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Special Issue "Childhood Obesity: Novel Approaches to a Global Problem"

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 September 2014)

Special Issue Editor

Guest Editor
Prof. Dr. Andrew P. Hills

Professor of Allied Health Research – Maternity and Neonatology Mater Mothers’ Hospital; Director – Centre for Nutrition and Exercise, Mater Research; Conjoint Professorial appointment: Griffith Health Institute, Griffith university Aubigny Place, Raymond Terrace South Brisbane, Queensland, Australia 4101
Website | E-Mail
Interests: childhood obesity; body composition assessment; exercise for weight management; physical activity; energy expenditure; nutrition

Special Issue Information

Dear Colleagues,

Global levels of obesity in adults have increased to such an extent in recent decades that terms such as ‘epidemic’ and ‘pandemic’ have been used to describe the extent of the problem. Sadly, and irrespective of the definition employed to categorise overweight or obesity, the problem is not limited to adults but an increasing number of infants, children and adolescents are affected. Furthermore, the problem of overweight and obesity and related health conditions including type 2 diabetes are not limited to the developed world but are increasingly problematic in the developing world, particularly in areas experiencing a nutrition and physical activity transition.

To improve the body composition status of future generations, greater attention needs to be paid to better understanding the interplay between lifestyle (eating and activity) behaviours at key stages of the lifespan including pre-pregnancy, pregnancy and the post-partum period for mothers and infancy and early childhood for offspring. Each of these stages provides a potential window of opportunity for interventions to improve nutrition and/or physical activity. The focus of this special issue will be on novel nutrition and physical activity strategies during key life stages to improve body composition and health status of future generations. We welcome a range of contributions including both review and empirical studies that present novel approaches to childhood obesity prevention and management from a global perspective.

Prof. Dr. Andrew P. Hills
Guest Editor

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed Open Access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs).

Published Papers (16 papers)

