Childhood obesity is a major public health concern for Americans. Many school-based health interventions and campaigns have been in place in the elementary school setting to help lower the rates of childhood obesity and to make students aware of their health. This study focuses on the implementation of the Healthy Monday campaign to fourth and fifth grade students in two Kentucky elementary schools. Particularly the focal points of the campaign consist of nutrition and physical activity. The campaign highlights two spin-off campaigns from the Healthy Monday campaign titled the Monday Mile and Meatless Monday. This study looks at the effectiveness of the overall health campaign to the fourth and fifth grade students, their parents, and teachers in the two schools. Pre and post surveys were developed in order to test four components of the health campaign: campaign awareness, attitudes, nutrition knowledge, and behavior change. This study shows that the health campaign increased student’s awareness, nutrition knowledge, and behavior change. Also the parent and teacher population showed significant increase in campaign awareness and behavior change. Overall, the health campaign created awareness among all three populations.

With the passage of the Child Nutrition and WIC Reauthorization Act of 2004, all schools that participate in the National School Lunch Program are required to establish local wellness policies to address childhood obesity. In the state of Kentucky, Senate Bill 172 requires all elementary schools to adopt a local wellness policy addressing competitive foods, healthy choices, and daily physical activity. This study measured federal and state compliance among schools that responded to the 2008 Kentucky School Nutrition Survey. This study analyzed differences in the school nutrition environment among policies based on data from the 2002 and 2008 Kentucky School Nutrition surveys. The majority of school wellness policies were compliant with both federal and state guidelines. Significant differences in the school environment include a reduction in the availability of vending machines, decreased percentage of teachers using food as a reward, and increased use by teachers of non food items as a reward. Significant differences were not found among foods offered in vending machines, snack bars, and classroom parties. In 2008, elementary schools provided an average of 174 minutes of physical activity weekly, which is above the recommended guideline of 150 minutes per week.

Recent research suggests that sedentary behaviours have detrimental effects on the health and well-being of children, including effects on obesity. Specifically, television viewing is consistently associated with childhood obesity. Two explanations have been proposed: 1) reduced energy expenditure, and 2) increased food intake. However, it has been suggested that the association between television viewing and childhood obesity may be better explained by an increase in energy intake than by a reduction in energy expenditure. To date, children of different weight status have not been compared in their dietary patterns in front of the television, and it is not known if total sedentary time is linked with food intake in children. The objectives of this thesis are: 1) to determine if obese children consume food more frequently while watching television than normal weight children, and 2) to examine which of television viewing or total sedentary time better predicts dietary patterns in children. Overall, our results re-affirm the notion that television viewing is associated with obesity, although physical activity plays a role in this association. Also, children who are obese consume fast food and fruits/vegetables more frequently during television watching than normal weight children. Furthermore, television viewing appears to be a better predictor of dietary patterns in children than overall sedentary time. Globally, these results provide evidence for the deleterious effects of television viewing on children’s dietary patterns and justification for future intervention studies designed to reduce television viewing in children with obesity.

Childhood obesity is a growing problem in the United States. Though a great body of research has focused on this area, little is still known about the factors that influence this phenomenon in rural settings. Sedentary behavior and parenting factors are just two factors that influence this trend toward obesity. However, even less is known about how the intersection of parenting influences affects child sedentary behaviors in rural communities. This study examines the relationship between parenting factors and child sedentary behaviors within the context of rurality. This study was completed in two parts. Part one consisted of a comprehensive review of the literature that provided background on the current practices and set the stage for the statistical analysis that followed. Part two included the statistical analysis, which focused on examining the relationships between parents’ TV and behavior rules, and child’s sedentary activity behaviors. Pearson correlation and Spearman’s rank were used to assess whether relationships existed between variables. Correlations between weekday and weekend activity and gender were not found to be significant. Also, relationships between rule enforcement and activity were not found to be significant. This study found a glaring gap in the literature that examines how parenting factors influence child sedentary behaviors in rural settings. Also, the statistical analysis revealed that parental rules have no associations with child sedentary activity, despite medium rates of enforcement.

