Prevalence and risk factors of obesity in children aged 3-12 years visiting primary healthcare setting of Dubai health authority during the COVID-19 pandemic, Dubai UAE, 2021

ABSTRACT

Introduction:

This study aims to investigate the prevalence and risk factors of Obesity in children aged 3 to 12 years visiting the primary healthcare setting of the Dubai health authority during the COVID-19 pandemic.

Materials and Methods:

This is a cross-sectional included 383 children in the included age of 3 to 12 years. Data were collected between August 2021 and February 2022. The sample had children from different nationalities who visited primary healthcare centers with no serious medical condition. Our exclusion criteria include children with serious illnesses, children taking any chronic medication, and children not living in the UAE.

Results:

The average weight of participants is 33.75 kgs, average height is 1.29 meters, and average BMI is 19.23 kg/m². In our study, 35.8% of children were obese, 11.2% overweight, and 42.6% had normal BMI, whereas 46.2% were underweight. The majority (68.1%) of participants were Emirati nationals. Around 30.8% of parents reported being smokers, 50% are university graduates, and 70.8% reported having sufficient income. Around 56.1% of parents said their weight is normal, whereas 38.2% believe their spouse’s weight is normal. The following factors are significant risk factors of obesity: gender (males, P = 0.012), age (11-12, P = 0.003), smoking parents (P = 0.046), and time on screens (≥4 to 6 hours daily, P = 0.00).

Conclusion:

Obesity is associated with parents’ education level. The lower the education, the higher the percentage of obese children. Smoking parents, screen time of 4 hours or higher, junk food, and eating outside are significantly associated with children’s obesity. Obesity is substantially higher in males compared to females and is considerably higher in those aged 10 to 11 years.

Introduction

Obesity, typified by the excessive accumulation of fat, is often measured using the body mass index (BMI)—a ratio of weight (kg) to the square of height (m). When BMI surpasses the 95^th percentile, the condition is classified as obesity between the 85^th and 95^th percentile as overweight, whereas percentiles below this range indicate normal to underweight statuses. Despite obesity being a long-recognized health concern, it remains inadequately managed.[1] Alarmingly, the prevalence of obesity is on the rise, with approximately 18% of individuals between ages 5 and 19 classified as obese globally.[2]

A confluence of factors, such as socioeconomic conditions, psychological issues, unchecked dietary habits, and lack of physical exercise, predominantly contributes to childhood obesity. Children may resort to excessive eating as a coping mechanism for their emotional stressors such as isolation, family tension, and anxiety.[1,3] Evidence suggests a significant correlation between childhood obesity and the increased risk of obesity in adulthood.[4,5] Furthermore, a marked association between dental caries and obesity has been identified, with the former condition more prevalent among the obese population, primarily due to high sugar consumption and fluoride exposure.[6] The type of school attended also plays a role in obesity prevalence, with different findings relating to physical activity levels and dietary habits in private and public schools. The COVID-19 pandemic has exasperated the issue by significantly reducing children’s physical activity levels due to school closures.[4] Moreover, socioeconomic status has a direct bearing on obesity, with different outcomes seen based on access to healthy foods and physical activity.[1]

Preventing the factors leading to obesity and timely intervention during the overweight stage can avert the transition to obesity. Obesity can precipitate serious health conditions like diabetes, cardiovascular diseases, and cancer. Therefore, inculcating healthy lifestyle habits is paramount. Ascertaining the prevalence and risk factors of obesity in children aged 3-12 years in Dubai during the COVID-19 pandemic will aid in planning early interventions, thus mitigating the health impacts of obesity. This effort will enhance the quality of life from early years and reduce the burden and cost of health services.

A Turkish study in 2009[5,6,7,8] concluded that despite similar daily caloric intake, obese children were less engaged in physical activity compared to their nonobese counterparts. Parental obesity was found to be a significant predictor of childhood obesity. Accordingly, enhancing maternal knowledge about healthy diets and encouraging families to engage in physical activities are crucial preventive measures.

Materials and Methods

This cross-sectional study aims to investigate the prevalence and risk factors of obesity in children aged 3 to 12 and his cross-sectional study was conducted to investigate the incidence and contributing factors of obesity among children aged 3-12 years who accessed primary healthcare services during the COVID-19 pandemic in Dubai, UAE. A total of 383 children, representing various nationalities and devoid of serious medical conditions, were included in the study. Children with severe illnesses, those on long-term medications, and non-UAE residents were excluded.

