Pediatric adiposity stabilized in Switzerland between 1999 and 2012

Significant Decrease in Childhood Obesity and Waist Circumference over 15 Years in Switzerland: A Repeated Cross-Sectional Study

Despite a global increase in childhood obesity over the past decades, several countries, including Switzerland, have recently reported stabilizing trends. Using national data from school-aged children in Switzerland over the past 16 years, our study aim was to assess changes in the prevalence of overweight and obesity, central adiposity and predictors of obesity related to lifestyle and parental factors. Nationally representative samples of children aged 6–12 years were studied in 2002 (n = 2493), 2007 (n = 2218), 2012 (n = 2963), and 2017/18 (n = 2279). Height and weight, waist circumference, and multiple skinfold thicknesses were measured. Potential risk factors for overweight and obesity were determined using a self-administered questionnaire in 2017/18, collecting data on diet, physical activity, and parental factors. Prevalence (95% CI) of overweight (incl. obesity) and obesity in 2017/18 was 15.9% (14.4–17.4) and 5.3% (4.5–6.3), respectively. Binary logistic regression revealed a small but significant decrease in the prevalence of overweight (including obesity) since 2002 (OR (95% CI) = 0.988 (0.978–0.997)), while the change in obesity alone was not significant. The most important risk factors for childhood overweight/obesity in 2017/18 were low parental education, non-Swiss origin of the parents, low physical activity of the child, and male sex. In conclusion, we have shown a small but significant declining trend in the childhood overweight/obesity prevalence over the past 15 years in Switzerland. Based on the risk factor analysis, preventive action in schoolchildren might be most effective in boys, migrant populations, and families with lower education, and should emphasize physical activity.

Overweight in childhood cancer patients at diagnosis and throughout therapy: A multicentre cohort study

BACKGROUND

Childhood cancer patients (CCP) have been reported to be at increased risk of becoming overweight during treatment. We assessed prevalence of overweight in CCP at diagnosis and at the end of treatment, determined risk factors, and identified weight change during treatment by type of cancer.

METHODS

In a multicentre cohort study, we collected height and weight measurements of CCP at diagnosis and repeatedly during treatment. We calculated age- and sex-adjusted BMI Z-scores using references of the International Obesity Taskforce for children. Risk factors were described by multivariable linear regression, and weight change during treatment by multilevel segmented linear regression.

RESULTS

The study included 327 CCP with a median age of 7 years (IQR 3-12) at diagnosis (55% boys), who had been diagnosed with acute lymphoblastic leukaemia (ALL, 29%), lymphoma (16%), central nervous system (CNS) tumours (13%), sarcoma (18%), and other types of cancer (24%). At diagnosis, 27 CCP (8%) were overweight. This increased to 43 (13%) at end of treatment, on average 0.7 years after diagnosis. Being a boy (p = 0.005) and having been diagnosed with ALL or lymphoma (p < 0.001) were risk factors for weight gain during treatment. During the first half of treatment, BMI Z-scores increased in ALL (regression slope β = 0.4, 95% CI 0.1-0.7) and lymphoma (β = 1.5, 95% CI 0.2-2.9) patients, whereas for patients with CNS tumours (β = -1.4, 95% CI -2.7 to -0.2), sarcoma (β = -1.4, 95% CI -2.0 to -0.7), or other types of cancer (β = -0.3, 95% CI -1.5-0.9) BMI Z-scores tended to drop initially. During the second half of treatment BMI Z-scores of all patients tended to increase. Exploratory analyses showed that BMI Z-scores of younger ALL patients (<7 years at diagnosis) increased during induction (β = 3.8, 95% CI 0.5-7.0). The inverse was seen for older ALL patients (≥7 years at diagnosis), in whom BMI Z-scores tended to decrease during induction (β = -1.5, -5.1-2.2), both groups tended to increase afterwards.

CONCLUSION

CCP diagnosed with ALL or lymphoma are at increased risk of weight gain during treatment, and might particularly benefit from early lifestyle interventions.

Secular trends in the prevalence of childhood overweight and obesity across Australian states: A meta-analysis

OBJECTIVE

To describe secular trends in the prevalence of overweight and obesity in Australian children in each state and territory.

DESIGN

Systematic search and numerical meta-analysis.

METHODS

A systematic search was conducted to identify all sources that objectively measured the height and weight of Australian children (aged 2-18 years) and had a sample size of at least 300. Raw and summary data were requested from authors and divided into age×sex×state×yearly slices to derive estimates of the prevalence of overweight and obesity. Following a double arcsine transformation to facilitate meta-analysis, all estimates were standardised for age, stratified by sex and analysed using sample-weighted non-linear regressions.

