Magnitude and Determinants of Overweight and Obesity among High School Adolescents in Addis Ababa, Ethiopia
Background: The 2004 World Health Assembly called for specific actions to halt the overweight and obesity epidemic that is currently penetrating urban populations in the developing world. Adolescents require particular attention due to their vulnerability to develop obesity and the fact that adolescent weight tracks strongly into adulthood. However, there is scarcity of information on the modifiable risk factors to be targeted for primary intervention among urban adolescents in Ethiopia. This study was aimed at determining the magnitude and risk factors of overweight and obesity among high school adolescents in Addis Ababa. Methods: An institution-based cross-sectional study was conducted in February and March 2014 on 456 randomly selected adolescents from 20 high schools in Addis Ababa city. Demographic data and other risk factors of overweight and obesity were collected using self-administered structured questionnaire, whereas anthropometric measurements of weight and height were taken using calibrated equipment and standardized techniques. The WHO STEPS instrument for chronic disease risk was applied to assess dietary habit and physical activity. Overweight and obesity status was determined based on BMI-for-age percentiles of WHO 2007 reference population. Results: The prevalence rates of overweight, obesity, and overall overweight/ obesity among high school adolescents in Addis Ababa were 9.7% (95%CI = 6.9-12.4%), 4.2% (95%CI = 2.3-6.0%), and 13.9% (95%CI = 10.6-17.1%), respectively. Overweight/obesity prevalence was highest among female adolescents, in private schools, and in the higher wealth category. In multivariable regression model, being female [AOR(95%CI) = 5.4(2.5,12.1)], being from private school [AOR(95%CI) = 3.0(1.4,6.2)], having >3 regular meals [AOR(95%CI) = 4.0(1.3,13.0)], consumption of sweet foods [AOR(95%CI) = 5.0(2.4,10.3)] and spending >3 hours/day sitting [AOR(95%CI) = 3.5(1.7,7.2)] were found to increase overweight/ obesity risk, whereas high Total Physical Activity level [AOR(95%CI) = 0.21(0.08,0.57)] and better nutrition knowledge [AOR(95%CI) = 0.160.07,0.37)] were found protective. Conclusions: More than one in ten of the high school adolescents were affected by overweight/obesity with dietary habit and physical activity are important modifiable risk factors. Well-tailored nutrition education program targeting lifestyle change should be initiated with more emphasis to female adolescents and students in private schools.
[1] UNICEF. Adolescence An Age of Opportunity. the state of the world’s children 2011 www.unicef.org/publication. ISBN:978-92-806-45677-2
[2] WHO. Strengthening the health sector response to adolescent health and development, 2009; available at http://www.who.int/child-adolescent-health
[3] World Health Organisation. Obesity and overweight’s. Fact sheet N°311, 2014.
[4] De Onis M, Onyango A, Borghi E et al. WHO growth reference for school-aged children and adolescents, Bull WHO 2007, 85: 660–667.
[5] Franklin MF, Pfeffer Frania. Comparison of weight and height relations in boys from 4 countries. Am J Clin Nutr 1999;70(S):157–62.
[6] Maria M, Antoni P, Josep A. Prevelence of overweight and obesity in aolescents: A Sysetmatic review of Article. vol 2013, Arti ID 39592747, 1-14. Available at PubMed.
[7] WHO.Reducing Risks and Promoting Healthy Life, Geneva. 2002.
[8] Keats Sharada, Steve W. Future diets. Kye message:Jan 2014 ISSN2052-7209.
[9] Popkin BM. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with non-communicable diseases. Am J Clin Nutr 2006; 84:289–98.
[10] Yibeltal T, Charles T, Uriyoan C. The Rising Overweight-obesity and Its Socio-Demographic Correlates in Addis Abaa, Ethiopia,2000-2011; 1–14.
[11] Teshome T, Singh P, Moges D. Prevalence and Associated Factors of Overweight and Obesity Among High School Adolescents in Urban Communities of Hawassa, Southern Ethiopia. J Curr Res Nutr Food Sci 2013;1(1):23–36. Avialabe at Open Access.
