Skip to main content

Advertisement

SpringerLink
Log in

Family and Neighborhood Correlates of Overweight and Obesogenic Behaviors Among Chinese Children

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

The prevalence of childhood obesity is increasing rapidly in China. However, research on its modifiable environmental determinants to inform preventive interventions is limited.

Purpose

This paper reports a cross-sectional study that aimed to identify family and neighborhood environmental correlates of overweight and related health behavior among Chinese primary school-aged children in urban areas.

Methods

Routinely collected height and weight data of third year students (8–10 years) from four primary schools in socioeconomically distinct districts of two southern cities of China was obtained. Using the WHO 2007 reference values, children were categorized into overweight/obese or non-overweight. Parents of the same children completed a questionnaire, comprising mainly validated questions, about family and perceived neighborhood environments, parental physical activity habits, and the child's dietary and physical activity patterns. Multiple logistic regression analysis was performed to examine the association between these environmental factors and childhood overweight or whether or not the child engages in at least 1 h daily moderate to vigorous physical activity. Multiple linear regression analysis was undertaken to examine the association between environmental factors and the frequency of consumption of unhealthy snacks, fruit, and vegetables in children.

Results

Data on 497 children were available. Children who were mainly cared for by their grandparents were over twice as likely to be overweight/obese (adjusted OR 2.03; 95 % CI 1.19–3.47) and to have higher consumption of unhealthy snacks and sugar-added drinks (B = 2.13, 95 % CI 0.87–3.40), compared with children who were mainly cared for by their parents or other adult. Children who lived with at least two grandparents in the household were at higher risk for being overweight/obese than children who lived without any grandparent (adjusted OR 1.72; 95 % CI 1.00–2.94). No evidence was found for associations between perceived neighborhood environmental characteristics and child's weight status and obesogenic behaviors in this study.

Conclusions

Children's family environment, particularly the living-in grandparents, should be targeted in future preventive interventions among China's southern urban populations.

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. Chengye J, Cheng Tsung O. Epidemic increase in overweight and obesity in Chinese children from 1985 to 2005. Int J Cardiol. 2009;132:1–10.

    Article  Google Scholar 

  2. Cy JI, Cheng TO. Prevalence and geographic distribution of childhood obesity in China in 2005. Int J Cardiol. 2008;131:1–8.

    Article  Google Scholar 

  3. Adair LS, Popkin BM. Are child eating patterns being transformed globally. Obesity Reviews. 2005;13(7):1281–99.

    Article  Google Scholar 

  4. Zhai FY, Ge KY, Jin SG. Summary report of China Health and Nutrition Survey. J Hyg Res. 1996;22:16–25.

    Google Scholar 

  5. Yu D, Zhang B, Zhao L. Snacks consumption in Chinese children and adolescents at the ages of 3–17 years. Chin J Healthc Res. 2008;37:710–3.

    Google Scholar 

  6. Waller CE, Du S, Popkin BM. Patterns of overweight, inactivity, and snacking in Chinese children. Obes Res. 2003;11:957–61.

    Article  PubMed  Google Scholar 

  7. Tudor-Locke C, Ainsworth BE, Adair LS, Du S, Popkin BM. Physical activity and inactivity in Chinese school-aged youth: the China Health and Nutrition Survey. Int J Obes Relat Metab Disord. 2003;27:1093–9.

    Article  CAS  PubMed  Google Scholar 

  8. Wu L, Xi B, Zhang M, Shen Y, Zhao X, Cheng H, et al. Associations of six single nucleotide polymorphisms in obesity-related genes with BMI and risk of obesity in Chinese children. Diabetes. 2010;59:3085–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Yuan P, Luo L. Meta-analysis of risk factor on simple obesity of children under age 14 in China. Chin J Child Health Care. 2002;10:161–3.

    Google Scholar 

  10. Jing R, Han LT, Liu XD, Li L, Li XY, Yang SX. Meta-analysis of risk factors of childhood simple obesity among school age children in China. Chin J Hosp Stat. 2008;15:307–9.

    Google Scholar 

  11. Lin R, Du L, Liu WJ, Lin L, Wu JG, Liu W, et al. Influencing factors of overweight and obesity among children in Guangzhou urban district. Chin J Child Health Care. 2011;19:409–11.

    Google Scholar 

  12. Jiang F, Zhu S, Yan C, Jin X, Bandla H, Shen X. Sleep and obesity in preschool children. J Pediatr. 2009;154:814–8.

    Article  PubMed  Google Scholar 

  13. Wing YK, Li SX, Li AM, Zhang J, Kong APS. The effect of weekend and holiday sleep compensation on childhood overweight and obesity. Pediatrics. 2009;124:e994–1000.

