Social inequality and age-specific gender differences in overweight and perception of overweight among Swedish children and adolescents: a cross-sectional study

Missed Opportunities in Guideline-based Fatty Liver Screening among 3.5 million children

OBJECTIVE

Determine screening rates and examine socio- demographic characteristics of MAFLD screening in a large population of obese children.

METHODS

We used Explorys (IBM) which contains aggregated population-level electronic health record data from approximately 360 hospitals and 317,000 providers across the United States to determine MAFLD screening rates. In children 10-14 years, obesity was determined based on BMI >=95%, or encounter with an ICD obesity code. We determined screening rates by calculating the percentage of children with obesity who had an alanine aminotransferase (ALT) tested, further analyzed by gender, race and insurance.

RESULTS

Of 3,558,420 children, 513,170 (14.4%) were obese. Of obese children, only 9.3% were screened for NAFLD. Females were more likely screened than males (odds ratio (OR) 1.09 (95% CI:1.07-1.12)); white children were more likely screened than non-white children (OR 1.21 (95% CI:1.18-1.23)), and children with Medicaid more likely screened than children with non-Medicaid insurance (OR 1.34 (95% CI:1.32- 1.37)).

CONCLUSION(S)

The percentage of obese children receiving screening for MAFLD was low. Female gender, white race, and Medicaid insurance were associated with increased screening rates. These findings highlight the need to increase adherence to MAFLD screening. Reporting screening as a health quality measure may reduce implementation gaps in MAFLD screening. WHAT'S NEW IN THIS STUDY?: Our study adds knowledge about screening rates and sociodemographic characteristics of MAFLD screening among children.

Proportionate universalism intervention is effective for tackling nutritional social gradient in adolescents: the PRALIMAP-INÈS mixed randomised trial

OBJECTIVE

This study aimed to investigate the effectiveness of proportionate universalism intervention to reduce the slope of the nutritional social gradient in adolescents.

STUDY DESIGN

A mixed (experimental and quasi-experimental) multicentre trial.

METHODS

Data from 985 adolescents of the PRALIMAP-INÈS trial (North-eastern France, 2012-2015) were analysed. For this, adolescents were split into five social classes according to the Family Affluence Scale: Highly Less Advantaged (H.L.Ad; n = 33), Less Advantaged (L.Ad; n = 155), Intermediate (Int; n = 404), Advantaged (Ad; n = 324) and Highly Advantaged (H.Ad; n = 69). The overweight care management was a standard care for all and a strengthened one adapted to the social class of adolescents. The main outcome was the 1-year change of the body mass index z-score (BMIz) slope. Other nutritional outcomes were BMI, ΔBMI_p95 (BMI minus 95th percentile of the WHO reference), %BMI_p95 (percent of 95th percentile of the WHO reference), leisure-time sport, consumption of fruits and vegetables and consumption of sugary foods and drinks.

RESULTS

The inclusion data confirmed a weight social gradient expressed by a significant BMIz linear regression coefficient (β = -0.09 [-0.14 to -0.04], P < 0.0001). The higher the social class, the lower the BMIz. The 1-year BMIz linear regression coefficient was -0.07 [-0.12 to -0.02], corresponding to a significant weight social gradient reduction of 23.3% (β = 0.021 [0.001 to 0.041]; P = 0.04). Consistent results were found for other nutritional outcomes.

CONCLUSIONS

PRALIMAP-INÈS shows that proportionate universalism intervention is effective to reduce the adolescents' nutritional social gradient and suggests that equitable health programmes and policies are a realistic goal.

Socio-economic inequalities in body mass index among preschool children: do sports programs in early childhood education and care centers make a difference?

Background

Overweight in childhood is considered to be one of the most serious public health challenges. Many studies have investigated individual-level determinants of children's body mass index (BMI), yet studies exploring determinants at the meso-level are sparse. The aim of our study was to examine how a sports focus at early childhood education and care (ECEC) centers moderates the effect of parental socio-economic position (SEP) on children's BMI.

