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High prevalence of overweight and obesity in 11-15-year-old children from Sicily.

BACKGROUND AND AIM: To evaluate the prevalence of overweight and obesity in children and adolescents from Sicily, we carried out a cross-sectional study in a large cohort of 48,897 (24,119 males and 24,778 females) randomly selected 11-15-year-old Sicilian schoolchildren. METHODS AND RESULTS: Anthropometric data (weight and height) were obtained in all children. Urban vs. rural areas were taken into account. Centiles were obtained using the LMS method. Obesity and overweight prevalence were defined using as references both the values of the National Center for Disease Control (CDC 2000) in the United States and those of the International Obesity Task Force (IOTF). Median body mass index (BMI) values in Sicily were comparable to values observed in South and Center-North Italy. BMI cut-off values in Sicilian children were higher than reference values established in the U.S. CDC growth chart 2000. Using both the IOTF or the U.S. CDC 2000 cut-off values the prevalence of overweight and obesity in 11-15-year-old Sicilian children was very high: nearly 40% at age 11 and, although progressively decreasing with age increase, still over 25% at age 15. CONCLUSIONS: The prevalence of overweight and obesity in 11-15-year-old Sicilian schoolchildren is one of the highest ever reported. The prevalence is much higher at a younger age; thereafter it progressively decreases and values tend to reconcile with those observed in other geographical areas at age 14-15.

Adolescent↗

Mental health correlates of healthy lifestyle attitudes, beliefs, choices, and behaviors in overweight adolescents.

INTRODUCTION: A tripling in the number of overweight adolescents has occurred during the past two decades, with type 2 diabetes reaching epidemic proportions. Although obesity has been identified as a correlate of depression and low self-esteem in adolescents, the relationships among key cognitive/mental health variables and healthy attitudes, beliefs, choices, and behaviors in overweight teens have yet to be explored. Therefore, the aim of this study was to describe these relationships so that an effective intervention program to promote and sustain healthy lifestyle behaviors could be implemented. METHODS: A descriptive correlational study was conducted with 23 overweight teens. Key variables measured included depressive symptoms, state and trait anxiety, self-esteem, beliefs/confidence about engaging in a healthy lifestyle, perceived difficulty in leading a healthy lifestyle, and healthy attitudes, choices, and behaviors. FINDINGS: Teens with higher state and trait anxiety as well as depressive symptoms had less healthy lifestyle beliefs, and teens with higher self-esteem had stronger beliefs about their ability to engage in a healthy lifestyle. Stronger beliefs about the ability to engage in healthy lifestyles were related to healthier living attitudes and healthier lifestyle choices. Teens who perceived healthy lifestyles as more difficult had less healthy attitudes and reported less healthier choices and behaviors. DISCUSSION: Including a strong cognitive behavioral skills building component into clinical interventions with overweight teens may be key in boosting their beliefs/confidence about being able to engage in healthy behaviors and lessening their perceived difficulty in performing them, which should result in healthier choices and lifestyle behaviors.

Adaptation, Psychological↗

Is migration to Canada associated with unhealthy weight gain? Overweight and obesity among Canada's immigrants.

This paper aims to address a gap in our understanding of immigrant health issues by examining the determinants of excess weight--an important indicator of current and future health. The paper combines data drawn from recent large health surveys to identify how the weight of recent immigrants compares with that of native-born people, and how the likelihood of becoming overweight or obese changes with additional years in Canada. We find evidence that on average, immigrants are substantially less likely to be obese or overweight upon arrival in Canada. These measures converge slowly to native-born levels, but there is marked variation by the ethnicity of the immigrant. Since changes in weight will reflect choices with respect to diet and activity, the extent to which overweight and obesity rates change with years in Canada may reflect the extent to which immigrants interact with or are influenced by members of their ethnic group who reside in the same area. We find evidence that ethnic group social network effects exert a quantitatively important influence on the incidence of being overweight and obese for members of most ethnic minorities, tempering the process of adjustment to Canadian lifestyle norms that may be driving excess weight gain with additional years in Canada.

