Kong, Pik Shan. / Thesis (M.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 149-178). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

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Unhealthy diet, low levels of physical activity, high levels of sedentary behaviour and sleep deprivation are important weight related behaviours that have contributed to the increased prevalence of adolescent obesity. Numerous interventions have been developed to improve weight-related behaviours but they are usually focused on the individual and they ignore the effects of social networks on these behaviours. Much of the research in obesity has explored the role of social networks in promoting health through social influence and selection. However, little research has examined how the structure of social networks and the position of the individuals in the network could condition behaviour association (regardless of the underlying mechanism being social influence or selection) in adolescent friendship networks. Examining social network structure, individual position in the network and how they interact with individual behaviour in friendship networks can assist in better understanding the development and persistence of weight-related behaviours in adolescent friendship networks and provides valuable insight on how to modify these behaviours. Hence, this study aims to examine the role of friendship network properties (density, popularity and centrality) on the association between individual's and friends' weight-related behaviours after reviewing the literature and analysing social network and behavioural survey data. Methods are drawn from a set of analytical tools known as 'Social Network Analysis', which uses friendship nomination data from a complete network (socio-metric), along with reported data on diet, physical activity, sedentary behaviour, and sleep deprivation to investigate how friendship network structure is moderating behaviour association between individuals and their friends in the network. Four schools in Kingdom of Bahrain participated in the study with a total of 673 adolescents between the ages of 11 and 15. Findings suggest that there are associations between adolescents and their friends' in multiple weight-related behaviours. There is also evidence for the moderating role of some network properties on these associations. Findings are gender specific, which has implications for gender-tailored interventions.

Previous research has identified ethnic differences in adult obesity but has not fully explored the pathways that explain the ethnic differences, which may relate to both individual and area-level characteristics. This thesis identifies ethnic differences in obesity for eight key ethnic groups in England, before and after accounting for a range of individual-level and area-level factors. In addition, the thesis explores ethno-religious differences in obesity. Four key pathways to obesity are explored: social and structural inequality, migration-related, culture and health behaviour. Area-level factors examined are area deprivation, co-ethnic density and ethnic area type. As a basis for this comparative analysis, the thesis also examines approaches to the measurement of obesity and is the first study to use weight and waist as obesity outcomes in a study of ethnic differences in obesity (with height and hip respectively as explanatory variables). Data come from four years of the Health Survey for England (1998, 1999, 2003 and 2004) and linked area-level data from the 2001 Census. Multi-level modelling methods are used to account for individual-level and area-level factors. For waist, before adjusting for explanatory factors, Indian, Pakistani, Bangladeshi and Irish men and all seven of the women's ethnic minority groups have larger waists than the White group. After adjusting for individual and area-level factors, only the Indian and Pakistani men and Bangladeshi, Pakistani and Chinese women have statistically significantly larger waists than the White group. For weight, before adjusting for explanatory factors, Black Caribbean, Black African and Pakistani women are heavier than White women. However, in the adjusted models, the Pakistani women are no longer heavier than the White women. Both the unadjusted and adjusted models reveal that Black African Muslim women are lighter in weight than Black African non-Muslim women. Indian Sikh men and women have the largest waists of the Indian ethno-religious groups. The study finds that the pathway to ethnic and ethno-religious differences in obesity is multi-dimensional; a combined effect of social and structural inequality, migration, culture, and health behaviour for most ethnic groups. Waist circumference - individual level pathways: After adjusting for explanatory factors, the largest decrease to the waist circumference of men and women, relative to White women, is due to entering the migration-related variables into the models. This is consistent for men and women in all ethnic minority and all ethno-religious groups. In addition, entering the socio-economic position variables into the models substantially decreases the waist of Pakistani, Bangladeshi and Black African women, relative to White women - this is due to the low socio-economic position of these ethnic groups. Entering the socio-economic position variables into the models also decreases the waist of the Black African and Indian Muslim women to a greater extent than the non-Muslim Black