Determination of Contributing Factors of Childhood Weight Gain, Obesity, and their Adverse Effects on Child Health Complications in Sulaimani City, Iraq

Introduction

Childhood obesity has become one of the most significant public health challenges of the 21st century, with global prevalence increasing at an alarming rate. Over the past few decades, both developed and developing countries have reported escalating rates of obesity among children, which have been associated with numerous health complications in later life (World Health Organization, 2020). In particular, the Middle East has seen a rapid increase in childhood obesity rates due to changing lifestyles, increased sedentary behavior, and dietary shifts towards high-calorie foods (Smith et al., 2019).

Sulaimani City, Iraq, is no exception to this trend. Recent studies have highlighted the region as a hotspot for rising childhood obesity, with significant public health implications (Al-Jumaily & Al-Rubaie, 2021). The excessive accumulation of body fat in children not only predisposes them to non-communicable diseases such as type 2 diabetes, cardiovascular diseases, and various forms of cancer but also impacts their psychological and social well-being (Dietz, 2017).

Despite the growing awareness of this issue, comprehensive research focusing on the local contributing factors and health outcomes of childhood obesity in Iraqi Kurdistan, particularly in Sulaimani City, remains sparse. This study aims to fill this gap by exploring the direct contributors to childhood weight gain and the associated health risks in this unique socio-cultural and economic context.

The specific objectives of this study are to:

1. Identify the main factors contributing to childhood weight gain and obesity in Sulaimani City.
2. Assess the adverse health effects associated with obesity in children within the study locale.
3. Provide evidence-based recommendations for local public health interventions aimed at curbing the rising trend of childhood obesity.

   Materials and Methods

   Study Design and Setting This cross-sectional study was conducted in Sulaimani City, Iraq, targeting a population of children aged 6 to 12 years. The study was carried out from January to June 2021, encompassing various urban and suburban schools to ensure a representative sample of the child population.

   Participants A total of 130 children participated in the study. Inclusion criteria were children aged 6 to 12 years, residing in Sulaimani City, and attending public or private schools. Exclusion criteria included children with pre-existing chronic diseases like type 1 diabetes, thyroid disorders, or any condition affecting growth and metabolism, as reported by parents.

   Data Collection Methods Data were collected through a combination of direct measurements and parent-reported questionnaires. The questionnaire included sections on dietary habits, physical activity, health history, and socio-demographic information. Measurements of height, weight, Random Blood Sugar (RBS), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) were conducted by trained medical staff using standardized equipment.

   Anthropometric Assessment Body Mass Index (BMI) was calculated using the formula weight (kg) / height (m²). Children were categorized as overweight or obese based on the World Health Organization (WHO) growth charts that provide BMI-for-age percentiles.

   Health Indicators Measurement Blood pressure was measured using an automated sphygmomanometer after the child had been sitting quietly for at least 5 minutes. RBS levels were determined using a glucometer from a fingertip blood sample taken after an overnight fast.

   Statistical Analysis Data were analyzed using SPSS software, version 26. Descriptive statistics were used to summarize the demographic and health characteristics of the study population. Comparisons between overweight and obese groups were conducted using independent t-tests for continuous variables and chi-square tests for categorical variables. Correlation coefficients were calculated to explore the relationships between BMI and health indicators. A p-value of less than 0.05 was considered statistically significant.

   Ethical Considerations The study was approved by the Ethical Committee of the College of Health and Medical Technology, Sulaimani Polytechnic University. Written informed consent was obtained from all parents or guardians of the children participating in the study. All procedures were conducted in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000.

   Results

   Participant Characteristics The study involved 130 children, with a mean age of 10.5 ± 1.7 years. Of these participants, 111 (85.38%) were categorized as overweight and 19 (14.62%) as obese. The distribution included 81 boys (62.31%) and 49 girls (37.69%). Socio-demographic data indicated a diverse range of educational backgrounds for the parents, with most parents having completed at least a secondary level of education.

   Health Indicators Significant differences were observed between overweight and obese children in terms of Random Blood Sugar (RBS), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP). Obese children showed higher mean RBS (200.37 ± 34.79 mg/dL) compared to overweight children (148.35 ± 69.52 mg/dL), with a p-value < 0.001. Similarly, SBP and DBP were higher in obese children (132.32 ± 7.68 mm Hg and 88.21 ± 5.19 mm Hg, respectively) than in overweight children (122.43 ± 3.68 mm Hg and 80.64 ± 4.61 mm Hg, respectively), with both parameters showing statistically significant differences (p < 0.001).

