The importance of physical activity in the prevention of overweight and obesity in childhood: a review and an opinion

The prevalence of childhood obesity is increasing and there are a number of theoretical reasons as to why intervention may be more effective in childhood. There are certain risk times for the development of obesity in childhood, which provide a basis for targeted intervention. In addition, tracking data supports the persistence of obesity, at least in later childhood, as well as cardiovascular risk factors. Physical activity is the discretionary component of energy expenditure and there is evidence that falling levels of physical activity are contributing to the obesity epidemic. Physical activity in children is related to developmental stage, is reduced with increasing age and is influenced by parental physical activity. While there is debate about the immediate health benefits of physical activity to children, there are data to support that lower physical activity levels and sedentary behaviours are associated with a higher prevalence of obesity in children. Physical activity is an accepted strategy in the treatment of established obesity (tertiary prevention). The role of physical activity in the prevention of obesity (primary and secondary prevention) is less clear. However a number of recent school‐based interventions directed at either increasing physical activity and/or decreasing sedentary behaviours, have shown encouraging results. On balance, increasing physical activity in children is an attractive and non‐restrictive approach to obesity prevention. To adopt this approach requires the support and involvement of many community sectors other than health.     

我国成人超重、肥胖和腹型肥胖的流行特点

肥胖患病率在全球呈快速增长趋势。肥胖是指体内脂肪过度堆积,并显著增加心血管代谢紊乱性疾病的发病风险。已观察到在一些人群中,超重/肥胖和腹型肥胖患病率的变化表现不一致。本文就我国超重/肥胖和腹型肥胖患病率的变迁进行总结。     

Influence of overweight and obesity on upper endoscopic findings

BACKGROUND: In previous studies, increasing body mass index (BMI, kg/m(2)) was related to chronic gastrointestinal symptoms, such as frequent vomiting, upper abdominal pain, bloating and diarrhea. However, there have been no reports about the relationship between increasing BMI and abnormal upper endoscopic findings such as gastritis or ulcer. METHODS: The study group consisted of 27 319 individuals who underwent medical checkup at a healthcare center from 1 January to 31 December 2003. The following classification of BMI was applied. (i) underweight; BMI < 18.5; (ii) normal weight; 18.5 or= 30.0. The subjects were grouped according to the findings of upper endoscopy as follows: group 1, those with erosive gastritis, gastric ulcers (benign and malignant) and duodenal ulcers; group 2, those with reflux esophagitis; and group 3, those with findings of upper endoscopy other than group 1 and group 2. RESULTS: The prevalence of obesity and overweight was 2.2% and 30.5%, respectively. By multivariate analyses, overweight (OR 1.31, 95% CI; 1.22-1.40, P = 0.000) and obesity (OR 1.40, 95% CI; 1.14-1.72, P = 0.001) were significant contributors of group 1. Overweight (OR 1.61, 95% CI; 1.42-1.83, P = 0.000) and obesity (OR 2.23, 95% CI; 1.59-3.11, P = 0.000) were also significant contributors of group 2. CONCLUSIONS: In the general population, increasing BMI was associated with abnormal upper endoscopic findings, such as erosive gastritis, gastric ulcer, duodenal ulcer and reflux esophagitis. Clarification of the cause-and-effect relationships and the mechanisms of these associations require further investigation.     

A national survey of the prevalence of childhood overweight and obesity in Italy

To estimate the prevalence of childhood overweight and obesity among Italian schoolchildren and to examine geographic differences and present and future implications for health care, we used data from a nationwide representative survey performed in May 2008 among third-grade students in 18 of Italy's 21 regions. Cluster sampling was used to identify classes for participation. The study population included all children aged 8–9 years whose parents agreed to opt-out consent. Parents, children and teachers completed brief questionnaires, and children were weighed and measured by trained staff using standardized equipment. Consent was obtained for 97% of 50 197 third-graders, of whom 44 676 (89%) met study inclusion criteria. Obesity levels (defined using International Obesity Task Force cut-offs) ranged from 7.5% (95% confidence intervals 6.7–8.2) in the north to 16.6% (95% confidence intervals 15.8–17.4) in the south. Behaviours known to be associated with obesity also showed geographic differences. The estimated burden of obesity-related pathologies also increased from north to south. These findings suggest the need for community as well as individual interventions in all areas of the country but with particular attention to the south.     

