Prevalence of overweight and obesity in the Netherlands

This paper shows the trends in the prevalence of overweight (body mass index [BMI] >or= 25 kg m-2) and obesity (BMI >or= 30 kg m-2) in the Netherlands. Overweight (obesity) prevalence in adult males increased from 37% (4%) in 1981 to 51% (10%) in 2004, and in adult females from 30% (6%) in 1981 to 42% (12%) in 2004, according to self-reported data. In boys and girls, obesity prevalence doubled or even tripled from 1980 to 1997, and again from 1997 to 2002-2004 a two- or threefold increase was seen for almost all ages. According to the most recent data, overweight (obesity) prevalence figures range, depending on age, from 9.2% to 17.3% (2.5-4.3%) in boys, and from 14.6% to 24.6% (2.3-6.5%) in girls. There is a lack of data on the national prevalence of overweight and obesity based on measured height and weight and on prevalences in different subgroups of the population. Regular national representative health examination surveys that measure height and weight are needed to assess the prevalence of overweight and obesity and its distribution over subgroups in the population, and to properly direct and evaluate prevention activities.     

Temporal trends in overweight and obesity in Canada, 1981-1996

OBJECTIVE: To assess changes in the prevalence of overweight and obesity among Canadian children and adults between 1981 and 1996 using recent recommendations for the classification of overweight and obesity. DESIGN: Epidemiological study comparing the prevalence of overweight and obesity from the 1981 Canada Fitness Survey (CFS) to the 1996 National Longitudinal Survey of Children and Youth (NLSCY) and the 1996 National Population Health Survey (NPHS). SUBjECTS: Adults 20-64 y of age and children 7-13 y of age from the CFS, NLSCY and NPHS. MEASUREMENTS: BMI was calculated from directly measured or self-reported body mass and height. For adults 20-64 y of age, overweight and obesity were defined as BMI > or = 25 kg/m2 and BMI > or = 30 kg/m2, respectively. Age- and sex-specific cut-off points for children that correspond to the adulthood categories were used to define overweight and obesity for children 7-13 y of age. RESULTS: The prevalence of overweight increased from 48 to 57% among men and from 30 to 35% among women, while the prevalence of obesity increased from 9 to 14% in men and from 8 to 12% in women. The corresponding increases were from 11 to 33% in boys and from 13 to 27% in girls for overweight and from 2 to 10% in boys and from 2 to 9% in girls for obesity. CONCLUSION: The results indicate dramatic increases in the prevalence of both overweight and obesity in Canada over the last 15 y, and the problem is particularly pronounced among children.     

Prevalence of obesity in Canada

Excess weight represents a critical and common health problem in Canada. The last survey of a national representative sample based on measured anthropometrics has been conducted in 1992. According to surveys using measured data, the prevalence of obesity (body mass index, BMI = 30.0 kg m(-2)) between 1970 and 1992 for those aged 20-69 years increased from 8% to 13% in men and 13% to 15% in women. The proportion of Canadians displaying a BMI > or =25.0 kg m(-2) increased from 47% to 58% in men and from 34% to 41% in women in the same period. The most recent prevalence estimates from self-reported data in a national representative sample indicated that 15% of the adult population (> or =18 years) was affected by obesity, while an additional 33% was classified in the overweight category (BMI 25.0-29.9 kg m(-2)) in 2003. However, it has been suggested that self-reported height and weight underestimate the prevalence of obesity by approximately 10%. Canadian children, aboriginal populations, and immigrants are some of the vulnerable groups particularly at risk of excess weight or for which the increase in the recent decades has been greater than the national increase. The increases in overweight and obesity over the past 30 years among Canadians have been dramatic. It will be possible to precisely analyse the current situation and its evolution in the last 10 years when data based on measured height and weight will be released, that is, in 2005 and after.     

Defining overweight and obesity in pre‐school children: IOTF reference or WHO standard?

