Multilevel Analysis: Factors Associated with Overweight and Obesity in Primary School Children in Surakarta, Central Java
Background: Life course studies have shown that early onset obesity is a risk factor for morbidity and mortality later in life. In both sexes, rates of diabetes, coronary heart disease, atherosclerosis, hip fracture, and gout were increased in those who were overweight as adolescents. Contextual factor at higher level such as school may have indirect effect on the incidence of overweight or obesity through eating behavior. However, studies into factors affecting child obesity in Indonesia using multilevel approach are lacking. This study aimed to examine factors associated with overweight and obesity in primary school children in Surakarta, Central Java, using multilevel analysis.
Subjects and Method: A case control study was conducted at 25 primary schools in Surakarta, Central Java, from March to April 2018. A sample of 225 primary school children was selected by fixed disease sampling, consisting of 75 children with overweight or obesity and 150 children with normal weight. The variables of children were placed at the first level of the multilevel model. The potential contextual effect of school was determined at the second level. The dependent variable was overweight or obesity. The independent variables were maternal education, maternal body mass index (BMI), physical activity, family income, and school environment. The data were collected by questionnaire and analyzed by a multilevel logistic regression run on Stata 13.
Results: Child overweight or obesity was positively associated with maternal BMI ?25 (b= 0.11; 95% CI= 0.04 to 0.18; p= 0.002) and high family income (b= 0.04; 95% CI= 0.02 to 0.06; p< 0.001). Child overweight or obesity was negatively associated with high physical activity (b= -0.03; 95% CI= -0.05 to -0.01; p= 0.009). School environment had a negligible contextual effect on child obesity with ICC= 5.08%.
Conclusion: Child obesity is positively associated with maternal BMI ?25 and family income, and is negatively associated with physical activity. School environment has a negligible contextual effect on child obesity.
Keywords: obesity, primary school children, maternal body mass index, physical activity
Burrows T, Skinner J, Joyner MA, Palmieri J, Vaughan K, Gearhardt AN (2007). Food Addiction in Children: Association withthe Obesity, Parental F ood Addition and Feeding Practices, Eating Behavior, 26: 114-120.
Fu WPC, Lee HC, Ng CJ, Tay YKD, Kau CY, Seow CJ, Siak JK, Hong CY (2003). Screening for Chilhood Obesity: International vs PopulationSpecific Definitions. Which is More Appropriate?. International Journal of Obesity, 27(9): 1121-1126.
Galjaard S, Pasman SA, Ameye L, Timmerman D, Devlieger R. IntimaMedia Tickness Measurements in the Fetus and Mother During Pregnancy: A Feasibility Study. Ultrasound in Medicine & Biology. 1-9.
Gunter KB, Nader PA and John DH. (2015).Physical Activity Levels and Obesity Status of Oregon Rural Elementary School Children. Preventive Medicine Reports, 2: 478
Hasdianah (2012). Diabetes Melitus pada Orang Dewasa dan Anak-Anak Dengan Solusi Herbal. Yogyakarta: Nuha Medika.
Isacco L, Roche J, Quinart S, Thivel D, Gillet V, Negre V and Mougin F (2017) Cardiometabolic Risk is Associated with the Severity of Sleep Disordered Breathing in Children with Obesity. Physiology and Behavior, 10. Centers for Disease Control and Prevention.
Kementerian Kesehatan RI (2015). Profil Kesehatan Indonesia 2015. Jakarta: Pusat Data dan Informasi Kementerian Kesehatan RI 2015.
Knapp MB, Hall MT, Mundorf AR, Partridge KL, Johnson CC (2018). Perceptions of School Based Kitchen Garden Programs in Low Income, African American Communities. Health Promotion Practice, 20(10):1.
Koirala M, Khatri RB, Khanal V, Amatya A (2015). Prevalence and Factors Associated with Childhood Overweight /Obesity of Private School Children inNepal. Obesity Research & Clinical Practice, (9): 220-227.
Lee GY, Choi YJ (2016). Effects of an Obesity Management Mentoring Program Children. Applied Nursing Research, 31: 160-164.
Liu W, Liu W, Rong L, Li B, Pallan M, Cheng K, Adab P (2016). Socioeconomic Determinans of Chilhood Obesity Among Primary School Children in Ghoangzhou, China. BMC Public Health, 16:482.
Macieira LMDM, Saraiva JMT, Santos LDC (2017). Overweight and Obesity and Their Associated Factor among Early Adolescence School Children in Urban and Rural Portugal. BMC Nutrion, 3-17.
Murti B (2013). Desain dan Ukuran Sampel untuk Penelitian Kuantitatif dan Kualitatif di Bidang Kesehatan. Yogyakarta: Gajah Mada University Press.
Murti B (2016b). Prinsif dan Metode Riset Epidemiologi. Cetakan pertama. Program Pascasarjana IKM Universitas Sebelas Maret. Surakarta: Yuma Pustaka.
Navalpotro L, Regidor E, Ortega P, Martinez D, Villanueva R, Astasio P (2012). Area Based Socioeconomic Environment, Obesity Risk Behaviors, Area Facilities and Childhood Overweight and Obesity. Socio-environment and Childhood Overweight. Preventive Medicin, 55(2): 102-107.
Nevil AM, Duncan MJ, Lahart IM, Sandercock G (2017). Cardiorespiratory Fitness and Activity Explains the ObesityDeprivation Relationship in Children. Health Promotion International.
Scott A, Ejikeme CS, Clottey EN, Thomas JG (2013). Obesity in Sub-Sahara Africa: Development of an Ecological Theoretical Framework. Health Promotion International, 28(1): 4-16.
Supariasa IDN, Bakri B, Fajar I (2016). Penilaian Status Gizi Edisi 2. Jakarta: EGC.
Undang-Undang Republik Indonesia No. 20 Tahun 2003. Tentang Sistem Pendidikan Nasional.
World Health Organization (2014). Report of the First Meeting of the Ad hoc Working Group on Science and Evidence for Ending Childhood Obesity. Geneva, Switzerland:World Health Organization.
World Health Organization.(2015). Fiscal Policies for Diet and The Prevention of Noncommunicable Disease
World Health Organization. (2016).Word Health Statistics 2016 monitoring health for the SDGs. Geneva: word health statistics.
Whitfield M, Bhanbhro S, Green G, Lewis K, Hindle L, Levy C (2016). Development a Framework for Estimating the Potential Impact of Obesity Intervention in A European City. Health Promotion International, 31(3): 684-691.
Yanuar EA (2011). Diet Sehat dan Aman Untuk Anak-Anak. Yogyakarta: Rapha Publishing.