Overweight in children: definitions, measurements, confounding factors, and health consequences

Moving beyond moderate-to-vigorous physical activity: the role of light physical activity during adolescence

Regular physical activity is an important component of a healthy lifestyle for young people. However, an estimated 80% of adolescents globally are insufficiently active. Traditionally, health benefits were attributed only to physical activity of at least moderate intensity, and recommendations focused on achieving a threshold of moderate-to-vigorous physical activity, without consideration of other aspects of movement within the 24 h cycle. Recently, the overall daily balance of active and sedentary behaviours has gained recognition as an important determinant of health. However, the relationship between light intensity physical activity and health has not been fully explored. In this perspective paper, we discuss key challenges in defining, measuring and analysing light physical activity which have hindered the advancement of knowledge in this area. Next, we suggest three ways in which light physical activity may enhance adolescent wellbeing: firstly, by replacing sedentary behaviours to increase daily movement; secondly, by supporting the accumulation of higher intensities of physical activity; and thirdly, by providing positive experiences to facilitate lifelong engagement with physical activity. In highlighting the importance of light physical activity during adolescence, we aim to encourage critical reflection and the exploration of new approaches towards physical activity within public health and beyond.

Parents' perception of health promotion: What do parents think of a healthy lifestyle in parenting and the impact of the school environment? A qualitative research in the Netherlands

PURPOSE

This study aimed at gaining insight into parents' perceptions towards health behaviour in parenting and the impact of the school environment. Healthcare professionals experience barriers to discuss health behaviour in families where levels of overweight and obesity are elevated. There is a need to understand parents' perception and perceived significance of health behaviour.

DESIGN AND METHODS

Sixty-three semi-structured interviews were conducted with parents of children from three primary schools located in two different neighbourhoods in Zwolle, the Netherlands. Parents were asked to formulate their top three priority goals in parenting, additionally supplemented with 15 predetermined goals, including a health behaviour related goal. Parents ranked the goals in order of importance and gave an explanation. Finally, parents shared their opinions regarding the school environment in promoting health behaviour, according to the EnrG framework.

RESULTS

In 8 out of 63 interviews, health was reported in the top three self-formulated goals. Other goals considered important were happiness and being respectful to others. When health was ranked as less important in parenting, routine of health behaviour, own beliefs and religion were given as explanations. The physical school environment and teachers were mentioned as important factors in promoting health behaviour.

CONCLUSIONS

Parents indicate health behaviour as a key-element in parenting, even when health behaviour is not considered as the most important priority.

PRACTICE IMPLICATIONS

Since school is perceived as a logical and powerful environment, healthcare professionals should collaborate with school staff to empower their own, teachers' and parents' roles to address health promotion.

Infant feeding and growth trajectories in early childhood: the application and comparison of two longitudinal modelling approaches

BACKGROUND/OBJECTIVES

The role of infant feeding practices in longitudinal growth trajectories in children remains equivocal. This study utilised two longitudinal approaches to examine the associations of infant feeding mode (breastfeeding, mixed feeding, formula feeding), breastfeeding duration, and the timing of solid foods introduction with body mass index (BMI) z-score in early childhood.

SUBJECTS/METHODS

Secondary analyses of data from the Healthy Beginnings Trial were conducted. Infant feeding practices were reported by mothers at 6, 12, and 24 months of child age. Child weight and length were measured at birth, 12, 24, 42, and 60 months. Two longitudinal approaches: linear spline multilevel model (LSMM) and group-based trajectory modelling (GBTM) were used to describe BMI z-score trajectories and assess its associations with infant feeding practices.

RESULTS

The LSMM approach demonstrated that the breastfeeding group showed lower BMI z-scores from ages 12 to 60 months than the mixed feeding and formula feeding groups. Children who were breastfed for ≥ 6 versus < 6 months exhibited a lower BMI z-score trajectory from ages 12 to 60 months. Results from the GBTM approach revealed that the mixed feeding (OR: 1.83, 95%CI 1.04, 3.21) and the formula feeding group (OR: 2.00, 95%CI 0.67, 5.92) showed a tendency for higher odds of following the "High BMIz" trajectory than the breastfeeding group. Breastfeeding duration ≥6 versus < 6 months was linked with lower odds of following the "High BMIz" trajectory (OR 0.65, 95%CI 0.43, 0.98). Both approaches revealed no evidence of an association between the timing of solid foods introduction and BMI z-score trajectory.

