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Morbidity patterns among the underweight, overweight and obese between 2 and 18 years: population-based cross-sectional analyses

Abstract

Context:

No study has documented how symptomatic morbidity varies across the body mass index (BMI) spectrum (underweight, normal weight, overweight and obese) or across the entire child and adolescent age range.

Objective:

To (1) quantify physical and psychosocial morbidities experienced by 2–18-year-olds according to BMI status and (2) explore morbidity patterns by age.

Design, setting and participants:

Cross-sectional data from two Australian population studies (the Longitudinal Study of Australian Children and the Health of Young Victorians Study) were collected during 2000–2006. Participants were grouped into five age bands: 2–3 (n=4606), 4–5 (n=4983), 6–7 (n=4464), 8–12 (n=1541) and 13–18 (n=928) years.

Main measures:

Outcomes—Parent- and self-reported global health; physical, psychosocial and mental health; special health-care needs; wheeze; asthma and sleep problems. Exposure—measured BMI (kg m−2) categorised using standard international cutpoints.

Analyses:

The variation in comorbidities across BMI categories within and between age bands was examined using linear and logistic regression models.

Results:

Comorbidities varied with BMI category for all except sleep problems, generally showing the highest levels for the obese category. However, patterns differed markedly between age groups. In particular, poorer global health and special health-care needs were associated with underweight in young children, but obesity in older children. Prevalence of poorer physical health varied little by BMI in 2–5-year-olds, but from 6 to 7 years was increasingly associated with obesity. Normal-weight children tended to experience the best psychosocial and mental health, with little evidence that the U-shaped associations of these variables with BMI status varied by age. Wheeze and asthma increased slightly with BMI at all ages.

Conclusions:

Deviation from normal weight is associated with health differences in children and adolescents that vary by morbidity and age. As well as lowering risks for later disease, promoting normal body weight appears central to improving the health and well-being of the young.

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Acknowledgements

We thank all the parents and children who took part in LSAC and HOYVS, and the major contributions of all field workers in both studies. This paper uses unit record data from Growing Up in Australia, the Longitudinal Study of Australian Children. The study is conducted in partnership between the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA), the Australian Institute of Family Studies (AIFS) and the Australian Bureau of Statistics (ABS). The third wave of the Health of Young Victorians Study (HOYVS) was funded by the Australian National Health and Medical Research Council (NHMRC) Project Grant 334303, and the second wave by grants-in-aid from the National Heart Foundation, Murdoch Childrens Research Institute and the Financial Markets Foundation for Children. MW is supported by the NHMRC Career Development Award 546405, GP by the NHMRC Senior Principal Research Fellowship 454360 and EW by the Jack Brockoff Foundation and NHMRC Child and Adolescent Obesity Prevention Capacity Building Grant. MCRI research is supported by the Victorian Government’s Operational Infrastructure Support Program.

Author Contributions

All the authors had access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. MW is the study guarantor. MW, EW, GP, JW, Kylie Hesketh and Timothy Olds conceived the third wave of the Health of Young Victorians Study, obtained funding and directed the study. LC carried out the preliminary analyses and SC carried out the final analyses under the supervision of JC. MW and SC wrote the paper, with critical input from the other authors.

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Correspondence to M Wake.

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The findings and views reported are those of the authors and should not be attributed to FaHCSIA, AIFS or the ABS. The funding bodies had no role in the conduct of the studies or development of this manuscript. The researchers were independent of the funders.

Ethical approval

LSAC: Written informed consent was obtained at wave 1, and the study was approved by the Australian Institute of Family Studies Ethics Committee. HOYVS: Each wave was approved by the Royal Children's Hospital Ethics in Human Research Committee and the authorities responsible for each education sector, and parents provided written consent (plus written adolescent consent for wave 3).

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Wake, M., Clifford, S., Patton, G. et al. Morbidity patterns among the underweight, overweight and obese between 2 and 18 years: population-based cross-sectional analyses. Int J Obes 37, 86–93 (2013). https://doi.org/10.1038/ijo.2012.86

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