The epidemiology of overweight and obesity among Australian children and adolescents, 1995-97

Trends in overweight and obesity in pre-school children in urban areas of Ho Chi Minh City, Vietnam, from 2002 to 2005

OBJECTIVE

To assess the trends in overweight and obesity in pre-school children in urban areas of Ho Chi Minh City (HCMC), Vietnam, over the period 2002 to 2005.

DESIGN

Two cross-sectional studies were conducted in 2002 and 2005. Multistage cluster sampling was used in both surveys to select the subjects. Sociodemographic information was collected using a self-administered questionnaire given to parents in 2002 and using an interview-administered questionnaire to parents in 2005. Weight and height were measured using the same standard methods in both surveys. BMI (kg/m2) was calculated and overweight/obesity was defined using the age- and sex-specific BMI cut-off points proposed by the International Obesity Taskforce.

SUBJECTS AND SETTING

Children aged 4 to 5 years, attending pre-schools in urban areas of HCMC, Vietnam, in 2002 (n 492) and 2005 (n 670).

RESULTS

The prevalence of overweight and obesity almost doubled from 2002 to 2005 (21.4 % and 36.8 %, respectively). The increase was more evident in less wealthy districts than in wealthy districts. The proportion of boys classified as obese in 2005 (22.5 %) was three times that in 2002 (6.9 %).

CONCLUSION

The prevalence of overweight and obesity has increased rapidly in children aged 4 to 5 years in urban areas, and especially in less wealthy districts, over a 3-year period. These results signal an urgent need for prevention programmes to control and reverse this rapid upward trend in overweight and obesity in young children in HCMC.

Gross for kids but good for parents: differing messages in advertisements for the same products

Objectives

There has been surprisingly little research into the effects of food advertising on parents’ perception of commonly consumed children’s food items, although the available research suggests that parents may find nutritional claims in these advertisements confusing. The purpose of the present study was to investigate parents’ perceptions of branded snack foods targeted at children, and the extent to which these perceptions are influenced by advertising messages.

Design

Using an intercept survey, participants were shown either adult-targeted or child-targeted advertisements for the same food products.

Setting

Central business district of a major Australian city.

Subjects

One hundred adults, mean age 40 years.

Results

The study results suggest that: (1) adults’ perceptions of advertised food products and, most importantly, purchase intentions for those products differ according to the version of the advertisement seen (for three of the products, 42–54% would buy the product after seeing the child version compared with 82–84% after seeing the adult version); and (2) adults clearly perceive distinctly different messages in advertisements for the same products which are targeting parents vs. those targeting children (e.g. for three of the products, 74–92% perceived that the adult version of the advertisement suggested the food was nutritionally beneficial compared with 2–14% perceiving this for the child version).

Conclusions

It is clear that the messages conveyed to children about specific foods are quite different to the messages conveyed to adults – and importantly parents – about the same foods.

Cardiovascular and metabolic effects of obesity

1. Obesity is an important risk factor for hypertension and its incidence is increasing around the world. 2. The mechanisms underlying obesity-related hypertension include sympathetic activation, altered vascular responses, hormonal changes, enhanced inflammatory markers and structural changes. 3. This review summarizes recent evidence of the underlying impact of obesity on blood pressure. A number of candidate mechanisms include increased sympathetic activity, activation of the renin-angiotensin system, altered vasoconstrictor or dilator responses and the attendant systemic inflammatory state. 4. While adult lifestyle factors undoubtedly contribute to the incidence of obesity and its attendant hypertension, evidence suggests that the programming of obesity may occur following over-nutrition during development. A growing body of evidence links maternal obesity, offspring obesity and hypertension. 5. Finally, epigenetic modification of genes relevant to hypertension may contribute to the development of hypertension following a suboptimal intrauterine environment. To date the cardiovascular effects of early nutritional changes have been largely investigated following maternal under-nutrition or protein restriction; further work is necessary to determine the impact of maternal obesity.

Make your Best Guess: an updated method for paediatric weight estimation in emergencies

BACKGROUND

For children requiring weight-based resuscitative measures, it is often difficult to obtain an accurate weight. In these cases, it is common practice to estimate the weight based on age. As the average weight of Australian children has increased over the last two decades, the widely used advanced paediatric life support (APLS) method might systematically underestimate weight in paediatric patients.

OBJECTIVE

To devise a simple age-based method for estimating weight that is more accurate than the APLS method.

METHODS

A retrospective observational study of all patients (aged 0-14 years) presenting to a tertiary paediatric ED over a 3 year period was performed. Presentations were divided into infants (<12 months), preschool-aged (1-4 years) and school-aged children (5-14 years). Weight measurements performed at triage were recorded and regression analysis performed to produce equations describing the relationship between weight and age for each group.

RESULTS

There were 70,181 presentations suitable for inclusion in the present study. Mean weight for age (+/-2 SD) is presented in tabular form. Three simplified linear equations were derived to calculate mean weight for age. For Infants < 12 months: Weight (kg) = (age in months + 9)/2 For Children aged 1-5 years: Weight (kg) = 2 x (age in years + 5) For Children aged 5-14 years: Weight (kg) = 4 x age in years.

CONCLUSION

The present study devised an age-based method for paediatric weight estimation which should more accurately predict weight than the widely used APLS formula.

Clustering of psychosocial symptoms in overweight children

OBJECTIVE

The aims of the present study were to (i) examine the relationship between children's degree of adiposity and psychosocial functioning; and (ii) compare patterns of clustering of psychosocial measures between healthy weight and overweight/obese children.

METHOD

Cross-sectional data from a population-based cohort of 158 healthy weight, 77 overweight, and 27 obese children aged 8-13 years were analysed. Height, weight depression, quality of life, self-esteem, body dissatisfaction, eating disorder symptoms, peer relationships and behavioural and emotional problems were measured.

RESULTS

Multi-level analysis showed significant linear associations between child body mass index z-scores and the psychosocial variables, with increasing adiposity associated with increasing levels of psychosocial distress. Principal components analyses indicated subtle differences between the healthy weight and overweight/obese groups with regards to the clustering of psychosocial measures. In particular, in overweight/obese, but not in healthy weight children, global self-worth clustered with body image and eating disorder symptoms.

CONCLUSIONS

The psychosocial burden of excess weight is significant and broad reaching, with overweight/obese children showing multiple significant psychosocial problems.

Obesity in Swedish schoolchildren is increasing in both prevalence and severity

PURPOSE

To monitor and describe, on a national level, the development of body mass index (BMI), overweight, and obesity of schoolchildren in Sweden aged 7-18 years over a period of 8 years.

