Tracking of overweight from mid-adolescence into adulthood: consistent patterns across socio-economic groups

Body Mass Index and Prevalence of Obesity in Brazilian Adult Women: Temporal Comparison of Repeated Population-Based Cross-Sectional Surveys

Background: Obesity is a complex multifactorial disease that has been associated with higher morbidity and mortality. Objectives: This study aimed to compare changes in body mass index (BMI) and obesity prevalence between two cross-sectional samples of Brazilian women. Furthermore, retrospective assessments of lifetime body weight changes were explored. Methods: Two independent population-based cross-sectional surveys were conducted in 2003 (first survey) and 2015 (second survey) with women living in the urban area city in southern Brazil. Both surveys had a similar design and included 981 women aged 20-60 years. Mean BMI and the presence of obesity (BMI ≥ 30 kg/m2) were estimated. Additionally, lifetime body weight change was obtained for the retrospective longitudinal assessment. Results: After 12 years, there was a significant increase from 25.9 ± 5.3 kg/m2 to 28.1 ± 6.2 kg/m2 in mean BMI. Between 2003 and 2015, the prevalence of obesity increased by 73% (18.0%; 95% CI: 15.8-20.6 vs. 31.2%; 95% CI: 28.3-34.1; p < 0.001). The means of estimated cumulative body weight gain from 15 to 50 years were 15.2 kg (95% CI: 13.3-17.1) and 17.2 kg (95% CI: 15.5-18.9) in 2003 and 2015, respectively; the greater cumulative difference between the two periods was observed at 40 years of age (3.3 kg). Conclusions: There was a significant increase in the mean BMI and prevalence of obesity between 2003 and 2015. Moreover, women experienced higher body weight gain during their lives in both survey periods, mainly in early adulthood.

Cost-effectiveness of a day-camp weight-loss intervention programme for children: Results based on a randomised controlled trial with one-year follow-up

AIMS

The aim was to analyse the cost-effectiveness of an intensive weight-loss intervention for children compared with a low-intensity intervention.

METHODS

One hundred and fifteen overweight children (mean age 12.0 ± 0.4) were randomised to either the camp group (CG) ( N=59) or the standard group (SG) ( N=56). Participants in the CG were offered a six-week day-camp weight-loss programme followed by a family-based supportive programme containing four meetings during the succeeding 46 weeks. Participants in the SG were offered a weekly two-hour exercise session for six weeks. Changes in body mass index (BMI) and BMI z-score 12 months after inclusion were used to compare the effects of the two interventions. Incremental cost-effectiveness ratios (ICER) were estimated from the perspective of a Danish municipality. To achieve the required number of participants, an additional intervention was initiated one year later.

RESULTS

In comparison with the SG, the CG changed their mean BMI by -1.2 (95% CI -1.8 to -0.5). Compared with the SG children, the CG children changed their BMI z-score by -0.20 (95% CI -0.35 to -0.05). The ICER per decreased BMI point in the CG compared with the SG was DDK 24,928.

CONCLUSIONS

Compared with the SG, the CG showed favourable effects after 12 months. However, the CG was more costly. The results observed in the present study may be helpful in guiding decision makers to take more informed decisions when choosing different types of intervention.

Socioeconomic position and childhood-adolescent weight status in rich countries: a systematic review, 1990-2013

Background

Childhood obesity is a major problem in rich countries due to its high prevalence and its harmful health consequences. An exploratory analysis conducted in the PubMed database highlighted that the number of papers published on the relationship between socioeconomic position (SEP) and childhood-adolescent weight status had risen substantially with respect to an earlier review which had covered the period 1990–2005.

Methods

To describe the findings on the relationship between SEP and childhood-adolescent weight status in papers published in rich countries from 1990 through 2013, studies were identified in the following databases: PubMed; Web of Knowledge (WOK); PsycINFO; Global Health; and Embase. We included observational studies from the 27 richest OECD countries, which covered study populations aged 0 to 21 years, and used parental education, income and/or occupation as family SEP indicators. A total of 158 papers met the inclusion criteria and reported 134 bivariable and 90 multivariable analyses.

Results

Examination of the results yielded by the bivariable analyses showed that 60.4 % of studies found an inverse relationship, 18.7 % of studies did not found relationship, and 20.9 % of studies found a relationship that varied depending on another variable, such as age, sex or ethnic group; the corresponding percentages in the multivariable analyses were 51.1, 20.0 and 27.8 %, respectively. Furthermore, 1.1 % found a positive relationship.

