Vol.3, No.8, 487-489 (2011)
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Diets of obese and non-obese children
Atsuko Satoh1*, Seiko Fujita2, Kazuko Menzawa3, Sangun Lee4, Masao Miyamoto1, Hidatada Sasaki5
1Akita University of Nursing and Welfare, Odate, Japan; *Corresponding Author: a-satoh@well.ac.jp
2Hiroaki Kensei Hospital, Hirosaki, Japan;
3Faculty of Education, Hirosaki University, Hirosaki, Japan;
4Department of P hysical Therapy, Aomori University of Health and Welfare, Aomori, Japan;
5Sendai Tomisawa Hospital, Sendai , Ja pan.
Received 23 March 2011; revised 8 May 2011; accepted 20 July 2011.
Aim: To compare diets betw een obese and non-
obese in children. Methods: Thirty-four obese
and ten non-obese school children were re-
cruited and their habitual factors of obesity
were asked. Intakes of food in the obesity and
non-obesity groups were checked using a
model nutriti onal balance cha rt (M NBC). Resul ts:
Average intake ratio of food relative to ideal
food intake was significantly higher in the
non-obesity group than the obesity group. The
relationship between obesity and exercise was
significant but not significant for intake ratio of
food, times watching TV and playing games.
Conclusion: Food intake is not a primary factor
of obesity but exercise is a key factor for obe-
sity in school children. Since the effect of diet
intervention in obese children was slight, exer-
cise habit would be a more import ant strategy to
reduce obesity than diet in school children.
Keywords: Food Intake; Exercise; Sedentary
Times; Children; Obesity
In the last 20 years, the prevalence of obesity in-
creased two-fold (from 5% to 10%) in school children in
Japan [1]. Childhood obesity is an urgent issue to sub-
side increasing metabolic syndrome in adulthood be-
cause obesity in children tends to persist into adulthood.
Interventions to prevent childhood obesity resulted in
not consistent or limited effects of dietary habits and
physical activity [2]. Physical activity in children above
the government-recommended intensity was not associ-
ated with a change in obesity [3]. Cro ss-sectional studies
showed that children’s weights were associated with
food consumption [4] and sedentary activities [5]. How-
ever, it has not been reported which is the key factor to
contribute obesity. In the present report, we studied diets
between obese and non-obese children and compared
diets with physical activity, time watching TV and play-
ing games.
The subjects were recruited from primary school chil-
dren and a junior high school in Odate City, Akita pre-
fecture, Japan, where the authors had school health as-
signments as nurses. A child was considered to be obese
when the body weight exceeded 120% of the standard
body weight, which is defined as the mean body weight
corresponding to the he ight for that age and sex obtained
from national statistics for Japanese school children in
2009 [1]. The criteria for inclusion as non-obese children
are body weight less than 120% of the standard body
weight. The subjects of the present study had no endo-
crine, metabolic or kidney disease. Among 43 obese
children, 9 children refused to participate in the study,
leaving 34 children female/male, 20/14, average age
11.9 ± 1.5 years, and ranging from 8 - 14 years. Fifteen
children were randomly chosen for the non-obese group.
Five children in the non-obese group refused to partici-
pate in the study leaving 10 children (female/male, 5/5,
average 11.7 ± 2.3 years, ranging from 7 to 14 years) in
the non-obese group. Among the 10 non-obese children,
5 were in primary school and 5 were in junior high
school. It took one year of serial participation by the
subjects, from August 2003 to July 2004.
All the participants, including their parents, completed
a questionnaire about physical characteristics, health
assessment, life styles, such as exercise habits and time
watching television an d playing games, family composi-
tion, and eating habits. Exercise habits were defined as
participating in sporting clubs such as football, basket-
ball, baseball and so on associated with the school or
outside school and practiced exercise at least twice a
week. Food intakes were asked using the model nutri-
A. Satoh et al. / Health 3 (2011) 487-489
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
tional balance chart (MNBC) as described previously
and explained briefly here [6]. The MNBC was designed
to outline a 6697 kj intake according to the recommen-
dation by the Japan Obesity Society [7]. The MNBC
demonstrates the ideal dietary distribution of 11 catego-
ries of food: meat, fish, eggs, milk and dairy products
(hereinafter called milk), beans and bean products, such
as bean curd and miso soup (hereinafter called beans),
green and yellow vegetables, light-colored vegetables,
fruit, potatoes and grains (hereinafter called grains), oil,
and sugar. The number of times each food category was
consumed was marked with black dots; the foods eaten
were recorded by category, but not by amount. The child
(and/or mother) filled out a meal chart which consisted
of columns for breakfast, lunch, dinner, and snacks be-
tween meals. The meal chart was to be filled out for 3
days of the last week of one month; Friday, Saturday,
and Sunday. We calculated the nutritional balance, as
follows: (intake ratio of food = the actual food intake
[black dots] ÷ the ideal food intake following the MNBC
[black dots]). Thus the nutritional balance based on the
MNBC was ideally “1”. Ethical approval was obtained
from the Ethical Committee of the University. The
Mann-Whitney’s U test was used for the significance.
