Overweight, obesity, weight-related concerns and behaviours in Hong Kong Chinese children and adolescents

Aim: To study the prevalence of overweight and obesity, and weight-related concerns and behaviours among overweight, obese and non-overweight children and adolescents. Methods: We carried out a cross-sectional survey of all Chinese students in primary schools in the Central and Western District of Hong Kong in March 2002. Thirty-one of 32 schools participated, and 5402 boys and 5371 girls aged 8 to 15 y who completed a standardized questionnaire were included. We used the International Obesity Task Force definition (IOTF reference) to define overweight and obesity. Results: The prevalence (95% CI) of overweight was 16.4% (15.7-17.1%) (19.9% in boys, 12.9% in girls), and that of obesity was 7.7% (7.2-8.2%) (10.3% in boys and 5.1% in girls). The combined prevalence of overweight and obesity was similar to that based on the local reference. Overweight children had more concerns about their weight than obese children. They were more likely than obese children to feel fat, wish to be lighter, diet and exercise to lose weight. Although obese children were heavier, they did not make more effort to lose weight than overweight children.

Conclusions: The differences in weight-related concerns and behaviours among overweight, obese and non-overweight children suggested good validity of the IOTF reference and the self-reported data. The differences between overweight and obese children suggested that the two groups had different psychological states and that they needed different weight management programmes and other intervention strategies.     

Overweight and obesity prevalence in children and adolescents from a private school in Recife

OBJECTIVES: To determine the prevalence of overweight and obesity in students from a private school in Recife; compare the prevalence rates of overweight and obesity in boys and girls and in different age groups (children and adolescents) and verify the correlation between body mass index and triceps skinfold thickness in this population. METHODS: Cross-sectional study with 762 students (332 children and 430 adolescents) from a middle/upper class school in Recife, in 1999. Overweight was defined as body mass index equal or above the 85th percentile for age and gender. Obesity was defined as body mass index and triceps skinfold thickness equal or above the 85th percentile. RESULTS: The prevalence rates were 26.2% (95%CI = 23 to 29%) for overweight, and 8.5% (CI95% = 6.5 to 10.5%) for obesity. Overweight was more prevalent among children (34.3%) than among adolescents (20.0%) (P<0.001). Obesity was more frequent among children (14.2%) than among adolescents (4.2%) (P<0.001). The prevalence of overweight in boys (34.6%) was higher than in girls (20.6%) (P<0.001). The prevalence of obesity was also higher in boys (14.7%) than in girls (4.4%) (P<0.001). The correlation coefficient between body mass index and triceps skinfold thickness was equal to 0.64 (95%CI = 0.60 to 0.68). CONCLUSIONS: The prevalence of overweight in our study population was as high as that found in industrialized countries; obesity, however, was less frequent.     

Reference body mass index curves for Turkish children 6 to 18 years of age

AIM: To determine reference body mass index (BMI) curves for Turkish children 6 to 18 years old and to compare with BMI in other countries. METHODS: A cross-sectional study conducted in Kayseri, Turkey. A total of 5,727 children (2,942 girls, 2,785 boys) aged between 6 and 18 years were selected to construct a reference curve using LMS method. RESULTS: BMI age reference charts of Turkish children were constructed. The 50th percentile curve of Turkish girls is lower than Italian and Turkish girls in The Netherlands but higher than Iranian girls. The 50th percentile curve of Turkish boys is lower than Italian and Turkish boys in The Netherlands and similar to Iranian boys after 13 years of age. CONCLUSION: BMI references of Turkish children are lower than in South East Europe, UK and North American populations, but higher than in Central European and Scandinavian countries.     

