High Prevalence Of Childhood Obesity Research Articles

Advanced lipid testing in children: a call for pediatric reference intervals

Abstract Introduction Abnormal serum lipid levels in childhood are associated with dyslipidemia and increased risk of cardiovascular disease in adulthood. High prevalence of childhood obesity in the US has increased concerns about the adverse effects of abnormal lipids in children, prompting recommendations for universal lipid screening in adolescents. While specialized analysis of lipoproteins by nuclear magnetic resonance (NMR) has been predominately used in adults with risk factors for CVD, our laboratory also receives pediatric samples for NMR testing, most commonly associated with diagnostic codes for hyperlipidemia and/or abnormal weight gain. Currently adult-based reference ranges for the NMR lipoprotein measurements are used in children. The objective of this pilot study was to compare lipoprotein profiles of healthy adults and children and to assess the impact of reference intervals for children on clinical interpretation of pediatric results. Methods Serum samples were collected from 60 healthy children, ages 1 – 17 years, and 148 healthy adults, ages 19 – 64 years old. NMR lipoprotein analysis was performed using the Axinon lipoFIT by NMR assay on a 600 MHz NMR (Bruker). Statistical analysis was conducted in Excel and GraphPad Prism. Reference intervals (RIs) were determined in EP Evaluator as the central 95% interval. Results The levels of atherogenic low-density lipoprotein particle number (LDL-P) and small LDL-P (sLDL-P) were significantly lower in children compared to adults: 783±222 vs 1212±412 nmol/L and 302±142 vs 498±306 nmol/L, respectively (p<0.00001). Additionally, LDL size (LDL-s) was significantly larger in children than adults (21.23±0.29 vs 21.06±0.44 nm, p=0.006), reflecting prevalence of less dense LDL-P in the former group. Pediatric samples also had lower number of anti-atherogenic high-density lipoprotein particles (HDL-P) compared to adults: 29.4±4.6 vs 33.5±4.6 µmol/L, p<0.00001. The significant differences in the number and size of lipoprotein particles between adults and children implies that currently used adult reference intervals might not be appropriate for evaluating pediatric NMR samples. Therefore, we estimated RIs for our heathy pediatric and adult cohorts and applied these RIs to our retrospective data of 618 samples from children 1-17 years old, which were submitted for NMR lipoprotein testing in recent years. The analysis showed that using the adult RIs, 37% and 27% of pediatric samples would not flag for abnormally elevated LDL-P and sLDL-P, respectively; but they would be flagged based on the RI derived from our pediatric cohort. Moreover, 12% pediatric samples flagged for low HDL-P would have normal HDL-P levels if pediatric RIs are used instead of adult RIs. Conclusions Use of adult reference intervals in children may result in misclassification of lipid status and underestimation or overestimation of dyslipidemia and CVD risk in children. This pilot study highlights the need for pediatric reference intervals to guide interpretation of advanced lipid testing in children.

A-227 One Step Toward Implementation of Advanced Lipoprotien Testing in Children: A Pilot Study on Pediatric Reference Ranges

