Comorbidities of overweight/obesity in Australian preschoolers: a cross-sectional population study

Adiposity, cardiovascular, and health-related quality of life indicators and the reallocation of waking movement behaviors in preschool children with overweight and obesity: An isotemporal data analysis

Background

Isotemporal substitution evaluates hypothetical time replacement scenarios of physical movement on health, with few studies conducted among ethnically diverse preschool-aged populations. This study examines the reallocation of waking movement behaviors on adiposity, cardiovascular, and quality of life indicators among low-income, majority Hispanic preschool-aged youth (2–5 years) with overweight.

Methods

Participants wore an ActiGraph monitor (waist) and completed adiposity, cardiovascular, and health-related quality of life health assessments. Covariates included age, sex, ethnicity, and socioeconomic status. The isotemporal substitution approach was employed to address study aims.

Results

Complete data were available for 131 preschoolers. For boys, reallocating 5 minutes of stationary time with light intensity, moderate to vigorous intensity, or total physical activity showed a relation with beneficial reductions in adiposity indicators; for girls, these relations were statistically null. For boys and girls, reallocating 5 minutes of stationary time [-2.2 (95% CI: -3.7, -0.7) mmHg], light intensity [-2.1 (95% CI: -3.7, -0.7) mmHg], or moderate intensity activity [-2.7 (95% CI: -5.0, -0.4) mmHg] to vigorous intensity activity was related to favorable systolic blood pressure. Reallocating 5 minutes of stationary time to moderate to vigorous intensity activity [0.6 (95% CI: -1.0, -0.1) mmHg] or total physical activity [-0.2 (95% CI: -0.3, -0.01) mmHg] was related to lowered systolic blood pressure. Reallocating 5 minutes of stationary time to moderate to vigorous intensity activity [0.6 (95% CI: -1.1, -0.02) bpm] was related to lowered resting heart rate. No significant results for quality of life were found.

Conclusion

Reallocation of time from stationary time to other movement behaviors is associated with several favorable adiposity and cardiovascular health outcomes among preschool children with overweight and obesity.

Physical Activity Habits and Well-Being among 6-Year-Old Children: The "Improving Umbrian Kids' Healthy Lifestyle", an Uncontrolled Pilot Study Project

There is evidence that promoting physical activity programs and decreasing sedentary behavior is a potential strategy for improving health-outcomes, peer relationships and social/emotional well-being in at-risk youth. The World Health Organization recommends enhancing physical education and school-based programs with multi-component and evidence-based assessment methodology. In Umbria (Italy) an uncontrolled pilot study project referred to as "Improving Umbrian kids' healthy lifestyle" was implemented as a systemic school-based intervention directed at 6-year-old primary school children. The intervention applied a consolidated assessment methodology developed by the C.U.R.I.A.Mo. and Eurobis projects that inserted two hours per week of physical education activity into the school curriculum, structured and supervised by specialists with Exercise and Sport Science degrees, for eight months (from October to June) of the school year. We measured anthropometric values (BMI, waist circumference, waist-to-height ratio index) with objective tools. Moreover, we evaluated physical performance variables (speed, strength, and flexibility) using standard tests. Additionally, self-report measures (measured physical activity during the week, sedentary habits, and psychological well-being) were assessed using validated questionnaires. We observed a significant decrease in waist to height ratio, and improvements in physical performance values and self-report questionnaire measures. Our study suggests that the promotion of physical activity in the school setting is likely to result in physically, mentally, and psycho-socially healthier primary-school-age children.

Patterns of multimorbid health conditions: a systematic review of analytical methods and comparison analysis

Background

The latest review of studies on multimorbidity patterns showed high heterogeneity in the methodology for identifying groups of multimorbid conditions. However, it is unclear how analytical methods used influence the identified multimorbidity patterns.

Methods

We undertook a systematic review of analytical methods used to identify multimorbidity patterns in PubMed and EMBASE from their inception to January 2017. We conducted a comparison analysis to assess the effect the analytical methods had on the multimorbidity patterns identified, using the Australian National Health Survey (NHS) 2007-08 data.

Results

We identified 13 194 studies and excluded 13 091 based on titles/abstracts. From the full-text reviews of the 103 remaining publications, we identified 41 studies that used five different analytical methods to identify multimorbid conditions in the studies. Thirty-seven studies (90%) adopted either the factor-analysis or hierarchical-clustering methods, but heterogeneity arises for the use of different proximity measures within each method to form clusters. Our comparison analysis showed the variation in identified groups of multimorbid conditions when applying the methods to the same NHS data. We extracted main similarities among the groupings obtained by the five methods: (i) cardiovascular and metabolic diseases, (ii) mental health problems and (iii) allergic diseases.

Conclusion

We showed the extent of effects for heterogeneous analytical methods on identification of multimorbidity patterns. However, more work is needed to guide investigators for choosing the best analytical method to improve the validity and generalizability of findings. Investigators should also attempt to compare results obtained by various methods for a consensus grouping of multimorbid conditions.

