Childhood Obesity and Cognitive Achievement

Body weight in childhood, adolescence, and young adulthood in relation to later risk of disabilities and early retirement among Danish female nurses

BACKGROUND

Obesity is now the most common health problem in the younger population in Western societies and obesity rates are higher in lower socioeconomic status (SES) groups. We investigated whether overweight in childhood, independently of overweight in adulthood, influenced adult employment status and later risk of having disabilities. Using data from the Danish Female Nurse Cohort study, we examined associations between overweight in childhood/adolescence, and young adulthood and disabilities and early retirement in later adulthood (>44 years) and whether it was influenced by menopausal age (

RESULTS

Our results showed that overweight in childhood, adolescence and young adulthood was associated with an increased risk of disabilities and early retirement. Especially childhood overweight that did not persist into adulthood was associated with an increased risk of disabilities (OR = 1.82, 95% CI = 1.26-2.63) and early retirement (OR = 2.05, 95% CI = 1.38-3.03) in the postmenopausal group. A similar increased risk for disabilities (OR = 1.76, 95% CI = 1.26-2.47) was seen for adolescent overweight that did not persist into adulthood.

CONCLUSION

The results show that in a well-educated population of women, overweight in childhood and/or adolescence had adverse socioeconomic consequences for later risk of disabilities and early retirement irrespective of weight status in adulthood.

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MESH Headings

• Humans
• Female
• Denmark/epidemiology
• Adolescent
• Retirement/statistics & numerical data
• Adult
• Risk Factors
• Disabled Persons/statistics & numerical data
• Child
• Nurses/statistics & numerical data
• Young Adult
• Body Mass Index
• Middle Aged
• Pediatric Obesity/epidemiology
• Overweight/epidemiology
• Socioeconomic Factors
• Employment/statistics & numerical data
• Body Weight/physiology
• Cohort Studies

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Affiliation(s)

Hanna Kruse Reiband The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.
Rikke Tannenberg Klemmensen The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
Susanne Rosthøj The Danish Cancer Institute, Research Centre, Copenhagen, Denmark Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Thorkild I A Sørensen Center for Childhood Health, Copenhagen, Denmark Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark NNF Centre for Basic Metabolic Health, University of Copenhagen, Copenhagen, Denmark
Berit Lilienthal Heitmann The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark Department of Public Health, Section for general Practise, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark

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Early Weight Status and Human Capital in Adulthood: A 32-Year Follow-Up of the 1970 British Cohort Study

Objectives: To prospectively evaluate the effects of early weight status (childhood and adolescence) and changes in obesity status on human capital in adulthood. Methods: We employed data from the 1970 Birth Cohort Study in the United Kingdom. Data on height and weight during childhood and adolescence, human capital variables in adulthood were collected from 2,444 participants. Human capital includes cognitive ability, non-cognitive skill, educational attainment and health status. Data were analyzed through linear regression and logistic regression models. Results: Our results showed that obesity during adolescence was negatively associated with cognitive ability (β = -0.83, p < 0.01), educational attainment (β = -0.49, p < 0.01), and some health outcomes; and that underweight in childhood also adversely affected educational attainment in females (β = -0.66, p < 0.05). In terms of changes in obesity status, becoming obese in adolescence negatively affected cognitive ability (β = -1.18, p < 0.01), educational attainment (β = -0.62, p < 0.05) and some health outcomes, remaining obese was associated with all adverse health outcomes. Conclusion: Our results suggest that obesity during adolescence negatively affects a range of human capital outcomes in adulthood, and adolescence is a critical period during which early obesity affects adult human capital.

Untangling the relationship between BMI and academic achievement in the elementary years

Although the negative relationship between BMI and academic achievement (AA) is well documented, no prior studies have investigated the potential bi-directional relationship between BMI and AA in childhood. We investigated the longitudinal relationships between child BMI and AA across different school subjects (reading, math and science) and sexes. To do so, we employed the Early Childhood Longitudinal Study kindergarten cohort (2011), which is a nationally representative sample of American children who entered kindergarten in 2010-2011. We utilised the kindergarten-fifth grade longitudinal sample (n 17 480) and applied cross-lagged panel models with fixed effects to address unobserved heterogeneity. Our results showed significant but small reciprocal relationships between BMI and math/science achievement for girls (n 8540) (year-to-year effect sizes ranged from -0·01 to -0·04), but not for reading. In contrast, we did not find any evidence of reciprocal relationships between BMI and AA for boys (n 8940). Our results reveal that early weight status and academic performance may be jointly responsible for a vicious cycle of poor AA and unhealthy weight. Breaking the cycle from AA may complement existing obesity prevention strategies, particularly for girls in the science, technology, engineering and mathematics field.

The relationship between overweight and education revisited: a test of the selection hypothesis based on adolescents' educational aspirations

OBJECTIVES

This paper examines the selection mechanism underlying the association between overweight/obesity and educational aspirations of adolescents.

STUDY DESIGN

This is a cross-sectional study based on a survey conducted in secondary schools in Spain in 2016.

METHODS

We estimate linear probability models to determine the association between adolescents' body mass index (BMI) and their expectations to obtain a university degree, as well as their school choices representing the most usual path towards higher studies. To address the potential endogeneity of BMI, we use the instrumental variables (IV) method. Additionally, we account for potential unobserved heterogeneity by including school fixed-effects and a wide set of individual and family characteristics in our analysis.

