Activity, inactivity, and screen time in relation to weight and fatness over adolescence in girls

Objective: The impact of activity and inactivity on relative weight and fatness change are best evaluated longitudinally. We examined the longitudinal relationship of physical activity, inactivity, and screen time with relative weight status and percentage body fat (%BF) and explored how it differed by parental overweight status. Research Methods and Procedures: Non‐obese pre‐menarcheal girls (173), 8 to 12 years old, were followed until 4 years post‐menarche. %BF, BMI z‐score, and time spent sleeping, sitting, standing, walking, and in vigorous activity were assessed annually. We developed a physical activity index to reflect time and intensity of activity. Inactivity was defined as the sum of time spent sleeping, sitting, and standing. Screen time was defined as time spent viewing television, videotapes, or playing video games. Parental overweight was defined as at least one parent with BMI > 25. Results: In separate linear mixed effects models, activity, inactivity, and screen time were unrelated to BMI z‐score longitudinally, with and without accounting for parental overweight. After controlling for parental overweight, activity was inversely related (p < 0.001), and inactivity was directly related (p < 0.035) to increased %BF longitudinally. Screen time was unrelated to %BF change. With stratification for parental overweight, effects of activity and inactivity on %BF were observed only among girls with at least one overweight parent. Discussion: In this cohort of initially non‐overweight girls, activity and inactivity were related to accrual of BF over adolescence, particularly among children with at least one overweight parent. These results suggest that girls with a family history of overweight represent a target population of high priority for interventions around physical activity and inactivity.     

Parental Weight Status and Girls’ Television Viewing,Snacking, and Body Mass Indexes

Objective: The purpose of this study was to examine whether television viewing (TVV) provides a context for patterns of snacking fostering overweight in young girls from overweight and non‐overweight families. Research Methods and Procedures: Participants were 173 non‐Hispanic white girls and their parents from central Pennsylvania, assessed longitudinally when girls were 5, 7, and 9 years old. Path analysis was used to test patterns of relationships among girls’ TVV, snacking while watching television, snacking frequency, fat intake from energy‐dense snack food, and girls’ increase in body mass index (BMI) from age 5 to 9. Results: In both overweight and non‐overweight families, girls who watched more television consumed more snacks in front of the television. In families where neither parent was overweight, television viewing was the only significant predictor of girls’ increase in BMI. In families where one or both parents were overweight, girls who watched more television snacked more frequently, and girls who snacked more frequently had higher intakes of fat from energy‐dense snacks, which predicted their increase in BMI from age 5 to 9. TVV did not directly predict girls’ increase in BMI in girls from overweight families. Discussion: The results of this study support and extend previous findings that have shown that excessive television viewing and snacking patterns are risk factors for the development of overweight in children; however, patterns of relationships may differ based on parental weight status. For overweight families, TVV may provide a context for excessive snack consumption, in addition to inactivity.     

Reexamining Obesigenic Families: Parents’ Obesity‐related Behaviors Predict Girls’ Change in BMI

Objective: It has been shown that girls from families in which mothers and fathers had high dietary intake and low physical activity (i.e., obesigenic families) were at increased risk of obesity from ages 5 to 7 years. This follow‐up study uses additional data collected when girls were 9 and 11 years old to examine whether girls from obesigenic families continued to show greater increases in BMI over time and reported unhealthy dietary and activity patterns. Research Methods and Procedures: Families from the original cohort were reexamined when girls were 9 and 11 years of age. Parents’ and girls’ BMI, dietary intake, and physical activity and girls’ percentage body fat and television viewing were assessed. Results: In comparison with girls from non‐obesigenic families, girls from obesigenic families showed greater increases in BMI and BMI z score from ages 5 to 7 years that were maintained across ages 7 to 11 years. Furthermore, girls from obesigenic families had higher percentage body fat at ages 9 and 11 years. These results were independent of parents’ BMI. Additional findings showed that girls from obesigenic families had diets higher in percentage fat and had higher levels of television viewing than girls from non‐obesigenic families. Discussion: The environment that parents create, by way of their own dietary and physical activity behaviors, may have a lasting negative effect on children's weight trajectories and their emerging obesity risk behaviors, such as their dietary patterns. These findings further highlight the importance of the family in establishing children's obesity risk and the necessity of targeting parents of young children in obesity prevention efforts.     

