Convergence of overweight and undernutrition in urban adolescents and the dissonance of correlated factors; a transition?

INTRODUCTION:  The prevalence of overweight has increased sharply among adolescents. This suggests that not only habits and lifestyle, but also the environment influence choices and nutritional status of adolescents in a complex way. Objective: To evaluate the prevalence of thinness and overweight among adolescents in a large urban center and to verify, through a hierarchical modeling, factors from the individual, the household and the neighborhood associated to the adolescent’s nutritional status and their well-being.

METHODS:  This study is part of a population-based household survey named “Saúde em Beagá study”, conducted in two sanitary districts of Belo Horizonte in 2008-2009. Data was obtained from an adult and an adolescent at the household, through a confidential questionnaire and anthropometric evaluation. The outcome was the adolescent’s Body Mass Index (BMI) classified in thinness, normal weight and overweight. Multinomial regression analysis was performed considering distal and proximal influences.

RESULTS:  The prevalence of overweight was 21.9% and thinness 4.6%, among 1030 adolescents surveyed. At the most distal level, average to high income was associated to overweight (OR=1.73), but higher education of the family’s head was a protective factor to weight gain in adolescents (OR=0.57) independently of the reported income. Report of unsafely neighborhood was associated to thinness. At the household, an overweight adult was associated both to overweight (OR=3,21) and thinness (OR=0,37) in the adolescent. Adult’s physical inactivity was significantly associated to an overweight adolescent. Report of unhealthy diet (eating the skin from the chicken/beef fat and whole milk) were inversely associated to thinness. A worst wellbeing of adolescents was either related to thinness and overweight.

CONCLUSIONS:  Findings of this study support the multiple etiology of overweight and the importance of investing in changes in the context where the adolescent lives, in health habits within the family and even in the social context.