Prevalence Of Childhood Obesity In Europe And Its Associated Risk Factors: Systematic Literature Review

Prevalence of Childhood Obesity in Europe and its associated risk factors: Systematic Literature Review

Objective: The need to put emphasis and be aware of obesity prevalence in Europe based population and several associated risk factors towards childhood obesity, conduct a systematic literature review on the prevalence of childhood obesity in Europe, there can assimilate to ratios of certain cases among the European countries, the testing done within the population and to recognize and be aware of childhood obesity within its associated risk factors.

Methods: Collation of search strategies applies here, this pertains to various journals and articles in bringing prevalence and some risks factors of childhood obesity found and studied in Europe. For instance, journals such as journal of public health and international journal of obesity will e a part of this systematic literature review. Study parameters will be about 15 years study up to the present time frame. Most importantly, these materials have to account to prevalence and risks factors involved for obesity among children and young people in Europe, to attain success in the systematic review. Aside, the journal name and title, author, year of study, year of publication, associated risk factors and the prevalence rate, which was expressed in percentage, are being extracted. The quality assessment engaged the utilization of the sample size (A> 5000, B = 1000- 5000, C < 1000) and a modified eight point quality rating system published by the US department of Health and Human Resources, Agency For Healthcare Research and Quality (2003). The checklist included; Study question, study population, comparability of subjects, and exposure to intervention, outcome measurement, statistical analysis, results, and discussion. Each point was scored and rescaled to 100 for clarity with 100 representing the highest score as the two methods were adopted because of the differences in the populations and settings from which the results of the studies were obtained.

Results: There was a total of 16-18 research journals/articles being reviewed in organized manner, there provided prevalence of childhood obesity it was with 16 research papers presenting research findings in such statistical implied rates towards the prevalence of obesity in countries found in Europe such as UK, France, Cyprus, Norway and others meanwhile, the rest of the papers have noted estimates of the prevalence but, all of the presented papers have accompany to the prevalence and some factors associated for childhood obesity study and occurrence. The prevalence of childhood obesity in Europe varies predominantly both on boys and girls affected by obese situation notably about 44 percent from expected percentage assumption. Childhood obesity is ideally linked as well as noted among children ages 6 years old and above. Thus, several of the risk factors for childhood obesity do include gender, age, family, body weight, socio-economic status, school and eating habits and some other related factors that are at risk when considering obesity found in childhood.

Conclusions: The informative knowledge and data gathered was in supporting stature to previous but recently posted studies, showing Europe grounds and the predominance of obesity cases in children and young people.

KEY WORDS: Prevalence of Childhood Obesity, Europe, risks factors

INTRODUCTION

Childhood obesity has reached prevalence levels in developed countries as there were about 70 % of obese adolescents grow up to become obese adults (Nicklas TA, T. B, K.W. C, 2001; Parsons, Power, Logan and Summerbell, 1999; Whitaker, Wright, Pepe, Seidel and Dietz, 1997). Another, in the year 1998, The World Health Organization project monitoring of cardiovascular diseases (MONICA) reported Iran as one of the seven countries with the highest prevalence of childhood obesity. The prevalence of BMI as noted in percentage between 85th and 95th percentile in girls was significantly higher than that in boys (10.7, SD = 1.1 vs. 7.4, SD = 0.9). The same pattern was seen for the prevalence of BMI > 95th percentile (2.9, SD = 0.1 vs. 1.9, SD = 0.1) (Kelishadi, Pour, Sarraf-Zadegan, Sadry, Ansari, Alikhassy and Bashardoust, 2003). Thus, in certain European countries such as the Scandinavian countries the prevalence of childhood obesity is lower as compared with Mediterranean countries; nonetheless, the proportion of obese children is rising in both cases (Livingstone, 2001). Henceforth, highest prevalence rates of childhood obesity have been observed in developed countries, however, its prevalence is increasing in developing countries as well. The prevalence of childhood obesity is high in the Middle East, Central and Eastern Europe (James, 2004).