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.     

Amount of Food Group Variety Consumed in the Diet and Long‐Term Weight Loss Maintenance

Objective: Decreases in variety of foods consumed within high‐fat‐dense food groups and increases in variety of foods consumed within low‐fat‐dense food groups are associated with lower energy intake and greater weight loss during obesity treatment and may assist with weight loss maintenance. This study examined food group variety in 2237 weight loss maintainers in the National Weight Control Registry, who had lost 32.2 ± 18.0 kg (70.9 ± 39.5 lbs) and maintained a weight loss of at least 13.6 kg (30 lbs) for 6.1 ± 7.7 years. Research Methods and Procedures: At entry into the registry, registry members completed a food frequency questionnaire from which amount of variety consumed from different food groups was assessed. To provide a context for interpreting the level of variety occurring in the diet of registry participants, food group variety was compared between registry participants and 96 individuals who had recently participated in a behavioral weight loss program and had lost at least 7% of initial body weight. Results: Registry members reported consuming a diet with very low variety in all food groups, especially in those food groups higher in fat density. Registry participants consumed significantly (p < 0.001) less variety within all food groups, except fruit and combination foods, than recent weight losers after 6 months of weight loss treatment. Discussion: These results suggest that successful weight loss maintainers consume a diet with limited variety in all food groups. Restricting variety within all food groups may help with consuming a low‐energy diet and maintaining long‐term weight loss.     

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.     

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.     

Ability to taste 6-n-propylthiouracil and BMI in low-income preschool-aged children

Background: Sensitivity to the bitter compound 6‐n‐propylthiouracil (PROP) is genetically mediated. Sensitivity to PROP has been associated with weight status in both adults and children. Objective: To determine whether there is an association between PROP sensitivity and BMI in low‐income children of diverse race/ethnicity, among whom there is a high prevalence of obesity. Methods and Procedures: Eighty‐one preschool‐aged children attending Head Start tasted a solution of 560 μmol/l PROP and reported whether it tasted “like water” or “like something else”. Mothers reported child's race, age, maternal education, maternal weight and height, child's reluctance to sample new foods via the Food Neophobia Scale (FNS), and child's dietary intake using a food frequency questionnaire. Child weight and height were measured. BMI was calculated and for children, expressed in z‐scores. Regression analyses were used to evaluate the relationship between child's PROP taster status and BMI z‐score, testing covariates child's age, gender, race, maternal education and BMI, and child's FNS score. Children's dietary intake was compared by PROP taster status. Results: PROP tasters, compared with nontasters, had significantly higher BMI z‐scores (0.99 (s.d. 1.24) vs. 0.03 (1.12), P = 0.004) and had a significantly higher prevalence of overweight (31.8% vs. 5.6%, P = 0.025), but demonstrated no differences in reported dietary intake. The most parsimonious model predicting the child's BMI z‐score included only maternal BMI and the child's PROP taster status (R ² = 22.3%). Discussion: A genetically mediated ability to taste bitter may contribute to obesity risk in low‐income, preschool‐aged children.     

Obesity‐susceptibility loci and the tails of the pediatric BMI distribution

Objective: To determine whether previously identified adult obesity susceptibility loci were associated uniformly with childhood BMI across the BMI distribution. Design and Methods: Children were recruited through the Children's Hospital of Philadelphia (n = 7,225). Associations between the following loci and BMI were assessed using quantile regression: FTO (rs3751812), MC4R (rs12970134), TMEM18 (rs2867125), BDNF (rs6265), TNNI3K (rs1514175), NRXN3 (rs10146997), SEC16B (rs10913469), and GNPDA2 (rs13130484). BMI z‐score (age and gender adjusted) was modeled as the dependent variable, and genotype risk score (sum of risk alleles carried at the 8 loci) was modeled as the independent variable. Results: Each additional increase in genotype risk score was associated with an increase in BMI z‐score at the 5th, 15th, 25th, 50th, 75th, 85th, and 95th BMI z‐score percentiles by 0.04 (±0.02, P = 0.08), 0.07 (±0.01, P = 9.58 × 10^?7), 0.07 (±0.01, P = 1.10 × 10^?8), 0.09 (±0.01, P = 3.13 × 10^?22), 0.11 (±0.01, P = 1.35 × 10^?25), 0.11 (±0.01, P = 1.98 × 10^?20), and 0.06 (±0.01, P = 2.44 × 10^?6), respectively. Each additional increase in genotype risk score was associated with an increase in mean BMI z‐score by 0.08 (±0.01, P = 4.27 × 10^?20). Conclusion: Obesity risk alleles were more strongly associated with increases in BMI z‐score at the upper tail compared to the lower tail of the distribution.     

