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Overweight and obesity is a global epidemic among children of all ages. Pre School and primary school children who are overweight and obese are more likely to continue to be obese as adolescents and adults, as well as stand at an increased risk for poor health outcomes associated with excess weight. While the central physical cause of overweightness and obesity is the imbalance of energy intake from food and energy expended through physical activity, excess weight is also caused by a number of other contributory factors including personal, social and environmental influences.
Among school-aged children, there seems to be substantial interest and resources currently being devoted to primary and secondary prevention, though intervention studies have yielded somewhat mixed results. Education, interventions, and evaluations of the effectiveness and outcomes of new initiatives aiming to reduce childhood overweight and obesity are needed to recommend future programs with the greatest likelihood of success.
Overweight and obesity are a global pandemic(1). The body weight that is greater than what is consider normal and healthy for a certain height is referred as the term ‘overweight’ and ‘obesity’.
Overweight is due to extra body fat and also be due to extra muscle, bone or water. Obesity refers to an excessive body fat and adiposity. In adults, overweight and obesity is classified by the BMI which is a general index of weight for height. It is calculated by individual’s weight in kilograms (kg) divided by the square of his height in meter (kg/m^2).
The global prevalence of the overweight and obesity is on the rise.
The global burden of overweight and obese adults in 2013 was 36% in men and 37% in women worldwide. Globally, the epidemic has affected both developed and developing countries, men, women and adults and children. Although there are great variations in their prevalence and trends among regions or countries and sexes(2). In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese (WHO). 39% of adults aged 18 years and over were overweight in 2016 and 13% were obese (WHO). 41 million children under the age of 5 were overweight and obese in 2016 (WHO). Over 340 million children and adolescents aged 5-19 were overweight and obese in 2016 (WHO).
The global study found that among children and adolescents, obesity has increased substantially worldwide. Between 1980 and 2013, the prevalence of overweight and obese children and adolescents increased by nearly 50%. In 2013, more than 22% of girls and nearly 24% of boys living in developed countries were found to be overweight or obese. Rates are also on the rise among children and adolescents in the developing world, where nearly 13% of boys and more than 13% of girls are overweight or obese. Particularly high rates of child and adolescent obesity were seen in Middle Eastern and North African countries, notably among girls(3).
Over the last 33 years, rates of either being overweight and obese increased among Bangladeshi adults and children. In 1980, 7% of adults and 3% of children were overweight or obese. In 2013, those rates had climbed to 17% for adults but only 4.5% for children(3). Among of the 17% of overweight or obese adults in Bangladesh, just 4% were obese and obesity rates in Bangladesh are increasing at a slower pace. From 1980 to 2013 obesity rates in adults grew from 2% to 4%, and rates in children and adolescents remained at about 1.5%(3). In one study from Dhaka, 17.9% were obese and 23.6% overweight school children and adolescents of affluent family.
When looking at the region, South Asia has seen a steady increase in overweight and obesity since 1980, with the rate of overweight or obese adults rising from 16% to 21% in 2013. South Asia also has the lowest child overweight/obesity prevalence among all regions (6%) and the lowest child obesity prevalence (3%). Within the region, Pakistan has the highest obesity rate for adults (14%), and Bhutan has the highest obesity rate for children (6%). South Asia also has the smallest gender gap in adult obesity among all regions (4.8% male, 5.2% female)(3).
Childhood overweight and obesity are among the most nutritional problems in the developed and developing countries are on the rise. These problems are associated with increased consumption of processed and fast foods, dependence on television and computers for leisure and less physically active lifestyle. Obesity has serious long terms consequences like hypertension, hypercholesterolemia, type 2 diabetes mellitus, left ventricular hypertrophy, non-alcoholic steatohepatitis, asthma, obstructive sleep apnoea, mental health concerns and orthopedic disorders(4).
Many factors have been implicated in etiology of obesity like nutritional behavior, a level of physical activity, genetic make-up and environmental influences.
The combination of an excessive nutrient intake such as fast-food chains, high soft drinks and a sedentary lifestyle are the main causes in developing obesity. Many chronic diseases are associated with obesity; around 30% of individuals who are overweight have at least mildly elevated blood pressure as long as increased incidence of strokes and heart attacks with obesity(5).
