0
Article |

Environmental Influences, Physical Activity, and Weight Status in 8- to 16-Year-Olds FREE

Marsha Dowda, DrPH; Barbara E. Ainsworth, PhD, MPH; Cheryl L. Addy, PhD; Ruth Saunders, PhD; William Riner, PhD
[+] Author Affiliations

From the Departments of Exercise Science (Drs Dowda, Ainsworth, and Riner), Epidemiology and Biostatistics (Drs Ainsworth and Addy), and Health Promotion and Education (Dr Saunders), Norman J. Arnold School of Public Health, University of South Carolina, Columbia, and the John Morrison White Clinic, University of South Carolina, Lancaster (Dr Riner).


Arch Pediatr Adolesc Med. 2001;155(6):711-717. doi:10.1001/archpedi.155.6.711.
Text Size: A A A
Published online

Objective  To assess the association between vigorous physical activity, participation on sport teams and in exercise programs, television watching, family environment, and weight status in youth.

Design  Cross-sectional data from the Third National Health and Nutrition Examination Survey.

Participants  A group of 2791 youth between the ages of 8 and 16 years who were enrolled in the Third National Health and Nutrition Examination Survey.

Main Outcome Measures  Overweight was defined using age- and sex-specific 85th percentile of body mass index using Center for Disease Control and Prevention growth charts.

Results  Both males and females who had an overweight mother and or father were more likely to be overweight compared with youth who did not have an overweight parent. Females who watched 4 or more hours of television were more likely to be overweight than those who watched less than 4 hours. Males and 14- to 16-year-old females who participated in sport team and exercise programs were less likely to be overweight than their counterparts who did not participate. Also, females with larger families and males from families with higher family incomes were less likely to be overweight.

Conclusions  These results suggest that family environment is associated with overweight in youth and that sport and exercise program participants are less like to be overweight and that, for females, increased television watching is related to overweight.

Figures in this Article

FROM 1976 to 1990, there was a 40% increase in the prevalence of overweight among youth between ages 6 and 17 years.1,2 Using a 95th percentile cutoff for body mass index (BMI), prevalence of overweight had increased from 4% to 11%. Using an 85th percentile cutoff for BMI, it is estimated that 22% of youth aged 6 to 17 years were overweight in 1995 and 25% in 1998.2,3 Being overweight during adolescence is associated with risk factors for cardiovascular disease,4 being an overweight adult,5 and increased risk of all-cause mortality, an increased prevalence of coronary heart disease and other chronic diseases.6,7

The increase of overweight and obesity among youth may be associated with decreased physical activity. Traditional opportunities for physical activity, such as required participation in school physical education at all levels, have been reduced for many youth. The 1995 Youth Risk Behavior Survey (YRBS) reported that 59.6% of surveyed students in grades 9 through 12 participated in physical education classes, but only 48.8% participated in 1997.8,9 The relationship of moderate to vigorous exercise and weight status is open to interpretation. A body of work1012 supports the traditional view that physical activity is inversely associated with being overweight, while other studies have failed to support the idea that participation in physical activity is associated with a lower BMI.13,14

Overweight has been associated with an increase in sedentary activities, such as watching television. In the Third National Health and Nutrition Examination Survey (NHANES III) children, interviewed between 1988 and 1994, who reported watching 4 or more hours of television had on average greater BMI (P<.001) than children who reported watching less than 2 hours.15 Possible reasons for the association between television watching and body fatness include the following: television may reduce time spent in activities that require more energy expenditure,16 advertising may influence the selection of high-energy dietary food among youth,17 and a positive relationship exits between watching television and fat intake.18,19 However, the association between watching television and obesity is also inconsistent with some studies failing to find a relationship.10,20

Because of the increased prevalence of overweight among youth and the risk of subsequent chronic disease in adulthood, it is important to determine the correlates of overweight in youth. Environmental factors that may be related to overweight in youth include having overweight parents and other family factors.2124 The purpose of this study was to determine what associations exist between overweight in youth and vigorous physical activity, participation on sport teams and in exercise programs, and time spent in a sedentary activity in a triethnic sample of youth aged 8 to 16 years. Environmental factors, including overweight status of mother and father, family size, and poverty index, were also examined.

