Evidence of a Double Burden of Malnutrition in Urban Poor Settings in Nairobi,Kenya

Background

Many low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the neighborhood and household level, in an urban poor setting in Nairobi, Kenya.

Methods

Data were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults.

Results

Of the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese.

Conclusion

The findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further research is needed to understand the pathways to this coexistence, and to test feasibility and effectiveness of context-specific interventions to curb associated health risks.     

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

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

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

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

The High Prevalence of Overweight and Obesity in Mexican Children

Objective: To establish the prevalence of overweight and obesity in Mexican children 10 to 17 years of age according to the percentiles from both the Centers of Disease Control and Prevention (CDC) and the International Obesity Task Force (IOTF). Research Methods and Procedures: Heights and weights were measured in children from nationally representative, randomly chosen households in the Mexican National Health Survey 2000. The study population consisted of 7862 boys and 8947 girls, 10 to 17 years of age. Measurements used were the percentage of children in the corresponding BMI categories for overweight and obesity specified by the CDC and the IOTF BMI percentiles. Results: The children were short, with mean Z scores for height by age varying from ? 0.62 ± 1.26 to ?1.12 ± 1.06 in boys and from ?0.45 ± 1.25 to ?1.19 ± 1.12 in girls. CDC‐based overweight prevalences varied by age from 10.8% to 16.1% in boys and 14.3% to 19.1% in girls, with obesity prevalences from 9.2% to 14.7% in boys and 6.8% to 10.6% in girls; these prevalences did not relate to stunting. IOTF‐based excess weight prevalences were similar, with higher overweight rates (boys, 15.4% to 18.8%; girls, 18.4% to 22.3%) but lower obesity rates (boys, 6.1% to 9%; girls, 5.9% to 8.2%). Discussion: Mexican children have one‐half the overweight/obesity prevalences of U.S. Mexican‐American children; however, there are higher rates in Northern Mexico, which is closer to the U.S. These escalating rates of excess weight demand new prevention, as well as management, policies.     

Prevalence of overweight and obesity among the affluent adolescent school children of Amritsar, Punjab

In the present study, an attempt has been made to assess the prevalence of overweight and obesity in adolescent children (between 10-15 years of age) of the affluent families of Amritsar district of Punjab, a state in rapid economic and epidemiological transition. A total of 640 children (323 boys and 317girls) were measured for height and weight. Overweight and obesity were assessed using age and sex-specific body mass index (BMI) cut-off points. 9.91% boys and 11.99% girls were overweight, and 4.95% boys and 6.31% girls were obese. The prevalence of overweight and obesity among the affluent children in Amritsar was as high or higher as in some industrialized countries.     

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.     

Growth and Body Mass Index of Brazilians Ages 9 Through 17 Years

Obesity during adolescence is considered a strong predictor of adult obesity, and obesity and overweight have been increasing among Brazilian adults. To gauge the relative frequency of overweight among adolescents in Brazil, we compared the distributions of body mass index (kg/m²) and stature in national population based samples of the U.S. and Brazil. U.S. adolescents were on average about 10 cm taller than Brazilians, although growth spurts occurred at the same age for both populations. Brazilian adolescents were leaner than their U.S. counterparts. This difference was reduced among girls in the postpubertal period. At age 17 years, U.S. boys were about 10 kg heavier than Brazilian boys, but the difference among girls was only 2 kg. In families above the poverty level in the more developed South region, body mass index distribution for boys was closer to that of the U.S., and older girls tended to have higher body mass index than U.S. girls. Within Brazil, body mass index varied by ethnicity with Mulattos, but not Blacks, of both sexes having lower body mass index than Whites of the same age. Urban adolescents had higher body mass index than those living in rural areas. In general, the patterns seen among Brazilian adults were found among children. Among girls, in particular, overweight has become an identifiable problem during adolescence.     

Increase in prevalence of overweight in Dutch children and adolescents: a comparison of nationwide growth studies in 1980, 1997 and 2009

Objective

To assess the prevalence of overweight and obesity among Dutch children and adolescents, to examine the 30-years trend, and to create new body mass index reference charts.

Design

Nationwide cross-sectional data collection by trained health care professionals.Participants: 10,129 children of Dutch origin aged 0–21 years.

Main Outcome Measures

Overweight (including obesity) and obesity prevalences for Dutch children, defined by the cut-off values on body mass index references according to the International Obesity Task Force.

