1. Significant of study
Vietnam is one of lower- middle income countries with limited resources in healthcare (Word Bank 2017); therefore, Vietnam has high rate of malnutrition in children. According to Vietnamese National Institute of Nutrition and United Nations of Children’s Fund (2011), the percentage of children underweight was 17,5% while that proportion of stunting children is 29,3 %. However, in the last decade, the number of overweight/ obesity children and adolescents increased significantly from three to four times between 2000 and 2009, in 2011 there was 23,4 % adolescents who were overweight or obesity (Vietnamese Ministry of Health 2015). While overweight or obesity can affect negatively on children physical health such as diabetes or cardiovascular (World Health Organisation, 2017), mental health problems (Krause, Lampert & Kleiber 2014, p. 252; Cortese 2009, pp.87-88), or their behaviour (Krause, Lampert & Kleiber 2014, p. 255).
The terms of overweight and obesity in adolescents are defined by growth reference for school-aged children and adolescents: “overweight = one standard deviation body mass index for age and sex, and obese = two standard deviations body mass index for age and sex” (WHO 2017).
2. Question for literature review
What are the factors contributing to obesity/ overweight among adolescents aged from 11 to 19 years old in Vietnam over the last ten years?
3. Search strategy
Evidences were conducted online used Medline, CINNAL and Scopus database systems which are available from the University of Wollongong Library. Based on the search question, the concepts of search strategy are obesity, factors, adolescents and Vietnam. Search terms, then, were identified by using truncation, wildcards and phrases which were fit with the databases. While the term, ‘factor’, was removed because it is too general and not a good search term due to most of articles will mention it without using it in search term (explanation of a librarian of The University of Wollongong).
The study was limited generally in English language, published from 2007 to 2017, adolescents between 11 and 19 years old, focusing on medicine, nursing and social science. About 300 journal articles were found. However, after review titles and abstracts, 10 articles
were analysed full article.
4. Summary of evidence
The studies were examined based on three following groups of factors that contribute to overweight and obesity in Vietnam: (a) food consumption, (b) economic status, (c) daily activities.
4.1 Food consumption
Evidences shows that adolescents get higher risks of overweight and obesity when they have unhealthy including high energy or bedtime meals (Huong et al. 2013; Lachat 2009), fast food (Pengpid & Peltzer 2016) and soft drink and less fruits (Tang et al. 2010). In particular, the cross - sectional study of Huong et al (2013) in 763 boys and 765 girls school aged from 11 to 14 illustrates that overweigh and obesity students consume higher energy than normal students. They are 2342 ± 468.8 and 2048 ± 344.2 (Kcal) respectively (p < 0.001). Meanwhile, the research of Pengpid & Peltzer (2016) focusingon 30,284 school students aged 13-15 years in seven southern east countries including Vietnam (n=1,742), concludes that high rate of overweight and obesity in group of male students who serving three or more vegetable a day and female students who consume fast food more than one time a week. Tang et al. (2010) indicates that adolescents who consume soft drink frequently associate with overweight and obesity with OR= 3.0 (p<0.05) compared to OR=2.3 in crude group (p< 0.05). this study was conducted from 2678 students aged 11-16 in Ho Chi Minh city. However, the study of Tang et al. (2010) has attrition bias when people who withdrew were not included in analysis (analysed number is 2660 with 34 missing people). In short, the rates of overweight and obesity are higher in group of people who eat high energy meals, junk food and drink carbonate beverage frequently.
