Skip to main content
SpringerLink
Log in

Prevalence and lifestyle determinants of central obesity in children

  • Original Contribution
  • Published:
European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

Central obesity is a strong risk factor for metabolic disorders and cardiometabolic diseases in children and adolescents. The aim of the present study was to evaluate the prevalence of central obesity and to determine its cross-sectional association with lifestyle habits in a sample of school-aged children in Greece.

Methods

The study sample consisted of 124,113 children (9.9 ± 1.1 years old, 51 % boys) attending the third and fifth grade of primary school. Anthropometric measurements were performed by trained physical education teachers, and central obesity was defined as waist-to-height ratio ≥0.5. Children’s lifestyle habits were assessed through 7-day recall questionnaires.

Results

Of the participating children, 33.4 % were classified as centrally obese. Central obesity was significantly more prevalent in boys than in girls (36.0 vs. 30.7 %, P < 0.001) and was present in 95 % of obese children, as well as in a significant percentage of overweight (69.5 %) and normal-weight ones (12.0 %). Children with central obesity, compared to their non-centrally obese counterparts, reported poorer dietary habits and were less physically active. According to multiple logistic regression analysis, frequent breakfast (OR 0.72, 95 % CI 0.69–0.75) and snack consumption (OR 0.70, 95 % CI 0.67–0.74), as well as frequent participation in sedentary activities (OR 1.10, 95 % CI 1.07–1.14), were the strongest lifestyle determinants of central obesity.

Conclusion

Strategies for the prevention of central obesity and associated comorbidities are urgently needed, for both obese and non-obese children. Our results suggest the need for a shift towards a healthier environment for our children, with emphasis on specific lifestyle habits, such as regular meal consumption and low sedentariness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ebbeling CB, Pawlak DB, Ludwig DS (2002) Childhood obesity: public-health crisis, common sense cure. Lancet 360(9331):473–482. doi:10.1016/S0140-6736(02)09678-2

    Article  Google Scholar 

  2. Wang Y, Lim H (2012) The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. Int Rev Psychiatry 24(3):176–188. doi:10.3109/09540261.2012.688195

    Article  Google Scholar 

  3. Wang Y, Lobstein T (2006) Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes IJPO 1(1):11–25

    Article  Google Scholar 

  4. Canoy D, Boekholdt SM, Wareham N, Luben R, Welch A, Bingham S, Buchan I, Day N, Khaw KT (2007) Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk cohort: a population-based prospective study. Circulation 116(25):2933–2943. doi:10.1161/CIRCULATIONAHA.106.673756

    Article  Google Scholar 

  5. Despres JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E, Rodes-Cabau J, Bertrand OF, Poirier P (2008) Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol 28(6):1039–1049. doi:10.1161/ATVBAHA.107.159228

    Article  CAS  Google Scholar 

  6. Krekoukia M, Nassis GP, Psarra G, Skenderi K, Chrousos GP, Sidossis LS (2007) Elevated total and central adiposity and low physical activity are associated with insulin resistance in children. Metab Clin Exp 56(2):206–213. doi:10.1016/j.metabol.2006.09.014

    Article  CAS  Google Scholar 

  7. Olza J, Aguilera CM, Gil-Campos M, Leis R, Bueno G, Valle M, Canete R, Tojo R, Moreno LA, Gil A (2014) Waist-to-height ratio, inflammation and CVD risk in obese children. Public Health Nutr. doi:10.1017/S1368980013003285

    Google Scholar 

  8. Manios Y, Moschonis G, Kourlaba G, Bouloubasi Z, Grammatikaki E, Spyridaki A, Hatzis C, Kafatos A, Fragiadakis GA (2008) Prevalence and independent predictors of insulin resistance in children from Crete, Greece: the children study. Diabet Med 25(1):65–72. doi:10.1111/j.1464-5491.2007.02318.x

    CAS  Google Scholar 

  9. Kollias A, Psilopatis I, Karagiaouri E, Glaraki M, Grammatikos E, Grammatikos EE, Garoufi A, Stergiou GS (2013) Adiposity, blood pressure, and carotid intima-media thickness in greek adolescents. Obesity (Silver Spring) 21(5):1013–1017. doi:10.1002/oby.20194