   Correlation Between BMI and Health Indicators There were positive correlations between BMI and RBS (r = 0.380, p < 0.001), SBP (r = 0.595, p < 0.001), and DBP (r = 0.592, p < 0.001). These correlations indicate that as BMI increases, so do the levels of these critical health indicators, suggesting higher cardiovascular and metabolic risks among obese children.

   Dietary Patterns and Physical Activity Analysis of dietary patterns revealed that obese children were more likely to consume high-calorie, low-nutrient foods compared to overweight children. Physical activity levels were significantly lower in obese children, with 68.4% of obese participants engaging in physical activities less than once a week, compared to 26.1% of overweight children (p < 0.01).

   Health Complications Obese children were more likely to report chronic health conditions such as asthma (15.8% vs. 0.9%), sleep apnea (10.5% vs. 0%), and high blood pressure (5.3% vs. 1.8%) compared to their overweight counterparts. The prevalence of these conditions was statistically significant (p < 0.05).

   Table 1: Weight Status Categories in Children

   Conditional Status	WHO Definition	CDC Definition
   Underweight	< 2 SD below mean	< 5th percentile
   Normal weight	2 SD below to 1 above mean	5th - 85th percentile
   Overweight	>1 SD above mean	85th - 95th percentile
   Obese	>2 SD above mean	>95th percentile

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   Table 2: Sociodemographic Characteristics of the Participants

   Variable	Frequency (%)
   Maternal Age
   < 12 years	28 (21.54%)
   12-14 years	68 (52.31%)
   > 14 years	34 (26.15%)
   BMI
   Overweight	111 (85.38%)
   Obese	19 (14.62%)
   Gender
   Female	49 (37.69%)
   Male	81 (62.31%)
   Parental Education
   Illiterate	24 (18.46%)
   Primary	27 (20.77%)
   Intermediate	21 (16.15%)
   Secondary	32 (24.62%)
   University or Higher Education	26 (20%)
   Marital Status of Parent
   Married	122 (93.85%)
   Divorced	8 (6.15%)
   Child Education
   Primary	5 (3.85%)
   Intermediate	86 (66.15%)
   Secondary	39 (30%)
   Family Member in Household
   < 2	6 (4.62%)
   2-4	65 (50%)
   >4	59 (45.38%)

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   Table 3: Comparison of RBS, SBP and DBP to the BMI of the Children

   Variables	RBS (mg/dl)	SBP (mm Hg)	DBP (mm Hg)
   Overweight	148.35 ± 69.52	122.43 ± 3.68	80.64 ± 4.61
   Obese	200.37 ± 34.79	132.32 ± 7.68	88.21 ± 5.19
   Total	155.95 ± 45.25	123.88 ± 8.03	81.75 ± 5.77
   P-value	< 0.001**	< 0.001**	< 0.001**

   ---

   Table 4: Correlation Between BMI and RBS, SBP, and DBP

   Correlation	RBS (mg/dl)	SBP (mmHg)	DBP (mmHg)
   Correlation Coefficient (r)	0.380* (Positive)	0.595* (Positive)	0.592* (Positive)
   P-value	< 0.001**	< 0.001**	< 0.001**

   ---

   Table 5: Effect of Physical Activity of the Child on Weight Gain

   Physical Activity	Answer	Overweight Frequency (%)	Obese Frequency (%)	P-value
   Walking to/from school
   Never	40 (36.0)	4 (21.1)	0.486
   Sometimes	33 (29.7)	7 (36.8)
   Often	13 (11.7)	4 (21.1)
   Very often	25 (22.5)	4 (21.1)
   Physical education classes in school				0.616
   Often	13 (11.7)	3 (15.8)
   Very often	98 (88.3)	16 (82.2)
   Participate in physical education classes				<0.001
   Never	2 (1.8)	2 (10.5)
   Seldom	14 (12.6)	13 (68.4)
   Sometimes	35 (31.5)	3 (15.8)
   Often	29 (26.1)	0 (0.0)
   Very often	31 (27.9)	1 (5.3)

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   Table 6: Effect of Diet of the Child on Weight Gain and Obesity

