Philosophiae Doctor - PhD / Overweight/obesity is a risk factor for non-communicable diseases such as cardiovascular diseases, diabetes, and some cancers. Obesity in childhood is known to predict later obesity in adolescence and adulthood. Understanding the factors associated with overweight/obesity among children may present an opportunity for timely and appropriate interventions in the African setting.

Background: Adolescent obesity and overweight in the US continue to be a serious public health issue. Youth obesity and overweight are associated with increased health risks and healthcare utilization costs and have steadily climbed since the 1990s. The national Youth Risk Behavior Survey (YRBS) is administered bi-annually to a representative sample of high school students enrolled in public and private schools throughout the US and is publicly accessible for study. The purpose of this study is to examine risk trends of youth obesity and overweight over 20 years (1999-2019) on a national scale, as well as specifically within the State of Tennessee. Methods: Statistical analyses were performed using SAS 9.4 and SUDAAN 11.0.3. Linear and quadratic analyses specifically examined disparities and risk trends of obesity and overweight prevalence using stratification methods of age (grade 9-12) and race (White, African American, Hispanic/Latino, Other races) to better understand the issue of childhood obesity and overweight. Overweight is defined as a BMI at or above the 85th percentile and below the 95th for children and teens of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. Results: Overall, there were 161,606 cases included in our sample representing 20 years of YBRS survey data. The obesity prevalence of high school students in the US increased 2.38% from 1999 to 2005, decreased 1.15% from 2005 to 2009, then increased 3.65% thereafter. Over the two decades period, youth obesity rates significantly increased (~5%) in the US, based on results of the Cochran-Armitage trend test (Z=16.10, P Conclusion: Except for Hispanics from 2003 to 2009, a higher prevalence of youth overweight or obese among each race were seen in Tennessee each year, and except for 2003, there was a higher prevalence of both males and females in Tennessee who were overweight or obese each year. While national rates increased over the 20-year period, the increase was higher in TN. Rising obesity in the US is a public health crisis. Obesity is a grave public health threat, more serious even than the opioid epidemic or covid19. Obesity-related prevention research should be a priority because there are high costs to individuals and states due to the burden and health care costs the condition presents.

Objective. The current study examined the use of stimulus control, self-monitoring, and reinforcement by youth, parents, and interventionists as related to weight management in lifestyle intervention programs. Design. Secondary analysis of an existing data set was used to integrate the results of 14 published, randomized treatment–control intervention trials for overweight youth aged 2 to 18 years. Main outcome measure. Between-group differences in weight-related outcomes, including weight, body mass index (BMI), and percentage overweight, measured at the end of treatment, were used to calculate effect sizes for each treatment–control comparison. Additionally, average effect sizes were calculated among sets of comparisons sharing similar approaches to implementing behavioral techniques. Results. Treatment programs that taught youth to use stimulus control, taught youth to self-monitor, and taught parents to use reinforcement, produced significantly larger effect sizes than programs that did not include these components. The beneficial effects of these specific behavioral techniques appeared to be amplified when used with multiple key individuals. Conclusion. This initial study quantitatively demonstrated significant benefits associated with teaching youth stimulus control and self-monitoring, and teaching parents reinforcement to shape health behaviors in lifestyle interventions for pediatric overweight. Furthermore, teaching youth and parents the same techniques may contribute to better weight-related outcomes. These findings and descriptive information on how techniques were described, taught, and delivered may guide future research efforts aimed at identifying and examining the most effective behavioral components to include in brief interventions.

Objective: To assess the association between weight dissatisfaction, weight status, and weight loss in Mexican-American children participating in a weight management program. Methods: Participants included 265 Mexican American children recruited for a school-based weight management program. All children completed baseline assessments and changes in standardized body mass index (zBMI) were monitored in at-risk for overweight and overweight children (i.e., >85th BMI percentile) who had been randomized to receive the weight loss intervention (n = 101). Results: Participants classified as at-risk for overweight or overweight reported greater weight dissatisfaction than normal weight children. Lower weight dissatisfaction at baseline was associated with greater changes in zBMI at 6 months. Weight dissatisfaction did not change across the course of treatment. Conclusions: Mexican-American children whose weight status is greater than normal have greater weight dissatisfaction. Children with greater weight dissatisfaction are less likely to lose weight in a weight management program and weight dissatisfaction remains stable over the course of treatment.

Parent involvement has been recognized as a promising component in the treatment of pediatric overweight. However, to what extent and how to involve parents remains unclear. Family systems models have been used to treat a range of childhood illnesses and may also provide a useful framework for understanding and treating pediatric overweight. The current review presents relevant literature on family systems and child health, discusses the current state of intervention efforts in pediatric overweight, and utilizes family systems ideas to offer suggestions for practice and directions for research regarding the role of parents in treatment.