Childhood obesity is a major public health issue. Canada has one of the highest childhood obesity rates in the world. Food advertising and marketing have contributed to the rapid rise in childhood obesity. High energy and low nutrient foods have been promoted directly to children through attractive imagery on packages, including the use of popular cartoon characters. Children’s food packaging also features a range of nutrition information targeted at parents, including nutrition claims; however, there is relatively little research on the impact of these nutrition claims and the extent to which they may interact with child-friendly imagery to influence parents’ perception of food quality. The current study used a 2 x 2 experimental design to examine the effect of four front-of-package (FOP) nutrition information and four cartoon characters on parental perceptions of children’s food products. Participants consisted of 897 parents recruited across Canada through GMI, a market research company. Participants were over 18, had at least one child between ages 4-10 and the primary shopper of their household. Participants completed an online survey in July 2011. Participants were shown images of food products with or without cartoon characters and with or without FOP nutrition information and were asked to rate the food product on appeal, nutritional quality, intention to buy and willingness to pay. Participants were also asked to rate the FOP nutrition information on believability, ease of understanding and perceived effectiveness. Linear mixed modelling examined the influence of cartoon characters, FOP nutrition information and socio-demographic factors on these outcomes. Results indicated that cartoon characters increased product appeal and FOP nutrition information increased the perceived nutritional quality of food products with low nutritional value. No significant differences were observed for intention to buy or willingness to pay. There was no consistent pattern between socio-demographic factors and product rating outcomes. For FOP nutrition information ratings, Health Check and Source of Fibre were rated more believable, easier to understand and more effective overall than Sensible Solution and Given the Thumbs Up by Kids. Overall, the findings indicate that cartoon characters can increase the perceived appeal and FOP nutrition information can increase the perceived nutritional quality of food products with low nutritional value.

Εισαγωγή: Η παιδική παχυσαρκία αποτελεί μία επιδημία του σύγχρονου δυτικού κόσμου και ορίζεται λειτουργικά ως η υπέρμετρη αύξηση του λιπώδους ιστού. Η παχυσαρκία αποτελεί ανεξάρτητο παράγοντα κινδύνου για την ανάπτυξη μίας πληθώρας συνοσηροτήτων όπως την αντίσταση στην ινσουλίνη, το σακχαρώδη διαβήτη τύπου 2, καρδιοαγγειακά νοσήματα και μεταβολικό σύνδρομο. Ο λιπώδης ιστός είναι ένα παρακρινές και ενδοκρινές όργανο, το οποίο μέσω της έκκρισης κυτταροκινών και φλεγμονογόνων παραγόντων έχει την ικανότητα να ρυθμίσει το ενεργειακό ισοζύγιο του οργανισμού. Η αντιπονεκτίνη μία από τις πιο σημαντικές κυτταροκίνες του λιπώδους ιστού, μέσω των υποδοχέων της AdipoR1 και AdipoR2, ενεργοποιεί την ινσουλινοεπαγώμενη πρόσληψη της γλυκόζης από το λιποκύτταρο, ενώ έχει αντι-φλεγμονώδης και αντι-αθηρωματική δράση σε άλλους ιστούς του οργανισμού. Ο PPAR-γ, ανήκει στην υπερ-οικογένεια των πυρηνικών υποδοχέων