The Association between School Obesogenicity and Body Fat Percentage among High School Students in Indonesia

Document Type : Original Article

Authors

Department of Nutrition Science, Faculty of Public Health, Hasanuddin University, Makassar, South Sulawesi, Indonesia

10.30476/ijns.2026.110165.1633

Abstract

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.

Highlights

Laksmi Trisasmita (Google Scholar)

Keywords


  1. World Health Organization. Obesity and overweight: fact sheet. Geneva: World Health Organization; 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  2. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes. 2011;35:891-898. DOI:10.1038/ijo.2010.222. PMID:20975725.
  3. Park MH, Falconer C, Viner RM, et al. The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev. 2012;13:985-1000. DOI:10.1111/j.1467-789X.2012.01015.x. PMID:22731928.
  4. Masoumi SJ, Nekooeian AA, Tanideh N, et al. Effect of allium porrum on streptozotocin-induced diabetes mellitus hyperglycemia and insulin resistance in male Sprague Dawley rats. Onl J Vet Res. 2020;24:573-577. DOI: 10.5555/20203531172.
  5. Swinburn BA, Egger G, Raza F. Dissecting obesogenic environments: the development and application of a framework for identifying environmental determinants of obesity. Prev Med. 1999;29:563-570. DOI:10.1006/pmed.1999.0585. PMID:10600438.
  6. Story M, Kaphingst KM, French S. The role of schools in obesity prevention. Future Child. 2006;16:109-142. DOI: 10.1353/foc.2006.0007. PMID: 16532661.
  7. World Health Organization. Population-based approaches to childhood obesity prevention. Geneva: World Health Organization; 2012.
  8. Ghasemifard N, Akhlaghi M, Faghih S. Diet Quality of Adolescents in Shiraz, Southern Iran Needs Moderate to Severe Improvement. Int J Nutr Sci. 2017;2:66-72.
  9. Datar A, Nicosia N, Shier V. School nutrition policies and student body mass index. J Adolesc Health. 2014;55:437-442. DOI:10.1016/j.jadohealth.2014.02.010. PMID:24726723.
  10. Guldager JD, Andersen PT, von Seelen J, et al. Physical activity in the school environment: context matters. Health Educ Res. 2018;33:232-242. DOI: 10.1093/her/cyy012. PMID: 29741620.
  11. Momeni M, Riasatian M, Karimian Z, et al. Improvement of Snack Choices among Children by TrafficLight Food Labeling Education Employing Jigsaw Method. Int J Nutr Sci. 2025;10:22-29. DOI: 10.30476/ijns.2025.100348.1278.
  12. World Health Organization, Regional Office for South-East Asia. The double burden of malnutrition in South-East Asia. New Delhi: WHO SEARO; 2018.
  13. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766-81. DOI: 10.1016/S0140-6736(14)60460-8. PMID: 24880830.
  14. Ministry of Health, Republic of Indonesia. National Basic Health Research (RISKESDAS) 2018. Jakarta: Ministry of Health; 2019.
  15. Goh YM, Sadiva SH, Paras T. Development and validation of the School Obesogenic Environment Score (SOES) to evaluate obesogenic factors in school settings. Public Health Nutr. 2019;22:1720-1729. DOI:10.1017/S1368980019000184. PMID:30755149.
  16. O’Dea JA, Wilson R. Socio-cognitive and nutritional factors associated with body mass index in children and adolescents. Public Health Nutr. 2006;21:796-805. DOI: 10.1093/her/cyl125.PMID: 17095571.
  17. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr. 2004;23:1226-1243. DOI:10.1016/j.clnu.2004.06.004. PMID:15380917.
  18. Durão S, Wilkinson M, Davids EL, et al. Effects of policies or interventions that influence the school food environment on children’s health and non-health outcomes: a systematic review. Nutr Rev. 2024;82:332-360. DOI:10.1093/nutrit/nuad059. PMID: 37253393.
  19. França FCO, Andrade IS, Zandonadi RP, et al. Food environment around schools: a systematic scoping review. Nutrients. 2022;14:5090. DOI:10.3390/nu14235090. PMID: 6501120.
  20. Huse O, Sethi V, Rowel D, et al. Home, school, and retail food environments driving obesity among adolescent girls in South Asia. BMJ. 2025;388:e080359. DOI:10.1136/bmj-2024-080359. PMID: 40032315.
  21. Hassanzadeh-Rostami Z, Mirshekari M, Ranjbaran H, et al. Effect of GameBased Nutrition Education on Nutritional Knowledge of Preschool Children. Int J Nutr Sci. 2018;3:50-55.
