Obesity in childhood and adolescence: evidence based clinical and public health perspectives

Parental support and adolescent motivation for dieting: the Self-Determination Theory perspective

This article focuses on parents' role in overweight adolescents' motivation to diet and successful weight loss. The study employed Self-Determination Theory (SDT) as the theoretical framework (Deci & Ryan, 2000, 2011). Ninety-nine participants (ages 20-30) who had been overweight during adolescence according to their Body Mass Index (BMI mean = 25, SD = 1.6), completed retrospective questionnaires about their motivation to diet and their parents' behavior in the context of dieting. Findings from a structural equation modeling analysis suggested that participants who viewed their parents' as more need-supportive demonstrated more autonomous motivation to diet, which, in turn, contributed to their successful weight loss. The findings highlight the importance of parental support of adolescents' psychological needs in the quality of their motivation to diet. This is an important insight for parents and professionals who aim to encourage more constructive parent involvement in adolescents' dieting and well-being.

Relationship between sleep duration and dietary intake in 4- to 14-year-old Danish children

A negative association between sleep duration and BMI has been observed in children. However, knowledge about the association between sleep duration and diet is limited. The objective was to examine the association between sleep duration and intake of foods and nutrients in children. In the present cross-sectional study, dietary intake and sleep duration were recorded by the parents for seven consecutive days in a food and sleep record in a representative sample of 802 4- to 14-year-old children. No sex differences were found regarding age and sleep duration. Sleep duration was negatively correlated to age (ρ = -0·68; P < 0·001) and BMI (ρ = -0·41; P < 0·001). In multiple linear regression analyses, sleep duration was not associated with energy intake (b = -0·015; P = 0·20), but there was a trend towards a positive association with intake of dietary fibre (b = 0·006; P = 0·05) and vegetables (b = 0·011; P = 0·05), and a negative association with intake of poultry (b = -0·002; P = 0·02), and a trend towards a negative association with intake of liquid 'discretionary calories' (b = -0·01; P = 0·05). Furthermore, in a comparison of dietary intake between age-dependent tertiles of sleep duration, only intake of liquid 'discretionary calories' was significantly lower in long sleepers than in short and medium sleepers (P = 0·03). In conclusion, sleep duration was not associated with energy intake and the proposal that children with short sleep duration have less healthy eating habits than children with longer sleep duration was only weakly supported by the present findings.

Future Intent to Run and Running Performance of Students Exposed to a Traditional versus an Autonomy Supportive Motivational Running Program

Background. The study's primary purpose was to investigate whether an autonomy supportive motivational climate in a running program would increase future running intent among high school students. A secondary purpose was to examine whether the program would increase individual performance in the Cooper 12-minute run. Methods. Students participated in a 4-month running intervention program which included four timed runs, one per month, and a future intent questionnaire prior to the start of the timed runs and following the last run. Results. Factorial repeated measures ANOVA revealed significance regarding future intent (P = .026) at both schools. Factorial repeated measures ANOVA indicated differences between the runs at both schools (P < .001). Paired samples t-tests were conducted to look at significance with paired runs. Results revealed significance in two of the six pairs at the treatment school, notably between the first and last timed runs (P = .004). Only one pair was found to be significant (P < .001) with the control school. Conclusion. At both schools, the overall number of laps increased as well as future intent to run scores. The results do not support evidence of a greater effect from the autonomy supportive environment over a traditional environment.

The relationship between internet addiction and body mass index in Turkish adolescents

The purpose of this study was to investigate Internet use patterns and Internet addiction among adolescents and to examine the correlation between Internet addiction and eating attitudes and body mass index (BMI). The study was conducted among 1,938 students, aged between 14 and 18 years. The Internet Addiction Test (IAT), the Eating Attitudes Test (EAT), and a sociodemographic query form were used to collect data. According to the IAT, 12.4% of the study sample met the criteria for Internet addiction. A significant positive correlation between BMI and the IAT (r=0.307; p<0.01) and weekly Internet use (r=0.215; p<0.01) was found. Nine students with Internet addiction (3.8%) and 90 with average Internet use (5.3%) were found to have a possible eating disorder (p>0.05). No relationship was found between the EAT and the IAT and duration of weekly Internet use. Linear regression analysis revealed a significant independent association of the IAT with BMI (r=0.235; p<0.001). These results indicate an association between Internet addiction and BMI. Further studies are needed to describe the causality of this association.

Prevalence of overweight and obesity in adolescents: a systematic review

Objective. To review the extant literature on the prevalence of overweight and obesity in adolescents (10-19 years old) of both sexes. Design. The search was carried out using Medline and Scopus considering articles published from the establishment of the databanks until June 7, 2012. Data on the prevalence of children being overweight and obese from the International Obesity Task Force (IOTF) website was also reviewed. Only original articles and one National Health Report were considered. Forty studies met the inclusion criteria. Results. Twenty-five of these studies were nationally representative, and ten countries were represented only by regional data. Conclusions. The prevalence of overweight and obesity among adolescents worldwide is high, and obesity is higher among boys. The IOTF criterion is the most frequently used method to classify adolescents as overweighed or obese in public health research.

Canadian Study of Determinants of Endometabolic Health in ChIlDrEn (CanDECIDE study): a cohort study protocol examining the mechanisms of obesity in survivors of childhood brain tumours

BACKGROUND

Childhood obesity has reached epidemic proportions and is impacting children's health globally. In adults, obesity is associated with chronic low-grade inflammation that leads to insulin resistance, which is one of the important mechanisms through which dysregulation of metabolism occurs. There is limited information available about the contribution of inflammation to metabolic health in obese children, and how individual and lifestyle factors impact this risk. One of the paediatric groups at risk of higher rates of obesity includes the survivors of childhood brain tumours. The aim of this study was to evaluate the mechanisms that contribute to inflammation in obese survivors of childhood brain tumours.

METHODS AND ANALYSIS

This is a prospective cohort study. We will recruit lean and obese survivors of childhood brain tumours, and a control group composed of lean and obese children with no history of tumours. We will measure circulating and urinary cytokine levels and cytokine gene expression in monocytes. In addition, the methylation patterns of cytokine genes and that of toll-like receptor genes will be evaluated. These will be correlated with individual and lifestyle factors including age, sex, ethnicity, puberty, body mass index, fasting lipid levels, insulin sensitivity, diet, exercise, sleep, stress and built environment. The sample size calculation showed that we need 25 participants per arm

ETHICS AND DISSEMINATION

This study has received ethics approval from the institutional review board. Once completed, we will publish this work in peer-reviewed journals and share the findings in presentations and posters in meetings.

DISCUSSION

This study will permit the interrogation of inflammation as a contributor to obesity and its complications in obese survivors of childhood brain tumours and compare them with lean survivors and lean and obese controls with no history of tumours, which may help identify therapeutic and preventative interventions to combat the rising tide of obesity.

