Aviva Must

Long-term morbidity and mortality of overweight adolescents : a follow-up of the Harvard growth study of 1922 to 1935

BACKGROUND Overweight in adults is associated with increased morbidity and mortality. In contrast, the long-term effect of overweight in adolescence on morbidity and mortality is not known. METHODS We studied the relation between overweight and morbidity and mortality in 508 lean or overweight adolescents 13 to 18 years old who participated in the Harvard Growth Study of 1922 to 1935. Overweight adolescents were defined as those with a body-mass index that on two occasions was greater than the 75th percentile in subjects of the same age and sex in a large national survey. Lean adolescents were defined as those with a body-mass index between the 25th and 50th percentiles. Subjects who were still alive were interviewed in 1988 to obtain information about their medical history, weight, functional capacity, and other risk factors. For those who had died, information on the cause of death was obtained from death certificates. RESULTS Overweight in adolescent subjects was associated with an increased risk of mortality from all causes and disease-specific mortality among men, but not among women. The relative risks among men were 1.8 (95 percent confidence interval, 1.2 to 2.7; P = 0.004) for mortality from all causes and 2.3 (95 percent confidence interval, 1.4 to 4.1; P = 0.002) for mortality from coronary heart disease. The risk of morbidity from coronary heart disease and atherosclerosis was increased among men and women who had been overweight in adolescence. The risk of colorectal cancer and gout was increased among men and the risk of arthritis was increased among women who had been overweight in adolescence. Overweight in adolescence was a more powerful predictor of these risks than overweight in adulthood. CONCLUSIONS Overweight in adolescence predicted a broad range of adverse health effects that were independent of adult weight after 55 years of follow-up.

Social and economic consequences of overweight in adolescence and young adulthood.

BACKGROUND AND METHODS Overweight in adolescents may have deleterious effects on their subsequent self-esteem, social and economic characteristics, and physical health. We studied the relation between overweight and subsequent educational attainment, marital status, household income, and self-esteem in a nationally representative sample of 10,039 randomly selected young people who were 16 to 24 years old in 1981. Follow-up data were obtained in 1988 for 65 to 79 percent of the original cohort, depending on the variable studied. The characteristics of the subjects who had been overweight in 1981 were compared with those for young people with asthma, musculoskeletal abnormalities, and other chronic health conditions. Overweight was defined as a body-mass index above the 95th percentile for age and sex. RESULTS In 1981, 370 of the subjects were overweight. Seven years later, women who had been overweight had completed fewer years of school (0.3 year less; 95 percent confidence interval, 0.1 to 0.6; P = 0.009), were less likely to be married (20 percent less likely; 95 percent confidence interval, 13 to 27 percent; P < 0.001), had lower household incomes (

Risks and consequences of childhood and adolescent obesity

6,710 less per year; 95 percent confidence interval,

Physical activity and sedentary behavior: A review of longitudinal studies of weight and adiposity in youth.

3,942 to

A Community Intervention Reduces BMI z-score in Children: Shape Up Somerville First Year Results

9,478; P < 0.001), and had higher rates of household poverty (10 percent higher; 95 percent confidence interval, 4 to 16 percent; P < 0.001) than the women who had not been overweight, independent of their base-line socioeconomic status and aptitude-test scores. Men who had been overweight were less likely to be married (11 percent less likely; 95 percent confidence interval, 3 to 18 percent; P = 0.005). In contrast, people with the other chronic conditions we studied did not differ in these ways from the nonoverweight subjects. We found no evidence of an effect of overweight on self-esteem. CONCLUSIONS Overweight during adolescence has important social and economic consequences, which are greater than those of many other chronic physical conditions. Discrimination against overweight persons may account for these results.

Morbidity and mortality associated with elevated body weight in children and adolescents.

This report reviews the risks and consequences associated with childhood and adolescent obesity. Although no consensus definition of childhood obesity exists, the various measures encountered in the literature are moderately well correlated. The paper is organized in three parts. The first section reviews childhood obesity sequelae that occur during childhood. These short-term risks, for orthopedic, neurological, pulmonary, gasteroenterological, and endocrine conditions, although largely limited to severely overweight children, are becoming more common as the prevalence of severe overweight rises. The social burden of pediatric obesity, especially during middle childhood and adolescence, may have lasting effects on self-esteem, body image and economic mobility. The second section examines the intermediate consequences, such as the development of cardiovascular risk factors and persistence of obesity into adulthood. These mid-range effects of early obesity presage later adult disease and premature mortality. In the final section, the small body of research on the long-term morbidity and mortality associated with childhood obesity is reviewed. These studies suggest that risk of cardiovascular disease and all-cause mortality is elevated among those who were overweight during childhood. The high prevalence and dramatic secular trend toward increasing childhood obesity suggest that without aggressive approaches to prevention and treatment, the attendant health and social consequences will be both substantial and long-lasting.

Body mass index in children and adolescents: considerations for population-based applications

Aim:To review the published prospective observational studies of the relationship of physical activity and sedentary behavior with the development of overweight and adiposity, with an emphasis on methodologic issues.Methods:Sample size, population studied, length of follow-up, assessment of exposure (physical activity, inactivity, or sedentary behavior), assessment of outcome (relative weight, overweight, % body fatness, adiposity), statistical approach, and main findings were extracted, summarized, and key methodological issues highlighted.Results:In total, 17 studies of physical activity and 15 studies of inactivity/sedentary behavior were identified; as these were not mutually exclusive, 20 unique studies were reviewed. Results were mixed, with most studies showing an inverse association of physical activity with weight or fatness outcomes and/or a direct association of inactivity/sedentary behavior with weight or fatness outcomes. The effects identified were generally of small magnitude. Imprecise measurement of activity exposures likely weakens the observed relationships. Most studies used a pre–post design and had limited duration of follow-up (≤2 y). Studies with longer and more frequent follow-up did not always use the most advantageous statistical approach.Conclusions:On balance, the available evidence from prospective observational studies suggests that increased physical activity and decreased sedentary behavior are protective against relative weight and fatness gains over childhood and adolescence. In addition to improved measurement methods, longer and more frequent follow-up as well as truly longitudinal analysis methods would help establish these important prevention and intervention targets, and identify subgroups or development periods where interventions would likely be effective.

Adolescent obesity and risk for subsequent major depressive disorder and anxiety disorder: prospective evidence.

Objective: The objective was to test the hypothesis that a community‐based environmental change intervention could prevent weight gain in young children (7.6 ± 1.0 years).

Active play and screen time in US children aged 4 to 11 years in relation to sociodemographic and weight status characteristics: a nationally representative cross-sectional analysis

The immediate and long-term risks associated with overweight in childhood and adolescence are best considered separately. Short-term mortality is rarely associated with overweight of the young. The greatest health burden of overweight in children and adolescents arises from long-term consequences. Long-term follow-up studies of children and adolescents indicate that the risk of adult overweight is about twofold greater for individuals who were overweight as children compared with individuals who were not overweight. Persistence is greatest for extreme overweight and when overweight is carried through late adolescence. The few studies of long-term health consequences in adolescent males find that even moderate overweight is associated with excess mortality in adulthood. Females have been studied infrequently; it appears that overweight confers long-term health risks, but these are less severe. However, because of concern about weight preoccupation in this age group and lack of data of sufficient precision to support specific recommendations, weight guidelines for children and adolescents are not now warranted.

Food Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children

Body mass index in children and adolescents: considerations for population-based applications