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EFFECT OF NUTRITIONAL COUNSELING AND PHYSICAL ACTIVITY ON OVERWEIGHT AND OBESE IN-SCHOOL ADOLESCENTS IN TWO LOCAL GOVERNMENT AREAS OF SOUTH EAST NIGERIA
Abstract
Overweight and obesity have become topical issues in public health due to the morbidities and mortalities associated with them. Among adolescents, the prevalence has been increasing as in other age groups; Nigeria has recorded up to 11.4% for overweight in previous studies. Adolescents constitute an important population group in our country, which is why this study set out to determine the prevalence and ascertain the risk factors for overweight and obesity in this age group. It also assessed the effect of lifestyle modification on the mean Body Mass Index of the study respondents.
An intervention study was carried out among adolescents in Umuahia the capital of Abia state while adolescents in Owerri the capital of Imo served as the control. A total of two thousand and fifty one (2051) ‘In-School’ adolescents were recruited into the study: the control had one thousand and twenty five (1025) and the intervention had one thousand and twenty six (1026) participants. After stratifying the schools into public and private owned, two public and three private schools were selected using a simple random sampling technique from each stratum. The respondents were recruited using a systematic random sampling from the class register. Variables assessed were socio-demographic profile, anthropometric values, physical and sedentary activities, dietary pattern and hours of sleep. Thereafter, a subset of 60 overweight and obese adolescents was selected for the intervention while the same number (60) of overweight and obese was used as control. The intervention involved: a) increase in physical activity; hours of sleep; consumption of fruits and vegetable; b) reduction in screen time and sedentary behavior for a period of 5 months.
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Results show that most of the participants’ parents belonged to the high socioeconomic class while most of the respondents belonged to the age bracket of 10-14 years. The mean age of participants was 13.77±1.96 years, while the mean BMI was 21.29±3.75kg/m2. The prevalence of overweight and obesity were 5.6% and 19.0% respectively. Factors associated with overweight and obesity were being female, belonging to the high socio-economic class, attending a private school, high intake of snacks, not being physically active and a largely sedentary life. In addition, overweight and obese adolescents had shorter sleeping hours compared to those with normal BMI. Logistic regression models assessing the influence of demographic and lifestyle variables showed the following risk factors; gender 1.33 (95% CI: 1.06-1.67), attending private school 1.79 (95% CI: 1.32-1.42), high socioeconomic class 1.74 (1.12-2.70), high level of sedentary activities 1.31(1.02-1.67), skipping of breakfast 1.37(1.05-1.79) and frequent consumption of snacks 1.32(1.00-1.74). Being sufficiently active 0.12(0.08-0.16) and regular consumption of vegetables 0.65(0.45-0.10) had protective effects.
Intervention led to increase in physical activity, fruits and vegetables consumption and hours of sleep; and decrease in screen time, sedentary activities, and consumption of snacks and sweetened beverages. Paired t test and Wilcoxon tests were all significant (p < 0.05) in these variables before and after the intervention for the intervention group, and for the difference between the intervention and the control groups. The mean BMI of the intervention group reduced by 0.38kg/m2, while the mean BMI of the control group increased by 0.09kg/m2. Again, in the intervention group, the proportion of overweight adolescents reduced by 0.3% compared to the baseline.
It is therefore concluded that the introduction of physical activities, reduction of sedentary lifestyle, increase in consumption of fruits and vegetables and increase in sleep time were
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effective in reducing the mean BMI, and the proportion of overweight and obese ‘in-school’ adolescents. It is therefore recommended that since the epidemiological transition in diet and a largely sedentary life pattern identified as the risk factors for the increasing prevalence of overweight and obesity are modifiable, school-based (physical exercise) and family-based (dietary change, limitation of screen time and increasing sleeping time) interventions be co-opted into the school curriculum to improve BMI among these adolescents.