Chemokine (C-C motif) Ligand 2 is a potential biomarker of inflammation & physical fitness in obese children: a cross-sectional study

BACKGROUND

Obesity is a global epidemic that is impacting children around the world. Obesity is a chronic inflammatory state with enhanced production of multiple cytokines and chemokines. Chemokine (C-C motif) Ligand 2 (CCL2) is produced by immune and metabolic cells and attracts immune cells into liver, muscle and adipose tissue, resulting in initiation and propagation of the inflammatory response in obesity. How obesity and fitness affect the production of this chemokine in children is unknown.This study tested the hypotheses that CCL2 levels are higher in obese children when compared to lean controls, and that fitness modulates CCL2 levels allowing its use as a biomarker of fitness.

METHODS

This was a cross sectional case-control study conducted in a Pediatric Tertiary care center in Hamilton, Ontario, Canada. Controls were recruited from the community. This study recruited overweight/obese children (BMI ≥ 85th percentile, n = 18, 9 female, mean age 14.0 ± 2.6 years) and lean controls (BMI < 85th percentile, n = 18, 8 female, mean age 14.0 ± 2.6 years) matched for age, sex and biological maturation.Aerobic fitness test was done using a cycle ergometer performing the McMaster All-Out Progressive Continuous Cycling test to exhaustion to determine peak oxygen uptake. Fasting CCL2 samples were taken prior to test. Categorical variables including subject categorization into different aerobic fitness levels in overweight/obese and lean children was reported based on the median split in each group.

RESULTS

Obese participants had significantly higher CCL2 levels when compared to lean group (150.4 ± 61.85 pg/ml versus 112.7 ± 38 pg/ml, p-value 0.034).To establish if CCL2 is a biomarker of fitness, we divided the groups based on their fitness levels. There was a main effect for group (F (3,32) = 3.2, p = 0.036). Obese high fitness group were similar to lean unfit and fit participants. Post-hoc analysis revealed that the overweight/obese low fitness group had significantly higher level of CCL2 compared to the lean low fitness group when adjusted to age, sex and maturity offset (F (3,29) = 3.1, p = 0.04).

CONCLUSIONS

CCL2 serves a dual role as a potential biomarker of inflammation and fitness in obese children.

Combined paediatric NAFLD fibrosis index and transient elastography to predict clinically significant fibrosis in children with fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of disease from simple steatosis to steatohepatitis, to fibrosis and cirrhosis. The paediatric NAFLD fibrosis index (PNFI) and transient elastography (TE) are potential noninvasive markers for fibrosis. To prospectively evaluate the performance of PNFI and TE in assessing clinically significant fibrosis in children with biopsy-proven NAFLD.

METHODS

Our cohort consisted of 67 consecutive children with biopsy-proven NAFLD. The stage of fibrosis was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network. Fibrosis ≥ 2 was considered clinically significant. PNFI was calculated using age, waist circumference and triglycerides. TE was performed using the Fibroscan apparatus.

RESULTS

Ten patients had fibrosis stage 2-3 and 57 patients had stage 0-1. Both PNFI and TE values were significantly higher in patients with significant fibrosis (P < 0.05). The area under the receiver operating characteristic (ROC) curve for predicting significant fibrosis of PNFI and TE were 0.747 and 1.00 respectively (P = 0.005). The combined use of PNFI and TE could predict the presence or absence of clinically significant fibrosis in 98% of children with NAFLD.

CONCLUSIONS

In children with NAFLD, the combination of PNFI and TE can be used to accurately assess the presence of clinically significant liver fibrosis. This will help to identify patients who should undergo liver biopsy because the confirmation of advanced fibrosis would lead to closer follow-up and screening for cirrhosis-related complications.

Obesity-related behaviors of Malaysian adolescents: a sample from Kajang district of Selangor state

This study aims to determine the association between obesity-related behaviors (dietary practices, physical activity and body image) and body weight status among adolescents. A total of 382 adolescents (187 males and 195 females) aged 13 to 15 years in Kajang, Selangor participated in this study. Majority of the respondents were Malays (56.0%), followed by Chinese (30.1%) and Indians (13.9%). Dietary practices, physical activity and body image of the adolescents were assessed through the eating behaviors questionnaire, two-day dietary record, two-day physical activity record and multi-dimensional body image scale (MBIS), respectively. Body weight and height were measured by trained researchers. The prevalence of overweight and obesity (19.5%) was about twice the prevalence of underweight (10.5%). About two-thirds of the respondents (72.3%) skipped at least one meal and half of them (56.2%) snacked between meals with a mean energy intake of 1,641 ± 452 kcal/day. More than half of the respondents (56.8%) were practicing sedentary lifestyle with a mean energy expenditure of 1,631 ± 573 kcal per day. Energy intake (r = 0.153, P < 0.05), physical activity (r = 0.463, P < 0.01) and body image (r = 0.424, P < 0.01) were correlated with BMI. However, meal skipping, snacking and energy expenditure per kg body weight were not associated with body weight status. Multiple linear regression analysis showed that body image, physical activity and energy intake contributed significantly in explaining body weight status of the adolescents. In short, overweight and obesity were likely to be associated not only with energy intake and physical activity, but also body image. Hence, promoting healthy eating, active lifestyle and positive body image should be incorporated in future obesity prevention programmes in adolescents.

Macrophage migration inhibitory factor is elevated in obese adolescents

OBJECTIVES

The prevalence of obesity in childhood and adolescence is continuing rising. Macrophage migration inhibitory factor (MIF) participates in inflammatory and immune responses as a pro-inflammatory cytokine. The present study aimed to investigate MIF in overweight adolescents.

METHODS

Seventy-nine male adolescents were enrolled. Thirty-eight were overweight according to the 90th%ile of the age-specific waist circumference. Various parameters were recorded at one visit, including body mass index. MIF was determined using multiplex immune-assay technology.

RESULTS

Overweight adolescents had increased systolic blood pressure and CRP levels. Furthermore, increased circulating MIF concentrations were observed (Median: 964.6 pg/ml, Interquartile range: 590.3-2019.4 versus Median: 562.7 pg/ml, Interquartile range: 430.6-813.7, p = 0.003). Increased MIF concentrations were associated with increased markers of inflammation and obesity.

CONCLUSIONS

We demonstrated elevated MIF levels in obese adolescents. Taken together with other markers, this indicates the presence of low-grade inflammation in these young subjects, possibly representing a link between obesity and related co-morbidities.

Perception makes the difference: the association of actual and perceived weight status with self-reported and parent-reported personal resources and well-being in adolescents

The study analyzed associations between actual weight status and weight perceptions with personal resources, physical and psychological health, as well as physical performance among adolescents (N = 5,518; age: 11-17 years). Analyses are based on data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Self-report measures, parental reports, as well as objective test data were considered. Results indicate that weight perceptions, rather than actual weight status, were associated with personal resources, health, and perceived physical performance. Comparing groups, we found that adolescents who felt they had "just the right weight" achieved more favourable results than those who perceived themselves as "too fat", regardless of their actual weight status. However, actual physical performance was predicted better by actual weight status. Furthermore, weight perceptions were found to mediate the link between actual weight status and all the assessed outcomes (personal resources, health, and physical performance). With respect to self-reports, the mediational effect was consistently stronger for girls, whereas the reverse was true regarding physical performance. Parental reports were not moderated by sex. Findings provide further evidence that among overweight adolescents there are subgroups that differ significantly with regard to risks and resources. Implications for practice are discussed.