RESULTS

Our results indicate that adolescents with a higher BMI have lower expectations to obtain a university degree and are less likely to enrol in high school with the intention to pursue higher education in the future. The estimated effect is quite sizable and statistically significant only for girls. We estimate that a five-unit increase in BMI (e.g., the change between healthy weight and overweight) reduces girls' expectations to complete higher education by 19 percentage points and odds of enrolling in high school (vs. vocational training) by 21 percentage points.

CONCLUSIONS

We provide empirical evidence supporting the selection hypothesis behind the relationship between BMI and adolescents' educational aspirations. That is, unhealthy weight in adolescence is associated with poorer aspirations for further education. Lower educational aspirations during adolescence can lead to lower academic achievement, which in turn, may result in poorer health, labour market outcomes, and well-being during adulthood.

Parental support for free school lunches in Australian primary schools: associated factors and perceived barriers

OBJECTIVE

(1) To explore the feasibility of such programmes in Australia, this study examined parents' views on free school lunch provision. (2) To examine the associations between parents' demographic and personal characteristics and their support for free universal school lunches.

DESIGN

An online cross-sectional survey of parents.

SETTING

Australia, April 2021.

PARTICIPANTS

Seven hundred and eighty-seven parents took the survey. They had a mean age of 40. The respondents were predominantly female (95 %) and had a university degree (72 %).

RESULTS

Fifty-three percentage of the respondents agreed that all students should have access to healthy and well-balanced, free school lunches. Parents were concerned about healthiness, catering, allergies and cost of school-provided school lunches. Ethnic background, universalism values and education levels were significantly associated with support for free school lunch provision. Non-native English-speaking parents were almost three times more likely to support free universal lunches in primary schools than their native English-speaking counterparts. Parents with higher universalism-concern values were more likely to endorse free lunches in primary school. However, the level of education was negatively associated with parents' support for free school lunches.

CONCLUSIONS

The survey results highlight the complexity of parental views on free school lunch provision. Parents' concerns regarding lunches should be considered in developing school lunch programmes that meet the needs and preferences of diverse communities. These findings can be used to guide future primary school lunch provision initiatives.

Boys with overweight status lagged behind girls with overweight status in reading: evidence from mendelian randomization

OBJECTIVES

We investigated the relationship between childhood weight status and academic achievement across sexes and different school subjects in Norway.

STUDY DESIGN AND SETTING

We used data from the Norwegian Mother, Father and Child Cohort Study (MoBa), which includes genetic data (N = 13,648, 8-year-old children). We employed within-family mendelian randomization, using a body mass index (BMI) polygenic risk score as an instrument to address unobserved heterogeneity.

RESULTS

Contrary to most previous findings, we observed that overweight status (including obesity) has more detrimental effects on reading achievement in boys than in girls; the test scores of boys with overweight were about a standard deviation lower than those of normal weight boys, and the negative effects on reading achievement became stronger in the later grade.

CONCLUSION

Previous obesity prevention studies have mainly targeted girls, based on the assumption that the obesity penalty is greater for girls. Our findings highlight that particular attention to boys with overweight may help reduce the existing gender gap in academic achievement.

Umbrella systematic review finds limited evidence that school absence explains the association between chronic health conditions and lower academic attainment

Introduction

Absence from school is more frequent for children with chronic health conditions (CHCs) than their peers and may be one reason why average academic attainment scores are lower among children with CHCs.

Methods

We determined whether school absence explains the association between CHCs and academic attainment through a systematic review of systematic reviews of comparative studies involving children with or without CHCs and academic attainment. We extracted results from any studies that tested whether school absence mediated the association between CHCs and academic attainment.

Results

We identified 27 systematic reviews which included 441 unique studies of 7, 549, 267 children from 47 jurisdictions. Reviews either covered CHCs generally or were condition-specific (e.g., chronic pain, depression, or asthma). Whereas reviews found an association between a range of CHCs (CHCs generally, cystic fibrosis, hemophilia A, end-stage renal disease (pre-transplant), end-stage kidney disease (pre-transplant), spina bifida, congenital heart disease, orofacial clefts, mental disorders, depression, and chronic pain) and academic attainment, and though it was widely hypothesized that absence was a mediator in these associations, only 7 of 441 studies tested this, and all findings show no evidence of absence mediation.

Conclusion

CHCs are associated with lower academic attainment, but we found limited evidence of whether school absence mediates this association. Policies that focus solely on reducing school absence, without adequate additional support, are unlikely to benefit children with CHCs.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285031, identifier: CRD42021285031.

Potential cost-effectiveness of e-health interventions for treating overweight and obesity in Australian adolescents

BACKGROUND

E-health, defined as the use of information and communication technologies to improve healthcare delivery and health outcomes, has been promoted as a cost-effective strategy to treat adolescent overweight and obesity. However, evidence supporting this claim is lacking.

OBJECTIVES

Assess the potential cost-effectiveness of a hypothetical e-health intervention for adolescents with overweight and obesity.

METHODS

The costs and effect size (BMI reduction) of the hypothetical intervention were sourced from recent systematic reviews. Using a micro-simulation model with a lifetime time horizon, we conducted a modelled cost-utility analysis of the intervention compared to a 'do-nothing' approach. To explore uncertainty, we conducted bootstrapping on individual-level costs and quality-adjusted life years (QALYs) and performed multiple one-way sensitivity analyses.

RESULTS

The incremental cost-effectiveness ratio (ICER) for the e-health intervention was dominant (cheaper and more effective), with a 96% probability of being cost-effective at a willingness-to-pay (WTP) of $50 000/QALY. The ICER remained dominant in all sensitivity analyses except when using the lower bounds of the hypothetical intervention effect size, which reduced the probability of cost-effectiveness at a WTP of $50 000/QALY to 51%.

