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PubMed2005

Population-based trends and correlates of maternal overweight and obesity, Utah 1991-2001.

OBJECTIVE: This study aims to identify recent population-based trends in maternal overweight and obesity and adverse outcomes. STUDY DESIGN: Statewide retrospective cohort study of birth certificate data for live singleton births to women in Utah between 1991 and 2001. RESULTS: Prepregnancy overweight and obesity increased from 25.1% in 1991 to 35.2% in 2001, a 40.2% increase (prevalence ratio [PR] 1.40 [1.37-1.43]), whereas maternal obesity at delivery rose 36.2% from 28.7% to 39.1% (PR 1.36 [1.33-1.39]). The attributable fraction of cesarean delivery in overweight and obese women was 0.388 (0.369-0.407). Statewide, among all women having a cesarean delivery in 2001, 1 in 7 is attributable to overweight and obesity. CONCLUSION: This is the first state-wide analysis of maternal obesity trends demonstrating a significant increase in maternal overweight and obesity. Overweight and obese women are at increased risk of cesarean delivery, preeclampsia, eclampsia, dystocia, and macrosomia, risks that increase as the body mass index rises.

Adolescent↗
PubMed2006

Obstetric outcomes in overweight and obese adolescents.

OBJECTIVE: Obese adult pregnant women have increased rates of maternal and neonatal complications. Our objective was to examine adverse obstetric outcomes in overweight adolescent women. STUDY DESIGN: In a retrospective case-control study of 4822 women who were < 19 years old, 3324 appropriate-weight subjects (body mass index, 18.5-24.9 kg/m2) and 1498 overweight subjects (body mass index, > or = 25 kg/m2) were compared. Frequencies and odds ratios for adverse maternal or neonatal events were computed. RESULTS: Compared with appropriate-weight adolescents, primary cesarean delivery (odds ratio, 1.6; 95% CI, 1.4-1.9), failure to progress/cephalopelvic disproportion (odds ratio 1.6; 95% CI, 1.3-1.9), labor induction (odds ratio, 1.4; 95% CI, 1.3-1.7), pregnancy-induced hypertension (odds ratio, 1.8; 95% CI, 1.4-2.3), preeclampsia (odds ratio, 1.7; 95% CI, 1.2-2.4), and gestational diabetes mellitus (odds ratio, 3.0, 95% CI, 1.6-5.4) were significantly more common in overweight adolescents. Significant neonatal findings included an increased incidence of macrosomia (odds ratio, 1.6; 95% CI, 1.2-2.0) and a decreased incidence of low birth weight infants (odds ratio, 0.6; 95% CI, 0.4-0.8) and small for gestational age infants (odds ratio, 0.8; 95% CI, 0.7-1.0). CONCLUSION: Overweight adolescent women are at increased risk for adverse neonatal and perinatal outcomes. With rates of overweight increasing overall, overweight in the gravid adolescent is a pressing perinatal and public health concern.

Adolescent↗
PubMed2005

A longitudinal study to explain strategies to change weight and muscles among normal weight and overweight children.

Previous research has indicated that both boys and girls strive for a slim body, with boys having an additional focus on a muscular body build. The current study was designed to evaluate the utility of a biopsychosocial model to explain body image and body change strategies among children. The study evaluated changes over time in body image and strategies to lose weight and increase muscles among 132 normal weight and 67 overweight boys (mean age = 9.23 years) and 158 normal weight and 55 overweight girls (mean age = 9.33 years). The predictive role of BMI, positive and negative affect, self-esteem and perceived sociocultural pressures to lose weight or increase muscle on body image and body change strategies over a 16 month period was evaluated. All participants completed the questionnaire on both occasions. The results demonstrated that both overweight boys and girls were more likely to be dissatisfied with their weight, place more importance on their weight, engage in more strategies to lose weight as well as perceive more pressure to lose weight. Overweight boys and girls were also more likely to report lower levels of self-esteem and positive affect, and higher levels of negative affect, and reported a reduction in their self-esteem over time. Regression analyses demonstrated that among overweight boys, low self-esteem and high levels of perceived pressure to lose weight predicted weight dissatisfaction; for overweight girls, weight dissatisfaction was also predicted by low levels of self-esteem. The implication of these findings in terms of factors contributing to the adoption of health risk behaviors among children is discussed.

Body Composition↗
PubMed2005

Proximal femur bone geometry is appropriately adapted to lean mass in overweight children and adolescents.

