Obesity is a form of malnutrition that often results from an imbalance between food intake and energy utilization. Overweight and obesity in children and adolescents are considered global epidemic. Recent statistics show that, 16% of children, 6 - 11 years old, are overweight [1] . In actual numbers, the estimate suggested that 150 - 160 million school-age children worldwide were overweight, of which, 35 - 40 million were obese [2] . Statistics also show that, prevalence of overweight continues to increase during the school age and adolescent stages [3] .

Obesity in childhood increases the risk of development of metabolic syndrome, diabetes mellitus, cardiovascular and even fatty liver in later life. Asthma, shortness of breath and sleep apnea are common respiratory problems associated with obesity. Children who are obese also have a negative body-image, which leads to lower self-esteem. In Egypt, obesity among school age children constitutes an emerging concern; the Egyptian Medical Association for the Study of Obesity in early 2010 estimates that 15 percent of Egyptian (school-age) children are obese, in comparison with its 1990’s estimate of only six percent. The rapid increase in prevalence of overweight and obesity signals that development of strategies to face such problem is a health priority [4] .

The etiology of childhood obesity is poorly understood. Obesity is not a single disorder but a heterogeneous group of conditions with multiple causes. Body weight is determined by an interaction between genetic, environmental and psy- chosocial factors acting through the physiological mediators of energy intake and expenditure. Although genetic differences are of undoubted importance, the marked increase in the prevalence of both overweight and obesity is best explained by behavioral and environmental changes that are results of technological advances [5] . These changes had resulted in increased intake of large quantities of foods high in sugar and energy-rich foods combined with lack of physical exercise. Sedentary lifestyle resulting from spending most of the day watching television, or playing computer or video games is considered a serious factor for obesity. Role of environmental effects on body weight is well noticed in various settings such as at home, in school, and in the community. At home, parents can improve children’s food choices and motivate them to practice and have a heal- thy lifestyle. School also should promote healthy food choices and physical activity among students who spend most of their times in it. As regards communities in the absence of accessible and affordable choices of healthy food and facilities for physical activities as safe side walks, bike paths, and safe parks obesity is a must [4] .

711 students were successfully enrolled in this study, 323 boys (45.4%) and 388 girls (54.6%). The mean age of the studded sample was 10.36 years and the standard deviation was 1.92 years, 36.8% of the participants were from urban areas while 63.2% were from rural areas, as shown in Table 1.

Table 2 presents distribution of the studied children as regard prenata, parental, early life and life style factors, about one fifth of the mothers of the studied sample were obese (19.8%), received high level of education (21.2%) while more than 84% were house wives. 92% of the studied children were full term at birth and 85.5% had average birth weight. As regard practice of sport more than 72% of them did not practice sport regulary.

Figure 1 Shows distribution of the studied primary school children as regard BMI. By plotting BMI against standard percentile Egyptian curves, 117 (16.5%) were overweight and 104 (14.6%) were obese.

Table 3 shows that high significant association (P value = 0.004) presents between residing in urban areas and both overweight and obesity, as 19.9% and 13% of urban school children were obese and overweight respectively compared to 11.6% and 18.5% of the rural children. Significant association also presents between overweight and obesity in school children and obesity of one or both parents. More than 20% children with obese parents were obese compared to 10% of children with normal weight parents’. More than 25% of children whose mothers’ finished primary level of education only were obese compared to 10.5% of those finished faculty indicating significant association (P value < 0.05). As regard type of feeding in infancy 31% of the obese children were on formula feeding compared to 13% of those who were breast fed either exclusively or with formula and the difference is significant (P value < 0.05).

Table 4 indicates presence of very high statistically significant association between not consuming fresh fruits and vegetable daily and overweight and

obesity among school children (P value = 0.000), more than fifth (21.7%) the children who occasionally eat fresh fruits and vegetables were obese or overweight compared to 14% and 16.8% of those who consume it more than two times daily. No significant association was found as regard frequency of consumption of fast food and sugary juices or practice of physical exercises (P value > 0.05) taking in consideration that only (27.6%) of the studied school children practiced sports regularly.

The current study aimed at identification of the prevalence of overweight and obesity among school children and its association with certain socio demogra- phic, parental, early life, dietary and life style risk factors.

In the present study, the overall prevalence of obesity among children from 6 - 14 years of age was (14.6%) and the prevalence of overweight was (16.5%). We faced difficulty in comparing our results because of absence of previous studies about the prevalence of obesity in children in Sohag governorate. By comparing our results with studies conducted in Cairo, Alex and Port Said we found that the prevalence of overweight was similar to that of Port Said [6] and Alex [7] but lower than that of Cairo [8] . As regards the prevalence of obesity, it was higher than values reported in Cairo and Alex and similar to values reported in Port Said. These variations might be partially attributed to the difference in the standard curves used for defining obesity and overweight, as [8] used the American standard curve and [7] used the WHO Z-score cutoff points, while in our study and in that of Port Said [6] , the local Egyptian BMI charts were used. Variations also can be explained by differences between Alex, and Sohag as regards the society as rural children in the current study represented 63.2% compared with 25.1% in Alexandria. The lowest prevalence of obesity in Cairo also linked to the time of conduction of the study which was conducted 10 years ago; many changes have been evolved as regards life style and food consumption since that time.

