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.     

Behavioral pattern of overweight and obese school children

The aim of this study was to determine socio economic, health status, nutritional and behavioral differences in obese, overweight and normal weight children attending first grade elementary school. In overweight group there is 13.8% of boys and 12.6% of girls, in obese group 8.3% of boys and 6.9% of girls. In factor analysis 12 factors was excluded with cumulative loading of 60% variability. Discriminant analysis was performed with 12 factors as predictive variables and discriminant variables were three BMI groups: normal weight, overweight and obese. Function 1 discriminate well normal weight group from overweight and obese group. Overweight and obese groups is described with lower number of children in the family and lower order of birth, higher education of parents, they eat less vegetables and fruits, spend more time playing computer games, have less physical activity, drink more alcohol with their meals, exactly opposite to normal weight group.     

Personal, behavioral, and environmental risk and protective factors for adolescent overweight

Objective: The objective was to examine a breadth of personal, behavioral, and socio‐environmental factors as potential risk and protective factors of overweight among male and female adolescents. Research Methods and Procedures: A longitudinal study was conducted with an ethnically and socio‐economically diverse sample of 2516 adolescents who completed surveys at both Time 1 (1998 to 1999) and Time 2 (2003 to 2004) of the Project Eating Among Teens (EAT) study. Results: In 1998 to 1999, 335 (25.7%) girls and 282 (26.4%) boys met the age‐adjusted criteria for overweight. During the 5‐year study period, 236 (70.5%) of the overweight girls and 185 (65.7%) of the overweight boys remained overweight and 115 (12.0%) girls and 77 (9.9%) boys originally not overweight became overweight. Although differences by sex were found, a number of personal, behavioral, and socio‐environmental factors were associated with overweight among both male and female adolescents. Body dissatisfaction and weight concerns at Time 1 predicted overweight at Time 2 for both male and female adolescents. Dieting and use of unhealthy weight control behaviors at Time 1 also predicted overweight at Time 2. Greater frequency of breakfast consumption at Time 1 was protective against overweight. Higher levels of weight‐related teasing and parental weight‐related concerns and behaviors at Time 1 were positively associated with Time 2 overweight. Discussion: Body dissatisfaction, weight concerns, use of unhealthy weight control behaviors, weight‐related stigmatization, and parental concern about the child's weight may increase risk for adolescent overweight. Interventions that enhance adolescents’ body satisfaction while providing them with skills to avoid dieting and to engage in more effective weight‐control behaviors should be developed and tested.     

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.     

Childhood Overweight and Academic Performance: National Study of Kindergartners and First‐Graders

Objective: To examine the association between children's overweight status in kindergarten and their academic achievement in kindergarten and first grade. Research Methods and Procedures: The data analyzed consisted of 11, 192 first time kindergartners from the Early Childhood Longitudinal Study, a nationally representative sample of kindergartners in the U.S. in 1998. Multivariate regression techniques were used to estimate the independent association of overweight status with children's math and reading standardized test scores in kindergarten and grade 1. We controlled for socioeconomic status, parent‐child interaction, birth weight, physical activity, and television watching. Results: Overweight children had significantly lower math and reading test scores compared with nonoverweight children in kindergarten. Both groups were gaining similarly on math and reading test scores, resulting in significantly lower test scores among overweight children at the end of grade 1. However, these differences, except for boys’ math scores at baseline (difference = 1.22 points, p = 0.001), became insignificant after including socioeconomic and behavioral variables, indicating that overweight is a marker but not a causal factor. Race/ethnicity and mother's education were stronger predictors of test score gains or levels than overweight status. Discussion: Significant differences in test scores by overweight status at the beginning of kindergarten and the end of grade 1 can be explained by other individual characteristics, including parental education and the home environment. However, overweight is more easily observable by other students compared with socioeconomic characteristics, and its significant (unadjusted) association with worse academic performance can contribute to the stigma of overweight as early as the first years of elementary school.     

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.     

Implications of Overweight Onset and Persistence for Social and Behavioral Development Between Kindergarten Entry and Third Grade

The current study examines the social and behavioral development of school-age children with different histories of overweight onset. Eight thousand children from the Early Childhood Longitudinal Study–Kindergarten Cohort (ECLS-K) participated. Three groups of children were identified for analysis: (1) those who were persistently overweight from kindergarten and/or first grade through third grade; (2) those who were overweight only at third grade; and, (3) those who were never overweight between kindergarten and third grade. Models controlled for child, parent, and family characteristics and tested the linear and quadratic effects of time, the main effects of overweight group and gender, and the interactions among time, overweight group, and gender. Results revealed an effect of overweight on children's social and behavioral functioning, with several effects moderated by gender and time. Findings are discussed within the context of gender and development during early middle childhood.     

