Trends in excess weight and thinness among Spanish schoolchildren in the period 1992-2004: the Cuenca study

Gender differences and climate zones in overweight and obesity prevalence in European elementary school children from 2000 to 2020: a systematic review and meta-analysis

Introduction

After 2000, there are more obese than underweight people in the world. We face a rapid increase in average global warming of 1.5°C, reported as a syndemic problem of three interconnected epidemics: obesity, global warming, and undernutrition. We aimed to analyze the impact and association between global warming and obesity in children and differences by gender across Europe after 2000.

Methods

We searched PubMed, MEDLINE, Google Scholar, ScienceDirect, and Embase databases. The considered population were children aged 6-14. Only cross-sectional studies that defined obesity by the IOTF cutoffs and the subjects' place of residence, used to determine precise climate zones, were included. We assessed the prevalence of obesity and overweight using a random-effects and the Mantel-Haenszel fixed-effect method when heterogeneity was greater/lower than 50%. We did a subgroup analysis for prevalence across gender, obesity, and overweight, two decades, regions, countries, and the Köppen-Geiger climate zones. Random effects of the meta-regression were used to study the global warming impact and differences in trends across European countries by gender for both conditions separately.

Results

We identified 114 studies that included 985,971 children from 39 European countries. A significant difference between genders was in favor of obese girls 4.78 (95% CI: 3.85-5.93) versus boys 5.76% (95% CI: 5.11-6.48, p = 0.03), respectively, but not for overweight children. Most of the obese girls were in South Europe 7.51% (95% CI: 6.61-8.51) versus East Europe 2.86% (95% CI: 23-3.12), versus boys in South Europe 8.66% (95% CI: 7.68-9.74) and North Europe 3.49% (95% CI: 2.90-4.19), respectively. The "cold" Köppen-Geiger climate zone, with lowest temperatures, has the largest trend rise between two decades of 2.8% and 1.53% for obese girls and boys, and 5.31% and 1.81% for overweight girls and boys, respectively, followed by the smallest number of obese girls 3.28% (95% CI: 2.17-4.92) and boys 3.58% (95% CI: 2.39-5.33), versus the zone with the highest temperatures "hot" for girls 7.02% (95% CI: 6.30-7.82) and for boys 8.23% (95% CI: 7.55-8.96), respectively. The meta-regression proved global warming has a significant impact on the distribution of obesity and overweight across climate zones, R2 = 0.52 and R2 = 0.22. No significant gender differences, or significant interaction, was noted.

Conclusion

Our meta-analysis provides a comprehensive overview of the association between and impact of global warming on obesity. This impact increases obesity among children in Europe throughout all climate zones, and emphasizes an urgent call for further preventive methods in schools, since obesity differences continue their trend of disappearing into the future.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021282127, identifier: CRD42021282127.

School-based obesity prevention programs in rural communities: a scoping review

OBJECTIVE

The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural communities, as well as identify current gaps in the literature.

INTRODUCTION

Pediatric obesity is a significant public health condition worldwide. Rural residency places children at increased risk of obesity. Schools have been identified as an avenue for obesity prevention in rural communities.

INCLUSION CRITERIA

We considered citations focused on children (5 to 18 years of age) enrolled in a rural educational setting. We included obesity prevention programs delivered in rural schools that focused on nutrition or dietary changes, physical activity or exercise, decreasing screen time, or combined nutrition and physical activity that aimed to prevent childhood obesity. We included all quantitative, qualitative, and mixed methods research designs, as well as text and opinion data.

METHODS

A search was conducted of published and unpublished studies in English from 1990 through April 2020 using PubMed, CINAHL Complete, ERIC, Embase, Scopus, Academic Search Premier, Cochrane Register of Controlled Trials, and ClinicalTrials.gov. Gray literature was also searched. After title and abstract review, potentially relevant citations were retrieved in full text. The full texts were assessed in detail against the inclusion criteria by 2 independent reviewers. Included citations were reviewed and data extracted by 2 independent reviewers and captured on a spreadsheet targeting the review objectives.

RESULTS

Of the 105 studies selected for full-text review, 72 (68.6%) were included in the final study. Most of the studies (n = 50) were published between 2010 and 2019 and were conducted in the United States (n = 57). Most studies included children in rural elementary or middle schools (n = 57) and targeted obesity prevention (n = 67). Teachers implemented the programs in half of the studies (n = 36). Most studies included a combination of physical activity and nutrition components (n = 43). Other studies focused solely on nutrition (n = 9) or physical activity (n = 9), targeted obesity prevention policies (n = 9), or other components (n = 8). Programs ranged in length from weeks to years. Overall, weight-related, physical activity-specific, and nutrition-specific outcomes were most commonly examined in the included citations.

CONCLUSIONS

Obesity prevention programs that focused on a combination of physical activity and nutrition were the most common. Multiple outcomes were examined, but most programs included weight-specific and health behavior-specific outcomes. The length and intensity of rural school-based obesity prevention programs varied. More research examining scientific rigor and specific outcomes of rural school-based obesity prevention programs is needed.

French youth trends in prevalence of overweight, obesity and underweight from 2008 to 2018

Objective

Because the prevalence overweight and obesity remains high during adolescence in Europe, tracking weight status in children and adolescents is needed. We aimed to estimate French trends in the prevalence of weight status in children and adolescent from 2008 to 2018.

Results

The prevalence of overweight and obesity were higher in boys (P < 0.0001). Underweight was more prevalent in girls (P < 0.0001). In adolescents aged 16–17 years old, a stabilization was observed for overweight and obesity whereas the prevalence of underweight increased significantly in boys (P < 0.0001). For children and adolescents aged to 10–12 and 13–15 years old, the obesity and overweight decreased significantly while the underweight was increased for both sexes aged 10–12 years (P < 0.0001). Underweight increased in boys aged 13–15 years (P < 0.0001) while that a stagnation was observed in girls. These encouraging results show the permanent need to develop preventive strategies promoting an healthy active living in order to modify the lifestyle for adolescents with underweight, overweight or obesity.

Underweight among adolescents in Denmark: prevalence, trends (1998-2018), and association of underweight with socioeconomic status

BACKGROUND

Underweight among adolescents is an important clinical and public health issue. It is associated with adverse health outcomes throughout the life-span and may reflect food poverty, unhealthy eating habits, or some underlying health conditions.

OBJECTIVE

To study prevalence and trends in underweight among adolescents 1998-2018, to examine social inequality in underweight, and whether social inequality changed over time.

METHODS

Data were derived from 6 cross-sectional school surveys from The Health Behaviour in School-aged Children study in Denmark. The study included 11-, 13-, and 15-year-old schoolchildren in random samples of schools in 1998, 2002, 2006, 2010, 2014, and 2018 (n = 22,177). Underweight was determined by body mass index-for-age thinness grade 2-3 (the Cole and Lobstein method). Socioeconomic status was determined using occupational social class (the Danish OSC Measurement).

RESULTS

The overall prevalence of underweight was 3.1% among boys and 5.3% among girls (P < 0.0001) and decreased by age (P < 0.0001) among both boys and girls. The prevalence of underweight was almost stable from 1998 to 2018. There was no observed absolute or relative social inequality in the prevalence of underweight among boys or girls.

