Obesity is a disease defined as excessive fat that a person develops. The body mass index (BMI) is the calculation of a person’s body mass where weight (kg) is divided by the height (m) square. A body mass index (BMI) above the 95^th percentile is considered obese; the range between the 85^th and 95^th percentile is classified as overweight; and the percentiles below that are categorized as normal to underweight. Obesity has been poorly treated since it was recognized [1]. Despite that, obesity is increasing, and the World Health Organization showed that nearly 18% of the 5–19 age groups are obese [2].

Socioeconomic and psychological circumstances, uncontrolled food intake, and the absence of physical activity might be the factors that have the highest impact on child obesity. Children might deal with their problems by eating large portions of food. The psychological factors that affect child obesity are isolation, family stress, and anxiety [1]. Studies show that children with obesity are more likely to be obese as adults [3]. Studies show a strong link between dental caries and obesity, with obese people being more likely to have dental caries. The main factors that increase dental caries are the high intake of sugar and high fluoride exposure [4]. School type can be a factor that affects obesity; a study that measured obesity in private and public schools' results showed that low physical activity, low water intake, minerals, and vitamins were mainly found in public schools where high BMI values are found. Nevertheless, some research in different countries showed high obesity in private schools, conducting the effect of the school environment on obesity. Consequently, the lack of physical activities has increased during the CVOID-19 pandemic, and the closing of schools was one of the main reasons behind the decrease in physical activity in children [3]. Other studies focused on     socioeconomic factors and the relationship between socioeconomic status and obesity. Studies on poor socioeconomic circumstances showed that low physical activity and low healthy food intake affected obesity negatively. On the other hand, other studies concluded that with a good socioeconomic status and access to a fat-rich diet, it is easy to have more obesity [1].

Since children are more likely to be obese as adults, preventing the factors that affect obesity and preventing going from overweight to obesity before it is too late is the best approach to avoid obesity. Obesity results in several diseases, such as diabetes, cardiovascular diseases, and cancer. To avoid these consequences, healthy lifestyle decisions must be made. Knowing the prevalence of obesity in children aged 3–12 years in Dubai during the COVID-19 pandemic and studying the risk factors contributing to childhood obesity will result in planning early interventions and preventing the negative impact of obesity on health. This will therefore result in a better quality of life from the early years of life and decrease the load and cost of health services [5]. IN a study carried out in Turkey in 2009 Results showed that in order to investigate the associations between obesity and potential risk variables, a logistic regression model was created. Children were classified as obese or nonobese in approximately 32% (n = 184) and 69% (n = 408) of cases, respectively. Even though the daily calorie intake of obese and nonobese children was the same, only 13.6% of obese and 40.9% of nonobese children reported engaging in frequent physical activity. Parental obesity was highly correlated with obesity Intake of calories, regular exercise, the existence of obesity in the mother's, father's, and mother's family, and having a mother who works outside the home were also strongly linked to obesity. To stop kids from becoming overweight, it's important to teach moms about the importance of a healthy diet and encourage families to get moving. 

This cross-sectional study aims to investigate the prevalence and risk factors of obesity in children aged 3 to 12 years visiting a primary health center during the COVID-19 pandemic in the UAE. Our study included 383 children in total, aged 3 to 12 years. The sample had children from different nationalities who visited primary healthcare centers with no serious medical conditions. Children with serious illnesses, children who take long-term medications and children who don't live in the UAE are not eligible. This study gathered data between August 2021 and February 2022. A questionnaire over the telephone was used among the participants' parents. The questionnaire has two parts, which aim to gather information from both the child and parents. The questionnaire was used in many similar studies in both Arabic and English [6]. The questionnaire was validated through a pilot study. The research question aims to answer some of the data in this questionnaire were extracted from the participant's medical records.

The data collection questionnaire included 2 parts. The first one included demographical data like age, sex, BMI, and nationality, while the second one collected data about risk factors and other information like sleeping hours, family income, etc. The data was analyzed using Minitab and SPSS statistical analysis software, and the P value cutoff for significance was 0.05. In this study, we analyzed continuous and categorical data using multiple hypothesis testing methods and categorical data analysis techniques.

Statistical analysis

Numerical variables are presented as mean and SD, and categorical variables are presented as count and percent.

Results show that our sample is relatively balanced in gender distribution, with 47% of males and 53% of males. The average weight of participants is 33.75 kg, the average height is 1.29 meters, and the average BMI is 19.23 kg/m2. 35.8% of children were obese, 11.2% were overweight, 10.4% were underweight, and 42.6% had a normal body mass index (BMI). The majority (68.1%) of participants were Emarati nationals. In our study, 30.8% of parents reported being smokers; 50% were university graduates; and 70.8% reported having sufficient income. 56.1% of parents said their weight is normal, while 38.2% believed their spouse's weight is normal.

