Introduction to the Active Living Research Reference List January – July 2008

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R. J. Ferreira and P. M. Marques-Vidal. (2008). Prevalence and determinants of obesity in children in public schools of Sintra, Portugal. Obesity (Silver Spring). 16, 497-500.

OBJECTIVE: To assess the prevalence of and the factors related to overweight and obesity in a sample of children from the region of Sintra, Portugal. METHODS AND PROCEDURES: Cross-sectional study, stratified for freguesia with random selection of schools. Height, weight, triceps skinfold, upper arm and waist circumferences were measured, and overweight/obesity defined according to international criteria. Breast-feeding, number of daily meals and parents' height and weight data were also collected. RESULTS: One thousand two hundred and twenty-five children aged 6-10 years were assessed. Overall prevalence of overweight and obesity was 35.6% (23% overweight and 12.6% obesity). Overweight or obese children had higher triceps skinfold, upper arm circumference, arm muscle area, and waist circumference than their normal weight counterparts (P < 0.001). On multivariate analysis, relatively to a child without obese progenitors, a child with one obese progenitor had an obesity risk multiplied by 2.78 (95% confidence interval (CI): 1.76-4.38), while a child with two obese progenitors had a risk multiplied by 6.47 (95% CI: 5.59-16.19). Conversely, being picky was significantly related with a smaller risk of obesity: for boys, odds ratio (OR) = 0.15 (95% CI: 0.04-0.63); for girls, OR = 0.19 (95% CI: 0.06-0.64). Finally, no relationships were found between obesity, birth weight, birth height or breast-feeding. DISCUSSION: Prevalence of overweight and obesity are elevated among children of the Sintra region in Portugal compared to most other regions of Europe. The relationship with the parents' nutritional state stresses the need to target families for preventing obesity.

V. Floriani and C. Kennedy. (2008). Promotion of physical activity in children. Curr Opin Pediatr. 20, 90-5.

PURPOSE OF REVIEW: Promotion of physical activity continues to be recommended as an essential component of obesity treatment and prevention interventions. This review explores recent updates in the area of physical activity promotion and its impact on the physical and mental health consequences of childhood obesity. RECENT FINDINGS: Despite the availability of opportunities for physical activity in the school environment, namely recess and physical education classes, students do not appear to be meeting activity recommendations at school alone. Access to neighborhood parks may increase levels of physical activity and reduce time spent in sedentary behaviors at home. Less time spent watching television and in other sedentary behaviors such as playing videogames may contribute to higher rates of physical activity. Frequency of physical activity also appears to be related to improved mental health status, although the direction of this relationship warrants further exploration. SUMMARY: Physical activity is an evidence-based intervention that offers benefits to both physical and mental health. Pediatric health care providers are encouraged to engage in discussions with patients and families on the topic of physical activity and to assist them in finding ways to incorporate activity into daily life.

D. Fussenegger, A. Pietrobelli and K. Widhalm. (2008). Childhood obesity: political developments in Europe and related perspectives for future action on prevention. Obesity Reviews. 9, 76-82.

The dramatically increasing prevalence of obesity, especially among children, has become a major public health problem in Europe. In reaction to this alarming trend, a series of initiatives and actions has been launched in recent years. As the potential impact of these activities is widely unknown so far, we underline the need for adequate evaluation of these measures. The aim of this paper is to report the latest developments in the fight against obesity at different political levels across Europe, with special attention to the major results of the recent World Health Organization European Ministerial Conference on Counteracting Obesity. In accordance with the main principles of the European Charter on Counteracting Obesity adopted at the meeting, immediate action should be taken now by implementing the few available schemes with proven effectiveness. Finally, given the lack of appropriate evaluation, we consider it particularly important to establish national research centres to collect country-specific data that are to be evaluated together by a central European administration department. Based on the results of such a comprehensive data pool, concrete strategies could be developed for future policy building.

P. S. Gaskin, H. Broome, C. Alert and H. Fraser. (2008). Misperceptions, inactivity and maternal factors may drive obesity among Barbadian adolescents. Public Health Nutr. 11, 41-8.

