Introduction to the Active Living Research Reference List 2007



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L. S. Adair. (2007). Child and adolescent obesity: Epidemiology and developmental perspectives. Physiology & Behavior.

From infancy through adolescence, more and more children are becoming overweight. National prevalence data show that more than 17% of youth have a body mass index (BMI) above the 95th percentile of the US age and sex-specific reference. Particularly alarming are rates in children as young as 2 years of age, and among minority children. Periods of heightened vulnerability to weight gain have been identified, and research supports the notion that obesity has its origins in early life. This paper focuses on susceptibility to increased adiposity during the prenatal period, infancy, mid-childhood and adolescence, and how factors operating in each of these periods influence risk of becoming overweight. Prenatal exposure to over or undernutrition, rapid growth in early infancy, an early adiposity rebound in childhood, and early pubertal development have all been implicated in the development of obesity. The persistence of obesity from young ages emphasizes the importance of understanding growth trajectories, and of developing prevention strategies to overcome strong influences of obesigenic environments at young ages.

S. M. Ayatollahi and F. Mostajabi. (2007). Prevalence of obesity among schoolchildren in Iran. Obesity Review.

The prevalence of overweight and obesity among schoolchildren aged 6.5-11.5 years in Shiraz (southern Iran) are presented in this paper. The body mass index (BMI) percentiles of these children are compared with the Center for Disease Control and Prevention (CDC) reference data and with the Iranian standard. The data are based on a random multistage sample survey of 2397 healthy school attenders (1268 boys, 1129 girls) living in Shiraz, whose heights and weights were measured in the 2002-2003 academic year. Joint height and weight measurements were obtained for 2195 schoolchildren (91.6%), consisting of 1138 boys (89.7%) and 1057 girls (93.6%). A total of 77 boys (6.8%) and 40 girls (3.8%) were overweight, and the difference between them was significant (P = 0.001). However, obesity was significantly less prevalent in boys (3.3%) than in girls (6.1%) (P = 0.001). Our children's median BMI lie almost on the 38th centile of the CDC reference data, whereas that of their counterparts born more than 10 years ago lay on the 20th centile of their American counterparts, showing the development of children's obesity in a period of less than 15 years in Iran. A positive secular trend in BMI has been seen during the past decade in Iran, suggesting policymakers and health professionals should pay special attention to children's health.

S. E. Barlow. (2007). Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics.

To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child's obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient's age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.

J. N. Bodor and D. D. Rose. (2007). Snacking patterns and away-from-home eating in relation to macronutrient intake and body weight in US children. Faseb Journal.

C. M. Bonfiglioli, B. J. Smith, L. A. King, S. F. Chapman and S. J. Holding. (2007). Choice and voice: obesity debates in television news. The Medical Journal of Australia.

OBJECTIVE: To examine whether television news and current affairs coverage of overweight and obesity frames obesity in ways that support or oppose efforts to combat obesity. DESIGN AND SETTING: A content and framing analysis of a structured sample of 50 television news and current affairs items about overweight and obesity broadcast by five free-to-air television channels in New South Wales between 2 May and 31 October 2005. MAIN OUTCOME MEASURES: Dominant discourses about causes of overweight and obesity; proposed solutions and location of responsibility for the problem; the age-group focus of television items; the relative prominence of stakeholders; and the aspects of obesity which attract news attention. RESULTS: Most television items (72%) framed obesity as a problem of poor nutrition. Obesity was largely seen as the responsibility of individuals (66% of items). Just over half of news items (52%) focused only on adults while 26% focused only on children. Obesity was framed largely as a problem to be solved by individual nutritional changes, exercise and surgical and medical interventions. CONCLUSIONS: While individual lifestyle is crucial to controlling weight, the research community now recognises the importance of sociocultural and environmental factors as drivers of the obesity epidemic. However, television news portrays obesity largely as an individual problem with individual solutions centred mostly on nutrition. Media emphasis on personal responsibility and diet may detract attention from the sociopolitical and structural changes needed to tackle overweight and obesity at a population level.

A. H. Brandes. (2007). Leisure time activities and obesity in school-aged inner city African American and Hispanic children. Pediatric Nursing.

This descriptive-correlational study investigated three research questions: (a) What are the leisure time activities (LTA) of school-aged African American and Hispanic boys and girls? (b) What are their body mass index (BMI) distributions? and (c) What relationships exist between total activity scores of LTA and BMI in the total sample of children, and for boys and girls analyzed separately? The convenience sample consisted of 78 children, aged 9 to 14, who were in the fifth to seventh grades of two elementary schools. Children responded to a modified version of the Know Your Body Health Habits Survey to assess LTA; BMI was calculated based on child height and weight. Results indicated that the LTAs of this group of African American and Hispanic children and their distribution of BMIs were similar to those of White children, and that no appreciable relationships existed between LTAs and BMI in the sample as a whole or boys and girls analyzed separately.

