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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 2  |  Page : 75-80

The characteristics of excess body weight in the school-going students of Qatar


Department of Public Health, Ministry of Public Health, Doha, Qatar

Date of Submission17-Oct-2021
Date of Decision24-Jan-2022
Date of Acceptance01-Feb-2022
Date of Web Publication24-Mar-2022

Correspondence Address:
Muhammad Asif Ijaz
Department of Public Health, Ministry of Public Health, PO Box 42, Doha
Qatar
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_114_21

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  Abstract 


Background: Overweight and obesity among students have become a global public health concern. If no effective and timely measures are taken, the percentage is expected to rise. The ministry of public health growth monitoring program aims to gather accurate information about the health status of children and adolescents in the state of Qatar. The results help categorize the participants based on the body mass index (BMI) score as overweight and obese. Materials and Methods: The data were collected during the academic year 2016–17, from 332 school campuses and included 186,986 students. Weight in Kilograms and height in meters was calculated to compute BMI. Using the BMI results, patient's data was segregated based on the World Health Organization procedures for BMI-z-Score. The data were then further analyzed by age, sex, nationality, and on a municipality level. Results: Among 186,986 eligible students, about 42.3% were categorized as overweight and obese, with an approximately equal proportion of students being overweight (20.9%) or obese (21.4%). At 47.1%, Qatari male students had the highest prevalence of overweight and obesity, followed by Qatari females (43.8%), non-Qatari males (43.2%), and non-Qatari females (38.4%). On the basis of gender and nationality, Qatari and non-Qatari male students were predominantly more obese, whereas a higher proportion of female students from both nationalities were overweight. Conclusions: The 2016–2017 growth monitoring project results are somewhat similar to the previous growth monitoring findings. This school-based study provides evidence for relatively high levels of overweight, obesity in the state of Qatar compared to the global average.

Keywords: Body mass index, growth monitoring, obesity, overweight, Qatar


How to cite this article:
Al-Thani MH, Hassan Khalifa SA, Akram H, Vinodson B, Ijaz MA. The characteristics of excess body weight in the school-going students of Qatar. Apollo Med 2022;19:75-80

How to cite this URL:
Al-Thani MH, Hassan Khalifa SA, Akram H, Vinodson B, Ijaz MA. The characteristics of excess body weight in the school-going students of Qatar. Apollo Med [serial online] 2022 [cited 2022 Jul 1];19:75-80. Available from: https://www.apollomedicine.org/text.asp?2022/19/2/75/340828




  Introduction Top


Obesity is a public health problem of global concern, and like the rest of the world, the Middle Eastern region is also suffering from this pandemic. Childhood and adolescent overweight and obesity have increased exponentially over the last few decades, with preponderance in both the developed and the developing countries.

Interestingly, the percentage of overweight children exceeds that of the United States in some countries, including Egypt, Argentina, Nigeria, Peru, Uzbekistan, Jamaica, and Qatar.[1],[2] Previous studies in the area suggest that annually 0.5%–1% of children globally gain excess body fat with up to 8% of these individuals become obese and 32% become overweight.[3] In 2016, forty-one million toddler and preschool children (i.e., under the age of five) were found to be obese, whereas, in the same year, 340 million school-going children and teenagers (aged 5–19 years) were found overweight or obese.[4] Globally, the combined prevalence of childhood overweight and obesity has increased from 4.2% in the year 1990 to 6.7% in 2010.[5] It is now expected that by the year 2030, approximately 254 million children will be affected.[5] Overweight and obese youth is at an increased risk of adulthood overweight and obesity and related morbidity and mortality.[6],[7],[8],[9]

Overweight and obesity carries an increased risk of cardiovascular diseases, diabetes mellitus, dyslipidemia, osteoarthritis, gall bladder disease, sleep apnea, asthma, metabolic syndrome, psychological problems including eating disorders and cancers of colon, prostate, endometrium, breast, ovarian, liver gall bladder, and kidney.[4],[6],[9],[10],[11],[12],[13] Childhood and adolescent obesity among females is also strongly associated with polycystic ovarian syndrome, infertility, and some pregnancy-related complications later in their lives.[6],[14],[15] Complications associated with overweight and obesity make up a sizeable percentage of health-related problems, for example, obesity accounts for two-thirds of the individuals affected with hypertension (HTN); obesity and overweight are also associated with type 2 diabetes which accounts for 90% of all diabetics in the gulf region.[15],[16]

