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

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(2008). Large-Scale Childhood Obesity Prevention Efforts. IDEA Fitness Journal. 5, 62.

This article offers an overview of organizations and coalitions that introduce childhood obesity prevention efforts in the U.S. Action for Health Kids is a national nonprofit organization devoted to optimizing school-based efforts to address childhood obesity. The Alliance for a Healthier Generation created the Healthy Schools Program to improve school nutrition and physical activity. The Food Trust works on initiatives to expand food access, education and marketing campaigns aimed at improving health.
(2008). Childhood Obesity in a South Florida Elementary School. Journal of School Health. 78, 243.

A letter to the editor is presented in response to a study about childhood obesity in the Miami-Dade County Public Schools in Miami-Dade County, Florida.

L. S. Adair. (2008). Child and adolescent obesity: epidemiology and developmental perspectives. Physiol Behav. 94, 8-16.

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.

A. K. Adams, H. Harvey and D. Brown. (2008). Constructs of Health and Environment Inform Child Obesity Prevention in American Indian Communities. Obesity (19307381). 16, 311.

The article describes a qualitative research project designed to identify parental perceptions regarding children's health that might either enable or limit healthy behaviors related to obesity. In this study, focus group sessions were conducted to explore parental perspectives on children's health, diet and physical activity in American Indian (AI) populations.

A. Albertini, A. Tripodi, A. Fabbri, M. Mattioli, G. Cavrini, R. Cecchetti, E. Dalle Donne, C. Cortesi, S. De Giorgi, V. Contarini, L. Andreotti, B. Veronesi, I. Stefanelli and E. Di Martino. (2008). Prevalence of obesity in 6- and 9-year-old children living in Central-North Italy. Analysis of determinants and indicators of risk of overweight. Obes Rev. 9, 4-10.

The objective of our article is to survey the prevalence of overweight and obesity among 6- and 9-year-old children in Emilia-Romagna, a region of Central-North Italy, and to study the eating habits and behaviours of these children and their families. During 2003 and 2005, we analysed a stratified sample of the general population of children attending pre-school (2681 children aged 6 years) and primary school (2955 children aged 9 years). Their height and weight were measured by healthcare workers. In the 6-year-old children, information concerning their eating habits was collected by means of a questionnaire completed by their parents. The prevalence of overweight was 16.5% in 6-year-old children and 20.6% in 9-year-old children. The increase of overweight from 6- to 9-year-old children was observed in males (13.5% in 6-year-old/21.3% in 9-year-old boys), but not in females. The prevalence of obesity was 8.9% in children aged 6 years and 9.0% in those aged 9 years, and it was higher in comparison with Italian surveys carried out in 1993 and in 2001: 7.5% in 6-year-old and 7.8% in 9-year-old children in 1993, and 6.6% in 6-year-old and 7.2% in 9-year-old children in 2001. In pre-school children, overweight and obesity were closely influenced by the education level, occupation and nutritional status of the parents.

A. N. Al-Isa and L. Thalib. (2008). Body mass index of Kuwaiti adolescents aged 10-14 years: reference percentiles and curves. East Mediterr Health J. 14, 333-43.

The aim of this population-based study was to develop body mass index (BMI) reference standards for Kuwaiti adolescents for use in Kuwait and other Gulf countries. All available intermediate school students aged 10-14 years (32 624 males and 30 209 females) were measured for weight and height. Polynomial regression smoothing techniques were used to obtain the best-fitting curves for BMI percentiles. The BMI of boys at lower centiles and ages was almost always higher than girls. At higher centiles, the BMI of girls was almost always higher than boys. The data were compared with the United States National Center for Health Statistics standards and data from Saudi Arabian and Iranian adolescents.

C. J. Apfelbacher, J. Cairns, T. Bruckner, M. Mohrenschlager, H. Behrendt, J. Ring and U. Kramer. (2008). Prevalence of overweight and obesity in East and West German children in the decade after reunification: population-based series of cross-sectional studies. J Epidemiol Community Health. 62, 125-30.

