Child Overweight Status Research Articles

Sleep Difficulties and Obesity Among Preadolescents

To determine if sleep difficulties are associated with overweight/obesity status among preadolescents. A total of 606 (288 males, 318 females) students, ages 11-13 years from southern Ontario, Canada, were included in this analysis. Overweight/obesity status was determined using age- and gender-specific criteria. Sleep difficulty status was determined if the parents reported children 'sometimes' or 'often' experiencing waking up at night, snoring or breathing loudly, and restlessness while sleeping. Logistic regression analysis was used to examine the association of childhood overweight status and sleep difficulties adjusting for age, gender, total physical activity score, total calories intake, maternal education level, and total hours of sleep. In this sample, 28% of children (76 boys and 95 girls) were identified as being overweight or obese. Relative to their normal-weight peers, overweight and obese individuals reported a higher prevalence of sleep difficulties (10.3% vs. 26.3%, p < 0.0001), reduced hours of sleep (9.4 vs. 9.2 hrs, p < 0.001), and a lower physical activity score (17.2 vs. 19.1, p < 0.01). Using a multiple logistic regression model, in comparison to children reporting none of the three sleep behaviour problems, the odds ratios (95% CI) of being overweight or obese for those having any one, two, or all three sleep behaviour problems were 1.04 (0.46-2.36), 1.35 (0.58-2.10), and 3.52 (1.42-8.74), respectively. The results suggest that the risk of overweight/obesity is associated with sleep difficulties among preadolescents. Further study is needed to determine the direction of this relationship.

Contributions of Built Environment to Childhood Obesity

AbstractAs childhood obesity has reached epidemic proportions, it is critical to devise interventions that target the root causes of obesity and its risk factors. The two main components of childhood obesity are physical inactivity and improper nutrition, and it is becoming increasingly evident that the built environment can determine the level of exposure to these risk factors. Through a multidisciplinary literature review, we investigated the association between various built environment attributes and childhood obesity. We found that neighborhood features such as walkability/bikeability, mixed land use, accessible destinations, and transit increase resident physical activity; also that access to high‐caloric foods and convenience stores increases risk of overweight and obesity, whereas the presence of neighborhood supermarkets and farmers' markets is associated with lower childhood body mass index and overweight status. It is evident that a child's built environment impacts his access to nutritious foods and physical activity. In order for children, as well as adults, to prevent onset of overweight or obesity, they need safe places to be active and local markets that offer affordable, healthy food options. Interventions that are designed to provide safe, walkable neighborhoods with access to necessary destinations will be effective in combating the epidemic of obesity. Mt Sinai J Med 78:49–57, 2011. © 2011 Mount Sinai School of Medicine

Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease 12

Obesity is a significant public health threat to children in the United States. The aims were to: 1) Determine the prevalence of obesity in a multicenter cohort of children with inflammatory bowel disease (IBD); 2) Evaluate whether overweight and obese status is associated with patient demographics or disease characteristics. We used data from the ImproveCareNow Collaborative for pediatric IBD, a multicenter registry of children with IBD, collected between April 2007 and December 2009. Children ages 2-18 years were classified into body mass index (BMI) percentiles. Bivariate analyses and multivariate logistic regression were used to compare demographic and disease characteristics by overweight (BMI >85%) and obese (BMI >95%) status. The population consisted of 1598 children with IBD. The prevalence of overweight/obese status in pediatric IBD is 23.6%, (20.0% for Crohn's disease [CD] and 30.1% for ulcerative colitis [UC] and indeterminate colitis [IC]). African American race (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.10-2.48) and Medicaid insurance (OR 1.67, 95% CI 1.19-2.34) were positively associated with overweight/obese status. Prior IBD-related surgery (OR 1.73, 95% CI 1.07-2.82) was also associated with overweight and obese status in children with CD. Other disease characteristics were not associated with overweight and obesity in children with IBD. Approximately one in five children with CD and one in three with UC are overweight or obese. Rates of obesity in UC are comparable to the general population. Obese IBD patients may have a more severe disease course, as indicated by increased need for surgery. Sociodemographic risk factors for obesity in the IBD population are similar to those in the general population.