CONCLUSIONS

The two longitudinal approaches revealed similar findings that infant feeding mode and breastfeeding duration, but not the timing of solid foods introduction, were associated with BMI z-score trajectory in early childhood. The findings provide robust longitudinal evidence to encourage and support extended breastfeeding for childhood obesity prevention.

Growth patterns from birth to overweight at age 5-6 years of children with various backgrounds in socioeconomic status and country of origin: the ABCD study

INTRODUCTION

Children from minority groups are at increased risk of overweight. This study compared BMI growth patterns from birth onwards of boys and girls with overweight at 5-6 years, according to socioeconomic status (SES) and country of origin, in order to gain more insight into the critical periods of growth to overweight.

METHODS

A total of 3714 singletons of the multi-ethnic ABCD study were included. Within children with overweight at age 5-6 years (N = 487, prevalence boys: 11.6%, girls: 14.6%), BMI growth patterns from birth onwards (12.8 serial measurements; SD = 3.1) were compared between children from European (69.4%) and non-European mothers (30.6%), and between children from low (20.8%), mid (37.0%) or high SES (42.2%), based on maternal educational level.

RESULTS

BMI growth to overweight did not differ between children of European or non-European mothers, but it did differ according to maternal SES. Children with overweight in the low and mid SES group had a lower BMI in the first 2 years of life, an earlier adiposity rebound and increased in BMI more rapidly after age 2, resulting in a higher BMI at age 7 years compared to children with overweight in the high SES group [∆BMI (kg/m2 ) between high and low SES: boys 1.43(95%CI:0.16;3.01) and girls 1.91(0.55;3.27)].

CONCLUSION

Children with overweight from low SES have an early adiposity rebound and accelerated growth to a higher BMI at age 5-6 years compared to children with overweight from the high SES group. These results imply that timing of critical periods for overweight development is earlier in children with a low socioeconomic background as compared to other children.

Trends of Child's Weight Perception by Children, Parents, and Healthcare Professionals during the Time of Terminology Change in Childhood Obesity in the United States, 2005-2014

OBJECTIVE

To investigate the changes on self- and parental weight perceptions and parental communication with healthcare professionals (HCPs) in the United States during the mid-2000s period when the terminology changed for classifications of childhood obesity/overweight.

METHODS

A repeated cross-sectional study was conducted with 6799 children aged 8-15 years with the National Health and Nutrition Examination Survey 2005-2014. BMI was calculated from objectively measured heights and weights, and children were classified as normal/underweight, overweight or obese, using the new terminology. Children reported their own weight status. Parents reported their child's weight status and reported how HCPs described their children's weight status. Logistic regressions were used to investigate changes in weight perceptions among overweight/obese children themselves and their parents and parental communication with HCPs about children's overweight/obesity status during the time of the terminology change.

RESULTS

The proportion of parents told by HCPs about children's weight status increased for overweight children [6.8% in 2005-2006 to 18.8% in 2013-2014, p for trend (ptrend = 0.02)], and marginally increased between 2005-2006 (37.1%) and 2007-2008 (45.4%) for obese children (p = 0.09). However, parental perceptions for obese/overweight children did not change. Also, obese children's weight perception did not change, and the proportion of overweight children who perceived their weight status accurately declined in 2005-2012 (25.9%-16.4%, ptrend = 0.02).

CONCLUSIONS

Although the terminology change about childhood obesity/overweight was associated with increased communication about child's weight status by HCPs, the accuracy of weight perceptions among obese/overweight children or their parents did not improve or declined.

Differences in intermittent postural control between normal-weight and obese children

AIM

The main objective of this study was to determine differences in postural control between obese and non-obese children.

