Predicting maintenance or achievement of healthy weight in children: the impact of changes in physical fitness

Physical fitness is often inversely associated with adiposity in children cross-sectionally, but the effect of becoming fit or maintaining fitness over time on changes in weight status has not been well studied in children. We investigated the impact of changes in fitness over 1-4 years of follow-up on the maintenance or achievement of healthy weight among 2,793 schoolchildren who were first measured as 1st to 7th graders. Students were classified as "fit" or "underfit" according to age- and gender-specific norms in five fitness domains: endurance, agility, flexibility, upper body strength, and abdominal strength. Weight status was dichotomized by BMI percentile: "healthy weight" (<85th percentile) or "overweight/obese" (≥85th percentile). At baseline, of the 38.3% overweight/obese children, 81.9% (N = 875) were underfit. Underfit overweight students were more likely to achieve healthy weight if they achieved fitness (boys: odds ratio (OR) = 2.68, 95% confidence interval (CI) = 1.24-5.77; girls: OR = 4.67, 95%CI = 2.09-10.45). Initially fit overweight children (N = 194) were more likely to achieve healthy weight if they maintained fitness (boys: OR = 11.99, 95%CI = 2.18-65.89; girls: OR = 2.46, 95%CI = 1.04-5.83). Similarly, initially fit healthy-weight children (N = 717) were more likely to maintain healthy weight if they maintained fitness (boys: OR 3.70, 95%CI = 1.40-9.78; girls: OR = 4.14, 95%CI = 1.95-8.78). Overweight schoolchildren who achieve or maintain physical fitness are more likely to achieve healthy weight, and healthy-weight children who maintain fitness are more likely to maintain healthy weight. School-based policies/practices that support physical fitness may contribute to obesity reduction and maintenance of healthy weight among schoolchildren.     

High prevalence of the metabolic syndrome in Iranian adolescents

Objective : No evidence exists regarding the prevalence of the metabolic syndrome in adolescents in Middle Eastern countries. We aimed to evaluate the prevalence of the metabolic syndrome in a representative sample of Iranian adolescents. Research Methods and Procedures : Anthropometry, biochemical measurements, and blood pressure were assessed in a population‐based cross‐sectional study of 3036 Iranian adolescents (1413 boys and 1623 girls) 10 to 19 years of age. Metabolic syndrome was defined according to modified Adult Treatment Panel III definition. Overweight (≥95th percentile) and at risk for overweight (≥85th to <95th percentile) was defined based on the standardized percentile curves of BMI suggested for Iranian adolescents. Results : The prevalence of the metabolic syndrome was 10.1% (95% confidence interval: 9.0 to 11.1) among Iranian adolescents (boys: 10.3%, 8.6 to 11.8; girls: 9.9%, 8.4 to 11.3). Overall, low serum high‐density lipoprotein‐cholesterol and high serum triglycerides were the most common components of the metabolic syndrome (42.8% and 37.5%, respectively). Overweight subjects had the highest proportion of metabolic syndrome compared with those at risk for overweight and those with normal weight (boys: 41.1% vs. 11.4% and 3.0%, respectively, p < 0.01; girls: 43% vs. 15.2% and 5.0%, respectively, p < 0.01). Discussion : This study provides evidence showing a high prevalence of the metabolic syndrome in Iranian adolescents, particularly among overweight adolescents.     

Family Dinner and Adolescent Overweight

Objective: The purpose of this study was to examine both cross‐sectional and longitudinal associations between frequency of family dinner and overweight status in a large sample of 9‐ to 14‐year‐old children. Research Methods and Procedures: We studied a cohort of 7784 girls and 6647 boys, 9 to 14 years of age at baseline in 1996, participating in the Growing Up Today Study. From annual mailed surveys, we calculated BMI from self‐reported height and weight and assessed frequency of family dinner over the previous year. We defined “overweight” as age‐ and sex‐specific BMI >85th percentile. We performed multiple logistic regression analyses; the longitudinal analyses assessed the association of previous year family dinner consumption with 1‐year incidence of becoming overweight, using prospective data from 1996 through 1999. Results: At baseline in 1996, 16% of participants had family dinner “never or some days,” 40% on “most days,” and 44% “every day.” Across these categories, overweight prevalence for girls was 19.4%, 16.6%, and 16.7% and for boys was 24.6%, 23.3%, and 22.7%, respectively. In cross‐sectional analyses, adjusting for potential confounders, the odds of being overweight was 0.85 [95% confidence interval (CI): 0.76, 0.96] among children who ate family dinner on “most days” or “every day” compared with those who ate family dinner “never or some days.” In longitudinal multivariate models, the odds ratios between previous year frequency of eating family dinner and 1‐year incidence of becoming overweight were 0.95 (95% CI: 0.78, 1.16) and 1.04 (95% CI: 0.85, 1.27) for children who ate family dinner on “most days” and “every day,” respectively, compared with those who ate family dinner “never or some days.” Discussion: The frequency of eating family dinner was inversely associated with overweight prevalence at baseline but not with likelihood of becoming overweight in longitudinal analyses.     

