The prevalence of childhood obesity is increasing at an alarming rate and is implicated in the onset of serious and life threatening health problems of both a physical and psychological nature. The current research comprised of three main components. Firstly, the reliability of a readiness to change questionnaire was examined, which had been completed by parents of obese children enrolled in the Bodywise childhood obesity programme. Secondly, an analysis of outcome data from 36 families who completed the above programme was also undertaken in order to determine if the data identified their stage of change, as defined by the questionnaire Thirdly, four semi-structured interviews were conducted with families involved with the Bodywise programme. These parents provided information related to their experiences of lifestyle change, including what initiated change, what assisted change, and what barriers to change they had encountered. Findings revealed that in accordance with the transtheoretical model the readiness to change questionnaire was a reasonably reliable instrument for indentifying parents' readiness to change their child's eating patterns and physical activity levels. Analysis of the outcome data from the 36 families revealed individuals in the action stage of change for both eating and physical activity made more rapid change at the outset of the programme than individuals in earlier stages of change. In addition, information derived from the interviews with families identified several promoters and barriers to change, many of which were similar across families. Until now no studies have examined the application of the transtheoretical model to an intervention for childhood obesity. Previous research has shown support for the model's use with other health problems. Overall this study lends support for the utility of the transtheoretical model in childhood obesity intervention.

<p>This dissertation encompasses three essays which examine the development of obesity in black and white girls and its responses to interventions. </p><p>The first chapter asks the question, how does obesity develop in girls? Using the National Growth and Health Study (NGHS), a longitudinal study of 2400 girls from age 9 to age 18, this chapter aims to address gaps in knowledge about the development and persistence of obesity in girls. Analyses using multivariate regression and growth-mixture modeling describe trajectories of body mass change in children and their correlates. Results suggest that obesity in children begins early and persists in most cases--BMI at age 17 is, on average, 1.3 times BMI at age 9. However, change does occur; 0.8 percent of the sample move from being obese at age 9 to healthy weight at age 17, and 2.2 percent of the sample make the reverse journey from healthy weight to obese. Where change occurs, it is most commonly seen among those who socio-demographically were anomalies among their body mass cohort at age 9. These results emphasize the importance of early interventions as well as the need for more study into body mass mutability in population subsamples. </p><p>The second chapter investigates 1) what motivates children to pursue weight loss; and 2) what aspects of interventions may most effectively support healthy child motivations and program success. These questions are qualitatively studied among a sample of 45 obese girls aged 9 to 13 girls participating in a behavior modification intervention. In total, 106 interviews were conducted. All of the girls in the study were interested in losing weight, most commonly in order to fit in (n=11), reduce teasing (n=10), or express particular social identities (n=6). However, not all of the girls were able to translate this desire to lose weight into a healthy and effective lifestyle change motivation. Several factors were associated with adopting healthy motivation and behavior, including familial involvement, self-regulation skills, non-social weight desires, realistic weight loss goals, and clear messages about body ideals. Other program protocols also supported motivation during difficult periods for those who adopted healthy motivation, including nutrition information, incentives, lack of physician judgment, and patient autonomy. Finally, two other potential program protocols were mentioned by girls in the study as useful aids. More support services, particularly during the summer, and more information on the expected course of weight loss could, these girls argued, help sustain motivation. Together, these findings suggest a role for self-regulation theory in the design of lifestyle change motivation and for more directly addressing expectations in weight loss treatment.</p><p>The third chapter investigates the relationship between self-worth and obesity among girls, again using the National Growth and Health Study. Results indicate a negative relationship between self-worth and obesity across all participants. However, this relationship only has predictive power from early body mass to later self-worth and self-worth trajectories. That is, higher body mass at age 9 predicts lower self-worth at age 17 and decreases in self-worth from age 9 to age 17. The effect is larger for Caucasians and for those in young adolescence but persists across the sample. Mechanisms for this relationship are also investigated, and some support found for stigma. Analyses using self-worth components suggest most of the self-worth effects are driven by social concerns, while mediational analyses suggest social body image pressures explain the relationship between global self-worth and body mass. Overall, the findings suggest a complex interrelation between self-worth and body mass in girls, meriting further investigation as well as a more nuanced discussion in the public realm.</p> / Dissertation

