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1.  Prevalence of overweight and obesity in a provincial population of Canadian preschool children 
Background
More and more school-aged children in Canada and elsewhere are becoming overweight or obese. Many countries are now reporting a similar trend among preschool children. However, little information is available on the prevalence of overweight and obesity among preschool children in Canada. In addition, available data are based on reported rather than measured heights and weights. We conducted this study to determine the prevalence of overweight and obesity, using measured heights and weights, in the 1997 cohort of children aged 3–5 years born in Newfoundland and Labrador.
Methods
We calculated the body mass indices (BMIs) using heights and weights measured by public health nurses during the province-wide Preschool Health Check Program conducted between October 2000 and January 2003. Descriptive data on the children's BMIs and prevalence estimates were generated and analyzed by sex and age with the use of the classification system recommended by the International Obesity Task Force.
Results
Data were available for 4161 of the 5428 children born in 1997; boys and girls were equally represented (50.1% and 49.9% respectively). Overall, 25.6% of the preschool children in the cohort were overweight or obese. The rates did not differ significantly by sex or age group
Interpretation
These results indicate that a high proportion of children aged 3–5 years in Newfoundland and Labrador are overweight or obese. It appears that prevention measures should begin before the age of 3 years.
doi:10.1503/cmaj.1040075
PMCID: PMC490073  PMID: 15289421
2.  Feasibility of Increasing Childhood Outdoor Play and Decreasing Television Viewing Through a Family-Based Intervention in WIC, New York State, 2007-2008 
Preventing Chronic Disease  2011;8(3):A54.
Introduction
Active Families is a program developed to increase outdoor play and decrease television viewing among preschool-aged children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Our objective was to assess its feasibility and efficacy.
Methods
We implemented Active Families in a large WIC clinic in New York State for 1 year. To this end, we incorporated into WIC nutrition counseling sessions a community resource guide with maps showing recreational venues. Outcome measures were children's television viewing and time playing outdoors and parents' behaviors (television viewing, physical activity), self-efficacy to influence children's behaviors, and parenting practices specific to television viewing. We used a nonpaired pretest and posttest design to evaluate the intervention, drawing on comparison data from 3 matched WIC agencies.
Results
Compared with the children at baseline, the children at follow-up were more likely to watch television less than 2 hours per day and play outdoors for at least 60 minutes per day. Additionally, parents reported higher self-efficacy to limit children's television viewing and were more likely to meet physical activity recommendations and watch television less than 2 hours per day.
Conclusion
Results suggest that it is feasible to foster increased outdoor play and reduced television viewing among WIC-enrolled children by incorporating a community resource guide into WIC nutrition counseling sessions. Future research should test the intervention with a stronger evaluation design in multiple settings, with more diverse WIC populations, and by using more objective outcome measures of child behaviors.
PMCID: PMC3103559  PMID: 21477494
3.  Relationship between obesity and asthma symptoms among children in Ahvaz, Iran: a cross sectional study 
Background
Obesity has been identified as a risk factor for higher prevalence of asthma and asthma-related symptoms in children. The objective of this study was to evaluate the relationship between the prevalence of asthma symptoms and obesity among school-age children in the city of Ahvaz, Iran.
Methods
A total of 903 children, 7 to 11 years of age, were enrolled in this study through cluster sampling. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to identify the children who were currently suffering from asthma. Height and weight were measured and body mass index (BMI) was calculated in kg/m2. Overweight was defined as BMI greater than the age- and sex-specific 85th percentile, and obesity as BMI greater than the 95th percentile. We determined the relationship between obesity and asthma symptoms by chi-square tests.
Results
The prevalence of wheeze ever, current wheezing, obesity, and overweight was 21.56%, 8.7%, 6.87%, and 9.5%, respectively. The current prevalence of wheezing among obese and overweight children was 68.75% and 37%, respectively, and there was a statistical association between obesity and the prevalence of current wheezing (p < 0.001), night cough (p < 0.001), and exercise-induced wheezing (p = 0.009), but obesity and overweight were not associated with eczema and allergic rhinoconjunctivitis, so it seems that the pathophysiology of asthma in obese and overweight children is not related to allergy.
Conclusion
There is a strong association between asthma symptoms and both overweight and obesity in both sexes among school-age children.
doi:10.1186/1824-7288-37-1
PMCID: PMC3024283  PMID: 21208461
4.  Prevalence of underweight, overweight and obesity in preschool children of Tehran, Iran 
BACKGROUND:
It is reported that prevalence of overweight and obesity have increased in all age groups, but little is known about prevalence of overweight and obesity in preschool children. Therefore, the purpose of this study was to survey the prevalence of underweight, overweight and obesity in 3-6 year-old Tehranian children in 2009-2010.