CONCLUSION

E-health interventions for treatment of adolescent overweight and obesity demonstrate very good cost-effectiveness potential and should be considered by healthcare decision makers. However, further research on the efficacy of such interventions is warranted to strengthen the case for investment.

Single-cell RNA sequencing identifies hippocampal microglial dysregulation in diet-induced obesity

Obesity is a growing global concern in adults and youth with a parallel rise in associated complications, including cognitive impairment. Obesity induces brain inflammation and activates microglia, which contribute to cognitive impairment by aberrantly phagocytosing synaptic spines. Local and systemic signals, such as inflammatory cytokines and metabolites likely participate in obesity-induced microglial activation. However, the precise mechanisms mediating microglial activation during obesity remain incompletely understood. Herein, we leveraged our mouse model of high-fat diet (HFD)-induced obesity, which mirrors human obesity, and develops hippocampal-dependent cognitive impairment. We assessed hippocampal microglial activation by morphological and single-cell transcriptomic analysis to evaluate this heterogeneous, functionally diverse, and dynamic class of cells over time after 1 and 3 months of HFD. HFD altered cell-to-cell communication, particularly immune modulation and cellular adhesion signaling, and induced a differential gene expression signature of protein processing in the endoplasmic reticulum in a time-dependent manner.

Strengthening Global Legislative Actions to Protect Children from the Harmful Impacts of Unhealthy Food and Non-alcoholic Beverage Marketing

PURPOSE OF REVIEW

Drawing on current global food marketing policies and the academic literature, we illustrate why and how existing legislative approaches can be strengthened to better achieve the goal of protecting children from the harmful impacts of unhealthy food and non-alcoholic beverage marketing.

RECENT FINDINGS

Around the world, governments are starting to implement legislative actions to protect children from exposure to unhealthy food and non-alcoholic beverage marketing. However, the scope of these approaches is limited and unlikely to meet their objective of safeguarding children from harmful marketing practices. The key opportunities for strengthening legislative design include increasing the age threshold of a child to 18 years; the broadening of focus from 'child-directed' marketing to all marketing that children are exposed to; designing tailored regulations for multiple settings, media and techniques; strengthening underlying food classification systems; balancing a comprehensive approach with stepwise regulatory implementation; and strengthening monitoring and enforcement systems. Our review and recommendations can aid policymakers when designing legislative approaches to protect children from the harmful impacts of unhealthy food and non-alcoholic beverage marketing.

Bodyweight and human capital development: Assessing the impact of obesity on socioemotional skills during childhood in Chile

This article analyzes the effect of bodyweight on socioemotional skills for children aged two to 12 years in Chile. Using an instrumental variable approach and a representative survey, we show that both BMI and obesity are causality related to children's socioemotional development, even after assuming that our instrument is imperfect. Although we did not find significant differences between boys and girls, we do identify heterogeneous effects by age: the weight penalty for girls starts earlier than for boys. Our findings suggest that early interventions for childhood obesity not only might generate positive impacts on children's health, but also a greater accumulation of non-cognitive human capital in the future.

Associations between sociodemographic and behavioural parameters and child development depending on age and sex: a cross-sectional analysis

OBJECTIVES

To explore environmental and individual factors that are associated with child development and to investigate whether the strength of these associations differs according to the age of the children.

DESIGN

Cross-sectional study.

SETTING

This study was part of the LIFE Child study, a large cohort study conducted in Leipzig, Germany.

PARTICIPANTS

778 children aged between 0.5 and 6 years (48.6% girls, mean age=2.67 years).

OUTCOME MEASURES

The outcomes were cognitive development, language development, body and hand motor skills, social-emotional development, and tracing skills, measured with a standardised development test. We analysed the associations between development and gestational age, socioeconomic status (SES), sex, behavioural difficulties, siblings, sleep duration, breastfeeding duration and overweight/obesity. We also tested for interactions between these variables and child age or sex.

RESULTS

Higher gestational age (b ranging between 0.12 and 0.26) and higher SES (b ranging between 0.08 and 0.21) were associated with better outcomes in almost all developmental domains (all p<0.019). Children with older siblings had improved body and hand motor skills compared with children without older siblings (both b=0.55, all p<0.029). Boys had poorer scores than girls in body and hand motor skills and tracing (b=-0.45, -0.68 and -1.5, all p<0.019). Children with behavioural difficulties had significantly poorer outcomes in most developmental domains. Some of the associations with SES and sex were stronger in older than in younger children. Associations between gestational age and motor development were weaker in older children. We did not find significant associations between child development and sleep duration, breastfeeding duration or overweight/obesity.

CONCLUSION

Some factors had a protective, others an adverse effect on development of children under 6 years of age. The effect of SES and sex increased, while the effect of gestational age decreased with age.

TRIAL REGISTRATION NUMBER

NCT02550236.

Impact of Weight Status Reporting on Childhood Body Mass Index

Background: Many states have adopted school-based BMI screening or surveillance programs in an effort to address high rates of childhood obesity, some of which involve provision of confidential BMI reports to parents. While there is evidence that parents are attuned to information in the reports, there is less evidence showing that the reports are effective in preventing excess childhood weight gain. Methods: Data from Arkansas, the state with the nation's first and longest running and BMI screening program, were used to measure the impact of BMI reports. This was done through a regression discontinuity design that compared future BMI z-scores among children falling within a narrow band around the obese and overweight thresholds. We derived the effects of BMI reports by comparing students who received different types of reports around the relevant threshold. Results: While we are unable to detect any differences in BMI z-scores between the children who received the overweight report and the children who received the healthy weight report, we detected some differences between children who received the obese report and children who received the overweight report. These findings hold across subsamples by age, minority status, and school meal status. Conclusions: Based on these data, overweight or obese reports to do not meaningfully impact future BMI z-scores. This may be due, in part, to the format of parental reports, which may dampen the surprise element of an overweight or obese report.

