The overall aim of this paper is to describe important issues regarding paediatric obesity as a public health problem. This paper focuses on actions taken, and on the prevalence of obesity in children, teens and adults in Denmark. In addition, the paper describes some important prevention studies, all of which are performed outside Denmark. Thus, this paper is not a classical review but rather a highlight of some aspects that the author finds important. The latest Danish national figures show a marked increase in the prevalence of obesity, especially among young men-a sevenfold increase from 1987 to 2000 (0.7 to 4.9%). Among young women aged 16-24, the increase is threefold in the same period. Among teens, the prevalence has increased by 2-3 times in recent decades. Nevertheless, compared to other European countries and the US, Denmark has a relatively low prevalence of obesity in adolescents. The present paper also covers results from prevention studies performed in both preschool and school settings. Some of these focus on the reduced intake of carbonated drinks, whereas others focus on both diet and physical exercise. Finally, this paper demonstrates that Denmark is at the forefront regarding a national action plan against obesity. Conclusion: This paper highlights some important aspects of the epidemiology, prevention and actions in the field of paediatric obesity with special focus on Denmark.
To examine the associations of adiposity, dietary restraint and other personal characteristics with energy reporting quality.
Secondary analysis of 230 women and 158 men from the 1997/98 Ontario Food Survey.
Energy reporting quality was estimated by ratios of energy intake (EI) to both basal metabolic rate (BMR) and total energy expenditure (TEE). Multivariate regression analyses were conducted to examine energy reporting quality between two dietary recalls and in relation to body mass index (BMI) with adjustment for potential confounders. Energy reporting quality was explored across categories of age, BMI, income, education, dieting status and food insecurity through analysis of variance (ANOVA).
From the ANOVA, energy reporting quality was associated with BMI group, age category and weight loss for men and women, as well as with education among women (P 0.05). EI:BMR and EI:TEE on the first and second 24-hour recalls were positively related (P
AIM: To examine the relation between adiposity assessment methods (percentage body fat (%BF), BMI, and waist circumference (WC)) and individual metabolic risk factors (f-insulin, HDL cholesterol, triglycerides) and a combined measure of metabolic risk. METHODS: Crosssectional study of 300 males (BMI 20.8 +/- 3.0 kg/m(2)) and females (BMI 21.3 +/- 2.9 kg/m(2)) 17 years of age. F-insulin and components of the metabolic syndrome defined by the International Diabetes Federation (IDF) were used as metabolic risk indicators, with samples stratified into BMI, %BF, and WC groups, respectively. Diagnostic accuracy was expressed as the area under the ROC curve (AUC). RESULTS: In males, diagnostic accuracy for HDL and f-insulin was poor to fair for BMI (AUC 0.70, p = 0.001; 0.60, p = 0.22), WC (0.68, p = 0.003; 0.63, p = 0.11), and %BF (0.65, p = 0.009; 0.66, p = 0.04). The diagnostic accuracy for triglycerides was greater for all three measures (BMI 0.92, WC 0.95, %BF 0.87; all p or =2 metabolic risk factors (AUCs 0.76-0.91, p
To develop algorithm equations that could be used to adjust self-reported height and weight to elicit better estimates of actual BMI.
Linear regression analyses were performed to generate equations that could predict actual height and weight from self-reported data collected through telephone interviews on a representative sample of Canadians aged 18 years or older.
There were systematic biases in self-reported height and weight, leading to an underestimation of BMI. The application of our calibration equations to self-reported data produced closer estimates to actual rates of overweight and obesity.
We advocate the use of our correction equation whenever dealing with self-reported height and weight from telephone surveys to avoid potential distortions in estimating obesity prevalence.
Psychosocial development in children with chronic disease is a key issue in paediatrics. This study investigated whether psychosocial adjustment could be reliably assessed with the 42-item Adolescent Adjustment Profile (AAP) instrument. The study mainly focused on adjustment-to-obesity measurement, although it compared three patient groups with chronic conditions. All phenylketonuria (PKU) patients in Sweden between ages 9 and 18 and their parents and teachers were invited to participate. Patients with neurobehavioural syndromes and obesity were age- and gender-matched with PKU patients. Healthy children constituted a reference group. Psychosocial adjustment was measured using the AAP, which is a multi-informant questionnaire that contains four domains. Information concerning parents' socio-economic and civil status was requested separately. Respondents to the three questionnaires judged the PKU patients to be normal in all four domains. Patients with neurobehavioural syndromes demonstrated less competence and the most problems compared with the other three groups. According to the self-rating, the parent rating and the teacher rating questionnaires, obese patients had internalizing problems. The parent rating and the teacher rating questionnaire scored obese patients as having a lower work capacity than the reference group. Compared with the reference group, not only families with obese children but also families with children with neurobehavioural syndromes had significantly higher divorce rates. Obese patients were also investigated with the Strength and Difficulties Questionnaire (SDQ), another instrument that enables comparison between two measures of adjustment. The AAP had good psychometric properties; it was judged a useful instrument in research on adolescents with chronic diseases.
Canada faces a similar epidemic of obesity in their adolescent population as other Western countries. However, the development of programs to treat obesity and manage its sequelae has evolved in a unique way. This is in part due to differences in health care funding, population distribution, public demand, and availability of expertise and resources. In this article, we will describe the evolution of adolescent bariatric care in Canada and describe the current programs and future directions. The focus will be on the province of Ontario, the site of the first adolescent bariatric program in the country.
