Abstract
Introduction
Overweight and obesity have become a concern in low- and middle-income countries,
such as Indonesia, in recent years. This is an important issue for the country because the
detrimental health impacts of obesity on non-communicable disease are well established. The
overall aim of this thesis is to provide better understanding of overweight and obesity
epidemiology among Indonesian populations.
Methods
This thesis involved a secondary data analysis of the Indonesia Family Life Survey, a
large population-based longitudinal study over a 21-year period (1993 – 2014). Trends in body
mass index of Indonesian adults and body mass index-z score of Indonesian children and
adolescents were estimated using longitudinal analyses. Risk factors for overweight and obesity
among Indonesian adults, children and adolescents were assessed using both longitudinal and
cross-sectional analyses.
Results
In adults aged 19 years and over, the mean BMI increased between 1993 and 2014 (21.4
kg/m2 in 1993 to 23.5 kg/m2 in 2014). Longitudinal analysis showed that the increase in mean
BMI over the period was being driven by younger cohorts (those born in 1970s – 1990s). Three
distinct BMI trajectory groups were identified: group 1 (56.7% of participants) maintained a
normal weight, on average, throughout adulthood, group 2 (34.7%) where BMI increased from
a normal weight to obese, on average, and group 3 (8.6%) were consistently obese, on average,
over the adult years. Both longitudinal and cross-sectional analysis showed that being born in
recent birth cohort (1970s – 1990s), being female, having a university education, being married,
working with low physical activity, and living in urban areas were associated with higher BMI.
Cross-sectional analysis showed that frequent consumption of meat, fast foods, and fried snacks
were associated with higher BMI in adults.
In children and adolescents aged 6 – 18 years, the mean BMI-z score increased between
1993 (−0.743 SD) and 2014 (−0.414 SD). Four distinct BMI-z trajectory groups were identified:
group 1 (11.7% of children) had an average BMI-z that was moderately underweight throughout
the period, group 2 (54.3%) where BMI-z was normal on average with a very slow increase over time, group 3 (28.4%) had an average BMI-z that was normal throughout the period but it
was increasing faster than group 2, and group 4 (5.6%) where the average BMI-z was in the
overweight category at the beginning of period and shifted to obese at the end of survey. Both
longitudinal and cross-sectional analysis showed that having a parent that holds a university
education, having caregivers that are obese, living in a small family (four or fewer family
member), and living in urban areas were associated with higher BMI-z score. Cross-sectional
analysis showed that more frequent consumption of meat, fast foods, and soft drinks were risk
factors for overweight and obesity in children and adolescents.
Conclusion
Overweight and obesity have increased with time in both adults and children. The most
recent birth cohort was an important driver in the increasing mean BMI among adults. Both
overnutrition and undernutrition are still prevalent in children and adolescents. A range of host,
agent, and environment factors were associated with overweight and obesity both in adults and
children. The findings support the urgent need for overweight and obesity prevention and
intervention programs in Indonesia.