|Year : 2019 | Volume
| Issue : 4 | Page : 190-200
Prevalence of obesity in Iranian children: Systematic review and meta-analysis
Moloud Fakhri1, Diana Sarokhani2, Mandana Sarokhani2, Ali Hasanpour Dehkordi3, Leila Jouybari4
1 Traditional and Complementary Medicine Research Center, Addiction Institute; Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
2 Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
3 Department of Medical-Surgical, Faculty of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
4 Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
|Date of Submission||08-Jan-2019|
|Date of Decision||18-Mar-2019|
|Date of Acceptance||08-Apr-2019|
|Date of Web Publication||18-Nov-2019|
Dr. Ali Hasanpour Dehkordi
Department of Medical-Surgical, Faculty of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord
Dr. Leila Jouybari
Nursing Research Center, Golestan University of Medical Sciences, Gorgan
Source of Support: None, Conflict of Interest: None
Background of the Study: Childhood obesity, in addition to the likelihood of its continuation in adulthood, is associated with an increase in mortality and various diseases. Purpose of the Study: This meta-analytic study aimed at determining the prevalence of obesity among Iranian children. Methodology: Two researchers independently searched national and international databases using MeSH, Scopus, PubMed, Science Direct, Web of Science, Springer, Magiran, Iranmedex, SID, Medlib, and the Google Scholar search engine. The heterogeneity between studies was evaluated using the I2 index. Data were analyzed using STATA software. This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Among 93 studies with a sample size of 3,845,768, the prevalence of obesity in Iranian children was 7% (girls 8% and boys 10%), and the prevalence of overweight was 12% (girls 17% and boys 15%). The incidence rate of obesity in children was 13% based on US centers for disease control and prevention (CDC) 2000 reference, 11% on international obesity task force (IOTF) reference, 9% on World Health Organization reference, 9% on Iranian reference, 5% on CDC reference, and 3% on national center for health statistics (NCHS) reference. Meta-regression diagram also showed that the prevalence of obesity in children was not dependent on sample size. However, the prevalence of obesity declined during the years 1999–2016, which was statistically significant. Conclusion: The prevalence of obesity in Iranian children was less than of their overweight. On the other hand, the prevalence of childhood obesity in girls was lower than that of boys, and the prevalence of child overweight among girls was higher than that of boys.
Keywords: Children, Iran, meta-analysis, obesity, prevalence, overweight
|How to cite this article:|
Fakhri M, Sarokhani D, Sarokhani M, Dehkordi AH, Jouybari L. Prevalence of obesity in Iranian children: Systematic review and meta-analysis. Indian J Med Spec 2019;10:190-200
|How to cite this URL:|
Fakhri M, Sarokhani D, Sarokhani M, Dehkordi AH, Jouybari L. Prevalence of obesity in Iranian children: Systematic review and meta-analysis. Indian J Med Spec [serial online] 2019 [cited 2020 Jan 21];10:190-200. Available from: http://www.ijms.in/text.asp?2019/10/4/190/271222
| Introduction|| |
The World Health Organization (WHO) has identified obesity as a global issue and referred to it as the most serious global health issue that affects the quality of life and ends up in physical, mental, and psychological disorders., The prevalence of childhood obesity has dramatically increased throughout the world over the past decades. Obesity in adolescence is mostly rooted in childhood. According to international definitions, at least 10% of children worldwide are overweight or obese. In other words, about 22 million children worldwide have excess weight. In 2010, overweight/obesity led to the death of 3.4 million people, a loss of 3.9% of the length of their lives, and 3.8% of disability. It has been estimated that up to one-third of the population of children in developed countries is overweight. The prevalence of obesity in Canadian children in the age range of 7–13 years ranged from 5% to 15% between 1981 and 1996. From 2011to 2012, 32.2% of the US children were overweight and 17.3% were obese. In addition, 5.9% of children with obesity had Grade 2 and 2.1% had Grade 3 of obesity criteria. Although these rates were not significantly different from those of 2009–2010, all obesity classes have increased over the past 14 years. Obesity in Iran is a serious problem and is linked to the pandemic of obesity in the world. Lifestyle changes in many developing countries including Iran have been accompanied by aftermaths such as weight gain and obesity and now, childhood obesity has become a global epidemic with domestic, psychological, and economic complications.,,,, Obesity is associated with an increase in adult mortality and is also accompanied with childhood problems such as insulin resistance, type 2 diabetes, dyslipidemia, polycystic ovary syndrome, pulmonary disorders, orthopedic ailments, psychiatric problems, chronic cardiovascular diseases, and hypertension. Obesity in children is also accompanied by depression, confusion, low self-esteem, and frustration. The importance of obesity in childhood and adolescence is not only due to early physical and psychological complications, but also because of the increase in adulthood obesity, the increased incidence of diseases and mortality, and also heavy economic burdens on the society. Given the risks in health issues and the significant rise in obesity, it has become a major global health challenge. Obesity has not only increased, but it has not been controlled over the past 33 years. Therefore, international collaboration is needed to help tackle this problem.,, It is also necessary to have information about the prevalence of obesity among children because it can lead to the identification of subgroups at risk to take preventive measures. Prevention of obesity is very important because effective treatments for this condition are limited. Food management and increased physical activity should be encouraged, promoted, and prioritized to protect children.,,,,,,,, Over the past few years, many studies have been published on the prevalence of obesity in Iranian children, which have reported different outcomes. This study aimed to determine the prevalence of obesity among Iranian children through a systematic review and meta-analysis.
| Literature Review|| |
Protocol of study
We registered the study protocol on the PROSPERO site (ID: 128049, Date: 09/03/2019).
