Prevalence of obesity and overweight and associated nutritional factors in a population-based Swiss sample: an opportunity to analyze the impact of three different European cultural roots

Purpose

Obesity represents a growing public health concern worldwide. The latest data in Switzerland rely on self-reported body mass index (BMI), leading to underestimation of prevalence. We reassessed the prevalence of obesity and overweight in a sample of the Swiss population using measured BMI and waist circumference (WC) and explored the association with nutritional factors and living in different linguistic-cultural regions.

Methods

Data of 1,505 participants of a cross-sectional population-based survey in the three linguistic regions of Switzerland were analyzed. BMI and WC were measured, and a 24-h urine collection was performed to evaluate dietary sodium, potassium and protein intake.

Results

The prevalence of overweight, obesity and abdominal obesity was 32.2, 14.2 and 33.6 %, respectively. Significant differences were observed in the regional distribution, with a lower prevalence in the Italian-speaking population. Low educational level, current smoking, scarce physical activity and being migrant were associated with an higher prevalence of obesity. Sodium, potassium and protein intake increased significantly across BMI categories.

Conclusions

Obesity and overweight affect almost half of the Swiss adolescents and adults, and the prevalence appears to increase. Using BMI and WC to define obesity led to different prevalences. Differences were furthermore observed across Swiss linguistic-cultural regions, despite a common socio-economic and governmental framework. We found a positive association between obesity and salt intake, with a potential deleterious synergistic effect on cardiovascular risk.     

Prevalence and factors associated to overweight and obesity in adolescents

OBJECTIVE: To assess the prevalence and factors associated to overweight and obesity in urban area adolescents. METHODS: A cross-sectional population-based study was carried out in the municipality of Pelotas, Southern Brazil, between 2001 and 2002. Adolescents between 15 and 18 years old were weighed, measured and asked to complete a self-administered questionnaire. Of 90 areas drawn, 86 dwellings were visited in each area, comprising a total of 960 adolescents interviewed. Overweight and obesity prevalences were defined based on the body mass index, according to cutoff values and adjusted to age and sex. Multivariate analysis with Poisson regression was performed using a hierarchical model of variables associated to overweight and obesity. RESULTS: Overweight and obesity prevalences were 20.94% and 5% respectively. There was found an inverse relationship between obesity and age and schooling. An association of overweight and obesity with reporting parents' obesity (p=0.03) and adolescents' sexual maturation (p=0.01) was seen. Dieting and skipping meals were associated to obesity with a risk of 3.98 (95% CI: 1.83-8.67) and 2.54 (95% CI: 1.22-5.29) respectively. CONCLUSIONS: Overweight and obesity prevalences in the area studied are of concern despite adolescents' behaviors to prevent to obesity. There is a need to implement more effective campaigns to provide better guidance to adolescents.     

Prevalence and factors associated to overweight and obesity in public schools

This study assessed the association between environmental factors and the prevalence of overweight and obesity in public schools. It was studied 480 students, by means of anthropometric measurements evaluation, weight and height--BMI by sex and age and in accordance with the parameters of WHO and IOTF. Environmental information was obtained using a questionnaire applied to students. The Epi Info Program, version 3.3.2, was used to data collection and analysis. Prevalence rates of obesity varied according to the criteria it was used. According to the IOTF, prevalence of obesity was 7.1%, while, according parameters of the WHO, the prevalence was 18%. The significant risk factor for obesity was the father obesity (PR = 1.08; CI: 0.57-2.04). We concluded that the nutritional profile of the school serves as a subsidy for tracking trends of overweight in this group. This study could instruct the rationalization of the use of the time and public financial resources, proving the need to invest in the school feeding and in the health students.     

Prevalence of overweight and obesity among Bahraini adolescents: a comparison between three different sets of criteria

OBJECTIVE: The aim of this study is to determine the prevalence of overweight and obesity among Bahraini adolescents using three different sets of criteria/standards. DESIGN: Cross-sectional prevalence study. SETTING: Intermediate and secondary schools in Bahrain. SUBJECTS: The study included a population-representative sample of 506 Bahraini students (249 males and 257 females) between 12 and 17 y of age. The sample was selected using multistage stratified random sampling technique. MEASUREMENT: Anthropometric measurements including weight, height and triceps and subscapular skinfolds were taken on the adolescents. Age was verified against school records. To minimize inter-observer error, weight and height were taken by one person while skinfold was taken by two trained persons (one for each sex). RESULTS: The overall prevalence of obesity among Bahraini boys and girls was high, especially in girls. Obesity was highest (21% in males and 35% in females) when the WHO recommended criteria of BMI for age and skinfolds for age percentiles were applied and lowest (15% in boys and 18% in girls) when the age and sex specific BMI cut-off values of Cole et al were used. Compared with those of WHO criteria, estimates of overweight and obesity prevalence obtained with Must et al and Cole et al were generally close. CONCLUSIONS: Our data revealed a much higher prevalence rate of obesity in the Bahraini adolescent population than was previously reported, especially among girls. The BMI reference values of Must et al and that of Cole et al gave relatively similar estimates and appear to be more practical for use in surveys aimed at estimating the prevalence of overweight and obesity among adolescents than the WHO recommended composite criteria.     