METHODS

Longitudinal and cross-sectional studies of two nationally representative cohorts. A representative sample of 3,749 individuals from a birth cohort of 109,663 individuals born in 1973, and another representative sample of 3,158 individuals from a birth cohort of 94,064 individuals born in 1981; 4.5% and 1.6% of those born in 1973 and 1981, respectively, were missing from the sample. Data regarding height and weight from school health records.

RESULTS

From age 7-18 year, a strong positive secular change in BMI is found at all ages, and the rate of overweight and obesity is increasing for both boys and girls. Furthermore, obesity is growing more severe.

CONCLUSIONS

Nationally representative longitudinal BMI data for two cohorts, in which nonresponse bias is minimized, permitted monitoring and revealed a nationwide strongly positive secular change in BMI in Sweden, over a period of 8 years for individuals aged 7-18 years.

Secular trends of pedometer-determined physical activity in Swedish school children

AIM

To explore the secular trends (time change) of pedometer-determined physical activity (steps per day) in Swedish schoolchildren 7-9 years of age from 2000 to 2006. It was an additional aim to examine the secular trends in body mass index.

METHODS

The study was analyzed between two cross-sectional cohorts on children 7-9 years of age carried out in October 2000 (336 children, 153 girls) and March/April 2006 (168 children, 83 girls) in the same five schools in south eastern Sweden, using identical procedures at the two occasions. Data of mean steps per day were collected during four consecutive weekdays (sealed pedometer Yamax SW-200 Tokyo, Japan) and in addition height and weight were measured.

RESULTS

Physical activity (mean steps per day) was significantly higher in 2006 than in 2000 among girls (13,788 vs. 15,141 steps per day) and boys (15,991 vs. 16,973 steps per day). The share of girls and boys to meet the preliminary weight control recommendations of 12,000 and 15,000 steps per day respectively was higher in 2006 than in 2000: 90% versus 75% (girls) and 67% versus 60% (boys).

CONCLUSION

The level of physical activity (steps per day) during school weekdays was higher in 2006 than in 2000. Enhanced focus on physical activity in society and at school might have influenced the result.

Randomised controlled trial: A parent-based group education programme for overweight children

AIM

Childhood overweight and obesity is a significant community health problem with severe long-term complications. This paper aims to evaluate a four-by-two-hour weekly group parent education programme targeting children who are overweight.

METHODS

A randomised time series design with wait-list controls was conducted for overweight and obese children aged 3-10 years.

RESULTS

A statistically significant reduction in child body mass index and energy intake was found post treatment; no differences were reported for child sedentary electronic media time, physical activity and waist circumference. Children's baseline activity levels were found to be at or slightly above national recommended standards. No change occurred in primary parent body mass index or waist circumference after treatment.

CONCLUSIONS

A brief group education programme for parents was effective in reducing childhood overweight at 3 months follow-up.

Can the impact on health of a government policy designed to create more liveable neighbourhoods be evaluated? An overview of the RESIDential Environment Project

There is growing interest in the impact of community design on the health of residents. In 1998, the Western Australian Government began a trial of new subdivision design codes (i.e. Liveable Neighbourhoods Community Design Code) aimed at creating pedestrian-friendly neighbourhoods to increase walking, cycling and public transport use. The trial provided a unique opportunity for a natural experiment to evaluate the impact of a government planning policy on residents. Nevertheless, evaluations of this kind present a number of methodological challenges in obtaining the highest quality evidence possible. This paper describes the RESIDential Environment Project's study design and discusses how various methodological challenges were overcome.

Motivational interviewing and cognitive behaviour therapy in the treatment of adolescent overweight and obesity: study design and methodology

BACKGROUND

Despite the high prevalence and negative physical and psychosocial consequences of overweight and obesity in adolescents, very little research has evaluated treatment in this population. Consequently, clinicians working with overweight and obese adolescents have little empirical research on which to base their practise. Cognitive behavioural therapy has demonstrated efficacy in promoting behaviour change in many treatment resistant disorders. Motivational interviewing has been used to increase motivation for change and improve treatment outcomes. In this paper we describe the rationale and design of a randomised controlled trial testing the efficacy of motivational interviewing and cognitive behaviour therapy in the treatment of overweight and obese adolescents.

METHODS

Participants took part in a motivational interview or a standard semi-structured assessment interview and were then randomly allocated to a cognitive behavioural intervention or a wait-list control condition. The cognitive behavioural intervention, the CHOOSE HEALTH Program, consisted of 13 individual treatment sessions (12 face-to-face, 1 phone call) followed by 9 maintenance sessions (7 phone calls, 2 face-to-face). Assessments were conducted prior to participation, after the treatment phase and after the maintenance phase of intervention. Improvement in body composition was the primary outcome; secondary outcomes included improved cardiovascular fitness, eating and physical activity habits, family and psychosocial functioning.

CONCLUSION

Despite the demonstrated effectiveness of motivational interviewing and cognitive behavioural therapy in the long-term management of many treatment resistant disorders, these approaches have been under-utilised in adolescent overweight and obesity treatment. This study provides baseline data and a thorough review of the study design and treatment approach to allow for the assessment of the efficacy of motivational interviewing and cognitive behavioural therapy in the treatment of adolescent overweight and obesity. Data obtained in this study will also provide much needed information about the behavioural and psychosocial factors associated with adolescent overweight and obesity.

What effect do attempts to lose weight have on the observed relationship between nutrition behaviors and body mass index among adolescents?

Background

Little research has given consideration to how people's weight control behaviors may moderate the relationships between nutrition and body mass index (BMI) in large cross-sectional studies. The objective of the current study is to determine how attempts to lose weight confound the relationships between nutrition behaviors and BMI among a population of predominately overweight adolescents.

Methods

Data were drawn from the baseline measurements of the Pacific OPIC (Obesity Prevention In Communities). Participants included approximately 3500 high school students in New Zealand. Students in the sample primarily identified as a Pacific Island ethnicity (57%) and the mean age for participants was 14.8 years. Participants completed a questionnaire about nutrition and physical activity patterns and were weighed and measured for height.

Results

In our sample, 57% of students were overweight/obese, with the highest prevalence among Pacific Island students (71%). Approximately 50% of students were currently trying to lose weight, and this was more common among females, Pacific Island students and overweight/obese students. Examination of the nutritional correlates of BMI in the total population found inverse relationships between BMI and consumption of high-fat/high-sugar foods and positive relationships between BMI and eating 5 or more fruits and vegetables a day (all significant after controlling for age, sex, and ethnicity). For example, students who drank the most soft drinks or ate fruit and vegetables infrequently had the lowest mean BMI. Students' attempts to change their weight significantly moderated the relationships between most nutritional behaviors and BMI. In most cases, among students not trying to change their weight, expected relationships were observed; among students trying to lose weight, unexpected or no relationships were observed.

