We sought to determine whether interventions that emphasize decreasing sedentary behaviours in children and adolescents result in behaviour change and weight control. A comprehensive literature search was conducted to identify all comparative studies of interventions to reduce sedentary behaviour among children, alone or in combination with other health messages. Two investigators evaluated articles for eligibility and validity. As methods, settings and interventions differ across studies, results were synthesized narratively. Twelve studies met the inclusion criteria and provided relevant data. Six targeted clinic-based populations that were overweight or at risk of overweight, and six were population-based prevention studies. Approaches varied, but all reduced sedentary behaviour and improved weight indices. An emphasis on decreasing sedentary behaviours is an effective intervention to decrease sedentary behaviours and control weight in children and adolescents.

Objective: To determine whether a multidisciplinary pediatric weight management program effectively improves BMI, BMI z-score, and cardiovascular risk factors (CVRFs) in high-risk populations. Methods and Procedures: A retrospective chart review was performed on children seen in the NEW Kids Program at the Children's Hospital of Wisconsin, a family-based clinic that treats pediatric obesity using medical management, nutrition education, behavioral intervention, and physical activity. Inclusion criteria were program participation for ≥9 months and >4 visits. Analyses were performed to identify factors associated with pre-to postintervention changes in BMI, BMI z-score, and CVRF laboratory values. Results: A total of 66 patients met inclusion criteria; the mean age was 11 years (s.d. ± 3.4), 56% were racial/ethnic minorities, 45% were Medicaid recipients, 48% resided in impoverished communities, and 38% had a BMI ≥40 kg/m 2 . Of the 66 patients, 91% had more than one weight-related comorbidity, 88% had CVRFs, and the preintervention mean BMI was 37 kg/m 2 . After the intervention, there was an overall increase in absolute BMI, but a small, yet significant decrease in BMI z-score (mean -0.03 ± 0.16; P < 0.05). There were significant pregroup to postgroup improvements in total cholesterol, low-density lipoprotein, and triglycerides levels (P < 0.05). Insurance coverage, race/ethnicity, gender, age, and initial BMI were not significantly associated with changes in BMI or BMI z-score. Discussion: A multidisciplinary pediatric weight management program can improve the weight status of high-risk populations, including minorities, Medicaid recipients, patients with multiple comorbidities and CVRFs, and the severely obese.

Morbidly obese asthma patients have a higher degree of insulin resistance compared to morbidly obese non-asthma patients. We speculate that the pro-inflammatory state of insulin resistance may contribute to the pathogenesis of asthma in obese patients. Future prospective studies should address insulin resistance as a possible risk factor for asthma in obese children and adolescents.

One out of every three children is overweight. Obesity is linked to increased risks of diseases such as type 2 diabetes, liver disease, hypertension, and heart disease. As the numbers of children with chronic disease goes up, so will the strain on the U.S. health care system, including the cost of health care. The Ecological Model of Childhood Overweight allows one to consider how an individual child's weight is influenced by characteristics ranging from the individual to the society. This article focuses on community characteristics that interact with children's weight status. It reviews community-based programs and whether they are successfully slowing the rate of childhood obesity, including demonstrations of recipe preparation, community gardens, and school-based curricula. It concludes with suggestions for intervention efforts and funding priorities focusing on high-risk populations of low-income overweight women of childbearing years. Interventions that occur during preconception may be true primary prevention of childhood obesity.

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