acase@tulane.edu / Recent research has suggested a strong link between attention-deficit/hyperactivity disorder (ADHD) and obesity in youth. Both ADHD and obesity have high prevalence and are associated with an enormous personal, family, and social burden. Approximately 5% of children worldwide are currently diagnosed with ADHD, and the prevalence of obesity is estimated to increase relatively by 40% in children with ADHD. Thus, it is imperative to examine potential behavioral mechanisms that underlie comorbid ADHD and obesity, one of which may be abnormal eating behaviors. These behaviors compounded by ADHD symptomology contribute to weight gain in this population. Despite evidence that frequently sharing family meals may protect against abnormal eating behaviors, health-adverse behaviors, and overweight/obesity in youth, only half of families in the United States eat dinner together 6-7 nights per week. This study examines whether United States youth ages 10-17 who present with ADHD are more likely to be overweight/obese than those without ADHD and whether the frequency of shared family meals moderates this comorbidity. Data were obtained from the 2011/2012 National Survey of Children’s Health (NSCH). Using an ordinal regression analysis with moderation, the current study found that youth with ADHD are more likely to be overweight/obese. Frequency of shared family meals was not found to moderate the relationship between ADHD and weight status in the current study sample. Implications of the findings and suggestions for future research are discussed. / 1 / Emma Clare Lewis

Obesity has been on the rise for several decades in both children and adults. Furthermore, obesity is associated with diseases. Children's environment is suspected to affect children's eating habits and lack of exercise, but the salient aspects of children's environments are still not well understood. The present research addresses the possibility that work to family spillover may disrupt family eating patterns and children's physical activity sufficient enough to cause weight gain. Other researchers have examined the environment of the family in terms of parenting style and family rituals. This literature however has not examined the possible moderating effect of parenting styles on the effects of work to family spillover on children's obesity. The study included a cross-sectional sample of children and adolescents (n = 312) in a Houston study. Participants included both parents (if a father was present in the household) and one child aged either 9-11 or 13-15. Bivariate, multivariate, and logistic regression analyses were performed. Work to family spillover, family meal rituals and parenting styles were found to have a relationship with children obesity measures for both age groups. However, these relationships are less strong when combined into a full model. Only a mothers' work strain was associated with increased odds of having overweight children in the 9-11 age group. Although the relationship between mothers? work strain and mothers' controlling parenting style and obesity-related variables remained significant, there was no evidence that a maternal or paternal parenting style moderates the relationship between work spillover and children obesity measures. Father dinner ritual importance was associated with lower odds of having overweight children among 13-15 year old adolescents. However, findings did not support hypothesis that family meal ritual variables children eating while watching TV, mother eating while watching TV nor Father dinner ritual (all significant in the full model) moderated the positive relationship between mothers work strain and overweight, at-risk for overweight, or healthy weight children for neither age group.

