Racial/ethnic differences in body fatness among children and adolescents

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

Which Metric of Relative Weight Best Captures Body Fatness in Children?

Objective: To evaluate the relative merits of BMI (kilograms per meter squared) and age‐ and gender‐adjusted BMI, age‐ and gender‐specific z score of BMI, and age‐ and gender‐specific percentiles of BMI as surrogate measures of body fatness among a sample of youth. Research Methods and Procedures: The sample comprised 596 children and adolescents 5 to 18.7 years old and was 40% male and 55% white. Height and weight were measured by trained research staff. DXA was used to determine body fat mass. BMI, age‐ and gender‐specific percentile of BMI, and age‐ and gender‐specific z scores of BMI were computed, and these metrics were compared with measured body fatness. Results: The BMI values in the sample ranged from 12.9 to 55.0 kg/m², with a mean of 24.9 kg/m². The Spearman correlations with percentage body fat were similar for all of the BMI metrics (r = 0.82 to 0.88). Linear regression models with age‐ and gender‐specific percentiles of BMI explained significantly less of the variance (65%) than models with log‐transformed BMI (81%) or age‐ and gender‐specific z scores of BMI (75% to 79%). z scores were the most accurate at classifying children who were overfat (sensitivity = 0.84, specificity = 0.96 for z score ≥1). However, using a BMI ≥85th percentile or a BMI ≥20 kg/m² was also accurate at classifying youth. Discussion: The BMI metrics had similar correlations with body fatness, but age‐ and gender‐specific percentiles of BMI were the least accurate proxy measure of body fatness. However, a BMI z score ≥1, BMI percentile ≥85, and BMI ≥20 kg/m² are all useful for identifying children who may be overfat.     

Associations of adiposity with measured and self-reported academic performance in early adolescence

Objective: To examine the associations of adiposity with measured and self‐reported academic performance independently of demographics and physical activity among U.S. adolescents. Research Methods and Procedures: We surveyed 666 students 11 to 14 years old from seven middle schools in Los Angeles, CA. Weight and height were measured. Actual grade point average was obtained from school records. Self‐reported school grades and physical activity time were measured by questionnaire. Adiposity measures included BMI, BMI percentile (≥85th percentile defined as at‐risk‐of‐overweight), and percentage body fat (bioimpedance). Results: After adjusting for gender, ethnicity, age, and physical activity time, overweight at‐risk status, BMI, and percentage body fat were negatively related to only self‐reported (p < 0.01) but not measured grades. Level of moderate‐to‐vigorous physical activity time was negatively related to measured and self‐reported grades, independently of adiposity (p < 0.01). Discussion: To our knowledge, this is the first study to examine both body mass and body fat in relation to measured and self‐reported school grades. Adiposity did not relate to actual academic performance in a sample of predominantly Latino and Asian‐American adolescents. The use of measured vs. self‐reported academic outcomes may represent different constructs and influence study conclusions. Cultural factors may also play a role in our findings, but this requires further study.     

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

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

Calcium and Dairy Intake and Measures of Obesity in Hyper‐ and Normocholesterolemic Children

Objective: Calcium intake has been inversely associated with body weight and body fatness in adults and, to a lesser extent, in children. Dairy intake has been inversely associated with metabolic syndrome in overweight but not normal‐weight adults. We assessed whether intakes of calcium and dairy foods were associated with measures of obesity in hypercholesterolemic (HC) and normocholesterolemic (non‐HC) children at baseline and over 1 year. Research Methods and Procedures: Non‐obese 4‐ to 10‐year‐old HC and non‐HC children (342) completed three 24‐hour dietary recalls and provided measures of relative weight (BMI and BMI z scores) and adiposity (sum of skinfolds, trunk skinfolds) at baseline, 3, 6, and 12 months. Cross‐sectional and longitudinal regression analyses, stratified by cholesterol risk status (HC vs. non‐HC) and age (4 to 6 years and 7 to 10 years) and adjusted for potential confounders, were conducted. Results: After adjusting for age, sex, energy intake, and percentage energy from fat, calcium intake was inversely associated with BMI, sum of skinfolds, and trunk skinfolds at baseline and over 1 year in the 7‐ to 10‐year‐old non‐HC children. Results from the regression models also indicated an inverse relation between intake of dairy foods and measures of obesity at baseline in these children. Calcium or dairy intake was not associated with measures of obesity in HC children or in the 4‐ to 6‐year‐old non‐HC children. Discussion: These results suggest a complex relation among intake of calcium and dairy foods, measures of obesity, age, and serum cholesterol in children. Older children without risk of metabolic syndrome may benefit most from increased calcium intake.     

