Racial/Ethnic Disparities in Health-Related Quality of Life and Health in Children Are Largely Mediated by Family Contextual Differences

ObjectiveTo examine (1) racial/ethnic disparities in health-related quality of life (HRQOL), and overall health status among African-American, Hispanic, and white 5th graders in the general population and (2) the extent to which socioeconomic status (SES) and other family contextual variables mediate any disparities.MethodsA total of 4824 African-American, Hispanic, and white fifth-graders participating in a population-based, cross-sectional survey conducted in 3 U.S. metropolitan areas reported their own HRQOL by using the Pediatric Quality of Life Inventory Version 4.0 and supplemental personal and social well-being scales. Parents reported these children's overall health status. SES was indexed by parent education and household income. Other family contextual variables included family structure and degree to which English is spoken at home.ResultsMarked racial/ethnic disparities were observed across all measures of HRQOL and health status, favoring white children and especially disfavoring Hispanic children. Most of these disparities were no longer significant after adjusting for SES and other family contextual differences that were observed among these racial/ethnic groups. Only disparities in parent-reported overall health status and self-reported global self-worth remained.ConclusionsRacial/ethnic disparities in children's health status are substantial but may be mediated by corresponding disparities in SES and other family contextual variables. Race/ethnicity and family context are related to one another and should be considered jointly in efforts to reduce health disparities in children.     

Prevalence and regional distribution of childhood overweight and obesity in Shandong Province, China

Background

The rising prevalence of childhood obesity was observed in China. This study assessed the prevalence and district distribution of childhood obesity in Shandong Province, China.

Methods

A cross-sectional study was conducted in the province. A total of 42 275 students (21 222 boys and 21 053 girls) aged 7–18 years from 16 districts participated in this study. Height and body weight of all subjects were measured, and the body mass index (BMI) was calculated. The prevalence of overweight and obesity was obtained according to the International Obesity Task Force (IOTF) cut-offs.

Results

In 2010, the prevalence rates of combined overweight and obesity reached 26.86% in urban boys, 18.32% in rural boys, 14.36% in urban girls, and 11.31% in rural girls, respectively. An increasing trend was observed in the prevalence of overweight and obesity from the low socioeconomic status (SES) group to the moderate and high SES groups. The prevalence rates of combined overweight and obesity in the three SES groups were 18.46%, 21.08% and 27.31% in boys and 10.43%, 12.42% and 15.18% in girls, respectively.

Conclusions

There is a high level of overweight and obesity among children and adolescents in Shandong Province, China. The distribution of childhood obesity is positively associated with the regional SES.     

Overweight and obesity in Norwegian children: prevalence and socio‐demographic risk factors

Aim: The aim of this study was to estimate the prevalence of childhood overweight and obesity and to identify socio‐demographic risk factors in Norwegian children. Methods: The body mass index of 6386 children aged 2–19 years was compared with the International Obesity Task Force (IOTF) cut‐off values to estimate the prevalence of overweight including obesity (OWOB) and obesity (OB). The effect of socio‐demographic factors on this prevalence was analysed using multiple ordinal logistic regression analysis in a subsample of 3793 children. Results: The overall prevalence of OWOB was 13.8% (13.2% in boys and 14.5% in girls, p = 0.146), but the prevalence was higher in primary school children aged 6–11 years (17%, p < 0.001). The risk of being OWOB or OB increased in children with fever siblings (p = 0.003) and with lower parental educational level (p = 0.001). There was no association with parental employment status, single‐parent families or origin. Conclusion: The prevalence of OWOB and OB in Norwegian primary school children is of concern. Socio‐demographic factors have pronounced effects on the current prevalence of overweight and obesity in a cohort of Norwegian children. This knowledge could help to work out strategies to reduce the burden of overweight and obesity in children.     

