Childhood overweight and obesity, is an emerging public health concern in developing countries like Bangladesh. However, regular television watching by child’s mother and its impact on excess weight gain or overweight and obesity to their offspring is not reported elsewhere. The aim of the present analysis was to determine the socio-demographic characteristics among overweight and obese children based on those mothers who watch television regularly and compare this finding with malnourished and well-nourished under-5 children. A total of 20,800 under-5 children were enrolled during 1996 to 2012 in the Diarrheal Disease Surveillance System (DDSS) of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Mean weight-for-age z-score (–1.61 vs. –2.30; mean difference: ?0.69; p < 0.001), height-for-age z-score (–1.42 vs. –1.99; –0.57; <0.001), weight-for-height z-score (–1.59 vs. –1.07; –0.53; <0.001), BMI-for-age z-score (–1.09 vs. –1.61, –0.52; <0.001) differed significantly between the children whose mother did and did not watch television regularly. Under-5 children whose mother watched television regularly (2%) compared to those who did not (1%), had 2.28 [(95% CI-1.61 - 3.24) p < 0.001] times increased odds of being overweight and obese. Television watching of mothers is associated with childhood overweight and obesity and is one of the most public health concerns in Bangladesh. These changes may be in part of better socio-economic condition, changes in life style behaviour and dietary pattern.
The double burden of under nutrition and over nutrition has already been determined as global health con- cern [
Overweight and obesity, an emerging childhood malnutrition, is a growing public health concern in develop- ing countries like Bangladesh affecting all age groups as well [
Researcher had found that watching television has direct relation with childhood overweight and obesity [
The study was conducted among under five children visiting the Dhaka Hospital of icddr,b, located in Dhaka, the capital city of Bangladesh which provides cost free care and treatment to about 140,000 patients each year. The DDSS of icddr,b has been established since 1979, to collect longitudinal data on the hospital’s patient populations. The DDSS currently collects information on clinical, epidemiological and demographic character- istics including watching television, nutritional status of infants and young children. A trained research assistant interviewed care givers of children.
The DDSS recently explored a dramatic increase in overweight and obese under-5 children [
Detailed socio-demographic information including mother’s television practice (watching television regularly or not) were also collected. Child’s nutritional indices (weight and height) were measured following standard guideline [
Data analysis was done using Statistical Package for Social Sciences (SPSS) for Windows (Version 15.2; Chi- cago, IL) and Epi Info (Version 6.0, USD, Stone Mountain, GA). Data were first categorized into two groups 1) watched TV (=1); 2) did not watch TV (=0) and compared their socio-demographic information, clinical characteristic and pathogen responsible for diarrhea by Chi-square test and a probability of <0.05 (Type I error) was considered as statistically significant. Proportion of mother watched TV was analyzed by nutritional status (over- weight and obese, well-nourished, and malnourished). Then in-depth analysis was performed assuming the proportion of overweight and obese was higher among children whose mother watched TV regularly. Here data was categorized into 3 quarters among TV watching group as 1) overweight and obese, 2) well-nourished, and 3) malnourished and compared by applying both descriptive and analytical methods. Overweight and obese was con- sidered as risk group while well-nourished and malnourished as referral categories to determine the predictors of overweight and obese among children whose mother watched TV on regular basis.
