Asia Pacific J Clin Nutr (1997) 6(3): 172-174
Asia Pacific J Clin
Nutr (1997) 6(3): 172-174
of overweight and obese school children aged between 7 to 16 years
amongst the major 3 ethnic groups in Kuala Lumpur, Malaysia
K Kasmini MBBS, DPM, AM, FRC Psych, MN Idris MD, MPH,
A Fatimah Pgd Dip Diet, MSC, PhD, S Hanafiah MBBS, MPH, H Iran Sm Sa, Msc, MN Asmah Bee Sm Sa, Dip Pend, MSc
Dept of Psychiatry, Medical Faculty,
Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
6239 children aged 7 to 16 years, attending 22 primary
and secondary schools in Kuala Lumpur, Malaysia, were screened using
a self report questionnaire, with their heights and weights measured
using a digital electronic SECA beam balance. The selection was
done by a two staged stratified random sampling from a total of
226 schools in Kuala Lumpur. The racial distribution was 56.7% Malays,
33.8% Chinese and 8.1% Indians; 3.6% (n:222) of the children were
identified as obese and 6% (n:373) identified as overweight. The
definitions of obese and overweight were computed using growth charts
of the National Centre for Health Statistics (NCHS) from the median
of the reference population.
There were no significant differences amongst the
3 major ethnic groups in the obese group. The differences were significant
in the overweight group with the Indians most overweight, followed
by the Chinese and the Malays.
Keywords: Epidemiology, prevalence,
obese, overweight, school children, Kuala Lumpur, Malaysia, Malay,
Obesity in childhood has been identified as a problem
in many affluent societies, particularly in countries where children
consume unhealthy foods, snacks or beverages every day. Obesity is
usually defined as an excess of body fat which results in significant
impairment of health1. Although the health risks of obesity
in children are poorly established, obesity in childhood predisposes
the individual to obesity in adulthood2 where the health
risks of obesity are clear. The world-wide prevalence of obesity in
childhood varies from 2.6-3.6% in Finland3, to 10.8% in
United States4, 11.2-12.5% in Navajo Indian school children5,
7.56 in Indian children6, 16.1% in Singapore school children7,
14.3% in Thailand8, and about 7.8% in a local Malaysian
study of school children in a rural area9.
Sometimes, the variation in prevalence is due to varying
obesity definitions and measurement criteria. These include measurements
using the sum of various skinfolds (Canadian Standardised Test of
Fitness, CSTF, 1986), body mass index (BMI) and weight for height
considered with respect to age and gender of a reference population.
Obesity is related to age, sex, social class and cultural
background. In developed countries, obesity is more prevalent in lower
than higher income groups. Prevalence rates therefore will vary with
methodology, population characteristics and obesity definitions.
This paper reports the prevalence of overweight and
obese children amongst the three major ethnic groups in children attending
schools in Kuala Lumpur.
of obesity and overweight
In this study, the childrens standard body weight
and, in turn the median weight was calculated by dividing the actual
weight of each child by the reference weight for gender, age and height
from the National Centre for Health Statistics (NCHS)10.
The obesity population is defined as those children having weight
for gender, age and height at +2 standard deviation or above the median
weight of the reference population. Overweight children are those
children whose weight lies between +1 standard deviation to less than
+2 standard deviation of the median of the same reference population
(³ 110% and £ 120% median weight-for-height).
Of the total of 226 schools throughout the city of
Kuala Lumpur, 22 schools were selected by a two staged stratified
random sampling. In the first stage, the city of Kuala Lumpur was
stratified into specific zones and the schools were randomly selected
proportional to the number of schools in each zone. Each zone was
defined based on government districts according to their geographical
lay out and not on population size or ethnic population distribution.
All schools (primary and secondary) were selected with the exclusion
of private schools, schools for the handicapped and schools whose
student population was below 200 students.
Of the 22 schools identified, 14 were primary schools
and 8 were secondary schools. In the second stage, subjects selected
were those attending primary one to secondary three classes. The total
number of school children screened was 6239. The children were aged
between 7 years and 16 years old. The childs height and weight
was recorded by two research assistants, using an electronic SECA
beam balance which measures both height and weight digitally. Measurements
were carried out between the months of September 1994 and March 1995
with a break during the school holidays and during the Islamic fasting
Ethical approval was obtained from the Universiti
Kebangsaan Malaysia Research Committee and from the Ministry of Education,
Malaysia. Chi square test was used for statistical analysis.