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Research

Jump to: Review

Open AccessArticle Evaluating Physical and Perceptual Responses to Exergames in Chinese Children
Int. J. Environ. Res. Public Health 2015, 12(4), 4018-4030; doi:10.3390/ijerph120404018
Received: 3 November 2014 / Revised: 24 February 2015 / Accepted: 30 March 2015 / Published: 13 April 2015
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Abstract
Purpose: The primary objective of this study was to examine whether exergames could help children reach the recommendations for PA and cardiorespiratory fitness regarding exercise intensity. Differences in perceived physical exertion, EE, VO2, and HR between normal weight (NW) and
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Purpose: The primary objective of this study was to examine whether exergames could help children reach the recommendations for PA and cardiorespiratory fitness regarding exercise intensity. Differences in perceived physical exertion, EE, VO2, and HR between normal weight (NW) and overweight (OW) children participating in exergames were also examined. Methods: Twenty-one children (age: 10.45 ± 0.88) were assessed for EE, VO2 and HR during rest, in a maximal treadmill test, and while playing different exergames. Ratings of perceived exertion (RPE) (category range: 0 to 10) were also measured during exergaming. Three types of exergames were examined: running, table tennis, and dancing. These games were either performed on a Chinese game console, I-Dong, or another well-developed Western game console (Sony PlayStation 3 or Nintendo Wii). Results: Exergaming resulted in EE (kcal/min) from 2.05–5.14, VO2 (mL/kg/min) from 9.98–25.54, and HR (beats per minute) from 98.05–149.66. Children reported RPE ranging from 1.29 to 5.29. The Chinese exergame, I-Dong Running, was the only game in which children reached a moderate intensity and met the recommended minimum VO2reserve (50%) for cardiorespiratory fitness. Conclusion: Exergames could provide alternative opportunities to enhance children’s physical activity. They could be used as light-to-moderate PA, and with exergames, children can even reach the recommended intensity for developing and maintaining cardiorespiratory fitness. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessArticle Attentional Distraction during Exercise in Overweight and Normal-Weight Boys
Int. J. Environ. Res. Public Health 2015, 12(3), 3077-3090; doi:10.3390/ijerph120303077
Received: 19 October 2014 / Revised: 2 March 2015 / Accepted: 4 March 2015 / Published: 13 March 2015
Cited by 1 | PDF Full-text (695 KB) | HTML Full-text | XML Full-text
Abstract
The purpose of this study was to investigate the effect of attentional distraction on field running distance and activity intensity during an exercise session in normal-weight and overweight youngsters and to investigate potential mediators. Fifty-three 12–14 yr-old boys participated twice in a 12-min
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The purpose of this study was to investigate the effect of attentional distraction on field running distance and activity intensity during an exercise session in normal-weight and overweight youngsters and to investigate potential mediators. Fifty-three 12–14 yr-old boys participated twice in a 12-min running test and a 20-min exercise session, once with attentional distraction (by listerning to music) and once without distraction (counterbalanced randomised controlled design). At the end of the endurance test running distance was recorded. During the exercise session activity intensity was assessed by accelerometers. After each experiment, rate of perceived exertion (RPE) was estimated and seven questions were asked about how participants experienced the experiment. Both overweight and normal-weight boys ran further during the running test with music (p < 0.05) and this effect was mediated by a decrease in feelings of annoyance. During the exercise session with music, both overweight and normal-weight boys exercised less at low and high intensity and more at moderate and very high intensity (p < 0.01) and this effect was mediated by a decrease in RPE. We can conclude that attentional distraction has a positive effect on running distance on a field endurance test and on activity intensity during an exercise session through different mechanisms in both overweight and normal-weight boys. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessArticle Overweight and Obese Adolescent Girls: The Importance of Promoting Sensible Eating and Activity Behaviors from the Start of the Adolescent Period
Int. J. Environ. Res. Public Health 2015, 12(2), 2306-2329; doi:10.3390/ijerph120202306
Received: 9 October 2014 / Revised: 4 December 2014 / Accepted: 9 February 2015 / Published: 17 February 2015
Cited by 9 | PDF Full-text (1027 KB) | HTML Full-text | XML Full-text
Abstract
The adolescent period is associated with changes in eating and activity behaviors in girls. Less reliance on parental provision and choice of food, coupled with a decrease in participation in physical activity and sport, can create an energy imbalance, predisposing to weight gain.