Conclusion

Our findings suggest that among this population of predominately overweight students, solely relying on cross-sectional findings between nutrition behaviours and BMI would misinform intervention strategies. It appears that many students are already taking appropriate steps to reduce their weight. Intervention efforts should now move beyond education-based strategies to environmental changes that support students in adopting healthier nutrition practices.

Body change strategies in children: relationship to age and gender

The "Body Image and Body Change Inventory Questionnaire" was administered to 958 students, aged 8.00-13.99 years, to determine the types of strategies used by children to accomplish changes in body size/shape. Each individual strategy score was compared for each gender and with respect to age. The girls' score for food restrictive practices was significantly higher than for other body change strategies. For the boys, the score for the use of food and exercise strategies to increase muscle size was significantly higher than all other practices except exercise strategies to increase body size. Both boys and girls reported the lowest scores for food and exercise strategies to increase body weight. The variance explained by age was small and not considered biologically significant. While the findings do not demonstrate a relationship between desire to change body size/shape and age, weight concerns should not be overlooked, as both genders seem concerned with keeping their body weight low. The different practices used by each gender demonstrate that different body image ideals hold for boys and girls.

Growth pattern and prevalence of obesity in affluent schoolchildren of Delhi

OBJECTIVE

To investigate the prevalence of obesity in affluent schoolchildren of Delhi.

DESIGN

This was a cross-sectional study covering over 4000 students. Anthropometric measurements and birth weights of all the students were recorded.

SETTING AND SUBJECTS

The study was carried out in a school catering to the affluent section of Indian society and included both boys and girls in the age range 4 to 17 years.

RESULTS

The heights and weights of the children were almost similar to those of the National Center for Health Statistics standards, and were much above the values reported by the Indian National Nutrition Monitoring Bureau, which largely captures rural children belonging to lower socio-economic strata in India. Of the subjects studied, 22% were overweight and 6% were obese. Only 6% of these children had low birth weight.

CONCLUSION

The prevalence of obesity is rising among children because of their change in lifestyle. Children born with a birth weight of > or = 3 kg tended to have higher body mass index in their adolescent years and maybe consequently in their adult years. Nutrition education can play an important part in reducing the incidence of overweight/obesity and its associated complications.

The aetiology of childhood obesity: a review

Whilst the prevention of childhood obesity is the only viable, enduring, cost-effective solution to the obesity epidemic, effective methods for it remain elusive. Furthermore, strategies to influence obesogenic environments remain relatively unexplored. In order to be able to develop powerful population-level interventions and public health policies to prevent childhood obesity, it is important to understand its aetiology and those environments that are most amenable to measurable change. First, the present paper considers why we should be concerned about obesity in children, from both the perspective of the increased health risk to the individual and the high economic cost of treatment of obesity and related diseases, highlighting why the prevention of childhood obesity is important. Next, the determinants of health behaviour and the obesogenic environment are explored, which helps us to understand why the aetiology is so complex and that potential causal factors should not be considered in isolation, as the interaction between these factors is also important. The paper then considers the multi-factorial aetiology of childhood obesity and the rationale for the increasing trends in obesity that are evident, in order to understand what is changing in society and our children's behaviour that is triggering the positive energy balance leading to obesity. The review emphasises the need for multi-level approaches if we truly want to prevent childhood obesity. It also serves to highlight that there is a need to extend the current research base in order to build a well-founded framework to form the basis of a strategy for the prevention of childhood obesity.

The association of self-esteem, depression and body satisfaction with obesity among Turkish adolescents

BACKGROUND

The purpose of this study was to determine the prevalence of overweight and obesity and to examine the effects of actual weight status, perceived weight status and body satisfaction on self-esteem and depression in a high school population in Turkey.

METHODS

A cross-sectional survey of 2101 tenth-grade Turkish adolescents aged 15-18 was conducted. Body mass index (BMI) was calculated using weight and height measures. The overweight and obesity were based on the age- and gender-specific BMI cut-off points of the International Obesity Task Force values. Self-esteem was measured using the Rosenberg Self-Esteem Scale, and depression was measured using Children's Depression Inventory. Logistic regression analysis was used to examine relationships among the variables.

RESULTS

Based on BMI cut-off points, 9.0% of the students were overweight and 1.1% were obese. Logistic regression analysis indicated that (1) being male and being from a higher socio-economical level were important in the prediction of overweight based on BMI; (2) being female and being from a higher socio-economical level were important in the prediction of perceived overweight; (3) being female was important in the prediction of body dissatisfaction; (4) body dissatisfaction was related to low self-esteem and depression, perceived overweight was related only to low self-esteem but actual overweight was not related to low self-esteem and depression in adolescents.

CONCLUSION

The results of this study suggest that school-based adolescents in urban Turkey have a lower risk of overweight and obesity than adolescents in developed countries. The findings of this study suggest that psychological well-being of adolescents is more related to body satisfaction than actual and perceived weight status is.

Factors associated with adolescents' overweight and obesity at community, school and household levels in Xi'an City, China: results of hierarchical analysis

OBJECTIVE

To identify personal and environmental factors associated with adolescent overweight and obesity in Xi'an city, China.

SUBJECTS/METHODS

A total of 1804 adolescents from 30 junior high schools in six districts in Xi'an City. Community, school, household and individual characteristics were self reported by parents, school doctors and students. Factors associated with adolescent overweight and obesity were identified using a hierarchical logistic regression.

RESULTS

In all adolescents, after adjustment for age and gender, factors significantly associated with overweight and obesity were: living in urban districts (odds ratio (OR): 4.0, 95% confidence interval (CI): 2.7-6.0); limited use of school sports facilities (OR: 1.7, 95% CI: 1.1-2.6); wealthy households (OR: 1.7, 95% CI: 1.1-2.6); parental restrictions on purchasing snacks (OR: 1.5, 95% CI: 1.03-2.0); having an overweight/obese parent (OR: 1.8, 95% CI: 1.3-2.5); having soft drinks more than four times per week (OR: 1.6, 95% CI: 1.02-2.5) and not fussy about foods (OR: 1.7, 95% CI: 1.2-2.2). Eating sweets was negatively associated with overweight/obesity (OR: 0.6, 95% CI: 0.4-0.9). Separate gender analyses revealed that in boys, low physical activity (OR: 2.0, 95% CI: 1.1-3.8) and higher energy intake (OR: 1.8, 95% CI: 1.1-2.9) were also associated with overweight/obesity. In girls, less school sports meetings (OR: 2.3, 95% CI: 1.3-4.0); parental decisions about eating fast foods (OR: 1.8, 95% CI: 1.1-2.9) and availability of home video games (OR: 1.7, 95% CI: 1.1-2.5) were also significant.