Of the 6239 school children screened, aged between
7 to 16 years 48.5% (n: 3026) and 51.5% (n: 3213) were females and
males respectively. The ethnic breakdown was 56.7% (n: 3540) Malays,
33.8% (n: 2107) Chinese, 8.1% (n: 506) Indians and 1.4% (n: 86) of
The total number of overweight and obese children
combined, was 9.6% (n: 595); obese 3.5% (n: 222) and overweight 6.0%
(n: 373). The mean ages and SD of the total sample, the overweight
and the obese is as sh 1000 own in Table 1.
Table 1. Mean age and standard deviation of
0.02 (1 tailed)
Overweight versus obese: t = 1.9234 (p < 0.05 )
The prevalence of the overweight and obese children
(combined) by age, (Figure 1) was lowest at 3.3% (n: 11) for the 16
year old group and highest at 12.2% (n:102) for the 12 year old group.
Gender distribution showed that males were more obese
than females at x2 = 10.04 (p < 0.001) and more overweight
than females at x2 = 13.81 (p< 0.0005). (Table 2). The
prevalence of overweight children by age ranges from 2.4% to a 7.9%,
whilst the prevalence of obese children by age, ranges from 0.9% to
5.1%. The children gradually become overweight as they reach puberty
reaching a maximum at age 12 years, (7.9%) whilst there were more
children at age 9 years who were obese (5.1%) Figure 1.
Figure 1. Percentage distribution of the overweight
and obese children by age.
Table 2. Percentage of overweight and obese
children according to ethnic groups and sex.
Overweight: Malay males cf. Chinese males x2
= 16.14 (p < 0.0005). Malay males cf. Indian males x2
= 5.62 (p < 0.01). Indian females cf. Chinese females x2
= 499 (p < 0.05). Chinese males cf Chinese females x2
= 18.01 (p < 0.00015). Indians cf Malays x2 = 7.2 (p
< 0.01). Malays cf Chinese x2 = 3.35 (p = 0.06). Others
Ethnic distribution shows that 8.2% (n: 46) Indians
were overweight followed by Chinese 6.5% (n: 138) and Malays 5.3%
(n: 189) (Table 2) with the India 1000 ns versus Malays at x2
= 7.2 (p < 0.01). Three point eight percent (n: 21) of the Indians
were obese, followed by Malays 3.6% (n: 129) and Chinese 3.4% (n:
72) but their differences were not significant. Generally the males
were more overweight and obese than females at all ages (7-16 years)
except at age 7 years; female children were more overweight at x2
= 3.6 (p = 0.05).
The Chinese males were not found to be significantly
more overweight, 8.9% (n: 92), than Indian males, 8.5% (n: 27). However
there was a significant difference between overweight Chinese males
and overweight Malay males at x2 = 16.14 (p < 0.0005).
There was no significant difference between the three ethnic groups
amongst the obese males.
Amongst the females, 7.9% of the Indian females were
overweight followed by Malays 5.6% and Chinese 4.2%; with the Indian
females versus Chinese females at x2 = 4.99 (p<0.05).
Amongst obese females, 3.2% of the Chinese females were found to be
obese, and just as with the obese males, there were no statistical
differences between the 3 races for the obese females.
With regard to the gender differences by ethnic group,
the only significant difference was amongst the Chinese; the Chinese
males were more overweight than the Chinese females at x2
= 18.01 (p < 0.0001).
The prevalence of the obese and overweight school
children in Kuala Lumpur was 3.5% and 6.0% respectively, using NCHS
median reference data and +2 and +1 SDs respectively for cut-off.
This is much lower than the Singapore prevalence rates of child obesity
which range from 12.8% to 16.7% for Primary one to Secondary four7.
The age range of school children studied was comparable. Even when
the prevalences of the obese and overweight were combined, the overall
overweight prevalence rate, ranging from 3.3% to 12.2%, was still
comparatively lower than the 1993 Singapore report for ages 7 to 16
years, but similar to the 1991 study in Singapore11.
However, male school children were found to be more
obese and overweight than females with a similar ratio of male: female
in Singapore (9:7) and Malaysia (10:7).
With regard to age distribution, most children were
found to be overweight and obese around the pubertal period, between
11 to 14 years. The obese children showed a similar distribution.
The peak at puberty can be explained by the fact that there is an
associated increase in adipose tissue as well as in the childrens
overall body weight during puberty.
The percentages of overweight and the obese children
were found to be less after puberty (Figure l) and this may be a cohort
effect. However, it may be physiological for most children as they
enter the post pubertal age. The other possibility is whether children
become weight conscious post pubertal and therefore diet. This raises
questions about weight reduction in school children unless prepubertal.
