Article

Simulation of Growth Trajectories of Childhood Obesity into Adulthood

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Background: Although the current obesity epidemic has been well documented in children and adults, less is known about long-term risks of adult obesity for a given child at his or her present age and weight. We developed a simulation model to estimate the risk of adult obesity at the age of 35 years for the current population of children in the United States. Methods: We pooled height and weight data from five nationally representative longitudinal studies totaling 176,720 observations from 41,567 children and adults. We simulated growth trajectories across the life course and adjusted for secular trends. We created 1000 virtual populations of 1 million children through the age of 19 years that were representative of the 2016 population of the United States and projected their trajectories in height and weight up to the age of 35 years. Severe obesity was defined as a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 35 or higher in adults and 120% or more of the 95th percentile in children. Results: Given the current level of childhood obesity, the models predicted that a majority of today's children (57.3%; 95% uncertainly interval [UI], 55.2 to 60.0) will be obese at the age of 35 years, and roughly half of the projected prevalence will occur during childhood. Our simulations indicated that the relative risk of adult obesity increased with age and BMI, from 1.17 (95% UI, 1.09 to 1.29) for overweight 2-year-olds to 3.10 (95% UI, 2.43 to 3.65) for 19-year-olds with severe obesity. For children with severe obesity, the chance they will no longer be obese at the age of 35 years fell from 21.0% (95% UI, 7.3 to 47.3) at the age of 2 years to 6.1% (95% UI, 2.1 to 9.9) at the age of 19 years. Conclusions: On the basis of our simulation models, childhood obesity and overweight will continue to be a major health problem in the United States. Early development of obesity predicted obesity in adulthood, especially for children who were severely obese. (Funded by the JPB Foundation and others.).

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Childhood obesity is a major public health concern because of its many adverse health outcomes [1][2][3] and because childhood obesity (and its comorbidities) can continue into adulthood [4,5]. Childhood obesity is a result of the complex interaction of environmental, genetic, behavioral, and socioeconomic factors [2,5]. ...
... Childhood obesity is a major public health concern because of its many adverse health outcomes [1][2][3] and because childhood obesity (and its comorbidities) can continue into adulthood [4,5]. Childhood obesity is a result of the complex interaction of environmental, genetic, behavioral, and socioeconomic factors [2,5]. Although the prevalence of childhood obesity varies between countries, the global prevalence of childhood obesity rose from 4% in 1975 to 18% in 2016 [6]. ...
... The prevalence of childhood overweight and obesity in the U.S. is well-reported [7][8][9][10][11][12][13]. For example, the prevalence of overweight tripled between 1980 and 2000 [3]; between 1999 and 2018, obesity increased from 13.9% to 19.3%, and severe obesity rose from 3.6% to 6.1% [7,8,14]. A recent study estimated that more than half of U.S. children between 2 and 19 years of age in 2016 will be obese by the age of 35 [5]. The probability that an obese child will still be obese at age 35 increases with age, from 74.9% for an obese 2-year-old child to 88.2% for an obese 19-year-old adolescent. ...
Article
Full-text available
This study evaluates the cross-sectional trends in body fat percentage (BF%) and body mass index (BMI) percentile rank, and the relationship between the two in 332 (177 boys, 155 girls) 12- to 17-year-old children. Body mass index (BMI) was calculated using measured height and body mass, and sex-specific BMI for age percentile rank was determined using CDC growth charts. Body fat percentage (BF%) was measured with DEXA. Fat mass index (FMI) and fat-free mass index (FFMI) were calculated by normalizing the fat mass and fat-free mass for height. Compared to boys of the same age, girls had significantly higher BF% and FMI values and lower FFMI values. Compared to boys, at a given BMI percentile rank, females had a higher BF% and FMI, and a lower FFMI. In both boys and girls, there was an exponential increase in adiposity above the 70th percentile rank. BMI percentile rank is not an equivalent indicator of body fatness in boys and girls. Other measures of body composition can further inform the practitioner of a child’s adiposity.
... Alarmingly, the global prevalence of childhood overweight and obesity has increased from only 4% in 1975 to 18% in 2016, indicating that over 124 million children and adolescents aged 5-19 had overweight or obesity [2]. This is concerning given that early childhood obesity is a significant predictor of adolescent and adult obesity [3][4][5][6], which is associated with increased risk of chronic diseases, such as heart disease and type 2 diabetes [2]. That is, early childhood (aged between 4 and 6 years) has been recognized as a critical period to promote and develop healthy PA behaviors that track through the lifespan [3][4][5][6], which may lead to long-term health benefits [1]. ...
... This is concerning given that early childhood obesity is a significant predictor of adolescent and adult obesity [3][4][5][6], which is associated with increased risk of chronic diseases, such as heart disease and type 2 diabetes [2]. That is, early childhood (aged between 4 and 6 years) has been recognized as a critical period to promote and develop healthy PA behaviors that track through the lifespan [3][4][5][6], which may lead to long-term health benefits [1]. activity (MVPA). ...
Article
Full-text available
Background: Motor skill competence (MSC) and perceived competence (PC) are primary correlates that are linked with physical activity (PA) participation, yet there is limited evidence of the mutual longitudinal or temporal associations between these variables in preschoolers. Therefore, this study's purpose was to examine the bidirectional relationships between MSC and PA, MSC and PC, and PC and PA in preschoolers over time. Methods: The final sample were 61 preschoolers (Mage = 4.45 years, ranging from 4 to 5) from two underserved schools. MSC was assessed using the Test of Gross Motor Development, Second Edition (TGMD-2). PC was assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children. PA was assessed using ActiGraph GT9X Link accelerometers during three consecutive school days. All assessments of MSC, PC, and PA were measured in identical conditions at schools at the baseline (T1) and the end of the eighth week (T2). We employed a cross-lagged model approach to understand the bidirectional relationships between MSC, PC, and PA. Results: The results showed that T1 MSC significantly predicted T2 MSC (p < 0.01) and T1 MSC significantly predicted T2 PA only in girls (p = 0.03). Additionally, a cross-lagged effect of T1 MSC and T2 PC was only observed in boys (p = 0.03). Lastly, a significant association for T1 moderate-to-vigorous physical activity (MVPA) and T2 PC was only observed in girls (p = 0.04). Conclusions: Bidirectional relationships between the variables were not observed in preschoolers. However, significant gender differences were observed in each cross-lagged model.
... Obesity is a major risk factor for atherosclerotic cardiovascular disease in adults (1,2). Childhood adiposity, which tracks into adulthood, also is associated with cardiovascular risk factors and disease in adulthood (3)(4)(5)(6)(7). Carotid intima-media thickness and distensibility are two measures of arterial structure and function, respectively. ...
... Previously, childhood overweight that normalizes in adulthood has been associated with the same risk of cardiovascular risk factors in adulthood, compared with having a healthy BMI across life (5). Obesity also tracks from childhood to adulthood (3,4). Therefore, on a population-based level, our findings underline the importance of a healthy BMI from infancy onward. ...
Article
Full-text available
Objective: Associations of obesity with cardiovascular disease may originate in childhood. This study examined critical periods for BMI in relation to arterial health at school age. Methods: Among 4,731 children from a prospective cohort study, associations of infant peak weight velocity, both age and BMI at adiposity peak, and BMI trajectories with carotid artery intima-media thickness and carotid artery distensibility at 10 years were examined. Results: A 1-standard deviation score (SDS) higher peak weight velocity and BMI at adiposity peak were associated with higher intima-media thickness (0.10 SDS; 95% CI: 0.06 to 0.13 and 0.08 SDS; 95% CI: 0.05 to 0.12) and lower distensibility (-0.07 SDS; 95% CI: -0.10 to -0.03 and -0.07 SDS; 95% CI: -0.11 to -0.03) at 10 years. For distensibility, current BMI explained these associations. Children within the highest BMI tertile at ages 2 and 10 years had the lowest distensibility (p < 0.05), but similar intima-media thickness, compared with children constantly within the middle tertile. Conclusions: Infant weight growth patterns and childhood BMI are associated with subtle differences in carotid intima-media thickness and carotid distensibility at school age. For distensibility, current BMI seems critical. Follow-up is needed to determine whether these associations lead to adult cardiovascular disease.
... Moreover, metaanalytic data suggest that the contribution of childhood and adolescent obesity to CVD risk may be driven primarily by tracking to adulthood obesity, as individuals who have overweight in childhood but normal weight in adulthood have comparable CVD risk measures as adults who were normal weight from childhood [43]. Given the high rate of persistence of obesity from childhood into adulthood [44], intervention earlier in life course to manage weight is likely more effective at preventing the later development of CVD risk phenotypes. While similar metabolic changes with improvement in BMI observed in this study may occur in older adults with obesity, irreversible vascular damage may already be present. ...
... There was also a lack of participants with BMI in the healthy range, which precludes the generalisability of the findings to all children and adolescents. However, our findings are relevant to a growing proportion of youth with obesity, as approximately 80% of children with obesity will still have obesity by adulthood [44] and therefore represent a population at high risk for later obesity-related co-morbidities. Another consideration is that in this study, we have focused on models with BMI as the exposure and metabolomic measures as the outcome, based on Mendelian randomisation studies that have reported BMI having a casual effect on NMR metabolomic measures [24]. ...
Article
Full-text available
Background Obesity in childhood is associated with metabolic dysfunction, adverse subclinical cardiovascular phenotypes and adult cardiovascular disease. Longitudinal studies of youth with obesity investigating changes in severity of obesity with metabolomic profiles are sparse. We investigated associations between (i) baseline body mass index (BMI) and follow-up metabolomic profiles; (ii) change in BMI with follow-up metabolomic profiles; and (iii) change in BMI with change in metabolomic profiles (mean interval 5.5 years). Methods Participants (n = 98, 52% males) were recruited from the Childhood Overweight Biorepository of Australia study. At baseline and follow-up, BMI and the % >95th BMI-centile (percentage above the age-, and sex-specific 95th BMI-centile) indicate severity of obesity, and nuclear magnetic resonance spectroscopy profiling of 72 metabolites/ratios, log-transformed and scaled to standard deviations (SD), was performed in fasting serum. Fully adjusted linear regression analyses were performed. Results Mean (SD) age and % >95th BMI-centile were 10.3 (SD 3.5) years and 134.6% (19.0) at baseline, 15.8 (3.7) years and 130.7% (26.2) at follow-up. Change in BMI over time, but not baseline BMI, was associated with metabolites at follow-up. Each unit (kg/m²) decrease in sex- and age-adjusted BMI was associated with change (SD; 95% CI; p value) in metabolites of: alanine (−0.07; −0.11 to −0.04; p < 0.001), phenylalanine (−0.07; −0.10 to −0.04; p < 0.001), tyrosine (−0.07; −0.10 to −0.04; p < 0.001), glycoprotein acetyls (−0.06; −0.09 to −0.04; p < 0.001), degree of fatty acid unsaturation (0.06; 0.02 to 0.10; p = 0.003), monounsaturated fatty acids (−0.04; −0.07 to −0.01; p = 0.004), ratio of ApoB/ApoA1 (−0.05; −0.07 to −0.02; p = 0.001), VLDL-cholesterol (−0.04; −0.06 to −0.01; p = 0.01), HDL cholesterol (0.05; 0.08 to 0.1; p = 0.01), pyruvate (−0.08; −0.11 to −0.04; p < 0.001), acetoacetate (0.07; 0.02 to 0.11; p = 0.005) and 3-hydroxybuturate (0.07; 0.02 to 0.11; p = 0.01). Results using the % >95th BMI-centile were largely consistent with age- and sex-adjusted BMI measures. Conclusions In children and young adults with obesity, decreasing the severity of obesity was associated with changes in metabolomic profiles consistent with lower cardiovascular and metabolic disease risk in adults.
... One study even reported a ten-fold increase in risk [6]. A recent study predicting obesity among future adults pointed out that 57% of today's children will be obese by the time they reach 35 years old [7]. Other than the risk of adulthood obesity, adolescents with obesity or overweight are prone to obesity-related diseases during their adolescence [2, 6,8]. ...
Article
Plasma levels of branched-chain amino acids (BCAA) and aromatic amino acids (AAA) are considered early metabolic markers of obesity and insulin resistance (IR). This study aimed to assess changes in plasma concentrations of BCAA/AAA and HOMA-IR2 (homeostasis model assessment of IR) after intervention-induced modifications in fat mass (FM) and fat-free mass (FFM) among French Polynesian adolescents. FM, FFM, plasma levels of BCAA and AAA, HOMA-IR2 were recorded at baseline and post intervention among 226 adolescents during a 5-month school-based intervention on diet and physical activity. Participants were divided into two subgroups according to their college attendance status which determined their intervention adherence: externs/half-residents (n = 157) and residents (n = 69). Four ordinal categories of body composition changes post-intervention were created for the analysis (FMgain/FFMlost < FMgain/FFMgain < FMlost/FFMlost < FMlost/FFMgain). After 5 months, changes in BCAA (p-trend < 0.001) and AAA (p-trend = 0.007) concentrations were positively associated with ordinal categories of body composition. HOMA-IR2 significantly decreased with FMlost (-0.40; 95% CI, -0.60 to -0.20) and increased with FMgain (0.23; 95% CI, 0.11 to 0.36). Our results suggest that FM loss is associated with a decrease in concentrations of obesity and IR metabolic markers which is more substantial when FM loss is accompanied with FFM gain.
... In particular, childhood obesity has shown a higher incidence rate compared to adulthood obesity, which is of substantial interest as it is a threat to the healthy growth of children [5]. Furthermore, childhood obesity can be a burden on public health resources because it often leads to adulthood obesity [6,7]. The risk of cardiovascular disease is increased by hypercholesterolemia, which is associated with the excessive consumption of saturated fatty acids (SFAs) [8,9]. ...
Article
Background/objectives: The prevalence of obesity has been increasing in Korean children. As an unhealthy diet is known as one of the major determinants of childhood obesity, assessing and monitoring dietary fat intake of children is needed. Subjects/methods: This analysis included 9,998 children aged 3-11 yrs from the 2007-2017 Korea National Health and Nutrition Examination Surveys. Dietary data were obtained from a single 24-h dietary recall. Intakes of total fat and fatty acids, including saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), n-3 fatty acid (n-3 FA), and n-6 fatty acid (n-6 FA) were evaluated as the absolute amount (g) and proportion of energy from each fatty acid (% of energy). The total fat and SFA intake were also assessed according to compliance with dietary guidelines. Linear trends in the dietary fats intake across the survey period were tested using multiple regression models. Results: Total fat intake significantly increased from 38.5 g (20.3% of energy) to 43.4 g (23.3% of energy) from 2007 to 2017. This increase was mainly accounted for the increases in intakes of SFA (7.2% to 8.4% of energy) and MUFA (6.2% to 7.5% of energy). PUFA intake increased from 4.4 to 4.7% of energy during the 11-yrs period: from 0.57 to 0.63% of energy for n-3 FA and from 3.8 to 4.1% of energy for n-6 FA. The proportions of children who consumed amounts exceeding the dietary guidelines for total fat and SFA significantly increased from 2007 to 2017, with increases from 9.8% to 17.4% for total fat and from 36.9% to 50.9% for SFA. Conclusions: Prominent increasing trends in the consumption of total fat and SFA but tiny change in n-3 FA intake were observed in Korean children. The healthy intake of dietary fats should be emphasized in this population.
