The childhood obesity epidemic continues to escalate, disproportionately impacting Mexican American children. It is unclear how Mexican American mothers, who are at high-risk of rearing obese children, perceive childhood obesity, prevention or their role in prevention. Three studies - a systematic literature review, a qualitative study focusing on Mexican American mothers' perceptions of childhood obesity, and a qualitative study examining Mexican American mothers' perceptions regarding childhood obesity prevention and their role in prevention - were used to address this research question. The first study is a systematic review of the literature regarding Mexican American mothers' perceptions of childhood obesity and their role in prevention. Four databases were searched for relevant articles and 22 studies met inclusion criteria and were included in the review. Social Cognitive Theory was used to sort similar findings across studies and identify scarce areas researched. Major findings included: (a) mothers felt inadequate to be role models for their children's healthy behaviors, (b) mothers did not identify short-term consequences of childhood obesity, (c) only 23% of studies explicitly used a theoretical framework to guide their study, and (d) most studies used heterogeneous groups (including all caretakers, including all Hispanics/Latinos) to discuss perceptions. The second study used naturalistic inquiry to examine mothers' perceptions regarding childhood obesity, its causes and its consequences. Using a Social Ecological Model adapted to childhood obesity, the study examined causes of childhood obesity at different levels of influence - intrapersonal, interpersonal, and community. Obesity was identified as an adult issue by the mothers. Mothers were more aware of the health risks associated with having underweight children rather than overweight children. Lastly, mothers identified overweight children as those who are suffering from consequences. The third study used a narrative inquiry approach to qualitatively investigate mothers' perceptions. Mothers suggested several ways parents could prevent childhood obesity and overweight among their children. However, fathers, grandparents and schools could unintentionally counter mothers' efforts to encourage healthful behaviors. Mothers identified a lack of ability to speak English, feelings of guilt associated with limiting food intake, and a lack of knowledge and skills as impediments in carrying out obesity preventive behaviors within the home.

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BACKGROUND: The purpose of this study was to explore demographic associations and their predictive value of effective weight maintenance among participants in the Children's Healthcare of Atlanta [CHOA] Strong4Life program for children and youth ages 2 to 20. METHODS: Analyses are based on the Strong4Life clinic data collected by Strong4Life from 2010 through 2014. Participants of the program fell into the 85th percentile and above for Body Mass Index (BMI). Descriptive tests, comparison of means, and logistic regression analyses were run to determine if patterns in the data examining demographic characteristics of the sample and their relationship to successful weight management were statistically significant. RESULTS: Logistic regression findings indicate that ethnicity (OR=2.737, CI: 1.273-5.892) p =0.01 is a predictor of successful weight management (n=324). Stong4Life defined program success as a decrease in BMI z-score of 0.04. While gender, race, baseline weight, asthma and pre-diabetes status were examined; statistical tests did not detect significant variations among the participants. Overall, the Strong4Life program is successful as seen by the p value< 0.001. CONCLUSIONS: Findings from this study are important for childhood obesity programs because tailoring strategies that align with unique segments of the population maximize their potential reach. Obesity research is required to advance intervention development that is sensitive to patterns and distinctions that exist among subpopulations. These findings are important for prevention of childhood obesity efforts and promotion of multidisciplinary approaches to combat obesity world-wide.

In response to the rising prevalence of childhood overweight and obesity in Canada and around the world, the food environment has been recognized as one important determinant of health status. In order to fill some existing knowledge gaps in Canadian food environment research to better understand factors that may lead to health disparities, as well as to develop healthy public policies in response, this study characterized food environments in restaurants for children (10-13 years) living in Saskatoon, and examined their associations with neighbourhood socioeconomic characteristics. Specifically, using GIS-based techniques and a structured observation tool (NEMS-R), it examined community and consumer restaurant food environments by neighbourhoods categorized by distress level. The distribution of different restaurant types differs with respect to neighbourhood distress level. According to NEMS-R results, significant differences were found in the healthfulness of foods and beverages offered in restaurants by different categories. Restaurants within lower distress level neighbourhoods presented higher (more healthful) NEMS-R scores. However, the fast food environment for children was not significantly different according to their neighbourhood distress level.

In Canada, obesity and associated chronic diseases disproportionately affect First Nations children. The objectives of this research were to assess obesity, physical activity, and perceptions of lifestyle behaviors in Cree First Nations children (5-12 years) in one Alberta reserve community. Levels of obesity (20.0%), abdominal obesity (49.5%), and physical inactivity (64.0%) were high. Most overweight and obese children were also abdominally obese (88.0%). Focus groups interviews indicated that cultural/traditional knowledge was overarching and integral to childrens understandings of health, food, and activity. Discussions revealed that family members were childrens main source of health knowledge. Explanations of the meaning of health included healthy foods and activities, respectful relationships with nature, and the absence of chronic conditions. Children preferred foods and activities they considered to be healthy. Our findings indicate the need to develop local strategies that integrate cultural/traditional practices and ensure family participation to promote healthy weights in First Nations children. / Nutrition & Metabolism

