1. Introduction
hildhood obesity is among the major health problems worldwide [1]. Obesity and overweight in children are also risk factors for adult obesity [5]. Obesity is increasing among children and adolescents. In Iran, the prevalence of obesity is higher in adolescents [7]. Various risk factors for childhood obesity have been studied. Obesity is caused by several characteristics, including genetics, hormonal, metabolic, and behavioral factors [8]. The importance of nutritional behaviors and the problem of obesity derived from it has been raised as a serious problem for the present century [10].
Considering the significance of childhood obesity and its complications, as well as easier correction of related factors in this age group, the present study aimed to investigate the role of some factors related to family, nutrition, and lifestyle on childhood obesity. 
2. Materials and Methods
This age-matched case study was performed on children referring to Amir Kabir Hospital in Arak City, Iran, after obtaining the code of ethics, in the spring and summer of 2019. The sample size in this study was estimated using the results of a similar study [14] and a 95% Confidence Interval (CI) using STATA to equal 150 children per research group. To collect the necessary data, the weight and height of each child were initially measured. The weight was computed by a scale with an accuracy of 1 kg and in a situation where the child used a standard measuring tape with an accuracy of 1 cm to measure height. Then, Body Mass Index (BMI) and percentile were calculated for each examined child.
Data collection was performed, using a three-part checklist, including information about birth, the type of delivery, the presence of consanguineous marriage, birth weight, the number of children in the family, nutritional data, and lifestyle information. The obtained data were analyzed using STATS at a 95%CI.
3. Results
Table 1 indicates that childhood obesity was significantly related to the father’s age, parents’ BMI, and the number of children in the family (P<0.05).


Moreover, according to Table 2, there was a significant relationship between obesity and the consumption of fruits and vegetables, fast food, and breakfast, dietary supplementation (P<0.05).


The Odds Ratio (OR) data revealed that the odds of obesity in children who consume fewer fruits and vegetables and those who consume more of these edibles was higher than those who did not consume at all, respectively was equal to 0.3(95%CI: 0.1-05.41) and 0.19 (95%CI: 0.03-0.76).
Table 3 illustrates data concerning the relationship between obesity and variables related to lifestyle factors.


There was a significant relationship between obesity in children and good chewing of food, participation in preparing food and table, and using food as a reward (P<0.05). Furthermore, the OR data suggested that the odds of becoming obese in children who played computer games for more than two hours (95%CI: 1.08-12.37) was 3.5 times higher, compared to those who did not play computer games. The OR for good chewing of food, in comparison with children who did not chew food well, was equal to 0.38 (95%CI: 0.2-0.69).
4. Discussion and Conclusion
The present study data indicated that the older the parents, the lower the child’s obesity. Moreover, the odds of obesity increase in children with the enhanced number of children, as well as overweight and obesity of parents (i.e., a strong risk factor for obesity in children). According to some studies, factors related to parents, including maternal obesity, can also lead to childhood obesity [15, 16]. The present study data revealed the consumption of fruits and vegetables and eating breakfast, as protective factors, and consumption of supplements and fast food, as risk factors for childhood obesity; these results were consistent with those of some studies [21, 22, 23].
Another eating habit of obese children is consuming multiple snacks, i.e., evaluated in this study. The OR results for these variables were not significant. Additionally, playing computer games for more than two hours, participating in the preparation of food and table, and using food as a reward was also mentioned as risk factors for childhood obesity. Some studies indicated that active video games prevent the occurrence of childhood obesity [32]. The present study findings found that with increasing sleep time, the child’s chances of obesity increase. Studies have generally revealed that sleep disorders lead to weight gain for various reasons, including sedentary lifestyles, and that irregular sleep (either too much or too little) increases the odds of becoming obese [40].
Obesity is associated with some family-related characteristics, such as nutrition, playing computer games, and lifestyle factors. Due to the existence of various risk factors and adjustable protection, it is necessary to properly educate families and children to reduce obesity.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1396.119). The research procedure was explained to the parents of the examined children and an informed written informed consent form was obtained from them.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
Conceptualization: Javad Farahani, Yazdan Ghandi; Data analysis: Javad Farahani; Investigation, writing – original draft, and writing – review & editing, methodology: All authors.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgements
The authors would like to thank the staff of the Amirkabir Hospital Clinical Research Development Center in Arak.


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