[12] WHO: Global health risk. Mortality and burden of disease attributable to selected major risks: WHO Library Cataloguing-in-Publication Data 2009; 50–89.
[13] WHO: Non-communicable diseases country profiles 2011 WHO global report. ISBN: 9789241502283. availabla at http://www.who.int/nmh/publications/ncd_profiles2011/en/
[14] Moran R. Evaluation and treatment of childhood obesity: American Family Physician 1999; 59, 861-873.
[15] Troiano RP, Flegal KM. Overweight children and adolescents: Descriptions, epidemiology, and demo-graphics. Am J Pediatrics 1998, 101, 497-504
[16] CDC: Overweight children and adolescents Recommendation to Screen, Assess and Manage. CDC Module safer Healthier people 2006.
[17] Wiley Blackwell. Childhood obesity prevention on the region of subsaharan Africa. A John Wiley & Sons 2011: 56–9.
[18] Finance and Economic Development Bureau. Addis Ababa population images 2009; Addis Ababa, Ethiopia: available at www.aabofed.gov.et/Documents/Final%20Image1.pdf
[19] WHO. The WHO Stepwise approach to chronic disease risk factor surveillance (STEPS), Switzerland 2007. http://www.who.int/about/licensing/copyright_form/en/index.html.
[20] WHO. Global recommendation on physical activity, Switzerland. http://www.who.int/dietphysicalactivity/physical-activity-recommendations-5-17years.pdf; 2011.
[21] WHO: WHO AnthroPlus for personal computers. Manual:Software for assessing growth of the world’s children and adolescents. Geneva (2009).
[22] Adesina FA, Peterside O, Anochie I, Akani AN. Weight status of adolescents in secondary schools in port Harcourt Italia using Body Mass Index (BMI). Ital J Pediatr 2012,38:31;1–17.
[23] Garza JR, Pérez EA, Prelip M, McCarthy WJ, Feldman JM, Canino G, Ortega AN. Occurrence and Correlates of Overweight and Obesity among Island Puerto Rican Youth: case-control study. J Ethn DiS 2011,21:2, 163–9. Available at PubMed
[24] WHO. Diet, nutrition and prevention of chronic diseases,” WHO Technical Report Series 916, WHO, Geneva, Switzerland 2003. http://www.who.int/about/licensing/copyright_form/en/index.html.
[25] Abdulrahman O. Musaiger. Overweight and Obesity in Eastern Mediterranean Region: Prevalence and Possible Causes. Hindawi J Obesity 2011(artid407237):1–17.
[26] Rani MA, Sathiyasekaran BWC. Behavioural determinants for obesity: a cross-sectional study among Urban Adolescents in India. J Prev Med. Public Health 2013 Jul;46(4):192–200
[27] Muhammad UmairMushtaql SG, Sibogha Gull, Komal Mushtaq,et al. Dietary, physical activities and sedentary lifestyle asssociated with overweight and obesity among Pakistani primary school children. I.J.Beh. Nut. and Phy.Acti. 2011,8:130,5–20. Available at Open Access
[28] Gebregergs GB, Yesuf ME,BeyeneBT. Overweight and Obesity, and Associated Factors among High School Students in Gondar Town, North West Ethiopia.cross-sectional. J Obes Wt Loss 2013,3:165, 2–5. Availble at Open Access.
[29] Hanley AJ, Harris SB, Gittelsohn J, Wolever TM, Saksvig B, Zinman B. Overweight among children and adolescents native Canadian community prevalence and associated factors. Am J Clin Nutr 2000,71:3,693–700.
[30] Youfa W, Carlos M, Popkin BM. Trends of obesity and underweight in older children and adolescents in United States, Brazil, China, Russia. Am J Clin. Nutr 2002,75:6, 971–977.
