The epidemic of obesity in developed countries is commonly associated with poor dietary habit and sedentary lifestyle. However, other determinants, including education background and family income, may contribute towards the problem especially in developing countries. This study aimed to determine the influence of socioeconomic status (SES) on obesity among 12-year-old school adolescents in Terengganu, Malaysia. Body weight and height were measured and BMI was categorised based on WHO z-score cut-off points. Information was obtained from self-reported questionnaire on parents’ education background, family income and occupation. A total of 3,798 school adolescents aged 12 years (44% boys and 56% girls) were recruited. There was no significant difference in BMI status between boys and girls, or between rural and urban participants. There were significant differences between BMI categories and gender, household income and SES level within rural areas. In the urban areas, significant differences were found between BMI categories and gender, parents’ occupational and educational level, household income and size, and SES level. A logistic regression model found several SES factors to be predictors of obesity in this population, namely, gender, household size, father’s occupation level, household income level and SES level. Each component of SES has been significantly associated with the BMI category of school adolescents, particularly in the urban areas. This suggests the requirement of multifaceted approaches, including the role of family, society and authorities, in the effort to curtail adolescent obesity.

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Background Childhood obesity has been associated with increased odds of adult obesity and co-morbidities in later life. Finding the key determinants may help in designing the most appropriate and effective interventions to prevent obesity. This study aimed to identify the determinants of obesity among school adolescents in a sub-urban state of Malaysia. Methods This cross-sectional study involved 1,404 school adolescents aged 12 years (46% boys and 54% girls). Socio-demographic, dietary and physical activity data were collected using questionnaires whilst body weight and height were measured and body mass index was classified based on WHO BMI-for-age Z-scores cut-off. Results A multivariable linear regression model showed that BMI z-score was positively associated with parents’ BMI (P<0.001), birth weight (P=0.003), and serving size of milk and dairy products (P=0.036) whilst inversely associated with household size (P=0.022). Overall, 13.1% of the variances in BMI Z-scores were explained by parents’ BMI, birth weight, servings of milk and dairy products and household size. Conclusion This study found important determinants of body weight status among adolescents mainly associated with family and home environmental factor. This evidence could help to form the effective and tailored strategies at the earliest stage to prevent obesity in this population.

BackgroundBody weight is highly associated with overall health status. Being severely thin or obese may impose the risk of many health problems. Early detection of body mass index (BMI) status may help to reduce the associated comorbidities. Although many studies in the literature have investigated the BMI of school adolescents in Malaysia, the data on status of body weight among school adolescents in suburban states like Terengganu is limited. This study aimed to describe the body weight status of the whole population of school adolescents in all seven districts in Terengganu, Malaysia.MethodsUsing a cross-sectional study design, body weight and height were measured, and BMI was calculated and classified using WHO BMI-for-age Z-score. Data was obtained using the National Fitness Standard (SEGAK) assessment, which was uploaded in a specific Health Monitoring System (HEMS).ResultsFrom a total of 62,567 school adolescents, 50.7% were boys and 49.3% were girls. Girls had significantly higher BMI than boys in age groups of 13 to 15 and 16 to 17 years old. Among boys and girls, there were significant differences in mean BMI of school adolescents between rural and urban school locations in all age groups (p < 0.001). There were also significant differences in BMI between boys and girls in all districts in Terengganu, except Kemaman and Kuala Terengganu, for all age groups (p < 0.001). Overall, the prevalence of thinness, normal, overweight and obesity were 8.4, 64.6, 15.0 and 12.0%, respectively. There were significant differences between BMI categories and genders in total participants, and within rural and urban school locations (p < 0.05). In all districts except Marang and Dungun, significant difference was also found between BMI categories and genders.ConclusionThe prevalence of thinness, overweight and obesity in Terengganu were substantial. In this study, BMI category was associated with gender, age, school location and district. However, the actual effects of these factors on the prevalence of thinness and obesity among this population demand further investigation.

Obesity among schoolchildren has been regarded as one of the most serious public health challenges in this decade. This problem has now become more evident in the developing countries including Malaysia. It is linked with numerous risk factors mainly unhealthy lifestyle (1) . Despite many surveys that have been conducted globally, the latest data on its determinants among Malaysian schoolchildren, particularly in sub-urban state like Terengganu, is limited. Therefore, this study aimed to provide the current analysis on obesity determinants including demographic, socioeconomic status, dietary intake, physical activity, and physical fitness level and its relationship with childhood obesity. Using a cross-sectional study design, a total of 1,404 schoolchildren were involved in the study (46·3 % boys and 53·7 % girls; 67·7 % urban and 32·3 % rural). Data on demographic and socioeconomic were gathered using a selfadministered questionnaire. Height and body weight were measured and BMI-for-age Z-score was calculated using WHO AnthroPlus software and compared with WHO BMI-for-age Z-score classifications (2007) (2) . Dietary intake and physical activity level were measured using FFQ and c-PAQ, respectively, whereas physical fitness level was assessed using SEGAK test, a standardised fitness norm test for Malaysian students. All data were analysed using multivariable analysis.Interestingly in the final model, obesity in both genders was found to be positively associated with parental obesity, birth weight and serving of milk and dairy products intake whilst negatively associated with household size. Schoolchildren of father or mother with one unit higher in BMI, will have 0·073 unit or 0·069 unit higher in BMI Z-score, respectively (P < 0·001). Schoolchildren who were 1 kg heavier at birth will have 0·357 unit higher in BMI Z-score (P = 0·003). Similarly, an increase in one serving size of milk and dairy products intake will increase BMI Z-score by 0·194 unit (P = 0·036). Nevertheless, schoolchildren with one extra household family member will have 0·085 unit lower in BMI Z-score (P = 0·022). Overall, 13·1 % of the variation in BMI Z-score was explained by father's BMI, mother's BMI, birth weight, household number, and serving size milk and dairy products according to the multiple linear regression (MLR) model (R 2 = 0·131).This new finding suggests the requirement of multifaceted and community-wide programs and policies including parental important roles in obesity preventive strategies and interventions. Therapeutic lifestyle changes specifically in eating behaviour, through parental ingenuity and social support, remain the most important approaches in managing childhood obesity.This study was funded by the Malaysian Ministry of Higher Education.