Application of anthropometric indices in childhood obesity

OBJECTIVES: The purpose of this study was to determine which anthropometric index can best predict childhood obesity and to investigate the interrelationship between these anthropometric indices and metabolic abnormalities. METHODS: This was a cross-sectional study. In March 2000, 2005 children aged 7 to 8 from the first grade of primary schools in Taichung City in Taiwan were enrolled in this study. Data were obtained on the children's anthropometry, blood pressure, and serum lipid profiles. Body mass index (cutoff points by international age- and sex-specific body mass index [BMI]) and weight-length index (WLI) were measured. The t test, the chi2 test, and stepwise multivariate logistic regression were used. All subjects were divided into four groups: Group 1, nonobese by BMI definition, WLI < 1.2; group 2, obese by BMI definition, WLI < 1.2; group 3, nonobese by BMI definition, WLI > or = 1.2; and group 4, obese by BMI definition, WLI > or = 1.2. RESULTS: There were 951 girls (47.43%) and 1,054 boys (52.57%). The mean age was 7.3 +/- 0.4 years. The prevalence of obesity was 4.21% in girls and 7.87% in boys using BMI definition, and 12.83% in girls and 14.14% in boys using WLI definition. The prevalence of obesity revealed an increased trend with age in both sexes, whether by BMI or WLI definition. Group 4 had the highest prevalence rate of all metabolic abnormalities, except hypertriglyceridemia. After controlling for age and sex, and with group 1 as a reference, odds ratios were considerably higher in group 3 for the risk of hypertension (2.73; 95% confidence interval [CI], 1.67-4.44) and hypertriglyceridemia (5.83; 95% CI, 1.42-23.95). Odds ratios were considerably higher in group 4 for the risk of hypertension (3.75; 95% CI, 2.31-6.07) and high level of low-density lipoprotein cholesterol (1.93; 95% CI, 1.32-2.82). CONCLUSIONS: The prevalence of obesity apparently differs depending on the definition of estimation. Childhood obesity exhibits significant correlation with some metabolic abnormalities. We hypothesize that, at present, both indices, BMI and WLI, should be used together to define childhood obesity in clinical practice until a more appropriate and excellent index can be established.     

家庭-学校-社区志愿合作对肥胖儿童健康教育模式的研究

目的 探讨肥胖儿童生活环境控制,为及早控制肥胖儿童的体重提供科学依据.方法 以家庭干预为主,配合学校和社区的指导和健康教育,以控制饮食、增加运动、心理健康指导为主要干预内容.结果 干预后,肥胖儿童及家长健康知识、态度和行为有明显提高(P＜0.05);肥胖儿童BMI、血压和体重明显降低(P＜0.01),肥胖组儿童每天吃杂粮、薯类、豆类、蔬菜、水果的人数增多(P＜0.01),吃甜食、油炸食物和进餐速度快的人数明显下降(P＜0.01);肥胖儿童组平均体重平均减少了6.7Kg.结论 通过“家庭-学校-社区”的综合干预,让肥胖儿童意到肥胖问题的严重性,从而达到自觉控制体重过度增加的目的,促进儿童的正常发育.     

