Measured Weight Status Research Articles

An exploratory examination of medical and nursing students’ intentions to discuss body image, weight, and eating disorders with their patients

BackgroundAlthough many people have concerns about their body image, weight, and eating behaviors these issues are not usually discussed in a productive manner with medical providers. Thus, we examined nursing and medical students’ willingness to discuss patients’ weight, body image, and eating disorders and reasons why they may do so.MethodOne hundred and eighty-three nursing and medical students (Mage = 25.06, SD = 5.43) participated in this study. Participants completed open-ended questions pertaining to their willingness to discuss body image, eating, and weight-related issues with future patients. We further queried students’ perspective on body mass index (BMI) as a measure of weight status and sought to determine if participants’ own weight, weight concerns, appearance evaluation, body appreciation, and experiences of stigma were associated with their willingness to discuss weight-related issues with prospective patients.ResultsCoding of qualitative data indicated that nursing and medical students were “sometimes” willing to discuss prospective patients’ weight, body image, and eating disorders, especially if a health concern was evident. Nursing students seemed somewhat more willing to discuss weight issues than medical students and willingness to discuss one of these issues (e.g., body image) was positively associated with willingness discuss the others. Plans for future discussions of body image and weight were marginally associated with personal experiences of weight stigma. The majority of participants indicated that BMI was not a valid measure of health.ConclusionsTaken together, findings suggest that future providers’ conversations with patients about these sensitive topics are less likely to be associated with their own experiences and more with the relevance of these topics to specific patients.

High BMI z-Scores from Different Growth References Are Not Comparable: An Example from a Weight Management Trial with an Anti-Obesity Medication in Pubertal Adolescents with Obesity.

Background: The BMI z-score is a standardized measure of weight status and weight change in children and adolescents. BMI z-scores from various growth references are often considered comparable, and differences among them are underappreciated. Methods: This study reanalyzed data from a weight management clinical study of liraglutide in pubertal adolescents with obesity using growth references from CDC 2000, CDC Extended, World Health Organization (WHO), and International Obesity Task Force. Results: BMI z-score treatment differences varied 2-fold from -0.13 (CDC 2000) to -0.26 (WHO) overall and varied almost 4-fold from -0.05 (CDC 2000) to -0.19 (WHO) among adolescents with high baseline BMI z-score. Conclusions: Depending upon the growth reference used, BMI z-score endpoints can produce highly variable treatment estimates and alter interpretations of clinical meaningfulness. BMI z-scores cited without the associated growth reference cannot be accurately interpreted.

Is body image misperception associated with sociodemographic factors and life habits? a cross-sectional study 1399 Tunisian school-adolescents

IntroductionUnderstanding adolescents perceptions of their weight status and the factors influencing these perceptions is pivotal for developing targeted interventions and policies to counteract the rising obesity trends.ObjectivesThis cross-sectional study aimed to determine the accuracy of weight status perceptions among Tunisian adolescents compared to objective metrics and to identify sociodemographic characteristics and life habits associated with the underestimation of weight status.MethodsA cross-sectional, school-based study was conducted among a randomized sample of adolescents attending secondary schools in Sousse, Tunisia. A total of 1399 students participated, with anthropometric measurements taken, and a pre-tested Arabic questionnaire administered to gather sociodemographic data and perceived weight status, assessed using the Figure Rating Scale (FRS). The accuracy of perceived weight status was determined by comparing the measured weight status with participants; self-reported perceptions. We evaluated the association between body weight distortion and life habits which included regular physical activity, screen time (time spent on internet per day), number of fruits and vegetables consumed per day, and fast-food consumption.ResultsThe study achieved an 86.68% response rate, with over half of the participants being female (60.5%), and the average age being 17 years. The majority of adolescents (41%) perceived themselves as having normal body weight, while 34.5% perceived themselves as underweight, 16.6% as overweight, and 7.9% as obese. However, based on BMI categories, 72.6% had a normal measured weight, 20.4% were overweight, and 6.9% were obese. A substantial proportion of participants (45.6%) underestimated their weight status, with a significant proportion being objectively overweight or obese (26%). Furthermore, we found a significant association between the perception of weight accuracy with four correlates: gender, mother educational level, regular physical activity, and the number of fruits and vegetables consumed per day.ConclusionsThe findings revealed a disparity between perceived and actual weight status among Tunisian adolescents, with a significant underestimation of weight status, particularly among those who are overweight or obese. The results highlighted the crucial need for interventions that address weight perception inaccuracies and promote healthy weight awareness and management among adolescents in Tunisia. The study underscored the importance of further research to understand the development and progression of body weight underestimation throughout adolescence and the roles of lifestyle behaviors in shaping weight perceptions.Disclosure of InterestNone Declared

