Rising rates of obesity among children have become one of the most pressing issues in modern public health. Childhood obesity threatens both the mental and physical well-being of children. Attempts to halt the rise in obesity take many forms, but one of them is the recent implementation of a programme of measurement of primary children at reception and in year 6, with results being fed back to parents. This National Child Measurement Programme (NCMP) is controversial and has been criticised in some quarters as unethical, in being a form of screening programme with no clear or effective interventions available for those detected as having a problem. Study aims and objectives The main aim of the study was to explore the relationship between weight status and children’s mental wellbeing, especially in the context of the NCMP. Within this overall aim, key specific objectives of the study were: i) to investigate the association between weight status of 10-11 year old school children and their mental well-being; ii) to assess the impact on the mental wellbeing of children, of participating in the NCMP; and iii) to collect information about parents’/guardians’ and children’s reaction to the NCMP, with particular interest in identifying whether parents/guardians and their children found the feedback useful in moving towards the adoption of a healthy lifestyle. Methods The study was undertaken in primary schools in the catchment area of Gateshead Primary Care Trust (PCT). The overall study used a mixed methods study design. The study involved administering a questionnaire prior to NCMP measurement to a total sample of 264 children, sampled using a proportionate stratified random sampling technique. One-to-one semi-structured interviews were also conducted post measurement with 21 children purposively sub-sampled from the larger group, and with 16 parents/guardians. Results Prior to measurement, most children misclassified their weight status. About 1 in 10 children who were of ideal weight perceived themselves as overweight. Over three quarters of overweight children perceived themselves to be of ideal weight. There was no significant relationship between any of the indicators of mental wellbeing and actual weight status of children. However, there was very strong evidence for a Preface xxv significant relationship between perceived weight status and mental wellbeing among children. Seven major themes emerged from the post measurement interview data, but perhaps the most intriguing was the cycle of emotional reaction of families to the NCMP and weight feedback. Discussion The reactions of parents/guardians whose children are indicated to have weight problems follow a sequence of behaviours ranging from shock, disgust with the programme, through denial and self-blame to acceptance, worry and help seeking. Reasons for these responses relate in many cases to the way the weight problem is portrayed to the parents. While health authorities are keen to portray this problem as a medical one, parents/guardians see it as social one. The roots of overeating and lack of exercise are seen as lying in the complex social and cultural milieu in which this sample of people live. Consequently, associating this problem in feedback letters with dangerous diseases like cancer, and advising parents to visit GPs to resolve child weight issues, seems inappropriate to the recipients and causes controversy and anger. Conclusion The NCMP’s routine feedback could potentially induce families into the state of readiness to change lifestyle behaviours; however, given the reactions described in this study, it seems critical to avoid placing blame on individuals but rather to acknowledge the influence of the environment surrounding families and to provide non-medical support aimed at bringing families on board to support interventions for combating child weight problems.

