Prevalence and Determinants of Obesity in Children in Algeria

Abstract

Our objectives through this paper are multiple: to measure the prevalence of overweight and obesity in children between 5–11 years; highlight the main causes that lead children under 12 years old to become overweight or obese, especially by highlighting the cause and effect relationship between eating disorders “bulimia nervosa” and obesityoverweigh; highlight the risk factors associated with overweight or obese children; and finally, the strategies to be planned and the policies to be applied to curb the phenomenon of obesity in this age group. This is a descriptive and cross-sectional survey which aims to study and analyze a representative sample of children under the age of 12 who attend a municipal swimming pool during the month of July 2018. The sample is made up of 509 children from less than 12 years old; the majority of children are regulars at the municipal swimming pool during the summer located in the department of Constantine, a department in the North-East of Algeria. Overweight affects 14% of children aged 5–11 years old, while moderate obesity affects 4% of children in this age category, frank obesity affects 1% of this age group. The percentage of boys and girls with a BMI3, 4 or 5 are around 13% and 23%, respectively, of the entire sample.

1. Introduction

The prevalence of overweight and obesity has risen at an alarming rate in recent decades, particularly among children and adolescents, becoming one of the greatest public health challenges of the twenty-first century [1, 2]. Childhood and adolescent obesity is a global problem, affecting both developed and low- and middle-income countries, particularly in urban areas [3, 4, 5].

In 2019, an estimated 38.2 million children under the age of 5 years were overweight or obese. Once seen as specific problems of high-income countries, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. In Africa, the number of overweight or obese children has increased by almost 24% since 2000. Almost half of overweight or obese children under 5 years lived in Asia in 2019. More than 340 million children and adolescents aged 5 to 19 years were overweight or obese in 2016 [1].

Overweight and obesity are becoming a serious public health problem; one in two Algerians and one in three Algerian women are overweight [6]. The phenomenon hardly spares children; the tendency to overweight is rather on the rise in a society inclined to a sedentary lifestyle and excessive consumption of fast-food products. Globally, the number of obese children and adolescents aged 5 to 19 years has increased 10-fold over the past four decades. If current trends continue, by 2022 there will be more obese children and adolescents than moderately or severely underweight children [7].

Through a questionnaire, we conducted a survey of children under 12 years old. This survey aims to study and analyze the causes and consequences of overweight or obesity on a sample of children aged 5 to 11 years old.

2. Patients and methods

This was a descriptive cross-sectional study on a representative sample of 509 children between 5 and 11 years old, the survey was conducted during the month of July 2018.

2.1 Study type and population

The study population consisted of 509 children aged 5 to 11 years old, who visit a public swimming pool during the summer holidays. The children are selected by chance, during the 4 weeks of July 2018.

2.2 Study variables

We studied age, sex, height, weight and BMI. The weight, expressed in kilograms, was measured in a lightly dressed, barefoot subject, standing on a SECA digital medical scale (Seca 703 digital column scale with measuring rod, Germany).

BMI was calculated by dividing the weight expressed in kilograms by the square of the height expressed in meters. We used the definition of the International Obesity Task Force/ IOTF [8], which is based on the recommendations of the European Childhood Obesity Group for epidemiological studies of Rolland-Cachera [9].

In 2000, the Childhood Obesity Working Group of the International Obesity Task Force (IOTF), a working group under the aegis of the WHO, developed a new definition of childhood obesity with curves for boys and girls aged 2 to 18 according to the thresholds proposed by Cole et al. [8]. This definition has the specificity of coordinating the characteristics of childhood obesity and adult: it uses the same index (BMI) and refers to the same thresholds. Body mass index (BMI) was calculated by dividing weight by height squared BMI = Weight/Height2 (kg/m2). The International Obesity Task Force (IOTF) proposes 5 BMI groups [9]:

• Group BMI 1 < 20: subjects with a weight deficit;

• Group BMI 2 group between 20 and 25: normal population;

• Group BMI 3 between 25 and 30: overweight;

• Group BMI 4 between 30 and 40: moderate obesity;

• Group BMI 5 > 40: frank obesity (morbid).

