Children Obesity in Saudi Arabia - Prevalence and Intervention - Research Paper Example

Children Obesity in Saudi Arabia: Prevalence and Intervention Abstract Obesity in childhood is increasingly becoming a major problem because of the many lifestyle changes occurring in our society. Increasing television and computer games use, fast food, reduced physical activity, and reduced access to affordable fresh fruits and vegetables are some of the factors contributing to increasing children overweight and obesity rate. This problem is not limited to developed countries as obesity rates in developing countries are similarly high and rapidly increasing. Along with children in Southeast Asia, Africa, and others, Saudi children are also increasingly becoming obese and requiring appropriate intervention. However, most of those RCTs reviewed and evaluated are somewhat ineffective in reducing weight gain among children thus a target specific and more innovative approach is required. 1. Introduction Obesity in childhood is increasingly becoming a major problem because of the many lifestyle changes occurring in our society. The epidemic in childhood obesity according to Paxon (2006) is being attributed to a number of factors such as increasing television and computer games use, the proliferation of fast-food restaurants, increase in sugar and fat-laden foods, junk foods offered in schools, reduced access to affordable fresh fruits and vegetables, and lessening outdoor activities (p.3). Consequently, obesity in children has become one of the leading international health challenges particularly in preschool-aged that include children two to five years of age and young adults with age ranging from twelve to nine years. In Australia for instance, 25% of children with age ranging from 2 to 18 was found overweight and obese in the 1980s national survey. In Indonesia, the obesity rate went as high as 10% while researchers in Spain found 32% overweight and obesity rate in 4 years old. Similarly, the worldwide estimate suggests that more than 20 million children below five years of age are obese while one in ten children is overweight (Bagchi, 2010). The focus of this study is mainly to describe and justify the need to determine the prevalence and required intervention to alter the number of children becoming overweight and obese in the Kingdom of Saudi Arabia. However, the scope is limited to literature review and analysis of information contained in studies conducted within Saudi Arabia and focusing on excessive weight gain and obesity in children. These include several systematic reviews of RCTs and clinical controlled trials evaluating the design, methods, and effectiveness of actual interventions. Knowledge gained from literature and systematic reviews can benefit future efforts aimed at reducing children overweight and obesity as well as advancement of own professional practice. 2. Literature Review 2.1 Prevalence of Obesity Generally, excess fat is not considered as source of obesity but excess body weight leading to higher BMI. (Aznar, 2011). Similarly, there is no clear guidelines on how such overweight and obesity problem can be considered a health risk for children. (ibid). Obesity had been identified as a medical problem among adults in the United States in the late 1940s but it had also become a common problem in children in the 1980s (Bynum, 2006). For instance, the number of overweight and obese American children rose from 5 to 13 percent between 1980 and 2000 (ibid). Since medical records or a person’s vital statistics cannot be considered as systematic data, data from surveys and population studies are used (Aznar, 2011). In Canada for instance, health determinants and status are provided by cross-sectional studies. They are also sometimes used to determine the level of Canadian health system of children particularly those with age ranging from two to nineteen (ibid, 71). In contrast, the NHANEs program is used in the United States to determine the level of obesity among children. However, like Canada, the US program use data from cross-sectional studies conducted on children of different ethnic communities such as Mexican American and other groups (ibid, 73). Although there seems not much readily available data to present a general view of children’s weight and height, the prevalence of obesity among children in the 1980s onwards appear to have increased considerable. As indicated by some reports coming from 34 countries around the world, obesity is more prevalent in the United Kingdom, North America, parts of Europe and the Mediterranean (Bagchi, 2010). For instance, children and young adults with age ranging from two to nineteen are overweight and obese in the United States. These children has BMI greater than 85th percentile of the 2000 growth charts or BMI greater than 25 kg/m2 which is an increase of about 20% since 1963 and later part of 2006. Moreover, older black and American children with Latin origin showed significant increase in obesity cases (around 30%) in the survey conducted between 2003 and 2006 (ibid, 31). Studies using DXA or Dual Energy X-ray Absorptiometry also found the relationship between BMI levels and percentage of body fat where a child’s BMI predict the level of child’s body. For instance, children with BMI higher than normal are typically obese with high fat levels (ibid, 33). 