Hira Sing, R.A.

Kist-van Holthe, J.E.

Rest, J. van

Schwiebbe, L.

Verhagen, E.

Visser, R.W.M.

DSpace at VU

West Indian Med J 2011; 60 (4): 442
From: 1Department of Public and Occupational Health and the EMGO
Institute for Health and Care Research, VU University Medical Center,
Amsterdam, The Netherlands, and 2Richard Visser Institute, Oranjestad,
Aruba.
Correspondence: Dr J Kist-van Holthe, Department of Public and
Occupational Health and the EMGO Institute for Health and Care Research,
VU University Medical Center, van der Boechorststraat 7, 1081 BT
Amsterdam, The Netherlands. E-mail: j.kist@vumc.nl, fax +31204448387.
INTRODUCTION
Worldwide, the prevalence and severity of overweight and
obesity among children is increasing (1, 2). Obesity leads to
chronic illnesses like type 2 diabetes, hypertension and car-
diovascular disease (3–5). The Governor of Bonaire re-
quested a determination of the prevalence of overweight and
obesity among Bonarian children. A high response rate was
expected in this study. It was also expected that there would
Childhood Obesity in the Caribbean
L Schwiebbe1, J van Rest1, E Verhagen1, RWM Visser2, J Kist-van Holthe1, RA Hirasing1
ABSTRACT
Objective: To determine the prevalence of overweight among school children in Bonaire, an island in
the Caribbean, and to obtain clues for prevention of overweight.
Methods: In a cross-sectional school-based study, weight and height were measured in all 4–16-year
old children in Bonaire (n = 2148). Body mass index was categorized as defined by the International
Obesity Task Force (IOTF). The children were administered a questionnaire pertaining to lifestyle and
nutrition.
Results: The prevalence of overweight, including obesity, in boys is 24.3%, and 31.9% in girls; obesity
is 9.9% and 13.7%, respectively. Approximately half of the children have an unhealthy food pattern.
Significantly less overweight (49%) and obese children (45%) are physically active for > 1 hour/day
compared to normal weight children (56%).
Conclusion: The prevalence of overweight and obesity in children in Bonaire is high. Prevention of
overweight should focus on stimulating healthy eating habits and more physical activity.
Keywords: Bonaire, Caribbean, child, obesity
La Obesidad Infantil en el Caribe
L Schwiebbe1, J van Rest1, E Verhagen1, RWM Visser2, J Kist-van Holthe1, RA Hirasing1
RESUMEN
Objetivo: El objetivo de este estudio fue determinar la prevalencia de sobrepeso entre los niños
escolares en Bonaire – una isla en el Caribe – y obtener ideas para la prevención del sobrepeso.
Métodos: Se realizó un estudio transversal en una escuela, en el cual se midió el peso y la altura de
todos los niños de 4–16 años de edad en Bonaire, (n = 2148). El índice de masa corporal se categorizó
de acuerdo con las definiciones dadas por la llamada International Obesity Task Force. A los niños se
les aplicó una encuesta sobre el estilo de vida y la nutrición.
Resultados: La prevalencia de sobrepeso – incluyendo la obesidad – en los niños fue 24.3%, y en las
niñas 31.9%, en tanto que la prevalencia de la obesidad fue 9.9% y 13.7% respectivamente.
Aproximadamente la mitad de los niños tenía un patrón alimentario poco saludable. Un número
significativo de niños de menos sobrepeso (49%) y menos obesos (45%) era físicamente activo durante
> 1 hora/día, en comparación con los niños de peso normal (56%).
Conclusión: La prevalencia de sobrepeso y la obesidad en los niños de Bonaire es alta. La prevención
de sobrepeso debe centrarse en estimular hábitos saludables de alimentación y mayor actividad física.
Palabras claves: Bonaire, Caribeño, niño, obesidad
West Indian Med J 2011; 60 (4): 442
443
be a low influence of fast-food chains on the island. Fast
food is often associated with overweight and obesity (6).
The aim of this study was to determine the prevalence
of overweight and obesity in school children in Bonaire and
to compare the outcome with studies from other islands in the
Caribbean. A second aim of the study was to obtain clues for
prevention of overweight.
SUBJECTS AND METHODS
A cross-sectional study was carried out among all school
children in Bonaire, an island in the Caribbean, from March
– April 2008. All children attending public school were
asked to participate in the study. Parental permission for
participation in the study was given by means of passive
informed consent.
Measurement of weight and height was performed by
two trained research assistants. Weight was measured to the
nearest 0.1 kg with a calibrated digital scale (Seca® type 80)
without shoes in light summer clothes. Height was measured
to the nearest 0.1 cm with a microtoise. Body mass index
(BMI) was calculated as weight (kg)/height (m2). Over-
weight and obesity are categorized according to cut-off
values defined by the International Obesity Task Force
[IOTF] (7).
To get a perspective of the severity of overweight and
obesity, the prevalence of obesity was divided by the pre-
valence of overweight (and obesity), and this was called the
obesity index.
A questionnaire pertaining to lifestyle and nutrition
was administered by two research assistants. The question-
naire contained items about fruit and vegetable consumption,
physical activity, television and computer time on the
previous day and consumption of breakfast on the morning of
the study.
Statistical analysis was performed using SPSS version
15.0. The chi-square test was used to calculate differences
