Topics - OBESITA'

Interventions Aimed at Decreasing Obesity in Children Younger Than 2 Years

Objective: To assess the evidence for interventions designed to prevent or reduce overweight and obesity in children younger than 2 years.
Data Sources: MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and references from relevant articles.
Study Selection: Included were published studies that evaluated an intervention designed to prevent or reduce overweight or obesity in children younger than 2 years.
Data Extraction: Extracted from eligible studies were measured outcomes, including changes in child weight status, dietary intake, and physical activity and parental attitudes and knowledge about nutrition. Studies were assessed for scientific quality using standard criteria, with an assigned quality score ranging from 0.00 to 2.00 (0.00-0.99 is poor, 1.00-1.49 is fair, and 1.50-2.00 is good).
Data Synthesis: We retrieved 1557 citations; 38 articles were reviewed, and 12 articles representing 10 studies met study inclusion criteria. Eight studies used educational interventions to promote dietary behaviors, and 2 studies used a combination of nutrition education and physical activity. Study settings included home (n = 2), clinic (n = 3), classroom (n = 4), or a combination (n = 1). Intervention durations were generally less than 6 months and had modest success in affecting measures, such as dietary intake and parental attitudes and knowledge about nutrition. No intervention improved child weight status. Studies were of poor or fair quality (median quality score, 0.86; range, 0.28-1.43).
Conclusions: Few published studies attempted to intervene among children younger than 2 years to prevent or reduce obesity. Limited evidence suggests that interventions may improve dietary intake and parental attitudes and knowledge about nutrition for children in this age group. For clinically important and sustainable effect, future research should focus on designing rigorous interventions that target young children and their families.

Articolo completo: Interventions Aimed at Decreasing Obesity in Children Younger Than 2 Years - Arch Pediatr Adolesc Med. 2010;164(12):1098-1104. doi:10.1001/archpediatrics.2010.232;
Philip J. Ciampa, MD, MPH; Disha Kumar, BA; Shari L. Barkin, MD, MSHS; Lee M. Sanders, MD, MPH; H. Shonna Yin, MD, MS; Eliana M. Perrin, MD, MPH; Russell L. Rothman, MD, MPP

Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement

Description: Update of the 2005 US Preventive Services Task Force (USPSTF) statement about screening for overweight in children and adolescents.
Methods: The USPSTF examined the evidence for the effectiveness of interventions that are primary care feasible or referable. It also examined the evidence for the magnitude of potential harms of treatment in children and adolescents.
Reccomendation: The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to intensive counseling and behavioral interventions to promote improvements in weight status (grade B recommendation).

Articolo completo: Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement - Pediatrics 2010;125;361-367;
US Preventive Services Task Force

Treatment of childhood obesity by retraining eating behaviour: randomised controlled trial

Objective: To determine whether modifying eating behaviour with use of a feedback device facilitates weight loss in obese adolescents.
Design Randomised: controlled trial with 12 month intervention.
Setting: Hospital based obesity clinic.
Participants: 106 newly referred obese young people aged 9-17.
Interventions: A computerised device, Mandometer, providing real time feedback to participants during meals to slow down speed of eating and reduce total intake; standard lifestyle modification therapy.
Main outcome measures: Change in body mass index (BMI) standard deviation score (SDS) over 12 months with assessment 18 months after the start of the intervention. Secondary outcomes were body fat SDS, metabolic status, quality of life evaluation, change in portion size, and eating speed.
Results: Using the last available data on all participants (n=106), those in the Mandometer group had significantly lower mean BMI SDS at 12 months compared with standard care (baseline adjusted mean difference 0.24, 95% confidence interval 0.11 to 0.36). Similar results were obtained when analyses included only the 91 who attended per protocol (baseline adjusted mean difference 0.27, 0.14 to 0.41; P<0.001), with the difference maintained at 18 months (0.27, 0.11 to 0.43; P=0.001) (n=87). The mean meal size in the Mandometer group fell by 45 g (7 to 84 g). Mean body fat SDS adjusted for baseline levels was significantly lower at 12 months (0.24, 0.10 to 0.39; P=0.001). Those in the Mandometer group also had greater improvement in concentration of high density lipoprotein cholesterol (P=0.043).
Conclusions: Retraining eating behaviour with a feedback device is a useful adjunct to standard lifestyle modification in treating obesity among adolescents.
Trial registration: NCT00407420.