African and Indian women. When the health behaviour variables are entered into the models, there is a large decrease in waist for Pakistani and Bangladeshi men relative to White men - this is due the low levels of physical activity among these ethnic groups compared to the White group. Entering health status into the models also results in a decrease to Bangladeshi men and women, Pakistani women, Indian women and Black Caribbean women's waist, relative to White women - this is due to the poorer health status of these groups. Weight - individual level pathways: After adjusting for explanatory factors, the largest decrease in women's weight, for all ethnic and ethno-religious groups relative to White women, is due to the migration-related variables and the health behaviour variables. For most groups the migration-related variables have the largest effect but for Pakistani and Bangladeshi women the health behaviour variables have the largest effect - this is due to the low levels of physical activity among Pakistani and Bangladeshi women. Entering the socio-economic position variables into the models also decreases the weight of the Black African and Indian Muslim women but increases (or makes little difference to) the weight of non-Muslim Black African and Indian women. In contrast, men's weight increases for all ethnic groups, relative to White men, after adjusting for all the explanatory factors - for all groups this effect is mainly due to the socio-economic position variables and, for the Indian and Pakistani men, the migration-related variables. Area-level pathways: Area-level pathways contribute to ethnic/ethno-religious differences in obesity but to a lesser extent than individual-level pathways. Predicted values from interaction models suggest that the effect of area deprivation on weight/waist is different for different ethnic groups. For example, White men and women's weight and waist increases, on average, as area deprivation increases but Indian men's waist and weight and Indian women's waist decreases as area deprivation increases. Interaction models also suggest that co-ethnic density may work differently for different ethnic groups - for example an increase in co-ethnic density results in a decrease to the weight or waist of the Indian, Chinese and Pakistani groups but an increase to the waist of Black Caribbean women. The ethnic area type research needs further study but the results suggest that Indian and Pakistani area types may have a protective effect upon both men's waist and weight.

Alterações sócio-econômicas, demográficas e epidemiológicas ocorridas nas últimas décadas resultaram em importantes modificações no perfil de morbi-mortalidade da população brasileira. Incluem-se neste cenário alterações do padrão nutricional da população, expressas pelo aumento da obesidade em adultos e pela redução da desnutrição em crianças. Isto implica questionarmos sobre a importância relativa dos problemas do balanço energético (desnutrição e obesidade), tanto em relação à magnitude quanto à determinação dos agravos nutricionais, com vistas a discutirmos intervenções de saúde e nutrição nos diferentes estratos da população. Visando aferir e qualificar o estágio da transição nutricional no país no final dos anos 80, estimamos e comparamos as freqüências da desnutrição e da obesidade na população brasileira de crianças entre 6 e 35 meses de idade (n=3641) e de adultos, ou seja, mulheres (n=15669) e homens (n=14235) da Pesquisa Nacional de Alimentação e Nutrição -PNSN-, realizada em 1989 pelo IBGE, através de amostra representativa dos domicílios do país. Desenvolvemos para tanto critérios comparáveis de avaliação do estado nutricional de mulheres, homens e crianças. Primeiramente, selecionamos índices antropométricos que expressassem a condição nutricional atual de adultos e crianças (Índice de Massa Corporal - IMC, no caso dos adultos e peso/idade e peso/altura, no caso das crianças). Adotamos o modelo normativo de diagnóstico da desnutrição e da obesidade em crianças e em adultos com o intuito de atribuir idêntica especificidade aos diagnósticos (valores críticos correspondentes aos percentis 5 e 95 das populações de referência). Para o diagnóstico da obesidade, os valores do IMC correspondem a 27,7 kg/m2 na população adulta feminina e 28,4 kg/m2 na população adulta masculina e para o diagnóstico da desnutrição os valores do IMC correspondem aos do percentil 5 nas diferentes idades. Para o conhecimento da natureza dos agravos nutricionais, nos valemos da análise da distribuição intra-familiar da desnutrição e da obesidade. Tal análise ficou restrita às famílias compostas por mãe, pai e pelo menos uma criança com idade entre 6 e 35 meses (n=2232). Utilizou-se a técnica de modelos log-lineares para testar as hipóteses de independência ou de associação entre o estado nutricional dos membros de uma mesma família. A ordenação das modalidades de desnutrição e obesidade, de acordo com a magnitude alcançada pelos problemas, revelou a obesidade em mulheres e a desnutrição em crianças, nesta ordem, como os principais problemas nutricionais do país. Os dois problemas são os mais prevalentes entre a população residente nas áreas urbanas das regiões Norte, Nordeste e Centro-Oeste e nas áreas rurais das regiões Sudeste e Centro-Oeste, apenas alternando a ordem entre si. Por outro lado, a obesidade é hegemônica em adultos e crianças das áreas urbanas das regiões Sudeste e Sul e do Sul rural. No Nordeste rural, ao contrário, a hegemonia