Active (Opt-In) Consent Underestimates Mean BMI-z and the Prevalence of Overweight and Obesity Compared to Passive (Opt-Out) Consent. Evidence from the Healthy Together Victoria and Childhood Obesity Study

Childhood obesity in the ED: A prospective Australian study

OBJECTIVE

To determine (i) the prevalence of overweight and obesity among children presenting to all EDs in a large regional Australian city and (ii) whether age, sex, socioeconomic status (SES) or hospital setting (public vs private) were associated with overweight and obesity.

METHODS

This prospective observational study included children aged ≥2 and <18 years who presented to any of three EDs over an 18 month period who had their height and weight measured. Age, sex and residential postcode were collected. Weight category was determined by sex and age standardised body mass index (BMI) z-score. Weight category was assessed by sex, age, SES and hospital setting with chi-squared tests, and ordinal logistic regression with cluster sandwich error estimators. Results were reported using odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

Data were collected for 3827 children, of which 11.6% were obese and 19.8% overweight. The prevalence of obesity was highest in those aged 8-14 years and in those from lower SES postcodes. The likelihood of obesity was higher in the public than the private hospitals (OR 0.66, 95% CI 0.51-0.86), whereas the likelihood of overweight was similar (OR 1.00, 95% CI 0.83-1.22).

CONCLUSIONS

Almost one-third of children who presented to EDs were overweight or obese. Obesity was particularly high in those aged 8-14 years and those from lower SES postcodes. In the evolving obesity crisis, the high proportion of children presenting to EDs above a healthy weight might represent an opportunity for EDs to identify and refer children for body weight and lifestyle management.

Healthy together Victoria and childhood obesity study: effects of a large scale, community-based cluster randomised trial of a systems thinking approach for the prevention of childhood obesity among secondary school students 2014-2016

BACKGROUND

Healthy Together Victoria (HTV) was a Victorian Government initiative that sought to reduce the prevalence of overweight and obesity through targeting chronic disease risk factors including physical activity, poor diet quality, smoking, and harmful alcohol use. The intervention involved a boosted workforce of > 170 local-level staff in 12 communities; employed to deliver system activation around health and wellbeing for individuals, families and communities. A cluster randomised trial (CRT) of a systems thinking approach to obesity prevention was embedded within HTV. We present the two-year changes in overweight and obesity and associated behaviours among secondary school students across Victoria, Australia.

METHODS

Twenty-three geographically bounded areas were randomised to intervention (12 communities) or comparison (11 communities). Randomly selected secondary schools within each community were invited to participate in the trial in 2014 and 2016. Students in Grade 8 (aged approximately 13-15 years) and Grade 10 (aged approximately 15-16 years) at participating schools were recruited using an opt-out approach across July-September 2014 and 2016. Primary outcomes were body mass index (BMI) and waist circumference. Secondary outcomes were physical activity, sedentary behaviour, diet quality, health-related quality of life, and depressive symptoms. Linear mixed models were fit to estimate the intervention effect adjusting for child/school characteristics.

RESULTS

There were 4242 intervention children and 2999 control children in the final analysis. For boys, the two-year change showed improvement in intervention versus control for waist circumference (difference in change: - 2.5 cm; 95% confidence interval [CI]: - 4.6, - 0.5) and consumption of sugar-sweetened beverages per day (< 1 serve: 8.5 percentage points; 95% CI: 0.6, 16.5). For girls, there were no statistically significant differences between conditions.

CONCLUSIONS

HTV seemed to produce favourable changes in waist circumference and sugar-sweetened beverage consumption for boys, however, no effect on BMI was observed. Although the HTV intervention was cut short, and the period between data collection points was relatively short, the changes observed in HTV contribute to the growing evidence of whole-of-community interventions targeting childhood obesity.

TRIAL REGISTRATION

This trial is unregistered. The intervention itself was a policy setting delivered by government and our role was the collection of data to evaluate the effect of this natural experiment. That is, this study was not a trial from the classical point of view and we were not responsible for the intervention.

Evaluation of a cluster-randomized controlled trial: Communities for Healthy Living, family-centered obesity prevention program for Head Start parents and children

BACKGROUND

This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families.

