Understanding the aetiology of childhood obesity: implications for treatment

Childhood obesity poses one of the greatest challenges to paediatric health in the 21st century. Developing effective strategies for treatment and prevention is therefore a priority for clinical medicine and public health. This process is taking place at a time of unprecedented change in the understanding of the role of genetic factors in human health and disease, and genetic research into obesity has challenged assumptions about causal processes. In the spirit of the conference theme, the present paper will discuss the implications of the understanding of genetic and environmental influences on obesity for the development of effective behavioural treatments.     

儿童肥胖的流行趋势及影响因素研究进展

儿童期单纯肥胖症是21世纪世界各国面临的最大公共卫生挑战之一,对儿童乃至成人后的健康构成了严重的威胁。儿童肥胖是遗传和环境因素交互作用的结果,但环境因素极其重要。目前发现儿童肥胖的影响因素有:父母肥胖与受教育程度低、家长错误的喂养观念与行为、母亲初潮年龄过早、围产期营养不良、母乳喂养不足、儿童不合理饮食、睡眠时间过少、久坐行为伴随电视游戏等。该文对有关儿童肥胖的诊断标准、流行趋势、分布特征及环境影响因素研究进行了综述,为针对性地开展儿童肥胖早期干预提供了流行病学参考。     

Developing obesity prevention interventions among minority ethnic children in schools and places of worship: The DEAL (DiEt and Active Living) study

Background  

Childhood obesity is a major public health concern with serious implications for the sustainability of healthcare systems. Studies in the US and UK have shown that ethnicity is consistently associated with childhood obesity, with Black African origin girls in particular being more vulnerable to overweight and obesity than their White peers. Little is known, however, about what promotes or hinders engagement with prevention programmes among ethnic minority children.     

Convenience Sampling of Children Presenting to Hospital-Based Outpatient Clinics to Estimate Childhood Obesity Levels in Local Surroundings

Childhood obesity is a critical public health matter associated with numerous pediatric comorbidities. Local-level data are required to monitor obesity and to help administer prevention efforts when and where they are most needed. We hypothesized that samples of children visiting hospital clinics could provide representative local population estimates of childhood obesity using data from 2007 to 2013. Such data might provide more accurate, timely, and cost-effective obesity estimates than national surveys. Results revealed that our hospital-based sample could not serve as a population surrogate. Further research is needed to confirm this finding.Childhood obesity is a worldwide epidemic whose prevalence continues to increase1–4; it causes significant health consequences, such as type 2 diabetes, hyperlipidemia, hypertension, and adult obesity.5–9 Effective evaluation requires local-level data to monitor obesity and to help administer prevention efforts when and where they are needed most. School-based samples are often used to determine the prevalence of childhood obesity; however, schools are becoming increasingly reluctant to allow researchers to collect data because of the perceived burden on teachers and students, issues of student privacy, and the possibility of stigmatizing students with unhealthy weight. Children who visit health care facilities routinely have their height and weight measured using precision scales and stadiometers,10 so values from this population may accurately estimate regional obesity. In this report, we compared the mean body mass index z-scores (BMI-Z) in a hospital-based sample with a school-based sample to determine whether a hospital-based sample could be used to estimate regional obesity levels.     

Peer Reviewed: Engaging and Mobilizing Community Members to Prevent Obesity Among Adolescents

Community-based public health interventions are designed on the premise that the community is an asset in transforming the health system for health protection. One such intervention is Diabetes Today, a training program for health professionals and lay community leaders that has been successful in building awareness of diabetes as a public health problem. We advocate the use of this program to prevent obesity among adolescents.     

Predictors of overweight and obesity in five to seven-year-old children in Germany: Results from cross-sectional studies

Background  

Childhood obesity is a serious public health problem and epidemiological studies are important to identify predictive factors. It is the aim of this study to analyse factors associated with overweight/obesity in samples of German children.     

母乳喂养对生命早期危险因素与儿童肥胖关联的修饰作用研究进展

儿童肥胖已成为全球共同关注的公共健康问题，其发生发展与生命早期危险因素暴露密切相关。近年来，越来越多流行病学研究证据显示，母乳喂养对儿童肥胖的生命早期危险因素如肥胖高遗传风险、母亲患妊娠糖尿病、出生巨大儿等因素带来的健康危险效应具有修饰作用。本文通过对该领域现有的研究结果进行综述，总结母乳喂养对儿童肥胖遗传及生命早期环境危险因素的修饰作用，为明确母乳喂养对特定高危儿童的肥胖防控效益和实施针对性的防控策略提供参考。     