... Once obesity is established in early life it may extend into adulthood, therefore creating a lifelong condition that is difficult to resolve (Geserick et al., 2018;Simmonds et al., 2016). Predictive modelling suggests, given the current levels of childhood obesity, that 60% of children today will have obesity by 35 years of age (Ward et al., 2017). ...
Article
Full-text available
The prevalence of childhood obesity is increasing worldwide with long-term health consequences. Effective strategies to stem the rising childhood obesity rates are needed but systematic reviews of interventions have reported inconsistent effects. Evaluation of interventions could provide more practically relevant information when considered in the context of the setting in which the intervention was delivered. This systematic review has evaluated diet and physical activity interventions aimed at reducing obesity in children, from birth to 5 years old, by intervention setting. A systematic review of the literature, consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Three electronic databases were searched from 2010 up to December 2020 for randomised controlled trials aiming to prevent or treat childhood obesity in children up to 5 years old. The studies were stratified according to the setting in which the intervention was conducted. Twenty-eight studies were identified and included interventions in childcare/school (n = 11), home (n = 5), community (n = 5), hospital (n = 4), e-health (n = 2) and mixed (n = 1) settings. Thirteen (46%) interventions led to improvements in childhood obesity measures, including body mass index z-score and body fat percentage, 12 of which included both parental/family-based interventions in conjunction with modifying the child's diet and physical activity behaviours. Home-based interventions were identified as the most effective setting as four out of five studies reported significant changes in the child's weight outcomes. Interventions conducted in the home setting and those which included parents/families were effective in preventing childhood obesity. These findings should be considered when developing optimal strategies for the prevention of childhood obesity.
... 13 Not only do rates of obesity rise as children get older, 14 recent evidence indicates that children who are obese are more likely to be obese as an adult. 15 Furthermore, they face higher risks of developing non-communicable diseases such as diabetes, cardiovascular disease and certain types of cancer during adulthood. 16 The economic burden of overweight and obesity is also striking. ...
... From 1975 to 2016, the number of children with obesity increased from 5 to 50 million for girls and 6 million to 74 million for boys [1]. Childhood obesity can lead to an increased risk of adult obesity, along with other worth-concerning health problems [2,3]. ...
Article
Full-text available
Objectives Global childhood obesity is of great concern. In 2019, the World Health Organization released global guidelines on movement behaviors for the children under 5 y of age to combat this epidemic. This study aimed to estimate the prevalence of Vietnamese preschoolers meeting the guidelines, and examined whether guideline compliance is associated with adiposity and motor development. Methods A cross-sectional study was conducted on 103 healthy preschoolers who were conveniently sampled from pre-schools in urban and rural areas around Ho Chi Minh city. Time spent in different intensities of physical activity and sedentary behavior was measured using Actigraph GT3X + accelerometers over three consecutive days. Sleep and screen time were obtained via parent questionnaires. Children were classified as meeting or not meeting the global guidelines. Height, weight, and motor skills were measured by the research staff. Regression models were applied to quantify the association between guideline compliance and adiposity and motor development, adjusting for age and sex. Results While 17.5% of children met all three guidelines, 5.8% met no guidelines. The prevalences of children who met guidelines for physical activity time, sleep duration, and screen time were 50.4%, 81.4%, and 44.7%, respectively. There was no association between guideline compliance and adiposity and motor development. Conclusion This study found a low proportion of children who met the global guidelines, whereas a high proportion of those with overweight and obesity was reported. Health programs should promote more physical activities of various intensities in young children.
... This is consistent with other findings that found a positive association between having breakfast and physical activity among school-going children [45]. Breakfast of poor quality is a risk factor for the development of overweight or obesity, as well as chronic conditions that can lead to adulthood obesity, hypertension, and diabetes [46,47]. ...
Article
Full-text available
Obesity is a global public health concern that begins in childhood and is on the rise among people aged 18 and up, with substantial health consequences that offer socioeconomic challenges at all levels, from households to governments. Obesity and associated risk factors were investigated in children and adolescents in the Eastern Cape Province of South Africa. A cross-sectional study was conducted at Mt Frere among 209 conveniently selected participants using anthropometric measurements and a structured questionnaire. Chi-squared statistics or Fisher’s exact test were used to evaluate the risk factors predicting different outcomes such as hypertension or diabetes mellitus. A 5% level of significance was used for statistical significance (p-value 0.05). The prevalence of overweight or obesity among females when using waist circumference (2.7%), triceps skinfold (6.9%), and body mass index cut-offs (16.4%) were respectively higher when compared to those of males. About 89% engaged in physical activities. After school, 53% watched television. About 24.9% of participants did not eat breakfast. Most of overweight or obese participants (92.9%) brought pocket money to school. Use of single anthropometric measurements for assessing nutritional status indicated inconclusive results. Strengthening parental care, motivation for consumption of breakfast and limiting pocket money for children going to school are important steps to improve child health.
... The findings from this study provide evidence of differing combinations of self-regulation across behavioral and eating domains, and the potential influence on children's obesity risk varies across self-regulation profiles. Obesity tracks from childhood through adolescence (75) and adulthood, (76) and based on the current prevalence of obesity in U.S. children, it is estimated that nearly 60% of children with obesity will become adults with obesity (77). The development of obesity in children and adolescents is particularly troubling given its links with a multitude of negative physical health outcomes, (78,79) and psychosocial and behavioral challenges (80). ...
Article
Full-text available
Appetitive traits that contribute to appetite self-regulation have been shown to relate to non-food-related regulation in general domains of child development. Latent profile analysis (LPA) was used to identify typologies of preschool children's behavioral self-regulation (BSR) and appetitive traits related to appetite self-regulation (ASR), and we examined their relation with children's BMIz and food parenting practices. Participants included 720 children and their parents (90% mothers), drawn from the baseline assessment of a childhood obesity preventive intervention. BSR measures included teacher reports of children's inhibitory control, impulsivity and attentional focusing, as well as an observed measure of inhibitory control. ASR was assessed using parents' reports of children's appetitive traits related to food avoidance ( e.g. , satiety responsiveness, slowness in eating) and food approach ( e.g. , enjoyment of food, food responsiveness). Children's body mass index z-score (BMIz) was calculated from measured height and weight. Parents' BMI and food parenting practices were also measured. Four profiles were identified that characterized children with dysregulated behavior, higher food approach and lower food avoidance (16%), dysregulated behavior but lower food approach and higher food avoidance (33%), regulated behavior but highest food approach and lowest food avoidance (16%), and highly-regulated behavior, lowest food approach and highest food avoidance (35%). Children's BMIz was highest in the profile consisting of children with dysregulated behavior, higher food approach and lower food avoidance. BMI was similar in the profile with children with regulated behavior but highest food approach and lowest food avoidance; children in this profile also had parents who reported the highest levels of controlling food parenting practices, and the lowest levels of parental modeling of healthy eating. Compared to all other profiles, children in the profile characterized by highly-regulated behavior, lowest food approach and highest food avoidance had the lowest BMIz and had parents who reported food parenting practices characterized by the highest levels of child control in feeding and the lowest levels of pressure to eat. These findings provide evidence of differing patterns of relations between self-regulation across behavioral and eating domains, and children's obesity risk may vary based on these different patterns.
... An estimated 57% of children in the US today will have obesity by the time they are 35, and roughly half of these cases will emerge during childhood (Ward et al., 2017). Parents play a major role in preventing obesity in their children, as they are responsible for selecting much of the child's diet (Moore et al., 2016;Spill et al., 2019). ...
Article
This study surveyed 185 parents to determine whether their perceived risk of their child developing obesity and their implicit theories about the malleability of weight independently and/or interactively predict their child-feeding and pursuit of child-related obesity risk information. Higher risk perceptions were associated with healthier feeding intentions and more information seeking. More incremental (malleable) beliefs predicted healthier feeding intentions and greater pursuit of environmental, but not genetic, information. Contrary to hypotheses, the influence of implicit theories and risk perceptions were primarily independent; however, more incremental beliefs predicted less “junk food” feeding among only parents with lower perceived risk.
... This statistic increases to a third by the time children enter secondary school [3]. Furthermore, longitudinal modelling suggests that once obesity is established in early life it tracks through adolescence to adulthood [4], thus creating a life-long condition [5]. Since the determinants of obesity are critically important for population health, there has been a major research effort in recent years to identify the responsible contributing factors in order to reduce rates of childhood obesity [6]. ...
Article
Full-text available
Background Rates of childhood obesity are increasing globally, with poor dietary quality an important contributory factor. Evaluation of longitudinal diet quality across early life could identify timepoints and subgroups for nutritional interventions as part of effective public health strategies. Objective This research aimed to: (1) define latent classes of mother-offspring diet quality trajectories from pre-pregnancy to child age 8–9 years, (2) identify early life factors associated with these trajectories, and (3) describe the association between the trajectories and childhood adiposity outcomes. Design Dietary data from 2963 UK Southampton Women’s Survey mother-offspring dyads were analysed using group-based trajectory modelling of a diet quality index (DQI). Maternal diet was assessed pre-pregnancy and at 11- and 34-weeks’ gestation, and offspring diet at ages 6 and 12 months, 3, 6-7- and 8–9-years using interviewer-administered food frequency questionnaires. At each timepoint, a standardised DQI was derived using principal component analysis. Adiposity age 8–9 years was assessed using dual-energy X-ray absorptiometry (DXA) and BMI z-scores. Results A five-trajectory group model was identified as optimal. The diet quality trajectories were characterised as stable, horizontal lines and were categorised as poor (n = 142), poor-medium (n = 667), medium (n = 1146), medium-better (n = 818) and best (n = 163). A poorer dietary trajectory was associated with higher maternal pre-pregnancy BMI, smoking, multiparity, lower maternal age and lower educational attainment. Using linear regression adjusted for confounders, a 1-category decrease in the dietary trajectory was associated with higher DXA percentage body fat (0.08 SD (95% confidence interval 0.01, 0.15) and BMI z-score (0.08 SD (0.00, 0.16) in the 1216 children followed up at age 8–9 years. Conclusion Mother-offspring dietary trajectories are stable across early life, with poorer diet quality associated with maternal socio-demographic and other factors and childhood adiposity. The preconception period may be an important window to promote positive maternal dietary changes in order to improve childhood outcomes.
... A secular trend in growth trajectories among children and adolescents has been documented globally [11,12]. A systematic review of 52 studies from India also reported an increase in the combined prevalence of overweight and obesity from 16.3% in 2001-05 to 19.3% in 2010 [13]. ...
Article
Background: The reference cut-offs for overweight and obesity have evolved from the use of International obesity task force (IOTF) to extended IOTF and revised Indian Academy of Pediatrics (IAP) growth charts. Methods: Secondary analysis of anthropometric data of school-going children from Delhi in the year 2008, 2013 and 2015 was performed. The proportions of children with overweight, obesity, and undernutrition were checked for agreement using different diagnostic cutoffs, and compared at three-time points. Results: Among 8417 adolescents, weighted Kappa statistics showed good agreement between extended IOTF and IAP cutoffs (k=0.933; 95% CI 0.93-0.94), between eIOTF and IOTF (k=0.624; 95% CI 0.619 - 0.629) and between IAP and IOTF (k=0.654; 95% CI 0.645-0.662). A higher proportion of adolescents were diagnosed with obesity with extended IOTF and IAP charts than IOTF charts (P<0.001 for both genders). The mean (SD) BMI showed a rising trend for adolescents overall from 19.61 (3.89) kg/m2 in 2008, 20.44 (4.37) kg/m2 in 2013 and 20.88 (4.60) kg/m2 in 2015 (P<0.001). 158 adolescent (97 girls) were undernourished using combined IAP and extended IOTF criteria. Conclusion: Both extended IOTF and IAP charts showed good agreement for diagnosing overweight and obesity in adolescents. A secular trend in malnutrition was observed in adolescent girls.
... [21][22][23] The mechanisms underlying how age at onset of overweight contributes to hypertension remain unclear. Given that few individuals with young-onset overweight return to normal weight later in life, 24 the strong association between hypertension and overweight in younger adulthood as opposed to later adulthood may be explained by longer duration of exposure to excess adiposity. 25 It is well known that overweight and obesity arise from the interplay between genetic and environmental factors. ...
Article
Full-text available
Objective The aim of this study was to examine the association between age at onset of overweight and incident hypertension. Methods We analysed 4742 participants with new-onset overweight from the Kailuan study between 2006 and 2015 and and 4742 age-matched and sex-matched controls selected randomly from the same cohort but with normal weight. Participants were compared with respect to subsequent risk of hypertension, with sub-HR calculated with the Fine and Gray model, according to age of onset of overweight. Results Over a mean follow-up period of 5.17 years, 1642 overweight participants (34.6%) and 1293 normal-weight controls (27.3%) were subsequently diagnosed with hypertension. The median age at onset of overweight was 49.1 years. Compared with normal-weight controls, the multivariable-adjusted sub-HR for hypertension among participants with onset of overweight at 18–39 years of age, 40–49 years of age, 50–59 years of age and ≥60 years of age was 1.38 (95% CI 1.11 to 1.72), 1.27 (95% CI 1.09 to 1.49), 1.23 (95% CI 1.09 to 1.38) and 1.14 (95% CI 0.99 to 1.32), respectively. Onset of overweight in each age range was significantly associated with increased risk of hypertension, except for the group with onset at ≥60 years of age. The risk increased with each decade of attenuation of age at onset, peaking at 18–39 years of age. Conclusions Younger age at onset of overweight across adulthood was associated with significantly increased risk of hypertension, with the highest relative risk among participants with onset of overweight at 18–39 years of age.