SUBJECTS

Study participants were enrolled in the Third National Health and Nutrition Examination Survey (NHANES III). The NHANES was designed to describe the health and nutritional status and estimate the prevalence of common chronic diseases and associated risk factors of the noninstitutionalized civilian population of the United States.25 Children 2 months to 5 years old, persons 60 years or older, non-Hispanic blacks, and Mexican Americans are oversampled to ensure reliable estimates for those groups.

A group of 2791 children, 8 to 16 years of age, interviewed between 1988 to 1994, for whom data were complete, were included in the study. From the original data set of 5052, youth were deleted who did not complete the physical activity questions (n = 951). Other deletions included youth categorized in the "other" race group (n = 184), those diagnosed as having physical conditions that precluded physical activity or its measurement (n = 44), missing BMI data for themselves or their biological parents (n = 917), missing poverty index (n = 161), and time spent watching television (n = 4).

DEMOGRAPHIC AND FAMILY VARIABLES

The subject's age used in the study was that obtained during the physical examination held in a mobile examination center.25 Children were divided into 3 age groups: 8 to 10, 11 to 13, and 14 to 16 years. The race or ethnicity of the child was reported by an adult 18 years or older during the home interview, and categorized as non-Hispanic white, non-Hispanic black, and Mexican American. The respondent was the mother in 89% of the interviews and the father in 7% of the interviews. Other respondents included older siblings, grandparents, aunts, and uncles (4%). Family variables included family size (number of family members living at home) and poverty index an indication of socioeconomic status.25,26 Poverty index was expressed as a ratio calculated by the US Census Bureau, based on annual family income, family size, and other economic information. Scores above 1.00 indicate that family income was above the poverty line.

BODY MEASUREMENTS AND WEIGHT STATUS

Physical measurements were performed during the physical examination. Standing height, body weight, and skinfolds were measured using standard methods.25 Equipment was calibrated between each measurement. Height and weight of the biologic parents were reported during the home interview.

Body mass index was calculated by dividing weight in kilograms by height in meters squared. Youth were dichotomized into overweight and nonoverweight, using age- and sex-specific 85th percentile of BMI from the Centers for Disease Control and Prevention growth charts.27 Weight status was used as the dependent variable in all analyses, with nonoverweight the referent group. Biological parents were categorized as overweight if their BMI was 25 or greater.28

PHYSICAL ACTIVITY AND TIME SPENT WATCHING TELEVISION

Physical activity behavior was assessed by asking how many times per week the subjects "played or exercised enough to make them sweat and breathe hard." Youth who reported 3 or more sessions of physical activity were classified as active. Those reporting fewer than 3 sessions were in the low-active group. A question was asked concerning the number of sport teams and exercise programs participated in within the past year. Youth were instructed not to include physical education or gym class. Those who reported no participation on sport teams and in exercise programs were classified in the no-participation group, and those who reported 1 or more sport teams and exercise programs were in the participation group. Youth were also asked how many hours they had watched television the day preceding the examination. Respondents were grouped into 4 or more hours or fewer than 4 hours watched per day.15

STATISTICAL ANALYSES

We used χ2 analyses to determine differences, by sex, in physical activity behaviors, television watching, and percentage overweight, and t tests to determine differences in age, weight indexes, family size, and poverty index between the weight groups. Crude odds ratios (ORs) and 95% confidence intervals (CIs) were used to examine associations between weight status of the youth and demographic characteristics, vigorous physical activity, participation on sport teams and in exercise programs, television watching, and the mother's and father's weight status. Multiple logistic analysis models were calculated to examine the relationships of the independent variables with weight status. Two-way interaction terms were tested for age and race/ethnicity group by physical activity, sport teams and exercise programs, hours of television watching, and weight status of mother and father. Only interactions significant at P<.01 were considered to minimize the possibility of a type I error. All analyses were conducted separately for males and females.

The complex survey design that was used for NHANES III data collection was incorporated into data analyses by using SUDAAN.29 Sampling weights were incorporated into all analyses. The sampling weights had been calculated to take into account unequal selection probabilities resulting from the cluster design and oversampling of some groups.

