Childhood Obesity and Parental Responsibilities

Partner's and own education: does who you live with matter for self-assessed health, smoking and excessive alcohol consumption?

Contribution of metabolic factors to alanine aminotransferase activity in persons with other causes of liver disease

Understanding the mechanisms that explain the pervasive association between socioeconomic status and health has been identified as an important area of research. Using the 1994-1995 National Population Health Survey, this study examines whether exposure to psychosocial stressors may be one mediating mechanism of the social gradient in health. Data were obtained including indicators of socioeconomic status (SES); exposure to recent life events and chronic stressors; and self-rated health status. Results showed a clear gradient in poor self-rated health with decreasing SES. Higher exposure to stressors across several domains was also observed with decreasing SES. Exposure to stressors was further associated with poor self-rated health, above and beyond adjusting for SES. Across income adequacy groups, exposure to stressors accounted for 16% to 26% of the relationship between income group and poor self-rated health among men and for 6% to 15% among women, suggesting that exposure to psychosocial stressors may be one of the mediators underlying the higher prevalence of poor self-rated health within lower socioeconomic groups.

The Whitehall studies have come to be closely associated with the investigation of socioeconomic differences in physical and mental illness and mortality: the social gradient.1,2 That was not the initial purpose of the first Whitehall study. Donald Reid and Geoffrey Rose set up Whitehall, in the 1960s, as a kind of British Framingham:3 ‘Framingham’ insofar as it was a longitudinal study of cardiorespiratory disease and diabetes, looking at individual risk factors for disease; ‘British’ in that it was done on the cheap—a simple screening examination with follow-up limited to deaths identified from the National Health Service Central Registry. Socioeconomic differences were initially not on the agenda. In the 1970s there was a small group of researchers who continued the British tradition that went back to William Farr in the nineteenth century of examining social inequalities in health.4 For the most part, within epidemiology, ‘social class’ was not an object of study but a control variable: a potential confounder that you got rid of in order to arrive at the ‘correct’ conclusion about the association between risk factor and disease. To the extent that there was a focus on inequalities in health, the general view was that poor people got diseases of material deprivation and rich people got heart disease and peptic ulcers. If this perception had been true,5,6 Whitehall showed that it was no longer so. In a population of middle-aged men, all employed in stable jobs in the British Civil Service, there was an inverse social gradient in mortality: the lower the grade, the higher the risk of death. Tenyear follow-up showed that there was a steep inverse relation between grade of employment and death from all causes, from coronary heart disease (CHD), and from non-coronary causes.7 The relative risk of death owing to CHD was 2.2 in clerical compared with senior administrative staff, and 1.6 for those in the intermediate professional and executive grade. The first Whitehall study made clear that inequalities in health were not limited to the health consequences of poverty. Important as that issue remains, the Whitehall question was why there should be a social gradient in disease in people above the poverty threshold. When conventional risk factors were controlled for, two-thirds of the mortality risk differential between the clerical and administrative grades remained unexplained.7,8 Mortality gradients in the study were in the same direction as national social class mortality data,9 but larger. We hypothesized that psychosocial factors and aspects of nutrition other than those affecting plasma cholesterol (which was higher in high grades in Whitehall) might fill in the unexplained part of the social gradient in mortality.7 We therefore set up the Whitehall II study, a new longitudinal study of British civil servants, with the explicit intention of examining reasons for the social gradient in health and disease in men and extending the research to include women.

Social rank and adult male nutritional status: Evidence of the social gradient in health from a foraging-farming society

A lifetime spent studying how social determinants of health lead to health inequalities has clarified many issues. First is that social stratification is an appropriate topic of study for epidemiologists. To ignore it would be to ignore a major source of variation in health in society. Not only is the social gradient in health appropriate to study but we have made progress both in understanding its causes and what can be done to address them. Post-modern ‘critical theory’ raises questions about the social construction of science. Given the attack on science by politicians of bad faith, it is important to recognise that epidemiology and public health have a crucial role to play in providing evidence to improve health of society and reduce inequalities. Evidence gives grounds for optimism that progress can be made both in improving the health of the worst-off in society and narrowing health inequalities. Theoretical debates about ‘inequality of what’ have been helpful in clarifying theories that drive further gathering of evidence. While it is important to consider alternative explanations of the social gradient in health—principal among them reverse causation—evidence strongly supports social causation. Social action is by its nature political. It is, though, a vital function to provide the evidence that underpins action.

