours of children and its
relation to being overweight or obese. Out of these studies, the researchers have found out that
short sleep increases the risk of being overweight and obese. In addition, late bedtimes in
children were also found to be a risk factor for overweight or obesity. The studies also
suggested that changes in eating pathways may increase body fat. 68 However, in our study, the
results show that only there is no significant relationship between sleeping hours per day and
risk of being overweight/obese evidenced by only a little percentage of the population having
shorter sleeping hours.

Passive entertainment
Of the total sample population, 27.2% watched TV or played computer games for <1-2
hours during the weekdays. On the other hand, during the weekends, 8.8% watched TV or
played computer games for 4 hours, 14.0% for 3 hours and another 5.3% for 6 hours or more.
The Displacement theory hypothesizes that the time spent watching television and
playing computer games reduces the time allocated to physical activity. In a study done by
Steele et al, results showed that more active children were less likely to be overweight or
obese, but greater screen-time use alone did not significantly increased the risk of being
overweight or obese.69In support to this, Marshall et al reported that the positive association
between screen-time and excess in body weight was too small to be clinically significant. 70
However, in a study by Vanderwater et al, results have shown that there was a strong
relationship between weight status of younger children and time spent playing electronic games,
but not television use.71
In this study, 44% of children who spend 2 hours playing computer games or watching
television during weekends were obese and 33.3% were overweight. Only 4% were obese and
5.6% were overweight among children who spend none to less than an hour playing computer
games or watching television during weekends.

Carbonated drinks and Sweetened beverages

Results from our study says that frequency of intake of sweetened beverages was a risk
factor for childhood obesity.
Ludwig et al examined the relationship between the consumption of sugar-sweetened
drinks and childhood obesity in 548 ethnically diverse children, over a period of 19 months.
They reported that with each increased serving of sugar-sweetened carbonated drink, body
mass index and frequency of obesity increased. The odds ratio of becoming obese increasing

33

1.6 times for each additional sugar-sweetened drink consumed each day. 72 A final crosssectional survey of 385 school children in Santa Barbara County, CA assessed BMI and body
fat directly, and diet and lifestyle by questionnaire. The odds of being overweight were 46%
higher (95% CI=2110%) among those students (n=49) who reported consuming 3 SSB
(sugar sweetened drinks) servings/day compared to those consuming lower amounts, after
adjustment for age, gender, ethnicity and television viewing, but many other lifestyle and dietary
factors were not considered in this study.73
Obesity and overweight were attributed to the increase in intake of high-energy foods
that are high in fat, salt and sugars but low in vitamins and minerals. Sugary beverages in
kindergarten at least weekly were associated with more than double the odds of severe
kindergarten obesity. One study correlated the high consumption of sugar-sweetened
beverages or SSBs is associated with development of metabolic syndrome and type 2 diabetes.
These data provide empirical evidence that intake of SSBs should be limited to reduce obesityrelated risk of chronic metabolic diseases.74Our study also had similar results of other studies.

Fast foods
In a study by Currie et al, they found out that there was an increase in the number of
children who became obese (5.27%) is associated with one-mile proximity with a fast food
chain. 75In our study, eating fast foods is not a predictor for overweight or obesity though there
were fast food chains in the proximity of the school.

Milk type and amount

Factors involved in childhood obesity begin by reviewing the childs energy intake,
energy expenditure, and "energy balance. This gives us the notion that children who eat more
"empty calories" and expend fewer calories through physical activity are more likely to be obese
than other children. Included also were the changes in the child's environment to upset this
energy balance equation. In particular, they examine changes in the food market, in the built
environment, in schools and child care settings, and in the role of parentspaying attention to
the timing of these changes.76
Among the changes that affect children's energy intake are the increasing availability of
energy-dense, high-calorie foods and drinks through schools. Despite studies claiming that the
intake of these energy dense high calorie food and drinks are of significant value to ones
predisposition to obesity, our results revealed that frequency of milk consumption was not found
to be a risk factor to childhood obesity, neither was the frequency of carbonated drink
consumption.
This was in contrast to a cohort study from the Framingham Childrens study involving
92 children. They found out that children who consumed least dairy during pre-school acquired
significantly more body fat during childhood than those who consumed the most. Preschool
children with the lowest dairy intake (<1.25 servings/day for girls and <1.7 serving/day for boys)
have significantly greater gains in body fat during childhood(an extra 25mm subcutaneous fat by
early adolescence).77In a study by Gianvincenzo et al in 2005, an investigation among 1087
children showed that milk consumption was still significantly and inversely associated with BMI z
scores in the whole milk consumers when controlling for age and the frequency of various
food.78

34

Chips
Chips are energy dense foods which are said to contribute to childhood obesity. There
have been studies that linked the rise in obesity incidence with increasing consumption of
snacks, fast foods, and soft drinks and with the consumption of high-energy-density diets. 79
However this study showed no significant association between consumption of chips and
overweight or obesity.

