Active healthy living: prevention of childhood obesity through increased physical activity

Effect of school-based physical activity interventions on body mass index in children: a meta-analysis

BACKGROUND

The prevalence of childhood obesity is increasing at an alarming rate. Many local governments have enacted policies to increase physical activity in schools as a way to combat childhood obesity. We conducted a systematic review and meta-analysis to determine the effect of school-based physical activity interventions on body mass index (BMI) in children.

METHODS

We searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials up to September 2008. We also hand-searched relevant journals and article reference lists. We included randomized controlled trials and controlled clinical trials that had objective data for BMI from before and after the intervention, that involved school-based physical activity interventions and that lasted for a minimum of 6 months.

RESULTS

Of 398 potentially relevant articles that we identified, 18 studies involving 18 141 children met the inclusion criteria. The participants were primarily elementary school children. The study duration ranged from 6 months to 3 years. In 15 of these 18 studies, there was some type of co-intervention. Meta-analysis showed that BMI did not improve with physical activity interventions (weighted mean difference -0.05 kg/m(2), 95% confidence interval -0.19 to 0.10). We found no consistent changes in other measures of body composition.

INTERPRETATION

School-based physical activity interventions did not improve BMI, although they had other beneficial health effects. Current population-based policies that mandate increased physical activity in schools are unlikely to have a significant effect on the increasing prevalence of childhood obesity.

Examining attendance, academic performance, and behavior in obese adolescents

Although academics and safety continue to rank as high-priority issues in public schools, educators and administrators are beginning to recognize the importance of student health on school success. This move toward a holistic approach suggests that efforts to improve a student's physical, social, and emotional well-being are as important as efforts to increase test scores. Adolescent obesity is epidemic, and it is a complex integration of social, psychological, and physical factors that exacerbate the turbulent transitional years of adolescence. Adolescents are vulnerable to issues related to weight, and they are at risk for suffering obesity's negative effects, thereby resulting in unfortunate school outcomes such as decreased rates of attendance, poor academic performance, and school suspensions. Disparities related to overweight and obesity exist; therefore, the negative effects of obesity may disproportionately affect minorities and poor schoolchildren. Examining school outcomes for the overweight or obese adolescent is crucial and may provide valuable insight into constructive changes required for a responsive school environment.

Diet and physical activity patterns of school-aged children

Childhood provides an opportunity for establishing healthful lifestyle habits, yet little is known about diet and physical activity patterns of elementary school-aged children. A cohort of 35 boys and girls in grades 3 through 5 (mean age=9.5 years) was studied during the course of the 2004-2005 school year, providing seasonal assessments of diet and physical activity. Objectively measured data included height, weight, and pedometer step counts. Subjective data included seasonal 3-day diet diaries, a food frequency questionnaire, and a physical activity questionnaire. Participants were white, well-nourished, and within the healthy range for body mass index for age. Only three students (9%) were overweight and another three were "at risk" for overweight. Food intake patterns fell far below MyPyramid guidelines for average daily servings of fruits and vegetables. High intakes of saturated fat (average of 12% of calories) and sodium were noted, along with inadequate fiber intakes. Snacks, desserts, and entrees that contributed most to calorie and saturated fat intake were identified. Self-reported physical activity appears in line with recommendations, but step counts fall short, particularly for girls and during winter months. These findings identify targets for behavioral and environmental interventions to reduce childhood obesity risks. Additional research involving more diverse populations is warranted.

School Physical Education: The Pill Not Taken

Physical education programs in schools have the potential to promote healthy, active lifestyles by providing children with some of their recommended physical activity, increasing their physical fitness levels, and teaching them generalizable movement and behavioral skills. If “exercise is medicine,” physical education is the pill not taken. Numerous barriers, including limited curriculum time allocations, low subject status, and inadequate resources hinder physical education from playing a major role in providing and promoting physical activity. This article profiles physical education as it relates to physical activity, describes its current status from both historical and contextual standpoints, and concludes with recommendations for improving it.

Effect of a school-based intervention to promote healthy lifestyles in 7-11 year old children

BACKGROUND

Physical inactivity is recognised as a public health concern within children and interventions to increase physical activity are needed. The purpose of this research was to evaluate the effect of a school-based healthy lifestyles intervention on physical activity, fruit and vegetable consumption, body composition, knowledge, and psychological variables.

METHOD

A non-randomised controlled study involving 8 primary schools (4 intervention, 4 control). Participants were 589 children aged 7-11 years. The intervention lasted 10 months and comprised a CD-rom learning and teaching resource for teachers; an interactive website for pupils, teachers and parents; two highlight physical activity events (1 mile school runs/walks); a local media campaign; and a summer activity wall planner and record. Primary outcome measures were objectively measured physical activity (pedometers and accelerometers) and fruit and vegetable consumption. Secondary outcomes included body mass index, waist circumference, estimated percent body fat, knowledge, psychological variables. Multi-level modelling was employed for the data analysis.

