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PubMed2002

Behavioral weight control for overweight adolescents initiated in primary care.

OBJECTIVE: This study evaluates the post-treatment and short-term follow-up efficacy of, as well as participant satisfaction for, a 4-month behavioral weight control program for overweight adolescents initiated in a primary care setting and extended through telephone and mail contact. RESEARCH METHODS AND PROCEDURES: 44 overweight adolescents were randomly assigned to either a multiple component behavioral weight control intervention (Healthy Habits [HH]; n = 23) or a single session of physician weight counseling (typical care [TC]; n = 21). Weight, height, dietary intake, physical activity, sedentary behavior, and problematic weight-related and eating behaviors and beliefs were assessed before treatment, after the 4-month treatment, and at 3-month follow-up. Participant satisfaction and behavioral skills use were measured. RESULTS: HH adolescents evidenced better change in body mass index z scores to post-treatment than TC adolescents. Body mass index z scores changed similarly in the conditions from post-treatment through follow-up. Behavioral skills use was higher among HH than TC adolescents, and higher behavioral skills use was related to better weight outcome. Energy intake, percentage of calories from fat, physical activity, sedentary behavior, and problematic weight-related or eating behaviors/beliefs did not differ by condition or significantly change over time independent of condition. The behavioral intervention evidenced good feasibility and participant satisfaction. DISCUSSION: A telephone- and mail-based behavioral intervention initiated in primary care resulted in better weight control efficacy relative to care typically provided to overweight adolescents. Innovative and efficacious weight control intervention delivery approaches could decrease provider and participant burden and improve dissemination to the increasing population of overweight youth.

Adolescent↗
PubMed2004

Dramatic rise in overweight and obesity in adult filipino women and risk of hypertension.

OBJECTIVE: To assess trends in BMI of adult Filipino women over a 16-year period of rapid socioeconomic change; to identify factors associated with those trends; and to estimate the risk of hypertension associated with overweight, obesity, and high waist-to-hip ratio (WHR). RESEARCH METHODS AND PROCEDURES: Women from randomly selected urban and rural communities of Metro Cebu, Philippines were recruited during a 1983 to 1984 index pregnancy, then followed prospectively for 16 years. Overweight and obesity were defined using BMI cut-off points of 25 and 30, respectively. The analysis sample included women 15 to 45 years of age when measured 4 months postpartum. Weight change in subsequent intervals from 1985 to 1999 was modeled using linear regression. The relationship of BMI and WHR to risk of hypertension in the last survey was modeled using logistic regression. RESULTS: The prevalence of overweight and obesity combined increased nearly 6-fold from approximately 6% in 1983 to 1984 to 35% in 1998 to 1999. Weight gain was positively associated with urban residence, improved socioeconomic status, fewer pregnancies and months of lactation, and more away-from-home work hours. Risk of hypertension was independently elevated by high WHR and overweight/obesity. DISCUSSION: The dramatic trend of increasing overweight and obesity in this sample of women represents a serious health concern, especially in light of the strong association of excess weight, particularly in the truncal region, to risk of hypertension.

Adolescent↗
PubMed2004

Major increase in prevalence of overweight and obesity between 1987 and 2001 among Danish adults.

OBJECTIVE: The aim of the study was to examine the secular trends in the prevalence of obesity (BMI >or= 30.0 kg/m(2)) and overweight (25.0 <or= BMI < 30.0 kg/m(2)) in Danish adults between 1987 and 2001. RESEARCH METHODS AND PROCEDURES: The study included self-reported weight and height of 10,094 men and 9897 women 16 to 98 years old, collected in a series of seven independent cross-sectional surveys. Prevalence and changes in prevalence of obesity and overweight stratified by sex and age groups were determined. RESULTS: The prevalence of obesity more than doubled between 1987 and 2001, in men from 5.6% to 11.8% [odds ratio (OR) = 2.3, 95% confidence interval (CI) = 1.9 to 2.8, p < 0.0001] and in women from 5.4% to 12.5% (OR = 2.6, 95% CI = 2.1 to 3.2, p < 0.0001), with the largest increase among the 16- to 29-year-old subjects (men, from 0.8% to 7.5%, OR = 10.2, 95% CI = 4.1 to 25.3, p < 0.0001; women, from 1.4% to 9.0% OR = 7.0, 95% CI = 3.5 to 14.1, p < 0.0001). Between 1987 and 2001, the prevalence of overweight increased from 34% to 40% in men and from 17% to 27% in women. DISCUSSION: The prevalence of overweight and obesity in Denmark has increased substantially between 1987 and 2001, particularly among young adults, a development that resembles that of other countries. There is clearly a need for early preventive efforts in childhood to limit the number of obesity-related complications in young adults.

