Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a metaanalysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.

http://activeworking.com/pdfs/research/71.pdf

Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update.

The present study aims to estimate childhood overweight and obesity prevalence and their association with individual and population-level correlates in Eastern and Western European countries. Data were obtained from the School Children Mental Health in Europe, a cross-sectional survey conducted in 2010 in Italy, Germany, the Netherlands, Romania, Bulgaria, Lithuania and Turkey. The sample consists of 5,206 school children aged 6 to 11 years old. Information on socio-demographics, children’s height and weight, life-style and parental attitude were reported by the mothers. Country-level indicators were obtained through several data banks. Overweight and obesity in children were calculated according to the international age and gender-specific child Body Mass Index cut-off points. Multivariable logistic regression models included socio-demographic, lifestyle, mothers’ attitude, and country-level indicators to examine the correlates of overweight. Overall prevalence was 15.6% (95% CI = 19.3-21.7%) for overweight and 4.9% (95% CI = 4.3-5.6%) for obesity. In overweight (including obesity), Romanian children had the highest prevalence (31.4%, 95% CI = 28.1-34.6%) and Italian the lowest (10.4%, 95% CI = 8.1-12.6%). Models in the pooled sample showed that being younger (aOR = 0.93, 95% = CI 0.87-0.97), male (aOR = 1.24, 95% CI = 1.07-1.43), an only child (aOR = 1.40, 95% CI = 1.07-1.84), spending more hours per week watching TV (aOR = 1.01, 95% CI =1.002-1.03), and living in an Eastern Country were associated with greater risk of childhood overweight (including obesity). The same predictors were significantly associated with childhood overweight in the model conducted in the Eastern region, but not in the West. Higher Gross Domestic Product and Real Domestic Product, greater number of motor and passenger vehicles, higher percentage of energy available from fat, and more public sector expenditure on health were also associated with lower risk for childhood overweight after adjusting for covariables in the pooled sample and in the east of Europe, but not in the West. Prevalence rates of overweight and obesity in school children is still high, especially in Eastern regions, with some socio-demographic factors and life-styles associated with being overweight. It is also in the Eastern region itself where better macro-economic indicators are related with lower rates of childhood overweight. This represents a public health concern that deserves special attention in those countries undertaking economic and political transitions.

/pdf/country-level-and-individual-correlates-of-overweight-and-amlbly4s5h.pdf

Country-level and individual correlates of overweight and obesity among primary school children: a cross-sectional study in seven European countries.

Research Questions
What are the non-modifiable (socioeconomic, genetic) and modifiable factors (physical activity, dietary behaviors) related to childhood (under age 12) obesity? How can this knowledge be applied to oral health professionals' efforts to prevent or manage dental caries in children?

Objectives
Studies have identified risk factors for childhood obesity. The purpose of this scoping review was to develop a conceptual model to identify non-modifiable and modifiable risk factors for childhood obesity and to illustrate how these findings are relevant in developing interventions aimed at preventing obesity and dental caries in children.

Methods
The authors searched PubMed and Embase and limited the study to English-language publications. A total of 2,572 studies were identified. After de-duplication, 2,479 studies remained and were downloaded into a citation-management tool. Two authors screened the titles and abstracts for relevance. Two hundred and sixty studies remained and were retrieved for a full-text review, and 80 studies were excluded, resulting in 180 studies included in the scoping review. An inductive content analytic methods was used to organize all statistically significant obesity risk factors into seven domains, which were classified as non-modifiable or modifiable; then a conceptual model of common risk factors associated with childhood obesity and dental caries was developed.

Results
Non-modifiable obesity risk factors include biological and developmental (e.g., genes, developmental conditions, puberty), sociodemographic and household (e.g., race/ethnicity, socioeconomic status, parent education, unemployment), cultural (e.g., degree of acculturation), and community (e.g., neighborhood composition). Modifiable risk factors included behavioral (e.g., diet, physical activity, weight), psychosocial (e.g., maternal stress, family functioning, parenting practices, child temperament), and medical (e.g., parent smoking, maternal health, child health).

Conclusions
Identifying common risk factors has important implications for future oral health research aimed at preventing childhood obesity and dental caries. Epidemiologic knowledge gleaned from the literature can be used to develop rigorous interventions and programs aimed at preventing these highly prevalent diseases and improving health outcomes for children.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jphd.12221

A scoping review of epidemiologic risk factors for pediatric obesity: Implications for future childhood obesity and dental caries prevention research.

Sex Differences in Cardiometabolic Risk Factors among Hispanic/Latino Youth

Childhood body mass index trajectories predicting cardiovascular risk in adolescence

BACKGROUND: Previous studies have demonstrated gender-related differences in body composition, physical activity, and diet. This observational study assesses gender variance in independent predictors for obesity to determine targeted areas for intervention. METHODS: Data from 1714 sixth-grade students enrolled in Project Healthy Schools were compared by using health behaviors and physiologic markers (lipids, random glucose, blood pressure, and resting and recovery heart rates). Students were stratified by gender and obesity (BMI ≥95th percentile by age and gender). Physiologic markers and behaviors were compared by using χ 2 analysis. Univariate associations with P RESULTS: Nonobese students (both boys and girls) showed significantly healthier physiologic parameters compared with their obese counterparts. Two behaviors independently correlated with obesity in both boys and girls: regularly eating school lunches (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.01–1.64; OR 1.27, 95% CI 1.00–1.62, respectively) and watching ≥2 hours of television per day (OR 1.19, 95% CI 1.07–1.32; OR 1.19, 95% CI 1.06–1.34, respectively). Vigorous physical activity and involvement in school sports teams appeared to be protective against obesity in boys (OR 0.90, 95% CI 0.82–0.98; OR 0.77, 95% CI 0.64–0.94, respectively), whereas milk consumption appeared protective in girls (OR 0.81, 95% CI 0.67–0.98). CONCLUSIONS: Among middle-school children, we observed gender-related differences in factors associated with obesity. Additional research is warranted to determine the beneficial impact of improving school lunches and decreasing screen time, while improving our understanding of gender-related differences in milk consumption and physical activities in relation to BMI.

Gender Differences in Physiologic Markers and Health Behaviors Associated With Childhood Obesity

Over the past three decades the proportion of students classified as overweight has almost tripled. This trend in childhood obesity is a cause for concern. Stakeholders have come together to stem growth and implement healthy habits in childhood to not only prevent obesity, but also future cardiovascular risk. School-based health interventions have proven to be an effective medium to reach youth. Sustainable practices remain the largest determinant of long-term success of these programs. Project Healthy Schools, a community‐university collaborative school-based health intervention program, sustainable practices have led to positive changes in participating middle schools. This collaborative has provided important insight on key factors needed for long-term sustainability for a school-based wellness program. These key factors are described under leadership, policy, finances, and reproducibility. Future school-based programs may plan for success with sustainability while drawing from our experience.

/pdf/sustainable-practices-within-a-school-based-intervention-a-ptytva4ar6.pdf

Sathish Mohan

Papers

Gender Differences in Physiologic Markers and Health Behaviors Associated With Childhood Obesity

Sustainable Practices Within a School-Based Intervention: A Report from Project Healthy Schools

Widely adopted surgical quality improvement initiatives