Defining obesity in children should be based on health issues, not just BMI
Mental health issues are consistent across BMI groups
April 2, 2019
Science Daily/McMaster University
A new study aims to identify what influences the success participants achieve in weight management programs and help improve these programs. The study follows participants for three years.
Physicians are told to gauge the severity of a child's problem with obesity using the body mass index (BMI) that measures weight against height. But that doesn't work well to identify health issues, especially those of mental health, in children with obesity seeking care, says a study led by McMaster University.
Other medical issues, including high blood pressure, prediabetes and non-alcoholic fatty liver disease are also common, and are only slightly more frequent in those with the most severe obesity compared to those with less severe obesity, according to the study.
The details of the study called the Canadian Pediatric Weight Management Registry (CANPWR) were published today in The Lancet Child & Adolescent Health. This study found two thirds of children entering weight management programs across Canada have severe obesity based on their BMI.
"We found that social and mechanical health issues were more common in those with the highest body mass index. However, mental health issues, for example, are consistent across the BMI groups," said Katherine Morrison, principal investigator of the CANPWR study, and professor of the Department of Pediatrics at McMaster.
"If you are only using BMI to identify the youth who need the most care, you would be presuming the kids with the lowest BMI class would be the least likely to have mental health issues or metabolic issues, but our findings suggest this is not true. This study suggests that using a clinical staging system, one that evaluates the health of the child and not just the BMI, is likely the best approach."
Morrison is also co-director of the Centre for Metabolism, Obesity and Diabetes Research at McMaster, an investigator of the Population Health Research Institute, and a pediatric endocrinologist at McMaster Children's Hospital. She said the end goal is to improve care of these children.
"There is a lot said about preventing obesity, we also really need to focus on how best to treat children with obesity. This is especially true when we see the burden of health illness that is associated with obesity in children entering weight management programs."
The CANPWR study aims to identify what influences the success participants achieve in weight management programs and help improve these programs. The study follows participants for three years.
The 10 clinics taking part in the study are in Vancouver, Edmonton, Calgary, Toronto, Hamilton, Ottawa and Montreal.
The paper used information from 847 children with obesity and the health issues were determined at their initial visit to one of the multidisciplinary weight management clinics across Canada. Participants were aged five to 17 at the time of enrolment.
In this study, researchers showed that using a clinical staging system called the Edmonton Obesity Staging System for Pediatrics, or EOSS-P, was more useful for understanding the health issues of the children in these clinics than the BMI class system. They suggest that using a clinical staging system will better assist the design of health care interventions for children with obesity.
Obesity-related health issues were common. Mental health concerns were the most common (90 per cent), followed by metabolic (85 per cent), social (65 per cent) and mechanical (62 per cent) health issues. The most common mental health issue identified was anxiety.
The most commonly identified metabolic health complication was dyslipidemia, followed by non-alcoholic fatty liver disease.
Bullying was the most commonly identified social health factor, followed very closely by low household income. More than one-third of children in the highest obesity group came from low income homes, which was significantly higher than those with lower levels of obesity.
Those with the most severe obesity by BMI were more likely to have experienced bullying, and more likely to report difficulties with peer relationships, compared to the less severe obesity groups.
https://www.sciencedaily.com/releases/2019/04/190402215621.htm
Obesity could be linked to early childhood behavior
February 27, 2018
Science Daily/University of Waterloo
New research has found that it is generally a combination of unhealthy behaviors among youth that could be the greatest predictors of whether or not young people will experience obesity issues in adulthood.
A study led by the University of Waterloo found it's generally a combination of unhealthy behaviours among youth that could be the greatest predictors of whether or not young people will experience obesity issues in adulthood.
The study concluded that public health efforts focusing on obesity prevention must identify and correct poor behaviours that are often developed in early childhood.
"Adolescents with obesity often maintain their weight status into adulthood, increasing their risk of developing cardiovascular disease, diabetes, and high blood pressure," says Rachel Laxer, who formed part of the research team while doing her PhD at Waterloo. "Public health practitioners should be targeting clusters of risky behaviours using a comprehensive and multi-pronged approach."
"Research tells us that while calorie intake has not dramatically changed over time, habits such as exercising, smoking, drug use and alcohol consumption have," said Laxer. "It's increasingly important to target these risky behaviours together, and early, before they become habits."
The study involved Ontario students in grades nine and ten, ranging from 13 to 17 years of age and participating in the COMPASS Study, a nine-year study started in 2012 that is funded by the Canadian Institute for Health Research.
Students reported risky behaviours at the beginning of the study, and their heights and weights were tracked for two additional years. Based on their reported behaviours, the teens were classified as Typical High School Athletes, Inactive High Screen-Users ("Screenagers"), Moderately Active Substance Users, or Health Conscious. The researchers found that although the four groups saw similar increases to their weight status over the years that they were followed, students in the Health Conscious group had the healthiest body weight at the beginning of the study.
"It's important to try to improve behaviours before they become habits, which are much harder to correct," said Laxer. "This could have important implications for public health initiatives. Intervening and modifying unhealthy behaviours earlier might have a greater impact than during adolescence. Health promotion strategies targeting higher risk youth as they enter secondary school might be the best way to prevent or delay the onset of obesity, and might have better public health outcomes over the longer term."
https://www.sciencedaily.com/releases/2018/02/180227111651.htm