A Narrative Review of Medical and Genetic Risk Factors among Children Age 5 and Younger with Severe Obesity

Severe obesity defined as an age- and gender-specific body mass index ≥120% of the 95th percentile in children younger than 5 years is well recognized as a significant challenge for prevention and treatment. This article provides an overview of the prevalence, classification of obesity severity, patterns of weight gain trajectory, medical and genetic risk factors, and comorbid disorders among young children with an emphasis on severe obesity. Studies suggest rapid weight gain trajectory in infancy, maternal smoking, maternal gestational diabetes, and genetic conditions are associated with an increased risk for severe obesity in early childhood. Among populations of young children with severe obesity seeking care, co-morbid conditions such as dyslipidemia and fatty liver disease are present and families report behavioral concerns and developmental delays. Children with severe obesity by age 5 represent a vulnerable population of children at high medical risk and need to be identified early and appropriately managed.

Weight Status and Dental Problems in Early Childhood: Classification Tree Analysis of a National Cohort

A poor quality diet may be a common risk factor for both obesity and dental problems such as caries. The aim of this paper is to use classification tree analysis (CTA) to identify predictors of dental problems in a nationally representative cohort of Irish pre-school children. CTA was used to classify variables and describe interactions between multiple variables including socio-demographics, dietary intake, health-related behaviour, body mass index (BMI) and a dental problem. Data were derived from the second (2010/2011) wave of the 'Growing Up in Ireland' study (GUI) infant cohort at 3 years, n = 9793. The prevalence of dental problems was 5.0% (n = 493). The CTA model showed a sensitivity of 67% and specificity of 58.5% and overall correctly classified 59% of children. Ethnicity was the most significant predictor of dental problems followed by longstanding illness or disability, mother's BMI and household income. The highest prevalence of dental problems was among children who were obese or underweight with a longstanding illness and an overweight mother. Frequency of intake of some foods showed interactions with the target variable. Results from this research highlight the interconnectedness of weight status, dental problems and general health and reinforce the importance of adopting a common risk factor approach when dealing with prevention of these diseases.

Early Childhood Dental Problems

Investigations into the wider bioecological understanding of dental problems in early childhood are limited in national surveys. Classification tree analysis (CTA) was used to explore multilevel interactions among key aspects of child and primary caregiver (PCG) psychosocial and physical health affecting dental problems in preschool children. Data were derived from the Growing Up in Ireland study, a nationally representative sample of 9-mo-olds (N = 11,134) in 2007/2008 followed up at age 3 y (N = 9,793) in 2010/2011. Analysis included PCG reports of children’s dental problems, general health, temperament, emotional and behavioral difficulties, and their own general health, stress and depression, relationship, and sociodemographic variables. Misclassification costs were specified for the model by applying a higher penalty for misclassifying those with a dental problem (minority class). Logistic regression analyses were carried out for comparison. Dental problems were reported among 302 infants (2.7%) at 9 mo of age and 493 children (5.0%) at 3 y. CTA identified infant temperament (Infant Characteristics Questionnaire unpredictable) as the primary predictor of dental problems at 9 mo and child global health at 3 y of age. First-level predictors were PCG depression score and use of a soother at 9 mo and PCG ethnicity and unscheduled hospital visits at 3 y of age. Regression analyses results supported the most important predictors at 9 mo and 3 y of age. The CTA model for 9-mo-old infants had a specificity of 90.4%, sensitivity of 31.2%, and overall accuracy of 88.8% while that for 3-y-olds had a specificity of 58.5%, sensitivity of 66%, and overall accuracy of 59%. Key aspects of infant/child and PCG health, as well as psychosocial characteristics associated with reported dental problems, should be considered in future multidisciplinary approaches to child health.

Knowledge Transfer Statement: The results of this data analysis should help raise awareness among clinicians of how primary caregiver and child psychosocial and general health factors are associated with early childhood dental problems, even before the primary dentition is complete. Classification tree analysis visually demonstrates how factors such as infant temperament (9 mo) and child global health (3 y) can interact at multiple levels and affect different subgroups of the child population. Future intervention strategies for oral health should involve consideration of the psychological and general health characteristics of the young child and PCG at both the patient and population levels. This knowledge could assist decision makers adopt an integrated multidisciplinary approach in formulating a coherent oral health policy for preschool children.

Do thin, overweight and obese children have poorer development than their healthy-weight peers at the start of school? Findings from a South Australian data linkage study

Little is known about the holistic development of children who are not healthy-weight when they start school, despite one fifth of preschool-aged children in high income countries being overweight or obese. Further to this, there is a paucity of research examining low body mass index (BMI) in contemporary high-income populations, although evidence from the developing world demonstrates a range of negative consequences in childhood and beyond. We investigated the development of 4-6 year old children who were thin, healthy-weight, overweight, or obese (as defined by BMI z-scores) across the five domains of the Australian Early Development Census (AEDC): Physical Health and Wellbeing, Social Competence, Emotional Maturity, Language and Cognitive Skills, and Communication Skills and General Knowledge. We used a linked dataset of South Australian routinely collected data, which included the AEDC, school enrollment data, and perinatal records (n = 7533). We found that the risk of developmental vulnerability among children who were thin did not differ from healthy-weight children, after adjusting for a range of perinatal and socio-economic characteristics. On the whole, overweight children also had similar outcomes as their healthy-weight peers, though they may have better Language and Cognitive skills (adjusted Risk Ratio [aRR] = 0.73 [95% CI 0.50-1.05]). Obese children were more likely to be vulnerable on the Physical Health and Wellbeing (2.20 [1.69, 2.87]) and Social Competence (1.31 [0.94, 1.83]) domains, and to be vulnerable on one or more domains (1.45 [1.18, 1.78]). We conclude that children who are obese in the first year of school may already be exhibiting some developmental vulnerabilities (relative to their healthy-weight peers), lending further support for strategies to promote healthy development of preschoolers.