CONCLUSIONS

Preventive strategies for adolescent overweight and obesity in Xi'an should address the community and school environments to reinforce behavioral change. Gender differences also need to be considered when planning interventions.

Marked increase in type 1 diabetes mellitus incidence in children aged 0-14 yr in Victoria, Australia, from 1999 to 2002

OBJECTIVES

The objectives of the study were to (i) determine the incidence of type 1 diabetes mellitus (T1DM) in children aged <15 yr in Victoria, Australia, from 1999 to 2002 and (ii) to analyze trends in incidence over this period.

METHODS

Prospective population-based incidence study. The primary source of case ascertainment was from the Australasian Paediatric Endocrine Group (APEG) Victorian diabetes register. The secondary source was the National Diabetes Register (NDR), which ascertains cases from the National Diabetes Service Scheme (NDSS), a Commonwealth government initiative, where patients register to receive diabetes supplies at a subsidized price.

MAIN OUTCOME MEASURES

Age-standardized incidence, trends in incidence by age, sex and year, and variation in incidence by region, season, and socioeconomic status.

RESULTS

Case ascertainment was 99.1% complete using the capture-recapture method. The mean annual age-standardized incidence was 19.3 per 100 000 person years from 1999 to 2002. On average, incidence increased by 9.3% per year, with a greater relative increase in the 0-4 yr age-group (p = 0.037). No gender bias in incidence was found, but the increase in females was statistically significant (13.6% per year, 95% confidence interval 3.7-24.3). Variation in geographical distribution and seasonal onset of incidence was not statistically significant.

CONCLUSIONS

The marked increase in the incidence of T1DM in Victoria is greater than that recently described in other Australia states and developed nations. The etiology of this rise is unclear, while the increased caseload has major implications for diabetes health care providers for current and future resource allocation.

Overweight in medical paediatric inpatients: detection and parent expectations

AIMS

(i) To determine prevalence and rates of detection of overweight/obesity among general paediatric inpatients. (ii) To explore parental expectations regarding detection and management of overweight/obesity during admission.

METHODS

This is a cross-sectional survey conducted in the Royal Children's Hospital, Melbourne, Australia. A total of 102 children aged 2-12 years admitted to a general paediatric unit at the Royal Children's Hospital and their parents participated in the survey. The main outcome measures are body mass index (BMI); documentation of weight, height and BMI in patient notes; parent description of child's weight, parent concern about child's weight, and parent opinion about detection and management of overweight.

RESULTS

Twelve of 102 children (11.7%, 95% confidence intervals 6.2%, 19.7%) were overweight or obese. All children had a documented weight, two children (2.0%) had a documented height and none had BMI documented. Seven of 12 parents of overweight children described their child's weight as healthy; five of 12 parents of overweight children were not concerned about their child's weight. Eight of 12 parents of overweight children believed all admitted children should have their BMI calculated. All parents thought the hospital should take action if a child was found to be overweight.

CONCLUSIONS

Although prevalence of overweight was lower than expected, documentation of overweight did not occur for any patient in the study. Parents of overweight children with acute illnesses believed that the hospital should screen for overweight and discuss it with parents. Further studies are required to determine expectations among other patient populations.

Adenotonsillar surgery in morbidly obese children: routine elective admission of all patients to the intensive care unit is unnecessary

Morbidly obese children undergoing adenotonsillectomy, often with co-morbid obstructive sleep apnoea, may be considered at a higher risk of postoperative respiratory compromise. This retrospective study aimed to assess the frequency and severity of postoperative respiratory complications in these patients and to identify preoperative risks factors for such morbidity. Medical and nursing chart review of all consecutive elective post-adenotonsillectomy admissions of morbidly obese children (defined as >95th centile for body mass index adjusted for age and gender) to our intensive care unit over a 30-month period was performed. A total of 26 morbidly obese children were identified. The majority (14/26) had an uncomplicated recovery following surgery. Of those cases that required postoperative intervention, 10 patients required supplemental oxygen with or without suctioning and/or repositioning alone, whilst two required continuous positive airway pressure therapy. No patient required re-intubation. An oxygen saturation nadir of < 70% and the presence of more than one central apnoea, noted on preoperative overnight polysomnography, were associated with postoperative respiratory complications requiring intervention. Although the intervention group were younger, more obese and had a higher respiratory disturbance index, none of these factors were statistically significant. Routine admission to the paediatric intensive care unit of all morbidly obese children undergoing adenotonsillectomy may be unnecessary, once a suitable high level of nursing is available in an alternative setting, to administer simple positional and suctioning intervention and to perform regular patient observation. Special consideration should be given to the postoperative nursing environment for those patients with a SaO2 nadir < 70% noted preoperatively, indicating the presence of a significant central disease component.

Consumption of 'extra' foods (energy-dense, nutrient-poor) among children aged 16-24 months from western Sydney, Australia

OBJECTIVE

This study evaluates the contribution of energy-dense, nutrient-poor 'extra' foods to the diets of 16-24-month-old children from western Sydney, Australia.

DESIGN

An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either 'core' or 'extras' according to the Australian Guide to Healthy Eating.

SETTING

Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants' homes at the 18-month assessment.

PARTICIPANTS

Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.

RESULTS

The mean consumption of 'extra' foods was approximately 150 g day(-1) and contributed 25-30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. 'Extra' foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of 'extra' foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of 'extra' foods was inversely associated with the intake of core foods.

CONCLUSIONS

The high percentage of energy contributed by 'extra' foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1-2 years. These preliminary data on commonly consumed 'extra' foods and portion sizes may inform age-specific dietary assessment methods.

The increasing prevalence of diabetes in South Australia: The relationship with population ageing and obesity

OBJECTIVES

To use representative population surveillance data to monitor and project changes in the prevalence of diabetes for different age and body mass index (BMI) groups.

STUDY DESIGN

Representative, annual, face-to-face South Australian Health Omnibus Surveys, 1991-2003 (n=3000 per year).

METHODS

Trends in self-reported diabetes prevalence by age group and BMI were examined. Separate projections were made on the basis of predicted changes in population demography and diabetes prevalence.

RESULTS

The age-sex standardized absolute prevalence of self-reported diabetes among people aged 15 years and over increased from 3.5% in 1991 to 6.7% in 2003. If this current trend continues, the prevalence is expected to increase to 10.5% by 2016. The prevalence of diabetes was significantly higher among those classified as obese (6.5% in 1991 to 12.2% in 2003) than those with normal BMI. The greatest relative percentage increase in prevalence between 1991 and 2003 (169%) was seen among people aged 15-39 years. Taking both age group and BMI classification into account, the greatest relative percentage increases over this time were seen among those with normal BMI aged 60 years or older (148%), and those who were obese and aged less than 60 years (139%).

