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php/jpkm Corresponding Author.
email address : purwo.
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Received : 13 Maret 2026 Revised : 19 Maret 2026 Accepted : 9 April 2026 Demographic and Food Insecurity Factors Linked to Adolescent Overweight in Thailand: A Binary Logistic Regression Analysis Purwo Setiyo Nugroho & 2Abubakar Yakubu Abbani Department of Public Health.
Faculty of Public Health.
Universitas Muhammadiyah Kalimantan Timur.
Samarinda.
Kalimatan Timur.
Indonesia Institute for Population and Social Research.
Mahidol University.
Salaya Campus.
Phutthamonthon.
Nakhon Pathom Province.
Thailand
ABSTRACT
Overweight among adolescents in Thailand is a growing public health concern, influenced by demographic and socioeconomic factors.
Food insecurity further complicates this issue through the food insecurityAe obesity paradox, where limited access to nutritious food coexists with excess weight.
However, nationally representative evidence on this relationship remains limited.
This study examined the association between demographic characteristics .
ex, age, and school grad.
and food insecurity with overweight among Thai adolescents using data from the 2021 Global School-based Student Health Survey (GSHS).
This study employed a cross-sectional design using secondary data.
A total of 4,510 students aged 13Ae17 years were included, with an overall overweight prevalence of 19.
Logistic regression showed that boys had lower odds of overweight than girls (OR = 0.
709, 95% CI: 0.
705Ae0.
Age was significantly associated with overweight, with the highest risk observed among adolescents aged 15Ae16 years (OR = 1.
972 and Lower school grades were associated with reduced odds compared to grade 12.
Food insecurity was positively associated with overweight (OR = 1.
509, 95% CI: 1.
480Ae1.
These findings highlight the complex interplay of demographic and contextual factors.
Targeted interventions addressing age, gender, school level, and food insecurity are essential to reduce adolescent overweight in Thailand.
Keywords: Adolescent Overweight.
Thailand.
Demographic Factors.
Food Insecurity.
Logistic Regression INTRODUCTION Across Thai adolescents .
oughly ages 10Ae19, with many studies focusing on 12Ae18 or similar school-age range.
, overweight prevalence has been repeatedly documented in the single-digit to low-teens range, with variation by definition (BMI cut-point.
, age group, gender, and urban-rural setting.
Nationally representative data using established international references (IOTF.
WHO, or WPRO) consistently show that overweight/obesity constitutes a nontrivial but heterogeneous burden among Thai youth, and that boys tend to have higher overweight prevalence than girls in several Thai samples, though some subnational studies report differing patterns (Sirirassamee et al.
Sabri et al.
, 2.
Several repeatedly associated with overweight among adolescents, including sex, age, urban vs rural residence, and household socioeconomic status (SES).
In many Thai samples, males show higher overweight prevalence than females, though patterns vary by age band and setting.
Age is typically inversely related to overweight within adolescence, with younger adolescents often at higher risk in some cohorts although risk levels may shift as age increases.
Overall.
DOI : 10.
47575/jpkm.
932 | VOL.
7 NO.
1 APRIL 2026 | ISSN (Onlin.
: 2774-8502 | Page : 11-18 This Journal is licensed under a Creative Commons Attribution-ShareAlike 4.
0 International License.
Nugroho & A.
Abbani.
Demographic and Food Insecurity Factors Linked to Adolescent Overweight demographic factors interact with regional context, dietary patterns, and physical activity levels to shape overweight risk among Thai adolescents (Sritart et al.
, 2022.
Ochola et al.
Zhou et al.
, 2.
The relationship between food insecurity and overweight/obesity among Thai adolescents is nuanced and emerges from a mix of national school surveys, rural-urban studies, and regional analyses.
Across settings, food insecurity can coexist with overweight/obesity in adolescence, reflecting the malnutrition obesity paradox observed in Southeast Asia and other LMIC contexts.
Several Thai studies indicate that overweight/obesity increases alongside indicators of dietary transition and food insecurity in certain subgroups, while others show weaker or context-specific Methodological heterogeneity different BMI cutoffs (IOTF.
WHO.
WPRO), age bands, and urbanicity can influence observed links between food insecurity and weight status.
Overall, the evidence supports a co-occurrence pattern in Thai adolescents, with stronger associations in urban, higher-SES, or transitioning contexts and potential gender and regional variation (Niemeier and Fitzpatrick.
Sritart et al.
, 2022.
Pengpid & Peltzer.
RooioarE et al.
, 2.
There is limited empirical evidence linking household food insecurity to overweight among Thai adolescents using nationally comparable school-based survey data.
Existing studies often examine these issues separately rather than within a unified analytical framework.
Many GSHS-based studies in Southeast Asia report descriptive prevalence or simple bivariate associations.
