

























 

 Epidemiology and Society Health Review| ESHR 
Vol. 6, No. 2, 2024, pp. 106-118 ISSN 2656-6052 (online) | 2656-1107 (print) 
      http://journal2.uad.ac.id/index.php/eshr/index                                                   eshr@ikm.uad.ac.id 

 

 

      10.26555/eshr.v3i1.3629  

 
 

106 

 
 

  

 
Review Article 
 

Environmental, Genetic, and Behavioral Associations 
with the Incidence of Obesity in Primary School Children: 
A Systematic    Review 
Nurul Annisa1*, Sulistyawati Sulistyawati1, Surahma Asti Mulasari1  

1Faculty of Public Health, Ahmad Dahlan University, Yogyakarta, Indonesia 

* Correspondence: nurul7260@gmail.com  
 
Received 25 August 2024; Accepted 09 Dec 2024; Published 25 Dec 2024 
 

ABSTRACT 

Background: Obesity is influenced by complex interactions between environmental, genetic, and 
behavioural factors. This study aims to explore the relationship between these three factors and the 
incidence of childhood obesity. 

Method: A systematic literature review was used following PRISMA guidelines. The data were 
collected from three main databases: Google Scholar, PubMed, and Garuda. Screening was carried 
out from 89 articles found until 10 relevant articles were obtained for analysis. 

Results: The analysis shows that childhood obesity is influenced by genetic factors, behaviour 
(including eating habits and physical activity), and environment (such as access to healthy food and 
sports facilities). These three factors interact to increase the risk of obesity. 

Conclusion: This study emphasizes that obesity prevention requires a multidisciplinary approach 
that involves the roles of family, school, government, and community. Recommended efforts include 
improving access to nutritious food, education on healthy lifestyles, and creating an environment that 
supports physical activity. The findings provide important insights for designing more effective 
interventions to address obesity in primary school-aged children. 

Keywords: Obesity; Genetic; Environmental; Behavior; Primary School; Children 

INTRODUCTION 

Along with the development of the times resulting in nutritional problems in toddlers and 
children, it is a double problem, namely the discovery of the problem of undernutrition coupled 
with the discovery of the problem of excess nutrients such as energy, fat and salt.

1 Obesity is 
an excessive or abnormal accumulation of body fat that increases the risk of health problems. 
Children who are overweight or obese tend to remain obese into adulthood, potentially 

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increasing the risk of non-communicable diseases, such as diabetes mellitus and 
 

 with the discovery of the problem of excess nutrients such as energy, fat and salt.
1 Obesity is 

an excessive or abnormal accumulation of body fat that increases the risk of health problems. 
Children who are overweight or obese tend to remain obese into adulthood, potentially 
increasing the risk of non-communicable diseases, such as diabetes mellitus and 
cardiovascular disease, at a young age.2 The 2018 Riskesdas data shows that the prevalence 
of obesity in Indonesian children aged 5-12 years is 9.2% for boys, 10.7%, and for girls, 7.7%.

3 
According to Hendrik L. Blum (1974), the degree of public health is influenced by factors such as 
environment, behaviour, health services and heredity; health status will be achieved optimally 
when the four factors together have optimal conditions, one of which is in a disturbed state 
(not optimal), the health status will be shifted below optimal.

4 

Obesity occurs when energy intake exceeds energy expenditure because of genetic and 
environmental changes. In obese individuals, leptin resistance occurs when the body cannot 
respond to leptin. Leptin is an enzyme vital in maintaining the body's energy balance. It functions 
to control appetite so that even though food intake is sufficient, obese people cannot control 
their appetite. Obesity in children can be assessed through various examination methods or 
techniques, one of which is measuring body mass index (BMI).

5 

Family history factors play an essential role in the development of obesity. Genetic research 
has identified several genes related to energy metabolism, appetite and fat storage, all of 
which may influence an individual's risk of obesity. However, genetic factors do not work in 
isolation. They interact with environmental and behavioural characteristics to influence a 
person's weight status. Genetics also affect the incidence of childhood obesity. Ancestry has 
been known to influence the amount of body fat elements and exceed the normal amount. 
Parents who are obese have a higher risk of having obese children.

