Childhood Overweight and Obesity in Vietnam: A Landscape Analysis of the Extent and Risk Factors

Abstract

Tackling childhood overweight and obesity is critical not only to improve the health and well-being of children and adolescents, but also for entire populations and future generations. This paper provides the latest evidence on the extent of, and risk factors for, childhood overweight and obesity in Vietnam. The landscape analysis tool developed by the United Nations Children’s Fund (UNICEF) and World Health Organization (WHO) was used. A search for peer-reviewed articles in English on online databases was undertaken. Peer-reviewed Vietnamese articles were also retrieved from a range of sources. The prevalence of overweight among children aged under 5 years increased from 5.6% in 2010 to 7.4% in 2019. For overweight and obesity among children aged 5 to 19 years, prevalence rose from 8.5% and 2.5% in 2010 to 19% and 8.1% in 2020, respectively. Maternal malnutrition, gestational diabetes during pregnancy, and inadequate infant and young child feeding practices are all risk factors for early childhood overweight. Unhealthy diets, insufficient physical activity, and lack of sleep are among the risk factors for overweight and obesity among school aged children and adolescents. The prevention of overweight and obesity among Vietnamese children requires a whole-of-government, cross-sectoral approach to addresses the obesogenic environment that is negatively influencing the nutrition of children.

Keywords

childhood overweight childhood obesity Vietnam risk factors prevalence rate

Key Message

Children with overweight or obesity are more likely to be overweight or obese as adults, substantially increasing the risk of non-communicable diseases (NCDs) including cardiovascular diseases and chronic diseases. This paper provides the latest evidence on the extent of, and risk factors for, the emerging critical public health issue of childhood overweight and obesity in Vietnam. Policies that could effectively address the obesogenic environment include introduction of an sugar-sweetened beverages (SSB) tax, legislation to restrict the sale and marketing of unhealthy food and drink to children, front of pack nutrition labeling to healthier food and drink choices and raising public awareness to generate the demand for healthier diets and food options as well as improved data collection and reporting. The findings of this paper are not only useful for Vietnam, but also for other countries with similar settings in the region.

Introduction

The prevalence of infant, childhood and adolescent overweight and obesity has been rising around the world in recent decades.¹ In the 1990s, the prevalence of child obesity in low-income countries was estimated as 3%.² Recent findings, however, suggest that the figure of childhood and adolescent obesity in low- and middle-income countries may be approaching the levels seen in high-income countries.³

Children who are overweight or obese are at a higher risk of developing a range of non-communicable diseases (NCDs).⁴ They may also experience psychological and psychosocial impacts, such as weight stigma, social isolation, depression, low self-esteem, and poor educational attainment.⁵ Furthermore, children with overweight or obesity are more likely to be overweight or obese as adults, substantially increasing the risk of NCDs including cardiovascular diseases and chronic diseases such as hyperlipidaemias, hyperinsulinemia, hypertension, and early atherosclerosis, and premature mortality.^6,7

Vietnam is a country located in South East Asia, with a total population in 2019 of 96.5 million, of whom 26.2 million are children under the age of 18 years.⁸ In 30 years, the country has been transformed from one of the poorest countries in the world to a middle-income country with a sustained and constant economic growth (Gross Domestic Product (GDP) annual growth rate has been consistently higher than 7% between 2000 and 2010 and more than 6% since 2014).⁹ Ending hunger and malnutrition has been considered a top priority, while childhood overweight and obesity were not reported as problems in Vietnam before 1995.¹⁰

In recent years, thanks to the country’s reform program, the Vietnamese economy has transformed into an open, market-oriented and globally integrated model, which has improved the food supply on a macro scale. The changes have also contributed to an increasingly obesogenic environment that encourages the consumption of high-energy, ultra-processed foods and sedentary behaviors.^10,11

As a result, overweight and obesity has increased, especially among children and adolescents and in urban areas⁷ and there has been a significant shift in the country’s disease burden from communicable to NCDs. Vietnam has been identified as a country with a high incidence of NCDs, which are responsible for approximately 73% of all deaths, accounting for more than 379 000 deaths per year.¹²

In this paper, we set out the most recent evidence on the extent of overweight and obesity among children in Vietnam and describe the risk factors for overweight and obesity in early and later childhood. We also propose policies, programs and actions that might be undertaken to tackle overweight, and obesity experienced by children in Vietnam.