METHODS:
This cross-sectional study was performed on a total of 756 (378 boys and 378 girls) preschool children aged 3-6. Subjects were selected through stratified sampling from 5 geographic regions of Tehran (east, west, north, south, and center). Body weight and height were measured directly. Underweight, overweight and obesity was defined as Body Mass Index (BMI) ≤ 5th percentile (underweight), 5th to 85th percentile (normal weight), 85th to 95th percentile (overweight), and > 95th percentile (obesity); based on recommendation of Centers for Disease Control (CDC) in 2000.
RESULTS:
Findings showed that the prevalence of underweight, overweight and obesity was 4.77%, 9.81% and 4.77% in boys and 4.77%, 10.31% and 4.49% in girls, respectively.
CONCLUSIONS:
Our findings showed a relatively high prevalence of overweight and obesity in Tehranian preschool children that is a serious problem. This result can be used in clinical setting and preventive programs.
PMCID: PMC3214402  PMID: 22091313
Prevalence; Preschool; Obesity; Overweight; Underweight
5.  The prevalence of obesity and the level of adherence to the Korean Dietary Action Guides in Korean preschool children 
Nutrition Research and Practice  2013;7(3):207-215.
The objective of this study was to investigate the associations between the prevalence of overweight and obesity and the degree of adherence to the Korean Dietary Action Guides for Children (KDAGC). In a cross-sectional study based on a child care center-based survey in Seoul, Korea, we collected parental-reported questionnaires (n = 2,038) on children's weight and height, frequency of fruit and vegetable consumption, and the quality of dietary and activity behaviors based on the 2009 KDAGC Adherence Index (KDAGCAI) which was developed as a composite measure of adherence to the KDAGC. Overweight and obesity were determined according to age- and sex-specific BMI percentile from the 2007 Korean national growth chart. Associations were assessed with generalized linear models and polytomous logistic regression models. Approximately 17.6% of Korean preschool children were classified as overweight or obese. Obese preschoolers had lower adherence to the KDAGCAI compared to those with lean/normal weight. Preschoolers with a high quality of dietary and activity behaviors had a 51% decreased odds ratio (OR) of being obese (highest vs. lowest tertile of KDAGCAI-score, 95% CI 0.31, 0.78; P = 0.001); the associations were more pronounced among those who were older (P = 0.048) and lived in lower income households (P = 0.014). A greater frequency of vegetable consumption, but not fruit, was associated with a borderline significant reduction in the prevalence of obesity. Our findings support the association between obesity prevention and high compliance with the Korean national dietary and activity guideline among preschool children.
doi:10.4162/nrp.2013.7.3.207
PMCID: PMC3679330  PMID: 23766882
Preschool children; obesity; dietary guideline
6.  The Pediatric Obesity Epidemic Continues Unabated in Bogalusa, Louisiana 
Pediatrics  2010;125(5):900-905.
Objectives
To examine 35-year trends in the prevalence of overweight and obesity among children and adolescents from Bogalusa, LA.
Patients and Methods
Height and weight were measured for 11,653 children and adolescents between 5 and 17 years of age in 8 cross-sectional surveys. The Bogalusa Heart Study contributed data from 1973–1994, and routine school screening provided 2008–2009 data. Trends in mean BMI, mean gender-specific BMI-for-age z-scores, prevalence of overweight/obesity (BMI ≥85th percentile), and prevalence of obesity (BMI ≥95th percentile) by age, race, and gender were examined.
Results
Since 1973–1974, the proportion of children and adolescents aged 5 to 17 years who are overweight (overweight plus obese) has more than tripled, from 14.2% to 48.4% in 2008–2009. Similarly, the proportion of obese children and adolescents has increased more than fivefold from 5.6% in 1973–1974 to 30.8% in 2008–2009. The prevalence of overweight or obesity, and secular changes, were similar across black and white boys and girls.
Conclusions
In semirural Bogalusa, the childhood obesity epidemic has not plateaued, and nearly half of children are now overweight or obese.
doi:10.1542/peds.2009-2748
PMCID: PMC3023706  PMID: 20368311
Overweight; obesity; trends; rural
7.  The Prevalence and Epidemiology of Overweight and Obesity in Children with Inflammatory Bowel Disease 
Inflammatory Bowel Diseases  2010;17(10):2162-2168.
Background
Obesity is a significant public health threat to children in the United States.
Aims
1) Determine the prevalence of obesity in a multi-center cohort of children with IBD; 2) Evaluate whether overweight and obese status is associated with patient demographics or disease characteristics.
Methods
We used data from the ImproveCareNow Collaborative for pediatric IBD, a multi-center registry of children with IBD, collected between April 2007 and December 2009. Children ages 2-18 years were classified into BMI percentiles. Bivariate analyses and multivariate logistic regression were used to compare demographic and disease characteristics by overweight (BMI>85%) and obese (BMI>95%) status.
