Prevalence of overweight and obesity among 6-13 year old Kuwaiti school children: secular trends, risk factors and their implications

Evidence of childhood obesity as a strong predictor of risk of non-commnuicable diseases has been accumulating world wide over the last three decades. The focus of this study was to provide a cross-sectional picture of the influence of the demographic and epidemiological transition on health habits, lifestyle changes, dietary patterns and obesity risk among 6-13 year old Kuwaiti school children. A sample of 1536 Kuwaiti school children was recruited in 2001 through a multi-stage cluster and stratified sampling technique to investigate the impact of these environmental factors. The study design included administration of a structured and pretested socio-demographic, health habits and lifestyle questionnaire. Of these a sub-sample of 224 ramdomly selected subjects( >14% of total) (with a response rate of 86.6% n=194) undertook a 7-day dietary intake and physical activity record and anthropometric measurements. Some biochemical indices of nutritional risk were further assessed among 224 of eligible subjects (mean age 10.3± 2-4 yrs; response rate 50.9%,n =114)in 2003. Findings from this study confirm the presence of high income and increased food availability and choice the consequences of which included intake of high energy, high fat, sugar and salt-based diets (above recommended intakes) coupled with a sedentary lifestyle with low levels of daily total energy expenditure. Positive energy balance was confirmed by evidence of overweight and obesity (>65% above 85th percentile for BMI cut-off of 25k gm-2) with at least 21% obese (above 95h percentile i.e. BMI 30 kg/m2), increased ZSFT and increased WHR.
Furthermore, biochemical evidence of the nutritional risk was found with high levels of serum fasting glucose, total triacylglycerols and total cholesterol levels associated with low HDL-c levels, the latter further supporting the notion that their levels of physical activity were low (mean physical activity level PAL of 1.29 ±0.13). The biochemical indices suggest that nearly 15% of subjects were at risk of the metabolic complications. These findings also evidenced by increasing trends of obesity over the last two decades in a similar age-matched cohort suggest the presence of a nutritional transition with potentially serious health consequences. This provides opportunities for action and implementation of new nutrition and public health actions to avert any health crisis in this population. A strategic framework for intervention involving school-based nutrition and health promotion, community, family and stakeholder participation and government policy reviews and interventions have been proposed as a medium to long term solution.