A longitudinal study is required to see whether overfat
children have obesity and weight problems in adulthood. Previous works
show that the number of fat cells multiplies during periods of rapid
growth up to about 16 years of age12, after which increased
fat ordinarily accumulates by increasing the size of cells already
present. This, or other mechanisms, might provide a biological explanation
for a linkage between adolescent and adult obesity.
Looking at ethnic group, there were more overweight
children amongst the Indians, followed by the Chinese and Malays.
For gender, Indian males were more obese, Chinese males more overweight,
Chinese females more obese and Indian females mor 1000 e overweight.
Significant differences in overweight prevalence rates werefound between
the 3 ethnic groups. Obesity was equally prevalent in all 3 major
ethnic groups, irrespective of gender. The difference prevalences
for the overweight group could be due to nutritional or activity pattern
differences between each ethnic group. Indians are known for the high
fat content of their foods, whilst the Chinese consume much more carbohydrate
and oils, and food is eaten more frequently than for the other ethnic
groups. This could be related to the greater acceptance of over-eating
in the Chinese family where the children are brought up to show filial
love by eating more in front of their parents and where obesity and
overweight are signs of wealth and success13,14, since
even the Chinese gods of luck and wealth are almost always depicted
ConclusionAlthough the prevalences of both overweight and obesity amongst school
children in this study were found to be less than 10%, it constitutes
an emergent problem. A longitudinal study of Malaysian school children
in 5 and 10 years will establish secular trends for body fatness in
an urban setting amongst the 3 major ethnic groups.
Acknowledgements. We would like to thank Universiti Kebangsaan Malaysia for their
support through the IRPA grant 03-07-03-099 for making this study
possible. Also to all the research assistants for their painstaking
- Burton, BT, WR Foster, J Hirsch, TB Van Hallie.
Health implications of obesity. An NIH consensus development conference.
Int J Obesity 1985; 9: 155-169.
- Brownell KD, F Kaye. A school based behaviour modification,
nutrition education, and physical activity program for obese children.
Am J Clin Nutr 1982; 35: 277-283.
- Nuutinen EM, Turtinen J, Pokka T, et al. obesity
in children, adolescents and young adults. Annuals Med, 1991; 23(1):
- Tiwary CM, Holguin AH. Prevalence of obesity among
children of military dependants at two major medical centres. Am.
J. Public Health, 1992; 82(3):354 - 7.
- Sugarman JR, white LL, Gilbert TJ. Evidence for
a secular change in obesity, height and weight among Navajo Indian
school children. Am J Clin Nutr 1990; 52(6): 960-6.
- Gupta AK, Ahmad AJ. Childhood obesity and hypertension,
Indian Pediatr. 1990;27 (4):333-7.
- Annual Report. School Health Service. Primary Health
Division. Ministry of Health Singapore, 1993.
- Suttapreyasri D, Suthontan N, Kanpoem J, Krainam,
Boonsuya C. Weight control training methods for obese pupils in
Bangkok. J of Med Assoc. Thai 1990; 73(7) 394-400.
- Chia. A, J. Safurah. Obesity rate among year 1
and year 6 school children in Selangor Darul Ehsan (unpublished)
Ministry of Health. Malaysia, 1991.
- United States Public Health service, Health Resources
Administration NCHS growth charts, Rockville, MD 1976, (HRA 76-1120,
- Ho TF, Yip WCL, Tay JSH, Rajan U. Social class
distribution of obese Chinese children. J Singapore Paediatr Soc
1991; 33: 55-58
- Hirsch J.Cell number and size as a determinant
of subsequent obesity.In M.Winick (ed), Childhood obesity. New York:
John 5fd Wiley and Sons, 1975.
- Lee S. Anorexia Nervosa in Hong Kong: A Chinese
perspective. Psych. Med. 1991; 21:703 -711.
- Lee S, Chin HFK, Chen C. Anorexia Nervosa in Hong
Kong; why not more in Chinese. B J Psych 1989; 154; 683-688.
Prevalence of overweight and obese
school children aged between 7 to 16 years amongst the major 3 ethnic
groups in Kuala Lumpur, Malaysia
K Kasmini, MN Idris, A Fatimah, S Hanafiah, H Iran, MN Asmah Bee
Asia Pacific Journal of Clinical Nutrition (1997) Volume 6, Number
Copyright © 1997 [Asia Pacific Journal of Clinical
Nutrition]. All rights reserved.
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