Prevalensen för övervikt och fetma hos världens befolkning har tredubblats mellan 1975 och 2016. Hos den vuxna befolkningen uppskattas 1,9 miljarder ha övervikt varav 650 miljoner har fetma. Motsvarande siffror för barn under fem år som har övervikt eller fetma är 39 miljoner. Övervikt och fetma var tidigare ett ohälsoproblem i höginkomstländer, men det ökar även nu i låg- och medelinkomstländer och särskilt på landsbygden (World Health Organization, 2021). I Sverige hade år 2018 ca 11 procent av barn i 4-års ålder övervikt eller fetma. Övervikt och fetma ökar snabbare hos unga, än hos de äldre, vilket innebär en tidigare debut med kronisk sjukdom och som leder till ökade samhällskostnader (Folkhälsomyndigheten, 2023a). Övervikt är nära kopplat till livsstilsvanor, så som kosthållning och fysisk aktivitet. Fetma, även kallat obesitas, är en kronisk sjukdom som ökar risken för andra kroniska sjukdomar som; diabetes, hjärt-kärlsjukdom, cancer och psykisk ohälsa.  Även livskvaliteten kan påverkas och social stigmatisering förekommer (Folkhälsomyndigheten, 2023b). Hos barn ökar övervikt och fetma risken för bland annat insulinresistens, ateroskleros och hjärt-kärlsjukdom. Risk för depression och dålig självkänsla är större än hos normalviktiga barn, men även smärta och trötthet ifrån rörelseapparaten samt andningsbesvär förekommer (Hanseus et al., 2020). Enligt årsrapporten för uppföljning av barn med fetma, framkom det att endast en minoritet av barnen fått regelbunden behandling eller uppföljning i hälso- och sjukvårdens regi (Socialstyrelsen, 2022a). Det finns idag begränsad tillgång till manualbaserade föräldrastödsprogram. Det är därför av stor vikt att ge familjen stöd och insatser i ett tidigt skede när barn har övervikt och fetma (Rikshandboken-bhv). Distriktssköterskor har ett ansvar att arbeta för att främja hälsa och goda levnadsvanor hos alla barn (Svensk sjuksköterskeförening, 2019) men de upplever att övervikt och fetma hos barn är ett svårt och känsligt ämne att lyfta med föräldrar. Övervikt och fetma är ofta något föräldrar skäms över och är ovilliga att prata om. Ibland kan föräldrarna bli arga och kränkta när ämnet kommer på tal och då gå i försvar.  Relationen till föräldrarna anses därför många gånger viktigare, än samtala om barnets övervikt eller fetma. Risk finns för att ämnet undviks tills nästa besök, som kan dröja ett helt år (Isma et al., 2012).  Forskning visar att bedömning och hantering av barns övervikt kan vara komplext eftersom distriktssköterskor måste ta hänsyn till alla familjemedlemmar (Water, 2011). Distriktssköterskor har en viktig roll genom att anpassa hälsosamtalen för att möjliggöra en lyckad livsstilsförändring, så att familjerna upplever att det är förståeligt, användbart och genomförbart (Rikshandboken-bhv, 2023).

No description available.

No description available.

No description available.

No description available.

No description available.

No description available.

No description available.

