Children and adolescents presenting in general practice: potential for identification and intervention against overweight

Early intervention for childhood overweight: A randomized trial in general practice

OBJECTIVE

To evaluate the effect of two intervention modalities concerning overweight and obesity among children in general practice.

DESIGN

Prospective randomized controlled trial.

SETTING

A total of 60 general practices in the former County of Funen, Denmark.

SUBJECTS

Overweight children, identified by International Obesity Task Force criteria, aged 5-9 years.

INTERVENTION

Model 1 with health consultations in general practice during a two-year period or Model 2, an educational programme for the children and their families in addition to the health consultations.

MAIN OUTCOME MEASURES

Change in body mass index (BMI) z-score in order to compare the results, independent of gender- and age-related changes over time.

RESULTS

A total of 80 children were recruited with 35 and 45 children allocated to Model 1 and Model 2, respectively. No significant differences were found in the change in BMI z-score (SDS) between the two groups. A decrease in the mean BMI z-score from baseline to study end of -0.20 (95%CI -0.38 to -0.01) in Model 1 and -0.26 (95%CI -0.44 to -0.09) in Model 2, respectively, was detected. The majority of the participants (2/3) continued in the study for more than one year in both models, with a mean of 12 consultations in general practice.

CONCLUSION

In this particular setting the two intervention strategies against overweight and obesity did not differ significantly with regard to change in BMI z-scores.

Overweight among Four-Year-Old Children in Relation to Early Growth Characteristics and Socioeconomic Factors

Objectives. To assess early growth characteristics and socioeconomic factors of children in relation to body mass index (BMI) and presence of overweight among four-year-old children. Methods. Two Child Health Centres (CHC) participated in the study. They were selected to obtain two populations of children featuring divergent socio-economic characteristics. Growth data registered at the CHCs from birth to the 4-year check-up were recovered. Overweight was defined by the BMI cut-offs established by IOTF. BMI values expressed as BMI standard deviation score (BMISDS) were used for analysis. Results. At the 4-year check-up, the BMISDS and the proportion of children with overweight (including the obese) were significantly higher in the district with lower socio-economic status. High BMI at birth and low socio-economic status of the population in the CHC-district were shown to be independent determinants for overweight and BMISDS at four years of age. Conclusions. More research is needed to understand the mechanisms and how intervention programs should be designed in order to prevent the development of overweight and obesity in children.

Preventing obesity: challenges and pitfalls for health promotion

OBJECTIVE

To explore challenges to health promotion strategies against obesity, with special attention to the Scandinavian context.

METHODS

Analytic induction, a procedure for verifying theories and propositions, based on purposefully selected literature references, with subsequent critical reflection.

RESULTS

Health promotion efforts against obesity face challenges related to the unequal distribution of vulnerability to weight gain within the population, and to the complex neuroregulatory determinants that explain why obesity is not just a simple matter of lifestyle. Cultural understandings of identity and morality may create victim blaming and disempowerment, thus obstructing clinical health promotion strategies for weight control. Finally, the conceptual validity of obesity measurements and their predictive power deserves attention.

CONCLUSION

Preventing obesity is difficult. Awareness of individual vulnerability and neurobiological mechanisms that lead to weight gain must be taken into account when strategies for health promotion are developed. These strategies must transcend a simplistic energy balance view.

PRACTICE IMPLICATIONS

Clinical health promotion needs to be highly individualized and tailored. Preventing weight gain requires attention to the person's sociodemographic, cultural and genetic characteristics. Cultural trends such as sedentary lifestyles and the nutrition transition should be counteracted without turning body weight control into a question of morality and inferior identity.

When do adolescents become smokers? Annual seven-year population-based follow-up of tobacco habits among 2000 Swedish pupils--an open cohort study

OBJECTIVE

To follow the development of a class of pupils' tobacco habits for seven years, and to study differences in tobacco use between girls and boys.

SETTING

Kronoberg County in southern Sweden.

SUBJECTS

All the approximately 2000 pupils were followed from approximately age 12 to approximately age 18.

DESIGN

Yearly cross-sectional surveys from 1994 to 2000. Each year, the pupils filled in an established tobacco questionnaire. They did it anonymously in the classroom.

MAIN OUTCOME MEASURES

Percentage of smokers, number of cigarettes smoked per day, and percentage of pupils using "snus", the Swedish variety of oral moist snuff.

RESULTS

From grade 6 of compulsory school to grade 12 of upper secondary school, the proportion of daily smokers rose, from 0.2% to 22% for girls and from 0.5% to 14% for boys. Among both genders, the increase occurred mainly between grades 7 and 10, and from grade 10 onwards the daily smokers were the largest group of smokers. Starting from grade 9, boys had higher total tobacco consumption than girls, as a result of their increased use of "snus", and at the end of the study 39% of the boys used tobacco compared with 34% of the girls.

CONCLUSION

Studying young people's tobacco habits over time gives an understanding of when preventive measures should be implemented. In order for these to influence attitudes, they should be put in place well before tobacco is introduced.

Association of BMI and fasting insulin with cardiovascular disease risk factors in seven-year-old Icelandic children

OBJECTIVE

. To look at overweight and common cardiovascular disease (CVD) risk factors, and associations with body mass index (BMI) and fasting insulin in seven-year-old schoolchildren in Reykjavik, Iceland.

STUDY DESIGN

Cross-sectional study of seven-year-old schoolchildren.

SETTING

Six elementary schools in Reykjavik.

SUBJECTS

All children attending second grade in these six schools were invited to participate.

MAIN OUTCOME MEASURES

Overweight, fasting serum insulin, CVD risk factors.

RESULTS

Some 14% of the participating children were classified as overweight. Overweight children had higher fasting insulin, higher fasting glucose, and higher systolic and diastolic blood pressure. Furthermore, they had significantly lower total cholesterol (TC), lower high-density lipoprotein (HDL), and lower low-density lipoprotein (LDL) but a similar TC/LDL ratio to normal-weight children. The factors that were strongly associated with BMI were serum fasting insulin, systolic blood pressure (SBP), HDL and fasting glucose, while the sum of four skinfolds, triglycerides, glucose, and LDL were highly associated with fasting insulin.

CONCLUSION

Overweight children are likelier to have unfavourable levels of common CVD risk factors included in metabolic syndrome, but surprisingly had lower LDL and TC. Skinfold thickness, higher triglyceride and glucose levels, and being female were associated with increased serum insulin.