Demographic characteristics, physical activity behaviors, and television watching are presented in Table 1. Weighted percentages were not statistically different for sex, age groups, or weight status between the subset (N = 2791) used in this study and those with missing information (N = 2261). There were statistical differences (P<.05) for race/ethnicity, participation in vigorous physical activity, sport teams and exercise programs, and watching television for the subset, compared with those youth who did not meet the inclusion criteria. About 51% of the study sample were male, 7.5% Mexican American, 14.2% non-Hispanic black, and 78.3% non-Hispanic white, and were equally distributed among the age groups. About 30% of the youth were overweight based on age- and sex-specific 85th percentile BMI from the Centers for Disease Control and Prevention growth charts.27 Nearly 81% of the youth reported vigorous physical activity 3 or more times per week and 24% watched 4 or more hours of television, similar to the results reported by Andersen et al.15 About 65% of the youth participated on 1 or more sport teams or in 1 or more exercise programs. There were no differences between males and females regarding weight status, but more males reported participation in 3 or more sessions of vigorous physical activity, participation on sport teams and in exercise programs, and watching 4 or more hours of television (Table 2).

Table Graphic Jump LocationTable 1. Demographic Characteristics, Physical Activity Behaviors, and Watching Television of Youth Aged 8 to 16 Years Who Did Not Meet (n = 2261) and Who Did Meet (n = 2791) Inclusion Criteria From the Third National Health and Nutrition Examination Survey
Table Graphic Jump LocationTable 2. Frequencies and Weighted Percentages for Physical Activity Behaviors and Watching 4 or More Hours of Television and Overweight Among 1336 Males and 1455 Females Aged 8 to 16 Years in the Third National Health and Nutrition Examination Survey

The percentages of overweight youth were 7%, 39%, and 54%, with 0, 1, or 2 overweight parents, respectively (Figure 1). Youth classified as overweight had significantly higher values for BMI, the 3 skinfold measurements, and sum of skinfolds (P<.001) (Table 3). There were no significant differences in mean age between the weight groups.

Place holder to copy figure label and caption

Percentage of overweight youth (n = 2791) with 0, 1, or 2 overweight parents.

Graphic Jump Location
Table Graphic Jump LocationTable 3. Age and Weight Indexes by Overweight Status for 1336 Males and 1455 Females Aged 8 to 16 Years in the Third National Health and Nutrition Examination Survey

Associations of categorical variables with overweight are shown in Table 4. Among females, non-Hispanic black females were more likely to be overweight compared with non-Hispanic white females. Male and female sport team and exercise program participants during the past year were less likely to be in the overweight group. Females who watched 4 or more hours of television were more likely to be overweight compared with those who watched less. Females with an overweight father were more likely to be overweight, as were those with an overweight mother for both males and females. Family income (poverty index) was significantly higher among those in the nonoverweight group compared with the overweight group for males and females. No other significant associations were observed.

Table Graphic Jump LocationTable 4. Weighted Percentage, Unadjusted Odds Ratios (ORs), and 95% Confidence Intervals (CIs) for Categorical Variables nd Means and SEs for Continuous Variables of Youth Aged 8 to 16 Years for Overweight Status, From the Third National Health and Nutrition Examination Survey

Table 5 shows the results of multiple logistic analyses by sex. Non-Hispanic black males were less likely to be in the overweight group when compared with non-Hispanic white males (OR = 0.68). For males, participants on sport teams and in exercise programs were less likely to be in the overweight group (OR = 0.63). Among the females, a significant interaction was found between age group and sport team and exercise program participation. Female sport team and exercise program participants in the group aged 14 to 16 years were less likely to be in the overweight group (OR = 0.23). Larger family size was associated with nonoverweight status among females (OR = 0.88). Higher family income was associated with nonoverweight for males (OR = 0.85). Females who watched 4 or more hours of television were more likely to be in the overweight group than those who watched less television (OR = 1.88). An overweight father increased the risk of being in the overweight group (OR = 1.74 for males, OR = 1.81 for females) compared with those who did not have an overweight father. Youth with an overweight mother were more likely (OR = 2.31 for males, OR = 2.73 for females) to be in the overweight group. No other significant associations were found.

Table Graphic Jump LocationTable 5. Adjusted Odds Ratio (ORs) and 95% Confidence Intervals (CIs) of the Independent Variables With Overweight Status for Males and Females, From the Third National Health and Nutrition Examination Survey

This study evaluated the environmental influences and physical activity behaviors of overweight and nonoverweight 8- to 16-year-olds. Participation in vigorous physical activity was not related to being overweight, while being a sport team or exercise program participant was associated with not being overweight among all males and 14- to 16-year-old females. Females who watched 4 or more hours of television on the day preceding the survey were more likely to be overweight. Environmental factors associated with overweight were being from smaller families for females, being from a family with a smaller family income for males, and having at least 1 overweight parent for both.