The purpose of this study was two-fold: (a) to identify, in a large representative sample of Canadian children, the age-related trajectories of overweight and obesity from toddlerhood into childhood and (b) to investigate the associations between these trajectories and children’s temperaments, their parents’ parenting practices and their interactions. Potentially important familial characteristics (i.e., the parents’ or surrogates’ age, income level, and educational attainment) were considered in the models. The sample for this study was drawn from the Canadian National Longitudinal Survey of Children and Youth (NLSCY). Group-based mixture modeling analyses were conducted to identify the number and types of distinct trajectories in the development of obesity (i.e., to explicate the developmental processes in the variability of childhood obesity) in a representative sample of children who were between 24 to 35 months of age, at baseline, and followed biennially over a 6-year span. Discriminant analysis was conducted to assess the theoretical notion of goodness-of-fit between parenting practices and children’s temperament, and their association with membership in the BMI trajectory groups. The results of the group-based modeling established three different BMI trajectories for the boys, namely: stable-normal BMI, transient-high BMI, and j-curve obesity. The analyses revealed four different trajectories of BMI change for the girls: stable-normal BMI, early-declining BMI, late-declining BMI, and accelerating rise to obesity. The multivariate analysis revealed that the combined predictors of the obesity trajectories of the girls (group membership) included having a fussy temperament, ineffective parenting, and parents’ educational attainment. Predictors of the boys’ obesity trajectory (group membership) included household income, parental education, and effective parenting practices. Understanding the different ways in which a child may develop obesity will allow nurses and other health professionals to take different approaches in the assessment, intervention and evaluation of obesity and obesity-related health problems. The results of this study further our understanding of factors associated with the development of obesity at a young age and hence may inform the development of early preventive programs.

Background: An understanding of the meaning of health is an integral component in the development of effective health promotion programs aimed at promoting health or preventing diseases such as childhood obesity. One group of Canadian children known to be at higher risk for obesity is those living in rural settings. The purpose of this current research was to explore the meaning of health of preadolescent children living in rural Saskatchewan. The following four research questions were addressed: (a) What are the general health characteristics of the study sample?, (b) What is the rural context of children participating in this study?, (c) What is the meaning (i.e. values, norms, beliefs, behaviors) of health from the perspectives of a group of preadolescent children?, and (d) Is the meaning of health thematically congruent from the perspectives of healthy weight and unhealthy weight children?. Study Design: Mixed methods explanatory sequential design (Participant selection model) with qualitative emphasis. Methods: Participants were recruited through classroom presentations and invitational letters sent out to all children attending a rural elementary school in Saskatchewan. Ninety-nine children (51.0% response rate) participated in the quantitative component [measurement of height and weight for purposes of determining healthy weight and unhealthy weight (overweight or obese) status and completion of health questionnaire examining dietary and physical activity patterns]. Of the children who met the selection criteria for qualitative follow up (Grade 4, 5, & 6 children who agreed to be interviewed and had a parent who agreed to be interviewed), twenty children and their parents were randomly selected to be individually interviewed for a total of 71 interviews. An observational assessment of the community was conducted by the researcher for the purpose of gaining a greater understanding of the rural context in which the study participants construct their meaning of health. Results: Prevalence of unhealthy weights in these rural children was high (34%) with gender differences evident at a very young age. Regardless of weight or health status, children described their cultural meaning of health as an integration of Knowing Stuff, Having a Working Body, and Feeling Happy. Of these three themes Feeling Happy was recognized as the most meaningful and children described that receiving encouragement and support from valued relationships contributed to their happiness and overall meaning of health. The rural environment appeared to provide a sense of safety, security, and freedom in which children frequently engaged. Significance of Findings: The high prevalence of unhealthy weights in this sample of rural children has the potential to negatively influence the present and future health of these children. Developing an understanding of the cultural meaning of health and how this culture may influence patterns of healthy behaviors may be a foundation to the development of successful interventions aimed at promoting healthy weights in rural children.

