Obesity is one of the most serious public health problems of the 21st century that is characterized by abnormal or excessive fat accumulation in the body that may impair health [1]. In the past decade,overweight and obesity among children has become a major public health problem in developed and developing countries .Adverse outcomes of overweight and obesity include psychological and physical effects during childhood and also increased risk of adult obesity, which is a major independent risk factor for cardiovascular diseases, diabetes, hypertension and cancer[2]. 

Literature from both, developed and developing countries have documented association between childhood obesity with many adverse health effects, ranging from hyperlipidemia, hypertension, respiratory disorders, glucose intolerance and type 2 diabetes mellitus, depression and low self esteem to social discrimination .All these adverse effects point to the necessity of preventing childhood obesity [3]. 

Childhood obesity and overweight are outlined by the Centers for Disease Control and Prevention (CDC) as a body mass index (BMI) at or on top of the 85th percentile and below the 95th percentile for overweight and at or on top of the 95th percentile for obesity in the children of the same age and gender [4].

The worldwide prevalence of obesity nearly tripled between 1975 and 2016. In 2019, an estimated 38.2 million children under the age of 5 years were overweight or obese. Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings [5].

The prevalence of overweight and obesity among school children ranged from 7% to 45%. Possible factors determining obesity in this region include: inactivity, a shorter duration of breastfeeding, frequent snacking, skipping breakfast, a high intake of sugary beverages, an increase in the incidence of eating outside the home, long periods of time spent viewing television, massive marketing promotion of high fat foods, cultural elements and food subsidize policy [6].

Overweight and obesity have reached epidemic proportions in many Asian countries, the highest rate of obesity in Asia is in Thailand, Philippines, China which once had the leanest of population [7].

There are few studies on how common obesity is among Iraqi school children, According to a study, 6.3% to 12.3% of Baghdad. [8] Iraqi schoolchildren are fat and Numerous studies in the Babel governorate of central Iraq revealed that the prevalence of overweight and obesity among pupils aged 7 to 13 was, respectively, 6.0 and 1.3% [9].

Body mass index(BMI) is a number calculated from child's weight and height. BMI is a reliable indicator of body fatness for most children and teens [10].

The normal range for BMI in children vary with age and sex. The Centers for Disease Control and Prevention Centers for Disease Control and Prevention defines obesity as a BMI greater than or equal to the 95th percentile [11].

Aim of the Study

To assess the prevalence of obesity in primary school children in Baghdad city.

The methodology used to obtain the prevalence of obesity in primary schools in Baghdad city will involve a cross-sectional study design. This design will allow for the collection of data at a single point in time, which is suitable for obtaining information on the prevalence of obesity. The study will involve the use of questionnaires and physical measurements to collect data from a sample of primary school students.

Selection of Sample

The sample for this study will be selected using a multi-stage sampling technique. The first stage will involve the selection of primary schools in Baghdad city using a random sampling technique. The second stage will involve the selection of classes within each school using a simple random sampling technique.

The third stage will involve the selection of students within each class using a systematic random sampling technique. All students within each selected class will be included in the study, and their parents or guardians will be asked to provide informed consent before participation.

To ensure the sample is representative, schools from different areas within Baghdad city will be included in the study. Additionally, efforts will be made to ensure that both genders are equally represented in the sample. Children who are unable to participate due to medical reasons or other factors will be excluded from the study.

Data Collection

Data collection for this study will involve measuring the height and weight of children using standard procedures and equipment. The data collected will be entered into a database for analysis. The questionnaire included two main parts; the first part was focused on the child’s and the parents’ socio-demographic data. The second part was focused on the child’s dietary and activity-related behaviours.

Data Analysis

The prevalence of obesity in primary schools in Baghdad city will be calculated as the percentage of children with a BMI above the 95th percentile for their age and gender. Chi square test was used. Significant level considered with a p value < 0.05. used to compare differences between groups such as socioeconomic status or the children parents’ employment.

This study was carried out on 575 primary school students aged 6-12 years. Two hundred seventy-one (47%) were girls, and 304 (53 %) were boys. The prevalence of obesity was one third (33%) of all students that were studied (Table 1). 

Table 1: The Relationship Between Age, Gender and BMI

The prevalence of obesity was higher (51%) among girls compared to 49% in boys, while the prevalence of obesity was the highest in age 12 years among other age groups.