In this study, 26% of youth who had participated on sport teams and in exercise classes were overweight compared with 36% of youth who did not participate. This association was significant for all males and for 14- to 16-year-old females. Ross et al30 reported that most children's physical activity takes place in organized programs outside of school. Sports participation is associated with better dietary habits, with youth involved in organized sports reporting more fruit and vegetable consumption than nonparticipants.31,32

As part of dietary guidelines it is recommended that all Americans be physically active each day.33 Among the suggested activities for children and teens was joining after-school or community physical activity programs. But data from the 1997 Youth Risk Behavior Survey indicate that there is a decline in participation in both school and organized sports unaffiliated with schools during high school, especially among females.9 This may be because of a decrease in accessibility or availability of structured activity.

The association between parental weight status and children's BMI was consistent with other studies. Youth with an overweight father or mother had an increased risk of being overweight. Familial patterns of obesity have been attributed to both genetics and family environment.1,34 Youth in families with 1 or 2 overweight parents consume a higher percentage of their energy intake as fat.18,35 No doubt this contributes to the development of overweight in youth. The relationship between overweight and other family variables is similar to previous findings. Troiano and Flegal2 using NHANES III found an inverse relationship between poverty index and non-Hispanic white males. Increases in overweight in youth with smaller family size has been noted.24

Using NHANES III data, Andersen et al15 found a significant positive relationship between television watching and BMI. This study, after controlling for demographic, physical activity behaviors, and environmental variables, found that females who reported watching 4 or more hours of television were more likely overweight than those who watched fewer than 4 hours of television per day. Reducing television watching may be a way to reduce and prevent overweight. Several recent school-based interventions that were successful in reducing the amount of time spent watching television reduced the BMI among females.36,37

This study found that there is an association between overweight status and lack of participation on sport teams and in exercise programs, but the use of a cross-sectional study design precludes conclusions about temporal sequence. Thus, it is not known if nonoverweight youth elected to participate on sport teams and in exercise programs or if participation in these activities helped to prevent youth from becoming overweight. It should also be noted that the duration of vigorous physical activity was not assessed in NHANES III and conclusions about a dose-response relation between the amount of physical activity and overweight cannot be assessed. The subset used in this study was composed of a slightly higher percentage of white youth; they were slightly more active and watched fewer hours of television than those from the NHANES III sample who were not included. Also, this study was limited to youth with reported BMIs for both biologic parents. Despite these limitations, the inclusion of data from a large national data set of youth with a wide range of ages and 3 race/ethnic groups increases the external validity of these results.

School-based interventions have shown that physical education classes can provide vigorous physical activity and promote skills necessary for developing good activity patterns.3840 Schools and communities need to provide physical activity programs that meet the needs and interests of all youth.41 Physicians can serve as advisors for schools and communities to ensure that such programs are safe and enjoyable and provide activities for youth of all ages and race/ethnic groups and for youth with different abilities and interests. Such programs may help to prevent more youth from becoming overweight.42

Parents are instrumental in bringing about weight loss in youth. Epstein and colleagues4346 presented a series of successful family-based interventions based on principles of behavior modification in 5- to 12-year-old obese children that incorporated physical activity, nutrition, and decreased television watching. Physicians need to educate parents about the complications of overweight and evaluate the diet and physical activity of their pediatric and adolescent overweight patients.47 The physician should encourage families to make changes that include increases in physical activity of the overweight youth, limiting television watching, and development of healthy eating habits.

No differences were observed in the number of sessions of reported vigorous physical activity between overweight and nonoverweight youth. Overweight youth were found to be less likely to have participated on sport teams and in exercise programs and were more likely to have overweight parents. Normal-weight females were more likely to have watched less television and come from larger families, while males were from families with higher incomes than their overweight counterparts.

Accepted for publication January 5, 2001.

Corresponding author: Marsha Dowda, DrPH, Department of Exercise Science, University of South Carolina, Columbia, SC 29208 (e-mail: mdowda@sph.sc.edu).