    Article  PubMed  Google Scholar 

  14. Shan XY, Xi B, Cheng H, Hou DQ, Wang Y, Mi J. Prevalence and behavioral risk factors of overweight and obesity among children aged 2−18 in Beijing, China. Int J Pediatr Obes. 2010;5:383–9.

    Article  PubMed  Google Scholar 

  15. Wang YF. Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status. Int J Epidemiol. 2001;30:1129–36.

    Article  CAS  PubMed  Google Scholar 

  16. Duncker K. Experimental modification of children's food preferences through social suggestion. J Abnorm Soc Psychol. 1938;33:489–507.

    Article  Google Scholar 

  17. Harper LV, Sanders KM. The effect of adults' eating on young children's acceptance of unfamiliar foods. J Exp Child Psychol. 1975;20:206–14.

    Article  Google Scholar 

  18. Birch LL. Effects of peer models' food choices and eating behaviors on preschoolers' food preferences. Child Dev. 1980;51:489–96.

    Google Scholar 

  19. Cutting TM, Fisher JO, Grimm-Thomas K, Birch LL. Like mother, like daughter: familial patterns of overweight are mediated by mothers' dietary disinhibition. Am J Clin Nutr. 1999;69:608–13.

    CAS  PubMed  Google Scholar 

  20. Fisher JO, Mitchell DC, Smiciklas-Wright H, Birch LL. Parental influences on young girls' fruit and vegetable, micronutrient, and fat intakes. J Am Diet Assoc. 2002;102:58–64.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Rasmussen M, Krolner R, Klepp KI, Lytle L, Brug J, Bere E, et al. Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: quantitative studies. Int J Behav Nutr Phys Act. 2006;3:22.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Bauer KW, Neumark-Sztainer D, Fulkerson JA, Hannan PJ, Story M. Familial correlates of adolescent girls' physical activity, television use, dietary intake, weight, and body composition. Int J Behav Nutr Phys Act. 2011;8:25.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Moore LL, Lombardi DA, White MJ, Campbell JL, Oliveria SA, Ellison RC. Influence of parents' physical activity levels on activity levels of young children. J Pediatr. 1991;118:215–9.

    Article  CAS  PubMed  Google Scholar 

  24. Fogelholm M, Nuutinen O, Pasanen M, Myohanen E, Saatela T. Parent–child relationship of physical activity patterns and obesity. Int J Obes Relat Metab Disord. 1999;23:1262–8.

    Article  CAS  PubMed  Google Scholar 

  25. Salmon J, Timperio A, Telford A, Carver A, Crawford D. Association of family environment with children's television viewing and with low level of physical activity. Obes Res. 2005;13:1939–51.

    Article  PubMed  Google Scholar 

  26. Fulkerson JA, Farbakhsh K, Lytle L, Hearst MO, Dengel DR, Pasch KE, et al. Away-from-home family dinner sources and associations with weight status, body composition, and related biomarkers of chronic disease among adolescents and their parents. J Am Diet Assoc. 2011;111:1892–7.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Taveras EM, Rifas-Shiman SL, Berkey CS, Rockett HR, Field AE, Frazier AL, et al. Family dinner and adolescent overweight. Obes Res. 2005;13:900–6.

    Article  PubMed  Google Scholar 

  28. Gillman MW, Rifas-Shiman SL, Frazier AL, Rockett HRH, Camargo Jr CA, Field AE, et al. Family dinner and diet quality among older children and adolescents. Arch Fam Med. 2000;9:235–40.

    Article  CAS  PubMed  Google Scholar 

  29. Vereecken CA, Keukelier E, Maes L. Influence of mother's educational level on food parenting practices and food habits of young children. Appetite. 2004;43:93–103.

    Article  PubMed  Google Scholar 

  30. Pocock M, Trivedi D, Wills W, Bunn F, Magnusson J. Parental perceptions regarding healthy behaviors for preventing overweight and obesity in young children: a systematic review of qualitative studies. Obes Rev. 2010;11:338–53.

    Article  CAS  PubMed  Google Scholar 

  31. Birch LL, Marlin DW, Rotter J. Eating as the means activity in a contingency: effects on young children's food preferences. Child Dev. 1984;55:431–539.

    Article  Google Scholar 

  32. Schmitz KH, Lytle LA, Phillips GA, Murray DM, Birnbaum AS, Kubik MY. Psychosocial correlates of physical activity and sedentary leisure habits in young adolescents: the teens eating for energy and nutrition at school study. Prev Med. 2002;34:266–78.

    Article  PubMed  Google Scholar 

  33. Gillander Gadin K, Hammarstrom A. Can school-related factors predict future health behavior among young adolescents? Public Health. 2002;116:22–9.