METHODS

Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one of three intervention start times. CHL involved a media campaign and enhanced nutrition support. Parents were invited to join Parents Connect for Healthy Living (PConnect), a 10-week wellness program. At the beginning and end of each school year (2017-2019), data were collected on the primary outcome of child Body Mass Index z-score (BMIz) and modified BMIz, and secondary outcomes of child weight-related behaviors (diet, physical activity, sleep, media use) and parents' weight-related parenting practices and empowerment. Data from 2 years, rather than three, were utilized to evaluate CHL due to the COVID-19 pandemic. We used mixed effects linear regression to compare relative differences during intervention vs. control periods (n = 1274 vs. 2476 children) in (1) mean change in child BMIz and modified BMIz, (2) the odds of meeting child health behavior recommendations, (3) mean change in parenting practices, and (4) mean change in parent empowerment. We also compared outcomes among parents who chose post-randomization to participate in PConnect vs. not (n = 55 vs. 443).

RESULTS

During intervention periods (vs. control), children experienced greater increases in BMIz and modified BMIz (b = 0.06, 95% CI = 0.02,0.10; b = 0.07, 95% CI = 0.03, 0.12), yet were more likely to meet recommendations related to three of eight measured behaviors: sugar-sweetened beverage consumption (i.e., rarely consume; Odds Ratio (OR) = 1.5, 95% CI = 1.2,2.3), water consumption (i.e., multiple times per day; OR = 1.6, 95% CI = 1.2,2.3), and screen time (i.e., ≤1 hour/day; OR = 1.4, 95% CI = 1.0,1.8). No statistically significant differences for intervention (vs. control) periods were observed in parent empowerment or parenting practices. However, parents who enrolled in PConnect (vs. not) demonstrated greater increases in empowerment (b = 0.17, 95% CI = 0.04,0.31).

CONCLUSIONS

Interventions that emphasize parent engagement may increase parental empowerment. Intervention exposure was associated with statistically, but not clinically, significant increases in BMIz and increased odds of meeting recommendations for three child behaviors; premature trial suspension may explain mixed results.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03334669 , Registered October 2017.

Four-Year Accelerometry Outcomes from a Cluster Randomized Whole of Systems Trial of Prevention Strategies for Childhood Obesity

Background: We investigated the effect of the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) intervention on children's objectively measured physical activity and sedentary time (ST). Methods: We conducted a cluster randomized controlled trial with children in grades 4 (∼9-10 years old) and grade 6 (∼11-12 years old) from 10 communities in the Great South Coast region of Victoria, Australia. Communities were randomly allocated (1:1) to receive the WHO STOPS intervention in 2015. WHO STOPS was a whole of community systems-based approach to preventing childhood obesity. Outcome data were collected using a repeat cross-sectional design in 2015, 2017, and 2019. Children were asked to wear a hip-mounted accelerometer for 7 days. Age-specific Axis 1 activity counts were converted into duration (minutes/day) spent engaged in moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and ST. Linear mixed regression models were fitted to estimate the effects of the intervention on the three activity outcomes across the study period. Results: Analyses were based on valid accelerometer data from 1406 children (intervention n = 745; control n = 661). Results for MVPA, LPA, and ST were nonsignificant. Between 2015 and 2017, there were positive, but nonsignificant, changes in mean MVPA favoring intervention boys [3.7 minutes/day; 95% confidence interval (CI): -5.7 to 13.1] and girls (5.5 minutes/day; 95% CI: -1.5 to 12.6). By 2019, these effects had attenuated. Conclusions: Although the WHO STOPS intervention did not significantly change activity levels, the magnitudes of the effects on MVPA suggest that further research with whole-of-community interventions in larger samples would be worthwhile. Clinical trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR.org.au) identifier 12616000980437.

