Childhood obesity is a major national and worldwide public health crisis. The occurrence of childhood obesity, caused to large extent by an imbalance between caloric intake and caloric expenditure, has increased in the last 30 years. Although the prevalence of obesity has stabilized in recent years, it remains a top public health concern in the United States, especially in urban centers. The purpose of this study was to examine the associations between diet, physical activity, and the built environment in relation to the mean body mass index (BMI) of adolescents aged 12 to 17 years living in South Los Angeles, California. The research design, methods, and data analysis were based on the California Health Interview Survey 2007-2013 dataset. This database was mined for the independent variables: physical security, food insecurity, parental education and income, and availability of recreational facilities necessary for a healthy lifestyle; the dependent variable was BMI. Descriptive statistics and multiple regression analysis were used in analyzing for the association between the dependent variable and the independent variables. The outcomes of this study showed no associations between neighborhood physical security, recreational facilities, adolescent's physical activity, parents' education level, parents' income level, and BMI. However, the results did show a significant correlation between adolescent's dietary intake, food security, and BMI. This study will contribute to positive social change by informing public health officials and policy makers of the benefits of food security to healthier eating habits and BMI among the adolescents studied. Resulting actions could result in collaborative efforts toward reduction and prevention of childhood obesity.

Background: Childhood excess weight and family food insecurity are food-system related public health problems that exist in Canada. Since both relate to issues of food accessibility and availability, which have elements of “place”, they may share common risk factors in the local environment that are amenable to intervention. In this area of research, the literature derives mostly from a US context, and there is a dearth of high quality evidence, specifically from longitudinal studies. Objectives: The main objectives of this thesis were to examine the adjusted associations between the place factors: material deprivation, social deprivation, social cohesion, disorder, and living location, with change in child BMI Z-score and with change in family food insecurity status in a Canadian cohort of children. Methods: The Québec Longitudinal Study of Child Development was used to meet the main objectives of this thesis. Response data from six collection cycles (4 – 10 years of age) were used in three main analyses. The first analysis examined change in child BMI Z-score as a function of the place factors using mixed models regression. The second analysis examined change in child BMI Z-score as a function of place factors using group-based trajectory modeling. The third and final analysis examined change in family food insecurity status as a function of the place factors using generalized estimating equations. Results: Social deprivation, social cohesion and disorder were strongly and positively associated with family food insecurity, increasing the odds by 45-76%. These place factors, on the other hand, were not consistently associated with child weight status. Material deprivation was not important for either outcome, except for a slight positive association in the mixed models analysis of child weight status. Living location was not important in explaining family food insecurity. On the other hand, it was associated with child weight status in both analyses, but the nature of the relationship is still unclear. Conclusions: Results do not suggest that addressing similar place factors may alleviate both child excess weight and family food insecurity. More high quality longitudinal and experimental studies are needed to clarify relationships between the local environment and child weight status and family food insecurity.

Abstract Background: The World Health Organization has expressed a great concern about the increasing prevalence of childhood obesity. Region Västra Götaland (VGR) has developed a web based program to support school nurses in their work to promote health among children with obesity. Previous research on childhood obesity emphasizes the importance of support from nurses and how their work is organized. Aim: The aim of the study is, firstly, to explore school nurses experiences with health promotion work among obese children. Secondly, to investigate whether school nurses use the salutogenic theory of health. Method: A qualitative study design was adopted. Data in form of semi structured interviews was collected from seven school nurses in the VGR. A directed content analysis was used for the analysis of the data. Results: The results are presented in three categories from the Tannahill health promotion model; health education, prevention and health protection. A new category emerged from the interviews and to be significant for the nurses´ work; organization. The last category was the salutogenic theory. The possibility to work in a health promotion manner became hard because of inadequate resources. However, we found that health education, prevention and health protection were areas of daily attention. The school nurses´ work was based on the salutogenic theory. Conclusion: School nurses were aware of the importance of health promotion. Overall, there was a feeling of diffuse guidelines for working in a health promotion manner (with childhood obesity), although a web-based tool was available. We recommend the use of a new model for daily practice capturing the key elements of health promotion.

