African Journal for Physical, Health Education, Recreation and Dance

(AJPHERD), Volume 19(2), June 2013, pp. 448-458.

Overweight and obesity and associated factors among schoolaged adolescents in Thailand
SUPA PENGPID1,2 AND KARL PELTZER1,2,3
1

ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon,

Nakhonpathom, Thailand, 73170
2
University of Limpopo, Turfloop Campus, Private Bag X1106, Sovenga 0727, South Africa
3
HIV/AIDS/SIT/and TB (HAST), Human Sciences Research Council, Private Bag X41, Pretoria
0001, South Africa; E-Mail: Kpeltzer@hsrc.ac.za
(Received: 18 November 2012 ; Revision Accepted: 11 February 2013 )

Abstract
The aim of this study was to assess overweight and obesity and associated factors in schoolgoing adolescents in Thailand. Using data from the Thailand Global School-Based Student
Health Survey (GSHS) 2008, we assessed the prevalence of overweight and obesity and its
associated factors among adolescents (N=2758). Bivariate and multivariate analyses were applied
to assess the relationship between dietary behaviour, substance use, physical activity,
psychosocial factors, overweight and obesity. The prevalence of overweight and obesity was
determined based on self-reported height and weight and the international child body mass index
standards. Results indicate an overall prevalence of overweight and obesity of 10.0% and 4.4%,
respectively, overweight 12.7% among boys and 7.6% among girls, and obesity 5.0% and 3.9%
among girls and boys, respectively. Among boys younger age (12 years and younger), being
physically inactive, sedentary behaviour and no history of illicit drug use were associated with
obesity using bivariate and multivariate analysis, and among girls none of the variables (dietary
behaviour, substance use, physical activity and psychosocial factors) was found to be associated
with obesity. Moderate prevalence rates of overweight or obesity were found among adolescents
in Thailand. Increasing physical activity participation should be the focus of strategies aimed at
preventing and treating overweight and obesity in male youth.

Keywords: Overweight, obesity, global school-based health survey, dietary behaviour,

substance use, physical activity, sedentary behaviour, psychosocial factors, Thailand.
How to cite this article:
Pengpid, S. & Peltzer, K. (2013). Overweight and obesity and associated factors among schoolaged adolescents in Thailand. African Journal for Physical, Health Education, Recreation and
Dance, 19(2), 448-458.

Introduction
The prevalence of overweight and obesity in children has increased worldwide
during the past 20 years (de Onis & Lobstein, 2010). Obesity in childhood and
adolescence has been found to be associated with premature mortality and physical
morbidity (In-Iw & Biro, 2011; Reilly & Kelly, 2011) as well as impaired health
during childhood itself including an increase in the prevalence of type 2 diabetes
mellitus and metabolic syndrome among children in Thailand (Panamonta, Thamsiri