Background/Objectives: The possible relationship between smoking and risk of colonic diverticulosis has been suggested by recent epidemiological studies, although the results were inconsistent. This meta-analysis was conducted to summarize all available data. Methods: A comprehensive literature review was conducted using the MEDLINE and EMBASE databases through May 2017 to identify all studies that compared the risk of colonic diverticulosis among current and former smokers versus nonsmokers. Effect estimates from each study were extracted and combined together using the random-effect, generic inverse variance method of DerSimonian and Laird. Results: Of 465 potentially eligible articles, three prospective cohort studies with 130,520 participants met the eligibility criteria and were included in the meta-analysis. The risk of colonic diverticulosis in current smokers was significantly higher than nonsmokers with the pooled risks ratio of 1.46 (95% confidence interval [CI], 1.13-1.89). However, the risk of colonic diverticulosis in former smokers was not significantly higher than nonsmokers with the pooled risk ratio of 1.13 (95% CI, 0.88-1.44). Conclusions: A significantly increased risk of colonic diverticulosis among current smokers is demonstrated in this study.

In the military, excessive weight could put members at risk for training injuries, loss of potential career opportunities, and possible discharge from military service. This could increase cost to United States' national defense through increased injuries, decreased retention due to early discharge, cost of retraining, and lifelong chronic health conditions. The purpose of the study was to determine if there was a correlation or predictive value between active duty Navy members' perception of care provided for weight management and the active duty Navy member's motivation for weight management interventions. The social capital theory served as the theoretical framework for this cross-sectional survey design quantitative study. Data were collected from 241 active duty Navy members using a survey that included questions about clinical practice guidelines and motivation to change. Data were analyzed using Pearson chi-square and multiple linear regression to determine if individual demographics (body mass index [BMI], age, gender, ethnicity, military rank, and marital status) had a correlation or predictive value between reported care received and motivation to change. The results demonstrated a correlation between BMI, age, ethnicity, and care reported (p < 0.01); between BMI and motivation to change (p < 0.01) and between reported care and motivation to change (p <0.01). The potential positive social change implications from the findings of this study could lead to knowledge of individual factors and social factors that support a fit Navy force, lower cost to the nation for national defense through increased retention of highly trained members, decreased chronic health conditions, and lower cost of military health care.

Implementation of an Evidence-Based Childhood Obesity Toolkit in a Rural Pediatric Clinic in Cookeville, TN: A Quality Improvement Project Dawn G. Johnson, MSN, APRN, FNP-BC Tennessee Technological University Nursing 6802 – DNP Project Development Dr. Victoria Pope & Dr. Candice Short March 23, 2022 Author Note Dawn G. Johnson https://orcid.org/0000-0002-7090-8036 College of Nursing, Tennessee Technological University There are no conflicts of interest to disclose. Correspondence concerning this manuscript should be addressed to Dawn G. Johnson, Tennessee Technological University, 248 Haven Lane, Algood, TN 38506 Email: djohnson@tntech.edu Abstract Purpose: The purpose of this quality improvement project is to increase the early identification of overweight or obese children in the primary care setting and provide education through the implementation of an evidence-based childhood obesity toolkit. Aims: This project aims to implement the Healthy Care for Healthy Kids Physical Activity and Nutrition Survey Management Plan to educate patients and parents about childhood obesity. The Healthy Care for Healthy Kids Physical Activity and Nutrition Survey Management Plan is an evidence-based questionnaire and action plan used by healthcare providers in the prevention and treatment of childhood obesity. Processes: Nurses will provide the toolkit to children ages 5-18 who present to the clinic for well-child examinations and have a BMI classified as overweight or obese. Providers will then review the screening toolkit with the patient and family and make a corrective plan of action. The screening tool will then be signed by the patient, caregiver, and provider and placed in the child’s electronic medical record. Results: To be determined after project implementation is complete. Results are anticipated to be that more overweight and obese children are identified by the clinic and proper education is provided to the patient and family. Limitations: The study is limited to one location and only available to the providers who perform well-child examinations. Conclusions: Implementation of an evidence-based childhood obesity toolkit in the pediatric setting with increase the early identification of overweight and obese children. Keywords: childhood obesity, pediatric obesity, toolkit, obesity, overweight

Syftet med denna uppsats är att få kännedom om hur överviktiga barns situation ser ut och vilka erfarenheter de professionella har vad gäller hur barn blir bemötta och vilket stöd som finns i skolan. De professionella intervjuades och delade med sig av sina erfa-renheter och utsagor angående de överviktiga barnens olika situationer i skolan. Jag önskar också att belysa vad skolan gör i relation till överviktsproblemet och vilka ätgär-der som vidtas i fråga om attityder och förhållningssätt gällande övervikt. Övervikts-problemet är komplext och därför finns det inga tydliga svar på mina frågeställningar utan svaren är beroende av de olika faktorer som finns i barnens omgivning. Hur ett barn till exempel mår fysiskt, psykiskt och socialt eller behandlas i skolan är beroende på vilka attityder, engagemang och stöd som finns hemifrån, i skolan och i det övriga samhället. Med andra ord så styr attityden hur överviktiga bemöts samt hur stödet och engagemanget ser ut. Min viktigaste uppgift som lärare i detta sammanhang kommer därför att vara, att tag i överviktsproblemet så att det inte leder till psykiska men som sätter spår för resten av livet.

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