OBJECTIVE: To analyse time trends in overweight and obesity from 1991 to 2000 in samples of German children and to test the hypothesis of a trend difference between the samples from East and West Germany during this time period. DESIGN: Repeated cross-sectional studies using data of 35,434 five to seven-year-old children from school entry examinations in several rural and urban areas in East and West Germany (between 1991 and 2000). The main outcome measures were overweight and obesity. Weight and height were measured and body mass index was calculated. International cut-off points were used to classify overweight and obesity. RESULTS: From 1991 to 2000, the prevalence of overweight increased from 10.0% to 17.5% in the East and from 14.8% to 22.2% in the West. The prevalence of obesity increased from 2.1% to 5.7% in the East and from 3.6% to 7.6% in the West. All increases were significant. There was no evidence of a trend difference between the East and the West German samples. CONCLUSIONS: Unlike in other countries in transition, prevalences of childhood overweight and obesity were increasing in samples of East German children after reunification in 1990, possibly as a result of the rapid adoption of a western lifestyle in the East. Although prevalences were generally higher in the West German samples, there was no evidence that the increase was levelling off in the West. Overall, trends were similar in the East and West German samples.

C. J. Apfelbacher, A. Loerbroks, J. Cairns, H. Behrendt, J. Ring and U. Kramer. (2008). Predictors of overweight and obesity in five to seven-year-old children in Germany: Results from cross-sectional studies. Bmc Public Health. 8,

Background: Childhood obesity is a serious public health problem and epidemiological studies are important to identify predictive factors. It is the aim of this study to analyse factors associated with overweight/obesity in samples of German children. Methods: 35,434 five to seven year-old children (50.9% boys) participated in cross-sectional studies between 1991 and 2000 in several rural and urban areas in East and West Germany. Weight and height were measured and body mass index was calculated. International cut-off points, recommended by the International Obesity Task Force, were used to classify childhood overweight and obesity. Predictive modelling was employed to analyse independently associated factors, using logistic regression to adjust for confounding. Results: 15.5% were overweight, and 4.3% were obese. Female sex, other than German nationality, smoking in the living place and increasing birth weight were found to increase the odds of overweight and obesity, while increasing educational level, living space > 75 m(2) and breastfeeding for more than three months were inversely associated. Conclusion: The findings add to the evidence informing public health action, both through health promotion strategies (promoting breastfeeding, tackling smoking) and wider societal change management (addressing children from migrant families and families with low educational level).

A. C. Benson, M. E. Torode and M. A. Fiatarone Singh. (2008). Effects of resistance training on metabolic fitness in children and adolescents: a systematic review. Obes Rev. 9, 43-66.

The majority of resistance training (RT) research with children to date has focused on pre-adolescents and the safety and efficacy of this type of training rather than the potential metabolic health benefits. Our objectives, using computerized databases, were (i) to systematically review studies utilizing RT interventions with children and adolescents <18 years; (ii) to investigate the metabolic health outcomes (adiposity, lipids, insulin, glucose) associated with RT; (iii) to provide recommendations for future investigations. A total of 12 studies met the review criteria. There is only a small amount of evidence that children and adolescents may derive metabolic health-related adaptations from supervised RT. However, methodological limitations within the body of this literature make it difficult to determine the optimal RT prescription for metabolic fitness in children and adolescents, and the extent and duration of such benefits. More robustly designed single modality randomized controlled trials utilizing standardized reporting and precise outcome assessments are required to determine the extent of health outcomes attributable solely to RT and to enable the development of evidence-based obesity prevention and treatment strategies in this cohort.