between groups. A p-value < 0.05 was considered statisti-
cally significant.
RESULTS
Eighty-seven per cent (2148/2460) of 4–16-year old children
living in Bonaire participated in the study, of which 49.6%
(1065) were boys. The overall prevalence of overweight,
including obesity, is 24.3% (259/1065) in boys and 31.9%
(346/1083) in girls. For obesity, the prevalence is 9.9%
(105/1065) and 13.7% (148/1083), respectively. In Fig. 1,
the age and gender specific prevalence of overweight and
obesity in children in Bonaire is given. The obesity index for
6–11-year old boys in Bonaire is 0.42, and for girls 0.40. For
12–16-year old children, the obesity index is 0.36 and 0.46,
respectively. Table 1 depicts lifestyle and nutrition
characteristics (food pattern, physical activity and screen
time) of 74% (1581/2148) of children derived from the
questionnaire. Information concerning the type of household
was available for 82% (1758/2148) of children; of these, 57%
Schwiebbe et al
Fig. 1a: Prevalence of overweight and obesity in 4–16-year old boys in
Bonaire.
Table 1: Lifestyle and nutrition characteristics of 74% (1581/2148) of
children according to weight status in Bonaire
Normal Overweight Obesity nw-ov nw-ob
weight
% % % p p
breakfast 70 65 70 ns ns
vegetables 55 57 58 ns ns
fruit ≥ 2 pieces 49 50 45 ns ns
sweet beverage 73 69 71 ns ns
fast-food 36 34 30 ns ns
physical activity ≥ 1 h 56 49 45 < 0.05 < 0.05
physical activity ≥ 2 h 31 25 21 < 0.05 0.001
TV viewing > 2 h 27 26 27 ns ns
TV in bedroom 46 49 49 ns ns
computer > 2 h 14 12 15 ns ns
Fruit and vegetable consumption, physical activity, television and computer
time pertain to the previous day and breakfast to the morning of the study;
measurements. nw-ov: children with normal weight compared to overweight;
nw-ob: children with normal weight compared to obesity; ns: not significant.
Fig. 1b: Prevalence of overweight and obesity in 4–16-year old girls in
Bonaire.
pe
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444Childhood Obesity in the Caribbean
(1041) belonged to a single parent household. Single parent
households were evenly distributed among children with nor-
mal weight (57%), overweight (54%) and obesity (57%).
DISCUSSION
The small population (14 000 residents) and surface area (111
square miles) of the island make it relatively easy to collect
data from all children in Bonaire. Because of this, the
participation in the study was high (87%).
More girls than boys in Bonaire are overweight and
obese. The prevalence of overweight (including obesity) in
children in the Caribbean is high, but varies among islands
(Table 2). Compared to Bonaire, less children in St Lucia,
risk factor for overweight in children (6). Fast food is easily
accessible due to the presence of numerous selling points and
low prices in Aruba. In Bonaire, however, at the time of the
study, there was only one small Kentucky Fried Chicken
restaurant and there were no other fast-food chains. None-
theless, in the absence of fast-food chains, children still eat
the local fast food which frequently contains fat and sugar in
abundance.
Approximately half of the children have an unhealthy
food pattern: they consume less than two pieces of fruit a day
and no vegetables. A recent survey on nutrition also showed
that no more than 57% of adults in Bonaire consume vege-
tables and only 46% eat fruit on a daily basis (14). The high
price of fresh vegetables and fruit may well be an inhibiting
factor.
The National Association for Sports and Physical Edu-
cation in the United States of America (USA) recommends
that school-age children accumulate at least 60 minutes and
up to several hours of physical activity per day while avoid-
ing prolonged periods of inactivity (15). In Bonaire, signi-
ficantly less over-weight (49%) and obese (45%) children are
physically active for more than 60 minutes a day compared
to normal weight (56%) children. Although from the present
study we cannot conclude if this physical inactivity is the
cause or the consequence of being overweight, a systematic
review concluded that higher levels of regular physical
activity are protective against child and adolescent obesity
(16).
It is important to prevent or delay the transition from
overweight to obesity. The obesity index is a tool that can be
used to monitor this transition. Compared to Bonaire (0.42)
the obesity index for 6–11-year old boys in Aruba (0.47) is
higher but in the USA (0.34) it is lower. The same applies to
6–11-year old girls; their obesity index is 0.40 (Bonaire),
0.43 (Aruba) and 0.37 [USA] (2, 12).
CONCLUSION
The prevalence of obesity in 4–16-year old children is high
in Bonaire despite the low influence of fast-food companies
on the island. Effective measures are urgently needed to pre-
vent obesity in children in Bonaire. Prevention of overweight
should focus on stimulating healthy eating habits and more
physical activity.
ACKNOWLEDGEMENTS
This work was supported by the Department of Health and
Hygiene of Bonaire and Maduro & Curiels Bank. We thank
S Pourier, Head of the department of Child Health Care in
Bonaire, for her contribution to the study. We also thank the
children and their parents, as well as the school staff for their
participation in the study.
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Table 2: Prevalence of overweight including obesity in children and
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