Stability in the prevalence of Swedish children who were overweight or obese in 2003 and 2011

Maternal body mass index in early pregnancy is associated with overweight and obesity in children up to 16 years of age

AIMS

Childhood obesity is an increasing public health problem. The aim of this study was to investigate the correlation between maternal body mass index in early pregnancy and body mass index in children up to the age of 16 years, and to estimate the prevalence of childhood overweight and obesity in a rural municipality in Sweden.

METHODS

The study population comprised 312 pregnant women who attended the antenatal clinics in Lidköping during the year 1999 and their 319 children. Data on body mass index from antenatal clinics, child health care centres and school health care were used in linear and multinomial logistic regressions adjusted for maternal age, smoking status, and parity.

RESULTS

Overweight or obesity were found in 23.0% of 16-year-olds. The correlation between maternal and child body mass index at all studied ages was positive and significant. Body mass index in 16-year-old boys showed the strongest correlation with maternal body mass index (adjusted r-square = 0.31). The adjusted relative-risk ratio for 16-year old children to be classified as obese as compared to normal weight, per 1 unit increase in maternal body mass index was 1.46 (95% confidence interval 1.29-1.65, p<0.001). Among adolescents with obesity, 37.6% had been overweight or obese at 4 years of age.

CONCLUSIONS

This study confirms the correlation between maternal and child body mass index and that obesity can be established early in childhood. Further, we showed a high prevalence of overweight and obesity in children, especially in boys, in a Swedish rural municipality. This suggests a need for early intervention in the preventive work of childhood obesity, preferably starting at the antenatal clinic and in child health care centres.

Prevalence of overweight and obesity from 5 to 19 years of age in Gothenburg, Sweden

AIM

The aim of this study was to present prevalence data for overweight and obesity across school age in a large, recent, population-based cohort of children in Gothenburg, Sweden.

METHODS

We included 66,807 children (48.5% girls) aged 5-18.9 years who had their height and weight measured in school health care 2015-2018. The BMI values were categorised according to the age-dependent cut-offs for overweight and obesity from the International Obesity Task Force (IOTF).

RESULTS

Overall, the prevalence of overweight and obesity for girls and boys was 18.1% and 18.0%, respectively. We observed increasing proportions of overweight (girls 11.5-17.1% and boys 8.4-17.4%) and obesity (girls 3.0-4.2% and boys 2.7-6.1%) with increasing age (p < 0.001 for trend in both sexes). Moreover, girls had higher prevalence of overweight during ages 5.0 to 8.9 years compared with boys (p < 0.001), while boys had higher prevalence of obesity 15.0-18.9 years compared with girls (p < 0.001).

CONCLUSION

In conclusion, we demonstrate increasing prevalence of overweight and obesity across the entire school age range, as well as differences in prevalences between boys and girls, in a population-based sample of 67,000 children in Gothenburg city, Sweden. Continuous monitoring of schoolchildren, together with effective preventive measures, is crucial to curb the obesity epidemic and its consequences.

Trends in prevalence of thinness, overweight and obesity among Swedish children and adolescents between 2004 and 2015

AIM

This study explored weight trends among children aged 4, 7, 11, 14 and 17 years in Jönköping County Sweden, from 2004 to 2015.

METHODS

The study had a repeated cross-sectional design, and body mass index (BMI) was calculated based on height and weight measurements collected from child health and school health records. The prevalence of thinness, overweight and obesity was estimated with international cut-offs, with linear trends calculated separately for boys and girls.

RESULTS

There were 190 965 measurements of BMI and these covered 82-97% of the younger children and 55-69% of the older children during the study period. The prevalence of thinness varied between 0.2% and 2.2% across time and age groups and did not change over the study period. There was a small decrease in overweight among both girls and boys aged four years. There were increasing trends in overweight and obesity in both girls and boys aged 11 and 14 years of age and a sharp increase among 17-year-old boys, with 7.3% obese in 2014/2015 and 3.6% in 2004/2005.

CONCLUSION

The prevalence of obesity decreased from 2004 to 2015 or was stable in younger Swedish children, but increased among older children, with a large increase in adolescent boys.

