Bovet, Pascal

Mangroo , Gaynor

Marie , Georgiana

Viswanathan, Bharathi

Serveur académique lausannois

1 Overweight, obesity and walking time among children and adolescents: findings from the School Screening Program in 2016 and comparison with findings since 1998   Gaynor Mangroo (1), Bharathi Viswanathan (1), Georgiana Marie (2), Pascal Bovet (1,2)  1) Unit for Prevention and Control of Cardiovascular Diseases (UPCCD), Public Health Authority, MOH, Seychelles 2) School Health Program Manager, Public Health Authority, Ministry of Health, Seychelles 3) Institute of Social and Preventive Medicine, University of Lausanne, Switzerland  With the collaboration of the following school nurses: Juliette Albert (BVA); Elmonda Ernesta (BVA, GLA); Cecile Bacco (ARO); Vicky Rosine (BLA); Graciana Bossy (GAP); Brenda Bristol (PLS); Serra Desir (ERI); Nanne Bonne (BEO); Micheline Jeanne (LDI); Lorna Marie (ERI); Wihelmina Matombe (ABO); Marie Jane Henriette (TAK); Samta Dubignon (BSA); Rose Mary Poiret (PGL); Flavia Louis (PGL); Amelie Richmond (MFL), Huguette Vidot (AAP).   Public Health Authority, Ministry of Health, Seychelles, 3 April 2017   Summary    Within the School Screening Program, around 16 school nurses measure selected health markers every year, including weight, height and walking time to/from school, in all ~5000 students attending C2, P4, S1 and S4 classes in all schools.  Overweight and obesity are defined along standard age and sex specific criteria by the International Obesity Task Force (IOTF).  In 2016, weight and height were measured in 3759 students from 5545 eligible students, a participation rate of 68%.  In 2016, the prevalence of combined overweight or obesity (i.e. excess weight) was 20.1% in boys and 24.2% in girls and the prevalence of obesity alone was 8.8% in boys and 8.7% in girls. This prevalence is very high by international standards.  The prevalence of overweight/obesity markedly increased between 1998 and 2016, including in recent years.  In 2016, around 50% of children report to walk less than 15 minutes per day and around 70% less than 30 minutes.  Walking time to go to/from school decreased in the late 1990s but is fairly stable since the early 2010s.  Walking time is not associated with body weight. This is does not negate the fact that regular physical activity is a key component of good health but it emphasizes that unhealthy nutrition as the main underlying cause of excess weight (i.e. excess calories intake).   The continued secular increase in body weight of children, which is consistent with the continued increase of body weight in adults in adult surveys in Seychelles, stresses the need to address the societal causes of overweight (the “obesogenic environment”) through interventions in all sectors, e.g. banning advertisement and promotion of junk foods and beverages in schools and on TV, introduction of a tax on sugar drinks, develop mandatory food labeling for prepackaged foods, develop standards for school meals, increasing the number of physical activity at school, etc.  Continued monitoring of overweight/obesity in school children of Seychelles is an essential mechanism to guide policy. The School Screening Program should be strengthened, including by enabling school nurses to have sufficient time to perform the screening in all schools and provide related counseling on healthy lifestyles to children.     2 A) The school health program  The School Screening Program is run in schools by the Ministry of Health. Around 15‐20 school nurses screen all students of C2, P4, S1 and S4 of all schools (~5500 children) every year since 1998. The mean age of students at these grades is 5.4, 9.2, 12.5 and 15.5 years, respectively. Anthropometric variables (weight and height) and blood pressure are measured and students are asked about tobacco use, alcohol use, substance use, and physical activity. The use of same methods over years allows valid comparison of the findings over years. Overweight and obesity in children are defined along the standard age and sex specific criteria of the International Obesity Task Force (IOTF).  B) Results related to overweight and obesity in 2016  Participation to the school screening program in 2016 was 68% (3759 from 5545 eligible students in C2, P4, S1 and S4). Non participation relate to different factors, particularly to the fact that school nurses often lack time to complete the screening program due to competing duties at health centre level. Good organization by the school nurses and maintaining adequate equipment and facilities for screening are important factors for the smooth functioning of the screening program.  