Editorial
Epidemic increase in overweight and obesity in Chinese children from 1985 to 2005

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Abstract

This study tracks the temporal changes in prevalence of childhood and adolescent overweight and obesity in different regions of China from 1985 to 2005. Using a series data of the Chinese National Survey on Students Constitution and Health, we compared the temporal changes over a 20-year period of the prevalence of overweight and obesity among ten regions in China for school-aged children between 7 and 18 years of age. Large disparities in the temporal changes of obesity prevalence exist in different regions of China. North coastal residents, especially those of the upper socioeconomic status, had the earliest and largest increase in prevalence. Similar increases then followed successively in other regions of upper, moderate and low socioeconomic status, and finally in the affluent rural regions. No significant increase was found in the developing rural areas. Regions where the obesity epidemic occurred late also began to show rather rapid increases in prevalence in recent years. In 2005, the national estimates indicated that 7.73% of Chinese youth are overweight and 3.71% of them are obese, representing an estimated 21.37 million Chinese children (13.43 million boys and 7.94 million girls).

Introduction

The increasing global prevalence of overweight and obesity among children and adolescents constitutes a public health crisis [1], [2]. Prevalence of obesity and overweight has increased dramatically in both the developed countries and the urbanized areas of developing countries [3], [4], [5]. The increase in most Western countries took place in the 1970s, and reached an epidemic proportion by the late 1990s, most noticeably in the United States and Western Europe [6], [7], [8], [9]. In the U.S., the prevalence of overweight increased from 14.0% and 13.8% in 1999–2000 to 18.2% and 16.0% in 2003–2004, for male and female children and adolescents, respectively, [10] with one in three children being overweight or worse in 2008 [11]. In Sweden, overweight and obesity among children aged 6–11 years increased from 11.5% in 1986 to 23% in 2001 [6]. In Finland, the prevalence of overweight and obesity increases from 8.3% and 4.4% for boys and girls, aged 12–18 years in 1977 to 19.4 and 11.2% in 1999 [12]. A similar trend became evident in Central and Eastern Europe more recently [13]. In Cracow, Poland, where the prevalence of obesity is much lower than in most Western countries, the prevalence of overweight and obesity among girls had almost doubled in 30-year period from 1971 to 2000 [14].

China, used to be known for her slender people, has now joined the world epidemic of obesity [15]. Previous reports suggested that the epidemic of childhood overweight and obesity in China has spread all over the country since the end of 20th century, although there are differences among different regions [16]. We previously reported that the rates in combined category of overweight and obesity in Chinese children in the upper socioeconomic status regions in China approached that of developed countries, followed by other city regions and rural areas [17]. Similar geographical differences of prevalence of overweight school-aged children were reported in the United States [18]. If these geographical differences are not taken into consideration, erroneous predictions may ensue [19].

The geographical distribution of childhood obesity in China is mainly caused by the disparity in the socioeconomic status related to dietary and lifestyle changes in modern China [17]. Although geographical comparison of prevalence of overweight and obesity in school-aged children in China is important for the understanding of the epidemics of childhood and adolescent obesity in China, it is just as important to analyze the temporal changes of the prevalence in different periods of time. Time is the best measure of evolution. Evolution differs in different regions of China at different periods of time.

The purposes of this study are: a) to assess the temporal changes of the prevalence of overweight and obesity in school-aged children in different socioeconomic regions of China between 1985 and 2005 using the Chinese population-specific reference, [20] b) to estimate the obesity prevalence of the school-aged children on a national level, and c) to investigate the effects of environmental factors on the outcomes.

Section snippets

Samples and data collection

Data were obtained from the 1985, 1991, 1995, 2000 and 2005 cycles of the CNSSCH (Chinese National Survey on Students Constitution and Health) [21], [22], [23], [24], [25]. The sampling frame and principles of the CNSSCH were described in detail in our previous publication [17]. This survey, with its largest nationally representative sample size so far in China, have been widely used to produce national and state prevalence estimates for a variety of health indicators of the school-aged

Dramatic increase in obesity prevalence in major cities

Table 2, Table 3 depict in details the temporal changes from 1985 to 2005 in the obesity prevalence in ten geographical regions in China. They are graphically shown in Fig. 2. The largest increases in prevalence were found in group I (north coastal upper socioeconomic status cities) and occurred as early as 1985, and the prevalence of combined category in overweight and obesity increased steadily and rapidly. During this period, higher rates of obesity were found than those of overweight, for

Discussion

The present study focuses on the 20-year trends in childhood obesity in China from 1985 to 2005. The 20-year period can be divided into five stages, each of which has special features:

  • I)

    The year of 1985 can be considered as the beginning of childhood overweight and obesity epidemic in China. Prevalence of overweight significantly increased in the north coastal upper socioeconomic status cities, while most of the obese cases came from the metropolises, such as Beijing and Shanghai.

  • II)

    Years 1985–1991

Acknowledgement

This study was supported by the 973 national grants, Ministry of Sciences and Technology, China (2001CB510310). We would like to thank Mr. WK. Liao, Mr. WH. Xing, Ms X Zhang, and other CNSSCH (Chinese National Survey on Students' Constitution and Health) members for providing access to the survey data.

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