Childhood obesity has been prevalent for a number of years despite programs designed to educate children and families on healthy diets and activities. Multiple disciplines have reported chronic stress can interfere with normal neuroendocrine functions in the body which include energy balance. Research into alternate mechanisms contributing to childhood obesity is just beginning to include psychosocial factors’ and their influence on biology. Healthy coping strategies can reduce the effects of stress and influence perceptions of what is stressful. Warm, secure relationships with parents, family connectedness, and a secure stable environment all contribute to the buffering of chronic stress as well as promote the ability to cope with stress. Through the years, changes in the family environment through divorce, single parenthood, and cohabitation may play a role in the child’s ability to cope with stress. Therefore, the purpose of this study was to explore relationships between the child’s perceptions of chronic stress, coping strategies, family connectedness, family characteristics, and weight in 4th and 5th grade children. This study used a cross sectional and correlational design. The conceptual framework guiding this study was the Bio-Psycho-Social Model for Health integrating the three dimensions (biological, psychological, and sociological) as they relate to obesity in children. Well established instruments were used to measure chronic stress, coping, family connectedness, and weight. Results did not reveal a relationship between chronic stress and children’s weights. The ‘frequency the family sat down to eat dinner together’ was significantly related to weight: the more dinners together the lower the body mass indices and accounted for 14.7% variance in children’s body mass indices. Frequency of family meals was also correlated with the frequency of cooking dinner and negative trending of both ‘frequency’ and ‘helpfulness’ of coping strategies: possibly suggesting less need for the coping strategies. Parents’ education was positively correlated with more sleep on school nights for children. The findings suggest the importance of family time together is related to lower body mass indices in children. / text

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: Physical activity and childhood obesity have been studied extensively across the globe, but only few studies have been done in children who are aware of their obesity, overweight status and among children who are taking measures to control their weight. The purpose of this study is to examine agreement between perceived weight and ideal weight differences across gender, grade level, race and levels of weight control. METHODS: This study is based on the secondary analysis of the Youth Risk Behavior Surveillance System (YRBSS) conducted in the state of Georgia in 2009 (n=1882). The 2009 YRBS for each state that participated used a two-stage cluster sample design to produce a fairly representative sample of public school students in the grades of 9-12. Agreement between the perceived weight and the ideal weight differences across gender, grade level and race was measured using Kappa statistic. RESULTS: In general, agreement between perceived weight and the ideal weight were better in females compared to males. A much higher degree of concordance between perceived weight and the ideal weight was observed in Whites compared to Blacks and Hispanics. The analysis by grade resulted in 12th grade participants showing a high concordance value between their ideal weight and their perceived weight than the lower grade levels. CONCLUSION: The results are in particular very insightful to the public health professionals who are in the process of promoting healthy behaviors. The study implies that minority groups such as Blacks and Hispanics may be more uninformed about their obesity status. Public health programs that are specifically designed to increase obesity awareness may help to alleviate obesity and its related consequences. Race and gender specific programs may help to increase perception about obesity in at-risk 9-12 children and adolescents.