... Physical activity has positive effects on physical and mental functions in children, and is also important in relation to risk factors for lifestyle-related diseases that have been detected at increasingly young age, such as overweight/obesity and type 2 diabetes (Berman et al., 2012;Swedish Research Council for Sport Science, 2017). A sedentary lifestyle with insufficient PA is a main contributor to childhood obesity (Wolfenden et al., 2016), a disease that tracks into adulthood (Simmonds et al., 2016;Ward et al., 2017), which underscores the importance of addressing physical inactivity early in life. The WHO recommends that all children between 6 and 17 years should be active, preferably in any aerobic exercise, at least one hour per day at moderate-to-high intensity, and that sedentary time and recreational screen time should be limited (Bull et al., 2020). ...
Article
Full-text available
Background Many children with intellectual developmental disorders are insufficiently physically active and do not reach recommendations for physical activity. Pediatric healthcare providers play a key role in addressing these children’s needs, including promoting interventions for physical activity. Aim To explore pediatric healthcare providers’ perceived needs, barriers, and facilitators for promoting physical activity for children with intellectual developmental disorders. Methods Semi-structured focus groups, analyzed using qualitative content analysis. Sixteen healthcare providers participated. Results Main findings are the importance of parental support and engagement, need for structure, and stakeholder collaboration to bridge the gap between pediatric organizations and external stakeholders. Conclusion The study highlights the need for developing and implementing strategies to promote physical activity for children with intellectual developmental disorders in pediatric health care, and for producing guidelines regarding physical activity interventions for this vulnerable group.
... Given the growing prevalence of cardiovascular risk factors in childhood (2,3) and the likely impact this will have on EVA, focus should shift to primordial prevention to promote cardiovascular health from early life. For the time being, more work is required to identify the determinants and consequences of EVA in children and adolescents and the most effective and sustainable lifestyle prescription to counteract EVA in early life and to promote longevity. ...
... Interestingly, when using the linear annual rate of increase reported in that study and the prevalence of obesity among adults in Los Angeles in 2011, we estimated that the projected prevalence of obesity in 2074 would be ∼67%. A study of the growth trajectory, which used a simulation model, also found that about 57.3% could become obese by the age of 35 (42). Lastly, the predicted life-time risk of diagnosed diabetes from age 20 was estimated to be about 40% for men and women in a nationally representative sample (43). ...
Article
Full-text available
Background Obesity is a major public health problem affecting millions of Americans and is considered one of the most potent risk factors for type 2 diabetes. Assessing future disease burden is important for informing policy-decision making for population health and healthcare. Objective The aim of this study was to develop a computer model of a cohort of children born in Los Angeles County to study the life course incidence and trends of obesity and its effect on type 2 diabetes mellitus. Methods We built the Virtual Los Angeles cohort—ViLA, an agent-based model calibrated to the population of Los Angeles County. In particular, we developed the ViLA-Obesity model, a simulation suite within our ViLA platform that integrated trends in the causes and consequences of obesity, focusing on diabetes as a key obesity consequence during the life course. Each agent within the model exhibited obesity- and diabetes-related healthy and unhealthy behaviors such as sugar-sweetened beverage consumption, physical activity, fast-food consumption, fresh fruits, and vegetable consumption. In addition, agents could gain or lose weight and develop type 2 diabetes mellitus with a certain probability dependent on the agent's socio-demographics, past behaviors and past weight or type 2 diabetes status. We simulated 98,230 inhabitants from birth to age 65 years, living in 235 neighborhoods. Results The age-specific incidence of obesity generally increased from 10 to 30% across the life span with two notable peaks at age 6–12 and 30–39 years, while that of type 2 diabetes mellitus generally increased from <2% at age 18–24 to reach a peak of 25% at age 40–49. The 16-year risks of obesity were 32.1% (95% CI: 31.8%, 32.4%) for children aged 2–17 and 81% (95% CI: 80.8%, 81.3%) for adults aged 18–65. The 48-year risk of type 2 diabetes mellitus was 53.4% (95% CI: 53.1%, 53.7%) for adults aged 18–65. Conclusion This ViLA-Obesity model provides an insight into the future burden of obesity and type 2 diabetes mellitus in Los Angeles County, one of the most diverse places in the United States. It serves as a platform for conducting experiments for informing evidence-based policy-making.
... The continuing burden of obesity [1] is not shared but is concentrated in populations from ethnic and racial minority backgrounds [2] and lower education and income levels [3]. This is reflected internationally, where youth such as non-Hispanic black (22%) and Hispanic (26%) youth in the United States (US) exhibit a higher obesity prevalence compared to those from non-Hispanic white backgrounds (14%) [4]. ...
Article
Full-text available
The unrelenting obesity pandemic in Middle Eastern (ME) adolescents living in Australia warrants culturally responsive and locally engineered interventions. Given the influence of parents on the lifestyle behaviours of adolescents, this qualitative study aimed to capture the opinions of ME parents on the barriers and enablers to sufficient physical activity and limiting screen time behaviours in adolescents. Semi-structured interviews were conducted with 26 ME parents (female) aged 35–59 years old, most of whom resided in lower socioeconomic areas (n = 19). A reflexive thematic analysis using the Theoretical Domains Framework and the Capability, Opportunity, Motivation-Behaviour model was performed for coding. Parents voiced confidence in their knowledge of the importance of physical activity and limiting screen time but were less optimistic in their ability to enable change in behaviours, especially for older adolescents without outside support. Despite adolescents having the necessary skills to engage in a wide array of sports, the parents admitted deep fears regarding the safety of the social environment and restricted their children’s independent mobility. Gender differences were noted, with parents reporting older girls expressing disinterest in sports and having limited physical opportunities to participate in sports at school. It may be that a community-based participatory framework is needed to improve physical activity opportunities and to address specific physical, social, and cultural barriers.
... For nearly half a century, the rapidly increasing prevalence of childhood overweight/obesity has raised worldwide concern [1]. Mounting evidence has demonstrated that childhood obesity, often tracking into adulthood [2], can increase risks of numerous adverse consequences in later life, such as metabolic syndrome, cardiovascular diseases, type 2 diabetes, and some cancers [3,4]. Thus, it is important to identify early-life risk factors for childhood obesity. ...
Article
Full-text available
Background Childhood overweight/obesity is a global public health concern. It is important to identify its early-life risk factors. Maternal poor sleep is common in late pregnancy, and previous studies indicated that poor sleep may influence the offspring’s adiposity status. However, very few studies in humans investigated the effect of the different sleep parameters (sleep quantity, quality, and timing) on the offspring’s adiposity indicators, and long-term studies are even more scarce. In addition, the underlying mechanism remains unclear. The present study therefore aimed to examine the association between the three maternal sleep dimensions in the late pregnancy and the offspring adiposity indicators and to explore the potential mediating effect of the cord blood DNA methylation in the above association. Methods Included participants in the current study were 2211 healthy pregnant women with singleton gestation from the Shanghai Birth Cohort (SBC) and Shanghai Sleep Birth Cohort (SSBC). Maternal nighttime sleep duration, quality, and midpoint (an indicator of circadian rhythm) were assessed by the same instrument in both cohorts during late pregnancy, and the offspring’s body mass index (BMI) and subcutaneous fat (SF) were measured at 2 years old. Additionally, in 231 SSBC samples, the genome-wide DNA methylation levels were measured using the Illumina Infinium Methylation EPIC BeadChip. The multivariate linear regression was used to determine the associations between the maternal sleep parameters and the offspring adiposity indicators. The epigenome-wide association study was conducted to identify the maternal sleep-related CpG sites. The mediation analysis was performed to evaluate the potential intermediate role of DNA methylation in the association between maternal sleep and offspring adiposity indicators. Results The mean maternal nighttime sleep duration and the sleep midpoint for combined cohorts were 9.24 ± 1.13 h and 3.02 ± 0.82, respectively, and 24.5% of pregnant women experienced poor sleep quality in late pregnancy. After adjusting for the covariates, the maternal later sleep midpoint was associated with the increased SF in offspring (Coef. = 0.62, 95% CI 0.37–0.87, p < 0.001) at 2 years old. However, no significant associations of the nighttime sleep duration or sleep quality with the offspring adiposity indicators were found. In the SSBC sample, 45 differential methylated probes (DMPs) were associated with the maternal sleep midpoint, and then, we observed 10 and 3 DMPs that were also associated with the offspring’s SF and BMI at 2 years, of which cg04351668 (MARCH9) and cg12232388 significantly mediated the relationship of sleep midpoint and SF and cg12232388 and cg12225226 mediated the sleep midpoint–BMI association, respectively. Conclusions Maternal later sleep timing in late pregnancy was associated with higher childhood adiposity in the offspring. Cord blood DNA methylation may play a mediation role in that relationship.
... Introduction Childhood obesity is a non-communicable disease that has drastically increased in prevalence worldwide, with an increase from 30 million children under aged 5 years affected in 2000 to nearly 39 million in 2020 [1]. Furthermore, childhood obesity is usually carried over to adulthood, with a 1.3 fold increase in the risk of developing adulthood obesity compared with nonobese children [2]. In addition, children with obesity have a higher risk of developing metabolic disorders and disabilities, such as diabetes, in later life [3]. ...
Article
Full-text available
The preventive effects of regular exercise on obesity-related health problems are carried over to the non-exercise detraining period, even when physical activity decreases with aging. However, it remains unknown whether regular childhood exercises can be carried over to adulthood. Therefore, this study aimed to investigate the effects of long-term childhood exercise and detraining on lipid accumulation in organs to prevent obesity in adulthood. Four-week-old male Otsuka Long-Evans Tokushima Fatty (OLETF) rats were used as obese animals. OLETF rats were allocated into sedentary and exercise groups: exercise from 4- to 12-week-old and detraining from 12- to 20-week-old. At 12-week-old immediately after the exercise period, regular exercise completely inhibited hyperphagia, obesity, enlarged pancreatic islets, lipid accumulation and lobular inflammation in the liver, hypertrophied adipocytes in the white adipose tissue (WAT), and brown adipose tissue (BAT) whitening in OLETF rats. Additionally, exercise attenuated the decrease in the ratio of muscle wet weight to body weight associated with obesity. Decreased food consumption was maintained during the detraining period, which inhibited obesity and diabetes at 20-week-old after the detraining period. Histologically, childhood exercise inhibited the enlargement of pancreatic islets after the detraining period. In addition, inhibition of lipid accumulation was completely maintained in the WAT and BAT after the detraining period. However, the effectiveness was only partially successful in lipid accumulation and inflammation in the liver. The ratio of muscle wet weight to body weight was maintained after detraining. In conclusion, early long-term regular exercise effectively prevents obesity and diabetes in childhood, and its effectiveness can be tracked later in life. The present study suggests the importance of exercise during childhood and adolescence to inhibit hyperphagia-induced lipid accumulation in metabolic-related organs in adulthood despite exercise cessation.
... Overweight and obesity in children can have serious health consequences. Furthermore, children who are overweight or obese are more likely to also have weight problems in adulthood and to develop illnesses such as diabetes type II, cardiovascular diseases, and musculoskeletal disorders in later life [3][4][5]. Preventing overweight and obesity in childhood is, therefore, an important public health priority. ...
Article
Full-text available
Overweight and obesity in children are an increasing public health problem. Health literacy (HL) is a determinant of obesity and body mass index (BMI) rates in adults, but few studies have addressed the impact of children’s own HL on their weight and lifestyle. In this study, we aim to assess the impact of Dutch children’s HL on (1) their BMI z-score, (2) dietary behaviour, and (3) the amount of physical activity (PA) they engage in. A sample of 139 children (age 8–11 years) filled out a digital questionnaire, including an HL measurement instrument and questions regarding their food intake and PA. Furthermore, the height and weight of the children were measured, and background information was collected using a parental questionnaire. Multiple regression revealed a significant positive relation between children’s HL and their PA. No significant association between children’s HL and their BMI z-score or dietary behaviour was found. HL of children in primary school thus has an impact on some aspects of children’s lifestyle, although more research in a larger, more diverse sample is needed to further investigate this.
... Notably, childhood obesity and the psychosocial influence of racial and ethnic disparities at a young age may have an unforeseen contribution to the obesity epidemic [9,10]. Current growth trajectories predict that over half of toddlers and children will be obese by the age of 35 [11]. Supporting these trajectories, clinical and experimental studies have shown that prenatal life and early childhood determine the predisposition of the individual to gain weight and/or develop impairments in energy metabolism homeostasis [12,13]. ...
Article
Full-text available
Background Adverse childhood experiences (ACEs) are an independent risk factor for chronic diseases, including type 2 diabetes, stroke and ischemic heart disease. However, the effect of ACEs considering sex and race are not often reported in cohorts showing multiracial composition, with power to evaluate effects on underrepresented populations. Aim To determine how sex and race affected the association of combined and individual ACEs with metabolic health biomarkers in the Southern Community Cohort Study (2012–2015). Methods Self-reported data were analyzed from ACE surveys performed during the second follow-up of a cohort comprised by over 60% of Black subjects and with an overall mean age of 60 years. Results BMI steadily increased with cumulative ACEs among Black and White women, but remained relatively stable in White men with ≥ 4 ACEs. Contrary, Black men showed an inverse association between ACE and BMI. Secondary analysis of metabolic outcomes showed that physical abuse was correlated with a 4.85 cm increase in waist circumference in Black subjects. Total cholesterol increased among individuals with more than 4 ACEs. In addition, increases in HbA1c were associated with emotional and maternal abuse in Black women and sexual abuse in White women. Conclusions BMI is strongly associated with cumulative ACEs in women regardless the race, while waist circumference is strongly associated with ACEs in Black individuals, which combined with reduced BMI may indicate increased central adiposity in Black men. Our study suggests that sex and race influence the contribution of certain ACEs to impair metabolic health.
... Kegemukan pada masa ini dapat meningkatkan risiko kegemukan di masa remaja bahkan dewasa. Di antara anak-anak yang mengalami obesitas, ditemukan bahwa kemungkinan mereka akan tetap mengalami obesitas pada usia 35 tahun meningkat seiring dengan bertambahnya usia, sebesar 74,9% (Ward et al., 2017). Tahun 2010, sebanyak 43 juta anak (35 juta diantaranya berasal dari negara berkembang) mengalami kegemukan dan obesitas (De Onis et al., 2010). ...
