Barnfetma är ett av de allvarligaste folkhälsoproblemen, ungefär 20-25 % av Sveriges barn och ungdomar är överviktiga. Barn med övervikt riskerar att drabbas av sjukdomar såsom diabetes, leverpåverkan och fettrubbningar samtidigt som de riskerar att bli mobbade av andra barn. Syftet var att ta reda på hur barn och föräldrar kan förebygga övervikt och fetma hos barnet samt vilken roll sjuksköterskan spelar i förebyggandet av barnövervikt. Vetenskapliga artiklar söktes på Pubmed och har sammanställts till ett resultat. Två av studierna beskrev att programmet "Let's go 5-2-1-0" kan motivera barn att gå ner i vikt och förbättra sina hälsovanor, tillsammans med motiverande samtal ger det ännu bättre resultat. Även genom att använda äldre elever som mentor till yngre elever kan hälsovanor förbättras. Föräldrarna spelar en stor roll, det kan bli problem när föräldrarna inte anser att barnets övervikt är ett problem och det finns även en rädsla för ätstörningar om ämnet tas upp med barnet. Ett annat problem som beskrevs vara den enkla åtkomsten av onyttig mat och dryck och bristen på billiga faciliteter för utförande av fysiska aktiviteter. Två studier belyste att sjuksköterskorna upplevde brist på tid, verktyg och resurser för att arbeta förebyggande mot och behandla barnfetma. Slutsatsen är att för att lyckas med förebyggande och behandling av övervikt krävs att föräldrarna är motiverade att utföra ändringar i vardagen. Sjuksköterskor inom primärvården och på barnmottagningen och skolsköterskor anser sig inte ha tid, verktyg eller resurser att hantera detta problem och de anser att det krävs mer utbildning och tid. / Childhood obesity is a serious public health problem, 20-25% children and youth in Sweden are overweight. Children who are overweight are at risk of diseases such as diabetes, liver disorders, lipid disorders and risk of being bullied by other children. The aim was to find out how children and parents can prevent overweight and obesity in children and what role nurses play in the prevention of child obesity. A search for scientific articles was made on PubMed and those where compiled to a result. Two studies described the "Let's go 5-2-1-0" program as successful to motivate children to lose weight and to better their health habits, together with motivational interviewing an even better result emerged. Using older students as mentors for the younger students can also improve the children's healthy habits. The parents play a big role in the prevention and treatment of childhood obesity and it can become a problem when the parents don't consider their child to be overweight or obese and there is a fear for eating disorders if the subject is brought up with the child.  Another problem described was the easy access to unhealthy food and lack of cheap facilities for the execution of physical activity. Nurses experienced a lack of time, tools and recourses to work preventive against and to treat childhood obesity.  In conclusion, to succeed with the prevention and treatment it is required that the parents are motivated to make the necessary lifestyle changes, and the nurses need more education and time.

Sammanfattning  Bakgrund  Övervikt och fetma definieras som ”onormal eller överdriven ansamling av fett som utgör en risk för hälsa”. Förekomsten av fetma har globalt fördubblats sedan 1980-talet. Enligt barnhälsovården var 2011 8,0 - 13,5 % av Sveriges fyraåringar överviktiga och 1,8 - 2,7 % hade fetma.  Syfte  Att belysa barn och ungdomars (8-19 år) erfarenheter av att leva med övervikt eller fetma samt granska hur den metodologiska aspekten datainsamlingsmetod beskrivs.  Metod  Litteraturstudie med deskriptiv design. Sammanställning av tolv artiklar med kvalitativ och kvantitativ ansats samt mixed metod. Systematisk databassökning i PubMed.  Resultat  Barn och ungdomar har svårt att identifiera sig som överviktigt/feta. Kroppsuppfattning är individuellt och skiljer sig mellan könen, flickor identifierar sig i större utsträckning som överviktiga/feta.  Barn och ungdomar med övervikt/fetma upplever i större utsträckning utsatthet/mobbning än normalviktiga i t.ex. skola, vid fysisk aktivitet eller sociala medier där vänner och/eller familjemedlemmar ger viktrelaterade kommentarer. Samband kan ses mellan utsatthet/mobbning under ungdomsåren och senare i livet.  Reducerad livskvalitet är vanligt förekommande i form av försämrat självförtroende, depression samt påverkad fysisk aktivitet.  Generellt finns en god förståelse gällande sund livsstil, detta uppfattas svårt att leva efter och familjen har en viktig stöttande roll. Trygghet och tillhörighet återfinns även hos andra överviktiga/feta kamrater.  