6 

Obesity is caused by several factors, namely genetic/hereditary factors, dietary factors, 
socioeconomic status factors and physical activity factors; one of the factors that most 
influence the occurrence of obesity is physical activity. The rapid development of technology 
contributes to the increase in the prevalence of obesity; without realizing it, technology 
accompanies us to a sedentary lifestyle, including lack of physical activity, eating instant food, 
and consuming less fruit and vegetables; physical activity is any body movement produced by 
skeletal muscles that requires energy expenditure, Lack of physical activity is an independent 
risk factor for chronic diseases and overall is estimated to cause death globally.

7 

Weight gain is also closely related to increased intake of fast food or fast food; fast food in 
question is packaged, easy to serve, practical or processed. These foods are generally 
produced by the food processing industry with high technology and provide various additives 
to preserve and flavour these products. Children's high frequency of fast food can increase 
calorie deposits in the body, increasing BMI values. In addition, this habit is often exacerbated 
by low physical activity, which reduces calorie burning, and a genetic predisposition that 
increases the risk of obesity. Fast food is viewed negatively due to its unbalanced nutritional 

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content, with a high proportion of carbohydrates, fat, cholesterol and salt. In contrast, the 
content of fibre and other essential nutrients is very low. 

Obesity in elementary school-aged children is an increasing health problem that requires 
serious attention. Various systematic studies have shown that childhood obesity is 
multifactorial and influenced by genetic, environmental, and behavioural factors. Genetic 
factors, such as a family history of obesity, contribute to excessive body fat accumulation risk. 
In addition, environments that do not support healthy lifestyles, such as limited access to 
nutritious food and exercise facilities, exacerbate the situation. Unhealthy eating behaviours, 
including fast food that is high in fat and low in fibre, are also significant causes. In this 
context, obesity is a primary degenerative disease problem that needs immediate attention 
and concerted efforts from various parties. Primary and tertiary health interventions are 
required to prevent and overcome obesity. Public health efforts should focus on increasing and 
facilitating physical activity to overcome the obesity epidemic and encourage people to adopt 
a healthy and regular diet. 

This systematic literature review aims to determine the relationship between environment, 
genetics, and behaviour to the incidence of obesity in primary school children. It is expected 
to provide new insights into the factors that influence childhood obesity and become the basis 
for prevention and treatment interventions. Prevention strategies should be designed to 
promote healthy lifestyles among children by increasing access to nutritious foods, raising 
awareness about the importance of physical activity, and building an environment that supports 
healthy behaviours. In addition, approaches that recognize individual differences and the role 
of genetics in obesity may aid in developing more personalized interventions and effectively 
analyze the influence of diet and physical activity on the incidence of obesity. 

METHOD 

This systematic literature review aims to analyze the relationship between genetic, behavioural 
and environmental factors on the incidence of obesity in primary school children. The 
methodology followed the steps of a literature review designed to describe, organize and 
evaluate previously published scientific articles related to this topic. The process began with 
formulating the background and objectives of the study, followed by developing research 
questions to guide the literature search process. The literature search was conducted through 
several databases, such as Google Scholar, PubMed, and Garuda, and relevant keywords 
were used. The articles found were examined, categorized, and selected based on 
predetermined criteria. After the duplicate article elimination process, 10 relevant journals were 
identified for further analysis. These articles were organized and evaluated based on their 
quality using pre-defined inclusion and exclusion criteria. Finally, these 10 selected journals 
were used as the material in the analysis process to support this research. 

This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-
Analyses) guidelines during the systematic review process for search results and study 
selection

8. A systematic review summarizes primary research results to present more 
comprehensive and balanced facts. Throughout the process, the systematic review method 
provides a strong basis for exploring the relationship between knowledge, attitudes, and 
motivation in managing vaccine cold chains by combining existing research results and 

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presenting them in a systematic and objective manner. 

 

 

Data Search Strategy 

The data search strategy includes methods used to search for information relevant to the 
research topic. In this case, the plan was carried out using various databases such as Google 
Scholar, PubMed, and Garuda with the keywords "Obesity," " Genetics," "Environment," 
"Behavior," and "Primary school children." The purpose of this data search strategy is to 
identify sources of information relevant to the research topic. 