Latina Mothers’ Perceptions of Healthcare Professional Weight Assessments of Preschool-Aged Children

To understand Latina mothers’ definitions of health and obesity in their children and perceptions of physician weight assessments. 24 low-income Spanish speaking Mexican mothers of children ages 2–5 years were recruited to participate in 4 focus groups. Half of the mothers had overweight or obese children and half had healthy weight children. Focus group comments were transcribed and analyzed using grounded theory. Themes and supporting comments were identified independently by 3 reviewers for triangulation. A fourth reader independently confirmed common themes. Mothers define health as a function of their child’s ability to play and engage in all aspects of life. Obesity was defined with declining physical abilities. Mothers state health care provider assessments help determine a child’s overweight status. Causative factors of obesity included family role-modeling and psycho-social stress, physical inactivity, and high-fat foods consumed outside the home. Controlling food intake was the primary approach to preventing and managing obesity but mothers described family conflict related to children’s eating habits. These findings held constant with mothers regardless of whether their children were overweight, obese, or at a healthy weight. Mothers utilize physical limitations and health care professional’s assessment of their child’s weight as indicators of an overweight status. These results highlight the importance of calculating and communicating body mass indices (BMI) for Latino children. Eliminating non-nutritive foods from the home, increasing physical activity, and involving family members in the discussion of health and weight maintenance are important strategies for the prevention and management of childhood obesity.

Migration and the overweight and underweight status of children in rural China

The rapid economic growth in China is accompanied by a large scale rural-to-urban migration, but over time more children are left behind rural areas. This paper studies how the overweight and underweight status of the rural children is associated with the out migration of others in their household. We find that migration is related to different nutritional outcomes for the left-behind children. The older children (aged 7–12) are more likely to be underweight; the younger (aged 2–6) are less likely to be overweight if left behind without the care of a grandparent. We also find evidence that the remaining adult household members spent less time preparing meals, whereas older children take up more household chores.

Consumption of Vegetables, Cooked Meals, and Eating Dinner is Negatively Associated with Overweight Status in Children

To evaluate potential associations between diet- and physical activity-related lifestyle patterns and obesity indices in a cohort of children. Dietary and physical activity information and anthropometric indices were collected from 1138 children (53% girls; age, 11.2 ± 0.7 years). Dietary intake was evaluated with two 24-hour recalls, which were analyzed for nutrient and food intake, eating frequency, and meal quality. Principal component analysis was used to extract salient lifestyle patterns. Five lifestyle behavioral patterns were identified. The "dinner, cooked meals and vegetables pattern," a multidimensional lifestyle pattern including the consumption of vegetables, cooked meals, and eating dinner, was negatively associated with all obesity indices, even after adjustment for potential confounders and exclusion of low energy reporters. A "high fiber pattern," representing high consumption of whole-grain cereals, legumes, and low intake of sugar-sweetened beverages was negatively correlated with obesity indices; when the analysis included only acceptable energy reporters, these associations became non-significant, except for triceps skinfolds. Our findings are supportive of the synergistic or conditional effects of distinct lifestyle-related behaviors on obesity. Although these results are hypothesis-generating and need replication, they suggest potential preventive approaches, interventional approaches, or both to combat childhood obesity.

Physical activity, quality of life, weight status and diet in adolescents

This cross-sectional study aimed to investigate the relationship between quality of life (QoL), physical activity (PA), diet and overweight status in children 11 to 15 years old. Participants (N = 1,771) children with self-reported physical activity and QoL outcome data. Cross-sectional survey of four secondary schools, using the PedsQL and EQ-5D QoL instruments; the CAPANS physical activity instrument and a food intake screener questionnaire. The correlational analysis indicates little or no relationship between self-reported QoL, BMI and moderate to vigorous PA. We found no statistically significant differences between the two groups of children, who achieved the recommended PA guidelines and those who did not, on any of the dimensions of the PedsQL and the EQ-5D utility score. Only on the EQ-5D VAS dimensions score was there a statistically significant difference. Children who self-reported a BMI of overweight to obese had significantly lower QoL on both dimensions of the EQ-5D and every dimension of the PedsQL apart from School functioning. Overall this study showed mixed results for pupils achieving the recommended targets for physical activity and diet and their relationship with QoL. Hence, further study into PA and diet and their effects on QoL is needed.

Understanding the Nature of Metabolic Syndrome Components in Children and What They Can and Cannot Do to Predict Adult Disease

Understanding the Nature of Metabolic Syndrome Components in Children and What They Can and Cannot Do to Predict Adult Disease

Overweight in Children and Adolescents Associated with TV Viewing and Parental Weight: Project HeartBeat!

