Introduction to the Active Living Research Reference List 2007

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U. Ekelund, K. K. Ong, Y. Linne, M. Neovius, S. Brage, D. B. Dunger, N. J. Wareham and S. Rossner. (2007). Association of weight gain in infancy and early childhood with metabolic risk in young adults. The Journal of clinical endocrinology and metabolism.

CONTEXT: Early postnatal life has been suggested as an important window during which risks for long-term health may be influenced. OBJECTIVE: The aim of this study was to examine the independent associations between weight gain during infancy (0-6 months) and early childhood (3-6 yr) with components of the metabolic syndrome in young adults. DESIGN: This was a prospective cohort study (The Stockholm Weight Development Study). SETTING: The study was conducted in a general community. PARTICIPANTS: Subjects included 128 (54 males) singletons, followed from birth to 17 yr. MAIN OUTCOME MEASURE: None of these young adults met the full criteria for the metabolic syndrome. We therefore calculated a continuous clustered metabolic risk score by averaging the standardized values of the following components: waist circumference, blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, glucose, and insulin level. RESULTS: Clustered metabolic risk at age 17 yr was predicted by weight gain during infancy (standardized beta = 0.16; P < 0.0001) but not during early childhood (standardized beta = 0.10; P = 0.23), adjusted for birth weight, gestational age, current height, maternal fat mass, and socioeconomic status at age 17 yr. Further adjustment for current fat mass and weight gain during childhood did not alter the significant association between infancy weight gain with the metabolic risk score (standardized beta = 0.20; P = 0.007). CONCLUSIONS: Rapid weight gain during infancy (0-6 months) but not during early childhood (3-6 yr) predicted clustered metabolic risk at age 17 yr. Early interventions to moderate rapid weight gain even at very young ages may help to reduce adult cardiovascular disease risks.

D. W. Elizabeth and L. A. Baur. (2007). Adolescent obesity: making a difference to the epidemic. International Journal of Adolescent Medicine and Health.

Adolescent obesity is a major public health problem in Australia, and in many other parts of the world. Recent data suggest that as many as one quarter of young people in Australia are either overweight or obese, and that the majority of obese young people have one or more risk factors for chronic disease. Efforts to reduce the health and economic burden of obesity must focus on both management of affected individuals and prevention of further cases. This paper reviews some of the research currently underway in Australia, and includes recent data on both the prevalence of obesity and the associated complications, from large surveys and smaller cohorts. State and Federal governments have developed policies aimed at obesity prevention, but these are yet to be fully evaluated. Two large-scale community-based interventions are underway, one of which has reported positive preliminary findings. A number of smaller research programs are examining macro and individual level causation of obesity and include unique research examining the way adolescents perceive their environment. Other research includes the development and evaluation of service delivery models specifically targeting adolescents. A greater emphasis on environmental determinants and management of adolescent obesity is needed in future programs.

L. H. Epstein, R. A. Paluch, J. N. Roemmich and M. D. Beecher. (2007). Family-based obesity treatment, then and now: twenty-five years of pediatric obesity treatment. Health Psychology.

OBJECTIVE: Family-based treatments for pediatric obesity were developed over 25 years ago. Over that time, youth have become more obese and the environment more obesiogenic, which may influence efficacy of pediatric weight control. Mixed-effects regression models were used to compare the efficacy of programs initiated 20 to 25 years ago to current programs through 24-month follow-up, as well as to reanalyze 10-year outcomes of previous research using contemporary measures and analytic strategies. MAIN OUTCOME MEASURES: z-BMI and percent overweight. RESULTS: Results showed significant reductions over time, with no differences in z-BMI change for older versus contemporary studies. Age was a predictor of z-BMI up to 24 months, with younger children showing larger change. Mixed-effects regression models replicated previous long-term effects of family-based interventions. Gender was a predictor of long-term z-BMI change, with girls benefiting more over time than did boys. CONCLUSION: The efficacy of the family-based behavioral approach to treating pediatric obesity replicates over a 25-year period. Challenges in evaluating treatment effects over time are discussed. Ideas for studying choice of treatments that vary in effect size and for strengthening family-based behavioral treatments are noted.