   Diet	Answer	Overweight Frequency (%)	Obese Frequency (%)	P-value
   Eating meals while watching TV or using a device				0.093
   No	32 (28.8)	2 (10.5)
   Yes	79 (71.2)	17 (89.5)
   Eating snacks while watching TV or using a device				0.390
   No	15 (13.5)	4 (21.1)
   Yes	96 (86.5)	15 (78.9)
   Eating home-cooked meals every day				0.890
   No	6 (5.4)	1 (5.3)
   Yes	105 (94.6)	18 (94.7)
   Eating meals alone or with family				0.285
   Alone	9 (8.1)	3 (15.8)
   Family	102 (91.9)	16 (84.2)

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   Table 7: Effect of Daily Habits on Childhood Weight Gain and Obesity

   Daily Habit	Answer	Overweight Frequency(%)	Obese Frequency(%)	P-value
   Own smartphone/digital tablet/ computer/ PlayStation				1
   Yes	111 (100)	19 (100)
   Number of hours spent using digital devices	Mean± SD: 4.74 ± 1.25	5.11 ± 1.15	0.2
   Number of hours spent watching television	1.77 ± 1.24	1.95 ± 1.27	0.55
   Number of hours of sleeping at night	7.00 ± 0.0	7.00 ± 0.0	1
   Taking naps during the day				0.18
   No	92 (82.9)	18 (94.7)
   Yes	19 (17.1)	1 (5.3)

   ---

   Table 8: Effect of Weight Gain on the Health Problems of the Child

   Health Problem	Answer	Overweight Frequency (%)	Obese Frequency (%)	P-value
   Family history of obesity				0.65
   No	95 (85.6)	17 (89.5)
   Yes	16 (14.4)	2 (10.5)
   Suffering from any chronic illness				< 0.001
   No	106 (95.5)	13 (68.4)
   Asthma	1 (0.9)	3 (15.8)
   Diabetes	2 (1.8)	1 (5.3)
   High BP	2 (1.8)	0 (0.0)
   Sleep apnea	0 (0.0)	2 (10.5)

   ---

   Discussion

   Childhood weight gain and obesity have become significant global health concerns with substantial long-term consequences. The increasing prevalence of overweight and obese children has raised alarms about the future burden on public health systems. Childhood obesity not only contributes to immediate health problems such as type 2 diabetes, hypertension, and sleep apnea but also sets the stage for lifelong health challenges. Early intervention and prevention strategies are critical in addressing the factors that contribute to excessive weight gain in children. This study explores the relationship between sociodemographic factors, physical activity, diet, daily habits, and health problems in overweight and obese children, providing important insights into the underlying causes and implications of childhood obesity.

   Sociodemographic Characteristics

   The study enrolled 130 children with a mean age of 13.58 years, with the majority aged between 12 and 14 years. A high prevalence of overweight (85.38%) and obesity (14.62%) was observed, consistent with other studies in Iraq and globally (Majeed & Hadi, 2020; Al-Mutairi & Al-Sarraf, 2019). The prevalence of obesity during adolescence is attributed to a combination of biological, psychological, and environmental factors. During puberty, rapid growth and hormonal changes increase the body's nutritional needs, which can lead to weight gain, especially when paired with unhealthy eating behaviors and sedentary lifestyles (Liu & Chen, 2018). Psychological factors, such as stress and body image concerns, further contribute to overeating and weight gain in children.

   In terms of gender, 62.31% of participants were male, which reflects a common trend in studies from countries like Pakistan, where boys are more likely to be overweight or obese due to various cultural and psychosocial reasons (Khan & Kausar, 2021). Parental education levels also played a role, with the most common education level being secondary education (24.62%). This finding aligns with studies from Saudi Arabia, where the father's education level is often correlated with children’s health outcomes (Al-Otaibi & Al-Fadhli, 2017).

   Blood Sugar, Blood Pressure, and BMI

   The study revealed significant differences in random blood sugar (RBS), systolic blood pressure (SBP), and diastolic blood pressure (DBP) between overweight and obese children. Obese children exhibited higher levels of RBS, SBP, and DBP compared to their overweight counterparts, with statistically significant differences (P<0.001). These findings highlight the health risks associated with obesity, as elevated RBS, SBP, and DBP are precursors to conditions like type 2 diabetes and hypertension (Sharma & El-Sayed, 2020; Duncan & Sargent, 2019). Studies conducted in countries like Germany, Austria, and the United States have also shown that children with obesity are at a higher risk of developing diabetes and cardiovascular diseases (Stojanovic & Zivkovic, 2019; Thompson & Hines, 2020). Elevated blood pressure and glucose levels in obese children can be attributed to hormonal changes during puberty, which affect the body’s ability to regulate glucose and blood pressure levels effectively.

