THE SAMI AND OTHER PEOPLE: OVERWEIGHT AND OBESITY AMONG RURAL SCHOOLCHILDREN OF THE RUSSIAN ARCTIC AND NORTH IN 1994-2019



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Abstract

Introduction. Until 2017, there were no unified criteria for assessing the nutritional status of children in the Russian Federation. Therefore, information on the spread of obesity in schoolchildren of rural settlements and small towns remained disconnected. This made it difficult to consider the pace of change in the remote northern regions.

This study aimed to trace the prevalence of overweight and obesity in children aged 6-17 living in rural areas of some northern regions of Russia between 1994 and 2019.

Materials and methods. The data (sex, age, body weight and stature) were collected during regular medical examinations of 7548 rural children 6-17 years old in the same settlements in 1994, 1997-08, 2005-09 and 2016-19 in the Murmansk Oblast, Khanty-Mansi Autonomous District, Komi Republic, Komi-Permyak District. Individual cases of overweight were identified by BMI values using the WHO methodology.

Results. The prevalence of excess body weight grew in all the localities. A general conclusion for all the study subgroups is that the prevalence of excess body weight was 4-7% (including 0.6-0.8% obesity) in 1994-98, 7.5-18.7% (obesity 0.9-5.0%) in 2005-09, and 23.9-26.6% (obesity 7.7-11.9%) in 2016-19. As the data of 2019 showed, there is no difference in the prevalence of excess body weight between the schoolchildren residing in rural settlements, small towns, large industrial centers, and Moscow.

Conclusion. The rapid spread of overweight and obesity among children of Russia appertains to the second decade of the 21st century. The geographic (Arctic, non-Arctic North, Central Russia) and socio-economic (various levels of urbanization) factors do not play a major role in that negative dynamics.

Full Text

THE SAMI AND OTHER PEOPLE: OVERWEIGHT AND OBESITY
AMONG RURAL SCHOOLCHILDREN
OF THE RUSSIAN ARCTIC AND NORTH IN 1994-2019

 

Introduction

Overweight and obesity spread rapidly in rural areas around the world [1, 2]. As many scholars show, populations of northern (higher than 60°N) regions are also vulnerable to this process [3, 4]. For example, 64% of Canada's Inuit were found overweight or obese [5]. Among middle-age Greenland Inuit, the proportion of obese individuals increased from 12.6% in 1993 to 27.3% in 2014 [6]. In 2010, 15.8% of all Greenlandic children at school entry were overweight and 6.8% obese [7]. According to recent reports, the proportion of children with BMI above the norm in Greenland settlements, excluding Nuuk’s residents, is 28.8% [8].

Indigenous northerners of Russia are also face widespread of fat metabolism disorders [9]. Mid-2010s surveys reported excessive body weight (including obesity) in 62-63% of the Nenets and Khanty people living in large settlements or a big city of the North-Western Siberia [10, 11].

The studies on the prevalence of obesity in the adult indigenous population of the northern regions of Russia are scarce, but since different authors use common criteria for excessive weight, they provide an integrated picture. As for children, the situation is different.

Until the beginning of the 2000s, Russian practitioners used regional evaluation tables to assess the growth of children. The tables were being constructed on the basis of average measurements of children's body in every particular region. They also had been updated every 7-10 years, reflecting the change in the anthropometric characteristics of the population. It was only in 2017 that the Ministry of Health of the Russian Federation recommended using the WHO child growth standards and references for screening examinations. These circumstances make it difficult to estimate the change in the spread of obesity when a researcher has no access to primary data and should judge by the publicated reports. We considered this issue elsewhere [12].

The outcome of the studies where the criteria for overweight and obesity were consistent with those of WHO Growth Reference allows us to see the following picture. Between 1992 and 1998, the percentage of children with excessive weight in Russia fell from 15.6% to 9.0%, but then has slowly started to increase. In 1999-2001, obesity rate was 5.6% in the rural and 8.4% in urban 6-18 year old subjects [13], and in 2004 the prevalence of obesity among those 10-18 years old reached 11.1% [14]. A study conducted in 2010 found 19.9% of urban children overweight and 5.6% obese. That is, the proportion of children having BMI above recommended values reached 22.5% [15].

These reports reflect the situation that has developed in large urban centers. Information on how childhood obesity spreads in rural settlements and small towns remained fragmented, making it difficult to assess the rate of change in remote northern regions. Thus, our data collected over a number of years in the same settlements and processed by the common protocol are of some value.

The aim of this study was to assess the prevalence of overweight and obesity in the children 6-17 years of age living in rural areas of some northern regions of the Russian Federation in the years between 1994 and 2019.