Methods

We used data from the German National Educational Panel Study and included 1,891 children (955 boys and 936 girls) from 224 ECEC centers in our analysis. Linear multilevel regressions were used to estimate the main effects of family SEP and the ECEC center sports focus, as well as their interaction, on children's BMI. All analyses were stratified by sex and adjusted for age, migration background, number of siblings, and employment status of parents.

Results

Our analysis confirmed the wellknown health inequalities in childhood overweight with a social gradient toward a higher BMI for children from lower SEP families. An interactive effect between family SEP and ECEC center sports focus was found. Boys with low family SEP not attending a sports-focused ECEC center had the highest BMI among all boys. In contrast, boys with low family SEP attending a sports-focused ECEC center had the lowest BMI. For girls, no association regarding ECEC center focus or interactive effects emerged. Girls with a high SEP had the lowest BMI, independent of the ECEC center focus.

Conclusion

We provided evidence for the gender-specific relevance of sports-focused ECEC centers for the prevention of overweight. Especially boys from low SEP families benefited from a sports focus, whereas for girls the family's SEP was more relevant. As a consequence, gender differences in determinants for BMI at different levels and their interaction should be considered in further research and preventive measures. Our research indicates that ECEC centers may decrease health inequalities by providing opportunities for physical activity.

Family socioeconomic status and childhood adiposity in Europe - A scoping review

Childhood obesity is a considerable public health problem worldwide. In Europe, lower parental socioeconomic status (SES) relates to higher childhood adiposity. This scoping review strives to discover, which SES indicators are the most commonly used and meaningful determinants of childhood adiposity (greater level of continuous adiposity indicator, e.g. body mass index z-score, or overweight or obesity categorized by established definitions). The review focused on studies about European general populations from the 21st century (January 2000-April 2021) considering children and adolescents aged 0-17 years. PubMed and reference lists of articles were searched in February-April 2021. Total of 53 studies with 121 association analyses between different SES indicators and adiposity indicators, were identified and reviewed. Different SES indicators were grouped to 25 indicators and further to six indicator groups. The most used indicator was mother's education (n of association analyses = 24) and the most used indicator group was parental education (n of association analyses = 51). Of all association analyses, 55% were inverse, 36% were non-significant, and 8% were positive. Composite SES (80%), parental education (69%) and parental occupation (64%) indicators showed most frequently inverse associations with obesity measures (i.e. lower parental SES associating with higher adiposity), while parental income (50% inverse; 50% non-significant) and property and affluence (42% inverse; 50% nonsignificant) indicators showed approximately even number of inverse and non-significant associations. Instead, majority of parental employment (60%) indicators, showed non-significant associations and 33% showed positive associations (i.e. higher parental SES associating with higher adiposity). Despite some variation in percentages, majority of the associations were inverse in each age group and with different outcome categorizations. In girls and in boys, non-significant associations predominated. It seems that children with parents of higher SES have lower likelihood of adiposity in Europe. Parents' employment appears to differ from other SES indicators, so that having an employed parent(s) does not associate with lower likelihood of adiposity. Positive associations seem to occur more frequently in poorer countries. Criteria for uniform childhood SES and adiposity measures should be established and used in studies in order to be able to produce comparable results across countries.

Effects of the coronavirus disease 2019 pandemic and the policy response on childhood obesity risk factors: Gender and sex differences and recommendations for research

Childhood obesity is a public health concern globally, with generally higher prevalence rates in boys compared to girls. Although biological sex is an important determinant, gender roles and norms influence the exposure and vulnerability to risk factors for noncommunicable diseases. Norms and roles might be reinforced or change due to coronavirus disease 2019 (COVID-19) related measures as well as the exposure to risk factors for childhood obesity. COVID-19 related changes, such as home confinement, influence a child's risk of obesity. Using Dahlgren and Whitehead's model of the main determinants of health, this paper aims to provide a roadmap for future research on sex, gender, and childhood obesity during the time of COVID-19. It examines how COVID-19 has led to important changes in children's general socioeconomic, cultural, and environmental conditions, social and community networks, and individual lifestyle factors and how these may affect a child's risk for obesity. It focuses on the influence of gender and sex and outlines key considerations and indicators to examine in future studies concerned with promoting health and gender equity and equality. We need to understand the differential impact of COVID-19 related measures on girls' and boys' risk for obesity to adequately react with preventive measures, policies, and programs.

