Associations between Biological Maturation, Chronological Age, Body Mass Index, Sex, and Motor Competence in Prepubertal Children: A Network Analysis.

BACKGROUND: The development of motor competence (MC) during childhood is crucial for future physical activity and health outcomes, and it is affected by both biological and psychosocial factors. Most MC research has focused on children's age, with fewer studies examining separate associations between MC and biological maturation. METHODS: This cross-sectional study used network analysis to assess the nonlinear associations between biological maturation (the child's percentage of predicted mature stature to indicate somatic maturation), chronological age, sex, BMI, and MC (Test of Gross Motor Development, third edition) in 218 children (100 boys, 118 girls) aged 7-9 years. RESULTS: Biological maturation was not significantly associated with MC in boys and weakly associated with MC in girls for the dribble, under-hand throw, and gallop. Age was positively associated with MC in girls and boys. Centrality measures indicated that the gallop and slide in girls and the dribble, catch, and run in boys were the most important network variables. Positive associations were observed between maturation and BMI for girls (r = 0.579) and, to a lesser degree, for boys (r = 0.267). CONCLUSIONS: The findings suggest that age, rather than biological maturation, is positively associated with MC in 7- to 9-year-olds. Centrality measures showed that some skills may influence other skills.

Investigating the Construct Validity and Reliability of the Test of Motor Competence Across Iranians' Lifespan.

Motor competence (MC) has been extensively examined in children and adolescents, but has not been studied among adults nor across the lifespan. The Test of Motor Competence (TMC) assesses MC in people aged 5-85 years. Among Iranians, aged 5-85 years, we aimed to determine the construct validity and reliability of the TMC and to examine associations between TMC test items and the participants' age, sex, and body mass index (BMI). We conducted confirmatory factor analysis (CFA) to evaluate the TMC's factorial structure by age group and for the whole sample. We explored associations between the TMC test items and participant age, sex, and BMI using a network analysis machine learning technique (Rstudio and qgraph). CFA supported the construct validity of a unidimensional model for motor competence for the whole sample (RMSEA = 0.003; CFI = 0.998; TLI = 0.993) and for three age groups (RMSEA <0.08; CFI and TLI >0.95). Network analyses showed fine motor skills to be the most critical centrality skills, reinforcing the importance of fine motor skills for performing and participating in many daily activities across the lifespan. We found the TMC to be a valid and reliable test to measure MC across Iranians' lifespan. We also demonstrated the advantages of using a machine learning approach via network analysis to evaluate associations between skills in a complex system.

Prevalence of fundamental movement skill proficiency among Iranian children aged 2.5-14 years.

OBJECTIVES: To determine the prevalence of fundamental movement skill (FMS) proficiency among a sample of Iranian children. DESIGN: Cross sectional, representative sample of 2200 children aged 2.5-14 years (50% girls), living in Tehran in 2018. METHODS: Trained field staff assessed 7 locomotor and 4 object control skills in educational settings using the Ohio State University Scale of Intra-Gross Motor Assessment (OSU-SIGMA). Scores for levels 1-3 represent immature performance and level 4 represents proficiency. Data were analyzed by age and sex. RESULTS: Overall, proficiency prevalences were higher in boys than girls. Proficiency in walking and running emerged in children from age 2.5 years, and proficiency in more complex locomotor skills (i.e., jumping, skipping, hopping, ladder-climbing) and object control skills emerged at age 6 years. The prevalence of proficiency in hopping, jumping, skipping and all object control skills were low in children aged <9 years. All children aged ≥9 years were proficient in all locomotor skills. At age 9 years, the prevalence of object control proficiency were high for throwing (boys 100%, girls 89%), catching (boys 89%, girls 65%), striking (boys 69%, girls 53%) and low for kicking (boys 45%, girls 41%). All children ≥11 years were proficient in all FMS except kicking (boys 61%, girls 55%). CONCLUSIONS: FMS proficiency were age and sex related with proficiency in most skills emerging around age 6 years. All children aged ≥11 years were proficient in all FMS, except kicking. The findings may be useful to guide the development of intervention programs in Iranian children aged 2.5-10 years.

Elements of Effective Population Surveillance Systems for Monitoring Obesity in School Aged Children.

