Overweight more prevalent among children than among adolescents

Overweight and Obesity in Children under 5 Years: Surveillance Opportunities and Challenges for the WHO European Region

Background

Many children who have overweight or obesity before puberty can develop obesity in early adulthood, which is associated with increased morbidity and mortality. The preschool years (ages 0–5) represents a point of opportunity for children to be active, develop healthy eating habits, and maintain healthy growth. Surveillance of childhood overweight and obesity in this age group can help inform future policies and interventions.

Objective

To review and report available prevalence data in WHO European Region Member States and determine how many countries can accurately report on rates of overweight and obesity in children under 5 years.

Methods

We conducted a rapid review of studies reporting on overweight and obesity prevalence in children ages 0–5 in the WHO European region member states from 1998 to 2015.

Results

Currently, 35 of the 53 member states have data providing prevalence rates for overweight and obesity for children under 5 years. There was little consistency in study methods, impacting comparability across countries. The prevalence of overweight and obesity in children under 5 years ranges from 1 to 28.6% across member states.

Conclusion

Although measuring overweight and obesity in this age group may be challenging, there is an opportunity to leverage existing surveillance resources in the WHO European Region.

Obesity in Nursery School Children in Corum, Turkey

BACKGROUND

Regular body mass index (BMI) screenings in schools is important to ensure that 3- to 6-year-old children are not negatively affected by obesity in terms of their current and future health.

OBJECTIVES

The aim of this study was to determine the overweight and obesity results of 3- to 6-year-old children and to guide children and their family in making healthier dietary choices by informing them.

METHODS

This analytical-descriptive study was conducted in Corum, Turkey, in the year 2011. The study's sample consisted of all available 3- to 6-year-old children entering nursery school (specifically, the Buharaevler, Karsıyaka, Nasrettin Hoca, Ulukavak, Mimar Sinan, and Sevgi nursery schools). Findings from the study were statistically analyzed using the SPSS 15.0 program. The Chi-square test and analysis of variance (ANOVA) program were used in the comparison of study data. A p-value of less than 0.05 was considered significant.

RESULTS

It was determined that 9.5% of the participating female children and 5.2% of the male children were underweight and that the boys were more obese than the girls in general. The correlation between the child's gender and their BMI was not found to be statistically significant (P-value > 0.05). The overweight frequency of the children was 12.1%, and the obesity frequency was 14.3%. Furthermore, it was determined that the obesity rates of the children increased with their age. Accordingly, the correlation between the child's age and BMI was found to be statistically significant (P-value < 0.05).

CONCLUSIONS

An approach to preventing obesity must not be enacted only in health centers. Schools should also offer information and resources for families in order to prevent obesity in children.

Physical self-esteem--a ten-year follow-up study from early adolescence to early adulthood

INTRODUCTION

One variable that has been consistently associated with adolescents' physical activity is perceived activity competence. Perceived physical (or sport) competence is considered a sub-domain to the physical self-esteem or self-worth (i.e., a person's valuation of what is good and worthy in their self-description).

OBJECTIVE

This study aimed to describe levels of and inter-correlations among physical self-esteem, physical activity, and body mass index in a longitudinal design spanning adolescence to early adulthood.

MATERIALS AND METHODS

At mean ages of 12.7, 15.7, 17.7 and 22.7 years, we measured perceived physical self-esteem in 39 (22 boys) Swedish adolescents. Physical activity (steps/day) for four consecutive schooldays, height, and weight were also measured.

RESULTS

No significant difference between the four time points for any variable of perceived physical self-esteem was seen, neither in boys nor girls. In general, all physical self-variables revealed non-linear trajectories across time, where the general trend was an increase during the younger ages followed by a decrease during older ages. At ages 12 and 15 years in boys and girls physical condition and physical strength as well as body attractiveness and physical strength, respectively, had the strongest correlations to physical self-esteem. At age 17 and 22 years sports competence had the strongest correlation to self-esteem in girls, while body attractiveness and physical strength had the strongest correlation to self-esteem in boys.

CONCLUSION

An overall stability in physical self-esteem was found. However the impact of a sub-domain upon physical self-esteem vary during adolescence and early adulthood. Such information may be useful when creating physical activity programs that support and develop physical self-esteem.

Dietary intake, leisure time activities and obesity among adolescents in Western Sweden: a cross-sectional study

BACKGROUND

Overweight and obesity among adolescents are increasing worldwide. Risk factors include dietary intake characteristics and high levels of physical inactivity. In Sweden, few large comprehensive population-based surveys of dietary intake and lifestyle among adolescents have been carried out. Thus, the purpose of the current study was to describe dietary intake and food choices as well as leisure time activities in relation to overweight and obesity in a total sample of all schoolchildren aged 15 years in Western Sweden.

