Family‐based hip‐hop to health: Outcome results

Objective:

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 BMI at 1‐year follow‐up.

Design and Methods:

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).

Results:

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.

Conclusions:

While the data reflect a downward trend in obesity among these young Hispanic children, obesity rates remained higher at 1‐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.     

A community intervention reduces BMI z-score in children: Shape Up Somerville first year results

Objective: The objective was to test the hypothesis that a community‐based environmental change intervention could prevent weight gain in young children (7.6 ± 1.0 years). Research Methods and Procedures: A non‐randomized controlled trial was conducted in three culturally diverse urban cities in Massachusetts. Somerville was the intervention community; two socio‐demographically‐matched cities were control communities. Children (n = 1178) in grades 1 to 3 attending public elementary schools participated in an intervention designed to bring the energy equation into balance by increasing physical activity options and availability of healthful foods within the before‐, during‐, after‐school, home, and community environments. Many groups and individuals within the community (including children, parents, teachers, school food service providers, city departments, policy makers, healthcare providers, before‐ and after‐school programs, restaurants, and the media) were engaged in the intervention. The main outcome measure was change in BMI z‐score. Results: At baseline, 44% (n = 385), 36% (n = 561), and 43% (n = 232) of children were above the 85th percentile for BMI z‐score in the intervention and the two control communities, respectively. In the intervention community, BMI z‐score decreased by ?0.1005 (p = 0.001, 95% confidence interval, ?0.1151 to ?0.0859) compared with children in the control communities after controlling for baseline covariates. Discussion: A community‐based environmental change intervention decreased BMI z‐score in children at high risk for obesity. These results are significant given the obesigenic environmental backdrop against which the intervention occurred. This model demonstrates promise for communities throughout the country confronted with escalating childhood obesity rates.     

Bright Start: Description and Main Outcomes From a Group‐Randomized Obesity Prevention Trial in American Indian Children

The aim of the Bright Start study was to develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first‐grade American Indian children. Bright Start was a group‐randomized, school‐based trial involving 454 children attending 14 schools on the Pine Ridge Reservation in South Dakota. Children were followed from the beginning of their kindergarten year through the end of first grade. Main outcome variables were mean BMI, mean percent body fat, and prevalence of overweight/obese children. The goals of the intervention were to: increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. At baseline, 32% of boys and 25% of girls were overweight/obese. Although the intervention was not associated with statistically significant change in mean levels of BMI, BMI‐Z, skinfolds or percentage body fat, the intervention was associated with a statistically significant net decrease of 10% in the prevalence of overweight. Intervention children experienced a 13.4% incidence of overweight, whereas the control children experienced a corresponding incidence of 24.8%; a difference of ?11.4% (P = 0.033). The intervention significantly reduced parent‐reported mean child intakes of sugar‐sweetened beverages, whole milk, and chocolate milk. Changes in duration of school physical activity were not significant. Because obesity is the most daunting health challenge facing American Indian children today, more intervention research is needed to identify effective approaches.     

Body mass effects of a physical activity and healthy food intervention in middle schools

Objective: To evaluate the effects of a 2‐year middle school physical activity and healthy food intervention, including an environmental and computer‐tailored component on BMI and BMI z‐score in boys and girls. Research Methods and Procedures: A random sample of 15 schools with seventh and eighth graders was randomly assigned to three conditions: an intervention with parental support group, an intervention‐alone group, and a control group. Weight and height were measured at the beginning and end of each school year to assess BMI and BMI z‐score. A physical activity and healthy food program was implemented over 2 school years. Results: In girls, BMI and BMI z‐score increased significantly less in the intervention with parental support group compared with the control group (p < 0.05) or the intervention‐alone group (p = 0.05). In boys, no significant positive intervention effects were found. Discussion: This was the first study evaluating the effectiveness of an intervention combining environmental changes with personal computer‐tailored feedback on BMI and BMI z‐score in middle school children. After 2 school years, BMI and BMI z‐score changed in a more positive direction in girls as a result of the intervention with parental support.     

