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Studies in a variety of countries have shown increases in the prevalence of overweight and obesity among children in recent years. These increases have given rise to concern about children's health and well-being. The terminology used in these studies varies considerably. However, whatever the terminology used, such studies are generally based on weight (expressed as body mass index (BMI), a measure of weight for height, calculated as weight in kilograms divided by the square of height in meters) and not on body fatness per se. There are many different BMI references that can be used to define childhood overweight or obesity for population surveillance purposes using a variety of BMI cut-points. BMI is a screening tool, not a diagnostic tool. Children with a BMI over these cut-points do not necessarily have clinical complications or health risks related to over-fatness. More in-depth assessment of individual children is required to ascertain health status. The definitions based on BMI generally used are working definitions that are valuable for general public health surveillance, screening, and similar purposes. Terminology and measures used in studies of weight and adiposity in children and in adults is a complex area. Considerable confusion arises from the disparate uses of the descriptive terms ‘overweight’ and ‘obesity’ in children. Different reports may use the same term but define it quite differently. This chapter examines some of the definitions and terminology in use today and some of the underlying issues in arriving at consistent and coherent definitions.

‘Mom, I hate it when they weigh me’. These words were uttered by a child of one of the authors of this chapter. This quote was chosen as the title of this chapter on stigma and BMI screening in schools since it captured some of the experience of children made to feel different in a public setting because of their weight. School is a particularly important public setting, full of children striving for acceptance by their peers, as well as themselves, hoping perhaps to stand out in terms of achievement but not in terms of characteristics that will lead to ridicule and isolation. What role, if any, might Body Mass Index (BMI) screening in schools play in increasing stigmatization of the overweight/obese? Are there solid reasons justifying BMI screening in schools? Might other approaches provide us with the same information? This chapter explores some of these issues and offers some alternative paths for dealing with weight issues in the school setting.

In the United States, the prevalence of obesity among 2–19 year old children and adolescents tripled between 1980 and 1999. Between 1999 and 2008, however, the rate of increase slowed and the prevalence did not increase significantly. This chapter presents a review of published results on the obesity prevalence and trends between 1999–2000 and 2007–8 among US children and adolescents. These results are based on the US National Health and Nutrition Examination Survey. Obesity among children and adolescents 2–19 years of age is defined as BMI (weight in kilograms divided by height in meters squared) at or above the 95th percentile on the 2000 CDC sex-specific BMI-for-age growth charts. Although there were no significant linear trends in the prevalence of obesity among children and adolescents between 1999–2000 and 2007–8, the prevalence remains high in the US. Almost 17% of children and adolescents were obese and significant disparities remain by race/ethnicity. These disparities may in part reflect differences in adiposity between race/ethnic groups. Disparities by income and education are not consistent. In the United States, the prevalence of obesity among 2–19 year old children and adolescents tripled between 1980 and 1999. Between 1999 and 2008, however, the rate of increase slowed and the prevalence did not increase significantly. Childhood obesity remains a health concern in part because obese children often become obese adults and can suffer from immediate health consequences such as elevated blood pressure, adverse lipid levels, and insulin resistance. The chapter also presents a review of published results on the obesity prevalence and trends between 1999–2000 and 2007–8 among US children and adolescents. These results are based on the US National Health and Nutrition Examination Survey. Changes in the population distribution of body mass index (BMI) and disparities in obesity prevalence are also presented.