1. Resources 

Information sources are places or media where data and information can be found. The 
primary sources of information used in this research are various databases and scientific 
literature related to the topic, namely scientific articles obtained from Google Scholar, 
PubMed, and Garuda. These sources of information are used to collect data relevant to the 
research. 

2. Eligibility Criteria 

Eligibility criteria determine whether an information source or article can be included in the 
research. In this case, the eligibility criteria include topics, source, publication period, 
language and research design. Only sources that meet these criteria will be included in the 
analysis. 

3. Quality Assessment 

Quality assessment is the process of evaluating the quality of sources used in research. In 
this study, the quality assessment was conducted by reading the abstracts and full 
manuscripts to assess whether the sources had a clear methodology and were relevant to 
the research topic. 

4. Data Extraction 

Data extraction is the process of retrieving relevant information from selected information 
sources. In this study, data extraction includes retrieving information about the relationship 
between environmental, genetic, and behavioural factors and the incidence of obesity in 
primary school children. The extracted data will be used for further analysis. 

5. Data Synthesis 

Data synthesis is the stage where information from various sources is combined, analyzed, 
and presented systematically. In this study, data synthesis includes grouping articles based 
on inclusion and exclusion criteria and analyzing articles that meet these criteria. The 
following inclusion and exclusion criteria are outlined in Table 1. 

Table 1. Inclusion and Exclusion Aspects of Literature in this Study 

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Aspect Inclusion Exclusion 
Topic Articles must focus on the relationship 

between genetics, behaviour, and 
environment with obesity among elementary 
school children. 

Articles discussed outside the topic  

Type of 
Research 

Scientific articles, empirical research Articles published in unrecognized journals 
or sources that cannot be verified or 
literature review 

Period & 
Language 

Published between 2019-2023. Articles 
written in English or Bahasa 

Published outside the range applied and 
using language apart from Bahasa and 
English.  

Research 
Design 

Articles such as empirical research must 
have a clear and relevant methodology for 
the research topic. 

Articles lacking a clear methodology or not 
relevant to the research topic  

RESULTS 

We yielded 242 articles based on the keywords entered in the databases. The selected articles 
are the results of relevant studies and by the objectives, in English, international standards, 
and published in 2019-2024. Exclusion criteria in this literature review are articles that do not 
examine the variable factors that cause obesity, the age of obese subjects being 7-12 years, 
articles not in the time range used, and full-text articles that cannot be accessed. The article 
selection process is presented in Figure 1. 

 

Figure 1. Database search and selection of studies based on PRISMA guidelines 

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From the selection process, 10 articles were found appropriate and suitable for further review, 
as presented in Table 2. It has generally been shown that genetic factors play a significant 
role in increasing the risk of obesity in primary school-aged children. Children who come from 
families with a history of obesity tend to be more prone to weight problems. Genes that affect 
the way the body manages energy and regulates appetite can be inherited, so these children 
have a higher tendency to be obese. Thus, parents need to understand that family health 
history can be an indicator of risk for childhood obesity, and preventive measures need to be 
taken early on. In addition to genetic factors, poor eating habits also contribute greatly to the 
incidence of obesity in children. Analysis shows that many children consume fast food that is 
high in calories and low in nutrients, which can lead to excess calorie intake. Exposure to 
unhealthy food advertisements and easy access to fast food exacerbate children's eating 
patterns. 

Therefore, it is essential to educate children on the importance of healthy eating and provide 
more nutritious food options at home and school to reduce the risk of obesity. Lack of physical 
activity was also a significant risk factor in this analysis. Many children spend more time on 
sedentary activities, such as watching television or playing video games than exercising. The 
study shows that the combination of an unhealthy diet and lack of physical activity creates 
conditions that favour obesity. Therefore, it is essential to encourage children to be more 
physically active through regular exercise or outdoor activities to help maintain a healthy weight 
and improve overall health. 