Immigrational Background Affects the Effectiveness of a School‐based Overweight Prevention Program Promoting Water Consumption

We tested whether a simple overweight prevention program promoting water consumption in elementary schools is equally effective in children with an immigrational background (MIG) and in those without (non‐MIG). Thus, a secondary analysis of a controlled cluster trial, lasting one school year, was conducted. Thirty‐two elementary schools located in low socioeconomic districts in two German cities were included. Of the 2,950 school children analyzed, 1,306 were MIG children. Water fountains were installed in the schools of the intervention group (IG) and teachers held lessons to promote water consumption. Control schools (control group (CG)) did not receive any intervention. Before and after intervention, body weight and height was measured. Overweight was defined by age‐ and sex‐specific BMI cutoffs that are linked to an adult BMI of 25 kg/m². Beverage consumption was assessed in questionnaires. Modification of intervention effects by immigrational background was tested by interaction terms. The immigrational background modified the intervention effect on prevalence and remission of overweight (interaction term: P = 0.03 and P = 0.02), but not on the incidence of overweight (P = 0.06). After intervention, the risk of being overweight was reduced in the IG compared to the CG among non‐MIG (odds ratio = 0.51, 95% confidence interval (CI): 0.31–0.83), but not among MIG children (odds ratio = 1.02, 95% CI: 0.63–1.65). After intervention, water consumption significantly increased in the IG equally among both, non‐MIG and MIG, by ～1 glass/day. A simple school‐based intervention promoting water consumption prevented overweight in non‐MIG children, but failed in MIG children. Different beverage consumption, among other lifestyle factors, may account for this effect but scientific discussion remains open.     

Gamification of Dietary Decision-Making in an Elementary-School Cafeteria

Despite the known health benefits of doing so, most US children do not consume enough fruits and vegetables (FV). School-based interventions can be effective in increasing FV consumption, but the most effective of these require that schools allocate their time, effort, and financial resources to implementing the program: expenditures that schools may be reluctant to provide in climates of academic accountability and economic austerity. The present demonstration project used a behaviorally based gamification approach to develop an intervention designed to increase FV consumption while minimizing material and labor costs to the school. During the intervention, the school (N = 180 students in grades K-8) played a cooperative game in which school-level goals were met by consuming higher-than-normal amounts of either fruit or vegetables (alternating-treatments experimental design). School-level consumption was quantified using a weight-based waste measure in the cafeteria. Over a period of 13 school days, fruit consumption increased by 66% and vegetable consumption by 44% above baseline levels. Use of an alternating-treatment time-series design with differential levels of FV consumption on days when fruit or vegetable was targeted for improvement supported the role of the intervention in these overall consumption increases. In post-intervention surveys, teachers rated the intervention as practical in the classroom and enjoyed by their students. Parent surveys revealed that children were more willing to try new FV at home and increased their consumption of FV following the intervention. These findings suggest that a behaviorally based gamification approach may prove practically useful in addressing concerns about poor dietary decision-making by children in schools.     

Four-year follow-up of school-based intervention on overweight children: the KOPS study

