Siddhi Memorial Hospital, Bhimsenstan, Bhaktapur, Nepal, India

Corresponding Author Email: connect.anyl@gmail.com

Article Publishing History

INTRODUCTION

Adolescence is a critical developmental stage where health-related behaviors are established, many of which extend into adulthood. Globally, non-communicable diseases (NCDs) linked to physical inactivity and poor dietary patterns are increasingly affecting adolescent populations (World Health Organization, 2023). Rapid urbanization, academic pressure, digital entertainment, and the availability of fast foods have reshaped the lifestyle of adolescents, particularly in urban South Asia (Popkin et al., 2020, Ahmed 2025).

Physical activity has been positively associated with improved body mass index (BMI), reduced stress, and enhanced academic outcomes (Janssen & LeBlanc, 2010). Recent global estimates suggest that more than 80% of adolescents are not sufficiently physically active (WHO, 2023). Conversely, sedentary behavior and late-night eating habits are linked with obesity, metabolic syndrome, and poor sleep quality (Chaput et al., 2016). While physical education programs exist in many schools, a lack of structured curricula and infrastructure often limits their effectiveness (Bhandari et al., 2020; Melendez-Torres et al.,2023).

Despite growing evidence on adolescent health risks in South Asia, there is limited empirical research from countries in South East Asia,  exploring the interaction of physical activity and dietary behaviors. For instance, In Nepal, high school students in urban centers like Kathmandu face multiple lifestyle-related risk factors due to environmental and socio-economic shifts. The Global School-based Student Health Survey (GSHS) 2015, conducted again in Nepal, indicated that 30.9% of students consumed carbonated soft drinks daily and only 28.4% consumed fruits daily (MoHP, 2017). Similarly, in yet another study conducted in  Bangladesh, Rahman et al. (2020) reported that only 18% of school children engaged in daily physical activity, with a marked increase in fast food consumption among urban adolescents.

Therefore, the present study aims to assess the correlation between physical activity and dietary habits among high school students in Kathmandu, Nepal. Understanding these behaviors in a regional context is critical for designing culturally and demographically tailored interventions to improve adolescent health outcomes in South Asia. This type of study is crucial as it might provide localized data needed for evidence-based health policies tailored to Nepal’s unique socio-cultural context. To the best of our knowledge, very few studies were done earlier in Nepal to highlight this very important issue. Early identification of at-risk adolescents allows timely prevention of chronic diseases. Additionally, comparing findings with countries like India, Bangladesh, and Sri Lanka will offer valuable regional insights for collaborative public health strategies across South Asia.

METHODOLOGY

A cross-sectional quantitative study design was employed to explore the correlation between dietary habits and physical activity levels among adolescents in Kathmandu. The study was conducted from March to May 2025 in six purposively selected high schools (three public and three private) located within Kathmandu Metropolitan City, ensuring diversity in socio-economic representation.

The study used a multistage stratified random sampling technique, ensuring balanced representation across different school types and student demographics. In the first stage, stratification by School Type where schools in Kathmandu were first stratified into public and private categories. From each stratum, three schools were randomly selected using a lottery method. In the second Stage 2, Class-wise Stratification i.e within each selected school, students were further stratified by grade level (classes 8 to 12), corresponding to the target age range of 13–18 years. In the third stage, simple random sampling of students was done using a computer-generated random number list. A total of 150 students were selected proportionately from each school, ensuring representation across all age groups and both sexes.

Data Collection Source: Primary data were collected on-site at the respective schools. Before data collection, the study protocol received approval from the Institutional Review Board (IRB) of SM Hospital, Katmandu and written informed consent was obtained from both the students and their legal guardians.

A structured, pre-tested, and pre-validated questionnaire was used for data collection. The instrument was adapted from the World Health Organization’s Global School-based Student Health Survey and localized to suit the Nepali sociocultural context through expert review and pilot testing(WHO-GSHS,2013).

Key features of the questionnaire included four sections primarly divided into Section A: Demographics – Age, gender, class level, and parental education/occupation, Section B which included measuring the dietary behaviors by means of frequency of daily/weekly consumption of fruits, vegetables, snacks, fast foods, and sugary beverages, meal-skipping habits (e.g., breakfast skipping). The third section was related to measuring the  physical activity patterns by means of evaluating the types of activity (moderate-to-vigorous physical activity,MVPA) such as  school sports, recreational play, walking/cycling to school, and household chores, their frequency (days/week) and duration (minutes/day) of Sedentary behavior (screen time, sitting hours). Last but not the least, the final section was related to health and lifestyle indicators which measured self-perceived health status and sleep duration.

The questionnaire was translated into Nepali, back-translated into English, and reviewed for content and construct validity by a panel of public health experts and educators. The anthropometric measurements were done by trained field investigators who collected anthropometric data following standard WHO protocols such as height measured using a stadiometer (to the nearest 0.1 cm), weight measured using a calibrated digital scale (to the nearest 0.1 kg) and BMI calculated and categorized using WHO adolescent growth reference charts.