Abstract Background Abnormal serum lipid levels in childhood are associated with dyslipidemia and increased risk of cardiovascular disease in adulthood. High prevalence of childhood obesity in the US has increased concerns about the adverse effects of abnormal lipids in children, prompting recommendations for universal lipid screening in adolescents. While specialized analysis of lipoproteins by nuclear magnetic resonance (NMR) has been predominately used in adults with risk factors for CVD, our laboratory also receives pediatric samples for NMR testing, most commonly associated with diagnostic codes for hyperlipidemia and/or abnormal weight gain. Currently adult-based reference ranges for the NMR lipoprotein measurements are used in children. The objective of this pilot study was to compare lipoprotein profiles of healthy adults and children and to assess the impact of reference intervals for children on clinical interpretation of pediatric results. Methods Serum samples were collected from 60 healthy children, ages 1 - 17 years, and 148 self-identified healthy adults, ages 19 - 64 years old. NMR lipoprotein analysis was performed using the Axinon lipoFIT by NMR assay on a 600 MHz NMR (Bruker). Statistical analysis was conducted in Excel and Graph Pad Prism. Reference intervals (RIs) were determined in EP Evaluator as the central 95% interval. Results The levels of atherogenic low-density lipoprotein particle number (LDL-P) and small LDL-P (sLDL-P) were significantly lower in children compared to adults: 783±222 vs 1212±412 nmol/L and 302±142 vs 498±306 nmol/L, respectively (p<0.00001). Additionally, LDL size (LDL-s) was significantly larger in children than adults (21.23±0.29 vs 21.06±0.44 nm, p=0.006), reflecting prevalence of less dense LDL-P in the former group. Pediatric samples also had lower number of anti-atherogenic high-density lipoprotein particles (HDL-P) compared to adults: 29.4±4.6 vs 33.5±4.6 µmol/L, p<0.00001. The significant differences in the number and size of lipoprotein particles between adults and children implies that currently used adult reference intervals might not be appropriate for evaluating pediatric NMR samples. Therefore, we estimated RIs for our heathy pediatric and adult cohorts and applied these RIs to our retrospective data of 618 samples from children 1-17 years old, which were submitted for NMR lipoprotein testing in recent years. The analysis showed that using the adult RIs, 37% and 27% of pediatric samples would not flag for abnormally elevated LDL-P and sLDL-P, respectively; but they would be flagged based on the RI derived from our pediatric cohort. Moreover, 12% pediatric samples flagged for low HDL-P would have normal HDL-P levels if pediatric RIs are used instead of adult RIs. Conclusions Use of adult reference intervals in children may result in misclassification of lipid status and underestimation or overestimation of dyslipidemia and CVD risk in children. This pilot study highlights the need for pediatric reference intervals to guide interpretation of advanced lipid testing in children.

Process evaluation of implementation of the early stages of a whole systems approach to obesity in a small Island.

The small Atlantic island of St Helena is a United Kingdom Overseas Territory (UKOT) with a high prevalence of childhood obesity (over a quarter of 4-5 and 10-11 year olds) and, anecdotally, adulthood obesity and its associated health detriments. St Helena have taken a whole systems approach to obesity (WSAO) to address the issue. A WSAO recognises the factors that impact obesity as a complex system and requires a 'health in all policies' approach. UK academic and public health technical support was provided to the local St Helena delivery team. This process evaluation sought to explore the early stages of the WSAO implementation and implications for the transferability of the approach to other small island developing states and UKOT. Data was collected via eight semi-structured interviews, paper based and online surveys, and document analysis. Thematic analysis was used to analyse the data. The analysis identified three factors which aided the first phase of WSAO implementation: (1) senior leaders support for the approach; (2) the academic support provided to establish and develop the approach; and (3) effective adaptation of UK Government resources to suit the local context. Key challenges of early implementation included: maintaining and broadening stakeholder engagement; limited local workforce capacity and baseline knowledge related to obesity and systems thinking; and limited capacity for support from the UK-based academic team due to contract terms and COVID-19 restrictions. Early stages of implementation of a WSAO in a UKOT can be successful when using UK's resources as a guide and adapting them to a small island context. All participants recommended other small islands adopt this approach. Continued senior support, dedicated leadership, and comprehensive community engagement is needed to progress implementation and provide the foundation for long-term impact. Small island developing states considering adopting a WSAO should consider political will, senior level buy-in and support, funding, and local workforce knowledge and capacity to enable the best chances of successful and sustainable implementation.

Relation between Body Composition Trajectories from Childhood to Adolescence and Nonalcoholic Fatty Liver Disease Risk.