Overweight and obesity among school-aged adolescents 449

& Panamonta, 2010; Reilly & Kelly, 2011). Once obesity is established in children
(as in adults) it is hard to reverse (de Onis & Lobstein, 2010). Monitoring the
prevalence of obesity in order to plan services for the provision of care and to access
the impact of policy initiatives is essential (de Onis & Lobstein, 2010).
A number of local studies in Thailand found increases and moderate rates of
overweight and obesity among adolescents and adults. Aekplakorn and Mo-Suwan
(2009) note significant increases in the prevalence of obesity in adults: from 13.0%
in men and 23.2% in women in 1991 to 18.6% and 29.5% in 1997 and 22.4% and
34.3% in 2004 respectively. Obesity prevalence in children increased from 5.8% in
1997 to 7.9% in 2001 for the 2-5-year-olds and from 5.8% to 6.7% for the 6-12year-olds (Aekplakorn & Mo-Suwann, 2009). The prevalence of overweight and
obesity among school children in suburb Thailand was 12.8% and 9.4%
(Rerksuppaphol & Rerksuppaphol, 2010), 12.6% among grade 7-12 who attended
two metropolitan Bangkok schools (In-Iw, Manaboriboon, & Chomchai, 2010),
27.6% overweight school children (aged 10-15 years) in Khon Kaen province
(Panamonta et al., 2010), 18.4% among girls (11-17 years) overweight or obese in
suburban Thailand (Pawloski, Ruchiwit & Pakapong, 2008), and overall 4.9% obese
and 9.5% overweight (4.8% obesity and 9.4% overweight among boys and 4.9%
obesity and 9.9% overweight among girls) among 12- to 18-years-olds attending the
secondary school in the municipality of Khon Kaen (Sengmeuangpa,
Kukongviriyapana, Pasurivonga, Jonesb & Khrisanapanta, 2010). Although
differences exist between urban and rural men, the odds of being overweight or
obese were similar in urban and rural women (Aekplakorn, Hogan,
Chongsuvivatwong, Tatsanavivat, Chariyalertsak & Boonthum, 2007).
Studies found that factors associated with childhood overweight or obesity include
lower physical activity levels (Janssen, Katzmarzyk, Boyce, King, & Pickett, 2004a;
Janssen et al. 2005), higher sedentary behaviour (such as television viewing times)
(Janssen et al., 2004a; Collins, Pakiz, & Rock, 2008), dietary behaviour such as
frequency of sweets intake (Janssen et al., 2005), psychosocial factors (Vmosi,
Heitmann & Kyvik, 2010; Spruijt-Metz, 2011) female gender (Kimani-Murage,
Kahn, Pettifor, Tollman, Klipstein-Grobusch, & Norris, 2011), victims and
perpetrators of bullying behaviours (Janssen, Craig, Boyce & Pickett, 2004b),
inaccurate perceptions of the need to diet, poorer self-perceived health status and
potential social isolation (Pawloski, Kitsantas, & Ruchiwit, 2010), and poorer selfimage (In-Iw et al., 2010). Overweight status has not been found to be associated
with the intake of fruits and vegetables (Janssen et al., 2005; Pawloski et al., 2010).
Risk factors such as dietary behaviour, life style factors (substance use), physical
activity and psychosocial factors for obesity in low-income countries are not wellknown and might differ from those in other countries. Therefore, the aim of this
study was to assess overweight and obesity and associated factors in school-going
adolescents in an Asian low income country (Thailand).

450 Pengpid and Peltzer

Methodology
Participants and procedures
The study involved the secondary analysis of existing data from the 2008 Thailand
Global School-Based Health Survey (GSHS) (Centers for Disease Control, 2009).
The aim of the GSHS is to collect data from students of age 13 to 15 years. The
Thailand GSHS was a school-based survey of students in Grades 7, 8, 9, and 10. A
two-stage cluster sample design was used to collect data to represent all students in
Grades 7, 8, 9, and 10 in the country.
At the first stage of sampling, schools were selected with probability proportional to
their reported enrollment size. In the second stage, classes in the selected schools
were randomly selected and all students in selected classes were eligible to
participate irrespective of their actual ages. The school response rate was 100%, the
student response rate was 93%, and the overall response rate was 93%. Students
self-completed the questionnaires to record their responses to each question on a
computer scan able answer sheet. A total of 2,767 students participated in the
Thailand GSHS (Ministry of Public Health, 2008). The GSHS 10 core questionnaire
modules address the leading causes of morbidity and mortality among children and
adults worldwide: tobacco, alcohol and other drug use; dietary behaviors; hygiene;
mental health; physical activity; sexual behaviors that contribute to HIV infection,
other sexually transmitted infections, and unintended pregnancy; unintentional
injuries and violence; protective factors and respondent demographics (Centers for
Disease Control, 2009; Ministry of Public Health Thailand, 2008).
Measures
Body Mass Index (BMI) measurement and overweight classification
Height and body weight were based on self-reports. BMI was calculated as
weight/height2 (kg/m2). The international age- and gender-specific child BMI cutpoints were used to define underweight, overweight and obesity (Cole, Bellizzi,
Flegal & Dietz, 2000). These cut-points were derived from a large international
sample using regression techniques by passing a line through the health-related adult
cut-points at 18 years. Youth with BMI values corresponding to an adult BMI of <
25.0 kg/m2 were classified as normal weight and youth with BMI values
corresponding to an adult BMI of 25.0 kg/m2 were classified as overweight. Thus,
in this study overweight youth included those who were obese. The overweight
youth was further subdivided into pre-obese (BMI corresponds to adult values of
25.029.9 kg/m2) and obese (BMI is corresponding to an adult value of 30.0
kg/m2) groups. The response rate on the BMI was for Thailand 97%.