    Article  Google Scholar 

  10. de Moraes AC, Fadoni RP, Ricardi LM, Souza TC, Rosaneli CF, Nakashima AT, Falcao MC (2011) Prevalence of abdominal obesity in adolescents: a systematic review. Obes Rev 12(2):69–77. doi:10.1111/j.1467-789X.2010.00753.x

    Article  Google Scholar 

  11. Xi B, Mi J, Zhao M, Zhang T, Jia C, Li J, Zeng T, Steffen LM, Public Health Youth C, Innovative Study Group of Shandong U (2014) Trends in abdominal obesity among U.S. children and adolescents. Pediatrics 134(2):e334–e339. doi:10.1542/peds.2014-0970

    Article  Google Scholar 

  12. Dehghan M, Akhtar-Danesh N, Merchant AT (2005) Childhood obesity, prevalence and prevention. Nutr J 4:24. doi:10.1186/1475-2891-4-24

    Article  Google Scholar 

  13. Popkin BM (2006) Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr 84(2):289–298

    CAS  Google Scholar 

  14. Popkin BM, Adair LS, Ng SW (2012) Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 70(1):3–21. doi:10.1111/j.1753-4887.2011.00456.x

    Article  Google Scholar 

  15. Al-Hazzaa HM, Abahussain NA, Al-Sobayel HI, Qahwaji DM, Musaiger AO (2012) Lifestyle factors associated with overweight and obesity among Saudi adolescents. BMC Public Health 12:354. doi:10.1186/1471-2458-12-354

    Article  Google Scholar 

  16. Bradlee ML, Singer MR, Qureshi MM, Moore LL (2010) Food group intake and central obesity among children and adolescents in the Third National Health and Nutrition Examination Survey (NHANES III). Public health Nutr 13(6):797–805. doi:10.1017/S1368980009991546

    Article  Google Scholar 

  17. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN (2009) Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity 17(8):1528–1533. doi:10.1038/oby.2009.127

    Article  Google Scholar 

  18. Iaccarino Idelson P, Scalfi L, Vaino N, Mobilia S, Montagnese C, Franzese A, Valerio G (2014) Healthy behaviours and abdominal adiposity in adolescents from southern Italy. Public health Nutr 17(2):353–360. doi:10.1017/S1368980012005654

    Article  Google Scholar 

  19. Nurul-Fadhilah A, Teo PS, Huybrechts I, Foo LH (2013) Infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity in Malaysian school-aged adolescents. PLoS One 8(3):e59297. doi:10.1371/journal.pone.0059297

    Article  CAS  Google Scholar 

  20. Deshmukh-Taskar PR, Nicklas TA, O’Neil CE, Keast DR, Radcliffe JD, Cho S (2010) The relationship of breakfast skipping and type of breakfast consumption with nutrient intake and weight status in children and adolescents: the National Health and Nutrition Examination Survey 1999–2006. J Am Diet Assoc 110(6):869–878. doi:10.1016/j.jada.2010.03.023

    Article  CAS  Google Scholar 

  21. Nasreddine L, Naja F, Akl C, Chamieh MC, Karam S, Sibai AM, Hwalla N (2014) Dietary, lifestyle and socio-economic correlates of overweight, obesity and central adiposity in Lebanese children and adolescents. Nutrients 6(3):1038–1062. doi:10.3390/nu6031038

    Article  Google Scholar 

  22. Schroder H, Mendez MA, Gomez SF, Fito M, Ribas L, Aranceta J, Serra-Majem L (2013) Energy density, diet quality, and central body fat in a nationwide survey of young Spaniards. Nutrition 29(11–12):1350–1355. doi:10.1016/j.nut.2013.05.019

    Article  Google Scholar 

  23. Schroder H, Mendez MA, Ribas-Barba L, Covas MI, Serra-Majem L (2010) Mediterranean diet and waist circumference in a representative national sample of young Spaniards. Int J Pediatr Obes IJPO 5(6):516–519. doi:10.3109/17477161003777417

