Journal of M ind and M edical Scie nces [601870]

Journal of M ind and M edical Scie nces
Volume 5 |Issue 1 Article 14
Dietary habits and li festyle in scho ol-a ged chi ldren
from B uch arest, Romania
Anca Pantea Stoian
Carol Davila University of M edicine and Ph armacy, Department of Di abetes, Nutrition and M etabolic Dise ase,
ancas toian@yahoo .com
Liliana F. Andronache
Carol Davila University of M edicine and Ph armacy, Department of F oreign Languages
Razvan H ainarosie
Carol Davila University of M edicine and Ph armacy Bucharest, Romania
Dan N . Paduraru
Carol Davila University of M edicine and Ph armacy, Bucharest, Romania
Cristinel D . Badiu
Carol Davila University of M edicine and Ph armacy, Bucharest, Romania
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Claudia; Ditu , Ge orgiana; Pituru, Silviu M .; Orlo v, Cristina; Or os, M ihaela; and N itipir, Cornelia () " Dietary habits a nd lifestyle in
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DOI: 10.22543/7674.51.P8592
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Dietary habits and li festyle in scho ol-a ged chi ldren from B uch arest,
Romania
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Auth ors
Anca P antea Stoian, L iliana F. Andronache, Razvan Hainarosie , Dan N. Paduraru, Cristinel D. Badiu, Andreea
Arsene, Claudia M ehedintu, Ge orgiana Ditu , Silviu M . Pituru, Cristina Orlo v, Mihaela Or os, a nd C ornelia
Nitipir
This research a rticle i s available in J ournal of M ind a nd M edical S ciences:https://s cholar.valpo .edu/jmm s/vol5/iss1/14

J Mind Med Sci. 2018 ; 5(1): 85-92
doi: 10.22543/7674.51.P8592

*Correspond ing author:
Anca Pantea -Stoian, Carol Davila University of Medicine and Pharmacy,
Department of Diabetes, Nurition and Metabolic Disease, Ion Movila Street, no 5 –
7, Bucharest, Romania, tel: +40 [anonimizat],
e-mail: [anonimizat] To cite this article : Pantea -Stoian A, Andronache LF, Hainarosie R, Paduraru DN, Badiu
CD, Arsene A, Mehedintu C, Ditu G, Pituru SM, Orlov C, Oros M, Nitipir C. Dietary habits
and lifestyle in school -aged children from Bucharest, Romania. J Mind Med Sci. 2018; 5(1):
85-92. DO I: 10.22543/7674.51.P8592

Research Article
Dietary habits and lifestyle in school -aged
children from Bucharest, Romania
Anca P antea Stoian1*, Liliana F. Andronache2, Razvan Hainarosie3, Dan N. Paduraru3,
Cristinel D. Badiu3, Andreea Arsene3, Claudia Mehedintu3, Georgiana Ditu4, Silviu M.
Pituru3, Cristina Orlov5, Mihaela Oros6, Cornelia Nitipir3
Department of Diabetes, Nutrition and Metabolic Disease1, Department of Foreign Languages2, Carol
Davila University of Medicine and Pharmacy, Bucharest, Romania3; N.C. Paulescu Nationa l Institute
of Diabetes, Nutrition and Metabolic Disease, Bucharest, Romania4; Elias University Emergency
Hospital, Department of Medical Oncology, Bucharest, Romania5; Queen Mary Hospital, Department
of Clinic Pediatry, Bucharest, Romania6