This activity was approved by the Research and Ethical Review Committees of icddr,b and the detail has been reported elsewhere [
Mean weight-for-age z-score (−1.61 vs. −2.30; mean difference: −0.69; p < 0.001), height-for-age z-score (−1.42 vs. −1.99; mean difference: −0.57; p < 0.001), weight-for-height z-score (−1.59 vs. −1.07; mean differ- ence: −0.53; p < 0.001), and BMI-for-age z-score (−1.09 vs. −1.61, mean difference: −0.52; p < 0.001) differed significantly between the children whose mother did and did not watch television regularly (data not shown). Under-5 children whose mother watched television regularly (2%; n = 297) compared to those who did not (1%; n = 39), had 2.28 [(95% CI-1.61-3.24) p < 0.001] times increased odds of being overweight and obese (
Among under-5 children whose mother watched television regularly; higher proportion of those mothers were literate, had smaller family size, living in a non slum residential area, had higher monthly family income (>100 USD), used sanitary toilet, used boiled water for drinking compared to non-watching group (
Indicators | Watched TV; n = 16,043 (%) | Did not-watch TV; n = 4757 (%) | OR (95% CI) p-value |
---|---|---|---|
Overweight and obese | 297 (2) | 39 (1) | 2.28 (1.61, 3.24) < 0.001 |
Well-nourished | 8115 (50) | 1518 (32) | 2.18 (2.04, 2.34) < 0.001 |
Malnourished | 7631 (48) | 3200 (67) | 0.44 (0.41, 0.47) < 0.001 |
Indicators | Watched TV; n = 16,043 (%) | Did not watch TV; n = 4757 (%) | OR (95% CI) p-value |
---|---|---|---|
Age | |||
24 - 59 months | 2284 (14) | 857 (18) | 0.76 (0.69, 0.82) < 0.001 |
12 - 23 months | 4408 (28) | 1355 (29) | 0.95 (0.88, 1.02) 0.178 |
0 - 11 months | 9351 (58) | 2545 (54) | 1.21 (1.14, 1.30) < 0.001 |
Male | 9858 (61) | 2952 (62) | 0.97 (0.91, 1.04) 0.458 |
Maternal literacy | 11788 (74) | 2076 (44) | 3.58 (3.34, 3.83) < 0.001 |
Family size (<5) | 10435 (65) | 3200 (67) | 0.91 (0.84, 0.97) 0.004 |
Residence (non-slum) | 15000 (93) | 3906 (72) | 3.14 (2.85, 3.46) < 0.001 |
Monthly income (>100 USD) | 8348 (52) | 1087 (23) | 3.66 (3.40, 3.95) < 0.001 |
Sanitary toilet | 11131 (69) | 2113 (44) | 2.84 (2.65, 3.03) < 0.001 |
Drink boiled water | 5978 (37) | 750 (16) | 3.17 (2.91, 3.46) < 0.001 |
While we compared within the TV watching groups, overweight and obese were different in socio-economic aspects from their counterpart. For example, higher proportion of mothers belonging to overweight and obese children were literate, had higher monthly income (>100 USD), used sanitary toilet, and boiled drinking water compared to well-nourished and malnourished children (
In multivariate analysis, children aged 24 - 59 months, male children, literate mother and higher monthly family income (>100 USD) were significantly associated with overweight and obese children whose mother watched TV regularly when well-nourished was considered as referral group (
Watching television by the mothers of young children has strong association with excess weight gain with sub- sequent ramification to overweight and obesity in late childhood [
This study was conducted among children attending a large diarrheal disease health facility and may not be rep- resentative of for general population. Strengths of our study include long time period for data collection, and use of large, systematic sample and unbiased sampling of the surveillance system.