Impact of Objective and Subjective Social Status on Obesity in a Biracial Cohort of Adolescents

Objective: To characterize the associations between socioeconomic status (SES), two levels of subjective social status (SSS), and adolescent obesity. Research Methods and Procedures: Cross‐sectional study of 1491 black and white adolescents attending public school in a suburban school district in Greater Cincinnati, Ohio. BMI ≥95th percentile derived from measured height and weight defined overweight. Students rated SSS on separate 10‐point scales for society and school. A parent provided information on parent education and household income for SES. Results: Although there were no sex differences in SES, black students were more likely to come from families with less well‐educated parents and lower incomes (p < 0.001). Black girls had the lowest societal SSS (p = 0.003), lowest school SSS (p = 0.046), and highest BMI (p < 0.001). Prevalence of overweight was highest among black girls (26.0%) and boys (26.2%), intermediate for white boys (17.2%), and least for white girls (11.6%). Logistic regression modeling revealed that parent education, household income, and school SSS were each associated with overweight. In a fully adjusted model, school SSS retained its association to overweight (odds ratio, 1.16; 95% CI, 1.06, 1.26) independent of SES. The association of school SSS was strongest among white girls, intermediate for white and black boys, and absent for black girls. Discussion: Perceptions of social stratification are independently associated with overweight. There were important racial and sex differences in the social status‐overweight association. SSS in the more immediate, local reference group, the school, had the strongest association to overweight.     

Obesity and Sugar‐sweetened Beverages in African‐American Preschool Children: A Longitudinal Study

A representative sample of 365 low‐income African‐American preschool children aged 3–5 years was studied to determine the association between sugar‐sweetened beverage consumption (soda, fruit drinks, and both combined) and overweight and obesity. Children were examined at a dental clinic in 2002–2003 and again after 2 years. Dietary information was collected using the Block Kids Food Frequency Questionnaire. A BMI score was computed from recorded height and weight. Overweight and obesity were defined by national reference age‐sex specific BMI: those with an age‐sex specific BMI ≥85th, but <95th percentile as overweight and those with BMI ≥95th age‐sex specific percentile as obese. The prevalence of overweight was 12.9% in baseline, and increased to 18.7% after 2 years. The prevalence of obesity increased from 10.3 to 20.4% during the same period. Baseline intake of soda and all sugar‐sweetened beverages were positively associated with baseline BMI z‐scores. After adjusting for covariates, additional intake of fruit drinks and all sugar‐sweetened beverages at baseline showed significantly higher odds of incidence of overweight over 2 years. Among a longitudinal cohort of African‐American preschool children, high consumption of sugar‐sweetened beverages was significantly associated with an increased risk for obesity.     

The association between an objective measure of physical activity and weight status in preschoolers

Objective: Our objective was to determine the association between physical activity and BMI among racially diverse low‐income preschoolers. Research Methods and Procedures: This was a cross‐sectional study of 2‐ to 5‐year‐olds (n = 56) enrolled in Massachusetts Special Supplemental Nutrition Program for Women, Infants & Children (WIC). Physical activity was measured for 7 consecutive days with an accelerometer. Height and weight were obtained from WIC records, and BMI‐for‐age percentiles were calculated based on the Centers for Disease Control and Prevention's (CDC) 2000 Growth Charts. At‐risk‐for‐overweight (BMI‐for‐age of ≥85th to <95th percentile) and overweight (BMI‐for‐age ≥95th percentile) groups were combined and referred to as overweight. Final analysis inclusion criteria were: completion of 4.5 days of activity assessment and anthropometric data obtained within 90 and 120 days of the activity assessment for children ages 24 to 35.99 and 36 to 59.99 months, respectively. Results: Overweight children had significantly lower mean daily very vigorous minutes (VVM) (2.6 mins vs. 4.6 mins, p < 0.05) and lower very active minutes (VAM) [i.e., sum of vigorous minutes (VM) and VVM] per day (22.9 mins vs. 32.1 mins, p < 0.05) than children who were not overweight. Daily VVM [odds ratio (OR) = 0.68; 95% confidence interval (CI), 0.49 to 0.96], VM (OR = 0.94; CI, 0.88 to 1.00), and VAM (OR = 0.94; 95% CI, 0.89 to 1.00) were all associated with significantly lower odds of being overweight. Discussion: This study suggests that, in a diverse group of preschoolers, vigorous and very vigorous activity are associated with lower odds of overweight. However, these findings require corroboration in a diverse sample of preschoolers using a longitudinal design.     