我国11城市3～6岁儿童单纯肥胖症危险因素分析

目的 探索我国城市3 ～6 岁儿童生活方式和饮食习惯与肥胖的关系,为制订儿童肥胖干预策略提供依据.方法 采用分层整群抽样,分别从成都、济南、深圳、沈阳、上海、重庆、郑州、西安、长沙、青岛和海口11 个城市中随机抽取3 个城区,每个城区随机抽取幼儿园6 所,所有在园儿童进行体格测量,以WHO 的身高标准体重加2 个标准差作为肥胖判断标准.将调查中确诊的单纯肥胖症儿童与同性别、同年龄、同班级的正常体重儿童进行1∶2配对后,对所有肥胖儿童和配对的正常体重儿童进行家长自填问卷调查,回收的完整调查问卷中2218 份肥胖问卷和5380 份正常体重问卷,分别作为本研究的肥胖组和对照组.结果 单因素和多因素Logistic 回归分析结果显示,高出生体重(OR ＝1.48)、母亲受教育程度低(OR ＝1.20)、父母超重(OR ＝1.55、OR ＝1.81)、每周食用甜饮料≥3 次(OR ＝1.34)、食欲好(OR ＝4.07)、进食速度快(OR ＝2.77)、4 个月前非纯母乳喂养(OR ＝1.71)为儿童肥胖发生的危险因素;分别有45.6%和84.9%的肥胖儿童家长对儿童体型和肥胖对健康危害的认识做出不正确的评价和存在错误认识;分别有53.4%、43.3%和51.2%的肥胖儿童家长有鼓励进食、食物奖励和不限制零食的行为.结论 3 ～6 岁儿童肥胖的发生与家庭养育环境密切相关,喂养方式、饮食习惯和错误的育儿观念是儿童肥胖发生的主要危险因素.     

Changes in body image during a 6-month lifestyle behaviour intervention in a sample of overweight and obese individuals

BackgroundIndividuals with long-term chronic body image dissatisfaction may experience excessive stress and negative cognitions and feelings. Changes in negative cognition about body image are often reported as outcomes of obesity treatment. In turn, body image dissatisfaction also influences behavioural adherence and success in weight loss.ObjectivesThe purpose of the present study was to elucidate psychological changes during 6 months of lifestyle behaviour intervention and the association of these changes with actual weight loss.MethodsThe study examined associations between body image dissatisfaction and obesity treatment-related variables among 33 overweight and obese adults (age = 38.9 ± 6.5 years) participating in a 6-month diet and exercise weight loss intervention. Measurements of body image dissatisfaction and anthropometric variables were taken at baseline and after 6-months.DiscussionSignificant improvements were observed in all physical variables (e.g. weight, percentage of body fat mass, waist and hip circumference) after intervention. Body image dissatisfaction improved significantly over the treatment, and these changes were associated with changes in obesity indicators.ConclusionsChanges in weight and body image probably influence each other dynamically. Results from this study support the inclusion of cognitive intervention aimed at improving body image in weight management programs.     

Too big to be seen: Weight‐based discrimination among nursing students

An educational intervention was conducted to determine the efficacy of an obesity sensitivity program to determine nursing students’ attitudes toward obese clients. As part of the clinical curriculum, nursing students (N = 103) received weekly obesity sensitivity education on weight‐based discrimination. Students’ completed a preproject and postproject attitudes toward obese persons scale (Barra, 2015) to evaluate discriminatory beliefs and actions. All clinical groups had a significant positive change in their own weight prejudices postobesity education intervention. Chi‐square analysis was utilized as a measure of association between pre‐ and postobesity education with clinical application concerning obesity size, body odor, appearance, and lifestyle, along with provider fear of a back injury. Promoting nursing student awareness of obese client bias can dissipate negative stigmas to promote a therapeutic patient–provider relationship.     

Effect of a successful intensive lifestyle program on insulin sensitivity and glucose tolerance in obese youth

OBJECTIVE—To evaluate the impact on glucose metabolism of a lifestyle program (the Yale Bright Bodies Program) for obese children.RESEARCH DESIGN AND METHODS—Thirteen Bright Bodies and ten clinic-care control subjects who were part of a large randomized clinical trial had 75-g oral glucose tolerance tests at the beginning and end of the 12-month study.RESULTS—Bright Bodies subjects had significantly greater decreases in weight, BMI, and body fat than clinic-care subjects, and the Bright Body subjects’ changes in body composition were accompanied by marked improvements in insulin sensitivity (P = 0.009) and glucose tolerance (P = 0.04).CONCLUSIONS—An intensive lifestyle program that successfully reduces body weight and body fat can markedly improve insulin sensitivity and glucose metabolism in obese youth.In an attempt to respond to the childhood obesity epidemic, we developed Yale''s Bright Bodies weight-management program, a family-based lifestyle intervention that includes nutrition education, exercise, and behavior modification. Its efficacy was validated by a 12-month randomized clinical trial (RCT) with more than 170 overweight children and adolescents. In this RCT, Bright Bodies subjects had significant improvements in BMI and body composition, including a 9.2-kg difference in change in total body fat versus that in the clinic-care control group (1). To examine the impact of the Bright Bodies program on insulin sensitivity and glucose metabolism in obese children, a randomly selected subset of subjects from both groups underwent an oral glucose tolerance test (OGTT) at the beginning and end of the 12-month study.     