Overweight and obesity among school-aged adolescents 451

Fruits and vegetables consumption and hunger
Fruits: During the past 30 days, how many times per day did you usually eat fruit,
such as country specific examples? Response options were 1 = I did not eat fruit
during the past 30 days, 2 = less than one time per day, 3 = 1 time per day to 7 = 5 or
more times per day.
Vegetables: During the past 30 days, how many times per day did you usually eat
vegetables, such as country specific examples? Response options were 1 = I did
not eat vegetables during the past 30 days, 2 = less than one time per day, 3 = 1 time
per day to 7 = 5 or more times per day. Adolescents indicated that they were
consuming fruits (or vegetables) less than once a day was coded as having
inadequate consumption patterns. The inadequate fruits and vegetables consumption
variables were re-coded separately into two categories: inadequate fruits
consumption (less than once = 1) and adequate fruits consumption (once or more a
day = 0) and inadequate vegetable consumption (less than once = 1) and adequate
vegetable consumption (once or more a day = 0).
Hunger: A measure of hunger was derived from a question reporting the frequency
that a young person went hungry because there was not enough food at home in the
past 30 days (response options were from 1 = never to 5 = always) (coded 1 = most
of the time or always and 0 = never, rarely or sometimes).
Substance use variables: Smoking cigarettes (current smoking) was assessed with
the question, During the past 30 days, on how many days did you smoke
cigarettes? Response options included 1=0 days to 7=all 30 days. Alcohol use was
assessed with the question, During the past 30 days, on how many days did you
have at least one drink containing alcohol? Response options included 1=0 days to
7=all 30 days. Drug use: During your life, how many times have you used drugs,
such as methamphetamines (Yaba), ecstasy, 4x100, or marijuana? (ever drugs).
Physical Activity. Leisure time physical activity was assessed by asking participants:
"During the past 7 days, on how many days were you physically active for a total of
at least 60 minutes per day?" and "During a typical or usual week, on how many
days are you physically active for a total of at least 60 minutes per day?" Physical
activity was defined as any activity that increases heart rate and makes one get out of
breath some of the time. Physical activity can be done in sports, playing with
friends, or walking to school. Some examples of physical activity are running, fast
walking, biking, dancing, and football. Physical education or gym classes were not
supposed to be included. According to the scoring protocol of the
PACE+Adolescent Physical Activity Measure, physical activity was defined as
obtaining at least 60 min of physical activity per day on at least five days per week.
For analysis, the number of active days "during the past week" and the number of
active days "during a typical week" were averaged.

452 Pengpid and Peltzer

Leisure time sedentary behaviour was assessed by asking participants about the time
they spend mostly sitting when not in school or doing homework: How much time
do you spend during a typical or usual day sitting and watching television, playing
computer games, talking with friends, or doing other sitting activities (3 hours of
more per day).
Psychosocial distress variables. Loneliness During the past 12 months, how often
have you felt lonely? (Response options were from 1 = never to 5 = always)
(Coded 1 = most of the time or always and 0 = never, rarely or sometimes). Anxiety
or worried. During the past 12 months, how often have you been so worried about
something that you could not sleep at night? (Response options were from 1 = never
to 5 = always) (Coded 1 = most of the time or always and 0 = never, rarely or
sometimes). Sadness. During the past 12 months, did you ever feel so sad or
hopeless almost every day for 2 weeks or more in a row that you stopped doing your
usual activities? (Response option 1 = yes and 2 = no) (Coded 1 = 1, 2 = 0). Suicide
plan. During the past 12 months, did you make a plan about how you would
attempt suicide? (Response option was 1 = yes and 2 = no, coded 1 = 1, 2 = 0).
Bullied: The variable ever being bullied was defined as those who reported they
were bullied at least once in the preceding 30 days, by any form of bullying.
Data analysis
Data analysis was performed using STATA software version 10.0 (Stata
Corporation, College Station, TX, USA). This software has the advantage of directly
including robust standard errors that account for the sampling design, i.e. cluster
sampling owing to the sampling of school classes. Psychosocial distress was
assessed across the 4 mental health measures when a students response was
indicative of distress: loneliness, anxiety or worried, sadness and suicide plan. The
number of psychosocial distress indicators was calculated by determining if students
had 0, 1, 2-4 indicators. Associations between dietary behavior and substance use,
physical activity and psychosocial distress and overweight or obesity among school
children were evaluated calculating odds ratios (OR). Unconditional logistic
regression was used for evaluation of the impact of explanatory variables for
overweight or obesity for boys and girls (binary dependent variables). All variables
statistically significant at the P < .05 levels in bivariate analyses were included in the
multivariable models. In the analysis, weighted percentages are reported. The
reported sample size refers to the sample that was asked the target question. The
two-sided 95% confidence intervals are reported. The P values less or equal to 5% is
used to indicate statistical significance. Both the reported 95% confidence intervals
and the P value are adjusted for the multi-stage stratified cluster sample design of the
study.