Abstract Background . This study evaluated the difference between boys and girls in terms of
nutritional status, lifestyle, and dietary habits during school life.
Materials and Methods . A descriptive and observational study was conducted in 2016, in
which 251 childre n, aged 7 -17, from 3 elementary schools and a high school in Bucharest,
Romania, were evaluated. A questionnaire was used to assess food behavior, eating, and lifestyle
habits.
Results . Boys had a significantly higher waist circumference (71.18±9) than gi rls
(67.46±9.91) (p=0.004). Thus 27% of boys were overweight or obese compared with only 22% of
the girls. Differences were also seen between the two groups in terms of main meals and snacks
and following a rhythm of meals: a statistically significant perc entage of girls (36.3%) skip
breakfast, while most boys (63.8%) take a food package to school. A total of 23.8% of the boys
and 24% of the girls state that they eat while sitting in front of the computer or TV.
Conclusions . We found that boys are more ove rweight or obese than girls. Obesity in the
pediatric population of Romania could be explained by the country’s emergence from
communism 25 years ago, pattern typical of all Eastern European countries and which currently
involve an overexposure of people t o fast food, fizzy drinks and sweets, as well as to a high
consumption of salt and food additives. Unbalanced and highly caloric food had been preferable
to healthy food in the last period. Leisure time is rather spent in front of the TV, tablet,
detriment al to rational physical exercise, recreational sports or hiking. The family environment is
very important and all our actions should be focused on continuous education about the risks of
unhealthy food and a sedentary lifestyle.
Keywords  school -aged c hildren, obesity, eating habits, lifestyle, nutrition
Highlights ✓ The great majority of Romania n children do not follow a healthy schedule of meals
and snacks, with many giving up breakfast deliberately.
✓ The boys are more obese than girls (9% vs. 5%) whil e the overweight figure was
27% among the boys and 22% among the girls.

Anca Pantea -Stoian et al.
86
Introduction
Much evidence indicates that eating habits and
lifestyle during childhood and adolescence are risk
factors for different nutritional and cardiovascular
diseases in adulthood. Obesity is perhaps the most
frequent chronic disease in children and adolescents,
affecting each group of age, beginning with infancy.
However, obesity is the most common nutritional
disorder in children worldwide, its prevalence growi ng in
both developed and developing countries, affecting all
social and economic categories, both sexes, all ages and
ethnic groups. Obesity among children and adolescents
represents a serious public health problem, since it is
frequently associated with m etabolic syndrome, type II
diabetes mellitus, hypertension, dyslipidemias as well as
more frequent sleep apnea and orthopedic diseases/
osteoporosis (1, 2).
The growing rate of overweight and obesity in
children is 30% higher in developing countries
(clas sified as countries with poor and average incomes
by the World Bank) than in developed countries. Data
provided by the Order of the Ministry of Health in 2013
pertaining to the international situation of obesity
indicate that “wealth disease” is a problem even for very
many poor countries (3, 4).
The prevalence of overweight in Europe ranges
between 40 -59.9% in adults aged 20 years or older. The
prevalence of insufficient physical activity in European
youngsters aged 15 or older ranges between 20 -60%
depe nding on the country, while the number of daily
calories per capita varies between 2700 and over 3500
(4).
The increase in time spent in front of the computer,
TV, or video games is a significant factor in the growth
of obesity at a global level (2). A stu dy published by the
Milken Institute in 2012 notes that each 10% investment
of information technology generates a 1% increase in the
obesity rate, while a 0.4% growth of the obesity rate due
to the time spent in front of the screen leads to an overall
grow th of 1.4% of the obesity rate. These data show that,
for example, in a country with a population of 300
million inhabitants, there will be 4.2 million new cases of
obesity. The study also reveals that in countries with a
large investment in informational technology, a growth
of 1% in the number of physically active people can
prevent a growth of 0.2% of obesity (5).
In Romania, overweight and obesity represent a
serious epidemiologic and public health problem, due to
its growing prevalence. Twenty percent of the children
aged 6 -12 years and 11% of those aged 13 -17 years are
diagnosed as overweight or obese. The prevalence of
obesity in 2014 was 10.1% in both urban and rural areas in Romania. This increased incidence is due to a long –
term positive energy bal ance supported by a modern
lifestyle, excess caloric feeding originating in junk -food,
a sedentary lifestyle, and the lack of an adequate
nutritional education (6).
According to the latest studies, Romania is now 3rd
in Europe in terms of overweight, up from 23rd in 2003.
Specialists state that the explanation for such a worrying
phenomenon is due to the occurrence of the first “fast –
food” generation among adults after the ’90s.
Acknowledging problems related to food quality is a
starting point in solvin g such a problem. The formation
of healthy eating habits begins in the very first years of
development, yet the first years at school may lead to
developing bad eating habits, for example, buying snacks
from shops often found within the school (5, 6).
It is concerning that children begin watching TV
from the age of 2, spending an average of 2 -4 hours/day,
a situation that is detrimental to physical exercise. More
than 7% of children and adolescents frequently eat fast –
food, which is rich in carbohydrates, lipids, salt, and
sugar. Such a lifestyle is frequently seen within the entire
family, especially in disorganized or single parent homes
(7).
The purpose of this study was to assess differences
between boys and girls regarding nutritional status,
lifestyl e, and eating habits in the schooling period.
Developing positive lifestyle habits should become a
national strategy among the young so as to promote
physical exercise, understand patterns of a sedentary
lifestyle and their control, impart nutritional educ ation on
a large scale among the entire population, and promote
healthy norms of sleep and work schedules (8).