Acculturation↗

Differences in eating and activity markers among normal weight, overweight, and obese rural women.

PURPOSE: The purpose of this study was to examine differences in healthy eating and physical activity behaviors and associated biomarkers among normal weight (body mass index [BMI] < 25), overweight (BMI 25-29.9), and obese (BMI > or = 30) rural women. METHODS: Random digit dialing was used to recruit 225 rural women (57.9 +/- 5.6 years). Measures of healthy eating and physical activity were completed on the computer during individual sessions at the rural sites. Research nurses then assessed a battery of biomarkers of activity and eating, including blood lipids, blood pressure, cardiorespiratory fitness (VO(2max)), and resting heart rate. RESULTS: Major findings were differences across weight categories in daily calories consumed and expended, daily fruit servings, daily meat group servings, high-density lipoprotein cholesterol, vital signs, and cardiorespiratory fitness. The obese women both consumed and expended significantly more calories daily than those in the other two weight groups. Obese women consumed significantly fewer fruit group servings than both the normal weight and overweight women. Obese women consumed significantly more meat group servings than overweight women. There also were significant differences in systolic blood pressure, diastolic blood pressure, resting heart rate, high-density lipoprotein cholesterol, and cardiorespiratory fitness across the three weight groups. CONCLUSIONS: This study provides evidence of major differences in some eating and activity behaviors and biomarkers across BMI groups. Major differences exist between the normal weight and overweight group as compared to the obese group.

Activities of Daily Living↗

[Cardiovascular risk factors in overweight and obesity. Changes after a weight loss treatment].

BACKGROUND AND OBJECTIVE: For the treatment of obesity, an adecuate control of associated cardiovascular risk factors (CRF) is fundamental. The objective of this study was to assess the relationship between body mass index (BMI) and CRF, and the effect of a weight loss program on overweight subjects. PATIENTS AND METHOD: A single-centered cross-sectional prospective study was carried out during 1997-2001 on 1,018 overweight subjects (788 women and 230 men) who were seeking aid to lose weight at an obesity clinic. A program involving a hypocaloric, Mediterranean diet was prescribed plus recommendations for spare-time exercise. Variables measured included weight, height, blood pressure, serum lipids and blood glucose concentrations, measured both at baseline and at the end of the weight loss program. RESULTS: After adjusting for age, variables showing a significant increase upon higher BMI were: blood pressure, HDL cholesterol (HDL-C) (inverse relationship, only in women), triglycerides and blood glucose. Total cholesterol (CLT), LDL cholesterol (LDL-C) and CLT/HDL-C showed no relationship with BMI. Weight loss had beneficial effects on blood pressure and triglycerides, regardless of the initial values, and on CLT, LDL-C and CLT/HDL-C when the initial levels were increased. No significant changes were found with regard to HDL-C. CONCLUSIONS: Overweight and obese subjects carry a burden of common coronary risk factors which ncrease upon greater obesity. Weight loss has important beneficial effects with regard to coronary risk factors associated with overweight and obesity, particularly if these factors are previously altered, even when weight loss is < 5% of initial weight.

Adolescent↗

Self-directed hostility and family functioning in normal-weight bulimics and overweight binge eaters.

The aim of this study was to examine whether overweight binge eaters demonstrate similar perceptions of family interactions and views of the self as do normal-weight bulimics. We compared 37 obese binge eaters and 37 normal-weight bulimics to 38 normal-weight non-bulimic controls, and 10 overweight nonbulimic controls on the Bulimia Test (BULIT). Profile of Mood States (POMS), Structural Analysis of Social Behavior (SASB) Short Form, which includes measure of hostility of family interactions and self-directed hostility; the Family Interaction Survey (FIS), and a measure of history of physical and sexual abuse and familial psychopathology. Both normal-weight bulimics and overweight binge eaters differed from nonbulimic controls across all measures of symptomatology, family functioning, history of abuse, familial psychopathology, and self-directed hostility. Normal-weight bulimics demonstrated significantly higher BULIT scores and self-directed hostility than did overweight binge eaters. Post hoc analysis showed that among binge eaters and bulimics, self-directed hostility accounted for a significant percentage of the variance of BULIT scores when controlling for the effects of age, BMI, family hostility, and mood. The possible role of self-directed hostility in the maintenance of bulimic symptomatology is discussed.