METHODS

The study design was cross-sectional, prospective, between-subjects. Postural control variables were obtained from a group of obese children and a normal-weight control group under two different postural conditions: bipedal standing position with eyes open and bipedal standing with eyes closed. Variables were obtained for each balance condition using time domain and sway-density plot analysis of the center of pressure signals acquired by means of a force plate.

RESULTS

Pairwise comparisons revealed significant differences between obese and normal-weight children in mean velocity in antero-posterior and medio-lateral directions, ellipse area and mean distance with both eyes open and eyes closed. Normal-weight subjects obtained lower values in all these variables than obese subjects. Furthermore, there were differences between both groups in mean peaks with eyes open and in mean time with eyes closed.

CONCLUSION

Alterations were detected in the intermittent postural control in obese children. According to the results obtained, active anticipatory control produces higher center of pressure displacement responses in obese children and the periods during which balance is maintained by passive control and reflex mechanisms are of shorter duration.

Parents' obesity-related behavior and confidence to support behavioral change in their obese child: data from the STAR study

OBJECTIVE

Successful childhood obesity interventions frequently focus on behavioral modification and involve parents or family members. Parental confidence in supporting behavior change may be an element of successful family-based prevention efforts. We aimed to determine whether parents' own obesity-related behaviors were related to their confidence in supporting their child's achievement of obesity-related behavioral goals.

METHODS

Cross-sectional analyses of data collected at baseline of a randomized control trial testing a treatment intervention for obese children (n = 787) in primary care settings (n = 14). Five obesity-related behaviors (physical activity, screen time, sugar-sweetened beverage, sleep duration, fast food) were self-reported by parents for themselves and their child. Behaviors were dichotomized on the basis of achievement of behavioral goals. Five confidence questions asked how confident the parent was in helping their child achieve each goal. Logistic regression modeling high confidence was conducted with goal achievement and demographics as independent variables.

RESULTS

Parents achieving physical activity or sleep duration goals were significantly more likely to be highly confident in supporting their child's achievement of those goals (physical activity, odds ratio 1.76; 95% confidence interval 1.19-2.60; sleep, odds ratio 1.74; 95% confidence interval 1.09-2.79) independent of sociodemographic variables and child's current behavior. Parental achievements of TV watching and fast food goals were also associated with confidence, but significance was attenuated after child's behavior was included in models.

CONCLUSIONS

Parents' own obesity-related behaviors are factors that may affect their confidence to support their child's behavior change. Providers seeking to prevent childhood obesity should address parent/family behaviors as part of their obesity prevention strategies.

Swimming pool attendance, respiratory symptoms and infections in the first year of life

We evaluated the relationship between indoor and outdoor swimming pool attendance and respiratory symptoms and infections during the first year of life. A population-based mother-child cohort study was conducted in four Spanish areas (INMA project). Study subjects were recruited at pregnancy, followed to delivery and 14 months after birth. Information on swimming pool attendance and health manifestations during the first year of life was collected at 14 months: low respiratory tract infection (LRTI), persistent cough, wheezing, atopic eczema and otitis. Odds ratios and 95 % confidence interval (OR 95 %CI) were calculated by logistic regression adjusting for confounders. Among the 2,205 babies included, 37 % reported having LRTI, 37 % wheezing, 16 % persistent cough, 22 % atopic eczema, 33 % otitis and 50 % attended swimming pools during the first year of life. Around 40 % went to outdoor pools in summer with a median cumulative duration of 7.5 h/year, and 20 % attended indoor pools with a median cumulative duration of 18 h/year. Pool attendance differed by area, season of birth and sociodemographic characteristics, and was not associated with LRTI, wheezing, persistent cough, atopic eczema or otitis. Adjusted OR of wheezing and LRTI were, respectively, 1.06 (95 %CI, 0.88-1.28) and 1.09 (0.90-1.31) for babies attending vs. babies not attending pools. Stratification by type of swimming pool, cumulative duration or parental atopy did not modify the results.