Associations of overweight/obesity and socioeconomic status with hypertension prevalence across racial and ethnic groups

Racial/ethnic disparities in the prevalence of diagnosed hypertension are persistent but may be partially explained by racial/ethnic differences in weight category and neighborhood socioeconomic status. The authors compared hypertension prevalence rates among 4 060 585 adults with overweight or obesity across 10 healthcare systems by weight category and neighborhood education level in geographically and racially diverse individuals. Data were obtained from electronic health records. Hypertension was defined as at least two outpatient visits or one inpatient hospitalization with a coded diagnosis. Logistic regression, adjusted for age, sex, and site, with two‐way interactions between race/ethnicity and weight category or neighborhood education, was used to examine the association between hypertension and race/ethnicity, with whites as the reference. Results documented that odds ratios for hypertension prevalence were greater for blacks, American Indians/Alaskan Natives, Asians, and Native Hawaiians/other Pacific Islanders compared with whites and lower for Hispanics in similar weight categories and neighborhood education levels. Although two‐way interactions were statistically significant, the magnitude of the odds of hypertension compared with whites did not substantially vary across weight or neighborhood education. Hypertension odds were almost double relative to whites for blacks and Native Hawaiians/other Pacific Islanders across most weight categories and all neighborhood education levels. Odds of hypertension were about 50% greater for Asians relative to whites across weight categories. Results suggest that other factors might be associated with racial/ethnic disparities in hypertension. More research is needed to understand the many factors that may contribute to variation in diagnosed hypertension across racial/ethnic groups with overweight or obesity.     

Economic burden of childhood overweight and obesity: A systematic review and meta-analysis

To update existing literature and fill the gap in meta-analyses, this meta-analysis quantitatively evaluated the worldwide economic burden (in 2022 US $) of childhood overweight and obesity in comparison with healthy weight. The literature search in eight databases produced 7756 records. After literature screening, 48 articles met the eligibility criteria. The increased annual total medical costs were $237.55 per capita attributable to childhood overweight and obesity. Overweight and obesity caused a per capita increase of $56.52, $14.27, $46.38, and $1975.06 for costs in nonhospital healthcare, outpatient visits, medication, and hospitalization, respectively. Length of hospital stays increased by 0.28 days. Annual direct and indirect costs were projected to be $13.62 billion and $49.02 billion by 2050. Childhood obesity ascribed to much higher increased healthcare costs than overweight. During childhood, the direct medical expenditures were higher for males than for females, but, once reaching adulthood, the expenditures were higher for females. Overall, the lifetime costs attributable to childhood overweight and obesity were higher in males than in females, and childhood overweight and obesity resulted in much higher indirect costs than direct healthcare costs. Given the increased economic burden, additional efforts and resources should be allocated to support sustainable and scalable childhood obesity programs.     

Clinical aspects of obesity in childhood and adolescence

The level of fatness of a child at which morbidity acutely and/or later in life increases is determined on an acturial basis. Direct measurements of body fat content, e.g. hydrodensitometry, bioimpedance, or DEXA, are useful tools in scientific studies. However, body mass index (BMI) is easy to calculate and is generally accepted now to be used to define obesity in children and adolescents clinically. An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been greater than the 75th percentile as adolescents. Childhood obesity seems to substantially increase the risk of subsequent morbidity whether or not obesity persists into adulthood. The genetic basis of childhood obesity has been elucidated to some extent through the discovery of leptin, the ob gene product, and the increasing knowledge on the role of neuropeptides such as POMC, neuropeptide Y (NPY) and the melanocyte concentrating hormone receptors (for example, MC4R). Environmental/exogenous factors largely contribute to the development of a high degree of body fatness early in life. Twin studies suggest that approximately 50% of the tendency toward obesity is inherited. There are numerous disorders including a number of endocrine disorders (Cushing's syndrome, hypothyroidism, etc.) and genetic syndromes (Prader‐Labhard–Willi syndrome, Bardet Biedl syndrome, etc.) that can present with obesity. A simple diagnostic algorithm allows for the differentiation between primary or secondary obesity. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidemia, back pain and psychosocial problems. Therapeutic strategies include psychological and family therapy, lifestyle/behaviour modification and nutrition education. The role of regular exercise and exercise programmes is emphasized. Surgical procedures and drugs used in adult obesity are still not generally recommended in children and adolescents with obesity. As obesity is the most common chronic disorder in industrialized societies, its impact on individual lives as well as on health economics has to be recognized more widely. This review is aimed towards defining the clinical problem of childhood obesity on the basis of current knowledge and towards outlining future research areas in the field of energy homoeostasis and food intake in relation to child health. Finally, one should aim to increase public awareness of the ever increasing health burden and economic dimension of the childhood obesity epidemic that is present around the globe.     