As regards the prevalence of overweight among school children in the Arab countries, our results are consistent with [9] and [10] in Saudi, [11] in Jordan and [12] in Qatar. On the other hand, our results were much lower than [13] in Kuwait. Concerning the prevalence of obesity, our results were in agreement with [10] [11] , but it was higher than [9] [12] and [13] . Apart from Kuwait, all of these studies showed nearly similar rates of overweight, while the prevalence of obesity showed marked variation. As we mentioned before, this could be explained by differences in standard curves used for defining obesity and overweight, in addition to differences in socio economic status between Sohag governorate and those countries. This governorate is one of Egypt poorest governorates that results in a relatively less consumptions of energy dense foods and high consumption of the cheap high fiber diet. In addition, availability of private cars on individual level had led to reduced physical activities of children.

Variations between boys and girls as regards prevalence of overweight and obesity were reported by many studies [7] [14] and [15] although [10] reported presence of variation between boys and girls as regards obesity only but not overweight in Saudi. As in boys, it may indicate health and strength but girls prefer to remain slim. This disagreed with our results, as we found nearly similar rates of obesity among boys and girls while the percentage of overweight was more among boys with no statistically significant difference (P value = 0.5). Meanwhile our results agree with [16] in Egypt and [17] in Turkey. This could be explained by the fact that more than 70% of the studied children are below or around 10 years. As no much control on weight gain is practiced by female children in this age.

We found that 19.9% of the studied urban children were obese compared with 11.6% of the studied rural children while the percentage of overweight was higher among rural children with very high statistically significant difference (P value = 0.004). These results agree with [7] [16] and [18] . This difference could be attributed to both dietary variations (absence of fast food restaurants, plenty of fresh fruits and vegetables nearby) and increased physical activity in rural areas as means of transportation are uncommon and children usually walk to schools.

Maternal role in childhood obesity extends beyond genetics; it appears in developing and maintaining healthy dietary habits and life style. This role is affected by her education and availability of time enough for caring her children especially their feeding.

We studied maternal role in obesity and overweight among children by assessing three factors, presence of maternal or paternal obesity, level of maternal education and whether she is a working mother or housewife. In agreement with several studies [6] [14] [16] [17] [19] [20] and [21] , we found significant association between obesity among one or both parents and both obesity and overweight among children. 51.9% of the overweight children and 39.3% of the obese children had an obese parent or both parents were obese compared with 30% of the normal weight and underweight children. Significant association was also found between the level of maternal education and childhood overweight and obesity, 25% of children whose mothers had primary education were obese com- pared with only 10% of those whose mothers finished the faculty. This agrees with [17] and disagrees with [16] and [22] . Absence of public awareness about healthy nutrition may explain prevalence of obesity among children of mothers with low level of education. On the contrary, maternal occupation showed no significant association with childhood obesity in agreement with [14] [17] and [23] while [16] and [18] disagreed with us. Several previous studies reported the protective role of breast feeding against childhood overweight and obesity. We found that 31% and 22% of formula fed children were obese and overweight respectively compared with 13.8% and 15.8% of breast fed children (P value <0.05). This significant association was also reported by [20] [24] [25] and [26] .

With rapid economic and technologic development, worldwide life style changes in the form of less physical activity and more consumption of fast and fat rich food predominate. We assessed association between frequency of consumption of fast food, sugary juices, fresh vegetables and fruits and practicing sport and both childhood overweight and obesity. Frequency of consumption of fresh fruits and vegetables was the only significant risk factors. More than 43% of the children who ate fresh fruits or vegetables occasionally were overweight or obese compared with 30% of those who ate them twice daily with very high statistically significant difference. This agrees with [6] [27] and [28] and disagrees with [20] . No significant association was found concerning other factors in agreement with [20] [22] and [29] as regards fast food and [29] and [30] as regards sugary juices. On the other hand, [6] [20] [23] and [28] disagree with us. This could be explained by absence of fast food restaurants in rural areas of the study setting where more than 63% of the study samples were formulated. It is well known that absence of physical activity is an important risk factor of overweight or obesity. On the contrary to many previous studies [6] [17] [23] [28] and [31] , we found no significant association between overweight and obesity and non practice of sport by children. This may be explained by the fact that 72.4% of the studied children whether normal weight or overweight do not practice any sport or regular physical exercises as a result of lack of physical activities facilities among these children in agreement with [32] .

Hadhood, S.E.S.A., Ali, R.A.E., Mohamed, M.M. and Moham- med, E.S. (2017) Prevalence and Correlates of Overweight and Obesity among School Children in Sohag, Egypt. Open Journal of Gastroenterology, 7, 75-88. https://doi.org/10.4236/ojgas.2017.72009