Childhood obesity has been increased dramatically and become a public health concern in China. Parents have strong influence on children's eating and weight status. However, there is a lack of data about the influence of Chinese parents' child-feeding practices on children's weight status. This study aimed to assess parents' child-feeding practices and examine their relationships to young Chinese adolescents' weight status. A self-administrated survey was conducted among parents of young Chinese adolescents in Beijing urban areas. The survey included 29 items from Birch's Child-feeding Questionnaire (CFQ) and 15 items developed by the researcher to assess parents' attitudes, behaviors and family food environment regarding child feeding. Parents were recruited through students in public middle schools in two Beijing urban areas. Children's annual check-up data (weight and height) was obtained from schools. 598 parents of students in 7th and 8th grades were surveyed and 548 of them responded to the survey. By excluding those who were not primarily responsible for preparing family meals and those whose children's check-up data was missing, final data analysis included 355 records. The prevalence of overweight and obesity among children were 19.4% and 9.0%, respectively, using International Obesity Task Force recommendations. Boys had significant higher prevalence of obesity than girls. Results show that parents of young Chinese adolescents used controlling feeding practices to regulate the child's eating, including restriction of certain food, pressure to eat and monitoring of the child's eating. Parents indicated that they had some concerns about their child's being overweight. The family food environment was generally positive in these families with some unhealthy elements in sizeable proportion of families. After adjusting for socioeconomic factors and parents' BMI, multiple regression analysis showed there were positive associations of restriction and family eating patterns, and an inverse association of pressure to eat to children's BMI z-scores. Parents' child-feeding practices may have significant influence on children's weight status. Family-based intervention is needed to help establish or maintain a healthy eating environment at home in order to combat the rising obesity prevalence in Chinese youths. Further studies also are needed to gain better understanding of parental influence on children's weight status.

Childhood obesity is a prevalent subject of research currently, and many researchers have studied the effectiveness of school programs in battling obesity among students. This case study, utilizing ethnographic tools of observation, interviews, and investigation of artifacts, examines educators' perceptions of the role of the school in the prevention of this epidemic, how perceptions affect practices, and the barriers to prevention efforts. The lens of caring theory, social justice, and critical theory frame the analysis of how educators in a medium-sized elementary school contend with the problem of childhood obesity. Educators in this setting perceived their role in the prevention of childhood obesity as limited and tended to blame parents for the condition of obese students. Because of this perception, attempts at prevention were somewhat sporadic and individualistic in nature. Barriers included a lack of training in critical reflection and the stresses of mandated testing and budget cuts. Teachers and staff members cared for their obese students' well-being, but generally lacked the resources to help them. They were often uncomfortable discussing obesity with parents and tended to avoid the subject, and unfortunately, this conversation needs to occur in order to find help for their obese students.

Introduction: Childhood obesity is associated with increased physical and psychosocial co-morbidities, and with lower cognitive function and educational attainment. Clinical guidelines recommend lifestyle interventions (healthy diet, increased physical activity and decreased sedentary behaviour) for the treatment of childhood obesity. Lifestyle interventions are known to benefit cognitive function and educational attainment in normal weight children. However, it is not known whether the same benefits occur when lifestyle interventions are used to treat overweight and obese children. Aim & Objectives: The aim of this thesis was to assess the effect of lifestyle interventions on educational attainment in overweight and obese children in three studies: Objective 1: Assess the efficacy of lifestyle interventions for improving educational attainment. Objective 2: Establish the feasibility of assessing the effectiveness of a childhood primary care weight management programme on educational attainment. Objective 3: Investigate the potential mechanisms for how lifestyle interventions for weight management might benefit educational attainment of overweight children. Methods: Study 1: Systematic (Cochrane) review and meta-analysis of randomised controlled trials of single or multicomponent lifestyle interventions in children aged 3-18 years. Study 2: Quasi-experimental study linking childhood weight management data of children 5-15 years with education data from local education authorities in Scotland. Study 3: Qualitative study designed to gain insight into overweight and obese children’s and their parents’ perceptions and experiences in school and weight management programme obtained from focus groups and interviews. Results: Study 1: The systematic review included six studies of 674 overweight and obese children and adolescents. Findings indicated that school-based healthy lifestyle education combined with nutrition interventions can produce small improvements in overall school attainment. Single component physical activity interventions produced small improvements in mathematics attainment and associated cognitive skills (executive function, and working memory). There was no evidence of an effect of any lifestyle intervention on reading, vocabulary and language attainment, attention, inhibitory control, and simultaneous processing. Study 2: Cross-sectorial administrative data-linkage was shown to be feasible. This pilot study showed no evidence of a beneficial effect of a primary care child weight management programme on reading, writing and mathematics attainment in overweight and obese children. However, a definitive study to properly assess the effectiveness of lifestyle interventions outside the research environment is clearly feasible in Scotland. Study 3: The themes emerging from focus groups and interviews were body weight related school experiences, attitudes towards school, obesity and school performance, and influence of weight management. Participants perceived that being overweight can benefit educational attainment because a lack of friends means they are less distracted from learning. Low psychosocial well-being experienced by the participants was improved after taking part in a weight management programme. Parents understood this benefit could potentially impact positively on school experiences and attainment in the long-term. Conclusion: Given the high prevalence of childhood obesity, educational and cognitive outcomes could be improved, to some extent, in a very large number of school-aged children through increased physical activity and nutrition education intended for weight management. Health policy makers should be aware of these potential additional benefits when promoting physical activity and healthy eating in schools. Childhood weight management programmes exist widely and thus provide an opportunity to evaluate their impact on educational outcomes in the community. Implemented child weight management programmes may benefit from improved recording of routine data and from obtaining participants’ administrative education data to ensure adequate support and supervision of this vulnerable population. In addition, weight management programmes could consider promoting psychosocial well-being of participants to potentially benefit both health and educational outcome. Lifestyle interventions for obese children and adolescents are under-investigated particularly with regard to a) efficacy in clinical and community settings, b) short and long-term effectiveness for improving educational attainment and c) mechanisms of benefit on educational attainment and cognitive function.

