Abstract
Background
Overweight and obesity prevalence is increasing in Canadian children. In the Capital Health region of Alberta, there is a need to examine this public health issue and implement strategies to overcome it. Two growth references, one provided by the US Centers for Disease Control and Prevention (CDC), and the other by the International Obesity Task Force (IOTF), are available to assess individuals and screen populations for overweight and obesity. The prevalence can vary as a function of the reference used. The primary objective of this study is to determine prevalence estimates of overweight and obesity in 4–6 year olds in the Capital Health region. The secondary objective is to explore differences in estimates using both classification systems.
Methods
Anthropometric measurements were incorporated into regular preschool immunization visits. Body Mass Index (BMI), defined as the bodyweight in kilograms divided by height in metres squared was calculated for each record and percentiles for age and sex were determined using cut-offs from the IOTF and CDC. The prevalence estimates of overweight and obesity using both classification systems were determined and compared.
Results
Out of 7,369 children, 13.8% were overweight and 11.4% were obese according to the CDC reference. The IOTF reference classified 11.5% as overweight and 6.8% as obese. The two reference systems had moderate agreement (kappa 0.69, p<0.01).
Conclusion
The results indicate a lower prevalence estimate of overweight and obesity among young children in the Capital Health region compared to other parts of Canada. The IOTF reference provides more conservative estimates than the CDC reference, accounted for more by the difference in estimates of obesity than by the difference in estimates for overweight.
Key words: Overweight; obesity; child development; Body Mass Index (BMI); child, preschool
Résumé
Contexte
La prévalence de l’embonpoint et de l’obésité est en hausse chez les enfants canadiens. Dans la région sanitaire d’Edmonton (Alberta), il a été jugé nécessaire d’examiner ce problème de santé publique et de mettre en œuvre des stratégies pour le surmonter. Deux graphiques de croissance sont disponibles pour analyser l’embonpoint et l’obésité individuellement et à l’échelle d’une population: celui des Centers for Disease Control and Prevention des Etats-Unis (CDC) et celui du groupe de travail international sur l’obésité (IOTF). La prévalence peut varier en fonction du graphique utilisé. L’objectif principal de notre étude était de calculer la prévalence estimative de ‘embonpoint et de l’obésité chez les enfants de 4 à 6 ans dans la région sanitaire d’Edmonton. Le deuxième objectif était d’analyser les différences dans les estimations produits par les deux systèmes de classification.
Méthode
Des mesures anthropométriques ont été intégrées dans les visites de vaccination systématique au préscolaire. Nous avons calculé l’indice de masse corporelle (IMC) de chaque enfant (le poids corporel en kilogrammes divisé par la taille en mètres carrés) et déterminé les centiles d’âge et de sexe en utilisant les seuils de l’IOTF et des CDC. Nous avons ensuite déterminé et comparé les estimations de la prévalence de l’embonpoint et de l’obésité selon les deux systèmes de classification.
Résultats
Sur 7 369 enfants, 1 3,8 % faisaient de l’embonpoint et 11,4 % étaient obèses selon le graphique des CDC. Selon celui de l’IOTF, 11,5 % faisaient de l’embonpoint et 6,8 % étaient obèses. Les deux systèmes de classification affichaient un degré de concordance moyen (coefficient Kappa de 0,69, p<0,01).
Conclusion
Les résultats indiquent que la prévalence estimative de l’embonpoint et de l’obésité chez les jeunes enfants de la région sanitaire d’Edmonton est plus faible qu’ailleurs au Canada. Les estimations obtenues selon le graphique de l’IOTF sont plus prudentes que celles obtenues avec le graphique des CDC, ce qui s’explique davantage par les écarts dans les estimations de l’obésité que de l’embonpoint.
Mots clés: embonpoint; obésité; développement de l’enfant; indice de masse corporelle (IMC); enfant, préscolaire
Footnotes
Acknowledgement: Funding support for this study was provided by Capital Health Young Family Wellness Initiative
References
- 1.Tremblay MS, Katzmarzyk PT, Willms JD. Temporal trends in overweight and obesity in Canada, 1981–1996. Int J Obesity. 2002;26:538–43. doi: 10.1038/sj.ijo.0801923. [DOI] [PubMed] [Google Scholar]
- 2.Statistics Canada. Shields M. Nutrition: Findings from the Canadian Community Health Survey -Overweight Canadian Children and Adolescents. Catalogue no. 82-620-MWE2005001.