The prevalence of obesity is high in the United States. One of the many concerns with the high prevalence of obesity is its association with an increased risk of falls and subsequent injury. Thus, it is important to understand factors affecting falls among individuals who are obese, to help develop effective intervention solutions to mitigate falls in this population. Obese individuals have been hypothesized to have an impaired plantar sensitivity, and this may influence their balance control, thus lead to more falls. Executive function deficits in individuals who are obese may affect their ability to allocate attentional resources to dual tasks (walking while performing other tasks), and may put them at higher risks of falls. Gait alterations and muscle strength deficits in individuals who are obese may also increase their fall risks. Therefore, three studies were carried out to provide better understanding into the factors affecting falls in individuals who are obese. The first study investigated the effects of obesity on plantar sensitivity, and explored the relationship between plantar sensitivity and postural sway during quiet standing. Plantar sensitivity was measured as the force threshold at which an increasing force applied to the plantar surface of the foot was first perceived, and the force threshold at which a decreasing force was last perceived. Measurements were obtained while standing, and at two locations on the plantar surface of the dominant foot. Postural sway during quiet standing was then measured under three different sensory conditions. Results indicated less sensitive plantar sensitivity and increased postural sway among individuals who are obese, and statistically significant correlations between plantar sensitivity and postural sway that were characterized as weak to moderate in strength. As such, impaired plantar sensitivity among individuals who are obese may be a mechanism by which obesity degrades standing balance among these individuals. The second study investigated the influence of obesity on executive function, and determined whether there is a relationship between executive function and fall risk (as estimated from selected gait parameters). Four major components of executive function were assessed, including selective attention, divided attention, semantic memory and working memory. Both single- and dual-task walking (walking-while-talking) were completed to evaluate fall risk during gait. Less effective selective attention, semantic memory, and working memory were found among young obese adults. Participants exhibited higher fall risks during dual-task walking, and executive function scores were associated with gait during dual-task walking. In conclusion, obese individuals exhibited less effective executive function, which may be associated with their increased fall risk. The third study explored differences in gait, plantar sensitivity, executive function, lower extremity muscle strength, and body size between fallers and non-fallers, and the strength of the association between the same factors and slip severity. Participants' gait, plantar sensitivity, executive function, lower extremity muscle strength, and body size measures were obtained. An unexpected slip was introduced in a laboratory setting to obtain slip severity related measures and slip outcome. Results indicated obese fallers exhibited better executive function (selective attention), stronger lower extremity muscle strength, lower BMI and smaller waist circumference. Results also indicated increased slip severity was associated with faster walking speed, longer step length, higher RCOF, worse executive function (working memory), and lower BMI. Slower reactive recovery response was also associated with lower BMI. As such, better selective attention and stronger muscle strength exhibited limited benefit in slip recovery among individuals who are obese. Altered gait pattern, and working memory may be factors by which obesity increased slip severity, and lower BMI among individuals who are obese may increase slip-induced fall risks. In conclusion, reduced plantar sensitivity, impairments in executive function, altered gait pattern were associated with deficits in standing and walking balance control, and increased slip severity among individuals who are obese. Therefore, appropriate fall prevention/intervention program targeting at some or all of these factors may be considered as solutions to decrease fall risks for obese individuals. / Ph. D.

Objective: Measure the association between School Health Index (SHI) scores and student health outcomes related to physical activity (PA) and nutrition. Design: Cross-sectional design utilized to collect SHI scores and administer questionnaires regarding nutrition and PA behaviors, knowledge and the home environment in 5 counties of southwest Virginia. Participants: Staff, administrators and students (grades 4, 7, 10; n = 1094) in 27 schools in 5 school divisions. Main Outcome Measures: SHI scores were obtained from school surveys while LWP score, student BMI percentile and fitness (mile run, PACER) measures were obtained from school data. The School Physical Activity and Nutrition questionnaire was used to measure student nutrition, PA behaviors and knowledge, and the home food environment was measured through a validated questionnaire. Analysis: Two-sided Pearson's correlation (p<0.05) measuring associations between SHI score and student health outcomes of BMI percentile, one mile/PACER, nutrition and PA behaviors and health knowledge and beliefs. Results: SHI was negatively correlated with BMI percentile for 4th grade students (-0.472, p<0.001) and positively correlated with BMI percentile for 8th grade students (0.679, p<0.001). SHI was positively correlated with 4th grade mile run (0.412, p<0.001), 8th grade mile run (0.218, p<0.001) and 4thgrade PACER (0.414, p<0.001). Conclusion: Behavioral influences are multifactorial and factors outside the school environment may affect the correlations between these variables. Application: Data concerning the influence of the school health environment can be used towards making evidence-based changes to school health programs. / Master of Science