Objective: To evaluate the 4‐year outcome of a school‐based health promotion on weight status as part of the Kiel Obesity Prevention Study (KOPS). Research Methods and Procedures: Within a cluster‐sampled quasi‐randomized controlled trial, 1764 children at 6 and 10 years of age were assessed between 1996 and 2005 in 32 primary schools in Kiel, North Germany. Six nutrition units followed by 20‐minute running games were performed within the first year at school. Prevalence, incidence, and remission of overweight were main outcome measures. Results: The 4‐year change in BMI was +11.6%, with increases in prevalence of overweight and obesity from 5.2% to 11.1% and 3.9% to 5.1%, respectively. Cumulative 4‐year incidence of overweight and obesity was 9.2% and 3.1%, respectively. Intervention had no effect on mean BMI. The effect on prevalence was significant in children from families with high socioeconomic status [odds ratio (OR), 0.35; 95% confidence interval (CI), 0.14 to 0.91] and marginally significant in children of normal‐weight mothers (OR, 0.57; 95% CI, 0.33 to 1.00). Cumulative 4‐year incidence of overweight was lower only in intervention children from families with high socioeconomic status (OR, 0.26; 95% CI, 0.07 to 0.87). Remission of overweight was most pronounced in children of normal‐weight mothers (OR, 5.43; 95% CI, 1.28 to 23.01). Prevalence of underweight was unchanged. The intervention had minor but favorable effects on lifestyle. Discussion: A school‐based health promotion has sustainable effects on remission and incidence of overweight; it was most pronounced in children of normal‐weight mothers and children from families with high socioeconomic status. There was no effect on obesity. The data argue in favor of additional measures of prevention.     

Hip-Hop to Health Jr. for Latino preschool children

Objective: Hip‐Hop to Health Jr. was a diet/physical activity intervention designed to reduce gains in BMI (kilograms per meter squared) in preschool minority children. Research Methods and Procedures: Twelve predominantly Latino Head Start centers participated in a group‐randomized trial conducted between Fall 2001 and Winter 2003. Six centers were randomized to a culturally proficient 14‐week (three times weekly) diet/physical activity intervention. Parents participated by completing weekly homework assignments. The children in the other six centers received a general health intervention that did not address either diet or physical activity. The primary outcome was change in BMI, and secondary outcomes were changes in dietary intake and physical activity. Measures were collected at baseline, post‐intervention, and at Years 1 and 2 follow‐up. Results: There were no significant differences between intervention and control schools in either primary or secondary outcomes at post‐intervention, Year 1, or Year 2 follow‐ups. Discussion: When Hip‐Hop to Health Jr. was conducted in predominantly black Head Start centers, it was effective in reducing subsequent increases in BMI in preschool children. In contrast, when the program was conducted in Latino centers, it was not effective. Although the intervention did not prevent excessive weight gain in Latino children, it was very well received. Future interventions with this population may require further cultural tailoring and a more robust parent intervention.     

Childhood Obesity Prevention: An Intervention Targeting Primary Caregivers of School Children

Community‐based participatory research (CBPR) was used to design and evaluate the effectiveness of a culturally relevant, science‐based intervention for the prevention of childhood obesity in the Commonwealth of the Northern Mariana Islands (CNMI), a US Commonwealth in the western Pacific. This cognitive behavioral lifestyle intervention, Project Familia Giya Marianas (PFGM), was offered during the 2005–2007 school years in all CNMI public elementary schools over eight sessions to primary caregivers of 3rd grade children (N = 407). A crossover design was utilized with half of the schools offering the intervention in the Fall term, while the other half delivered the sessions in the Spring term. The primary outcome measure was change in BMI z‐score. There was an intervention‐dependent effect on BMI z‐score, with program impact being a function of baseline BMI and the number of lessons attended. This effect was most apparent in students whose baseline BMI z‐score was in healthy range (≥5 to <85 percentile). In both Asian and Pacific Island groups, children whose caregivers completed 5–8 lessons experienced a significant change in BMI z‐score as compared to those with 0 lessons (P < 0.05). Research that integrates multidisciplinary and multimethod approaches is effective in identifying and/or devising solutions to address a complex condition such as childhood obesity. PFGM demonstrated that community participation can be successfully utilized in the development and implementation of childhood obesity prevention programs.     

