Azusa Uemura
Laboratory of Human Ecology, Graduate School of Health Sciences, Hokkaido University
Now, obesity is the most important public healthconcern around the world !

Background―Various risk factors―

orldwide trend
Obesity is prevalent in…

CardiovascularDiabetesdiseaselow-, middle- income countries

only high-income countries（particularly urban areas）

childrenonly adults

obesity

Indonesia• Economic development has been accelerated.

Musculoskeletal（GDP doubled ! ※2005~2009)

disordersCancers• Child obesity increases in urban areas*.

etc.

Study area

Obesity increases lifestyle-related diseases !

Why childhood obesity is serious health concern?
• It relates to adulthood obesity.

Jakarta• It develops lifestyle-related diseases at a younger age.

outin

physical activity

Food recall• Attach the accelerometer for 7▼various food models !

What did you eat?
When did you eat ?
How many/much～did you eat ?

2. Estimate the portion size

(n=30)

2,457

2,276

protein (g)

69.9

63.8

fat (g)

76.5

67.3

carbohydrate (g)

360.4

337.3

• Calculate Total daily energy

13.0±0.4

12.8±0.5
153.5±6.4

Weight (kg)70.4±10.4

66.0±9.9

BMI (kg/m2)

28.5±3.1

27.9±3.0％fat (%)

31.6±7.836.5±4.6

Fat free mass (kg)47.9±7.441.8±5.2

expenditure (TEE) and daily step
frequency (STEP)▲ Accelerometer

4040BoysBMI（㎏/m/m2）

GirlsBMI ≒ 97th percentile
35p97
p95

30p90
p85

25p75
p50
p25
p10
p5p3

20

p95
p90
p85

25p75
p50
20p25
p10
p5p3

1214Age (years)

161012141,7351,5783) PAL : physical activity levelTEE2) (kcal/day)

2,666

2,398

expenditure(TEE / BMR)

PAL3)

1.58

1.52

STEP (step/day)

9,320

7,775

PAL ：Light to Moderate
STEP < recommended level• PAL was light to moderate**inboth boys and girls.
• STEP was below the recommended level(boys 14,000/girls 11,000 ***) in both boys and girls.
walk (4%)

16▲Compared to US CDC growth charts, themean BMI of both boys and girls almost
corresponded to the 97th percentile .

( CDC: United States Centers for Disease Control.)Acknowledgments

2) TEE : total energyBMR1) (kcal/day) To prevent childhood obesity…?
Evaluate accuratelyown dietary intake

Means of commuting to school ?

Age (years)(※RDA: boys 2,400 / girls 2,350 kcal)

Inactive lifestyle cause
obesity to children !

1) BMR: basal metabolic rate

(n=24)

1010• Compared data from a nationwide survey inIndonesia, the mean “weight for height” ofboth boys and girls exceeded the 97th percentile.

Dietary intake was appropriate,but physical activity level was low.

Girlsp9730• Energy was approximately equal to RDA (recommended
daily allowance) of Indonesia in both boys and girls.

Discussion

Boys(n=55)

15

10▲Fried noodles,
chicken, snacks,
juice etc.

(n=31)

156.9±7.615Energy (kcal)

consecutive days

(n=62)

Age (year)

35

GirlsGirls〈Comparison to US CDC growth chart (2000) 〉▼There are many “outside foodstore” around the school.

Energy ≒ recommended level

Boys

Height (cm)

1. Interview

3. Calculate TEI (total energy intake)and nutrition intake

Acceleration monitoring

characteristics of subjects

Ask about both “quality” and “quantity” ofwhat they ate and drankBMI（㎏/m/m2）

dietary intakeBoyscapital of the provinceof Central Javafocus on lifestyle of obese children.

In my study,(n=60)

Semarang：：urban area

▲ There are many carsaround the school.

• Among urban elementary school
children who were classified“obesity” or “overweight”,
only 4 % walked to school.

go by car obesity(96%)

underweight

overweight

Most of them went
to school by car!

normal(Yoshimura et al., 2010)

Future prospects

Incorporate exercise • Reveal current status of prevalent of child obesityand examine lifestyle of them in rural area of Indonesia.
into daily life

Maintain healthy body weight
and fat percentage.

⇒ Compare those data in rural to urban area.

• Examine characteristics of obese children in detail.
(Ex. cardiopulmonary function, QOL, characteristics of parents)

References• Taro Yamauchi Ph.D : Faculty of Health Sciences, Hokkaido Univ. * Popkin BM, Conde W, Hou N, Monteiro C (2006) Is there a lag globally in overweight trends for children compared with adults?, Obesity, 14(10), pp.1846-1853** Torun B et al. (1996) Energy requirements and dietary energy recommendations for children and adolescents 1t o 18 years old; European journal of clinical nutrition, 50 (1),• Maria Mexitalia : Faculty of Medicine, Diponegoro Univ,
pp.37-80
Indonesia** * Tudor-Locke C et al. (2004) BMI-referenced standards for recommended pedometer-determined step/day in children; Preventive medicine, 38, pp.857-864• All members of SmileLab.