Methods

Design

This landscape analysis was based on a UNICEF global protocol¹³ which proposes indicators for overweight and obesity and their risk factors. The selection of indicators was based on global knowledge about risk factors and with suggestions for data sources which were easily accessible.

Data Source and Search Strategies

The magnitude of childhood overweight and obesity, the risk factors, and the systems and environments that influence those risk factors were assessed through a desk review. The purposes were to:

(i) Review the current prevalence of, and trends in, childhood overweight and obesity in Vietnam.

(ii) Review the risk factors associated with increased risk of childhood overweight and obesity in Vietnam.

(iii) Identify the policies and programs which shape obesogenic environments in Vietnam.

A search was undertaken for population surveys, nutrition policy documents and academic literature to identify relevant studies conducted in Vietnam. Peer-reviewed articles published in the English language were searched through online databases including PubMed, EMBASE, and the Google Scholar. Peer-reviewed articles in Vietnamese were retrieved from Hanoi Medical University Library, Hanoi University of Public Health Library, and Vietnamese online journals. A variety of gray literature sources were gathered from the online portals of Vietnamese governmental agencies, World Health Organization (WHO), international organizations, and non-governmental organizations working in the field of NCDs. The reference lists of identified studies were screened and reviewed for additional eligible studies.

For searching peer-reviewed articles, the search strategy was developed by using keywords with the following combinations: (“Vietnam” OR “Viet Nam”) AND (“childhood” OR “child” OR “children”) AND (“overweight” OR “obesity” OR “nutrition status”) in the title/abstract. There was no set limit or range of chronological time in searching for published documents so that trends over time could be captured. We used Endnote software for searching, managing and screening for relevant articles.¹⁴ The end date for searching peer-reviewed articles and relevant nutrition policy documents for this review was on 09th December, 2022.

Definitions

Outcomes

Overweight and obesity in children under 5 years: Overweight is defined as weight-for-height Z-score (WHZ) above +2 SD (standard deviation) of the WHO Child Growth Standards median, while WHZ above +3 SD is referred to obesity.¹⁵

Overweight and obesity in children aged 5 to 19 years: Overweight is defined as BMI-for-age Z-score (BMIZ) above +1 SD of the WHO Growth Reference median (BMI—Body Measurement Index). A BMIZ above +2 SD is referred to obesity. A BMI-for-age above +3 SD is referred to as severe obesity¹⁵

Rating scales

Levels of outcomes and determinants were classified into 5 categories: “Very low,” “low,” “medium,” “high,” and “very high.”¹⁶ Details on rating scales are shown in Supplemental 1.

Data Processing, Extraction, and Synthesis

Data processing: We searched nutrition policy documents through Vietnam National Institute of Nutrition, Vietnam Ministry of Health, WHO in Vietnam, and articles through 3 electronic databases PubMed, EMBASE and Google scholar. We found out 486 articles and documents in total. After removing the duplicates, we had 380 articles and documents. KQL and TTA did both “title and abstracts” and full-text screening simultaneously. Disagreements were resolved by discussion with HVM. At the title and abstract screening, 281 articles were excluded owing to: not nationally representative data, conference abstracts without full-text found, qualitative study without quantified magnitude of childhood overweight or obesity. At the full-text screening stage, an additional 54 records were excluded because they did not report overweight and/or obesity content (ie, focus on stunting/underweight/Vitamin A/Vitamin D/Severe acute malnutrition) (17 articles); reported age groups that were not recommended by UNICEF’s landscape analysis (3 articles); reported provincial-level data rather than national-level data (13 articles); focused on oral health topic (5 articles), reported data that were obsolete (3 articles); discussed other studied subject of interest (ie, for health nutrition professional) (1 article); debated child social support topic (1 article); or simply reported no information about childhood overweight or childhood obesity. Ultimately, 12 documents and articles were selected for this review, of which, 9 were national level surveys, government documents (policy, strategies) and 3 were peer-reviewed articles.

Data extraction and synthesis: Data were simultaneously extracted and synthesized by KQL and HVM. 100% of agreement was reached for data reported.