Y. Brooks, D. R. Black, D. C. Coster, C. L. Blue, D. A. Abood and R. J. Gretebeck. (2007). Body mass index and percentage body fat as health indicators for young adults. American Journal of Health Behavior.

OBJECTIVES: To investigate the validity of an axiom that body mass index (BMI) and percentage body fat (%BF), above an ideal, are health risk factors. METHODS: Participants were 2615 volunteers who participated in a health-screening program conducted in college residence halls over a consecutive 8-year period. RESULTS: Nearly half of all participants were misclassified when BMI and/or %BF were used to define better versus poorer health whether analyzing all variables together, by individual factor, or by type of variable. CONCLUSIONS: Results of this study indicate that BMI and %BF are poor indicators of health status among young adults.

K. J. Campbell and K. D. Hesketh. (2007). Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years. A systematic review of the literature. Obesity Review.

Preventing the development of obesity in children is an international health priority. To assess the effectiveness of interventions designed to prevent obesity, promote healthy eating and/or physical activity and/or to reduce sedentary behaviours in 0-5-year-old children, a systematic review of the literature was performed. Literature searches were limited to articles published between January 1995 and June 2006, printed in English and sampling children aged 0-5-years. Searches excluded literature concerned with breastfeeding, eating disorders, and interventions which were school-based or concerned with obesity treatment. Two reviewers independently extracted data and assessed study strengths and weaknesses. Nine included studies were grouped based on the settings in which they were delivered. Most studies involved multi-approach interventions, were conducted in the USA and varied in study designs and quality. All showed some level of effectiveness on at least one obesity-behaviour in young children. These studies support, at a range of levels, the premise that parents are receptive to and capable of some behavioural changes that may promote healthy weight in their young children. The small quantity of research heralds the need, particularly given the potential for early intervention to have long-lasting impacts on individual and population health, to build in a substantial way upon this evidence base.

D. M. Castelli, C. H. Hillman, S. M. Buck and H. E. Erwin. (2007). Physical fitness and academic achievement in third- and fifth-grade students. Journal of Sport & Exercise Psychology.

The relationship between physical fitness and academic achievement has received much attention owing to the increasing prevalence of children who are overweight and unfit, as well as the inescapable pressure on schools to produce students who meet academic standards. This study examined 259 public school students in third and fifth grades and found that field tests of physical fitness were positively related to academic achievement. Specifically, aerobic capacity was positively associated with achievement, whereas BMI was inversely related. Associations were demonstrated in total academic achievement, mathematics achievement, and reading achievement, thus suggesting that aspects of physical fitness may be globally related to academic performance in preadolescents. The findings are discussed with regards to maximizing school performance and the implications for educational policies.

H. R. Clark, E. Goyder, P. Bissell, L. Blank and J. Peters. (2007). How do parents' child-feeding behaviours influence child weight? Implications for childhood obesity policy. Journal Of Public Health.

Background Parents have some responsibility for children's dietary habits and they are often the focus of public health interventions designed to improve children's diets and thereby reduce the prevalence of childhood obesity. The current UK interventions promote awareness of healthy food choices, but offer little guidance for parents on child-feeding behaviours. Methods A review of recent literature regarding child-feeding behaviours and child weight. Results Parents report using a wide range of child-feeding behaviours, including monitoring, pressure to eat and restriction. Restriction of children's eating has most frequently and consistently been associated with child weight gain. Furthermore, there is substantial evidence for a causal relationship between parental restriction and childhood overweight. Conclusions Parents may inadvertently promote excess weight gain in childhood by using inappropriate child-feeding behaviours. We recommend the development of interventions to increase awareness of the possible consequences of inappropriate child-feeding behaviours. Parents who are concerned about their child's weight will also require guidance and support in order to adopt more appropriate child-feeding behaviours.

S. Conroy, R. Ellis, C. Murray and J. Chaw-Kant. (2007). An integrative review of Canadian childhood obesity prevention programmes. Obesity Reviews.