Conclusion

The relationship between SEP and childhood-adolescent weight status in rich countries is predominantly inverse and the positive relationship almost has disappeared. The SEP indicator that yields the highest proportion of inverse relationships is parents’ education. The proportion of inverse relationships is higher when the weight status is reported by parents instead using objective measurements.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0443-3) contains supplementary material, which is available to authorized users.

Privileging physical activity over healthy eating: 'Time' to Choose?

Physical activity and healthy eating have long been promoted as key strategies in tackling the 'wicked problem' of obesity. Both practices are assumed to go hand-in-hand, but whether one dominates the other has largely remained unexamined. Moreover, time, a dimension beyond the socio-ecological model, is a critical factor of families' busy lives, but related challenges are rarely articulated. We conducted 47 family interviews as part of a mixed methods study examining environmental influences on youth obesity in Nova Scotia, Eastern Canada. Participants were recruited from six schools at the junior high school level (grades 7-9; age range 12-14 years) based on location (urban, suburban and rural) and neighborhood socioeconomic status (high and low socioeconomic status). Time pressure to meet the demands associated with scheduled physical activity for youth was the dominant theme across interviews from all neighborhoods. Physical activity and healthy eating were valued differently, with greater value placed on physical activity than healthy eating. The pressure to engage youth in organized physical activity appeared to outweigh the importance of healthy eating, which led to neglecting family meals at home and consuming fast food and take out options. Our findings further reinforce the need to move beyond the socio-ecological model and integrate critical dimensions such as 'time', its challenges and opportunities, to allow for a more nuanced understanding of contemporary healthy living. It appears 'timely' to focus on healthy public policy in support of families, instead of unwittingly supporting a fast food industry that profits from time-pressured families.

Socioeconomic inequalities in health trajectories in Switzerland: are trajectories diverging as people age?

Do socioeconomic differences in health status increase as people age, reflecting cumulative advantage or disadvantage in health trajectories? Life course research hypothesises that cumulative advantage/disadvantage (CAD) is an important underlying social process that shape inequalities as people age. The objective of this study is to examine whether health trajectories are diverging as people age across socioeconomic positions (education, employment status and income). In a random sample of 3,665 respondents living in Switzerland (Swiss Household Panel 2004-2011), trajectories of self-rated health, body mass index, depression and medicated functioning were examined with multilevel regression models. The results showed that employment status and income were associated with diverging health trajectories among men; however, only a few associations supported the CAD hypothesis. Education was rarely associated with diverging health trajectories. In conclusion, little evidence was found to support the CAD model.

Socio-economic position as a moderator of 9–13-year-old children’s non-core food intake

Objective

There is limited understanding as to why children of low socio-economic position (SEP) consume poorer diets than children of high SEP. Evidence suggests that determinants of dietary intake may differ between SEP groups. The present study aimed to determine if SEP moderated associations of personal and environmental predictors with children’s non-core food and sweetened drink intakes and unhealthy dietary behaviours.

Design

Children completed online questionnaires and parents completed computer-assisted telephone interviews to assess intrapersonal and environmental dietary predictors. Dietary intake was measured using an FFQ. Parents reported demographic information for maternal education, occupation and employment, and household income.

Setting

Twenty-six primary schools in South Australia, Australia.

Subjects

Children aged 9–13 years and their parents (n 395).

Results

Multiple personal and home environment factors predicted non-core food and sweetened drink intakes, and these associations were moderated by SEP. Maternal education moderated associations of girls’ sweetened drink intake with self-efficacy, cooking skills and pressure to eat, and boys’ non-core food intake with monitoring, parent’s self-efficacy and home environment. Maternal occupation and employment moderated associations of sweetened drink intake with attitudes, self-efficacy, pressure to eat and food availability, and non-core food intake with parents’ self-efficacy and monitoring. Income moderated associations with pressure to eat and home environment.

Conclusions

Identifying differences in dietary predictors between socio-economic groups informs understanding of why socio-economic gradients in dietary intake may occur. Tailoring interventions and health promotion to the particular needs of socio-economically disadvantaged children may produce more successful outcomes and reduce socio-economic disparities in dietary intake.