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Many Lankan kids having junk food for breakfast: Study

09 Apr 2021

The prevalence of being underweight remains a major nutritional problem among adolescent schoolchildren in the Ratnapura District, while a high percentage of students who consumed junk food as their breakfast suffered from being overweight and obesity, all of which are conditions increasing at an alarming rate. There was also a negative relationship between the body mass index (BMI) of students and their physical activity. This was noted in an article titled “Junk Food Consumption, Physical Activity, and the Nutritional Status of Adolescent Schoolchildren: A Case Study in the Ratnapura District”, authored by U.L.N.S. Ekanayake (attached to the Postgraduate Institute of Agriculture of the University of Peradeniya) and D.G.N.G. Wijesinghe (attached to the Department of Food Science and Technology of the Faculty of Agriculture of the University of Peradeniya) and published recently in the Tropical Agricultural Research Journal. According to the World Health Organisation (WHO), recently, the incidences of being overweight and of obesity have dramatically risen in low and middle-income countries. The nutritional transition in developing countries has shifted people from their traditional diet based on cereals, legumes, vegetables, and fruits to an energy-dense diet, rich in saturated fatty acids, salt, and sugar. This is associated with the changes in the socioeconomic status of society, which has created significant changes in the lifestyles of adults as well as children. In addition to changing the dietary patterns, according to the WHO, increased time spent on sedentary activities has become a major factor in causing childhood obesity. Being overweight and obesity have a close relationship with non-communicable diseases (NCDs) such as diabetes, blood pressure, asthma, low back pain, and depression. The lack of physical activity such as prolonged television viewing and playing computer games, as well as nutritional factors such as the consumption of junk food and calorie-dense food, along with a family history of obesity, are the main causes of being overweight and of obesity among young individuals. Junk food contains a high energy content that causes a reduction in appetite. The free availability of junk food in the market, low prices, attractive advertisements and packaging, and the lack of parental awareness are the main causes of children’s tendency to consume them. Sri Lanka is a developing country in South Asia with a lower middle-income status. It has been reported by local researchers that the prevalence of being overweight and of obesity among the adult population in Sri Lanka was 25.2% and 9.2%, respectively. A study conducted in the urban areas of Colombo showed that after the application of the Asian BMI cut offs, the respective prevalence of being underweight, being of normal weight, being overweight, and obesity were 7.7%, 26.8%, 34.3%, and 31.2%, respectively. It was predicted that being overweight will account for 18-40% of diet-related chronic diseases and 20.9% of all deaths by 2025. According to the Food and Nutrition Policy of Sri Lanka (2004-2010), the majority of national public health programmes and research on children have focused on the undernutrition status while the overnutrition problem has not been adequately addressed. The Ratnapura District consists of wealthy communities compared to many other parts of the country. However, both overnutrition and undernutrition are seen among adolescent schoolchildren in the said district. Among the meals consumed during the day, breakfast is an important meal which supplies an optimum intake of nutrients. Contents of breakfast also have shown a strong relation to the prevalence of being overweight and obesity. Adolescent schoolchildren of 12-14 years of age have shown an increase in being overweight and obesity compared to primary school children. Furthermore, adolescents can be considered to have a better understanding and are relatively independent when it comes to food selection compared to primary children. During the pretesting of the questionnaire for this study, it was found that the study sample consumed junk food mostly during breakfast than during other main meals, the most common reason being the lack of time for parents to prepare breakfast at home. A cross-sectional study was conducted in September 2019 with students of four mixed schools in the Ratnapura District. They showed a fair representation of all social levels. All students whose ages were in the range of 12-14 years and were present in school on the day of the survey were considered as eligible subjects. A total of 425 students participated in the study. A self-guided questionnaire was requested to be filled by the students. It contained questions on behaviour, breakfast, and socioeconomic factors. Prior to the preparation of the final questionnaire, an exploratory survey was conducted as a pretest with 25 randomly selected students to identify the different types of junk food consumed and the factors that are likely to influence the consumption of junk food. The height and weight of the students were measured. Lifestyle practices were assessed using a pretested questionnaire which covered all domains of physical activity including transport, household, fitness, and sports, representing light, moderate, and vigorous-intensity physical activities. Light intensity physical activities included slow walking. Moderate intensity physical activities included normal-paced walking, brisk walking, recreational swimming, household activities, and recreational sports such as volleyball and badminton. Vigorous-intensity physical activities were stair climbing, jogging, running, cycling, and active sports such as basketball. The questionnaire allowed the calculation of the total energy expenditure per week based on metabolic equivalent (MET-min – amount of energy expended during a minute while at rest) values of all types of physical activities reported by each participant. To measure the participant’s level of physical activity, the total MET-min/week was used. The classifications adapted for activity levels in this study were based on two cut off points of 30 and 60 minutes per day of at least a moderate level of physical activity. The daily 60 minutes of at least a moderate level of physical activity was based on the 2010 physical activity recommendations by the WHO. This was then converted into three activity categories based on the total MET minute/week as follows: Active MET-min/week (60 minutes into seven days into four METs – equal to 1,680), and the minimally active category was assigned if the MET-min/week ranged between 840 (30 minutes into seven days into four METs) and 1,680, whereas the inactive category was assigned if it was less than 840 MET-min/week. The term junk food was used to describe food and drinks low in nutrients (e.g. protein, vitamins, minerals, and fibre) and high in energy, saturated fat, added sugar and/or added salt with or without other additives. Junk food contributes to a nutritionally imbalanced diet and regular consumption is known to cause