Endocrine Care

PREVALENCE OF OBESITY AND OVERWEIGHT AMONG

SCHOOL CHILDREN IN CLUJ-NAPOCA

C. Valean, S. Tatar, M. Nanulescu, A. Leucuta, G. Ichim

Pediatric Chair (3rd Pediatric Clinic) of „Iuliu Haþieganu” University of Medicine and
Pharmacy, Cluj-Napoca, Romania
Abstract
Background. A rising trend in obesity among children has been observed in recent years
in most countries. The majority of obese children will become obese adults having an increased
risk for chronic diseases associated with obesity, with a negative impact on their lifespan.
Objective. Assesing the obesity prevalence among school children in Cluj-Napoca.
Methods. The study included 7904 school children of all grades (grade 1 to grade 12) from
20 schools in Cluj-Napoca. The weight, height and body mass index (BMI) were recorded for
each child. Using the BMI percentile, they were classified as: normal (BMI < 85th percentile),
overweight (BMI between 85th and 95th percentile) or obese (BMI > 95th percentile). BMI average
and standard deviation have been calculated per age groups and sex.
Results. 8.29% of school children in Cluj-Napoca are obese, while 12.84% of them are
overweight. The difference between sex groups is statistically significant with boys more likely to
be obese or overweight than girls (p<0.0001). The highest prevalence has been observed among
the 6-10 years age group, while teenagers have recorded the lowest prevalence figures.
Conclusion. Data derived from this study would place Romania among the countries
with an average prevalence of obesity. However, extending such studies at national level
would provide more accurate data about obesity prevalence in Romania.

Key words: obesity, children, prevalence.

INTRODUCTION

Obesity is an important health problem for adults and children alike. Recent studies
have highlighted an increasing obesity prevalence in children (1-3), associated with a
high risk of chronic diseases associated with obesity and even an increased mortality.
The high prevalence of obesity in children is related to lifestyle and eating
changes introduced by modern society: technology advancements (TV, computer,
video games) which encourage a sedentary lifestyle or food rich in saturated fats
and cholesterol which negatively impacts child’s metabolism.
*Correspondence to: Simona Tatar, MD PhD, 3rd Pediatric Clinic of „Iuliu Haþieganu” University of
Medicine and Pharmacy, Campeni, No 2-4, 400217 Cluj-Napoca, Romania,
email: simonatatar@gmail.com, telephone:+40-729958052, fax: +40264-590492
Acta Endocrinologica (Buc), vol. V, no. 2, p. 213 - 219, 2009

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Obesity treatment is difficult. Most treatment strategies are based on diet and
exercise, but they are hard to monitor and not very effective. Therefore, currently the
emphasis falls on obesity prevention, particularly by promoting a healthy lifestyle.
The present study attempts to evaluate the prevalence of obesity in school-age
children from Cluj-Napoca.

METHODS

The study included 7904 children of grades 1 to 12, from 20 schools in Cluj-
Napoca. The study was approved by the local Ethical Committee and the informed
consent was obtained from all parents.
Allocation by age and sex groups is shown in Table 1.
The weight and height have been measured and then the body mass index
(BMI) calculated for each child. The body mass index is obtained through division
of weight by square height. BMI was calculated using the BMI Percentile Calculator
for Child and Teen available at http://apps.nccd.cdc.gov/dnpabmi/ and then compared
against the BMI-for-age charts available at http://www.cdc.gov/nchs/about/major/nhanes
/growthcharts/clinical_charts.htm.
Based on their calculated BMI, each child has been included in one of the following
categories: normal (BMI under 85th percentile), overweight (BMI between 85th and 95th
percentile) and obesity (over the 95th percentile).
The statistical analysis was performed. All results were expressed as means
(standard deviation) and proportions. An unpaired Student’s t test was used to
compare boys with girls; differences in the prevalence of overweight and obesity
between different age groups of children were assessed by χ2 test. A probability
level of p < 0.05 was used to indicate statistical significance.
MedCalc, 8.1.1.0 version for Windows package for personal computers was used
for all statistical analyses.
Table 1. Demographic and antropometric profile.
Age Sex
male female
6-10 years (grade 1 to 4) 2688 1333 1355
10-14 years (grade 5 to 8) 2568 1306 1262
over 14 years (grade 9 to 12) 2648 1249 1399
total 7904 3888 (49.2%) 4016 (50.8%)