Upper segment/lower segment ratio and armspan-height difference in healthy Turkish children

Aim: The determination of body proportions is an important part of the clinical evaluation of children with short stature. The upper segment/lower segment ratio (US/LS ratio) and armspan-height difference is commonly used for this purpose. However, reference data are scarce in this respect, and available standards do not include standard deviations for the measurements. We aimed to establish the normal values for upper segment/lower segment ratio and armspan-height difference in Turkish children. Methods: In the present study, height, upper and lower segment, and armspan were measured in 1302 healthy children (3-18 y). The age-related mean and standard deviation curves of the US/LS ratio and armspan-height difference were constructed for each sex. Results: The mean values of the US/LS ratio in boys were decreased from 1.108 at 3 y to 0.984 at 10 y. The nadir of the US/LS ratio (0.922) was reached at age 15 y. In girls, the mean value of the US/LS ratio gradually decreased to less than 1 at 9 y of age (1 y earlier than in boys). The nadir of the US/LS ratio (0.946) was reached at age 13 y in girls (2 y earlier than in boys). Armspan was shorter than height as expected in younger ages, but became slightly longer at around age 12 in girls and boys. Unlike boys, the armspan-height difference did not change much after puberty in girls.

Conclusion: US/LS ratio and armspan-height difference are practical parameters and easy to perform in any setting. We hope that these standards will aid clinicians in the evaluation of children with short stature.     

Body fat reference curves for healthy Turkish children and adolescents

Childhood obesity is a major worldwide health problem. In addition to body mass index (BMI), body fat percentiles may be used to predict future cardiovascular and metabolic health risks. The aim of this study is to define new age- and gender-specific body fat centiles for Turkish children and adolescents. A total of 4,076 (2,276 girls, 1,800 boys) children and adolescents aged 6–18 years were recruited for this study. Total body fat was measured by a bioelectrical impedance noninvasive method. Body fat percentiles were produced by the LMS method. The body fat percentile curves of boys appear to rise from age 6 to 12 years and then slope downwards to age 15 years and then flatten off. The body fat % percentiles of girls increased until 14 years of age through 75th to 97th percentiles and then slope downwards, but through the third to 50th percentiles, they showed a downward slope after 14 years old. Conclusions: Since BMI may not always reflect body fat content, direct assessment of adiposity by a practical method would be significantly useful for clinical decisions. Therefore, this study provides normative data for body fat percentage in healthy Turkish children and adolescents. To this goal we used a practical and clinically applicable method. These references can be useful for evaluation of overweight and obesity.     

Increasing prevalence of overweight in young schoolchildren in Umeå, Sweden,from 1986 to 2001

Aim: To investigate the current prevalence and trend of overweight in young schoolchildren in Umeå, Sweden. Methods: Two cross‐sectional samples of children were studied: 1115 randomly selected children from preschool class to grade 6 (aged 6–13 y) attending school in 2001 and a matched sample of 507 schoolchildren from grades 0, 1 and 4 (aged 6–11 y) attending school in 1986. Overweight was defined according to age‐ and gender‐specific body mass index (BMI) cutoff values, corresponding to BMI values of 25 kg/m² (level 1) and 30 kg/m² (level 2) at late adolescence. Results: In the population from 2001, the prevalence of overweight was 23% (18% at level 1, 5% at level 2). The prevalence differed with age, with a higher prevalence at the ages of 6 and 13 y. Comparing children from grades 0, 1 and 4, attending school in 1986 and 2001, respectively, the total prevalence of overweight was twice as high in 2001 as in 1986. Regarding severe overweight (level 2), the difference was even larger (five times). In the 1986 sample, the prevalence of overweight did not differ between girls and boys, while significantly more girls than boys were overweight in 2001. Conclusion: In this sample of young children from Sweden, the prevalence of overweight doubled over the past 15 y and severe overweight increased even more, suggesting a need for intensified preventive efforts in young schoolchildren.     