Physical environmental correlates of childhood obesity: a systematic review

Increasing rates of childhood obesity in the USA and other Western countries are a cause for serious public health concern. Neighborhood and community environments are thought to play a contributing role in the development of obesity among youth, but it is not well understood which types of physical environmental characteristics have the most potential to influence obesity outcomes. This paper reports the results of a systematic review of quantitative research examining built and biophysical environmental variables associated with obesity in children and adolescents through physical activity. Literature searches in PubMed, PsychInfo and Geobase were conducted. Fifteen quantitative studies met the inclusion criteria for this systematic review. The majority of studies were cross-sectional and published after 2005. Overall, few consistent findings emerged. For children, associations between physical environmental variables and obesity differed by gender, age, socioeconomic status, population density and whether reports were made by the parent or child. Access to equipment and facilities, neighborhood pattern (e.g. rural, exurban, suburban) and urban sprawl were associated with obesity outcomes in adolescents. For most environmental variables considered, strong empirical evidence is not yet available. Conceptual gaps, methodological limitations and future research directions are discussed.     

A systematic review of economic evaluations of interventions targeting childhood overweight and obesity

This systematic review critically appraised and synthesized evidence from economic evaluations of interventions targeting childhood excess weight. We conducted systematic searches in 11 databases from inception to April 19, 2023. Studies were eligible if they evaluated interventions targeting children up to 18 years and the study intervention(s) targeted childhood excess weight or sought to improve diet or physical activity, regardless of the type of economic evaluation or the underpinning study design. We synthesized evidence using narrative synthesis methods. One-hundred fifty-one studies met the eligibility criteria and were classified into three groups based on the intervention approach: prevention-only (13 studies), prevention and treatment (100 studies), and treatment-only (38 studies). The predominant setting and study design differed considerably between the three groups of studies. However, compared with usual care, most interventions were deemed cost-effective. The study participants' ages, sex, and socioeconomic status were crucial to intervention cost-effectiveness. Interventions whose effects were projected beyond childhood, such as bariatric surgery, lower protein infant formula, and home-based general practitioner consultations, tended to be cost-effective. However, cost-effectiveness was sensitive to the assumptions underlying the persistence and intensity of such effects. Our findings can inform future recommendations on the conduct of economic evaluations of interventions targeting childhood overweight and obesity, as well as practice and policy recommendations.     

Nutrition‐related interventions targeting childhood overweight and obesity: A narrative review

Systematic reviews of nutritional interventions indicate limited efficacy in reducing childhood obesity, but their blanket conclusions could obscure promising components. This narrative review sought more detail on effective components within nutrition‐related interventions involving children aged 2 to 11 years. In May 2016, the World Health Organization (WHO) searched the Cochrane Library and PubMed for relevant reviews. From 36 reviews, we screened 182 nutrition‐related randomized trials for inclusion. We then reviewed those that reported at least 1 statistically significant (P < 0.05) treatment benefit on body weight and/or composition outcomes at their longest follow‐up assessment. Fourteen trials met inclusion criteria (median n = 554; mean intervention duration = 10.8 mo; follow‐up = 4.4 mo). “Effective” approaches included environmental changes such as school water fountain installations and cafeteria menu changes and possibly less sustainable strategies such as health education lessons. However, effect sizes even of these selected significant treatment benefits were modest—significant body mass index z‐score effects range from ?0.1 to ?0.2. Each trial was associated with very small improvements in body composition. Because this is a “best‐case” scenario (reflecting our design), trialists should rigorously test these strategies alone and possibly together; be open to novel strategies; and ensure that each strategy is culturally relevant and self‐sustainable.     