METHODS

In 2008, a questionnaire was sent to all 21,651 adolescents born in 1992 in Västra Götaland Region, Sweden. Participation rate was 54.3 % (50.7 % girls/49.3 % boys). The questionnaire included a 73-item semi-quantitative food frequency questionnaire and questions on lifestyle. Results were evaluated against the Nordic Nutrition Recommendations and Swedish indicators of healthy diet and exercise habits. Associations with concurrent overweight and obesity were evaluated in multiple linear regression analysis.

RESULTS

Among girls, 49.5 % reached the goal of consuming fruit and vegetables at least daily, whereas for boys the figure was 34.4 %. Among both sexes, 15 % reached the goal of consuming fish at least twice weekly. Two-thirds of both sexes reached the goal of regular moderate or vigorous physical activity weekly. In total, 12.4 % were overweight and 2.4 % were obese. More girls than boys were underweight, whereas more boys than girls were overweight or obese (p < 0.001). Boys exhibited a more frequent intake of sodas and concentrated fruit juices, milk 3 % fat, bread and potatoes and fast food (p < 0.001). Frequent intake of candies and chocolate was reported by both sexes. Among girls and boys, living in rural areas, living in apartments and reporting no frequent leisure time physical activity were significant risk factors for being overweight or obese, also when adjusted for other risk factors.

CONCLUSIONS

Dietary habits of adolescents in Western Sweden warrant improvements. Public health actions should be taken to increase consumption of fruit, vegetables and fish, and decrease consumption of sodas and candies and also to increase frequency of physical activity. These actions may be helpful in reducing risks for overweight and obesity.

Feeling 'too fat' rather than being 'too fat' increases unhealthy eating habits among adolescents - even in boys

Background

Adolescence is a period of gender-specific physical changes, during which eating habits develop. To better understand what factors determine unhealthy eating habits such as dieting to lose weight, skipping meals, and consumption of unhealthy foods, we studied how physical measurements and body perception relate to eating habits in boys and girls, before and during adolescence.

Methods

For this cross-sectional study, we obtained data from both written questionnaires and physical measurements of height, weight, and waist circumference (WC).

Results

Dieting to lose weight and skipping breakfast were more common among adolescents than among younger boys and girls (p<0.05). The strongest risk factor for dieting in both boys and girls was perception of overweight, which persisted after adjusting for age and for being overweight (p<0.01). Another independent risk factor for dieting behaviour was overweight, as defined by body mass index (BMI) among boys (p<0.01) and WC among girls (p<0.05). In both boys and girls, skipping breakfast was associated with both a more negative body perception and higher BMI (p<0.05). Skipping breakfast was also associated with age- and gender-specific unhealthy eating habits such as skipping other meals, lower consumption of fruits and vegetables, and higher consumption of sweets and sugary drinks (p<0.05).

Conclusion

Body perception among adolescents is an important factor relating to unhealthy eating habits, not only in girls, but even in boys. Focus on body perception and eating breakfast daily is crucial for the development of healthy food consumption behaviours during adolescence and tracking into adulthood.

The More and Less Study: a randomized controlled trial testing different approaches to treat obesity in preschoolers

Background

While obesity has been shown to be difficult to treat in school aged children and in adolescence, promising results have been detected for children who started treatment in early childhood. Yet knowledge on the effectiveness of structured early childhood obesity treatment programs is limited, preventing the widespread implementation of such programs. The main objective of this study is to evaluate the effectiveness of early treatment of childhood obesity with respect to treatment focus (parenting practices or lifestyle), length and intensity. The study will also examine the influence of gender, age, parental weight status, parenting practices, child behavior as well as parents’ socioeconomic status and child and parental psychosocial health on children’s weight status.

Methods/design

This is a parallel open label randomized controlled trial assessing two different behavioral treatment approaches offered in three conditions to families with children aged 4–6 years in Stockholm County, Sweden. Children (n = 180) identified as obese will be referred from primary child health care, school health care, and from outpatient pediatric clinics, and randomized to: 1) a standard treatment with focus on lifestyle, provided within the current healthcare system (n = 90); 2) a 10-session, 1.5 h/week group treatment with focus on parenting (n = 45); or 3) the same group treatment as 2) with additional follow-up sessions (n = 45). The primary study outcome is change in children’s body mass index standard deviation score (BMI SDS) one year post-baseline. Secondary outcomes include changes in children’s waist circumference, metabolic health, lifestyle patterns (Food Frequency Questionnaire), obesity-related child behaviors (Child Eating Behavior Questionnaire and Lifestyle Behavior Checklist, Problem Scale), parents’ general and feeding parenting practices (Communicating with Children and Child Feeding Questionnaire) and lifestyle-specific self-efficacy (Lifestyle Behavior Checklist, Confidence Scale), family functioning (Family Assessment Device), child and parental psychosocial health (Child Behavior Checklist and Beck’s Depression Inventory II).