OBJECTIVES: To describe (1) the prevalence of overweight and obesity and their association with physical activity; (2) the effect of different cut-off points for body mass index (BMI) on weight status categorisation; and (3) associations of weight status with perceptions of body size, health and diet quality. DESIGN: A cross-sectional study. SETTING: Secondary schools in Barbados. SUBJECTS: A cohort of 400 schoolchildren, 11-16 years old, selected to study physical education practices. RESULTS: Prevalence of overweight (15% boys; 17% girls) and obesity (7% boys; 12% girls) was high. Maternal obesity, as defined by the International Obesity Task Force (IOTF) BMI cut-off points, predicted weight status such that reporting an obese mother increased the odds of being overweight by 5.25 (95% confidence interval: 2.44, 11.31). Physical activity was inversely associated with weight status; however levels were low. Recreational physical activity was not associated with weight status in either category. Overweight subjects tended to misclassify themselves as normal weight and those who misclassified perceived themselves to be of similar health status to normal-weight subjects. The National Center for Health Statistics and IOTF BMI cut-off points produced different estimates of overweight and obesity. CONCLUSIONS: Our findings suggest that inadequate physical activity and ignorance related to food and appropriate body size are promoting high levels of adiposity with a strong contribution from maternal obesity, which may be explained by perinatal and other intergenerational effects acting on both sexes. Prevalence studies and local proxy tools for adiposity assessment are needed.

G. S. Goldfield, R. Mallory, D. Prud'homme and K. B. Adamo. (2008). Gender Differences in Response to a Physical Activity Intervention in Overweight and Obese Children. Journal of Physical Activity & Health. 5, 592.

Background: This study evaluated the effects of gender on response to a behavioral intervention that rewarded increases in physical activity (PA) with increases in access to TV viewing. Methods: We performed a secondary analysis of a clinical trial that randomized 30 overweight or obese, 8- to 12-year-old children to an intervention (8 boys, 6 girls) or control (7 boys, 9 girls) group. Participants wore accelerometers every day for 8 weeks and attended biweekly meetings to download the activity monitors. For the intervention group, accumulating 400 counts of PA on accelerometers earned 1 hour of TV time, which was controlled by a Token TV electronic device. Controls wore activity monitors but had free access to TV. Results: Compared with girls, boys in the intervention group exhibited greater increases in overall daily PA counts (110% versus 40%, P <.05) and minutes per day of moderate-to-vigorous physical activity (MVPA; +18.1 versus +2.7, P <.05). Neither boys nor girls in the control group showed significant changes in overall PA or intensity of PA. Conclusion: Wearing an accelerometer in combination with rewarding PA with TV might be a more effective intervention for increasing overall PA and time spent in MVPA in overweight and obese boys than it is for overweight or obese girls.

C. Gundersen, B. J. Lohman, J. C. Eisenmann, S. Garasky and S. D. Stewart. (2008). Child-specific food insecurity and overweight are not associated in a sample of 10- to 15-year-old low-income youth. J Nutr. 138, 371-8.

In the United States, 17% of children and adolescents are overweight and 20% live in a food insecure household. Previous studies examining the association between household food insecurity and overweight among children have been inconclusive but are limited insofar as they did not assess child-specific measures of food insecurity and overweight. In response, this study examined the association between food insecurity and child overweight status when these variables were measured for the same child using information on children (n = 1031) aged 10-15 y from the Three-City Study. Approximately 8% of the children were food insecure, whereas 50% were either at risk of overweight or overweight. Bivariate analyses indicated that there were no significant differences in the prevalence of at risk of overweight and overweight between food secure and food insecure children. Gender, race, and income showed similar patterns. Results from logistic regression analyses also indicated that the likelihood of being overweight or at risk of overweight was not significantly different for food secure and food insecure children. Although child-specific food insecurity was not associated with overweight in this sample of low-income children, food insecurity and overweight coexist among these low-income children, because approximately 25% of the food insecure children were overweight. Additional research is needed to explore the potential relationships between food insecurity and overweight and to better inform policy that attempts to address these issues among low-income households with children.

S. Harding, A. Teyhan, M. J. Maynard and J. K. Cruickshank. (2008). Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol. 37, 162-72.