It is unclear if the bones of overweight children are appropriately adapted to increased loads. The objective of this study was to compare bone geometry in 40 overweight (body mass index [BMI] > 85th percentile) and 94 healthy weight (BMI < or = 85th percentile) subjects, ages 4-20 years. Dual energy X-ray absorptiometry (Hologic QDR 2000) scans were analyzed at the femoral shaft (FS) and narrow neck (NN) by the Hip Structure Analysis program. Subperiosteal width, cortical thickness and indices of bone axial and bending strength (bone cross-sectional area [CSA] and section modulus [Z]) were measured from bone mass profiles. Multivariate regression models were used to compare overweight and healthy weight subjects. Z was 11 (95% CI 5, 19) and 13 (7, 20) percent higher at the FS and NN, respectively, in overweight subjects (P < 0.001), adjusted for height, maturation and gender. At the NN, higher Z was due to greater subperiosteal width [4% (2, 7)] and bone CSA [10% (5, 16]) and at the FS, to higher bone CSA [10% (5, 16)] and thicker cortices [9% (3, 15)]. When lean mass was added to the models, bone variables did not differ between overweight and healthy weight subjects (P > 0.22), with the exception of NN subperiosteal width [3% (0, 6), P = 0.04]. Fat mass did not contribute significantly to any model. In summary, proximal femur bone geometric strength in overweight children was appropriately adapted to lean mass and height but greater weight in the form of fat mass did not have an independent effect on bone bending strength. These geometric adaptations are consistent with the mechanostat hypothesis that bone strength adapts primarily to muscle forces, not to static loads represented by body weight.

Adolescent↗
PubMed2006

School-based physical fitness testing identifies large disparities in childhood overweight in Los Angeles.

Few data are available on the epidemic of childhood overweight in local jurisdictions. To determine the prevalence and identify demographic and socioeconomic correlates of childhood overweight, we assessed height and weight data on 281,630 Los Angeles County, CA, public school students collected during school-based physical fitness testing in 2001. Overweight prevalence was 20.6% overall and varied by race/ethnicity: 25.2% among Latinos, 20.0% among Pacific Islanders, 19.4% among blacks, 17.6% among American Indians, 13.0% among whites, and 11.9% among Asians. By using multilevel analysis, we found that school-level percentage of students enrolled in free or reduced-price meal programs was independently associated with overweight, after controlling for school-level median household income and student-level demographic characteristics. When local overweight prevalence data are unavailable, percentage enrollment in free or reduced-price meal programs might be a useful indicator to identify schools where focused overweight prevention and control interventions are most needed.

Adolescent↗
PubMed2005

Overweight status and depressive symptoms during adolescence.

PURPOSE: To: (a) extend previous research on the association between overweight status and depressive symptoms among adults to adolescents, (b) consider whether this association varies across social structural contexts and school context, and (c) explore additional mechanisms linking overweight status to depressive symptoms. METHODS: We used survey regression procedures to analyze data from the first wave of the National Longitudinal Study of Adolescent Health. Degree of overweight was indicated by body mass index (BMI), which we calculated using self-reported height and weight information, whereas depressive symptoms were assessed with the Center for Epidemiological Studies Depression Scale (CES-D). Data were analyzed to determine (a) the social groups in which being overweight was least common, (b) the association between overweight status and depressive symptoms, and (c) potential mediators of the association between relative weight and symptoms of depression, including dieting and self-rated health. The analytic sample contained 18,924 adolescents aged 11 to 21 years (mean age was 15.68). Approximately half the sample consisted of females (n = 9634). RESULTS: Adjusting for exercise and sociodemographic characteristics, we found that relative weight was associated with depressive symptoms for girls but not boys. For both, the association between overweight status and symptoms of depression was stronger among adolescents in lower grades. Dieting explained the positive association between relative weight and depressive symptoms for girls, whereas self-rated health mediated the association between relative weight and symptoms of depression for adolescents in lower grades. CONCLUSION: To fully understand both the physical and mental health consequences of adolescent obesity, the social dimension of weight must be examined.

Adolescent↗
PubMedDate not supplied

Fit WIC: attitudes, perceptions and practices of WIC staff toward addressing childhood overweight.