The World Health Organization (WHO) estimated that by the year 2020, three-quarters of all the deaths in the world would be related to noncommunicable diseases (NCDs),[1],[17] with overweight and obesity playing a pivotal role.[6],[9],[17] As per recent WHO estimates, annually more than 2.8 million people die globally because of the medical conditions resulting from being overweight and obese.[10] Obesity and overweight also lead to 4% of years of life lost and 4% of disability-adjusted life years.[18] Overweight and obesity are a major cause of health care expenditures: Global health care expense was calculated to increase to 144 billion US$ in 2020 and around 69 billion of this amount was to be spent by the gulf cooperation council countries, a large proportion of which is related to the diseases and disabilities associated with diabetes.[19]

The Ministry of Public Health (MoPH) growth monitoring program aims at gathering accurate information about the prevalence of overweight and obesity among school-going children and teenagers in the state of Qatar. This program uses the WHO new growth monitoring charts and is part of the country-level nutrition and physical activity action plan. The plan aims to reduce the burden of obesity and related chronic diseases among both citizens and residents in the state of Qatar.


  Materials and Methods Top


In 2016, the MoPH in collaboration with the Ministry of Education and Higher Education invited all the schools in Qatar to participate in the nationwide growth-monitoring program. Overall, 332 schools from the public and private sectors agreed to participate. The data for this cross-sectional study thus included 186,986 students, 5–19 years old students, during the school year 2016–2017. In 2016, Qatar's total population was 2.6 million, with approximately 308,700 individuals in the age group 5–19 years. School nurses trained through several workshops on the WHO method for collecting anthropometric measurements examined 204,442 students from the participating school campuses. For this analysis, measurements from 17,456 (8.5%) students were excluded because of parameters being beyond the expected range and/or recording errors or missing critical information for the calculation of body mass index (BMI); hence, 186,986 students were eligible for the study. Around 3.5% of the overall excluded data belonged to Qatari students (2.2% for Qatari males and 1.3% for Qatari males), and 5.0% of the data were from non-Qatari students (3.1% for non-Qatari males and 2.2% for non-Qatari females).

For the participants, height was recorded in centimeters to the nearest decimal place using SECA model 206 CM. Similarly, weight was measured in kilogram to the nearest decimal place using the SECA model 813 digital floor scale by a trained nurse. Height and weight were recorded without shoes. The individual height and weight were then used to calculate the BMI by dividing the weight by the square of the height in meters (kg/m2). For each student, the BMI measurement was computed to age- and sex-specific BMI-z-score using the following formula:

z = (BMI/M)L – 1/L × S

Where L, M, and S, respectively, denote the skewness curve, median curve, and the coefficient of variation curve. The calculation method relies on the generalized additive model for location scale and shape.[20]

Based on the BMI Z-score children were categorized into five groups; namely, severe thinness (BMI-z-score <−3), thinness (BMI-z-score ≥−3 to <−2), normal (BMI-z-score ≥−2 to < 1), overweight (BMI-z-score≥+1 to <+2), and obese (BMI-z-score ≥ + 2). Furthermore, using the BMI-z-score data were also segregated into two further categories; not overweight or obese and overweight or obese using the BMI-z-score cut-off value of one. If the calculated BMI-z-scores values were below-5 or above + 5, the values were ruled out from the analysis, considering them as outliers or values derived from recording errors.[21] Data were presented in counts, percentages, and prevalence rates. Statistical analysis was performed by doing z-test using STATA 13.1 for Microsoft Windows (STATA Corp., College Station, TX, USA). The ethical approval for the study was obtained from the Research Ethics Board of the MoPH, Qatar. This research did not receive any monetary grant from funding agencies in the public, commercial, or not-for-profit sectors. Permission was also granted from the administration of each school.


  Results Top


About 42.3% of the total eligible students (N = 186,986) were found overweight and obese, with almost a similar percentage of students being overweight (20.9%) and obese (21.4%).