CONCLUSIONS

The prevalence of diabetes and obesity increased significantly between 1991 and 2003. Population ageing and an increase in diabetes prevalence in the future will further increase the burden of diabetes. Future increases in diabetes prevalence are not inevitable, however, if investments are made in public health prevention programmes, particularly those addressing obesity.

Total body protein in healthy adolescent girls: validation of estimates derived from simpler measures with neutron activation analysis

BACKGROUND

Little recent and accurate information about body protein content in healthy adolescent girls is available.

OBJECTIVE

The objective was to assess the total body nitrogen (TBN) and total body protein (TBPr) contents of fat-free mass (P:FFM) in a group of healthy adolescent girls and to validate previously published TBN prediction equations.

DESIGN

TBN was measured with in vivo neutron activation analysis (TBNNAA). Bone mineral density and FFM were measured with dual-energy X-ray absorptiometry (FFMDXA), total body water and FFM were measured with bioimpedance analysis, and FFM was assessed by measuring skinfold thicknesses in 51 girls with a mean (+/- SD) age of 14.7 +/- 0.7 y. The validity of the TBN prediction equations was assessed with Bland-Altman analysis.

RESULTS

TBNNAA in our adolescent group was higher (1.49 kg) than values reported in earlier studies of women (1.25 and 1.31 kg), and P:FFM was slightly higher (23%) than that documented in adults (19-21%). Previously published TBN equations showed either systematic bias or wide limits of agreement.

CONCLUSION

A predictive equation derived from the present study population based on FFMDXA improves the prediction of TBN for groups of young girls but may not be helpful for individuals in clinical settings.

Dietary intake, physical activity and TV viewing as mediators of the association of socioeconomic status with body composition: a cross-sectional analysis of Australian youth

BACKGROUND

There is emerging evidence of socioeconomic gradients in adiposity among Australian youth. Behavioral mechanisms for these trends are unexplained.

METHODS

In total, 194 South Australian children (97 boys, 11.48+/-0.43 years; 97 girls, 11.60+/-0.38 years) were assessed for pubertal status, stature, weight, skinfolds and waist girth. Socioeconomic status (SES) was represented by postcode of residence (Socioeconomic Index for Areas) and parent education. Children reported moderate-to-vigorous physical activity (MVPA), TV viewing (TV) and dietary intake (daily energy intake as a ratio of predicted basal metabolic rate (DEI/BMR); and fat intake), using three x 24 h recall. Path analysis (partial least-squared method) was used to analyze the independence and interdependence of pathways linking SES, anthropometric variables and measured behaviors.

RESULTS

SES was negatively associated with waist girth and skinfolds in girls, and waist girth in boys. In models including behavioral variables, these SES gradients in girls were largely unattenuated; accordingly, physical activity and dietary intake were not confirmed as mediators of the association of SES and girls' adiposity. In boys there was evidence that the negative relationship between SES and waist girth was mediated by fat intake.

CONCLUSIONS

The inverse relationships between SES and girls' adiposity were unexplained by the behavioral attributes measured in this study. Mediators of SES gradients in youth adiposity remain elusive, and may require intensive methodologies to explicate.

Overweight, obesity and girth of Australian preschoolers: prevalence and socio-economic correlates

OBJECTIVE

(1) To determine the prevalence of overweight and obesity in Australian 4-5-year-old children. (2) To investigate associations between socio-economic characteristics and (a) overweight/obesity and (b) waist circumference.

DESIGN

Cross-sectional population survey.

SETTING

Wave 1 (2004) of the Longitudinal Study of Australian Children.

PARTICIPANTS

Nationally representative sample of 4983 4-5-year-old children (2537 boys and 2446 girls; mean age 56.9 months (s.d. 2.64 months; range 51-67 months)).

MAIN OUTCOME MEASURES

Prevalence of overweight and obesity (International Obesity TaskForce definitions) and waist circumference (cm).

ANALYSIS

Prevalence estimates were obtained as weighted percentages. Uni- and multivariable ordinal logistic regression (using the proportional odds model) were used to assess associations between potential predictors and the risk of higher child body mass index status and a multivariable linear regression model to assess relationships between the same potential predictors and waist circumference.

RESULTS

15.2% of Australian preschoolers are estimated to be overweight and 5.5% obese. In univariate analyses, seven of the 12 variables were associated with higher odds of being in a heavier body mass index category. In a multivariable regression model, speaking a language other than English (particularly for boys), indigenous status and lower disadvantage quintile were the clearest independent predictors of higher body mass index status, with children in the lowest quintile of social disadvantage having 47% higher odds (95% CI 14, 92%) of being in a heavier body mass index category compared to those in the highest quintile. Waist circumference was not related to any socio-economic variable.

CONCLUSIONS

This nationally representative survey confirms high rates of overweight and obesity in preschoolers throughout Australia. The recent emergence of a substantial socio-economic gradient should bring new urgency to public health measures to combat the obesity epidemic.

Consumption of ‘extra’ foods (energy-dense, nutrient-poor) among children aged 16–24 months from western Sydney, Australia

Objective

This study evaluates the contribution of energy-dense, nutrient-poor ‘extra’ foods to the diets of 16–24-month-old children from western Sydney, Australia.

Design

An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either ‘core’ or ‘extras’ according to theAustralian Guide to Healthy Eating.

Setting

Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants’ homes at the 18-month assessment.

Participants

Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.

Results

The mean consumption of ‘extra’ foods was ∼150 g day− 1and contributed 25–30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. ‘Extra’ foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of ‘extra’ foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of ‘extra’ foods was inversely associated with the intake of core foods.

Conclusions

The high percentage of energy contributed by ‘extra’ foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1–2 years. These preliminary data on commonly consumed ‘extra’ foods and portion sizes may inform age-specific dietary assessment methods.

Natural history and risk factors for microalbuminuria in adolescents with type 1 diabetes: a longitudinal study

OBJECTIVE

To describe the natural history and risk factors for persistent microalbuminuria in children and adolescents with type 1 diabetes followed for up to 15 years.

RESEARCH DESIGN AND METHODS

This study contained a longitudinal cohort of 972 patients; analysis of baseline risk factors was performed using logistic regression and predictors over time using survival analysis. Albumin excretion rate was measured on three consecutive timed overnight urine collections on at least two occasions. Normoalbuminuria was defined as a median albumin excretion rate < 7.5 microg/min, borderline microalbuminuria as 7.5-20 microg/min, and microalbuminuria as 20-200 microg/min. Microalbuminuria was further classified as persistent if its duration was >12 months. Median age was 12.7 years (interquartile range 11.5-14.4) and diabetes duration 6.5 years (4.1-9.3) at first assessment, and median follow-up was 6.2 years (range 1-15.3).

