Hospital Length of Stay, Charges, and Costs Associated With a Diagnosis of Obesity in US Children and Youth, 2006-2016.

BACKGROUND: Childhood obesity is linked with adverse health outcomes and associated costs. Current information on the relationship between childhood obesity and inpatient costs is limited. OBJECTIVE: The objective of this study was to describe trends and quantify the link between childhood obesity diagnosis and hospitalization length of stay (LOS), costs, and charges. RESEARCH DESIGN: We use the National Inpatient Sample data from 2006 to 2016. SUBJECTS: The sample includes hospitalizations among children aged 2-19 years. The treatment group of interest includes child hospitalizations with an obesity diagnosis. MEASURES: Hospital LOS, charges, and costs associated with a diagnosis of obesity. RESULTS: We find increases in obesity-coded hospitalizations and associated charges and costs during 2006-2016. Obesity as a primary diagnosis is associated with a shorter hospital LOS (by 1.8 d), but higher charges and costs (by $20,879 and $6049, respectively); obesity as a secondary diagnosis is associated with a longer LOS (by 0.8 d), and higher charges and costs of hospitalizations (by $3453 and $1359, respectively). The most common primary conditions occurring with a secondary diagnosis of obesity are pregnancy conditions, mood disorders, asthma, and diabetes; the effect of a secondary diagnosis of obesity on LOS, charges, and costs holds across these conditions. CONCLUSIONS: Childhood obesity diagnosis-related hospitalizations, charges, and costs increased substantially during 2006-2016, and obesity diagnosis is associated with higher hospitalization charges and costs. Our findings provide clinicians and policymakers with additional evidence of the economic burden of childhood obesity and further justify efforts to prevent and manage the disease.

Association between the price of ultra-processed foods and obesity in Brazil.

BACKGROUND AND AIMS: To estimate the relationship between the price of ultra-processed foods and prevalence of obesity in Brazil and examine whether the relationship differed according to socioeconomic status. METHODS AND RESULTS: Data from the national Household Budget Survey from 2008/09 (n = 55 570 households, divided in 550 strata) were used. Weight and height of all individuals were used. Weight was measured by using portable electronic scales (maximum capacity of 150 kg). Height (or length) was measured using portable stadiometers (maximum capacity: 200 cm long) or infant anthropometers (maximum capacity: 105 cm long). Multivariate regression models (log-log) were used to estimate price elasticity. An inverse association was found between the price of ultra-processed foods (per kg) and the prevalence of overweight (Body mass index (BMI) ≥25 kg/m2) and obesity (BMI ≥30 kg/m2) in Brazil. The price elasticity for ultra-processed foods was -0.33 (95% CI: -0.46; -0.20) for overweight and -0.59 (95% CI: -0.83; -0.36) for obesity. This indicated that a 1.00% increase in the price of ultra-processed foods would lead to a decrease in the prevalence of overweight and obesity of 0.33% and 0.59%, respectively. For the lower income group, the price elasticity for price of ultra-processed foods was -0.34 (95% CI: -0.50; -0.18) for overweight and -0.63 (95% CI: -0.91; -0.36) for obesity. CONCLUSION: The price of ultra-processed foods was inversely associated with the prevalence of overweight and obesity in Brazil, mainly in the lowest socioeconomic status population. Therefore, the taxation of ultra-processed foods emerges as a prominent tool in the control of obesity.

The influence of socioeconomic status and age on the prevalence of overweight and obesity among 5 to 10-year-old children in Curitiba, Brazil.

