The epidemiology of overweight and obesity among Australian children and adolescents, 1995-97

The prevalence and burden of avoidant/restrictive food intake disorder (ARFID) in a general adolescent population

BACKGROUND

Little is known about the prevalence and impairment associated with possible Avoidant/restrictive food intake disorder (ARFID) in community adolescent populations. We aimed to investigate the prevalence, health-related quality of life (HRQoL), and psychological distress associated with possible ARFID in a sample of adolescents from the general population in New South Wales, Australia.

METHODS

A representative sample of 5072 secondary school students aged between 11 and 19 years completed the online EveryBODY survey in 2017. The survey included demographic data, eating behaviours, psychological distress and both physical and psychosocial health-related quality of life.

RESULTS

The prevalence of possible ARFID was 1.98% (95% CI 1.63-2.41) and did not differ significantly across school years 7-12. The weight status of participants with possible ARFID did not differ significantly from those without possible ARFID. When measuring gender identity, the ratio of males to females with possible ARFID was 1:1.7. This was statistically significant, however, the effect size was very small. Psychological distress and HRQoL did not differ significantly between the possible ARFID and non-ARFID group.

CONCLUSIONS

The prevalence of possible ARFID was found to be similar to that of anorexia nervosa and binge eating disorder in the general adolescent population. Adolescents who identify as girls rather than boys may be more likely to develop ARFID, replication with new samples is required to confirm these findings. The impact of ARFID on HRQoL may be minimal in adolescence and become more significant in adulthood, further research using longitudinal design, healthy control groups and/or diagnostic interviews is required.

Multilevel legal approaches to obesity prevention: A conceptual and methodological toolkit

INTRODUCTION

State lawmakers have explored numerous policy alternatives to reduce overweight and obesity. Evaluating effects of these laws is important but presents substantial methodological challenges. We present a conceptual framework that allows for classification of obesity prevention laws based on ecological level of influence and the underlying legal mechanism involved to guide analysis of the relationship between a substantial range of obesity prevention laws and BMI.

METHODS

Obesity prevention laws (OPLs) for all 50 states and DC were obtained via primary legal research using the LexisNexis Advanced Legislative Services (ALS) database. For legal provisions that met inclusion criteria, reviewers abstracted information on bill state, citation, passage and effective dates, target population, and obesity prevention mechanism. Laws were categorized by ecological level of influence on weight-related behaviors and the legal mechanism utilized to change behavioral determinants of BMI.

RESULTS

Laws designed to increase community-level opportunities for physical activity were the most frequently enacted OPL while laws designed to alter nutrition standards for school meals or competitive foods were comparatively less common, appearing in only 16% and 34% of states, respectively.

CONCLUSION

Prior studies of obesity policies have focused on specific interventions. We identified and categorized state-level laws that operate at all ecological levels and found that laws passed during the initial burst of lawmaking were largely confined to measures aimed at increasing opportunities for physical activity. Creating public spaces for recreation is an important step to promoting healthier lifestyles to reduce obesity risk; more comprehensive, multilevel legal approaches should also be pursued.

Measuring Rural Food Environments for Local Action in Australia: A Systematic Critical Synthesis Review

Poor diet is a significant contributor to obesity and chronic disease. With all being more prevalent in rural than urban Australia, modifying the food environment is a potential intervention point to improve the health of rural populations. This review examined the applicability of measurement tools used in rural food environment research for rural Australia. Six electronic databases were searched for peer-reviewed literature, published in English between 2006 and 2018, including at least one objective measure of the Community or Consumer Food Environment in a rural or mixed rural/urban context. One-hundred and seventy-seven papers were returned after removal of duplicates, with a final review of 25. Most studies were cross-sectional, with one intervention study of quasi-experimental design. Nine studies employed a conceptual model; there was considerable variability in tools used; and few described psychometric testing. The most common attribute measured was price, followed by available healthy options. The findings of this review do not offer a suite of ‘gold standard’ measurement tools known to be reliable, valid and sensitive to change to assess the community or consumer food environments in rural Australian towns. However, recommendations are proposed to progress this important area of research within a rural context.

Geographical variation and urban-rural disparity of overweight and obesity in Chinese school-aged children between 2010 and 2014: two successive national cross-sectional surveys

PURPOSE

The urban-rural disparity for childhood overweight and obesity shows different patterns in most countries. This study aimed to examine the recent trend of urban-rural disparity for childhood overweight and obesity at national and subnational levels in Chinese children from 2010 to 2014.

DESIGN

Two successive national cross-sectional studies. Overweight and obesity were classified using Chinese national age-specific and sex-specific body mass index reference. The prevalence of overweight and obesity was compared between urban and rural areas at national and subnational levels.

SETTING

Thirty-one provinces in China.

PARTICIPANTS

Data were obtained from the Chinese National Survey on Students' Constitution and Health in 2010 and 2014 with 215 214 (107 741 in 2010 and 107 473 in 2014) children aged 7-12 years.

RESULTS

The overweight and obesity prevalence increased from 17.1% in 2010 to 22.5% in 2014. The overweight and obesity prevalence in both urban and rural areas was higher in the eastern provinces but lower in the western provinces. The urban-rural disparity in overweight and obesity decreased steadily from 2010 to 2014 (1.79 to 1.42 for prevalence OR). There was greater urban-rural disparity in western China than eastern China. A reversal occurred in 2014 in several eastern provinces where the overweight and obesity prevalence in rural children surpassed that of their urban peers.

CONCLUSIONS

A narrowing urban-rural disparity and the reversal signal between urban and rural areas in overweight and obesity would contribute to a growing proportion of obese children in rural areas. Therefore, urgent region-specific policies and interventions with a forward-looking approach should be considered for Chinese children, especially in rural areas.

Secular trends in the prevalence of childhood overweight and obesity across Australian states: A meta-analysis

OBJECTIVE

To describe secular trends in the prevalence of overweight and obesity in Australian children in each state and territory.

DESIGN

Systematic search and numerical meta-analysis.

METHODS

A systematic search was conducted to identify all sources that objectively measured the height and weight of Australian children (aged 2-18 years) and had a sample size of at least 300. Raw and summary data were requested from authors and divided into age×sex×state×yearly slices to derive estimates of the prevalence of overweight and obesity. Following a double arcsine transformation to facilitate meta-analysis, all estimates were standardised for age, stratified by sex and analysed using sample-weighted non-linear regressions.

RESULTS

The systematic search identified 73 eligible sources (47 raw and 26 summary datasets), with 72.8% of data sourced from Victoria and South Australia. Prevalence trends varied from state to state, with three states or territories showing a marked plateau, two showing a decline in the more recent years and three showing continued linear increases. Tasmania and Northern Territory generally had the highest prevalence (30.2% and 24.3% overweight and obesity respectively), and the Australian Capital Territory had the lowest (12.4% overweight and obesity).

CONCLUSIONS

Prevalence, as well as prevalence trends, varied amongst Australian states and territories. At a national level, the prevalence trend has nearly plateaued for the past 15 years. However, upward prevalence trends appear to be persisting in Western Australia, South Australia and Tasmania. Findings highlight the need for ongoing efforts to address the issue of childhood obesity.

Protocol for a randomized controlled trial testing the impact of feedback on familial risk of chronic diseases on family-level intentions to participate in preventive lifestyle behaviors

Background

Common disease risk clusters in families due to shared genetics, exposure to environmental risk factors, and because many health behaviours are established and maintained in family environments. This randomised controlled trial will test whether the provision of a family health history (FHH) risk assessment tool increases intentions and engagement in health behaviors. Message distribution and collective behavior change within family networks will be mapped using social network analysis. The relative intervention impact will be compared between families from different ethnic backgrounds.