In 2004, Ontario’s Chief Medical Officer of Health Report, Healthy Weights, Healthy Lives (Ministry of Health and Long Term Care, 2004) identified the family (as well as the government, food industry, workplaces, schools, and individuals) for recommendations for action. As a means to promote, achieve, and maintain healthy body weights for both parents and children, Healthy Weights, Healthy Lives (2004) recommended enjoying family meals whenever possible. Very little evidence, however, exists to justify the promotion of family meals within Canada. Therefore, the purpose of this thesis was to describe family meal frequency and meal environments, and to examine the associations with diet quality (as assessed using a Canadian adaptation to the Health Eating Index (HEI-C; Glanville and McIntyre, 2006), and other commonly reported food behaviours and attitudes. The sample (males=1572 and females=1627) comprised students in grade six (n=1266), seven (n=1359), and eight (n=579) classrooms from Northern Ontario (Porcupine Region n=385), Southern Ontario (Peel Region n=1413, Region of Waterloo n=405, Toronto District n=216), and Nova Scotia (as part of the Physical Activity in Children and Youth (PACY) study n=804) participating in school surveillance-based studies. Data were collected using the web-based Food Behaviour Questionnaire, which included a 24 hour food recall, food frequency questionnaire, and specific questions relating to family meals. The majority of participants reported frequent family meals (70% on 6-7 days/week, 19% on 3-5 days/week, and 11% on 0-2 days/week). Family meal frequency decreased with increasing grade (X2=30.629 (df=4), p<0.001), and was significantly higher among participants from Porcupine, and lower among participants from Peel (X2=46.815 (df=8), p<0.001). The mean HEI-C score across all participants was 65.1 (SD 13.2) and the majority (73%) were rated in the needs improvement category. Family meal frequency, particularly between 0-2 and 6-7 days/week, was positively associated with diet quality scores (adjusted p=0.045) and ratings (p=0.049). When investigating the person(s) with whom meals were consumed, participants who ate breakfast with family members (versus alone, p=0.012) and/or lunch with friends (versus alone, p=0.007 or with family members, p<0.001) had a significantly greater likelihood of having a better diet quality. Participants who skipped breakfast (p<0.001) and/or lunch (p<0.001) had a greater likelihood of having a worse diet quality than those that consumed each meal. Cluster K-means procedures were used to classify observations about the four meal environment variables (where the meal was consumed, with whom the meal was consumed, who prepared the meal, and where the food was originally purchased) into groups. A total of 3, 8, and 6 clusters of meal environments were identified for breakfast, lunch, and dinner, respectively. Diet quality was negatively associated with consuming/purchasing meals outside of the home, and skipping breakfast and/or lunch. Meal skipping had a larger impact on overall diet quality than the environmental conditions under which the meal was consumed. Finally, associations among family meal frequency and other commonly reported food behaviours and attitudes were investigated. Higher family meal frequency was significantly associated with less pop consumption, consuming breakfast on the day of the survey, having higher self-efficacy for healthy eating when at home with family and during social times with friends. This research, in a large, geographically diverse sample of grade six, seven, and eight students from Ontario and Nova Scotia, found that family meal frequency and specific aspects of meal environments were positively associated with diet quality, and various healthy eating behaviours and attitudes. This research supports the growing body of literature in favour of family meals. Since the diet of most students in grade six, seven, and eight was suboptimal, strategies to promote healthy family meals should be widely encouraged.

In 2004, Ontario’s Chief Medical Officer of Health Report, Healthy Weights, Healthy Lives (Ministry of Health and Long Term Care, 2004) identified the family (as well as the government, food industry, workplaces, schools, and individuals) for recommendations for action. As a means to promote, achieve, and maintain healthy body weights for both parents and children, Healthy Weights, Healthy Lives (2004) recommended enjoying family meals whenever possible. Very little evidence, however, exists to justify the promotion of family meals within Canada. Therefore, the purpose of this thesis was to describe family meal frequency and meal environments, and to examine the associations with diet quality (as assessed using a Canadian adaptation to the Health Eating Index (HEI-C; Glanville and McIntyre, 2006), and other commonly reported food behaviours and attitudes. The sample (males=1572 and females=1627) comprised students in grade six (n=1266), seven (n=1359), and eight (n=579) classrooms from Northern Ontario (Porcupine Region n=385), Southern Ontario (Peel Region n=1413, Region of Waterloo n=405, Toronto District n=216), and Nova Scotia (as part of the Physical Activity in Children and Youth (PACY) study n=804) participating in school surveillance-based studies. Data were collected using the web-based Food Behaviour Questionnaire, which included a 24 hour food recall, food frequency questionnaire, and specific questions relating to family meals. The majority of participants reported frequent family meals (70% on 6-7 days/week, 19% on 3-5 days/week, and 11% on 0-2 days/week). Family meal frequency decreased with increasing grade (X2=30.629 (df=4), p<0.001), and was significantly higher among participants from Porcupine, and lower among participants from Peel (X2=46.815 (df=8), p<0.001). The mean HEI-C score across all participants was 65.1 (SD 13.2) and the majority (73%) were rated in the needs improvement category. Family meal frequency, particularly between 0-2 and 6-7 days/week, was positively associated with diet quality scores (adjusted p=0.045) and ratings (p=0.049). When investigating the person(s) with whom meals were consumed, participants who ate breakfast with family members (versus alone, p=0.012) and/or lunch with friends (versus alone, p=0.007 or with family members, p<0.001) had a significantly greater likelihood of having a better diet quality. Participants who skipped breakfast (p<0.001) and/or lunch (p<0.001) had a greater likelihood of having a worse diet quality than those that consumed each meal. Cluster K-means procedures were used to classify observations about the four meal environment variables (where the meal was consumed, with whom the meal was consumed, who prepared the meal, and where the food was originally purchased) into groups. A total of 3, 8, and 6 clusters of meal environments were identified for breakfast, lunch, and dinner, respectively. Diet quality was negatively associated with consuming/purchasing meals outside of the home, and skipping breakfast and/or lunch. Meal skipping had a larger impact on overall diet quality than the environmental conditions under which the meal was consumed. Finally, associations among family meal frequency and other commonly reported food behaviours and attitudes were investigated. Higher family meal frequency was significantly associated with less pop consumption, consuming breakfast on the day of the survey, having higher self-efficacy for healthy eating when at home with family and during social times with friends. This research, in a large, geographically diverse sample of grade six, seven, and eight students from Ontario and Nova Scotia, found that family meal frequency and specific aspects of meal environments were positively associated with diet quality, and various healthy eating behaviours and attitudes. This research supports the growing body of literature in favour of family meals. Since the diet of most students in grade six, seven, and eight was suboptimal, strategies to promote healthy family meals should be widely encouraged.