Health-Related Quality of Life in a Community Sample of Preschool-Age Children with and without Obesity

While mothers seeking obesity treatment for preschoolers report poorer child health-related quality of life (HRQOL) than mothers of healthy-weight peers, little is known about this relationship in non-clinical preschoolers. Eighty-six mothers of 3-5-year-olds completed the parent-proxy PedsQL. HRQOL scores for children with obesity and without were compared. No significant differences were found between groups for any PedsQL subscales, nor did differences reach established Minimally Clinically Important Differences. Mothers of preschoolers with obesity from the community did not report poorer HRQOL. If parents do not view their child's HRQOL as impacted by weight status, they may be unlikely to seek treatments.

Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents

Australia is predicted to have the highest overweight/obesity rate in the world by 2022 outranking the USA and UK. The purpose of this systematic review was to evaluate the associations between childhood obesity and physical and psychological health co-morbidities. Therefore, a systematic literature search was conducted from six databases (2004-2014). Studies were included if they investigated obesity-related co-morbidities with participants residing in Australia aged 0-18 years. Forty-seven studies fulfilled selection criteria. Evidence suggests that overweight/obese Australian children and adolescents, compared to normal-weight peers, had more cardio-metabolic risk factors and higher risk factors of non-alcohol fatty liver disease and were experiencing more negative psychological outcomes (depression, low self-esteem and lower scores of health-related quality of life). Many other health consequences have either not been investigated in Australia, or as frequently as in other countries.

CONCLUSIONS

Given Australia's current overweight/obesity prevalence and trajectory, Australia-based studies are needed to identify the suspected co-morbidities, understand the range of individual, social and environmental mechanisms driving obesity, and help identify policies, interventions and strategies that will change the future trajectory and 'disease burden' both in Australia and internationally.

WHAT IS KNOWN

• Trend analyses have shown that obesity prevalence in Australia is increasing and will outrank UK and the USA by 2022. • Every third Australian child/adolescent between 5 and 19 years old is predicted to be classified as overweight or obese by 2025. • Childhood obesity is associated with multiple immediate physical and psychological health co-morbidities as well as co-morbidities in adulthood. These have often been identified and examined individually. What is New: • This paper presents a holistic picture of childhood obesity and the associated multiple co-morbidities in Australia. • The extensive health-related outcomes from childhood obesity and those requiring further research are identified. • The findings of this paper will influence the development of local/regional, state and national strategies to change Australia's future trajectory.

GPs, families and children's perceptions of childhood obesity

BACKGROUND

Childhood obesity has a high risk of becoming a chronic disease requiring life-long weight management. Evidence based guidelines were developed and distributed to GPs throughout Australia by the NHMRC, but current application falls short. Measuring height and weight, and calculating BMI for children appears to be rare. Some general practitioners (GPs) perceive significant barriers to managing this patient cohort, and patients report not having confidence in their GPs.

AIM

To explore perceptions and experiences of treating childhood obesity of (i) GPs, (ii) families involved in a childhood obesity study in general practiceâ?? and (iii) families not involved in the project, but who had concerns about childhood obesity.

METHODOLOGY

Supported by the literature, a semi-structured schedule was developed to address the aims. Ten GPs and eight families involved, and four families previously not involved in the project participated in interviews in 2009. All family interviews were audio-taped and transcribed verbatim. Data were thematically analyzed.

FINDINGS

Five themes emerged: (1) raising the topic, (2) frustrations experienced by GPs and families, (3) support available for GPs to provide to families and/or anticipated by families, (4) successes from involvement in the project and (5) sustaining improvements â?? the GPsâ?? and family's perspectives.

DISCUSSION AND CONCLUSION

All acknowledged that childhood obesity is a sensitive issue with both GPs and parents preferring the other to raise the topic. GPs reported successes in practice and patient management such as improved patient records. For families, the GPs dedication and support were major factors sought.

Preschoolers' parent-rated health disparities are strongly associated with measures of adiposity in the Lifeways cohort study children

OBJECTIVE

To examine the relationship between lifecourse factors from preschoolers' microecosystem and their parent-reported (mother-reported) health (PRH), following them prospectively from preconception to age 5 years. To investigate if preschoolers' body mass index (BMI) and waist circumference were associated with preschoolers' PRH when controlled for lifecourse predictors.

DESIGN

Lifeways cross-generation cohort study.

SETTING

Ireland.

PARTICIPANTS

Of 1082 families, 62% mothers responded on a health and lifestyle questionnaire at follow-up. Food frequency, BMI and waist circumference were measured. There were 547 family data sets available for analysis of children's PRH.

MAIN OUTCOME MEASURE

Mother-reported children's PRH at age 5. Associations with child's individual and familial exposures from preconception to age 5 years examined using logistic regression.