OBJECTIVE: The aim of this study was to examine the influence of the socioeconomic status (SES) and age on the prevalence of overweight and obesity among 5 to 10-year-old children from Brazil. METHODS: The sample consisted of 80 782 (41 063 boys) students aged 5 to 10-year-old. Height and weight were measured and body mass index (BMI) was calculated. SES was self-reported by parents when registering for school in the same year as the assessment. RESULTS: An increasing trend in the prevalence of obesity, for boys and girls, and overweight, for girls, as they got older was observed. The prevalence of obesity was greater among medium SES boys, 18.1% (95% CI: 17.7, 18.6), and girls, 18.1% (95% CI: 17.7, 18.6), compared with low SES. For each year boys and girls get older their odds of being underweight, overweight and obese increase. Medium and high SES boys were 23% (95% CI: 1.14, 1.32) and 25% (95%CI: 1.03, 1.52) more likely to be obese than low SES boys. Girls with high SES were 20% (OR = 1.20; 95% CI: 1.10, 1.31) more likely of being obese than girls with low SES. Furthermore, age and being in the medium SES for both sexes and in the high SES for boys was positively related to the BMI z-score. CONCLUSION: Both age and SES were factors associated with obesity among Brazilian children. For public health policies to be effective, it is necessary to understand why higher SES children and older children have higher risk and prevalence of obesity and overweight.

Cost-utility and cost-benefit analyses of school-based obesity prevention program.

BACKGROUND: Economic evaluation of school-based obesity interventions could provide support for public health decision of obesity prevention. This study is to perform cost-utility and cost-benefit assessment of three school-based childhood obesity interventions including nutrition education intervention (NE), physical activity intervention (PA) and comprehensive intervention (both NE and PA, CNP) with secondary data analysis of one randomized controlled trial. METHODS: The standard cost-effectiveness analysis methods were employed from a societal perspective to the health outcome and costs that are attributable to the intervention. NE, PA and CNP were carried out separately for 2 semesters for childhood obesity interventions in primary schools. The additional quality-adjusted life years (QALYs) resulting from the interventions were measured as the health outcome. A cost-utility ratio (CUR) and A cost-benefit ratio (CBR) was calculated as the ratio of implementation costs to the total medical and productivity loss costs averted by the interventions. RESULTS: The CUR and CBR were ¥11,505.9 ($1646.0) per QALY and ¥1.2 benefit per ¥1 cost respectively, and the net saving was ¥73,659.6 ($10,537.9). The CUR and CBR for nutrition education and physical activity interventions were ¥21,316.4 ($3049.6) per QALY and ¥0.7 benefit per ¥1 cost, ¥28,417.1 ($4065.4) per QALY and ¥0.4 benefit per ¥1 cost, respectively (in 2019 RMB). Compared with PA intervention, the ICERs were ¥10,335.2 ($1478.6) and 4626.3 ($661.8) for CNP and NE respectively. The CBR was ¥1.2, 0.7, and 0.4 benefits per ¥1 cost for CNP, NE, and PA interventions, respectively. Net estimated savings were achieved only through CNP intervention, amounting to ¥73,659.6 ($10,537.9). CONCLUSIONS: Comprehensive school-based obesity intervention is a beneficial investment that is both cost-effective and cost saving. Compared with PA intervention, both CNP and NE intervention were more cost-effective.

Measuring commissioners' willingness-to-pay for community based childhood obesity prevention programmes using a discrete choice experiment.

BACKGROUND: In the UK, rates of childhood obesity remain high. Community based programmes for child obesity prevention are available to be commissioned by local authorities. However, there is a lack of evidence regarding how programmes are commissioned and which attributes of programmes are valued most by commissioners. The aim of this study was to determine the factors that decision-makers prioritise when commissioning programmes that target childhood obesity prevention. METHODS: An online discrete choice experiment (DCE) was used to survey commissioners and decision makers in the UK to assess their willingness-to-pay for childhood obesity programmes. RESULTS: A total of 64 commissioners and other decision makers completed the DCE. The impact of programmes on behavioural outcomes was prioritised, with participants willing to pay an extra £16,600/year if average daily fruit and vegetable intake increased for each child by one additional portion. Participants also prioritised programmes that had greater number of parents fully completing them, and were willing to pay an extra £4810/year for every additional parent completing a programme. The number of parents enrolling in a programme (holding the number completing fixed) and hours of staff time required did not significantly influence choices. CONCLUSIONS: Emphasis on high programme completion rates and success increasing children's fruit and vegetable intake has potential to increase commissioning of community based obesity prevention programmes.

Cost-effectiveness of community-based childhood obesity prevention interventions in Australia.