OBJECTIVE: To assess the attitudes, perceptions, and practices of staff of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in providing nutrition education on childhood overweight topics with WIC participants. DESIGN: Descriptive and correlational study. SETTING: WIC clinics in Virginia. PARTICIPANTS: 106 employees working in direct contact with WIC participants. MEAN OUTCOME MEASURE(S): Demographic information; comfort level and frequency of discussing childhood overweight-related topics with participants; perception of WIC's ability to prevent and help address overweight among children and adults; body mass index (BMI); and attitudes toward personal weight. ANALYSIS: Descriptive statistics, regression, and analysis of variance. RESULTS: WIC staff in this study reported a lack of comfort, practice, and confidence in addressing and/or preventing childhood overweight with WIC participants, with differences existing based on job title (P < .05). Barriers to implementing programs included perceived attitudes of participants, transportation, time, cultural issues, and childcare. Staff BMIs were significantly correlated to ethnicity, age, feeling overweight, unhappiness with current weight, and comfort level discussing fruit and vegetable intake and physical activity (P < .05). CONCLUSIONS AND IMPLICATIONS: Staff training, health promotion programs, and culturally relevant educational materials are warranted for WIC staff to build a strong knowledge base and promote self-efficacy about childhood overweight-related topics.

Adult↗
PubMed2004

Energy restriction restores the impaired immune response in overweight (cafeteria) rats.

Impaired immune function linked to obesity has been shown in both human and animal studies. The purpose of this work was to evaluate the effects of a 4-week energy restriction (50% of total energy intake) on immune function in previously diet-induced (cafeteria) overweight rats. Flow cytometric analysis revealed that the number of spleen T helper cells were significantly (P < 0.05) elevated in control and overweight energy-restricted rats as compared with groups fed ad libitum groups. The proliferative response of splenocytes to phytohaemaglutinin and concanavalin A from overweight rats after energy restriction was significantly (P < 0.05) higher compared to overweight nonrestricted rats. The cytotoxic activity of natural killer cells tended to be lower in overweight rats compared to controls. Finally, control rats under the dietary deprivation period presented higher levels of uncoupling protein 2 mRNA and lower levels of leptin receptor mRNA compared with the reference control group. These results suggest that energy restriction is able to restore, at least in part, the impaired immune response commonly observed in overweight animals.

Animals↗
PubMed2005

Health-related quality of life in overweight and nonoverweight black and white adolescents.

OBJECTIVES: To assess the impact of obesity on quality of life (QOL) in black and white adolescents. STUDY DESIGN: One hundred ten overweight (body mass index [BMI], 41.7 +/- 8.9 kg/m2) and 34 nonoverweight adolescents (BMI, 20.6 +/- 2.9 kg/m2) and their parents completed measures of QOL. RESULTS: Overweight was associated with poorer adolescent-reported QOL and parent reports of their children's QOL. Examining groups by weight status and race, overweight whites reported the greatest impairment on Social/Interpersonal, Self-Esteem, and Physical Appearance QOL (all P < .01), whereas parents of overweight blacks reported the poorest General Health Perceptions scores regarding their children. Interactions between BMI z-score and race were detected for Social/Interpersonal, Self-esteem, Daily Living, Self-Efficacy, Self-regard, and Physical Appearance QOL (all P < .05): Higher BMI in whites was associated with greater impairments in QOL than in blacks. Parents reported similar relations for their children. CONCLUSIONS: According to adolescent and parent reports, overweight is associated with poorer QOL in adolescence, regardless of race; however, compared with overweight white adolescents, blacks report less impairment in QOL. Future research is required to determine whether differences in QOL are predictive of treatment success.

Activities of Daily Living↗
PubMed2004

Overweight in children: definitions, measurements, confounding factors, and health consequences.

The epidemic of childhood overweight continues to grow at staggering rates, increasing nearly four-fold between 1963 and 2000. Children that are overweight are more apt to be overweight adults and are more likely to suffer adverse health consequences associated with excess weight. Nurses have a unique presence in the healthcare environment to assess children for overweight, provide parent/child nutritional education, and conduct obesity-related research. This article provides an overview of the current body of literature surrounding the definition and measurement of overweight and the morbidity association with childhood overweight.

Adolescent↗
PubMed1997

Cardiovascular health risks related to overweight.

