The prevalence of overweight and obesity among Chinese children and adolescents has increased rapidly in the past decades, which has emerged as a crucial public health concern. The review synthesizes current literature to understand the multifaceted factors contributing to this epidemic through the lens of the Socio-Ecological Model (SEM). The model emphasizes the interplay between individual, interpersonal, societal, and physical environmental influences. Recognizing the risk factors of childhood obesity by using SEM would help policymakers, health professionals, and community leaders to develop comprehensive strategies to promote healthier eating behaviours and reduce obesity prevalence in this vulnerable population, which would help to tackle the problem effectively.
References
[1]
Rosengren, A., Aberg, M., Robertson, J., Waern, M., Schaufelberger, M., Kuhn, G., et al. (2017) Body Weight in Adolescence and Long-Term Risk of Early Heart Failure in Adulthood among Men in Sweden. European Heart Journal, 38, 1926-1933. https://doi.org/10.1093/eurheartj/ehw221
[2]
Ohlsson, C., Bygdell, M., Sonden, A., Rosengren, A. and Kindblom, J.M. (2016) Association between Excessive BMI Increase during Puberty and Risk of Cardiovascular Mortality in Adult Men: A Population-Based Cohort Study. The Lancet Diabetes & Endocrinology, 4, 1017-1024. https://doi.org/10.1016/S2213-8587(16)30273-X
[3]
Zhang, N. and Ma, G. (2018) Childhood Obesity in China: Trends, Risk Factors, Policies and Actions. Global Health Journal, 2, 1-13. https://doi.org/10.1016/S2414-6447(19)30115-0
[4]
Wang, Y., Xue, H., Sun, M., Zhu, X., Zhao, L. and Yang, Y. (2019) Prevention and Control of Obesity in China. The Lancet Global Health, 7, e1166-e1167. https://doi.org/10.1016/S2214-109X(19)30276-1
[5]
Wang, R., Feng, Z., Liu, Y. and Qiu, Y. (2020) Is lifestyle a Bridge between Urbanization and Overweight in China? Cities, 99, Article 102616. https://doi.org/10.1016/j.cities.2020.102616
[6]
Wang, H. and Zhai, F. (2013) Programme and Policy Options for Preventing Obesity in China. Obesity Reviews, 14, 134-140. https://doi.org/10.1111/obr.12106
[7]
Liu, Z., Wu, Y., Niu, W.Y., Feng, X., Lin, Y., Gao, A., et al. (2019) A School-Based, Multi-Faceted Health Promotion Programme to Prevent Obesity among Children: Protocol of a Cluster-Randomised Controlled Trial (The DECIDE-Children Study). BMJ Open, 9, e027902. https://doi.org/10.1136/bmjopen-2018-027902
[8]
Verrotti, A., Penta, L., Zenzeri, L., Agostinelli, S. and De Feo, P. (2014) Childhood Obesity: Prevention and Strategies of Intervention. A Systematic Review of School-Based Interventions in Primary Schools. Journal of Endocrinological Investigation, 37, 1155-1164. https://doi.org/10.1007/s40618-014-0153-y
[9]
Zhu, Z. and Yin, P. (2023) Overweight and Obesity: The Serious Challenge Faced by Chinese Children and Adolescents. Journal of Global Health, 13, Article 03036. https://doi.org/10.7189/jogh.13.03036
[10]
The GBD 2015 Obesity Collaborators (2017) Health Effects of Overweight and Obesity in 195 Countries over 25 Years. The New England Journal of Medicine, 377, 13-27. https://doi.org/10.1056/NEJMoa1614362
[11]
Sahoo, K., Sahoo, B., Choudhury, A.K., Sofi, N.Y., Kumar, R. and Bhadoria, A.S. (2015) Childhood Obesity: Causes and Consequences. Journal of Family Medicine and Primary Care, 4, 187-192. https://doi.org/10.4103/2249-4863.154628
[12]
Franks, P.W., Hanson, R.L., Knowler, W.C., Sievers, M.L., Bennett, P.H. and Looker, H.C. (2010) Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death. The New England Journal of Medicine, 362, 485-493. https://doi.org/10.1056/NEJMoa0904130
[13]
Cote, A.T., Harris, K.C., Panagiotopoulos, C., Sandor, G.G. and Devlin, A.M. (2013) Childhood Obesity and Cardiovascular Dysfunction. Journal of the American College of Cardiology, 62, 1309-1319. https://doi.org/10.1016/j.jacc.2013.07.042
[14]