This chapter reviews the secular trends in childhood obesity and associated risk factors from three nationwide surveys across China conducted between 1982 and 2006. The Chinese National Surveys on Students' Constitution and Health (CNSSCH) have been conducted every five years since 1985. To date, it is the largest nutrition and health survey of a nationally representative sample of school-age children and adolescents in China. All the subjects were primary or high school students aged 7–18 years randomly selected from each of the mainland provinces, excluding Tibet. The China National Nutrition (and Health) Surveys (CNNHS) are nationally representative cross-sectional surveys conducted in 1982, 1992, and 2002; and include dietary intake data in 1982, 1992, and 2002 and physical activity information in 2002. The survey is a longitudinal study conducted in eight provinces in 1991, 1993, and 1997; and nine provinces in 2000, 2004, and 2006. The average interval between surveys was three years. For CNSSCH, the 2000 weight for height screening criteria in Chinese children and adolescents was used to define childhood overweight and obesity. For the same age-, sex-, and height- group, a child with body weight equal to or more than 110% of the reference body weight was categorized as overweight, and a child with body weight equal to or more than 120% of the reference body weight was categorized as obesity. The age- and sex-specific BMI cut-offs recommended by the International Obesity Task Force (IOTF) were used in CNNHS and CHNS. The prevalence of childhood overweight and obesity in China has increased dramatically over last three decades, especially in boys in urban areas. Parallel with the increasing prevalence of childhood obesity has been a decline in the intake of dietary energy and vegetables, and an increase in the intake of dietary fat and animal foods among Chinese children. In 2002, the proportion of children who reported regular exercise was very low while the level of reported sedentary activity was high.

Health policy-makers seeking to estimate the burden of childhood obesity and health-promotion workers designing interventions to reduce prevalence levels need to be aware of trends and the extent of the problem of childhood obesity. Representative surveys of child obesity prevalence are required, and they depend on agreed definitions of child obesity, taking account of children's natural growth — especially the changes in growth rates found in early infancy and puberty. There are several approaches to measuring obesity in children, and these give differing estimates of the extent of the problem. This chapter discusses the definition of child overweight and obesity, prevalence levels in childhood and adolescence, and secular trends in prevalence.

This chapter focuses on the prevalence of overweight and obesity, as indicated by the body mass index (BMI), in a variety of populations worldwide. The emphasis is on recent surveys and time-trends and data have been selected that are based on representative population surveys with measured weight and height. Most attention is devoted to the affluent countries with established market economies (e.g., North America, Europe, Australia, New Zealand, and Japan) because the data quality and time span covered by it are reasonably comparable. The goal is to convey a sense of the magnitude of the obesity problem in the affluent parts of the world.

This chapter gives an overview of obesity's economic burden by taking an international perspective. It briefly illustrates the fundamentals of health economic concepts and their importance in the interpretation of economic analyses. It summarizes the current data comprehensively and presents them according to various geographical regions of the world. The findings are discussed in the last part of the chapter.

Obesity prevalence amongst children is rising virtually in all countries with acceleration since 1990. In the USA, obesity prevalence in children has increased from around 5% in 1963 to 1970 to 17% in 2003 to 2004. In Australia, the prevalence of overweight and obesity among children and adolescents is around 25%, so one in four adolescents seen in general practice may be overweight. Hong Kong is a leading world financial centre with an increasingly affluent lifestyle so the general pattern of mortality and morbidity among young people is similar to the United States and other developed countries. With a rapidly growing economy, there is also a worrying trend that the Chinese population elsewhere, especially in mainland China, is fast catching up with the West in terms of the prevalence of overweight and obesity. Macao, like Hong Kong, has undergone rapid economic growth over the last decade. The youth risk behavioural survey in Macao conducted in 2003 showed that the risk behaviours related to obesity, such as lack of physical activities and inadequate consumption of fruits and vegetable, had similar pattern as Hong Kong and cities in USA. Taiwan, another important Chinese community is regarded as one of the ‘Four Dragons’ of Asia (the other three are Hong Kong, Korea, and Singapore), also shows increasing trends in youth overweight and obesity. The Chinese youth population has shifted from optimal weight during the early post war period to overweight and obesity at the turn of this century. This chapter investigates the trends and risk factors associated with childhood overweight and obesity amongst the Chinese population, especially Hong Kong and Macao, with some recent data on youth risk behaviours and the health status of students. The chapter can serve as a good reference for other Asian countries undergoing similar demographic and social changes.

