Is Childhood Overweight/Obesity Perceived as a Health Problem by Mothers of Preschool Aged Children in Bangladesh? A Community Level Cross-Sectional Study

Maternal misperception of under-five children weight status and associated factors: A cross-sectional study

Maternal perceptions, about the nutritional status of their children, may have implications for timely health care seeking and feeding behaviour. Shreds of evidence are limited in this area that assessed maternal perception about the nutritional status of the children in the context of Bangladesh. The objective of this study is to assess the differences in mothers' perceptions about their children's nutritional status who are less than 5 years of age and their associated factors in the context of urban slum areas. A cross-sectional study (Quantitative approach) was conducted in two of the largest urban slums of Dhaka city. A total of 437 mother-children dyads were included in the final analysis. The outcome of interest was the mother's 'varied perceptions' regarding the nutritional status of their children under five. 'Varied perception' refers to the difference between a mother's subjective assessment of her child's nutritional condition and the anthropometrically measured nutritional status. The prevalence of mother's varied perceptions was around 46%, and among them, 37% of mothers underestimated and 9% overestimated their child's nutritional status. 'The child doesn't want to eat' (AOR = 3.69; 95% CI: 2.34-5.85; p < 0.001) and 'Feels light when carried' (AOR = 3.39; 95% CI: 1.69-6.81; p = 0.001) were the significant reasons behind the mother's perception about the nutritional status of their under-five children. About one in two mothers' perceptions about their children varied from the anthropometry-derived status. Various research findings indicate that providing health education on proper feeding practices for children, along with anthropometric measurements, can assist mothers in enhancing their understanding and assessing their child's nutritional status with greater accuracy. Further qualitative research may be instrumental in getting deeper insights into maternal perception to develop context-specific interventions.

Healthy eating perceptions of mothers and caregivers of children in South Africa

Background

The perceptions of mothers and caregivers of children attending early childhood development (ECD) centres play a very critical role in promoting healthy eating habits in children and impact long-term health consequences. Food preferences that are developed during childhood continue into adolescence and adulthood and are difficult to change.

Aim

The aim of the study was to assess the perception of mothers and caregivers of children attending ECD centres regarding healthy eating practices.

Setting

The study was conducted in ECD centres in Gauteng, North West and Limpopo.

Methods

A quantitative descriptive design was used to collect data among 290 respondents using a structured, researcher-administered questionnaire.

Results

The findings indicated that the majority (77%) of respondents did not believe that choosing a healthy diet is a matter of knowing foods that are good and bad for health. The majority (59%) of respondents believed that the food they eat and drinks are healthy and see no need to make changes.

Conclusion

The study findings showed that the majority of respondents lack awareness about choosing healthy diets. Furthermore, the current dietary patterns of respondents and their children will remain the same as long as the mothers and caregivers feel that the food they eat is healthy.

Contribution

The findings of the study contribute to the appropriate measures of educating mothers and caregivers in offering healthy diets to children at home and in early childhood centres.

Violation of Food Advertising Regulations in Iran: A Systematic Review

Background

The prevalence of non-communicable diseases (NCDs) and the status of nutritionally high-risk behaviors in the country are not promising. Because of undeniable impact of media advertising on food choices, to combat the problem some regulations on food advertisements are developed in the country. However, the high prevalence of NCDs warns of the possibility that either the laws are not given the necessary attention or they are not implemented properly. Therefore in the present review, all studies on how the country's visual and written mass media comply with regulations related to food product advertisement were systematically reviewed.

Methods

We searched all studies, including Persian and English articles, dissertations, and research projects, published and unpublished reports in eight domestic and international databases and search engines during the years 1996 to December of 2020 (25 years). Then, the content of the eligible studies was extracted, evaluated, and reported.

Results

A total of 18 eligible studies (articles and reports) were included in the review. The results indicated violations of rules and regulations including displaying food products of low nutritional value and obese people, misleading/exaggerating claims, award offers, induction of gluttony, consumerism, and inconsistency with scientific facts. Most of the studies (55%) had, implicitly or explicitly, targeted children and adolescents.

Conclusions

The results of this study indicated a violation of the rules and regulations of health policies, mainly in the field of promoting foods of low nutritional value during the study period. Violations of the ban on advertising for children were also reported in more than half of the studies.

24-hour movement guidelines and weight status among preschool-aged children in Bangladesh: A community-level cross-sectional study

BACKGROUND

Increasing levels of urbanization and digitization in Bangladesh may be adversely associated with children's weight status and related movement behaviors. This study examined the prevalence of obesity, physical activity (PA), sedentary behavior, and sleep among young children from a district town in northern Bangladesh and identified factors associated with unhealthy weight status.