The continuing high prevalence of child overweight and obesity globally means that it remains the most common chronic health condition in children. Population-based child obesity surveillance systems are critical for monitoring trends in obesity and related behaviours, and determining the overall effect of child obesity prevention strategies. Effective surveillance systems may vary in methods, scope, purpose, objectives, and attributes, and our aim was to provide an overview of child obesity surveillance systems globally, and to highlight main components and other types of survey data that can enhance our understanding of child obesity. Measures of adiposity, including body mass index and waist circumference are essential, but effective surveillance must also include measures of weight-related behaviours, including diet, physical activity, sedentary time, and sleep. While objective measures are desirable, the variability in psychometrics and rapid evolution of wearable devices is potentially problematic for examining long-term trends over time and how behaviours may change. Questionnaires on self-reported behaviours are often used but also have limitations. Because the determinants of obesity are not only functioning at the individual level, some measures of the broader environmental and commercial determinants, including the built and food environments, are useful to guide upstream policy decisions.

Ecological study of playground space and physical activity among primary school children.

OBJECTIVES: To examine the relationship between school playground size and total physical activity (PA), fitness and fundamental movement skills (FMS) of primary school students. DESIGN: Cross-sectional ecological analysis. SETTING: 43 primary schools in New South Wales, Australia. PARTICIPANTS: Data were from 5238 students, aged 5 to 12 years, participating in the Schools Physical Activity and Nutrition Survey. OUTCOME MEASURES: Self (for age ≥11 years) and parent (for age <11 years) report of PA (meeting PA recommendations and number of days meeting recommendations), objectively measured FMS and cardiorespiratory and muscular fitness. RESULTS: Associations between playground space and measures of PA and fitness were mostly non-linear and moderated by loose equipment. Students in schools with no loose equipment showed a weak association between space and meeting PA recommendations (self-report). In schools with equipment, students' predicted probability of meeting PA recommendations increased sharply between 15 m2 and 25 m2 per student from 0.04 (95% CI: 0.01 to 0.08) to 0.30 (95% CI: 0.14 to 0.46), but at 30 m2 returned to levels comparable to students in schools with no equipment (0.18, 95% CI: 0.07 to 0.28). For cardiorespiratory fitness, in schools with no loose equipment, probabilities for being in the healthy cardiovascular fitness zone varied between 0.66 and 0.77, showing no consistent trend. Students in schools with loose equipment had a predicted probability of being in the healthy fitness zone of 0.56 (95% CI: 0.41 to 0.71) at 15 m2 per student, which rose to 0.75 (95% CI: 0.63 to 0.86) at 20 m2 per student. There was no relationship between space and FMS. CONCLUSIONS: School space guidelines need to incorporate sufficient playground space for students. Our study provides evidence supporting better PA outcomes with increasing space up to 25 m2 per student, and access to loose equipment, however further research is required to determine precise thresholds for minimum space. Intersectoral planning and cooperation is required to meet the needs of growing school populations.

Cross-sectional changes in weight status and weight related behaviors among Australian children and Australian Indigenous children between 2010 and 2015.

BACKGROUND: Since 2006 there has been substantial long-term investment in school-based child obesity prevention programs in New South Wales (Australia). Whether these programs have led to population level improvements in children's weight status and weight-related behaviors are yet to be determined. The purpose of this study was to describe changes in children's weight status and weight-related behaviors, including Indigenous children, who are at greater risk of poorer health outcomes than non-Indigenous children. METHODS: Representative cross-sectional population surveys conducted in 2010 and 2015 among children age 5-16 years (n = 15,613). Objective measurements included height, weight, waist circumference, cardiorespiratory fitness, and fundamental movement skills. Indigenous status and indicators of weight-related behavior (i.e., diet, physical activity, school travel, screen-time) were measured by questionnaire with parents responding for children age <10 years and self-report by children age ≥10 years. RESULTS: The prevalences of overweight/obesity, obesity and abdominal obesity were higher in 2015, than 2010, and higher among Indigenous than non-Indigenous children at both timepoints. There were some small positive changes towards healthier weight-related behaviors between surveys among all children, but many unhealthy weight-related behaviors remain highly prevalent. The magnitude of changes and the 2015 prevalences of weight-related behaviors were generally similar for Indigenous and non-Indigenous children. CONCLUSIONS: Schools play an important role in health promotion, but our findings suggest the current approaches need re-thinking. Upstream factors that shape weight-related behaviors such as the regulation of the food industry and food environment, urban, neighborhood and public transport planning must be including in solutions to ensure populations can eat healthily and be physical active.