Bakgrund: Barn har rätt till stöd som möjliggör en god hälsa och sjuksköterskor inom barnhälsovården (BVC-sjuksköterskor) ska arbeta hälsofrämjande genom ett stödjande och vägledande arbetssätt. En tidig identifiering av viktproblem är väsentlig eftersom åtgärder bör implementeras under tidig barndom. För att minska utveckling av till exempel hjärt- och kärlsjukdomar samt diabetes är det viktigt att BVC-sjuksköterskor aktivt arbetar mot övervikt och fetma. Medvetandegörande om de faktorer som kan påverka BVC-sjuksköterskor i det hälsofrämjande arbetet är viktigt för att kunna utveckla och förbättra arbetet. Syftet var att belysa vilka faktorer som kan påverka BVC-sjuksköterskans hälsofrämjande arbete mot övervikt och fetma. Metod: En integrativ litteraturöversikt genomfördes. Artikelsökning genomfördes i elva olika databaser. Sökningen genererade i 20 resultatartiklar som bearbetades systematiskt. Resultat: Resultatet presenteras utifrån analysens framkomna kategorier: BVC-sjuksköterskans stödjande faktorer, BVC-sjuksköterskans hindrande faktorer, Föräldrarnas påverkan och BVC-sjuksköterskans förhållningssätt. Resultatet diskuterades utifrån Nola J Penders omvårdnadsteori. Konklusion: BVC-sjuksköterskor påverkas av olika faktorer som har betydelse för det hälsofrämjande arbetet. För att uppnå framgång i det hälsofrämjande arbetet är det viktigt att föräldrar är involverade och har insikt i barnets rådande överviktsproblematik. BVC-sjuksköterskor efterfrågar mer utbildning i kommunikation samt mer kunskap om hur övervikt och fetma ska hanteras inom barnhälsovården. För att vidareutveckla BVC-sjuksköterskors hälsofrämjande arbete för överviktiga och feta barn krävs mer forskning inom området. / Background: Children are entitled to receive support that enables their good health. Support and guidance are fundamental aspects in the child health care. An early identification of weight problems is essential because the measures should be implemented in early childhood. To reduce the development of cardiac diseases and diabetes, it is important that the child health care nurse works actively against children with weight problems and obesity. Various factors can affect the child health care nurse in health promotion. Awareness concerning these factors are important in order to develop and improve health promotion. The aim was to illustrate the factors that may affect the child health care nurse´s health promotion for children with weight problems and obesity. Method: An integrative literature review was performed. Article search was conducted from eleven different databases. The search generated 20 articles that were processed systematically. Result: The results are presented on the basis of the analysis presented originated categories: child health care nurse supportive factors, child health care nurse impeding factors, the influence of parents and child health care nurse approach. The results were discussed according to nursing theorist Nola J. Pender´s theory. Conclusion: Child health care nurses affected by various factors that are important for health promotion. To achieve success in health promotion, it is important that parents are involved and have an insight into their child's current weight problems. Child health care nurses feel they need more training in communication and more knowledge about how weight problems and obesity should be handled within child health care. To help develop the child health care nurse health promotion for children with weight problems and obesity further research is required.

This paper explores public health campaigns as they relate to tweens and their use of technology. After considering how this demographic utilizes both traditional and new media, further examination was done on general health problems that affect this group. Three major health issues were then chosen for analysis. A relevant campaign for each issue was also evaluated, as were its overall marketing and communication efforts. The health problems and corresponding campaigns chosen include childhood obesity and the “Let’s Move” campaign, electronic aggression and the “Stop Bullying” campaign and youth suicide and the “WeCanHelpUs” campaign. From these analyses, recommendations for ways to improve each campaign were provided, as were general conclusions for reaching this demographic more efficiently and effectively. / text