Compared to Qatari male students, the odds of non-Qatari male students becoming obese were merely 0.67 times (confidence interval [CI]: 0.66, 0.69). Similarly, in contrast to Qatari females, at odds of 0.79 times (CI: 0.77, 0.81), non-Qatari female students were less likely to be overweight (P < 0.001). The prevalence of combined overweight and obesity, was 44.5% for male students (odds ratio [OR]: 1.21, CI: 1.19, 1.24), and for the female students, it was 40.2%. At a nationality level, the combined prevalence of overweight and obesity was found to be 45.4% for Qatari students (OR: 1.23, CI: 1.21, 1.26) and 40.7% for non-Qatari students. Among the Qatari students, at 47.1%, the combined overweight and obesity prevalence was the highest in the Qatari male students (OR: 1.20, CI: 1.16, 1.24), followed by Qatari female students (43.8%). Between Qatari and non-Qatari students, the combined overweight and obesity prevalence (47.1% vs. 43.2%) was relatively less in non-Qatari males, and non-Qatari females (43.8% vs. 38.4%).

Age wise, a higher prevalence of overweight (24.2%) and obesity (25.5%) was seen among 10–14-year-old students. Compared to the 5–9 years old students, the odds of combined overweight and obesity in 10–14 years old students was 1.76 (CI: 1.72, 1.80). At 17.6% for Overweight, and 18.0% for Obesity, the 5–9-year-old students had the lowest prevalence of either overweight or obesity (P < 0.001). As for thinness, a slightly higher prevalence (3.8%, CI: 3.67, 3.93) of thinness was seen among 5–9-year-old students. Compared to this, the odds of thinness among 10–14 years old students were 0.92 times (CI: 0.86, 0.97) and in 15–19 years old students, the odds of thinness were insignificant at 0.96 (CI: 0.90, 1.04). Overall, sparse prevalence of thinness and severe thinness was found in the children of all age groups as well as among the overall sample [Figure 1].
Figure 1: Prevalence of obesity, overweight, and thinness by gender

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During nationality-wise comparison, at 25.6% (CI: 25.21, 25.89) versus 19.3% (CI: 19.04, 19.48), a higher proportion of Qataris were obese compared to non-Qatari (OR: 1.47, CI: 1.43, 1.51). However, at 21.5%, non-Qataris had a relatively higher prevalence of overweight P < 0.001 [Figure 2].
Figure 2: Prevalence of obesity, overweight, and thinness by nationality

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Gender wise, obesity was more prevalent among both Qatari and non-Qatari male students. Male students had 1.50 times higher odds (CI: 1.46, 1.53) of becoming obese than female students. However, compared to the male students, at 1.01 (CI: 0.99, 1.03), the odds of female students becoming overweight were slightly higher, but this was insignificant [Table 1].
Table 1: Distribution of body mass index indicatos by gender, age and nationality

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[Table 2] shows the characteristics of the sample by school type and the level of education. Furthermore, the prevalence of overweight, obesity and categories of body weight are provided.
Table 2: Obesity classification based on the level of education, municipality and type of schools

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At a school level, the combined prevalence for overweight (23.8%) and obesity (24.6%) was highest among the students in the preparatory school (OR: 1.41, CI: 1.37, 1.44). This was followed by secondary school students with overweight and obesity prevalence of 22.3% and 21.0%, respectively (combined OR: 1.13 CI: 1.10, 1.16) and finally by the primary school students with an overweight prevalence of 19.5% and obesity levels of 20.3% (P < 0.001).

By regions, a higher prevalence of obesity was seen among students who were attending schools in Al Wakrah, Umm Slal, and Doha municipalities [Table 2].


  Discussion Top


This annual report showed that during the study period, overweight, obesity, thinness, and severe thinness rates in students of various schools of the state of Qatar remained relatively stable. Over the past few years, there was no decline or rise in the above-mentioned parameters of growth monitoring.

The results of the 2016–2017 growth monitoring project show that a high percentage of students were either overweight or obese. This is in correlation to the previous growth monitoring results from children and adolescents from the State of Qatar. They consistently show a sustained trend of overweight and obesity among students in the State of Qatar. In 2016–17, the prevalence of overweight and obesity among 5–19-year-old students was 42.3%, which was in line with the findings from the growth monitoring report from the year 2015–2016 (42.7%).[22] Unfortunately, the results are consistently higher than the global prevalence of overweight and obesity (18%) as reported by the WHO in 2016.[23]

The ratio of overweight (24.2%) and obesity (25.5%) was highest in the age group comprising of the 10–14 years old children. At 25.2% for obesity and 24.2% for overweight, a similar pattern was reported during the Growth monitoring program of 2015–2016.[22] A similar higher prevalence was also observed in other regional countries like Kuwait and Saudi Arabia.[16] The 2015 population-based survey from the state of Kuwait showed that 19.8% and 26.2% of the children between 5 and 19 years of age were found overweight and obese, respectively.[24] This may be attributable to the sustained improved socio-economic conditions, urbanization, and lifestyle changes observed in the Gulf region over the past 3–4 decades.[1],[2],[14]