Results
The population consisted of 1598 children with IBD. The prevalence of overweight/obese status in pediatric IBD is 23.6%, (20.0% for Crohn's disease (CD) and 30.1% for ulcerative colitis (UC) and indeterminate colitis (IC)). African American race (OR 1.64, 95% CI 1.10-2.48) and Medicaid insurance (OR 1.67, 95% CI 1.19-2.34) were positively associated with overweight/obese status. Prior IBD related surgery (OR 1.73, 95% CI 1.07-2.82) was also associated with overweight and obese status in children with CD. Other disease characteristics were not associated with overweight and obesity in children with IBD.
Conclusions
Approximately 1/5 of children with CD and 1/3 with UC are overweight or obese. Rates of obesity in UC are comparable to the general population. Obese IBD patients may have a more severe disease course, as indicated by increased need for surgery. Sociodemographic risk factors for obesity in the IBD population are similar to those in the general population.
doi:10.1002/ibd.21585
PMCID: PMC3116044  PMID: 21910178
8.  Trends in general and abdominal obesity among Chinese children and adolescents 1993–2009 
Pediatric obesity  2012;7(5):355-364.
Objective
This study aimed to examine the secular trends in body mass index (BMI), waist circumference (WC), and the prevalence of general and abdominal obesity among Chinese children and adolescents from 1993 to 2009.
Methods
Data were obtained from the China Health and Nutrition Survey conducted from 1993 to 2009. 9693 children and adolescents aged 6-17years were included in this study, with their height, weight and WC were measured. General obesity was defined using the BMI cutoffs for overweight recommended by the International Obesity Task Force, and abdominal obesity was assessed when a WC above the 90th percentile for sex and age.
Results
Among total participants, mean BMI and WC increased significantly over the period 1993–2009: BMI increased from 17.6 to 17.8 kg/m2, and WC increased from 61.4 to 63.1 cm (both increases P <0.001). The prevalence of general obesity and abdominal obesity increased significantly over the period: general obesity (including overweight) rose from 6.1% to 13.1% and abdominal obesity from 4.9% to 11.7% (both increases P <0.001). WC and abdominal obesity increased at a relatively higher rate than BMI and general obesity. Upward trends in the prevalence of general and abdominal obesity were observed in all subgroups of sex, age and region (all increases P <0.05), except for abdominal obesity in girls aged 13–17 years old (P =0.102).
Conclusion
General and abdominal obesity increased significantly over the past 17 years in Chinese children.
doi:10.1111/j.2047-6310.2012.00066.x
PMCID: PMC3440532  PMID: 22718681
trend; body mass index; waist circumference; obesity; children; adolescents; China
9.  Early predictors of obesity and cardiovascular risk among American Indian children 
Maternal and child health journal  2012;16(9):1879-1886.
American Indian (AI) children have the highest rates of obesity among ethnic groups in the United States, and rates continue to increase. This study was designed to examine the effects of prenatal and early postnatal factors on AI children’s body mass index (BMI) trajectories, adiposity, and cardiovascular risk markers during early childhood. We screened 471 AI children (ages 5–8) from three Wisconsin tribes. Screenings included anthropometric and body fat measures and non-fasting lipid and glucose via fingerstick blood samples. Tribal records from Women Infants and Children (WIC) programs and clinic charts provided data on children’s BMI trajectories, maternal prenatal factors, and the early postnatal feeding environment. Forty-seven percent of children were overweight or obese. Analysis of growth trajectories showed that children’s BMI category was largely determined within the first year of life. Significant predictors of children's BMI category at age 1 included macrosomia (OR: 4.38), excess gestational weight gain (OR: 1.64) and early termination of breastfeeding (OR: 1.66). Children who were overweight/obese at age 1 had greater odds of being overweight (OR: 3.42) or obese (OR: 3.36), and having unhealthy levels of body fat (OR: 2.95) and LDL cholesterol (OR: 1.64) at ages 5–8. Children’s BMI category is determined in the early post-natal environment, within the first year of life, by factors including excess gestational weight gain and early termination of breastfeeding. In turn, children’s BMI category at age 1 predicts the emergence of cardiovascular risk markers in early childhood.
doi:10.1007/s10995-012-1024-9
PMCID: PMC3438386  PMID: 22527771
American Indian; Breastfeeding; Gestational Weight gain; Growth trajectories; Macrosomia
10.  The Relation of Body Mass Index and Blood Pressure in Iranian Children and Adolescents Aged 7–18 Years Old 
Iranian Journal of Public Health  2010;39(4):126-134.
Background:
The obesity and hypertension are the major risk factors of several life threatening diseases. The present study was aimed to investigate the relation between body mass index (BMI) the validated index of adiposity and different aspect of blood pressure (BP).
Methods:
Systolic and diastolic blood pressures and also weight and height of 7 to 18 years old children and adolescent collected in 2002 and 2004 respectively. Data was consisted of 14865 schoolchildren and adolescents from representative sample of country. BMI was classified according to CDC 2000 standards into normal (BMI<85th percentile), at risk of overweight (BMI≥85th and <95th percentile) and overweight (BMI≥95th percentile). Then, age-sex specific prevalence of being overweight was derived. ANOVA was used to investigate the effect of BMI on systolic blood pressure and diastolic blood pressure and mean arterial pressure of participants.
