Context
Childhood obesity increases the risk of diseases as diabetes, cardiovascular disease, and nonalcoholic fatty liver disease.
Objective
To evaluate the prevalence of comorbidities in school-age children with obesity and to compare its prevalence and the effect of a lifestyle intervention between children in primary and secondary school and between boys and girls.
Design
Cross-sectional analysis and lifestyle intervention.
Setting
Centre for Overweight Adolescent and Children’s Healthcare.
Patients
Comorbidities were evaluated in 149 primary and 150 secondary school children with (morbid) obesity (162 girls). The effect of lifestyle intervention was studied in 82 primary and 75 secondary school children.
Intervention
One-year interdisciplinary lifestyle intervention.
Results
Insulin resistance (37%), impaired glucose tolerance (IGT) (3%), dyslipidemia (48%), hypertension (7%), and elevated liver transaminase levels (54%) were already common in primary school children. Glomerular hyperfiltration and insulin resistance were more prevalent in secondary school children. IGT was more prevalent in girls. The change in body mass index z score after intervention was greater in primary school children (primary vs secondary: −0.25 ± 0.32 vs −0.11 ± 0.47), even as the change in low-density lipoprotein cholesterol concentrations [primary vs secondary: −0.30 (interquartile range, −0.70 to 0.10) vs −0.10 (interquartile range, −0.40 to 0.30)] and systolic blood pressure z score (primary vs secondary: −0.32 ± 1.27 vs 0.24 ± 1.3). The change in body mass index z score, but not in comorbidities, was greater in boys (boys vs girls: −0.33 ± 0.45 vs −0.05 ± 0.31).
Conclusions
The presence of comorbidities is already evident in primary school children with obesity. The effect of a lifestyle intervention on these comorbidities is greater in primary compared with secondary school children, stressing the need for early interventions.
Background: The COVID-19 pandemic has exacerbated the already existing pandemic of physical inactivity. In adolescents, the effect of COVID-19related governmental measures may beeven more pronounced,as they experience school closures, home confinement, social distancing and possible mental health issues as a result.The currentstudy uses the COVID-19 pandemic and associated governmental measures as a natural experiment to understand the impact it may have on the lifestyle of adolescents with relation to physical activity, sedentary and dietary behaviour. We also aim to describe the determinants of change in lifestyle behaviours.Methods/Design: A before-after experimental study design will be followed in which baseline measurements have been undertaken in 2018-19 before the COVID-19 pandemic, and the follow-up measurements will be repeated during the COVID-19 pandemic. Twenty government and private schools of Punjab, India form the primary unit of participation from which 1086adolescents participated in the study. Validated questionnaires are used to measurephysical activity, sedentarybehaviour, and dietary behaviour. Additionally, objective measures of physical activity will be performed using ActiGraph wGT3X-BT over a 7-day period on a sub-sample. Body mass index (BMI) and waist circumference will be assessed objectively as a measure of central obesity. Qualitative interviews and focus group discussions will be conducted to have a better understanding for reasons of change in physical activity, sedentary and dietary behaviour or any possible differences between groups.Discussion: The study aims torevealthe impact of COVID-19 governmental measures on physical activity, sedentary and dietary behaviour of adolescents. It is one of the first studies to show both subjective and objective measures of physical activity levels and sedentary time of school-going adolescents during COVID-19. Due to the mixed method approach we will be able to identify reasons for changes in lifestyle behaviours and possibly also detect innovative ways of stayingphysically active during the era of physical distancing.
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