Studies Investigate Childhood Obesity, Diabetes and Related Conditions

Archives of Pediatrics & Adolescent Medicine theme issue examines risk factors and interventions

Factors identified early in childhood could predict obesity in the teen years and beyond, and researchers continue to assess methods to prevent and treat excess weight gain and its consequences in children and teens, according to several reports published in the April issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

The issue—a theme issue on childhood obesity and diabetes—is being published in conjunction with a JAMA theme issue on diabetes. The March issue of Archives of Ophthalmology and Archives of Neurology, along with the April issues of Archives of Dermatology and Archives of Surgery, also feature research on diabetes, obesity and their related co-morbidities.

Studies featured in this issue include the following:

School-Based Intervention Changes Some, But Not All, Behaviors and Measures of Obesity

An interdisciplinary program designed to increase awareness of obesity and change the behaviors of Dutch school children appears to have reduced the amount of sugary beverages consumed by boys and girls and also improved body composition in girls alone, but did not seem to affect other behaviors. Amika S. Singh, Ph.D., and colleagues at VU University Medical Center, EMGO Institute, Amsterdam, the Netherlands, assessed the effectiveness of the intervention among 1,108 adolescents (average age 12.7). The program included 11 lessons in biology, physical education and lifestyle changes over eight months.

Students at the 10 schools that participated in the program drank fewer sugar-sweetened beverages at the end of the intervention (287 milliliters per day less for boys and 249 milliliters per day less for girls) and 12 months later (233 milliliters per day less for boys and 271 milliliters per day less for girls) than did those in the eight schools that did not participate. In addition, at a 20-month follow-up, the intervention remained effective in preventing unfavorable increases in the sum of all skinfold measurements (taken at the triceps, biceps, below the shoulder and between the hip joint and ribcage) in girls. However, no changes were seen in consumption of snacks or in walking or biking to school.

“Hence, our results do not show consistently positive findings on all anthropometric and behavioral outcome measures. Our findings are important, especially when considering the need for evidence on the long-term effectiveness of interventions in the field of obesity prevention,” the authors write. “Reducing intake of sugar-containing beverages should therefore be considered a good behavioral target for future interventions aimed at the prevention of overweight among adolescents.”

Schools remain “an obvious and important channel for providing obesity-prevention programs, as the vast majority of youth spend a great deal of time each week throughout their development from childhood to young adulthood in schools,” writes Leslie A. Lytle, Ph.D., of the University of Minnesota, Minneapolis, in an accompanying editorial. “However, as the extent of the published research in this field is substantial and the findings consistently mixed and modest, it may be time to re-evaluate where the research needs to move.”

Arch Pediatr Adolesc Med. 2009;163[4]:309-317, 388-389. 


Replacing Sugary Beverages With Water Is Associated With Decreases in Children and Teens’ Calorie Intake

Encouraging children and teens to drink water instead of sugary beverages is associated with decreases in their total calorie intake of an average of 235 per day. Y. Claire Wang, M.D., Sc.D., of Columbia Mailman School of Public Health, New York, and colleagues assessed data from 3,098 children and teens (age 2 to 19) participating in the 2003-2004 National Health and Nutritional Examination Survey. The participants reported which beverages they consumed during two separate 24-hour periods.

Every additional 8-ounce serving of sugary beverages the children and teens drank corresponded to an additional 106 calories in their daily diet—similar to the amount of calories in each beverage, suggesting that individuals do not compensate for these calories by eating less. “Our results also indicate that replacing sugar-sweetened beverages with water is associated with a significant decrease in total energy intake,” the authors write. “Each 1 percent of beverage replacement was associated with a 6.6-calorie lower total energy intake, a reduction not negated by compensatory increases in other food or beverages.”

The results suggest that reducing the amount of sugary beverages children drink could reduce their risk for obesity, but only if those beverages are replaced with water instead of milk or juice, the authors note.

Arch Pediatr Adolesc Med. 2009;163[4]:336-343. 