Results:
Mean systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) significantly increased with BMI (P< 0.0001) and age groups (P< 0.0001), and was significantly (P< 0.0001) higher in boys than girls especially in older ages. (P< 0.0001, interaction of age and BMI level). The proportion of being overweight was significantly higher in boys than girls was (7.4% vs. 3.6%; P< 0.0001).
Conclusion:
There is an association between BP and BMI in children and adolescence. SBP, DBP and MAP are associated with rise in BMI and age, which was lower in girls. This data can provide basics for public health policy makers and primary prevention policies in the country.
PMCID: PMC3481696  PMID: 23113046
Blood pressure; Body mass index (BMI); Relation; Children; Adolescents
11.  Overweight and Obesity Among Hawai‘i Children Aged 4 to 5 Years Enrolled in Public Schools in 2007–2008 and Comparison with a Similar 2002–2003 Cohort 
This assessment provides the most recent estimates of overweight and obesity among children 4 to 5 years old who were enrolled in public schools in the 2007–2008 school year, using data obtained from Student Health Records for 12,823 children, which represents 91% of the 14,070 children who were enrolled in kindergarten in 2007–2008. This assessment is a census of 4 to 5 year olds that entered public schools in Hawai‘i in 2007–2008 and represents approximately 38% of the total Hawai‘i population for those aged 4 to 5 years, since kindergarten is not a requirement. A limited data set with data on age, sex, height, and weight was used to calculate BMI (body mass index) percentiles. We compare this data with age and sex-specific BMI obtained from Student Health Records from 10,199 children aged 4 to 5 years entering public schools during 2002–2003. The results illustrate that like the 2002–2003 data (28.5%), over one in four (28.6%) of the children aged 4 to 5 years entering Hawai‘i public schools in 2007–2008 were either overweight or obese. Total proportions overweight and obese were persistently higher (32.5% or more in both 2002–2003 and 2007–2008) in some specific school complexes on O‘ahu as well as in some rural and Neighbor Island school complexes. Physicians, public health and school health professionals, advocates, schools, and communities should be vigilant about this persistent problem and seek to implement practices to combat overweight and obesity. In addition, the use of Student Health Records for on-going pediatric obesity surveillance should be explored more fully.
PMCID: PMC3727572  PMID: 23900736
12.  Diet, Activity, and Overweight Among Preschool-Age Children Enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) 
Preventing Chronic Disease  2006;3(2):A49.
Introduction
Overweight is affecting children at younger ages and in increasing numbers, putting them at risk for a lifetime of chronic disease. Consumption of unhealthy foods and time spent watching television have increased concurrently.
Methods
Parents of 526 children aged 2 to 4 years old enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) answered questions about their children's food and beverage consumption, television-viewing and computer time, and physical activity. The children's height and weight measurements were collected from administrative records. Crude and adjusted odds ratios were calculated to test for associations between demographic, consumption, and activity variables and overweight or at risk of overweight (body mass index ≥85th percentile for age and sex).
Results
Of the participants, 38% of the children were overweight or at risk of overweight. Hispanic and white children were twice as likely as black children to be overweight or at risk of overweight. Fifty-eight percent of the children drank more than one and 30% drank more than two 8-oz servings of fruit juice per day. The children who drank more than one serving of nonjuice fruit drink per day (30%) had increased odds of being overweight or at risk of overweight. On average, the children spent more than twice as much time watching television and using computers as they did engaging in physical activity. In multivariate analyses, race and ethnicity as well as physical activity were associated with being overweight or at risk of overweight.
Conclusion
Efforts to improve nutrition and prevent overweight in children should focus on the parents of infants and toddlers and provide them with anticipatory guidance on physical activity for young children and nutrition and food transitions.
PMCID: PMC1563967  PMID: 16539790
13.  Overweight and obesity at school entry among migrant and German children: a cross-sectional study 
BMC Public Health  2005;5:45.
Background
Overweight and obesity have become a global epidemic and are increasing rapidly in both childhood and adolescence. Obesity is linked both to socioeconomic status and to ethnicity among adults. It is unclear whether similar associations exist in childhood. The aim of the present study was to assess differences in overweight and obesity in migrant and German children at school entry.
Methods
The body mass index (BMI) was calculated for 525 children attending the 2002 compulsory pre-school medical examinations in 12 schools in Bielefeld, Germany. We applied international BMI cut off points for overweight and obesity by sex and age. The migration status of children was based on sociodemographic data obtained from parents who were interviewed separately.