Slutsats  Barn och ungdomar med övervikt/fetma mår sämre än normalviktiga. Detta visar sig i sämre kroppsuppfattning, reducerad livskvalitet och utsatthet/mobbning. Därför är av stor vikt att i tidigt skede uppmärksamma barn och ungdomar med viktproblematik, detta för att i erbjuda adekvata vårdinsatser. / Abstract  Background  Overweight and obesity is defined as abnormal or an overexaggerated amount of fat that creates a risk for ones health. The presence of obesity has doubled globally since the 1980's. According to the Child Health Care 2011 were 8,0 - 13,5 % of Swedens four year olds considered to be overweight, and 1,8 - 2,7 % are considered obese.  Purpose  The purpose of the literaturestudy is to describe the experiences of children and adolescents (8-19 years) living with overweight/obesity and examine how the methodological aspect of data collection method is described.  Method  The methods consisted of: a literature study with descriptive design, a systemativ computer based search with PubMed and a summary of 12 qualitative and quantitative studys and mixed metod.  Results Children and adolescents have a hard time identifying themselves as overweight/obese. Body image is individual and there is a clear distinction between the sexes, where girls tend to identify themselves more as overweight/obese. Children and adolescents tend to experience a greater degree of bullying and vulnerability then would children of normal weight, in school, social media and when exerting themselves physically from friends and family members who make weight related comments. Correlations can be seen between vulnerability and bullying in both the youth ages and into adulthood. Reduced quality of life is often experienced through weakened sense of self-confidence, and depression, as well as poorer performance in physical activity. Children and adolescents in general have a good understanding of what it means to have a healthy lifestyle, but find it difficult to follow. Family has a very important role in supporting this lifestyle, security and belonging are also found in other overweight/obese peers. Conclusion Children and adolescents who are overweight/obese feel worse than normal weight peers. This shows itself through poorer body awareness, reduced quality of life and vulnerability/bullying. Therefore it is of great importance to the early attention to children and young people with weight problems, in order to offer appropriate health care interventions.

The aim of the current study is to understand the health trajectory of female veterans who participated in a VHA sponsored weight management program and explore possible barriers to sustained weight loss and improved metabolic functioning over time. Obesity is a major health concern for discharged service members and women veterans in particular are faced with an increasing prevalence of obesity at a younger age with obese ethnic minorities posing the greatest health risk over time. The current study measured body mass index (BMI), triglycerides, and total cholesterol in female participants enrolled in the MOVE! ® Weight Management Program for Veterans at the Miami VAHS from 2005-2008 (N = 170). The sample was derived from an archival data set and participants were predominantly non-Hispanic Black (NHB) (n = 93, 54.7%), with a mean age of 48.26 (SD = 11.77) and BMI of 34.97 (SD = 6.61) at program entry. Medical information was gathered as part of routine primary care and participants were not asked to provide additional information. Multilevel modeling was utilized to measure change in BMI, triglycerides, and total cholesterol across seven time points before and after MOVE! ® participation. For the piecewise model, results showed a positive linear growth pattern in BMI prior to program enrollment, SE = .12, p < .001, and a negative linear pattern post-intervention, SE = .08, p = .05. For the continuous models, significant differences in triglycerides were observed between ethnic groups at program entry, but overall triglycerides did not significantly change over time. A significant negative linear effect was found for total cholesterol, SE = 1.08, p < .001. Age was found to be a significant negative predictor of triglycerides, SE = .003, p = .008, and total cholesterol, SE = .27, p = .003. VA user status, small sample size, and other extraneous lifestyle factors not directly measured in the current study may explain the lack of significant differences in BMI found between ethnic groups relative to literature on weight loss outcomes. Additionally, BMI in women may underestimate their total fat, which for the present study may explain why larger improvements in metabolic functioning were not observed. Future designs may consider measuring waist circumference to understand the complex relationship between total fat distribution and markers for poor health and utilizing a tailored approach to weight management.