Purpose of the study
This study aimed at determining the prevalence of obesity in Iranian children through meta-analysis.
The design of the study
This research was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses study of reporting system.
All articles on the prevalence of obesity in Iranian children have been studied. Two researchers independently used the keywords “Prevalence, Obesity, Overweight, children, Meta-analysis, and Iran” and their combinations and scrutinized the national and international databases including Scopus, PubMed, Science Direct, Web of Science, Springer, Magiran, Iranmedex, SID, Medlib, and the Google Scholar search engine. For generalization of the research step, internal and external keywords were used for general keywords and in external databases, the combination of keywords was used with the “AND” and “OR” operators. The search step was unrestricted and updated by November 2017. In order to complete the search process, manual search was also performed through reviewing the sources of the articles found.
The inclusion criteria included articles that reported the prevalence of obesity among Iranian children. Exclusion criteria involved studies that had nonrandom sampling, studies that did not have sufficient data and information, studies with inaccessible full texts, studies that did not have the required quality, studies that were not of childhood age range, and studies that were conducted outside Iran. The language of the articles was Persian and English, but in the search phase, no time and language restrictions were applied.
The researchers examined the quality of articles using the STROBE checklist, a well-known international standard checklist for qualitative evaluation of articles. This checklist consists of 22 different sections and covers different parts of a report including sampling, variable measurement, statistical analysis, confounding modifications, validity, and reliability of used tools and study objectives. The score range for this checklist is between 0 and 44, and articles scoring <15.5 were excluded from the study.
Studies that conformed to the required criteria were finally analyzed. To reduce the reporting bias and error in data collection, two researchers independently extracted data from articles. The researchers listed a checklist including the name of the author, study title, age, the prevalence of obesity (in general, the girl and the boy), the prevalence of weight gain (in general, the girl and the boy), the prevalence of weight loss, the year and place of the study, the total number, and the number of girls and boys.
The variance of each study was calculated according to the binomial distribution. Studies were combined according to the sample number and variance. Regarding the heterogeneity of the studies, the random effects model was used. In order to evaluate the studies, Cochran method and I2 index were utilized. The I2 <25% indicates a low heterogeneity, I2 between 25% and 75% indicates a moderate heterogeneity, and I2 >75% indicates a high heterogeneity. The heterogeneity in our study was 99.2%, which was categorized as high heterogeneity. To investigate the relationship between the prevalence of obesity and the quantitative variables of years, and the number of samples, the meta-regression model was used. Data were analyzed using STATA version 11 (KitelyTech's industry leading custom software development services, Chicago). The significance level of the tests was considered to be P < 0.05.
| Results|| |
While conducting the study, 93 articles had entered the meta-analysis process, which were in the period from 1998 to 2017.,,, The total number of participants in the study was 3,845,768. As the selected studies had high heterogeneity, the random effects model was used. The meta-analysis of the prevalence of obesity in Iranian children resulted from the combination of the results of studies presented in [Flowchart 1] and [Table 1]. The properties of the studies are listed in [Table 1].,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|Table 1: The information on the articles included in the systematic review and meta-analysis|
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The prevalence of obesity in Iranian children was 7% (girls 8% and boys 10%) [Figure 1], of which, the weight gain was 12% (girls 17% and boys 15%), and the incidence of weight reduction was 13% [Table 2].
|Figure 1: The prevalence and 95% confidence intervals of obesity among Iranian children based on the authors' name and years of research drawing on the random effects model. The middle point of each section reveals the prevalence of obesity in children in each study. The lozenge shows the prevalence of obesity in Iranian children for all studies|
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|Table 2: The results of meta-analysis on the prevalence of obesity in Iranian children|
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As shown in [Figure 2], there was no significant relationship between the prevalence of obesity in Iranian children and the number of research samples (P = 0.116). However, there was a significant relationship between the prevalence of obesity and the year of study (P = 0.039) [Figure 3].
|Figure 2: The relationship between the prevalence of obesity in Iranian children and the number of research samples using the meta-regression model|
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|Figure 3: The relationship between the prevalence of obesity in Iranian children and the year of research using the meta-regression model|
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| Discussion|| |
Overall, 144 articles with the sample size of 377,858 people (134,588 males and 164,858 females) were included in the study. The prevalence of obesity in populations above the age of 18 in Iran was estimated as 21.7% (95% confidence interval [CI]: 18.5%–25%) and in population below 18, it was 6.1% (95% CI: 6.8%–5.4%). Regarding 93 studies with 3,845,768 people, the prevalence of obesity among Iranian children was 7% (girls 8% and boys 10%), and the prevalence of weight gain was 12% (girls 17% and boys 15%). The results of this study indicated that the prevalence of childhood obesity in boys was higher than that of girls. In a study regarding 23 provinces in Iran in the years 2003–2004, the prevalence of weight gain and obesity in schoolchildren was 9.8% and 4.4%, respectively. The findings of these studies indicated that the prevalence of weight gain was higher than that of obesity in children, which was quite consistent with the current study. In a study conducted in Canada by Veugelers and Fitzgerald, the prevalence of obesity was 9% in girls and 10.9% in boys. In another study in Greece in 2007, the incidence rate of obesity was 48.9% in girls and 51.1% in boys (aged 8–10 years old). In their study, which was similar to this research, the prevalence of childhood obesity was higher in boys than girls. However, in a study in Sweden in 2006, the prevalence of obesity was 5% for girls and 10% for boys (10%), which was inconsistent with the current study's findings.