Results

In 2009, 12.8% of the Dutch boys and 14.8% of the Dutch girls aged 2–21 years were overweight and 1.8% of the boys and 2.2% of the girls were classified as obese. This is a two to three fold higher prevalence in overweight and four to six fold increase in obesity since 1980. Since 1997, a substantial rise took place, especially in obesity, which increased 1.4 times in girls and doubled in boys. There was no increase in mean BMI SDS in the major cities since 1997.

Conclusions

Overweight and obesity prevalences in 2009 were substantially higher than in 1980 and 1997. However, the overweight prevalence stabilized in the major cities. This might be an indication that the rising trend in overweight in the Netherlands is starting to turn.     

Overweight in Swiss children and associations with children's and parents' characteristics

Objective: The objective was to assess the prevalence of overweight and obesity in children in a canton of Switzerland and the association with various characteristics of the parents and the children. Research Methods and Procedures: A cross‐sectional survey was conducted in all children of the sixth school grade of the canton of Vaud, Switzerland. Weight and height were measured, and selected lifestyle variables were assessed with a self‐administered semiquantitative questionnaire. Information on children's parents was gathered through a mailed structured questionnaire. Overweight and obesity were based on the International Obesity Task Force criteria. Results: Of 6873 eligible children, 5207 (76%) participated (2621 boys, 2586 girls; mean age, 12.3 years; standard deviation, 0.5 year). The prevalence of overweight (including obesity) was 15.0% (95% confidence interval, 13.7% to 16.4%) in boys and 12.4% (11.1% to 13.7%) in girls, and the prevalence of obesity was 1.8% (1.3% to 2.3%) and 1.7% (1.2% to 2.2%), respectively. In both univariate and multivariate analyses, overweight was strongly associated with high television viewing time and selected characteristics of the parents (overweight, low educational level, and foreign nationality). Discussion: The prevalence of pediatric overweight and obesity was lower in this region of Switzerland than in several European countries. The correlates of overweight found in this region suggest areas for potential interventions.     

The extent of overweight index in children and adolescents from Cracow,Poland (1971–2000)

Obesity indices describe the percentage of overweight and obese children in a given population but they do not show the extent to which the norms have been exceeded. The aim of this work was to determine the extent of overweight index (EOW), suggested by Jolliffe, 2004a, Jolliffe, 2004b, by examining children and adolescents from Cracow in order to obtain information on overweight and obesity prevalence and on the amounts by which the BMI age- and sex-specific norms are exceeded, emphasising usefulness of EOW in population studies.The study material comprises three randomly selected groups, representative for Cracow: (1) measured in 1971 which includes 4090 individuals of both sexes and aged 7–19 years, (2) measured in 1983 with 6542 individuals aged 3–19 years and (3) measured in 2000 with 4524 boys and girls aged 3–19 years. The EOW index of overweight is a mean relative deviation from BMI threshold, assuming that for values lower than the threshold ones, the deviation amounts to zero.The EOW index values in boys increased from 0.9 in 1971 up to 2.2 in 2000 i.e. by 144%, indicating an increase of both prevalence of overweight and obesity and an increase of the amount by which the limits of overweight are exceeded. In girls the index also increased, though less dramatically, from 0.7 in 1971 to 1.5 in 2000 i.e. by 114%.An analysis of the results showed that the increasing prevalence of overweight and obesity in children and adolescents is accompanied by an increase of the amount by which the BMI threshold values are exceeded.     

Obesity and physical activity among Aboriginal Canadians

Objective: To investigate ethnic differences in obesity and physical activity among Aboriginal and non‐Aboriginal Canadians. Methods and Procedures: The sample included 24,279 Canadians (1,176 Aboriginals, 23,103 non‐Aboriginals) aged 2–64 years from the 2004 Canadian Community Health Survey (CCHS). Adult participants were classified as underweight/normal weight, overweight (BMI 25–29.9 kg/m²) or obese (BMI ≥ 30 kg/m²). Children and youth 2–17 years of age were classified as normal weight, overweight or obese based on the International Obesity Task Force criteria. Leisure‐time physical activity levels over the previous 3 months were obtained by questionnaire in those aged 12–64 years. Results: The prevalence of obesity in adults was 22.9% (men: 22.9%; women: 22.9%), and the prevalence was higher among Aboriginals (37.8%) compared to non‐Aboriginals (22.6%). The prevalence of obesity in children and youth was 8.2% (boys: 9.2%; girls: 7.2%), and the prevalence was higher among Aboriginals (15.8%) compared to non‐Aboriginals (8.0%). In both youth and adults, the odds for obesity were higher among Aboriginals (youth: OR = 2.3 (95% CI: 1.4–3.8); adults: OR = 2.4 (95% CI: 1.6–3.6)) after adjustment for a number of covariates. There were no ethnic differences in the prevalence of physical inactivity; however, physical inactivity was a predictor of obesity in both the Aboriginal and non‐Aboriginal samples. Discussion: The prevalence of obesity is higher among Canadian Aboriginals compared to the rest of the population. Further research is required to better delineate the determinants of obesity and the associated health consequences in this population.     