Quality appraisal: We applied a set of criteria from Authority, Accuracy, Coverage, Objectivity, Date and Significance (AACODS) Checklist (http://dspace.flinders.edu.au/dspace/) and the Joanna Briggs Institute (JBI) Checklist (https://jbi.global/critical-appraisal-tools), which are the most preferred for quality assessment of gray literature and analytical cross-sectional studies,¹⁷ respectively. KQL and HVM independently evaluated the documents and studies, discussed any discrepancies and obtained consensus. For 9 nutrition policy documents appraised with AACODS checklist, all questions were answered with “yes” except for the question “Has it been peer – reviewed” and “Has it been edited by a reputable authority?” For 3 cross-sectional studies appraised with JBI checklist, all questions were answered with “yes” except for questions “Were confounding factors identified?” and “Were strategies to deal with confounding factors stated?.” We made a decision not to exclude studies based on quality because of the explorative nature of this review and the limited number of documents and studies available.

Results

With 484 articles and documents found through 3 electronic databases and Vietnamese articles and gray literature, this review selected 12 articles and documents for data extraction and synthesis.

The Magnitude of Childhood Overweight and Obesity in Vietnam

Table 1 presents current data on overweight and obesity among children in Vietnam. The prevalence of overweight among infants and children under 5 years was 7.4% in 2019. The figure for children and adolescents (5-19 years) was higher, at 19.0%. About 8% of children and adolescents (5-19 years) were obese. The prevalence of overweight and obesity was higher among boys and children living in the urban areas. The annual growth rate was categorized as “very rapid.”

Table 1.

Overweight and Obesity Among Children in Vietnam.

	Level	Rating
Infants and children (under 5 years) classified with overweight^{a 18}	7.4%	Medium
Children and adolescents (5-19 years) classified with overweight^{b 19}	19.0%	Very high
Boys	22.4%	Very high
Girls	16.4%	Very high
Urban	24.3%	Very high
Rural	14.2%	High
Children and adolescents (5-19 years) classified with obesity^{b 19}	8.1%	Medium
Boys	10.9%	High
Girls	4.6%	Low
Urban	9.0%	Medium
Rural	5.5%	Medium
Under 5 yrs trend: annualized growth rate	5.7%	Very rapid
Older children trend: annualized growth rate (overweight)	8.4%	Very rapid
Older children trend: annualized growth rate (obesity)	12.5%	Very rapid

Data in 2019.

Data in 2020.

Figure 1 illustrates the trend in overweight and obesity among children under 5 years and 5 to 19 years. Overall, the prevalence of overweight and obesity increased over time in both age groups. The increase in overweight among children under 5 years of age was from 5.6% in 2010 to 7.4% in 2019. For overweight and obesity among children aged 5 to 19 years, there was a rise from 8.5% and 2.5% in 2010 to 19% and 8.1% in 2020, respectively.

Figure 1.

(a) Trend in overweight among children under 5 years; (b) Trend in overweight and obesity among children aged 5 to 19 years.

Risk Factors for Childhood Overweight and Obesity in Vietnam

Risk factors for overweight and obesity in early childhood

Table 2 summarizes the risk factors in early childhood in Vietnam. The prevalence of overweight (BMI > 25 kg/m²) among women of reproductive age in Vietnam was 21.3% and the increase in recent years is classified as “Moderate.” According to Euromonitor International reports, there has a very rapid increase in sales of baby foods (and milk formula) at an average annual growth rate of 5.5%.

Table 2.

Risk Factors for Early Childhood Overweight and Obesity in Vietnam.