DISCUSSION  

Our study found that genetic factors have a significant role in predisposing children to obesity. 
Research shows that children who have parents with a history of obesity tend to have a higher 
risk of becoming obese. Specific genes, such as those that affect fat metabolism, can increase 
a person's tendency to gain weight. Previous study shows that children from families with a 
history of obesity more often experience excessive body fat accumulation.9 This suggests that 
genetic factors cannot be ignored when understanding the incidence of obesity. Genetic 
factors are important in determining a person's predisposition to obesity. Research shows that 
children with obese parents are more likely to be obese themselves due to the presence of 
genetic predispositions that affect body metabolism and fat storage. Specific genes, such as 
those that affect the activity of the enzyme lipoprotein lipase (LPL) in fat tissue, can increase 
a person's tendency to gain weight faster compared to people who do not have similar genetic 
factors.10 Obesity is more deadly than malnutrition. Overweight and obesity affect children's 
health and are major risk factors for mortality11. Genetic and lifestyle factors affecting energy 
intake led to obesity and other complex health problems. Obese parents are a contributing 
factor to obesity in students. Pregnancy experienced by obese mothers causes the size of 
babies born to exceed regular numbers. The cause of this is the increase in the fat element in 
the body, which is becoming more prominent. 

The environment in which children grow and develop also significantly influences the incidence 
of obesity. Environments that are less supportive of physical activity, such as limited open 
space for play or lack of sports facilities, can cause children to spend more time in sedentary 
activities, such as watching television or playing video games. In addition, family and social 
environments that are less supportive of healthy eating also increase the risk of obesity.12 Poor 

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diet, such as fast-food habits or consumption of high-calorie, low-nutrient foods, is often found 
in families with low education levels or limited income. Children's food consumption is far  

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Vol. 6, No. 2, 2024, pp. 106-118 ISSN 2656-6052 (online) | 2656-1107 (print) 

      http://journal2.uad.ac.id/index.php/eshr/index                                                                                                                                                             eshr@ikm.uad.ac.id 

 

 
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Table 2. Data from article included in the review 

No Researchers Title Design Sample Objective Results 
1 Lisa Agustina, Linda T. 

Maas, Zulfendri (2019) 
Analysis of Risky 
Behaviors Related 
to Obesity Among 
Children Aged 9-
12 Years in SD 
Harapan 1 Medan 

Cross-
sectional 

The sample in this 
study was 59 
respondents 
selected from all 
students in grades 
IV, V, and VI. 

The purpose of this study was to analyze risk 
behavior factors associated with the incidence 
of obesity in children aged 9-12 years. 

Significant risk factors for obesity in elementary school children 
include eating habits, physical activity, exposure to television 
advertisements, and pocket money. Of the four factors, pocket 
money was the dominant factor with a probability of obesity 
incidence of 80.5% in children who had large pocket money. The 
study also revealed that 54.2% of the total sample were obese, 
while 45.8% were not. The study highlighted the need for schools 
to play a role through programs such as the School Health Unit 
(UKS) in monitoring children's nutritional status and creating a 
school environment that supports healthy eating and adequate 
physical activity. In addition, parental support in managing 
children's eating and activity habits, as well as limiting exposure 
to television advertisements, are important steps to prevent 
obesity early on. 

2 Sriwahyuni, Junaidin, 
Noyumala, Alfiah, 
Vitarianti Tangkelayuk 
(2021) 

Diet on the 
Incidence of 
Obesity in Children 

Cross-
sectional 

The samples in this 
study were all 
fourth and fifth 
grade children at 
SD Frater Bakti 
Luhur Makassar 
whose body weight 
was more than 
normal. The 
number of samples 
used in this study 
were 30 people 

This study aims to understand how children's 
fast-food diet can affect their nutritional status 
and contribute to obesity cases. 