E. A. Farmaki, M. Yannakoulia, I. Hatzopoulou, N. Vidra, M. Tzirkalli, E. Evaggelidaki, G. Kapravelou, C. Papoutsakis and G. Dedousis. (2007). Association between eating patterns, eating frequency and obesity in school-age children. International Journal Of Obesity.

V. Floriani and C. Kennedy. (2007). Promotion of physical activity in primary care for obesity treatment/prevention in children. Current Opinion in Pediatrics.

PURPOSE OF REVIEW: Physical activity has been highlighted internationally as a beneficial intervention for weight control and the improvement of physical and mental health. This review highlights findings from recent literature to guide office-based promotion of physical activity for obesity treatment and prevention. RECENT FINDINGS: Children worldwide participate in far less than the current physical activity recommendations. Family-based activity provides children with positive role modeling as well as motivational support for maintaining an active lifestyle. The integration of physical activity into daily life can be an effective alternative to sports and structured exercise programs. Decreasing sedentary behaviors is also a positive contribution, although its link to physical activity levels is still unclear. Some families may see neighborhood safety and access to recreational facilities as barriers to keeping their children physically active. SUMMARY: Research in the field of pediatric obesity and overweight treatment and prevention continues to find challenges and solutions. Promotion of physical activity by the pediatric provider is demonstrated by current evidence to be a positive intervention against this global problem.


M. J. Friedrich. (2007). Researchers address childhood obesity through community-based programs. Journal of the American Medical Association.

L. Gibbs, T. O'Connor, E. Waters, M. Booth, O. Walsh, J. Green, J. Bartlett and B. Swinburn. (2007). Addressing the potential adverse effects of school-based BMI assessments on children's wellbeing. International Journal of Pediatric Obesity.

Introduction. Do child obesity prevention research and intervention measures have the potential to generate adverse concerns about body image by focussing on food, physical activity and body weight? Research findings now demonstrate the emergence of body image concerns in children as young as 5 years. In the context of a large school-community-based child health promotion and obesity prevention study, we aimed to address the potential negative effects of height and weight measures on child wellbeing by developing and implementing an evidence-informed protocol to protect and prevent body image concerns. fun 'n healthy in Moreland! is a cluster randomised controlled trial of a child health promotion and obesity prevention intervention in 23 primary schools in an inner urban area of Melbourne, Australia. Body image considerations were incorporated into the study philosophies, aims, methods, staff training, language, data collection and reporting procedures of this study. This was informed by the published literature, professional body image expertise, pilot testing and implementation in the conduct of baseline data collection and the intervention. This study is the first record of a body image protection protocol being an integral part of the research processes of a child obesity prevention study. Whilst we are yet to measure its impact and outcome, we have developed and tested a protocol based on the evidence and with support from stakeholders in order to minimise the adverse impact of study processes on child body image concerns.

J. Gittelsohn and M. B. Kumar. (2007). Preventing childhood obesity and diabetes: is it time to move out of the school? Pediatric Diabetes.

Childhood obesity interventions in the USA and Europe have predominantly focused on the school environment for over two decades with mixed or modest success. The focus on school--while intuitive, apparently efficient, and convenient--does not address larger upstream environmental factors, which affect obesity among youth. In this article, we examine potential drawbacks and limitations of previous school-based obesity and diabetes prevention programs. The future of school-based obesity and diabetes interventions and potential strategies for improvement is explored. Increased use and reporting of diversified theoretical frameworks, formative research to inform the interventions, and process evaluations to improve programs are recommended. More importantly, addressing the broader issue of the overall food environment and its impact on children's diet with intensified involvement of key stakeholders, including families, supermarkets, and corner stores is essential. We discuss the development of healthy eating zones around schools as a potential tool in the fight to reduce childhood obesity.

B. C. Grant and S. Bassin. (2007). The challenge of paediatric obesity: more rhetoric than action. N Z Med J.

A growing body of knowledge clearly shows a rapid increase in the prevalence of childhood obesity. But in spite of the many empirically-driven research projects and more laissez-faire initiatives intent on finding ways to ensure the healthy development of our young people, translating what we know into appropriate behaviour in the home, school, and community is more difficult than it sounds. It is, therefore, not surprising this concern is attracting the attention of politicians, health professionals, and educators. This article reflects on the paediatric obesity research and argues for a more coordinated effort in addressing what could (but need not) become a major public health issue.