	Level	Rating
Women of reproductive age with overweight (BMI > 25 kg/m²)^a,²⁰	21.3%	Moderate
Women of reproductive age with obesity (BMI > 30 kg/m²)^a,²⁰	2.7%	Low
Women of reproductive age with under-nutrition (BMI < 18.5 kg/m²)^a,²⁰	18.0%	High
Female overweight: annualized growth rate	3.3%	Very rapid
Female obesity: annualized growth rate	6.3%	Very rapid
Female under nutrition: annualized growth rate	−1.3%	Decreasing
Births underweight <2.5 kg^b,²¹	8.2%	Moderate
Births overweight >4.0 kg^b,²²	2.3%	Low
Women tobacco smoking^b,²³	1.1%	Low
Gestational diabetes (GDM) or hyperglycemia in pregnancy²⁴	21.3%	High
Births with breastfeeding initiated^d,¹⁹	65.0%	Moderate
Infants 0-5 month not exclusively breastfed^d,¹⁹	54.6%	Moderate
Under 5 yrs stunting^d,¹⁹	19.6%	Medium
Stunting: annualized growth rate	−3.1%	Decreasing
Under 5 yrs wasting^a,²¹	6.4%	Low
Not meet minimum acceptable diet^d,¹⁹	57.6%	Moderate
Not meet minimum diet diversity^d,¹⁹	47.9%	Moderate
Trends in baby foods (and milk formula)^c (CAGR)²⁵	5.5%	Very rapid

Data in 2015.

Data in 2016.

Data in 2019.

Data in 2020.

Risk Factors for Overweight and Obesity in Later Childhood

Risk factors for overweight and obesity in later childhood are described in Table 3. While the risk factors are considered moderate to low, it is still worrying that over one-third of children reported drinking at least one sugary drink per day, more than 1 in 10 ate confectionery daily and 17% consumed fast food at least once a week. Furthermore, physical activity among children aged 5 to 19 years is not sufficient, with 76% experiencing insufficient physical activity and 43% excessive sedentary behaviors.

Table 3.

Risk Factors for Later Childhood Overweight and Obesity in Vietnam.

	Level	Rating
Sugary drinks once per day^a,²⁶	34.9%	Moderate
Consumption of fast food (at least 1 time per week)^a,²⁶	17.1%	Low
Consumption of confectionery (daily eating)^b,²⁷	11.9%	Low
Unimproved water^c,²¹	5.3%	Good
Unimproved sanitation^c,²¹	9.7%	Good
Insufficient physical activity^a,²⁶	75.9%	Poor
Inactive transport to school^a,²⁶	40.7%	Moderate
Excessive sedentary behavior^a,²⁶	43.1%	Moderate
Sleep (lack of sleep <10 h)^d,²⁸	43.0%	Poor
Children outdoors <2 h a day²⁹	39.1%	Moderate
Consumption of sugar-sweetened beverages or carbonated beverages (liters per week, per capita) ^a,²⁵	1.2 l	Moderate
Consumption of confectionery (grams per week per capita) ^a,²⁵	23.1 g	Low

Data in 2019.

Data in 2017.

Data in 2015.

Data in 2014

Figure 2 shows the food energy (kilocalories) supply per person per day in Vietnam, from all foods and disaggregated by animal fats, vegetable oils, sugar, and sweeteners. Overall, there has been a rise in total calories per person, from 1985 to 2018. Calories from sugars and sweeteners contribute the greatest amount of energy per person per day among the Vietnamese.

Figure 2.

(a and b) Trend in food energy (kilocalories) supply per person per day.

Discussion

The Extent of Childhood Overweight and Obesity in Vietnam

The prevalence of overweight and obesity among children in Vietnam has increased rapidly in recent years. The estimated prevalence of overweight among children under 5 years of age was 7.4% in 2019, which is similar to the South-eastern Asia regional average (7.4% in 2019).²¹ This prevalence is higher than that of Laos (3.5% in 2017), Philippines (4.0% in 2018), but lower than Indonesia (8.0% in 2018).²¹

Among children and adolescents aged 5 to 19 years, the prevalence of overweight (including obesity) in Vietnam in 2020 was 19.0% which was higher than most low and middle income countries in South-eastern Asia, including Cambodia 13.4%; Laos 16.6%; Myanmar 14.1%; the Philippines 14.5%; and Indonesia 18.0%, and higher than the South-eastern Asia regional average level (17.3% in 2019).²¹

The speed of the increase in childhood overweight and obesity in both age groups is rapid and without effective intervention, it is estimated that 2 million children with obesity aged 5 to 19 years will be living in Vietnam by 2030.³⁰

