Knowledge and Practices on Prevention of Overweight and Obesity Among Secondary School Adolescents in Morogoro Municipality, Tanzania
Abstract
Recently, overweight and obesity among adolescents have become a growing concern, necessitating a comprehensive understanding of both preventive and effective management strategies. The present study aimed to assess knowledge and practices on the prevention of overweight and obesity among secondary school adolescents in Morogoro Municipality. An institutional-based cross-sectional study was conducted from April to May 2023 among 253 randomly selected students studying in Form 1, Form 2, and 3 classes. Data were collected through face-to-face interviews using a semi-structured questionnaire. Statistical Package for Social Science (SPSS) Version 25 was used for descriptive statistics to describe the study variables and logistic regression to identify factors associated with knowledge and practices on prevention of overweight and obesity. Among 253 respondents, 129 (51.0%) were females. Approximately 30% (n = 75) of the students mentioned vegetables and fruits as healthy foods, while 20.6% (n = 57) of the students were not aware of unhealthy foods. Despite the small number of students knowing that fruits and vegetables are healthy, only 20.2% (n = 51) and 43.5% (n = 110) reported consuming them 7 days a week, respectively. Most of the participants (82.2%, n = 208) were aware of the causes of overweight and obesity, and increasing physical activity (51.8%, n = 131) was the most cited preventive measure. Being in a higher level of study, that is, Form 2 (AOR 9.33, 95% CI: 2.71–32.10) and Form 3 (AOR 5.02, 95% CI: 1.38–18.25) were significantly associated with increased knowledge and practices on prevention of overweight and obesity. Conclusively, knowledge and practices regarding the prevention of obesity and overweight among secondary school adolescents vary significantly. While some aspects showed good knowledge and practices, others were less understood and practiced. This suggests a need for implementing a comprehensive community-based health education program focusing on adolescents as a window of opportunity for current and future prevention of overweight, obesity, and associated comorbidities.
1. Introduction
Overweight and obesity have become significant public health concerns globally, with their prevalence rising dramatically in both developed and developing countries [1]. Tanzania, like many other countries, is facing a growing burden of overweight and obesity, particularly among adolescents [2]. Adolescents, especially those in secondary schools, are vulnerable due to the transitional nature of this life stage and the influence of various factors on their dietary habits and physical activity levels [3]. Also, this demographic group is of particular concern due to the long-term health implications associated with excessive weight gain during adolescence, leading to hypertension, diabetes, risk of cardiometabolic diseases, osteoarthritis, dementia, depression, and some types of cancers [4, 5]. Between 1975 and 2016, the global prevalence of overweight or obesity in children and adolescents aged 5–19 years increased by more than four times, from 4% to 18% [4].
In Tanzania, likewise, the number of overweight or obese children is approaching half a million, with the highest rates seen among adolescent girls in urban areas [6]. However, the prevalence of overweight is rapidly rising across nearly all age groups and genders. Historically, the rising prevalence of overweight and obesity was initially observed primarily among adults, but the rates are on the rise in both adults and children [7].
The rise in overweight and obesity among adolescents is multifactorial as it is influenced by a complex interplay of genetic, behavioral, and environmental factors [8]. Unhealthy dietary habits, sedentary lifestyles, and socioeconomic status are among the key modifiable determinants contributing to this epidemic [9]. The knowledge of adolescents regarding these factors and their prevention is crucial in the reduction of the growing concern about these conditions [10]. Understanding the knowledge and practices of adolescents regarding the prevention and management practices of overweight and obesity is crucial for designing effective interventions [11].
While there has been growing attention on overweight and obesity in Tanzania, there is a paucity of research focusing on knowledge and practices in the prevention and management of overweight and obesity among adolescents, and if done, the focus is among adults. Most studies have focused on the prevalence and factors associated with overweight and obesity, as well as dietary intake among school adolescents’ [12–14]. This study seeks to bridge this gap by providing valuable insights that can inform targeted interventions for promoting healthy lifestyles among adolescents as a window of opportunity for the prevention of DR-NCDs in the future. The findings of this study will not only contribute to the existing body of knowledge but also have practical implications for policymakers, educators, and healthcare providers involved in adolescent health promotion programs.