S. E. Hampl, C. A. Carroll, S. D. Simon and V. Sharma. (2007). Resource utilization and expenditures for overweight and obese children. Archives Of Pediatrics & Adolescent Medicine.

OBJECTIVES: To compare health care utilization and expenditures for healthy-weight patients, overweight patients, and patients with diagnosed and undiagnosed obesity and to examine factors associated with a diagnosis of obesity. DESIGN: Retrospective study using claims data from a large pediatric integrated delivery system. SETTING: An urban academic children's hospital. PARTICIPANTS: Children aged 5 to 18 years who presented to a primary care clinic for well-child care visits during the calendar years 2002 and 2003 and who were followed up for 12 months. MAIN OUTCOME MEASURES: Diagnosis of obesity, primary care visits, emergency department visits, laboratory use, and health care charges. RESULTS: Of 8404 patients, 57.9% were 10 years or older, 61.2% were African American, and 72.9% were insured by Medicaid. According to the criteria of body mass index (calculated as weight in kilograms divided by the square of height in meters), 17.8% were overweight and 21.9% were obese. Of the obese children, 42.9% had a diagnosis of obesity. Increased laboratory use was found in both children with diagnosed obesity (odds ratio [OR], 5.49; 95% confidence interval [CI], 4.65-6.48) and children with undiagnosed obesity (OR, 2.32; 95% CI, 1.97-2.74), relative to the healthy-weight group. Health care expenditures were significantly higher for children with diagnosed obesity (adjusted mean difference, $172; 95% CI, $138-$206) vs the healthy-weight group. Factors associated with the diagnosis of obesity were age 10 years and older (OR, 2.7; 95% CI, 2.0-3.4), female sex (OR, 1.5; 95% CI, 1.2-1.8), and having Medicaid (OR, 1.6; 95% CI, 1.1-2.3). CONCLUSIONS: Increased health care utilization and charges reported in obese adults are also present in obese children. Most children with obesity had not been diagnosed as having obesity in this administrative data set.

S. E. Hampson, J. A. Andrews, M. Peterson and S. C. Duncan. (2007). A cognitive-behavioral mechanism leading to adolescent obesity: children's social images and physical activity. Annals of behavioral medicine.

BACKGROUND: Increasing levels of youth obesity constitute a threat to the nation's health, and identification of the influences during childhood that lead to youth obesity is urgently needed. Physical activity is one such influence that is potentially modifiable. PURPOSE: This study examined the influence of children's social images of other children who engage in physical activity on the development of their own physical activity over 3 years and related growth in physical activity to levels of obesity 2 years later. METHODS: Participants (N = 846, 50% female) were members of the Oregon Youth Substance Use Project, a longitudinal study of a community sample. The racial/ethnic composition of the sample was 86% Caucasian; 7% Hispanic; 1% Black; and approximately 2% each of Asian/Pacific Islander, American Indian, or Alaskan Native, and other or mixed race/ethnicity. The mean age at the first assessment was 9.5 years. A model examining the effect of early social images on the growth of physical activity (athleticism modeled as a curve of factors) predicting obesity was evaluated using latent growth modeling. RESULTS: More favorable social images predicted the initial levels (i.e., intercept) but not the change over time (i.e., slope) of children's athleticism, and both the intercept and the slope of athleticism predicted obesity. CONCLUSIONS: Children's social images of exercise in early childhood influence their subsequent activity levels, and hence obesity, and should be targeted in obesity prevention interventions.

M. He and A. Evans. (2007). Are parents aware that their children are overweight or obese? Do they care? Canadian Family Physician.

OBJECTIVE: To compare children's actual weight status with their parents' perceptions of their weight status. DESIGN: Cross-sectional study, including a self-administered questionnaire. SETTING: Seven elementary schools in Middlesex-London, Ont. PARTICIPANTS: A convenience sample of pupils in grades 4 to 6 and their parents. Of the 770 child-parent pairs targeted, 355 pairs participated in the study. MAIN OUTCOME MEASURES: Children's weight, height, and body mass index (BMI). Parents' perceptions of their children's weight status, family demographics, and parents' self-reported body weight and height. The United States Centers for Disease Control's BMI-for-age references were used to define children's weight status (underweight, overweight, or obese). RESULTS: Response rate was 46%. Children's actual weight status (ie, 29.9% overweight or obese and 1.4% underweight) was different from their parents' perceptions of their weight status (ie, 18.3% overweight or obese and 17.2% slightly underweight or underweight). Factors such as children's sex and ethnicity and mothers' weight influenced parents' ability to recognize their children's weight status. Parents' misperceptions of their children's weight status seemed to be unrelated to their levels of education, their family income, or their children's ages. CONCLUSION: A large proportion of parents did not recognize that their children were overweight or obese. Effective public health strategies to increase parents' awareness of their children's weight status could be the first key steps in an effort to prevent childhood obesity.