Body weight is an important indicator of current and future health and it is even more critical in children, who are tomorrow's adults. This paper analyzes the relationship between childhood obesity and neighbourhood walkability in Calgary, Canada. A multivariate analytical framework recognizes that childhood obesity is also associated with many factors, including socioeconomic status, foodscapes, and environmental factors, as well as less measurable factors, such as individual preferences, that could not be included in this analysis. In contrast with more conventional global analysis, this research employs localized analysis and assesses need-based interventions. The one-size-fit-all strategy may not effectively control obesity rates, since each neighbourhood has unique characteristics that need to be addressed individually. This paper presents an innovative framework combining local analysis with simulation modeling to analyze childhood obesity. Spatial models generally do not deal with simulation over time, making it cumbersome for health planners and policy makers to effectively design and implement interventions and to quantify their impact over time. This research fills this gap by integrating geographically weighted regression (GWR), which identifies vulnerable neighbourhoods and critical factors for childhood obesity, with simulation modeling, which evaluates the impact of the suggested interventions on the targeted neighbourhoods. Neighbourhood walkability was chosen as a potential target for localized interventions, owing to the crucial role of walking in developing a healthy lifestyle, as well as because increasing walkability is relatively more feasible and less expensive then modifying other factors, such as income. Simulation results suggest that local walkability interventions can achieve measurable declines in childhood obesity rates. The results are encouraging, as improvements are likely to compound over time. The results demonstrate that the integration of GWR and simulation modeling is effective, and the proposed framework can assist in designing local interventions to control and prevent childhood obesity.

While some obese children are metabolically healthy (MHO), some have additional health problems, such as hypertension, dyslipidemia, insulin resistance, and hepatosteatosis, which increase mortality and morbidity related to cardiovascular diseases (CVD) during adulthood. These children are metabolically unhealthy obese (MUO) children. In this study we assessed the factors that affect metabolic health in obesity and the clinical and laboratory findings that distinguish between MHO and MUO children. In total, 1085 patients aged 6-18 years, with age- and sex-matched BMI exceeding the 95th percentile were included in the study (mean 11.1±2.9 years, 57.6% female, 59.7% pubertal). Patients without dyslipidemia, insulin resistance, hepatosteatosis, or hypertension were considered as MHO. Dyslipidemia was defined as total cholesterol level over 200 mg/dL, triglyceride over 150 mg/dL, LDL over 130 mg/dL, or HDL under 40 mg/dL. Insulin resistance was calculated using the homeostasis model of assesment for insulin resistance (HOMA-IR) index. Hepatosteatosis was evaluated with abdominal ultrasound. Duration of obesity, physical activity and nutritional habits, screen time, and parental obesity were questioned. Thyroid and liver function tests were performed. Six hundred and forty-two cases (59.2%) were MUO. Older age, male sex, increased BMI-SDS, and sedentary lifestyle were associated with MUO. Excessive junk food consumption was associated with MUO particularly among the prepubertal obese patients. Our results revealed that the most important factors that affect metabolic health in obesity are age and BMI. Positive effects of an active lifestyle and healthy eating habits are prominent in the prepubertal period and these habits should be formed earlier in life.

There are presented data of the study of the prevalence rate of obesity in children and adolescents residing in the city of Ivanteevka of the Moscow region. Indices of the prevalence rate of obesity were calculated per 1000 in child population of the appropriate age. The obesity in children and adolescents in the structure of endocrine diseases was found to be ranked as second. During the period from 2000 to 2013 there was revealed a consistent upward trend in the frequency of obesity in children. There was shown a possibility for the existence of regional features of the prevalence of obesity in children. The low incidence rate of the detection of obesity in children of the Moscow region may be caused by underdiagnosis of this form ofpathology. On the basis of own data the authors showed that the true prevalence rate of the obesity in children is much higher than the official data according to medical help seeking by patients. However, only 26.6% of children and adolescents with obesity are observed and receive treatment at the pediatric endocrinologist. This demonstrates the needfor increment in the medical activity and responsibility of children and parents, enhancement of their motivation in keeping healthy lifestyle, as well as improvement of the efficiency of the prevention of obesity by medical staff of children's polyclinics.

IntroductionThe finding that there is a social gradient in health has prompted considerable interest in public health circles. Recent influential works describing health inequities and their causes do not always argue cogently for a policy framework that would drive the most appropriate solutions differentially across the social gradient This paper aims to develop a practice heuristic for proportionate universalism.MethodsThrough a review the proposed heuristic integrates evidence from welfare state and policy research, the literature on universal and targeted policy frameworks, and a multi-level governance approach that adopts the principle of subsidiarity.ResultsThe proposed heuristic provides a more-grained analysis of different policy approaches, integral for operationalizing the concept of proportionate universalism.ConclusionThe proposed framework would allow governments at all levels, social policy developers and bureaucrats, public health professionals and activists to consider the appropriateness of distinctive policy objectives across distinctive population needs within universal welfare state principles.