2. Methodology
2.1. Study Design, Population, and Area
A cross-sectional study was conducted in the Morogoro region between April and May, 2023. Morogoro municipality was selected purposively due to the high level of overweight/obesity (37.5%) among women of reproductive age [2], which may also partly contribute to the increasing rates of overweight and obesity in children. Morogoro is one of the 31 administrative regions in Tanzania. It is the second largest region in the country after Tabora region, made up of nine districts council (DC), namely Morogoro urban (municipality), Ifakara (TC), Morogoro (DC), Kilosa (DC), Malinyi (DC), Mlimba (DC), Gairo (DC), Mvomero (DC), and Ulanga (DC). The regional capital is the municipality of Morogoro, which is the selected study area. In 2016, the region had 180 public and 58 private secondary schools. The number of schools increased to 182 for public and 64 for private in 2019 [15]. The national population census of 2022 reported that the estimated total population of the Morogoro region was 3,197,104, whereby the proportion of children and adolescents aged 10–19 years was 702,589, where 355,526 were males and 347,063 females [16]. This study included students who were in Forms 1, 2, and 3 and excluded those who had hearing or speech problems and those who were very sick to respond to the questions, as well as those whose parents refused to consent.
2.2. Sampling Technique
Two secondary schools were selected purposively based on the presence of school clubs. Proportionate sampling was used to determine the number of respondents from each school. In this case, 54% of the study participants were selected from Sokoine University of Agriculture (SUA) Secondary School and 46% from Kihonda Secondary School. Students in each selected class were stratified by sex to get a representation of both sexes. From each selected school, a list of students was provided, and simple random sampling was used to obtain individuals from each class who met the prescribed inclusion criteria and consented to participate.
2.3. Sample Size Determination
This study was part of the project dealing with NCDs among adolescents; hence, the proportion of the target population with NCDs was represented by the prevalence of elevated blood pressure (i.e., p = 18%) among primary school children [18] with an assumed response rate of 90%.
2.4. Data Collection Procedures
Before the data collection, 2 days of training on the basics of the data collection techniques were conducted, followed by a practical demonstration, coupled with pretesting of the questionnaire to adolescent students who were not included in this study.
Face-to-face interviews were conducted among students using a pretested questionnaire to get their demographic information and level of knowledge of the prevention and management of overweight and obesity, which took an average of 70 min to complete. Multiple answers were allowed in relevant questions and coded afterward during data management. Information collected included but was not limited to respondents’ views on the causes, consequences, and risk factors, as well as the prevention and management of overweight and obesity. Common practices used to prevent, screen, and manage weight were also assessed using a knowledge attitude and practice (KAP) questionnaire. This included both closed and open-ended questions adapted from the Tanzania STEPS survey and modified to suit the study context. To facilitate good discussion, a Kiswahili translated version of the questionnaire was used.
2.5. Data Analysis
Data were cleaned, coded, entered, and analyzed using the Statistical Package for Social Science (SPSS) version 25. In this software, descriptive statistics, such as frequencies, means, median, and percent, were obtained for demographic information, knowledge, and practices on the prevention of overweight and obesity. An association among factors was obtained by binary logistic regression analysis involving both univariate and multivariate analysis. The dependent variables, which are knowledge of the prevention of overweight and obesity, were dichotomized into either having knowledge or not having knowledge. Independent variables included were demographic characteristics. Multivariable logistic regression analysis was used to find associations between dependent and independent variables using the stepwise backward elimination condition method. Crude and adjusted odd ratios were obtained for each factor associated with knowledge of prevention of overweight/obesity at p < 0.05.
2.6. Ethical Considerations
This study was conducted after obtaining research permits from relevant authorities, including SUA, regional, municipal, and school authorities. Ethical approval was obtained from the Tanzania National Institute for Medical Research (NIMR) with reference number NIMR/HQ/R.8a/VOL.IX/4239. Participants were informed about the study, the procedure, benefits, and risks associated with their participation. They were also told that participation in the study was voluntary, with the possibility for the participant to withdraw at any time without being held responsible. Written consent was obtained from each participant prior to entry into the study, and parental consent was sought from participants below 18 years of age.