Two international datasets are used to define overweight and obesity in pre‐school children: the International Obesity Task Force (IOTF) reference and the WHO standard. This study compares the performance of the two datasets in defining overweight and obesity in 24–60 months old children. This was done by plotting the IOTF cut‐offs against WHO curves and by comparing the prevalence of overweight and obesity, as defined by the IOTF reference and by the WHO standard, using 2001 data from the Czech Republic. The IOTF cut‐off for overweight in 24–60 months old children goes from 1.7 to 1.1 z‐scores on the WHO chart, and for obesity it shifts with age from 2.7 to 2.2 z‐scores. As a consequence, at 5 years of age the prevalence of overweight in Czech girls is 3.4% using the WHO and 15.3% using the IOTF definition. These discrepancies are due to the choice of cut‐offs and to the different criteria used to select the sample for the IOTF reference and the WHO standard. Research is urgently needed to identify, for the WHO standard, BMI cut‐offs associated with an increased risk of overweight and obesity, and associated health outcomes later in life.     

A comparison of national estimates of obesity prevalence from the behavioral risk factor surveillance system and the National Health and Nutrition Examination Survey

BACKGROUND: Obesity interventions are implemented at state or sub-state level in the United States (US), where only self-reported weight and height data for adults are available from the Behavioral Risk Factor Surveillance System (BRFSS). The prevalence estimates of overweight and obesity generated from self-reported weight and height from BRFSS are known to underestimate the true prevalence. However, whether this underestimation is consistent across different demographic groups has not been fully investigated. METHODS: In this study, we compared the prevalence estimates of obesity (body mass index (BMI) > or =30 kg/m(2)) and overweight (BMI > or =25 kg/m(2)) in different demographic groups in the US from the National Health and Nutrition Examination Survey (NHANES) and BRFSS during 1999-2000. We also compared the rank orders of the obesity and overweight prevalence across different demographic groups from the two data sources. RESULTS: Compared to NHANES, BRFSS underestimated the overall prevalence of obesity and overweight by 9.5 and 5.7 percentage points, respectively. The underestimation differed across different demographic groups: the underestimation of obesity and overweight prevalence was higher among women (13.1 and 12.2 percentage points, respectively) than among men (5.8 and -0.6 percentage points, respectively). The variation of underestimation was higher among men. A clear inverse association between educational attainment and obesity prevalence among non-Hispanic African American women was observed from BRFSS data. However, no such association was found from NHANES. While BRFSS can identify correctly the population with the highest obesity and overweight burden, it did not accurately rank the obesity and overweight prevalence across different demographic groups. CONCLUSION: Compared to NHANES, BRFSS disproportionately underestimates the prevalence of obesity and overweight across different gender, race, age, and education subgroups.     

Overweight and obesity prevalence in children based on 6- or 12-month IOTF cut-points: does interval size matter?

The International Obesity Taskforce (IOTF) recommends using age- and gender-specific body mass index (BMI) cut-points for defining the prevalence of overweight and obesity in children. These are given in both 6- and 12-month age intervals. Since the BMI-for-age curves are nonlinear, a degree of bias will be introduced when age intervals are wide. We aimed to quantify this bias in prevalence estimates in 2178 Australian children aged 4-12 years using 12- versus 6-month age intervals. Using the 12-month interval, the prevalence of overweight and obesity was underestimated by 1.4% compared to the 6-month interval estimates; however, this was age-dependent. It overestimated prevalence for 4-year olds, but underestimated it for older ages by up to 2.6%. Overweight prevalence was generally affected more than obesity prevalence. The use of different age intervals for IOTF cut-points introduces a small but systematic bias in prevalence estimates of overweight and obesity.     

Increases in clinically severe obesity in the United States, 1986-2000

BACKGROUND: We know that Americans are increasingly becoming overweight, but we do not know whether this trend applies to clinically severe obesity (>100 lbs [45 kg] overweight), which is believed to have different causes than typical weight gain. Severe obesity is more serious for an individual's health and creates different challenges for the health care system. This study estimates trends for extreme weight categories between the years 1986 and 2000. METHODS: The data come from the Behavioral Risk Factor Surveillance System. The dependent variable is weight category according to the body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) based on self-reported weight and height. Regression models adjust for changes in population characteristics and state participation. RESULTS: Between 1986 and 2000, the prevalence of a BMI (self-reported) of 40 or greater (about 100 lbs [45 kg] overweight) quadrupled from about 1 in 200 adult Americans to 1 in 50; the prevalence of a BMI of 50 or greater increased by a factor of 5, from about 1 in 2000 to 1 in 400. In contrast, obesity based on a BMI of 30 or greater roughly doubled during the same period, from about 1 in 10 to 1 in 5. CONCLUSIONS: The prevalence of clinically severe obesity is increasing much faster than obesity. The widely published trends for overweight/obesity underestimate the consequences for physician practices, hospitals, and health plans because comorbidities and resulting service use are much higher among severely obese individuals. Accommodating severely obese patients will no longer be a rare event, and providers have to prepare to treat such patients on a regular basis.     