RESULTS

In univariate analysis, relatively positive rating of children's PRH were associated with children's lower intake of fats (OR (95% CI) 2.2 (1.1 to 4.3)), higher intake of fruits/vegetables (OR (95% CI) 2.2 (1.1 to 4.3)); as well as familial socioeconomic characteristics {higher household income (OR (95% CI) 3.0 (1.6 to 5.9)), non-entitlement to means-tested healthcare (OR (95% CI) 2.1 (1.0 to 4.3)), mothers' higher education (OR (95% CI) 1.9 (1.0 to 3.6))}, psychosocial characteristics {father's participation in study (OR (95% CI) 2.1 (1.0 to 4.3)), mothers' perceiving better support from partner (OR (95% CI) 2.3 (1.2 to 4.3)), children (OR (95% CI) 1.9 (1.0 to 3.7)) or relatives (OR (95% CI) 2.2 (1.1 to 4.1))}, parents' lifestyle {mothers' lower intake of energy (OR (95% CI) 2.2 (1.1 to 4.3)), fathers' non-smoking status (OR (95% CI) 2.2 (1.1 to 4.4))} and parents' health {mothers' self-rated health relatively positive (OR (95% CI) 5.1 (2.6 to 9.9)), fathers' self-rated health relatively positive (OR (95% CI) 3.0 (1.5 to 6.0))}. In multivariable analysis (χ(2)=34.2, df=21, N=303, R(2 )= 0.26, p<0.05), one of the two strong predictors of children's relatively positive PRH was child not being obese by International Obesity Task Force classification (OR (95% CI) 5.5 (1.4 to 21.0)), observed also using BMI (kg/m(2); OR (95% CI) 0.73 (0.58 to 0.93)) or waist circumference (cm; OR (95% CI) 0.89 (0.81 to 0.98)) as continuous variables. The other significant predictor was mothers' self-rated health relatively positive (OR (95% CI) 4.2 (1.5 to 12.2)).

CONCLUSIONS

Preschoolers' health is adversely associated with obesity and this is independent of lifecourse and social and environmental inequalities. The findings suggest that reducing childhood obesity and improving maternal health may be useful ways to improve child's global health.

Overweight and obesity are associated with musculoskeletal complaints as early as childhood: a systematic review

In order to examine (i) the association between weight status and musculoskeletal complaints (MSC) in children, and (ii) whether overweight and obese children have a higher risk of developing MSC than normal-weight children Medline, Embase, Web of Science and Cochrane were searched (all years up to 2 January 2013) for observational studies studying direct associations between body mass index (or weight status) and MSC in children. Forty studies, together studying over one million children, were included. There was moderate quality of evidence that being overweight in childhood is positively associated with musculoskeletal pain (risk ratio [RR] 1.26; 95% confidence interval [CI]: 1.09-1.45). In addition, low quality of evidence was found for a positive association between overweight and low back pain (RR 1.42; 95% CI: 1.03-1.97) and between overweight and injuries and fractures (RR 1.08; 95% CI: 1.03-1.14). Although the risk of developing an injury was significantly higher for overweight than for normal-weight adolescents (RR: 2.41, 95% CI: 1.42 to 4.10), this evidence was of very low quality. Overweight and obesity are associated with musculoskeletal pain, injuries and fractures as early as childhood. More high-quality prospective cohort studies are needed to study the nature of this relationship.

Quality of life in overweight and obese children and adolescents: a literature review

PURPOSE

The purpose of the study is to present a literature review on quality-of-life (QOL) assessment in overweight or obese children and adolescents in order to identify the most affected dimensions and better understand associated factors.

METHODS

The ERIC, FRANCIS, MEDLINE, PsycARTICLES, PsycINFO, and Academic Search Premier databases were searched for articles reporting cross-sectional QOL studies in obese children and adolescents published in English before January 2013. The reference lists of retained articles were also screened.

RESULTS

Among the 34 articles retained for the analysis, only three did not report lower QOL among obese youth. Clinical populations appeared to be more affected than the general population. Several variables were associated with QOL such as self-image, bullying, bodily pain, quality of food intake, physical activity, screen time, parents' educational level, and weight status.

CONCLUSIONS

Identifying variables associated with lower QOL in obese children and adolescents offers new perspectives for prevention and care. Further research is needed to better elucidate these findings. Better understanding QOL is a key element essential for the treatment for childhood and adolescent obesity.

Childhood obesity: a review of increased risk for physical and psychological comorbidities

BACKGROUND

Worldwide estimates of childhood overweight and obesity are as high as 43 million, and rates continue to increase each year. Researchers have taken interest in the childhood obesity epidemic and the impact of this condition across health domains. The consequences of childhood and adolescent obesity are extensive, including both medical and psychosocial comorbidities.

OBJECTIVE

The purpose of this review was to consolidate and highlight the recent literature on the comorbidities associated with childhood obesity, both nationally and internationally.

METHODS

PubMed and PsychINFO searches were conducted on childhood obesity and comorbidities.

RESULTS

The initial search of the terms obesity and comorbidity yielded >5000 published articles. Limits were set to include studies on children and adolescents that were published in peer-reviewed journals from 2002 to 2012. These limits narrowed the search to 938. Review of those articles resulted in 79 that are included in this review. The major medical comorbidities associated with childhood obesity in the current literature are metabolic risk factors, asthma, and dental health issues. Major psychological comorbidities include internalizing and externalizing disorders, attention-deficit hyperactivity disorder, and sleep problems.

