The Prevalence of Obesity Among School Children in Kuwait

Introduction

Background of the Study

Overweight and obesity are defined by the World Health Organization (2011) as excessive accumulation of fat, having negative health implications on individuals and are recognized as the fifth risk factor which can lead to morbidity and mortality. According to the World Health Organization data (WHO, 2011) nearly 2.8 million of adults die annually as a consequence of their overweight or obesity. Using body mass index (BMI) for classifying overweight and obesity, it can be stated that a BMI greater than 25 is referred to as overweight and a BMI greater than 30 is referred to as obesity., the rates of the worldwide obesity doubled since 1980 (WHO, 2011).

The statistical data offered by the International Obesity Task Force in 2006 stated that more than 22 million of children at the age of 5 and below are obese or overweight (Wang & Lobstein, 2006). EL-Mouzan et al. (2010) note that most children who are overweight at the age of 10 will carry this problem to their adulthood. According to the findings of Dehghan, Noori & Merchant (2005) obesity at the age between 5 to 20 years can decrease the individual’s life expectancy by several years. The main causes of childhood obesity and overweight include genetics, diets and upbringing (Amin, Al-Sultan and Ali, 2008). Ng et al. (2011) pointed out that recent lifestyle changes including the reduction of physical activity and increase of calorie intake lead to childhood obesity. Along with the growing popularity of television and computer games, children’s physical activity decreased because of changes in school curricula and decreased hours of physical education (Dehghan, Noori, &Merchnt, 2005; Mirmiran et al., 2010).

The extent of childhood overweight/obesity prevalence differs from country to country, depending on socio-cultural and other influential factors such as the climate, quality of healthcare services(Ng et al., 2011). In the United States, for instance, over 30% of children have excess weight (BMI >95th percentile) (Eisenmann, Heelan, & Welk, 2004).The rates of obesity prevalence in other developed countries have been increasing where in England it reached 20.7% for males and 27.4% for females in 2002 (Wang & Lobstein, 2006). Recent statistics have cited Eastern Europe and the Middle East regions have the highest prevalence of childhood overweight and obesity, while India and Sri-Lanka have recorded the lowest rates (Ng et al., 2011). In Eastern Europe, Bosnia has the highest prevalence at 48.35% and 30.77% among boy and girls respectively aged between 13-14 years (Aziz, 2009). Therefore, gender and age characteristics should be carefully considered while establishing the corresponding health improvement programs. Importantly, gender aspects should be evaluated with regard to social, cultural, and economic factors. In addition, nutrition-related diseases and deviations should also be considered as far as the problem of obesity and overweight is concerned. According to the studies provided by Ng et al. (2011), such diseases as cardiovascular diseases, type 2 diabetes, metabolic syndrome, coronary heart disease belong to the group of chronic nutrition-related diseases.

A recent study by El-Bayoumy, Shady and Lofty (2009) among 10-14 years adolescents recorded an increased overweight prevalence rate of 29.3% and 32.1% among males and females respectively. This study is important because it investigates the sample that suits this particular research. At this point, the statistics reveals that about 12.7 % of the total amount of Kuwaiti children under the age category from 10 to 14 are suffering from excess weight. The main reason for increased percentile of obese and overweight children (with BMI of 85-95 %) is the high level of daily calorie intake, as well as physical inactivity (El-Bayoumy, Shady and Lofty, 2009). The problem can be eliminated if the corresponding dietary and physical activity programs are implemented to handle obesity-related risks. In addition, reconsideration of family-based behavior should also take place. Effective implementation of health reforms, as well as reconstruction of behavioral patterns of food intake culture, can provide viable solutions to the problem.

Aside from gender distribution of obese and overweight children, age and socioeconomic characteristics should also be taken into the deepest consideration (Mirmiran et al., 2010). Hence, a comparative analysis of various age groups has revealed a steady increase in obesity/overweight among children who are under the stage of puberty. It has been found that 10 year-olds children are under the highest risk of obesity (Mirmiran et al., 2010). As per social and economic aspects, it has been disclosed that sedentary lifestyles, high-calorie intakes, and lack of physical activities contribute to obesity. Notably, obesity rates are the highest ones in Middle East, in the urban areas (Mirmiran et al., 2010). Judging from the findings, food consumption and dietary patterns largely depend on income and dietary choices. In addition, cultural beliefs concerning the concept of body image, as well as parents’ level of education, also refer to important factors influencing prevalence of obesity and overweight among children.