RESULTS

The incidence of persistent microalbuminuria was 4.6 (95% CI 3.3-6.1) per 1,000 patient-years. Predictors of persistent microalbuminuria from the first assessment using multiple logistic regression were high cholesterol (odds ratio 2.2 [95% CI 1.2-4.0]) and borderline microalbuminuria (2.5 [1.2-5.2]). Predictors using Cox regression were HbA(1c) (hazard ratio 1.4 [95% CI 1.1-1.7]), age at diagnosis (1.2 [1.1-1.3]), obesity (3.6 [0.8-15.5]), and insulin dose (2.7 [1.0-7.5]).

CONCLUSIONS

Children and adolescents with type 1 diabetes who have borderline microalbuminuria are more than twice as likely to develop persistent microalbuminuria. In addition to poor glycemic control, clinical markers of insulin resistance were associated with an increased risk of microalbuminuria.

New drug policy in childhood obesity

OBJECTIVE

To update physicians, especially paediatricians, in the rapidly developing field of pharmacotherapy of childhood and adolescent obesity.

METHODS

The paper reviews current and investigational antiobesity drugs.

RESULTS

At present, there are only few drugs approved by the Food and Drug Administration (FDA) for the treatment of adult obesity. The most important ones are sibutramine and orlistat. The FDA in the USA approved the latter drug in 2003, and it has recently been approved by the European Union for the treatment of adolescents. There are several investigational antiobesity agents but only few new and promising substances like Rimonabant (a cannabinoid receptor antagonist) and axokine (ciliary neutrotrophic factor) are already at an advanced stage of development.

CONCLUSION

In adults, it seems to be justified using drugs for long-term treatment of 'medically important' obesity. Strict guidelines concerning the treatment of obese adolescents with orlistat are needed. It is only hoped that double-blind placebo-controlled studies investigating the new and promising drugs will also include adolescents and provide sufficient scientific data to get them licensed for the treatment of obese adolescents.

Prevalence of obesity, overweight, and underweight in Qatari adolescents

BACKGROUND

Overweight and obesity have reached epidemic proportions in Arabian oil-rich countries and are threatening to become a global epidemic. Excess weight has a great impact on the health and quality of life of individuals. However, prevalence of underweight in the developing world has shown a decline during the last decade.

OBJECTIVE

The aim of this cross-sectional study was to determine the prevalence of underweight, overweight, and obesity, as measured by body-mass index, in a representative sample of adolescents aged 12 to 17 years in the State of Qatar.

METHODS

Qatari schoolchildren (n = 3,923) from 30 schools in urban and semiurban districts responded to a sociodemographic questionnaire. Body-mass index was calculated and the prevalence of overweight and obesity was determined on the basis of cutoff points of the International Obesity Task Force (IOTF) values (above the 85th and 95th percentiles, respectively, for overweight and obesity). Underweight was defined on the basis of CDC (Centers for Disease Control and Prevention) less than 5th percentile of BMI for age.

RESULTS

The final sample consisted of 1,968 boys and 1,955 girls. The prevalence of underweight, overweight, and obesity was 8.6%, 28.6%, and 7.9%, respectively, among adolescent boys and 5.8%, 18.9%, and 4.7% among girls. The prevalence of underweight was highest at 16 years of age among boys (10.5%) and at 17 years among girls (8.9%). The prevalence of obesity was highest at 12 years of age among boys (11.7%) and at 13 years among girls (6.4%). The 95th percentile curve for boys was above the IOTF standard curve; the 95th percentile curve for girls was below the IOTF curve.

CONCLUSIONS

Adolescents living in the State of Qatar are at high risk for overweight and obesity. There is a need to establish a national program for the prevention and treatment of obesity and related complications.

Breastfeeding and obesity at 14 years: a cohort study

AIM

To determine the influence of breastfeeding on overweight and obesity in early adolescence.

METHODS

Data about breastfeeding duration, BMI of children at 14 years, and confounding variables, were collected from an ongoing longitudinal study of a birth cohort of 7776 children in Brisbane. Prevalence of overweight and obesity at 14 years was assessed according to duration of breastfeeding, with logistic regression being used to adjust for the influence of confounders.

RESULTS

Data were available for 3698 children, and those not included were significantly different in age, educational level, income, race, birthweight, and small-for-gestational-age status. Breastfeeding for longer than six months was protective of obesity (OR 0.6, 95% CI 0.4, 0.96) though not of overweight. When confounding variables were considered the effect size diminished and lost statistical significance OR 0.8 (95% CI 0.5, 1.3). Breastfeeding for less than 6 months had no effect on either obesity or overweight though a trend was found for increased prevalence of overweight at 14 years with shorter periods of breastfeeding.

CONCLUSION

This investigation contributes to the gathering body of evidence that breastfeeding for longer than 6 months has a modest protective effect against obesity in adolescence.

The impact of childhood obesity on musculoskeletal form

Despite the greater prevalence of musculoskeletal disorders in obese adults, the consequences of childhood obesity on the development and function of the musculoskeletal system have received comparatively little attention within the literature. Of the limited number of studies performed to date, the majority have focused on the impact of childhood obesity on skeletal structure and alignment, and to a lesser extent its influence on clinical tests of motor performance including muscular strength, balance and locomotion. Although collectively these studies imply that the functional and structural limitations imposed by obesity may result in aberrant lower limb mechanics and the potential for musculoskeletal injury, empirical verification is currently lacking. The delineation of the effects of childhood obesity on musculoskeletal structure in terms of mass, adiposity, anthropometry, metabolic effects and physical inactivity, or their combination, has not been established. More specifically, there is a lack of research regarding the effect of childhood obesity on the properties of connective tissue structures, such as tendons and ligaments. Given the global increase in childhood obesity, there is a need to ascertain the consequences of persistent obesity on musculoskeletal structure and function. A better understanding of the implications of childhood obesity on the development and function of the musculoskeletal system would assist in the provision of more meaningful support in the prevention, treatment and management of the musculoskeletal consequences of the condition.

7. Sport for special groups

Sports participation among children is declining. Sport and physical activity are important in childhood for optimising bone mass and reducing obesity and insulin resistance. Physical activity reduces cardiovascular risk factors in adults, and can improve survival in patients with cardiac failure. Musculoskeletal injury is the most common complication of sports participation in adults - not cardiac events. Some of the decline in function which occurs with ageing can be positively affected by regular physical activity.

