Journal of Health Research and Reviews (in Developing Countries)

REVIEW ARTICLE
Year
: 2018  |  Volume : 5  |  Issue : 3  |  Page : 111--116

Obesogenic factors influencing overweight among Asian children and youth


Iza Donna Ramos Togbo 
 Medical Specialists and Diagnostic Center, Philippine Women's University, Manila, Philippines

Correspondence Address:
Ms. Iza Donna Ramos Togbo
Medical Specialists and Diagnostic Center, Philippine Women's University, 1743 Taft Avenue, Manila
Philippines

Abstract

Obesity is a public health dilemma worldwide. The prevalence of childhood obesity is increasing tremendously in the world. Overweight children and youth are probable to develop diseases in the later years. This study described the obesogenic factors influencing overweight among Asian children and youth. The study also determined the association of these factors to children and youth weight status. This narrative review obtained thirty-four pertinent articles published between 2010 and 2018. The data were extracted from Google Scholar, EBSCO, and PubMed. Numerous reviewed articles identified obesogenic factors influencing overweight among Asian children and youth as follows: familial factors, food retail environment, Westernization, food advertisement, and unhealthy food choices in school. Familial factors comprise parenting style and socioeconomic status. Food retail environment results were gathered from Thailand, China, Philippines, Saudi Arabia, and Korea. The effect of Westernization was seen in four cities of India and China. Influences of food advertisement were studied in Korea, Thailand, Singapore, and Malaysia. Unhealthy food choices in school were evident in South Asia, China, India, and Malaysia. These five factors are considered and an appropriate health program must be established to address this health problem.



How to cite this article:
Togbo ID. Obesogenic factors influencing overweight among Asian children and youth.J Health Res Rev 2018;5:111-116


How to cite this URL:
Togbo ID. Obesogenic factors influencing overweight among Asian children and youth. J Health Res Rev [serial online] 2018 [cited 2019 Feb 18 ];5:111-116
Available from: http://www.jhrr.org/text.asp?2018/5/3/111/248446


Full Text

 Introduction



Globally, obesity has become an epidemic problem and has been tripled since 1975. In 2016, World Health Organization reported that 1.9 billion adults 18 years old and above were overweight while 650 million of them were obese. It was estimated that 39% were overweight and 13% were obese. More than 340 million were overweight and obese in children and adolescents aged 5-19 years old. 41 million estimate overweight and obese children under 5 years old. Overweight children under 5 years old were nearly half in Asia and Africa.[1] Obesity is a condition brought about by increase amounts of body fat, growth of excess body adiposity and a result of an energy imbalance.[1],[2],[3] Obesogenic pertains to a term that develops weight gain to every person of the country's population.[4],[5]

Childhood obesity is a public health threat worldwide. Overweight children are susceptible to obesity as they approach adulthood with a higher risk to develop heart ailments, chronic diseases and diabetes. Physical inactivity, unhealthy dietary pattern or both of these behaviors are the major causes associated to childhood obesity. Hence, it is essential to determine the possible sociodemographic factors related with overweight which enable to provide information as evidence for program development and implementation.[6]

In the past few decades, the overweight and obesity prevalence has risen in Asian countries. Thailand has the highest obesity rate while in India followed by the Philippines have the lowest obesity rate. Over 25% childhood obesity was evident in various developing countries. Studies showed an emerging obesity prevalence among children in China, India, Malaysia, Singapore and other countries in Asia. China is rapidly following the West in terms of obesity and overweight prevalence in just a short period of time. The obesity rate in big cities of China was about >20% among children aged 7–17 years.[7]

In Singapore, 22.5% were overweight among children aged 10–12 years while schoolchildren aged 7–9 years from urban areas of northeastern Thailand were overweight with 7.9%. In Indonesia, urban children aged 8–10 years were 17.8% in boys and 15.3% in girls. Children studying in private schools (24.9%) and in public schools (5.8%) were at greater risk to be overweight in Manila, Philippines. Moreover, the primary schoolchildren in Selangor, Malaysia were 7.8% overweight. In Kuala Lumpur, a study on 5,995 primary schoolchildren, between 7-10 years old revealed that the prevalence of overweight with boys (9.7%) and girls (7.1%). 21.8% were overweight among children aged 10–12 years in Kuala, Selangor. In Peninsular, Malaysia, a rising prevalence of overweight among school-age children from 20.7 % (2002) to 26.5% (2008).[6]

In Saudi Arabia, a research was conducted among 224 preschool children in Jeddah city in April and May 2006. The study showed that the prevalence of obesity was 9.2% in boys and 11.5% in girls. Similarly, the overall overweight prevalence among children aged 2-17 years old was 21% in Central region, 13.4% in Southwestern region and 20.1% in Northern region in 2012. Moreover, the obesity distribution was 9.3% in central, 6% in southwestern, and 9.1% in northern regions.[2]

This study described the unhealthy eating habits of overweight and obese Asian children and youth. The study also examined the familial factors, food retail environment, Westernization, food advertisement, and unhealthy food choices in school.

