Prevalence and socio-demographic distributions of meeting RMI Guidelines for Healthy Living among elementary school children in Majuro, Republic of Marshall Islands: a cross-sectional population-based survey

BACKGROUND: Childhood obesity is high in Republic of Marshall Islands (RMI). We report the prevalence and socio-demographic distribution of selected obesity-related risk factors among children in Majuro, RMI. METHODS: Sixteen elementary schools were approached and students and parents in Grades 1, 3, and 5 invited to participate in this cross-sectional population-based survey. Accelerometry and a questionnaire were used to collect data on children's physical activity (PA), sleep, screen time and dietary behaviours. Descriptive statistics and mixed-effects logistic regression were used to examine differences in the proportions of children meeting selected RMI Healthy Living Guidelines by sex, school grade and school sector. FINDINGS: Thirteen schools and 958 children were recruited, of which 892 (52.2% girls; mean age 9.3 ± 1.8 years) provided useable data. Around 90% met the PA, 29% screen time, 13% sleep, 69% sugar-sweetened beverage and 56% highly processed food guidelines. The proportion meeting individual guidelines was higher among children in Grade 1 compared with Grade 5. Being a girl (0.27; 95% CI 0.16, 0.46) was associated with lower odds of meeting the PA recommendation. Compared with children from Grade 1, those in Grade 5 had lower odds of meeting the PA (0.28; 95% CI 0.15, 0.55), screen time (0.60; 95% CI 0.40, 0.89), sleep duration (0.33; 95% CI 0.18, 0.59), sugar-sweetened beverage (0.35; 95% CI 0.23, 0.53), and consumption of highly processed foods recommendations (0.49; 95% CI 0.33, 0.72). INTERPRETATION: While most children in RMI are adequately active, resources are needed to promote healthier levels of screen time, sleep, sugar-sweetened beverage and highly processed food consumption, especially among older children. FUNDING: This study was funded by 10.13039/501100018939World Diabetes Foundation; Canvasback Missions, RMI; 10.13039/501100000925NHMRC Australia (APP1176858); Pacific Community.