EMERGING CHILDHOOD OBESITY IN INDONESIA: WHAT SHOULD BE DONE

1. EMERGING CHILDHOOD OBESITY IN INDONESIA:WHAT SHOULD BE DONE HamamHadi Alma Ata Center for Healthy Life and Food (ACHEAF) Yogyakarta, Indonesia

2. OBESITY PREVALENCE WORLDWIDE

4. PREVALENCE OF OVERWEIGHT AND OBESITY IN INDONESIAN ADULTS >18 YEARS, 2007-2018 BMI ≥ 27,0 BMI ≥25,0 s/d <27,0 RISKESDAS 2007-2018

5. PREVALENCE OF CENTRAL OBESITY IN INDONESIAN ADULTS ≥15 YEARS, 2018 Abdominal Circumference > 80 cm (females); > 90 cm (males) RISKESDAS 2007-2018

6. PREVALENCE OF OBESITY IN INDONESIAN PRIMARY SCHOOL CHILDREN RISKESDAS 2007-2013

7. Obesity Prevalence in Preliminary School Children in Indonesia Hadi H et al, 2013

8. Obesity Prevalence in Indonesian Preliminary School Children by Residence Hadi H et al, 2013

9. WHY IS THAT SO? • Indonesian children became more sedentarian • Indonesian children eat more junk food • Indonesian children eat lese fruit & vegetable

10. The Odds of Obesity in Indonesian Primary School Childrenby Sedentary Behaviour 9 >5,5 <3,75 3,75 – 5,5 Sedentary time (hours)/ day HADI H: 2019

11. The Odds of Obesity in Indonesian Primary School Childrenby Fruit and Vegetable Consumption 3,2 2,4 1,3 1 Never 3+ Serving/d 1 Serving/d 2 Serving/d

12. The Odds of Obesity in Indonesian Primary School Children by Junk Food Energy (JFE) Intake 2 JFE Intake <50% JFE Intake 50%+

13. Hadi H et al, 2013

14. Hadi H et al, 2013

15. Obesity status by frequency of vegetable consumption Hadi H et al. 2019

16. Obesity status by frequency of fruit consumption Hadi H et al. 2019

17. Obesity status by sedentary behavior Hadi H et al. 2019

18. Obesity status by adequacy of vegetable consumption Hadi H et al. 2019

19. Obesity status by adequacy of fruit consumption Hadi H et al. 2019

20. Obesity status by adequacy of fruit, vegetable, and energy from junk food Hadi H et al. 2019

21. Odds ratio Obesity risk by adequacy of vegetable consumption and sedentary behavior Hadi H et al. 2019

22. Odds ratio Obesity risk by adequacy of fruit consumption and sedentary behavior Hadi H et al. 2019

23. Odds ratio Obesity risk by adequacy of fruit and vegetable consumption & energy from Junk food Hadi H et al. 2019

24. The Prevalence of Underweight, Overweight, and Obesity in Urban Indonesian Boys HADI H 2004

25. CONCLUSSIONS • Overweight & obesity in children are increasing very dramatically • Overweight & obesity are more prevalent among new generation • Overweight & obesity are more prevalent in urban areas

26. CONCLUSSIONS • The obesity risk increases as children • become more sedentary • The obesity risk increase as children • eat less fruit and vegetable • The obesity risk increases as children more • junk foods

27. RECOMMENDATIONS • To reduce obesity prevalence among children, • the followings are necessary: • Health education and promotion • Strong regulation on food production, • distribution and food labeling • Strong regulation on unhealthy food • advertisement • Providing public services which promote • children to be more physically active

28. THANK YOU

29. Increased number of fast food establishments in Indonesia during the last two decades Lack of access to full service grocery stores selling affordable healthful foods Less healthy food & beverage advertising aimed at children The Food Environment

30. Increased consumption of sugar sweetened beverages Continued low consumption of fruitsand vegetables Dietary Behaviors

31. Increased frequency of meals eaten away from home Dietary Behaviors

32. Breakfast Associated with Overweight/ Obesity In Sao Paulo Children and Adolescents Aged 7-18 years Breakfast Normal weight overweight/ obese AoR (95% CI) Never 264 (10,8%) 127 (16,6%) 1 1-2 days/ week 293 (12,0%) 116 (15,1%) 0,93 (0,68-1,27) 3-5 days/ week 234 (9,6%) 73 (9,5%) 0,73 (0,52-1,03) > 5 days/ week 1650 (67,6%) 450 (58,7%) 0,59 (0,46-0,75) Duncan S, 2011

35. Travel to School Associated with Overweight/ Obesity In Sao Paulo Children and Adolescents Aged 7-18 years Travel Normal weight Overweight/ob AoR (95% CI) Car 846 (35,2%) 352 (46,3%) 1 Bus 357 (14,8%) 118 (15,5%) 0,72 (0,56-0,93) Bicycle 122 (5,1%) 37 (4,9%) 0,61 (0,40-0,94) Walk 1044(43,4%) 234 (30,8%) 0,59 (0,48-0,72) Other 37(1,5%) 19 (2,5%) 1,32 (0,68-2,57) Duncan S, 2011

36. The importance of a walk side around Singapore waterfront (Right side) People run in hurry to catch up MRT in Sinagpore (left side)

37. Before: Example: West Palm Beach, FL

38. After two-way traffic wide shaded sidewalks Example: West Palm Beach, FL

39. After: raised intersections shortened pedestrian crosswalks narrowed streets on street parking Example: West Palm Beach, FL

40. After Renovated abandoned buildings for mixed use development Example: West Palm Beach, FL

41. Prevalence of overweight and obesity in São Paulo children and adolescents aged 7-18 years. *Significant difference (P < 0.05). **Significant difference (P < 0.01).

42. PREVALENCE OF CENTRAL OBESITY IN INDONESIAN ADULTS ≥15 YEARS, 2018 Abdominal Circumference > 80 cm (females); > 90 cm (males)

43. Nurwanti E, Hadi H, et al. 2018

44. Nurwanti E, Hadi H, et al. 2018