Adolescent↗
PubMed2004

The high prevalence of overweight and obesity in Mexican children.

OBJECTIVE: To establish the prevalence of overweight and obesity in Mexican children 10 to 17 years of age according to the percentiles from both the Centers of Disease Control and Prevention (CDC) and the International Obesity Task Force (IOTF). RESEARCH METHODS AND PROCEDURES: Heights and weights were measured in children from nationally representative, randomly chosen households in the Mexican National Health Survey 2000. The study population consisted of 7862 boys and 8947 girls, 10 to 17 years of age. Measurements used were the percentage of children in the corresponding BMI categories for overweight and obesity specified by the CDC and the IOTF BMI percentiles. RESULTS: The children were short, with mean Z scores for height by age varying from - 0.62 +/- 1.26 to -1.12 +/- 1.06 in boys and from -0.45 +/- 1.25 to -1.19 +/- 1.12 in girls. CDC-based overweight prevalences varied by age from 10.8% to 16.1% in boys and 14.3% to 19.1% in girls, with obesity prevalences from 9.2% to 14.7% in boys and 6.8% to 10.6% in girls; these prevalences did not relate to stunting. IOTF-based excess weight prevalences were similar, with higher overweight rates (boys, 15.4% to 18.8%; girls, 18.4% to 22.3%) but lower obesity rates (boys, 6.1% to 9%; girls, 5.9% to 8.2%). DISCUSSION: Mexican children have one-half the overweight/obesity prevalences of U.S. Mexican-American children; however, there are higher rates in Northern Mexico, which is closer to the U.S. These escalating rates of excess weight demand new prevention, as well as management, policies.

Adolescent↗
PubMed2004

Prevalence of overweight and obesity in elderly people in Spain.

OBJECTIVE: To estimate the prevalence of obesity and overweight in the older adult population in Spain by sex, age, and educational level. RESEARCH METHODS AND PROCEDURES: A cross-sectional study was carried out in 2001 in a sample of 4009 persons representative of the noninstitutionalized population > or = 60 years of age. Anthropometric measurements (BMI and waist circumference) were obtained using standardized techniques and equipment. Overweight was considered at a BMI of 25 to 29.9 kg/m2 and obesity at a BMI of > or = 30 kg/m2. Central obesity was considered at a waist circumference of >102 cm in men and >88 cm in women. RESULTS: The mean BMI was 28.2 kg/m2 in men and 29.3 kg/m2 in women. The prevalence of overweight and obesity in men was 49% and 31.5%, respectively. The corresponding percentages in women were 39.8% and 40.8%. The prevalence of obesity was higher in persons with no education than in those with third level education (i.e., university studies), especially among women (41.8% vs. 17.5%). The prevalence of central obesity was 48.4% in men and 78.4% in women. Differences by educational level were seen in only women, in whom the prevalence of central obesity was 80.9% in those with no education and 59% in those with third-level education. DISCUSSION: The prevalence of overweight and obesity in the Spanish adult elderly population is very high. Some other populations show similar prevalences, especially in Mediterranean countries. Socioeconomic conditions in Spain during the years these cohorts were born may partly explain the high-frequency of obesity.

Aged↗
PubMed2006

The feet of overweight and obese young children: are they flat or fat?