Adult↗

Use of the BULIT bulimia screening questionnaire to assess risk and progress in weight management for overweight women who weight cycle. BULImia Test.

A bulimia screening questionnaire was examined for usefulness in assessing risk for bulimia and measuring progress in reducing binge eating in overweight women who weight cycle. In two studies the BULIT test was used to screen for risk for bulimia. Study 1 was a descriptive study of motivations for overeating in normal weight women compared to overweight women who weight cycled. In Study 2, overweight women who weight cycled were examined at baseline, 6, and 12 months for effectiveness of a clinical treatment strategy to reduce binge eating. In Study 1, BULIT scores were statistically significantly higher for overweight compared to normal weight subjects. In Study 2, subjects' BULIT scores were lower after using a long term clinical treatment strategy to gain control of eating. The BULIT test was useful for specifying four categories of eating patterns to assess risk for bulimia and progress in reducing binge eating.

Adult↗

The utility of the international child and adolescent overweight guidelines for predicting coronary heart disease risk factors.

The purpose of this study was to assess the association between the international overweight cutoffs for children and youth and coronary heart disease risk factors. The sample included 410 boys and 337 girls 9-18 years of age from the Québec Family Study. Participants were classified as normal weight or overweight using the international BMI cutoffs, and into normal and elevated risk groups based on the 90th percentile of sex-specific age-adjusted risk factors [blood pressure, fasting total cholesterol (CHOL), LDL-C, HDL-C, CHOL/HDL-C, triglycerides, glucose, and physical work capacity]. Overweight participants had between 1.6 and 9.1 times the risk of elevated risk factors compared to normal-weight participants. Further, boys and girls with four or more risk factors were 19 and 43 times more likely to be overweight, respectively, compared to participants with no risk factors. The results add evidence that the international cutoffs are related to health risks in youth, supporting the adoption of the guidelines.

Adolescent↗

Varying sensitivity of waist action levels to identify subjects with overweight or obesity in 19 populations of the WHO MONICA Project.

It has been suggested in the literature that cut-off points based on waist circumference (waist action levels) should replace cut-off points based on body mass index (BMI) and waist-to-hip ratio in identifying subjects with overweight or obesity. In this article, we examine the sensitivity and specificity of the cut-off points when applied to 19 populations with widely different prevalences of overweight. Our design was a cross-sectional study based on random population samples. A total of 32,978 subjects aged 25-64 years from 19 male and 18 female populations participating in the second MONICA survey from 1987 to 1992 were included in this study. We found that at waist action level 1 (waist circumference > or =94 cm in men and > or =80 cm in women), sensitivity varied between 40% and 80% in men and between 51% and 86% in women between populations when compared with the cut-off points based on BMI (> or =25 kg/m2) and waist-to-hip ratio (> or =0.95 for men, > or =0.80 for women). Specificity was high (> or =90%) in all populations. At waist action level 2 (waist circumference > or =102 cm and > or =88 cm in men and women, respectively, BMI > or =30 kg/m2), sensitivity varied from 22% to 64% in men and from 26% to 67% in women, whereas specificity was >95% in all populations. Sensitivity was in general lowest in populations in which overweight was relatively uncommon, whereas it was highest in populations with relatively high prevalence of overweight. We propose that cut-off points based on waist circumference as a replacement for cut-off points based on BMI and waist-to-hip ratio should be viewed with caution. Based on the proposed waist action levels, very few people would unnecessarily be advised to have weight management, but a varying proportion of those who would need it might be missed. The optimal screening cut-off points for waist circumference may be population specific.

Abdomen↗

[Study of overweight and obesity in a population of urban school children in Sousse, Tunisia].