METHOD

The core effectiveness of systematic literature review is to guide in careful assessment and analysis of the 16 studies on the prevalence of childhood obesity across Europe, within ratios on the relevant cases among basis towards the population as tested such as in the UK and other EU countries as well as the studying of associated risk factors towards childhood obesity. There was an interim Google scholar search as found linking to the journal of international obesity, journal of public health and others by means of the keywords as noted as Prevalence AND childhood obesity AND Europe. Search strategies involved search databases of acquiring articles and journals 15 years old up to the present era ideally from around 1995 to 1996 up to this year, 2009 at around 25 articles are known at but some of it was rejected due to methods used and the type of research undertaken. For this one, there will be focus on SURVEY only in order to allow good comparison to happen and present precisely the literature review in a systematic manner (see tables for concrete details of the review). Further, several articles/journals for the systematic review was investigated on Science direct, Elsevier, BMJ, oxford journals, Obesity research databases and useful extracts put together by academic notion. Thus, studies reporting childhood obesity and its prevalence in English tenets and some indirect English were allowed, studies indicating prevalence of overweight and prevalence of obesity ratios, only the prevalence of obesity information have been retrieved. Agreeing that primary and secondary publications are duly accountable for the selection of papers used, should center towards European countries of childhood obesity prevalence and its risks factors as being put into consideration to amiably relate data on childhood obesity prevalence. Thus, research materials reporting childhood obesity prevalence based on descriptive, cohort study was not included as a possible reference. There was about one to three research studies happened in the same EU country even as a comparative option. Another engine search support through prevalence AND risk factors AND childhood obesity AND Europe did recognise about 35 studies with just 12 as related one, being present from interim research review.

RESEARCH QUESTIONS

A) WHAT ARE THE PREVALENCE OF OBESITY AMONG CHILDREN AND YOUNG PEOPLE IN EUROPE?

B) WHAT ARE THE RISK FACTORS ASSOCIATED WITH THE PREVALENCE OF OBESITY AMONG CHILDREN AND YOUNG PEOPLE IN EUROPE?

FINDINGS

Availability of Information

Sixteen journals/articles reviewed and critiqued, six to ten articles denote certain risk factors of childhood obesity within European countries namely, Cyprus, England, France, Germany, Greece, Netherlands, Norway, Switzerland as well as UK presenting in surveys and cross section based analysis in comprehensive encounter of several studies as part of preliminary literature review. The studies presented have effective research paradigm and spontaneity of research methods and findings provide appropriate basis of childhood obesity found within EU based populations. There is ample amount of critical thinking as there found good reasoning and reflective, rational thinking based on systematic literature knowledge and there were enough analysis of the available information and ideas.

Salient article/journal information is being shown in table below.

TABLE 1 Units of analysis

STUDY

TITLE

AUTHORS

JOURNAL

PUBLICATION YEAR.

STUDY 1

Prevalence and determinants of obesity in Spanish children and young people.

Serra-Majem L,

British journal of nutrition

2006

STUDY 2

Childhood obesity and elevated blood pressure in the rural population of northern Greece.

Mavrakanas T A

The international journal of rural and remote health research, education practice and policy.

2009

STUDY 3

Overweight and Obesity among adolescents in Norway: Cultural and Socio-economic differences.

Groholt E

Journal of Public Health

2008

STUDY 4

Dietary Habits, Physical activity and Prevalence of Overweight/Obesity among adolescents in Greece: the Vyronas Study.

Kosti R I

International Medical Journal of Experimental and Clinical Research

2007

STUDY 5

Differences in Prevalence of Overweight and Stunting in 11-year olds across Europe: The Pro Children Study.

Yngve A

European Journal of Public Health.

2007

STUDY 6

Time Trend in Height, Weight and Obesity Prevalence in School Children from Northern France, 1992-2000.

Heude B

Diabetes and Metabolism

2003

STUDY 7

Prevalence of Obesity in Preschool Greek Children, in relation to Parental Characteristics and reigion of Residence.

Manios Y

BMC Public Health

2007

STUDY 8

Overweight and Obesity in 6-12 year old Children in Switzerland

Zimmermann M B

Swiss Medical weekly

2004

STUDY 9

Prevalence of Overweight and Obesity and trends in body mass index in Germany pre-school children, 1982-1997

Kalies H

International Journal of Obesity.

2002

STUDY 10

Prevalence of Overweight and Obesity in the Netherlands in 2003, compared to 1980 and 1997.

Hurk K

Achieves of Disease in Childhood

2007

STUDY 11

Ethnic group differences in Overweight and Obese Children and Young people in England: cross-sectional Survey.

Saxena S

Achieves of Disease in Childhood.

2004

STUDY 12

Overweight and Obesity Trends from 1974 to 2003 in English Children: What is the Socioeconomic factors?

Stamatakis E

Achieves of Disease in Childhood

2005

STUDY 13

Prevalence of Overweight and Obesity in Australian Children and Adolescents: Reassessment of 1985 and 1995 data against new standard international definitions.

