Trends in overweight and obesity in Lebanon: evidence from two national cross-sectional surveys (1997 and 2009)

Lara Nasreddine, Farah Naja, Marie Claire Chamieh, Nada Adra, Abla-Mehio Sibai, Nahla Hwalla, Lara Nasreddine, Farah Naja, Marie Claire Chamieh, Nada Adra, Abla-Mehio Sibai, Nahla Hwalla

Abstract

Background: Even though the obesity epidemic continues to grow in various parts of the world, recent reports have highlighted disparities in obesity trends across countries. There is little empirical evidence on the development and growth of obesity in Lebanon and other countries of the Eastern Mediterranean Region. Acknowledging the need for effective obesity preventive measures and for accurate assessment of trends in the obesity epidemic, this study aims at examining and analyzing secular trends in the prevalence of overweight and obesity over a 12-year period in Lebanon.

Methods: Based on weight and height measurements obtained from two national cross-sectional surveys conducted in 1997 and 2009 on subjects 6 years of age and older, BMI was calculated and the prevalence of obesity was determined based on BMI for adults and BMI z-scores for children and adolescents, according to WHO criteria. Age -and sex- adjusted odds ratios for overweight and obesity were determined, with the 1997 year as the referent category. Annual rates of change in obesity prevalence per sex and age group were also calculated.

Results: The study samples included a total of 2004 subjects in the 1997 survey and 3636 in the 2009 survey. Compared to 1997, mean BMI values were significantly higher in 2009 among all age and sex groups, except for 6-9 year old children. Whereas the prevalence of overweight appeared stable over the study period in both 6-19 year old subjects (20.0% vs. 21.2%) and adults aged 20 years and above (37.0% vs. 36.8%), the prevalence of obesity increased significantly (7.3% vs. 10.9% in 6-19 year olds; 17.4% vs. 28.2% in adults), with the odds of obesity being 2 times higher in 2009 compared to 1997, in both age groups (OR = 1.96, 95% CI:1.29-2.97 and OR = 2.01, 95% CI: 1.67-2.43, respectively). The annual rates of change in obesity prevalence ranged between +4.1% in children and adolescents and +5.2% in adults.

Conclusion: The study's findings highlight an alarming increase in obesity prevalence in the Lebanese population, over the 12-year study period, and alert to the importance of formulating policies and nutritional strategies to curb the obesity rise in the country.

Figures

Figure 1
Figure 1
Median body mass index of study subjects by sex, age group and survey year in the study population, Lebanon 1997-2009.
Figure 2
Figure 2
Prevalence (%) of obesity among Lebanese adults, children and adolescents (using both IOTF and CDC criteria[12,13]) compared to those reported from selected countries of the Eastern Mediterranean region & worldwide.