Actually the higher percentage of obesity and overweight in middle socioeconomic status (61%) but this result was statistically not significant, (p-value 0.081). Also, there was significant association between mother educational level and pupils’ BMI (p-value 0.006). But the working mothers’ children present with high prevalence of obesity 88%. With Increase in father educational level that can be associated with excessive body weight among their children (65% were obese/ overweight) but this result was statistically not significant, p-value 5.112. In addition to there was no significant association founds between fathers’ occupation and body weight categories (p = 0.131) (Table 2).

Table 2: Demographic Characteristics and Weight Status of the Students and Socio-Economic Status of the Parents and the Children Parents’ Employment

The prevalence of overweight and obesity increased with student whose on bottle feeding in early life (77%) as well as in student without physical activity (94%) .TV-watching and Playing video games, daily Fast food or Sweet and bicarbonate Beverage consumption increase the percentage of pupils obesity in primary schools as a result (96%, 88%, 89% ) while early sleeping , Fruit and vegetable intake decrease the prevalence of obesity of primary schools students (27% ,26%) (Table 3).

Table 3: Significant Risk Factor of Obesity 

The present cross-sectional study was conducted among 575 students in the primary school in Baghdad city, The study aimed to determine the prevalence of obesity of primary school students (6-12 years old) in Baghdad city. 

As regards the percentage distribution of the studied children by BMI, the present study found that 33% of students were obese and overweight while overall prevalence of overweight, including obesity of the subjects was lower in pervious study in china about (17.85%) [12].

In this study the prevalence of obesity was higher (51%) among girls compared to 49% in boys while other studies conducted among children in Africa have reported similar gender difference in the prevalence of child obesity [13], In addition to the prevalence of obesity was the highest in age 12 years different from study in Erbil the results is higher in age 10 years [14].

Our study results of socioeconomic class showed an insignificant association (p value 0.081) with BMI, as both overweight, and obesity were more prevalent among the children from middle socioeconomic class, on the contrary to these results; the study done by N. El-Said Badawi et al in Cairo University, Egypt, the socioeconomic class showed a significant direct association (p value 0.047) with BMI [15].

In consistent with a previous study in Turkey, having a working mother and father was significantly associated with increase in childhood obesity in contrast of our study was insignificantl associated with increase in childhood obesity [16].

In Afaf Amer et al, There was a significant relationship between the BMI and fathers' education (p<0.05) and non-significant relationship between the BMI and mothers' education but we concluded in this study, with increase in father educational level was statistically non-significant (p-value 5.112) and there was significant association between mother educational level and pupils’ BMI( p-value 0.006) [17].

In Amira M.M. Hamed et al. who reported that 41% of normal children were breast-fed additionally, they found that 46% of normal children were bottle-fed, compared to 23% of overweight and obesity in our study children [18].

As well as in student without physical activity the percentage of obesity in this study was (94%) while in Al-Ahsa District of Saudi Arabia was (37.6%) [19].

Now, TV-watching and Playing video games, daily Fast food or Sweet and bicarbonate Beverage consumption increase the percentage of pupils with obesity in primary schools as a result (96%, 88%, 89% ) but in 2016 , the previous study in Baghdad show the less results to the same risk factors (36.2 %,45.4% ) respectively [1]. 

In our study, early sleeping, Fruit and vegetable intake decrease the prevalence of obesity in primary school’s students (27% ,26%) these results are close to results in Egypt in 2019 [18].

From this study we conclude that the prevalence of overweigh and obesity among primary school children was relatively high in Baghdad city. Socioeconomic class, Dietary pattern and sedentary lifestyle are important factors contributing to the high prevalence among this group of children and showed a strong association with the BMI of students.

Recommendations

We recommend the introduction of school meal program in both the public and private school to augment calorie intake among the public school children and modulate same for those in private schools.

The hallmark of prevention and treatment of obesity includes lifestyle modification. Parents must play their role in these interventions. Nutrition and physical activity lessons can be introducing into the school curriculum to learn the students how can choose and maintain healthy lifestyles. Schools can provide healthy food choices and limit marketing of unhealthy foods like sugar sweetened beverages in the cafeteria. Annual measurement of weight, height and BMI for each student in the school and inform the results to their families. This would help parents to become aware of any weight abnormality and early intervention.

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