  22. Angele M, Steinacker JM, Conrad J, et al. Effects of nutrition intervention strategies in the primary prevention of overweight and obesity in school settings: a protocol for a systematic review and network meta-analysis. Syst Rev. 2021;10:122. DOI: 10.1186/s13643-021-01661-1. PMID: 33888162.
  23. Durão S, Kredo T, Gerritsen A. Effects of policies or interventions that influence the school food environment on children's health and nonhealth outcomes: a systematic review. Nutr Rev. 2024;82:332-360. DOI: 10.1093/nutrit/nuad059. PMID: 37253393
  24. Vazquez CE, Cubbin C. Socioeconomic status and childhood obesity: a review of literature from the past decade to inform intervention research. Curr Obes Rep. 2020;9:562-570. DOI:10.1007/s13679-020-00402-2. PMID: 32785878.
  25. Stunkard AJ. Socioeconomic status and obesity. Ciba Found Symp. 1996:201:174-82; discussion 182-7, 188-93. PMID: 9017281.
  26. Yang X. The relationship of socioeconomic status and obesity among adolescents. Adv Soc Sci Educ Humanit Res. 2022;652:240-245.
  27. Crinin FM, Hurley SM, Buckley T, et al. Mediators of socioeconomic differences in overweight and obesity among youth in Ireland and the UK (2011-2021): a systematic review. BMC Public Health. 2022;22:1585. DOI: 10.1186/s12889-022-14004-z. PMID: 35987999.
  28. Wang J, Chen Y, Zhang Y, et al. Trends in overweight and socioeconomic inequality among Chinese children and adolescents aged 7-18 years in China from 2010 to 2020. BMC Public Health. 2025;25:3611. DOI: 10.1186/s12889-025-24170-5. PMID: 41146120
  29. Masumi SJ, Moradi F, Mehrabani D, et al. Prevalence And Quality Of Life In Qashqai Migrating Nomads With Irritable Bowel Syndrome In Southern Iran. Iran Red Crescent Med J. 2009;11:1-4.
  30. de França FCO, Andrade IS, Zandonadi RP, et al. The food environment in schools and their immediate vicinities and its relation to adolescents’ excess weight: a systematic review and meta-analysis. Health Place. 2021;71:102664. DOI: 10.1016/j.healthplace.2021.102664. PMID: 34507035.
  31. Hassan MA, McDonough DJ, Ryu S, et al. Comparative effectiveness of school-based obesity prevention programs for children and adolescents: a systematic review and network meta-analysis. Front Public Health. 2024;12:1504279. DOI:10.3389/fpubh.2024.1504279. PMID: 39741939.
  32. Wang H, Pang J, Yang X, et al. School-based environment and physical activity in adolescents: A systematic review and meta-analysis. Prev Med. 2025:191:108221. DOI: 10.1016/j.ypmed.2025.108221. PMID: 39765307
  1. Zhou Y, Wang L, Chen R, et al. Associations between class-level factors and student physical activity during physical education lessons in China. Int J Behav Nutr Phys Act. 2025;22:1. DOI: 10.1186/s12966-024-01703-6. PMID: 39748427.
  2. Chen P, Wang D, Shen H, et al. Physical activity and health in Chinese children and adolescents: an expert consensus statement (2020). Br J Sports Med. 2020;54:1321-1331. DOI: 10.1136/bjsports-2020-102261. PMID: 32471813.
  3. Guthold R, Stevens GA, Riley LM, et al. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants. Lancet Child Adolesc Health. 2020;4:23-35. DOI:10.1016/S2352-4642(19)30323-2. PMID:31761562.
  4. Manole LM, Ghiga G, Iftinchi O, et al. Bioelectrical impedance analysis versus dual X-ray absorptiometry for obesity assessment in pediatric populations: a systematic review. Diagnostics. 2025;15:1505. DOI:10.3390/diagnostics15121505. PMID: 40564826.
  5. Samouda H, Langlet J. Body fat assessment in youth with overweight or obesity by an automated bioelectrical impedance analysis device, in comparison with dual-energy X-ray absorptiometry: a cross sectional study. BMC Endocr Disord. 2022;22:195. DOI:10.1186/s12902-022-01111-6. PMID: 35918676.
  6. Kaczmarek M, Durda-Masny M, Hanć T. Reference data for body composition parameters in normal-weight Polish adolescents: results from the population-based ADOPOLNOR study. Eur J Pediatr. 2024;183:5021-5031. DOI: 10.1007/s00431-024-05736-8. PMID: 39325216
  7. Mojiri A, Behzad-Behbahani A, Saberifirozi M, et al. Hepatitis B Virus Genotypes In Southwest Iran: Molecular, Serological And Clinical Outcomes. World J Gastroenterol. 2008;14;14:1510-3. DOI: 10.3748/wjg.14.1510. PMID: 18330939.