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5 pp. / Recommendations for program planners, parents, teachers, school staff, and health professionals who are concerned about children and weight.

The Trans-community Approaches to Childhood Obesity Prevention and Treatment Study (Activa Y Sana) was a two-year (August 2006 to May 2008) intervention in one hundred and forty-one 3rd and 4th grade children and their parents from four schools in the Sunnyside School District in Tucson, Arizona. Activa was designed to expand upon schools as an intervention venue, and was the first to test the feasibility and impact of a multi-level, or "trans-community" approach (involving children, their parents or caregivers, schools, and community agencies) on the prevention of childhood weight gain in an at-risk Mexican-American population.Families were assigned to one of three interventions, depending upon which school the child attended: Level 1, state-mandated nutrition- and physical activity-based health curricula; Level 2, Level 1 curricula plus an after-school program; or Level 3, Level 1 + Level 2 activities, plus a family intervention.Primary endpoints of this study were changes in child BMI z-score, % fat, abdominal circumference, activity levels and food intake, psychosocial characteristics and correlates of these measures.The three manuscripts contained herein represent the main findings of this pilot study. Identifying potential mediators and describing their influence on childhood overweight is essential to development of successful interventions. In Study #1, the findings for the examination of correlates of child BMI z-score and % fat are reported. Activa Y Sana was designed to test whether combining different levels of intervention would have a greater impact on child weight. In Study #2, the results of this trans-community intervention on child weight status is discussed. The majority of evidence-based obesity prevention programs in use today were not designed with minorities in mind, and the continued scarcity of research in Latino populations has hindered the development of culturally-competent interventions that might reduce overweight prevalence. The challenges encountered while implementing Activa Y Sana, a population-specific intervention, are described in Study #3.The results from this research may be used to help inform the design of future intervention programs with the goal of reducing the burden of obesity in Mexican-American children, currently the fastest-growing segment of the U.S. population.

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The systematic evaluation of effective health behavior interventions is critical for addressing overweight and obesity. Process evaluation assesses whether critical intervention components are delivered as intended and can enhance our understanding of program effects by linking participant program exposure to outcomes. The purpose of this study was to conduct a process evaluation of PROACTIVE, an intervention program to prevent and reduce obesity in clinical settings, and to explore associations between measures of dose, fidelity, and session quality with participant outcomes in an effort to explain gender differences in PROACTIVE program response observed at 24 months. Overweight and obese men (n = 74) and women (n = 175) were randomized into the 24-month health behavior counselling intervention. Outcomes of waist circumference (WC) and physical activity (PA; 7-Day PA Recall) were measured at 12 and 24 months. Process outcomes were distilled from Session Summary Forms completed by Health Educators after each session. Dose was a significant predictor of WC (β = -.12, p < .01) and PA (β = -.16, p < .05) at 24 months. Fidelity predicted 12 month WC (β = -.11, p < .05) and PA (β = .21, p < .05). Quality was significantly associated with 12 month (WC: β = .07, p < .05; PA: β = -.18, p < .01) and 24-month outcomes (WC: β = .10, p < .01; PA: β = -.15, p < .05). No gender differences were found for complete program adherence (dose; p = .51) or treatment implemented (fidelity; p = .06). Men and women were exposed to a similar amount of PROACTIVE session content and maintained similar levels of adherence throughout the 24-month intervention, therefore the difference in program success between men and women could not be attributed to unequal program exposure between the two groups. Insight yielded into the relationship between program exposure and participant outcomes via this process evaluation can help guide and refine future program implementation along with providing areas for future research. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2013-01-29 17:29:48.89

