Children and Adolescents Obesity: Risk Factors and Primary Prevention Strategies in China

7/31/2019 Children and Adolescents Obesity: Risk Factors and Primary Prevention Strategies in China

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Children and Adolescents Obesity

Risk Factors and Primary Prevention Strategies in China

Yeling Zhao, B Pharm, MPH

Department of Public Health, University of Sydney

[email protected]


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Children and Adolescents Obesity: Risk Factors and Primary Prevention Strategies in China

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Background

An increasingly sedentary lifestyle and rapidly changing dietary practices have

brought about a dramatic increase in prevalence of obesity, which has been

recognized as an important public health problem all over the world [1-4]. Accordingto World Health Organization (WHO), in 2010, approximately 40 million children

were overweight globally. Nearly 35 million of them are living in developing

countries, because they are more vulnerable to energy imbalanced diet and low levels

of physical activity [5]. During the period from 1985 to 2005, it was estimated that the

prevalence of overweight and obesity in China, among 7 to 18 years old children, has

increased from 0.93% and 1.62% to 14.9% and 8.9%, for boys and girls, respectively

[6].

Obesity has significant consequences for morbidity, disability and quality of life. It

has been presented as an important risk factor for some non-communicable diseases,such as cardiovascular diseases (mainly heart disease and stroke), diabetes and some

cancers (endometrial, breast and colon) [5, 7]. Obesity in childhood could result in a

higher chance of obesity, disability and premature death in adulthood. Moreover,

childhood obesity could increase the risks of breathing difficulties, fractures,

hypertension, as well as early markers of cardiovascular disease, insulin resistance [5].

Furthermore, childhood obesity also has psychological consequences obese children

are more predispose to have higher levels of anxiety, depression, and low self-esteem

as well [8, 9].

Risk Factors for Childhood Obesity

A number of risk factors contribute to the high prevalence of overweight and obesity

among children and adolescents in China, ranging from behavioral to

socio-economical, as well as cultural and political determinants.

Behavioral Risk Factors

Lots of research [2, 5, 7, 10, 11] has shown that behavioral factors, such as

insufficient physical activity, a sedentary lifestyle, eating behaviors and inadequatesleep time etc., are associated with overweight and obesity.

Table 1 [12] illustrates the prevalence of some major behavioral risk factors among

school age children (6 - 18) in Beijing, the capital city of China, in 2010. Although it

is recommended that students should do moderate or vigorous physical activity for at

least one hour every day, approximately 80% of those school age children cannot

meet the recommendation. Sedentary lifestyles are another serious issue and related to

overweight and obesity in Chinese students. More than 44% school age children spent

at least two hours per day to use computer, play video games or watch TV. In terms of

eating behaviors, frequent consumption of western fast food and snacks could the


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contributing factors for weight gain as well. The prevalence of eating behaviors for

consumption of snack and western fast food are 32.0% and 3.7%, respectively.

Finally, lack of sleep in childhood could increase the long-term risk in overweight and

obesity [10, 11]. Based on the US National Sleep Foundation recommendation [13],

school age children (5 -12 years old) need 10-11 hours of sleep, those aged 13-18need at least 8.5 hours. However, only one quarter of students have the sufficient

hours of sleep.

Socio-economical Risk Factors

In contrast to most developed countries, whose socioeconomic status (SES) varies

inversely with overweight and obesity [14], children and adolescents in high SES

level have higher prevalence of overweight and obesity than those who are in lower

SES level [15, 16]. China, as the biggest developing country in the world, has the

same situation [17].

Table 2 [17] provides gender-specific information about the prevalence of overweight

and obesity among children aged 7-18, according to local school area SES and urban

versus rural residency in China in 2005. The risk of child and adolescent obesity is

much greater in high SES areas compared with those in low and intermediate SES

areas. In addition, urban residency comprises a doubled share of overweight and

obesity compared with rural residency. Thus,itappearsthat thosepeopleliving

inurbanareaswithahighsocioeconomicstatusareatgreaterriskofoverweight

andobesitythanthoseinpoorer,ruralareas.

