John J. Reilly

Health consequences of obesity

The recent epidemic of childhood obesity1 has raised concern because of the possible clinical and public health consequences.2,3 However, there remains a widespread perception among health professionals that childhood obesity is a largely cosmetic problem, with minor clinical effects. No systematic review has yet focused on the diverse array of possible consequences of childhood obesity, though older non-systematic reviews are available.4,5 In addition, no review to date has considered the vast body of evidence on the health impact of childhood obesity which has been published recently. The aim of the present review was therefore to provide a critically appraised, evidence based, summary of the consequences of childhood obesity in the short term (for the child) and longer term (in adulthood).

Early life risk factors for obesity in childhood: cohort study

Abstract Objective To identify risk factors in early life (up to 3 years of age) for obesity in children in the United Kingdom. Design Prospective cohort study. Setting Avon longitudinal study of parents and children, United Kingdom. Participants 8234 children in cohort aged 7 years and a subsample of 909 children (children in focus) with data on additional early growth related risk factors for obesity. Main outcome measures Obesity at age 7 years, defined as a body mass index 3 95th centile relative to reference data for the UK population in 1990. Results Eight of 25 putative risk factors were associated with a risk of obesity in the final models: parental obesity (both parents: adjusted odds ratio, 10.44, 95% confidence interval 5.11 to 21.32), very early (by 43 months) body mass index or adiposity rebound (15.00, 5.32 to 42.30), more than eight hours spent watching television per week at age 3 years (1.55, 1.13 to 2.12), catch-up growth (2.60, 1.09 to 6.16), standard deviation score for weight at age 8 months (3.13, 1.43 to 6.85) and 18 months (2.65, 1.25 to 5.59); weight gain in first year (1.06, 1.02 to 1.10 per 100 g increase); birth weight, per 100 g (1.05, 1.03 to 1.07); and short (< 10.5 hours) sleep duration at age 3 years (1.45, 1.10 to 1.89). Conclusion Eight factors in early life are associated with an increased risk of obesity in childhood.

Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review

Background and objective:The last systematic review on the health consequences of child and adolescent obesity found little evidence on consequences for adult health. The present study aimed to summarize evidence on the long-term impact of child and adolescent obesity for premature mortality and physical morbidity in adulthood.Methods:Systematic review with evidence searched from January 2002 to June 2010. Studies were included if they contained a measure of overweight and/or obesity between birth and 18 years (exposure measure) and premature mortality and physical morbidity (outcome) in adulthood.Results:Five eligible studies examined associations between overweight and/or obesity, and premature mortality: 4/5 found significantly increased risk of premature mortality with child and adolescent overweight or obesity. All 11 studies with cardiometabolic morbidity as outcomes reported that overweight and obesity were associated with significantly increased risk of later cardiometabolic morbidity (diabetes, hypertension, ischaemic heart disease, and stroke) in adult life, with hazard ratios ranging from 1.1–5.1. Nine studies examined associations of child or adolescent overweight and obesity with other adult morbidity: studies of cancer morbidity were inconsistent; child and adolescent overweight and obesity were associated with significantly increased risk of later disability pension, asthma, and polycystic ovary syndrome symptoms.Conclusions:A relatively large and fairly consistent body of evidence now demonstrates that overweight and obesity in childhood and adolescence have adverse consequences on premature mortality and physical morbidity in adulthood.

Objective measurement of physical activity and sedentary behaviour: review with new data

Objective methods are being used increasingly for the quantification of the amount of physical activity, intensity of physical activity and amount of sedentary behaviour in children. The accelerometer is currently the objective method of choice. In this review we address the advantages of objective measurement compared with more traditional subjective methods, notably the avoidance of bias, greater confidence in the amount of activity and sedentary behaviour measured, and improved ability to relate variation in physical activity and sedentary behaviour to variation in health outcomes. We also consider unresolved practical issues in paediatric accelerometry by critically reviewing the existing evidence and by providing new evidence.

The ABC of Physical Activity for Health: A consensus statement from the British Association of Sport and Exercise Sciences

