A nutritional comparison of foods and beverages marketed to children in two advertising policy environments

Childhood obesity is associated with children's exposure to food/beverage marketing. Policy options in this area are being sought in order to reduce childhood obesity rates on a population-level. We examined the nutritional quality of foods advertised to children during their preferred television viewing in Ontario (Canada), where advertising is self-regulated by industry, and in Quebec (Canada), where a child-directed advertising ban exists. A total of 428 children aged 10-12 years completed television viewing diaries for 7 days. Thirty-two television stations were recorded simultaneously between 6 AM and midnight. A content analysis of 90 h of English Ontario, French Quebec, and English Quebec children's preferred viewing was then undertaken. A total of 429 food and beverage advertisements were analyzed and their nutritional quality was assessed. Food advertisements in the Quebec French sample were statistically significantly higher in total fat, saturated fat and protein, and lower in carbohydrates and sugar per 100 g, and as a percentage of energy than food ads in the two English samples. A statistically significantly lower percentage of the Quebec French food advertisements were classified as either high fat, sugar or sodium and a smaller proportion of food ads were classified as "less healthy" compared to the Ontario and Quebec English samples. These results suggest that the Quebec advertising ban is influencing the macronutrient profile of advertised foods viewed by French Quebec children during their preferred viewing and that their promotions are marginally healthier than that viewed by the English samples.     

Food insecurity and increased BMI in young adult women

Food insecurity has been associated with weight status in children and adults although results have been mixed. We aimed to identify whether food insecurity was associated with BMI in young adults and whether this association differed by gender and was modified by food stamp use and the presence of children in the home. Cross-sectional data from wave 4 (2007-2008) of the National Longitudinal Study of Adolescent Health were analyzed. Multiple linear regression was used to investigate the association between food insecurity and BMI in gender stratified models of young adult women (n = 7,116) and men (n = 6,604) controlling for age, race/ethnicity, income, education, physical activity, smoking, alcohol use, the presence of children in the home, and food stamp use in young adulthood and/or adolescence. Food insecurity was more common in young adult women (14%) than young adult men (9%). After controlling for a variety of individual variables, food insecure women had a BMI that was on average 0.9 kg/m(2) units higher than women who were food secure. This difference in BMI persisted after controlling for recent or past food stamp use and was not different among women with or without children in the household. No relationship was found between food insecurity and BMI in young adult men. Providers should inquire about food insecurity, especially when treating obesity, and policy initiatives should address the role of access to healthy food in those facing food insecurity.     

Childhood obesity,is fast food exposure a factor?

Access to fast food has often been blamed for the rise in obesity which in turn has motivated policies to curb the spread of fast food. However, robust evidence in this area is scarce, particularly using data outside of the US. It is difficult to estimate a causal effect of fast food given spatial sorting and ever-present exposure. We investigate whether the residential access to fast food increased BMI of adolescents at a time when fast food restaurants started to open in the UK. The time period presents the study with large spatial and temporal differences in exposure as well as plausibly exogenous variation. We merge data on the location and timing of the first openings of all fast food outlets in the UK from 1968−1986, with data on objectively measured BMI from the 1970 British Cohort Survey. The relationship between adolescent BMI and the distance from the respondents’ homes and time since opening, is studied using OLS and Instrumental Variables regression. We find that fast food exposure had no effect on BMI. Extensive robustness checks do not change our conclusion.     

Differences in Overweight and Obesity among Children from Migrant and Native Origin: The Role of Physical Activity,Dietary Intake,and Sleep Duration

A cross-sectional survey was performed to examine to what degree differences in overweight and obesity between native Dutch and migrant primary school children could be explained by differences in physical activity, dietary intake, and sleep duration among these children. Subjects (n=1943) were primary school children around the age of 8–9 years old and their primary caregivers: native Dutch children (n=1546), Turkish children (n=93), Moroccan children (n=66), other non-western children (n=105), and other western children (n=133). Multivariate regressions and logistic regressions were used to examine the relationship between migrant status, child’s behavior, and BMI or prevalence of overweight, including obesity (logistic). Main explanatory variables were physical activity, dietary intake, and sleep duration. We controlled for age, sex, parental educational level, and parental BMI. Although sleep duration, dietary intake of fruit, and dietary intake of energy-dense snacks were associated with BMI, ethnic differences in sleep duration and dietary intake did not have a large impact on ethnic differences in overweight and obesity among children from migrant and native origin. It is suggested that future preventive strategies to reduce overweight and obesity, in general, consider the role of sleep duration. Also, cross-cultural variation in preparation of food among specific migrant groups, focusing on fat, sugar, and salt, deserves more attention. In order to examine which other variables may clarify ethnic differences in overweight and obesity, future research is needed.     