2.2 Childhood Obesity and BMI Most literature discussing childhood obesity are mostly focused on BMI or the result of dividing height by the weight of the body. Some include population cut-off of the 85th percentile to define overweight and 95th percentile to define obesity. However, according to Gerritsen (2006), BMI may be only appropriate in determining obesity in adults and may be somewhat inaccurate for use in children. For instance, a child body mass may be increasing due to growth parameters such as muscle mass. This is the advantage of DXA over BMI as it has the ability to assess total as well as regional body composition such as trunk, arms, and legs (p.315). Another is the fact that BMI in adults is different from children thus, researchers should be careful in generalizing obesity in the population. According to Waters et al. (2011), children with Body Mass Index higher than 30 kilograms per meter squared is obese but there may be a problem when a BMI a little below 30 kg/m2 is overweight since variations in weight and height can occur in growing children. Rather than BMI, the common approach in determining obesity in young children is to use weight-for-height. This is done by using Z >+ 2.0 above a reference population mean as the criteria for excess weight for a given age and gender (p.17). It may be also appropriate to use waist circumference as a method for determining obesity in children as there similarity in their diagnostic accuracy. However, such relationship is yet to proven in future studies. In summary, BMI for age is still the most appropriate in terms of diagnostic and obesity definition for children and young adults (Reilly, 2010). 2.3 Causes of Obesity and its Effect to Children Obesity starts from simple interaction between children and their environment. According to Korbonits (2008), children are susceptible to factors affecting food intake and energy expenditure such obesogenic environment responsible for encouraging children to take energy –dense foods, snacks between meals, and regular consumption of sugar-rich beverages. Similarly, energy expenditure is decreased by sedentary activities influenced by modern lifestyle such watching television, playing computer games, and other life convenience eliminating the need for greater physical activity (p.88). There are also pathological causes of obesity such as genetic and endocrine abnormalities where children’s obesity is inherited. Although rare, pathological causes of obesity contribute to up to 75 percent of BMI (Barnett et al, 2009). There are health hazards associated with excessive weight and serious obesity in children and these include problems related to high blood pressure, diabetes type II, apnea, dyslipidemia, left ventricular hyperthrophy, steatohepatitis, and psychosocial problems (Kiess, 2004). However, childhood obesity can lead to problems in adulthood including health risk associated with high BMI (WHO, 2000). Obesity can also lead to problems related to growth, maturity, performance, physical activity, and metabolic complications such as fatness. Fatness can lead to different motor and cardiovascular problems that can affect their strength, flexibility, and proficiency (Malina et al, 2004). Study shows that more than 40% of overweight children will be obese in adulthood while 15 to 20% of obese adults had been overweight in their childhood (Kiess et al, 2004). According to Korbonits (2008), childhood obesity tracks into adult life as some 68% of children diagnosed with a BMI in the 85th percentile grew up as obese adults. Another important issue is children obesity is preschool or children age ranging from 5 to 19 years particularly in developing countries like Nigeria, Peru, Bolivia, and others. For instance, figures gathered on children’s obesity in Asian Indian preschool children from the 1990s to 2006 are relatively stable at 1.6% and 1.5% respectively (p.89). 2.4 Prevalence of Children Obesity in the West compared to developing countries The rate obesity is also alarming in many parts of the world as in Brazil where obesity prevalence in children with age ranging from six to 18 is higher with 4.1 to 13% for the last 20 years. In Thailand, the prevalence of obesity in children with age ranging from five to twelve years of age increased from more than 12% to almost 166% over a period of 2 years while China is experiencing 1% increase in every 6 years since 1991. Moreover, Indonesia and Pakistan saw an increase from a little more than 5% to almost 9% and 3.0 to almost 6% between 1990 and 2005 respectively (Preedy, 2011). Despite poverty and other nutrition-related problem, statistics coming from the World Health Organizations’ Global Database on Child Growth and Malnutrition suggest that there is still 8.1% rate of overweight in preschool children in North Africa particularly in Algeria, Morocco, and Egypt. Latin America has 4.4% child obesity rate while south central Asia scored 2.1% and Western Africa with 2.6%. Over 16 registered developing countries