This diploma thesis is based on a study of seven year old children Childhood Obesity Surveillance Initiative (COSI) processed by Institute of Endocrinology sponsored by WHO Europe and MZ ČR and on a study of adolescents Childhood Obesity Prevalence And Treatment (COPAT) organized by Institute of Endocrinology sponsored by Norway grants and MŠMT ČR. These studies were focused on the prevalence of overweight and obesity among children and adolescents and on factors possibly related to origin of overweight and obesity. Obesity is a severe chronical multifactorial disease that significantly affects health conditions and development of children. Obesity, as a risk factor, is involved in origin of cardiometabolic problems (II. type diabetes mellitus, ischemic heart disease, hypertension, dyslipidemia), cancer, musculosceletal problems and reproductive system disorders (infertility, hypogonadism, polycystic ovary syndrome, disorders of sexual development in children). Preventive programs, focused on childhood obesity, are important part of health care. These programs are based on results of factors involved in the origin of obesity. The aim of this thesis is determine and compare the prevalence of overweight and obesity in seven year old children and adolescents by classification of Czech republic, WHO...

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Published Article / Objective: To determine the relationship between body mass index (BMI), energy intake and levels of physical activity of HIV negative and HIV positive women. Design: Cross sectional study. Methodology: A random sample of 500 pre-menopausal women within the two age group categories of 25-34 and 35-44 years was selected. Data on physical activity was obtained using an adapted Baecke questionnaire and categorized into low, medium, and high levels of physical activity. Weight and height were used to calculate BMI. Dietary intake was determined by means of a standardized food frequency questionnaire. Results: Sixty-one percent of younger women and 38% of older women were HIV infected. The vast majority of women (91%) had low levels of physical activity, while only 9% of the sample had physical activity levels that fell within the normal to high category. More than 50% of respondents were either overweight or obese (BMI above 25 kg/m2). BMI of HIV positive younger women was, however, significantly lower than that of HIV negative women. Median energy intakes were high (more than 10 000 kJ) for both HIV positive and HIV negative women. Conclusions: Reverting to a more traditional lifestyle, including diet and physical activity, could assist in addressing unfavorable BMI parameters of these women and improve health status and quality of life of HIV infected women.

The emergence of obesity as a distinct disease could have far reaching consequences for an organisation where optimum health and physical fitness are required for personnel to perform their occupational roles effectively. The aim of this thesis is to increase our understanding of the prevalence, correlates and predictors of obesity in the British Army. Systematic review indicated a smaller body of knowledge in respect of the treatment and correlates of obesity in military populations. Successful treatment interventions incorporated exercise, healthy eating information, behavioural modification, self-monitoring, relapse prevention, structured follow-up and were supported by trained personnel. The major significant correlates of obesity were being enlisted personnel, male, ≥35 years of age, African-American/Hispanic ethnicity, and married (with spouse present). The review highlighted the deficit in knowledge concerning treatment, and correlates of obesity in military populations. The trend of escalating obesity has prompted some armed forces to report obesity trends and prevalence, the findings of which suggest that obesity is a growing concern in the armed services. A study based on the secondary analysis of data covering 50,000 British Army soldiers indicated that according to BMI, 56.7% of the study population were overweight and of those individuals 12% were obese. When waist circumference data were added to the BMI data, the results indicate that females displayed a higher percentage of risk of obesity related ill-health (a combination of BMI and waist circumference) than males (30.4% and 24% respectively). Further analysis suggested that age, marital status, rank and military employment category were significant correlates of obesity. Additionally, obesity and increased risk of obesity related-ill-health were linked to higher failure and lower attendance on British Army physical tests. Data suggested older army personnel (>30) had a higher pass rate, but a lower attendance rate. The final analysis of all available variables suggested physical test outcome, age, medical status and enlisted status were the most significant predictors of obesity. A final study based on a different study population (n=1124) from the high readiness component of the UK based British Army sought to identify relationships between health behaviours that were not supportive of healthy weight and to understand the predictive influence of individual and collective behaviour in relation to obesity and the risk of obesity related ill-health in military personnel. The investigation used a health behaviour questionnaire to assess health behaviours that might influence weight status. Final analysis of this highly active population suggested, restrained eating, food preparation in the working week, injury status, age, sedentary behaviour, leisure-time physical activity engagement and type of motivation for exercise were the most significant factors. This thesis highlights the lack of knowledge, and gives evidence to support the impact of obesity on individual health and collective occupational capability. Obesity is a complex multifaceted disease where no single causal route predominates. However, the identification of potential causal and predictive relationships will aid in the prevention and treatment of obesity in the British Army.

