Parental Characteristics Have a Larger Effect on Children's Health Behaviour than Their Body Weight

Objective: Parents take an important role in a child's development, but there is currently limited information on parental correlates with children's health behaviour. The purpose of this study, therefore, was to examine whether parental characteristics, such as body weight, TV consumption and sport participation, affect children's body weight and health behaviour. Methods: To examine the effects of parental characteristics on children's body weight and health behaviour, baseline data of 1,118 elementary school children (7.6 ± 0.4 years) participating in a school-based intervention in southwest Germany was used. Children's height and weight were measured and parent as well as child behaviour was assessed via questionnaire. Results: BMI percentiles of children were positively associated with parental BMI (r = 0.2, p < 0.01). Further, high parental TV time increased the odds for high TV time in children (ORmother = 2.2, ORfather = 2.3) and parental club sport participation increased the odds for club sport participation in children (ORmother = 1.9, ORfather = 1.7). The relationship between parental and child behaviour was stronger than the relationship between parental BMI and BMI percentiles of the child. Conclusion: These results suggest that parental behaviour and role modelling provide an important contribution to childrens' health behaviour, especially at younger ages

Evaluation of a health promotion program in children: Study protocol and design of the cluster-randomized Baden-Württemberg primary school study [DRKS-ID: DRKS00000494]

<p>Abstract</p> <p>Background</p> <p>Increasing prevalences of overweight and obesity in children are known problems in industrialized countries. Early prevention is important as overweight and obesity persist over time and are related with health problems later in adulthood. "Komm mit in das gesunde Boot - Grundschule" is a school-based program to promote a healthier lifestyle. Main goals of the intervention are to increase physical activity, decrease the consumption of sugar-sweetened beverages, and to decrease time spent sedentary by promoting active choices for healthy lifestyle. The program to date is distributed by 34 project delivery consultants in the state of Baden-Württemberg and is currently implemented in 427 primary schools. The efficacy of this large scale intervention is examined via the Baden-Württemberg Study.</p> <p>Methods/Design</p> <p>The Baden-Württemberg Study is a prospective, stratified, cluster-randomized, and longitudinal study with two groups (intervention group and control group). Measurements were taken at the beginning of the academic years 2010/2011 and 2011/2012. Efficacy of the intervention is being assessed using three main outcomes: changes in waist circumference, skinfold thickness and 6 minutes run. Stratified cluster-randomization (according to class grade level) was performed for primary schools; pupils, teachers/principals, and parents were investigated. An approximately balanced number of classes in intervention group and control group could be reached by stratified randomization and was maintained at follow-up.</p> <p>Discussion</p> <p>At present, "Komm mit in das Gesunde Boot - Grundschule" is the largest school-based health promotion program in Germany. Comparative objective main outcomes are used for the evaluation of efficacy. Simulations showed sufficient power with the existing sample size. Therefore, the results will show whether the promotion of a healthier lifestyle in primary school children is possible using a relatively low effort within a school-based program involving children, teachers and parents. The research team anticipates that not only efficacy will be proven in this study but also expects many other positive effects of the program.</p> <p>Trial registration</p> <p>German Clinical Trials Register (DRKS), DRKS-ID: DRKS00000494</p

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Theoriegeleitete Entwicklung und Implementation einer schulbasierten Intervention zur Gesundheitsförderung