Indicators | Overweight n = 297 (%) | Well nourished n = 8115 (%) | OR1 (95% CI) p-value | Malnourished n = 7631 (%) | OR2 (95% CI) p-value |
---|---|---|---|---|---|
Age | |||||
24 - 59 months | 45 (15) | 817 (10) | 1.60 (1.14, 2.23) 0.006 | 1422 (19) | 0.78 (0.56, 1.09) 0.149 |
12 - 23 months | 89 (30) | 2285 (28) | 1.09 (0.84, 1.42) 0.538 | 2034 (27) | 1.18 (0.91, 1.53) 0.230 |
0 - 11 months | 163 (55) | 5013 (62) | 0.75 (0.59, 0.96) 0.019 | 4175 (55) | 1.01 (0.79, 1.28) 0.998 |
Male | 209 (74) | 4824 (59) | 1.62 (1.25, 2.10) < 0.001 | 4825 (63) | 1.38 (1.06, 1.79) 0.014 |
Maternal literacy | 270 (91) | 6767 (83) | 1.99 (1.31, 1.49) < 0.001 | 4751 (62) | 6.06 (4.01, 9.22) < 0.001 |
Family size (<5) | 201 (68) | 5058 (62) | 1.27 (0.98, 1.963) 0.070 | 5176 (68) | 0.99 (0.77, 1.28) 0.993 |
Residence (non-slum) | 293 (99) | 7842 (97) | 2.54 (0.91, 8.05) 0.081 | 6825 (90) | 8.16 (2.93, 25.74) < 0.001 |
Monthly income (>100 USD) | 231 (78) | 5139 (63) | 2.03 (1.52, 2.70) < 0.001 | 2978 (39) | 5.47 (4.11, 7.29) < 0.001 |
Sanitary toilet | 251 (85) | 6078 (75) | 1.83 (1.32, 2.55) 0.002 | 4802 (63) | 3.21 (2.32, 4.48) < 0.001 |
Drink boiled water | 154 (52) | 3487 (43) | 1.43 (1.13, 1.81) 0.002 | 2337 (31) | 2.24 (1.92, 3.10) < 0.001 |
Overweight and obese, and well-nourished = OR1 (95% CI) p-value; Overweight and obese, and Malnourished = OR2 (95% CI) p-value.
Indicators | OR (95% CI) | p-Value |
---|---|---|
Age | ||
24 - 59 months | 1.67 (1.22, 2.29) | <0.001 |
12 - 23 months | 1.06 (0.86, 1.42) | 0.430 |
0 - 11 months | 1 | |
Male | 1.71 (1.35, 2.17) | <0.001 |
Maternal literacy | 1.47 (1.04, 2.07) | 0.030 |
Monthly income (>100 USD) | 1.56 (1.20, 2.03) | <0.001 |
Sanitary toilet | 1.34 (0.98, 1.83) | 0.071 |
Drink boiled water | 1.04 (0.81, 1.32) | 0.782 |
Dependent variable: overweight and obese = 1, well-nourished = 0.
(b)
Dependent variable: overweight and obese = 1, malnourished = 0.
Our study demonstrated that, mothers’ television watching is associated with childhood overweight and obesity. However, recently in Bangladesh overweight and obesity is gaining attention under public health issues. These changes may be the consequences of better socio-economic condition, modified life style behaviour and dietary pattern as well. The findings of present study may be a snap shot of the hidden underlying burden and thus en- hance further researches especially on daily behaviour on watching television by the mother’s of young children becoming overweight and obese.
There is no potent conflict of interest to declare. All authors confirmed that there is no professional affiliation, financial agreement or other involvement with any company whose product figures prominently in the submitted manuscript.
JD, SKD, SH, MJC, MAM, ASGF, AAM―have made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; JD, SKD, MJC-have been involved in drafting the manuscript; JD, SKD, SH, MJC, MAM, AR, ASGF, AAM, MHRS, FDF, FF revised it critically for important intellectual content; ASGF, SKD-have given final approval of the version to be published. Each author has par- ticipated sufficiently in the work to take public responsibility for appropriate portions of the content. All authors have read and approved the final manuscript.
icddr,b acknowledges with gratitude the commitment of the Government of the People’s Republic of Bangla- desh to it’s research efforts who funded the study through IHP-HNPRP. icddr,b is also thankful to the Govern- ments of Australia, Bangladesh, Canada, Sweden and the United Kingdom for providing core/unrestricted sup- port.
BMI: Body Mass Index
CI: Confidence Interval
DDSS: Diarrheal Disease Surveillance System
icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh
SPSS: Statistical Package for Social Sciences
SD: Standard Deviation
USD: United States Dollar
WHO: World Health Organization