Abstract
BackgroundChildhood obesity is a major public health challenge. We aimed to investigate the incidence of overweight/obesity among Chinese children; and prospectively examine the associations of weight-change intention with risk of overweight/obesity and behavioral changes in initially normal-weight children.MethodsA national sample of 21,796 children aged 6–17 years were investigated in September 2013 and followed up nine months later, of which 19,887 (91%) were normal weight and 1909 (9%) were underweight at baseline. Weight and height were objectively measured. Weight perception, weight-change intention, weight control practices, weight-related behaviors, and demographic information were obtained by questionnaires.ResultsAmong children with underweight or normal-weight, the cumulative incidence of overweight/obesity was 2.77% (95% CI 2.55–2.99). Among normal-weight children, those who overestimated their weight had higher baseline BMI z-scores and an increased relative risk (RR) of overweight/obesity (RR 1.51, 95% CI 1.15–1.99). Children who misperceived themselves as underweight or overweight had stronger weight-change intention than their counterparts. However, children with weight-change intention did not develop greater changes in dietary intakes, physical activities, or sedentary behaviors than those without intention. There was no significant association between weight-change intention and incidence after adjusting for BMI z-scores at baseline. Self-reported improving diet, increasing physical activity, and dieting were associated with certain actual behavioral improvements and smaller increase in BMI z-score, but not associated with decreased risk of overweight/obesity.ConclusionThe 9-months cumulative incidence of overweight/obesity was 2.77% among Chinese children. Weight-change intention was not associated with incidence of overweight/obesity in normal-weight children, regardless of their weight perception. More importantly, children’s weight-change intention was insufficient in achieving desirable behavioral changes. Future overweight and obesity prevention programs should directly target on promoting children’s actual behavioral changes.
Highlights
The substantial increase in childhood overweight and obesity poses a major public health problem worldwide [1, 2]
When compared to children with accurate weight perception, though children with overweight perception had smaller increase in Body mass index (BMI) z-score (P < 0.001), they had higher risk of overweight/obesity after adjusted covariates [relative risk (RR) =1.51, 95% confidence interval (CI): 1.15, 1.99)]
About 75% of American children who became obese between the ages of 5 and 14 years had a BMI z-score above 0.52 at baseline [16]. These findings indicate that overweight and obesity intervention needs to expand the target population to children who are in the range of normal BMI, especially those who are most susceptible to becoming overweight or obesity in less than a year
Summary
The substantial increase in childhood overweight and obesity poses a major public health problem worldwide [1, 2]. Fueled by the new dietary patterns and sedentary lifestyles, childhood obesity in China increased rapidly during the past two decades [3]. In 2013, approximately 23.0% and 14.0% of Chinese boys and girls aged 2–19 years were overweight or obese [2]. As childhood obesity damages health beginning early in life, it is imperative to take early intervention. Identification of promising intervention strategies requires a clear understanding of modifiable factors contributing to childhood obesity. Gaps persist in our knowledge about how psychosocial factors impact the development of obesity among children [4]. Childhood obesity is a major public health challenge. We aimed to investigate the incidence of overweight/obesity among Chinese children; and prospectively examine the associations of weight-change intention with risk of overweight/obesity and behavioral changes in initially normal-weight children
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