Background: The percentage of overweight children has tripled in the last thirty years. Inconsistent findings are published regarding the relationship between socioeconomic variables and being overweight in childhood.Objective: To determine whether socioeconomic variables are associated with risk of being overweight among six year olds. Methods: Six year olds with BMI data were selected from the National Survey of Children's Health (n=4,362). Variables were coded and a low socioeconomic index was created. Using population weights, descriptive statistics were generated and regression was utilized to assess the relationship between socioeconomic variables and being 'at risk' for overweight. Socioeconomic variables were also compared by risk status.Results: Approximately 47% of the sample was 'at risk' of overweight (BMI ≥ 85th percentile). Males and nonwhites were more likely to be 'at risk' than their counterparts. After adjustment, the proportion of those with Medicaid was greater among the 'at risk' group compared to those who were 'not at risk' (38.3% vs. 35.3%' p-value=0.010). Those 'at risk' were also more likely to have free/reduced-cost breakfast/lunch (60.3% vs. 51.8%, p-value=Conclusion: Several low socioeconomic indicators as well as a composite index were associated with being 'at risk' for childhood overweight. With the current obesity epidemic, governmental agencies should identify low socioeconomic groups and target interventions specific to these vulnerable populations.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

The primary aim of the research attempted to investigate whether ethnic differences in self-image existed amongst White and African females. It further investigated whether specific factors such as family, peer relations and psychosocial factors (specifically perceptions regarding the media) have had a positive or negative influence on weight. Additionally it explored whether black females may still perceive a fuller figure as being more acceptable or whether changes have occurred within past and/or present ideologies. The study used both qualitative and quantitative analysis. In order to establish whether ethnicity was significantly different from BMI, BSQ, SATAQ-3, t-tests (non-parametric one-way ANOVA comparisons) were performed. Ethnicity was not significantly different in relation to the dependent variables BSQ; overall SATAQ-3 scores and its dimensions; and affirmation, belonging and commitment of the MEIM. However significant differences were found between BMI, the overall MEIM and its subscale ethnic identity. Low and high scores of the MEIM revealed no differences across all measurement instruments used within the study, demonstrating no effect upon BSQ or the SATAQ-3 and its subscales. However there was a significant difference found between ethnic groups with regard to BMI. Fisher’s –z was used to conduct comparisons between the correlations established using Pearson’s Rank Coefficient Correlations. The results indicated that significant relationships did exist between the BSQ, specific subscales of the SATAQ-3, and BMI. Results obtained from Fisher’s-z revealed significant differences on the BSQ and SATAQ-3 (including its subscales) correlations. Multiple Regression was conducted to establish whether BMI, MEIM and SATAQ-3 have had an impact upon the outcome of BSQ. The comparisons revealed that BMI and sociocultural factors may have an impact upon the perceptions of body shape and size. Major themes identified within the qualitative analysis were culture, inherited concepts, media, family, friends and parental (mother) influences amongst others. The results revealed that White females may experience greater body dissatisfaction. African females had stated that their body concept is influenced by ethnicity, while White females communicated media and stereotyped images of white females as being the source of pressure to loose weight.

Övervikt är ett globalt växande hälsoproblem som under kort tid ökat markant. Detta medför att sjuksköterskor utsätts för nya komplexa utmaningar i mötet med överviktiga personer. Trots att övervikt har blivit allt mer vanligare förekommer det stigmatisering, negativa attityder och fördomar mot överviktiga personer. Enligt hälso- och sjukvårdslagen ska alla människor behandlas med respekt och lika värde för den enskilda människans värdighet. Syftet med litteraturöversikten var att beskriva sjuksköterskors erfarenheter av att möta personer med övervikt. En kvalitativ design utformade arbetet där en induktiv ansats användes. Tio artiklar valdes ut för analys, där samtliga genomgick Jönköpings Hälsohögskolas kvalitetsgranskningsprotokoll och analyserades med hjälp av Fribergs femstegsmodell. I resultatet framkom det att sjuksköterskors erfarenheter av att möta personer med övervikt påverkade arbetsmiljön samt vårdrelationen. En av slutsatserna är att överviktiga personer har en negativ påverkan på sjuksköterskors arbetsmiljö, då utrustningen inte är anpassad utefter överviktiga personer. Den andra slutsatsen är att vårdrelationen mellan sjuksköterskor och överviktiga personer är svårhanterliga, då personer med övervikt och sjuksköterskor inte visar ömsesidig förtroende till varandra.

