Prevalence of obesity in Maltese children aged 5 and 9 years

Abstract

Reason for research: The steady increase in body weight noted in many developed countries over the last decades has also been noted in the Maltese population. As a result of childhood obesity, an increased burden at all levels of the healthcare system will occur. This study aims to assess by means of an epidemiological investigation of a representative random sample of Maltese schoolchildren aged 5 and 9 years: • The current prevalence of obesity in Maltese children in a given sample and relate it to other developed countries. • The risk factors which may be associated with the development of childhood obesity. Methodology: This study was carried out on a random sample of a total of 431 children: 220 males (51.1 %) and 211 females (48.9%) representative of the target population. Body Mass Index (BMI) and waist circumference were measured from the study population. On calculation of the BMI, the school children were divided into three groups: lean, overweight and obese using the International Obesity Task Force (IOTF) classification (Cole T.J. et aI, 2000). A validated questionnaire was distributed to the children included in the sample population. The questionnaire was filled out by the parents and assessed child lifestyle characteristics including physical activity, nutrition, family general characteristics and birth weight. Both the anthropometric measurements and the variables assessed in the questionnaire were analysed to examine for any possible associations. Results: The prevalence of childhood overweight / obesity in the five year old children was 28.8% for boys and 32.7% for girls while the prevalence rates for the 9 year olds was 48.9% for boys and 45.1 % for girls. Inter-relationships were found between a history of metabolic disease in parents and obesity in the corresponding children. A statistically significant relationship was found between a history of a lack of breast feeding and obesity in the 5 year old children [p=0.04]. Statistically significant observations between birth weight [p=0.002], anthropomorphic measures [p=0.0l] and physical activity [p=0.002] were noted. Certain observations were also found between physical activity and corresponding obesity in both age groups, as were statistically significant relationships between diet and childhood obesity especially in the nine year olds. The overweight/obese nine year children consumed less fruit juice, milk whole fat and flavoured milk [p=0.03, p=0.004, p=0.03] respectively as compared to their lean counterparts. Discussion: The increase of prevalence of overweight and obese children especially in the nine year olds has reached alarming rates. The 'U' odds-risk pattern described in previous studies as the thrifty phenotype hypothesis of obesity was noted in this study. Here the nine year olds born in both the low [<2500g] and high birth weight [>4000g] groups showed to have higher anthropomorphic measures as compared to the children who were born of a normal birth weight [2500-3900g]. Obese children could be spending more time performing passive activities instead of sleeping. It was also noted that the obese nine year olds were deliberately restricting the consumption of energy dense food in order to control weight. Conclusion: The family physician is ideally placed to directly help reduce the impact of childhood obesity on the eventual health of the individual and indirectly reduce the demands placed on the health services. Childhood obesity has to be monitored more closely by the family physician especially with children exhibiting risk factors to becoming obese. These include children born of a low and high birth weights, lack of breast feeding, and a history of metabolic syndrome in the parents.