Results
The overall prevalence of overweight in children aged 6–7 was 11.9% (overweight incl. obesity), the obesity prevalence was 2.5%. The prevalence of overweight and obesity was higher for migrant children (14.7% and 3.1%) than for German children (9.1% and 1.9%). When stratified by parental social status, migrant children had a significantly higher prevalence of overweight than German children in the highest social class. (27.6% vs. 10.0%, p = 0.032) Regression models including country/region and socioeconomic status as independent variables indicated similar results. The patterns of overweight among migrant children differed only slightly depending on duration of stay of their family in Germany.
Conclusion
Our data indicate that children from ethnic minorities in Germany are more frequently overweight or obese than German children. Social class as well as family duration of stay after immigration influence the pattern of overweight and obesity in children at school entry.
doi:10.1186/1471-2458-5-45
PMCID: PMC1142329  PMID: 15882467
14.  Early Onset of Overweight and Obesity among Low-Income 1- to 5-Year Olds in New York City 
Early-childhood obesity has reached epidemic proportions, particularly among low-income, minority, urban children. Understanding the progression of obesity prevalence rates from infancy through early childhood can inform public health efforts to combat this epidemic and create developmentally appropriate strategies. In this study, we assessed the prevalence of overweight and obesity among urban 1- to 5-year olds and estimated risk by age and gender. We surveyed the medical records of a random sample of 1,713 children seen at a New York City primary-care network. Outcome measures were weight-for-length for <2-year olds and body mass index for 2- to 5-year olds. Overweight was defined as percentiles ≥85% to <95%, obesity ≥95%. Analysis utilized chi-square, logistic regression, and z tests. Between 1 and 5 years of age, overweight increased 3.7% to 20.8% and obesity 7.5% to 29.8% (p < 0.01). Risk increased with age: compared with 1-year olds, 5-year olds were 8.2 times as likely (95% confidence interval (CI) = 5.5–12.21) to be overweight or obese. Boys were more likely to be obese than girls (adjusted odds ratio = 1.3; 95% CI = 1–1.64). Significant increases in overweight and obesity occurred between ages 1 and 3 years (overweight, 3.7% to 16%, p < 0.01; obesity, 7.5% to 30.2%, p < 0.01). Among urban children, more than half were overweight or obese by age 5. Overweight and obesity rates increased dramatically between the ages of 1 and 3 years. Interventions aimed at this age period may have the greatest impact at preventing childhood obesity.
doi:10.1007/s11524-008-9285-8
PMCID: PMC2443255  PMID: 18470622
Body mass index, BMI; Childhood obesity; Community health; Ethnic minorities; Prevalence
15.  A randomized controlled trial to prevent childhood obesity through early childhood feeding and parenting guidance: rationale and design of study 
BMC Public Health  2013;13:880.
Background
Early and rapid growth in Infants is strongly associated with early development and persistence of obesity in young children. Substantial research has linked child obesity/overweight to increased risks for serious health outcomes, which include adverse physical, psychological, behavioral, or social consequences.
Methods/design
The goal of this study is to compare the effectiveness of structured Community Health Worker (CHW)- provided home visits, using an intervention created through community-based participatory research, to standard care received through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) office visits in preventing the development of overweight (weight/length ≥85th percentile) and obesity (weight/length ≥95th percentile) in infants during their first 3 years of life. One hundred forty pregnant women in their third trimester (30–36 weeks) will be recruited and randomly assigned to the intervention or control group.
Discussion
This study will provide prospective data on the effects of an intervention to prevent childhood obesity in children at high risk for obesity due to ethnicity, income, and maternal body mass index (BMI). It will have wide-ranging applicability and the potential for rapid dissemination through the WIC program, and will demonstrate the effectiveness of a community approach though employing CHWs in preventing obesity during the first 3 years of life. This easy-to-implement obesity prevention intervention can be adapted for many locales and diverse communities and can provide evidence for policy change to influence health throughout life.
Trial registration
Clinical Trials Number: NCT01905072
doi:10.1186/1471-2458-13-880
PMCID: PMC3852597  PMID: 24063435
Childhood obesity; Home visiting; Community approach
16.  Family-Based Hip-Hop to Health: Outcome Results 
Obesity (Silver Spring, Md.)  2013;21(2):10.1002/oby.20269.
This pilot study tested the feasibility of Family-Based Hip-Hop to Health, a school-based obesity prevention intervention for 3–5 year old Latino children and their parents, and estimated its effectiveness in producing smaller average changes in body mass index at one year follow-up.
Four Head Start preschools administered through the Chicago Public Schools were randomly assigned to receive a Family-Based Intervention (FBI) or a General Health intervention (GHI). Parents signed consent forms for 147 of the 157 children enrolled.
Both the school-based and family-based components of the intervention were feasible, but attendance for the parent intervention sessions was low. Contrary to expectations, a downtrend in BMI Z score was observed in both the intervention and control groups.