Vegetables and Fruits

In this study, the amount of consumption of fruits and vegetables had no significance in
predicting the occurrence of obesity and overweight in elementary children. Although the WHO
in their Global Strategy on Diet, Physical Activity and Health (2002) cited a low intake of fruits
and vegetables as among the top 10 risk factors for obesity and other preventable
noncommunicable diseases80, a study by Ledoux and Hingle in 2011 showed that the inverse
relationship between the consumption of fruits and vegetables and weight gain appeared to be
significant only among the adult population. No association was shown among children as
well.81

Child Eating and Behaviour Questionnaire

CEBQ describes the development of a multi dimensional questionnaire generally
regarded as one of the most comprehensive instruments in assessing childrens eating
behaviour based on parents reports of their childs behaviour. Individual differences in eating
behaviour were conceptualized as having several dimensions.
The literature in eating behaviour suggested eight areas for consideration: Food
Responsiveness (FR), Enjoyment of Food (EF), Emotional OverEating (EOE), Desire to Drink
(DD), Slowness in Eating (SE), Satiety Responsiveness (SR), Food Fussiness (FF) and
Emotional UnderEating (EUE).
EF and FR reflect different aspects of excessive responsiveness to external food cues.
EOE and EUE measure an increase or a decrease in eating response to a range of negative
emotions such as anger, loneliness or anxiety. DD reflects the inclination of children to drink
frequently, sometimes associated with an increased intake of sugar sweetened drinks. SR
represents the ability of a child to reduce food intake after eating to regulate its energy intake.
High scores of SE meant a reduction in eating rate as a consequence of lack of enjoyment and
interest in food. FF is related with a rejection of a substantial amount of novel and common
foods, narrowing the range of the variety of consumed foods.
The first four subscales (EF, FR. EOE and DD) are foodapproach subscales that
indicate positive inclinations for eating while the other four subscales (SR, SE, FF and EUE) are
considered as foodavoidant subscales related to negative inclinations to food intake.
This study provided information of association between young grade school childrens
eating behaviour and their BMI. The present study showed the presence of 3 positive subscales
(FR, EF and EOE) as predictors of obesity and one negative subscale predictor (SR). The
results were similar to previous studies showing that children with increased BMI are highly
responsive to environmental food cues. The inverse association between BMI and SR subscale

35

are similar to other studies. The CEBQ subscales DD, SE, FF and EUE showed no association
with childhood obesity.
Higher levels of childrens Food responsiveness (FR), Enjoyment of Food (EF) and
Emotional Over Eating (EOE) were positively associated with obesity while Satiety
Responsiveness (SR) was negatively related to obesity. Food responsiveness (FR) is measured
behaviourally by seeing whether food intake is reduced to compensate for a prior increase in
consumption. Enjoyment of food (EF) assessed behaviourally on the basis of the amount of
goodtasting versus lessgoodtasting food consumed in standard conditions. Emotional
overeating (EOE) is characterized by either an increase in eating in response to a range of
negative emotions, such as anger and anxiety. Satiety responsiveness (SR) represents the
ability of a child to reduce food intake after eating to regulate its energy intake.
Individual differences in eating style contribute both to overweight and underweight.
Many different eating styles have been implicated in the etiology of overweight or obesity.
Eating behaviour is susceptible to modification through interventions to prevent childhood
obesity is important in focusing on behavioural traits.82
It was revealed thru multiple regression that only FR (0.002), EF (0.003) and SE
(<0.0005) are significant (p value<0.05) predictors of increased BMI among elementary children
in WVSU-ILS. FR and EF are both positive predictors of increased BMI while SE is a negative
predictor of high BMI. More specifically, multiple regression of CEBQ scores to determine the
odds for overweight and obesity revealed that there is a positively strong association of obesity
to FR and EF. There was a weak positive association of obesity to EOE. The SR is also a
weakly negative predictor for risk of obesity.

36

CONCLUSIONS
The prevalence of obesity and overweight among elementary students of WVSU ILS are
21.9% and 15.8% respectively. For the males, 35.7% are obese, while 21.9% are overweight.
For the females, 13.9% are obese, while 15.3% are overweight. As to age, 64.3% of 9 years old
students, 28.6% of 8 year old students and 26.1% of 11 years old students are obese. While
27.8% of 10 year old students, 26.1% of 11 years old students, 16.7% of 12 years old students
are overweight. Significant positive associations existed only between obesity and consumption
of sweetened beverages (p=0.048), high CEBQ score for food responsiveness (p<0.0005),
enjoyment of food (p<0.0005), emotional over eating (p=0.025), and low CEBQ score for satiety
responsiveness (p=0.007). There are no significant associations between the predetermined
risk factors and being overweight.