CONCLUSION

No association was detected between pool attendance and LRTI, wheezing, persistent cough, atopic eczema or otitis during the first year of life in Spain.

More than just a gut instinct-the potential interplay between a baby's nutrition, its gut microbiome, and the epigenome

Substantial evidence links early postnatal nutrition to the development of obesity later in life. However, the molecular mechanisms of this connection must be further elucidated. Epigenetic mechanisms have been indicated to be involved in this process, referred to as metabolic programming. Therefore, we propose here that early postnatal nutrition (breast and formula feeding) epigenetically programs the developing organs via modulation of the gut microbiome and influences the body weight phenotype including the predisposition to obesity. Specifically, the early-age food patterns are known to determine the gross composition of the early gut microbiota. In turn, the microbiota produces large quantities of epigenetically active metabolites, such as folate and short chain fatty acids (butyrate and acetate). The spectrum of these produced metabolites depends on the composition of the gut microbiota. Hence, it is likely that changes in gut microbiota that result in altered metabolite composition might influence the epigenome of directly adjacent intestinal cells, as well as other major target cell populations, such as hepatocytes and adipocytes. Nuclear receptors and other transcription factors (the PPARs, LXR, RXR, and others) could be physiologically relevant targets of this metabolite-induced epigenetic regulation. Ultimately, transcriptional networks regulating energy balance could be manipulated. For these reasons, we postulate that early nutrition may influence the baby epigenome via microbial metabolites, which contributes to the observed relationship between early nutrition and adult obesity.

Physical activity in the prevention of childhood obesity

The current high prevalence of childhood obesity and its co-morbidities is concomitant with a low level of physical activity and an abundance of sedentary pastimes for Westernised children. To increase the participation of a majority of children in a sustained physical activity, interventions require a fair understanding and consideration of the influences of this behaviour, especially as children are overweight or obese. Basically, the physical activity behaviour of children depends on biological, sociocultural and psychosocial factors and their interplay. The recent literature lends support to the fact that some psychosocial factors such as self-efficacy and physical competence may be solid anchor points upon which to improve the participation of overweight and obese children in free-living physical activity. Thus, interventionists should first concentrate on improving these personal dimensions around which physiological and environmental factors might revolve. The development of motor skills may be a good means for enhancing the self-image of obese children.

Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies

The current review aimed to systematically identify dietary, physical activity and sedentary behaviours in preschool children (4-6 years of age) that are prospectively related to overweight or obesity later in childhood. Prospective studies published between January 1990 and June 2010 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Library. Studies examining the prospective association between at least one relevant behaviour measured during preschool period (children aged 4-6 years at baseline) in relation to at least one anthropometric measurement at follow-up (age <18 years) were included. Harvest plots were used to summarize the results and draw conclusions from the evidence. Of the 8,718 retrieved papers, 23 papers reporting on 15 different study samples were included in this review. Strong evidence was found for an inverse association between total physical activity and overweight. Moderate evidence was observed for a positive association between television viewing and overweight. Because of the heterogeneity in the assessed dietary behaviours, insufficient evidence was found for an association between dietary intake or specific dietary behaviours and overweight. These results suggest that interventions aiming to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group. However, despite the lack of evidence for dietary behaviours from the present review, future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight.

OBESITY, ACADEMIC PERFORMANCE AND REASONING ABILITY IN PORTUGUESE STUDENTS BETWEEN 6 AND 12 YEARS OLD

Obesity has been linked to several physiological and psycho-social diseases, decreases in cognitive function, poor levels of scholastic achievement, low socioeconomic status and delayed onset of maturity. This study investigates the association between obesity and both academic performance and reasoning ability in 394 male and 398 females students between the ages of 6 and 12 from Lisbon, Portugal. It also assesses how this relationship may be influenced by chronological age, maturity and socioeconomic status. The results suggest that: 1) reasoning ability is independent of socioeconomic status and level of maturity; 2) no differences in reasoning ability exist between groups of different BMI; 3) academic performance is moderated by chronological age in boys, and by maturity in both genders; 4) obesity is not associated with academic performance. It is concluded that reasoning ability and academic performance are not associated with obesity, and that inter-individual differences in academic performance in boys may be explained by differences in their level of maturity.