Table 1: Characteristics of data

Food that is high in calories from sugar and/or fat, and possibly also sodium, but with little dietary fiber, protein, vitamins, minerals, or other important forms of nutritional value

Children were divided into four age groups: 3–4 years, 5-7 years, 8–10 years, and 11–12 years, representing 19.8%, 27.2%, 41.8%, and 11.2% of the sample, respectively. A significant majority of parents (p = 0.00) believe their child is normal, while only 19% believe their child is obese or overweight. Our study identified some factors to investigate their relation to childhood obesity. Those factors are sleeping hours ( explain the effect and percentage ) , screen time, physical activity per week, taking breakfast daily, eating vegetables and fruits, eating junk food, and eating outside. Data shows that 12.3% of children were sleeping less than 8 hours, around 45% had screen time more than 4 hours, and 64% had minimal physical activity per week, where minimal is defined by either never having physical activity or having it one to two times per week. 1.6% never had breakfast, and 7% rarely had breakfast. Only 41.5% of children reported eating fruits and vegetables every day. Nearly half of children reported always eating junk food, and 21.1% always ate outside.

Figure 1: BMI category vs. Gender

There is a significant difference (p = 0.012) between male obesity and female obesity percentage. Males are more obese compared to females

                           Figure 2: BMI category vs. age group.

Obesity is highest in children at 11 to 12 years old compared to other age groups (p = 0.003).

Figure 3: BMI category vs. parents' smoking status

If one or two of the children's parents are smokers, the kids will be significantly (p = 0.046) more likely to be obese. Results show that 43.2% of kids with smoking parents are obese, compared to 32.4% of nonsmoking parents

Figure 4: BMI category vs. parent education level (pie chart).

There is a significant relationship between lower parents' education levels and high obesity in children (p = 0.028).

Figure 5: Parent education level vs. children's Obesity (Time series).

Figure 6: Screen time vs. BMI category.

Children who watch screens for 4 to 6 hours or longer than 6 hours have a more significant probability (p = 0.00) of being obese.

Figure 7: Eating from outside vs. parent level of education.

There is no relation between parent education level and eating from outside (p = 0.056).

In our study, we tried to investigate the prevalence and risk factors of obesity in children aged 3–12 years visiting the primary health care setting of the Dubai Health Authority during the COVID-19 pandemic. Our study showed that 35.8% of children between the ages of 3 and 12 are obese, which is close to the obesity percentage in some Gulf countries like Qatar. The obesity prevalence is 40.4% among children from 5 to 19 ( Althani M. et al., 2008). Our study also reported similar findings to the Qatar study, where obesity in children was significantly higher in females. According to the results of our study, a significant number of children also eat outside and consume insufficient amounts of fruits and vegetables. These results are consistent with a related study (Ali H. et al., 2013) conducted in the United Arab Emirates, which found that youngsters are not adhering to dietary guidelines and are not obtaining their calories from nutritious sources. The findings showed that girls aged 9 to 13 ingested roughly 264 calories daily from sugar-sweetened beverages and 206 kcal from candies and sweets. The percentage of participants who consumed more calories from saturated fat than is advised ranged from 27.6% (males aged 9 to 13) to 45.9% (males aged 6 to 8 years). The estimated average requirements for all the subgroups were lower than the mean intakes of vitamins A, D, and E. The mean calcium consumption was lower than recommended for all age and sex subgroups. More than 90% of each of the six subgroups for the milk group and 100% of boys between the ages of 9 and 18 who consumed more vegetables than the recommended number of servings each day were among the individuals whose intakes from the food groups were below the required amounts. To improve the quality of the diets of children and adolescents in the UAE aged 6 to 18, the findings of this study point to the necessity for interventions. There is a significant relationship between lack of physical activity and obesity in children because of being in COVID-19, where the amount of physical activity dropped significantly. A study in KSA during COVID-19 reported that COVID-19 virus outbreaks unfavorably affected Saudi children's movement behaviors, specifically girls, which should be considered in future research. The results show what has changed because of the COVID-19 restrictions, and they could be used as part of Saudi Arabia's plans for how to respond. Given the methodological variety of the epidemiological studies addressing them, it is challenging to pinpoint the exact prevalence of obesity and concomitant cardiometabolic illnesses in the UAE. However, between 1989 and 2017, studies found a 2-3-fold increase in the prevalence of overweight and obesity in the UAE [3].

The consumption of junk food, as appears from our study results, is considered a major cause of obesity. Between 2016 and 2017, yearly growth in soft drink sales volumes fell in Saudi Arabia (from 5.44% to 1.33%), the United Arab Emirates (from 7.37% to 5.93%), and Bahrain (from 5.25% to 5.09%). In Oman, a decrease was seen between 2018 and 2019 (3.60% to 2.99%), and in Qatar, a tax was applied in 2019, leading to a decline in sales volume growth between 2019 and 2020 (3.78% to 2.45%). Kuwait was the last GCC nation to impose taxes in 2020, and between 2019 and 2020, the rise in sales volumes fell from 6.31% to 5.47% [7].

The UAE introduced a comprehensive framework for preventing obesity in 2017, which has assisted with the implementation of a tax on sugar-sweetened beverages, front-of-pack labeling, the creation of school canteen guidelines, and strengthened implementation of the International Code of Marketing of Breast-milk Substitutes. In addition to all the efforts made, obesity remains a major issue for children, and there must be a comprehensive approach to deal with this issue. In addition to educating parents about obesity and its risks, the role of families, schools, clinics, and the media is very important[8,9].

Obesity is associated with parents' education level. The lower the education, the higher the percentage of obese children Smoking parents screen time of 4 hours or higher, junk food, and eating outside are significantly associated with children's obesity. Obesity is substantially higher in males compared to females and is considerably higher in those aged 10 to 11 years.

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