NAFLD has become the leading cause of chronic liver disease in children, as a direct consequence of the high prevalence of childhood obesity. This study aimed to characterize body composition trajectories from childhood to adolescence and their association with the risk of developing nonalcoholic fatty liver disease (NAFLD) during adolescence. The participants were part of the 'Chilean Growth and Obesity Cohort Study', comprising 784 children who were followed prospectively from age 3 years. Annual assessments of nutritional status and body composition were conducted, with ultrasound screening for NAFLD during adolescence revealing a 9.8% prevalence. Higher waist circumference measures were associated with NAFLD from age 3 years (p = 0.03), all skin folds from age 4 years (p < 0.01), and DXA body fat measurements from age 12 years (p = 0.01). The fat-free mass index was higher in females (p = 0.006) but not in males (p = 0.211). The second and third tertiles of the fat mass index (FMI) had odds ratios for NAFLD during adolescence of 2.19 (1.48-3.25, 95% CI) and 6.94 (4.79-10.04, 95% CI), respectively. Elevated waist circumference, skin folds, and total body fat were identified as risk factors for future NAFLD development. A higher FMI during childhood was associated with an increased risk of NAFLD during adolescence.

Trends estimation of obesity prevalence among South Asian young population: a systematic review and meta-analysis

The premise for effective prevention and treatment of obesity is the availability of accurate prevalence figures. However, the prevalence of pediatric obesity and overweight in South Asian countries has seldom been analyzed. This article provides a comprehensive review and meta-analysis of studies on overweight and obesity to provide a more precise prevalence estimate. The study protocol was registered on PROSPERO (CRD42022320625). PubMed and Embase databases were comprehensively searched from inception till September 2023. The random-effects model was utilized to derive the pooled prevalence of obesity and overweight. Subgroup meta-analysis was used to assess variations in prevalence estimates across subgroups. A meta-regression analysis was also performed to assess the trend of overweight and obesity over the years. 152 studies were included with 489,525 participants. The pooled prevalence was 12.4 (95% CI 11.1–13.6) for overweight, 6.6% (95% CI 5.6–7.8) for obesity, and 19.3% (95% CI 17.1–21.7) for obesity and overweight. In subgroup analysis, Bangladesh reported a higher prevalence for both obesity (8.9%; 95% CI 4.9–13.9) and overweight (13.6%; 95% CI 9.2–18.8). Meta-regression analysis found a significant association between obesity prevalence and the publication year (β = 0.004; p = 0.03; R2 = 2.74%). The results of this study indicate a relatively higher prevalence of childhood obesity in South Asia, emphasizing the necessity for large-scale awareness efforts and context-specific preventative methods.

A Narrative Review of Public Health Interventions for Childhood Obesity.

Public health interventions that intervene on macrolevel systems hold the promise of reducing childhood obesity at the population level through prevention. The purpose of this review is to highlight some of the recent and best scientific evidence related to public health interventions for the prevention of childhood obesity. We provide a narrative review of scientific evidence for six categories of public health interventions and their impact on childhood obesity: federal nutrition assistance programs, programs implemented in early care and education centers, interventions to support healthy nutrition and physical activity in schools, community-based programs and policies, labeling policies and marketing to children, and taxes on sugar sweetened beverages (SSB). Federal nutrition assistance programs have the strongest evidence to support reduction in childhood obesity and serve populations with the highest prevalence of childhood obesity. Other interventions including SSB taxes, community-wide interventions, and interventions at schools and early care and education centers also show significant improvements in child weight status. Overall public health interventions have strong evidence to support widespread implementation in service of reducing childhood obesity rates at the population level. To effectively address the recalcitrant childhood obesity epidemic, multi-pronged solutions are needed. The current evidence for public health obesity interventions is consistent with the paradigm that recognizes the importance of macrolevel systems influences on childhood obesity: interventions that are most effective intervene at macrolevels.