NCDs in the long run. According to the results of the pretested questionnaire, the extensively consumed junk food by students in the study area included a variety of short eats (e.g. rolls, cutlets, wade, samosa, etc.), candies, French fries, different types of sweets and cookies, ice cream, chips, and deep fried street foods like bite mixtures. The parents’ awareness of junk food consumption by their children was obtained from the responses given by the student participants. Of the 425 students recruited to the study, only 300 students completed the questionnaire. A significant difference in weight, height, and BMI between boys and girls was not observed in the study sample. Furthermore, a significant difference in the energy expenditure was also not observed between boys and girls. According to the BMI status of the students, more than half (55%) were in the normal BMI range. Although nearly half of the adolescent schoolchildren suffered from nutritional issues, conditions such as obesity and being overweight were slightly higher (24%) than the condition of being underweight (21%). A study conducted in an urban area in Colombo using Grade Six to Seven schoolchildren reported that they suffered from conditions such as obesity or being overweight because they were addicted to an inactive lifestyle. From the pretest of the survey, it was revealed that most students consumed junk food for their breakfast rather than for lunch or dinner. When students were asked to respond to junk food consumption as an alternative to their breakfast, 22% reported that they consumed junk food five to six times per week while the majority (44.7%) reported that they consumed junk food sometimes (two to three times per week). The rest of the students (33.3%) did not consume junk food as their breakfast. There were two main reasons for consuming junk food by the respondents: Firstly, facing a tight schedule with their studies during the day and hence not having enough time to eat a proper meal, and secondly, when their parents did not wake up early enough in the morning to prepare breakfast. Those who did not consume junk food stated that their parents were strictly against the consumption of junk food and hence the parents prepared breakfast for children. According to literature, a common reason motivating students to consume junk food was that most students receive money from their parents to take the morning meal from the cafeteria. The majority of the participants who consumed junk food believed that junk food provides them with a pleasant feeling due to their deliciousness. When the students were asked to select the factor that influenced them in selecting the type of junk food, 73% opted for taste, 13.7% for saving time, 7.7% for the low price, and 6% for other reasons. According to literature, taste is the most critically influencing factor because students get addicted to the artificial taste of junk food. Breakfast-skipping was associated with gaining weight, obesity, and addiction to unhealthy dietary habits including more frequent junk food consumption. The students also considered the convenience of junk food as an attraction to them: They were relatively affordable, and quick and easy to consume. Furthermore, the participants mentioned that the variety of flavours and colours of junk food are other factors motivating consumption. Additionally, social norms and friendship were also expressed as motivating factors for junk food consumption. Some participants stated that they ate junk food unwillingly, but simply as a measure of maintaining social harmony with their friends. The majority of obese (76%) and overweight (67%) children consumed junk food as the morning meal. There was a statistically significant difference between the status of being obese, underweight, and overweight with the consumption of junk food for breakfast, indicating that students who consumed a higher amount of junk food for breakfast have a higher BMI than those who consumed junk food very rarely for breakfast. Thus, there was a clear relationship between junk food consumption at breakfast and the BMI among adolescent students. A total of 87% of the respondents said their parents were aware of their junk food consumption habits. A few students (8%) said that they did not have an idea regarding their parents’ awareness about their junk food consumption. Other respondents (5%) said that their parents were unaware of their junk food consumption, implying that they consumed it secretly, unbeknownst to their parents. The majority of the students (72%) correctly identified junk food as being unhealthy. They were aware that junk food may lead to depression in teenagers, increase in body weight, impaired digestion, and increase in the risk of heart and kidney diseases and cancer. A few students (28%) believed that junk food was healthy food, good for bodily functions. Therefore, the adolescent students in this area had fair knowledge about a healthy and unhealthy diet. The majority (54.3%) of the students mentioned that they check the label containing nutrient facts because they want to know the contents of the food. Some students (34.7%) only occasionally checked the nutrient fact panel. Due to the fact that they mostly consumed junk food either at school or in the street, a minority of students (11%) said that they did not check the nutrient contents or ingredients in the labels at all. Foreign researchers have reported that individuals with a low intake of fat have an idea about nutrition labels. According to other foreign researchers, many teenagers had a general idea that junk food is unhealthy but lacked specific knowledge about the ingredients, preservatives, and chemicals used in junk food and their respective safety levels. However, in the present study, awareness of the participants about the ingredients in the labels could be considered as satisfactory. The results revealed that the majority of the students agreed to the fact that they were not eating right but felt that the diet is not of much importance and that they were too busy to think much about food. This study indicated that 64% and 35.6% of inactive students suffered from obesity and being overweight, respectively. A higher percentage of obese students were physically inactive compared to students who were overweight or normal. Minimally active and inactive groups were combined as less active students and accordingly, 40.4% normal weight children and 67.6% underweight children were less active whereas 96% obese and 91.2% overweight children were less active. According to the results, a clear relationship could be established between the BMI of the students and the physical activity level. Thus, there was a clear relationship between the level of physical activity of the students and their BMI. Literature reported a similar, statistically significant relationship between the BMI status and the physical activity level among schoolchildren aged 14-15 years in the Kalutara District. The study further indicated a linear association between energy expenditure and the BMI value. There is a negative correlation between the BMI and energy expenditure.


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