| BackgroundAs a developing country with fast development in economy and large number of population,China faces double burdens of rapidly increasing in overweight and obese children and adolescent and slowly decreasing in underweight children and adolescent.How to analysis the existing problems in development of spirit and body for children and adolescent and its influencing factors and take efficient measures to guide them growing up healthily is important public and social problems for us to solve urgently.The past studies in this field seldom overall access epidemic status of underweight,overweight,and obesity for children and adolescent and related factors need to be studied deeply.The past studies also seldom focus on effects of underweight,overweight,and obesity on mental health especially in self esteem among children and adolescent.ObjectiveWe chosen the students aged 12-14 years in urban Chenzhou,Hunan Province as study sample to arrive three goals:1.To assess the prevalence of underweight,overweight,and obesity among students aged 12-14 years in Urban Chenzhou,Hunan Province. To study the distributions of blood pressure(BP) among different groups.2.To separately assess the risk factors and protective factors of underweight,overweight,and obesity among students aged 12-14 years from four domains which include biological factors,behavior and lifestyle,social environment and medical care demand and utilization.3.To evaluate effects of underweight,overweight,and obesity on mental health especially self esteem among students.All what we do above are to provide bases for future researches.MethodsWith cross-sectional design and through cluster sampling randomly, A total of 2042 students(1088 for boys,954 for girls) aged 12-14 years from 3 middle schools in Urban Chenzhou were investigated by questionnaire and physically measured by height,weight,waist circumference(WC),and hip circumference(HC) in April,2007.The questionnaire was designed to include the items related to four domains which included biological factors,behavior and lifestyle,social environment,medical care demand and utilization,and psychological test tools included self esteem scale(SES),self rating anxiety scale(SAS), and self rating depression scale(SDS).Body mass index(BMI) was calculated by weight in kilograms divided squared height in meters, waist-hip circumference ratio(WHR) by WC divided HC,and waist-height ratio(WHTR) by WC divided height.Overweight and obesity were categorized with body mass index(BMI) cutoffs from Working Group of Obesity in China(WGOC) and underweight was categorized by the revised Chinese standards of weight-for-height.We used prevalence,constituent ratio or bar chart to describe the distributions of underweight,normal weight,overweight,and obese students.We separately acted underweight,overweight,and obese students as case and those normal weight students as control.Mono-factor logistic regression and multiple logistic regression were used to screen the significantly variables.At last,structural equation modeling(SEM) was used by AMOS(Analysis of Moment Structures ) 7.0 software to analysis relationships between overweight and obesity,anxiety,depression,and self esteem of students.Results1.Through cluster sampling randomly,2042 students aged 12-14 years(1088 for boys and 954 for girls) were investigated.2.The prevalence of underweight,overweight,and obesity among students aged 12-14 years in urban Chenzhou in 2007 were 17.5%,10.6% and 5.9%,respectively.The prevalence of underweight,overweight,and obesity for boys were 14.8%,13.1%and 7.4%,respectively.The prevalence of underweight,overweight,and obesity for girls were 20.0%, 7.8%and 4.2%,respectively.The prevalence of underweight,overweight, and obese students at age of 12 were 8.7%,11.2%and 7.1%,respectively. The prevalence of underweight,overweight,and obese students at age of 13 were 19.9%,10.3%and 5.6%,respectively.The prevalence of underweight,overweight,and obese students at age of 14 were 28.4%, 10.9%and 4.7%,respectively.3.The prevalence of underweight was lower in boys than girls (X~2=11.638,P=0.000) the prevalence of overweight was higher in boys than girls(X~2=15.528,P=0.000) and.the prevalence of obesity was higher in boys than girls(X~2=9.643,P=0.002).4.The prevalence of underweight among students increased with age (X~2=60.251,P=0.000).There were no significantly differences among overweight students at different age(X~2=0.387,P=0.824).There were no significantly differences among obese students in different age (X~2=2.167,P=0.339)5.The prevalence of students with hypertension was 4.7%(5.0%for boys and 4.3%for girls).There was no significantly differences between boys and girls(X~2=0.478,P=0.489).The prevalence of students with hypertension increased with weight(X~2=59.020,P=0.000).6.Multiple logistic regression showed that female students (OR=2.909,95%CI:2.048-4.133 ),elder students(OR=2.953,95%CI: 2.258-3.860,and slowly eating(OR=1.576,95%CI:1.207-2.059) were risk factors for underweight students.Multiple logistic regression also showed that mother with higher education level(OR=0.798,95%CI: 0.693-0.917 ),longer sleeping time daily(OR=0.798,95%CI: 0.644-0.990),and no food