A family-based approach to preventing excessive weight gain

Objective: Preventing weight gain in adults and excessive weight gain in children is a high priority. We evaluated the ability of a family‐based program aimed at increasing steps and cereal consumption (for breakfast and snacks) to reduce weight gain in children and adults. Research Methods and Procedures: Families (n = 105) with at least one 8‐ to 12‐year‐old child who was at‐risk‐for‐overweight or overweight (designated as the target child) were recruited for the study. Eighty‐two families were randomly assigned to receive the family‐based intervention and 23 families to the control condition. The 13‐week intervention consisted of specific increases in daily steps (an additional 2000 steps/d) and consumption of 2 servings/d of ready‐to‐eat cereal. Results: The intervention was successful in increasing walking (steps) and cereal consumption. The intervention had positive, significant effects on percentage BMI‐for‐age and percentage body fat for target children and weight, BMI, and percentage body fat for parents. On further analysis, the positive effects of the intervention were seen largely in target girls and moms, rather than in target boys and dads. Discussion: This family‐based weight gain prevention program based on small changes holds promise for reducing excessive weight gain in families and especially in growing overweight children.     

A pediatric weight management program for high-risk populations: a preliminary analysis

Objective: To determine whether a multidisciplinary pediatric weight management program effectively improves BMI, BMI z‐score, and cardiovascular risk factors (CVRFs) in high‐risk populations. Methods and Procedures: A retrospective chart review was performed on children seen in the NEW Kids Program at the Children's Hospital of Wisconsin, a family‐based clinic that treats pediatric obesity using medical management, nutrition education, behavioral intervention, and physical activity. Inclusion criteria were program participation for ≥9 months and >4 visits. Analyses were performed to identify factors associated with pre‐ to postintervention changes in BMI, BMI z‐score, and CVRF laboratory values. Results: A total of 66 patients met inclusion criteria; the mean age was 11 years (s.d. ± 3.4), 56% were racial/ethnic minorities, 45% were Medicaid recipients, 48% resided in impoverished communities, and 38% had a BMI ≥40 kg/m². Of the 66 patients, 91% had more than one weight‐related comorbidity, 88% had CVRFs, and the preintervention mean BMI was 37 kg/m². After the intervention, there was an overall increase in absolute BMI, but a small, yet significant decrease in BMI z‐score (mean ?0.03 ± 0.16; P < 0.05). There were significant pregroup to postgroup improvements in total cholesterol, low‐density lipoprotein, and triglycerides levels (P < 0.05). Insurance coverage, race/ethnicity, gender, age, and initial BMI were not significantly associated with changes in BMI or BMI z‐score. Discussion: A multidisciplinary pediatric weight management program can improve the weight status of high‐risk populations, including minorities, Medicaid recipients, patients with multiple comorbidities and CVRFs, and the severely obese.     

Quality of life in Mexican-American children following a weight management program

Objective: The objective was to evaluate quality of life (QOL) in at‐risk‐for‐overweight and overweight Mexican‐American children after participating in 6 months of intensive weight management or self‐help. Research Methods and Procedures: Eighty sixth‐ and seventh‐grade at‐risk‐for‐overweight (BMI ≥85th to <95th percentile) and overweight (BMI ≥95th percentile) Mexican‐American children were randomly assigned to either intensive instructor‐led intervention (ILI) or self‐help (SH). The ILI condition included daily participation for 12 weeks in a school‐based program comprised of nutrition education, physical activity, and behavior modification, followed by ongoing monthly maintenance. QOL was assessed at baseline and 6 months via child self‐report PedsQL. QOL outcomes were compared across treatment groups, and the impact of change in zBMI on change in QOL was evaluated. Results: Children in the ILI condition not only achieved significantly greater weight loss (zBMI, ?0.13 ± 0.14; p < 0.001) but also significantly greater physical QOL improvements than those in the SH condition at 6 months (p < 0.05). Furthermore, physical QOL increases were associated with zBMI reduction (p < 0.05). However, neither psychosocial nor total QOL was significantly impacted by intervention or zBMI change. Discussion: These findings show that even modest decreases in zBMI after weight management result in improved physical QOL in Mexican‐American children. These results illustrate the clear need to include evaluation of QOL in the process of identifying effective weight management programs.     