    Article  CAS  PubMed  Google Scholar 

  34. Veugelers P, Sithole F, Zhang S, Muhajarine N. Neighborhood characteristics in relation to diet, physical activity and overweight of Canadian children. Int J Pediatr Obes. 2008;3:152–9.

    Article  PubMed  Google Scholar 

  35. Hackett A, Boddy L, Boothby J, Dummer TJB, Johnson B, Stratton G. Mapping dietary habits may provide clues about the factors that determine food choice. J Hum Nutr Diet. 2008;21:428–37.

    Article  CAS  PubMed  Google Scholar 

  36. Jago R, Baranowski T, Baranowski J, Cullen K, Thompson D. Distance to food stores and adolescent male fruit and vegetable consumption: mediation effects. Int J Behav Nutr Phys Act. 2007;4:35.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Carver A, Timperio A, Crawford D. Neighborhood road environments and physical activity among youth: the CLAN study. J Urban Health. 2008;85:532–44.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Dunton GF, Kaplan J, Wolch J, Jerrett M, Reynolds KD. Physical environmental correlates of childhood obesity: a systematic review. Obes Rev. 2009;10:393–402.

    Article  CAS  PubMed  Google Scholar 

  39. Mota J, Almeida M, Santos R, Ribeiro JC, Santos MP. Association of perceived environmental characteristics and participation in organized and non-organized physical activities of adolescents. Pediatr Exerc Sci. 2009;21(2):233–9.

    PubMed  Google Scholar 

  40. Galvez MP, Pearl M, Yen IH. Childhood obesity and the built environment. Curr Opin Pediatr. 2010;22:202–7.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Santos MP, Page AS, Cooper AR, Ribeiro JC, Mota J. Perceptions of the built environment in relation to physical activity in Portuguese adolescents. Health Place. 2009;15:548–52.

    Article  PubMed  Google Scholar 

  42. Bungum T, Lounsbery M, Moonie S, Gast J. Prevalence and correlates of walking and biking to school among adolescents. J Community Health. 2009;34:129–34.

    Article  PubMed  Google Scholar 

  43. Hume C, Salmon J, Ball K. Children's perceptions of their home and neighborhood environments, and their association with objectively measured physical activity: a qualitative and quantitative study. Health Educ Res. 2005;20:1–13.

    Article  CAS  PubMed  Google Scholar 

  44. Pearce A, Kirk C, Cummins S, Collins M, Elliman D, Connolly AM, et al. Gaining children's perspectives: a multiple method approach to explore environmental influences on healthy eating and physical activity. Health Place. 2009;15:614–21.

    Article  CAS  PubMed  Google Scholar 

  45. Lindsay AC, Sussner KM, Greaney ML, Peterson KE. Influence of social context on eating, physical activity, and sedentary behaviors of Latina mothers and their preschool-age children. Health Educ Behav. 2009;36:81–96.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Ferreira I, Van Der Horst K, Wendel-Vos W, Kremers S, Van Lenthe FJ, Brug J. Environmental correlates of physical activity in youth—a review and update. Obes Rev. 2007;8:129–54.

    Article  CAS  PubMed  Google Scholar 

  47. Cerin E, Saelens BE, Sallis JF, Frank LD. Neighborhood environment walkability scale: validity and development of a short form. Med Sci Sports Exerc. 2006;38:1682–91.

    Article  PubMed  Google Scholar 

  48. Cerin E, Macfarlane DJ, Ko HH, Chan KC. Measuring perceived neighborhood walkability in Hong Kong. Cities. 2007;24:209–17.

    Article  Google Scholar 

  49. Vereecken CA, Maes L. A Belgian study on the reliability and relative validity of the health behavior in school-aged children food-frequency questionnaire. Public Health Nutr. 2003;6:581–8.

    Article  PubMed  Google Scholar 

  50. Kolodziejczyk JK, Merchant G, Norman GJ. Reliability and validity of child/adolescent food frequency questionnaires that assess foods and/or food groups. J Pediatr Gastroenterol Nutr. 2012;55(1):4–13.

    Article  PubMed  Google Scholar 

  51. Godin G, Shephard RJ: Godin Leisure-Time Exercise Questionnaire. Med Sci Sports Exerc. 1997; S36-S38.

  52. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32:S498–504.

    Article  CAS  PubMed  Google Scholar 

  53. World Health Organization. Growth reference data for 5–19 years. Geneva: WHO Reference 2007; 2007.

    Google Scholar 

  54. Group of China Obesity Task Force: Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents. Chin J Epidemiol. 2004; 97-102.

  55. Ball K, Timperio AF, Crawford DA. Understanding environmental influences on nutrition and physical activity behaviors: where should we look and what should we count? Int J Behav Nutr Phys Act. 2006;3:33.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Jiang JX, Xia XL, Cui SZ, Song QS, Yuan QL. Influence of grandparents on eating behaviors of young children in Chinese three-generation families. Chin J Child Health Care. 2006;14:46–8.