INTRODUCTION: Obesity is a major public health concern for youth in the United States. Eating behaviors, such as meal skipping and eating family dinner, are associated with obesity. School connectedness and family connectedness assess the degree to which an individual feels that he or she belongs in an environment, and strong feelings of school connectedness are associated with decreased BMI. This study qualitatively evaluates the relationships between feelings of home and school connectedness and specific eating behaviors associated with obesity in an adolescent population. METHODS: Participants were recruited from an adolescent clinic at Boston Children's Hospital. Inclusion criteria for recruitment included adolescents who were: Black/ African American or Hispanic and non-White, between 13 and 19 years of age, and living in the Boston neighborhoods of Dorchester, Roxbury, or Mattapan. Participants were interviewed using a semi-structured interview guide, and participant data was analyzed by systematically identifying thematic language in the data by identifying similar phrases, patterns of descriptions, and notable disparities in participant content. RESULTS: 14 (10 females, 4 males; M=15.8 years of age) were enrolled and interviewed. Mean participant BMI was 27.3. 10 participants rarely/never skipped lunch, and 4 participants often/always skipped lunch. 6 participants ate dinner at home with their family always/ often, and 4 rarely/never ate dinner at home with their family. Most reported that their school's community, quality of education, and small environments were the most important aspects of their school. Of the 4 participants who attended school in the suburbs, 3 were connected or very connected to their school and disconnected from their neighborhoods. Every participant expressed feeling safe at school, but many cited lack of safety as their least favorite aspect of their neighborhood. Some reported that they felt safe, even though they knew that their neighborhoods were unsafe. CONCLUSION: Of the five students who felt 'very connected' to their schools, all but one always/often ate the food provided by their schools. These students discussed the ways in which their schools listened to student suggestions about school food. These feelings may suggest a stronger sense of feeling respected by one's school. Strong feelings of school connectedness in the majority of students who attend school in the suburbs warrant further exploration, as those who experience discordant home and school environments seemed more likely to embrace their school environment than their neighborhood environment. Furthermore, understanding how perceived neighborhood safety may contribute to feelings of home and neighborhood connectedness and possibly eating behaviors at or around home merits further examination.

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammatory polyarthritis, typically of the small joints. Obesity, a serious global epidemic, has been shown to increase systemic inflammatory biomarkers, several of which are related to RA pathophysiology. Associations have been observed between obesity and worsened RA disease activity outcomes in crosssectional studies. Limited longitudinal studies investigated the effects of weight change on RA disease activity measures. Surgical interventions for weight loss in RA patients showed marked improvement in RA disease activity measures and outcomes but typical weight change in a clinical setting has not been investigated. OBJECTIVE: To investigate the impact of typical weight change on RA disease activity measures. METHODS: We conducted a retrospective cohort study on 178 RA patients seen in typical clinical practice that met the inclusion criteria for the study, which included patients with a minimum of two clinical disease activity assessments (CDAI) with corresponding body mass index (BMI) measures. Medical record review was conducted for each clinic visit where CDAI and BMI were measured, and at each of these visits, sociodemographic, lifestyle, medication usage, questionnaire data, RA characteristics, laboratory values, and comorbidities were collected. Linear regression was used to analyze the association between ΔBMI and ΔCDAI, defined at the dates of minimum and maximum BMI for each subject, adjusting for confounders including sex, age, disease duration, smoking status, serologic status, and steroid usage. Logistic regression was performed to evaluate whether ΔBMI was associated with low/remission RA disease activity according to accepted CDAI cutoffs. RESULTS: Unadjusted linear regression was performed on all 178 subjects to analyze the overall trend within the sample population. For every 1 kg/m2 increase in BMI, CDAI increased by 0.49 points, but these results were not statistically significant (p=0.155, 95%CI -0.176, 1.097). Subjects were stratified into BMI gain, stable, and loss groups. Within the BMI loss group (defined as those whose BMI decreased by more than 1 kg/m2), a significant association was found with ΔCDAI (β= -2.61 [p=0.028, 95%CI -4.91, -0.298]). Unadjusted linear regression on the BMI gain and stable groups was found to be not statistically significant. This association remained significant after adjusting for sex, age, disease duration, smoking status, serologic status, and steroid usage (β=-2.499 [p=0.044, 95%CI -4.94, -0.061]). There was no association between ΔBMI and low/remission RA disease activity (OR 0.990, (95%CI 0.855, 1.146). When stratified by BMI gain, stable, and loss groups there was no significant association with low/remission RA disease activity. CONCLUSION: These results suggest that weight loss may be associated with improved disease activity among patients with RA seen in a typical clinical setting. Weight loss has the potential to be a non-pharmacologic intervention to improve RA disease activity. Prospective studies of weight loss and RA disease activity are necessary to replicate these results.

Postpartum weight retention is commonly considered an important precursor to long-term weight gain, with existing research suggesting that failure to lose weight in postpartum has significant future health implications. While postpartum has been identified as a possible ‘window of opportunity’ for women to make health behaviour change and manage their weight, it remains unclear how mothers, and in particular ‘large’ (BMI ≥ 40 kg/m2) mothers, experience health and engage with health-related behaviours at this particular point in the life course. Existing research has done little to enhance our understandings of the lived, embodied and practical realities of caring for an infant and, crucially, how this impacts health and weight management during the postpartum period. In addition, qualitative research focusing on postpartum has largely ignored the temporal dimensions of this period and, instead, has tended to focus attentions on a single ‘snapshot’ in time. To address these gaps in the literature, this study employed longitudinal qualitative methodology to explore 15 ‘large’ (BMI ≥ 40 kg/m2) women’s lived experience of health and weight management over the first six months following childbirth. Participants were recruited from a specialist antenatal metabolic clinic based in Edinburgh, Scotland. When possible, three in-depth semi-structured interviews were carried out with each participant: the first at six weeks postpartum, the second at three months and, the third at six months postpartum. Both six weeks and six months have consistently been identified in the literature as important markers for postpartum women. Hence, it was hoped that by interviewing at these and an intervening time point (i.e. three months) it would be possible to capture and understand processes of change with regards to weight management in the postpartum period. The analysis revealed that accounts of health and weight were far from straightforward and seemed to be heavily influenced by the wider social context, which routinely pathologises, demonises and stigmatises ‘fatness’. Challenging contemporary discourses of the ‘obesity epidemic’ which frame the large body as a direct consequence of individual lifestyle, participants principally drew upon lay notions of inheritance and implicated a genetic predisposition to resist individual responsibility for weight and body size. The analysis suggests that concerns for health were largely predicated on subjective experiences and, in the absence of tangible and embodied experiences of ill-health, participants expressed little if any impetus to engage in weight management for the purpose of improving their health. In short, the idea that their weight was an indicator of poor health, or future health risk, was not a view shared by participants. Instead, they expressed more complex understandings of their weight, and their responsibilities to engage in health changing behaviour. Despite articulating often strong desires to engage in weight management ‘for the baby’, the longitudinal focus revealed a disjuncture between these intentions and the reality of those engagements. Influential in this discordance was the transition from an intensely medicalised and closely monitored pregnancy, to a period of minimal or no follow up in postpartum. The lack of ‘surveillance’ appeared to have a notable impact on participants’ engagements with health-related behaviours once at home and going about the day-to-day tasks of caring for their infant. Dominant discourses around ‘good’ mothering also made it difficult for participants to prioritise their own needs (such as weight management) ahead of those of their children and other family members. When participants reflected on their experiences of mothering they frequently drew upon understandings of themselves as relational beings and, at times, positioned themselves as phenomenologically inseparable from their baby. This relationality was often experienced as a diminishing of individual autonomy, as the body of the mother and the baby became inter-embodied and bounded. Consequently, my analysis serves to problematise the individualised expectation surrounding a mother’s ability to act autonomously and engage in health-related behaviours in postpartum. These findings also call for a stronger appreciation to be developed of the complexities surrounding engagements with health-related behaviours at this particular point in the life course. In particular this research demonstrates the importance and utility of adopting a more embodied approach, which in turn has some notable implications for public health policy and practice.