preference or choosy in food(OR=0.698, 95%CI:0.506-0.963) were protective factors for underweight students.7.Multiple logistic regression showed that elder father(OR=2.040, 95%CI:1.365-3.048),eating food made of bean frequently(0R=1.296, 95%CI:1.045-1.607),no fond of eating snack(OR=1.508,95%CI: 1.140-1.994),and no food preference or choosy in food(OR=1.548, 95%CI:1.098-2.183 ) were risk factors for overweight students.Multiple logistic regression also showed that female students(OR=0.613,95%CI: 0.434-0.866 ),not from one child family(OR=0.553,95%CI: 0.354-0.863),and thinner father(OR=0.565,.95%CI:0.429-0.744) were protective factors for overweight students.8.Multiple logistic regression showed that mother with higher educational level(OR=2.244,95%CI:1.466-3.436),no food preference or choosy in food(OR=2.298,95%CI:1.413-3.735),eating more food every meal(OR=1.611,95%CI:1.167-2.224),and not caring self health (OR=1.759,95%CI:1.294-2.391 ) were risk factors for obese students. Multiple logistic regression also showed that female students(OR=0.594, 95%CI:0.363-0.971 ) and not from one.child family(OR=0.229,95%CI: 0.103-0.509) were protective factors for obese students. 9.The mean scores of SES,SAS,and SDS were(25.56±2.90), (44.13±9.07) and(50.79±8.95),respectively.The mean scores of SES for both boys and girls were(25.61±3.11 ) and(25.12±2.54),respectively. The mean scores of SAS for both boys and girls were(43.73±8.60) and (44.69±9.26),respectively.The mean scores of SDS for both boys and girls were(50.47±8.74) and(51.25±8.91 ),respectively.10.For girls,the mean score of SDS was higher in underweight students than those normal weight students(t=-2.203,P=0.028 ).There no other significantly differences of SES,SAS,and SDS between underweight and normal weight students in same sex(P＞0.05).But the underweight students had more anxiety emotion than those normal weight students(X~2=5.496,P=0.019) and more depression emotion than those normal weight students(X~2=19.036,P=0.000).11.The mean scores of SES of male students with normal weight were higher than those overweight and obese students with same sex (F=16.343,P=0.000).The mean scores of SES of female students with normal weight were higher than those overweight and obese students with same sex(F=29.056,P =0.000).The mean scores of SAS of female students with normal weight were lower than those obese female students (F=7.606,P=0.000).The mean scores of SDS of female students with normal weight were lower than those overweight and obese female students(F=9.612,P=0.000).There no other significantly differences of SAS and SDS for boys between normal weight,overweight,and obese students(P＞0.05) But the overweight and obese students had more anxiety emotion than those normal weight students(X~2=9.388,P=0.009) and more depression emotion than those normal weight students (X~2=21.486,P=0.000)12.SEM showed that overweight and obesity had direct negative effect on students' self esteem(β=-0.212,P＜0.01) and no direct positive effect on students' negative emotion(β=0.000) Self esteem had direct negative effect on students' negative emotion(β=-0.216,P＜0.01) Overweight and obesity had indirect effect on students' negative emotion through self esteem pathway.Conclusions1.The prevalence of underweight,overweight,and obesity among students aged 12-14 years in urban Chenzhou in 2007 are 17.5%,10.6%, and 5.9%,respectively.The prevalence of underweight,overweight,and obesity for boys are 14.8%,13.1%,and 7.4%,respectively.The prevalence of underweight,overweight,and obesity for girls were 20.0%, 7.8%,and 4.2%,respectively.2.The prevalence of overweight and obesity is higher in boys than girls and the prevalence of underweight is lower in boys than girls.3.The prevalence of underweight increased with age.There were no significantly differences among overweight or obese students at different age.4.The prevalence of students with hypertension was 4.7%(5.0%for boys and 4.3%for girls).The prevalence of students with hypertension increased with weight.5.Biological factors,behavior and lifestyle,and social environmental factors especially family factors may have important influences on underweight,overweight,and obese students.6.Underweight,overweight,and obesity may have different effects on students',psychological status.7.Self esteem as a mediated variable may mediate the relationships between overweight and obesity and negative omotion.Innovation1.Having extended the domains of the study and research:We are from four domains which include biological factors,behavior and lifestyle,social environment,and medical care demand and utilization to assess the risk factors and protective factors of underweight,overweight, and obese students.2.Having chosen the control correctly:We have chosen the normal weight students as control to separately assess the risk factors and protective factors of underweight,overweight,and obese students.3.Having studied the risk factors and protective factors of overweight.4.Having adopted SEM:We have adopted the SEM to explore the direct and indirect effects of overweight and obesity on self esteem, anxiety,and depression among students.
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