Fear and stigmatization are often used to motivate overweight individuals to engage in healthy behaviors, but these strategies are often counterproductive and can lead to undesirable outcomes. In the present study, I examined the impact of weight-based stigma on cognitive ability (i.e., inhibitory control) and food selection (i.e., calories selected) in individuals who consider themselves to be overweight. I predicted that participants higher in perceived weight stigma would perform more poorly on an inhibitory control task and order more calories on a menu task when they read about discrimination against the overweight versus discrimination against a self-irrelevant out-group. Additionally, I expected that inhibitory control would mediate the relationship between perceived weight stigma and calories ordered for participants who read about discrimination against the overweight, but not for control participants. Participants completed online prescreen measures assessing whether or not they considered themselves to be overweight and their perceptions of weight stigma. Those individuals who considered themselves overweight were then invited into the laboratory to complete tasks to (1) manipulate weight-based discrimination, (2) measure inhibitory control, and (3) measure food selection. As predicted, participants higher in perceived weight stigma performed more poorly on the inhibitory control task and ordered more calories when they read about discrimination against the overweight, but not when they read about discrimination against an out-group. Conversely, inhibitory control did not mediate the relationship between perceived weight stigma and number of calories ordered by participants. Importantly, the present findings provide evidence that perceptions of weight stigma are critical in our understanding of the impact of weight discrimination. Additionally, these results have theoretical and practical implications for both understanding and addressing the psychological and physical consequences of weight-based stigma.

Bakgrund: Barns övervikt ökar i Sverige, vilket är en trend som behöver brytas. Vårdpersonal upplever att det är svårt att samtala om ämnet med föräldrar. Syfte: Undersöka och öka förståelsen för föräldrarnas perspektiv av samtalen med vårdpersonal gällande barns övervik samt identifiera barriärer inom kommunikationen. Metod: Arbetet är en allmän litteraturöversikt som visar på det sammanfattade kunskapsläge som råder. Resultat: Fyra kategorier samt 11 subkategorier har framkommit i resultatet. Föräldrar anser att bemötandet och relationen med vårdpersonal är viktig. Vissa ordval bör undvikas och föräldrarna bör mötas med respekt och inte skuldbeläggas. Familjecentrerad vård föredras. Föräldrar kan ha ett annat synsätt på vad som är mest motiverande för att genomföra en livsstilsförändring. Ett område som delade gruppen föräldrar är huruvida barnet ska närvara vid övervikssamtal. Rädsla att barnet ska ta skada uppgavs vara orsaken. Rådgivningen som ges kritiseras generellt. Föräldrars oro för barnets övervikt behöver tas på större allvar. Barriärer som okunskap, tidsbrist, övervikt och omedvetenhet hos föräldrar samt kulturella skillnader har också identifierats. Slutsats: Arbetet visar på att övervikt ska behandlas som vilket annat sjukdomstillstånd som helst. Familjecentrerad vård föredras där hela familjen involveras. Familjen ska mötas med respekt och inte skuldbeläggas. Kunskapsnivån och motivation till förändring kan förbättras av vårdpersonal. Negligera inte oro för övervikt. Barriärer inom området kräver eftertanke från vårdpersonalens sida. / Background: Overweight among children in Sweden increases, this trend needs to change. Health care professionals find it difficult to talk about the subject with parents. Aim: Increase the understanding of parents’ perspective on conversations with health care professionals regarding their child’s overweight and identify barriers in communication. Methods: General literature review. Result: Four categories and 11 subcategories have emerged. Parents consider the relationship with health care professionals to be important. Certain choices of words should be avoided and parents should be treated with respect and not guilt. Family-centered care is preferred. Parents may have another approach to what’s most motivating to make a change in their lifestyle. One area that divides the group of parents’ is whether or not the child should be present during the meeting about overweight. The cause of this is fear that the child should be harmed. Counseling given today is generally criticized. Parents concearns about the childs overweight should be taken seriously. Barriers such as ignorance, lack of time, overweight in parents, unawareness of parents and cultural differences have been identified. Conclusion: Overweight should be treated as any other health condition. Family-centered care is preffered where the whole family is involved. The family should be treated with respect and not be subject to guilt. Knowledge and motivation for change can be improved by health care professionals. Do not neglect concerns about overweight. Barriers in this area require consideration from the health care professionals.