Do Children Lose and Maintain Weight Easier Than Adults: A Comparison of Child and Parent Weight Changes From Six Months to Ten Years

Recent research has shown weight maintenance for obese preadolescent children over 60 and 120 month intervals, while studies on adults consistently show they fail to maintain weight loss. This paper is designed to examine differences in percent overweight changes at 6, 60 and 120 months in obese parents and children from 113 families who participated in randomized controlled outcome studies evaluating family-based behavioral treatment. Analyses showed children had significantly greater changes in percent overweight than their parents at each time point. Chi-Square and Logistic Regression analyses showed children were more likely than their parents at each time point to have percent overweight decreases greater than 20%, with over 20% of the children and less than 1% of the parents showing changes this large. The implications of these results for weight control are discussed. These results suggest there may be differences in the efficacy of treating obesity in children versus adults.     

Actividad física,condición física y sobrepeso en niños y adolescentes: evidencia procedente de estudios epidemiológicos

Physical activity and fitness play a significant role in prevention of overweight and obesity in children and adolescentes. Current understanding and evidence from epidemiologic studies provide useful insights to better understand how they relate to each other and how to develop future intervention strategies. This paper summarizes the most relevant information from cross-sectional and longitudinal studies on the relationships between physical activity, physical fitness, and overweight in early life. According to current scientific evidence: (i) High levels of physical activity during childhood and adolescence, particularly vigorous physical activity, are associated to lower total and central adiposity at this age and later in life; (ii) the level of physical fitness, especially aerobic fitness, is inversely related to current and future adiposity levels; (iii) overweight children and adolescents with a high fitness level have a healthier cardiovascular profile than their overweight, low fit peers and a similar profile to their normal weight, low fit peers. This suggests that high fitness levels may counteract the negative consequences attributed to body fat. These findings suggest that increasing physical fitness in overweight children and adolescentes may have many positive effects on health, including lower body fat levels.     

Overweight Children's Barriers to and Support for Physical Activity

Objective: As the epidemic of overweight increases among youth, research needs to examine factors that may influence children's participation in weight‐related health behaviors. This study examined overweight children's perceived barriers to and support for physical activity compared with nonoverweight children. Research Methods and Procedures: Barriers to and support for physical activity were examined among 84 overweight children attending a summer fitness camp or a university‐based weight loss clinic. Barriers and support levels were then compared with those of 80 nonoverweight children of a similar age range. Results: Body‐related barriers were the most predominant barrier type among overweight youth, especially among overweight girls. Overweight children, particularly girls, reported significantly higher body‐related, resource, and social barriers to physical activity compared with nonoverweight children and lower levels of adult support for physical activity. Discussion: Overweight children may be particularly vulnerable to body‐related barriers to physical activity, and reducing such barriers may serve as physical activity intervention points most relevant for overweight youth. Future interventions may also benefit from enhancing support for physical activity from adults and peers.     

Global prevalence of overweight and obesity in preschoolers

Twenty-three studies reporting cross-sectional and longitudinal data were conducted in 14 different countries between 1998 and 2008. The number of preschool age children totaled more than 43,837 with one study not reporting a sample size. Studies used both international (i.e., International Obesity Task Force (IOTF), World Health Organization (WHO)) and national reference standards (i.e., United States - Centers for Disease Control and Prevention (CDC), Spain - SRS, Italy - Luciano) to classify children as overweight or obese. Within the same sample the percentage of children classified in these categories often showed a 1.5- to 2-fold difference in the prevalence of overweight/obesity with greatest differences in the between country-specific standards (CDC vs. Luciano). WHO percentages frequently exceeded the IOTF percentages. The prevalence of overweight/obese children escalated with increasing age from 2-5 years in both boys and girls with girls showing higher frequencies in 2/3rds of the 72 sex-paired comparisons. The results indicate a recent high prevalence of overweight and obesity in middle and high income countries, among both well-off and lower income segments of populations, in both rural and urban areas, and among all ethnic and racial groups represented. Because a high proportion of preschool overweight/ obese children will continue to increase their adiposity and are at risk for the early onset of metabolic syndrome, cardiovascular disease, type 2 diabetes, musculoskeletal disorders and behavioral problems, concerted public health efforts are needed to coordinate culturally-appropriate parental and caregiver education, home lifestyle changes, dietary and exercise modifications that will reverse the current trajectory.     