CONCLUSION

The prevalence of underweight in 11- to 15-year-olds was significantly higher among girls than boys. The prevalence remained stable from 1998 to 2018. There was no significant association between SES and prevalence of underweight. It is important to elucidate the underlying causes of underweight such as malnutrition, eating disorders, eating problems, loss of appetite, chronic diseases, insufficient knowledge of nutrients effects on bodily functions, and persistent pain.

Has the Prevalence of Childhood Obesity in Spain Plateaued? A Systematic Review and Meta-Analysis

The prevalence of excess body weight (overweight plus obesity) in children has risen during the last decades in many countries, but it is unclear whether it has reached a plateau in Spanish children. We performed an updated systematic review and meta-analysis for the prevalence of excess body weight in children from Spain, comparing the trends between 1999 and 2010 and 2011 and 2021. Data were reported in a prior meta-analysis, plus an updated search using the Web of Science, MEDLINE (via PubMed) and EMBASE databases for data from January 2018 until December 2021. Thirteen representative studies were identified (34,813 children aged 2 to 13 years), with sample sizes averaging 2678 (range: 396-16,665). The prevalence of excess body weight in Spanish children aged 2 to 6 years increased from 23.3% (95% CI, 18.5% to 25.5%) during the period 1999-2010 to 39.9% (95% CI, 35.4% to 44.7%) during 2011-2021. In children aged 7 to 13 years, the prevalence of excess body weight increased from 32.3% (95% CI, 29.1-35.6%) during the period 1999-2010 to 35.3% (95% CI, 32.9-37.7%) during 2011-2021. The prevalence of childhood overweight and obesity in Spain has substantially increased in the last decade. New food policies to address the childhood obesity epidemic are urgently required to reverse current trends.

Trends in the prevalence of overweight, obesity and underweight in French children, aged 4-12 years, from 2013 to 2017

OBJECTIVE

To assess the prevalence of underweight, overweight and obesity in French children from 2013 to 2017.

DESIGN

Cross-sectional study performed in fourteen regions of France. Physical measures included weight, height and BMI. Underweight, overweight and obesity were defined according to age- and sex-specific BMI cut-off points from the International Obesity Task Force.

SETTING

France.

SUBJECTS

Children (10 159 boys, 9757 girls) from the voluntary, non-representative Diagnoform programme between 2013 and 2017, at the age of 4-12 years.

RESULTS

The prevalence of overweight and obesity was higher in girls compared with boys (P < 0·001). Underweight was also more prevalent in girls (P < 0·05). Although there were no significant changes in the prevalence of obesity in boys or girls from 2013 to 2017, a significant decrease in overweight among boys and girls was found (P < 0·001) during the same time period. In contrast, the prevalence of underweight increased in girls and boys (from 10·0 to 20·0 %, P < 0·0001) between 2013 and 2017.

CONCLUSIONS

Results of the current study show that the prevalence of obesity was stable, while the prevalence of overweight decreased significantly, despite high in French children. Findings suggest also that thinness is becoming an important phenomenon in children. Developing preventive and nutritional programmes in order to modify the lifestyle might help control underweight and obesity in children.

Effects of Tabata Training During Physical Education Classes on Body Composition, Aerobic Capacity, and Anaerobic Performance of Under-, Normal- and Overweight Adolescents

Physical education classes often fail to include sufficient exercise intensity to induce changes in body tissue composition and physical fitness. Short-term high-intensity interval training protocols incorporated into physical education lessons are one possible solution to this problem. Existing studies have not examined how individuals differing in body mass index (e.g., normal-weight, underweight) respond to high-intensity interval training exercises. Therefore, this study aimed to evaluate the effects of a Tabata protocol on body composition measurements, aerobic capacity, and motor performance in underweight and overweight adolescents (the experimental groups) vs normal-weight adolescents (here regarded as the control group). The sample included 58 adolescents (28 boys, mean age = 16.2 years; 30 girls, mean age = 16.2 years) who completed the high-intensity interval training and the following set of measurements pre- and post- intervention: height, weight, body fat percentage and waist-to-hip ratio, physical efficiency index (based on the Harvard Step Test), agility (in 4 × 10 shuttle run test), and lower-limb muscle power in vertical jump. The results showed that high-intensity interval training was effective in reducing body weight, waist-to-hip ratio, and body fat percentage only in overweight individuals. Improvement in aerobic capacity was found only in underweight and overweight boys. Further research should focus on the development of customized exercise protocols and their adaptation to girls and assess the sustainability of the changes induced.

Prevalence, trends and risk factors of thinness among Greek children and adolescents

Introduction

Thinness affects more children and adolescents than obesity. Thus, the aim of the study is to examine the recent estimates of thinness and associated risk factors, and to identify trends in thinness, among Greek schoolchildren.

Methods

Epidemiological study. Population data from the recent estimates are derived from a school-based health survey polled in 2015 on 336,014 participants aged 4- to 17-years-old. To assess trends of thinness (1996-2015) we included a total of 300,104 children aged 8- to 9-years-old. Physical activity, dietary habits and sedentary activities were assessed through self-completed questionnaires. The gender and age-specific body mass index cut-off points proposed by International Obesity Task Force were used in order to define weight groups.

Results

Percent 8.4% of girls and 6.5% of boys were thin (all grades included). The prevalence of thinness decreased with age more in boys (from 13.8% at 4-years-old to 5.1% at 17-years-old, p < 0.001), than in girls (from 10.9% at 4-years-old to 8.7% at 17-years-old, p < 0.001). Sufficient dietary habits (OR: 0.87, 95% CI: 0.77-0.97) and adequate physical activity levels (OR: 0.92, 95% CI: 0.85-0.99) were associated with decreased risk of thinness. Thin schoolchildren performed better in aerobic fitness test than normalweight ones. Between 1996 and 2015, thinness rates decreased from 8.0% to 6.5% in boys (p = 0.046) and from 10.6% to 8.4% in girls (p = 0.036).

Conclusions

Our results suggest that thinness is a significant overlooked phenomenon. Although the prevalence of thinness has decreased the last two decades among Greek schoolchildren, actions need to be taken from public policy makers in order to establish and maintain a healthy body weight.

Prevalence and Trends of Overweight and Obesity in European Children From 1999 to 2016: A Systematic Review and Meta-analysis

IMPORTANCE

Studies of trends in excess weight among European children throughout the last few decades have rendered mixed results. Additionally, some studies were outdated, were based on self-reported weight and height, or included only a few European countries.

OBJECTIVE

To assess prevalence trends in measured overweight and obesity among children across Europe from 1999 to 2016 using a systematic methodology.

DATA SOURCES

MEDLINE, Embase, CINAHL, and Web of Science were searched from their inception until May 2018. Moreover, searches were conducted on health institutions' websites to identify studies not published in scientific journals.

STUDY SELECTION

The inclusion criteria were: (1) studies reporting the population-based prevalence of excess weight (overweight plus obesity) or obesity according to body mass index cutoffs proposed by the International Obesity Task Force; (2) cross-sectional or follow-up studies; and (3) studies including populations aged 2 to 13 years.

DATA EXTRACTION AND SYNTHESIS

Literature review and data extraction followed established guidelines. The Mantel-Haenszel method was used to compute the pooled prevalence estimates and their 95% CI whenever there was no evidence of heterogeneity (I2 < 50%); otherwise, the DerSimonian and Laird random-effects method was used. Subgroup analyses by study year, country, or European region (Atlantic, Iberian, Central, and Mediterranean) were conducted. Prevalence estimates were calculated as an aggregate mean, weighted by the sample size and the number of individuals in each study.