Investment case for the prevention and reduction of childhood and adolescent overweight and obesity in Mexico

Despite efforts to curb the rise in Mexico's child and adolescent overweight and obesity rates, prevalence in Mexico has grown by 120% since 1990 to 43.3% in 2022. This investment case identifies policies that will produce the largest returns for Mexico. The investment case model builds beyond a cost-of-illness analysis by predicting the health and societal economic impact of implementing child and adolescent overweight and obesity interventions in a cohort aged 0–19 from 2025 to 2090. The Markov model's impacts include healthcare expenditures, years of life lost, and reduced wages and productivity. We projected and compared costs in a status quo scenario to an intervention scenario to estimate cost savings and calculate return-on-investment (ROI). Total lifetime health and economic costs amount to USD 1.8 trillion—USD 30 billion on average per year. Implementing five interventions can reduce lifetime costs by approximately 7%. Each intervention has a low cost per disability-adjusted life year averted over 30-year, 50-year, and lifetime horizons. The findings demonstrate that a package of interventions mitigating child and adolescent overweight and obesity offers a strong ROI. The novel investment case methods should be applied to other countries, particularly low- and middle-income countries.     

Assessment of body composition in pediatric overweight and obesity: A systematic review of the reliability and validity of common techniques

Accurate measurement of body composition is required to improve health outcomes in children and adolescents with overweight or obesity. This systematic review aimed to summarize the reliability and validity of field and laboratory body composition techniques employed in pediatric obesity studies to facilitate technique selection for research and clinical practice implementation. A systematic search in MEDLINE (via PubMed), EMBASE, CINAHL, and SPORTDiscus from inception up to December 2019 was conducted, using a combination of the following concepts: body composition, pediatric overweight/obesity, and reliability/validity. The search strategy resulted in 66 eligible articles reporting reliability (19.7%), agreement between body composition techniques cross sectionally (80.3%), and/or diagnostic test accuracy (10.6%) in children and adolescents with overweight or obesity (mean age range = 7.0–16.5 years). Skinfolds, air‐displacement plethysmography (ADP), dual‐energy X‐ray absorptiometry (DXA), and ultrasound presented as reliable techniques. DXA, ADP, and isotope dilution showed similar and the best agreement with reference standards. Compared with these laboratory techniques, the validity of estimating body composition by anthropometric equations, skinfolds, and BIA was inferior. In conclusion, the assessment of body composition by laboratory techniques cannot be replaced by field techniques due to introduction of measurement errors, which potentially conceal actual changes in body components.     

The association between childcare arrangements and risk of overweight and obesity in childhood: a systematic review

Over 80% of preschool‐aged children experience non‐parental childcare. Childcare type has the potential to influence weight outcomes, but its impact on childhood overweight/obesity is not well established. This review aims to (i) systematically evaluate the effects of childcare type on childhood overweight/obesity risk and (ii) investigate the impact of childcare intensity and age at commencement. Five electronic databases were searched for observational studies quantifying an association between childcare type ≤5 years and weight outcomes <18 years. Twenty‐four studies were included (n = 127,529 children). Thirteen studies reported increased risk of overweight/obesity in children attending informal care (n = 9) or centre care (n = 4) vs. parental care. Seven studies reported decreased risk of overweight/obesity for children in centre vs. ‘non‐centre’ care (parental and informal). Four studies reported no association between informal or centre care and overweight/obesity. Early (<3 years) informal care, especially by a relative, was associated with increased risk of overweight/obesity. Higher intensity childcare, especially when commenced early (<1 year), increased overweight/obesity risk. Later (≥3 years) centre care was associated with decreased risk of overweight/obesity. Early informal care, earlier commencement age and higher intensity represent a risk for childhood obesity. Exploration of the obesogenic aspects of these contexts is essential to inform preventative measures.     