Bakgrund: Övervikt och fetma är ett ökande problem i det moderna samhället, och bär med sig fysiska komplikationer som exempelvis diabetes och hjärt- och kärlsjukdomar. Även psykiska utmaningar som stress och depression kan framträdas. Stereotypisering av överviktiga personer kan innebära bemötande av varierande kvalitet. Syfte: Syftet med denna studie var att belysa människors upplevelser av att leva med övervikt och fetma. Metod: En litteraturstudie med tio artiklar, varav två var kvantitativa och åtta kvalitativa. Resultat: Tre teman identifierades: Känsla av stigmatisiering/fördomar, Känsla av förnedring, Skuld och skam. Slutsats: Övervikt och fetma bär med sig fysiska, psykiska och sociala komplikati oner. Det kan hända att överviktiga individer väljer att inte söka vård på grund av att de har upplevt att de blivit förnedrade av vårdgivare. Klinisk betydelse: För att överviktiga personer ska få bättre vård krävs det att vårdgivare som exempelvis sjuksköterskor blir mer medvetna om överviktigas upplevelser. Genom detta, kan omvårdnad av dessa personer uppnå bättre kvalitet. / Background: Overweight and obesity is a rising problem in the modern society, and carries physical complications such as diabetes and cardiovascular diseases. Psychical complications such as stress and depression can also become apparent. Stereotyping of overweight people could lead to treatment of varying quality. Aim: The purpose of this study was to elucidate people's experiences of living with overweight and obesity. Method: Literature review with ten articles, in which two are quantitative and eight qualitative. Results: Three themes were identified: Feelings of stigmatization/prejudice, Feelings of humiliation, Shame and guilt. Conclusion: Overweight and obesity carries physical, psychological and social complications. People with overweight may choose not to seek health care due to having experienced humiliation from caregivers. Clinical significance: In order for overweight people to receive better health care, caregivers such as nurses need to become more aware of overweight people's experiences. In doing so, health care can achieve better quality.

Background: Studies show that being overweight and obese is the greatest health issue facing the youth today. The physical, psychological and social effects have both short and long term risks for obesity related diseases that will require healthcare. Information concering preventive methods that are available for health care personnel and nurses is a requirement. Purpose: The purpose with this literary study is to describe secondary preventive methods and their effects on overweight or obese children. Method: In this literary study, eight quantitative research papers have been examined and analysed to draw conclusions. The following databases have been used for research: PubMed and CINAHL. Manual research was also conducted. Results: The analysation of the conclusions draw resulted in headlines that describe the interventions and their effects, both short and long term. Four components could be identified: 1. ”MI- motivational iinterviewing”, 2. ”CBT- cognitive behavioral therapy”, 3. ”Social cognitive theory”, and 4. ”Combined strategies”. Conclusion: Despite varying models, positive results could be seen in every case study. Consolidated information concering secondary preventive methods is needed. This information must become readily available to health care personnel and nurses in particular. More research is a necessity. / Bakgrund: Studier visar att övervikt och fetma är det största hälsoproblemet hos barn och unga. De fysiska, psykiska och sociala effekter tillståndet medför på både kort- och lång sikt ökar risken för överviktsrelaterade sjukdomar som slutligen landar hos sjukvården. Information kring preventiva metoder är något som därför behövs. Syfte: Syftet med litteraturstudien var att beskriva sekundärpreventiva metoder och dess effekter vid barns övervikt och fetma. Metod: I denna litteraturstudie har åtta kvantitativa studier granskats och analyserats för att bilda ett resultat. Sökningar gjordes i databaserna PubMed och CINAHL. Manuella sökningar utfördes även. Resultat: Analysen resulterade i rubriker som beskriver interventionerna, deras effekter samt långsiktiga effekter. Även fyra komponenter kunde urskiljas i studierna: 1. “MI-motivational interviewing”, 2. “KBT-kognitiv beteendeterapi”, 3. “Social inlärningsteori” samt 4. “Kombinerade strategier”. Slutsats: Trots varierande modeller kunde effekter ses i alla studier som analyserats. Sammanställd information kring sekundärpreventiva metoder behövs för att lätt nå sjukvårdspersonal, och då i synnerhet sjuksköterskan. Vidare forskning inom området behövs.