PPARs (peroxisome proliferative-activated receptors) και είναι ένας μεταγραφικός παράγοντας, ο οποίος σε ανταπόκριση στα κυκλοφορούντα ελεύθερα λιπαρά οξέα, ενεργοποιεί τη διαφοροποίηση των προλιποκυττάρων σε ώριμα λιποκύτταρα μικρού μεγέθους με πολλά λιποσταγονίδια. Το PPAR-γ μέσω της ενεργοποίησης του από τους ενδογενείς υποκαταστάτες του, τις θειαζολιδινεδιόνες, επάγει την ινσουλινοευαισθησία και αυξάνει την έκφραση της αντιπονεκτίνης. Τα ενδοκανναβινοειδή, μέσω των υποδοχέων τους CB1 και CB2, ρυθμίζουν την όρεξη στο κεντρικό νευρικό σύστημα, ενώ μπορούν να ενεργοποιήσουν περιφερικά τη λιπογένεση και να μειώσουν τη γονιδιακή έκφραση της αντιπονεκτίνης. Τα ενδοκανναβινοειδή βρίσκονται υπερενεργοποιημένα σε ενήλικες παχύσαρκους, ενώ τα επίπεδα της αντιπονεκτίνης μειώνονται σημαντικά. Σκοπός: Να μελετηθούν τα επίπεδα έκφρασης του AdipoR1, του PPAR-γ, του CB1 και των ενζύμων των ενδοκανναβινοειδών FAAH και DAGL-α, σε λεπτόσωμα και παχύσαρκα προεφηβικά παιδιά και να συσχετιστούν με τα κυκλοφορούντα επίπεδα της αντιπονεκτίνης και της ινσουλίνης. Μεθοδολογία: Για το σκοπό αυτό αναπτύχθηκαν πρωτογενείς καλλιέργειες προλιποκυττάρων και ώριμων λιποκυττάρων από βιοψίες κοιλιακού υποδόριου λιπώδους ιστού 17 παχύσαρκων (BMI>95%) και 36 λεπτόσωμων (BMI<85%) προεφηβικών παιδιών. Τα παιδιά χωρίστηκαν σε δύο ηλικιακές ομάδες, ομάδα Α: 2μηνών-7 ετών και ομάδα Β: 9-12 ετών. Η γονιδιακή και πρωτεϊνική έκφραση του AdipoR1, PPAR-γ και CB1 μελετήθηκαν με τη μέθοδο RT-PCR και Western Immunoblotting. Επίσης, η γονιδιακή έκφραση των ενζύμων των ενδοκανναβινοειδών FAAH και DAGL-α, μελετήθηκαν με Real-Time PCR. Τα κυκλοφορούντα επίπεδα της ολικής και HMW αντιπονεκτίνης όπως και της ινσουλίνης μετρήθηκαν με ELISA, ενώ υπολογίστηκε ο δείκτης ινσουλινοαντίστασης HOMA-IR και μετρήθηκε η περίμετρος κοιλίας σε κάθε παιδί. Αποτελέσματα: Η πρωτεϊνική έκφραση του AdipoR1 βρέθηκε μειωμένη στα προλιποκύτταρα και ώριμα λιποκύτταρα των μικρότερων παχύσαρκων παιδιών της ομάδας Α, σε σύγκριση με τα αντίστοιχα λεπτόσωμά τους. To PPAR-γ βρέθηκε αυξημένο στα ώριμα λιποκύτταρα των λεπτόσωμων και παχύσαρκων παιδιών, σε σύγκριση με τα προλιποκύτταρά τους, ενώ ήταν και σημαντικά αυξημένο στα ώριμα λιποκύτταρα των μικρότερων παχύσαρκων παιδιών, σε σύγκριση με τα αντίστοιχα λεπτόσωμά τους. Ο υποδοχέας των ενδοκανναβινοειδών, CB1, ήταν σημαντικά μειωμένος στα ώριμα λιποκύτταρα των παχύσαρκων παιδιών και των δύο ηλικιακών ομάδων, σε σύγκριση με τα αντίστοιχα λεπτόσωμά τους, ενώ παρουσίασε μία σημαντική αύξηση με την ηλικία. Επιπρόσθετα, το ένζυμο αποδόμησης FAAH (για την ανανδαμίδη) μειώθηκε με την ηλικία στα μεγαλύτερα λεπτόσωμα παιδιά της ομάδας Β, ενώ στα μεγαλύτερα παχύσαρκα παιδιά ήταν αυξημένο σε σύγκριση με τα αντίστοιχα λεπτόσωμά τους. Το ένζυμο βιοσύνθεσης DAGL-α (για το 2-AG) βρέθηκε αυξημένο στα μεγαλύτερα λεπτόσωμα και παχύσαρκα παιδιά της ομάδας Β σε σύγκριση με τα λεπτόσωμα και παχύσαρκα παιδιά της ομάδας Α. Η ινσουλίνη και το HOMA-IR ήταν σημαντικά αυξημένα στα μεγαλύτερα παιδιά, λεπτόσωμα και παχύσαρκα, σε σύγκριση με τα μικρότερα παιδιά. Η HMW αντιπονεκτίνη βρέθηκε μειωμένη στα λεπτόσωμα και παχύσαρκα παιδιά της ομάδας Β σε σύγκριση με τα αντίστοιχα παιδιά της ομάδας Α, ενώ ήταν σημαντικά αυξημένη στα μικρότερα παχύσαρκα παιδιά σε σύγκριση με τα αντίστοιχα λεπτόσωμά τους. Η περίμετρος κοιλίας ήταν σημαντικά αυξημένη στα μεγαλύτερα παχύσαρκα αγόρια