BACKGROUND: Ethnicity is a consistent correlate of excess weight in youth. We examine the influence of lifestyles on ethnic differences in excess weight in early adolescence in the UK. METHOD: Data were collected from 6599 pupils, aged 11-13 years in 51 schools, on dietary practices and physical activity, parental smoking and overweight, and on overweight and obesity (using International Obesity Task Force criteria). RESULTS: Skipping breakfast [girls odds ratio (OR) 1.74, 95% confidence interval (CI) 1.30-2.34; boys OR 2.06; CI 1.57-2.70], maternal smoking (girls OR 2.04, CI 1.49-2.79; boys OR 1.63, CI 1.21-2.21) and maternal overweight (girls OR 2.01, CI 1.29-3.13; boys OR 2.47, CI 1.63-3.73) were associated with obesity. Skipping breakfast, more common among girls, was associated with other poor dietary practices. Compared with White UK peers, Black Caribbeans (girls OR 1.62, CI 1.24-2.12; boys OR 1.49, CI 1.15-1.95) and Black Africans (girls OR 1.96, CI 1.52-2.53; boys OR 2.50, CI 1.92-3.27) were more likely to skip breakfast and engage in other poor dietary practices, and Indians were least likely. White Other boys reported more maternal smoking (OR 1.37, CI 1.03-1.82). All these reports were more common among those born in the UK than those born elsewhere. Black Caribbean girls were more likely to be overweight (OR 1.38, CI 1.02-1.87) and obese (OR 1.65, CI 1.05-2.58), Black African girls to be overweight (OR 1.35, CI 1.02-1.79) and White Other boys to be overweight (OR 1.37, CI 1.00-1.88) and obese (OR 1.86, CI 1.15-3.00). Adverse dietary habits and being born in the UK contributed to these patterns. CONCLUSION: These findings signal a potential exacerbating effect on ethnic differences in obesity if adverse dietary habits persist. Combined adolescent and parent-focused interventions should be considered.

W. W. Ho, R. E. Adams, J. A. Boscarino and D. Laraque. (2008). The prevalence and characteristics of childhood overweight in a multiethnic, school-based health setting. Ethn Dis. 18, 98-103.

OBJECTIVE: The prevalence and correlates of overweight and the risk of overweight in minority children attending urban school-based health centers remains poorly characterized. The purpose of our study was to examine the prevalence and characteristics of overweight and at risk for overweight in low socioeconomic status minority children enrolled in East Harlem school-based health centers in New York City. DESIGN: A retrospective cross-sectional study during the period of September 2002 to August 2003. SETTING: Four Pediatric School-based Health Centers in East Harlem. PARTICIPANTS: Children and adolescents, aged 5 to 18 years. MAIN OUTCOME MEASURES: We examined presence of overweight or the risk of overweight based on body mass index (BMI) percentile and other clinical characteristics. Bivariate and multivariate analyses were performed to assess the relationship between demographics and clinical characteristics with overweight and the risk of overweight. RESULTS: Of the 491 children enrolled, 45.8% were either overweight or at risk for overweight, with the highest risk observed in Hispanic/Latino children. This latter relation remained significant after adjusting for age, sex, and birthweight status. In addition, high screening office blood pressure was related to overweight status and higher BMI percentile. CONCLUSIONS: A large proportion of minorities, especially Hispanic/Latino children, attending school-based health centers in an urban community sample, are overweight or at risk for overweight. Elevated screening blood pressure was also a common co-morbidity. Further research should determine the predictors and correlates of overweight, and effective targeted school-based interventions should be tested in this high-risk population.

A. I. Ibrahim, Z. M. Hawamdeh, J. T. Al-Smadi and B. A. Ammari. (2008). Prevalence of overweight and obesity in urban and semi-urban Jordanian children aged 3-6 years. Child Care Health And Development. 34, 464-469.

Objectives To show the prevalence of overweight and obesity among the Jordanian urban and semi-urban children; to compare their body mass index (BMI) with the international standards of BMI. Methods We measured 1695 healthy children (842 boys and 853 girls) between 3 and 6 years for height, weight and mid upper arm circumference. BMI was calculated and transformed into percentiles. Children were divided into boys and girls. Results The mean and SD values of BMI observed in our study were 16.69 +/- 4.9 kg/m(2) for boys and 16.82 +/- 4.77 kg/m(2) for girls aged 3-6 years. The prevalence of obesity and overweight among boys was 20.8% and 3.8% respectively and among girls was 19.1% and 7.2% respectively. In total, 48.0% of boys and 38.1% of girls were of healthy weight. Conclusions The mean BMI observed in our study's children aged 3-6 years was higher than the expected 50th percentile of the (World Health Organization/Centers for Disease Control and Prevention) reference values for a similar age range but, it was equivalent to the 75th percentile values. Obesity was more frequent than overweight among boys and girls aged 3-6 years.