Articolo completo: Treatment of childhood obesity by retraining eating behaviour: randomised controlled trial - Bmj 340 (51): b5388. (2009)
Anna L Ford, research nurse, Cecilia Bergh, CEO of Mando Group AB, Per Sodersten, professor, Matthew A Sabin, RCH Foundation clinical research fellow, Sandra Hollinghurst, senior lecturer, Linda P Hunt, senior lecturer, Julian P H Shield, professor

Obesity Prevalence Among Low-Income, Preschool-Aged Children --- United States, 1998--2008

Childhood obesity continues to be a leading public health concern that disproportionately affects low-income and minority children (1). Children who are obese in their preschool years are more likely to be obese in adolescence and adulthood (2) and to develop diabetes, hypertension, hyperlipidemia, asthma, and sleep apnea (3). One of the Healthy People 2010 objectives (19-3) is to reduce to 5% the proportion of children and adolescents who are obese (4).
CDC's Pediatric Nutrition Surveillance System (PedNSS) is the only source of nationally compiled obesity surveillance data obtained at the state and local level for low-income, preschool-aged children participating in federally funded health and nutrition programs.
To describe progress in reducing childhood obesity, CDC examined trends and current prevalence in obesity using PedNSS data submitted by participating states, territories, and Indian tribal organizations during 1998--2008. The findings indicated that obesity prevalence among low-income, preschool-aged children increased steadily from 12.4% in 1998 to 14.5% in 2003, but subsequently remained essentially the same, with a 14.6% prevalence in 2008. Reducing childhood obesity will require effective prevention strategies that focus on environments and policies promoting physical activity and a healthy diet for families, child care centers, and communities.

Articolo completo: Obesity Prevalence Among Low-Income, Preschool-Aged Children --- United States, 1998--2008
July 24, 2009 / 58(28);769-773 - Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention

Do overweight children necessarily make overweight adults? Repeated cross sectional annual nationwide survey of Japanese girls and women over nearly six decades

Objective: To compare growth curves of body mass index from children to adolescents, and then to young adults, in Japanese girls and women in birth cohorts born from 1930 to 1999.
Design: Retrospective repeated cross sectional annual nationwide surveys (national nutrition survey, Japan) carried out from 1948 to 2005.
Setting: Japan.
Participants: 76635 females from 1 to 25 years of age.
Main outcome measure: Body mass index.
Results: Generally, body mass index decreased in preschool children (2-5 years), increased in children (6-12 years) and adolescents (13-18 years), and slightly decreased in young adults (19-25 years) in these Japanese females. However, the curves differed among birth cohorts. More recent cohorts were more overweight as children but thinner as young women. The increments in body mass index in early childhood were larger in more recent cohorts than in older cohorts. However, the increments in body mass index in adolescents were smaller and the decrease in body mass index in young adults started earlier, with lower peak values in more recent cohorts than in older cohorts. The decrements in body mass index in young adults were similar in all birth cohorts.
Conclusions: An overweight birth cohort in childhood does not necessarily continue to be overweight in young adulthood. Not only secular trends in body mass index at fixed ages but also growth curves for wide age ranges by birth cohorts should be considered to study obesity and thinness. Growth curves by birth cohorts were produced by a repeated cross sectional annual survey over nearly six decades.

Do overweight children necessarily make overweight adults? Repeated cross sectional annual nationwide survey of Japanese girls and women over nearly six decades
Ikuko Funatogawa, Takashi Funatogawa, Eiji Yano
BMJ 2008;337:a802

Do overweight children necessarily make overweight adults? Repeated cross sectional annual nationwide survey of Japanese girls and women over nearly six decades

Accurate appropriate assessment of overweight and obesity in children and adolescents is a critical aspect of contemporary medical care. However, physicians and other health care professionals may find this a somewhat thorny field to enter. The BMI has become the standard as a reliable indicator of overweight and obesity. The BMI is incomplete, however, without consideration of the complex behavioral factors that influence obesity.Because of limited time and resources, clinicians need to have quick, evidence-based interventions that can help patients and their families recognize the importance of reducing overweight and obesity and take action. In an era of fast food, computers, and DVDs, it is not easy to persuade patients to modify their diets and to become more physically active. Because research concerning effective assessment of childhood obesity contains many gaps, this report is intended to provide a comprehensive approach to assessment and to present the evidence available to support key aspects of assessment. The discussion and recommendations are based on >300 studies published since 1995, which examined an array of assessment tools. With this information, clinicians should find themselves better equipped to face the challenges of assessing childhood overweight and obesity accurately.