Children's diet, especially the consumption of fast food more than 
twice per week, is significantly associated with the incidence of 
obesity. Of the total 30 children at SD Frater Bakti Luhur 
Makassar, 86.7% were obese, while the remaining 13.3% were 
overweight. Children who frequently consume fast food, both at 
school and outside the home, tend to have a higher risk of obesity. 
This fast-food consumption generally includes foods high in 
calories, fat, salt, and low in fiber. Environmental factors such as 
the availability of school canteens that sell fast food contribute to 
the high consumption of this type of food. In addition, family 
habits, such as frequent meals at fast food restaurants, also 
increase the risk of obesity in children. This study emphasizes the 
important role of families and schools in monitoring children's 
diets, including providing healthy food alternatives and limiting 
children's access to fast food. This is expected to reduce the 
prevalence of obesity and maintain children's health in the long 
run. 

3 Shinta Maharani, Rice 
Hernanda (2020) 

Factors associated 
with obesity  

Cross-
sectional 

The sample in this 
study were all 
students at SDN 10 
Semende Darat 

The aim of this study was to identify and 
understand the factors that influence the 
incidence of obesity among school-aged 
children. 

Most children were not obese (81.0%), with most respondents 
being female (55.8%), having adequate sleep duration (<8.5 
hours, 65.5%), and light physical activity (82.2%). Analysis 
showed no association between gender and obesity (p-value = 

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      http://journal2.uad.ac.id/index.php/eshr/index                                                                                                                                                             eshr@ikm.uad.ac.id 

 

 
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113 

No Researchers Title Design Sample Objective Results 
In School-Age 
Children 

Laut Muara Enim 
Regency, which 
numbered 163 
students. 

0.092). However, a significant association was found between 
sleep duration (p-value = 0.034) and physical activity (p-value = 
0.004) with the incidence of obesity. This study concluded that 
insufficient sleep duration and low physical activity are associated 
with the incidence of obesity. It is recommended that schools 
improve monitoring of children's nutritional status through health 
programs such as the School Health Unit (UKS) to prevent 
obesity. 

4 Justiyulfah Syah, Desy, 
Afif D Alba, Zulikha 
(2021) 

Relationship 
between Diet and 
Lifestyle with the 
Occurrence of 
Obesity in Children 
Aged 7-12 Years in 
Flamboyant Lot in 
Batam City in 2021 

Cross-
sectional 

The sample in this 
study was 56 
respondents 
consisting of 
children aged 7-12 
years who lived in 
Flamboyan Lot, 
Batam City in 
2021. 

The purpose of this study is to analyze the 
relationship between diet and lifestyle with the 
occurrence of obesity in children aged 7-12 
years in Flamboyan Lot, Batam City in 2021. 

Most obese children have an unbalanced diet, characterized by 
consumption of foods high in calories and low in fiber. The 
lifestyles of obese children also tend to be less physically active, 
with more free time spent on sedentary activities such as watching 
television or playing games. Statistical analysis showed a 
significant association between unhealthy diet and sedentary 
lifestyle with the incidence of obesity in children (p-value <0.05). 
A diet high in fast food consumption and low in fruit and vegetable 
consumption contributed significantly to obesity.   Poor diet and 
sedentary lifestyle are the main risk factors for obesity in school-
age children. 

5 Elsi 
Rahmadani,Pawiliyah, 
Novi Ade Suryani, 
Suryani (2022) 

The Relationship 
of Physical 
Activity, Parental 
History and Diet 
with the Incidence 
of Obesity in 
Children in 
Elementary School 

Cross 
sectional 

The sample in this 
study consisted of 
52 school-age 
children who were 
in grades 4 and 5 at 
MIN 2 Bengkulu 
City. 

The aim of this study focuses on school-aged 
children, specifically in grades IV and V to 
explore how two key factors-physical activity 
and diet-contribute to the growing problem of 
obesity among children. 

Most obese children have low levels of physical activity, with more 
time spent on sedentary activities such as watching television or 
playing gadgets. A history of obesity in parents was also found to 
contribute significantly to the incidence of obesity in children, 
indicating the role of genetic factors and family habits. In addition, 
an unbalanced diet, such as consumption of foods high in 
calories, low in fiber, and frequent consumption of fast food, was 
also strongly associated with childhood obesity. Statistical 
analysis showed a significant association between these three 
factors-physical activities (p-value < 0.05), parental history of 
obesity (p-value < 0.05), and diet (p-value < 0.05)-with the 
incidence of childhood obesity. 