Introduction: The prevalence of childhood and adolescent obesity in the U.S. and in other countries has continued to rise over the last several decades. Health behaviors such as physical activity and inactivity patterns have been shown to influence rates of obesity among adolescents. Racial/ethnic disparities related to adolescent obesity have been recognized through existing research, and differences in socioeconomic and cultural backgrounds have been noted as possible contributing factors to the risk of adolescents becoming overweight or obese. The primary purpose of this study was to analyze the association of physical activity and sedentary activity with obesity prevalence among adolescents aged 12-15 years old across ethnic groups in the U.S. Methods: This study utilized data from the combined 2007-2012 National Health and Nutrition Examination Survey (NHANES). Descriptive characteristics of the study population were analyzed for both ethnicity and BMI status, and Chi-square tests were used to assess differences among the variables. The association between BMI status categories and ethnicity were evaluated. A univariate analysis was conducted to evaluate the association of the independent and covariate variables with obese status among adolescents. A multivariable logistic regression was also performed to determine the association between BMI status and physical activity, controlling for the covariate variables. For sedentary activity, the frequency statistics were analyzed between each of the ethnicities and BMI status, and t-tests were conducted to determine statistical significance. Results: The sample size for this population included 939 adolescents. Approximately 40% of adolescents were categorized as obese, according to age- and sex-specific BMI percentiles. Among ethnicity, Non-Hispanic white adolescents had the greatest prevalence of obesity, compared to Non-Hispanic Black and Mexican-American adolescents. There was not significant association between BMI status and demographic characteristics, including ethnicity, in the sample. Regarding physical activity, there was some indication that those who engaged in moderate and vigorous physical activity were less likely to be obese, however these findings were not found to be significant. Non-Hispanic black obese adolescents reported significantly less moderate activity compared to Non-Hispanic white adolescents(p=0.02). Obese adolescents in this sample had reported slightly less mean sitting time per day, compared to those who were not obese. Conclusion: Although the findings of this analysis showed some indication of differences in physical activity and sedentary behavior patterns among obese adolescents, the overall findings did not provide a statistically significant association between the variables and ethnicity. Further studies related to this topic could analyze differences in cultural and social norms across ethnicities that could influence physical activity behaviors in adolescents. Also, access to exercise facilities and differences in dietary behaviors among adolescents could be considered.

Background: Infant mortality rate is a serious problem in today’s society. This statistic is often used as one measure of a country’s success and growth. One factor that is strongly associated with infant mortality is low weight in children. In Mozambique, the percentage of underweight children under the age of five was 16% in 2012 (UNICEF, 2013). In order to reduce the number of underweight children in this country, characteristics of caregivers that could potentially contribute to this problem should be investigated. One particularly important characteristic is maternal literacy, which to date has been under investigated. Objective: This study aimed to determine whether maternal literacy affected the weight and body-mass-index (BMI) of children ages 0 to 3 years old in Mozambique. Methodology: A cross-sectional study of 6,762 children between the ages of 0 and 47 months was conducted using the 2011 Demographic and Health Survey for Mozambique. Analysis of covariance (ANCOVA) procedures with Scheffe post hoc tests were performed in order to identify differences in mean child weight and BMI Z-score in reference to maternal literacy level. The data were analyzed using Statistical Analysis Software Version 9.4. Results: 396 (6.05%) of the children in the study sample were found to be underweight and 4467 (58.69%) of mothers were found to be illiterate. There was a statistically significant association between maternal literacy level and the weight and BMI of children between the ages of 0 and 3 years of age. Interestingly, a trend of stronger association was observed for each one-year increase in child age. Conclusion: Maternal literacy is significantly associated with child weight and BMI. Therefore, prioritizing secondary education for women is one important approach for ameliorating the risk of underweight children. Increased literacy rates in women could lead to better understanding of child nutritional needs, and ultimately, an overall reduction in the number of underweight children.

