Childhood obesity is an extensive problem in the United States and North Dakota (CDC, 2014). Significant health consequences are linked to obesity, including type two diabetes, hypertension, hyperlipidemia, cardiovascular disease, cancers, and psychological disorders (Pandita et al., 2016; Xu & Mishra, 2018). Obesity comorbidities, previously presented in later adulthood, now emerge in younger populations (Pandita et al., 2016). Unfortunately, treatment of obesity is not effective, and therefore, prevention must be the primary focus (Daniels et al., 2015; Pandita et al., 2016). Diet and eating behaviors have a significant impact on weight, and children develop taste preferences and lifelong eating behaviors within the first few years of life (Birch & Anzman, 2010; Daniels et al., 2015; IOM, 2011). Therefore, targeting interventions on feeding and nutrition in infancy may foster healthy habits for life and play a role in the prevention of obesity. Responsive feeding interventions hold promise in supporting healthy growth. Ellyn Satter’s Division of Responsibility promotes the responsive feeding relationship between parent and child. The purpose of the practice improvement project was to address childhood obesity prevention through the development of an educational curriculum on feeding and nutrition. The parent-focused education correlated with each well child visit (WCV) between the ages of two weeks and three years. A multidisciplinary team of representatives from pediatrics, behavioral health, and patient education was consulted to develop the education. Ten providers at Midwestern primary care clinics reviewed the educational curriculum and provided feedback on the content and methods to deliver the education to parents. Most providers found the content to be accurate (n = 7; 70%) and comprehensive (n = 8; 80%). Three providers suggested expanding on topics such as breastfeeding and mixing formula. Providers unanimously agreed that the curriculum is relevant and understandable. A formal literacy evaluation resulted in grade-level readability scores between the 6th and 8th-grade levels. Almost all providers (n = 9) believed the curriculum would be valuable for use in practice. The preferred delivery method chosen was one on one provider to parent education. The project clinic plans to pilot the curriculum with parents attending infant and toddler WCVs.

Approximately one-third of children in the United States are overweight or obese with increased risks for numerous physical and psychosocial comorbidities. Schools are ideal environments to address this serious health crisis and school nurses are uniquely positioned qualified healthcare providers to actively participate in childhood obesity prevention (COP). A review of the literature provided findings to identify a gap in the knowledge regarding the association between school nurse COP perceptions and practices. A modified theoretical framework based on Bandura’s health promotion by social cognitive theory guided this study. The purpose of this study was to identify the key perceptions (self-efficacy, perceived benefits and perceived barriers) influencing school nurse participation in COP practices and determine associations between school nurse characteristics and COP perceptions and practices. Preliminary research was conducted to determine content validity for modified perception scales, clarity of instructions and questions, data collection and retrieval procedures, and refinement of recruitment strategies. Adequate reliability and validity was determined for modified scales measuring school nurse self-efficacy, perceived benefits, perceived barriers, and COP practices targeting individual children (child-level) and the entire school population (school-level). Florida RN school nurses (n = 171) completed self-administered anonymous questionnaires from an emailed weblink or a paper version offered at two Florida Association of School Nurses conferences. School nurses with characteristics reflecting more education engaged in more COP practices (p < .05) than those without education-related characteristics. School nurses with > 8 hours of COP education reported higher COP self-efficacy than those with none (p < .01). Linear regressions showed that a model comprised of self-efficacy, perceived benefits, and perceived barriers significantly explained 12.0% of the variance in child-level practices (p < iv .001) and 9.1% of school-level practices (p < .001). Self-efficacy explained the most variance of school nurse child-level and school-level practices (p < .001), and perceived barriers were inversely associated with child-level practices (p < .05). Four series of regressions showed that only perceived barriers partially mediated the influence of self-efficacy on child-level practices. Data analyses indicated self-efficacy and perceived barriers were key determinants of school nurse COP practices. Therefore, policy changes and educational interventions to increase selfefficacy and reduce perceived barriers may be effective in mobilizing school nurses to actively engage in COP practices

