Prevalence of Overweight/Obesity Among Under-Five Children in Lower Middle-Income Countries and Assessment of the
Rounik Talukdar1,2, Sombuddha Biswas3, Anusha Seelamantula4
1Department of Preventive Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India.
Insights
Childhood overweight and obesity in low- and middle-income countries (LMICs) is a growing concern. This review found an 8.57% pooled prevalence, highlighting the need for targeted interventions and region-specific policies to combat rising overnutrition.
Area of Science:
- Global Health
- Pediatrics
- Nutritional Epidemiology
Background:
- Childhood overweight/obesity is a significant global health issue, particularly in low- and middle-income countries (LMICs).
- Limited consolidated evidence exists on the burden of childhood overnutrition in LMICs, hindering effective intervention strategies.
- This review synthesizes community-based study data to estimate prevalence and identify associated factors of overweight/obesity in children under five in LMICs.
Purpose of the Study:
- To estimate the pooled prevalence of overweight/obesity in children under five in LMICs.
- To explore factors associated with childhood overweight/obesity in these regions.
- To provide evidence for targeted interventions and region-specific policies.
Main Methods:
- A systematic literature search was conducted across PubMed, Scopus, and EMBASE for studies published between April 2014 and 2024.
- Quality assessment of eligible studies was performed using the Joanna Briggs Institute (JBI) tool.
- Meta-analysis using a random-effect model was employed to pool prevalence data, with heterogeneity assessed using I-squared statistics and explored through subgroup analyses and meta-regression.
Main Results:
- Twenty-one studies were included, revealing a pooled prevalence of overweight/obesity of 8.57% (95% CI: 5.24-12.63) among under-five children in LMICs, with significant heterogeneity (I²=100%).
- Overnutrition prevalence increased from 7.43% (2014-2018) to 9.12% (2019-2023).
- Prevalence varied geographically (highest in Africa: 17%, lowest in Southeast Asia: 3.41%) and by gender (boys: 6.89%, girls: 4.75%). Children of mothers with secondary education or higher had increased odds of overweight/obesity (OR: 1.51).
Conclusions:
- Childhood overnutrition trends in LMICs are alarming, with prevalence rates approaching those in some high-income nations.
- Significant geographic, gender, and socioeconomic disparities (maternal education) underscore the need for tailored public health strategies.
- Region-specific policies focusing on community engagement and awareness are crucial to address the rising burden of childhood overweight/obesity.
Background:
Overweight/obesity among children under five is a growing global concern, especially in low- and middle-income countries (LMICs), yet consolidated evidence of this burden remains limited, which is crucial to target interventions. This review synthesises data from community-based studies to estimate the overall and individual pooled prevalences of overweight/obesity in this population and explores the factors associated.
Methodology:
PubMed, Scopus and EMBASE were searched and screened for eligible studies published between April 2014 and 2024 individually by two researchers. Quality assessment of the eligible studies was conducted using the Joanna Briggs Institute (JBI) tool. Data regarding the prevalence of overweight, obesity and their associated factors, including maternal education, area of residence, maternal body weight, household incomes and breastfeeding practices, as reported in these included studies, were extracted. A random-effect model was used for the meta-analysis, and heterogeneity was evaluated using I 2 statistics. Sources of heterogeneity were explored through subgroup analyses comparing effect sizes across categories of geographic regions, overweight/obesity measurement guidelines, sample sizes and publication years. Meta-regression assessed the relationship between these variables and the pooled estimates.
Results:
Of the 13 734 studies screened, 21 were eligible for inclusion. The pooled prevalence of overweight/obesity among the under-five children in LMICs was 8.57% (95% confidence interval (CI) 5.24-12.63, I 2 100% at p value < 0.01) with significant heterogeneity. Overnutrition prevalence increased from 7.43% during the 5 years of 2014-2018 to 9.12% during 2019-2023. The pooled prevalence of overweight/obesity varied significantly across geography, with the highest prevalence in the African region (17%) and the lowest in the Southeast Asian region (3.41%). Across the four studies that reported maternal education, children of mothers with secondary school education or higher had increased odds of having overweight/obesity [Odds Ratio (OR) (95% CI): 1.51 (1.21-1.88)]. Prevalence estimates also differed significantly by gender, with 6.89% for under-five boys and 4.75% for girls [OR (95% CI): 1.48 (1.08-2.04)]. Although individual studies reported significant associations with other factors such as area of residence, maternal body weight, income status and breastfeeding practices, a meta-analysis could not be performed due to heterogeneity.
Conclusion:
Trends in childhood overnutrition in LMICs are concerning, with overall prevalence approaching estimates of those reported in a few high-income nations. Geographic variability, gender disparity and association with maternal education emphasise the need for region-specific policies, focusing on community engagement and awareness towards rising overnutrition.
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