Background and objective: Childhood obesity is a serious global health problem and it is associated with insulin resistance and significantly increased risk for development of type 2 diabetes and cardiovascular disease. Metformin reduces the risk of developing T2D in adult patients with obesity and insulin resistance. However there is limited and inconclusive data in obese non diabetic children and adolescents. The objective of the Metformin in Obese Children and Adolescents (MOCA trial) was to assess the effect of metformin on body composition, metabolic risk factors and adipokines. Design and methods: The MOCA trial was a six month multi-centre randomized, double-blind placebo-controlled trial of metformin (1.5g daily) in children and adolescents (8-18 years) with insulin resistance and/or impaired glucose tolerance. Auxology, blood pressure measurement and fasting blood tests (insulin, glucose, fasting lipids, ALT, bilirubin, CRP, lactate, resistin, adiponectin, leptin) were performed at baseline, three and six months. A prolonged oral glucose tolerance test was performed at baseline and after six months. Measures of insulin resistance/sensitivity were calculated including HOMA-IR and the adiponectin: leptin (A/L) ratio. Results: 151 obese children participated in the trial (metformin:77, placebo:78). 102 (67.5%) female, 99 (65.6%) post-pubertal, 115 (76.2%) White British and 36 (23.8%) British Asian or Afro-Caribbean. Mean age of participants was 13.7 ±2.3 year and mean BMI-SDS 3.4 (0.5). In regression analysis, controlling for baseline values, sex, ethnicity and pubertal status, metformin had a greater treatment effect over placebo for BMI at three months, that was sustained at six months (-0.25 kg/m2, p=0.01, 95% CI 0.29 to 1.86) and BMI-SDS (-0.1, p=0.01, 95% CI 0.02 to 0.19). Fasting glucose reduced (-0.03 mmol/l, p=0.03) and A/L ratio increased at three months (+0.04, p=0.03), but the improvements were lost at six months. The other measures of insulin sensitivity, metabolic risk factors and concentrations of adipokines did not change with metformin treatment. Conclusions: Metformin therapy for obese children with abnormal insulin glucose status is safe, well tolerated and has a small beneficial treatment effect over placebo for BMI, BMI-SDS, fasting glucose and A/L ratio at three months, with the changes in body composition sustained at six months. A three month course of metformin should be considered by Paediatricians to halt the inexorable rise in BMI-SDS in these children, improve insulin glucose status and act as catalyst and support for more radical change in lifestyle in the individual. Trial register number: ISRCTN 19517475.

Childhood obesity has become a national epidemic. Although many of the consequences of childhood obesity are known, such as physical, social, emotional, and academic effects on a student's development, there is a lack of literature on the topic of childhood obesity in Native American tribes. The purpose of this case study was to explore how school personnel address the effects of obesity on students' social, emotional, academic, and physical development in an elementary school in the southwest United States where 90% of the students are Native Americans. Bronfenbrenner's socioecological model served as the theoretical foundation. The research questions explored strategies for how school personnel addressed childhood obesity. Interviews with 7 teachers, 1 administrator, 1 school nurse, 1 school psychologist, and 1 cafeteria manager were conducted. Open, axial, and selective coding strategies were employed to analyze the data. Findings revealed that the local school personnel lack professional development on working with Native American obese students and desire to implement a prevention and intervention obesity program targeted for Native American students. Recommendations include creating professional development related to childhood obesity, providing alternatives to food rewards, allotting time for healthful living practices, writing grants for healthy snacks, and collaborating with families and tribal affiliations. Implications for social change include greater understanding among school personnel at the study site of practices to address childhood obesity in Native American students, which may lead to effective interventions for enriching the academic success of obese students.