Background: Overweight and obesity affect approximately one-third of Canadian children and these children are at an increased risk of developing life-long obesity-related health consequences. Treatment efforts in the pediatric setting focus on behavioural modification – including modification of dietary intake. Eating behaviours encompass a modifiable aspect of dietary intake and could be a useful approach for weight reduction in the context of pediatric weight management (PWM) programs. Objectives: 1) To describe changes in family, child and parent eating behaviours over a 12-month period after enrolment in a PWM program. 2) To examine if changes in family eating behaviours over the first 6 months in a PWM program can predict child BMI z-score at 12 months, even when controlling for other factors related to changes in BMI z-score. Methods: Children ages 2-17 with a BMI >85th percentile were included in this analysis. Data was collected at baseline, 6 month and 12-month timepoints as part of the CANadian Pediatric Weight management Registry. BMI z-score was derived from height (cm) and weight (kg). Eating behaviours (eating related to hunger (ERH) and eating style (ES)) were measured in children, parents and families using the Family Eating and Activity Habits Questionnaire. Child and parental scores were summed to generate a family score. Decrease in scores over time indicated improvements in eating behaviours. Results: 807 children were included in the analysis (48.3% male, 51.7% female, mean age 12.08, mean baseline BMI z-score 3.55). Family ERH scores decreased significantly from baseline to 6 months by 1.63% (-0.16 points, SD=0.09, p<0.05) but by 12 months scores were the same as at baseline. Child ERH scores decreased significantly by 2.06% at 6 months (-0.14 points, SD=0.02, p<0.05), but at 12 months scores were the same as at baseline. Parent ERH scores did not change significantly. Family ES scores decreased from baseline to 6 months by 1.88% (-1.99 points, SD=0.21, p<0.05) and stayed approximately the same at 12 months. Child ES scores were similar, decreasing 2.86% (-1.68 points, SD=0.03, p<0.05) from baseline to 12 months. Parents ES score decreased significantly by 6 months, but after 12 months, scores were the same as at baseline. Change in either family eating behaviours from baseline to 6 months did not predict child BMI z-score at 12 months when adjusting for age, sex and BMI z-score at baseline. In subsequent exploratory analysis, increases in child eating behaviour scores at 6 months was a significant predictor of increases in child BMI z-score at 12 months (p=0.02) when adjusting for age, sex and BMI z-score at baseline. Conclusion: In the context of PWM programs, eating style and eating for hunger improved over the first 6 months after enrolment. Improvements in child eating behaviour after 6 months could predict improvements in child BMI z-score after 12 months. / Thesis / Master of Science (MSc)

While weight loss programs over the past 30 years have proven to be effective in producing initial weight-loss, long-term weight maintenance has remained an elusive goal. Given the serious negative health consequences associated with obesity, new approaches to weight management are warranted. The purpose of this study was to evaluate the efficacy of a maintenance-oriented weight management program in producing changes in weight, body composition, fitness, blood lipids, physical activity, and strength following completion of the treatment program and at 3-month follow-up. Fifty overweight and obese men (n = 18) and women (n = 32), ages 27-55 (M = 40.52) who had low cardiorespiratory fitness (M = 20.87 ml/kg/min) and high total cholesterol (M = 223.36) were randomly assigned to one of three treatment conditions: 1] Behavioral Choice Treatment (BCT) with a theory-based maintenance-oriented program, moderate calorie goals, and the New Healthy Pyramid for nutrition recommendations; 2] a traditional exercise and nutrition education program (USDA) using the current Dietary Guidelines for Americans with the Food Guide Pyramid; and 3] a wait-list control group that was transitioned into BCT without the maintenance-oriented program (WLC/BCT w/o maintenance). All groups (during treatment) received a center-based strength and aerobic program utilizing short-duration, but prescriptive protocols aimed at increasing fitness and strength. Assessments were completed at baseline, 16 weeks, 28 weeks, and 40 weeks (WLC/BCT w/o maintenance only). Participants in BCT and USDA experienced significant health changes compared to WLC who experienced minimal weight gain and decreased fitness across the 4-month waiting period. Results comparing BCT, BCT w/o maintenance, and USDA revealed that participants in all treatment conditions significantly improved aerobic fitness, strength, and physical activity during treatment (p's < .05). Participants in the BCT groups experienced significant decreases in weight, total % body fat, waist and hip circumferences, BMI, and LDL-C (p's < .05), while participants in USDA did not. At 3-month follow-up, while participants in both BCT groups continued to make improvements on multiple health outcomes, only participants in BCT with maintenance group were able to maintain their fitness gains (p < .001). In addition, BCT with maintenance group showed a trend toward continued weight loss, maintenance of physical activity, and increased strength. Taken together, the data indicate that any BCT offers greater health outcomes compared to a more traditional educationally based program both at post-treatment and follow-up. Importantly, BCT with maintenance offered additional benefits including continued weight loss, continued decreased intra-abdominal fat, maintenance of fitness, physical activity, and strength compared to BCT w/o maintenance. In conclusion, given the limited scope of small center-based trials, future studies need to examine the effectiveness of this program in a more community-based setting where there is potential for greater public health impact. / Ph. D.