in the WHO database showed a rising prevalence of childhood overweight. For instance, Seychelles, a rapidly developing country in the Indian Ocean has a population consisting of 12.6% overweight and 3.8% obese children. These figures are as high as in industrialized countries like the United Kingdom and Germany (Kiess, 2004). Findings of studies conducted about child overweight and obesity in developing countries and industrialized countries showed strikingly different patterns. For instance, prevalence of obesity in Western countries suggests that obesity is most common with girls than boys while the reverse was reported in Southeast Asia (O’Dea & Eriksen, 2010). According to comparison made between 13 European countries and the US, the rate of overweight and obesity among children was highest in the US particularly with girls. In England, the same degree of prevalence was found in the results of national studies conducted for children. In contrast, studies conducted in China found more overweight boys than girls. Similarly, reports from Malaysia and Indonesia reveal the increasing prevalence of obesity among males. Further investigation of this phenomenon in Western countries suggest that while social expectations about body size and proportion between girls and boys contribute to the varying rate, higher occurrences of overweight and obesity in developed countries are among children from households with low economic status. For instance, a national study from eastern France in early 2000 found high occurrences of excessive weight gain and obese children in low economic zones. Similar findings have been reported in the US where prevalence of excessive weights and obese in children is most common in low-income families. In Vietnam, researchers found increasing probability of childhood overweight in wealthier households than poor families (ibid, 137). In summary, these findings suggest that patterns of children’s excessive weight gain and obesity among children in Southeast Asia are different from those of in industrialized countries. More importantly, it is an indication that interventions developed in the West may not be appropriate in developing countries. 2.5 Prevalence of Children Overweight and Obesity in Saudi Arabia In Saudi Arabia, different studies on obesity and excessive weight gain among children with age ranging from 1 to 18 yield different findings. The review conducted by El-Hazmi & Warsy (2002) for instance, suggest that variability in the pervasiveness of obesity and excessive weight gain in Saudi children particularly in age groups below 13 years of age. Moreover, occurrences of children with excessive weight and obese varies from province to province with the Eastern regions registering the highest prevalence rates compared to the South with lowest score. Overweight and Obesity of Saudi children are more identified with age but it is much lower to those of Germany, United States, Canada, North Western Spain, and other countries in the West (p.304). In contrast, the study conducted by Alam (2008) in North West Riyadh yield a more informative result. Out of the 1072 students surveyed with an overwhelming participant turn out of almost 90% obesity was found more prevalent in wealthier students while the percentage of obese students get higher by age and schooling grade. This is despite the fact that almost all students admitted doing exercises (p.1139). Previous studies conducted in 1997 by El-Hazmi & Warsy already identified factors contributed to overweight and obesity and these include sedentary lifestyle and increased energy intake, and genetics. The study also confirmed the previous reports that BMI percentiles of children between 6 to 16 years of age in Saudi Arabia had lower values than their American counterpart. Females in all provinces of Saudi population are more obese than males particularly in the Central Province with 24.40%. The contributing factors provided this time include the climate that is preventing physical activities for at least six to eight months and encouraging afternoon siesta after a meal (Hazmi & Warsy 1997). The comparative study conducted by the same author in 2002 yield similar results as out of the total 12,701 children, the pervasiveness of obesity in girls (6.74) aged 1 to 18 years is higher compared to boys (5.98). Although a little different, prevalence of overweight and obesity is present in all provinces of Saudi Arabia with the Eastern Province having the highest (El-Hazmi & Warsy, 2002). In 2001, Al-Shammari et al. (2001) found that out of 1,848 children, those in rural area are more overweight and obese compared to urban children (p.179). In establishing the occurrences and development in obesity among male students in central Saudi Arabia from late 1980s and 2005, Al-Hazzaa (2007) found an increase in the mean BMI standard deviation indicating the there is a rising trend of obesity among schoolboys for the last 17 years (p.1569). A more dietary centred investigation conducted by Farghaly et al. (2006) in Abha reveal some interesting facts about the occurrences of excessive weight and obese children in Saudi Arabia. For instance, findings from this study suggest