Pollock, N.K. (2015) Childhood Obesity, Bone Development, and Cardiometabolic Risk Factors. Molecular and Cellular Endocrinology, 410, 52-63. https://doi.org/10.1016/j.mce.2015.03.016
[15]
Tanamas, S.K., Reddy, S.P., Chambers, M.A., Clark, E.J., Dunnigan, D.L., Hanson, R.L., et al. (2018) Effect of Severe Obesity in Childhood and Adolescence on Risk of Type 2 Diabetes in Youth and Early Adulthood in an American Indian Population. Pediatric Diabetes, 19, 622-629. https://doi.org/10.1111/pedi.12627
[16]
The Global BMI Mortality Collaboration (2016) Body-Mass Index and All-Cause Mortality: Individual-Participant-Data Meta-Analysis of 239 Prospective Studies in Four Continents. The Lancet, 388, 776-786. https://doi.org/10.1016/S0140-6736(16)30175-1
[17]
Buttermore, E., Campanella, V. and Priefer, R. (2021) The Increasing Trend of Type 2 Diabetes in Youth: An Overview. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 15, Article 102253. https://doi.org/10.1016/j.dsx.2021.102253
[18]
World Health Organization (2024) Obesity and Overweight 2024. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
[19]
Zhen, S., Ma, Y., Zhao, Z., Yang, X. and Wen, D. (2018) Dietary Pattern is Associated with Obesity in Chinese Children and Adolescents: Data from China Health and Nutrition Survey (CHNS). Nutrition Journal, 17, Article No. 68. https://doi.org/10.1186/s12937-018-0372-8
[20]
Zhang, B., Zhai, F.Y., Du, S.F. and Popkin, B.M. (2014) The China Health and Nutrition Survey, 1989-2011. Obesity Reviews, 15, 2-7. https://doi.org/10.1111/obr.12119
[21]
Qin, X. and Pan, J. (2016) The Medical Cost Attributable to Obesity and Overweight in China: Estimation Based on Longitudinal Surveys. Health Economics, 25, 1291-1311. https://doi.org/10.1002/hec.3217
[22]
Wang, Z., Wang, B., Hu, Y., Cheng, L., Zhang, S., Chen, Y., et al. (2020) Relationships among Weight Stigma, Eating Behaviors and Stress in Adolescents in Wuhan, China. Global Health Research and Policy, 5, Article No. 8. https://doi.org/10.1186/s41256-020-00138-3
[23]
He, Y., Pan, A., Wang, Y., Yang, Y., Xu, J., Zhang, Y., et al. (2017) Prevalence of Overweight and Obesity in 15.8 Million Men Aged 15-49 Years in Rural China from 2010 to 2014. Scientific Reports, 7, Article No. 5012. https://doi.org/10.1038/s41598-017-04135-4
[24]
Pan, X.F., Wang, L. and Pan, A. (2021) Epidemiology and Determinants of Obesity in China. The Lancet Diabetes & Endocrinology, 9, 373-392. https://doi.org/10.1016/S2213-8587(21)00045-0
[25]
Min, J., Xue, H., Wang, V.H.C., Li, M. and Wang, Y. (2017) Are Single Children More Likely to be Overweight or Obese than Those with Siblings? The Influence of China’s One-Child Policy on Childhood Obesity. Preventive Medicine, 103, 8-13. https://doi.org/10.1016/j.ypmed.2017.07.018
[26]
Zhang, J., Xu, P. and Liu, F. (2020) One-Child Policy and Childhood Obesity. China Economic Review, 59, Article 100938. https://doi.org/10.1016/j.chieco.2016.05.003
[27]
Hale, L. and Guan, S. (2015) Screen Time and Sleep among School-Aged Children and Adolescents: A Systematic Literature Review. Sleep Medicine Reviews, 21, 50-58. https://doi.org/10.1016/j.smrv.2014.07.007
[28]
Guo, Y., Miller, M.A. and Cappuccio, F.P. (2021) Short Duration of Sleep and Incidence of Overweight or Obesity in Chinese Children and Adolescents: A Systematic Review and Meta-Analysis of Prospective Studies. Nutrition, Metabolism and Cardiovascular Diseases, 31, 363-371. https://doi.org/10.1016/j.numecd.2020.11.001
[29]
Robinson, T.N., Banda, J.A., Hale, L., Lu, A.S., Fleming-Milici, F., Calvert, S.L., et al. (2017) Screen Media Exposure and Obesity in Children and Adolescents. Pediatrics, 140, S97-S101. https://doi.org/10.1542/peds.2016-1758K
[30]
Xian, J., Zeng, M., Cai, Z., Xie, C., Xie, Y., Sharma, M., et al. (2021) Influence of the Request and Purchase of Television Advertised Foods on Dietary Intake and Obesity among Children in China. BMC Public Health, 21, Article No. 1130. https://doi.org/10.1186/s12889-021-11191-z
[31]
