[The implications of using different body mass index references in children and adolescents].

To classify children as overweight or obese, their body mass index (BMI) must be compared with a growth reference and be accompanied by a clinical assessment. In Denmark, there is a lack of consensus on which BMI reference to use; a mix of national and international references are used in clinics, hospitals and research institutions. In this article, the implications of using different references are illustrated with Danish data. The comparisons show that the references yield different prevalences of overweight in a non-predictable way, making comparisons and monitoring challenging.

Ethnic Inequalities in Overweight and Obesity Prevalence among Copenhagen Schoolchildren from 2002 to 2007.

BACKGROUND: The stabilization in levels of childhood overweight has masked increasing gaps among different ethnic and socioeconomic groups in several countries. OBJECTIVE: To examine if levels and trends in childhood overweight and obesity differed by ethnicity and socioeconomic areas in Copenhagen schoolchildren. METHODS: From measured heights and weights of 32,951 children 5-8 and 14-16 years of age, the prevalence of overweight (including obesity) and obesity were estimated using International Obesity Task Force criteria. Differences in prevalence levels and trends across six school years by ethnicity and socioeconomic areas were examined using logistic regression. RESULTS: The prevalence of overweight significantly decreased from 2002 to 2007 among the youngest Western girls and boys, showed no significant changes among the oldest non-Western girls and increased among the oldest non-Western boys. In all years, the youngest non-Western children had significantly higher levels of overweight than Western children. Although the prevalence of overweight tended to be higher in low socioeconomic areas as compared with high socioeconomic areas, few differences were statistically significant. Consistent trends in overweight across the years by socioeconomic area were not observed. CONCLUSION: Ethnic and social inequalities exist in childhood overweight among Copenhagen schoolchildren; thus appropriate interventions targeting high-risk groups are needed.

Danish clinical guidelines for examination and treatment of overweight and obese children and adolescents in a pediatric setting.

Overweight children are at an increased risk of becoming obese adults, which may lead to shorter life expectancies in the current generation of children as compared to their parents. Furthermore, being an overweight child has a negative psycho-social impact. We consider obesity in children and adolescents a chronic illness, which is in line with the American Medical Society. We summarize the evidence for the efficacy of a combination of diet, physical activity and behavior-focused interventions in a family-based setting. The present guidelines propose a multidisciplinary service implemented as a "chronic care model" based on "best clinical practice" inspired by an American expert committee and the daily practice of The Children's Obesity Clinic at Copenhagen University Hospital Holbaek. Children and adolescents should be referred for examination and treatment in a pediatric setting when BMI corresponds to an isoBMI of minimum 30 or BMI corresponds to an isoBMI of 25 and complex obesity is suspected. Obtaining a thorough medical history is pivotal. We propose a structured interview to ensure collection of all relevant information. We recommend physical examination focused on BMI, waist circumference, growth, pubertal stage, blood pressure, neurology and skin and provide comprehensive paraclinical investigations for obesity and obesity related conditions. Treatment of obesity in children and adolescents is fully dependent on the combined effort of the entire family. This cannot be overemphasized! The main principle of the treatment is developing an individual detailed plan for every patient to reduce caloric intake whilst increasing physical activity, leaving no ambiguity with the recommendations.

Overweight and obesity trends in Copenhagen schoolchildren from 2002 to 2007.

AIM: The purpose of this study is to monitor the prevalence trend in overweight and obesity among Copenhagen schoolchildren from the school years 2002 to 2007. METHODS: Copenhagen community health service doctors conducted routine examinations at school entry (ages 5-8 years) and exit (ages 14-16 years). Body mass index (kg/m²) of 33,245 schoolchildren was calculated. The prevalence of overweight (including obesity) and obesity was classified using the International Obesity Task Force definitions. RESULTS: From 2002 to 2007, although the prevalence of overweight (including obesity) in young girls decreased from 17.8 to 15.9%, the trend was non-significant. In young boys, the trend slightly decreased, and the prevalence fell from 14.0 to 11.6%. In adolescent girls, the prevalence varied considerably and increased from 22.7 to 25.4% without a discernable trend. In adolescent boys, the trend slightly increased, and the prevalence rose from 15.8 to 18.9%. There were no significant changes in the prevalence of obesity. CONCLUSION: In contrast to the preceding decades, we identified a potential stagnation in the obesity epidemic among children but a continuing increase among adolescents. It remains critical to continue monitoring and to increase preventive measures to reduce the prevalence of overweight and obesity.

Screening Copenhagen school children at risk of type 2 diabetes mellitus using random capillary blood glucose.

AIM: To screen adolescents at risk of type 2 diabetes mellitus (T2DM) using random capillary blood glucose (RCBG). METHODS: Ninth grade pupils who were overweight and/or had a family history of T2DM were offered to have RCBG measured and were referred for further investigation if the value was > or = 7.8 mmol/L. RESULTS: Two thousand four hundred and eleven pupils were examined, 19% were overweight, 4% being obese. 589 met inclusion criteria and 384 participated. Ethnic minorities and pupils in low socio-economic school-areas (SESA) were significantly more overweight than ethnic Danes and pupils in high SESA. Compared to ethnic Danish pupils, the relative risk of having a positive parent history of T2DM was increased five-fold for ethnic Turkish and Arab pupils and 13-fold for ethnic Pakistani pupils. One pupil had a diagnosed T2DM. Two had elevated RCBG values. One of these had an undiagnosed T2DM. CONCLUSION: Our study shows a high prevalence of overweight adolescents in Copenhagen, especially in school areas with low socio-economic standard and in pupils with Turkish, Pakistani and Arab ethnicity. Only three out of the 10 pupils with the highest risk participated. New strategies to reach and motivate risk groups to follow health recommendations and new methods of screening should be developed.