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Incidence of childhood overweight and obesity and its association with weight-related attitudes and behaviors in China: a national longitudinal study

Cai, Li, Dai, Meixia, Lin, Lizi, Yang, Wenhan, Chen, Yajun, Ma, Jun, Jing, Jin
The international journal of behavioral nutrition and physical activity 2018 v.15 no.1 pp. 108
Chinese people, attitudes and opinions, behavior change, body mass index, childhood obesity, children, dieting, food intake, longitudinal studies, physical activity, public health, questionnaires, relative risk, risk reduction, underweight, weight control, China
BACKGROUND: Childhood obesity is a major public health challenge. We aimed to investigate the incidence of overweight/obesity among Chinese children; and prospectively examine the associations of weight-change intention with risk of overweight/obesity and behavioral changes in initially normal-weight children. METHODS: A national sample of 21,796 children aged 6–17 years were investigated in September 2013 and followed up nine months later, of which 19,887 (91%) were normal weight and 1909 (9%) were underweight at baseline. Weight and height were objectively measured. Weight perception, weight-change intention, weight control practices, weight-related behaviors, and demographic information were obtained by questionnaires. RESULTS: Among children with underweight or normal-weight, the cumulative incidence of overweight/obesity was 2.77% (95% CI 2.55–2.99). Among normal-weight children, those who overestimated their weight had higher baseline BMI z-scores and an increased relative risk (RR) of overweight/obesity (RR 1.51, 95% CI 1.15–1.99). Children who misperceived themselves as underweight or overweight had stronger weight-change intention than their counterparts. However, children with weight-change intention did not develop greater changes in dietary intakes, physical activities, or sedentary behaviors than those without intention. There was no significant association between weight-change intention and incidence after adjusting for BMI z-scores at baseline. Self-reported improving diet, increasing physical activity, and dieting were associated with certain actual behavioral improvements and smaller increase in BMI z-score, but not associated with decreased risk of overweight/obesity. CONCLUSION: The 9-months cumulative incidence of overweight/obesity was 2.77% among Chinese children. Weight-change intention was not associated with incidence of overweight/obesity in normal-weight children, regardless of their weight perception. More importantly, children’s weight-change intention was insufficient in achieving desirable behavioral changes. Future overweight and obesity prevention programs should directly target on promoting children’s actual behavioral changes.