Female adolescents with overweight and obesity share their perspectives on the clinical setting and weight management

The clinical setting remains a strategic environment for early assessment, identification and treatment of adolescents with obesity. Yet, healthcare providers' (HCPs) efforts have been unsuccessful in improving physical activity, nutritional intake or body mass index in adolescents with obesity. Obesity is a chronic condition that influences how patients interact with HCPs and experience ambulatory healthcare appointments. However, it is unknown how female adolescents with obesity perceive the clinical setting, especially regarding weight management. The purpose of this study was to explore the perceptions of female adolescents with obesity regarding health and weight management in the clinical setting. Using a qualitative design, 28 English-speaking female adolescents, 13 to 19 years of age, with a body mass index ≥85th percentile for height and weight participated in individual interviews. Results demonstrate that adolescents with obesity desire to be recognized as unique individuals and to be involved in their own health conversations. The participants reported that their health care was inadequate when they received impersonal and vague advice from HCPs on weight loss. Weight-related communication was best received in a kind and empathetic manner, with a focus on improving one's health (instead of losing weight). Adolescents in this study articulated the components of healthy eating and physical exercise, yet were unable to synthesize this knowledge into specific dietary practices and daily physical activities. The insights derived from female adolescents with obesity provide guidance on how HCPs can improve their relationship and engage the adolescent in weight-based discussions. Concrete, actionable recommendations are provided for providers who work with female adolescents who are overweight or obese.

Latent Class Analysis of Lifestyle Risk Factors and Association with Overweight and/or Obesity in Children and Adolescents: Systematic Review

Background: Multiple modifiable lifestyle factors are well-known contributors to many health problems. Objectives: This study aims to determine the association between latent class analysis (LCA) of modifiable lifestyle risk factors with being overweight and/or obese for children and/or adolescents. Methods: Articles were selected from six databases, without limitation regarding language or date. The review included studies that identify latent classes of modifiable lifestyle risk factors [e.g., physical activity (PA), diet, sedentary behavior (SB), and/or unhealthy behavior] by LCA to determine the association between latent classes with being overweight and/or obese. The methodology of the selected studies was evaluated using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Owing to the heterogeneity between latent classes of modifiable lifestyle risk factors with obesity and/or being overweight, the results are described narratively. Results: Using a selection process in two phases, nine articles were included. All of the included studies were of high methodological quality. The studies were conducted in six different countries: the USA, Brazil, Canada, Portugal, Italy, and Australia. Sample sizes ranged from 166 to 18.587 children and adolescents, and in terms of age (range 5-19 years). Across study clusters characterized by low consumption of fruit and vegetables, and high consumption of fatty foods, sugar snack foods, sweets, chips and fries, low PA (<1 hour each day), and high SB (screen time and TV >2 hours/day), sleep time (<10 hours/day) were positively associated with being overweight and/or obese. Conclusion: Overall there is good evidence to support that the modifiable lifestyle risk factors clustered together by LCA should be novel targets for the treatment of obesity and its associated comorbidities.

Comparison of Body-Image Dissatisfaction Among Chinese Children and Adolescents at Different Pubertal Development Stages

Background

Body-image dissatisfaction among children and adolescent has become increasingly serious, and may be the result of staged differences in the puberty-development process. The aim of this study was to compare differences in body-image dissatisfaction among children and adolescents at different pubertal stages.

Methods

A total of 574 students aged 8–15 years were recruited from two nine-year schools via stratified cluster sampling, their secondary sex characteristics and external genital development examined, and body-image cognition surveyed using the teenage body-image annoyance questionnaire. This questionnaire covers body-shape, gender, sexual organ, and appearance dissatisfaction. Lower scores indicate a more negative body image.

Results

Total, gender, and appearance-dissatisfaction scores in girls were significantly lower than in boys (P<0.05); however, sexual organ–dissatisfaction scores in girls were significantly higher than in boys (P<0.05). Girls’ gender-dissatisfaction scores before breast development Tanner II were higher than those after menarche (P<0.05); however, girls’ sexual organ–dissatisfaction scores before breast development Tanner II were significantly higher than those after menarche (P<0.05).