Prevalence of overweight among Baltimore City schoolchildren and its associations with nutrition and physical activity

Objective: To determine the prevalence of overweight and at‐risk‐for‐overweight in schoolchildren from Baltimore City. Research Methods and Procedures: Ten schools within city limits were randomly selected from each tertile of income, using eligibility for free school lunch as a proxy. A total of 209 third grade students from eight public schools in Baltimore City were surveyed in May 2000. Anthropometric data including height, weight, subscapular and triceps skinfold thickness, and percentage body weight from bioelectrical impedance were collected. Nutrition‐related knowledge, attitudes, and behaviors were assessed using a validated questionnaire. Physical activity was assessed by questionnaire. Results: Based on International Obesity Taskforce reference values for BMI‐for‐age, 20.7% of girls and 17.2% of boys were overweight (BMI > 95th percentile) and 15.3% of girls and 14.1% of boys were at‐risk‐for‐overweight (BMI between the 85th and 95th percentiles). The prevalence of overweight and at‐risk‐for‐overweight did not vary by self‐reported physical activity levels or by nutrition‐related knowledge and behaviors. Discussion: The high prevalence of overweight and at‐risk‐for‐overweight in this sample of inner‐city children from Baltimore City highlights a need for targeted preventive and treatment interventions.     

Psychosocial Concerns and Health-Compromising Behaviors among Overweight and Nonoverweight Adolescents

Objective: To compare weight-specific and global psychosocial concerns and health-compromising behaviors among overweight and nonoverweight youth across gender and ethnicity. Methods: A cross-sectional school-based survey of 31,122 adolescents in grades 7 to 12. Based on self-reported heights and weights, respondents were categorized as nonoverweight (body mass index (BMI) <85th percentile), moderately overweight (85th percenile <BMI <95th percentile), or severely overweight (BMI >95th percentile). Results: Global psychosocial concerns, such as emotional well-being, suicidal ideation, future job concerns, and peer concerns, did not differ greatly between nonoverweight, moderately overweight, and severely overweight adolescents. Substance abuse behaviors were equally or less prevalent among the overweight group. Overweight girls were significantly less likely to consume alcohol, whereas overweight boys were at lower risk for marijuana use. In contrast, overweight youth were more likely to perceive their health as only fair or poor and were more likely to express weight-specific concerns and engage in behaviors such as chronic dieting and binge eating than nonoverweight youth. Overweight American Indian girls perceived their physical health more positively than nonoverweight American Indian girls. Strong associations were found between overweight status and chronic dieting among African American boys and girls. Conclusions: Nutritional counseling and educational programs need to address the weight-specific concerns and behaviors of overweight adolescents. However, assumptions regarding global psychosocial concerns and health-compromising behaviors among overweight adolescents of different genders and ethnicities should be avoided. These broad issues need to be explored in more depth at both the research and intervention levels.     

