학령기 아동의 비만도 변화에 관한 분석

Abstract

비만은 현대사회의 가장 광범위하고 심각한 공중 보건상의 문제 중의 하나이다. 특히 아동기의 비만율은 더욱 빠르고 급속하게 증가하고 있고, 성인기 비만으로 연결되며 성인병 발생의 중요한 요인이 된다. 또한 외모에 대한 열등감과 자존감의 저하 등과 같은 정신, 심리적인 문제가 동반되므로 그 중요성이 크다. 그러나 학교에서의 비만예방이나 관리 사업은 아직 소극적인 상태에 머물러 있다. 본 연구의 목적은 학령기 아동의 비만관련 특성을 파악하고 초등학교 1학년부터 6학년까지의 신장, 체중, 체질량지수(BMI)를 분석하여 초등학교 현장에서 비만예방이나 관리사업을 위한 기초자료를 제공하기 위해서이다. 연구대상자는 서울시의 G 초등학교 6학년 아동 229명이었으며, 2002년 9월 1일부터 25일까지 자료수집을 하였다. 자료는 학생건강기록부에서 1학년부터 6학년까지의 신장, 체중 자료를 구했고 체질량지수를 계산했다. 비만관련 특성은 15문항으로 구성된 설문지로 조사하였다. 수집된 자료는 SPSS 통계 프로그램을 이용하여 실수, 백분율, 평균, 표준편차, χ²-test, F -test, t -test를 이용하여 분석하였으며 결과는 다음과 같다. 1. 대상아동의 체중별 분포는 229명 중 저체중 46명(20.1%), 정상체중 115명(50.2%), 과체중 24명(10.5%), 비만 44명(19.2%)으로 나타났다. 성별에 따른 분포에서 남자아동은 117명으로 저체중 18명(15.4%), 정상체중 62명(53.0%), 과체중10명(8.5%), 비만 27명(23.1%)이었고, 여자아동은 112명으로 저체중 28명(25.0%), 정상체중 53명(47.3%), 과체중14명(12.5%), 비만 17명(15.2%)이었다. 2. 비만관련 특성에서 영아기 수유방법은 정상군에서 모유 수유가, 과체중군과 비만군은 혼합유가, 저체중군에서는 분유비율이 많았다(p=.044). 또한 비만한 형제·자매가 있는 경우에 없는 경우보다 비만 아동이 많았다(p=.017). 3. 출생시 체중과 현재 비만도는 통계상 유의한 차이는 없었으나(p=.068) 출생시 체중이 비만아동은 3.52kg, 과체중아동은 3.43kg, 정상아동은 3.33kg, 저체중아동은 3.29kg이었다. 4. 대상아동의 신장의 변화는 1학년 때 119.62cm에서 6학년 때 149.45cm로 29.83cm 증가하였다. 신장의 연간 증가량은 5~6학년 사이에 6.10cm로 가장 많았다. 1, 2, 3학년 때는 남자아동의 신장이 높고, 4, 5, 6학년 때는 여자아동의 신장이 높아서 성별 교차 시기는 3~4학년 사이로 나타났다. 초등학교 전 학년에서 비만그룹에 따른 신장의 차이는 없었다. 5. 대상아동의 체중의 변화는 1학년 때 22.93kg에서 6학년때 44.48kg으로 21.55kg 증가하였다. 체중의 연간 증가량은 5~6학년 사이에 5.88kg로 가장 많았다. 체중은 1~5학년까지는 남자아동이 더 많았으나 6학년 때는 그 차이가 크지는 않았지만 여자아동이 0.49kg 더 많아서 체중의 교차시기는 5~6학년 시기인 것으로 나타났다. 비만그룹에 따른 체중은 전학년에 걸쳐 유의한 차이가 있었다(p=.000). 6. 대상아동의 체질량지수(BMI)의 변화는 1학년 때 15.97에서 6학년 때 19.78로 3.81 증가하였다. 체질량지수의 연간 증가량은 3~4학년 사이에 1.19로 가장 많았다. 초등학교 모든 시기에서 체질량지수가 남자아동이 여자아동보다 높았다. 비만도 그룹에 따른 차이는 전학년에 걸쳐 유의한 차이가 있었다(p=.000). 이상의 연구결과에서 비만아동은 19.2%이며 비만도는 영아기 수유방법과 비만한 형제·자매의 유무가 관계가 있었다. 신장과 체중은 5~6학년 시기에, 체질량지수는 3~4학년 시기에 가장 증가량이 많았으며 남자아동의 체질량 지수가 높았다. 이는 본격적으로 체질량지수가 증가하기 전인 초등학교 저학년 시기부터 특히 남자아동에게 집중적인 비만관리가 요구됨을 알 수 있다. 본 연구결과를 바탕으로 다음과 같이 제언한다. 첫째, 본 연구에서 저체중 아동의 비율이 비만보다 많았으므로 비만아동뿐 아니라 저체중 아동에 관한 건강관리 및 연구도 다양하게 이뤄져야 한다 둘째, 본 연구에서는 초등학교 시기를 대상으로 하였는데 좀 더 장기간의 비만변화를 파악할 수 있는 연구가 필요하다. 셋째, 학교 현장에서 비만의 예방과 관리 목적으로 사용할 수 있는 비만정도에 따라 차별화 된 프로그램이 개발되어야 한다. 아울러 적절한 체중을 유지함으로서 건강을 유지, 증진할 수 있도록 비만 관련 보건교육 및 학교보건사업이 더욱 활성화되어야 한다. ; Obesity is one of the most wide and serious problems in modern public health. Especially childhood obesity prevalence increases rapidly and speedily because the over nutrition and the drop in physical activity make the most obesity reasons. Obesity occurs various problems to all age groups. Childhood Obesity is specially easy to continue to the adult obesity and it becomes the main reason to occur the chronic diseases while it becomes easily to make the complex of self appearance and the drop of self-esteem in their growing up period that is developing the notion of self enough to appear the spiritual and psychological problems at the same time. But school obesity prevention and management program remain to be passive yet, so obesity prevention program needs to practice much more actively. The purpose of this study aimed to supply the basic data of obesity prevention and management program to be useful of the actual scene of elementary school. For this purpose, the general specific character, which was concerned with obesity of elementary school pupil, was researched so that the obesity increasing period might be found in vertical analysis of height, weight, and BMI for the elementary school 1st to 6th grade. The subjects of this study were the 6th grade 229 pupils of G elementary school in Seoul Metropolitan City and the data were collected from Sept.1, 2002 to Sept.25, 2002. And data were analyzed as lean, normal, overweight, and obesity in use of the Standard Body Weight of Korean Children while the general specific characters were investigated by questionnaires consisted of 15 questions. Height, weight, and BMI of the subject the 1st to 6th grade of elementary school were used in the record of Pupil s Health Records. The data were analyzed as Real Number, Percentage, X²-test, Mean, Variation, F-test(Anova), and T-test in use of SPSS statistical program. The study results were as follows: 1. The whole Distribution of the subject were lean 46 pupils (20.1%), normal 115 pupils (50.2%), overweight 24 pupils (10.5%), and obesity 44 pupils (19.2%) while lean was shown a little more than obesity. In the Distribution of sex distinction, 117 boys out of total pupils 229 were lean 18(15.4%), normal 62(53.0%), overweight 10(8.5%), and obesity 27(23.1%) while 112 girls were lean 28(25.0%), normal 53(47.3%), overweight 14(12.5%), and obesity 17(15.2%). Boys were higher rate than girls in obesity, but girls were higher rate than boys in lean. Obesity group was shown as mild obesity 20 pupils (45.5%), moderate obesity 20 pupils (45.5%), and severe obesity 4 pupils (9.1%). 