Childhood Overweight and Obesity and Its Determinants MOVING OUR CHILDREN TO THE LIGHTER SIDE A webinar in observance of World Obesity Day 04 March 2021 CRISTINA G. MALABAD Senior Science Research Specialist
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Childhood Overweight
and Obesity and Its
Determinants
MOVING OUR CHILDREN TO THE LIGHTER SIDE A webinar in observance of World Obesity Day
04 March 2021
CRISTINA G. MALABADSenior Science Research Specialist
Childhood overweight and obesity is a global problem which is a result of imbalance between calories consumed and calories expended.
(Source: World Health Organization, 2020)
For children under 60 months:• Overweight is weight-for-height greater than 2 standard
deviations above WHO Child Growth Standards median• Obesity is weight-for-height greater than 3 standard deviations
above the WHO Child Growth Standards median.
(Source: World Health Organization, 2020)
For school-age children 5 to 10 years old:• Overweight is BMI greater than 1 standard deviation above WHO
Growth Reference Standards median• Obesity is BMI greater than 2 standard deviations above the
WHO Growth Reference Standards median.
In 2019, an estimated 38.2 million children under the age of 60 months were overweight or obese. Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings.
(Source: World Health Organization, 2020)
In the Philippines, childhood overweight and obesity is an emerging public health concern that affects about 0.3M under-5 children and 1M school-age children.
The problem is commonly observed among urban areas and among households in the rich and richest quintiles.
(Source: FNRI-DOST, ENNS 2019)
1.9
2.93.5
4.35.1
3.9 4.0
2.9
0
2
4
6
8
10
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Pe
rce
nt
(%
)
Survey Periods
Prevalence of Overweight-for-Height
among Under-five Children (0-59 months)
1.1% point decrease
5.86.8 6.6
7.4
9.1 8.6
11.7
9.2
0
2
4
6
8
10
12
14
16
18
20
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Pe
rce
nt
(%)
Survey Periods
Prevalence of Overweight/Obese among Children,
5.08 to 10 years old
2.5% point decrease
Childhood obesity can profoundly affect children’s physical health, social, and emotional well-being and self-esteem. It is also associated with poor academic performance and a lower quality of life.
ANGELES-AGDEPPA, I.A. and ARIAS, F.P.S.Journal of Food and Nutrition Research, 2020, Vol. 8, No. 1, 1-14
Individual and Environmental Factors
are Important Predictors of
Overweight and Obesity among 0 to 60
Months Old Children in the Philippines:
2013 NNS Data
Data from a total of 13,021 Filipino children aged 0 to 60 months old from the 2013 National Nutrition Survey (NNS) were included in the study wherein:
• 2,392 are infants (0 to less than 12 months)• 4,732 are toddlers (12 to less than 36 months), and • 5,897 are preschoolers (36 to 60 months)
(Source: FNRI-DOST, 2013)
This study is focused on analyzing the individual and environmental factors of overweight and obesity among children aged 0-60 months.
Environmental factors include the following:
1. Household’s socio-demographic profile2. Participation in government programs
1. Household’s socio-demographic profile- Wealth quintile category, locale (place of
residence), family type, ethnicity, household type, parental education and working status
2. Participation in government programs- Vitamin A Supplementation- Deworming- Newborn Screening- Iron Supplementation
- Gender, birth information (birth weight, gestation, type of delivery, birth size), feeding practices and nutritional status
- Food and macronutrient intake (carbohydrates, protein, total fat and total sugar)
Children were characterized as:
1. Mostly male (51.5%)
2. Majority dwells in rural areas (57.0%)
3. Majority were children coming from families with more than 5 members (84.7%) and with extended families (50.1%)
4. Majority were from households belonging to the rich wealth quintile (32.4%).
5. Majority of the parents had completed secondary education; most mothers are non-working (74.3%) while most fathers are working (90.1%).
• Among infants, there were no environmental factors associated with overweight/obesity.
• At the individual level, only feeding practices and the presence of stunting were associated with overweight and obesity.
This is supported by a previously published study which revealed that stunting causes a series of important long-lasting changes such as:
1. Lower Energy Expenditure2. Higher Susceptibility to the Effects of High-Fat Diets3. Lower Fat Oxidation4. Impaired Regulation of Food Intake
(Source: Sawaya & Robert, 2003)
• However, in the logistic regression, feeding practices is not a significant factor of overweight/ obesity.
