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The Rising Tide of Overweight among Kuwaiti Children: Study from Al-Adan Hospital, Kuwait

Objective This study was designed to screen patients who sought medical services in the Pediatric Outpatient Department, Al-Adan Hospital, Kuwait for overweight. Subjects and Methods Body mass index (BMI) was used to screen 361 children (≤10 years old) for risk of overweight and overweight (BMI between 85th and 94th, and ≥95th percentile, respectively). Overweight children were fully examined and abdominal ultrasound was done for each of them. Results Of the 361 children, 52 (14.41%) and 77 (21.33%) were at risk of overweight and overweight, respectively. There was a slight male predominance for overweight (40 males, 51.95%, compared to 37 females, 48.05%) and within the overweight category; 28 males (70%) and 26 females (70.27%) were above 6 years of age. In overweight children over 6 years, 4 (7.41%) had hepatomegaly with fatty changes and 3 (5.56%) had blood pressure above the 95th percentile for age and sex. Conclusion Childhood overweight at Al-Adan Hospital was high and increased with age. Hence childhood screening for overweight is recommended at an early age because it is an important risk factor of chronic diseases.

Overweight among Al-Adan Children Med Princ Pract 2013;22:600-602 DOI: 10.1159/000350416 601 their anthropometric measurements were excluded from the study. A total of 560 patients were recruited, 57 were excluded due to inaccuracy in data collection. Of the 503 patients screened, 142 were younger than 2 years of age and were thus excluded since the screening method, BMI, is interpreted using children's BMI percentile charts that do not include children younger than 2 years of age [5] . Hence 361 children (166 girls and 195 boys) were enrolled in the study.
For each studied case, both weight and height were measured. Body weight was measured to the nearest 50 g using a regularly calibrated scale with the subject lightly clothed. A special board calibrated in centimeters and millimeters was used to measure height to the nearest 0.5 cm with the subject barefoot. BMI was calculated as: BMI = weight in kg/height in meters 2 . BMI values were used to determine a percentile score on the basis of the population-based references developed by the Centers for Disease Control and Prevention in 2000. Classification into underweight (BMI <5th percentile), normal (BMI between 5th and 84th), risk of overweight (BMI between 85th and 94th) and overweight (BMI ≥ 95th percentile) was done according to Skelton and Rudolf [6] , who stated that though the terms overweight and obesity are used interchangeably, overweight is the preferred term in children and adolescents. For cases of proven overweight, blood pressure was measured with complete clinical examination as well as abdominal ultrasound in cases with hepatomegaly.

Statistical Analysis
The collected data was coded, tabulated, and statistically analyzed using SPSS program (Statistical Package for Social Sciences, version 17). Descriptive statistics were done for categorical data by number and percentage. The prevalence rate for each item was calculated as the number of cases per 100 children; χ 2 test was used to compare frequency of qualitative variables among males and females. For comparisons a probability (p) less than 0.05 was considered significant.
Among overweight children over 6 years, 4 (7.41%) had hepatomegaly with fatty changes as detected by ultrasound and 3 (5.56%) had blood pressure above the 95th percentile for age and sex. Complications were not detected in patients younger than 6 years of age.

Discussion
The 21.33% overweight reported in the current study is higher than the 18.4% overweight and 16.7% obesity previously reported among Al-Ahmadi governorate students [7] . This discrepancy can be attributed to the fact that our series is bigger and contains a wider age range (the previous study included only 5th grade students who are 10 years old while our study included children 2-10 years old). However, the percentage of overweight detected in the current study is close to that reported as a crisis, which currently affects nearly one third of American children and adolescents aged 2-19 years [8] .
The percentage of overweight in our sample of children increased with age and showed a slight male predominance. These results are consistent with the US Preventive Services Task Force and Barton [9] , who reported that the prevalence of obesity varied with age and was more likely to be higher in older than younger children and in males. Although the US Preventive Services Task Force did not find sufficient evidence for screening children younger than 6 years, the current study reported that 29.87% of cases occurred before the age of 6 years. Since many of these children could continue as such throughout late childhood to adolescence when complications of obesity are more evident, we suggest that screening starts at a younger age.
The hepatomegaly with fatty changes detected by ultrasound in 7.41% of the studied overweight children over 6 years is reinforced by the results of Babusik et al. [10] , who recently reported that abdominal obesity had an independent predictive value for developing liver steatosis among adults in Kuwait.

Conclusion
The prevalence of childhood overweight at Al-Adan Hospital was high and increased with age. Hence childhood screening for overweight is recommended at an early age because it is an important risk factor of chronic diseases.