Health Economic Aspects of Childhood Excess Weight: A Structured Review

An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted.

Normal Weight 6-12 Years Boys Demonstrate Better Cognitive Function and Aerobic Fitness Compared to Overweight Peers

Background and Objectives: This study evaluated and compared the cognitive function (CF) and aerobic fitness (AF) of 15 normal-weight (NW) and 15 overweight (OW) children, aged 6−12 years. In addition, the relationship between CF and AF was evaluated. Materials and Methods: The ANAM4 battery was used to evaluate CF, and a constant treadmill walking exercise (6 km/h for 6 min) and a progressive treadmill exercise (modified Balke test) were used to assess pulmonary oxygen uptake (VO2). Results: The OW children displayed worse attention and visual tracking (88.95 ± 4.45% and 93.75 ± 3.16%), response inhibition (90.27 ± 1.54% and 93.67 ± 2%), and speed of processing (93.65 ± 1.5% and 94.4 ± 1.54%) than the NW children (p < 0.05). The VO2 max was higher and the time constant of VO2 kinetics was shorter in NW children (56.23 ± 3.53 mL/kg/min and 21.73 ± 1.57 s, respectively) than in OW children (45.84 ± 1.89 mL/kg/min and 33.46 ± 2.9 s, respectively; p < 0.05). Conclusion: The OW children aged 6−12 years demonstrated poorer CF and lower AF than their NW peers. An association between AF and CF indicators was identified in both groups.

Body Mass Index and Academic Achievement Among Chinese Secondary School Students: The Mediating Effect of Inhibitory Control and the Moderating Effect of Social Support

Based on Embodied Cognition Theory, Inhibitory Decline Theory, and Risk Protective Factors Model, this study verified that body mass index (BMI) affects secondary school students’ academic performance through the mechanism of inhibitory control. In addition, it was verified that the strength of this mechanism depends on the teacher, parent, and peer support received by secondary school students. By using height and weight measurements, the classic stroop task, and the social support scale, 264 secondary school students in Shanxi Province, China, were surveyed and their academic performance was collected. The results showed that students with high BMI had poorer academic performance, and inhibitory control partially mediated the effect between BMI and academic performance, with the inhibitory control mediated effect accounting for 36.68% of the total effect. Support from teachers, parents, and peers can ameliorate the negative effects of BMI on academic performance, with teacher support and parental support also ameliorating the negative effects of BMI on inhibitory control. Thus, high BMI impairs inhibitory control and thus has a negative impact on academic performance, which can be buffered by social support.

The effect of gender-specific labor market conditions on children's weight

BACKGROUND

Macroeconomic conditions are widely known to influence health outcomes through direct behavioral change or indirect mental effects of individuals. However, they have not received much attention in relation to childhood obesity.

METHODS

Using gender-specific predicted employment growth rates as an index for labor market conditions, we analyze how economic shocks affect children's weight status in Arkansas. To understand the underlying mechanisms behind these results, we use data on individual time use to examine how economic shocks are related to activities related to children's weight.

RESULTS

Improvement in the female labor market is associated with an increase in body mass index (BMI) and the probability that a child is overweight or obese, while an improvement in the male labor market has no significant effects on children's weight. This impact is particularly evident among female children, older children, and African-American children. We also find a negative effect of improvements in the female labor market on time spent on preparation for foods at home.

CONCLUSIONS

These results suggest that a decrease in time spent preparing home-cooked foods might be a plausible explanation for the pro-cyclical relationship between children's weight and improvement in the labor market conditions. Thus, the policy implications of our paper should be aimed at mitigating the adverse effects of women's labor participation.

The effect of parental smoking on children's cognitive and non-cognitive skills

Economic research emphasises the importance of cognitive and non-cognitive skills in children for long-term labour market, health and social outcomes. In contrast to previous studies that focus on the effects of maternal smoking during pregnancy, we contribute to the literature by examining whether parental current smoking impacts on children's cognitive and non-cognitive development. We exploit data from the Longitudinal Study of Australian Children and address potential endogeneity and self-selectivity bias using robust estimation methods. Overall, we find evidence that parental smoking results in worse development outcomes in children. Specifically, our fixed-effects estimates indicate that children living with parents who are smokers exhibit lower cognitive outcomes ranging between 0.09 and 0.17 standard deviation, while the impacts on non-cognitive outcomes range between 0.06 and 0.80 standard deviation. We also provide insights on some of the mechanisms of transmission. Our findings suggest that campaigns, programs and policies that reduce tobacco consumption may have positive externalities in terms of improving children's cognitive and non-cognitive development, and long-term labour market outcomes.