 Methods



The narrative review focus on the obesogenic factors in Asian countries. The articles were searched in the electronic databases including PubMed, Google Scholar, and EBSCO that encompassed about obesity, Westernization, food environment and unhealthy eating habits, and overweight. After thorough search of articles, 34 secondary sources were relevant related to the subject matter. This narrative approach contained studies from a content analysis, cross-sectional study, longitudinal study, cohort study, focus-group discussion, interviews, and review articles. The inclusion criteria for the selected articles were as follows: published articles from 2010 to 2018, English language articles, and studies interrelated to overweight among children and youth in Asian countries.

Major obesogenic factors and unhealthy eating habits

Unhealthy eating habits refer to failure in fulfilling the eating patterns that the body requires.[8],[9] Unhealthy eating habits may contribute to obesity.[10],[11] There are five major obesogenic factors influencing overweight among Asian children and youth [Table 1].{Table 1}

Familial factors (parenting style/improved socioeconomic status)

Family factors which include family meal habits and frequency of dining out had been correlated to child weight status while parenting style and sedentary activity with their physical activity and dietary behavior. In southern China, a study showed that family-level environmental factors were related to obesity among urban schoolchildren. It shows that the presence of grandparents as main carer influences child's weight. In China's one-child policy, grandparents tend to pamper their grandchildren particularly with food. In Japan, studies showed that children were preferably more healthy with their mothers as main carer.[12] In indonesia, obesity in children was higher in percentages with mothers who worked at the private sector (26.9%) compared with mothers who stayed at home (5.4%).[13]

Tung and Yeh (2013) study stated that there were three parenting styles such as authoritative, authoritarian, and permissive. Authoritative parenting style allows fair reasons of rules that the child should follow but supportive to child's needs and autonomy. Authoritarian parenting style emphasizes the significance of obedience, parental guidance, and respecting the authority. Permissive parenting style refers to the reverse part of an authoritarian parent. In 2008, parenting style and childfeeding practices in relation to weight status had been studied among 465 parent–child pairs on the second and fourth primary schoolchildren in Taiwan. Child's weight status was measured and monitored in 2008 and 2009 by a trained school nurse. In 2009, results showed that parenting style and feeding practices such as controlling and monitoring of mother on child's weight associated to children's overweight status. Studies in 2009 showed that an authoritative parent with more concern on child's weight was a significant determinant on child's overweight status. However, children with an authoritative mother were not prone to be overweight if the mother monitors their children's food intake. In 2009, an authoritarian mother with concern on children's weight status was an insignificant determinant on child's overweight status. Furthermore, monitoring was correlated to child's higher chance of being overweight. Finally, perceiving child's weight status in 2008 was a significant determinant on overweight child in 2009 with a less permissive parent. A concern permissive mother after controlling child's weight in 2008 was a significant determinant on child's weight status in 2009.[14]

Kubota and Nagai reviews concluded that childhood obesity was common in developed countries such as Japan and Korea from families with low socioeconomic status. It was also common in families with high socioeconomic status in developing countries such as China, Indonesia, Malaysia, Sri Lanka and Vietnam.[15]

In Korea, a study found that a higher prevalence of obesity and overweight was evident in children with low socioeconomic status. Additionally, a decline of obesity prevalence from a high-income families.[16] Ngan et al. study indicated that children with high maternal income, educational attainment, and physical inactivity had an increase probability to be obese and overweight in Haiphong city, Vietnam.[17] In Sylhet, Bangladesh, a study revealed that obesity and overweight were highest among schoolchildren from middle- and high-income families.[18]

Food retail environment

In Southeast Asia, Thailand became prominent because of its fast growth in food retail outlets which dominated the market industry. However, obesity in Thailand had risen as the occurrence of food retail environment.[19]