Excesso de peso e fatores associados em adolescentes

OBJETIVO: Verificar a prevalência e os fatores associados ao excesso de peso em estudantes adolescentes em Rio Branco, Acre, Brasil. MÉTODOS: Estudo transversal com 741 adolescentes de escolas particulares de Rio Branco, Acre. Foram mensuradas as seguintes variáveis: sexo, idade, classe socioeconômica, escolaridade dos pais, número de moradores no domicílio, número de irmãos, atividade física, tempo de TV e de computador. A regressão logística binária foi utilizada para verficar as possíveis relações entre excesso de peso corporal e algus fatores associados. RESULTADOS: A prevalência geral de excesso de peso foi de 26,9% (30,0% nos meninos e 24,2% nas meninas): apenas o sexo (masculino, OR=1,34), a classe socioeconômica (média alta, OR=2,06 e alta, OR=2,36) e a atividade física (insuficientemente ativo, OR=2,75) apresentaram maior risco para desenvolver excesso de peso. CONCLUSÃO: Os estudantes adolescentes do sexo masculino, de classe socioeconômica elevada e que praticam pouca atividade física foram os que apresentaram maior risco de excesso de peso nessa região do Brasil.

Sedentarism: the effects of Internet use on human obesity in the United States

This paper analyzes the impact of Internet use on human obesity in the United States. The United States is facing a skyrocketing obesity epidemic among adults and children. The authors hypothesize that the more individuals use the Internet, the more they increase their risks of becoming obese. The explanation is that Internet use may cause sedentarism, which refers to decreased energy expenditure or, simply, physical inactivity. Sedentarism, in turn, may increase obesity.

Consumption of takeaway and fast food in a deprived inner London Borough: are they associated with childhood obesity?

OBJECTIVE

A major concern is the ubiquitous presence of fast food and takeaway outlets within easy walking distance of schools, particularly in the light of the increasing burden of childhood obesity. Here, the associations between the schoolchildren's weights, their consumption of fast food and takeaway outlets were examined in a deprived inner London Borough.

DESIGN

This is a cross-sectional study.

PARTICIPANTS

193 schoolchildren (aged between 11 and 14 years old) participated in this study.

MAIN OUTCOME MEASURES

Body mass index (BMI) percentiles specific for age and gender were obtained. Frequency of food and drinks purchased from fast food outlets and takeaway outlets over a weekly period and preferred types of drinks and food products usually consumed were measured.

RESULTS

More than 50% of the children in our survey purchased food or drinks from fast food or takeaway outlets twice or more a week, with about 10% consuming fast food or drinks from these outlets daily. About 70% of these children from Black ethnic groups and 54% of Asians purchased fast food more than twice a week. BMI has a significantly inverse relationship to fast food consumption. However, when age and gender are accounted, the BMI age-gender percentile is no longer significantly related to fast food consumption.

CONCLUSIONS

This study revealed a very high frequency of fast food consumption among the schoolchildren. Taste, quick access and peer influence were major contributing factors. These schoolchildren are exposed to an obesogenic environment, and it is not surprising that in this situation, many of these children are already overweight and will likely become obese as adults.

Is dieting behaviour decreasing in young adolescents?

Objective

To report trends in underweight, overweight and obesity in 12–15-year-old adolescents and examine changes in dieting behaviour, which have been less well documented.

Design

Comparison of two independent representative cross-sectional surveys.

Setting

Northern Ireland.

Subjects

Weight and height were objectively measured in 1324 boys and 1160 girls in 1996 and 1274 boys and 1374 girls in 2007. Participants reported whether they were following any particular diet including a self-proposed or prescribed weight-reduction diet.

Results

Overweight and obesity increased in girls from 15 % to 23 % and 2 % to 6 %, respectively. Increases were more modest in boys with overweight increasing from 13 % to 18 % and obesity from 3 % to 6 %. The proportion of underweight adolescents decreased from 9 % to 6 % in girls and 8 % to 5 % in boys. Evidence of social disparity was observed in girls from a manual socio-economic background, with overweight/obesity prevalence rates increasing from 21 % to 36 % compared with 15 % to 26 % in girls from a non-manual background. Despite these trends fewer adolescents, in particular girls, reported following weight-reduction diets (14 % of overweight/obese girls in 2007 v. 21 % in 1996; 8 % of boys in 2007 v. 13 % in 1996). Of these girls, the proportion from a manual background following weight-reduction diets decreased from 25 % to 11 %.

Conclusions

Overweight and obesity are continuing to increase in adolescents despite government and media awareness strategies. There also appears to be reduced dieting behaviour, despite increasing body weight, particularly in girls from manual socio-economic backgrounds.

Self-reported weight status rather than BMI may be closely related to psychopathological symptoms among Mainland Chinese adolescents

Evidence in respect of the psychological consequences of child and adolescent obesity is mixed. More studies indicated that mental health appears to be more strongly associated with concern about weight and shape, regardless of body mass index (BMI). Using the data from a national large school-based cohort (N = 10 403), we examined the association between obesity, perceived obesity and mental health. There was no relationship between BMI weight status and psychopathological symptoms after adjusting for weight perception and other factors for both genders. More importantly, it was determined that perception of weight as either underweight or overweight was related to higher behavioral symptoms and social adaptation problems. In conclusion, psychological well-being of adolescents is more related to weight perception than BMI is.

Metabolic, endocrine, and immune consequences of sleep deprivation

Over the last three to four decades, it has been observed that the average total hours of sleep have decreased to less than seven hours per person per night. Concomitantly, global figures relating to obesity and diabetes mellitus have increased in an alarming fashion in adults and children, and it has been hypothesized that neuro-hormonal changes accompanying this behavioral sleep deprivation may lead to insulin resistance and, subsequently, to diabetes mellitus. Sleep deprivation has been associated with multiple physiological changes, including increased cortisol and ghrelin levels, decreased leptin levels and impaired glucose metabolism. Experimental studies have also shown an increase in inflammatory and pro-inflammatory markers, which are indicators of body stress, under sleep deprivation. This review elaborates further on this hypothesis, exploring the molecular basis for the link between both entities and the underlying pathophysiology that results in insulin resistance and diabetes mellitus. We review the results of experimental and epidemiological studies, specifically examining the relationship between sleep duration and the immune and endocrine systems.

Reliability and validity of the 3DNX accelerometer during mechanical and human treadmill exercise testing

OBJECTIVE

This study aimed to assess the validity and reliability of the 3DNX triaxial accelerometer in a laboratory and mechanical setting.

METHODS

Experiment 1: A total of 10 units were fixed to a Multi-axis shaker table. A schedule comprising a range of accelerations was repeated on two occasions along each of the three measurement axes. Experiment 2: A total of 11 recreationally active individuals completed a treadmill protocol (4-20 km hr(-1)) on two occasions. Two 3DNX accelerometers were secured to the lower back, logging data every 5 s. Oxygen uptake was measured using the Douglas Bag technique. Reliability inter- and intra-units were assessed using a combination of limits of agreement (LoA), coefficient of variation (CV) and intra-class correlation coefficient (ICC). Validity was assessed using simple linear regression. All data are expressed in counts per 5 s (counts 5 s(-1)).