Federal food policy and childhood obesity: a solution or part of the problem?

Amid growing concern about childhood obesity, the United States spends billions of dollars on food assistance: providing meals and subsidizing food purchases. We examine the relationship between food assistance and body mass index (BMI) for young, low-income children, who are a primary target population for federal food programs and for efforts to prevent childhood obesity. Our findings indicate that food assistance may unintentionally contribute to the childhood obesity problem in cities with high food prices. We also find that subsidized meals at school or day care are beneficial for children's weight status, and we argue that expanding access to subsidized meals may be the most effective tool to use in combating obesity in poor children.

Moving beyond the stigma: systematic review of video games and their potential to combat obesity

Increasing epidemic proportions of overweight children in the United States presents formidable challenges for education and healthcare. Given the popularity and pervasiveness of video gaming culture in North American children, the perfect opportunity arises to investigate the potential of video games to promote healthful behaviour. Our objective was to systematically review the literature for possible benefits of active and educational video games targeting diet and physical activity in children. A review of English-language journal articles from 1998 to 2011 using EMBASE and PubMed was conducted. Thirty-four studies concerned with children, video games, physical, and/or nutritional outcomes were included. Results of these studies that showed some benefit (increased physical activity and nutritional knowledge as a result of gaming) demonstrate the possibility of video games to combat childhood obesity—looking beyond the stigma attached to gaming.

Swimming pool attendance, asthma, allergies, and lung function in the Avon Longitudinal Study of Parents and Children cohort

RATIONALE

Cross-sectional studies have reported inconsistent findings for the association between recreational swimming pool attendance and asthma and allergic diseases in childhood.

OBJECTIVES

To examine whether swimming in infancy and childhood was associated with asthma and allergic symptoms at age 7 and 10 years in a UK longitudinal population-based birth cohort, the Avon Longitudinal Study of Parents and Children.

METHODS

Data on swimming were collected by questionnaire at 6, 18, 38, 42, 57, 65, and 81 months. Data on rhinitis, wheezing, asthma, eczema, hay fever, asthma medication, and potential confounders were collected through questionnaires at 7 and 10 years. Spirometry and skin prick testing were performed at 7 to 8 years. Data for analysis were available for 5,738 children.

MEASUREMENTS AND MAIN RESULTS

At age 7 years, more than 50% of the children swam once per week or more. Swimming frequency did not increase the risk of any evaluated symptom, either overall or in atopic children. Children with a high versus low cumulative swimming pool attendance from birth to 7 years had an odds ratio of 0.88 (95% confidence interval, 0.56-1.38) and 0.50 (0.28-0.87), respectively, for ever and current asthma at 7 years, and a 0.20 (0.02-0.39) standard deviation increase in the forced midexpiratory flow. Children with asthma with a high versus low cumulative swimming had an odds ratio for current asthma at 10 years of 0.34 (0.14-0.80).

CONCLUSIONS

This first prospective longitudinal study suggests that swimming did not increase the risk of asthma or allergic symptoms in British children. Swimming was associated with increased lung function and lower risk of asthma symptoms, especially among children with preexisting respiratory conditions.

Parental perceptions of their child's overweight: an integrative review of the literature

This integrative review described recent published data addressing parental perceptions of their child's overweight. Seventeen studies met the inclusion criteria for the study. Parents of overweight children underestimate their child's weight status or are not concerned about the risks associated with overweight. Child age, gender, and ethnicity may influence parental perceptions of child overweight. Some parents may use criteria other than growth charts to perceive overweight as a problem. Health care providers need to understand parents' perceptions to tailor effective child weight loss interventions. A formalized tool is needed to aid practitioners in identifying parental perceptions of child overweight.