Racial Differences in the Tracking of Childhood BMI to Adulthood

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

Physical Activity as a Predictor of Body Composition in American Indian Children

Objective: To examine physical activity in second grade American Indian children as a predictor of percentage body fat 3 years later. Research Methods and Procedures: Physical activity was assessed as average vector magnitude (AVM) counts from an accelerometer in 454 second grade children as part of the Pathways study. BMI was assessed, and skinfolds and bioelectrical impedance were used to estimate fat mass, fat‐free body mass, and percentage body fat in validated prediction equations. Associations were examined using mixed models regression controlling for baseline body composition. Results: In normal‐weight children, higher AVM counts were significantly associated with decreases in percentage body fat. Among overweight children, higher AVM counts were significantly associated with increases in BMI, fat mass, and fat‐free mass but not percentage body fat. Discussion: Higher physical activity levels in second grade were associated with lower levels of percentage body fat in fifth grade in normal‐weight but not in overweight children. BMI showed no association with physical activity among normal‐weight children, and increases in BMI were associated with increasing amounts of physical activity among overweight children. These findings emphasize the importance of valid body composition measures and may indicate important differences in associations between physical activity and adiposity in normal‐weight as compared with overweight children.     

Rate of Fat Gain Is Faster in Girls Undergoing Early Adiposity Rebound

Objective: To determine the changes in body composition (fat and lean mass) occurring in children during adiposity rebound (AR). Research Methods and Procedures: Thirty‐nine girls, 3 to 6 years of age at baseline, underwent yearly DXA scans for 2 years. An additional DXA scan was obtained 4 to 5 years after baseline. Age at AR was determined by modeling, and the velocity of change in height, weight, fat mass, and lean mass was estimated for each child using random coefficient models. Girls with an AR <5 years of age were classified as having an early AR, and those having an AR ≥5 years were classified as late AR. Results: Although body composition was similar at age 5, by age 9, girls with an early AR were significantly taller (3.5% more) and heavier (14.4%), with greater fat mass (50%) and percentage body fat (27%) than girls with a later AR. In addition, more girls were overweight according to BMI (18% vs. 6%) or percentage body fat (29% vs. 11%) at this time, despite no differences at baseline. Annual velocity of fat mass gain was over 2‐fold higher in early compared with late rebounders (17.1% vs. 6.5%, p < 0.0001), with no difference in lean mass velocity (13.1% vs. 12.5%, p = 0.116). Discussion: Differences in BMI during AR were caused specifically by alterations in body fat and not by alterations in lean mass or height. Children undergoing early AR gained fat at a faster rate than children who rebounded at a later age.     

Racial and ethnic differences in secular trends for childhood BMI, weight, and height

Objectives: The prevalence of childhood overweight in the United States has markedly increased over the last 30 years. We examined differences in the secular trends for BMI, weight, and height among white, black, and Mexican‐American children. Research Methods and Procedures: Analyses were based on nationally representative data collected from 2 to 17 year olds in four examinations (1971–1974 through 1999–2002). Results: Overall, black children experienced much larger secular increases in BMI, weight, and height than did white children. For example, over the 30‐year period, the prevalence of overweight increased ～3‐fold (4% to 13%) among 6‐ to 11‐year‐old white children but 5‐fold (4% to 20%) among black children. In most sex‐age groups, Mexican‐American children experienced increases in BMI and overweight that were between those experienced by blacks and whites. Race/ethnicity differences were less marked among 2 to 5 year olds, and in this age group, white children experienced the largest increase in overweight (from 4% to 9%). In 1999–2002, the prevalence of extreme BMI levels (≥99th percentile) reached 6% to 7% among black girls and Mexican‐American boys. Discussion: Because of the strong tracking of childhood BMI levels into adulthood, it is likely that the secular increases in childhood overweight will greatly increase the burden of adult disease. The further development of obesity interventions in different racial/ethnic groups should be emphasized.     