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The adolescent period is associated with changes in eating and activity behaviors in girls. Less reliance on parental provision and choice of food, coupled with a decrease in participation in physical activity and sport, can create an energy imbalance, predisposing to weight gain. Physiological alterations to body composition, reduction in insulin sensitivity, and psychological adjustments may further amplify the risk of becoming overweight and maintaining an unhealthy level of body fat into childbearing years. During pregnancy excess body fat is a risk factor for poor pregnancy outcomes and may predispose an infant to a lifelong heightened risk of being overweight and developing chronic disease. Interventions aimed at preventing the accumulation of body fat in adolescent girls and young women may have far reaching impact and be critically important in reducing intergenerational weight gain. Lifestyle interventions in adolescence have the potential to modify adult obesity risk by switching at-risk individuals from a high to lower obesity risk trajectory. This paper discusses multiple approaches to assist at-risk individuals reduce obesity risk. A key focus is placed on engagement in food preparation and choice, and opportunities for physical activity and sport. Support, education, and opportunity at home and at school, are often associated with the success of lifestyle interventions, and may enable adolescents to make positive choices, and engage in health promoting behaviors during adolescence and childbearing years. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessArticle An Innovative Approach to Addressing Childhood Obesity: A Knowledge-Based Infrastructure for Supporting Multi-Stakeholder Partnership Decision-Making in Quebec, Canada
Int. J. Environ. Res. Public Health 2015, 12(2), 1314-1333; doi:10.3390/ijerph120201314
Received: 1 November 2014 / Accepted: 14 January 2015 / Published: 23 January 2015
Cited by 2 | PDF Full-text (1957 KB) | HTML Full-text | XML Full-text
Abstract
Multi-stakeholder partnerships (MSPs) have become a widespread means for deploying policies in a whole of society strategy to address the complex problem of childhood obesity. However, decision-making in MSPs is fraught with challenges, as decision-makers are faced with complexity, and have to reconcile
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Multi-stakeholder partnerships (MSPs) have become a widespread means for deploying policies in a whole of society strategy to address the complex problem of childhood obesity. However, decision-making in MSPs is fraught with challenges, as decision-makers are faced with complexity, and have to reconcile disparate conceptualizations of knowledge across multiple sectors with diverse sets of indicators and data. These challenges can be addressed by supporting MSPs with innovative tools for obtaining, organizing and using data to inform decision-making. The purpose of this paper is to describe and analyze the development of a knowledge-based infrastructure to support MSP decision-making processes. The paper emerged from a study to define specifications for a knowledge-based infrastructure to provide decision support for community-level MSPs in the Canadian province of Quebec. As part of the study, a process assessment was conducted to understand the needs of communities as they collect, organize, and analyze data to make decisions about their priorities. The result of this process is a “portrait”, which is an epidemiological profile of health and nutrition in their community. Portraits inform strategic planning and development of interventions, and are used to assess the impact of interventions. Our key findings indicate ambiguities and disagreement among MSP decision-makers regarding causal relationships between actions and outcomes, and the relevant data needed for making decisions. MSP decision-makers expressed a desire for easy-to-use tools that facilitate the collection, organization, synthesis, and analysis of data, to enable decision-making in a timely manner. Findings inform conceptual modeling and ontological analysis to capture the domain knowledge and specify relationships between actions and outcomes. This modeling and analysis provide the foundation for an ontology, encoded using OWL 2 Web Ontology Language. The ontology is developed to provide semantic support for the MSP process, defining objectives, strategies, actions, indicators, and data sources. In the future, software interacting with the ontology can facilitate interactive browsing by decision-makers in the MSP in the form of concepts, instances, relationships, and axioms. Our ontology also facilitates the integration and interpretation of community data, and can help in managing semantic interoperability between different knowledge sources. Future work will focus on defining specifications for the development of a database of indicators and an information system to help decision-makers to view, analyze and organize indicators for their community. This work should improve MSP decision-making in the development of interventions to address childhood obesity. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessArticle Preventing Obesity in the Military Community (POMC): The Development of a Clinical Trials Research Network
Int. J. Environ. Res. Public Health 2015, 12(2), 1174-1195; doi:10.3390/ijerph120201174
Received: 2 September 2014 / Accepted: 12 December 2014 / Published: 22 January 2015
Cited by 3 | PDF Full-text (763 KB) | HTML Full-text | XML Full-text
Abstract
