OBJECTIVE:Obesity prevention is necessary to address the steady rise in the prevalence of obesity. Although all experts agree that obesity prevention has high priority there is almost no research in this area. The effectiveness of different intervention strategies is not well documented. There is also no structured framework for obesity prevention. DESIGN: Based on (i) our current and limited knowledge and (ii) the idea that prevention of childhood obesity is an effective treatment of adult obesity, the Kiel Obesity Prevention Study (KOPS) was started in 1996. Concept, intervention strategies and first results of KOPS are reported in this paper. KOPS is an ongoing 8 y follow-up study. We first enrolled a large scale cohort of 5 to 7-y-old children, providing sufficient baseline data. KOPS allows further analyses of the role of individual risk factors as well as of long-term effectiveness of different intervention strategies. RESULTS: From 1996 to 1999 a representative group of 2440 5 to 7-y-old children was recruited (ie 30.2% of the total population of 5 to 7-y-old children examined by the school physicians) and a full data set was obtained from 1640 children. Of the children, 340 (20.7%) were considered as overweight and obese, 1108 children (67.6%) were normal weight, and underweight was found in 192 children (11.7%). Of the normal-weight children, 31% or 346 (21.1% of the total population) were considered to have a risk of becoming obese. Cross-sectional data provided evidence that (i) there is an inverse social gradient in childhood overweight as well as health-related behaviours and (ii) parental fatness had a strong influence on childhood overweight. We observed considerable changes in health-related behaviours within 1 y after combined 'school-' and 'family-based' interventions. Interventions aimed to improve health-related behaviours had significant effects on the agedependent increases in median triceps skinfolds of the whole group (from 10.9 to 11.3 mm in 'intervention schools' vs from 10.7 to 13.0 mm in 'control schools', P < 0.01) as well as in percentage fat mass of overweight children (increase by 3.6 vs 0.4% per year without and with intervention, respectively; P < 0.05). CONCLUSION: First results of KOPS are promising. Besides health promotion, a better school education and social support seem to be promising strategies for future interventions.
Objective: To assess relationships between TV viewing and body composition, energy expenditure, physical activity, fitness and nutrition habits in prepubertal children. Design: Cross-sectional study. Subjects: Sixty prepubertal children (mean body mass index: 20.8 kg m 22 , age: 5±11 years, overweight: n 52Y normal weight: n 8). Methods: TV consumption, socio-economic status (SES) and nutrition habits were estimated by questionnaires. Fat mass and fat-free mass were assessed by anthropometrics and bioelectrical impedance analysis, and resting energy expenditure by indirect calorimetry. Total energy expenditure was measured by a combination of indirect calorimetry and individually calibrated 24-hour heart rate (HR) monitoring. Activity-related energy expenditure and physical activity level were calculated. Aerobic fitness (VO 2 submax) was determined by ergometry, muscle strength (musculus quadriceps, musculus ischiocruralis) was measured by computer tensiometry. Children were stratified according to their daily TV consumption: #1 h of TV per day (group I) and .1 h of TV per day (group II). Results: When compared with children of group I, children of group II had increased body weight, body mass index, skinfolds, fat mass and prevalence of overweight P , 0X05 and ,0.01, respectively). By contrast, fat-free mass, energy expenditure, measures of physical activity and muscle strength were similar. Children of group II had normal absolute VO 2 submax but reduced adjusted VO 2 submax P , 0X05). They also had parents with a lower educational level P , 0X05X Similar nutritional habits were observed in both groups. There were no significant differences in the observed parameters between children with high (1±3 h day 21) and very high (.3 h day 21 ) TV viewing. Conclusions: There is a positive relationship between TV viewing and fatness. Increased TV viewing does not reflect reduced 24-hour energy expenditure as assessed by 24-hour HR monitoring, submaximal VO 2 , muscle strength or poor dietary intake. Increased TV consumption is associated with a low SES. Keywords Physical inactivity Activity Energy expenditure Childhood obesity Childhood nutritionIn Western societies overweight and obesity are epidemic and their incidence is increasing. Present data show that children are also getting fatter 1±3 . Environmental factors frequently discourage physical activity and promote overeating, thus supporting childhood obesity 1±4 . A low level of physical activity is considered as an increased risk factor of obesity 1,5±9 . Reduced physical activity results in a reduction in total energy expenditure (TEE), favouring a positive energy balance. However, the relationship between childhood obesity and energy expenditure or physical activity is far from clear. Obese subjects did not consistently show reduced activity 10,11 . Doubly labelled water (DLW) techniques, heart rate (HR) monitoring and accelerometers have been used to assess energy expenditure and physical activity directly in children and adults 9,12±15 . In addi...