CONCLUSIONS

The high prevalence rates of childhood obesity have resulted in extensive research in this area. Limitations to the current childhood obesity literature include differential definitions of weight status and cut-off levels for metabolic risk factors across studies. Additionally, some results are based on self-report of diagnoses rather than chart reviews or physician diagnosis. Even so, there is substantial support for metabolic risk factors, internalizing disorders, attention-deficit hyperactivity disorder, and decreased health-related quality of life as comorbidities to obesity in childhood. Additional investigations on other diseases and conditions that might be associated with childhood obesity are warranted and intervention research in this area is critical.

Motor and Cognitive Performance of Overweight Preschool Children

Gross and fine motor skills and cognitive performance in obese and overweight children were compared to healthy weight children. Participants were 1,543 children (797 boys and 746 girls) ages 43 to 84 months, attending child-care centers in Munich, Germany. According to German Body Mass Index (BMI) standards for age and sex, 4.6% of the children were classified as obese (percentile greater or equal 97), 6.8% as overweight (percentile greater or equal 90 and less than 97), 5.9% as underweight (percentile less than 10), and 83.1% as being of healthy weight. Dependent variables were physical characteristics (height, weight, skinfold thickness), physical fitness (standing broad jump, shuttle run, hanging), body coordination (balancing forward, balancing backward, lateral jump, hopping), manual dexterity (right and left hand), and cognitive performance (intelligence, verbal ability, concentration). Higher proportions of children from lower socioeconomic and immigrant backgrounds were overweight. There was no association between weight and sex. Overweight children showed lower performance on gross motor skills (coordination and fitness), manual dexterity, and intelligence compared to healthy weight children, even after controlling for the effects of social class and immigration status.

Day-to-day physical functioning and disability in obese 10- to 13-year-olds

What is already known about this subject? Compared with their healthy-weight peers, children with obesity have; impaired physical health-related quality of life reduced physical activity levels reduced capacity to perform certain weight-bearing tasks in field-based fitness tests What this study adds? First investigation of obesity-related disability in children using the International Classification for Functioning, Disability and Health framework for Children and Youth. Obesity in children appears to be associated with disability impacting basic locomotor skills and physical health-related quality of life. Children's participation in key life areas related to physical functioning appears to be minimally impacted by obesity.

OBJECTIVE

The aim of this study was to investigate whether obesity is related to impaired day-to-day physical functioning and disability in children.

METHODS

An observational case-control study was conducted in three Australian states. Obese (n = 107) and healthy-weight (n = 132) 10- to 13-year-olds (132 male, 107 female) were recruited via media advertisements. Assessment of body composition (dual energy X-ray absorptiometry), locomotor capacity (six-minute walk test [6MWT], timed up and down stairs test [TUDS] and timed up and go [TUG]) and child-reported physical health-related quality of life (HRQoL) were undertaken. Participants wore an accelerometer for 8 days and completed two use-of-time telephone interviews to assess participation in key life areas.

RESULTS

Compared with their healthy-weight counterparts, obese children had lower physical HRQoL scores (P < 0.01) and reduced locomotor capacity (TUDS z-score, TUG and 6MWT; P < 0.01). Higher percent body fat was significantly related to lower physical HRQoL scores (r = -0.48, P < 0.01), slower performance times for the TUDS and TUG (r = 0.59 and 0.26 respectively, P < 0.01), shorter 6MWT distances (r = -0.51, P < 0.01) and reduced time spent in community participation activities (r = -0.23, P < 0.01).

CONCLUSIONS

As anticipated, obesity appears to undermine physical functioning in children, including the capacity to perform basic locomotor skills yet, unexpectedly, participation in key life areas related to physical functioning appeared largely unaffected.

Impaired health-related quality of life in preschoolers with obesity

OBJECTIVES

To examine whether health-related quality of life (HRQOL) for treatment-seeking preschoolers with obesity (N = 60) differed from preschoolers in a nonclinical comparison sample (N = 457).

METHODS

Parents in both samples completed the parent-proxy form of the pediatric quality of life inventory (PedsQL). Between-group comparisons were conducted to examine differences for all scales and summary scores of the PedsQL.

RESULTS

Parent proxy-reported HRQOL was significantly lower for treatment-seeking preschoolers with obesity for all scales and summary scores except school functioning. Differences on the total scale score met the criterion for being a clinically important difference.

CONCLUSIONS

Our study suggests treatment-seeking families perceive worse HRQOL for children with obesity as early as the preschool years. Discussion of HRQOL may be a more effective strategy for health care professionals in broaching the topic of weight with parents and identifying families who may be more receptive to weight management suggestions for preschoolers.

Morbidity patterns among the underweight, overweight and obese between 2 and 18 years: population-based cross-sectional analyses

CONTEXT

No study has documented how symptomatic morbidity varies across the body mass index (BMI) spectrum (underweight, normal weight, overweight and obese) or across the entire child and adolescent age range.

OBJECTIVE

To (1) quantify physical and psychosocial morbidities experienced by 2-18-year-olds according to BMI status and (2) explore morbidity patterns by age.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional data from two Australian population studies (the Longitudinal Study of Australian Children and the Health of Young Victorians Study) were collected during 2000-2006. Participants were grouped into five age bands: 2-3 (n=4606), 4-5 (n=4983), 6-7 (n=4464), 8-12 (n=1541) and 13-18 (n=928) years.

