|ORIGINAL RESEARCH REPORT
|Year : 2016 | Volume
| Issue : 3 | Page : 117-121
Stakeholders views on why child overweight and obesity is rising in Lagos, Nigeria: A qualitative study
Adeteju A Adedini, Bolajoko A Aina, Uche P Ogbo
Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Idi Araba, Lagos, Nigeria
|Date of Web Publication||4-Jul-2016|
Adeteju A Adedini
Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Idi Araba, Lagos
Source of Support: None, Conflict of Interest: None
Background and Objective: According to the World Health Organization, the number of obese children would increase to 70 million by 2025 if no intervention is made. An increase in the prevalence of overweight and obesity among school children in Lagos State, Nigeria has been established, but specific factors promoting its prevalence are unknown. The aim of this study was to elicit the views of stakeholders on the perceived causes for the rise in child overweight and obesity. Methods: Five focus group discussions were conducted with different groups of stakeholders involved in child care, namely: Parents, teachers, and healthcare givers. Participants were recruited using a purposive sampling method; a structured question guide was employed for the discussion sessions. The discussions were recorded, collated, and analyzed using grounded theory to extract themes. Results: Six themes emerged as factors responsible for the rise, of which civilization and lifestyle imbalance of the populace emerged as the prominent cause. Of the fifty respondents, 76% of respondents identified parents (particularly young mothers) as major contributors to the prevalence of overweight and obesity in children of Lagos State; and 52.3% of the participants reported that a direct relationship exists between income class of parent and weight of a child resident in Lagos. Conclusion: Civilization and lifestyle imbalance, insecurity and congestion, low level of public awareness, inadequate educative and enlightenment programs, myths and societal perception were factors identified to responsible for the rise in the prevalence of child obesity in Lagos, Nigeria. Preventive strategies to control the prevalence of overweight and obesity in children residing in Lagos State should be considered for further studies.
Keywords: Children, Lagos, obesity, overweight, stakeholders
|How to cite this article:|
Adedini AA, Aina BA, Ogbo UP. Stakeholders views on why child overweight and obesity is rising in Lagos, Nigeria: A qualitative study. J Clin Sci 2016;13:117-21
|How to cite this URL:|
Adedini AA, Aina BA, Ogbo UP. Stakeholders views on why child overweight and obesity is rising in Lagos, Nigeria: A qualitative study. J Clin Sci [serial online] 2016 [cited 2019 May 24];13:117-21. Available from: http://www.jcsjournal.org/text.asp?2016/13/3/117/185248
| Introduction|| |
Obesity, which is defined as a condition where a pathological excess of body fat is present in an individual is gradually becoming a social problem with damaging health implications.  It is one of the most complex and poorly understood clinical syndromes that affect children and adults all over the world.  Globally, child obesity is on the rise  and evidence from the United States suggests that this upward trend has continued into the 21 st century.  By 2025, it is expected that the number of obese children would have increased from 10 million to 70 million if no intervention is made.  Various studies have shown evidence that moderate number of obese children will grow up as obese adults with related adverse health consequences such as heart disease, hyperlipidemia, hyperinsulinemia, hypercholesterolemia, Type 2 diabetes, and even increased mortality in adulthood. ,,, In developing countries, where undernutrition, kwashiorkor, and marasmus are still taking a toll on the population including children, not much attention has been given to obesity and overweight. Data have however shown that there is a double burden of disease in developing countries consisting of diseases of the poor as well as diseases of the affluent.  With reference to malnutrition, in particular, a double burden of under nutrition and over nutrition is being documented. However, awareness has remained very low as many cultural and ethnic beliefs, as well as widespread ignorance contribute to rising incidence of obesity in the developing countries. The incidence of obesity is not only rising among adults in developing countries but also among children. 
In 2009, a study on the prevalence of obesity among Nigerian nurses stated that there are no data to back up the prevalence of overweight and obesity among members of the entire population  however, a prevalence of 18% among school-age children was reported in 2011.  In addition, Ben-Bassey et al.,  reported an 3.7% prevalence rate of overweight and obesity among school children living in Lagos State while a study conducted in 2014  on the prevalence rate of overweight and obesity among school children residing on the island of Lagos State was 46% of which 26% of the study population was obese.
The objective of this study was to elicit stakeholders' views on why child overweight and obesity is rising in Lagos, Nigeria.
| Methods|| |
The study was a qualitative study using focus group discussion approach. A sample size of fifty stakeholders (consisting of parents, teachers, and healthcare providers) was recruited using purposive sampling technique, and a total of five focus group discussion sessions were conducted between November 2014 and January 2015. Each participant was informed about the objective of the study and their right to decline or accept participation. Written informed consent was obtained at the beginning of each session.
A structured question guide was designed and used for all the sessions. Each group session began with broad, open-ended questions followed by queries that were more specific. This allowed matters of significance to the participants emerge naturally before questions of specific interest to the researcher were addressed. Each focus group interview lasted about 45 min. The discussions were recorded; collated and analyzed using grounded theory.
Approval for the conducting the research was obtained from the Ethics Committee of College of Medicine, the University of Lagos through the Postgraduate Research Committee of the Faculty of Pharmacy, University of Lagos.
| Results|| |
A total of fifty stakeholders were recruited for the study. Among the participants 54% were females while 46% were males. Stakeholders recruited include: Parents (40%), teachers (40%), and healthcare providers (20%) [Table 1].