Conclusion

The girls were more dissatisfied with their gender and appearance than the boys, and the boys were more dissatisfied with their sexual organs than the girls. The girls were more dissatisfied with their sexual organs before breast development Tanner II and more dissatisfied with their gender after menarche.

Food Insecurity Associated With Underestimation of Weight Status in Children With a Healthy Weight

OBJECTIVE

Accurate parental weight perception of one's child is an important step in addressing healthy behaviors, but its associations with socioeconomic status (SES) and household food insecurity (HFI) are unclear. We aimed to assess the association of parental weight perception with HFI.

METHODS

This was a secondary data analysis of a cross-sectional study of 284 children ages 2 to 8 years whose parents completed surveys about weight perception, SES, and HFI. Height and weight were measured to determine the children's body mass index scores and were self-reported by parents. We performed chi-square tests to compare HFI and accuracy of parental weight perception and used logistic regression to assess accuracy, adjusting for significant covariates and stratifying by child weight category.

RESULTS

Approximately two thirds of children had healthy weight, 18% had overweight, and 15% had obesity. About one third of parents inaccurately identified their child's weight category, almost always underestimating weight status. Twenty-eight percent of the families were food insecure. HFI was not associated with parental weight perception in bivariate analysis. When stratified by weight status, food insecure families with children at healthy weight had 0.16 times the odds of accurately perceiving their children's weight status. There was no association between HFI and accuracy of weight perception in children with overweight or obesity.

CONCLUSIONS

Food insecurity was associated with a decrease in the accuracy of parental weight perceptions in children with healthy weight. Pediatricians should clearly communicate about weight status, as families with HFI may adopt unhealthy eating behaviors under the incorrect assumption that their child is underweight.

Geospatial Monitoring of Body Mass Index: Use of Electronic Health Record Data Across Health Care Systems

OBJECTIVES

The Colorado BMI Monitoring System was developed to assess geographic (ie, census tract) patterns of obesity prevalence rates among children and adults in the Denver-metropolitan region. This project also sought to assess the feasibility of a surveillance system that integrates data across multiple health care and governmental organizations.

MATERIALS AND METHODS

We extracted data on height and weight measures, obtained through routine clinical care, from electronic health records (EHRs) at multiple health care sites. We selected sites from 5 Denver health care systems and collected data from visits that occurred between January 1, 2013, and December 31, 2015. We produced shaded maps showing observed obesity prevalence rates by census tract for various geographic regions across the Denver-metropolitan region.

RESULTS

We identified clearly distinguishable areas by higher rates of obesity among children than among adults, with several pockets of lower body mass index. Patterns for adults were similar to patterns for children: the highest obesity prevalence rates were concentrated around the central part of the metropolitan region. Obesity prevalence rates were moderately higher along the western and northern areas than in other parts of the study region.

PRACTICE IMPLICATIONS

The Colorado BMI Monitoring System demonstrates the feasibility of combining EHRs across multiple systems for public health and research. Challenges include ensuring de-duplication across organizations and ensuring that geocoding is performed in a consistent way that does not pose a risk for patient privacy.

Factors Influencing Parents' and Children's Misperception of Children's Weight Status: a Systematic Review of Current Research

PURPOSE OF REVIEW

Misperception of children's weight status is prevalent among parents and children themselves and may impact parents' and children's health behaviors. This study was conducted in order to provide a descriptive systematic review of research on factors influencing parents' and children's misperceptions of children's weight status published in the past 5 years.

RECENT FINDINGS

Factors studied most often in relation to parents' and children's misperception included children's weight status, gender, and age, as well as parents' weight status, parental education levels and socioeconomic status, and ethnicity. Most determinants that were found to have a significant influence on misperception in parents also did in children. The literature on misperception of children's weight status is extensive. Most determinants assessed in included studies were known determinants of childhood obesity. Further research should be directed toward better understanding the impact of weight status perception (whether it is accurate or not) on health behaviors and weight gain over time.