Obesity in South Australian adults--prevalence, projections and generational assessment over 13 years

OBJECTIVES

To examine the trend in obesity prevalence using annual representative cross-sectional samples of the South Australian population, to project the increase of obesity using current trends, and to examine the increase in prevalence by generational assessment.

METHODS

Face-to-face interviews of representative population samples of people aged 18 years and over living in South Australia from 1991 to 1998 and again in 2001 and 2003. Information on height and weight was provided by participants, in order to calculate body mass index (BMI) as a measure of obesity.

RESULTS

The proportion of respondents classified as obese according to their self-reported body mass index (BMI > or = 30 to <35) increased significantly from 8.7% in 1991 to 14.1% in 2003 (chi2 trend=79.4, p<0.001). Severe obesity (BMI > or = 35) increased significantly from 2.6% in 1991 to 5.3% in 2003 (chi2 trend=50.4, p<0.001). Current prevalence trends indicate that by 2013, the self-reported prevalence of obesity in South Australian adults will be 27.8%, with the prevalence in males being 26.4% and in females, 29.3%. Secular obesity trends indicate that younger birth cohorts had the greatest percentage increases.

CONCLUSIONS

Obesity has increased significantly between 1991 and 2003, and is increasing fastest among younger adults. Multifactorial interventions at all levels of the population are required to prevent overweight and obesity and promote weight maintenance, weight loss and address the health burden of obesity.

Retinal vessel diameters and obesity: a population-based study in older persons

OBJECTIVE

Obesity is linked with large vessel atherosclerosis and diabetes. Its association with microvascular changes is less clear. We investigated the associations among retinal vessel diameters, vessel wall signs, and BMI in an older population.

RESEARCH METHODS AND PROCEDURES

Retinal photographs were taken on 3654 persons aged 49+ years at baseline of the Blue Mountains Eye Study in Australia. Arteriolar and venular diameters were measured from digitized retinal photographs of the right eyes. BMI was calculated as weight (kilograms)/height (meters2). Incident obesity was defined in persons with BMI < or = 30 at baseline but > 30 after 5 years. A significant weight gain was defined as an increase in BMI of 2+ SDs (4 or more units) over the 5-year period.

RESULTS

At baseline, mean BMI was 26.1 (+/-4.6) in this population. At 5-year examinations, 177 (10.0% of 1773 at risk) developed incident obesity, and 136 (6.4% of 2143 at risk) had significant weight gain. After adjusting for age, sex, smoking, triglyceride levels, and mean arterial blood pressure, persons with wider retinal venular diameters had a higher risk of incident obesity (odds ratio, 1.8; 95% confidence interval, 1.0 to 3.1, comparing the highest with lowest venular diameter quintiles) and significant weight gain (odds ratio, 1.7; 95% confidence interval, 0.9 to 3.2). These associations were attenuated with further adjustment for baseline BMI. Arteriolar diameter was unrelated with baseline or change in BMI.

DISCUSSION

Wider retinal venular diameter is associated with risk of obesity, independent of hypertension, diabetes, lipids, and cigarette smoking. These data may support a role for impaired microvascular function in the course of weight gain.

Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations

Childhood obesity is a global epidemic and rising trends in overweight and obesity are apparent in both developed and developing countries. Available estimates for the period between the 1980s and 1990s show the prevalence of overweight and obesity in children increased by a magnitude of two to five times in developed countries (e.g. from 11% to over 30% in boys in Canada), and up to almost four times in developing countries (e.g. from 4% to 14% in Brazil). The goal of this synthesis research study was to develop best practice recommendations based on a systematic approach to finding, selecting and critically appraising programmes addressing prevention and treatment of childhood obesity and related risk of chronic diseases. An international panel of experts in areas of relevance to obesity provided guidance for the study. This synthesis research encompassed a comprehensive search of medical/academic and grey literature and the Internet covering the years 1982-2003. The appraisal approach developed to identify best practice was unique, in that it considered not only methodological rigour, but also population health, immigrant health and programme development/evaluation perspectives in the assessment. Scores were generated based on pre-determined criteria with programmes scoring in the top tertile of the scoring range in any one of the four appraisal categories included for further examination. The synthesis process included identification of gaps and an analysis and summary of programme development and programme effectiveness to enable conclusions to be drawn and recommendations to be made. The results from the library database searches (13,158 hits), the Internet search and key informant surveys were reduced to a review of 982 reports of which 500 were selected for critical appraisal. In total 158 articles, representing 147 programmes, were included for further analysis. The majority of reports were included based on high appraisal scores in programme development and evaluation with limited numbers eligible based on scores in other categories of appraisal. While no single programme emerged as a model of best practice, synthesis of included programmes provided rich information on elements that represent innovative rather than best practice under particular circumstances that are dynamic (changing according to population subgroups, age, ethnicity, setting, leadership, etc.). Thus the findings of this synthesis review identifies areas for action, opportunities for programme development and research priorities to inform the development of best practice recommendations that will reduce obesity and chronic disease risk in children and youth. A lack of programming to address the particular needs of subgroups of children and youth emerged in this review. Although immigrants new to developed countries may be more vulnerable to the obesogenic environment, no programmes were identified that specifically targeted their potentially specialized needs (e.g. different food supply in a new country). Children 0-6 years of age and males represented other population subgroups where obesity prevention programmes and evidence of effectiveness were limited. These gaps are of concern because (i) the pre-school years may be a critical period for obesity prevention as indicated by the association of the adiposity rebound and obesity in later years; and (ii) although the growing prevalence of obesity affects males and females equally; males may be more vulnerable to associated health risks such as cardiovascular disease. Other gaps in knowledge identified during synthesis include a limited number of interventions in home and community settings and a lack of upstream population-based interventions. The shortage of programmes in community and home settings limits our understanding of the effectiveness of interventions in these environments, while the lack of upstream investment indicates an opportunity to develop more upstream and population-focused interventions to balance and extend the current emphasis on individual-based programmes. The evidence reviewed indicates that current programmes lead to short-term improvements in outcomes relating to obesity and chronic disease prevention with no adverse effects noted. This supports the continuation and further development of programmes currently directed at children and youth, as further evidence for best practice accumulates. In this synthesis, schools were found to be a critical setting for programming where health status indicators, such as body composition, chronic disease risk factors and fitness, can all be positively impacted. Engagement in physical activity emerged as a critical intervention in obesity prevention and reduction programmes. While many programmes in the review had the potential to integrate chronic disease prevention, few did; therefore efforts could be directed towards better integration of chronic disease prevention programmes to minimize duplication and optimize resources. Programmes require sustained long-term resources to facilitate comprehensive evaluation that will ascertain if long-term impact such as sustained normal weight is maintained. Furthermore, involving stakeholders in programme design, implementation and evaluation could be crucial to the success of interventions, helping to ensure that needs are met. A number of methodological issues related to the assessment of obesity intervention and prevention programmes were identified and offer insight into how research protocols can be enhanced to strengthen evidence for obesity interventions. Further research is required to understand the merits of the various forms in which interventions (singly and in combination) are delivered and in which circumstances they are effective. There is a critical need for the development of consistent indicators to ensure that comparisons of programme outcomes can be made to better inform best practice.

