Wealth and obesity in pre-adolescents and their guardians: A first step in explaining non-communicable disease-related behaviour in two areas of Nairobi City County

The prevalence of non-communicable diseases is increasing in lower-middle-income countries as these countries transition to unhealthy lifestyles. The transition is mostly predominant in urban areas. We assessed the association between wealth and obesity in two sub-counties in Nairobi City County, Kenya, in the context of family and poverty. This cross-sectional study was conducted among of 9-14 years old pre-adolescents and their guardians living in low- (Embakasi) and middle-income (Langata) sub-counties. The sociodemographic characteristics were collected using a validated questionnaire. Weight, height, mid-upper arm circumference, and waist circumference were measured using standard approved protocols. Socioeconomic characteristics of the residential sites were accessed using Wealth Index, created by using Principal Component Analysis. Statistical analyses were done by analysis of variance (continuous variables, comparison of areas) and with logistic and linear regression models.A total of 149 households, response rate of 93%, participated, 72 from Embakasi and 77 from Langata. Most of the participants residing in Embakasi belonged to the lower income and education groups whereas participants residing in Langata belonged to the higher income and education groups. About 30% of the pre-adolescent participants in Langata were overweight, compared to 6% in Embakasi (p<0.001). In contrast, the prevalence of adults (mostly mothers) with overweight and obesity was high (65%) in both study areas. Wealth (β = 0.01; SE 0.0; p = 0.003) and income (β = 0.29; SE 0.11; p = 0.009) predicted higher BMI z-score in pre-adolescents. In, pre-adolescent overweight was already highly prevalent in the middle-income area, while the proportion of women with overweight/obesity was high in the low-income area. These results suggest that a lifestyle promoting obesity is high regardless of socioeconomic status and wealth in Kenya. This provides a strong justification for promoting healthy lifestyles across all socio-economic classes.

Attributes of parenting identities and food practices among parents in Nairobi, Kenya

Dramatic changes in daily life are leading to increased rates of obesity and non-communicable diseases (NCD) in Kenya, including among children. Parenting plays a vital role in helping children establish healthy eating habits to prevent obesity and NCDs. The objective of this study was to describe parenting identity and how attributes of parenting influence food parenting practices in an urban Kenyan context. A qualitative study design was employed with 18 participants recruited using quota sampling to include parents who were born in (n = 8) or migrated to Nairobi in the last five years (n = 10). In-depth qualitative interviews were conducted by an experienced ethnographic interviewer that inquired about parenting identity and food parenting practices. Transcripts were analyzed using thematic coding in a multi-step and emergent process. Parents described their parenting identities as an integration of tradition and personal experiences during their upbringing with the modern realities of daily life. Their own experiences with discipline, modern urban lifestyles, and social pressures were dominant influences on their identities. Parenting identities included four distinct but related attributes: good disciplinarian, trustworthy, protective, and balanced provider and nurturer. Food parenting practices were described as expressions of parenting identity and included the goals: children becoming better eaters; nourishing through food; impart joy; and bonding. The study findings illustrate the influence of modern urban lifestyles on food parenting identities and practices. Understanding emerging identities and practices in rapidly changing low- and middle-income countries (LMIC) contexts is essential for health promoting policies and programs.

Patterns and predictors of elevated blood pressure and hypertension among primary school children in urban Kenya

OBJECTIVE

We examined the prevalence of elevated blood pressure (BP) and hypertension among 390 primary school children of different socioeconomic status (SES) in two urban settings in Kenya and explored the association between children's BP status and their sociodemographic characteristics, dietary behaviours and overweight/obesity status.

METHODS

Children's BP and anthropometric measurements were taken and parents, with the help of their children, completed questionnaires on the children's dietary behaviours. An average of three BP readings was used to calculate BP percentiles by age, sex and height. BMI-for-age z-scores, waist-circumference-to-height ratio and the sum of skinfold measures were calculated. We utilized prevalence ratio analysis to examine the association between BP and sociodemographic characteristics, dietary behaviours and overweight/obesity.

RESULTS

About 9% of the school children had elevated BP and 33% had stage 1 hypertension. Among overweight children, the proportion of children with elevated BP was 1.85-fold greater and the proportion of children with hypertension was 1.83-fold greater compared with children with healthy body weight. Similar patterns of significant associations were seen among obese children, children with central obesity and children with high total skinfold values. The proportion of children with hypertension was 1.42-fold greater among children with high frequency of consumption of chips/crisps compared with children with lower frequency of consumption.