In the analysis, the prevalence of childhood obesity on the basis of different references was examined. It was found that the prevalence of obesity in children was 13% based on CDC 2000 reference, 11% on IOTF reference, 9% on WHO reference, 9% on Iranian reference, 5% on CDC reference, and 3% on NCHS reference. These results indicated that, according to the CDC 2000 reference, the prevalence of obesity in children was the highest, and based on the NCHS reference, the prevalence of obesity in children was the lowest. In China, the incidence rate of obesity in children under 6 years of age was 3.2%, 3.5%, and 6.8%, using the WHO, IOTF, and CDC guidelines, respectively. The corresponding values for children aged 6–9 years were 10%, 6.3%, and 10.4%, respectively. In Sweden in 2006, the prevalence of obesity was 3.4% and that of weight gain was 22% for 10-year-old children using the WHO reference. In Iran, Prevalences of overweight, obesity, hypertension and abdominal obesity were 21.92, 5.28, 13.16 and 25.31% respectively. The highest prevalence of obesity and abdominal obesity reported in District 3, which is north of Tehran and the lowest was related to boys from region 19 of southern Tehran. According to the WHO criteria, the prevalence of obesity in Iranian children was about three times as much as Swedish children. In the analysis adjusting for children's age groups, the children were divided into two groups of 6 and over 6 years old. It was found that the prevalence of obesity was 8% for children under the age of 6 years and 7% for children aged 6 years and above. It can be said that the prevalence of obesity in Iranian children less than 6 years old was higher than that of children over the age of 6 years. According to the results of a study in Korea in 2005, the prevalence of obesity and weight gain on 54,324 children under the age of 6 years was 6.3% and 10%, and on 32,673 children aged 7–12 years was 8.6% and 12.3%, respectively. The findings of that study were not consistent with the results of the current study. In another study conducted by Armstrong et al. in Scotland on 32,200 children aged 6–8 years, it was found that the prevalence of obesity in children was 8.55%; 8.1% in girls and 9% in boys.
In [Figure 2], the size of a large circle shows sample numbers. No significant relationship was observed between the prevalence of obesity in Iranian children and the number of research samples (P = 0.116). This means that the prevalence of obesity in Iranian children will not increase with increasing number of samples. According to [Figure 3], there is a significant relationship between the prevalence of obesity in Iranian children and the years of study (P = 0.039). Thus, during the years studied, the incidence of obesity in Iranian children declined in the period between 2008 and 2017. There was no difference between the prevalence of obesity in urban and rural communities of Iran and in both regions, the prevalence of obesity was 9%, which may have resulted in the same results due to the unmatched number of studies in each of these two groups. The results of a review study on 144 children show that, in 2010, nearly 43 million infants were overweight or obese. In the USA, during 1999–2000, 16% of children were overweight and 31% of them were at the risk of becoming overweight or were actually overweight. This signified an increase of almost 30% since 1960 and a rise of 45% since the last completed studies in the years 1996–1988. A study on 6 to 11-year-old American children showed that the prevalence of obesity ranged from 4.2% in 1970 to 18.8% in 2004. As for girls living in California, 21.7% were overweight. In Sicily, the prevalence of weight gain in children aged 11 years was 40% and in 15 year olds, it was 25%. According to a study by Martin et al., in Sorocaba in 2010, the prevalence of weight gain and obesity in children aged 7–11 years was 13.1% and 9%, respectively. In another report from the USA, Figueroa-Colon et al. reported the prevalence of obesity among young girls under the age of 5 years as 23%, 10% for White girls aged 5–11 years, 47% for Black girls, and 27% for Whites. The findings of a study by Veugelers and Fitzgerald in Canada in 2003 showed that the prevalence of obesity and weight gain in children aged 10–11 years was 9.9% and 32.9%, respectively. In a study by Valean et al., in Romania, the prevalence of obesity and weight gain in children aged 10 years was 13.31% and 15.95%, respectively. It could be said that the prevalence of obesity among Iranian children was lower than those of many European countries.
Limitations of the study
The limitations of this study included the lack of access to the full texts of some studies and the uneven distribution of studies among urban and rural areas.
| Conclusion|| |
Given the high prevalence of obesity and the economic, social, and socioeconomic consequences that ensue the society and families, governments should opt for scientific and educational approaches in devising plans to control and alleviate this phenomenon. Fast foods should be limited or removed from the daily diet. Health-care providers should check the child's risk of obesity and other health problems. Moreover, for children under the age of 2 years, body mass index should be monitored regularly, and electronic health record programs and anthropometric criteria should be devised for children's health control programs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gill T, Antipatis V, James W. The global epidemic of obesity. Asia Pac J Clin Nutr 1999;8:75-81.
Hasanpour Dehkordi A. Influence of yoga and aerobics exercise on fatigue, pain and psychosocial status in patients with multiple sclerosis: A randomized trial. J Sports Med Phys Fitness 2016;56:1417-22.