Regional Variations in Pediatric Metabolic and Bariatric Surgeon Availability: A Call for Action

IntroductionObesity is a significant public health concern in children. The American Academy of Pediatrics recommends the use of metabolic and bariatric surgery (MBS) in children with severe obesity, however; MBS remains underutilized in part due to lack of access. This study aims to characterize the prevalence of pediatric obesity and compare this to regional pediatric MBS provider availability. MethodsState-specific prevalence rates of childhood obesity in children aged 10-17 were obtained from the National Survey of Children's Health. The member directory provided by the American Society for Metabolic and Bariatric Surgeons was used to identify all pediatric MBS providers and used to calculate the prevalence of MBS providers by state. ResultsThe five states with the highest prevalence rates of childhood obesity were Kentucky, Mississippi, Louisiana, West Virginia, and Alabama. The five states with the highest prevalence (per 100,000 children with obesity) of MBS providers doing pediatric cases were North Dakota, New Jersey, Kansas, New York, and Utah. Notably, there was a negative correlation between the states with the lowest prevalence of pediatric MBS providers and states with the highest prevalence of childhood obesity (r −0.40, ∗P = 0.002). ConclusionsOur study demonstrates significant state-to-state variation in the prevalence of pediatric obesity and MBS provider availability by state as a proxy for access to surgical care for pediatric obesity. Further work to establish accessible multidisciplinary pediatric weight loss centers is needed to ensure that children and adolescents with obesity receive thorough evaluation and have access to MBS.

Costs to Implement a Pediatric Weight Management Program Across 3 Distinct Contexts.

The Connect for Health program is an evidence-based program that aligns with national recommendations for pediatric weight management and includes clinical decision support, educational handouts, and community resources. As implementation costs are a major driver of program adoption and maintenance decisions, we assessed the costs to implement the Connect for Health program across 3 health systems that primarily serve low-income communities with a high prevalence of childhood obesity. We used time-driven activity-based costing methods. Each health system (site) developed a process map and a detailed report of all implementation actions taken, aligned with major implementation requirements (eg, electronic health record integration) or strategies (eg, providing clinician training). For each action, sites identified the personnel involved and estimated the time they spent, allowing us to estimate the total costs of implementation and breakdown costs by major implementation activities. Process maps indicated that the program integrated easily into well-child visits. Overall implementation costs ranged from $77,103 (Prisma Health) to $84,954 (Denver Health) to $142,721 (Massachusetts General Hospital). Across implementation activities, setting up the technological aspects of the program was a major driver of costs. Other cost drivers included training, engaging stakeholders, and audit and feedback activities, though there was variability across systems based on organizational context and implementation choices. Our work highlights the major cost drivers of implementing the Connect for Health program. Accounting for context-specific considerations when assessing the costs of implementation is crucial, especially to facilitate accurate projections of implementation costs in future settings.

Obesity during Adolescence and Feeding Practices during Infancy: Cross-Sectional Study.

Breastfeeding is proposed to play a role in reducing the risk of obesity throughout life. Kuwait has an extremely high prevalence of childhood obesity (45% of adolescents are overweight/obese) and extremely low breastfeeding indicators, particularly exclusive breastfeeding. In fact, little is known about the association between breastfeeding and obesity from Kuwait and the broader Middle East. To estimate the prevalence of overweight/obesity in female adolescents in Kuwait and assess its association with breastfeeding during infancy. This is a cross-sectional study that included 775 girls randomly selected from public and private high schools in Kuwait. The primary exposure was breastfeeding in the first four months of life, and the outcome was overweight/obesity during adolescence. Multivariable logistic regression was used to assess the association between breastfeeding and overweight/obesity while adjusting for potential confounders. Approximately 45% of adolescent girls were either overweight/obese. We found no significant association between breastfeeding (exclusive/mixed breastfeeding and formula feeding/no breastfeeding) and overweight/obesity neither in univariable analysis (Crude Prevalence Ratio: 1.14, 95%CI [0.92-1.36] & Crude Prevalence Ratio: 1.29, 95%CI [0.86-1.68]; p = 0.293) for mixed feeding and no breastfeeding respectively, nor in multivariable analysis (Adjusted Prevalence Ratio: 1.14, 95%CI [0.85-1.42] & Adjusted Prevalence Ratio: 1.20, 95%CI [0.68-1.68]; p = 0.589) for mixed feeding and no breastfeeding respectively. Breastfeeding during infancy was not significantly associated with overweight/obesity during adolescence. However, breastfeeding should be encouraged for its indisputable benefits for infants and their mothers alike. Further prospective studies are needed to assess the association.