Metabolic imprinting: critical impact of the perinatal environment on the regulation of energy homeostasis

Epidemiological studies in humans suggest that maternal undernutrition, obesity and diabetes during gestation and lactation can all produce obesity in offspring. Animal models have allowed us to investigate the independent consequences of altering the pre- versus post-natal environments on a variety of metabolic, physiological and neuroendocrine functions as they effect the development in the offspring of obesity, diabetes, hypertension and hyperlipidemia (the 'metabolic syndrome'). During gestation, maternal malnutrition, obesity, type 1 and type 2 diabetes and psychological, immunological and pharmacological stressors can all promote offspring obesity. Normal post-natal nutrition can reduce the adverse impact of some of these pre-natal factors but maternal high-fat diets, diabetes and increased neonatal access to food all enhance the development of obesity and the metabolic syndrome in offspring. The outcome of these perturbations of the perinatal environmental is also highly dependent upon the genetic background of the individual. Those with an obesity-prone genotype are more likely to be affected by factors such as maternal obesity and high-fat diets than are obesity-resistant individuals. Many perinatal manipulations appear to promote offspring obesity by permanently altering the development of central neural pathways, which regulate food intake, energy expenditure and storage. Given their strong neurotrophic properties, either excess or an absence of insulin and leptin during the perinatal period are likely to be effectors of these developmental changes. Because obesity is associated with an increased morbidity and mortality and because of its resistance to treatment, prevention is likely to be the best strategy for stemming the tide of the obesity epidemic. Such prevention should begin in the perinatal period with the identification and avoidance of factors which produce permanent, adverse alterations in neural pathways which control energy homeostasis.     

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

Objectives:

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

Design and Methods:

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

Results and Conclusion:

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

肥胖的研究进展

肥胖已经成为一种社会现象,其发病过程复杂,危害严重,近年来的研究表明,肥胖是一种由食欲和能量调节紊乱引起的疾病,与遗传、环境、膳食结构等多种因素有关,其中基因是主要的决定因素,肥胖与Ⅱ型糖尿病、心血管疾病、某些肿瘤等有明确的关系。目前对肥胖的治疗尚处于探索时期,１９９４年发现的苗条素（leptin)仍然是争论的一大焦点。本文综述介绍了肥胖的流行、病因、危害与治疗,并对苗条素进行了比较详细的介绍,以帮助读者了解肥胖的概貌、基础研究进展以及部分临床问题。     

Away-from-home food intake and risk for obesity: examining the influence of context

Objective: This study examined sociodemographic and cultural determinants of away‐from‐home food consumption in two contexts and the influence of frequency of away‐from‐home food consumption on children's dietary intake and parent and child weight status. Methods and Procedures: Parents of children (N = 708) in grades K‐2 were recruited from 13 elementary schools in Southern California. Parents were asked through a questionnaire the frequency with which they eat meals away from home and the restaurant they frequented most often. The height and weight of the parents and their children were measured to calculate BMI. Results: Consuming foods at least once a week from relatives/neighbors/friends (RNF) homes was associated with children's dietary intake and children's risk for obesity. For example, children of parents with weekly or greater RNF food consumption drank more sugar‐sweetened beverages. Parents of families who ate at restaurants at least weekly reported that their children consumed more sugar‐sweetened beverages, more sweet/savory snacks, and less water compared with families who did not frequent restaurants this often. The type of restaurant visited did not affect diet intake or obesity. More acculturated families exhibited less healthy dietary behaviors than less acculturated families. Discussion: Restaurants remain an important setting for preventing child and adult obesity, but other settings outside the home need to be considered in future intervention research. This may especially involve eating in the homes of RNF.     

A role for beta-endorphin in the pathogenesis of human obesity?

The discovery of several endogenous substances with morphine-like activity (endorphins and enkephalins) which possess potent behavioral effects, interfering with food and water intake, has led to suggest their implications in the pathogenesis of human obesity. This suggestion is mainly based on: 1) the ability of opiate antagonists naloxone and naltrexone to reduce food intake in some particular situations associated with obesity: 2) the existence of raised plasma levels of beta-endorphin in obese children and adults not corrected by weight loss; and 3) the increased responsiveness to the metabolic and hormonal effects of opiate agonism and antagonism found in obese but not in normal weight subjects. Although the problem still awaits a definite answer, it seems not hazardous to hypothesize a role for beta-endorphin in some pathogenetic events associated with human obesity.     

Are our actions aligned With our evidence? The skinny on changing the landscape of obesity

Recent debate about the role of food deserts in the United States (i.e., places that lack access to healthy foods) has prompted discussion on policies being enacted, including efforts that encourage the placement of full‐service supermarkets into food deserts. Other initiatives to address obesogenic neighborhood features include land use zoning and parks renovations. Yet, there is little evidence to demonstrate that such policies effect change. While we suspect most researchers and policymakers would agree that effective neighborhood change could be a powerful tool in combating obesity, we desperately need strong and sound evidence to guide decisions about where and how to invest.     

