Assessing knowledge and attitudes toward childhood obesity among Syrian refugees in Al Za'atari refugee camp: a...

Childhood obesity is a growing global concern, particularly among conflict-affected populations. In contexts such as Al Za'atari Refugee Camp, monotonous diets, dependence on food aid, and low levels of physical activity all increase the risk of obesity. When combined with low health literacy, these conditions contribute to a double burden of malnutrition. Yet little is known about how displaced families themselves understand childhood obesity.

This study aimed to evaluate the knowledge, attitudes and practice of Syrian refugee parents and their children (aged 6-18 years) concerning childhood obesity in the Al Za'atari Refugee Camp.

A cross-sectional quantitative survey was conducted among 381 Syrian refugee households (N = 762; 381 parents and 381 children). A structured questionnaire was used to collect data on demographic characteristics, knowledge, attitudes, and practices related to childhood obesity. The questionnaire was administered using the KOBO Toolbox system. Statistical analyses included descriptive statistics and multivariable linear regression and mediation analyses.

Overall, 34.1% of children were overweight and 30.5% were obese. Higher parental nutritional knowledge was associated with lower child BMI-for-age Z-scores (BAZ) (β = -2.104; 95% CI: -3.641 to -0.567) and healthier dietary behavior (β = -0.761; 95% CI: -0.848 to -0.673). Boys and older children had lower BAZ than girls and younger peers. Household food insecurity showed a weak, non-significant positive association with BAZ. Higher parental BMI was significantly related to higher child BAZ, whereas self-reported family history of obesity was not. Parental attitudes and feeding practices were both associated with children's dietary behavior; feeding practices showed only small, non-significant mediation of the attitude's behavior link. Socioeconomic instability especially parental unemployment and reliance on informal or unstable income was strongly associated with higher BAZ and poorer dietary behavior, while more stable employment was linked to healthier outcomes.

In this refugee camp setting, childhood obesity is highly prevalent and closely linked to parental nutritional knowledge, parental BMI, and household economic conditions, more than to food insecurity alone. Family-focused, gender-responsive interventions that combine caregiver nutrition education with economic stability and access to healthy foods are critical to reducing obesity risk among displaced children.