I read the recent publication by Montgomery-Reagan et al with great interest1.
Montgomery-Reagan et al concluded that 'eating breakfast at home and at school and increased hours of television viewing may be associated with higher BMI, especially in younger boys1'. Indeed, the problem of obesity in rural children is a current concern, even in developing countries2.
The affordability of food and eating habits, both of which can be affected by the family's socioeconomic status, are important factors in determining the body weight of rural children2. It is most important to know what the children eat, and clarifying "eating at home and at school" from Montgomery-Reagan et al.'s preliminary report seems important. Even more important, however, is the discordance in findings between the US report1 and a previous report from Thailand, a developing Asian country2. The US finding that higher income was associated with a decreased incidence of obesity is in contrast to the Thai report that found a high income to be associated with an increased incidence of obesity. The Thai study hypothesized that wealthier parents tend to provide excessive amounts of high-sugar foods for their children, and this can lead to pediatric obesity2.
It may be that there is a difference in fundamental health knowledge (in this case regarding pediatric nutrition) between parents in developed and developing countries. Indeed, an Australian study showed that eating patterns in among lower-educated populations in Aboriginal communities include greater amounts of high sugar foods, compared with a higher educated urban population3. Further collaborative research across developed and developing countries is suggested to fully examine this issue.
Viroj Wiwanitkit, MD
Bangkhae, Bangkok, Thailand
1. Montgomery-Reagan K, Bianco JA, Heh V, Rettos J, Huston RS. Prevalence and correlates of high body mass index in rural Appalachian children aged 6-11 years. Rural and Remote Health 9: 1234. (Online) 2009. Available: www.rrh.org.au (Accessed 12 March 2009).
2. Wiwanitkit V, Sodsri P. Underweight schoolchildren in a rural school near the Thai-Cambodian border. Southeast Asian Journal of Tropical Medicine and Public Health 2003; 34(2): 458-461.
3. Lee AJ, O'Dea K, Mathews JD. Apparent dietary intake in remote aboriginal communities. Australian Journal of Public Health 1994; 18(2): 190-197.