According to Leahey, LaRose, Fava, and Wing (2011), nearly half of all young adults are considered overweight or obese. Further, on average, young adults gain between 1 and 2 pounds annually, making them more susceptible to yearly weight gain than any other age group. College students in particular may be vulnerable to continual weight gain over the course of their 4-year education; a review by Hellmich (2008) revealed that many students gain between 6 and 9 pounds during their freshman year alone. Despite the increased risk for weight gain during the young adult years, Leahey and colleagues report that this age group is underrepresented in behavioral weight management programs. Therefore, research must determine the psychosocial factors that are likely to influence young people in their efforts to manage their weight and health. Social support may be such a mechanism; a study by Strong and colleagues (2008) demonstrated that social support was influential in college students' decisions to participate in exercise and avoid sedentary behaviors. However, a scale measuring social support has not been developed for use with college students in regard to general health behaviors. In the current study, a 37-item self-report instrument was developed. This social support measure was administered to 466 Virginia Tech undergraduates, along with a battery of questionnaires assessing other health habits. Results revealed three possible types of social support, and indicated that social support — while unrelated to body mass index — is related to healthy eating behaviors, vigorous exercise, and health choices of significant others. / Ph. D.

Yes / Allied Health Professionals (AHPs) have the capacity to promote healthy behaviours in young children through routine ‘contact points’, as well as structured weight management programmes. This scoping review aims to evaluate the impact of AHPs in the prevention of obesity in young children. Methods: Databases were searched for relevant evidence between 1st January 2000 and 17th January 2022. Eligibility criteria included primary evidence (including, but not limited to; randomised controlled trials, observational studies, service evaluations) evaluating the impact of AHPs on the primary and secondary prevention of obesity in young children (mean age under five years old). Results: AHP related interventions typically demonstrated improvements in outcomes such as nutritional behaviour (e.g., lower sweetened drink intake), with some reductions in screen time. However, changes in weight outcomes (e.g., Body Mass Index (BMI) z score, BMI) in response to an AHP intervention were inconsistent. There was insufficient data to determine moderating effects, however tentative evidence suggests that those with a lower socioeconomic status or living in an underprivileged area may be more likely to lose weight following an AHP intervention. There was no evidence identified evaluating how AHPs use routine ‘contact points’ in the prevention of obesity in young children. Conclusion: AHP interventions could be effective in optimising weight and nutritional outcomes in young children. However, more research is required to determine how routine AHP contact points, across the range of professional groups may be used in the prevention of obesity in young children.