RESULTS

Relative to children in control schools, those in intervention schools significantly increased their total time in moderate-to-vigorous physical activity (MVPA) (by 9 minutes/day vs a decrease of 10 minutes/day), their time in MVPA bouts lasting at least one minute (10 minutes/day increase vs no change) and increased daily steps (3059 steps per day increase vs 1527 steps per day increase). A similar pattern of results was seen in a subset of the least active participants at baseline. Older participants in intervention schools showed a significant slowing in the rate of increase in estimated percent body fat, BMI, and waist circumference. There were no differences between groups in fruit and vegetable intake. Extrinsic motivation decreased more in the intervention group.

CONCLUSION

The intervention produced positive changes in physical activity levels and body composition. It appeared to have little or no effect on consumption of fruit and vegetables. Schools are a suitable setting for the promotion of healthy lifestyles although more work, particularly focussed on dietary change, is needed in a variety of schools and social settings.

Assessing coordination of legal-based efforts across jurisdictions and sectors for obesity prevention and control

America’s increasing obesity problem requires federal, state, and local lawyers, policymakers, and public health practitioners to consider legal strategies to encourage healthy eating and physical activity. The complexity of the legal landscape as it affects obesity requires an analysis of coordination across multiple sectors and disciplines. Government jurisdictions can be viewed “vertically,” including the local, state, tribal, and federal levels, or “horizontally” as agencies or branches of government at the same vertical level. Inspired by the successful tobacco control movement, obesity prevention advocates seek comprehensive strategies to “normalize” healthy behaviors by creating environmental and legal changes that ensure healthy choices are the default or easy choices. With many competing demands on diminishing municipal budgets, strategic coordination both vertically and horizontally is essential to foster the environmental and social changes needed to reverse the obesity epidemic.

Maturation of luteinizing hormone (gonadotropin-releasing hormone) secretion across puberty: evidence for altered regulation in obese peripubertal girls

CONTEXT

Peripubertal obesity (body mass index-for-age >or= 95%) in girls is associated with hyperandrogenemia. LH likely contributes to this relationship, but overnight LH secretion in obese girls is poorly characterized.

OBJECTIVE

The aim of the study was to evaluate LH pulse characteristics in obese girls throughout pubertal maturation.

DESIGN

We conducted a cross-sectional analysis.

SETTING

The study was performed in a general clinical research center.

PARTICIPANTS

Eight nonobese and five obese Tanner 1-2 girls participated, as well as 32 nonobese and 12 obese Tanner 3-5 girls.

INTERVENTION

Blood samples were collected every 10 min overnight (from 1900 to 0700 h).

MAIN OUTCOME MEASURES

LH pulse frequency, amplitude, and mean LH were measured in three 4-h time blocks (block 1, 1900-2300 h; block 2, 2300-0300 h; and block 3, 0300-0700 h).

RESULTS

Tanner stage 1-2 nonobese girls demonstrated nocturnal increases of LH frequency (P < 0.01, block 1 vs. 2) and mean LH (P < 0.05, block 1 vs. 2 and 3). Obese Tanner 1-2 girls had lower 12-h LH frequency and LH amplitude (P < 0.05 for both), with no overnight changes of LH pulse parameters. Compared to normal, LH frequency was elevated in Tanner 3-5 obese girls (P < 0.01 in all blocks), whereas LH amplitude was low (P < 0.05 in all blocks). Overnight increases of LH amplitude were observed in nonobese Tanner 3-5 girls (P < 0.0001), but not in obese Tanner 3-5 girls.

CONCLUSIONS

Obesity in prepubertal and early pubertal girls is associated with reduced LH secretion and reduced nocturnal changes of LH. In later pubertal girls, obesity is linked with reduced LH amplitude, but elevated LH frequency; the latter may reflect effects of hyperandrogenemia.

Adherence to physical activity and electronic media guidelines in Australian pre-school children

The aim of this study was to determine compliance with the National Association for Sport and Physical Education (NASPE) guideline for physical activity and American Academy of Pediatrics (AAP) recommendation for electronic media use among urban pre-school children in two large cities on the East Coast of Australia. Cross-sectional data were collected from 266 parents. Time spent using electronic media (watching television, DVDs or on the computer) and in physical activity were parent reported. The proportion who met each guideline was calculated. 56 per cent and 79% of children met the NASPE guideline on weekdays and weekends, respectively, while 73% and 70% met the AAP recommendation on weekdays and weekends, with no difference between boys and girls. A substantial minority do not meet physical activity and electronic media use recommendations, highlighting the need to better understand what factors contribute to physical activity and electronic media use among this group of pre-schoolers.

Active play and screen time in US children aged 4 to 11 years in relation to sociodemographic and weight status characteristics: a nationally representative cross-sectional analysis

BACKGROUND

The high prevalence of childhood obesity underscores the importance of monitoring population trends in children's activity and screen time, and describing associations with child age, gender, race/ethnicity, and weight status. Our objective was to estimate the proportion of young children in the US who have low levels of active play or high levels of screen time, or who have both these behaviors, and to describe associations with age, gender, race/ethnicity, and weight status.