Hasanpour-Dehkordi A, Jivad N, Solati K. Effects of yoga on physiological indices, anxiety and social functioning in multiple sclerosis patients: A randomized trial. J Clin Diagn Res 2016;10:VC01-5.
Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014;311:806-14.
Wang Y, Zhang Q. Are American children and adolescents of low socioeconomic status at increased risk of obesity? Changes in the association between overweight and family income between 1971 and 2002. Am J Clin Nutr 2006;84:707-16.
Deckelbaum RJ, Williams CL. Childhood obesity: The health issue. Obes Res 2001;9 Suppl 4:239S-243S.
De Onis M, Blössner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010;92:1257-64.
Behrman R, Kliegman RM, editors. Nutrition and nutritional disorders. In: Nelson Essentials of Pediatrics. 14th
ed: W.B. Saunders Company; 2001. p. 65-9.
Tremblay MS, Katzmarzyk PT, Willms JD. Temporal trends in overweight and obesity in Canada, 1981-1996. Int J Obes Relat Metab Disord 2002;26:538-43.
Skinner AC, Skelton JA. Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. JAMA Pediatr 2014;168:561-6.
Bahrami H, Sadatsafavi M, Pourshams A, Kamangar F, Nouraei M, Semnani S, et al.
Obesity and hypertension in an Iranian cohort study; Iranian women experience higher rates of obesity and hypertension than American women. BMC Public Health 2006;6:158.
Amiri M. Diabetes mellitus type 2; An international challenge. Annals of Research in Dialysis 2016. p. 1.
Mahmoodnia L, Beigrezaei S. Chronic kidney disease and obesity; a mini-review to the current knowledge. J Nephropharmacol 2017;6:30-32.
Mahmoodnia L, Tamadon MR. On the occasion of world kidney day 2017; obesity and its relationship with chronic kidney disease. J Nephropathol 2017;6:105-9.
Shahbazian H, World diabetes day; 2013. J Renal Inj Prev 2013;2: p. 123.
Barsh GS, Farooqi IS, O'Rahilly S. Genetics of body-weight regulation. Nature 2000;404:644-51.
Roper H. Child and adolescent obesity: Causes and consequences, prevention and management. J R Soc Med 2003;96:312-3.
Chandra A, Biersmith M, Tolouian R. Obesity and kidney protection. J Nephropathol 2014;3:91-7.
Moghanloo MN, Mohammadzadeh NA, Lotfi H, Mahmoudi R, Abbasi M, Alipour FG, et al.
Polymorphism rs9939609 of fat mass and obesity-associated gene correlation with leptin level of obese women suffered from type 2 diabetes. Curr Diabetes Rev 2017;14:559-64.
Nasiri A, Khazaie T. Comparing the obesity risk factors in obese and normal children of Birjand 2006. Dena J 2006;1:1-9.
Karaji Bani M, Montazerifar F, Mohammadi M, Dashipour AR. The prevalence of obesity and wasting in primary school girls in the city of Zahedan. Zahedan Univ Med Sci Health Serv Tabibe Sharg 2004;6:289-96.
Amiri M, Hosseini SM, Maghsoudi R. Diabetes mellitus type 1; Is it a global challenge. Acta Epidemioendocrinologica 2016;1.
Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. New England; J Med 2017;376:254-66.
Entezari MH, Salehi M, Rafieian-Kopae M, Kafeshani M. Fat and carbohydrate proportions influence on the insulin resistance; a systematic review and meta-analysis on controlled clinical trials. J Prev Epidemiol 2017;2:e2.
Hassanpour-Dehkordi A, Jalali A, Effect of progressive muscle relaxation on the fatigue and quality of life among Iranian aging persons. Acta Medica Iranica 2016. p. 430-6.
Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, et al
. Pediatric obesity—assessment, treatment, and prevention: an Endocrine Society Clinical Practice guideline. J Clin Endocrinol Metab 2017;102:709-57.
Kafeshani M. Diet and immune system. Immunopathol Persa 2016:1:e04.
Minoo F, Impact of the severity of obesity on microalbuminuria in obese normotensive nondiabetic individuals. J Renal Inj Prev 2015;4. p. 34.
Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016. Jama 2018;319:1723-5.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al.
Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:1.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al.
Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ 2007;335:806-8.
Mosavi Jazayeri S. Overweight and obesity among school-aged children of metropolitan Tehran. Iran Pak J Nutr 2005;4:342-4.
Ghanbari H, Nuri R, Moghadasi M, Torkfar A, Mehrabani J. Prevalence of obesity and some associated factors among 8-12 year old boy students in SHIRAZ. Iran J Endocrinol Metab 2013;15:14-20.
Fesharakinia A, Zarban A, Sharifzadeh G. Relationship of body mass index with serum lipids in elementary school students. Indian J Pediatr 2009;76:729-31.
Zekavat OR, Makarem AR, Shayan Z, Shojaee M, Karami MY. Obesity and overweight among primary school children in Iran. Minerva Pediatr 2014;66:579-84.
Khatibi M, Sanjari M, Farrokhi H, Amirzadeh R, Kashani B. Prevalence of underweightness and obesity as risk factors of future cardiovascular disease and type 2 diabetes among children in Iran. World Heart J 2016;8:251-9.