Time trend in height,weight, and obesity prevalence in school children from Northern France, 1992-2000

OBJECTIVE: The aim of this study was to evaluate the changes in height, weight and in the prevalence of overweight and obesity between 1992 and 2000 in children living in two towns of northern France. METHODS: Two cross-sectional studies were performed in every pre-school (last section) and primary schools of the two towns in 1992 (383 girls and 421 boys enrolled) and 2000 (296 girls and 305 boys). Children were 5 to 12 year old in both studies. MEASUREMENTS: Body height and weight were measured, and BMI was calculated (weight/height(2)). Prevalence of overweight and obesity was determined according to the gender- and age- specific cut-offs of the new international reference (IOTF). We also used the 90(th) and the 97(th) percentiles of the French reference gender- and age-specific BMI curves to define two grades of overweight. RESULTS: After adjustment for age, boys were on average 1.5 cm taller in 2000 than in 1992 (p<0.001), and the same trend was observed in girls (+ 0.9 cm, p<0.075). Height-adjusted or age-adjusted weight and BMI were significantly higher in 2000 than in 1992. In girls, obesity defined by IOTF criteria increased from 1.6 to 4.4% (p<0.03) and overweight from 14.1 to 18.6% (p<0.11). In boys, the change in prevalences was significant only when the less stringent criteria (i.e. the 90(th) percentile of French references) was used (13.8% in 1992 vs 20% in 2000, p=0.03). CONCLUSION: Over an 8 years period, there was an increase in height and BMI in both boys and girls. These results show that the increase in the prevalence of obesity is accompanied by a global trend of accelerated growth.     

High prevalence of overweight and obesity in 11-15-year-old children from Sicily

BACKGROUND AND AIM: To evaluate the prevalence of overweight and obesity in children and adolescents from Sicily, we carried out a cross-sectional study in a large cohort of 48,897 (24,119 males and 24,778 females) randomly selected 11-15-year-old Sicilian schoolchildren. METHODS AND RESULTS: Anthropometric data (weight and height) were obtained in all children. Urban vs. rural areas were taken into account. Centiles were obtained using the LMS method. Obesity and overweight prevalence were defined using as references both the values of the National Center for Disease Control (CDC 2000) in the United States and those of the International Obesity Task Force (IOTF). Median body mass index (BMI) values in Sicily were comparable to values observed in South and Center-North Italy. BMI cut-off values in Sicilian children were higher than reference values established in the U.S. CDC growth chart 2000. Using both the IOTF or the U.S. CDC 2000 cut-off values the prevalence of overweight and obesity in 11-15-year-old Sicilian children was very high: nearly 40% at age 11 and, although progressively decreasing with age increase, still over 25% at age 15. CONCLUSIONS: The prevalence of overweight and obesity in 11-15-year-old Sicilian schoolchildren is one of the highest ever reported. The prevalence is much higher at a younger age; thereafter it progressively decreases and values tend to reconcile with those observed in other geographical areas at age 14-15.     

Body mass index in 7-9-y-old French children: frequency of obesity, overweight and thinness

OBJECTIVE: To assess the frequency of different grades of nutritional status (obesity, overweight and thinness) in French children aged 7-9 y using four current definitions based on body mass index (BMI). METHODS: Data were collected in 2000 in a randomly selected sample of French children following the protocol recommended by the European Childhood Obesity Group (ECOG). After computing the BMI (weight/height squared), four references were used to define grades of nutritional status: (1) the French references to define thinness and overweight (3rd and 97th percentiles respectively); (2) the Must et al references to define thinness, overweight and obesity (5th, 85th and 95th percentiles respectively); (3) the International Obesity Task Force cut-offs to define overweight and obesity; and (4) the Center for Disease Control 2000 references to define thinness, overweight and obesity (5th, 85th and 95th percentiles respectively). RESULTS: Age and gender standardized frequencies were estimated in 1582 children. According to the French, Must et al, IOTF and CDC references, overweight (including obesity) affected 16.3, 23.9, 18.1 and 20.6% of children, respectively; obesity affected 9.3, 3.8 and 6.4% of children according to the Must, IOTF and CDC references, respectively. Thinness was present in 3.9, 6.0 and 6.0% of children according to the French, Must and CDC references. Whatever the definition, little difference was observed between sexes. Through age classes, as a rule, overweight and obesity tended to decrease while thinness tended to increase. CONCLUSION: The present study revealed an increasing prevalence of overweight in comparison with previous French data and a trend for increasing prevalence of thinness. The IOTF-based prevalence of overweight (including obesity) in 2000 in France was similar with the prevalence recorded in the late 1980s in the USA and the prevalence of obesity in 2000 in France was similar to the prevalence of obesity in the late 1970s in the USA. Data in France are comparable to those reported in other studies conducted in Western Europe. This study provides baseline information for analysis of time trends and for geographical comparisons.     

