Introduction to the Active Living Research Reference List 2007


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L. Roblin. (2007). Childhood obesity: food, nutrient, and eating-habit trends and influences. Applied Physiology Nutrition And Metabolism-Physiologie Appliquee Nutrition Et Metabolisme.

The need has never been greater to support healthy eating and physical activity in children and youth; the numbers of overweight and obese children have doubled and tripled, respectively, over the past 3 decades. Poor eating habits, including inadequate intake of vegetables, fruit, and milk, and eating too many high-calorie snacks, play a role in childhood obesity. Grain products provide the highest percentage (31%) of daily calories, followed by "other foods," which have limited nutritional value (22% of daily calories). Snacks account for 27% of total daily calories, which is more than the calories consumed at breakfast (18%) and lunch (24%), but not dinner (31%). For Canadians older than 4 years of age, more than 41% of daily snack calories come from other foods, such as chips, chocolate bars, soft drinks, fruit drinks, sugars, syrup, preserves, fats, and oils. Habits that protect against childhood obesity include eating more vegetables and fruit, eating meals with family, and being physically active. Children's food habits and choices are influenced by family, caregivers, friends, schools, marketing, and the media. Successful interventions for preventing childhood obesity combine family- and school-based programs, nutrition education, dietary change, physical activity, family participation, and counseling.

J. J. Sabia. (2007). The effect of body weight on adolescent academic performance. Southern Economic Journal.

A recent study by Cawley found consistent evidence of a negative relationship between body weight and wages for white women, even after controlling for fixed individual-level unobserved heterogeneity and reverse causality. Building on this work, I estimate the relationship between adolescent body weight and academic achievement to examine whether early human capital accumulation is adversely affected by obesity. Using data from the National Longitudinal Study of Adolescent Health, I estimate ordinary least squares, instrumental variables, and individual fixed effects models. The pattern of findings across models suggests consistent evidence of a significant negative relationship between body mass index and grade point average (GPA) for white females aged 14-17. Estimates reflect that a difference in weight of 50 to 60 pounds (approximately two standard deviations) is associated with an 8 to 10 percentile difference in standing in the GPA distribution. For nonwhite females and males, there is less convincing evidence of a causal link between body weight and academic performance after controlling for unobserved heterogeneity.

M. A. Sabin, A. Ford, L. Hunt, R. Jamal, E. C. Crowne and J. P. Shield. (2007). Which factors are associated with a successful outcome in a weight management programme for obese children? Journal of Evaluation of Clinical Practice.

AIMS AND OBJECTIVE: To identify factors important in determining whether an obese child achieves significant reductions in Body Mass Index Standard Deviation Score (BMI SDS) within a UK, hospital-based paediatric obesity service aimed at lifestyle modification. DESIGN: Observational Study. SUBJECTS: 137 obese children (63 boys) who have attended our childhood obesity service within the last three and a half years at The Royal Hospital for Children, Bristol, UK. MEASUREMENTS: BMI SDS with a target reduction of - 0.5 or greater. RESULTS: 70% of children achieved reductions in BMI SDS with 18% achieving the target reduction. In those attending the clinic for a year or more the levels improved to 83% and 28% respectively. Age was found to be the most important predictor with younger children achieving larger reductions in BMI SDS. More boys than girls were likely to achieve target reductions in BMI SDS and those without a parental history of obesity were more likely to achieve greater reductions in BMI SDS. Socio-economic status did not appear to impact upon the child's level of success. CONCLUSIONS: In families of obese children, motivated to seek help by attending a hospital-based weight control clinic, improvements in BMI are possible by a simple approach of education and continued support. Improvement is greatest in younger children with maximal benefit being seen in boys without a parental history of obesity. We believe this emphasizes the importance of identifying significant obesity in primary school aged children, who seem most likely to benefit from simple lifestyle modification, while many older children may require additional intervention programmes to improve BMI.