Master of Science / Department of Statistics / Wei-Wen Hsu / Polychlorinated biphenyls (PCBs) and dichlorodiphenyldichloroethylene (DDE) are endocrine disrupting chemicals which can imbalance the hormonal system in the human body and lead to deleterious diseases such as diabetes, irregular menstrual cycles, endometriosis, and breast cancer. These chemicals as environmental exposures still exist in the environment and food chains and can be accumulated in human fatty tissues for many years. These chemicals can also be passed from mothers to their children through placental transfer or breastfeeding; therefore, their offspring may be at increased risk of adverse health outcomes from these inherited chemicals. However, it is still unclear how the parental association with offspring health outcomes and the inter-generational phenotypic inheritance could be affected by these chemical compounds. In this study, we mainly focus on how PCBs and DDE can affect the inheritance of Body Mass Index (BMI) across generations, as BMI is the primary health outcome (or phenotype) linked to diabetes. We propose a biometrical inheritance model to investigate the effects of PCBs and DDE on the heritability of BMI over two generations. Technically, a linear mixed effects model is developed based on the decomposition of phenotypic variance and assuming the variance of the environmental effect depends on parental exposures. The proposed model is evaluated extensively by simulations and then is applied to Michigan Fisheater Cohort data for answering the research question of interest.

Background: The prevalence of overweight, obesity and obesity-related disease, mainly cardiovascular disease (CVD), is increasing in both developed and developing countries. Ethnic differences have been reported in the prevalence of overweight, obesity and CVD. However, measures used to define overweight and obesity, and identify increased risk of CVD were developed and validated in predominately Caucasian populations in developed countries. Consequently, these measures may not accurately define disease risk in all population groups. Therefore the specific aims of this programme of study were: 1. To establish the relationship between adiposity and cardiovascular risk factors in different ethnic groups. 2. To identify field measures of adiposity, relating to cardiovascular risk in different ethnic groups. 3. To compare the relationship of adiposity and cardiovascular risk factors in a single ethnic group, that of a rural and an urban population in Zimbabwe. 4. To identify risk factors for CVD related to adiposity in a population of African origin. Study design: Three empirical studies were undertaken. In study one, 312 adult subjects from three ethnic groups (Afro-Caribbean (n=106), Caucasian (n=165) and South Asian (n=41)) were recruited from a University. Twenty-six (26) of each group were individually matched for age (±3 years) gender and BMI (±2 kg/m2) to allow for comparability. Measures of body composition included height, weight, waist and hip circumferences, skinfold thickness measures, body density and percentagebody fat. In study two, 81 subjects from two ethnic groups (Afro-Caribbean (n=39) and Caucasian (n=42)) were recruited and tested. They were matched for age, gender and BMI using the same criteria as study one. In addition to the body composition measures taken in study one, random non-fasting blood glucose, total cholesterol, triglycerides and blood pressure were taken. In study three, 55 men and 108 women from rural Zimbabwe, 8 men and 17 women from an urban low-density suburb in Harare Zimbabwe, and 28 male and 16 female students from the University of Zimbabwe were recruited and tested. In addition to all measures of body composition in studies one and metabolic analysis in study two, participants’ dietary intake was assessed by food frequency questionnaire and 24hour recall and physical activity was assessed by a physical activity questionnaire. Main findings: • The relationship between BMI and %BF was not the same in all ethnic groups. (aim 1) • There were ethnic differences in the cardiovascular risk predictors between Afro-Caribbean and Caucasian men and women. (aim 1) • It is not recommended that BIA is used as a substitute for TBW estimation in multi-compartment models. (aim 2) • In three groups of Zimbabweans from urban, rural and university locations, a pattern emerged. Amongst women, urban women were at greatest risk, reporting highest values for all variables, followed by rural then university women. Amongst men, urban men were at highest risk, however there were few differences between rural and university men. (aim 3). • Finally, increased WC and dyslipidemia are associated with increasing BMI in populations of African origin. (aim 4) Conclusions: The relationships between overweight, obesity and risk of obesity-related disease differ between different ethnic groups. Moreover, in the groups from Zimbabwe, differences in obesity-related risk were associated with being female and living in urban areas. Therefore, application of universal measures for defining obesity and related diseases may not be applicable to all ethnic groups.