3. Results
3.1. Characteristics of the Respondents
Of the 253 assessed students, 51% (n = 129) were females. Among them, 39.1% (n = 99) participants were studying in Form 1, 31.6% (n = 80) in Form 2, and 29.2% (n = 74) in Form 3 classes. The majority of participants, 72.3% (n = 183), were studying science subjects. Only 2.8% (n = 7) of participants used alcohol. About 24.9% (n = 63) of participants have a family history of diabetes, and 42.3% (n = 107) have a family history of hypertension (Table 1).
| Variables | Frequency | Percent |
|---|---|---|
| Kihonda Secondary | 117 | 46.2 |
| SUA Secondary | 136 | 53.8 |
| Sex | — | — |
| Female | 129 | 51.0 |
| Male | 124 | 49.0 |
| Education level | — | — |
| Form 1 | 99 | 39.1 |
| Form 2 | 80 | 31.6 |
| Form 3 | 74 | 29.2 |
| Studying science subjects | — | — |
| Yes | 183 | 72.3 |
| No | 70 | 27.7 |
| Have ever used alcohol | — | — |
| Yes | 7 | 2.8 |
| No | 246 | 97.2 |
| Used alcohol within 12 months | — | — |
| Yes | 2 | 0.8 |
| No | 5 | 2.0 |
| History of diabetes in the family | — | — |
| Yes | 63 | 24.9 |
| No | 182 | 71.9 |
| Do not know | 8 | 3.2 |
| History of hypertension in the family | — | — |
| Yes | 107 | 42.3 |
| No | 133 | 52.6 |
| Do not know | 13 | 5.1 |
3.2. Knowledge of Prevention and Management of Overweight and Obesity
The majority of participants, 82.2% (n = 208), reported being aware of the causes of overweight and obesity. Among those who reported to know the causes, 79.9% (n = 167) mentioned high intake of energy foods, followed by low physical exercise 8.1% (n = 17), and low physical exercise combined with high fat intake 5.7% (n = 12). Notably, almost half 52.2% (n = 132) of the respondents recognize that hypertension is an effect of overweight/obesity, and engaging in or increasing physical activity 51.8% (n = 131) was the most cited preventive measure (Table 2).
| Variables | Frequency | Percent |
|---|---|---|
| Know the causes of overweight and obesity | — | — |
| Yes | 208 | 82.2 |
| No | 41 | 16.2 |
| Do not know | 4 | 1.6 |
| Causes of overweight and obesity | — | — |
| High intake of energy foods | 167 | 79.9 |
| Low intake of fruits and vegetables | 6 | 2.9 |
| Low physical exercises | 17 | 8.1 |
| Low physical exercise and high fat intake | 12 | 5.7 |
| Too much eating | 5 | 2.4 |
| Inheritance | 2 | 1.0 |
| Effects of overweight/obesity | — | — |
| Diabetes | 29 | 11.5 |
| Hypertension | 132 | 52.2 |
| Diabetes and hypertension | 24 | 9.5 |
| Others | 13 | 5.1 |
| Diabetes, hypertension, and cancer | 3 | 1.2 |
| Hypertension and heart diseases | 1 | 0.4 |
| Diabetes, hypertension, and heart diseases | 2 | 0.8 |
| Do not know | 49 | 19.4 |
| Measures to prevent overweight and obesity | — | — |
| Reduce energy intake | 51 | 20.2 |
| Eat vegetables and fruits more often | 9 | 3.6 |
| Eat legumes/whole grains more often | 3 | 1.2 |
| Engage/increase physical activities | 131 | 51.8 |
| Low-fat intake and increase activity | 30 | 11.9 |
| Reduce intake of fat and sugar foods | 6 | 2.4 |
| Balance diet | 9 | 3.6 |
| Eat vegetables and fruits, physical activity, and reduce intake of energy food | 2 | 0.8 |
| Eat legume/whole grains and Physical activity | 2 | 0.8 |
| Do not know | 10 | 4.0 |
| Total | 253 | 100.0 |
3.3. Pattern of Consuming Fruits per Week Among School Adolescents
The results show that no students 0% (n = 0) reported to consume fruits every day. Participants exhibited a range of motivations for consuming fruits, which were availability 30.4% (n = 77), followed by preference for taste (28.5%, n = 72). Results also show that the majority of students consume mixed fruits, mostly 85.8% (n = 217), with fewer students consuming other fruits without mixing them (Table 3).