Outcomes after slipped capital femoral epiphysis: a population-based study with three-year follow-up

PURPOSE

To evaluate outcomes three years after treatment for slipped capital femoral epiphysis (SCFE): development of avascular necrosis (AVN), subsequent surgery, hip function and the contralateral hip.

METHODS

This prospective cohort study included a total national population of 379 children treated for SCFE between 2007 and 2013. A total of 449 hips treated for SCFE and 151 hips treated with a prophylactic fixation were identified. The Barnhöft questionnaire, a valid patient-reported outcome measure (PROM), was used.

RESULTS

In all, 90 hips had a severe slip, 61 of these were clinically unstable. AVN developed in 25 of the 449 hips. Six of 15 hips treated with capital realignment developed AVN. A peri-implant femur fracture occurred in three slipped hips and in two prophylactically pinned hips. In three of these five hips technical difficulties during surgery was identified. In 43 of 201 hips scheduled for regular follow-up a subsequent SCFE developed in the contralateral hip. Implant extraction after physeal closure was performed in 156 of 449 hips treated for SCFE and in 51 of 151 prophylactically fixed hips. Children with impaired hip function could be identified using the Barnhöft questionnaire.

CONCLUSION

Fixation in situ is justified to remain as the primary treatment of choice in SCFE. Overweight is more common in children with SCFE than in the average population. Prophylactic fixation is a safe procedure when performed using a correct technique. The number of patients who developed AVN after capital realignment is of concern. We recommend rigorous follow-up of both hips, including PROM evaluation, until physeal closure.

LEVEL OF EVIDENCE

II - prospective cohort study.

The prevalence of underweight, overweight and obesity in children and adolescents from Ukraine

The aim of this study was to evaluate the prevalence of overweight, obesity and underweight in children from Ukraine. A cross-sectional study was performed on data collected from a representative sample of Ukraine children (13,739 children (boys 48%, girls 52%) aged 6.0-18.9 years). The measurement of body weight was performed with medical scales and height was measured using a stadiometer. Based on the results obtained, body mass index (BMI) was calculated. Three criteria were used to define childhood underweight, overweight and obesity: The International Obesity Task Force (IOTF) reference, World Health Organization (WHO) child growth standard and The US Center for Disease Control and Prevention (CDC). The combined prevalence of obesity and overweight among children aged 6-18 years old was 12.1%, 17.6%, and 12.6% based on the IOTF reference, WHO growth standard, and the CDC, respectively. Obesity was 2.1%, 4.2%, and 3.6% respectively. Significantly more girls were underweight than boys. Furthermore, a higher prevalence of overweight and obesity was diagnosed in younger that older Ukrainian population.

Media framing and construction of childhood obesity: a content analysis of Swedish newspapers

Objective

Despite lower prevalence than most European countries, childhood obesity is a Swedish public health priority due to its lasting health impacts and socioeconomic patterning. Mass media content influences public and political perceptions of health issues, and media framing of childhood obesity may influence perceptions of its solutions. This study examines framing of childhood obesity in Swedish morning and evening newspapers from 1996 to 2014.

Methods

Content analysis of 726 articles about childhood obesity published in the five most-circulated Swedish newspapers. Article content coded quantitatively and subjected to statistical analysis, describing relationships between themes and trends over time.

Results

Childhood obesity was consistently problematised, primarily in health terms, and linked to socio-economic and geographical factors. The yearly frequency of articles peaked in 2004, followed by a decline, corresponding with evidence about prevalence. Childhood obesity was framed as being driven by individual behaviours more frequently than structural or environmental factors. Structural framings increased over time, but constructions of the problem as driven by individual behaviours, particularly parenting, remained prominent.

Conclusions

A relative growth in structural framings of causes and solutions over time, combined with prominent coverage of socio-economic inequalities, might be indicative of public and political amenability towards societal-level solutions, but individual behaviours remain prominent in framing of the issue. Health advocates might incorporate these insights into media engagement.

