Parent-reported health status of overweight and obese Australian primary school children: a cross-sectional population survey

Introduction: Childhood overweight/obesity is associated with poor physical and psychosocial health in clinical samples. However, there is little information on the health status of overweight and obese children in the community, who now represent a large proportion of the child population. We examined parent-reported child health and well-being and parent concern about child weight by body mass index (BMI) category in a population sample of primary school children.

Design: A stratified two-stage random cluster sample of 24 primary schools representative of the state of Victoria, Australia.

Measures: BMI (weight/height2) transformed to normalised Z-scores using the 1990 UK Growth Reference; the Child Health Questionnaire (CHQ), a 13-scale 50-item parent-completed measure of health and well-being; parent self-reported height and weight; parent concern about child's weight.

Results: Data were available for 2863 children aged 5-13 y (50.5% male), of whom 17% were overweight and 5.7% obese. Using logistic regression analyses with 'normal weight' as the referent category, obese boys were at greater risk of poor health (ie <15th centile) on seven of the 12 CHQ scales: Physical Functioning (odds ratio (OR) 2.8), Bodily Pain (OR 1.8), General Health (OR 3.5), Mental Health (OR 2.8), Self Esteem (OR 1.8), Parent Impact¾Emotional (OR 1.7) and Parent Impact¾Time (OR 1.9). Obese girls were at greater risk of poor health on only two scales: General Health (OR 2.1) and Self Esteem (OR 1.8). Forty-two percent of parents with obese children and 81% with overweight children did not report concern about their child's weight. Parents were more likely to report concern if the child was obese (OR 21.3), overweight (OR 3.5) or underweight (OR 5.4) than normal weight (P<0.05). Concern was not related to child gender, parental BMI or parental education after controlling for child BMI. Perceived health and well-being of overweight/obese children varied little by weight category of the reporting parent (overweight vs non-overweight).

Conclusions: Parents were more likely to report poorer health and well-being for overweight and obese children (particularly obese boys). Parental concern about their child's weight was strongly associated with their child's actual BMI. Despite this, most parents of overweight and obese children did not report poor health or well-being, and a high proportion did not report concern. This has implications for the early identification of such children and the success of prevention and intervention efforts.

Television, computer use and body mass index in Australian primary school children

Objective: To investigate relationships between children's body mass index (BMI) and parent reports of children's television and video game/computer habits, controlling for other potential risk factors for paediatric obesity.

Methods: Child BMI was calculated from measured height and weight collected in 1997 as part of a large, representative, cross-sectional study of children in Victoria, Australia. Parents reported the amount of time children watched television and used video games/computers, children's eating and activity habits, parental BMI and sociodemographic details.

Results: A total of 2862 children aged 5−13 years participated. Child mean BMI z-score was significantly related to television (F = 10.2₃, P < 0.001) but not video game/computer time (F = 2.2₃, P = 0.09), but accounted for only 1 and 0.2% of total BMI variance, respectively. When parental BMI, parental education, number of siblings, food intake, organized exercise and general activity level were included, television ceased to be independently significantly related to child BMI. Using adjusted logistic regression, the odds of being overweight and obese generally increased with increasing television viewing. No relationship was found for video game/computer use.
Conclusions: A small proportion of variance in child BMI was related to television, but not video game/computer time. This was far outweighed by the influence of other variables. Causal pathways are likely to be complex and interrelated.

Weight concerns among elementary school children : a review of prevention programs

There is increasing evidence that children display high levels of weight and muscle concerns, which include body dissatisfaction and problem eating. In order to address these issues, researchers have designed and implemented prevention programs for this age group. Thirteen published studies were located and reviewed, with children aged 8–12 years from elementary schools, or equivalent. Overall, the programs were shown to be effective in improving children's knowledge at post-test and at follow-up assessments. However, there is limited evidence to show that the programs reduced or prevented body image concerns and/or problem eating. Too few studies have examined muscle concerns so no conclusions can yet be drawn about this domain. Limitations of the studies and suggestions for future prevention efforts are discussed.

Double disadvantage : the influence of ethnicity over socioeconomic position on childhood overweight and obesity: findings from an inner urban population of primary school children

Objective: To examine the relationship between overweight/obesity in children, socioeconomic status and ethnicity/cultural background.

Design: Cross-sectional survey of children aged 4–13 years.

Setting: A total of 23 primary (elementary) schools in an inner urban municipality of Melbourne, Australia.