[31] Kruger R, Kruger HS, Macintyre U. The determinants of overweight and obesity among 10- to 15-year-old school children in the North West Province, South Africa the -THUSA BANA (Transition and Health during Urbanisation of South Africans; BANA, children). Public Health Nutr.2006 May;(9):351–8. availabel at PubMed
[32] Peltzer K, Pengpid S. Overweight and Obesity and Associated Factors among School-Aged Adolescents in Ghana and Uganda. Int J Environ Res Public Health. 2011;8(3859-3870):1–12. Available at Open Access.
[33] Ziraba AK, Fatso JC, Ochako R. Overweight and obesity in urban Africa: A problem of the rich or the poor? J. BMC Public Health 2009, 9:46
[34] Ezendam NP, Springer AE, Brug J, Oenema A,Hoelscher DH. Do trends in physical activity, sedentary and dietary related behaviors support trends in obesity prevalence in 2 border regions in Texas?. J Nutr Educ Behav 2011, 43:4, 210-8
[35] Bhuiyan MU, Zaman S, Ahmed T. Risk factors associated with overweight and obesity among urban school children and adolescents in Bangladesh: a case–control study. BMC Pediatr 2013,13:72;4–10. Available at Open Access.
[36] Vera Verbestel, Henawum SD, Maes L, et al. Using the intervention mapping protocol to develop a community-based intervention for the prevention of childhood obesity in a multi-centre European project: the IDEFICS intervention. I J Beh Nut and Phy Acti 2011; 08:8,:5–15. Available at Open Access.
[37] Marcela Perez-Rodriguez, Guillermo Melendez, Claudia Nieto, Marisol Aranda, FraniaP. Dietary and Physical Activity/Inactivity Factors Associated with Obesity in School-Aged Children. J Adva Nutr 2012;3:4,622S-628S. Available atPubMed
[38] Robert F. Zoeller Jr, PhD. Physical Activity, Sedentary Behavior, and Overweight/Obesity in Youth America:Evidence from Cross-sectional, Longitudinal, and Interventional Studies. Am J Lifestyle Med 2009, 3, 110-114.
[39] Strath SJ, Bassett DR Jr Swartz A. Comparison of MTI accelerometer cut-points for predicting time spent in physical activity. Int J Sport Med 2003, 24:4, 298–304.
[40] Mei Z, Grummer-Strawn LM, Pietrobelli A, Goulding A, Goran MI. Validity of body mass index compared with other body-composition screening indexes for the assessment of body fatness in children and adolescents. Am J Cli Nutr 2010,7:5,97–8.
[41] WHO. Global recommendation on physical activity, Switzerland. http://www.who.int/dietphysicalactivity/physical-activity-recommendations-5-17years.pdf; 2011.
[42] Rozane Márcia Triches, Elsa Regina, Justo Giuglian. Obesity, eating habits and nutritional knowledge among school children England. rev soude publica 2005; 3:4, 1-7
[43] Government of the Federal Democratic Republic of Ethiopia. National Nutrition Programme 2008-2015, 1-45.
[44] G. O Brien and M. Davies. Nutritional knowledge and BMI. J Advance access 2007, 22:4, 571–575.
[45] Janet M Wojcicki and Melvin B Heyman. Adolescent nutritional awareness and use of food labels: Results from the national nutrition health and examination surve. Wojcicki and Heyman BMC Pediatrics 2012, 12:55, 1-8. Available at open access,
[46] .Netra Thakur, MD; Frank D’Amico, PhD: Relationship of Nutrition Knowledge and Obesity in Adolescence; Clinical Research and Methods 1999, 31:2, 123-7.
[47] .D.Gracey, N.Stanley, V.Burke, B.Corti1, LJ.Beilin: Nutritional knowledge and behavior in adolescents. J Heal Edu Research 1996 11:2,187-20.
[48] McArthur, M Pena, D Holber. Obesity knowledge among Latin America adolescents; International Journal of Obesity 2001) 25, 1262–1268.
[1] UNICEF. Adolescence An Age of Opportunity. the state of the world’s children 2011 www.unicef.org/publication. ISBN:978-92-806-45677-2
[2] WHO. Strengthening the health sector response to adolescent health and development, 2009; available at http://www.who.int/child-adolescent-health
[3] World Health Organisation. Obesity and overweight’s. Fact sheet N°311, 2014.