A. P. Hills, N. A. King and T. P. Armstrong. (2007). The contribution of physical activity and sedentary behaviours to the growth and development of children and adolescents: implications for overweight and obesity. Sports Medicine.

The obesity epidemic is a global trend and is of particular concern in children. Recent reports have highlighted the severity of obesity in children by suggesting: "today's generation of children will be the first for over a century for whom life expectancy falls." This review assesses the evidence that identifies the important role of physical activity in the growth, development and physical health of young people, owing to its numerous physical and psychological health benefits. Key issues, such as "does a sedentary lifestyle automatically lead to obesity" and "are levels of physical activity in today's children less than physical activity levels in children from previous generations?" are also discussed.Today's environment enforces an inactive lifestyle that is likely to contribute to a positive energy balance and childhood obesity. Whether a child or adolescent, the evidence is conclusive that physical activity is conducive to a healthy lifestyle and prevention of disease. Habitual physical activity established during the early years may provide the greatest likelihood of impact on mortality and longevity. It is evident that environmental factors need to change if physical activity strategies are to have a significant impact on increasing habitual physical activity levels in children and adolescents. There is also a need for more evidence-based physical activity guidelines for children of all ages. Efforts should be concentrated on facilitating an active lifestyle for children in an attempt to put a stop to the increasing prevalence of obese children.

U. Holmback, J. Fridman, J. Gustafsson, L. Proos, C. Sundelin and A. Forslund. (2007). Overweight more prevalent among children than among adolescents. Acta Paediatrics.

AIMS: To study if there is a change in paediatric overweight/obesity prevalence from 1982 to 2002 in a population with a high proportion of post-graduate education. DESIGN: Two samples of children in Uppsala County, Sweden, were compared: children who were 4, 10 and 16 year old in 1982; or 4, 10 and 16 year old in 2002. Mean BMI (in the lowest 10%, middle 50% and highest 10%) and ISO-BMI ('age adjusted BMI') cut-off values were calculated in each age and gender group. RESULTS: Using the mean BMI or ISO-BMI cut-off values, the BMI-distribution shifted from 1982 to 2002. More 4- and 10-year-old girls and boys were overweight/obese, although this shift was larger in girls. No shift was seen in the 16-year-olds, only the middle 50% group in the 16-year-old girls had a slight increase of their mean BMI. In the 2002 4-year-old, and both 10-year-old samples, a higher proportion of the girls were overweight/obese compared to the boys, but no difference was seen in the 16-year-old sample. CONCLUSION: Young children, especially girls, have become much more overweight/obeSEuring the past 20 years, despite a high proportion of post-graduate education in the population. The lack of major change in 16-year-olds may suggest a rather recent change in the children's environment/lifestyle.

L. Humenikova and G. E. Gates. (2007). Dietary intakes, physical activity, and predictors of child obesity among 4-6th graders in the Czech Republic. Central European journal of public health.

The prevalence of child obesity in the Czech Republic has increased in the last several years, especially among school-aged children. While obesity trends are closely monitored in the Czech Republic, very little is known about the dietary habits and exercise behaviors of Czech children. The purpose of this study was to evaluate nutrient intakes and physical activity, as well as identify predictors of BMI-for-age in a sample of Czech school-aged children. Ninety-seven fourth, fifth and sixth graders and their parents from two large Czech cities participated in the study. Two 24-hour recalls provided total amount of energy, fat, percentage of energy derived from fat, dietary fiber, and servings of fruits and vegetables. Physical activity was measured by the Self-administered Physical Activity Checklist (SAPAC). Children consumed less energy and dietary fiber than suggested by Czech dietary recommendations. The proportion of energy that children consumed from fat was 28.5%. Children consumed 1.4 cups of fruit and 1.2 cups of vegetables. Children's physical activity levels fell within the current recommendations. Age was the only significant predictor of higher BMI-for-age. Poor dietary quality may be responsible for increasing rates of child obesity in the Czech Republic. Nutritional professionals in the Czech Republic should focus on increasing consumption of fruits, vegetables, and other high-fiber foods in order to reduce the risk for overweight among Czech children.