Overweight and obesity among school-aged adolescents 453

Results
Sample characteristics
Table 1 gives the sample characteristics of 2758 participants, mainly between 12 to
15 years old and 53.2% females and 46.8% males. The study found an overall
prevalence of overweight and obesity of 10.0% and 4.4%, respectively, overweight
12.7% among boys and 7.6% among girls, and obesity 5.0% and 3.9% among girls
and boys, respectively. In terms of dietary behavior, more boys as opposed to girls
had fruits or vegetables less than once a day, and 3.4% indicated that mostly or
always they felt hungry. More than three quarters of students indicated physical
inactivity, almost half that they would not walk to school and more than one quarter
engaged in three or more hours sedentary behaviour per day. Regarding
psychosocial factors, being bullied was the most frequent one, followed by sadness,
having a suicide plan and having no close friends; females scored significantly
higher than boys on no close friends, suicide plan and anxiety (Table 1).
Table 1: Sample characteristics among adolescents in Thailand, 2008, N=2758
Age (years)
12
13
14
15
Gender
Female
Male
Hunger
Weight
Overweight
Obese
Dietary behaviour
Fruits less than once a day
Vegetables less than once a day
Most of the time or always hunger
Substance use
Current smoking
Current alcohol use
Lifetime illicit drug use
Physical activity
Physical activity less than 60 min per day on at least five
days per week
Sedentary behavior (3 hours of more per day)
Psychosocial factors
Psychosocial distress
0
1
2-4
Being bullied

Total
N (%)

Males
N (%)

Females
N (%)

466 (17.0)
840 (29.5)
870 (28.7)
582 (24.9)

201 (15.6)
407 (30.9)
443 (30.3)
313 (23.2)

265 (18.2)
433 (28.1)
427 (27.2)
269 (26.5)

1394 (53.2)
1364 (46.8)
94 (3.4)

63 (4.7)

31 (2.1)

269 (10.0)
118 (4.4)

164 (12.7)
67 (5.0)

105 (7.6)
51 (3.9)

638 (23.2)
358 (12.8)
94 (3.4)

373 (27.1)
195 (14.0)
63 (4.7)

265 (19.6)
163 (11.7)
31 (2.1)

220 (8.2)
368 (14.8)
167 (6.0)

190 (15.0)
247 (21.2)
147 (11.1)

30 (2.2)
121 (9.3)
20 (1.3)

2073 (76.3)

914 (67.5)

1159 (84.6)

1039 (37.5)

518 (37.4)

521 (37.7)

1939 (73.4)
445 (16.9)
257 (9.7)
679 (27.8)

935 (73.3)
239 (16.6)
128 (10.1)
383 (32.9)

1004 (73.4)
206 (17.3)
129 (9.3)
296 (23.2)