Infrequent Breakfast Consumption Is Associated with Higher Body Adiposity and Abdominal Obesity in Malaysian School-Aged Adolescents

Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents. However, the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined. Thus, the aim of the present study was to assess any associations between breakfast consumption practices and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years. A self-administered questionnaire on dietary behaviour and lifestyle practices and a dietary food frequency questionnaire were used. Body composition and adiposity indices were determined using standard anthropometric measurement protocols and dual energy χ-ray absorptiometry (DXA). Mean age of the participants was 15.3±1.9 years. The majority of participants (71.2%) fell in the normal body mass index (BMI) ranges. Breakfast consumption patterns showed that only half of the participants (50%) were consuming breakfast daily. Gender-specific multivariate analyses (ANCOVA) showed that in both boys and girls, those eating breakfast at least 5 times a week had significantly lower body weight, body mass index (BMI), BMI z-scores, waist circumference, body fat mass and percent body fat (%BF) compared to infrequent breakfast eaters, after adjustment for age, household income, pubertal status, eating-out and snacking practices, daily energy intakes, and daily physical activity levels. The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity. Therefore, daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth.     

Fast Food Intake Increases the Incidence of Metabolic Syndrome in Children and Adolescents: Tehran Lipid and Glucose Study

The aim of the study was to evaluate the association between fast food consumption and incidence of metabolic syndrome (MetS) and its components among children and adolescents over a 3.6 year follow-up. Dietary data of 424 healthy subjects, aged 6–18 years, was collected using a valid and reliable food frequency questionnaire. Metabolic syndrome was defined according to the Cook et al criteria. Consumption of fast foods including hamburgers, sausages, bologna (beef), and fried potatoes was calculated and further categorized to quartiles. Multiple logistic regression models were used to estimate the incidence of MetS and its components in each quartile of fast food intake. The incidence of MetS was 11.3% after a 3.6 year follow up. In the fully adjusted model, compared to the lowest quartile of fast food intake, individuals in the highest had odds ratios of 2.96 (95% CI: 1.02–8.63; P for trend<0.001), 2.82 (95% CI: 1.01–7.87; P for trend = 0.037), and 2.58 (95% CI: 1.01–6.61; P for trend = 0.009) for incidence of MetS, hypertriglyceridemia, and abdominal obesity, respectively. No significant association was found between fast food intakes and other components of MetS. Fast food consumption is associated with the incidence of MetS, abdominal obesity, and hypertriglyceridemia in Tehranian children and adolescents.     

Zooming Toward a Telehealth Solution for Vulnerable Children with Obesity During Coronavirus Disease 2019

Health inequities exist throughout the life course, resulting in racial/ethnic and socioeconomic disparities in obesity and obesity‐related health complications. Obesity and its comorbidities appear to be linked to coronavirus disease 2019 (COVID‐19) mortality. Approaches to reduce obesity in the time of COVID‐19 closures are urgently needed and should start early in life. In New York City, a telehealth pediatric weight‐management collaborative spanning NewYork‐Presbyterian, Columbia University Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine was developed during COVID‐19 with show rates from 76% to 89%. To stave off the impending exacerbation of health disparities related to obesity risk factors in the aftermath of the COVID‐19 pandemic, effective interventions that can be delivered remotely are urgently needed among vulnerable children with obesity. Challenges in digital technology access, social and linguistic differences, privacy security, and reimbursement must be overcome to realize the full potential of telehealth for pediatric weight management among low‐income and racial/ethnic‐minority children.     

徐州市学龄期儿童肥胖现况调查及影响因素分析

目的:对徐州学龄期儿童的肥胖现状进行调查,分析其肥胖原因,以期找到有效的预防方法。方法:随机选取2014年1月-2016年1月徐州市学龄期儿童1021例,采用自理调查量表收集儿童及其父母的基本情况,统计儿童肥胖发生率,采用Logistic多因素回归分析儿童肥胖的影响因素。结果:男童肥胖率为11.15%(58/520),女童肥胖率为5.79%(29/501),男童肥胖率明显高于女童(P0.05);Logistic多因素回归分析显示,儿童肥胖危险因素有家族肥胖史(OR=3.647)、食欲(OR=2.065)、垃圾食品(OR=3.032)、甜食(OR=2.937),保护因素为周末运动时间(OR=-0.865)、体育特长(OR=-0.641)。结论:徐州学龄期儿童肥胖情况较为严重,应当控制肥胖儿童卡路里的摄入,积极进行体育锻炼,从各方面进行防治。     

Modeling the potential public health impact of prepregnancy obesity on adverse fetal and infant outcomes