σε σύγκριση με τα αντίστοιχα λεπτόσωμά τους. Συμπεράσματα: Η μειωμένη έκφραση του CB1 και η αυξημένη έκφραση του PPAR-γ στα μικρότερα παχύσαρκα προεφηβικά παιδιά της ομάδας Α, σε συνάφεια με τα αυξημένα επίπεδα της HMW αντιπονεκτίνης, πιθανόν να αντικατοπτρίζουν έναν προστατευτικό μηχανισμό ελεγχόμενης λιπογένεσης και διατήρησης της ινσουλινοευαισθησίας στα παιδιά αυτά που ήδη παρουσιάζουν μειωμένα επίπεδα έκφρασης του υποδοχέα της αντιπονεκτίνης, AdipoR1. Επιπλέον, τα μειωμένα επίπεδα της HMW αντιπονεκτίνης και τα αυξημένα επίπεδα της ινσουλίνης στα μεγαλύτερα παιδιά πιθανόν απεικονίζει την προετοιμασία των παιδιών αυτών για την «φυσιολογική» ινσουλινοαντίσταση της εφηβείας. Η αύξηση των ενζύμων FAAH και DAGL-α στα μεγαλύτερα παχύσαρκα παιδιά της ομάδας Β, μπορεί έμμεσα να μας δείχνει ότι τα επίπεδα της ανανδαμίδης στα παιδιά αυτά είναι μειωμένα, ενώ τα επίπεδα του ενδοκανναβινοειδούς 2-AG αυξάνονται, θέτοντας πιθανόν τα παχύσαρκα παιδιά σε μεγαλύτερο κίνδυνο για λιπογένεση. Η μειωμένη έκφραση του CB1 στα μεγαλύτερα παχύσαρκα παιδιά όμως, μπορεί να απεικονίζει είτε την προσπάθεια του οργανισμού να περιορίσει την λιπογένεση στα παιδιά αυτά, που ήδη βρίσκονται σε κίνδυνο λόγω της παχυσαρκίας τους, είτε αντικατοπτρίζει τη μειωμένη ικανότητα του υποδόριου λιπώδους ιστού να αποθηκεύσει λίπος αυξάνοντας τον κίνδυνο εναπόθεσης λίπους ενδοκοιλιακά, το οποίο μπορεί να διαταράξει την ενεργειακή ισορροπία του οργανισμού τους προκαλώντας διαταραγμένη ανοχή στη γλυκόζη. / Introduction: Childhood obesity is the new epidemic of the western world and reflects the excessive storage of body fat. Obesity is a risk factor for the development of metabolic comordities like insulin resistance, diabetes mellitus type 2, cardiovascular diseases and metabolic syndrome. Adipose tissue is an endocrine and paracrine organ, which through the secretion of adipokines and pro-inflammatory molecules it can regulate the body’s energy homeostasis. Adiponectin is one of the most important secreted adipokines of adipose tissue and through its AdipoR1 and AdipoR2 it can activate the insulin-dependent glucose uptake of adipocytes. In addition, adiponectin has anti-inflammatory and anti-atherogenic action in other peripheral tissues of the body. PPAR-γ belongs to the family of nuclear receptors PPARs (peroxisome proliferative-activated receptors) and it is a transcription factor, which responds to circulating Free Fatty Acids activating the preadipocyte differentiation into small multilocular mature adipocytes. PPAR-γ through its activation from its endogenous ligands, the thiazolidenidions, can regulate the body’s insulin sensitivity and can increase the transcription of adiponectin. The endocannabinoids, through their receptors CB1 and CB2, can regulate food intake via their central nervous system action, they activate lipogenesis in the periphery and reduce the gene expression of adiponectin. The endocannabinoids are found to be upregulated in adult obesity, whereas adiponectin levels are decreased. Aim: To study the expression of AdipoR1, PPAR-γ, CB1 and the endocannabinoid enzymes FAAH and DAGL-α, in prepubertal lean and obese children in relation to their adiponectin and insulin levels in their blood serum. Materials & Methods: Primary cultures of preadipocytes and mature adipocytes were developed from surgical biopsies of abdominal subcutaneous adipose