Systematic review of childhood obesity prevention

This systematic review identified the current state of the evidence related to the prevention of obesity in young children. The results indicate five areas of emphasis in the literature: prevalence of the problem; prevention as the best option; preschool population as the target; crucial parental involvement; and numerous guidelines. Because the gap between clear articulation of the problem as well as population and the best strategies to impact the prevention of the problem is evident, health care practitioners must be involved in well-constructed implementation and evaluation studies that build on the limited base of current evidence.

The Gene-Diet Attica investigation on childhood obesity (GENDAI): overview of the study design

BACKGROUND

There is limited evidence on the role of genetic and environmental factors in the etiology of childhood obesity, a major health problem worldwide.

METHODS

The Gene-Diet Attica Investigation on childhood obesity (GENDAI) evaluates the contributions to and pivotal interactions of genetic, dietary and physical activity variables on children's weight. We describe the design, methodology, and present preliminary data. So far, 920 participants have been enrolled and the final projected sample is 1000 fifth- and sixth-grade students from selected elementary schools in Attica (10-14 years). In this school-based cross-sectional study, more than 400 variables describing anthropometric, dietary, clinical, genetic, sociodemographic and other lifestyle characteristics were collected from participating children and their families.

RESULTS

Increased body mass index was identified in 39.3% of subjects (30.5% overweight and 8.8% obese), with males presenting a more unfavorable metabolic profile, i.e., higher blood lipids, glucose, and insulin, compared to females. Normal-weight children had a significant advantage when compared to all children of increased weight in terms of lipid profile and insulin, as well as behaviors examined. Specifically, normal-weight children exhibited less skipping of meals and less sedentary activities.

CONCLUSIONS

The overall high prevalence of overweight and obesity in the current population is significant and underscores the need for environmental and genetic information that will shed light on the phenomenon of childhood obesity.

Trends and sociocultural factors for childhood overweight in La Reunion Island

OBJECTIVE

To examine time trends (study 1) and sociocultural factors associated with childhood overweight (study 2) in La Reunion Island.

DESIGN

Study 1: a longitudinal analysis of anthropometric data available from health services in the town of Saint-Pierre. Study 2: a case - control study.

SUBJECTS

Study 1: 1753 children born between 1977 and 1996. Study 2: 101 six-year old overweight children sex-matched with 101 non-overweight children.

MEASUREMENTS

Study 1: overweight at birth (birth weight>4 kg) and at age 4 and 6 using French references and references from the International Obesity Task Force. Study 2: parental and perinatal data, child's lifestyle and representation of food, all collected from the mother.

RESULTS

Study 1: a dramatic increase in the prevalence rate of overweight at 4 and at 6 is observed, more severe in girls. Study 2: multivariate logistic regressions showed that mother's overweight was the only variable significantly associated with overweight in both the sexes. The other associated factors were related to sociocultural and family features and sedentarity. Logistic probability functions derived from these data are proposed as a tool for detection of at risk families.

CONCLUSION

Our results show the need for a targeted prevention of overweight. We offer a proposal based on education and behaviour modification in La Reunion Island.

Examination of Weight Status and Dietary Behaviors of Middle School Students in Kentucky

OBJECTIVE

There is growing interest in understanding the roles that fruit, vegetable, milk, breakfast, and soft drink consumption play in relation to adolescents' weight status. This study examines the relationship between weight status and dietary practices of middle school students.

DESIGN

This study consists of secondary analysis of a cross-sectional survey given to 4,049 middle school students in central Kentucky.

METHODS

Students' self-reported height and weight data, as well as 7-day recall of fruits, vegetables, milk, soft drinks, and breakfast consumption prior to completion of the survey, were collected. Self-reported height and weight were converted to body mass index (BMI) percentile according to Centers for Disease Control and Prevention's classification criteria.

OUTCOME MEASURES

Measures included dietary consumption of fruits, vegetables, milk, soft drinks, and breakfast in relation to students' BMI percentile.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics were extracted on demographics, BMI percentile, and food consumption. Bivariate analyses included chi2 tests of association and Spearman rank correlation.