Influence of School-Level Socioeconomic Status on Children's Physical Activity, Fitness, and Fundamental Movement Skill Levels.

BACKGROUND: Authorities recommend that youth undertake at least 60 minutes of daily moderate-to-vigorous physical activity (MVPA), with young people having the opportunity to undertake at least half of this MVPA during school hours. METHODS: In this study, we examined the influence of school-level socioeconomic status (SES) on children's PA, fitness and fundamental movement skill (FMS) levels, and the barriers and enablers of children's PA in 86 Australian schools (41 primary, 45 secondary). School-level SES was based on an Index of Community Socio-Educational Advantage (ICSEA). School representatives reported potential barriers and enablers for children's PA. We used subjective and objectives measures of PA, fitness, and FMS levels. Multiple logistic regression examined the associations of ICSEA category (low or high) with barriers and enablers, and PA outcomes, adjusting for children's language background and residence. RESULTS: Children from high SES schools were more likely to achieve the healthy fitness zone for cardiorespiratory fitness; those from low SES schools consistently reported more barriers and fewer enablers than their high SES counterparts. CONCLUSIONS: Extra efforts may be required to address school-level barriers and enablers to enhance PA, fitness, and FMS levels for schools in disadvantaged areas.

Sustained low consumption of fruit and vegetables in Australian children: Findings from the Australian National Health Surveys.

ISSUE ADDRESSED: Intakes of fruit and vegetables in children are inadequate. Our purpose was to examine national data on the proportion of Australian children meeting the fruit and vegetable recommendations in 2011-2012 and 2014-2015, assessing changes over time and differences by age, sex and socio-economic status (SES). METHODS: Secondary analysis of 2011-2012 and 2014-2015 Australian National Health Surveys of Australian children aged 2-18 years. Percentages of children meeting fruit and vegetable recommendations by survey year, age group, sex and SES tertile were calculated using population weights supplied by the Australian Bureau of Statistics (ABS). Chi-squared tests and logistic regression were used to test for the relative influence of each factor. RESULTS: In 2011-2012, 64.6%, 5.1% and 4.6% of children met the recommended intake for fruit, vegetable and fruit-vegetable combined, respectively. In 2014-2015, 68.2%, 5.3% and 5.1% of all children met the recommended intake for fruit, vegetable and fruit-vegetable combined, respectively. There was a large reduction in proportions of children meeting both the fruit and vegetable recommendations between 3 and 4 years of age, which coincides with when most Australian children start pre-school. There were consistent differences by sex for both fruit and vegetables, but we found little evidence that SES is a significant factor predicting the difference in meeting the vegetable recommendations. CONCLUSION: The proportion of Australian children meeting fruit and vegetable recommendations are sub-optimal across all SES groups which suggests that a national approach across demographic strata is warranted. SO WHAT?: Future health promotion interventions should have a refocus on vegetables instead of "fruit and vegetables," particularly in the key transition period when children start pre-school.

Trends in overweight, obesity, and waist-to-height ratio among Australian children from linguistically diverse backgrounds, 1997 to 2015.

OBJECTIVE: To report the cross-sectional prevalence and 18-year trends in overweight, obesity and abdominal obesity among Australian children from culturally and linguistically diverse (CALD) backgrounds. SUBJECTS/METHODS: Four cross-sectional population health surveys conducted among children (age 4-16 years; n=26, 449) in 1997-2004-2010-2015 in New South Wales, (NSW) Australia. Adiposity outcomes were measured by trained field staff using standard procedures. Binomial regression models with a robust error variance were used to estimate prevalence ratio (PR) and 95% confidence intervals (CI) for overweight and obesity, obesity, and waist-to-height ratio (WHtR) ≥ 0.5 for children from Asian, European, and Middle Eastern language backgrounds compared with children from English-speaking backgrounds, adjusted for sociodemographic characteristics. RESULTS: Over time, children from Middle Eastern language backgrounds were consistently more likely to be overweight-obese (PR: 1.29-1.42), obese (PR: 1.49-1.65), and have WHtR ≥ 0.5 (PR: 1.42-1.90), compared with children from English-speaking backgrounds. Children from European language backgrounds generally had higher prevalence and children from Asian language backgrounds had lower prevalence, compared with children from English-speaking backgrounds. Between 1997 and 2015, there were significant trends in the prevalence of overweight and obesity combined among children from English-speaking (PR: 1.06, 95%CI: 1.02, 1.09), Middle Eastern (PR: 1.14, 95%CI: 1.05, 1.24), and Asian language backgrounds (PR: 1.14, 95%CI: 1.05, 1.24). The prevalence of WHtr ≥ 0.5 increased among children from English-speaking (PR: 1.21, 95%CI: 1.13, 1.31) and Middle Eastern (PR: 1.35, 95%CI: 1.16, 1.56) language backgrounds. CONCLUSIONS: Overall, the prevalence of overweight and obesity and abdominal obesity is high among NSW children from CALD backgrounds and has increased over time. This suggests that there is a greater scope in understanding, developing, and implementing interventions across the early life-course of children from CALD backgrounds.

