Obesity: Baur LA

Quak SH, Furnes R, Lavine J, Baur LA, Anonymous00095. · Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · J Pediatr Gastroenterol Nutr. · Pubmed #18664884 No free full text.

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Baur LA. · No affiliation provided · BMJ. · Pubmed #18689432 No free full text.

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Baur LA. · No affiliation provided · Int J Pediatr Obes. · Pubmed #17902209 No free full text.

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Baur LA. · No affiliation provided · J Paediatr Child Health. · Pubmed #16898875 No free full text.

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Baur LA. · No affiliation provided · Int J Obes (Lond). · Pubmed #15768039 No free full text.

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Waters EB, Baur LA. · No affiliation provided · Med J Aust. · Pubmed #12720504 links to  free full text

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Baur LA. · No affiliation provided · Med J Aust. · Pubmed #11453322 links to  free full text

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Gill TP, Baur LA, Bauman AE, Steinbeck KS, Storlien LH, Fiatarone Singh MA, Brand-Miller JC, Colagiuri S, Caterson ID. · Institute of Obesity, Nutrition and Exercise, University of Sydney, Sydney, NSW. · Med J Aust. · Pubmed #19203314 No free full text.

Abstract: Recent reports have suggested that the problem of childhood and adolescent obesity has been exaggerated in Australia, and that community-wide obesity prevention initiatives are not warranted; we argue that this is not an accurate reflection of the situation. Available data indicate that obesity affects 6%-8% of Australian schoolchildren, and that the proportion has continued to increase in recent years. Childhood and adolescent obesity is associated with a wide range of immediate health concerns, as well as increasing the risk of disease in adulthood. Some weight-related health problems are also found in overweight children. A range of strategies, including whole-of-community obesity prevention programs, will be required to tackle this problem. Concerns about disordered eating in children and adolescents should not preclude appropriate action on childhood obesity.

Li M, Li S, Baur LA, Huxley RR. · The George Institute for International Health, University of Sydney, NSW, Australia. · Obes Rev. · Pubmed #18503504 No free full text.

Abstract: The aim of this paper was to conduct a systematic review of intervention studies in China aimed at the prevention or control of excess weight gain among children and adolescents. Two Chinese databases (The China Full Text Database and Wanfang Database) and two English databases (Medline and Meditext) were searched with keywords for intervention studies published between 1990 and 2006. Data were extracted on aspects of study quality, methodology and effectiveness of interventions. Quality assessment was conducted using a previously established assessment tool. Twenty-two studies were included, of which 17 were conducted among overweight and/or obese children and/or adolescents. Interventions strategies varied across studies but the majority focused on improving the level of knowledge, physical activity levels and/or diet of overweight children and adolescents. Most studies reported a beneficial effect of the intervention with one or more of the study outcomes, but all of the studies had serious, or moderate, methodological weaknesses. None of the trials identified by this systematic review demonstrated convincing evidence of the efficacy of any single intervention for the prevention of overweight and obesity in children and adolescents from Mainland China. Future intervention trials should address the methodological weaknesses identified in this review.

Denney-Wilson E, Baur LA. · Discipline of Paediatrics and Child Health, University of Sydney, Sydney NSW 2006 Australia. · Int J Adolesc Med Health. · Pubmed #17937139 No free full text.

Abstract: Adolescent obesity is a major public health problem in Australia, and in many other parts of the world. Recent data suggest that as many as one quarter of young people in Australia are either overweight or obese, and that the majority of obese young people have one or more risk factors for chronic disease. Efforts to reduce the health and economic burden of obesity must focus on both management of affected individuals and prevention of further cases. This paper reviews some of the research currently underway in Australia, and includes recent data on both the prevalence of obesity and the associated complications, from large surveys and smaller cohorts. State and Federal governments have developed policies aimed at obesity prevention, but these are yet to be fully evaluated. Two large-scale community-based interventions are underway, one of which has reported positive preliminary findings. A number of smaller research programs are examining macro and individual level causation of obesity and include unique research examining the way adolescents perceive their environment. Other research includes the development and evaluation of service delivery models specifically targeting adolescents. A greater emphasis on environmental determinants and management of adolescent obesity is needed in future programs.