OBJECTIVES: The objective of this study is to examine, from a limited societal perspective, the cost-effectiveness of community-based obesity prevention interventions (CBIs)-defined as a programme of community-level strategies to promote healthy eating and physical activity for Australian children (aged 5-18 years). METHODS: The effectiveness of CBIs was determined by undertaking a literature review and meta-analysis. Commonly implemented strategies to increase physical activity and improve nutrition were costed (in 2010 Australian dollars) to determine the average cost of a generic programme. A multiple cohort Markov model that simulates diseases associated with overweight and obesity was used to estimate the health benefits, measured as health-adjusted life years (HALYs) and healthcare-related cost offsets from diseases averted due to exposure to the intervention. Health and cost outcomes were estimated over the lifetime of the target population. Monte-Carlo simulation was used to assess second-order uncertainty of input parameters to estimate mean incremental cost-effectiveness ratios (ICER) with 95% uncertainty intervals (UIs). Scenario analyses tested variations in programme intensity, target population, and duration of effect. RESULTS: The meta-analysis revealed a small but significant difference in BMI z-score (mean difference of - 0.07 (95% UI: - 0.13 to - 0.01)) favouring the CBI community compared with the control. The estimated net cost of implementing CBIs across all local government areas (LGAs) in Australia was AUD426M (95% UI: AUD3M to AUD823M) over 3 years. This resulted in 51,792 HALYs gained (95% UI: 6816 to 96,972) over the lifetime of the cohort. The mean ICER was AUD8155 per HALY gained (95% UI: AUD237 to AUD81,021), with a 95% probability of being cost-effective at a willingness to pay threshold of AUD50,000 per HALY. CONCLUSIONS: CBIs are cost-effective obesity prevention initiatives; however, implementation across Australia will be (relatively) expensive when compared with current investments in preventive health.

Disparities in childhood overweight and obesity by income in the United States: an epidemiological examination using three nationally representative datasets.

BACKGROUND/OBJECTIVES: Overweight and obesity (OWOB) is a global epidemic. Adults and adolescents from low-income households are at higher risk to be OWOB. This study examined the relationship between income and OWOB prevalence in children and adolescents (518 years) in the United States (US) within and across race/ethnicities, and changes in this relationship from 1971 to 2014. SUBJECTS/METHODS: A meta-analysis of a nationally representative sample (N = 73,891) of US children and adolescents drawn from three datasets (i.e., National Health and Nutrition Examination Survey, National Longitudinal Survey of Youth, & the Early Childhood Longitudinal Program) which included 14 cross-sectional waves spanning 1971-2014 was conducted. The exposure was household income-to-poverty ratio (low income = 0.00-1.00, middle income = 1.01-4.00, high income >4.00) with prevalence of overweight or obesity (body mass index ≥ 85th percentile) as the outcome. RESULTS: Children and adolescents from middle-income and high-income households were 0.78 (95% CI = 0.72, 0.83) and 0.68 (95% CI = 0.59, 0.77) times as likely to be OWOB compared to children and adolescents in low-income households. Separate analyses restricted to each racial/ethnic group showed children and adolescents from middle- and high-income households were less likely to be OWOB compared to their low-income peers within the White, Hispanic, and Other race/ethnic groups. Children and adolescents from low-income households who were Black were not more likely to be OWOB than their high- and middle-income counterparts. Analyses within each income stratum indicated that race/ethnicity was not related to the prevalence of OWOB in low-income households. However, racial/ethnic differences in OWOB were evident for children and adolescents in middle- and high-income households. Disparities in the prevalence of OWOB between low-income children and adolescents and their middle- and high-income counterparts have increased from 1971 to 2014. CONCLUSIONS: Income and OWOB are related in US children and adolescents. Racial/ethnic differences in the prevalence of OWOB emerge in middle- and high-income households. Disparities in OWOB prevalence are growing.

Addressing childhood obesity in low-income, ethnically diverse families: outcomes and peer effects of MEND 7-13 when delivered at scale in US communities.