Prevalence of overweight and obesity and associated factors among schoolchildren in a southern Brazilian city

This cross-sectional study aimed to determine the prevalence of overweight and obesity in a group of 11-13-year-old schoolchildren in Cap?o da Canoa, Rio Grande do Sul State, Brazil, and to investigate the association with possible risk factors for excess body weight. The sample was stratified, proportional to the number of pupils in each school. Nutritional status was assessed by body mass index (BMI) cutoffs according to age and gender as proposed by Cole et al. (2000). Socioeconomic, demographic, genetic, and behavior variables were analyzed. 719 children from 11 schools were interviewed, of whom there were 541 (75.2%) with normal BMI, 153 (21.3%) with overweight, and 25 (3.5%) with obesity. Statistically significant associations were found with type of school, parents' nutritional status, level of physical activity, and time of sedentary behavior. Prevalence of overweight and obesity in these schoolchildren was high (24.8%), in keeping with the literature, confirming the problem's magnitude and severity in Brazil.     

Perception of overweight and obesity among Portuguese adolescents: an overview of associated factors

PURPOSE: A national, representative school-based sample of Portuguese youth was used to both identify psychosocial indicators that distinguish obese and overweight adolescents from their peers, and key explainers of body image among obese and overweight adolescents. METHODS: Data on 5697 sixth, eighth and tenth grade public school students, age 11-16 years, from Portugal who participated in the 1998 (HBSC/WHO) survey of adolescent health were analysed. Body mass index (BMI) was calculated based on self-reported weight and height. Body image was measured using a body image tool with a sequence of seven body silhouettes progressing from very thin to overweight. BMI was calculated by reported weight/height (kg/m2), and was categorized based on Cole normalization curve. Adolescents whose BMI was above the 95th percentile (obese) and those with a BMI between 85 and 95 (overweight) were compared with the remainder. Separate analyses of psychosocial variables were conducted by gender, using the chi2-test, t-tests, ANOVA and multiple linear regression. RESULTS: There was a significant difference in physical activity between obese and non-obese youth (P<0.05). Girls reported dieting more than boys (P<0.001), with 15.3% of overweight teens dieting versus 6% of non-overweight teens. Those classified as overweight were significantly more likely to describe themselves as not healthy (P<0.001). A significantly greater proportion of obese/overweight versus non-overweight youth reported difficulty in making friends (P<0.001). BMI (beta=0.491; P=0.000), age (beta=-0.413; P=0.000), involvement in dieting (beta=0.110; P=0.000) and attitude toward appearance (beta=0.032; P=0.007) were significantly associated with body image. CONCLUSIONS: Inaccurate perceptions of the need to diet, poorer self-perceived health status and potential social isolation of those who are overweight were found. The importance of these findings to health promotion strategies is discussed.     

Prevalence of overweight and obesity in a national representative sample of Greek children and adolescents

OBJECTIVE: The aim of this study was to examine the prevalence of overweight and obesity in Greek school age children and adolescents. DESIGN: Nationwide representative survey. SETTING: Primary and secondary schools all over Greece. SUBJECTS: In all, 6448 students (50.4% boys, 49.6% girls) 6-17 years old. METHOD: A nationwide multistage procedure was followed to obtain a representative sample of youths. Body mass and height were measured by trained personnel. Data were collected between October 1990 and May 1991. RESULTS: According to the 12-month-International Obesity Task Force cutoff values, the overall prevalence of overweight was 17.3% (16.9% for boys, 17.6% for girls). The rate of obesity was 3.6% (3.8% for boys, 3.3% for girls). The prevalence of overweight and obesity was decreasing with age in girls (6-9 years: 23.2 and 6.7%, respectively, 10-17 years: 14.8 and 1.6%, respectively). In boys, the prevalence of overweight was higher in 10-17 years (19.3 and 2.7%, for the rate of overweight and obesity, respectively) than in 6-9 years (12.1 and 5.9%, respectively). CONCLUSION: The prevalence of overweight and obesity in Greek children and adolescents is comparable to that reported for most European countries.     