Chronic environmental exposure to inorganic arsenic is widely associated with human disease. Low human arsenic secondary methylation efficiency (SME), represented by high urinary monomethylarsonic acid (%uMMA) and low urinary dimethylarsinic acid to monomethylarsonic acid ratio (uDMA/uMMA), has been consistently associated with increased risk of arsenic-related diseases. Therefore the determination of factors modulating arsenic SME acquires particular importance. The aims of the present study are to identify novel factors of variability in arsenic secondary methylation, and to test for potential factors influencing arsenic SME for which there is equivocal literature support. A population of 808 subjects was recruited from northwest Mexico environmentally exposed to arsenic. The mean total urinary arsenic in the population was 171 μg/L. Great interindividual variability in %uMMA excretion was observed (0.85% - 40.5%). Three intronic polymorphisms in arsenic (3+ oxidation state) methyltransferase (AS3MT), the key gene in the metabolism of arsenic, were confirmed to be associated with increased arsenic SME in this study. Further analysis of this genomic region showed a large block of linkage disequilibrium (LD) comprising these three genetic variants and other 43 intronic polymorphisms within AS3MT and four additional genes. Genetic association analysis showed that all linked polymorphisms in this region except one were significantly associated with higher arsenic SME. The existence of this long region of LD associated with arsenic SME underscores the complexity of association studies involving any of these linked polymorphisms since there is no certainty of which polymorphism or gene is the causative of the association. In addition, a strong positive association between body mass index (BMI) and arsenic SME was observed in females but not in males. This association was replicated in two independently recruited populations of adult women. Moreover a unique finding of this study is the association between higher genetically estimated indigenous American (AME) ancestry and increased arsenic SME in this ancestrally admixed Mexican population. These results establish the importance of genetic and phenotypic factors in the efficiency of arsenic secondary methylation. Furthermore this study has identified several arsenic-associated risk factors that should be carefully considered in future studies seeking to better understand disease susceptibility in arsenic-exposed populations.

The present programme of research discusses a series of studies which explore the relationships between individual characteristics and well being. The FIT theory (e.g. Fletcher & Stead, 2000a) was used as a framework. It attempts to explain individual’s cognitions and behaviours using two broad dimensions: an ‘Inner’ dimension which details factors used to guide decision making (a cognitive dimension), and an ‘Outer’ dimension which focuses on behaviour. The research explored whether FIT was directly or indirectly related to well being. Initial findings from an exploratory, cross-sectional, study revealed that individuals with greater ‘Inner’ FITness demonstrated significantly lower levels of anxiety and depression. They also perceived their work and personal projects more positively. Individuals with greater ‘Outer’ FITness were found to demonstrate better physical well being. This latter finding was replicated in the second study which explored why individuals with reater ‘Outer’ FITness would demonstrate a significantly lower Body Mass Index (BMI). The results showed that ‘Outer’ FITness did not relate to weight management behaviours, such as controlling calorie intake or regular exercise, measured over a week, via the components of the Theory of Planned Behaviour (e.g. Ajzen, 1991). It was hypothesised that it may instead be underpinned by habitual behaviour. Study 3 explored whether ‘Outer’ FITness could be trained and whether this would impact on habits and BMI. A longitudinal pilot intervention was run which encouraged individuals to Do Something Different in order to change habits and facilitate weight loss. Doing something different did increase ‘Outer’ FITness and this increase had a ‘dose-response- relationship with BMI change – the greater the increase in ‘Outer’ FITness, the greater the decrease in BMI. This was accompanied by changes to dietary and exercise behaviours. A qualitative follow up of a sub-sample revealed that doing something different did facilitate changes to some habitual behaviours but the formation of implementation intention plans was also a significant contributor to weight loss. Further research is required to elucidate the exact relationship between behavioural flexibility, habitual behaviour and weight loss.

The main goal of this study was to investigate whether residents of rural areas especially in deprived communities in BC have reasonable geographic access to healthy and affordable food providers (e.g., supermarkets, grocery stores, and farmers’ markets), and if lack of access impacts their weight status. As well, I investigated the extent to which farmers’ markets improve food accessibility in BC’s rural food deserts. In order to identify food deserts, the methodology which has been developed by USDA was modified and adapted to BC’s rural situations. In the first step, using Principal Component Analysis, deprived rural regions were identified based on selected socioeconomic and demographic variables. Then, using ArcGIS Network Analyst extension, the distance based on driving time from the Population Weighted Centroid of each rural region to the closest supermarket or grocery store was calculated on BC road networks. A 15 minute driving time cut-off was set to identify low access areas. Deprived rural regions which were also classified as low access were identified as food deserts. The impact of food accessibility on the weight status of rural British Columbians was investigated using the 2013-14 Canadian Community Health Survey (CCHS). A hierarchical regression model was constructed with weight status of residents as the dependent variable and distance to the closest supermarket or grocery store as the independent target variable. I found that food deserts are more concentrated in the Central Coast, Cariboo, and Peace River regions of the province. In addition, farmers’ markets play no role in providing healthy foods to the residents of food deserts. Lastly, distance from food stores is not significantly associated with the weight status of rural respondents in CCHS data. The findings of this study can be highly beneficial to government officials within different jurisdictions and health practitioners to develop or refine food policies toward providing healthy and affordable food to deprived residents and Aboriginal peoples in rural and remote communities. / Graduate

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.