ABSTRACT INTRODUCTION: Studies on the topic of adverse childhood experiences (ACEs) and childhood obesity collectively indicate an association, but there is a lack of replication in nationally representative sample of children aged 10-17 years. This study aims to expand on the definition of ACEs to include: socio-economic hardship, racial discrimination, witness or victim of neighborhood violence, and bereavement, and to examine their individual and joint association with BMI levels, especially childhood obesity (primary outcome). METHODS: The 2011-2012 National of Children’s Health (NSCH) was used for this study (N=45,309). One child interview weight was produced; hence, the estimates are generalized to all non-institutionalized children 10-17 years of age in the US and each state. Statistical methods used included descriptive statistics and multivariable multinomial logistic regression models. ACEs examined included: (1) Socioeconomic hardship, (2) Parental divorce or separation, (3) Bereavement, (4) Incarcerated family member, (5) Witness to domestic violence, (6) Victim/witness of neighborhood violence, (7) Household mental illness, (8) Household substance abuse, (9) Racial discrimination. BMI for the same sex and age (10-17 years) percentile relative measurement, using growth charts recommended by CDC, among children and teens were used as indicators of BMI. BMI-95th percentile or greater was considered obese. RESULTS: The prevalence of childhood obesity and ACE exposure was higher for boys compared to girls. Controlling for gender, among those who were obese, White-non-Hispanic children had the highest prevalence of obesity compared to other races for both genders. Southern States constituted 80% and 60 % of top 10 states with the highest prevalence of childhood obesity and ACE, respectively. Approximately 25.4 million (89.5%) children aged 10-17 years had experienced 3 or less ACE. The most prevalent ACE category of nine asked about for child was-living with parents who were either divorced or separated after his/her birth (26.77%) and the least prevalent was living with a parent who died (4.84 %). ACEs were not mutually exclusive, and all nine categories of ACEs were interrelated. The adjusted odds ratio of covariates to their reference groups that were only statistically significant for childhood obesity relative to healthy weight encompassed: a) Place of residence in metropolitan statistical area, b) two or more chronic health conditions of 18 asked about, c) Watching TV, videos, or playing video games across categories >1 to≥4 hours, d) family members in the household eat a meal together 7 days of the week, e) and computer, cell phone or electronic device use ≤1 hour. Moreover, the explanatory variables, namely, age, sex, the physical health status of parents, and physical activity, were strongly related to childhood obesity (associated both with higher odds and lower odds of outcome) compared to overweight and underweight BMI categories. CONCLUSIONS: This is the first study to explore the co-occurrence, individual and joint association of ACEs with childhood obesity using nationally representative sample of children aged10-17 years in the U.S. Having childhood obesity, BMI-95th percentile or above was strongly related to ACE dichotomy, ACE score ≥2 and two ACE types (socioeconomic hardship and bereavement) than the probability of overweight, BMI-85th to 94th percentile. Underweight-BMI less than 5th percentile had only statistically significant association with socioeconomic hardship ACE category. Sociodemographic, parental, and childhood related factors were also independently associated with childhood obesity.

The possibility that faulty expectations about success and relapse recovery contributed to poor adherence was examined in this study. Support for such an expectancy model was sought through comparing an index of relative task magnitude to adherence rates. Instructions designed to improve adherence through changing expectations about relapse and relapse recovery were also administered to 46 clients in two clinical nutritional programs. Their adherence rates <in days) were compared to the rates obtained from the records of 64 other clients who did not receive the instructions. To further understand the adherence phenomenon, several other measures were obtained from the treatment subjects. These data were compared to adherence rates in an attempt to identify potential co-variate relationships. Statistical procedures including analysis of variance to determine comparability of subject groups, Pearson Product Moment correlations, t tests of the difference between means, and the Lawshe—Baker Nomograph comparing per cent adherence rates were performed on the data. Obtained results did not support the predicted relationship between relative task magnitude and adherence. This may have been due to differences between subjective assessments of task magnitude and the objective measure used in this study. Although improvement in adherence was noted in both treatment groups, statistical significance was achieved only in the university based clinic. Differences in the settings, assisting nutritionists, and participating subjects could have produced these findings. However, because improvement did occur in both settings, and because the techniques may be easily and inexpensively utilized by clinical nutritionists, these instructions were recommended for inclusion as a routine component of nutritional clinic procedures. No strong co-variate relationships were found between adherence and the additional measures included in the study. The only variables which correlated with adherence more than trivially, emotional response to a verbal food stimulus, and imaging ability, did lend support for this cognitively active method of improving adherence.