    Article  Google Scholar 

  24. Moraes AC, Falcao MC (2013) Lifestyle factors and socioeconomic variables associated with abdominal obesity in Brazilian adolescents. Ann Hum Biol 40(1):1–8. doi:10.3109/03014460.2012.745900

    Article  Google Scholar 

  25. Hussey J, Bell C, Bennett K, O’Dwyer J, Gormley J (2007) Relationship between the intensity of physical activity, inactivity, cardiorespiratory fitness and body composition in 7–10-year-old Dublin children. Br J Sports Med 41(5):311–316. doi:10.1136/bjsm.2006.032045

    Article  CAS  Google Scholar 

  26. Ortega FB, Ruiz JR, Sjostrom M (2007) Physical activity, overweight and central adiposity in Swedish children and adolescents: the European Youth Heart Study. Int J Behav Nutr Phys Act 4:61. doi:10.1186/1479-5868-4-61

    Article  Google Scholar 

  27. Ortega FB, Tresaco B, Ruiz JR, Moreno LA, Martin-Matillas M, Mesa JL, Warnberg J, Bueno M, Tercedor P, Gutierrez A, Castillo MJ, Group AS (2007) Cardiorespiratory fitness and sedentary activities are associated with adiposity in adolescents. Obesity 15(6):1589–1599. doi:10.1038/oby.2007.188

    Article  Google Scholar 

  28. Olafsdottir S, Berg C, Eiben G, Lanfer A, Reisch L, Ahrens W, Kourides Y, Molnar D, Moreno LA, Siani A, Veidebaum T, Lissner L (2014) Young children’s screen activities, sweet drink consumption and anthropometry: results from a prospective European study. Eur J Clin Nutr 68(2):223–228. doi:10.1038/ejcn.2013.234

    Article  CAS  Google Scholar 

  29. Hanifah RA, Majid HA, Jalaludin MY, Al-Sadat N, Murray LJ, Cantwell M, Su TT, Nahar AM (2014) Fitness level and body composition indices: cross-sectional study among Malaysian adolescent. BMC Public Health 14(Suppl 3):S5. doi:10.1186/1471-2458-14-S3-S5

    Article  Google Scholar 

  30. Ara I, Moreno LA, Leiva MT, Gutin B, Casajus JA (2007) Adiposity, physical activity, and physical fitness among children from Aragon, Spain. Obesity 15(8):1918–1924. doi:10.1038/oby.2007.228

    Article  Google Scholar 

  31. Klein-Platat C, Oujaa M, Wagner A, Haan MC, Arveiler D, Schlienger JL, Simon C (2005) Physical activity is inversely related to waist circumference in 12-y-old French adolescents. Int J Obes 29(1):9–14. doi:10.1038/sj.ijo.0802740

    Article  CAS  Google Scholar 

  32. World Medical Association declaration of Helsinki (1997) Recommendations guiding physicians in biomedical research involving human subjects. JAMA 277(11):925–926

    Article  Google Scholar 

  33. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320(7244):1240–1243

    Article  CAS  Google Scholar 

  34. Cole TJ, Flegal KM, Nicholls D, Jackson AA (2007) Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 335(7612):194. doi:10.1136/bmj.39238.399444.55

    Article  Google Scholar 

  35. BSI (1990) Body measurements of boys and girls from birth to 16.0 y, BS7321. British Standards Institute London, London

    Google Scholar 

  36. Browning LM, Hsieh SD, Ashwell M (2010) A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev 23(2):247–269. doi:10.1017/S0954422410000144

    Article  Google Scholar 

  37. McCarthy HD (2014) Measuring growth and obesity across childhood and adolescence. Proc Nutr Soc 73(2):210–217. doi:10.1017/S0029665113003868

    Article  Google Scholar 

  38. Ashwell M, Hsieh SD (2005) Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr 56(5):303–307. doi:10.1080/09637480500195066

    Article  Google Scholar 

  39. Taylor RW, Williams SM, Grant AM, Taylor BJ, Goulding A (2011) Predictive ability of waist-to-height in relation to adiposity in children is not improved with age and sex-specific values. Obesity 19(5):1062–1068. doi:10.1038/oby.2010.217