Cross-sectional surveys of the civilian noninstitutionalized population of the United States, including in-home interviews and clinical examinations, were employed to examine trends in consumption of energy and fat, prevalence of overweight in the population, the association of overweight with levels of blood pressure and blood cholesterol, and the prevalence of high blood pressure and high blood cholesterol among the overweight compared with the nonoverweight. Data from participants 20 years of age and older are reported. Study results suggest that total mean energy intake, although generally accepted to be underreported in dietary surveys, may have increased. Total fat and saturated fat intake as a percent of energy decreased, but remained above recommended levels. Overweight has increased in the population, despite decreases in the prevalence of high blood pressure and high blood cholesterol levels. Increased levels of overweight, reported as body mass index, are associated with increased cardiovascular risk factors of high blood pressure and high blood cholesterol. These data suggest the need for health care practitioners to emphasize the requirement for energy balance (or weight loss if overweight, ie, not at a "healthy weight"). A focus on fat intake alone without emphasis on energy balance is inadequate for achieving and maintaining recommended weight.

Adult↗
PubMed1998

Association of being overweight with greater asthma symptoms in inner city black and Hispanic children.

OBJECTIVE: To determine whether the weight status of inner city black and Hispanic children with asthma differs from that of their peers and to assess whether overweight asthmatic children experience greater asthma symptoms. STUDY DESIGN: A cross-sectional study in an ambulatory chest clinic of an inner city medical center. METHODS: We studied black and Hispanic children aged 2 to 18 years (n = 209) with the single diagnosis of asthma. The peer control subjects consisted of a sample of black and Hispanic children aged 6 to 13 years (n = 1017), enrolled in the New York City schools. Asthma symptoms, the number of asthma medications prescribed, and peak expiratory flow rate (PEFR) measurements were used to classify asthma severity and relate to body mass index (BMI). Bivariate categorical analysis and chi 2 tests were performed to examine the relationship between high BMI and the individual measures of asthma severity. RESULTS: The prevalence of overweight was significantly higher in children with moderate to severe asthma than in their peers. The risk of overweight based on a BMI in the 85th percentile or greater was significantly associated with the following measures of asthma severity: (1) the number of school days missed per year; (2) a PEFR less than or equal to 60% of the predicted PEFR; and (3) the number of asthma medications prescribed. CONCLUSIONS: The prevalence of overweight was significantly higher in children with moderate to severe asthma than in their peers, and being overweight was associated with significantly more severe asthma symptoms. Further studies in overweight asthmatic children are needed, including the effect of weight loss on lung function and other markers of asthma severity.

Adolescent↗
PubMed2004

The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil.

BACKGROUND: The association between overweight parents and overweight children/adolescents was investigated in Rio de Janeiro, Brazil between 1995 and 1996, controlling for the influence of socio-economic and demographic factors. METHODS: Data were obtained from a two-stage, residence-based, random sample survey of children and adolescents aged 6-19 years and their parents. Body mass index (BMI) was used to classify nutritional status. Initially, a logistic regression model was built, using an indicator of parental weight (maternal BMI) as one of the independent variables and the child/adolescent's BMI as the dependent variable. Following that, the association between socio-economic and demographic variables and overweight children/adolescents was analysed in a univariate analysis. These variables were pre-selected for inclusion in the logistic model, provided that their levels of statistical significance were below P=0.25, and were added to the model individually according to the order of association strength in the univariate analysis. Finally, variables were retained in this model at a significance level of P=0.05. RESULTS: This study found that 20.7% of girls and 26.9% of boys were overweight, with a larger prevalence among children aged less than 9 years. In addition to maternal BMI, the predictors of overweight children and adolescents were age, gender and the number of people in a house. CONCLUSIONS: These results demonstrate the relationship between maternal nutritional status and overweight children and adolescents, suggesting that obesity-prevention programmes should be focused on the family.

Adolescent↗
PubMed1995

Can self-reported data accurately describe the prevalence of overweight?

Overweight is an important public health problem affecting around 50% of the population of Wales, resulting in increased risk of illness, premature disability and premature death. The aim of this study was to examine critically the accuracy of self-reported data in describing the prevalence of overweight in Wales. A sample of 1622 adults aged 18 to 64 years was taken from the Welsh Heart Health Survey 1985. In that survey weight and height data were collected on a self-completed questionnaire and by clinical measurement. Mean differences between self-reported and measured weight and height were used as indicators of bias, and the accuracy of BMI and the prevalence of overweight based on this data were analysed. Weight was reported without significant bias in men, but women under-reported their weight by an average of 1.1 kg. Height was over-reported by 1.4 cm in men, and 0.7 cm in women, on average. More than two-thirds of subjects reported to within 2.3 kg and 2.5 cm of their actual weight and height. Reporting was more biased in older and overweight groups. The calculation of body mass index resulted in amplification of bias and underestimation of the prevalence of overweight and obesity in the study sample of 4.5% in men and 6.7% in women. The results have important implications for the use of self-reported data for the scientific measurement of the prevalence of overweight, especially in longitudinal studies, and suggest that further research should be conducted into the stability of reporting bias over time.

