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Obesity in children and adolescents, as measured by BMI and ideal weight: case educational institutions in Caracas, Venezuela

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Abbreviations: RR, relative risks; BMI, body mass index;
WHO, world health organization; CDC, center for disease control and
prevention
Introduction
Nowadays, globally, both overweight and obesity are a health
problem, because in many countries it has been present, particularly
in vulnerable groups, such as children and adolescents.1 On the other
hand, obesity and overweight are serious problems that involve an
increasing economic burden for families, particularly in families
with lower incomes, since it implies continuous attendance at the
medical consultation, as a consequence of the problems it causes.
Moreover, if one takes into account that overweight acquired during
childhood or adolescence can persist during adulthood, and increase
future risks of coronary heart disease, diabetes, gallbladder diseases,
some types of cancer and osteoarthritis of the joints that support
weight. Fortunately, this evil can be prevented to a large extent by
introducing appropriate changes in lifestyle.2 Additionally, in the case
of nutritional deciencies such as protein malnutrition, energy, iron,
vitamin A and iodine deciency, these affect the participation and
learning of schoolchildren, because they are a very vulnerable age
group.3 It must be borne in mind that obesity is a complex disease
characterized by the excessive accumulation of fat tissue in the body,
weight gain and its consequences, with numerous complications, and
can be caused by many causes. Obesity results from an imbalance
between consumption and energy expenditure, although it is also
associated with social, behavioral, cultural, physiological, metabolic
and genetic factors. Obesity does not distinguish between skin color,
age, socioeconomic status, sex or geographical location, and it has
multiple health consequences.4,5 Similarly, obesity is part of the
metabolic syndrome; It is a known risk factor for chronic diseases
such as: heart disease, diabetes, high blood pressure, stroke and some
forms of cancer. The evidence suggests that it is a multifactorial
disease: genetic, environmental, and psychological, among others,
excessive accumulation of fat in the body, general hypertrophy of
adipose tissue.6 Additionally, obesity is a disease whose prevalence
has had a marked increase in the last four decades; such an increase
has led to obesity being considered as a public health problem since
1997,7 which must be addressed promptly, since as expressed by
the WHO, “The health of the population contributes decisively to
economic development And social”; In addition, it is important to bear
in mind that “Health is both an objective and a decisive contribution
to the achievement of other objectives.7,8 The latest calculations of
the World Health Organization (WHO), indicate that in 2005 there
were around 1600 million adults (over 15 years old) overweight
worldwide; at least 400 million obese adults and at least 20 million
children under 5 overweight.9,10 However, even though overweight
and obesity were previously considered a problem unique to high-
income countries, recent studies show that it is increasing alarmingly
in low- and middle-income countries, particularly in urban areas.9,10
However, for many specialists worldwide, dening obesity is
difcult, and this is due to the fact that there are many factors that
cause it and vary among populations. In such a way that in the case
of children, it becomes much more difcult to dene it, but it is
important to know that it is considered normal that at four months of
age there is a large amount of fat, which decreases steadily between
two and six years and increase around seven years. On the other hand,
it is known that when a child is obese between six months and seven
years of age, the probability of this being obese in adulthood is 40%.
If a child is obese between ten and thirteen, the odds are 70%; This
is explained because the cells that store fat, that is, the adipocytes,
multiply at this stage of life, which increases the child’s chance of
being obese as an adult.1,2
MOJ Biol Med 2018;3(3):5862. 58
© 2018 Bauce. This is an open access article distributed under the terms of the Creative Commons Attribution License, which
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Obesity in children and adolescents, as measured by
BMI and ideal weight: case educational institutions in
Caracas, Venezuela
Volume 3 Issue 3 - 2018
Gerardo Bauce
School of Nutrition and Dietetics, Central University of
Venezuela, Venezuela
Correspondence: Gerardo Bauce, School of Nutrition and
Dietetics, Central University of Venezuela, Venezuela,
Email gbauce@hotmail.com
Received: December 05, 2017 | Published: June 20, 2018
Abstract
This study was carried out, whose objective was to compare obesity using ideal weight
and BMI, in a group of children and adolescents of Caracas, for which it was taken as
probabilistic sample, the students of two educational institutions of the Capital District,
conformed by 441 schoolchildren, of them 255 (52.68%) males and 229 (47.32%)
females. The variables were measured: sex, age, weight, ideal weight, height and BMI,
descriptive statistical measures were applied, as well as relationship, sensitivity and
specificity. The results revealed that percentages of similar overweight between CDC
and PV, and between OMS and PI; likewise, it is observed that the percentage of
obesity with the PI is much higher than that obtained with OMS; However, when
the WHO model was considered as a reference model, a sensitivity of 0.95 and a
specificity of 0.84 were obtained for the PI criterion. In conclusion, it can be affirmed
that for this group of schoolchildren, the criterion of the PI is acceptable, since, it
allows to placing the students in the category of obesity with a 95% probability.
