2025, Vol. 14, No. 1, pp.17-22
ISSN(Print):1857-8152; ISSN(Online):1857-8160
, Goran Nikovski2 , Martin Andonovski3 , Matej Majeric4 2Ss. Cyril and Methodius University, Faculty of Physical Education, Skopje, Macedonia
3Ss. Cyril and Methodius University, Faculty of Physical Education, Skopje, Macedonia
4Faculty of Sport, Ljubjana, Republic of Slovenia;
Abstract
Childhood obesity in North Macedonia, affecting 33.6% of boys and 27.3% of girls aged 6–9, is a growing public health concern, driven by low physical activity and poor dietary habits. This study synthesizes drivers to inform physical education and health interventions. Using the PICO framework, we reviewed 15 studies (2010–2024) from PubMed, Scopus, and grey literature (e.g., UNICEF, WHO) to identify behavioral, environmental, and socioeconomic drivers of obesity in children aged 0–18. Narrative synthesis, guided by Social Determinants of Health (SDOH) and Ecological Model frameworks, categorized findings. Urban children and boys show higher obesity rates, linked to limited recreational spaces (22% meet activity guidelines) and unhealthy school food environments. Suboptimal breastfeeding (24% exclusive for six months) and low parental nutrition knowledge exacerbate risks. Roma children face higher stunting (11%), reflecting socioeconomic disparities. Barriers include inadequate school physical education, fast-food access, and cultural dietary norms. Multi-level interventions, including enhanced physical education curricula, school nutrition policies, and community play spaces, are critical. Training patronage nurses to promote physical activity and engaging families can address SDOH and ecological barriers. Continuous monitoring and school-based programs are needed to reduce obesity’s 5% GDP burden (€482 million annually). These findings inform physical education strategies to foster healthier lifestyles in North Macedonian children.
Key words: childhood obesity, North Macedonia, behavioral drivers, social determinants of health, ecological model
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References
World Health Organization. (2020). Obesity and overweight. Available from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Ball, K., Mishra, G. D., & Crawford, D. (2003). Social factors and obesity: An investigation of the role of health behaviours. International Journal of Obesity, 27(3), 394–403.
Whitehead, M., & Dahlgren, G. (2006). Concepts and principles for tackling social inequities in health: Levelling up Part 1. World Health Organization: Studies on Social and Economic Determinants of Population Health, No. 2.
Wijnhoven TM, van Raaij JM, Spinelli A, Starc G, Hassapidou M, Spiroski I, Rutter H, Martos É, Rito AI, Hovengen R, Pérez-Farinós N, Petrauskiene A, Eldin N, Braeckevelt L, Pudule I, Kunešová M, Breda J: WHO Eu
Pereira HR, Bobbio TG, Antonio MÂ, Barros Filho AD. Childhood and adolescent obesity: how many extra calories are responsible for excess of weight?. Revista paulista de pediatria: orgao oficial da Sociedade de Pediatria de Sao Paulo. 2013 Jun
Exclusive breastfeeding to reduce the risk of childhood overweight and obesity, available from https://www.who.int/tools/elena/interventions/breastfeeding-childhood-obesity
University of Wollongong Library (n.d.). Systematic review: Frameworks. https://uow.libguides.com/systematic-review/frameworks Spiroski, I., et al. (2021). Childhood obesity in North Macedonia: Findings from the 2022 WHO study. Acta Medica Macedonica, 34. Available from https://amj.mk/index.php/amj/article/view/34
State Statistical Office. (2019). North Macedonia MICS 2018–2019. https://www.stat.gov.mk/dokumenti/mics_18-19.pdf
UNICEF. (2021). Childhood obesity and its impact on health status in adulthood. Available from https://www.unicef.org/northmacedonia/reports/childhood-obesity-and-its-impact-health-status-adulthood
2021 UNICEF research report on Childhood Obesity and its Impact on Health Status in Adulthood, available from https://www.unicef.org/northmacedonia/reports/childhood-obesity-and-its-impact-health-status-adulthood
2019 North Macedonia MICS North Macedonia and North Macedonia Roma Settlements Multiple Indicator Cluster Survey, available from https://www.stat.gov.mk/dokumenti/mics_18-19.pdf
UNICEF Situation analysis of children rights, available from SITAN_2024_ENG.pdf.
Gontarev S, Kalac R. Association between obesity and socioeconomic factors in Macedonian children and adolescents. Advanced in Life Sciences and Health. 2014;1(1):55-63).
McLeroy, K.R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351-377. https://doi.org/10.1177/109019818801500401
Abarca-Gomez, L., Abdeen, Z.A., Hamid, Z.A., Abu-Rmeileh, N.M., Acosta-Cazares, B., Acuin, C., & NCD Risk Factor Collaboration. (2017). Worldwide trends in body-mass index, underweight, overweight and obesity from 1975-2016. A pooled analysis of 2416 population-based measurement studies in 128 million children, adolescents and adults. The Lancet, 390(10113), 2627-2642. https://doi.org/10.1016/S0140-6736(17)3212903
Bozhinovski, A., Shikoska, A., Velichkovska, M, & Shikoski, J. (2022). Prevalence of overweight and obesity in children: Variation in different ethnicities, age and sex in North Macedonia. Acta Morphologica, 19(1), 5-14. https://pubmed.ncbi.nlm.nih.gov/37382576/
Jebeile, H., Kelly, A.S., O’Malley, G., & Baur, L. A. (2022). Obesity in children and adolescents. Epidemiology, causes, assessment and management. The Lance Diabetes & Endocrinology, 10(5), 351-365. https://doi.org/10.1016/S2213-8587(22)00047X
Kumari, M., Bharti, R., Singh, K., Sinha, M., Kumar, A., & Shukla, U. (2022). Childhood obesity: prevalence and prevention in modern society. Journal of Preventive Medicine and Holistic Health, 8(2), 83-89. https://doi.org/10.18231/j/jpmhh.2022.016
Lister, N. B., Baur, L.A., Felix, J. F., Hill, A. J., Marcus, C., Reinehr, T., & Jebeile, H. (2023). Child and adolescent obesity. Nature Review