Pediatric Weight Management

Pediatrics and Physical Activity


De Vito, E, La Torre, G, Langiano, E, Berardi, D, & Ricciardi, G. Overweight and obesity among secondary school children in Central Italy.  Eur J Epidemiol 1999;15:649-654.

PubMed ID: 10543355
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

In order to plan a nutritional and health educational program, this study was conducted to carry out a survey on the nutritional status of the school age population.

Inclusion Criteria:

None stated

Exclusion Criteria:

None stated

Description of Study Protocol:

Each student was interviewed about physical activity and underwent the following measurements: height, weight, bicipital, tricipital, subscapular and over-iliac skinfold. Students’ parents answered a questionnaire about family structure, age, educational level and job, current height and weight, presence of pathological conditions, and number of hours weekly spent by their children playing sports.

Statistical Analysis

Pearson X2 and one way ANOVA were used for the univariate comparisons.  Two-tailed tests were used to examine differences existing between each pairing of the groups.  Multiple logistic regression analysis was performed to identify the variables that affect the risk of overweight and the obesity of students.

Data Collection Summary:

Timing of Measurements

Dependent Variables

  • overweight and obesity of students

Independent Variables

  • age
  • gender
  • parents education level
  • parents BMI
  • number of weekly hours of physical activity

Control Variables

  • maturation
Description of Actual Data Sample:

Initial N: Twelve schools from the list of 158 schools in the province of Frosinone were randomly sampled (2053 students).

Attrition (final N): The actual sample consisted of 1357 children (804 males and 553 females)

Age: age range 11-19 years old.

Ethnicity: Not reported

Other relevant demographics: 8.4% were obese; 21.2% were overweight

Location: province of Frosinone

Summary of Results:

Results of the multiple logistic regression analysis indicated that significant predictors of students’ risk of overweight were:

  • mother’s BMI (odd ratio (OR): 1.97, grade 1 (BMI 25.00-29.99); OR: 4.28, grade 2 (BMI 30.00-39.99) of overweight)
  • fathers’ nutritional status (OR:2.1, grade 1; OR: 2.36, grade 2 overweight).

Moreover, students’ obesity was significantly associated with mother’s grade 2 of overweight (OR: 2.46), female sex (OR: 0.42) and hours of physical activity (OR: 0.52).

Author Conclusion:

Mother’s education strongly affects time spent on athletics, but our analysis shows that when mothers have a low educational level, physical activity appears to have a stronger influence on nutritional status of children, compared to students from better educated mothers.

Funding Source:
University/Hospital: University of cassino (Italy)
Reviewer Comments:

The main risk factors for overweight seem to be linked to parents’ nutritional conditions, mother’s educational level and students’ physical inactivity.


Self-completed questionnaire to gain data from parents.


Large sample size.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? No
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? No
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? No
  2.2. Were criteria applied equally to all study groups? N/A
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? Yes
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? Yes
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? N/A
  4.1. Were follow-up methods described and the same for all groups? N/A
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) N/A
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? N/A
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) No
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? No
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? No
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? No
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? No
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? No
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? No
  7.5. Was the measurement of effect at an appropriate level of precision? ???
  7.6. Were other factors accounted for (measured) that could affect outcomes? ???
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? No
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? ???
  10.1. Were sources of funding and investigators' affiliations described? No
  10.2. Was the study free from apparent conflict of interest? ???