Discussion

This study will facilitate a close examination of key components of treatment for obesity during early childhood and mechanisms of change. Results from this study will lead to better healthcare options for obesity treatment during early childhood and ultimately to the prevention of obesity later in life.

Trial registration

ClinicalTrials.gov NCT01792531 Registered February 14, 2013.

Overweight and dental caries: the association among German children

OBJECTIVES

The aim of this study was to determine the relationship between iso-body mass index (iso-BMI) and both dental caries status and caries increment among German school children.

METHODS

Six hundred and ninety-four students (age range 9-12 years, mean 10.34 ± 0.56, 48% females) were recruited from the fifth grade of 18 primary schools. Weight, height, and oral health data number of decayed, missing and filled teeth (DMFT) as well as parent/legal guardian questionnaire (measuring SES) were collected during school dental examination at baseline and after one and a half-year follow-up. The body mass index (BMI) was calculated using the international classification system for childhood overweight and obesity (iso-BMI). Statistical analyses were performed using Poisson regression models.

RESULTS

Iso-BMI was significantly associated with dental caries prevalence and severity in the permanent dentition (P = 0.039). Low-normal weight children had a lower mean DMFT (0.56) than did overweight/obese children (0.70). In addition, a border-line significant association was found between overweight/obese children and caries increment (P = 0.055).

CONCLUSION

Although iso-BMI was associated with dental caries prevalence and severity, the association between caries increment and iso-BMI did not reach a statistical significance. Overweight/obese children however acquired more additional carious lesions during the follow-up period than children with low-normal weight.

Frequency of obesity and related risk factors among school children and adolescents in a low-income community. A cross-sectional study

CONTEXT AND OBJECTIVE

The frequency of obesity at an early age may contribute to atherosclerosis and cardiovascular disease (CVD) in adults. This study measured the frequency of obesity and cardiovascular risk factors in children and adolescents aged 6 to 17 years.

DESIGN AND SETTING

Cross-sectional study in a school located in a region of low income and socioeconomic status in Santa Rita do Sapucai, Minas Gerais, Brazil.

METHODS

A total of 175 students were classified using body mass index (BMI) and their waist circumference, blood pressure, number of hours of sedentary behavior and school meals were evaluated. Serum concentrations of fasting blood glucose, total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) were analyzed.

RESULTS

37.2% of the students had BMI above the 85th percentile and had significantly lower age, higher prevalence of hypertension, higher serum TC, LDL-C and TG, and greater waist circumference than those with BMI below the 85th percentile. Hypertension was observed in 2.9% of the students; 5.1% presented impaired glucose tolerance, 40% had two risk factors for atherosclerosis and 26.9% had three risk factors. A sedentary lifestyle was significantly less prevalent among subjects with BMI above the 85th percentile and was significantly correlated with serum TC and LDL-C. The school meals were hypoglycemic, hyperproteic and hyperlipidemic.

CONCLUSION

One third of the children and adolescents had weights greater than or equal to the age-adjusted weight, and this was associated with greater waist circumference, hypertension and prevalence of dyslipidemia.

Weight, body image and bullying in 9-year-old children

AIM

To explore the association between weight and bullying; considering victims and perpetrators as two aspects of bullying, and subjective perception and objective measurement as two aspects of weight.

METHODS

This study is based on the first wave of data collection from Growing Up in Ireland - the National Longitudinal Study of Children. The two-stage sample design included a sample of 910 primary schools in Ireland, from which a sample of 8568 nine-year-old children and their families was randomly selected. Analysis is based on statistically reweighted data to ensure that it is representative of all 9-year-olds in Ireland.

RESULTS

Significantly (P < 0.001) more girls were overweight or obese (33.1%: 23.1% overweight and 10% obese) than boys (25.2%: 18.3% and 6.9%). Children who were body mass index (BMI) classified as overweight or obese were significantly (P < 0.001) more likely to be victimised when compared with children whose BMI was not classified as overweight or obese. BMI-classified thinness was not significantly associated with victimisation; however, the body image of being skinny or very skinny was significantly (P = 0.015) associated with being victimised. Bullying perpetration was not associated with BMI-derived weight classification but was significantly (P < 0.001) associated with the child's own self-description of weight.