K. L. Saunders. (2007). Preventing obesity in pre-school children: a literature review. Journal Of Public Health.

Obesity in children is increasing worldwide, impacting on both long- and short-term health. Obesity prevention is an important contemporary public health priority and is firmly on the Government's agenda in the UK. Prevention involves addressing the main risk factors of diet and physical inactivity and also involves a wide range of environmental factors including access to sport and leisure, family life, diet, education and information. A literature review undertaken on preventing obesity in children aged < 5. The review confirms that there is a limited and immature evidence and lack of comprehensive evidence on effective strategies to prevent obesity in younger children. The overall quality of studies is poor. The need remains for structured, focused and systematic research on child obesity prevention. Well-designed studies examining a range of interventions remain a priority. The findings in this review support the recommendations in the National Institute for Health and Clinical Excellence (NICE) guidelines on obesity.

M. B. Schwartz and K. D. Brownell. (2007). Actions necessary to prevent childhood obesity: creating the climate for change. Journal of Law, Medicine & Ethics.

Childhood obesity has become a public health epidemic, and currently a battle exists over how to frame and address this problem. This paper explores how public policy approaches can be employed to address obesity. We present the argument that obesity should be viewed as the consequence of a "toxic environment" rather than the result of the population failing to take enough "personal responsibility." In order to make progress in decreasing the prevalence of obesity, we must shift our view of obesity away from the medical model (which focuses on the individual) to a public health model (which focuses on the population). At the same time, we must be sensitive to the problem of weight bias. Potential obstacles to taking a public policy approach are identified, as well as suggestions on how to overcome them.

B. Sherry, M. E. Jefferds and L. M. Grummer-Strawn. (2007). Accuracy of adolescent self-report of height and weight in assessing overweight status: a literature review. Archives Of Pediatrics & Adolescent Medicine.

OBJECTIVE: To examine the accuracy of self-reported height and weight data to classify adolescent overweight status. Self-reported height and weight are commonly used with minimal consideration of accuracy. DATA SOURCES: Eleven studies (4 nationally representative, 7 convenience sample or locally based). STUDY SELECTION: Peer-reviewed articles of studies conducted in the United States that compared self-reported and directly measured height, weight, and/or body mass index data to classify overweight among adolescents. MAIN EXPOSURES: Self-reported and directly measured height and weight. MAIN OUTCOME MEASURES: Overweight prevalence; missing data, bias, and accuracy. RESULTS: Studies varied in examination of bias. Sensitivity of self-reported data for classification of overweight ranged from 55% to 76% (4 of 4 studies). Overweight prevalence was -0.4% to -17.7% lower when body mass index was based on self-reported data vs directly measured data (5 of 5 studies). Females underestimated weight more than males (ranges, -4.0 to -1.0 kg vs -2.6 to 1.5 kg, respectively) (9 of 9 studies); overweight individuals underestimated weight more than nonoverweight individuals (6 of 6 studies). Missing self-reported data ranged from 0% to 23% (9 of 9 studies). There was inadequate information on bias by age and race/ethnicity. CONCLUSIONS: Self-reported data are valuable if the only source of data. However, self-reported data underestimate overweight prevalence and there is bias by sex and weight status. Lower sensitivities of self-reported data indicate that one-fourth to one-half of those overweight would be missed. Other potential biases in self-reported data, such as across subgroups, need further clarification. The feasibility of collecting directly measured height and weight data on a state/community level should be explored becauSEirectly measured data are more accurate.

A. Simmons, L. Mathews and B. Swinburn. (2007). Community capacity building for obesity prevention using a 'Student Ambassador' model. International Journal Of Obesity.
J. A. Snethen, J. B. Hewitt and D. H. Petering. (2007). Addressing childhood overweight: Strategies learned from one Latino community. Journal Of Transcultural Nursing.

The purpose of this study is to understand one Latino community's perspectives about childhood overweight within this high-risk ethnic group. Three focus groups, consisting of 12 mothers, 12 fathers, and 8 boys and 4 girls ages 10-12, participated. Transcripts of interviews were coded using N-VIVO and analyzed thematically. Several themes emerge: parents' demanding work schedules, lack of time, transportation issues, opportunities for physical activities, and lack of meal preparation. Participants knew good nutrition and exercise help prevent obesity. Nursing interventions must address multiple challenges with childhood obesity at the family and community levels.

K. Steinbeck. (2007). Adolescent overweight and obesity--how best to manage in the general practice setting. Australian Family Physician.