[4] De Onis M, Onyango A, Borghi E et al. WHO growth reference for school-aged children and adolescents, Bull WHO 2007, 85: 660–667.
[5] Franklin MF, Pfeffer Frania. Comparison of weight and height relations in boys from 4 countries. Am J Clin Nutr 1999;70(S):157–62.
[6] Maria M, Antoni P, Josep A. Prevelence of overweight and obesity in aolescents: A Sysetmatic review of Article. vol 2013, Arti ID 39592747, 1-14. Available at PubMed.
[7] WHO.Reducing Risks and Promoting Healthy Life, Geneva. 2002.
[8] Keats Sharada, Steve W. Future diets. Kye message:Jan 2014 ISSN2052-7209.
[9] Popkin BM. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with non-communicable diseases. Am J Clin Nutr 2006; 84:289–98.
[10] Yibeltal T, Charles T, Uriyoan C. The Rising Overweight-obesity and Its Socio-Demographic Correlates in Addis Abaa, Ethiopia,2000-2011; 1–14.
[11] Teshome T, Singh P, Moges D. Prevalence and Associated Factors of Overweight and Obesity Among High School Adolescents in Urban Communities of Hawassa, Southern Ethiopia. J Curr Res Nutr Food Sci 2013;1(1):23–36. Avialabe at Open Access.
[12] WHO: Global health risk. Mortality and burden of disease attributable to selected major risks: WHO Library Cataloguing-in-Publication Data 2009; 50–89.
[13] WHO: Non-communicable diseases country profiles 2011 WHO global report. ISBN: 9789241502283. availabla at http://www.who.int/nmh/publications/ncd_profiles2011/en/
[14] Moran R. Evaluation and treatment of childhood obesity: American Family Physician 1999; 59, 861-873.
[15] Troiano RP, Flegal KM. Overweight children and adolescents: Descriptions, epidemiology, and demo-graphics. Am J Pediatrics 1998, 101, 497-504
[16] CDC: Overweight children and adolescents Recommendation to Screen, Assess and Manage. CDC Module safer Healthier people 2006.
[17] Wiley Blackwell. Childhood obesity prevention on the region of subsaharan Africa. A John Wiley & Sons 2011: 56–9.
[18] Finance and Economic Development Bureau. Addis Ababa population images 2009; Addis Ababa, Ethiopia: available at www.aabofed.gov.et/Documents/Final%20Image1.pdf
[19] WHO. The WHO Stepwise approach to chronic disease risk factor surveillance (STEPS), Switzerland 2007. http://www.who.int/about/licensing/copyright_form/en/index.html.
[20] WHO. Global recommendation on physical activity, Switzerland. http://www.who.int/dietphysicalactivity/physical-activity-recommendations-5-17years.pdf; 2011.
[21] WHO: WHO AnthroPlus for personal computers. Manual:Software for assessing growth of the world’s children and adolescents. Geneva (2009).
[22] Adesina FA, Peterside O, Anochie I, Akani AN. Weight status of adolescents in secondary schools in port Harcourt Italia using Body Mass Index (BMI). Ital J Pediatr 2012,38:31;1–17.
[23] Garza JR, Pérez EA, Prelip M, McCarthy WJ, Feldman JM, Canino G, Ortega AN. Occurrence and Correlates of Overweight and Obesity among Island Puerto Rican Youth: case-control study. J Ethn DiS 2011,21:2, 163–9. Available at PubMed
[24] WHO. Diet, nutrition and prevention of chronic diseases,” WHO Technical Report Series 916, WHO, Geneva, Switzerland 2003. http://www.who.int/about/licensing/copyright_form/en/index.html.
[25] Abdulrahman O. Musaiger. Overweight and Obesity in Eastern Mediterranean Region: Prevalence and Possible Causes. Hindawi J Obesity 2011(artid407237):1–17.