Fat and fat-free masses and fat distribution are related to cardiometabolic risk.
to explore how birth weight, childhood body mass index (BMI) and BMI gain were related to adolescent body composition and central obesity.
In a population-based longitudinal study, body composition was measured by dual-energy X-ray absorptiometry in 907 Norwegian adolescents (48% girls). Associations between birth weight, BMI categories, and BMI gain were evaluated by fitting linear mixed models and conditional growth models with fat mass index (FMI, kg/m2 ), fat-free mass index (FFMI, kg/m2 ) standard deviation scores (SDS), and central obesity at 15 to 20 years, as well as change in FMI SDS and FFMI SDS between ages 15 to 17 and 18 to 20 as outcomes.
Birth weight was associated with FFMI in adolescence. Greater BMI gain in childhood, conditioned on prior body size, was associated with higher FMI, FFMI, and central overweight/obesity with the strongest associations seen at age 6 to 16.5 years: FMI SDS: ß = 0.67, 95% CI (0.63-0.71), FFMI SDS: 0.46 (0.39, 0.52), in girls, FMI SDS: 0.80 (0.75, 0.86), FFMI SDS: 0.49 (0.43, 0.55), in boys.
Compared with birth and early childhood, high BMI and greater BMI gain at later ages are strong predictors of higher fat mass and central overweight/obesity at 15 to 20 years of age.
Obesity has been increasing in adolescents in Fiji and obesogenic dietary patterns need to be assessed to inform health promotion. The objective of this study was to identify the dietary patterns of adolescents in peri-urban Fiji and determine their relationships with standardized body mass index (BMI-z).
This study analysed baseline measurements from the Pacific Obesity Prevention In Communities (OPIC) Project. The sample comprised 6,871 adolescents aged 13-18 years from 18 secondary schools on the main island of Viti Levu, Fiji. Adolescents completed a questionnaire that included diet-related variables; height and weight were measured. Descriptive statistics and regression analyses were conducted to examine the associations between dietary patterns and BMI-z, while controlling for confounders and cluster effect by school.
Of the total sample, 24% of adolescents were overweight or obese, with a higher prevalence among Indigenous Fijians and females. Almost all adolescents reported frequent consumption of sugar sweetened beverages (SSB) (90%) and low intake of fruit and vegetables (74%). Over 25% of participants were frequent consumers of takeaways for dinner, and either high fat/salt snacks, or confectionery after school. Nearly one quarter reported irregular breakfast (24%) and lunch (24%) consumption on school days, while fewer adolescents (13%) ate fried foods after school. IndoFijians were more likely than Indigenous Fijians to regularly consume breakfast, but had a high unhealthy SSB and snack consumption.Regular breakfast (p
Cites: Lancet. 2001 Feb 17;357(9255):505-811229668
Cites: Obes Rev. 2001 May;2(2):117-3012119663
Cites: J Am Diet Assoc. 2000 Dec;100(12):1511-2111138444
Cites: Obes Rev. 2004 May;5 Suppl 1:4-10415096099
Cites: Obes Res. 2004 May;12(5):778-8815166298
Cites: JAMA. 2004 Aug 25;292(8):927-3415328324
Cites: Am J Clin Nutr. 1990 Sep;52(3):421-52393004
Cites: Am J Clin Nutr. 1994 Feb;59(2):350-57993398
Cites: Am J Clin Nutr. 1994 Oct;60(4):640-28092104
This article examines factors associated with adolescent self-concept and the impact of adolescent self-concept on psychological and physical health and health behaviour in young adulthood.
The data are from the household cross-sectional (1994/95) and longitudinal (1994/95 to 2000/01) components of Statistics Canada's National Population Health Survey.
Scores on self-concept indicators in 1994/95 were compared between the sexes and age groups (12 to 15 versus 16 to 19). Multivariate analyses were used to examine cross-sectional and longitudinal associations between adolescent self-concept and depression, self-perceived health, physical activity and obesity, controlling for other possible confounders.
Self-concept tends to be low among girls compared with boys. Cross-sectionally, adolescent self-concept was associated with household income and emotional support. For girls and for young adolescents, a weak self-concept in 1994/95 was related to the incidence of depression over the next six years; it was also predictive of physical inactivity among boys, and obesity among both sexes. A strong self-concept had a positive long-term effect on girls' self-perceived health.
Based on direct measures of height and weight, this article compares the prevalence of obesity among adults aged 18 or older in 1978/79 and 2004. Prevalence by demographic, socio-economic and lifestyle characteristics is presented, along with associations between obesity and selected chronic conditions. Canadian and US data are also compared.
Data are from the 2004 Canadian Community Health Survey: Nutrition, the 1978/79 Canada Health Survey and the 1986 to 1992 Canadian Heart Health Surveys. US data are from the 1999-2002 National Health and Nutrition Examination Survey.
Descriptive statistics were used to estimate the proportion of adults who were obese in 2004 in relation to selected characteristics. Logistic regression models were used to examine relationships between obesity and high blood pressure, diabetes and heart disease, controlling for socio-economic status and other risk factors such as smoking and physical activity.
In 2004, 23% of adults, 5.5 million people aged 18 or older, were obese--up substantially from 14% in 1978/79. An additional 36% (8.6 million) were overweight. Obese individuals tended to have sedentary leisure-time pursuits and to consume fruit and vegetables infrequently. As body mass index (BMI) increased, so did an individual's likelihood of reporting high blood pressure, diabetes and heart disease.