In the United States, over two-thirds of adults are overweight or obese, and the number of children and adolescents who are overweight is increasing. Obesity is a significant issue as obesity-related chronic diseases can result in diminished quality or life, high morbidity and mortality, and substantial healthcare costs. The purpose of this study was to examine neighborhood social capital and how it relates to adolescent obesity. The socio-ecological model was used as the theoretical framework of this study to examine how the environment and social contexts influence health behaviors. Utilizing a quantitative cross-sectional research design, bivariate and multivariate analyses were conducted on 43864 10 to 17 year-olds using secondary data from the 2011-2012 National Survey of Children's Health. Controlling for age, gender, race, and overall health status, logistic regression analysis indicated that supportive environments predict the odds of adolescent overweight and obesity, while safer communities did not significantly predict the odds of adolescent overweight or obesity. The results of this study showed that there was a significant association between living in a supportive neighborhood and a decreased likelihood of an adolescent being overweight or obese (OR = 0.797). Associations were also found in demographic variables such as race, gender, and age. Positive social change implications from this study may include use of the findings by public health practitioners to better understand the factors that influence adolescent obesity in general, and the role of the social neighborhood environment in particular. In turn, public health workers can use this improved understanding to improve the quality of interventions, programs, and policies, resulting in positive social change among adolescents.

Obesity has become a global epidemic. Healthcare cost continues to increase due to co-morbidities such as diabetes, hypertension, and coronary artery disease associated with obesity. The purpose of this project was to examine whether teaching nutritious food choices to obese African American and Hispanic females in healthy cooking demonstrations would have an effect on their dietary behavior. The holistic self-care model was used to develop healthy strategies for weight loss. The model guided the development of nutritional support, exercise, and spiritual strategies for weight reduction. African American and Hispanic females between the ages of 25 to 64 were solicited from a local faith-based organization. Criteria for inclusion were a BMI greater or equal to 30, completion of a pre- and post- 24-hour dietary journal, and a pre- and post- Mediterranean diet assessment survey. Women had to participate in 3 out of 4 cooking demonstration classes. Ten participants met the full criteria for inclusion in the data. The results of the participants' responses were totaled and a percentage value was determined for each question. Comparison of the percentages between the 2 surveys showed no change in the participants' dietary habits, except in the area of red meat consumption, which decreased by 40%. The participants' mean BMI pre-survey was 37.92 and 37.80 post-survey. Lifestyle modifications such as dietary changes have the potential to decrease the obesity rate. The positive impact of the cooking demonstrations on African American and Hispanic families includes a potential decrease in comorbidities associated with obesity. A healthy future for these population groups will depend on the health of their children, and social change can occur if children adopt the healthy lifestyle behaviors of the adults in their household.

Childhood obesity is a global concern among all ethnic groups. Childhood obesity is a problem that continues into adulthood, exacerbating the incidence of diseases such as diabetes or heart disease. The purpose of this phenomenological study was to explore, understand, and describe the perceptions and experiences of African American parents in the management and care of their obese or overweight children. This study used the health-belief model (HBM) as its theoretical foundation, focusing on the constructs of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. This research study used an interview tool and an 8-item demographic questionnaire to explore and describe how African American parents managed the care of obese children between the ages of 6 and 11. Interviews were transcribed and then inductively analyzed for themes. Parents reported having a difficult time deciding how to implement successful overweight strategies on a daily basis. Parents felt helpless in supporting their child's efforts to lose weight. Parents shared that their child and family members participated in weight-loss activities such as making diet changes and physical activities. The implication for social change from this study is in providing local public health leaders with increased understanding of the personal experiences of African American parents in the management of overweight children. Findings may assist in effective program development for the targeted population.

