Kristina Langnäse

Parental overweight, socioeconomic status and high birth weight are the major determinants of overweight and obesity in 5–7 y-old children: baseline data of the Kiel Obesity Prevention Study (KOPS)

OBJECTIVES: To identify the major risk factors of overweight and obesity in prepubertal children.DESIGN: Cross-sectional study.SETTING: In all, 32 primary schools in Kiel (248 000 inhabitants), northwest Germany.SUBJECTS: A total of 2631 5–7-y-old German children and their parents.MAIN OUTCOME MEASURES: Weight status, socio-economic status (SES), parental overweight, dietary intake, activity, inactivity and further determinants (birth weight, breast feeding, nutritional status of siblings) of the children.RESULTS: The prevalence of overweight (≥90th BMI percentile of reference) was 9.2% in boys and 11.2% in girls, respectively. Considered univariately, family-, environment- and development-related determinants showed some relations to overweight and obesity. In multivariate analyses parental overweight, a low SES as well as a high birth weight were the strongest independent risk factors of overweight and obesity in children. Additionally, there were sex-specific risk factors: parental smoking and single households were risk factors in boys, whereas a low activity was associated with obesity in girls. Birth weight was associated with obesity, but not with overweight. The prevalence of obesity reached 29.2% in boys and 33.4% in girls with all the three main risk factors.CONCLUSIONS: Overweight families of low SES have the highest risk of overweight and obese children. Future prevention programmes must also take into account sex-specific risk factors.

Prevention of obesity--more than an intention. Concept and first results of the Kiel Obesity Prevention Study (KOPS).

OBJECTIVE: Obesity prevention is necessary to address the steady rise in the prevalence of obesity. Although all experts agree that obesity prevention has high priority there is almost no research in this area. The effectiveness of different intervention strategies is not well documented. There is also no structured framework for obesity prevention.DESIGN: Based on (i) our current and limited knowledge and (ii) the idea that prevention of childhood obesity is an effective treatment of adult obesity, the Kiel Obesity Prevention Study (KOPS) was started in 1996. Concept, intervention strategies and first results of KOPS are reported in this paper. KOPS is an ongoing 8 y follow-up study. We first enrolled a large scale cohort of 5 to 7-y-old children, providing sufficient baseline data. KOPS allows further analyses of the role of individual risk factors as well as of long-term effectiveness of different intervention strategies.RESULTS: From 1996 to 1999 a representative group of 2440 5 to 7-y-old children was recruited (ie 30.2% of the total population of 5 to 7-y-old children examined by the school physicians) and a full data set was obtained from 1640 children. Of the children, 340 (20.7%) were considered as overweight and obese, 1108 children (67.6%) were normal weight, and underweight was found in 192 children (11.7%). Of the normal-weight children, 31% or 346 (21.1% of the total population) were considered to have a risk of becoming obese. Cross-sectional data provided evidence that (i) there is an inverse social gradient in childhood overweight as well as health-related behaviours and (ii) parental fatness had a strong influence on childhood overweight. We observed considerable changes in health-related behaviours within 1 y after combined ‘school-’ and ‘family-based’ interventions. Interventions aimed to improve health-related behaviours had significant effects on the age-dependent increases in median triceps skinfolds of the whole group (from 10.9 to 11.3 mm in ‘intervention schools’ vs from 10.7 to 13.0 mm in ‘control schools’, P<0.01) as well as in percentage fat mass of overweight children (increase by 3.6 vs 0.4% per year without and with intervention, respectively; P<0.05).CONCLUSION: First results of KOPS are promising. Besides health promotion, a better school education and social support seem to be promising strategies for future interventions.

Social class differences in overweight of prepubertal children in northwest Germany.

OBJECTIVES: To assess social class differences in overweight and health-related behaviours in 5–7-y-old German children.DESIGN: Cross-sectional study.SETTING: Twenty-nine primary schools in Kiel (inhabitants: 248 000), northwest Germany.SUBJECTS: A total of 1350 German 5–7-y-old children and their parents.Main outcome measures: Body mass index (BMI), fat mass and health-related behaviours of the children. Self-reported height and weight of their parents, parental school education as a measure of social class.RESULTS: The prevalence of overweight (≥90th percentile of reference) was 18.5%. There was an inverse social gradient (P<0.01): the highest fat mass was observed in children from low social class. The odds ratios for overweight reached 3.1 (CI 1.7–5.4) in boys and 2.3 (CI 1.2–4.3) in girls, respectively (low vs high social class). Overweight parents (BMI≥25 kg/m2) were more likely to have overweight children. Parental overweight enhanced the inverse social gradient. The prevalence of overweight was 37.5% (low social class) vs 22.9% (high social class) in children from overweight parents, respectively. There was an inverse social gradient in unhealthy behaviours. Parental BMI and physical inactivity were independent risk factors of overweight in children.CONCLUSIONS: In 5 to 7-y-old children overweight and health-related behaviours are inversely related to social class. Parental overweight enhanced the risk of childhood overweight. The familial effect on body weight is most pronounced in children with low social class. Preventive measures should specifically tackle ‘overweight families’ from low social class.