MAIN MEASURES

Outcomes-Parent- and self-reported global health; physical, psychosocial and mental health; special health-care needs; wheeze; asthma and sleep problems. Exposure-measured BMI (kg m(-2)) categorised using standard international cutpoints.

ANALYSES

The variation in comorbidities across BMI categories within and between age bands was examined using linear and logistic regression models.

RESULTS

Comorbidities varied with BMI category for all except sleep problems, generally showing the highest levels for the obese category. However, patterns differed markedly between age groups. In particular, poorer global health and special health-care needs were associated with underweight in young children, but obesity in older children. Prevalence of poorer physical health varied little by BMI in 2-5-year-olds, but from 6 to 7 years was increasingly associated with obesity. Normal-weight children tended to experience the best psychosocial and mental health, with little evidence that the U-shaped associations of these variables with BMI status varied by age. Wheeze and asthma increased slightly with BMI at all ages.

CONCLUSIONS

Deviation from normal weight is associated with health differences in children and adolescents that vary by morbidity and age. As well as lowering risks for later disease, promoting normal body weight appears central to improving the health and well-being of the young.

Four-year prospective study of BMI and mental health problems in young children

OBJECTIVE

To investigate prospectively the relationship between BMI and the mental health and health-related quality of life (HRQoL) of young children.

METHODS

In this study we used data from the Longitudinal Study of Australian Children obtained when children were 4 to 5 and 8 to 9 years old. BMI was available for 3363 children at both waves. Mental health problems were assessed by using the Strengths and Difficulties Questionnaire (SDQ), which was completed by parents and teachers. HRQoL was assessed by using the Pediatric Quality of Life Inventory (PedsQL), which was completed by the parents.

RESULTS

Logistic regression models were adjusted for children's age, gender, baseline SDQ or PedsQL scores, and maternal characteristics. A 1-SD increase in BMI in children aged 4 to 5 years was associated with increased odds of scoring in the abnormal range of the SDQ peer problems scale of 1.15 (95% confidence interval [CI]: 1.03-1.28) for parent reports and 1.20 (95% CI: 1.04-1.37) for teacher reports when these children were aged 8 to 9 years. The odds ratio for children who scored above the at-risk cutoff on the parent-reported PedsQL social problems scale was 1.17 (95% CI: 1.06-1.28) for each 1-SD increase at 4 to 5 years of age. There were also increased odds for teacher reports of childhood emotional problems.

CONCLUSIONS

Higher BMI in children aged 4 to 5 years was positively related to poorer peer relationships and teacher-reported emotional problems but not to other childhood mental health problems, in these children at 8 to 9 years of age. Prospective studies are needed to determine if peer problems experienced by children with higher BMI predict subsequent mental health problems in other areas.

Bimodal effects of obesity ratio on disease duration of respiratory syncytial virus infection in children

BACKGROUND

Morbid obesity may be associated with hospitalization and possibly death from the 2009 pandemic H1N1 infection, suggesting a yet unknown association between obesity and the severity of viral infections. Thus, we examined association between obesity ratios and duration of disease in children with Respiratory Syncytial Virus (RSV) infection.

METHODS

A retrospective survey of 243 children admitted for bronchitis, bronchiolitis, pneumonia, and those who tested positive for a RSV test, were observed from a single institute in Japan. Primary outcome was set as the total days of wheezing in both the outpatient clinic and during hospitalization. Secondary outcomes were as follows: 1) total days of fever (37.5°C≤) during hospitalization, and 2) days of drip infusion during hospitalization.

RESULTS

When the obesity ratio was 6 and less, days of wheezing showed significant negative association with obesity ratios. In contrast, when the obesity ratio was more than 6, days of wheezing, days of fever during admission and days of drip infusion showed significant positive association with obesity ratios.

CONCLUSIONS

These results suggest that disease duration of RSV infection may be prolonged not only in lean but also in obese children.

Changes in body mass index and health related quality of life from childhood to adolescence

OBJECTIVE

To determine longitudinal relationships between body mass index (BMI) and health-related quality of life (HRQoL) in an adolescent population sample. Design. Data collected in 2000 and 2005 within the Health of Young Victorians longitudinal cohort study.

SETTING

Originally a community sample of elementary school students in Victoria, Australia. Follow-up occurred in either secondary schools or individuals homes.

PARTICIPANTS

Cohort recruited in 1997 via a random sampling design from Victorian elementary schools. Originally comprising 1 943 children, 1 569 (80.8%) participated in 2000 (wave 2, 8-13 years) and 851 (54%) in 2005 (wave 3, 13-19 years). Main outcome measures. In both waves participants and their parents completed the PedsQL, a 23-item child HRQoL measure, and BMI z-scores and status (non-overweight, overweight or obese) were calculated from measured height and weight. Associations were tested cross-sectionally and longitudinally (linear regression, adjusted for baseline values)

RESULTS

A total of 81.6% remained in the same BMI category, while 11.4% and 7.0% moved to higher and lower categories, respectively. Cross-sectional inverse associations between lower PedsQL and higher BMI categories were similar to those for elementary school children. Wave 2 BMI strongly predicted wave 3 BMI and wave 2 PedsQL strongly predicted wave 3 PedsQL. Only parent-reported Total PedsQL score predicted higher subsequent BMI, though this effect was small. Wave 2 BMI did not predict wave 3 PedsQL.