To examine successful Canadian nursing and health promotion intervention programmes for childhood obesity prevention during gestation and infancy, an integrative review was performed of the literature from 1980 to September 2005. The following databases were used: PubMed; Cochrane Database of Systematic Reviews; Cochrane Controlled Trials Register; Database of Abstracts of Reviews of Effects; ACP Journal Club; MEDLINE; EMBASE; CINAHL; Web of Science; Scopus; Sociological Abstracts; Sport Discus; PsycInfo; ERIC and HealthStar. MeSH headings included: infancy (0-24 months), gestation, gestational diabetes, nutrition, prenatal care, pregnancy, health education, pregnancy outcome, dietary services with limits of Canadian, term birth. Of 2028 articles found, six Canadian childhood obesity prevention programmes implemented during gestation and/or infancy were found; three addressed gestational diabetes with five targeting low-income Canadian urban and/or Aboriginal populations. No intervention programmes specifically aimed to prevent childhood obesity during gestation or infancy. This paucity suggests that such a programme would be innovative and much needed in an effort to stem the alarming increase in obesity in children and adults. Any attempts either to develop new approaches or to replicate interventions used with obese adults or even older children need careful evaluation and pilot testing prior to sustained use within the perinatal period.

M. C. Costanza, S. Beer-Borst and A. Morabia. (2007). Achieving energy balance at the population level through increases in physical activity. American Journal of Public Health.

OBJECTIVES: We estimated the amount of physical activity required for individuals to expend an additional 418.4 kJ (100 kcal) per day with the goal of achieving energy balance at the population level. METHODS: Data on total daily energy expenditures were derived from a random sample of adults residing in Geneva, Switzerland, who completed a self-administered physical activity frequency questionnaire. TheSEata were used to simulate the effects of typical physical activity pyramid recommendations on average population energy expenditures for various activity intensities and rates of population compliance with pyramid recommendations. RESULTS: If an average 418.4 kJ (100 kcal) per day increase in energy expenditures is to be achieved, assuming 100% compliance with physical activity pyramid recommendations, the bottom tier of the pyramid must correspond to everyday activities performed at moderate to high intensity levels (e.g., moderate walking or biking). Expected population gains in energy expenditures would be only 167.4 to 251.0 kJ (40 to 60 kcal) per day at a 50% compliance rate. CONCLUSIONS: Achieving population-level energy balance through increasing energy expenditures with physical activity increases alone would require profound structural and environmental changes promoting more active lifestyles.

S. Croezen, T. L. Visscher, N. C. Ter Bogt, M. L. Veling and A. Haveman-Nies. (2007). Skipping breakfast, alcohol consumption and physical inactivity as risk factors for overweight and obesity in adolescents: results of the E-MOVO project. European Journal Of Clinical Nutrition.

Objective/Background:To investigate the association between skipping breakfast, alcohol consumption and physical inactivity with overweight and obesity in adolescents. The design comprises cross-sectional electronic health survey (E-MOVO).Subjects/Methods:Over 35 000 Dutch adolescents in grade 2 (13-14 years of age) and grade 4 (15-16 years of age) of secondary educational schools were recruited by seven community health services. Analyses were performed on 25 176 adolescents. Body mass index was calculated from self-reported body weight and height. Frequency of skipping breakfast per week, amount of alcoholic drinks consumed per occasion, and numbers of physical active days per week were considered as determinants for overweight and obesity.Results:In grade 2, adjusted odds ratios for the association with overweight were 2.17 (95% CI: 1.66-2.85) for skipping breakfast, 1.86 (1.36-2.55) for alcohol consumption and 1.73 (1.19-2.51) for physical inactivity. Statistically significant associations with overweight were also found in grade 4. In grade 2, dose-response relations (P for trend <0.05) were present between all risk factors and overweight. In a multivariate model containing all risk factors, breakfast skipping showed the strongest relation with overweight (OR 1.68, 95% CI 1.43-1.97 for grade 2, OR 1.32 95% CI 1.14-1.54 for grade 4) and obesity.Conclusions:Skipping breakfast, alcohol consumption and physical inactivity were associated with overweight in second and fourth grade adolescents. The associations were strongest for younger adolescents. The most important risk factor for overweight and obesity was skipping breakfast.European Journal of Clinical Nutrition advance online publication, 28 November 2007; doi:10.1038/sj.ejcn.1602950.

M. M. Davis, B. Gance-Cleveland, S. Hassink, R. Johnson, G. Paradis and K. Resnicow. (2007). Recommendations for prevention of childhood obesity. Pediatrics.

The majority of US youth are of healthy weight, but the majority of US adults are overweight or obese. Therefore, a major health challenge for most American children and adolescents is obesity prevention-today, and as they age into adulthood. In this report, we review the most recent evidence regarding many behavioral and practice interventions related to childhood obesity, and we present recommendations to health care providers. Because of the importance, we also suggest approaches that clinicians can use to encourage obesity prevention among children, including specific counseling strategies and practice-based, systems-level interventions. In addition, we suggest how clinicians may interact with and promote local and state policy initiatives designed to prevent obesity in their communities.

E. Desjardins and A. L. Schwartz. (2007). Collaborating to combat childhood obesity. Health Affairs (Millwood).

Despite outstanding advances in children's health over the past several decades, rates of childhood obesity are near epidemic proportions. This paper highlights foundations' efforts to fight childhood obesity by convening organizations and effecting change at many levels of the community.