Parental obesity and TV viewing are risk factors for childhood obesity. This study assessed the association of children's TV viewing and computer use with body mass and examined whether parental weight status modified the association. Cross-sectional associations of parental weight status, hours of TV viewing and computer use, and children's body composition were studied in a subsample of 526 black and nonblack children, aged 8, 11, and 14 years at baseline, enrolled in Project HeartBeat!, a longitudinal study of cardiovascular disease risk factors, 1991-1995. BMI, fat-free mass (FFM), and percent body fat (PBF) were calculated from children's body composition measured at baseline. Children's TV viewing and computer use habits and parental height and weight were self-reported. Multivariate regression analysis was used in assessing inter-relations of parental weight status and child's TV viewing and computer use habits with BMI, FFM, PBF, and risk for overweight status (BMI > or =85th percentile), adjusting for age, gender, race, and Tanner stage. Children of one or two overweight/obese parents watched an average of 22+/-6 minutes or 30+/-11 minutes more TV per day than children of normal-weight parents, respectively (both p<0.01). In multivariate regression analyses, BMI and PBF increased significantly by 0.42 kg/m(2) and 1.14% (both p<0.001), respectively, for each hour of TV watched among children with overweight parents, but not for those with normal-weight parents (p(interaction)<0.05). Similar results were observed for total screen time. These study findings are consistent with a genetic contribution of parental weight; however, overweight/obese parents may also exhibit behavior patterns that negatively influence children's TV viewing and have an impact on child overweight status. The effect of parental BMI on children's BMI may have both a genetic and an environmental linkage.

Childhood Overweight Status Predicts Diabetes at Age 21 Years: A Follow‐up Study

We examined the prospective association of childhood BMI z-score and BMI categories (normal or overweight) with young adult diabetes, controlling for early life, childhood, and adolescence factors. A subsample of 2,639 young adults from the Mater-University study of pregnancy (MUSP) and its outcomes, a prospective birth cohort who were born in Brisbane, Australia and for whom we had measured height and weight at 5 years and self-reported diabetes at age 21 years. The risk of developing diabetes by age 21 years was greater among young adults who had greater BMI z-score or were overweight at age 5 years than those who had normal BMI at age 5 years. Young adults who were overweight at age 5 years had an increased odds ratio of 2.60 (95% confidence interval (CI): 1.29, 5.22, in age- and sex-adjusted model) of experiencing diabetes by age 21 years. Adjustment for potential confounders and mediators including intrauterine environmental factors, childhood dietary patterns, television watching, participation in sports and exercise, and current weight, did not substantively alter these associations. Overweight and increasing BMI z-score at childhood is an independent predictor of young adult's type 1 and type 2 diabetes. Findings of this study suggest that childhood BMI may be central to the development and rising incidence of all diabetes.

Longer Hours and Larger Waistlines? The Relationship between Work Hours and Obesity

Additional work hours may lead to weight gain by decreasing exercise, causing substitution from meals prepared at home to fast food and pre-prepared processed food, or reducing sleep. Substitution toward unhealthy convenience foods could also influence the weight of one's spouse and children, while longer work hours for adults may further impact child weight by reducing parental supervision. I examine the effects of adult work hours on the body mass index (BMI) and obesity status of adults as well as the overweight status of children. Longer hours increase one's own BMI and probability of being obese, but have a smaller and statistically insignificant effect on these outcomes for one's spouse. Mothers', but not mother's spouse's, work hours affect children's probability of being overweight. My estimates imply that changes in labor force participation account for only 1.4% of the rise in adult obesity in recent decades, but a more substantial 10.4% of the growth in childhood overweight.

Are Eating Occasions and Their Energy Content Related to Child Overweight and Socioeconomic Status?