Assessment of child and adolescent overweight and obesity
Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D.
Pediatrics 2007;120 Suppl 4:S193-228

Assessment of child and adolescent overweight and obesity

Pilot of 'Families for Health': community-based family intervention for obesity

Objective: To develop and evaluate 'Families for Health' - a new community based family intervention for childhood obesity. Design: Programme development, pilot study and evaluation using intention-to-treat analysis. Setting: Coventry, England Participants: 27 overweight or obese children aged 7-13 years (18 girls, 9 boys) and their parents, from 21 families. Intervention: 'Families for Health' is a 12 week programme with parallel groups for parents and children, addressing parenting, lifestyle change and social & emotional development. Main Outcome Measures: Primary: change in baseline BMI z-score at end of programme (3 months) and 9 month follow-up. Attendance, drop-out, parents' perception of programme, child's quality of life and self esteem, parental mental health, parent-child relationships and lifestyle changes were also measured. Results: Attendance rate was 62%, with 18 of the 27 (67%) children completing the programme. For the 22 children with follow-up data (including 4 drop-outs), BMI z-score was reduced by -0.18 (95%CI -0.30 to -0.05) at end of programme and by -0.21 (-0.35 to -0.07) at 9 months. Statistically significant improvements were observed in children’s quality of life and lifestyle (reduced sedentary behaviour, increased steps and reduced exposure to unhealthy foods), child-parent relationships and parents’ mental health. Fruit and vegetable consumption, participation in moderate/vigorous exercise and children’s self-esteem did not change significantly. Topics on parenting skills, activity and food were rated as helpful and were used with confidence by the majority of parents. Conclusions: Families for Health is a promising new childhood obesity intervention. Definitive evaluation of its clinical effectiveness by randomised controlled trial is now required.

Pilot of 'Families for Health': community-based family intervention for obesity
Wendy Robertson, Tim Friede, Jackie Blissett, Mary CJ Rudolf, Maybelle A Wallis and Sarah Stewart-Brown
Arch Dis Child. Published Online First: 7 May 2008. doi:10.1136/adc.2008.139162

Childhood body-mass index and the risk of coronary heart disease in adulthood

BACKGROUND: The worldwide epidemic of childhood obesity is progressing at an alarming rate. Risk factors for coronary heart disease (CHD) are already identifiable in overweight children. The severity of the long-term effects of excess childhood weight on CHD, however, remains unknown. METHODS: We investigated the association between body-mass index (BMI) in childhood (7 through 13 years of age) and CHD in adulthood (25 years of age or older), with and without adjustment for birth weight. The subjects were a cohort of 276,835 Danish schoolchildren for whom measurements of height and weight were available. CHD events were ascertained by linkage to national registers. Cox regression analyses were performed. RESULTS: In 5,063,622 person-years of follow-up, 10,235 men and 4318 women for whom childhood BMI data were available received a diagnosis of CHD or died of CHD as adults. The risk of any CHD event, a nonfatal event, and a fatal event among adults was positively associated with BMI at 7 to 13 years of age for boys and 10 to 13 years of age for girls. The associations were linear for each age, and the risk increased across the entire BMI distribution. Furthermore, the risk increased as the age of the child increased. Adjustment for birth weight strengthened the results. CONCLUSIONS: Higher BMI during childhood is associated with an increased risk of CHD in adulthood. The associations are stronger in boys than in girls and increase with the age of the child in both sexes. Our findings suggest that as children are becoming heavier worldwide, greater numbers of them are at risk of having CHD in adulthood. Copyright 2007 Massachusetts Medical Society.

Childhood body-mass index and the risk of coronary heart disease in adulthood
Baker JL, Olsen LW, Sørensen TI.
N Engl J Med 2007;357(23):2329-37

Childhood body-mass index and the risk of coronary heart disease in adulthood

Recommendations for treatment of child and adolescent overweight and obesity

In this article, we review evidence about the treatment of obesity that may have applications in primary care, community, and tertiary care settings. We examine current information about eating behaviors, physical activity behaviors, and sedentary behaviors that may affect weight in children and adolescents. We also review studies of multidisciplinary behavior-based obesity treatment programs and information about more aggressive forms of treatment. The writing group has drawn from the available evidence to propose a comprehensive 4-step or staged-care approach for weight management that includes the following stages: (1) Prevention Plus; (2) structured weight management; (3) comprehensive multidisciplinary intervention; and (4) tertiary care intervention. We suggest that providers encourage healthy behaviors while using techniques to motivate patients and families, and interventions should be tailored to the individual child and family. Although more intense treatment stages will generally occur outside the typical office setting, offices can implement less intense intervention strategies. We not ony address specific patient behavior goals but also encourage practices to modify office systems to streamline office-based care and to prepare to coordinate with professionals and programs outside the office for more intensive interventions.

