OBJECTIVE: To assess the efficacy of a school-based intervention programme to reduce the prevalence of overweight in 6 to 10-year-old children. DESIGN: Cluster-randomized, controlled study. SUBJECTS: A total of 3135 boys and girls in grades 1-4 were included in the study. METHODS: Ten schools were selected in Stockholm county area and randomized to intervention (n=5) and control (n=5) schools. Low-fat dairy products and whole-grain bread were promoted and all sweets and sweetened drinks were eliminated in intervention schools. Physical activity (PA) was aimed to increase by 30 min day(-1) during school time and sedentary behaviour restricted during after school care time. PA was measured by accelerometry. Eating habits at home were assessed by parental report. Eating disorders were evaluated by self-report. RESULTS: The prevalence of overweight and obesity decreased by 3.2% (from 20.3 to 17.1) in intervention schools compared with an increase of 2.8% (from 16.1 to 18.9) in control schools (P
BACKGROUND: Guidelines for treating overweight and obesity have been suggested by the World Health Organization and other expert groups. We asked whether most men and women targeted in obesity guidelines would already be included in existing clinical recommendations for the prevention of coronary heart disease (CHD) or whether a new group of patients would be added to current workloads. SUBJECTS AND METHODS: In 1997 the Norwegian National Health Screening Service examined CHD risk factors in subjects aged 40-42 y living in three counties. We studied 6911 men and 7992 women who did not report treatment for diabetes, hypertension or the presence of cardiovascular disease. Estimated 10 y risk of CHD was calculated using the Framingham equation. RESULTS: The prevalence of single risk factors (systolic blood pressure > or =160 mmHg, diastolic blood pressure > or =95 mmHg, total cholesterol level > or =7.8 mmol/l and nonfasting glucose > or =11.1 mmol/l) ranged between 0 and 11% among subjects with body mass index > or =25 kg/m2. Adding low HDL cholesterol ( or =10%). Sensitivities and specificities of using body mass index (BMI) or BMI and waist circumference as a screen for elevated CHD risk ranged between 22 and 91%. Screening for 10 y CHD risk of > or =10% or one or more risk factors among men and screening for one or more risk factors among women gave positive predictive values of 19-50%; however, the positive predictive value of screening for 10 y CHD risk of > or =10% was only 1-2% among women. Compared with men with BMI
The prevalence of type 2 diabetes is increasing rapidly worldwide. Much of this increase in type 2 diabetes epidemic is related to the increase in obesity. There is now firm evidence from randomised trials that type 2 diabetes is preventable by lifestyle modification influencing diet, physical activity and obesity. This prevention effect is sustainable for many years after cessation of active intervention. The slow progression in the development and implementation of population-based strategies in the prevention of obesity and its most common and serious co-morbidity, type 2 diabetes, is of great concern. We summarise published implementation programmes and describe briefly the activities carried out in Finland. In the Finnish implementation programme for the prevention of type 2 diabetes (FIN-D2D), it was found that it is possible to prevent type 2 diabetes "in real life" in the primary health-care settings. We point out that innovative strategic guidelines and their proper implementation are needed to prevent the diabetes epidemic. Among the different tools, also taxation and other regulation to promote healthy food selection and good interaction with the media should be considered.
The purpose of this study was to determine diet quality and physical activity behaviours of grade 6 students by sex and body weight status, and to determine the associations between diet quality and physical activity behaviours. The Web-based Food Behaviour Questionnaire, which included a 24-h diet recall and the modified Physical Activity Questionnaire for Older Children (PAQ-C), was administered to a cross-section of schools (n = 405 students from 15 schools). Measured height and weight were used to calculate body mass index and weight status (Cole et al. 2000). A Canadian version of the Healthy Eating Index (HEI-C) was used to describe overall diet quality. The mean HEI-C was 69.6 (13.2) with the majority (72%) falling into the needs improvement category. The overall mean physical activity score was 3.7 out of a maximum of 5, with obese subjects being less active compared with normal weight and overweight (p
To estimate the associations between maternal pre-pregnancy body mass index (BMI) or gestational weight change (GWC) during pregnancy and offspring BMI at 3 years of age, while taking several pre-and postnatal factors into account.
The Norwegian Mother and Child Cohort Study is a population-based pregnancy cohort study of women recruited from all geographical areas of Norway.
The study includes 31?169 women enrolled between 2000 and 2009 through a postal invitation sent to women at 17-18 weeks of gestation. Data collected from 5898 of the fathers were included. MAIN OUTCOME MESURES: Offspring BMI at 3 years was the main outcome measured in this study.
Mean maternal pre-pregnancy BMI was 24.0 kg?m(-2) (s.d. 4.1), mean GWC in the first 30 weeks of gestation was 9.0 kg (s.d. 4.1) and mean offspring BMI at 3 years of age was 16.1 kg?m(-2) (s.d. 1.5). Both maternal pre-pregnancy BMI and GWC were positively associated with mean offspring BMI at 3 years of age. Pre-pregnancy BMI and GWC also interacted, and the strength of the interaction between these two factors was strongly associated with the increase in offspring BMI among mothers who gained the most weight during pregnancy and had the highest pre-pregnancy BMI. Our findings show that results could be biased by not including pre-pregnant paternal BMI.
This large population-based study showed that both maternal pre-pregnancy BMI and GWC were positively associated with mean offspring BMI at 3 years of age.