Associations of Parental Self-Efficacy With Diet, Physical Activity, Body Composition, and Cardiorespiratory Fitness in Swedish Preschoolers: Results From the MINISTOP Trial

BACKGROUND

High parental self-efficacy (PSE) has been associated with healthy diets and higher levels of physical activity (PA) in children; however, data on PSE in relation to body weight and body composition are scarce. The objective of this study was to investigate associations of PSE with measures of diet, PA, body composition, and physical fitness in early childhood.

METHOD

We used baseline data from the MINISTOP trial in healthy Swedish children ( n = 301; 4.5 ± 0.15 years). PSE was assessed using a questionnaire, dietary data were collected using a mobile technology-assisted methodology, and PA was obtained (sedentary behavior and moderate-to-vigorous) by accelerometry. Body composition was measured using the pediatric option for BodPod and cardiorespiratory fitness by the 20 m shuttle run. Linear regression was conducted to evaluate cross-sectional associations of the outcomes in relation to total PSE and scores computed for the individual PSE factors: (1) diet, (2) limit setting of unhealthful behaviors, and (3) PA.

RESULTS

Higher scores of total PSE and the diet factor were associated with higher fruit intake (β = 0.82 g/point and 1.99 g/point; p = .014 and .009, respectively) and lower consumption of unhealthy snacks (β = -0.42 g/point and -0.89 g/point; p = .012 and .020, respectively) after adjustment for parental body mass index and education, respondent, and child's sex and age. No associations were observed between PSE and PA, body composition, or cardiorespiratory fitness.

CONCLUSIONS

Our study noted that PSE should be considered in conjunction with other strategies for a sustainable impact on childhood obesity.

Mobile-based intervention intended to stop obesity in preschool-aged children: the MINISTOP randomized controlled trial

Background: Traditional obesity prevention programs are time- and cost-intensive. Mobile phone technology has been successful in changing behaviors and managing weight; however, to our knowledge, its potential in young children has yet to be examined.Objective: We assessed the effectiveness of a mobile health (mHealth) obesity prevention program on body fat, dietary habits, and physical activity in healthy Swedish children aged 4.5 y.Design: From 2014 to 2015, 315 children were randomly assigned to an intervention or control group. Parents in the intervention group received a 6-mo mHealth program. The primary outcome was fat mass index (FMI), whereas the secondary outcomes were intakes of fruits, vegetables, candy, and sweetened beverages and time spent sedentary and in moderate-to-vigorous physical activity. Composite scores for the primary and secondary outcomes were computed.Results: No statistically significant intervention effect was observed for FMI between the intervention and control group (mean ± SD: -0.23 ± 0.56 compared with -0.20 ± 0.49 kg/m²). However, the intervention group increased their mean composite score from baseline to follow-up, whereas the control group did not (+0.36 ± 1.47 compared with -0.06 ± 1.33 units; P = 0.021). This improvement was more pronounced among the children with an FMI above the median (4.11 kg/m²) (P = 0.019). The odds of increasing the composite score for the 6 dietary and physical activity behaviors were 99% higher for the intervention group than the control group (P = 0.008).Conclusions: This mHealth obesity prevention study in preschool-aged children found no difference between the intervention and control group for FMI. However, the intervention group showed a considerably higher postintervention composite score (a secondary outcome) than the control group, especially in children with a higher FMI. Further studies targeting specific obesity classes within preschool-aged children are warranted. This trial was registered at clinicaltrials.gov as NCT02021786.

The rise and the recent decline of childhood obesity in Swedish boys: the BEST cohort

BACKGROUND/OBJECTIVES

Childhood obesity increases the risk for adult obesity and diseases. The aim of this study was to investigate secular changes of childhood body mass index (BMI), overweight and obesity in boys born during 1946-2006, using the population-based BMI Epidemiology STudy (BEST) cohort in Gothenburg, Sweden.

SUBJECTS/METHODS

We collected height and weight from archived school health records for boys born every 5 years 1946-2006 (birth cohort 1946 n=1584, each birth cohort 1951-2006 n=425). Childhood BMI at 8 years of age was obtained for all the participants.