综合健康教育对单纯性肥胖儿童脂肪肝的干预

目的 研究综合健康教育对单纯性肥胖儿童脂肪肝的干预,探讨控制儿童肥胖的有效方式.方法 对58例脂肪肝肥胖儿童采用以家庭行为疗法为基础,加以运动训练和饮食控制以及行为治疗在内等综合干预,并对其疗效进行比较,同时选取体重正常儿童58名作为对照组.结果 干预前肥胖组体重、BMI值、收缩压及舒张压、TC、TG、LDL-C均高于对照组(P＜0.01),干预后BMI、收缩压、TC、TG低于干预前(P＜0.01);HDL-C低于对照组(P＜0.01),干预后HDL-C高于干预前(P＜0.01).结论 对肥胖儿童采取综合健康干预措施可以起到改善血脂水平的作用.使体内中性脂肪减少,降低脂肪肝的发生率.     

Which factors are associated with a successful outcome in a weight management programme for obese children?

AIMS AND OBJECTIVE: To identify factors important in determining whether an obese child achieves significant reductions in Body Mass Index Standard Deviation Score (BMI SDS) within a UK, hospital-based paediatric obesity service aimed at lifestyle modification. DESIGN: Observational Study. SUBJECTS: 137 obese children (63 boys) who have attended our childhood obesity service within the last three and a half years at The Royal Hospital for Children, Bristol, UK. MEASUREMENTS: BMI SDS with a target reduction of - 0.5 or greater. RESULTS: 70% of children achieved reductions in BMI SDS with 18% achieving the target reduction. In those attending the clinic for a year or more the levels improved to 83% and 28% respectively. Age was found to be the most important predictor with younger children achieving larger reductions in BMI SDS. More boys than girls were likely to achieve target reductions in BMI SDS and those without a parental history of obesity were more likely to achieve greater reductions in BMI SDS. Socio-economic status did not appear to impact upon the child's level of success. CONCLUSIONS: In families of obese children, motivated to seek help by attending a hospital-based weight control clinic, improvements in BMI are possible by a simple approach of education and continued support. Improvement is greatest in younger children with maximal benefit being seen in boys without a parental history of obesity. We believe this emphasizes the importance of identifying significant obesity in primary school aged children, who seem most likely to benefit from simple lifestyle modification, while many older children may require additional intervention programmes to improve BMI.     

Learning about Activity and Understanding Nutrition for Child Health (LAUNCH): Rationale,design, and implementation of a randomized clinical trial of a family-based pediatric weight management program for preschoolers

Obesity affects nearly 2 million preschool age children in the United States and is not abating. However, research on interventions for already obese preschoolers is limited. To address this significant gap in the literature, we developed an intervention targeting obesity reduction in 2 to 5 year olds, Learning about Activity and Understanding Nutrition for Child Health (LAUNCH). This paper describes the rationale, design, participant enrollment, and implementation of a 3-arm randomized, parallel-group clinical trial comparing LAUNCH to a motivational-interviewing intervention (MI) and standard care (STC), respectively. Whereas LAUNCH was designed as a skills based intervention, MI focused on addressing the guardian's motivation to make changes in diet and activity and providing tools to do so at the guardian's level of readiness to implement changes. Child body mass index z-score was the primary outcome, assessed at pretreatment, posttreatment (Month 6), and 6 and 12 month follow-ups (Months 12 and 18). Mechanisms of weight change (e.g., dietary intake, physical activity) and environmental factors associated with weight (e.g., foods available in the home, caregiver diet) were also assessed.This study is unique because it is one of the few randomized controlled trials to examine a developmentally informed, clinic and home skills based behavioral family intervention for preschoolers who are already obese. Being obese during the preschool years increases the likelihood of remaining obese as an adult and is associated with serious health conditions; if this intervention is successful, it has the potential to change the health trajectories for young children with obesity.     