METHODS

We analyzed data collected during the National Health and Nutrition Examination Surveys 2001-2004, a US nationally representative cross-sectional study. We studied 2964 children aged 4.00 to 11.99 years. Our main outcomes were reported weekly times that the child played or exercised hard enough to sweat or breathe hard (active play), daily hours the child watched television/videos, used computers, or played computer games (screen time), and the combination of low active play and high screen time. Low active play was defined as active play 6 times or less per week. High screen time was defined as more than 2 hours per day. We accounted for the complex survey design in analyses and report proportions and 95% confidence intervals. We used Wald Chi-square to test for differences between proportions. To identify factors associated with low active play and high screen time, we used multivariate logistic regression.

RESULTS

Of US children aged 4 to 11 years, 37.3% (95% confidence interval, 34.1% to 40.4%) had low levels of active play, 65.0% (95% CI, 61.4% to 68.5%) had high screen time, and 26.3% (95% CI, 23.8% to 28.9%) had both these behaviors. Characteristics associated with a higher probability of simultaneously having low active play and high screen time were older age, female gender, non-Hispanic black race/ethnicity, and having a BMI-for-age > or =95th percentile of the CDC growth reference.

CONCLUSION

Many young children in the US are reported to have physical activity and screen time behaviors that are inconsistent with recommendations for healthy pediatric development. Children who are overweight, approaching adolescence, girls, and non-Hispanic blacks may benefit most from public health policies and programs aimed at these behaviors.

Translating research on healthy lifestyles for children: meeting the needs of diverse populations

This article provides two examples of approaches nursing can take to reach diverse populations of children and their families to enhance health lifestyles. First, a descriptive summary of a brief after-school intervention program aimed at influencing 8- and 9-year-old children's media habits and the prevention of negative health behaviors is presented. Design consideration for translating health lifestyles research findings into a nurse-managed inner city primary care practice is reviewed in the second example.

A pilot of a video game (DDR) to promote physical activity and decrease sedentary screen time

OBJECTIVE

We examined the feasibility of Dance Dance Revolution (DDR), a dance video game, in participants' homes, to increase physical activity (PA) and to decrease sedentary screen time (SST).

METHODS AND PROCEDURES

Sixty children (7.5 +/- 0.5 years) were randomized in a 2:1 ratio to DDR or to wait-list control (10-week delay). DDR use was logged, PA was measured objectively by accelerometry. SST was self-reported at weeks 0 and 10. At week 28, after both groups had access to DDR, accelerometry and SST were repeated.

RESULTS

Mean use of DDR was 89 +/- 82 (range 0-660 min) min per week (mpw). The DDR group showed increased vigorous PA and a reduction in light PA; the control group showed no increase in moderate and/or vigorous PA (MVPA) although they also had a reduction in light PA. Differences between the groups were not observed. The DDR group also reported a decrease in SST of -1.2 +/- 3.7 h per week (hpw) (P < 0.05), whereas the controls reported an increase of +3.0 +/- 7.7 hpw (nonsignificant). The difference in SST between the groups was significant, with less SST in the DDR group. Between weeks 10 and 28, numeric reductions in SST were reported in both groups. In the DDR group, SST at week 28 (8.8 +/- 6.0 hpw) was lower than baseline (10.5 +/- 5.5 hpw; P < 0.03).

DISCUSSION

This pilot study suggests that DDR reduces SST and may facilitate slight increases in vigorous PA. Further study is needed to better characterize children and contexts in which DDR may promote a healthy lifestyle.

Lipid screening and cardiovascular health in childhood

This clinical report replaces the 1998 policy statement from the American Academy of Pediatrics on cholesterol in childhood, which has been retired. This report has taken on new urgency given the current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension, and cardiovascular disease in older children and adults. The approach to screening children and adolescents with a fasting lipid profile remains a targeted approach. Overweight children belong to a special risk category of children and are in need of cholesterol screening regardless of family history or other risk factors. This report reemphasizes the need for prevention of cardiovascular disease by following Dietary Guidelines for Americans and increasing physical activity and also includes a review of the pharmacologic agents and indications for treating dyslipidemia in children.

Type 2 diabetes in youth: epidemiology and current research toward prevention and treatment

Type 2 diabetes mellitus has emerged as a diagnosis among adolescents in the United States, particularly among minority groups and concurrent with the well-documented epidemic of overweight and obesity. Opportunities for prevention of type 2 diabetes and approaches to optimized treatment regimens for adolescents with the disease have drawn largely from studies conducted in adult populations. Recognizing that much work remains to be done, this review summarizes key findings from recent research and highlights recent findings from large, ongoing studies of youth that address the prevalence and incidence of type 2 diabetes in young people, the prevalence of complications among this group, and the current knowledge base that informs opportunities for prevention and treatment of type 2 diabetes in adolescents.