Study Identifies Racial Disparities in Childhood Obesity

Obesity appears twice as common among American Indian and Native Alaskan children than non-Hispanic white or Asian children at age 4. Sarah E. Anderson, Ph.D., of The Ohio State University College of Public Health, Columbus, and Robert C. Whitaker, M.D., M.P.H., of Temple University, Philadelphia, studied a nationally representative sample of 8,550 U.S. children born in 2001. In 2005, 18.4 percent of the 4-year-olds were obese, including 31.2 percent of American Indian/Native Alaskan children, 22 percent of Hispanic children, 20.8 percent of non-Hispanic black children, 15.9 percent of non-Hispanic white children and 12.8 percent of Asian children.

“To help arrest the trends in childhood obesity, both the Surgeon General and the Institute of Medicine have recommended that obesity-prevention efforts begin early in life,” the authors write. “These efforts might benefit from a better understanding of how differences in obesity risk between racial/ethnic groups emerge early in the life course. Because families are the social units with the greatest influence on very young children, future research might focus on racial/ethnic differences in household behaviors that affect obesity and how these behaviors are influenced by the community context.”

Arch Pediatr Adolesc Med. 2009;163[4]:344-348

Teens Who Give Birth More Likely to Be Overweight

Girls who give birth between ages 15 and 19 appear to be substantially heavier, with more abdominal fat, regardless of their childhood weight or of other risk factors for weight gain. Erica P. Gunderson, Ph.D., of Kaiser Permanente, Oakland, Calif., and colleagues studied 1,890 girls (983 black and 907 white) who were age 9 to 10 at the beginning of the study in 1987-1988. After nine to 10 years—in 1996-1997—31 percent of black girls and 10 percent of white girls had given birth during adolescence or young adulthood. Those who did were more likely to experience increases in weight, body mass index, hip circumference and percentage of body fat. The association was stronger among black women than white women.

“Our findings are potentially important because adolescence has been identified as one of the critical periods of development that set the stage for the onset of obesity later in life,” the authors write. “Earlier age at a first birth (younger than 20 years) has been associated with increased rates of coronary heart disease in women. Thus, the influence of gestational weight gain on changes in growth and adiposity during adolescence is an important aspect for future investigation.”

Arch Pediatr Adolesc Med. 2009;163[4]:349-356. 


Diabetes and Blood Pressure Medication Prescriptions Increase Among Children and Teens

The number of children and teens prescribed medicine to treat high blood pressure or diabetes appears to have increased between 2004 and 2007. Joshua N. Liberman, Ph.D., of CVS Caremark in Hunt Valley, Md., and colleagues analyzed the prescription records of more than 5 million commercially insured individuals ages 6 to 18 covered by a pharmacy benefits manager.

The prevalence of children and teens who were prescribed medications for hypertension (high blood pressure), dyslipidemia (abnormal cholesterol) or diabetes (including insulin) increased 15.2 percent, from 3.3 per 1,000 youths in November 2004 to 3.8 per 1,000 youths in June 2007. “The increasing use of oral anti-diabetic and antihypertensive pharmacotherapy among children and adolescents, especially in the younger age group, indicates either an increased awareness of treatment needs or increased incidence of cardiovascular risk factors typically associated with adult populations,” the authors write.

When assessed separately, cholesterol-controlling therapy was uncommon (prescribed to 0.2 per 1,000 youths overall) and declined 22.9 percent during the study period. “The decrease in treatment of dyslipidemia may reflect the ongoing controversy regarding statin use,” the authors conclude.

The results indicate that these drugs are not currently being overused in this population, writes Stephen R. Daniels, M.D., Ph.D., of the University of Colorado Denver School of Medicine, in an accompanying editorial. “While the potential for misuse of these medications remains, that does not appear to be happening at this time. Nevertheless, it will be important to collect data in an ongoing manner to monitor use of these medications but also to identify appropriateness of use and ultimate reduction of risk factor levels in children and adolescents.”

Arch Pediatr Adolesc Med. 2009;163[4]:357-364, 389-391.