Methods

One hundred and fifty mothers (50 Anglo-Australian, 50 Italian-Australian, 50 Vietnamese-Australian) will be recruited, with four or more other family members across three generations, including a child (aged 10–18 years). Each family is randomly assigned to intervention or control. At baseline and 6-month follow-up, all participants complete surveys to assess dietary and physical activity intentions and behaviors, attitudes towards food, and perceived disease risk. Intervention families receive a visual pedigree detailing their FHH of diabetes, heart disease, breast and bowel cancer, a health education workbook to ascertain members’ disease risk (i.e. average or above average risk), and screening and primary prevention recommendations. After completion of follow-up assessments, controls will receive their pedigree and workbook. The primary hypothesis is that attitudes and lifestyle behaviors will improve more within families exposed to FHH feedback, although the extent of this improvement may vary between families from different ethnic backgrounds. Additionally, the extent of improvement in the treatment group will be moderated by the level of family disease risk, with above-average risk leading to greater improvement. A secondary aim will explore different family members’ roles in message distribution and collective responses to risk using social network approaches and to compare network functioning between families with different ethnic backgrounds.

Discussion

Results will guide future health promotion programs aimed at improving lifestyle factors. This research will assess whether FHH can motivate families to adopt family-level strategies to support health promoting behaviors. Secondary analyses aim to identify change agents within the family who are particularly effective in shifting normative behaviors.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12613001033730. Retrospectively registered: 17 September, 2013.

Understanding the causes of obesity in children with trisomy 21: hyperphagia vs physical inactivity

BACKGROUND

Individuals with intellectual disabilities are at increased risk of becoming overweight or obese. This is particularly evident in people with trisomy 21 and Prader-Willi syndrome (PWS). Although metabolic factors are known to contribute to obesity in trisomy 21 and hyperphagia plays a primary role in PWS, hyperphagia has not yet been investigated as a possible contributing factor to obesity in trisomy 21.

METHODS

Participants comprised three diagnostic groups: trisomy 21 (T21 group), PWS (PWS group) and lifestyle-related obesity (LRO group). They were required to be aged 6-18 years and have a body mass index over the 85th percentile for age and gender. A parent of each participant completed the Hyperphagia Questionnaire and the Children's Leisure Activity Study Survey. Mean scores for each domain and across all domains of the Hyperphagia Questionnaire and the Children's Leisure Activity Study Survey were compared between diagnostic groups using linear regression analysis.

RESULTS

The study group consisted of 52 young people (23 men and 29 women) aged 6-18 years (mean 12.5 years; T21 group n = 17, PWS group n = 16 and LRO group n = 19). As hypothesised, the PWS group had the highest mean scores across all domains of the Hyperphagia Questionnaire, and the LRO group had the lowest. Food-seeking behaviour was more pronounced in the PWS group than the T21 group (mean score 13.2 vs. 8.6, p = 0.008). The LRO group spent more hours per week engaged in physical activity (14.7) in comparison with the other groups (9.6 and 9.7), whereas between the groups, differences in time spent in sedentary activities were less pronounced.

CONCLUSIONS

Preoccupation with food and low levels of physical activity may contribute to the development of overweight and obesity in some individuals with trisomy 21. These factors warrant consideration in the clinical context.

Do thin, overweight and obese children have poorer development than their healthy-weight peers at the start of school? Findings from a South Australian data linkage study

Little is known about the holistic development of children who are not healthy-weight when they start school, despite one fifth of preschool-aged children in high income countries being overweight or obese. Further to this, there is a paucity of research examining low body mass index (BMI) in contemporary high-income populations, although evidence from the developing world demonstrates a range of negative consequences in childhood and beyond. We investigated the development of 4-6 year old children who were thin, healthy-weight, overweight, or obese (as defined by BMI z-scores) across the five domains of the Australian Early Development Census (AEDC): Physical Health and Wellbeing, Social Competence, Emotional Maturity, Language and Cognitive Skills, and Communication Skills and General Knowledge. We used a linked dataset of South Australian routinely collected data, which included the AEDC, school enrollment data, and perinatal records (n = 7533). We found that the risk of developmental vulnerability among children who were thin did not differ from healthy-weight children, after adjusting for a range of perinatal and socio-economic characteristics. On the whole, overweight children also had similar outcomes as their healthy-weight peers, though they may have better Language and Cognitive skills (adjusted Risk Ratio [aRR] = 0.73 [95% CI 0.50-1.05]). Obese children were more likely to be vulnerable on the Physical Health and Wellbeing (2.20 [1.69, 2.87]) and Social Competence (1.31 [0.94, 1.83]) domains, and to be vulnerable on one or more domains (1.45 [1.18, 1.78]). We conclude that children who are obese in the first year of school may already be exhibiting some developmental vulnerabilities (relative to their healthy-weight peers), lending further support for strategies to promote healthy development of preschoolers.

Physical activity decreased by a quarter in the 11- to 12-year-old Swedish boys between 2000 and 2013 but was stable in girls: a smartphone effect?

AIM

This study explored physical activity, body mass index (BMI) and overweight and obesity from 2000 to 2013 using a convenience sample of second- and fifth-grade Swedish schoolchildren aged 8-9 years and 11-12 years, respectively.

METHODS

We examined cross-sectional cohorts of 126 second-grade children in 2000, 84 in 2006 and 44 in 2013 and 105 fifth-grade children in 2000 and 38 in 2013. No fifth graders were available in 2006. Physical activity data were collected based on pedometer readings over four consecutive weekdays, and height and weight were measured. Identical instruments and procedures were used in all three years.

RESULTS

There was an increase in physical activity in second-grade girls from 2000 to 2006 (p < 0.01), which then stabilised between 2006 and 2013, but second-grade boys and fifth-grade girls were stable throughout the study period. Fifth-grade boys decreased significantly (24%) from 16 670 to 12 704 steps per day (p < 0.01) from 2000 to 2013. Mean BMI scores remained stable over time.

CONCLUSION

Time trends in physical activity differed between boys and girls. Second-grade boys and fifth-grade girls were stable throughout, whereas second-grade girls increased from 2000 to 2006 before stabilising. Fifth-grade boys showed a significant 24% reduction from 2000 to 2013. Changes in recess and leisure time habits, such as smartphone use, may have influenced the result.

In utero and childhood polybrominated diphenyl ether exposures and body mass at age 7 years: the CHAMACOS study

BACKGROUND

Polybrominated diphenyl ethers (PBDEs) are lipophilic flame retardants that bioaccumulate in humans. Child serum PBDE concentrations in California are among the highest worldwide. PBDEs may be associated with obesity by disrupting endocrine systems.

OBJECTIVE

In this study, we examined whether pre- and postnatal exposure to the components of pentaBDE mixture was associated with childhood obesity in a population of Latino children participating in a longitudinal birth cohort study in the Salinas Valley, California.

METHODS

We measured PBDEs in serum collected from 224 mothers during pregnancy and their children at 7 years of age, and examined associations with body mass index (BMI) at age 7 years.

