Association Between Primary School Students’ Unhealthful Behaviors and Overweight/Obesity: A Cross-Sectional Analysis in Urban Kenya

Introduction : Although obesity prevalence is known to be rising in East Africa, research on childhood obesity is still minimal. We conducted a cross-sectional study to examine the prevalence of unhealthful dietary patterns, physical activity and sleep behaviors among primary school children in two urban settings in Kenya and explored the association between the behaviors and overweight/obesity among the children. Methods Six public schools, with children from low-, medium- and high-income households in Nairobi and Kisumu cities were purposively selected to participate in the study. Data was collected on randomly-selected students aged 10–12 years at each school. Students’ weights, heights, waist circumferences, and tricep, bicep, subscapular and suprailiac skinfolds were measured. Body-mass-index-for-age z-scores were used to classify students into underweight, healthy weight, overweight and obese categories. Waist-circumference-to-height ratio above 0.5 was used to define abdominal obesity and the total amount of body fat was estimated from the sum of skinfold measures. Parents, with the help of their children, completed questionnaires on student’s dietary, physical activity, and sleep behaviors. Anthropometric measurements and questionnaires were available for 390 students. We utilized prevalence ratio analysis to examine the association between socio-economic/demographic characteristics, unhealthful behaviors and overweight/obesity. Results Overall, 21% of the students were overweight or obese and 9% of them had abdominal obesity. Median total skinfold measurements was 32.5 mm. Prevalence of unhealthful behaviors varied significantly by student’s age, gender, school income levels, city, and frequency of consumption of restaurant foods. Students who consumed less than recommended amount of fruit servings had 1.68 times the risk of being overweight/obese, 2.49 times the risk of having abdominal obesity and 1.47 times the risk of having high total skinfold values compared to students with adequate fruit intake. Students with high frequency of consumption of red/processed meats had 1.50 times the risk of being overweight/obesity compared to students with less-frequent consumption. Conclusion We found a rather high prevalence of unhealthful dietary behaviors among primary school students in Kenya, identified their determinants, and the association between specific behaviors and overweight/obesity. These results can guide childhood obesity prevention measures in Kenya and other nations in East Africa.