[26] Rani MA, Sathiyasekaran BWC. Behavioural determinants for obesity: a cross-sectional study among Urban Adolescents in India. J Prev Med. Public Health 2013 Jul;46(4):192–200
[27] Muhammad UmairMushtaql SG, Sibogha Gull, Komal Mushtaq,et al. Dietary, physical activities and sedentary lifestyle asssociated with overweight and obesity among Pakistani primary school children. I.J.Beh. Nut. and Phy.Acti. 2011,8:130,5–20. Available at Open Access
[28] Gebregergs GB, Yesuf ME,BeyeneBT. Overweight and Obesity, and Associated Factors among High School Students in Gondar Town, North West Ethiopia.cross-sectional. J Obes Wt Loss 2013,3:165, 2–5. Availble at Open Access.
[29] Hanley AJ, Harris SB, Gittelsohn J, Wolever TM, Saksvig B, Zinman B. Overweight among children and adolescents native Canadian community prevalence and associated factors. Am J Clin Nutr 2000,71:3,693–700.
[30] Youfa W, Carlos M, Popkin BM. Trends of obesity and underweight in older children and adolescents in United States, Brazil, China, Russia. Am J Clin. Nutr 2002,75:6, 971–977.
[31] Kruger R, Kruger HS, Macintyre U. The determinants of overweight and obesity among 10- to 15-year-old school children in the North West Province, South Africa the -THUSA BANA (Transition and Health during Urbanisation of South Africans; BANA, children). Public Health Nutr.2006 May;(9):351–8. availabel at PubMed
[32] Peltzer K, Pengpid S. Overweight and Obesity and Associated Factors among School-Aged Adolescents in Ghana and Uganda. Int J Environ Res Public Health. 2011;8(3859-3870):1–12. Available at Open Access.
[33] Ziraba AK, Fatso JC, Ochako R. Overweight and obesity in urban Africa: A problem of the rich or the poor? J. BMC Public Health 2009, 9:46
[34] Ezendam NP, Springer AE, Brug J, Oenema A,Hoelscher DH. Do trends in physical activity, sedentary and dietary related behaviors support trends in obesity prevalence in 2 border regions in Texas?. J Nutr Educ Behav 2011, 43:4, 210-8
[35] Bhuiyan MU, Zaman S, Ahmed T. Risk factors associated with overweight and obesity among urban school children and adolescents in Bangladesh: a case–control study. BMC Pediatr 2013,13:72;4–10. Available at Open Access.
[36] Vera Verbestel, Henawum SD, Maes L, et al. Using the intervention mapping protocol to develop a community-based intervention for the prevention of childhood obesity in a multi-centre European project: the IDEFICS intervention. I J Beh Nut and Phy Acti 2011; 08:8,:5–15. Available at Open Access.
[37] Marcela Perez-Rodriguez, Guillermo Melendez, Claudia Nieto, Marisol Aranda, FraniaP. Dietary and Physical Activity/Inactivity Factors Associated with Obesity in School-Aged Children. J Adva Nutr 2012;3:4,622S-628S. Available atPubMed
[38] Robert F. Zoeller Jr, PhD. Physical Activity, Sedentary Behavior, and Overweight/Obesity in Youth America:Evidence from Cross-sectional, Longitudinal, and Interventional Studies. Am J Lifestyle Med 2009, 3, 110-114.
[39] Strath SJ, Bassett DR Jr Swartz A. Comparison of MTI accelerometer cut-points for predicting time spent in physical activity. Int J Sport Med 2003, 24:4, 298–304.
[40] Mei Z, Grummer-Strawn LM, Pietrobelli A, Goulding A, Goran MI. Validity of body mass index compared with other body-composition screening indexes for the assessment of body fatness in children and adolescents. Am J Cli Nutr 2010,7:5,97–8.
[41] WHO. Global recommendation on physical activity, Switzerland. http://www.who.int/dietphysicalactivity/physical-activity-recommendations-5-17years.pdf; 2011.