Birthweight, breast-feeding, parental weight and prevalence of obesity in schoolchildren aged 10–12 years, in Greece; the Physical Activity, Nutrition and Allergies in Children Examined in Athens (PANACEA) study

Background: The purpose of the present study was to determine the prevalence of overweight and obesity in a sample of Greek children aged 10–12 years, and to evaluate these rates in relation to parental weight and birthweight.
Methods: During the 2005–2006 school period, 700 schoolchildren (323 boys, 377 girls) were randomly recruited from 18 schools, in Athens. Height and weight were measured and body mass index (BMI) was calculated. Cut-off points for BMI defining obesity and overweight for gender and age were calculated in accordance with international standards.
Results: Overall, 8.6% of boys and 9.0% of girls were obese, and 33.9% of boys and 22.1% of girls were overweight. Having an obese parent increased the odds of having an overweight or obese child (P < 0.01). Compared to non-breast-fed, boys who were breast-fed for >3 months had 70% lower likelihood of being overweight or obese (P < 0.01) and breast-fed girls had 80% lower odds (P < 0.01). Excessive birthweight (>3500 g) increased by 2.5-fold the likelihood of being overweight or obese only in girls (P < 0.05).
Conclusions: Parental weight, lack of breast-feeding and excess birthweight (in girls) were significant predictors of overweight or obesity in Greek children aged 10–12 years.     

Growth references for Turkish children aged 6 to 18 years

Aim: To create up-to-date reference standards for Turkish children, and to compare these with growth standards for US children (CDC 2000 Growth Charts) and with previous local data. Subjects and methods: Height and weight measurements of 1100 boys and 1020 girls were obtained by biannual visits to six schools located in relatively well-off districts of Istanbul city. All children came from well-to-do families and all were healthy. All measurements were made by two trained technicians. The LMS method was used in the analyses. Results: Heights of the boys and girls in all age groups were close to the updated 2000 USA growth references and showed an increase from data on Turkish children born 30 y earlier. Weight values were high compared to reference data on US children and to the older data on Turkish children.

Conclusion: These results indicate that height growth in Turkish school-age children of high socio-economic level conforms to the updated growth data on US children. The data also show a secular upward trend in Turkey. Weight-for-age values indicate an increase in obesity. The results also point to the value of collecting and evaluating local growth data periodically.     

中国0～18岁儿童、青少年体块指数的生长曲线

目的 研究制定0～18岁中国儿童的体块指数(BMI)生长参照值及生长曲线.方法 根据"2005年中国九市7岁以下儿童体格发育调查"及"2005年中国学生体质与健康调研"所获得的资料,采用九省市93 702名0～19岁(差1天未满19岁)城区健康儿童青少年的身高(3岁以下测量身长)、体重测量数据,计算BMI值并应用LMS方法对数据进行拟合修匀,通过L、M、S三个参数计算产生所需要的百分位和标准差单位(Z分值)数值并绘制相应的曲线图.采用与中国成人BMI界值点接轨的方法探讨中国儿童超重肥胖的筛查界值点.结果 制定出0～18岁儿童的BMI百分位数及标准差单位生长参照值及曲线图,并计算出了筛查2～18岁儿童超重肥胖的参考界值点.本参照曲线与世界卫生组织(WHO)BMI曲线及美国疾病预防控制中心2000年(CDC2000)曲线进行比较,三者之间存在明显的差异,尤其是在青春期、第97百分位(P97)上.总体上中国男童BMI在p97处于三者之间,而女童最低.与日本比较,在P97也有明显差异.结论 使用BMI生长曲线图有利于儿童青少年的生长与营养监测,早期识别童的超重和肥胖,建议在临床工作及预防保健服务领域推广使用.     