RESULTS

A total of 103 studies (477 620 children aged 2 to 13 years) with data from 28 countries were included. The combined prevalence of overweight and obesity in the Iberian region tended to decrease from 30.3% (95% CI, 28.3%-32.3%) to 25.6% (95% CI, 19.7%-31.4%) but tended to increase in the Mediterranean region from 22.9% (95% CI, 17.9%-27.9%) to 25.0% (95% CI, 14.5%-35.5%). No substantial changes were observed in Atlantic Europe or Central Europe, where the overweight and obesity prevalence changed from 18.3% (95% CI, 14.0%-23.9%) to 19.3% (95% CI, 17.7%-20.9%) and from 15.8% (95% CI, 13.4%-18.5%) to 15.3% (95% CI, 11.6%-20.3%), respectively.

CONCLUSIONS AND RELEVANCE

The prevalence of childhood overweight and obesity is very high, but trends have stabilized in most European countries. There are substantial between-country differences in the current levels and trends of overweight and obesity. The rising prevalence in some Mediterranean countries is worrisome.

TRIAL REGISTRATION

PROSPERO identifier: CRD42017056924.

School-based obesity prevention programs in rural communities: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to map the available literature on school-based obesity prevention programs in rural communities.

INTRODUCTION

Significant health disparities are associated with childhood obesity, and these disparities disproportionately affect children in disadvantaged communities, such as rural areas. Youth in rural areas are 26% more likely to be obese than youth in urban communities. To combat obesity in children, schools have become an avenue for educating children about the importance of healthy diet and physical activity. Although many school-based obesity prevention programs have been implemented in recent years, more information is needed on programs in rural communities.

INCLUSION CRITERIA

This scoping review will consider studies that include children 5 to 18 years of age who are enrolled in elementary, middle or high school in a rural setting and that investigate school-based obesity prevention programs. Studies that include children who are in non-rural areas, who are home-schooled, who are in an alternative setting (e.g. juvenile detention) or who are hospitalized will be excluded. Studies published in English since 1990 will be included.

METHODS

Multiple databases will be searched, including PubMed, CINAHL, ERIC, Embase, Scopus and Academic Search Premier. Trials registers and gray literature will also be searched. After screening the titles and abstracts of identified citations, potentially relevant studies will be retrieved in full. Data will be extracted by independent reviewers and presented in a diagrammatic or tabular form, accompanied by a narrative summary.

Adiposity-Age Distribution and Nutritional Status in Girls With Adolescent Idiopathic Scoliosis

STUDY DESIGN

Cross-sectional comparative study.

OBJECTIVES

To assess the adiposity-age distribution in girls with adolescent idiopathic scoliosis (AIS) and to define the prevalence of underweight, overweight, and obesity in these patients as compared with healthy controls.

SUMMARY OF BACKGROUND DATA

The current literature focusing the nutritional status of individuals with AIS does not provide data on the prevalence of overweight in these patients.

METHODS

The sample consisted of 112 adolescent girls with idiopathic scoliosis and 231 healthy age-matched girls from the same geographic region. Three different validated body mass index (BMI) cutoffs for adolescents were used to define the nutritional status. Adiposity was labeled according to Adiposity & Fat Distribution for Adolescents (AFAD-A) criteria.

RESULTS

There were significant differences in BMI and fat percentage according to age (p < .005) in both AIS patients and healthy controls. The overall prevalence of underweight was similar in both groups (scoliotic girls, 4.5%; controls, 4.8%). Obesity was more prevalent in AIS patients than in healthy controls. The World Health Organization-2007 and the Centers for Disease Control and Prevention cutoffs detected similar percentages of AIS girls with obesity (10.7%) and healthy controls (5.4%). The International Obesity Taskforce detected a 6.3% of AIS girls with obesity and only 3.0% in controls. Fat-age distribution gradually decreases from 11-13 to 16-17 years in AIS patients (p < .05). The overall prevalence of adolescents with fat overload (body fat index [BFI] >7.6) was similar in both groups (AIS, 0.9%; controls, 0.8%).

CONCLUSIONS

The proportion of adolescents with obesity was twofold higher among AIS girls than in age-matched healthy controls. However, in AIS girls, the BFI differed from that shown by healthy peers, being lower along the middle adolescence period (13-15 years). AIS girls showed an important increase in underweight at late adolescence (16-17 years).

LEVEL OF EVIDENCE

Level III, diagnostic.

Prevalence of underweight in children and adolescents (aged 3-18 years) from Kraków (Poland) in 1983 and 2010

OBJECTIVE

To estimate the changes in the prevalence of underweight among girls and boys living in Kraków that occurred between 1983 and 2010.

DESIGN

The study was based on two cross-sectional surveys conducted in 1983 and 2010. The prevalence of underweight was estimated based on the International Obesity Task Force (IOTF) and Centers for Disease Control and Prevention (CDC) cut-off points.

SETTING

The study was conducted in Kraków, Poland.

PARTICIPANTS

Children aged 3-18 years (n 5245).

RESULTS

Between 1983 and 2010 the prevalence of underweight decreased in both sexes. Using the IOTF criteria, the prevalence of underweight decreased from 10·5 to 10·3 % in girls and from 8·9 to 7·5 % in boys, but it was still higher in girls than in boys. According to the CDC criteria, this prevalence decreased from 5·1 to 4·4 % and from 5·9 to 4·6 %, respectively, and was slightly lower in girls. According to the IOTF criteria, underweight prevalence increased slightly during childhood in both sexes while according to the CDC criteria it decreased in boys and did not change in girls. Among juveniles and adolescents, it decreased regardless of the method used.

CONCLUSIONS

The frequency of underweight in the population of children and adolescents from Kraków changed slightly in 1983 and 2010 despite economic and social changes. Depending on the cut-off points used, not only the magnitude but also the direction of changes between series could be different. In order to aid global monitoring, the prevalence of underweight as well as overweight should always be evaluated by several methods.

MOVI-daFIT! Intervention: Rationale and design of a cluster randomized controlled trial testing the effects on improving adiposity, cognition, and subclinical atherosclerosis by increasing cardiorespiratory fitness in children

INTRODUCTION

High-intensity interval training (HIIT) programs have demonstrated positive effects on cardiorespiratory fitness and cardiometabolic parameters, but their impact on other health parameters (such as body mass and fat) and cognition remains unclear. This paper presents the rationale and methods of a HIIT after-school physical activity (PA) intervention (MOVI-daFIT!) on reducing fat mass and cardiovascular risk, and improving physical fitness, executive function, and academic achievement among children aged 9 to 11 years old.

METHODS

A cluster randomized controlled trial (RCT), including 10 schools from Cuenca province, Spain, was designed. Schools were randomly assigned to the MOVI-daFIT! intervention and to the control group. Children were evaluated at the beginning (September 2017) and at the end (June 2018) of the school year. Children in the intervention group were involved in 60-minute after-school sessions 4 days per week developed in the school setting. Each session consisted of 15 minutes of set-up and warm-up games, 28 minutes of games using the HIIT protocol, and 10 minutes of cool down. In addition, children in the intervention and control groups received 2 regular 50-minute physical education sessions per week, as it is compulsory by law in Spanish schools.

