sabato, Luglio 20, 2024

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The complex puzzle of youth obesity: not only “calorie issue” but policies and choices as well

Childhood and adolescent obesity have been identified as one of the most serious health issues of the 21st century. Adolescents represent an important target for potential health policy interventions because they are at an age when their health behaviors, preferences and interactions with the environments are evolving. Literature reviews assessing the influence of environments on childhood obesity suggest that the majority of existing evidence has come from observational studies. These studies often have found somewhat varying results with respect to whether environments matter and for whom. Studies that are suited to address causality, such as the Moving to Opportunity housing experiment and other quasi- and natural experiment studies, have not directly or simultaneously assessed the independent roles of built, social and economic environments on obesity. Instead, they have either focused only on a narrow set of environmental characteristics such as supermarkets, restaurants or examined the effects of place as a whole.

Moreover, these well-designed studies have primarily been among adults. New research from the University of Southern California shows now that the built environment, not social and economic environments, is a strong predictor of adolescents’ body mass index (BMI), overweight and obesity status, and eating behaviors. This study provides the first quasi-experimental empirical evidence of these environments on adolescents’ BMI, overweight, obesity and related behaviors. Previous research by the study’s authors utilized a natural experiment, the plausibly exogenous assignment of military service members and adolescents in their families to different places to assess place effects on obesity and obesity-related behaviors. The current study builds on the previous work by using the same natural experiment to simultaneously assess the role of built, social and economic environments in adolescent obesity and related behaviors.

This experiment relies on the routine assignment of military personnel (and their families) to different installations based on the needs of the Army; and assessed the role of a narrow set of environmental factors such as neighborhood physical activity opportunities or food environment or assessed the combined influence of the environment as a whole showing that adolescents whose military parents were assigned to counties with higher obesity rates were more likely to present with overweight or obesity. Researchers analyzed data from the Military Teenagers Environments, Exercise and Nutrition Study, a co-hort study of adolescents in military families. Data was collected on adolescents’ BMI, overweight, obesity and self-reported diet and exercise. Forty-eight percent of the analysis sample was female, with an age range of 12 to 14 years old and 41% of participants being non-Hispanic White, 22% non-Hispanic Black, 23% Hispanic and 14% other.

Three indices for the built, social and economic environments characterized 35 county-level environments based on 19 indicators. Significant heterogeneity existed in the two measures of exposure to the civilian environment: 61% of families had been assigned to the military installations for more than 2 years and 54% were not living on military bases but in the surrounding community. Results revealed that exposure to higher (i.e., more healthful) built environment index scores for more than 2 years were associated with lower probability of obesity, and lower overweight or obesity status, but not with BMI z scores. All else equal, after more than 2 years of exposure, the likelihood of adolescent obesity is estimated to be 3.6 percentage points higher in a county with a built environment index at the 25th percentile relative to a county at the 75th percentile of the built environment distribution. Results were similar for adolescents not living on military bases.

More advantageous built environments were also associated with lower consumption of unhealthy foods but not with physical activity. Social and economic environments were not associated with any outcomes. An interesting finding is that it was specifically the built environment that mattered – features like how close the adolescent lives to fast-food restaurants versus park and recreation facilities. Less important were the social and economic environmental factors like crime, social support, household income, household education – and while very important for adolescents’ health, these factors were not directly tied to obesity risk or eating behaviors in this study, and these factors are also harder to modify. According to researchers, the built environment, on the other hand, can be improved with policy change and economic investment like incentivizing grocery stores to come to food deserts, limiting fast-food outlets near school zones and enacting complete street policies to ensure pedestrians and cyclists are safe on the road.

Besides the recent release of the American Academy of Pediatric’s clinical practice guidelines reminds us that evidence-based treatment is a critical tool in our fight against childhood obesity, putting concerted effort into improving the built environment is also essential both for obesity prevention and to assist those families who have obesity and are trying to develop healthier habits. Improving the built environment will require input and action from many stakeholders, like urban planners and concerned community members – to create healthier spaces for children. Neither physical activity alone nor diet restriction will be able to curb the tide of childhood obesity, according to a new study by the University of Sydney, that for the first time maps the complex pathways that lead to obesity in childhood. The investigation found children whose parents did not complete high school and who live with social disadvantage, were more likely to be affected by overweight or obesity in mid-adolescence.

In Australia, 1 in 4 school-aged children and adolescents are affected by overweight or obesity, with 1 in 12 affected by obesity. It is more common in those living in regional and remote areas, those from lower socioeconomic areas, those from one-parent families and those with a disability. The study, published in BMC Medicine today, drew on data from ‘Growing up in Australia: The Longitudinal Study of Australian Children,’ a nationally representative sample of over 10,000 Australian Children.The team of leading scientists and clinicians­­, found that childhood obesity is largely a by-product of socio-economic status; and parental high school levels (both paternal and maternal) serve as on-ramps to childhood obesity. Age seems to matte ras well: when children are aged 2 to 4 years the causal pathway is: socio-economic status/parental high school level -> parental BMI -> child BMI.

When children are aged 8 to 10 years, an additional pathway emerged focused on how children spend their leisure time: parental high school level /socio economic status -> electronic games ->free time activity-> child BMC. In addition, the upstream influences on free time activity were different in boys compared with girls. The strong and independent link between parent’s BMIs and childhood BMI suggests a biological link (high weight runs in families, and this is in part because of shared genes). Other interesting findings from the research include how different drivers of obesity play out at different life stages, particularly the influence of free time activity after the age of eight. There are also different influences on how free time is spent and influenced for boys versus girls. For boys, more electronic gaming leads to less active free time. For girls, better sleep quality leads to longer sleep time and more active free time.

All these data highlight how obesity si not only a matter of genetics and feeding; public interventions, municipalities and policies may do the difference as well.

  • Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.

Scientific references

Prados MJ et al. Pediatrics 2023 Apr; 31(4):1085-94.

Zhu W et al. BMC Medicine 2023 Mar 21; 21(1):105.

Economos C et al. BMC Pub Health. 2023; 23(1):529.

Du Z et al. Front Pub Health. 2022 Oct; 10:1021646.

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Dott. Gianfrancesco Cormaci
Dott. Gianfrancesco Cormaci
Laurea in Medicina e Chirurgia nel 1998, specialista in Biochimica Clinica dal 2002, ha conseguito dottorato in Neurobiologia nel 2006. Ex-ricercatore, ha trascorso 5 anni negli USA alle dipendenze dell' NIH/NIDA e poi della Johns Hopkins University. Guardia medica presso la casa di Cura Sant'Agata a Catania. In libera professione, si occupa di Medicina Preventiva personalizzata e intolleranze alimentari. Detentore di un brevetto per la fabbricazione di sfarinati gluten-free a partire da regolare farina di grano. Responsabile della sezione R&D della CoFood s.r.l. per la ricerca e sviluppo di nuovi prodotti alimentari, inclusi quelli a fini medici speciali.

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