RESULTS

Maternal PBDE serum levels during pregnancy were associated with higher BMI z-scores in boys (BMI z-score βadjusted = 0.26; 95% CI: -0.19, 0.72) but lower scores in girls (BMI z-score βadjusted = -0.41; 95% CI: -0.87, -0.05) at 7 years of age (pinteraction = 0.04). In addition, child's serum BDE-153 concentration (log10), but not other pentaBDE congeners, demonstrated inverse associations with BMI at age 7 years (BMI z-score βadjusted = -1.15; 95% CI: -1.53, -0.77), but there was no interaction by sex.

CONCLUSIONS

We estimated sex-specific associations with maternal PBDE levels during pregnancy and BMI at 7 years of age, finding positive associations in boys and negative associations in girls. Children's serum BDE-153 concentrations were inversely associated with BMI at 7 years with no difference by sex. Future studies should examine the longitudinal trends in obesity with PBDE exposure and changes in hormonal environment as children transition through puberty, as well as evaluate the potential for reverse causality.

Secular trends of obesity prevalence in Chinese children from 1985 to 2010: Urban-rural disparity

OBJECTIVE

To examine the trend of urban-rural disparity in obesity prevalence among Chinese children from 1985 to 2010.

METHODS

The data were from five cross-sectional surveys (1985, 1995, 2000, 2005, and 2010) of Chinese National Surveys on Students' Constitution and Health. Logistic regression was used to estimate the prevalence odds ratio (POR) of urban-rural areas for obesity prevalence in different surveys.

RESULTS

The standardized prevalence of obesity in Chinese children increased rapidly from 0.1% in 1985 to 5.0% in 2010, and significant differences were found between two adjacent surveys in most of the age subgroups (P<0.01). Although the obesity prevalence was significantly higher in urban than in rural children of all age subgroups at different survey points, the changing pace was faster in rural than in urban areas from 1995 to 2010. The PORs had increased in 1995 in most age subgroups and then began to decline in all age subgroups after 1995.

CONCLUSIONS

The gradually decreasing urban-rural disparity suggests that the obesity prevalence in rural areas would contribute to a growing proportion of obese children. Therefore, rural children should be included in obesity prevention efforts even though obesity rates are still lower in rural than in urban areas.

Socio-economic and ethnic differences in the prevalence of overweight and obesity among school children

AIMS

To trial the collection of measurements to provide population-based prevalence of overweight and obesity in school children in western Sydney and examine the association between healthy weight and ethnicity and socio-economic status (SES) in a socio-economically and culturally diverse population.

METHODS

A cross-sectional population-based survey of 2341 children in Years 4 and 7 (mean ages 9 and 12 years, respectively) in 2007.

RESULTS

  Nineteen percent of children were overweight and a further 6% were obese. The prevalence of combined overweight and obesity was similar for boys and girls (26% vs. 24%, P= 0.35). SES was significantly associated with the prevalence of unhealthy weight: the odds of being overweight or obese were 1.79 times (95% confidence interval (CI) 1.35 to 2.36) higher for children from the lowest quartile than for children from the highest quartile. Compared to children from an English speaking background, children from a non-English speaking background were significantly more likely to be overweight or obese (21% vs. 31%, P < 0.001). The prevalence of combined overweight and obesity was significantly higher for children from a Pacific Island (odds ratio (OR) 2.66, 95% CI 1.63 to 4.33), Middle Eastern (OR 1.63, 95% CI 1.22 to 2.17) or European (OR 1.67, 95% CI 1.12 to 2.49) background than for English speaking background children.

CONCLUSION

Large jumps in the prevalence of overweight and obesity in children observed from the 1980s appear to be diminishing, with comparable prevalence reports in 2004 and 2007. Ethnicity and SES are each independently associated with the prevalence of unhealthy weight in children.

Effects of a cognitive-behaviorally based physical activity treatment for 4- and 5-year-old children attending US preschools

BACKGROUND

Inadequate volumes of physical activity may be associated with the increases in inappropriately high weight in children of 5 years of age and younger. Preschools have typically lacked sufficient time in daily physical activity.

PURPOSE

A preschool-administered physical activity treatment based on social cognitive and self-efficacy theory (Start For Life) was tested for its association with increased physical activity and reduced body mass index (BMI).

METHODS

Data from accelerometer and BMI assessments over a 9-month preschool year (18 treatment and 8 control classes of 17 to 20 children each; mean age = 4.4 years) were used to contrast the behaviorally based treatment of 30 min per day with a usual care condition of the same duration. The sample was primarily African-American. Preschool teachers administered all processes.

RESULTS

The Start For Life treatment was associated with a significantly greater percentage of the preschool day in moderate-to-vigorous and vigorous physical activity (approximately 30 min per week more), with sedentary time unaffected. The treatment was also associated with a significant reduction in BMI, with effect sizes greatest in overweight and obese children.

CONCLUSIONS

Although results were positive in contrast to usual care and other related interventions, the specific sample requires that the Start For Life treatment undergo sufficient replication to increase confidence in generalizability of the findings to others. Although reduction in sedentary time may require a different strategy, the practical application of the present treatment suggests possibilities for addressing overweight through increasing moderate-to-vigorous physical activity in preschool settings.

A comparative study of nutritional status and foodstuffs in adolescent girls in iran

BACKGROUND

The prevalence of obesity and overweight in children and adolescents is increasing world-wide. Obesity in children and adolescents is a major risk factor for diabetes, heart diseases, hypertension, and cancer in adulthood.

AIM

The aim of the study was to compare the nutritional status and food-stuffs among high-school girls in Arak, Iran, in matter of body mass index (BMI) and associated factors.

SUBJECTS AND METHODS

A cross-sectional survey of a representative sample of 278 adolescents was conducted in six randomly chosen high-schools. Height and weight of students were collected using standard methods and the BMI calculated and BMI percentiles of these girls are compared with the Center of Disease Control and Prevention (CDC) reference data. The 5(th), 8(th), and 95(th) percentiles of the CDC were adopted as cut-off points for underweight, overweight and obese girls, respectively. Data were analyzed using SPSS by analysis of variance and Chi-square tests.

RESULTS

On the basis of CDC, the overall prevalence rates of underweight, overweight, and obesity were estimated 10.1% (28/278), 12.9% (36/278), and 1.4% (4/278), respectively. There was no significant difference between nutritional knowledge scores and the rate of physical activities in various groups. The mean age at menarche was significantly higher among the obese girls (P = 0.02). Consumption of ice-cream and chocolate was significantly higher in the obese girls group (P = 0.03).

CONCLUSION

According to the present study, the prevalence of overweight and obesity in high-school girls of Arak is lower than that of many other parts of Iran and some neighboring countries, which are at the high-risk of overweight and obesity. This study warrants the necessity of paying attention to promote healthy life-style and weight control. The earlier age of menarche is alarming.

Body fatness in relation to physical activity and selected socioeconomic parameters of adolescents aged 15-17 years in Merida, Yucatan

BACKGROUND

Increasing rates of overweight and obesity in adolescents are major concerns in many countries, including Mexico.

OBJECTIVES

To study anthropometric and body composition characteristics (BCC) and their relations with socioeconomic status (SES), biological history and physical activity (PA) of school-going adolescent boys and girls in the city of Merida, Yucatan, Mexico.

SUBJECTS AND METHODS

In this cross-sectional study, a sample of 321 adolescents (156 boys and 165 girls) aged 15-17 years from public and private schools in Merida, was taken from a study carried out in 2008-2009.

RESULTS

Body mass index had significant correlations to BCC (fat mass and fat-free mass). The rate of stunting was higher in girls (18.20%) than in boys (7.69%). Stunted adolescents had higher body fat (%) than normally growing peers. High rates of overweight (boys 26.28%, girls 24.24%) and obesity (boys 10.26%, girls 6.06%) were recorded. SES (parents' age, education and occupation; crowding index in the family; household food expenditure), participants' biological history and PA are related with height and BCC by age and sex.