CONCLUSION

This study will determine the effect of an after-school physical activity intervention (MOVI-daFIT!), designed as a HIIT program, on reducing fat mass and cardiovascular risk, and improving fitness and cognition, including executive function and academic achievement.

Stabilization and reversal of child obesity in Andalusia using objective anthropometric measures by socioeconomic status

BACKGROUND

Childhood obesity continues to be a significant public health issue worldwide. Recent national studies in Spain show a stable picture. However, prevalence and trends differ by socio-economic status, age, and region. We present the trend in childhood excess weight prevalence, aged 8-15 years, in Andalusia from 2011-2012 to 2015-2016 by socio-economic status.

METHODS

Using the cross-sectional Andalusian Health Surveys, objective anthropometric measures were taken for a representative sample of 8-15 year olds in Andalusia in 2011-2012 and 2015-2016. Prevalence and changes in prevalence of excess weight (overweight plus obesity) were calculated, using both the WHO and IOTF criteria, overall and for sex, age and three different indicators of SES.

RESULTS

Overall prevalence of excess weight decreased from 42.0% in 2011-2012 to 35.4% in 2015-2016. Overweight decreased from 28.2 to 24.2% and obesity from 13.8 to 11.2%. In 2011-2012 the prevalence of excess weight in boys was 46.0%and 37.9% in girls; in 2015-2016 the difference became significant with 41% of boys with excess weight compared with 30% in girls.

CONCLUSIONS

Childhood excess weight prevalence in Andalusia has decreased slightly between 2011-2012 and 2015-2016. Notably, a decrease in obesity prevalence in girls aged 8-15 years was recorded. In 2011-2012 a social gradient for excess weight prevalence across three SES indicators was observed: in 2015-2016 this gradient disappeared. Nonetheless, prevalence remains too high.

Prevalence of obesity in Italian adolescents: does the use of different growth charts make the difference?

BACKGROUND

Since populations are becoming increasingly multi-ethnic, the use of local or international charts is a matter of debate. This study aimed to evaluate how the choice of cut-off thresholds affected prevalence of underweight (UW), overweight (OW), obesity (OB) in 1200 11-12-year Italian adolescents, and how their somatic growth depended on parental origin.

METHODS

The height, weight and body mass index were expressed as standard deviation score (SDS) using Italian (ISPED-2006) and UK (UK-1990) charts. The classification of UW/OW/OB was computed with the IOTF international cut-offs, and thresholds were identified as centiles corresponding to BMI values of 18.5/25.0/30.0 kg/m² at 18-year in ISPED-2006 or UK-1990 references.

RESULTS

About 30% participants had non-Italian parents, above all from North-Africa and Romania. Referring to the UK-1990 charts, all groups showed negative mean SDS for height, and positive SDS for weight and BMI. Referring to the ISPED-2006 charts, all mean SDS were negative. Percentage of UW individuals was higher in accordance with ISPED-2006 than with UK-1990 charts, whereas percentages of OW/OB were higher with UK-1990 than ISPED-2006 charts. The results obtained using IOFT cut-offs were similar to UK-1990 cut-offs. These results were due to the different shape of age-dependent cut-off centiles. Independently by the parental origin, the percentages of adolescents classified as OW/OB were closer to the expected values using the ISPED-2006 then the UK-1990 cut-offs. The results suggested the use of the Italian references for adolescents with immigrant parents.

CONCLUSION

The use of local charts seems more appropriate at least in Italian adolescents in the age range studied.

Trends in Child Obesity and Underweight in Spain by Birth Year and Age, 1983 to 2011

INTRODUCTION AND OBJECTIVES

The prevalences of child obesity and overweight are increasing worldwide and are a significant public health issue, particularly in terms of long-term cardiovascular risk profiles, which continue into adulthood unless obesity is reversed. Accurately identifying trends and at-risk subgroups is crucial to correctly target public health initiatives. The objective of this study was to examine changes in the prevalences of child obesity and underweight in Spain from 1983 to 2011 taking into consideration both age and birth year.

METHODS

A series of cross-sectional studies representative of the pediatric population in Spain between 1987 and 2011 was used to calculate the prevalence and trends of excess weight and underweight in girls and boys aged 2 to 14 years per survey year and per birth year.

RESULTS

The overall prevalence of overweight and obesity remained relatively stable. The prevalence of overweight in boys aged 10 to 14 years increased from 13.9% to 22.2%. The prevalence of obesity in girls aged 2 to 5 years decreased from 30% to 19.8%, whereas the prevalence of underweight in this group increased from 13.7% to 22.6%.

CONCLUSIONS

Child obesity trends in Spain over the last 2 decades appear to be stable with some fluctuations, but the trends differ depending on age and sex, and have stabilized at too high a level. The prevalence of underweight also appears to have increased and should be considered alongside excess weight when designing and implementing child health and weight measures.

Prevalence of overweight, obesity, underweight and normal weight in French youth from 2009 to 2013

OBJECTIVE

To determine the prevalence of underweight, overweight and obesity in French youth from 2009 to 2013 and to determine if there are differences in weight categories according to socio-economic status.

DESIGN

Cross-sectional study performed in different regions of France. Physical measures included weight, height and BMI. Underweight, overweight and obesity were defined according to age- and sex-specific BMI cut-off points from the International Obesity Task Force.

SETTING

France.

SUBJECTS

Children and adolescents (n 9670; 4836 boys, 4834 girls) from the French national BOUGE Program between 2009 and 2013.

RESULTS

The prevalence of obesity was higher in boys than girls (P0·05) and remained unchanged in boys (7·1-7·3 %) between 2009 and 2013. Overweight and obesity were higher in low socio-economic families (P<0·0001).

CONCLUSIONS

Findings suggest that the prevalence of overweight was stable although high in French children and adolescents, while the prevalence of obesity increased significantly. Changes in underweight, although not significant, were high in girls and merit further attention. Improving public health interventions, especially in high-risk low socio-economic populations, may help to modify the behaviour that contributes to underweight, overweight and obesity in young boys and girls.

Family factors and health behaviour of thin adolescent boys and girls

AIM

The aim of this study was to examine prevalence of extreme thinness and thinness in adolescent boys and girls and to study associations between family factors, health behaviour and thinness in boys and girls.

BACKGROUND

Extreme thinness carries high health risks. The family and health behavioural factors related to adolescent thinness have not been studied previously using a nationally representative data.

DESIGN

This is a cross-sectional quantitative study.

METHODS

The nationally representative data were obtained from the Finnish School Health Promotion study conducted in 2013. The sample of this study included 12-17 year old adolescents (n = 71,973) who were categorised as extremely thin, thin and normal weight using international age and gender body mass index (BMI) cut-off points for children and adolescents. Associations with family factors and health behaviour were examined separately for boys and girls using cross-tabulations, Chi-square test and multinomial logistic regression.

RESULTS

Thinness and extreme thinness were more common in girls than in boys. Health behaviour, such as smoking and exercise, were associated with thinness and extreme thinness in both genders. Regarding family factors; low maternal education, family meal and parental knowledge of adolescents' friends and whereabouts were associated with thinness and, or extreme thinness in both boys and girls. However, there were gender differences in the associations.

CONCLUSIONS

It is important for healthcare professionals working with adolescents to be aware of prevalence in thinness and aware of health behaviour and family factors that are associated with thinness and extreme thinness in adolescence.