Esfarjani S, Vala S. Determination of prevalence of obesity and review of some of associated factors in Ahvaz primary school students in 2009. Biomed Pharmacol J 2015;8:67-75.
Shidfar F, Abedi Taleb E, Nasiri nezhad F, Keyvani H, Rezaei Hemami M, Zarrati M. Prevalence of obesity, abdominal obesity and hypertension in 10-13 years old children of governmental and nongovernmental elementary school in some regions of Tehran in year 2011. Iran J Endocrinol Metab 2014;16:183-9.
Asadi Noghabi F. Prevalence of obesity and overweight among children in Bandar abbas. Med J Hormozgan 2011;15:216-26.
Nuh jah S, Karandish M, Malihi R, Tamadon F. Prevalence of Overweight and Obesity in Children Aged 2-5 Years Covered by Health Centers. Ahvaz: WHO; 2008.
Ebrahimzade Kor B, Kalantari N, Ebadi R. The prevalence of obesity and its relative factors among less than 5 years aged children, Bandar Turkmen district, Iran. J Kerman Univ Med Sci 2012;19:384-91.
Aminzadeh M, Hosseinzadeh M, Nikfar R, Ghaderian M, Mohsenpourian S. Incidence in overweight and obesity among schoolchildren, Ahvaz-2010. Jundishapur Sci Med J 2013;12:355-61.
Taheri F. Epidemiologic study of obesity in school age children in Birjand. J Birjand Univ Med Sci 2002;9:20-5.
Soheili Far J, Sadri G. Prevalence of Obesity in Hamadan primary-schools' students in 1998. Sci J Hamadan Univ Med Sci 2000;7:15-9.
Baygi F, Eshraghian M, Dorosty A. Prevalence of obesity among school children in Neishabour. J Qazvin Univ Med Sci 2008;12:73-6.
Azarbayjani M, Tejari F, Habibi Nejad M. The relation between obesity, physical activity and socioeconomic status among girl students living in Northern Tehran. J Feyz 2011;15:133-8.
Solki S, Salehi L, Jamshidi E. Obesity and some related factors among students of elementary schools in Shahryar city. Iran J Endocrinol Metab 2013;14:464-71.
Karam Soltani Z, Dorosty motlagh AR, Eshraghian MR, Siassi F, Jazayeri GH. Obesity and food security in Yazd primary school students. Tehran Univ Med J 2007;65:68-76.
Haeri Behbahani B, Dorosty A, Eshraghian M. Assessment of obesity in children: Fat Mass index versus (FMI) body mass index (BMI). Tehran Univ Med J 2009;67:408-14.
Dorosty A, Karamsoltani Z, Jazayeri A, Siyasi F, Eshraghian MR. Association between obesity, food security and related family factors. SJSPH 2008;6:1-9.
Salem Z, Vazirinejad R. Prevalence of the metabolic syndrome components among 7-11 year-old children in Rafsanjan, 2008. Iran J Nutr Sci Food Technol 2010;5:63-71.
Kalantari N, Shenavar R, Rashidkhani B, Houshiar Rad A, Nasihatkon A, Abdollahzadeh M. Association of overweight and obesity in first-year primary school children in Shiraz with breastfeeding pattern, birth weight, and family socio-economic status in school year 2008-09. Iran J Nutr Sci Food Technol 2010;5:19-28.
Yavarikia A. Evaluation of relationship between body mass index and tibial eminent fracture and ACL injury in children under 14 years of age, in a study at Beasat Hospital of Hamedan during 2011-12. Iran J Surg 2013;23:28-44.
Rafat R, Dorosti-motlagh AR, Eshraghian MR, Rezazadeh A. The association of myopia and overweight in elementary school children: A case- control study in Islamshahr, Iran. Iran J Epidemiol 2009;7:34-43.
Shahgholian N, Aein F, Deris F. 90th
percentile of body mass index (BMI) and some obesity risk factors among 7-12 years old school children, Chaharmahal and Bakhtiari, 2002. Shahrekord Univ Med Sci J 2004;5:42-8.
Hushiar Rad A, Dorosty AR, Kalantari N, Abdollahi M, Abtahi M. Prevalence of stunting, underweight, wasting and overweight among Iranian under-five-year-old children (2000-2002). Iran J Nutr Sci Food Technol 2009;3:49-56.
Gaeini A, Samadi A, Khalesi M. Fat Mass Index (FMI) comparing to Body Mass Index (BMI) in the determination of obesity in preschool children. Razi J Med Sci 2014;21:52-60.
Mirsolimany H, Mokhtari N, Mirhadiyan L, Kazemnejad Leili E. Survey predictors of overweight and obesity in children beginning J Holist Nurs Midwifery 2015;25:55-62.
Mirzaei M, Karimi M. Prevalence of overweight and obesity among the first grade primary students in Yazd. SJIMU 2011;18:43-9.
Golestan M, Akhavan-karbasi S, Fallah-tafti M, Sharaf-aldini M. Prevalence of obesity, overweight and underweight in guidance school students. J Shahid Sadoughi Univ Med Sci 2008;16:31-5.
Akhavan Karbasi S, Fallah R, Golestan M, Sadr-Bafghi M. Prevalence and risk factors of obesity and overweight among primary school children in Yazd. J Shahid Sadoughi Univ Med Sci 2009;16:8-13.