儿童肥胖干预场所研究进展

儿童肥胖已成为发达国家和发展中国家常见的公共卫生问题,适宜的干预措施和适宜的干预场所对于实施有效干预至关重要。本文从儿童肥胖干预场所的角度出发,综述儿童肥胖干预场所(学校、家庭、社区和多个场所联合)的干预研究进展,探讨各种场所进行干预的作用与局限性,发现更为有效且实施性强的干预方式。     

促进儿童肥胖的预防性干预研究

儿童肥胖是亟需解决的重要公共卫生问题。尽管儿童肥胖的预防性干预研究取得了一定进展, 但在家长参与和干预保真度等方面仍具有挑战。倡导今后开展学龄前甚至孕前干预研究, 研发适用于不同地区、在大规模人群中行之有效的干预模式, 同时从基因、心理和行为等多个角度系统地分析儿童肥胖的影响因素, 为开展针对儿童特点的个性化肥胖干预和精准防控策略提供参考。     

The impact of BMI on direct costs in Children and Adolescents: empirical findings for the German Healthcare System based on the KiGGS-study

Background  

Childhood obesity is a growing public health burden. Among German children and adolescents, 15% are overweight (including obese) and 6.3% are obese according to a national reference. This is the first German study to assess aspects of the economic burden associated with overweight and obesity in children and adolescents based on a representative cross-sectional survey.     

基于基因与环境交互作用的儿童肥胖病因研究进展

儿童肥胖是全球性的公共健康问题,不仅危害儿童自身健康,还是成年期慢性病发病的重要诱因。近年来,随着精准医学研究的深入开展,越来越多的研究证据指明环境、行为因素,如早期宫内环境、儿童饮食、体力活动等,与儿童自身基因风险对肥胖的发病具有显著的交互作用,可以促进或抑制儿童肥胖的发生发展。本文对该领域现有研究进行综述,总结基因风险和环境暴露因素对儿童肥胖发病的交互作用及潜在机制,为不同遗传背景儿童的肥胖精准防控提供参考依据。     

Do Maternal Caregiver Perceptions of Childhood Obesity Risk Factors and Obesity Complications Predict Support for Prevention Initiatives Among African Americans?

Objectives African American maternal caregiver support for prevention of childhood obesity may be a factor in implementing, monitoring, and sustaining children’s positive health behaviors. However, little is known about how perceptions of childhood obesity risk factors and health complications influence caregivers’ support of childhood obesity prevention strategies. The objective of this study was to determine if childhood obesity risk factors and health complications were associated with maternal caregivers’ support for prevention initiatives. Methods A convenience sample of maternal caregivers (N?=?129, ages 22–65 years) completed the childhood obesity perceptions (COP) survey. A linear regression was conducted to determine whether perceptions about childhood obesity risk factors and subsequent health complications influenced caregivers’ support for prevention strategies. Results Caregivers’ perceptions of childhood obesity risk factors were moderate (M?=?3.4; SD?=?0.64), as were their perceptions of obesity-related health complications (M?=?3.3; SD?=?0.75); however, they perceived a high level of support for prevention strategies (M?=?4.2; SD?=?0.74). In the regression model, only health complications were significantly associated with caregiver support (β?=?0.348; p?<?0.004). Conclusions Childhood obesity prevention efforts should emphasize health complications by providing education and strategies that promote self-efficacy and outcome expectations among maternal caregivers.     

Educating Health Care Professionals in Advocacy for Childhood Obesity Prevention in Their Communities: Integrating Public Health and Primary Care in the Be Our Voice Project

