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Epidemiology and Population Health

Association of dietary intake, physical activity, and sedentary behaviours with overweight and obesity among 282,213 adolescents in 89 low and middle income to high-income countries

International Journal of Obesity volume 45, pages 2404–2418 (2021)Cite this article

Subjects

Abstract

Background

Adolescent overweight and obesity are well documented in high-income countries (HICs). They are also emerging as a global public health concern in low-and middle-income countries (LMICs), yet there is a lack of reliable, national-level data to inform policies and interventions. This study aimed to estimate the prevalence of overweight and obesity and assess associated lifestyle risk factors amongst school-going adolescents in LMICs as well as HICs.

Methods

A total of 282,213 samples were drawn from 89 LMICs and HICs in the ‘latest Global School-based Student Health Survey’ of school children, aged 11–17 years, during 2003 to 2015, in the six World Health Organisation (WHO) regions. The prevalence of adolescent overweight and obesity were estimated using the WHO BMI-for-age growth standards. A multinomial logistic regression model was employed to estimate the adjusted (age and sex) association of food patterns, physical activity, and sedentary behaviours with adolescent overweight and obesity.

Results

The pooled prevalence of overweight and obesity amongst adolescents was 10.12%, and 4.96%, respectively, ranging from 2.40% in Sri Lanka to 29.08% in Niue for overweight and 0.40% in Sri Lanka to 34.66% in the Cook Islands for obesity. Overweight and obesity were associated with unhealthy dietary intake and lifestyles including respectively fast-food intake (adjusted relative risk ratio, RRR = 1.09; 95% CI: 1.05–1.12 and RRR = 1.32; 95% CI: 1.26–1.38), a high level of carbonated soft drinks consumption (RRR = 1.19; 1.12–1.24 and RRR = 1.28; 1.18–1.38), a low level of physical activity (RRR = 1.11; 1.06–1.17 and 1.20; 1.12–1.28), and high level of sedentary behaviours (RRR = 1.33; 1.27–1.39 and RRR = 1.73; 1.63–1.84). Adolescents who consumed vegetables at least two times per day had a lower risk of overweight (22%) and obesity (17%) than those who did not consume vegetables per day.

Conclusions

Adolescent overweight and obesity represent a global public health problem and can possibly track into adult weight status and morbidity. School-based obesity prevention that promotes environmental and policy changes related to healthy dietary practices and active living are urgently needed to curb the trend.

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Acknowledgements

This research paper was drafted and completed during the first author’s postdoctoral-1 research works under the School of Social Science, Western Sydney University, Australia. The revision of this manuscript was performed during the first author’s postdoctoral-2 (health economics) research works under NHMRC Clinical Trials Centre, the School of Medicine and Health, the University of Sydney, Australia. We would also like to thank the global school-based student health survey for providing access to the data utilised in the research. Finally, we would like to gratefully acknowledge the study’s participants, reviewers, and the academic editors of our manuscript.

Author information

Authors and Affiliations

  1. Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia

    Rashidul Alam Mahumud & Rachael Lisa Morton

  2. Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia

    Rashidul Alam Mahumud

  3. School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia

    Berhe W. Sahle

  4. Centre for Quality and Patient Safety Research (QPS), Alfred Health Partnership, Melbourne, VIC, Australia

    Berhe W. Sahle

  5. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

    Berhe W. Sahle

  6. Bureau of Integrated Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Ebenezer Owusu-Addo

  7. Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China

    Wen Chen

  8. Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China

    Wen Chen

  9. School of Medicine, Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia

    Andre M. N. Renzaho

  10. Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia

    Andre M. N. Renzaho

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  1. Rashidul Alam Mahumud
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Contributions

Conceptualised the study: RAM; Contributed data extraction and analyses: RAM under the guidance of RLM and AMNR. Result interpretation: RAM, under the guidance of RLM and AMNR. Prepared the first draft: RAM, BWS, EOA, WC and AMNR. Contributed during the conceptualisation and interpretation of results and substantial revision: RAM, AMNR and RLM. Revised and finalised the final manuscript: RAM, BWS, EOA, WC, RLM and AMNR. All authors read and approved the final version of the manuscript.

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Correspondence to Rashidul Alam Mahumud.

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Mahumud, R.A., Sahle, B.W., Owusu-Addo, E. et al. Association of dietary intake, physical activity, and sedentary behaviours with overweight and obesity among 282,213 adolescents in 89 low and middle income to high-income countries. Int J Obes 45, 2404–2418 (2021). https://doi.org/10.1038/s41366-021-00908-0

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