RESULTS

Childhood BMI increased 0.18 kg m^-2 (95% confidence interval: 0.16-0.20) per decade increase in birth year, during 1946-2006. The increase was significant from birth year 1971, peaked 1991 and was then followed by a stabilization or tendency to a reduction. Next, we aimed to thoroughly explore the trend after birth year 1991 and therefore expanded birth cohorts 1991 (n=1566), 2001 (n=6478) and 2006 (n=6515). Importantly, decreases in mean BMI (P<0.01), prevalences of overweight (P<0.01) and obesity (P<0.05) were observed after birth year 1991. For boys born in Sweden and with parents born in Sweden, a substantial reduction in the prevalences of overweight (-28.6%, P<0.001) and obesity (-44.3%, P<0.001) were observed between birth year 1991 and birth year 2006.

CONCLUSIONS

This long-term study captures both the rise and the recent decline of childhood obesity. As childhood obesity is strongly associated with subsequent adult obesity, we anticipate a similar reduction in adult obesity during the coming decades in Swedish men.

Trends and changes in paediatric tonsil surgery in Sweden 1987-2013: a population-based cohort study

OBJECTIVES

The objective of this study was to longitudinally describe the history of tonsil surgery in Swedish children and adolescents regarding incidence, indications for surgery, surgical methods and the age and gender distributions.

SETTING

A retrospective longitudinal population-based cohort study based on register data from the Swedish National Patient Register (NPR) and population data from Statistics Sweden.

PARTICIPANTS

All Swedish children 1-<18 years registered in the NPR with a tonsil surgery procedure 1987-2013.

RESULTS

167 894 tonsil surgeries were registered in the NPR 1987-2013. An increase in the total incidence rate was observed, from 22/10 000 person years in 1987 to 47/10 000 in 2013. The most marked increase was noted in children 1-3 years of age, increasing from 17 to 73/10 000 person years over the period. The proportion children with obstructive/sleep disordered breathing (SDB) indications increased from 42.4% in 1987 to 73.6% in 2013. Partial tonsillectomy, tonsillotomy (TT), increased since 1996 and in 2013 55.1% of all tonsil procedures were TTs.

CONCLUSIONS

There have been considerable changes in clinical practice for tonsil surgery in Swedish children over the past few decades. Overall, a doubling in the total incidence rate was observed. This increase consisted mainly of an increase in surgical procedures due to obstructive/SDB indications, particularly among the youngest age group (1-3 years old). TT has gradually replaced tonsillectomy as the predominant method for tonsil surgery.

Associations Between Swedish Mothers' and 3- and 5-Year-Old Children's Food Intake

OBJECTIVE

To investigate associations between mothers' and children's food intake.

DESIGN

Cross-sectional study. Background variables collected through self-reports and from the register of the total population. Mothers recorded their own and their children's food intake in a diary during 2 4-day periods.

SETTING

Eight counties in mid Sweden.

PARTICIPANTS

Three- and 5-year-old children and their mothers were randomly selected from the register of the total population. A total of 2,045 families were invited, 355 of whom accepted. Mothers who accepted were older and to a larger extent born in Sweden. The final sample of mother-child pairs with complete food records was 189.

MAIN OUTCOME MEASURES

Mothers' and children's food intake (16 food items).

ANALYSIS

Spearman rank-order correlation with 95% confidence intervals (2-sided). Moderation was investigated using generalized estimation equations with robust variance.

RESULTS

The strongest correlations between mothers' and children's food intake were found for pizza and oily fish (r = .70-.80). The weakest correlations were found for sugared drinks and fruit and berries (r = .24-.26). Children's age moderated the relationship between mothers' and children's intake of savoury snacks, as did place of residence for pizza intake.

CONCLUSIONS AND IMPLICATIONS

There were substantial correlations between children's and mothers' intake of various foods. Modeling of mothers' intake might be more effective in influencing young children's intake of certain foods, whereas other strategies, such as encouraging parents to influence food availability (eg, gatekeeping), might be more useful for some foods.