Prevalence and cluster of cardiometabolic biomarkers in overweight and obese schoolchildren: results from a large survey in southwest Germany

BACKGROUND: Obesity is associated with substantial metabolic changes and subclinical inflammation. We explored associations between body mass index (BMI) and cardiometabolic biomarkers and their clustering in overweight and obese schoolchildren. METHODS: In this population-based, cross-sectional study among 450 children 10 years old, we measured adiponectin, leptin, inflammatory markers, apolipoprotein (apo) AI and B, and lipoprotein-associated phospholipase A(2) (Lp-PLA(2)). Except for adiponectin and apoAI (10th percentile) the 90th percentile was used as cutoff point. Body weight was categorized in age- and sex-specific BMI percentiles and overweight and obesity according to International Obesity Task Force definitions. RESULTS: In linear regression models, all cardiometabolic markers except apoB were statistically significantly associated with overweight. In logistic regression models, compared with the reference category (25th-75th percentile of BMI), overweight was associated with increased concentrations of leptin [odds ratio (OR) 59.80; 95% CI 16.68-214.39], C-reactive protein (6.30; 2.95-13.45), fibrinogen (2.82; 1.33-6.01), and low apoAI (2.62; 1.19-5.75). Overweight was positively associated with interleukin-6, Lp-PLA(2), and apoB concentrations and inversely with adiponectin concentrations. Most importantly, in obese children 35% showed one, 20% two, 10% three, and 15% four or more abnormal cardiometabolic biomarkers. The number of abnormal cardiometabolic markers increased in overweight (p(trend) <0.001) and obese (p(trend) <0.001) children. CONCLUSIONS: Overweight and obesity in children are associated with complex metabolic changes and a low-grade inflammatory response, and thus might not only accelerate cardiovascular disease later on, but may also be associated with the initiation of atherosclerosis in early life.     

肥胖症儿童临床相关因素

目的 通过对肥胖症儿童血脂、空腹血糖、空腹胰岛素、肝功能、肝脏彩超进行分析研究,探讨肥胖症儿童相关并发症高血压、非酒精性脂肪肝、糖代谢异常、血脂紊乱的发生情况,以帮助早期识别和干预。方法 通过对103例肥胖症儿童间进行体格检查,检测血脂、肝功能、空腹血糖、空腹胰岛素、餐后2 h血糖、肝脏彩超等检查结果进行临床分析。结果 本次调查发现3组肥胖儿童的甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、舒张压及收缩压、胰岛素抵抗指数差异有统计学意义(P＜0.05)。随体重的增加非高密度脂蛋白胆固醇血压及胰岛素抵抗指数呈上升趋势,而高密度脂蛋白胆固醇有所减低。103例肥胖症儿童并发高血压19例（18.4%);血脂紊乱36例(35.0%);糖代谢异常18例（17.5%）,其中2型糖尿病2例（1.9%）,该2型糖尿病患儿为中、重度肥胖症者。并发非酒精性脂肪肝24例（23.3%）,其中有肝功能异常14例（13.6%）。结论 儿童肥胖症会引起血糖、血脂指标异常、胰岛素抵抗等现象,使儿童患高血压、非酒精性脂肪肝及糖尿病等疾病的风险增加。肥胖儿童要减轻体重,定期体检,以此调节其各项指标的水平,降低由肥胖导致的各种并发症的发生率。     

Prevalence and risk factors of excess weight in school children in West Greece

The present study estimated the prevalence of childhood obesity and identified risk factors in 10–13 year old children. A cross‐sectional study was conducted, including 200 children and their parents, in seven randomly‐selected primary schools across Patras, Greece. Height, weight, and waist circumference were measured, and self‐reported information was collected via face‐to‐face interviews. Body mass index was calculated for the children and their parents. The effect of risk factors on overweight and obesity was analyzed using regression analysis. The prevalence of overweight and obesity was 32% and 10.5%, respectively. The odds of being overweight/obese increased in children whose parents had a lower educational level and/or higher body mass index. Fewer daily meals and more time spent in front of the television and/or on the computer were significantly associated with obesity in 10–13 year old children. The prevalence of excess weight in primary school children in Patras is of concern, especially for boys. Children's nutritional habits, leisure activities, and parental characteristics influence their somatometric characteristics. These findings highlight the need for future weight loss interventions targeted at this population.     