Mela, D.J. (2001) Determinants of Food Choice: Relationships with Obesity and Weight Control. Obesity Research, 9, 249S-255S. https://doi.org/10.1038/oby.2001.127
[32]
van Meer, F., Charbonnier, L. and Smeets, P.A. (2016) Food Decision-Making: Effects of Weight Status and Age. Current Diabetes Reports, 16, Article No. 84. https://doi.org/10.1007/s11892-016-0773-z
[33]
Ren, Y., Zhao, J., Glauben, T. and Campos, B.C. (2022) Supermarket Environment and Nutrition Outcomes: Evidence from Rural China. Journal of Rural Studies, 92, 79-92. https://doi.org/10.1016/j.jrurstud.2022.03.019
[34]
Wang, Y., Zhao, L., Gao, L., Pan, A. and Xue, H. (2021) Health Policy and Public Health Implications of Obesity in China. The Lancet Diabetes & Endocrinology, 9, 446-461. https://doi.org/10.1016/S2213-8587(21)00118-2
[35]
Ren, H., Zhou, Z., Liu, W.K., Wang, X. and Yin, Z. (2017) Excessive Homework, Inadequate Sleep, Physical Inactivity and Screen Viewing Time Are Major Contributors to High Paediatric Obesity. Acta Paediatrica, 106, 120-127. https://doi.org/10.1111/apa.13640
[36]
Li, B., Adab, P. and Cheng, K.K. (2015) The Role of Grandparents in Childhood Obesity in China—Evidence from a Mixed Methods Study. International Journal of Behavioral Nutrition and Physical Activity, 12, Article No. 91. https://doi.org/10.1186/s12966-015-0251-z
[37]
He, Q., Li, X. and Wang, R. (2018) Childhood Obesity in China: Does Grandparents’ Coresidence Matter? Economics & Human Biology, 29, 56-63. https://doi.org/10.1016/j.ehb.2018.02.001
[38]
Gupta, N., Goel, K., Shah, P. and Misra, A. (2012) Childhood Obesity in Developing Countries: Epidemiology, Determinants, and Prevention. Endocrine Reviews, 33, 48-70. https://doi.org/10.1210/er.2010-0028
[39]
Nie, P., SousaPoza, A. and He, X. (2015) Peer Effects on Childhood and Adolescent Obesity in China. China Economic Review, 35, 47-69. https://doi.org/10.1016/j.chieco.2015.06.002
[40]
Zhang, N., Becares, L. and Chandola, T. (2016) Patterns and Determinants of Double-Burden of Malnutrition among Rural Children: Evidence from China. PLOS ONE, 11, e0158119. https://doi.org/10.1371/journal.pone.0158119
[41]
de Wild, V.W., de Graaf, C. and Jager, G. (2013) Effectiveness of Flavour Nutrient Learning and Mere Exposure as Mechanisms to Increase Toddler’s Intake and Preference for Green Vegetables. Appetite, 64, 89-96. https://doi.org/10.1016/j.appet.2013.01.006
[42]
Qian, L., Newman, I.M., Yuen, L.W., Du, W. and Shell, D.F. (2019) Effects of a Comprehensive Nutrition Education Programme to Change Grade 4 Primary-School Students’ Eating Behaviours in China. Public Health Nutrition, 22, 903-911. https://doi.org/10.1017/S1368980018003713
[43]
Chen, Y., Ma, L., Ma, Y., Wang, H., Luo, J., Zhang, X., et al. (2015) A National School-Based Health Lifestyles Interventions among Chinese Children and Adolescents against Obesity: Rationale, Design and Methodology of a Randomized Controlled Trial in China. BMC Public Health, 15, Article No. 210. https://doi.org/10.1186/s12889-015-1516-9
[44]
Li, M., Li, S., Baur, L.A. and Huxley, R.R. (2008) A Systematic Review of School-Based Intervention Studies for the Prevention or Reduction of Excess Weight among Chinese Children and Adolescents. Obesity Reviews, 9, 548-559. https://doi.org/10.1111/j.1467-789X.2008.00495.x
[45]
The State Council of the People’s Republic of China (2019) Healthy China Initiative (2019 to 2030). http://www.gov.cn/xinwen/2019-07/15/content_5409694.htm
[46]
Kong, F., Xiong, L., Wang, A., Xie, D., He, J., Su, J., et al. (2020) Healthy China 2030: How to Control the Rising Trend of Unintentional Suffocation Death in Children under Five Years Old. BMC Pediatrics, 20, Article No. 376. https://doi.org/10.1186/s12887-020-02281-9
[47]
Chen, P., Li, F. and Harmer, P. (2019) Healthy China 2030: Moving from Blueprint to Action with a New Focus on Public Health. The Lancet Public Health, 4, e447. https://doi.org/10.1016/S2468-2667(19)30160-4