'Just stuff yourself': Identifying health-promotion strategies from the perspectives of adolescent boys from disadvantaged neighbourhoods

Context

The prevalence of overweight and obesity among adolescents has risen dramatically in the last decade, disproportionally affecting adolescents from disadvantaged neighbourhoods. Adolescent boys from disadvantaged neighbourhoods are hard to reach for health promotion.

Objective

This study aims to understand perceptions of health and health‐promotion strategies among adolescent boys from disadvantaged neighbourhoods in order to identify opportunities for health promotion that are better tailored to their needs.

Methods

A qualitative, participatory research approach was used. Sixty‐three adolescent boys (aged 12‐18) were recruited from disadvantaged neighbourhoods in Amsterdam, the Netherlands. Semi‐structured interviews, participant observations and co‐creation sessions were conducted. Data were analysed using ethnographic content analysis.

Results

Boys associate the consumption of large portions of unhealthy foods, especially meat, with masculinity and autonomy. Buying junk food is an important part of their social lives. According to boys, current health promotion does not fit their needs. They stress that entertaining activities, humour and short‐term benefits of healthy choices must be central to health promotion. Some differing interests in health promotion appear between boys, but all boys plead for cheap, satisfying, tasty and healthy food options in their neighbourhoods.

Conclusions

Adolescent boys from disadvantaged neighbourhoods do see opportunities for health promotion. There is an emerging acceptance of boys taking care of their body and health, but the social norm of unhealthy consumption dominates. For health promoters, it is vital to gear health messages to who the boys are and wish to be, especially in relation to their peers.

The Effects of Gender and Family Wealth on Sexual Abuse of Adolescents

Background: Sexual abuse and sexual assaults against adolescents are among the most significant threats to their health and well-being. Some studies have found poverty to be a risk factor for sexual abuse. The present study investigates the effects of gender and family affluence on the prevalence of sexual abuse of 15-year-old Icelanders in the 10th grade. Methods: The study is based on data collected for the Icelandic part of the Health Behaviour in School-aged Children study in 2014. Standardized questionnaires were sent to all students in the 10th grade in Iceland, of which 3618 participated (85% of all registered students in this grade). Results: Girls were more than twice as likely to be sexually abused as boys (20.2% versus 9.1%). Adolescents perceiving their families to be less well off than others were twice as likely to report sexual abuse as those of ample or medium family affluence. However, family affluence had more effect on the prevalence of abuse in girls than in boys. Conclusion: Female gender and low socioeconomic status may independently contribute to the risk of sexual abuse.

Socioeconomic inequality in childhood obesity and its determinants: a Blinder-Oaxaca decomposition

OBJECTIVE

Childhood obesity has become a priority health concern worldwide. Socioeconomic status is one of its main determinants. This study aimed to assess the socioeconomic inequality of obesity in children and adolescents at national and provincial levels in Iran.

METHODS

This multicenter cross-sectional study was conducted in 2011-2012, as part of a national school-based surveillance program performed in 40,000 students, aged 6-18-years, from urban and rural areas of 30 provinces of Iran. Using principle component analysis, the socioeconomic status of participants was categorized to quintiles. Socioeconomic status inequality in excess weight was estimated by calculating the prevalence of excess weight (i.e., overweight, generalized obesity, and abdominal obesity) across the socioeconomic status quintiles, the concentration index, and slope index of inequality. The determinants of this inequality were determined by the Oaxaca Blinder decomposition.

RESULTS

Overall, 36,529 students completed the study (response rate: 91.32%); 50.79% of whom were boys and 74.23% were urban inhabitants. The mean (standard deviation) age was 12.14 (3.36) years. The prevalence of overweight, generalized obesity, and abdominal obesity was 11.51%, 8.35%, and 17.87%, respectively. The SII for overweight, obesity and abdominal obesity was -0.1, -0.1 and -0.15, respectively. Concentration index for overweight, generalized obesity, and abdominal obesity was positive, which indicate inequality in favor of low socioeconomic status groups. Area of residence, family history of obesity, and age were the most contributing factors to the inequality of obesity prevalence observed between the highest and lowest socioeconomic status groups.