This chapter describes the prevalence and trends of overweight and obesity and associated factors among children and adolescents in Vietnam and Southeast Asia. In general there is very limited data available about child and adolescent obesity for this region. However, the results indicate a very rapid increase of overweight and obesity in school students, from pre-school to high school, especially in urban areas. In most studies, the prevalence of overweight among boys was greater than that among girls. This is a different pattern compared to child and adolescent obesity studies from industrialized countries, where the progressive increase in overweight and obesity in younger age groups was observed. Furthermore, while studies from western countries showed higher prevalence of overweight and obesity amongst children from households with low economic status, the findings from Southeast Asian countries revealed the reverse of this pattern, such as in Vietnam and Indonesia. The methods used to assess the prevalence of overweight and obesity varied among countries in this region, making cross country comparisons difficult. Studies in Southeast Asia have mentioned differences in adolescent overweight and obesity across gender and age groups, which might influence the likelihood of participating in physical activity and sport, and may differentially influence the benefits of physical activity in maintaining a healthy weight status. School location was also a notable risk factor of overweight and obesity in children in many studies of this region. Children from private schools had higher odds of overweight/obesity than those from public schools (Philippines, Indonesia); higher odds of overweight in students studying at schools in wealthy urban districts were found in Vietnam.

This chapter describes the prevalence, distribution, and changing trends of overweight and obesity among Brazilian adolescents across the last three decades, including the most recent population study from 2002 to 2003. Increases in height, weight, and BMI were observed in both genders and across all time periods and income groups. Among males, the prevalence of overweight and obesity increased consistently during all three time periods and among all income groups. Among females, overweight and obesity increased in the early studies, but tended to decrease in more recent years and this trend was particularly marked in the higher income groups. The chapter suggests that improved nutrition and infant health in conjunction with better social and educational conditions may have influenced the increase in height, weight, and overweight among Brazilian children and adolescents over the past few decades. The recent decrease in overweight and obesity among young females may be explained by the social pressure for a slim body. Further studies should investigate these trends and should particularly focus on explaining the socioeconomic factors which appear to impact on childhood obesity.

This chapter reports on recent obesity trends among Swedish children. Sweden has a relatively low prevalence of childhood obesity. Yet, the rates in children as well as in adults have increased in the past decades. For instance, childhood overweight and obesity today are two to three times more common than in the 1980s. Moreover, a strong socioeconomic gradient has been apparent for a number of years. This chapter describes the developments of obesity and overweight in younger and older Swedish children. Where available it reports on the most recent trends, to determine whether the increase seen since the end of the 20th century has continued into the 21st century. When socioeconomic gradients are available it analyses if the gap is widening or narrowing. Finally, the chapter examines selected changes that have occurred in Swedish society that might explain the latest trends.

Successful treatment of the obese child or adolescent offers one approach to preventing the long-term consequences of obesity. This chapter provides an overview of the co-morbidities of childhood obesity, the existing literature on treatment approaches, including the most recent recommendations of an Expert Panel regarding staged treatment, and the potential for reducing the prevalence and sequelae of obesity in adult life.

In this chapter, an overview of the prevalence and health problems of childhood obesity in Singapore provides a backdrop to the discussion on the measures of prevention and intervention of childhood obesity in Singapore and the success and failures of these measures. While there is a lack of major publications on the prevention and management of childhood obesity in Singapore, the various reports and limited publications give us a glimpse into the strategies used, the effectiveness, flaws, and the ongoing programs to combat childhood obesity. In addition, the chapter provides new research data and clinical experience in the areas of childhood obesity and related issues such as eating disorders.

Obesity was seen as a non-Asian phenomenon in New Zealand in the past, but research in recent years is suggesting a different picture. Obesity is characterized by the excessive accumulation of adipose tissue to an extent that health is impaired. Obesity in children and adolescents may have serious consequences, ranging from short-term physical and psychosocial consequences to long-term consequences that persist into adulthood (e.g. type 2 diabetes). The global increase in obesity is also evident in Asian populations, especially in those who have migrated to Western countries with obesity-promoting environments. High energy foods and lack of exercise along with many other factors, contribute to this weight gain. Bearing in mind that the majority of these factors are modifiable risk factors, early detection and intervention are very important in preventing excessive weight gain in such populations. This chapter discusses weight issues among Asians in New Zealand, as well as risk factors and suggestions for community development-type approaches to health promotion.