OBJECTIVES: Implementation of a large-scale, child weight management program in low-income, ethnically diverse communities provided an important opportunity to evaluate its effectiveness under service level conditions (i.e. provision as a primary care child weight management service). METHODS: MEND 7-13 is a community-based, multi-component, childhood obesity intervention designed to improve dietary, physical activity and sedentary behaviors. It comprises twice weekly sessions for 10 consecutive weeks (35 contact hours) and is delivered to groups of children and accompanying parents/caregivers. The evaluation used an uncontrolled, repeated measures design. Overall, 3782 children with overweight or obesity attended 415 MEND 7-13 programs in eight US states, of whom 2482 children (65.6%) had complete data for change in zBMI. The intervention targeted low-income, ethnically diverse families. Changes in anthropometric, cardiovascular fitness and psychological outcomes were evaluated. A longitudinal multivariate imputation model was used to impute missing data. Peer effects analysis was conducted using the instrumental variables approach and group fixed effects. RESULTS: Mean changes in BMI and zBMI at 10 weeks were -0.49 kg/m2 (95% CI: -0.67, -0.31) and -0.06 (95% CI: -0.08, -0.05), respectively. Benefits were observed for cardiovascular fitness and psychological outcomes. Mean peer reduction in zBMI was associated with a reduction in participant zBMI in the instrumental variables model (B = 0.78, P = 0.04, 95% CI: 0.03, 1.53). Mean program attendance and retention were 73.9% and 88.5%, respectively. CONCLUSION: Implementing MEND 7-13 under service level conditions was associated with short-term improvements in anthropometric, fitness and psychological indices in a large sample of low-income, ethnically diverse children with overweight and obesity. A peer effect was quantified showing that benefits for an individual child were enhanced, if peers in the same group also performed well. To our knowledge, this is the first US study to evaluate outcomes of an up-scaled community-based, child weight management program and to show positive peer effects associated with participation in the intervention.

Estimating CHU-9D Utility Scores from the WAItE: A Mapping Algorithm for Economic Evaluation.

BACKGROUND: The Weight-Specific Adolescent Instrument for Economic Evaluation (WAItE) is a new condition-specific patient reported outcome measure that incorporates the views of adolescents in assessing the impact of above healthy weight status on key aspects of their lives. Presently it is not possible to use the WAItE to calculate quality adjusted life years (QALYs) for cost-utility analysis (CUA), given that utility scores are not available for health states described by the WAItE. OBJECTIVE: This paper examines different regression models for estimating Child Health Utility 9 Dimension (CHU-9D) utility scores from the WAItE for the purpose of calculating QALYs to inform CUA. METHODS: The WAItE and CHU-9D were completed by a sample of 975 adolescents. Nine regression models were estimated: ordinary least squares, Tobit, censored least absolute deviations, two-part, generalized linear model, robust MM-estimator, beta-binomial, finite mixture models, and ordered logistic regression. The mean absolute error (MAE) and mean squared error (MSE) were used to assess the predictive ability of the models. RESULTS: The robust MM-estimator with stepwise-selected WAItE item scores as explanatory variables had the best predictive accuracy. CONCLUSIONS: Condition-specific tools have been shown to be more sensitive to changes that are important to the population for which they have been developed for. The mapping algorithm developed in this study facilitates the estimation of health-state utilities necessary for undertaking CUA within clinical studies that have only collected the WAItE.

Monetary diet cost is positively associated with diet quality and obesity: an analysis of school-aged children in Southwest China.