CONCLUSION

These results increase our understanding BP patterns and determinants among school children in Kenya and can help inform noncommunicable disease prevention efforts.

Overnutrition and Associated Factors Among High School Adolescents in Mid COVID-19 Pandemic in Ethiopia: Neglected Public Health Concern

BACKGROUND

Adolescent overnutrition is becoming a global public health problem, increasing at an alarming rate in developing countries. Overnutrition increases the risks of serious diet-related chronic diseases, including type 2 diabetes, hypertension, cardiovascular disease, and stroke. However, there is limited evidence on the magnitude and risk factors of overnutrition in the study area.

OBJECTIVE

To determine the magnitude of overnutrition and associated factors among school adolescents in Dire Dawa, Eastern Ethiopia.

METHODS

A cross-sectional study was conducted from May to June 2021 among 498 adolescent students selected using a multi-stage sampling procedure. A systematic random sampling technique was employed. Self-administered questionnaires, including food frequency and anthropometric measurement, were used to collect the data. The BMI-for-age Z score was calculated using the WHO Anthro-Plus. A binary logistic regression model was fitted with an odds ratio, and 95% confidence levels. Statistical significance is declared at a p-value below 0.05.

RESULTS

A total of 498 (98.4%) were included with the overall prevalence of overnutrition of 26.1% (95% CI: 22.3-29.9), where 23.7% and 2.4% had overweight and obesity, respectively. Being female (AOR = 3.32; 95% CI: 1.65-6.63), attending at private school (AOR = 4.97; 95% CI: 1.72-14.35), having sweet food preferences (AOR = 6.26; 95% CI: 3.14-12.5), snacking (AOR = 3.05; 95% CI: 1.11-8.36), sedentary behavior (AOR = 3.20; 95% CI: 1.67-6.09), and eating while watching TV (AOR= 2.95; 95% CI: 1.47-5.95) were significantly associated with overnutrition.

CONCLUSION

Overnutrition is a major emerging public health problem in eastern Ethiopia. School type, sex, sweet food preferences, habits of snacking, sedentary behaviors, and eating while watching TV were significantly associated with overnutrition. Therefore, public health strategies to curb overweight and obesity among high school adolescents are urgently needed in order to reduce the prevalence and its adverse complications.

Eating habits, lifestyle factors and body weight status among Moroccan school adolescents (12–19 years): The case of Beni Mellal city

BACKGROUND: Overweight and obesity among children and adolescents are serious public health issues worldwide. A better understanding of the relationships between obesity and lifestyle factors is necessary for effective prevention and management of obesity in youth. AIMS: This study aimed to assess the prevalence of overweight/obesity and associated factors among schoolchildren aged 12–19 years at Beni Mellal city, Morocco. METHODS: A school based cross sectional study was carried out. A total of 516 children were included in the study. The nutritional status was classified according to the reference curves of WHO (2007). Multivariable logistic regression analysis was used to identify factors associated with overweight/obesity. The association between dependent and independent variables were assessed using odds ratio with 95% confidence interval and p value < 0.05 was considered statistically significant. RESULTS: The prevalence of overweight was 12.40% and that of obesity was 5.20%. Overweight and obesity were statistically associated with gender (Odds Ratio (OR) = 10.15[95% CI 1.37–3.81], p = 0.001); skipping breakfast (OR = 9.19 [95% CI 1.42–5.17], p = 0.002) and eating cake, pastry and biscuit 1 to 3 times per week (OR = 4.14 [95% CI 1.02–3.25], p = 0.04) and 4 or more times a week (OR = 7.83 [95% CI 1.31–4.66], p = 0.005). CONCLUSIONS: This study revealed that prevalence of overweight/obesity among school-aged children in Beni Mellal city was high. Thus, promoting healthy dietary practices, particularly improving fruit and vegetable intake is essential to reduce the burden of overweight and obesity. Furthermore, it is important to strengthen nutrition education about avoiding junk food consumption and encouraging regular physical activity.

