| BackgroundIn recent years, the incidence of childhood obesity has showed a rising trend in China. Overweight and obesity has become a major risk factor to many chronic diseases, and become a major public health problem affecting people’s health and quality of life, even affecting the development of the entire world population. As the rate of obesity in children is rising, its costs for treatment of obesity and related chronic disease are increasing year by year, and become a directly relation to chronic metabolic disease and the important reasons of medical burden. Overweight or obesity in children is affected by many factors, due to improper diet and lifestyle habits, which are considered to be one of the important reasons. Appropriate and effective interventions can reduce childhood obesity and the incidence of overweight, which may effectively reduce the medical burden generated.ObjectiveTo investigate the factors to childhood obesity; Integrated interventions with health education, dietary and exercise were used to explore the effects of interventions, including childhood obesity-related health indicators and blood biochemistry; Then the burden of childhood diseases through the investigation were detected by the cost-effectiveness analysis and cost-benefit analysis, which could evaluate the effect of comprehensive intervention, thus providing a scientific basis for further intervention and correction method in obese children.MethodsRandom cluster sampling method was used to select eight primary schools in the area of a district in Shanghai. In each grade from grades 2 to 5 in each school, two classes were chosen for the study by random method. From the beginning of the study, a retrospective collection of information, including historical data, such as birth data was undertaken (Part I). The subjects were divided into intervention group and control group for dietary health education+ physical activity integrated intervention for 1 year (part II). Results of the intervention (change in obesity-related indicators and serum biochemical testing) were observed by a prospective, randomized, controlled, double-blind clinical intervention study. Medical burden data before and after the intervention within 1 year of study was collected. Intervention costs were statistically calculated and a cost-effectiveness analysis and cost-benefit analysis of the effect (Part III) were taken for a comprehensive evaluation of the intervention.Results1. Factors affected of childhood obesity(1) Rates of childhood obesity and overweight:A total of 1507 students were collected in this survey, in which 758 boys (50.3%) and 749 girls (49.7%). A total of 95 cases of obesity (6.3%) and 123 cases (8.16%) of overweight respectively in this survey. In this study, obese boys 53 and overweight 64, obese girls 42, overweight 59(2) The impact of birth data on childhood obesity:maternal pre-pregnancy BMI in overweight and obese group was significantly higher than the control group; Proportion of over 15kg in weight gain during pregnancy in overweight and obese group (11.23%,26.32%) was significantly higher than the control group (8.87%).(3) The impact of diet on childhood obesity:In overweight and obesity group, the incidence of* eating sweets frequently* (54.47%,65.26%) was significantly higher than the nomal BMI group (34.83%). The incidence of "often eating midnight snack" (53.65%,55.79%) was significantly higher than the nomal BMI group (43.91%). Bedtime eating behavior analysis found that the frequency of "daily" was significantlyhigher in overweight and obesity group than the control group (21.95%,26.32%, 19.55%). Statistical analysis of snacks chosen in children found that overweight and obese children liked more "tea" (42.28%,51.58 %vs 33.82% in normal BMI children), "cake" (44.71%,55.79% vs 26.14% in normal BMI children), In the normal BMI children, the ratio of eating "fruit" (21.33%) was significantly higher than the obesity and overweight children (11.38%,11.58%).(4) The impact of the children’s extracurricular activities on childhood obesity:Statistics analysis of school and outside activities in three groups found that the ratio of ≥3 hours extracurricular activities in the normal BMI children (33.36%) was significantly higher than the overweight and obesity children (11.63%,10.53%). While, there is no significant difference among three groups about time in extracurricular school activities and the degree of physical activity.(5) Children’s perceptions and attitudes toward obesity:This survey found that 42.27% of overweight children and 42.11% of obese children, were aware of their obesity problem. But only 44.71% and 47.36% of overweight and obesity pupils dissatisfied their shape. The rate giving the right answer on obesity questions was no statistical difference among these three groups.(6) The impact of parental overweight and obesity on childhood obesity: In parental BMI, parental physical activity, parental smoking and drinking, there were no statistically significant difference (P>0.05) among the obesity children, the overweight children and the control children.(7)Multiple analysis of influencing factors to childhood obesity: Logistic regression found that "midnight snack", "Eating sweets"," extracurricular activities time" ranked in the top three factors in childhood obesity. After adjustment for age and sex, the OR values (95% CI) were 4.290(2.764～11.273),3.801 (2.036～9.943),3.209 (1.930～9.076), respectively.2 Effect of comprehensive Intervention in childhood obesity(1) The prevalence of obesity before and after the intervention:obesity rate of boys in the intervention group after intervention (2.68%) was significantly lower than before (9.02%) and the control group (6.67%) After the intervention, obesity rate of girls (2.46%) in the intervention group was significantly lower than before (6.9%), but had no significant difference to the control group.(2) Obesity-related indicators and serum biochemical index before and after the intervention:Waist (66.33±9.21cm), Waist-height ratio(0.45 ±0.10) in intervention group were significantly lower than the control group (69.27±9.29 cm, t=7.532, P=0.003 and 0.49±0.10, t= 5.762, P=0.027) after the intervention;Serum LDL levels in intervention group (2.39±0.38mmol/L) was significantly lower than the control group (2.49±0.40mmol/L,(t= 4.989, P= 0.036).(3) Obesity-related indicators and serum biochemical detection of overweight and obesity children in the intervention group before and after the intervention:Before intervention, the weight, waist circumference, BMI and waist-height ratio of the obesity and overweight children were significantly higher than normal BMI children. Low serum density lipoprotein levels was also significantly higher (2.65±0.50 mmol/L, 2.64+0.41 mmol/L,2.52±0.44 mmol/L). After 1 year intervention, the waist circumference, waist-height ratio and low-density lipoprotein were no longer statistically different among overweight, obesity and normal BMI children except weight, BMI.3. Health economic evaluation of childhood obesity intervention(1) Intervention costs and medical burden statistics:the average cost of the intervention was 118.09 yuan/person. The average medical costs of all subjects were 839.69yuan/person, in which 214.12yuan/person was attributed to obesity expenses.(3) Cost-benefit analysis:total benefit was RMB10491.88;cost.ratio was 0.12. To reduce a obesity and overweight children cost RMB1805.16.Conclusion1. Many factors, such as birth weight, progestational BMI, increasing of gestaional weight, eating habits, exercise, are the risk factors to obesity in children and their future development.2. Both carrying out health and nutrition education for students, parents, teachers and cafeteria staff, and increasing students’physical activity could significantly reduce the incidence of obesity.3. Comprehensive intervention could adjust the biochemical indicators for childhood obesity. Further more, the program of intervention for childhood obesity is cost-effective. |