Psychological factors related to physical education classes as predictors of students' intention to partake in leisure-time physical activity

In view of the rise in sedentary lifestyle amongst young people, knowledge regarding their intention to partake in physical activity can be decisive when it comes to instilling physical activity habits to improve the current and future health of school students. Therefore, the object of this study was to find a predictive model of the intention to partake in leisure- time physical activity based on motivation, satisfaction and competence. The sample consisted of 347 Spanish, male, high school students and 411 female students aged between 13 and 18 years old. We used a questionnaire made up of the Sport Motivation Scale, Sport Satisfaction Instrument, and the competence factor in the Basic Psychological Needs in Exercise Scale and Intention to Partake in Leisure-Time Physical Activity, all of them adapted to school Physical Education. We carried out confirmatory factor analyses and structural equation models. The intention to partake in leisure-time physical activity was predicted by competence and the latter by satisfaction/fun. Intrinsic motivation was revealed to be the best predictor of satisfaction/fun. Intrinsic motivation should be enhanced in order to predict an intention to partake in physical activity in Physical Education students.

Parental misperceptions of children's underweight status: a meta-analysis

BACKGROUND

Accurate parental perceptions of their children's underweight status are needed to prevent overlooking potential disordered eating patterns or health conditions affecting growth.

PURPOSE

The aim of this study is to determine overall proportion of parents who misperceive children's underweight status and correlates of such misperceptions.

METHODS

Original studies published to January 2013 were chosen through a literature search in established databases. Studies included assessed parental perceptions of their children's underweight and then compared perceptions to recognized standards for defining underweight based on anthropometric measures. Random- and mixed-effects models were used.

RESULTS

Thirty-seven articles (representing 39 studies; N = 4,039) were included. Pooled effect sizes indicated that 46.58 % (95 % CI 40.90-52.35 %) of parents misperceive their children's underweight status, though the extent of misperceptions depended on a number of moderators.

CONCLUSIONS

Nearly half of parents perceive their underweight children as weighing more than they actually do. Health care professionals are well positioned to take steps to remedy misperceptions and encourage healthy behaviors.

Gender differences on effectiveness of a school-based physical activity intervention for reducing cardiometabolic risk: a cluster randomized trial

Background

Studies that have examined the impact of a physical activity intervention on cardiometabolic risk factors have yielded conflicting results. The objective of this study was to assess the impact of a standardized physical activity program on adiposity and cardiometabolic risk factors in schoolchildren.

Methods

Cluster randomized trial study of 712 schoolchildren, 8–10 years, from 20 public schools in the Province of Cuenca, Spain. The intervention (MOVI-2) consisted of play-based and non-competitive activities. MOVI-2 was conducted during two 90-minute sessions on weekdays and one 150-minute session on Saturday mornings every week between September 2010 and May 2011. We measured changes in adiposity (overweight/obesity prevalence, body mass index [BMI], triceps skinfold thickness [TST], body fat %, fat-free mass, waist circumference) and other cardiometabolic risk factors (LDL-cholesterol, triglycerides/HDL-cholesterol ratio, insulin, C-reactive protein and blood pressure). The analyses used mixed regression models to adjust for baseline covariates under cluster randomization.

Results

Among girls, we found a reduction of adiposity in intervention versus control schools, with a decrease in TST (−1.1 mm; 95% confidence interval [CI] -2.3 to −0.7), body fat % (−0.9%; 95% CI −1.3 to −0.4), waist circumference (−2.7 cm; 95% CI −4.5 to −0.9), and an increase in fat-free mass (0.3 kg; 95% CI 0.01 to 0.6). The intervention also led to lower serum LDL-cholesterol and insulin levels. Among boys, a reduction in waist circumference (−1.4 cm; 95% CI −2.6 to −0.1; P = 0.03), and an increase in fat-free mass (0.5 kg; 95% CI 0.2 to 0.9; P = 0.003) was associated with the intervention versus control schools. The prevalence of overweight/obesity or underweight, BMI, and other cardiometabolic risk factors was not modified by the intervention. No important adverse events were registered.

Conclusions

An extracurricular intervention of non-competitive physical activity during an academic year, targeting all schoolchildren regardless of body weight, is a safe and effective measure to reduce adiposity in both genders and to improve cardiometabolic risk profile in girls.

Trial registration

Clinical trials NCT01277224.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-014-0154-4) contains supplementary material, which is available to authorized users.

Trends in thinness prevalence among adolescents in ten European countries and the USA (1998-2006): a cross-sectional survey

OBJECTIVE

To describe the prevalence of 'graded thinness' in children aged 11, 13 and 15 years in eleven developed countries and to identify trends in the prevalence of 'thinness' (BMI < 17 kg/m2 at age 18 years) by age and gender.

DESIGN

Cross-sectional study using data collected through self-reported questionnaires.

SETTING

Data were taken from the 1997/1998, 2001/2002 and 2005/2006 surveys of the Health Behaviours in School-aged Children (HBSC) Study.

SUBJECTS

Children and adolescents from ten European countries and the USA (n 158 000).

RESULTS

Prevalence of grades 1, 2 and 3 of thinness was higher among 11-year-old students compared with the 13- and 15-year-olds in all countries. A higher prevalence of thinness was observed in girls than in boys. Since 1998 the prevalence of thinness decreased steadily in Czech boys and girls, while it increased for French girls. In the total European sample of females, thinness decreased from 1998 to 2006 (χ 2 for trend, P < 0·01). Age-adjusted logistic regression analysis showed that Czech boys and girls, and Flemish and American girls were less likely to be thin in 2006 than in 1998; while a noteworthy increment, even if borderline significant, was observed for French girls with a 41% increase in the likelihood to be thin.

CONCLUSIONS

Our findings suggest that thinness is an important overlooked phenomenon with wide variation in prevalence and trends across developed countries. It deserves further longitudinal studies in a multinational context that could increase the understanding of the factors associated with thinness and contribute to developing preventive and nutritional programmes targeted at controlling obesity and chronic diseases, while monitoring thinness.

Active commuting to school, weight status, and cardiometabolic risk in children from rural areas: the Cuenca study

PURPOSE

The aim of this study was to examine (a) whether distance from home to school is a determinant of active commuting to school (ACS), (b) the relationship between distance from home to heavily used facilities (school, green spaces, and sports facilities) and the weight status and cardiometabolic risk categories, and (c) whether ACS has a positive impact on schoolchildren's health.

METHOD

A cross-sectional study was conducted with 956 schoolchildren aged 10 to 12 years from the province of Cuenca, Spain. Height, weight, fat mass, waist circumference, blood pressure, fasting plasma lipid profile, insulin, fitness, physical activity, and ACS were measured. Distances from home to facilities were measured by a geographic information system, and a validated metabolic syndrome index was used.

FINDINGS

Children living closer to school (less than 600 m) commuted actively to school more frequently than children living further away (more than 800 m). Normoweight boys lived further away from sports facilities than overweight/obese peers, and children presenting higher cardiometabolic risk levels lived closer to school than those who did not. No differences were found between children who daily walked/cycled to school and those commuting actively to school less frequently in body mass index, metabolic syndrome index, fitness, and physical activity.

CONCLUSIONS

ACS had no positive impact on schoolchildren's health. Distance to school is an indicator of active commuting. However, it seems that not enough physical activity is done to prevent obesity and cardiometabolic risk factors in rural areas.