that diets of most Saudi children are rich in carbohydrates but deficient in fiber. Males are more involved with physical exercise than females thus excessive weight and obesity is more prevalent among girls in primary and secondary grades. In summary, both diet and lifestyle play an important role in children’s obesity rate (p. 415). In Al-Hassa, a significant number of obese and children with excessive weight was found in city schools and those with higher age group. The frequency of eating out is high among these children and those consuming more egg, potato, carbonated soft drinks, sugary drinks, and sweets are more in weight compared to those consuming fruits, vegetables, and dairy products (Amin et al, 2008). In Jeddah, a study grouped preschool children by gender and found little difference between obese and non-obese in terms of age. However, children at preschool that are obese were much serious in terms of weight, taller, and with higher BMI compared to non-obese. They are also spending more time watching television resulting to lesser physical activity and exposure to food advertising. In summary, the study concluded that a large portion of Saudi preschool children is obese mainly due to physical inactivity (Al-Hazzaa & Al-Rasheedi, 2006). Al- Hazzaa, also investigated the impact of physical activity in the following year and the result suggest that most of the boys in the study had fat content exceeding 25% of their body weight. According to cut-off points formulated for measuring Body Mass Index, overweight and obesity among participants 20.3% and 12.4 % respectively while data from the study shows the close relationship between physical activity levels and increased BMI values (Al-Hazzaa, 2007). Using the Saudi reference data set created in 2005 for calculating BMI of young people with age ranging from 5 to 18 years and the WHO’s reference created in 2007, El-Mouza et al (2010) investigated the incidence of excessive weight and obesity in children and young adults. Out of the 19, 317 children and young adults with healthy body, the total incidence of children with excessive weight, obese, and seriously obese in all age group was around 23%, 9%, and 2% respectively. Young males are reported having the highest obesity rates while obese children in school-age is less than young adults. However, the obesity rate between young males and females shows little difference while the rates are getting lower whenever the 2000 CDC reference is used for comparison (p.8). In terms of prevention and intervention, some studies conducted in Saudi Arabia points to the implications physical idleness and obesity to children’s heart problems. Most of Saudi children according to this study do not meet even the minimum requirements of physical activity thus more than 15% of school children are obese with body fat content over 20% of body mass (Al-Hazzaa, 2002). Studies analyzing the most appropriate intervention to prevent obesity and excessive weight gain in children living around the world carried out different systematic review of randomized controlled trials. One that is conducted by Monasta et al (2010) found none of the 17 RCTs is effective in preventing overweight and obesity (p.107). However, this systematic review only selected articles that are in the English language, majority are from industrialized countries such as North American and Western Europe while only one from Asia. The findings of this systematic review are therefore not representative of the general population particularly those that are in developing countries. More importantly, it cannot represent Saudi children since none of those involved in RCTs are even near to Saudi Arabian demographics and limited to Westernized society. The systematic review conducted by Brown & Summerbell (2008) on the other hand found that out of the 3 diet studies, some fifteen studies concerning physical activity, and nine of the 20 combined diet and physical studies, assessment of dietary and physical activity interventions is problematic due to lack of evidence. Although there is an indication that physical activity can reduce weight, the interventions reviewed are inconsistent and somewhat short term in effect (p.109). This systematic review suffers from lack of high quality articles that may be caused by poor research method and criteria applied. For instance, although its article inclusion criteria is based on NICE obesity guidance, its selection criteria include studies reporting weight outcome which is confusing. Another weakness or limitation is inclusion of healthy eating in its lifestyle intervention but in actual article selection, it did not include studies focusing on children with eating disorders. The systematic review conducted by Dobbins et al. (2009), found school-based intervention unrelated with leisure time physical activity rates and BMI. However, there is sufficient evidence to suggest that physical activity, educational materials, and change in lifestyle behaviour can positively affect the health of children and adolescents (p.2). Although the result of this systematic review is interesting it cannot hide the limitations caused by excluding studies conducted