Body Image Misperceptions Among Tunisian Adolescents.

Background Obesity is a globally recognized health concern with profound consequences for individual health, especially among adolescents. Tunisia, like many countries, is experiencing alarming rates of adolescent obesity. Understanding adolescents' perceptions of their weight status and the factors influencing these perceptions is pivotal for developing targeted interventions and policies to counteract the rising obesity trends. Objective To determine the accuracy of weight status perceptions among Tunisian adolescents compared to objective metrics and to identify sociodemographic characteristics associated with the inaccurate estimation of weight status. Methods A cross-sectional, school-based study was conducted among adolescents attending secondary schools in Sousse, Tunisia, during the 2017-2018 academic year. A total of 1399 students participated, with anthropometric measurements taken, and a pre-tested Arabic questionnaire administered to gather sociodemographic data and perceived weight status, assessed using the Figure Rating Scale (FRS). The accuracy of perceived weight status was determined by comparing the measured weight status with participants' self-reported perceptions. Results The study achieved an 86.68% response rate, with over half of the participants being female (60.5%), and the average age being 17 years. The majority of adolescents (41%) perceived themselves as having normal body weight, while 34.5% perceived themselves as underweight, 16.6% as overweight, and 7.9% as obese. However, based on BMI categories, 72.6% had a normal measured weight, 20.4% were overweight, and 6.9% were obese. A substantial proportion of participants (45.6%) underestimated their weight status, with a significant proportion being objectively overweight or obese (26%). Furthermore, we found a significant association between the perception of weight accuracy and both gender (p = 0.010) and the mother's educational level (p = 0.035). Conclusions The findings revealed a disparity between perceived and actual weight status among Tunisian adolescents, with a significant underestimation of weight status, particularly among those who are overweight or obese. The results highlighted the crucial need for interventions that address weight perception inaccuracies and promote healthy weight awareness and management among adolescents in Tunisia.

Do family characteristics contribute to a socioeconomic gradient in overweight in early childhood? – Single mediation analyses of data from German preschool children

Children’s overweight is strongly associated with family socioeconomic position (SEP) and family characteristics (FC). There is limited research on the extent to which FC account for a socioeconomic gradient in childhood overweight. This study examined whether FC explain SEP differences in the prevalence of overweight. The study used baseline data of preschool-aged children from the German ‘PReschool INtervention Study’. The sample (n = 872, 48% girls) was recruited at kindergartens in Baden-Württemberg, Germany. Data included children’s measured weight status and parents’ reports on socioeconomic indicators (e.g., school education, vocational education, income) and FC. Variables represent main determinants of overweight (nutrition: sweets consumption in front of TV, soft drink consumption, regular breakfast, child sets table; physical activity: outdoor sports; parental role model). In single mediation analyses indirect effects of SEP on overweight were analysed (OR[95%CI]). Preschool girls and boys with low parental education had higher odds for overweight than children with high parental education. Among boys, low levels of parental education contributed to the odds of overweight via indirect effects by both factors ‘sweets consumption in front of TV’ (OR = 1.31[1.05–1.59]) and ‘no sports’ (OR = 1.14[1.01–1.38]). Among girls, FC measured did not explain SEP differences in overweight. Family nutrition and parental/family physical activity contribute to inequalities in overweight among preschool boys, but not girls. Research is needed to identify FC that explain inequalities in overweight for both.