A collaborative approach to develop an intervention to strengthen health visitors’ role in prevention of excess weight gain in children

BackgroundThe high prevalence of childhood obesity is a concern for public health policy and practitioners, leading to a focus on early prevention. UK health visitors (HVs) are well-positioned to prevent excessive weight gain trends in pre-school children but experience barriers to implementing guideline recommended practices. This research engaged with HVs to design an intervention to strengthen their role in prevention of early childhood obesity.MethodsWe describe the processes we used to develop a behaviour change intervention and measures to test its feasibility. We conducted a systematic review to identify factors associated with implementation of practices recommended for prevention of early childhood obesity. We carried out interactive workshops with HVs who deliver health visiting services in County Durham, England. Workshop format was informed by the behaviour change wheel framework for developing theory-based interventions and incorporated systematic review evidence. As intended recipients of the intervention, HVs provided their views of what is important and acceptable in the local context. The findings of the workshops were combined in an iterative process to inform the four steps of the Implementation Intervention development framework that was adapted as a practical guide for the development process.ResultsTheoretical analysis of the workshop findings revealed HVs’ capabilities, opportunities and motivations related to prevention of excess weight in 0-2 year olds. Intervention strategies deemed most likely to support implementation (enablement, education, training, modelling, persuasion) were combined to design an interactive training intervention. Measures to test acceptability, feasibility, and fidelity of delivery of the proposed intervention were identified.ConclusionsAn interactive training intervention has been designed, informed by theory, evidence, and expert knowledge of HVs, in an area of health promotion that is currently evolving. This research addresses an important evidence-practice gap in prevention of childhood obesity. The use of a systematic approach to the development process, identification of intervention contents and their hypothesised mechanisms of action provides an opportunity for this research to contribute to the body of literature on designing of implementation interventions using a collaborative approach. Future research should be directed to evaluate the acceptability and feasibility of the intervention.

Influences of the COVID-19 Pandemic on Obesity and Weight-Related Behaviors among Chinese Children: A Multi-Center Longitudinal Study.

COVID-19-related lockdown measures have been affecting children’s weight status and weight-related behaviors, which are often associated with an increase in childhood obesity. However, large-scale longitudinal studies are lacking. Our study aimed to analyze changes in obesity and weight-related behaviors in Chinese children before and during the COVID-19 pandemic and provide references for addressing the high prevalence of childhood obesity. A prospective multi-center longitudinal survey was conducted among Chinese children (n = 5963), collecting data on weight status, COVID-19-related measures, and lifestyle behaviors. Changes were assessed using t-tests and χ2 tests for paired samples, or the Wilcoxon signed-rank test, according to the type and distribution of data. The Generalized Estimating Equations model was used to explore influential factors of obesity. The prevalence of overweight and obesity increased from 9.2% and 8.6% before the pandemic to 10.5% and 10.6% during the pandemic (p < 0.001), respectively. Daily physical activity, sleep duration, and sugar-sweetened beverage consumption decreased while screen time increased. The results of the generalized estimating equations showed that ethnic minority, older age, less daily physical activity, reduced sleep duration, and longer screen time were positively associated with obesity. There is an intensifying trend of obesity in children in the context of the COVID-19 pandemic, to which altered weight-related behaviors might have contributed largely. Maintaining a healthy lifestyle, especially in social crises, should be highlighted to ease the burden of childhood obesity.