Collaborative school planning and active schools: a case study of Lee County, Florida

To contribute to the understanding of the links between urban planning and school siting and, ultimately, the impact of both on physical activity, we conducted a case study of Lee County, Florida. Our study examined the extent of state-mandated collaboration between the Lee County School Board and Lee County government (e.g., the Lee County Department of Planning, the Office of Smart Growth, and the Department of Parks and Recreation). Specifically, we investigated planning processes under mandated coordination between the school board and the county and the impact of such coordination on the integration of land-use planning and school facility planning. By describing the process of mandated collaborative school planning in Florida, we illustrate the promise and pitfalls of such top-down legislation and offer insights to other state and local governments looking for ways to improve local planning and to increase physical activity among children.

Promoting the participation of children with disabilities in sports, recreation, and physical activities

The benefits of physical activity are universal for all children, including those with disabilities. The participation of children with disabilities in sports and recreational activities promotes inclusion, minimizes deconditioning, optimizes physical functioning, and enhances overall well-being. Despite these benefits, children with disabilities are more restricted in their participation, have lower levels of fitness, and have higher levels of obesity than their peers without disabilities. Pediatricians and parents may overestimate the risks or overlook the benefits of physical activity in children with disabilities. Well-informed decisions regarding each child's participation must consider overall health status, individual activity preferences, safety precautions, and availability of appropriate programs and equipment. Health supervision visits afford pediatricians, children with disabilities, and parents opportunities to collaboratively generate goal-directed activity "prescriptions." Child, family, financial, and societal barriers to participation need to be directly identified and addressed in the context of local, state, and federal laws. The goal is inclusion for all children with disabilities in appropriate activities. This clinical report discusses the importance of physical activity, recreation, and sports participation for children with disabilities and offers practical suggestions to pediatric health care professionals for the promotion of participation.

Evaluation of youth pedometer-determined physical activity guidelines using receiver operator characteristic curves

OBJECTIVE

Evidence-based pedometer guidelines have not been sufficiently validated in youth. The purpose of this paper was to evaluate the utility of current pedometer-determined physical activity guidelines for youth.

METHODS

Participants (n=812, mean age 9.7 years) were from two Midwestern communities during Fall 2005. Participants completed 7 days of pedometer monitoring using a Digiwalker 200-SW. ROC analyses were utilized to assess the utility of the cutpoints in reference to weight status. The percentage of subjects meeting physical activity recommendations (steps/day) was determined using two published recommendations.

RESULTS

The mean (SD) steps/day for boys, girls, and sexes combined were 12,709 (3,384), 10,834 (2562), and 11,665 (3028), respectively. Depending on the recommendation, approximately 55-75% of children did not meet the recommended number of steps/day. Sensitivity was high and specificity was low for both current guidelines evaluated. The ROC analysis indicated that lowering the steps/day cutpoint for boys and girls may increase accuracy.

CONCLUSIONS

This study demonstrates that a large percentage of children from two Midwestern communities do not meet current pedometer-based physical activity recommendations. Because the percentage of children categorized as active or inactive depends on the criteria that are employed, it is recommended that researchers select cutpoints based on the preferred context of application.

Medical conditions affecting sports participation

Children and adolescents with medical conditions present special issues with respect to participation in athletic activities. The pediatrician can play an important role in determining whether a child with a health condition should participate in certain sports by assessing the child's health status, suggesting appropriate equipment or modifications of sports to decrease the risk of injury, and educating the athlete, parent(s) or guardian, and coach regarding the risks of injury as they relate to the child's condition. This report updates a previous policy statement and provides information for pediatricians on sports participation for children and adolescents with medical conditions.

Physical activity for youth with disabilities: a critical need in an underserved population

The recommended amount of daily physical activity for youth is 60 minutes a day, most days of the week. Youth with disabilities are not achieving this target and are significantly less active and more obese than their non-disabled peers. The combination of the health risks associated with physical inactivity and obesity presents a serious health concern in this population. While there is a small amount of research on interventions aimed at improving fitness among youth with disabilities, the majority of these studies were conducted in clinical settings where most or all of the common barriers to participation were eliminated (e.g. transportation, lack of knowledgeable staff, adaptation of programmes and/or facilities to child's needs). One of the most important challenges for paediatric rehabilitation and healthcare professionals is finding ways to increase physical activity and fitness among youth with disabilities in community-based settings. The use of information technology (IT) to customize physical activity programmes for youth with disabilities offers a promising approach to addressing this important health issue in the future.

Promoting physical activity in middle school girls: Trial of Activity for Adolescent Girls

BACKGROUND

Physical activity is important for weight control and good health; however, activity levels decline in the adolescent years, particularly in girls.

DESIGN

Group randomized controlled trial.