Materials and Methods
A descriptive, observational, cohort study was
undertaken in which 251 children were assessed, with
ages between 7 -17 year s (mean = 12.27±2.72 years) in
three elementary schools and one high school in
Bucharest, Romania. The children were divided into two
groups based on gender: 41.8% (105) boys and 58.2%
(146) girls, with relatively close ages. Data were
collected between Fe bruary -March 2016, in Bucharest,
Romania.
The demographic, anthropometric (weight, height,
waist, and hip diameter) parameters were assessed and a
questionnaire was used to evaluate the eating behavior
and habits and their connection to lifestyle. Data
included direct observation methods, questionnaire
response patterns, and physical examination. The
questionnaire was comprised of lifestyle -related
questions, work and sleep schedule, frequency and

Dieta ry habits and lifestyle in schools from Romania
87
schedule of meals, meal content, eating habits, and
lifesty le habits among the subjects’ own families. The
questionnaire included questions about the consistency
of daily meals, the types and the quantity of drinks
consumed daily, the types of daily and weekly exercise,
the number of leisure hours spent in front o f a computer
or TV, and questions related to compliance with
recommended food groups and their introduction into the
daily diet provided by the Ministry of Public Health
(Romania). These school -aged children also reported
about the conditions during which meals were eaten by
selecting from the following categories: standing,
directly from the food pot, watching TV, eating due to
boredom, emotional eating, and eating at night or only in
small amounts but frequently. Informed consent was
given by parents.
In terms of physical evaluation, calculation of the
Body Mass Index (BMI) involved measurement of both
weight and height under conditions of food and beverage
fasting for more than 8 hours. Children were weighed on
an empty bladder and slightly dressed and t heir BMI was
correlated with the percentile graphics specific to boys
and girls.
BMI is an indicator of body fatness, so even though
it cannot be used to diagnose health issues, it can be used
as an early screening tool. For children and teenagers,
BMI wa s evaluated using age and gender -specific charts
that take into account different growth patterns for the
sexes. Weight and the amount of fat in the body differ
for boys and girls and those levels change with height
and age. BMI percentiles for boys (2 to 20 years) and
BMI percentiles for girls (2 to 20 years) were used (7).
Statistics
Data were analyzed using Excel and SPSS v 20,
with P -values <0.05 for two -tailed tests considered
statistically significant. Data are expressed as median
(interquartile range ) for continuous variables and as
number of cases and percentages for category variables.
Subjects were classified by gender, and the groups were
compared using one -way ANOVA and t tests. The
confidence index was higher than 95%.
Results
Regarding anthrop ometric indices, boys had a
significantly higher waist circumference (71.18±9) than
girls’ (67.46±9.91) (p=0.004). In addition, comparative
analysis (Table 1, Figure 1) indicated a higher percentage
of obesity in boys (9%) than girls (5%) although this
difference was not significant (p=0.25).
Regarding eating habits and a consistent rhythm in
main meals, a significantly higher percentage of girls
than girls (36.3% vs 22.9%) skip breakfast; most
boys(63.8%) take a school lunch (Table 2) and only 30.5% of the boys and 40.1 % of the girls have a family
meal.
Regarding meal content, boys are large consumers
of fruits, eggs, meat, dairy, and farinaceous (starchy)
foods, while the girls are larger consumers of sweets
(65.1%) (Table 3). 79% of the boys and 73.3% o f the
girls have at least one weekly meal at a fast food
restaurant (Figure 2). Content of the most frequent foods
according to gender is represented in Figure 3.
Boys Girls
Number of children
assessed 105 146
Underweight
(< 5th %ile) 8% 7%
Normal
(5th – 85th %ile) 66% 71%
Overweight or obese (≥
85th %ile) (6) 27% 22%
Obese
(≥ 95th %ile) 9% 5%
Table 1. Group distribution according to gender and
percentile;
6Terminology based on: Barlow SE and the Expert
Committee. Expert committee recommendation s
regarding the prevention, assessment, and treatment
of child and adolescent overweight and obesity:
summary report. Pediatrics. 2007; 120 (suppl
4):s164 -92.