A hitchhiker's guide to assessing young people's motor competence: Deciding what method to use.

OBJECTIVES: To offer a user's guide to select appropriate measures of motor competence for children and adolescents. DESIGN: Expert consensus among a working group of the International Motor Development Research Consortium (I-MDRC). METHODS: The guide provides information on objective (motion devices and direct observation) and subjective (self-reports and proxy reports) methods for assessing motor competence among children and adolescents. Key characteristics (age group, sample size, delivery mode, assessment time, data output, data processing) as well as limitations and practical considerations (e.g., cost, sources of error) with regard to each method are included in this paper. We do not recommend specific instruments, rather a guide to assist researchers and practitioners interested in assessing children's motor competence. RESULTS: A decision flow chart was developed to support practitioners and researchers in selecting appropriate methods for measuring motor competence in young people. Real-life scenarios are presented to illustrate the use of different methods in research and practice. CONCLUSIONS: Policy makers, practitioners and researchers should consider the strengths and limitations of each method when measuring motor competence in children and adolescents. This will allow them to choose the most appropriate instrument(s) that meets their needs.

Association Between Sitting, Screen Time, Fitness Domains, and Fundamental Motor Skills in Children Aged 5-16 Years: Cross-Sectional Population Study.

BACKGROUND: To examine the associations between school-age children's sedentary behavior, screen time, and 3 physical activity attributes: muscular strength, cardiorespiratory endurance (CRE), and fundamental movement skills. METHODS: Cross-sectional survey of 2734 children in years 2 and 4 and 3671 adolescents in years 6, 8, and 10. Total sitting time, 6 screen time behaviors, and physical activity were measured by self-report. Muscular strength was assessed by standing broad jump; CRE by 20-m shuttle run test; and fundamental movement skills by process-oriented checklists. Associations between incremental sitting and screen time (in hours) and meeting the healthy zone of physical activity attributes were examined using logistic regression. RESULTS: After adjusting for covariates and physical activity, children had lower odds of achieving the healthy zone for muscular strength and CRE for each hour of week (but not weekend) screen time. For adolescents, each hour of screen time per day was associated with lower odds of achieving the healthy fitness zone for CRE, locomotor skills, and overall healthy zone, and each hour of weekend screen time was associated with lower odds of achieving the healthy zone for most attributes and overall healthy zone. The associations were slightly stronger among adolescent girls than boys. The findings were similar for total sitting time. CONCLUSIONS: Screen time was associated with a lower likelihood to achieve healthy zones of physical activity attributes, and the effect was more consistent and slightly stronger among adolescents than children. This may suggest that the negative effects of screen time are incremental, emerging during adolescence.

School-Level Socioeconomic Status Influences Adolescents' Health-Related Lifestyle Behaviors and Intentions.

