Background: Obesogenic school environments may influence adolescent obesity, but evidence linking school-level obesogenicity with body composition remains inconsistent. This study examined associations between school obesogenicity and body composition (body fat percentage) among Indonesian high school students comparing public and private schools.
Methods: In a cross-sectional study, 282 students (193 public; 89 private) were selected by multistage sampling. School obesogenicity was assessed using the School Obesogenic Environment Score (SOES) across seven domains. Body fat percentage was estimated using bioelectrical impedance analysis. Group differences were tested using t-tests and chi-square tests, and effect sizes with 95% confidence intervals were calculated. Because obesogenic exposure was measured at the school level in only two schools, no individual-level regression of body composition on school exposure was undertaken.
Results: The public school had a higher SOES than the private school (1291 vs. 352), mainly driven by the food environment domain. Private school students had a higher mean body fat percentage than public school students (30.26±12.15% vs. 25.49±10.86%; p=0.002) and a higher prevalence of overweight/obesity (30.3% vs. 18.1%; p=0.032). The direction of the school-level contrast was opposite to that of obesogenic exposure; while the school with the higher SOES had students with the lower mean body fat percentage (mean difference of 4.77 percentage points, 95%CI of 1.79 to 7.75).
Conclusion: Differences in adolescent body composition were not explained by school obesogenicity alone. It seems prevention measures should combine school-based interventions with broader socioeconomic and lifestyle-focused approaches.