é da desnutrição em crianças, homens e mulheres. A análise da distribuição intra-familiar da desnutrição indica que o problema tem natureza preponderantemente individual, ou seja, na maioria dos estratos estudados, a ocorrência da desnutrição em um dos membros da família não implica aumento do risco de desnutrição nos demais. Apenas entre as famílias em \"extrema pobreza\" (renda familiar inferior a 1/4 de salário mínimo per capita), detecta-se uma fraca associação entre a condição nutricional (desnutrição/não desnutridos) de seus membros. A análise da distribuição intra-familiar da obesidade também indica o problema como de ordem essencialmente individual. Somente entre as famílias de renda intermediária (renda familiar entre 1/2 e 1,O salário mínimo per capita) verifica-se associação entre a condição nutricional (obesidade/não obesos) de pais e mães. São várias as implicações dos achados deste estudo com relação ao desenho de políticas e programas nutricionais no Brasil. Destacam-se a maior prioridade que deveria merecer a prevenção e controle da obesidade em todas as classes sociais e a evidência de que o controle da desnutrição infantil deveria se fazer através de ações de saúde. Programas que incluam a distribuição generalizada de alimentos estariam justificados em estratos específicos da população. / Socio-economic, demographic and epidemiological changes which have occurred over recent decades have led to striking changes in the Brazilian population\'s morbidity and mortality pro files. This scenario includes changes in the nutritional patterns of the population, as evidenced by the increase in obesity among adults and the decrease in undernutrition children. This calls for a reevaluation of the relative importance of the problems of the energy balance (undernutrition and obesity) both as regards the magnitude and the cause of nutritional damage, with a view to discussing health and nutrition interventions in different strata of the population. In order to measure and qualify the stage of nutritional transition in the country at the end of the 1980s, we estimated and compared frequencies of undernutrition and obesity in the Brazilian population among children between 6 months and 35 months of age (n=3641) and adults,that is to say, in women (n=15669) and in men (n=14235), as registered in the National Health and Nutrition Survey (PNSN) of 1989, conducted by the IBGE (Brazilian Institute of Geography and Statistics), by means of a representative sample of households nationwide. We first selected anthropometric indices which express the current nutritional status of adults and children: the Body Mass Index - BMI for adults, and weight-for-age and weight-for-height for children. We adopted a normative model to diagnose undernutrition and obesity in children and adults with a view to ascribing identical specificity to the diagnoses (cut-offs corresponding to the 5th and 95th percentile of the reference). To diagnose obesity, the BMI values correspond to 27.7 kg/m2 and 28.4 kg/m2 female and male adult population, respectively, and to diagnose malnutrition the BMI values of 5th percentile at different ages among the adult population. In order to study the nutritional damage we made use the of the analysis o f intrafamiliar distribution o f undernutrition and obesity. This analysis was restricted to families comprising mother, father and at least one child between the ages of 6 months and 35 months (n=2232). The log-linear model technique was used to test the hypotheses of independence and association between the nutritional status of members of the family. Ordering the modalities of undernutrition and obesity, in accordance with the magnitude of the problems, showed obesity in women and undernutrition in children, in this order, to be the principal nutritional problems in Brazil. The two problems are the most frequent in the urban population ofthe north, northeast and center-west regions, and in the southeast and center-west rural regions, although they occasionaly change position. Obesity leads among adults and children in the urban areas of the southeast and south regions, and in the rural south. In the northeast rural area undernutrition leads among children, men and women. Analysis of intrafamily distribution of malnutrition indicates that the problems is overwhelmingly individual. That is to say, in most of the strata which were studied, malnutrition in one of the members of the family does not imply increased risk of malnutrition in the other family members. Only among families living in \"extreme poverty\" (family income below 1/4 minimum salaries per capita) cana weak association be detected between nutritional status (malnutrition/no malnutrition) in its members. Analysis in the intrafamily distributions of obesity also reveals the problem to be essentially individual. Only among middle-income families (family income between 1/2 and 1.0 salary per capita) can an association be detected between nutritional status (obesity/no obesity) of the parents (mother and father). The key implications of these findings have a bearing upon the planning ofthe nutrition politics and interventions in Brazil. The prevention and control of obesity should target the population of all the different social strata and the evidence of the control of children undernutrition should be mainly geared towards health actions. Programs which include widespread distribution of food would be justified in certain strata of the population.

