Study design
This cross-sectional, questionnaire-based study was conducted at 2 randomly-chosen ambulatory health care centers on the Abu Dhabi Islands: the Al Bateen clinic and the Zaafarana clinic.

Study participants
Children aged 2–12 years (n = 274) and their parents were recruited from February 2014 to January 2015. Children with chronic diseases, children of parents who were non-Arabic and non-English speakers, and children not accompanied by their parents were excluded from the study. The total study population size was estimated to be 1,253 based on clinic visits the same months of the previous year. The sample size of 291 was calculated using a sample size calculator with 95% CI and 5% margin of error. The final sample size was 274 after the exclusion of 17 subjects because of missing medical records.

Questionnaire
The questionnaire was developed based on those used in previously reported studies. The questionnaire was divided into three parts: 1) Questions regarding family socio-demographic factors and parental factors contributing to the development of childhood obesity (8 questions); 2) Questions regarding the child’s lifestyle, including dietary practices, physical activities, and sleeping hours (11 questions); 3) Questions regarding physical parameters, including the child’s weight, height, and BMI. The questionnaire was prepared in 2 versions, Arabic and English.

Part 1 of the questionnaire included the ages of the parents (20–30 years, 31–40 years, 41–50 years, or above 50 years), nationality (UAE national or non-UAE national), level of education (illiterate, primary school, secondary school, or university), family income (very low, not sufficient, sufficient, more than sufficient), whether either parent was overweight or obese (yes or no), the number of children in the family (1–2, 3–4, 5–6, or more than 7), and age of the child subject (2–4, 5–7, 8–10, or 11–12 years). Part 2 included questions regarding the consumption of healthy food and junk food (never, rare, sometimes, or always), activities including watching TV, video games, iPad use (never, 1–3, 4–6, or more than 6 h), exercise (never, 1–2, 3–4, or 5 or more times/week), and sleeping hours (less than 4, 4–6, 7–10, or more than 10 hours/day), and parent’s impression of their child’s weight (thin, normal, overweight, or obese). Part 3 asked about the child’s weight (kg), height (cm), and BMI (number and percentile). A pilot study was conducted before finalizing the questionnaire, and modifications were made accordingly.

Data collection
All children aged 2–12 years who were accompanied by a parent, were approached by a staff nurse to request their participation in the study until the sample size was achieved. The BMIs were obtained from the medical records of all selected participants. Trained, qualified nurses working in the ambulatory health service assessed the growth characteristics of the children as part of routine health care at each clinic visit. They measured the height and weight using an electronic scale and height meter. The height was measured with the subject in a standing position without shoes, and the weight was measured while the subject wore light clothing. Growth charts and parameters, including BMIs, were recorded by the nurses using a computerized system.

Statistical analysis
The data were organized using the Excel software program and analyzed using the Statistical Package for Social Sciences (SPSS) version 18. The total and sub-category scores were compared with each other and with socio-demographic factors using the Pearson correlation coefficient (r) and chi-square coefficient (2). A p-value <0.05 was considered indicative of statistical significance.

Ethics approval
The National Institute of Health (NIH) web-based training course “Protecting Human Research Participants,” was completed to meet the ethics requirements. Approval was obtained from the SKMC Institutional Review Board/Research Ethics Committee (IRB/REC) in February 2014.

Demographic characteristics of participants
This study enrolled 274 participants, 71.9% of whom were accompanied by their mothers and 28.1% by their fathers. The majority of the parent participants were 31–40 years old (62.7% of mothers, 56.3% of fathers). The cohort comprised 61.2% UAE nationals and 38.8% non-UAE-nationals. The majority of the respondents (54.4%) were university graduates, while 1.1% were illiterate. The perceived family income was sufficient in 73.5%, sufficient with savings in 19.8%, and insufficient in 6.7%. Most of the participants had 3–4 children (53.3%), while 17.6% had 1–2, 22.4% had 5–6, and only 6.6% had 7 or more. The age distribution of the child participants was almost uniform, with 26.6% age 2–4, 28.1% 5–7, 25.9% 8–10, and 19.3% 11–12 years. The socio-demographics of the study population are presented in Table 1.