Syfte: Att undersöka hur mycket fysisk aktivitet barn i åldrarna 14-17 år registrerade vid överviktsenheten på ett barnsjukhus i Mellansverige utför samt att jämföra flickors och pojkars fysiska aktivitet. Vidare har barns självskattning av fysisk aktivitet jämförts med hur det sedan ser ut när de registrerat sin fysiska aktivitet i en aktivitetsdagbok. Metod: En kvantitativ tvärsnittsstudie utfördes. Femtiotre barn inskrivna på överviktsenheten vid ett sjukhus i Mellansverige, varav 27 var pojkar och 26 var flickor, inkluderades i studien. Relevant data för studiens syfte samlades in från de enkäter som fylls i vid nybesök samt från deltagarnas aktivitetsdagböcker. Deltagarna kategoriserades och delades in i grupper efter fysisk aktivitetsnivå samt deras uppskattade fysisk aktivitetsnivå varpå statistiska analyser genomfördes. Resultat: Drygt 22 % av deltagarna uppnådde den mängd fysiska aktivitet som rekommenderas i Sverige för den aktuella ålderskategorin. Ingen statistiskt signifikant skillnad fanns mellan kön och fysisk aktivitet, däremot fanns en signifikant skillnad mellan hur enkäterna besvarades och kön som visade att flickor överskattar sin fysiska aktivitet. De flesta av studiens deltagare trodde sig utföra mindre fysisk aktivitet än jämnåriga vilket också stämde överens med hur mycket fysisk aktivitet de faktiskt utförde. Slutsats: Enligt utförd studie är det få av de barnen inskrivna på överviktsenheten som kommer upp i NNR:s rekommendationer om fysisk aktivitet, dock krävs mer omfattande studier för att kunna generalisera detta på en större befolkning. Det fanns ingen statistiskt signifikant skillnad gällande utövande av fysisk aktivitet mellan könen, för att undersöka detta mer noggrant krävs vidare studier med större urval. En signifikant skillnad fanns i hur flickor och pojkar skattade sin egna fysiska aktivitet där flickor skattade sin fysiska aktivitet högre än jämnåriga pojkar. Det krävs vidare studier för att undersöka anledningen till detta. Det är viktigt att en förståelse för detta fenomen finns hos vårdgivare för att optimera samarbetet med patienten och för att på bästa sätt kunna hjälpa denne i sin situation och i sitt lidande. / Objective: To examine how much physical activity the children at the Obesity Unit at a hospital in the middle of Sweden, between the ages of 14-17, registered and to compare differences between boys and girls and differences in how the children perceive their physical activity compared to the physical activity that they registered in an activity diary. Methods: A quantitative cross-sectional study was performed. Fifty-three children enrolled at the Obesity Unit at a hospital in central Sweden were included in the study, of whom 27 were boys and 26 were girls. Relevant data for the purpose of the study was collected from the questionnaires filled out by the participants during their first visit to the Obesity Unit and from their activity diaries. The participants were categorized and divided into groups according to their physical activity level and imagined physical activity level, whereupon statistical analyses were performed. Results: A little bit more than 22% of the participants attained the amount of physical activity recommended in Sweden for that age category. No statistically significant difference was found between gender and physical activity, however, a significant difference was found between how the questionnaires were answered and gender, which showed that girls overestimated their physical activity. Most of the study participants believed they performed less physical activity than their peers which is also accurate with how much physical activity they actually performed. Conclusions: In the study conducted, few of the children enrolled at the Obesity Unit attained NNR's recommendations for physical activity, however more extensive studies are acquired to be able to generalise this on a larger population. There was no statistically significant difference regarding the practice of physical activity between the sexes, to investigate this further deeper studies are required. A significant difference was found in how girls and boys rated their own physical activity where girls rated their physical activity higher than their male peers. Further studies are required to examine the reasons why. Comprehension about this phenomena is important to optimise interactions with this patient group.

