Mediterranean diet paradox; A systematic review of childhood obesity trends among European Mediterranean countries

The Mediterranean diet, originating in the countries of Italy, Greece, Spain, and Southern France, is world renowned for its health benefits, yet, paradoxically, these countries are experiencing among the highest childhood obesity rates in the world. These countries share similar climate, diet, lifestyle, and now, pediatric obesity trends, with more than 30% of each country's elementary school-age children classified as overweight or obese. Childhood overweight is associated with several adverse consequences ranging from physical and psychosocial co-morbidities, to economic sequelae that may burden a government due to increased health care costs. Risk factors include increased consumption of unhealthful high-fat, high-sugar food items, sedentary lifestyle, and parental obesity. Little research has explored the strikingly high childhood obesity rates among these countries and ways to address this issue. This study presents a systematic review of the literature focusing on peer reviewed articles published between 2003 and 2008. The reviewed literature reports pediatric obesity trends among pre-pubertal children (up to the age of 10) from Italy, Greece, Spain, and Southern France. Specifically, this study explores: 1) pediatric obesity trends among the Mediterranean countries, including risk factors and complications of obesity; 2) inconsistencies in instruments used to measure and define BMI/obesity including scales by the CDC, the International Obesity Task Force (IOTF), and national references developed by each country; and 3) the role of the family, schools, health professionals, government, industry, and the media in addressing childhood obesity. Preliminary results indicate large measurement discrepancies when assessing BMI using different scales. Future research should focus on developing a more internationally accepted instrument or methodology that would more accurately define pediatric obesity.