Cultural and Political Risk Factors

In the traditional cultural, Chinese people hold the beliefs that fatness is a sign of

happiness and prosperity [18]. Moreover, the cultural basis for son preference also

could result in the overweight and obesity for boys, since they are likely to enjoy

more of the familys resources. This can be testified from the data of Table 2 no

matter in which category, the prevalence of overweight and obesity is much higher for

boys than those in girls. However, these traditional beliefs have not kept pace with the

development of socioeconomic, which have contributed to a more food demand andthe potential for over consumption and energy imbalance [18].

In addition, due to the one child policy in China, a single child, especially a boy, is

likely to be spoiled by both parents and grandparents, which could lead to the

overfeeding of children [19].

Primary Prevention Strategies

Childhood and adolescent overweight and obesity have been recognized as an

increasing health problem worldwide. Primary prevention plays a significant role in


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our effort to address obesity, and needs to be of high priority [20]. This is not only

because the short-term and long-term effects of both medical and psychological, but

also because:

Children are the population group most vulnerable to the environment and gainmost from intervention efforts [20].

Obesity, once established, is difficult to reverse and treat [7, 21].The author of this paper separate the prevention program in terms of school-based and

community-based, details as followed:

School-Based Prevention

Most school-based interventions focus on changing unhealthy behaviors for school

aged children, including [22-25]:

increase physical activity through structured physical fitness classes,decrease sedentary behavior and increase sleep time through pamphlets and

lectures,

deliver nutritional education, modification of food being provided by schoolcanteens, change in diet (such as reducing the intake of high caloric food ).

According to the review conducted by Consuelo et al. [26], the duration of

school-based prevention program is in direct proportion to its effectiveness. Thus,

long-running strategies for preventing and managing childhood and adolescents

overweight and obesity should be taken into consideration by school principals and

policymakers. A successful example of school-based prevention in China is a 3-year

obesity intervention conducted by Capital Institute of Pediatrics in Beijing [27],

where students and their parents were involved in a program of nutrition education

and physical activity to increase awareness and change their unhealthy lifestyle. An

unsuccessful example of this intervention is a nutrition-based comprehensive

intervention study on childhood obesity in China [28]. It was conducted in six schools

located in six cities from the beginning of 2009. However, due to the outbreak of

H1N1 in the second half year of 2009, many schools refused the researchers of the

study to enter schools; therefore, the intervention implementation had to be suspended.

Hence, the appreciation and cooperation from school staff are of crucial importance inthis situation.

However, due to the limitation of educational resources and a large population in

China, the competition in study is relatively high. As a result, an increasing pressure

on students to preform in academic has caused a decreased emphasis on physical

activity in school; therefore, a further decline in physical activity and increase in

sedentary behavior [2]. Based on this situation, more amendment and cooperation in

Chinese education system are need, which could contribute to improving either

childrens health or overall well-being [12].


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Community-Based Prevention

Most community-based interventions are aimed either at reducing the behavioral

determinants, or at reducing the socioeconomic and cultural-political risk factors. The

target population of this intervention, therefore, is children and adolescents, as well astheir parents and grandparents, especially those in high SES areas and urban areas. A

national media campaign and educational program, which aimed at providing useful

information to reduce the incidence of childhood obesity, could be one of the most

cost-effective interventions. The information offered from those campaigns should

cover not only the modification of unhealthy lifestyle, but also:

fatness is not a sign of happiness and prosperitydo not spoil children, even he or she is the only child in the family.

This campaign could include pamphlets and brochures available at maternity hospital,poster, TV programs, websites, and guidelines from health professionals. Cooperation

between health sectors, community and government service could contribute to this

campaign. In return, this campaign would benefit the modification of unhealthy

lifestyle among children and adolescents.

Unfortunately, few studies or reviews about socio-economical or cultural-political

interventions were found in China. This is probably because the relations

between SES risk factors and childhood obesity are complex and not fully understood

[30]; and the one child policy is still a sensitive political topic, hence few study is

focused on this part of intervention.

Summary

This paper explores the prevalence and consequences of childhood and adolescent

overweight and obesity. Then, lists the social determinants related to gaining weight

in school age children. Based on those risk factors, primary prevention strategies,

which aimed at reducing the rate of obesity in young people, are provided. Success of

the interventions requires appreciation and cooperation not only from each

stakeholders, but also from the Chinese education system. In addition, without thecombination and cooperation of the school-based and community-based programs,

hardly could we reduce the incidence of obesity of Chinese children and

adolescences.


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Children and Adolescents Obesity: Risk Factors and Primary Prevention Strategies in China