Bereits im Kindes- und Jugendalter zeigen sich deutliche Defizite im Gesundheitsverhalten, weshalb Maßnahmen zur Gesundheitsförderung schon in jungen Jahren notwendig sind. Besonders schulbasierte Interventionen scheinen empfehlenswert; der Erfolg solcher Programme hängt neben einer theoretischen Fundierung maßgeblich von der Implementation ab. Diese Arbeit untersucht im Rahmen des Programms "Komm mit in das gesunde Boot - Grundschule" Forschungsfragen zur Interventionsentwicklung und zur Prozessevaluation. Zur theoriegeleiteten Entwicklung der schulbasierten Intervention werden die ersten fünf Schritte des Intervention Mapping-Ansatzes (IMA) von Bartholomew (Bartholomew, L., 2006) verwendet: (1) eine ausführliche Bedarfsanalyse und (2) eine Zielformulierung in Form von Matrizen, (3) die Auswahl theoretischer Rahmenmodelle und Umsetzungsstrategien sowie (4) die Planung des Programms und (5) die Konzeption der Umsetzung und Implementation. Die Prozessevaluation wird durch eine schuljahresbegleitende Evaluation und durch die Erfassung von Einsatzhäufigkeit und Zufriedenheit mit den Materialien und dem Programm umgesetzt. Bewegungsförderung, Medienreduktion, Verminderung des Konsums zuckerhaltiger Getränke sowie Förderung des Obst- und Gemüseverzehrs sind die Schwerpunkte des entwickelten Programms. Der lehrerzentrierte Ansatz wird durch ein landesweites Multiplikatorensystem umgesetzt. Das Interventionsprogramm umfasst Unterrichtseinheiten, Bewegungsübungen, Materialien zur Elternarbeit. Die Umsetzung des Programms erfolgte im Schuljahr 2009/2010 durch 31 Multiplikatoren, die insgesamt 453 Lehrer in ganz Baden-Württemberg fortbildeten. Der IMA bietet eine fundierte Anleitung zur forschungsbasierten Entwicklung eines umfassenden Interventionsprogramms. Aufgrund der guten Ergebnisse der Prozessevaluation und der großen Reichweite des Programms scheint der Einsatz eines Multiplikatorensystems auch für andere schulbasierte Maßnahmen zur Gesundheitsförderung sinnvoll

Cross-sectional associations of objectively assessed sleep duration with physical activity, BMI and television viewing in German primary school children

Abstract Background The global incidence of overweight and obesity has increased dramatically among children and adolescents over the past decades. Insufficient sleep duration and physical inactivity are known risk factors for overweight and obesity in children. To engage children in a healthier lifestyle knowledge about associations of sleep duration and behavioural aspects in children are vital. Therefore, this study investigated the mentioned associations in German primary school children. Methods Data of 308 first and second graders (7.1 ± 0.6 years) was used; children’s anthropometric data were taken during a school visit. Children’s physical activity (PA) and sleep duration were assessed objectively (Actiheart©, CamNtech Ltd., Cambridge, UK); children’s daily television time and socio-demographic data were collected via parental questionnaire. Linear mixed-effects regression models as well as logistic regressions were used to determine associations of PA, television viewing, age, gender, BMI z-scores and socio-economic variables on sleep duration. Results In linear regression models young age and not having a migration background were significantly associated with long sleep duration (p < 0.001). In logistic regressions, long night time sleep (≥10:08 h; compared to medium and short sleep duration) was significantly associated with not reaching the PA guideline (OR 0.60 [0.36;0.99]), daily television viewing of less than one hour (OR 0.44 [0.24;0.80]), young age (OR 0.38 [0.21;067]), a high parental education level (OR 0.52 [0.27;0.99]) and the lack of migration background (OR 0.21 [0.10;0.48]). However, if controlling for age, gender, parental education level and migration background, reaching the PA guideline stayed no longer significantly associated with a tertiary sleep level. Conclusions Children in the highest sleep category showed a negative association with reaching the PA guideline and a positive association with daily television viewing. This therefore adds to previously primarily subjectively assessed associations of sleep and risk factors for obesity (related behaviours) with a detailed insight based on objective data. Hence, interventions trying to decrease children’s BMI and television viewing should also aim at extending children’s night-time sleep and inform parents about the importance of sufficient sleep during childhood. Trial registration DRKS-ID: DRKS00000494

Intervention Effects of the Health Promotion Programme “Join the Healthy Boat” on Objectively Assessed Sedentary Time in Primary School Children in Germany

Sedentary behaviour (SB) in children is related to negative health consequences that can track into adulthood. The programme &ldquo;Join the Healthy Boat&rdquo; promotes reduced screen time and a less sedentary lifestyle in schoolchildren. This study investigated the effects of the programme on children&rsquo;s SB. For one year, teachers delivered the programme. A total of 231 children (7.0 &plusmn; 0.6 years) participated in the cluster-randomised study; there were 154 one year later at follow-up. Children&rsquo;s SB was assessed using multi-sensor accelerometery, screen time via parental questionnaire. Effects were analysed using (linear) mixed effects regression models. At baseline, children spent 211 (&plusmn;89) min daily in SB, at follow-up 259 (&plusmn;109) min/day with no significant difference between the intervention (IG) and control group (CG). SB was higher during weekends (p &lt; 0.01, for CG and IG). However, at follow-up, daily screen time decreased in IG (screen time of &gt;1 h/day: baseline: 33.3% vs. 27.4%; follow-up: 41.2% vs. 27.5%, for CG and IG, respectively). This multi-dimensional, low-threshold intervention for one year does not seem to achieve a significant reduction in children&rsquo;s SB, although screen time decreased in IG. Therefore, it should be considered that screen time cannot be the key contributor to SB and should not solely be used for changing children&rsquo;s SB. However, if screen time is targeted, interventions should promote the replacement of screen time with active alternatives