CONCLUSION

Adolescents with excess weight (overweight + obesity) reported being less physically active. SES and PA were strongly related to growth and body fatness in the studied adolescents.

Parental obesity as a predictor of childhood overweight/obesity in Australian migrant children

SUMMARY

Obesity levels are increasing disproportionately in immigrant children worldwide. We investigated predictors of immigrant children's obesity status in a well-documented 3-year follow-up study of children at 9 years (n = 1232) and 12 years (n = 628) of age living in inner city areas of Sydney (Australia). The major immigrant groups in this sample were from Europe, the Middle East and SE Asia. Having an obese parent and having either parent or child not being born in Australia and not playing organised sport were predictors of childhood obesity. If either parent was obese compared to non-obese, then the odds ratio for a 9-year-old child of being obese compared to normal weight was 4.9 (95% CI: 3.0-8.0); for 12-year olds the odds ratio was 8.0 (95% CI: 3.6-18). For the survey of 9-years old, a parent born outside Australia or if the child himself was born outside Australia was associated with an almost twofold chance of being obese (OR = 1.8, 95% CI: 1.1-3.0), and not participating in organised sports was significantly associated with childhood obesity. Nine-year olds who did not participate in organised sports outside of school hours were almost twice as likely to be obese (OR = 1.9, 95% CI: 1.2-2.9). When stratified by ethnicity, participation in sports was not related to lower obesity status in children of SE Asian origin. One reason for this could be because SE Asian had very limited participation in sports compared to their counterparts. Accordingly, we believe that health promotion messages to avoid obesity need to be targeted ethnic-specifically.:

Family and neighbourhood socioeconomic inequalities in childhood trajectories of BMI and overweight: longitudinal study of Australian children

BACKGROUND

Socioeconomic inequalities in longitudinal patterning of childhood overweight could cause marked differentials in total burden by adulthood. This study aims to determine timing and strength of the association between socioeconomic status (SES) and children's body mass index (BMI) in the pre- and primary school years, and to examine socioeconomic differences in overweight trajectories across childhood.

METHODS

Participants were 4949 children from the Longitudinal Study of Australian Children. BMI was measured at four biennial waves starting at age 4-5 years in 2004. Developmental trajectories of childhood overweight were identified with latent class analyses. Composite variables of family and neighbourhood SES were used.

RESULTS

Socioeconomic differences in mean BMI z-scores already present at age 4-5 more than doubled by age 10-11 years, reflecting decreasing mean BMI among advantaged rather than increasing means among disadvantaged children. Latent class analysis identified children with 'stable normal weight' (68%), and with 'persistent' (15%), 'late-onset' (14%), and 'resolving' overweight (3%). Risks of persistent and late-onset childhood overweight were highest among low SES families (e.g. most disadvantaged quintile: OR(persistent) = 2.51, 95%CI: 1.83-3.43), and only partly explained by birth weight and parental overweight. Relationships with neighbourhood SES were weaker and attenuated fully on adjustment for family SES. No socioeconomic gradient was observed for resolving overweight.

CONCLUSIONS

Childhood has become the critical period when socioeconomic inequalities in overweight emerge and strengthen. Although targeting disadvantaged children with early overweight must be a top priority, the presence of childhood overweight even among less-disadvantaged families suggests only whole-society approaches will eliminate overweight-associated morbidity.

Association of children's obesity with the quality of parental-child attachment and psychological variables

AIM

This study aimed to investigate the association of children's obesity with parental attachment and psychological variables as impulsivity, self-control and efficiency of eating control.

METHODS

This cross-sectional study was conducted among 202 obese students aged 9-13 years selected by multistage cluster sampling from different areas of Isfahan, Iran. Three questionnaires were considered to be answered by the students and one for their parents. The students completed the following questionnaires: (i) Inventory of Parent and Peer Attachment-Revised version for Children (IPPA-R); (ii) Impulsivity Scale (IS); (iii) Efficiency of Eating Control; and (iv) Self-control Rating Scale (SCRS).

RESULTS

The quality of children's attachment had direct effects on self-efficacy of eating management and on obesity by mediating of self-efficacy of eating. Moreover, attachment had direct effect on self-control and impulsivity, and in turn through these psychological variables, it had indirect effects on self-efficacy of eating management.

CONCLUSION

The findings of this study underscore the importance of parent-child attachment quality. It can be suggested that childhood obesity can be prevented and managed with creating a secure attachment bond between children and parents and increasing perceived self-efficacy eating management in children.

Cognitive-behavioural physical activity treatment in African-American pre-schoolers: effects of age, sex, and BMI

AIM

Prevalence of overweight and obesity in children of 5 years and younger has greatly increased in countries including Australia, Canada, the UK and the USA, with African-Americans most affected in the USA. Low amounts of physical activity may be a primary cause. Interventions intended to increase physical activity during pre-school have had minimal effects.

METHODS

A physical activity intervention derived from self-efficacy and social cognitive theory administered by pre-school teachers in the USA (Start For Life) was contrasted with typical care over 8 weeks. The 30-min-per-day treatment incorporated structured gross motor skill physical activities and training in self-management and self-regulation skills. The African-American children in the treatment (n = 154, 21 classrooms) and control (n = 121, 11 classrooms) groups ranged in age from 3.5 to 5.6 years.

RESULTS

Mixed-model repeated measures analysis of variances indicated significantly (P ≤ 0.05) greater increases in moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA) in the treatment group when both the children and classrooms were the unit of analysis. Time in sedentary activities was not affected. Together, age, sex and body mass index (BMI) percentile significantly predicted treatment-related changes in MVPA (R(2) = 0.11) and VPA (R(2) = 0.11), with age (β = -0.22 and β = -0.23, respectively) and BMI percentile (β = -0.24 and β = -0.23, respectively) contributing uniquely to the explained variances indicating greater treatment effects for participants who were younger and had a lower BMI percentile.

CONCLUSIONS

The Start For Life treatment was associated with increased MVPA by approximately 1 h per week, with most of that change being in VPA. After sufficient replication, adjustments may be made to maximise treatment effects.

A pilot evaluation of appetite-awareness training in the treatment of childhood overweight and obesity: a preliminary investigation

OBJECTIVE

The aim of this study was to conduct a preliminary evaluation of Children's Appetite Awareness Training (CAAT), a treatment for childhood obesity which encourages overweight children to eat in response to internal appetite cues.

METHOD

Overweight children (ages 6-12 years old) were randomized to either the CAAT treatment group (N = 23), to receive 1-h treatment sessions over 6 weeks, or a wait-list group (N = 24). Weight and height of children and parents in both groups were assessed at pre- and post-treatment (or equivalent time for wait-list control) and at a 6-month follow-up for those in the CAAT group.

RESULTS

The intervention had a significant, short-term effect on the BMI of children who participated. Although at 6-month follow-up, children's BMI has not increased significantly, the difference between pretreatment and follow-up BMI was no longer significant.

DISCUSSION

These results are encouraging for the use of CAAT with overweight children. Long-term effectiveness could be enhanced through increasing the duration of the program, adding booster sessions and increased involvement of parents.

Lipids in Australian children: cause for concern? 2005-2007 Busselton Health Study

AIM

To report the current lipid status of Australian school children from a population-based sample and compare this to international and Australian data.