Comparison of Obesity Rates in Early Childhood (4 to 80 months) by Parental Socioeconomic Status Using National Cohort Dataset in Korea

Introduction: A life course approach has been suggested as the most appropriated to establish the actual impact of socioeconomic status (SES) on health outcomes. Hypothesis: We assessed the hypothesis that SES trajectories from childhood to adulthood are useful to better evaluate the role of SES towards mortality risk in a large general population-based cohort. Methods: Longitudinal analysis on 22,194 subjects recruited in the general population of the Moli-sani study, Italy (2005-2010). Educational attainment (low/high) and SES in adulthood (measured by a score including occupational social class, housing and overcrowding, and dichotomized as low/high) were used to define four possible trajectories both in low and high SES in childhood (age of 8). Hazard ratios (HR) with 95% confidence intervals (95%CI) were calculated by multivariable Cox regression and competing risk models. Results: Over a median follow-up of 8.3 years (182,924 person-years), 1155 all-cause, of which 414 cardiovascular (CVD), deaths were ascertained. In the group with low SES in childhood, as opposed to those stably low (low education and low SES in adulthood), an upward in both educational attainment and material factors in adulthood was associated with lower risk of both all-cause (HR=0.64; 95%CI 0.52-0.79; Table) and CVD mortality (HR=0.62; 0.43-0.88), respectively. Subjects with high childhood SES experienced an increased risk of total and CVD death in absence of higher educational attainment despite a higher SES in adulthood (HR=1.47; 1.04-2.07 and HR=1.75;1.00-3.05, respectively) as compared to the group with both high education and high SES in adulthood. Conclusions: In conclusion, for individuals with low SES in childhood, an upward of both educational attainment and material factors over the life course is associated with lower risk of total and CVD death. In advantaged groups in childhood, lack of a higher educational attainment, rather than material factors, over the life course appears to be unfavourably associated with survival.

Modelling of future outcomes to estimate the cost effectiveness of interventions related to child and adolescent overweight and obesity

To identify the major risk factors of overweight and obesity in prepubertal children. Cross-sectional study. In all, 32 primary schools in Kiel (248 000 inhabitants), northwest Germany. A total of 2631 5-7-y-old German children and their parents. Weight status, socio-economic status (SES), parental overweight, dietary intake, activity, inactivity and further determinants (birth weight, breast feeding, nutritional status of siblings) of the children. The prevalence of overweight (>/=90th BMI percentile of reference) was 9.2% in boys and 11.2% in girls, respectively. Considered univariately, family-, environment- and development-related determinants showed some relations to overweight and obesity. In multivariate analyses parental overweight, a low SES as well as a high birth weight were the strongest independent risk factors of overweight and obesity in children. Additionally, there were sex-specific risk factors: parental smoking and single households were risk factors in boys, whereas a low activity was associated with obesity in girls. Birth weight was associated with obesity, but not with overweight. The prevalence of obesity reached 29.2% in boys and 33.4% in girls with all the three main risk factors. Overweight families of low SES have the highest risk of overweight and obese children. Future prevention programmes must also take into account sex-specific risk factors.

Efforts of governments to adjust the responsiveness and efficiency of their health care systems are evident across the globe. In the seemingly constant search for solutions providing both better health outcomes and manageable costs, the directions and designs for change are neither consistent nor well studied. Opportunities for shared learning concerning what strategies for transforming health care systems lead to effective and sustainable change are being missed. There is an urgent need to study and understand the processes of change initiated by health policy shifts aimed at controlling health care costs, altering health service delivery and influencing outcomes of health care. In partial response to this need, research was initiated to study health policy transition within the Western Canadian province of Alberta. The primary objective of this research was: to identify, describe, compare and contrast the processes of change adopted and implemented in a variety of health authorities as a result of health policy shift. Change processes initiated by a specific health policy shift (the restructuring of Alberta’s health care system) were explored from the perspective of the change agents (individuals managing the health system reforms) in order to discover indicators of effective change and to identify questions for further consideration and testing in relation to change process related to health policy shift. This qualitative exploratory study coincided with real time alteration to the health system via legislated health policy shift. Findings relate changes in the structure, process and outcome of the health policy transition. Additionally, a number of questions linked to the reported findings are highlighted to encourage additional and continuing efforts to improve understanding of change process related to health policy shift.