AIM: The aim of this study was to assess the prevalence of obesity and overweight and their relationship with cardiovascular disease risk factors. METHODS: Epidemiological survey based on a representative sample of 1569 urban school children of Sousse, Tunisia. RESULTS: Overweight (BMI > or = 25) was significantly higher in girls (16.1%) than in boys (11.6%); (chi 2 = 8.2; p = 0.004). Obesity (BMI > or = 30) was slightly higher in girls (3.7%) than in boys (2.7%); (chi 2 = 0.89; p = 0.34). Girls had significantly higher BMI, diastolic blood pressure, cholesterol and HDL cholesterol levels than boys who had however significantly higher levels of systolic blood pressure. Overweight was significantly higher in children who did not practice sport at school: 22 versus 13.1% (p < 0.002), in groups of youngsters who were not affiliated to school sport or city associations. Overweight children had a significantly higher levels of cholesterol, HDL cholesterol and means of systolic and diastolic blood pressures. CONCLUSION: These results will serve to set up a regional program of health promotion at schools.

Adolescent↗

Emotional eating in overweight, normal weight, and underweight individuals.

Emotional states and situations can affect food intake. We predicted that underweight individuals would eat less and overweight individuals would eat more during negative as well as positive emotional states and situations. Questionnaires to assess eating during emotional states and situations were distributed and collected in person in several major university and public libraries. Ninety questionnaires, representing for each gender the 15 most overweight, the 15 closest to normal weight, and the 15 most underweight, were analyzed. Gender had only minor effects on the eating ratings, and therefore the results are presented for the sexes combined. Underweight individuals reported eating less (P=.000) than both the normal and overweight groups during negative emotional states and situations. More surprisingly, underweight individuals also reported eating more (P=.01) than the other groups during positive emotional states and situations. Thus, part of the prediction was confirmed: the relative undereating by the underweight group, and the relative overeating by the overweight group during negative emotional states and situations. As compared to their usual eating behavior, undereating by underweight individuals during negative emotional states and situations was of a greater magnitude than their own overeating during positive states and situations (P=.01). Undereating by underweight individuals when experiencing negative emotions may contribute to their low body weight.

Journal Article↗

Overweight children overeat after exposure to food cues.

Overweight is becoming more common in children, but we know nearly nothing about the eating behavior of overweight children. Learning theory predicts that overeating follows from learned associations between the smell and taste of palatable food on the one hand and intake on the other hand. It was tested whether overweight children overeat after confrontation to these cues. They indeed failed to regulate food intake after both the exposure to the intense smell of tasty food (without eating it) and after eating a small preload of appetizing food, whereas normal-weight children decreased their intake after both cues. Overweight children are thus more vulnerable to triggers of overeating. Their overeating was not related to psychological factors like mood, body esteem, and a restrained eating style, but it was related to cue-elicited salivation flow. Apart from supporting the cue reactivity model of overeating, the data point to an interesting satiety phenomenon in normal eaters after prolonged and intense smelling palatable food without eating it.

Journal Article↗

To be an immigrant: a risk factor for developing overweight and obesity during childhood and adolescence?

Childhood overweight and obesity, especially among migrant children, are current health problems in several European countries. In the present study the prevalence of overweight and obesity among migrant children from Turkey and the former Yugoslavia was documented and compared with that of Austrian children in Vienna. Anthropometric data from 1,786 children were collected at the ages of 6, 10 and 15 years. Body mass was estimated by means of the body mass index and percentile curves were used to determine weight status. The prevalence of overweight and obesity was found to be significantly higher among migrant children. Children and adolescents from the former Yugoslavia and Turkish girls exhibited especially high rates of overweight and obesity. Biosocial and cultural factors are discussed as causes of these observations.

Adolescent↗

Data from the StEP TWO programme showing the effect on blood pressure and different parameters for obesity in overweight and obese primary school children.