In children and adolescents, curves have been developed to take into account the specificity of sex and age.

2.3 Statistical analysis

Using a standardized questionnaire, respecting confidentiality, anonymity and after informing the families. We recorded a few refusals, since we distributed 600 copies of questionnaires, and we recovered only 509, thus a percentage of recovery which is around 84.83%. Most uncollected copies are those of children accompanied by adults who are not their parents. According to the questionnaire, two types of data were collected: information on the parents of the children, and others on the children themselves who were the subject of the study.

Data were analyzed using SPSS 21.0 software. Quantitative variables were represented as mean, standard deviation (SD), 95% confidence interval (95% CI), while qualitative variables were represented as numbers (n) and percentage (%). The p value <0.05 was considered statistically significant and a two-tailed test was used.

3. Results

3.1 Prevalence of overweight and obesity in children by gender

The study sample consists of 509 children aged between 5 and 11 years old, among them 235 males and 274 females. By referring to the thresholds of the International Obesity Task Force/IOTF, we obtained the following results (Table 1).

Age (years)	Gender	Number	Normal	Overweight	p*	Obesity	p**
5	Boys	31	28	01	0.029	02	0.183
	Girls	32	27	05		00
	Total	63	55	06		02
6	Boys	42	35	06	0.383	01	0.091
	Girls	54	45	06		03
	Total	96	80	12		04
7	Boys	42	38	04	0.514	00	0.041
	Girls	33	27	03		03
	Total	75	65	07		03
8	Boys	35	28	05	0.000	02	0.204
	Girls	61	38	18		05
	Total	96	66	23		07
9	Boys	39	32	05	0.683	02	0.088
	Girls	32	25	07		00
	Total	71	57	12		02
10	Boys	25	25	00	0.000	00	0.045
	Girls	54	43	08		03
	Total	79	68	08		03
11	Boys	21	18	03	0.488	00	0.535
	Girls	08	05	03		00
	Total	29	23	06		00
Total	Boys	235	204 (86.8%)	24 (10.2%)	0.000	07 (3.0%)	0.188
	Girls	274	210 (76.7%)	50 (18.2%)		14 (5.1%)
	Total	509	414 (81.4%)	74 (14.5%)		21(4.1%)

Table 1.

Prevalence of overweight and obesity in children by gender.

*

p-value: comparison of overweight prevalence between boys and girls.

**

p-value: comparison of prevalence of obesity between boys and girls.

The normal body mass index/BMI2 is around 86.8% in boys and 76.7% in girls. Girls had a significantly higher BMI than boys in all age groups, whether overweight (BMI3) or obese (BMI4 and BMI5). By comparing the two sexes, we can see that the difference between the two sexes in BMI becomes more visible with age. The average weight was 31.61 ± 10.33 kg (i.e. 30.23 ± 10.22 kg for boys and 32.46 ± 11.24 kg for girls) in children aged between 5 and 11 years, that of height was 116.23 ± 15.43 cm (i.e. 115.70 ± 12.68 cm for boys and 118.79 ± 9.68 cm for girls) and that of BMI was 19, 39 ± 4.12 kg/m2 (i.e. 18.96 ± 3.85 kg/m2 for boys and 19.97 ± 4.06 kg/m2 for girls). Overweight affects 14% of children aged between 5 and 11 years old, moderate obesity affects 4% of children and frank obesity affects 1% in this age group. The percentage of boys and girls with a BMI of 3, 4 or 5 is around 13% and 23% respectively of the entire sample. The prevalence of overweight in our study was respectively 14.5% (including 18.2% in girls against 10.2% in boys) and that of obesity was 4.1% (including 5.1% in girls against 3.0% in boys). By comparing the prevalence of overweight between the two sexes, the Pearson test shows quite significant differences in girls than boys, on the other hand the same test shows few differences between the two sexes among those who suffer from obesity (Table 1).