RESULTS

Obesity and overweight prevalence have been evaluated overall and per age
and sex groups. The overall results appear in Figure 1 and Table 2.
According to data analysis, the global prevalence is 8.29% for obesity and 12.84%

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Table 2. Obesity prevalence according to sex.

overweight obesity
totally 8.29% 12.84%
male 419 (10.77%) 553 (14.22%)
female 237 (5.9%) p<0.0001 462 (11.51%) p=0.0001

for overweight. Distribution of the prevalence according to sex and age is highlighted in
Table 3. Analysing prevalence on age sub-groups, the highest prevalence was found
within the 7 to 10 years old group: 13.31% for obesity and 15.99% for overweight.
Within total population as well as within each age group, males registered a higher
prevalence of obesity than females (P < 0.0001). The lowest prevalence for both obesity
and overweight was found in the over 14 years old group.

Figure 1. BMI percentiles of the children studied

Table 3. Prevalence of obesity and overweight according to age and sex.

overweight obesity
6-10 years 15.99% 13.31%
(grade 1 to 4)
F=15.12% F=9.81%
M=16.8% p=0.1025 M=16.87% p<0.0001

10-14 years 14.87% 7.67%

(grade 5 to 8)
F=14.1% F=6.18%
M=15.62% p=0.0699 M=9.11% p=0.0001

over 14 years 7.66% 3.81%

(grade 9 to 12)
F=5.63% F=1.85%
M=9.92% p<0.0001 M=6% p<0.0001

DISCUSSION

Overweight and obesity in childhood has significant implications on mental and

physical health. Prevalence of obesity among children and teenagers is increasing around
the world. Studies on the natural history of obesity had shown that 80-85% of obese

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children would become obese adults (4, 5). World wide there are many health
organizations coordinating studies to detect the prevalence of obesity among children and
trying to elaborate early education programs for obesity prevention.
Although there is insufficient data about obesity prevalence in Romania and is
difficult to compare it with prevalence in other regions or with previous data, this study
is useful for evaluating nutritional status of children in Cluj-Napoca and also underlines
the importance of conducting similar studies in other regions of our country.
The purpose of the present study was to evaluate prevalence of obesity among
school children in Cluj-Napoca. According to the results of the Study for Evaluation
of Health and Nutrition State in USA performed by the National Center for Health
Services (NCHS), it is recommended to use the Body Mass Index (BMI) for
defining the normal weight, the overweight and obesity in children, irrespective of
the age of the child (6). BMI is a standard criterion for diagnosing obesity in adults.
The BMI value is also correlated to the size of the adipose tissue in children and
adolescents. As opposed to adults, for children, the calculated value of BMI (weight
divided to squared height) is compared against age, sex, weight and height
percentiles (7, 8) and falls in one of the following categories: normal weight (BMI
under 85th percentile), overweight or at risk for obesity (between 85th and 95th
percentile) and obesity (over 95th percentile) (9). Our study has used the same
criteria for defining obesity, as BMI over 95th percentile and overweight between
85th and 95th percentile. Reporting in literature is different, some studies report the
obesity including the overweight, so that the resulting values are higher.
The results of this study place Romania among the countries with an average
prevalence of obesity. If compared according to International Obesity Task Force
(10), which includes obesity in overweight as the BMI over 85th percentile, the
prevalence would be of 21.13%.
In Europe, data collected from 25 European countries highlights an average
prevalence of 16-22% for overweight and 4-6% for obesity (10). In Southern
Europe prevalence is higher, because of the Mediterranean diet, rich in fats, sugar
and salt. The Mediterranean overweight prevalence reaches 30%(11). In France,
Switzerland, Hungary, Germany percentages are between 10 and 20% (10).
The statistical data from the United States highlights a growing prevalence obesity
in children in recent years. Comparing data from 1976-1980 and 2003-2004 there is a
significant increase in prevalence of overweight in each age group: from 5% to 13.9%
among 2-5 years children, from 6.5% to 18.8% among 6-11 years old and from 5% to
17.4% among teenagers (12-19 years) (12). In three decades in the United States the
number of obese children had tripled for all age groups. About 1 of 4 children are either
overweight or at risk of becoming overweight (3).
Similar to what has happened in the United States, the obesity prevalence in Europe
showed an ascendant trend, in particular over the last years: from an annual increase in
obesity prevalence of 0.2% in 1970 to 2% in 2000 (10). France also recorded an increase
in prevalence of overweight from 10% to 16% during 1992-2000, while Great Britain
moved from a 8% to a 20% prevalence of overweight during 1984-1998 (13). The results

