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PAPER a Social Epidemiologic Study of Obesity Among Preschool Children in Thailand

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PAPER a Social Epidemiologic Study of Obesity Among Preschool Children in Thailand International Journal of Obesity (2001) 25, 389±394 ß 2001 Nature Publishing Group All rights reserved 0307±0565/01 $15.00 www.nature.com/ijo PAPER A social epidemiologic study of obesity among preschool children in Thailand N Sakamoto1*, S Wansorn2, K Tontisirin3 and E Marui1 1Department of Community Health and Medicine, Research Institute, International Medical Center of Japan, Tokyo, Japan; 2Department of Education, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Nakorn-Pathom, Thailand; and 3Institute of Nutrition, Mahidol University, Mahidol University, Salaya, Nakorn-Pathom, Thailand OBJECTIVE: To describe the prevalence of childhood obesity in a moderately industrialized province in Thailand and examine the in¯uence of socioeconomic status (SES) on childhood obesity. DESIGN: Cross-sectional study. SUBJECTS: One thousand one hundred and ®fty seven children in the second or third grade of kindergartens in Saraburi Province, Thailand. MEASUREMENTS: Height and weight were measured and the weight-for-height index with the Thai national standard was used for assessing nutritional status. A questionnaire was used for measuring parents' socioeconomic status. RESULTS: The prevalence of childhood obesity over 97th percentile for weight-for-height (>p97) was 22.7% in urban and 7.4% in rural areas. There were marked relationships between childhood obesity and parents' educational level and household income. CONCLUSION: Childhood obesity is an emerging health problem in developing countries, especially in urban areas. This study demonstrates a marked correlation between SES and prevalence of childhood obesity in an Asian developing country. International Journal of Obesity (2001) 25, 389 ± 394 Keywords: childhood obesity; preschool children; socioeconomic status; social epidemiology; Thailand Introduction obesity for the successful prevention of adulthood obesity.6 Childhood obesity is an increasing health problem in devel- The major grounds of this recommendation are the tracking oped countries, and is also a growing concern in developing to adulthood obesity and the forming of a lifestyle including countries. An increase in childhood obesity has been a dietary style.7±10 reported sporadically in some Asian countries, such as Among the South East Asian countries, Thailand has the Korea, Singapore, Thailand, and Indonesia, following their highest literacy rate due to its highly organized educational economic development.1±4 Most of the studies were con- system.11 The duration of compulsory education is only ducted in only capital or big cities where socioeconomic primary school at the present, but it will be extended in status (SES) was higher than in any other areas in those the near future. Though a few studies on childhood obesity countries. of school age children were conducted by using the school- Childhood obesity is positively correlated with eventual ing system, no valid study of preschool children with a large adult obesity. It is related to many of the same risk factors as sample size has been done yet.12 ± 14 It is necessary to describe adult obesity, most notably cardiovascular and psychosocial the present situation of childhood obesity among preschool factors.5 It is widely accepted that prevention is the best way children in Thailand and examine the factors related to SES, to control childhood obesity. The preschool age has been with the valid data of a large sample size. recognized as the most effective period to start to care about Objectives and methods *Correspondence: N Sakamoto, TAKEMI Program, Harvard School of The aim of this study was to describe the prevalence of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA. childhood obesity and to provide valid data in an Asian E-mail: [email protected] Received 8 September 1999; revised 3 July 2000; developing country. Moreover, by comparing two areas accepted 4 August 2000 having different SES, but similar cultural and geographical Obesity among preschool children in Thailand N Sakamoto et al 390 backgrounds, we were aiming to examine the in¯uence of was 5.8 y. There is no difference in age between the urban SES on childhood obesity. and rural subjects. The nutritional status was assessed by using the weight- for-height index and division into percentiles. The results were classi®ed into ®ve categories by percentile; <3, 3 ± <10, Subjects 10 ± 90, <90 ± 97, or >97 of the Thai national standards.15 The survey was conducted in Saraburi Province, located The standards were developed for boys and girls separately. 