Understanding weight status and dietary intakes among Australian school children by remoteness: a cross-sectional study.

To determine whether primary school children's weight status and dietary behaviours vary by remoteness as defined by the Australian Modified Monash Model (MMM). A cross-sectional study design was used to conduct secondary analysis of baseline data from primary school students participating in a community-based childhood obesity trial. Logistic mixed models estimated associations between remoteness, measured weight status and self-reported dietary intake. Twelve regional and rural Local Government Areas in North-East Victoria, Australia. Data were collected from 2456 grade 4 (approximately 9-10 years) and grade 6 (approximately 11-12 years) students. The final sample included students living in regional centres (17·4 %), large rural towns (25·6 %), medium rural towns (15·1 %) and small rural towns (41·9 %). Weight status did not vary by remoteness. Compared to children in regional centres, those in small rural towns were more likely to meet fruit consumption guidelines (OR: 1·75, 95 % CI (1·24, 2·47)) and had higher odds of consuming fewer takeaway meals (OR: 1·37, 95 % CI (1·08, 1·74)) and unhealthy snacks (OR = 1·58, 95 % CI (1·15, 2·16)). Living further from regional centres was associated with some healthier self-reported dietary behaviours. This study improves understanding of how dietary behaviours may differ across remoteness levels and highlights that public health initiatives may need to take into account heterogeneity across communities.

The Correlation of Built Environment on Hypertension, and Weight Status amongst Adolescence in Saudi Arabia.

The prevalence of hypertension is becoming more common in children and adolescents than ever before. Thus, the aim of this study was to evaluate the associations between the built environment on physical activity, sedentary behaviour, waist circumference, and health amongst adolescents in Saudi Arabia. A systolic and diastolic blood pressure, resting heart rate and waist circumference of 380 boys and girls aged between 15-19 years old (male = 199 and females = 181) were measured. The International physical activity Questionnaire Short Form was used to assess the physical activity levels and time spent sitting. The statistical analysis conducted were means and standard deviation, 2-way and 3-way of variance (ANOVA), Bonferroni post hoc tests, Chi-squared distribution and Pearson's correlations. Among males, 16.75% were classified as hypertensive, 12.69% as pre-hypertensive, and 70.56% as normal whereas, females, 23.20% were classified as hypertensive, 12.15% as pre-hypertensive and 64.64% as normal. There were significant differences (F1,379 = 16.50, p < 0.001) between males and females waist circumference. Pearson's correlation also revealed significant positive relationships in sedentary time (r = 0.123, p < 0.016), WC (r = 0.104, p < 0.043), and systolic blood pressure (r = 0.110, p < 0.032). The results revealed that systolic and diastolic blood pressure are significantly related to multiple measures of weight status, and sedentary behaviour. The results also highlight that active youth had lower resting heart rate compared to inactive peers. The present findings provide a foundation of knowledge for future research and highlight the major need for research and policy interventions, to address the concerning health habits of Al-Ahsa youth and broader Kingdom of Saudi Arabia.

Overweight/obesity and chronic health conditions in older people with intellectual disability in Ireland.