The scholars have considered a number of behavioral, environmental, and genetic reasons for increased rates of pediatric obesity. Along with other researchers (El-Bayoumy, Shady & Lofty, 2009; El-Hazmi & Warsy, 2002), Kerkadi, Abo-Elnaga and Ibrahim (2005) also attain the main role to diet problem in augmenting rates of overweight among children. Aside from family-based causes, the scholars pay closer attention to rates of obesity, which are much higher as compared to those in the developed economies(Kerkadi, Abo-Elnaga& Ibrahim, 2005). Such changes are due to “life style changes (physical activity, leisure, and modernization) and transition which are in relation with changing economic, social, and health factors” (Kerkadi, Abo-Elnaga, & Ibrahim, 2005, p. 44).

Amin, Al-Sultan & Ali (2008) provide an overview of children from 10-14 years old, which is among the groups having the highest risk of overweight and obesity. Specifically, the prevalence of overweight involved 14.2 % whereas obesity rates amounted to 9.7 %. These percentages are more characteristic of urban areas where children have less educated mothers involved in working routine. In addition, important findings have showed that obese children often lack breakfast intake at home, which is compensated by consumption of fast food. As a result, children fail to receive enough nutrition for sustaining a healthy lifestyle. The studies prove previous explorations of social and cultural factors being the key reasons contributing to high rates of obesity among children.

In contrast, this gender-based overweight and obesity prevalence portrayed a different picture in 12-17 year old Bahrainis whereby 35% of females and 21 % of males were identified as obese or over weight (Musaiger, 2011). Moreover, the researchers have revealed the ratios of adiposity as screening instruments for multiple risk factors, including insulin resistance, hypolipidaemia, and high blood pressure. BMI of children, hence, has turned out to be closely associated with that of adult obesity (Musaiger, 2011). As it has been estimated, about 75 % of deaths in the developing countries are due to the obesity and overweight. The given research proves that obesity problem has acquired an epidemic character because it is typical of the entire population. It also reports that children from 7 to 14 years amount to 85 % of overweight. In other words, the percentage of obese children ranges from 6 % to 30 % (El-Mouzan.et al., 2010). Interestingly, the study considers the connection between problems with excess weight and genetic contributions. In particular, the author states, “…genetic contribution is considerable, since obesity is a multifactorial complex genetic disorder” (El-Mouzan.et al., 2010, p. 304). The changing patterns of nutrition and physical activities among children can also be the reasons for extremely high levels of prevalence of obesity and overweight.

With regard to the presented facts and reviewed literature, it can be noted that few researches have pointed out viable solutions to the existing problem. Therefore, it is of the highest priority to define what kind of educational programs should be implemented to reduce the rates and increase the culture of healthy nutrition among children in Kuwait.

State of Kuwait

Kuwait Overview

Kuwait is a small country with its area estimated at approximately 17,820 square kilometers (Regional Health System Observatory, 2006). Over 90% of the population inhabits a 500-km² district around Kuwait City (Kuwait central statistical office, 2011). Kuwait is an Arab country located on the coast of the Arabian Gulf and bordered by Iraq in the North, Saudi Arabia in the South and Arabian Gulf in the East. Since attaining independence in June 19, 1961, Kuwait has maintained constitutional monarchy. It has a thriving economic which is heavily dependent on oil industry. Arabic is recognized as the official language although English is in wide usage across the population. The government provides free education right from elementary to university (Regional Health System Observatory, 2006). The 2009 census report estimated the population at 1.06 million citizens, 100,000 stateless, and 2.36 million foreigners (Kuwait central statistical office, 2011). The population was expected to grow at an annual growth rate of 3.549%. This census also estimated infant mortality rate at 8.97 deaths for every 1000 live births. Moreover, life expectancy was estimated at 76.51 and 78.96 years for males and females respectively (Kuwait central statistical office, 2011).