RESULTS

The systematic search identified 73 eligible sources (47 raw and 26 summary datasets), with 72.8% of data sourced from Victoria and South Australia. Prevalence trends varied from state to state, with three states or territories showing a marked plateau, two showing a decline in the more recent years and three showing continued linear increases. Tasmania and Northern Territory generally had the highest prevalence (30.2% and 24.3% overweight and obesity respectively), and the Australian Capital Territory had the lowest (12.4% overweight and obesity).

CONCLUSIONS

Prevalence, as well as prevalence trends, varied amongst Australian states and territories. At a national level, the prevalence trend has nearly plateaued for the past 15 years. However, upward prevalence trends appear to be persisting in Western Australia, South Australia and Tasmania. Findings highlight the need for ongoing efforts to address the issue of childhood obesity.

Finding big shots: small-area mapping and spatial modelling of obesity among Swiss male conscripts

BACKGROUND

In Switzerland, as in other developed countries, the prevalence of overweight and obesity has increased substantially since the early 1990s. Most of the analyses so far have been based on sporadic surveys or self-reported data and did not offer potential for small-area analyses. The goal of this study was to investigate spatial variation and determinants of obesity among young Swiss men using recent conscription data.

METHODS

A complete, anonymized dataset of conscription records for the 2010-2012 period were provided by Swiss Armed Forces. We used a series of Bayesian hierarchical logistic regression models to investigate the spatial pattern of obesity across 3,187 postcodes, varying them by type of random effects (spatially unstructured and structured), level of adjustment by individual (age and professional status) and area-based [urbanicity and index of socio-economic position (SEP)] characteristics.

RESULTS

The analysed dataset consisted of 100,919 conscripts, out of which 5,892 (5.8 %) were obese. Crude obesity prevalence increased with age among conscripts of lower individual and area-based SEP and varied greatly over postcodes. Best model's estimates of adjusted odds ratios of obesity on postcode level ranged from 0.61 to 1.93 and showed a strong spatial pattern of obesity risk across the country. Odds ratios above 1 concentrated in central and north Switzerland. Smaller pockets of elevated obesity risk also emerged around cities of Geneva, Fribourg and Lausanne. Lower estimates were observed in North-East and East as well as south of the Alps. Importantly, small regional outliers were observed and patterning did not follow administrative boundaries. Similarly as with crude obesity prevalence, the best fitting model confirmed increasing risk of obesity with age and among conscripts of lower professional status. The risk decreased with higher area-based SEP and, to a lesser degree - in rural areas.

CONCLUSION

In Switzerland, there is a substantial spatial variation in obesity risk among young Swiss men. Small-area estimates of obesity risk derived from conscripts records contribute to its understanding and could be used to design further studies and interventions.

Trends in childhood obesity and central adiposity between 1998-2001 and 2010-2012 according to household income and urbanity in Korea

BACKGROUND

This study examined trends in body mass index (BMI), waist circumference (WC), and childhood overweight and obesity prevalence between 1998-2001 and 2010-2012 according to household income and urbanity among nationally representative Korean children and adolescents aged 10-19.

METHODS

The repeated cross-sectional data from Korean National Health and Nutrition Examination Surveys in 1998-2001 and 2010-2012 were used. Gender specific trends in age-adjusted means of WC and BMI by household equivalized income and urbanity were compared between years. The age-standardized prevalence of childhood overweight and obesity was calculated using three international criteria (International Obesity Task Force, World Health Organization, US Centers for Disease Control and Prevention) and a Korean national reference standard.

RESULTS

Among boys, overall BMI and overweight prevalence increased between 1998-2001 and 2010-2012, while overall WC decreased. Clear gender differences were found in the relationship of childhood obesity metrics with household income and urbanity and the time trends of those relationships. Positive relationships between these parameters were found for boys while negative relationships appeared for girls. In addition, compared with the childhood obesity prevalence among boys in rural areas, the prevalence among boys in urban areas were slightly lower in 1998-2001 but became greater in 2010-2012.

CONCLUSIONS

This study revealed gender difference in the association of childhood obesity with household income and urbanity and its time trends. The long-term gender-specific monitoring of socioeconomic and urban-rural differences in childhood obesity measures is warranted in South Korea.

Trends in Measures of Childhood Obesity in Korea From 1998 to 2012

BACKGROUND

During the last several decades, the number of children who are overweight or obese has reached alarming levels worldwide. The purpose of the present study was to examine trends in measures of childhood obesity among Korean children aged 2-19 from 1998 to 2012.