BACKGROUND: Little is known about the relationships between diet cost, dietary intake and obesity in Chinese populations. This study explored how diet cost was related to diet quality and obesity among school-aged children in Southwest China. METHODS: Data from a cross-sectional study was analysed. Diet cost was estimated based on dietary intake assessed with 24-h dietary recalls and retail food prices. Diet quality was measured using the Chinese Children Dietary Index. Body height, weight, waist circumference and skinfold thicknesses were measured, and their body mass index standard deviation score (BMISDS), waist-to-height ratio (WHtR), fat mass index (FMI) and fat-free mass index (FFMI) were calculated. Multivariate regression models were used to explore the relevance of diet cost to diet quality and obesity. RESULTS: After adjustment for potential confounders, a positive association was observed between diet quality and energy-adjusted diet cost (ß = 0.143, 95% confidence interval, CI: 0.014-0.285, Pfor-trend = 0.0006). Energy-adjusted diet cost also showed a positive association with FMI (ß = 0.0354, 95% CI: 0.0001-0.0709, Pfor-trend = 0.01), BMISDS (ß = 0.0200, 95% CI: 0.0006-0.0394, Pfor-trend = 0.002) and WHtR (ß = 0.0010, 95% CI: 0.0003-0.0017, Pfor-trend = 0.02). CONCLUSIONS: Energy-adjusted diet cost was independently and positively associated with diet quality and obesity among Chinese school-aged children.

Effects of local authority expenditure on childhood obesity.

BACKGROUND: Under the 2013 reforms introduced by the Health and Social Care Act (2012), public health responsibilities in England were transferred from the National Health Service to local authorities (LAs). Ring-fenced grants were introduced to support the new responsibilities. The aim of our study was to test whether the level of expenditure in 2013/14 affected the prevalence of childhood obesity in 2016/17. METHODS: We used National Child Measurement Programme definitions of childhood obesity and datasets. We used LA revenue returns data to derive three measures of per capita expenditure: childhood obesity (<19); physical activity (<19) and the Children's 5-19 Public Health Programme. We ran separate negative binomial models for two age groups of children (4-5 year olds; 10-11 year olds) and conducted sensitivity analyses. RESULTS: With few exceptions, the level of spend in 2013/14 was not significantly associated with the level of childhood obesity in 2016/17. We identified some positive associations between spend on physical activity and the Children's Public Health Programme at baseline (2013/14) and the level of childhood obesity in children aged 4-5 in 2016/17, but the effect was not evident in children aged 10-11. In both age groups, LA levels of childhood obesity in 2016/17 were significantly and positively associated with obesity levels in 2013/14. As these four cohorts comprise entirely different pupils, this underlines the importance of local drivers of childhood obesity. CONCLUSIONS: Higher levels of local expenditure are unlikely to be effective in reducing childhood obesity in the short term.

Effects of Contextual Economic Factors on Childhood Obesity.

OBJECTIVES: To examine the association between changes in contextual economic factors on childhood obesity in the US. METHODS: We combined data from 2003, 2007, and 2011/2012 National Surveys of Children's Health for 129,781 children aged 10-17 with 27 state-level variables capturing general economic conditions, labor supply, and the monetary or time costs of calorie intake, physical activity, and cigarette smoking. We employed regression models controlling for demographic factors and state and year fixed effects. We also examined heterogeneity in economic effects by household income. RESULTS: Obesity risk increased with workforce proportion in blue-collar occupations, urban sprawl, female labor force participation, and number of convenience stores but declined with median household income, smoking ban in restaurants, and full service restaurants per capita. Most effects were specific to low income households, except for density of supercenters/warehouse clubs which was significantly associated with higher overweight/obesity risk only in higher income households. CONCLUSIONS FOR PRACTICE: Changes in state-level economic factors related to labor supply and monetary or time cost of calorie intake may affect childhood obesity especially for children in low-income households. Policymakers should consider these effects when designing programs aimed at reducing childhood obesity.

Influence of early-life risk factors on socioeconomic inequalities in weight gain.

Background: Previous research has examined the role of early-life risk factors on childhood weight gain.The extent to which these factors drive socioeconomic differences in weight is unclear. We aimed to quantify the influence of early-life risk factors on the development of socioeconomic inequalities in children's body mass index (BMI) z-score at 10-11 years. Methods: Overall, 2186 children from the Longitudinal Study of Australian Children were examined. Socioeconomic position (SEP) was measured as a continuous composite of parent's education, occupation and income. The Product of Coefficients mediation method was used to quantify the contribution of maternal smoking during pregnancy, gestational diabetes, prematurity, caesarean section, birthweight, not being breastfed, early introduction of solid food, maternal BMI and paternal BMI to the relationship between SEP and BMI z-score. Results: Each increasing decile of SEP (higher SEP) was associated with a 0.05 unit lower (95% CI: -0.06, -0.03) BMI z-score at 10-11 years. In total, 83.5% of these differences in BMI z-score could be explained by socioeconomic differences in maternal smoking during pregnancy (26.9%), maternal BMI (39.6%) and paternal BMI (17.0%). Conclusions: Interventions to reduce socioeconomic inequalities in excess weight gain during childhood should support the attainment of a healthy parental weight and prevent smoking during pregnancy.

