Örjan Ekblom

Response of Severely Obese Children and Adolescents to Behavioral Treatment

OBJECTIVES To investigate whether the degree of obesity predicts the efficacy of long-term behavioral treatment and to explore any interaction with age. DESIGN A 3-year longitudinal observational study. Obese children were divided into 3 age groups (6-9, 10-13, and 14-16 years) and also into 2 groups (moderately obese, with a body mass index [BMI]-standard deviation [SD] score [or z score] of 1.6 to <3.5, and severely obese, with a BMI-SD score of ≥3.5). SETTING National Childhood Obesity Center, Stockholm, Sweden. PARTICIPANTS Children 6 to 16 years of age who started treatment between 1998 and 2006. INTERVENTION Behavioral treatment of obesity. MAIN OUTCOME MEASURE Change in BMI-SD score during 3 years of treatment; a reduction in BMI-SD score of 0.5 units or more was defined as clinically significant. RESULTS A total of 643 children (49% female children) met the inclusion criteria. Among the youngest moderately obese children, 44% had a clinically significant reduction in BMI-SD score (mean reduction, -0.4 [95% CI, -0.55 to -0.32]). Treatment was less effective for the older moderately obese children. Twenty percent of children who were 10 to 13 years of age and 8% of children who were 14 to 16 years of age had a reduction in BMI-SD score of 0.5 units or more; 58% of the severely obese young children showed a clinically significant reduction in BMI-SD score (mean reduction, -0.7 [95% CI, -0.80 to -0.54]). The severely obese adolescents showed no change in mean BMI-SD score after 3 years, and 2% experienced clinically significant weight loss. Age was found to be a predictor of a reduction in BMI-SD score (odds ratio, 0.68 units per year [95% CI, 0.60-0.77 units per year]). CONCLUSIONS Behavioral treatment was successful for severely obese children but had almost no effect on severely obese adolescents.

Prevalence and regional differences in overweight in 2001 and trends in BMI distribution in Swedish children from 1987 to 2001

Aims: This study was undertaken to assess current prevalence and regional differences of overweight in 2001 and changes in body mass index (BMI) distribution between 1987 and 2001 in Swedish adolescents. Methods: Comparison was made of two independent samples. For assessment of prevalence and regional differences in 2001, a total of 1732 subjects were used. For trend analyses a total of 1,949 children (516 and 1,470 in 1987 and 2001, respectively), aged 10, 13, and 16 years. Results: The prevalence of overweight in 2001 was between 21.7% and 13.3% for boys and girls aged 10 to 16 years and the prevalence of obesity was between 2.9% and 6.2%. Mean BMI as well as prevalence of overweight and obesity was higher in subjects from schools in smaller towns or from the countryside. Median BMI among adolescents changed from 1987 to 2001, most notably in 13- and 16-year-old children. The prevalence of overweight and obesity combined has changed more than 2.5-fold in children aged 10 to 16 years. In this study, the most pronounced elevation in BMI is found in the upper part of the BMI spectrum. This change is especially apparent in girls. Conclusion: The change in mean BMI and prevalence of overweight and obesity in children in this study is mainly due to the pronounced change in BMI at the upper end of the spectrum, indicating that the factors leading to overweight or obesity have changed in only a subgroup of the child population.

Mortality amongst participants in Vasaloppet: a classical long‐distance ski race in Sweden

Abstract. Farahmand BY, Ahlbom A, Ekblom Ö, Ekblom B, Hållmarker U, Aronson D, Persson Brobert G (Stockholm Center of Public Health, and Institute of Environmental Medicine; Institute of Physiology and Pharmacology, Karolinska Institutet, Stockholm; Mora Hospital; and Astrazeneca R&D, Södertälje; Sweden). Mortality amongst participants in Vasaloppet: a classical long‐distance ski race in Sweden.

Independent associations of physical activity and cardiovascular fitness with cardiovascular risk in adults.

Background Uncertainty still exists whether physical activity (PA) and cardiovascular fitness (CF) contribute separately to cardiovascular disease (CVD) risk. This study examined the associations of PA and CF on individual as well as clustered CVD risk factors. Design Cross-sectional. Methods Seven hundred and eighty-one men and 890 women, aged 20–65 years, from two random population-based samples of Swedish women and men were included. PA was assessed by questionnaire and CF was predicted by a submaximal cycle ergometry test. Waist circumference, blood pressure, and fasting levels of blood lipids were assessed and dichotomized by conventional cut-off points. Results Participants reporting high PA level benefited from lower triglycerides and atherogenic cholesterol levels, regardless of CF. Higher CF level was, regardless of PA, associated with lower risk for all risk factors. With regard to clustering of risk factors, each higher CF level was associated with a gradually reduced risk by half or more, independent of PA. Furthermore, being unfit but reporting high PA was associated with a 50% lower risk compared with being unfit and inactive. Furthermore, high reported PA was associated with an additional reduced risk among fit participants. In addition, an excess risk of interaction was found for waist circumference, triglycerides, and the clustered CVD risk between neither being sufficiently active nor being fit. Conclusion This study suggests that both PA and CF are independently associated with lower cardiovascular risk, and that both variables should be taken into account when CVD risk is estimated.