OBJECTIVE: The purpose of this study was to determine whether the flat feet displayed by young obese and overweight children are attributable to the presence of a thicker midfoot plantar fat pad or a lowering of the longitudinal arch relative to that in non-overweight children. RESEARCH METHODS AND PROCEDURES: Foot anthropometry, an arch index derived from plantar footprints, and midfoot plantar fat pad thickness measured by ultrasound were obtained for 19 overweight/obese preschool children (mean age, 4.3 +/- 0.9 years; mean height, 1.07 +/- 0.1 m; mean BMI, 18.6 +/- 1.2 kg/m(2)) and 19 non-overweight children matched for age, height, and sex (mean age, 4.3 +/- 0.7 years; mean height, 1.05 +/- 0.1 m; mean BMI, 15.7 +/- 0.7 kg/m(2)). RESULTS: Independent t tests revealed no significant between-subject group differences (p = 0.39) in the thickness of the midfoot plantar fat pad. However, the overweight/obese children had a significantly lower plantar arch height (0.9 +/- 0.3 cm) than their non-overweight counterparts (1.1 +/- 0.2 cm; p = 0.04). DISCUSSION: The lower plantar arch height found in the overweight/obese children suggests that the flatter feet characteristic of overweight/obese preschool children may be caused by structural changes in their foot anatomy. It is postulated that these structural changes, which may adversely affect the functional capacity of the medial longitudinal arch, might be exacerbated if excess weight bearing continues throughout childhood and into adulthood.

Body Height↗
PubMed2006

Aerobic exercise and snoring in overweight children: a randomized controlled trial.

OBJECTIVE: To determine whether regular aerobic exercise improves symptoms of sleep-disordered breathing in overweight children, as has been shown in adults. RESEARCH METHODS AND PROCEDURES: Healthy but overweight (BMI > or =85th percentile) 7- to 11-year-old children were recruited from public schools for a randomized controlled trial of exercise effects on diabetes risk. One hundred children (53% black, 41% male) were randomly assigned to a control group (n = 27), a low-dose exercise group (n = 36), or a high-dose exercise group (n = 37). Exercise groups underwent a 13 +/- 1.5 week after-school program that provided 20 or 40 minutes per day of aerobic exercise (average heart rate = 164 beats per minute). Group changes were compared on BMI z-score and four Pediatric Sleep Questionnaire scales: Snoring, Sleepiness, Behavior, and a summary scale, Sleep-Related Breathing Disorders. Analyses were adjusted for age. RESULTS: Both the high-dose and low-dose exercise groups improved more than the control group on the Snoring scale. The high-dose exercise group improved more than the low-dose exercise and control groups on the summary scale. No group differences were found for changes on Sleepiness, Behavior, or BMI z-score. At baseline, 25% screened positive for sleep-disordered breathing; half improved to a negative screen after intervention. DISCUSSION: Regular vigorous exercise can improve snoring, a symptom of sleep-disordered breathing, in overweight children. Aerobic exercise programs may be valuable for prevention and treatment of sleep-disordered breathing in overweight children.

Body Mass Index↗
PubMed2000

A national study of the prevalence of overweight and obesity in 6-12 y-old Swiss children: body mass index, body-weight perceptions and goals.

OBJECTIVES: To estimate the prevalence of overweight and obesity in Swiss children and to obtain information on weight perceptions and weight control practices in this population. DESIGN: Cross-sectional, three-stage, probability-proportionate-to-size cluster sampling. SETTING: Middle schools throughout Switzerland. SUBJECTS: A representative national sample of 595 6-12 y-old schoolchildren. INTERVENTION: Measurement of weight and height; interview on weight perceptions and weight control practices. RESULTS: Body mass index (BMI) was calculated and used as an indicator of overweight. The BMIs of the Swiss children were compared with US, UK, French and Swiss reference data. Depending on which reference data were used, the prevalence of obesity varied between 9.7 and 16.1% and the prevalence of overweight varied between 21.7 and 34.2%. Girls were significantly more likely to consider themselves too fat (26% and 15%, respectively) and to report currently trying to lose weight (30% and 18%, respectively) compared to boys (P<0.05). CONCLUSIONS: The prevalence of overweight in Swiss children, and its attendant health and social consequences, are important public health concerns. SPONSORSHIP: The Swiss Foundation for Nutrition Research, Zürich, Switzerland.