Objective: Approximately one‐third of US reproductive‐aged women are obese, and prepregnancy obesity is a strong risk factor for adverse fetal and infant outcomes. The annual number of preventable adverse fetal and infant outcomes associated with prepregnancy obesity in the US was estimated. Design and Methods: Adverse fetal and infant outcomes for which statistically significant associations with prepregnancy obesity had been reported by peer‐reviewed meta‐analyses, which included fetal deaths and nine different major birth defects, were assessed. The true prevalence of prepregnancy obesity was estimated by multiplying self‐reported prepregnancy obesity by a bias factor based on the difference between measured and self‐reported obesity in US adult women. A Monte Carlo simulation approach was used to model the attributable fraction and preventable number, accounting for uncertainty in the estimates for: 1 strength of the association with obesity, 2 obesity prevalence, and 3 outcome prevalence. Results: Eliminating the impact of prepregnancy obesity would potentially prevent the highest numbers of four outcomes: fetal deaths (6,990; uncertainty interval [UI] 4,110‐10,080), congenital heart defects (2,850; UI 1,035‐5,065), hydrocephalus (490; UI 150‐850), and spina bifida (405; UI 305‐505). If 10% of women with prepregnancy obesity achieved a healthy weight before pregnancy or otherwise mitigated the impact of obesity, nearly 300 congenital heart defects and 700 fetal deaths per year could potentially be prevented. Conclusion: This simulation suggests that effective prevention strategies to reduce prepregnancy obesity or the risk associated with obesity could have a measurable impact on infant health in the US.     

Ghrelin and food reward: the story of potential underlying substrates

The incidence of obesity is increasing at an alarming rate and this worldwide epidemic represents a significant decrease in life span and quality of life of a large part of the affected population. Therefore an understanding of mechanisms underlying food overconsumption and obesity development is urgent and essential to find potential treatments. Research investigating mechanisms underlying obesity and the control of food intake has recently experienced a major shift in focus, from the brain's hypothalamus to additional important neural circuits controlling emotion, cognition and motivated behavior. Among them, the mesolimbic system, and the changes in reward and motivated behavior for food, emerge as new promising treatment targets. Furthermore, there is also growing appreciation of the impact of peripheral hormones that signal nutrition status to the mesolimbic areas, and especially the only known circulating orexigenic hormone, ghrelin. This review article provides a synthesis of recent evidence concerning the impact of manipulation of ghrelin and its receptor on models of food reward/food motivation behavior and the mesolimbic circuitry. Particular attention is given to the potential neurocircuitry and neurotransmitter systems downstream of ghrelin's effects on food reward.     

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.     

Did the Food Environment Cause the Obesity Epidemic?

Several putative explanations of the obesity epidemic relate to the changing food environment. Individual dietary macronutrients have each been theorized to be the prime culprit for population obesity, but these explanations are unlikely. Rather, obesity probably resulted from changes in the caloric quantity and quality of the food supply in concert with an industrialized food system that produced and marketed convenient, highly processed foods from cheap agricultural inputs. Such foods often contain high amounts of salt, sugar, fat, and flavor additives and are engineered to have supernormal appetitive properties driving increased consumption. Ubiquitous access to convenient and inexpensive food also changed normative eating behavior, with more people snacking, eating in restaurants, and spending less time preparing meals at home. While such changes in the food environment provide a likely explanation of the obesity epidemic, definitive scientific demonstration is hindered by the difficulty in experimentally isolating and manipulating important variables at the population level.     

Influence of socio-economic status and television watching on childhood obesity in Kolkata

Obesity is fast becoming an epidemic among the urban children and it has its adverse effect on the status of health even during adulthood. In this paper an attempt is made to assess the percentage of obesity among 6–10 year children and assess the effect of different socio-economic variables and TV watching on childhood obesity. We restricted our study to primary school-going children who attended classes I–IV. The sample consisted of 5216 children from 20 different Bengali medium and English medium schools in Kolkata. Categorical logistic regression of obesity on the socio-economic factors namely type of medium school, religion, parent's education, duration of television watching etc., has been carried out. The categorical logistic regression shows the significant effect of some of the socio-economic or demographic variables including the duration of television watching on obesity. We have seen a positive association between obesity and TV watching and also between obesity and consumption of fast food. This calls for making the parents aware and taking action as early as possible.     

Relative Food Prices and Obesity in U.S. Metropolitan Areas: 1976-2001

This study investigates the impact of food price on obesity, by exploring the co-occurrence of obesity growth with relative food price reduction between 1976 and 2001. Analyses control for female labor participation and metropolitan outlet densities that might affect body weight. Both the first-difference and fixed effects approaches provide consistent evidence suggesting that relative food prices have substantial impacts on obesity and such impacts were more pronounced among the low-educated. These findings imply that relative food price reductions during the time period could plausibly explain about 18% of the increase in obesity among the U.S. adults in metropolitan areas.