N° 58 | July 2011

Should promotion of healthy eating and active living be distinct for girls and boys?

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It is of utmost importance to be efficient in delivering health promotion as in the Canadian public health care system less than 3% is allocated for resources towards health promotion and primary prevention1. In this study2, we sought to assess gender-differentials in nutrition, physical activity and overweight among children aged 10 to 11 years in the province of Alberta, Canada, to bring more insights into the discussion on benefits of gender-focused prevention of chronic diseases.

Promoting healthy body weights

In 2008, we surveyed 3,421 grade five students (1,758 girls and 1,663 boys) and their parents from 148 randomly selected schools participating in the Raising Healthy Eating and Active Living Kids in Alberta (REALKidsAlberta.ca) survey. The survey aimed to evaluate a comprehensive initiative by Alberta Health and Wellness to Promote healthy body weights among children and youths. Students completed the Harvard food frequency questionnaire, questions on physical activities, and had their height and weight measured. Parents completed questions on socio-economic background and their child’s lifestyle.

Gender differences in nutrition

Overweight prevalence, including obesity, was slightly lower among girls (27.9%) than boys (29.1%). After adjusting for household income, parental education, residency, and calorie intake, findings from the multilevel logistic regression analysis showed statistically significant gender differentials in nutrition and physical activity. Relative to girls, boys were less likely to meet recommendation of six or more servings of vegetables and fruits per day (probability: 0.82; 95% CI: 0.71-0.96). Boys, relative to girls, were more likely to report to eat from a fast food restaurant (1.22; 95% CI: 1.05-1.43) and were more likely to have 30% or more of their dietary energy to be from dietary fat (1.68; 95% CI: 1.19-2.35). Boys were reportedly more physically active and engaged more in sports than girls.

This study confirmed the existence of gender differences in nutrition and physical activity, the underlying causes of overweight, in a large representative sample of Canadian preadolescents.

Higher physical activity level among boys

Differences in health behaviors and overweight between boys and girls may result from differences in biology, from differences assumed to be due to society or culture, or a combination of the two. Biological factors may include difference in body strength and in sexual maturation3-5. Consistent with our study2, others found that boys are more likely to be physically active than girls. In addition, physical activity levels fall as young people become older, particularly among girls5-8. Physical activity counterbalances excess energy intake and the risk for overweight. This risk seems to be higher in rural schools and calls for programs to promote physical activity, particularly among girls during their transition from childhood to adolescence and adulthood8. Adolescence is linked to physical maturity and may affect physical activity behaviors as sexual maturation may be intricately involved in the adolescent decline in physical activity4,9. As girls mature earlier than boys10, relatively more girls than boys are expected to have entered sexual maturation in our study population of preadolescents. This may have contributed to the higher physical activity levels among boys observed in this study.

Gender-differences in eating behaviors

Some studies support the view that social factors act like moderators in determining the relationship between behaviors and overweight, with different mechanisms among men and women3,11. The process of socialization that encourages girls and boys to become proficient in distinct roles affects their lives and their relative exposure to certain health behaviors. The present study observed genderdifferences in eating behaviors, with higher calorie intakes among boys relative to girls, which are in line with the few available studies that focused on gender and nutrition among children and youths12-14. This could be due to gender-specific socialization influences from family and peers5. Increasing concerns about weight and shape in the social environment for girls’ might also explain girls’ higher frequency in the consumption of vegetables and fruits and the lower frequency in consumption of convenience foods5.

The need of gender-focused promotion of healthy eating and active living!

Gender is important in understanding how girls and boys experience and respond to health promotion15,16. Our findings support genderfocused health promotion initiatives whereby priority is given to physical activity among girls and to healthy eating among boys. Health promotion policies that take girls’ and boys’ differential biology and social vulnerability into account are more likely to be successful and cost-effective, compared to policies that do not consider such differences1. In Canada, it is essential to invest the limited resources for health promotion and primary prevention in the most efficient way. We recommend multisectoral approaches, based on evidence gathered with gender dimensions in mind1.

This study adds to our understanding of the importance of gender specific promotion of healthy eating and active living as an effective strategy to reduce the burden of overweight and consequent chronic diseases.

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