Food Environment in and around Primary School Children's Schools and Neighborhoods in Two Urban Settings in Kenya

We conducted a cross-sectional study to provide an overview primary school children food environment in two urban settings in Kenya. Six schools, catering to children from low-, medium- and high-income households in the cities of Nairobi and Kisumu in Kenya, participated in the study. Data on types of food places and foods offered were collected and healthy and unhealthy food availability scores calculated for each place. We utilized prevalence ratio analysis to examine associations between food availability, food place characteristics and neighborhood income levels. Altogether, 508 food places, located within 1 km of the schools and the school children's neighborhoods were observed. Open-air market sellers and kiosks were most common. The proportion of food places with high healthy food availability was 2.2 times greater among food places in Nairobi compared to Kisumu, 1.9 times greater in food places with multiple cashpoints, 1.7 times greater in medium/large sized food places and 1.4 times greater in food places located in high income neighborhoods. These findings highlight differences in availability of healthy foods and unhealthy foods across types of food places and neighborhood income levels and inform public health interventions aimed at promoting healthy food environments in Kenya.

Magnitude of Overweight and Obesity and Associated Factors Among Public and Private Secondary School Adolescent Students in Mekelle City, Tigray Region, Ethiopia, 2019: Comparative Cross-Sectional Study

BACKGROUND

Overweight and obesity emerged as one of the most serious public health concerns in adolescents. Overweight and obesity are problems of not only high income but also low-middle income countries. Therefore, this study aimed to assess the magnitude and associated factors of overweight and obesity among public and private secondary school adolescents in Mekelle city, Tigray, Ethiopia, 2019.

MATERIALS AND METHODS

A school-based comparative cross-sectional study was conducted in Mekelle city, from April to May 2019. A multi-stage sampling technique was used to select 858 participants. Chi-square test was checked before bivariate logistic regression analyses. All variables at a p-value <0.25 in bivariate logistic regression were entered into a multivariable logistic regression to determine the association between a set of independent variables with the dependent variable. Finally, statistical significance was declared at a p-value <0.05.

RESULTS

The magnitude of overweight and obesity in private and public schools were 11.8% and 3.9%, respectively. Consuming dinner not daily [AOR=5.3:95% CI=1.93-14.6] and working moderate-intensity sports at least 10 minutes/day continuously [AOR=0.19:95% CI=0.04-0.9] were associated factors of overweight and obesity in public school adolescent students. Being female [AOR=2.03:95% CI=1.08-3.8], time taken from home to public physical activities ≤15 minutes [AOR=3.6:95% CI=1.13-11.51], using transport from school to home [AOR=2.2:95% CI=1.06-4.18] and good knowledgeable adolescents [AOR=0.5:95% CI=0.27-0.9] were associated factors of overweight and obesity in private schools.

CONCLUSION

The magnitude of overweight and obesity was higher among private schools. Consuming dinner not daily and working moderate-intensity sports at least 10 minutes/day continuously were the associated factors for the occurrence of overweight and obesity in public school adolescent students. Being female, time taken from home to public physical activity facilities ≤15 minutes, using transport from school to home, and nutritional knowledge status of adolescents were associated factors for overweight and obesity in private school adolescent students.

Prevalence and determinants of overweight/obesity among school-aged adolescents in the United Arab Emirates: a cross-sectional study of private and public schools

OBJECTIVES

To estimate the prevalence and predictors of obesity among adolescents in the United Arab Emirates.

DESIGN

Cross-sectional study.

SETTING

Private and public secondary schools.

PARTICIPANTS

Adolescents aged 13-19 years; 434 (46.6%) from private schools and 498 (53.4%) from public schools.

MEASURES

Self-report questionnaires were used to assess adolescents' sociodemographic factors, fruit/vegetable (F/V) intake and physical activity. Participants' weight, height, waist circumference (WC), hip circumference and body fat percentage (%BF) were measured, and waist-to-height ratio (WHtR), waist-to-hip ratio (WHR) and body mass index (BMI) were calculated. Overweight/obesity was determined by BMI ≥85th percentile for age, abdominal obesity (AO) (WC, WHtR and WHR) and %BF.