The Effect of Weight Loss on Sleep‐disordered Breathing in Obese Teenagers

The objective of this study was to assess the effect of weight loss on sleep‐disordered breathing (SDB) in obese teenagers attending a residential treatment center. We also assessed whether the presence of SDB at the start of the weight management therapy was correlated with the amount of weight loss achieved. Obese teenagers were recruited and underwent anthropometry and sleep screening. Subjects with SDB (apnea hypopnea index (AHI) ≥ 2) received a follow‐up screening after weight loss therapy. Sixty‐one obese subjects were included (age = 14.8 ± 2.3; BMI z score = 2.7 ± 0.4). Thirty‐one subjects were diagnosed with SDB with 38% continuing to have residual SDB after a median weight loss of 24.0 kg. Subjects with SDB had a higher median relative decrease in BMI z score compared to subjects without SDB which was 30.5, 33.6, and 50.4% in the group with AHI of the baseline screening study < 2, 2 ≤ AHI < 5, and AHI ≥ 5, respectively (P = 0.02). AHI of the baseline screening study correlated significantly with the relative decrease in BMI z score (partial r = 0.37; P = 0.003), controlling for gender, age, initial BMI z score, and time between both studies. In conclusion, weight loss was successful in treating SDB in obese teenagers. In addition, there was a positive association between the severity of SDB at the start of the treatment and the amount of weight loss achieved. These findings are in favor of considering weight loss as a first‐line treatment for SDB in obese children and adolescents.     

Preferences Predict Food Intake From 5 to 11 Years,but Not in Girls With Higher Weight Concerns,Dietary Restraint,and %Body Fat

Food preferences (FP) predict food intake in childhood; however, the predictive power of FP may decline among girls as weight concerns (WC) and dietary restraint (DR) increase during preadolescence. To examine longitudinal change in the preference‐intake (P‐I) relation and assess whether this relation weakens among non‐Hispanic white girls (n = 197) with a history of WC and DR from age 5 to 11. Girls' preferences for and intake (kcal) of 10 palatable snack foods were assessed biennially. Height, weight, percent body fat (%BF), WC, and DR were measured. Individual correlation coefficients were calculated per girl to capture within‐person P‐I correlations at each time of measurement. Overall, FP predicted girls' snack food calorie intakes between 5 and 11 years, but latent profile analysis (LPA) revealed three distinct patterns of change in P‐I correlations over time: “strong/stable” P‐I correlations were relatively high and became stronger with age; “increasing/later null” P‐I correlations were initially weak and became stronger between 5 and 9 years, but dropped to near 0 at 11 years; “initially weak/later strong” P‐I correlations were initially null and increased with age. Mixed models revealed that the “increasing/later null” group had greater increases in %BF, and higher WC, DR, and BMI percentiles from 5 to 11 years, compared to the other groups. In summary, FP predicted snack food calorie intake among most girls during childhood, but waned as a predictor of calorie intake at age 11 for a subset of girls with increasing %BF, and higher WC, DR, and BMIs.     