The impact of childhood obesity on human capital in high-income countries: A systematic review

Current evidence of the impact of childhood obesity on human capital development does not point in a consistent direction, and its interpretation is challenging. We carried out a systematic review of studies from high-income countries that used robust causal inference approaches to assess the impact of childhood overweight and obesity on outcomes typically linked to human capital development in economics. Global Health, Medline and EconLit were used to search for peer-reviewed papers. Three reviewers independently assessed study quality using the Newcastle-Ottawa Scale. Nineteen papers representing 22 studies met the inclusion criteria. Included studies were categorized based on three components of human capital: cognitive performance (n = 18), measured through test scores; educational attainment (n = 3), through grade progression and college completion; and labour market outcomes (n = 1), through wages. We find that childhood overweight and obesity hinder education outcomes, with effects mostly observed at older ages of exposure measurement (12+ years). Girls with overweight and obesity experienced larger negative effects and more often than boys. Future research should elucidate the pathways through which childhood obesity impacts human capital development, to support policies that may mitigate those impacts, thus averting social costs that are currently widespread, increasing and unaccounted for.

'Fat black sheep': Educational penalties of childhood obesity in an emerging country

OBJECTIVE

This article explores the relationship between childhood obesity and educational outcomes in Mexico, a country where excess weight is predominant.

DESIGN

Using complementary multivariate estimators, we empirically investigate the association between childhood excess weight, measured in 2002, and schooling attainment measured 10 years later. Non-linear specifications are tested, and heterogeneous effects according to gender, living area and economic backgrounds are investigated.

SETTING

To fill the literature gap, this study focuses on the understudied context of emerging countries such as Mexico.

PARTICIPANTS

Panel data from the Mexican Family Life Survey (2002-2012) are used. We restricted the sample to adolescent individuals who had between 9 and 15 years old in 2002 (attended primary or secondary school in 2002). The survey provides an accurate follow-up information on weight, height and waist circumference for each individual.

RESULTS

Controlling for a comprehensive set of covariates, we find that the relationship is non-linear in Mexico. While weight-based childhood obesity and abdominal adiposity are significantly associated with lower school attainment, at least in urban settings, no schooling gap is found between overweight students and their normal-weight counterparts. Along with rural-urban heterogeneity, obesity-based educational penalties appear to be stronger for girls and students from privileged economic backgrounds.

CONCLUSIONS

These results emphasise the co-occurrence of anti-fat and pro-fat social norms in Mexican schools: while anti-fat norms may particularly concern female, richer and urban students, pro-fat norms might persist among male, poorer and rural students. These findings have important implications for public policy, namely about awareness anti-obesity programmes.

Socioeconomics of Obesity

PURPOSE OF REVIEW

The purpose of this review is to evaluate and emphasize important findings in the recent literature regarding the socioeconomics of obesity. It is important to evaluate trends of this global epidemic and elucidate its impact on different demographic groups and across socioeconomic strata.

RECENT FINDINGS

Obesity rates continue to increase domestically and globally which is associated with a concomitant rise in medical and economic costs. There are disparities in obesity rates based on race/ethnicity, sex, gender and sexual identity, and socioeconomic status, yet these disparities are not explained fully by health behaviors, socioeconomic position, or cumulative stress alone-community and societal environmental factors have a significant role in the obesity epidemic. Socioeconomic factors contribute to obesity on an individual and community level, and any viable approach to sustainably addressing the obesity epidemic must take these factors into account.

Adverse labour market impacts of childhood and adolescence overweight and obesity in Western societies-A literature review

Overweight and obesity among children and adolescents are major health issues of today with both somatic and psychosocial consequences in childhood, adolescence and adulthood and potentially adverse effects for adult social life. We conducted a narrative review of the literature about the association of overweight and obesity in childhood and adolescence with possible adverse impact on labour market in adulthood. By PubMed and Google Scholar searches, we identified 12 original, prospective studies from Western countries and extracted data from these studies. We discuss the possible explanations of the associations and the conceptual and methodological challenges in these studies. Despite inherent difficulties in interpreting results, partly due to differences in outcome definitions, ages at exposure, measurements of overweight and obesity, confounder control and societal differences, the studies indicate adverse labour market impacts on adult wage and employment. Furthermore, penalties seemed present even if the excessive weight was lost before adulthood, and women seemed more affected than men, especially when weight persisted into adulthood. While both health and lower education might contribute to explain the adverse labour market outcomes, also discrimination, stigmatization and the development of cognitive and noncognitive skills seemed to influence the outcomes. Prevention of these adverse labour market impacts likely requires multilevel efforts.

The mediating effect of physical fitness on long term influences of overweight in primary school girls' academic performance

BACKGROUND

Overweight and obesity contribute to multiple health risks in children, while also impacting negatively on educational performance. Physical fitness can impact outcomes beyond health related measures therefore it can play a mediating role in combating the negative effects of being overweight.

METHODS

One hundred and seventy-two primary school girls aged 6-13 years old from the North West Province of South Africa formed part of this random stratified longitudinal research design in which three follow-up measurements took place over seven years. Body Mass Index was used to compile obesity profiles, while the progressive aerobic cardiovascular endurance run (PACER) was used to determine cardiovascular fitness. Academic school achievements for grades 1, grade 4 and grade 7, as well as national and provincial values were correlated with academic performance. Data were analyzed by a repeated measure over time ANOVA as well using a latent growth curve model from the structural equation modelling framework (SEM).

RESULTS

No differences (P>0.05) were found in the academic performance of obese and normal weight girls, although obese girls showed poorer physical fitness values (P<0.05). The SEM model was a good fit for all requirements (RMSEA, 0.60; CMIN DF, 2.837; CFI, 0.966). VO<inf>2</inf>max had a standardized indirect mediation effect (-132) while body composition showing a standardized direct effect (0.183) with academic achievement. Physical fitness showed a mediation effect with regard to obesity and academic achievement in grade 7 girls.