Socio‐economic and ethnic differences in the prevalence of overweight and obesity among school children

Aims: To trial the collection of measurements to provide population‐based prevalence of overweight and obesity in school children in western Sydney and examine the association between healthy weight and ethnicity and socio‐economic status (SES) in a socio‐economically and culturally diverse population. Methods: A cross‐sectional population‐based survey of 2341 children in Years 4 and 7 (mean ages 9 and 12 years, respectively) in 2007. Results: Nineteen per cent of children were overweight and a further 6% were obese. The prevalence of combined overweight and obesity was similar for boys and girls (26% vs. 24%, P= 0.35). SES was significantly associated with the prevalence of unhealthy weight: the odds of being overweight or obese were 1.79 times (95% confidence interval (CI) 1.35 to 2.36) higher for children from the lowest quartile than for children from the highest quartile. Compared to children from an English speaking background, children from a non‐English speaking background were significantly more likely to be overweight or obese (21% vs. 31%, P < 0.001). The prevalence of combined overweight and obesity was significantly higher for children from a Pacific Island (odds ratio (OR) 2.66, 95% CI 1.63 to 4.33), Middle Eastern (OR 1.63, 95% CI 1.22 to 2.17) or European (OR 1.67, 95% CI 1.12 to 2.49) background than for English speaking background children. Conclusion: Large jumps in the prevalence of overweight and obesity in children observed from the 1980s appear to be diminishing, with comparable prevalence reports in 2004 and 2007. Ethnicity and SES are each independently associated with the prevalence of unhealthy weight in children.     

Risk factors for childhood overweight

PURPOSE OF REVIEW: We review the 2004 literature on risk factors for childhood overweight. Given the steady increase in the prevalence of childhood overweight, the identification of risk factors is of increasing importance. RECENT FINDINGS: A number of studies confirmed that parental overweight is the most potent risk factor for childhood overweight. Childhood temperament was found to mediate the effects of parental overweight with a difficult temperament increasing the risk of overweight. Newer findings implicate regular consumption of fast food and sweetened drinks as risk factors, as well as sedentary behavior; although a meta-analysis suggested that the effects of the latter factor are small. Other work was consistent with the finding that parental overcontrol of children's feeding behavior, particularly for those at high risk of developing overweight, may lead to overweight. SUMMARY: Identification of groups of children at high risk for becoming overweight offers the potential for early intervention to reduce the intergenerational transfer of obesity. This is an area for future research because the nature of effective intervention is at present unclear. There is a suggestion that focused behavior change efforts on one target such as reducing the intake of sweetened beverages may be more successful than attempts to make broader dietary changes. There is also evidence that targeting parental behaviors may be more effective than interventions directed solely toward children, suggesting that modification of the environment that a child is exposed to during early development may have a lasting effect.     

Determinants of obesity in the Ulm Research on Metabolism, Exercise and Lifestyle in Children (URMEL-ICE)

We investigated the prevalence of overweight and obesity in German schoolchildren and analyzed determinants of overweight. In the context of a randomized intervention study, a baseline cross-sectional assessment was carried out in 2006. During a physical examination, height, weight, skin fold thickness, and upper arm and waist circumferences were measured according to a standardized protocol among 1.079 children aged 6–9 years. Overweight and obesity were classified according to the definitions of the International Obesity Task Force. Parents completed a questionnaire on potential determinants of overweight. Logistic regression models were calculated for determinants of overweight and obesity. The prevalence of overweight was 16.5% in boys and 17.3% in girls and of obesity 3.5% and 3.6%, respectively. Migration (29.4 %) was correlated with overweight and obesity. In particular, among boys with migration background, overweight (24.0%) and obesity (6.6%) were highly prevalent. Higher obesity prevalence was associated with maternal smoking during pregnancy, parental overweight, and low parental education. Indicators for physical inactivity such as watching television more than 1 h per weekday, participation in club sports less than once a week, consumption of sweetened drinks (≥3 times per week), and skipping breakfast before school were associated with childhood obesity. Our results provide further evidence that parental factors such as migration background and education are strongly associated with body mass of the offspring. Physically inactive children with regular consumption of sweetened drinks and no breakfast were prone to be overweight or obese. Changes of these lifestyle factors as targets of interventions are promising to prevent childhood obesity. Stephan K. Weiland (deceased).     