Obesity impacts the U.S. military by affecting the health and readiness of active duty service members and their families. Preventing Obesity in Military Communities (POMC) is a comprehensive research program within Patient Centered Medical Homes (PCMHs) in three Military Training Facilities. This paper
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Obesity impacts the U.S. military by affecting the health and readiness of active duty service members and their families. Preventing Obesity in Military Communities (POMC) is a comprehensive research program within Patient Centered Medical Homes (PCMHs) in three Military Training Facilities. This paper describes three pilot randomized controlled trials that target critical high risk periods for unhealthy weight gain from birth to young adulthood: (1) pregnancy and early infancy (POMC-Mother-Baby), (2) adolescence (POMC-Adolescent), and (3) the first tour of duty after boot camp (POMC-Early Career). Each study employs a two-group randomized treatment or prevention program with follow up. POMC offers a unique opportunity to bring together research and clinical expertise in obesity prevention to develop state-of-the-art programs within PCMHs in Military Training Facilities. This research builds on existing infrastructure that is expected to have immediate clinical benefits to DoD and far-reaching potential for ongoing collaborative work. POMC may offer an economical approach for widespread obesity prevention, from conception to young adulthood, in the U.S. military as well as in civilian communities. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessArticle The Healthy Lifestyles Programme (HeLP) — An Overview of and Recommendations Arising from the Conceptualisation and Development of an Innovative Approach to Promoting Healthy Lifestyles for Children and Their Families
Int. J. Environ. Res. Public Health 2015, 12(1), 1003-1019; doi:10.3390/ijerph120101003
Received: 24 October 2014 / Revised: 10 December 2014 / Accepted: 13 January 2015 / Published: 20 January 2015
Cited by 2 | PDF Full-text (693 KB) | HTML Full-text | XML Full-text
Abstract
Despite the rise in childhood obesity, there remains a paucity of evidence for effective interventions that engage children and parents sufficiently to make and sustain lifestyle behaviour change. The Healthy Lifestyles Programme (HeLP) is a school-located obesity prevention programme, which has been developed
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Despite the rise in childhood obesity, there remains a paucity of evidence for effective interventions that engage children and parents sufficiently to make and sustain lifestyle behaviour change. The Healthy Lifestyles Programme (HeLP) is a school-located obesity prevention programme, which has been developed with teachers, families and healthcare professionals. The underpinning assumption in the development of HeLP was to take a relational approach to changing behaviour, building relationships with the schools, children and their families to create supportive environments for healthy lifestyle choices. Thus, HeLP was conceptualised as a complex intervention within a complex system and developed as a dynamic, evolving set of processes to support and motivate children towards healthy behaviours. The delivery methods used are highly interactive and encourage identification with and ownership of the healthy lifestyle messages so that the children are motivated to take them home to their parents and effect change within the family. We have good evidence that HeLP engages schools and children such that they want to participate in the Programme. Results from an exploratory trial showed that the Programme is feasible and acceptable and has the potential to change behaviours and affect weight status. This paper presents an overview of and recommendations arising from the conceptualization; development and evaluation of the Healthy Lifestyles Programme as part of a special issue focusing on novel approaches to the global problem of childhood obesity. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessArticle Daily Physical Activity and Screen Time, but Not Other Sedentary Activities, Are Associated with Measures of Obesity during Childhood
Int. J. Environ. Res. Public Health 2015, 12(1), 146-161; doi:10.3390/ijerph120100146
Received: 31 October 2014 / Accepted: 15 December 2014 / Published: 23 December 2014
Cited by 5 | PDF Full-text (824 KB) | HTML Full-text | XML Full-text
Abstract
Childhood obesity is related to low physical activity level and a sedentary lifestyle. The aim of this study was to assess the physical activity level and sedentary behaviour of Malaysian children aged 7 to 12 years and to examine their association with body
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Childhood obesity is related to low physical activity level and a sedentary lifestyle. The aim of this study was to assess the physical activity level and sedentary behaviour of Malaysian children aged 7 to 12 years and to examine their association with body mass index (BMI), BMI-for-age Z-score (BAZ), body fatness (%BF) and waist circumference (WC). A total of 1736 children, representing all ethnic groups were recruited from six regions of Malaysia. Anthropometric measurements included body weight, height and waist circumference. Body fat percentage (%BF) was assessed using bioelectrical impedance. Physical activity was assessed by a physical activity questionnaire (PAQ) in all children and by pedometers in a subsample (n = 514). PAQ score and pedometer step counts were negatively associated with BMI, BAZ, %BF and WC after adjusting for covariates. Screen time was positively associated with BAZ and WC. However, other sedentary activities were not significantly related with any anthropometric indicators. Strategies to promote active living among children in Malaysia should focus not only on increasing physical activity but also emphasise reduction in sedentary behaviours. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessArticle Overweight and Obesity in Portuguese Children: Prevalence and Correlates