100 km north of Bangkok, in the Central Region of Thailand. The statistics in 1996 showed that 292 kindergartens and nursery schools existed in the province and the number of Results preschool children in the second and third grade of the Anthropometry kindergartens was 10 640. Table 1 shows the weight-for-height index distributions for Two groups of study children were selected by two-stage the children at each percentile category in the urban and random sampling. Three districts were randomly selected rural areas. Signi®cant differences were recorded between from the 13 districts in the province for representatives of them. The prevalence of overweight (p ) was 16.1% in children in rural areas, and the Saraburi municipality was 90 ± 97 urban group, and 8.7% in rural group. Moreover the pre- chosen for representatives of children in urban areas. Two valence of childhood obesity (>p ) was over 22% in the kindergartens were randomly selected from each district for 97 urban group, which was three times that in the rural group. the rural group and two from the municipality for the urban group. All the children in the second or third grade in the selected kindergartens who attended their kindergartens on the day of the anthropometry, a total of 1441 children, were Socioeconomic status of parents included in the study. SES of the parents was compared between urban and rural measured by educational level of parents and household income. Table 2 shows the distribution of educational Methods levels attained by the urban and rural parents. Urban parents The study was designed as a cross sectional survey and attained a higher educational level than rural parents conducted in March 1997. The anthropometry was carried (P<0.001). More than 90% of the fathers and 80% of the out at each kindergarten in collaboration with two commu- mothers ®nished junior high school in the urban area, while nity nurses. Height and weight were measured using a tape measure and Tanita digital scale to the nearest 0.1 cm and Table 1 Distribution of children in each percentile category of weight- 0.2 kg respectively. The tape measure was used ®xed onto a for-height index by urban=rural pillar. Rural Urban Other data were obtained by questionnaires completed by (n 554) (n 603) parents at home. The questionnaires were distributed to the children who underwent anthropometry. The number of the No. % No. % distributed questionnaires was 1441, and the number of P<3 23 4.2 8 1.3 returned questionnaires was 1208 with a return rate of P3±10 32 5.8 18 3.0 83.8%. The cases with many blanks in the returned ques- P10 ± 90 410 74.0 343 56.9 P 48 8.7 97 16.1 tionnaires were eliminated from the study, and the data of 90 ± 97 P 41 7.4 137 22.7 the remaining 1157 cases (rural 554; urban 603) were used >97 for analysis. The age ranged between 4 and 6 y, and mean age P<0.001, chi-square test between urban and rural. Table 2 Parents' educational level by urban=rural Father* Mother* Rural Urban Rural Urban (n 533) (n 596) (n 538) (n 599) No. % No. % No. % No. % >University 12 2.3 186 31.2 8 1.5 194 32.4 High school 106 19.9 275 46.1 68 12.6 220 36.7 Junior school 100 18.8 82 13.8 86 16.0 76 12.7 Primary school 298 55.9 51 8.6 341 63.4 106 17.7 <Primary school 17 3.2 2 0.3 35 6.5 3 0.5 *P<0.001, chi-square test between urban and rural. International Journal of Obesity Obesity among preschool children in Thailand N Sakamoto et al 391 Table 3 Monthly household income level by urban=rural 282 Baht; n 554), while that of the rural was 9895 Baht (s.d. 10 344 Baht; n 482). Income was categorized into Rural Urban (n 482) (n 554) four levels, <5 000, 5 000 ± <10 000, 10 000 ± <20 000, and 20 000 as Mo-suwan did in his study in Hat Yai.16 Table 3 Baht=month No. % No. % shows the distribution of income levels of the urban and <5,000 165 34.2 21 3.8 rural households. The income level of the urban households 5,000-10,000 201 41.7 96 17.3 was signi®cantly higher than that of the rural (P<0.001). 10,000-20,000 81 16.8 206 37.2 Nearly 80% of the urban households earn more than 10 000 20,000 35 7.3 231 41.7 Baht, while 76% of the rural earn less than 10 000 Baht per P<0.001, chi-square test between urban and rural. month. more than half of the rural parents had an educational level Socioeconomic status and body physique of less than primary school. The relationship between socioeconomic status of parents Total monthly household income was investigated. The and body physique of children was examined. The weight- mean income of the urban group was 29 797 Baht (s.d. 55 for-height index distributions of the children were compared Figure 1 Proportion of weight-for-height index percentile categories of children by mothers' educational level (All, Urban, Rural).
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