Maternal prepregnancy body mass index in relation to Hispanic preschooler overweight/obesity

The aim of the current study was to examine the role of maternal prepregnancy body mass index (BMI) on overweight/obesity among US Hispanic children ages 2 and 4 years old. We used US nationally representative data from preschoolers enrolled in the Early Childhood Longitudinal Study-Birth Cohort study. The findings revealed that a significantly higher percent (41.6%) of Hispanic mothers were overweight/obese prior to pregnancy compared to white mothers (34.8%). At 2 years of age, 38.3% of the children born to Hispanic mothers were overweight/obese compared to 29.4% of children born to white mothers. By the age of 4, overweight/obesity increased significantly for both racial/ethnic groups with preschoolers whose mothers were Hispanic being more likely to be overweight/obese (44.6%) compared to children whose mothers were white (34.2%). Further, preschoolers born to overweight/obese Hispanic mothers were more than twice as likely [odds ratio = 2.74 (95% confidence interval (CI) 1.60, 4.69)] to be overweight/obese than those born to Hispanic mothers of normal prepregnancy BMI. Preschoolers born to overweight/obese white mothers were approximately 1.4 (95% CI 1.05, 1.93) times more likely to be overweight/obese in comparison to those born to mothers with a normal prepregnancy BMI. Maternal prepregnancy weight is potentially a modifiable risk factor for preschooler overweight/obesity. Study findings support the design of early and targeted interventions to reduce this risk to the long-term health of Hispanic maternal and child dyads.     

Stature and weight status of children in an urban kindergarten population

To assess the prevalence of growth problems among school entrants in an urban population who were not preselected on poverty or other nutritional risk criteria, we analyzed height and weight measurements for 5170 4- and 5-year-old children (91.9% black, 5.5% white, and 2.6% Hispanic) who enrolled in District of Columbia public school kindergartens in the Fall of 1985. Compared to the National Center for Health Statistics reference, the white girls and boys were of average height, Hispanic girls were of average height, and Hispanic boys were shorter than average. The black girls and boys were taller than average. In light of published evidence for black-white differences in the timing and duration of growth, we tentatively attributed this tall stature to advanced skeletal maturation of the black children relative to the predominantly white United States population growth standards. Underweight was virtually absent in this population. Excess overweight was noted in all sex-racial/ethnic subgroups, particularly among Hispanic children. However, the extent to which overweight (high weight-for-height percentile) represents obesity in kindergarten-aged children and in different racial/ethnic groups needs clarification before the implications of the finding of excess overweight can be fully understood. Overall, the growth of these children was on a par with the National Center for Health Statistics growth reference population.     

Overweight and obesity in 6- to 14-year-old Czech children in 1991: protective effect of breast-feeding

OBJECTIVE: To assess the impact of breast-feeding on childhood overweight/obesity in an Eastern European socialist society with relatively homogeneous lifestyles. STUDY DESIGN: Cross-sectional survey data collected in 1991 on 33,768 school-children aged 6 to 14 years in the Czech Republic were analyzed by using multiple logistic regression analyses (main outcome body mass index [BMI] >90th percentile [overweight] and BMI >97th percentile [obesity]). RESULTS: Overall prevalence of overweight (obesity) was lower in breast-fed children: ever breast-fed (9.3%; 95% CI, 8.9-9.6 [3.2%; 95% CI, 3.0-3.4]) compared with never breast-fed (12.4%; 95% CI, 11.3-13.6 [4.4%; 95% CI, 3.7-5.2]). The effect of breast-feeding on overweight/obesity did not diminish with age in children 6 to 14 years old and could not be explained by parental education, parental obesity, maternal smoking, high birth weight, watching television, number of siblings, and physical activity. Adjusted odds ratios for breast-feeding were for overweight 0.80 (95% CI, 0.71-0.90) and for obesity 0.80 (95% CI, 0.66-0.96). CONCLUSIONS: A reduced prevalence of overweight/obesity was associated with breast-feeding in a setting where socioeconomic status was homogeneous. This suggests that the effect of breast-feeding on the prevalence of obesity is not confounded by socioeconomic status.     

Parental Concerns About Child Weight Among 10–17-Year Olds With Overweight/Obesity: A Family Ecological Model

ObjectivesThe purpose of this study was to identify child, family/household, organization (provider), and neighborhood/community factors associated with parental concern about weight among children with overweight/obesity in order to inform effective interventions for improving health in this pediatric population.MethodsPrevalence of parental concern about child weight was estimated and factors identified within an adapted family ecological framework. Using cross-sectional data from the 2018 National Survey of Children's Health, we conducted bivariate and multivariable analyses of 10 to 17-year olds (N = 15,427) for whom height and weight information was reported by parents or primary caregivers.ResultsThere were 4287 children, aged 10 to 17 years, with overweight/obesity (31%). Approximately 34% of parents of children with overweight/obesity reported being concerned about their child's weight, with the remainder being not concerned. In adjusted analyses, 23% of children with overweight and 45% of children with obesity had parents who reported being concerned. Factors associated with parental concern among children with overweight/obesity included child weight status, female gender, peer social difficulties, the extent of the child's daily activities affected by health conditions, poorer parental coping, and having been told the child was overweight by a provider.ConclusionsOnly one in three parents of children with overweight/obesity reported being concerned about their child's weight, although parental concern was more common among children affected by obesity more so than overweight. A combination of child, family, and organization (provider) factors were associated with parental concern. Provider feedback about child overweight may improve parental awareness of a weight-related health issue.     

Overweight and obesity and their associated factors in adolescents in Tehran, Iran, 2004–2005

Overview Obesity is a significant health crisis around the world. Of great concern are the data pointing to the recent increase in the prevalence of obesity irregardless of age group and country. Overweight and obesity in adolescence are markers of overweight and obesity in adults, respectively. Very little data are currently available on the prevalence of childhood obesity in Iran, and more research on the risk factors is required before preventive public health programs can be formulated and put into practice.Objective The objective of this study was to quantify the prevalence of overweight and obesity and their associated factors in adolescent children living in Tehran.Materials and methods During a multistage stratified cluster sampling, 2900 students (1200 males and 1700 females) aged 11–17 years were selected from 20 secondary schools in the school year of 2004–2005. A questionnaire was filled, and weight and height were measured.Discussions and conclusions The body mass index (BMI) was calculated and adjusted for age and sex. Prevalences of overweight and obesity were 17.9 and 7.1%, respectively. BMI increased with age, and it was higher in those who had lower levels of physical activity. Age at menarche was negatively associated with BMI. There was no relationship between macro- and micronutrient intake and overweight and obesity. This study highlights the high prevalence of overweight and obesity in adolescent children in Tehran.     

Prevalence of overweight,obesity, and associated risk factors among school children and adolescents in Tianjin,China

To estimate the prevalence and determinants of overweight and obesity among school children and adolescents (7–18 years), a cross-sectional study was conducted in Tianjin City of Northeast China. Five primary and middle schools were selected using a multistage random cluster sampling. Anthropometric measurements were taken by the research team. Then, standardized questionnaires on socioeconomic status, diet and lifestyle, parental weight and height were sent to the parents to be completed together with their child. Overall, 3,140 students were screened for overweight and associated risk factors. Body mass index classification reference proposed by the Working Group on Obesity in China was used as a screening reference to calculate the prevalence of overweight in these groups. The prevalence of overweight and obesity was found to be 12.5% and 15.7%, respectively. Logistic regression analysis (overweight compared with normal weight) showed that, overweight in children was significantly associated with male gender, parental obesity, parental educational level, mother’s history of gestational diabetes, high birth weight, less hours of physical activity per day, urban residence, motorized transportation, and eating food not prepared at home. After adjusting for parental obesity, the odds ratio of overweight children was increased by urban residence (rural as a reference, 2.68, 2.16–3.32), positive gestational diabetes (2.76, 1.37–4.50), and fast-food/restaurant food service (2.03, 1.34–3.07). Children who walked to school and participated in outdoor activities were 54% and 63% less likely to be overweight respectively. Conclusions: The prevalence of overweight and obesity is high among school children and adolescents in Tianjin. Changes in lifestyle, high socioeconomic status, parental obesity, mother’s history of gestational diabetes, and high birth weight are among the highly associated risk factors of overweight. An educational approach about maintaining a healthy weight should be introduced much earlier to high-risk children, parents, and women of childbearing age.     

Childhood Obesity in India: A Meta-Analysis

Developing countries are now facing the double burden of childhood underweight and obesity. Childhood obesity is a recent epidemic with a high magnitude in India. Therefore, the authors decided to assess the prevalence of overweight and obesity among Indian children. Studies were identified through computer-based and manual searches. Estimates of prevalence were studied using random effects meta-analysis. Nine studies including 92,862 subjects were identified and analysed. The prevalence of overweight was estimated to be 12.64% (95% CI 8.48-16.80%) and that of obesity to be 3.39% (95% CI 2.58-4.21%). Current evidence suggests that policies and interventions for children should prioritize reduction of obesity and overweight.     

Risk factors for overweight in 2- to 6-year-old children in Beijing, China.

OBJECTIVE: To assess the prevalence of overweight among Chinese preschool children and to explore risk factors of childhood obesity focusing on parental characteristics, feeding practice and lifestyle. METHODS: Data on 930 families with 2- to 6-year-old children in five kindergartens were obtained in a cross sectional study. Families were randomly selected from two of all six urban districts in Beijing, China. Information on parental characteristics, dietary habits, lifestyle habits, and feeding practice was collected by parental self-report questionnaires. The children's stature and weight were measured in light clothing and without shoes. Overweight and obesity were defined according to international cut-off values, as proposed by the International Obesity Task Force. Multivariate regression analysis was used to explore risk factors of child overweight. RESULTS: The overall prevalence of overweight and obesity was 10.7% and 4.2%, respectively, and increased with age. The prevalence of child overweight was 14.1% and 7.5% in obese and non-obese families, respectively. Significant associations were observed between child and parent characteristics for overweight, frequency of eating in restaurant, television hours, and hours of physical activity. Child overweight was associated with parental overweight (Odds Ratio [OR] 2.43, 95% CI 0.78, 6.59), low maternal education level (OR 2.22, 95% CI 1.39, 3.55), food restriction (OR 2.68, 95% CI 1.64, 4.29), and television watching >2h/d (OR 1.56, 95% CI 1.17, 2.09), after adjusting for sex, age, family income and kindergarten (for cluster study design). CONCLUSIONS: Overweight prevalence among Chinese preschool children in Beijing is comparable to some European countries. Prevention strategies should include identified lifestyle risk factors.     

The consequences of childhood overweight and obesity

Researchers are only gradually becoming aware of the gravity of the risk that overweight and obesity pose for children's health. In this article Stephen Daniels documents the heavy toll that the obesity epidemic is taking on the health of the nation's children. He discusses both the immediate risks associated with childhood obesity and the longer-term risk that obese children and adolescents will become obese adults and suffer other health problems as a result. Daniels notes that many obesity-related health conditions once thought applicable only to adults are now being seen in children and with increasing frequency. Examples include high blood pressure, early symptoms of hardening of the arteries, type 2 diabetes, nonalcoholic fatty liver disease, polycystic ovary disorder, and disordered breathing during sleep. He systematically surveys the body's systems, showing how obesity in adulthood can damage each and how childhood obesity exacerbates the damage. He explains that obesity can harm the cardiovascular system and that being overweight during childhood can accelerate the development of heart disease. The processes that lead to a heart attack or stroke start in childhood and often take decades to progress to the point of overt disease. Obesity in childhood, adolescence, and young adulthood may accelerate these processes. Daniels shows how much the same generalization applies to other obesity-related disorders-metabolic, digestive, respiratory, skeletal, and psychosocial-that are appearing in children either for the first time or with greater severity or prevalence. Daniels notes that the possibility has even been raised that the increasing prevalence and severity of childhood obesity may reverse the modern era's steady increase in life expectancy, with today's youth on average living less healthy and ultimately shorter lives than their parents-the first such reversal in lifespan in modern history. Such a possibility, he concludes, makes obesity in children an issue of utmost public health concern.     

Increasing incidence of childhood obesity

Childhood obesity is a nutritional, metabolic and endocrine disease; all of these factors have genetic components. Attractive for writers and painters, it has been found to be a medical risk. Childhood obesity had been neglected until about 30 years ago. A series of cross-sectional and longitudinal studies performed in many countries using mainly BMI values as determinant of overweight have shown that there is an overall fast rise in overweight in many populations, usually starting around age 7. In certain populations and ethnic groups the rise and degree of obesity are especially high, such as the Hispano-Black and Native Americans and European countries. School children in the US, Greece, Ireland and Portugal are more overweight than those in 12 other countries. In addition to genetic factors, rapid changes in life style (more energy intake and less energy output) are the major factors causing childhood obesity. In recent years it has been recognized as a fast increasing public health problem.     

The Relationship Between Body Mass Index in Children and Insurance Type,Parental Eating Concern,Asthma, and Allergies

IntroductionTrust for America's Health reported rising levels of obesity contributed to increased disease rates and health care costs (Levi et al., 2013). Factors associated with overweight and obesity rates include lower socioeconomic status, public insurance, and increased chronic disease rates.MethodsBody mass index percentile, health insurance, parental eating concern, asthma, and allergy information were evaluated from a dataset of 870 de-identified health assessment records.ResultsAmong overweight/obese children, we found significant differences in children insured by Medicaid (26%) versus commercial insurance (15.9%), children with asthma (22.1%) versus children without asthma (14.8%), and children with known allergies (7.8%) versus children without known allergies (16.7%). The difference between children with parental eating concerns (3.7%) and children without (18.1%) was nearly significant.DiscussionThe associations depicted can assist pediatric providers in recognizing risk factors for overweight/obesity among their patients. Combating obesity in childhood can improve health outcomes.     

Prolonged bottle use and its association with iron deficiency anemia and overweight: a preliminary study

To determine the prevalence of prolonged bottle feeding practices in young children, and its association with body mass index (BMI) and iron deficiency anemia (IDA), we conducted a cross-sectional survey study at 3 Bronx, NY, WIC sites. Caregivers of 95 predominantly Hispanic and African-American WIC-enrolled children aged 18-56 months presenting for recertification completed questionnaires. Half were overweight (>85th% BMI) and 36% were obese (>95th% BMI); 21% met CDC criteria for anemia. Two thirds (63%) received daily bottles of milk or sweet liquids. Daily bottle use ranged from 3 to 10 (mean=3.3, median=3). Bottle use was significantly associated with obesity (>95th% BMI, p<0.0005), not significant with overweight (>85th% BMI, p<0.06) and statistically significant with IDA.     

The Clinical Treatment of Childhood Obesity

With the rising prevalence of childhood obesity, pediatricians are increasingly called upon to treat clinically overweight children. The primary treatment options are behavioral lifestyle modification, pharmacotherapy, and surgery. The cornerstone of childhood obesity treatment is lifestyle modification and has been shown to be effective in improving the severity of overweight and obesity. Several guidelines discuss appropriate methods for lifestyle modification in overweight and obese children. This review will summarize three recent guidelines/recommendations (released by the Scottish Intercollegiate Network, the American Academy of Pediatrics, and the United Kingdom National Institute for Health and Clinical Excellence) and describe by way of example, a current child obesity treatment program in the United States (Duke University Medical Center). Finally, evidence for pharmacologic and surgical treatment options will also be discussed, which can be valuable treatment options for select patients.