Body Image↗
PubMed2004

Validation of the Dutch Eating Behaviour Questionnaire parent version (DEBQ-P) in the Italian population: a screening tool to detect differences in eating behaviour among obese, overweight and normal-weight preadolescents.

OBJECTIVE: To validate the Dutch Eating Behaviour Questionnaire Parent version (DEBQ-P) in the Italian population and investigate the differences in eating behaviour among Italian normal-weight, overweight and obese preadolescents. DESIGN: A cross-sectional validation study. Participants were measured and the approved translation of the questionnaire was administered to their parents. SETTING: : Three school communities in the province of Bergamo, Northern Italy. SUBJECTS: A total of 312 preadolescents (mean age 12.9 y; s.d. 0.8, both sexes) from three secondary schools of the province of Bergamo, Northern Italy, and their parents were invited to participate to the study. Informed written consent was obtained from each subject and their parents. Students were measured and their parents filled in the approved translation of the DEBQ-P. Recruitment was opportunistic and school based. RESULTS: Factor and internal consistency analysis confirmed the factor structure of the DEBQ-P and the high internal consistency of its three scales. Variance analysis showed that eating behaviour of Italian normal-weight, overweight and obese preadolescents differs significantly only in regards to the 'restrained eating' scale (F 19.29, P < 0.001), with overweight and obese scoring higher. CONCLUSIONS: The DEBQ-P can be used for screening projects regarding eating behaviour in the Italian population. The association between restrained eating and weight status was confirmed for both sexes, but the relationship between external eating and emotional overeating and overweight requires further exploration.

Adolescent↗
PubMed2006

Meal glycaemic load of normal-weight and overweight Hong Kong children.

OBJECTIVE: To describe the pattern of meal glycaemic load of children in Hong Kong and to determine whether the meal glycaemic load is associated with childhood overweight. METHOD: Dietary records (3-day) of 316 Hong Kong children aged 6-7 years were collected. Glycaemic load was calculated from the estimated weight (WT), carbohydrate content (%CHO) and glycaemic index (GI) of each food taken using the equation: (% CHO x GI x WT/100). The meal glycaemic load was then the sum of the glycaemic loads of all food taken in each meal. Logistic regression analyses were used to compare the average meal glycaemic load (of breakfast, lunch and dinner) and other dietary parameters between overweight children and normal-weight children. RESULTS: Breakfast, lunch, dinner and snacks provided, respectively, 17, 29, 29 and 25% of the total glycaemic load in a day. White rice (excluding congee (rice porridge) and glutinous rice) contributed almost half of the total glycaemic load. Adjusted logistic regression showed that the meal glycaemic load was not significantly associated with childhood overweight after adjusting for parental obesity, birth weight, sleeping duration, mean energy intake and paternal smoking. CONCLUSION: Meal glycaemic load calculated from current diet was not an independent factor associated with childhood overweight in children aged 6-7 years. Our data suggested that modifying the type of rice/staple consumed and choosing low-GI snacks could have a major influence on the total meal glycaemic load of young Hong Kong children.

Case-Control Studies↗
PubMed2006

Validity of overweight and obesity in a nation based on self-report versus measurement device data.

OBJECTIVE: To analyze overweight and obesity in a nation by self-report (SR) data and by data about the target person provided via other household members compared to measurement devices (MD). The magnitude of hypothesized under-reporting by the SR data should be estimated with adjustment for age, gender, and education. DESIGN: Two cross-sectional studies, nationally representative health examination surveys (response rates: 61.4 and 73.2%, respectively). SETTING: Adult general population of Germany aged 20-79 years. SUBJECTS: Sample 1 included 6806 residents. Samples 2 (n=98 673) and 3 (n=34 960) included residents in the second survey. MEASUREMENTS: In sample 1 MD data were collected, in sample 2 SR data were collected, and in sample 3 body weight and height information was provided from another household member living together with the target person. RESULTS: MD data revealed higher proportions of overweight and obesity compared to SR. Among women with body mass index (BMI) 35.00 or higher, the odds ratio (OR) was 3.9 (95% confidence interval, CI, 3.2-4.7), and among men 2.8 (CI, 2.2-3.6) for MD versus SR. Data from other household members also revealed higher proportions of overweight and obesity than SR (OR for BMI 35.00 or higher 2.1, CI, 1.7-2.5, for data from other household members versus SR in women and OR 1.3, CI, 1.1-1.5, in men). CONCLUSIONS: MD data should be used when providing proportions of overweight and obesity in a nation such as Germany.

