Parental Support and School Environment as Determinants of Obesity Risk among School-Aged Children: A Cross-Sectional Study

Authors

  • Nurharlinah Nurharlinah Department of Nursing, Sekolah Tinggi Ilmu Kesehatan Sumber Waras, Jakarta, Indonesia
  • Ari Athiutama Department of Nursing, Politeknik Kesehatan Palembang, South Sumatera, Indonesia
  • Karyatin Karyatin Department of Nursing, Sekolah Tinggi Ilmu Kesehatan Sumber Waras, Jakarta, Indonesia
  • Rini Herdiani Department of Hospital Administration, Sekolah Tinggi Ilmu Kesehatan Pondok Pesantren Assanadiyah, South Sumatera, Indonesia

DOI:

https://doi.org/10.55018/janh.v8i1.551

Keywords:

Body mass Index, Childhood Obesity, Parental Support, Public Health Nursing, School Environment

Abstract

Background: Childhood obesity is an increasing public health concern among school-aged children, particularly in low- and middle-income countries (LMICs). While parental support and the school environment are recognized as important determinants, evidence comparing their relative influence within a socio-ecological framework remains limited. This study aimed to examine the association between parental support, the school environment, and obesity risk among school-aged children in Indonesia.

Methods: A cross-sectional study was conducted on 120 children aged 7–12 years using a purposive sampling method. Data were collected using a validated parental support questionnaire, school environment assessment instrument, and anthropometric measurements to determine the body mass index (BMI) for age. Associations were analyzed using the chi-square tests and multivariable logistic regression. This study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Results: Both parental support and school environment were significantly associated with obesity risk. Children with low parental support had higher odds of obesity (OR = 2.50; 95% CI: 1.20–5.10), whereas those exposed to less healthy school environments had even higher odds of obesity (OR = 2.80; 95% CI: 1.35–5.80). Among the examined factors, the school environment demonstrated the strongest independent association with the risk of obesity.

Conclusion: Parental support and the school environment are important determinants of obesity risk among school-aged children; however, school-level factors appear to play a more dominant role in this regard. These findings highlight schools as a critical entry point for childhood obesity prevention within a socio-ecological framework, particularly in LMIC.

Downloads

Download data is not yet available.

References

Andrade de Medeiros Moreira, R., Ricardo Moreira, T., Dias da Costa, G., Vidigal Castro, L. C., & Minardi Mitre Cotta, R. (2020). Multilevel analysis of factors that influence overweight in children: research in schools enrolled in northern Brazil School Health Program. BMC Pediatrics, 20(1), 188. https://doi.org/10.1186/s12887-020-02096-8

Brown, T., Moore, T. H., Hooper, L., Gao, Y., Zayegh, A., Ijaz, S., Elwenspoek, M., Foxen, S. C., Magee, L., O’Malley, C., Waters, E., & Summerbell, C. D. (2019). Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews, 2025(8). https://doi.org/10.1002/14651858.CD001871.pub4

Caprio, S., Santoro, N., & Weiss, R. (2020). Childhood obesity and the associated rise in cardiometabolic complications. Nature Metabolism, 2(3), 223–232. https://doi.org/10.1038/s42255-020-0183-z

Chung, S. T., Krenek, A., & Magge, S. N. (2023). Childhood Obesity and Cardiovascular Disease Risk. Current Atherosclerosis Reports, 25(7), 405–415. https://doi.org/10.1007/s11883-023-01111-4

Daley, S. F., & Balasundaram, P. (2025). Obesity in Pediatric Patients.

de Assis, M. M., Gratão, L. H. A., da Silva, T. P. R., Cordeiro, N. G., do Carmo, A. S., de Freitas Cunha, C., de Oliveira, T. R. P. R., Rocha, L. L., & Mendes, L. L. (2022). School environment and obesity in adolescents from a Brazilian metropolis: cross-sectional study. BMC Public Health, 22(1), 1229. https://doi.org/10.1186/s12889-022-13592-0

Di Cesare, M., Sorić, M., Bovet, P., Miranda, J. J., Bhutta, Z., Stevens, G. A., Laxmaiah, A., Kengne, A.-P., & Bentham, J. (2019). The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Medicine, 17(1), 212. https://doi.org/10.1186/s12916-019-1449-8

