Backgroud: Body mass index (BMI) for gender and age and percentage-weight-for-height (PWH) for gender and height have been frequently used to diagnose childhood obesity. However, few studies have examined the optimal cutoff of percent body fat (%BF) to predict metabolic abnormalities in obese children. Methods: One thousand fi fteen obese children aged 10 to 15 years were enrolled in this study. The %BF cutoff values were calculated by ROC analysis for metabolic abnormalities. We also calculated %BF cutoff values corresponding to a BMI of > 85th or 95th percentile for gender and age and a PWH of > 120% for gender and height based on the 2007 Korean children and adolescents growth standard chart. To defi ne metabolic abnormalities in children, we used the criteria of metabolic syndrome recommended by International Diabetes Federation consensus for children and adolescents. Results: The %BF cutoff corresponding to the group having more than one metabolic abnormality in this study population were 38.4% (sensitivity 40.1%, specifi city 84.4%) in total, 38.4% (sensitivity 35.4%, specifi city 84.8%) in boys and 39.5% (sensitivity 38.9%, specifi city 90.9%) in girls. The %BF cutoff values corresponding to a BMI ≥ 95 percentile were 38.1% (sensitivity 50.5%, specifi city 72.7%), a BMI ≥ 85 percentile were 34.5% (sensitivity 69.3%, specifi city 74.2%), and a PWH ≥ 120% were 36.4% (sensitivity 72.3%, specifi city 64.4%) in total. Conclusion: The optimal cutoff value of percent body fat to predict metabolic abnormalities in obese children may be 38.4% (boys 38.4, girls 39.5%) and we suggest 34.5% as a cutoff value of %BF for screening childhood obesity.
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Background: To investigate the association between childhood obesity and its risk factors according to specific childhood developmental stages. Methods: We performed an analysis of data for 1922 children and adolescents aged 2 to 18 years obtained from the Third Korea National Health and Nutrition Examination Survey conducted in 2005. Weight and height were measured by trained interviewers. Childhood obesity was defined as BMI ≥95th percentile of the BMI cut-off point based on the Korean child growth curve. Data on socioeconomic characteristics such as age, education, occupation, income, physical activity and time spent watching television were collected using a well-established questionnaire and/or interview. Results: The prevalence of obesity defined by using the Korean child growth curve was 4.1% in children aged 2 to 6, 6.3% in children aged 7 to 12, and 8.7% in adolescents aged 13 to 18. In the multiple logistic regression model, parental obesity, and time spent watching television were associated with increased risk of obesity in children aged 2∼6. Parental obesity, family income level, birth weight, and time spent watching television were positively associated with obesity in children aged 7∼12. In adolescents aged 13∼18, participation in vigorous physical activity and attempts to control weight were associated with adolescent obesity. Conclusion: The prevalence and risk factors of childhood obesity vary substantially according to developmental stage. Differential approaches are needed for effective control of childhood obesity.
Background: Childhood obesity is becoming more prevalent, associated with a variety of adverse consequences which leads to adulthood obesity. Although diagnosis is usually made by body mass index, there is neither a cutoff point for the percentage body fat nor abdominal circumference. The aim of this study was to identify each cutoff point for both measures. Methods: The measurement of height, weight, abdominal circumference and percentage body fat was performed through manual assessment and bioelectrical impedance analysis for 4,242 subjects aged 11 in Gunpo City, South Korea. The cutoff point for body fat percentage and abdominal circumference is set to maximize the sum of sensitivity and specificity for detecting obesity and overweight using the Receiver Operating Characteristics (ROC) curve. Results: The mean percentage body fat was 13.6±6.9% for boys and 19.4±5.3% for girls. The mean abdominal circumference of boys was 68.0±9.1 cm, and that of girls was 64.3±7.7 cm. The cutoff point of percentage body fat for obesity was 21.8% in boys and 24.5% in girls. The prevalence of obesity was 15.2%, 16.7% for males and females, respectively. The abdominal circumference cutoff for obesity was 76.9 cm in boys and 70.7cm in girls. Based on that, the prevalence of obesity was 19.7% for boys and 20.0% for girls, which was higher than what was identified by body mass index, as in the case of body fat percentage. Conclusion: The cutoffs of body fat percentage and abdominal circumference in one city of Gyeonggi Province were lower than those suggested in the previous studies. (J Korean Acad Fam Med 2008;29:492-498)