This study examines overweight/obesity and chronic health conditions (CHCs) in older people with intellectual disability (ID). Data for this cross-sectional observational study emanated from Wave 2 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, a longitudinal study assessing the health and well-being of older Irish adults with ID aged ≥40years across all levels of ID. Participation involves an interview process and collation of objective health measures. In this study, body mass index (BMI) (n=572), used as a measure of weight status, was examined with clustered doctor's diagnosed CHCs. Descriptive analysis was conducted where counts (n) and proportions (%) were used to summarise the variables univariately, while cross-tabulations were used for bivariate summary into counts and proportions. With overweight/obesity prevalence established and patterns described using logistical regression, Pearson's chi-squared test was used to test for significant associations. Overweight/obesity identified in 69% of participants occurred with greater frequency in women (72%). A higher percentage of participants aged <50years (72.5%) were overweight/obese than those aged 50-64 (70%) and 65+ (61.4%). Level of ID and residence type were significantly associated with weight status (P<0.001), with overweight/obesity more prevalent in mild (85.7%) than moderate (72%) or severe/profound ID (51.4%). Of those who lived independently/with family, 78.4% were overweight/obese, as were 74% living in a community group home (P<0.001). Almost all overweight/obese participants' waist measurements were in the substantially increased risk of metabolic disease waist measurement category (92%, P<0.001). Logistical regression used to model CHCs on BMI showed significant association between BMI and gastrointestinal tract [odds ratio (OR)=0.57, P<0.008, 95% confidence interval (CI)=(0.37; 0.86)], respiratory condition [OR=8.95, P<0.004, 95% CI=(2.57; 56.72)] and musculoskeletal disorders [OR=0.40, P<0.001, 95% CI=(0.25; 0.63)]. The findings illustrate the strong cross-sectional association between overweight/obesity and CHCs. These findings suggest a need to prioritise weight status as a health risk to people with ID as they age.

The Relationship between Bodyweight Status and Weight Perception Explains Differences in Calories Ordered in a Food Choice Exercise.

Understanding food choice is critical to be able to address the rise in obesity rates around the globe. In this paper, we examine the relationship between measured (BMI, using self-reported height and weight) and perceived weight status with the number of calories ordered in a controlled online food choice exercise. A total of 1044 participants completed an online food choice exercise in which they selected ingredients for a sandwich from five categories: meat/protein, cheese, spread/dressing, bread, and vegetables. We examine the number of calories ordered by participants and use linear regression to study the relationship of BMI category relative to self-reported perceived weight status with calories ordered. As a comparison to previous literature, we also examine the relationship between relative weight status and self-reported dieting behavior using logistic regression. We find that participants perceiving themselves to have a higher BMI than their BMI calculated using height and weight ordered significantly fewer calories and were more likely to report dieting than participants who perceived themselves to have a lower BMI than their calculated BMI. The relationship between perceived weight status and measured weight status explains behavior in a food choice task. Understanding how people perceive their weight may help design effective health messages.

Sex differences in the relation between body mass index trajectories and adolescent social adjustment

AbstractMost research on weight‐related social difficulties in adolescence emphasizes categorical measures of weight status (e.g., overweight/obese vs. non‐overweight/non‐obese). However, teens who are not overweight can also experience weight‐related social adjustment problems, and girls may be at higher risk for maladjustment due to weight‐related stigmatization than their male counterparts. The current study modeled trajectories of BMI z‐score (zBMI), a continuous measure of BMI relative to U.S. reference standards for child age and sex, for boys and girls from ages 9 to 15. The sample of 938 adolescents, drawn from the Study of Early Child Care and Youth Development, contained proportions of normal weight and overweight/obese teens that approximate the U.S. population. Latent growth curve modeling was used to establish quadratic models describing zBMI change in boys and girls separately using measurements collected at ages 9, 10.5, 11.5, 12.5, 13.5, and 15.5. zBMI growth parameters were used to predict a latent social adjustment variable indicated by mother and adolescent reports of adaptive social functioning at age 15. Controlling for pubertal timing, socioeconomic status, race/ethnicity, the proportion of measurements at which children were classified as overweight, and age 9 social adjustment, girls’ more rapid BMI gains across the pubertal transition, and greater acceleration of these growth rates relative to national norms were associated with lower age 15 social adjustment. Findings suggest that a better understanding of weight‐related social adjustment may require broadening the scope of research and intervention efforts to normal‐weight teens, particularly normal‐weight girls.