H. C. Kang, S. H. Jee, Y. C. Park and S. W. Lee. (2007). Factors influencing the weight percentile change between 1st grade and 6th grade of elementary school. International Journal Of Obesity.

R. I. Kosti, D. B. Panagiotakos, A. Zampelas, C. Mihas, A. Alevizos, C. Leonard, Y. Tountas and A. Mariolis. (2007). The association between consumption of breakfast cereals and BMI in schoolchildren aged 12-17 years: The VYRONAS study. Public Health Nutrition.

OBJECTIVE: To evaluate whether consumption of breakfast cereals is associated with BMI in a sample of Greek adolescents. DESIGN: A cross-sectional health and nutrition survey.Setting and subjectsDuring 2004-5, 2008 schoolchildren aged 12-17 years were selected from twelve schools located in Vyronas region (Athens metropolitan area). Height and weight were measured and BMI was calculated. A semi-quantitative FFQ was applied and multiple logistic regression analysis was used. RESULTS: Overall, 4.7 % of boys and 1.7 % of girls were obese, whereas 19.4 % of boys and 13.2 % of girls were overweight. Only 20.7 % of boys and 15.5 % of girls reported that they consume cereals as a first choice for breakfast. Consumption of breakfast cereals was associated with lower BMI in boys (P = 0.08) and girls (P = 0.019), irrespective of age and physical activity status. More prominent results were observed for daily cereal consumption or for more than two daily servings of cereals consumed for breakfast. Consumption of pre-sweetened breakfast cereals was associated with lower BMI compared with non-pre-sweetened or no intake of cereals, in both genders (P < 0.001). Consumption of breakfast cereals was associated with 33 % (95 % CI 14 %, 48 %) lower likelihood of overweight/obesity, irrespective of age, sex and physical activity status. CONCLUSIONS: Consumption of breakfast cereals was associated with lower BMI levels and a lower likelihood of overweight/obesity in both genders; thus a solid basis for public health professionals could be built when issuing advice on weight management.

T. L. LaRowe, S. M. Moeller and A. K. Adams. (2007). Beverage patterns, diet quality, and body mass index of US preschool and school-aged children. Journal Of The American Dietetic Association.

Objective To evaluate diet quality and body mass index (BMI) by beverage patterns in children aged 2 to 11 years. Design Beverage patterns were formed using 24-hour dietary recall diet variables from the 2001-2002 National Health and Nutrition Examination Survey. Diet quality was assessed using energy, micronutrient intakes, and Healthy Eating Index (HEI) scores (a 100-point scale that measures adherence to the Dietary Guidelines for Americans). Subjects/setting Children, aged 2 to 5 years (n=541) and 6 to 11 years (n=793), were selected from 2001-2002 National Health and Nutrition Examination Survey data. Statistical analysis Cluster analysis was used to identify beverage patterns in preschool and school-aged children. General linear models were used to compare HEI scores, energy, micronutrient intakes, and BMI across beverage clusters. Results Four and five beverage clusters were identified for preschool and school-aged children, respectively. In preschool children, mean HEI differed between the fruit juice cluster (79.0) vs the high-fat milk cluster (70.9, P<0.01); however, both fruit juice and high-fat milk clusters had the highest micronutrient intakes. Mean HEI differed significantly across beverage patterns for school-aged children (from 63.2 to 69.9, P<0.01), with the high-fat milk cluster having the best diet quality, reflected by HEI and micronutrient intakes. Adjusted mean BMI differed significantly across beverage clusters only in school-aged children (from 17.8 to 19.9, P<0.05). Conclusions Beverage patterns were related to diet quality among preschool and school-aged children, but were only related to BMI in school-aged children. Children from all clusters could benefit by consuming fewer calorically sweetened beverages and increasing micronutrient-dense foods.




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