The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. Literature review shows that there have been many different methods utilized to halt obesity's progression, however rates continue to increase. The United States Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other agencies recommend obesity screening and counseling at every patient encounter, but most hospitals do not have a current obesity policy in place to accomplish this task. The purpose of this project is to develop a program proposal for a hospital-based, obesity tool based on the 5 A's framework to increase screening and referrals of obese, adult patients ages 18 and over. The logic model was utilized to guide the program development, implementation, evaluation, and dissemination. The program was accepted by the hospitalist group and nurse leaders for full development and evaluation. Key stakeholders and content experts were convened to create a proposal and algorithm to guide the project. The obesity program will increase screenings and referrals upon full adoption. Increase in screenings and referrals will improve care, quality of life, weight status, and decrease health care expenditure. The results of dissemination of the program may stimulate other facilities to adopt the program to combat obesity and contribute to social change The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. Literature review shows that there have been many different methods utilized to halt obesity's progression, however rates continue to increase. The United States Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other agencies recommend obesity screening and counseling at every patient encounter, but most hospitals do not have a current obesity policy in place to accomplish this task. The purpose of this project is to develop a program proposal for a hospital-based, obesity tool based on the 5 A's framework to increase screening and referrals of obese, adult patients ages 18 and over. The logic model was utilized to guide the program development, implementation, evaluation, and dissemination. The program was accepted by the hospitalist group and nurse leaders for full development and evaluation. Key stakeholders and content experts were convened to create a proposal and algorithm to guide the project. The obesity program will increase screenings and referrals upon full adoption. Increase in screenings and referrals will improve care, quality of life, weight status, and decrease health care expenditure. The results of dissemination of the program may stimulate other facilities to adopt the program to combat obesity and contribute to social change The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity-related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. A review of the literature showed that multiple methods have been used to address the rate of progression; however, obesity rates continue to increase. The U.S. Preventative Services Task Force, American Heart Association, and other agencies recommend obesity screening and counseling at every patient encounter; most hospitals do not have a policy to accomplish this task. The purpose of this project was to develop an obesity screening and referral tool for the hospital setting. The resulting tool was based on the 5 As framework to increase screening and referrals of obese patients. The logic model was used to guide program development, implementation, evaluation, and dissemination. Results of the obesity screening and referral program showed an increase in screenings and referrals upon a trial adoption, raising the number of identified referrals to 23, compared to 2 patients identified for referral prior to program implementation (p = 0.035). An increase in screenings and referrals can bring about positive change by improving care, quality of life, and weight status of patients and decreasing health care expenditure.

Obesity affects one out every six children in the United States, which places them at risk for other chronic conditions such as cardiovascular disease, diabetes, and continued obesity into adulthood. Considering military children are more likely to enter the Armed Forces than their civilian counterparts, an increase in obesity among military families decreases the number of potential future military recruits who are physically eligible to serve. Despite this growing epidemic, providers report a lack of education and a low self-efficacy in the treatment of this condition. This doctorate of nursing practice study addresses this educational gap by attempting to improve participants knowledge within a military setting regarding the clinical practice guidelines for the assessment, prevention, and treatment of childhood obesity through an one hour educational inservice. The educational project was guided by the principles of the chronic care model and used the theories of adult learning in the formation of the inservice. The content was derived from current evidence and the clinical practice guidelines endorsed by the American Academy of Pediatrics. Twenty-seven participants attended the 1-hour educational inservice program and 24 completed a 9 question pretest and posttest knowledge survey (p<0.00). Analysis of the data from this educational inservice found a significant improvement in participant knowledge between the pretest and posttest surveys. These findings suggest that it is feasible to offer a 1-hour inservice which can promote social change by significantly improving staff's knowledge about the clinical practice guidelines on childhood obesity.

No description available.