Figure 1. Group distribution according to weight
and gender
As for fluid consumption, 28.6 % of the boys
consume more than 2 glasses of fizzy drinks a day, while
only 16.43% of the girls consume more than 2 glasses;
29% fail to drink at least one glass of water a day
(Figure 4).

Anca Pantea -Stoian et al.
88
Male Female p
Breakfast Yes
No 77.1% (81)
22.9 (24) Yes
No 63.7% (93)
36.3% (53) 0.023
School
package Yes
No 63.8% (67)
36.2% (38) Yes
No 47.3% (69)
52.7% (77) 0.009
Lunch Yes
No 78.1% (82)
21.9% (23) Yes
No 75.3%(110)
24.7% (36) 0.641
Snack
between
lunch and
dinner Yes
No 72.4% (76)
27.6% (29) Yes
No 62.3% (91)
37.7 % (55) 0.097
Dinner Yes
No 80% (84)
20% (21) Yes
No 67.8% (99)
32.2% (47) 0.032
Eating all
the time Yes
No 30.5% (32)
69.5% (73) Yes
No 27.7% (41)
72.3%
(105) 0.906
Table 2. Meal and snack intake according to gender

Figure 2. Distribution of fa st food consumption
according to gender and frequency
The rhythm of meals is important, along with a
hygienic -dietary regimen important for this age category.
9.5% of boys and 6.2% of girls eat at night; 3.9% of boys
and 3.8% of girls eat when upset; 23.8 % of boys and
24% of girls report eating in front of the computer or TV.
A surprising result was that all children in this study
reported eating due to boredom at least once a week.
These observations suggest a compulsive aspect of
eating, which may lead t o the development of poor
eating habits in adulthood and to the previously
mentioned chronic complications.
Regarding leisure time spent in front of a TV, tablet,
or phone, boys spend 3.47±2.6 hours daily, significantly
higher than girls who spend 2.57±2. 1 hours/day. This difference is further reflected in the weekly time spent in
front of devices: boys spend approximately 17.38±5.55
hours/ week vs. girls who spend10.8±4.33 hours/ week, a
significant difference (Figure 5).

Food Male Female p
Vege –
tables <3
>3 81.9%(86)
18.1% (19) 76.7% (112)
23.3% (34) 0.049
Fruits <3
>3 79% (82)
21% (23) 76.7% (112)
23.3% (34) 0.54
Milk <3
>3 81% (85)
19% (20) 78.1% (114)
21.9% (32) 0.934
Eggs <3
>3 59% (62)
41% (43) 39.7% (58)
60.3% (88) 0.023
Meat and
cold meats <3
>3 82.9% (87)
17.1% (18) 72.6% (106)
27.4% (40) 0.034
Butter <3
>3 45.7% (48)
54.3% (57( 41.1% (60)
58.9% (86) 0.567
Pasta <3
>3 38.1% (40)
61.9% (65) 31.5% (46)
68.5% (100) 0.314
Bread <3
>3 81% (85)
19%(20) 71.2% (104)
28.8% (42) 0.05
Sweets <3
>3 64.8% (68)
35.3% (37) 65.1% (95)
34.9% (51) 0.075
Table 3. Frequency of food intake per week
according to gender

Dieta ry habits and lifestyle in schools from Romania
89

Figure 4. Fizzy drinks consumption by gender

Figure 5 . Children distribution by TV watching

Regarding physical activity, as in adults, increased
physical activity has been associated with increased life
expectancy and decreased risk for cardiovascular disease.
Physical activity triggers overall physical, psychological,
and social benefits (9). Analysis of the time spent
outdoors engaged in favorite or recreational sports
indicates roughly 2 hours daily for both boys and girls.
When asked if they participated in other physical
activities, only 29% answered affirmatively. Favorite
activities incl uded football, dancing, skating, modern
dancing, basketball, karate, swimming, walking,
movement to music, fitness exercise, Pilates, and
gymnastics. However, a significant percentage did not
engage in any physically active behavior (27% of the
boys and 19 % of the girls).
Among the boys’ favorite activities were: basketball,
17.6%; cycling, 6.7%; football, 21.4%; swimming, 4%;
rugby, 3.8%; roller -skating, 2.9%; and other, 16%.
Among girls’ favorite activities were: dancing, 10%;
ballet, 3.4%; cycling, 4.1% ; gymnastics, 12%;
swimming, 4%; roller -skating, 5%; tennis, 7%;
volleyball, 6%, and other, 11%.