The prevalence rate of childhood obesity has increased rapidly worldwide. The childhood obesity epidemic is associated with many adverse health consequences in children as well as a financial burden for a nation’s economy. A meta-analysis was conducted to investigate the effectiveness of school-based childhood obesity prevention programs in preventing childhood obesity. The objectives of this study were to 1) identify the most effective childhood obesity prevention programs through effect size comparison, and 2) identify important program components that affect the effectiveness of the intervention through subgroup analysis. The Comprehensive Meta-Analysis (CMA) program was used for all statistical analyses. Results of the meta-analysis demonstrated that the summary effect size was small (d = 0.039, 95% confidence interval). The school-based program identified in the meta-analysis as the most effective had a d value of 0.368. Subgroup analyses were performed because this meta-analysis study was heterogeneous (Q = 167.774, p = 0.001) with an I2 value of 68.410%. The subgroup moderators were length of program duration, age of participants, nutrition, physical activity, parental involvement, specialist involvement, and theory based versus non-theory based intervention programs. Subgroup analyses demonstrated that significant differences (p < 0.05) occurred among the moderator components. Programs that targeted younger children less than ten years old and programs that were theory based were more effective. The meta-analysis study contained publication bias because the funnel plot was skewed and smaller studies were missing. To further explore the publication bias problem, Classic fail-safe N and Duval and Tweedie’s trim and fill analyses were performed. Classic fail-safe N indicated that two programs were missing from the present study to achieve a non-biased result. The Duval and Tweedie’s trim and fill analysis demonstrated that a small mean effect size difference was detected between the present observed studies and the unbiased effect size. The small mean effect size difference indicated that the results and the reported effect sizes in this meta-analysis study were valid.

The effectiveness of an eight-week nutrition and physical activity intervention at a summer camp to prevent obesity, and promote healthy eating habits and physical activity among children in Kuwait was studied. Two summer camps were recruited for intervention and comparison groups. Convenient sampling was used (N= 79). Pre-test/post-test assessment were used for the participants in the intervention and comparison groups. Modified Healthy Habits Survey (HHS) was used to measure children’s knowledge, behavior and attitude about nutrition, screen time and physical activities, BMI-for age percentile were collected. Statistical analysis included independent t-test, paired t-test, chi-squared test, McNemar's test, and multiple regression. Results indicated that there was a significant increase in nutrition knowledge score (Pp= 0.013, p = 0.007, p = 0.002, and p = 0.012, respectively). There was no significant decrease in the number of servings of unhealthy foods for french-fries and chips, fruit flavored drinks or soft drinks. The only significant decrease in the unhealthy food intake was seen in the number of servings of sweets and candies. Thirty-three-point-three percent of participants in the intervention group decreased their consumption of sweets and candies to 1 time or less per day (P=0.001). There was a significant increase in the intervention group in both physical activity and screen time knowledge (Pp

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The objective of this study was to determine the effectiveness of a 6 week afterschool nutrition and physical activity intervention administered by a registered dietitian with the help of a humanoid robot targeting elementary school aged children aged 6-12 years. The study was conducted across four Young Men’s Christian’s Association (YMCA) sites in Miami-Dade County, Florida (N= 114, Mean age: 8.16 ±1.57 years) using a pretest-posttest quasi-experimental design via randomly assigned intervention (two sites; n=63) and comparison groups (two sites; n=51). The validated Coordinated Approach to Child Health (CATCH) kids club questionnaire and the validated Previous Day Physical Activity Recall (PDPAR) were used to assess nutrition and physical activity knowledge, attitudes/beliefs and behavior change. The Inbody 230 instrument (Biospace, California) was used to calculate body composition and weight. Body Mass Index (BMI) percentiles and associated BMI z-scores for age and gender were calculated based on the Center for Disease Control and Prevention (CDC) growth charts. Data measures were collected at baseline (week 0) and one-week post intervention (week 7). Statistical analysis included independent t-test, paired t-test, chi-squared test, Wilcoxon signed ranks test and logistic regression. Results indicated that nutrition knowledge score significantly increased from 67.43% ±21.03 to 81.31% ±18.47 in the intervention group (p