Prevalence of obesity in Sweden: cross-sectional study of a representative adult population

In order to facilitate research on body weight related diseases, and to plan suitable prevention and intervention programmes, data concerning the prevalence of overweight and obesity are required on a nationwide scale. In this study, data for weight and height from a representative sample (n = 14,549) of adult Swedes (16-84 years of age) were analysed. Data were obtained from the Study on Living Conditions conducted by Statistics Sweden, and body mass indices (BMI, kg m-2) were calculated from these interviews. They were then calibrated, since we had previously found that reported anthropometric measurements must be corrected so as to conform to recorded height and weight values, and we have developed equations accordingly. The overall mean BMI (+/- SE) was 24.02 +/- 0.99 kg m-2 for women and 24.56 +/- 0.88 kg m-2 for men. However, with regard to age, striking differences between the sexes were observed using this cross-sectional approach. Whereas in men there was a moderate increase in BMI with age, there was a sharp increase in women from 45-54 years onwards. If obesity is defined according to WHO recommendations (BMI for men greater than 30.0 kg m-2, and for women greater than 28.6 kg m-2), then 34.5% of all men in our sample were found to be overweight and 6.6% were found to be obese. The corresponding figures for women are 31.2% and 13.1%. Our data suggest that, on a nation-wide scale, overweight and obesity are common in men and women, but in women there is a marked increase from the menopause onward, for reasons that have yet to be clarified.     

Trends in overweight and obesity from 1985 to 2002 in Göteborg, West Sweden

OBJECTIVE: To study secular trends in overweight and selected correlates in men and women in G?teborg, Sweden. DESIGN: Cross-sequential population-based surveys. SUBJECTS: A total of 2931 female and 2691 male subjects aged 25-64 y participated in WHO MONICA surveys (1985, 1990, 1995) and the INTERGENE study (2002). MEASUREMENTS: Body mass index (BMI), waist-to-hip ratio (WHR), prevalence of overweight (BMI> or =25 kg/m(2)), and obesity (BMI> or =30 kg/m(2)). RESULTS: Mean body weight increased by 3.3 kg for women and 5 kg for men, with a significant upward trend for BMI in men but not women over the 17-y observation period. The prevalence of overweight and obesity increased significantly in both sexes over the period. The largest increase was observed in men, and in women aged 25-34 y. In 2002, the prevalence of overweight was 38% in women and 58% in men, and the prevalence of obesity was 11% in women and 15% in men. No significant secular trends were observed for WHR, but there was an upward trend in prevalence of WHR>0.85 in women. A decreased prevalence of smoking in both sexes was observed together with an increase in reported leisure time physical activity. No significant secular trends were observed in rates of self-reported diabetes, although the risk of diabetes attributable to obesity was 24%. CONCLUSION: The results indicate that 25-64-y-olds in the recent survey were more overweight and obese than earlier studied MONICA participants. The increase in BMI was more pronounced in men while abdominal obesity increased principally in women. Although obesity and overweight are clearly important risk factors for type 2 diabetes, the number of diabetics remains low and any secular increase is not yet apparent.     

