Prevalence and Multilevel Risk Factors for Overweight and Obesity Among Children Aged 6–13 Years in Public and Private Schools in Derna, Libya: A School-Based Cross-Sectional Study

Abstract

Childhood overweight and obesity are increasing public-health concerns in North Africa and the Middle East, yet evidence on their multilevel determinants among Libyan schoolchildren remains limited. This study aimed to determine the prevalence of thinness, overweight, obesity and central adiposity among children aged 6–13 years attending public and private schools in Derna, Libya, and to examine associated behavioural, familial, socioeconomic and school-related factors. A school-based analytical cross-sectional design was used with 860 children selected through three-stage multistage stratified cluster sampling. A structured parent-assisted Arabic questionnaire assessed demographic characteristics, household conditions, parental weight status, dietary behaviour, physical inactivity, sedentary behaviour and family and school environments. Trained researchers measured height, weight and waist circumference using standardised procedures. Weight status was classified using the World Health Organization BMI-for-age reference, and waist-to-height ratio ≥0.50 indicated central adiposity. Data were analysed using descriptive statistics, t-tests, analysis of variance, chi-square tests and multivariable binary logistic regression in SPSS. Overweight affected 19.7%, obesity 8.7%, thinness 8.8% and central adiposity 28.7%, while combined overweight and obesity prevalence was 28.4%. Excess weight was higher among boys than girls (31.4% vs. 25.3%, p = 0.045) and private-school than public-school pupils (33.3% vs. 25.7%, p = 0.015). Unhealthy dietary behaviour (AOR = 1.48, 95% CI 1.27–1.73), physical inactivity (AOR = 1.39, 95% CI 1.20–1.61) and sedentary behaviour (AOR = 1.31, 95% CI 1.13–1.52) were independently associated with excess weight. Private-school attendance remained significant after adjustment (AOR = 1.34, 95% CI 1.01–1.80). These findings support integrated school, family and community prevention strategies.