BACKGROUND: School-level socioeconomic status (SES) influences on adolescents' lifestyle behaviors is understudied. We examined how school-level SES and sex influence adolescents' health-related lifestyle behaviors and intentions. METHODS: Grade 8 students aged 13-14 years completed an online questionnaire regarding their sociodemographic characteristics, dietary behaviors, physical activity participation and recreational screen-time, and intentions regarding these behaviors. School-level SES, based on an Index of Community Socio-Educational Advantage (ICSEA), was categorized as low or high. Generalized estimating equations estimated individual-level summary statistics, adjusted for clustering. RESULTS: Students (N = 2538; response rate = 79%) from 23 high schools (low ICSEA = 16) participated. Compared with low ICSEA students, high ICSEA students were more likely to report eating breakfast daily (OR 1.9 [95% CI 1.5, 2.4]), not drinking sugar-sweetened beverages (SSBs) daily (2.9 [1.9, 4.3]), and were more likely to have intentions to eat breakfast (1.8 [1.3, 2.3]) and ≥ 5 vegetable serves (1.2 [1.0, 1.5]) daily. Boys were more likely than girls to meet recommendations for breakfast eating, vegetable intake, moderate-to-vigorous physical activity and screen-time, but boys were less likely to meet recommendations regarding SSB intake. CONCLUSIONS: Students from low ICSEA schools would benefit from additional support to improve dietary-related behaviors and intentions. More research is required to identify what targeted approaches will address sex differences in adolescents' lifestyle behaviors.

Review of Short-Form Questions for the Evaluation of a Diet, Physical Activity, and Sedentary Behaviour Intervention in a Community Program Targeting Vulnerable Australian Children.

Childhood obesity is associated with low socioeconomic status in developed countries, and community programs can deliver cost-effective obesity interventions to vulnerable children and adolescents at scale. Evaluating these programs in a low-cost, time-efficient, and culturally appropriate way with valid and reliable measures is essential to determining their effectiveness. We aimed to identify existing valid and reliable short-form instruments (≤50 items for diet, ≤15 items for physical activity) suitable for the assessment of change in diet, physical activity, and sedentary behaviour in an Australian obesity intervention program for children and adolescents aged 7⁻13 years from low socioeconomic groups, with a focus on Aboriginal and Torres Strait Islander children. Relevant electronic databases were searched, with a focus on Australian literature. Validity and/or reliability studies using diet instruments (5), physical activity/sedentary behaviour instruments (12), and diet and physical activity/sedentary behaviour instruments used with Aboriginal and Torres Strait Islander (3) children were identified. Seven questions on diet, one question on physical activity, and no questions on sedentary behaviour were recommended. These questions can be used for evaluation in community-based obesity programs among Australian children and adolescents, including those from low socioeconomic groups and Aboriginal and Torres Strait Islander children.

30-year changes in Australian children's standing broad jump: 1985-2015.

OBJECTIVES: Muscular strength is an important component of fitness that enables the execution of a range of daily activities across the lifespan including sport participation. The purpose of this study was to examine changes in children's standing broad jump, an indicator of muscular strength, between 1985 and 2015. DESIGN: Two representative cross-sectional population surveys of Australian children age 9-15 years (n=7051). METHODS: In 1985 and 2015 children's standing broad jump (SBJ; cm) and anthropometry were measured by trained field teams. General linear regression examined the temporal change in SBJ by sex and age adjusting for height, weight, socioeconomic status, and linguistic background. RESULTS: Over a 30-year period, the height, weight, and BMI of children significantly increased and muscular strength decreased. Among boys, the adjusted SBJ distance declined -4.5cms (95%CI -8.8, -0.10) in 9-11 year olds and 7.6cms (95%CI -12.5, -2.7) in 12-15 year olds. Among girls, the adjusted SBJ distance declined 8.5cms (95%CI -12.9, -4.2) in 9-11 year olds and 9.3cms (95%CI -14.1, -4.6) in 12-15 year olds. Larger declines in the distance jumped were observed among children and adolescents from non-English speaking backgrounds, than English speaking peers and children from low socioeconomic neighbourhoods than the declines among children from high SES neighbourhoods. CONCLUSIONS: Overall, the distance children and adolescents jumped in 2015 was lower than the distance their peers jumped in 1985. The declines differed by sex and sociodemographic characteristics, which suggests targeted sub-population interventions to improve children's muscular strength should be considered.

Descriptive epidemiology of changes in weight and weight-related behaviours of Australian children aged 5 years: two population-based cross-sectional studies in 2010 and 2015.