A systematic review of the implementation of obesity prevention interventions in early childcare and education settings using the RE-AIM framework.

Previous systematic reviews have examined the efficacy of obesity prevention interventions within early childcare/education settings. Often lacking in these reviews is reporting on external validity, which continues to be underemphasized compared to internal validity. More attention to external validity would help better translate evidence-based interventions to real-world settings. This systematic review aimed to determine the availability of data on both internal and external validity across dimensions of the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework in studies reporting on obesity prevention interventions in early childcare/education settings. Inclusion criteria included: randomized controlled trials, early childcare/education setting, targeted children 2-6 years old, addressed both diet and physical activity, collected measures of weight status and diet and/or physical activity, and published within the last 10 years. Searches were conducted in ERIC, PsychInfo, and PubMed; 23 studies met inclusion criteria. A validated RE-AIM abstraction tool was used to code studies. Most commonly reported dimensions were Reach (62.3%), Implementation (53.5%), and Efficacy/Effectiveness (48.7%). Adoption (21.7%) and Maintenance (11.6%) were less often reported. All studies reported on primary outcomes, but few reported on RE-AIM indicators of characteristics of participation and adoption, quality of life, methods used to identify staff, staff inclusion/exclusion criteria and adoption rates, implementation fidelity, measures of cost to start-up and deliver the intervention, and indicators of maintenance. This systematic review underscores the need for more focus on external validity to inform replication, dissemination, and implementation so that evidence-based early childcare/education obesity interventions can be generalized to real-world settings.

Managing Outliers in Adolescent Food Frequency Questionnaire Data

ObjectiveThe goal of this study was to explore the impact of 5 decision rules for removing outliers from adolescent food frequency questionnaire (FFQ) data. DesignThis secondary analysis used baseline and 3-month data from a weight loss intervention clinical trial. ParticipantsAfrican American adolescents (n = 181) were recruited from outpatient clinics and community health fairs. Variables MeasuredData collected included self-reported FFQ and mediators of weight (food addiction, depressive symptoms, and relative reinforcing value of food), caregiver-reported executive functioning, and objectively measured weight status (percentage overweight). AnalysisDescriptive statistics examined patterns in study variables at baseline and follow-up. Correlational analyses explored the relationships between FFQ data and key study variables at baseline and follow-up. ResultsCompared with not removing outliers, using decision rules reduced the number of cases and restricted the range of data. The magnitude of baseline FFQ-mediator relationships was attenuated under all decision rules but varied (increasing, decreasing, and reversing direction) at follow-up. Decision rule use increased the magnitude of change in FFQ estimated energy intake and significantly strengthened its relationship with weight change under 2 fixed range decision rules. Conclusions and ImplicationsResults suggest careful evaluation of outliers and testing and reporting the effects of different outlier decision rules through sensitivity analyses.

Lifetime antimicrobial use is associated with weight status in early adolescence-A register-based cohort study.

SummaryBackgroundAntimicrobial agents (AMs) are the most prescribed drugs to children. Early and repeated exposure to AMs in infancy is associated with increased risk of childhood overweight and obesity.AimsWe extended the investigation of AMs use, from birth to early adolescence, and evaluated their association with weight status.Materials & MethodsA total of 10093 children from Finnish Health in Teens cohort (Fin‐HIT) with register‐based data on AMs purchases and measured weight status at the mean age of 11.2 y (SD 0.82) were included in the study. The key exposures were the number AM purchases at a given age or the sum of these during the entire follow‐up time to describe lifetime exposure / use. Outcome was weight status in early adolescence defined with International Obesity Task Force cut‐offs for the age‐ and sex‐specific body mass index. Odds Ratio (OR) and 95% confidence intervals (CI) were estimated using Multinomial Logistic Regression.ResultsOf children, 73.7% were normal weight, 11.1% thin and 15.2% overweight/obese. AMs use was highest during the second year of life, when 65% of all children used AMs, but thereafter decreased with age. The highest mean purchases and prevalence at any given age along with the highest lifetime use were consistently seen among overweight children. Each episode of AMs use throughout life increased the risk of being overweight in adolescence [OR = 1.02 (1.02–1.03)]. However, there was an inverse association between AMs use and thinness [OR = 0.98 (0.97–0.99)].DiscussionDespite a high prevalence of AMs use during the early years, lifetime‐use was associated with weight status in early adolescence in a dose response manner.ConclusionFuture studies should address mechanisms underlying the relationship between AM use and weight.

