Health behaviours and health-care utilization in Canadian schoolchildren

Childhood obesity is a significant public health problem(1). Overweight and obese children are at increased risk of experiencing co-morbidities, such as CVD, type II diabetes and hypertension(2–4). Being overweight or obese in childhood consistently increases the risk of being overweight or obese in adolescence and adulthood(5–7), thereby leading to further co-morbidities(8) . A recent US study also suggested that, given the marked increase in the proportion of obese people, obesity has become an equal, if not greater, contributor to the burden of disease than smoking(9) . Poor nutritional habits and physical inactivity are two health behaviours that are believed to be linked with increasing rates of overweight and obesity in children, but these two behaviours are themselves manifestations of changing social and economic conditions(10). Environmental factors that contribute to obesity include communities designed to encourage driving rather than walking or cycling, unequal access to recreation facilities and green spaces, sedentary technologies that occupy our leisure time and ‘fast food’ restaurants that provide energy-dense, nutrient-poor food that is highly accessible, inexpensive and available in increasing portions(11–15). Together, these factors have created an ‘obesogenic environment’, described as ‘the sum of influences that the surroundings, opportunities, or conditions of life have on promoting obesity in individuals or populations’(16). As physical inactivity and poor nutrition are both determinants of obesity, health promotion initiatives aimed at modifying either or both of these health behaviours are increasingly being implemented, particularly those aimed at childhood obesity prevention(17). Further, evidence is accumulating for the importance of providing supportive environments for where children live, learn and play(17,18) . However, often such interventions are poorly implemented and evaluated(19) and lack an understanding of the health impact and costs associated with obesity prevention strategies. Public Health Nutrition *Corresponding author: Email r