6 Nourmayansa Vidya 
Anggraini (2022) 

Parental Education 
and School-Age 
Childhood Obesity 

Cross 
sectional 

The sample in this 
study was 242 
students selected 
by simple random 
sampling 
technique from SD 
X Depok, with an 

The purpose of this study was to determine 
whether there is a relationship between 
parental education and the incidence of 
obesity in school-age children. This study 
focuses on students at SD X Depok, where 
more than 30% of students are obese. In 
addition, this study also considers the impact 

Parents' education level plays an important role in children's diet 
and lifestyle. Parents with lower education levels tend to have less 
knowledge about balanced nutrition, resulting in uncontrolled 
diets, with consumption of high-calorie and low-fiber foods more 
common. In contrast, parents with higher education generally 
have a better understanding of the importance of a healthy diet 
and physical activity, which results in a reduced risk of childhood 

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114 

No Researchers Title Design Sample Objective Results 
age range of 7 - 11 
years. 

of the COVID-19 pandemic that causes 
children to stay at home more, thus reducing 
physical activity and increasing snacking 
habits, which contribute to weight gain. By 
analyzing the relationship between parental 
education and childhood obesity, this study 
aims to provide insights into how education 
levels can affect parental knowledge 
regarding nutrition and healthy eating, which 
in turn can impact children's nutritional status. 

obesity. Statistical analysis showed a significant association 
between parental education level and the incidence of childhood 
obesity (p-value <0.05). Children of parents with low education 
level have a higher risk of obesity compared to children of highly 
educated parents. 

7 Rr. Maghfira Nadia P, Sri 
Wahyuni, Sigit Ambar 
Widiyawati (2019) 

The Relationship 
between Physical 
Activity and the 
Incidence of 
Obesity in School 
Children in Mardi 
Rahayu Ungaran 
Elementary School 

Semarang 
Regency 

Cross 
sectional 

The sample in this 
study were 108 
students attending 
SD Mardi Rahayu 
Ungaran. 

The detailed objective of this study was to 
determine the relationship between physical 
activity and the incidence of obesity in school 
children at SD Mardi Rahayu Ungaran, 
Semarang Regency. This study aims to 
analyze how much influence physical activity 
has on the level of obesity among students, as 
well as provide recommendations to increase 
physical activity in schools as an effort to 
prevent obesity. 

Obese children have low levels of physical activity. These children 
tend to spend more time on sedentary activities, such as watching 
television, playing gadgets, or studying without being balanced 
with adequate exercise or physical activity. In contrast, children 
with moderate to high physical activity have a lower risk of obesity. 
Statistical analysis showed a significant association between 
physical activity and the incidence of obesity in school children (p-
value <0.05). Children with low physical activity have a higher 
chance of being obese than children with adequate or high 
physical activity. 

8 Nourmayansa,Vidya 
Anggraini, Ritanti, Diah 
Ratnawati (2022) 

Genetic Influences 
on the Incidence of 
Obesity in School-
Aged Children 

Cross 
sectional 

The sample in this 
study was 242 
students who were 
students in grades 
1 - VI at SD X 
Depok, with the 
inclusion criteria 
that the students 
were active. 

The detailed objective of this study is to 
determine whether genetics affect obesity in 
school-age children. This study focuses on 
the relationship between genetic factors and 
the incidence of obesity among SD X Depok 
students. 

Genetic factors play an important role in the incidence of obesity 
in school-aged children. Children who have parents with a history 
of obesity or overweight tend to have a higher risk of developing 
obesity. Further analysis shows that children from families with a 
history of obesity more often experience excessive body fat 
accumulation, leading to obesity. In addition to genetic factors, 
family life habits, such as unhealthy diet and lack of physical 
activity, were also found to contribute to the incidence of 
childhood obesity. However, the results indicate that genetic 
factors are the main determinant in the incidence of obesity in 
school-aged children. 