While the data reflect a downward trend in obesity among these young Hispanic children, obesity rates remained higher at one-year follow-up (15%) than those reported by the National Health and Nutrition Examination Survey (2009–2010) for 2–5 year old children (12.1%). Developing evidence-based strategies for obesity prevention among Hispanic families remains a challenge.
doi:10.1002/oby.20269
PMCID: PMC3465637  PMID: 23532990
childhood obesity; minorities; parents; diet; physical activity
17.  An after-school dance and lifestyle education program reduces risk factors for heart disease and diabetes in elementary school children 
Background
Forty-three percent of New York City's (NYC) school-age children are overweight or obese, placing them at risk for heart disease and type 2 diabetes mellitus (T2DM).
Objective
The objective of this study was to determine if an intensive after-school dance and lifestyle education program would reduce risk factors for heart disease, T2DM, and improve lifestyle choices.
Subjects
Subject include 64 fourth- and fifth-grade students at an elementary school in NYC.
Methods
Students received freestyle dance and lifestyle classes for 16 weeks and were evaluated for changes in body composition, endurance, biochemical measurements, and lifestyle choices.
Results
Significant improvements in BMI percentiles were found among children in the overweight and obese categories as well as in endurance and biochemical measurements that reflect heart disease and diabetes risk. Improvement was also reported in lifestyle choices.
Conclusion
An intensive after-school dance and lifestyle education program can reduce risk factors for heart disease and T2DM and improve lifestyle choices among elementary school children.
PMCID: PMC3897259  PMID: 22876547
childhood obesity; dance; lifestyle intervention; physical activity
18.  Prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children 
BMC Public Health  2011;11:724.
Background
Childhood obesity is becoming an equally challenging, yet under-recognized, problem in developing countries including Pakistan. Children and adolescents are worst affected with an estimated 10% of the world's school-going children being overweight and one quarter of these being obese. The study aimed to assess prevalence and socioeconomic correlates of overweight and obesity, and trend in prevalence statistics, among Pakistani primary school children.
Methods
A population-based cross-sectional study was conducted with a representative multistage cluster sample of 1860 children aged 5-12 years in Lahore, Pakistan. Overweight (> + 1SD) and obesity (> + 2SD) were defined using the World Health Organization child growth reference 2007. Chi-square test was used as the test of trend. Linear regression was used to examine the predictive power of independent variables in relation to BMI. Logistic regression was used to quantify the independent predictors for overweight and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were obtained. All regression analyses were controlled for age and gender and statistical significance was considered at P < 0.05.
Results
Seventeen percent (95% CI 15.4-18.8) children were overweight and 7.5% (95% CI 6.5-8.7) were obese. Higher prevalence of obesity was observed among boys than girls (P = 0.028), however, there was no gender disparity in overweight prevalence. Prevalence of overweight showed a significantly increasing trend with grade (P < 0.001). Children living in the urban area with high socioeconomic status (SES) were significantly at risk for being overweight and obese (both P < 0.001) as compared to children living in the urban area with lower SES and rural children. Being in higher grade (aOR 2.39, 95% CI 1.17-4.90) and living in the urban area with higher SES (aOR 18.10, 95% CI 10.24-32.00) independently predicted the risk of being overweight.
Conclusion
Alarmingly rapid rise in overweight and obesity among Pakistani primary school children was observed, especially among the affluent urban population. The findings support the urgent need for National preventive strategy for childhood obesity and targeted interventions tailored to local circumstances with meaningful involvement of communities.
doi:10.1186/1471-2458-11-724
PMCID: PMC3195095  PMID: 21943029
19.  Prevalence of Childhood and Adolescent Overweight and Obesity from 2003 to 2010 in an Integrated Health Care Delivery System 
Journal of Obesity  2013;2013:417907.
An observational study of the Kaiser Permanente Northern California (KPNC) BMI coding distributions was conducted to ascertain the trends in overweight and obesity prevalence among KPNC members aged 2–19 between the periods of 2003–2005 and 2009-2010. A decrease in the prevalence of overweight (−11.1% change) and obesity (−3.6% change) and an increase in the prevalence of healthy weight (+2.7% change) were demonstrated. Children aged 2–5 had the greatest improvement in obesity prevalence (−11.5% change). Adolescents aged 12–19 were the only age group to not show a decrease in obesity prevalence. Of the racial and ethnic groups, Hispanics/Latinos had the highest prevalence of obesity across all age groups. The KPNC prevalence of overweight and obesity compares favorably to external benchmarks, although differences in methodologies limit our ability to draw conclusions. Physician counseling as well as weight management programs and sociodemographic factors may have contributed to the overall improvements in BMI in the KPNC population. Physician training, practice tools, automated BMI reminders and performance feedback improved the frequency and quality of physician counseling. BMI screening and counseling at urgent visits, in addition to well-child care visits, increased the reach and dose of physician counseling.