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of a British study show insignificant prevalence changes between 1974 and 1984, but an
increase in obesity prevalence from 5.4% to 9% in boys and from 9.3% to 13.5% in girls
between 1984 and 1994 (14).
In Canada, prevalence of overweight increased between 1981 and 1996 from 15%
to 28.8% for boys and from 15% to 23.6% for girls (15). In Australia, assessing the trend
of obesity prevalence in 7-15 years old children between 1969 and 1997 showed a 2 to 4
times increase in prevalence among both sexes (16).
Unfortunately, in Romania there is insufficient data on prevalence of obesity among
children and adolescents. A clinical trial conducted in the 80-ies in the Western part of
the country, which included 5250 children with ages between 3 months and 16 years, has
revealed an obesity prevalence of 18.62% among infants, 15.05% among preschool
children and 14.20% among school children. The method used in this study for
classifying children as obese or not was skinfold measurement (17).
A recent study (2008) on 394 children initiated by Danone measuring inputs of
macro-and micro-nutrients in preschool children (MAMM) aimed at recording food
inputs for 7 consecutive days, in children of 3-6 years 54% of children have been found
to have a hyper-caloric intake.
The results from our study found the obesity prevalence in boys greater than the
values for girls. Many other studies have revealed higher prevalence figures for females
(10, 18), explained through the lack of physical activity in girls compared with boys (19).
However, a 2007 study (11) evaluating nutritional status for children in 11 European
countries, showed a much higher prevalence of obesity and overweight among the males
in each of the participating countries (Figs. 2 and 3).

Figure 2 Overweight prevalence in children in Europe

Figure 3 Obesity prevalence in children in Europe

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The higher obesity prevalence among youngsters evidenced in our study is also
reported in other studies (18), i.e. an increase in obesity prevalence between the age of 4
and 10 years, in particular for female sex. An American study conducted in 2004 (20),
also highlights a higher prevalence of obesity and overweight among children in the
fourth grade (22.4%) compared with those of larger classes.
One possible explanation points to recent changes in eating behaviour (increased
intake of fats and sweets) and lifestyle (lack of exercise), which are having a negative
impact on child’s weight.
Data derived from this study bring important information on the prevalence of
obesity in children in Romania. The study has only assessed the nutrition status of school
children in Cluj-Napoca, therefore the data cannot be extrapolated for the whole country.
But this study may represent a starting point in the development of more complex
programs, which will determine the prevalence values at national level.
Data reporting from several regions would enable not only an assessment of
obesity prevalence at national level and comparisons with other countries, but
would also recognise the importance of tackling the obesity increasing trend among
children in Romania.
In conclusion, obesity prevalence among school children in Cluj-Napoca city
is 8.29% and overweight prevalence is of 12.84% placing Romania as one of the
countries with an average prevalence of obesity, being significantly greater in males
than of females for both overweight and obesity. The highest prevalence is among the
6-10 years group, and the lowest prevalence among teenagers.
It is recommended to extend this research in Romania to evaluate the obesity
prevalence among children and to establish early prevention programs based on a
healthy lifestyle, encouraging physical activity and a balanced diet.

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