Recommendations for treatment of child and adolescent overweight and obesity
Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE, Schetzina KE, Taveras EM.
Pediatrics 2007;120 Suppl 4:S254-88

Recommendations for treatment of child and adolescent overweight and obesity

Musculoskeletal pain in obese children and adolescents

Aim: To determine whether bodyweight is associated with musculoskeletal pain within a population of obese children and adolescents. Methods: A descriptive, cross-sectional study of subjects evaluated at a tertiary care medical centre for the management of obesity. Analyses were conducted using both a person-specific model, and then again, using a joint site model in order to account for correlations between joints within children. Results: We evaluated 135 children and adolescents (68 girls, 67 boys) with a mean age of 12.3 years (range: 3-18). The study population was racially and ethnically diverse - Hispanic (51%), non-Hispanic white (26%), non-Hispanic black (13%), other (10%). The majority of subjects (61%) complained of at least one joint hurting more than once per month. Back pain was the most common complaint (39%), followed by foot (26%) and knee (24%) pain. After adjustment for age, pain in the knees and hips were associated with increased weight and/or body mass index (BMI). Conclusions: In this cross-sectional analysis of obese children and adolescents, musculoskeletal pain was common and, in the knee and hip joints, was positively associated with extra bodyweight. Clinicians may want to ask about musculoskeletal pain when recommending physical activity for weight management counselling.

Musculoskeletal pain in obese children and adolescents
Stovitz SD, Pardee PE, Vazquez G, Duval S, Schwimmer JB
Acta Paediatr 2008;97(4):489-93

Team Sports for Overweight Children

Objective To evaluate the feasibility, acceptability, and efficacy of an after-school team sports program for reducing weight gain in low-income overweight children. Design Six-month, 2-arm, parallel-group, pilot randomized controlled trial. Setting Low-income, racial/ethnic minority community. Participants Twenty-one children in grades 4 and 5 with a body mass index at or above the 85th percentile. Interventions The treatment intervention consisted of an after-school soccer program. The "active placebo" control intervention consisted of an after-school health education program. Main Outcome Measures Implementation, acceptability, body mass index, physical activity measured using accelerometers, reported television and other screen time, self-esteem, depressive symptoms, and weight concerns. Results All 21 children completed the study. Compared with children receiving health education, children in the soccer group had significant decreases in body mass index z scores at 3 and 6 months and significant increases in total daily, moderate, and vigorous physical activity at 3 months. Conclusion An after-school team soccer program for overweight children can be a feasible, acceptable, and efficacious intervention for weight control.

Team Sports for Overweight Children
Weintraub DL, Tirumalai EC, Farish Haydel K., et al.
Arch Pediatr Adolesc Med 2008;162(3):232-237.

A Randomized Trial of the Effects of Reducing Television
Viewing and Computer Use on Body Mass Index in Young Children

Objective To assess the effects of reducing television viewing and computer use on children's body mass index (BMI) as a risk factor for the development of overweight in young children. Design Randomized controlled clinical trial. Setting University children's hospital.Participants Seventy children aged 4 to 7 years whose BMI was at or above the 75th BMI percentile for age and sex. Interventions Children were randomized to an intervention to reduce their television viewing and computer use by 50% vs a monitoring control group that did not reduce television viewing or computer use. Main Outcome Measures Age- and sex-standardized BMI (zBMI), television viewing, energy intake, and physical activity were monitored every 6 months during 2 years. Results Children randomized to the intervention group showed greater reductions in targeted sedentary behavior (P < .001), zBMI (P < .05), and energy intake (P < .05) compared with the monitoring control group. Socioeconomic status moderated zBMI change (P = .01), with the experimental intervention working better among families of low socioeconomic status. Changes in targeted sedentary behavior mediated changes in zBMI (P < .05). The change in television viewing was related to the change in energy intake (P < .001) but not to the change in physical activity (P =.37). Conclusions Reducing television viewing and computer use may have an important role in preventing obesity and in lowering BMI in young children, and these changes may be related more to changes in energy intake than to changes in physical activity.