The Relationship of Childhood Adiposity to Parent Body Mass Index and Eating Behavior

Objective: To better understand risk factors for the development of obesity in early childhood, we examined the association between children's adiposity and their parents' eating behavior and body mass index (BMI). Research Methods and Procedures: Parents of 85 white children 36 months of age (49 boys and 36 girls) completed the Three‐Factor Eating Questionnaire measuring three dimensions of parent eating behavior: disinhibited eating, cognitive restraint of eating, and susceptibility to hunger. Parent BMI (kg/m²) was calculated using self‐reported height and weight. The children's percentage body fat was assessed by dual energy X‐ray absorptiometry analysis. Results: Twenty‐six percent of parents were obese (BMI ≥ 30 kg/m²). Both maternal and paternal BMI were associated with higher scores for disinhibition (r = 0.69 and r = 0.68, p < 0.001), and maternal BMI was also associated with higher scores for hunger (r = 0.51, p < 0.001). There were no significant relationships between children's percentage body fat and parent eating scores, and the correlation between children's percentage body fat and parent BMI was significant only between mothers and daughters (r = 0.35, p = 0.04). Obese parents were no more likely to have a child who was fatter (upper quintile of percentage body fat for gender). Discussion: Among 36 month‐old white children, parent eating behavior was related to parent BMI, but not to children's adiposity. There was only a weak relationship between parent BMI and child adiposity. Despite the aggregation of adiposity within families due to shared genes and environments, children may not express differences in susceptibility to obesity by 3 years of age.     

Soda consumption and overweight status of 2-year-old mexican-american children in california

Objective: The prevalence of overweight in United States children, 2 to 5 years old, has increased 2‐fold since 1975, with the highest prevalence in Mexican Americans. The objective of this study was to determine the association between current soda consumption and overweight in 2‐year‐old Mexican‐American children. Research Methods and Procedures: The Center for the Health Assessment of Mothers and Children of Salinas study is a longitudinal study of the health of low‐income Latino pregnant women and their children living in the Salinas Valley, CA. Six hundred pregnant women were enrolled (October 1999 to October 2000), and their children were followed until 2 years of age. This cross‐sectional analysis includes the 354 children who completed the 2‐year follow‐up interview. Standing height (centimeters) and weight (grams) were measured at 2 years. Overweight was defined as ≥95th percentile of the sex‐specific BMI for each child's age. Results: Fifty‐five (15.5%) children were overweight. Over half (56%) reported consuming any soda in the last week. After covariate adjustment, compared with no soda consumption, <1 soda/d was not related to overweight (adjusted odds ratio, 0.97; 95% confidence interval, 0.47, 1.99), but ≥1 soda/d was significantly associated with overweight (adjusted odds ratio, 3.39; 95% confidence interval, 1.43, 8.07), and the test for trend was significant (p = 0.02). Discussion: At 2 years of age, the prevalence of overweight among the Center for the Health Assessment of Mothers and Children of Salinas cohort is higher than the national prevalence estimate for Mexican‐American 2‐ to 5‐year‐old children and is significantly associated with current soda consumption. Interventions to reduce consumption of soda in young Mexican‐American children should be considered.     

Weight and BMI over 6 years in Korean Children: Relationships to Body Image and Weight Loss Efforts

Objective: To investigate the relationships among longitudinal weight status, body dissatisfaction, and attitude to weight loss among Korean children from the age of 7‐8 to 13‐14 years old. Research Methods and Procedures: 351 Korean school children's heights and weights were measured at the ages of 7‐8 and 13‐14 years old; at the age of 13‐14, they completed a questionnaire about body dissatisfaction and weight loss efforts. Results: At the age of 7‐8, 15.7% of children were overweight by International Obesity Task Force standards, as compared with 26.2% at the age of 13‐14. Of the 55 7‐ to 8‐year‐old overweight children, 85.5% were still overweight at the age of 13‐14 years old. Greater concerns about body image and stronger desires to be thinner were observed among stable overweight children and among those in whom there had been a rapid increase in BMI over the 6‐year study period. Girls favored thinner shapes than did boys, regardless of their weight status or BMI changes. In girls, the level of body dissatisfaction was related only to weight loss desire, regardless of weight status or changes in BMI. In boys, however, weight loss desire was related only to weight loss attempts and was independent of weight status, BMI changes, and level of body dissatisfaction. Discussion: Regardless of weight status, changes in BMI should be considered when dealing with body dissatisfaction and attitudes to weight loss in children.     