Rosenbaum  MLeibel  RL The physiology of body weight regulation: relevance to the etiology of obesity in children. Pediatrics. 1998;101525- 539
Troiano  RPFlegal  KM Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics. 1998;101497- 504
Troiano  RPFlegal  KMKuczmarski  RJCampbell  SMJohnson  CL Overweight prevalence and trends for children and adolescents: the National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med. 1995;1491085- 1091
Freedman  DSDietz  WHSrinivasan  SRBerenson  GS The relationship of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pedatrics. 1999;1031175- 1182
Guo  SSRoche  AFChumlea  WCGardner  JDSiervogel  RM The predictive value of childhood body mass index values for overweight at age 35 y. Am J Clin Nutr. 1994;59810- 819
Must  AJacques  PFDallal  GEBajema  CJDietz  WH Long-term morbidity and mortality of overweight adolescents: a follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med. 1992;3271350- 1355
Must  ASpadano  JCoakley  EHField  AEColditz  GDietz  WH The disease burden associated with overweight and obesity. JAMA. 1999;2821523- 1529
Kann  LWarren  CWHarris  WA  et al.  Youth Risk Behavior Surveillance—United States, 1995. Mor Mortal Wkly Rep CDC Surveill Summ. 1996;451- 84
Kann  LKinchen  SAWilliam  BI  et al.  Youth Risk Behavior Surveillance—United States, 1997. Morb Mortal Wkly Rep CDC Surveill Summ. 1998;471- 89
Wolf  AMGortmaker  SLCheung  LGray  HMHerzog  DBColditz  GA Activity, inactivity, and obesity: racial, ethnic, and age differences among schoolgirls. Am J Public Health. 1993;831625- 1627
Ward  DSTrost  SGFelton  G  et al.  Physical activity and physical fitness in African-American girls with and without obesity. Obes Res. 1997;5572- 577
Hernández  BGortmaker  SLColditz  GAPeterson  KELaird  NMParra-Cabrera  S Association of obesity with physical activity, television programs and other forms of video viewing among children in Mexico City. Int J Obes Relat Metab Disord. 1999;23845- 854
Huttunen  NPKnip  MPaavilainen  T Physical activity and fitness in obese children. Int J Obes. 1986;10519- 525
Romanella  NEWakat  DKLoyd  BHKelley  LE Physical activity and attitudes in lean and obese children and their mothers. Int J Obes. 1991;15407- 414
Andersen  RECrespo  CJBartlett  SJCheskin  LJPratt  M Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey. JAMA. 1998;279938- 942
Dietz  WHGortmaker  SL Do we fatten our children at the television set? obesity and television viewing in children and adolescents. Pediatrics. 1985;75807- 812
Taras  HLSallis  JFPatterson  TLNader  PRNelson  JA Television's influence on children's diet and physical activity. J Dev Behav Pediatr. 1989;10176- 180
Robinson  TNKillen  JD Ethnic and gender differences in the relationships between television viewing and obesity, physical activity, and dietary fat intake. J Health Educ. 1995;26 ((suppl)) S91- S98
Jeffrey  DBMcLellarn  RWFox  DT The development of children's eating habits: the role of television commercials. Health Educ Q. 1982;9174- 189
Robinson  TNHammer  LDKillen  JD  et al.  Does television viewing increase obesity and reduce physical activity? cross-sectional and longitudinal analysis among adolescent girls. Pediatrics. 1993;91273- 280
Maffeis  CTalamini  GTato  L Influence of diet, physical activity and parent's obesity on children's adiposity: a four-year longitudinal study. Int J Obes Relat Metab Disord. 1998;22758- 764
Eck  LHKlesges  RCHanson  CLSlawson  D Children at familial risk for obesity: an examination of dietary intake, physical activity and weight status. Int J Obes Relat Metab Disord. 1992;1671- 78
Fogelholm  MNuutinen  OPasanen  MMyöhänen  ESäätelä  T Parent-child relationship of physical activity patterns and obesity. Int J Obes Relat Metab Disord. 1999;231262- 1268
Dietz  WH Childhood obesity: susceptibility, cause, and management. J Pediatr. 1983;103676- 686
Department of Health and Human Services, Public Health Services, Centers for Disease Control and Prevention, NHANES III Reference Manuals and Reports [book on CD-ROM].  Hyattsville, Md National Center for Health Statistics1996;
Crespo  CJAinsworth  BEKeteyian  SJHeath  GWSmit  E Prevalence of physical inactivity and its relation to social class in U.S. adults: results from the Third National Health and Nutrition Examination Survey, 1988-1994. Med Sci Sports Exerc. 1999;311821- 1827
Centers for Disease Control and Prevention/National Center for Health Statistics, CDC Growth Charts: United States.  Hyattsville, Md Dept of Health and Human Services2000;
Not Available, Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med. 1998;1581855- 1867
Shah  BVBarnwell  BGBieler  GS SUDAAN User's Manual, Release 7.5.  Research Triangle Park, NC Research Triangle Institute1997;
Ross  JGDotson  COGilbert  GGKatz  SJ After physical education-physical activity outside of school physical education programs. J Phys Educ Recreation Dance. 1985;5635- 39
Pate  RRTrost  SGLevin  SDowda  M Sports participation and health-related behaviors among U.S. youth. Arch Pediatr Adolesc Med. 2000;154904- 911
Baumert  PWHenderson  JMThompson  NJ Health risk behaviors of adolescent participants in organized sports. J Adolesc Health. 1998;22460- 465
Not Available, Nutrition and Your Health: Dietary Guidelines for Americans. 5th ed. Hyattsville, Md Dept of Agriculture and Dept of Health and Human Services2000;Home and Garden Bulletin 232
Birch  LLFisher  JO Development of eating behaviors among children and adolescents. Pediatrics. 1998;101539- 549
Nguyen  VTLarson  DEJohnson  RKGoran  MI Fat intake and adiposity in children of lean and obese parents. Am J Clin Nutr. 1996;63507- 513
Gortmaker  SLPeterson  KWiecha  J  et al.  Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med. 1999;153409- 418
Robinson  TN Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;2821561- 1567
Sallis  JFMcKenzie  TLAlcaraz  JEKolody  BFaucette  NHovell  MF Effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Am J Public Health. 1997;871328- 1334
Luepker  RVPerry  CLMcKinlay  SM  et al. for the CATCH Collaborative Group, Outcomes of field trial to improve children's dietary patterns and physical activity: the Child and Adolescent Trial for Cardiovascular Health. JAMA. 1996;275768- 776
Perry  CLStone  EJParcel  GS  et al.  School-based cardiovascular health promotion: the Child and Adolescent Trial for Cardiovascular Health (CATCH). J Sch Health. 1990;60406- 413
Not Available, Guidelines for school and community programs to promote lifelong physical activity among young people: Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 1997;461- 36
Goran  MIReynolds  KDLindquist  CH Role of physical activity in the prevention of obesity in children. Int J Obes Relat Metab Disord. 1999;23 ((suppl 3)) S18- S33
Epstein  LHMcCurley  JWing  RRValoski  A A five year follow-up of family-based behavioral treatments for childhood obesity. J Consult Clin Psychol. 1990;58661- 664
Epstein  LHValoski  AWing  RRMcCurley  J Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA. 1990;2642519- 2523
Epstein  LHValoski  AWing  RRMcCurley  J Ten-year follow-up of behavioral family-based treatment for childhood obesity. Health Psychol. 1994;13373- 383
Epstein  LHPaluch  RAGordy  CCDorn  J Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med. 2000;154220- 226
Barlow  SEDietz  WHfor the Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services, Obesity evaluation and treatment: Expert Committee recommendations. Pediatrics. 1998;1021- 11Available athttp://www.pediatrics.org/cgi/content/full/102/3/e29Accessibility verified February 8, 2001