Racial Differences in the Tracking of Childhood BMI to Adulthood

Objective: The possibility that there are racial differences in the patterns of BMI (kilograms per meter squared) change throughout life has not been examined. For example, the high prevalence of obesity among black women could result from a higher prevalence of obesity among black girls or because normal‐weight black girls experience larger BMI increases in adolescence or adulthood than do their white counterparts. Therefore, we examined the tracking of childhood BMI into adulthood in a biracial (36% black) sample. Research Methods and Procedures: Five‐ to 14‐year‐old children (2392) were followed for (mean) 17 years. Childhood overweight was defined as BMI ≥ 95th percentile, and adult obesity was defined as BMI ≥ 30 kg/m². Results: The tracking of childhood BMI differed between whites and blacks. Among overweight children, 65% of white girls vs. 84% of black girls became obese adults, and predictive values among boys were 71% (whites) vs. 82% (blacks). These racial differences reflected contrasting patterns in the rate of BMI change. Although the initial BMI of black children was not higher than that of white children, BMI increases with age were larger among black girls and overweight black boys than among their white counterparts. In contrast, relatively thin (BMI < 50th percentile) white boys were more likely to become overweight adults than were their black counterparts. Discussion: These findings emphasize the black/white differences in BMI changes with age. Because of the adult health consequences of childhood‐onset obesity, early prevention should be given additional emphasis.     

Obesity and the occurrence of bronchitis in adolescents

Objective:

Previous studies have shown that an elevated BMI was associated with higher risks of bronchitis among children. The magnitude of how increase in BMI influencing the risk of incident bronchitis remained unexplored. The objective of this study is to assess the association between BMI and the incidence of bronchitis in the Taiwan Children Health Study.

Design:

A school‐based prospective cohort study.

Methods:

We conducted a population‐based prospective cohort study among seventh‐grade school children in 14 Taiwanese communities. A total of 3,634 adolescents completed follow‐up questionnaire in 2009. Associations between BMI and incident bronchitis were analyzed by multiple Poisson regression models, taking overdispersion into account.

Results:

Among eligible cohort participants without bronchitis at study entry, the proportion of overweight and obesity were 32.1% and 17.9%. Overweight was 40.7% and obesity was 27.7% among those with incident bronchitis. The BMI percentile categories showed significant increasing trends for bronchitis in total eligible children and in girls (P for trend <0.001). Overweight and obesity were both associated with increased risks of incident bronchitis. This association was significant in girls only while stratified by gender.

Conclusions:

Our data showed that the BMI percentile and weight status were associated with higher risks of incident bronchitis in adolescents, especially in girls.     

Adiposity, physical activity, and physical fitness among children from Aragón, Spain

Objective: The main purpose of this study was to determine the relationship between physical activity (PA) levels and adiposity. The secondary purpose was to assess the effect of physical fitness and living area on adiposity. Research Methods and Procedures: A cross‐sectional study was carried out in a regional representative sample of 1068 children 7 to 12 years of age. Anthropometric and physical fitness values (including BMI, aerobic capacity, strength levels, velocity assessment, and flexibility) were measured in all children. Results: The prevalence of being overweight and obese in the entire sample was 31% and 6%, respectively. No difference between urban and rural children was found. The proportion of boys who were classified as overweight and obese was similar in physically active and sedentary (non‐physically active) groups. However, physically active girls tended to show lower obesity prevalence compared with their sedentary counterparts (p = 0.06). In girls, the sum of the 6 skinfolds thickness (SSF) measurements was lower in the physically active group when compared with the non‐physically active group (p < 0.05); however, this effect was not observed in boys. Multiple regression analysis revealed that the level of physical activity (PA) had a significant effect on BMI and SSF in boys but not in girls, while maximal oxygen uptake (Vo _2max) was significantly related to adiposity in both sexes. Discussion: Regular participation in at least 2 hours per week of sports activities on top of the compulsory education program is associated with better physical fitness and lower whole body adiposity. In the children included in our study, among all physical fitness variables, Vo _2max showed the strongest relationship with BMI and fat mass assessed by means of skinfold measurements.     

Headaches in overweight children and adolescents referred to a tertiary-care center in Israel

Objective: To assess the association between obesity and primary headaches in children and adolescents. Methods and Procedures: In a prospective study, the short‐questionnaire version based on existing International Headache Society diagnostic criteria was administered. Two hundred and seventy‐three children and adolescents (61% females) aged 9–17 years were assessed. One hundred and sixteen (42.5%) subjects were of normal weight, 45 (16.5%) were at risk for overweight (BMI >85th and <95th percentile for age and gender) and 112 (41%) were overweight (BMI ≥95th percentile). The outcome measures were prevalence of headaches, type of headaches, association between headaches and elevated blood pressure in overweight subjects. Results: Headache was reported in 39 (14.3%) subjects, with a similar rate in females (14.5%) and males (14%). Among 39 subjects with headaches, 20 (17.9%) were overweight, 7 (15.6%) were at risk for overweight and 12 (10.3%) were normal‐weight children. Among females, 7.7% of normal‐weight group suffered from headaches, compared with 14.8% of the at risk for overweight group and 20.3% of the overweight group (P for trend 0.04). Among males, the occurrence of headaches was similar in all three weight groups (P = 0.96). The occurrence of headaches increased from 10.6% among children aged 9–11 years to 21.8% in the 15–18 years age group (P < 0.05). In multivariate analysis, a significant independent risk for headaches was present in overweight females (odds ratio (OR) = 3.93, 95% confidence interval (CI) 1.28–12.1) and in adolescents aged 15–18 years (OR = 2.62, 95% CI 1.07–6.45). Elevated blood pressure was not independently associated with headaches. Of the 15 children with migraine, 12 were either at risk for overweight or overweight. Discussion: Overweight females had an almost fourfold excess risk of headaches when compared with normal‐weight girls.     