Übergewicht und Bewegungsmangel bestimmen die Diskussion, wenn es um die Gesundheit der Kinder und Jugendlichen in Deutschland geht. Die Prävalenz von Adipositas ist seit 1980 gestiegen, körperliche Leistungsfähigkeit und Bewegungsumfang, vor allem im Bereich der Alltagsaktivität, haben abgenommen. Diese Tatsachen legen nahe, dass die Entwicklung von Präventions- und Therapieprogrammen, die Bewegung und körperliche Aktivität besonders im Alltag fördern, von höchster Wichtigkeit ist. Die vorliegende Studie beschäftigt sich mit der Effizienz von Bewegungsübungen im Unterricht. Die Schule stellt für Präventionsprogramme einen idealen Ort dar, weil Kinder und Jugendliche aller sozialen Schichten hier flächendeckend und frühzeitig erreicht werden können. Die Bewegungsübungen im Rahmen von kurzen Aktiv-Pausen während des Unterrichts zielen in erster Linie darauf ab, Kindern und Jugendlichen im Klassenverband Spaß und Freude an körperlicher Aktivität ohne Leistungsdruck zu vermitteln, um ihnen Bewegung wieder als attraktive Alternative zu Freizeitaktivitäten, die sitzend wahrgenommen werden, aufzuzeigen. Die Studie wurde mit 50 Schülerinnen und Schülern der Klassen fünf und sechs einer Hauptschule in Niedersachsen durchgeführt. Mithilfe von anthropometrischen Daten, v.a. BMI-Perzentilen und BMI-SDS-Werten, motorischen Tests, die die körperliche Leistungsfähigkeit abbilden sollten, und Fragebögen, die zur Darstellung des Bewegungsumfangs und der -intensität sowie der Einstellung der Studienteilnehmer und Studienteilehmerinnen zu Bewegung dienten, wurde die Effizienz des Präventionsprogramms über einen Zeitraum von 14 Wochen untersucht. Die Steigerung von Spaß und Freude an Bewegung ließ sich innerhalb der Studie zeigen, das Absinken von BMI-Perzentilen-Werten war tendenziell zu verzeichnen. Die Interventionsdauer und -intensität des Programms, die für diese Pilot-Studie verwendet wurden, reichten anscheinend nicht aus, um signifikante Veränderungen mittels der eingesetzten Methoden abzubilden. Insgesamt zeigte sich, dass die Schule sich als Setting für Programme zur Prävention von Lebensstil-assoziierten Erkrankungen wie Adipositas gut eignet, die Aktiv-Pausen gut in den Schulalltag zu integrieren sind und das Bewegungsprogramm sowohl von Schülerinnen und Schülern als auch von Lehrkräften sehr positiv bewertet wurde. Ein weiterer Einsatz der Bewegungsübungen zur Prävention von Adipositas ist in gesteigerter Intensität und Interventionsdauer und in Kombination mit einem Ernährungsprogramm gut vorstellbar. / / / / /

Objectifs : Analyser l’évolution de l’embonpoint chez les enfants québécois entre 4 et 8 ans et évaluer le rôle des différents facteurs de risque sur l’excès de poids persistant. Les données proviennent de l’étude longitudinale du développement des enfants du Québec (ÉLDEQ, 1998-2010). Cette enquête est réalisée par l’Institut de la statistique du Québec auprès d’une cohorte de 2120 nourrissons québécois nés en 1998, faisant l’objet d’un suivi annuel à partir de l’âge de 5 mois. Méthodes d’analyse : univariées, bivariées, modélisation semi-paramétrique, analyses de régressions logistique et log-linéaire (Poisson). Principaux résultats : i) L’excès de poids persistant chez les enfants âgés de 4 à 8 ans est un phénomène fluctuant, qui ne varie pas de façon significative selon le sexe ; ii) Le fait d’allaiter les enfants ne semble pas avoir un effet protecteur en ce qui concerne l’excès de poids ; iii) En ce qui concerne le poids à la naissance, les données dont on dispose ne nous permettent pas de tirer des conclusions ; iv) Le fait d’avoir une santé moins qu’excellente à la naissance semble augmenter le risque d’avoir un excès de poids persistant ; v)Ce qui influence surtout, c’est de toujours manger trop ou trop vite, ou le fait de vivre dans une famille avec un ou deux parents qui font de l’embonpoint ; vi) Les mères qui ont fume pendant leur grossesse présentent une probabilité plus élevée d’avoir des enfants avec un excès de poids persistant que celles qui n’ont pas fumé. / Objectives: Analysis of trends of overweight among children in Quebec between 4 and 8 years and evaluation of the role of various risk factors of persistent excess weight. Data: based on the Québec Longitudinal Study of Child Development (QLSCD 1998-2010). This survey is being conducted by the Institut de la statistique du Québec with a cohort of 2120 children born in Québec in 1998, being followed annually from the age of 5 months. Methods of analysis: univariate, bivariate, semi-parametric modeling, logistic and loglinear (Poisson) regression analysis. Main results: i) The persistent excess weight in children aged 4 to 8 years is a fluctuating phenomenon, which does not vary significantly by sex; ii) The act of breastfeeding children does not seem to have a protective effect with regard to children being overweight; iii) Regarding the birth weight, the available data do not allow us to draw any conclusion; iv) Having a less than excellent health at birth appears to increase the risk of persistently being overweight; v) Primary influences are always eating too much or too fast, or living in a family with one or two parents who are overweight; vi) Mothers who smoked during pregnancy are more likely to have children who are overweight than those who did not smoke.