BACKGROUND: The prevalence of overweight and obesity continues to increase in adolescents. Community level management is necessary as specialist services are limited. OBJECTIVE: This article outlines a management plan for the overweight adolescent in general practice, using a chronic care approach and follows the National Health and Medical Research Council Clinical practice guidelines for the management of overweight and obesity in children and adolescents. DISCUSSION: Overweight and obesity will not resolve spontaneously at puberty, and active intervention is required both to improve current health and wellbeing and to reduce the risks of premature morbidity and mortality in adult life. Modest, cumulative changes to lifestyle together with modest weight loss goals to reduce the risk of weight rebound are important. Any intervention has to take account of the rapid cognitive and behavioural changes of adolescence.

H. Stritecka and P. Hlubik. (2007). Prevalence of overweight and obesity school children. International Journal Of Obesity.
H. N. Sweeting. (2007). Measurement and definitions of obesity in childhood and adolescence: a field guide for the uninitiated. Nutrition Journal.

This paper aims to guide readers embarking on the complex literature in respect of childhood and adolescent obesity. It opens with a discussion of definitions of 'obesity' based on overall fat levels and the significance of fat distribution. This is followed by simple descriptions of the various techniques used to measure fat, including density-based, scanning, bioelectrical impedance and anthropometric methods. The paper then turns to 'overweight' and the measurement of weight in relation to height, particularly via body mass index (BMI). While it is a relatively simple measure and a valuable tool, BMI has several disadvantages, which are described. These include a lack of consensus on which values should be used to define 'overweight' or 'obese', with the result that the literature contains a confusing multiplicity of child and adolescent obesity rates.

B. Swinburn, C. Bell, L. King, A. Magarey, K. O'Brien and E. Waters. (2007). Obesity prevention programs demand high-quality evaluations. Australia and New Zealand Journal of Public Health.

Obesity prevention programs are at last underway or being planned in Australia and New Zealand. However, it is imperative that they are well-evaluated so that they can contribute to continuous program improvement and add much-needed evidence to the international literature on what works and does not work to prevent obesity. Three critical components of program evaluation are especially at risk when the funding comes from service delivery rather than research sources. These are: the need for comparison groups; the need for measured height and weight; and the need for sufficient process and context information. There is an important opportunity to build collaborative mechanisms across community-based obesity prevention sites to enhance the program and evaluation quality and to accelerate knowledge translation into practice and policy.

S. J. te Velde, I. De Bourdeaudhuij, I. Thorsdottir, M. Rasmussen, M. Hagstromer, K. I. Klepp and J. Brug. (2007). Patterns in sedentary and exercise behaviors and associations with overweight in 9-14-year-old boys and girls - a cross-sectional study. Bmc Public Health.

Background: Before starting interventions addressing energy-balance related behaviors, knowledge is needed about the prevalence of sedentary behaviors and low physical exercise, their interrelationships, possible gender differences. Therefore this study aimed to describe gender differences in sedentary and physical exercise behaviors and their association with overweight status in children from nine European countries. Additionally, to identify clusters of children sharing the same pattern regarding sedentary and physical exercise behavior and compare these groups regarding overweight status. Methods: Cross-sectional study among 11-year-old children in nine countries (n = 12538). Self-administered questionnaires assessed the time spent on TV viewing during dinner and during the day, PC use and on physical exercise. The parents reported children's weight and height. Descriptive statistics, cluster analyses, and logistic regression analyses were used for data analyses. Results: Boys spent more time on sedentary behaviors but also more on physical exercise than girls. High TV viewing and low exercise behavior independently increased the risk of being overweight. Based on the behaviors, five clusters were identified. Among boys, clear associations with being overweight were found, with the most unhealthy behavior pattern having the highest risks of being overweight. Among girls, high TV viewers and high PC users had increased risk of being overweight. In girls sedentary behaviors seemed more important than physical exercise with regard to overweight status. Conclusion: Despite selective non-response on BMI and reliance on self-reports, the associations between clusters and overweight in boys were clear, and differences between boys and girls regarding the behaviors and risks for overweight are noteworthy. TheSEifferences need to be considered when developing tailored intervention strategies for prevention of overweight.

J. Utter, R. Scragg, D. Schaaf, E. Fitzgerald and N. Wilson. (2007). Correlates of body mass index among a nationally representative sample of New Zealand children. International Journal of Pediatric Obesity.