CONCLUSIONS

Although the academic performance of obese girls did not show impairment before the age of 12 years, physical fitness had a reversible effect on relationships between obesity and academic achievement. This substantial influence of physical fitness should be used strategically in preventive intervention programs necessary to enhance cognitive functioning, academic performance and brain health among overweight children.

MOVE MORE, GAIN LESS: EFFECT OF A RECREATIONAL TRAIL SYSTEM ON CHILDHOOD BMI

We investigate the effect of residential proximity to recreational trails on childhood body mass index (BMI). We find that children living within 0.5 miles of recreational trails have BMI z-scores that are 0.0412 to 0.0507 standard deviations lower than those who do not live within 0.5 miles of trails. We also find that living nearby trails reduces the probability of becoming obese by 1.6 percentage points. The impact for BMI z-score is larger for children qualifying for free or reduced-price meals and for Hispanic children. These findings suggest that improving neighborhood amenities conducive to physical activity may help reduce disparities in childhood obesity. (JEL I10, R10).

The effect of physical education on children's body weight and human capital: New evidence from the ECLS-K:2011

This study provides evidence on the impact of physical education on child body weight, cognitive, and noncognitive achievement using data from the Early Child Longitudinal Survey Kindergarten Class of 2010-2011 (ECLS-K: 2011). Students in the 2011 cohort were exposed to increased accountability pressures by No Child Left Behind, yet average weekly physical education time has not decreased from that reported in studies using the original ECLS-K class of 1998-1999. We instrument for teacher-reported weekly PE time using state physical education laws and exploit the panel design of the data to estimate individual fixed effects models to address concerns of endogeneity. We find time spent in physical education has essentially no effect on child body weight or human capital outcomes of U.S. elementary school children.

Association among Executive Function, Physical Activity, and Weight Status in Youth

Background and objectives: Executive function (EF) is an umbrella term that encompasses the set of higher-order processes. Core EFs are inhibition, interference control, working memory, and cognitive flexibility. The aim of the study was to compare the EF between normal weight (NW) and inactive overweight (OW), NW and sport trained (ST), ST and OW 16-19-year-old youths. In addition, the relationship between EF and peak oxygen uptake (VO2peak) was evaluated. Materials and Methods: 10 NW, 14 ST, and 10 OW youths participated in this study. EF was evaluated using the ANAM4 battery. VO2peak was measured during an increasing walking exercise (modified Balke test). Results: The NW youths demonstrated better visual tracking and attention (94.28% ± 3.11%/90.23% ± 2.01%), response inhibition (95.65% ± 1.83%/92.48% ± 1.05%), speed of processing, and alternating attention with a motor speed component (95.5% ± 3.51%/89.01% ± 4.09%) than the OW youths (p < 0.05). The ST youths demonstrated better visual tracking and attention (96.76% ± 1.85%/90.23% ± 2.01%), response inhibition (97.58% ± 0.94%/92.48% ± 1.05%), speed of processing, and alternating attention with a motor speed component (98.35% ± 1.35%/89.01% ± 4.09%) than the OW youths (p < 0.05). The ST youths demonstrated better EF results than NW youths (p < 0.05). Conclusions: The ST 16-19-year-old youths demonstrated better EF than their OW and NW peers. The NW youths demonstrated better EF than their OW peers. There was a significant correlation between VO2peak and EF indicators in all groups of participants.

Do changes in weight status affect cognitive function in children and adolescents with obesity? A secondary analysis of a clinical trial

OBJECTIVES

It is unclear whether an association exists between obesity in children/adolescents and cognitive function, and whether the latter can be altered by body mass index (BMI) standard deviation score (SDS) reductions. We aimed to determine whether an association exists between BMI SDS and cognitive function in children/adolescents with obesity engaged in an obesity intervention. Second, we sought to determine if BMI SDS reduction at 12 months was associated with improved cognitive function.

DESIGN

Secondary analysis of a clinical trial.

PARTICIPANTS

Participants (n=69) were recruited from an obesity intervention. Eligible participants (recruited June 2013 to June 2015) were aged 6-16 years, with a BMI ≥98th centile or BMI >91st centile with weight-related comorbidities.

OUTCOME MEASURES

Primary outcome measure was change in BMI SDS from baseline at 12 months. Dependent variables of cognitive functioning and school achievement were assessed at baseline and 12 months, using dependent variables of cognitive functioning (elements of Ravens Standard Progressive Matrices, Wide Range Achievement Test-fourth edition and Wechsler Intelligence Scale for Children-fourth edition).

RESULTS

At baseline, BMI SDS was not associated with all aspects of cognitive function tested (n=69). Reductions in BMI SDS over time did not alter cognitive function overall. However, there was a greater reduction in comprehension standard scores in participants who increased their BMI SDS (adjusted estimated difference -6.1, 95% CI -11.6 to -0.6; p=0.03).

CONCLUSIONS

There were no observed associations between BMI SDS and cognitive function in participants, apart from comprehension in the exploratory analyses, which may have been a random finding. Further studies need to include larger longitudinal cohorts incorporating a wider BMI range at entry to determine whether our findings persist.

TRIAL REGISTRATION NUMBER

ANZCTR12611000862943; Pre-results.