Associations of Maternal Prenatal Smoking with Child Adiposity and Blood Pressure

Objective: To examine the extent to which maternal prenatal smoking is associated with adiposity, central adiposity, and blood pressure in 3‐year‐old children. Research Methods and Procedures: We studied 746 mother‐child pairs in Project Viva, a prospective cohort study, and categorized mothers as never, early pregnancy, or former smokers. Main outcome measures were overweight (BMI for age and sex > 85th percentile), BMI z‐score, sum of subscapular (SS) and triceps (TR) skinfolds, SS:TR skinfold ratio, and systolic blood pressure (SBP). Results: One hundred sixty‐one (22%) mothers quit smoking before pregnancy, 71 (10%) smoked in early pregnancy, and 514 (69%) never smoked. At age 3 years, 204 (27%) children were overweight. On multivariable analysis, compared with children of never smokers, children of early pregnancy smokers had an elevated risk for overweight [odds ratio (OR), 2.2; 95% confidence interval (CI), 1.2, 3.9] and higher BMI z‐score (0.30 units; 95% CI, 0.05, 0.55), SS + TR (2.0 mm; 95% CI, 0.9, 3.0), and SBP (2.4 mm Hg; 95% CI, ?0.1, 4.9). Children of former smokers were not more overweight (BMI z‐score, 0.02 units; 95% CI, ?0.15, 0.19) but had higher SBP (1.5 mm Hg; 95% CI, ?0.1, 3.2). We saw no relationship of smoking with central adiposity (SS:TR). Discussion: Former and early pregnancy smokers had children with somewhat higher SBP, but only early pregnancy smokers had children who were more overweight. Mechanisms linking smoking with child adiposity and blood pressure may differ. A long‐term impact of maternal smoking on offspring cardiovascular risk provides further reason to reduce smoking in women.     

Evolution of the Prevalence of Obesity in the Workers of a General Hospital in Mexico

Objective: The objective of this study was to compare the prevalence of overweight and obesity in the first Prevalencia de factores de nesso cardiovascular en Trabajadores survey (1994) with the prevalence of overweight and obesity observed in the second survey (1996). Research Methods and Procedures: For both surveys the following individual data were collected: age, sex, weight, height, and body mass index (BMI). The 1994 survey included 2383 people and the 1996 survey included 2759 people. The degree of BMI was classified according to the current World Health Organization definitions. The population was divided by gender and age group, and the prevalence of each level of overweight was calculated. Additionally, the prevalence of different cutoff levels of BMI was calculated by gender and age groups. Results: The global prevalence of age‐adjusted overweight increased from 26.91% to 37.45%. This increase was observed in both genders but the men had a higher increase from 24.51% to 40.21%. Overweight was more frequent in men than in women in all age groups. Male overweight prevalence was higher in the 40‐ to 59‐year‐old group and ≥60‐year‐old group. Female overweight prevalence was predominant in the 30‐ to 39‐year‐old, 40‐ to 49‐year‐old, and 50‐ to 59‐year‐old groups. Global prevalence of obesity (≥30 kg/m²) changed from 13.8% to 17.2%. Particularly, global prevalence of obesity class I increased from 9.66% to 12.6%; in men this figure increased from 9.04% to 13.05% and in women from 9.9% to 12.71%. Discussion: Prevalence of overweight and obesity has increased significantly in the studied population. It is necessary to implement lifestyle modifications to prevent the increase of prevalence of overweight and obesity.     

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.     

DXA measurements confirm that parental perceptions of elevated adiposity in young children are poor

Objective: To compare parental assessments of child body weight status with BMI measurements and determine whether children who are incorrectly classified differ in body composition from those whose parents correctly rate child weight. Also to ascertain whether children of obese parents differ from those of non‐obese parents in actual or perceived body weight. Research Methods and Procedures: Weights, heights, BMI, and waist girths of New Zealand children ages 3 to 8 years were determined. Fat mass, fat percentage, and lean mass were measured by DXA (n = 96). Parents classified child weight status as underweight, normal‐weight, slightly overweight, or overweight. Centers for Disease Control and Prevention 2000 percentiles of BMI were used. Results: Parents underestimated child weight status. Despite having 83% more fat mass than children with BMI values below the 85th percentile, only 7 of 31 children with BMI values at or above the 85th percentile were rated as slightly overweight or overweight. In the whole sample, participants whose weight status was underestimated by parents (40 of the 96 children) had l9% less fat mass but similar lean mass as children whose weight status was correctly classified. However, children of obese and non‐obese parents did not differ in body composition or anthropometry, and obese parents did not underestimate child weight more than non‐obese parents. Discussion: Because parents underestimate child weight, but BMI values at or above the 85th percentile identify high body fat well, advising parents of the BMI status of their children should improve strategies to prevent excessive fat gain in young children.     