The Double Burden of Obesity and Malnutrition in a Protracted Emergency Setting: A Cross-Sectional Study of Western Sahara Refugees

Background

Households from vulnerable groups experiencing epidemiological transitions are known to be affected concomitantly by under-nutrition and obesity. Yet, it is unknown to what extent this double burden affects refugee populations dependent on food assistance. We assessed the double burden of malnutrition among Western Sahara refugees living in a protracted emergency.

Methods and Findings

We implemented a stratified nutrition survey in October–November 2010 in the four Western Sahara refugee camps in Algeria. We sampled 2,005 households, collecting anthropometric measurements (weight, height, and waist circumference) in 1,608 children (6–59 mo) and 1,781 women (15–49 y). We estimated the prevalence of global acute malnutrition (GAM), stunting, underweight, and overweight in children; and stunting, underweight, overweight, and central obesity in women. To assess the burden of malnutrition within households, households were first classified according to the presence of each type of malnutrition. Households were then classified as undernourished, overweight, or affected by the double burden if they presented members with under-nutrition, overweight, or both, respectively.The prevalence of GAM in children was 9.1%, 29.1% were stunted, 18.6% were underweight, and 2.4% were overweight; among the women, 14.8% were stunted, 53.7% were overweight or obese, and 71.4% had central obesity. Central obesity (47.2%) and overweight (38.8%) in women affected a higher proportion of households than did GAM (7.0%), stunting (19.5%), or underweight (13.3%) in children. Overall, households classified as overweight (31.5%) were most common, followed by undernourished (25.8%), and then double burden–affected (24.7%).

Conclusions

The double burden of obesity and under-nutrition is highly prevalent in households among Western Sahara refugees. The results highlight the need to focus more attention on non-communicable diseases in this population and balance obesity prevention and management with interventions to tackle under-nutrition. Please see later in the article for the Editors'' Summary     

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.     

Eleven‐year Prevalence Trends of Obesity in Greek Children: First Evidence that Prevalence of Obesity Is Leveling Off

We examined 11‐year (1997–2007) trends in underweight, overweight, and obesity in Greek children. Population data derived from a yearly, school‐based health survey carried out between 1997 and 2007 in >80% of all Greek schools. Height and weight measurements from 651,582 children, aged 8–9 years (boys: 51.2%) were analyzed. The gender‐ and age‐specific BMI cutoff points by the International Obesity Task Force (IOTF) were used in order to define underweight, normal weight, overweight, and obesity. Trend analysis showed an increase in the prevalence of obesity from 7.2 ± 0.2% in 1997 to 11.3 ± 0.2% in 2004 for girls (P < 0.001) and from 8.1 ± 0.2% in 1997 to 12.3 ± 0.2% in 2004 for boys (P < 0.001). An apparent leveling off in obesity rates was observed during 2004–2007 for both boys and girls. The prevalence of overweight rose between 1997 and 2007 from 20.2 ± 0.2% to 26.7 ± 0.2% for girls (P < 0.001) and from 19.6 ± 0.2% to 26.5 ± 0.2% for boys (P < 0.001). The overall prevalence of thinness in the same period remained constant in both sexes. The presented population‐based data revealed that the prevalence of overweight and obesity among 8‐ to 9‐year‐old Greek children is alarmingly elevated, with the overweight rates rising continuously. However, an apparent leveling off in obesity rates for the past 4 consecutive years was documented for the first time in both genders.     

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.     

Association between obesity and hyperlipidemia among children.