Dual burden of body weight among Iranian children and adolescents in 2003 and 2010: the CASPIAN-III study

INTRODUCTION

Our aim was to compare changes of body mass index (BMI) and waist circumference (WC) curves of Iranian children by comparing the results of two national surveys of a surveillance program, i.e. CASPIAN-I (2003-2004) and CASPIAN-III (2009-2010). The second objective was to evaluate the prevalence of obesity, overweight and underweight among 10-18-year-old Iranian children and adolescents.

MATERIAL AND METHODS

This study was performed among students who were selected by multistage random cluster sampling from urban and rural areas of 27 provinces of Iran, as part of a national survey of school student high risk behavior entitled CASPIAN-III, conducted in 2009-2010.

RESULTS

We evaluated 5088 school students (50.2% boys). In rural areas, underweight was more common in boys and overweight and obesity in girls. In urban areas underweight and obesity were more common in boys, whereas overweight was more common in girls. The highest prevalence of underweight (23.5%) was seen in students aged 13 years and the lowest (11.4%) in those aged 18 years. Underweight was significantly more common in rural than in urban areas (22.1% vs. 15.8%, respectively, p < 0.0001) and overweight/obesity was more common in urban than in rural areas. Compared with the findings in 2003-2004, the overall prevalence of elevated body mass index (16.6%) including obesity (9.1%) and overweight (7.5%) as well as underweight (17.5%) increased from 2003 to 2010.

CONCLUSIONS

In recent years, the double burden of nutritional disorders has increased among Iranian children and adolescents, especially in rural areas. This change may be related to epidemiologic transition, notably in terms of nutrition transition and rapid changes in lifestyle habits. This finding is an important issue for policy-makers for interventional preventive programs.

[Natural evolution of excess body weight (overweight and obesity) in children]

OBJECTIVE

To analyze the chronological evolution of excess body weight (overweight and obesity) in order to raise public awareness within the different areas of intervention (family, school, business environment, health services) and to take effective actions.

MATERIAL AND METHODS

Weight, height and body mass index (BMI) of 604 healthy subjects (307 males and 297 females) have been recorded at birth and at the age of 1, 2, 3, 4, 6, 8, 10, 12 and 14 years. The excess body weight has been calculated according to national references from Ferrández et al.

RESULTS

Prevalence of excess body weight at age 14 years was significantly higher (P<.05) in males (29%) than in females (12.8%). BMI (kg/m2) was significantly higher (P<.05) for both sexes in every age period, except for birth and age 1 year, in those patients with excess body weight at age 14, with respect to patients with normal nutritional status of the same age. Those groups with excess body weight at age 14 showed a BMI (Z-score) reaching overweight or obesity levels at age 4, and progressively increasing.

CONCLUSIONS

Excess body weight probably starts at early stages in life, when dietary habits of the child depends almost exclusively on family habits, and may be aggravated during school attendance. Finally, a disproportionate weight increase occurs in adolescence that is probably related to unhealthy dietary habits and way of life.

Trends in excess of weight, underweight and adiposity among Spanish children from 2004 to 2010: the Cuenca Study

OBJECTIVE

To examine the trends in BMI and adiposity among schoolchildren from Cuenca, Spain, during 2004-2010.

DESIGN

Two methodologically comparable surveys were carried out in 2004 and 2010.

SETTING

Primary schools in Cuenca, a province in the middle of Spain.

SUBJECTS

All schoolchildren aged 8-11 years, belonging to 4th and 5th grades from twenty schools in the Province of Cuenca, were invited to participate in both cross-sectional studies. Weight, height and body fat percentage (BF%) from bioelectrical impedance were measured with standardized procedures.

RESULTS

The study included 550 boys and 539 girls in 2004, and 569 boys and 531 girls in 2010. In 2010, 8.1 % of children were underweight, 25.9 % overweight and 9.5 % obese. From 2004 to 2010, the prevalence of overweight rose from 21.6 % to 28.0 % (P = 0.004) and BF % increased from 22.6 % to 24.0 % (P = 0.001) among boys. No change was observed in overweight and BF % in girls, or in underweight and obesity in either sex. In boys, most of the distribution of BMI and BF % shifted to the right; in contrast, among girls no substantial change was apparent in the distribution of BMI and BF %.

CONCLUSIONS

From 2004 to 2010 the prevalence of overweight and adiposity has continued to increase among boys. However, the obesity epidemic may have levelled off in girls. Given that the prevalence of childhood excess weight is still very high, the current evidence-based efforts to halt the obesity epidemic in Spain should be strengthened.

Health-related quality of life, obesity, and fitness in schoolchildren: the Cuenca study

PURPOSE

The purpose of this study was to analyze the association of weight status and physical fitness with health-related quality of life (HRQoL) and to examine the independent association of body mass index (BMI), cardiorespiratory fitness (CRF) and musculoskeletal fitness (MF) with HRQoL in schoolchildren.

METHODS

Cross-sectional study of 1,158 schoolchildren, 8-11 years, from 20 schools in the Cuenca province, Spain. We measured weight, height, and physical fitness, measured by CRF (20-m shuttle run test) and MF index by summing the age-sex z scores of handgrip strength test/weight + standing broad jump test. Self-reported HRQoL was measured by KIDSCREEN-52 questionnaire.

RESULTS

Normal weight boys scored better in physical well-being, mood and emotions, autonomy, and social support and peers dimensions than overweight/obese boys. The mean in self-perception dimensions was lower in obese girls compared to normal weight or overweight girls. Higher levels of CRF and MF were associated with better physical well-being in both genders. Multiple linear regression models showed that the influence of MF in boys and CRF in girls on HRQoL was greater than that of overweight.

CONCLUSIONS

This is one of the first studies that assess the association of CRF and MF with HRQoL while controlling for BMI. CRF and MF are closely related to HRQoL, in particular to physical well-being. Improving fitness could be a strategy of particular interest for improving the HRQoL of schoolchildren.

Barriers, facilitators and preferences for the physical activity of school children. Rationale and methods of a mixed study

Background

Physical activity interventions in schools environment seem to have shown some effectiveness in the control of the current obesity epidemic in children. However the complexity of behaviors and the diversity of influences related to this problem suggest that we urgently need new lines of insight about how to support comprehensive population strategies of intervention. The aim of this study was to know the perceptions of the children from Cuenca, about their environmental barriers, facilitators and preferences for physical activity.

Methods/Design

We used a mixed-method design by combining two qualitative methods (analysis of individual drawings and focus groups) together with the quantitative measurement of physical activity through accelerometers, in a theoretical sample of 121 children aged 9 and 11 years of schools in the province of Cuenca, Spain.

Conclusions

Mixed-method study is an appropriate strategy to know the perceptions of children about barriers and facilitators for physical activity, using both qualitative methods for a deeply understanding of their points of view, and quantitative methods for triangulate the discourse of participants with empirical data. We consider that this is an innovative approach that could provide knowledges for the development of more effective interventions to prevent childhood overweight.

Morbidity patterns among the underweight, overweight and obese between 2 and 18 years: population-based cross-sectional analyses

CONTEXT

No study has documented how symptomatic morbidity varies across the body mass index (BMI) spectrum (underweight, normal weight, overweight and obese) or across the entire child and adolescent age range.

OBJECTIVE

To (1) quantify physical and psychosocial morbidities experienced by 2-18-year-olds according to BMI status and (2) explore morbidity patterns by age.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional data from two Australian population studies (the Longitudinal Study of Australian Children and the Health of Young Victorians Study) were collected during 2000-2006. Participants were grouped into five age bands: 2-3 (n=4606), 4-5 (n=4983), 6-7 (n=4464), 8-12 (n=1541) and 13-18 (n=928) years.