A protocol for coordinating rural community stakeholders to implement whole-of-community youth physical activity surveillance through school systems

Accurate and effective local data collection systems are needed to inform community change on youth health behaviors such as physical activity (PA). Systematic methods are particularly important for understanding PA behaviors that may be influenced by individual, interpersonal, organizational, and regional factors. The purpose of this study was to describe a protocol for coordinating community stakeholders to implement an online youth PA surveillance instrument. The research team collaborated with local health departments (LHDs) from two rural communities to coordinate schools in implementing school-wide youth PA surveillance. A data sharing agreement was established between all partners. School administrators and teachers attended in-person training sessions for an online PA survey and how to use the data. Following the training, students were provided individualized logins to complete the survey once a semester over a two-year academic period. Across both communities, 23 teachers and administrators attended the training sessions that were facilitated by the LHDs and research team. In Year 1 (Y1), a total of 465 3rd through 6th grade students were enrolled in the participating schools (community 1 = 227; community 2 = 238). Survey response rates ranged from 86.1% to 95.4% completion, depending on the community and semester. In Year 2 (Y2), a total of 501 3rd through 6th grade students were enrolled (community 1 = 260; community 2 = 241). Response rates ranged from 86.3% to 89.6% in the fall term. A protocol for coordinating LHD and community stakeholders was an effective strategy for implementing population-level youth PA surveillance with high levels of reach.

The impact of a community-based intervention on weight, weight-related behaviours and health-related quality of life in primary school children in Victoria, Australia, according to socio-economic position

Background

Approximately a quarter of Australian children are classified as overweight or obese. In high-income countries, childhood obesity follows a socio-economic gradient, with greater prevalence amongst the most socio-economically disadvantaged children. Community-based interventions (CBI), particularly those using a systems approach, have been shown to be effective on weight and weight-related behaviours. They are also thought to have an equitable impacts, however there is limited evidence of their effectiveness in achieving this goal.

Methods

Secondary analysis was conducted on data collected from primary school children (aged 6–13 years) residing in ten communities (five intervention, five control) involved in the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) cluster randomised trial in Victoria, Australia. Outcomes included Body Mass Index z-score (BMI-z) derived from measured height and weight, self-reported physical activity and dietary behaviours and health related quality of life (HRQoL). Repeat cross-sectional data from 2015 (n = 1790) and 2019 (n = 2137) were analysed, stratified by high or low socio-economic position (SEP). Multilevel linear models and generalised estimating equations were fitted to assess whether SEP modified the intervention effect on the outcomes.

Results

There were no overall changes in BMI-z for either SEP strata. For behavioural outcomes, the intervention resulted in a 22.5% (95% CI 5.1, 39.9) point greater improvement in high-SEP compared to low-SEP intervention schools for meeting physical activity guidelines. There were also positive dietary intervention effects for high SEP students, reducing takeaway and packaged snack consumption, although there was no significant difference in effect between high and low SEP students. There were positive intervention effects for HRQoL, whereby scores declined in control communities with no change in intervention communities, and this did not differ by SEP.

Conclusion

The WHO STOPS intervention had differential effects on several weight-related behaviours according to SEP, including physical activity. Similar impacts on HRQoL outcomes were found between high and low SEP groups. Importantly, the trial evaluation was not powered to detect subgroup differences. Future evaluations of CBIs should be designed with an equity lens, to understand if and how these types of interventions can benefit all community members, regardless of their social and economic resources.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12150-4.

Is the physical activity environment surrounding primary schools associated with students' weight status, physical activity or active transport, in regional areas of Victoria, Australia? A cross-sectional study

OBJECTIVES

To explore whether the physical activity (PA) environment (walkability, greenspace and recreational facilities) surrounding regional primary schools is associated with children's PA levels, active transport and weight status. Limited research on this topic has been conducted outside of major cities.

DESIGN

Cross-sectional ecological study using baseline data from two large-scale obesity prevention interventions.

SETTING

Eighty (n=80) primary schools across two regional areas in Victoria, Australia.

PARTICIPANTS

Students aged 8-13 years (n=2144) attending participating primary schools.

OUTCOME MEASURES

Measured weight status (body mass index z-score, proportion overweight/obese) and self-reported PA behaviours (meeting PA recommendations and active travel behaviour).

RESULTS

When adjusted for student and school demographics, students had significantly increased odds of using active transport to or from school when the school neighbourhood was more walkable (OR 1.21 (95% CI 1.09 to 1.35), had a greater number of greenspaces (OR 1.35 (95% CI 1.20 to 1.53)) and a greater number of recreational facilities (OR 1.18 (95% CI 1.07 to 1.31)). A higher cumulative PA environment score was also associated with a higher proportion of children using active transport (OR 1.33 (95% CI 1.28 to 1.51)). There were no significant associations between the PA environment measures and either weight status or meeting the PA recommendations in adjusted models.