A Randomized Trial of the Effects of Reducing Television Viewing and
Computer Use on Body Mass Index in Young Children

Epstein LH, Roemmich JN, Robinson JL, et al.
Arch Pediatr Adolesc Med 2008;162(3):239-245

L'Educazione Terapeutica familiare nel
trattamento dell'obesità

Premessa Nonostante il grande aumento della prevalenza dell'obesità, ancora oggi non sappiamo come trattarla. La terapia comportamentale, solitamente raccomandata, non è sempre disponibile né accettata dalle famiglie. Obbiettivo Il nostro lavoro descrive un approccio di Educazione Terapeutica “sostenibile”, costituito da soli 3 momenti: una visita iniziale, un incontro educativo di gruppo con i genitori ed una rivalutazione, seguiti da 2 visite nel primo anno e quindi un colloquio annuale. Materiali e metodi Il nostro studio clinico controllato riguarda 254 bambini/ragazzi soprappeso e obesi, senza rilevanti problematiche psicologiche, di cui 127 di età media, 10,4±3 con un BMI% medio 58,4±18,6, trattatati con un programma di Educazione Terapeutica e 127 bambini della stessa età con BMI% medio 47,3±19,5, trattati con dietoterapia, rivalutati dopo almeno 1 anno. Risultati Dopo 2,8±1,3 anni nel gruppo di studio il BMI% si è ridotto del 10,2±16,6% e gli obesi di grado severo del 50%. Dopo dietoterapia, invece, il BMI% è rimasto invariato come il numero delle forme severe. Conclusioni I risultati indicano l'efficacia e la sostenibilità di questo programma, suggerendolo come alternativa a quelli solitamente consigliati. La sua validità consiste nel essere svolto da un solo operatore con un ridotto impegno temporale, caratteristiche che lo rendono ben accetto alle famiglie ed ai bambini.

L'Educazione Terapeutica familiare nel trattamento dell'obesità
Rita Tanas, Renzo Marcolongo, Stefania Pedretti, Giuseppe Gilli
Pagine Elettroniche, 2007 giugno

Obesità infantile e funzionalità respiratoria

È questa l'affermazione d'esordio di una interessante review pubblicata su Archives of Disease in Childhood e che apre la scena a una serie di problematiche respiratorie che possono coinvolgere il bambino obeso: l'accumulo di grasso corporeo altera in modo più o meno marcato l'anatomia dell'apparato respiratorio a più livelli, conducendo a una alterazione della meccanica respiratoria. Si assiste pertanto a variazioni patologiche dei volumi e dei flussi polmonari e probabilmente anche ad alterazioni della reattività delle vie aeree e della risposta chemorecettoriale agli stimoli respiratori di ipossia e ipercapnia1. L'obesità pediatrica è attualmente considerata il maggiore problema di salute pubblica...

Obesità infantile e funzionalità respiratoria
C. Zanchi
Pagine Elettroniche, 2006 maggio

L'obesità in età pediatrica

Negli ultimi anni si è assistito a un aumento dell’obesità in tutte le fasce di età. Esistono diverse definizioni di obesità, ma quella più utilizzata è basata sull’indice di massa corporea (BMI). Attualmente circa il 7% della popolazione mondiale è obesa. La percentuale di soggetti in sovrappeso è di 2-3 volte maggiore. In alcuni esempi più estremi si è riscontrata una prevalenza del sovrappeso negli Stati Uniti raddoppiata nei bambini di età compresa tra 6 e 11 anni e triplicata in quelli tra 12 e 17 anni, tra il 1976-1980 e il 1999-2000. Circa il 14-15% dei teen-agers americani...

L’obesità in età pediatrica
F. Chiarelli, R. Capanna
Medico e Bambino 2005;24(8):513-525

Effects of a Weight Management Program on Body
Composition and Metabolic Parameters
in Overweight Children

Context.Pediatric obesity has escalated to epidemic proportions, leading to an array of comorbidities, including type 2 diabetes in youth. Since most overweight children become overweight adults, this chronic condition results in serious metabolic complications by early adulthood. To curtail this major health issue, effective pediatric interventions are essential. Objective. To compare effects of a weight management program, Bright Bodies, on adiposity and metabolic complications of overweight children with a control group. Design. One-year randomized controlled trial conducted May 2002-September 2005. Setting. Recruitment and follow-up conducted at Yale Pediatric Obesity Clinic in New Haven, Conn, and intervention at nearby school. Participants. Random sample of 209 overweight children (body mass index [BMI] >95th percentile for age and sex), ages 8 to 16 years of mixed ethnic groups were recruited. A total of 135 participants (60%) completed 6 months of study, 119 (53%) completed 12 months...

Effects of a Weight Management Program on Body Composition and Metabolic Parameters in Overweight Children
Savoye M, Shaw M, Dziura J, et al.
JAMA 2007;297:2697-2704

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