Qingmei Jiang

The Relationship between Childhood Obesity, Low Socioeconomic Status, and Race/Ethnicity: Lessons from Massachusetts

BACKGROUND Previous studies have shown race/ethnicity, particularly African American and/or Hispanic status, to be a predictor of overweight/obese status in children. However, these studies have failed to adjust for low socioeconomic status (SES). This study assessed whether race/ethnicity remained an independent predictor of childhood obesity when accounting for variations in SES (low-income) among communities in Massachusetts. METHODS This study was based on 2009 summarized data from 68 Massachusetts school districts with 111,799 students in grades 1, 4, 7, and 10. We studied the relationship between the rate of overweight/obese students (mean = 0.32; range = 0.10-0.46), the rate of African American and Hispanic students (mean = 0.17; range = 0.00-0.90), and the rate of low-income students (mean = 0.27; range = 0.02-0.87) in two and three dimensions. The main effect of the race/ethnicity rate, the low-income rate, and their interaction on the overweight and obese rate was investigated by multiple regression modeling. RESULTS Low-income was highly associated with overweight/obese status (p < 0.0001), whereas the effect of race/ethnicity (p = 0.27) and its interaction (p = 0.23) with low-income were not statistically significant. For every 1% increase in low-income, there was a 1.17% increase in overweight/obese status. This pattern was observed across all African American and Hispanic rates in the communities studied. CONCLUSIONS Overweight/obese status was highly prevalent among Massachusetts students, varying from 10% to 46% across communities. Although there were higher rates of overweight/obese status among African American and Hispanic students, the relationship disappeared when controlling for family income. Our findings suggest low SES plays a more significant role in the nations childhood obesity epidemic than race/ethnicity.

Assessing the incremental benefit of an extended duration lifestyle intervention for the components of the metabolic syndrome

Background Lifestyle interventions targeting the components of the metabolic syndrome (MetSyn) have been demonstrated to be a cost-effective and suitable treatment strategy for reducing one’s risk of developing coronary artery disease and diabetes. The optimal duration has not yet been defined. We sought to evaluate the incremental benefit of extending a lifestyle intervention from 3 months to 6 months. Methods We evaluated 114 participants with at least three criteria for the MetSyn in a physician-referred 6-month lifestyle intervention between August 2008 and December 2012. Baseline and follow-up physiological, biochemical, and anthropometric data were analyzed for mean change and incremental change at each time point. Results The mean age at enrollment was 53.0±10.2 years, and 42% of participants were males. The mean body mass index at enrollment was 38.2±0.86 kg/m2 for males and 38.6±0.93 kg/m2 for females. Anthropometric measures associated with weight management (body mass index, weight, and body fat percentage) improved significantly with the additional 3-month intervention (P<0.001). Systolic blood pressure (P=0.0001) and diastolic blood pressure (P=0.00006) and triglycerides, fasting blood glucose, and homeostatic model assessment of insulin resistance in diabetic participants (P=0.006, P=0.004, P=0.01, respectively) improved rapidly in the initial 3-month intervention without incremental benefit of the additional 3 months. Improvements in fasting insulin (P=0.01) and homeostatic model assessment of insulin resistance (P=0.02) for nondiabetic participants required the full 6-month intervention before significant reductions were achieved. Conclusion A 6-month lifestyle intervention yielded significantly better results for variables related to weight management. Standard physiological measures for the MetSyn respond rapidly in a 3-month lifestyle intervention. The long-term impact of an increased duration lifestyle intervention remains to be seen.

Sustained benefit over four-year follow-up of Michigan's Project Healthy Schools

OBJECTIVES We determined the sustainability of effects of a school-based intervention to improve health behaviors and cardiovascular risk factors among middle school children. METHODS We administered a questionnaire and health screenings to 5 schools in Ann Arbor and 2 schools in Ypsilanti, Michigan. We assessed demographics, physiological factors, diet, physical activity, and sedentary behaviors from 1126 students who received a health curriculum (Project Healthy Schools) in the fall of sixth grade in 2005, 2006, and 2007. We administered the questionnaire and screening again in the spring and each subsequent spring through ninth grade to all available, consenting students. RESULTS In the 4 years following the school-based intervention, total cholesterol, low-density lipoprotein cholesterol, and triglycerides improved, and for most years systolic and diastolic blood pressure improved. Serum glucose and body mass index did not change. Physical activity increased and sedentary behaviors diminished. CONCLUSIONS Project Healthy Schools is associated with sustainable improvements in both cardiovascular parameters and healthy behaviors.