Int. J. Environ. Res. Public Health 2014, 11(11), 11398-11417; doi:10.3390/ijerph111111398
Received: 10 September 2014 / Revised: 22 October 2014 / Accepted: 27 October 2014 / Published: 3 November 2014
Cited by 3 | PDF Full-text (1015 KB) | HTML Full-text | XML Full-text
Abstract
There are widespread differences in overweight/obesity prevalence in children, and understanding the reasons for this is very important. The present study aims: (I) to conduct a meta-analysis on overweight/obesity prevalence in Portuguese children; (II) to identify differences in biological and behavioural characteristics between
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There are widespread differences in overweight/obesity prevalence in children, and understanding the reasons for this is very important. The present study aims: (I) to conduct a meta-analysis on overweight/obesity prevalence in Portuguese children; (II) to identify differences in biological and behavioural characteristics between normal-weight and overweight/obese children; and (III) to investigate the importance of individual- and school-level correlates of variation in children’s BMI using multilevel modelling. A search was done for all published papers including Portuguese children during the last decade; further, 686 Portuguese children (9–11 years old) were sampled and their BMI, family income, maturity offset, nutritional habits, physical activity, sedentariness, sleep time, and school environment information were collected. Results showed a stabilization of overweight/obesity during the last decade, 30.6% (95%CI: 0.287–0.34) for boys, 28.4% (95%CI: 0.23–0.35) for girls, and 30.3% (95%CI: 0.27–0.34) for boys and girls together. Differences between weight groups were only found in individual-level biological traits. The multilevel analysis did not identify significant contributions of school-level variables to children’s BMI variation. In conclusion, no increase was found in the prevalence of overweight/obesity among Portuguese children since 2000. Normal-weight and overweight/obese children only differ in individual-level characteristics, and school context variables were not related to variation in BMI. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessArticle WHO European Childhood Obesity Surveillance Initiative: School Nutrition Environment and Body Mass Index in Primary Schools
Int. J. Environ. Res. Public Health 2014, 11(11), 11261-11285; doi:10.3390/ijerph111111261
Received: 3 June 2014 / Revised: 14 October 2014 / Accepted: 20 October 2014 / Published: 30 October 2014
Cited by 6 | PDF Full-text (513 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. Methods
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Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children’s weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children’s BMI/A Z-scores was calculated. Results: Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%-95% of schools) and school nutrition environment scores (range: 0.30-0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20-1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed. Conclusions: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the “unhealthy” school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessArticle Telephone-Based Adiposity Prevention for Families with Overweight Children (T.A.F.F.-Study): One Year Outcome of a Randomized, Controlled Trial
Int. J. Environ. Res. Public Health 2014, 11(10), 10327-10344; doi:10.3390/ijerph111010327
Received: 25 June 2014 / Revised: 23 September 2014 / Accepted: 29 September 2014 / Published: 3 October 2014
Cited by 2 | PDF Full-text (815 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
The one-year outcome of the randomized controlled T.A.F.F. (Telephone based Adiposity prevention For Families) study is presented. Screening of overweight (BMI-SDS > 90th centile) children 3.5–17.4 years was performed via the German CrescNet database, and candidates were randomized
