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DIETARY PATTERNS AND RISING OBESITY RATES AMONG ADOLESCENTS: EVIDENCE FROM UNIVERSITY COLLEGE HOSPITAL IBADAN

ABSTRACT

The global epidemic of adolescent obesity has reached alarming proportions, with Nigeria increasingly reflecting international trends of rising overweight and obesity prevalence among young people. This study investigates the relationship between dietary patterns and obesity rates among adolescents attending the University College Hospital (UCH) Ibadan. A cross-sectional study was conducted involving 380 adolescents aged 10–19 years, with data collected through validated 24-hour dietary recall instruments, the Diet Quality Index, anthropometric measurements, and a structured sociodemographic questionnaire. Recommendations for school-based nutrition education, family-level dietary counselling, and national food policy reform. This study contributes valuable evidence to the growing discourse on paediatric nutrition and non-communicable disease prevention in Nigeria.

 

1.0 INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Being the stage of development that is characterized by the rapid changes in physical, psychological, and behavioural aspects, adolescence as the period between the ages of 10 and 19 is a critical development phase that can be subjected to nutritional interventions (WHO, 2020). Eating habits that are developed in adolescence stage are likely to persist well into adulthood, making the period crucial in the prevention of diet-related non-communicable diseases such as type 2 diabetes, cardiovascular disease, and some kinds of cancers (Craigie et al., 2011).

Adolescent obesity has become one of the most characteristic of the twenty-first century public health emergency complexes, an integrated mix of genetic predisposition, environmental factors, socioeconomic determinants, and behavioural factors centred primarily around diet and physical activity (Lobstein et al., 2015). According to the World Health Organization (WHO), the number of obese children and adolescents aged 5 to 19 years has increased more than tenfold globally over the last four decades, between 11 million in 1975 to 124 million in 2016, and an extra 216 million are overweight (WHO, 2017). Due to rapid urbanisation, westernisation of dietary habits, and adoption of the sedentary lifestyle, this epidemiological transition that was formerly mostly related to high-income countries has increasingly become evident in low- and middle-income countries (LMICs), including Nigeria (Abodunrin et al., 2021).

The situation with the nutrition landscape among adolescents in Nigeria is characterised by a paradoxical dual burden of malnutrition: undernutrition remains prevalent among rural and economically disadvantaged populations, whereas overnutrition and obesity are becoming common among urban and peri-urban youth with more access to calorie-dense and nutrient-poor foods (Ene-Obong et al., 2017). Changes in the diet habits of adolescents have been marked by urbanisation of contexts and, in particular, in southwestern Nigeria (Sobngwi et al., 2002; Ukegbu et al., 2017).

As a leading tertiary healthcare provider and an academic centre of excellence in medical research, the University College Hospital (UCH) Ibadan started as the first teaching hospital in Nigeria in 1957. UCH is an institution at the heart of diverse adolescent population including students of both the public and private schools, children of civil servants, traders, and professionals located in the capital of Oyo State Ibadan and one of the largest urban centres of the country. The rapid urbanisation of Ibadan, the changing food environment and the shifting dietary habits of young people in the country make it a critical site in the investigation of the dietary-obesity nexus in Nigerian adolescents.

Compared to the individual food items or nutrients, dietary patterns offer a more holistic approach to understanding the dietary-disease relationship, and are gaining increasing popularity in nutritional epidemiology due to their ability to capture the synergistic effects of multiple dietary components consumed jointly (Hu, 2002). Among the Nigerian adolescents, research findings have identified specific clusters of dietary patterns, such as traditional and western patterns, with western dietary patterns characterised by high intakes of refined carbohydrate, animal protein, and processed foods with stronger associations with the adiposity outcomes (Okuneye et al., 2023). This paper thus discusses the correlation of diets and increased adolescent obesity among students in UCH Ibadan.

Adolescents in Nigeria are exposed to a complex nutrition environment, which is characterized by poverty, cultural food standards, rapid urbanisation, aggressive product marketing of unhealthy foods, and lack of access to nutrition education (Nigeria, 2021). The increasing prevalence of fast foods outlets, convenience stores, street vendors, and supermarkets with high stocks of ultra-processed foods have transformed the food environment of the city of Ibadan and other major cities in Nigeria, making them what public health scholars have dubbed as obesogenic environments (Swinburn et al., 2011).

Several national/regional surveys have reported increasing rates of overweight and obesity among Nigerian children and adolescents. The National Nutrition and Health Survey (NNHS, 2018) reported a prevalence of 5.2% and 2.5% prevalence of overweight and obesity respectively in children below five, and higher rates were expected in older adolescents residing in urban areas. A systematic review by Olutende et al. (2022) found prevalence rates of adolescent obesity in Nigeria varying between 3.2% and 22.4% across studies, with a large range due to geographic setting, characteristics of study population and methods of measurement.

Anecdotally, the Paediatric Endocrinology and Adolescent Medicine clinics report anecdotal increases in the number of adolescent patients presenting with obesity-related complications including hypertension, insulin resistance, and non-alcoholic fatty liver disease. Together with the recorded shifts in the food environment in Ibadan, this clinical observation is quite convincing, as an argument to support a systematic study of dietary habits and obesity in this context.

1.2 STATEMENT OF THE PROBLEM.

Although there is a growing global and regional interest in the problem of obesity in adolescents, the particular relationships between dietary patterns and obesity outcomes in adolescents in Ibadan and southwestern Nigeria has not yet been characterised sufficiently. Most of the current Nigerian researches on adolescent nutrition have been on undernutrition, stunting, and micronutrient deficiencies, with relatively little focus on the overnutrition, the other end of the malnutrition spectrum. Moreover, the limited research that has been done to explore adolescent overweight and obesity in Nigeria has typically been done using simple food frequency questionnaires and not using comprehensive dietary pattern analyses, which only limit the power of their explanations.