Prevention of obesity – is it possible?

Obesity prevention is necessary to address the steady rise in the prevalence of obesity. Although all experts agree that obesity prevention has high priority there is almost no research in this area. There is also no structured framework for obesity prevention. The effectiveness of different intervention strategies is not well documented. Regarding universal prevention little rigorous evaluation has been carried out in larger populations. Obesity prevention has been integrated into community‐wide programmes preventing coronary heart disease. Although effective with respect to reduction in cardiovascular risk factors these programmes did not affect mean body mass index (BMI) of the target populations. Selective prevention directed at high risk individuals (e.g. at children with obese parents) exhibited various degrees of effectiveness. However, at present, definitive statements cannot be made because of the limited number of studies as well as limits in study design. Finally, targeted prevention produced promising results in obese children when compared to no treatment. However, there are only very few long‐term follow‐up data. There is no clear idea about comprehensive interventions studying combinations of different strategies. It is tempting to speculate that predictors of treatment outcome (e.g. psychological and sociodemographic factors) may also serve as barriers to preventive strategies, but this has not yet been investigated. Taken together, obesity prevention should become a high priority research goal. First results of obesity prevention programmes are promising. As well as health promotion and counselling, better school education and social support appear to be promising strategies for future interventions.

Four-year follow-up of school-based intervention on overweight children: the KOPS study.

Objective: To evaluate the 4‐year outcome of a school‐based health promotion on weight status as part of the Kiel Obesity Prevention Study (KOPS).

Physical activity and diet in 5 to 7 years old children

OBJECTIVE To assess the possible associations between physical activity, diet, social state and overweight in children. DESIGN Cross-sectional study on 1468 children aged between 5 and 7 years old in Kiel, northwest Germany. METHODS Assessment of physical activity and social factors by a questionnaire, food frequency record, body composition analysis by anthropometrics and bioelectrical impedance analysis. RESULTS 23% of our children were overweight or obese. Low levels of physical activity (as assessed by TV viewing time) were associated with increased body mass index and a higher prevalence of overweight. TV-viewing of more than 1 h per day was associated with a high consumption fast food, sweets, chips and pizza whereas fruits and vegetables were less frequently consumed. Overweight, inactivity and unhealthy eating habits were seen more frequently in families with a low social status. CONCLUSIONS In 5 to 7 years old children, overweight is associated with physical inactivity, unhealthy eating habits and a low social status. Primary prevention efforts should be directed to low income families.

Nutrition and health in an adult urban homeless population in Germany

OBJECTIVE To assess the association between nutrition and health in an adult urban homeless population. DESIGN Cross-sectional--nutritional state (body mass index (BMI), triceps skinfold (TSF), upper arm circumference), dietary habits (food frequency), socio-demographic data and self-stated diseases were assessed. SETTING Four sites for homeless people in Kiel and Hamburg, Germany. SUBJECTS Sample of 75 homeless people (60 males, 15 females) aged 19-62 years. RESULTS A lack of food was not found in the majority of the homeless. Seventy-six per cent of the study population showed a normal dietary pattern. Critical food groups were fresh fruit and vegetables, rice and noodles. However, 52 or 29% of the homeless were malnourished (i.e. they were below the 25th or 5th percentile of arm muscle area). In addition, 22.7% of the homeless were obese (i.e. BMI>30 kg m-2 and/or TSF>90th percentile). Almost two-thirds of the population suffered from at least one chronic disease (prevalence of nutrition-related disorders 33.3%, gastrointestinal disorders 32.0%, dental diseases 22.7%, psychiatric disorders 18.7%, wasting diseases 6.7%). Smoking (prevalence rate 82%), drinking alcohol (51%) and drug abuse (20%) were frequent among homeless people. Food intake was not related to nutritional state, the prevalence of chronic diseases or addiction habits. By contrast, a poor nutritional state was associated with drug abuse and the prevalence of wasting diseases. CONCLUSION Prevention of nutritional problems should be directed to health-related problems such as the prevention or treatment of chronic diseases and addiction habits.