Variation in the Socioeconomic Gradient of Obesity by Ethnicity - England's National Child Measurement Programme.

ObjectiveThis study examined the prevalence and risk of overweight/obesity among expanded ethnicity categories within boys and girls in England and the differential influence of socioeconomic position using the 2015/2016 and the 2016/2017 cycles of the National Child Measurement Programme.MethodsThis cross‐sectional and descriptive study examined surveillance data of weight status among primary school children in England. Data were pooled across data collection years, representing 1.25 million children in Reception (aged 4‐5 years) and 1.1 million children in Year 6 (aged 10‐11 years). Ethnicity was classified according to National Health Service definitions, and child residence was used to calculate quintiles of Income Deprivation Affecting Children Index. Measured weight status was classified using the International Obesity Task Force’s definition. Logistic regression models were run for each sex and year group.ResultsWithin each sex, ethnicity‐ and socioeconomic‐specific differentials in overweight/obesity prevalence were evident. For example, among the five most populous ethnic groups in the most deprived quintile, 26.8% of White British girls in Reception had overweight/obesity compared with 20.7% of girls with Pakistani, 31.2% with Black African, 17.1% with Indian, and 22.2% with any Any Other White (e.g., White European) background.ConclusionsEthnicity had an independent influence on overweight/obesity risk after adjustment for socioeconomic position.

Factors associated with frequent consumption of fast food among Australian secondary school students.

To examine demographic and behavioural correlates of frequent consumption of fast food among Australian secondary school students and explore the associations between fast food consumption and social/environmental factors. Cross-sectional survey using a web-based self-report questionnaire. Secondary schools across all Australian states and territories. Students aged 12-17 years participating in the 2012-2013 National Secondary Students' Diet and Activity survey (n 8392). Overall, 38 % of students surveyed reported consuming fast food at least weekly. Being male, residing in lower socio-economic areas and metropolitan locations, having more weekly spending money and working at a fast food outlet were all independently associated with consuming fast food once a week or more, as were several unhealthy eating (low vegetable intake and high sugary drink and snack food intake) and leisure (low physical activity and higher commercial television viewing) behaviours and short sleep duration. Frequent fast food consumption and measured weight status were unrelated. Students who agreed they go to fast food outlets with their family and friends were more likely to report consuming fast food at least weekly, as were those who usually 'upsize' their fast food meals and believe fast food is good value for money. These results suggest that frequent fast food consumption clusters with other unhealthy behaviours. Policy and educational interventions that reach identified at-risk groups are needed to reduce adolescent fast food consumption at the population level. Policies placing restrictions on the portion sizes of fast food may also help adolescents limit their intake.

Sleep and obesity among children: A systematic review of multiple sleep dimensions.

SummaryThe objectives were to systematically investigate the multiple dimensions of sleep and their association with overweight or obesity among primary school‐aged children. CINHAL, PsycINFO, SPORTDiscus, Medline, Cochrane, Embase, and PubMed databases were searched for papers reporting on an association between children's sleep and weight status. Studies on clinical populations, published in languages other than English, without objectively measured weight status, or where weight status was reported outside the outlined age bracket (5‐13 years) were excluded. A total of 34 248 citations were extracted from our systematic search protocol, of which 112 were included for detailed review. Compared with sleep duration, of which 86/103 articles found a significant inverse association between sleep duration and measured weight status, few studies examined other dimensions of sleep, such as quality, efficiency and bed/wake times, and relationship with weight status. Where studies existed, variation in defining and measurement of these dimensions restricted comparison and potentially influenced discrepancies across results. Overall, the findings of this review warrant the need for further research of the outlined dimensions of sleep. Future research would benefit from clarity on definitions across the different dimensions, along with the use of valid and reliable tools.

