Childhood obesity is an extensive problem in the United States and North Dakota (CDC, 2014). Significant health consequences are linked to obesity, including type two diabetes, hypertension, hyperlipidemia, cardiovascular disease, cancers, and psychological disorders (Pandita et al., 2016; Xu & Mishra, 2018). Obesity comorbidities, previously presented in later adulthood, now emerge in younger populations (Pandita et al., 2016). Unfortunately, treatment of obesity is not effective, and therefore, prevention must be the primary focus (Daniels et al., 2015; Pandita et al., 2016). Diet and eating behaviors have a significant impact on weight, and children develop taste preferences and lifelong eating behaviors within the first few years of life (Birch & Anzman, 2010; Daniels et al., 2015; IOM, 2011). Therefore, targeting interventions on feeding and nutrition in infancy may foster healthy habits for life and play a role in the prevention of obesity. Responsive feeding interventions hold promise in supporting healthy growth. Ellyn Satter’s Division of Responsibility promotes the responsive feeding relationship between parent and child. The purpose of the practice improvement project was to address childhood obesity prevention through the development of an educational curriculum on feeding and nutrition. The parent-focused education correlated with each well child visit (WCV) between the ages of two weeks and three years. A multidisciplinary team of representatives from pediatrics, behavioral health, and patient education was consulted to develop the education. Ten providers at Midwestern primary care clinics reviewed the educational curriculum and provided feedback on the content and methods to deliver the education to parents. Most providers found the content to be accurate (n = 7; 70%) and comprehensive (n = 8; 80%). Three providers suggested expanding on topics such as breastfeeding and mixing formula. Providers unanimously agreed that the curriculum is relevant and understandable. A formal literacy evaluation resulted in grade-level readability scores between the 6th and 8th-grade levels. Almost all providers (n = 9) believed the curriculum would be valuable for use in practice. The preferred delivery method chosen was one on one provider to parent education. The project clinic plans to pilot the curriculum with parents attending infant and toddler WCVs.

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INTRODUCTION: Health professionals emphasize the importance of breastfeeding in the development of children up to 6-months of age. It is known that short chain volatile fatty acids (SCVFAs) are a byproduct of nutrient fermentation by gut microbiome. These SCVFAs interact with the gut/brain axis and are known to influence infant development. Therefore, a reflection of maternal gut microbiome could likely be found in breastmilk (BM) due to diffusion of SCVFAs across the gut wall into the blood. Previous research in our laboratory has shown differences in the SCVFA fecal fermentation profile between individuals with normal (N) versus overweight/obese (OWOB) body mass index (BMI). Therefore, our research question is: Is there a difference in the relative amount and diversity of SCVFAs in the BM of N compared to OWOB women? We hypothesized that women of N will have a more diverse SCVFA profile than OWOB women in their BM. METHODS: BM samples (200 ml) were collected from 44 women (22 N (BMI 22.0) and 22 OWOB (BMI 33.7) p2 while OWOB participants had a pre-gravid BMI of greater than 25.0 kg/m2. A 300 mg aliquot of lyophilized BM was placed in a separatory funnel with 5 ml of hexane and 5 ml of volatile fatty acid solution (VFA, (oxalic acid (0.1M/L), sodium azide (40mM/L))). The funnel was rocked back and forth 50 times and placed on a ring stand to rest for 10 minutes. The bottom phase of the solution was collected and freeze-dried. Five hundred µL of VFA solution was added to the samples to resuspend, centrifuged (4,000 x g) for 20 minutes, the supernatant was removed and transferred to a microcentrifuge tube then centrifuged (12,000 x g) for 15 minutes and decanted. Three hundred µL of supernatant was transferred to autoinjector vials fitted with a 350 µL insert and analyzed for SCVFAs via gas chromatography (GC) (Shimadzu) using a Phenomenex ZB-Wax Plus glass capillary column. RESULTS: SCVFAs acetate, propionate, isobutyrate, isovalerate and caproate were not different (p>0.10), while valerate (p< 0.02), isocaproate (pCONCLUSION:To our knowledge, this is the first time that SCVFAs have been quantified in the milk of lactating women using GC with an FID detector. This data supports the argument that the pre-gravid BMI of a mother can correlate to the SCVFA profile of her BM. It is unknown if the concentration observed in the mother’s BM in this study has an influence on the neonate’s gut/brain axis and neurological signals, however, we have demonstrated that the SCVFA profile is more diverse in the N BMI mother. Further research is warranted on the influence of maternal BM SCVFA composition on the growth and neurological development of her infant.