In addition, low family SES (which is prevalent in rural areas) has been associated with lower levels of activity.17 The rural youth in the present study were from lower SES families (40% of the students were eligible for free or reduced-cost lunches [e.g., household income < 185% of poverty level or $14,000 for a family of three]) than the urban youth (18% of the students were eligible for free or reduced-cost lunches), but the rural youth were more active. The higher prevalence of lower SES among rural Mississippi youth12 (76% were eligible for free or reduced cost lunches) may explain the different results observed in that study(6)
Changes in socioeconomic status have a significant effect on physical activity with the availability of easy transport, the increase in electrical home appliances and more involvement in office work, long periods in watching television and using the internet.
Urbanization and Physical Activity:
In recent years, multiple factors such as rapid urbanization, continually decreasing number of playgrounds, increasing purchasing power and easy access to new technological devices such as computer toys probably have led to less physical activity and more sedentary activity and thereby have attributed to an emerging overweight and obesity problem among young children(7).
The nature of children’s recreational pursuits has changed dramatically over the last few decades. Whereas children used to spend much of their recreational time engaged in active outdoor play, the emergence of television, computer games and the internet has meant that children are now spending much more of their free time engaged in sedentary pursuits. The importance of physical activity for the physical, mental and social health of youth is undisputed and therefore it is critically important that efforts are made throughout the world to “reintroduce” physical activity into our youth. The purpose of this is to assist in this drive towards a more physically active youth in Bangladesh. The Government of Bangladesh is keen that all parents, teachers and Physical Activity and other child educators participate in improving the levels of physical activity among youth. This needs to be an urgent priority. Unquestionably, the challenges posed by the growing issue of physical inactivity and childhood obesity can be considered to be some of the greatest challenges to public health in the 21st century.
The responsibility to improve levels of childhood physical activity and other health related childhood behaviors lies with everyone in society. However, as an individual directly involved with children, you are an especially important part of the influential network. Schools, homes and the community are excellent locations to assist children in improving health related lifestyle behaviors such as physical activity(8).
The school setting provides a promising environment to increase children’s physical activity. School-based PA promotion and PA opportunities hold great promise for increasing PA in children. However, to maximize these efforts school polices related to training staff about PA are needed. Physical activity (PA) provides several physical and psychological beneﬁts for children. Children spend as much as 60–70% of their waking hours at school and school stakeholders has identiﬁed the school as a key setting for improving health behaviors. Several factors associated with a child’s PA participation. These factors include individual characteristics of the child (e.g. gender); the school and home environment (e.g. Parent activity patterns); community and industry inﬂuence (e.g. availability of safe places to be active); and societal norms or values(9).
The availability of space and equipment dedicated to PA was an additional barrier. Several participants mentioned that lack of space was due to the increasing amount of portable buildings that had been added to the school yard. Furthermore, a lack of available equipment or lack of quality equipment was cited as a barrier by many schools. Recess interventions designed to increase PA in children have utilized playground modiﬁcations (i.e. foursquare, maps etc.), recreational equipment, designated space for games or activities and/or staff training(9).
Increased time spent with technology (i.e. television, video games),parents increased fears of safety for children playing outside, and overscheduling of children’s time has also contributed to the large decrease of ‘play’ time in children at school and at home. Perhaps a large part of staff training in the school environment could include teaching staff how to help children be playful and create easy, fun games on the playground to improve children’s desires to play. In this study, participants believed that girls felt that peer pressure and social norms were barriers to PA(9).
Regional challenges for the physical activity are; inadequate time allocated for the teaching of Physical Education classes Shortage of trained and qualified Physical Education teachers. Absence of a Regional Policy for Physical Education. For the differently able Absence of a structured curriculum and kindergarten. Institutional capacity to oversee the development and implementation of Physical Education. Lack of resources such as space, equipment, facilities, instructional materials, support staff(10).
PA is associated with significant and beneficial changes in fat percentage, waist circumference, systolic blood pressure, insulin, low-density lipoprotein cholesterol and total cholesterol, as well as with small non-significant changes in diastolic blood pressure, glucose, and high-density lipoprotein cholesterol. PA intervention may improve physical fitness and risk factors for cardiovascular disease in adolescents who are overweight or obese(11).