Materials and methods

The main data were collected in the course of annual medical check-ups of rural children 6-17 years old in Murmansk Oblast, Khanty-Mansi Autonomous Okrug-Yugra (KMAO), the Komi Republic, and Komi-Permyak Okrug (KPO) in Perm Krai. Additionally, in KPO and KMAO we also gathered information about schoolchildren in administrative centers of the districts - Kudymkar (population 30904 in 2019) and Berezovo (7050 inhabitants). From 1994 to 2019, when data were collected subsequently in a region, we did it in the same localities and schools.

The geographical localization of settlements and ethnic characteristics of their population are given in Table 1, the number of subjects in study groups by the year are shown in Table 2. The total number of subjects is 7548.

 

Table 1. Geografic localization of study sites and ethnic composition of study groups

Таблица 1. Географическое положение мест исследования и этнический состав обследованных групп

 

Residence

Latitude, Longitude

Ethnic composition

Murmansk Oblast, Lovozero settl.

68°02´N, 35°00´E

Sami, Komi, mixed

KMAO, rural settl.

63°32´N, 64°49´E

Khanty, Mansi

KMAO, Berezovo town

63°56´N, 65°03´E

Mixed

Komi Republic, Kortkeros and Palevitsy settl.

61°48´N, 51°34´E

Komi (Zyrian)

KPO, rural settl.

60°00´N, 54°29´E

Komi-Permyak, mixed

KPO, Kudymkar town

59°00´N, 54°40´E

Komi-Permyak, mixed

 

Table 2. Number of subjects by year of collection (schoolchildren 6-17 years old)

Таблица 2. Размеры выборок по годам исследований (школьники 6-17 лет)

 

Residence

Region

Year

Number of subjects

Sex

Total

M

F

Rural settlements

KPO

1994

169

186

355

1998

355

435

790

2009

293

269

562

2019

245

262

507

Komi Republic

2008

216

250

466

2018

283

270

553

Murmansk Oblast

1997

177

174

351

2005

165

168

333

2016

108

114

222

KMAO

2019

115

128

243

Administrative centers (towns)

KPO, Kudymkar

1994

147

165

312

2009

370

349

719

2019

661

633

1294

KMAO, Berezovo

2019

408

433

841

 

There is no data on the ethnicity of schoolchildren in Lovozero (Murmansk region) for 2016, but in 1997 ethnic Sami accounted for 69%, in 2005 - 60% of the study participants. Among those under examination in Komi Republic, the vast majority (more than 90%) were Komi. The study subjects in the rural areas of KMAO in 82% belong to the indigenous peoples of the North (Mansi 52%, Khanty 30%); 18% are representatives of other ethnic groups, mainly Russians. The medical records on the schoolchildren of Berezovo town (KMAO) does not contain the information about ethnicity. However, according to an estimate based on the data from Russian Statistical Agency [16], about 95% are of non-indigenous descend and about 5% are ethnic Mansi, Khanty or Nenets. In KPO, by the school archive records, 85% of the students of rural schools were ethnic Komi-Permyaks, while in Kudymkar town it was 59% (we do not have data on the ethnicity of our study subjects).

In those examinations where the ethnicity of individuals had been provided (Lovozero 1997 and 2005, KPO 1994 and 2009, KMAO 2019), we did not reveal significant differences in body weight estimates between representatives of the indigenous and non-indigenous population [17, 18]. In this publication we disregard ethnicity and only consider the region of residence.

The World Health Organization (WHO) recommended method and reference BMI values for children aged 5-19 years [19] were used to estimate an individual weight status. According to this technique, an individual BMI value undergoes standardization, i.e. transformation into a Z-score, using the referent standard deviation (SD) and median (M) for the appropriate sex and age group:

Z = (BMI - M) / SD

Then, depending on the range in which the Z-score value fell, an estimate on the individual weight status is being made according to the following rules.

-2 ≤ Z ≤ 1, normal;

1 < Z ≤ 2, overweight;

Z > 2, obesity.

Hereinafter, we use the term excessive body weight to refer to the combined weight class that includes the overweight and obesity estimates.

As far as the individual estimates account for the sex and age of a subject, we can characterize a region and time-specific study group by the percentage of subjects falling into the mentioned weight ranges (classes).

The authors obtained body height and weight data by either measurements or copying from schoolchildren’s medical records. A comparison of the weight class frequency distributions in the measurement- and record-derived data study groups in Murmansk region and the Komi Republic (2016 and 2018, respectively) did not reveal significant differences in the ranking results (in both cases, p > 0.51). With this in mind, in our analysis we combined the data of the two types (measured and extracted from medical records).

Statistical analysis consisted of group comparison using the Chi-square test adjusted for maximum likelihood. The significance level was set at 0.05.