The prevalence of obesity among students in the state of Qatar is more than the 2013 estimates for the under 20 years old boys (8.4%) and girls (10.2%) from the North Africa/Middle East region and the trend has not changed since 2015.[25] Like the previous survey conducted in 2015–16, the current study results also show that males are predominantly more obese, whereas females were found to be predominantly more overweight.[22] Similarly, in the year 2011, a study was conducted on 6–19 years old children of Abu Dhabi; this study also showed male students as being more predominantly obese and female students as being more prone to overweight.[26] Increased BMI calculations, possible related factors, and differences in the prevalence of overweight and obesity in either gender have been described in the previously published studies from the region.[27],[28],[29],[30],[31],[32] Nationality wise Qataris children are more prone to be obese, whereas non-Qatari children are more predominantly overweight. This finding is in line with the previous survey conducted in the year 2015–16.[22]

According to the WHO 1999 estimates, the number of overweight or obese infants and young children (aged 0–5 years) increased from 32 million to 42 million in 2013.[25] Similarly, the prevalence of overweight and obesity in developed countries has increased from 16.9% to 23.8% since 1980–2013 in boys and from 16.2% to 22.6% in girls.[25] Interestingly, this rise in the overweight and obesity epidemic was not limited to developed countries and the developing countries showed similar results. For boys, the overweight and obesity increased from 8.1% in 1980 to 12.9% in 2013 and from 8.4% to 13.4% for girls.[25] It is well documented that chronic NCDs have become a critical problem for the Gulf region. All these NCDs in adolescent and/or adult life are highly associated with overweight and obesity in children and teenagers. Close to 50%–60% of gulf inhabitants are <20 years old, thus battling childhood obesity and its related complications becomes a critical component of managing healthcare in the region.[15] Qatar spends one of the highest diabetes-related healthcare expenditures among the emerging economies.[33] Diabetes, HTN, cardiovascular diseases, and certain cancers, all related to obesity, account for about 50% of all the deaths in the Arab world.[34] Thus, the economic cost of managing obesity-related diseases makes a sizable contribution to the overall healthcare expenditure and carries a significant economic burden. Governmental initiatives like increased taxation on processed food items and sugar-sweetened beverages along with policies that create awareness about the role of energy imbalance caused by the disparity between dietary choices and physical activity can play a vital role in managing the obesity epidemic. This coupled with parental encouragement on, weight control, increased parental promotion, management, and control for healthy food choices, encouraging physical activity over sedentary entertainment opportunities; adequate sleep duration, and encouraging kids to regularly consume breakfast can help in decreasing the rate of spread of overweight and obesity pandemic.[1],[4],[8],[12],[13],[14],[34],[35],[36],[37],[38],[39],[40]

Limitations

Our data gathering and analysis was limited to height and weight measurements and did not include factors like Mid-arm circumference or waist circumference that can be used to measure obesity and overweight situations. Similarly, variables that can affect the bodyweight of the students such as physical activity, dietary patterns, parental education level, screen-time, and breakfast habits were not included in this report. Going forward, the inclusion of the above-mentioned variables can help understand the social, dietary, and family factors that can be contributory factors for the high overweight and obesity epidemic in children and adolescents from Qatar.


  Conclusions Top


Obesity and overweight prevalence in Qatar is one of the highest in the world and collectively, obesity and overweight are one of the major contributors to NCDs in the state of Qatar. The management of NCDs carries a high healthcare cost; hence, there is an urgent need to start preventive and intervention methods to combat overweight and obesity in the state of Qatar. This requires both government and parental efforts.

Over the years, different population surveys have shown a stable obese and overweight population in the state of Qatar. Although increased BMI is connected to multiple social, environmental, and behavioral factors, in previous studies carried out in Qatar we have seen some concerning factors that can be attributed to the overweight and obesity situation among adolescents in Qatar.[22],[41],[42],[43]

The reduction of overweight and obesity is rightfully a priority area for public health policy in the state of Qatar. Observational studies, population analysis, and different types of surveillance approaches, like this report, are vital in ensuring concerted and channelized efforts to improve and maintain population health.[44],[45]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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