Association between television in bedroom and adiposity throughout adolescence

Objective: The objective was to determine if having a television (TV) in the bedroom is associated with physical activity (PA), TV/video viewing, and adiposity throughout adolescence. Research Methods and Procedures: Longitudinal data (September 2002 through June 2005) were analyzed of 379 initially 12‐year‐old French adolescents participating as controls in the Intervention Centered on Adolescents’ Physical activity and Sedentary behavior (ICAPS). Presence of a TV set in the bedroom (TV_bedroom) and leisure activities were obtained by questionnaire. There was annual assessment of BMI, waist circumference, and body fat by bioimpedance. Results: In boys but not girls, baseline TV_bedroom was associated with higher TV/video viewing over time [odds ratio (OR) of high TV/video = 1.87; 95% confidence interval, 1.2 to 2.8] and less no‐sport club participation (OR = 0.59; 95% confidence interval, 0.35 to 1.0). Both boys and girls with baseline TV_bedroom had lower reading time (p < 0.0001 in boys; p = 0.04 in girls), while PA did not differ according to TV_bedroom for boys or for girls. For boys only, baseline TV_bedroom was associated with higher BMI (mean BMI over time 20.5 ± 0.5 vs. 19.0 ± 0.5 kg/m²; p = 0.001), waist circumference (70.9 ± 0.9 vs. 67.2 ± 0.8 cm; p < 0.001), and body fat (15.9 ± 0.9% vs. 13.5 ± 0.9%; p < 0.001), without interaction with time. These relationships remained significant after adjustment for socioeconomic status. TV/video viewing explained 26%, 42%, and 36% of the relationships of TV_bedroom with BMI, waist circumference, and body fat, respectively, while addition of other leisure activities in the models only marginally reduced the effects. Discussion: These results suggest the importance of keeping TV out of an adolescent's bedroom from an obesity prevention perspective but show gender differences.     

Calcium and body fat in peripubertal girls: cross-sectional and longitudinal observations

Objective: The objective was to investigate whether calcium intake is independently associated with body fat in peripubertal girls. Research Methods and Procedures: A total of 45 healthy premenarcheal girls (initially 10.5 ± 0.6 years of age) completed a 2‐year prospective observational study. Percent body fat and trunk fat (by DXA), height, weight, maturational stage, and eating attitudes (children's Eating Attitudes Test [EAT]) were measured at baseline and at 1 and 2 years. Physical activity (by questionnaire) and calcium intake (by calcium‐specific food frequency questionnaire and 3‐day food records) were assessed at 6‐month intervals. Results: Girls with 2‐year mean calcium intake below and above the median had similar age, height, lean mass, and maturational stage at baseline, but girls below the median had significantly higher baseline percentage body fat (29.3 ± 10.3% vs. 22.0 ± 6.8%, p < 0.01) and trunk fat (24.2 ± 10.6% vs. 15.8 ± 6.8%, p < 0.01). However, differences were no longer significant when covariates (most notably children's EAT dieting score) were considered. Regression analysis revealed that dieting score was a consistent positive predictor of percentage body and trunk fat at all cross‐sectional time‐points, accounting for >20% of the variance, but did not predict 2‐year change in percentage fat. Calcium intake did not enter longitudinal regression equations for 2‐year change in percentage fat. Discussion: In this group of girls, an inverse cross‐sectional association between calcium intake and body fat appeared to result from avoidance of foods high in calcium by girls who were concerned about their body weight or shape. Calcium intake was not associated with change in fat over time.     

Does Dieting Lead to Weight Gain? A Four‐Year Longitudinal Study of Middle School Girls

Objective: A majority of the published longitudinal research on children has reported that dieting is related to weight gain at a later point in time. The purpose of this study was to look at weight control behaviors and patterns of weight gain and loss, specifically whether dieting is related to weight gain. Research Methods and Procedures: Baseline data were collected from 1358 female students in grades 6 to 9 from schools in Hayward, CA, and Tucson, AZ. Data were obtained annually over a 4‐year period. Paper‐and‐pencil questionnaires and height and weight were obtained during the students’ regular classroom periods. Dieting was measured both with the single item, “In the past year, how often have you been on a diet to lose weight?” scored from “never” to “always,” and with a Dieting Behavior Scale including five items on weight control behaviors. Changes in BMI z‐scores were analyzed. Results: On average, girls who reported “never” dieting were most likely to have an increased BMI z‐score at the next measurement, and those who reported “always” dieting were most likely to have a decreased BMI z‐score. The same pattern was true for the Dieting Behavior Scale. Discussion: Our finding that dieting and weight gain were not related, independently of initial BMI, does not mean that dieting to lose weight is appropriate, especially among young girls. Additional research is needed both to examine this relationship and to determine exactly what behaviors children are engaging in when they report that they are dieting.     