Sleep, physical activity and BMI in six to ten-year-old children measured by accelerometry: a cross-sectional study

BackgroundThe aim of this study is to describe the relationship between objective measures of sleep, physical activity and BMI in Swedish pre-adolescents. The day-to-day association between physical activity and sleep quality as well as week-day and weekend pattern of sleep is also described.MethodWe conducted a cross sectional study consisted of a cohort of 1.231 children aged six to ten years within the Stockholm county area. Sleep and physical activity were measured by accelerometry during seven consecutive days. Outcome measures are total sleep time, sleep efficiency, sleep start and sleep end; physical activity intensity divided into: sedentary (<1.5 METS), light (1.5 to 3 METS) and moderate-to-vigorous (> 3 METS); and Body Mass Index standard deviations score, BMIsds.ResultsTotal sleep time decreased with increasing age, and was shorter in boys than girls on both weekdays and weekends. Late bedtime but consistent wake-up time during weekends made total sleep time shorter on weekends than on weekdays. Day-to-day within-subject analysis revealed that moderate-to-vigorous intense physical activity promoted an increased sleep efficiency the following night (CI < 0.001 to 0.047), while total sleep time was not affected (CI -0.003 to 0.043). Neither sleep duration (CI -0.024 to 0.022) nor sleep efficiency (CI -0.019 to 0.028) affected mean physical activity level the subsequent day. The between-subject analysis indicates that the sleep of children characterized by high moderate-to-vigorous physical activity during the day was frequently interrupted (SE = -.23, P < .01). A negative association between BMIsds and sleep duration was found (-.10, p < .01).ConclusionsShort sleep duration was associated with high BMI in six to ten year old children. This study underscores the importance of consistent bedtimes throughout the week for promoting sleep duration in preadolescents. Furthermore, this study suggests that a large proportion of intensive physical activity during the day might promote good sleep quality.

Infectious episodes before and after a marathon race.

The aim of this study was to investigate the incidence of self‐reported infectious episodes (IE) during 3 weeks before (pre‐IE) and 3 weeks after (post‐IE) a marathon race and relate these figures to training status, running time, socioeconomic and demographic factors. Two questionnaires, including questions about important factors for IE incidence, were given to a representative cohort of 1694 runners (17% of all finishers) in the Stockholm Marathon 2000.

Secular trends of physical fitness in Swedish adults

The aim of the present study was to study differences in fitness (maximal aerobic power (VO2max), balance control, abdominal strength and endurance) and anthropometric data in Swedish women and men (20–65 years of age) between two national cross‐sectional samples, studied in 1990/1991 and 2000/2001, respectively. The absolute and relative VO2max (aerobic fitness), estimated from a submaximal test, declined with increasing age in both genders. The submaximal test was validated against running VO2max. Furthermore, the relative aerobic fitness (mL/min/kg) was lower in the 2000/2001 sample in men but not in women. Overall physical activity level was unchanged in both genders. An unexpected finding was that in both samples there were no major differences in relative VO2max between men and women of the same age. Combined overweight and obesity (body mass index≥25) is becoming more prevalent in men, but not in women with prevalence in 2000/2001 of 61% and 38% for men and women, respectively. Balance control and abdominal strength and endurance decrease with increasing age with no differences between the two samples. Thus, the near future health situation for men may be worse, while for women it may be less or no differences compared with today.

Health‐related fitness in Swedish adolescents between 1987 and 2001

Aim: To assess trends in neuro‐muscular and cardio‐respiratory fitness and morphological fitness in Swedish adolescents between 1987 and 2001. Methods: Comparison of data from two samples, one from 1987 (n= 479) and one from 2001 (n = 1470). Subjects underwent functional tests of muscular strength in the lower limbs, trunk and upper body, sub‐maximal ergometrics, and measurement of body mass and height. Results: Cardio‐respiratory fitness showed only small changes between 1987 and 2001 among boys, with no changes in girls. Neuro‐muscular fitness, as measured by three functional tests, was lower in 2001 compared to 1987. The most pronounced changes in these functional tests were found in the arm‐hang test, while changes in lower body and trunk strength tests were less. Our results indicate that the difference in the prevalence of overweight in adolescents between 1987 and 2001 is mainly due to a large change in the most unfit group. The fittest group showed only marginal changes.

High prevalence of cardio-metabolic risk factors among adolescents with intellectual disability.

Adults with intellectual disabilities (IDs) have poor lifestyle‐related health compared with the general population. Our aim was to study whether such differences are present already in adolescents.

Importance of Age for 3-Year Continuous Behavioral Obesity Treatment Success and Dropout Rate

Objective: To assess whether first year weight loss, age, and socioeconomic background correlate with the success rate of continuous long-term behavioral obesity treatment. Methods: In a 3-year longitudinal study, obese children (n = 684) were divided into three groups based on age at the start of treatment, age 6–9 years, 10–13 years, and 14–16 years. Results: The mean BMI standard deviation score (BMI-SDS) decline was age-dependent (p = 0.001), independently of adjustment for missing data: –1.8 BMI-SDS units in the youngest, –1.3 in the middle age group, and –0.5 in the oldest age group. SES and parental BMI status did not affect the results. 30% of the adolescents remained in treatment at year 3. There was only a weak correlation between BMI-SDS change after 1 and 3 years: r = 0.51 (p < 0.001). Among children with no BMI-SDS reduction during year 1 (n = 46), 40% had a clinically significantly reduced BMI-SDS after year 3. Conclusion: Behavioral treatment should be initiated at an early age to increase the chance for good results. Childhood obesity treatment should be continued for at least 3 years, regardless of the initial change in BMI-SDS.