Background Children of obese parents are more likely to be obese themselves. Parental lifestyle habits could induce or aggravate children's obesity. This study was conducted to assess the relationship between parental lifestyle habits and children's overweight. Methods: Children who were enrolled in this study were first grade students from elementary schools in Gwacheon and Seoul. A total of 121 children (50 overweight children and 71 normal weight children) and their parents underwent anthropometric measurements and also were surveyed by a questionnaire. Results: The children of obese parents were more likely to be diagnosed as overweight compared to the children whose parents were normal weight (Father: P=0.037, Mother: P=0.001). Among the paternal lifestyle habits, hours of watching TV or computer usage (adjusted odd ratio =2.08, 95% CI=0.90∼4.80) and eating frequency of soda, ice cream, cake and chips (adjusted OR=5.77, 95% CI=1.65∼20.22) were found to be related to their children being overweight. Among the maternal lifestyle habits, hours of watching TV or computer usage (adjusted OR=2.35, 95% CI=0.99∼5.58), the frequency of eating breakfast (adjusted OR: 2.48, 95% CI=1.07∼5.75) and the frequency of overeating (adjusted OR: 2.15, 95% CI=0.91∼5.11) were found to be related to their children being overweight. Additive adjustment of children's lifestyle habits made the relationship between maternal lifestyle habits and children's overweight reduced. However, the odds ratio of paternal lifestyle habits was not reduced. Conclusion: Parental obesigenic lifestyle habits were related to children's overweight. Maternal lifestyle habits could affect her children's weight via an effect on her children's lifestyle habits. (J Korean Acad Fam Med 2008; 29:395-404)
Background TV viewing and computer use are sedentary behaviors and recent surveys report that they are associated with obesity in children. Association of these activities with obesity or obesity related lifestyles was investigated in this study. Methods: Using the database of questionnaires and physical check-ups among 4th to 6th grade elementary school students in Incheon, the association of television viewing and internet using time with obesity and obesity related factors (dietary habits, and physical activities) were investigated. A total of 2,750 students (1,100 normal weighted/1,650 overweight or obese) were included. Results: In the multiple analyses of computer using time among the boys and girls in weekdays and weekends respectively, according to their obesity degree, except for overweight and obese boys in weekends (P＜0.001), there were no significant differences examined. Multiple logistic regression revealed that children who watched TV more than 2 hours per day ate faster (OR 1.27), had breakfast more irregularly (OR 1.41) and ate vegetables more rarely (OR 1.53). The children who used computer more than 1 hour per day in weekdays were faster eaters (OR 1.38) and hardly ate fruits (OR 1.26) or vegetables (OR 1.60). In weekends, the children who spent time more than 90 minutes in the computer were faster to eat (OR 1.46), more snack eating (OR 1.22), less vegetable consuming (OR 1.59) and more obese (OR 1.46, 95%CI 1.24∼1.73) compared to the others. Conclusion: TV viewing and computer use were associated with several obesity related lifestyles in children. (J Korean Acad Fam Med 2008;29:182-188)
Background Bioelectrical impedance analysis (BIA) is frequently used to diagnose obesity in clinical setting, but the usefulness of BIA in children is not become known accurately. We analyzed the usefulness of BIA and anthropometric measurement compared with Dual-energy X-ray absorptiometry (DXA) as a diagnostic tool of childhood obesity. Methods: 205 volunteer primary and middle school children were recruited. We measured weight and height, and analyzed the body composition by BIA and DXA. By paired t-test and Bland-Altman plots, mean difference and limit of agreement were calculated between DXA and BIA according to sex and age groups. Sensitivity and specificity were displayed with the gold standard of PBF above 35% by DXA. Results: There was significantly positive correlation between DXA and BIA in fat mass (FM) (r=0.982, P＜0.001), fat free mass (FFM) (r=0.990, P＜0.001), and percent body fat (PBF) (r=0.956, P＜0.001). Mean difference between DXA and BIA in FM, FFM, and PBF were 0.4⁑1.4 kg (P＜0.001), 0.6⁑1.3 kg (P＜0.001), and 0.5⁑2.8% (P=0.016), respectively. Limit of agreement in FM, FFM, and PBF were 0.4⁑2.7 kg, 0.6⁑2.5 kg, and 0.5⁑5.5%, respectively. The most sensitive method of diagnosis of obesity was Korean BMI standards for 85 percentile (94.7%) and IOTF BMI 25 kg/m2 (94.7%). The sensitivity and specificity by BIA were 90.7% and 97.7%. Conclusions: BIA was not interchangeable with DXA. However because of higher diagnostic accuracy and correlation, it could be used to measure body composition as simple field method. We recommend Korean BMI standards for 85 percentile or IOTF BMI 25 kg/m2 as the screening test for diagnosis of Korean childhood obesity. (J Korean Acad Fam Med 2007;28:523-531)