CONCLUSIONS

Overall body image was found to have a stronger association with victimisation and bullying perpetration than objective BMI-derived weight classification. Further research investigating the mediating role of body image in the relationship between weight, victimisation and bullying is necessary to better understand this association.

Influence of obesity on nocturnal oxygen saturation in young children

Obesity is increasing worldwide and it is accompanied by major health effects. In adults and school-aged children, obesity is associated with decreased respiratory function, which may lead to disturbed sleeping and subsequently difficulties in concentration and behavioural disorders. The evidence for the association between obesity and decreased respiratory function in younger children is scarce. To explore the association between body weight and nocturnal respiratory function in young children, 1 to 3 years old, nocturnal pulse oximetry was performed at home. Children with tonsillar hypertrophy were excluded. Percentage of time with oxygen saturation (SpO(2)) <95 % was measured and its association with body mass index (BMI) for age z scores was analysed. Pulse oximetric data of 51 children, including 18 children with a BMI for age above +2 standard deviations, were obtained for this study. Linear regression analysis, correction for gender and parental smoking, showed a positive association between the natural logarithm of SpO(2) <95 % and BMI for age z score [regression coefficient (β) 0.19, 95 % confidence interval 0.00-0.39].

CONCLUSION

In young children, higher body weight is associated with a decrease in nocturnal oxygen saturation.

High prevalence of overweight and obesity among 6-year-old children in Finnmark County, North Norway

AIM

The aim was to determine the prevalence of overweight and obesity among 6-year-old children in Finnmark, the northernmost county of Norway.

METHODS

This is a survey of 1774 children born during 1999 and 2000 from 18 of 19 child healthcare centres in Finnmark. Body mass index data extracted retrospectively in 2007 from health records at the age of 6 years were compared with international definitions of over- and underweight. The prevalence figures were further compared with socio-demographic figures on municipality level.

RESULTS

Overall, 19% of the children were classified as overweight or obese; 5% were classified as obese. The prevalence of overweight and obesity was higher among girls (22%) than among boys (16%) (p < 0.01). The prevalence of underweight was 8% among both girls and boys. Despite large variations in the prevalence of overweight and obesity between municipalities (9-35%), no association was found with municipality figures on socio-demographic factors.

CONCLUSION

In the northernmost county Finnmark, the prevalence of overweight including obesity among 6-year-old children was somewhat higher than in previous surveys from Norway, especially among girls.

Prevalence and risk factors of excess weight in school children in West Greece

The present study estimated the prevalence of childhood obesity and identified risk factors in 10-13 year old children. A cross-sectional study was conducted, including 200 children and their parents, in seven randomly-selected primary schools across Patras, Greece. Height, weight, and waist circumference were measured, and self-reported information was collected via face-to-face interviews. Body mass index was calculated for the children and their parents. The effect of risk factors on overweight and obesity was analyzed using regression analysis. The prevalence of overweight and obesity was 32% and 10.5%, respectively. The odds of being overweight/obese increased in children whose parents had a lower educational level and/or higher body mass index. Fewer daily meals and more time spent in front of the television and/or on the computer were significantly associated with obesity in 10-13 year old children. The prevalence of excess weight in primary school children in Patras is of concern, especially for boys. Children's nutritional habits, leisure activities, and parental characteristics influence their somatometric characteristics. These findings highlight the need for future weight loss interventions targeted at this population.

'Children are exposed to temptation all the time'- parents' lifestyle-related discussions in focus groups

AIM

To explore parents' perspectives on providing their preschool child with a healthy lifestyle, including obstacles and resources.

METHODS

Five semi-structured focus group interviews were conducted, with 30 parents of 4-year-olds in Sweden. Interviews were transcribed verbatim and analysed using Systematic Text Condensation.

RESULTS

Four themes emerged from the qualitative analysis: Lifestyle -'The way you live is parents' responsibility', Challenges to promote children's healthy lifestyle, Support from professionals, and peers might facilitate, and Request for an overall responsibility from society. Parents felt that they were role models for their child's lifestyle, a concept including many factors. Attractive and tempting sedentary activities and unhealthy foods were perceived as obstacles, and parents were frustrated by the media's contradictory lifestyle messages. Child health services were expected to more actively invite parents to discuss their child's lifestyle issues. Parents desired some collective responsibility for children's lifestyles through agencies, services and media messages that support and promote healthy choices.

CONCLUSION

Parents struggled to give their children a healthy lifestyle and the 'temptations' of daily unhealthy choices causing hassles and conflicts. Parents desired professional support from preschool, Child Health Care and a collective responsibility from society with uniform guidelines. Parents groups were mentioned as peer support.