References

    1. Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world- a growing challenge. N Engl J Med. 2007;356:213–215. doi: 10.1056/NEJMp068177.
    1. Sibai A, Nasreddine L, Mokdad AH, Adra N, Tabet M, Hwalla N. Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence. Ann Nutr Metab. 2010;57:193–203. doi: 10.1159/000321527.
    1. Ng SW, Zaghloul S, Ali HI, Harrison G, Popkin BM. The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States. Obes Rev. 2011;12:1–13.
    1. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN, Farzadfar F, Riley LM, Ezzati M. on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–567. doi: 10.1016/S0140-6736(10)62037-5.
    1. Rokholm B, Baker JL, Sørensen TI. The levelling off of the obesity epidemic since the year 1999 - a review of evidence and perspectives. Obes Rev. 2010;11:835–846. doi: 10.1111/j.1467-789X.2010.00810.x.
    1. Orsi CM, Hale DE, Lynch JL. Pediatric obesity epidemiology. Curr Opin Endocrinol Diabetes Obes. 2011;18:14–22. doi: 10.1097/MED.0b013e3283423de1.
    1. Sibai AM, Hwalla N, Adra N, Rahal B. Prevalence and covariates of obesity in Lebanon: Findings from the first epidemiological study. Obes Res. 2003;11:1353–1361. doi: 10.1038/oby.2003.183.
    1. Sibai A, Fletcher A, Hills M, Campbell O. Non-communicable disease mortality rates using the verbal autopsy in a cohort of middle aged and older populations in Beirut during wartime, 1983–1993. J Epidemiol Community Health. 2001;55:271–276. doi: 10.1136/jech.55.4.271.
    1. Mehio-Sibai A, Obeid O, Batal M, Adra N, El Khoury D, Hwalla N. Prevalence and Correlates of metabolic syndrome in an adult Lebanese population. Prevention and Control. 2008;3:83–90. doi: 10.1016/j.precon.2007.06.002.
    1. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 1998;6(Suppl 2):51–209. Published correction appears in Obes Res 1998, 6:464.
    1. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660–667. doi: 10.2471/BLT.07.043497.
    1. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000;320:1240–1243. doi: 10.1136/bmj.320.7244.1240.
    1. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL. 2000 CDC growth charts for the United States: Methods and development. Vital Health Stat 11. 2002;246:1–190.
    1. Lebanese Republic Ministry of Social Affairs, Central Administration for Statistics and the United Nations Development Programme (UNDP) Living Conditions of Households - The National Survey of Household Living Conditions. Beirut: MOSA; 2004.
    1. United Nations Fund for Population Activities (UNFPA) and the Lebanese Republic Ministry of Social Affairs. Statistical Tables for the Population and Housing Survey (PHS, 1994–1996) Beirut: MOSA; 1996.
    1. Lee R, Nieman D. Nutritional Assessment. New York: McGraw-Hill Companies; 2007.
    1. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, Qizilbash N, Collins R, Peto R. Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083–1096. doi: 10.1016/S0140-6736(09)60318-4.
    1. Esteghamati A, Khalilzadeh O, Mohammad K, Meysamie A, Rashidi A, Kamgar M, Abbasi M, Asgari F, Haghazali M. Secular trends of obesity in Iran between 1999 and 2007: National Surveys of Risk Factors of Non-communicable Diseases. Metab Syndr Relat Disord. 2010;8:209–213. doi: 10.1089/met.2009.0064.
    1. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006;1:11–25. doi: 10.1080/17477160600586747.
    1. Lazzeri G, Pammolli A, Pilato V, Giacchi MV. Relationship between 8/9-yr-old school children BMI, parents’ BMI and educational level: a cross sectional survey. Nutr J. 2011;10:76. doi: 10.1186/1475-2891-10-76.
    1. Ahmed F, Waslien C, Al-Sumaie MA, Prakash P. Secular trends and risk factors of overweight and obesity among Kuwaiti adults: National Nutrition Surveillance System data from 1998 to 2009. Public Health Nutr. 2012;21:1–7.
    1. Al-Baghli NA, Al-Ghamdi AJ, Al-Turki KA, El-Zubaier AG, Al-Ameer MM, Al-Baghli FA. Overweight and obesity in the eastern province of Saudi Arabia. Saudi Med. 2008;29:1319–1325.
    1. Al-Kandari YY. Prevalence of obesity in Kuwait and its relation to sociocultural variables. Obes Rev. 2006;7:147–154.
    1. Fouad M, Rastam S, Ward K, Maziak W. Prevalence of obesity and its associated factors in Aleppo, Syria. Prev Control. 2006;l2:85–94.
    1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303:235–241. doi: 10.1001/jama.2009.2014.
    1. Berghöfer A, Pischon T, Reinhold T, Apovian CM, Sharma AM, Willich SN. Obesity prevalence from a European perspective: a systematic review. BMC Public Health. 2008;8:200. doi: 10.1186/1471-2458-8-200.
    1. Gharib M, Rasheed P. Obesity among Bahrani children and adolescents: Prevalence and associated factors. JBMS. 2008;20:114–123.
    1. Nasreddine L, Sibai AM, Mrayati M, Adra N, Hwalla N. Adolescent obesity in Syria: Prevalence and associated factors. Child Care Health Dev. 2010;36:404–413. doi: 10.1111/j.1365-2214.2009.01042.x.
    1. Bener A. Prevalence of obesity, overweight, and underweight in Qatari adolescents. Food Nutr Bull. 2006;27:39–45.
    1. Malik M, Bakir A. Prevalence of overweight and obesity among children in the United Arab Emirates. Obes Rev. 2006;8:15–20.
    1. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA. 2010;303:242–249. doi: 10.1001/jama.2009.2012.
    1. Taheri F, Kazemi T. Prevalence of overweight and obesity in 7 to 18 year-old children in Birjand/Iran. Iranian J Pediatr. 2009;19:135–140.
    1. El Mouzan MI, Foster PJ, Herbish AS, Al Salloum AA, Al Omer AA, Qurachi MM, Kecojevic T. Prevalence of overweight and obesity in Saudi children and adolescents. Ann Saudi Med. 2010;30:203–208. doi: 10.4103/0256-4947.62833.
    1. United Nations, Division for Public Administration and Development Management (DPADM), Department of Economic and Social Affairs (DESA) Republic of Lebanon, Public Administration, Country Profile. New York: United Nations; 2004.
    1. Flegal KM, Ogden CL, Carroll MD. Prevalence and trends in overweight in Mexican-American adults and children. Nutr Rev. 2004;62(Suppl 2):144–148.
    1. Fazah A, Jacob C, Moussa E, El-Hage R, Youssef H, Delamarche P. Activity, inactivity and quality of life among Lebanese adolescents. Pediatr Int. 2010;52:573–578. doi: 10.1111/j.1442-200X.2009.03021.x.
    1. Boone JE, Gordon-Larsen P, Adair LS, Popkin BM. Screen time and physical activity during adolescence: longitudinal effects on obesity in young adulthood. Int J Behav Nutr Phys Act. 2007;4:26. doi: 10.1186/1479-5868-4-26.
    1. Kalies H, Lenz J, von Kries R. Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982–1997. Int J Obes. 2002;26:1211–1217. doi: 10.1038/sj.ijo.0802013.

Source: PubMed

3
Abonnieren