D. Ilardi. (2008). Obesity wars continue. Home-based pediatric weight management. School Nurse News. 25, 22-4.

There is a growing demand for pediatric weight management programs that can be adminisetred at home. School staff, including school nurses and food service staff, are frustrated by the pressure of handling these problems exclusively in the school; parents who want to exercise successful influence over their child's food choices are at a loss for answers. A pilot study of the SUCCESS AT HOME Program indicated that children made significant improvements in a number of health-related areas (weight, body-mass index, body circumference measures, flexibility) after nine months of using the program. Overall, parents were highly satisfied with the program and saw significant improvements in the physical health and psychological well-being of their children.

E. Isganaitis and L. L. Levitsky. (2008). Preventing childhood obesity: can we do it? Curr Opin Endocrinol Diabetes Obes. 15, 1-8.

PURPOSE OF REVIEW: This review critically examines recent publications on prevention of childhood obesity and places these publications within a biologic, epidemiologic, public health, and policy context. It should help practitioners advocate effective preventive strategies and develop effective plans of action for research and policy. RECENT FINDINGS: Risk factors for childhood obesity include low socioeconomic status, maternal obesity, rapid infancy weight gain, and decreased physical activity. Changes in food availability and activity levels during the past 30 years are well documented. Obesity prevention programs have had limited success but they demonstrate that changes in school and community environments can decrease childhood weight gain. Legislative approaches to the obesity epidemic have not led to changes in governmental agricultural policy or in the food and marketing industry. SUMMARY: Obesity in childhood is a major public health problem and contributes to significant morbidity in adulthood. It is the natural biologic outcome of an unprecedented increase of food availability and intake, coupled with decreased energy output. Present obesity prevention measures have been small scale and timid. Public policy measures to address the obesity epidemic have not yet been sufficiently strong to be effective. Suggestions are made to intensify public education and change national behaviors.

T. H. Jafar, Z. Qadri, M. Islam, J. Hatcher, Z. A. Bhutta and N. Chaturvedi. (2008). Rise in childhood obesity with persistently high rates of undernutrition among urban school-aged Indo-Asian children. Arch Dis Child. 93, 373-8.

BACKGROUND: Childhood obesity is an emerging global public health challenge. Evidence for the transition in nutrition in Indo-Asian developing countries is lacking. We conducted these analyses to determine the trends in nutritional status of school-aged children in urban Pakistan. METHODS: Data on the nutritional status of children aged 5 to 14 years from two independent population-based representative surveys, the urban component of the National Health Survey of Pakistan (NHSP; 1990-1994) and the Karachi survey (2004-2005), were analysed. Using normative data from children in the United States as the reference, trends for age- and gender-standardised prevalence (95% CI) of underweight (more than 2 SD below the weight-for-age reference), stunted (more than 2 SD below the height-for-age reference) and overweight and obese (body mass index (BMI) 85(th) percentile or greater) children were compared for the two surveys. The association between physical activity and being overweight or obese was analysed in the Karachi survey using logistical regression analysis. RESULTS: 2074 children were included in the urban NHSP and 1675 in the Karachi survey. The prevalence of underweight children was 29.7% versus 27.3% (p = 0.12), stunting was 16.7% versus 14.3% (p = 0.05), and prevalence of overweight and obese children was 3.0 versus 5.7 (p<0.001) in the NHSP and Karachi surveys, respectively. Physical activity was inversely correlated with being overweight or obese (odds ratio, 95% CI, 0.51, 0.32-0.80 for those who engaged in more than 30 minutes of physical activity versus those engaged in less than 30 minutes' activity). CONCLUSIONS: Our study highlights the challenge faced by Pakistani school-aged children. There has been a rapid rise in the number of overweight and obese children despite a persistently high burden of undernutrition. Focus on prevention of obesity in children must include strategies for promoting physical activity.

D. M. Janicke, B. J. Sallinen, M. G. Perri, L. D. Lutes, J. H. Silverstein, M. G. Huerta and L. A. Guion. (2008). Sensible treatment of obesity in rural youth (STORY): design and methods. Contemp Clin Trials. 29, 270-80.