Figures

Place holder to copy figure label and caption

Percentage of overweight youth (n = 2791) with 0, 1, or 2 overweight parents.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Demographic Characteristics, Physical Activity Behaviors, and Watching Television of Youth Aged 8 to 16 Years Who Did Not Meet (n = 2261) and Who Did Meet (n = 2791) Inclusion Criteria From the Third National Health and Nutrition Examination Survey
Table Graphic Jump LocationTable 2. Frequencies and Weighted Percentages for Physical Activity Behaviors and Watching 4 or More Hours of Television and Overweight Among 1336 Males and 1455 Females Aged 8 to 16 Years in the Third National Health and Nutrition Examination Survey
Table Graphic Jump LocationTable 3. Age and Weight Indexes by Overweight Status for 1336 Males and 1455 Females Aged 8 to 16 Years in the Third National Health and Nutrition Examination Survey
Table Graphic Jump LocationTable 4. Weighted Percentage, Unadjusted Odds Ratios (ORs), and 95% Confidence Intervals (CIs) for Categorical Variables nd Means and SEs for Continuous Variables of Youth Aged 8 to 16 Years for Overweight Status, From the Third National Health and Nutrition Examination Survey
Table Graphic Jump LocationTable 5. Adjusted Odds Ratio (ORs) and 95% Confidence Intervals (CIs) of the Independent Variables With Overweight Status for Males and Females, From the Third National Health and Nutrition Examination Survey