Prevalence of overweight preschool children in public day care centers: a cross-sectional study

CONTEXT AND OBJECTIVE

Brazil is undergoing a period of epidemiological transition associated with demographic and nutritional changes. The prevalence of obesity is also increasing in children and is causing numerous health problems that are becoming public health issues. The aim here was to evaluate the prevalence of overweight among children of two and three years of age.

DESIGN AND SETTING

Cross-sectional study in municipal day care centers in Taubaté, state of São Paulo, Brazil.

METHODS

Weight and height measurements were made on 447 preschool children forming a probabilistic randomized sample. Their body mass index (BMI) was calculated. Their nutritional status was classified using the World Health Organization reference cutoff points (2006). Their mean weight, height and BMI were compared according to their age and sex.

RESULTS

The mean values for the final sample (n = 447) were as follows: mean age: 38.6 months (± 3.5) and Z scores for: weight/height (W/H): 0.50 (± 1.22); height/age: -0.03 (± 1.07); weight/age (W/A): 0.51 (± 1.23); and BMI: 0.51(± 1.23). The prevalence of overweight children (BMI > 1 z) was 28.86%, while the prevalence of underweight children (BMI < -2 z) was 0.89%. There were no differences in mean BMI among the two and three-year age groups (P = 0.66).

CONCLUSION

A high prevalence of overweight was observed in the sample of two and three-year-old children, with practically no malnutrition, thus showing that a significant nutritional transition may already be occurring, even in medium-sized cities of developing countries.

Prediction of obesity from infancy to adolescence

AIM

To examine the development of childhood obesity and to determine the earliest age when estimating body mass using only weight and height data is associated with a corresponding estimate at the age of 15.

METHODS

Subjects included are all children born in 1991 in Östergötland County, Sweden. Weight and height data collected during regular check-ups at well-child centres and school health care assessments up to 15 years of age were assembled from health records. Correlations between childhood estimates of body mass and the body mass index (BMI) at 15 years of age were computed pairwise. Correlations with r > 0.5 were defined as reliably strong.

RESULTS

Complete data were available for 3579 children (62%). Fewer girls (2.6%; C.I. 1.9-3.3) than boys (4.6%; C.I. 3.7-5.5) were obese at 15 years of age. Correlations with BMI at 15 years of age were strong (significantly higher than 0.5) from 5 years of age. Only 23% of girls and 8% of boys found to be obese at 5 years of age were of normal weight at the age of 15.

CONCLUSION

From 5 years of age, point estimates of body mass using only weight and height data are strongly associated with BMI at the age of 15. More data sources are needed to predict weight trajectories in younger children.

Anthropometric changes in Sweden during the obesity epidemic--increased overweight among adolescents of non-Nordic origin

AIM

To compare overweight, obesity and thinness prevalences in adolescents born in 1979 and 1985 and to evaluate the influence of parental migration background.

METHODS

A total of 2306 15- to 16-year-old girls and boys in Gothenburg, Sweden, participated in two cross-sectional surveys (1994 and 2000). Height and weight were measured and interviews about parental origin were conducted. Overweight and obesity were classified according to International Obesity Task Force (IOTF) and WHO. Thinness was classified according to Cole.

RESULTS

Among girls, the prevalence of thinness decreased, 8.4% vs. 4.7%. The prevalence of overweight, including obesity, according to IOTF criteria, was 11.8% and 13.7% in 1994 and 2000, respectively. The corresponding figures according to WHO criteria were 14.5% and 17.5%. No significant changes occurred between cohorts in prevalences of overweight and obesity. However, when interaction between survey year and origin was tested, there was a significant difference in overweight according to WHO criteria (p=0.022).

CONCLUSION

A shift entailing increased risk for overweight in adolescents of non-Nordic origin was observed, while no changes occurred in the general population. Individual background factors are important to consider both for correct conclusions about health development in the population and for identification of target groups for health-promoting interventions.

Low and high birth weight as risk factors for obesity among 4 to 5-year-old Australian children: does gender matter?

Studies testing whether birth weight and childhood obesity differ by gender are lacking. We aimed to describe the relationship between birth weight and childhood overweight/obesity and investigate the influence that gender has on this relationship among 4 to 5-year-old children. We performed a secondary analysis of an Australian nationally representative cross-sectional study in 4 to 5-year-old children. The main outcome measure was child overweight and obesity. We found that low birth weight (LBW) was associated with lower risk of overweight/obesity among girls at 4-5 years before (OR 0.50, 95%CI 0.32, 0.77) and after adjusting for socio-demographic factors (OR 0.51 95% CI 0.33, 0.80) and ethnicity (OR 0.52, 95%CI 0.33, 0.81) but was not associated with child overweight/obesity among boys before or after adjustment. High birth weight (HBW) was associated with a higher risk of overweight/obesity among both girls (adjusted OR: 1.76, 95% CI 1.12, 2.78) and boys (adjusted OR: 2.42 95% CI 2.06, 2.86).