A. Berghofer, T. Pischon, T. Reinhold, C. M. Apovian, A. M. Sharma and S. N. Willich. (2008). Obesity prevalence from a European perspective: a systematic review. Bmc Public Health. 8,

Background: Obesity has been recognised as an important contributing factor in the development of various diseases, but comparative data on this condition are limited. We therefore aimed to identify and discuss current epidemiological data on the prevalence of obesity in European countries. Methods: We identified relevant published studies by means of a MEDLINE search (1990-2008) supplemented by information obtained from regulatory agencies. We only included surveys that used direct measures of weight and height and were representative of each country's overall population. Results: In Europe, the prevalence of obesity (body mass index >= 30 kg/m(2)) in men ranged from 4.0% to 28.3% and in women from 6.2% to 36.5%. We observed considerable geographic variation, with prevalence rates in Central, Eastern, and Southern Europe being higher than those in Western and Northern Europe. Conclusion: In Europe, obesity has reached epidemic proportions. The data presented in our review emphasise the need for effective therapeutic and preventive strategies.

J. Bocarro, M. A. Kanters, J. Casper and S. Forrester. (2008). School Physical Education, Extracurricular Sports, and Lifelong Active Living. Journal of Teaching in Physical Education. 27, 155.

The purpose of this article is to examine the role of school-based extracurricular initiatives in facilitating immediate and long-term positive impact on physical activity, healthy behavior, and obesity in children. A critique of the role of various sports-related initiatives that have been developed to address the obesity epidemic currently facing children within the United States is provided, with a specific emphasis on intramural sports as a preferred mechanism to encourage long-term involvement in sport and physically active pursuits. The article presents support for the notion that a physical education curriculum that includes intramurals before, during, and after school can help children learn the skills to enjoy participation in a variety of sports designed to facilitate lifelong active living.

M. M. Boere-Boonekamp, M. P. L'Hoir, M. Beltman, J. Bruil, N. Dijkstra and A. C. Engelberts. (2008). [Overweight and obesity in preschool children (0-4 years): behaviour and views of parents]. Ned Tijdschr Geneeskd. 152, 324-30.

OBJECTIVE: Description of unhealthy behaviour and views regarding nutrition, physical exercise and education in families with young children, in relation to specific groups with a high risk of overweight. DESIGN: Cross-sectional study. METHOD: In wellbaby clinics for infants and toddlers in various sites in The Netherlands 534 parents were requested to fill in questionnaires on nutrition, physical exercise and education. Enquiry into background characteristics took place and several hypotheses were tested. Using a bivariate and multivariate analysis each hypothesis was examined with regard to linkage of the answers to specific high-risk groups. RESULTS: 73% (390 parents) responded. Overweight was found in 15% of the 2-4-year-olds, this included 3.7% with obesity. Relatively often, parents held views and showed behaviour characteristic of an unhealthy lifestyle for young children. For example, approximately 1 out of 7 families was not used to having breakfast. 43% of the respondents considered sweetened milk products approprite substitutes for milk and 39% of the children always had soft drinks at their disposal. One fifth of the parents indicated that they did not have enough time to go out with their child. Approximately 1 out of 10 toddlers aged 2-4 years had a TV in their own room; 22% were allowed to determine whether they wanted to watch TV or not and 9% were allowed to decide how long they watched. Such specific high-risk behaviour was seen in particular in families with non-western mothers, mothers with a low level of education or mothers living on social security. Regular use of child care or a nursery seemed to have some protective effect. CONCLUSION: In families with children aged 0-4 years, behaviour patterns related to overweight at a later age were frequently observed. In view of the increased incidence of overweight and obesity in young children, initiation of research aimed at optimisation of education is warranted, which should include special attention for the behaviour of parents with regard to 5 spearheads: breast-feeding, more outside play and more physical exercise, a regular wholesome breakfast, less consumption of sweetened drinks and less TV and computer use. Implementation of interventions in young age groups is able to prevent the development of unhealthy lifestyle and childrearing styles.

J. E. Boyington, L. Carter-Edwards, M. Piehl, J. Hutson, D. Langdon and S. McManus. (2008). Cultural attitudes toward weight, diet, and physical activity among overweight African American girls. Prev Chronic Dis. 5, A36.