Table 1. Socio-demographic data

Prevalence of overweight and obesity
The prevalence of overweight and obesity in the study population was found to be 32.8% (15.3% and 17.5%, respectively), with 59.1% of normal weight and 8% underweight (Figure 1).

Figure 1. Prevalence of childhood obesity (2–12-year-olds) in the Abu Dhabi Islands (n = 274)

Parent perception of weight
When asked about their own weight, 52.4 % of the parents perceived themselves as normal weight, while 43.6% saw themselves as overweight and 2.9% saw themselves as obese (Figure 2).

Figure 2. Parent perception of their own weight

When asked about their spouse’s weight, 4.1% of the parents perceived their spouse as underweight, 64.9% as normal, 28% as overweight, and 3% as obese (Figure 3). The majority of the respondents perceived their child’s weight as normal (71.8%), while only 15% perceived their children as overweight and 2.9% as obese (Figure 4).

Figure 3: Parent perception of spouse’s weight


Figure 4: Parent perception of child’s weight

Child lifestyle
Of the child participants, 0.4 % slept less than 4 hours/day, 11% slept 4–6 hours/day, 83% slept 7–10 hours/day, and 5.5 % slept more than 10 hours/day. The majority of children spent 1–3 hours/day watching TV (60.1%), while a minority (2.9%) watched TV for more than 6 hours/day. Most of the children exercised 1–2 times/week (45.5%), while only 11.9% exercised rarely or never (Table 2).

Table 2: Child lifestyle

The prevalence of childhood obesity was found to be higher among UAE nationals than non–UAE-nationals (22.2% vs. 10.4%; p = 0.016) (Figure 5).

Figure 5. Obesity prevalence among UAE nationals vs. non-nationals (n = 274)

Obesity and child age correlated significantly (p = 0.001), with obesity in 6.2% of children aged 2–4 years compared to 33.3% of children aged 8–10 years (Figure 6). The parents of 84% of normal weight children perceived their child as having a normal weight, while 16% of the parents of obese children perceived their child as obese. This finding was statistically significant (p < 0.001) (Figure 7).
Most of the children slept 7–10 hours, regardless of their weight (normal weight, 81% of participants; overweight, 90%; obese, 85.4%) (Figure 8). The majority of children spent 1–3 hours/day watching TV (normal weight, 63%; obese, 54.2%) (Figure 9). Most of the obese children exercised 3–4 times/week (37.5%), while the majority of overweight and normal weight children exercised 1–2 times per week (47.5% and 50%, respectively) (Figure 10).

Figure 6: Association between child age and obesity


Figure 7: Parent perception of their obese child’s weight status

Figure 8: Association between hours slept/day and child weight

Figure 9: Association between hours/day spent watching TV and child weight


Figure 10. Association between exercise hours/week and child weight

Eating habits
Most children reported a good appetite (44.3%), while 11.4% reported never having a good appetite. Of the obese children, 39% always had good appetite compared to only 15.7% of normal weight and 9.1% of underweight children. This difference is statistically significant (p < 0.001) (Figure 11). The majority of children always ate home-cooked food (49.3%), while only 1.5% never ate home-cooked food. The majority of children (55%) always ate breakfast, while a minority (4.1%) never did. Fruits and vegetables were sometimes eaten by 42.3% of the children and never eaten by 1.5%. The majority of obese children always ate home-cooked food, breakfast, and vegetables and fruits (Figure 12, 13, and 14, respectively). Fast food was eaten by 53.3% of the children; only 3.7 % never ate fast food. Chocolate, chips, and soft drinks were sometimes eaten by 49.3% of the children and never eaten by 0.7% (Table 3) The majority of the overweight and obese children sometimes eat these foods (Figures 15, 16, respectively).

Figure 11: Association between appetite and child weight

Figure 12: Association between eating home-cooked food and child weight

Figure 13: Association between eating breakfast and child weight

Figure 14. Association between eating vegetables and fruits and child weight


Table 3: Child eating habits


Figure 15. Association between eating fast food and child weight

Figure 16. Association between eating chocolate, chips, and soft drinks and child weight