CONCLUSIONS

This novel study confirmed previous cross-sectional associations, but did not provide convincing evidence that BMI is causally associated with falling HRQoL or vice versa across the transition from childhood to adolescence.

Obesity: the new childhood disability?

This review addresses the impact of obesity on paediatric physical functioning utilizing the World Health Organization International Classification of Functioning, Disability and Health Framework (ICF). The ICF encompasses functioning (as it relates to all body functions and structures), activities (undertaking a particular task) and participation (in a life situation) with disability referring to impairments in body functions/structures, activity restrictions or participation limitations. Electronic databases were searched for peer-reviewed studies published in English prior to May 2009 that examined aspects of physical functioning in children (≤18 years). Eligible studies (N = 104) were ranked by design and synthesized descriptively. Childhood obesity was found to be associated with deficits in function, including impaired cardiorespiratory fitness and performance of motor tasks; and there was some limited evidence of increased musculoskeletal pain and decrements in muscle strength, gait and balance. Health-related quality of life and the subset of physical functioning was inversely related to weight status. However, studies investigating impacts of obesity on wider activity and participation were lacking. Further research utilizing the ICF is required to identify and better characterize the effects of paediatric obesity on physical function, activity and participation, thereby improving targets for intervention to reduce disability in this population.

Rationale, design and methods for a randomised and controlled trial to evaluate "Animal Fun"--a program designed to enhance physical and mental health in young children

Background

Children with poor motor ability have been found to engage less in physical activities than other children, and a lack of physical activity has been linked to problems such as obesity, lowered bone mineral density and cardiovascular risk factors. Furthermore, if children are confident with their fine and gross motor skills, they are more likely to engage in physical activities such as sports, crafts, dancing and other physical activity programs outside of the school curriculum which are important activities for psychosocial development. The primary objective of this project is to comprehensively evaluate a whole of class physical activity program called Animal Fun designed for Pre-Primary children. This program was designed to improve the child's movement skills, both fine and gross, and their perceptions of their movement ability, promote appropriate social skills and improve social-emotional development.

Methods

The proposed randomized and controlled trial uses a multivariate nested cohort design to examine the physical (motor coordination) and psychosocial (self perceptions, anxiety, social competence) outcomes of the program. The Animal Fun program is a teacher delivered universal program incorporating animal actions to facilitate motor skill and social skill acquisition and practice. Pre-intervention scores on motor and psychosocial variables for six control schools and six intervention schools will be compared with post-intervention scores (end of Pre-Primary year) and scores taken 12 months later after the children's transition to primary school Year 1. 520 children aged 4.5 to 6 years will be recruited and it is anticipated that 360 children will be retained to the 1 year follow-up. There will be equal numbers of boys and girls.

Discussion

If this program is found to improve the child's motor and psychosocial skills, this will assist in the child's transition into the first year of school. As a result of these changes, it is anticipated that children will have greater enjoyment participating in physical activities which will further promote long term physical and mental health.

Trial registration

This trial is registered in the Australian and New Zealand Clinical trials Registry (ACTRN12609000869279).

Healthy for now? A cross-sectional study of the comorbidities in obese preschool children in the United States

OBJECTIVE

Examine health of preschoolers by BMI status.

METHODS

A cross-sectional analysis of children 3 to 5 years old in the 1999-2008 National Health and Nutrition Examination Survey was carried out. The measured age- and sex-specific BMI percentiles were used to categorize children as very obese, obese, overweight, or healthy weight. The authors used logistic regression to examine the effect of weight status on 17 available measures of current child health potentially related to obesity.

RESULTS

Except for very obese children, weight status had minimal effect on most measures of health for preschool-aged children (n = 2792). Parents of very obese children reported poorer general health and more activity limitations for their children. Additionally, very obese girls had more frequent/severe headaches, and overweight/obese boys had more asthma diagnoses.

CONCLUSIONS

Only severe obesity appears consistently related to immediate health problems in preschool-aged children. Parental perception that very obese children have worse health and more activity limitations may lead to decreases in physical activity, which would perpetuate obesity.

Comorbidities of obesity in school children: a cross-sectional study in the PIAMA birth cohort

BACKGROUND

There is ample evidence that childhood overweight is associated with increased risk of chronic disease in adulthood. The aim of this study was to investigate associations between childhood overweight and common childhood health problems.

METHODS

Data were used from a general population sample of 3960 8-year-old children, participating in the Dutch PIAMA birth cohort study. Weight and height, measured by the investigators, were used to define BMI status (thinness, normal weight, moderate overweight, obesity). BMI status was studied cross-sectionally in relation to the following parental reported outcomes: a general health index, GP visits, school absenteeism due to illness, health-related functional limitations, doctor diagnosed respiratory infections and use of antibiotics.

RESULTS

Obesity was significantly associated with a lower general health score, more GP visits, more school absenteeism and more health-related limitations, (adjusted odds ratios around 2.0 for most outcomes). Obesity was also significantly associated with bronchitis (adjusted odds ratio (aOR) and 95% confidence intervals (95%CI): 5.29 (2.58;10.85) and with the use of antibiotics (aOR (95%CI): 1.79 (1.09;2.93)). Associations with flu/serious cold, ear infection and throat infection were positive, but not statistically significant. Moderate overweight was not significantly associated with the health outcomes studied.