METHODS

Population-based cross-sectional study involving all kindergarten schools in Jamalpur District town. Schools and children aged 4-7 years were randomly selected and had their weight and height measured. Mothers completed a questionnaire on their child's PA, recreational screen time, and sleep and sociodemographic factors. Children's weight status was based on World Health Organization (WHO) categories. Meeting the PA recommendation was based on the WHO guidelines for children and adolescents, and meeting the sedentary behavior and sleep recommendations was based on the Canadian/Australian 24-hour movement guidelines for children and young people.

RESULTS

A total of 585 children and their parents were included in the study. Overall, 15% of children were overweight or obese. Three-quarters of children met the sleep guideline, and 50% met the PA guideline. Less than one third of children (31%) met the recreational screen time guideline, whereas 15% met all three guidelines. However, when adjusted for all predictors in the model, maternal education, family income, and child's age were significantly associated with overweight/obesity. Children with higher maternal education level were 2.3 times (AOR = 2.33, 95% CI: 1.19-4.78) more likely to be overweight/obese. Children in families with a higher monthly income had 1.9 times (AOR = 1.95, 95% CI: 1.14, 3.35) higher risk of being overweight/obese.

CONCLUSIONS

Prioritizing maternal education (mother-centric interventions) can help address the high levels of childhood obesity in Bangladesh.

Home environment factors associated with early childhood development in rural areas of Bangladesh: evidence from a national survey

Background

Knowing the relationship between the factors related to home environment and early childhood development (ECD) in Bangladeshi children aged 3 to 4  years would help to find out appropriate interventions for the children with lower ECD outcomes. Therefore, we aimed to understand the relationship between the home environment factors and ECD in rural Bangladeshi children aged 3 to 4  years.

Methods

We used data from the Multiple Indicator Cluster Survey (MICS) 2019, and included 7,326 rural children aged 3 to 4  years. The ECD index (ECDI) included four domains: literacy-numeracy, learning, physical and socio-emotional development. If a child met at least three of these four domains, the child was indicated as developmentally "on track".

Results

The findings show that 27.4% of rural children missed to reach developmentally on-track while 72.2% of children did not attain the literacy-numeracy domain of ECD. The home environment factors including parental participation in children's activities, was found to be associated with ECD. For instance, reading books to child had 26% (aOR = 1.26, 95% CI = 1.08-1.48), and telling stories to child had 29% (aOR = 1.29, 95% CI = 1.09-1.53) more developmentally on-track in overall ECDI. Similar associations between home environment factors and specific ECD domains were also obtained. We also identified that children aged 4  years, girls, and children of mothers with higher socio-economic status (SES) were higher developmentally on-track than their counterparts.

Conclusion

Home environment factors like reading books and telling stories to children were found to be significantly associated with ECD in rural areas of Bangladesh. Our study's findings would assist in implementing the essential public health intervention to enhance the ECD program especially in the rural Bangladeshi context.

Disparities in Childhood Obesity Prevalence and Spatial Clustering Related to Socioeconomic Factors in Isaan, Thailand

Globally, rapid economic growth has contributed to an overall increase in the incidence of childhood obesity. Although the prevalence of obesity has been well recognized, the disparities related to a region's socioeconomic environment in terms of the incidence of obesity are still less understood. Therefore, the purpose of this study was to examine the spatial pattern of childhood obesity and identify the potential associations between childhood obesity and socioeconomic environment in the northeastern region of Thailand, Isaan. Using nationally collected obesity data from children aged 0-5 years in 2019, we employed a geographic information system (GIS) to perform obesity cluster analysis at the smaller regional level, investigating a total of 322 districts in study area. Global and local statistical approaches were applied to calculate spatial associations between the socioeconomic status of neighborhoods and childhood obesity. The study revealed that 12.42% of the total area showed significant clusters at the district level, with high values observed in the western and northeastern areas. The results of the spatial statistical model revealed that childhood obesity was significantly positively associated with areas exhibiting high levels of socioeconomic environment factors. Identifying the associated factors and highlighting geographic regions with significant spatial clusters is a powerful approach towards understanding the role of location and expanding the knowledge on the factors contributing to childhood obesity. Our findings, as a first step, offer valuable references that could support policy-makers and local authorities in enhancing policy development with the aim of reducing childhood obesity and improving public health.

Maternal perception of child weight and concern about child overweight mediates the relationship between child weight and feeding practices

OBJECTIVE

To examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and maternal feeding practices.

SETTING

Pudong District, Shanghai, China.

PARTICIPANTS

A convenience sample of 1164 mothers who were primary caregivers of preschool children.

RESULTS

Sixty per cent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0·212, P < 0·001). Structural equation modelling indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0·035, P < 0·001), restriction (β = 0·022, P < 0·001), and food as a reward (β = -0·017, P < 0·05).