PASSIVE SCREEN TIME ASSOCIATED WITH UNHEALTHY DIETARY CONSUMPTION AND PHYSIOLOGICAL CHARACTERISTICS: A CLOSER LOOK AT CHILDHOOD BEHAVIORS

TV, computers, and video games are sedentary activities associated with childhood obesity. While studies show that screen time promotes unhealthy behaviors, there is evidence that these activities have varying effects due to food advertisements and activity levels. 1003 sixth graders were divided

HEALTH BEHAVIORS PREDICTS CARDIOVASCULAR RISK PROFILE IN MIDDLE-SCHOOL CHILDREN

Lifestyle behaviors related to diet, physical activity (PA) and sedentary behavior (SB) are associated with increased cardiovascular (CV) risk in adults; however, less is known about adolescents. We examined PA, SB and diet in association with CV risk factors among middle school students. Data from

Reported obstructive sleep apnea does not diminish the cardiometabolic health benefits from a comprehensive lifestyle intervention program

Obstructive sleep apnea (OSA) commonly coexists with the metabolic syndrome, a condition for which behavioral changes are often prescribed. Whether OSA diminishes the cardiometabolic health benefits from lifestyle interventions remains unclear. We evaluated 278 consecutive metabolic syndrome participants enrolled in a 12‐week comprehensive lifestyle intervention program. The changes in blood pressure (BP), along with other metabolic health parameters, from baseline to follow‐up were compared between those with and without OSA. Mean age was 52.4 ± 10.9 years and 37% were male. At enrollment, mean body mass index (BMI) was 38.2 ± 7.7 kg/m2. OSA was reported in 126 of 269 final participants (47%). At baseline, participants with reported OSA were more likely to be male, older, have a higher BMI, waist and neck size (all P < 0.05). At program completion, participants with (−5.8 ± 16.1/−3.0 ± 10.0 mm Hg) and without OSA (−4.7 ± 13.1/−3.3 ± 8.2 mm Hg) had significant reductions in systolic and diastolic BP as well as BMI, fasting glucose, and triglyceride levels. There were no significant differences in the absolute or percentage changes in BP or other metabolic parameters between groups. Our findings support that patients with the metabolic syndrome can derive substantial health benefits, including reductions in BP, by a lifestyle intervention program regardless of the presence of OSA.

Differences in Cardiovascular Disease Risk Factors and Health Behaviors between Black and Non-Black Students Participating in a School-Based Health Promotion Program

Purpose: To compare cardiovascular disease (CVD) risk factors of black and non-black children participating in Project Healthy Schools (PHS), a school-based wellness program. Design: Participants were surveyed and participated in physiological screenings pre- and post-PHS intervention. Setting: Middle schools in 4 Michigan communities of varying socioeconomic status. Participants: A total of 3813 sixth-grade students comprised the survey sample, and 2297 sixth-grade students comprised the screening sample. Intervention: Project Healthy Schools is a school-based intervention designed to reduce the risk of obesity and CVD in children through the promotion of healthy eating and physical activity. Measures: Physical examination, blood test, and self-reported survey data on dietary habits, physical activity, and sedentary behaviors were collected pre- and post-PHS. Analysis: Paired and independent t tests were used for physiologic variables. Wilcoxon sign-rank and rank-sum tests were used for survey variables. Results: At baseline, blacks had a higher percentage of overweight/obese students (43% vs 34%; P < .0001) and demonstrated poorer health habits than non-blacks; however, non-blacks had poorer lipid profiles. At follow-up (post-PHS intervention), both groups demonstrated significant improvements in physiological measures and health behaviors. Conclusion: Despite disparities between the groups at both baseline and follow-up, changes seen post-PHS intervention were beneficial in both groups. These results suggest that early intervention for risk factor modification is possible and may be of great importance in the prevention of CVD, particularly in high-risk groups.