[42] Rozane Márcia Triches, Elsa Regina, Justo Giuglian. Obesity, eating habits and nutritional knowledge among school children England. rev soude publica 2005; 3:4, 1-7
[43] Government of the Federal Democratic Republic of Ethiopia. National Nutrition Programme 2008-2015, 1-45.
[44] G. O Brien and M. Davies. Nutritional knowledge and BMI. J Advance access 2007, 22:4, 571–575.
[45] Janet M Wojcicki and Melvin B Heyman. Adolescent nutritional awareness and use of food labels: Results from the national nutrition health and examination surve. Wojcicki and Heyman BMC Pediatrics 2012, 12:55, 1-8. Available at open access,
[46] .Netra Thakur, MD; Frank D’Amico, PhD: Relationship of Nutrition Knowledge and Obesity in Adolescence; Clinical Research and Methods 1999, 31:2, 123-7.
[47] .D.Gracey, N.Stanley, V.Burke, B.Corti1, LJ.Beilin: Nutritional knowledge and behavior in adolescents. J Heal Edu Research 1996 11:2,187-20.
[48] McArthur, M Pena, D Holber. Obesity knowledge among Latin America adolescents; International Journal of Obesity 2001) 25, 1262–1268.
@article{"International Journal of Medical, Medicine and Health Sciences:72848", author = "Mulugeta Shegaze and Mekitie Wondafrash and Alemayehu A. Alemayehu and Shikur Mohammed and Zewdu Shewangezaw and Mukerem Abdo and Gebresilasea Gendisha", title = "Magnitude and Determinants of Overweight and Obesity among High School Adolescents in Addis Ababa, Ethiopia", abstract = "Background: The 2004 World Health Assembly called for specific actions to halt the overweight and obesity epidemic that is currently penetrating urban populations in the developing world. Adolescents require particular attention due to their vulnerability to develop obesity and the fact that adolescent weight tracks strongly into adulthood. However, there is scarcity of information on the modifiable risk factors to be targeted for primary intervention among urban adolescents in Ethiopia. This study was aimed at determining the magnitude and risk factors of overweight and obesity among high school adolescents in Addis Ababa. Methods: An institution-based cross-sectional study was conducted in February and March 2014 on 456 randomly selected adolescents from 20 high schools in Addis Ababa city. Demographic data and other risk factors of overweight and obesity were collected using self-administered structured questionnaire, whereas anthropometric measurements of weight and height were taken using calibrated equipment and standardized techniques. The WHO STEPS instrument for chronic disease risk was applied to assess dietary habit and physical activity. Overweight and obesity status was determined based on BMI-for-age percentiles of WHO 2007 reference population. Results: The prevalence rates of overweight, obesity, and overall overweight/ obesity among high school adolescents in Addis Ababa were 9.7% (95%CI = 6.9-12.4%), 4.2% (95%CI = 2.3-6.0%), and 13.9% (95%CI = 10.6-17.1%), respectively. Overweight/obesity prevalence was highest among female adolescents, in private schools, and in the higher wealth category. In multivariable regression model, being female [AOR(95%CI) = 5.4(2.5,12.1)], being from private school [AOR(95%CI) = 3.0(1.4,6.2)], having >3 regular meals [AOR(95%CI) = 4.0(1.3,13.0)], consumption of sweet foods [AOR(95%CI) = 5.0(2.4,10.3)] and spending >3 hours/day sitting [AOR(95%CI) = 3.5(1.7,7.2)] were found to increase overweight/ obesity risk, whereas high Total Physical Activity level [AOR(95%CI) = 0.21(0.08,0.57)] and better nutrition knowledge [AOR(95%CI) = 0.160.07,0.37)] were found protective. Conclusions: More than one in ten of the high school adolescents were affected by overweight/obesity with dietary habit and physical activity are important modifiable risk factors. Well-tailored nutrition education program targeting lifestyle change should be initiated with more emphasis to female adolescents and students in private schools.", keywords = "Adolescents, NCDs, overweight, obesity.", volume = "10", number = "4", pages = "215-7", }