The objectives of this study were: (i) to assess the relationships between childhood overweight (OW) and four eating behaviors: daily eating frequency, and the relative contribution of breakfast, main meals (lunch and dinner), and snacks to total daily energy intake (EI); (ii) to explore whether these eating behaviors are involved in the negative association between socioeconomic status (SES) and OW. A representative sample of French children aged 3-11 years (n = 748) was taken from the 1998-1999 cross-sectional French INCA1 (Enquête Individuelle et Nationale sur les Consommations Alimentaires) food consumption survey. Food intake was reported in a 7-day food record, and SES, physical activity, sedentary behavior (SED), weight, and height were reported by answering face-to-face questionnaires. After adjusting for EI, physical activity, and SED, OW was positively associated with the contribution of the main meals to EI (P = 0.03), not significantly associated with the contribution of breakfast to EI, and inversely correlated to the number of eating episodes (P = 0.009) and to the contribution of snacking episodes to EI (P = 0.007). Our data suggest that a combination of more frequent intake occasions and lower contribution of the main meals to total daily EI is associated with a smaller risk of OW in children. However, eating frequency was the only eating behavior that played a slight mediation role (contributing approximately 8%) in the inverse relationship between SES and OW.

Association of Bicycling and Childhood Overweight Status

Obesity is the most common chronic disease of childhood. Although it is accepted that diet and exercise practices are important, there is little data to discern the contributions of specific activities toward a healthy body weight. We sought to identify associations between bicycling and overweight status and to compare this with other physical activities and dietary practices thought to be protective against overweight status. We constructed a survey to gather dietary and activity practices in a cross-sectional, convenience sample of 100 children presenting to an urban hospital setting in Baltimore, Maryland. We chose to emphasize bicycling because it is a widely available activity that requires a sustained level of moderate energy expenditure, yet little is known about the relationship of this particular activity with childhood overweight status. The mean age of our population was 11.8 years and 56% were overweight (body mass index>85 percentile). Most (96%) knew how to ride a bike and 80% reported owning a bike. Children who rode a bike just once a week or less were the most likely to be overweight (multivariate-adjusted odds ratio 6.6, 95% confidence interval, 2.1-21). This association was stronger than for all other dietary and activity practices. We found that approximately half of our participants do not eat breakfast, fruits, or vegetables regularly. More than half never ride a bike to school, walk to school, or participate in any organized sport. Riding a bicycle at least 2 or more days during the week is associated with a decreased likelihood of being overweight during childhood.

Differences in Eating Style between Overweight and Normal-Weight Youngsters

Differences in eating styles between overweight and normal-weight youngsters were investigated with a child version of the Dutch Eating Behavior Questionnaire (DEBQ). Subjects were children (n=1458; M: 10.1; SD=1.3) and adolescents (n=1016; M: 14.9; SD=1.5). Overweight adolescent girls scored high on emotional eating while overweight adolescent boys displayed more external eating. In overweight children, already 10.5 per cent displayed emotional eating and 38.4 per cent reported external eating. All overweight youngsters reported restrained attitudes. Eating styles were positively associated with indicators of eating pathology. The results suggest the use of appropriate norms that take into account the child's age, gender and overweight status.

A Systematic Review of Parental Perception of Overweight Status in Children

To systematically review the proportion of parents able to recognize overweight status in their children who were recorded as being overweight by internationally recognized standards. Two independent reviewers searched electronic databases including MEDLINE, EMBASE, PSYCHINFO, and CINAHL for studies from inception to August 2007 using search terms related to childhood overweight and parents. Twenty-three studies satisfied inclusion criteria, representing 3864 overweight children from 7 countries and 5 distinct standard definitions of overweight status. Seventeen of 23 studies employed either greater than 95th centile or the International Obesity Task Force criteria. Parental recognition of their child's overweight status ranged from 6.2% to 73%, but in 19 of 23 studies, it was less than 50%. More than half of parents cannot recognize when their child is overweight. Relying on parents to seek help for their overweight children is likely to be ineffective, and hence population-based screening may be justified.

Primary Care of Overweight Children: The Importance of Parent Weight and Attitudes about Overweight: A MetroNet Study

The purpose of this study was to identify the association of parents' weight and attitude about their child's weight with the child's body mass index (BMI) status. Cross-sectional, clinic-based study in a practice-based research network. One hundred seventy-one parents or adults accompanying children aged 5 to 17 years to a primary care visit in 4 family medicine centers completed a questionnaire. Parent/adult overweight status and attitudes were compared with child overweight status. Forty-eight percent of children were overweight or obese (BMI >or= the 85th percentile) as were 56% of mothers and 77% of fathers (BMI >or= 25 kg/m(2)). Child and parent overweight were significantly associated, as were mother overweight and beliefs about child overweight status. Children aged 5 to 13 years were more likely to be overweight than those aged >or=14 years. Parents of overweight children are often overweight and many do not recognize that their children are overweight. Suggestions are made for primary care physicians to engage parents of overweight children in family weight control efforts.

