Child and adolescent obesity prevalence in the Gulf Cooperation Council countries and its impact on adolescent females in Kuwait

Student thesis: Doctoral Thesis

Abstract

Background: Obesity is a global problem that has become very prevalent in children and adolescents in the six Gulf Cooperation Council countries (GCC), with Kuwait being in the forefront. However, there is lack of evidence on the current im-pact of obesity among school-age children adolescents in Kuwait and the other GCC countries. Aims and objectives: This thesis aimed to assess the impact of child and adolescent obesity in Kuwait and the GCC countries through (a) testing how well child and adolescent obesity is monitored in the GCC states, (b) assessing the extent to which surveys and studies of obesity using the BMI might be underestimating the prevalence of obesity, and finally (c) investigating associations between adolescent obesity and educational attainment and cognitive inhibition. Methods: This thesis presents four manuscripts (studies 1-4). The first is a systematic review on the recent prevalence of obesity among school age children and adolescents in the GCC countries. The second, third, and fourth studies were based on a prospective study of 400 healthy Kuwaiti female adolescents. Study 2 examined the ability of BMI-for-age to define high body fatness (defined by ≥30 %) by com-paring BMI-for-age defined obesity against body fatness measures from bio-electrical impedance (BIA). Study 3 examined cross sectional associations between obesity (defined by both BMI-for-age and high body fatness) and educational attainment using Grade Point Average (GPA). Study 4 tested for an association between obesity (defined as both BMI-for-age and high body fatness) and cognitive inhibition, measured by the Stroop Colour Word Test (SCWT), the first computerised SCWT in the Arabic language. Results: The systematic review (Study 1) included 11 eligible studies from the six GCC countries that showed a high prevalence of obesity as defined by BMI-for-age among school-age children and adolescents, and prevalence seemed to in-crease consistently with age according to these 11 studies. Evidence on obesity prevalence in the GCC countries was quite limited e.g. Bahrain, Oman, and Qatar had no recent data on prevalence, and nationally representative surveys of prevalence are scarce. Kuwait was the only country from the GCC countries that had a national sur-vey for obesity prevalence. The second thesis study found a higher prevalence of obesity based on high body fatness (62% of the sample had body fat percentage above ≥30) than the prevalence of obesity based on BMI for age (42%). The sensitivity of BMI-for-age was moderate (66%) but specificity was high (96%). In the third study, obese students (defined by BMI and body fatness) had significantly lower academic attainment (measured by Grade Point Average) compared to their non-obese individuals, and BMI-defined obese individuals were more likely to be in the lowest quartile for the GPA than the non-obese individuals (OR 3.03, 95% CI 1.90-4.85, P < 0⋅001). In the fourth study, the performance on the Stroop Colour Word Test (SCWT) was significantly lower in obese (defined by BMI and body fatness) than non-obese individuals. BMI-defined obese individuals were at significantly higher risk of being in the lowest quartile of SCWT compared to non-obese individuals (OR 2.05, 95% CI 1.30 - 3.25, P
Date of Award28 Sep 2021
Original languageEnglish
Awarding Institution
  • University Of Strathclyde
SupervisorJohn Reilly (Supervisor) & Allan Hewitt (Supervisor)

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