Ghaferi, A. A., Schwartz, T. A., & Pawlik, T. M. (2021). STROBE Reporting Guidelines for Observational Studies. JAMA Surgery, 156(6), 577. https://doi.org/10.1001/jamasurg.2021.0528

Harrison, C. V., Rogge, N., Roy, J., Sacco, K., & Tartaglione, B. (2025). A rapid review exploring childhood obesity and parenting practices. Journal of Pediatric Nursing, 81, e31–e38. https://doi.org/10.1016/j.pedn.2025.01.028

Hassan, M. A., McDonough, D. J., Ryu, S., Zhou, W., Oginni, J., & Gao, Z. (2024). Comparative effectiveness of school-based obesity prevention programs for children and adolescents: a systematic review and network meta-analysis. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1504279

Hu, D., Zhou, S., Crowley-McHattan, Z. J., & Liu, Z. (2021). Factors That Influence Participation in Physical Activity in School-Aged Children and Adolescents: A Systematic Review from the Social Ecological Model Perspective. International Journal of Environmental Research and Public Health, 18(6), 3147. https://doi.org/10.3390/ijerph18063147

Hübner, H. L., & Bartelmeß, T. (2024). Associations of sugar-related food parenting practices and parental feeding styles with prospective dietary behavior of children and adolescents: a systematic review of the literature from 2017 to 2023. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1382437

Jebeile, H., Kelly, A. S., O’Malley, G., & Baur, L. A. (2022). Obesity in children and adolescents: epidemiology, causes, assessment, and management. The Lancet Diabetes & Endocrinology, 10(5), 351–365. https://doi.org/10.1016/S2213-8587(22)00047-X

Kemenkes RI. (2018). Laporan nasional Riset Kesehatan Dasar (Riskesdas) 2018. Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan RI. https://dinkes.babelprov.go.id/sites/default/files/dokumen/bank_data/20181228%20-%20Laporan%20Riskesdas%202018%20Nasional-1.pdf

Kemenkes RI. (2023). SURVEY KESEHATAN INDONESIA (SKI) 2023.

Khoe, L. C., Widyahening, I. S., Ali, S., & Khusun, H. (2022). Assessment of the obesogenic environment in primary schools: a multi-site case study in Jakarta. BMC Nutrition, 8(1), 19. https://doi.org/10.1186/s40795-022-00513-y

Kocaadam-Bozkurt, B., Sözlü, S., & Macit-Çelebi, M. S. (2023). Exploring the understanding of how parenting influences the children’s nutritional status, physical activity, and BMI. Frontiers in Nutrition, 9. https://doi.org/10.3389/fnut.2022.1096182

Lambrinou, C.-P., Androutsos, O., Karaglani, E., Cardon, G., Huys, N., Wikström, K., Kivelä, J., Ko, W., Karuranga, E., Tsochev, K., Iotova, V., Dimova, R., De Miguel-Etayo, P., M. González-Gil, E., Tamás, H., JANCSÓ, Z., Liatis, S., Makrilakis, K., & Manios, Y. (2020). Effective strategies for childhood obesity prevention via school based, family involved interventions: a critical review for the development of the Feel4Diabetes-study school based component. BMC Endocrine Disorders, 20(S2), 52. https://doi.org/10.1186/s12902-020-0526-5

Liu, C.-H., Chang, F.-C., Niu, Y.-Z., Liao, L.-L., Chang, Y.-J., Liao, Y., & Shih, S.-F. (2022). Students’ perceptions of school sugar-free, food and exercise environments enhance healthy eating and physical activity. Public Health Nutrition, 25(7), 1762–1770. https://doi.org/10.1017/S1368980021004961

Maia, C., Braz, D., Fernandes, H. M., Sarmento, H., & Machado-Rodrigues, A. M. (2025). The Impact of Parental Behaviors on Children’s Lifestyle, Dietary Habits, Screen Time, Sleep Patterns, Mental Health, and BMI: A Scoping Review. Children, 12(2), 203. https://doi.org/10.3390/children12020203

Noh, K., & Min, J. J. (2020). Understanding School-Aged Childhood Obesity of Body Mass Index: Application of the Social-Ecological Framework. Children, 7(9), 134. https://doi.org/10.3390/children7090134