Participants: A total of 2685 children aged 4–13 years and their parents.

Main exposure measures: Ethnicity/cultural background – maternal region of birth; socioeconomic position (SEP) indicators – maternal and paternal educational attainment, family employment status, possession of a healthcare card, ability to buy food, indicator of disadvantage (Socioeconomic Index for Areas, SEIFA) score for school; parental weight status.

Main outcome measure: Prevalence of overweight/obesity.

Results: Prevalence of overweight/obesity approached 1 in 3 (31%) in this sample. Prevalence of overweight/obesity was greater for children of both North Africa and Middle Eastern background and children of Southern, South Eastern and Eastern European background compared with children of Australian background. This difference remained after adjusting for age, sex, height, clustering by school, SEP indicators and parental weight status; odds ratio, OR=1.57 (95% confidence interval, CI 1.12–2.19) and 1.88 (95%CI 1.24–2.85), respectively.

Conclusions: There is a clear independent effect of ethnicity above and beyond the effect of socioeconomic status on overweight and obesity in children. Further research is required to explore the mediators of this gradient.

Cost-effectiveness of active transport for primary school children - Walking School Bus Program

Background : To assess from a societal perspective the incremental cost-effectiveness of the Walking School Bus (WSB) program for Australian primary school children as an obesity prevention measure. The intervention was modelled as part of the ACE-Obesity study, which evaluated, using consistent methods, thirteen interventions targeting unhealthy weight gain in Australian children and adolescents.

Methods : A logic pathway was used to model the effects on body mass index [BMI] and disability-adjusted life years [DALYs] of the Victorian WSB program if applied throughout Australia. Cost offsets and DALY benefits were modelled until the eligible cohort reached 100 years of age or death. The reference year was 2001. Second stage filter criteria ('equity', 'strength of evidence', 'acceptability', feasibility', sustainability' and 'side-effects') were assessed to incorporate additional factors that impact on resource allocation decisions.

Results : The modelled intervention reached 7,840 children aged 5 to 7 years and cost $AUD22.8M ($16.6M;$30.9M). This resulted in an incremental saving of 30 DALYs (7:104) and a net cost per DALY saved of $AUD0.76M ($0.23M; $3.32M). The evidence base was judged as 'weak' as there are no data available documenting the increase in the number of children walking due to the intervention. The high costs of the current approach may limit sustainability.

Conclusions : Under current modelling assumptions, the WSB program is not an effective or cost-effective measure to reduce childhood obesity. The attribution of some costs to non-obesity objectives (reduced traffic congestion and air pollution etc.) is justified to emphasise the other possible benefits. The program's cost-effectiveness would be improved by more comprehensive implementation within current infrastructure arrangements. The importance of active transport to school suggests that improvements in WSB or its variants need to be developed and fully evaluated.

Predictors of body mass index change in Australian primary school children

Objective. To assess associations between multiple potential predictors and change in child body mass index (BMI). Methods.In the 1997 Health of Young Victorians Study, children in Grades preparatory to three (aged 510 years) had their height and weight measured. Parents provided information on potential predictors of childhood overweight across six domains (children&rsquo;s diet, children&rsquo;s activity level, family composition, sociodemographic factors, prenatal factors and parental adiposity). Measures were repeated three years later in 2000/1. BMI was transformed to standardised (z) scores using the US 2000 Growth Chart data and children were classified as non-overweight or overweight according to international cutpoints.Regression analyses, including baseline BMI z-score as a covariate, assessed the contribution of each potential predictor to change in BMI z-score, development of overweight and spontaneous resolution of overweight in 1 373 children.Results. BMI z-score change was positively associated with frequency of take-away food, food quantity, total weekly screen time, non-Australian paternal country of birth, maternal smoking during pregnancy, and maternal and paternal BMI.Inverse associations were noted for the presence of siblings and rural residence (all pB0.05). Predictors of categorical change (development and resolution of overweight) were less clearly identified, apart from an association between maternal BMI and overweight development (p0.02). Multivariable models suggested individual determinants have a cumulative effect on BMI change. Conclusions. Strong short-term tracking of BMI makes it difficult to identify predictors of change. Nonetheless, putative determinants across all domains assessed were independently associated with adiposity change. Multi-faceted solutions are likely to be required to successfully deal with the complexities of childhood overweight.