37

Appendix
West Visayas State University
College of Medicine
La Paz, Iloilo City
12 July 2013
Emellie G. Palomo, Ph.D
Director WVSU - ILS
Dear Dr. Palomo
We are a group of thirteen third year medicine students from the West Visayas State University - College
of Medicine. As part of academic requirement, we are proposing to conduct a study entitled, "Prevalence
and Risk Factors for Obesity and Overweight Elementary Children at WVSU-ILS. In this study, we
would compute the BMI of students and ask questions to assess the risk factors.
In connection with this, we would like to ask for a consultation with your good office regarding the
feasibility of our study.
We hope for your favorable response on this matter.
Thank you very much and God bless.

Respectfully yours,

Bryan Atas
Group Representative
Noted:

Prof. Ma. Pilar Charmaine S. Malata,

Research Coordinator

Fred P. Guillergan, M.D.

Head, Office of Research

West Visayas State University

College of Medicine
La Paz, Iloilo City

July 26, 2013

Atty. Paulino Salmon
President, Parent-Teachers Association
West Visayas State University- Integrated Laboratory School
Cc:
Emellie G. Palomo, Ph.D
Director, West Visayas State University- Integrated Laboratory School

Dear Attorney Salmon;

Greetings!
We are a group of third year medical students of West Visayas State University who are
presently conducting a research study entitled Prevalence and Risk Factors of Overweight and
Obese Grade School Students of WVSU-ILS as a requirement in our colleges curriculum.
In line with this, we would like to request permission from the Parents -Teachers Association to
allow us to conduct this study involving the students and their parents. We plan to weigh the
elementary pupils and give out questionnaires pertaining to the childrens habits and lifestyles.
Your positive response on this matter will be highly appreciated.

Respectfully yours,

Bryan Atas
Group Representative

Noted:

Prof. Ma. Pilar Charmaine S. Malata,

Research Coordinator

Fred P. Guillergan, M.D.

Head, Office of Research

Schedule of Activities

TASKS
Plan for Pilot testing and

SPECIFICS
Check probable population

DATES
October 21-26

Finalize Paper works

October 28-31

Schedule Testing
Pilot Testing Proper

November 4-8

Evaluation of Pilot testing and

Validation of Questionnaire

November 11-15

Finalize paper works ILS

Meeting of each Class Advisers

concerning:
Background and
Objective of Study
Roles of Class Advisers
in the study
Arrange Schedule for
Anthropometric
Measurements

Finalize permission to access

records(birth certificate/list of
students/schedule of classes)

October 21-26

Accomplish Final Consent

form signed by:
- Director ILS
- Guidance Counselor
- PTA president
- Class Advisers
- Research Adviser
- Head Office Research,
COM
- Dean, COM

October 21-26

November 4-8

Giving of Consent Forms with

Questionnaires attached
Finalizing Sample Population
upon collection of returned
questionnaires with consent
forms
Anthropometric
Measurements

Short talk during classes

November 18-22

Finalize schedule of
anthropometric
measurements

November 25-29

December 2-6

Organize data collected

Data analysis
Start chapter 4-5

Christmas Break
January 6-10
January 13-24

Revise Chap 1-3

January 13-24

Revise whole paper

1st and 2nd week February

Editing final research paper

3rd and 4th week February

Budget Proposal
EXPENSES

ALLOTTED
BUDGET(PHP)

Printing

1000

Photocopying

2000

Binding

1000

Snacks for Students

3000

Honorarium

Statistician

Token

500

2000
School Advisers
Principal
Guidance
Counselor

TOTAL

10,500

RECOMMENDATIONS
It is recommended that:

1. a similar study be performed in both private and public schools to look into factors
may differ between the private and public schools,
2. to look into other factors which may be implicated in childhood obesity such as weight
gain in infancy, advanced maternal age at pregnancy, self-perception of obesity or race,
and
3. a prospective study on the BMI of children into adolescents or adults to monitor how
many obese or overweight children actually become obese or overweight adults

38

ACKNOWLEDGMENT
The researchers would like to thank the people whose contributions and participation
made this study possible. Truly, they are indebted to the following:
Jerusha Comuelo, MD, research adviser, for advise and guide in the formulation and
writing of this study
Prof. Malata, research coordinator, for the invaluable critic and guide in the writing of this
manuscript
Integrated Laboratory School faculty, administrators, advisers and student teachers for
facilitating the return of the questionnaires and assisting in the anthropometric measurement of
the children
Ms.Geneveve Parreo and Mr. Roderick Napulan for the statistical advice and
calculations
The staff of the WVSU Infirmary for allowing us to use the weigh beam scale.
Dr. Jane Wardle for the permission to use the Child Eating and Behaviour Questionnaire

39

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