AN ABSTRACT OF THE THESIS OF Rebecca Startzer, for the Master of Science degree in Community Nutrition, presented on November 6, 2008, at Southern Illinois University Carbondale. TITLE: A PILOT STUDY ON THE EFFECT OF A COMMUNITY-BASED LIFESTYLE INTERVENTION FOR MIDDLE SCHOOL STUDENTS WHO ARE "AT RISK" FOR TYPE 2 DIABETES MAJOR PROFESSOR: Dr. Sharon Peterson The prevalence of childhood Type 2 Diabetes Mellitus (T2DM) has increased by 33% over the last 15 years (Kaufman, 2002). With the growing number of adolescents with T2DM, it is important to identify adolescents who are "at risk" for T2DM and develop programs to help delay or prevent T2DM. Our pilot study, "R .U. A. Healthy Kid?" sought to examine the relationship of middle school students "at risk" for T2DM and lifestyle factors, including family meals, physical activity, and "screen time" in an effort to reduce their risk through a community-based intervention. At baseline a significant negative correlation was found between "screen time" levels and fruit (p= 0.041) and vegetable (p = 0.046) intake and a significant positive correlation between "screen time" levels and physical activity levels (p=0.006). At three months, a significant positive correlation was found between family meals at home and vegetable intake increased (p=0.024) and a significant positive correlation between family meal frequency increased and physical activity levels (p=0.047). From baseline to three months, frequency of family meals at home decreased (p=0.021). From this study, it could be concluded that improving "at risk" adolescent's behaviors related to family meals, physical activity, and "screen time" levels are critical while developing successful interventions for adolescents "at risk" for T2DM.

No description available.