Thus, the objective of this study was to examine the association between demographic characteristics and food insecurity with overweight among adolescents in Thailand using data from the Global School-based Student Health Survey (GSHS).
Specifically, the study aimed to identify whether demographic factors such as sex, age, and school level, as well as experiences of food insecurity, are significantly associated with the likelihood of being overweight among Thai adolescents through binary logistic regression METHODS Study Design and Settings This study analyzed data from the 2021 Global School-based Student Health Survey (GSHS) in Thailand, which was the third time the survey had been conducted in the country.
The survey targeted adolescents aged 13Ae17 years in grades 7Ae12 and used a two-stage sampling method: schools were selected based on size, and then classes within those schools were randomly chosen.
Participation was voluntary, and confidentiality was assured, with school names and locations excluded from the public dataset.
The survey achieved strong participation, with a 92% school response rate, a 90% student response rate, and an overall response rate of 83%.
After cleaning the data and addressing missing values using a listwise deletion approach, the final sample included 4,510 students.
Students completed self-administered questionnaires during class, covering a wide range of health-related topics such as alcohol and substance use, diet, mental health, physical activity, sexual behavior, tobacco use, and experiences of violence.
The survey was coordinated by ThailandAos Ministry of Public Health with technical support from the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), ensuring both methodological rigor and operational feasibility (World Health Organization, 2.
Variables In the 2021 Thailand GSHS, several demographic and contextual variables were measured using straightforward survey Age was assessed by asking students AuHow old are you?Ay with response options ranging from 11 years or younger to 18 years or older.
School grade was measured through the question AuIn what grade are you?Ay with options from Grade 7 to Grade 12.
We focused on adolescents aged 13Ae17 years because this age band corresponds to the Global Schoolbased Student Health Survey (GSHS) sampling frame in Thailand, which targets secondary school students in grades 7Ae12.
This narrower age range ensures comparability with national survey data while still capturing the critical mid-adolescent period.
Gender was determined JPKM: Jurnal Profesi Kesehatan Masyarakat, 7.
2026: 11-18 | 13 by asking AuWhat is your sex?Ay with two response categories: male or female.
Finally, food insecurity was captured by asking about the percentage of students who reported going hungry most of the time or always in the past 30 days because there was not enough food at home, with responses coded as yes or no.
In this study, overweight was defined using the WHO BMI-for-age growth reference, consistent with the Global School-based Student Health Survey (GSHS) methodology.
These simple, direct questions enabled the survey to collect consistent demographic information while also identifying important social determinants of health among adolescents.
Data Analysis In this study, the analysis was carried out step by step to explore how demographic factors and food insecurity were linked to overweight among Thai adolescents.
First, univariate analysis was used to describe the basic characteristics of the students, such as age, grade, gender, and food insecurity status.
Then, bivariate analysis examined the relationship between overweight and each factor one at a Finally, multivariate analysis applied binary logistic regression to assess the independent effect of each variable while controlling for others, with the findings reported as odds ratios (OR.
and confidence intervals (CI.
Model selection for the multivariate analysis was conducted through a backward elimination procedure.
This approach ensured that the results were both clear and statistically Ethical Consideration This study used data from the Global Schoolbased Student Health Survey (GSHS) Thailand 2021, which had already been collected by the Ministry of Public Health and Ministry of Education with national-level ethical Participation was voluntary, with informed consent from parents and assent from students when required.
All responses were anonymous, and no identifying information was collected, ensuring confidentiality and protecting participants.
Because the survey involved adolescents, special care was taken to make the questions appropriate and sensitive, especially those about health behaviors such as substance use, sexual activity, and mental For this secondary analysis, only deidentified, publicly available data were used, and there was no direct contact with students.
This secondary analysis posed minimal risk to However, the study acknowledges Figure 1 Percentage Distribution of Overweight Status among Adolescents in Thailand Nugroho & A.
Abbani.
Demographic and Food Insecurity Factors Linked to Adolescent Overweight several limitations, such as the school-based sampling design and reliance on self-reported answers, which may affect the way the findings are interpreted.
RESULT AND DISCUSSION
The bar chart (Figure .
illustrates the percentage distribution of overweight status among adolescents.
The results show that 07% of adolescents are overweight, while the majority, 80.
93%, are not overweight.
The inclusion of 95% confidence intervals (CI) around each bar indicates that the estimates are statistically reliable.
Table 1 presents the frequency distribution of respondent characteristics among overweight adolescents in Thailand.
The data show that overweight status was almost equally distributed between boys .
and girls .
10%).
However, among those without overweight, girls accounted for a larger proportion .
70%) compared to boys .
30%), and this difference was statistically significant .
< 0.
Age distribution revealed that overweight prevalence peaked at 13 years old .
60%), followed by 15 years .
20%) and 14 years .
