Jiang Yanfen, Hu Jiajin, Chen Fengyan, Liu Borui, Wei Mengna, Xia Wenqi, Yan Yinkun, Xie Jinchen, Du Shufa, Tian Xiangyang, Aris Izzuddin M, Wang Youfa, Zhang Jianduan
Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Lancet Reg Health West Pac. 2025 Apr 23;58:101553. doi: 10.1016/j.lanwpc.2025.101553. eCollection 2025 May.
Childhood obesity is a critical public health concern in China. This study identified the key determinants of childhood obesity in China and provided recommendations for future intervention strategies.
We conducted a comprehensive systematic review and meta-analysis to identify multiple-level determinants of childhood obesity in China and calculated the population-attributable risk percentage (PAR%) for each modifiable determinant. We also conducted expert consultations using the Socio-ecological Model to gain insights into the causes of obesity. Additionally, we reviewed current Chinese policies on childhood obesity intervention and compared them with the priorities identified in the meta-analysis and expert consultation to pinpoint policy gaps.
Our meta-analysis, incorporating 419 studies, identified 33 risk factors for childhood obesity. At the individual-level, we identified 11 key contributors including early-life risk factors such as maternal pre-pregnancy overweight/obesity (PAR%: 16.7%), breastfeeding duration of less than six months (14.1%), cesarean section delivery (11.1%), excessive gestational weight gain (10.5%), high birth weight (4.2%), and gestational diabetes mellitus (3.6%), and 13 behavioral factors during childhood such as sugar sweetened beverage consumption (16.4%), insufficient sleep (15.0%), rapid eating speed (14.7%), less than 2 h of physical activity per day (6.3%), and over 2 h of daily screen time (5.6%). We also identified six prominent family-level factors such as maternal overweight/obesity (24.3%) and paternal overweight/obesity (23.5%). Expert consultation highlighted genetic factors, and prioritized actionable risk factors, particularly dietary, expanding on the meta-analysis findings. Finally, policy review revealed that existing Chinese policies inadequately addressed these determinants, especially at the macro and structural levels.
This study highlights the importance of targeting high-risk populations and addressing detrimental behavioral factors, especially on early-life influences. However, real-world impacts require a comprehensive approach that goes beyond individual factors. More future effective intervention efforts are needed.
This study was funded by the National Natural Science Foundation of China (NSFC 82073567; NSFC 82273641) and the National Science and Technology Innovation 2030, Noncommunicable Chronic Diseases-National Science and Technology Major Project (Grant No. 2023ZD0508500, 2023ZD0508504).
儿童肥胖是中国一个关键的公共卫生问题。本研究确定了中国儿童肥胖的关键决定因素，并为未来的干预策略提供了建议。
我们进行了一项全面的系统综述和荟萃分析，以确定中国儿童肥胖的多层次决定因素，并计算每个可改变决定因素的人群归因风险百分比（PAR%）。我们还使用社会生态模型进行了专家咨询，以深入了解肥胖的原因。此外，我们审查了中国目前关于儿童肥胖干预的政策，并将其与荟萃分析和专家咨询中确定的优先事项进行比较，以查明政策差距。
我们纳入419项研究的荟萃分析确定了33个儿童肥胖的风险因素。在个体层面，我们确定了11个关键因素，包括孕前母亲超重/肥胖等早期生活风险因素（PAR%：16.7%）、母乳喂养时间不足6个月（14.1%）、剖宫产（11.1%）、孕期体重过度增加（10.5%）、高出生体重（4.2%）和妊娠期糖尿病（3.6%），以及儿童期的13个行为因素，如饮用含糖饮料（16.4%）、睡眠不足（15.0%）、进食速度快（14.7%）、每天体育活动少于2小时（6.3%）和每天屏幕时间超过2小时（5.6%）。我们还确定了6个突出的家庭层面因素，如母亲超重/肥胖（24.3%）和父亲超重/肥胖（23.5%）。专家咨询强调了遗传因素，并确定了可采取行动的风险因素的优先次序，特别是饮食方面，对荟萃分析结果进行了扩展。最后，政策审查表明，中国现有的政策没有充分解决这些决定因素，特别是在宏观和结构层面。
本研究强调了针对高危人群和解决有害行为因素的重要性，特别是对早期生活影响的关注。然而，实际影响需要一种超越个体因素的综合方法。未来需要更多有效的干预措施。
本研究由中国国家自然科学基金（NSFC 82073567；NSFC 82273641）和国家科技创新2030-慢性病-国家科技重大专项（项目编号：2023ZD0508500，2023ZD0508504）资助。