| Variables | Frequency | Percent |
|---|---|---|
| Number of days consumed fruits per week (n = 253) | ||
| Do not eat at all | 7 | 2.8 |
| 1 day | 48 | 19.0 |
| 2 days | 61 | 24.1 |
| 3 days | 65 | 25.7 |
| 4 days | 15 | 5.9 |
| 5 days | 6 | 2.4 |
| 6 days | 51 | 20.2 |
| 7 days | 0 | 0.0 |
| The most consumed fruits (n = 246) | ||
| Mixed fruits | 217 | 85.8 |
| Mango | 2 | 0.8 |
| Banana | 10 | 4.0 |
| Avocado | 4 | 1.6 |
| Oranges | 12 | 4.7 |
| Apple | 1 | 0.4 |
| Reasons for consuming such fruits mostly (n = 246) | ||
| Just prefer | 72 | 28.5 |
| Availability | 77 | 30.4 |
| Affordability | 4 | 1.6 |
| Get micronutrients | 34 | 13.4 |
| Good health | 55 | 21.7 |
| Availability and preference | 3 | 1.2 |
| Do not know | 1 | 0.4 |
3.4. Pattern of Consuming Vegetables per Week Among School Adolescents
A total of 110 (43.5%) students declared to consume vegetables 7 days per week, followed by those who consumed 3 days per week 23.7% (n = 60), while a negligible proportion 0.8% (n = 2) reported not consuming any vegetables during the week. Participants provided insights into the primary factors driving their preference for consuming vegetables to be the motivation to obtain micronutrients (35.5%, n = 89). It was also found that the majority of participants, 96% (n = 241), consumed mixed vegetables (Table 4).
| Variables | Frequency | Percent |
|---|---|---|
| Number of days consumed vegetables per week (n = 253) | ||
| Do not eat | 2 | 0.8 |
| 1 day | 12 | 4.7 |
| 2 days | 23 | 9.1 |
| 3 days | 60 | 23.7 |
| 4 days | 31 | 12.3 |
| 5 days | 11 | 4.3 |
| 6 days | 4 | 1.6 |
| 7 days | 110 | 43.5 |
| Most consumed vegetables (n = 251) | ||
| Mixed vegetables | 241 | 96.0 |
| Amaranths | 4 | 1.6 |
| Sweet potato leaves | 3 | 1.2 |
| Cowpea leaves | 1 | 0.4 |
| Chinese | 2 | 0.8 |
| Reasons for consuming such vegetables (n = 251) | ||
| Just prefer | 45 | 17.9 |
| Availability | 60 | 23.9 |
| Affordability | 6 | 2.4 |
| Get micronutrients | 89 | 35.5 |
| Good health | 46 | 18.3 |
| Good health and micronutrients | 1 | 0.4 |
| Do not know | 4 | 1.6 |
3.5. Factors Associated With Knowledge of Prevention and Management of Overweight and Obesity
Univariate analysis revealed that sex, studying science subjects, and participating in physical activities were not significantly related to knowledge of prevention and management of overweight and obesity; therefore, they were removed from the model. However, a significant association was observed in education level (being in Form 2) (AOR 9.33, 95% (CI: 2.71−32.10), and being in Form 3 (AOR 5.02, 95% (CI: 1.38−18.25) (Table 5).
