Individual, family, and community predictors of overweight and obesity among Colombian children and adolescents

Abstract

Introduction: Information from high-income countries is often used to design childhood obesity prevention interventions in low- and middle-income countries, even though determinants may differ greatly between settings. Methods: We examined the associations of individual, family (household), and community (municipality) characteristics with body mass index (BMI) z scores and likelihood of overweight among children aged 5 to 18 years measured for the Colombian National Nutrition surveys of 2005 (n = 9,119) and 2010 (n = 21,520). We used 3- level hierarchical linear models with child as level 1, household as level 2, and municipality as level 3. Results: The prevalence of combined overweight and obesity among Colombian children and adolescents was 15.7% in 2005 and 16.6% in 2010. The household level explained 40% in 2005 and 31% in 2010 of the variability in BMI z scores. Wealth was positively associated with BMI in 2005 (0.09 increase in z score per quintile) (P < .01). Children and adolescents from extended families had higher BMI z scores than those from nuclear families; BMI z scores were inversely associated with the number of family members living in the same household. The municipality level explained only between 2% and 3% of the variability in BMI. Income inequality was positively associated with BMI z scores in 2010. Conclusion: These patterns differ from those commonly described in high-income countries and suggest more appropriate opportunities for interventions to prevent child and adolescent obesity in Colombia and other Latin American settings and populations.