tissue of 17 obese (BMI>95%) and 36 lean (BMI<85%) prepubertal children. The gene and protein expression of AdipoR1, PPAR-γ and CB1 were investigated by RT-PCR and western immunoblotting. The gene expression of the endocannabinoid enzymes FAAH and DAGL-α were studied by Real-Time PCR. Total and HMW adiponectin together with insulin were measured in blood serum by ELISA, whereas the insulin resistance index HOMA-IR was estimated and waist circumference was measured in every child. Results: The protein expression of AdipoR1 was significantly decreased in the preadipocytes and the mature adipocytes of the younger obese prepubertal children of group A when compared to their respective lean. PPAR-γ was increased in the mature adipocytes of all the children in comparison to their respective preadipocytes, whereas it was significantly increased in the mature adipocytes of the younger obese children compared to their respective lean. The endocannabinoid receptor, CB1, was significantly decreased in the mature adipocytes of the obese children in both age groups, when compared to their respective lean, whereas it increased with age in the older lean children. Furthermore, the degradation enzyme FAAH (for anandamide) decreased significantly with age in the older lean prepubertal children of group B, in comparison to the younger lean and it was significantly increased in the older obese children in comparison to their respective lean. The biosynthetic enzyme DAGL-α (for 2-AG) was found significantly increased in the older lean and obese prepubertal children of group B when compared to the younger children of group A. Insulin and the HOMA-IR were significantly increased in the older children, both lean and obese in comparison to their respective younger children. HMW adiponectin was decreased in the older prepubertal children of group B in comparison to group A, whereas it was significantly increased in the younger obese children of group A when compared to their respective lea. Waist circumference was significantly increased in the older obese boys when compared with their respective lean. Conclusions: The decreased expression of CB1 together with the increased expression of PPAR-γ and the increased levels of HMW adiponectin in the younger obese prepubertal children of group A, possibly reflects their body’s attempt to further limit their pathologic lipogenesis and to maintain normal insulin sensitivity in these obese children, who already have decreased AdipoR1 expression. In addition, the decreased HMW adiponectin levels and the increased insulin in the older children could be indicative of their “physiological” insulin resistance during puberty. The increased expression of the enzymes FAAH and DAGL-α in the older obese prepubertal children of group B, may indirectly demonstrate that anandamide is decreased and 2-AG is increased in these children, possibly pre-empting them for increased lipogenesis. The decreased expression of CB1 in the older obese children may also indicate either the body’s attempt to further limit lipogenesis since they are already at risk due to their obesity or it reflects their decreased ability of storing fat in their subcutaneous adipose tissue, increasing the risk of visceral fat disposition that can disrupt their energy homeostasis and could possibly lead to the development of glucose intolerance.

Eating behaviors, notably eating behaviors conceptualized as appetitive traits, have been suggested as important determinants of individual differences in body weight and thus overweight and obesity. Such appetitive traits include emotional overeating, food responsiveness, enjoyment of food, satiety responsiveness and slowness in eating. Yet little is known about the factors that influence the development of these appetitive traits. Therefore, the current study prospectively investigated a range of predictors of appetitive traits related to both individual child characteristics and parent factors in a large population-based sample of children followed from age 6 to 8 years (N = 689). When adjusting for the initial levels of the specific appetitive trait in question at age 6 and the other predictors, the results showed that instrumental feeding and low levels of effortful control predicted emotional overeating at age 8, whereas instrumental feeding and parental restrained eating predicted food responsiveness at age 8. Enjoyment of food, satiety responsiveness and slowness in eating were not affected by any of the predictors investigated in this study. In conclusion, these findings support low effortful control and instrumental feeding as predictors of emotional overeating, and instrumental feeding and parental restrained eating as predictors of food responsiveness. These findings are relevant in providing a better understanding of the development of children’s eating behaviors, in addition to informing prevention and treatment strategies for childhood obesity.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-01-11T18:05:36Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) lazaro_lopes_moreira.pdf: 478779 bytes, checksum: cb3b83c748ea630e568731db3461c587 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-01-16T17:53:02Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) lazaro_lopes_moreira.pdf: 478779 bytes, checksum: cb3b83c748ea630e568731db3461c587 (MD5) / Made available in DSpace on 2018-01-16T17:53:02Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) lazaro_lopes_moreira.pdf: 478779 bytes, checksum: cb3b83c748ea630e568731db3461c587 (MD5) Previous issue date: 2017 / Atualmente a obesidade infantil tem se apresentado como um desafio em v?rios pa?ses do mundo, inclusive nos pa?ses latino-americanos como o Brasil. A proposi??o de iniciativas de interven??o no problema s?o urgentes e necess?rias. Neste sentido, o objetivo deste estudo foi verificar os efeitos de um programa de interven??o com exerc?cios f?sicos (acumulado e cont?nuo) em escolares do ensino fundamental no excesso de peso do grupo. Para tal, foram selecionados 40 escolares de ambos os sexos que apresentaram valores de IMC para idade ? percentil 85. Trata-se de um ensaio cl?nico controlado com crian?as de 6 a 11 anos de idade divididas em tr?s grupos: 1) Controle (n=12), 2) treinamento aer?bico acumulado (N=14) e 3) treinamento aer?bico cont?nuo (N=14), em um per?odo de 10 semanas. O grupo controle n?o participou do programa e manteve suas atividades cotidianas. Foram realizadas avalia??es antropom?tricas e bioqu?mica antes e ap?s as 10 semanas. As an?lises estat?sticas foram realizadas usando o programa livre R vers?o 3.3.2, sendo utilizado teste de Anova para avaliar diferen?as entre valor m?dio de cada vari?vel Pr? e P?s interven??o, caso identificada essa diferen?a utilizou o Teste Tukey para identificar quais essas diferen?as sendo adotado o n?vel de signific?ncia (p<0,05). Os resultados revelaram que no grupo de atividade f?sica acumulada houve diminui??o da m?dia e do desvio padr?o nos valores do IMC P?s do Grupo acumulado (20,6 ? 2,85) em rela??o ao IMC P?s do Grupo controle (21,4 ? 2,22) com o valor de p= 0,039. Dessa forma, conclui-se que o programa de atividade f?sica de forma acumulada por um per?odo de 10 semanas foi efetivo na redu??o do IMC em escolares e, consequentemente na redu??o de crian?as com sobrepeso e obesidade. Tais resultados evidenciam que as interven??es no espa?o escolar se apresentam como estrat?gias fact?veis de interven??o ao excesso de peso em crian?as. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017. / Objective: To verify the effects of intervention programs with physical exercise in an accumulated and continuous way in a playful way in elementary school students in the Body Mass Index (BMI), parameter Biochemical and weight. METHODS: We selected 40 schoolchildren of both sexes who were enrolled and frequent, presenting BMI values for age ?85th percentile. This was a controlled clinical trial with children aged 6 to 11 years divided into three groups: 1) Control (N = 12), 2) aerobic training accumulated (N = 14) and 3) continuous aerobic training (N = 14) over a period of 10 weeks. The control group did not participate in the program and maintained their daily activities. BMI and Biochemical parameters and weight were measured before and after 10 weeks. The statistical analyzes were performed using the free program R version 3.3.2, using Anova test to examine the differences between the mean value of each variable Pre and Post intervention, if identified the most recent difference Tukey test to identify which are these The level of significance (p <0.05) was used. Results: The accumulated physical activity group presented significant results in the decrease of mean and standard deviation of our BMI values. Post-accumulated group (20.6 ? 2.85) in relation to BMI Post Control group (21.4 ? 2.22) With the value of P = 0.039. Conclusion: It is concluded that the program of physical activity accumulated over a period of 10 weeks, is effective in reducing BMI in schoolchildren and consequently in the reduction of children with overweight and obesity.