Table 1. Prevalence (in percent) of students who are overweight or obese in 2016 according to school and grade    C2     P4     S1     S4   School N %   N %   N %   N % AAP 51 23.5   68 22.1             ABO 81 17.3   75 22.7   121 26.4   64 21.9 ACA 36 13.9   48 10.4             AET 44 11.4   58 27.6             ARO 65 16.9   77 20.8   133 30.1   67 25.4 BEA 71 8.5   81 30.9             BEL       0 0  0 0 BLA 34 14.7   41 17.1             BOM 29 13.8   28 35.7             BSA 66 7.6   58 20.7             BVA 51 31.4   67 26.9    0 0   0   0 CAS 48 10.4   30 40.0             ERI       0 0  0 0 GAM 15 40.0   19 31.6             GAP 52 23.1   45 20.0   126 23.8   44 18.2 GLA 20 25.0   27 22.2             IND 0 0  0 0  0 0  0 0 LAD 30 20.0   37 35.1   45 24.4   39 23.1 LMI 27 14.8   14 14.3             LRE 19 5.3   25 24.0             LRO 120 13.3   105 35.2             MFL 70 10.0   91 24.2   100 28.0   85 24.7 PER 51 15.7   63 20.6             PGL 24 8.3    0 0              PLA 46 10.9   52 32.7   133 22.6   81 23.5 PLS 129 17.1   137 23.4   126 23.8   113 23.0 TAK 26 19.2   31 3.2             Total 1,205 15.5   1,277 24.8   784 25.6   493 23.1  3 C) Trends in overweight and obesity between 1998 and 2016  Table 1 show that the prevalence of combined overweight or obesity was 15.5% at crèche level, 24.8% at P4 level, 25.6% at S1 level and 23.1% at S4 level. Differences in results between different schools may relate to real differences or can be due to random variation due to the fairly small numbers of children in individual schools.   Table 2. Trends in the prevalence (in percent) of combined overweight or obesity, respectively obesity, between 1998 and 2016      Boys           Girls         Year N C2 P4 S1 S4 Total   C2 P4 S1 S4 Total Overweight or obese           1998 3'023 7.4 8.4 10.0 9.4 8.8  9.9 12.4 10.8 15.4 12.1 1999 5'492 8.5 9.1 11.3 7.5 9.1  12.3 15.2 18.1 17.7 15.8 2000 3'647 8.7 11.3 14.2 10.4 11.1  10.1 16.7 18.6 18.4 16.0 2001 5'387 7.6 13.7 11.6 9.1 10.5  11.7 17.3 16.9 16.0 15.5 2002 5'138 10.7 11.6 14.8 9.1 11.5  13.7 18.5 21.5 17.7 17.8 2003 5'793 11.5 15.0 15.8 12.5 13.7  13.3 19.9 21.9 20.4 18.9 2004 4'853 11.9 14.6 15.9 11.6 13.5  14.0 19.9 19.4 21.1 18.6 2005 5'616 8.7 13.8 18.3 12.8 13.4  13.0 20.6 20.4 20.4 18.6 2006 5'446 9.5 18.7 20.4 15.0 15.9  14.2 22.4 23.8 22.0 20.6 2011 4'715 11.5 20.9 21.5 17.2 17.8  12.2 19.0 23.5 22.2 19.2 2012 4'835 12.2 18.4 26.1 18.9 18.9  16.4 24.0 23.4 24.0 22.0 2013 4'220 13.1 17.8 26.3 19.0 19.1  15.6 24.7 25.2 20.2 21.4 2014 4'618 11.7 20.6 26.7 18.3 19.3  18.2 25.6 26.2 24.8 23.7 2015 4'259 15.0 18.1 27.5 19.2 20.0  17.0 23.7 28.1 26.1 23.7 2016 3'759 14.6 22.0 23.9 20.0 20.1  16.4 27.6 27.3 25.6 24.2 Obese             1998 3'023 1.6 2.3 2.2 2.5 2.1  3.2 1.9 2.8 4.4 3.1 1999 5'492 3.2 3.2 3.5 2.4 3.1  4.0 4.7 4.7 5.3 4.7 2000 3'647 2.9 3.0 4.9 3.1 3.5  2.4 4.5 3.7 6.4 4.2 2001 5'387 3.2 4.7 4.1 2.8 3.7  3.9 7.0 4.7 4.2 5.0 2002 5'138 4.5 4.8 3.9 3.1 4.1  5.3 5.7 5.4 6.3 5.7 2003 5'793 3.3 5.7 6.4 3.3 4.7  4.1 6.7 7.1 5.4 5.8 2004 4'853 6.0 6.2 4.6 3.8 5.1  5.9 7.2 6.4 5.8 6.3 2005 5'616 4.4 5.1 4.4 2.8 4.2  5.5 8.1 6.5 5.8 6.5 2006 5'446 3.6 7.9 6.8 5.5 6.0  5.2 9.0 8.3 9.0 7.9 2011 4'715 4.9 6.6 10.3 7.0 7.2  5.8 7.2 9.2 9.6 8.0 2012 4'835 5.3 8.8 10.9 7.4 8.1  6.2 8.8 9.6 10.5 8.8 2013 4'220 5.7 6.3 10.3 7.7 7.5  5.9 9.9 9.4 6.7 8.0 2014 4'618 4.2 9.6 9.7 7.2 7.7  8.5 10.4 9.5 11.7 10.0 2015 4'259 6.5 8.6 10.3 8.9 8.6  6.7 9.7 12.2 10.6 9.8 2016 3'759 7.6 10.2 8.9 8.6 8.8   5.7 10.4 7.9 10.6 8.7 Note: Percent in “Total” is based on the average of the prevalence rates in the 4 grades.  Table 2 shows that the prevalence of overweight has more than doubled between 1998 and 2016. In 2016, 20.1% of boys and 24.2% of girls aged 5-16 years had combined overweight or obesity, and 8.8% of boys and 8.7% of girls had obesity in 2016. These prevalence rates are very high by international standards.  Figure 1 shows that the prevalence of combined overweight or obesity (in blue) and obesity (in red) increased steadily over time in both boys and girls. The rates seem on a continued increase in recent years, with no sign of plateauing. 