Prevalence of overweight and obesity among adult Malaysians: an update

A total of 4428 adults (>18 years old) from 5 different selected regions in Peninsular and East Malaysia participated in this health survey. Using World Health Organization recommendations for body mass index (BMI), the prevalence of overweight and obesity were found to be 33.6% (95% CI= 32.2, 35.0) and 19.5% (95% CI= 18.3, 20.7) respectively. There were more females who were obese (22.5%, 95% CI=20.9, 24.0) compared to males (14.1%, 95% CI=12.3, 15.9). Highest prevalence of obesity were among the Indians (24.6%, 95% CI=20.3, 29.3), followed closely by the Malays (23.2%, 95% CI=21.6, 24.8%) and lowest prevalence was among the Chinese subjects (8.2%, 95% CI=6.2, 10.6). More than 43% of the 531 younger subjects (<30 years old) were either overweight (20%, 95% CI=16.6, 23.6) or obese (13.9%, 95% CI=11.1, 17.2%). All subjects who claimed to be non-diabetes were required to undergo 75 g glucose tolerance test. Compared to subjects with normal BMI (18.5-24.9 kg/m2), there was a 3- and 2-folds increase in the prevalence of newly diagnosed diabetes and impaired glucose tolerance respectively, among obese subjects (BMI>30 kg/m2) who initially claimed to have no diabetes. This study highlights a need for more active, inter-sectoral participation advocating a health-promoting environment in order to combat obesity in this country.     

Association of physical activity intensity levels with overweight and obesity in a population-based sample of adults

BACKGROUND: Clarify the association between physical activity intensity and overweight/obesity. METHODS: Population-based 1997-2001 survey in Geneva, Switzerland (n=5,757, ages 35 to 74). Intensity of physical activity energy expenditure (EE) defined as percentage of total EE in moderate activities [3-3.9 x basal metabolism rate (BMR), e.g., normal walking, household chores] and high-intensity activities (> or =4 x BMR, e.g., brisk walking, sports). Overweight or obesity based on measured body mass index (BMI). RESULTS: Comparing participants in the lowest vs. the highest tertile of the percentage of high-intensity EE, the odds ratios (ORs) were, for obesity vs. normal weight, 2.8 (95% confidence interval: 2.0-3.8, P<0.0001) in men and 2.4 (1.7-3.4, P<0.0001) in women. For obese vs. overweight, the men/women ORs were 1.9 (1.4-2.6, P<0.0001)/1.5 (1.0-2.2, P<0.05). For overweight vs. normal weight, the men/women ORs were 1.4 (1.1-1.7, P<0.002)/1.7 (1.3-2.1, P<0.0001). Less or no relationship was found for the percentage of moderate-intensity EE. CONCLUSIONS: This cross-sectional study cannot determine whether exercise is an effective strategy for weight control or whether overweight or obese people exercise less. However, clear dose-response associations in both genders between obesity or overweight and energy expenditure in high (but not in moderate)-intensity activities are findings with potentially major public health implications meriting validation in an experimental intervention study.     

The impact of country of birth and time in Sweden on overweight and obesity: a population-based study

AIMS: A study was undertaken to investigate the relationship between country of birth, time in Sweden, and overweight and obesity. METHODS: Approximately 4,000 people aged 20-80 participated in a cross-sectional survey in 1994. The ethnic differences in overweight and obesity were analysed in a multivariate logistic regression analysis adjusting for age and education. The effect of number of years spent in Sweden on overweight and obesity was assessed for some of the ethnic groups compared with the Swedish-born group. RESULTS: Men from Yugoslavia and Arabic-speaking countries were overweight/obese (BMI 25.0-) and obese (BMI 30.0-) to a significantly higher extent than men born in Sweden. Women born in Poland, Arabic-speaking countries, and all other countries were overweight/obese and obese to a significantly higher extent than women born in Sweden. Both Arabic men and women who had immigrated to Sweden in 1989 or earlier had an increased risk of overweight/obesity and obesity compared with the participants born in Sweden, while no increased risk was observed for the Arabic group that immigrated after 1989. CONCLUSIONS: There were significant differences in overweight and obesity between the country of birth groups. The findings follow the patterns of low leisure time physical activity among certain ethnic groups reported in a previous study, which has implications for public health measures directed to decrease differences in overweight and obesity by country of birth.     