2. The general specific character according to obesity index was shown feeding method before weaning diet to be the attentive difference (p=0.044) as normal group showed much breast-fed, overweight and obesity showed much mixed-milk, and lean showed much powdered milk in rate. Also obesity pupils who have obesity brother or sister showed more than pupils who have not as showing the attentive difference (p=0.017). 3. At the time of birth, weight and obesity index didn t show the attentive difference (p=0.068) statistically as obesity 3.52kg, overweight 3.43kg, normal 3.33kg, and lean 3.29kg while average difference was shown in order of obesity, overweight, normal, and lean as the same weight as of elementary school 6th grade. 4. The height change of the whole subject increased 29.83㎝ from the 1st grade 119.62㎝ to the 6th grade 149.45㎝. The whole pupils increasing yearly showed the highest in the period of the 5th-6th grade while boys showed the highest in the period of the 5th-6th grade and girls showed the highest in the period of the 4th-5th grade. Boys average height showed higher than girls in the 1st, 2nd, 3rd grade while girls average height showed higher than boys in the 4th, 5th, 6th grade, so height crossing period should be read as the 3rd - 4th grade period. In the whole grade of elementary school, the height difference according to obesity index was not shown and the difference among the four groups of lean, normal, overweight, and obesity in the 6th grade was not also shown the attentive difference as p=0.989. 5. The weight change of the whole subject was increased two times nearly from the 1st grade 22.93㎏ to the 6th grade 44.88㎏. The highest rate period in increasing yearly was showed as the 5th-6th grade period to all boys and girls. Boys were increased 5.53㎏ and girls were increased 6.23㎏. The weight was showed as boys were heavier in the 1st - 5th grade but the 6th grade was not showed any difference specially except girls were 0.49㎏ more, so weight crossing period should be read as the 5th-6th grade period. Weight difference according to obesity index was shown the attentive difference (p=0.000) through the whole grade while the 6th grade was shown lean 36.43㎏, normal 42.34㎏, overweight 48.43㎏, obesity 56.35㎏ to be the attentive difference (p=0.000) among the 4 groups. This should be read as the weight difference among the 4 groups had continued from the 1st grade. 6. The BMI change of the whole subject was increased from the 1st grade 15.97 to the 6th grade 19.78 and the change was increased continuously according to the grade. The increase yearly of the whole pupils was shown the highest in the 3rd-4th grade period while boys were the highest in the 3rd-4th grade period and girls were the highest in the 5th-6th grade period. Through the whole period of the elementary school, boys BMI were higher then girls so the crossing period of boys and girls was not showed in BMI. The difference of BMI according to obesity index was showed through the grade as the attentive difference (p=0.000) while the 6th grade BMI according to obesity index was showed lean 16.24, normal 18.76, overweight 21.63, obesity 25.17 to be the attentive difference (p=0.000) among the 4 groups. This result should be read as the obesity index was increased and the difference among the 4 groups became larger after the 3rd grade, so obesity prevention and management program should perform actively from the low grade of the elementary school. The results of this study are suggested as follows: 1. In this study, lean pupils rate was higher than obesity so health management and various studies for lean pupils should be carried out. 2. In this study, the subject of obesity index was the elementary school pupils, but the longer period -from the entrance of the elementary school to the graduation of the high school- of the whole school age period should be researched vertically. 3. The differentiated programs according to obesity prevalence, just like lean, normal, overweight, obesity and the like, should be developed in order to use them as obesity prevention and management program at the actual scene of school. More over it, the health education and the school health business should be activated still more in order to maintain the suitable weight and the healthful life.