METHODS

A cross section of school children aged 6 to 16.9 years in Busselton, Western Australia (WA) between 2005 and 2007 had fasting lipids tested. The first analysis compares the Busselton sample to data recommended by the American Academy of Paediatrics (AAP) 2008. The second analysis compares the Busselton sample to data from the Schools Physical Activity and Nutrition Survey (SPANS) study, New South Wales (NSW), Australia, 2004 and the 1985 Australian Health and Fitness Survey (AHFS). The third analysis applies laboratory-reported cut-points in WA to report percentages over 'healthy desirable norms'.

RESULTS

Analysis 1: higher levels of total cholesterol and triglycerides in Busselton children compared to AAP data source. Boys had higher low-density lipoprotein (LDL) levels. Analysis 2: comparable rates of dyslipidaemia to SPANS 2004 but lower rates compared to the AHFS, 1985. Analysis 3: total and LDL-cholesterol above recommended range in 32.7% and 19.4% of boys and 38.2% and 24.6% of girls.

CONCLUSION

In a large population-based sample of Australian school children, we found a higher frequency of abnormal lipid profiles when compared to American data. In addition, many children have levels outside reported healthy norms for Australian children. Research tracking lipid profiles of Australian children into adulthood is needed to understand the association of these levels with future cardiovascular risk.

Television watching from adolescence to adulthood and its association with BMI, waist circumference, waist-to-hip ratio and obesity: a longitudinal study

OBJECTIVE

To examine the prospective association of television (TV) watching from adolescence to young adulthood with BMI, waist circumference (WC), waist-to-hip ratio (WHR) and obesity.

DESIGN

A community-based longitudinal cohort study.

SETTING

Mater-University of Queensland Study of Pregnancy (MUSP) Cohort, Brisbane, Australia.

SUBJECTS

A sub-sample of 2439 children was followed up at ages 14 years and 21 years as part of a population-based birth cohort. Offspring reported the number of TV viewing hours each day at 14 and 21 years. BMI, WC and WHR were measured at 21 years.

RESULTS

In the adjusted model, offspring who watched TV for <3 h/d at 14 years but for ≥ 3 h/d at 21 years, or who watched TV for ≥ 3 h/d at 14 and 21 years, had greater BMI, WC and WHR at 21 years. Offspring who watched TV for ≥ 3 h/d at 14 years but for <3 h/d at 21 years had similar mean BMI, WC and WHR at 21 years to those who watched TV for <3 h/d at 14 and 21 years. Those offspring who reduced their TV watching hours to <3 h/d during the transition from adolescence into young adulthood were at less risk of becoming obese and those who continued or increased their TV watching to ≥ 3 h/d were at greater risk of becoming obese. This association remained independent of the potential confounding factors considered.

CONCLUSIONS

The present findings suggest that our efforts to decrease obesity by reducing TV watching hours among adults should consider interventions to reduce TV time among adolescents.

Rural-urban comparison in prevalence of overweight and obesity among children and adolescents of Asian Indian origin

OBJECTIVES

To study whether the prevalence of overweight and obesity in children and adolescents is restricted by habitat (urban vs rural).

METHODS

A total of 753 healthy children and adolescents, out of which 293 (159 boys and 134 girls) were collected Santiniketan (rural area) and 460 (241 boys and 219 girls) were from Calcutta and the suburbs (urban area), aged 8 to 18 years took part in the study. Participants were subsequently divided into 3 age groups: group I, 8 to 12 years; group II, 13 to 15 years, and group III, 16 to 18 years.

RESULTS

It was observed that the overall prevalence of overweight and obesity in the study was 9.6% and 5.7%, respectively. Urban residence and high level of parental education are associated with overweight and obesity in children and adolescents (R(2) = 40.3%).

CONCLUSION

Prevalence of overweight and obesity among children and adolescents is not restricted to any particular habitat and warrants early intervention if this global epidemic is to be checked.

Socio-economic, familial and perinatal factors associated with obesity in Sydney schoolchildren

AIM

To examine associations between socio-economic, familial and perinatal factors with overweight/obesity in 6- and 12-year-old schoolchildren.

METHODS

Eligible year-1 (1765/2238, mean age 6.7 years) and year-7 students (2353/3144, mean age, 12.7 years) from a random cluster sample of 55 Sydney schools were examined during 2003-2005. Height, weight and body mass index were measured. Overweight or obesity was classified using International Obesity Task Force cut points. Information about each child's socio-demographic status, familial and perinatal information was sought in parental questionnaires.

RESULTS

After multivariate adjustment, lower parental education was significantly associated with prevalent overweight and obesity in 6-year-old children, odds ratio (OR) 1.52 (95% confidence interval (CI) 1.15-2.01) and OR 2.16 (CI 1.34-4.13), respectively. Smoking during pregnancy was associated with a higher likelihood of being obese among both 6- and 12-year-old children, OR 1.90 (CI 1.05-3.46) and OR 1.78 (CI 1.22-2.61). Population attributable risk estimates indicate that 14.9% and 10.1% of prevalent cases of obesity in 12-year-old children may be attributable to being: an only child or a heavy newborn, respectively.

CONCLUSIONS

We show interdependent relationships between socio-economic, familial and perinatal factors and childhood weight status. Improved understanding of these pathways may help in developing childhood obesity prevention strategies.

High incidence of obesity co-morbidities in young children: a cross-sectional study

AIM

The prevalence of overweight and obesity in children is a public health problem because of future morbidity. However, the prevalence of medical complications in overweight and obese primary school children in Australia is not well documented. As part of the larger, prospective cohort Growth and Development Study, this report aimed to identify the medical complications of obesity in a population-based community sample of primary school-aged children.

METHODS

Two groups of primary school children were studied: a random community sample of overweight/obese children (not seeking treatment) and a matched community sample of normal weight children. Demographics, medical history, family history and symptoms of complications of overweight were collected. Children had a physical examination, oral glucose tolerance tests with insulins, fasting lipid profiles and liver function tests.

RESULTS

Data from 283 children are presented (6.1-13.4 years, mean 9.8 years). There were no differences in birth data, family composition, parental age or socio-economic status between groups. Overweight and obese children were more likely to complain of musculoskeletal pain, depression, anxiety and bullying, and had more adverse examination findings than control children. They also had more abnormal investigations: overweight children: impaired glucose tolerance (IGT) 1.3%, hyperinsulinism 19.5%, dyslipidaemia 63.8%, raised alanine transaminase (ALT) 9.0%; obese children: IGT 5.3%, hyperinsulinism 38.9%, dyslipidaemia 73.7%, raised ALT 31.6%.

CONCLUSION

Overweight and obese primary school-aged children have significant medical complications of their weight status. Overweight children, in addition to obese children, should be screened for complications. A secondary finding is a high proportion of normal weight children with lipid levels outside desirable healthy ranges.

Evaluation of the Living 4 Life project: a youth-led, school-based obesity prevention study

The Living 4 Life study was a youth-led, school-based intervention to reduce obesity in New Zealand. The study design was quasi-experimental, with comparisons made by two cross-sectional samples within schools. Student data were collected at baseline (n=1634) and at the end of the 3-year intervention (n=1612). A random-effects mixed model was used to test for changes in primary outcomes (e.g. anthropometry and obesity-related behaviours) between intervention and comparison schools. There were no significant differences in changes in anthropometry or behaviours between intervention and comparison schools. The prevalence of obesity in intervention schools was 32% at baseline and 35% at follow-up and in comparison schools was 29% and 30%, respectively. Within-school improvements in obesity-related behaviours were observed in three intervention schools and one comparison school. One intervention school observed several negative changes in student behaviours. In conclusion, there were no significant improvements to anthropometry; this may reflect the intervention's lack of intensity, insufficient duration, or that by adolescence changes in anthropometry and related behaviours are difficult to achieve. School-based obesity prevention interventions that actively involve young people in the design of interventions may result in improvements in student behaviours, but require active support from leaders within their schools.