CONCLUSION

There are gender differences in the association of birth weight with child overweight/obesity. HBW was associated with a higher risk of child overweight/obesity in boys and girls before and after adjustment for socio-demographic factors. However, LBW was associated with a lower risk of child overweight/obesity in girls but not in boys. These gender differences need to be considered when planning interventions to reduce child overweight/obesity.

Changes in adiposity status from childhood to adolescence: a 6-year longitudinal study in Portuguese boys and girls

BACKGROUND

Cross-sectional data show high prevalence of overweight in Portuguese children, but there are few longitudinal studies describing the patterns of obesity development in the young.

AIM

To examine the trajectories of obesity from late childhood to adolescence.

SUBJECTS AND METHODS

Triceps and subscapular skinfold thickness measurements were carried out in 288 children at age 9 (baseline) and later at age 15 (follow-up). Percentage body fat (%BF) was estimated according to Slaughter equations and the health-related definition of obesity ( ≥ 25%BF in boys and ≥ 30%BF in girls) was used.

RESULTS

In boys, the prevalence of obesity decreased from 21.9% to 14.8% (p < 0.05) while in girls it increased from 14.3% to 19.5%. The incidence of obesity in the 6-year study period was 2.6% and 8.3% for boys and girls, respectively (p < 0.05). In comparison with girls, the percentage of boys that reversed obesity was more than 3-fold higher (3% vs 9.7%, p < 0.05). Obesity tracked moderately in both sexes (Kappa = 0.6, p < 0.001).

CONCLUSION

The results indicate a marked sex difference in the incidence and reversal of obesity from late childhood to adolescence that is unfavourable to girls. Consideration of this difference might be important when designing programmes for the prevention and treatment of obesity focusing on this period.

Nutritional status of students in Kocaeli, Turkey: a population-based study

BACKGROUND

  The aim of this study was to determine the nutritional status of students in Kocaeli, Turkey.

METHODS

  This cross-sectional study was carried out among the students of secondary schools in Kocaeli. Of the students, 2491 subjects were selected using multi-stage stratified sampling.

RESULTS

  Of the students, 51.1% were male and 48.9% were female. Mean age was 14.35±1.87 (range 10.1-19.8) in overall subjects, 14.38±1.87 in boys and 14.31±1.85 in girls. The prevalence of obesity and of overweight was estimated as 7.3% and 11.8%, respectively. Also, 3.1% of the subjects were underweight and 2.9% were thin. The rate of obesity was 1.5 times higher in girls and that of overweight was 1.2 times higher in girls. Similarly, students aged 15 years old and younger were 1.2 times more obese and 1.7 times more overweight than older students. Students living in urban areas had a higher prevalence of obesity and of overweight.

CONCLUSION

  Nutritional problems in students should be dealt with by some regulations in schools; for example, providing healthy food in schools or food aid, particularly in poor regions.

Change in prevalence of overweight and obesity in Finnish children - comparison between 1974 and 2001

OBJECTIVE

To analyse the possible changes in the prevalence of overweight and obesity comparing birth cohorts from four different decades in Finland.

DESIGN

A retrospective longitudinal growth study.

METHODS

The subjects representing five birth cohorts: 1974 (n = 1109), 1981 (n = 987), 1991 (n = 586), 1995 (n = 856) and 2001 (n = 766) in the city of Tampere and three rural municipalities in Finland. Data included five consecutive height and weight measurements from 2 to 15 years of age. Normal weight, overweight and obesity at the time points were classified by body mass index (BMI, kg/m(2) ) according to international age- and gender-specific BMI cut-off points. The chi-square test was used to analyse the differences in the between birth cohorts.

RESULTS

The combined prevalence of overweight and obesity decreased significantly in 2-year-old boys (p = 0.009) and girls (p = 0.002) from 1974 to 2001. Insignificant fluctuation was seen in 5- and 7-year-old children. Both the prevalence of obesity and the combined prevalence of overweight and obesity showed a significant increase in 12- (p = 0.031 and p < 0.001) and 15-year-old boys (p < 0.001 in both) from the 1970s to 2000s. In girls, the prevalence of obesity as well as the combined prevalence of overweight and obesity increased significantly in the age group of 12 years (p = 0.023), but not in that of 15 years.