Molecular genetics of attention-deficit hyperactivity disorder (ADHD): an update

Attention-deficit hyperactivity disorder (ADHD) is a heritable and behavioral condition of childhood, affecting 5-10% of school-age children worldwide. Affected patients exhibit various behavioral problems such as carelessness, restlessness, disobedience and failure to stay quiet in class. The etiology of ADHD is not known. However, family, twin and adoption studies have provided strong evidence for a genetic etiology of the disorder. A genome-wide scan has identified six chromosomal loci with LOD scores suggestive of linkage. Animal studies suggest the involvement of the brain dopamine pathway and its alteration in ADHD but there is no direct evidence to support this hypothesis. In addition, there are at least 20 candidate genes of small effect that have been studied but none of them appear to be the major gene causing ADHD. Medical intervention along with psychosocial therapy proved to be beneficial for controlling ADHD, although some undesirable side effects have been encountered during medical treatment. In the future, identification of environmental factors, study of additive gene effects and the interaction of genes and environmental factors may provide better insight into the pathophysiology of ADHD. This may lead to an effective new treatment strategy.     

Maternal BMI and country of birth as indicators of childhood obesity in children of Mexican origin

Objective: The goal of this study was to evaluate the relationship between maternal and childhood BMI at baseline in a group of 5‐ to 18‐year‐old children and their mothers, all of whom were of Mexican origin, low socioeconomic status, and enrolled in a cohort study in Houston, TX. Research Methods and Procedures: Using data from 438 mother‐child dyads residing in the same household, we completed logistic regression analyses to determine maternal factors associated with the child being overweight or at‐risk‐for‐overweight, after adjusting for the child's gender, age, and level of physical activity and other maternal confounders. Results: Almost one‐half of the boys and girls (47% and 44%, respectively) were either overweight or at‐risk‐for‐overweight. Obese mothers were twice as likely to have an overweight and/or at‐risk‐for‐overweight child compared with normal‐weight mothers. Women born in the U.S. were twice as likely to have an overweight and/or at‐risk‐for‐overweight child compared with women born in Mexico. In addition, women with less than a high school education were twice as likely to have an overweight child compared with their more educated peers. Discussion: The high prevalence of overweight or at‐risk‐for‐overweight among Mexican‐origin children of low socioeconomic status suggests a continued need to develop and implement culturally sensitive preventive interventions for this minority population. Our data also suggest a need to tailor such interventions particularly for children of obese mothers and those born in the U.S.     

Relation of Food Intake Behaviors and Obesity Development in Young Common Marmoset Monkeys

Objective : Increasing prevalence of childhood obesity and associated risks of adult type disease have led to worldwide concern. It remains unclear how genetic predisposition, environmental exposure to obesogenic food, and developmental programming interact to lead to overweight and obese children. The development of a nonhuman primate model of obesity, and particularly juvenile obesity, is an important step to elucidating the factors associated with obesity and evaluating intervention strategies. Design and Methods : Infant marmosets were followed from birth to 12 months of age. Feeding phenotypes were determined through the use of behavioral observation, solid food intake trials, and liquid feeding trials monitored via lickometer. Results : Marmosets found to be obese at 12 months of age (more than 14%body fat) start consuming solid food sooner and initiate more time off of care givers. These individuals developed stable feeding phenotypes that included being more efficient consumers during liquid intake trials, drinking more grams of diet per contact with the licksit. Conclusions : The weaning process appears to be particularly important in the development of feeding phenotypes and the development of juvenile obesity for the marmosets, and thus this is the time that should be focused upon for intervention testing in both nonhuman primates and children.     

Differences in physical activity between non-overweight, overweight and obese children

The purpose of the study was to find out differences in moderate to vigorous physical activity among non-overweight, overweight and obese children, and between boys and girls. The sample included 364 children (179 boys and 185 girls), aged 6.4 years (+/- 0.3 SD). Physical activity was assessed by 7-day questionnaire. Age adapted BMI was used as overweight and obesity indicator. The children were divided into non-overweight, overweight and obese groups. It was found out, that there are significant differences in non-overweight, overweight and obese children (p < 0.05). Boys were significantly (p < 0.05) less moderate to vigorous physical active than girls, especially in indoor activities. There were also significant differences (p < 0.05) in moderate to vigorous physical activity among non-overweight and obese boys and among overweight and obese boys in weekends and total weekly activity. In girls there are significant differences (p < 0.05) in non-overweight, overweight and groups in weekends and total weekly activity. It is possible to conclude, that obese boys and overweight and obese girls, are prone to less physical activity.     