Magarey A M

The Medical Journal of Australia

2001

STUDY 14

Prevalence and trends in Overweight and Obesity in three Cross Sectional studies of British Children, 1974-94

Chinn S

British Medical Journal

2001

STUDY 15

Prevalence of Overweight and Obesity among young people in Great Britain.

Jebb S A

Public Health Nutrition

2003

STUDY 16

Obesity in Children and Adolescents in Cyprus. Prevalence and Predisposing factors.

Savva S C

International Journal of Obesity

2002

There can be increase to obesity prevalence as noted mostly in the studies conducted in EU, Great Britain and England and that obesity prevalence is affecting mostly on children. For instance, study 8-11 have noted that the ‘prevalence of childhood obesity is increasing and are affecting not just UK, Britain, England but in almost all parts of EU region. Furthermore, studies have found only three fourths up to one half of obese children vary in age, gender and family as risk factors thus, perceived by some as overweight, and possesses school problems and issues towards eating habits.

In one study, the outcome have posted that prevalence of obesity were 11.8 % and 2.4 %, respectively, higher among boys, lower educational plans and poor family economy were both significantly associated with the obesity.

Title of study

Yr. of study

Prevalence (%)

RESPONSE RATE. %

95% CI & p -value

Method/Type of study

Study population

Region/location of recruitment

Sample size

Statistical Test used

Country of study

BMI

STUDY 1 [Serra-Majem L,]

1998 and 2000

13.9

95% CI = (12.7, 15.1)

Cross-sectional

2 -13yrs

National ( Spanish population)

3534

SPSS

Spain

BMI = 97 percentile

STUDY 2 [Mavrakanas T A]

2007

Boys – 13.6

Girls – 14.4

95% CI for boys = 9.6-17.6

CI for girls = 10.3-18.5

4-10 yrs

Northern Greece

572

Greek

STUDY 3 [Groholt E ]

2000-2004

2.4

Mean response rate = 86.4

P<0.001 OR – 1.0

Survey (school – based)

15 -16yrs

Norway

15966

SPSS

Norway

STUDY 4

2004 -2005

Males – 4.4

Females – 1.7

Survey

12 – 17yrs

Vyronas region of Athens

2008

males – 1021

Females - 987

Multiple logistic regression.

SPSS

Greek

BMI> 30kg/m2

STUDY 5

*change prevalence to IOTF/ might want to make prev. total

2003

Girls –

Denmark – 1.1

The Netherlands – 1.1

Portugal – 5.3

Spain – 4.9

Boys –

Belgium – 2.2

Denmark – 3.0

Portugal - 10.7

Spain – 7.7

77.8

P<0.001

95% CI

Cross – sectional study (Questionnaire)

11yr olds

9 countries in Europe –Austria, Belgium, Denmark, Iceland, The Netherlands, Norway, Portugal, Spain, Sweden.

10519

Chi-square

Europe

STUDY 6

1992 and 2000

1992 – 1.6

2000 – 2.8

99.9

P = 0.12

Cross-sectional Surveys

5-12yrs

Northern France

1992 – 805

2000 - 607

Chi-square

Logistic multivariate regression model

SAS ( used in all analysis)

France

STUDY 7

2003-2004

Boys – 6.2

Girls – 8.1

P<0.001

Retrospective Cohort (questionnaire)

1-5yrs

Pre school children in Greek

2518

z-test

chi-square

multiple logistic regression analysis

Greek

STUDY 8

1960s and 1980s

Boys – 3.85

Girls – 3.72

76.4

Cross -Sectional

6-12yrs

Swiss primary school children

3413

Chi-square

Switzerland

STUDY 9

1982-1997

1982 – 1.8

1987 – 2.1

1992 – 2.5

1997 – 2.8

1997 Boys

5yrs – 3.1

6yrs – 2.9

1997 Girls

5yrs – 3.3

6yrs – 3.3

98.3

P<0.01

95%CI for 1982 – (1.3-2.3)

95%CI for1987 – (1.7-2.6)

95%CI for 1992 – (2.1-3.0)

95%CI for 1997 – (2.4-3.3)