UNLABELLED: Obesity in childhood, which is associated with cardiovascular risk factors such as hypertension, is on the increase. Countermeasures are necessary. In this paper, we present the baseline and final data from the StEP TWO programme, a prospective study to prevent overweight and obesity in primary schools. METHODS: We recorded and calculated, from 1689 children, anthropometric data, including analyses of bioelectric impedance, waist and hip circumferences, body mass index and its standard deviation, and the ratio of waist to hip. Blood pressure was measured after 5 minutes at rest. From the three schools involved in a programme of intervention, 121 children were invited to take part, and 40 (33.1 per cent) completed the programme. The effect was compared with 155 overweight and obese children identified at the 4 control schools. RESULTS: 830 (49.5 per cent) boys and 848 girls (50.5 per cent) took part. Their mean age was 8.2 plus or minus 1.3 years, their height was 1.31 plus or minus 0.09 metres, they weighed 30.0 plus or minus 8.2 kilograms, and their mean index of body mass was 17.1 plus or minus 2.9 kilograms per metre squared. Of the children, 7.3 per cent were obese, 10.4 per cent were overweight, 75.7 per cent had normal weights, and 6.6 per cent were underweight. Resting hypertension was observed in 2.3 per cent of the children. Increased blood pressure was associated with a higher body weight, body mass index, standard deviation score for body mass index, and waist and hip circumferences (each p < 0.001), but not with the ratio of waist to hip. Hypertension at rest was also found in 11.0 per cent of obese children, 4.4 per cent of those who were overweight, 1.2 per cent of those with normal weight, and 1.0 per cent of underweight children (p < 0.001). After the intervention, the increase of the body mass index tended to be lower in those in whom we had intervened (p = 0.069), and in these the decrease of the standard deviation score for body mass index was significantly higher (p = 0.028). Systolic blood pressure was reduced by about 10 millimetres of mercury in those in whom we had intervened (p = 0.002), while there were no changes in the control group. Diastolic blood pressure was lowered by 3 millimetres of mercury, but this was not significant. CONCLUSION: Obese children had the highest values for systolic and diastolic blood pressure. Increased levels of blood pressure are associated with other parameters of obesity, such as the circumference of the waist and hip. Early preventive measurements in childhood are necessary, and appropriate intervention appears to be effective.

Blood Pressure↗

Socioeconomic status, overweight and obesity in prepuberal children: a study in an area of Northern Italy.

The aim of this study was to determine whether socio-economical status (SES) is associated with overweight and obesity in prepuberal children. In an area of North-Western Italy a sample of 1420 children, aged 10-11 years, had his/her height and weight recorded, (overweight and obesity were defined, respectively, as relative body weight > or = 120% and > or = 140%), and parents were requested to compile a questionnaire exploring some demographic and social conditions. 23% of the sample resulted overweight or obese. Prevalence rate ratios (PRR) of overweight and obesity (together) were calculated, adjusting for parents' age, parents' area of birth, and school district. PRR for mother's lowest educational level compared to the highest was 1.59 (95% CI: 1.19-2.13), while for father's education was 1.21 (0.90-1.63). PRRs for 'unemployed' or 'manual' mother compared to 'upper non manual' were respectively 1.83 (1.20-2.79) and 2.20 (1.31-3.68), while for 'unemployed' or 'manual' father were 2.63 (1.97-2.63), and 1.63 (1.27-2.09). The cultural resources of the mother, and the economical resources of the family seem to influence the prevalence of weight gain in prepuberal children. This should be taken into account when planning programs for the prevention or reduction of obesity in children.

Child↗

Overweight and Obesity among secondary school children in Central Italy.