Maternal employment and overweight children: does timing matter?

Recent literature has shown consistent evidence of a positive relationship between maternal employment and children's overweight status. These studies largely use average weekly work hours over the child's life to measure employment. This paper specifically aims at exploring the importance of the timing of employment. Using various econometric techniques to control for observable and unobservable child and family characteristics, the results show that full-time maternal employment during mid-childhood positively affects the probability of being overweight at age 16. There is no evidence that part-time or full-time employment at earlier/later ages affects this probability.

Accurate Parental Classification of Overweight Adolescents' Weight Status: Does It Matter?

Our goal was to explore whether parents of overweight adolescents who recognize that their children are overweight engage in behaviors that are likely to help their adolescents with long-term weight management. The study population included overweight adolescents (BMI >/= 85th percentile) who participated in Project EAT (Eating Among Teens) I (1999) and II (2004) and their parents who were interviewed by telephone in Project EAT I. Cross-sectional analyses were conducted with 314 adolescent-parent dyads, and longitudinal analyses were completed with 170 dyads. Parents who correctly classified their children as overweight were no more likely than parents who did not correctly classify their children as overweight to engage in the following potentially helpful behaviors: having more fruits/vegetables and fewer soft drinks, salty snacks, candy, and fast food available at home; having more family meals; watching less television during dinner; and encouraging children to make healthful food choices and be more physically active. However, parents who recognized that their children were overweight were more likely to encourage them to diet. Parental encouragement to diet predicted poorer adolescent weight outcomes 5 years later, particularly for girls. Parental classification of their children's weight status did not predict child weight status 5 years later. Accurate classification of child overweight status may not translate into helpful behaviors and may lead to unhealthy behaviors such as encouragement to diet. Instead of focusing on weight per se, it may be more helpful to direct efforts toward helping parents provide a home environment that supports healthful eating, physical activity, and well-being.

Overweight children: Assessing the contribution of the built environment

Objective To examine the relationship between the built environment and overweight status in children. Methods Analyses were based on 2482 children aged 5–18 and their primary care givers who participated in the second wave of the Child Development Supplement (CDS-II) of the Panel Study of Income Dynamics (PSID). CDS-II is a nationally representative survey that was administered in October 2002–May 2003. A number of built environment characteristics were examined: population density, alpha index of connectivity, urban design, pedestrian fatality from motor vehicle crashes, restaurant density, and grocery store and convenience store densities. Also, interviewer's observations on neighborhood physical disorder, such as the condition and upkeep of the buildings and street surface on the block were analyzed. Results Living in a neighborhood with higher convenience store density (OR = 1.3, p < 0.05) and living in a neighborhood built after 1969 (OR = 1.9, p < 0.01) is associated with a higher probability of being overweight for children and adolescents. Living in the neighborhood where no physical disorder (OR = 0.5, p < 0.01) is observed is associated with a decreased likelihood of being overweight. Conclusions The results of this study emphasize a particular importance of the built environment of the neighborhood for weight status of children and adolescents.

Child-Specific Food Insecurity and Overweight Are Not Associated in a Sample of 10- to 15-Year-Old Low-Income Youth ,

In the United States, 17% of children and adolescents are overweight and 20% live in a food insecure household. Previous studies examining the association between household food insecurity and overweight among children have been inconclusive but are limited insofar as they did not assess child-specific measures of food insecurity and overweight. In response, this study examined the association between food insecurity and child overweight status when these variables were measured for the same child using information on children (n = 1031) aged 10–15 y from the Three-City Study. Approximately 8% of the children were food insecure, whereas 50% were either at risk of overweight or overweight. Bivariate analyses indicated that there were no significant differences in the prevalence of at risk of overweight and overweight between food secure and food insecure children. Gender, race, and income showed similar patterns. Results from logistic regression analyses also indicated that the likelihood of being overweight or at risk of overweight was not significantly different for food secure and food insecure children. Although child-specific food insecurity was not associated with overweight in this sample of low-income children, food insecurity and overweight coexist among these low-income children, because ∼25% of the food insecure children were overweight. Additional research is needed to explore the potential relationships between food insecurity and overweight and to better inform policy that attempts to address these issues among low-income households with children.