The incidence of chronic disease is escalating much more rapidly in developing countries than in industrialized countries. A potential emerging public health issue may be the increasing incidence of childhood obesity in developing countries and the resulting socioeconomic and public health burden faced by these countries in the near future. In a systematic review carried out through an electronic search of the literature from 1950-2007, the author compared data from surveys on the prevalence of overweight, obesity, and the metabolic syndrome among children living in developing countries. The highest prevalence of childhood overweight was found in Eastern Europe and the Middle East, whereas India and Sri Lanka had the lowest prevalence. The few studies conducted in developing countries showed a considerably high prevalence of the metabolic syndrome among youth. These findings provide alarming data for health professionals and policy-makers about the extent of these problems in developing countries, many of which are still grappling with malnutrition and micronutrient deficiencies. Time trends in childhood obesity and its metabolic consequences, defined by uniform criteria, should be monitored in developing countries in order to obtain useful insights for primordial and primary prevention of the upcoming chronic disease epidemic in such communities.

Childhood Overweight, Obesity, and the Metabolic Syndrome in Developing Countries

LUTFIYYA, MAY NAWAL, MARTIN S. LIPSKY, JENNIFER WISDOM-BEHOUNEK, AND MELISSA INPANBUTR-MARTINKUS. Is rural residency a risk factor for overweight and obesity for U.S. children? Obesity. 2007;15:2348–2356. Objective: Despite studies suggesting that there is a higher prevalence of overweight or obese children in rural areas in the U.S., there are no national studies comparing the prevalence levels of overweight or obese rural to metropolitan children. The objective of this research was to examine the hypothesis that living in a rural area is a risk factor for children being overweight or obese. Research Methods and Procedures: Using the National Survey of Children’s Heath, the prevalence of overweight and/or obese rural children was compared with that of children in metropolitan settings. Multivariate analyses were performed on the data to detect if differences varied by health services use factors or demographic factors, such as household income, gender, and race. Results: Multivariate analysis revealed that overweight or obese children 5 years of age were more likely to live in rural rather than metropolitan areas (odds ratio 1.252; 95% confidence interval, 1.248, 1.256). Rural overweight U.S. children 5 years of age of age were more likely than their metropolitan counterparts to: be white, live in households 200% of the federal poverty level, have no health insurance, have not received preventive health care in the past 12 months, be female, use a computer for non-school work 3 hours a day, and watch television for 3 hours a day. In addition, they were more likely to have comorbidities. Discussion: Living in rural areas is a risk factor for children being overweight or obese.

https://onlinelibrary.wiley.com/doi/epdf/10.1038/oby.2007.278

Is rural residency a risk factor for overweight and obesity for U.S. children

The study tested the effect of aerobic exercise training on executive function in overweight children Ninety-four sedentary, overweight but otherwise healthy children (mean age = 92 years, body mass index 85th percentile) were randomized to a low-dose (20 min/day exercise), high-dose (40 min/day exercise), or control condition Exercise sessions met 5 days/week for 15 weeks The Cognitive Assessment System (CAS), a standardized test of cognitive processes, was administered individually before and following intervention Analysis of covariance on posttest scores revealed effects on executive function Group differences emerged for the CAS Planning scale (p = 03) Planning scores for the high-dose group were significantly greater than those of the control group Exercise may prove to be a simple, yet important, method of enhancing aspects of children's mental functioning that are central to cognitive and social development

Effects of Aerobic Exercise on Overweight Children's Cognitive Functioning: A Randomized Controlled Trial.

Objectives. Obesity in childhood is associated with the presence of risk factors for later disease and with the early development of these diseases. This paper aims to estimate the numbers of children with obesity-related disease risk factors and co-morbidities in the European Union (EU). Methods. A search of the scientific literature identified prevalence rates relating variously to impaired glucose tolerance, hyperinsulinaemia, type 2 diabetes, several cardiovascular risk factors, non-alcoholic fatty liver disease, and the metabolic disease syndrome among obese children. Using the lowest likely prevalence rates for each disease indicator, estimates were made of the expected numbers of obese children within the EU likely to be showing the specified indicator. Results. On the most conservative estimate, over 20 000 obese children in the EU have type 2 diabetes, while over 400 000 have impaired glucose tolerance. Over a million obese children are likely to show a range of indicators for cardiovascular dise...

Estimated burden of paediatric obesity and co-morbidities in Europe. Part 2. Numbers of children with indicators of obesity-related disease.

Context Pediatric studies have shown that aerobic exercise reduces metabolic risk, but dose-response information is not available. Objectives To test the effect of different doses of aerobic training on insulin resistance, fatness, visceral fat, and fitness in overweight, sedentary children and to test moderation by sex and race. Design, Setting, and Participants Randomized controlled efficacy trial conducted from 2003 through 2007 in which 222 overweight or obese sedentary children (mean age, 9.4 years; 42% male; 58% black) were recruited from 15 public schools in the Augusta, Georgia, area. Intervention Children were randomly assigned to low-dose (20 min/d; n = 71) or high-dose (40 min/d; n = 73) aerobic training (5 d/wk; mean duration, 13 [SD, 1.6] weeks) or a control condition (usual physical activity; n = 78). Main Outcome Measures The prespecified primary outcomes were postintervention type 2 diabetes risk assessed by insulin area under the curve (AUC) from an oral glucose tolerance test, aerobic fitness (peak oxygen consumption [V. O 2 ]), percent body fat via dual-energy x-ray absorptiometry, and visceral fat via magnetic resonance, analyzed by intention to treat. Results The study had 94% retention (n = 209). Most children (85%) were obese. At baseline, mean body mass index was 26 (SD, 4.4). Reductions in insulin AUC were larger in the high-dose group (adjusted mean difference, −3.56 [95% CI, −6.26 to −0.85] × 10 3 μU/mL; P = .01) and the low-dose group (adjusted mean difference, −2.96 [95% CI, −5.69 to −0.22] × 10 3 μU/mL; P = .03) than the control group. Dose-response trends were also observed for body fat (adjusted mean difference, −1.4% [95% CI, −2.2% to −0.7%]; P  3 [95% CI, −6.0 to −1.7 cm 3 ]; P  3 [95% CI, −4.9 to −0.6 cm 3 ]; P = .01) in the high- and low-dose vs control groups, respectively. Effects in the high- and low-dose groups vs control were similar for fitness (adjusted mean difference in peak V. O 2 , 2.4 [95% CI, 0.4-4.5] mL/kg/min; P = .02 and 2.4 [95% CI, 0.3-4.5] mL/kg/min; P = .03, respectively). High- vs low-dose group effects were similar for these outcomes. There was no moderation by sex or race. Conclusion In this trial, after 13 weeks, 20 or 40 min/d of aerobic training improved fitness and demonstrated dose-response benefits for insulin resistance and general and visceral adiposity in sedentary overweight or obese children, regardless of sex or race. Trial Registration clinicaltrials.gov Identifier: NCT00108901

https://jamanetwork.com/journals/jama/articlepdf/1360862/joc120073_1103_1112.pdf

Brent Flickinger

Papers

Prevalence of cardiovascular risk factors in schoolchildren in a rural Georgia community.