3.2 Factors associated with overweight and obesity according to the study sample

Four main questions have been asked to locate the risk factors responsible for overweight or obesity in children under 12: We have not recorded a relationship between the socioeconomic situation of the family and the BMI of the child; on the other hand, other factors can constitute a major risk for these young people gaining extra pounds (Table 2).

Risk factors	Group 1 (%)	Group 2 (%)	p-value
Boys	32	33	0.480
Girls	68	67	0.510
Family history of overweight and obesity	85	52	0.005
The lack of food culture	53	73	0.019
Non-compliance with recommended daily meals	58	60	0.310
Non-practice of physical activity (sedentary lifestyle)	22	38	0.023

Table 2.

Factors associated with overweight and obesity in children.

Group 1: those who are overweight (BMI3).

Group 2: those who are obese (BMI4 and BMI5).

We can clearly see that overweight and obesity are indeed present in girls more than in boys; since 68% of those who are overweight (group 1) and 67% of those who suffer from obesity (group 2) are female; i.e. two thirds of those who have (BMI3, BMI4 and BMI5). Two out of three of the parents questioned have a medium or high level of education. Weight gain begins early in 85% of children, where the family history is pointed out. We found an absence of a food culture in 53% of the families of children in both groups and an insufficient culture in 32% of the families of children in the two groups. What is worrying in both groups; it is the non-taking of breakfast which is around 58% in children of the two categories, the non-taking of breakfast at home is responsible for the multiple snacks before and after lunch, thus the majority of the children of the two groups have tendency to snack all the time, in other words to have one or more snacks during the day. We noticed that 78% of the children in two groups admitted: never or rarely practicing physical activity during the week outside of school. The majority of “never” or “rarely” answers are those of girls of the two groups, who admit that they never or rarely practice a physical activity outside the school establishment, this percentage is close to 100% among girls aged 10 and 11 years, in the same wake 89% of children admit to spending more than an hour in front of an electronic device for entertainment daily, even during school days.

4. Discussion

In our study, the prevalence of overweight including obesity is 18% in children between 5 and 11 years old, according to the international IOTF thresholds corresponding to BMI4 and 5 in adulthood. We arrived at the following results: 14% of the children in the study sample are overweight, while moderate and frank obesity concerns 4% of this age group. Girls are the most affected by overweight and obesity with 18 and 5% respectively, compared to 10 and 3% for boys. The proportions of overweight and obese children are close to those found in the national literature [4, 5, 10, 11]. However, the situation is changing from 1 year to year, since in 6 years: the prevalence of overweight including obesity is 18% after it was 13.1%; if overweight only affected 10% of children before, now it affects 14%; obesity only affected 3.1% of this age category at the beginning of this decade, now it affects 4% globally according to the most recent study on this age category [4, 5, 12]. The prevalence of overweight including obesity is 24% according to IOTF international thresholds. According to a study conducted in 2013 by the Algerian Nutrition Society (SAN), 13% of adolescents aged 10 to 17 are overweight [6]. Globally, the obesity rate among children continues to rise from 1 year to the next, as this rate has risen from less than 1% in 1975 (i.e. 11 million children), to more than 6% (i.e. 124 million) in 2016. So these figures show that the number of obese children aged 5 to 19 in the world is multiplied by 10. We must not forget that the number of overweight children is very worrying; we recorded 213 million in 2016. Fortunately, obesity in Algeria is below world averages, but measures must be taken to counter this scourge [1].

