The epidemiological transition and the global childhood obesity epidemic

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Date
2015Author
Broyles, S.T.
Denstel, K.D.
Church, T.S.
Chaput, J-P.
Fogelholm, M.
Hu, G.
Kuriyan, R.
Kurpad, A.
Lambert, E.V.
Maher, C.
Maia, J.
Matsudo, V.
Olds, T.
Onywera, V.
Sarmiento, O.L.
Standage, M.
Tremblay, M.S.
Tudor-Locke, C.
Zhao, P.
Katzmarzyk, P.T.
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Show full item recordAbstract
OBJECTIVES: Childhood obesity is now recognized as a global public health issue. Social patterning of obesity, consistent with the
theory of epidemiologic transition, has not been well described in children, and the limited research has focused on developed
settings. The aim of this study was to describe the relationship between childhood obesity and household income using objective
measures of adiposity and to explore how this relationship differs across levels of country human development.
METHODS: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was a multi-national cross-
sectional study conducted in 12 urban/suburban study sites that represented all inhabited continents and wide ranges of
development. ISCOLE collected objectively measured height, body mass and percentage body fat in 7341 10-year-old children.
Multi-level random-effects models were used to examine income gradients in several obesity measures.
RESULTS: The mean age of the children was 10.4 years, and 12.6% were obese, ranging from 5.4% (Finland) to 23.8% (China). For
both boys and girls, obesity prevalence, body fat percentage and body mass index (BMI) z-score increased linearly with higher
income at lower levels of development (all P for trend ⩽ 0.0012), but decreased linearly with higher income at higher levels of
development (all P for trend ⩽ 0.0003). Country human development explained 75% of the variation in the country-specific
income–obesity relationships (r = − 0.87, P = 0.0003).
CONCLUSIONS: Results are consistent with the theory of epidemiologic transition. Global efforts to control obesity must account
for socioeconomic factors within a country’s context. Future research should seek to understand global socioeconomic patterns in
obesity-related lifestyle behaviors.