10%), while younger adolescents aged 11 years or younger Table 1 Frequency Distribution of Adolescent Respondent Characteristics in Thailand.
Categorized by Overweight and Non-overweight Status (N: 4,.
Overweight No overweight p-value .
: 3,.
Variables Demographic status Sex Boys <0.
Girls Age 11 years old or younger <0.
12 years old
13 years old
14 years old
15 years old
16 years old
17 years old
18 years old or older
School class
7th grade
1,021
<0.
8th grade
9th grade
10th grade
11th grade
12th grade
Food insecurity Yes
3,515
Sources: Processed Secondary Data JPKM: Jurnal Profesi Kesehatan Masyarakat, 7.
2026: 11-18 | 15 .
20%) and 12 years .
70%) showed much lower prevalence.
These differences across age groups were also significant .
< 0.
Overall, the findings suggest that sex and age are strongly associated with overweight status, with boys and adolescents in the early to midteen years being more likely to experience overweight compared to their peers.
Table 2 presents the binary logistic regression analysis of demographic factors and food insecurity associated with overweight among adolescents in Thailand.
The results show that boys had lower odds of being overweight compared to girls (OR = 0.
95% CI: 0.
705Ae0.
714, p < 0.
Age was significantly associated with overweight status.
Compared to adolescents aged 18 years or older, those aged 15 years (OR = 1.
972, 95%
CI: 1.
922Ae2.
023, p < 0.
and 16 years (OR = 202, 95% CI: 2.
150Ae2.
256, p < 0.
had the highest odds of being overweight.
Adolescents aged 14 years (OR = 1.
325, 95% CI: 1.
290Ae 361, p < 0.
and 13 years (OR = 1.
95% CI: 0.
991Ae1.
050, p < 0.
also showed elevated risks, while those aged 11 years or younger (OR = 0.
313, 95% CI: 0.
287Ae0.
p < 0.
and 12 years (OR = 0.
707, 95% CI:
684Ae0.
730, p < 0.
had significantly lower School grade was inversely associated with overweight status when compared to 12th For example, adolescents in 7th grade (OR = 0.
563, 95% CI: 0.
547Ae0.
580, p < 0.
8th grade (OR = 0.
594, 95% CI: 0.
578Ae0.
p < 0.
, 9th grade (OR = 0.
445, 95% CI:
434Ae0.
457, p < 0.
, and 10th grade (OR = 392, 95% CI: 0.
383Ae0.
402, p < 0.
all had reduced odds of overweight.
Even 11th grade (OR = 0.
712, 95% CI: 0.
698Ae0.
726, p = 0.
Table 2 Binary Logistic Regression Analysis of Demographic Factors and Food Insecurity Associated with Overweight Among Adolescents in Thailand Boys Variable 95% CI p-value Lower Upper Demographic status Sex Boys <0.
Age .
ef 18 years old or olde.
11 years old or younger <0.
12 years old <0.
13 years old <0.
14 years old <0.
15 years old <0.
16 years old <0.
17 years old School class .
ef: 12th grad.
7th grade <0.
8th grade <0.
9th grade <0.
10th grade <0.
11th grade Food insecurity .
ef: N.
Yes <0.
Sources: Processed Secondary Data Nugroho & A.
Abbani.
Demographic and Food Insecurity Factors Linked to Adolescent Overweight showed lower odds compared to 12th grade.
Finally, food insecurity was paradoxically associated with overweight.
Adolescents reporting food insecurity had significantly higher odds of being overweight (OR = 1.
95% CI: 1.
480Ae1.
537, p < 0.
Age within adolescence is a consistently important modifier of overweight risk in Thailand, reflecting developmental, behavioral, and environmental changes that occur as children transition from late childhood into early and mid-adolescence.
Across Thai studies, younger adolescents often show different overweight patterns than older adolescents, with some cohorts showing higher risk earlier in adolescence and others showing rising risk into late adolescence as exposure to obesogenic environments accumulates.
Methodological choices (BMI cutoffs, age bands, school-based population-based design.
influence the observed age-related gradients, underscoring the need for standardized age-range reporting when comparing studies.
In Thai samples, younger adolescents sometimes exhibit different prevalence levels compared with older adolescents, consistent with a maturation- and behavior-driven shift in risk (Ding et al.
, 2021.
Pengpid & Peltzer, 2.
Previous studies in Thailand have reported that boys tend to have higher overweight prevalence than girls, though some subnational studies report differing patterns(Sirirassamee, et al.
, 2018.
Sabri et al.
In our adjusted analysis, however, boys showed lower odds of overweight compared to girls, suggesting that crude prevalence patterns may be influenced by confounding factors such as age and school grade.
This highlights the importance of considering demographic and contextual variables when interpreting gender differences in adolescent overweight.