Prevalence and correlates of objectively measured weight status among urban and rural Mozambican primary schoolchildren: A cross-sectional study.

BackgroundThe coexistence of undernutrition (thinness) and overnutrition (overweight/obesity) among children and adolescents is a public health concern in low-middle-income countries. Accurate prevalence estimates of thinness and overweight/obesity among children and adolescents are unavailable in many low-middle-income countries due to lack of data. Here we describe the prevalences and examine correlates of objectively measured weight status among urban and rural schoolchildren in Mozambique.MethodsA cross-sectional study design was applied to recruit 9-11-year-old schoolchildren (n = 683) from 17 urban and rural primary schools in Mozambique. Body mass index (BMI) was computed from objectively measured height and weight and participants’ weight categories were determined using the World Health Organization cut-points. Actigraph GT3X + accelerometers were worn 24 hours per day for 7 days to assess movement behaviours. Multilevel multivariable modelling was conducted to estimate odds ratios and confidence intervals.ResultsCombined prevalence of overweight/obesity (11.4%) was significantly higher among urban participants compared to rural participants (5.7%; χ2 = 7.1; p = 0.008). Conversely, thinness was more prevalent among rural (6.3%) compared to urban (4.2%) participants. Passive school commute, not meeting daily moderate- to vigorous-intensity physical activity (MVPA) guidelines, and maternal BMI >25 kg/m2 were associated with overweight/obesity while possessing one or more functional cars at home, maternal BMI >25 kg/m2 and being an older participant were associated with thinness in the present sample. The proportion of total variance in the prevalences of obesity and/or thinness occurring at the school level was 8.7% and 8.3%, respectively.ConclusionPrevalences of thinness, overweight/obesity and other key variables differ between urban and rural schoolchildren in Mozambique. MVPA, active transport and mother’s BMI are important modifiable correlates of weight status among Mozambican schoolchildren. Results from this study demonstrate important differences between urban and rural schoolchildren that should not be ignored when designing interventions to manage malnutrition, formulating public health strategies, and interpreting findings.

Depressive Symptom Clusters in Relation to Body Weight Status: Results From Two Large European Multicenter Studies.

Background: There is strong evidence for a bidirectional association between depression and obesity. Several biological, psychological, and behavior-related factors may influence this complex association. Clinical impression and preliminary evidence suggest that patients with a diagnosis of major depressive disorder may endorse very different depressive symptom patterns depending on their body weight status. Until now, little is known about potential differences in depressive symptoms in relation to body weight status. Objective: The aim of this analysis is the investigation of potential differences in depressive symptom clusters (mood symptoms, somatic/vegetative symptoms, and cognitive symptoms) in relation to body weight status. Methods: Cross-sectional baseline data were derived from two large European multicenter studies: the MooDFOOD Trial and the NESDA cohort study, including persons with overweight and obesity and normal weight reporting subthreshold depressive symptoms (assessment via Inventory of Depressive Symptomatology Self-Report, IDS-SR30). Different measures for body weight status [waist-to-hip ratio (WHR) and body mass index (BMI)] were examined. Propensity score matching was performed and multiple linear regression analyses were conducted. Results: A total of n = 504 individuals (73.0% women) were analyzed. Results show that more somatic/vegetative depressive symptoms, such as pain, change in appetite and weight, gastrointestinal symptoms, and arousal-related symptoms, were significantly associated with both a higher BMI and higher WHR, respectively. In addition, being male and older age were significantly associated with higher WHR. Mood and cognitive depressive symptoms did not yield significant associations for both body weight status measures. Conclusions: Somatic/vegetative symptoms and not mood and cognitive symptoms of depression are associated with body weight status. Thus, the results support previous findings of heterogeneous depressive symptoms in relation to body weight status. In addition to BMI, other body weight status measures for obesity should be taken into account in future studies. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02529423.