SETTING/PARTICIPANTS

Middle school girls with English-speaking skills and no conditions to prevent participation in physical activity in 36 schools in six geographically diverse areas of the United States. Random, cross-sectional samples were drawn within schools: 6th graders in 2003 (n=1721) and 8th graders in 2005 (n=3504) and 2006 (n=3502).

INTERVENTION

A 2-year study-directed intervention (fall 2003 to spring 2005) targeted schools, community agencies, and girls to increase opportunities, support, and incentives for increased physical activity. Components included programs linking schools and community agencies, physical education, health education, and social marketing. A third-year intervention used school and community personnel to direct intervention activities.

MAIN OUTCOME MEASURES

The primary outcome, daily MET-weighted minutes of moderate-to-vigorous physical activity (MET-weighted MVPA), was assessed using accelerometry. Percent body fat was assessed using anthropometry.

RESULTS

After the staff-directed intervention (pre-stated primary outcome), there were no differences (mean= -0.4, 95% CI= -8.2 to 7.4) in adjusted MET-weighted MVPA between 8th-grade girls in schools assigned to intervention or control. Following the Program Champion-directed intervention, girls in intervention schools were more physically active than girls in control schools (mean difference 10.9 MET-weighted minutes of MVPA, 95% CI=0.52-21.2). This difference is about 1.6 minutes of daily MVPA or 80 kcal per week. There were no differences in fitness or percent body fat at either 8th-grade timepoint.

CONCLUSION

A school-based, community-linked intervention modestly improved physical activity in girls.

Associations among physical activity, health indicators, and employment in 12th grade girls

OBJECTIVES

This study compared physical activity, sedentary behaviors, and other health indicators between 1381 employed and nonemployed 12th grade girls.

METHODS

The girls were from 22 high schools in South Carolina (2002-2003); 56% of the girls were African American, and the mean age was 17.7 (0.6) years. Physical activity and sedentary behaviors were measured using the 3-Day Physical Activity Recall (3DPAR). Fitness, depressive symptoms, and smoking behavior were assessed.

RESULTS

Fifty percent of the girls were employed, and on average, employed girls worked 9.6 30-minute blocks per day. Girls who worked reported significantly (p < or = 0.001) higher average total metabolic equivalents (METs) (mean [M] 66.4, SE 0.5) than girls who did not work (M 59.5, SE 0.5). Also, a higher percent of girls who worked reported 2+ blocks of moderate to vigorous physical activity (MVPA) (89.3%), and fewer (20.2%) reported 4+ blocks of electronic media (EM) compared with girls who did not work (MVPA 62.7%, EM 41.7%). After on-the-job activity was subtracted, total METs for girls who worked was reduced to 48.0 (SE 0.4), and only 48.5% reported 2 or more blocks on average of MVPA. No significant differences (p > 0.05) were found between girls who reported working (W) and those who did not (NW) for body mass index (BMI) (W: M 25.2, SE 0.2; NW: M 24.6, SE 0.2), depression scores (W: M 14.4, SE 0.5; NW: M 14.4, SE 0.5), fitness (W: M 11.3 kg . m/min/kg, SE 0.2; NW: M 11.7 kg . m/min/kg, SE 0.2), or smoking during the past 30 days (W: 18.5%; NW: 17.4%).

CONCLUSIONS

Nearly one third of employed high school girls' total physical activity occurred while they were at work. Employed girls also spent less time using electronic media. Employment was not associated with fitness, smoking, or depressive symptoms in 12th grade girls.

L.I.F.E.: A School-Based Heart-Health Screening and Intervention Program

This article describes the development and growth of Lifestyle Improvements in the Family Environment ( L.I.F.E.), a school-based heart-health screening and intervention program. The primary goals of L.I.F.E. through three rounds of grant funding remained constant: (a) to identify cardiovascular risk factors in students and their families and (b) to provide counseling, education, and opportunities to change lifestyle routines that contribute to those risk factors. The program began with direct ties to a university-based research program and grew with evidence-based successes and development of community partnerships. Waves of growth were influenced by capacity-building efforts, partnership development, and resource availability. School nurses managed the screening component and partnered with appropriate others in the intervention programming. School nurses are appropriately positioned to assist families as well as school and community partners in decreasing the incidence of obesity and promoting healthy lifestyle behaviors.

Promotion of physical activity in children

PURPOSE OF REVIEW

Promotion of physical activity continues to be recommended as an essential component of obesity treatment and prevention interventions. This review explores recent updates in the area of physical activity promotion and its impact on the physical and mental health consequences of childhood obesity.

RECENT FINDINGS

Despite the availability of opportunities for physical activity in the school environment, namely recess and physical education classes, students do not appear to be meeting activity recommendations at school alone. Access to neighborhood parks may increase levels of physical activity and reduce time spent in sedentary behaviors at home. Less time spent watching television and in other sedentary behaviors such as playing videogames may contribute to higher rates of physical activity. Frequency of physical activity also appears to be related to improved mental health status, although the direction of this relationship warrants further exploration.