The relationship between body mass index and waist circumference: implications for estimates of the population prevalence of overweight

OBJECTIVE: Body mass index (BMI) based on self-reported height and weight is a systematically biased, but acceptable measure of adiposity and is commonly used in population surveys. Recent studies indicate that abdominal obesity is more strongly associated with obesity-related health problems than is adiposity measured by BMI. The purpose of this study was to determine the relationships of both measured and self-reported BMI with measured waist circumference in a randomly selected sample of Australian adults. DESIGN: Cross-sectional survey with self-reported and laboratory-based measures of adiposity. SUBJECTS: 1140 randomly-selected Australian adults aged 18-78 y resident in the city of Adelaide, South Australia. MEASUREMENTS: Data on self-reported and measured height and weight as well as measured waist circumference were drawn from the Pilot Survey of the Fitness of Australians database. The proportion of men and women with acceptable BMI (BMI/=94 cm for men and >/=80 cm for women) was determined. Differences in the prevalence of overweight based on BMI alone or BMI and waist circumference were also determined. RESULTS: Compared with the prevalence based on self-reported BMI alone, the prevalence of overweight among men based on self-reported BMI and waist circumference combined was 2.4%, 5.3%, 19.1% and 7.5% greater for men aged 18-39 y, 40-59 y, 60-78 y and for all men, respectively. Among women, compared with the prevalence based on self-reported BMI alone, the prevalence of overweight based on the combined measures was 9.9%, 24.0%, 33.3% and 20.6% greater for women aged 18-39 y, 40-59 y, 60-78 y and for all women, respectively. CONCLUSIONS: If waist circumference is used as the criterion, then the prevalence of overweight among Australian adults, and probably other Caucasian populations, may be significantly greater than indicated by surveys relying on self-reported height and weight. The development of valid self-reported measures of waist circumference for use in population surveys may allow more accurate epidemiological monitoring of overweight and obesity.     

Secular trends in overweight and obesity among Finnish adolescents in 1977-1999

OBJECTIVE: To study the trends in overweight and obesity among Finnish adolescents in 1977-1999. DESIGN: Mailed surveys every other year. SUBJECTS: Nationally representative samples of 12, 14, 16 and 18-y-olds (n = 64,147, response rate 78.9%). METHODS: Overweight and obesity were measured by body mass index (BMI) and relative weight (RW) based on self-reported height and weight. BMI > or = the 85th percentile cut-off point for BMI in each age- and sex-specific group in the entire data set was considered as overweight, and BMI > or = 95th percentile cut-off point as obesity. RW > or = 110% and > or = 120%, calculated as the individual's weight divided by the mean weight in each age- and sex-specific height percentile group in the entire data set, were considered as overweight and obesity, respectively. The trends in overweight and obesity are described by the change in the 85th and 95th percentile cut-off points of BMI over time. The prevalence of overweight and obesity is also reported using BMI reference values recommended for international comparisons. Because of the similarity of the BMI and the RW criteria in classifying adolescents as overweight and obese, only results based on BMI are presented. RESULTS: Overweight and obesity increased linearly in all sex and age groups from 1977 to 1999. Depending on the age group, the average increase in the 85th percentile cut-off point of the BMI per 10 y was 0.6-1.1 kg/m2 in boys and 0.3-0.7 kg/m2 in girls. The 95th percentile cut-off point of the BMI for boys and girls increased by 1.1-1.6 kg/m2 and by 0.6-1.0 kg/m2 per 10 y, respectively. In boys, the increase in overweight and obesity was largest in the two youngest age groups. In girls, the increase in overweight was largest in the oldest age group, and that of obesity both in the 14 and 18-y-olds. Overweight and obesity increased more in boys than in girls in all age groups except in the 18-y-olds among whom the increase was similar in both sexes. Examination of the entire BMI distribution showed that there was little or no change over time at the lower (5th, 15th) and middle (50th) percentiles, but increasing differences at the upper end of the distribution, the increases in the 95th percentile being even more marked than those in the 85th percentile curves. According to international reference values, the age-standardized prevalence of overweight increased in boys from 7.2 to 16.7%, and in girls from 4.0 to 9.8%, between 1977 and 1999. The prevalence of obesity in boys was 1.1% in 1977 and 2.7% in 1999, and in girls 0.4 and 1.4%, respectively. CONCLUSION: Overweight and obesity increased remarkably among Finnish adolescents from 1977 to 1999. The changes concentrated at the upper end of the BMI distribution, suggesting that factors behind this development have influenced only a part of the adolescent population.     