INTRODUCTION: The growing epidemic of childhood obesity has led to an increasing focus on strategies for prevention. However, little is known about attitudes and perceptions toward weight, diet, and physical activity among American youth, and particularly among young African American females. This pilot study sought to qualitatively explore cultural attitudes and perceptions toward body image, food, and physical activity among a sample of overweight African American girls. METHODS: We recruited 12 overweight girls, aged 12 to 18 years, from a hospital-based pediatric diabetes screening and prevention program. Five semistructured group interviews were conducted to explore attitudes on weight, diet, and physical activity. Sessions averaged 1 hour and were conducted by trained interviewers. Data were transcribed and evaluated for content and relevant themes. RESULTS: The following themes emerged: weight and body size preferences were primarily determined by the individual and her immediate social circle and were less influenced by opinions of those outside of the social circle; food choices depended on texture, taste, appearance, and context more than on nutritional value; engagement in recreational physical activity was influenced by time constraints from school and extracurricular activities and by neighborhood safety; participation in structured exercise was limited because of the cost and time related to maintenance of personal aesthetics (hair and nails); and celebrities were not perceived as role models for diet and physical activity habits. CONCLUSION: In this sample of girls, the findings imply that perceptions of weight and healthy lifestyle behaviors are largely determined by environmental and personal influences. These factors should be considered in the development of healthy-weight interventions for African American girls.

M. Bronikowski, M. González-Gross, K. Kleiner, E. Knisel, I. Martinková, A. Stache, A. Kantanista, D. C. a. Lòpez and A. Konlechner. (2008). PHYSICAL ACTIVITY, OBESITY AND HEALTH PROGRAMS IN SELECTED EUROPEAN COUNTRIES. Studies in Physical Culture & Tourism. 15, 9.

One of the main health-related problems Europe is facing today is the increasing prevalence of obesity in all age groups, especially in youth. According to the International Obesity Task Force (2004) 155 million school-age children and adolescents worldwide show symptoms of obesity or overweight. Obese children are less confident, have lower self-esteem and engagement rate both in and after school physical activity. This is becoming a huge and very costly economic and social problem as well. Positive changes will require modification of the physical education curriculum, especially its contents and teachers' approach. Specially designed programs are required. HEALTH(A)WARE (128737-CP-1-2006-1-DE-Comenius-C2) is a project funded by the European Commission in the Socrates-Comenius Program to enable experimental health teaching within and across school courses. Cross-curricular instruction of knowledge and skills may help pupils in the process of lifelong learning, and hopefully may be implemented in the curricula of European schools. ABSTRACT FROM AUTHOR

H. Brunt, N. Lester, G. Davies and R. Williams. (2008). Childhood overweight and obesity: is the gap closing the wrong way? Journal Of Public Health. 30, 145-152.

Background Obesity is a significant public health issue. Obese children have an increased risk of developing chronic adult diseases. Knowledge of socio-economic distribution trends in childhood overweight/obesity is limited. Methods Body mass indices for 3-year-old children resident in three South Wales localities from 1995 to 2005 were derived from the National Community Child Health Database (NCCHD) and examined in relation to residence lower super output area (LSOA) Townsend Material Deprivation Score. Results Over 11 years, 53-69% of children had height/weight measurements recorded (with little difference observed across deprivation fifths). Amalgamating the data for all 11 years showed no significant association of prevalence with LSOA socio-economic status. Annual trends varied substantially: the most deprived fifth had the lowest proportion on five, and the highest on six, occasions. Linear regression analysis suggested a greater rate of increase of overweight/obesity in children from most-deprived LSOA areas compared with those from least deprived areas (not statistically significant). Conclusions Socio-economic difference in overweight/obesity prevalence lessened between 1995 and 2005. Despite annual variation, this apparent closing of the gap has been the result of an increase in overweight/obesity prevalence in children from the most deprived areas who, initially, had a lower prevalence compared with children from least deprived areas, but by 2005, had overtaken them.

G. M. Budd and L. L. Hayman. (2008). Addressing the childhood obesity crisis - A call to action. Mcn-The American Journal Of Maternal-Child Nursing. 33, 111-118.