Despite increasing prevalence, significant negative biopsychosocial consequences, and few treatment options, overweight and obesity in adolescence has received very little attention in the scientific literature. The major objective of this research program was to evaluate the efficacy of a cognitive behavioural (CBT) program in the treatment of adolescent overweight and obesity. Sixty three overweight or obese adolescents (28M, 35F) aged 11.5 to 18.9 years (M = 14.41, SD = 1.85) participated in a randomized controlled trial evaluating the efficacy of a CBT weight loss intervention. This comprehensive intervention program incorporated a range of CBT techniques aimed at assisting adolescents to establish and maintain healthy eating and physical activity habits. Treatment resulted in improved body composition post treatment and sustained or improved body composition following maintenance. Participation in a motivational interview (MI) prior to this CBT intervention did not influence treatment outcomes. Despite reductions in weight and body fat, lean body mass was not affected by the intervention, thus, treatment did not detrimentally effect linear growth and lean body tissue. Poor compliance with measurement protocols limits conclusions that can be drawn regarding the impact of treatment on eating and activity habits. However, results suggest that treatment resulted in a reduction in fat consumption, reduced saturated fat intake, and reduced time spent in sedentary activities. Increases in physical activity were not evident. The treatment seeking sample did not report elevated psychopathology levels and treatment did not impact on adolescent depression, anxiety, or stress. Adolescents receiving treatment reported improvements in disordered eating relative to those in the control condition. A secondary aim of this research program was to redress the limited information available on the behavioural and psychosocial factors associated with adolescent overweight and obesit y. These factors were explored in community samples of adolescents (n = 161, M = 16.3, SD = I .8) and their parents, and young adults (n = 292, M = 19.7, SD = 2.0). In comparison to both normal and overweight adolescents, treatment seeking adolescents reported greater body dissatisfaction and weight. discontent. Body weight was not associated with psychopathology in the community samples and treatment seeking adolescents did not differ from normal or overweight adolescents from the community sample in terms of psychopathology. However, young adults who reported being overweight during childhood reported greater psychopathology as young adults. These findings suggest that excess weight in adolescence may have longer term rather than immediate effects on psychopathology. A number of family factors were associated with body weight in both adolescents and young adults. Combined, results indicated that CBT is efficacious in the treatment of overweight and obesity in adolescents and MI does not improve the efficac y of CBT. The current findings suggest that the impact of excess weight on psychosocial functioning is limited to body discontent and dissatisfaction in adolescence but is associated with increased psychopathology in early adulthood. Results also highlighted the importance of parents and family in the treatment of overweight and obesity in adolescents.

Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2005.

Background: The role of dietary calcium in weight management is gaining support in the nutrition research community. It has been hypothesized that high calcium diets protect against fat gain by creating a balance of lipolysis over lipogenesis in adipocytes (Zemel et al., 2000) and that a diet deficient in calcium is associated with higher body weight and that augmenting calcium intake may reduce weight and fat gain or enhance fat loss (Shapses et al., 2004). Objectives: A lack of baseline data on the physical, physiological and mental effects of obesity on urban African women was the motivation for the POWIRS (Profiles of Obese Women with Insulin Resistance Syndrome) study. The aim of the study was to assess the effects of obesity on health determinants of urban African and white women by comparing the lifestyle and risk factors for non-communicable diseases (NCDs) of lean, overweight and obese subjects. This led to a multi-disciplinary cross-sectional case-control study in which health determinants and health status, as well as the underlying mechanistic relationships between these factors were measured in a sample of African women volunteers. The study was repeated a year later, done in a sample of white women volunteers, POWIRS II. The effect of calcium intake on body composition was assessed during this study. Methods: One hundred and two apparently healthy urban African women, between the ages of 20 and 50 years participated in the first phase of this case-control cross-sectional survey. For a period of about three weeks, each afternoon ten subjects were to report at a Metabolic Unit Facility (consisting of 10 single bedrooms, 2 bathrooms, a living room and kitchen). Each subject received a "participant sheet" which guided them through the different research 'stations' where the various measurements were done. During the course of the evening demographic questionnaires were filled in and all anthropometric measurements were taken, except weight and height measurements. All participants received an identical light supper which excluded alcohol and caffeine at 20h00, went to sleep before 23h00 and fasted overnight. From 06h00 in the morning weight, height and blood pressure measurements were taken. After a fasting blood sample was taken, a two-hour glucose tolerance test commenced. Subjects received a breakfast and afterwards habitual dietary intake questionnaires were completed. Results: Mean total dietary calcium intake as significantly higher in white women (POWIRS II), with a mean intake 1053.8 mg per day, as opposed to a mean intake of 494.8 mg calcium per day in the blacks subjects (POWIRS I). Mean fat intake in the black subjects was 59.3 g per day, and in the white women 103.1 g per day. Thus the calcium:fat ratio in white women was higher than in black women (11.0 and 8.4 respectively). After adjustment for age and total dietary energy intake, significant negative correlations were found between dietary calcium intake and various variables, only in the white subjects. These were BMI (r=-0.255, p=0.01), percentage body fat (r=-0.252, p=0.01), fasting insulin (r=-0.205, p=0.05) and fasting glucose (r=-0.199, p=0.046). The calcium:fat ratio correlated negatively with BMI (r=-0.378, p<0.0001), percentage body fat (r=-0.401, p<0.0001), fasting glucose (r=-0.229, p=0.02), fasting insulin (r=-0.212, p=0.04) and plasma leptin (r=-0.284, p=0.004). Adjustment for smoking resulted in slightly different correlation coefficients, but similar significant correlations were still found. The only significant association that was found in the black population, was a negative correlation between dietary calcium intake and systolic blood pressure (p=0.03) as well as diastolic blood pressure (p=0.04). After adjustment for age, smoking and dietary energy intake no significant correlations were found in the black subjects. Conclusion: The results from the POWIRS study in white women are consistent with the hypothesis that there may be an inverse relationship between adiposity and calcium intake. In our study higher calcium intakes were associated with lower body fat, lower BMI, lower fasting glucose and insulin, as well as plasma leptin in white women. The association seems to be significant in subjects with high intakes of fat and calcium (as seen in the white women). / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2005.