Introduction: The prevalence of childhood overweight and obesity has steadily increased in recent decades, presenting a serious risk to public health and significant burden on individuals, healthcare systems, and society more broadly. Early intervention family-based lifestyle programs are an efficacious intervention for addressing childhood obesity. However, many studies have not included a process evaluation which can limit future scale-up of efficacious interventions. The Family Healthy Living Program (FHLP), an evidence-based, stakeholder-informed family-based healthy living intervention for children with a BMI-for-age ≥85th and their families was developed and piloted in British Columbia. The free 10-week program, based on the multi-process action control theory, utilized a blended delivery model consisting of 90-minute weekly group sessions plus online lessons, four community-based activities and four maintenance sessions. Topics included healthy eating, physical activity, sleep, screen-time, positive mental health, food and physical literacy, and behavior change techniques. Eleven programs ran in seven BC communities (September 2018-April 2019). Purpose: To evaluate the recruitment, intervention content, delivery, and implementation of the FHLP for quality improvements and to inform decisions about potential scale-up. Methods: A mixed-methods concurrent triangulation process evaluation design with equally-weighted qualitative and quantitative data was used and represented one component of a Type I hybrid effectiveness trial for the FHLP Study. Implementation was evaluated at both family and program delivery levels. Family measures were reach, recruitment, dose received, satisfaction, and facilitators and barriers to participation. Program delivery measures were adoption, fidelity, acceptability, feasibility, compatibility, and facilitators and barriers to program implementation. Qualitative data was collected through interviews and focus groups with parents, program leaders, recreation centre managers, and program support team. Quantitative data was collected from parent and child satisfaction surveys, weekly program leader surveys, attendance forms, and online lesson analytics. Quantitative descriptives were generated using SPSS. Qualitative interviews were recorded and transcribed using Transcriptive™ software, and analysis conducted using NVIVO. A framework analysis approach was applied. Results: 132 families were eligible (n=211 enquiries), and 79 families (88 children) registered (42%). 55 families (63 children) started the program and 80% completed. Of those, 82.5% of families attended 70% of sessions. 26% of families accessed 30%+ of core online lesson content. Average contact time was 17.7 hours (range 12.78-25.02). Family participation facilitators were: free of cost, location, sibling inclusion, and complimentary recreation passes. Participation barriers were: other commitments, illness, transportation, and scheduling. Program acceptability/satisfaction across parents and children was high, with satisfaction ratings over 4/5 for all measures. Seven of the nine (78%) communities originally identified as pilot sites implemented the program. Fidelity was 73.5% across program components (range 42-95%). At the delivery-level, implementation facilitators were high compatibility and feasibility, context (support from recreation centre, having qualified staff), and resources (room availability, manual, equipment, grant funding). Barriers to implementation were recruitment, small group size, attendance, and limited time to deliver material. Interviews showed program leader acceptability/satisfaction across all sites. Conclusions: The FHLP was acceptable and feasible for families and program delivery partners, but recruitment, attendance, and on-line engagement were implementation challenges. Program adjustments are recommended prior to scale-up. / Graduate / 2021-08-26

Patients with obesity develop a metabolic heart disease (MHD) of unclear mechanisms and limited therapeutic options. MHD is characterized by left-ventricular hypertrophy and impaired ventricular relaxation and is associated with cardiac lipid accumulation, oxidative stress and impaired energetics. Mitochondria play a critical role in cardiac metabolism and mitochondrial dysfunction results in a pathologic decrease in ATP production and increase in reactive oxygen species (ROS) generation. I hypothesized that nutrient excess and cardiac lipid accumulation impair mitochondrial function and cause cardiac remodeling through mitochondrial oxidative stress. Mice overexpressing fatty acid transport protein 1 (FATP1) in cardiomyocytes have increased uptake and use of cardiac lipids and develop MHD. I observed that FATP1 mice have increased cardiac diacylglycerols and PKC activation and decreased mitochondrial biogenesis, size, and oxygen consumption with unchanged ATP synthesis and ROS production. Overexpression of the antioxidant enzyme catalase in mitochondria (mCAT) does not attenuate MHD in FATP1 mice. This suggests that FATP1-driven cardiac lipid accumulation leads to compensated downregulation of mitochondrial function without oxidant overproduction. Mice fed a high fat, high sucrose (HFHS) diet have myocardial oxidative stress and develop MHD. I observed that cardiac mitochondria of HFHS-fed mice have increased ROS production and decreased ATP synthesis and oxygen consumption. HFHS-fed mCAT mice do not develop mitochondrial dysfunction or cardiac remodeling, suggesting that mitochondrial ROS may mediate HFHS-driven mitochondrial dysfunction and MHD. Mice with partial loss of the mitochondrial transporter ABCB10 exhibit cardiac oxidative stress leading to impaired recovery from ischemic injury. I generated mice with cardiomyocyte-specific ABCB10 deletion and observed that ABCB10 loss decreases mitochondrial oxygen consumption and increases ROS production without altering ATP synthesis or affecting cardiac structure and function. After HFHS feeding, mice with heterozygous loss of cardiomyocyte ABCB10 have exaggerated MHD and increased mortality, suggesting a protective role of ABCB10 in MHD induced by HFHS diet. In summary, cardiac lipid accumulation leads to transcriptional downregulation of mitochondrial respiration, while dietary fat and sugar excess leads to mitochondrial dysfunction and cardiac remodeling driven by mitochondrial oxidative stress and exacerbated by loss of ABCB10. This study suggests that oxidant-driven mitochondrial dysfunction plays a key role in MHD.