Keywords: overweight, obesity, ideal weight, body mass index, children, adolescents
MOJ Biology and Medicine
Research Article Open Access
Obesity in children and adolescents, as measured by BMI and ideal weight: case educational institutions
in Caracas, Venezuela 59
Copyright:
©2018 Bauce.
Citation: Bauce G. Obesity in children and adolescents, as measured by BMI and ideal weight: case educational institutions in Caracas, Venezuela MOJ Biol Med.
2018;3(3):5862. DOI: 10.15406/mojbm.2018.05.00077
In the case of Venezuela, gures for the year 2004, place obesity
for the group of children and adolescents from 7 to 14 years old, in
13.7%.4,6 And according to the Food and Nutritional Surveillance
System (SISVAN), in Venezuela, for the year 2007, the gure of
boys and girls with overweight reached 13.12%, higher than the
previous year, which stood at 11.67%.11 More recently, according to
the INN, in the voice of María Alejandra Chávez, who afrms that
“It is said that for every ten children, three are obese, which indicates
that in the future our society will be obese”.12 While according
to the AVN, for the year 2010, the obesity gure is 9.0%.13 The
complications of overweight and obesity in childhood are several:
cardiovascular (cardiopathies and cerebral vascular accidents),
diabetes, hypertension, increase in total cholesterol, increase in serum
triglycerides, increase in LDL (low density lipoprotein), increase of
VLDL (very low density lipoproteins), decrease in HDL (high density
lipoprotein), hyperinsulinism, cholelithiasis, sliding and attening
of the capital femoral epiphysis, pseudotumor cerebri, Pickwick
syndrome, abnormal pulmonary function tests, etc.3,14, This may be
linked to sociocultural factors of these low-income populations, where
access to food is limited by the low purchasing power of families, as
well as the lack of knowledge about the benets of many foods that
do not consume.
Materials and methods
The sample was selected through a probabilistic stratied sampling
procedure, with a reliability of 95% and a maximum error of 3.3%; It is
made up of 340 schoolchildren of the El Libertador Educational Unit,
located in the Chacao Municipality, Miranda State and 144 students
of the Antímano II Educational Unit, located in the West Sector of the
Libertador Municipality, Capital District, for a total of n=484 school
The information collection period was between November 2010 and
March 2011. The following variables were considered: sex, age,
weight, height, BMI and Ideal Weight. For the measurement of these
variables, the criteria suggested by the WHO were taken into account;3
likewise, internationally validated anthropometric techniques were
used.15 Measurements were made for each of these variables, with the
support of a group of previously standardized students of Nutrition
and Dietetics; the students were measured and weighed without shoes,
in their underwear, following established and internationally accepted
techniques.16,17 The BMI was obtained through the methods a) Center
for Disease Control and Prevention (CDC, 2000), percentile≥85 and
<95, risk of overweight, percentile≥95, obesity; b) WHO, BMI>+1DE,
overweight and BMI≥+2DE, obesity; c) Venezuela Project, percentile
between P90 and P97, risk of overweight, d) ideal weight,% of
ideal weight between 110 and 120, overweight; percentage of ideal
weight>120; obesity.