Data Analysis: The data were entered and cleaned using IBM SPSS version 26. Descriptive statistics (mean, standard deviation, frequencies) were calculated for demographic and behavioral variables with results were presented as percentages (%). Chi-square tests were used to identify associations between categorical variables (e.g., school type and dietary pattern).Pearson’s correlation coefficient was used to assess the strength and direction of association between physical activity and dietary habits. Statistical significance was set at p < 0.05.

Results in this school-based cross-sectional study, data were collected from 150 high school students aged between 13 and 18 years in Kathmandu. The mean age of the students was 15.5 ± 1.6 years. Gender distribution showed that 54.9% of the respondents were girls while 45.1% were boys. Anthropometric measurements indicated that the average height was 158.2 ± 12.5 cm and the average weight was 53.4 ± 11.8 kg. The mean Body Mass Index (BMI) among participants was 22.6 ± 3.4 kg/m², reflecting an overall moderate range for this adolescent population.

Approximately 12.3% of the students reported having health conditions including asthma, eczema, allergies, cramps, epilepsy, and anemia. Parental literacy was universal with a 100% literacy rate. Furthermore, 86.1% of the responses to the structured questionnaire were recorded by mothers, while the remaining 13.9% were documented by other family members. Regarding BMI distribution, 45% of students were classified as underweight, 23.8% as normal weight, 18.8% as overweight, and 12.3% as obese, with no cases of morbid obesity. These figures call attention to the dual burden of undernutrition and overnutrition among high school adolescents in urban Nepal.

RESULTS AND DISCUSSION

In this school-based cross-sectional study, data were collected from 150 high school students aged between 13 and 18 years in Kathmandu. The mean age of the students was 15.5 ± 2.6 years. Gender distribution showed that 55% of the respondents were girls, while 45% were boys. Anthropometric measurements indicated that the average height was 158.2 ± 12.5 cm and the average weight was 53.4 ± 11.8 kg. The mean Body Mass Index (BMI) among participants was 22.6 ± 3.4 kg/m², reflecting an overall moderate range for this adolescent population(Table 1).

Approximately 12.3% of the students reported having health conditions, including asthma, eczema, allergies, cramps, epilepsy, and anemia. Parental literacy was universal, with a 100% literacy rate. Furthermore, 86.1% of the responses to the structured questionnaire were recorded by mothers, while the remaining 13.9% were documented by other family members.

Table 1: Basic and Anthropometric Details of High School Students

Parameter	Value
Total number of students	150
Age range (years)	13–18
Mean age (years)	15.5 ± 2.6
Gender distribution	55% girls, 45% boys
Mean height (cm)	158.2 ± 12.5
Mean weight (kg)	53.4 ± 11.8
Mean BMI (kg/m²)	22.6 ± 3.4
Children with medical conditions	12.3%
Parental literacy rate	66%
Questionnaire filled by mother	86.1%

Regarding BMI distribution, 45% of students were classified as underweight, 23.8% as normal weight, 18.8% as overweight, and 12.3% as obese, with no cases of morbid obesity (Table 2). These figures call attention to the dual burden of undernutrition and overnutrition among high school adolescents in urban Nepal.

Table 2: Categorization of children’s body mass index (BMI).

Types of BMI	Frequencies	Percentages
Underweight	55	45.1%
Normal	29	23.8%
Overweight	23	18.8%
Obesity	15	12.3%
Morbid-Obesity	00	0%

The dietary behaviors of high school students in Kathmandu revealed both encouraging and concerning trends. While 68.7% of students reported regular consumption of fruits and vegetables, a significant portion exhibited poor dietary habits. Approximately 59.3% consumed fast food more than once per week, and an overwhelming 90.6% frequently consumed snacks, indicating a shift towards high-calorie, low-nutrient foods. This pattern reflects an urgent need for school-based nutrition education and policy interventions to curb unhealthy eating practices among adolescents (Table 3).

Table 3. shows the percentage of adolescents following various dietary habits.

Dietary Habits	Frequency (%)
Regular fruit and vegetable intake	68.7
Fast food consumption (>1/week)	59.3
Frequent snack consumption	90.6

On the physical activity front, 75.4% of students reported participating in some form of activity, with walking and school sports being most common (Table 4 and 5). Although promising, this statistic may encompass low-intensity or irregular activity. Most notably, a significant positive correlation (p < 0.05) was identified between physical activity and healthy dietary behaviors. This finding suggests that physically active students are more likely to make healthier food choices, emphasizing the importance of promoting physical activity not only for fitness but also as a catalyst for broader lifestyle improvements.

Table 4. shows the Physical Activity Participation.

Physical Activity Parameter	Details
Participated in any physical activity	75.40%
Most common types of Physical activity performed by students	Walking, school sports

Table 5. List of physical activities for school children.

