Interventions for treating obesity in children (Review)

Childhood obesity affects both the physical and psychosocial health of children and may put them at risk of ill health as adults. The number of obese children in developed countries is increasing dramatically. There are many different lifestyle change programmes to help parents and children control their weight. Although 18 research studies were found, most of these were very small studies and so evidence from them is limited. In conclusion, there is a limited amount of quality data on the effects of programs to treat childhood obesity, and as such no conclusions can be drawn with confidence.

Modifiable risk factors for overweight and obesity in children and adolescents from São Paulo, Brazil

Background: Brazil is currently experiencing a nutrition transition: the displacement of traditional diets with foods high in saturated fat, sodium, and cholesterol and an increase in sedentary lifestyles. Despite these trends, our understanding of child obesity in Brazil is limited. Thus, the aims of this study were (1) to investigate the current prevalence of overweight and obesity in a large sample of children and adolescents living in São Paulo, Brazil, and (2) to identify the lifestyle behaviors associated with an increased risk of obesity in young Brazilians.Methods: A total of 3,397 children and adolescents (1,596 male) aged 7-18 years were randomly selected from 22 schools in São Paulo, Brazil. Participants were classified as normal weight, overweight, or obese based on international age-and sex-specific body mass index thresholds. Selected sociodemographic, physical activity, and nutrition behaviors were assessed via questionnaire.Results: Overall, 19.4% of boys and 16.1% of girls were overweight while 8.9% and 4.3% were obese. Two-way analysis of variance revealed that the prevalence of overweight and obesity was significantly higher in boys and in younger children when compared to girls and older children, respectively (P < 0.05 for both). Logistic regression analysis revealed that overweight was associated with more computer usage, parental encouragement to be active, and light soft drink consumption after controlling for differences in sex, age, and parental education (P < 0.05 for all). Conversely, overweight was associated with less active transport to school, eating before sleep, and consumption of breakfast, full-sugar soft drinks, fried food and confectionery (P < 0.05 for all).Conclusions: Our results show that obesity in São Paulo children and adolescents has reached a level equivalent to that seen in many developed countries. We have also identified three key modifiable factors related to obesity that may be appropriate targets for future intervention in Brazilian youth: transport mode to school, computer usage, and breakfast consumption.

Overweight and obesity in children: known facts and new trends

The prevalence of overweight and obesity in children is increasing. A growing number of children are thus suffering from complications of obesity. Contributing factors can be found on an individual level as well as in the familial and social environment of affected children. Currently there is no single evidence-based treatment strategy available. Studies from family practice are scarce. Multimodal, long-term, easily accessible treatments as offered in family practice are promising and likely to be cost-effective. The sustainability of these changes in behavior still needs to be demonstrated.

Asthma and obesity in children: current evidence and potential systems biology approaches.

Both obesity and asthma are highly prevalent, complex diseases modified by multiple factors. Genetic, developmental, lung mechanical, immunological and behavioural factors have all been suggested as playing a causal role between the two entities; however, their complex mechanistic interactions are still poorly understood and evidence of causality in children remains scant. Equally lacking is evidence of effective treatment strategies, despite the fact that imbalances at vulnerable phases in childhood can impact long-term health. This review is targeted at both clinicians frequently faced with the dilemma of how to investigate and treat the obese asthmatic child and researchers interested in the topic. Highlighting the breadth of the spectrum of factors involved, this review collates evidence regarding the investigation and treatment of asthma in obese children, particularly in comparison with current approaches in 'difficult-to-treat' childhood asthma. Finally, the authors propose hypotheses for future research from a systems-based perspective.

Distortion of self-image: risk factor for obesity in children and teenagers

Introduction: Self-image is important in the behaviour and lifestyle of children and adolescents. Analysing the self-image they have and the factors that might influence their distortion, can be used to prevent problems of obesity and anorexia. The main objective of present publication was to analyse the risk factors that may contribute to self-image distortion. Material and Methods: A descriptive survey study was conducted among 659 children and adolescents in two social classes (low and medium-high), measuring height and weight, calculating BMI percentile for age and gender. Body image and self-perception were registered. Results: The percentage of overweight-obesity is higher in scholars (41.8% boys, 28.7% girls) than in adolescents (30.1% and 22.2% respectively), with no difference between socioeconomic classes. The multinomial logistic regression analysis gives a risk of believing thinner higher (p=0.000) among boys OR=2.9(95%CI:1.43-3.37), school (p=0.000) OR=2.42(95%CI:1.56-3.76) and much lower (p=0.000) between normally nourished OR=0.08(95%CI:0.05-0.13), with no differences according to socioeconomic status. The risk of believing fatter is lower (p=0.000) between boys OR=0.28(95%CI:0.14-0.57), school(p=0.072) OR=0.54(95%CI:0.27-1.6), and much higher among underweight (p=0.000) OR=9x108(95% CI:4x108-19x108). Conclusions: Are risk factors of believing thinner: males, being in a group of schoolchildren and overweight-obesity. Conversely, are risk factors of believing fatter: females, teen and above all, be thin.

Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: the electronic games to aid motivation to exercise (eGAME) study

BACKGROUND: Childhood obesity has reached epidemic proportions in developed countries. Sedentary screen-based activities such as video gaming are thought to displace active behaviors and are independently associated with obesity. Active video games, where players physically interact with images onscreen, may have utility as a novel intervention to increase physical activity and improve body composition in children. The aim of the Electronic Games to Aid Motivation to Exercise (eGAME) study is to determine the effects of an active video game intervention over 6 months on: body mass index (BMI), percent body fat, waist circumference, cardio-respiratory fitness, and physical activity levels in overweight children.

METHODS/DESIGN: Three hundred and thirty participants aged 10-14 years will be randomized to receive either an active video game upgrade package or to a control group (no intervention).

DISCUSSION: An overview of the eGAME study is presented, providing an example of a large, pragmatic randomized controlled trial in a community setting. Reflection is offered on key issues encountered during the course of the study. In particular, investigation into the feasibility of the proposed intervention, as well as robust testing of proposed study procedures is a critical step prior to implementation of a large-scale trial.

Dietary sodium intake and overweight and obesity in children and adults: a protocol for a systematic review and meta-analysis.

BACKGROUND: Overweight and obesity in children and adults is a major public health concern. Emerging evidence suggests dietary sodium intake may be associated with obesity. This systematic review and meta-analysis will aim to (i) assess the relation between dietary sodium intake and measures of adiposity in children and adults and (ii) examine the relation between sodium intake and sugar-sweetened beverage (SSB) consumption, which is a known risk factor for obesity. METHODS/DESIGN: An electronic search will be conducted using Medline Complete, CINAHL, Scopus, Embase and Cochrane central register of controlled trials (CENTRAL). The search strategy will identify published peer-reviewed articles that report on dietary sodium and either a marker of adiposity or SSB consumption. Only human studies (ages >1 year) in English will be included, and no limits will be placed on publication date. No restrictions will be placed on the method of sodium intake assessment. Cross-sectional, prospective studies, and randomised controlled trials with a duration of ≥ 3 months will be included. Studies with participants with renal disease, cancer, type 1 diabetes or heart failure or who are pregnant will be excluded. To assess the quality of studies, the Cochrane's Collaboration tool for assessing risk of bias in randomised trials will be used for randomised controlled trials (RCTs), and the modified Newcastle-Ottawa Scale will be used for cross-sectional and prospective studies. Meta-analysis will be used to assess the relation of sodium intake with two primary outcomes: (i) BMI and body weight in adults and BMI z-score in children and (ii) weight category (i.e. healthy weight vs. overweight/obese). For any outcomes in which meta-analysis is not possible, we will present data as a systematic review. Findings will be grouped and reported separately for children and adolescents (ages 1-17 years) and adults (ages >18 years). DISCUSSION: This review and meta-analysis will provide insight into the relation between dietary sodium intake and overweight and obesity. This information can be used to inform public health policies which target population sodium consumption.

The journey towards comprehensive school health within an aboriginal community

The purpose of this research is to describe the journey towards Comprehensive School Health at two Aboriginal elementary schools. An advocate and a healthy schools committee were identified at both schools and were responsible for developing initiatives to create a healthy school community. A case study was used to gather an in-depth understanding of Comprehensive School Health for the two schools involved. As a researcher, I functioned within the role of a participantobserver, as I was actively involved in the programs and initiatives completed in both schools. The research process included: the pilot study, ethics clearance and distribution of letters of invitation and consent forms. Data collection included 16 semi-structured, guided interviews with principals, teachers, and stupents. Participant observations included sites of the gymnasium, classroom, playgrounds, school environments, bulletin boards as well as artifact analysis of decuments such as school newsletters, physical education schedules and school handbooks. The interviews were transcribed and coded using an inductive approach which involves finding patterns, themes and categories from the data (patton, 2002). Research questions guided the findings as physical activity, physical education, nutrition and transportation were discussed. Themes developed t~rough coding were teacherstudent interactions, cultural traditions, time constraints and professional development and were discussed using a Comprehensive School Health framework.