This dissertation presents three separate studies investigating elementary school personnel's perceptions of and recommendations for managing child obesity. First, a systematic literature review will be presented with an assessment of the very limited current body of literature related to elementary school personnel's perceptions of child obesity to determine the direction of the second and third studies. The systematic review presents personnel's perspectives of (1) the extent of child obesity, (2) contributing factors of child obesity, (3) solutions for child obesity, and (4) barriers to overcoming child obesity. Second, drawing upon the systematic review, a qualitative investigation of elementary school personnel's perceptions of and recommendations for managing child obesity will be presented. Utilizing an emergent design, data collection comprised one-on-one interviews with 31 elementary school personnel. A thematic analysis was employed on raw data and a socioecological model was utilized to explain emergent themes. Participating school personnel identified the home environment and parental factors as the leading factors contributing to child obesity. Personnel also emphasized child control of dietary and physical activity choices, most notably within the home environment. Third, a qualitative case study examining an elementary physical education (P.E.) teacher's perspectives of the impact of obesity on her obese students' experiences in her classroom will be presented. A narrative framework was employed, utilizing both thematic and structural analyses to examine the narratives elicited during the interview. The thematic analysis illuminated a participation refusal pattern of obese students within this P.E. teacher's classroom. The structural analysis highlighted the participating P.E. teacher's customized intervention for her obese students' participation refusals. The combination of thematic and structural methodologies resulted in a preliminary model of the behavioral impact of obesity in this P.E. classroom, which provided a more holistic view than either method alone. Prior to this study, just seven studies had investigated elementary school personnel's perceptions of and recommendations for managing child obesity; only three of which were published in the past decade. Thus, this study is both timely and desperately needed. The valuable insights gained from participating elementary school personnel in this study provide a justification for their inclusion in future studies addressing child obesity.

Childhood obesity is a growing concern for practitioners and researchers. In addition to obesity being a risk factor for cardiovascular disease, children classified as obese are more likely to demonstrate other risk factors associated with cardiovascular disease. Furthermore, children classified as obese are more likely to be victims of bullying and discrimination. This dissertation tested a dynamic cascade model of the development of childhood obesity. It was hypothesized that externalizing behaviors and internalizing problems would lead to increased body mass index. This model was tested in Mplus v7 (Muthén & Muthén, 1998) using data from the NICHD Study of Early Child Care. This dissertation used parent report of externalizing behaviors and internalizing behaviors, teacher report of externalizing behaviors, and body mass index to examine several different ways in which developmental psychopathology related to childhood obesity. The results suggested that body mass index predicts the development of internalizing problems in late childhood. However, externalizing behaviors were not directly or indirectly associated with body mass index. These findings suggested that the assessment of children with internalizing problems should include an assessment of their weight and weight related concerns.

Background: An understanding of the meaning of health is an integral component in the development of effective health promotion programs aimed at promoting health or preventing diseases such as childhood obesity. One group of Canadian children known to be at higher risk for obesity is those living in rural settings. The purpose of this current research was to explore the meaning of health of preadolescent children living in rural Saskatchewan. The following four research questions were addressed: (a) What are the general health characteristics of the study sample?, (b) What is the rural context of children participating in this study?, (c) What is the meaning (i.e. values, norms, beliefs, behaviors) of health from the perspectives of a group of preadolescent children?, and (d) Is the meaning of health thematically congruent from the perspectives of healthy weight and unhealthy weight children?. Study Design: Mixed methods explanatory sequential design (Participant selection model) with qualitative emphasis. Methods: Participants were recruited through classroom presentations and invitational letters sent out to all children attending a rural elementary school in Saskatchewan. Ninety-nine children (51.0% response rate) participated in the quantitative component [measurement of height and weight for purposes of determining healthy weight and unhealthy weight (overweight or obese) status and completion of health questionnaire examining dietary and physical activity patterns]. Of the children who met the selection criteria for qualitative follow up (Grade 4, 5, & 6 children who agreed to be interviewed and had a parent who agreed to be interviewed), twenty children and their parents were randomly selected to be individually interviewed for a total of 71 interviews. An observational assessment of the community was conducted by the researcher for the purpose of gaining a greater understanding of the rural context in which the study participants construct their meaning of health. Results: Prevalence of unhealthy weights in these rural children was high (34%) with gender differences evident at a very young age. Regardless of weight or health status, children described their cultural meaning of health as an integration of Knowing Stuff, Having a Working Body, and Feeling Happy. Of these three themes Feeling Happy was recognized as the most meaningful and children described that receiving encouragement and support from valued relationships contributed to their happiness and overall meaning of health. The rural environment appeared to provide a sense of safety, security, and freedom in which children frequently engaged. Significance of Findings: The high prevalence of unhealthy weights in this sample of rural children has the potential to negatively influence the present and future health of these children. Developing an understanding of the cultural meaning of health and how this culture may influence patterns of healthy behaviors may be a foundation to the development of successful interventions aimed at promoting healthy weights in rural children.