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The one-year outcome of the randomized controlled T.A.F.F. (Telephone based Adiposity prevention For Families) study is presented. Screening of overweight (BMI-SDS > 90th centile) children 3.5–17.4 years was performed via the German CrescNet database, and candidates were randomized to an intervention group (IG) and control group (CG). The intervention consisted of computer-aided telephone counselling for one year, supported by mailed newsletters. The primary endpoint was change in BMI-SDS; secondary endpoints were eating behavior, physical activity, media consumption, quality of life. Data from 289 families (145 IG (51% females); 144 CG (50% females)) were analyzed (Full Analysis Set: FAS; Per Protocol Set: PPS). Successful intervention was defined as decrease in BMI-SDS ≥ 0.2. In the FAS, 21% of the IG was successful as compared to 16% from the CG (95% CI for this difference: (−4, 14), p = 0.3, mean change in BMI-SDS: −0.02 for IG vs. 0.02 for CG; p = 0.4). According to the PPS, however, the success rate was 35% in the IG compared to 19% in the CG (mean change in BMI-SDS: −0.09 for IG vs. 0.02 for CG; p = 0.03). Scores for eating patterns (p = 0.01), media consumption (p = 0.007), physical activity (p = 9 × 10−9), quality of life (p = 5 × 10−8) decreased with age, independent of group or change in BMI-SDS. We conclude that a telephone-based obesity prevention program suffers from well-known high attrition rates so that its effectiveness could only be shown in those who adhered to completion. The connection between lifestyle and weight status is not simple and requires further research to better understand. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessArticle Lifestyle Practices and Obesity in Malaysian Adolescents
Int. J. Environ. Res. Public Health 2014, 11(6), 5828-5838; doi:10.3390/ijerph110605828
Received: 21 April 2014 / Revised: 22 May 2014 / Accepted: 27 May 2014 / Published: 30 May 2014
Cited by 2 | PDF Full-text (252 KB) | HTML Full-text | XML Full-text
Abstract
Aim: To determine the influence of physical activity (PA) and sedentary behavior (SB) on obesity profiles of 454 Malaysian adolescents aged 12 to 19. Methods: Validated PA and SB questionnaires were used and body composition assessed using anthropometry and dual-energy X-ray absorptiometry (DXA).
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Aim: To determine the influence of physical activity (PA) and sedentary behavior (SB) on obesity profiles of 454 Malaysian adolescents aged 12 to 19. Methods: Validated PA and SB questionnaires were used and body composition assessed using anthropometry and dual-energy X-ray absorptiometry (DXA). Results: Gender-specific multivariate analyses showed boys with high levels of total PA and moderate-to-vigorous physical activity (MVPA) exhibited significantly lower levels of total body fat, percent body fat and android fat mass compared with low PA and MVPA groups, after adjusting for potential confounders. Girls with high SB levels showed significantly higher BMI, waist circumference and DXA-derived body fat indices than those at lower SB level. Multiple logistic analyses indicated that boys with low levels of total PA and MVPA had significantly greater obesity risk, 3.0 (OR 3.0; 95% CI, 1.1–8.1; p < 0.05) and 3.8-fold (OR 3.8; 95% CI, 1.4–10.1; p < 0.01), respectively, than more active boys. Only in girls with high SB level was there a significantly increased risk of obesity, 2.9 times higher than girls at low SP levels (OR 2.8; 95% CI, 1.0–7.5; p < 0.05).  Conclusions: The present findings indicate that higher PA duration and intensity reduced body fat and obesity risk while high screen-based sedentary behaviors significantly adversely influenced body fat mass, particularly amongst girls when the PA level was low. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessArticle Higher Household Income and the Availability of Electronic Devices and Transport at Home Are Associated with Higher Waist Circumference in Colombian Children: The ACFIES Study
Int. J. Environ. Res. Public Health 2014, 11(2), 1834-1843; doi:10.3390/ijerph110201834
Received: 15 November 2013 / Revised: 24 January 2014 / Accepted: 29 January 2014 / Published: 7 February 2014
Cited by 6 | PDF Full-text (177 KB) | HTML Full-text | XML Full-text
Abstract
Background: The current “epidemic” of childhood obesity is described as being driven by modern lifestyles with associated socioeconomic and environmental changes that modify dietary habits, discourage physical activity and encourage sedentary behaviors. Objective: To evaluate the association between household income and
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Background: The current “epidemic” of childhood obesity is described as being driven by modern lifestyles with associated socioeconomic and environmental changes that modify dietary habits, discourage physical activity and encourage sedentary behaviors. Objective: To evaluate the association between household income and the availability of electronic devices and transport at home, and the values of waist circumference (WC), as an indicator of abdominal obesity, in children and adolescents from Bucaramanga, Colombia. Methods: Cross-sectional study of public elementary and high school population, of low-middle socioeconomic status. Results: A total of 668 schoolchildren were recruited. After adjusting for potential confounders, significant positive associations between waist circumference and higher household income (p = 0.011), and waist circumference and the availability of electronic devices and transport at home (p = 0.026) were found. Conclusions: In low-middle socioeconomic status schoolchildren in a developing country, those from relatively more affluent families had greater waist circumference, an association that is opposite to that observed in developed countries. This finding could be related to higher income family’s ability to purchase electronic devices and motorized transport which discourage physical activity and for their children to buy desirable and more costly western fast food. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)