Background Recently, the prevalence of childhood obesity has increased dramatically, but the cause still remains incompletely understood. The goal of this study was to present a direction for treatment and prevention of childhood obesity on the basis of the data of physical activity energy expenditure, inactive time and dietary habits of Korean children. Methods: A total of 56 children were selected from 8 elementary schools in Seoul and Gwacheon-city. Children's physical activity pattern and dietary habits were obtained by questionnaire. The children wore accelerometer on their wrists from Friday to Tuesday over the whole weekend. Then, we calculated the activity energy expenditure using the activity counts recorded on the accelerometer. Results: Neither the physical activity energy expenditure (kcal/kg) nor the activity pattern showed a significant difference between the normal weight group and the overweight group. The overweight children spent more time watching TV and using the computer. The overweight group did not have breakfast and ate much more and faster in terms of dietary habit. Conclusion: This study suggests that bad habituations in diet and increase of inactivity time can play more important role than physical activity in causing overweight in 7-year-old children. (J Korean Acad Fam Med 2007;28: 195-203)
Background : The purpose of this study was to find the factors associated with becoming obese children during the past 2 years in 6th grade children of elementary school and then to evaluate the high risk groups for childhood obesity.
Methods : The 738 children from May to June, 2001 in 6th grade of 5 elementary schools in Busan were the subjects of this study. The children's height and weight in 4th grade and 6th grade were obtained from school health records. We calculated the body mass index in 4th and 6th grades and classified into 3 weight groups (normal, at risk for obesity, and obese) according to the age and sex-specific BMI established by the Korean Academy of Pediatrics. If children's weight group in 4th grade was changed to heavier weight group in 6th grade, we defined it as increased group. Otherwise, we defined it as non-increased group. The association between the increase in weight group and parental and children's characteristics were analyzed by χ2-test, χ2-test for the trend, t-test, ANOVA and multiple logistic regression.
Results : Among the total, 3.3% of children with normal weight and 16.9% of children at the risk for obesity in 4th grade were transformed to increased group in 6th grade, respectively (P＜0.001). Children who had excessive appetite (P＜0.001), watched TV greater than or equal to 2 hours per day (P=0.004) or had an obese father (P=0.044) were more likely to become increased group. After adjusting for father's obesity, appetite and TV watching time in children, the odds ratio of transforming to increased group after 2 years in children at risk for obesity or in obese child in 4th grade was 2.5 (95% CI: 1.09∼5.55) compared to children with normal weight. Children having excessive appetite were 3.2 times (95% CI: 1.42∼7.01) more likely to become the increased group after adjusting for father's obesity, TV watching time and weight in 4th grade. Children watching TV greater than or equal to 2 hours/day was 2.8 times (95% CI: 1.27∼6.18) more likely to become increased group after adjusting for father's obesity, appetite and weight in 4th grade.
Conclusion : The risk of becoming obese was higher in children at risk for obesity or obese children in those with excessive appetite or those who have watched TV ≥2 hours/day for the past two years. These findings suggest promotion of educational plan to prevent childhood obesity.
Background : The purpose of this study was to find changes in percentage obesity and the factors associated with the changes after its treatment in obese children and adolescents.
Methods : A total of 42 obese children from 3- to 17- year-olds (males 60%) were enrolled in an obesity treatment program at least 3 times. They were provided with an individual weight control program that included dietary, activity, and behavioral change information. The paired t-test, Kruskal-Wallis test, Mann-Whitney test, and linear regression were used for analyses.
Results : The means of BMI, percent body fat, and percent obesity were 27.4 kg/m2, 39.4%, and 52.3%, respectively. Among them, 85.3% of obese children had one or more abnormalities on biochemical tests and 32.4% of them had 3 or more abnormalities. There was a significant reduction in weight (1.4 kg), BMI (1.1 kg/m2), percent body fat (1.8%) and percent obesity (7.1%), whereas height increased significantly by 1.3 cm after the treatment. The decrease in percent obesity was associated significantly with the number of follow-up, the number of accompanied biochemical abnormality, and the duration of treatment. The decrease in percent obesity was 12.9% among obese children who were followed-up 6 times or more, by 12.2% among those who did not accompany biochemical abnormality and by 13.3% among those who were retained in the program for 76 days or over. However, the change in % obesity was not associated with sex, age groups (＜12, ≥12-year-old), severity of obesity and parental obesity. The percent obesity decreased by 5.2% as the number of follow-up (n=3/4, 5/6∼17) increased after adjusting for sex, age groups and the number of biochemical abnormalities. The number of follow-up also explained 38% for the variance of change in percent obesity in that model.
