Introduction: Childhood obesity has more than doubled since it was formally recognized as a global epidemic in 1997 by World Health Organization (WHO). With increasingly dwindling space for private schools in Ethiopia, there is unresolved concern among the public on the possible effect of limited play area in schools on childrens sedentary behavior and its consequences including overweight and obesity. Previous studies reported a prevalence of overweight and obesity ranging from 10 to 23% among adolescents in private schools. The present study intended to determine and compare the levels of overweight and obesity among adolescents in private schools with and without adequate play area in Addis Ababa.

Methods: School based comparative cross-sectional study was conducted among 1276 adolescents of age 10-19 years. The study involved 20 private schools grouped into two based on the size of play area for their students. A three-stage random sampling technique was used to select study participants. Data was collected through face-to-face interview using a pre-tested questionnaire. Anthropometric measurements were also taken to assess nutritional status of participants. Descriptive statistical tests, bivariate and multivariate logistic regression analysis were done to identify factors associated with overweight/obesity.

Results: The overall magnitude of overweight and/or obesity was 17.0% with 95% CI (15% - 19%). It was significantly higher in schools without adequate play area, 19.4% with 95% CI (17% - 22%) than in schools with adequate play area which was 14.6% with 95% CI (13% - 17%) and p-value of 0.01. Adolescents with lower total physical activity level per day, those within the middle wealth quintile and who used private car as a means of transportation from and to school were significantly more likely to have overweight/obesity with OR (95% CI) = 1.57 (1.11-2.23), 2.2 (1.22-4.06) and 1.86 (1.09-3.17) respectively.

Conclusions: The findings of the study gave insight on the possible effect of inadequate play area in schools as an important contributor for a higher burden of overweight/obesity. Low physical activity and sedentary behavior were also found to be significant factors associated with overweight/obesity among private school adolescents.

Key words: Adolescent, Overweight, Obesity, Schools play area