Although remarkable progress has been made in controlling the problem of underweight among adolescents in the country, over-nutrition is a major problem among adolescents with about 11.4 percent being overweight and two percent obese.

This was according to the first Global School-Based Student Health Survey (GSHS) conducted in 2016 among school children aged between 13 and 17 years in 50 schools across the country.

The figure is higher than that of most countries in the region, it states.

Of 7,990 students, about 7,578 participated in the study, giving an overall response rate of 95 percent. About 44 percent of the students were boarding students.

It was found that more females (15 percent) and young students (13 percent) were overweight than males (eight percent) and older students (10 percent).

According to the survey, day scholars were significantly more overweight (13 percent) than boarding students (9 percent).

However, the prevalence of obesity did not differ significantly by age or sex.  Nutritional status was assessed by calculating the body mass index (BMI) of the students.

Changing dietary habits like, for instance, increased consumption of sugary drinks and fast food are leading to the problems of overweight and other risk factors associated with non-communicable diseases (NCDs), it states.

About 40 percent of the students reported drinking carbonated soft drinks one or more times a day.

The survey found the prevalence of undernutrition was 2.1 percent and 3.1 percent of students reported going hungry most of the time or always because of the lack of food in their homes or boarding school.

Only 32.1 percent reported eating fruits two or more times a day; 42 percent reported eating vegetables three or more times a day. About 32.2 percent said that they ate fast food at least four days a week before the survey.

The study states that nutritional deficiencies as a result of food insecurity affect students and their learning.

It states that there is a lack of comprehensive national data on health behaviours and protective factors that are proven to be the leading causes of morbidity and mortality among adolescents worldwide. Therefore, in order to effectively and strategically guide policymakers and stakeholders to further promote the health and well-being of adolescents in Bhutan, an assessment of the dietary behaviours of adolescents is important.

The survey, conducted to obtain systemic information on select risk behaviours among adolescents to support youth health programmes and policies in Bhutan, was also aimed at providing accurate data on health behaviours and protective factors among students.

It states that adolescence (a person aged between 10 and 19) is a critical transition period, as it is during this time the foundations for health and well-being are established.

Adolescents constitute about one-quarter of Bhutan’s population.

In terms of being physically active, 23.5 percent of the students reported being physically active for at least 60 minutes per day for five or more days before the survey. About 30 percent said they spent three or more hours a day on sedentary activities.

The study found that a high proportion of students followed healthy practices related to personal hygiene and the level of knowledge of HIV/AIDS was high with 86.3 percent reporting that they had heard about it.

Only 4.2 percent said that they never or rarely washed their hands after using the toilet, while 3.7 percent reported rarely washing their hands before eating. About one-third (33.6 percent) reported having no access to clean drinking water in school.

While some of the findings are encouraging, the study states that some areas need urgent attention such as reducing the tobacco, alcohol and drug use, increasing parental engagement, creating a better environment at school.

Controlling of bullying and interpersonal violence and encouraging physical activity could be considered while creating a better environment at school. About 39 percent of the students reported having been physically assaulted at least once in the past year and about 26.5 percent said they have been bullied on one or more days a month before the survey.

The study found that about 11 percent of the students had attempted suicide one or more times during the last 12 months before the survey.

While the prevalence of tobacco use was estimated at 29.4 percent, the rate of exposure to second-hand smoke as measured by people smoking in their presence on one or more day in the last seven days was 49.7 percent.

“Though 55.2 percent of the respondents had tried to smoke tobacco before the age of 14 years, it was encouraging to note that 83 percent had tried to quit in the year preceding the survey,” it states.

About 65.8 percent reported consuming betel nut products on one or more days in the last 30 days before the survey.

In terms of alcohol, almost one-quarter (24.2 percent) of students reported that they consume alcohol. In addition, one in 10 (12 percent) students said they currently used marijuana one or more days in the past 30 days and 7.2 percent reported currently using controlled substances like Nitrosun 10 (N10), Spasmo-proxivon (SP) or dendrite.

According to the study, the country’s school-going adolescents require focused interventions for reducing the risk factors for NCD and mental health issues. “Programmatic measures must be developed to implement the holistic policies adopted so as to intervene early, since these behaviours may extend into adult life, fueling an NCD epidemic and mental health problem.”

There is a need for intensification of actions both at the upstream policy level and the downstream programmatic level that is, the community and school levels to ensure the physical, mental and social well-being of adolescents and the youth.

“Any laxity in taking measures for this age group and during this time period could represent a missed opportunity to improve the health of the overall population,” it states.


The following recommendations have been made based on the GSHS 2016 findings.

  • Strengthen policies and programmes to control tobacco, alcohol, doma and pan masala use focusing on adolescents.
  • Promote healthy diet focusing on improved food diversity in schools.
  • Promote physical activity and encourage schools to make use of the time allocated for PE (physical education) classes, abiding by the education ministry’s policy of reserving 50 minutes a week for PE.
  • Strengthen the school parent/guardian education awareness programme to address the health and behavioural needs of the children.
  • Local government to integrate the promotion of mental health, and reduction in the risk factors for NCDs in their sectoral plans and programmes.
  • Further strengthen comprehensive sex education in schools focusing on sexually transmitted diseases and unintended pregnancies
  • Encourage schools to strengthen programmes for mental health and appropriate referral of children.

Dechen Tshomo