Conclusion : Continuous program retention was an effective factor to reduce percent obesity. Therefore, further investigation is needed to develop methods to enforce program retention.
Background : Recently, childhood obesity has increased and became a major health concern in Korea. The aim of this study is to measure the prevalence of childhood obesity in rural city and to explore the risk factors of obesity including obesity of parents.
Methods : We made 13 convenience samples of elementary school and attached kindergarten located in Asan-city, ChungNam, in 2001. We surveyed children's height, weight, and risk factors of childhood with a self-recorded questionnaire answered by parents. Children's obesity was evaluated by ideal body weight which is defined as the 50th percentile of weight for Korean children of the same height and sex in 1998. The criteria of parents' obesity was over 25of BMI.
Results : The subjects were 1,558 children among 1870 respondents. The prevalence of childhood obesity was 9.4% and that of male children was 11.0% and that of female children was 7.9%. The older in both male and female, the higher the obesity prevalence was. Mother's age were significantly higher in obese children. Birth weight and family income were also significantly higher in obese children. Birth weight and family income were also significantly higher in obese children. There was a higher family history of obesity in obese children. Risk factors associated with childhood obesity were gender, age of child, mother's age, birth weight, number of siblings, family income, and family history of obesity.
Conclusion : The prevalence of childhood obesity in Asan-city was 9.4%. Children whose father, mother, or parents were obese tended to be obese.
Background : The purpose of this study was to provide useful information for prevention and management of childhood obesity in a school-based setting.
Methods : One thousand and 981 elementary children from 2 different elementary schools in Seoul were studied. The survey concerning the risks of childhood obesity was carried out by having parents answer a questionnaire.
Results : The prevalence of childhood obesity was 18.1% showing significantly higher rate in boys than in girls (P<0.05). It was found that obese children had a higher intake of fish and meat (P<0.05) and a lower intake of vegetables compared to the non-obese group (P<0.05). Obesity was more prevalent among children who frequently skipped breakfast (P<0.05) and also more prevalent among an only child (P<0.05). The obese children significantly spent more time watching TV (P<0.05). There was a higher family history of obesity, hypercholesterolemia and DM in the obese group (P<0.05). The factors which significantly attributed to childhood obesity were birth weight, parenteral BMI, and father's age (P<0.05).
Conclusion : The prevalence of childhood obesity was 18.1%. There was a statistically significant correlation between childhood obesity and gender, eating habit, time spent on watching TV, number of siblings, birth weight, parenteral BMI, father's age and family history such as obesity, hypercholesterolemia and DM.
Background : Although childhood obesity is an increasing public health problem in our society and a number of regimens have been developed and distributed for the treatment of adult obesity, few studies have focused on therapeutic programs for obese children. The objective of this study was to develop and measure the effects of an OPD-based childhood obesity control program.
Methods : The OPD-based childhood obesity control program was developed by reviewing the preexisting literature and consulting specialists. It was applied to the 4-6th grade obese(obesity index≥30%) children. The effects of intervention were assessed by the changes in obesity-related behavior, caloric and nutrient intake and exercise amount. The effects in the OPD-based group(group I) were also compared with the school-based group(group II)and the no intervention group(group III).
Results : The OPD-based program was developed based on behavioral modification principles such as self monitoring, stimulus control, positive reinforcement, social support, cognitive change and behavioral contracts and contained diet and exercise therapy. The developed program was applied to 34 pairs(child and mother) in the treatment group of which 21 pairs completed the basic sessions and 17 pairs completed the additional follow up session. Significant changes, decreases in obesity index were observed in the OPD-based group. No significant changes were found in the school-based group whereas increased degrees of obesity were found in the no intervention group. Obesity related behavior scores were significantly increased in both the OPD- and school-based groups. The children in both the OPD-based group showed significant decrease in dietary intake and increase in exercise amount.
Conclusion : Although it was a short-term treatment result, the OPD-based program was more effective than the school-based program in childhood obesity control. We suggest that a control program of comparable intensity and individualization as ours is required, for effective childhood obesity control.
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