Kuwait Health System

Though the Ministry of Health in Kuwait was established in1926, history and origins of health system data back to much earlier periods. In particular, Shaykh Mubarak Al Sabah the Great, the Kuwaiti ruler, invited physicians and nurses from the United States to create a hospital in 1910 (Regional Health Systems Observatory, 2006). A year later, the group organized a clinic for males and in 8 years there was a hospital for women. 1934 was marked by the foundation of Olcott Memorial Hospital and counted thirty-four beds for patients. Until 1946, the country experienced significant improvement of health care services (Regional Health Systems Observatory, 2006). Specifically, the mortality rates range between 20 and 25 per 1000 people; as per infant mortality, the figures fluctuate between 100 and 100 for 1000 births. In1949, the Amiri Hospital was organized, which greatly contributed to the fall of mortality rates. This hospital was established on the revenues that the government received from oil industry. High level of health care and acceptable standards of patient treatment was achieved through educational development and welfare system created since the declaration of independence in 1961 (Regional Health Systems Observatory, 2006). The second half of the past century was marked by the development of a consistent health care system providing free services to Kuwaiti population. Budgeting and expenditures took the third place of importance, after educational and public sector. The improvements were significant due to the establishment of acceptable doctor-to-patient ration (one to 600) (Regional Health Systems Observatory, 2006). Infant mortality rates significantly decreased and amounted to 15 for 1000 born babies. By the end of the twentieth century, life expectancy rose dramatically and counted 72 years for males and 76 years for females (Regional Health Systems Observatory, 2006). This allowed Kuwait to take an honorable status of industrialized countries.

By 1990, the country introduced an extensive welfare plan that provided citizens with free health care services from highly qualified practitioners and in well-equipped facilities (Regional Health Systems Observatory, 2006). All these services were provided free of taxes as well because it was supported by revenues received from finance. Despite high life expectancy levels, welfare programs failed to distribute services evenly among the entire population in Kuwait. Specifically, noncitizens had much less benefits.

Currently, there are over 72 primary healthcare centers speared across the country, where patients can access various services, such as maternity care, density nursing care, preventive medical care and childcare. Complex medical cases from primary centers are usually referred to secondary (six hospitals) and tertiary health centers (sixteen clinics). Furthermore, public health system is adequately staffed with over 31, 338 employees comprising of doctors, nurses and other technical medical staff (Regional Health System Observatory, 2006). As per the private sector, the Kuwaiti government underscores the role of health care services delivery and invests money to increase quality and safety of provided services. Recently, Health of Ministry has accepted 35 applications from private companies planning to establish private clinics in Kuwait. In future, the Ministry of Health plan to set up Health insurance hospital and carry out privatization of some of the health care services in the public sector, including nuclear medicine, radiology and medical laboratory.

Kuwait is often considered to be among the fast developing economies in the world. However, economic growth and social welfare of citizens have not contributed greatly to improving health issues. This is of particular concern to children who suffer from unhealthy nutrition and decreased physical activity. Kuwait has become one of the important countries where obesity rates exceed the accepted norms. Regarding the problem of overweight children in Kuwait in a broader context, it is possible to define causes and reasons for increase in percentage of children with excess weight. More importantly, it is imperative to explore the related researches and reviews of the problem in a global context to define the extent to which the problem is considered worldwide.

Kuwait health care system incorporates both the public and private sectors, although over 80% of health care services are provided by the public sector under the Ministry of Health (MOH) (Regional Health Systems Observatory, 2006). Medical services are provided free of charge to the public in government clinics. This public health care system is run through a complex network of primary health care centers, research institutions and specialized hospitals, making Kuwait’s health care system one of the finest in the world.