The Sydney playground project: popping the bubblewrap--unleashing the power of play: a cluster randomized controlled trial of a primary school playground-based intervention aiming to increase children's physical activity and social skills

Background

In the Westernised world, numerous children are overweight and have problems with bullying and mental health. One of the underlying causes for all three is postulated to be a decrease in outdoor free play. The aim of the Sydney Playground Project is to demonstrate the effectiveness of two simple interventions aimed to increase children's physical activity and social skills.

Methods/Design

This study protocol describes the design of a 3-year cluster randomised controlled trial (CRCT), in which schools are the clusters. The study consists of a 13-week intervention and 1 week each of pre-and post-testing. We are recruiting 12 schools (6 control; 6 intervention), with 18 randomly chosen participants aged 5 to 7 years in each school. The two intervention strategies are: (1) Child-based intervention: Unstructured materials with no obvious play value introduced to the playground; and (2) Adult-based intervention: Risk reframing sessions held with parents and teachers with the aim of exploring the benefits of allowing children to engage in activities with uncertain outcomes. The primary outcome of the study, physical activity as measured by accelerometer counts, is assessed at baseline and post-intervention. Additional assessments include social skills and interactions, self-concept, after school time use and anthropometric data. Qualitative data (i.e., transcriptions of audio recordings from the risk reframing sessions and of interviews with selected teacher and parent volunteers) are analysed to understand their perceptions of risk in play. The control schools have recess as usual. In addition to outcome evaluation, regular process evaluation sessions are held to monitor fidelity to the treatment.

Discussion

These simple interventions, which could be adopted in every primary school, have the potential of initiating a self-sustaining cycle of prevention for childhood obesity, bullying and mental ill health.

Trial registration

Australian and New Zealand Clinical Trials Registration Number ACTRN12611000089932.

The co-benefits for health of investing in active transportation

Amid growing concerns about the impact of rising obesity and physical inactivity levels, climate change, population growth, increasing traffic congestion and declining oil supplies, multiple sectors are now promoting active transportation as an alternative to driving. This paper considers the health benefits and co-benefits of investing in active transportation, enabling comparison of policy options to optimise societal objectives aimed at creating healthy, socially and environmentally sustainable communities. Policies promoting the use of both energy-efficient motor vehicles and increased active transportation would almost double the impact on greenhouse gas emissions and would reduce disease burden by increasing physical activity. More co-benefit and economic analyses research is required to inform 'joined-up' policy solutions.

Body mass index and waist circumference are associated with blood pressure in preschool-aged children

PURPOSE

Population-derived data on the association between body mass index (BMI) and blood pressure (BP) during early childhood are lacking. We investigated the association between BMI, waist circumference, and BP among preschool-aged children.

METHODS

A total of 1294 children ages 3 to 6 years were examined in the Sydney Paediatric Eye Disease Study during 2007 to 2009. Height, weight, and waist circumference were collected and BMI calculated. The weight status of each child was classified on the basis of age- and sex-specific BMI percentiles. BP was measured by the use of a standard protocol.

RESULTS

A prevalence of 11.0% and 15.1% of children were obese or overweight, respectively. The prevalence of elevated BP was 21.3% among obese children compared with 12.4% of nonoverweight/obese children (p = .03). An increase of 1 BMI unit was independently associated with, on average, a 0.57 and 0.56 mm Hg increase in systolic and diastolic BP, respectively. Each unit increase in waist circumference was associated with a 0.14 and 0.23 mm Hg increase in systolic and diastolic BP, respectively.

CONCLUSIONS

A strong and independent association between adiposity and BP was present during early childhood. These data have important public health implications because elevated BP at a young age may be associated with increased cardiovascular risk in later life.

What helps children eat well? A qualitative exploration of resilience among disadvantaged families

It is well known that persons of low socioeconomic position consume generally a less healthy diet. Key determinants of unhealthy eating among disadvantaged individuals include aspects of the family and external environment. Much less is known about family and environmental determinants of healthy eating among social disadvantaged children. The aim of this study was to gain insight into the family and environmental factors underlying resilience to poor nutrition among children and their mothers living in disadvantaged neighbourhoods. Semi-structured interviews were conducted with 38 mother-child pairs (N = 76) from disadvantaged neighbourhoods. Children were selected if they were a healthy weight, consumed adequate intakes of fruit and vegetables and were physically active. Two main themes emerged from the interviews: active strategies from parents to promote healthy eating and external barriers and supports to healthy eating. Mothers believed that exercising control over access to unhealthy food, providing education and encouragement for consumption of healthy food and enabling healthy food options aided their child to eat well. Children did not perceive food advertisements to be major influences on their eating preferences or behaviour. The results of the current study offer insight into potential avenues for nutrition promotion among disadvantaged children.

Reduced food access due to a lack of money, inability to lift and lack of access to a car for food shopping: a multilevel study in Melbourne, Victoria

Objective

To describe associations between demographic and individual and area-level socio-economic variables and restricted household food access due to lack of money, inability to lift groceries and lack of access to a car to do food shopping.

Design

Multilevel study of three measures of restricted food access, i.e. running out of money to buy food, inability to lift groceries and lack of access to a car for food shopping. Multilevel logistic regression was conducted to examine the risk of each of these outcomes according to demographic and socio-economic variables.

Setting

Random selection of households from fifty small areas in Melbourne, Australia, in 2003.

Subjects

The main food shoppers in each household (n 2564).

Results

A lack of money was significantly more likely among the young and in households with single adults. Difficultly lifting was more likely among the elderly and those born overseas. The youngest and highest age groups both reported reduced car access, as did those born overseas and single-adult households. All three factors were most likely among those with a lower individual or household socio-economic position. Increased levels of area disadvantage were independently associated with difficultly lifting and reduced car access.

Conclusions

In Melbourne, households with lower individual socio-economic position and area disadvantage have restricted access to food because of a lack of money and/or having physical limitations due difficulty lifting or lack of access to a car for food shopping. Further research is required to explore the relationship between physical restrictions and food access.

Fatness, fitness, and increased cardiovascular risk in young children

OBJECTIVES

To investigate the relationships between cardiorespiratory fitness and adiposity among young children, and their influence on a comprehensive cardiovascular risk profile.

STUDY DESIGN

The sample included 95 healthy weight, 54 overweight, and 31 obese children (n=180, 10.9+/-2.1 years). All children had a medical assessment that included a physical examination and fasting investigations including glycated hemoglobin, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, insulin and glucose levels. Body mass index and waist circumference z-scores were calculated. Children's fitness level was measured with the Queens College step test.

RESULTS

Although low fitness was independently associated with cardiovascular risk, multi-level analysis demonstrated that waist circumference z-score was the only significant predictor of cardiovascular risk factors including SBP (beta=3.29, P<.001), DBP (beta=1.88, P<.005), high-density lipoprotein (beta=-0.12, P<.001), and triglyceride levels (beta=0.14, p<.001), fasting insulin (beta=2.83, P<.001), C-peptide (beta=0.11, P<.001), and HOMA-IR (beta=0.34, P<.001), with increasing waist circumference z-score associated with increasing cardiovascular risk. Within the healthy weight children, high fitness was associated with significantly reduced triglyceride levels, and lower fasting glucose, insulin and HOMA-IR.