Multivariate logistic regression was used to determine
the variations. Values were presented as mean ± SD.
Statistical significance was considered for p < 0.05.
Percentage overweight values of obese children and
non-obese ch ildren were 50 ± 21% an d –3 ± 8%, respec-
tively. The numbers of children with exercise habits and
without exercise habits were 9 and 25 in the obesity
group and 8 and 2 in the non-obesity group, resp ectively.
Intake-ratio of food in the obesity group was signifi-
cantly lower than that of the non-o besity group (p < 0.01)
(Table 1). Exercise performance was significantly higher
in non-obese children than obese children (p < 0.01).
Children with exercise showed a significantly lower de-
gree of obesity than children withou t exercise (11 ± 20%
vs. 56 ± 23%) (p < 0.01). Time watching TV was sig-
nificantly lower in non-obese children (2.0 ± 0.9 h) than
obese children (3.0 ± 1.5 h) (p < 0.05). Time playing
games was significantly lower in non-obese children (0.1
± 0.3 h) than obese children (0.4 ± 0.8 h) (p < 0.05). The
children with exercise showed significantly shorter times
of summation of watching TV and playing games than
the children without exercise (2.7 ± 1.2 h vs. 3.2 ± 2.3 h)
(p < 0.01). The relative impact for obesity (where obese
and non-obese ch ildren corresponded to 0 and 1, respec-
tively) verses intake ratio of food, exercise, time watch-
ing TV and time playing games was assessed using mul-
tiple logistic regression wh ere intake ratio of food 1.1 or
more and less than 1.1 corresponded to 0 and 1, exercise
yes and no corresponded to 0 and 1, time watching TV
of 2.6 hours or more and less than 2.6 hours corre-
sponded to 0 and 1, time playing games of 0.3 hours
or more and less than 0.3 hours corresponded to 0 and
1, respectively. Multiple logistic regression of the rela-
tion- ship between obesity and exercise was significant
(odds ratio = 24.8, 95% confidence interval = 1.2
500.9, p < 0.05) and not significant for other factors.
It was an unexpected finding that the non-obesity
group showed a higher intake ratio of food than the obe-
sity group (Table 1). If food-intake is not a primary fac-
tor in determining obesity, there may be other factors.
We observed that exercise was the key factor to deter-
mine obesity. The non-obesity group took less time
watching TV and playing games than that of obesity
groups. The children with exercise show significantly
shorter times of watching TV and playing games. Taking
together these results, obesity might not be brought by
too much food, but might be brought by non-exercise
performance such as watching TV and playing games in
In obese children, the intervention of diet control was
effective using MNBC but limited as the percentage
overweight decreased only from 50% to 40% [6]. Since
the intervention of obesity was limited by the way of
food intake, habitual exercise would determine the obe-
sity. The present non-obese children were volunteer
school children and some selections might cause a dif-
ferent result. Surveillance of Japanese school children
shows approximately 85% of primary school children
performed exercise and 80% of junior high school chil-
dren performed exercise although the percentage of ex-
ercise decreased to 60% in high school students [8]. Of
the present non-obese children, 80% performed exercise
Table 1. Intake-ratio of food in obesity and non-obesity groups.
Meat Fish Egg Milk Beans
Green and yellow
vegetables Light-colored veget a b l e sFruitGrain Oil Sugar Mean ± SD
Obesity group 1.0 0.6 1.4 0.5 0.8 0.3 0.5 0.91.5 1.4 1.4 0.9 ± 0.4
Non-obesity group 1.3 1.1 1.1 1.5 1.1 0.5 0.7 1.11.5 1.8 2.5 1.3 ± 0.4
NS * NS *** NS * * NSNS ** ** **
*(p < 0.05), **(p < 0.01) and ***(p < 0.001) shows dignificances between the obesity group and non obesity group using the two-sided Mann-Whitney’s U test.
NS shows no significance. Values are mean ± SD.
A. Satoh et al. / Health 3 (2011) 487-489
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
which seems to be an average percentage for exercise.
The present study suggests that in school children, if
they exercised, obesity would not be a problem irrespec-
tive of the amount of food they took. The present MNBC
was proved to be useful for self-care dependent older
patients with diabetes mellitus [9]. The subjects were
responsible for reporting their own food intake by cate-
gory but not by the amount of food, which precludes any
quantitative estimate of their actual food intake [6]. In
adults and older patients with diabetes mellitus, since
exercise performance is limited due to social and physi-
cal reasons, diet control might be more important in re-
ducing obesity as well as for controlling diabetes melli-
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