    Article  Google Scholar 

  40. Hara M, Saitou E, Iwata F, Okada T, Harada K (2002) Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese schoolchildren. J Atheroscler Thromb 9(3):127–132

    Article  Google Scholar 

  41. Rodea-Montero ER, Evia-Viscarra ML, Apolinar-Jimenez E (2014) Waist-to-height ratio is a better anthropometric index than waist circumference and BMI in predicting metabolic syndrome among obese mexican adolescents. Int J Endocrinol 2014:195407. doi:10.1155/2014/195407

    Article  Google Scholar 

  42. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, Georgiou C, Kafatos A (2000) Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 24(11):1453–1458

    Article  CAS  Google Scholar 

  43. Mokha JS, Srinivasan SR, Dasmahapatra P, Fernandez C, Chen W, Xu J, Berenson GS (2010) Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatr 10:73. doi:10.1186/1471-2431-10-73

    Article  Google Scholar 

  44. Chrzanowska M, Suder A (2010) Changes in central fatness and abdominal obesity in children and adolescents from Cracow, Poland 1983–2000. Ann Hum Biol 37(2):242–252. doi:10.3109/03014460903193237

    Article  Google Scholar 

  45. Garnett SP, Baur LA, Cowell CT (2011) The prevalence of increased central adiposity in Australian school children 1985 to 2007. Obes Rev 12(11):887–896. doi:10.1111/j.1467-789X.2011.00899.x

    Article  CAS  Google Scholar 

  46. Li C, Ford ES, Mokdad AH, Cook S (2006) Recent trends in waist circumference and waist-height ratio among US children and adolescents. Pediatrics 118(5):e1390–e1398. doi:10.1542/peds.2006-1062

    Article  Google Scholar 

  47. McCarthy HD, Ashwell M (2006) A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message—‘keep your waist circumference to less than half your height’. Int J Obes 30(6):988–992. doi:10.1038/sj.ijo.0803226

    Article  CAS  Google Scholar 

  48. McCarthy HD, Jarrett KV, Emmett PM, Rogers I (2005) Trends in waist circumferences in young British children: a comparative study. Int J Obes 29(2):157–162. doi:10.1038/sj.ijo.0802849

    Article  CAS  Google Scholar 

  49. Tzotzas T, Kapantais E, Tziomalos K, Ioannidis I, Mortoglou A, Bakatselos S, Kaklamanou M, Lanaras L, Kaklamanou D (2011) Prevalence of overweight and abdominal obesity in Greek children 6–12 years old: results from the National Epidemiological Survey. Hippokratia 15(1):48–53

    CAS  Google Scholar 

  50. Albuquerque D, Nobrega C, Samouda H, Manco L (2012) Assessment of obesity and abdominal obesity among Portuguese children. Acta Med Port 25(3):169–173

    Google Scholar 

  51. Ying-Xiu Z, Ya-Lin L, Jin-Shan Z, Zun-Hua C, Jing-Yang Z (2013) Distributions of waist circumference and waist-to-height ratio for children and adolescents in Shandong, China. Eur J Pediatr 172(2):185–191. doi:10.1007/s00431-012-1862-x

    Article  Google Scholar 

  52. Schroder H, Ribas L, Koebnick C, Funtikova A, Gomez SF, Fito M, Perez-Rodrigo C, Serra-Majem L (2014) Prevalence of abdominal obesity in Spanish children and adolescents. Do we need waist circumference measurements in pediatric practice? PLoS One 9(1):e87549. doi:10.1371/journal.pone.0087549

    Article  Google Scholar 

  53. Xiong F, Garnett SP, Cowell CT, Biesheuvel C, Zeng Y, Long CL, Wang Q, Wang DG, Luo YH, Luo SQ (2011) Waist circumference and waist-to-height ratio in Han Chinese children living in Chongqing, south-west China. Public health Nutr 14(1):20–26. doi:10.1017/S136898001000042X