In China, the rapid growth of fast-food restaurant became popular to children and was correlated to children obesity. For the next 3 to 4 years, McDonald's outlets will be doubled to 2,000 in 2015. In 1992, Kentucky Fried Chicken (KFC) had 10 outlets with an increase to 2,500 in 2009. These food outlets in urban areas contributed to adolescents' susceptibility with obesity promoting food.[20]

Childhood overweight among Asians was associated with their dietary behaviors such as fast-food consumption, excessive meat, and sweetened beverages. Filipino youth gained their one third of calories from outdoor hawker stalls and patronizing take-out food with 39.7 % (1994) and 38.5% (2002) as revealed in the Cebu Longitudinal Health and Nutrition Survey in the Philippines.[21]

Both obese and normal weight Saudi children were reported to have an increased frequency of fast food consumption whereas weekly fast food consumption of obese children were substantially higher.[22] Likewise, obese children frequently consumed fast food and drink soda according to Lee et al. observations in Korea.[23]

Westernization

Sugar was originated in India and a well-known sweetener worldwide. Indians were fond consuming Indian produced sweets with sugar-sweetened beverage and Westernized sugar-loaded food products that contains large amounts of fat and sugar. In 2013, a total of 1800 schoolchildren and adolescents between 9-18 years old and their mothers were studied in four cities of India such as Agra, Bangalore, Delhi and Pune. The results revealed overconsumption of sweetened food products. Moreover, findings showed that children's food consumption was influenced by “fashion” for Westernized foods, peer pressure, and television advertisements. Furthermore, calorie consumption and obesity were strongly associated.[24]

In Delhi, India, the association of Westernization and obesity were studied among the 8th and 10th grade. The study showed that health behaviors such as physical activity, sedentary lifestyle and dietary behavior contribute to obesity. Unfortunately, studies observed that Westernization has no direct association to obesity. Nevertheless, adaptation of students to Western living influences their physical activity, dietary behaviors and sedentary lifestyle which put them at greater risk to obesity.[25]

In China, Westernized fast-food outlets have been increasing rampantly. Fast food becomes accessible and affordable to children. Chinese children likely to eat at KFC than its other US counterparts as reported on a cross-cultural study. Moreover, children consumed more Western fast food as their age increased. The prevalence of fast-food consumption in young children was unchangeable.[26] Zhao et al. study reported that almost 50% of students had consumed 51.9% Western fast food and/or 43.6% Chinese fast food at least one time a week for the past 3 months in mega cities (Shanghai, Nanjing, Xi'an, and Beijing) in China.[27]

Food advertisement

Television food advertising had been a useful element to influence the young children on their food preferences. Singaporean children had been vulnerable to the marketing strategy of unhealthy food advertisements which contributed to the obesogenic environment. In 2007, food groups screened the food advertisement during 98 h of children's television program. The study showed that 34% of most frequently advertised foods were candy and confectionery. The next most frequently advertised foods were retail foods and milk with 26% and 14%, while the 45% was for fast-food advertisements. The remaining 1.2% was use for free gifts advertisements.[28]

In Malaysia, the noncore foods were the predominant advertisements on the Malaysian TV channels which highly exposed the children as the study conducted from November 2012 to August 2013. Multinational companies in Malaysia advertised sugar-filled drinks in high proportions in TV channels. The proliferation of sugar-sweetened beverages was also common in some Asia-Pacific countries, India and Spain.[29] In Thailand, free TV and digital TV channels advertised noncore foods as majority food products. Free TV channels predominantly advertised sugar-sweetened beverages while formula milk for infant and toddler were shown on digital TV channels.[30]

In 2008, 403 Korean television advertisements were studied in terms on their persuasive appeals, health-related presentation manner and food types. Results showed that the advertising messages stressing emotional appeals and sensory which yearns children in an unhealthy foods consumptions. Hence, food marketers give minimal health information in the advertisement. Among 11 product categories, the most frequently advertised were soft drinks, coffee and tea with 22.6%, family restaurants and fast food with 16.6%; candies, sweets, snacks, and desserts with 15.9%; convenience and prepared foods with 9.9%; dairy foods with 8.7%; and fruit and vegetable juice with 7.2%, and the least frequently advertised were fish, meat, and poultry with 1.0%.[31]