BACKGROUND: This study was undertaken to show the association between obesity and hyperlipidemia among the children. METHODS: In March 2000, while conducting a comprehensive health examination, we analyzed 2011 children from the first grade of primary schools in Taichung City in Taiwan. To study the association between obesity and hyperlipidemia, the t test, chi-square analysis, and multivariate logistic regression were used. RESULTS: There were 1057 boys (52.56 percent) and 954 girls (47.44 percent). The mean age was 7.27 +/- 0.46 years. The proportion of overweight was 11.07 percent in boys and 11.64 percent in girls. The proportion of obesity was 14.19 percent in boys and 12.89 percent in girls. After controlling the other covariates, the multivariate logistic regression analysis showed that overweight was associated with a low level of high density lipoprotein cholesterol. Obesity was associated with hypertriglyceridemia, a high level of low density lipoprotein cholesterol, and a low level of high density lipoprotein cholesterol. CONCLUSIONS: Our findings disclosed that the prevalence of overweight and obesity was high in childhood. Early intervention to control and prevent childhood obesity might be warranted. Obesity was associated with hyperlipidemia in children. A wide-scale survey will be suggested in the future to establish causal-effect issues between obesiyy and hyperlipidemia.     

Trends in body mass index, prevalence of overweight and obesity in preschool Lithuanian children, 1986-2006

The study provides the body mass index (BMI), the prevalence of overweight and obesity in preschool Lithuanian children, 1986-2006. In the 2003-2006 more than 1000 preschool 3-6 year old children from Vilnius (the capital of Lithuania) were investigated according to the standard anthropometric methods. The prevalence of overweight (OW) and obesity (OB) was estimated according to the cut-off points recommended by the International Obesity Task Force (IOTF). Recent data were compared with the data of preschool children from the 1986 Vilnius study and with the data from the other countries. The BMI of preschool children did not change significantly during the last 20 years, except for the statistically significant BMI increment in 6 years old girls. The prevalence of OB among preschool Lithuanian children was low (0.8%-3.7% in boys, and 0-1.9% in girls) and did not change significantly during 1986-2006. The prevalence of OW was higher in preschool girls (10.7%-18.2%) in comparison with preschool boys (6.5%-12.4%). The significant increment of the prevalence of OW was observed among the 6-year-old girls from the 2006 study in comparison with the 1986 study. The possible socio-economic reasons of the defined trend in the BMI and prevalence of OW and OB among preschool Lithuanian children are discussed in the paper.     

Changes in BMI and the prevalence of overweight and obesity in children and adolescents in Cracow, Poland, 1971-2000.

The aim of this study is to examine changes in prevalence of overweight and obesity, using International Obesity Task Force criteria, in three cohorts of children and youth living in Cracow, Poland, in 1971, 1983 and 2000. Rates of overweight and obesity doubled among boys and girls, from 7.5% and 6.5% in 1971, to 15.2% and 11.8% in the year 2000. The greatest increases in prevalence occurred in the youngest age groups (7-12 years for boys and 7-10 years for girls), increases being less extensive among adolescents, and lowest of all in the oldest age groups (16-18 years in boys and 14-18 years in girls). The absence of a positive secular trend in BMI among adolescent females relative to males may be due to sociocultural pressures associated with transition to a free market economy in Poland. The extent to which girls attempt to achieve the ideal body, as portrayed by media and society more generally, increases across adolescence.     

Trends in the prevalence of overweight and obesity among young Australians, 1985, 1997, and 2004

Objective: To determine secular trends in overweight/obesity among 7‐ to 15‐year‐olds for the periods 1985, 1997, and 2004. Research Method and Procedures: Data from representative surveys conducted in New South Wales, Australia, in 1985, 1997, and 2004 were analyzed. Height and weight were measured, and BMI categories were created using International Obesity Task Force definitions. Students were grouped as Grades 2 + 4 + 6 and 8 + 10. Results: The prevalences of overweight/obesity for 1985, 1997, and 2004 were 10.9%, 20.6%, and 25.7% among the younger boys and 10.6%, 19.5%, and 26.1% among the older boys. The average annual rate of increase for 1985 to 1997 was 0.81% and for 1997 to 2004 was 0.73% among the younger boys and was 0.74% and 0.94% for the two periods among the older boys. The prevalences of overweight/obesity in 1985, 1997, and 2004 were 14.0%, 22.0%, and 24.8% among the younger girls and 8.3%, 17.9%, and 19.8% among the older girls, respectively. The average annual rates of increase for the two periods were 0.8% and 0.4% among the younger girls and 0.80% and 0.27% among the older girls. Change in the prevalence of overweight/obesity and socioeconomic status were not associated. Discussion: Over the period 1985 to 1997, the prevalence of overweight and obesity increased significantly among the younger and older boys and the younger girls. The prevalence of overweight, but not obesity, increased among the older girls over this period. Over the period 1997 to 2004, the prevalence of overweight/obesity combined increased significantly among boys of both age groups but not among girls.