CONCLUSIONS

During the last three decades, overweight and obesity have become clearly more prevalent in Finnish young adolescents. This trend has been more obvious in boys than in girls. At the same time, 2-year-old children have shown an opposite trend.

Family stress and BMI in young children

AIM

The aim of this study was to investigate if family stress and parental attachment style are associated with body mass index (BMI) in young children, and identify possible explanations.

METHODS

A cross-sectional survey with a two-stage design was used. Parents of 873 children participated. They completed a demographic questionnaire, the Swedish Parenthood Stress Questionnaire (SPSQ), the Relationship Questionnaire (RQ) and reported their children's television-viewing habits (as a marker of physical activity). Children's height, weight and BMI were obtained from a general population-based register, BASTA. Associations with over- and underweight in children were assessed using multiple logistic regression analysis.

RESULTS

Family stress indicated by SPSQ-score was associated with suboptimal BMI. Maternal, but not paternal, SPSQ-stress score was statistically significantly associated with overweight and underweight, with adjusted odds ratios (and 95% confidence interval) of 4.61 (3.11-6.84; p < 0.001) and 3.08 (1.64-5.81; p < 0.001) respectively. Associations between childhood BMI and parental attachment style were identified, but were not independent of maternal SPSQ-score.

CONCLUSION

Our findings support a role for family stress in development of both overweight and underweight among young children. This is likely to be attributed to behavioural mechanisms but a more direct metabolic influence of stress could also be involved.

Overweight and obesity in Norwegian children: prevalence and socio-demographic risk factors

AIM

The aim of this study was to estimate the prevalence of childhood overweight and obesity and to identify socio-demographic risk factors in Norwegian children.

METHODS

The body mass index of 6386 children aged 2-19 years was compared with the International Obesity Task Force (IOTF) cut-off values to estimate the prevalence of overweight including obesity (OWOB) and obesity (OB). The effect of socio-demographic factors on this prevalence was analysed using multiple ordinal logistic regression analysis in a subsample of 3793 children.

RESULTS

The overall prevalence of OWOB was 13.8% (13.2% in boys and 14.5% in girls, p = 0.146), but the prevalence was higher in primary school children aged 6-11 years (17%, p < 0.001). The risk of being OWOB or OB increased in children with fever siblings (p = 0.003) and with lower parental educational level (p = 0.001). There was no association with parental employment status, single-parent families or origin.

CONCLUSION

The prevalence of OWOB and OB in Norwegian primary school children is of concern. Socio-demographic factors have pronounced effects on the current prevalence of overweight and obesity in a cohort of Norwegian children. This knowledge could help to work out strategies to reduce the burden of overweight and obesity in children.

Overweight and obesity in infants and pre-school children in the European Union: a review of existing data

The objective of this study was to synthesize available information on prevalence and time trends of overweight and obesity in pre-school children in the European Union. Retrieval and analysis or re-analysis of existing data were carried out. Data sources include WHO databases, Medline and Google, contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference and cut-offs, and the WHO standard. Data were available from 18/27 countries. Comparisons were problematic because of different definitions and methods of data collection and analysis. The reported prevalence of overweight plus obesity at 4 years ranges from 11.8% in Romania (2004) to 32.3% in Spain (1998-2000). Countries in the Mediterranean region and the British islands report higher rates than those in middle, northern and eastern Europe. Rates are generally higher in girls than in boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20-30 years in the five countries with data. The use of the WHO standard with cut-offs at 1, 2 and 3 standard deviations yields lower rates and removes gender differences. Data on overweight and obesity in pre-school children are scarce; their interpretation is difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.

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.

Prevalence of overweight and obesity in 5- and 12-year-old Finnish children in 1986 and 2006

OBJECTIVE

To investigate the prevalence and the trends of overweight and obesity in Finnish 5- and 12-year-old children in 1986 and 2006.

DESIGN

Retrospective cross-sectional study.

SUBJECTS AND METHODS

Anthropometric data were collected retrospectively from health examinations in Tampere and in three rural municipalities. The size of the 5- and 12-year-old cohorts were 2108 in 1986 and 4013 in 2006, respectively. The body mass index (BMI) was calculated. Overweight and obesity was estimated using the International Obesity Task Force cutoff values (ISO BMI).