SUMMARY

Physical activity is an evidence-based intervention that offers benefits to both physical and mental health. Pediatric health care providers are encouraged to engage in discussions with patients and families on the topic of physical activity and to assist them in finding ways to incorporate activity into daily life.

A cross-sectional study of dietary habits and lipid profiles. The Rivas-Vaciamadrid study

The relations between dietary habits and serum lipids have been firmly established in adults. In children, this relation has been less extensively studied. We have assessed the relations between dietary components, including the different types of fatty acids (saturated, polyunsaturated and monounsaturated) and serum lipids and apolipoproteins in a group of 673 6-year-old children of the town of Rivas-Vaciamadrid, Spain. Children in the highest tertile of total fat consumption, when compared with children in the lowest tertile, had higher mean levels of total cholesterol (188.3 mg/dl vs. 146.8 mg/dl), triglycerides (56.7 mg/dl vs. 51.3 mg/dl), LDL cholesterol (120.7 mg/dl vs. 92.6 mg/dl), HDL cholesterol (56.2 mg/dl vs. 54.5 mg/dl) and apolipoprotein B (86.8 mg/dl vs. 62.9 mg/dl). When compared with children in the lowest tertile, children in the highest tertile of saturated fat consumption had significantly higher mean levels of total cholesterol (206.3 mg/dl vs. 151.8 mg/dl), LDL cholesterol (140.6 mg/dl vs. 95.1 mg/dl) and apolipoprotein B (99.2 mg/dl vs. 64.3 mg/dl) and lower mean levels of HDL cholesterol (53.5 mg/dl vs. 57.5 mg/dl), whereas children in the highest tertile of monounsaturated fat consumption had significantly higher mean levels of HDL cholesterol (56.5 mg/dl vs. 51.8 mg/dl) and lower levels of total cholesterol (133.2 mg/dl vs. 201.6 mg/dl), LDL cholesterol (93.1 mg/dl vs. 137.5 mg/dl) and apolipoprotein B (68.6 mg/dl vs. 94.9 mg/dl) than children in the lowest tertile. No statistically significant relation between polyunsaturated fat and lipid levels was found. We have found a strong association between diet composition and lipid and apolipoprotein levels in 6-year-old children. Our findings strengthen the role of monounsaturated fatty acid consumption as a part of a healthy diet in childhood.

State of the Art Reviews: Using the Internet to Promote Physical Activity and Healthy Eating in Youth

The prevalence of overweight children and adolescents is increasing at alarming rates. Since 1980, the prevalence of overweight among children aged 6 to 11 years has more than doubled and more than tripled among adolescents aged 12 to 19. Innovative, effective weight loss strategies that effectively promote healthy eating and physical activity are needed to address this obesity epidemic. The Internet may prove to be an effective means of reaching youth to reduce overweight and, ideally, prevent weight gain. This article reviews the available literature of Internet-based interventions promoting healthy eating, physical activity, and/ or weight loss in school, home, camp, and medical settings. Findings show that few examples of well-designed trials exist in the youth literature. However, several studies show promise for the use of the Internet. It is recommended that future trials use adequate sample sizes, randomized designs, objective measures, boys and girls, health disparity youth, longer intervention periods (at least 16 weeks), long-term follow-up, theory-based skill building (eg, tracking of behavior, goal setting, feedback, increasing social support), the involvement of parents or caretakers, and improved means for sustaining interest and use in the site over time.

The childcare environment and children's physical activity

BACKGROUND

With increased numbers of children attending child care, this setting presents an ideal opportunity to promote physical activity and the early development of healthy behaviors. The purpose of this study was to examine the relationships between the childcare environment and physical activity behavior of preschool children.

METHODS

Aspects of the environment hypothesized to influence children's physical activity were assessed in 20 childcare centers using the Environment and Policy Assessment and Observation (EPAO) instrument. Physical activity behavior was assessed over 2 days using direct observation.

RESULTS

Children in centers with supportive environments achieved more moderate-to-vigorous physical activity (15% of observations vs 9%; effect size [ES]=1.17), spent less time in sedentary activities (50% vs 61%; ES=-1.52), and had higher mean physical activity levels (2.68 vs 2.43; ES=1.41) compared to centers with less supportive environments. Facets of the physical and social environment related to physical activity behavior included active opportunities, portable play equipment, fixed play equipment, sedentary environment, and physical activity training and education.

CONCLUSIONS

Previous research indicates that the childcare center that children attend significantly affects physical activity behavior. The current findings extend this evidence by identifying aspects of the childcare environment that relate to the physical activity behavior of children. These factors should be considered when identifying determinants of physical activity and designing interventions.

Contribution of youth sport to total daily physical activity among 6- to 12-yr-old boys

PURPOSE

The purpose of this study was twofold: 1) to determine the contribution of organized youth sport to total daily physical activity (PA), and 2) to examine the contribution of daily recess and physical education (PE) to total daily PA.