Absract Our understanding of the relationship between physical activity and health is constantly evolving. Therefore, the British Association of Sport and Exercise Sciences convened a panel of experts to review the literature and produce guidelines that health professionals might use. In the ABC of Physical Activity for Health, A is for All healthy adults, B is for Beginners, and C is for Conditioned individuals. All healthy adults aged 18–65 years should aim to take part in at least 150 min of moderate-intensity aerobic activity each week, or at least 75 min of vigorous-intensity aerobic activity per week, or equivalent combinations of moderate- and vigorous-intensity activities. Moderate-intensity activities are those in which heart rate and breathing are raised, but it is possible to speak comfortably. Vigorous-intensity activities are those in which heart rate is higher, breathing is heavier, and conversation is harder. Aerobic activities should be undertaken in bouts of at least 10 min and, ideally, should be performed on five or more days a week. All healthy adults should also perform muscle-strengthening activities on two or more days a week. Weight training, circuit classes, yoga, and other muscle-strengthening activities offer additional health benefits and may help older adults to maintain physical independence. Beginners should work steadily towards meeting the physical activity levels recommended for all healthy adults. Even small increases in activity will bring some health benefits in the early stages and it is important to set achievable goals that provide success, build confidence, and increase motivation. For example, a beginner might be asked to walk an extra 10 min every other day for several weeks to slowly reach the recommended levels of activity for all healthy adults. It is also critical that beginners find activities they enjoy and gain support in becoming more active from family and friends. Conditioned individuals who have met the physical activity levels recommended for all healthy adults for at least 6 months may obtain additional health benefits by engaging in 300 min or more of moderate-intensity aerobic activity per week, or 150 min or more of vigorous-intensity aerobic activity each week, or equivalent combinations of moderate- and vigorous-intensity aerobic activities. Adults who find it difficult to maintain a normal weight and adults with increased risk of cardiovascular disease or type 2 diabetes may in particular benefit from going beyond the levels of activity recommended for all healthy adults and gradually progressing towards meeting the recommendations for conditioned individuals. Physical activity is beneficial to health with or without weight loss, but adults who find it difficult to maintain a normal weight should probably be encouraged to reduce energy intake and minimize time spent in sedentary behaviours to prevent further weight gain. Children and young people aged 5–16 years should accumulate at least 60 min of moderate-to-vigorous-intensity aerobic activity per day, including vigorous-intensity aerobic activities that improve bone density and muscle strength.

Fundamental movement skills and habitual physical activity in young children.

PURPOSE To test for relationships between objectively measured habitual physical activity and fundamental movement skills in a relatively large and representative sample of preschool children. METHODS Physical activity was measured over 6 d using the Computer Science and Applications (CSA) accelerometer in 394 boys and girls (mean age 4.2, SD 0.5 yr). Children were scored on 15 fundamental movement skills, based on the Movement Assessment Battery, by a single observer. RESULTS Total physical activity (r=0.10, P<0.05) and percent time spent in moderate to vigorous physical activity (MVPA) (r=0.18, P<0.001) were significantly correlated with total movement skills score. Time spent in light-intensity physical activity was not significantly correlated with motor skills score (r=0.02, P>0.05). CONCLUSIONS In this sample and setting, fundamental movement skills were significantly associated with habitual physical activity, but the association between the two variables was weak. The present study questions whether the widely assumed relationships between motor skills and habitual physical activity actually exist in young children.

Total energy expenditure and physical activity in young Scottish children: mixed longitudinal study

Childhood obesity has been attributed to a decline in total energy expenditure (TEE). We measured TEE, physical activity, and sedentary behaviour in a representative sample of young children from Glasgow, UK, at age 3 years (n=78), and we did a follow-up study at age 5 years (n=72). Mean physical activity level (TEE/resting energy expenditure) was 1.56 (SD 0.39) at age 3 years and 1.61 (0.22) at age 5 years. Median time in sedentary behaviour was 79% of monitored hours at age 3 years (IQR 74-84) and 76% (71-80) at age 5 years. Median time spent in moderate to vigorous physical activity represented only 2% of monitored hours at age 3 years (IQR 1-4) and 4% at age 5 years (2-6). Modern British children establish a sedentary lifestyle at an early age.

Objectively measured physical activity and fat mass in a large cohort of children

Background Previous studies have been unable to characterise the association between physical activity and obesity, possibly because most relied on inaccurate measures of physical activity and obesity. Methods and Findings We carried out a cross sectional analysis on 5,500 12-year-old children enrolled in the Avon Longitudinal Study of Parents and Children. Total physical activity and minutes of moderate and vigorous physical activity (MVPA) were measured using the Actigraph accelerometer. Fat mass and obesity (defined as the top decile of fat mass) were measured using the Lunar Prodigy dual x-ray emission absorptiometry scanner. We found strong negative associations between MVPA and fat mass that were unaltered after adjustment for total physical activity. We found a strong negative dose-response association between MVPA and obesity. The odds ratio for obesity in adjusted models between top and the bottom quintiles of minutes of MVPA was 0.03 (95% confidence interval [CI] 0.01–0.13, p-value for trend <0.0001) in boys and 0.36 (95% CI 0.17–0.74, p-value for trend = 0.006) in girls. Conclusions We demonstrated a strong graded inverse association between physical activity and obesity that was stronger in boys. Our data suggest that higher intensity physical activity may be more important than total activity.

Breastfeeding and lowering the risk of childhood obesity

Breastfeeding might confer protection against obesity later in life, but the evidence is inconclusive. We tested the hypothesis that breastfeeding is associated with a reduced risk of obesity in a population-based sample of 32200 Scottish children studied at age 39-42 months in 1998 and 1999. Obesity was defined as body-mass index (BMI) at the 95th and 98th percentiles or higher. The prevalence of obesity was significantly lower in breastfed children, and the association persisted after adjustment for socioeconomic status, birthweight, and sex. The adjusted odds ratio for obesity (BMI > or = 98th percentile) was 0.70 (95% CI 0.61-0.80). Our results suggest that breastfeeding is associated with a reduction in childhood obesity risk.

Epidemic of obesity in UK children

Data from a nationally representative sample of 2630 English children show that the frequency of overweight ranged from 22% at age 6 years to 31% at age 15 years and that of obesity ranged from 10% at age 6 years to 17% at age 15 years.