doi:10.1155/2013/417907
PMCID: PMC3732626  PMID: 23970960
20.  The Relationship between Asthma and Obesity in Urban Early Adolescents 
Asthma and obesity, which have reached epidemic proportions, impact urban youth to a great extent. Findings are inconsistent regarding their relationship; no studies have considered asthma management. We explored the association of obesity and asthma-related morbidity, asthma-related health care utilization, and asthma management in urban adolescents with uncontrolled asthma. We classified 373 early adolescents (mean age=12.8 years; 82% Hispanic or Black) from New York City public middle schools into 4 weight categories: normal (body mass index [BMI]<85th percentile); overweight (85th percentile≤BMI<95th percentile); obese (95th percentile≤BMI<97th percentile); and very obese (BMI≥97th percentile). We compared sample obesity prevalence to national estimates, and tested whether weight categories predicted caregiver reported asthma outcomes, adjusting for age and race/ethnicity. Obesity prevalence was 37%, with 28% of the sample being very obese; both rates were significantly higher than national estimates. We found no significant differences in asthma-related health care utilization or asthma management between weight categories, and a few differences in asthma-related morbidity. Relative to normal weight and obese youth, overweight youth had higher odds of never having any days with asthma-related activity limitations. They also had higher odds of never having asthma-related school absences compared with obese youth. Overweight youth with asthma-related activity limitations had more days with limitations compared with normal weight youth. Overweight, but not obese youth, missed more school due to asthma than normal weight youth. Overweight and obesity prevalence was very high in urban, Hispanic, and Black adolescents with uncontrolled asthma, but not strongly associated with asthma-related morbidity, asthma-related health care utilization, or asthma management practices.
doi:10.1089/ped.2012.0145
PMCID: PMC3429276  PMID: 22970423
21.  Maternal and Early Childhood Risk Factors for Overweight and Obesity among Low-Income Predominantly Black Children at Age Five Years: A Prospective Cohort Study 
Journal of Obesity  2012;2012:457173.
Objective. To identify maternal and early childhood risk factors for obesity and overweight among children at age 5 in the state of Alabama. Methods. We recruited 740 mothers during early pregnancy from University of Alabama Prenatal Clinics in a prospective cohort study and followed them throughout pregnancy. We followed their children from birth until 5 years of age. The main outcome measure was obesity (BMI for age and sex ≥ 95th percentile) at 5 years of age. We used poisson regression with robust variance estimation to compute risk ratio (RR). Results. At the 5th year of followup, 71 (9.6%) of the children were obese and 85 (11.5%) were overweight (BMI ≥ 85th–<95th percentile). In multivariable analysis, maternal prepregnancy overweight (RR: 2.30, 95% CI: 1.29–4.11) and obesity (RR: 2.53, 95% CI: 1.49–4.31), and child's birth weight >85th percentile (RR: 2.04, 95% CI: 1.13–3.68) were associated with childhood obesity. Maternal prepregnancy BMI, birth weight, and maternal smoking were associated with the child being overweight 1–12 cigarettes/day versus 0 cigarettes/day (RR: 1.40, 95% CI: 1.02–1.91). Conclusion. Children of overweight and obese mothers, and children with higher birth weight, are more likely to be obese and overweight at age 5. Maternal smoking 1–12 cigarettes per day is associated with the child being overweight.
doi:10.1155/2012/457173
PMCID: PMC3465910  PMID: 23056928
22.  Prevalence of Obesity Among Children in Six Chicago Communities: Findings from a Health Survey 
Public Health Reports  2008;123(2):117-125.
SYNOPSIS
Objectives
We analyzed data from a community health survey to assess levels of obesity and overweight among children in some Chicago communities compared with national U.S. estimates.
Methods
Data came from the Sinai Improving Community Health Survey, which was conducted via face-to-face interviews with people living in six racially and ethnically diverse Chicago communities during 2002 and 2003. A stratified, three-stage probability study design was employed to obtain a representative sample from each community. Height and weight data reported by the primary caretakers of 501 randomly selected children aged 2–12 years were used to determine age- and gender-specific body mass index (BMI), which was then used to classify weight status (obese ≥95th percentile for age and gender).
Results
Compared with 16.8% for the U.S., the prevalence of obesity was 11.8% in a non-Hispanic white community on Chicago's north side, 34.0% in a Mexican American community on the west side, and 56.4% in a non-Hispanic black community on the south side.
Conclusions
Surveillance of the childhood obesity epidemic at the local level is limited. Findings describe the extent of disparities in childhood overweight and obesity within one city and how local-level data can shape new initiatives for improved health, one community at a time.
PMCID: PMC2239321  PMID: 18457064
23.  Prevalence of Overweight and Obesity among Iranian School Children in Different Ethnicities 
Iranian Journal of Pediatrics  2011;21(4):514-520.
Objective
Malnutrition, overweight and obesity are major health concerns in modern societies and especially among children. Overweight and obesity affect children's current and future health. It is known that the prevalence of overweight differs by race, sex, and geographic location.