References

Rosenbaum  MLeibel  RL The physiology of body weight regulation: relevance to the etiology of obesity in children. Pediatrics. 1998;101525- 539
Troiano  RPFlegal  KM Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics. 1998;101497- 504
Troiano  RPFlegal  KMKuczmarski  RJCampbell  SMJohnson  CL Overweight prevalence and trends for children and adolescents: the National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med. 1995;1491085- 1091
Freedman  DSDietz  WHSrinivasan  SRBerenson  GS The relationship of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pedatrics. 1999;1031175- 1182
Guo  SSRoche  AFChumlea  WCGardner  JDSiervogel  RM The predictive value of childhood body mass index values for overweight at age 35 y. Am J Clin Nutr. 1994;59810- 819
Must  AJacques  PFDallal  GEBajema  CJDietz  WH Long-term morbidity and mortality of overweight adolescents: a follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med. 1992;3271350- 1355
Must  ASpadano  JCoakley  EHField  AEColditz  GDietz  WH The disease burden associated with overweight and obesity. JAMA. 1999;2821523- 1529
Kann  LWarren  CWHarris  WA  et al.  Youth Risk Behavior Surveillance—United States, 1995. Mor Mortal Wkly Rep CDC Surveill Summ. 1996;451- 84
Kann  LKinchen  SAWilliam  BI  et al.  Youth Risk Behavior Surveillance—United States, 1997. Morb Mortal Wkly Rep CDC Surveill Summ. 1998;471- 89
Wolf  AMGortmaker  SLCheung  LGray  HMHerzog  DBColditz  GA Activity, inactivity, and obesity: racial, ethnic, and age differences among schoolgirls. Am J Public Health. 1993;831625- 1627
Ward  DSTrost  SGFelton  G  et al.  Physical activity and physical fitness in African-American girls with and without obesity. Obes Res. 1997;5572- 577
Hernández  BGortmaker  SLColditz  GAPeterson  KELaird  NMParra-Cabrera  S Association of obesity with physical activity, television programs and other forms of video viewing among children in Mexico City. Int J Obes Relat Metab Disord. 1999;23845- 854
Huttunen  NPKnip  MPaavilainen  T Physical activity and fitness in obese children. Int J Obes. 1986;10519- 525
Romanella  NEWakat  DKLoyd  BHKelley  LE Physical activity and attitudes in lean and obese children and their mothers. Int J Obes. 1991;15407- 414
Andersen  RECrespo  CJBartlett  SJCheskin  LJPratt  M Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey. JAMA. 1998;279938- 942
Dietz  WHGortmaker  SL Do we fatten our children at the television set? obesity and television viewing in children and adolescents. Pediatrics. 1985;75807- 812
Taras  HLSallis  JFPatterson  TLNader  PRNelson  JA Television's influence on children's diet and physical activity. J Dev Behav Pediatr. 1989;10176- 180
Robinson  TNKillen  JD Ethnic and gender differences in the relationships between television viewing and obesity, physical activity, and dietary fat intake. J Health Educ. 1995;26 ((suppl)) S91- S98
Jeffrey  DBMcLellarn  RWFox  DT The development of children's eating habits: the role of television commercials. Health Educ Q. 1982;9174- 189
Robinson  TNHammer  LDKillen  JD  et al.  Does television viewing increase obesity and reduce physical activity? cross-sectional and longitudinal analysis among adolescent girls. Pediatrics. 1993;91273- 280
Maffeis  CTalamini  GTato  L Influence of diet, physical activity and parent's obesity on children's adiposity: a four-year longitudinal study. Int J Obes Relat Metab Disord. 1998;22758- 764
Eck  LHKlesges  RCHanson  CLSlawson  D Children at familial risk for obesity: an examination of dietary intake, physical activity and weight status. Int J Obes Relat Metab Disord. 1992;1671- 78
Fogelholm  MNuutinen  OPasanen  MMyöhänen  ESäätelä  T Parent-child relationship of physical activity patterns and obesity. Int J Obes Relat Metab Disord. 1999;231262- 1268