The World Health Organization (WHO) published in 2006 a new
International Child Growth Pattern, referring to infants and young
children and suggests the following table to classify the Body Mass
Index. Severe thinness (<- 3DE); Thinness (<-2DE); Normal (-1DE
to+1DE); Overweight (>+1DE); Obesity (≥+2DE). The overweight
category is equivalent to BMI 25 kg/m2 to 19 years, and the obesity
category is equivalent to BMI 30kg/m2 to 19 years.18 Similarly, the
Center for Disease Control, CDC for its acronym in English, presented
in 2000, the revised version of the growth charts, specically the
Tables of Body Mass Index (BMI) for age and sex, establishing as
criterion the percentiles, and suggest the following cut-off points:
Below the appropriate weight (P<5%); Healthy weight (P5 to P85);
Overweight risk (P>95%); Overweight (P85 to P95),19 For its part, the
Venezuela Project considers as a classication criterion for overweight
and obesity, based on the percentiles according to weight and gender,
the following: Decit (P<3%); Decit risk (P3 to P10); Normal ((P10
to 90); Overweight risk (P90 to P97) and Overweight (P>97%).20
The French physician and surgeon Paul Pierre Broca, in the year
1871, based on studies carried out in a group of soldiers, proposed
the use of an index that consists in obtaining the body weight of an
individual from his height; this way it has that the suitable weight
or ideal weight comes given by: P (kg)=E (cm)-100; where P is the
weight, expressed in kg and E the height, measured in cm. The value
obtained varies according to sex: men:±10% and women:±15%; also
it has limitations, since applicable only to people with less than 1.65 m
height; reason why other methods are used, particularly the body mass
index (BMI).21 For the classication a percentage of Ideal Weight is
taken into account, which is given by% PI= Real Weight x 100 / Ideal
Weight, and the following categories: Severe malnutrition (<60% of
the PI), Moderate malnutrition (60% to 90% of the PI), Normality
(90% to 110% of the PI), Overweight (110% to 120% of the PI) and
Obesity (>120% of the PI). The BMI Group Calculator-Metric_no99.
xls program of the CDC was used to calculate the BMI values and
the corresponding percentiles. Descriptive statistical measures were
obtained as average, deviation and coefcient of variation; measures
of association such as chi-square and evaluation as sensitivity and
specicity.
Result
The group made up of 484 schoolchildren distributed as follows:
144 of the Antímano II Educational Unit and 340 of the Libertador
Educational Unit, both of the Capital District, Caracas, Venezuela,
enrolled in the 2010-2011 school years. As can be seen in the results
presented in (Table 1), the averages for age, weight and BMI are
higher in the Educational Liberating Unit, while the average of the
size is the same in both institutions. With regard to the ideal weight,
the averages are very similar for both institutions, although the
standard deviation is slightly higher in the El Libertador Educational
Unit. When comparing the results, by gender and institution, it can be
seen that in the Antímano II Educational Unit, the averages, of all the
variables, for the female gender are higher than the averages for the
male gender; while in the El Libertador Educational Unit, the averages,
of all the variables, for the female gender, are lower than the averages
for the male gender. Similarly, for the variables age, weight and BMI,
the averages are higher in the El Libertador Educational Unit, with
average height and ideal weight being very similar. According to
the WHO criteria, the prevalence of overweight is 8.88%; while the
prevalence of obesity is 4.14%. By gender, overweight is similar in
children (8.63%) and girls (9.17%).
Regarding the classication, according to the CDC the results
indicate that the prevalence of overweight 18.39% and prevalence of
risk of overweight (obesity) of 9.71%. In the case of Overweight, the
prevalence is higher in girls than in boys; likewise, there is a higher
percentage (Prevalence) of risk of overweight in children (11.76%)
than in girls (7.42%). Regarding the Venezuela Project criteria, the
prevalence of Overweight Risk is 16.74%, being similar in both
genders (46.91% and 43.09% for boys and girls, respectively), while
prevalence of overweight is 7.43%, being much higher in children
(63.89%) than in girls (36.11%). On the other hand, the classication
according to the criterion of Ideal Weight the prevalence of Obesity
is 19.63% and of Overweight is of 9.71%. When considering each
gender, we have that for Obesity there are 21.96% in children and
Obesity in children and adolescents, as measured by BMI and ideal weight: case educational institutions
in Caracas, Venezuela 60
Copyright:
©2018 Bauce
Citation: Bauce G. Obesity in children and adolescents, as measured by BMI and ideal weight: case educational institutions in Caracas, Venezuela MOJ Biol Med.
2018;3(3):5862. DOI: 10.15406/mojbm.2018.05.00077
17.03% in girls, while for Overweight there are 10.20% in boys and
9.17% in girls. When the WHO criterion was considered as a model,
and the criterion was compared using the Ideal Weight, to classify
the children and adolescents in obese and non-obese, a Sensitivity of
0.95 and a Specicity of 0 was obtained, 8362, which allows to afrm
that there is a probability of 0.95 to classify them as obese, using the
PI; while there is a probability of 0.84 to classify them as non-obese,
when using this criterion Table 2.
Table 1 Statistical measures of the variables: Age, Weight, Size, BMI and Ideal Weight, school children of the Educational Units Antímano II and Libertador, by
gender,
Caracas Venezuela. School year 2010-2011
Variable Antímano II educational unit
Male Female Total
Media Desv. Maximum Minimum Media Desv. Maximum Minimum Media Desv. Maximum Minimum
1,76 13,00 6,00 9,80 1,77 13,00 6,00 9,61 1,77 13,00 6,00
Peso 33,55 9,63 68,00 19,50 35,50 10,27 67,00 20,10 34,51 9,96 68,00 19,50
Talla 136,14 11,86 166,00 111,00 138,20 10,81 160,00 113,00 137,15 11,37 166,00 111,00
IMC 17,79 3,09 30,22 13,92 18,23 3,16 28,62 12,89 18,00 3,12 30,22 12,89
Peso Ideal
(Brocca) 36,14 11,86 66,00 11,00 38,20 10,81 60,00 13,00 37,15 11,37 66,00 11,00
Variable Libertador Educational Unit
Male Female Total
Media Desv. Maximum Minimum Media Desv. Maximum Minimum Media Desv. Maximum Minimum
Edad 10,54 2,08 15,00 6,00 10,06 2,01 15,00 2,08 10,32 2,05 15,00 6,00
Peso 37,47 14,15 108,80 18,80 35,96 10,87 108,80 14,14 36,77 12,73 108,80 17,80
Talla 137,24 14,13 173,00 108,00 136,74 13,53 173,00 14,13 137,01 13,84 173,00 105,00
IMC 19,29 4,09 40,45 12,96 18,83 3,15 40,45 4,09 19,08 3,68 40,45 12,20
Peso Ideal
(Brocca) 37,24 14,13 73,00 8,00 36,74 13,53 73,00 5,00 37,01 13,84 73,00 5,00
Table 2 Distribution of school children, according to WHO, CDC, Venezuela Project and Ideal Weight criteria. Antímano II and El Libertador Educational Units.
Caracas, November 2010 - March 2011
OMS criterio (2006) Condition M % F % T %
-2DE < IMC≤-1DE Undened 28 10,98 31 13,54 59 12,19
-1 DE < IMC≤ 1DE Normal 191 74,90 171 74,67 362 74,79
+1DE <IMC≤+2DE Overweight(a) 22 8,63 21 9,17 43 8,88
IMC >+2 DE Obesity(b) 14 5,49 6 2,62 20 4,14
Total 255 52,69 229 47,31 484 100,00
CDC criterion Condition M%F%T%
IMC < %5 Under weight 7 2,75 9 3,93 16 3,30
5% ≤ IMC < 85% Healthy weight 175 68,63 157 68,56 332 68,60
85% ≤ IMC < 95% Overweight Risk 43 16,86 46 20,09 89 18,39
IMC ≥ %95 Overweight 30 11,76 17 7,42 47 9,71
Total 255 52,69 229 47,31 484 100,00
Venezuela project criterion Condition M % F % T %
P < 3% Decit 2 50,00 2 50,00 4 0,83
P3 - P10 Decit risk 4 36,36 7 63,64 11 2,27
P10 – P90 Normal 188 53,41 164 46,59 352 72,73
P90 - P97 Overweight Risk 38 46,91 43 43,09 81 16,74
Obesity in children and adolescents, as measured by BMI and ideal weight: case educational institutions
in Caracas, Venezuela 61
Copyright:
©2018 Bauce.
Citation: Bauce G. Obesity in children and adolescents, as measured by BMI and ideal weight: case educational institutions in Caracas, Venezuela MOJ Biol Med.