CONCLUSIONS

Young children's health may be influenced more by body fatness, and in particular, the distribution of body fat than by cardiorespiratory fitness. However, within the healthy weight children, high fitness was associated with a favorable metabolic profile, suggesting that cardiorespiratory fitness may exert a protective effect on metabolic risk in children whose risk is not confounded by fatness.

Understanding children's sedentary behaviour: a qualitative study of the family home environment

Electronic media (EM) (television, electronic games and computer) use has been associated with overweight and obesity among children. Little is known about the time spent in sedentary behaviour (SB) among children within the family context. The aim of this study was to explore how the family home environment may influence children's electronic-based SB. Focus groups and family interviews were conducted with 11- to 12-year old children (n = 54) and their parents (n = 38) using a semi-structured discussion guide. Transcripts were analysed using a thematic content approach. A brief self-completed questionnaire was also used to measure leisure behaviour and electronic devices at home. Children incorporated both sedentary and physical activities into their weekly routine. Factors influencing children's EM use included parent and sibling modelling and reinforcement, personal cognitions, the physical home environment and household EM use rules and restrictions. Participants were not concerned about the excessive time children spent with EM. This under-recognition emerged as a personal influencing factor and was viewed as a major barrier to modifying children's electronic-based SB. Efforts to reduce SB in children should focus on the influencing factors that reciprocally interact within the family home. An emphasis on increasing awareness about the risks associated with spending excessive time in screen-based activities should be a priority when developing intervention strategies aimed at modifying the time children spend in SB.

Embodied image: gender differences in functional and aesthetic body image among Australian adolescents

Perceptions of the body are not restricted to the way the body "looks"; they may also extend to the way the body "functions". This research explores body image among male and female adolescents using the Embodied Image Scale (EIS), which incorporates body function into body image. Adolescents (N=1526, male=673, female=853) aged 12-17 (M=13.83, SD=1.02), from 26 Western Australian high schools were surveyed. Information was gathered on pubertal timing, body mass index (BMI) and body image. Participants reported significantly higher value of, behavioral-investment in, and satisfaction with the functional dimension of the body compared to the aesthetic dimension. After controlling for age, pubertal timing, and BMI, females reported significantly higher aesthetic values and aesthetic behavioral-investment, and lower aesthetic satisfaction, functional values, functional behavioral-investment and functional satisfaction than male participants. Grade, pubertal timing and BMI category differences were also explored.

Reproducibility and comparative validity of a food frequency questionnaire for Australian children and adolescents

BACKGROUND

Dietary intake during childhood and adolescence is of increasing interest due to its influence on adult health, particularly obesity, cardiovascular disease and diabetes. There is a need to develop and validate dietary assessment methods suitable for large epidemiologic studies of children and adolescents. Limited large scale dietary studies of youth have been undertaken in Australia, due partly to the lack of a suitable dietary intake tool. A self-administered, semi-quantitative food-frequency questionnaire (FFQ), the 'Australian Child and Adolescent Eating Survey' (ACAES), was developed for youth aged 9-16 years. This study evaluated reproducibility and comparative validity of the ACAES FFQ using assisted food records (FRs) as the reference method.

METHODS

The ACAES FFQ was completed twice (FFQ1 and FFQ2) at an interval of 5 months, along with four one-day assisted FRs. Validity was evaluated by comparing the average of the FRs with FFQ2 (n = 113) as well as with the average of FFQ1 and FFQ2 (n = 101). Reproducibility was evaluated by comparing FFQ1 and FFQ2 (n = 101). The two methods were compared using correlations, Kappa statistics and Bland-Altman plots.

RESULTS

Correlation coefficients for comparative validity ranged from 0.03 for retinol to 0.56 for magnesium for transformed, energy-adjusted, deattenuated nutrient data, with correlation coefficients greater than 0.40 for total fat, saturated fat, monounsaturated fat, carbohydrate, sugars, riboflavin, vitamin C, folate, beta-carotene, magnesium, calcium and iron. Correlation coefficients for reproducibility ranged from 0.18 for vitamin A to 0.50 for calcium for transformed, energy-adjusted, deattenuated nutrient data. The ACAES FFQ ranked individuals reasonably accurately, with the comparative validity analysis showing that over 50% of participants were classified within one quintile for all nutrients, with only a small percentage grossly misclassified (0-7%).

CONCLUSION

The ACAES FFQ is the first child and adolescent specific FFQ available for ranking the dietary intakes of Australian children and adolescents for a range of nutrients in epidemiologic research and public health interventions.

Abdominal fat assessment in adolescents using dual-energy X-ray absorptiometry

BACKGROUND

Abdominal obesity is an increasing problem in adolescents, often persisting into adulthood. Reliable assessment has been restricted to techniques limited by relatively high radiation doses or cost.

AIM

To investigate the reliability of several abdominal regions using dual-energy X-ray absorptiometry (DXA), and to assess the construct validity of these methods against metabolic profile.

METHODS

Inter- and intra-rater precision of two assessors were examined, for fat mass analysis in six different abdominal regions using DXA in overweight/obese and normal weight adolescents. Construct validity was examined in overweight/obese individuals.

RESULTS

All methods had acceptable intra- and inter-rater reliability. Region 1 was most precise in overweight/obese individuals, while Region 6 was most precise in normal weight individuals. In all regions, assessments were less precise in overweight/obese individuals. All regions were equally predictive of insulin outcomes.

CONCLUSIONS

Abdominal adiposity can be reliably assessed in adolescents using DXA, and the most precisely assessed regions were identified. All regions predicted insulin outcomes.

Relationships between body fatness, small-screen sedentary activity and regionality among schoolchildren in Victoria, Australia

OBJECTIVE

To examine the difference in body fatness and engagement in small-screen activities across children living in different degrees of regionality, and to examine the relationship between child body fatness and small-screen activities.

DESIGN

Cross-sectional study design.

PARTICIPANTS

Grade 5-6 schoolchildren (n = 393) from central and metropolitan Victoria, and a parent/guardian of each child (n = 393).

MAIN OUTCOME MEASURES

Parents completed a questionnaire on their child's engagement in television (TV) viewing and video game playing (VGP). Children's weight and height were measured by a researcher. Body mass index (BMI) (kg/m(2)) was calculated and adjusted for age and sex. Regionality (metropolitan, population > 100 000; regional, 100 000 > population < 20 000; and rural, population < 10 000) and socioeconomic status (socioeconomic indexes for areas: index of disadvantage) were assigned according to school attended.

RESULTS

BMI did not differ across regionality or sex. Boys engaged in more VGP than girls, and metropolitan children engaged in more VGP than rural and regional children. TV viewing did not differ across sex or regionality. VGP did not predict BMI, and TV viewing did not predict girls' BMI. Three to four per cent of the variance in boys' BMI was predicted by TV viewing.

CONCLUSIONS

Boys and metropolitan children engage in more VGP. Boys', but not girls', BMI is related to TV viewing. Interventions designed to decrease engagement in TV viewing should be targeting boys.

Cardiovascular risk factors in Australian indigenous and non-indigenous children: a population-based study

AIM

Indigenous people have a two- to tenfold increased risk of premature death from cardiovascular disease. We aimed to determine whether some key risk factors for cardiovascular disease occur more commonly in Aboriginal than non-Aboriginal Australian children.