Discussions
The problem of pediatric overweight and obesity is
already a serious public health problem in Romania. In
our study, we noted that 27% of the boy s are overweight
or obese compared with 22% of girls. Obesity among the
pediatric population in Romania might partially be
explained by the country’s emergence from communism 25 years ago, a pattern seen in all Eastern European
countries, where children’s diets are now characterized
by overexposure to fast foods, fizzy drinks, and sweets,
as well as high consumption of salt and food additives
(2).
Imbalanced and high caloric diets were preferable to
healthy food. Spending free time in front of the TV,
phon e, or tablet has become preferable to rational
physical exercise, recreational sports, or hiking. Family
environment is critically important, as it should provide
modelling for children as well as continuous education
regarding the risks of unhealthy food and a sedentary
lifestyle.
Although daily breakfast consumption is considered
healthy for nutritional status, cognitive function, and
body weight control, school -aged children appear not to
know this information. In a meta -analysis on the benefits
of bre akfast consumption by school -aged children,
conducted by Szajewska and Ruszczynski in 2010, 13 of
16 studies revealed that breakfast has a protective effect
against becoming overweight or obese (10). Our study
indicates that 36.3% of the girls and 22.9 % o f the boys
skip breakfast. The finding that girls skip breakfast more
than boys has now been reported in multiple studies and
has been interpreted as girls being more concerned about
body image and dieting, hoping that skipping breakfast
will reduce their overall calorie intake and weight (11).
In general, about half the adolescents consume
vegetables, fruits, and red meat more than three times a
week.
A strategy of preventing overweight/ obesity in
children should directly address the entire family,
encou raging the consumption of fresh fruits and
vegetables, grain cereals, moderately low fat dairy
products and cheese, and unprocessed meat products (as
opposed to pre -cooked food, junk food, and fizzy
drinks). Nevertheless, the education of children in schoo l
settings is also critical, with the requirement and/or
promotion of nutritional educational programs and
various outdoor activities.
The low intake of fruits and vegetables is of
particular concern since such foods are protective against
certain chronic diseases, including obesity,
cardiovascular diseases, and some types of cancer (11).
High consumption of fast foods presents a considerable
risk factor for obesity (12), with our study revealing that
around 70% of children eat fast -food at least once a
week. As for meal content, most children regularly eat
bread, meat, and vegetables.
Studies have also demonstrated that snacking
between meals could be a protective factor against
obesity, although this depends greatly on the quality and
quantity of the sna cks. The low intake of fruits and

Anca Pantea -Stoian et al.
90
vegetables in the daily diet of children in this sample is a
serious problem, particularly since the consumption of
such foods categories are well -known protective effects.
Girls specifically ingest a lower quantity of suc h foods,
as seen in our study, and this is may be due to the
generalized tendency (especially in female teens) to
maintain a lower body weight by sacrificing at 1 -2
meals/ day and giving up snacks. Regarding meal
content, girls consistently consume less fo od than boys,
probably associated with girls’ overall smaller size,
smaller waists, and lower obesity (5% vs. 9% in boys).
Increased television watching, playing video games,
and protracted use of the Internet are contributory factors
to an increased sede ntary behavior during free time,
which can lead to decreased physical activity (13 -15).
Our findings indicate that both girls and boys spent
approximately 2 -4 hours/day in front of the computer or
TV, undoubtedly due to the current widespread
availability of TV sets and computers. Free time devoted
to sports or physical activities consumes roughly 2
hours/day in both girls and boys, which most likely
corresponds to compulsory classes in physical education
within the school’s daily schedule (16).
To prevent childhood obesity, parents should
encourage healthy eating habits (i.e., plenty of
vegetables, fruits, and whole -grain products, low -fat or
non-fat milk or dairy products, lean meats, poultry, fish,
lentils and beans for protein, plenty of water and fewer
sugar -sweetened beverages and less sugar, sodium, and
saturated fat), ensure that their children understand the
benefits of being physically active, encourage them to be
active and reduce sedentary time (on TV, video games,
Internet, etc.) to no more than 2 hours/day, and develop
new fun and engaging physical activities with other
family members or simply on their own (1 7, 18).