Risk Factors for Childhood Overweight and Obesity in Vietnam

The prevalence of overweight and obesity (24.0%) and underweight (18%) in women of reproductive age are indicative of a poor situation by WHO.³¹ These figures are worrying because maternal overweight and underweight are associated both with low birth weight and later overweight and obesity in childhood.^32,33 The prevalence of overweight and obesity in women of reproductive age is similar to some the Association of Southeast Asian Nations (ASEAN) countries such as Myanmar (24.8%); and Laos (25.4%) but lower than Indonesia (28.2%) and the Philippines (27.6%), and higher than Timor-Leste (21.6%).³⁴ Furthermore, 1 in 5 Vietnamese women (21.3%) suffer from gestational diabetes during pregnancy. A meta-analysis, including 35 papers and over 24.000 infants, reported that infants of mothers with gestational diabetes have 62 g greater fat mass than infants of mothers without gestational diabetes mellitus and are more likely to be overweight and obese.³⁵ The very rapid growth in milk formula and baby food sales and consumption is another risk factor. Studies have shown that early intake of milk formula is associated with overweight and/or obesity in children and adolescents.^36-38

Among older children, unhealthy diets were identified as a critical risk factor for overweight and obesity. Consumption of sugary drinks was especially high. Various systemic reviews, meta-analyses of randomized controlled trials (RCTs) and prospective cohort studies have shown that consumption of sugar-sweetened beverages (SSBs) promotes weight gain in adults and children. Studies of dietary intake in China^39,40 and Vietnam⁴¹ have demonstrated positive associations between overweight and obesity, and consumption SSBs. A cross-sectional survey of 2678 students from 31 junior high schools in Ho Chi Minh City conducted in 2004 found that the odds of overweight/obesity were significantly higher for frequent consumption of soft drinks, and were lower for consumption of fruit/vegetables and being physically active.⁴¹ WHO recommends that free sugar intake should be less than 10% of total energy intake and ideally less than 5% of total energy intake.⁴²

Insufficient physical activity was another important risk factor for overweight and obesity among children and adolescence in Vietnam.⁴³ This finding is compatible with the findings of studies in other countries. A cross-sectional study conducted in Thailand reported that sedentary behaviors are associated with child and adolescent overweight/obesity. Children who spent more than 2 hours per day watching television, increased the odds for obesity by 2.32 times as compared to those who spent less than 1 hour per day.⁴⁴ WHO recommends that children aged 5 to 17 years of age should do an average of 60 minutes per day of moderate-to-vigorous physical exercise.⁴⁵

Insufficient sleep was a further risk factor for overweight or obesity among older children and adolescents in Vietnam. This finding is also in line with other study findings. A meta-analysis of 12 studies including 15 cohorts showed that short sleep duration was significantly associated with obesity.³⁵ Risk factors, including short sleep duration was significantly and independently associated with the risk of childhood overweight or obesity, and importantly significance persisted under 3 different growth criteria.⁴⁶ Insufficient sleep and low exercise have been found to be associated with increased body mass index (BMI) while children who slept for 8 hours or less were 2.2 times more likely to be overweight/obese.⁴⁷ Another meta-analysis concluded that short sleep duration is consistently associated with development of overweight/obesity in children and young adults.⁴⁸

Policy Implications for Vietnam

Children in Vietnam are living in an increasingly obesogenic environment where unhealthy, often ultra-processed, food and drink are being sold and marketed to children and where lifestyle changes are leading to more time spent in sedentary activities with less sleep. Addressing the obesogenic environment and preventing overweight and obesity requires a whole-of-government approach in which policies across all systems (food, education, health, water, and sanitation and social welfare) take nutrition.