Provider views on childhood obesity management in primary care settings: a mixed methods analysis.

BACKGROUND: Pediatric providers are key players in the treatment of childhood obesity, yet rates of obesity management in the primary care setting are low. The goal of this study was to examine the views of pediatric providers on conducting obesity management in the primary care setting, and identify potential resources and care models that could facilitate delivery of this care. METHODS: A mixed methods approach was utilized. Four focus groups were conducted with providers from a large pediatric network in San Diego County. Based on a priori and emerging themes, a questionnaire was developed and administered to the larger group of providers in this network. RESULTS: Barriers to conducting obesity management fell into four categories: provider-level/individual (e.g., lack of knowledge and confidence), practice-based/systems-level (e.g., lack of time and resources), parent-level (e.g., poor motivation and follow-up), and environmental (e.g., lack of access to resources). Solutions centered around implementing a team approach to care (with case managers and health coaches) and electronic medical record changes to include best practice guidelines, increased ease of documentation, and delivery of standardized handouts/resources. Survey results revealed only 23.8% of providers wanted to conduct behavioral management of obesity. The most requested support was the introduction of a health educator in the office to deliver a brief behavioral intervention. CONCLUSION: While providers recognize the importance of addressing weight during a well-child visit, they do not want to conduct obesity management on their own. Future efforts to improve health outcomes for pediatric obesity should consider implementing a collaborative care approach.

Regional disparities in obesity/emaciation and income in schoolchildren in Osaka City.

BACKGROUND: We assessed the association between socioeconomic status at residential area-level in the 24 wards of Osaka City, differentiated by indices of mean income-related deprivation, and inequalities in childhood obesity and emaciation. METHODS: Data from representative samples of 26 474 schoolchildren (first and fifth grades of elementary school, and third grade of junior high school [i.e. ninth grade of elementary school]) in Osaka City taken from a somatometric check in spring 2016 were analyzed. The cross-sectional association between socioeconomic factors, that is, the census-based annual income of each ward, and the prevalence of childhood overweight/obesity and emaciation, was examined. RESULTS: The prevalence of overweight/obesity in boys and girls in the first and fifth grades of elementary school and the third grade of junior high school was 3.98% and 4.53%, 10.18% and 8.69%, and 7.02% and 5.55%, respectively. The prevalence of emaciation in boys and girls in the first and fifth grades of elementary school, and the third grade of junior high school was 0.14% and 0.10%, 0.46% and 1.06% and 3.95% and 3.05%, respectively. Mean physical value, expressed as % degree of overweight, had a negative correlation with mean annual income of each ward in girls in the first and fifth grades of elementary school, girls in the third grade of junior high school and boys in the first grade of elementary school. CONCLUSIONS: Overweight/obesity at school age is greatly affected by poverty. Efforts should be made to prevent emaciation not only in girls, but also in boys, in junior high school.

Why Early Prevention of Childhood Obesity Is More Than a Medical Concern: A Health Economic Approach.

BACKGROUND: Childhood overweight and obesity are a non-deniable health concern with increasing economic attention. SUMMARY: International studies provide robust evidence about substantial lifetime excess costs due to childhood obesity, thereby underscoring the urgent need to implement potent obesity prevention programs in early childhood. Fortunately, this is happening more and more, as evidenced by the increase in well-conducted interventions. Nevertheless, an important piece of the puzzle is often missing, that is, health economic evaluations. There are 3 main reasons for this: an insufficient number of economic approaches which consider the complexity of childhood obesity, a lack of (significant) long-term effect sizes of an intervention, and inadequate planning of health economic evaluations in the design phase of an intervention. Key Messages: It is advisable to involve health economists during the design phase of an intervention. Equally necessary is the development of a tailored toolbox for efficient data acquisition.