Background: Childhood excess weight and family food insecurity are food-system related public health problems that exist in Canada. Since both relate to issues of food accessibility and availability, which have elements of “place”, they may share common risk factors in the local environment that are amenable to intervention. In this area of research, the literature derives mostly from a US context, and there is a dearth of high quality evidence, specifically from longitudinal studies. Objectives: The main objectives of this thesis were to examine the adjusted associations between the place factors: material deprivation, social deprivation, social cohesion, disorder, and living location, with change in child BMI Z-score and with change in family food insecurity status in a Canadian cohort of children. Methods: The Québec Longitudinal Study of Child Development was used to meet the main objectives of this thesis. Response data from six collection cycles (4 – 10 years of age) were used in three main analyses. The first analysis examined change in child BMI Z-score as a function of the place factors using mixed models regression. The second analysis examined change in child BMI Z-score as a function of place factors using group-based trajectory modeling. The third and final analysis examined change in family food insecurity status as a function of the place factors using generalized estimating equations. Results: Social deprivation, social cohesion and disorder were strongly and positively associated with family food insecurity, increasing the odds by 45-76%. These place factors, on the other hand, were not consistently associated with child weight status. Material deprivation was not important for either outcome, except for a slight positive association in the mixed models analysis of child weight status. Living location was not important in explaining family food insecurity. On the other hand, it was associated with child weight status in both analyses, but the nature of the relationship is still unclear. Conclusions: Results do not suggest that addressing similar place factors may alleviate both child excess weight and family food insecurity. More high quality longitudinal and experimental studies are needed to clarify relationships between the local environment and child weight status and family food insecurity.

Background: The incidence of childhood obesity and associated risk factors is increasing. Schools are an ideal vehicle for the delivery of obesity prevention programs for children and adolescents. Action Schools! BC - Healthy Eating is a school-based obesity prevention initiative that utilizes an innovative whole-school approach to target fruit and vegetable consumption. Objective: To assess the effectiveness of Action Schools! BC - Healthy Eating in affecting positive change in: 1) students' intake of fruit and vegetables, 2) students' knowledge, attitudes and perceptions regarding fruit and vegetables and 3) students' willingness to try new fruit and vegetables. Methods: Five schools that represented geographic, socioeconomic and size variation were recruited as Action Schools! BC - Healthy Eating intervention schools. A second set of five schools were selected as matched healthy eating usual practice schools. Student outcomes were measured at baseline and at 6-month follow-up using the following self report questionnaires: 1) 24-hour recall, 2) Food Frequency Questionnaire, 3) Knowledge, Attitudes and Perceptions Survey, and 4) Food Neophobia Scale for Children. Classroom logs and progress reports were used to assess implementation dose and fidelity. Intervention: Intervention schools established an Action Team and developed an individualized Action Plan addressing healthy eating goals across six Action Zones. Schools received the Action Schools! BC - Healthy Eating resources, a comprehensive training workshop, and ongoing facilitator support throughout the school year. Teachers were asked to implement school-wide activities and to deliver a minimum of 2 healthy eating activities and 1 tasting activity in the classroom per week. Results: Outcomes.- Usual practice schools had significantly higher servings of fruit (p=.0001), total servings of fruit and vegetables (p=.004), variety of fruit and vegetables eaten p = .020), and number of fruit and vegetables tried from a fixed list (p=.000I ) at baseline. There was also a significant difference in student ages between conditions at baseline (p=.0001). Significant differences between conditions over time while controlling for baseline levels were found for servings of fruit, total servings of fruit and vegetables, variety of fruit and vegetables eaten, and percent of fruit and vegetables tried from a fixed list. Number of total servings of fruit and vegetables increased (+.18) in Action Schools! BC - Healthy Eating schools while it decreased in the usual practice schools (-.79). Implementation Fidelity: Teachers implemented a mean of 64% of requested classroom dose, and school Action Teams implemented activities across 80% of the whole-school model. Conclusion: The Action Schools! BC model had a modest impact on fruit and vegetable intake, and appeared to be feasible. Due to a short intervention period, further implementation and evaluation are necessary to fully understand the effectiveness of this initiative.

