title: Double Burden of Undernutrition and Obesity in Palestinian Schoolchildren: A Cross-Sectional Study.
abstract: The coexistence of underweight and overweight (double burden) remains a major problem in many developing countries. Little is known about the factors associated with the double burden of malnutrition in Palestinian children.
  
  
  
  To assess factors associated with undernutrition and overnutrition in 1500 schoolchildren aged 5 to 16 years, in the West Bank.
  
  
  
  We surveyed a sample of 22 schools run by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the Palestinian government. Binary logistic regression was used to examine the factors associated with malnutrition. The hunger index, a composite score from 8 questions, was used to measure food insecurity.
  
  
  
  In the 1484 children enrolled in UNRWA and government schools in the West Bank, the prevalence of stunting was 7% and underweight 3%. Around 12% of students were overweight and 6% obese. The hunger index was negatively associated with height for age. Factors associated with being underweight were male sex, mother being unemployed, and households not having enough food to eat for at least 2 days in the previous month. Factors associated with obesity were older age and time spent watching television. When overweight and obesity were combined in the analysis, they were inversely associated with increasing number of days spent playing sports.
  
  
  
  Our results show that the important nutritional risks for school-age children in the West Bank would seem to be the simultaneous occurrence of undernutrition and obesity. The study highlights the need to balance obesity management and prevention with interventions to tackle undernutrition.
authors.affiliation: Palestinian National Institute of Public Health and Juzoor for Health and Social Development, Ramallah, West Bank, Palestine salwamassad@gmail.com.
authors.forename: Salwa
authors.initials: S
authors.lastname: Massad
authors.affiliation: Department of Pediatrics and Institute of Human Nutrition, Columbia University, New York, NY, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Deckelbaum
authors.affiliation: Department of Women's and Children's Health, Pediatrics, University Hospital, Uppsala, Sweden.
authors.forename: Mehari
authors.initials: M
authors.lastname: Gebre-Medhin
authors.affiliation: Department of Pediatrics and Institute of Human Nutrition, Columbia University, New York, NY, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Holleran
authors.affiliation: USAID Bureau of Global Health, Washington, DC, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Dary
authors.affiliation: UNICEF, Jerusalem, Palestine.
authors.forename: Maysoun
authors.initials: M
authors.lastname: Obeidi
authors.affiliation: Institute of Human Nutrition, Columbia University, New York, NY, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Bordelois
authors.affiliation: Health Department, UNRWA, Jerusalem, Palestine.
authors.forename: Umaiyeh
authors.initials: U
authors.lastname: Khammash
mesh_terms: D000293:Adolescent; D018912:Arabs / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008877:Middle East / Q000453:epidemiology; D063766:Pediatric Obesity / Q000453:epidemiology*
keywords: Palestine; malnutrition; physical activity; schoolchildren