9 Zefanya Marsella 
Sumael, Achmad 
Paturusi, Agusteivie 
Telew (2020) 

Relationship 
between Physical 
Activity and the 
Incidence of 
Obesity at 

Cross 
sectional 

The sample in this 
study consisted of 
85 people who 
were taken through 
the total sampling 
technique from all 

The purpose of this study was to analyze and 
determine the relationship between physical 
activity and the incidence of obesity in 
Pangolombian Health Center. This study aims 
to provide a better understanding of how 
physical activity levels can affect the 

Obese individuals have low levels of physical activity. They tend 
to spend more time on sedentary activities, such as watching 
television or playing gadgets, without doing enough exercise or 
physical activity. In contrast, individuals with high levels of 
physical activity show a lower prevalence of obesity. Statistical 
analysis using the chi-square test showed a significant 

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https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 Epidemiology and Society Health Review| ESHR 
Vol. 6, No. 2, 2024, pp. 106-118 ISSN 2656-6052 (online) | 2656-1107 (print) 

      http://journal2.uad.ac.id/index.php/eshr/index                                                                                                                                                             eshr@ikm.uad.ac.id 

 

 
Vol. 6, No. 2, 2024, pp. 106-118    10.26555/eshr.v6i2.11441 

  
 

115 

No Researchers Title Design Sample Objective Results 
Pangolombian 
Health Center 

patients visiting the 
Pangolombian 
Health Center in 
September 2020. 

incidence of obesity in the population studied, 
as well as to provide information that can be 
used in obesity prevention efforts in the 
region. 

association between physical activity and the incidence of obesity 
(p-value <0.05). Individuals with low physical activity have a 
higher risk of obesity compared to individuals who are more 
physically active. 

10 Nadiya Zia Nurhaliza, 
Zuraidah Nasution, 
Ramadhani Syafitri 
Nasution (2023) 

Factors Associated 
with the Incidence 
of Obesity in 
School Children at 
Sdn 002 Sapat  
Kuala Indragiri 
Riau District in 
2021 

Cross 
sectional 

The sample in this 
study were all 
grade I, V, and VI 
students at SDN 
002 Sapat, Kuala 
Indragiri District, 
totaling 79 people, 
with the sampling 
technique using 
total sampling. 

The purpose of this study was to analyze the 
relationship between several factors, such as 
maternal education, physical activity, and 
genetics, with the incidence of obesity in 
school children at SDN 002 Sapat, Kuala 
Indragiri District. This study aims to identify 
factors that have a significant effect on 
childhood obesity, as well as to provide 
recommendations based on the results of the 
analysis conducted. 

Factors associated with the incidence of childhood obesity in the 
school. The first factor found was diet. Children with unbalanced 
eating habits, such as consuming high amounts of fast food and 
sugary drinks, have a greater risk of obesity. In addition, lack of 
physical activity also contributes to the incidence of obesity. 
Children who spend more time in sedentary activities, such as 
watching television or playing games, tend to be overweight. 
Another factor that also plays a role is a family history of obesity. 
Children who have parents or family members with obesity or 
overweight problems show a higher prevalence of obesity. Family 
socio-economic factors also play a role, with families with higher 
socio-economic status tending to provide more access to high-
calorie foods and less attention to healthy eating. 

 

 

http://journal2.uad.ac.id/index.php/eshr/index
mailto:eshr@ikm.uad.ac.id
https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 
 

Annisa et al. (Environmental, Genetic, and Behavioral Associations with the Incidence of Obesity in Primary School Children…) 
 

 

      10.26555/eshr.v3i1.3629  

 
 

116 

 
 

  

removed from their preference for vegetables and fruits. Children tend to prefer fast food, 
flavoured foods, and soft drinks. These foods are high in calories and fat, which accelerates 
obesity in children.13 Prior research revealed that poor dietary patterns, such as the 
consumption of high-calorie fast food, are often found in families with low education levels or 
limited income. Social and economic environments that are less supportive of healthy eating 
also increase the potential for obesity. Social and economic environments that are less 
supportive of healthy eating also increase the potential for obesity.14 