CONCLUSIONS

This study is the first of its kind exploring school neighbourhood environments and child weight status and PA in regional areas of Australia. It highlights the potential of the environment surrounding primary schools in contributing to students' active travel to and from school. Further research with the use of objective PA measurement is warranted in regional areas that have been under-researched.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ANZCTR.org.au) identifier 12616000980437; Results.

Association between the school physical activity environment, measured and self-reported student physical activity and active transport behaviours in Victoria, Australia

Background

Environments within schools including the physical, social-cultural and policy/practice environments have the potential to influence children’s physical activity (PA) behaviours and weight status. This Australian first study comprehensively examined the association(s) of physical, social-cultural and policy/practice environments with PA, active transport (AT) and weight status among regional primary school children.

Methods

Data were from two childhood obesity monitoring systems in regional Victoria, Australia. Measured height and weight were collected from students in Year 2 (aged approx. 7–8 years), Year 4 (9–10 years), and Year 6 (11–12 years). Self–reported PA behaviour, including AT were collected from students in Year 4 and 6 and a sub-sample wore an ActiGraph (wGT3X-BT) accelerometer for 7-days. A school physical activity environment audit was completed by the school principal and responses were used to calculate school physical activity environment scores (PAES) and active transport environment scores (ATES). Mixed effects logistic regression was used to assess the relationship between the proportion of students meeting the PA guidelines (≥60mins/day of moderate-to-vigorous PA) and PAES tertiles (low, medium, high) and those using AT and school ATES tertiles, controlling for gender, school size/type and socioeconomic composition.

Results

The analysed sample included 54/146 (37%) schools and 3360/5376 (64%) students. In stratified analysis, girls in schools with a medium PAES score were more likely to meet the objectively measured PA guideline compared to low PAES score (OR 2.3, 95%CI 1.27, 4.16). Similarly, students in schools with a medium or high ATES score had higher odds of self-reported AT (medium OR 3.15, 95%CI 1.67, 5.94; high OR 3.71, 95%CI: 1.80, 7.64). No association between PAES or ATES and weight status were observed. Self-reported AT among boys (OR 1.59, 95%CI 1.19, 2.13) and girls (OR 1.56, 95%CI 1.08, 2.27) was associated with higher odds of meeting self-reported PA guidelines on all 7-days than those who did not report using AT.

Conclusions

In this study of regional Victorian primary schools, PA environments were only associated with girls’ adherence to PA guidelines. School AT environments were strongly associated with students’ AT behaviours and with increased likelihood of students being physically active.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01151-6.

Four-Year Behavioral, Health-Related Quality of Life, and BMI Outcomes from a Cluster Randomized Whole of Systems Trial of Prevention Strategies for Childhood Obesity

OBJECTIVE

This study aimed to test the effectiveness of the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS Childhood Obesity) for behavioral, health-related quality of life (HRQoL), and BMI outcomes.

METHODS

This was a cluster randomized trial of 10 communities randomly allocated (1:1) to start intervention in 2015 (step 1) or in 2019 (after 4 years) in South West Victoria, Australia. Data were collected from participating primary schools in April to June of 2015 (73% school participation rate), 2017 (69%), and 2019 (63%). Student participation rates were 80% in 2015 (1,792/2,516 invited), 81% in 2017 (2,411/2,963), and 79% in 2019 (2,177/2,720). Repeat cross-sectional analyses of measured height and weight (grades two, four, and six [aged approximately 7 to 12 years]), self-reported behavior, and HRQoL (grades four and six) were conducted.

RESULTS

There was an intervention by time interaction in BMI z scores (P = 0.031) and obesity/overweight prevalence (P = 0.006). BMI z score and overweight/obesity prevalence decreased between 2015 and 2017 and increased between 2017 and 2019 in intervention communities. The intervention significantly reduced takeaway food consumption (P = 0.034) and improved physical (P = 0.019), psychosocial (P = 0.026), and global (P = 0.012) HRQoL. Water consumption increased among girls (P = 0.033) in the intervention communities, as did energy-dense, nutrient-poor snack consumption among boys (P = 0.006).

CONCLUSIONS

WHO STOPS had a positive impact on takeaway food intake and HRQoL.