454 Pengpid and Peltzer

Association with overweight or obesity
Among boys younger age, being physically inactive, sedentary behaviour and no
history of illicit drug use were associated with obesity in bivariate and
multivariable analysis, and among girls none of the study variables (dietary
behaviour, substance use, physical activity and psychosocial factors) were found
to be associated with obesity (Table 2).
Table 2: Bivariate and multivariable logistic regression analysis of factors that are associated
with obesity among adolescents in Thailand, 2008
Variables
Male
Female
OR1 (95% CI)
AOR2 (95% CI)
OR1 (95% CI)
Age
12 years
1.00
1.00
1.00
13
0.27 (0.12-0.58)**
0.25 (0.11-0.53)***
0.76 (0.28-2.08)
14
0.46 (0.21-1.01)
0.42 (0.19-0.95)*
0.93 (0.44-1.96)
15 years
0.27 (0.11-0.64)**
0.23 (0.09-0.57)**
1.37 (0.74-2.52)
Dietary behaviour and
substance use
Fruits less than once a
1.11 (0.62-1.99)
--1.02 (0.29-3.54)
day
Vegetables less than
0.58 (0.16-2.22)
--0.23 (0.04-1.40)
once a day
Most of the time or
1.02 (0.23-4.40)
--0.79 (0.08-7.87)
always hunger
Substance use
Current alcohol use
0.73 (0.36-1.46)
--0.91 (0.27-3.01)
Current smoking
0.83 (0.45-1.54)
----Ever illicit drug use
0.23 (0.06-0.93)*
0.20 (0.05-0.80)*
--Physical activity
Physical activity less
2.12 (1.25-3.58)**
2.26 (1.38-3.71)**
0.83 (0.34-2.04)
than 60 min per day on
at least five days per
week
Sedentary behaviour (3
1.74 (1.08-2.79)*
1.75 (1.09-2.81)*
0.97 (0.53-1.79)
hours of more per day)
Psychosocial factors
Psychosocial distress
0
1.00
--1.00
1
1.42 (0.63-3.21)
1.06 (0.36-3.13)
2-4
1.13 (0.47-2.72)
1.07 (0.26-4.43)
Being bullied
1.33 (0.85-2.08)
--1.75 (0.93-3.29)
1
OR=Odds Ratio; 2 AOR=Adjusted Odds Ratio. ***P<.001; **P<.01; *P<.05.

Discussion
The study found an overall prevalence of overweight and obesity of 10.0% and
4.4%, respectively, among school-going adolescents in Thailand. These rates
were similar to local studies among adolescents in Thailand (Pawloski et al.,

Overweight and obesity among school-aged adolescents 455

2008; Rerksuppaphol & Rerksuppaphol, 2010; Sengmeuangpa et al., 2010). This
study did not find significant gender differences between male and female
adolescents regarding body weight, which is conformed to other studies in
Thailand (Rerksuppaphol & Rerksuppaphol, 2010).
Further the study found that among boys younger age, being physically inactive,
sedentary behaviour and no history of illicit drug use were associated with
obesity, and among girls none of the study variables (dietary behaviour,
substance use, physical activity and psychosocial factors) were found to be
associated with obesity. In a study among 12 to 18 year-olds in Thailand the
prevalence did also not increase with age (Sengmeuangpa et al., 2010).
The effect of physical inactivity and sedentary behaviour in this study among
boys is conforming to a number of other studies (Janssen et al., 2004b; Haug et
al., 2009; Sirikulchayanonta et al., 2011). Overweight status was in this study
also not associated with the intake of fruits, vegetables, as found in other studies
(Janssen et al., 2005; Spruijt-Metz, 2011; Pawloski et al., 2010). Further, the
study found that being most of the time or always hungry was not associated
with overweight. In a review of studies on food insecurity related to overweight
and obesity in children and adolescents in the USA, Eisenmann, Gundersen,
Lohman Garasky and Stewart (2011) found no associations between food
insecurity and overweight among more recent studies with larger samples and
that food insecurity and overweight co-exist.
We studied health-risk behaviours that could influence energy metabolism such
as alcohol and tobacco use (Dupuy, Godeau, Vignes & Ahluwalia, 2011).
Substance use (illicit drug use among boys) was in this study significantly
inversely associated with overweight or obesity, which needs further
investigation.
Study limitations
This study had several limitations. Firstly, the GSHS only enrolls adolescents
who are in school. School-going adolescents may not be representative of all
adolescents in a country as the occurrence of obesity may differ between the two
groups. Also we did not assess regional and urban-rural differences in obesity.
Furthermore, this study was based on data collected in a cross-sectional survey.
We cannot, therefore, ascribe causality to any of the associated factors in the
study. The cut-offs used with self-reported BMI may lead to underestimation or
overweight and obesity (Elgar, Roberts, Tudor-Smith, & Moore, 2005). The BMI
was assessed by self-reported weight and height and could have included
anthropometry to evaluate weight status and body fat content. In addition, a
number of factors known to be associated with weight status were not assessed
including dietary intake, low quality diet, skipping breakfast, environmental,