outside school setting and those with children under the age of 5. Moreover, majority of selected articles were RCTs conducted in the United States and European countries that is far from being representative of those in the Middle East and Asia. Systematic reviews of RCTs and 12 weeks controlled clinical trials was also conducted by Summerbell et al. (2009) to find the level of efficiency of interventions aimed in reducing the number of obese children dietary changes, increase physical activity, and active lifestyle. However, five of six long-term studies showed no effect on overweight status between groups while those that are aimed to reduced obesity by changing diet and increasing activities among children shows no improvement in reducing BMI considerably (p.2). Note that this systematic review changed its protocol in the last minute of the review. This is from inclusion of all studies with minimum twelve months to studies with shorter duration or with minimum duration of three months. For this reason, the study lend itself to bias and limitations caused by multiple RCTs with entirely different objectives and aims. Moreover, it did excluded those interventions dealing with already obese children that may not be helpful particularly when the main objective is the evaluation of dietary educational interventions and physical interventions. The study failed to recognize the fact that such children’s obesity were caused by either poor educational or physical interventions. The systematic review conducted by Wilks et al. (2010) involving 10 observations studies established the relationship between physical activity and adiposity in children regardless of ethnicity. However, this only limited to children with age ranging from 3 to 12 while one study included in the review deals with 4 and 19 years of age. Apparently, such inclusion can lead to confusion with result limited to majority of children with same age bracket. Moreover, as admitted by these authors, included studies differ in their design, quality and statistical analyses thus problematic in terms of generalization (p.119). Kamath et al. (2008) systematic review and meta-analysis of RCTs aimed to find evidence regarding the effectiveness of interventions aimed at changing lifestyle behaviours. Searching from nine electronic databases, 34 studies were included and analysed using random-effects meta-analyses, planned subgroup analyses, and quantified inconsistency with I2. The result suggests that paediatric obesity preventions has no considerable effect on lifestyle behaviours and BMI. The limitations of this study seems negligible as include RCTs conducted on children and young adults with age ranging from 2 to 18 which is preferable in terms of coverage. However, this limitation becomes significant when it excluded studies with obese participants and those with eating disorders. Note that the objective is to find evidence of dietary interventions effectiveness but the systematic review refused to acknowledge the actual consequences of RCTs failure. In general, this systematic review is limited in scope, which is primarily caused by poor inclusion criteria. In summary, interventions to prevent obesity in children must be developed and designed properly. Although current interventions can effectively promote healthy diet and increase physical activity levels among participants, they are not effective in preventing weight gain. The intensity of interventions may be considered along with the scope and processes that may be required to ensure helpful results. 3. Summary and Significance of Findings Childhood excessive weight and obesity is no doubt a global problem as they are prevalent in both industrialized and poor countries. The epidemic in childhood obesity is mainly brought about lifestyle changes occurring in a society dominated by fast food, automation, and sedentary lifestyle. Over 20 million children with age ranging from 1 to 5e are obese while one out of ten children is overweight. BMI in adults is different from children thus overweight and obesity intervention and prevention in Saudi Arabia must be specific and consider the application of the most appropriate method such as BMI for age. Moreover, since obesity in children is commonly carried through adulthood with all the associated health risks, people carrying out the intervention must recognize the importance of their efforts and the negative consequences of their failures. The prevalence of overweight and obesity among Saudi children is evident. Although it may vary from province to province and lower compared to the West and other developing countries, it must be remembered that it is rising consistently and in time may become a national epidemic. More importantly, results of systematic reviews of RCTs and clinical controlled trials particularly those that are centred on dietary and physical activity intervention clearly suggests the need for an intensified approach and larger intervention scope to ensure reduction of obesity rate. These findings can help future interventions concerning overweight and obesity in children re-evaluate their approach, innovate, and proceed in a direction more suitable to their target population. 