Background: South Africa is experiencing a unique double burden of disease due to the nutrition transition, facing diseases related to both under and over nutrition. Childhood obesity is associated with a poor childhood diet, physical inactivity and sedentary lifestyle. Promoting healthy eating and physical activity is important. Promoting healthy eating patterns and regular activity are essential components of lifestyle modification of children. An obesity prevention programme with elements of music and dance for children aimed at improved nutritional knowledge to combat ignorance ofhealthy diets and highlight importance ofphysical activity seemed to be an ideal solution. Aim :The aim of this study was to investigate the effect of a novel nutrition intervention programme based on the South African food-based dietary guidelines (SAFBDG; musical play) on the transfer of nutritional knowledge towards a healthy lifestyle (healthy dietary behaviour and physical activity) in primary school children. Methods: Children (n=203; boys=93; girls=110), aged 6 to 12 years from different ethnic groups were recruited. Participation was voluntary. Only children whose parents/guardians gave written informed consent were included. Children were randomly assigned to a control group (n=99) exposed to the standard school nutrition curriculum and to an experimental group (n=104) who also participated in a musical play with short messages based on the SAFBDG for two sessions a week for five weeks. After each session pamphlets on the relevant SAFBDG message were given to the children to take home. At the end of the intervention the children performed the musical play for their parents/guardians. At baseline demographic information was obtained, anthropometrical measurements taken, a validated nutritional knowledge questionnaire administered and a 24-hour dietary recall completed. All measurements except the demographic questionnaire were repeated after the intervention. Results: Overall nutritional knowledge of the children exposed to the musical play increased with statistical and practical significance [11.9% (p < 0.05) versus. 11.1% (d> 0.05)]. Children 6 to 12 years consumed more grains and less dairy, vegetables, :fruit and meat than the recommended intakes. No measurable changes occurred in food group consumption after the intervention except for :fruit intake which increased in girls aged 8 -10 years in the experimental group (p < 0.05). Boys and girls aged 6 12 years have inadequate intakes « 67% of the Recommended Dietary Allowances (RDA)) of calcium, vitamins A, C, D, and B12, iron and folate. No statistically significant changes anthropometrical measurements were found after the intervention. Z-scores showed that children from the lower grades (grade 1 3) were more prone to stunting while children from the higher grades (grade 4 -6) were more prone to be obese. Furthermore, a high prevalence of overweight and obesity was found amongst white boys, whereas stunting was more prevalent amongst black boys and girls. Conclusion: The results of the study showed that the musical play based on the SAFBDG improved overall nutritional knowledge in a group of primary school children. Diet quality based on food group recommendations and nutrient intakes remained low which suggests that other factors apart from nutritional knowledge influenced food choices and, therefore, the diet quality in this group of children. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2010.

This research study focuses on examining the views of patients, their families, and staff member providers of the Centre for Healthy Active Living a clinical obesity management program for children and youth at the Children’s Hospital of Eastern Ontario, in Ottawa, Canada. Qualitative methodology was used and content analysis was conducted with data obtained from family questionnaires and a provider focus group. Analysis of obtained data was conducted to determine alignment of views between patient, family, and provider views, and the formal goals of the program. Emerging themes from the data indicated that patients and families place higher value on the formal goals of “improve quality of life; improve eating behaviours; improving fitness, increasing activity levels; and empower/strengthen families.” (Children’s Hospital of Eastern Ontario, 2012). Specific recommendations with regards to each component of these goals were provided. Instrumental, procedural, systemic, and conceptual recommendations of program components were also provided.