Geospatial Food Environment Exposure and Obesity among Low Income Baltimore City Children: Associations Differ by Data Source and Processing Method

ABSTRACT Due to the high prevalence of childhood obesity, it is imperative to assess the relationship children’s access to food retailers and obesity. However, the influence of methodological decisions on these associations has been understudied. We examined relationships between different measures of geospatial food environment (using 4 data sources, and 2 data processing methods), and BMI in a sample of low-income children in Baltimore, Maryland. The choice of data sources and data processing methods produced large differences in estimates of children’s exposures to certain store types, such as supermarket-like stores, but had less impact on associations with BMI z-scores.

Exploring parents' perspectives on feeding their young children: a qualitative study using photo-elicitation in Chile.

Childhood obesity is considered one of the most important public health problems around the world. Chile is currently one of the Latin American countries with a high prevalence of childhood obesity. Given that parents' food parenting practices shape their children's lifelong eating habits, addressing those practices is key to curbing later problems of obesity. However, studies of the influences on Chilean parents' food parenting practices are scarce. Hence, this study explores factors that influence food parenting practices of preschool-aged children in Chile. Qualitative research, using interviews with the photo-elicitation technique. Metropolitan Region, Chile. Twenty-five parents from families recruited from public childcare centres. Through a thematic analysis with an inductive approach, we identified five themes that influence food parenting practices: (1) parents' previous experiences and how they determine their current goals and beliefs; (2) responses to the child's characteristics; (3) the influences of other family members, especially grandparents; (4) parents' nutritional knowledge; and (5) living contexts, especially limited budgets and lack of time. The study reveals multilevel influences, which converge at the family level, on food parenting practices. A family-centrerd approach that addresses the mentioned influences is necessary to improve the management of the childhood obesity problem in Chile.

Childhood Obesity in Public and Private Middle School Students

Background: Obesity is defined as the syndrome in which excessive fat deposits in the adipose tissues, which affects the normal functioning of the body. Childhood obesity is the great challenge these days. In Pakistan recent study on children 10-15 years of age shows high prevalence of childhood obesity. The present study will help to inform the community regarding the frequency and percentage of overweight and obese children in middle standard schools. Objective: Objective so this study were to identify the recent estimate of frequency of obesity in middle school students in year 2017 and then to compare the frequency of obesity in public and private sector schools. Material and methods: This Descriptive cross sectional study was conducted in 2 private schools of Sahiwal and 2 government schools of Lahore, Punjab, Pakistan. About 324 children (81 from each school) were recruited randomly and interviewed about their physical activities. Height and weight were measured and BMI was calculated. Children were distributed in different BMI group and obesity as assessed. Results: The mean age of children in government school was 13.01 ± 1.09 years while in private school was 12.75 ± 1.08. 50% were females from government school and 50% from private school. 50% were male students from government school and 50% from private schools. The mean BMI of participants was 18.48 ± 3.36 kg/m2 in government school while 20.14 ± 3.66 kg/m2 in private school. When frequency of government and private school was compared results shows that out of 162 students from each school, 13 (8%) in government schools and 24 (14.8%) in private schools are overweight, while 8 (4.9%) in government schools and 17 (10.5%) in private schools are obese. Conclusion: High frequency of obesity and over weight in children of middle schools was noted. This frequency is greater in students of private schools both males and females as compared to students of government schools both males and females. Keywords: Obesity, school going Children, private school, government school, body mass index, height, weight

A 15 month - old Bangladeshi Baby With Very Severe Hypertriglyceridemia, Secondary to Glycogen Storage Disease

Hypertriglyceridemia is increasingly identified in children and adolescents, due to improved screening and higher prevalence of childhood obesity. The etiologic origin can be primary (genetic) or secondary, but it is often multifactorial. Management is challenging because of the interplay of genetic and secondary causes and lack of evidence-based guidelines. In this case report a fifteen month old boy was incidentally found with hypertriglyceridemia while finding the cause of his abdominal distension and was managed with oral and intravenous medications. KYAMC Journal. 2021;12(3): 182-186

Assessment of body mass index in a pediatric population aged 7–17 from Ukraine according to various international criteria–A cross-sectional study