Maternal Smoking and Infant Low Birth Weight: Exploring the Biological Mechanism Through the Mother’s Pre-pregnancy Weight Status

Maternal smoking has been found to adversely affect birth outcomes, such as increasing the odds of having low birth weight infants. However, the mechanisms explaining how a mother’s smoking is linked to a child’s low birth weight status are underexplored. This study merged two nationally representative datasets in the United States (US)—the National Longitudinal Survey of Youth 1979 (NLSY79) and the NLSY79 Child and Young Adult (NLSYCYA)—to examine whether maternal weight status before pregnancy serves as a biological mechanism. We applied a recently developed mediation analysis technique to a data sample of 6550 mother–child pairs, and we compared the estimated coefficients across nested probability models. We found that maternal body mass index (BMI) (in kg/m2), a widely used measure of weight status, reduces the odds of delivering a low birth weight infant, and this mechanism explains about 10.2% of the adverse impact of maternal smoking on having a low birth weight child. Moreover, when categorizing maternal pre-pregnancy BMI into four weight statuses (i.e., underweight, normal weight, overweight, and obese), we found that, in contrast to mothers with normal weight status, underweight mothers are 70% more likely to have a low birth weight child. Our findings suggest that maternal weight status plays a role in understanding how maternal smoking affects low birth weight outcome, indicating that maintaining a proper weight status for women who plan to give birth may be a possible policy to promote infant health.

Physical activity interventions in early life aimed at reducing later risk of obesity and related non-communicable diseases: A rapid review of systematic reviews.

To identify useful components of interventions aimed at prevention of childhood obesity and related non-communicable diseases (NCDs), which included physical activity and which targeted any or all of four life-course stages: peri-conception; pregnancy; infancy and toddlerhood (0 to 23months); and early childhood (24 to 59months). In May 2016, WHO Geneva searched the Cochrane Library and PubMed for systematic reviews of interventions including physical activity to prevent childhood obesity or risk factors for obesity-related NCDs. Using a narrative synthesis, the efficacy of randomized controlled trials (RCTs) to alter energy balance outcomes (measures of weight status or body fatness) was characterized by life-course stage, study characteristics, intervention functions (as defined in the behaviour change wheel), and level of the socio-ecological model (SEM) targeted. The quality of included systematic reviews was assessed. We retrieved 82 reviews from the World Health Organization (WHO) search, of which 23 were eligible for the present synthesis. The number of eligible studies by life-course stage was: 0 (peri-conception); 0 (pregnancy); 8 (infancy and toddlerhood, age 0 to 23months; seven RCTs; age); and 37 (early childhood, age 24 to 59months; 30 RCTs;). Thus, there was a lack of evidence for physical activity interventions during peri-conception and pregnancy. Almost all relevant studies in the 0- to 23- and 24- to 59-month life-course stages were multicomponent interventions (ie, targeted physical activity, dietary, and/or sedentary behaviours). Interventions with evidence of efficacy tended to target multiple levels of the SEM, with emphasis on parents, and extend over long periods. Effective intervention elements for early life obesity prevention included classes on parenting skills, alteration of the kindergarten playground, and financial incentives. Evidence from low- and middle-income countries was scarce, and evidence for intervention effect on obesity-related NCDs was missing. Future physical activity interventions in toddlerhood and early childhood aimed at prevention of obesity should adopt the characteristics typical of effective interventions identified by the present synthesis. There is an urgent need for more evidence on physical activity interventions set in low- and middle-income countries and which target the peri-conception and pregnancy periods.