Introdução: Os adolescentes são considerados vulneráveis do ponto de vista nutricional, pois tendem a omitir refeições e não realizá-las com a família. Refeições em família propiciam oportunidade de socializar o adolescente e ensiná-lo sobre nutrição e bons hábitos alimentares. Objetivos Verificar associação entre freqüência de refeições em família com o consumo de alimentos e estado nutricional de adolescentes. Metodologia: Foram estudados adolescentes do ensino médio de 12 escolas técnicas da região metropolitana de São Paulo, com amostragem aleatória simples. Os adolescentes responderam dois questionários, sendo um sobre atitude alimentar e outro sobre a freqüência alimentar. Foi realizada mensuração antropométrica e calculado o Índice de Massa Corporal (IMC) para analisar o estado nutricional, utilizando-se o IMC/ idade. Para a análise dos dados foram utilizados os testes Qui-quadrado e a Análise de Variância e também comparações múltiplas quando houve diferenças significativas entre médias. Resultados: Foram avaliados 1167 adolescentes, sendo 51por centomeninos e 49por centomeninas. A média de IMC para ambos os gêneros foi de 22,28kg/m2 (±3,9) e observou-se baixa ingestão de verduras, legumes, frutas e leite. Verificou-se que aproximadamente 70por centodos adolescentes informaram realizar pelo menos 3 vezes/ semana refeições junto com a família. Detectou-se que realizar pelo menos 1 vez por dia refeições em família está associado com maior ingestão de verduras, legumes e frutas e há a tendência de ingerir maior quantidade de carnes e ovos. Não foi observada associação entre freqüência de refeições em família e estado nutricional. Conclusão: Foi verificado que a maioria dos adolescentes realizava pelo menos 3 refeições em família por semana e aqueles que faziam com maior freqüência ingeriam maior quantidade de verduras, legumes e frutas. Não houve diferença estatisticamente significante para o estado nutricional / Introduction: By the nutritional point of view, the adolescent are considered vulnerable, because they run to omit and not to perform the meals with the family. Family meals create the opportunity of socialize the adolescent and teach them nutrition and good food habits. Objectives: Checking the associations between the frequency of family meals and the food intake and adolescent nutritional status. Methods: This study was made with high school adolescents of 12 technical schools of São Paulo city, using simple random sampling. These adolescents answered two questionnaires; the first attended the food attitude, and the second attended the food frequency. The anthropometric measurements were made and the Body Mass Index (BMI) was computed to analyze the nutritional status, supported by the BMI/ age. For this study were used the Chi-square and ANOVA as well the multiple confrontation was made when significant differences between averages were detected. Results: There were assessed 1167 adolescent, being 51 per cent boys and 49 per cent girls, and the BMI average was 22,28kg/m2 (±3,9) for both. There were observed the low intake of vegetables, fruits and milk. And it as clear that close 70 per cent of adolescent told they have at least 3 meals with the family. It was observed that perform at least one daily family meal is related with higher intake of vegetables, fruits and there is the tendency of consume more quantity of the meat and eggs. It wasnt found the association between the family meals and nutritional status. Conclusion: It was observed that the most of adolescent performed at least 3 meals per week with their family, and for those that got it with more frequency consumed more vegetables and fruits. There wasnt any statistically significant difference to the nutritional status

Introdução Refeições em família (RF) são consideradas como refeições em que a família se senta junto e concentra sua atenção na experiência comum de aproveitar a refeição, preferencialmente, tendo uma conversação ao mesmo tempo. A alimentação em família desempenha importante papel para aquisição de bons hábitos alimentares. Objetivos - Identificar os fatores que contribuem para a prática de refeições em família, o impacto das mesmas no consumo alimentar e avaliar se a intervenção com múltiplos componentes promoveu mudanças nos hábitos alimentares de adolescentes e no ambiente das refeições em família. Métodos O projeto Hábitos Saudáveis, Meninas Saudáveis Brasil é um ensaio comunitário, randomizado e controlado, com 253 adolescentes do sexo feminino de escolas técnicas de São Paulo. Avalia estratégias de mudanças de comportamentos. Foi estruturado com base na Teoria Social Cognitiva e utilizados múltiplos componentes tais como materiais instrucionais, seminários, oficinas culinárias, envio de mensagens pelo WhatsApp®. Resultados As adolescentes realizavam em média 5,04±ep0,20 RF por semana, a prática de RF regulares foi associado: a atividade física vigorosa ativa (p=0,009), a preparação de refeição conjunta com a família (p=0,024), a oferta de legumes nas refeições (p=0,037) e entre outros a escolha de alimentos com menor teor de gordura (p<0,001). Foram enviadas 26 mensagens motivadoras, que promoveram 503 interações. Conclusões - A prática de RF regulares sofre forte influência do ambiente, e após a intervenção houve alteração na dinâmica das refeições e melhoria no consumo de frutas, legumes e verduras. Expor as adolescentes a diferentes metodologias com abordagem social e cognitiva, foi importante, principalmente, para produzir a mudança de ação. / Introduction Family meals (FM) are considered meals that family are together and focus their attention in a common experience to turn the meal, in special, making a conversation at the same time. Family meals have an important role in the acquision of adequate eating habits. Objective Identify factors that contribute for family meal practices, their impact in dietary intake and assess the intervention with multiple components that promoted changes in eating habits in adolescents and family environment meals. Methods The Healthy Habits, Healthy Girls Brazil is a randomized controlled trial with 253 adolescent girls from technical schools of São Paulo. It was bases on the Social Cognitive Theory and used multiple components such as instructional materials, seminars and nutrition workshops, Whatsapp® messages. Results Adolescents realized on average 5.04±er0.20 FM per week, the practice for regular FM were associated to vigorous physical activity (p=0.024), availability of vegetables during meals (p=0.037) and among others the choices for foods reduced in fats (p<0.001). 26 motivational messages were sent, and promoted 503 interactions. Conclusions - Regular FM presents a great influence on the environment, and after the intervention there was a change on meals and enhanced intake of fruits and vegetables. Exposure the girls to different methodologies with social cognitive approaches, was important, specially, for promoting action chances.