Accelerometry‐Measured Activity or Sedentary Time and Overweight in Rural Boys and Girls

Objective: The aim of this study was to examine the association between overweight and physical activity or sedentary time measured by accelerometry in rural boys and girls 7 to 19 years old. Research Methods and Procedures: A cross‐sectional study was conducted involving 130 girls and 99 boys in elementary, middle, and high school in rural Maryland. After weight, height, and body composition were measured, children wore an Actiwatch accelerometer for 6 days. Comparisons for activity counts were made between normal and overweight or at risk for overweight (at‐risk/overweight) participants (≥85th percentile of BMI). The associations between body composition and accelerometry‐defined activity levels (sedentary, light, moderate, and vigorous) were analyzed by age group for boys and girls. Results: Differences in total activity in counts per day or counts per minute were not observed between normal and at‐risk/overweight boys or girls in all age groups. No associations between measures of body composition and time spent in an activity level were seen in boys. Fat mass and percentage fat were positively correlated to time spent in sedentary activity (range r = 0.42 to 0.54, all p < 0.01) for girls. In contrast, fat mass and percentage fat were negatively related to time spent in light activity (range, r = ?0.40 to ?0.51, p < 0.05) for girls. Discussion: In girls, but not boys, greater body fat is associated with greater time spent being inactive, and lower levels of body fat are associated with more time spent in light activity. Physical activity interventions targeting inactive children in rural communities are warranted.     

The Relationship Between Parent and Child Self‐Reported Adherence and Weight Loss

Objective: Better adherence to treatment strategies in family‐based behavioral weight control programs may lead to greater weight reduction and improved weight maintenance in youth. This study assessed the influence of child and parent self‐reported adherence to behavioral strategies on changes in 2‐year child and parent percentage overweight. Research Methods and Procedures: Participants included 8‐ to 12‐year‐old children in ≥ 85th BMI percentile and their parents from 110 families taking part in two family‐based randomized controlled weight control studies. This study examined whether self‐reported adherence to behavioral strategies measured at 24 months increased prediction of child and parent percentage overweight change through 24‐month follow‐up after accounting for other factors that may influence weight change. Results: Child adherence to weighing and to preplanning for celebrations where high‐fat foods are served and parent adherence to praising the child and modeling healthy eating habits predicted 24‐month child percentage overweight change (p < 0.001). Child adherence to recording food and calories and parent adherence to modeling healthy eating habits predicted 24‐month parent percentage overweight change (p < 0.001). In hierarchical regression models, child weighing and preplanning and parent modeling were significant (p < 0.01) incremental predictors (r² of 24.8%) of 24‐month child percentage overweight. Child recording and parent modeling were significant (p < 0.01) incremental predictors (r² of 14%) of parent 24‐month percentage overweight change. Discussion: Child and parent adherence to specific components of family‐based behavioral weight control treatment are independent predictors of long‐term child and parent percentage overweight change.     

Relationship of Physical Fitness to Prevalence and Incidence of Overweight among Schoolchildren

Objectives: We examined the relationship between comprehensive fitness tests and overweight using a school surveillance system in a racially diverse city in the United States. Research Methods and Procedures: Trained physical education teachers measured weight, height, and fitness annually from 2001 to 2003. We compiled data for a cross‐sectional analysis (11, 845 measurements on 6297 students, 5 to14 years of age) and a 1‐year prospective analysis (4215 measurements on 2927 students not overweight at baseline, 5 to 13 years of age). Overweight was defined as a BMI ≥95th percentile (Centers for Disease Control and Prevention 2000 growth charts), and underfit was defined as failing at least one of five fitness tests: endurance run, abdominal strength, flexibility, upper body strength, and agility (Amateur Athletic Union and Fitnessgram). Associations between fitness and overweight were examined using multivariate logistic regression models, adjusting for sociodemographic status and repeated measurements over time. Results: The mean number of fitness tests passed was lower among students with a BMI above the 80th percentile. Overweight incidence over 1 year was 7% and 2% for underfit and fit girls, respectively (odds ratio, 3.3; 95% confidence interval, 2.0 to 5.6). Not passing either the endurance run or upper body strength test was associated with overweight incidence in both boys and girls. After adjusting for baseline BMI, the endurance run remained a significant predictor of incident overweight among girls (odds ratio, 2.0; 95% confidence interval, 1.1 to 3.5). Discussion: Findings support a cross‐sectional inverse relationship between physical fitness and overweight among school‐aged children. The direction of causation between fitness and overweight is not clearly established and merits further study.     

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

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