CONCLUSION

Childhood obesity is not merely a risk factor for disease in adulthood, but obese children may experience more illness and health related problems already in childhood. The high prevalence of the outcomes studied implies a high burden of disease in terms of absolute numbers of sick children.

Parent perception of healthy infant and toddler growth

We hypothesized that parents of infants prefer growth at higher percentiles and are averse to growth at lower percentiles. Of 279 participating parents, only 10% desired their child's weight to be in the lowest quartile. For children weighing in the lowest quartile, 57% of parents thought their child's weight was "too low." In contrast, 66% of parents whose child's weight was in the top quartile preferred their child weigh that much. When viewing hypothetical infant growth trajectories, 47% ranked a growth chart demonstrating growth along the 10th percentile for weight as "least healthy" of 6 growth patterns, and 29% chose charts showing an infant at the 90th percentile for weight at age 1 as "healthiest." In conclusion, parents are averse to growth at the bottom of the weight growth chart but are much less likely to feel negatively about growth at higher percentiles. This is troubling given the childhood obesity epidemic.

Issues in obesity monitoring, screening and subsequent treatment

PURPOSE OF REVIEW

Despite intense policy, media and research interest, childhood obesity rates continue to rise in most countries. Screening may seem a logical response to a situation in which obesity does not usually resolve spontaneously, yet most obese children do not present for treatment. This article explores recent evidence for and against monitoring and screening of children's BMI.

RECENT FINDINGS

Whether conducted in primary care or school settings, population screening of children's BMI can be feasible, acceptable and not intrinsically harmful. However, it incurs a substantial cost, and randomized controlled trials do not suggest that it improves BMI outcomes. Population trends in BMI are more complex than a simple rise in obesity; birth cohorts with higher rates of childhood overweight are not inevitably more overweight as young adults. The consequences of a concomitant increase in thinness are uncertain.

SUMMARY

Systematic monitoring of BMI is essential, but need not be continuous, and could involve representative samples rather than all individuals in a population. In contrast, BMI screening cannot be recommended until more effective management becomes available for overweight and mildly obese children. Research into prevention and intervention should, therefore, be prioritized over population screening at this point in time.

Update on physical activity including special needs populations

PURPOSE OF REVIEW

Childhood obesity rates remain high, especially among adolescents, minorities, and children with disabilities. The American Academy of Pediatrics and American Medical Association have released recommendations for childhood obesity treatment and prevention which include interventions related to physical and sedentary activity. This review explores recent updates in the area of physical activity and sedentary behavior related to these recommendations as well as emerging evidence relevant to physical activity among children with disabilities.

RECENT FINDINGS

Safety and access are among some of the environmental barriers to children's participation in extracurricular physical activity that need to be addressed. Analyses of the relationship between physical activity and sedentary screen time continue to show inconsistent results, although evidence in support of active video games is increasing. Children with disabilities are a special subpopulation for whom physical activity should particularly be encouraged.

SUMMARY

Increased physical activity and decreased sedentary behaviors are essential components of obesity management in children with and without disabilities. Pediatric providers are encouraged to address barriers to physical activity with all families and act as advocates for changes in the local community that support access to physical activity for all children.

Opportunities for the primary prevention of obesity during infancy

Many parents, grandparents, and clinicians have associated a baby’s ability to eat and gain weight as a sign of good health, and clinicians typically only call significant attention to infant growth if a baby is failing to thrive or showing severe excesses in growth. Recent evidence, however, has suggested that pediatric healthcare providers should pay closer attention to growth patterns during infancy. Both higher weight and upward crossing of major percentile lines on the weight-for-age growth chart during infancy have long term health consequences, and are associated with overweight and obesity later in life. Clinicians should utilize the numerous available opportunities to discuss healthy growth and growth charts during health maintenance visits in the first two years after birth. Further, providers should instruct parents on strategies to promote healthy behaviors that can have long lasting obesity preventive effects.

An update in prevention and treatment of pediatric obesity

BACKGROUND

Obesity prevalence is growing as well as its severity with increasing morbidity and mortality. This "globesity" also affects developing countries where under nutrition and stunting frequently coexist with overweight and obesity. One third of obese adults began to be so in the pediatric ages. There are two main types of prevention: general one representing greater actions from health authorities and the individual one carried out by the pediatrician and the patient at risk. Once the state of obesity is reached (relative body mass index, rBMI >121%) the longer lasting care becomes more complex and frequently unsuccessful. The treatment of obesity is aimed to care for the present and silent disorders and for preventing its further tracking to adulthood.

DATA SOURCES

Identification of pediatric population at risk which is the one with an rBMI of 111%-120% plus other risk factors. Specific individual actions include reduction of food intake, increase of energy expenditure, involvement of parents, and the child-adolescent himself in the prevention. Therapy is based on some principles plus the important medical and emotional approach.

RESULTS

A Cochrane study based on only 10 appropriate studies showed a predominant poor efficacy of the undergone preventive action. Treatment guides are presented after our own experience with a group of 400 kids with an average follow-up of 7 years and other individual prevention studies.

CONCLUSIONS

Involving motivated pediatricians with a minimum of time for visits and better follow-up in the frame of a general national preventive programme could be a rational outcome. Treatment of obesity should never be postponed whatever the clinical care is.