| Variables | COR 95% CI | p-Value | AOR 95% CI |
|---|---|---|---|
| Age | 0.745 (0.562–0.989) | 0.041 | NA |
| Sex | — | — | — |
| Female | 1 | — | — |
| Male | 1.536 (0.801–2.946) | 0.196 | NA |
| Education level | — | — | — |
| Form 1 | 1 | — | — |
| Form 2 | 0.538 0.261 1.109 | 0.093 | 9.33 (2.71–32.10) |
| Form 3 | 0.107 0.031 0.368 | 0.001 | 5.02 (1.38–18.25) |
| Studying science subject | — | — | — |
| Yes | 1 | — | — |
| No | 1.66 (0.754–3.654) | 0.208 | NA |
| Participate in physical activities | — | — | — |
| No | 1 | — | — |
| Yes | 0.927 (0.482–1.781) | 0.82 | NA |
3.6. Knowledge of Healthy and Unhealthy Foods
About 27% (n = 75) of the students mentioned vegetables and fruits to be healthy foods, followed by 18.6% (n = 47) who mentioned healthy foods to be proteins, vitamins, and carbohydrates. Nearly half of the respondents, 48.2% (n = 122), mentioned high-fat foods to be the unhealthiest foods, followed by 20.6% (n = 57) who did not know the unhealthy foods at all (Table 6).
| Variables | Frequency | Percent |
|---|---|---|
| Knowledge of healthy foods (n = 253) | ||
| Cereals | 35 | 13.8 |
| Roots/tubers | 7 | 2.8 |
| Vegetables and/or fruits | 75 | 29.6 |
| Less fat foods | 5 | 2.0 |
| Meat and meat products | 5 | 2.0 |
| fish and fish products | 1 | 0.4 |
| Milk, fruits, vegetables, legumes | 8 | 3.2 |
| Less sugar foods | 1 | 0.4 |
| High-protein foods | 17 | 6.7 |
| Low-energy foods (unrefined foods) | 1 | 0.4 |
| Low salt, fat, and sugar foods | 1 | 0.4 |
| All foods are good for health | 10 | 4.0 |
| Vegetables and CHO foods | 26 | 10.3 |
| Protein, vitamin, CHO foods | 47 | 18.6 |
| Do not know | 14 | 5.5 |
| Knowledge of unhealthy foods (n = 253) | ||
| Cereals | 3 | 1.2 |
| Roots/tubers | 2 | 0.8 |
| Vegetables and/or fruits | 2 | 0.8 |
| More fat foods | 122 | 48.2 |
| Meat and meat products | 5 | 2.0 |
| Fish and fish products | 1 | 0.4 |
| Legumes | 2 | 0.8 |
| Much sugar foods | 20 | 7.9 |
| High-fat, salt, and sugar foods | 20 | 7.9 |
| High-energy foods (refined foods) | 4 | 1.6 |
| Much sugar and high fat | 20 | 7.9 |
| Do not know | 52 | 20.6 |
3.7. Practices on Prevention and Management of Overweight and Obesity
About 60% (n = 152) of the students reported to care about their body weight with the aim of avoiding diseases (66.4%, n = 101), followed by those who aim to avoid overweight/obesity (15.8%, n = 24). Most of the students (75.2%, n = 115) control their body weight by doing physical exercise alone. In addition, 63.2% (n = 160) of the students care about the types of foods they consume, of which the majority (73.8%, n = 118) do so to avoid diseases. However, only 59.3% (n = 150) of the students engage in sports, whereby nearly half (47.3%, n = 71) do it once per week, and almost half of the students (49.8%, n = 126) use transport to go to school (Table 7).
