Ethnic issues in the epidemiology of childhood obesity

Counseling Latina mothers of preschool children about weight issues: suggestions for a new framework

OBJECTIVE

To assess Latina mothers' health beliefs and attitudes regarding early childhood weight issues and to use the information to update current nutrition education methods.

DESIGN

Data were collected in eight focus group sessions using a semistructured questionnaire.

SUBJECTS/SETTING

Forty-three Latina mothers (and grandmothers) with children aged 2 to 5 years were recruited at five different Special Supplemental Nutrition Program for Women, Infants, and Children sites in California.

ANALYSIS

Transcripts of focus groups were imported into QSR NUD*IST software, facilitating in-depth iterative analysis of emergent themes.

RESULTS

Fifteen emergent themes were identified and organized into four functional domains relevant to nutrition education: health beliefs surrounding weight, impact and cause of overweight, life values and concerns, and strategies for making changes in children's eating and activity patterns. Information from this qualitative study demonstrates that the traditional nutrition counseling paradigm may not be effective with Latina mothers. In addition, cultural beliefs can be barriers to successful prevention and treatment of overweight. To ensure that culturally competent services are provided, educators must be prepared to adjust education approaches according to the cultural background of the clients. Key among the issues was mothers' difficulty acknowledging overweight among their children and their perception that health and weight were poorly associated. Certain cultural values were identified as barriers to adopting healthful behaviors. Mothers were able to identify specific ways in which nutrition education could be improved.

APPLICATIONS/CONCLUSIONS

Our findings suggest that nutrition education efforts targeting Latina mothers of young children can be reframed to better address the belief system and cultural framework of the population, like identifying positive eating behaviors rather than focusing on a child's weight.

Changes in body mass index in 11-12-year-old children in Hawkes Bay, New Zealand (1989-2000)

OBJECTIVE

To describe and compare the body mass index (BMI; weight/height2) profile of 11-12-year-old children in Hawkes Bay, New Zealand in 1989 and 2000. To subsequently determine the prevalence of overweight and obesity at the two time points using international definitions.

METHODOLOGY

As part of asthma prevalence studies in Hawkes Bay data on height, weight and ethnicity were collected from 871 school children in 1989, and 894 children in 2000 who reached 12 years of age during the year of testing.

RESULTS

In the total study population the geometric mean BMI increased from 18.1 kg/m2 (95% CI 17.9; 18.3) in 1989 to 19.8 kg/m2 (95% CI 19.6; 20.0) in 2000, a relative increase of 9.2% (95% CI 7.6; 10.9), P < 0.001. Significant relative increases were found for males (9.0%: 95% CI 6.8; 11.3), females (9.3%: 95% CI 6.8; 11.8), Maori (7.6%: 95% CI 4.3; 11.1), European (9.1%: 95% CI 7.3; 11.0) and Pacific Island children (11.0%: 95% CI 2.2; 20.5). In 2000 20.9% of Hawkes Bay children were classified as overweight and 9.1% as obese. The risk of being overweight in 2000 was 2.2 times greater than the risk in 1989, and the risk of being obese was 3.8 times greater, with these problems more pronounced among Maori (overweight 24.7%, obese 15.3%) and Pacific Island (overweight 35.0%, obese 15.0%) than European (overweight: 18.2%, obese 5.7%) children. However, the risk of being overweight (RR = 3.0, 95% CI 2.2-4.0) or obese (RR = 8.3, 95% CI 3.0-23.3) in 2000 compared to 1989 was greater among European children.

CONCLUSION

Higher percentages of Maori and Pacific Island children are overweight or obese compared to European, but in all ethnic groups there has been a statistically significant increase in mean BMI over an 11-year period. This increase reflects the trend observed in other developed countries and underlines childhood obesity as a major health problem in New Zealand.

Longitudinal study of skipping breakfast and weight change in adolescents

BACKGROUND

Several cross-sectional studies reported that heavier children eat breakfast less often. However, no longitudinal studies have addressed whether skipping breakfast leads to excessive weight gain.

OBJECTIVE

To investigate whether skipping breakfast was prospectively associated with changes in body fatness.

METHODS

A cohort of >14000 boys and girls from all over the US, 9- to 14-y-old in 1996, returned annual mailed questionnaires (1996-1999) for the Growing Up Today Study. We analyzed change in body mass index (BMI; kg/m(2)) over three 1-y periods among children who reported breakfast frequency.

RESULTS

Children who reported that they never eat breakfast had lower energy intakes than those who eat breakfast nearly every day. Children who were more physically active reported higher energy intakes, as did those who reported more time watching television/videos and playing videogames. Like previous studies, skipping breakfast was associated with overweight, cross-sectionally. However, overweight children who never ate breakfast lost BMI over the following year compared to overweight children who ate breakfast nearly every day (boys: -0.66 kg/m(2) (s.e.=0.22); girls: -0.50 kg/m(2) (s.e.=0.14)). But normal weight children who never ate breakfast gained weight relative to peers who ate breakfast nearly every day (boys: +0.21 kg/m(2) (s.e.=0.13); girls: +0.08 kg/m(2) (s.e.=0.05)). Breakfast frequency was positively correlated with self-reported quality of schoolwork.