- 3.Willms JD, Tremblay MS, Katzmarzyk PT. Geographic and demographic variation in the prevalence of overweight Canadian children. Obesity Res. 2003;11(5):668–73. doi: 10.1038/oby.2003.95. [DOI] [PubMed] [Google Scholar]
- 4.Dieticians of Canada, Canadian Paediatric Society, the College of Family Physicians of Canada,Community Health Nurses Association of Canada. The use of growth charts for assessing and monitoring growth in Canadian infants and children. Can J Dietet Pract Res. 2004;65(1):22–32. doi: 10.3148/65.1.2004.22. [DOI] [PubMed] [Google Scholar]
- 5.Centers for Disease Control and Prevention. CDC Growth Charts: United States. Centers for Disease Control and Prevention [website]. Available online at: https://doi.org/www.cdc.gov/growthcharts (Accessed January 15, 2004).
- 6.Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000;320:1240–43. doi: 10.1136/bmj.320.7244.1240. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Ball GD, Willows ND. Definitions of pediatric obesity. CMAJ. 2005;172(3):309–10. doi: 10.1503/cmaj.1041328. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Flegal KM, Ogden CL, Wei R, Kuczmarski RL, Johnson CL. Prevalence of overweight in US children: Comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index. Am J Clin Nutr. 2001;73:1086–93. doi: 10.1093/ajcn/73.6.1086. [DOI] [PubMed] [Google Scholar]
- 9.Willows ND, Johnson M, Ball GDC. Prevalence estimates of overweight and obesity in Cree preschool children in Northern Quebec according to International and U.S. reference criteria. Am J Public Health. 2007;97(2):311–16. doi: 10.2105/AJPH.2005.073940. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Maternal and Child Health Bureau (MCHB). Related Maternal and Child Health modules. Centers for Disease Control and Prevention [website]. Available online at: https://doi.org/www.depts.washington.edu/growth/ (Accessed January 15, 2004).
- 11.Canning PM, Courage ML, Frizzell LM. Prevalence of overweight and obesity in a provincial population of Canadian preschool children. CMAJ. 2004;171(3):240–42. doi: 10.1503/cmaj.1040075. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.He M, Sutton J. Using routine growth monitoring data in tracking overweight prevalence in young children. Can J Public Health. 2004;95(6):419–23. doi: 10.1007/BF03403984. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Flynn MA, Hall K, Noack A, Clovechok S, Enns E, Pivnick J, et al. Promotion of healthy weights at preschool public health vaccination clinics in Calgary: An obesity surveillance program. Can J Public Health. 2005;96(6):421–26. doi: 10.1007/BF03405181. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Lamerz A, Kuepper-Nybelen J, Wehle C, Bruning N, Trost-Brinkhues G, Brenner H, et al. Social class, parental education, and obesity prevalence in a study of six-year-old children in Germany. Int J Obes Relat Metab Disord. 2005;29(4):373–80. doi: 10.1038/sj.ijo.0802914. [DOI] [PubMed] [Google Scholar]
- 15.Moffat T, Galloway T, Latham J. Stature and adiposity among children in contrasting neighborhoods in the city of Hamilton, Ontario. Canada. Am J Hum Biol. 2005;17(3):355–67. doi: 10.1002/ajhb.20125. [DOI] [PubMed] [Google Scholar]
- 16.Veugelers PH, Fitzgerald AL. Prevalence of and risk factors for childhood overweight and obesity. CMAJ. 2005;173(6):607–13. doi: 10.1503/cmaj.050445. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Wang Y. Cross-national comparison of childhood obesity: The epidemic and the relationship between obesity and socioeconomic status. Int J Epidemiol. 2001;31:1129–36. doi: 10.1093/ije/30.5.1129. [DOI] [PubMed] [Google Scholar]
- 18.Oliver LN, Hayes MV. Neighbourhood socioeconomic status and the prevalence of overweight Canadian children and youth. Can J Public Health. 2005;96(6):415–20. doi: 10.1007/BF03405180. [DOI] [PMC free article] [PubMed] [Google Scholar]