Prevalence of alcohol abuse and associated factors in a population-based study

OBJECTIVE: To estimate the prevalence of alcohol abuse/dependence and identify associated factors among demographic, family, socioeconomic and mental health variables. METHODS: A household survey was carried out in the urban area of Campinas, southeastern Brazil, in 2003. A total of 515 subjects, aged 14 years or more were randomly selected using a stratified cluster sample. The Self-Report Questionnaire and the Alcohol Use Disorder Identification Test were used in the interview. Prevalences were calculated, and univariate and multivariate logistic analyses performed by estimating odds ratios and 95% confidence intervals. RESULTS: The estimated prevalence of alcohol abuse/dependence was 13.1% (95% CI: 8.4;19.9) in men and 4.1% (95% CI: 1.9;8.6) in women. In the final multiple logistic regression model, alcohol abuse/dependence was significantly associated with age, income, schooling, religion and illicit drug use. The adjusted odds ratios were significantly higher in following variables: income between 2,501 and 10,000 dollars (OR=10.29); income above 10,000 dollars (OR=10.20); less than 12 years of schooling (OR=13.42); no religion (OR=9.16) or religion other than Evangelical (OR=4.77); and illicit drug use during lifetime (OR=4.47). Alcohol abuse and dependence patterns were different according to age group. CONCLUSIONS: There is a significantly high prevalence of alcohol abuse/dependence in this population. The knowledge of factors associated with alcohol abuse, and differences in consumption patterns should be taken into account in the development of harm reduction strategies.     

Prevalence of overweight and obesity in public school pupils according to three anthropometric diagnostic criteria

To compare the prevalence of child obesity according to three criteria, a cross-sectional study was performed with 6-to-11-year-old children in eight elementary public schools in the city of S?o Paulo. Z scores for weight-for-height (W/H) and body mass index (BMI) were calculated from the weight and height variables. Prevalence rates for overweight in males, according to Must, Cole, and WHO criteria, were 10.92%, 10.29%, and 11.94%, respectively, and for obesity 8.17%, 13.67%, and 10.29%. For females, prevalence rates for overweight according to Must, Cole, and WHO criteria were 13.51%, 13.83%, and 13.67%, respectively, and for obesity 8.25%, 16.50%, and 11.73%. The study analyzes the variations in obesity estimates based on different criteria, highlighting the need for clinical and population studies to support the development of a single criterion. Such studies, in addition to identifying individuals with a higher probability of excess body fat, could also correlate body fat to risk of illness and death (similar to the 25 and 30 BMI cutoff points in adults).     

Prevalence and factors associated with behavioral disorders in adolescents: a population-based study

This study proposed to estimate the prevalence of behavioral disorders and associated factors in adolescents (11-15 years), using a cross-sectional design (n = 1,145). Subjects answered a self-administered questionnaire. Behavioral disorder was assessed with the Mini International Neuropsychiatric Interview (MINI). The study analyzed disorders in relation to gender, age, socioeconomic status, schooling, failure in school, religion, smoking, sedentary lifestyle, alcohol consumption, drug use, depression, and bullying (as victim). Ordinal regression was used for the statistical analysis, with a hierarchical model for the outcome. An estimated 29.2% of the sample presented behavioral disorders. In the multivariate analysis, the odds ratio for a male adolescent to present one additional point on the behavioral disorder scale was 2.04 (95%CI: 1.53-2.71). Alcohol consumption, drug use, and suffering bullying were associated with higher scores on the behavioral disorder scale. The findings also showed that the factors associated with behavioral disorder showed a strong interrelationship between health behaviors in adolescence.     

Prevalence of overweight and obesity and associated factors among adolescents in the Northeast and Southeast regions of Brazil, 1996 to 1997

The purpose of this study was to assess the prevalence and factors associated with overweight and obesity (OW/O) among Brazilian adolescents, based on the Living Standards Survey conducted in 1996 and 1997 (IBGE, 1998a). The sample included 1,027 and 854 adolescents aged 15 to 19 years from the Northeast and Southeast regions, respectively. Body Mass Index (w/h2) was calculated. Statistical analysis considered expansion factors and sample design. Prevalence of OW/O was 8.45% in the Northeast and 11.53% in the Southeast. In the Northeast there was a higher risk of OW/O for girls (PR = 3.00), with the same situation in both urban (PR = 3.21) and rural areas (PR = 2.27). In the Southeast, the risk of OW/O was lower among girls (PR = 0.58). The same situation occurred in girls from urban areas (PR = 0.51), but in rural areas there was an increased risk among girls (PR = 1.86). Per capita monthly income was associated with the risk of OW/O among boys in both regions. Programs to prevent OW/O should incorporate nutritional reeducation and encourage physical exercise, besides considering socioeconomic, cultural, and regional differences and the location of the target population.