Batch JA, Baur LA. · Department of Endocrinology and Diabetes, Royal Children's Hospital, Brisbane, QLD. · Med J Aust. · Pubmed #15698360 links to  free full text

Abstract: Obesity in children and adolescents has reached alarming levels--20%-25% of children and adolescents are overweight or obese, and 4.9% of boys and 5.4% of girls are obese. Rates of obesity have increased significantly in Australia from 1985 to 1995, with the prevalence of overweight doubling and obesity trebling. Body mass index (related to reference standards for age and sex) is recommended as a practical measure of overweight and obesity in children, and is used in monitoring individual progress in clinical practice. Obesity in childhood and adolescence may be associated with a range of medical and psychological complications, and can predispose individuals to serious health problems in adult life, including type 2 diabetes, hypertension, dyslipidaemia and non-alcoholic steatohepatitis. Obesity interventions for which there is some evidence include family support, a developmentally appropriate approach, long-term behaviour modification, dietary change, and increased physical activity and decreased sedentary behaviour. Prevention of obesity in children and adolescents requires a range of strategies involving changes in both the microenvironment (eg, housing, neighbourhoods, recreational opportunities) and the macroenvironment (eg, food marketing, transport systems, urban planning).

Baur LA, O'Connor J. · University of Sydney Discipline of Paediatrics & Child Health, The Children's Hospital at Westmead, Westmead, New South Wales, Australia. · Clin Dermatol. · Pubmed #15475236 No free full text.

Abstract: Child and adolescent obesity is increasingly prevalent in westernized countries. It is associated with significant medical and psychosocial co-morbidities that are both immediate and long-term. While genetic factors influence the susceptibility of a given child to an obesity-conducive environment, the current epidemic is due to massive environmental change over the past few decades leading to a rise in sedentary pursuits, a decrease in physical activity and increased energy intake. Effective management requires a family-focused, developmentally sensitive, behavioural management approach that addresses, for example, eating habits, incidental activity and television viewing. Prevention of childhood obesity will ultimately require multi-faceted, large-scale interventions.

Proietto J, Baur LA. · Department of Medicine, Repatriation Hospital, Melbourne, Vic. · Med J Aust. · Pubmed #15115430 links to  free full text

Abstract: Obesity has reached epidemic proportions in Australia, with 67.5% of men, 52.1% of women and 19%-23% of children and adolescents being overweight or obese. Genetically predisposed individuals are especially vulnerable to developing obesity in the highly obesogenic environment of 21st century Australia. Obesity causes or contributes to many comorbidities, including type 2 diabetes, hypertension, dyslipidaemia, sleep apnoea, non-alcoholic steatohepatitis, orthopaedic problems and polycystic ovary syndrome. Management in the individual requires their complete co-operation and should be tailored to individual needs and complications. Management of obesity in children should consider the family context and involve the parents. All treatment strategies must involve lifestyle modification, with a reduction of energy intake and an increase in physical activity. Some patients may also require the assistance of drug therapy or bariatric surgery.

Baur LA. · University of Sydney School of Paediatrics & Child Health, The Children's Hospital at Westmead, Westmead, NSW, Australia. · Asia Pac J Clin Nutr. · Pubmed #12492643 No free full text.

Abstract: The early 21st century has seen the development of a global epidemic of obesity in both developed and developing countries. In Australia at least one in five children and adolescents are overweight or obese, with rapid rises in prevalence apparently continuing. Similar trends are seen in other countries. Child and adolescent obesity is associated with both immediate and long-term medical and psychosocial problems, including a clustering of risk factors for the development of cardiovascular disease and diabetes. Thus, obesity poses a major health problem for the paediatric population. Major environmental and societal changes have led to a decrease in physical activity, a rise in sedentary behaviour and the consumption of high fat and high-energy foods, all in turn influencing the development of obesity. Effective management involves a multimodal approach with a developmentally aware approach, involvement of the family, a focus on healthy food choices, incorporation of physical activity and a decrease in sedentary behaviour all being important. Ultimately, however, the obesity epidemic requires a major focus on primary prevention. Australia has a national strategy for the prevention of overweight and obesity that depends upon intersectoral and intergovernmental cooperation, supported by adequate resourcing and significant community ownership.

Booth ML, Macaskill P, Lazarus R, Baur LA. · Department of Public Health and Community Medicine, University of Sydney, NSW, Australia. · Int J Obes Relat Metab Disord. · Pubmed #10375047 No free full text.