The Influence of Physical Activity,Socioeconomic Status,and Ethnicity on the Weight Status of Adolescents

Objective: This study examined the effects of physical activity, television viewing, video game play, socioeconomic status (SES), and ethnicity on body mass index (BMI). Research Methods and Procedures: The sample was 2389 adolescents, 10 to 16 years of age (12.7 ± 1.0 years); 1240 (52%) females and 1149 (48%) males; 77% white and 23% African American; from rural (77%) and urban (23%) settings. BMI and skinfolds were directly assessed. All other data were obtained from questionnaires. Results: Watching television on non‐school days was related to being overweight (p < 0.005). However, when BMI analyses were adjusted for ethnicity and SES, there were no significant effects of television viewing on BMI (p > 0.061). Increased hours of video game play enhanced the risk of being overweight for both genders when analyses were adjusted for ethnicity and SES (p < 0.019). In males, participation in as little as one high‐intensity physical activity 3 to 5 days a week decreased the ethnic‐ and SES‐adjusted relative risk of being overweight (RR = 0.646; CI: 0.427 to 0.977). For females, the ethnic‐ and SES‐adjusted relative risk for being overweight was not significantly altered by physical activity. The logistic analyses further indicated the influence of low SES and African American ethnicity overshadowed any direct effect of television or videos. Discussion: Because weight status of male adolescents appears to be more related to exercise habits than to television or video game habits, increased participation in high‐intensity exercise appears to be important. For females, neither videos nor exercise habits appear to be related to risk of being overweight. However, ethnicity and SES may be important factors that can influence body weight status, while television viewing may be of some importance. Thus, programs to reduce obesity in female adolescent should focus their efforts in lower SES communities.     

Eating in the Absence of Hunger: A Genetic Marker for Childhood Obesity in Prepubertal Boys?

Objective: Eating in the absence of hunger (EAH) may be a behavioral trait through which obesity‐promoting genes promote positive energy balance. The primary aim of this study was to compare children born at high vs. low risk for obesity with respect to EAH at 5 years of age. Research Methods and Procedures: This was an observational investigation of families enrolled in the University of Pennsylvania and The Children's Hospital of Philadelphia's Infant Growth Study. Five‐year‐old children born at high (N = 28) or low (N = 25) risk for obesity on the basis of maternal prepregnancy body weight were evaluated at a hospital‐based laboratory. Children consumed 11 snack foods ad libitum after consuming an ad libitum dinner and reporting fullness. Parents reported on snack foods at home and their own eating styles. Nutritive sucking at 3 months of age was evaluated by computerized apparatus. Results: EAH in high‐risk boys (mean ± standard error = 326 ± 66 kJ] was more than twice that of low‐risk boys (mean ± standard error = 151 ± 39 kJ), p = 0.03. Among girls, there was a trend for EAH to be associated with increased parental limitations on daughter snack food consumption at home (p = 0.06). EAH was unrelated to 3‐month sucking behavior. Discussion: Genes that promote childhood obesity may partially exert their influence through EAH, an effect that was limited to boys born at risk for obesity. The unique influences of genes and home environment on this trait should be disaggregated in subsequent studies.     

RETRACTION: C-reactive Protein and Metabolic Syndrome in Youth: A Strong Relationship?