Physical activity levels of normal-weight and overweight girls and boys during primary school recess

Objective: This study aimed to compare moderate‐to‐vigorous physical activity (MVPA) and vigorous physical activity (VPA) in normal‐weight and overweight boys and girls during school recess. Research Methods and Procedures: Four hundred twenty children, age 6 to 10 years, were randomly selected from 25 schools in England. Three hundred seventy‐seven children completed the study. BMI was calculated from height and weight measurements, and heart rate reserve thresholds of 50% and 75% reflected children's engagement in MVPA and VPA, respectively. Results: There was a significant main effect for sex and a significant interaction between BMI category and sex for the percent of recess time spent in MVPA and VPA. Normal‐weight girls were the least active group, compared with overweight boys and girls who were equally active. Fifty‐one boys and 24 girls of normal weight achieved the 40% threshold; of these, 30 boys and 10 girls exceeded 50% of recess time in MVPA. Eighteen overweight boys and 22 overweight girls exceeded the 40% threshold, whereas 8 boys and 8 girls exceeded the 50% threshold. Discussion: Overweight boys were significantly less active than their normal‐weight male counterparts; this difference did not hold true for girls. Even though nearly double the number of normal‐weight children achieved the 40% of MVPA during recess compared with overweight children, physical activity promotion in school playgrounds needs to be targeted not only at overweight but at other health parameters, as 40 overweight children met the 40% MVPA target proposed for recess.     

Prevalence of Overweight among Inner City Hispanic‐American Children and Adolescents

Objective: National surveys have pointed to a particularly high risk of pediatric overweight among U.S. Hispanics. However, the data have been primarily from the Mexican‐American community. We studied the prevalence of overweight and clinical comorbidities in children and youth of predominantly El Salvadoran ancestry. Research Methods and Procedures: A sample of 309 Hispanic youth, 6–18 years was surveyed from two inner city Washington, DC, clinics. BMI; triceps skinfold (TSF) and subscapular skinfold thickness (SSSF); bioelectrical impedance analysis (BIA); and blood pressure measures were obtained, along with information regarding physical activity, sedentary behavior, dietary history, family, and personal medical history. Results: Thirty‐eight percent were overweight (BMI ≥ 95th percentile) and 22% at risk for overweight (BMI 85–94th percentile). Thirty‐four percent had TSF ≥ 90th percentile and 29% had SSSF ≥ 90th percentile. Fifty‐one percent of males and 70% of females had body fat > 30%. Compared to their nonoverweight counterparts, overweight youth had significantly higher systolic blood pressure (111.4 ± 1.3 vs. 104.5 ± 0.9 mm Hg, p < 0.0001). Among children younger than 11 years, overweight was associated with onset of adrenarche (23% vs. 10%, p = 0.01). Participation in one or more sports teams was negatively correlated with overweight) p = 0.04). Discussion: The prevalence of overweight and at risk for overweight in this sample was twice the national average for U.S. children and 1.7 times greater than that of Mexican‐American children in national surveys. Overweight was associated with advanced pubertal development, high body fat, elevated blood pressure, and decreased sports participation.     