OBJECTIVE: Over the past 10-15 years there has been substantial investment in New South Wales (NSW), Australia, to reduce child obesity through interventions in children aged 0-5 years. We report changes in weight and weight-related behaviours of 5-year-old children. DESIGN: Cross-sectional surveys conducted in 2010 and 2015. SETTING: NSW schools (2010 n=44; 2015 n=41) PARTICIPANTS: Australian children in kindergarten (2010 n=1141 and 2015 n=1150). OUTCOME MEASURES: Change in anthropometry and indicators of diet, screen time, school travel and awareness of health recommendations. Additionally, we examined 2015 differences in weight-related behaviours by sociodemographic characteristics. RESULTS: Prevalence of overweight/obesity was 2.1% lower (adjusted OR (AOR) 0.83, 95% CI 0.67 to 1.04) and abdominal obesity 1.7% higher (AOR 1.35, 95% CI 0.93 to 1.98) in 2015 than 2010. Significant improvements in multiple weight-related behaviours were observed among children in the highest tertile of junk food consumption (AOR 0.63, 95% CI 0.50 to 0.80), rewarded for good behaviour with sweets (AOR 0.59, 95% CI 0.47 to 0.74) and had a TV in their bedroom (AOR 0.65, 95% CI 0.43 to 0.96). In 2015, children from low socioeconomic neighbourhoods and non-English-speaking backgrounds were generally less likely to engage in healthy weight-related behaviours than children from high socioeconomic status neighbourhoods and from English-speaking backgrounds. Children in these demographic groups were less likely to eat breakfast daily, have high junk food intake and eat fast food regularly. Children from rural areas tended to have healthier weight-related behaviours than children from urban areas. CONCLUSIONS: There were significant positive changes in 5-year-old children's weight-related behaviours but children from low socioeconomic neighbourhoods and from non-English-speaking backgrounds were more likely to engage in unhealthy weight-related behaviours than children from high socioeconomic neighbourhoods and English-speaking backgrounds. The findings indicate that there is a need to enhance population-level efforts and ensure community programmes are targeted and tailored to meet different subpopulation needs.

Exploring the Relationship Between Fundamental Motor Skill Interventions and Physical Activity Levels in Children: A Systematic Review and Meta-analysis.

BACKGROUND: Physical activity provides many health benefits, yet few children meet the physical activity recommendations. In school-age children, low proficiency in fundamental movement skills (FMS) is associated with low physical activity (PA). It is unknown if the same relationship exists in pre-schoolers (aged 3-5 years). OBJECTIVES: The aims of this review were to firstly evaluate interventions for improving FMS and PA levels in children aged 3-5 years and 5-12 years, and secondly to determine, where possible, if there is a similar relationship between change in FMS and change in PA across both age groups. METHODS: A systematic search of electronic databases was conducted up until 20 July 2017. Controlled trials that implemented an FMS/PA intervention and measured PA levels (objective/subjective) and FMS (objective) in healthy children between the ages of 3 and 12 years were included. Sub-analysis was conducted based on the type of intervention (teacher-led [TL] or teacher educated), sessions per week (< 3 or ≥ 3) and age group. RESULTS: Search terms yielded 17,553 articles, of which 18 met the inclusion criteria. There was significant improvement in FMS with TL interventions of three or more sessions per week (standardised mean difference = 0.23 [0.11-0.36]; p = 0.0002). In TL interventions, there was a strong negative correlation between moderate-vigorous physical activity (MVPA) and sedentary behaviour (SB) (r = - 0.969; p = 0.031). CONCLUSIONS: There are limited studies measuring both FMS and PA following an FMS intervention, especially in school-aged children. Results indicate that training pre-schoolers at least three times a week in FMS can improve proficiency, increase intensity of PA, and reduce SB, possibly helping to reduce the burden of childhood obesity and its associated health risks.

The trends and prevalence of obesity and morbid obesity among Australian school-aged children, 1985-2014.

