Original Article | Published:

Pediatric Epidemiology and Population Health

School environment and policies, child eating behavior and overweight/obesity in urban China: the childhood obesity study in China megacities

International Journal of Obesity volume 41, pages 813819 (2017) | Download Citation

  • An Erratum to this article was published on 08 August 2017

Abstract

Objectives:

Childhood obesity is rising rapidly in China, especially in urban areas. Knowledge about how school environment and policies (SEPs) may have contributed to the epidemic remains limited. We examined SEP and their associations with students’ eating behaviors and overweight/obesity in urban China.

Methods:

Data were collected from 1648 students (plus their parents and schools) in 16 primary and middle schools (4 schools per city) in four megacities across China: Beijing, Shanghai, Nanjing and Xi’an. We examined nutrition-related SEP such as unhealthy food restriction, healthy food promotion, price control and nutrition guideline in school cafeterias (SCs), campus food stores (CFS), school vicinity food stalls (SVFS); SEP on physical activity, physical education (PE) and physical examination. Cluster robust regression models were fit to assess associations of SEP with child eating behaviors and overweight/obesity (defined based on body mass index, from measured weight and height).

Results:

All 16 schools had regular PE classes and annual physical examination. Most schools (n=12; 75%) had food policies in SC; few had policies on CFS (n=1; 6.25%) or SVFS (n=4; 25%). Local governments had a major role in regulating food prices, setting nutrition guidelines and regulating SVFS. Policies on CFS and SVFS were associated with less frequent intake of sugary beverage (odds ratio (OR)=0.54 (0.47–0.61); OR=0.70 (0.61–0.80)), snack (OR=0.84 (0.74–0.95); OR=0.78 (0.67–0.92)) and fast food (OR=0.58 (0.42–0.81); OR=0.56 (0.39–0.80)). The associations were stronger for boys. Policies on SC, CFS and SVFS were associated with lower likelihood for overweight/obesity (OR=0.60 (0.46–0.79); OR=0.74 (0.62–0.90); OR=0.51 (0.35–0.73)) and central obesity (OR=0.79 (0.70–0.89); OR=0.67 (0.48–0.92); OR=0.63 (0.48–0.84)) in boys. Policies on SC were associated with lower overweight/obesity odds (OR=0.48 (0.28–0.82)) for girls.

Conclusions:

SEP are heterogeneous in the four Chinese megacities, high-income areas. They affect child unhealthy eating and overweight/obesity, and are critical for fighting childhood obesity in China.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    , , . Prevalence of obesity and severe obesity in US children, 1999–2014. Obesity 2016; 24: 1116–1123.

  2. 2.

    , , , , . Epidemiology of obesity in developing countries: challenges and prevention. Global Epidemic Obes 2014. Available at (accessed on 17 January 2016).

  3. 3.

    , , , , , et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766–781.

  4. 4.

    , , . Ending childhood obesity: a time for action. Lancet 2016; 387: 825–827.

  5. 5.

    , , . School environment factors were associated with BMI among adolescents in Xi'an City, China. BMC Public Health 2011; 11: 792–792.

  6. 6.

    , , . Schools and obesity prevention: creating school environments and policies to promote healthy eating and physical activity. Milbank Q 2009; 87: 71–100.

  7. 7.

    , . Targeting childhood obesity in schools: an examination of the stability and utility of the Value Added Index. Pediatr Obes 2014; 9: 197–208.

  8. 8.

    , , , , , et al. Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis Comparative effectiveness review no. 115 Agency for Healthcare Research and Quality: Rockville, MD, USA, 2013. Available at: (accessed on 1 February 2016).

  9. 9.

    , , , . Association between school food environment and practices and body mass index of US public school children. J Am Diet Assoc 2009; 109: S108–S117.

  10. 10.

    , , . Schoolwide food practices are associated with body mass index in middle school students. Arch Pediatr Adolesc Med 2005; 159: 1111–1114.

  11. 11.

    , , , , . School lunch and snacking patterns among high school students: associations with school food environment and policies. Int J Behav Nutr Phys Act 2005; 2: 14.

  12. 12.

    , , , . School beverage environment and children's energy expenditure associated with physical education class: an agent-based model simulation. Pediatr Obes 2016. e-pub ahead of print 20 April 2016 doi:10.1111/ijpo.12126.

  13. 13.

    , , , . School factors associated with the provision of physical education and levels of physical activity among elementary school students in Ontario. Can J Public Health 2015; 106: E290–E296.

  14. 14.

    , , , , . Physical activity breaks and facilities in US secondary schools. J School Health 2014; 84: 697–705.

  15. 15.

    , , , , . Does a higher incidence of break times in primary schools result in children being more physically active? J School Health 2015; 85: 149–154.

  16. 16.