Five themes were identified as factors responsible for the increase in the prevalence of child overweight and obesity in Lagos, Nigeria [Table 2],[Table 2] and [Table 3].
|Table 2: Factors responsible for the rise in child overweight and obesity in Lagos|
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|Table 3: Roles of stakeholders that support overweight and obesity in children|
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Among the participants, 56% stated that there is a direct relationship between parent's income status and the tendency of raising an overweight or obese child while 44% identified that no relationship exist between parent's income status and child obesity [Table 4].
|Table 4: Relationship between income status of parents and child obesity|
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| Discussion|| |
In identifying factor (s) responsible for obesity in children, the majority of the participants reported five common factors which are peculiar to Lagos. These are civilization and lifestyle imbalance; insecurity and congestion of the state, ignorance of the populace, inadequate educative and enlightenment programs in schools and myths and societal perception.
The level of civilization and lifestyle imbalance of young mothers in Lagos State was reported to be a key factor responsible for the prevalence of child obesity. Busy work schedules of parents (particularly young mothers) who work in Lagos result in less time to care for their children and monitor their feeding pattern leading to the adoption of westernized culture and promotion of preference for processed and fast food meals. This is similar to a study that has shown that children and adolescents who consume fast foods frequently have high energy intakes and poor diet quality, compared with those who do not.  Furthermore, the "fast-track" lifestyle practiced in Lagos, heavy traffic on roads, and the high level of stress imposed on residents of the state were identified to promote the adoption of westernized culture.
High level of insecurity and congestion were identified as a contributing factor promoting physical inactivity in Lagos. Majority of participants (70%) stated that children are forced to play indoor because of the increased rate of kidnapping, few playgrounds in schools, and frequent occurrence of road accidents. It was argued that the listed reasons justify why many parents prefer to buy video games, cartoon CDs for children to watch rather than playing outdoors. This is in support of the results indicated by Vandewater et al. in 2004  on the link between obesity and activity level with children's television and video game use.
In 1993, Mo-Suwan et al. spotted ignorance of populace as a contributing factor to child obesity in Thailand. Participants (85%) in this study confirmed that many parents (learned and unlearned) are not aware of the calorie contents of food products given to their wards. It was reported that high energy-dense drinks (such as Coca-Cola), large portion sizes of meals, and sugary snacks are served on a daily basis in an attempt to display love and affection. Furthermore, inadequate education and facts disseminated by schools and healthcare system in Nigeria on the causes, prevention and treatment strategies to curb prevalence was identified as a challenge in childhood obesity. Participants reported that no public advertisement is on-going to caution parents on the prevalence of overweight among schoolchildren, and many schools are not advocates of healthy nutrition. In some discussion sessions, participants reported limited concise information is available on the importance of daily consumption of fruits and vegetables by children. 
The cultural belief of the African man regarding children who are overweight and obese was the fifth prominent factor identified by participants. It was accentuated that an average African woman prefers to have an overweight child as against a normal weight child. This was linked to the wrong societal perception of overweight and obesity. In Nigeria, overweight and obesity in children is perceived as a reflection of the affluence status of parent and extraordinary care assumed to a child.  Participants (56%) indicated that in Nigeria; "the wealthier a man is, the more frequent his visits of fast foods and consumption of unhealthy diets."
The participants identified three stakeholders and their roles in the prevalence of child obesity. These are: Parents (particularly young mothers), schools teachers and government.
Participants specified that young mothers are the major stakeholders responsible for a rise in prevalence as the African woman is exclusively in charge of her child/children's well-being. Today, many young mothers in Lagos are believed to be more career-driven thereby creating less time for child care. Their preference for fast foods, low consumption of fruits and vegetables, a rare visit to recreation centers and large meal portion size served to children were roles attributed to mothers. These findings are in support of a study by Constanzo and Woody  which stated that imposing limit to access of food by parents will help spare children the negative social consequences of being overweight and obese. 
The roles of schools highlighted include inadequate education and information on healthy diets and its health benefits to parents and children, limited playgroups to encourage outdoor activities, daily servings of sweetened drinks and high-calorie snacks as lunch meals, low awareness on childhood obesity prevalence and lack of counseling of mothers with obese children. The highlighted school roles have also been identified in developed countries in consideration of the development of prevention strategies. 
Unrestricted importation of high-calorie food products (e.g,. cereals, noodles) and easy affordability of these products to the populace were identified as major ways by which the government contributes to prevalence of child obesity. Lack of implementation of policies on importation of food products, poor regulation on acceptable brands of imported products, and big gram sizes of high-calorie products packaged by the manufacturers to salvage production cost. In developing country like Chile, the burden of childhood obesity is being addressed by formulation and implementation of intersectoral policies, controls on food content, safety, and marketing among others. ,
Socioeconomic status was reported to be directly related to child overweight and obesity. Among the participants, 56% of respondents reported direct relationships exist between socioeconomic status and child obesity while 44% reported a null relationship exist. Participants who agreed to an existence of a direct relationship stated that children whose parents are high- or middle-income earners are more overweight or obese compared to children whose parents are low-income earners as a result of frequent visits to fast foods when compared to low-income earners. It was reported that frequent visits to restaurants and intake of processed meals are ways of displaying affluence in Nigeria. This report contradicts what obtains in developed countries as studies in developed countries have reported a higher prevalence of obesity in children from low socioeconomic status. ,
| Conclusion|| |
Civilization and lifestyle imbalance, insecurity and congestion, low level of public awareness, inadequate educative and enlightenment programs, myths and societal perception were factors identified to responsible for the rise in the prevalence of child obesity in Lagos, Nigeria. Roles played by different stakeholders in promoting this condition in Lagos and the relationship between socioeconomic status and child obesity were also reported.
The study design employs relatively identical groups to provide in-depth information around the specified research topic. It is useful at an early stage of research as a means for eliciting issues which participants think are relevant, which can then be used to inform the design of larger studies  hence, it is an explorative research. Its major limitations include tendencies for certain types of socially acceptable opinion to emerge, and for certain types of the participant to dominate the research process. 
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]