Prevalence of overweight and obesity in children and adolescents in a county in Sweden

Overweight among young people in Sweden is increasing. The aim of the present study was to investigate the frequency of overweight and obesity based on body mass index (BMI) values among children and adolescents. Overweight was defined as a BMI value > or = 91st percentile and obesity as a BMI value > 98th percentile on an international reference BMI curve. The study population included boys and girls from four age groups: 9, 12, 15 and 18 y. The data consisted of self-reported measures of height and weight that were obtained from questionnaires used in a cross-sectional study in December 1997. A validation study was performed using a part of the study population. A total of 7011 (81.7%) participants completed the questionnaire. The correlation between self-reported estimations and objective measures of height and weight was high in the oldest age groups (0.88-0.98), but lower in the 9-y-old age groups (0.37-0.72). These self-reported estimations in the 9-y-olds were excluded from further analysis. It was found that 12.3%, 11.6% and 11.4% of the boys in the 12-, 15- and 18-y-old age groups and 6.8%, 5.5% and 4.8% of the girls in the same age groups were overweight and 7.9%, 8.9% and 7.3% of the boys and 5.1%, 4.2% and 3.9% of the girls were obese. Conclusion: The prevalence of overweight and obesity was found to be high in the study population and is a serious public health problem. The prevalence of obesity was significantly higher (p < 0.05) in 15-y-old boys living in rural areas than in city and town dwellers of the same age.     

A study of growth parameters and prevalence of overweight and obesity in school children from delhi

OBJECTIVE: (1) To assess the height, weight and body mass index (BMI) of school children from Delhi and generate percentile charts as appropriate for age, gender and socio-economic status. (2) To determine the prevalence of overweight and obesity in school children from low and upper socioeconomic status (LSES and USES respectively). DESIGN: Cross sectional evaluation of anthropometric parameters in Delhi school children (5-18 years) from different geographical zones. SETTING: Government schools (non-fee paying) and Private Schools (fee paying) in Delhi. SUBJECTS: 21485 children, 8840 (3566 boys, 5274 girls) from government schools and 12645 (6197 boys, 6448 girls) from private schools. Methods: Subjects underwent assessment of height and weight and calculation of BMI. Children were classified as normal, overweight and obese as per IOTF guidelines. Height, weight and BMI percentile charts specific for the socioeconomic status were generated using the LMS method. Prevalence of overweight and obesity was assessed and compared between the two socio-economic groups. RESULTS: A significant difference was noted in height, weight and BMI between LSES and USES. The prevalence of overweight and obesity in USES children was 16.75 % and 5.59 % in boys and 19.01 % and 5.03 % in girls respectively. CONCLUSIONS: There is a significant disparity in anthropometric parameters between children from USES and LSES, with a high prevalence of overweight and obesity in USES children.     

Prevalence of overweight and obesity in 5- and 12-year-old Finnish children in 1986 and 2006

Objective: To investigate the prevalence and the trends of overweight and obesity in Finnish 5- and 12-year-old children in 1986 and 2006.
Design: Retrospective cross-sectional study.
Subjects and methods: Anthropometric data were collected retrospectively from health examinations in Tampere and in three rural municipalities. The size of the 5- and 12-year-old cohorts were 2108 in 1986 and 4013 in 2006, respectively. The body mass index (BMI) was calculated. Overweight and obesity was estimated using the International Obesity Task Force cutoff values (ISO BMI).
Results: The prevalence of overweight (ISO BMI >25) and obesity (ISO BMI >30) in 5-year-old boys in 2006 was 9.8% and 2.5% and in girls 17.7% and 2.5%, respectively. At the age of 12 years, the corresponding figures in boys were 23.6% and 4.7% and in girls 19.1% and 3.2%. Between 1986 and 2006, the prevalence of overweight in 12-year-old children had increased 1.8 fold in boys (p < 0.001) and 1.5 fold in girls (p = 0.008). Overweight was significantly more common in rural than in urban areas.
Conclusion: During the last 20 years the prevalence of overweight has markedly increased in 12-year-old Finnish children, but remained nearly unchanged in 5-year-old 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.     