RESULTS

A total of 34.7% of participants were overweight/obese (BMI ≥85th percentile) and 378 (40.6%) had high %BF. AO was noted in 47.3%, 22.7% and 27.1% of participants, based on WC, WHR and WHtR, respectively. Significantly more participants from public schools were overweight/obese (37.8% vs 31.1%) and had greater AO (based on WC, WHR, WHtR) compared with those from private schools. Predictors of obesity based on BMI were: consuming less than five servings of F/V (adjusted OR (AOR) 2.41, 95% CI: 1.73 to 3.36), being physically inactive (AOR 2.09, CI: 1.36 to 3.22) and being men (AOR 3.35, 95% CI: 2.20 to 5.10). Predictors of AO were being men (WC: AOR 1.42, 95% CI: 1.01 to 2.00; WHtR: AOR 2.72, 95% CI: 1.81 to 4.08); studying at public school (WHR: AOR 1.67, 95% CI: 1.06 to 2.66); being Emirati (WHR: AOR 0.62, 95% CI: 0.43 to 0.90); consuming less than five servings of F/V (WC: AOR 1.71, 95% CI: 1.27 to 2.30; WHtR: AOR 1.46, 95% CI: 1.05 to 2.03), and being physically inactive (WC: AOR 1.63; 95% CI: 1.13 to 2.35).

CONCLUSIONS

Focused interventions are needed to combat obesity while considering AO indicators and BMI to diagnose obesity in adolescents.

Overnutrition and Associated Factors: A Comparative Cross-Sectional Study between Government and Private Primary School Students in Gondar Town, Northwest Ethiopia

Introduction

Childhood overnutrition is a public health problem in low- and middle-income countries because its effect is likely to progress into adulthood that results in developing noncommunicable diseases at a younger age. There is no such previous comparative study that investigated this issue. Therefore, the aim of this study is to assess the prevalence and associated factors of overnutrition among government and private primary school students in Gondar town, northwest Ethiopia.

Methods

Institution-based comparative cross-sectional study was conducted from March 5 to April 9, 2019. A multistage sampling technique was used to select 736 participants. Data were collected through face-to-face interview. Data was entered into EPI-info version 7.2.1.0 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regressions were carried out to identify associated factors with overnutrition. Statistical significance was declared using p value< 0.05.

Results

The overall prevalence of overnutrition was 9.1%. The prevalence was higher among private schools (51 (14%)) than government (16 (4.3%)). Eating habit while watching television (AOR = 4.08, 95%CI: 1.10–15.16) and not having close friend (AOR = 3.72, 95%: CI: 1.21–2 11.48) were significantly associated with overnutrition in the government schools, while no father education (AOR = 2.59, 95%:CI:1.05–6.39), sweet food preference (AOR = 2.86, 95%:1.19–6.87), fat consumption more than three days per week (AOR = 3.79, 95%CI:1.61–8.91), eating habit while reading (AOR = 4.95, 95%CI:2.29–10.70), and vigorous-intensity sports (AOR = 2.23, 95%:1.02–4.86) were associated with overnutrition in private schools.

Conclusion

Prevalence of overnutrition was higher among private than government schools. Hence, it requires attention through creating awareness about healthy diet, healthy lifestyle, and physical activity in collaboration with health and education sectors.

Contribution of Home and School Environment in Children's Food Choice and Overweight/Obesity Prevalence in African Context: Evidence for Creating Enabling Healthful Food Environment

This review aimed primarily to investigate the current trends of overweight and obesity in school children in the African context, secondly to explore the contribution of home and school environments on the children’s food choices and lastly suggesting measures for creating a healthier food environment. Despite the increase in overweight and obesity among school children, empirical evidence on their determinants in the African context is scarce, thus calls for consideration of home and school environments. A literature search was conducted between October and December 2018 using Medline (PubMed), Directory of Open Access Journals, Google Scholar, manual search and “grey” literature. This review included articles published between the 1st January 2008 and 30th June 2018. Out of 343 articles, 49 were included for the full text reading after meeting the inclusion criteria. Five reports from grey literature were also included. Results show that the prevalence of overweight and obesity among school children in Africa is increasing and ranges from <5% to >40% in the 10-year period in which the review was taken. High socio-economic status, urban residence and female gender predicted higher prevalence of overweight/obesity. Few reviewed articles on the contribution of home and school environments on children’s food choices showed a shred of evidence, thus calls for further research to address this gap. This review found an increasing prevalence of overweight and obesity in school children in Africa. Therefore, further investigation of home and school environment is imperative to curb the increase in the magnitude of overweight and obesity.