Association of fast-food restaurants with overweight and obesity in school-aged children and adolescents: A systematic review and meta-analysis

We aimed to explore associations between the accessibility of fast-food restaurants (FFRs) and weight-related outcomes in children and adolescents through a systematic review and meta-analysis of studies. We searched three databases for studies published before October 21, 2022. Study quality was assessed using the National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Meta-analysis was performed, and the leave-one-out method was used for sensitivity analysis. A total of 60 studies were included. According to our analysis, FFRs within a smaller buffer radius from residences or that provide unhealthy foods may have a more significant influence on children's and adolescents' weight. Children of younger ages and girls may have a higher possibility of being overweight due to FFRs. Though we could hardly avoid bias, the estimates in low-and middle-income countries (only six studies) are much higher than those in high-income countries (54 studies). More research analyses based on microscope data and individual economic levels are needed. This study yields quantitative results, provides policymakers and urban planners with a theoretical support for building resilient and sustainable human settlements, and promotes the translation of research findings from public health to environmental planning.     

Primary upper-extremity deep vein thrombosis: high prevalence of thrombophilic defects

Primary deep venous thrombosis of the upper extremity (UEDVT) is an unusual disorder. Limited data are available on the contribution of hypercoagulable status in the pathogenesis of this disease. This study aims to report the prevalence of inherited and acquired thrombophilic risk factors (TF) in patients with primary (effort-related and spontaneous) UEDVT. From 1993 to 2002, 31 patients (17 females, median age 38.8 years, range 16-60 years; and 14 males, median age 31.4 years, range 20-56 years) with primary UEDVT (n = 15 effort-related and n = 16 spontaneous) were referred for screening of hypercoagulable status. Nineteen (61.3%) patients had at least one coagulation abnormality. The most common acquired TF were antiphospholipid antibodies (31% lupus anticoagulant and 12.9% anticardiolipin antibodies). Factor V Leiden (12.9%) and prothrombin G20210A mutation (20%) were the most prevalent genetic risk factors. Five patients (16.1%) had high plasma homocysteine levels, and one patient (4.7%) had protein S deficiency. Effort-related UEDVT was associated with male gender (P = 0.04) and younger age (P = 0.02). There was no significant difference in the prevalence of acquired or inherited TF between patients with effort-related or spontaneous UEDVT. A local anatomic abnormality was detected in seven patients (22.5%), and the prevalence of TF was significantly lower within this group (P = 0.006). The incidence of TF in patients without an anatomic abnormality was 75% (RR 5.25). This study found a high prevalence of an underlying thrombophilic status in spontaneous and effort-related UEDVT. Hypercoagulable status may play a significant role in both groups. Screening for local anatomical abnormalities and thrombophilia should be included in the evaluation of primary UEDVT.     

Adverse labour market impacts of childhood and adolescence overweight and obesity in Western societies—A literature review

Overweight and obesity among children and adolescents are major health issues of today with both somatic and psychosocial consequences in childhood, adolescence and adulthood and potentially adverse effects for adult social life. We conducted a narrative review of the literature about the association of overweight and obesity in childhood and adolescence with possible adverse impact on labour market in adulthood. By PubMed and Google Scholar searches, we identified 12 original, prospective studies from Western countries and extracted data from these studies. We discuss the possible explanations of the associations and the conceptual and methodological challenges in these studies. Despite inherent difficulties in interpreting results, partly due to differences in outcome definitions, ages at exposure, measurements of overweight and obesity, confounder control and societal differences, the studies indicate adverse labour market impacts on adult wage and employment. Furthermore, penalties seemed present even if the excessive weight was lost before adulthood, and women seemed more affected than men, especially when weight persisted into adulthood. While both health and lower education might contribute to explain the adverse labour market outcomes, also discrimination, stigmatization and the development of cognitive and noncognitive skills seemed to influence the outcomes. Prevention of these adverse labour market impacts likely requires multilevel efforts.