This methodological problem of consistency between classifications of childhood obesity is the major obstacle in studying global secular trends for younger age groups Here, we review the published data and some additional unpublished data collected by the International Obesity TaskForce in collaboration with regional task forces and members of the International Association for the Study of Obesity. It should be noted that there are several constraints on the use of survey data for interpreting trends in obesity in children and adolescents.
Some of the results presented in this section are based on national representative surveys, while others are based on smaller surveys that do not represent national populations. Sexual maturation. Sexual maturation influences body fatness: fat gain occurs in both boys and girls early in adolescence, then ceases and may even temporarily reverse in boys but continues throughout adolescence in girls see later in this report.
Secular trends in growth and development. These trends have affected some populations more than others, and at different rates of change. Comparisons between populations should take these secular trends into account.
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Stunted children are more likely to be overweight in countries undergoing a rapid nutrition transition 60 see later in this report. This is of particular significance when examining the trends in obesity in developing countries, where the secular trends in linear growth continue and the prevalence of stunting has declined.
Adiposity rebound see sections 4. Considerable differences may exist in the timing and patterns of adiposity rebound between populations—in particular between populations in industrialized and in developing countries. Measurement errors. Data collected in different studies and countries and over time may not have the same quality. The potential influence of measurement errors should not be ignored. All these factors may influence the observed secular trends. Nonetheless, survey material is an invaluable source of data for understanding the rising epidemic of childhood obesity.
The continued collection of such data is essential, and several recommendations can be made to improve the value of the data. Collection of longitudinal data, which can be used to track the development of obesity and evaluate interventions, needs to be encouraged. Longitudinal studies may prove particularly valuable for examining the social, environmental, behavioural and biological factors that may contribute to the secular trends in childhood obesity.
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In the descriptions below it will be seen that some surveys have used definitions based on 85 th and 95 th centiles. Similarly, statements apply to the use of definitions of overweight and underweight based on standardized deviation Z scores. For a normal Gaussian distribution, a Z score of 1 is approximately equivalent to the 16 th lower and 84 th upper centile, while a Z score of 2 is approximately equivalent to the 2 nd lower or 98 th upper centile.
For BMIs in children this does not relate to a specified centile, but can be read as approximately equivalent to the 85 th and 95 th centiles, respectively, of that standard reference group. Nevertheless, data collected in national and local surveys from different parts of the world provide useful insights into the global obesity situation among young people.
These data are listed in Appendix 1, Tables A1 1 to A1 5. Based on surveys in different years. As can be seen from Fig. Trends in the prevalence of overweight, — Overweight defined by IOTF criteria. Prevalence of overweight according to family income levels.
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Children aged 6—18 years. Prevalence of overweight according to residential area. In rural areas these changes were far less marked, with figures for overweight 6. It is likely that many other developing countries will show similar trends as economic conditions develop. Only Russia shows a reversal of the trend — probably attributable to the dramatic fall in economic prosperity suffered by that country during the early s see Fig.
Extensive data have been collected over the past three decades that allow examination of the prevalence rates and secular trends of childhood obesity in the Americas see Appendix 1. An estimate for the region as a whole is shown in Fig. Prevalence of overweight and obesity in the Americas. These data show that the combined prevalence of obesity and overweight among American children and adolescents has more than doubled, while the prevalence of obesity has increased fourfold — and the rates continue to increase 68 , US data for overweight prevalence among children according to household income are shown earlier in this section.
Obesity among children according to racial group. Obesity according to 95 th centile, CDC reference. Data from Brazil and Chile are good examples to show that the rate of increase of obesity among children in some developing countries is similar to or even faster than that in the USA. The prevalence of overweight including obesity IOTF criteria tripled between the s and the late s, increasing from 4.
A number of studies have examined the trends in childhood obesity in European countries, including material collected by IOTF in collaboration with the European Childhood Obesity Group 71 , These data suggest that childhood obesity has increased steadily in this region over the past two to three decades see Appendix 1 , although there are complex patterns in the prevalence and trends, which vary with time, age, sex and geographical region Fig.
The highest prevalence levels are observed in southern European countries. Caroli unpubl. Prevalence of overweight and obesity in Europe. Prevalence percentage of overweight children in various European countries. Overweight defined by IOTF criteria includes obese. The reasons for a north—south gradient are not clear. Genetic factors are unlikely, because the gradient can be shown even within a single country, such as Italy Economic recession may affect the rate of increase in obesity levels.
Some countries in the region have reported a fall in obesity rates; in Russia the prevalence of overweight and obesity declined from Several countries in this region appear to be showing high levels of childhood obesity. Similar trends are found in other parts of North Africa. Estimates for the region are shown in Fig.
Prevalence of overweight and obesity in the North African and Middle East region.
As shown in Appendix 1, the available data indicate that the prevalence of overweight varies considerably between different countries in this region. An estimate of the overall regional prevalence is given in Fig. It should be noted that no data are available for some countries in the region e.
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Nauru, Cook Islands, Fiji where adult obesity prevalence rates are known to be high. In these countries, prevalence rates in the child and adolescent populations are also expected to be high. In most countries where trends data are available, childhood obesity has increased. In some countries this has been very rapid, while in other countries it has occurred at a much slower pace.
In Japan, between and , the prevalence of overweight including obesity doubled, rising from 5.
In Hong Kong and Taiwan the prevalence also increased in the s 88 , 89 , although the increase was not as dramatic as that in mainland China. In general, the prevalence of childhood obesity remains very low in this region, except for countries such as South Africa where obesity has become prevalent in adults, particularly among women, and where childhood obesity is also rising.
Overall, the prevalence of overweight including obesity was 8.
Data from South Africa 92 show the prevalence of overweight including obesity to be amongst the highest in the whole region. A reduction in adult productivity through sickness or through having to care for a sick family member will reduce family earnings and reduce access to food supplies for children as well as adults. Medical costs may mean that land and livestock are sold, jeopardizing food security. The rise in childhood obesity has been accompanied by higher rates of the correlates of obesity and the emergence of new, or newly identified, health conditions.
deidentifier.com/2827-phone-monitoring.php Once considered rare in children, cardiovascular risk factors, type 2 diabetes and menstrual abnormalities began to be reported in paediatric literature in the s and s. Their occurrence in some populations is now routinely observed. Not only is a greater proportion of the population overweight, but those that are overweight are more overweight than typically observed before, with the most extreme levels in particular appearing more frequently.
The delineation of the full range of health consequences linked to excess bodyweight among children and adolescents may help to direct resources to their prevention. Until recently, the complications of childhood obesity were unlikely to be clinically apparent for many years after the obesity developed, so that the consequences of obesity during childhood were rarely seen.
Clinical studies of obese children have suggested a range of medical conditions for which obese children are at greater risk As shown in Table 5 , there are few organ systems that severe obesity does not affect. Secondary metabolic correlates of obstructive sleep apnoea include hyperinsulinaemia, after accounting for obesity severity Clinically significant effects on learning and memory function in obese children with obstructive sleep apnoea represent a troubling consequence of severe obesity A representative survey in the UK showed asthma and obesity linked among girls in an inner city area, but not among boys Asthma and its symptoms are a difficult topic for study and a causative biological link between excess weight and asthma should not be assumed: children with asthma may have reduced physical activity levels, and asthma treatment medication may cause weight gain Nonetheless, the observation that weight loss can improve lung function in obese adults suggests that obesity prevention may decrease the impact of asthma, if not its occurrence.