Title of Dissertation: AN EPIDEMIOLOGY OF ADOLESCENT OBESITY IN LATIN AMERICA AND THE CARIBBEAN

Dissertation Chair: Dr. Ike Okosun

Background: Adolescent obesity is a serious public health problem in high-income countries of the world. However, despite the sociodemographic, cultural background  and structural healthcare access and sustainable development differences among high-income countries, results of obesity studies are often generalize to all high-income counties, including high-income developing countries. Little studies exist, describing the relationship between obesity and associated factors in high-income developing countries.  Hence this investigation aims to answer three research questions: 1) What is the socio-demographic distribution of obesity and associated risk factors within and between high-income, developing countries in Latin America and the Caribbean (LAC)? 2) Are the proportion of obesity and risk factors in the Caribbean higher than in Latin American countries? 3) What are the predictors of obesity in high-income, developing LAC countries?

Method : Data from the Global School-Based Student Health Survey for six countries: Anguilla (2015- 2016), Bahamas (2012 - 2013), Curacao (2014 - 2015), Uruguay (2011-2012), Chile (2012-2013), and Argentina (2011 - 2012) were used to estimate the effect of socio-demographics, health behaviors, psychosocial and substance misuse factors on risk of obesity. We compared prevalence of obesity and associated risk factors across studies countries. Multivariate logistic regression analyses were used to estimate risk of obesity between studies countries.

Results: Sub-regional prevalence rate of obesity was 19%; 31.3% for the Caribbean, 17.6% for Latin America, 35.8% for the Bahamas, 31.7 for Anguilla, 32.3% for Chile, 25.5% for Curacao 17.5% for Uruguay, and 16.5% for Argentina.  Increased odds of obesity in the Caribbean was estimated for females (AOR: 1.44, 95%CI: 1.16 - 1.79), and bullying victims (AOR: 1.36, 95% CI: 1.01 - 1.82) , and bullying victimization (AOR: 1.99, 95% CI: 1.28 - 3.08) and being 14 years old (AOR: 1.59, 95% CI: 1.02 - 2.47) in Latin America. Decreased odds of obesity was associated with engaging in physical activity  in Anguilla (AOR: 0.31, 95% CI: 0.15 - 0.65), whereas increased odds of obesity was associated with female gender in the Bahamas (AOR: 1.65, 95% CI: 1.23 - 2.23), bullying victimization in Curacao (AOR: 2.02, 95% CI: 1.27 - 3.21), Uruguay (AOR: 1.36, 95% CI: 1.06 - 1.81) and Argentina (AOR: 1.28, 95% CI: 1.05 - 1.56), age 14 years olds in Uruguay (AOR: 1.33, 95% CI: 1.02 - 1.73), 15 years in Uruguay (AOR: 1.51, 95% CI: 1.07 - 2.12), Chile (AOR: 2.21, 95% CI: 1.51 - 3.22) and Argentina (AOR: 1.35, 95% CI: 1.02 - 1.79).

Conclusion: Our findings confirm our assumption high-income developing countries in the region have different risk factors.   Our results suggest that obesity prevalence is significantly higher in the Caribbean than Latin America.  Our findings indicate an association between obesity and bullying victimization, older aged adolescents, being female and physical activity in the region Further research is needed  to understand these associations to inform development of evidence-based targeted anti-obesity strategies for school-going adolescents in Latin America and the Caribbean .