Dietz  WH Childhood obesity: susceptibility, cause, and management. J Pediatr. 1983;103676- 686
Department of Health and Human Services, Public Health Services, Centers for Disease Control and Prevention, NHANES III Reference Manuals and Reports [book on CD-ROM].  Hyattsville, Md National Center for Health Statistics1996;
Crespo  CJAinsworth  BEKeteyian  SJHeath  GWSmit  E Prevalence of physical inactivity and its relation to social class in U.S. adults: results from the Third National Health and Nutrition Examination Survey, 1988-1994. Med Sci Sports Exerc. 1999;311821- 1827
Centers for Disease Control and Prevention/National Center for Health Statistics, CDC Growth Charts: United States.  Hyattsville, Md Dept of Health and Human Services2000;
Not Available, Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med. 1998;1581855- 1867
Shah  BVBarnwell  BGBieler  GS SUDAAN User's Manual, Release 7.5.  Research Triangle Park, NC Research Triangle Institute1997;
Ross  JGDotson  COGilbert  GGKatz  SJ After physical education-physical activity outside of school physical education programs. J Phys Educ Recreation Dance. 1985;5635- 39
Pate  RRTrost  SGLevin  SDowda  M Sports participation and health-related behaviors among U.S. youth. Arch Pediatr Adolesc Med. 2000;154904- 911
Baumert  PWHenderson  JMThompson  NJ Health risk behaviors of adolescent participants in organized sports. J Adolesc Health. 1998;22460- 465
Not Available, Nutrition and Your Health: Dietary Guidelines for Americans. 5th ed. Hyattsville, Md Dept of Agriculture and Dept of Health and Human Services2000;Home and Garden Bulletin 232
Birch  LLFisher  JO Development of eating behaviors among children and adolescents. Pediatrics. 1998;101539- 549
Nguyen  VTLarson  DEJohnson  RKGoran  MI Fat intake and adiposity in children of lean and obese parents. Am J Clin Nutr. 1996;63507- 513
Gortmaker  SLPeterson  KWiecha  J  et al.  Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med. 1999;153409- 418
Robinson  TN Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;2821561- 1567
Sallis  JFMcKenzie  TLAlcaraz  JEKolody  BFaucette  NHovell  MF Effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Am J Public Health. 1997;871328- 1334
Luepker  RVPerry  CLMcKinlay  SM  et al. for the CATCH Collaborative Group, Outcomes of field trial to improve children's dietary patterns and physical activity: the Child and Adolescent Trial for Cardiovascular Health. JAMA. 1996;275768- 776
Perry  CLStone  EJParcel  GS  et al.  School-based cardiovascular health promotion: the Child and Adolescent Trial for Cardiovascular Health (CATCH). J Sch Health. 1990;60406- 413
Not Available, Guidelines for school and community programs to promote lifelong physical activity among young people: Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 1997;461- 36
Goran  MIReynolds  KDLindquist  CH Role of physical activity in the prevention of obesity in children. Int J Obes Relat Metab Disord. 1999;23 ((suppl 3)) S18- S33
Epstein  LHMcCurley  JWing  RRValoski  A A five year follow-up of family-based behavioral treatments for childhood obesity. J Consult Clin Psychol. 1990;58661- 664
Epstein  LHValoski  AWing  RRMcCurley  J Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA. 1990;2642519- 2523
Epstein  LHValoski  AWing  RRMcCurley  J Ten-year follow-up of behavioral family-based treatment for childhood obesity. Health Psychol. 1994;13373- 383
Epstein  LHPaluch  RAGordy  CCDorn  J Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med. 2000;154220- 226
Barlow  SEDietz  WHfor the Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services, Obesity evaluation and treatment: Expert Committee recommendations. Pediatrics. 1998;1021- 11Available athttp://www.pediatrics.org/cgi/content/full/102/3/e29Accessibility verified February 8, 2001

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles