Insufficient Physical Fitness and Deficits in Basic Eating Habits in Normal-Weight Obese Children Are Apparent from Pre-School Age or Sooner.

Normal-weight obesity appears to be an extended diagnosis/syndrome associated with insufficient physical fitness levels and inadequate eating habits at least from school years. However, its relation to long term health parameters in pre-school children remains unknown, even though pre-school age is crucial for the determining healthy lifelong habits. Therefore, the aim of the current study was to investigate the differences in physical fitness level and basic eating habits between normal-weight obese, normal-weight non-obese, and overweight and obese preschoolers. The research sample consisted of 188 preschoolers aged 4.0-6.9 years (Mage = 5.52 ± 0.8 year), normal-weight obese = 25; normal-weight non-obese = 143, overweight and obese = 20. Body composition was measured using bio-impedance InBody230. Six tests assessed the physical fitness level: sit-ups; standing long jump; shuttle running 4 × 5 meters; throwing with a tennis ball; multistage fitness tests; sit and reach. A four-item eating habits questionnaire for parents focusing on breakfast regularity, consumption of sweet foods and drinks, selection of food and attitude towards eating was used. A non-parametric analysis of variance and Fisher's exact test along with suitable effect sizes were used for data processing of physical fitness tests and the basic eating habits questionnaire, respectively. Normal-weight obese children performed significantly worse (from p = 0.03 to p < 0.001, ES ω2-G = low to medium) in muscular fitness, cardiorespiratory fitness and running agility compared to normal-weight non-obese counterparts and did not significantly differ in the majority of physical fitness performance tests from overweight and obese peers. In basic eating habits, normal-weight obese boys preferred significantly more sweet foods and drinks (p = 0.003 ES = 0.35, large), while normal-weight obese girls had significantly more negative attitude towards eating (p = 0.002 ES = 0.33, large) in comparison to their normal-weight non-obese peers. Normal-weight obesity seems to develop from early childhood and is associated with low physical fitness and deficits in eating habits which might inhibit the natural necessity for physically active life from pre-school age or sooner.

Impaired Cardiorespiratory Fitness and Muscle Strength in Children with Normal-Weight Obesity.

Despite the health-related implications of normal-weight obesity in children, very little research has explored the fundamental associations between this status and important long-term health parameters. Therefore, the aim of the current study was to investigate the physical fitness of children with normal-weight obesity, in comparison to normal-weight non obese and overweight and obese counterparts. A total of 328 middle-school-aged children (9.8 ± 0.5 y) took part in this study (n = 44 normal-weight obese; n = 237; normal-weight non obese; n = 47 overweight and obese). Height, weight, and body-fatness were measured. Four physical fitness tests were conducted: (1) Multistage fitness test; (2) shuttle run 4 × 10 m; (3) sit-ups for 60 s; (4) the broad jump. Welch's analysis of variance (ANOVA), stratified by sex, with post-hoc testing where necessary, was performed. Children with normal-weight obesity had significantly (p < 0.01) lower cardio-respiratory and muscular fitness than normal-weight non obese peers. In addition, normal-weight obese and overweight and obese boys had comparable deficits in strength and explosiveness of lower limbs, speed coordination, and endurance, compared to normal-weight non obese counterparts. Normal-weight obese children appear to have similar deficits in PF as their overweight and obese peers, compared to normal-weight non obese counterparts, whilst boys had larger deficits than girls.

Poor Skeletal Robustness on Lower Extremities and Weak Lean Mass Development on Upper Arm and Calf: Normal Weight Obesity in Middle-School-Aged Children (9 to 12).

Background: Normal weight obesity in children has been associated with excessive body fat, lower bone density and decreased total lean mass. However, no studies have been done into whether normal weight obese children differ in skeletal robustness or lean mass development on the extremities from normal weight non-obese, overweight, and obese peers although these are important indicators of healthy development of children. Methods: Body height, body weight, BMI, four skinfolds, and two limb circumferences were assessed. We calculated total body fat using Slaughter's equations, the Frame index for skeletal robustness and muscle area for the upper arm and calf using Rolland-Cachera equations. Using national references of BMI and measured skinfolds, three subgroups of participants (9-12 years) consisting of 210 middle-school-aged children (M-age = 11.01 ± 1.05)-110 girls and 100 boys-were selected: (A) overweight obese (OWOB) (n = 72); (B) normal weight obese (NWO) (n = 69); and, (C) normal weight non-obese (NWNO) (n = 69). All values, were converted to Z-scores to take account of participant's sex and age. Results: NWO children had significantly poorer skeletal robustness on lower extremities and poorer muscle area on the upper arm and calf compared to NWNO counterparts with significantly higher evidence in boys-skeletal robustness NWO boys: Z-score = -0.85; NWO girls: Z-score = -0.43; lean mass on the calf: NWO boys Z-score = -1.34; NWO girls: Z-score = -0.85. The highest skeletal robustness-but not muscle area on the calf-was detected in OWOB children. Conclusions: Further research should focus on whether this poor skeletal and lean mass development: (1) is a consequence of insufficient physical activity regimes; (2) affects physical fitness of NWO children and could contribute to a higher prevalence of health problems in them. We have highlighted the importance of the development of a simple identification of NWO children to be used by pediatricians.