Characterizing a "Big Data" Cohort of Over 200,000 Low-Income U.S. Infants and Children for Obesity Research: The ADVANCE Early Life Cohort.

Introduction Low-income populations have elevated exposure to early life risk factors for obesity, but are understudied in longitudinal research. Our objective was to assess the utility of a cohort derived from electronic health record data from safety net clinics for investigation of obesity emerging in early life. Methods We examined data from the PCORNet ADVANCE Clinical Data Research Network, a national network of Federally-Qualified Health Centers serving >1.7 million safety net patients across the US. This cohort includes patients who, in 2012-2014, had ≥1 valid body mass index measure when they were 0-5 years of age. We characterized the cohort with respect to factors required for early life obesity research in vulnerable subgroups: sociodemographic diversity, weight status based on World Health Organization (<2 years) or Centers for Disease Control (≥2 years) growth curves, and data longitudinality. Results The cohort includes 216,473 children and is racially/ethnically diverse (e.g., 17.9% Black, 45.4% Hispanic). A majority (56.9%) had family incomes below the Federal Poverty Level (FPL); 32% were <50% of FPL. Among children <2 years, 7.6 and 5.3% had high and low weight-for-length, respectively. Among children 2-5 years, 15.0, 12.7 and 2.4% were overweight, obese, and severely obese, respectively; 5.3% were underweight. In the study period, 79.2% of children had ≥2 BMI measures. Among 4-5 year olds, 21.9% had >1 BMI measure when they were <2 years. Discussion The ADVANCE Early Life cohort offers unique opportunities to investigate early life determinants of obesity in the understudied population of low income and minority children.

Socioeconomic inequalities in childhood overweight: heterogeneity across five countries in the WHO European Childhood Obesity Surveillance Initiative (COSI-2008).

BACKGROUND: Excess risk of childhood overweight and obesity occurring in socioeconomically disadvantaged families has been demonstrated in numerous studies from high-income regions, including Europe. It is well known that socioeconomic characteristics such as parental education, income and occupation are etiologically relevant to childhood obesity. However, in the pan-European setting, there is reason to believe that inequalities in childhood weight status may vary among countries as a function of differing degrees of socioeconomic development and equity. SUBJECTS AND METHODS: In this cross-sectional study, we have examined socioeconomic differences in childhood obesity in different parts of the European region using nationally representative data from Bulgaria, the Czech Republic, Lithuania, Portugal and Sweden that were collected in 2008 during the first round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. RESULTS: Heterogeneity in the association between parental socioeconomic indicators and childhood overweight or obesity was clearly observed across the five countries studied. Positive as well as negative associations were observed between parental socioeconomic indicators and childhood overweight, with statistically significant interactions between country and parental indicators. CONCLUSIONS: These findings have public health implications for the WHO European Region and underscore the necessity to continue documenting socioeconomic inequalities in obesity in all countries through international surveillance efforts in countries with diverse geographic, social and economic environments. This is a prerequisite for universal as well as targeted preventive actions.

Communities of Color Creating Healthy Environments to Combat Childhood Obesity.

Ethnic and racial health disparities present an enduring challenge to community-based health promotion, which rarely targets their underlying population-level determinants (e.g., poverty, food insecurity, health care inequity). We present a novel 3-lens prescription for using community organizing to treat these determinants in communities of color based on the Robert Wood Johnson Foundation's Communities Creating Healthy Environments initiative, the first national project to combat childhood obesity in communities of color using community organizing strategies. The lenses--Social Justice, Culture-Place, and Organizational Capacity-Organizing Approach--assist health professional-community partnerships in planning and evaluating community organizing-based health promotion programs. These programs activate community stakeholders to alter their community's disease-causing, population-level determinants through grassroots policy advocacy, potentially reducing health disparities affecting communities of color.