Increased Adiposity as a Potential Risk Factor for Lower Academic Performance: A Cross-Sectional Study in Chilean Adolescents from Low-to-Middle Socioeconomic Background

We explored the association between excess body fat and academic performance in high school students from Santiago, Chile. In 632 16-year-olds (51% males) from low-to-middle socioeconomic status (SES), height, weight, and waist circumference were measured. Body-mass index (BMI) and BMI for age and sex were calculated. Weight status was evaluated with 2007 World Health Organization (WHO) references. Abdominal obesity was diagnosed with International Diabetes Federation (IDF) references. Total fat mass (TFM) was measured with dual-energy X-ray absorptiometry (DXA). TFM values ≥25% in males and ≥35% in females were considered high adiposity. School grades were obtained from administrative records. Analysis of covariance examined the association of fatness measures with academic performance, accounting for the effect of diet and physical activity, and controlling SES background and educational confounders. We found that: (1) having obesity, abdominal obesity, or high adiposity was associated with lower school performance alone or in combination with unhealthy dietary habits or reduced time allocation for exercise; (2) high adiposity and abdominal obesity were more clearly related with lower school grades compared to obesity; (3) the association of increased fatness with lower school grades was more salient in males compared to females.

A Mediation Analysis on the Relationship of Physical Fitness Components, Obesity, and Academic Performance in Children

OBJECTIVES

To examine the relationship between a battery of obesity indicators and physical fitness components with academic performance in children and to explore the combined and mediation role of the physical fitness components in the relationship between obesity and academic performance in children.

STUDY DESIGN

A cross-sectional study including data from 250 Spanish schoolchildren (Balearic Islands) between 10 and 12 years of age (mean age, 10.98 ± 0.76 years) was conducted. Obesity measures (body mass index, body fat, waist circumference, hip circumference, and waist-to-height ratio), physical fitness components (cardiorespiratory fitness, muscular fitness, and speed-agility), and academic performance (Spanish language, Catalan language, English language, natural sciences, social sciences, arts, physical education, religion, and grade point average [GPA]) were collected.

RESULTS

All obesity measures were negatively related to at least 3 of the 10 academic indicators, including GPA (β range, -0.135 to -0.229; all P < .05). Cardiorespiratory fitness and speed-agility were positively related to all academic indicators (β range, 0.182 to 0.350; all P < .046) and muscular fitness with 3 academic indicators (β range, 0.143 to 0.253; all P < .039). Children considered as fit had better academic performance than their unfit peers (score +0.75; P = .001). The association between body mass index and GPA was mediated by cardiorespiratory fitness and speed-agility.

CONCLUSIONS

This investigation contributes to the current knowledge by adding evidence about the crucial role of physical fitness in terms of academic performance rather than obesity status, suggesting that physical fitness may ameliorate the negative influence of obesity on academic performance.

For richer, for poorer: the relationship between adolescent obesity and future household economic prosperity

Adolescent obesity not only has serious long-term health implications, but also the potential to lead to a socioeconomic trajectory of lower earnings and household income. However, the magnitude and mechanisms of such outcomes across the life course are poorly understood. Using birth cohort data from the British National Child Development Study (1958 to 2008), we examined the relationship between adolescent obesity (at age 16) and future household income, employment, wages, marriage and spousal earnings when individuals were in their 30s, 40s and 50s. We additionally investigated the role of obesity persistence from childhood (age 11) through to adulthood (age 33). After adjusting for a rich set of childhood characteristics, compared to normal weight, obesity at age 16 was associated with significantly lower levels of future household income for women (by approximately 14%), but not men. This household income penalty was greater for women with obesity in both childhood and adulthood. The household income penalty for women appeared to be driven by a lower likelihood of marriage and lower spousal earnings for those who were married, and not by their own wage penalty in the labour market. The spousal earnings penalty occurred even when obesity did not persist into adulthood.

Impact of Early-Life Weight Status on Cognitive Abilities in Children

OBJECTIVE

Whether obesity is associated with childhood cognition is unknown. Given the sensitivity of the developing brain to environmental factors, this study examined whether early-life weight status was associated with children's cognition.

METHODS

Using data from mother-child pairs enrolled in the Health Outcomes and Measures of the Environment (HOME) Study (2003-2006), children's early-life weight status was assessed using weight-for-length/height standard deviation (SD) scores. A battery of neuropsychological tests was administered to assess cognition, executive function, and visual-spatial abilities at ages 5 and 8 years. Using linear mixed models, associations between early-life weight status and cognition were estimated.

RESULTS

Among 233 children, 167 were lean (≤1 SD) and 48 were nonlean (>1 SD). After covariate adjustment, the results suggest that full-scale intelligence quotient scores decreased with a 1-unit increase in weight-for-height SD score (β = -1.4, 95% CI: -3.0 to 0.1). For individual component scores, with a 1-unit increase in weight-for-height SD score, perceptual reasoning (β = -1.7, 95% CI: -3.3 to 0.0) and working memory (β: -2.4, CI: -4.4 to -0.4) scores decreased. Weight status was generally not associated with other cognition measures.

CONCLUSIONS

Within this cohort of typically developing children, early-life weight status was inversely associated with children's perceptual reasoning and working memory scores and possibly with full-scale intelligent quotient scores.

Protocol for an economic evaluation of WHO STOPS childhood obesity stepped-wedge cluster randomised controlled trial

INTRODUCTION

Prevention of overweight and obesity in childhood is a priority because of associated acute and chronic conditions in childhood and later in life, which place significant burden on health systems. Evidence suggests prevention should engage a range of actions and actors and target multiple levels. The Whole of Systems Trial Of Prevention Strategies for childhood obesity (WHO STOPS) will evaluate the outcomes of a novel systems-based intervention that aims to engage whole communities in a locally led multifaceted response. This paper describes the planned economic evaluation of WHO STOPS and examines the methodological challenges for economic evaluation of a complex systems-based intervention.