Association of Hypertension and Obesity with Risk Factors of Cardiovascular Diseases in Children Aged 6-9 Years Old in the Eastern Cape Province of South Africa

Cardiovascular disease (CVD) risk factors are known to begin early in life, but limited data on the relationship of obesity and hypertension with other known CVD risk factors, such as endothelial dysfunction, oxidative stress, and chronic low-grade inflammation is available on children. In this cross-sectional study involving 6–9 years old school children aged from the Eastern Cape Province of South Africa the relationship between obesity/hypertension and other risk factors for CVDs was investigated. General anthropometric parameters were measured, followed by blood pressure (BP) measurements and pulse wave velocity (PWV). Urine samples were collected for the determination of albumin, creatinine, asymmetric dimethylarginine (ADMA), 8-hydroxy-2deoxyguanosine (8-OHdG), and thiobarbituric acid-reactive substance (TBARS). Overweight/obesity (19.28%) and pre-hypertension/hypertension (42.16%) were prevalent in children. Mid-upper arm circumference (MUAC), a marker of obesity, was positively correlated with ADMA, while ADMA and PWV were significantly different (p < 0.05) between hypertensive and normotensive children. Also, TBARS and 8-OHdG were significantly (p < 0.05) increased in hypertensive subjects. Creatinine was significantly (p < 0.05) increased in obese, as well as in hypertensive children, and positively associated with waist circumference (WC) and neck circumference (NC). In conclusion, obesity and hypertension were associated with renal-cardiovascular disease risk, while oxidative stress showed a possible association with obesity in 6 to 9 year old South African children of African descent. This suggests that South African children of African descent may be becoming more prone to developing CVDs, and therefore may require early intervention for the prevention of CVDs in the near future.

Overweight/obesity and associated cardiovascular risk factors in sub-Saharan African children and adolescents: a scoping review

INTRODUCTION

Recently, childhood and adolescence overweight/obesity has increased disproportionately in developing countries, with estimates predicting a parallel increase in future cardiovascular disease (CVD) burden identifiable in childhood and adolescence. Identifying cardiovascular risk factors (CVRF) associated with childhood and adolescence overweight/obesity is pivotal in tailoring preventive interventions for CVD. Whilst this has been examined extensively in high-income countries, there is scant consistent or representative data from sub-Saharan Africa (SSA).

OBJECTIVE

This scoping review synthesises contemporary studies on CVRF associated with overweight and obesity in SSA children and adolescents to provide evidence on the current burden of overweight/obesity and CVD in this population.

METHODS

We searched MEDLINE and Google Scholar up to July 31, 2019 for observational and experimental studies and systematic reviews addressing childhood and adolescence overweight/obesity and CVRF in SSA without language restriction. Four investigators working in four pairs, independently selected and extracted the relevant data. The methodological quality of all included studies was assessed.

RESULTS

We included 88 studies with a total of 86,637children and adolescents from 20 SSA countries. The risk of bias was low in 62 (70.5%), moderate 18 (20.5%), and high in eight (9%) studies. Overweight/obesity in SSA children and adolescents is rising at an alarming rate. Its main associations include physical inactivity, unhealthy diets, high socio-economic status, gender and high maternal body mass index. Identified CVRF in overweight/obese SSA children and adolescents are mainly metabolic syndrome, hypertension, dyslipidaemia, diabetes and glucose intolerance. There is a dearth of guidelines or consensus on the management of either childhood overweight/obesity or CVRF in overweight/obese SSA children and adolescents.

CONCLUSION

The current findings suggest an urgent need to review current health policies in SSA countries. Health education and transforming the current obesogenic environment of the SSA child and adolescent into one which promotes physical activity and healthy dietary habits is required.

Prevalence of obesity and its risk factors among school children in Karachi, Pakistan

A cross-sectional questionnaire study was conducted during 2012 in private and public-sector schools of Karachi to determine the prevalence and factors influencing overweight and obesity among school children (aged 11-15 years). Sociodemographic characteristics and dietary habits were explored. The CDC Growth Chart was used to record height and weight. Of a total of 887 children, being overweight and frankly obese was found in 169 (19.1%) and 96 (10.8%), respectively. Of these, 176 (66.4%) were from private schools, and significant associations were found in 202 (76.2%) who were spending > 2 h/day watching television and 139 (52.5%) sleeping > 8 h/day.

Overweight/obesity among school aged children in Bahir Dar City: cross sectional study

BACKGROUND

Developing countries, including Ethiopia are experiencing a double burden of malnutrition. There is limited information about prevalence of overweight/obesity among school aged children in Ethiopia particularly in Bahir Dar city. Hence this study aimed to assess the prevalence of overweight/obesity and associated factors among school children aged 6-12 years at Bahir Dar City, Northwest Ethiopia.

