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Determinants and consequences of childhood overweight in Canada Open Access


Other title
risk factors
Type of item
Degree grantor
University of Alberta
Author or creator
Kuhle, Stefan
Supervisor and department
Veugelers, Paul (School of Public Health)
Examining committee member and department
Voaklander, Don (School of Public Health)
Ohinmaa, Arto (School of Public Health)
Sharma, Sangita (Faculty of Medicine)
Taylor, Jennifer (Department of Family & Nutritional Sciences, University of Prince Edward Island)
Kirk, Sara (School of Health Administration, Dalhousie University)
School of Public Health Sciences

Date accepted
Graduation date
Doctor of Philosophy
Degree level
The prevalence of childhood obesity has increased dramatically over the last three decades in Canada with substantial consequences for the physical, mental, and economic wellbeing of the population. The overarching objective of this thesis was to examine the various aspects of childhood obesity in Canada, from prevalence trends and risk factors to economic and medical consequences. A systematic review (Objective 1) showed that the prevalence of childhood obesity in Canada has tripled since 1980. Using a prediction model (Objective 2), I demonstrated that the prevalence of overweight and obesity will further increase by 10% over the next 15 years if current trends continue unabated. An analysis of a population-based survey data among Grade 5 students in Nova Scotia linked with a perinatal database (Objective 3) showed that perinatal factors (large-for-gestational age, maternal pre-pregnancy weight) play an important role in the development of childhood overweight. Calculating the population attributable risk fractions for these risk factors (Objective 4), I was able to show that excess screen time and maternal pre-pregnancy weight offer the largest potential for prevention. My analysis of the health care costs associated with childhood obesity (Objective 5) found that the obese children incurred 21% higher costs than normal weight children. Using data from the Canadian Health Measures Survey (Objective 6) I showed that the higher health care use is paralleled by a more frequent use of prescription medications in obese compared to normal weight children. An analysis of the medical reasons for this cost differential (Objective 7) found that obese children had higher health care utilization for internalizing disorders, asthma, other respiratory disorders, obesity, and chronic adenoid/tonsil disorder. I was further able to show, for the first time, that childhood obesity is strongly associated with otitis media (Objective 8), one of the most frequent childhood disorders. In my analysis of the diagnostic properties of an ICD code for obesity for the detection of measured obesity (Objective 9), the sensitivity was 10%. Children correctly identified as obese by an ICD code had a higher BMI and higher health care utilization.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
Kuhle S, Allen AC, Veugelers PJ. Perinatal and childhood determinants of overweight in Canadian Grade 5 students. Int J Pediatr Obes 2010; 5:88-96.Kuhle S, Allen AC, Veugelers PJ. Prevention potential of risk factors for childhood overweight. Can J Public Health 2010; 101:365-368.Kuhle S, Kirk S, Ohinmaa A, Yasui Y, Allen AC, Veugelers PJ. Use of health services among overweight and obese Canadian children. Int J Pediatr Obes 2010; 6: 142-148.Kirk SF, Kuhle S, Ohinmaa A, Colman I, Veugelers PJ. Health care utilization from prevalent medical conditions in normal weight, overweight and obese children. J Pediatr (forthcoming).

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