2018;3(3):5862. DOI: 10.15406/mojbm.2018.05.00077
P > 97% Overweight 23 63,89 13 36,11 36 7,43
OMS criterio (2006) Condition M % F % T %
Total 255 52,69 229 47,31 484 100,00
Ideal weight criterion Nutritional situation M % F % T %
< 60 Severe Malnutrition 0 0 1 0,44 1 0,21
60 - 90 Moderate malnutrition 89 34,90 75 32,75 164 33,88
90 - 110 Normal 84 32,94 93 40,61 177 36,57
110 - 120 Overweight 26 10,20 21 9,17 47 9,71
>120 Obesity 56 21,96 39 17,03 95 19,63
Total 255 52,69 229 47,31 484 100,00
Discussion
The classication according to the CDC reects an incidence of
risk of overweight of 9.71% and overweight of 18.38%, results higher
than those reported by Arbes et al, who found that about 16.00% of
children and young Americans from 2 to 19 years old are obese, as
reported by Tango, who found that about 24.00% of children aged
2 to 5 years are obese,22,23 higher than those reported by Somaya &
Mustafa22 who found that BMI according to the CDC classication,
5.8%, of children with overweight, as well as greater than the result
obtained by Marqués et al.,23 8.3% of obesity; and also higher
than those reported by Bauce, who reports 10.20%.24 The WHO
classication allowed obtaining an obesity prevalence of 4.14% and
8.88% of overweight, which is lower than those reported by Arbes &
Tango et al.,20,21 where the incidence of obesity is 16.0% and 24.0%,
respectively, although the percentage of obesity of 4.14% is lower than
that reported by Somaya & Mustafa22,25 who report 5.8%. Similarly,
these results are lower than those reported by Tovar Mojica et al.,26
who studied a group of 655 children between 7 and 18 years old, and
the prevalence of overweight and obesity was 20% and 18.1%.
Respectively, and both the percentage of obesity and the overweight,
lower than that reported by Bauce (4.93% and 9.54%).24 percentage
of overweight is signicantly lower (20.8%).27 Regarding the results
obtained when applying the criteria of the Venezuela Project, there is a
7.43% overweight, higher than that reported by Somaya and Muatafa,
but lower than reported by Arbes et al, Tango, Tovar Mojica;20–23,28
although similar to that reported by Bauce (7.24%).24 Likewise, when
applying the criterion of Ideal Weight, it is necessary that 19.63%
of Obesity, is lower than that obtained by Somaya & Mustafa22 and
that obtained by Tovar Mojica; although higher than that obtained by
Arbes & Tango et a.,20–23 and much higher than that obtained by Bauce
(2,63%).24 On the other hand, the application of several methods
or criteria to estimate the prevalence of overweight and obesity in
children and adolescents, leads to obtaining dissimilar results,
however, when calculating the Relative Risks (RR), considering the
genders, we have that for the CDC method, for overweight the RR is
equal to 1.33 and the RR for obesity is 1.59, which means that it is
1.3 times more likely that there is a male overweight than in females;
while it is 1.59 times more likely that there is an obese male than a
female. Likewise, the RR was calculated for the other two methods
used, and it is tained that for the WHO method, it is 0.91 more likely
to nd an overweight male than a female, and it is 1.21 times more
likely to nd an obese male than a female; while for the PV method,
it turns out that it is 1.07 times more likely to nd an overweight male
than to nd an overweight female and it is 0.79 times more likely to
nd an obese male than to nd an obese female. As we can see, with
the PV method, the RR value is lower R=0.78) in the case of obesity,
and with the WHO method the RR value is lower (RR=0.91) in the
case of overweight. Additionally, the WHO model was considered as
a reference model, and the PI model was used to classify children and
adolescents in obese and non-obese, and a sensitivity of 0.95 and a
specicity of 0.84 were obtained. However, no references were found
from previous studies that consider these two indicators, in order to
make a comparison.