METHODS

A school based cross-sectional study was carried out. A total of 634 children were included in the study. Multi stage systematic random sampling technique was used. A multivariable logistic regression analysis was used to identify factors associated with overweight/obesity. The association between dependent and independent variables were assessed using odds ratio with 95% confidence interval and p-value ≤0.05 was considered statistically significant.

RESULTS

The overall prevalence of overweight and/or obesity was 11.9% (95% CI, 9.3, 14.4) (out of which 8.8% were overweight and 3.1% were obese). Higher wealth status[adjusted OR = 3.14, 95% CI:1.17, 8.46], being a private school student [AOR = 2.21, 95% CI:1.09, 4.49], use of transportation to and from school [AOR = 2.53, 95% CI: 1.26,5.06], fast food intake [AOR = 3.88, 95% CI: 1.42,10.55], lack of moderate physical activity [AOR = 2.87, 95% CI: 1.21,6.82], low intake of fruit and vegetable [AOR = 6.45, 95% CI:3.19,13.06] were significant factors associated with overweight and obesity.

CONCLUSION

This study revealed that prevalence of overweight/obesity among school aged children in Bahir Dar city is high. Thus, promoting healthy dietary habit, particularly improving fruit and vegetable intake is essential to reduce the burden of overweight and obesity. Furthermore, it is important to strengthen nutrition education about avoiding junk food consumption and encouraging regular physical activity.

The Emerging Nutritional Problems of School Adolescents: Overweight/Obesity and Associated Factors in Jimma Town, Ethiopia

BACKGROUND

Globally, overweight is rapidly becoming one of the most important medical and public health problems. Adolescent obesity is a multisystem disease with potentially devastating consequences that persist into adulthood. However, there is a paucity of available information regarding the adolescent overweight and obesity in Ethiopia, particularly in the study area.

METHODS

A school-based cross-sectional study was conducted from March to April/2015 among 546 adolescents. Study participants were selected using a multi-stage, stratified random sampling method. An interviewer administered questionnaire was used to collect data. Multivariable logistic regression analysis was used to identify independent predictors of overweight and obesity at 95% confidence intervals.

RESULTS

The mean dietary diversity score of school adolescents was 6.97±1.15. Cereal based diets (99.6%) and vegetables (73.9%) are the two common foods of adolescents. The prevalence of overweight/obesity was 13.3%. Overweight/Obesity was significantly associated with being a female (AOR=3.57 [95% CI:1.28-9.9]), attending private schools (AOR=7.53 [2.51-22.3]), lack of paternal education (AOR=5.57 [95% CI:1.53-20.26]), wealthy households (AOR=3 [95% CI:1.09-8.26]) and not being a vegetarian (AOR=9.23 [95% CI:1.68-50.8]). Adolescents who are physically inactive (AOR=3.7 [95% CI:1.06-13.02]) and those with sedentary lifestyles (AOR=3.64 [95% CI:1.39-9.5]) were more obese compared to their counter peers.

CONCLUSIONS

The proportion of overweight/obesity among school adolescent was considerably high. Being a female, learning in private school, high household economic status, not being a vegetarian and having a sedentary life were significantly associated with overweight/obesity.

PRACTICE IMPLICATIONS

Findings of this study can be used to guide the development of programs aimed at preventing overweight/obesity in Ethiopia by informing policymakers and other stakeholders about this emerging nutrition-related problem among school adolescents.

Perceived Body Image, Eating Behavior, and Sedentary Activities and Body Mass Index Categories in Kuwaiti Female Adolescents

Background. The State of Kuwait has a growing obesity epidemic in both genders and all age groups; however, obesity rates in the young seem to be rising. Methods. We conducted a cross-sectional survey in 169 Kuwaiti female adolescents attending both private and public schools spanning the six governorates in the State of Kuwait in order to explore female adolescents' self-image, body dissatisfaction, type of school (private versus public), TV viewing, and computer games and their relationship to body mass index. Results. Approximately half the students classified as obese perceived their body image to lie in the normal range. Females in the obese category were the most dissatisfied with their body image, followed by those in the overweight category. Eating behavior, level of physical activity, school type, television viewing, computer/video usage, and desired BMI were not significantly associated with level of obesity. Conclusion. This study was one of the few studies to assess adolescent females' body image dissatisfaction in relation to obesity in the State of Kuwait. The results suggest that including body image dissatisfaction awareness into obesity prevention programs would be of value.