Obesity prevention is necessary to address the steady rise in the prevalence of obesity. Although all experts agree that obesity prevention has high priority there is almost no research in this area. There is also no structured framework for obesity prevention. The effectiveness of different intervention strategies is not well documented. Regarding universal prevention little rigorous evaluation has been carried out in larger populations. Obesity prevention has been integrated into community-wide programmes preventing coronary heart disease. Although effective with respect to reduction in cardiovascular risk factors these programmes did not affect mean body mass index (BMI) of the target populations. Selective prevention directed at high risk individuals (e.g. at children with obese parents) exhibited various degrees of effectiveness. However, at present, definitive statements cannot be made because of the limited number of studies as well as limits in study design. Finally, targeted prevention produced promising results in obese children when compared to no treatment. However, there are only very few longterm follow-up data. There is no clear idea about comprehensive interventions studying combinations of different strategies. It is tempting to speculate that predictors of treatment outcome (e.g. psychological and sociodemographic factors) may also serve as barriers to preventive strategies, but this has not yet been investigated. Taken together, obesity prevention should become a high priority research goal. First results of obesity prevention programmes are promising. As well as health promotion and counselling, better school education and social support appear to be promising strategies for future interventions.
The purpose of the present study was to assess different aspects of physical activity and fitness in order to develop a basis for sport programmes for overweight and obese children. Eighty-eight prepubertal children (49 boys, 39 girls, 4.8-11.4 years old, 61% obese, 14% overweight and 25% normal weight) were examined. Body composition was assessed by combined use of anthropometrics and bioelectrical impedance analysis. Resting energy expenditure (REE) and total energy expenditure (TEE) were measured by indirect calorimetry (IC) and individually calibrated 24-h heart rate (HR) monitoring, respectively. Activity-related energy expenditure (AEE) and physical activity level (PAL) were calculated from TEE and REE. Fitness [assessed by O2-pulse, respiratory exchange ratio (RER) at submaximal work intensities] was determined by ergometry. The maximal isometric muscle strength of the legs (m. quadriceps, Fa max, m. ischiocruralis, Fb max) was measured by computer tensiometry. Children were grouped according to their nutritional state, AEE, O2-pulse and muscle strength. When compared with normal weight children, obese and overweight children had increased fat mass (FM), fat-free mass (FFM), waist-to-hip ratio and REE, but no group differences were observed for TEE, AEE, and PAL. Obese and overweight children spent more hours per day watching TV. After correction for body weight and FFM, no group differences in REE were observed, but normal weight children had a higher O2-pulse than overweight and obese children. By contrast, RER was increased in the latter group. The fittest group had the lowest body weight, BMI, FM and FFM. Children with a low O2-pulse spent more hours per day watching TV. Grouping children according to their degree of muscle strength, younger children (4-7.5 years) did not show group differences in nutritional state, energy expenditure, physical activity and fitness. However, in the group of 7.6- to 11-year-old children, those with the greatest muscle strength and FFM had reduced BMI, skin folds, FM and FFM. FM correlated inversely with O2-pulse, but was not associated with TEE, AEE, PAL or muscle strength. By contrast TV consumption was positively associated with FM. To summarize, overweight and obese children were less fit and watched more TV than their normal weight counterparts. FM did not correspond to TEE, AEE or PAL. Muscle strength was not associated with FM in young children, but was inversely associated with FM in older children. Our cross-sectional data are consistent with the idea that increased fitness and reduced physical inactivity may prevent children from being overweight.
Objective: To assess the possible associations between physical activity, diet, social state and overweight in children. Design: Crossectional study on 1468 children aged between 5 and 7 years old in Kiel, northwest Germany. Methods: Assessment of physical activity and social factors by a questionnaire, food frequency record, body composition analysis by anthropometrics and bioelectrical impedance analysis. Results: 23% of our children were overweight or obese. Low levels of physical activity (as assessed by TV viewing time) were associated with increased body mass index and a higher prevalence of overweight. TV-viewing of more than 1 h per day was associated with a high consumption fast food, sweets, chips and pizza whereas fruits and vegetables were less frequently consumed. Overweight, inactivity and unhealthy eating habits were seen more frequently in families with a low social status. Conclusions: In 5 to 7 years old children, overweight is associated with physical inactivity, unhealthy eating habits and a low social status. Primary prevention efforts should be directed to low income families.
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