A refeição familiar desempenha uma função estruturante das relações sociais, mas os convívios comensais de jovens órfãos com suas famílias podem ser afetados no contexto da orfandade pelo HIV/AIDS. Como parte de um projeto de pesquisa temático sobre Estigma e Discriminação relacionados ao HIV/AIDS, realizou-se um estudo para apreender os aspectos condicionantes das refeições familiares e caracterizar os convívios comensais de jovens órfãos pela AIDS em São Paulo. Portanto, realizou-se um estudo transversal com abordagem qualitativa e quantitativa a partir de perspectiva interdisciplinar entre antropologia da alimentação, saúde pública e ecologia cultural. Na fase qualitativa, foram utilizadas 19 entrevistas com jovens órfãos pela AIDS. As narrativas foram percorridas em busca de categorias contextuais e da sincronia de convívios espaciais e temporais para refeições. Na abordagem quantitativa, utilizou-se amostra com 276 jovens órfãos pela AIDS. Foram realizadas análises descritivas dos dados com distribuição de frequências e posteriormente foi aplicado o teste de Rao Scott. Os testes foram conduzidos em nível de significância de 5% e poder de teste de 80%. Para realização destas análises utilizou-se do programa STATA 10.0. As metodologias foram consideradas complementares e o processo de construção da análise foi desenvolvido a partir da ideia de artesanato intelectual proposta por Wright Mills (2009). Os resultados demonstraram que (1) a refeição familiar reflete a estrutura familiar; (2) a refeição atua como eixo da sincronia familiar em ritmos temporais e espaciais, e (3) as refeições refletem as mudanças nos convívios contemporâneos e os compromissos temporais com a família favorecem a adaptabilidade do jovem órfão em contexto urbano. / The family meal plays a structuring role in social relations, but commensal gatherings of young orphans and their families might be affected in the context of orphaned by HIV/AIDS. As part of a themed research project on Stigma and Discrimination Related to HIV/AIDS, this study was conducted in order to understand all conditioning aspects of family meals and to characterize commensal gatherings of young people orphaned by AIDS in São Paulo. For such, we performed a crosssectional study with qualitative and quantitative approaches from an interdisciplinary perspective between food anthropology, public health and cultural ecology. In the qualitative phase, interviews with 19 young people orphaned by AIDS were used. The narratives were covered in search of contextual categories and synchrony of spatial and temporal gatherings for meals. The quantitative approach was used to sample 276 young people orphaned by AIDS. Descriptive analyzes of the data with frequency distribution were performed and then the Rao Scott test used. Tests were conducted at a significance level of 5% and power of 80%. For these analyzes we used the STATA 10.0 software. The methodologies were complementary and stemmed from the idea of intellectual craft proposed by Wright Mills (2009). The results showed that (1) the family meal reflects the family structure; (2) the meal acts as an axis of family synchrony in spatial and temporal rhythms, and (3) meals reflect changes in contemporary gatherings and family time commitments promote the adaptability of the young orphan in an urban context.

Obesity among children is a public health concern. Preschool-­‐aged children, especially those from low-­‐income families, are no exception to the obesity epidemic. During the RD Parent Empowerment Program, parents of Head Start children in Johnson City, TN completed a structured education program over the course of 4 workshops related to healthy habits of families. The goal was to empower parents to shop smart, cook healthy, and eat right. The Family Nutrition and Physical Activity (FNPA) screening tool was used as an assessment tool to evaluate behavior change over the course of the program. Improvement in overall FNPA score was seen at the conclusion of the program. Individual assessment of breakfast consumption, family meal patterns, fruit and vegetable intake, beverage choices, and restriction occurred. Participation in the RD Parent Empowerment Program resulted in maintaining healthy behaviors or improved behaviors for many participants. A larger sample may provide more conclusive results.