Review

Jump to: Research

Open AccessReview The Challenges of Underweight and Overweight in South African Children: Are We Winning or Losing the Battle? A Systematic Review
Int. J. Environ. Res. Public Health 2015, 12(2), 1156-1173; doi:10.3390/ijerph120201156
Received: 18 November 2014 / Revised: 14 January 2015 / Accepted: 15 January 2015 / Published: 22 January 2015
Cited by 2 | PDF Full-text (956 KB) | HTML Full-text | XML Full-text
Abstract
Underweight and overweight are adverse effects of malnutrition and both are associated with negative health consequences in children and adolescents. In South Africa, the burden of economic and social disparity coexists with malnutrition in children. The purpose of this study was to review
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Underweight and overweight are adverse effects of malnutrition and both are associated with negative health consequences in children and adolescents. In South Africa, the burden of economic and social disparity coexists with malnutrition in children. The purpose of this study was to review available South Africa studies regarding the comprehensive summary of prevalence of underweight and overweight and evaluates government policies in addressing undernutrition and overnutrition in South African children and adolescents. We searched subject-specific electronic bibliographic databases of observational studies published on malnutrition, undernutrition, overnutrition, underweight and overweight in South African boys and girls from birth to 20 years of age in studies published on or after 1990. A total of sixteen cross-sectional, three longitudinal studies and one report met the criteria for inclusion in this review. Descriptive data synthesis revealed the small number of longitudinal studies highlights the dearth of research in tracking undernutrition and overnutrition in South African children. In this review, 0.7%–66% of underweight was reported among children in rural areas compared to a 3.1%–32.4% of overweight in urban areas. All studies reported a higher rate of underweight in boys than girls who were significantly more likely to have higher body fat. The data indicated that both underweight and overweight were positively related with health-related physical activity and psychological health problems such as low activity, low fitness, low self-image and self-esteem. Numerous recommendations were made in the reviewed studies, however effective strategic programs in eradicating both underweight and overweight are minimal. It is evident from the reviewed studies that the burden of underweight and overweight are still a problem in South African children. The most highly affected by underweight are rural children, while children in urban areas in transition are faced with burden of overweight. There is little evidence to suggest that government strategic programs are effective in addressing underweight and overweight in South African children. Based on these findings, sustainable school-based feeding schemes and physical education programmes are needed for optimal benefits in children and adolescents. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessReview Diet and Physical Activity Interventions to Prevent or Treat Obesity in South Asian Children and Adults: A Systematic Review and Meta-Analysis
Int. J. Environ. Res. Public Health 2015, 12(1), 566-594; doi:10.3390/ijerph120100566
Received: 26 October 2014 / Accepted: 18 December 2014 / Published: 9 January 2015
Cited by 6 | PDF Full-text (1303 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Background and Aims: The metabolic risks associated with obesity are greater for South Asian populations compared with White or other ethnic groups, and levels of obesity in childhood are known to track into adulthood. Tackling obesity in South Asians is therefore a
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Background and Aims: The metabolic risks associated with obesity are greater for South Asian populations compared with White or other ethnic groups, and levels of obesity in childhood are known to track into adulthood. Tackling obesity in South Asians is therefore a high priority. The rationale for this systematic review is the suggestion that there may be differential effectiveness in diet and physical activity interventions in South Asian populations compared with other ethnicities. The research territory of the present review is an emergent, rather than mature, field of enquiry, but is urgently needed. Thus the aim of this systematic review and meta-analysis was to assess the effectiveness of diet and physical activity interventions to prevent or treat obesity in South Asians living in or outside of South Asia and to describe the characteristics of effective interventions. Methods: Systematic review of any type of lifestyle intervention, of any length of follow-up that reported any anthropometric measure for children or adults of South Asian ethnicity. There was no restriction on the type of comparator; randomised controlled trials, controlled clinical trials, and before-after studies were included. A comprehensive search strategy was implemented in five electronic databases: ASSIA, Cochrane Controlled Trials Register, Embase, Medline and Social Sciences Citation Index. The search was limited to English language abstracts published between January 2006 and January 2014. References were screened; data extraction and quality assessment were carried out by two reviewers. Results are presented in narrative synthesis and meta-analysis. Results: Twenty-nine studies were included, seven children, 21 adult and one mixed age. No studies in children under six were identified. Sixteen studies were conducted in South Asia, ten in Europe and three in USA. Effective or promising trials include physical activity interventions in South Asian men in Norway and South Asian school-children in the UK. A home-based, family-orientated diet and physical activity intervention improved obesity outcomes in South Asian adults in the UK, when adjusted for baseline differences. Meta-analyses of interventions in children showed no significant difference between intervention and control for body mass index or waist