| Variables | Frequency | Percent | |||
|---|---|---|---|---|---|
| Care about body weight (n = 253) | |||||
| Yes | 152 | 60.1 | |||
| No | 101 | 39.9 | |||
| Reasons for caring (n = 152) | |||||
| To look good | 19 | 12.5 | |||
| To avoid diseases | 101 | 66.4 | |||
| Increase work performance (being active) | 6 | 3.9 | |||
| Good looking and avoid diseases | 2 | 1.4 | |||
| Avoid overweight/obesity | 24 | 15.8 | |||
| Measures taken to control body weight (152) | |||||
| Doing exercises | 115 | 75.2 | |||
| Reduce intake of high-fat and sugar foods | 3 | 2.0 | |||
| Reduce the amount of food | 3 | 2.0 | |||
| Reduce intake of fatty foods | 5 | 3.3 | |||
| Management of diet and increase physical activities | 13 | 8.5 | |||
| Balance diet | 8 | 5.2 | |||
| Balance diet and physical activities | 5 | 3.3 | |||
| Tendency of measuring body weight | |||||
| Daily | 1 | 0.4 | |||
| Weekly | 1 | 0.4 | |||
| Monthly | 43 | 17.0 | |||
| Rarely | 121 | 47.8 | |||
| Never | 87 | 34.4 | |||
| Care about types of food to eat (n = 253) | |||||
| Yes | 160 | 63.2 | |||
| No | 93 | 36.8 | |||
| Reasons for caring (n = 160) | |||||
| To avoid diseases | 118 | 73.8 | |||
| To avoid overweight/obesity | 35 | 21.9 | |||
| To avoid diseases and being overweight/obesity | 2 | 1.2 | |||
| Just decided | 3 | 1.9 | |||
| Increase weight to look good | 2 | 1.2 | |||
| Participate in sports (n = 253) | |||||
| Yes | 150 | 59.3 | |||
| No | 103 | 40.7 | |||
| Number of days doing physical activities in a week (n = 150) | |||||
| 1 day | 71 | 47.3 | |||
| 2 days | 26 | 17.3 | |||
| 3 days | 15 | 10.0 | |||
| 4 days | 5 | 3.3 | |||
| 5 days | 8 | 5.3 | |||
| 7 days | 25 | 16.7 | |||
| Type of school transport (n = 253) | |||||
| Walking | 124 | 49.0 | |||
| Motorcycle, public transport, school bus | 126 | 49.8 | |||
| Bicycle | 3 | 1.2 | |||
4. Discussion
The present study assessed knowledge and practices on the prevention of overweight and obesity among secondary school adolescents in Morogoro municipality, Tanzania. The results of the study indicated that the majority of respondents were aware of the causes of overweight and obesity. However, only 6% of the respondents acknowledged that both sedentary lifestyle and high intake of fat foods are associated with overweight and obesity. More than half of the respondents mentioned hypertension as the consequence of overweight and obesity. Very few students mentioned that eating vegetables and fruits, engaging in physical exercise, and reduced intake of high-fat foods are the preventive measures for overweight and obesity. The possible reasons for these observations could be misinformation or myths about weight, diet, and health, that is, circulating among children, leading to misunderstandings about what constitutes a healthy lifestyle. One of the prevalent myths is that skipping meals, particularly breakfast, can help in weight management or even lead to weight loss. Another misconception is that certain foods or diets can incredibly burn fat or promote rapid weight loss without the need for exercise or overall dietary changes. These findings are consistent with a study conducted in India, which reported that the majority of students have inadequate knowledge of some of the components of prevention of overweight and obesity as only 33% of participants knew the consequence of obesity in the body, 63% had knowledge about measures needed to treat obesity while 46% had knowledge of factors contributing to obesity [19]. Another similar study was conducted in Tanzania and reported poor knowledge and practices on the prevention and management of overweight and obesity; however, it was done among adults [20]. Another study conducted in Nigeria is in contrary with the current findings, which revealed that about two-thirds of the participants have knowledge of different components for preventing overweight and obesity, including the causes, whereby taking too much sugary foods and drinks, as well as lack of exercise, were mentioned to be among the causes of obesity [21].