    Google Scholar 

  57. Li Bai: Childhood Obesity Prevention In China: A Mixed-Methods Approach To Inform Development Of Theoretically Based Interventions. PhD Thesis. University of Birmingham; 2013.

  58. Pearce A, Li L, Abbas J, Ferguson B, Graham H, Law C. Is childcare associated with the risk of overweight and obesity in the early years? Findings from the UK Millennium Cohort Study. Int J Obes. 2010;34:1160–8.

    Article  CAS  Google Scholar 

  59. Takahashi E, Yoshida K, Sugimori H, Miyakawa M, Izuno T, Yamagami T, et al. Influence factors on the development of obesity in 3-year-old children based on the Toyama study. Prev Med. 1999;28:293–6.

    Article  CAS  PubMed  Google Scholar 

  60. Zhang J, Seo DC, Kolbe L, Middlestadt S, Zhao WH: Associated Trends in Sedentary Behavior and BMI Among Chinese School Children and Adolescents in Seven Diverse Chinese Provinces. Int J Behav Med. 2011; 1-9.

  61. Xu F, Li JQ, Ware RS, Owen N. Associations of television viewing time with excess body weight among urban and rural high-school students in regional mainland China. Public Health Nutr. 2008;11:891–6.

    Article  PubMed  Google Scholar 

  62. Dubois L, Farmer A, Girard M, Peterson K. Social factors and television use during meals and snacks is associated with higher BMI among preschool children. Public Health Nutr. 2008;11:1267–79.

    Article  PubMed  Google Scholar 

  63. BeLue R, Francis LA, Rollins B, Colaco B. One size does not fit all: identifying risk profiles for overweight in adolescent population subsets. J Adolesc Health. 2009;45:517–24.

    Article  PubMed Central  PubMed  Google Scholar 

  64. Hesketh K, Wake M, Graham M, Waters E. Stability of television viewing and electronic game/computer use in a prospective cohort study of Australian children: relationship with body mass index. Int J Behav Nutr Phys Act. 2007;4:60.

    Article  PubMed Central  PubMed  Google Scholar 

  65. te Velde SJ, van Nassau F, Uijtdewilligen L, van Stralen MM, Cardon G, De Craemer M, et al. ToyBox-study group: energy balance-related behaviors associated with overweight and obesity in preschool children: a systematic review of prospective studies. Obes Rev. 2012;13:56–74.

    Article  Google Scholar 

  66. Fulkerson JA, Kubik MY, Story M, Lytle L, Arcan C. Are there nutritional and other benefits associated with family meals among at-risk youth? J Adolesc Health. 2009;45:389–95.

    Article  PubMed Central  PubMed  Google Scholar 

  67. Gable S, Chang Y, Krull JL. Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children. J Am Diet Assoc. 2007;107:53–61.

    Article  PubMed  Google Scholar 

  68. Sen B. Frequency of family dinner and adolescent body weight status: evidence from the national longitudinal survey of youth, 1997. Obesity. 2006;14:2266–76.

    Article  PubMed  Google Scholar 

  69. Skidmore P, Welch A, van Sluijs E, Jones A, Harvey I, Harrison F, et al. Impact of neighborhood food environment on food consumption in children aged 9–10 years in the UK SPEEDY study. Public Health Nutr. 2010;13:1022–30.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Timperio A, Ball K, Roberts R, Campbell K, Andrianopoulos N, Crawford D. Children's fruit and vegetable intake: associations with the neighborhood food environment. Prev Med. 2008;46:331–5.

    Article  PubMed  Google Scholar 

  71. Jennings A, Welch A, Jones AP, Harrison F, Bentham G, van Sluijs EMF, et al. Local food outlets, weight status, and dietary intake: associations in children aged 9−10 years. Am J Prev Med. 2011;40:405–10.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank the staff at the Unit of School Health and Hygiene (Guangzhou Education Bureau) and Hechi City Government for their support in the study's data collection in China. Our sincere thanks also go to all the participants (e.g., children, family members, and school staff) in Guangzhou and Hechi cities, for their time and cooperation.

Author information

Authors and Affiliations

  1. Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK

    Bai Li, Peymanè Adab & Kar Keung Cheng

Authors
  1. Bai Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peymanè Adab
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kar Keung Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bai Li.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Li, B., Adab, P. & Cheng, K.K. Family and Neighborhood Correlates of Overweight and Obesogenic Behaviors Among Chinese Children. Int.J. Behav. Med. 21, 700–709 (2014). https://doi.org/10.1007/s12529-013-9333-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-013-9333-y

Keywords

Search

Navigation