OBJECTIVES: To describe how nutrition behaviours and physical activity are associated with body mass index (BMI) among New Zealand children and to determine if these relationships vary by ethnicity. METHODS: Data were collected during the 2002 National Children's Nutrition Survey. 3250 children provided information about their eating and activity behaviours and anthropometric measurements. RESULTS: Approximately 31% of New Zealand children aged 5 to 14 years were overweight/obese, with the highest prevalences of overweight/obesity among Pacific children (62%) and Maori children (41%). Higher prevalences of obesity were also observed among females and children experiencing socioeconomic deprivation. Television use, buying school food from the dairy/takeaway shops, skipping breakfast, consumption of fruit drinks/soft drinks, and low physical activity were associated with BMI in analyses controlling for demographic characteristics among the total population. Buying school food from the dairy/takeaway (p=0.04) and skipping breakfast (p=0.007) retained significance when all nutrition behaviours and physical activity were analysed simultaneously. Significant interactions between ethnicity and bringing school food from home and buying school food from school were observed in relation to BMI. In most cases, the relationships were most significant for Pacific children. CONCLUSIONS: Strategies to address childhood obesity among all New Zealand children should primarily include efforts to increase breakfast consumption and decrease food purchases away from home. Given the high rates of obesity between Pacific and Maori children, targeted interventions are warranted and should include strategies to improve the school food environment.

L. C. Villard, L. Ryden and A. Stahle. (2007). Predictors of healthy behaviours in Swedish school children. European Journal of Cardiovascular Prevention and Rehabilitation.

AIM: To evaluate the impact of predictors of adopting a healthy lifestyle in Swedish schoolchildren. METHODS: A sample of 1409 Swedish schoolchildren (mean age 12.5 years) representative of different socio-economic and geographical living areas participated in a questionnaire-based survey on healthy habits and knowledge of healthy behaviour. A logistic regression analysis was performed to identify intrapersonal, social and environmental predictors of healthy habits. RESULTS: A normal body mass index (intrapersonal determinant) was connected to refraining from tobacco (P<0.05). For children to perceive family (P<0.001), themselves (P<0.001), or someone else (P<0.01) as a source of inspiration (social determinant) to be physically active was related to a high physical activity level. Paternal (P=0.01) and maternal (P<0.001) attention to the use of tobacco (social determinant) was of importance for children to refrain from such habits. To live in a socio-economically wealthy area (environmental determinant) was of importance for healthy food choices (P<0.01) and physical activity (P<0.05). Children from rural (P<0.01) areas (environmental determinant) were more physically active than children from urban areas. CONCLUSION: Social aspects such as parental support for physical activity and refraining from tobacco were found to be important for healthy behaviours. Moreover, environmental factors such as socio-economic and geographical living area favourably influenced food choices and physical activity. Parental attitudes and economy are therefore important for physical activity, healthy food choices and refraining from tobacco in children. Consequently, future interventions need to address the psychological and environmental influences of the home environment through the active involvement of parents, even in school-based interventions.

P. T. von Hippel, B. Powell, D. B. Downey and N. J. Rowland. (2007). The effect of school on overweight in childhood: gain in body mass index during the school year and during summer vacation. American Journal of Public Health.

OBJECTIVES: To determine whether school or nonschool environments contribute more to childhood overweight, we compared children's gains in body mass index (BMI) when school is in session (during the kindergarten and first-grade school years) with their gains in BMI when school is out (during summer vacation). METHODS: The BMIs of 5380 children in 310 schools were measured as part of the Early Childhood Longitudinal Study, Kindergarten Cohort. We used these measurements to estimate BMI gain rates during kindergarten, summer, and first grade. RESULTS: Growth in BMI was typically faster and more variable during summer vacation than during the kindergarten and first-grade school years. The difference between school and summer gain rates was especially large for 3 at-risk subgroups: Black children, Hispanic children, and children who were already overweight at the beginning of kindergarten. CONCLUSIONS: Although a school's diet and exercise policies may be less than ideal, it appears that early school environments contribute less to overweight than do nonschool environments.