MAIN MEASURES

Outcomes-Parent- and self-reported global health; physical, psychosocial and mental health; special health-care needs; wheeze; asthma and sleep problems. Exposure-measured BMI (kg m(-2)) categorised using standard international cutpoints.

ANALYSES

The variation in comorbidities across BMI categories within and between age bands was examined using linear and logistic regression models.

RESULTS

Comorbidities varied with BMI category for all except sleep problems, generally showing the highest levels for the obese category. However, patterns differed markedly between age groups. In particular, poorer global health and special health-care needs were associated with underweight in young children, but obesity in older children. Prevalence of poorer physical health varied little by BMI in 2-5-year-olds, but from 6 to 7 years was increasingly associated with obesity. Normal-weight children tended to experience the best psychosocial and mental health, with little evidence that the U-shaped associations of these variables with BMI status varied by age. Wheeze and asthma increased slightly with BMI at all ages.

CONCLUSIONS

Deviation from normal weight is associated with health differences in children and adolescents that vary by morbidity and age. As well as lowering risks for later disease, promoting normal body weight appears central to improving the health and well-being of the young.

Secular trends in the prevalence of overweight and obesity in Sicilian schoolchildren aged 11-13 years during the last decade

The present study evaluates trends in the prevalence of overweight and obesity in relation to gender and area of residence between two cohorts of students aged 11–13 years in Sicily. The analysis was performed on 1,839 schoolchildren, with 924 and 915 children being studied in 1999–2001 and 2009–2010, respectively. The children who were enrolled during 2009–2010 had significantly higher body mass indexes (BMI), BMI z-scores, and waist circumferences than the children who were studied during 1999–2001 (p<0.0001 for all); these differences was also observed when the cohort was subdivided according to gender or residence area The prevalence of obesity increased significantly from 7.9% in 1999–2001 to 13.7% in 2009–2010 (p<0.0001), whereas thinness decreased significantly from 10.1% to 2.3% (p<0.0001) in the same periods. The increase of trends in the prevalence of obesity was significantly higher in males (9.7% vs. 17.6%, p = 0.0006) than in females (6.3% vs. 9.8%, p = 0.04) and was slightly higher in urban areas (8.8% vs. 14.3%, p = 0.002) than in rural areas (7.8% vs. 13.0%, p = 0.012). The male gender was associated with a higher risk of being overweight or obese (odds ratio: 1.63; 95% confidence intervals: 1.24–2.15; p = 0.0005) in 2009–2010 than in 1999–2001, after adjusting for age and the residence area. In conclusion, this study showed an increasing trend in the prevalence of overweight and obesity in Sicilian schoolchildren during the last decade and that this trend was related to gender, age and the area of residence. More specifically, our data indicated that the prevalence of obesity increased by 5.8%, the prevalence of thinness decreased by 7.8% and the prevalence of normal-weight children did not change over the course of a decade. These results suggest a shift in the body weights of Sicilian children toward the upper percentiles.

[Weight status, dietary habits and physical activity among 6-12 year-old children in Castile-La Mancha]

INTRODUCTION

Childhood obesity is a multifactorial disease, in which unhealthy dietary patterns and sedentary lifestyles play a decisive role. The aim of this study was to assess the weight status, dietary habits and physical activity in Castile-La Mancha children.

SUBJECTS AND METHODS

A cross-sectional study was conducted on 3061 children 6-12 years-old who were participating in the programme, "Alimenta su salud". Anthropometric measurements, food consumption frequency, dietary habits and physical activity were assessed by a questionnaire, including gender, age and geographical influences.

RESULTS

The prevalence of subjects with excess weight-for-height was 24.0% and obesity was 14.3%, with geographical differences. Girls more often have mid-morning snacks, consume more supplements, and reported to be less active than boys. Special diets and sports activities were lower in children aged 6-9 years as compared to the 10-12 years old group. The intake of vegetables and fruit is low, while there is overconsumption of sausages, pastries, salted snacks, sweets and fast food, with some differences by age group.

CONCLUSIONS

One out of four children is overweight or obese in this population. Children do not meet recommendations for fruit and vegetables and there is a high consumption of foods associated with obesity risk. Physical inactivity was more prevalent during the weekends, and among girls.

Perceived and desired weight, weight related eating and exercising behaviours, and advice received from parents among thin, overweight, obese or normal weight Australian children and adolescents

Background

Thin children are less muscular, weaker, less active, and have lower performance in measures of physical fitness than their normal weight peers. Thin children are also more frequently subjected to teasing and stigmatization. Little is known about thin children's weight perceptions, desired weight and attitudes and behaviours towards food and exercise. The study aimed to compare perceived weight status, desired weight, eating and exercise behaviours and advice received from parents among thin, overweight, obese or normal weight Australian children and adolescents.

Methods

The sample included 8550 school children aged 6 to 18 years selected from every state and territory of Australia. The children were weighed, measured and classified as thin, normal, overweight or obese using international standards. The main outcome measures were perceived and desired weight, weight related eating and exercising behaviours, and advice received from parents.

Results

The distribution of weight status was - thin 4.4%; normal weight 70.7%; overweight 18.3%; and obese 6.6%. Thin children were significantly shorter than normal weight, overweight or obese children and they were also more likely to report regularly consuming meals and snacks. 57.4% of thin children, 83.1% of normal weight children, 63.7% of overweight and 38.3% of obese children perceived their weight as "about right". Of the thin children, 53.9% wanted to be heavier, 36.2% wanted to stay the same weight, and 9.8% wanted to weigh less. Thin children were significantly less likely than obese children to respond positively to statements such as "I am trying to get fitter" or "I need to get more exercise." Parents were significantly less likely to recommend exercise for thin children compared with other weight groups.

Conclusions

Thin children, as well as those who are overweight or obese, are less likely than normal weight children to consider their weight "about right'. Thin children differ from children of other weights in that thin children are less likely to desire to get fitter or be encouraged to exercise. Both extremes of the spectrum of weight, from underweight to obese, may have serious health consequences for the individuals, as well as for public health policy. Health and wellness programs that promote positive social experiences and encourage exercise should include children of all sizes.

UAE population reference standard charts for body mass index and skinfold thickness, at ages 0-18 years

AIMS

To determine a range of anthropometric measurements including skinfold thickness measurements in four different areas of the body, to construct population growth charts for body mass index (BMI), skinfolds, and to compare these with growth charts from other countries. One aim was also to validate body fat charts derived from skinfold thickness.

METHODS

A national cross-sectional growth survey of children, 0-18 years old, was conducted using multistage stratified random sampling. The sample size included at least 200 children in each age-sex group. Height, weight, biceps skinfold, triceps skinfold, subscapular skinfold, suprailiac skinfold, and mid-upper-arm circumference were measured in each child. We describe correlation, standard deviation scores relative to the other standards, and calculation of body density in the United Arab Emirates population. We determined whether any of the above is a good indicator of fatness in children.

RESULTS

BMI, upper-arm circumference, sum of four skinfolds, and percentage body fat charts were constructed using the LMS method of smoothing. BMI was very significantly correlated with sum of skinfold thicknesses, and mid-upper-arm circumference. Prevalence of obesity and overweight in ages 13-17 years was respectively 9.94% and 15.16% in females and 6.08% and 14.16% in males. Derived body fat charts were found not to be accurate.