Prevalence of obesity in elementary schoolchildren living in Northeast Attica, Greece

Objective: To assess the prevalence of obesity and obesity trend in schoolchildren living in Northeast Attica, Greece. Research Methods and Procedures: Mean (standard deviation) and median weight and BMI were calculated in 4131 (2054 boys and 2077 girls) 6‐ to 11‐year‐old Greek schoolchildren living in Northeast Attica between November 2003 and April 2004. Two hundred thirty‐six (95 boys, 141 girls) immigrant children also participated in the study. The secular trend for obesity was determined comparing our data with those of a similar study performed in 1994. Results: Of boys, 27.8% were overweight, and 12.3% were obese. For girls, the corresponding values were 26.5% for overweight and 9.9% for obesity. There was an increase in the prevalence of overweight and obesity in the last 10 years in both sexes. For boys, overweight increased by 4.2% and obesity by 2.9%, whereas, for girls, overweight increased by 3.8% and obesity by 1.6%. Overweight and obesity were less prevalent in the immigrant children compared with their Greek peers. For immigrant boys, overweight was 15.9% and obesity was 7.9%, and for immigrant girls, overweight was 15.2% and obesity was 8.7%. Discussion: Greek schoolchildren living in Northeast Attica present a high prevalence of overweight and obesity and a positive secular change in the prevalence of obesity.     

Prevalence and Covariates of Obesity in Lebanon: Findings from the First Epidemiological Study

Objective: To estimate the prevalence of overweight and obesity and examine associated covariates in the Lebanese population. Research Methods and Procedures: A cross‐sectional survey of a representative sample of 2104 individuals, 3 years of age and older. Anthropometric measurements and dietary assessments were conducted following standard methods and techniques. Overweight and obesity (classes I to III) were defined according to internationally standardized criteria for classification of BMI. Results: For children 3 to 19 years of age, prevalence rates of overweight and obesity were higher overall for boys than girls (22.5% vs. 16.1% and 7.5% vs. 3.2%, respectively). For adult men and women (age ≥ 20 years), the prevalence of overweight was 57.7% and 49.4%, respectively. In contrast, obesity (BMI ≥ 30 kg/m²) was higher overall among women (18.8%) than men (14.3%), a trend that became more evident with increasing obesity class. BMI, percentage of body fat, and waist circumference increased to middle age and declined thereafter. Whereas lack of exercise associated significantly with obesity among children, obesity in older adults was more prevalent among the least educated, nonsmokers, and those reporting a family history of obesity. Discussion: The results from this national population‐based study in Lebanon show high prevalence rates of overweight and obesity comparable with those observed in developed countries such as the United States. While further studies are needed to examine the underlying social and cultural factors associated with lifestyle and nutritional habits, now is the time to institute multicomponent interventions promoting physical activity and weight control nationwide.     

Reference Growth Curves for Cypriot Children 6 to 17 Years of Age

Objective: The purpose of the study was to present smoothed percentiles for body weight and height, waist circumference, and body mass index (BMI) in Cypriot children and to compare their BMI 85th and 95th percentiles with those of children in other countries. Research Methods and Procedures: The study was a cross‐sectional study, including a representative sample of 2472 healthy children (49.1% boys) in Cyprus ages 6 to 17 years, who were evaluated during the 1999–2000 school year. Body weight and height and waist circumference were measured using standard procedures. BMI was calculated as weight in kilograms per height in square meters. Smoothed, sex‐specific percentiles for these variables were calculated using polynomial regression models. Crude weight, height, waist, and BMI percentile values are presented in sex‐specific tables and smoothed percentile curves are presented in charts. The 85th and 95th percentiles for BMI were compared with measurements from other countries, because of the concern of the upper limits of BMI in respect to the evaluation of obesity. Results: The 85th and 95th BMI percentile values are higher in Cypriot boys than in Swedish and Iranian boys through all ages and in girls ages 6 to 15 years, whereas after the age of 15 years, both Swedish and Iranian girls’ percentiles are equalized with their Cypriot peers. Discussion: Weight, height, waist circumference, and BMI values and charts are presented for the first time for Cypriot children and adolescents. Much concern should be addressed to the observation that for the majority of the Cypriot sample, the upper BMI limits are higher than the peers of developing and developed countries.     