Childhood obesity is one of the most serious public health problems. The prevalence of obesity among children is increasing and may negatively affect their immediate health, but it can also lead to obesity in adulthood. The aim of the study was to compare BMI cut-off points by examining three main international references: the World Health Organization (WHO), the International Task Force Obesity (IOTF) and the US Center for Disease Control and Prevention (CDC). Ultimately, the study group consisted of 18,144 children and adolescents aged 6.5–17.5 years. Body mass was measured on medical scales with an accuracy of ± 100 g and height measurement was taken using a height meter with an accuracy of ± 0.1 cm three times. Underweight, overweight and obesity were calculated according to WHO, IOTF and CDC BMI international references. There were differences in the incidence of underweight between the classifications: 16.8% according to IATF, 5.3% according to WHO and 9.9% according to CDC. There were also differences in the incidence of overweight and obesity between the classifications: 13% according to IOTF, 19.7% according to WHO and 14.1% according to CDC. In the CDC and WHO studies, a significantly higher prevalence of childhood obesity (4.0% and 4.7%, respectively) was observed compared with IOTF (2.1%). The prevalence of overweight and obesity in this study was higher among boys compared to girls. However, estimates of prevalence of overweight and obesity differ in methods and reference cut-off points. Higher prevalence was obtained in IOTF classification, followed by the WHO and CDC classification.

High prevalence of childhood overweight and obesity in ten Caribbean countries: 2018 cross-sectional data and a narrative review of trends in Trinidad and Tobago

ABSTRACT Background: There is an increasing prevalence of obesity among school-children globally, including the Caribbean region. Aim: To obtain cross-sectional data on childhood obesity in the Caribbean, and to explore trends in prevalence of childhood overweight and obesity over the past two decades in Trinidad and Tobago. Methods: The 2018 Caribbean Island Urinary Iodine Survey (CRUISE) was a multi-site, cross-sectional, primary school-based study in ten Caribbean countries, in which healthy school-children aged 6–12 years (n = 3040) from urban and rural clusters were selected to complete a questionnaire and obtain anthropometric data using standardised methods. Additionally, all reported studies among school-children (aged 5–18 years) in Trinidad and Tobago within the last 20 years were utilised in a narrative review of the trends in prevalence of childhood obesity and associated risk factors. Results: All 10 Caribbean territories had a high prevalence of overweight (28 · 0–44 · 5%) and obesity (14 · 3–19 · 8%). The highest cumulative overweight and obesity percentage were in Dominica (60 · 1%) and the lowest in Grenada (43 · 0%). Trinidad and Tobago ranked fifth, but in this territory the combined percentage of overweight and obese school-children has been steadily increasing from 12% in 2001 to 51 · 5% in 2018. This corresponds with a notable decline in physical activity (29 · 2% to 20 · 5%) and increase in sedentary time (47 · 3% to 49 · 0%) from 2011 to 2017. Conclusion: There is an alarmingly high prevalence of childhood obesity across the Caribbean. Within the last two decades, the percentage of overweight and obese school-children in Trinidad and Tobago has increased four-fold, likely reflecting a decline in physical activity and rise in sedentary behaviour.

Influence of a Physical Exercise Program in the Anxiety and Depression in Children with Obesity.