CONCLUSION

A national BMI, upper-arm circumference, and sum of four skinfolds chart has been constructed that can be used as a reference standard for the United Arab Emirates. Sum of four skinfold thickness charts can be used as crude determinants of adiposity in children, but derived body fat charts were shown to be inaccurate.

[Cost-effectiveness of an intervention to reduce overweight and obesity in 9-10-year-olds. The Cuenca study]

OBJECTIVE

To assess the cost-effectiveness a school-based intervention designed to reduce overweight/obesity and other cardiovascular risk factors in children.

METHODS

Standard cost effectiveness analysis methods and two perspectives (societal and institutional) were used. A cluster-randomized controlled trial with 10 intervention schools (691 children) and 10 control schools (718 children) was performed. Net costs were calculated by subtracting the usual after-school care cost from intervention costs. The effectiveness of the intervention was measured as the reduction in health outcomes compared with the control group.

RESULTS

The intervention costs totaled 125,469.75€, representing 269.83 €/year/child. The usual after-school care was estimated at 844,56 €/year/child. Intervention children showed a decrease in triceps skinfold thickness (-1.25mm, 95% CI: -1.82 to -0.67; P<.001). Intervention children with body mass index (BMI) between the percentiles 25 and 75 showed a decrease in the percentage of body fat (-0.59%; 95% CI: -1.03 to -0.67; P<.001), and those with a BMI>P75 showed a decrease in triceps skinfold thickness (-1.87mm; 95%CI: -3.43 to -0.32; P<.001), and percentage of body fat (-0.67%; 95%CI: -1.32 to -0.01; P<.05).

CONCLUSIONS

This type of after-school program for recreational physical activity to prevent obesity are likely to be a cost-effective use of public funds and warrant careful consideration by policy makers and program planners.

Parental perception of overweight and underweight in children and adolescents

AIMS

To compare the parental perception of overweight and underweight in their children to objective criteria, based on body mass index (BMI), waist circumference and triceps skinfold thickness, and to explore the effects of potential determinants.

METHODS

Logistic regression of anthropometric measurements, socio-demographic characteristics and self-reported parental height and weight on the parental perception of their child's weight status in 3770 children aged 2-19.

RESULTS

Seventy per cent of overweight/obese children and 40.8% of underweight children were perceived having normal weight by parents. In 2- to 5-year-old overweight children, 91.2% were considered to have normal weight. For a given BMI, primary school age children, adolescents and girls had a higher probability to be assigned as overweight, whereas adolescents and girls had a lower probability to be assigned as underweight. Overweight parents more readily assigned their children as underweight, but there was no effect of parental educational level or parental underweight.

CONCLUSION

Parental ability to recognize overweight or underweight in their offspring was generally poor. The findings emphasize the need for objective criteria based on physical measurements in the routine follow up of children, as parental ability to recognize weight problems in their children is nonreliable.

Availability of data assessing the prevalence and trends of overweight and obesity among European adolescents

OBJECTIVE

To review recent data on objectively measured overweight/obesity in national representative samples of European adolescents (aged 10-18 years), as well as availability of studies assessing trends in overweight/obesity in this target group. Attention was paid to the ability of the data to describe the obesity epidemic, especially in sociodemographic subgroups.

DESIGN/SETTING/SUBJECTS

Data on prevalence and trends in overweight/obesity among adolescents in the twenty-seven European Community member states, Iceland, Norway and Switzerland, available as scientific publications as well as reports or unpublished data by the end of 2009, were retrieved. Reports on the most recent objectively measured data from national representative samples were selected and described with regard to the years of data collection, sample sizes, response rates, age ranges included, trends by age, type of measures of overweight/obesity, sociodemographic variables and the sources of information.

RESULTS

Objectively measured data on national representative samples were identified for only half of the countries, and the trend studies were mainly conducted applying subnational samples. Most studies used the criteria from the International Obesity Task Force (IOTF) to define overweight/obesity, but the age ranges studied and the years of data collection varied, and information on sample sizes and response rates were often not presented. Data on trends of overweight/obesity over time are increasing, and the most recent studies indicate that the prevalence rate of overweight/obesity has stabilized. Few studies reported data by sociodemographic subgroups other than gender and age.

CONCLUSIONS

Objectively measured data on national representative samples of adolescents appear scattered, and there is a large heterogeneity with respect to the quality and comparability of available data. Increasing use of the IOTF criteria for overweight/obesity contributes to improved comparability across studies. Data by sociodemographic subgroups, and in particular by socio-economic status, are scarce.

Childhood underweight, weight gain during childhood to adolescence/young adulthood and incidence of adult metabolic syndrome in the SUN (Seguimiento Universidad de Navarra) Project

OBJECTIVE

To assess associations between childhood body weight, weight gain during childhood to adolescence/young adulthood and incidence of adult metabolic syndrome (MetS).

DESIGN

A dynamic prospective cohort study (the SUN Project; Seguimiento Universidad de Navarra). Participants were asked to select which of nine body images most closely represented their body shape at ages 5 and 20 years, and it was used as a proxy of BMI. An incident case of MetS was diagnosed according to criteria of the International Diabetes Federation. Associations between childhood body weight, weight gain during childhood to adolescence/young adulthood and incidence of adult MetS were estimated by multiple-adjusted odds ratios and their 95 % confidence intervals.

SETTING

University of Navarra, Spain.

SUBJECTS

The study included 5317 university graduates, followed-up for a median of 6·1 years.

RESULTS

The incidence of MetS was 2·9 % (1·7 % in women and 5·1 % in men). Among men, body shape at age 5 years was inversely related to adult MetS (OR = 0·83, 95 % CI 0·72, 0·97), whereas weight gain during childhood to adolescence/young adulthood was directly associated with adult MetS (OR = 1·49, 95 % CI 1·01, 2·18); both childhood underweight (OR = 5·20, 95 % CI 1·87, 14·50) and childhood obesity (OR = 4·66, 95 % CI 1·40, 15·51) increased the likelihood of adult MetS. No association was apparent among women.

CONCLUSIONS

These results support treating childhood underweight and weight gain during childhood to adolescence/young adulthood as part of comprehensive adult MetS prevention efforts in men.

Issues in obesity monitoring, screening and subsequent treatment

PURPOSE OF REVIEW

Despite intense policy, media and research interest, childhood obesity rates continue to rise in most countries. Screening may seem a logical response to a situation in which obesity does not usually resolve spontaneously, yet most obese children do not present for treatment. This article explores recent evidence for and against monitoring and screening of children's BMI.

RECENT FINDINGS

Whether conducted in primary care or school settings, population screening of children's BMI can be feasible, acceptable and not intrinsically harmful. However, it incurs a substantial cost, and randomized controlled trials do not suggest that it improves BMI outcomes. Population trends in BMI are more complex than a simple rise in obesity; birth cohorts with higher rates of childhood overweight are not inevitably more overweight as young adults. The consequences of a concomitant increase in thinness are uncertain.

SUMMARY

Systematic monitoring of BMI is essential, but need not be continuous, and could involve representative samples rather than all individuals in a population. In contrast, BMI screening cannot be recommended until more effective management becomes available for overweight and mildly obese children. Research into prevention and intervention should, therefore, be prioritized over population screening at this point in time.