Article
Full-text available
Obesity incidence in children, especially primary school children, is increasing. This obesity can be caused by environmental factors: availability of food at home and the home environment or home environment such as the physical environment, exposure to screen time, mother knowledge, and maternal behaviour in providing feeding practices. This study aims to determine the difference between food availability and home environment for obese and non-obese children. The design of this research was case-control conducted with the subject of elementary school-age children in Yogyakarta city. The research was conducted in March-November 2017. Samples were chosen by the multistage sampling method. Subjects were grouped into children with obese nutritional status as a case (n=71) and children with normal nutritional status as control (n=71) based on the BFA index. The data were collected by anthropometric measurements, interviewing, and filling out Home Environment Survey questionnaires on children and their parents. Data analysis using Mann Whitney statistical test, Spearman test, McNemar test, and logistic regression. Food availability showed significant mean differences in case and control groups (p <0,05). Other environmental factors showed no significant differences, but in the case group, the mother's feeding scores were less healthy than the control group; the average duration of case group screen time was higher than 20 minutes than the control group; higher physical environmental support scores control group than case groups. In conclusion, food availability had significant mean differences in both groups.
... The prevalence of adolescent obesity is rising worldwide at an alarming rate, with dire projections for the near future. Currently it is estimated that nearly 60% of US children will develop obesity by their early thirties, mostly by adolescence, with half progressing to severe obesity [40]. With rising levels of obesity, we may expect a continued rise in type 1 diabetes. ...
Article
Full-text available
Aims/hypothesis Studies in children have reported an association between increased BMI and risk for developing type 1 diabetes, but evidence in late adolescence is limited. We studied the association between BMI in late adolescence and incident type 1 diabetes in young adulthood. Methods All Israeli adolescents, ages 16–19 years, undergoing medical evaluation in preparation for mandatory military conscription between January 1996 and December 2016 were included for analysis unless they had a history of dysglycaemia. Data were linked with information about adult onset of type 1 diabetes in the Israeli National Diabetes Registry. Weight and height were measured at study entry. Cox proportional models were applied, with BMI being analysed both as a categorical and as a continuous variable. Results There were 777 incident cases of type 1 diabetes during 15,819,750 person-years (mean age at diagnosis 25.2±3.9 years). BMI was associated with incident type 1 diabetes. In a multivariable model adjusted for age, sex and sociodemographic variables, the HRs for type 1 diabetes were 1.05 (95% CI 0.87, 1.27) for the 50th–74th BMI percentiles, 1.41 (95% CI 1.11, 1.78) for the 75th–84th BMI percentiles, 1.54 (95% CI 1.23, 1.94) for adolescents who were overweight (85th–94th percentiles), and 2.05 (95% CI 1.58, 2.66) for adolescents with obesity (≥95th percentile) (reference group: 5th–49th BMI percentiles). One increment in BMI SD was associated with a 25% greater risk for incidence of type 1 diabetes (HR 1.25, 95% CI 1.17, 1.32). Conclusions Excessively high BMI in otherwise healthy adolescents is associated with increased risk for incident type 1 diabetes in early adulthood. Graphical abstract
... Physical inactivity is, alongside a poor diet, the main driver of childhood obesity [6]. As obesity in childhood tracks into adulthood [7,8], addressing physical inactivity in early life is crucial. Particularly in middle childhood, social factors and physical inactivity are important risk factors for obesity [9]. ...
Article
Full-text available
Background Physical inactivity is a main cause of childhood obesity which tracks into adulthood obesity, making it important to address early in life. Physical activity on prescription (PAP) is an evidence-based intervention that has shown good effect on physical activity levels in adults, but has not been evaluated in children with obesity. This project aims to evaluate the prerequisites, determinants, and feasibility of implementing PAP adapted to children with obesity and to explore children’s, parents’, and healthcare providers’ experiences of PAP. Methods In the first phase of the project, healthcare providers and managers from 26 paediatric clinics in Region Västra Götaland, Sweden, will be invited to participate in a web-based survey and a subset of this sample for a focus group study. Findings from these two data collections will form the basis for adaptation of PAP to the target group and context. In a second phase, this adapted PAP intervention will be evaluated in a clinical study in a sample of approximately 60 children with obesity (ISO-BMI > 30) between 6 and 12 years of age and one of their parents/legal guardians. Implementation process and clinical outcomes will be assessed pre- and post-intervention and at 8 and 12 months’ follow-up. Implementation outcomes are the four core constructs of the Normalization Process Theory; coherence, cognitive participation, collective action, and reflexive monitoring; and appropriateness, acceptability, and feasibility of the PAP intervention. Additional implementation process outcomes are recruitment and attrition rates, intervention fidelity, dose, and adherence. Clinical outcomes are physical activity pattern, BMI, metabolic risk factors, health-related quality of life, sleep, and self-efficacy and motivation for physical activity. Lastly, we will explore the perspectives of children and parents in semi-structured interviews. Design and analysis of the included studies are guided by the Normalization Process Theory. Discussion This project will provide new knowledge regarding the feasibility of PAP for children with obesity and about whether and how an evidence-based intervention can be fitted and adapted to new contexts and populations. The results may inform a larger scale trial and future implementation and may enhance the role of PAP in the management of obesity in paediatric health care in Sweden. Trial registration ClinicalTrials.gov Identifier: NCT04847271 , registered 14 April 2021.
... There are numerous factors contributing to childhood and adolescent obesity including gender, biology, geographical and socio-economical aspects, amongst others [12][13][14] . It is paramount that immediate preventive and management plans are instituted to effectively deal with childhood and adolescent obesity that inevitably will have a repercussion on their life course with potential development of adult obesity [15][16][17] . This narrative review aims to provide a holistic understanding of the various factors contributing to the global childhood and adolescent epidemic while exploring their significance especially now amidst a pandemic to ensure a sustainable global future. ...
Article
Full-text available
Purpose Childhood obesity is a global epidemic and a chronic disease. Multifactorial determinants have long been linked with childhood obesity. These have been challenged with the onset of COVID-19 and the associated mitigation measures. The study aimed to re-highlight these determinants while exploring the effects of the ongoing COVID-19 pandemic on these pre-existing childhood obesity determinants, while providing evidence that may be beneficial for the post-Covid-19 recovery plan. Methods A PubMed literature search (2016-2021) using the keywords, “childhood obesity”, “gender”, “sex”, “obesity in youth”, “obesity in adolescents”, “COVID-19” and “SARS-CoV2” was performed. Results Genetic predisposition, biologically low leptin levels, certain cultural beliefs and socio-economic statuses, as well as exposure to an “obesogenic” environment were found to have a positive association with childhood obesity. Additionally, the onset of COVID-19 further aggravates the childhood obesity epidemic, increasing childrens’ susceptibility to obesity and all associated consequential diseases. Discussion A possible key to the control and prevention of the burden of childhood obesity, lies in dealing with its precursors and risk factors. Certain factors, including socio-cultural norms, cultural beliefs and geographical factors are amenable. COVID-19 further challenged these and it is evident that the childhood obesity epidemic is still a critical one. Encouraging preventative interventions, such as screening programs, public awareness and policies targeting the environment, amongst others, are recommended.
... Nowadays, the prevalence of overweight and obesity is alarmingly increasing in children and adolescents, increasing the risk of noncommunicable diseases in adulthood and, as a result, premature death [1]. It is estimated that 57.3% of children with obesity between the age of 2 and 19 in 2016 will continue to be obese at the age of 35 years [2]. Moreover, approximately 81% of adolescents globally do not achieve the recommended 60 min of physical activity per day [3]. ...
Article
Full-text available
Background: Balanced nutrition is crucial for adolescent's proper physical and mental development. Dietary habits change significantly with a child's development. Along with increasing age and the shift towards adolescence, unhealthy diet-related habits become more common. The objective of the survey study was to determine the differences in nutritional habits between children and adolescents according to their age and body mass index (BMI). Methods: "Let's get the kids moving" campaign (pol. "Uruchamiamy dzieciaki") was launched in 2016. Within the campaign, the survey study was conducted in 2913 participants between 6 and 17 years old from primary and junior high schools in Wroclaw (Poland). The survey was anonymous, and its supplement was voluntary. Participants were divided into age groups. The study group of 2913 consisted of 29.8% of 6-9-year-olds, 32.7% of 10-12-year-olds, and 37.5% of 13-17-year-olds. Body mass index (BMI) was calculated and further interpreted as a BMI z-scores depending on children's age and gender. Results: A total of 19.3% of participants consumed 3 meals a day or less. Children from the oldest age group (13-17) consumed statistically significantly fewer meals per day than younger children (p < 0.001). Children from the oldest age group (13-17) consumed breakfast statistically less often than children of age group 10-12 years (75.0% vs. 83.6%; p < 0.001) and children of age group 6-9 years (75.0% vs. 84.0%; p < 0.001). Severely thin children consumed breakfast significantly more often than overweight (85.8% vs. 76.3%; p = 0.004) and children with obesity (85.8% vs. 75.9%; p = 0.021). Children with obesity consumed vegetables significantly less often than severely thin (p < 0.008), thin (p < 0.001), and children with normal body weight (p < 0.007). The oldest children (13-17 years) consumed Coca-Cola and SSB (p < 0.001) and fruit-flavored beverages (p < 0.05) significantly more often than children from other age groups. Boys consumed carbonated beverages with added sugar significantly more often than girls (p < 0.01). Conclusions: Unhealthy diet-related behaviors in children and adolescents may promote overweight and obesity and should be targeted in health promotion programs. Special attention should be paid to 13-17-year-olds, as adolescents from this group made more unhealthy choices than younger children.
... Due to the rapid nutritional transition and the increasing prevalence of overweight and obesity around the world, many countries, especially the low-income countries, had the double burden of underweight and overnutrition [2]. It was well-known that BMI status had trajectory, and the direct evidence was that the childhood obesity predicted obesity in adulthood, which increased the risks of multiple chronic diseases, such as hypertension, diabetes, hyperlipidemia, chronic respiratory diseases, cardiovascular and cerebrovascular diseases [3]. Similarly, underweight at childhood also had a positive association with higher risk of infectious diseases and late growth retardation [4]. ...
Article
Full-text available
Objective To assess the effects of prepubertal BMI on pubertal growth patterns, and the influence of prepubertal BMI and pubertal growth patterns on long-term BMI among Chinese children and adolescents. Methods A total of 9606 individuals aged between 7 and 18 years from longitudinal surveys in Zhongshan city of China from 2005 to 2016 were enrolled. Age at peak height velocity (APHV) and peak height velocity (PHV) were estimated using Super-Imposition by Translation and Rotation (SITAR) model. Associations between prepubertal BMI, APHV, PHV, and long-term overweight and obesity were assessed by linear regression and multinominal logistic regression. Scatter plots were elaborated to show the associations between prepubertal BMI and pubertal growth patterns according to prepubertal BMI categories. Results Prepubertal BMI Z-Score was positively correlated with long-term BMI Z-Score, and negatively correlated with APHV in both sexes. In addition, there was a negative association between prepubertal BMI Z-Score and PHV in boys. With 1-year decrease in APHV, risk of long-term underweight decreased by 92%, while overweight increased by 33% in boys. Corresponding risk of long-term underweight and overweight for girls decreased by 42% and increased by 20%, respectively. Conclusion High prepubertal BMI levels were associated with earlier APHV and lower PHV, and the early onset of pubertal development could increase the risks of long-term overweight and obesity at 17–18 years of age both in boys and girls. Such evidence emphasized the importance of reducing prepubertal obesity risks combined with appropriate pubertal development timing, including later APHV and higher PHV, so as to prevent the obesity and related cardiovascular diseases in adulthood.
... While both hyperplasia and hypertrophy are contributing factors to adipose tissue expansion and obesity in adults, hyperplasic processes play a much more critical role in children's adipose tissue and hyperplasia is significantly increased in obese children (Landgraf et al., 2015), potentially making them more susceptible to adipogenic compounds facilitating or accelerating adipose tissue expansion. Obese children have a 90% chance of being overweight as adolescents (Geserick et al., 2018) and the early onset of overweight and obesity in children is a determining factor for co-morbidities in adulthood (Korner et al., 2007;Vukovic et al., 2019;Ward et al., 2017). ...
Article
Full-text available
The obesity pandemic is presumed to be accelerated by endocrine disruptors such as phthalate-plasticizers, which interfere with adipose tissue function. With the restriction of the plasticizer di-(2-ethylhexyl)-phthalate (DEHP), the search for safe substitutes gained importance. Focusing on the master regulator of adipogenesis and adipose tissue functionality, the peroxisome proliferator-activated receptor gamma (PPARγ), we evaluated 20 alternative plasticizers as well as their metabolites for binding to and activation of PPARγ and assessed effects on adipocyte lipid accumulation. Among several compounds that showed interaction with PPARγ, the metabolites MINCH, MHINP, and OH-MPHP of the plasticizers DINCH, DINP, and DPHP exerted the highest adipogenic potential in human adipocytes. These metabolites and their parent plasticizers were further analyzed in human preadipocytes and mature adipocytes using cellular assays and global proteomics. In preadipocytes, the plasticizer metabolites significantly increased lipid accumulation, enhanced leptin and adipsin secretion, and upregulated adipogenesis-associated markers and pathways, in a similar pattern to the PPARγ agonist rosiglitazone. Proteomics of mature adipocytes revealed that both, the plasticizers and their metabolites, induced oxidative stress, disturbed lipid storage, impaired metabolic homeostasis, and led to proinflammatory and insulin resistance promoting adipokine secretion. In conclusion, the plasticizer metabolites enhanced preadipocyte differentiation, at least partly mediated by PPARγ activation and, together with their parent plasticizers, affected the functionality of mature adipocytes similar to reported effects of a high-fat diet. This highlights the need to further investigate the currently used plasticizer alternatives for potential associations with obesity and the metabolic syndrome.
... [1] An alarming fact is that worldwide trends in overweight and obesity in children are increasing rapidly, from 1975 to 2016 the obese child population surged from 4% to 18%. [1] Importantly, childhood or adolescent obesity has an impact on adult life [2] in the increased incidence rate of type 2 diabetes, cardiovascular complications and various types of cancers. [3,4] Although BMI is heritable (in 25-40%), genetic obesity is less than 5% of cases of childhood obesity. ...
Article
Excessive lipid accumulation is a serious problem in obesity leading to adipose tissue (AT) overgrowth, chronic inflammation, endothelial dysfunction, and elevated risk of cardiovascular complications. In this work, Raman techniques coupled with fluorescence imaging were applied to characterize the effects of short-term (2 weeks) and extended (up to 8 weeks) high-fat diet (HFD) feeding on various depots of the adipose tissue of young and mature mice. Our results proved the synergistic effect of age and HFD-induced obesity manifested by changes in the morphology of adipocytes and the chemical composition of lipids. After 2 weeks of HFD feeding of young animals, substantial hypertrophy of adipocytes but only for the periaortic adipose tissue was detected with a significant decrease in lipid unsaturation degree solely in the epididymal white adipose tissue. The periaortic AT did not altered chemically due to short-term HFD feeding, however, it changed with age and with prolonged exposure to harmful factors. For older animals only brown AT remains resistant on HFD underlying its protective role and highlighting its potential as a target in obesity therapies.