Across global and regional literature, including evidence relevant to Thailand, food insecurity (FI) and overweight/obesity often co-occur in adolescence, a pattern termed the food insecurity-obesity paradox.
In Thai contexts, several nationally representative and subnational studies imply that FI can be associated with higher odds of overweight among adolescents, though findings are heterogeneous and context-specific (Dewi et , 2020.
Abera et al.
, 2.
The observed association is influenced by how FI is measured .
ousehold vs child-level FI), the BMI cutoffs and age bands used, urbanization and SES, and gender.
Some Thai and regional studies report stronger FIAeoverweight signals in urban transitioning settings and among girls or specific regions, while others show null or weaker associations, underscoring the need for longitudinal designs and harmonized measures (Niemeier and Fitzpatrick, 2.
Mechanisms proposed in the broader literature include reliance on inexpensive, energy-dense foods when resources are constrained, cyclic hunger leading to compensatory overeating, and stress-related eating patterns.
This AuFIAeobesity paradoxAy has been observed across LMICs and in adolescence, with variation by gender, age, and In Thailand, rapid dietary transition and urban food environments can amplify these mechanisms in susceptible subgroups, aligning with regional patterns of the double burden nutrition in youth.
Nationally representative Thai data show rising overweight/obesity among adolescents alongside changing FI dynamics linked to economic conditions and school feeding policies.
While direct FIAe overweight estimates for Thai adolescents are not uniformly published in a single large cohort, cross-national Thai studies embedded in GSHS-era datasets have documented cooccurring overweight/obesity and indicators of FI or hunger in adolescents, and reported that FI interacts with urbanization and SES to shape weight outcomes (Niemeier and Fitzpatrick.
Dewi et al.
, 2020.
Pengpid and Peltzer.
Overweight among Thai adolescents shows different patterns depending on gender and school level.
Studies often find that boys have a higher prevalence of overweight than girls, but this difference changes across age groups and grade levels.
Biological factors like puberty and body composition, behavioral changes such as diet choices and physical activity, and sociocultural influences like body image expectations all play a role in shaping these patterns.
School-level factors also matter:
higher grades often bring more independence, exposure to cafeterias, and less structured physical activity, which can affect boys and girls JPKM: Jurnal Profesi Kesehatan Masyarakat, 7.
2026: 11-18 | 17 In addition, differences between urban and rural schools, socioeconomic status, and the reach of school-based health programs can further influence overweight risk.
These findings highlight the importance of looking at overweight by both gender and grade level, and suggest that interventions should be tailored to specific age groups, school contexts, and gender-related needs to be most effective (Ganbold et al.
, 2019.
Dewi et al.
, 2020.
Lee et al.
, 2020.
Abera et al.
, 2023.
Pengpid and Peltzer, 2.
Limitation of the Study This study used data from the Global Schoolbased Student Health Survey (GSHS) Thailand 2021, which provides valuable national and international insights but also has some Because the survey was conducted only among students, adolescents who were not in school were excluded, even though they may face higher health risks.
The survey relied on self-reported questionnaires, which can lead to errors or biased answers, especially on sensitive topics like substance use, sexual activity, or mental health.
In addition, the survey was cross-sectional, meaning it captured information at one point in time and cannot show cause-and-effect relationships.
External factors, such as the COVID-19 pandemic, may also have influenced responses, making comparisons with earlier surveys more difficult.
Finally, cultural and language differences could affect how questions were understood, possibly leading to underreporting of certain behaviors.
Despite these limitations, the survey remains an important tool for monitoring adolescent health in Thailand and contributes to global evidence.
A further limitation is that food insecurity was assessed using a single severe-hunger item from the GSHS.
This measure does not account for milder or multidimensional aspects of food insecurity .
, anxiety about food supply, reduced dietary diversit.
, which may also influence adolescent weight outcomes.
Schools should implement nutrition-focused programs that combine healthy meal provision, food security monitoring, and education to address the food insecurityAeoverweight paradox among CONCLUSION In conclusion, this study shows that age, gender, school level, and food insecurity are all important factors linked to overweight among Thai adolescents.
Boys and younger adolescents in early to mid-teen years were more likely to be overweight compared to girls and older students, while those in higher grades .
specially Grade .
showed greater risk than lower grades.
A striking finding was the food insecurityAeoverweight paradox, where adolescents reporting hunger also had higher odds of being overweight, reflecting broader patterns seen in Southeast Asia.
These results highlight the complex interplay of biological, behavioral, and social factors shaping adolescent health.
While the surveyAos schoolbased design and reliance on self-reported data limit causal interpretation, the findings provide valuable evidence for policymakers and educators.
Tailored interventions that consider gender differences, age stages, school environments, and food insecurity contexts are essential to effectively address overweight among Thai adolescents and to guide future public health strategies.
REFERENCES