Veghari G, Marjani AA, Abd elahi AA, Rahmani H, Molaei EA, Hosseini SA, et al
. The comparison of children physical growth status between Turkman and non-Turkman in rural area in Gorgan, North of Iran. J Gorgan Univ Med Sci 2009;11:47-52.
Esna Ashari F, Shafiean M, Torkashvand L. Obesity and overweight among primary school children. Payesh 2016;15:69-77.
Taheri F, Hassanzadeh-Taheri MM, Kazemi T, Nazari A, Sharifzadeh GH. Prevalence of overweight and obesity in 2-5 year olds and its relationship with parental obesity. J Birjand Univ Med Sci 2014;21:370-6.
Torabi Z, Rabbani O, Ahmadiafshar A. Prevalence and risk factors of obesity among 2-5 year-old-children in Zanjan city in 2012. ZUMS J 2015;23:116-25.
Khaji A, Khodaii SH, Karbakhsh M, Faeghi A. Blood pressure and obesity in young adolescents in Tehran. Iran J Pediatr Obesity Blood Pressure Adolescentes 2006;16:45-50.
Talaie-Zanjani A, Faraji F, Mohajeraniamid H. The study of obesity and overweight in Arak primary school students, 2009. J Kermanshah Univ Med Sci 2012;16:174-9.
Khorramabadi S, Saeidi Fard N, Ebrahimzad F, Fallahi A. Study of associated factors with obesity and overweight among students of Khorramabad city in 2011-2012. Yafte 2017;19:98-110.
Soheilifar J, Emdadi M. To determine the relationship between breast feeding with overweight & obesity in primary school children in Hamedan. Iran J Pediatr 2005;12:54-7.
Vafa M, Afshari SH, Moslehi N, Salehpoor A, Hosaini F, Goharinezhad M, et al
. Relationship between infant nutrition feeding and childhood obesity in first grade Tehranian students of primary schools, 2009. Iran J Endocrinol Metab 2011;12:505-12.
Agha Alinejad H, Farzad B, Salari M, Kamjoo S, Piri M, Bayati M. Prevalence of overweight and obesity and their relation with physical fitness among Tehranian children of preschool age. Iran J Endocrinol Metab 2013;15:370-7.
Mozafary H, Nabaee B. Prevalence of obesity and overweight in primary school. Payesh 2002;1:15-9.
Nabavi M, Karimi B, Ghorbani R, Mazlom Jafarabadi M, Talebi M. The prevalence of obesity and associated factors in students aged 7-12 Payesh 2010;9:443-51.
Sodaei Zenoozagh H, Maghbooli L, Payghambardoost R, Vahab A. Overweight and obesity among students: A study from Marand, Iran. Payesh 2013;12:415-22.
Amanollahi A, Sohrabi M, Montazeri A, Abdi AR, Kolahi AA. Prevalence of obesity and overweight in primary school girls. Payesh 2011;11:89-95.
Tabatabaei M, Dorosty A, Siassi F, Rahimi A. Using different reference values to determine prevalence of obesity among school children in Ahvaz. J Sch Public Health Inst Public Health Res 2004;2:11-8.
Mahmoodpoor F, Gaemmagami SJ, Ostadrahimi A, Vafa MR. Growth status of first secondary students of Tabriz city based on WHO 2007 and CDC 2000 standards. Alborz Univ Med J 2012;1:151-8.
Kabir K, Tizvir A, Hadian S, Moslemkhani Z. A survey on the relation between the rate of watching and playing computer game and weight disorder regarding first grade students in elementary school in Karaj in 2012. Alborz Univ Med J 2013;2;211-6.
Seyedamini B, Moradi A, Malek A, Ebrahimi-Mamaghani M. The role of watching TV in obesity and behavioral problems in children. IJN 2010;23:8-14.
Mohammadian S, Khoddam H, Kaveh M. Related factors of obesity and overweight among secondary school girls (Gorgan-Iran). J Gorgan Univ Med Sci 2010;12:57-62.
Ebrahimzadeh Koor B, Kalantary N, Kabir MJ, Abadi AR. Correlation between obesity, exclusively breast feeding and breast feeding duration among infants, Bandar Turkmen district Northern, Iran. J Gorgan Univ Med Sci 2011;13:107-11.
Naderi Beni M, Lak P, Jazaeri SA, Eftekhar Ardebili H. Prevalence of malnutrition under five years in Chadegan (area district city) Iran 2011. Indones Res J Educ 2013;9:22-8.
Mirshekar S, Safavi S, Yadegarfar G. The relationship between food insecurity and stunting combined with obesity and overweight in children aged 7 to 11 years in Zabol, Iran. Indones Res J Educ 2017;12:44-54.
Dorosty Motlagh A, Hoshiar-rad A, Mohammad-pour Ahranjani B, Siasi, F. Determination of the most relevant body mass index standard references to define obese Iranian school-age children. Iran J Nutr Sci Food Technol 2009;4:71-80.
Zamani M, Namdar A, Haydari ST, Jafarzadeh A. Anthropometric survey of preschool children in Jahrom, 2011-12. J Jahrom Univ Med Sci 2013;11:25-31.
Yapan Gharavi A, Ebrahimzadehkor B, Dorri A. Growth indices of low and normal birth weight of 2-5 year old children in rural areas of Gonbad, Iran. J Res Dev Nurs Midwifery 2015;12:38-43.