... However, in children with obesity, thorough clinical and biochemical examination can reveal prediabetes, dyslipidemia and elevated blood pressure -all of which can be characterized as part of the metabolic syndrome (MetS) (4)(5)(6). Onset of obesity in childhood is associated with increased risk of continuous obesity into adulthood and development of T2D in adulthood (7,8). Obesity in childhood is also associated with an increased risk of developing other diseases in adulthood, including CVD, hypertension, sleep apnea, and certain cancers (9)(10)(11). ...
Article
Full-text available
Introduction: Childhood obesity is an increasing condition associated with continuous obesity into adulthood and development of comorbidities. Adult studies show an association between serum uric acid (SUA) levels and body mass index (BMI). The aim of this retro perspective exploratory study was to investigate SUA in obese children and adolescents and the effects of a subsequent weight reduction. Materials and Methods: One hundred and seventy-one children (age 4–18), with obesity (i.e. BMI-SDS of +2 or higher) were included in a multifactorial lifestyle intervention. The children participating were annually measured for anthropometrics, blood samples and DEXA-scans for up to 3 years. Eighty-nine children were included for follow-up analysis. Results: After a follow-up of 20.7 ± 9.4 months a reduction in BMI-SDS of −0.34 ± 0.53 ( p < 0.01) was observed. SUA was found to be positively associated with changes in BMI-SDS. SUA levels decreased in the 65 children who lost weight during the trial, conversely, SUA increased in the 23 children who gained weight during the trial ( p < 0.01 between groups). Conclusion: SUA was found to correlate with measures of obesity and for the first time, this intervention demonstrates a positive relationship between SUA and weight reduction in children with obesity.
Article
Background: Lifestyle behaviors (LB), defined by diet and physical activity, are associated with cardiometabolic health among adults. The association of LB with cardiometabolic health among middle-school children is uncertain. Methods: An abbreviated version of the School Physical Activity and Nutrition survey was used to examine LB among students participating in a wellness program between 2004 and 2018. Students were incorporated into three groups determined by self-reported healthy LB (≥6, 4-5, ≤3 behaviors), including; ≤1 serving/day sugary foods/beverages; ≤1 serving/day fried/fatty foods; ≥1 serving/day fruits and vegetables; ≤2 hours of screen time/day; ≥1 day/week of physical education; ≥1 team sport/year; and ≥1 session/week of moderate to vigorous activity. Baseline cardiometabolic parameters [BMI, lipids, glucose, and blood pressure (BP)], resting heart rate (HR), and HR recovery were examined in association with LB groups. Results: Of 2538 children, 488 (19.2%) reported ≥6, 1219 (48.0%) reported 4-5, and 831 (32.7%) reported ≤3 LB. White or Asian race and higher socioeconomic status were associated with ≥6 LB (p < 0.001). Students performing ≤3 LB exhibited higher BMI (p < 0.001), BP (p = 0.001), resting HR (p < 0.001), and HR recovery (p < 0.001). Students performing ≥6 LB were less likely to be overweight (p < 0.001), obese (p < 0.001), or have low high-density lipoprotein (p = 0.05); however, more likely to have elevated triglycerides (p < 0.01). Conclusions: Among middle-school students, baseline BMI, BP, resting, and recovery HR were higher among children reporting fewer healthy LB. Students performing more healthy LB were less likely to be overweight or obese. Efforts to improve LB among middle-school children may be important for primordial cardiovascular prevention efforts.
Article
Full-text available
In this article, we describe the advances in the field of pediatrics that have been published in the Italian Journal of Pediatrics in 2020. We report progresses in understanding allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, orthopedics, respiratory tract illnesses, rheumatology in childhood.
Article
Background: Obesity treatment based on glucagon-like peptide-1 receptor agonists (GLP-1 RAs) proved to limit morbidity and mortality in adult population. In children, optimizing lifestyle intervention and reducing culpable environmental exposures represents the mainstay strategy for obesity prevention and management. However, there remains a subset of children and adolescents whose obesity is resistant to lifestyle approach. For these poor responders, the need for safe and effective weight reducing agents is apparent. The purpose of this review is to provide an overview of the efficacy and safety of approved GLP-1 RA in the management of adult and paediatric obesity. Summary: We presented the main outcomes of clinical trial programs called SCALE and STEP that supported a market authorization approval for liraglutide and semaglutide for the treatment of obesity in adult population. Then we summarised the studies on the efficacy of GLP-1 RA in paediatric obesity that have been accumulating from two larger studies with liraglutide and few other smaller studies with exenatide and liraglutide. The results indicate that GLP-1RA are safe, tolerable, and effective in reducing weight and also in improving cardiometabolic profile in children with obesity and poor response to lifestyle intervention alone. At present, liraglutide is the first and so far the only GLP-1 RA, that received FDA approval in 2020 for use in children age 12-17 years with obesity. New trials including semaglutide for paediatrics obesity are ongoing. Key messages: There is a strong interest in current use and further development of obesity treatments based on GLP-1 agonism. In adolescents with obesity, who are poor responders to lifestyle approach, the use of GLP-1 RA as an adjunct to lifestyle intervention is effective and safe. Due to limited experience, a general recommendation is to prioritise long acting over short acting GLP-1 RA because they are approved for the treatment of obesity and have better tolerability, safety and treatment response effect. In the future research, more high-grade evidence including novel iterations of GLP-1 agonism and long-term follow-ups are needed in paediatrics population.
Article
Background Despite the public health significance of overweight and obesity, weight management has remained a low priority for health-related programming on university campuses. Objective Investigate the need for and feasibility of implementing university-based weight loss programs. Methods The Practical, Robust Implementation and Sustainability Model (PRISM) was used as a framework. Semi-structured individual interviews were conducted with fifteen university staff and students from two large U.S. universities in the Northeast and Mid-Atlantic. Interviews aimed to assess readiness, preferences, characteristics, barriers and facilitators in each of the four adapted PRISM domains: (1) Organizational and Recipient (Student) Perspectives on the Intervention, (2) Recipient (Student) Characteristics, (3) Internal Environment (organizational characteristics and infrastructure), and (4) External Environment. Verbatim transcriptions were analyzed using inductive and deductive thematic analyses. Themes were extracted as outlined by Consensual Qualitative Research. Results Participants supported university-based weight loss programs, but recognized barriers of resources, coordination across entities, and competing health issues taking priority for school programming. Campus built environment and students’ busy schedules were identified as barriers to maintaining healthy weight and participation in weight loss programs. Recommendations included designing weight loss programming with a positive and holistic approach, minimizing weight-stigma, ensuring support from university leaders and students, and securing external funding. Conclusions The identified themes provide recommendations for universities looking to develop and implement weight loss programming.
Article
Importance: Abundant evidence links obesity with adverse health consequences. However, controversies persist regarding whether overweight status compared with normal body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is associated with longer survival and whether this occurs at the expense of greater long-term morbidity and health care expenditures. Objective: To examine the association of BMI in midlife with morbidity burden, longevity, and health care expenditures in adults 65 years and older. Design, setting, and participants: Prospective cohort study at the Chicago Heart Association Detection Project in Industry, with baseline in-person examination between November 1967 and January 1973 linked with Medicare follow-up between January 1985 and December 2015. Participants included 29 621 adults who were at least age 65 years in follow-up and enrolled in Medicare. Data were analyzed from January 2020 to December 2021. Exposures: Standard BMI categories. Main outcomes and measures: (1) Morbidity burden at 65 years and older assessed with the Gagne combined comorbidity score (ranging from -2 to 26, with higher score associated with higher mortality), which is a well-validated index based on International Classification of Diseases, Ninth Revision codes for use in administrative data sets; (2) longevity (age at death); and (3) health care costs based on Medicare linkage in older adulthood (aged ≥65 years). Results: Among 29 621 participants, mean (SD) age was 40 (12) years, 57.1% were men, and 9.1% were Black; 46.0% had normal BMI, 39.6% were overweight, and 11.9% had classes I and II obesity at baseline. Higher cumulative morbidity burden in older adulthood was observed among those who were overweight (7.22 morbidity-years) and those with classes I and II obesity (9.80) compared with those with a normal BMI (6.10) in midlife (P < .001). Mean age at death was similar between those who were overweight (82.1 years [95% CI, 81.9-82.2 years]) and those who had normal BMI (82.3 years [95% CI, 82.1-82.5 years]) but shorter in those who with classes I and II obesity (80.8 years [95% CI, 80.5-81.1 years]). The proportion (SE) of life-years lived in older adulthood with Gagne score of at least 1 was 0.38% (0.00%) in those with a normal BMI, 0.41% (0.00%) in those with overweight, and 0.43% (0.01%) in those with classes I and II obesity. Cumulative median per-person health care costs in older adulthood were significantly higher among overweight participants ($12 390 [95% CI, $10 427 to $14 354]) and those with classes I and II obesity ($23 396 [95% CI, $18 474 to $28 319]) participants compared with those with a normal BMI (P < .001). Conclusions and relevance: In this cohort study, overweight in midlife, compared with normal BMI, was associated with higher cumulative burden of morbidity and greater proportion of life lived with morbidity in the context of similar longevity. These findings translated to higher total health care expenditures in older adulthood for those who were overweight in midlife.
Article
Full-text available
Blood pressure (BP) assessment and management are important aspects of care for youth with obesity. This study evaluates data of youth with obesity seeking care at 35 pediatric weight management (PWM) programs enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). Data obtained at a first clinical visit for youth aged 3–17 years were evaluated to: (1) assess prevalence of BP above the normal range (high BP); and (2) identify characteristics associated with having high BP status. Weight status was evaluated using percentage of the 95th percentile for body mass index (%BMIp95); %BMIp95 was used to group youth by obesity class (class 1, 100% to < 120% %BMIp95; class 2, 120% to < 140% %BMIp95; class 3, ≥140% %BMIp95; class 2 and class 3 are considered severe obesity). Logistic regression evaluated associations with high BP. Data of 7943 patients were analyzed. Patients were: mean 11.7 (SD 3.3) years; 54% female; 19% Black non‐Hispanic, 32% Hispanic, 39% White non‐Hispanic; mean %BMIp95 137% (SD 25). Overall, 48.9% had high BP at the baseline visit, including 60.0% of youth with class 3 obesity, 45.9% with class 2 obesity, and 37.7% with class 1 obesity. Having high BP was positively associated with severe obesity, older age (15–17 years), and being male. Nearly half of treatment‐seeking youth with obesity presented for PWM care with high BP making assessment and management of BP a key area of focus for PWM programs.
Article
We examined associations between sex‐specific alcohol intake trajectories and alcohol‐related cancer risk using data from 22,756 women and 15,701 men aged 40‐69 years at baseline in the Melbourne Collaborative Cohort Study. Alcohol intake for 10‐year periods from age 20 until the decade encompassing recruitment, calculated using recalled beverage‐specific frequency and quantity, was used to estimate group‐based sex‐specific intake trajectories. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated for primary invasive alcohol‐related cancer (upper aerodigestive tract, breast, liver and colorectum). Three distinct alcohol intake trajectories for women (lifetime abstention, stable light, increasing moderate) and six for men (lifetime abstention, stable light, stable moderate, increasing heavy, early decreasing heavy, late decreasing heavy) were identified. 2,303 incident alcohol‐related cancers were diagnosed during 485,525 person‐years in women and 789 during 303,218 person‐years in men. For men, compared with lifetime abstention, heavy intake (mean≥60 g/day) at age 20‐39 followed by either an early (from age 40‐49) (early decreasing heavy; HR=1.75, 95% CI: 1.25‐2.44) or late decrease (from age 60‐69) (late decreasing heavy; HR=1.94, 95% CI: 1.28‐2.93), and moderate intake (mean<60 g/day) at age 20‐39 increasing to heavy intake in middle‐age (increasing heavy; HR=1.45, 95% CI: 1.06‐1.97) were associated with increased risk of alcohol‐related cancer. For women, compared with lifetime abstention, increasing intake from age 20 (increasing moderate) was associated with increased alcohol‐related cancer risk (HR=1.25, 95% CI: 1.06‐1.48). Similar associations were observed for colorectal (men) and breast cancer. Heavy drinking during early adulthood might increase cancer risk later in life. This article is protected by copyright. All rights reserved.
Article
Objective To gain insight into the extent of body mass index (BMI) change during an academic year for children with overweight or obesity at entry to an early learning programme with nutrition and physical activity components ( Head Start). We explored whether meeting with families to discuss weight and nutrition and age of entry in the programme were associated with movement towards healthy weight via a reduction in BMI. Design Quantitative analyses of administrative Head Start data of children aged 3–5 years old who entered the programme with a BMI labelled as overweight or obese. Setting Children who participated in a Head Start early learning programme in the Southwest USA. Method Descriptive analyses of BMI changes over the Head Start programme year. Ordinary least square regression analyses were run to explore whether a meeting with a family regarding their child’s weight and nutrition (i.e. a family service event) and age of entry predicted BMI change over the programme year. Results Children with BMI labelled as overweight or obese, on average, reduced BMI over the academic year. Unexpectedly, having a family service event was related to an increase in BMI over the school year. Earlier age of entry predicted reduced BMI over the programme year. Conclusion Head Start programming appears well suited to support decreases in prevalence of childhood obesity and that earlier entry was better. A meeting with families regarding their child’s weight and nutrition predicted an increase in BMI, though several factors indicated the need for more nuanced research on the types and intensity of these events.
Article
Background and Objective: India currently faces the triple burden of malnutrition characterized by the coexistence of undernutrition and overnutrition along with micronutrient deficiencies. The unequal distribution of child health outcomes in the population may affect the goal of a ‘malnutrition free world’. The nutritional status and its inequalities among post under-five age have rarely been assessed in the country. This study examines the degree and extent of asset-based household wealth inequalities in malnutrition among preschool and school children in the Maharashtra state of India. Methods: The study utilizes the fourth round of the District Level Health Survey 2012-2013 to provide district-level estimates of the inequalities in five malnutrition indicators-stunting, wasting, underweight, overweight, and anemia among children. Concentration curves, normalized concentration index, geographical maps and correlation matrix are used to analyze the data by districts, rural-urban residence and gender. Results: Considerable proportion of children are malnourished in Maharashtra, even with its advanced economic status. Malnutrition levels among school going children are as high as those of children under six years of age. The findings indicate that malnutrition inequalities manifest primarily among the weaker sections of society. However, children from affluent households are more likely to suffer from overweight and obesity issues. The prevalence of malnutrition is higher in rural areas, but inequality is significantly higher in urban regions. The nutritionally backward areas are concentrated in the tribal districts of the Marathwada division and a few others from Vidarbha and Amravati. Many districts of Maharashtra have multiple burdens of malnutrition and have high inequalities on more than one indicator. A negative correlation is observed between the prevalence of malnutrition and human development indicators. Conclusion: There is a need to capture broader age groups in the nutrition monitoring frameworks. Recognizing the regional heterogeneity in the malnutrition prevalence and distribution calls for unique health intervention strategies to specific district targets.