Association of cigarettes smoked daily with obesity in a general adult population

Objective: We analyzed the cross‐sectional association between obesity and smoking habits, taking into account diet, physical activity, and educational level. Research Methods and Procedures: We used data from the 2002 Swiss Health Survey, a population‐based cross‐sectional telephone survey assessing health and self‐reported health behaviors. Reported smoking habits, height, and weight were available for 17,562 subjects (7844 men and 9718 women) ≥25 years of age. BMI was calculated as (self‐reported) weight divided by height². Results: Mean BMI was 25.1 kg/m² for non‐smokers, 26.1 kg/m² for ex‐smokers, 24.6 kg/m² for light smokers (1 to 9 cigarettes/d), 24.8 kg/m² for moderate smokers (10 to 19 cigarettes/d), and 25.3 kg/m² for heavy smokers (≥20 cigarettes/d) in men and 24.0, 24.1, 22.9, 22.9, and 23.3 kg/m², respectively, in women. Obesity (BMI ≥ 30 kg/m²) was increasingly frequent with older age, lower physical activity, lower fruits/vegetables intake, and lower educational level. Compared with non‐smokers, the odds ratio for obesity vs. normal weight (BMI = 18.5 to 25.0 kg/m²) adjusted for age, nationality, educational level, leisure time physical activity, and fruit/vegetable intake were 1.9 (95% confidence interval: 1.5 to 2.3) for ex‐smokers, 0.5 (0.3 to 0.8) for light smokers, 0.7 (0.4 to 1.0) for moderate smokers, and 1.3 (1.0 to 1.7) for heavy smokers in men and 1.3 (1.1 to 1.6), 0.7 (0.5 to 1.0), 0.8 (0.5 to 1.0), and 1.1 (0.8 to 1.4), respectively, in women. Discussion: Among smokers, obesity was associated in a graded manner with the number of cigarettes daily smoked, particularly in men. More emphasis should be put on the risk of obesity among smokers.     

Changes in Circulating Satiety Hormones in Obese Children: A Randomized Controlled Physical Activity‐Based Intervention Study

The aims of this study are to examine in children: (i) obesity‐related alterations in satiety factors such as leptin, ghrelin, and obestatin; (ii) the link between satiety factors and cardiometabolic risk factors; and (iii) the impact of a physical activity‐based lifestyle intervention on the levels of these satiety factors in the obese. We studied a total of 21 adolescents (BMI percentile, 99.0 ± 0.6 for 15 obese and 56.2 ± 1.1 for 6 lean). The obese subjects underwent a 3‐month randomized controlled physical activity‐based lifestyle intervention. Leptin, soluble leptin receptor (sOB‐R), ghrelin, and obestatin levels were determined as the primary outcome measures. Other markers of cardiometabolic disease such as inflammation and insulin resistance were also determined. Body composition was measured by dual‐energy X‐ray absorptiometry. The concentrations of ghrelin, obestatin, and sOB‐R were significantly lower in the obese children compared to the lean controls, whereas that of leptin was higher (all P < 0.05). Although intervention led to a net increase in obestatin (P < 0.01) and no change in ghrelin levels, the balance between ghrelin and obestatin (ratio of ghrelin to obestatin, G/O) decreased (P < 0.02). Intervention reduced leptin and increased sOB‐R (P < 0.01 for both). Significant associations between satiety factors and other cardiometabolic risk factors were also observed. Taken together, alterations in the levels of satiety factors are evident early in the clinical course of obesity, but physical activity‐based lifestyle intervention either prevented their continued increase or normalized their levels. These beneficial effects appear to aid in the maintenance of body weight and reduction in cardiovascular risk.     