Project STORY is a 3-arm, randomized, planning and feasibility study assessing the effectiveness of two behavioral weight management interventions in an important and at-risk population, overweight children and their parents in medically underserved rural counties. Participants will include 90 parent-child dyads from rural counties in north central Florida. Families will be randomized to one of three conditions: (a) a Family-Based Behavioral Group Intervention, (b) a Parent-Only Behavioral Group Intervention, and (c) a waitlist control condition. Child and parent participants will be assessed at baseline (month 0), post-treatment (month 4) and follow-up (month 10). Assessment and intervention sessions will be held at Cooperative Extension offices within each local participating county. The primary outcome measure is change in child body mass index (BMI) z-score. Additional key outcome measures include child dietary intake, physical activity, self-esteem, body image, and parent BMI. The goals of the study are to (a) assess the feasibility of recruitment in rural settings, (b) develop and evaluate training protocol for group leaders, (c) determine strategies to increase adherence to monitoring and goal setting protocol, (d) evaluate strategies for participant retention, (e) assess the relative cost-effectiveness of the interventions, (f) assess the acceptability of the intervention to families and Cooperative Extension administrators and personnel, and (g) if successful, estimate the sample size needed for a full-scale trial. This research has potential implications for medically underserved rural communities with limited resources and preventive health care services. If successful, a Parent-Only intervention program may provide a cost-effective and practical intervention for families in underserved rural communities.

M. Julia, M. M. van Weissenbruch, E. P. Prawirohartono, A. Surjono and H. A. Delemarre-van de Waal. (2008). Tracking for underweight, overweight and obesity from childhood to adolescence: a 5-year follow-up study in urban Indonesian children. Horm Res. 69, 301-6.

AIMS: To assess tracking of body mass index (BMI) of urban Indonesian children from childhood to adolescence and to compare the prevalence of underweight, overweight and obesity in 6- to 8-year-old children from two surveys: years 1999 and 2004. METHODS: A longitudinal study assessing BMI tracking of 308 urban children followed from age 6-8 to 11-13 years and two cross-sectional surveys comparing the prevalence of underweight, overweight and obesity in 6- to 8-year-old children: year 1999 (n = 1,524) and 2004 (n = 510). RESULTS: Childhood BMI determined 52.3% variation of later BMI. After 5.1 (0.6) years the prevalence of overweight and obesity increased from 4.2 and 1.9% in childhood to 8.8 and 3.2% in adolescence. The prevalence of underweight decreased from 27.3 to 18.8%. All obese children remained obese, 84.6% overweight children stayed overweight, 56.0% underweight children remained underweight. In cross-sectional comparison the prevalence of overweight and obesity raised from 5.3 to 8.6% and from 2.7 to 3.7%, respectively. The prevalence of underweight remained constant. CONCLUSIONS: The prevalence of overweight and obesity increases as children grow into adolescence. Overweight or obese children are more likely to remain overweight or obese. Cross-sectional comparison shows, while the prevalence of underweight stays constant, the prevalence of overweight and obesity increases.

P. T. Katzmarzyk, L. A. Baur, S. N. Blair, E. V. Lambert, J. M. Oppert and C. Riddoch. (2008). International conference on physical activity and obesity in children: summary statement and recommendations. Applied Physiology Nutrition And Metabolism-Physiologie Appliquee Nutrition Et Metabolisme. 33, 371-388.

The increasing prevalence of obesity among the world's children and youth was the impetus for an international conference convened in Toronto, Canada, to examine issues related to physical activity and obesity in children (24-27 June 2007). The goal of the conference was to assimilate, interpret, and share scientific evidence with key stakeholders to develop recommendations concerning effective physical activity policies and programs to address obesity in children. The conference was attended by approximately 1000 delegates from 33 countries who gathered to listen to the invited speakers and to share information on promising practices related to the promotion of physical activity with the aim of reducing the burden of obesity in children. The major topics addressed at the conference included the biological and behavioural causes of obesity, current and past levels of physical activity and sedentarism in children, the role of the social, family, and built environments in addressing the physical activity deficit, and the role of legislation and industry in promoting physical activity. Promising physical activity interventions among children were presented, and important research, policy, and practice recommendations to address the issue of physical inactivity and obesity were provided.

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