Behavioral and Environmental Risk Factors Associated with Primary School Children's Overweight and Obesity in Urban Indonesia

Objectives: To aid the design of nutrition interventions in low- and middle-income countries undergoing a nutrition transition, this study examined behavioral and environmental risk factors associated with childhood overweight and obesity in urban Indonesia. Design: Body height and weight of children were measured to determine BMI-for-age Z-scores and childhood overweight and obesity status. A self-administered parental survey measured socioeconomic background, children's diet, physical activity, screen time, and parental practices. Logistic and quantile regression models were used to assess the association between risk factors and the BMI-for-age Z-score distribution. Setting: Public primary schools in Central Jakarta, sampled at random. Participants: Children (n=1,674) aged 6-13 years from 18 public primary schools. Results: Among the children, 31.0% were overweight or obese. The prevalence of obesity was higher in boys (21.0%) than in girls (12.0%). Male gender and height (aOR=1.67; 95% CI 1.30, 2.14 and aOR=1.16; 95% CI 1.14, 1.18, respectively) increased the odds of being overweight or obese, while the odds reduced with every year of age (aOR=0.43; 95% CI 0.37, 0.50). Maternal education was positively associated with children's BMI at the median of the Z-score distribution (P=0.026). Dietary and physical activity risk scores were not associated with children's BMI at any quantile. The obesogenic home food environment score was significantly and positively associated with the BMI-for-age Z-score at the 75th and 90th percentiles (P=0.022 and 0.023, respectively). Conclusions: This study illustrated the demographic, behavioral, and environmental risk factors for overweight and obesity among primary school children in a middle-income country. To foster healthy behaviors in primary school children, parents need to ensure a positive home food environment. Future gender-responsive interventions should involve both parents and children, promote healthy diets and physical activity and improve food environments in homes and schools.