Screening for body‐weight disorders in Nigerian children using contrasting definitions

Several indices for body‐weight disorders exist in scientific literature, but it is inconclusive whether or not they can yield comparable results when applied to Nigerian children. The prevalence of weight disorders in Nigerian children was examined using the Centre for Disease Control and Prevention (CDC) body mass index (BMI) for age charts and the International Obesity Task Force's (IOTF) age‐ and sex‐specific BMI cut‐off points. Participants were 2015 pupils (979 boys and 1036 girls) aged 9–12 years, attending 19 public primary schools in Makurdi, Nigeria. Stature and body mass were measured using standard techniques. Results were analysed using student t‐test and Chi‐squared statistics, with the probability level set at ≤0.05. CDC's BMI charts categorized 2.1%, 1.6% (boys) and 3.2%, 2.8% (girls) as overweight and obese respectively. Corresponding data for the IOTF's BMI charts were 1.7%, 0.9% (boys) and 2.6%, 2.0% (girls). CDC cut‐off points indicated higher prevalence of overweight and obesity, thus suggesting the need for a single definition for evaluating measurements of body mass‐for‐stature in the children. However, more disconcerting is the fact that CDC charts showed a high prevalence of underweight for the boys (87.1%) and girls (79.7%). Prevalent underweight conditions in our sample need urgent intervention. The IOTF method is limited in its utility to identify children who are underweight and may be at risk of growth faltering.     

First national epidemiological survey on the prevalence of obesity and abdominal fat distribution in Greek adults

AIM: To provide estimates of the prevalence of obesity, overweight and body fat distribution among the adult population of Greece. DESIGN: Epidemiological, cross-sectional nationwide survey providing self-reported data. Subjects: A total of 17,341 men and women aged from 20 to 70 years and classified into five 10-year age groups participated. The selection was conducted by stratified sampling through household family members of Greek children attending school. MEASUREMENTS: The participants reported data on weight, height, waist and hip circumference. BMI and waist-to-hip ratio were calculated. Abdominal obesity was defined as waist circumference > or = 102 cm in men and > or = 88 cm in women. RESULTS: In the total population, the mean BMI was 26.5 kg/m2, (27.3 in men, 25.7 in women). The overall prevalence of obesity was 22.5%, (26% in men, 18.2% in women) while that of overweight was 35.2% (41.1% in men, 29.9% in women). The percentages of obesity and overweight in men were similar in almost all age groups, while in women they progressively increased with age. Abdominal obesity was more frequent among women than men (35.8 vs. 26.6%, respectively), especially after the age of 50. CONCLUSIONS: Excess body weight is reaching epidemic proportions in Greece and obesity rates are among the highest, if not the highest, in Western society. The problem affects particularly men, and women after menopause. Interestingly, more women than men present with abdominal obesity. Preventive and treatment strategies are urgently needed to stop the obesity epidemic in this Mediterranean European country.     

Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982-1997

OBJECTIVE: To examine the prevalence of overweight and obesity in the entire population of 5- and 6-y-old children entering school in Germany, Bavaria, and to assess time trends over the last 15 y and the impact of ethnicity. DESIGN: Cross-sectional studies were based on the obligatory school entry health examinations: all health districts of Bavaria in 1997 (n=127 735); three health districts every 5 y from 1982 to 1997 (n=16 281). MEASUREMENTS: Body mass index (BMI; kg/m(2)) was calculated and the prevalence of overweight and obesity was defined based on national and international agreed cut-off points. Ethnicity was measured as German and non-German nationality. RESULTS: The prevalence of overweight and obese children as defined by international reference values was 9.4 and 3.1% for 5-y-old boys, 10.0 and 2.9% for 6-y-old boys, 12.2 and 3.3% for 5-y-old girls and 12.4 and 3.3% for 6-y-old girls. The whole BMI distribution in non-German children compared to German children was shifted to the right with median values in non-German children 0.3-0.5 kg/m(2) higher. In these the prevalence of overweight/obesity was 1.9/2.4 times higher for boys and 1.5/1.9 times higher for girls. The time trend between 1982 and 1997 shows an increase of the BMI distribution in the upper percentiles, whereas the lower percentiles did not change substantially. The increased prevalences of overweight/obesity for both sexes as defined by international references increased from 8.5/1.8% in 1982 to 12.3/2.8% in 1997. CONCLUSION: This large study on all children entering school in Bavaria in 1997 shows patterns of overweight and obesity which are comparable with other European data but are lower than US and Australian data. Increasing prevalences since 1982 indicate that overweight and obesity in children are of increasing public health importance in Bavaria. The upwards shift of the BMI distribution in non-German children needs further investigation.     