Childhood obesity has become a growing problem in America; rates have tripled over the past 30 years, and more than 17 percent of America's children are classified as overweight or obese.  To combat the rise in childhood obesity, the federal government mandated in 2004 that all public school districts adopt a local school wellness policy that incorporates goals to improve the wellness environments of these public schools.  Previous research has indicated that the success of these policies is mixed; however, there has been no comprehensive research evaluating the quality of school wellness policies in Virginia, Maryland and the District of Columbia. The purpose of this research is to evaluate local wellness policies within the Mid-Atlantic region.  These evaluations include a preliminary wellness policy evaluation based on locale (rural and urban school districts), an evaluation of the strength and comprehensiveness of template-based policies versus locally developed policies, and a comprehensive evaluation of physical activity policies within Virginia, Maryland and DC.  The last study included is an evaluation of the association between physical activity policy quality and physical activity rates within selected middle schools. The results of this research show that wellness policy quality across the Mid-Atlantic region is weak and moderately comprehensive, and that the adoption process may impact the quality of a local policy.  Furthermore, physical activity policy within the region is also weak and moderately comprehensive, and the results show that school districts that have adopted stronger and more comprehensive polices may be associated with higher local physical activity rates. / Ph. D.

Worldwide obesity has increased at an alarming rate since the 1970’s. It has become a considerable health issue in the United States. A third of the population currently qualifies as obese. These numbers strain the healthcare system and result in higher health care costs related to comorbidities such as type 2 diabetes mellitus, hypertension, and hyperlipidemia. Many individuals attempt to lose weight with dietary changes, physical activity, or medications. These strategies can be effective and assist with modest weight loss but they often fail to meet a patient’s expectations or achieve desired weight loss. Therefore, bariatric surgery becomes an attractive option for many people. There are several types available and significant weight loss is seen with some losing over one hundred pounds in the course of year. These dramatic weight losses improve quality of life and improve or eliminate some comorbid diseases. Unfortunately, research shows that about 1.5 to 2 years post operatively, a large proportion of these people experience a weight regain and results are usually not sustained. Seemingly, this weight regain starts to occur due to a lack of structure and support. Prior to bariatric surgery, there are requirements that one must complete including demonstrating weight loss on their own, attending sessions with a nutritionist, and undergoing a psychological evaluation. In contrast, few surgical programs provide patients with this type of structure post-surgically. Thus, this proposed study aims to incorporate a standardized online multi-disciplinary intervention to prevent weight regain after bariatric surgery. Information on weight trends will be recorded at regular follow up appointments and health related quality of life determined by surveys. After completing this intervention, it is predicted that patients will experience fewer weight fluctuations, limited to no recurrence of comorbidities and an improved quality of life.

The current method of quantifying obesity in the veterinary patient is the subjective body condition score; however, scant research has focused on the development of an objective measurement. The present two part study evaluates the ability to create and refine an objective body mass index (BMI) formula for the large breed canine patient. In the first part of this study, seven morphometric measurements were obtained from seventy large breed dogs allowing the creation of five BMI formulas. In the second part of this study, computed tomography images were obtained from twenty-two dogs and the total percent body fat (TBF) was calculated. Results from the five formulas were compared to the calculated TBF to evaluate their accuracy. A final BMI formula was developed that has a very strong correlation with the TBF, and provides an objective measurement of obesity in the large breed canine patient.

Regular consumption of dairy is thought to aid in preserving lean body mass while decreasing body fat, however, studies have reported inconsistent results. The overall aim of this cross-sectional study was to examine the influence of dairy consumption on body composition, specifically body fat percentage, among college-aged individuals in Mississippi. Total dairy consumption, type of dairy, and the relationship between race and sex were examined in 580 participants aged 18-26 years. Two-tailed correlation tests revealed a nonsignificant relationship between frequency of dairy consumption and body fat percentage among males, (r = .02, p = .68, n = 98) and females, (r = .06, p = .17, n = 469). There was also a nonsignificant interaction among race categories and dairy consumption. Future studies examining college-aged individuals should be performed with a more diverse sample to see if a relationship exists.