METHODS

Height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated. Age-adjusted means of WC and BMI were compared between years. We used three international criteria (International Obesity Task Force [IOTF], World Health Organization [WHO], United States Centers for Disease Control and Prevention [CDC]) and a Korean national reference standard (Korea Centers for Disease Control and Prevention [KCDC]) to calculate age-standardized prevalence of childhood overweight and obesity.

RESULTS

Despite differences in absolute prevalence of childhood overweight and obesity according to the four different criteria, the time trends of prevalence were generally similar across criteria. The prevalence of childhood overweight and obesity generally stabilized from 2001-2012 in both boys and girls. WC decreased from 2001-2012 in both boys and girls aged 2-19.

CONCLUSIONS

Further studies exploring the factors causing plateaued trends of childhood obesity measures are needed to implement effective policies for reducing the prevalence of childhood overweight and obesity.

Localization of Physical Activity in Primary School Children Using Accelerometry and Global Positioning System

Background

Ecological approaches have highlighted the importance of the built environment as a factor affecting physical activity. However, knowledge on children’s activity patterns is still incomplete. Particularly, data on the spatial context of physical activity is limited, which limits the potential to design location-based interventions effectively. Using global positioning system (GPS) and accelerometry, this study aimed to identify locations where children engage in moderate-vigorous physical activity (MVPA).

Methods

Participants included 119 children (11–14 years, 57% girls) from public schools in Winterthur, Switzerland. During a regular school week between February and April 2013, children wore an accelerometer and GPS sensor for seven consecutive days. Time-matched accelerometer and GPS data was mapped with a geographic information system and each data point was assigned to one of seven defined activity settings. Both the absolute amount of MVPA and proportion of time in MVPA were calculated for every setting. Multilevel analyses accounting for the hierarchical structure of the data were conducted to investigate any gender differences.

Results

Children achieved most MVPA on streets (34.5%) and on school grounds (33.4%). The proportion children spent in MVPA was highest in recreational facilities (19.4%), at other schools (19.2%) and on streets (18.6%). Boys accumulated significantly more MVPA overall and on other school grounds (p < 0.05) and showed a significantly higher proportion of time in MVPA at own school and outside of Winterthur (p < 0.05).

Conclusions

The results indicate the importance of streets and school grounds as activity-promoting environments. The high use of streets may be an indicator for active transportation, which appears to contribute to an active lifestyle in both genders. In contrast, the school setting is more likely to encourage physical activity in boys. Recreational facilities seem to be conducive for MVPA among both genders, although infrequently visited during the week of measurement.

Should children with overweight or obesity be excluded from height references?

BACKGROUND AND OBJECTIVES

Growth reference charts are usually based on measurements of children free from a medical condition that affects growth. However, samples collected during the past decades often contain a large proportion of overweight or obese children. Because obesity increases linear growth, the question arises to what extent the percentiles curves for length/height are affected by the presence of children with overweight or obesity.

METHODS

Data from two cross-sectional samples of 2-year-old to 18-year-old children were analysed: 12,252 Belgian children, measured in 2002-2004, and 6159 Norwegian children, measured in 2003-2006. The LMS method was used to estimate height-for-age curves with and without children considered overweight or obese according to the International Obesity Task Force thresholds.

RESULTS

The prevalence of overweight (including obesity) and obesity was 13.0% and 2.8% in the Belgian and 13.8% and 2.3% in the Norwegian sample. Children were taller when overweight (+0.49 and 0.43 SD, in the Belgian and Norwegian sample, respectively) or obese (+0.73 and 0.72 SD in the Belgian and Norwegian sample, respectively). Effect sizes were smaller in younger and older children, which points to an advanced age of maturation as a possible cause. Excluding overweight and obese children had only a minor impact on the growth curves with largest difference in mean height SD scores -0.09 in the Belgian and -0.12 in the Norwegian sample with a corresponding increase of up to 0.5% and 1.2% in number of children >+2 SD.

CONCLUSIONS

Current Belgian and Norwegian growth references for length/height were found to be largely unaffected by the current proportion of overweight and obese children. There is, therefore, no need for revised height charts that exclude overweight or obese children.

Risk factors for overweight and obesity in Swiss primary school children: results from a representative national survey

PURPOSE

Obesity is a global epidemic affecting around 10 % of 5- to 17-year olds. With the causes for obesity being multifactorial, a better understanding of the influencing factors is essential for effective treatment and prevention programs. The aim of this study was therefore to identify specific risk factors for overweight and obesity in children in Switzerland.