Dosing in obesity: a simple solution to a big problem

The global epidemic of obesity has led to an increased prevalence of chronic diseases and need for pharmacological intervention. However, little is known about the influence of obesity on the drug exposure profile, resulting in few clear dosing guidelines for the obese. Here we present a semi-mechanistic model for lean body weight (LBW) that we believe is sufficiently robust to quantify the influence of body composition on drug clearance, and is therefore an ideal metric for adjusting chronic dosing in the obese.     

The Weighty Matter intervention: a family-centered way to tackle an overweight childhood

The complexity of childhood overweight and obesity requires that researchers continue to investigate potential solutions. We developed "The Weighty Matter" intervention to prevent obesity in mildly overweight 4- and 6-year-old children. This article describes the intervention protocol, the health habits of families (n=86), and the effect of the intervention on children's weight for height, parents' body mass indices, and family health habits after a 12-month follow-up. Positive changes were seen in families' health habits, although the results did not reach statistical significance. As a result of this study, a new and practical method was developed to focus on the issue of family health habits.     

Factors influencing BMI classifications of Korean adults

[Purpose] This study aimed to identify factors influencing the BMI classifications of 3,583 Korean adults using data from the fifth Korean National Health and Nutrition Examination Survey. [Subjects and Methods] Measures included lifestyle factors, physiologic factors, perceived health state, stress, subjective body recognition, health-related quality of life, and weight control behavior. [Results] Body perception scores were lower with underweight and higher with overweight and obesity than with a healthy weight. There was a lower proportion of underweight men and a higher proportion of overweight or obese men than women. Instances of Alcohol Use Identification Scores (AUDIT) ≥ 9 were proportionately lower with underweight and more with overweight or obesity relative to an AUDIT score < 9 with healthy weight. Hemoglobin A1c and systolic blood pressure were higher with obesity than with healthy weight. The total cholesterol level was greater with overweight and obesity than with healthy weight. [Conclusion] These results suggest that obesity intervention for adults should be based on age and sex and should include drinking habits and physical activity.Key words: Adults, Body mass index, Obesity     

Effects of regular exercise on obesity and type 2 diabete mellitus in Korean children: improvements glycemic control and serum adipokines level

[Purpose] The aim of the study was to clarify the effects of regular exercise on lipid profiles and serum adipokines in Korean children. [Subjects and Methods] Subjects were divided into controls (n=10), children who were obese (n=10), and children with type 2 diabetes mellitus (n=10). Maximal oxygen uptake (VO₂max), body composition, lipid profiles, glucagon, insulin and adipokines (leptin, resistin, visfatin and retinol binding protein 4) were measured before to and after a 12-week exercise program. [Results] Body weight, body mass index, and percentage body fat were significantly higher in the obese and diabetes groups compared with the control group. Total cholesterol, triglycerides, low-density lipoprotein cholesterol and glycemic control levels were significantly decreased after the exercise program in the obese and diabetes groups, while high-density lipoprotein cholesterol levels were significantly increased. Adipokines were higher in the obese and diabetes groups compared with the control group prior to the exercise program, and were significantly lower following completion. [Conclusion] These results suggest that regular exercise has positive effects on obesity and type 2 diabetes mellitus in Korean children by improving glycemic control and reducing body weight, thereby lowering cardiovascular risk factors and adipokine levels.Key words: Leptin, Resistin, Visfatin     

Body composition and adipose tissue cellularity before and after jejuno-ileostomy in severely obese subjects