The aim of the study was to estimate the association between maternal perception of their child’s health status and (mis)classification of their child’s actual weight with future weight change. We present cross-sectional and longitudinal analyses from the Peruvian younger cohort of the Young Lives Study. For cross-sectional analysis, the exposure was maternal perception of child health status (better, same or worse); the outcome was underestimation or overestimation of the child’s actual weight. Mothers were asked about their perception of their child’s weight (same, lighter or heavier than other children). Actual weight status was defined with IOTF BMI cut-off points. For longitudinal analysis, the exposure was (mis)classification of the child’s actual weight; the outcome was the standardized mean difference between follow-up and baseline BMI. A Generalized Linear Model with Poisson family and log-link was used to report the prevalence ratio (PR) and 95% confidence intervals (95% CI) for cross-sectional analyses. A Linear Regression Model was used to report the longitudinal analysis as coefficient estimates (β) and 95% CI. Normal weight children who were perceived as more healthy than other children were more likely to have their weight overestimated (PR = 2.06); conversely, those who were perceived as less healthy than other children were more likely to have their weight underestimated (PR = 2.17). Mean follow-up time was 2.6 (SD: 0.3) years. Overall, underweight children whose weight was overestimated were more likely to gain BMI (β = 0.44); whilst overweight children whose weight was considered to be the same of their peers (β = -0.55), and those considered to be lighter than other children (β = -0.87), lost BMI. Maternal perception of the child’s health status seems to influence both overestimation and underestimation of the child’s actual weight status. Such weight (mis)perception may influence future BMI. / RMC-L, JJM, AB-O, and the CRONICAS Center of Excellence in Chronic Diseases were supported by the National Heart, Lung, and Blood Institute Global Health Initiative under the contract Global Health Activities in Developing Countries to Combat Non-Communicable Chronic Diseases (Project Number 268200900033C-1-0-1). AB-O is currently supported by a Wellcome Trust Research Training Fellowship in Public Health and Tropical Medicine (Grant 103994/Z/14/Z). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. / Revisión por pares

Este trabalho propõe pensar a obesidade infantil à luz do diálogo entre psicanálise e cultura. Isso se reflete em toda a trama de probabilidades de se operar com e em torno da palavra, ou seja, como campo do discurso e da psicanálise. O itinerário que iremos traçar se constituirá de linhas que levarão o leitor a percorrer um caminho atravessado pelas composições do pesquisar as quais foram sendo construídas com base em uma experiência clínica com três duplas mãe-filho, realizada no ambulatório de um hospital de Porto Alegre. A escolha pelo tema da dissertação alicerçou-se em um percurso genuíno de abertura a uma escuta que chamaremos, aqui, de inventiva e que traz no seu cerne o método de pesquisa em psicanálise. Nossa proposta de deslindar a obesidade na infância caracteriza-se por desejarmos problematizá-la em sua articulação com linhas de força que constituem o sujeito que padece. Entre construções e sintomas, entre empobrecimento da experiência, escassez do brincar e crítica cultural, entre inibição e angústia, entre angústia e desamparo, entre a constituição do sujeito e da palavra, entre compulsão e repetição, entendemos que a tessitura de conceitos tão fundamentais à psicanálise pode se apresentar por uma via de criatividade para se ter uma leitura arejada, dinâmica e fluida. / This research work intends to think about childhood obesity in the light of the dialogue between psychoanalysis and culture. Such a dialogue is reflected throughout the web of probabilities woven with and around the word, that is, in the field of the discourse and psychoanalysis. The itinerary to be traced will be constituted of lines that will take the reader to travel a way trespassed by the compositions of research, which have been built based on a clinical experience with three mother-child pairs, accomplished in the outpatient clinic of a hospital in Porto Alegre. The choice for the theme of this thesis was based on a genuine drive towards openness to listening, that will be, for the purposes of this research, called inventive. The inventive listening, as we call it, brings in its core idea the research method in psychoanalysis. Our proposal to unwind obesity in childhood is characterized by the desire to problematize its articulation with lines of force that constitute the subject that suffers. Among constructions and symptoms, impoverishment of experience, lack of playing and culture criticism, between inhibition and anguish, between anguish and abandonment, between the constitution of the subject and of the word, between compulsion and repetition, we understand that the structuring of such fundamental concepts to psychoanalysis can present itself by means of creativity to allow fluid, dynamic and ventilated reading.