4.2 Economic status
Most of chosen articles have a similar result that the rates of overweight and obesity of adolescents in Vietnam were high in wealthy economic families or areas. The overweight and obesity was higher about four and nine times in group of wealthy economic status compared to that of bottom economic status in Peru (05% CI 2.21-8.18) and Vietnam respectively (95% CI 1.07-77.42 (Carrillo-Larco, Miranda & Bernabé-Ortiz 2016). This is a secondary study conducted in a big sample (n= 5764) in Peru and Vietnam however, it is heterogeneity because there are differences in culture and sampling procedure between two countries. In addition, it has attrition bias when missing participants were not included in the analysis process. The cross-sectional study of Nguyen et al. (2013) indicates that the percentage overweight and obesity children aged 11-14 years in wealthy districts in Ho Chi Minh city are 20.5% of boys and 3,8% of girls. That number is higher in less wealthy districts with 12.1% and 3.8% (p<0.001) in that order. The rates of overweight and obesity of adolescents in wealthy and less wealthy were showed in other articles. They are 8.2% overweight and0.6% obesity in wealth areas and 1.6% and 0.2% respectively in poor areas (Tang et al. 2007). In short, wealthy economics status is a factor that associates with the high rate of overweight and obesity among adolescents in Vietnam
4.3 Daily activities / behaviours
Daily activities or behaviours of adolescents can impact on their body mass index. Firstly, this is physical activities. Adolescents tend to become overweight and obesity in group of those do not walking or biking to schools (Pengpid & Peltzer 2016). In addition, in the cross sectional study of Nguyen et al. (2016) conducted by survey in 2051 students indicates that the proportion of overweight and obesity in children age 11-14 in Ho Chi Minh city is 21% and it associates with screening time for watching television, video, DVD or using computers two hours per day or above (OR=1.48, 95% CI, p< 0.02). This factor is similar to a study of Tang et al. (2010); children is two-time higher risk of overweight or obesity when they have televisions in their bedroom.
5. Critical review of evidence
Generally, the methodology of chosen evidence was fair. Most of the studies had cross sectional study designs where there was not randomisation in selecting participants (Huong et al, 2013; Lachat, et al. 2009; Nguyen et al. 2013; Vuong, Gallegos, & Ramsey R 2015). The majority of the studies did not provide a detailed description of the experience that participants had during the studies. The content, duration and mode of educational factors were reported poorly in the studies (Krause et al. 2014; Lachat, et al. 2009; Nguyen et al. 2013). The evidence with a secondary research design had no specific criteria in selecting the studies. Therefore, the level of heterogeneity was high (Carrillo-Larco et al. 2016; Pengpid & Peltzer 2016; Tang et al. 2007;). Furthermore, there was a failure to present clear definitions about the standard care for the comparison groups in all of the studies.
6. Strength and limitation
The literature review is located common factors that contribute to overweight and obesity in Vietnam based on evidence practice. These studies were conducted with large sample (n>1000), and focus on finding the causes of increase in overweight and obesity in Vietnam
However, it is important to address the limitation of evidences. Firstly, there is no study which was conducted in the whole country, Vietnam. Many of them were collected data in Ho Chi Minh city and Hanoi. They are two biggest cities in Vietnam, so the result can be not representative for the adolescents in Vietnam. Secondly, there are attrition bias in some studies (Carrillo-Larco, Miranda & Bernabé-Ortiz 2016; Tang et al. 2010). That can affect the result of these studies because it is difficult to identify the data for missing people in the research.
7. Therelevance and impact of findings and identified gaps
The evidences in this paper can present to common factors of overweight and obesity among adolescents in Vietnam. From that, health practitioners can have more information for their practice to develop suitable strategies in treatment, caring and prevention overweight and obesity among adolescents. This is also an evidence in education and consultation in health service and communities to maintain healthy bodies for adolescents in Vietnam. However, the limitation of number of evidences could be not cover all the factors that associates overweight and obesity in young people aged 11 to 19-year-old in Vietnam.
In this paper, by using online search strategies in three different database systems, there were 10 articles were chosen to analyse factors contributing to overweight and obesity among adolescents in Vietnam. Despite the limitations of evidences, the literature provides a general view of reasons of the change in body mass index of the young people. This trend was influenced by food consumption, economic status and daily activities. From these evidences, health practitioners, communities or health policy makers should acknowledge and have solution to prevent overweight and obesity in childhood in Vietnam.
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