This chapter discusses the role of parents in the prevention of childhood obesity, with a particular focus on how best to involve parents in treatment as well as preventive efforts. Parental involvement differs widely from one study to the next, making it difficult to compare interventions and draw conclusions as to which approach may be the most effective. The chapter reviews international childhood obesity interventions that involved children or adolescents between the age of 2 through 19 and at least one parent. This review was not intended to be exhaustive but rather to examine select published literature.

Weight or body size is a common focus of teasing among youth. Being teased about one's weight (or weight-related teasing) is associated with adverse psychosocial and behavioural outcomes that may put youth at risk for developing eating disorders and obesity. For example, weight-related teasing is associated with greater body dissatisfaction, which is an established risk factor for eating disorders and is also associated with binge eating behaviours and lower levels of physical activity. Thus, intervention programs aimed at reducing weight-related teasing among youth have the potential to prevent eating disorders and obesity. This chapter provides details of research at the University of Minnesota, which has aimed to increase understanding of the psychosocial and behavioural consequences of obesity and weight-related bias, specifically teasing. The research seeks to guide the development of interventions aimed at preventing obesity and other weight-related disorders among children and adolescents.

A previous review of the small number of early childhood obesity prevention literature promoted healthy eating, physical activity, and/or reduce sedentary behaviours in 0–5 year olds, suggesting that this is a new and developing research area. This chapter reviews rapidly emerging evidence in this area and assesses the quality of studies reported. Ten electronic databases were searched to identify literature published from January 1995 to August 2008. Inclusion criteria were interventions reporting child anthropometric, diet, physical activity or sedentary behaviour outcomes, and focusing on children aged 0–5 years of age. Exclusion criteria were focusing on breastfeeding, eating disorders, obesity treatment, malnutrition, or school-based interventions. Two reviewers independently extracted data and assessed study quality. Twenty-three studies met all criteria. Most were conducted in preschool/childcare (n=9) or home settings (n=8). Approximately half targeted socioeconomically disadvantaged children (n=12) and three quarters were published from 2003 onwards (n=17). The interventions varied widely although most were multi-faceted in their approach. While study design and quality varied, most studies reported that their interventions were feasible and acceptable, although the impact on behaviours that contribute to obesity were not achieved by all. Early childhood obesity prevention interventions represent a rapidly growing research area. Current evidence suggests that behaviours that contribute to obesity can be positively impacted upon in a range of settings and provides important insights into the most effective strategies for promoting healthy weight from early childhood.

This chapter provides an overview of childhood obesity causes and discusses the efficacy of potential preventive interventions. Interventions for obesity prevention generally have had no or limited effects with no obvious patterns in findings to guide program development. The chapter assumes imbalances in dietary intake and physical activity account for most of the problem. To elucidate the problems in obesity prevention research, the Mediating Moderating Variable Model (MMVM) is used to deconstruct the variables and pathways from intervention design to change in adiposity, and thereby elucidate problems at each step in intervention design, implementation, and evaluation. As more is learned about these causal pathways, intervention protocols may be developed that offer different or different intensity interventions to subgroups that may need different procedures.

This chapter discusses seven key, cross-cutting themes related to obesity that have direct implications for social work: community participation, assets of marginalized communities, program evaluation, social justice and obesity, schools as part of the community, the role of social work, and cultural competence. These seven cross-cutting themes provide valuable insights for those in social work and other helping professions as they strive to gain an in-depth understanding of the rewards and challenges associated with having communities play an instrumental role in efforts to reduce and prevent excessive weight in urban communities of color. The chapter also considers the interconnectedness of values, theory, and field examples, the implications for social work practice, and the appropriateness of employing a social justice lens.