The prevalence of overweight is higher in girls than in boys of children between 5 and 11 years old. Thus, girls between the ages of 4 and 11 are 2.08 times more likely to be overweight and twice to become obese, which is consistent with the results of published research [13, 14]. In the present study, we found age to be a factor associated with overweight and obesity. Thus, 14% of children between 5 and 11 years old are overweight, and 4% are obese. Therefore, over the years, weight gain seems inevitable, which is consistent with the results of published research [4, 15]. According to our survey, the birth weight of the child and the BMI of the parents are risk factors for overweight or obesity. Thus, 85% of parents of children who have extra pounds admit that they still have curves. In addition, 52% of children suffering from excess weight have overweight or obese parents; which is consistent with the results of published studies [16, 17, 18]. The results of this survey showed that 85% of families ignore or neglect the nutritional content of the meals consumed by their children [19]. In the same vein, 53% of parents of overweight or obese children admit that the nutritional culture of food is not taken into consideration at home, which is consistent with the results of published studies. According to this survey, few children respect the recommended number of meals (i.e. 3–4 meals per day). What is worrying is that 58% of the subjects in the sample do not have breakfast at home in the morning. For those who are overweight or obese, the majority of them take at least two snacks a day, which is consistent with the results of published studies [18, 20, 21]. In the present study, we arrived that 78% of the children do not practice, or rarely, a sports activity outside the school establishment, to tell the truth apart from the 2 hours of physical activity within the school; they have no other sporting activity, which consistent with the results of published studies [4, 18, 22]. Most surprisingly, for those who do not practice any physical activity or rarely outside school, it is the percentage of girls between the ages of 10 and 11 which is close to 100%. This is mainly due to social taboos and the absence of stadiums or sports halls reserved for girls and teenagers. If the non-practice of sporting activity is quite visible, sedentary lifestyle is becoming more and more accentuated among young people. Our results show that 37% of children spend more than 2 hours in front of an electronic entertainment device, so overweight or obese children suffer more from this scourge, who over time become dependent on this kind of leisure.

5. Conclusion

Overweight and obesity have progressed rapidly over the past 5 decades; children are not immune to this phenomenon which affects all age groups, which has become a serious public health problem throughout the world. Algeria is not an exception, since the plural transition that has known this country for the last 4 decades has generated profound changes and bad habits among Algerians, in this case among the children of this country. Since the 1990s, Algeria has experienced an economic transition towards a market economy, and that after more than 30 years of socialism, this economic opening has allowed an abundance of goods on the shelves of supermarkets, among these goods those which do not are not necessarily healthy (sweets, sodas, fast food, etc.). A marked improvement in purchasing power; enabled Algerians to direct their spending towards the impulsive purchase of energy products, fast foods, and fatty meals. Children do not escape this new life, which promotes a sedentary lifestyle and cheap unhealthy meals. The results of our survey confirm the significant increase in overweight and obesity among Algerian children. Our results converge with the majority of results from national and international research, which have sounded the alarm about the dangerousness of the phenomenon and its rapid progression. The responsibility is shared between: parents, schools, media, food industry, etc. In order to fight against the consequences of obesity on our children, in this case chronic diseases, several preventive solutions can be sought: early food education must be taken into consideration in textbooks from primary school; make manufacturers aware of reducing the levels of the three whites (sugar, salt, white flour) in food; encourage homemade meals that protect our dear health; children must be made aware of the reduction of the time devote in front of an electronic entertainment device; encourage young people to devote more time to physical activity outside of school. It is the responsibility of local elected officials and non-profit associations to devote a few hours during the week to girls, adolescents and adult women in stadiums, sports halls and municipal swimming pools, to initiate a strategy to counteract overweight and obesity among women.

Our study is arguably limited by several aspects of design and analysis. Based on our small sample size, our findings may not generalize to all obese or overweight children in this country. Interest, the strength lies in the results which open the way to larger studies on children who live in large cities, or those who are confined during the long months of COVID-19.

Acknowledgments

The authors would like to thank the anonymous reviewers and the editor for their insightful comments and suggestions.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author contributions

NA and LH authors contributed equally to the ideas presented. SKMB and AL wrote the draft of the paper. All authors contributed to editing the final version and approved the submitted version.