Prevalence of the obesity in Kuwait

Obesity has become a major cause of concern for healthcare professionals of many countries, including Kuwait. The studies carried out in Kuwait indicate that more than 50 % of Kuwaiti population suffer from overweight, obesity, or metabolic syndrome (Al Rashdan & Nesef, 2010, p. 42). It has also been noted that Kuwait is one of the leading countries in obesity rates (Jackson et al, 2001; Al-Isa, 2004; El-Bayoumy, Shady, & Lotfy, 2009). The underlying causes of these problems can be different. Specifically, they can include unhealthy lifestyles, genetic predisposition to overweight, stress, and unavailability of healthy food (Simopoulos, 2005, p. 9). Nonetheless, these causes differ in various countries and regions, and empirical studies are needed to show why Kuwaiti children suffer from overweight. The prevalence of obesity has increased in a variety of developed countries, and it is often associated with high morbidity rates (Rubenstein, 2005).

The problem of unhealthy lifestyle has emerged in 1960s, when the oil was discovered in the Arabian Gulf region, Kuwait, along with such countries as Qatar, Oman, Bahrain, the United Arab Emirates, and Saudi Arabia established the Gulf Cooperation Council that worked on improvement of the population welfare and controlling wealth and income of people (Al Rashdan & Nesef, 2010). The economic growth, however, introduced significant increases in the sphere of health lifestyle. Specifically, increased rates of health diseases, which are often connected to nutrition transition, have become as a recognized problem leading to increased rates of obesity among the population, particularly among children (Regional Health System Observatory, 2006). Therefore, the presented program in improving economic welfare has also significantly contributed to the problem of obesity among children in Kuwait.

Many scholars believe that health risks can be averted in case overweight problems are identified at an early age (El-Bayoumy, Shady, & Lotfy 2009, p. 154; Rubinstein, 2005, p. 103). Health care professionals should focus their attention on childhood obesity because it is a good predictor of dangerous diseases that can manifest themselves during adulthood. In particular, timely disclosure can prevent such diseases as hypertension, diabetes, respiratory disorders, or cardiovascular diseases (El-Bayoumy, Shady, & Lotfy 2009, p. 154; International Diabetes Federation, 2011). According to several studies, parents often fail to report overweight and obesity problems that their children have. Moreover, they often assume that the condition is permanent and cannot be changed (Wake et al., 2002 p. 718; Jain et al., 2001, p. 1138). Parental neglect and unwillingness to change the lifestyles of their children can be an underlying cause of overweight problems (Yu, 2011, p. 105).

Apart from physical factors, psychologists single out the following factors which increase the risk of obesity, namely, parental neglect, family dysfunction, and psychiatric condition of parents (Tanasescu et al., 2000, p 1739). It has been observed that obesity can be caused by various factors such as family background (Giugliano & Carneiro, 2004, p. 17). Additionally, the increasing prevalence of obesity is often attributed to the changes in children’s diet and lack of physical exercises (El-Bayoumy, Shady & Lotfy, 2009). Therefore, there is a need to examine the prevalence and causes of obesity among Kuwaiti children. This knowledge is essential for helping those people who suffer from overweight problems. Mirmiran et al. (2010) indicate that childhood obesity is rapidly spreading in the Middle East. The first category of studies exploring the causes of childhood obesity in Kuwait claims that family history of obesity and diabetes mellitus are the main reasons for obesity, whereas physical activity and social status are insignificant (Moussa et al., 1999). A similar conclusion regarding the impact of family history of obesity was drawn by Al-Isa, Campbell and Desapriya (2010) who state that having obese relatives living at home can significantly increase the risks of overweight and obesity among children. The risk of overweight is also associated with school level, chronic disease, and increased age.

The second category of studies emphasizes the misbalanced diets combined with physical inactivity as the main causes of the prevalence of overweight and obesity. El-Bayuomi, Shady & Lofty (2009) have conducted a cross-sectional study among intermediate school adolescents aged 10-14 and have found out that high caloric intake and physical inactivity are the most influential factors associated with overweight and obesity of Kuwaiti adolescents. Musaiger (2011) stated that the factors contributing to the prevalence of overweight and obesity in the Eastern Mediterranean region included urbanization and unhealthy eating habits implying frequent snacking, intake of sugary beverages, as well as long time spent on watching television. El-Ghazali et al. (2010) concluded that lifestyle aspects, including dietary habits, emotional eating, and much time spent on sedentary activities, such as television and video games, are among the most important factors causing overweight among Kuwaiti children. El-Sabban and Badr (2011) have reported that the deficiency of knowledge on healthy eating habits and lifestyles is the main cause of overweight and obesity in Kuwaiti students. Al-Qaoud et al. (2010) have examined the perceptions of Kuwaiti mothers of their children’s weight status to conclude that these perceptions are inappropriate. Mirmiran et al. (2010) have defined that positive image and irregular perception of overweight can be explained with the socio-cultural variables attributed to Kuwait as one of the Gulf States.

Another category of studies go deeper into the underlying causes of overweight and obesity prevalence in Kuwait and explore the impact of lack of awareness on healthy lifestyles and socio-cultural perceptions which can result in overweight and obesity. El-Sabban and Badr (2011) indicated that the deficiency of knowledge on healthy eating habits and lifestyles was the main cause of overweight and obesity in Kuwaiti students. Al-Qaoud et al. (2010) examined the perceptions of Kuwaiti mothers of their children’s weight status and concluded that these perceptions were mainly inappropriate. Mirmiran et al. (2010) concluded that positive image and irregular perception of overweight can be explained with the socio-cultural variables attributed to Kuwait as one of the Gulf States.

Significance of the Study

The study of obesity problem among Kuwaiti children is largely explained by the recently emerging concerns with overweight crisis in major countries of the world. Moreover, the problem is thoroughly examined at an international level. While exploring the problem of obesity, few researchers have been found that would directly relate to educational programs aimed at reducing the percentage of obese children in Kuwait, but the studies conducted in different studies underscore the seriousness of the problem. Moreover, they provide different socio-cultural perspectives of exploring excess weight among children, as well as different research designs.

To justify the chosen sample population (children 10-14), it is purposeful to refer to the research observations presented by El-Bayoumy, Shady, and Lotfy (2009) who have defined that intermediate school adolescents of this age category are in the greatest need of consideration because children experience significant physical, psychological, and biological changes. So, rational calories intake, healthy diet, and proper family behaviour are indispensible for reducing the problem of obesity among Kuwaiti children of this age. According to the study introduced by Amin, Al-Sultan and Ali (2008) children of this age category are under the greatest risk. His studies have revealed that this group of children has the highest percentage of overweight (over 30 %) and obese children (about 13 %) (Amin, Al-Sultan & Ali, 2008).

The above-presented studies underscore the importance of conducting the given research to define the causes of excess weight among children all over the world. However, little research has been found concerning the necessity of introducing specific training and educational programs to reduce the rates of overweight children. In this respect, the presented study is especially significant due to the perspectives and dimensions researched in the content of the global problems. In addition, there is a significant literature gap in research dedicated to exploring the governmental polices health care reforms oriented on improving the problem of obesity among children in Kuwait. So, the given research can significantly contribute to highlighting and outlining the actual reasons, including external and internal factors, for obesity in Kuwait, as well as to promoting the development of new educational programs aimed at decreasing the ratio of children with excess weight. More importantly, the presented study will narrow down the directions and objectives of the government with regard to the introducing of health care reforms aimed at improving the concept of health lifestyles among children.

Aside from the necessity of introducing specific educational programs, the significance of the study lies in the focusing on children under the age category of 10-14 as an important category of children. Recent study, hence, fails to discuss this particular group of children in more detail, including analysis of their family background, environment, and their psychological profile. In fact, these are one of the most influential factors.

Statement of the Problem

Childhood obesity has been classified as a burdening health problem that doubles the risk of other medical complications in adulthood (Wang & Lobstein, 2006). Moreover, body fatness associated with adolescence overweight and obesity has been linked to increased morbidity and mortality during adulthood (Kelishadi, 2007). Similarly, the link between obesity and non-communicable diseases is well documented. Most of these diseases that have been frequently reported include type 2 diabetes mellitus (Kerkadi, Abo-Elnaga & Ibrahim, 2005), cardiovascular diseases (Kelishadi, 2007), glucose intolerance (Flynn et al., 2005), musculo-skeletal problems (Ng et al., 2011), and respiratory difficulties (Musaiger, 2004).