Conclusion
The application of several methods to estimate overweight and
obesity, involves the use of different criteria that therefore produce
results that may vary in terms of the prevalence of these two health
situations, more when it comes to populations that by their very nature
are vulnerable. However, the results obtained by the method suggested
by the Project Venezuela, are lower in terms of risk of overweight, and
even lower in the case of overweight, which if assumed as obesity
estimated by the other methods, is still much less. There is a need
to continue carrying out this type of study with more numerous
populations, in order to verify the results obtained here, and in this
way to validate one of the methods used. It must be taken into account
that since obesity is associated with chronic diseases, it is interesting
to keep in mind what was afrmed by Farías Yáñez,27 such as the
fact that obesity leads to “insulin resistance and increases circulating
levels of insulin”. Such situation is aggravated because” at some point
the control of the glycemia is lost and the glucose intolerance occurs;
and nally type 2 diabetes occurs. Likewise, it is very important to
carry out studies on the incidence of childhood obesity, taking into
account that according to the WHO, in 2013, more than 42 million
children under the age of ve was overweight, which evidence that
the near future will be potential obese adults.28
Acknowledgments
Thanks to Dr. Carmen Cecilia Jiménez Palacios, for authorizing the
use of the database, which was part of his doctoral thesis, presented to
the Central University of Venezuela to qualify for the title of Doctor
in Dentistry; and to it were added the anthropometric variables to be
used in this investigation.
Conict of interest
Author declares no conict of interest.
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Obesity in children and adolescents, as measured by BMI and ideal weight: case educational institutions
in Caracas, Venezuela 62
Copyright:
©2018 Bauce
Citation: Bauce G. Obesity in children and adolescents, as measured by BMI and ideal weight: case educational institutions in Caracas, Venezuela MOJ Biol Med.
2018;3(3):5862. DOI: 10.15406/mojbm.2018.05.00077
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Objective to evaluate the WWCI, as an indicator of overweight and obesity, in three cities of Venezuela and the purpose of proposing it as an indicator of overweight and obesity. Materials and Methods: Descriptive, prospective and correlational study in a representative sample of 896 children and adolescents aged 6 to 15 years, 50.4% of whom were male. The variables sex, age, weight, height, Waist circumference (WC), Body Mass Index (BMI), Body Fat Percentage (BFP) and Weight-Waist Circumference Index (WWCI); means, deviation, correlations and ROC curve were determined. Results: Data show weight averages 43.1±14.8 kg; size 146.2±15.8 cm; BMI 19.6±3.6 kg/m2; WC 66.7±9.3 cm; BFP 15.5±7.3 and WWCI 0.64±0.2. Very good correlations between Size-Weight (0.87); Weight-BMI (0.84); Weight-WWCI (0.91); Size-WWCI (0.80) and BMI-WWCI (0.75); the percentages of children and adolescents, according to BMI and WWCI values, reveal Overweight 10.9% (BMI) and 11.6% (WWCI); Obesity 5.3% (BMI) and 5.8% (WWCI), according to percentiles. Overweight 4.1% (BMI) and 8.1% (WWCI); Obesity 0.3% (BMI) and 4.2% (WWCI), according to Mean and deviation. Overweight 7.2% (BMI) and 8.0% (WWCI); Obesity 3.3% (BMI) and 3.6% (WWCI), according to Fundacredesa. Averages, by sex, for weight, height, BMI, WC and WWCI, not significant; if the averages of the PGC (p<0,000). ROC curve moves away from the diagonal, coupled with the fact that the area under the curve is 0.983, reflects the goodness of the model, complemented by a high sensitivity and specificity, thus guaranteeing a discriminant power. Conclusion: The WWCI assessment reflects that it correlates with Weight, Height and BMI, classifies with similar and lower percentages, according to BMI criteria; the ROC curve reveals high Sensitivity and Specificity, which is why it is recommended as an indicator to evaluate overweight and obesity in children. KEYWORDS: Weight-Waist Circumference Index, Body Mass Index, Overweight, Obesit
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Presidency of the Nation. World Survey of School Health Results. Argentina
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Obesity in children and adolescents, as measured by BMI and ideal weight: case educational institutions in Caracas
Citation: Bauce G. Obesity in children and adolescents, as measured by BMI and ideal weight: case educational institutions in Caracas, Venezuela MOJ Biol Med. 2018;3(3):58-62. DOI: 10.15406/mojbm.2018.05.00077