The process of cardiovascular disease (CVD) begins in childhood, and associated risk factors, including inactivity and obesity, track through adolescence (ages 11–25 years) into adulthood, imparting heightened risk of premature mortality. Urban living in communities with multiple deprivations and limited access to safe open spaces has been shown to have detrimental health impact. Urban residential areas can present a hostile environment to psychological, physical and cognitive wellbeing, engendering chronic stress and isolation(12). Several studies have proved that performing physical activities on a regular basis (at least 30 minutes a day of moderate intensity physical activity) improves life quality and health status and prevent and control cardiovascular diseases, hypertension, diabetes, obesity, etc. According to WHO estimates, up to 80% of diabetes cases and cardiovascular diseases and up to 30% of some types of cancer (WHO 2003) could be avoided by establishing preventive interventions such as improvement of diet quality and physical activity(13).
In order to enhance the quality of learning and teaching of Physical Education (PE) in schools, it is important to identify and thoroughly examine the role and influence of those “significant others” with whom the learners interact in their learning and living environments. It is widely recognized and acknowledged that parents are important agents within the wider community that can be relied upon to influence the teaching and learning of PE for their children by serving as role models and by encouraging and supporting them. Parents have vital influence on the activity patterns of children.
Parents have a major impact on their children attraction to participate in Physical Activity. Parents may exert significant social influence on their children PA and PE through a variety of mechanisms which include parental encouragement, beliefs and attitudes towards PE and PA, role modelling, involvement and facilitation such as through transport and fee paying and attendance to selected activities such as sport days such as PE exhibitions(14).Indeed, it is their responsibility to facilitate their children’s active participation in physical activity and PE related activities discourage inactive lifestyles and encourage healthy eating habits. Such parental influence and role can contribute immensely towards the adoption and promotion of the teaching of PE and health education in educational institutions. The involvement of parental support in the teaching and learning of PE is particularly significant and relevant to the situation(14).
When addressing youth overweight status, mental health problems also need to be addressed; mental health problems increased with increasing BMI; overweight youth had a higher reported occurrence of mental health problems than youth who were classified as normal weight(15). This relation was true for all of the mental health problems. Youth who were overweight were more likely to have been told by a health professional that they suffer from depression, to have problems coping with stress or to have been told by a health professional that they have a behavior compared with normal-weight children. Overweight were significantly more likely to be reported as suffering from depression or anxiety, feeling worthless or inferior, having a behavior problem, and bullying others than their no overweight. Body image may play a role in the relationship between mental health problems and overweight(15).
Rates of mental health problems in young people are also high, and increasing, with around one in ten children aged 5-16 years having a diagnosable condition. Obesity, mental ill health has been identified as a major cause of persistent disability with attendant economic implications. There are many plausible reasons why excess adiposity may be associated with poor psychological adjustment. These include: the impact of obesity on self-esteem and social confidence; the direct effect of hormonal and metabolic changes on brain function; the result of changes in dietary behavior and physical activity levels that can be a consequence of depressed mood(16).
Adolescents who are overweight are commonly victimized by peers and experience higher rates of low self-esteem, sadness, nervousness and loneliness than peers in the normal weight range. Some of these adolescents, in particular girls and younger adolescents suffer depressive symptoms and are more likely to experience suicidal contemplation if subject to weight-based teasing. Heightened body consciousness has been identified as a unique barrier to physical activity for overweight youth as compared to non-overweight youth. Moreover, overweight youth tend to perceive a greater number of barriers to sports participation, including feeling insecure about their appearance(17).
Excess weight is also caused by a number of other contributory factors including personal, social and environmental influences that pose more challenges in terms of understanding, measurement and change. Personal characteristics and behaviors can negatively impact a child’s weight, mental health and sleep.
Social and environmental factors include those influences in the home, school, community and society. For instance, family and friends influence and support one’s lifestyle and daily habits; schools are seemingly providing fewer opportunities for physical activity, due to a greater emphasis on academic achievement; and environmental factors including community resources and even media in society are sending conflicting messages concerning a healthy lifestyle(18).
The positive relationship between television viewing and obesity in children and adolescents is well known. Television viewing has also been linked to a number of other important public health issues in youth including violent and aggressive acts, initiation of early sexual behaviors, body self-image issues and substance use and abuse. Excessive computer and video game use has been associated with many of the same health and social problems(19).
The purpose of the present paper is to provide an overview of research linking to reduce overweight and obesity related behavioral risk factors and to challenge the current notion that prevention should focus on nutrition, weight and physical activity among school going children in rural area of Bangladesh.
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