    , , , . School-based interventions on childhood obesity: a meta-analysis. Am J Prev Med 2009; 37: 418–427.

  17. 17.

    , , , , , . Effect of childhood obesity prevention programs on blood pressure: a systematic review and meta-analysis. Circulation 2014; 129: 1832–1839.

  18. 18.

    , , , , , et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev 2015; 16: 547–565.

  19. 19.

    , , . Growing global burden of chronic noncommunicable diseases and an alarming situation in China. Beijing Da Xue Xue Bao 2012; 44: 688–693.

  20. 20.

    , , , , . Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. Int J Obes (Lond) 2007; 31: 177–188.

  21. 21.

    . Fast food, automobiles, television and obesity epidemic in Chinese children. Int J Cardiol 2005; 98: 173–174.

  22. 22.

    , , , , , . Prevalence and behavioral risk factors of overweight and obesity among children aged 2–18 in Beijing, China. Int J Pediatr Obes 2010; 5: 383–389.

  23. 23.

    , , , , , et al. Secular trends of obesity prevalence in Chinese children from 1985 to 2010: urban–rural disparity. Obesity (Silver Spring, MD) 2015; 23: 448–453.

  24. 24.

    , , , , . Prevalence and trends in obesity among China's children and adolescents, 1985–2010. PLos One 2014; 9: e105469.

  25. 25.

    , , , , , et al. School sport policy and school-based physical activity environments and their association with observed physical activity in middle school children. Health Place 2012; 18: 31–38.

  26. 26.

    , . Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes 2012; 7: 284–294.

  27. 27.

    , , , , , et al. Waist circumference reference values for screening cardiovascular risk factors in Chinese children and adolescents aged 7–18 years. Zhonghua liu xing bing xue za zhi=Zhonghua liuxingbingxue zazhi 2010; 31: 609–615.

  28. 28.

    StataCorpStata Statistical Software: Release 14. StataCorp LP: College Station, TX, USA, 2015.

  29. 29.

    , . Prevalence and geographic distribution of childhood obesity in China in 2005. Int J Cardiol 2008; 131: 1–8.

  30. 30.

    , , , , . Human female attractiveness: waveform analysis of body shape. Proc R Soc B 2002; 269: 2205–2213.

  31. 31.

    , , . Beauty and society. Semin Cutan Med Surg 2003; 22: 79–92.

  32. 32.

    , , , . Secular trends of obesity prevalence in urban Chinese children from 1985 to 2010: gender disparity. PLoS One 2013; 8: e53069.

  33. 33.

    . Unbearable Weight: Feminism, Culture, and the Body. University of California Press: Berkeley, CA, USA, 1993.

  34. 34.

    Prosperity versus pathology: a social history of obesity in China. In: (ed.), Feeding China's Little Emperors: Food, Children, and Social Change. Stanford University Press: Pao Alto, CA, USA, 2000, pp 207–209.

  35. 35.

    Men, masculinities and health. In: , (eds.), Hazardous Waist: Tackling Male Weight Problems. Radcliffe Publishing: Oxford, UK, 2007.

  36. 36.

    , , , . Sex disparity and perception of obesity/overweight by parents and grandparents. Paediatr Child Health 2014; 19: e113–e116.

  37. 37.

    , , , , . Young urban women and the nutrition transition in China: a familiar pattern emerges. Glob Health Promot 2010; 17: 43–51.

Download references

Acknowledgements

The present study is funded by research grant from the National Institute of Health (NIH, U54 HD070725). The U54 project (U54 HD070725) is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Office of the Director, National Institutes of Health (to OD). Dr Wang is the principal investigator of the projects. The content of the paper is solely the responsibility of the authors and does not necessarily represent the official views of the funders. We thank all the study participants and the school personnel who participated in the study and our collaborators who have contributed to the study. None of the authors has been paid to write this article by a pharmaceutical company or other commercial agencies.

Author information

Author notes

    • P Jia
    •  & M Li

    These authors equally contributed to this work.

Affiliations

  1. Systems-Oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA

    • P Jia
    •  & M Li
  2. Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, University of Twente - ITC, Enschede 7500, The Netherlands

    • P Jia
  3. Fisher Institute of Health and Well-being, College of Health, Ball State University, HP 302E, Muncie, IN 47306, USA

    • H Xue
    •  & Y Wang
  4. Beijing Xicheng District Center for Disease Control and Prevention, Beijing, China

    • L Lu
  5. Nanjing City Center for Disease Control and Prevention, Nanjing, China

    • F Xu

Authors

  1. Search for P Jia in:

  2. Search for M Li in:

  3. Search for H Xue in:

  4. Search for L Lu in:

  5. Search for F Xu in:

  6. Search for Y Wang in:

Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to Y Wang.

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/ijo.2017.2

Further reading Further reading