The effect of low birth weight on height,weight and behavioral outcomes in the medium-run

A number of studies have documented negative long term effects of low birth weight. Yet, not much is known about the dynamics of the process leading to adverse health and educational outcomes in the long run. While previous studies focusing mainly on LBW effects on physical growth and cognitive outcomes have found effects of the same size at both school age and young adulthood, others have found a diminishing negative effect over time. The purpose of this paper was to bring new evidence to this issue by analyzing the medium run effects of low birth weight on child behavioral outcomes as well as physical growth at ages 6 months, 3½, 7½ and 11 years using data from the Danish Longitudinal Survey of Children. Observing the same children at different points in time enabled us to chart the evolution of anthropometric and behavioral deficits among children born with low birth weight and helped understanding the nature and timing of interventions.     

Parenting style and cultural influences on overweight children's attraction to physical activity

Objective: To investigate the associations among parenting style, gender, Chinese culture, and overweight children's attraction to physical activity. Research Methods and Procedures: A total of 104 parents with overweight children were recruited from six primary schools in Hong Kong, China. Only overweight children in grades 3 through 6 (8 to 12 years of age) were invited to participate. Overweight children were defined and identified using the international cut‐off points stratified by sex and age. Questionnaires were used to assess Children's Attraction to Physical Activity (CAPA), perceived competence, and parental socialization influences. Results: Parental influence, especially father's role modeling, was significantly related to attraction to physical activity in overweight Chinese children. Perceived physical competence was also an important correlate of an overweight child's attraction to physical activity. Gender differences in CAPA were not significant among the Chinese overweight children. However, gender differences were observed in the relationship between parent physical activity orientation and CAPA. Discussion: In addition to a child's perceived competence, father's role modeling can provide additional and significant influence with regard to overweight children's attraction to physical activity. Differences in cultural orientation toward body weight should be considered when explaining overweight children's physical activity.     

Nature,nurture, and childhood overweight.

The relative importance of dietary and familial factors in determining weight in early infancy were studied in 203 5-year-old children. Their age at weaning, energy intake in infancy and at 5 years, and maternal percentage expected weight were studied in relation to their percentage expected weight. Neither the estimated energy intake in infancy nor the intake at 5 years correlated significantly with their percentage expected weight at 5 years. Overweight 5-year-olds had not been weaned earlier than normal-weight 5-year-olds. There was a significant correlation between the percentage expected weights of the mothers and those of their children at 5 years of age, although the children of overweight mothers did not have higher energy intakes than the children of underweight mothers. A familial, perhaps genetically determined, tendency to overweight seems to be more important in determining whether a child will be overweight at 5 years old than early weaning and overfeeding in infancy.     

Primates and pandemics: A biocultural approach to understanding disease transmission in human and nonhuman primates

Investigations into zoonotic disease outbreaks have been largely epidemiological and microbiological, with the primary focus being one of disease control and management. Increasingly though, the human–animal interface has proven to be an important driver for the acquisition and transmission of pathogens in humans, and this requires syncretic bio-socio-cultural enquiries into the origins of disease emergence, for more efficacious interventions. A biocultural lens is imperative for the examination of primate-related zoonoses, for the human-primate interface is broad and multitudinous, involving both physical and indirect interactions that occur due to shared spaces and ecologies. I use the case example of a viral zoonotic epidemic that is currently endemic to India, the Kysanaur Forest Disease, to show how biocultural anthropology provides a broad and integrative perspective into infectious disease ecology and presents new insights into the determinants of disease outbreaks. Drawing on insights from epidemiology, political ecology, primate behavioral ecology and ethnoprimatology, this paper demonstrates how human-primate interactions and shared ecologies impact infectious disease spread between human and nonhuman primate groups.     

Comparison of BMI and percentage of body fat of Indian and German children and adolescents

Today, serious health problems as overweight and obesity are not just constricted to the developed world, but also increase in the developing countries (Prentice 2006, Ramachandram et al. 2002). Focusing on this issue, BMI and percentage of body fat were compared in 2094 schoolchildren from two cross-sectional studies from India and Germany investigated in 2008 and 2009. The German children are in all age groups significantly taller, whereas the Indian children show higher values in BMI (e.g. 12 years: Indian: around 22 kg/m2; German: around 19 kg/m2) and in the percentage of body fat (e.g. 12 years: Indian: around 27%; German: around 18-20%) in most of the investigated age groups. The Indian children have significantly higher BMI between 10 and 13 (boys) respectively 14 years (girls). Indian children showed significant higher percentage of body fat between 10 and 15 years (boys) and between 8 and 16 years (girls). The difference in overweight between Indian and German children was strongest at 11 (boys) and 12 (girls) years: 70% of the Indian but 20% of the German children were classified as overweight. In countries such as India that undergo nutritional transition, a rapid increase in obesity and overweight is observed. In contrast to the industrialized countries, the risk of overweight in developing countries is associated with high socioeconomic status. Other reasons of the rapid increase of overweight in the developing countries caused by different environmental or genetic factors are discussed.