The results of empirical studies have indicated that Kuwait has the highest rates of obesity prevalence in the Gulf region and these levels may continue to increase (Flynn et al., 2005). Wang and Lobstein (2006) attributed this prevalence to the hot and dry climate of Kuwait that discourages strenuous physical exercise and sports engagement. Moreover, Kuwaitis’ lifestyles have been changing gradually towards increased intake of calorie-high food and decrease of physical activity as a result of positive socio-economic changes.

While most studies focus on the causes of adolescents’ obesity and overweight, further research is required for investigating the measures which are imposed by schools and governments for raising awareness of children, their families and school communities and the general public on the meaning of leading healthy lifestyles. This study will explore the awareness of parents’ teachers and schoolchildren aged 10-14 on the importance of healthy diets and physical activity and analyze the effectiveness of health promotion programs at Kuwaiti schools.

Purpose of the Study

This study aims at exploring the prevalence of overweight and obesity among school children in Kuwait. The key problem is that not much attention has been paid to those factors which increase the risk of these health issues. The focus of the research will be children aged between 10 and 14 years. There are several objectives that this research has:

1. To establish the prevalence of overweight and obesity in children aged between 10 and 14 years in Kuwait;
2. To explore the perceptions and attitudes of parents and teachers about childhood obesity in Kuwait;
3. To determine the government policies aimed at addressing overweight and obesity among Kuwaiti school children;
4. To assess the effectiveness of school health promotion programs in reducing childhood obesity and overweight among school children of between 10 and 14 years.

In general, the purpose of this study is to offer a description on the prevalence of obesity and overweight in school-going children in Kuwait. These findings can help medical workers identify those children who are at a higher risk of developing overweight problems. Additionally, the study will be aimed at examining the perceptions and attitudes of both parents and teachers regarding childhood obesity. This information can be of the crucial importance because very these health problems are often associated with lack of parental awareness (Al-Kandari, 2006). The study will also offer recommendations for reducing the obesity epidemic in Kuwait.

Research Objectives and Questions

The objective of this study is to evaluate overweight and obesity prevalence in schoolchildren aged 10-14 years in relation to the awareness of adolescents, parents and teachers in Al Farwaniyah Governorate (province) in Kuwait on healthy lifestyles. Furthermore, this study will evaluate the effectiveness of health promotion programs launched by schools on reducing the prevalence of overweight and obesity.

This study will be guided by the following research questions:

• What is the prevalence of overweight and obesity among school children aged between 10-14 years in Kuwait?
• What are the knowledge perceptions and attitudes of parents and teachers about childhood obesity in Kuwait?
• What governmental health policies have been formulated to address overweight and obesity among Kuwaiti school children aged between 10-14 years?
• How effective is a school community health promotion program in reducing childhood obesity and overweight among school children aged between 10-14?

Definition of Terms

WHO (World Health Organization) “is the directing and coordinating authority for health within the United Nations systems” (World Health Organization, 2012). The organization is responsible for promoting leadership for such global health problems and shapes the current health research agenda.

BMI (Body Mass Index) a measure of weight with regard to height of a person. For an adult, the BMI should be within the identified frame of 21-23 kg/m². The range of 18.5 to 24.9 kg/m² is acceptable to minimize the morbidity risks. If BMI is greater than 30, a person is considered to suffer from obesity.

Excess weight means excess of body weight.

Obesity implies to excess of fat or muscles. For the given research, overweight will be considered as excess ratio of fats in an organism.

Health risk factors are identified with regard to the BMI, waist circumference (relates to obesity and overweight), other risk factors connected to obesity, such high level of blood pressure, high or low level of cholesterol, and high level of triglycerides, family history, genetic predisposition, and physical activities.

Structure of the Thesis

The entire thesis is composed of the following chapters. The first chapter provides a background of the study, purpose statement, and research objectives. It also sheds light on the significance of the study and background information related to the research topic. The second chapter will focus on literature review related to the study. It will specifically deal with the problem of obesity, governmental polices introduced to handle the problem, and physical education in Kuwait. The chapter will also serve as a theoretical framework for the study. The third chapter will be dedicated to exploring the nature of design, including methodology and data collection. The analysis presented in the fourth chapter will be linked to the results and findings of the study that answer the main research questions. Therefore, basically, the research design will be aligned to an ethnographic study. The fifth chapter will disclose the main stages of data analysis, that will involve observations, interview transcribing, data coding, and note taking. The sixth chapter will provide possible weaknesses of methodology and limitations to the research. The seventh chapter will provide conclusion and findings to the presented studies. They will heavily rely both on interview results and statistical data received once all interviews are conducted. Finally, the eighth chapter will provide recommendation and implication for the future work. The list of references will follow the conclusion section. Relevant charts and statistics will be presented in the appendices as soon as the interview data is transcribed.