METHODS AND ANALYSIS

Economic evaluation alongside a stepped-wedge cluster randomised controlled trial in regional and rural communities in Victoria, Australia. Cost-effectiveness and cost-utility analyses will provide estimates of the incremental cost (in $A) per body mass index unit saved and quality adjusted life year gained. A Markov cohort model will be employed to estimate healthcare cost savings and benefits over the life course of children. The dollar value of community resources harnessed for the community-led response will be estimated. Probabilistic uncertainty analyses will be undertaken to test sensitivity of results to plausible variations in all trial-based and modelled variables. WHO STOPS will also be assessed against other implementation considerations (such as sustainability and acceptability to communities and other stakeholders).

ETHICS AND DISSEMINATION

The trial is registered by the Australian New Zealand Clinical Trials Registry (ACTRN12616000980437). Full ethics clearances have been received for all methods described below: Deakin University's Human Research Ethics Committee 2014-279, Deakin University's Human Ethics Advisory Group-Health (HEAG-H) HEAG-H 194_2014, HEAG-H 17 2015, HEAG-H 155_2014, HEAG-H 197_2016, HEAG-H 118_2017, the Victorian Department of Education and Training 2015_002622 and the Catholic Archdiocese of Ballarat. Trial findings (including economic evaluation) will be published in peer-reviewed journals and presented at international conferences. Collected data and analyses will be made available in accordance with journal policies and study ethics approvals. Results will be presented to relevant government authorities with an interest in cost-effectiveness of these types of interventions.

TRIAL REGISTRATION NUMBER

ACTRN12616000980437; Pre-results.

Longitudinal Associations Between Childhood Obesity and Academic Achievement: Systematic Review with Focus Group Data

PURPOSE

The purposes of this study were to review the evidence on longitudinal associations between child and adolescent obesity and academic achievement and to provide perceptions of adolescents with obesity and their parents on this topic.

RECENT FINDINGS

Synthesis of 31 studies (from 17 cohorts) suggested that relationships between obesity and academic achievement are not well established, except for adolescent girls' maths attainment, potentially mediated by both weight-related bullying and executive cognitive functions. Focus groups with adolescent girls with obesity confirmed experiences of psychosocial distress at school particularly during Physical Education. Adolescents perceived that obesity was not related to academic achievement directly, but by their attitude to school. Interventions are warranted to promote psychosocial wellbeing and cognitive abilities linked to academic achievement in adolescent girls with obesity. Physical Education should be a positive experience for children and adolescents with obesity.

Obese Adolescents Show Reduced Cognitive Processing Speed Compared with Healthy Weight Peers

BACKGROUND

Childhood obesity and obesity-associated diabetes and metabolic syndrome (MetS) continue to rise. Obesity has been linked to structural and functional brain abnormalities, particularly in the frontal lobe.

METHODS

One hundred sixty-two adolescents (aged 19.53 ± 1.53 years) underwent medical, neurocognitive, and brain magnetic resonance imaging assessments. Participants were either healthy weight (BMI <25.0 kg/m² or BMI percentile <85%) or obese (BMI ≥30.0 kg/m² or BMI percentile ≥95%). We evaluated frontal lobe cognitive functions and the size of the corpus callosum (CC).

RESULTS

Groups differed on four measures of processing speed contained in four different cognitive tests, but not on executive function. A confirmatory factor analysis verified that the significant processing speed variables loaded on the same factor. We also found differences between the weight groups on the area of the anterior portion of the CC, but not the overall CC. Only the Controlled Oral Word Association Test (COWAT) was significantly correlated with the area of the anterior portion of the CC. In the obese group, 32.4% met criteria for MetS. No differences were found between obese participants with or without MetS and none of the MetS factors contributed consistently to cognitive performance.

CONCLUSIONS

Obese adolescents show slower cognitive processing speed while maintaining equivalent performance on executive functioning compared with their healthy weight peers. The group differences in the anterior portion of the CC, responsible for frontal lobe interhemispheric communication, may in part explain our processing speed findings. Future studies should include a longitudinal design and diffusion tensor imaging to examine the integrity of white matter.

Cognitive functions among predominantly minority urban adolescents with metabolic syndrome

The rise in the rate of adolescent obesity has led to a concurrent rise in the rate of metabolic syndrome (MetS) among young people. In addition to diabetes and cardiovascular disease, MetS has also been linked to cognitive dysfunction. The goal of this study was to assess whether cognitive differences exist between minority urban adolescents carrying excess weight who meet criteria for MetS as compared to their peers without MetS. Two hundred and ninety-six urban adolescents, predominantly Hispanic and carrying excess weight as defined by a BMI above 25 kg/m², were screened for MetS and divided into MetS and no MetS groups. All participants completed the CNS Vital Signs (CNS-VS) computerized neurocognitive battery that assesses cognitive domains of Memory, Processing Speed, Reaction Time, Executive Function, Complex Attention, and Cognitive Flexibility. The MetS group (29.2%, n = 84) performed significantly lower on 2 of the 7 cognitive domains: Executive Function (EF) and Cognitive Flexibility. Additionally, waist circumference was determined to be a significant predictor of both these domains. These findings suggest EF is negatively impacted in adolescents with MetS, despite there being no statistical differences between MetS groups on most other measured cognitive domains. Due to the interrelated nature of obesity, waist circumference, and MetS, these findings have larger implications for the obesity epidemic as well.