D. B. Downey and H. R. Boughton. (2007). Childhood body mass index gain during the summer versus during the school year. New Dir Youth Dev.

The nationwide increase in obesity affects all population sectors, but the impact on children is of special concern because overweight children are prone to becoming overweight adults. Contrary to the opinion of experts, research suggests that schools may be more part of the solution than the problem. Recent seasonal comparison research (comparing children's outcomes during the summer and during school year) reports that children gain body mass index (BMI) nearly twice as fast during the summer as during the school year. Whereas most children experience healthier BMI gain during the school year than the summer, this is especially the case for black and Hispanic children and for children already overweight.

K. J. Duffey, P. Gordon-Larsen, D. R. Jacobs, Jr., O. D. Williams and B. M. Popkin. (2007). Differential associations of fast food and restaurant food consumption with 3-y change in body mass index: the Coronary Artery Risk Development in Young Adults Study. American journal of clincial nutrition.

BACKGROUND: Away-from-home food consumption has rapidly increased, though little is known about the independent associations of restaurant food and fast food intake with body mass index (BMI) and BMI change. OBJECTIVE: The aim was to compare the associations of restaurant food and fast food consumption with current and 3-y changes in BMI. DESIGN: Multivariate linear regression models, with control for demographic and lifestyle factors, were used to examine cross-sectional and longitudinal associations of away-from-home eating with BMI by using data from subjects of the Coronary Artery Risk Development in Young Adults Study (n = 3394) obtained at exam years 7 (1992-1993) and 10 (1995-1996). RESULTS: Forty percent of the sample increased their weekly consumption of restaurant or fast food, though mean (+/-SD) changes were -0.16 +/- 2.39 times/wk (P = 0.0001) and -0.56 +/- 3.04 times/wk (P < 0.0001), respectively. Cross-sectionally, fast food, but not restaurant food, consumption was positively associated with BMI. Similarly, higher consumption of fast food at year 7 was associated with a 0.16-unit higher BMI at year 10. After adjustment for baseline away-from-home eating, increased consumption of fast food only (beta: 0.20; 95% CI: 0.01, 0.39) and of both restaurant food and fast food (beta: 0.29; 95% CI: 0.06, 0.51) were positively associated with BMI change, though the estimates were not significantly different (P = 0.47). Increased consumption of restaurant food only was unrelated to BMI change (beta: -0.01; 95% CI: -0.21, 0.19), which differed significantly (P = 0.014) from the estimate for an increase in both restaurant food and fast food intake. CONCLUSIONS: We found differential effects of restaurant food and fast food intakes on BMI, although the observed differences were not always statistically significant. More research is needed to determine whether the differential effects are related to consumer characteristics or the food itself.

E. F. Durand, C. Logan and A. Carruth. (2007). Association of maternal obesity and childhood obesity: implications for healthcare providers. Journal of Community Health Nursing.

The purpose of this critical appraisal was to assess the available literature on the association of maternal obesity as a risk factor for childhood obesity and to explore the implications for incorporating this evidence into practice. The increasing prevalence of childhood obesity, with its documented adverse health effects, is a critical public health threat in the United States and worldwide. Research studies have documented increased rates of childhood obesity associated with maternal obesity. Healthcare providers are challenged to expand their competencies to recognize the association of maternal obesity and childhood obesity and to address both primary and secondary prevention of childhood obesity. Stopping the cycle of obesity before it becomes the leading cause of preventable disease and death in the United States is a priority for community health nurses.

J. C. Eisenmann, K. R. Laurson, E. E. Wickel, D. Gentile and D. Walsh. (2007). Utility of pedometer step recommendations for predicting overweight in children. International Journal of Obesity (London).

OBJECTIVE: The purpose of this study was to examine the utility of pedometer-based physical activity recommendations in predicting childhood adiposity. DESIGN: Subjects (n=608) (9.6 years) were from two Midwestern USA communities. Physical activity was assessed by a pedometer. The percentage of subjects meeting physical activity recommendations was determined using published recommendations. Overweight and obesity were determined based on reference values for the body mass index (BMI) developed by the International Obesity Task Force. An elevated waist circumference (WC) was determined based on age- and sex-specific reference values >75th percentile. RESULTS: Children who did not meet the pedometer recommendations were about two times more likely to be overweight/obese and have an elevated WC compared with those meeting recommendations. The BMI and WC were significantly different across pedometer step count groups in males and females. CONCLUSION: Subjects not meeting the recommendations for steps per day were more likely to be classified with the overweight phenotype than those meeting the recommendation. A dose-response relationship between pedometer steps per day and adiposity is also apparent.

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