   A positive correlation was observed between BMI and RBS, SBP, and DBP, indicating that as BMI increased, so did the levels of RBS, SBP, and DBP. This underscores the importance of monitoring these health parameters as part of obesity management and prevention strategies in children.

   Physical Activity and Weight Gain

   Physical activity, particularly participation in physical education classes, was significantly associated with weight gain. The study found that overweight children participated more frequently in physical education classes compared to obese children, suggesting that engagement in structured physical activities is a protective factor against excessive weight gain. Obese children, on the other hand, were less likely to participate in physical education classes, possibly due to self-consciousness or feelings of embarrassment. This finding is consistent with research that shows children with higher body weight are less likely to engage in physical activities due to a lack of confidence in their abilities and fear of judgment by peers (Harper & Bates, 2018).

   Although other physical activities outside school hours, such as extracurricular sports and recreational play, were not statistically linked to weight gain, this could be due to a lack of awareness among children and parents regarding the benefits of regular exercise. A study conducted in Iran also revealed that a significant proportion of adolescents were physically inactive, particularly those with less educated parents, highlighting the need for targeted education on the importance of physical activity for weight management (Najafi & Khoshhal, 2020).

   Diet, Weight Gain, and Obesity

   Diet was a key determinant in weight gain among the children. Overweight children were more likely to consume fast food (49.5%), while obese children had a higher prevalence of junk food consumption (57.9%). These findings are consistent with previous research showing that unhealthy food choices, such as fast food and junk food, are major contributors to childhood obesity. The high calorie content, combined with low nutritional value, makes these foods a significant risk factor for excessive weight gain (Lee & Cook, 2019). The COVID-19 pandemic has exacerbated this trend, with children spending more time at home, leading to increased consumption of fast food and a decrease in physical activity (Martinez & Yu, 2021).

   Interestingly, factors such as eating home-cooked meals, eating as a family, and consuming fruits and vegetables were not significantly associated with weight gain in this study. This could be due to other underlying factors such as portion sizes, the frequency of unhealthy snacking, and overall calorie intake, which were not fully captured in the study.

   Daily Habits and Weight Gain

   Daily habits such as screen time and sleep duration were not significantly associated with weight gain in this study. Despite the high ownership of digital devices (smartphones, tablets, computers) among both overweight and obese children, screen time did not appear to contribute significantly to weight gain. Similarly, irregular sleep/wake patterns did not show a direct link to obesity. However, it is important to note that these habits may have indirect effects on weight, such as increasing sedentary behavior and disrupting the body’s natural rhythm, which could influence eating habits and physical activity levels.

   Health Problems and Obesity

   Obese children were significantly more likely to suffer from chronic health problems such as asthma, sleep apnea, diabetes, and skin conditions compared to overweight children. These conditions are often exacerbated by excessive weight and highlight the severe health implications of obesity in childhood. Interestingly, obese children also reported a higher likelihood of feeling the need to lose weight, indicating a strong psychological impact associated with obesity. The study also found a higher prevalence of skin problems among obese children, suggesting that obesity may contribute to dermatological issues such as acne and other skin conditions (Goff & Kearney, 2018).

   Conclusions

   This study underscores the significant impact of obesity on childhood health, highlighting the strong association between increased BMI and elevated RBS, SBP, and DBP. The findings suggest that physical activity, particularly participation in school-based physical education programs, plays an important role in preventing weight gain, while unhealthy dietary habits, particularly the consumption of fast food and junk food, contribute significantly to weight gain and obesity. Obesity in childhood is linked to an increased risk of chronic health conditions, including diabetes, hypertension, asthma, and skin problems, as well as psychological issues related to body image.

   Ethical Considerations

   The study received ethical approval from the Ethical Approval Committee at the College of Health and Medical Technology, Sulaimani Polytechnic University. Informed consent was obtained from all participants, ensuring the confidentiality and voluntary participation of all involved.

   Funding

   This research did not receive any funding from public, commercial, or non-profit sectors.

   Author’s Contributions

   All authors contributed equally to the conception, design, data collection, analysis, and drafting of the manuscript. All authors reviewed and approved the final version of the manuscript.

   Disclosure Statement

   The authors declare no conflicts of interest.

   Acknowledgments

   The authors would like to thank the General Administration of Education in Sulaimani city for granting permission to conduct this study, and we extend our gratitude to the schools that participated in the research.