AIM: Children with obesity have a greater risk of adverse social and physical health outcomes. We examined temporal changes in body mass index (BMI) z-scores and the prevalence obesity and morbid obesity in children from 1985 to 2014. METHODS: Secondary data analysis of BMI data for children aged 7-15 years from five cross-sectional Australian datasets. Changes in age- and gender-adjusted BMI (BMI z-scores) and nutritional status were categorised using the International Obesity Task Force cut-off points. RESULTS: The percentage of children who were obese tripled between 1985 and 1995 from 1.6 to 4.7%, before plateauing between 1995 and 2014. The percentage of morbidly obese children was <1% in 1985 and 1995, increasing to 2% between 1995 and 2007, with no further increase between 2007 and 2014. The proportion of obese children classified as morbidly obese was 12% in 1985-1995, 24% in 2007-2012 and 28% in 2014. Between 1985 and 2012, the mean BMI z-score increased in children categorised as obese from 1.94 (standard deviation 0.15) to 2.03 (0.22), and then plateaued. For morbidly obese children, the mean BMI z-score was 2.4 (0.13) and remained similar over the study period. CONCLUSIONS: Our findings suggest that the relative fatness of children with morbid obesity, as measured by BMI z-score, has remained stable. The proportion of obese and morbidly obese children has also plateaued between 2007 and 2014. However, the prevalence of obesity remains high, and more dedicated resources are required to treat children with obesity to reduce the short- and long-term health impact.

Association between adolescents' consumption of total and different types of sugar-sweetened beverages with oral health impacts and weight status.

OBJECTIVE: To examine the associations between adolescents' intake of sugar-sweetened beverages (SSBs) with oral health impacts (OHI) and weight status. METHODS: Cross-sectional health survey with anthropometry and self-report OHI (toothache and avoiding some foods because of oral problems) and SSB intake (fruit juice, flavoured water, soft, diet, sports and energy drinks) collected in 2015. RESULTS: A total of 3,671 adolescents participated (50% girls; mean age 13.2 years ±1.7). Drinking ≥1cup/day of SSBs was consistently associated with higher odds of OHI compared with drinking <1cup/day: diet soft drinks (AOR, 5.21 95%CI 2.67, 10.18); sports drinks (AOR 3.60 95%CI 1.93, 6.73); flavoured water (AOR 3.07 95%CI 1.55, 6.06); and energy drinks (AOR 2.14 95%CI 1.44, 3.19). Daily SSB intake was not consistently associated with weight status. The odds of overweight/obesity (AOR 1.27 95%CI 1.01, 1.59) and obesity (AOR 1.61 95%CI 1.01, 2.57) were higher for energy drink consumption, compared with not drinking energy drinks; and the odds of abdominal obesity were twice as high among adolescents who drank ≥1cup/day of sports drinks, compared with <1cup/day intake. CONCLUSIONS: Daily consumption of SSBs is prevalent among adolescents and is consistently associated with higher odds of OHI. The most popular SSBs among adolescents were energy drinks. Different types of SSB were differentially associated with OHI and weight status. Implications for public health: Different types of SSBs were differentially associated with OHI and weight status in adolescents. Diet soft drinks and new generation SSBs such as energy and sport drinks and flavoured water had a greater impact on adolescents' OHI compared with soft drinks and fruit juice.

Children's adherence to health behavior recommendations associated with reducing risk of non-communicable disease.

The aim of this study is to report the proportions of Australian children age 5-16 years meeting six health behavior recommendations associated with reducing risk of non-communicable disease. Data comes from a representative cross-sectional population survey conducted in 2015. Parents completed a health behavior questionnaire for children age < 10 years and adolescents age > 10 years self-reported. Adherence rates were calculated separately for children and adolescents on meeting recommendations for fruit (2-serves/day), vegetables (5-serves/day), physical activity (≥ 60 min/day), screen-time (< 2 h/day), oral health (brush-teeth twice daily) and sleep (children 9-11 h/night; adolescents: 8-10 h/night). Participants were 3884 children and 3671 adolescents. Adherence to recommendations was low, with children adhering to an average of 2.5 and adolescents to 2.3 of six recommendations. Overall, recommendation adherence rates were 7% for vegetables, 18% for screen-time, 20% for physical activity, 56% for sleep, 67% for dental (teeth brushing) 79% for fruit; 3.3% reported zero adherence with recommendations and < 0.5% adhered to all six recommendations. There was evidence of social disparity in adherence rates; children and adolescents from low socioeconomic neighborhoods met fewer recommendations and were less likely to meet screen-time and dental recommendations, compared with high socioeconomic peers. Children and adolescents from rural areas met more recommendations, compared with urban peers. Children's and adolescents' adherence to health behavior recommendations is sub-optimal, exposing them to risk of developing non-communicable diseases during adulthood. Better communication and health promotion strategies are required to improve parents' and children's awareness of and adherence to health behavior recommendations.