No published study has undertaken a systematic examination on the dietary pattern of adolescents attending UCH Ibadan in particular, and the relationship between such relationship and measured anthropometric outcomes using validated dietary assessment tools. This gap implies that the paediatric and adolescent health practitioners in the hospital have no specific evidence base that they can use to design and implement facility-based dietary counselling and obesity prevention programmes specific to their patients.

The rising consumption of ultra-processed foods and sugar-sweeter drinks among Nigerian adolescents due to the aggressive marketing of products and the shift of social norms about food, is a nutritional public health crisis that warrants urgent empirical investigation. The current research fills the aforementioned gap by presenting rigorous data on dietary patterns related to anthropometric results, which will be actionable evidence to be used by health practitioners, nutritionists, and policymakers.

1.3 OBJECTIVES OF THE STUDY

The broad objective of this study is to investigate the relationship between dietary patterns and obesity rates among adolescents at UCH Ibadan. The specific objectives are to:

1. Assess the prevalence of overweight and obesity among adolescents attending UCH Ibadan.
2. Characterise the predominant dietary patterns among adolescents in the study population.
3.  Determine the association between specific dietary patterns and anthropometric outcomes (BMI, waist circumference) among adolescents at UCH Ibadan.
4. Examine the socio-demographic and lifestyle factors that moderate the dietary pattern-obesity relationship in the study population.
5. Recommend evidence-based nutritional and public health interventions to address rising obesity rates among Nigerian adolescents.

 

1.4 RESEARCH QUESTIONS

The following research questions guide this study:

1. What is the prevalence of overweight and obesity among adolescents attending UCH Ibadan?
2. What dietary patterns are predominant among the study population?
3.  Is there a significant association between specific dietary patterns and obesity outcomes among adolescents at UCH Ibadan?
4. How do socio-demographic and lifestyle factors moderate the dietary pattern-obesity relationship in the study population?
5. What evidence-based interventions can effectively address rising adolescent obesity rates in Nigeria?

 

1.5 RESEARCH HYPOTHESES

The following null hypotheses guide the statistical analyses:

H01: There is no significant association between western dietary patterns characterised by high ultra-processed food intake and obesity prevalence among adolescents at UCH Ibadan.

H02: There is no significant difference in obesity prevalence between adolescents with high and low consumption of sugar-sweetened beverages.

H03: There is no significant relationship between socio-demographic factors (gender, age group, family income) and dietary patterns among adolescents in the study population.

 

1.6 SIGNIFICANCE OF THE STUDY

This study makes a substantial contribution to nutritional epidemiology and public health practice in Nigeria. By generating comprehensive dietary pattern data linked to obesity outcomes among UCH Ibadan adolescents, the study provides a strong evidence base for the development of targeted, culturally appropriate nutrition education programmes at the facility and community levels. The findings will be directly applicable to the work of dietitians, paediatricians, and public health nurses at UCH and other teaching hospitals across Nigeria.

From a policy standpoint, the study’s findings will inform advocacy for regulatory measures addressing the marketing of unhealthy foods to children and adolescents, fiscal policies such as sugar-sweetened beverage taxes, school nutrition standards, and the integration of nutrition education into the Nigerian school curriculum. The evidence will be relevant to the Federal Ministry of Health, the Federal Ministry of Education, and national nutrition bodies including the Nutrition Society of Nigeria.

Academically, the study contributes a rigorous methodological approach to adolescent dietary pattern research in Nigeria, utilising validated instruments and robust statistical methods that can serve as a model for future nutritional epidemiology studies in the country. It also contributes to the growing international literature on the nutrition transition in Africa.

 

1.7 SCOPE OF THE STUDY

This study is limited to adolescents aged 10–19 years attending outpatient clinics at the University College Hospital, Ibadan, during the period from February to July 2023. The study focuses on dietary patterns and their association with overweight and obesity as measured by BMI-for-age and waist circumference. Physical activity levels are assessed as a confounding variable but are not the primary focus of the study. The cross-sectional design limits causal inference, and findings are specific to the UCH Ibadan setting, though they may have broader relevance for urban adolescent populations in southwestern Nigeria.

 

1.8 DEFINITIONS OF TERMS

Adolescent: An individual aged between 10 and 19 years, as defined by the World Health Organization.

Dietary Pattern: The quantity, proportion, variety, and combination of different foods and beverages in diets, and the frequency with which they are habitually consumed, characterised through statistical methods such as principal component analysis or cluster analysis applied to dietary data.

Obesity: Abnormal or excessive fat accumulation that presents a risk to health, operationally defined for adolescents using BMI-for-age z-scores at or above the 95th percentile based on the WHO growth reference (2007).

Overweight: BMI-for-age z-scores at or above the 85th percentile but below the 95th percentile based on WHO growth reference (2007).

Ultra-processed Foods: Foods that undergo extensive industrial processing and contain substances not typically found in home kitchens, as defined by the NOVA food classification system.

Sugar-Sweetened Beverages (SSBs): Liquids sweetened with various forms of added sugars, including carbonated soft drinks, fruit juices, energy drinks, and flavoured milk products.

Nutrition Transition: The shift in dietary patterns from traditional, plant-based diets toward energy-dense, nutrient-poor western-style diets, typically associated with economic development and urbanisation.

 

REFERENCES

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Craigie, A. M., Lake, A. A., Kelly, S. A., Adamson, A. J., & Mathers, J. C. (2011). Tracking of obesity-related behaviours from childhood to adulthood: A systematic review. Maturitas, 70(3), 266–284. https://doi.org/10.1016/j.maturitas.2011.08.005

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