Article
Full-text available
Introduction Women with obesity are at a higher risk of infertility as well as gestational and neonatal complications. Lifestyle changes are universally recommended for women with obesity seeking fertility treatments, but such intervention has only been assessed in very few robust studies. This study’s objectives are therefore to assess the clinical outcomes and cost-effectiveness of an interdisciplinary lifestyle intervention (the Fit-For-Fertility Programme; FFFP) targeting women with obesity and subfertility in a diverse population. Methods and analysis This pragmatic multicentre randomised controlled trial (RCT) will include 616 women with obesity (body mass index ≥30 kg/m ² or ≥27 kg/m ² with polycystic ovary syndrome or at-risk ethnicities) who are evaluated at a Canadian fertility clinic for subfertility. Women will be randomised either to (1) the FFFP (experimental arm) alone for 6 months, and then in combination with usual care for infertility if not pregnant; or (2) directly to usual fertility care (control arm). Women in the intervention group benefit from the programme up to 18 months or, if pregnant, up to 24 months or the end of the pregnancy (whichever comes first). Women from both groups are evaluated every 6 months for a maximum of 18 months. The primary outcome is live birth rate at 24 months. Secondary outcomes include fertility, pregnancy and neonatal outcomes; lifestyle and anthropometric measures; and cost-effectiveness. Qualitative data collected from focus groups of participants and professionals will also be analysed. Ethics and dissemination This research study has been approved by the Research Ethics Board (REB) of Centre intégré universtaire de santé et des services sociaux de l’Estrie—CHUS (research coordinating centre) on 10 December 2018 and has been or will be approved successively by each participating centres’ REB. This pragmatic RCT will inform decision-makers on improving care trajectories and policies regarding fertility treatments for women with obesity and subfertility. Trial registration number NCT03908099 . Protocol version: 1.1, 13 April 2019
Article
School physical activity breaks are currently being proposed as a way to improve students’ learning. However, there is no clear evidence of the effects of active school breaks on academic-related cognitive outcomes. The present systematic review with meta-analysis scrutinized and synthesized the literature related to the effects of active breaks on students’ attention. On January 12th, 2021, PubMed, PsycINFO, Scopus, SPORTDiscus, and Web of Science were searched for published interventions with counterbalanced cross-over or parallel-groups designs with a control group, including school-based active breaks, objective attentional outcomes, and healthy students of any age. Studies’ results were qualitatively synthesized, and meta-analyses were performed if at least three study groups provided pre-post data for the same measure. Results showed some positive acute and chronic effects of active breaks on attentional outcomes (i.e., accuracy, concentration, inhibition, and sustained attention), especially on selective attention. However, most of the results were not significant. The small number of included studies and their heterogeneous design are the primary limitations of the present study. Although the results do not clearly point out the positive effects of active breaks, they do not compromise students’ attention. The key roles of intensity and the leader of the active break are discussed.
Article
Purpose To examine the associations and interactions between levels of food security and emotional and behavioral disorders with obesity in adolescents. Methods Multiple logistic regression modeling was used to analyze the association of adolescent obesity with levels of food security and emotional and behavior disorders in children aged 12–17 years using data from National Health Interview Survey 2016–2018 combined years. Presence of emotional and behavioral disorders within food security categories was added to logistic regression modeling to examine interactions. Results When added individually to multiple logistic regression models, marginal and low food security, Attention Deficit Hyperactivity Disorder (ADHD) and anxiety were associated with increased odds of obesity, but very low food security and depression were not. Within the group of adolescents with very low food security, those with anxiety, depression, or ADHD had a nearly two to three-fold increase in odds of obesity compared to adolescents with very low food security and no emotional and behavioral disorders. A similar increase in the odds of obesity with the presence of anxiety, depression, or ADHD was not seen in the adolescents with high food security. Discussion This study finds a significant interaction between food security level and emotional and behavioral disorders. The distinction that very low food security in adolescents is only associated with obesity when either anxiety, depression or ADHD are present, but not independently, is an important contribution to understanding complex interactions contributing to obesity.
Article
Background: Worldwide, More than 340 million children and adolescents have overweight problems, and snacking habits are likely contributing factors. However, little is known about habitual snack consumption in school, especially regarding snack types that may lead to overweight. Purpose: Our study aims to analyse the association between habitual snack consumption and the prevalence of overweight in junior high school students. Methods: An observational study with a cross-sectional design was conducted in Tasikmalaya, West Java, Indonesia, involving 397 participants from five public junior high schools. The habitual snack consumption included the consumption habits of various types of snacks (sweet-fried snacks, salty-fried snacks, sweet-non-fried snacks, salty-non-fried snacks, fruits, and sugar-sweetened beverages) measured by a food frequency questionnaire (FFQ) and categorised into rarely and often. The overweight status was determined based on the BMI-for-age z-score (BAZ) and categorised into not-overweight and overweight. We analysed the data using a logistic regression test. Results: The habits of often consuming sweet-fried snacks (p<0.001; aOR=5.448; 95% CI=2.303–12.886), salty-fried snacks (p=0.040; aOR=3.662; 95%CI=1.063-12.621), and sugar-sweetened beverages (p=0.026; aOR= 3.100; 95%CI=1.143-8.407) were risk factors associated with overweight. Conclusion: The habit of often consuming sweet-fried snacks was a risk factor for being overweight with the greatest odds. Therefore, education on healthy snacks could be included in school learning materials to prevent overweight in adolescent students.
Article
BACKGROUND Recess has been shown to increase total daily energy expenditure, which may favorably impact body mass index by decreasing adiposity. This study examines associations between recess participation and adiposity. METHODS The study sample included male (N = 1434) and female (N = 1409) children 5 to 11 years of age participating in the 2013-2016 National Health and Nutrition Examination Survey. Overweight and obesity were defined using age- and sex-specific percentiles. Recess participation interview questions were answered via proxy response. RESULTS Compared to a referent group participating in recess 5 days/week for >30 minutes/day and independent of demographic and behavioral factors, analysis revealed significantly greater odds of obesity in females reporting no recess participation (odds ratio 1.80; 95% confidence interval, 1.03-3.15, p = .03). Furthermore, minority females were consistently found to possess greater odds of overweight and obesity independent of recess participation time. Only Mexican American boys were found to have greater odds of obesity independent of participation recess time. CONCLUSIONS In a large nationally representative sample of US children, reporting no recess was associated with significantly greater odds of obesity in females. Minority females were also more likely to be overweight and obese and Mexican American boys are more likely to be obese independent of recess participation time.
Article
Full-text available
Background: Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. Methods: Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4-14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5-<25·0 kg/m(2). Findings: All-cause mortality was minimal at 20·0-25·0 kg/m(2) (HR 1·00, 95% CI 0·98-1·02 for BMI 20·0-<22·5 kg/m(2); 1·00, 0·99-1·01 for BMI 22·5-<25·0 kg/m(2)), and increased significantly both just below this range (1·13, 1·09-1·17 for BMI 18·5-<20·0 kg/m(2); 1·51, 1·43-1·59 for BMI 15·0-<18·5) and throughout the overweight range (1·07, 1·07-1·08 for BMI 25·0-<27·5 kg/m(2); 1·20, 1·18-1·22 for BMI 27·5-<30·0 kg/m(2)). The HR for obesity grade 1 (BMI 30·0-<35·0 kg/m(2)) was 1·45, 95% CI 1·41-1·48; the HR for obesity grade 2 (35·0-<40·0 kg/m(2)) was 1·94, 1·87-2·01; and the HR for obesity grade 3 (40·0-<60·0 kg/m(2)) was 2·76, 2·60-2·92. For BMI over 25·0 kg/m(2), mortality increased approximately log-linearly with BMI; the HR per 5 kg/m(2) units higher BMI was 1·39 (1·34-1·43) in Europe, 1·29 (1·26-1·32) in North America, 1·39 (1·34-1·44) in east Asia, and 1·31 (1·27-1·35) in Australia and New Zealand. This HR per 5 kg/m(2) units higher BMI (for BMI over 25 kg/m(2)) was greater in younger than older people (1·52, 95% CI 1·47-1·56, for BMI measured at 35-49 years vs 1·21, 1·17-1·25, for BMI measured at 70-89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46-1·56, vs 1·30, 1·26-1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. Interpretation: The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations. Funding: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, US National Institutes of Health.
Article
Full-text available
Non-Alcoholic Fatty Liver Disease (NAFLD) is now the most prevalent form of chronic liver disease, affecting 10%-20% of the general paediatric population. Within the next 10 years it is expected to become the leading cause of liver pathology, liver failure and indication for liver transplantation in childhood and adolescence in the Western world. While our understanding of the pathophysiological mechanisms underlying this disease remains limited, it is thought to be the hepatic manifestation of more widespread metabolic dysfunction and is strongly associated with a number of metabolic risk factors, including insulin resistance, dyslipidaemia, cardiovascular disease and, most significantly, obesity. Despite this, "paediatric" NAFLD remains under-studied, under-recognised and, potentially, undermanaged. This article will explore and evaluate our current understanding of NAFLD in childhood and adolescence and how it differs from adult NAFLD, in terms of its epidemiology, pathophysiology, natural history, diagnosis and clinical management. Given the current absence of definitive radiological and histopathological diagnostic tests, maintenance of a high clinical suspicion by all members of the multidisciplinary team in primary and specialist care settings remains the most potent of diagnostic tools, enabling early diagnosis and appropriate therapeutic intervention.
Article
Full-text available
Background Obesity is a serious childhood health problem today. Studies have shown that overweight and obesity tend to be stable (track) from birth, through childhood and adolescence, to adulthood. However, existing studies are heterogeneous; there is still no consensus on the strength of the association between high birth weight or high body mass index (BMI) early in life and overweight and obesity later in life, nor on the appropriate age or target group for intervention and prevention efforts. This study aimed to determine the presence and degree of tracking of overweight and obesity and development in BMI and BMI standard deviation scores (SDS) from childhood to adolescence in the Fit Futures cohort from North Norway. Methods Using a retrospective cohort design, data on 532 adolescents from the Fit Futures cohort were supplemented with height and weight data from childhood health records, and BMI was calculated at 2–4, 5–7, and 15–17 years of age. Participants were categorized into weight classes by BMI according to the International Obesity Taskforce’s age- and sex-specific cut-off values for children 2–18 years of age (thinness: adult BMI <18.5 kg/m2, normal weight: adult BMI ≥18.5- < 25 kg/m2, overweight: adult BMI ≥25- < 30 kg/m2, obesity: adult BMI ≥30 kg/m2). Non-parametric tests, Cohen’s weighted Kappa statistic and logistic regression were used in the analyses. ResultsThe prevalence of overweight and obesity combined, increased from 11.5 % at 2–4 years of age and 13.7 % at 5–7 years of age, to 20.1 % at 15–17 years of age. Children who were overweight/obese at 5–7 years of age had increased odds of being overweight/obese at 15–17 years of age, compared to thin/normal weight children (crude odds ratio: 11.1, 95 % confidence interval: 6.4–19.2). Six out of 10 children who were overweight/obese at 5–7 years of age were overweight/obese at 15–17 years of age. Conclusions The prevalence of overweight and obesity increased with age. We found a moderate indication of tracking of overweight/obesity from childhood to adolescence. Preventive and treatment initiatives among children at high risk of overweight and obesity should start before 5–7 years of age, but general preventive efforts targeting all children are most important.
Article
Full-text available
Policy makers seeking to reduce childhood obesity must prioritize investment in treatment and primary prevention. We estimated the cost-effectiveness of seven interventions high on the obesity policy agenda: a sugar-sweetened beverage excise tax; elimination of the tax subsidy for advertising unhealthy food to children; restaurant menu calorie labeling; nutrition standards for school meals; nutrition standards for all other food and beverages sold in schools; improved early care and education; and increased access to adolescent bariatric surgery. We used systematic reviews and a microsimulation model of national implementation of the interventions over the period 2015-25 to estimate their impact on obesity prevalence and their cost-effectiveness for reducing the body mass index of individuals. In our model, three of the seven interventions-excise tax, elimination of the tax deduction, and nutrition standards for food and beverages sold in schools outside of meals-saved more in health care costs than they cost to implement. Each of the three interventions prevented 129,000-576,000 cases of childhood obesity in 2025. Adolescent bariatric surgery had a negligible impact on obesity prevalence. Our results highlight the importance of primary prevention for policy makers aiming to reduce childhood obesity. © 2015 by Project HOPE - The People-to-People Health Foundation.
Article
Full-text available
Efforts to expand Medicaid while controlling spending must be informed by a deeper understanding of the extent to which the high medical costs associated with severe obesity (having a body mass index of 35 kg/m2 or higher) determine spending at the state level. Our analysis of population-representative data indicates that in 2013, severe obesity cost the nation approximately $69 billion, which accounted for 60 percent of total obesity-related costs. Approximately 11 percent of the cost of severe obesity was paid for by Medicaid, 30 percent by Medicare and other federal health programs, 27 percent by private health plans, and 30 percent out of pocket. Overall, severe obesity cost state Medicaid programs almost $8 billion a year, ranging from $5 million in Wyoming to $1.3 billion in California. These costs are likely to increase following Medicaid expansion and enhanced coverage of weight loss therapies in the form of nutrition consultation, drug therapy, and bariatric surgery. Ensuring and expanding Medicaid-eligible populations' access to costeffective treatment for severe obesity should be part of each state's strategy to mitigate rising obesity-related health care costs.
Article
Full-text available
Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.