Variation in the Socioeconomic Gradient of Obesity by Ethnicity - England's National Child Measurement Programme

OBJECTIVE

This study examined the prevalence and risk of overweight/obesity among expanded ethnicity categories within boys and girls in England and the differential influence of socioeconomic position using the 2015/2016 and the 2016/2017 cycles of the National Child Measurement Programme.

METHODS

This cross-sectional and descriptive study examined surveillance data of weight status among primary school children in England. Data were pooled across data collection years, representing 1.25 million children in Reception (aged 4-5 years) and 1.1 million children in Year 6 (aged 10-11 years). Ethnicity was classified according to National Health Service definitions, and child residence was used to calculate quintiles of Income Deprivation Affecting Children Index. Measured weight status was classified using the International Obesity Task Force's definition. Logistic regression models were run for each sex and year group.

RESULTS

Within each sex, ethnicity- and socioeconomic-specific differentials in overweight/obesity prevalence were evident. For example, among the five most populous ethnic groups in the most deprived quintile, 26.8% of White British girls in Reception had overweight/obesity compared with 20.7% of girls with Pakistani, 31.2% with Black African, 17.1% with Indian, and 22.2% with any Any Other White (e.g., White European) background.

CONCLUSIONS

Ethnicity had an independent influence on overweight/obesity risk after adjustment for socioeconomic position.

Protocol for the measurement of changes in knowledge and engagement in the stepped wedge cluster randomised trial for childhood obesity prevention in Australia: (Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND))

BACKGROUND

Community-based interventions have shown promise in addressing the childhood obesity epidemic. Such efforts rely on the knowledge of key community members and their engagement with the drivers of obesity in their community. This paper presents the protocol for the measurement and evaluation of knowledge and engagement among community leaders within a whole-of-community systems intervention across 10 large intervention communities in Australia.

METHODS

We will investigate the role of stakeholder knowledge and engagement in the implementation and effectiveness of the stepped wedge cluster randomised trial in ten communities in Victoria, Australia. Data will be collected using the Stakeholder-driven Community Diffusion Survey (SDCD) to measure levels of knowledge and engagement prior to commencement (2019), across the three separate levels of governance within the intervention at five time points. Primary outcomes will be baseline overall knowledge and engagement scores across the three levels of governance and change in overall knowledge and engagement over time.

DISCUSSION

We hypothesise there will be heterogeneity between intervention sites on levels of knowledge and engagement and that these differences will be associated with variability in implementation success.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12618001986268 . Registered on 11 December 2018.

Protocol for economic evaluation alongside the SHINE (Supporting Healthy Image, Nutrition and Exercise) cluster randomised controlled trial

INTRODUCTION

Limited evidence exists on the cost-effectiveness of interventions to prevent obesity and promote healthy body image in adolescents. The SHINE (Supporting Healthy Image, Nutrition and Exercise) study is a cluster randomised control trial (cRCT) aiming to deliver universal education about healthy nutrition and physical activity to adolescents, as well as targeted advice to young people with body image concerns who are at risk of developing disordered eating behaviours. This paper describes the methods for the economic evaluation of the SHINE cRCT, to determine whether the intervention is cost-effective as an obesity prevention measure.

METHODS AND ANALYSIS

A public payer perspective will be adopted, with intervention costs collected prospectively. Within-trial cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) will quantify the incremental costs and health gains of the intervention as compared with usual practice (ie, teacher-delivered curriculum). CEA will present results as cost per body mass index unit saved. CUA will present results as cost per quality-adjusted life year gained. A modelled CUA will extend the target population, time horizon and decision context to provide valuable information to policymakers on the potential for incremental cost offsets attributable to disease prevention arising from intervention. Intervention costs and effects will be extrapolated to the population of Australian adolescents in Grade 7 of secondary school (approximate age 13 years) and modelled over the cohort's lifetime. Modelled CUA results will be presented as health-adjusted life years saved and healthcare cost-savings of diseases averted. Incremental cost-effectiveness ratios will be calculated as the difference in costs between the intervention and comparator divided by the difference in benefit. Semi-structured interviews with key intervention stakeholders will explore the potential impact of scalability on cost-effectiveness. These data will be thematically analysed to inform sensitivity analysis of the base case economic evaluation, such that cost-effectiveness evidence is reflective of the potential for scalability.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Deakin University Human Research Ethics Committee (#2017-269) and the Victorian Department of Education and Training (#2018_003630). Study findings will be disseminated through peer-reviewed academic papers and participating schools will receive annual reports over the 3 years of data collection.