RESULTS

The prevalence of overweight (ISO BMI >25) and obesity (ISO BMI >30) in 5-year-old boys in 2006 was 9.8% and 2.5% and in girls 17.7% and 4.3%, [corrected] respectively. At the age of 12 years, the corresponding figures in boys were 23.6% and 4.7% and in girls 19.1% and 3.2%. Between 1986 and 2006, the prevalence of overweight in 12-year-old children had increased 1.8 fold in boys (p < 0.001) and 1.5 fold in girls (p = 0.008). Overweight was significantly more common in rural than in urban areas.

CONCLUSION

During the last 20 years the prevalence of overweight has markedly increased in 12-year-old Finnish children, but remained nearly unchanged in 5-year-old children.

Trends in body mass in Swedish adolescents between 2001 and 2007

AIM

(1) Compare BMI standard deviation scores (BMIsds) in 16-year olds in 2001 and 2007 to assess trends. (2) Describe tracking of BMIsds between ages 10 and 16 years, in a longitudinal 6-year follow-up. (3) Identify possible predictors in 2001 for high BMIsds in 2007 and increase in BMIsds between 2001 and 2007.

METHODS

A six-year follow-up study on 296 subjects, aged 10 years at baseline and a panel study among 16-year olds. BMIsds was used as the main outcome. RESULTS. No difference in BMIsds in 16-year-old adolescents was found between 2001 and 2007. Strong tracking (r = 0.80, 95% CI: 0.75-0.84) was found for BMIsds between ages 10 and 16 years. Low aerobic capacity and high BMIsds at age 10 years predicted overweight at age 16 years. High BMIsds in 2001 predicted a decline in BMIsds (OR: 0.58, 95% CI: 0.43-0.76) and high level of self-reported moderate-to-vigorous physical activity predicted an increased BMIsds (OR: 1.38, 95% CI: 1.13-1.67).

CONCLUSION

There was no difference in prevalence of overweight plus obesity between the 2001 and 2007 samples. Normal weight and good aerobic fitness in 10-year-old children seems to decrease the risk of elevated relative BMI in 16-year olds.

Self-esteem in a clinical sample of morbidly obese children and adolescents

AIM

To study self-esteem in clinical sample of obese children and adolescents.

METHODS

Obese children and adolescents aged 8-19 years (n = 107, mean age 13.2 years, mean BMI 32.5 [range 22.3-50.6], mean BMI z-score 3.22 [range 2.19-4.79]; 50 boys and 57 girls) were referred for treatment of primary obesity. Self-esteem was measured with a validated psychological test with five subscales: physical characteristics, talents and skills, psychological well-being, relations with the family and relations with others. A linear mixed effect model used the factors gender and adolescence group, and the continuous covariates: BMI z-scores, and BMI for the parents as fixed effects and subjects as random effects.

RESULTS

Age and gender, but neither the child's BMI z-score nor the BMI of the parents were significant covariates. Self-esteem decreased (p < 0.01) with age on the global scale as well as on the subscales, and was below the normal level in higher ages in both genders. Girls had significantly lower self-esteem on the global scale (p = 0.04) and on the two subscales physical characteristics (p < 0.01) and psychological well-being (p < 0.01).

CONCLUSION

Self-esteem is lower in girls and decreases with age. In treatment settings special attention should be paid to adolescent girls.

Tracking and determinants of subcutaneous fat mass in early childhood: the Generation R Study

OBJECTIVES

To examine the development and tracking of subcutaneous fat mass in the first 2 years of life and to examine which parental, fetal and postnatal characteristics are associated with subcutaneous fat mass.

DESIGN

This study was embedded in the Generation R Study, a prospective cohort study from early fetal life onward. Subcutaneous fat mass was measured by skinfold thickness (biceps, triceps, suprailiacal, subscapular) at the ages of 1.5, 6 and 24 months in 1012 children. Information about parental, fetal and postnatal growth characteristics was collected by physical and fetal ultrasound examinations and questionnaires.

RESULTS

Normal values of subcutaneous fat mass are presented. Total subcutaneous fat mass was higher in girls than in boys at the age of 24 months (P=0.01). Subjects in the lowest and highest quartiles at the age of 6 months tended to keep their position in the same quartile at the age of 24 months (odds ratios 1.86 (95% confidence interval (CI) 1.3, 2.7)) and 1.84 (95% CI: 1.3, 2.6), respectively). Maternal height and weight, paternal weight, fetal weight at 30 weeks, birth weight and weight at the age of 6 weeks were each inversely associated with subcutaneous fat mass at the age of 24 months after adjustment for current weight at 24 months.

CONCLUSION

This study shows for the first time that subcutaneous fat mass tends to track in the first 2 years of life. Furthermore, the results suggest that an adverse fetal environment and growth are associated with increased subcutaneous fat mass at the age of 24 months. Further studies are needed to examine whether these associations persist in later life.