• Among toddlers, the environmental factors associated with overweight and obesity were:
1. Locale (Urban/Rural)2. Wealth Quintile3. Household Type4. Parents’ Educational Status
5. Mother’s Working Status6. Participation in newborn screening7. Participation in vitamin A supplementation
These environmental factors relate more to socio-economic characteristics of the households.
• Generally, the relationship between socio-economic factors and being overweight mainly results from the access that the population has to healthier and less energy-dense foods.
• In urban areas, access to unhealthy foods, and proximity to fast-food stores and food service establishments characterized as obesogenic environment could promote weight gain
(Source: Gorman et al., 2007)
• The predictor on mother’s working status wherein most mothers in this study are working may indicate an additional income to the family.
• In a previous study, higher income and better wealth status have been founded to be significantly associated with diets rich in animal fats. predisposing children to excess weight gain
(Source: Drewnoski and Popkin, 2007)
• The low educational level of parents, particularly the mothers, in this study puts the child at higher risk of becoming overweight and obese.
(Source: McLaren, 2007)
A previous study reported that educated parents may be more concerned about obesity and have higher awareness regarding the consequences of obesity. Hence, they tend to have a healthier diet, characterized by greater consumption of fruit, vegetables and lower fat milk and less consumption of fats.
• Children who received Vitamin A supplements are less likely to be overweight or obese.
• Vitamin A is linked in the regulation of fat cells and the hormones they release could play a role in maintaining healthy body.(Source: Hollung, 2004)
• Among toddlers, the individual factors associated with overweight and obesity were:
Type of Birth Delivery
Child’s Birth Size
• Among pre-schoolers, the environmental factors associated with overweight and obesity were:
1. Locale2. Family Size3. Wealth Quintile4. Household Type5. Parents’ Educational Status6. Mother’s Working Status7. Participation in Newborn Screening8. Participation in Deworming
• Children who were not dewormed are more prone to having intestinal parasitic infectionswhich had been associated with micronutrient deficiencies and changes in gut microbiota and mucosa.
• Both micronutrient deficiencies and gut microbiota had been related to higher risk of obesity.
(Source: Church et al., 2013)
• Among pre-schoolers, the individual factors associated with overweight and obesity were:
Type of Birth Delivery
Child’s Birth Size
Presence of Stunting
• Results of logistic regression showed that carbohydrate, protein, total sugar intakes were not associated to the prevalence of overweight among infants.
• Among toddlers, the odds of being overweight decreases by 0.02 (p=0.013) as total sugar intake increases.
• As for pre-schoolers, as total fat intake increases by 1 gram the likelihood of becoming overweight increases by 2%.
• This finding corroborates with the findings of a previous study that energy from fat was the only macronutrient that was identified as significant predictor of body fatness among children where a significant trend for increasing fatness is observed as fat intake increased(Source: Mcgloin et al., 2002)
The predictor of overweight/obesity among infants is nutritional status while among toddlers and pre-schoolers the common predictors are urbanity, wealth quintile, mother’s working status, type of delivery, birth size, and household type.
Additionally, other predictor among toddlers is Vitamin A supplementation while among pre-schoolers are family size, deworming, and nutritional status.
Overweight and obesity among infants is predicted by individual factor while among toddlers and pre-schoolers, the factors are dominated by environmental factors.
This study showed stunting was the only factor which predicted overweight/ obesity among infants.
The predictors of overweight and obesity among toddlers and pre-schoolers are more on environmental factors: locale, wealth quintile, household type, mother’s working status, type of delivery, and birth size.
Additionally, Vitamin A supplementation and total sugar intake were unique determinants for toddlers.
On the other hand, family size, deworming participation, and total fat intake were unique among pre-schoolers.
DOST Compound, Gen. Santos Ave., Bicutan, Taguig City, Metro Manila, PhilippinesTel Nos.: (632) 837-2071 to 81 local 2296; 839-1843; 839-1846│Telefax No.: (632) 837-2934
Website: http://www.fnri.dost.gov.ph│ E-nutrition: http://enutrition.fnri.dost.gov.ph
Department of Science and Technology - Food and Nutrition Research Institute
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