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.

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Department of Science and Technology - Food and Nutrition Research Institute

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