Racial/ethnic differences in body fatness among children and adolescents

Background: Although the BMI is widely used as a measure of adiposity, it is a measure of excess weight, and its association with body fatness may differ across racial or ethnic groups. Objective: To determine whether differences in body fatness between white, black, Hispanic, and Asian children vary by BMI‐for‐age, and whether the accuracy of overweight (BMI‐for‐age ≥ Centers for Disease Control and Prevention (CDC) 95th percentile) as an indicator of excess adiposity varies by race/ethnicity. Methods and Procedures: Total body dual‐energy X‐ray absorptiometry (DXA) provided estimates of %body fat among 1,104 healthy 5‐ to 18‐year‐olds. Results: At equivalent levels of BMI‐for‐age, black children had less (mean, 3%) body fatness than white children, and Asian girls had slightly higher (1%) levels of %body fat than white girls. These differences, however, varied by BMI‐for‐age, with the excess body fatness of Asians evident only among relatively thin children. The ability of overweight to identify girls with excess body fatness also varied by race/ethnicity. Of the girls with excess body fatness, 89% (24/27) of black girls, but only 50% (8/16) of Asian girls, were overweight (P = 0.03). Furthermore, the proportion of overweight girls who had excess body fatness varied from 62% (8/13) among Asians to 100% (13/13) among whites. Discussion: There are racial or ethnic differences in body fatness among children, but these differences vary by BMI‐for‐age. If race/ethnicity differences in body fatness among adults also vary by BMI, it may be difficult to develop race‐specific BMI cut points to identify equivalent levels of %body fat.     

Energy intake, diet composition, energy expenditure, and body fatness of adolescents in northern Greece

Objective: The purpose of this study was to examine energy intake, energy expenditure, diet composition, and obesity of adolescents in Northern Greece. Research Methods and Procedures: Anthropometric measurements were taken for all participants. Height, weight, and skinfold thickness at two sites were measured. BMI and percentage body fat were calculated. Energy intake and macronutrient and micronutrient intakes were determined by a 3‐day weighed dietary diary. Energy expenditure was calculated based on calculated resting metabolic rate (RMR) 1 multiplied by an activity factor based on reported physical activity. Results: Thirty‐one percent of boys and 21% of girls had BMI corresponding to ≥25 kg/m² at 18 years and were classified as overweight. Both overweight boys and girls reported a lower energy intake compared with their non‐overweight counterparts when expressed as kilocalories per kilogram body weight. Overweight children had a higher negative energy balance. Both overweight and non‐overweight adolescents had higher than recommended fat intakes. Mean daily carbohydrate, protein, and fat intake, expressed as grams per kilogram body weight, of overweight adolescents were significantly lower compared with the non‐overweight adolescents. Total daily carbohydrate intake, when expressed in grams, was found to be higher for non‐overweight adolescents. Both overweight boys and girls had lower iron intakes than their non‐overweight counterparts. Overweight boys had statistically lower fiber and niacin intakes than non‐overweight boys. Both overweight and non‐overweight adolescents had lower than recommended iron intakes. Furthermore, overweight adolescents consumed more snacks (potato chips, chocolate bars, pizza, cheese pie, and cream pie), more sugar, jam, and honey, and fewer legumes, vegetables, and fruits than their non‐overweight counterparts. Discussion: Reported energy intake of overweight adolescents was lower than their non‐overweight counterparts. Regarding diet composition overweight subjects had significantly lower intakes of carbohydrates compared with non‐overweight subjects. The food consumption pattern of overweight children showed less adherence to the traditional Mediterranean diet.     

Obesity and Overweight Prevalence in Polish 7‐ to 9‐Year‐Old Children

Objective: Secular trend in childhood obesity is a well‐known phenomenon, and it is important to monitor it in cross‐sectional studies. The study aim was to estimate prevalence of obesity and overweight in Polish 7‐ to 9‐year‐old children and to compare the results with a French study based on the same protocol. Research Methods and Procedures: The study was conducted in 2001 according to the protocol of the European Childhood Obesity Group. Height and weight were measured, and BMI was calculated to define nutritional status in a randomly selected group of 2916 (1445 girls and 1471 boys) primary school children. Obesity and overweight were estimated according to International Obesity Task Force references with curve for obesity and overweight passing through 30 and 25 kg/m² at age 18, respectively. Results: Overweight (including obesity) was found in 15.4% of Polish children (in 15.8% of girls and 15.0% of boys) and obesity in 3.6% (3.7% of girls and 3.6% of boys) compared with 18.1% of overweight and 3.8% of obese children in French study. There was no significant difference in nutrition status between Polish and French children except for higher frequency of overweight in French 9‐year‐old boys. The same trend of decreasing overweight through age classes was observed in both populations. Discussion: The prevalence of obesity and overweight (including obesity) in prepubertal children estimated in two European countries according to the same protocol and using the same references showed little differences between the two populations despite higher prevalence of obesity in Polish than French adults.