METHODS

Children were enrolled from primary schools throughout New South Wales, the state with the highest number of Aboriginal people. Associations between ethnicity, gender, birthweight, socio-demographic status and hypertension, obesity, baseline and persistent albuminuria were determined.

RESULTS

A total of 2266 children (55% Aboriginal) were enrolled. Mean age was 8.9 years (+/-3.8 years). Obesity (body mass index >or=2 standard deviations) was detected in 7.1%, systolic hypertension (blood pressure >90th percentile) in 7.2%, diastolic hypertension in 5.9%, baseline albuminuria (albumin : creatinine >or=3.4 mg/mmol) in 7.3% and persistent albuminuria in 1.5% with no differences between Aboriginal and non-Aboriginal children. Hypertension was less common with increasing social disadvantage (trend P < 0.02). Increasing body mass index standard deviation was strongly associated with systolic and diastolic hypertension (both P < 0.0001).

CONCLUSIONS

Many risk factors for cardiovascular disease are already common in young children but not more prevalent in Aboriginal than in non-Aboriginal children. In all children, overweight and obesity have the strongest association with hypertension, but social disadvantage appears protective for hypertension. Our findings suggest that risk for cardiovascular health disparities seen in indigenous adults manifests beyond childhood and that a window of opportunity exists to prevent some of these outcomes.

Racial/ethnic, socioeconomic, and behavioral determinants of childhood and adolescent obesity in the United States: analyzing independent and joint associations

PURPOSE

This study examines independent and joint associations between several socioeconomic, demographic, and behavioral characteristics and obesity prevalence among 46,707 children aged 10-17 years in the United States.

METHODS

The 2003 National Survey of Children's Health was used to calculate obesity prevalence. Logistic regression was used to estimate odds of obesity and adjusted prevalence.

RESULTS

Ethnic minority status, non-metropolitan residence, lower socioeconomic status (SES) and social capital, higher television viewing, and higher physical inactivity levels were all independently associated with higher obesity prevalence. Adjusted obesity prevalence varied by age, gender, race/ethnicity, and SES. Compared with affluent white children, the odds of obesity were 2.7, 1.9 and 3.2 times higher for the poor Hispanic, white, and black children, respectively. Hispanic, white, and black children watching television 3 hours or more per day had 1.8, 1.9, and 2.5 times higher odds of obesity than white children who watched television less than 1 hour/day, respectively. Poor children with a sedentary lifestyle had 3.7 times higher odds of obesity than their active, affluent counterparts (adjusted prevalence, 19.8% vs. 6.7%).

CONCLUSIONS

Race/ethnicity, SES, and behavioral factors are independently related to childhood and adolescent obesity. Joint effects by gender, race/ethnicity, and SES indicate the potential for considerable reduction in the existing disparities in childhood obesity in the United States.

Physical activity, health, body mass index, sleeping habits and body complaints in Australian senior high school students

Adolescents in the industrial world are becoming less physically active and are increasingly adopting a sedentary life-style in front of computers and television screens.

OBJECTIVE

to determine self-related health, physical activity, sleeping habits, prevalence of overweight, and body complaints in Australian senior high school students.

METHODS

Participants were 466 high school students aged 15-17 years enrolled in academic and vocational programs. A questionnaire was completed at two senior high schools with questions about weight and height, health, physical activity, type of physical activity/sport, intensity, sleeping habits, and possible injuries or complaints during the last three months.

RESULTS

Seventy seven percent of the high school students participated in sports on a regular basis. Compared with vocational programs, more males and females in academic programs participated in sports (71% and 80% respectively) (p = .036). Males reported significantly better health than females (p < .0001). 65% of the study group reported body complaints during the last 3 months. A higher number of females than males reported complaints about the back (p = .007) and the hip (p = .05). Good sleep was reported in 82.1% of males and in 76.6% of females. In males, 44.3% were often sleepy in the daytime (females 56.6%, p < .01).

CONCLUSIONS

Underweight, physical activity and good sleep are factors with significant positive effect on good health, whereas overweight is a negative factor. Proper sleep habits and higher physical activity levels should be promoted among high school students, and TV viewing time and video game use restricted. Additionally, schools should provide opportunities for young people to participate in a wider range of physical activities that address their individual needs while promoting the health benefits of engaging in regular exercise.

Obesity and persisting sleep apnea after adenotonsillectomy in Greek children

BACKGROUND

The relative importance of obesity and adenotonsillar hypertrophy in the pathogenesis of obstructive sleep-disordered breathing (SDB) in childhood is unclear. Adenotonsillectomy (AT) for SDB is not always curative, and obese children are at increased risk for residual disease postoperatively.

OBJECTIVE

The aim of this investigation was to assess the efficacy of AT as treatment for SDB in obese and nonobese children.

METHODS

Children with adenoidal and/or tonsillar hypertrophy who underwent AT for the treatment of SDB underwent polysomnography preoperatively and postoperatively. A body mass index (BMI) z score of > 1.645 was used to define obesity. The achievement of a postoperative obstructive apnea-hypopnea index (OAHI) of less than one episode per hour (ie, the cure of SDB) was the primary outcome measure.

RESULTS

Twenty-two obese children (mean [+/- SD] age, 5.8 +/- 1.8 years; mean BMI z score, 2.6 +/- 0.8; mean OAHI, 9.5 +/- 9.7 episodes per hour) and 48 nonobese children (mean age, 6.9 +/- 2.6 years; mean BMI z score, 0.09 +/- 1.1; OAHI, 6 +/- 5.4 episodes per hour) were recruited. After surgery, obese and nonobese subjects did not differ in the efficacy of AT (postoperative OAHI of less than one episode per hour, 22.7% vs 25% of subjects, respectively; p > 0.05). The presence of obesity, adenoidal or tonsillar hypertrophy, gender, and postoperative BMI change were not significant predictors of SDB cure.

CONCLUSIONS

Obesity does not necessarily predict an unfavorable outcome of AT as treatment for SDB.

Trends in overweight and obesity in pre-school children in urban areas of Ho Chi Minh City, Vietnam, from 2002 to 2005

OBJECTIVE

To assess the trends in overweight and obesity in pre-school children in urban areas of Ho Chi Minh City (HCMC), Vietnam, over the period 2002 to 2005.

DESIGN

Two cross-sectional studies were conducted in 2002 and 2005. Multistage cluster sampling was used in both surveys to select the subjects. Sociodemographic information was collected using a self-administered questionnaire given to parents in 2002 and using an interview-administered questionnaire to parents in 2005. Weight and height were measured using the same standard methods in both surveys. BMI (kg/m2) was calculated and overweight/obesity was defined using the age- and sex-specific BMI cut-off points proposed by the International Obesity Taskforce.

SUBJECTS AND SETTING

Children aged 4 to 5 years, attending pre-schools in urban areas of HCMC, Vietnam, in 2002 (n 492) and 2005 (n 670).

RESULTS

The prevalence of overweight and obesity almost doubled from 2002 to 2005 (21.4 % and 36.8 %, respectively). The increase was more evident in less wealthy districts than in wealthy districts. The proportion of boys classified as obese in 2005 (22.5 %) was three times that in 2002 (6.9 %).

CONCLUSION

The prevalence of overweight and obesity has increased rapidly in children aged 4 to 5 years in urban areas, and especially in less wealthy districts, over a 3-year period. These results signal an urgent need for prevention programmes to control and reverse this rapid upward trend in overweight and obesity in young children in HCMC.