Adult↗
PubMed1997

Plasma beta-endorphin and insulin concentrations in relation to body fat and nutritional parameters in overweight and obese prepubertal children.

OBJECTIVE: To investigate the relationship between plasma beta-endorphin (beta-end) and insulin concentrations and 1) body fat, and 2) nutritional parameters in overweight or obese prepubertal children. DESIGN: Cross-sectional study on plasma beta-end and insulin concentrations, body fat, indirect parameters of appetite namely daily energy and macronutrient intake. SUBJECTS: 143 (67 boys and 76 girls) overweight or obese children (group I) and 48 (27 boys and 21 girls) healthy children with normal parameters of somatic development (group II). Age: 5.8-9.6 y. MEASUREMENTS: Weight, height and subcutaneous skinfold thicknesses, plasma beta-end and insulin concentrations, diet history for energy and macronutrient intake. RESULTS: Group I was characterised by significantly higher average concentrations of beta-end and insulin in comparison to the control group. The analysis of these concentrations in the subgroups in relation to the percentage of body fat indicates that beta-end concentrations increased more than insulin concentrations with increasing fatness. A significantly positive correlation between beta-end and insulin levels was only noted in group I. Also, only in this group was there a significant positive correlation between beta-end levels and energy and macronutrient intake. In both groups the percentage of energy intake which was fat, correlated positively with beta-end concentrations. Furthermore energy and fat intakes showed a significant positive correlation with insulin levels in both groups. CONCLUSIONS: beta-endorphin and insulin concentrations in overweight and obese prepubertal children are not only higher than in non-obese children but also are positively correlated with each other and with the percentage of body fat. The relationship between plasma beta-end levels and food intake shows that the beta-end level may be able to be used as an indicator of appetite in overweight and obese prepubertal children whose food intake is not restricted.

Adipose Tissue↗
PubMed1998

Overweight and obesity in the United States: prevalence and trends, 1960-1994.

OBJECTIVE: To describe the prevalence of, and trends in, overweight and obesity in the US population using standardized international definitions. DESIGN: Successive cross-sectional nationally representative surveys, including the National Health Examination Survey (NHES I; 1960-62) and the National Health and Nutrition Examination Surveys (NHANES I: 1971-1974; NHANES II: 1976-1980; NHANES III: 1988-94). Body mass index (BMI:kg/m2) was calculated from measured weight and height. Overweight and obesity were defined as follows: Overweight (BMI > or = 25.0); pre-obese (BMI 25.0-29.9), class I obesity (BMI 30.0-34.9), class II obesity (BMI 35.0-39.9), and class III obesity (BMI > or = 40.0). RESULTS: For men and women aged 20-74 y, the age-adjusted prevalence of BMI 25.0-29.9 showed little or no increase over time (NHES I: 30.5%, NHANES I: 32.0%, NHANES II: 31.5% and NHANES III: 32.0%) but the prevalence of obesity (BMI > or = 30.0) showed a large increase between NHANES II and NHANES III (NHES I: 12.8%; NHANES I, 14.1%; NHANES II, 14.5% and NHANES III, 22.5%). Trends were generally similar for all age, gender and race-ethnic groups. The crude prevalence of overweight and obesity (BMI >> 25.0) for age > or = 20 y was 59.4% for men, 50.7% for women and 54.9% overall. The prevalence of class III obesity (BMI > or = 40.0) exceeded 10% for non-Hispanic black women aged 40-59 y. CONCLUSIONS: Between 1976-80 and 1988-94, the prevalence of obesity (BMI > or= 30.0) increased markedly in the US. These findings are in agreement with trends seen elsewhere in the world. Use of standardized definitions facilitates international comparisons.

Adult↗
PubMed2000

Overweight and obese children have low bone mass and area for their weight.