RESULTS

Experiment 1: CV(intra) ranged from 0.0 to 8.9% in all axes. The absolute bias±95% LoA values were all below four counts 5 s(-1). CV(inter) did not rise above 4.5%. ICCs were 1.0 for all stages in all axes. The relationship between 3DNX counts and acceleration yielded an R(2) value of 0.99 and a standard error of the estimate (SEE) of six counts 5 s(-1). Experiment 2: CV(inter) ranged from 7.7 to 16.0% for trial 1 and from 7.7 to 16.2% for trial 2. ICCs between units ranged from 0.95 to 1.00 for trial 1 and from 0.90 to 0.99 for trial 2. Mean ratio bias±95% LoA values for intra-unit and inter-unit reliability were -0.7% (P>0.05)±12.4% and 0.4% (P>0.05)±5.6%, respectively. The relationship between VO(2) and 3DNX counts for walking and running was linear (R(2)=0.65, SEE=1.42 ml kg(-1) min(-1); R(2)=0.62, SEE=3.63 ml kg(-1) min(-1)).

CONCLUSION

The 3DNX accelerometer is a reliable and valid device for measuring acceleration in a mechanical setting and during human treadmill exercise.

Sobrepeso e obesidade em escolares brasileiros de sete a nove anos: dados do projeto Esporte Brasil

OBJETIVO: Descrever a prevalência de sobrepeso e obesidade em escolares brasileiros de sete a nove anos e verificar a associação com as variáveis: sexo, idade e região geográfica. MÉTODOS: Estudo epidemiológico transversal conduzido em 2.913 escolares (1.478 do sexo masculino e 1.435 do feminino) com idade entre sete e nove anos. Como critério de diagnóstico de sobrepeso e obesidade foram utilizados os pontos de corte do índice de massa corpórea, propostos pela International Obesity Task Force. A comparação entre as proporções foi realizada mediante o teste qui-quadrado. As diferenças entre as proporções foram testadas por meio do teste de comparação entre duas proporções. RESULTADOS: A prevalência de sobrepeso e obesidade foi de 15,4 e 7,8% em meninos e meninas, respectivamente, com proporções similares entre sexo e idades. No sexo masculino, foi verificada associação do sobrepeso e obesidade apenas com região geográfica (p<0,001), com prevalências mais elevadas nas crianças da região Sul. No feminino, sobrepeso mais elevado foi observado nas crianças de sete anos da região Norte, enquanto a prevalência de obesidade foi maior nas crianças da região Sul. CONCLUSÕES: As crianças da região Sul apresentam maiores prevalências de sobrepeso e obesidade que aquelas das demais regiões do país. Os achados do presente estudo apontam uma tendência de aumento na prevalência de sobrepeso e obesidade na infância e corroboram os resultados encontrados em pesquisas mais abrangentes realizadas no Brasil.

Sleep duration and body-weight development during puberty in a Dutch children cohort

BACKGROUND

Short sleep duration is associated with obesity during childhood and adulthood.

OBJECTIVE

The objective of our study was to investigate the relationship between sleep duration and body mass index (BMI) from Tanner stages 1 to 5 in a Dutch children cohort.

DESIGN

In 98 children, anthropometric measurements and leptin concentrations were measured from age 7 to 16 years; body composition, physical activity (Baecke questionnaire), hours television viewing and self-reported sleep duration were measured yearly from age 12 to 16 years. Moreover, the polymorphisms of the FTO gene (rs9939609) and parental BMI's were determined.

RESULTS

At Tanner stages 1-5 sex differences were observed in height, body weight, waist circumference, fat mass per squared meter height and leptin concentrations per kg fat mass. Inverse relationships were observed between the change in BMI (kg m(-2)) and the change in hours of sleep per night (h) from Tanner stages 1 to 4 (r=-0.68, P<0.001), from Tanner stages 2 to 5 (r=-0.35, P<0.05) and from Tanner stages 1 to 5 (r=-0.33, P<0.05). Univariate analysis of variance showed that with progressive Tanner stages, BMI increases and sleep duration decreases in an interrelated way independent of possible confounders (R(2)=0.38, P<0.02).

CONCLUSION

Changes in BMI during puberty were inversely related to changes in sleep duration, independent of possible confounders.

Influence of schoolyard renovations on children's physical activity: the Learning Landscapes Program

OBJECTIVES

We examined whether schoolyard improvements led to increased physical activity levels among both boys and girls and assessed the aspects of schoolyard design that have an impact on physical activity.

METHODS

In a quasi-experimental research design, 6 schools with renovated schoolyards and 3 control schools were divided into activity areas. We calculated measures of children's physical activity by area during school hours as well as after-school hours.

RESULTS

The volume of schoolyard use was significantly higher at schools with renovated schoolyards than at control schools, and students were significantly more active at these schools. Also, activity levels were significantly higher among both boys and girls in certain schoolyard areas, such as those with soft surfaces.

CONCLUSIONS

Because few public elementary schools in the United States provide daily physical education or its equivalent for all students throughout the school year, noncurriculum approaches to increasing children's physical activity are important. Renovated schoolyards increase the number of children who are physically active, as well as their overall activity levels, and reduce sedentary behaviors.

Alterações ortopédicas em crianças e adolescentes obesos

INTRODUÇÃO: A obesidade infanto-juvenil é um problema muito frequente e implica complicações que podem estar presentes precocemente, como as alterações ortopédicas. OBJETIVO: descrever as alterações que atingem o aparelho locomotor em crianças e adolescentes com sobrepeso e obesidade. METODOLOGIA: Foram consultadas as bases de dados MEDLINE, SciELO, LILACS, ISI e base de dados da Universidade de Standford, com a combinação dos seguintes descritores: "obesidade", "complicações", "criança", "dores músculo-esqueléticas", "postura", "alterações ortopédicas", "marcha" e seus respectivos sinônimos em inglês. RESULTADOS: Pôde-se observar que as crianças e adolescentes obesos são mais predispostos a apresentar essas complicações ortopédicas que os indivíduos eutróficos, e os principais problemas relatados foram as alterações posturais, como hiperlordose lombar e joelhos valgos, e dores músculo-esqueléticas, principalmente na coluna lombar e membros inferiores. Os principais fatores que causam esses problemas não são bem definidos, mas incluem aumento da sobrecarga articular associado à fragilidade óssea em fase de crescimento e à diminuição da estabilidade postural, o que conduz ao aumento das necessidades mecânicas regionais. CONCLUSÃO: A identificação precoce dessas disfunções é fundamental para que essas crianças recebam tratamento multidisciplinar adequado.

Perception of body weight status: a case control study of obese and lean children and adolescents and their parents

BACKGROUND

The objective of this study was to investigate differences in weight perception and self-concept of obese and lean children, and to examine parents' awareness of overweight in themselves and their children. A total of 59 obese patients aged 7-17 years and 49 of their parents from a pediatric obesity out-patient clinic participated and were compared with 96 normal-weight patients and 81 of their parents from a pediatric pulmonary disease out-patient clinic.