circumference. Meta-analyses of adult interventions showed significant improvement in weight in data from two trials adjusted for baseline differences (mean difference −1.82 kgs, 95% confidence interval −2.48 to −1.16) and in unadjusted data from three trials following sensitivity analysis (mean difference −1.20 kgs, 95% confidence interval −2.23 to −0.17). Meta-analyses showed no significant differences in body mass index and waist circumference for adults. Twenty of 24 intervention groups showed improvements in adult body mass index from baseline to follow-up; average change in high quality studies (n = 7) ranged from 0.31 to −0.8 kg/m2. There was no evidence that interventions were more or less effective according to whether the intervention was set in South Asia or not, or by socio-economic status. Conclusions: Meta-analysis of a limited number of controlled trials found an unclear picture of the effects of interventions on body mass index for South Asian children. Meta-analyses of a limited number of controlled trials showed significant improvement in weight for adults but no significant differences in body mass index and waist circumference. One high quality study in South Asian children found that a school-based physical activity intervention that was delivered within the normal school day which was culturally sensitive, was effective. There is also evidence of culturally appropriate approaches to, and characteristics of, effective interventions in adults which we believe could be transferred and used to develop effective interventions in children. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessReview Childhood Obesity: A Role for Gut Microbiota?
Int. J. Environ. Res. Public Health 2015, 12(1), 162-175; doi:10.3390/ijerph120100162
Received: 27 October 2014 / Accepted: 12 December 2014 / Published: 23 December 2014
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Abstract
Obesity is a serious public health issue affecting both children and adults. Prevention and management of obesity is proposed to begin in childhood when environmental factors exert a long-term effect on the risk for obesity in adulthood. Thus, identifying modifiable factors may help
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Obesity is a serious public health issue affecting both children and adults. Prevention and management of obesity is proposed to begin in childhood when environmental factors exert a long-term effect on the risk for obesity in adulthood. Thus, identifying modifiable factors may help to reduce this risk. Recent evidence suggests that gut microbiota is involved in the control of body weight, energy homeostasis and inflammation and thus, plays a role in the pathophysiology of obesity. Prebiotics and probiotics are of interest because they have been shown to alter the composition of gut microbiota and to affect food intake and appetite, body weight and composition and metabolic functions through gastrointestinal pathways and modulation of the gut bacterial community. As shown in this review, prebiotics and probiotics have physiologic functions that contribute to changes in the composition of gut microbiota, maintenance of a healthy body weight and control of factors associated with childhood obesity through their effects on mechanisms controlling food intake, fat storage and alterations in gut microbiota. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)
Open AccessReview Global School-Based Childhood Obesity Interventions: A Review
Int. J. Environ. Res. Public Health 2014, 11(9), 8940-8961; doi:10.3390/ijerph110908940
Received: 31 May 2014 / Revised: 19 August 2014 / Accepted: 20 August 2014 / Published: 28 August 2014
Cited by 8 | PDF Full-text (359 KB) | HTML Full-text | XML Full-text
Abstract
Background: The issue of childhood overweight and obesity has become a global public health crisis. School-based interventions have been developed and implemented to combat this growing concern. The purpose of this review is to compare and contrast U.S. and international school-based obesity
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Background: The issue of childhood overweight and obesity has become a global public health crisis. School-based interventions have been developed and implemented to combat this growing concern. The purpose of this review is to compare and contrast U.S. and international school-based obesity prevention interventions and highlight efficacious strategies. Methods: A systematic literature review was conducted utilizing five relevant databases. Inclusion criteria were: (1) primary research; (2) overweight or obesity prevention interventions; (3) school-based; (4) studies published between 1 January 2002 through 31 December 2013; (5) published in the English language; (6) child-based interventions, which could include parents; and (7) studies that reported outcome data. Results: A total of 20 interventions met the inclusion criteria. Ten interventions each were implemented in the U.S. and internationally. International interventions only targeted elementary-aged students, were less likely to target low-income populations, and were less likely to be implemented for two or more years in duration. However, they were more likely to integrate an environmental component when compared to U.S. interventions. Discussion: Interventions implemented in the U.S. and internationally resulted in successful outcomes, including positive changes in student BMI. Yet, varying approaches were used to achieve success, reinforcing the fact that a one-size-fits-all approach is not necessary to impact childhood obesity. However, building on successful interventions, future school-based obesity prevention interventions should integrate culturally specific intervention strategies, aim to incorporate an environmental component, and include parents whenever possible. Consideration should be given to the potential impact of long-term, frequent dosage interventions, and subsequent follow-up should be given attention to determine long-term efficacy. Full article
(This article belongs to the Special Issue Childhood Obesity: Novel Approaches to a Global Problem)

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