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Background: Compared to other regions of the United States, people living in Appalachia bear a heavier burden from obesity related chronic conditions such as cardiovascular disease, stroke, diabetes, fibromyalgia, and sleep apnea as well as higher rates of premature mortality for those diseases. Childhood obesity in particular poses a burgeoning and understated threat to the public health system. Objectives: The purpose of this study was, working with the Appalachian Funders Network, identify the policies and practices that have a positive impact on the reduction of childhood obesity and chronic disease in central Appalachia (TN, VA, KY, WV, NC, and OH). Methods: Mixed methods approach was utilized. Survey of practitioners and funders identified efforts to reduce childhood obesity including obesity prevention, healthy eating and/or physical activity. Focus groups conducted across the region provided participant generated strategies to address gaps and needs. Results: Over 400 practitioners and 40 funders completed the survey. Eight focus groups were conducted across central Appalachia. Based on the finding, a set of recommendations to inform future grant making strategies will be compiled. Preliminary results demonstrate some areas of disconnect between funders and practitioners. Programs were more sustainable if funded from within the community rather than from an outside source. Further, the success of a program seems to be based on need and the collaboration of the practioners and funders. Conclusions: Using a mixed-methods approach, an aggregate of data provides a comprehensive picture of the current health condition of central Appalachia. Working with the Appalachian Funders Network, a group of 80 funders, the findings from this study have the potential to impact the work on practitioners and funders in the region. This collaboration hopes to promote a sustainable healthy lifestyle within Tennessee and greater Appalachia.

The prevalence of overweight and obese children has increased dramatically in the United States over the past 20 years and is a symptom of multiple systemic and cultural changes that have significantly influenced alterations in energy intake, energy expenditures, and the energy balance of children across the nation. School-based obesity prevention programs addressing nutrition and healthy eating behaviors within the school environment and cultural context provide a unique opportunity to educate and engage students in healthy food consumption practices. This study evaluated the effectiveness of a three-year elementary school nutrition education program for students in grades kindergarten through fifth using a longitudinal analysis of two separate data sets, a nutrition skills behavior assessment survey of self-reported eating behaviors, and body mass index (BMI) scores derived from height and weight measurements of program participants. Nutrition survey results indicated that students reported making healthier food choices from August 2001 to November 2004, with a significant decrease in reported consumption of fats/oils/sweets and significant increases in reported consumption of milk, meat, vegetables, fruit and grains. BMI results indicated a 7.8% decline in the percentage of students in the "overweight" and "at-risk for overweight" categories between August 2001 and October 2004. The combined results of both measures indicate that the nutrition education program appeared to positively affect eating behaviors and body mass index percentages. Implications of the study and strategies for further research are proposed.

Childhood obesity has many negative impacts on health and occurs due to genetic, environmental, and contextual factors (U.S. Department of Health and Human Services and U.S. Department of Agriculture [HHS and USDA], 2015). A major concern for this population of children is the resulting adverse effects on motor development, including challenges reaching appropriate developmental milestones impacting overall development and participation in daily activities (Cataldo et al., 2016). Occupational therapy practitioners can address multiple areas which contribute to this problem, including motor development and body functions, feeding and healthy meal preparation skills, family routines and activities of daily living, as well as contextual and cultural factors (American Occupational Therapy Association [AOTA], 2020). WHOLE Family is an online family based approach directed at positively impacting childhood obesity and motor development through a holistic approach.

Background While previous research indicates that low maternal sensitivity in mother-child interactions puts children at risk of overweight and obesity, maternal intrusiveness has rarely been investigated in association with children's weight. We investigated whether maternal sensitivity and intrusiveness in early childhood predict children's increased body mass index standard deviation scores (BMI-SDS) at school age. BMI-SDS are standardized for age and gender with respect to a reference standard. Methods At baseline (t1), we assessed maternal sensitivity and (non-)intrusiveness of 116 mothers with their children (48.3% female) aged 5–47 months (M = 24.00, SD = 11.36) using the emotional availability scales. We obtained anthropometric data for mothers at t1 by measuring height and weight in the laboratory and for children at birth assessed by medical staff. Six years later (t2) we obtained anthropometric data for children in the laboratory or based on parental report. Linear regression analyses were run with child BMI-SDS at t2 as outcome and sensitivity and (non-)intrusiveness as predictors, adjusting for confounders and exploring child age and gender as moderators. Results Maternal sensitivity only negatively predicted children's BMI-SDS in girls, while maternal intrusiveness predicted higher child BMI-SDS at school age regardless of child gender. The effect of maternal non-intrusiveness remained significant when controlling for confounders. Conclusion Maternal intrusiveness in early childhood seems to represent a risk factor for increased BMI-SDS in children, while lower maternal sensitivity tends to be a risk factor for increased BMI-SDS in girls. This may have implications for prevention or intervention programmes.

Childhood obesity is a global health concern that puts children at risk for developing serious health complications. With increasing rates worldwide, it is important to determine how to decrease its prevalence and promote prevention in future generations. Emerging evidence indicating that pre-pregnancy weight status and/or gestational weight gain (GWG) may be linked with overweight/obesity in children. Much of this body of research focused on weight status of offspring at birth and at preschool age. The purpose of this study is to: (1) analyze the research findings regarding obesity in children 5 to 18 years and their mother’s pre-pregnancy weight status and/or GWG, and (2) make recommendations for prevention based on a review of current research. A database search of CINAHL, Medline, ERIC and PsycInfo was conducted. A total of 14 articles were identified based on their relevance to key search terms and meeting criteria. This literature review indicated support for associations between an underweight/overweight/obese pre-pregnancy weight status combined with greater than recommended total GWG and higher overweight/obesity in older children and adolescent offspring. Findings also supported the associations between pre-pregnancy weight status with high GWG during early pregnancy and increased offspring overweight/obesity. Pre-pregnancy overweight/obese weight status of mothers was the single factor consistently found to be strongly associated with risk for overweight and obesity in children 5 to 18 years of age. Results of this review support the need for further education, interventions, and policies aimed at healthy nutrition for women during and prior to pregnancy to prevent childhood obesity.

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This report is the outcome of an exam work made in interaction design, bachelor degree, at the School of Arts and Communication, Malmö University. Working in collaboration with the childhood obesity unit, Region Skåne, our aim was to fulfill their request of a web based application preparing the children for treatment at their facility. Furthermore the application intends to give the children knowledge concerning obesity as well as teaching them how to obtain a healthier lifestyle in terms of provision and activities. The application concerns children in different ages and therefore different stages of their learning abilities. Our conclusions are that they need to be challenged and obtain feedback in different ways to get motivated. For a younger child it is often enough with feedback in terms of a voice approving their choices. For an older child however it is important to constantly challenge them in order to maintain their interest. This can for example be achieved by making tasks harder but still obviously reachable within the children’s capabilities. Adding different difficulty levels is another way to motivate and challenge children in different ages and stadiums of development. The report leads you through our complete design process, from our initial ideas to our latest prototype. We describe what context in which we have been working, the methods we have been using, and finally a discussion concerning the results and conclusions we have made.