Attention-deficit hyperactivity disorder (ADHD) and obesity both present a significant burden to the health of children and adolescents. Research suggests a possible association between ADHD and obesity. This dissertation focused on examining the association between ADHD and obesity, and the roles physical activity, sedentary behavior, gender, and medication might play in this relationship. The first manuscript is a review of the literature examining research on the association between ADHD and obesity in children and adolescents. The search included studies that reported on the prevalence of obesity among those with ADHD, the prevalence of ADHD among those who are obese, clinical studies comparing those with ADHD versus non-ADHD, and the association if any between ADHD, obesity, physical activity, eating behavior, medication, and gender. The search resulted in 657 studies, 233 after duplicates removed and 31 after screening. The studies suggested that there is a significant association between ADHD and obesity. Further, behavioral symptoms of ADHD, such as inattention and impulsivity might contribute to decreased physical activity, increased sedentary time, and dis-regulated eating. In addition, research indicated that medication possibly moderates the relationship between ADHD and body mass index BMI via a biophysical effect on the catecholamingeric system. The second manuscript is an original study testing a model assessing the mediating effects of ADHD on physical activity, sedentary behavior, and BMI. The study sample consisted of 3,788 adolescents ages 11-17 from the 2011-2012 National Survey of Children’s Health. Structural equation modeling was used to test the path associations. The model fit the data well, [RMSEA]=.043; [CFI]=.937; [TLI]= .889, and [SRMR]=.025. The total effect for ADHD was 0.073 and was significant. ADHD severity plays a role in increasing BMI status, working through physical activity and sedentary behavior. The third manuscript is another original study assessing moderating effects of gender and medication on the relationship between ADHD and BMI. The model fit the data well for gender and medication [RMSEA]=0.052; [CFI]=0.850; [TLI]=0.775; [RMSEA]=0.053; [CFI]=0.825; [TLI]=0.715. Although the total effect for ADHD on BMI was significant, medication and gender did not moderate this relationship. Also, medication did not moderate the relationship between physical activity, sedentary behavior and ADHD severity.

This study investigated the effect of a Making Healthy Choices lesson on junior high school students' preference rankings of items used to motivate students to increase academic performance. Results indicated that the lesson resulted in increased ranking scores on healthy items. This study used an assessment procedure that may be used to identify healthy rewards that may motivate students to increase academic performance as well as practice healthy decision making to prevent obesity.

The present study examined the relationship between the variables weight status (expected weight, at-risk for overweight, and overweight), ethnicity, and gender and the dependent variables dietary intake and physical activity behaviors among adolescents. Data presented in this study were collected using the Nutrition and Exercise Survey for Students, which was completed by 535 6th grade and 9th grade students across 3 middle and 2 high-schools in southwest Florida. Multivariate analysis of variance (MANOVA) was used to identify differences in dietary intake and physical activity behaviors between groups. The primary questions related to interactions and main effects between the variables weight category, ethnicity, and gender and the dependent variables dietary intake and physical activity behaviors. Weight category was determined by computing each participant's body mass index percentile (BMI = weight in kilograms/height in meters2). The findings of this study indicate that there are group differences in dietary intake behaviors among 6th graders and physical activity behaviors among 6th and 9th grade participants. With respect to dietary intake behaviors, an interaction was observed for gender and ethnicity, and main effects were observed for weight category and gender. Follow-up univariate F-tests were significant for weight category on meat/beans and junk food consumption; and gender differences on meat/beans consumption. All obtained effect sizes were small. For physical activity behaviors, a main effect was observed for gender among 6th grade participants and interaction was observed for gender and ethnicity among 9th grade participants. The follow-up univariate F-tests were significant for gender differences on total and vigorous activity behaviors (males had higher means than females) and small effect sizes were observed. The follow-up univariate F-tests for the gender and ethnicity interaction were not significant. Implications for the field of school psychology are discussed within the primary, secondary, and tertiary prevention model. Within this framework, a discussion of how school psychologists can assist in creating environments that encourage health-supporting behaviors at the individual and school-wide levels will be presented. Further, the need for school psychologists to collaborate with other health professionals to address overweight and some of its physical and mental health consequences is provided.

The present study examined the relationship between the variables weight status (expected weight, overweight), ethnicity, and gender and the dependent variables dietary intake and physical activity behaviors among adolescents. The data presented in this study were collected using the Nutrition Questionnaire for High School Students, which was completed by 199 adolescents in a high school in southwest Florida in February of 2004. Multivariate analysis of variance (MANOVA) was used to identify differences in dietary intake and physical activity behaviors between weight status groups. The primary questions in this study related to interactions and main effects between the variables weight category, ethnicity, and gender and the dependent variables dietary intake and physical activity behaviors. Weight category was determined by computing each participant's body mass index (BMI = weight in kilograms/height in meters²). A BMI > 24.9 was considered overweight and a BMI < 25.0 was considered expected weight. Ethnicity and gender were based on self-report. The findings of this study indicate that there are group differences in dietary intake behaviors and physical activity behaviors. With respect to dietary intake behaviors, main effects were observed for weight category, gender, and ethnicity. However, follow-up univariate F-tests were not significant. The lack of statistical significances may be to due the very small sample sizes which reduced statistical power. Medium effect sizes were reported for gender differences on milk consumption (males had higher means than females), and for ethnic differences on junk food consumption (African Americans had the highest consumption followed by Caucasians and Latinos, respectively). For physical activity behaviors, main effects were observed for gender and ethnicity, but not for weight category. The follow-up univariate F-tests were significant for gender differences on vigorous activity behaviors (males had higher means than females), and for ethnic differences on moderate activity behaviors (Caucasians had the larger mean followed by African Americans and Latinos, respectively). Medium effect sizes were also observed on these pairwise comparisons. Implications for the field of school psychology are discussed with example opportunities for school psychologists to assist in the development of accommodation plans, to collaborate with medical professionals to address overweight and some of its physical and mental health consequences, to help create environments that encourage health-supporting behaviors, and to assist in the development of individual and school-wide interventions.

<p><strong>Background:</strong> The past three decades have seen a growth in health promotion research and practice, stimulated by the epidemiologic transition of the leading causes of death from infectious to chronic diseases. An estimated 50% of mortality from the 10 leading causes of death is due to behaviour, which suggests individuals can make important contributions to their own health by adopting some health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a brief counselling approach for behavioural modification that builds on a patient empowerment perspective by supporting self-esteem and self-efficacy. MI has become increasingly popular in a variety of health care settings as well as non-health care settings.</p><p><strong>Aims:</strong> The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on the learning and practice of MI. The aim of study I was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services. The aim of study II was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies.</p><p><strong>Methods:</strong> Participants in study I were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Participants in study II were 15 community pharmacy pharmacists in Östergötland Sweden. Data for both studies were obtained through focus group interviews with the participants, using interview guides containing open-ended questions related to the aims of the studies. Study II also included five individual interviews. Interview data were interpreted from a phenomenological perspective.</p><p><strong>Results:</strong> In study I, important barriers were nurses’ lack of recognition that overweight and obesity among children constitutes a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything, and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem, and working with obese children rather than those who were overweight. In study II, pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. The opportunity to decide on appropriate clients and/or healthrelated behaviours for counselling was also an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. They also experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations.</p><p><strong>Conclusions:</strong> Learning and practicing MI effectively is difficult for many practitioners as it requires a new way of thinking and acting. Practitioners’ use of MI is not effective unless there is recognition that there is an important health-related problem to be solved. Practitioners feel more confident using MI with clients who have health-compromising behaviours and/or risks in which the practitioners feel they have expertise. Possessing considerable MI counselling skills does not compensate for insufficient knowledge about a targeted health-related behaviour and/or risk. Feedback from clients plays an important role for the quality and quantity of practitioners’ MI use.</p>