95%CI for 1997 Boys, 5yrs – 2.8-3.3

6yrs – 2.7-3.0

95%CI for 1997 Girls, 5yrs – 3.0-3.6

6yrs – 3.1-3.4

Cross –Sectional

5-6yrs

Children entering school in Brvaria, Germany

16281

129881

Chi-square

Germany

STUDY 10

2002-2004

2003 Boys – 2.1-3.9

2003 Girls – 2.4-5.4

compare to 1980 and 1997

1980 Boys – 0.1-0.3

1997 Boys – 0.8-1.9

Girls

1980 – 0.4-0.8

1997 – 1.2-3.0

4-16yrs

Children living in the Netherlands

90071

Fitted distribution

The Netherlands

Study 11

1999

p<0.0001

Health Survey

2-20yrs

People living in private households in England

6648

Chi square

Multiple logistic regression

Stata

England

STUDY 12

1974-2003

Boys

1974 – 1.1

1994 - 1.6

1998-99 – 2.9

2002-03-4.6

Girls

1974 – 1.4

1994 – 2.9

1998-99 – 5.4

2002-03 – 6.8

95%CI for boys

1974 – 0.7-1.4

1994 – 1.1-2.1

1998-99-1.9-3.9

2002-03–3.7-5.6

95%CI for girls

1974 – 1.0-1.8

1994 – 2.2-3.6

1998-99-4.0-6.8

2002-03-5.6-8.0

p<0.0001

Health Survey

5-10yrs

White English Children

28601

Logistic regression

England

STUDY 13

1985 and 1995

1985

Boys -1.4

Girls-1.2

1995

Boys- 4.5

Girls – 5.3

100

95%CI, 2.51-4.29

1985 – Australian health and fitness Survey

1995 – National Nutrition Survey.

1985 – 7-15yrs

1995 – 2-18yrs

Australian School Children.

1985 – 8492

1995 - 3007

Stata

Australia

STUDY 14

1974-94

1974-1994

Eng.boys-1.4-1.7

Eng.girls-1.5-2.6

Scot.boys-1.7-2.1

Scot.girls-1.9-3.2

95%CI for Eng. boys – 0.6-1.7

95%CI for Eng. Girls - 0.6-2.1

95%CI for Scot.boys-0.5-2.0

95%CI for Scot.girls-0.5-2.4

Cross Sectional Survey

4-11yrs

Primary Schools in England and Scotland

England – 20151

Scotland - 10604

Logistic Regression

Test of interaction

England

STUDY 15

1997

4.0

P<0.001

Cross Sectional Analysis ( interview by an investigator-led questionnaire)

4-18yrs

Households

2672

Multiple logistic regression

Chi square

Great Britain

STUDY 16

1999-2000

Males- 6.9

Females -5.7

P<0.001

Cross Sectional survey (questionnaire)

6-17yrs

Public elementary and secondary schools in Cyprus

2600

Logistic regression

Chi-square test.

Cyprus

Table 2: Table showing evidences of childhood obesity and other salient aspects as found from sixteen articles/journals in form of highlighted headings as seen in the table above.

Several of journal/article studies presented has accounted to high obesity prevalence and risks factors not just found in Britain or UK but some of Europe’s neighbours such as United States. There comprised for about twenty percent of prevalence ratios such as those presented in England based study, affecting England based children signifying that certain excess weight may result and lead to obesity conditions. Notably, surveys are used to describe in technique of data collection in which questionnaires or interviews are used to gather data about an identified population. It can be used within many designs according to Burns & Grove (2001).

Quality assessment was done using the sample size (A> 5000, B = 1000- 5000, C < 1000) and a modified eight point quality rating system published by the US department of Health and Human Resources, Agency For Healthcare Research and Quality (2003). The checklist included; Study question, study population, comparability of subjects, and exposure to intervention, outcome measurement, statistical analysis, results, and discussion. Each point was scored and rescaled to 100 for clarity with 100 representing the highest score. These two methods were adopted because of the differences in the populations and settings from which the results of the studies were obtained.

Table 3: The quality assessment score for the presented research studies.

STUDY(yr of publication)

QUALITY ASSESSMENT SCORE (sample size)

QUALITY ASSESSMENT SCORE (checklist score)

Study 1

100 percent

Study 2

77 percent

Study 3

100 percent

Study 4

100 percent

Study 5

88 percent

Study 6

100 percent

Study 7

100 percent

Study 8

100 percent

Study 9

88 percent

Study 10

100 percent

Study 11

77 percent

Study 12

100 percent

Study 13

88 percent

Study 14

100 percent

Study 15

100 percent

Study 16

88 percent

A total of 44 papers were identified after applying the inclusion and exclusion criteria. The final 16 papers were selected based on papers containing risk factors associated with childhood obesity, refer to unit of analysis in table one. Thus, of the 16 journals selected and identified, more than ten of the papers were based on the prevalence studies of childhood obesity particular to EU countries such as Switzerland, Greece and United Kingdom. Two to three papers based on prevalence studies of childhood obesity and BMI also known as the body mass index as well as those caters to National Health and Nutrition Examination Survey (NHANES)