Fundamental movement skills - How do primary school children perform? The 'Move it Groove it' program in rural Australia

Child Fundamental Movement Skills (FMS) underpin active lifestyles yet little is known of their distribution and mastery.

‘Move it Groove it’ project rated proficiency of primary school children (n=1045, 18 schools) in skills of balance, throw, catch, sprint, hop, kick, side gallop and jump. Rating categories were ‘mastery’, ‘near mastery’ or ‘poor’ (ie mastered all, all but one, or less of the five to six components of an FMS).

Less than half of all child tests were rated at mastery (21.3%) or near mastery (25.7%) level. In grade three, 75.4% of children achieved mastery or near mastery (MNM) in static balance but less than half did so for any other FMS. In grade four, 59.0% achieved MNM in the side gallop and 56.0% in the catch but less than half did so for any other FMS.

Although the highest percent mastery for both genders was for the balance, the skills best performed thereafter by boys (throw and kick) rated poorest for girls. Conversely the hop and side gallop which rated, after balance, as the skills best mastered by girls, were among the more poorly performed skills for boys.

The low prevalence of FMS mastery found in this survey suggests that there may be great potential to improve fundamental movement skills of primary aged children in many parts of rural Australia. Even if the aim were for children to achieve near mastery levels, the improvement could be substantial in every skill category. Where appropriate, gender differences in mastery might easily be addressed by tailored physical education programs and modification of social and physical environments.

Practising gender : the production of identity by school children

The thesis utilises ‘practice theory’ to argue that the self is not only an effect of social practices but also a technique for action and develops an alternative way of explicating and conceptualising the constitution of the self within the micro-practices of routine, everyday life. This is in contrast to a general tendency within ‘practice theory’, ‘constructionist’ and ‘discursive’ approaches towards a determinist conception of the self. The thesis explores this conceptual framework in fieldwork focussed on formation and production of gender-identity among young school children and offers a new perspective of gender-identity in the classroom. The thesis provides a fourfold contribution: (1) It provides insights into how in the classroom, children take up (conventional) gender differentiated conduct and dispositions in order to forge both their identity and the establishment of a social order based on gender. This gender order is not simply imposed on them by teachers but is actively constructed by the children. The thesis provides insights into how the children in the classroom seize and appropriate the practices of gender for their own ends. These ends, I argue, are the construction of their gender-identity, and the establishment and maintenance of a ‘matrix of intelligibility’. (2) It offers a close-up illustration of how gender construction is negotiated and contested between girls and boys. This is characterised as largely a struggle for enablement — the power to be and to do — rather than as a struggle of one gender over another. (3) It develops an analysis of classrooms as productive sites, as ‘complex strategical situations’ in which the participating agents — the teachers and students—deploy and utilise available resources in their ongoing construction of the world. This suggests that that the social world is not as unitary and totalising as ‘constraint perspectives’ within practice theory often imply. (4) It proposes methodological perspectives and strategies for researching empirically the day-to-day production of gender and for capturing that complex and often elusive process ‘in flight’. It shows the value of an ‘ascending analysis’, one that does not foreclose findings on the basis of a pre-existing theoretical position, and the rich potential of ‘flashpoints’ as a way of illuminating ongoing and often ‘unremarkable’ and therefore unnoticed practices of gender production. The theoretical terrain explored a range of theorists on the self not usually brought together, including Butler, Rose, Foucault, Giddens and Garfinkel and Schatzki. These theorists share in common the perspective that social practices rather than the agent or social totality are the ontological basis of the social world. It is argued that the self is constituted in its enactment and the thesis pursues Foucault’s (2002) question of how the self participates in its own subjectification. The empirical focus of the thesis examined the activities of children at school for insights into how they participated in the making of their gender-identity. The research addressed the questions: (1) To what extent do children construct their gender-identity and what kinds of encouragement do they receive for this? (2) To what extent did the children seem to be appropriating gender practices and inciting the making of gender-identity in the classroom? (3) To what extent can the classroom be viewed as a site of gender contestation and borderwork? Using the concept of ‘flashpoints’, — significant or poignant moments in the classroom — classroom activities were observed to catch gender-identity production ‘in flight’ and to describe how the children seize upon moments to make gender salient. Year Three children in five classrooms in two Victorian schools were observed during English communication and literacy lessons. Individual interviews with teachers in the participating schools and group interviews with the children from the classrooms were undertaken to amplify the observations. Much of the children’s behaviour can be interpreted as their efforts to make gender salient in social interactions. Gender-identity production and gender ‘border work’ (Thorne, 1993) and contestation appeared to be a major activity and preoccupation of the children, even in the face of teacher’s attempts to encourage a gender-neutral environment The children were often more active than the teachers in imposing the ‘gender agenda’ identified by Evans (1988). Overall, this thesis contributes to the development of the theory of subjectivity and identity formation. Social practices are not imposed and individuals seize upon social practices to further their own ends. It is through these routine, everyday activities that social practices are reproduced. The study provides an avenue for understanding the actions of children and the operation of gender power and border work within the classroom.