Results of Go Girls: A Weight Control Program for Overweight African‐American Adolescent Females

Objective: Go Girls was a church‐based nutrition and physical activity program designed for overweight African‐American (AA) adolescent females. Research Methods and Procedures: Ten predominantly middle‐socioeconomic churches were randomized to either a high‐intensity (20 to 26 sessions) or moderate‐intensity (six sessions) culturally tailored behavioral group intervention delivered over 6 months. Each session included an experiential behavioral activity, ～30 minutes of physical activity, and preparation and tasting of healthy foods. In the high‐intensity group, girls also received four to six telephone counseling calls. From the 10 churches, 123 girls completed baseline and 6‐month post‐test assessments. The primary outcome was BMI; secondary outcomes included waist and hip circumferences, percentage body fat estimated by bioimpedance, serum insulin, glucose, and lipids, and cardiovascular fitness at 6‐month follow‐up. Selected measures were also collected at 1‐year follow‐up. Results: At 6‐month follow‐up, the net difference between the high‐ and moderate‐intensity groups was 0.5 BMI units. This difference was not statistically significant (p = 0.20). There were no significant group differences in secondary outcomes. Girls in the high‐intensity condition, however, who attended more than three‐quarters of the sessions had significantly lower BMI and percentage body fat relative to girls in the high‐intensity group who attended fewer sessions. Findings at 1‐year follow‐up mirrored those at 6 months. Discussion: We concluded that the intervention was not effective in reducing adiposity, although there were some positive findings among high attenders. Despite the null result, the intervention was generally well received by participants. Future interventions may require greater dose and a more structured dietary change program.     

School-based obesity prevention programs: an evidence-based review

Objective: This review seeks to examine the effectiveness of school‐based programs for reducing childhood overweight or obesity. Methods and Procedures: A systematic review of the research literature published since 1990 was conducted to identify experimental or quasi‐experimental school‐based curricular or environmental preventive interventions, with evaluation ≥ 6 months after baseline, which reported outcomes in terms of a measure of overweight. Results: Fourteen studies were identified, including one involving a nutrition‐only program, two physical activity promotion interventions and eleven studies combining nutrition and physical activity components. Most studies (n = 10) offered weak (grade 2) quality evidence. One study offered strong (grade 4) evidence reducing the odds ratio for overweight in girls only, while four grade 2 studies reported significant improvements in BMI or at‐risk‐for overweight or overweight prevalence in boys, girls, or both. Twelve studies reported significant improvement in at least one measure of dietary intake, physical activity, and/or sedentary behavior. Discussion: Our ability to draw strong conclusions as to the efficacy of school‐based obesity prevention programs is limited by the small number of published studies and by methodological concerns. Qualitative analysis suggests programs grounded in social learning may be more appropriate for girls, while structural and environmental interventions enabling physical activity may be more effective for boys. High‐quality evaluation protocols should be considered essential components of future programs.     

PROP taster status interacts with the built environment to influence children's food acceptance and body weight status

Objectives:

Eating behaviors and obesity are complex phenotypes influenced by genes and the environment, but few studies have investigated the interaction of these two variables. The purpose of this study was to use a gene‐environment interaction model to test for differences in children's food acceptance and body weights.

Design and Methods:

Inherited ability to taste 6‐n‐propylthiouracil (PROP) was assessed as a marker of oral taste responsiveness. Food environment was classified as “healthy” or “unhealthy” based on proximity to outlets that sell fruits/vegetables and fast foods using Geographic Information Systems (GIS). The cohort consisted of 120 children, ages 4‐6 years, recruited from New York City over 2005‐2010. Home address and other demographic variables were reported by parents and PROP status, food acceptance, and anthropometrics were assessed in the laboratory. Based on a screening test, children were classified as PROP tasters or non‐tasters. Hierarchical linear models analysis of variance was performed to examine differences in food acceptance and body mass index (BMI) z‐scores as a function of PROP status, the food environment (“healthy” vs. “unhealthy”), and their interaction.

