Background: Childhood overweight and obesity is considered a global
epidemic. From being a health problem mainly in high-income countries, it is
now an emerging problem in low- and middle-income parts of the world as
well. Contextual knowledge of obesity development dynamics is important as
a basis for prevention and intervention strategies.
Aims: To study overweight and obesity in preschool children focusing on
prevalence, incidence and associated factors including parents’ conceptions,
in one urban and one rural setting of Hanoi, Vietnam.
Methods: All studies were conducted identically in two Health and
Demographic Surveillance Sites, one urban and one rural. Cross-sectional
studies were used to study the prevalence of overweight, obesity and
associated factors as well as feeding practices involving a total of 2,677
children three to six years of age. Follow-up studies of the same children
were used to describe incidences and prevalence changes over three years.
Parents were interviewed and anthropometric data of children and parents
were collected. The children were classified as overweight or obese following
the definitions of the International Obesity Task Force. Focus group
discussions about mothers’ conceptions of childhood overweight were
conducted and analysed with a phenomenographic approach.
Results: In 2013, the estimated prevalence of overweight in the urban and
rural area was 13.3% and 4.8% respectively. For obesity, the prevalence was
9.2% and 3.5% respectively. Three years later, the prevalence of overweight
increased to 25.6% in the urban and to 7.7% in the rural children. The
prevalence of obesity decreased to 7.1% in the urban and to 1.9% in the rural
rural area, frequent consumption of fried food, irregular snacks, and increased
sedentary time were identified as additional risk factors. The main protective
factors were physical activity, having meals at home in the urban area and
longer sleep duration at night in the rural area. At the family level, higher
socioeconomic status was associated with a higher prevalence of overweight
in the urban children. Frequently watching TV food advertisement and
availability of snacks at home were risks for the rural children. The
qualitative study showed that mothers were concerned about health problems
in overweight children. They used their own experiences, growth charts and
information from health care providers as well as the mass media to
recognise overweight. The mothers considered unhealthy lifestyle,
heritability and economic development as factors contributing to overweight
development and based their management of overweight on these as much as
possible. This was sometimes challenged by grandparents who commonly
regard chubbiness as healthy.
Conclusion: The prevalence of overweight among preschool children is
considerable in Vietnam and increases with age, particularly in the urban
area. Obesity prevention and interventions should start early, already at
preschool age and include education programmes with focus on healthy
lifestyle for children as well as the entire extended families, not least
grandparents. The prevention and interventions should preferably be tailored
differently for urban and rural areas. Restrictions on non-healthy food
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