There are several policies and programs with robust global evidence of impact but which are either not implemented, or only on a small scale in Vietnam without enforcement mechanisms or effective monitoring. These actions could contribute to reducing overweight and obesity among Vietnamese children. A priority action for Vietnam is to implement the National Nutrition Strategy 2021 to 2030 with a vision to 2045 which included targets and indicators on overweight and obesity in children and adolescents. This provides a framework for government accountability. Introduction of an SSB tax will be another priority. Taxes on SSBs have been introduced in Malaysia, the Philippines and Thailand and found to reduce sales of SSBs in the Philippines⁴⁹ and Thailand⁵⁰ while a modeling study in Thailand found that a 20% tax on SSBs could reduce the prevalence of obesity by 4%.⁵¹ Implementing legislation to restrict the sale and marketing of unhealthy food and drink to children has also been shown to be effective. In Singapore, for example, restrictions on food marketing to children through any media, resulted in a reduction in unique advertisements for unhealthy food products from 55.1% pre-implementation to 37.65%.⁵² Front of pack nutrition labeling can support children and families to choose healthier food and drink. Healthier Choice labels have been introduced in Brunei, Malaysia, Singapore and Thailand with some evidence from Singapore that individuals who consume Healthier Choice Symbol products were more likely to meet nutrient guidelines than individuals who did not consume any targeted products.⁵³ Raising public awareness, strengthening nutrition education and communication to improve the diets and dietary behaviors of children and generate the demand for healthier diets and food options should also be a key focus for Vietnam. Finally, there is a need to strengthen monitoring, data collection and reporting on overweight and obesity through annual nutrition surveillance, periodic surveys, and scientific research, and to increase collaboration between government ministries and through partnership with the private sector with a focus on improving nutrition and access to healthy diets.

By providing the latest evidence on the currently emerging critical public health issue of childhood overweight and obesity in Vietnam and making international comparisons with other neighboring countries on the same topic, the present paper helps to highlight policy implications for Vietnam and for other countries with similar settings in the region.

Limitation of the Landscape Analysis

Comparisons across studies were difficult because many studies used different instruments and age-groups of children. Furthermore, the review focused on individual and familial risk factors rather than the underlying factors in the obesogenic environment. Additional limitation of this study is that some relevant studies may have been missed as they were published in local journals that did not appear in the literature search.

Conclusion

The prevalence of overweight and obesity among children in Vietnam has increased rapidly in recent years. Maternal overweight and underweight, gestational diabetes during pregnancy, and inadequate infant and young child feeding practices are associated with overweight and obesity in childhood. Unhealthy diets, insufficient physical activity and insufficient sleep are risk factors for overweight or obesity among older children and adolescents in Vietnam.

Prevention requires a whole-of-government, cross-sectoral approach (food, education, health, water and sanitation and social welfare) to address the obesogenic environment that is negatively influencing the nutrition of children. The National Nutrition Strategy 2021 to 2030 with a vision to 2045 including indicators on overweight and obesity in children and adolescents should be strikingly implemented with measures such as improving the food environment for children (imposing tax on SSB, restricting the sale and marketing of unhealthy food and drink to children, implementing regulations on nutrition labeling on the front of prepackaged products), raising public awareness, strengthening communication and education on nutrition, and data monitoring and reporting.

Supplemental Material

sj-docx-1-inq-10.1177_00469580231154651 – Supplemental material for Childhood Overweight and Obesity in Vietnam: A Landscape Analysis of the Extent and Risk Factors

Supplemental material, sj-docx-1-inq-10.1177_00469580231154651 for Childhood Overweight and Obesity in Vietnam: A Landscape Analysis of the Extent and Risk Factors by Hoang Van Minh, Dr Quynh Long Khuong, Tuan Anh Tran, Hong Phuong Do, Fiona Watson and Tim Lobstein in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Footnotes

Author Contributions

HVM and KQL equally contributed to this paper. TL developed the method. TL, FW, DHP, HVM, KQL, TTA were involved in the conception and design. HVM, KQL, and TTA led the collection of data and analysis of the data. All named authors contributed to the interpretation of data, the drafting of the paper and all critically reviewed its content and have approved the final version submitted for publication.

Declaration of Conflicting Interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DHP and FW are employed by the United Nations Children’s Fund (UNICEF) who funded this work. HVM, KQL, TL and TTA benefited from contractual support from UNICEF. The authors alone are responsible for the views expressed in this publication. All other authors have no competing interests to declare. We see no conflict of interest regarding how the research was conducted or the results selected and presented.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This review was funded by UNICEF.

Ethical Standards Disclosure

Not applicable.

Patient Consent Statement

Not applicable.

Permission to Reproduce Material From Other Sources

Not applicable.

ORCID iD

Tran Tuan Anh

Supplemental Material

Supplemental material for this article is available online.

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