OBJECTIVES: To determine whether girls and boys categorized from body mass index (BMI) values as overweight or obese for their age have lower bone mineral content (BMC) or lower bone area in relation to total body weight than children of normal adiposity. DESIGN: Cross-sectional study in a university bone research unit. SUBJECTS: Two hundred girls and 136 boys aged 3-19 y recruited from the general population by advertisement. MEASUREMENTS: Total body BMC (g) and bone area (cm2) measured by dual energy X-ray absorptiometry (DXA) in relation to body weight (kg), lean tissue mass (kg) and fat mass (kg) in boys and girls of three different BMI percentile groupings: normal weight (BMI<85th percentile); overweight (85 to 94th BMI percentile); obese (> or =95th BMI percentile). RESULTS: Obese children had higher BMC, bone area, and fat mass for chronological age than those of normal body weight (P<0.001). In spite of this the observed values for age-adjusted total body BMC and bone area relative to body weight were each lower than predicted values, in both overweight and obese children (2.5-10.1% less, P<0.05) than in children of lower adiposity. CONCLUSION: In overweight and obese boys and girls there is a mismatch between body weight and bone development during growth: their bone mass and bone area are low for their body weight.

Adipose Tissue↗
PubMed2000

Trends in body mass index and overweight prevalence among children and adolescents in the region of Aragón (Spain) from 1985 to 1995.

OBJECTIVE: To analyse trends in body mass index (BMI) and overweight prevalence for children and adolescents in the region of Aragón (Spain), from 1985 to 1995. DESIGN: Nine cross-sectional examinations of schoolchildren conducted yearly from 1985 to 1995. SUBJECTS: A total of 90,997 children (45,970 males and 45,027 females) in the first school year (6-7 y of age); 106,284 scholars (52,772 males and 53,512 females) in the last school year (13-14 y of age). MEASUREMENTS: Heights and weights were measured and BMI (kg/m2) was calculated. RESULTS: We observed a trend to higher BMI values across the surveys, by sex and age. The secular trends in BMI showed the largest increases at the upper ends of the distribution, especially in males. In children in the first school year, prevalences of overweight were higher in females than in males (P<0. 001); however, in adolescents in the last school year, prevalences were higher in males than in females (P<0.001). We observed a significant trend in overweight prevalence from 1985 to 1995 in children from the first school year (P=0.0183, in males and P=0.0168, in females). In children in the last school year there was only a significant trend in males (P<0.0001). CONCLUSION: Significant changes in BMI occurred in the population studied during the period 1985-1995, but these changes differ by age and sex. The increasing skewness of BMI in the upper percentiles of the population, especially in boys, suggests that, not only is the pediatric population getting fatter, but the fatter members are becoming more obese. Our results also show a striking increase in the prevalence of overweight children in the region of Aragón (Spain) during the 1985-1995 decade.

Adolescent↗
PubMed2001

How does maturity adjustment influence the estimates of overweight prevalence in adolescents from different countries using an international reference?

OBJECTIVE: To investigate the effect of adjusting for differences in timing of maturation when assessing overweight prevalence among adolescents in different populations by using an international reference recommended by the WHO. DESIGN: Cross-sectional, comparative study in three large samples from China, Russia and the United States. SUBJECTS: A total of 2014 American, 1316 Chinese and 744 Russian non-pregnant adolescent girls aged 10-18 y. MEASUREMENTS: Data on body weight, height, menarcheal status and age at menarche (AAM) were collected. Overweight was defined as age-sex-specific body mass index (BMI) greater than the 85th percentiles from the US NHANES I data (collected in 1971-1974), which is recommended by the WHO for international use. Maturity adjustments were made using population differences in median age at menarche (MAM), calculated using the status quo method. MAM was 12.8 in the WHO reference population, 13.7 in China, 13.2 in Russia, and 12.6 in the US (NHANES III data). Maturation age-matched BMI cut-offs were used to compute the adjusted prevalence. We also compared population-adjusted results with individually adjusted results in post-menarcheal American girls (based on each girl's AAM) and in pre-menarcheal girls (based on breast stage). RESULTS: Maturity adjustment increased the estimated prevalence of overweight in China and Russia where girls mature later than the reference population, and decreased it in the NHANES III sample. The unadjusted and adjusted prevalence was 3.5 vs 4.9% in the China sample, 8.3 vs 9.7% in Russia, and 29.2 vs 28.0% in the US. The adjustment had a greater effect in younger adolescent girls (10-13 y) than in older girls (14-18 y). In general, we found a good agreement between the population and individual adjustments. Viewing the individual adjustment as a 'gold standard', the population method has a high sensitivity and specificity. CONCLUSION: This is the first study to assess WHO recommendations for maturation adjustment when estimating overweight prevalence in different countries. While the overall effects of adjustment are small, maturation status should be considered, particularly when assessing young adolescents, and populations with markedly different timing of maturation relative to the international reference. Population-based adjustment is useful and practical in situations where individual maturity data are not available.