Unhealthy food choices in school

In the last two decades, South Asian countries had undergone a tremendous economic development resulted to food systems, economic and social transformation. The increment of income levels leads to a nutrition transition from a traditional low-fat diet and high carbohydrates toward a higher consumption of saturated fat, salt, sugar, and diets with a lower carbohydrates. Children spend more time of their day in school which tend them to buy junk food and oily snacks from school canteen that were cheaper and delicious in most cities in South Asia. This signifies that they are not interested or lack of time for physical fitness and exercise.[32]

In Xi'an City, China, a study among adolescents reported that school environment factors which include school curricula, schools' fast food outlets and soft drinks availability were related with results of students' body mass index (BMI). Moreover, Western fast-food outlets in school vicinity, soft drink availability at school convenience store, less frequency of sports meeting, lack of morning and recess exercise were all related to students' BMI.[20]

In Kolkata, India, a study revealed that 17.63% were overweight and 5.1% were obese among school girls. The children's overweight rates from Chennai and Punjab were 15.8% and 14.3% while 7.4 % in Delhi, India. The English speaking schoolchildren have a high prevalence of overweight in Wardha City, Central India (9.7%) and other schools (3.7%). The high frequency of obesity and overweight in the study was a result of their food consumption habit and lack of awareness. These findings showed that students were not easily convinced to involve in physical activities. Students mostly consumed between meals, cold beverages, ice cream and fast food. Obesity was also evident among schoolchildren of Davangere city. High-energy junk foods taken as snacks by schoolchildren were contributing factors of obesity among Davangere and English medium schoolchildren.[33]

In Kelantan, Malaysia, Rosmawati et al. studies revealed that the most types of food sold in sixteen primary school canteen were food high in carbohydrates (72.5%), fat (38.4%), protein (30.8%), food products with added sugar (13.3%), fruits (3.6%), and milk products (3.5%). Junk foods and candies are the usual forbidden foods. These types of food that were easily accessible to children increases the probability of obesity and overweight.[34]

Furthermore, it has been observed and evidently shown from the multiple reviewed articles that overweight and obesity were growing rapidly. Numerous published articles identified the factors associated with overweight and obesity in Asian countries. However, findings on the prevalence of overweight and obesity were not generally specified in an urban or rural location and do not represent the entire population of a certain Asian country.

Conceptual framework

This study primarily described the children and youth's unhealthy eating habits related to their weight status. The study also looks on the relationship of these factors to children and youth's unhealthy eating habits [Figure 1].{Figure 1}

 Discussion



The Asian children and youth's unhealthy eating habits resulted to weight gain. The findings revealed a significant association to the five major obesogenic factors that contributed to their unhealthy eating habits.

The findings showed that familial factors influence children and youth's unhealthy eating habits. Apparently, grandchildren were pampered by their grandparents as their carer influences to child's food intake and weight gain in China.[12] A working mother[13] and parenting style[14] also affect the children's weight status. In developing countries, childhood obesity was common in families with high socioeconomic status such as Sri Lanka, China, Indonesia, Vietnam, Malaysia,[15] and Bangladesh.[18]

The result found that food retail environment influences children and youth's unhealthy eating habits. The fast-food restaurants rapidly became popular in Asian countries. Fast-food restaurants had caused obesity immensely among children and youth.[19],[20],[21],[22],[23] The Asian children and youth adapted the Western way of eating habits that contributed to the risk of overweight.[24],[25],[26],[27]

Moreover, children's unhealthy food preferences were strongly influenced by food advertisements in Singapore, Malaysia, Thailand, and Korea. The most advertised food products contain sugar.[28],[29],[30],[31] Unhealthy food choices influence schoolchildren and youth's dietary pattern. During school days, children and youth students tend to buy available foods in school canteen and nearby food stores.[20],[32] Fast-food outlet, oily snacks, and junk foods are some food choices that contribute to children's overweight and obesity.[20],[32],[33],[34]

 Conclusions



Obesity is a public health problem that affects the global population. The obesity prevalence is increasing rapidly in Asian countries. Obesity has a long-term effect on children and youth's health and well-being. Overweight children and youth are at a higher risk to develop diseases such as diabetes, cardiovascular disease, and musculoskeletal problem in the future. There are multiple obesogenic factors that influence children and youth's food consumption. These factors are familial factors, food retail environment, Westernization, food advertisement and unhealthy food choices in the school. These obesogenic factors appeared to influence the weight of children and youth. Furthermore, all of these factors are considered. Global and national health programs must be established to continually monitor and properly take a health problems solution.

Acknowledgment

The author would like to express her gratitude to the professors of Master of Health Social Science, De La Salle University-Manila, Philippines.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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