Data were collected from August 2021 to February 2022 using a telephone questionnaire administered to parents. This instrument, utilized in numerous similar studies and available in Arabic and English,[9] comprised two sections aiming to gather information from both the child and parents. The questionnaire’s validity was affirmed through a pilot study. Some of the data were extracted from participants’ medical records.

The questionnaire comprised two sections: the first one collected demographic data such as age, sex, BMI, and nationality, whereas the second part gathered information about potential risk factors and other details like sleep duration and family income. The data were processed using Minitab and SPSS software for statistical analysis, with a P value cutoff of 0.05 signifying statistical significance. Multiple hypothesis testing methods and categorical data analysis techniques were employed to analyze continuous and categorical data.

Statistical analysis

Quantitative variables are presented as mean and standard deviation (SD), whereas qualitative variables are presented as frequency and percentage.

Results

Results show that our sample is relatively balanced in gender distribution, with 47% of males and 53% of males. The average weight of participants is 33.75 kg, the average height is 1.29 meters, and the average BMI is 19.23 kg/m² [Figure 1]. 35.8% of children were obese, 11.2% were overweight, 10.4% were underweight, and 42.6% had a normal body mass index (BMI). The majority (68.1%) of participants were Emirati nationals [Table 1].

Figure 1.

BMI category vs. Gender. There is a significant difference (P = 0.012) between male obesity and female obesity percentage. Males are more obese compared to females

Table 1.

Characteristics of data

Characteristics	Value
Gender, n (%)
Male	180 (47.0)
Female	203 (53.0)
Weight, mean (SD), Kgs	33.75 (15.27)
Height, mean (SD), in cm	129.66 (17.27)
BMI Category, n (%)
Underweight	40 (10.4)
Normal	163 (42.6)
Overweight	43 (11.2)
Obese	137 (35.8)
Nationality, n (%)
UAE National	261 (68.1)
Non-UAE national	122 (31.9)
You or your spouse are a smoker, n (%)
Yes	118 (30.8)
No	265 (69.2)
Level of Education, n (%)
Illiterate	4 (1.0)
Primary school	22 (5.7)
Secondary School	145 (37.9)
University	192 (50.1)
Above university	20 (5.2)
Family income (from participants point of view), n (%)
Not Sufficient	73 (19.1)
Sufficient	271 (70.8)
Sufficient and saving	39 (10.2)
Perception regarding your weight, n (%)
Underweight	16 (4.2)
Normal	215 (56.1)
Overweight	96 (25.1)
Obese	56 (14.6)
Perception regarding your spouse’s weight, n (%)
Underweight	14 (3.7)
Normal	223 (38.2)
Overweight	101 (26.4)
Obese	45 (11.7)
Child age group, n (%)
3-4 years	76 (19.8)
5-7 years	104 (27.2)
8-10 years	160 (41.8)
11-12 years	43 (11.2)
You think your child is n (%)
Underweight	59 (15.4)
Normal	251 (56.5)
Overweight	51 (13.3)
Obese	22 (5.7)
Sleep hours per day, n (%)
<8 h	47 (12.3)
8-10 h	313 (81.7)
>10 h	23 (6.0)
Screen time (noneducation time) per day, n (%)
Never/<1 h	52 (31.6)
1-3 h	159 (41.5)
4-6 h	101 (26.4)
>6 h	71 (18.5)
Physical activity per week, n (%)
Never/rarely	82 (21.4)
1-2 times	163 (42.6)
3-5 times	75 (19.6)
Five or more	63 (16.4)
Breakfast daily, n (%)
Never	6 (1.6)
Rarely	27 (7.0)
Sometimes	84 (21.9)
Always	266 (69.5)
Vegetables and fruits, n (%)
Never	19 (5.0)
Rarely	57 (14.9)
Sometimes	148 (38.6)
Always	159 (41.5)
Junk food**, n (%)
Never	6 (1.6)
Rarely	46 (12.0)
Sometimes	142 (37.1)
Always	149 (49.3)
Eating from outside, n (%)
Never	2 (0.5)
Rarely	95 (24.8)
Sometimes	205 (53.5)
Always	81 (21.1)

**Food that is high in calories from sugar and/or fat, and possibly also sodium, but with little dietary fiber, protein, vitamins, minerals, or other important forms of nutritional value

In our study, 30.8% of parents reported being smokers; 50% were university graduates; and 70.8% reported having sufficient income. 56.1% of parents said their weight is normal, whereas 38.2% believed their spouse’s weight is normal [Figure 2].

Figure 2.