Results

The prevalence of overweight and obesity in 6-17 year old children living in rural areas of Murmansk region, KMAO, the Komi Republic and KPO of Perm Krai are presented in Table 3.

 

Table 3. Prevalence of excessive body weight among 6-17 years old children in northern regions of the Russian Federation (per cent, disregarding ethnic belonging)

Таблица 3. Частота избыточной массы тела у школьников 6-17 лет в северных регионах Российской Федерации (в процентах, без учёта этнической принадлежности)

 

Years

Region, residence

Body weight, by classes, %

1

2

1+2

Overweight

Obesity

Excessive

1994

KPO, rural settl.

3.4

0.6

4.0

KPO, Kudymkar town

6.4

0.6

7.0

1997-98

Murmansk Obl., Lovozero settl.

3.9

0.8

4.7

KPO, rural settl.

6.3

0.6

6.9

2005-09

Murmansk Oblast, Lovozero settl.

6.6

0.9

7.5

Komi Republic, rural settl.

13.7

5.0

18.7

KPO, rural settl.

11.7

3.3

15.0

KPO, Kudymkar town

8.9

4.0

12.9

2016-19

Murmansk Oblast, Lovozero settl.

16.2

7.7

23.9

Komi Republic, rural settl.

17.4

9.2

26.6

KMAO., rural settl.

11.1

11.9

23.0

KMAO, Berezovo town

17.7

7.9

25.6

KPO, rural settl.

17.8

8.3

26.1

KPO, Kudymkar town

14.6

10.2

24.8

 

 

The proportion of children with excessive body weight has increased over time in all the locations. As our data show (see Table 4), in the 1990s 4-7% of schoolchildren had BMI above the norm, in the 2010s, the percentage increased substantially in all the localities. By the end of the second decade of the 21st century, 23-26% of the rural 6-17-year-old children in the northern regions of the Russian Federation were overweight or obese.

The prevalence of excessive body weight and obesity by the year of collecting data are presented in Table 4.

 

Table 4. Prevalence of excessive body weight and obesity in 6-17 years old children by year of data collection

Таблица 4. Частота избыточной массы тела и ожирения у детей 6-17 лет по годам обследования

 

Site, year

Sample size

Excessive body weight, %

p*

Obesity, %

p*

KPO, rural settl.

1994

355

4.0

--

0.6

--

1998

790

6.9

0.039

0.6

0.889

2009

562

15.0

0.001

3.3

0.000

2019

505

26.1

0.001

8.3

0.001

KPO, Kudymkar town

1994

312

7.0

--

0.6

--

2009

719

12.9

0.004

4.0

0.001

2019

1292

24.8

0.001

10.2

0.000

Murmansk Oblast, Lovozero settl.

1997

351

4.7

--

0.8

--

2005

333

7.5

0.103

0.9

0.946

2016

222

23.9

0.001

7.7

0.001

Komi Republic, rural settl.

2008

466

18.7

--

5.0

--

2018

553

26.6

0.003

9.2

0.008

* significancy of the difference from the value in the previous line

 

A comparison of data sets collected at a close time (less than a decade) revealed no considerable differences between the regions. Except for the cases when the prevalence of obesity in 2005-09 was lower in Lovozero settlement of Murmansk region (0.9%) than in the Komi Republic (5%) and KPO (3.3%, p < 0.05 in both cases), and in 2016-19 it was virtually higher in Kudymkar town (KPO) compared with Berezovo town of KMAO (10.2 and 7.9%, respectively, p = 0.058).

The materials collected in KPO and Berezovo district of KMAO allowed us to consider the differences between the children living in settlements and administrative centers of the rural areas (Table 3).

In KPO, there were no such differences in the percentage of either overweight or obese subjects in all three consecutive data sets for 1994, 2009, and 2019 (p > 0.1 in all cases).

In 2019, excessive weight was roughly equally prevalent among the children from settlements and Berezovo town of KMAO (p = 0.42), although the former had a higher percentage of obesity cases compared to the towners with the level of significancy close to the critical value (11.9 and 7.9%, respectively, p = 0.055).

Discussion

Our observations affirm that overweight and obesity in children spread rapidly in rural areas of northern parts of Russia (see Tables 3, 4). The changes were occurring simultaneously in various geographically remote areas such as Murmansk Oblast and the Komi Republic, which belong to the Barents Region, KPO on the northern Urals, and KMAO located on the north of Western Siberia. The prevalence of excessive body weight in 1994-98 was 4-7% (including obesity 0.6-0.8%), in 2005-09 it became 7.5-18.7% (including obesity 0.9-5.0%), and in 2016-19 it further increased to 23.9-26.6% (including obesity 7.7-11.9%).