CONCLUSION

Child weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.

Socioeconomic position and body composition in childhood in high- and middle-income countries: a systematic review and narrative synthesis

BACKGROUND

The relation between socioeconomic position (SEP) and obesity measured by body mass index (BMI), a measure of weight for height, has been extensively reviewed in children, showing consistent associations between disadvantaged SEP and higher BMI in high-income countries (HICs) and lower BMI in middle-income countries (MICs). Fat mass (FM), a more accurate measure of adiposity, and fat-free mass (FFM) are not captured by BMI, but have been shown to track from childhood to adulthood, and be important for cardiovascular health and functional outcomes in later life. It is not clear whether body composition is associated with SEP. We systematically reviewed the association between SEP and body composition in childhood.

METHODS

A systematic review was carried out following PRISMA guidelines. The protocol was pre-registered with PROSPERO (CRD42019119937). Original studies in the English language, which examined the association between SEP and body composition in childhood, were included. An electronic search of three databases was conducted. Two independent reviewers carried out screening, data extraction and quality assessment. Due to heterogeneity in results, a narrative synthesis was conducted. Heterogeneity in findings according to SEP, sex, body composition measure and country income level was investigated.

RESULTS

50 papers were included, the majority from HICs. No papers were from low-income countries. Disadvantage in childhood was associated with greater FM and lower FFM in HICs, but with lower FM and lower FFM in MICs. When measures of FFM indexed to height were used there was no evidence of associations with SEP. In HICs, more studies reported associations between disadvantaged SEP and higher FM among girls comparative to boys.

CONCLUSIONS

Inequalities in FM are evident in HICs and, in the opposite direction, in MICs and follow similar trends to inequalities for BMI. Inequalities in height are likely important in understanding inequalities in FFM.

International study of 24-h movement behaviors of early years (SUNRISE): a pilot study from Bangladesh

BACKGROUND

The World Health Organization (WHO) released guidelines for physical activity, sedentary behavior, and sleep for children under 5 years of age in 2019. In response to these guidelines, this pilot study aimed to (i) determine the proportion of preschool children (ages 3-4 years) who met the WHO guidelines; (ii) examine the feasibility of the proposed protocol for the SUNRISE study; and (iii) assess the impact of the COVID-19 pandemic on movement behaviors of preschool children in Bangladesh.

METHODS

Time spent in physical activity, sedentary behavior and sleep were objectively measured using two types of accelerometers (ActiGraph wGT3x-BT and ActivPAL4). Screen time and sleep quality were assessed via parent questionnaire. Fine and gross motor skills were measured using the Ages and Stages Questionnaire (3rd edition). Three executive functions were assessed using the Early Years Toolbox. Focus groups were conducted with parents and childcare staff to determine the feasibility of the protocol. Follow-up data during COVID-19 pandemic was collected from parents over phone.

RESULTS

Data from 63 preschool-aged children and their parents was analyzed in this pilot study. Only three children (4.7%) met all components of the WHO guidelines. Separately, children meeting physical activity, sedentary screen time and sleep guidelines were 71.9%, 17.5%, and 59.7% respectively. The proportion of all children who were developmentally on-track for the gross and fine motor skills was 58.7% and 50.8%, respectively. Parents and educators reported that the protocol was feasible except for the activPAL-4 accelerometer. Approximately, 39% of children (14 out of 37) who wore this device developed itchy skin and rashes resulting in the suspension of using this device mid-way through data collection. During COVID-19, there was a significant decrease in children's total physical activity (- 193 min/day), and time spent outside on weekdays (- 75 min/day) and weekend days (- 131 min/day) and a significant increase in sedentary screen time (+85 min/day).

CONCLUSION

Only a low proportion of children met the WHO guidelines. Methods and devices (except ActivPAL4) used in this pilot study proved to be feasible and this has paved the way to conduct the main SUNRISE study in Bangladesh. Future measures should be taken to address the issue of movement behaviors of children during the time of pandemics like COVID-19.

Community readiness for childhood obesity prevention programs: findings from an urban population in Iran

This study aimed to examine the Iranian local communities' readiness stage to engage with childhood obesity prevention programs for late primary school children in districts 2 and 16 of Tehran as the representatives of high and low socio-economic districts, respectively. First, a Delphi approach was conducted to assess the socio-cultural necessity/appropriateness and adequacy of the community readiness model and its dimensions as a planning basis for childhood obesity prevention program(s) in Iran. Then, the community readiness interview guide's translation, modification, content and face validity were performed. Finally, 66 interviews with key informants were conducted and scored to assess community readiness. The socio-cultural necessity/appropriateness and adequacy of community readiness model and its dimensions were confirmed by Delphi participants and two questions were added to the interview guide. Content and face validity of the interview guide were at acceptable levels. Assessment of the community readiness based on the key informants' perspective showed that the overall mean readiness score of targeted local communities was 4.61 ± 0.54 and 4.22 ± 0.26 in high and low socio-economic districts, respectively, corresponded to 'preplanning stage'. The highest score was 5.00 ± 0.48 correspond to the 'preparation stage', which belonged to girls' schools in district 2. Small differences were found in the readiness stage of local communities by sex and socio-economic status of schools. The results highlight the need to increase community awareness, gain their support to recognize childhood obesity as a priority, address cultural misconceptions and improve the obesity prevention programs to achieve a higher level of readiness.