High prevalence of overweight and obesity among 6-year-old children in Finnmark County, North Norway

Aim: The aim was to determine the prevalence of overweight and obesity among 6‐year‐old children in Finnmark, the northernmost county of Norway. Methods: This is a survey of 1774 children born during 1999 and 2000 from 18 of 19 child healthcare centres in Finnmark. Body mass index data extracted retrospectively in 2007 from health records at the age of 6 years were compared with international definitions of over‐ and underweight. The prevalence figures were further compared with socio‐demographic figures on municipality level. Results: Overall, 19% of the children were classified as overweight or obese; 5% were classified as obese. The prevalence of overweight and obesity was higher among girls (22%) than among boys (16%) (p < 0.01). The prevalence of underweight was 8% among both girls and boys. Despite large variations in the prevalence of overweight and obesity between municipalities (9–35%), no association was found with municipality figures on socio‐demographic factors. Conclusion: In the northernmost county Finnmark, the prevalence of overweight including obesity among 6‐year‐old children was somewhat higher than in previous surveys from Norway, especially among girls.     

Recent anthropometric trends among Swedish school children: evidence for decreasing prevalence of overweight in girls

Aim: To assess the recent prevalence of overweight and obesity in 10 year old children in Göteborg, Sweden. Methods: Cross‐sectional data on weight and height from school health examinations, including fourth grade children, born in 1974 (n = 4126), 1990 (n = 4683) and 1994 (n = 4193) and measured in academic years 1984/1985, 2000/2001 and 2004/2005, were used. Weight classification was based on age‐ and sex‐specific body mass index cutoff values. The two latest cohorts were classified according to socio‐economic areas. Results: Between 2000/2001 and 2004/2005, the prevalence of overweight plus obesity in girls decreased from 19.6% to 15.9% (p < 0.01). Prevalence of obesity was 3.0% and 2.5% (nonsignificant), respectively. In boys, all differences between the corresponding cohorts were nonsignificant: 17.1% versus 17.6% were overweight (including obese) and 2.9% versus 2.8% were obese. In 1984/1985, prevalence of overweight plus obesity was only 8.6% among girls and 7.2% among boys, while 0.8% and 0.7% were classified as obese, respectively. The socio‐economic gradient in overweight prevalence remained, particularly in girls. Conclusions: This study suggests that the obesity epidemic in 10–11 year olds may be easing off in urban Sweden, and possibly reversing among girls. Even if future monitoring confirms these findings, much health promoting work still remains since the power of the ‘obesogenic environment’ will probably continue to be strong.     

Overweight and obesity in Norwegian children: secular trends in weight-for-height and skinfolds

AIM: The prevalence of overweight and obesity in paediatric populations has been rapidly increasing in many countries over the past decades. The aims of the present study were to provide new data on weight-for-height and skinfolds, and to compare these to growth references for children between 3 and 17 years, collected in the same city between 1971 and 1974. MATERIAL: The present study is based on cross-sectional data of 4115 children (2086 boys and 2029 girls) aged 4-15 years measured in 2003-6. RESULTS: Overall, 18.0% of the boys and 20.1% of the girls were above the 90th weight-for-height percentile of the 1971-1974 references, 8.0% and 7.2% were above the 97.5th percentile, indicating an upward shift in weight-for-height. An even more prominent increase was observed for skinfold thicknesses; for triceps skinfolds about 30% of the boys and 28% of the girls were above the 90th percentile of the 1971-1974 references, and corresponding values for subscapular skinfolds were 26.5% and 25.9%. Using international cut-off values for body mass index, the overall prevalence of overweight and obesity was 12.5% and 2.1% in boys, and 14.8% and 2.9% in girls. CONCLUSIONS: Our study has demonstrated a significant increase in weight-for-height in Norwegian children over the last 30 years, and that these changes are caused by an increase in fat tissue, as shown by skinfold measurements. The current prevalence of overweight and obesity is comparable to recent estimates from most Western and Northern European countries.     