Adult↗
PubMedDate not supplied

Prevalence of the metabolic syndrome and overweight among adults in China.

BACKGROUND: The metabolic syndrome and obesity are major risk factors for cardiovascular disease. Little information exists on the prevalence of the metabolic syndrome in China. We aimed to provide up-to-date estimates of the prevalence of the metabolic syndrome and overweight in the general adult population in China. METHODS: We did a cross-sectional survey in a nationally representative sample of 15,540 Chinese adults aged 35-74 years in 2000-01. Metabolic syndrome was defined according to guidelines from the US National Cholesterol Education Program. Overweight was defined as body-mass index of 25.0 kg/m2 or greater. FINDINGS: The age-standardised prevalence of metabolic syndrome was 9.8% (95% CI 9.0-10.6) in men and 17.8% (16.6-19.0) in women. The age-standardised prevalence of overweight was 26.9% (25.7-28.1) in men and 31.1% (29.7-32.5) in women. The prevalence of the metabolic syndrome and overweight was higher in northern than in southern China, and higher in urban than rural residents. INTERPRETATION: Our results indicate that a large proportion of Chinese adults have the metabolic syndrome and that overweight has become an important public health problem in China. These findings emphasise the urgent need to develop national strategies for the prevention, detection, and treatment of overweight and the metabolic syndrome, to reduce the societal burden of cardiovascular disease in China.

Adult↗
PubMed1986

Environmental effects on the intake of overweight and normal-weight men.

The effects of changes in portion size and social condition on food intake were compared for overweight and normal-weight men. Subjects believed they were participating in a luncheon test of the acceptability of lasagna. In Study 1, under conditions designed to mimic social dining in a cafeteria, subjects were given either 255 or 426 g of lasagna. All subjects at a particular session received the same size portion and could ask for as many helpings as they wished. While overweight subjects ate more than normal-weight subjects, changes in portion size had no significant effects on intake. In Study 2, the effects of social vs. isolated dining were compared. Overweight subjects ate more than normal-weight subjects, and both overweight and normal-weight subjects eating socially ate more than subjects eating alone. In both studies there was a significant relationship between preference rating and intake for overweight subjects but not for normal-weight subjects. The results support the existence of differences in intake between overweight and normal-weight individuals and also indicate the potential importance of environmental factors in the intake of both groups.

Adult↗
PubMed2003

Epidemiologic trends in overweight and obesity.

Obesity in adults is associated with excess mortality and excess risk of coronary heart disease, hypertension, hyperlipidemia, diabetes, gallbladder disease, certain cancers, and osteoarthritis. Overweight children often become overweight adults, and overweight in adulthood is a health risk. Although childhood overweight may not always result in excess adult health risk, immediate consequences of overweight in childhood are psychosocial and also include cardiovascular risk factors such as hypertension, high cholesterol, and abnormal glucose tolerance. The causes of obesity are poorly understood, and both the prevention and the treatment of obesity are difficult. In this context, the ability to track epidemiologic trends in overweight and obesity is important.

Adolescent↗
PubMed2001

Sociodemographic factors and trends on overweight prevalence in children and adolescents in Aragón (Spain) from 1985 to 1995.

From 1985 to 1995, the Aragón School Health Examination Surveys staff has surveyed the whole population of children (age 6-7 years) and adolescents (age 13-14 years). A total of 90,997 children (age 6-7 years) were examined in the nine cross-sectional surveys conducted between 1985 and 1995. A total of 106,284 adolescents (age 13-14 years) were also examined. We defined overweight when the body mass index was > or = 95th percentile. The measure of association between overweight and the other variables studied was the odds ratio, which was calculated by logistic regression. In the children and adolescents studied, the probability to be overweight was higher in the rural than in the urban areas. In the adolescents, the probability to be overweight was higher in the public than in the private schools. Our results also show a significant increase in the prevalence of overweight children in the region of Aragón (Spain) during the 1985-1995 decade, especially in males. Prevention of overweight in the populations at risk would help reduce social inequality in health, a major challenge for public health policy.

Adolescent↗