A MULTILEVEL STUDY ON THE ASSOCIATION OF HOME, SCHOOL, AND INDIVIDUAL FACTORS WITH CHILDHOOD OBESITY IN SASKATOON, SASKATCHEWAN, CANADA

Background Obesity is a growing global health issue that impacts the physical and psychosocial development of children and potentially their quality of life during adulthood. The multifactorial nature of childhood obesity makes it challenging to develop specific interventions for this problem. Evaluating factors that contribute to childhood obesity can help better understand how to address or curb this problem. Research Aim To determine the association of diet and physical activity factors with childhood obesity among Saskatoon children at the individual, family, home, and school levels. Methods Saskatoon children aged 10-14 years, attending Saskatoon elementary schools in 2012 participated in this research. Information regarding their demography, built and food environment, diet, sedentariness, and physical activity levels were collected by the Smart Cities, Healthy Kids Project. Dietary and physical activity data from the study sample were also compared with national guidelines for healthy eating and physical activity, respectively. A multilevel modelling strategy using individual, family, home, and school levels was used to evaluate children’s body mass index (BMI) percentiles, as a measure of childhood obesity, based on the socioecological framework and the 6-C’s model of childhood obesity. Results Among the 1409 students who were included, about 61.36% had normal BMI while 37.5% of students were overweight, obese, or severely obese. About 54.5% and 31.7% of students who were overweight, obese, or severely obese reported their health was good and very good, respectively. Male students were found to have lower sedentary behavior and higher moderate and vigorous activity compared to females. Sedentary behavior was significantly associated with student grades (p=0.005), Aboriginal status (p=0.007), self-reported health (p=0.003), and sex (p=0.039). Whereas moderate activity was associated with sex (p=0.007) and sleep hours (p=0.001). Overall, Saskatoon children were spending most of their waking hours engaging in sedentary behavior (standardized mean of 86 minutes/day) and were not meeting the recommended ≥60 minutes of moderate-to-vigorous physical activity per day. Factors that were significantly associated with a higher amount of average sleep hours in children were younger age (p=0.026), being a recent immigrant (p=0.008), better self-reported health status (p=0.018), and lower accelerometer wear hours (p=<0.001). A majority of the children’s families shopped at supermarkets or grocery stores (94.18%). Although about 43% of children had a fast-food restaurant available within 2 km of their home, more than half the study population (67.57%) rarely consumed fast-food (i.e., less than once per week). The overall mean Healthy Eating Index (HEI) was 64.83 and was shown to increase with increased home and school neighborhood income levels. Saskatoon children were meeting the recommended guidelines for consumption of milk and milk products and meat and alternatives; however, they were consuming less than the recommended servings for grains and fruits and vegetables. Increased BMI percentiles in children was associated with Aboriginal status (p=0.005). In contrast, increased school neighborhood income (p=0.010) and having siblings (p=0.032) were associated with reduced BMI percentiles. Compared to children with families that shop mostly at supermarkets/grocery stores, those with families that shop at convenience stores were observed to have higher BMI percentiles (p=0.037). Furthermore, consumption of fried take-away meals 4-6 times per week and diet pop 1-3 cans per month were associated with a higher BMI percentile. A higher Nutrition Environment Measures Survey in Stores (NEMS-S) score, which is indicative of the total number of grocery and convenience stores in a neighborhood, was also associated with increased BMI percentiles. The effect of sedentariness on BMI percentiles was stronger (p=0.00), but that of HEI (p=0.02) was weaker for Aboriginal children compared to non-Aboriginal children. However, females showed a stronger effect of HEI on BMI compared to males (p=0.01). In regards to home environments, the effect of sedentariness on BMI percentiles is lower for children living in medium and higher home income neighborhoods compared to those in lower income neighborhoods (p=0.02). Conclusion Saskatoon children were not meeting the current recommendations for physical activity (i.e., minimum of 60 minutes of moderate-to-vigorous physical activity per day) but are receiving adequate amount of sleep daily. The diet quality of Saskatoon children, as measured by the HEI, requires improvement, especially the consumption of fruits and vegetables and grain food groups. Several factors at the individual, family, home, and school levels were associated with children’s BMI. The findings of this study can provide information to locals, government agencies, and policymakers about the current factors associated with childhood obesity among Saskatoon children.

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