CONCLUSION

This study provides considerable information on the high prevalence of excess weight in families with higher socioeconomic status at national and provincial levels. These findings can be used for international comparisons and for healthcare policies, improving their programming by considering differences at provincial levels.

Gender disparity in pediatrics: a review of the current literature

BACKGROUND

Gender-based medicine is an innovative branch of biomedical research and represents a new perspective for the future of health research. Many studies have been published on gender medicine in adults but very few data regarding children are available.

LITERATURE SEARCH AND RESULTS

A literature search covering articles published between 1stJuly, 2006 and 1st February, 2017 and concerning children only was conducted using multiple keywords and standardized terminology in Pubmed database. The search was limited to English-language publications. All relevant articles on endocrines, neurological, psychiatric, gastrointestinal, immunological, oncological, rheumatic, pneumological disorders, infectious diseases and analgesia were evaluated and pertinent articles were included in this review. Most of the available studies on gender disparity in childhood are about endocrine and neuro-psychiatric disorders, while there are few data in other areas of medicine.

CONCLUSIONS

Even if several studies on pediatric gender differences can be found on literature, few of them move forwards to analyze the reasons of the observed diversity. No data on pharmacokinetic and pharmacodynamic differences between boys and girls can be found. Hence, more efforts should be directed to investigate these topics in childhood.

Gender differences and the role of parental education, school types and migration on the body mass index of 2930 Austrian school children : A cross-sectional study

BACKGROUND

Austria faces increasing numbers of childhood overweight and obesity. Despite increasing numbers of studies, associations between parental body mass index (BMI) and education and the school type on overweight/obesity in students have not been reported. The objective of this study was to evaluate the influence of these parameters on the genesis of overweight/obesity in a large cohort representative of youth in Upper Austrian.

METHODS

A cross-sectional analysis of data from 2930 children and adolescents aged 10, 14 or 17 years from 11 different state school types was conducted. Students and their parents completed a questionnaire and heights and weights were measured.

RESULTS

Of the students 16.9% fulfilled the criteria for overweight and 5.6% for obesity, with the highest rates in the 10-year-olds (19.6% and 5.8%, respectively). While no gender differences were present in the youngest age group, the body mass index (BMI) during adolescence remained higher in boys but decreased significantly in girls. Male gender remained a risk factor through all calculations. Boys were overrepresented in schools with lower education levels and more often had BMIs ≥ 85th and ≥95th percentile. Higher parental education levels and lower parental BMIs were associated with lower BMIs of their offspring. Migration was an additional association factor for BMIs ≥ 85th percentile.

CONCLUSION

Low parental education levels, higher parental BMIs and migration background were associated with overweight and obesity in 10-year-olds. In adolescence, male gender and higher parental BMIs remained risk factors.

Feeling 'too fat' rather than being 'too fat' increases unhealthy eating habits among adolescents - even in boys

Background

Adolescence is a period of gender-specific physical changes, during which eating habits develop. To better understand what factors determine unhealthy eating habits such as dieting to lose weight, skipping meals, and consumption of unhealthy foods, we studied how physical measurements and body perception relate to eating habits in boys and girls, before and during adolescence.

Methods

For this cross-sectional study, we obtained data from both written questionnaires and physical measurements of height, weight, and waist circumference (WC).

Results

Dieting to lose weight and skipping breakfast were more common among adolescents than among younger boys and girls (p<0.05). The strongest risk factor for dieting in both boys and girls was perception of overweight, which persisted after adjusting for age and for being overweight (p<0.01). Another independent risk factor for dieting behaviour was overweight, as defined by body mass index (BMI) among boys (p<0.01) and WC among girls (p<0.05). In both boys and girls, skipping breakfast was associated with both a more negative body perception and higher BMI (p<0.05). Skipping breakfast was also associated with age- and gender-specific unhealthy eating habits such as skipping other meals, lower consumption of fruits and vegetables, and higher consumption of sweets and sugary drinks (p<0.05).

Conclusion

Body perception among adolescents is an important factor relating to unhealthy eating habits, not only in girls, but even in boys. Focus on body perception and eating breakfast daily is crucial for the development of healthy food consumption behaviours during adolescence and tracking into adulthood.