Activities	Frequencies	Percentages
Physical activity	115	94.3%
Physical effort	105	86.1%
Gym	14	11.5%
Running	115	94.3%
Walking	115	94.3%
Physical activity classes	88	72.1%
Irregular physical activity	34	27.9%

The present study provides critical insights into the dietary behaviors and physical activity patterns among high school adolescents in Kathmandu, Nepal. The findings reveal a complex interplay of moderate healthy habits coexisting with prominent unhealthy behaviors, necessitating urgent public health attention.

Dietary Behaviors: The dietary profile of students in this study presents a dual scenario. While 68.7% reported regular consumption of fruits and vegetables, suggesting a moderate awareness and availability of healthy options, nearly one-third still fail to meet the minimum dietary guidelines. Compared to similar studies, this figure is notably higher than the 24% fruit and vegetable intake reported among adolescents in India (Patel et al., 2019) and 18% in Bangladesh (Rahman et al., 2020), indicating a relatively better nutritional trend in Kathmandu. This might be attributed to cultural dietary practices and local food availability, but gaps still persist.

Alarmingly, 59.3% of students consumed fast food more than once per week, mirroring patterns found in urban Delhi (Verma et al., 2020) and Sri Lanka (Perera et al., 2021) where fast food consumption among adolescents is steadily rising due to urbanization, commercialization, and peer influence. Furthermore, 90.6% of students reported frequent snack consumption, reinforcing concerns raised in earlier Nepali studies (Paudel et al., 2021) about the increasing preference for energy-dense, nutrient-poor processed foods.

The unquantified but implied high intake of sugar-sweetened beverages aligns with WHO GSHS (2015) data that found 30.9% of Nepali adolescents consumed soft drinks daily. These trends contribute cumulatively to heightened risks of obesity, metabolic disorders, and poor academic performance.

Physical Activity: Encouragingly, 75.4% of students reported engaging in some form of physical activity, significantly higher than the 60–70% participation rates typically observed in similar South Asian contexts (UNICEF, 2022). The predominance of walking and school sports indicates a mix of informal and structured exercise habits. Compared to the Global School-based Student Health Survey (GSHS, 2015) for Nepal, which indicated low structured physical activity, this study shows a slight improvement—possibly due to increased health awareness campaigns and inclusion of physical education in the curriculum.

However, this figure must be interpreted cautiously. Since intensity and duration were not explicitly measured, students may not necessarily meet the WHO recommendation of 60 minutes/day of moderate-to-vigorous physical activity (MVPA). Research by Bhandari et al. (2020) has shown that Nepali schools often lack the infrastructure and trained personnel to conduct regular physical activity sessions, which may affect the consistency and quality of engagement.

Correlation Between Physical Activity and Diet: A significant positive correlation (p < 0.05) between physical activity and healthy dietary habits observed in this study aligns with findings from global literature. For instance, Janssen & LeBlanc (2010) noted that adolescents who are physically active tend to exhibit other favorable health behaviors, including better diet quality, reduced sedentary time, and improved psychosocial functioning.

The current findings strengthen the argument that physical activity may act as a behavioral gateway, encouraging adolescents to adopt a cluster of health-enhancing behaviors. This holistic perspective is vital in adolescent health interventions, especially in school settings where such patterns can be positively reinforced.

When contextualized within the broader South Asian region, Nepalese adolescents in this study appear to fare better in terms of fruit and vegetable intake than their peers in India, Bangladesh, and Sri Lanka. However, the convergence of high fast food and snack consumption rates across the region signifies a shared public health challenge driven by globalization, poor dietary literacy, and aggressive marketing of unhealthy foods.

The high physical activity participation rate is a unique strength observed in this cohort, yet structural limitations such as absence of dedicated sports periods, lack of equipment, and academic pressure remain persistent barriers in the region (Perera et al., 2021; Bhandari et al., 2020).

This study has a few limitations. Since the data were self-reported, students might not have remembered everything accurately or may have answered in a socially acceptable way. The study was cross-sectional, so it shows associations but not cause-and-effect. Physical activity was not measured by time or intensity, which limits understanding of its real impact. Also, the study was done only in Kathmandu, so the results may not apply to students in other parts of Nepal. Lastly, important factors like screen time, sleep habits, and family income were not included.

This study found that while many high school students in Kathmandu eat fruits and vegetables and are physically active, unhealthy habits like frequent fast food and snack consumption are still common. A positive link between physical activity and healthy eating suggests that encouraging one may improve the other. These results highlight the need for school-based programs that promote better nutrition and regular physical activity to support adolescent health.Future  research should include larger and more diverse samples from both urban and rural areas to improve generalizability. Studies using objective tools to measure physical activity and detailed dietary intake, including portion size and timing, are recommended. Longitudinal designs could help establish cause-and-effect relationships and track behavior changes over time. Exploring additional factors like screen time, sleep patterns, and family lifestyle would also provide a more complete picture of adolescent health.

Conflict of Interest: None

Data Availability:  Data are available with the corresponding author

Funding: Nil

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