Sedighi E, Azizi M, Parnow A. Evaluation of prevalence obesity and its association with physical activity levels in Javanroud girls' students with 7-12 years old. J Clin Res Paramed Sci 2016;4:351-9.
Hamidi A, Fakhrzadeh H, Moayyeri A, Pourebrahim R, Heshmat R, Noori M, et al.
Obesity and associated cardiovascular risk factors in Iranian children: A cross-sectional study. Pediatr Int 2006;48:566-71.
Faghih S, Keshani P, Salar A, Rajaei SH, Mirzaei Z, Moosavi SM, et al
. Assessment of obesity, unhealthy food habits, and nutritional knowledge of primary school children. Int J Sch Health 2015;2:25186.
Ghadimi R, Esmaili H, Kheirkhah D, Tamaddoni A. Is childhood obesity associated with iron deficiency anemia? Caspian J Pediatr 2015;1:59-66.
Ghadimi R, Asgharzadeh E, Sajjadi P. Obesity among elementary schoolchildren: A growing concern in the North of Iran, 2012. Int J Prev Med 2015;6:99.
] [Full text]
Veghari G, Vakili M. Trend of stunting, overweight and obesity among children under five years in a rural area in Northern Iran, 1998-2013: Results of three cross-sectional studies. Arch Iran Med 2016;19:397-402.
Khodaverdi F, Alhani F, Kazemnejad A, Khodaverdi Z. The relationship between obesity and quality of life in school children. Iran J Public Health 2011;40:96-101.
Hassanzadeh-Rostami Z, Kavosi E, Nasihatkon A. Overweight and obesity among preschool children from Fars province of Iran: Prevalence and associated factors. J Res Health Sci 2016;16:26-30.
Kafhami Khorasani H, Sargol Hasan Zade E, Keikhael F. Associations between sleep duration patterns and obesity in older children in Zahedan at 2013. Nutr Food Sci Res 2014;1:158.
Golestan M, Akhavan karbasi S, Fallah R. The effect of birth weight on overweight and obesity in preschool children. Iranian journal of pediatrics. 2013:23:22.
Keykhaei F, Shahraki M, Sargolhosseinzadeh E, Shahraki T, Dashipour A. Correlation of body mass index and physical activity among 7- to 11-year children at Zahedan, Iran. Food Nutr Bull 2016;37:364-74.
Kajbaf TZ, Asar S, Alipoor MR. Relationship between obesity and asthma symptoms among children in Ahvaz, Iran: A cross sectional study. Ital J Pediatr 2011;37:1.
Dalili S, Rezvani SM, Dalili H, Mohtasham Amiri Z, Mohammadi H, Medghalchi A, et al.
Cardio-metabolic risk factors in Iranian children: Where we are and the others? Acta Med Iran 2014;52:831-6.
Ayatollahi SM, Mostajabi F. Prevalence of obesity among schoolchildren in Iran. Obes Rev 2007;8:289-91.
Salehi-Abargouei A, Shiranian A, Ehsani S, Surkan PJ, Esmaillzadeh A. Caesarean delivery is associated with childhood general obesity but not abdominal obesity in Iranian elementary school children. Acta Paediatr 2014;103:e383-7.
Salehiniya H, Yazdani K, Barekati H, Asadi Lari M. The prevalence of overweight and obesity in children under 5 years in Tehran, Iran, in 2012: A population-based study. Res Cardiovasc Med 2016;5:e30425.
Maddah M, Nikooyeh B. Factors associated with overweight in children in Rasht, Iran: Gender, maternal education, skipping breakfast and parental obesity. Public Health Nutr 2010;13:196-200.
Tabesh H, Hosseiny SM, Kompani F, Saki A, Firoozabadi MS, Chenary R, et al.
Prevalence and trend of overweight and obesity among schoolchildren in Ahvaz, Southwest of Iran. Glob J Health Sci 2013;6:35-41.
Hajian-Tilaki K, Heidari B. Childhood obesity, overweight, socio-demographic and life style determinants among preschool children in Babol, Northern Iran. Iran J Public Health 2013;42:1283-91.
Zarrati M, Shidfar F, Moradof M, Nasiri Nejad F, Keyvani H, Rezaei Hemami M, et al.
Relationship between breast feeding and obesity in children with low birth weight. Iran Red Crescent Med J 2013;15:676-82.
Kelishadi R, Amiri M, Motlagh ME, Taslimi M, Ardalan G, Rouzbahani R, et al.
Growth disorders among 6-year-old Iranian children. Iran Red Crescent Med J 2014;16:e6761.
Mohammadian S, Mortezazadeh R, Zaeri H, Vakili MA. Relationship between 25-hydroxy Vitamin-D and obesity in 2-7 years old children referred to a paediatric hospital in Iran. J Clin Diagn Res 2014;8:PC06-8.
Hajian-Tilaki KO, Sajjadi P, Razavi A. Prevalence of overweight and obesity and associated risk factors in urban primary-school children in Babol, Islamic Republic of Iran. East Mediterr Health J 2011;17:109-14.
Taheri F, Kazemi T, Chahkandi T, Namakin K, Zardast M, Bijari B, et al.
Prevalence of overweight, obesity and central obesity among elementary school children in Birjand, East of Iran, 2012. J Res Health Sci 2013;13:157-61.