It is difficult to compare our results with the conclusions of other researchers because there were no uniform national criteria for children’s growth assessment in Russia until recently [12]. According to technically commensurable data, 16.40% of children towners in KMAO had BMI above the norm in 2009 [20]. It was found that 18.5% of rural children in Arkhangelsk region had excessive body weight in 2010 [21]. Both of these estimates are close to the values obtained in the current study for the settlement residents of the Komi Republic in 2008 (18.7%, see Table 4). Our findings are also in concert with the figures reported for the children of the Nordic countries that are part of the Barents Region. In the NordChild 2011 cross-sectional survey, 16.5% of Finnish and 15.3% of Norwegian 2-17 years of age children were found overweight or obese [22]. According to 2013 the Global Burden of Disease Study, at least 20% of individuals under the age of nineteen in developed countries have bodyweight above normal [23]. Our data obtained in the years 2016-19 comply with this assessment (Table 3).

As the current study shows, the prevalence of overweight and obesity are close in children living in rural settlements and the small towns located near them (Table 3). In a previous publication we reported on the similarity in the distribution of weight classes in schoolchildren of the rural settlements and the large industrial centers of Perm Krai (2005-09), Arkhangelsk (2010) and Murmansk (2012-16) regions [21]. The data obtained in 2019 made it possible to compare the prevalence of overweight and obesity in the school-age children of the largest city of Russia - Moscow, the main city of Perm Krai - Perm, the small town of Kudymkar, and small settlements of Kudymkar district of Perm Krai (Table 5). Pairwise comparisons revealed no significant differences in the prevalence of excessive body weight (p > 0.3 in all the cases). The obesity percentage for Perm city (6.9%) and Kudymkar town (10.2%), however, appeared to differ (p = 0.012).

 

Table 5. Prevalence of excessive body mass and obesity in schoolchildren of Moscow, Perm, Kudymkar (KPO small town), and rural settlemens of KPO

Таблица 5. Частота избыточной массы и ожирения у школьников Москвы, Перми, Кудымкара (малый город Коми-Пермяцкого округа) и сёл КПО

 

Locality

Population (in thousands)

Sample size (N)

Excessive (incl. obesity), %

Obesity, %

Moscow city (COSI, 4th round) 1

12655.1

2162

24.7

8.4

Perm city 2

1049.2

748

23.4

6.9

Kudymkar town (Perm Krai)

29.8

1294

24.8

10.2

Settlements (KPO, Perm Krai)

1.3

507

26.1

8.3

1 – [24] (7-year-old, genders combined, assessment made under condition of equal proportion of boys and girls.

2 – M.Otavina (2021), personal data

 

Thus, excessive weight in the children of Russia is almost equally prevalent in the populations of various geographical localization (the Arctic, non-Arctic North, Central Russia) and socio-economic characteristics of the region of residence (settlements, small town, large urban center, metropolis).

Conclusion

Overweight and obesity are highly prevalent and continue to rise among the rural children of the North-Western parts of European Russia and Siberia.

 A surge in the negative dynamics appertains to the second decade of the 21st century.

The rate and degree of the spread in rural children of northern regions are close to that in populations of large cities.

 

Author contribution

Both authors A.Kozlov and G.Vershubskaya in cooperation conceived the study, organized and performed data collection, statistical processing and analysis, discussed the results. A.Kozlov wrote the paper with input from G.Vershubskaya.

 

Acknowledgments

The study was conducted in the framework of Anthropology of Eurasian populations research theme (АААА-А19-119013090163-2) of D.Anuchin Research Institute and Museum of Anthropology, Moscow State University.

The authors are grateful to Dr. M.L. Otavina (Perm State Humanitarian-Pedagogical University) for the permission to use her unpublished data on schoolchildren of Perm city.

The publication was supported by a grant received by the Research Centre for Human Adaptation in the Arctic, Branch of the Federal Research Centre “Kola Science Centre of the Russian Academy of Science” (RCHAA KSC RAS) on "The contribution of reproductive health and the quality of the Arctic environment to the Wellbeing of the Kola Sami" is co-funded through the International Arctic Science Committee (IASC) cross-cutting funds with contributions from the IASC Social & Human Working Group (SHWG) and the International Science Initiative in the Russian Arctic (ISIRA).

 

Disclosure statement

The authors declare no conflict of interests.

×

About the authors

Андрей Игоревич Козлов

Московский государственный университет им. М.В. Ломоносова

Author for correspondence.
Email: dr.kozlov@gmail.com
ORCID iD: 0000-0002-6710-4862
Russian Federation

Galina Vershubskaya

Email: ggver@ya.ru
ORCID iD: 0000-0003-2452-1532
Russian Federation

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