(1) Background: The high prevalence of childhood obesity and its multicausal etiology make it necessary to approach it through different strategies, whose objective is to promote the physical, mental, and social well-being of children. Regular physical activity, in addition to having positive effects on the physical environment of those who practice it, influences positively in psychological aspects such as anxiety and depression, which are very frequent in children with obesity and overweight. (2) Objective: To analyze the changes produced by a program of physical exercise based on anthropometric indicators and levels of anxiety and depression in a population of Mexican children with obesity. (3) Methods: A longitudinal study with experimental group (EG) and control group (CG). The analysis population consisted of 105 children with a body mass index (BMI) for their gender and age group above the 95th percentile, of which 60 were girls and 45 were boys, with a mean age of 10.02 years (SD ± 0.79). By randomizing the participants, 54 were part of the EG and 51 of the, CG The EG participated in a physical exercise program, distributed in two weekly sessions, each lasting 50 min, for 20 consecutive weeks. The CG group continued its usual activities during the intervention period. An inferential analysis was performed between the socio-demographic, anthropometric and psychological variables. (4) Results: The implementation of a physical exercise program in children with obesity favors the appearance of positive thoughts, with improvements in their emotional well-being, self-perception and self-concept; although it does not produce significant changes in weight, height, Z-Score, level of anxiety or depressive thoughts. (5) Discussion: Regular physical exercise practice has positive effects on mental health, although new studies are required to analyze specifically its influence on anxiety and depression in children with obesity.

Childhood Obesity and Overweight in Ghana: A Systematic Review and Meta-Analysis.

The increasing prevalence of childhood obesity and overweight is considered a public health issue in both developed and developing countries. This systematic review and meta-analysis estimates the prevalence of childhood obesity and overweight in Ghana. A multiple database search was conducted for articles published between January 1, 2001, and October 31, 2019, reporting the prevalence of childhood obesity and overweight in Ghana. Databases searched include PubMed, Google Scholar, Scopus, Cochrane Library, World Health Organization (WHO) Library Information System, and Africa Journals Online. Data were pooled from the articles to calculate an overall estimate of childhood obesity and overweight using a random-effects model after variance stabilization with Freeman–Tukey double arcsine transformation. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixteen studies with a combined sample size of 29,160 were included in the review. Analysis indicates that approximately 19% of children in Ghana either have obesity or are overweight. The prevalence of childhood obesity and overweight was 8.6% (95% CI: 4.8%–13.4%) and 10.7% (95% CI: 5.9%–16.6%), respectively. Although not significant, higher obesity (4.6% vs. 2.6%) and overweight (11.0% vs. 7.2%) prevalence were estimated for females than for males. There was a significantly higher obesity prevalence estimate (17.4% vs. 8.9%) in rural settings than in urban settings (p=0.0255). The high prevalence of childhood obesity and overweight estimated in this review is of worrying concern. It is a significant public health problem that has implications on the health of present and future generations in Ghana and as such calls for proactive measures to be put in place. Also, the driving forces behind the increasing prevalence of childhood obesity in Ghana need to be investigated.

Insulin Resistence in Obese and Non Obese Pre-Pubertal Children:Cross Sectional Study in Indonesia

High prevalence of childhood obesity increases risk of insulin resistance in pre-pubertal children. The purpose of this study is to identify the presence of insulin resistance in pre-pubertal obese children and compare with children who had normal nutritional status. Observational analytic study with a cross sectional design is used for this research. There are 60 elementary school students aged 6-9 years involved in this study, 30 obese students and 30 students with normal nutritional status based on BMI for Age. Fasting insulin, fasting blood glucose and HOMA IR index were carried out in Parahita Laboratory at Sidoarjo. Statistical analysis using independent t-test was used to determine differences in fasting blood glucose, fasting insulin and HOMA IR between two groups and linear regression to analyze the effect of obesity on insulin resistance with a significance value &lt; 0.05.The results showed mean scores of BMI obese and non-obese group were 25.6 and 15.96 respectively, the mean value of BMI z score among obese group and non-obese was 3.7 and-0.6 respectively; the abdominal circumference value of obese and non obese group consist of 84.95 and 59.48 cm. Statistical analysis showed no significant difference in fasting blood glucose levels, but fasting insulin levels and HOMA IR between 2 groups differed significantly. Obesity (BMI and abdominal circumference) influenced incidence of insulin resistance. Furthermore, obese and non-obese groups have different sensitivity of insulin response but had the same blood glucose level; obese group had higher HOMAIR than non-obese group. So, there needs an intervention to reduce obesity at an early age to reduce the risk of insulin resistance in pre-pubertal age.