Abstract: BACKGROUND: Obesity in childhood and adolescence is associated with health problems, increases in cardiovascular disease (CVD) risk factors and a greater likelihood of becoming overweight as an adult. A description of the sociodemographic distribution of overweight and obesity among children and adolescents in the population may allow us to determine if health promotion resources should be differentially allocated to particular groups. METHODS: The New South Wales Schools Fitness and Physical Activity Survey, 1997 (n = 5518) was a cross-sectional survey which measured height, weight, waist and hip girths and skinfold thicknesses of randomly selected New South Wales students in school years 4, 6, 8 and 10. Height and weight only were measured among Year 2 students. The mean ages of students in school years 2, 4, 6, 8 and 10 were 7.3y, 9.3y, 11.3y, 13.3y and 15.3y, respectively. The values of body mass index (BMI), waist girth, waist-to-hip ratio (WHR) and sum of three skinfolds for students resident in urban and rural areas and in tertiles of socioeconomic status (SES) were compared. RESULTS: There were no differences on any of the anthropometric measures between urban and rural boys and girls, with the exception that WHR was higher among urban girls. Among boys, there were no differences between the SES tertiles on any of the measures. Among girls, each of the anthropometric measures (except sum of skinfolds) was inversely associated with SES, with body fatness tending to be lower in the high SES tertile, compared with the low and middle SES tertiles. None of the statistical interactions between school year and body fatness was significant, suggesting that the relationship is consistent from childhood to adolescence. CONCLUSION: On the basis of these results, we suggest that health promotion programs aimed at weight management among Australian girls of lower SES are not warranted. We recommend that health promotion programs emphasize regular physical activity, a healthy diet and acceptance of the normal range of body shapes.

Shrewsbury VA, O'Connor J, Steinbeck KS, Stevenson K, Lee A, Hill AJ, Kohn MR, Shah S, Torvaldsen S, Baur LA. · University of Sydney Clinical School, The Children's Hospital at Westmead, Sydney, NSW, Australia. · BMC Public Health. · Pubmed #19402905 links to  free full text

Abstract: BACKGROUND: There is a need to develop sustainable and clinically effective weight management interventions that are suitable for delivery in community settings where the vast majority of overweight and obese adolescents should be treated. This study aims to evaluate the effect of additional therapeutic contact as an adjunct to the Loozit group program -- a community-based, lifestyle intervention for overweight and lower grade obesity in adolescents. The additional therapeutic contact is provided via telephone coaching and either mobile phone Short Message Service or electronic mail, or both. METHODS AND DESIGN: The study design is a two-arm randomised controlled trial that aims to recruit 168 overweight and obese 13-16 year olds (Body Mass Index z-score 1.0 to 2.5) in Sydney, Australia. Adolescents with secondary causes of obesity or significant medical illness are excluded. Participants are recruited via schools, media coverage, health professionals and several community organisations. Study arm one receives the Loozit group weight management program (G). Study arm two receives the same Loozit group weight management program plus additional therapeutic contact (G+ATC). The 'G' intervention consists of two phases. Phase 1 involves seven weekly group sessions held separately for adolescents and their parents. This is followed by phase 2 that involves a further seven group sessions held regularly, for adolescents only, until two years follow-up. Additional therapeutic contact is provided to adolescents in the 'G+ATC' study arm approximately once per fortnight during phase 2 only. Outcome measurements are assessed at 2, 12 and 24 months post-baseline and include: BMI z-score, waist z-score, metabolic profile indicators, physical activity, sedentary behaviour, eating patterns, and psychosocial well-being. DISCUSSION: The Loozit study is the first randomised controlled trial of a community-based adolescent weight management intervention to incorporate additional therapeutic contact via a combination of telephone coaching, mobile phone Short Message Service, and electronic mail. If shown to be successful, the Loozit group weight management program with additional therapeutic contact has the potential to be readily translatable to a range of health care settings. TRIAL REGISTRATION: The protocol for this study is registered with the Australian Clinical Trials Registry (ACTRNO12606000175572).

Baur LA. · The University of Sydney and The Children's Hospital at Westmead, Westmead NSW 2145, Australia. · CMAJ. · Pubmed #19332745 links to  free full text

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Alexander SM, Baur LA, Magnusson R, Tobin B. · The Children's Hospital at Westmead, Sydney, NSW. · Med J Aust. · Pubmed #19203311 No free full text.