Children's eating behaviour and physical activity are two essential aspects that greatly 
influence the incidence of obesity. Unhealthy eating habits, such as consumption of high-
calorie foods, frequent consumption of junk food, and overeating, are among the main factors. 
Low physical activity also contributes significantly to fat accumulation in the body, as the 
incoming energy is not burned correctly. In addition, the duration of time spent on activities 
such as playing gadgets or watching television can increase the risk of obesity because the 
incoming calories are not balanced with the energy expended.15 Children's eating behaviour 
and physical activity are two essential aspects that greatly influence the incidence of obesity. 
Unhealthy eating habits, such as consuming foods high in calories, low in fibre, and low in 
physical activity, contribute significantly to fat accumulation in the body. Previous research 
showed that children with an unbalanced diet and lifestyle have a higher risk of obesity.16 In 
addition, the duration of time spent on activities such as watching television or playing with 
gadgets also contributes to the increased risk of obesity.  
 
Obesity is caused by eating too much carbohydrate, fat, or protein and lack of physical activity. 
Obesity in adolescents is significant to note because adolescents who are obese are 80% 
likely to become obese as adults. In addition, high BMI in adolescents is predicted to increase 
the risk of death and cardiovascular disease. Obese adolescents may suffer from 
comorbidities such as type 2 diabetes mellitus, liver disease, metabolic syndrome, and 
cardiovascular disease.17 It is essential to understand the interaction between these factors. 
Childhood obesity is not caused by just one factor but by a complex interaction between 
genetics, environment, and behaviour. Previous research emphasizes the importance of 
understanding how these three factors interact to develop more effective prevention 
strategies. For example, children who have obese parents and grow up in an environment that 
does not support healthy eating and physical activity tend to have a higher risk of obesity.18  
 
Preventing childhood obesity requires a multidisciplinary approach that involves the roles of 
families, schools, government and communities. Recommended efforts include increasing 
access to nutritious food, education about healthy lifestyles, and creating an environment that 
supports physical activity. Previous research also showed that parental education is essential 
in children's diet and lifestyle.19 Parents with higher education levels tend to understand better 
the importance of a healthy diet, which reduces the risk of obesity in children. Thus, a better 
understanding of the relationship between these factors may help design more effective 
interventions to prevent and address obesity in primary school-aged children.20 This study 
provides important insights for devising more comprehensive and sustainable prevention 
strategies. 

https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 
Annisa et al. (Environmental, Genetic, and Behavioral Associations with the Incidence of Obesity in Primary School Children…) 

 
 

117 
Vol. 6, No. 2, 2024, pp. 106-118    10.26555/eshr.v6i2.11441 

  

CONCLUSION 

Obesity in primary school-aged children is a complex health problem that is influenced by the 
interaction between genetic, environmental and behavioural factors. This study used a 
systematic literature review method to analyze the relationship between these three factors 
and found that children with a family history of obesity have a higher risk of becoming obese. 
In addition, unsupportive environments, such as lack of access to healthy food and exercise 
facilities, as well as unhealthy eating habits, such as consumption of high-calorie fast food, 
contribute significantly to the incidence of obesity. 

Declarations 

Authors' contribution 

NA, SS, and SAM equally contributed to the design of the study. NA completed the data 
collection and analysis and wrote the first draft. SS and SAM reviewed the draft. 

Funding statement 

The Indonesia Ministry of Education funded this research through Magister Thesis Research 
(PTM) with Research Subcontract Number 119/PTM/LPPM UAD/VI/2024 

Conflict of interest 

There is no conflict of interest in this research.  

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https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629
https://ejournal.undip.ac.id/index.php/mkmi/article/view/35624
https://pubmed.ncbi.nlm.nih.gov/33960637/
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https://ejournal.undip.ac.id/index.php/jgi/article/view/16587/12104
https://ejournal.almaata.ac.id/index.php/IJND/article/view/41/0
https://oamjms.eu/index.php/mjms/article/view/4225
https://e-abdimas.unw.ac.id/index.php/jhhs/article/view/13
https://e-abdimas.unw.ac.id/index.php/jhhs/article/view/13
https://journal.unisa-bandung.ac.id/index.php/jaia/article/view/268
https://journal.amikveteran.ac.id/index.php/jikki/article/view/2090
https://journal.arikesi.or.id/index.php/Vitamin/article/view/721
https://journal.victoryhaga.org/index.php/hjph/article/view/37