Adolescent↗
PubMed2001

Smoking and weight loss attempts in overweight and normal-weight adolescents.

AIM: To explore the relationship between smoking and dieting in a cross-sectional nationally representative sample of young adolescents. METHODS: Smoking was assessed by serum cotinine concentrations in 1132 adolescents aged 12-18 y enrolled in the NHANES III study. Information on adolescents' weight loss attempts were obtained by questionnaire. Normal weight was defined as a body mass index (BMI) less than the 85th percentile for age and gender. Overweight was defined as a BMI equal to or greater than the 85th percentile for age and gender. Nutritional intake was assessed with a 24 h recall and food frequency questionnaire. RESULTS: There was a two-fold increase in smoking among normal-weight adolescent girls who reported trying to lose weight (23.7% vs 12.6%, P<0.01). In contrast, prevalence of smoking was similar among overweight adolescent girls who tried to lose weight compared to those who did not (15.8% vs 14.1%, P=0.76). Similar trends were observed in boys. However, overweight boys who were trying to lose weight were less likely to smoke than overweight boys who were not trying to lose weight (9.8% vs 24.5%, P<0.05). There were no differences in body weight, BMI, caloric intake or fat intake among smokers and non-smokers. However, smokers reported eating less fruit and vegetables compared to non-smokers, and were over five times more likely to drink alcohol compared to non-smokers (odds ratio: > or =1x/month, 5.28 (3.82-7.28), > or =4x/month, 5.29 (3.58-7.82). CONCLUSION: Tobacco use is common among normal weight adolescents trying to lose weight. Tobacco use is also associated with a cluster of other unhealthy dietary practices in adolescents.

Adolescent↗
PubMed2003

Greater prevalence of iron deficiency in overweight and obese children and adolescents.

OBJECTIVE: To assess whether overweight children and adolescents, who often have poor dietary habits, are at increased risk of iron deficiency (ID). METHODS: The study sample included 321 children and adolescents followed in two endocrine centers in Israel between 1999 and 2001. The subjects were divided into three groups on the basis of body mass index (BMI) for age and gender as follows: group 1-BMI below 85th percentile (normal weight); group 2-BMI above 85th, but below 97th percentile (overweight); and group 3-BMI above 97th percentile (obese). ID was defined as iron levels <8 micromol/l (45 mcg/dl), and iron-deficiency anemia (IDA) was defined as ID and hemoglobin level below 2 standard deviation score (SDS) for the mean for age and gender. RESULTS: Iron levels below 8 micromol/l (45 mcg/dl) were noted in 38.8% of the obese children and 12.1% of the overweight children, compared with 4.4% of the normal-weight group (P<0.001). There was a significant negative correlation of low iron levels with BMI SDS (r=-0.44, P<0.001), but not with age or gender. Among the children with ID, 26.6% also had IDA. Groups 1, 2, and 3 accounted for 6.7%, 35%, and 58.3% of the children with IDA, respectively. CONCLUSIONS: ID is common in overweight and obese children. A significantly greater proportion of obese than normal-weight children have IDA. Insufficient dietary intake of iron, whether absolute or relative to body mass, and increased iron needs may be a result of unbalanced nutrition or repeated short-term restrictive diets. Because of potentially harmful effects of ID, obese children should be routinely screened and treated as necessary.

Adolescent↗