ABSTRACT ASSOCIATION OF ANTIOXIDANT INTAKE AND BODY MASS INDEX IN PRE-TO-EARLY ADOLESCENT CHILDREN by E. Kelly Imboden Background: The prevalence of overweight (Body Mass Index [BMI]85-<95th percentile) and obesity (BMI>95thpercentile) for individuals aged 2-19 years in the United States in 2009-2010 was estimated to be 31.8%. Excessive body fat increases the risk for chronic conditions such as hypertension and type 2 diabetes mellitus. Studies have established an association between obesity and oxidative stress and inflammation in children and adolescents. Antioxidants have been shown to have protective effects against inflammation and oxidative stress. However, the effect of dietary antioxidant intake on obesity is not fully understood. Objective: To examine dietary antioxidant intake by BMI classification in a population of normal, overweight and obese children. Methods: The study population included 296 healthy pre-to-early adolescent (age 6-15 years) African American and Caucasian children residing in Pittsburgh, PA. Demographic characteristics, anthropometric measures and nutrient intake were assessed at baseline and six months. A food frequency questionnaire was used to assess antioxidant intake (vitamin C, carotene, total vitamin A, zinc and vitamin E). Frequency analysis was used to describe demographic, anthropometric and nutrient data. The Kruskal Wallis test was used to evaluate difference in median antioxidant and kilocalorie intake by BMI classification at baseline. A Kendall’s tau correlation was performed to test for a linear relationship between BMI and antioxidant intake at baseline. Results: The median age of the population was 10 years (range, 8 to 11 years). The majority of the population was male (53%) and African American (60%). Weight and BMI (p = 0.028 and 0.000, respectively) were the only demographic and anthropometric characteristics that differed by gender. For the total cohort, median nutrient intake by BMI classification was significantly different for vitamin C (p = 0.015), zinc (p = 0.019), vitamin E (p = 0.022) and kilocalories (p = 0.015). When divided by gender, zinc intake in males (p = 0.047) and kilocalorie intake in females (p = 0.017) were the only nutrients found to be statistically different by weight classification. No linear relationship was observed between antioxidant intake and BMI for the total cohort and for each gender. Conclusion: Our results do not support a linear relationship between antioxidant intake and BMI. In contrast to our hypothesis, antioxidant intake was found to be highest in children who were overweight. Future studies should include a serum measure of inflammation and antioxidant levels in addition to antioxidant intake to better understand the impact, if any, of antioxidants in overweight and obese children and adolescents.

Fibrinolysis is the process by which fibrin blood clots are dissolved. Fibrinolytic research is clinically relevant because decreased fibrinolytic potential is linked to increased risk of an ischemic event. Fibrinolysis is known to increase in response to aerobic exercise, however, few research studies have focused on the fibrinolytic response to resistance exercise. Furthermore, women are severely underrepresented in fibrinolytic research, and there are no current studies that focus on women and resistance exercise. Estrogen has been shown to affect basal fibrinolytic potential resulting in the need for fibrinolytic research focused on female subjects. Body composition is known to influence basal fibrinolysis leaving individuals with higher absolute amounts of body fat at risk for cardiovascular events due to decreased fibrinolytic potential. Little is known, however, about the influence of body composition on the fibrinolytic response to exercise. Purpose. The purpose of this study was to describe the fibrinolytic response to acute resistance training in young women, and further, to determine how body fat percentage affects fibrinolysis at rest and following resistance exercise. Methods. Twenty-three sedentary, healthy women (22.5 ± 4 yrs, 22.3 ± 3.0 kg•m 2) participated in the study. Body fat percentage and fat distribution were assessed using dual-energy X-ray absorptiometry (DEXA), and subjects were separated into two groups by body fat percentage: <30% (lean, n=12) and >30% (obese, n=11). Each subject performed 6 sets of 10 leg extension repetitions at an intensity associated with 70% of her one-repetition maximum. The two primary mediators of fibrinolytic potential, tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1(PAI-1), were assessed at baseline and immediately after exercise in venous blood. Results. tPA activity increased in response to acute resistance exercise (p<0.05), however, there was no significant change in PAI-1 activity (p>0.05). A significant main effect of group was observed, indicating the lean women had higher tPA activity (p<0.05) and lower PAI-1 activity (p<0.05) than the obese group. A significant time x group interaction indicated that the tPA response was blunted in the obese group (p<0.05). Conclusions. Fibrinolytic potential increases in response to acute resistance exercise in young women due to increases in tPA activity. Obese women demonstrate a decreased fibrinolytic potential at rest and following acute resistance exercise compared to lean women. Given the relationship between fibrinolytic potential and outcomes of cardiovascular disease, these physiological responses suggest that overweight women may be at elevated risk of an adverse cardiovascular event both at rest and during exercise. / School of Physical Education, Sport, and Exercise Science