M. Westwood, D. Fayter, S. Hartley, A. Rithalia, G. Butler, P. Glasziou, M. Bland, J. Nixon, L. Stirk and M. Rudolf. (2007). Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence. Archives of disease in childhood.

BACKGROUND: Population monitoring has been introduced in UK primary schools in an effort to track the growing obesity epidemic. It has been argued that parents should be informed of their child's results, but is there evidence that moving from monitoring to screening would be effective? We describe what is known about the effectiveness of monitoring and screening for overweight and obesity in primary school children and highlight areas where evidence is lacking and research should be prioritised. DESIGN: Systematic review with discussion of evidence gaps and future research. DATA SOURCES: Published and unpublished studies (any language) from electronic databases (inception to July 2005), clinical experts, Primary Care Trusts and Strategic Health Authorities, and reference lists of retrieved studies. REVIEW METHODS: We included any study that evaluated measures of overweight and obesity as part of a population-level assessment and excluded studies whose primary outcome measure was prevalence. RESULTS: There were no trials assessing the effectiveness of monitoring or screening for overweight and obesity. Studies focussed on the diagnostic accuracy of measurements. Information on the attitudes of children, parents and health professionals to monitoring was extremely sparse. CONCLUSIONS: Our review found a lack of data on the potential impact of population monitoring or screening for obesity and more research is indicated. Identification of effective weight reduction strategies for children and clarification of the role of preventative measures are priorities. It is difficult to see how screening to identify individual children can be justified without effective interventions.

L. F. Wilson. (2007). Adolescents' attitudes about obesity and what they want in obesity prevention programs. The Journal of School Nursing.

Obesity is a major pediatric public health problem. Adolescents are a priority population for intervention strategies. School nurses are in key positions to design intervention strategies to promote healthy lifestyles and prevent adolescent obesity in the students they serve. To design effective programs, school nurses need to know what components their students perceive as important. This study involved the development and administration of a questionnaire to middle school students to determine their attitudes about overweight/obesity and what they felt would work for them. Adolescents are willing to exercise more, to change eating habits to include more fruits and vegetables, drink more water, and eat less junk food. They are not willing to give up soda, video/computer games, and watching television to improve their health. School nurses can use this questionnaire to collect data that will assist in the development of effective programs for their students.

F. Xu, J. Li, R. S. Ware and N. Owen. (2007). Associations of television viewing time with excess body weight among urban and rural high-school students in regional mainland China. Public Health Nutrition.

OBJECTIVE: To examine the relationship between television (TV) viewing and body mass index (BMI) among adolescents in a region of mainland China. DESIGN: Population-based cross-sectional study, conducted between September and November of 2004, on a sample of enrolled high-school students aged 12-18 years. SETTING: One hundred and sixty-eight classes randomly selected from both urban and rural areas and belonging to 15 senior and 41 junior high schools in Nanjing, China, with a regional population of 6.0 million. SUBJECTS: In total 6848 students participated; 47.7 % from urban and 52.3 % from rural areas; 49.0 % male and 51.0 % female. The response rate among eligible participants was 89.3 %. RESULTS: The proportion of overweight was 6.6 % according to the criteria of overweight recommended for Chinese adolescents. Boys than girls (8.9 % vs. 4.4 %) had higher odds of being overweight (odds ratio (OR) 2.12, 95 % confidence interval (CI) 1.74, 2.60), while the proportion of overweight was significantly lower among rural students than urban students (4.5 % vs. 8.9 %; OR 0.49, 95 % CI 0.40, 0.60). Those students who watched TV for more than 7 h/week had a 1.5 times greater odds of being overweight relative to their counterparts who watched TV for 7 h/week or less (adjusted OR 1.51, 95 % CI 1.24, 1.82). Furthermore, there was a positive linear relationship between TV viewing time and BMI, even after adjusting for age, gender, residence area, time spent in study, in sleeping and in physical activity, and monthly pocket money. CONCLUSIONS: Viewing TV might increase the likelihood of being overweight for Chinese adolescents in China.

R. Mendelson. (2007). Think tank on school-aged children: nutrition and physical activity to prevent the rise in obesity. Applied Physiology Nutrition And Metabolism-Physiologie Appliquee Nutrition Et Metabolisme.