Article
Full-text available
Background State-level estimates from the Centers for Disease Control and Prevention (CDC) underestimate the obesity epidemic because they use self-reported height and weight. We describe a novel bias-correction method and produce corrected state-level estimates of obesity and severe obesity. Methods Using non-parametric statistical matching, we adjusted self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS) 2013 (n = 386,795) using measured data from the National Health and Nutrition Examination Survey (NHANES) (n = 16,924). We validated our national estimates against NHANES and estimated bias-corrected state-specific prevalence of obesity (BMI≥30) and severe obesity (BMI≥35). We compared these results with previous adjustment methods. Results Compared to NHANES, self-reported BRFSS data underestimated national prevalence of obesity by 16% (28.67% vs 34.01%), and severe obesity by 23% (11.03% vs 14.26%). Our method was not significantly different from NHANES for obesity or severe obesity, while previous methods underestimated both. Only four states had a corrected obesity prevalence below 30%, with four exceeding 40%–in contrast, most states were below 30% in CDC maps. Conclusions Twelve million adults with obesity (including 6.7 million with severe obesity) were misclassified by CDC state-level estimates. Previous bias-correction methods also resulted in underestimates. Accurate state-level estimates are necessary to plan for resources to address the obesity epidemic.
Article
Full-text available
Background: High childhood obesity prevalence has raised concerns about future adult health, generating calls for obesity screening of young children. Objective: To estimate how well childhood obesity predicts adult obesity and to forecast obesity-related health of future US adults. Design: Longitudinal statistical analyses; microsimulations combining multiple data sets. Data sources: National Longitudinal Survey of Youth, Population Study of Income Dynamics, and National Health and Nutrition Evaluation Surveys. Methods: The authors estimated test characteristics and predictive values of childhood body mass index to identify 2-, 5-, 10-, and 15 year-olds who will become obese adults. The authors constructed models relating childhood body mass index to obesity-related diseases through middle age stratified by sex and race. Results: Twelve percent of 18-year-olds were obese. While screening at age 5 would miss 50% of those who become obese adults, screening at age 15 would miss 9%. The predictive value of obesity screening below age 10 was low even when maternal obesity was included as a predictor. Obesity at age 5 was a substantially worse predictor of health in middle age than was obesity at age 15. For example, the relative risk of developing diabetes as adults for obese white male 15-year-olds was 4.5 versus otherwise similar nonobese 15-year-olds. For obese 5-year-olds, the relative risk was 1.6. Limitation: Main results do not include Hispanics due to sample size. Past relationships between childhood and adult obesity and health may change in the future. Conclusion: Early childhood obesity assessment adds limited information to later childhood assessment. Targeted later childhood approaches or universal strategies to prevent unhealthy weight gain should be considered.
Article
Full-text available
Rapid early postnatal weight gain predicts increased subsequent obesity and related disease risks. However, the exact timing of adverse rapid postnatal weight gain is unclear. The objective was to examine the associations between rapid weight gain in infancy and in early childhood in relation to body composition at age 17 y. This prospective cohort study was conducted in 248 (103 males) singletons and their mothers. Height and weight were measured at birth, 6 mo, and 3 and 6 y. The rates of weight gain during infancy (0-6 mo) and early childhood (3-6 y) were calculated as changes in sex- and age-adjusted weight SD scores during these time periods. At 17 y, body composition was measured by air-displacement plethysmography. Increasing weight gain during infancy and early childhood were both independently associated with larger body mass index, fat mass, relative fat mass, fat-free mass, and waist circumference at 17 y (P < 0.005 for all; adjusted for sex, birth weight, gestational age, current height, maternal socioeconomic status, and maternal fat mass). Rapid weight gain in infancy, but not in early childhood, also predicted taller height at 17 y (P < 0.001). Rapid weight gain in both infancy and early childhood is a risk factor for adult adiposity and obesity. Rapid weight gain in infancy also predicted taller adult height. We hypothesize that rapid weight gains in infancy and early childhood are different processes and may allow separate opportunities for early intervention against obesity risk later in life.
Article
Full-text available
Policy makers generally agree that childhood obesity is a national problem. However, it is not always clear whether enough is being spent to combat it. This paper presents nine scenarios that assume three different degrees of reduction in obesity/overweight rates among children in three age groups. A mathematical model was then used to project lifetime health and economic gains. Spending $2 billion a year would be cost-effective if it reduced obesity among twelve-year-olds by one percentage point. The analysis also found that childhood obesity has more profound economic consequences than previously documented. Large investments to reduce this major contributor to adult disability may thus be cost-effective by widely accepted criteria.
Article
Full-text available
Objective: To determine the degree of tracking of adiposity from childhood to early adulthood, and the risk of overweight in early adulthood associated with overweight in childhood and parental weight status in a cohort of children born in the mid 1970s. Design: Longitudinal observational study. Subjects: Approximately 155 healthy boys and girls born in Adelaide, South Australia 1975-6 and their parents. Measurements: Height and weight of subjects at 2 years, annually from 4 to 8 years, biennially from 11 to 15 years and at 20 years, and of parents when subjects were aged 8 years. BMI of subjects converted to standard deviation scores and prevalence of overweight and obesity determined using worldwide definitions. Parents classified as overweight if BMI > 25kg/m2. Tracking estimated as Pearson correlation coefficient. Risk ratio used to describe the association between weight status at each age and parental weight status and weight status at 20 years and weight status at each earlier age, both unadjusted and adjusted for parental weight status. Results: The prevalence of overweight/obesity increased with age and was higher than that reported in international reference populations. Tracking of BMI was established from 6 years onwards to 20 years at r values > 0.6 suggesting that BMI from 6 years is a good indicator of later BMI. Tracking was stronger for shorter intervals and for those subjects with both parents overweight compared with those with only one or neither parent overweight. Weight status at an earlier age was a more important predictor of weight status at 20 years than parental weight status, and risk of overweight at 20 years increased further with increasing weight status of parents. Conclusion: Strategies for prevention of overweight and targeted interventions for prevention of the progression of overweight to obesity are urgently required in school aged children in order to stem the epidemic of overweight in the adult population.
Article
Full-text available
Markers of growth and changes of body mass index (BMI) are associated with adult chronic disease risk. To better understand such associations, the authors examined the 1946 (n approximately 5,300) and 1958 (n approximately 17,000) British birth cohorts to establish how child-to-adult height and BMI have changed across generations. Individuals born in 1958 were no heavier at birth than those born in 1946, but they were taller in childhood by about 1 cm on average, grew faster thereafter, and were 3-4 cm taller by adolescence. The 1958 cohort achieved adult height earlier and were taller by 1 cm, an increase that was entirely due to their longer leg length. BMI trajectories diverged from early adulthood, with a faster rate of BMI gain in the 1958 cohort than in the 1946 cohort, although the mean BMI at 7 years and rate of childhood gain had not shown an increase. By midadulthood, the 1958 cohort had on average a greater BMI (1-2 kg/m(2)), larger waist (6-7 cm) and hip (5 cm) circumferences, and a higher prevalence of obesity (25.1% vs. 10.8% in males and 23.7% vs. 14.8% in females). Changes in height and adiposity over a relatively short period of 12 years suggest the likelihood of opposing trends of influences on later disease risk in these populations.
Article
Full-text available
No nationally representative longitudinal data have been analyzed to evaluate the incidence of obesity in the transition between adolescence and adulthood. The objective was to examine dynamic patterns of change in obesity among white, black, Hispanic, and Asian US teens as they transitioned to young adulthood. We used nationally representative, longitudinally measured height and weight data collected from US adolescents enrolled in wave II (1996; ages 13-20 y) and wave III (2001; 19-26 y) of the National Longitudinal Study of Adolescent Health (n = 9795). Obesity incidence was defined on the basis of International Obesity Task Force (IOTF) cutoffs (wave II), which link childhood body mass index (BMI) centiles to adult cutoffs (BMI > or = 30; wave III), for comparability between adolescence and adulthood. In addition, the more commonly used cutoff of BMI > or = 95th percentile for age- and sex-specific cutoffs from the 2000 Centers for Disease Control and Prevention growth charts for adolescents (wave II) were compared with adult cutoffs (BMI > or = 30; wave III). On the basis of the IOTF cutoffs, obesity incidence over the 5-y study period was 12.7%; 9.4% of the population remained obese and 1.6% shifted from obese to nonobese. Obesity incidence was especially high in non-Hispanic black (18.4%) females relative to white females. The prevalence of obesity increased from 10.9% in wave II to 22.1% in wave III, and extreme obesity was 4.3% at wave III on the basis of a BMI > or = 40. During a 5-y transitional period between adolescence and young adulthood, the proportion of adolescents becoming and remaining obese into adulthood was very high. This upward trend is likely to continue. Effective preventive and treatment efforts are critically needed.
Article
Full-text available
To determine whether the U.S. Centers for Disease Control and Prevention (CDC; CDC Reference) or International Obesity Task Force (IOTF; IOTF Reference) BMI cut-off points for classifying adiposity status in children are more effective at predicting future health risk. The sample (N=1709) included 4- to 15-year-old (at baseline) boys and girls from the Bogalusa Heart Study. Overweight and obesity status were determined using both the CDC Reference and IOTF Reference BMI cut-off points at baseline. The ability of childhood overweight and obesity, determined from the two BMI classification systems, to predict obesity and metabolic disorders in young adulthood (after a 13- to 24-year follow-up) was then compared. Independently of the classification system employed to determine adiposity based on childhood BMI, the odds of being obese and having all of the metabolic disorders in young adulthood were significantly (p<0.05) higher in the overweight and obese groups by comparison with the nonoverweight groups. Childhood overweight and obesity, determined by both the CDC Reference and IOTF Reference, had a low sensitivity and a high specificity for predicting obesity and metabolic disorders in young adulthood. Overweight and obesity as determined by the CDC Reference were slightly more sensitive and slightly less specific than the corresponding values based on the IOTF Reference. Overweight and obesity during childhood, as determined by both the CDC and IOTF BMI cut-off points, are strong predictors of obesity and coronary heart disease risk factors in young adulthood. The differences in the predictive capacity of the CDC Reference and IOTF Reference are, however, minimal.
Article
Full-text available
To understand tracking of overweight status from childhood to young adulthood in a biracial sample. A longitudinal sample was created from cross-sectional surveys at two time points, childhood (baseline) and young adulthood (follow-up). Bogalusa Heart Study, Louisiana, United States of America. A total of 841 young adults, 19-35 years (68% Euro-Americans (EA), 32% African-Americans (AA)) were studied. The same subjects had also participated in one of the five cross-sectional surveys at childhood (9-11 years). Body mass index (BMI) was used to determine overweight status as per the Centers for Disease Control and Prevention standards. Change in the BMI status from childhood to young adulthood was used to group the participants into the following categories: normal weight to normal weight (NW-NW); normal weight to overweight (NW-OW); overweight to normal weight (OW-NW); and overweight to overweight (OW-OW). Tracking of overweight was defined by (1) correlations between baseline and follow-up BMI, (2) Cohen's kappa concordance test to determine the strength of tracking in BMI quartiles and (3) the percentage of individuals who remained in the same overweight status group from baseline to follow-up. From baseline to follow-up, the percentage of participants who were overweight increased from 24.7 to 57.7%. A total of 35.2% of the children shifted from normal weight in childhood to overweight in young adulthood (P < 0.0005). Baseline BMI was positively correlated with follow-up BMI (r = 0.66, P < 0.0005). A total of 61.9% of the participants in the highest BMI quartile in childhood remained in the highest BMI quartile in young adulthood. The strength of tracking in BMI quartiles was 27% for EA men (P < 0.0005), 23% for EA women (P < 0.0005), 27% for AA men (P<0.0005) and 35% for AA women (P < 0.0005). A total of 53.7% of the EA women remained in the NW-NW category and 31.2% of the AA women remained in the OW-OW category. The percentage tracking (NW-NW and OW-OW) was 72.8% in EA women, 59.6% in AA men, 59.5% in AA women and 48.8% in EA men (P < 0.0001). Childhood overweight tracked into young adulthood in this sample and the tracking of NW-NW and OW-OW was the most prominent among the EA women.
Article
Full-text available
To examine overweight and obesity in Australian children followed through to adulthood. A cohort study of 8498 children aged 7-15 years who participated in the 1985 Australian Schools Health and Fitness Survey; of these, 2208 men and 2363 women completed a follow-up questionnaire at age 24-34 years in 2001-2005. Height and weight were measured in 1985, and self-reported at follow-up. The accuracy of self-reported data was checked in 1185 participants. Overweight and obesity in childhood were defined according to international standard definitions for body mass index (BMI), and, in adulthood, as a BMI of 25-29.9 and > or =30 kg/m2, respectively, after correcting for self-report error. In those with baseline and follow-up data, the prevalence of overweight and obesity in childhood was 8.3% and 1.5% in boys and 9.7% and 1.4% in girls, respectively. At follow-up, the prevalence was 40.1% and 13.0% in men and 19.7% and 11.7% in women. The relative risk (RR) of becoming an obese adult was significantly greater for those who had been obese as children compared with those who had been a healthy weight (RR = 4.7; 95% CI, 3.0-7.2 for boys and RR = 9.2; 95% CI, 6.9-12.3 for girls). The proportion of adult obesity attributable to childhood obesity was 6.4% in males and 12.6% in females. Obesity in childhood was strongly predictive of obesity in early adulthood, but most obese young adults were a healthy weight as children.
Article
Full-text available
To evaluate how the changes in overweight status from childhood to adolescence are related to metabolic syndrome phenotypes in adolescents. A total 375 adolescents aged 16 years. The overweight status from childhood to adolescence (from 7 years of age to 16 years) was determined by body mass index (BMI, kg/m(2)) calculated from records of the School Physical Examination data. The change in body weight was classified into four groups: normal weight to normal weight (NW-NW); overweight to normal (OW-NW); normal to overweight (NW-OW); overweight to overweight (OW-OW). Metabolic syndrome phenotypes were examined from a cross-sectional survey. The mean values of all phenotypes except for body fatness (BMI and waist) and the cluster score of phenotypes at 16 years of age were not different between the NW-NW group and the OW-NW group, nor between the NW-OW group and the OW-OW group. However, the score as well as the level of body fatness and blood glucose were significantly different between current overweight and normal adolescents regardless of overweight status during childhood (P<0.05). There was a linear relationship between overweight status during childhood and metabolic syndrome phenotypes in adolescence but current overweight status (adolescence overweight) was more closely related to the adolescent risk of metabolic syndrome than childhood overweight status.