BMI category vs. parents’ smoking status. If one or two of the children’s parents are smokers, the kids will be significantly (P = 0.046) more likely to be obese. Results show that 43.2% of kids with smoking parents are obese, compared to 32.4% of nonsmoking parents

Children were divided into four age groups: 3-4 years, 5-7 years, 8-10 years, and 11-12 years, representing 19.8%, 27.2%, 41.8%, and 11.2% of the sample, respectively. A significant majority of parents (P = 0.00) believe their child is normal, whereas only 19% believe their child is obese or overweight [Figure 3].

Figure 3.

BMI category vs. age group. Obesity is highest in children at 11 to 12 years old compared to other age groups (P = 0.003)

Our study identified some factors to investigate their relation to childhood obesity. Those factors are sleeping hours (explain the effect and percentage), screen time, physical activity per week, taking breakfast daily, eating vegetables and fruits, eating junk food, and eating outside. Data show that 12.3% of children were sleeping less than 8 hours, around 45% had screen time more than 4 hours, and 64% had minimal physical activity per week, where minimal is defined by either never having physical activity or having it one to two times per week. 1.6% never had breakfast, and 7% rarely had breakfast. Only 41.5% of children reported eating fruits and vegetables every day. Nearly half of children reported always eating junk food, and 21.1% always ate outside [Figures 4–7].

Figure 4.

BMI category vs. parent education level (pie chart). There is a significant relationship between lower parents’ education levels and high obesity in children (P = 0.028)

Figure 7.

Eating from outside vs. parent level of education. There is no relation between parent education level and eating from outside (P = 0.056)

Figure 5.

Parent education level vs. children’s obesity (Time series)

Figure 6.

Screen time vs. BMI category. Children who watch screens for 4 to 6 hours or longer than 6 hours have a more significant probability (P = 0.00) of being obese

Discussion

The focus of our study was to ascertain the incidence and contributory factors of obesity among children aged 3-12 years in the primary healthcare setting of the Dubai Health Authority during the COVID-19 pandemic. The study found that 35.8% of children aged 3-12 years were obese, mirroring the obesity rates in certain Gulf countries such as Qatar, where 40.4% of children aged 5-19 are obese.[10] Consistent with the Qatar study, our study also revealed a significantly higher prevalence of obesity among female children.

Our results indicate a sizable number of children consume food outside the home and do not eat sufficient fruits and vegetables. These findings echo a previous study conducted in the UAE,[11] which reported a breach in adherence to dietary guidelines among the youth, leading to a consumption of less nutritive calories. The study found that girls aged 9-13 consumed approximately 264 kcal/day from sugar-sweetened beverages and 206 kcal/day from candies and sweets. Consumption of calories from saturated fat exceeded the recommended intake in several age and sex groups. A vast majority consumed less than the required servings from the food groups, underlining the need for interventions to improve the quality of diets among children and adolescents aged 6-18 years in the UAE.

A significant association was noted between reduced physical activity due to COVID-19 and increased childhood obesity. A Saudi study during the pandemic revealed unfavorable changes in children’s physical activities, particularly among girls.[10] These findings provide insights into the changed dynamics due to COVID-19 restrictions, which should be considered in future strategies.

An escalating trend in the prevalence of overweight and obesity was observed in the UAE between 1989 and 2017, marking a 2- to 3-fold increase.[12] As per our study, the consumption of junk food is a major contributor to obesity. A decline in the growth of soft drink sales was noted in several GCC countries after imposing taxes.[3] The UAE introduced a comprehensive framework to combat obesity in 2017, incorporating measures such as a tax on sugar-sweetened beverages, front-of-pack labeling, and school canteen guidelines. However, obesity remains a pressing issue among children, necessitating a multidimensional approach encompassing education about obesity risks, and the involvement of families, schools, clinics, and media. The manuscript highlights the significant impact of COVID-19 on child obesity in Dubai, providing novel insights into the situation during the pandemic and emphasizing the role of primary care providers in controlling the situation.

Conclusion

Our study found a significant correlation between childhood obesity and parental education levels, suggesting a higher prevalence of obesity in children whose parents have lower education levels. Additionally, we discovered a significant relationship between parental smoking habits and an increased incidence of obesity in their children. Contrary to previous studies, our research pointed towards a higher obesity prevalence in female children compared to males, particularly those aged between 10 and 11 years.

Noteworthy associations were also found between children’s obesity and lifestyle behaviors. Children indulging in screen activities for 4 hours or more displayed a marked rise in obesity rates. Furthermore, dietary factors like consuming junk food and frequent dining out were also significantly linked to obesity in children. Our findings underline the urgency to implement holistic strategies to curb childhood obesity, incorporating interventions targeting parental education, promoting healthier lifestyle habits, and encouraging nutritious dietary choices.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.