Regional Disparities in Prevalences and Risk Factors of Obesity and Overweight in Chinese Children and Adolescents

Abstract

Background: Geographical profiles of overweight and obesity in China are limited. We aimed to compare region-specific prevalences of overweight and obesity for Chinese children with a full range of ages and to describe the distribution of potential risk factors.Methods: We analyzed data from Prevalence and Risk factors for Obesity and Diabetes in Youth (PRODY) study, which was a cross-sectional survey of children aged 3-18 years from 11 provinces, autonomous regions, and municipalities that are geographically representative of western, southern, eastern, northern and central China. All participants underwent physical examinations, and their parents or caregivers completed online, self-administered questionnaires. We used multilevel logistic regression models to estimate prevalences of overweight and obesity and to assess related risk factors across sexes, age groups and regions. \n \nFindings: Between January 2017 and December 2019, 200,937 children in the PRODY study were included in our analysis. We found that children aged 8-13 years in northern China and children aged 3-5 years in western China were heavily burdened with overweight and obesity. In northern China the obesity prevalences peaked at 31·0% for boys and at 18·8% for girls, while in western China the prevalences of overweight and obesity peaked at 39·0% and 26·0%, respectively. Boys were vulnerable to overweight and obesity throughout all ages and regions (except western China). In addition, risk factors for overweight and obesity varied across ages, sexes and regions. Early-life factors (breast-feeding duration) and lifestyle factors (daily screen time, sleep time and exercise frequency) were the most important, modifiable factors for obesity control. Parental factors (parent’s overweight, socioeconomic characteristics and education status) had noteworthy impacts on their offspring’s overweight and obesity. \n \nInterpretation: The age- and sex-specific prevalences of overweight and obesity in Chinese children vary geographically; therefore, modifications of the major risk factors for the prevention and treatment of overweight and obesity should take age, sex and regional characteristics into consideration. Special attention should be paid to the most vulnerable children, and targeted interventions are urgently needed to mitigate the obesity burden in such a vast country. \n \nFunding: National Key RD National Natural Science Foundation of China; Zhejiang Provincial Key Science and Technology Project; Key Disciplines of Medicine; Fundamental Research Funds for the Central Universities. \n \nDeclaration of Interest: We declare no competing interests. \n \nEthical Approval: The study protocol was approved by the ethics review committee of The Children’s Hospital of the Zhejiang University (Approval Number:2016-JRB-018) and the cooperating institutions.