METHODS

A nationally representative sample of children aged 6-12 years was recruited (n = 2724). Height and weight were measured to calculate BMI (kg/m(2)). In addition, a questionnaire was distributed to all children asking about their physical activity, media consumption, and dietary habits as well as some parental factors.

RESULTS

The prevalence of overweight and obesity in boys was 11.8 and 7.5 %, respectively, and in girls, it was 11.9 and 5.7 %. In univariate analyses, a number of parental, dietary, and activity factors were shown to be associated with BMI category. Based on a multinomial logistic regression, parent nationality and media consumption were the most important factors predicting obesity in boys, while in girls it was parental education, nationality, and physical activity.

CONCLUSION

We have demonstrated that parental nationality and education play an important role in the development of childhood obesity, together with media consumption and physical activity. However, risk factors are also different according to child gender. Thus, an important target group for the treatment and prevention of childhood obesity in Switzerland are immigrant families, and the problem needs to be tackled differently in boys and girls as their risk factors are not the same.

Medical and non-medical complications among children and adolescents with excessive body weight

BACKGROUND

The burden of disease from childhood obesity is considerable worldwide, as it is associated with several co-morbidities, such as dyslipidemia, hypertension, type 2 diabetes (T2DM), orthopedic and psychosocial problems. We aimed at determining the prevalence of these complications in a population of children and adolescents with body weight excess.

METHODS

This is a cohort study including 774 new patients (1.7 - 17.9 yrs, mean 11.1 ± 3.0) attending a pediatric obesity care center. We assessed personal and family medical histories, physical examination, systemic blood pressure, biochemical screening tests.

RESULTS

We found that the great majority of the children suffered from at least one medical complication. Orthopedic pathologies were the most frequent (54%), followed by metabolic (42%) and cardiovascular disturbances (31%). However, non-medical conditions related to well-being, such as bullying, psychological complaints, shortness of breath or abnormal sleeping patterns, were present in the vast majority of the children (79.4%). Family history of dyslipidemia tends to correlate with the child's lipids disturbance (p = .053), and ischemic events or T2DM were correlated with cardiovascular risk factors present in the child (p = .046; p = .038, respectively).

CONCLUSIONS

The vast majority of obese children suffer from medical and non-medical co-morbidities which must be actively screened. A positive family history for cardiovascular diseases or T2DM should be warning signs to perform further complementary tests. Furthermore, well-being related-complaints should not be underestimated as they were extremely frequent.

Socioeconomic, temporal and regional variation in body mass index among 188,537 Swiss male conscripts born between 1986 and 1992

Background

Rising levels of overweight and obesity are important public-health concerns worldwide. The purpose of this study is to elucidate their prevalence and trends in Switzerland by analyzing variations in Body Mass Index (BMI) of Swiss conscripts.

Methods

The conscription records were provided by the Swiss Army. This study focussed on conscripts 18.5–20.5 years of age from the seven one-year birth cohorts spanning the period 1986–1992. BMI across professional status, area-based socioeconomic position (abSEP), urbanicity and regions was analyzed. Two piecewise quantile regression models with linear splines for three birth-cohort groups were used to examine the association of median BMI with explanatory variables and to determine the extent to which BMI has varied over time.

Results

The study population consisted of 188,537 individuals. Median BMI was 22.51 kg/m² (22.45–22.57 95% confidence interval (CI)). BMI was lower among conscripts of high professional status (−0.46 kg/m²; 95% CI: −0.50, −0.42, compared with low), living in areas of high abSEP (−0.11 kg/m²; 95% CI: −0.16, −0.07 compared to medium) and from urban communities (−0.07 kg/m²; 95% CI: −0.11, −0.03, compared with peri-urban). Comparing with Midland, median BMI was highest in the North-West (0.25 kg/m²; 95% CI: 0.19–0.30) and Central regions (0.11 kg/m²; 95% CI: 0.05–0.16) and lowest in the East (−0.19 kg/m²; 95% CI: −0.24, −0.14) and Lake Geneva regions (−0.15 kg/m²; 95% CI: −0.20, −0.09). Trajectories of regional BMI growth varied across birth cohorts, with median BMI remaining high in the Central and North-West regions, whereas stabilization and in some cases a decline were observed elsewhere.

Conclusions

BMI of Swiss conscripts is associated with individual and abSEP and urbanicity. Results show regional variation in the levels and temporal trajectories of BMI growth and signal their possible slowdown among recent birth cohorts.