DISCUSSION

This study highlighted the increasing prevalence of childhood obesity particular on the EU countries. The respective contributions of dietary energy intake and patterns of physical activity to the aetiology of childhood obesity present confused and confusing picture into the risk factors. Changing demographic and social circumstances throughout Europe are linked to childhood obesity but it is highly unlikely that these interact in similar ways in the genesis of obesity in different individuals and population groups. Thus, presence of certain limited understanding of the variability in susceptibility to obesity in European children and adolescents provides powerful justification for the development of preventive strategies which are population based rather than selectively targeted at high-risk children. Research accounts for the estimation of the prevalence in child obesity in Europe is severely hampered by methodological problems in the definition of obesity and the paucity of data sets that mirror the demographic, cultural and socioeconomic composition of the European population. The available cross-sectional data, however imperfect, suggest that there are complex patterns in prevalence which vary with time, age, sex and geographical region. Overall, the prevalence of obesity in young children is relatively low compared to adolescents. Gender differences in prevalence are inconsistent. The highest rates of obesity are observed in eastern and southern European countries and even within countries there may be marked variability in the rates of obesity. It is not clear whether prevalence of child obesity are a simple consequence of an overall increase in fatness in Europe or whether there may be sub-groups of children who, at certain ages, are either particularly susceptible to environmental challenges or are selectively exposed to such challenges.

RISK FACTORS FROM VARIOUS STUDIES

STUDY

Risk 1

Risk 2

Risk 3

Risk 4

Risk 5

Risk 6

personal data

education

sociodemographic factors, sex, age group, region, size of locality of residence, mother’s level of education and family SES level

family, dietary assessment

anthropometric measurements

physical activity

Health conditions

(elevated blood pressure)

Health conditions

(low cardiovascular risk)

primary clinical care setting

health education

patient treatment

Age, gender preferences

Lower educational plans

poor family economy

physical inactivity

Eating breakfast

dietary habits

some lifestyle characteristics

gender and age

consumption and the daily frequency of eating

reference population

Gender and age

Height-for-age

Weight-for-age

BMI-for-age

Age

Height

Weight

BMI

gender- and age- specific cut-offs

parental education level

parental body mass index

region

of residence

Parental demographic characteristics, such as age and educational level and parental

anthropometrical data, such as stature and body weight

adiposity

Height and weight

calculate body mass

index (BMI)

Triceps, biceps,

subscapular and suprailiac skin fold thickness

(SFT)

age or gender difference

time trends over the last 15 years

impact of ethnicity

Body mass index

international reference values

ethnicity and municipality size

Body Mass Index (BMI)

child health care system

age-related

distribution of BMI

pre-school intervention programs

ethnic

group

sex

cumulative risk of morbidity and mortality

cardiovascular disease

parental social class

household income

international body mass index (kg/m2) cut-offs

Socioeconomic status

household size

Gender and age

secular trends

Health professionals

BMI

Socio status

Mean weight for height increased in children in

the United Kingdom from 1984 to 1994

international obesity task force

health and growth

Confidence

Values

morbidity

Age

Gender

important demographic information on those

most at risk of obesity

Parental obesity status

Physical and sedentary activities

Socio-economic status definition

Certain diet and physical activities as

well as other socioeconomic family parameters

References

James PT: Obesity: The worldwide epidemic. Clinics in Dermatology 2004, 22:276-280.

Kelishadi R, Pour MH, Sarraf-Zadegan N, Sadry GH, Ansari R, Alikhassy H, Bashardoust N: Obesity and associated modifiable environmental factors in Iranian adolescents: Isfahan Healthy Heart Program - Heart Health Promotion from Childhood. Pediatr Int 2003, 45:435-442.

Livingstone MB: Childhood obesity in Europe: a growing concern. Public Health Nutr 2001, 4:109-116.

Nicklas TA, T. B, K.W. C, G. B: Eating Patterns, Dietary Quality and Obesity. Journal of the American College of Nutrition 2001, 20:599-608

Parsons TJ, Power C, Logan S, Summerbell CD: Childhood predictors of adult obesity: a systematic review. International Journal of Obesity 1999, 23:S1-S107.

Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH: Predicting obesity in young adulthood from childhood and parental obesity. New England Journal of Medicine 1997, 337:869-873.

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Prevalence Of Childhood Obesity In Europe And Its Associated Risk Factors: Systematic Literature Review

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