Abstract: Severe childhood obesity and its associated comorbidities are increasing in prevalence. Extreme childhood obesity may be viewed as a mirror image of severe non-organic failure to thrive. Parental neglect may be a causative factor in both circumstances. When suspicion of parental neglect arises, health care professionals may have both an ethical obligation and a statutory duty to notify child protection services. Guidelines on the point at which medical practitioners should seek state assistance in cases of severe childhood obesity would be helpful, not only for medical practitioners, but also for child protection services.

Timperio A, Salmon J, Ball K, Baur LA, Telford A, Jackson M, Salmon L, Crawford D. · Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, Australia. · Int J Pediatr Obes. · Pubmed #19086186 No free full text.

Abstract: OBJECTIVE: To examine associations between family physical activity and sedentary environment and changes in body mass index (BMI) z-scores among 10-12-year-old children over three years. METHOD: Design. Longitudinal (three-year follow-up). Subjects. In total, 152 boys and 192 girls aged 10-12 years at baseline. MEASUREMENTS: Measured height and weight at baseline and follow-up (weight status, BMI z-scores); aspects of the family physical activity and sedentary environment (parental and sibling modelling, reinforcement, social support, family-related barriers, rules/restrictions, home physical environment) measured with a questionnaire completed by parents at baseline. RESULTS: At baseline, 29.6% of boys and 21.9% of girls were overweight or obese, and mean (standard deviation, SD) BMI z-scores were 0.44 (0.99) and 0.28 (0.89), respectively. There was a significant change in BMI z-score among girls (mean change = 0.19, SD = 0.55, p < 0.001), but not boys. Among boys, the number of items at home able to be used for sedentary behaviour (B = 0.11, p = 0.037) was associated with relatively greater increases in BMI z-score. Among girls, sibling engagement in physical activity at least three times/wk (B = -0.17, p = 0.010) and the number of physical activity equipment items at home (B = -0.05, p = 0.018) were associated with relatively greater decreases in BMI z-score. CONCLUSION: Sibling physical activity and environmental stimuli for sedentary behaviours and physical activity within the home may be important targets for prevention of weight gain during the transition from childhood to adolescence.

Dwyer GM, Higgs J, Hardy LL, Baur LA. · University of Sydney Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Locked Bag 4001 Westmead, NSW 2145, Australia. · Int J Behav Nutr Phys Act. · Pubmed #19077255 links to  free full text

Abstract: ABSTRACT: BACKGROUND: Physical activity and small screen recreation are two modifiable behaviours associated with childhood obesity and the development of chronic health problems. Parents and preschool staff shape behaviour habits in young children. The aims of this qualitative study were to explore the attitudes, values, knowledge and understanding of parents and carers of preschool-age children in relation to physical activity and small screen recreation and to identify influences upon these behaviours. METHODS: This research involved a focus group study with parents and carers of the target population. A purposive sample of 39 participants (22 parents, 17 carers) participated in 9 focus groups. Participants were drawn from three populations of interest: those from lower socioeconomic status, and Middle-Eastern and Chinese communities in the Sydney (Australia) metropolitan region. RESULTS: All participants understood the value of physical activity and the impact of excessive small screen recreation but were unfamiliar with national guidelines for these behaviours. Participants described the nature and activity patterns of young children; however, the concept of activity 'intensity' in this age group was not a meaningful term. Factors which influenced young children's physical activity behaviour included the child's personality, the physical activity facilities available, and the perceived safety of their community. Factors facilitating physical activity included a child's preference for being active, positive parent or peer modelling, access to safe play areas, organised activities, preschool programs and a sense of social connectedness. Barriers to physical activity included safety concerns exacerbated by negative media stories, time restraints, financial constraints, cultural values favouring educational achievement, and safety regulations about equipment design and use within the preschool environment. Parents considered that young children are naturally 'programmed' to be active, and that society 'de-programs' this behaviour. Staff expressed concern that free, creative active play was being lost and that alternate activities were increasingly sedentary. CONCLUSION: The findings support the relevance of the socioecological model of behavioural influences to young children's physical activity. In this age group, efforts may best be directed at emphasising national guidelines for small screen recreation and educating families and carers about the importance of creative, free play to reinforce the child's inherent nature to be active.

Cretikos MA, Valenti L, Britt HC, Baur LA. · NSW Public Health Officer Training Program, Centre for Epidemiology and Research, NSW Department of Health, NSW, Australia. · Med Care. · Pubmed #18953227 No free full text.

Abstract: BACKGROUND: Childhood obesity is rapidly increasing in prevalence worldwide, but healthcare capacity to address this problem seems limited. OBJECTIVE: The purpose of this study was to describe the prevalence and rate of management of childhood overweight and obesity in Australian general practice. SUBJECTS: A cross-sectional study consisting of 3978 general practitioners (GPs), randomly selected using Medicare Australia claims, who recorded 42,515 encounters with children age 2-17 including 12,925 sub-sampled encounters with self or carer-reported height and weight collected. MEASURES: Prevalence of overweight and obesity, rate of management of overweight and obesity, content of encounters in overweight and nonoverweight children, content of encounters in those managed for overweight and obesity, and management to prevalence ratio. RESULTS: A total of 29.6% of sub-sampled children were classified as overweight (18.3%) or obese (11.4%). GPs managed overweight and obesity during 215 encounters, or once per 200 encounters with children age 2-17 and once per 58 encounters with overweight or obese children. The content of encounters in overweight and non-overweight children did not differ. Children who were managed for overweight or obesity presented with these conditions as reasons for the encounter significantly more often [66.5 (95% confidence interval (CI): 59.7-73.3) vs. 1.2 (95% CI: 1.0-1.3)] and were managed for more problems, particularly depression [4.2 (95% CI: 1.5-6.9) vs. 0.8 (95% CI: 0.7-0.9)], than average per 100 encounters. Consultations for overweight or obesity were significantly longer than average [16.7 (95% CI: 14.7-18.7) vs. 12.4 (95% CI: 12.2-12.5) minutes]. CONCLUSIONS: Overweight and obesity are prevalent in children presenting to Australian general practice but GPs do not use most of the available opportunities to manage this problem.

Morgan PJ, Okely AD, Cliff DP, Jones RA, Baur LA. · School of Education, University of Newcastle, Callaghan, New South Wales, Australia. · Obesity (Silver Spring). · Pubmed #18927553 No free full text.

Abstract: The aim of this study was to identify potential correlates of objectively measured physical activity in a sample of obese children. A cross-sectional design was used to assess 137 5-9-year-old obese children (mean +/- s.d. age = 8.3 +/- 1.1 years; mean BMI z-score = 2.76 +/- 0.70; 58% girls) from two regional cities in New South Wales, Australia, before commencement in a treatment trial. Correlates examined included age, BMI z, parental BMI, perceived competence, health-related quality of life, daily minutes spent in small screen recreation (SSR), and fundamental motor skill (FMS) proficiency. Physical activity was assessed using accelerometers and values were calculated for % of monitored time spent in moderate- (MPA) and vigorous (VPA)-intensity physical activity and mean counts per minute (CPM). Analyses were conducted separately for boys and girls. Motor skill proficiency was significantly correlated with a number of physical activity variables for boys and girls. For boys, regression analysis revealed object-control proficiency predicted CPM (R(2) = 0.25) and age was a predictor of %MPA (R(2) = 0.56). Age and object-control skill proficiency were salient predictors of %VPA (R(2) = 0.34). For girls, age and daily minutes of SSR were the only significant predictors for CPM (R(2) = 0.13). Age was the sole predictor of %MPA (R(2) = 0.38) and %VPA (R(2) = 0.15). The targeting of FMSs at an early age should be tested in experimental studies as potential strategies to increase physical activity among obese children, particularly for boys. Interventions aimed at reducing sedentary behaviors among obese girls should also be considered.

Cleland V, Crawford D, Baur LA, Hume C, Timperio A, Salmon J. · Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Hwy, Burwood, Victoria, Australia. · Int J Obes (Lond). · Pubmed #18852701 No free full text.

Abstract: OBJECTIVE: This study aimed to determine whether time spent outdoors was associated with objectively measured physical activity, body mass index (BMI) z-score and overweight in elementary-school aged children, cross-sectionally and prospectively over 3 years. METHODS: Three-year cohort study with data collected during 2001 and 2004. Nineteen randomly selected state elementary schools across Melbourne, Australia. One hundred and eighty eight 5-6-year-old and 360 10-12-year-old children. Baseline parent reports of children's time spent outdoors during warmer and cooler months, on weekdays and weekends. At baseline and follow-up, children's moderate and vigorous physical activity (MVPA) was objectively assessed by accelerometry, and BMI z-score and overweight was calculated from measured height and weight. RESULTS: Cross-sectionally, each additional hour outdoors on weekdays and weekend days during the cooler months was associated with an extra 27 min week(-1) MVPA among older girls, and with an extra 20 min week(-1) MVPA among older boys. Longitudinally, more time outdoors on weekends predicted higher MVPA on weekends among older girls and boys (5 min week(-1)). The prevalence of overweight among older children at follow-up was 27-41% lower among those spending more time outdoors at baseline. CONCLUSION: Encouraging 10-12-year-old children to spend more time outdoors may be an effective strategy for increasing physical activity and preventing increases in overweight and obesity. Intervention research investigating the effect of increasing time outdoors on children's physical activity and overweight is warranted.