This thesis is an investigation into women’s experiences of repeatedly attempting to lose weight and maintain a weight they find acceptable, and the implications of this for health education. This was an interpretivist inquiry which generated data through narrative interviews. The data was analysed using three different strategies to enable deeper understanding of the participants’ experiences. To set the context health education resources relating to body weight, healthy eating and activity were collected from local community and health settings. A former local practice nurse was also interviewed about her role in assisting women with weight loss. A literature review revealed an emphasis on research and policy that focuses on the dangers of overweight and obesity, prioritising individual behaviour and energy-deficit approaches to losing weight. A qualitative method was used to collect data from a convenience sample of five women. Data from interviews and autobiographical writing were recorded, transcribed and analysed within a narrative analysis framework. Analysis of the findings using three interpretive lenses are presented first as re-storied accounts of the women’s narratives, and secondly thematic analysis addressing issues of control, pleasure and pain, and embodiment and alienation. Finally a relational analysis reveals the ways in which participants position themselves in relation to themselves, other characters and the interviewer in order to build their desired identities. The data shows that the participants had followed a wide and diverse range of diets, eating and exercise plans, none of which had been successful in both reducing their weight and maintaining it at a level they were happy with, even after repeated attempts. Whilst biomedical literature suggests a dividing line between pathological eating disorders such as anorexia nervosa/bulimia and normality, the disordered eating and emotional difficulties described by the participants supports the view that a broad range of eating and body-image problems may be more culturally normative than is generally recognised. Dieting and weight cycling were common experiences. The findings of the thesis suggest that contrary to current public policy, the views of these women who are unhappy with their body weight are complex, idiosyncratic and demonstrate resistance to health messages that target individual responsibility for weight management. Their views are developed from personal experiences - the findings suggest that these women are stigmatised. However, one response to this can be to stigmatise other people whom they see as more overweight than themselves. Normative femininity is increasingly centred on appearance and women who do not comply with the requirements risk alienation and pain. The identities that the women construct are relevant for health education but not taken into account when national policy and strategies are developed to address overweight and obesity. The risks to health of weight cycling are also not addressed by policy. The implications of the thesis are discussed in relation to the embodied experiences and gendered roles of women, the role of health education and its relationship with biomedicine.

Background: Internalized weight stigma has gained growing interest due to its association with multiple health impairments in individuals with obesity. Especially high internalized weight stigma is reported by individuals undergoing bariatric surgery. For assessing this concept, two different self-report questionnaires are available, but have never been compared: the Weight Self-Stigma Questionnaire (WSSQ) and the Weight Bias Internalization Scale (WBIS). The purpose of the present study was to provide and to compare reliability, convergent validity with and predictive values for psychosocial health outcomes for the WSSQ and WBIS. Methods: The WSSQ and the WBIS were used to assess internalized weight stigma in N = 78 prebariatric surgery patients. Further, body mass index (BMI) was assessed and body image, quality of life, self-esteem, depression, and anxiety were measured by well-established self-report questionnaires. Reliability, correlation, and regression analyses were conducted. Results: Internal consistency of the WSSQ was acceptable, while good internal consistency was found for the WBIS. Both measures were significantly correlated with each other and body image. While only the WSSQ was correlated with overweight preoccupation, only the WBIS was correlated with appearance evaluation. Both measures were not associated with BMI. However, correlation coefficients did not differ between the WSSQ and the WBIS for all associations with validity measures. Further, both measures significantly predicted quality of life, self-esteem, depression, and anxiety, while the WBIS explained significantly more variance than the WSSQ total score for self-esteem.