Summary

In the introducing chapter, an overview of overweight and obesity among children in Kuwait has been presented. The increasing rate of obesity in Kuwait among school children has raised concern of many healthcare professionals. This trend is often attributed to changes in the dietary patterns and lifestyles. The proposed study will examine the factors which can contribute to obesity and children aged between 10 and 14. In order to define the main concerns in the sphere of obesity among children, an overall evaluation of Kuwait health system has been proposed. Further, the chapter argues the necessity to provide a describe of the prevalence of overweight among Kuwaiti children because this information can contribute to expanding knowledge on medical interventions. In addition, the chapter provides the purpose to establish specific governmental polices addressing the problem and work out efficient educational program aimed at reducing the obesity rates among children. To proceed with further study and analysis of information, specific terms and concepts should be define that will guide the entire research.

The second chapter will review literature related to the topic of obesity among children in Kuwait to define the reasons, internal and external factors, as well as governmental polices addressing the problem. It will first review statistics on obesity including morbidity rates and causes of childhood overweight. Further consideration of literatures refers to the analysis of social-cultural factors and their influence on the obesity rates among children. The studies were specifically concerned with gender, nationality, and age factors that have an impact on obesity rates. Finally, the researches obesity prevalence among adolescents has been analyzed to provide a comparative view on the problem.

References

Al Rashdan, I., & Al Nesef, Y. (2010). Prevalence of overweight, obesity, and metabolic syndrome among adult Kuwaitis: results from community-based national survey. Angiology, 61(1), 42-48

Al-Isa, A. N. (2004). Body mass index, overweight and obesity among Kuwaiti intermediate school adolescents aged 10-14 years, European Journal of Clinical Nutrition, 58, (9), 1273–1277.

Al-Isa, A., Campbell, J., & Desapriya, E. (2010). Factors associated with overweight and obesity among Kuwaiti elementary male school children aged 6-10. International Journal of Pediatrics, 2010, 1-6.

Al-Kandari, Y. (2006). Prevalence of obesity in Kuwait and its relation to sociocultural variables. Obesity Reviews: An Official Journal Of The International Association For The Study Of Obesity, 7(2), 147-154.

Al-Qaoud, N. et al. (2010). Kuwaiti mothers’ perception of their preschool children’s weight status.Journal of Developmental and Behavioral Pediatrics, 31(6), 505-510.

Amin, T. T., Al-Sultan, A.I, & Ali, A. (2008).Overweight and obesity and their relation to dietary habits and socio-demographic characteristics among male primary school children in Al-Hassa, Kingdom of Saudi Arabia.Eur J Nutr, 47, 310–318.

Aziz, S. (2009).Obesity in pediatric population of developing countries, a serious issue? J Pak Med Assoc, 59(3), 127-219.

Dehghan, M., Noori, A. & Merchant, A. (2005). Childhood obesity, prevalence and prevention.Nutritional Journal, 4(24), 16-34.

Eisenmann, J. C., Heelan, K. A. & Welk, G. J. (2004).Assessing body composition among 3- to 8-Year-Old Children: Anthropometry, BIA, and DXA. Obesity Research, 12, 1633–1640.

El-Bayoumy, I., Shady, I., & Lotfy, H., (2009). Prevalence of obesity among adolescents (10 to 14 Years) in Kuwait, Asia-Pacific Journal of Public Health, 21 (2), 153–159.

El-Ghazali et al. (2010). The relationship between lifestyle and body mass index among university students in Kuwait. The Egyptian Journal of Community Medicine, 28(1), 69 – 77.