基于不同体块指数筛查标准的2011年北京市儿童青少年超重和肥胖检出率比较研究

目的 描述2011年北京市7~18岁儿童青少年超重和肥胖的检出率,并比较基于不同BMI筛查标准的检出率的差异。方法 研究对象为2011年北京市中小学体检的7~18岁学龄儿童青少年。采用BMI作为评价超重和肥胖的指标。超重和肥胖筛查分别采用4种不同的国内（CN2010和WGOC）和国际（IOTF和WHO2007）标准。不同BMI筛查标准之间超重、肥胖检出率比较采用McNemar检验。结果 ①92 212名男女生BMI在P50、P85和P95上均显著高于全国水平(2009年“中国0~18岁儿童青少年体块指数的生长曲线”),男女生在对应百分位曲线上无交叉现象,男生BMI水平高于女生。②基于CN2010和WGOC标准,男生肥胖检出率分别为17.8%和18.2%,女生检出率分别为10.8%和10.9%;基于IOTF和WHO2007标准,男生肥胖检出率分别为12.9%和21.0%,女生检出率分别为6.0%和8.6%。③基于CN2010和WGOC标准,男生超重（含肥胖）检出率两标准间差异无统计学意义,均为36.0%,各年龄组差异亦不明显,但女生检出率CN2010标准高于WGOC标准（28.1％ vs 24.1%）,在7~15岁组差异较为明显,但在16~18岁组差异较小;与国际标准相比,基于国内标准的男生超重（含肥胖）检出率略高于IOTF标准,但却明显低于WHO2007标准,女生检出率超重（含肥胖）明显高于IOTF标准,但与WHO2007标准较为接近。④与基于WGOC标准的2004年北京市7~18岁儿童青少年超重和肥胖检出率相比,2011年超重和肥胖检出率显著增长,男女肥胖检出率分别增长5.8%和3.8%,超重（含肥胖）检出率分别增长9.3%和7.6%。结论 2011年北京市7~18岁学生中有1/3处于超重或肥胖状态。国内标准与国际标准存在明显差异,在反映中国儿童的超重肥胖流行状况时建议采用国内标准,而理想的国内标准应实现2～18岁的统一,并与成人接轨。     

北京市儿童青少年青春期发育与肥胖相关关系的研究

目的 分析北京市6~18岁儿童青少年青春期发育与超重肥胖的关系。方法 利用2004年北京市儿童青少年代谢综合征调查总样本中19 085名6~18岁儿童青少年的青春期发育、体重指数（BMI）和体脂含量百分比（FMP）等数据。采用女性乳房和男性睾丸容积Tanner分期指标衡量青春期发育，结合个体年龄将群体分为早、晚发育组；以BMI和生物电阻抗法所测FMP作为反映体脂含量的指标；7~18岁人群超重和肥胖的诊断采用中国肥胖问题工作组（WGOC）推荐的中国学龄儿童青少年超重、肥胖筛查BMI值分类标准进行，6岁组采用美国疾病预防与控制中心 2000年发布的儿童超重和肥胖BMI标准第P85和第P95分位值进行诊断；采用多元线形回归、Logistic回归分析早发育与体脂含量和超重、肥胖的相关联系。结果 早发育组的超重（合并肥胖）率和肥胖率均高于晚发育组，女性两组间差异大于男性；控制可能的混杂因素后，女性BMI和FMP与早发育呈正相关（BMI：β=2.25，P<0.001；FMP：β=4.55，P<0.001）；而男性BMI和FMP与早发育的联系相反，早发育组的BMI高于晚发育组，而FMP却低于晚发育组；以晚发育为参照组，控制年龄、城郊居住地等因素的影响后，早发育预测超重、肥胖的OR值（95%CI）：女性为3.39（2.94~3.92）和3.12（2.53~3.85），男性为1.12（0.96~1.31）和1.31（1.06~1.62）。结论 北京市儿童青少年青春期发育与肥胖密切相关，在评价超重、肥胖率及进行不同地区间肥胖流行状况的比较时，要注意青春期发育的效应修正作用。     

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.