TRIAL REGISTRATION NUMBER

ACTRN 12618000330246; Pre-results.

Weight status and obesity-related dietary behaviours among culturally and linguistically diverse (CALD) children in Victoria, Australia

Background

In developed economies, obesity prevalence is high within children from some culturally and linguistically diverse (CALD) backgrounds. This study aims to identify whether CALD groups in Victoria, Australia, are at increased risk of childhood overweight and obesity, and obesity-related dietary behaviours; compared to their non-CALD counterparts.

Methods

Objective anthropometric and self-report dietary behavioural data were collected from 2407 Grade 4 and 6 primary school children (aged 9–12 years). Children were categorised into CALD and non-CALD cultural groups according to the Australian Standard Classification of Languages. Overweight/obesity was defined according to the World Health Organization growth reference standards. Obesity-related dietary behaviour categories included excess consumption of takeaway foods, energy-dense, nutrient-poor snacks and sugar sweetened beverages. T-tests and chi-square tests were performed to identify differences in weight status and dietary behaviours between CALD and non-CALD children. Logistic regression analyses examined the relationship between CALD background, weight status and dietary behaviours.

Results

Middle-Eastern children had a higher overweight/obesity prevalence (53.0%) than non-CALD children (36.7%; p < 0.001). A higher proportion of Middle-Eastern children had excess consumption of takeaway foods (54.9%), energy-dense, nutrient-poor snacks (36.6%) and sugar sweetened beverages (35.4%) compared to non-CALD children (40.4, 27.0 and 25.0%, respectively; p < 0.05). Southeast Asian and African children were 1.58 (95% CI = [1.06, 2.35]) and 1.61 (95% CI = [1.17, 2.21]) times more likely, respectively, to consume takeaway foods at least once per week than non-CALD children.

Conclusions

Disparities in overweight/obesity prevalence and obesity-related dietary behaviours among children in Victoria suggest the need for cultural-specific, tailored prevention and intervention strategies.

Associations between combined overweight and obesity, lifestyle behavioural risk and quality of life among Australian regional school children: baseline findings of the Goulburn Valley health behaviours monitoring study

INTRODUCTION

Health related quality of life is a multi-dimensional construct of particular interest in determining the consequences of illness and disease. This study aimed to determine the relationships between overweight/obesity, and associated obesogenic risk behaviours with health related quality of life and physical, social, emotional and school sub-domains, among a large cohort of Australian primary school children.

METHODS

The data were derived from the Goulburn Valley Health Behaviours Monitoring study whereby a census-styled school recruitment process and high participatory opt-out (passive) procedure was employed. All primary schools in three Local Government Areas were invited to participate between July-September 2016 with 39/62 (62%) of schools participating and 1606/2034 (79%) students in Grade 2 (aged approx. 7-8 years), Grade 4 (aged approx. 9-10 years) and Grade 6 (aged approx. 11-12 years) participating. Measured height and weight were collected among participating students and older children (Grade 4 and 6) who also completed a self-report behavioural questionnaire, including the paediatric quality of life inventory.

RESULTS

Among 809 children aged 9 to 12 years, there were 219 (27.1%) classified as overweight/obese. Male children classified as overweight/obese reported significantly lower health related quality of life in the physical functioning and global functioning scores, compared to normal weight males. Significantly higher quality of life scores were observed among all children who met the physical activity recommendations on five out of the seven previous days. Significantly higher scores were observed among males adhering to the daily screen time recommendations, and among those meeting daily recommendations for fruit consumption. Among male school children, soft drink consumption was associated to lower health related quality of life.

CONCLUSION

Although cross-sectional, these findings highlight children with overweight/obesity and some underlying lifestyle behavioural risk factors, had significantly lower healthy-related quality of life, although this was observed most consistently among male school children. These findings have not previously been identified in young children and highlights the need to consider mental and emotional health in public health efforts to prevent obesity.

TRIAL REGISTRATION

ANZCTR Trial Registry: ACTRN12616000980437 retrospectively registered 26 July 2016.