Inconsistencies in bioelectrical impedance and anthropometric measurements of fat mass in a field study of prepubertal children.

The present study examined the consistency of bioelectrical impedance analysis (BIA) and anthropometric measurements in body composition analysis in a field study of prepubertal children using a representative group of 2286 5-7-year-old children from Kiel, north-west Germany. Body composition was assessed using anthropometric measures (A; four skinfolds) and BIA. Various published algorithms (according to Lohmann (1986) and Deurenberg et al. (1990) for A, Kushner et al. (1992), Schaefer et al. (1994) and Wabitsch et al. (1996) for BIA and Goran et al. (1996) for a combined approach) were used to estimate body composition. Using A resulted in a sum of four skinfolds varying between age-dependent median values of 24.0 and 28.2 mm in boys and 30.5 and 33.3 mm in girls. When fat mass (FM) was calculated from A, age- and algorithm-dependent differences in median values were observed, with values varying between 8.5 and 14.6% for boys and 1.11 and 14.9% for girls. Using different algorithms (Lohmann (1986) v. Deurenberg et al. (1990)) only minor inconsistencies were observed. BIA-derived resistance index (height2/resistance) varied between 18.8 and 24.4 cm2/omh for boys and 17.1 and 19.0cm2/ohm for girls. Using four different algorithms to estimate FM from BIA data resulted in high intra-individual variances in percentage FM (from 13.8 to 33.4) as well as in the prevalence of overweight (from 14.7 to 98.4% for boys and from 42.3 to 98.5 % for girls). Data obtained using the different BIA algorithms showed some, or even marked, inconsistencies as well as systematic deviations (an overestimation of FM at low percentage FM, Schaefer et al. (1994) v. Wabitsch et al. (1996)). When comparing BIA with A, BIA systematically overestimated FM. The differences between the results were influenced by BMI, gender and height. Considerable inconsistencies were observed at low BMI (<10th percentile) for girls and for small children. Although the within-observer as well as between-observer CV for both techniques are acceptable, we recommend caution in relation to the algorithms used for data analysis. The use of an interchange table of percentage FM derived from different algorithms for different percentile groups of skinfold thicknesses is recommended.

The Influence of Socio-Economic Status on the Long-Term Effect of Family-Based Obesity Treatment Intervention in Prepubertal Overweight Children.

The objective of this paper is to assess the effect of the socio‐economic status (SES) on long‐term outcomes of a family‐based obesity treatment intervention in prepubertal children. A total of 52 overweight and 26 normal weight children were investigated. Nutritional status, intake of fruit, vegetables and low fat foods, in‐between meals, sports club membership, frequency of exercise and daily television viewing were measured before intervention (t0 and after a mean period of 1.3 years (t1. The result obtained indicate that a low SES may serve as a barrier against family‐based intervention. The data provide evidence for the idea that there is need for social stratification of future measures of health promotion within families.

Adipositas: Eine Herausforderung für Public Health

Angesichts des inzwischen epidemischen Ausmaβes von Übergewicht und Adipositas sowie auch deren Begleit- und Folgeerkrankungen sind sowohl eine nachhaltig wirksame Behandlung als auch eine Public Health-Strategie zur Prävention der A dipositas notwendig. Beide Strategien sind komplementär und nicht konkurrierend. Ohne eine gleichzeitige Public Health-Strategie bleiben die Erfolge der individuellen Behandlung begrenzt. Adipositas ist nicht nur ein individuelles Problem, es ist aueh ein Problem unserer Gesellschaft. Wir sind heute eine „übergewichtige Gesellschaft“ welche sich auf dem Weg in eine „adipöse Gesellschaft“ befindet. Es ist an der Zeit, unsere Gesundheit in den Mittelpunkt der öffentlichen Auseinandersetzung zu stellen. Wir brauchen nationale und verschiedene Bereiche unserer Gesellschaft miteinbeziehende Aktionen zur Gesundheitsförderung und Prävention. Diese bedörfen der Einbindung von Politikern und verantwortlichen Interessenvertretern. Angehörige von Gesundheitsberufen sollten die Anwaltschaft für eine solche Aktion übernehmen.AbstractFaced with the obesity epidemic there is need for therapy as well as public health strategies for health promotion and obesity prevention. Both strategies add to each other, none should be done in isolation. Obesity is not only an individual problem. It is also a problem of our society. We are now an overweight society which is on the way to a fat society. There is urgent need for a national public health strategy for population wide prevention of overweight and obesity. Health authorities as well as politicians are asked to support public health strategies creating a supportive environment for making healthy choices.