Comment In: Int J Obes (Lond). 2012 Oct;36(10):1259-6023044902
What is already known about this subject Short sleep duration is a risk factor for obesity. Television (TV) in the bedroom has been shown to be associated with excess body weight in children. Children increasingly use other electronic entertainment and communication devices (EECDs) such as video games, computers, and smart phones. What this study adds Access to and night-time use of EECDs are associated with shortened sleep duration, excess body weight, poorer diet quality, and lower physical activity levels. Our findings reinforce existing recommendations pertaining to TV and Internet access by the American Academy of Pediatrics and suggest to have these expanded to restricted availability of video games and smart phones in children's bedrooms.
While the prevalence of childhood obesity and access to and use of electronic entertainment and communication devices (EECDs) have increased in the past decades, no earlier study has examined their interrelationship.
To examine whether night-time access to and use of EECDs are associated with sleep duration, body weights, diet quality, and physical activity of Canadian children.
A representative sample of 3398 grade 5 children in Alberta, Canada, was surveyed. The survey included questions on children's lifestyles and health behaviours, the Harvard Youth/Adolescent Food Frequency questionnaire, a validated questionnaire on physical activity, and measurements of heights and weights. Random effect models were used to assess the associations of night-time access to and use of EECDs with sleep, diet quality, physical activity, and body weights.
Sixty-four percent of parents reported that their child had access to one or more EECDs in their bedroom. Access to and night-time use of EECDs were associated with shortened sleep duration, excess body weight, poorer diet quality, and lower physical activity levels in a statistically significant manner.
Limiting the availability of EECDs in children's bedrooms and discouraging their night-time use may be considered as a strategy to promote sleep and reduce childhood obesity.
To identify factors which limit the ability of local governments to make appropriate investments in the built environment to promote youth health and reduce obesity outcomes in Atlantic Canada.
Policy-makers and professionals participated in focus groups to discuss the receptiveness of local governments to introducing health considerations into decision-making. Seven facilitated focus groups involved 44 participants from Atlantic Canada. Thematic discourse analysis of the meeting transcripts identified systemic barriers to creating a built environment that fosters health for youth aged 12-15 years.
Participants consistently identified four categories of barriers. Financial barriers limit the capacities of local government to build, maintain and operate appropriate facilities. Legacy issues mean that communities inherit a built environment designed to facilitate car use, with inadequate zoning authority to control fast food outlets, and without the means to determine where schools are built or how they are used. Governance barriers derive from government departments with distinct and competing mandates, with a professional structure that privileges engineering, and with funding programs that encourage competition between municipalities. Cultural factors and values affect outcomes: people have adapted to car-oriented living; poverty reduces options for many families; parental fears limit children's mobility; youth receive limited priority in built environment investments.
Participants indicated that health issues have increasing profile within local government, making this an opportune time to discuss strategies for optimizing investments in the built environment. The focus group method can foster mutual learning among professionals within government in ways that could advance health promotion.
INTRODUCTION: A global epidemic in overweight and obesity in children has been postulated. There is a lack of consensus over definitions however, and national standards of BMI centiles have been published in various countries. This has made results on the prevalence of overweight difficult to interpret. Internationally based cut-off points have now been published, and a British study reports trends in overweight and obesity in children, as defined by these. The aim of this study was to compare the BMI of a sample of Danish children attending school in 1986/1987-1996/1997 to that of Danish schoolchildren in 1971/1972. MATERIAL AND METHODS: The school health officers in 23 municipalities representing a "mini-Denmark" collected from the school health records 3-4 routine measurements of height and weight in children attending school in 1986/1987-1996/1997. From these measurements, the children's BMIs were calculated and BMI centiles were constructed. The data covered a total of 11,167 measurements of 3371 children. RESULTS: The children in our study had higher BMI values than had children in 1971/1972, both on average and for the highest centiles. The average BMI values were significantly higher from the age of 8 years in boys and 7 years in girls. The prevalence in overweight and obesity has increased. For 14-16-year-old boys, the average BMI was related to the educational level of the mother (negatively). DISCUSSION: The highest BMI centiles had especially increased. The proportion of overweight and obese 14-16-year-olds according to internationally based cut-off points had increased from 5.1% to 1.5% for boys and from 6.2% to 15.6% for girls since 1971/72. This trend calls for preventive efforts.
While many studies have shown associations between obesity and increased risk of morbidity and mortality, little comparable information is available on how body mass index (BMI) impacts health expectancy. We examined associations of BMI with healthy and chronic disease-free life expectancy in four European cohort studies.
Data were drawn from repeated waves of cohort studies in England, Finland, France and Sweden. BMI was categorized into four groups from normal weight (18.5-24.9?kg?m-2) to obesity class II (?35?kg?m-2). Health expectancy was estimated with two health indicators: sub-optimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years for each BMI category.
The proportion of life spent in good perceived health between ages 50 and 75 progressively decreased with increasing BMI from 81% in normal weight men and women to 53% in men and women with class II obesity which corresponds to an average 7-year difference in absolute terms. The proportion of life between ages 50 and 75 years without chronic diseases decreased from 62 and 65% in normal weight men and women and to 29 and 36% in men and women with class II obesity, respectively. This corresponds to an average 9 more years without chronic diseases in normal weight men and 7 more years in normal weight women between ages 50 and 75 years compared to class II obese men and women. No consistent differences were observed between cohorts.
Excess BMI is associated with substantially shorter healthy and chronic disease-free life expectancy, suggesting that tackling obesity would increase years lived in good health in populations.
Cites: PLoS One. 2014 Nov 04;9(11):e111480 PMID 25369457