    Article  CAS  Google Scholar 

  54. McCarthy HD, Ellis SM, Cole TJ (2003) Central overweight and obesity in British youth aged 11-16 years: cross sectional surveys of waist circumference. BMJ 326(7390):624. doi:10.1136/bmj.326.7390.624

    Article  Google Scholar 

  55. Garnett SP, Cowell CT, Baur LA, Shrewsbury VA, Chan A, Crawford D, Salmon J, Campbell K, Boulton TJ (2005) Increasing central adiposity: the Nepean longitudinal study of young people aged 7–8 to 12–13 y. Int J Obes 29(11):1353–1360. doi:10.1038/sj.ijo.0803038

    Article  CAS  Google Scholar 

  56. Okosun IS, Boltri JM, Eriksen MP, Hepburn VA (2006) Trends in abdominal obesity in young people: United States 1988–2002. Ethn Dis 16(2):338–344

    Google Scholar 

  57. Khoury M, Manlhiot C, McCrindle BW (2013) Role of the waist/height ratio in the cardiometabolic risk assessment of children classified by body mass index. J Am Coll Cardiol 62(8):742–751. doi:10.1016/j.jacc.2013.01.026

    Article  Google Scholar 

  58. Lytle LA (2009) Examining the etiology of childhood obesity: the IDEA study. Am J Community Psychol 44(3–4):338–349. doi:10.1007/s10464-009-9269-1

    Article  Google Scholar 

  59. Kaisari P, Yannakoulia M, Panagiotakos DB (2013) Eating frequency and overweight and obesity in children and adolescents: a meta-analysis. Pediatrics 131(5):958–967. doi:10.1542/peds.2012-3241

    Article  Google Scholar 

  60. Bellisle F (2014) Meals and snacking, diet quality and energy balance. Physiol Behav 134:38–43. doi:10.1016/j.physbeh.2014.03.010

    Article  CAS  Google Scholar 

  61. Kulovitz MG, Kravitz LR, Mermier C, Gibson AL, Conn CA, Kolkmeyer D, Kerksick CM (2014) Potential role of meal frequency as a strategy for weight loss and health in overweight or obese adults. Nutrition 30(4):386–392. doi:10.1016/j.nut.2013.08.009

    Article  Google Scholar 

  62. Jordan AB (2010) Children’s television viewing and childhood obesity. Pediatr Ann 39(9):569–573. doi:10.3928/00904481-20100825-08

    Article  Google Scholar 

  63. Robinson TN (2001) Television viewing and childhood obesity. Pediatr Clin North Am 48(4):1017–1025

    Article  CAS  Google Scholar 

Download references

Acknowledgments

This study was conducted with the support of the Institute for Translational Sciences at the University of Texas Medical Branch and of the Harokopio University Post Graduate programme in Nutrition and Dietetics, and supported in part by a Clinical and Translational Science Award (UL1TR000071) from the National Centre for Advancing Translational Sciences, National Institutes of Health and OPAP SA—Greece.

Author information

Authors and Affiliations

  1. Department of Nutrition and Dietetics, Harokopio University, 70, El. Venizelou str., Athens, Greece

    Dimitris A. Grigorakis, Michael Georgoulis, Glykeria Psarra, Konstantinos D. Tambalis, Demosthenes B. Panagiotakos & Labros S. Sidossis

  2. Department of Physical Education and Sport Science, University of Athens, 41, Ethnikis Antistaseos str., 17237, Daphne, Greece

    Konstantinos D. Tambalis

  3. Departments of Internal Medicine, Nutrition and Metabolism and Surgery, Shriners Hospital for Children, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX, 77555-0177, USA

    Labros S. Sidossis

Authors
  1. Dimitris A. Grigorakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Georgoulis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Glykeria Psarra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Konstantinos D. Tambalis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Demosthenes B. Panagiotakos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Labros S. Sidossis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Labros S. Sidossis.

Ethics declarations

Conflicts of interest

The authors have no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grigorakis, D.A., Georgoulis, M., Psarra, G. et al. Prevalence and lifestyle determinants of central obesity in children. Eur J Nutr 55, 1923–1931 (2016). https://doi.org/10.1007/s00394-015-1008-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00394-015-1008-9

Keywords

Search

Navigation