El-Hazmi, M. F. &Warsy, A. S. (2002).The prevalence of obesity and overweight in 1-18-year-old Saudi children. Annals of Saudi Medicine, 22(5-6), 303-308.

El-Mouzan, M. I.et al. (2010). Prevalence of overweight and obesity in Saudi children and adolescents. Annals of Saudi Medicine, 30(3), 203–208.

El-Sabban, F. & Badr, H. (2011).Assessment of nutrition knowledge and related aspects among first-year Kuwait university students.Ecology of Food and Nutrition, 50(2), 181 – 195.

Flynn, M.A. et al. (2005). Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’ recommendations. Obesity Reviews, 7(11), 7-66.

Giugliano, R. and Carneiro, E. C. (2004). Factors associated with obesity in school children, Jornal de Pediatria, 80 (1), 17–22.

International Diabetes Federation. (2011). Global Perspectives on Diabetes: Winning the Battle Against Childhood Obesity. Diabetes Voice. 56(1), pp. 1-48. Web.

Jackson, R. T., Al-Mousa, Z., Al-Raqua, M., Prakash, P., & Muhanna, A., (2001). Prevalence of coronary risk factors in healthy adult Kuwaitis, International Journal of Food Sciences and Nutrition, 52, (4), 301–311.

Jain, A., Sherman, S. N., Chamberlin, L. A., Carter, Y., Powers, S. W., & Whitaker, R. C., (2001). Why don’t low-income mothers worry about their pre-schoolers being overweight? Paediatrics, 107 (5), 1138–1146.

Kelishadi, R. (2007). Childhood overweight, obesity, and the metabolic syndrome in developing countries. Epidemiol, 29 (1), 62-76.

Kerkadi, A. Abo-Elnaga, N., & Ibrahim, W. (2005). Prevalence of overweight and associated risk factors among primary female school children in Al-Ain city United Arab Emirates. Emir. J. Agric. Sci, 17(1), 43-56.

Kuwait central statistical office (2011) Population of Kuwait. Web.

Mirmiran, P. et al. (2010). Childhood obesity in the Middle East: A review. Eastern Mediterranean Health Journal, 16(9), 1009-1018.

Moussa, M. et al. (1999). Factors associated with obesity in Kuwaiti children. European Journal of Epidemiology, 15, 41-49.

Musaiger, A. O. (2004). Overweight and obesity in the Eastern Mediterranean Region: Can we control it? Eastern Mediterranean Health Journal, 10(6), 789-792.

Musaiger, A. O. (2011). Overweight and obesity in Eastern Mediterranean Region: Prevalence and possible causes. Journal of Obesity, 1(1), 1-17.

Ng, S. W.et al. (2011). The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States ObesityReviews, 12(1), 1-13.

Qureshi, F., Hussain, J., & Saqib, A. (2011). Obesity: Prevalence Among Boys In Public And Private Secondary School Children. Professional Medical Journal, 18(3), 489-493.

Regional Health System Observatory (2006). Health System Organization. Web.

Rubenstein, A. H., (2005). Obesity: a modern epidemic, Transactions of the American Clinical and Climatological Association, 116, 103–113.

Simopoulos, A. (2005). Nutrition and fitness: obesity, the metabolic syndrome, cardiovascular disease, and cancer. London: Karger Publishers.

Tanasescu, M., Ferris, A. M., Himmelgreen, D. A., Rodriguez, N., and Pérez-Escamilla, R. (2000). Bio-behavioral factors are associated with obesity in Puerto Rican children, Journal of Nutrition, 130, (7), 1734–1742.

Wake, M., Salmon, L., Waters, E., Wright, M., & Hesketh, K. (2002). Parent-reported health status of overweight and obese Australian primary school children: a cross-sectional population survey, International Journal of Obesity, 26 (5), 717–724.

Wang, Y., & Lobstein, T. (2006).Worldwide trends in childhood overweight and obesity. International Journal of Pediatric Obesity, 1, 11-25.

WHO (2011).Obesity and overweight. Web.

Yu, H. (2011). Parental Communication Style’s Impact on Children’s Attitudes toward Obesity and Food Advertising. Journal Of Consumer Affairs, 45(1), 87-107.