Obesity is a growing concern in North America and current research suggests that for addressing childhood obesity, family-based behavioural interventions targeting children are the treatment of choice. Due to the lack of clinics that offer face to face treatment, the Internet may serve as a viable method for the delivery of such interventions. Three studies are presented in order to explore the viability of the internet as a treatment modality for delivering family-based interventions for children who are overweight. The first study attempted to deliver a family-based behavioural intervention via the internet - the Healthy Eating and Active Living Throughout Youth (HEALTHY) - for children aged 8 to 14 (M = 10.5). The initial goal was to evaluate the effectiveness of the internet as a treatment modality for childhood obesity. A total of 20 families consisting of 25 child-parent dyads consented to the intervention. However, adherence and attrition were significant issues throughout the 3-month intervention and only two child-parent dyads (8%) completed the 3-month intervention. Therefore the goals of this study changed to become primarily exploratory, with the aims of identifying factors related to treatment adherence and attrition. For the second study, the parents of the 20 families who consented to the HEALTHY intervention were invited to participate in a telephone interview around their impressions of the study, barriers to participation, and their needs in seeking services for their children. Sixteen families (80%) provided consent and thematic analyses were conducted. Four categories of themes emerged from the data and included: 'Knowledge and Education', 'Social Supports', 'Tools for Success', and 'Program Goals'. These categories, and the themes embedded within each category are presented and discussed. For the third study a systematic review of exclusively web-based studies for paediatric obesity was conducted. Five health and social sciences databases were search between 1995 and March 2012 (including an initial and updated search). A total of 2432 bibliographic records were identified (following de-duplication) and were subjected to title and abstract screening, and a further 120 records were subject to full-text screening. Two reviewers independently assessed the eligibility of each bibliographic record at these multiple levels and conflicts were resolved by third party. Three records were included in the review, and a further three records were identified as noteworthy in that they reported on one larger web-based study with a minimal face-to-face component (i.e., 4 sessions over 2 years). Data regarding attrition, adherence, and body composition changes were extracted by two independent reviewers. Attrition rates from the included studies ranged from 43% to 85%. The noteworthy study reported 18% overall attrition at six months (following randomization: 18% from the intervention group) and 34% overall attrition at two years (following randomization: 36% from the intervention group). Adherence measures were varied, but suggested low adherence to study components. Body composition changes were marginal in the short-term, but then lost in the longer-term. Implications for research and practice will be discussed. The contributions of this thesis include examining whether family-based interventions for pediatric obesity delivered over the internet are feasible. This question will be answered by exploring baseline characteristics that are related to treatment adherence and attrition, investigating barriers that interfere with adherence and contribute to attrition, and reviewing other research conducted in the field. Following from this thesis, and other relevant research, implications and recommendations for future research and clinical practice will be discussed

This project has identified increased adiposity and altered plasma leptin levels to be not associated with colon sensitivity to a colon carcinogen using diet-induced obesity (DIO) rodent and defective leptin signalling mutant mouse models. These findings do not support a direct link between the deregulation of insulin and adipokine levels observed in obese rats with increased risk of colon carcinogenesis. However, elevated leptin levels associated with increased dietary fat intake did increase the risk of colon carcinogenesis, supporting previously reported studies. Increased adiposity was associated with altered plasma insulin, leptin and triglyceride levels and 69 mitochondrial associated proteins in DIO rats. The changes in these mitochondrial protein profiles were not correlated with changes at the gene expression level assessed using real-time PCR arrays. The rat colon mitoproteome analysis is also presented here to provide a useful tool in assisting identification and interpretation of mitochondrial dysfunction implicated in colon pathogenesis. Animal studies have shown altered leptin levels linked to obesity can disrupt normal processes in colon. The role of leptin receptors identified in the colon is unknown. Deregulation of IL6, IL1β and CXCL1 was associated with leptin signalling in colon tissue. Cross talk of leptin and insulin signalling by modulation of IGBP3, IGF2 and AKT1 were also highlighted. Leptin regulation of mitochondria-associated apoptotic pathways involving UCP2, CASP3 and CASP9 in the colon was also identified. The study presents novel strategies to dissect signalling cascades in colon influenced by obesity and links with colon cancer.