Contributors to childhood obesity in Iran: the views of parents and school staff.

OBJECTIVE: To explore the contextual influences on childhood obesity in Tehran, Iran to inform future development of an obesity prevention intervention for Iranian primary school children. STUDY DESIGN: Qualitative study. METHODS: Focus groups and interviews with parents and school staff were convened to explore their perceptions of the causes of childhood obesity. Eleven focus groups and three interviews were held with parents and school staff (88 participants in total) from three different socio-economic areas in Iran's capital city, Tehran. All the discussions were transcribed verbatim in Persian. An iterative thematic approach was used for data analysis. RESULTS: Overall, the causes of childhood obesity were perceived to relate to macro-level policy influences, the school environment, sociocultural factors, and family and individual behavioural factors, acting in combination. A key emergent theme was the pervasive influence of Government policies on children's food intake and physical activity. Another key theme was the political and sociocultural context that does not support girls and women in Iran in having active lifestyles. CONCLUSION: The findings suggest that parents and school staff have sophisticated views on the possible causes of childhood overweight and obesity which encompassed behavioural, structural and social causes. A prominent emerging theme was the need for state level intervention and support for a healthy environment. Any local initiatives in Iran are unlikely to be successful without such support. WHAT IS KNOWN ON THIS SUBJECT: Childhood obesity is growing in Iran and it is seen as one of the features of the nutrition transition in developing countries. Findings from cross-sectional studies suggest a range of lifestyle factors contribute to obesity in the Iranian population. WHAT THIS STUDY ADDS: This qualitative study explores the socioenvironmental changes contributing to childhood obesity in primary school-aged children in Iran. Findings have provided important contextual data on the perceived contributors to childhood obesity in Iran, such as macro-level policy influences on accessibility to healthy food and physical activity, competing priorities at school level, sociocultural influences on diet and physical activity and limited knowledge and skills of parents. This has laid the foundation for the development of appropriate childhood obesity prevention interventions.

Prevalence of obesity in Iran.

Recent descriptive studies suggest that Iran has geared in the nutrition and epidemiological transition processes. Therefore, while the problems of undernutrition (e.g. growth retardation and micronutrient deficiencies) still exist, the burden of overweight/obesity and diet-related chronic diseases is increasing. The prevalence of overweight (body mass index > or = 85th reference percentiles) among urban 15-39 and 40-69 year olds is estimated at about 22% and 40% respectively. Corresponding values in rural areas are 16% and 26%. The transition seems faster among female population at national level. There are however, great differences between different provinces. Urgent preventive strategies are needed to simultaneously tackle both forms of malnutrition in the country.

Social factors and pregnancy weight gain in relation to infant birth weight: a study in public health centers in Rasht, Iran.

OBJECTIVES: This study aimed to examine the relationship between total pregnancy weight gain, maternal educational level, working status and infant birth weight among mothers and infants in urban health centers in Rasht, Iran. DESIGN: Pregnant women from six different public health centers in urban areas were studied in a prospective design. Data on women's age, parity, level of education, working status, infant birth weight, mothers' height, and prepregnancy weight and total weight gain during pregnancy were collected. The subjects were grouped based on their prepregnancy BMI and according to Institute of Medicine (IOM) recommendation for total pregnancy weight gain. The subjects were also categorized based on their years of schooling as less, intermediately and highly educated. In this study women were considered as either housewives or employed. SETTING: Public health centers in urban areas in Rasht, Iran. SUBJECTS: A total of 1914 pregnant women were studied. RESULTS: These data showed that pregnancy weight gain was not different between women with normal prepregnancy weight and underweight when educational levels and working status were taken into account. Besides, pregnancy weight gain was positively related to the level of education. Analysis of variance showed that infant birth weights were not similar in mothers who gain weight less, within and above recommended ranges. In all, 60% of the normal weight women and 56.7% of the underweight women had weight gain less than the lower cutoffs of IOM recommendation. Results of logistic regression analysis showed that low level of mother's education was the only predictor for low birth weight (LBW) (>12 y education OR = 0.27(0.10-0.69)) and 5-12 y education OR = 0.62 (0.2-0.94). CONCLUSION: These results showed that pregnancy weight gain lower recommended ranges are highly prevalent in Iranian women in public health centers in urban areas in Rasht. Moreover, mother's level of educational level may be considered as the most important determinant of birth weight and LBW in this population.

Prevalence of overweight and obesity in adolescent Tehrani students, 2000-2001: an epidemic health problem.

OBJECTIVE: Overweight has become a public health problem in most developing countries. Evidence suggests that adolescence is a critical period in determining adulthood obesity and its complications. The present study was carried out to assess the prevalence of overweight and obesity among secondary school students. DESIGN AND SETTING: This descriptive study was conducted in Tehran city, 2000-2001. Body weight and height were measured and body mass index (BMI) values were calculated. Underweight, overweight and obesity were defined as <5th, > or = 85th and > or = 95th percentile, respectively, of age- and sex-specific BMI values from the National Center for Health Statistics/Centers for Disease Control and Prevention (2000). SUBJECTS: Using a multistage sampling method, 2321 students (1068 males and 1253 females) aged 11-16 years were assessed in Tehran, the capital city of Iran. RESULTS: The overall prevalences of overweight and obesity were 21.1 and 7.8%, respectively. The prevalence of overweight among girl students (i.e. 23.1%; 95% confidence interval (CI) 20.8-25.4) was significantly higher than that among boys (i.e. 18.8%; 95% CI 16.5-21.1, P=0.01) even after adjustment for age (odds ratio 1.26, 95% CI 1.03-1.55, P=0.02). No significant risk of obesity associated with age was found in girls or boys. In both sexes, median values of age-specific BMI in this study were statistically higher than corresponding values collected in Tehrani adolescents 10 years ago (P=0.03). Similarly, a significant difference was seen between girl students in this study and the reference population (P=0.03). CONCLUSION: According to this study, overweight, especially in girls, should be considered an epidemic health problem among adolescent students in Tehran.