Weighing in on international growth standards: testing the case in Australian preschool children

Overweight and obesity in preschool‐aged children are major health concerns. Accurate and reliable estimates of prevalence are necessary to direct public health and clinical interventions. There are currently three international growth standards used to determine prevalence of overweight and obesity, each using different methodologies: Center for Disease Control (CDC), World Health Organization (WHO) and International Obesity Task Force (IOTF). Adoption and use of each method were examined through a systematic review of Australian population studies (2006–2017). For this period, systematically identified population studies (N = 20) reported prevalence of overweight and obesity ranging between 15 and 38% with most (n = 16) applying the IOTF standards. To demonstrate the differences in prevalence estimates yielded by the IOTF in comparison to the WHO and CDC standards, methods were applied to a sample of N = 1,926 Australian children, aged 3–5 years. As expected, the three standards yielded significantly different estimates when applied to this single population. Prevalence of overweight/obesity was WHO – 9.3%, IOTF – 21.7% and CDC – 33.1%. Judicious selection of growth standards, taking account of their underpinning methodologies and provisions of access to study data sets to allow prevalence comparisons, is recommended.     

Body mass, fat distribution and blood pressure in Southern Italian children: results of the ARCA project

OBJECTIVE: To investigate the association between the degree of adiposity, assessed using the international reference values for body mass index (BMI) of the International Obesity Task Force (IOTF), the fat distribution pattern and the blood pressure (BP) profile in children. METHODS: Anthropometric indices and blood pressure were measured in 3923 children aged 6-11 years in southern Italy. RESULTS: The prevalence of overweight and obesity (by IOTF references) and pediatric hypertension was, respectively: 27, 21 and 10% for boys; 25, 21 and 14% for girls. Body mass index and waist z-scores were the strongest determinants of BP by regression analysis. Overweight and obesity were associated with a greater tendency for central fat deposition and higher BP (waist, cm; boys: 59.2+/-6.0, 69.5+/-7.9, 79.0+/-9.7; girls: 58.8+/-6.5, 68.2+/-7.4, 75.3+/-8.9; SBP/DBP, mmHg; boys: 94/60+/-12/9, 99/62+/-13/8, 103/64+/-15/10; girls: 93/59+/-12/9, 99/62+/-14/9, 101/63+/-14/9; normal weight, overweight and obese, respectively; P<0.0001; M+/-SD), and a higher risk of hypertension (overweight: RR=2.33; 95% CI 1.76-3.08; obesity: RR=3.69; 95% CI 2.78-4.90), independent of age, physical activity, birth weight, parental adiposity and education. Among normal weight children, 99% had waist <85th percentile and 93% were normotensive. CONCLUSIONS: Overweight and obese children, identified according to the IOTF growth charts, are characterized by a central fat distribution pattern and higher BP.     

Obesity: a new disaster for haemophilic patients? A nationwide survey

Summary. The prevalence of obesity, an important risk factor for both cardiovascular disease and arthropathy, is strongly increasing in the general population, but data for the haemophilia population are scarce. Obesity may have a more profound effect on arthropathy and on cardiovascular disease in patients with haemophilia. To assess the prevalence of obesity in haemophilia patients and install adequate measures, if necessary. We performed a nationwide postal survey to measure the prevalence of overweight and obesity in Dutch haemophilia patients in 1992 (n = 980) and 2001 (n = 1066). A random sample of the Dutch male population served as the control group. In adult haemophiliacs, the prevalence of overweight (BMI 25–30 kg m^?2) increased from 27% to 35% (95% CI 31.1–38.0) and the prevalence of obesity (BMI ≥30 kg m^?2) doubled from 4% to 8% (95% CI 6.0–10.1), which was comparable with the general population. The increased prevalence of obesity in boys with haemophiliacs, which tripled in 10 years, is alarming. The increased prevalence of overweight and obesity in patients with haemophilia may have a profound effect on morbidity and quality of life of haemophilia patients by aggravating pre‐existing arthropathy and predisposing aged patients to cardiovascular disease. Measures to prevent overweight in haemophiliacs are therefore urgently needed.