METHODS

Children's and parents' self-perception of weight, desire for weight change and weight concerns, children's belief that their desired weight can be achieved, and parents' perception of their child's weight status were assessed using single questionnaire items. Children's self-concept was measured by the Self-Perception Profile for Children. In addition, children drew pictures about themselves and their favorite activity.

RESULTS

Obese patients wished to change their weight more frequently (p < 0.001) and had more weight concerns (p < 0.001). Their self-concept was significantly more negative. Physical activities were more common in their drawings than in those of normal-weight peers. Parents of obese children were more frequently overweight or obese themselves (p < 0.001). 35 of them and 73 parents of normal-weight children perceived their own weight realistically. Of the parents with overweight or obese children, 69.4% perceived their own child as overweight and 28.6% as very overweight, whereas 83% of them were obese.

CONCLUSION

Children and adolescents as well as their parents recognize overweight as a health problem. In the majority, weight perception matches real body weight. Most parents at least recognize overweight in their children.

Undernutrition and obesity in indigenous children: epidemiology, prevention, and treatment

Over the past 50 years there has been a shift in nutritional problems amongst Indigenous children in developed countries from under-nutrition and growth faltering to overweight and obesity; the major exception is small numbers of Indigenous children predominately living in remote areas of Northern Australia. Nutritional problems reflect social disadvantage and occur with disproportionately high incidence in all disadvantaged subgroups. There is limited evidence of benefit from any strategies to prevent or treat undernutrition and obesity; there are a limited number of individual studies with generalizable high grade evidence of benefit. Potential solutions require a whole of society approach.

Prevalência de sobrepeso e obesidade e indicadores de adiposidade central em escolares de Santa Catarina, Brasil

OBJETIVO: Estimar a prevalência de sobrepeso e obesidade entre escolares e sua associação com região, sexo, faixa etária e rede de ensino, e a correlação entre os índices antropométricos. MÉTODO: Estudo transversal com 4.964 escolares entre 6 a 10 anos de idade matriculados em 345 escolas do ensino fundamental do Estado de Santa Catarina. Foi utilizado o índice de massa corporal para diagnosticar sobrepeso e obesidade. Como indicadores de distribuição de gordura foram utilizadas circunferência de cintura, relação cintura-quadril, relação cintura-altura, dobras cutâneas triciptal e subescapular e razão subescapular-triciptal. Foram estimadas as razões de chance com IC 95% e calculada correlação de Pearson para avaliar a relação entre índice de massa corporal e índices antropométricos. RESULTADO: Do total dos escolares, 52,2% eram do sexo feminino. A prevalência de sobrepeso foi de 15,4% e de obesidade 6,0%. Não foi encontrada associação entre sobrepeso ou obesidade com regiões, sexo e faixa etária, somente entre sobrepeso e rede particular. Os escolares da rede particular apresentaram 1,46 (1,22-1,74) vezes mais chance de desenvolverem sobrepeso. Foi encontrada correlação forte entre o índice de massa corporal e a circunferência de cintura (r = 0,90). CONCLUSÃO: Os escolares da rede particular estão mais expostos ao sobrepeso e à obesidade, sugerindo que a condição socioeconômica dos escolares possa ser a explicação. A circunferência de cintura, além de indicador de adiposidade central, poderá ser utilizada como indicador de adiposidade total.

Fast-food and sweetened beverage consumption: association with overweight and high waist circumference in adolescents

Objective

Overweight and obesity have increased to epidemic proportions among adolescents and are associated with chronic non-communicable diseases and excess mortality in adulthood. The association of overweight/obesity with poor dietary habits has not been studied in adolescents in middle-income developing countries. The present study aimed to estimate the prevalence of overweight, obesity and high waist circumference (WC) in 15–19-year-old Jamaican adolescents and to investigate the association with fast-food and sweetened beverage consumption.

Design

The study enrolled 1317 (598 male, 719 female) adolescents aged 15–19 years using multistage, nationally representative sampling. Age-specific prevalence calculation used internal Z-score lines connecting with the WHO adult cut-off points. Logistic regression was used to examine the association of overweight or high WC with fast-food and sweetened beverage consumption, adjusting for potential confounders.

Results

The overall prevalence of overweight, obesity and high WC was approximately 15 %, 6 % and 10 %, respectively. Prevalence estimated using internal Z-scores was similar to that using the International Obesity Taskforce cut-off points. Obesity (8·0 % in females, 3·3 % in males) and high WC (16·2 % in females, 1·7 % in males) were significantly more prevalent in females when using internal Z-score cut-offs. High WC was associated with the absence of fruit consumption (P = 0·043) and overweight with high sweetened beverage consumption (P = 0·018).

Conclusion

Overweight occurs frequently among Jamaican 15–19-year-olds and is associated with increased consumption of sweetened beverages. High WC is more prevalent among females and is related to low consumption of fruits and vegetables. Measures to reduce the consumption of sweetened beverages and increase fruit intake may reduce the prevalence of excess body fat among adolescents.

Development and pilot testing a social cognitive theory-based intervention to prevent childhood obesity among elementary students in rural Kentucky

The purpose of this study was to develop and pilot test a social cognitive theory-based intervention for children to prevent childhood obesity. Focus groups were conducted with 5th grade students and their parents on the behaviors of physical activity, watching television, and eating habits, specifically fruit and vegetable intake and water consumption. Results from the focus groups were used to develop a 12-week program which was pilot tested in 5th grade physical education classes. The 12-week intervention was conducted with 122 students at a rural elementary school in Kentucky. Significant findings from the intervention were the increase in expectations for drinking water (p=0.049), increase in expectations for watching television (p=0.002), and increase in the number of glasses of water consumed (p=0.022) from pre-test to post-test. Recommendations have been offered for future obesity reduction programs that can be implemented in the elementary schools.

Waist circumference and fat intake are associated with high blood pressure in Mexican children aged 8 to 10 years

BACKGROUND

Elevated blood pressure at a young age is a predictor of blood pressure elevation later in life and has been associated with being overweight. However, it seems that there are other factors related to hypertension in childhood.

OBJECTIVE

To determine the anthropometric, physical activity, and dietary factors associated with both systolic and diastolic hypertension in a group of Mexican school-aged children.

DESIGN

In this cross-sectional descriptive study, blood pressure, anthropometrics, physical activity, and dietary intake (assessed with a multiple-pass 24-hour dietary recall) evaluations were performed on school-aged children from September 2005 to July 2006.

SUBJECTS

Children aged 8 to 10 years (626 boys and 613 girls) from a convenience sample of 23 public schools of low socioeconomic status in Mexico City were included. Systolic and diastolic hypertension were defined as blood pressure > or = 95th percentile for age, sex, and height, without diastolic or systolic prehypertension or hypertension, respectively. Mixed hypertension was defined as the presence of both systolic and diastolic hypertension.

STATISTICAL ANALYSIS

Descriptive statistics, chi(2) tests, analysis of variance, post hoc analysis with Bonferroni method, and logistic regression analysis were performed. Continuous variables are presented as mean+/-standard deviation, categorical variables as percentages, and the association measures as adjusted odds ratios (ORs). A P value < 0.05 was considered statistically significant, and 95% confidence intervals were calculated for adjusted ORs.