About one-third of the students mentioned vegetables and fruits to be healthy, while about 10% did not know and mentioned that all foods are good for health. This implies inadequate knowledge of healthy foods; hence, students may not make informed choices about their diet and could consume foods that contribute to overweight and obesity. The findings of the present study are similar to a study conducted in Uganda, which found inadequate knowledge of healthy diets among secondary adolescents [22]. Contrary to the current findings, the studies conducted in Pakistan and Bangladesh found that participants had adequate knowledge of healthy diets [23, 24]. In addition, nearly half of the respondents mentioned high-fat foods to be the unhealthiest foods, while a good number of students do not know the unhealthy foods. This suggests that there is a lack of knowledge about healthy eating, which can contribute to poor dietary choices and potentially increase the risk of overweight and obesity and finally noncommunicable diseases. The findings of the current study are similar to a scoping review, which revealed that most studies reported inadequate knowledge about healthy foods among adolescents [25].
It was further observed that two-thirds of the participants were concerned about their body weights; however, very few reported to maintain their body weight through the management of diet and increased physical activities. This indicates that secondary school adolescents have low knowledge concerning the prevention and management of overweight and obesity, as prevention of overweight and obesity involves incorporating factors such as diet and physical exercise, which reveals a gap in knowledge and practices regarding overweight and obesity prevention. Despite the concerns about their weights, participants lack regular monitoring, suggesting a disparity between intentions and actions. This underscores the need to promote practical strategies like regular weight monitoring, healthy eating, and physical activity to improve health outcomes. Furthermore, slightly more than half of the students acknowledged participating in sports but very few were engaging daily. Inconsistency to a present finding, a study done in Nigeria revealed that 90% of the students participate in physical exercise of which 40% of them participate daily [21]. The possible reason for this discrepancy may be due to cultural differences, differences in the availability of sports facilities and opportunities and variations in the emphasis on physical education in schools. In addition, two-thirds of the participants reported to be concerned about the foods they eat of which the majority reported to do so to avoid diseases and prevent overweight and obesity. This implies that they are conscious and proactive about their food choices to protect their health. The findings of the current study are consistent with a study conducted in Pakistan, as the majority of the participants-controlled diet with the intention of losing weight [24].
Most participants exhibited varied patterns of fruit consumption. However, the higher number of consuming fruits per week was reported to be 3 days per week, followed by those who consumed fruits 2 days per week. The findings of the current study are similar to several studies conducted in Burkina Faso, Bangladesh, and Arab countries, which revealed insufficient fruit and vegetables intake among adolescents [26–28]. The consumption of fruits and vegetables is largely influenced by availability and personal preference, accompanied by motivations associated with health and essential nutrient intake for those who are aware of the benefits of consuming vegetables and fruits. This finding is similar to a study conducted in South Africa, which found that the frequency of eating fruits and vegetables is influenced by availability and nutrition behavior [29].
The results for multivariate analysis showed that education level was strongly associated with knowledge of prevention and management of overweight and obesity among students. Students in Form 3 and 2 classes were five and nine times more likely to have good preventive knowledge than their counterparts, respectively. This was due to differences in knowledge levels among students in different classes. Students in Form 1 are at the beginning of their secondary school education and may not have been exposed to as much health education or nutrition-related topics as compared to those in higher forms. Similar findings were reported among secondary school students in Ikeja, Nigeria that there is a significant association between class and students’ level of knowledge [30]. Additionally, the curriculum or teaching methods in different forms or grades might vary in their emphasis on health education. Other factors, such as individual interest, prior knowledge, and exposure to health information outside of school, could also contribute to these differences.
5. Conclusion and Recommendations
The findings of this study indicate that secondary school adolescents have varying levels of knowledge and practices regarding overweight and obesity and their associated preventive methods. While some aspects show good understanding, others are lacking and poorly practiced; therefore, targeted programs are needed to increase knowledge among adolescents who are the near-future adults. This age group presents a window of opportunity to prevent obesity and associated comorbidities. Students can also be good ambassadors of spreading the knowledge to their families and hence, the community at large. These programs can include educational initiatives, school-based interventions, and community engagement efforts to promote healthy lifestyles that can help to prevent overweight and obesity-related health aspects.
Conflicts of Interest
The authors declare no conflicts of interest.
Funding
This work was supported by the Nestle Foundation.
Acknowledgments
We acknowledge the Nestle Foundation for funding the project which helped to come up with this manuscript. The project is also acknowledging the positive cooperation of the teachers and students from the participated schools.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