Retraction: Note from the Editor‐in‐Chief: This paper is retracted Objective: Metabolic syndrome (MS) is on the rise in youth. As high‐sensitivity C‐reactive protein (hs‐CRP) is associated with cardiovascular/metabolic disorders, we evaluated the association between MS and its components and hs‐CRP in a sample of Brazilian overweight and obese youth. Methods and Procedures: A total of 407 students (229 girls, 273 with excessive weight, 11.3 ± 3.2 years) were evaluated. Measurement included BMI, waist circumference (WC), blood pressure, lipids, insulin, and hs‐CRP. Excessive weight was defined using BMI z ‐score; MS by the modified National Cholesterol Education Program—Adult Treatment Panel III. Results: Subjects were classified into two groups: with MS (n = 72) and without (n = 335). hs‐CRP means and medians were higher in MS group (1.41 mg/l vs. 1.06 mg/l, P < 0.001; 2.21 mg/l vs. 1.23 mg/l, P < 0.001). Associations between hs‐CRP quartiles and insulin resistance (IR) (P < 0.001), MS (P < 0.001), WC (P < 0.000), BMI z‐score (P < 0.001), hypertension (P < 0.001), hypertriglyceridemia (P < 0.001), and low HDL‐c (P = 0.023) were significant; adjustment of hs‐CRP for BMI z‐score eliminated the previous association, except for the number of MS components (nMSc) (P < 0.001). Adjusting for homeostasis model assessment method of IR (HOMA‐IR) did not eliminate the relation between hs‐CRP and MS components. Furthermore, increases in BMI z ‐score and nMSc were associated with an increased hs‐CRP. Excessive weight (odds ratio (OR), 7.9; confidence interval (CI), 4.7–13.4; P = 0.000), hypertension (OR, 2.3; CI, 1.3–4.2; P = 0.003), and hypertriglyceridemia (OR, 2.3; CI, 1.5–3.7; P < 0.001) were independently associated with hs‐CRP. Discussion: In youth, hs‐CRP is strongly related with MS and its components, and is also determined by the body composition. This association indicates a precocious proinflammatory state.     

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.     

Childhood Overweight Status Predicts Diabetes at Age 21 Years: A Follow‐up Study

We examined the prospective association of childhood BMI z‐score and BMI categories (normal or overweight) with young adult diabetes, controlling for early life, childhood, and adolescence factors. A subsample of 2,639 young adults from the Mater–University study of pregnancy (MUSP) and its outcomes, a prospective birth cohort who were born in Brisbane, Australia and for whom we had measured height and weight at 5 years and self‐reported diabetes at age 21 years. The risk of developing diabetes by age 21 years was greater among young adults who had greater BMI z‐score or were overweight at age 5 years than those who had normal BMI at age 5 years. Young adults who were overweight at age 5 years had an increased odds ratio of 2.60 (95% confidence interval (CI): 1.29, 5.22, in age‐ and sex‐adjusted model) of experiencing diabetes by age 21 years. Adjustment for potential confounders and mediators including intrauterine environmental factors, childhood dietary patterns, television watching, participation in sports and exercise, and current weight, did not substantively alter these associations. Overweight and increasing BMI z‐score at childhood is an independent predictor of young adult's type 1 and type 2 diabetes. Findings of this study suggest that childhood BMI may be central to the development and rising incidence of all diabetes.     

The Relationship of Health Outcomes to Improvement in BMI in Children and Adolescents

Objective: To evaluate the clinical outcomes of patients participating in an outpatient program for managing childhood and adolescent obesity. Research Methods and Procedures: Based on a retrospective chart review, 394 physician‐referred obese youth (BMI > 95th percentile), 5 to 19 years of age, were treated in an interdisciplinary, family‐centered, behavioral weight management program in a hospital‐based outpatient setting. Treatment included group exercise, parent education, and behavioral intervention therapies to improve diet and physical activity. Results: A total of 177 (45%) completed the initial phase of treatment (mean duration = 5.6 months). For the completion group, there were significant improvements (all p < 0.001) in weight (?2.0 ± 4.9 kg), BMI (?1.7 ± 1.9 kg/m²), and BMI z score (?0.15 ± 0.15), without interfering with growth (height, 2.2 ± 1.3 cm; p < 0.001). Significant improvement was also found for blood pressure, total cholesterol, low‐density lipoprotein (LDL)‐cholesterol, triglycerides, insulin, and aerobic fitness. At onset of treatment, 134 (84%) patients had abnormal fasting insulin concentration, 88 (50%) had abnormal total cholesterol, 14 (8%) had abnormal diastolic blood pressure, and 69 (40%) had abnormal LDL‐cholesterol. At the end of treatment, a significant proportion of patients with baseline abnormal blood pressure, total cholesterol, and LDL‐cholesterol had normal values (p < 0.001). A decrease in BMI z score was associated with significant improvements in insulin and lipid values (all p < 0.05). Discussion: We have demonstrated that a modest decrease in BMI in an ongoing clinical pediatric weight management program is accompanied by significant improvements in related health measures. These results may be helpful in counseling families with overweight children and adolescents.