Methods
In a cross-sectional study 30092 Iranian children aged 7-18 years in six ethnic groups were selected by a cluster sampling. Prevalence of obesity and overweight and distribution of body mass index (BMI) by gender, age, and ethnicity were measured. Cutoff points of BMI for defining obesity and overweight were based on the Iranian, and IOTF standard values.
Findings
This study showed a significant ethnic difference in BMI. Prevalence of overweight and obesity among Iranian children was 9.27% and 3.22% respectively comparing international standards. The frequency of overweight and obesity was higher in boys.
Conclusion
This study showed a significant difference in BMI among different ethnic groups.
PMCID: PMC3446144  PMID: 23056841
BMI; Overweight; Obesity; School Children; Ethnicity
24.  Augmenting BMI and Waist-Height Ratio for Establishing More Efficient Obesity Percentiles among School-going Children 
Research Questions:
1. Are all the existing methods for estimating the obesity and overweight in school going children in India equally efficient? 2. How to derive more efficient obesity percentiles to determine obesity and overweight status in school-going children aged 7-12 years old?
Objectives:
1. To investigate and analyze the prevalence rate of obesity and overweight children in India, using the established standards. 2. To compare the efficiency among the tools with the expected levels in the Indian population. 3. To establish and demonstrate the higher efficiency of the proposed percentile chart.
Study Design:
A cross-sectional study using a completely randomized design.
Settings:
Government, private-aided, unaided, and central schools in the Thrissur district of Kerala.
Participants:
A total of 1500 boys and 1500 girls aged 7-12 years old.
Results:
BMI percentiles, waist circumference percentiles, and waist to height ratio are the ruling methodologies in establishing the obese and overweight relations in school-going children. Each one suffers from the disadvantage of not considering either one or more of the obesity contributing factors in human growth dynamics, the major being waist circumference and weight. A new methodology for mitigating this defect through considering BMI and waist circumference simultaneously for establishing still efficient percentiles to arrive at obesity and overweight status is detailed here. Age-wise centiles for obesity and overweight status separately for boys and girls aged 7-12 years old were established. Comparative efficiency of this methodology over BMI had shown that this could mitigate the inability of BMI to consider waist circumference. Also, this had the advantage of considering body weight in obesity analysis, which is the major handicap in waist to height ratio. An analysis using a population of 1500 boys and 1500 girls has yielded 3.6% obese and 6.2% overweight samples, which is well within the accepted range for Indian school-going children.
Conclusion:
The percentiles for school-going children based on age and sex were derived by comparing all other accepted standards used for measurement of obesity and overweight status. Hence, augmenting BMI and waist to height ratio is considered to be the most reliable method for establishing obesity percentiles among school-going children.
doi:10.4103/0970-0218.51233
PMCID: PMC2731976  PMID: 19714259
BMI; children; India; methodology; nutrition; overweight; percentile chart; waist circumference; waist-height ratio
25.  Augmenting BMI and Waist-Height Ratio for Establishing More Efficient Obesity Percentiles among School-going Children 
Research Questions
1. Are all the existing methods for estimating the obesity and overweight in school going children in India equally efficient? 2. How to derive more efficient obesity percentiles to determine obesity and overweight status in school-going children aged 7–12 years old?
Objectives
1. To investigate and analyze the prevalence rate of obesity and overweight children in India, using the established standards. 2. To compare the efficiency among the tools with the expected levels in the Indian population. 3. To establish and demonstrate the higher efficiency of the proposed percentile chart.
Study Design
A cross-sectional study using a completely randomized design.
Settings
Government, private-aided, unaided, and central schools in the Thrissur district of Kerala.
Participants
A total of 1500 boys and 1500 girls aged 7–12 years old.
Results
BMI percentiles, waist circumference percentiles, and waist to height ratio are the ruling methodologies in establishing the obese and overweight relations in school-going children. Each one suffers from the disadvantage of not considering either one or more of the obesity contributing factors in human growth dynamics, the major being waist circumference and weight. A new methodology for mitigating this defect through considering BMI and waist circumference simultaneously for establishing still efficient percentiles to arrive at obesity and overweight status is detailed here. Age-wise centiles for obesity and overweight status separately for boys and girls aged 7–12 years old were established. Comparative efficiency of this methodology over BMI had shown that this could mitigate the inability of BMI to consider waist circumference. Also, this had the advantage of considering body weight in obesity analysis, which is the major handicap in waist to height ratio. An analysis using a population of 1500 boys and 1500 girls has yielded 3.6% obese and 6.2% overweight samples, which is well within the accepted range for Indian school-going children.
Conclusion
The percentiles for school-going children based on age and sex were derived by comparing all other accepted standards used for measurement of obesity and overweight status. Hence, augmenting BMI and waist to height ratio is considered to be the most reliable method for establishing obesity percentiles among school-going children.
doi:10.4103/0970-0218.51233
PMCID: PMC2731976  PMID: 19714259
BMI; children; India; methodology; nutrition; overweight; percentile chart; waist circumference; waist-height ratio

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