METHODS

Using a cross-sectional design, 119 children wore an accelerometer during a school day in which they participated in organized youth sport. A subsample (N=36) wore the accelerometer on a nonsport day to examine day-to-day differences in PA. Total daily PA and PA during youth sport, recess, and PE were estimated. The contributions of youth sport, recess, and PE were determined by dividing the amount of PA from each activity by the total daily amount of PA.

RESULTS

Approximately 110 min of moderate to vigorous physical activity (MVPA) were achieved on the monitoring day. Youth sport contributed approximately 23% of the total MVPA, whereas PE and recess contributed almost 11 and 16%, respectively. Nearly half of the accumulated minutes of MVPA were attributed to unstructured activities (approximately 56 min). For the entire sample, approximately 52% of youth sport time was spent in either sedentary or light-intensity activities, whereas moderate and vigorous physical activity accounted for approximately 27 and 22% of the time, respectively. During a nonsport day, participants engaged in significantly more sedentary activity (P=0.02) and significantly less moderate (P=0.02) and vigorous activity (P<0.001) compared with the sport day.

CONCLUSION

Participants in this study averaged 110 min of MVPA during a day in which they participated in youth sport. The additional amount of MVPA accumulated on the sport day (approximately 30 min) was not maintained on a nonsport day.

Preventive care for children in low-income families: how well do Medicaid and state children's health insurance programs do?

OBJECTIVE

Child health problems that are caused or exacerbated by health behaviors remain a leading cause of medical spending for children. We examined receipt of clinician advice by low-income children, comparing children who had public insurance with those who had private insurance, as well as with children who were uninsured for part or all of the year.

METHODS

We used children who were aged 3 to 17 and living in families with incomes of <250% of the federal poverty level in the Medical Expenditure Panel Survey data from 2001 to 2003 to estimate linear probability models on receipt of preventive advice. The main outcome measures were receipt of clinician's advice about healthy eating, physical activity, the harmful effects of smoking in the home, proper safety restraints in a car, and use of a bicycle helmet. We also examined 2 related barriers to receiving clinician advice: whether the child had any preventive care visits in the past year and whether the child had a usual source of care other than a hospital emergency department.

RESULTS

Publicly insured children were more likely than privately insured, full-year-uninsured children, and part-year-uninsured children to have had a preventive care visit in the past year, but regardless of health insurance group, many children went without preventive care. Even conditional on having had a preventive care visit, 48% did not receive clinician advice in any of the areas measured, and 41% of the overweight children were advised about neither healthy eating nor exercise in the past year.

CONCLUSIONS

Enrolling more uninsured children in Medicaid and State Children's Health Insurance Programs could improve the chances that families receive advice about health behaviors and injury prevention; however, nearly half of the children who were insured for the entire year did not receive important advice from their clinicians.

Physical activity for the prevention and management of youth-onset type 2 diabetes mellitus: focus on cardiovascular complications

With the growing prevalence of childhood obesity and type 2 diabetes mellitus (T2DM) in youth, the challenge of cardiovascular disease risk management has entered the paediatric realm, affecting specialists, family physicians and allied healthcare professionals alike. Currently, there is little evidence to support optimal strategies for management of T2DM in youth and the associated cardiovascular complications. Physical activity plays a powerful role in the prevention and management of T2DM and cardiovascular disease in adults. This review will focus on the role of physical activity for the prevention of T2DM in youth and its associated cardiovascular complications. The first part describes the prevalence of cardiovascular risk factors in this cohort. The second part focuses on the role of physical activity in the prevention and management of T2DM in youth. Collectively, the limited intervention and observation studies published to date suggest that daily targets of 60-90 minutes of physical activity and less than 60 minutes of screen time (i.e. time spent in front of a television, computer or video games) are required for the prevention and management of T2DM in youth. Large-scale intervention studies are needed to determine the most effective physical activity strategies for the prevention and management of T2DM in youth.

Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health

OBJECTIVES

To determine physical activity levels in paediatric patients who underwent the Fontan procedure, and their relationship to functional status and exercise capacity.

STUDY DESIGN

We studied 147 patients (ages 7-18 years) at a median of 8.1 years after Fontan, as part of the Pediatric Heart Network cross-sectional study of Fontan survivors. Assessment included medical history, self-reported physical activity, parent-completed Child Health Questionnaire (CHQ), cardiopulmonary exercise testing and physical activity level measured by accelerometry (MTI Actigraph).

RESULTS

Measured time spent in moderate and vigorous activity was markedly below normal at all ages, particularly in females, and was not significantly related to self-reported activity levels, or to maximum Vo2, Vo2 at anaerobic threshold or maximum work rate on exercise testing. Lower measured activity levels were significantly related to lower perceived general health but not to self-esteem, physical functioning, social impact of physical limitations or overall physical or psychosocial health summary scores. Reduced exercise capacity was more strongly related than measured activity levels to lower scores in general health, self-esteem and physical functioning.

