Prevalence of Obesity and Its Association with Iron Deficiency in Elementary School Students in Al-Diwaniyah City

Abstract

Background: Childhood obesity and iron deficiency are growing public health concerns worldwide, particularly in developing countries undergoing nutritional and lifestyle transitions. Obesity has been increasingly linked to altered iron metabolism and a higher risk of iron deficiency. This study aimed to assess the prevalence of obesity and its association with iron deficiency among elementary school students in Al-Diwaniyah City, Iraq. Methods: A descriptive quantitative study was conducted from June to December 2025 among 300 male and female students selected through stratified random sampling from several public primary schools. These students had come to the Women's and Children's Teaching Hospital for treatment and vaccinations. Blood samples were taken from each student, and laboratory tests were performed. Data were collected using a structured questionnaire and included demographic information, BMI measurements, and hemoglobin levels. Statistical analysis was performed using SPSS version 25. Results: More than half of the students had normal BMI (56.0%), while 19.3% were obese, 14.7% overweight, and 10.0% underweight, indicating a dual burden of malnutrition. The prevalence of iron deficiency was 31.7% and anemia 34.0%. Health-related symptoms, such as pallor or nail changes, were reported by 29.3% of participants. A significant association was found between obesity and iron deficiency: 48.3% of obese students were iron deficient compared to 27.7% of non-obese students. Mean hemoglobin was lowest in obese students (10.7 g/dL), and the association between BMI and hemoglobin levels was statistically significant (F = 6.12, p = 0.0004). Conclusion: Obesity and iron deficiency are highly prevalent and interconnected health issues among elementary school students in Al-Diwaniyah City. Obesity was strongly associated with reduced hemoglobin levels and higher rates of iron deficiency, likely due to inflammation-mediated alterations in iron metabolism. These findings highlight the need for school-based nutritional screening, dietary education, and early interventions aimed at managing weight and preventing micronutrient deficiencies to improve children's overall health and academic performance. These results were not generalized because they were limited to the city of Diwaniyah.