4 Figure 1. Prevalence (in percent) of children and adolescents aged 5-16 years with overweight (in blue) and obesity (in red) according to sex and calendar years between 1998 and 2016    D) Walking time per day to go to/from school Walking time increases with age and findings are fairly similar in boys and girls. This may reflect increasing autonomy of adolescents vs. younger children. Around 40-50% of boys and girls in S1 and S4 walk less than 20 minutes per day. Figure 2. Walking time according to grade and sex between 1998 and 2016      7 68 7 79 89 10011 1112 12 11 112.1 3.13.53.74.14.75.1 4.26.00.07.28.17.5 7.7 8.6 8.80510152025199819992000200120022003200420052006201120122013201420152016BoysObeseOverweight911 12 111213 12 12 1301113 13 14 14163.14.7 4.25.05.75.86.3 6.57.90.08.08.8 8.010.0 9.88.70510152025199819992000200120022003200420052006201120122013201420152016Girls0%10%20%30%40%50%60%70%80%90%100%199819992000200120022003200420052006201120122013201420152016Boys, S1≥ 60min30-59 min15-29 min<15 min0%10%20%30%40%50%60%70%80%90%100%199819992000200120022003200420052006201120122013201420152016Girls, S10%10%20%30%40%50%60%70%80%90%100%199819992000200120022003200420052006201120122013201420152016Boys, S4≥ 60min30-59 min15-29 min<15 min0%10%20%30%40%50%60%70%80%90%100%199819992000200120022003200420052006201120122013201420152016Girls, S45 Table 3. Age- and sex-adjusted association between body mass index and walking time among students in S1 and S4 in 2016    Regression coefficient SE P value Walking time (minutes) 0.006 0.009 0.492 Age (years) 0.630 0.094 0.000 Sex (boys vs girls) -1.012 0.281 0.000  Table 3 shows that walking time is not statistically associated with body mass index in adolescents (P value for walking time is >0.05). The analysis is limited to students in S1 and S4 in 2016. This finding is not unexpected; other studies in Seychelles (e.g. METS study among young adults where physical activity was measured accurately with accelerometry) and studies in other countries repeatedly show that physical activity has generally only little impact on body weight. This does not negate the benefits of physical activity on health, but it emphasizes that excess calorie intake is the main driving force of the obesity epidemic.  Recommendations 1) There is a need to further educate students of all ages on healthy nutrition, including the importance of smaller portions, the need to prefer water (including tap water) to soft drinks, “flavored water” or fruit juices, and the need to have physical activity on most days of the week. 2) The large scale of the overweight problem in Seychelles (also in adults) implies the need to address the societal causes of obesity through interventions in multiple sectors, e.g. “health in all policy” and “whole of society” approaches. 3) This includes, inter alia, the need to: a) Enforce the National School Nutrition Policy, including increased availability of healthy foods in all settings (including in school tuck shops and canteens), b) Sustain the provision of free cold water in all schools through water fountains (as an alternative to soft drinks and fruit juice packets), c) Restrict or ban, through regulations, the marketing of energy dense foods (“junk foods”) in the mass media, d) Develop mandatory food labeling for prepackaged foods (particularly with regard to total calorie and sugar contents, e) Develop standards for healthy meals such as “green fork meals” in canteens (including school meals), tuck shops and take away food (quantifying minimal/maximal amounts/types of foods (e.g. less than X grams of rice, more than Y grams of vegetables per take away portion, etc), f) Promote physical activity in the school setting, particularly the strict implementation of two (or if possible three) periods of physical activity per week for all students, with a focus on physical activity that is suitable to all children, including girls or obese children, g) Further develop physical activity programs in different settings outside of school hours, h) Develop measures focusing on improving urban shaping enabling students to come to school by foot or by bike, including safe side-walks or bike lanes (e.g. between Plaisance, Perseverance and Victoria). i) Continued monitoring of overweight/obesity and other health markers in schools is essential to guide health policy. In particular, it is important that the school health nurses can dedicate sufficient time for effective implementation of all the components of the School Health Program, j) Of note the Seychelles National NCD Strategy (adopted by Cabinet in 2016) has set the target of a 0% relative increase of obesity between 2010 and 2025, consistent with the same global goal agreed by all WHO member states. The prevalence of overweight and obesity in children is a routine indicator that countries have agreed to report on a regular basis to WHO. 

Overweight, obesity and walking time among children and adolescents: findings from the School Screening Program in 2016 and comparison with findings since 1998

https://serval.unil.ch/resource/serval:BIB_8B6A9A5A73D5.P001/REF.pdf

Overweight, obesity and walking time among children and adolescents: findings from the School Screening Program in 2016 and comparison with findings since 1998

Abstract

Similar works

Full text

Available Versions

Serveur académique lausannois