CONCLUSIONS

Physical activity levels are reduced after Fontan, independent of exercise capacity, and are associated with lower perceived general health but not other aspects of functional status.

Physical activity-key issues in treatment of childhood obesity

Changes in physical activity with the aim of increasing energy expenditure are usually an important component of childhood obesity treatment. Physical activity also has several other aspects that are positive for the obese child's health, such as improving the metabolic profile and psychological well being. The aim of this paper is to give a short review of what we know about physical activity in paediatric obesity treatment. In addition, practical recommendations will be presented which a health care provider can suggest to obese children and their families with a special focus on daily activity, participation in physical education classes and sports, sedentary behaviours, active commuting to school and how to get family and friends involved in supporting the child.

Obesity and related risk factors among low socio-economic status minority students in Chicago

OBJECTIVES

To assess overweight and related risk factors among urban low socio-economic status (SES) African-American adolescents in an attempt to study the underlying causes of ethnicity and gender disparities in overweight.

METHODS

Cross-sectional data collected on anthropometric measures, diet, physical activity and family characteristics from 498 students in grades 5-7 in four Chicago public schools were analysed to study the risk factors for overweight using stepwise regression analysis.

RESULTS

Only 37.2% of the students lived with two parents. Nearly 90% had a television (TV) in their bedroom, and had cable TV and a video game system at home. Overall. 21.8% (17.7% boys versus 25.1% girls) were overweight (body mass index (BMI) >/= 95th percentile); and 39.8% had a BMI >/= 85th percentile. Compared with national recommendations, they had inadequate physical activity and less than desirable eating patterns. Only 66.1% reported having at least 20 min vigorous exercise or 30 min of light exercise in >/= 5 days over the past 7 days; 62.1% spent >3 h days- 1 watching TV/playing video games/computer, while 33.1% spent >/= 5 h days- 1. Their vegetable and fruit consumption was low, and they consumed too many fried foods and soft drinks: 55.1% consumed fried food twice or more daily and 19.5% four times or more daily; 70.3% consumed soft drinks twice or more daily and 22.0% four times or more daily on average. Gender, physical activity and pocket money were significant predictors of overweight (P < 0.05).

CONCLUSIONS

Several factors in the students' behaviours, school and family environments may increase overweight risk among this population. There is a great need for health promotion programmes with a focus on healthy weight and lifestyle, and targeting urban low-SES minority communities.

Family support for physical activity in girls from 8th to 12th grade in South Carolina

OBJECTIVE

To examine the relationship between perceived family support and other selected correlates of physical activity (PA) with changes in PA over time.

METHODS

A total of 421 girls in South Carolina completed questionnaires at 8th, 9th and 12th grades (1998-2003). Family support for PA, PA self-efficacy, perceived behavioral control, attitudes, availability of equipment, and PA were measured.

RESULTS

Growth curve analysis showed that family support, perceived behavioral control, and self-efficacy were independently related to age-related changes in PA as reflected by total METs. Girls who reported lower family support at the 8th grade measure had more rapid declines in PA, and a unit change in family support was related to approximately 1/3 of a standard deviation change in total METs.

CONCLUSIONS

Maintenance of support from family members may reduce the decline in PA independent of girls' self-efficacy and perceived behavioral control.

Promotion of physical activity in primary care for obesity treatment/prevention in children

PURPOSE OF REVIEW

Physical activity has been highlighted internationally as a beneficial intervention for weight control and the improvement of physical and mental health. This review highlights findings from recent literature to guide office-based promotion of physical activity for obesity treatment and prevention.

RECENT FINDINGS

Children worldwide participate in far less than the current physical activity recommendations. Family-based activity provides children with positive role modeling as well as motivational support for maintaining an active lifestyle. The integration of physical activity into daily life can be an effective alternative to sports and structured exercise programs. Decreasing sedentary behaviors is also a positive contribution, although its link to physical activity levels is still unclear. Some families may see neighborhood safety and access to recreational facilities as barriers to keeping their children physically active.

SUMMARY

Research in the field of pediatric obesity and overweight treatment and prevention continues to find challenges and solutions. Promotion of physical activity by the pediatric provider is demonstrated by current evidence to be a positive intervention against this global problem.

The importance of play in promoting healthy child development and maintaining strong parent-child bonds

Play is essential to development because it contributes to the cognitive, physical, social, and emotional well-being of children and youth. Play also offers an ideal opportunity for parents to engage fully with their children. Despite the benefits derived from play for both children and parents, time for free play has been markedly reduced for some children. This report addresses a variety of factors that have reduced play, including a hurried lifestyle, changes in family structure, and increased attention to academics and enrichment activities at the expense of recess or free child-centered play. This report offers guidelines on how pediatricians can advocate for children by helping families, school systems, and communities consider how best to ensure that play is protected as they seek the balance in children's lives to create the optimal developmental milieu.