CONCLUSIONS

Overweight children who never eat breakfast may lose body fat, but normal weight children do not. Since numerous studies link skipping breakfast to poorer academics, children should be encouraged to eat breakfast.

Obesity and hunger among Mexican-Indian migrant children on the US-Mexico border

BACKGROUND

Although Mexican-Indian migrant workers live under precarious conditions in both Mexico and the USA, they have more access to food than they did in their original communities. The nutritional status and food security among the children of these workers have not been reported.

OBJECTIVE

The purpose of this study was to assess the prevalence of overweight, obesity, undernutrition and hunger among migrant children in a city on the US-Mexico border.

DESIGN

During 2001-2002, a total of 1767 children from six schools from the Tijuana Indian school system was measured to assess anthropometric status. Third and fifth grade children were also interviewed for their perception of hunger experience and dietary intake by 24-h recall method.

RESULTS

The overall prevalence of overweight and obesity was 38%. Abdominal obesity was found in 26% of subjects, while 43% had both obesity and abdominal obesity. The prevalence of undernutrition according to weight-for-age was 1.2%, and by height-for-age it was 4.8%. The prevalence of hunger was 2.5%, and at risk of hunger was 44%. Daily intake of food groups in servings was: 8.7 grains, 1.2 fruit, 1.0 vegetable, 2.1 milk and 2.6 meat. Only one child (0.07%) consumed The Apple of Health recommended portions.

CONCLUSIONS

This study confirmed the coexistence of obesity, hunger, undernutrition and limited food group consumption among Indian children living in a prosperous and the largest US-Mexico border city.

Biocultural aspects of obesity in young Mexican schoolchildren

Obesity related to over-nutrition is investigated in a sample of 219 Mexican children from affluent families, ages 6-12 years. Defined as weight-for-age at or above the 95(th) percentile, obesity rates in middle childhood are very high in this population, being 24.2% of children (29.4% of boys and 19.1% of girls). Binary logistic regression shows that children are more likely to be obese if they are boys, from small households with few or no other children, and have more permissive, less authoritarian parents. Diet at school and activity patterns, including television viewing, are not different for boys and girls and so do not explain this gender variation. The value placed on children, especially sons, in smaller middle-class families, can result in indulgent feeding because food treats are a cultural index of parental caring. Parents also value child fatness as a sign of health. These obese Mexican children have no greater social problems (peer rejection or stigma) or psychological problems (anxiety, depression, or low self esteem) than their non-obese peers. More study specifically focused on feeding practices in the home environment is required to explain very high rates of child obesity. The differences in obesity risk related to specific aspects of children's developmental microniche emphasize the importance of including a focus on gender as a socio-ecological construct in human biological studies of child growth, development, and nutrition.

Identification of persons at high risk for kidney disease via targeted screening: the NKF Kidney Early Evaluation Program

BACKGROUND

More than 340,000 individuals were receiving renal replacement therapy in the United States at the end of 1999; this number is projected to double by the year 2010. Almost half had a primary diagnosis of diabetes mellitus particularly type 2, and more than one quarter a primary diagnosis of hypertension. Studies have demonstrated effective maneuvers to prevent or delay the rate of progression of kidney disease, and decrease morbidity and mortality. The objective of early diagnosis is early detection of asymptomatic disease at a time when intervention has a reasonable potential to have a positive impact on outcome.

METHODS

In 1997, the National Kidney Foundation launched KEEP trade mark (Kidney Early Evaluation Program), a free community-based screening that targets first order relatives of persons with hypertension, diabetes or kidney disease, and those with a personal history of diabetes or hypertension.

RESULTS

Of the 889 individuals screened in the pilot study, 71.4% had at least one abnormality. The program includes an educational component and referral to a physician for follow-up of abnormal values.

CONCLUSIONS

Targeted screenings are an effective means of identifying persons at risk for kidney disease, and can identify individuals at risk early enough in the course of their disease to allow for effective intervention.

Familial concordance of dietary fat practices and intake

This study examined parent and child dietary fat practices and child dietary fat intake. High- and low-fat practices and percentage of kilocalories from fat were obtained from food records completed by 132 students in the 4th to 6th grades. Parents completed three scales: meat modifications (MMOD); fat substitutions (FSUB); and fruit, juice, and vegetable practices (FJVP). A parent low-fat practices (PLFP) scale was created with the items matching the child low-fat practices (LFPs). Parent PLFP, FSUB, and FJVP were significantly correlated with child LFPs. Parent LFP was a significant predictor of child LFP. Family intervention programs targeting dietary fat behaviors should encourage use of low-fat dietary behaviors.