Objectives. We assessed the perceived need for and the effectiveness of the Be Our Voice advocacy training. In this training, health care professionals learned public health strategies to advocate for environmental systems changes to prevent childhood obesity in their communities.Methods. We assessed 13 trainings across 8 pilot sites. We conducted 2 rounds of surveys with participants—pre-training (n = 287, 84% response rate) and immediately post-training (n = 254, 75% response rate)—and semi-structured interviews with participants after training (n = 25).Results. We uncovered essential and promising elements of the training. Primary care providers found the Be Our Voice training effective at building their comfort with and motivation for engaging in public health advocacy; they reported achieving learning objectives, and they had positive responses to the training overall and to specific sessions. They articulated the need for the training and plans for advocacy in their communities.Conclusions. The Be Our Voice training provides an opportunity to integrate primary care providers into public health, community-based advocacy. It may be a model for future educational offerings for health care professionals in graduate and postgraduate training and in practice.The effort to reverse the epidemic of childhood obesity in the United States provides a key opportunity to integrate public health and primary care by educating clinicians to be public health advocates in their communities. Obesity rates among the nation''s children have tripled in the past 30 years.1 As of 2008, over 30% of children aged 2 to 19 years had body mass indexes at or above the 85th percentile for their age.2Public health strategies for community-level prevention and environmental change hold particular promise for positively affecting the environments in which children live, learn, and play, and ultimately, for reversing the obesity epidemic.3,4 Integrating the clinical expertise of primary care providers with such public health approaches may further accelerate obesity prevention in communities. Through the approach of community-oriented primary care, there is longstanding precedent for efforts to bring together primary care and public health at the community level.5–8Health care professionals (HCPs) have daily exposure to the childhood obesity epidemic via the patients they treat, and they are trusted leaders in and resources for their communities.9 Their scientific and clinical knowledge of the epidemic coupled with this trusted community role positions HCPs to participate in community-based advocacy outside of their clinics.10 Expert committees and professional organizations have called on HCPs to collaborate with the public health community and to engage in community-based advocacy, and research has demonstrated that many clinicians are interested in advocacy.11–13 Tobacco control, often cited by those engaged in reversing the obesity epidemic, is the most visible of several public health advances that benefitted from the active engagement of HCPs.14 For example, HCPs have been important participants in public health campaigns on issues including promotion of child safety seats and bicycle helmets.15–17Despite this potential role for HCPs as advocates, substantial barriers hinder clinicians becoming engaged in public health advocacy. Many medical schools include advocacy training in their curricula, and certain medical specialties, including pediatrics, require advocacy training as a part of residency training.18,19 However, although some curricular programs are beginning to be tested, standard curricula do not yet exist to guide these requirements, and there is insufficient attention to advocacy in continuing medical education.20,21 Additional barriers include clinical service delivery often being the sole determinant of payment, the time required to be involved in advocacy outside the clinic, and limitations in most clinicians’ knowledge of how to connect to their communities in public health advocacy.4,10,22,23In response to this opportunity, the National Initiative for Children''s Healthcare Quality, in partnership with the American Academy of Pediatrics (AAP), the California Medical Association Foundation, and the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity—the “National Partners”—created the Be Our Voice project with support from the Robert Wood Johnson Foundation. The project provides training and follow-up support to primary care providers to participate in community-based public health advocacy for childhood obesity prevention in their communities. This study examined the perceived need for this training and initial responses to it among HCPs in 8 pilot Be Our Voice communities.     

When two sides go to war: newspaper reporting of ‘television food advertising restrictions’ as a solution to childhood obesity

Childhood overweight and obesity is a major public health problem in Australia and overseas. Food advertising during children's television programmes has been identified as one contributing factor to childhood obesity. The media plays an important role in informing the public and presenting arguments supporting and opposing solutions to childhood obesity. The aim of this study was to analyse newspaper coverage of the debate over restricting television food advertising as a solution to preventing childhood obesity. A newspaper search was conducted over the period July 2002 to July 2005. One hundred and sixty-six articles were analysed for article characteristics, speakers quoted, causes and solutions of childhood obesity and arguments presented. The majority of the articles (82, 49%) took a positive slant towards restricting television food advertising to children while 35 (21%) had a negative slant. The main causes of childhood obesity presented were: television advertising of unhealthy foods, lack of physical activity, increased screen time and time stretched parents. The main areas presented as solutions of childhood obesity were: policy changes to food advertising, supportive environments for physical activity, supportive environments for healthy eating and healthy eating policies. Strong arguments and strong language dominated the debate which remained polarised between health professionals and Federal government and industry. In spite of opposition towards restrictions on television food advertising to children, the media's stories played an important part in keeping the issue on the public and political agenda.     

School-based obesity prevention: Research, challenges, and recommendations

Childhood overweight is one of the most serious problems currently affecting individual and public health. Schools represent a logical site for prevention because children spend 6-8 hours a day there during most of the year. Although reports of school-based overweight or obesity prevention programs exist, there are no summaries specifying which interventions are effective in preventing weight gain in the school environment. Researchers generally consider randomized controlled trials to be the most reliable and valid findings; so, naturally they are the best for providing evidence on which to base curriculum and policy guidelines. Consequently, the purpose of this paper is to provide an overview of school-based randomized controlled studies intended to prevent increases in schoolchildren's body weight or body mass index. This paper addresses the successes and other positive health outcomes, as well as the limitations of the school-based research. The goal of this paper is to assist school health administrators with curriculum decisions related to overweight or obesity prevention in schools. Following the critique, the challenges of childhood overweight or obesity prevention are discussed, and recommendations for further research, school activities, and policy changes are made.     

High prevalence of obesity among inner-city adolescent boys in the Bronx, New York: forgetting our boys

We examined sex differences in overweight and obesity in a sample of 1,619 inner-city adolescents. Participants were enrolled from 11 public schools in the Bronx, New York. The prevalence of overweight and obesity was 21.7% and 22.5%, respectively; prevalence of obesity was significantly higher among adolescent boys than adolescent girls (24.9 vs 20.1%). Childhood obesity is a public health concern in the United States, and the higher prevalence of obesity in adolescent boys requires additional attention.     

Purchasing and public health: the state of the union

The purchasing role of health authorities has been in existence for two years and public health physicians are expected to play a central part within this role. While the first year was dedicated to maintaining a "steady state", differences are now appearing between authorities is the way in which purchasing is managed. Based on the views of senior managers and public health physicians working in purchasing authorities, considers how the purchasing process is developing and reports how public health medicine is perceived to be contributing to it. Identifies sub-regional resource allocation as a major factor influencing the purchasing process. Conflicting views were found on the purchasing role of public health medicine, in particular with respect to health needs assessment. As purchasing evolves it remains unclear whether pubic health medicine will come to fulfil a largely technical role, or a more wider one in which it acts as advocate for the population's health.     

Peer Reviewed: High Prevalence of Obesity Among Inner-City Adolescent Boys in the Bronx,New York: Forgetting Our Boys

We examined sex differences in overweight and obesity in a sample of 1,619 inner-city adolescents. Participants were enrolled from 11 public schools in the Bronx, New York. The prevalence of overweight and obesity was 21.7% and 22.5%, respectively; prevalence of obesity was significantly higher among adolescent boys than adolescent girls (24.9 vs 20.1%). Childhood obesity is a public health concern in the United States, and the higher prevalence of obesity in adolescent boys requires additional attention.     

The Health at Every Size Paradigm and Obesity: Missing Empirical Evidence May Help Push the Reframing Obesity Debate Forward

A Health at Every Size (HAES) approach has been proposed to address weight bias and stigma in individuals living with obesity, and more recently articulated as a promising public health approach beyond the prevailing focus on weight status as a health outcome. The purpose of this article is to examine our understanding of HAES within the context of public health approaches to obesity, and to present strengths and limitations of the available evidence. Advancing our understanding of HAES from a public health perspective requires us to move beyond an ideological debate and give greater attention to the need for empirical studies across a range of populations. Only then can the value of HAES, as a weight-neutral, public health approach for the prevention of obesity and other chronic diseases, be fully understood.A recent Framing Health Matters article in the American Journal of Public Health highlighted the potential for Health at Every Size (HAES) to be framed as a public health approach to obesity,1 and included a focus on the need for a weight-neutral approach to address the unique social challenges of weight stigma and bias.2 This is an important and admirable goal, but one that may benefit from some additional clarifications and considerations. In a response to this earlier article, we seek to (1) describe the context in which the HAES paradigm has emerged, (2) further examine the current evidence for the effect of HAES principles on a range of health-related outcomes, and (3) reflect on the adequacy of this evidence within the context of public health approaches to obesity.     

The prevalence of childhood obesity in primary school children in urban Khon Kaen,northeast Thailand

Childhood obesity is a serious public health problem because of its strong association with adulthood obesity and the related adverse health consequences. The published literature indicates a rising prevalence of childhood obesity in both developed and developing countries. However no data exists on the prevalence in Northeast Thailand, one of the poorest regions of the country and one that has experienced a recent economic transition. The objective of this study was to estimate the prevalence of obesity in seven to nine year old children in urban Khon Kaen, Northeast Thailand. A cross-sectional school based survey was conducted to determine the prevalence of obesity in children of urban Khon Kaen, Thailand. Multi-staged cluster sampling was used to select 12 school clusters of 72 children each between the ages of 7 and 9 years, in primary school grades 1, 2 and 3 from government, private and demonstration schools. A total of 864 seven to nine year old school children were studied. Anthropometric measurements of standing height and weight were taken for all subjects to the nearest tenth of a centimetre and tenth of a kilogram respectively, Childhood obesity was defined as a weight-for-height Z-score above 2.0 standard deviations of the National Center for Health Statistics/World Health Organisation reference population median. The prevalence of childhood obesity was 10.8% (95% CI: 7.6, 13.9). Obesity was significantly more prevalent in boys than girls. The biggest difference was observed between the three school types, with the highest prevalence of obesity found at teacher training demonstration schools and the lowest at the government schools. This study provides the first data on childhood obesity prevalence in Northeast Thailand. The prevalence of 10.8 per cent is lower than that found in two other urban areas of Thailand but slightly higher than expected for this relatively poor region. If this prevalence rate increases, as observed in other countries in economic transition, the incidence of non-communicable diseases associated with obesity is also likely to increase, thus raising cause for concern and reason for intervention to both control and prevent obesity during childhood.