Prescripciones alimentarias y límites de la medicalización: polifonía y utilización de medios de comunicación en uma población urbana de México

Resumen La línea argumental del presente trabajo sostiene que la polifonía discursiva contenida en la información relacionada con prescripciones alimentarias, que reproducen diversos sujetos discursivos, contribuye a generar resignificaciones en la población sobre las prescripciones propuestas que se traducen en prácticas alimentarias de refracción, las mismas que pudieran explicar el impacto limitado que han tenido las intervenciones educativas para la promoción de “estilos de vida saludables”. El objetivo fue estudiar el proceso de refracción de la información prescriptiva sobre alimentación e identificar las prácticas alimentarias generadas en la población det un barrio de Monterrey, México, a partir de su interacción con sujetos discursivos claves, incluidos los medios de comunicación. Se realizó una etnografía polifónica de diez meses de duración que incluyó observación participante, entrevistas etnográficas y una encuesta. Se identificaron tres tipos de discursos prescriptivos: restrictivo, selectivo y asociado a la medicamentación. Producto de la refracción de dichos discursos, la población ha generado prácticas de sustitución y de restricción de ciertos alimentos, manifestando con ello su preocupación por la salud infantil.

TRACK Implementation: a Bangladesh Scenario

With the increasing burden of non-communicable diseases in low-income and middle-income countries (LMICs), biological risk factors, such as hyperglycemia, are a major public health concern in Bangladesh. Optimization of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost. Diabetes had 2 times more days of inpatient treatment, 1.3 times more outpatient visits, and nearly 10 times more medications than non-diabetes patients, as reported by British Medical Journal. And surprisingly, 80% of people with this so called "Rich Man's Disease" live in low- and middle-income countries. According to a recent study of American Medical Association, China and India collectively are home of nearly 110 million diabetic patients. The prevalence of diabetes in this region is projected to increase by 71% by 2035. Bangladesh was ranked as the 8th highest diabetic populous country in the time period of 2010-2011. In Bangladesh, the estimated prevalence of diabetes among adults was 9.7% in 2011 and the number is projected to be 13.7 million by 2045. The cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalization costs. According to Bangladesh Bureau of Statistics, in 2017 the annual average cost per T2DM was $864.7, which is 52% of per capita GDP of Bangladesh and 9.8 times higher than the general health care cost. Medicine is the highest source of direct cost (around 85%) for patients without hospitalization. The private and public financing of diabetes treatment will be severely constrained in near future, representing a health threat for the Bangladeshi population.

A 3-year longitudinal study of effects of parental perception of children's ideal body image on child weight change: The Childhood Obesity Study in China mega-cities

This study examined prevalence of childhood overweight and obesity (ov/ob) and central obesity in five mega-cities across China (Beijing, Shanghai, Xi'an, Nanjing and Chengdu); described parental perceptions of children's ideal body image (IBI); and prospectively examined associations between parental perception of child IBI and child weight changes over 3 years. In this NIH-funded, open cohort study, data were collected from students and their parents in 2015, 2016 and 2017 (n = 3298, in 3 waves). Cross-sectional analysis included all 3298 children; longitudinal data analysis used mixed effects models and included 1691 children aged 6-17 years with ≥two body mass index (BMI) measurements during 2015-2017. Ov/ob prevalence based on Chinese age-sex-specific BMI cut-points was 30.0%. Based on waist-to-height ratio (WHtR), the abdominal obesity rate was 19.8%. Parents reported different preferred IBI for boys vs girls, being about 3 times more likely to select ov/ob as ideal for boys than for girls (4.5% vs 1.5%, respectively, P < .001). In longitudinal analysis, children whose parents selected ov/ob as ideal had higher BMI Z-scores and WHtR increase over time than those whose parents selected an average body image (β [SE] = 0.042 [0.011], and β [SE] = 0.010 [0.004], respectively, all P < .05). Ov/ob rates were high among children in major cities in China. Chinese parents preferred a heavier ideal body image for their boys. Health promotion programs should help empower parents and their children to develop appropriate body images and maintain healthy body weight.