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Emily J. Tomayko, Katherine B. Gunter, John M. Schuna Jr., and Paul N. Thompson

on child health. We demonstrated significant differences in school-level variables between 4- and 5-day schools in Oregon, including higher PE exposure in FDSW schools, but did not observe differences in childhood obesity between school models. Of note, Oregon legislators recently amended the rules

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Dan Nemet

As the incidence of childhood obesity increases, there is a need to promote leisure time physical activity. Traditional approaches to promote the population physical activity levels have shown at best moderate improvements. High percentage of children today carry a cell phone, thus the use of this portable device seems promising for enhancing physical activity.

Pokémon Go, is a smartphone game that uses augmented reality, where players are incentivized to get out and walk significant distances to catch the Pokémon. Initial reports suggested increases in the number of steps that players performed, yet this effect of the game was not sustained. Incorporating physical activity into modern technology seems promising, clearly there is need to explore creative ways to achieve a longer term effect.

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Athanasios Z. Jamurtas, Antonios Stavropoulos-Kalinoglou, Stilianos Koutsias, Yiannis Koutedakis, and Ioannis Fatouros

Childhood obesity is increasing alarmingly, and a strong association with chronic diseases has been established. Specific adipokines are released from the adipose tissue and relate with chronic diseases even in the pediatric population. Adiponectin levels are lower in obesity and increase with decreasing body weight. A few pediatric studies examining a possible relationship between resistin and obesity do not provide a clear picture. Most studies agree that visfatin levels appear elevated in childhood obesity. Exercise seems to increase adiponectin levels whereas resistin levels are reduced. The lack of data on the effects of acute and chronic exercise on visfatin levels precludes us from making safe conclusions as to what the effects of exercise (acute or chronic) would be on visfatin levels in children. Clearly, exercise has an impact on the adipose tissue and the release of adiponectin, resistin, and visfatin. However, other factors affect the secretion rate of these adipokines from the adipose tissue; these factors should also be taken into consideration when examining the effects of exercise on adipokines. Gender, age, body composition, physical activity levels, mode and intensity of exercise are some of the factors that should be looked into in future studies.

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Jackie L. Puhl

The increasing prevalence of childhood obesity, persistence of obesity over time, and health risks associated with it place childhood obesity among the highest national health concerns. The extent to which excess caloric intake or insufficient energy expenditure contribute to childhood obesity has not yet been clearly delineated. This report examines the components of the energy alance equation, focusing on the major components of energy expenditure (rest, thermic effect of food, and physical activity) whereby differences may affect energy balance and promote or perpetuate obesity among children. Some implications of differences in energy expenditure to childhood obesity and areas of needed research are suggested.

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YoonMyung Kim

Childhood obesity is an epidemic ( 45 ), and it is recognized as a leading health concern due to its strong associations with comorbid conditions, such as impaired glucose tolerance ( 57 ), metabolic syndrome ( 7 ), type 2 diabetes (T2DM) ( 29 , 48 ), and nonalcoholic fatty liver disease (NAFLD

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Dan Nemet

obesity is now recognized as a worldwide epidemic, and major efforts are made to prevent and treat it. The mechanisms responsible for the continuing increase in childhood obesity are not yet completely understood. However, weight gain clearly results from an imbalance between energy intake and energy

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Consuelo Belmonte Gonzalez-Suarez and Karen Grimmer-Somers

Background:

Childhood obesity has been inconsistently associated with decreased levels of physical activity and fitness. Moreover, little is known about this relationship among Filipino preteens.

Methods:

This cross sectional study reports the association between childhood obesity, measures of physical activity, and fitness. Children aged 11 to 12 from randomly selected schools from San Juan, Metromanila were included. Outcome measures were body mass index, Filipino modified Physical Activity Questionnaire for Older children (F_PAQ-C), standing broad jump, 50 m sprint and 20 m multistage shuttle run.

Results:

380 children participated in the study. Obese children had significantly lower median scores in the F_PAQ-C compared with overweight children. Overweight children had lower scores in the standing broad jump, 50 m sprints and predicted VO2max as compared with children with normal BMI. There were modest associations between the 50 m sprint, predicted VO2max, and F_PAQ-C.

Conclusion:

Our study has showed that physical activity and fitness scores were strongly correlated with childhood obesity. If childhood physical fitness is a predictor of physical fitness in adulthood which is a risk factor in cardiovascular diseases, there is a strong possibility that the prevalence of cardiovascular disease in the Philippines will increase dramatically in the future.

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Dan Nemet

Importance:

Little evidence exists on which exercise modality is optimal for obese adolescents. Objective: To determine the effects of aerobic training, resistance training, and combined training on percentage body fat in overweight and obese adolescents.

Design, Setting, and Participants:

Randomized, parallel-group clinical trial at community-based exercise facilities in Ottawa (Ontario) and Gatineau (Quebec), Canada, among previously inactive postpubertal adolescents aged 14-18 years (Tanner stage IV or V) with body mass index at or above the 95th percentile for age and sex or at or above the 85th percentile plus an additional diabetes mellitus or cardiovascular risk factor. Interventions: After a 4-week run-in period, 304 participants were randomized to the following 4 groups for 22 weeks: aerobic training (n = 75), resistance training (n = 78), combined aerobic and resistance training (n = 75), or nonexercising control (n = 76). All participants received dietary counseling, with a daily energy deficit of 250 kcal.

Main Outcomes and Measures:

The primary outcome was percentage body fat measured by magnetic resonance imaging at baseline and 6 months. We hypothesized that aerobic training and resistance training would each yield greater decreases than the control and that combined training would cause greater decreases than aerobic or resistance training alone.

Results:

Decreases in percentage body fat were −0.3 (95% CI, −0.9 to 0.3) in the control group, −1.1 (95% CI, −1.7 to −0.5) in the aerobic training group (p = .06 vs. controls), and −1.6 (95% CI, −2.2 to −1.0) in the resistance training group (p = .002 vs controls). The −1.4 (95% CI, −2.0 to −0.8) decrease in the combined training group did not differ significantly from that in the aerobic or resistance training group. Waist circumference changes were −0.2 (95% CI, −1.7 to 1.2) cm in the control group, −3.0 (95% CI, −4.4 to −1.6) cm in the aerobic group (p = .006 vs controls), −2.2 (95% CI −3.7 to −0.8) cm in the resistance training group (p = .048 vs controls), and −4.1 (95% CI, −5.5 to −2.7) cm in the combined training group. In per-protocol analyses (> 70% adherence), the combined training group had greater changes in percentage body fat (-2.4, 95% CI, −3.2 to −1.6) vs the aerobic group (-1.2; 95% CI, −2.0 to −0.5; p = .04 vs the combined group) but not the resistance group (-1.6; 95% CI, −2.5 to −0.8).

Conclusions and Relevance:

Aerobic, resistance, and combined training reduced total body fat and waist circumference in obese adolescents. In more adherent participants, combined training may cause greater decreases than aerobic or resistance training alone.