Article
Participation in recommended levels of physical activity promotes a healthy body weight and reduced chronic disease risk. To inform investment in prevention initiatives, we simulate the national implementation, impact on physical activity and childhood obesity and associated cost-effectiveness (versus the status quo) of six recommended strategies that can be applied throughout childhood to increase physical activity in US school, afterschool and childcare settings. In 2016, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) systematic review process identified six interventions for study. A microsimulation model estimated intervention outcomes 2015–2025 including changes in mean MET-hours/day, intervention reach and cost per person, cost per MET-hour change, ten-year net costs to society and cases of childhood obesity prevented. First year reach of the interventions ranged from 90,000 youth attending a Healthy Afterschool Program to 31.3 million youth reached by Active School Day policies. Mean MET-hour/day/person increases ranged from 0.05 MET-hour/day/person for Active PE and Healthy Afterschool to 1.29 MET-hour/day/person for the implementation of New Afterschool Programs. Cost per MET-hour change ranged from cost saving to $3.16. Approximately 2500 to 110,000 cases of children with obesity could be prevented depending on the intervention implemented. All of the six interventions are estimated to increase physical activity levels among children and adolescents in the US population and prevent cases of childhood obesity. Results do not include other impacts of increased physical activity, including cognitive and behavioral effects. Decision-makers can use these methods to inform prioritization of physical activity promotion and obesity prevention on policy agendas.
Article
Background/objectives: State-specific obesity prevalence data are critical to public health efforts to address the childhood obesity epidemic. However, few states administer objectively-measured BMI surveillance programs. This study reports state-specific childhood obesity prevalence by age and sex correcting for parent-reported child height and weight bias. Subjects/methods: As part of the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES), we developed childhood obesity prevalence estimates for states for the period 2005-2010 using data from the 2010 U.S. Census and American Community Survey (ACS), 2003-2004 and 2007-2008 National Survey of Children's Health (NSCH) (n=133 213), and 2005-2010 National Health and Nutrition Examination Surveys (NHANES) (n=9377; ages 2-17). Measured height and weight data from NHANES were used to correct parent-report bias in NSCH using a non-parametric statistical matching algorithm. Model estimates were validated against surveillance data from five states (AR, FL, MA, PA, and TN) that conduct censuses of children across a range of grades. Results: Parent-reported height and weight resulted in the largest overestimation of childhood obesity in males ages 2-5 years (NSCH: 42.36% vs NHANES: 11.44%). The CHOICES model estimates for this group (12.81%) and for all age and sex categories were not statistically different from NHANES. Our modeled obesity prevalence aligned closely with measured data from five validation states, with a 0.64 percentage point mean difference (range: 0.23-1.39) and a high correlation coefficient (r=0.96, P=0.009). Estimated state-specific childhood obesity prevalence ranged from 11.0 to 20.4%. Conclusion: Uncorrected estimates of childhood obesity prevalence from NSCH vary widely from measured national data, from a 278% overestimate among males aged 2-5 years to a 44% underestimate among females aged 14-17 years. This study demonstrates the validity of the CHOICES matching methods to correct the bias of parent-reported BMI data and highlights the need for public release of more recent data from the 2011-2012 NSCH.International Journal of Obesity accepted article preview online, 27 July 2016. doi:10.1038/ijo.2016.130.
Article
National guidelines for the diagnosis and management of hypertension in children have been available for nearly 40 years. Unfortunately, knowledge and recognition of the problem by clinicians remain poor. Prevalence estimates are highly variable because of differing standards, populations, and blood pressure (BP) measurement techniques. Estimates in the United States range from 0.3% to 4.5%. Risk factors for primary hypertension include overweight and obesity, male sex, older age, high sodium intake, and African American or Latino ancestry. Data relating hypertension in childhood to later cardiovascular events is currently lacking. It is known that BP in childhood is highly predictive of BP in adulthood. Compelling data about target organ damage is available, including the association of hypertension with left ventricular hypertrophy, carotid-intima media thickness, and microalbuminuria. Guidelines from both the United States and Europe include detailed recommendations for diagnosis and management. Diagnostic standards are based on clinic readings, ambulatory BP monitoring is useful in confirming diagnosis of hypertension and identifying white-coat hypertension, masked hypertension, and secondary hypertension, as well as monitoring response to therapy. Research priorities include the need for reliable prevalence estimates based on diverse populations and data about the long-term impact of childhood hypertension on cardiovascular morbidity and mortality. Priorities to improve clinical practice include more education among clinicians about diagnosis and management, clinical decision support to aid in diagnosis, and routine use of ambulatory BP monitoring to aid in diagnosis and to monitor response to treatment.
Article
Importance Between 1980 and 2000, the prevalence of obesity increased significantly among adult men and women in the United States; further significant increases were observed through 2003-2004 for men but not women. Subsequent comparisons of data from 2003-2004 with data through 2011-2012 showed no significant increases for men or women. Objective To examine obesity prevalence for 2013-2014 and trends over the decade from 2005 through 2014 adjusting for sex, age, race/Hispanic origin, smoking status, and education. Design, Setting, and Participants Analysis of data obtained from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally representative health examination survey of the US civilian noninstitutionalized population that includes measured weight and height. Exposures Survey period. Main Outcomes and Measures Prevalence of obesity (body mass index ≥30) and class 3 obesity (body mass index ≥40). Results This report is based on data from 2638 adult men (mean age, 46.8 years) and 2817 women (mean age, 48.4 years) from the most recent 2 years (2013-2014) of NHANES and data from 21 013 participants in previous NHANES surveys from 2005 through 2012. For the years 2013-2014, the overall age-adjusted prevalence of obesity was 37.7% (95% CI, 35.8%-39.7%); among men, it was 35.0% (95% CI, 32.8%-37.3%); and among women, it was 40.4% (95% CI, 37.6%-43.3%). The corresponding prevalence of class 3 obesity overall was 7.7% (95% CI, 6.2%-9.3%); among men, it was 5.5% (95% CI, 4.0%-7.2%); and among women, it was 9.9% (95% CI, 7.5%-12.3%). Analyses of changes over the decade from 2005 through 2014, adjusted for age, race/Hispanic origin, smoking status, and education, showed significant increasing linear trends among women for overall obesity (P = .004) and for class 3 obesity (P = .01) but not among men (P = .30 for overall obesity; P = .14 for class 3 obesity). Conclusions and Relevance In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity in 2013-2014 was 35.0% among men and 40.4% among women. The corresponding values for class 3 obesity were 5.5% for men and 9.9% for women. For women, the prevalence of overall obesity and of class 3 obesity showed significant linear trends for increase between 2005 and 2014; there were no significant trends for men. Other studies are needed to determine the reasons for these trends.
Article
Importance Previous analyses of obesity trends among children and adolescents showed an increase between 1988-1994 and 1999-2000, but no change between 2003-2004 and 2011-2012, except for a significant decline among children aged 2 to 5 years. Objectives To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011-2014 and investigate trends by age between 1988-1994 and 2013-2014. Design, Setting, and Participants Children and adolescents aged 2 to 19 years with measured weight and height in the 1988-1994 through 2013-2014 National Health and Nutrition Examination Surveys. Exposures Survey period. Main Outcomes and Measures Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011-2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005-2006 and 2013-2014 also were conducted. Results Measurements from 40 780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988-1994 and 2013-2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% (95% CI, 15.5%-18.6%) and extreme obesity was 5.8% (95% CI, 4.9%-6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%-8.8%) in 1988-1994 to 13.9% (95% CI, 10.7%-17.7%) (P < .001) in 2003-2004 and then decreased to 9.4% (95% CI, 6.8%-12.6%) (P = .03) in 2013-2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%-13.4%) in 1988-1994 to 19.6% (95% CI, 17.1%-22.4%) (P < .001) in 2007-2008, and then did not change (2013-2014: 17.4% [95% CI, 13.8%-21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988-1994 (10.5% [95% CI, 8.8%-12.5%]) and 2013-2014 (20.6% [95% CI, 16.2%-25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%-5.0%] in 1988-1994 to 4.3% [95% CI, 3.0%-6.1%] in 2013-2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI, 1.7%-3.9%] in 1988-1994 to 9.1% [95% CI, 7.0%-11.5%] in 2013-2014; P < .001). No significant trends were observed between 2005-2006 and 2013-2014 (P value range, .09-.87). Conclusions and Relevance In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% and extreme obesity was 5.8%. Between 1988-1994 and 2013-2014, the prevalence of obesity increased until 2003-2004 and then decreased in children aged 2 to 5 years, increased until 2007-2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.
Article
Purpose: Overweight and obesity in children and adolescents is often accompanied by obesity-related comorbidities. An integrative review of the literature was performed to create a comprehensive algorithm to help primary care providers manage the common comorbidities associated with childhood overweight and obesity. Data sources: The Cumulative Index to Nursing and Allied Health Literature, ProQuest Nursing and Allied Health Source, and PubMed databases were searched. Evidence from 2002 to present was reviewed. Guidelines and algorithms from the American Academy of Pediatrics, National Association of Pediatric Nurse Practitioners, American Heart Association, American Diabetes Association, Centers for Disease Control and Prevention, National Heart, Lung, and Blood Institute, Agency for Healthcare and Research Quality, U.S. Department of Health and Human Services, and the International Diabetes Federation were also reviewed. Conclusions: Key information was extracted and data sources ranked according to the Polit and Beck evidence hierarchy. Highest level evidence guided the selection and development of recommendations to formulate a comprehensive resource for the recognition and management of pediatric hypertension, sleep apnea, vitamin D deficiency, nonalcoholic fatty liver disease, dyslipidemia, thyroid disease, diabetes mellitus, insulin resistance, metabolic syndrome, and polycystic ovarian syndrome. Implications for practice: The Childhood Overweight and Obesity Comorbidities Resource provides a consistent, convenient point-of-care reference to help primary care providers improve pediatric health outcomes.
Article
The growing prevalence of overweight and obesity among children is well documented, but prevalence estimates offer little insight into rates of transition to higher or lower body mass index (BMI; weight (kg)/height (m)2) categories. We estimated the expected numbers of years children would live as normal weight, overweight, and obese by race/ethnicity and sex, given rates of transition across BMI status levels. We used multistate life table methods and transition rates estimated from prospective cohort data (2007–2013) for Denver, Colorado, public schoolchildren aged 3–15 years. At age 3 years, normal-weight children could expect to live 11.1 of the following 13 years with normal weight status, and obese children could expect to live 9.8 years with obese status. At age 3 years, overweight children could expect to live 4.5 of the following 13 years with normal weight status, 5.1 years with overweight status, and 3.4 years with obese status. Whites and Asians lived more years at lower BMI status levels than did blacks or Hispanics; sex differences varied by race/ethnicity. Children who were normal weight or obese at age 3 years were relatively unlikely to move into a different BMI category by age 15 years. Overweight children are relatively likely to transition to normal weight or obese status.
Article
Background: This systematic review synthesizes the literature on incidence of obesity during childhood. Methods: We searched PubMed, Excerpta Medica database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINAHL), and used the Web of Science tool in June 2015. Studies were included if they were published in English, presented results from primary or secondary analyses, used data about children in the US, provided obesity incidence data on children 0 to 18 years born after 1970, and did not pertain to clinically defined populations (disease, medication use, etc.). Author(s), study year, study design, location, sample size, age, and obesity incidence estimates were abstracted. Results: Nineteen studies were included, three of which used nationally representative data. The median study-specific annual obesity incidences among studies using U.S. Centers for Disease Control and Prevention (CDC) growth charts were 4.0%, 3.2%, and 1.8% for preschool (2.0-4.9 years), school aged (5.0-12.9 years), and adolescence (13.0-18.0 years), respectively. This pattern of declining obesity incidence with age was consistent between and within studies. Conclusions: Studies of childhood obesity in the US indicate declining incidence with age. Childhood obesity prevention efforts should be targeted to ages before obesity onset. Longitudinal data and consistent obesity definitions that correlate with long-term morbidity are needed to better characterize the life history of obesity.
Article
Importance Many early life risk factors for childhood obesity are more prevalent among blacks and Hispanics than among whites and may explain the higher prevalence of obesity among racial/ethnic minority children.Objective To examine the extent to which racial/ethnic disparities in adiposity and overweight are explained by differences in risk factors during pregnancy (gestational diabetes and depression), infancy (rapid infant weight gain, feeding other than exclusive breastfeeding, and early introduction of solid foods), and early childhood (sleeping <12 h/d, presence of a television set in the room where the child sleeps, and any intake of sugar-sweetened beverages or fast food).Design Prospective prebirth cohort study.Setting Multisite group practice in Massachusetts.Participants Participants included 1116 mother-child pairs (63% white, 17% black, and 4% Hispanic)Exposure Mother’s report of child’s race/ethnicity.Main Outcomes and Measures Age- and sex-specific body mass index (BMI) z score, total fat mass index from dual-energy x-ray absorptiometry, and overweight or obesity, defined as a BMI in the 85th percentile or higher at age 7 years.Results Black (0.48 U [95% CI, 0.31 to 0.64]) and Hispanic (0.43 [0.12 to 0.74]) children had higher BMI z scores, as well as higher total fat mass index and overweight/obesity prevalence, than white children. After adjustment for socioeconomic confounders and parental BMI, differences in BMI z score were attenuated for black and Hispanic children (0.22 U [0.05 to 0.40] and 0.22 U [−0.08 to 0.52], respectively). Adjustment for pregnancy risk factors did not substantially change these estimates. However, after further adjustment for infancy and childhood risk factors, we observed only minimal differences in BMI z scores between whites, blacks (0.07 U [−0.11 to 0.26]), and Hispanics (0.04 U [−0.27 to 0.35]). We observed similar attenuation of racial/ethnic differences in adiposity and prevalence of overweight or obesity.Conclusions and Relevance Racial/ethnic disparities in childhood adiposity and obesity are determined by factors operating in infancy and early childhood. Efforts to reduce obesity disparities should focus on preventing early life risk factors.
Article
Previous efforts to forecast future trends in obesity applied linear forecasts assuming that the rise in obesity would continue unabated. However, evidence suggests that obesity prevalence may be leveling off. This study presents estimates of adult obesity and severe obesity prevalence through 2030 based on nonlinear regression models. The forecasted results are then used to simulate the savings that could be achieved through modestly successful obesity prevention efforts. The study was conducted in 2009-2010 and used data from the 1990 through 2008 Behavioral Risk Factor Surveillance System (BRFSS). The analysis sample included nonpregnant adults aged ≥ 18 years. The individual-level BRFSS variables were supplemented with state-level variables from the U.S. Bureau of Labor Statistics, the American Chamber of Commerce Research Association, and the Census of Retail Trade. Future obesity and severe obesity prevalence were estimated through regression modeling by projecting trends in explanatory variables expected to influence obesity prevalence. Linear time trend forecasts suggest that by 2030, 51% of the population will be obese. The model estimates a much lower obesity prevalence of 42% and severe obesity prevalence of 11%. If obesity were to remain at 2010 levels, the combined savings in medical expenditures over the next 2 decades would be $549.5 billion. The study estimates a 33% increase in obesity prevalence and a 130% increase in severe obesity prevalence over the next 2 decades. If these forecasts prove accurate, this will further hinder efforts for healthcare cost containment.