4. Limitations of this study Although significant work has been put on this research, there seems a limit in documented intervention about change in dietary intake and physical activity for obese children in Saudi Arabia. For instance, despite the significant number of articles done and presented on this paper, they are generally discussing about prevalence and trends of overweight and obesity in Saudi children. Even those RCTs and clinical trials presented in different systematic reviews do not include interventions conducted in the region. For this reason, it is safe to assume that in terms of intervention, the number of relevant sources or availability of documented interventions done in Saudi Arabia limits the result of this study. 5. Conclusion and Recommendation Children overweight and obesity in Saudi Arabia may not be as prevalent compared to the West and other developing countries but it is likely to develop into a national problem in the near future. Moreover, approaches developed to solve this problem is not yet established and in fact yielded disappointing results. For this reason, future interventions may benefit from innovative and target specific approaches such as dietary interventions incorporating the impact of extreme climate as in Saudi Arabia or social expectations that might affect children’s eating habit and food preference and economic situations preventing access to healthy foods. 6. References Alam A, (2008), Obesity among female school children in North West Riyadh in relation to affluent lifestyle, Saudi Med J 2008, Vol. 29 (8), pp. 1139-1144 Al-Hazzaa H, (2002), Physical activity, fitness and fatness among Saudi children and adolescents: Implications for cardiovascular health, Saudi Med J 2002, Vol. 23 (2), pp. 144-150 Al-Hazzaa H. & Al-Rasheedi A, (2006), Adiposity and physical activity levels among preschool children in Jeddah, Saudi Arabia, Saudi Med J 2007, Vol. 28 (5), pp.766-773 Al-Hazzaa H, (2007), Pedometer-determined Physical Activity among Obese and Non-obese 8 to 12 year old Saudi Schoolboys, J. Physiol Anthropol 26 (4), pp. 459-465 Al-Hazzaa H, (2007), Prevalence and trends in obesity among school boys in Central Saudi Arabia between 1988 and 2005, Saudi Med J 2007, Vol. 28 (10), pp.1569-1574 Al-Shammari A, Khoja T, & Gad A, (2001), Community-based study of obesity among children and adults in Riyadh, Saudi Arabia, Food and Nutrition Bulletin, Vol. 22, pp.178-183 Amin T, Al-Sultan A, & Ali A, (2008), Overweight and Obesity and their Association with Dietary Habits, and Socio-demographic Characteristics Among Male Primary School Children in Al-Hassa, Kingdom of Saudi Arabia, Indian Journal of Community Medicine, Vol. 33, Issue 3, pp. 172-181 Aznar A, (2011) Epediomology of Obesity in Children and Adolescents: Prevalence and Etiology, Germany: Springer Bagchi D, (2010), Global Perspectives on Childhood Obesity: Current Status, Consequences and Prevention, US: Academic Press Barnett A. Barnett T, & Kumar S, (2009), Obesity and Diabetes, US: John Wiley & Sons Brown T. & Summerbell C, (2008), Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence, Obesity Reviews 2009, 10, pp.110-141 Bynum W, (2006), The Western Medical Tradition: 1800 to 2000, US: Cambridge University Press Dobbins M, DeCorby K, Robeson P, & Husson H, (2009), School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 -18, Cochrane Database of Systematic Reviews, Issue 1, pp. 1-106 El-Hazmi M. & Warsy A, Prevalence of Obesity in the Saudi Population, Annals of Saudi Medicine, Vol. 17, No. 3, pp. 302-306 El-Hazmi M. & Warsy A, (2002), The Prevalence of Obesity and Overweight in 1-18 Year Old Saudi Children, Annals of Saudi Medicine, Vol. 22, Nos. 5-6, pp. 303-307 El-Hazmi M. & Warsy A, (2002), A Comparative Study of Prevalence of Overweight and Obesity in Children in Different Provinces of Saudi Arabia, Journal of Tropical Pediatrics, Vol. 48, pp. 172-177 El-Mouzan M, Foster P, Al Herbish A, & Al Salloum A, (2010), Prevalence of overweight and obesity in Saudi children and adolescents, Ann Saudi Med, 30 (3), pp. 203-208 Farghaly N, Ghazali B, Al-Wabel H, Sadek A, & Abbag F, (2006), Life style and nutrition and their impact on health of Saudi school students in Abha, Southwestern region of Saudi Arabia, Saudi Med J 2007, Vo. 28 (3), pp. 415-421 Gerritsen F, (2006), Respiratory Diseases in Infants and Children, UK: European Respiratory Society Kamath C, Vickers K, & Ehrlich A, (2008), Behavioral Interventions to Prevent Childhood Obesity: A Systematic Review and Metaanalyses of Randomized Trials, J Clin Endocrinol Metab, December 2008, 93(12), pp. 4606-4615 Kiess W, (2004), Obesity in Childhood and Adolescence, Germany: Karger Publishers Korbonits M, (2008), Obesity and Metabolism, Germany: Karger Publishers Malina R, Bouchard C, & Bar-Or O, (2004), Growth, Maturation, and Physical Activity, US: Human Kinetics Monasta L, Batty G, Macaluso A, Ronfani L, & Bavcar A, (2010), Interventions for the prevention of overweight and obesity in preschool children: a systematic review of randomized controlled trials, Obesity Reviews 2011, pp. 107-118 O’Dea J. & Eriksen M, (2010), Childhood Obesity Prevention: International Research, Controversies, and Interventions, UK: Oxford University Press Paxon C, (2006), Childhood Obesity: Number 1, Spring 2006, UK: Brookings Institution Press Preedy V, (2011), Handbook of Growth and Growth Monitoring in Health and Disease, Germany: Springer Reilly J, (2010), Assessment of obesity in children and adolescents: synthesis of recent systematic reviews and clinical guidelines, The British Dietetic Association Ltd, J Hum Nutr Diet, 23, pp.205-211 Summerbell C, Edmunds W, Sam K, Brown T, & Campbell K, (2009), Interventions for preventing obesity in children, Cochrane Databases of Systematic Reviews 2005 Issue 3, pp.1-80 Waters E, Swinburn B, Seidell J, & Uauy R, (2011), Preventing Childhood Obesity: Evidence Policy and Practice, US: John Wiley & Sons WHO, (2000), Obesity: Preventing and Managing the Global Epidemic, Geneva: World Health Organization Wilks D, Besson H, Lindroos A, & Ekelund U, (2010), Objectively measured physical activity and obesity prevention in children, adolescents and adults: A systematic review of prospective studies, Obesity Reviews (2011), 12, pp. 119-129 Read More

2. Literature Review 2.1 Prevalence of Obesity Generally, excess fat is not considered as source of obesity but excess body weight leading to higher BMI. (Aznar, 2011). Similarly, there is no clear guidelines on how such overweight and obesity problem can be considered a health risk for children. (ibid). Obesity had been identified as a medical problem among adults in the United States in the late 1940s but it had also become a common problem in children in the 1980s (Bynum, 2006). For instance, the number of overweight and obese American children rose from 5 to 13 percent between 1980 and 2000 (ibid).

Since medical records or a person’s vital statistics cannot be considered as systematic data, data from surveys and population studies are used (Aznar, 2011). In Canada for instance, health determinants and status are provided by cross-sectional studies. They are also sometimes used to determine the level of Canadian health system of children particularly those with age ranging from two to nineteen (ibid, 71). In contrast, the NHANEs program is used in the United States to determine the level of obesity among children.

However, like Canada, the US program use data from cross-sectional studies conducted on children of different ethnic communities such as Mexican American and other groups (ibid, 73). Although there seems not much readily available data to present a general view of children’s weight and height, the prevalence of obesity among children in the 1980s onwards appear to have increased considerable. As indicated by some reports coming from 34 countries around the world, obesity is more prevalent in the United Kingdom, North America, parts of Europe and the Mediterranean (Bagchi, 2010).

For instance, children and young adults with age ranging from two to nineteen are overweight and obese in the United States. These children has BMI greater than 85th percentile of the 2000 growth charts or BMI greater than 25 kg/m2 which is an increase of about 20% since 1963 and later part of 2006. Moreover, older black and American children with Latin origin showed significant increase in obesity cases (around 30%) in the survey conducted between 2003 and 2006 (ibid, 31). Studies using DXA or Dual Energy X-ray Absorptiometry also found the relationship between BMI levels and percentage of body fat where a child’s BMI predict the level of child’s body.

For instance, children with BMI higher than normal are typically obese with high fat levels (ibid, 33). 2.2 Childhood Obesity and BMI Most literature discussing childhood obesity are mostly focused on BMI or the result of dividing height by the weight of the body. Some include population cut-off of the 85th percentile to define overweight and 95th percentile to define obesity. However, according to Gerritsen (2006), BMI may be only appropriate in determining obesity in adults and may be somewhat inaccurate for use in children.

For instance, a child body mass may be increasing due to growth parameters such as muscle mass. This is the advantage of DXA over BMI as it has the ability to assess total as well as regional body composition such as trunk, arms, and legs (p.315). Another is the fact that BMI in adults is different from children thus, researchers should be careful in generalizing obesity in the population. According to Waters et al. (2011), children with Body Mass Index higher than 30 kilograms per meter squared is obese but there may be a problem when a BMI a little below 30 kg/m2 is overweight since variations in weight and height can occur in growing children.

Rather than BMI, the common approach in determining obesity in young children is to use weight-for-height. This is done by using Z >+ 2.0 above a reference population mean as the criteria for excess weight for a given age and gender (p.17). It may be also appropriate to use waist circumference as a method for determining obesity in children as there similarity in their diagnostic accuracy. However, such relationship is yet to proven in future studies.

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