Obita, G., & Alkhatib, A. (2022). Disparities in the Prevalence of Childhood Obesity-Related Comorbidities: A Systematic Review. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.923744

Olufadewa, I., Adesina, M., Oladele, R., Olufadewa, T., Solagbade, A., Ogundele, O., Asaolu, O., Adene, T., Oladesu, O., Lawal, E., Nnatus, J., Akinrinde, D., & Opone, E. (2023). Interventions to reduce and prevent childhood obesity in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Global Health, 11, S16. https://doi.org/10.1016/S2214-109X(23)00099-2

Oudat, Q., Messiah, S. E., Ghoneum, A. D., & Okour, A. (2025). A Narrative Review of Multifactorial Determinants of Childhood Eating Behaviors: Insights and Interventions Using the Social Ecological Model. Children, 12(3), 388. https://doi.org/10.3390/children12030388

Popkin, B. M., Corvalan, C., & Grummer-Strawn, L. M. (2020). Dynamics of the double burden of malnutrition and the changing nutrition reality. The Lancet, 395(10217), 65–74. https://doi.org/10.1016/S0140-6736(19)32497-3

Rahayuwati, L., Yani, D. I., Hendrawati, S., Setiawan, A. S., Irza, D., & Fauziah, S. R. (2025). Correlations between family characteristics and childcare in optimizing the growth of children under six years. BMC Public Health, 25(1), 807. https://doi.org/10.1186/s12889-025-21931-0

Rangkuti, N. A., Hadi, A. J., Ahmad, H., Widasary, L., Fakultas Kesehatan, F., Aufa Royhan, U., Kunci, K., Di Kantin Sekolah, M., Dan Minuman Sehat, M., & Sekolah, K. (2024). Faktor Lingkungan Sekolah yang Berperan Dalam Meningkatkan Obesitas Anak Sekolah Dasar. Jurnal Education and development, 12(2), 593–603. https://doi.org/10.37081/ed.v12i2.7566

Rizona, F., Anna Appulembang, Y., Rahmawati, F., Purwanto, S., Latifin Bagian Keperawatan, K., Kedokteran, F., Sriwijaya, U., Masjid Al Gazali, J., & Lama, B. (2024). OPTIMALISASI DUKUNGAN ORANG TUA DALAM UPAYA PENCEGAHAN OBESITAS PADA SISWA. http://jurnal.globalhealthsciencegroup.com/index.php/JPM

Singhal, J., Herd, C., Adab, P., & Pallan, M. (2021). Effectiveness of school‐based interventions to prevent obesity among children aged 4 to 12 years old in middle‐income countries: A systematic review and meta‐analysis. Obesity Reviews, 22(1). https://doi.org/10.1111/obr.13105

Smith, A. D., Kininmonth, A., Tommerup, K., Boniface, D., Gericke, C., Denning, T., Summerbell, C., Vogel, C., & Llewellyn, C. (2025). The impact of deprivation and neighbourhood food environments on home food environments, parental feeding practices, child eating behaviours, food preferences and BMI: The Family Food Experience Study-London. International Journal of Behavioral Nutrition and Physical Activity, 22(1), 91. https://doi.org/10.1186/s12966-025-01788-7

Trindade, T. S., Duarte, H. N., Brito, T. M., Silva, J. V., Aguiar, B. B., & Costa, M. (2025). Nurturing healthy futures: social and familial influences on childhood obesity. World Journal of Pediatrics, 21(4), 328–332. https://doi.org/10.1007/s12519-025-00906-6

WHO. (2022, June 22). WHO guideline on school health services. World Health Organization. https://www.who.int/publications/i/item/9789240029392

WHO. (2025a). BMI-for-age (5-19 years). World Health Organization. https://www.who.int/tools/growth-reference-data-for-5to19-years/indicators/bmi-for-age

WHO. (2025b, December 8). Obesity and overweight. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

Downloads

Additional Files

Published

2026-03-21

How to Cite

Nurharlinah, N., Athiutama, A., Karyatin, K., & Herdiani, R. (2026). Parental Support and School Environment as Determinants of Obesity Risk among School-Aged Children: A Cross-Sectional Study. Journal of Applied Nursing and Health, 8(1), 240–253. https://doi.org/10.55018/janh.v8i1.551