In severe obesity with adipose tissue hyperplasia it is difficult to achieve and sustain weight decrease by conventional therapy. Fifteen severely obese patients (mean body weight 135 kg) with hyperplastic obesity had a jejuno-ileostomy according to Payne to induce weight reduction by controlled malabsorption. Body composition, adipose tissue cellularity, and glucose tolerance were studied before and after the operation when the patients had reached a new stable weight (WS) a mean 21 months after surgery. Preoperative fat cell number was unchanged at follow-up in contrast to all other variables of body composition. Reductions in fat cell size were evenly distributed in different major subcutaneous regions. Body potassium was determined immediately after operation and at 6 months intervals until WS. The postoperative decrease stopped at 6 months, thus differing from the decrease in body weight. Significant positive correlations between the postoperative decrease in body weight or body fat, and preoperative body weight, body fat and body cell mass were analysed by multiple stepwise regression. Preoperative body weight and body fat were shown to predict postoperative weight loss at a leve of P less than 0.005. A positive correlation between body fat decrease and fat cell number could be explained hypothetically by an increased caloric demand in hyperplastic obesity.     

Primary Care Physician Attitudes and Practice Patterns in the Management of Obese Adults: Results from a National Survey

Abstract

Purpose: Obesity remains a serious public health problem. The purpose of this study was to identify the current attitudes and practices of primary care physicians (PCPs) with respect to obesity. Methods: A survey was systematically developed and administered electronically to PCPs, who received a small honorarium for their time. Results were analyzed to identify specific attitudes and practices and their associations with each other and with demographic and other variables. Results: Physicians expressed little confidence in their ability to manage obesity. In general, however, they believed that obesity could be successfully managed. Lifestyle changes were perceived to be the most effective available method for patients to lose weight, and respondents were more likely to recommend this approach over pharmacotherapy or bariatric surgery. Respondents perceive the greatest barrier to managing obese patients to be a lack of patient motivation. Physicians were significantly more likely to initiate discussions with obese patients about their weight if they believed they had positive attitudes about and knowledge of weight management, and adequate resources to manage the problem. Conclusions: Physicians report a lack of confidence in managing obesity. Lack of patient motivation is perceived to be the greatest barrier. Physicians with greater knowledge, more positive attitudes toward obesity management, and access to more resources are more likely to provide weight management in primary care settings.     

Obesity in children, adolescents and young adults

The prevalence of obesity in Finnish children, adolescents and young adults aged three to 24 years was estimated in three surveys performed within the multicentre project, "Cardiovascular Risk in Young Finns" (1980, 1983, 1986). Obesity was defined as either body mass index (weight/height) or skinfold thickness (triceps or subscapular) or both greater than 90th percentiles of age and sex-specific reference data for white children. Its mean prevalences among 9- to 18-year old boys and girls in three surveys (95% confidence limits) were 3.6% (3.1-4.2) and 2.1% (1.7-2.6) as estimated in terms of body mass index and triceps skinfold thickness or 4.3% (3.9-4.9) and 2.6% (2.2-3.1) according to body mass index and subscapular skinfold thickness. Thus the 9- to 18-year old boys were on average more often obese than the girls, but no statistically significant changes in the prevalence of obesity were observed over the period 1980-1986. Body mass index and triceps or subscapular skinfold thicknesses vary in sensitivity as indicators of obesity.     

综合健康干预对单纯性肥胖儿童血脂水平影响的研究

目的：研究综合健康干预对单纯性肥胖儿童血脂水平的影响。方法：对来院治疗的100例单纯肥胖儿童采用综合健康干预措施进行为期1年的干预试验,并比较干预前后身高、体重、BMI、血压及血脂水平的变化。结果：肥胖患儿干预前后体重、BMI、收缩压、舒张压的情况均有显著性差异（P〈0.01）,而身高无明显差异（P〉0.05）,肥胖患儿干预前后TC、TG、HDL-C、LDL-C的情况均有显著性差异（P〈0.01）。结论：综合健康干预措施能有效降低体重和BMI,改善单纯性肥胖儿童的血脂水平,起到调节异常内分泌代谢的作用。