The rise in childhood obesity has generated concern across a range of sectors. Stakeholders and experts in the area of children's health met at a Think Tank in Toronto organized by the Canadian Council for Food and Nutrition and the Program in Food Safety, Nutrition, and Regulatory Affairs at the University of Toronto to discuss the current evidence in place to inform the development of school policies to reduce childhood obesity. Although there is some evidence to suggest that school interventions may reduce obesity in children, there are other examples of programs that have had very little impact. The role of parents in the development of healthy eating and physical activity patterns is critical from the earliest stages of life and warrants further attention. Delegates agreed that we need ongoing input of experts and leaders from all sectors and fields to help us to effectively promote healthy lifestyles at schools and within the home, while respecting each child's need for safety, security, and respect.

B. W. Timmons, P. J. Naylor and K. A. Pfeiffer. (2007). Physical activity for preschool children--how much and how? Canadian Journal of Public Health.

Alarming trends in childhood obesity even among preschool children have re-focused attention on the importance of physical activity in this age group. With this increased attention comes the need to identify the amount and type of physical activity appropriate for optimal development of preschool children. The purpose of this paper is to provide the scientific evidence to support a link between physical activity and biological and psychosocial development during early childhood (ages 2-5 years). To do so, we summarize pertinent literature informing the nature of the physical activity required to promote healthy physical, cognitive, emotional, and social development during these early years. A particular focus is on the interaction between physical activity and motor skill acquisition. Special emphasis is also placed on the nature of physical activity that promotes healthy weight gain during this period of childhood. The paper also discusses the strongest determinants of physical activity in preschool-age children, including the role of the child's environment (e.g., family, child-care, and socio-economic status). We provide recommendations for physical activity based on the best available evidence, and identify future research needs.

D. M. Klohe-Lehman, J. Freeland-Graves, K. K. Clarke, G. Cai, V. S. Voruganti, T. J. Milani, H. J. Nuss, J. M. Proffitt and T. M. Bohman. (2007). Low-income, overweight and obese mothers as agents of change to improve food choices, fat habits, and physical activity in their 1-to-3-year-old children. Journal of the American College of Nutrition.

OBJECTIVE: To examine the effects of a weight loss program for mothers on the diet and activity of mothers and their 1-3 year old children. DESIGN: Overweight and obese mothers participated in an 8-week weight loss intervention encompassing diet, physical activity, and behavioral modification. Anthropometrics, demographic, dietary, and physical activity questionnaires were administered at weeks 0 and 8; anthropometrics were re-evaluated at week 24. SUBJECTS: Mothers (N=91) of a 1-3 year old child; body mass index (BMI) >or= 25 kg/m2; non-breastfeeding; age 18-45 years; income < 200% of federal poverty index; Hispanic, African American, or white; and English-speaking were recruited from Special Supplemental Program for Women Infants and Children (WIC) and public health clinics. INTERVENTION MEASURES OF OUTCOME: Weight loss in mothers and improvements in diet (reduction in calories, fat, snacks/desserts, sweetened beverages, and increases in fruit, vegetables) and activity in mothers and children. RESULTS: Weight loss in mothers was modest (-2.7 kg, p < 0.001) and sustained at week 24 (-2.8 kg, p < 0.001), and children gained in height and weight as expected for normal growth (p < 0.001). Initial energy intakes of children exceeded Estimated Energy Requirements (123%) and were reduced to acceptable levels post-intervention (102%, p < 0.001); additional beneficial changes in children's diets were decreased total (47.7 to 39.9 g/day) and saturated fat (19.2 to 16.6 g/day), high-fat snacks/desserts (1.6 to 0.9 servings/day), added fats (81.8 to 40.9% using), sweetened beverages (0.8 to 0.4 servings/day), and fast food consumption (11.6 to 6.6% of meals), and increased home-prepared meals (63.2 to 71.6% of meals) (p < 0.01 for all). Physical activity scores improved by 7% in children (p < 0.05). Comparable changes in food choices and activity also were seen in mothers. CONCLUSION: Offering weight loss classes was a successful method of enticing low-income women to participate in an educational intervention that benefited their children. Overweight and obese mothers who modified their food choices and fat habits made comparable changes for their child.

An Active Living program supported by The Robert Wood Johnson Foundation and administered by San Diego State University.

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