Illness and determinants of health-related quality of life in a cross-sectional sample of schoolchildren in different weight categories

[english] Aim: To study associations between health-related quality of life (HRQoL), frequency of illness, and weight in primary school children in southern Germany. Methods: Data from baseline measurements of the outcome evaluation of a teacher based health promotion programme (“Join the Healthy Boat”) were analysed. Parents provided information about their children’s HRQoL (KINDL, EQ5D-Y Visual Analogue Scale). The number of visits to a physician, children’s days of absence because of sickness, and parental days of absence from work due to their children’s illness during the last year of school/kindergarten were queried. Children’s weight status was determined by body mass index (BMI), central obesity by waist to height ratio (WHtR ≥0.5). Results: From 1,888 children (7.1±0.6 years), 7.8% were underweight, 82% had normal weight, 5.7% were overweight and 4.4% obese. 8.4% of all children were centrally obese. Bivariate analysis showed no significant differences for parental absence and visits to a physician in weight groups classified by BMI, but obese children had more sick days than non-obese. Centrally obese children differed significantly from the rest in the number of sick days and visits to a physician, but not in the frequency of parental absence. In regression analyses, central obesity correlated significantly with EQ5D-Y VAS, KINDL total score and the subscales of “psyche”, “family” and “friends”. BMI weight groups showed no significant associations. Conclusions: Central obesity but not BMI derived overweight and obesity is associated with HRQoL and visits to a physician in primary school children. Future studies should include WHtR. Preventive measures for children should focus on a reduction of or slowed increase in waist circumference

Response to: Comment on “Intervention Effects of a School-Based Health Promotion Programme on Obesity Related Behavioural Outcomes”

Studies have shown preventive effects of an active lifestyle during childhood on later life; therefore, health promotion has to start early. The programme “Join the Healthy Boat” promotes a healthy lifestyle in primary school children. In order to evaluate it, children’s behaviours in respect of increased physical activity (PA), a decrease in screen media use (SMU), more regular breakfast, and a reduction of the consumption of soft drinks (SDC) were investigated. 1943 children (7.1 ± 0.6 years) participated in the cluster-randomised study and were assessed at baseline and 1736 of them at follow-up. Teachers delivered lessons, which included behavioural contracting and budgeting of SMU and SDC. Daily SMU, PA behaviours, SDC, and breakfast patterns were assessed via parental questionnaire. After one-year intervention, significant effects were found in the intervention group for SMU of girls, children without migration background, and children with parents having a low education level. In the control group, second grade children skipped breakfast significantly more often. Tendencies but no significant differences were found for PA and SDC. This intervention seems to affect groups, which are usually hard to reach, such as children of parents with low education levels, which shows that active parental involvement is vital for successful interventions.</jats:p

Clinical Study Intervention Effects of a School-Based Health Promotion Programme on Obesity Related Behavioural Outcomes

Studies have shown preventive effects of an active lifestyle during childhood on later life; therefore, health promotion has to start early. The programme &quot;Join the Healthy Boat&quot; promotes a healthy lifestyle in primary school children. In order to evaluate it, children&apos;s behaviours in respect of increased physical activity (PA), a decrease in screen media use (SMU), more regular breakfast, and a reduction of the consumption of soft drinks (SDC) were investigated. 1943 children (7.1 ± 0.6 years) participated in the cluster-randomised study and were assessed at baseline and 1736 of them at follow-up. Teachers delivered lessons, which included behavioural contracting and budgeting of SMU and SDC. Daily SMU, PA behaviours, SDC, and breakfast patterns were assessed via parental questionnaire. After one-year intervention, significant effects were found in the intervention group for SMU of girls, children without migration background, and children with parents having a low education level. In the control group, second grade children skipped breakfast significantly more often. Tendencies but no significant differences were found for PA and SDC. This intervention seems to affect groups, which are usually hard to reach, such as children of parents with low education levels, which shows that active parental involvement is vital for successful interventions