456 Pengpid and Peltzer

family variables including parental weight status, socioeconomic status (Goyal et
al., 2010; Lieb, Snow & DeBoer, 2009; Spruijt-Metz, 2011), age at menarche
and order of birth (Pawloski et al., 2008; Pawloski et al., 2010), dissatisfaction
with body weight (In-Iw et al., 2010) and self-discipline (Sirikulchayanonta,
Ratanopas, Temcharoen & Srisorrachatr, 2011).
Conclusions
Moderate prevalence rates of overweight or obesity were found among
adolescents in Thailand. Increasing physical activity participation should be the
focus of strategies aimed at preventing and treating overweight and obesity in
male youth.
Acknowledgements
We are grateful to the World Health Organisation (Geneva) for making the data
available to us for analysis. We also thank the Ministries of Education and
Health and the study participants for making the Thailand Global School Health
Survey 2008 possible, and the country survey coordinator, Dr. Pensri
Kramomtong, Chief Department of Health, Ministry of Public Health. The
government of Thailand and the World Health Organization did not influence the
analysis, nor did they have influence on decision to publish these findings.
References
Aekplakorn, W., Hogan, M. C., Chongsuvivatwong, V., Tatsanavivat, P., Chariyalertsak, S. &
Boonthum, A. (2007). Trends in obesity and associations with education and urban or rural
residence in Thailand. Obesity, 15(12), 3113-3121.
Aekplakorn, W. & Mo-Suwan, L. (2009). Prevalence of obesity in Thailand. Obesity Reviews,
10(6), 589-92.
Cole, T. J., Bellizzi, M. C., Flegal, K. M., & Dietz, W. H. (2000). Establishing a standard
definition for child overweight and obesity worldwide: international survey. British Medical
Journal, 320 (7244), 1240-1243.
Collins, A. E., Pakiz, B. & Rock, C. L. (2008). Factors associated with obesity in Indonesian
adolescents. International Journal of Pediatric Obesity, 3(1), 58-64.
Centers for Disease Control (CDC) (2009). The Global School and Health Survey background
[Online]. Available at http://www.cdc.gov/gshs/background/index, 2009.
de Onis, M. & Lobstein, T. (2010). Defining obesity risk status in the general childhood
population: which cut-offs should we use? International Journal of Pediatric Obesity, 5(6), 458560.