Background: The role of dietary calcium in weight management is gaining support in the nutrition research community. It has been hypothesized that high calcium diets protect against fat gain by creating a balance of lipolysis over lipogenesis in adipocytes (Zemel et al., 2000) and that a diet deficient in calcium is associated with higher body weight and that augmenting calcium intake may reduce weight and fat gain or enhance fat loss (Shapses et al., 2004). Objectives: A lack of baseline data on the physical, physiological and mental effects of obesity on urban African women was the motivation for the POWIRS (Profiles of Obese Women with Insulin Resistance Syndrome) study. The aim of the study was to assess the effects of obesity on health determinants of urban African and white women by comparing the lifestyle and risk factors for non-communicable diseases (NCDs) of lean, overweight and obese subjects. This led to a multi-disciplinary cross-sectional case-control study in which health determinants and health status, as well as the underlying mechanistic relationships between these factors were measured in a sample of African women volunteers. The study was repeated a year later, done in a sample of white women volunteers, POWIRS II. The effect of calcium intake on body composition was assessed during this study. Methods: One hundred and two apparently healthy urban African women, between the ages of 20 and 50 years participated in the first phase of this case-control cross-sectional survey. For a period of about three weeks, each afternoon ten subjects were to report at a Metabolic Unit Facility (consisting of 10 single bedrooms, 2 bathrooms, a living room and kitchen). Each subject received a "participant sheet" which guided them through the different research 'stations' where the various measurements were done. During the course of the evening demographic questionnaires were filled in and all anthropometric measurements were taken, except weight and height measurements. All participants received an identical light supper which excluded alcohol and caffeine at 20h00, went to sleep before 23h00 and fasted overnight. From 06h00 in the morning weight, height and blood pressure measurements were taken. After a fasting blood sample was taken, a two-hour glucose tolerance test commenced. Subjects received a breakfast and afterwards habitual dietary intake questionnaires were completed. Results: Mean total dietary calcium intake as significantly higher in white women (POWIRS II), with a mean intake 1053.8 mg per day, as opposed to a mean intake of 494.8 mg calcium per day in the blacks subjects (POWIRS I). Mean fat intake in the black subjects was 59.3 g per day, and in the white women 103.1 g per day. Thus the calcium:fat ratio in white women was higher than in black women (11.0 and 8.4 respectively). After adjustment for age and total dietary energy intake, significant negative correlations were found between dietary calcium intake and various variables, only in the white subjects. These were BMI (r=-0.255, p=0.01), percentage body fat (r=-0.252, p=0.01), fasting insulin (r=-0.205, p=0.05) and fasting glucose (r=-0.199, p=0.046). The calcium:fat ratio correlated negatively with BMI (r=-0.378, p<0.0001), percentage body fat (r=-0.401, p<0.0001), fasting glucose (r=-0.229, p=0.02), fasting insulin (r=-0.212, p=0.04) and plasma leptin (r=-0.284, p=0.004). Adjustment for smoking resulted in slightly different correlation coefficients, but similar significant correlations were still found. The only significant association that was found in the black population, was a negative correlation between dietary calcium intake and systolic blood pressure (p=0.03) as well as diastolic blood pressure (p=0.04). After adjustment for age, smoking and dietary energy intake no significant correlations were found in the black subjects. Conclusion: The results from the POWIRS study in white women are consistent with the hypothesis that there may be an inverse relationship between adiposity and calcium intake. In our study higher calcium intakes were associated with lower body fat, lower BMI, lower fasting glucose and insulin, as well as plasma leptin in white women. The association seems to be significant in subjects with high intakes of fat and calcium (as seen in the white women). / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2005.