Gaeini A, Kashef M, Samadi A, Fallahi A. Prevalence of underweight, overweight and obesity in preschool children of Tehran, Iran. J Res Med Sci 2011;16:821-7.
Motlagh ME, Kelishadi R, Ziaoddini H, Mirmoghtadaee P, Poursafa P, Ardalan G, et al.
Secular trends in the national prevalence of overweight and obesity during 2007-2009 in 6-year-old Iranian children. J Res Med Sci 2011;16:979-84.
Moradi G, Mostafavi F, Azadi N, Esmaeilnasab N, Ghaderi E. Socioeconomic inequality in childhood obesity. J Res Health Sci 2017;17:e00391.
Maddah M, Shahraki T, Shahraki M. Underweight and overweight among children in Zahedan, South-East Iran. Public Health Nutr 2010;13:1519-21.
Saeidlou SN, Rezaiegoyjeloo F, Ayremlou P, Babaie F. Trend of overweight and obesity, based on population study among school children in North West of Iran: Implications for when to intervene. Maedica (Buchar) 2015;10:214-20.
Ziaoddini H, Kelishadi R, Kamsari F, Mirmoghtadaee P, Poursafa P. First nationwide survey of prevalence of weight disorders in Iranian children at school entry. World J Pediatr 2010;6:223-7.
Mottaghi A, Mirmiran P, Pourvali K, Tahmasbpour Z, Azizi F. Incidence and prevalence of childhood obesity in Tehran, Iran in 2011. Iran J Public Health 2017;46:1395-403.
Soheilipour F, Ghanbari Jolfaie A, Pourzahabi Z, Moradi-Lakeh M. The prevalence of obesity in school children of Zahedan-Iran; double burden of weight disorders. J Compr Ped 2015;6:26641.
Dorosty AR, Siassi F, Reilly JJ. Obesity in Iranian children. Arch Dis Child 2002;87:388-91.
Veghari G. Prevalence of overweight, obesity and socio- demographic related factors among Iranian Northern school Children. J Biol Sci 2011;11:487-91.
Shapouri Moghadam A, Safarian M, Vakili R, Ehteshamfar SM. Comparison of body mass index in children of two different regions of welfare. Acta Med Iran 2015;53:122-4.
Javedan G, Salehiniya H, Soheilipour F. Prevalence of obesity and overweight in preschool children in Northwest of Tehran, Iran. J Krishna Inst Med Sci 20165:58-63.
Rahmani A, Sayehmiri K, Asadollahi K, Sarokhani D, Islami F, Sarokhani M, et al.
Investigation of the prevalence of obesity in Iran: A systematic review and meta-analysis study. Acta Med Iran 2015;53:596-607.
Kelishadi R, Ardalan G, Gheiratmand R, Majdzadeh R, Hosseini M, Gouya MM, et al.
Thinness, overweight and obesity in a national sample of Iranian children and adolescents: CASPIAN study. Child Care Health Dev 2008;34:44-54.
Veugelers PJ, Fitzgerald AL. Prevalence of and risk factors for childhood overweight and obesity. CMAJ 2005;173:607-13.
Tambalis KD, Panagiotakos DB, Kavouras SA, Kallistratos AA, Moraiti IP, Douvis SJ, et al.
Eleven-year prevalence trends of obesity in Greek children:First evidence that prevalence of obesity is leveling off. Obesity (Silver Spring) 2010;18:161-6.
Neovius M, Janson A, Rössner S. Prevalence of obesity in Sweden. Obes Rev 2006;7:1-3.
Shan XY, Xi B, Cheng H, Hou DQ, Wang Y, Mi J, et al.
Prevalence and behavioral risk factors of overweight and obesity among children aged 2-18 in Beijing, China. Int J Pediatr Obes 2010;5:383-9.
Kyungwon O, Myoung JJ, Na Yeoun L, Jin Soo M, Chong Guk L, Myung Hwan Y, et al
. Prevalence and trends in obesity among Korean children and adolescents in 1997 and 2005. Korean J Pediatr 2008;51:950-5.
Armstrong J, Reilly JJ, Child Health Information Team. Breastfeeding and lowering the risk of childhood obesity. Lancet 2002;359:2003-4.
Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM, et al.
Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 2004;291:2847-50.
Jolliffe D. Extent of overweight among US children and adolescents from 1971 to 2000. Int J Obes Relat Metab Disord 2004;28:4-9.
Wille N, Erhart M, Petersen C, Ravens-Sieberer U. The impact of overweight and obesity on health-related quality of life in childhood – Results from an intervention study. BMC Public Health 2008;8:421.
Baratta R, Degano C, Leonardi D, Vigneri R, Frittitta L. High prevalence of overweight and obesity in 11-15-year-old children from Sicily. Nutr Metab Cardiovasc Dis 2006;16:249-55.
Martins C, Ribeiro R, Barros Filho A. Nutritional status of schoolchildren according to school geographical localization in the city of Sorocaba, Sao Paulo. Rev Paul Pediatr 2010;28:55-62.
Figueroa-Colon R, Franklin FA, Lee JY, Aldridge R, Alexander L. Prevalence of obesity with increased blood pressure in elementary school-aged children. South Med J 1997;90:806-13.
Valean C, Tatar S, Nanulescu M, Leucuta A. Prevalence of obesity and overweight among school children in Cluj-Napoca. Acta Endocrinol 2009;5:213-9.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]