Childhood and adolescent obesity prevalence rates have steadily increased in industrialised countries in the last 20 years. Current rates of obesity range between 6 and 30%. Several studies showed that risk factors for weight gain in school age are strongly linked to low physical activity and family environmental factors (parents' education and job, number of family members, number of hours spent on watching television, etc.). In order to plan a nutritional and health educational programme, a study was conducted on the nutritional status of the school age population of the Province of Frosinone, Central Italy, and family factors that can influence it. Three percentage of the school age population of the Province of Frosinone (2053 students) and their families were randomly sampled from the Province school district database. In each of the 12 recruited schools, a meeting with teachers and students was arranged to discuss aims and methods of research and to collect informed consent by students. Each student was interviewed about physical activity, and underwent the following measurements: height, weight, bicipital, tricipital, sub-scapular and over-iliacal skinfolds, sexual development. Students' parents were asked to answer a questionnaire about family structure, parents' educational level and job, parents' height and weight, presence in the family of pathologies as hypertension or diabetes. One thousand three hundred fifty-seven students (66% of the target population) and 1802 parents (66.5% of the responders' population) agreed to enter the study. Students' age range was 8 years (11-19 years; mean age was 14.9, SD, 2.55). Among them 8.4% were considered obese, with a higher prevalence in male population (9.8%) as compared to female population (6.5%). Of these responders, 21.4% were considered at risk of overweight with no statistical difference due to gender. Statistically significant correlations of teenagers' risk of overweight and obesity with nutritional conditions of parents, mother's educational level and amount of weekly physical activity were observed. Number of children in the family, parents' age and job do not appear to be correlated to obesity or risk of overweight. Our results show that, although the prevalence of obesity in the students population in the Province of Frosinone is comparable to other Italian Provinces and lower than other industrialised countries such as USA, the percentage of students at risk of overweight is particularly high. Main risk factors for developing obesity seem to be linked to parents' nutritional conditions, mother's educational level and children's physical inactivity and this should lead to intensify efforts for preventive interventions both at family level (focused on parents) and at school.

Adolescent↗

Causes and consequences of time perception differences in overweight and normal weight people.

Three experiments considered whether there are differences between overweight and normal weight subjects in time perception which represent the obese subjects' lack of internal responsiveness as well as heightened external reactivity in a noneating setting. In the first study, no time-relevant cues were provided, and overweight subjects were inaccurate in their temporal judgments and showed significantly higher group variability than did normals. In the second study, the effects of differential temporal information generated by interesting and boring cues was considered. The presentation of these time-relevant external cues reduced the judgment variability of the overweight subjects and influenced their perceived passage of time significantly more than normals. The third study examined the influence, on eating behavior, of differences in perceived passage of time as a consequence of manipulating cues for interest or boredom. When bored, overweight subjects perceived time to pass more slowly than did normals and thus ate sooner. Similarly, they delayed eating, judging time to have passed more quickly than it actually had, when they were attending to interesting cues. The implications of a generalized lack of internal sensitivity for a theory about the development and consequences of obesity are discussed.

Attention↗

Familial risk of overweight and obesity in the Canadian population using the WHO/NIH criteria.

OBJECTIVE: To determine the familial risk of overweight and obesity in Canada. RESEARCH METHODS AND PROCEDURES: The sample was comprised of 15,245 participants from 6377 families of the Canada Fitness Survey. The risk of overweight and obesity among spouses and first-degree relatives of individuals classified as underweight, normal weight, pre-obese, or obese (Class I and II) according to the WHO/NIH guidelines for body mass index (BMI) was determined using standardized risk ratios. RESULTS: Spouses and first-degree relatives of underweight individuals have a lower risk of overweight and obesity than the general population. On the other hand, the risk of Class I and Class II obesity (BMI 35 to 39.9 kg/m2) in relatives of Class I obese (BMI 30 to 34.9 kg/m2) individuals was 1.84 (95% CI: 1.27, 2.37) and 1.97 (95% CI: 0.67, 3.25), respectively, in spouses, and 1.44 (95% CI:1.10, 1.78) and 2.05 (95% CI: 1.37, 2.73), respectively in first-degree relatives. Further, the risk of Class II obesity in spouses and first-degree relatives of Class II obese individuals was 2.59 (95% CI: -0.91, 6.09) and 7.07 (95% CI: 1.48, 12.66) times the general population risk, respectively. DISCUSSION: There is significant familial risk of overweight and obesity in the Canadian population using the BMI as an indicator. Comparison of risks among spouses and first-degree relatives suggests that genetic factors may play a role in obesity at more extreme levels (Class II obese) more so than in moderate obesity.

Adolescent↗