Overweight and obesity among school-aged adolescents 457

Dupuy, M., Godeau, E., Vignes, C. & Ahluwalia, N. (2011). Socio-demographic and lifestyle
factors associated with overweight in a representative sample of 11-15 year olds in France:
results from the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) crosssectional study. BMC Public Health, 11, 442.
Elgar, F.J., Roberts, C., Tudor-Smith, C. & Moore, L. (2005). Validity of self-reported height and
weight and predictors of bias in adolescents. Journal of Adolescent Health, 37(5), 371-375.
Eisenmann, J. C., Gundersen, C., Lohman, B. J., Garasky, S. & Stewart, S. D. (2011). Is food
insecurity related to overweight and obesity in children and adolescents? A summary of studies,
1995-2009. Obesity Reviews, 12(5), e73-83.
Goyal, R. K., Shah, V. N., Saboo, B. D., Phatak, S. R., Shah, N. N., Gohel, M. C., Raval, P. B. &
Patel, S. S. (2010). Prevalence of overweight and obesity in Indian adolescent school going
children: its relationship with socioeconomic status and associated lifestyle factors. Journal of
the Association of Physicians in India, 58, 151-158.
Haug, E., Rasmussen, M., Samdal, O., Iannotti, R., Kelly, C., Borraccino, A., HBSC Obesity
Writing Group (2009). Overweight in school-aged children and its relationship with demographic
and lifestyle factors: results from the WHO-Collaborative Health Behaviour in School-aged
Children (HBSC) study. International Journal of Public Health, 54(Suppl 2),
167-179.
In-Iw, S. & Biro, F. M. (2011). Adolescent women and obesity. Journal of Pediatric and
Adolescent Gynecology, 24(2), 58-61.
In-Iw, S., Manaboriboon, B. & Chomchai, C. A. (2010). Comparison of body-image perception,
health outlook and eating behavior in mildly obese versus moderately-to-severely obese
adolescents. Journal of the Medical Association of Thailand, 93(4), 429-345.
Janssen, I., Katzmarzyk, P. T., Boyce, W. F., King, M. A. & Pickett, W. (2004a). Overweight
and obesity in Canadian adolescents and their associations with dietary habits and physical
activity patterns. Journal of Adolescent Health, 35(5), 360-367.
Janssen, I., Craig, W. M., Boyce, W. F. & Pickett, W. (2004b). Associations between overweight
and obesity with bullying behaviors in school-aged children. Pediatrics, 113(5), 1187-1194.
Janssen, I., Katzmarzyk, P.T, Boyce, W. F., Vereecken, C., Mulvihill, C., Roberts, C., et al.
(Health Behaviour in School-Aged Children Obesity Working Group) (2005). Comparison of
overweight and obesity prevalence in school-aged youth from 34 countries and their relationships
with physical activity and dietary patterns. Obesity Review, 6(2), 123-132.
Kimani-Murage, E. W., Kahn, K., Pettifor, J. M., Tollman, S. M., Klipstein-Grobusch, K. &
Norris, S. A. (2011). Predictors of adolescent weight status and central obesity in rural South
Africa. Public Health Nutrition, 14(6), 1114-1122.
Lieb, D. C., Snow, R. E. & DeBoer, M. D. (2009). Socioeconomic factors in the development of
childhood obesity and diabetes. Clinical Sports Medicine, 28(3), 349-378.
Ministry of Public Health Thailand (2008). The Global School-Based Student Health Survey
(GSHS) in Thailand. Bangkok, Thailand: Ministry of Public Health Thailand.

458 Pengpid and Peltzer

Panamonta, O., Thamsiri, N. & Panamonta, M. (2010). Prevalence of type II diabetes and
metabolic syndrome among overweight school children in Khon Kaen, Thailand. Journal of the
Medical Association of Thailand, 93(1), 56-60.
Pawloski, L. R., Ruchiwit, M. & Pakapong, Y. (2008). A cross-sectional examination of growth
indicators from Thai adolescent girls: evidence of obesity among Thai youth? Annals of Human
Biology, 35(4), 378-385.
Pawloski, L. R., Kitsantas, P. & Ruchiwit, M. (2010). Determinants of overweight and obesity in
Thai adolescent girls. International Journal of Medicine, 3(2), 352-356.
Rerksuppaphol, S. & Rerksuppaphol, L. (2010). Prevalence of overweight and obesity among
school children in suburb Thailand defined by the International Obesity Task Force standard.
Journal of the Medical Association of Thailand, 93(Suppl 2), S27-S31.
Reilly, J. J. & Kelly, J. (2011). Long-term impact of overweight and obesity in childhood and
adolescence on morbidity and premature mortality in adulthood: systematic review. International
Journal of Obesity, 35(7), 891-898.
Sengmeuanga, P., Kukongviriyapana, U., Pasurivonga, O., Jonesb, C. & Khrisanapanta, W.
(2010). Prevalence of obesity among Thai schoolchildren: a survey in Khon Kaen, Northeast
Thailand. Asian Biomedicine, 4(6), 965-970.
Sirikulchayanonta, C., Ratanopas, W., Temcharoen, P. & Srisorrachatr, S. (2011). Self-discipline
and obesity in Bangkok school children. BMC Public Health, 11, 158.
Spruijt-Metz, D. (2011). Etiology, treatment and prevention of obesity in childhood and
adolescence: A decade in review. Journal of Research in Adolescents, 21(1), 129-152.
Vmosi, M., Heitmann, B. L. & Kyvik, K. O. (2010). The relation between an adverse
psychological and social environment in childhood and the development of adult obesity: a
systematic literature review. Obesity Review, 11(3), 177-184.

Copyright of African Journal for Physical, Health Education, Recreation & Dance is the
property of African Journal for Physical, Health Education, Recreation & Dance and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.