Abstract inserted as part of Final MPH Thesis: Non-Communicable Diseases like diabetes, cardiovascular diseases, cancers and others, have become the major cause of premature death, morbidity and disability in many Pacific countries including Samoa. These are linked by common preventable risk factors like obesity, hypertension, smoking, unhealthy diets and physical inactivity. OBJECTIVES: To determine the trends and development of Non-Communicable diseases and its risk factors in Samoa over the last 24 years using the recently developed diagnostic criteria. RESEARCH DESIGN AND METHODS: This research thesis combines 3 large surveys that were done in 1978, 1991, and 2002, looking at the trends in the prevalence of diabetes, and the prevalence of the NCD risk factors such as blood pressure, obesity, cholesterol and smoking. The 3 survey samples were selected randomly from around similar regions (Urban Upolu, Rural Upolu, and Rural Savaii) of Samoa in 1978, 1991 and 2002, with a total of 5973 individuals (1978 survey = 1467; 1991 survey = 1778; 2002 survey = 2728) available for the thesis analysis. The 1978 and 1991 data sets were secured from Professor P Zimmet, and the 2002 STEPs survey data set was secured from the Samoa Ministry of Health. The 3 surveys methodologies, survey procedures, questionnaires and anthropometric measurements were similar though the diagnostic criteria used to measure obesity slightly differ between the surveys. The blood pressure measurements were similar though the diastolic blood pressure measure in 1978 was higher. The 1978 and 1991 surveys used fasting venous blood sampling to measure fasting plasma glucose, and cholesterol levels at the laboratory. OGTT was also used in 1978 and 1991, but not 2002. The 2002 survey used capillary sampling to measure fasting glucose using a glucometer, and cholesterol level using a cholesterol meter. The combined data was then cleaned, standardized and matched with each survey, to make analysis easier. The recent diagnostic criteria were then applied to all the surveys to diagnose diabetes (1999 WHO Diabetes Criteria), hypertension (WHO 1999, JNC-VII 2003, NHF 1999 Hypertension Criteria), obesity (BMI ≥30 kg/m??), and hypercholesterolaemia. The prevalences using the recent diagnostic criteria were then mapped out. RESULTS: The overall age-standardized prevalence of type 2 diabetes (known or previously unknown) utilizing the current 1999 WHO diagnostic criteria for men and women ≥20 years of age has increased from 5.4% (males 4.8%, females 5.9%) in 1978, to 12.0% (males 10.9%, females 13.5%) in 1991, and to 20.1% (males 17.2%, females 22.2%) in 2002. Among the individuals with diabetes in the 3 surveys, more than 60% had previously undiagnosed diabetes. Compared with the 1978 survey, the diabetes prevalence in 2002 represents a 4-fold increase over the 24 year period. This has occurred along with increasing obesity, urbanization and modernization, aging, cultural changes, and changes in physical activity. There is a high prevalence of non-communicable disease risk factors. The age-standardized prevalence of hypertension defined by the WHO 1999 and JNC-VII 2003 criteria was 47.2% in 1978, 22.5% in 1991, and 24.0% in 2002. The high prevalence of hypertension in 1978 was due to the method used for recording diastolic blood pressure. Hypertension was more common in the urban regions than rural regions in 1978 and 1991 while in 2002, there was no statistical difference between the rates of hypertension between the different regions due to the rise in the prevalence rate of hypertension in rural regions. There is a high prevalence of overweight and obesity in Samoa. Using the WHO classification for BMI, there was an increase in obesity (BMI ≥ 30kg/m??) prevalence in Samoa in the last decade, increasing steeply from 34.9% in 1978 to 51.3% in 1991, and slowing down to an increase to 57.4% in 2002. The prevalence of obesity is significantly higher in females compared with their male counterparts. The overweight prevalence (BMI 25-29.9kg/m??) was 34% in 1978, 31% in 1991 and 29% in 2002. The prevalence of obesity has increased by 65% from 1978 to 2002 with an increase of 47% from 1978 to 1991, and 12% from 1991 to 2002. Prevalence of obesity is increasing with age and is more of a problem in women than men. It is higher in the urban regions but there has been a faster rise in obesity prevalence in rural regions from 1978 to 2002 as the rural regions become urbanized. The prevalence of hypercholesterolaemia (total cholesterol ≥ 5.2 mmol/l) was 30.5% in 1978, and this increased to 51.1% in 1991. There was a marked decline of hypercholesterolaemia in 2002 (14.4%), which may be due to differences in the method of measurement. Although smoking prevalence remains high in Samoa it declined significantly from 42.4% 1978 to 35.3% 1991 but remained essentially steady at 38% in 2002. There was a significant gender difference in smoking with about 60% of men and 20% of women smoking regularly. CONCLUSION: Samoa is experiencing an increasing problem with Non-Communicable diseases like diabetes and some of its risk factors. Diabetes prevalence has dramatically increased by 4-fold in the last 24 years. The prevalence of hypertension has stabilized around 23% though there was a decrease from 1978. The prevalence of obesity has also increased. Smoking prevalence has slightly increased from 1991 to 2002 with a significant number of the population smoking. Hypercholesterolaemia is more common in 1991 with an apparent decrease in 2002. These findings have important implications for public health efforts and policy developments to contain the epidemic of Non-Communicable diseases in Samoa.