Burrows T, Warren JM, Baur LA, Collins CE. · Faculty of Health, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia. · Int J Obes (Lond). · Pubmed #18607380 No free full text.

Abstract: OBJECTIVE: The aims of this study were to describe the dietary intakes and food behavior changes of overweight and obese children participating in the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) study and to describe the impact of a best practice dietary modification program. DESIGN: A multicenter randomized controlled trial with allocation to one of three intervention arms: (1) parent-centered nutrition lifestyle program; (2) child-centered physical activity skill development program; or (3) both the programs. PARTICIPANTS: One hundred and sixty-five overweight, pre-pubertal children 5-9 years of age (58% female).Measurements:Dietary intake was assessed at baseline, 6 and 12 months post-commencement of the program using a semiquantitative food frequency questionnaire. RESULTS: After 6 and 12 months, all groups improved their dietary intake, with no differences detected between groups (P>0.05). Total quantity of food (g) and kJ kg(-1) decreased significantly at both time points (P<0.05). Percent energy derived from core food groups, except fruit, increased significantly at 12 months compared to baseline (P<0.05), and non-core foods decreased, with the largest decreases being for sweetened drinks (5.0+/-0.4 vs 2.9+/-0.3% of energy baseline to 12 months, P<0.001) and packaged lunch box snacks (5.4+/-0.3 vs 4.1+/-0.3% of energy baseline to 12 months, P<0.001). CONCLUSION: All treatment groups in the HIKCUPS study appear to be equally efficacious in improving dietary intake in overweight and obese children.

Denney-Wilson E, Hardy LL, Dobbins T, Okely AD, Baur LA. · NSW Centre for Overweight and Obesity, Level 2, Medical Foundation Bldg K25, University of Sydney, Sydney, New South Wales, Australia 2006. · Arch Pediatr Adolesc Med. · Pubmed #18524748 links to  free full text

Abstract: OBJECTIVE: To determine the association between measures of adiposity (body mass index and waist circumference) and risk factors for heart disease, type 2 diabetes, fatty liver disease, and the clustering of risk factors in middle adolescence. DESIGN: Cross-sectional study. SETTING: Secondary schools in Sydney. PARTICIPANTS: Grade 10 students (N = 496; 58.4% boys; mean [SD] age, 15.4 [0.4] years). MAIN EXPOSURES: Height, weight, waist circumference, blood pressure, and fasting blood samples. OUTCOME MEASURES: Participants were categorized as overweight or obese using the International Obesity Task Force cut points and the UK waist circumference cut points. Blood was analyzed for high- and low-density lipoprotein cholesterol, triglycerides, insulin, glucose, alanine aminotransferase, gamma-glutamyltransferase, and high-sensitivity C-reactive protein levels, and the results were categorized as normal or abnormal according to published guidelines where possible. Associations between overweight and obesity and risk factors were explored using logistic regression. Clustering of risk factors within individuals was also explored. RESULTS: Insulin (P < .001), alanine aminotransferase (P < .001), gamma-glutamyltransferase (P = .005), high-density lipoprotein cholesterol (P < .001), high-sensitivity C-reactive protein (P < .001), and blood pressure (P < .001) were significantly associated with overweight and obesity in adolescent boys. In adolescent girls, insulin, high-density lipoprotein cholesterol (P < .001), and high-sensitivity C-reactive protein (P < .001) were significantly associated with overweight and obesity. Obese adolescent boys and girls were significantly more likely to have 2 or more risk factors (boys: 73.5% vs 7.6%; girls: 44.4% vs 5.4%; P < .001 for both) than nonoverweight adolescents. CONCLUSIONS: Overweight and obese adolescents, especially boys, are at substantial risk for chronic conditions. Waist circumference is not a better predictor of metabolic risk factors than is body mass index.