Conclusions
This study found that boys are more obese than girls
(9% vs. 5%) while the overweight figure was 27%
among the boys a nd 22% among the girls. Obesity in the
pediatric population of Romania may be related to the
country’s communist period, which later favored the
overexposure to fast food, fizzy drinks, and sweets as
well as high consumption of salt and food additives (1 9,
20). Unbalanced and highly caloric food has been
preferred to healthy food (21 , 22).
The most important conclusion of our study is that
the great majority of children do not follow a healthy
schedule of meals and snacks, with many (especially
girls, over 36%) giving up breakfast deliberately. Most
school -aged children in this study also did not follow a
regimen consisting of main meals and snacks throughout the day (breakfast, the morning snack, lunch, the
afternoon snack, dinner). School -aged boys favored
dinner (80%), while girls (75%) favored lunch.
An important tradition in Romanian society is the
mother’s position at the center of the family and the one
responsible for preparing meals (2 2, 23). As such, she
typically ensures at least one cooked dish/day, an
assumption confirmed by more than 80% of all children.
Many girls and boys have at least one family meal/ day
(30% vs. 40%), but many also eat fast food occasionally
(73% vs. 79%).
One behavior that needs to be encouraged is eating
the snack at school that most school -aged children still
eat although girls are more likely to skip it, hoping to
maintain a lower body weight (63% of the boys and 47%
of the girls eat the snack). This snack could consist of a
sandwich, fruits or, as expected, sweets (65%). I n the
daily diet of school -aged children we mainly find bread
or polenta, potatoes, fruits and raw vegetables, milk and
dairy products, butter or margarine, fish or meat and
sweets. Almost one third (29%) do not consume water at
all during the day, and boy s consume at least 2 glasses of
sweetened fizzy drinks/day (28.61%) compared to girls
(16.43%). Regarding the conditions during which daily
meals are consumed, a sizable portion of children eat
while watching TV (approximately 24% of both girls and
boys) o r out of boredom -"sometimes" -100%. Some of
the boys and girls also prefer to eat at night (9.5% vs.
6.2%).
A large number of school -aged children attend
physical education classes (75%) and engage in various
outdoor activities (65%; football is the favor ite sport
among children in this group with a percentage of
17.24%), spending 2 hours a day for each one (physical
education, 59% of all children attend classes and 27% –
outdoor activities). Yet, the number of those who watch
TV daily and weekly is very h igh, the vast majority
choosing to spend 2 -4 hours daily in front of the TV,
roughly 17 hours/week for boys and 10 hours/week for
girls (24).
As a result of this study, in order to prevent a
growing prevalence of overweight among the pediatric
population i n Romania, we suggest the following
recommendations for school -aged children regarding
food and lifestyle:
1. Implementation of educational programs for both
families and schools via special classes on prevention. If
parents adopt a healthy lifestyle, thus being a good
example to follow, their children will be more likely to
follow the same path.
2. Development of a long -term national strategy that
incentivizes the benefits of an appropriate diet while

Dieta ry habits and lifestyle in schools from Romania
91
concomitantly drawing attention to non -healthy
alterna tives:
o Decrease in the frequency of fast -food meals, which
have become increasinly popular
o Higher consumption of fruits and dairy products
instead of chips and sweets at school
o Promotion of compotes, homemade cookies, and
jam instead of candies and chocho late as preferred
sweets
o Promotion of cooked main meals, and the
organization of school canteens/menus in which
children should be involved
o More natural juice made of raw fruit/ vegertables
and fewer or no fizzy drinks
o Age appropriate water consumption ma ndatory for
all school -aged children, with simultaneous
limitation of energetic beverages and coffee
3. Limitation of the leisure time in front of the TV or
computer:
o Overall less than 2 hours daily
o No TV, video games, computer interactions during
mealti mes
o No TV, video games, computers interactions due to
boredom, offset by the introduction of engaging
recreational activities
4. Greater attention to physical activities by the
school -aged child:
o Greater involvement in household chores as
appropriate
o Increased number of sports classes at school
o More attractive extracurricular activities to stimulate
school -aged children’s participation
o Introduction of recreational activities designed for
whole family participation
5. Scheduling regular visits to the fam ily
physician —especially if an obvious weight gain or loss
is noticed —who will communicate to parents a body
mass index outside the normal limits.

Acknowledgment
All authors have equally contributed to this paper

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