RESULTS

The dietary intake analysis showed that both boys and girls had low fiber intake (< 25 g/day) as well as an excessive mean consumption of total and saturated fat (> 35% and > 10% of daily energy, respectively). From the total group of children, 3.6% had systolic hypertension, 14.2% diastolic hypertension, and 22.8% mixed hypertension. The higher values of weight, body mass index, waist circumference, and prevalence of overweight and obesity were more commonly seen among children with mixed hypertension, followed by children in the systolic group. Subjects with diastolic and mixed hypertension had an elevated intake of dietary total fat (37.7% and 38.2% of daily energy intake, respectively). Moreover, an adjusted OR of 1.06 (95% confidence interval 1.01 to 1.11) for systolic hypertension per increase of 1 cm in waist diameter was found and total fat intake > 35% of the daily energy showed an adjusted OR of 2.61 (95% confidence interval 1.27 to 5.36) for diastolic hypertension.

CONCLUSIONS

In a sample of Mexican children of low socioeconomic status, the prevalence of hypertension was high. Waist circumference was the main factor associated with systolic hypertension, and higher intake of total fat was related to diastolic hypertension.

Potential determinants of obesity among children and adolescents in Germany: results from the cross-sectional KiGGS Study

BACKGROUND

Obesity among children and adolescents is a growing public health problem. The aim of the present paper is to identify potential determinants of obesity and risk groups among 3- to 17-year old children and adolescents to provide a basis for effective prevention strategies.

METHODS

Data were collected in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a nationally representative and comprehensive data set on health behaviour and health status of German children and adolescents. Body height and weight were measured and body mass index (BMI) was classified according to IOTF cut-off points. Statistical analyses were conducted on 13,450 non-underweight children and adolescents aged 3 to 17 years. The association between overweight, obesity and several potential determinants was analysed for this group as well as for three socio-economic status (SES) groups. A multiple logistic regression model with obesity as the dependent variable was also calculated.

RESULTS

The strongest association with obesity was observed for parental overweight and for low SES. Furthermore, a positive association with both overweight (including obesity) and obesity was seen for maternal smoking during pregnancy, high weight gain during pregnancy (only for mothers of normal weight), high birth weight, and high media consumption. In addition, high intakes of meat and sausages, total beverages, water and tea, total food and beverages, as well as energy-providing food and beverages were significantly associated with overweight as well as with obesity. Long sleep time was negatively associated with obesity among 3- to 10-year olds. Determinants of obesity occurred more often among children and adolescents with low SES.

CONCLUSION

Parental overweight and a low SES are major potential determinants of obesity. Families with these characteristics should be focused on in obesity prevention.

Performance of ELF serum markers in predicting fibrosis stage in pediatric non-alcoholic fatty liver disease

BACKGROUND & AIMS

Nonalcoholic fatty liver disease (NAFLD) is the most frequent chronic liver disease in children and adolescents in industrialized countries. It is important to accurately determine the stage of fibrosis in these patients. The enhanced liver fibrosis (ELF) test has been validated for staging liver fibrosis in adult patients with chronic liver diseases, including NAFLD. We investigated the performance of this test in assessing liver fibrosis in children and adolescents with NAFLD, identified by biopsy.

METHODS

The ELF test was performed on a panel of serum samples collected from 112 consecutive subjects that were likely to have NAFLD (64 male, mean age of 13.8+/-3.3). A previously described and validated algorithm was used to analyze the data on hyaluronic acid (HA), amino-terminal propeptide of type III collagen (PIIINP), and tissue inhibitor of metalloproteinase 1 (TIMP-1) levels.

RESULTS

In pediatric patients with NAFLD, the ELF test predicted liver fibrosis stage with a high degree of sensitivity and specificity; results were superior to those reported for adults. The area under receiver operating characteristic curves/best possible ELF test cut-off values for the prediction of "any" (>or= stage 1), moderate-perisinusoidal (>or= stage 1b), moderate-portal/periportal (>or= stage 1c), significant (>or= stage 2), or advanced (>or= stage 3) fibrosis were 0.92/9.28, 0.92/9.33, 0.90/9.54, 0.98/10.18 and 0.99/10.51, respectively.

CONCLUSIONS

The ELF test can be used to accurately assess the level of liver fibrosis in pediatric patients with NAFLD. This information is important for identifying patients with progressive fibrosis that require further histopathological analysis or therapeutic follow-up.

Obesity among Scottish 15 year olds 1987-2006: prevalence and associations with socio-economic status, well-being and worries about weight

BACKGROUND

Increases in the prevalence of child and adolescent obesity have accelerated since the mid 1980s. Socio-economic status (SES)-adiposity relationships appear less clear in adolescence than childhood, and evidence on whether increasing obesity is itself patterned according to SES is inconsistent. Increasing prevalence may have increased the tolerance, and reduced recognition of, or concern about, obesity. The aim of this study is to report the prevalence of obesity and its association with SES, well-being and worries about weight among 15-year olds in 1987, 1999 and 2006.

METHODS

Height and weight data obtained from 15-year olds in 1987 (N = 503), 1999 (N = 2,145) and 2006 (N = 3,019), allowed categorisation of obesity (UK90 criteria). SES was represented by parental occupational class and area deprivation; psychological wellbeing by the 12-item General Health Questionnaire (GHQ-12) and self-esteem; weight worries by 'a lot' of worry about weight.

RESULTS

Obesity prevalence was 6.7%, 10.6% and 15.9% (males), and 5.4%, 11.5% and 14.9% (females) in 1987, 1999 and 2006. Among obese males, BMIs increased over time. There was little evidence of differentials in obesity in respect of either SES measure, and none for increased disparities over time. There was no association between obesity and GHQ-12 'caseness' or (except females in 2006) self-esteem. Weight worries were more prevalent among the obese and increased over time overall, but the obesity-weight worry relationship did not change. At each date, large proportions of the obese did not worry 'a lot' about weight, while among the non-obese, up to 18.8% males and 40.1% females (in 2006) did worry.

CONCLUSION

Between 1987 and 2006, prevalence of obesity among Scottish 15 year olds increased around 2.5 times. However, this increasing prevalence did not impact on the obesity-weight-worry relationship. While many obese adolescents appear unconcerned about their weight, a significant minority of the non-obese worry needlessly.

An investigation of a novel three-dimensional activity monitor to predict free-living energy expenditure

The aim of this study was to assess the capability of the 3dNX accelerometer to predict energy expenditure in two separate, free-living cohorts. Twenty-three adolescents and 14 young adults took a single dose of doubly labelled water and wore a 3dNX activity monitor during waking hours for a 10-day period while carrying out their normal routines. Multiple linear regression with backward elimination was used to establish the strength of the associations between various indices of energy expenditure, physical activity counts, and anthropometric variables. 3dNX output accounted for 27% and 35% of the variance in the total energy expenditure of the adolescent and young adult cohort, respectively. The explained variance increased to 78%, with a standard error of estimate of 7%, when 3dNX output was combined with body composition variables. The 3dNX accelerometer can be used to predict free-living daily energy expenditure with a standard error of estimate of 1.65 MJ in adolescents and 1.52 MJ in young adults. The inclusion of anthropometric variables reduces the error to approximately 1 MJ. Although it remains to cross-validate these models in other populations, early indications suggest that the 3dNX provides a useful method of predicting energy expenditure in free-living individuals.