Obesity in children and adolescents with acquired brain injury

OBJECTIVES

To measure the prevalence of obesity and to assess associated clinical factors in children and adolescents with acquired brain injury (ABI).

STUDY DESIGN

This cross-sectional study included 88 subjects aged between 2.4-17.7 years attending the Brain Injury Clinic at a tertiary paediatric hospital. Body mass index (BMI) and BMI z-scores were calculated. Obesity and overweight were defined using the International Obesity Taskforce cut-points. Associations were examined between BMI z-scores and the following: ABI severity, mobility level, duration from injury and presence of radiological injury.

RESULTS

The prevalence of obesity in this population (obese = 15%) was higher than those in Australian children and adolescents (1995 National Nutrition Survey) while the prevalence of overweight (19.3%) was comparable. There was a linear trend for the participants to have a higher BMI z-score with increasing level of mobility (F = 6.91, df 1.70, p = 0.011).

CONCLUSION

There is no data about obesity in children and adolescents with ABI. The study with limited statistical power suggests that obesity is prevalent in this population and increases with increasing level of mobility. Further studies are required to address the issue of obesity and related complications in this population.

Obesity, weight loss and bariatric surgery

Obesity is shaping up to be the major health care problem and one of the most frequent causes of preventable death in Western countries in the 21st century. Bariatric surgery is the only current treatment that has been shown to achieve major and durable weight loss. Major weight loss in the severely obese leads to total or partial control of a wide range of common and serious diseases, such as diabetes, heart disease and hypertension. Laparoscopic adjustable gastric banding is the most common type of obesity surgery performed in Australia. It is effective, relatively safe and minimally invasive. The blocks to broader application of bariatric surgery should be identified and resolved.

Can Australian general practitioners tackle childhood overweight/obesity? Methods and processes from the LEAP (Live, Eat and Play) randomized controlled trial

BACKGROUND

General practitioners (GPs) could make an important contribution to management of childhood overweight. However, there are no efficacy data to support this, and the feasibility of this approach is unknown.

OBJECTIVES

To determine if GPs and families can be recruited to a randomized controlled trial (RCT), and if GPs can successfully deliver an intervention to families with overweight/obese 5- to 9-year-old children.

METHODS

A convenience sample of 34 GPs from 29 family medical practices attended training sessions on management of childhood overweight. Practice staff trained in child anthropometry conducted a cross-sectional body mass index (BMI) survey of 5- to 9-year-old children attending these practices. The intervention focused on achievable goals in nutrition, physical activity and sedentary behaviour, and was delivered in four solution-focused behaviour change consultations over 12 weeks.

RESULTS

General practitioners were recruited from across the sociodemographic spectrum. All attended at least two of the three education sessions and were retained throughout the trial. Practice staff weighed and measured 2112 children in the BMI survey, of whom 28% were overweight/obese (17.5% overweight, 10.5% obese), with children drawn from all sociodemographic quintiles. Of the eligible overweight/obese children, 163 (40%) were recruited and retained in the LEAP RCT; 96% of intervention families attended at least their first consultation.

CONCLUSIONS

Many families are willing to tackle childhood overweight with their GP. In addition, GPs and families can participate successfully in the careful trials that are needed to determine whether an individualized, family-based primary care approach is beneficial, harmful or ineffective.

Prevalence of obesity in Australia

Australia is a large country approximately equal in area to mainland United States. The relatively small population of around 20 million are composed primarily of Caucasians. Extensive immigration from many different countries has made Australia one of the most culturally diverse populations in the world. Indigenous Australians make up only 2.4% of the total population. Australia has a prosperous Western-style capitalist economy, and spends approximately 830 million dollars on the direct health care costs of obesity. For Australians, it is now more common to have a weight problem, with overweight affecting 48% of men and 30% of women and obesity affecting a further 19% of men and 22% of women. This paper reports on recent epidemiological studies documenting the extent of overweight and obesity in adults and children in Australia.

Methods of the NSW Schools Physical Activity and Nutrition Survey (SPANS)

The NSW Schools Physical Activity and Nutrition Survey (SPANS 2004) (N = 5407) was a representative population survey, conducted February-May 2004, among New South Wales (Australia) school students aged 4 y-16 y. Physical activity, fitness, fundamental movement skill proficiency and food habits are all related to overweight and obesity and were a focus of this study. The last population-based survey in NSW was conducted in 1997 and use of the same measurement instruments (with the exception of food habits) allowed examination of secular trends. Overweight and obese children are at risk for a number of serious, long-term health problems, and a sub-sample (n = 500) of urban dwelling Year 10 students (mean age 15.4 years) gave a fasting blood sample which was analysed for the presence of risk factors for the metabolic syndrome. This paper describes the methods of the NSW Schools Physical Activity and Nutrition Survey 2004 (SPANS 2004).

Precocious pubarche is associated with SGA, prematurity, weight gain, and obesity

BACKGROUND

Perinatal stress is thought to underlie the Barker sequelae of low birth weight, of which precocious pubarche may be a manifestation.

AIMS

To explore whether prematurity as well as smallness for gestational age (SGA) predisposes to precocious pubarche, and the potential role of excess weight gain during childhood.

METHODS

Retrospective chart review of 89 children (79 girls) with precocious pubarche.

RESULTS

Sixty five per cent were overweight/obese at diagnosis, compared with 19-24% of Australian children. Thirty five per cent had a history of SGA and 24% of prematurity. Weight SDS increased from birth to diagnosis in 91% of children. The mean change in weight SDS from birth to diagnosis was greater in those who were SGA (2.8, 95% CI 2.2 to 3.4) versus AGA (1.7, 95% CI 1.3 to 2.2), with no difference in the incidence of overweight/obesity. The latter was lower among children born premature (40% versus 72% term) but was associated with a mean increase in weight of 1.3 SDS during childhood. Nine out of ten girls and boys with precocious pubarche had at least one of the three risk factors studied.

CONCLUSIONS

Both prematurity and SGA were associated with precocious pubarche, as was overweight/obesity, irrespective of size or gestation at birth. Excess weight gain in childhood may predispose to precocious pubarche in susceptible individuals.