L’obésité est un problème majeur de santé publique et sa fréquence en Guadeloupe, est supérieure à celle observée en France hexagonale. Les causes de l’obésité sont multifactorielles. Des formes d’obésité monogénique ont été décrites chez moins de 5 % des patients obèses d’origine européenne mais, les variations génétiques sous-jacentes à l’obésité ne sont pas totalement connues. L’obésité infantile est associée à des effets néfastes sur la santé, incluant des complications métaboliques avec l’implication de nombreuses hormones et cytokines qui jouent un rôle important dans le métabolisme glucidique et l’homéostasie énergétique.Les objectifs de ces travaux étaient les suivants.- Évaluer le profil métabolique, incluant l’étude des taux de ghréline, leptine, adiponectine et de 25-hydroxyvitamine D chez 120 enfants scolarisés répartis en trois groupes : normo-pondéraux (G1), en surpoids (G2) et obèses (G3).- Analyser, à un an, les variations des paramètres anthropométriques et métaboliques après une intervention multidisciplinaire sur le mode de vie.- Investiguer, chez 25 enfants obèses de l’étude, les mutations de gènes connus et impliqués dans les formes monogéniques de l’obésité en utilisant des techniques récentes de séquençage.- Investiguer dans une population d’adultes l’association de variants de trois gènes candidats FABP2, ADIPOQ et NPPA avec le syndrome métabolique (dont l’obésité abdominale est une des composantes) en utilisant un score de risque génétique.Les travaux réalisés dans le cadre de cette thèse apportent des données nouvelles sur le profil métabolique des enfants obèses en Guadeloupe. Ils démontrent qu’une intervention sur le mode de vie améliore ce profil et pourrait contribuer à la prévention des complications cardio-métaboliques dans cette population à haut risque d’obésité et de diabète de type 2. Les effets bénéfiques de l’accompagnement familial et de l’approche multidisciplinaire en milieu scolaire sont aussi mis en exergue. L’identification, chez ces enfants obèses, de variants, rares et peu décrits, de gènes impliqués dans les formes d’obésité monogénique plaide en faveur d’une implication de ces variants dans la survenue de l’obésité. Par ailleurs, chez l’adulte, l’existence d’un effet cumulatif des variants des gènes FABP2, ANP et ADIPOQ sur le syndrome métabolique est aussi suggérée. / Obesity is a major public health problem and its frequency in Guadeloupe is higher than that observed in mainland France. The causes of obesity are multifactorial. Monogenic forms of obesity have been described in less than 5% of obese patients of European origin, but the genetic variations underlying obesity are not fully known.Obesity in children is associated with adverse health effects, includingmetabolic complications with the involvement of many hormones and cytokines that play an important role in glucose metabolism and energy homeostasis.The objectives of this work were as follows. Evaluate the metabolic profile, including ghrelin, leptin, adiponectin and vitamin D levels in 120 schoolchildren divided into three groups: normal weight (G1), overweight (G2) and obese (G3). Analyze, at one year, variations of anthropometric and metabolic parameters after a multidisciplinary lifestyle intervention. Investigate, in 25 obese children, mutations of genes known and involved in monogenic forms of obesity using next-generation sequencing. Investigate in an adult population the association of variants of three candidate genes FABP2, ADIPOQ and NPPA with metabolic syndrome (of which abdominal obesity is one of the components) using a genetic risk score.The results in this thesis provide new data on obese children metabolic profile in Guadeloupe. They demonstrate that a lifestyle intervention improves this profile and could contribute to prevention of cardio metabolic complications in this population at high risk of obesity and type 2 diabetes. The beneficial effects of family support and the multidisciplinary approach in schools are also highlighted.The identification, in these obese children of rare and little described gene variants involved in monogenic form of obesity argues for their involvement in the occurrence of this pathology. Moreover, in adults, the existence of a cumulative effect of FABP2, ANP and ADIPOQ gene variants on metabolic syndrome is also suggested.