Risk factors for adolescent obesity in LMICs: a meta-analysis using multiple adiposity indicators

Adolescent obesity is an escalating public health challenge in low- and middle-income countries (LMICs). Most evidence has relied on body mass index (BMI), which may underestimate central adiposity. We conducted a systematic review and meta-analysis to synthesize risk factors using multiple anthropometric indicators.

A systematic search of PubMed, Scopus, and Web of Science was conducted for studies published between January 2013 and December 2023. Studies were included if they reported adolescent obesity risk factors, were peer-reviewed, and published in English. Studies that did not assess risk factors, review articles, editorials, case reports, and animal studies were excluded. Data were extracted and synthesized both narratively and quantitatively, and the risk of bias of included studies was assessed using the Newcastle Ottawa Scale. From 196,775 records, 21 studies were included (n≈46,000 adolescents). Significant risk factors were genetic predisposition (OR 1.80; 95 % CI 1.35-2.40), socioeconomic status (OR 1.31; 95 % CI 1.13-1.52), unhealthy dietary patterns (OR 2.07; 95 % CI 1.11-3.88), environmental exposures (OR 1.25; 95 % CI 1.09-1.44), low physical activity (OR 1.14; 95 % CI 1.03-1.27), and psychosocial stress (OR 1.29; 95 % CI 1.08-1.54). Subgroup analyses revealed that the waist-to-height ratio was the most consistent predictor of obesity risk, whereas BMI exhibited more heterogeneous associations. Regional disparities were evident, with stronger associations in East Asia and Latin America.

Adolescent obesity in LMICs arises from intersecting biological, behavioral, and social determinants. The waist-to-height ratio may provide a more accurate measure of adiposity than the BMI. Effective prevention requires multisectoral policies addressing unhealthy diets, limited physical activity, psychosocial stress, and obesogenic environments.

Further research is expected to involve interventions to address obesity in LMICs by considering measurements using the waist-to-height ratio to measure adiposity rather than using BMI.