Childhood overweight/obesity (CHO) is a serious health concern for children and adolescents. Despite increased efforts to prevent CHO, prevalence rates have actually increased. Evidence suggests that parents are critical to successful interventions to reduce CHO among children. While research efforts aimed at parental inclusion have increased, limited research has been conducted to investigate fathers’ perception of CHO, or their influences on their children’s health. The objective of this two-phase study was to answer three research questions: a) How does the extant literature operationalize African American parental perceptions of childhood overweight/obesity? b) What are African American fathers’ perceptions of CHO? and c) How do African American fathers perceive CHO in relation to their own child’s weight status? Evidence-based studies reveal that fathers have the potential to play a significant role in CHO prevention. Phase one (literature review) revealed that published studies on parental perception of CHO either exclude fathers, include them only in data collection, and/or report no results specific to paternal perception. Thus, an exploratory qualitative study was needed to explore African American fathers’ perceptions of CHO. In phase two (qualitative study), four fathers were interviewed about their perceptions of CHO and how they contextualize this problem. The results indicated fathers believe that weight categories are racially & culturally insensitive and do not account for individual health status or differences in body/bone structure, and that parents with overweight children are financially disadvantaged, irresponsible and overworked. Fathers also indicated that colloquial terms (e.g., chunky, husky, big-boned, thick) were commonly substituted medical definitions for overweight and that child/teen sports participation was motivated by health, as well as non-health related benefits (e.g., competitiveness, educational scholarships). Further, fathers’ identification of CHO is subjective and includes visual means and parental assessment of health status (e.g., child mobility/activity levels). Implications of this study are that additional studies are needed to clarify fathers’ roles in CHO and that future studies should consider complex familial structures, as well as reframe prevention efforts to focus on optimal child health as opposed to weight labeling and focusing on parents’ accuracy in identifying weight categories.

The worldwide obesity epidemic is cause for alarm because of its link to major, life threatening diseases such as cardiovascular disease and Type 2 diabetes. Not only adults, but also children, are suffering from increasing rates of overweight and obesity. This is a matter of serious concern not just because of the specific diseases that are affecting growing numbers of children, but also because overweight and obesity in childhood greatly increase the likelihood that those children will be obese as adults. The incidence of childhood obesity in Texas is significantly higher than the U.S. average. One of the two Austin, Texas zip codes with the highest rates of childhood obesity is zip code 78745. A coalition of concerned residents, government representatives, nonprofit leaders, and religious activists known as Go Austin!/Vamos Austin! (GAVA) has spearheaded an initiative to combat childhood obesity in the zip code. One of GAVA’s three foci is physical activity. This professional report analyzes the physical activity opportunities for children in 78745 through free, publicly available recreation facilities and green spaces. It identifies those spaces that are closest to the childhood obesity hotspots and recommends actions that can be taken by the city, the school district, nonprofits, area businesses, and local residents to increase physical activity among area children through existing and proposed opportunities. / text

Introduction: Prevalence of obesity and overweight in children is growing in Canada and worldwide. In recent years multiple approaches have been utilized to treat childhood obesity. Multidisciplinary and family-based approaches have been shown to be successful in the management of obesity and overweight in children however, there is limited evidence about their use with younger children. Therefore the purpose of this thesis was to explore the translation of a family-based intervention, MEND 5-7, for the British Columbia (BC) context using the RE-AIM framework. Methods: A mixed methods design was used. Twenty-four children and their families who were enrolled in MEND program across 3 cities participated in the study. Anthropometrics and self-reported lifestyles and attitudes were measured for both children and parents pre and post program. MEND staff completed recruitment and registration tracking, and session feedback forms; were interviewed about implementation and meeting minutes were analysed for the process evaluation. In addition parent feedback surveys and site visit feedback forms were also included. Data were organized and analysed based on the RE-AIM framework. Results: The sample was too small to be representative but the demographics of the group appeared to be similar to the BC population. A number of significant improvements were seen related to physical activity (screen-time, p = .002; parent self-efficacy for increasing play and enjoyment, p = .05) and eating habits (parent fruit and vegetable consumption, p = .009). The small number of participants made in difficult to draw a valid conclusion about the changes in anthropometry. Data on implementation showed that families and group leaders were highly satisfied with the program. The program was found to be feasible and facilitators included team work, flexibility, participants’ engagement, community relations, preparation and planning, and support. Barriers to implementation included were time, recruitment, parental involvement, diversity, lack of flexibility in manual and location. Conclusion: MEND 5-7 appeared feasible for the BC population, however recruitment remains a significant challenge to program operations. Further research using an experimental design is needed. / Graduate