Results and Conclusion:

Results showed an interaction between taster status and the food environment on BMI z‐score and food acceptance. Non‐taster children living in healthy food environments had greater acceptance of vegetables than taster children living in healthy food environments (P ≤ 0.005). Moreover, non‐tasters from unhealthy food environments had higher BMI z‐scores than all other groups (P ≤ 0.005). Incorporating genetic markers of taste into studies that assess the built environment may improve the ability of these measures to predict risk for obesity and eating behaviors. Obesity (2012)     

Obesity indices and self-reported functional health in men and women in the EPIC-Norfolk

Objective: To investigate the association between two indices of obesity, BMI and waist‐to‐hip ratio (WHR), and self‐reported physical and mental functional health. Research Methods and Procedures: We examined the relationship between obesity indices and self‐reported physical and mental functional health measured by the Anglicized version of the Short‐Form 36‐item questionnaire in a population‐based cross sectional study of 16, 806 men and women 40 to 79 years old living in the general community in Norfolk, United Kingdom. Results: Higher BMI and WHR were both independently associated with poorer self‐reported physical functional health in men and women. The effect of BMI was greater in women compared with men, and the effect of WHR was greater in men compared with women, for poor physical functional health. Higher WHR but not BMI was associated with lower mental functional health in men and women. Discussion: High BMI and WHR seem to be adversely related to self‐perceived functional health in both men and women, although their relative impacts seem to differ by sex. Our findings also highlight the importance of using WHR in addition to BMI in assessing the impact of obesity on health outcome.     

Eating Frequency is Associated With Energy Intake but Not Obesity in Midlife Women

Midlife women tend to gain weight with age, thus increasing risk of chronic disease. The purpose of this study was to examine associations between overweight/obesity and behavioral factors, including eating frequency, in a cross‐sectional national sample of midlife women (n = 1,099) (mean age = 49.7 years, and BMI = 27.7 kg/m²). Eating behaviors and food and nutrient intakes were based on a mailed 1‐day food record. BMI was calculated from self‐reported height and weight, and level of physical activity was assessed by self‐reported questionnaire. After exclusion of low‐energy reporters (32% of sample), eating frequency was not associated with overweight/obesity (P > 0.05) and was not different between BMI groups (normal, 5.21 ± 1.79; overweight, 5.16 ± 1.74; obese, 5.12 ± 1.68, P = 0.769). Adjusted logistic regression showed that eating frequency, snacking frequency, breakfast consumption, eating after 10 pm and consuming meals with children or other adults were not significantly associated with overweight/obesity. Total energy intake increased as eating frequency increased in all BMI groups, however, obese women had greater energy intake compared to normal weight women who consumed the same number of meals and snacks. Intake of fruit and vegetables, whole grains, dietary fiber, dairy, and added sugars also increased as eating frequency increased. While eating frequency was not associated with overweight/obesity, it was associated with energy intake. Thus, addressing total energy intake rather than eating frequency may be more appropriate to prevent weight gain among midlife women.     

The association between changes in height and obesity in Chilean preschool children: 1996-2004

Objectives: To establish the association between changes in height and prevalence of obesity between 1996 and 2004 in Chilean preschool children. Research Methods and Procedures: Children registered in the Junta Nacional de Jardines Infantiles (JUNJI) preschool program were routinely measured three times a year and in consecutive years. Two indices [weight‐for‐height z‐scores (WHZ) and BMI centiles] were used to define obesity. Height‐for‐age z‐scores (HAZ) were used to define stature. Generalized estimating equations were used to describe the relationship between stature and obesity while controlling for repeated measurements in children. Results: The prevalence of obesity in Chilean preschool children has remained relatively constant over the past 9 years when either index is used. The prevalence of stunted (HAZ ≤2) children has decreased, while the proportion of children who are tall (HAZ >2) has increased. Using WHZ to define obesity, stunted children do not seem to be at increased risk of obesity when compared with children of normal height. Tall children were strongly protected from obesity when either criterion was used to define obesity. Discussion: The lack of association between stunting and obesity using WHZ ≥2 likely reflects the fact that Chile is in the post‐transitional phase of the nutrition transition, and stunting is no longer a risk factor for obesity; however, the associations observed between stunting and BMI suggest that either WHZ or BMI, or both, are inaccurate criteria to define overweight. Conclusions: There is a unique relationship between stature and obesity in preschool children that is different from that observed in older children in the same population.