Relationships between maturity status, physical activity and physical self-perceptions in primary school children

The aim of this study was to examine the influence of maturity status on primary school children's physical activity and physical self-perceptions. Altogether, 175 children (97 girls, 78 boys) aged 10.6 ± 0.3 years completed the Children and Youth Physical Self-Perception Profile and wore an ActiGraph accelerometer for five consecutive days to assess moderate-to-vigorous physical activity. Anthropometric measures were completed to estimate maturity status. A two-level, multi-level analysis was used to assess the influence of maturity status on moderate-to-vigorous physical activity and physical self-perceptions. Boys performed more moderate-to-vigorous physical activity than girls (P < 0.0001), but when the effect of maturity status was controlled the difference was reduced (P = 0.02). Significant differences between the sexes were also observed for physical self-perception sub-domains (boys > girls, P = 0.02 to 0.0001). When maturity status was added to the model, significant differences were no longer apparent for each sub-domain, with the exception of perceived strength. Significant interactions between gender and maturity status revealed that boys' physical self-perceptions improved with more advanced maturity status, whereas girls' self-perceptions decreased (P = 0.07 to 0.002). Significant differences between the sexes in moderate-to-vigorous physical activity and some domains of physical self-perceptions were reduced or no longer evident when the effect of maturity status was controlled. Maturity status may differentially influence boys' and girls' physical self-perceptions.

Overweight and obesity in infants and pre-school children in the European Union : a review

The objective of this study was to synthesize available information on prevalence and time trends of overweight and obesity in pre-school children in the European Union. Retrieval and analysis or re-analysis of existing data were carried out. Data sources include WHO databases, Medline and Google, contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference and cut-offs, and the WHO standard. Data were available from 18/27 countries. Comparisons were problematic because of different definitions and methods of data collection and analysis. The reported prevalence of overweight plus obesity at 4 years ranges from 11.8% in Romania (2004) to 32.3% in Spain (1998–2000). Countries in the Mediterranean region and the British islands report higher rates than those in middle, northern and eastern Europe. Rates are generally higher in girls than in boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20–30 years in the five countries with data. The use of the WHO standard with cut-offs at 1, 2 and 3 standard deviations yields lower rates and removes gender differences. Data on overweight and obesity in pre-school children are scarce; their interpretation is difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.

Assessing cost-effectiveness in obesity : active transport program for primary school children— TravelSMART schools curriculum program

Background: To assess from a societal perspective the cost-effectiveness of a school program to increase active transport in 10- to 11-year-old Australian children as an obesity prevention measure.
Methods: The TravelSMART Schools Curriculum program was modeled nationally for 2001 in terms of its impact on Body Mass Index (BMI) and Disability-Adjusted Life Years (DALYs) measured against current practice. Cost offsets and DALY benefits were modeled until the eligible cohort reached age 100 or died. The intervention was qualitatively assessed against second stage filter criteria (‘equity,’ ‘strength of evidence,’ ‘acceptability to stakeholders,’ ‘feasibility of implementation,’ ‘sustainability,’ and ‘side-effects’) given their potential impact on funding decisions.
Results: The modeled intervention reached 267,700 children and cost $AUD13.3M (95% uncertainty interval [UI] $6.9M; $22.8M) per year. It resulted in an incremental saving of 890 (95%UI –540; 2,900) BMI units, which translated to 95 (95% UI –40; 230) DALYs and a net cost per DALY saved of $AUD117,000 (95% UI dominated; $1.06M).
Conclusions: The intervention was not cost-effective as an obesity prevention measure under base-run modeling assumptions. The attribution of some costs to nonobesity objectives would be justified given the program’s multiple benefits. Cost-effectiveness would be further improved by considering the wider school community impacts.