Abstract
BackgroundThe Gulf Cooperation Council (GCC) countries have among the highest prevalence of adult obesity and type 2 diabetes in the world. This study aimed to estimate the recent prevalence of obesity among school-age children and adolescents in the GCC States.MethodsThe literature search for obesity prevalence data was carried out in July 2017 in Google Scholar, Physical education index, Medline, SCOPUS, WHO, 2007–2017, and updated in November 2018.In addition, 22 experts from the GCC were contacted to check the search results, and to suggest studies or grey literature which had been missed. Eligible studies were assessed for quality by using the Joanna Briggs Institute (JBI) tool for prevalence studies. Conduct of the systematic review followed the Assessment of Multiple Systematic Reviews Tool (AMSTAR) guidance. A narrative synthesis was conducted.ResultsOut of 392 studies identified, 41 full-text reports were screened for eligibility; 11 of which were eligible and so were included, from 3 of the 6 GCC countries (United Arab Emirates, Kuwait, Saudi Arabia). Surveillance seems good in Kuwait in compared to other countries, with one recent national survey of prevalence. Quality of the eligible studies was generally low-moderate according to the JNBI tool: representative samples were rare; participation rates low; power calculations were mentioned by only 3/11 studies and confidence intervals around prevalence estimates provided by only 3/11 eligible studies; none of the studies acknowledged that prevalence estimates were conservative (being based on BMI-for-age). There was generally a very high prevalence of obesity (at least one quarter-one third of study or survey participants obese according to BMI-for-age), prevalence increased with age, and was consistently higher in boys than girls.ConclusionsThe prevalence of obesity among school-age children and adolescents appears to have reached alarming levels in the GCC, but there are a number of major gaps and limitations in obesity surveillance in the GCC states. More national surveys of child and adolescent obesity prevalence are required for the GCC states.Trial registrationPROSPERO registration number CRD42017073692.
Highlights
The Gulf Cooperation Council (GCC) countries have among the highest prevalence of adult obesity and type 2 diabetes in the world
The search update in November 2018 identified further studies for full-text screening but no additional eligible studies, so only 11 eligible papers/survey reports were identified, reporting 13 separate prevalence estimates, from 3 of the 6 GCC countries (UAE, Kuwait, Kingdom of Saudi Arabia (KSA)): there were no eligible studies from Oman, Bahrain, and Qatar
The eligible studies and surveys which compared prevalence estimates by the different definitions based on Body mass index (BMI)-for-age found consistently that prevalence was substantially lower when the International Obesity Task Force (IOTF) definition of obesity was used compared to definitions based on the Centers for Disease Control (CDC) or World Health Organization 2007 (WHO), consistent with previous evidence [12]
Summary
The Gulf Cooperation Council (GCC) countries have among the highest prevalence of adult obesity and type 2 diabetes in the world. This study aimed to estimate the recent prevalence of obesity among school-age children and adolescents in the GCC States. We were unable to find a recent systematic review of obesity prevalence of children and adolescents in the GCC, so prevalence of the problem is unclear. A further problem with existing obesity prevalence data is that systematic reviews demonstrating limitations of BMI-for-age as a surveillance tool (high specificity for excessive fatness, but only low-moderate sensitivity) have become available only relatively recently [12, 13] and recent obesity prevalence studies or surveys from the GCC countries may not have made allowances for this important source of bias in prevalence estimates
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