Sugar intake, soft drink consumption and body weight among British children: further analysis of National Diet and Nutrition Survey data with adjustment for under-reporting and physical activity

We investigated associations between body mass index (BMI) and intake of non-milk extrinsic sugars (NMES) and caloric soft drinks using weighed 7-day food records, nutrient intakes, BMI measurements and 7-day physical activity (PA) diaries from the UK National Dietary and Nutritional Survey of Young People (n=1,294 aged 7-18 years). NMES and caloric soft drinks (excluding 100% fruit juice) were quantified by their contribution to energy intake. BMI z-scores were calculated from UK reference curves and International Obesity Task Force (IOTF) cut-off values were used to define overweight. The BMI z-score was weakly inversely correlated with percentage energy from NMES after adjustment for under-reporting and dieting (r=-0.06, P=0.03). The percentage of energy from soft drinks was not associated with the BMI z-score or PA. After excluding under-reporters and dieters, the heaviest children (top quintile: Q5 of BMI z-scores) consumed more total energy (+1,220 kJ/day) than those in the lowest quintile (Q1), but only 60 kJ (5%) was from soft drinks. In logistic regression (adjusted for age and gender, under-reporting, and dieting), overweight was positively associated with energy intake (MJ) (odds ratio [OR]=1.58, confidence interval [CI]=1.42-1.77) and sedentary activity (h) (OR=1.11, CI=1.01-1.23), and inversely associated with moderate/vigorous activity (h) (OR=0.71, CI=0.58-0.86). In the macronutrient model, high fat and protein intake (top tertile vs lowest tertile, g/day) were positively associated with overweight (OR>2.5, P<0.001) while starch had less impact (OR=1.60, CI=1.0-2.55, P<0.05). Top tertile intakes of caloric soft drinks were weakly associated with overweight (OR=1.39, CI=0.96-2.0, P=0.08), while other sources of NMES showed no association (OR=0.81, CI=0.52-1.27, P=0.4). Risk associated with caloric soft drinks appeared non-linear with an increase in odds only for very high consumers (top quintile, mean 870 kJ/day; OR=1.67, CI=1.04-2.66, P=0.03). These data are not consistent with any specific role for NMES or caloric soft drinks in obesity among British children and adolescents, but point instead to a general role of overeating and physical inactivity. Evidence of successful interventions is urgently needed but these must use reliable measurements of exposure (diet and PA) and outcome (BMI z-score, body fat, waist circumference) and have a sufficient timescale.

Effect of surgical weight loss on sleep architecture in adolescents with severe obesity

OBJECTIVES

Sleep duration and sleep fragmentation have been proposed to play a role in the development and progression of obesity-associated morbidity. Weight loss results in resolution of obesity-associated morbidity. Our aim was to determine the effect of weight loss on sleep architecture in adolescents with severe obesity.

METHODS

Retrospective analysis of polysomnograhic data from all adolescents who underwent overnight sleep study before and after weight loss surgery was performed. Polysomnographic variables of sleep architecture after weight loss were compared to baseline by paired Student's t test (normally distributed data) or Wilcoxon test (variables not meeting normality criteria).

RESULTS

The mean (+/-SEM) age of 19 subjects meeting inclusion criteria was 16.5 +/- 0.35 years, mean body mass index was 60.3 +/- 2.11 kg/m2, and 66% were female. Obstructive sleep apnea was present in 14 subjects (74%). The average interval between the baseline and repeat polysomnograms was 0.91 +/- 0.16 years, and average weight loss was 66.4 +/- 8.8 kg. Surgical weight loss resulted in increased sleep efficiency (80.2% vs 73.1%, p = 0.01), reduced time in stage 1 sleep (3.0% vs 6.0%, p = 0.02), and reduced arousal index (7.6 +/- 0.6/h vs 11.3 +/- 1.2, p = 0.01).

CONCLUSION

Our data demonstrate a marked improvement in sleep efficiency and sleep fragmentation with surgical weight loss. Given the emerging evidence that surgical weight loss results in resolution of obesity-associated psychosocial, metabolic, and cardiovascular morbidity, these results suggest that correction of sleep fragmentation could be an important but as yet underappreciated factor influencing changes in these other major comorbidities of obesity.

Gendered dimensions of obesity in childhood and adolescence

Background

The literature on childhood and adolescent obesity is vast. In addition to producing a general overview, this paper aims to highlight gender differences or similarities, an area which has tended not to be the principal focus of this literature.

Methods

Databases were searched using the terms 'obesity' and 'child', 'adolescent', 'teenager', 'youth', 'young people', 'sex', 'gender', 'masculine', 'feminine', 'male', 'female', 'boy' and 'girl' (or variations on these terms). In order to limit the potential literature, the main focus is on other reviews, both general and relating to specific aspects of obesity.

Results

The findings of genetic studies are similar for males and females, and differences in obesity rates as defined by body mass index are generally small and inconsistent. However, differences between males and females due to biology are evident in the patterning of body fat, the fat levels at which health risks become apparent, levels of resting energy expenditure and energy requirements, ability to engage in certain physical activities and the consequences of obesity for the female reproductive system. Differences due to society or culture include food choices and dietary concerns, overall physical activity levels, body satisfaction and the long-term psychosocial consequences of childhood and adolescent obesity.

Conclusion

This review suggests differences between males and females in exposure and vulnerability to obesogenic environments, the consequences of child and adolescent obesity, and responses to interventions for the condition. A clearer focus on gender differences is required among both researchers and policy makers within this field.

Leptin-adiposity relationship changes, plus behavioral and parental factors, are involved in the development of body weight in a Dutch children cohort

BACKGROUND

The development of body weight is determined by different factors, namely genetic, behavioral, parental and physiological.

OBJECTIVE

To investigate whether genetic, behavioral, parental and physiological factors are involved and the extent of involvement in the development of body weight at ages 12 and 13 y in a Dutch children cohort.

METHODS

In a Dutch cohort of 94 children at ages 12 and 13 y, we determined anthropometric measurements, body composition, leptin concentrations, TFEQ scores, physical activity, as well as 3 polymorphisms, and in the parents we determined anthropometric measurements and TFEQ scores.

RESULTS

11% of the children in the cohort were classified as overweight. The genotype frequency distributions of the PPARy2, GRL and CNTF genes at ages 12 and 13 y were not significantly different for the overweight children compared to the lean children. Overweight children showed higher dietary restraint and disinhibition scores. Overweight children's parents had a higher BMI, dietary restraint and disinhibition scores, compared to lean children's parents. A peak in leptin concentrations between 7 and 13 y was shown at 12 y. In lean boys, the decrease in leptin concentrations between 12 and 13 y was related to an increase in fat free mass. At the age of 12 y predominantly the physiological factors were predictors for body weight, and at the age of 13 y both the physiological and behavioral factors were predictors for body weight.

CONCLUSION

We conclude from this longitudinal study, that leptin appeared to play an important role in the development of body weight during puberty, in addition to behavioral and parental factors.