The prevalence of childhood obesity is increasing in the United States and globally. Associated with numerous comorbid conditions, childhood obesity is also recognized as a risk factor for multiple chronic conditions and premature mortality in adult life. Children and adolescents, particularly those from ethnic minorities and rural low income populations, bear an excess burden of obesity and its attendant comorbidities. A major contributor to childhood obesity is a physical and social environment that promote's foods high in fat and calories and minimizes the opportunities for physical activity. Despite the strong environmental influences that encourage overeating and sedentary behavior, weight maintenance is viewed as a personal responsibility. Addressing the obesity crisis requires a paradigm shift away from blaming individuals for the lack of willpower to control their eating and physical activity to one of recognizing the "toxic" or "obesigenic" environment as a primary determinant. This article addresses the obesity crisis from individual, family, local community, and public policy perspectives. Emphasis is placed on the role of nurses and nursing, acting to promote change with individuals and families and acting as advocates for multilevel policy initiatives, in reversing the epidemic and improving the health of future generations.

G. Bukara-Radujkovic and D. Zdravkovic. (2008). [Determinants of body mass index in children and adolescents]. Srp Arh Celok Lek. 136, 22-7.

INTRODUCTION: Body Mass Index (BMI) in boys and girls is predicted by parental BMI, age and occupation. OBJECTIVE: Correlation of BMI among children and adolescents in Banjaluka region (Bosnia and Herzegovina) and parental age, BMI, parents'educational level and occupation, as well as the number of family members were investigated as the possible determinants of overweight and obesity in childhood. METHOD: The study included 1204 children and adolescents (578 males, 626 females), 6-17 years old from primary and secondary schools in the Banjaluka region. BMI was calculated from height and weight using the standard formula. Each subject along with his parents answered the questionnaire that contained information about parents' height and weight, educational level and occupation, as well as the number of family members. RESULTS: In all studied children, the prevalence of overweight was 12.2% and of obesity 6.1%. Strong positive correlation was found between parental BMI and age (older than 40 years) in males and females (p<0.001), while parental higher BMI and higher educational level had positive correlation only in males (p<0.001).The number of family members showed negative correlation with overweight/obesity only in females. CONCLUSION: The prevalence of overweight and obesity in children's population in the Banjaluka region is 12.2% and 6.1%, respectively. There is a positive correlation of overweight and obesity in children with parental overweight and obesity, as well as older age, and parental higher educational level.

D. L. Burnet, A. J. Plaut, K. Ossowski, A. Ahmad, M. T. Quinn, S. Radovick, R. Gorawara-Bhat and M. H. Chin. (2008). Community and family perspectives on addressing overweight in urban, African-American youth. Journal Of General Internal Medicine. 23, 175-179.

OBJECTIVE: To assess weight-related beliefs and concerns of overweight urban, African-American children, their parents, and community leaders before developing a family-based intervention to reduce childhood overweight and diabetes risk. DESIGN: We conducted 13 focus groups with overweight children and their parents and eight semistructured interviews with community leaders. PARTICIPANTS AND SETTING: Focus group participants (N = 67) from Chicago's South Side were recruited through flyers in community sites. Interview participants (N = 9) were recruited to sample perspectives from health, fitness, education, civics, and faith leaders. RESULTS: Community leaders felt awareness was higher for acute health conditions than for obesity. Parents were concerned about their children's health, but felt stressed by competing priorities and constrained by lack of knowledge, parenting skills, time, and financial resources. Parents defined overweight in functional terms, whereas children relied upon physical appearances. Children perceived negative social consequences of overweight. Parents and children expressed interest in family-based interventions to improve nutrition and physical activity and offered suggestions for making programs interesting. CONCLUSIONS: This study provides insights into the perspectives of urban, African-American overweight children, their parents, and community leaders regarding nutrition and physical activity. The specific beliefs of these respondents can become potential leverage points in interventions.

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