RESULTS

Healthy weight was associated with consuming fruits, vegetables, breakfast, and milk. Underweight and healthy-weight students consumed more fruits than students who were at risk of being overweight and overweight. Healthy-weight students consumed more "other vegetables" than students who were at risk of being overweight and more "other vegetables" and carrots than overweight students. Underweight students consumed breakfast more often than all other students, and healthy-weight students consumed breakfast significantly more frequently than students at risk of being overweight and overweight. Finally, overweight students had a significantly lower consumption of milk than all other students.

CONCLUSIONS

Parents and school foodservice personnel should take these factors into consideration by developing menu strategies and tactics to encourage more healthful eating behaviors in children.

Childhood overweight: parental perceptions and readiness for change

Although the national health crisis of childhood obesity is a well-documented problem, few if any clinical interventions have had success in curbing its growth. In fact, childhood obesity, along with its associated morbidities, continues to climb even in the face of increased awareness. Research shows that factors contributing to obesity are almost entirely modifiable on some level. Furthermore, specific behavior changes have been shown to result in positive outcomes, yet these changes have not been widely implemented by practitioners, families, or individuals. The transtheoretical model of health behavior change offers insight into assessing individuals and targeting interventions for behavior change. This article focuses on guiding school nurses to assess parents of school-age children at risk for obesity for readiness for health behavior change, then choosing parent-focused interventions based on their stage of readiness for change.

Childhood Overweight: Parental Perceptions and Readiness for Change

Although the national health crisis of childhood obesity is a well-documented problem, few if any clinical interventions have had success in curbing its growth. In fact, childhood obesity, along with its associated morbidities, continues to climb even in the face of increased awareness. Research shows that factors contributing to obesity are almost entirely modifiable on some level. Furthermore, specific behavior changes have been shown to result in positive outcomes, yet these changes have not been widely implemented by practitioners, families, or individuals. The transtheoretical model of health behavior change offers insight into assessing individuals and targeting interventions for behavior change. This article focuses on guiding school nurses to assess parents of school-age children at risk for obesity for readiness for health behavior change, then choosing parent-focused interventions based on their stage of readiness for change.

Overweight more prevalent among children than among adolescents

AIMS

To study if there is a change in paediatric overweight/obesity prevalence from 1982 to 2002 in a population with a high proportion of post-graduate education.

DESIGN

Two samples of children in Uppsala County, Sweden, were compared: children who were 4, 10 and 16 year old in 1982; or 4, 10 and 16 year old in 2002. Mean BMI (in the lowest 10%, middle 50% and highest 10%) and ISO-BMI ('age adjusted BMI') cut-off values were calculated in each age and gender group.

RESULTS

Using the mean BMI or ISO-BMI cut-off values, the BMI-distribution shifted from 1982 to 2002. More 4- and 10-year-old girls and boys were overweight/obese, although this shift was larger in girls. No shift was seen in the 16-year-olds, only the middle 50% group in the 16-year-old girls had a slight increase of their mean BMI. In the 2002 4-year-old, and both 10-year-old samples, a higher proportion of the girls were overweight/obese compared to the boys, but no difference was seen in the 16-year-old sample.

CONCLUSION

Young children, especially girls, have become much more overweight/obese during the past 20 years, despite a high proportion of post-graduate education in the population. The lack of major change in 16-year-olds may suggest a rather recent change in the children's environment/lifestyle.

Metabolic syndrome in a multiethnic sample of school children: implications for the pediatric nurse

There is lack of translational work that may assist the pediatric nurse in identifying the child who is at risk for metabolic syndrome. Early identification of the syndrome could assist pediatric health care providers in intervening and in lowering child health risks. Fasting serum insulin, metabolic syndrome criteria, and dietary intake were examined in a multiethnic sample of children aged 9-15 years. Forty-seven percent had two or more risk factors for metabolic syndrome, and 28% had three or more risk factors. Insulin levels were negatively correlated with the recommended dietary allowance. A regression model, including gender, age, race, body mass index, serum glucose, high-density lipoprotein cholesterol, triglycerides, and blood pressure, explained 48% of insulin variance.