Obesity, hypertension, and mental health evaluation in adolescents: a comprehensive approach

The global epidemic of childhood and adolescent obesity in developing and developed countries has become a major public health concern. Given the relation between obesity and hypertension as documented in several landmark studies, it is no surprise that as the prevalence of obesity has increased in the pediatric population, the rates of hypertension have also increased substantially. Hypertension is one of the most important risk factors for cardiovascular diseases and stroke; therefore, evaluation and initiation of appropriate treatment are extremely important in the pediatric population. Evaluation for secondary causes of hypertension, including renovascular, renoparenchymal, and endocrine disease is the approach most commonly used in healthcare settings, with the goal to detect abnormalities that already have or might, if left unrecognized, affect the physical health of the child in the future. Children and adolescents are commonly evaluated for organic disease even in situations in which secondary hypertension is unlikely and overweight or obesity is most likely the primary factor contributing to hypertension. Psychological and psychosocial factors, which may play an important role in the etiology of obesity and related blood pressure elevation, are often addressed inadequately or completely ignored, potentially reducing long-term therapy success and increasing the incidence of avoidable complications. It is proposed that a comprehensive evaluation by a behavioral health provider will improve outcomes and potentially reduce long-term morbidity and hypertension-related end organ disease. A framework for mental health evaluation is provided.

Childhood obesity: are we missing the big picture?

Childhood obesity is increasing worldwide, raising alarm about future trends of cardiovascular disease, diabetes and cancer. This article discusses what may underlie our failure to respond effectively to the obesity epidemic, and presents a wider perspective for future research and public health agendas. So far targeting individual-level determinants and clinical aspects of childhood obesity has produced limited success. There is growing interest in understanding the wider determinants of obesity such as the built environment (e.g. walkability), social interactions, food marketing and prices, but much needs to be learned. Particularly, we need to identify distal modifiable factors with multiple potential that would make them attractive for people and policymakers alike. For example, walking-biking-friendly cities can reduce obesity as well as energy consumption, air pollution and traffic delays. Such agenda needs to be driven by strong evidence from research involving multi-level influences on behaviour, as well as the study of wider politico-economic trends affecting people's choices. This article highlights available evidence and arguments for research and policy needed to curb the obesity epidemic. The upstream approach underlying these arguments aims to make healthy choices not only the most rational, but also the most feasible and affordable.

Design and evaluation protocol of "FATaintPHAT", a computer-tailored intervention to prevent excessive weight gain in adolescents

BACKGROUND

Computer tailoring may be a promising technique for prevention of overweight in adolescents. However, very few well-developed, evidence-based computer-tailored interventions are available for this target group. We developed and evaluated a computer-tailored intervention for adolescents targeting energy balance-related behaviours: i.e. consumption of snacks, sugar-sweetened beverages, fruit, vegetables, and fibre, physical activity, and sedentary behaviours. This paper describes the planned development of a school-based computer-tailored intervention aimed at improving energy balance-related behaviours in order to prevent excessive weight gain in adolescents, and the protocol for evaluating this intervention.

METHODS/DESIGN

Intervention development: Informed by the Precaution Adoption Process Model and the Theory of Planned Behaviour, the computer-tailored intervention provided feedback on personal behaviour and suggestions on how to modify it. The intervention (VETisnietVET translated as 'FATaintPHAT') has been developed for use in the first year of secondary school during eight lessons. Evaluation design: The intervention will be evaluated in a cluster-randomised trial including 20 schools with a 4-months and a 2-years follow-up. Outcome measures are BMI, waist circumference, energy balance-related behaviours, and potential determinants of these behaviours. Process measures are appreciation of and satisfaction with the program, exposure to the program's content, and implementation facilitators and barriers measured among students and teachers.

DISCUSSION

This project resulted in a theory and evidence-based intervention that can be implemented in a school setting. A large-scale randomised controlled trial with a short and long-term follow-up will provide sound statements about the effectiveness of this computer-tailored intervention in adolescents.

TRIAL REGISTRATION

ISRCTN15743786.

The association of self-esteem, depression and body satisfaction with obesity among Turkish adolescents

BACKGROUND

The purpose of this study was to determine the prevalence of overweight and obesity and to examine the effects of actual weight status, perceived weight status and body satisfaction on self-esteem and depression in a high school population in Turkey.

METHODS

A cross-sectional survey of 2101 tenth-grade Turkish adolescents aged 15-18 was conducted. Body mass index (BMI) was calculated using weight and height measures. The overweight and obesity were based on the age- and gender-specific BMI cut-off points of the International Obesity Task Force values. Self-esteem was measured using the Rosenberg Self-Esteem Scale, and depression was measured using Children's Depression Inventory. Logistic regression analysis was used to examine relationships among the variables.

RESULTS

Based on BMI cut-off points, 9.0% of the students were overweight and 1.1% were obese. Logistic regression analysis indicated that (1) being male and being from a higher socio-economical level were important in the prediction of overweight based on BMI; (2) being female and being from a higher socio-economical level were important in the prediction of perceived overweight; (3) being female was important in the prediction of body dissatisfaction; (4) body dissatisfaction was related to low self-esteem and depression, perceived overweight was related only to low self-esteem but actual overweight was not related to low self-esteem and depression in adolescents.

CONCLUSION

The results of this study suggest that school-based adolescents in urban Turkey have a lower risk of overweight and obesity than adolescents in developed countries. The findings of this study suggest that psychological well-being of adolescents is more related to body satisfaction than actual and perceived weight status is.

Systematic review of interventions in the management of overweight and obese children which include a dietary component

BACKGROUND

The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective. Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness, if the risk of obesity-related morbidity and mortality is yet be reduced. Diet plays a pivotal role in successful treatment of obesity but to date, there is limited evidence on which to base practice.

OBJECTIVES

To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese.

SEARCH STRATEGY

Published English language literature was searched using the electronic databases CINAHL, MEDLINE, PRE-MEDLINE, DARE, COCHRANE, EMBASE, AUSTROM, Current Concepts and Dissertation Abstracts. The databases were limited to English Language from 1975 until 2003. Government reports from the UK, USA and Australian were also searched and a hand search performed for the Journal of the Dietitians Association of Australia, International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles.

SELECTION CRITERIA

(i) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity; (ii) Children aged less than 18 years; and (iii) Participants were defined as overweight or obese by relative weight or a measure of body weight status, studies that reported body weight per se were excluded.

DATA COLLECTION AND ANALYSIS

An experienced professional librarian searched the databases, and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion. The included studies were critically appraised for methodological quality by two people independently. Data were extracted from the appropriate articles and when a discrepancy arose, a third party would arbitrate.

MAIN RESULTS

There were 116 articles that met the inclusion criteria. While 49 articles described randomised controlled trials, they arose from 37 separate studies. There were 67 non-randomised trials. Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data. There was a high degree of heterogeneity between studies and this made comparisons between studies problematic. Interventions that include diet therapy generally result in significant weight loss, at least in the short term. Many studies were poorly designed and had no or only minimal follow up. The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported, making repetition of the studies difficult.

REVIEWERS' CONCLUSIONS

There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity. These studies require adequate follow up to ascertain if weight loss can be sustained in the long term. Details of the dietary prescription, adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice.