Maternal child feeding practices and obesity: a discordant sibling analysis

BACKGROUND: The relationship between maternal feeding practices and weight status of 7-12 year-old obese and nonobese siblings was evaluated in 18 families using a discordant sibling design. METHOD: Mothers completed measures of concern and perception of children's weight and eating behavior, their control over child feeding, and maternal eating behavior. RESULTS: Intraclass correlations suggested similarity between obese and nonobese siblings in maternal control over feeding. Mothers perceived differences between their obese and nonobese children's eating regulation. Mothers' weight status was positively associated with disinhibition of their own eating as well as concern about both their obese and nonobese children's weight and health. DISCUSSION: These findings fail to support the hypothesis that maternal control over child feeding is related to childhood obesity, but highlight the impact of maternal weight history and eating habits on her impression of children's future weight and health independent of the child's weight status.     

2001-2010年儿童肥胖相关的卫生保健服务文献热点分析

目的分析儿童肥胖相关的卫生保健服务的研究热点和规律。方法以“（child）AND（obesity）AND（de—liveryofheahhcare）”为检索策略，收集PubMed数据库中收录的2001～2010年发表的儿童肥胖相关的卫生保健服务文献，下载文献所标引的主题词并统计其出现的频次。根据设定阈值截取高频主题词进行系统聚类分析。结果共检出儿童肥胖相关的卫生保健服务文献808篇，截取30个高频主题词。共词聚类分析结果为：社会支持和社会经济冈素相关的研究，该类别中共包含10个高频主题词，分别为知识、态度和实践、调查表、体重指数、横断面研究、体重、社会经济因素、儿童营养生理学现象、家长／心理学、亲子关系和治疗效果；生活方式相关的研究，该类别包含5个高频主题词，分别为健康态度、生活方式、健康行为、活动和饮食习惯；健康教育和健康促进相关的研究，该类别下共包含9个高频主题词，分别为肥胖预防及控制、健康促进的方法学研究、运动量、儿童营养科学研究、项目评估、前驱性研究、肥胖／流行病学、社会营销和健康促进；儿童肥胖相关基线信息的研究，该类别下共包括6个高频主题词，分别为危险因素、患病率、卫生保健需求、美国／流行病学、护士角色和儿童福利。结论社会支持、生活方式、健康教育和儿童肥胖的基线信息研究是目前儿童肥胖相关的卫生保健服务领域的研究热点。     

Childhood obesity: do parents recognize this health risk?

OBJECTIVE: This study examined parents' understanding of excess weight as a health risk, knowledge of healthy eating habits, and recognition of obesity in their children. RESEARCH METHODS AND PROCEDURES: An anonymous questionnaire was distributed during well-care visits involving children 4 to 8 years of age at a pediatric faculty practice. Parents indicated their level of concern about excess weight and other familiar health risks using a four-point Likert scale, answered multiple-choice questions concerning healthy eating patterns, and communicated their perceptions about their child's weight using a visual analog scale. A parent's perception was considered "accurate" if it deviated from the child's growth chart percentile by <30 points. RESULTS: Of the 83 parents surveyed, 23% (19/83) had overweight children (> or = 95th percentile of age- and gender-specific BMI growth charts). These parents did not differ from other parents in their level of concern about excess weight as a health risk or in their knowledge of healthy eating patterns, but the two groups of parents did differ in the accuracy of their perceptions about their children's weight. Only 10.5% of parents of overweight children (2/19) perceived their child's weight accurately compared with 59.4% of other parents (38/64; p < 0.001). Parents of overweight children invariably underestimated their children's weight. The median difference between their perception and the growth chart percentile was -45 points. DISCUSSION: Given that most parents of overweight children fail to recognize that their child has a weight problem, pediatricians should develop strategies to help these parents correct their misperceptions.     

Disease Management Programs Targeting Obesity in Children

An epidemic of childhood obesity has been recognized over the past few decades and obesity is now the most common health problem among children in the developed world. Pediatric obesity rates have also increased in developing countries in recent years. There is a widespread perception among health professionals, patients, and families that childhood obesity is mainly a cosmetic problem, with relatively minor health risks. However, there is a large body of consistent and high-quality evidence showing that childhood obesity has significant health risks in both the short term (for the obese child) and in the long term (for the adult who was obese as a child). These include cardiovascular risk factors, fatty liver, psychological ill health, asthma, type 2 diabetes mellitus, inflammation, and orthopedic problems in childhood; and the persistence of obesity, cardiovascular risk factors, premature mortality, and adverse social and economic outcomes in adulthood. Systematic reviews have consistently concluded that high-quality evidence on the management of pediatric obesity is limited. Despite weaknesses in the evidence base, useful guidance on promising strategies to treat pediatric obesity are widely available. Key components of a successful weight management program include an increase in physical activity, dietary modification, targeting reduction in sedentary behaviors, involving parents in treatment, and employing behavioral techniques. These approaches produce modest improvements in weight-related outcomes (10–20% decrease in percentage overweight or 1–3 unit kg/m² change in body mass index [BMI]), and can increase physical fitness, enhance psychosocial functioning, and improve cardiovascular and metabolic health.Although treatment programs for obese children appear to be successful, it it widely recognized that broader preventive interventions targeting the school setting, the community, the physical environment, and society are needed to prevent and reduce obesity in children and young people.     

Health status, health behaviors, and acculturation factors associated with overweight and obesity in Latinos from a community and agricultural labor camp survey

BACKGROUND: U.S. Latino adults have experienced an 80% increase in obesity in the last decade. METHODS: A cross-sectional survey of 18-64-year-old Latino women (N = 380) and men (N = 335) from a community sample, and men (N = 186) from an agricultural labor camp sample in Monterey County, California, provided data on correlates of obesity. RESULTS: In the community and labor camp samples, prevalences of chronic disease risk factors (high blood pressure and cholesterol, diabetes) were 1.5-7 times higher in the heaviest compared with the leanest weight groups. Higher acculturation (generational status, years lived in the United States) was the strongest correlate of obesity (measured by BMI) in the community sample (P < 0.001), followed by less exercise and poorer diet (P values < 0.05). Women who exercised <2.5 h/week, watched TV regularly, ate chips/fried snacks, and ate no fruit the previous day were 45 lbs heavier than women with healthier habits. Men who did not exercise, rarely trimmed fat from meat, and ate fried foods the previous day were 16 lbs heavier than men with healthier habits. Discussions with health care providers about diet/exercise were associated with more accurate weight perception and more weight loss attempts in obese participants in both samples. CONCLUSIONS: The associations of acculturation, exercise, and diet to BMI implicate societal as well as individual contributors to obesity among U.S. Latinos.     

Differences in health care costs and utilization among adults with selected lifestyle-related risk factors

PURPOSE: This study examined the relationship between lifestyle-related health risks and health care costs and utilization in adults. DESIGN: A 2-year prospective study with no intervention was used to compare health care utilization and costs in employees with different levels of health risks. SETTING: Data were collected at a primarily white-collar worksite during 1994 and 1995. SUBJECTS: Subjects included 982 employees and spouses, mean age 32.1 +/- 10.1 years. MEASURES: Employee medical claims obtained from a third-party administrator were analyzed with respect to health care expenses and utilization. Exercise habits, stress, and overall wellness were assessed by self-report and obesity by the body mass index (BMI). Regression, regression with outliers removed, and odds ratios were used to analyze the associations. RESULTS: Employees who were at high risk for overall wellness (2.4 times), stress (1.9 times), and obesity (1.7 times) were more likely to have high health care costs (> $5,000) than subjects not at high risk. Mean total medical costs also were greater for high-risk subjects compared to lower risk subjects for overall wellness (difference = $1,973; F = 10.65, p = .001), stress (difference = $1,137; F = 7.35, p = .007), and obesity (difference = $1,092; F = 9.09, p = .003). The exercise habits measure was not significantly associated with health care costs or utilization. CONCLUSIONS: Results indicate that health risks, particularly obesity, stress, and general lifestyle, are significant predictors of health care costs and utilization in employed young adults.     

Excess body weight during pregnancy and offspring obesity: Potential mechanisms

The rates of child and adult obesity have increased in most developed countries over the past several decades. The health consequences of obesity affect both physical and mental health, and the excess body weight can be linked to an elevated risk for developing type 2 diabetes, cardiovascular problems, and depression. Among the factors that can influence the development of obesity are higher infant weights and increased weight gain, which are associated with higher risk for excess body weight later in life. In turn, mother’s excess body weight during and after pregnancy can be linked to the risk for offspring overweight and obesity through dietary habits, mode of delivery and feeding, breast milk composition, and through the influence on infant gut microbiota. This review considers current knowledge of these potential mechanisms that threaten to create an intergenerational cycle of obesity.     

Parent Reactions to a School-Based Body Mass Index Screening Program

Background:  This study assessed parent reactions to school-based body mass index (BMI) screening.
Methods:  After a K-8 BMI screening program, parents were sent a letter detailing their child's BMI results. Approximately 50 parents were randomly selected for interview from each of 4 child weight–classification groups (overweight, at risk of overweight, normal weight, underweight) to assess parent recall of the letter, reactions to BMI screening, and actions taken in response to the child's BMI results.
Results:  Most parents found the BMI screening letter easy to read and had poor recall of numerical information (eg, the child's BMI percentile) but good recall of the child's weight classification (eg, normal weight or overweight). Most parents, and ethnic-minority parents in particular, supported school-based BMI screening. Parents of children whose weight was outside of the normal range were more likely to recall receiving the letter and talking to the child and the child's doctor about it. Parents who recalled their child as being overweight were more likely to report changing the child's diet and activity level. Most parents, and ethnic-minority parents in particular, wanted their child to participate in an after-school exercise program. An overweight condition in parents, but not children, was associated with an interest in family-based cooking and exercise classes.
Conclusions:  Most parents, and ethnic-minority parents in particular, viewed school-based BMI screening and after-school exercise programs favorably. Parents reported taking action in response to a BMI result outside of the normal range. Parents who were overweight themselves were particularly interested in family cooking and exercise classes.     

The relative contributions of different levels of overweight and obesity to the increased prevalence of diabetes in the United States: 1976-2004

BACKGROUND: Policy makers are divided on whether to focus public health efforts to prevent type 2 diabetes on subpopulations at high risk or on the entire population. We examined the extent to which increases in the prevalence of overweight, obesity, and severe obesity have contributed to the increase in diabetes prevalence among U.S. adults between 1976-1980 and 1999-2004. METHODS: Using assembled data of 37,606 U.S. adults aged 20 to 74 years from 3 consecutive U.S. national surveys (NHANES II, III, and NHANES 1999-2004), we compared the body mass index distributions among prevalent diabetes cases over time and divided changes in prevalence of 5 diabetes-body mass index categories by changes in the diabetes prevalence observed in the total population. RESULTS: Prevalence of diabetes among adults aged 20 to 74 increased from 5.08% in 1976-1980 to 8.83% in 1999-2004. Of the 3.75 additional cases per hundred that existed in 1999-2004 as compared to 1976-1980, we estimated that -8% were among persons of normal or below normal weight (body mass index<25); 27% were among those who were overweight (body mass index 25 to 30); and 32%, 23%, and 26% among those with class I (body mass index 30 to 35), class II (body mass index 35 to 40), and class III obesity (body mass index>40), respectively. Thus, of the additional prevalent diabetes cases that existed in 1999-2004 as compared to 1976-1980, 81% were obese (i.e. body mass index>30) and 49% had class II or III obesity (body mass index>35), a group that increased in prevalence from 4% to 13% of the overall adult population. CONCLUSIONS: The increases in diabetes prevalence over recent decades have been disproportionately comprised of persons with extreme levels of obesity.     

Obesity and changes in body weight related to 10-year diabetes incidence in women in Taiwan

This study aimed to investigate the relation of obesity and changes in body weight through adulthood with risks of type 2 diabetes. This study of 954 middle-aged women free of diabetes (mean age, 37.1 +/- 9.6 years) was conducted in a hospital. The baseline and biannual health check-ups were performed from 1993 to 2003. The cumulative incidence rate of type 2 diabetes was 3.64 per 1000 person-years during the mean follow-up period of 10 years. 73.3% of subjects who developed type 2 diabetes were overweight (16.6%) or obese (56.7%). Obese subjects (body mass index more than 25 kg/m2) had a relative risk of type 2 diabetes of 10.4 (95% confidence interval 2.95-36.9) compared with subjects with an optimal body mass index (18-22.9 kg/m2). Long-term weight gain was strongly related to the risk of type 2 diabetes. Each 1 kg of weight gain was associated with a 16% increase in risk of developing diabetes. This study indicated that obesity at young adult and weight gain appreciably increase risk for type 2 diabetes. Maintaining a lean weight throughout adulthood seems to be beneficial in the primary prevention of type 2 diabetes.     

Prevalence and determinants of obesity and overweight among reproductive age women living in the semi-arid region of Brazil

The study estimated the prevalence and determinants of overweight and obesity in women of reproductive age in the Semi-Arid Region of Brazil. In the cluster sampling of 8,000 households of the state of Ceará, 6,845 women were surveyed. Overweight and obesity were measured by the body mass index and risk factors identified by multivariate analysis. The prevalences of overweight and obesity were 32.6% and 16.1%, respectively. After adjusted analysis, obesity was positively associated with age>30 years (PR=1.55), marital status, married (PR=1.36), elementary education (PR=1.40), age at menarche<12 years (OR=1.59), having >1 child (PR=1.65) and contraceptive use (PR=1.31). Specific health and nutritional conditions were identified as highly associated to morbid obesity: hypertension (PR=3.11), diabetes (PR=2.08), dissatisfaction with body image (PR=4.26) and procedures for weight loss (PR=2.73). The study concluded that overweight and obesity are highly prevalent in the Semi-Arid Region of Brazil. Education was the only socioeconomic determinant considered as amenable to change. The reproductive risk factors identified enforce the need to mobilize the services of prenatal and postpartum care and family planning to prevent and control obesity.     

Parents' reports of the body shape and feeding habits of 36-month-old children: an investigation of gender differences

OBJECTIVE: The current study examined parental perception of offspring body shape, differential reporting of offspring eating behaviors by mothers and fathers, and gender-specific patterns of offspring feeding habits. METHODS: Parents of a community sample of 36-month-old children (N = 93) completed measures regarding their offspring's feeding patterns and body shape. RESULTS: Results revealed noteworthy correlates (e.g., concerns about their child's appetite) of parental perception of offspring weight status. They further suggested that mothers and fathers often differed in their accounts of their child's eating habits, and that parents report certain eating behaviors differently depending on the gender of their child. CONCLUSION: Clinical and theoretical implications are discussed.     

Body mass index, physical activity, and the risk of decline in overall health and physical functioning in late middle age

OBJECTIVES: We examined the relation between body mass index, exercise, overall health, and physical functioning. METHODS: We studied 7867 adults aged 51 to 61 years in 1992 to 1996. Adjusted relative risks for health decline and new physical difficulties were determined with logistic regression. RESULTS: Overweight and obesity were independently associated with health decline (adjusted relative risk [ARR] = 1.29 and 1.36) and development of a new physical difficulty (ARR = 1.27 and 1.45). Regular exercise significantly reduced the risk of health decline and development of a new physical difficulty, even among obese individuals. CONCLUSIONS: Maintaining ideal body weight is important in preventing decline in overall health and physical functioning. However, regular exercise can reduce the risk of health decline even among individuals who cannot achieve ideal weight.     

Parents' stage of change for diet and physical activity: influence on childhood obesity

Highly visible public health education efforts have resulted in increased awareness of the childhood obesity epidemic but not a related decline in the number of overweight children. The Transtheoretical Model was used to examine the associations among child risk factors, parent's knowledge of factors associated with childhood obesity and their access to healthy foods in their community and parent's stage of change (SOC) in making behavior changes to improve their child's diet and level of physical activity. Parents (n = 124) of children between 6-12 years of age were surveyed. Perceived weight of the child and the child's body mass index (BMI) were found to be associated with parent's SOC for food portions and dietary fats, yet this was not observed for the fruits and vegetables or physical activity domains. Food availability and parent's childhood obesity knowledge was not found to be associated with parent's SOC. This study provides evidence that intervention efforts that stress knowledge of the causes and harmful effects of being overweight may have limited effectiveness.     

Factors associated with overweight in preschool-age children in southwestern France

BACKGROUND: Pediatric overweight and obesity are becoming an epidemic worldwide, which indicates the need for formulating preventive programs and policies during a child's early years. OBJECTIVE: We identified factors associated with overweight in young children in southwestern France. DESIGN: Children [n = 1780; x (+/-SD) age: 3.9 +/- 0.4 y] were recruited in kindergarten. Medical information on the parents, grandparents, and child as well as the child's 3-d dietary intake, participation in organized sports, and television-viewing habits were ascertained, and anthropometric measurements of the child were taken. RESULTS: The prevalence of overweight was 9.1% when using body mass index >or= 90th percentile of French reference curves as a cutoff. In a multivariate logistic regression, overweight at 4 y was associated with female sex, having an overweight mother, and having >or=1 diabetic grandparent; odds ratios (ORs; 95% CIs) for these variables were 1.9 (1.2, 3.0), 2.2 (1.0, 4.7), and 2.6 (1.6, 4.1), respectively. Being small or large for gestational age was not associated with the risk of overweight at 4 y, whereas this risk was increased for children who were overweight at 9 or 24 mo: ORs (95% CIs) were 4.0 (2.4, 6.9) and 11.7 (6.1, 22.2), respectively. Nutrient intakes did not differ significantly with weight status in girls; however, overweight boys had significantly greater energy and lipid intakes than did their nonoverweight counterparts. Overweight was positively associated with television viewing (>1 h/d) in both sexes and with participation in organized sports in girls only. CONCLUSIONS: A family history of overweight or diabetes, overweight in the first 2 y of life, and television viewing are associated with overweight at 4 y. These factors should be considered in developing programs for the prevention of overweight in early childhood.     

Weight characteristics and height in relation to risk of gestational diabetes mellitus

Increasing prevalence of overweight and obesity motivated this prospective examination of gestational diabetes mellitus in relation to self-reported adult height, weight, and weight fluctuation. Gestational diabetes was assessed by use of medical records in 1,644 women enrolled in Seattle and Tacoma, Washington, between 1996 and 2002. After adjustment, risk was inversely related to height and directly related to pregravid body mass index (p(trend) < 0.001). The relation with body mass index at age 18 years was J shaped, with higher risk among lean women (adjusted relative risk (RR) = 1.79, 95% confidence interval (CI): 1.01, 2.84) and obese women (RR = 4.53, 95% CI: 1.25, 16.43) versus normal-weight women. Weight gain between age 18 years and the study pregnancy was associated with increased risk independently of body mass index at 18 years and other confounders (>/=10-kg gain vs. <2.5-kg change: RR = 3.43, 95% CI: 1.60, 7.37). Weight cycling (loss and regain of >/=6.8 kg) was not associated after adjustment for body mass index at 18 years and adult weight change (>/=3 vs. zero cycles: RR = 1.23, 95% CI: 0.56, 2.73). Cycling was nonsignificantly related among women who gained 10 kg or more during adulthood (>/=3 vs. zero cycles: RR = 2.04, 95% CI: 0.83, 5.02). Efforts to prevent obesity and weight gain among young women may reduce gestational diabetes risk.     

Are Parental Perceptions of Child Activity Levels and Overall Health More Important than Perceptions of Weight?

Objectives To examine relationships between parental perceptions of child weight and overall health, reported lifestyle behaviors and measured body mass index (BMI). Methods Using community-partnered methods, we surveyed families residing in a two census tract area identified for targeted interventions to decrease diabetes related disparities. The survey included demographics, child dietary and physical activity behaviors, and parental perception of child’s health and weight. We measured child BMI using a standardized protocol. Results We surveyed parents of 116 children with a mean age of 7 years (range 3–15) with 51 % boys, 74 % Hispanic, and 26 % Black. Over half of the children (55 %) were overweight or obese. Half (50 %) of the parents underestimated their children’s weight. Reported daily hours of walking and/or running trended higher (3.6 vs. 2.6 h, p = 0.08) for children perceived to be of normal weight. Parents who correctly estimated their child’s weight status reported more hours of daily walking/running than parents who underestimated child weight status, 4.5 versus 2.4 h, p = 0.0002. Parents of healthy weight children were more likely to report that children were in excellent or very good health compared to parents of overweight/obese children, 75 versus 56 % respectively (p = 0.04). We found significant racial/ethnic differences in reported diet and physical activity behaviors and perception of overall health. Conclusions for Practice Parental perceptions of child health and physical activity level may be related to perceptions of their child’s weight status. Study findings informed community-based initiatives for reducing diabetes risk among children.     

Breastfeeding and obesity in school-age children from families of high socioeconomic status

OBJECTIVE: To examine the association between breastfeeding and obesity in school-age children from Brazilian families of high socioeconomic status. METHODS: A cross-sectional study was conducted including 555 students aged six to 14 years from a private school in the city of Sao Paulo. Obesity - the outcome variable - was defined as body mass index at or above the 85th centile plus sub scapular and triceps skin folds at or above the 90th centile using the sex and age specific standards of the US National Center for Health Statistics. Exposure was the frequency and duration of breastfeeding. Potential confounders, controlled for using multiple logistic regression, included child sex, age, birthweight, and dietary and physical activity patterns, and maternal age, body mass index, schooling, and practice of sports or physical exercise. RESULTS: Prevalence of obesity in the studied population was 26%. After confounder adjustment, the risk of obesity in children that had never been breastfed was twice that of other children (OR=2.06; 95% CI: 1.02; 4.16). There was no dose-response effect of duration of breastfeeding on prevalence of child obesity. CONCLUSIONS: Children who were never breastfed showed greater prevalence of obesity at school age. The absence of a dose-response effect in the relationship between duration of breastfeeding and prevalence of obesity and the still controversial findings regarding this association reported by other authors indicate a need for further studies on the subject, in particular studies with longitudinal design.