Background: South Africa is experiencing a unique double burden of disease due to the nutrition transition, facing diseases related to both under and over nutrition. Childhood obesity is associated with a poor childhood diet, physical inactivity and sedentary lifestyle. Promoting healthy eating and physical activity is important. Promoting healthy eating patterns and regular activity are essential components of lifestyle modification of children. An obesity prevention programme with elements of music and dance for children aimed at improved nutritional knowledge to combat ignorance ofhealthy diets and highlight importance ofphysical activity seemed to be an ideal solution. Aim :The aim of this study was to investigate the effect of a novel nutrition intervention programme based on the South African food-based dietary guidelines (SAFBDG; musical play) on the transfer of nutritional knowledge towards a healthy lifestyle (healthy dietary behaviour and physical activity) in primary school children. Methods: Children (n=203; boys=93; girls=110), aged 6 to 12 years from different ethnic groups were recruited. Participation was voluntary. Only children whose parents/guardians gave written informed consent were included. Children were randomly assigned to a control group (n=99) exposed to the standard school nutrition curriculum and to an experimental group (n=104) who also participated in a musical play with short messages based on the SAFBDG for two sessions a week for five weeks. After each session pamphlets on the relevant SAFBDG message were given to the children to take home. At the end of the intervention the children performed the musical play for their parents/guardians. At baseline demographic information was obtained, anthropometrical measurements taken, a validated nutritional knowledge questionnaire administered and a 24-hour dietary recall completed. All measurements except the demographic questionnaire were repeated after the intervention. Results: Overall nutritional knowledge of the children exposed to the musical play increased with statistical and practical significance [11.9% (p < 0.05) versus. 11.1% (d> 0.05)]. Children 6 to 12 years consumed more grains and less dairy, vegetables, :fruit and meat than the recommended intakes. No measurable changes occurred in food group consumption after the intervention except for :fruit intake which increased in girls aged 8 -10 years in the experimental group (p < 0.05). Boys and girls aged 6 12 years have inadequate intakes « 67% of the Recommended Dietary Allowances (RDA)) of calcium, vitamins A, C, D, and B12, iron and folate. No statistically significant changes anthropometrical measurements were found after the intervention. Z-scores showed that children from the lower grades (grade 1 3) were more prone to stunting while children from the higher grades (grade 4 -6) were more prone to be obese. Furthermore, a high prevalence of overweight and obesity was found amongst white boys, whereas stunting was more prevalent amongst black boys and girls. Conclusion: The results of the study showed that the musical play based on the SAFBDG improved overall nutritional knowledge in a group of primary school children. Diet quality based on food group recommendations and nutrient intakes remained low which suggests that other factors apart from nutritional knowledge influenced food choices and, therefore, the diet quality in this group of children. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2010.

Bakgrund: Barnfetma är på väg att bli ett stort folkhälsoproblem i samhället. 42 miljoner barn under fem år är överviktiga i världen. God självkänsla är viktigt för det psykiska välbefinnandet. Syfte: Vi vill undersöka om en överviktig ungdom löper större risk att drabbas av låg självkänsla jämfört med en normalviktig ungdom. Metod: Vi har gjort en litteraturstudie där vi har analyserat tio vetenskapliga artiklar. Resultat: Övervikt och fetma är ett stort problem med negativ påverkan på ungdomars psykiska hälsa. Skillnader finns mellan kön, etnicitet och socioekonomisk bakgrund. Flickor rapporterar lägre självkänsla än pojkar och ungdomar med afroamerikansk etnicitet rapporterar högre självkänsla än ungdomar från andra etniciteter. Slutsats: Övervikt och fetma har ett tydligt samband med låg självkänsla hos ungdomar, speciellt tydligt hos flickor. Därför är det viktigt att börja med insatser i tidig ålder för att motverka övervikt. / Background: Childhood obesity is becoming a major public health issue in the community. 42 million children under the age of five are overweight globally. Good self-esteem is important for mental well-being. Aim: We wanted to investigate if overweight youths were more likely to develop low self-esteem compared with normal weight youths. Method: We did a literature study where we analyzed ten scientific articles. Results: Overweight and obesity is a major problem with a negative impact on adolescent’s mental health. There is a difference between gender, ethnicity and socioeconomic background found in these studies. Girls report lower self-esteem compared to boys and young African-American report higher self-esteem compared to adolescents from other ethnicities. Conclusion: Overweight and obesity is clearly associated with low self-esteem in adolescents, especially evident in female gender. Therefore, it is important to start with interventions at an early age to prevent the problem of obesity.

The feasibility and outcomes of a 12-week extracurricular family-based intervention led by physical therapists that was designed to increase physical activity (PA) in three Hispanic male middle-school children was examined. This intervention has limited feasibility and may increase physical activity levels for overweight Hispanic middle school children. In a second study, differences in motor proficiency, strength, endurance, and PA among healthy weight, overweight and obese children were examined, and correlations between BMI and physical impairments were explored. Obese children demonstrated impairments in motor proficiency, strength, and endurance when compared to healthy weight children. Among overweight children, higher BMI was associated with more physical impairments. Overweight children were less physically active than healthy weight children. A high proportion of children were not meeting daily step recommendations to maintain a healthy weight. Girls were less active than boys at this crucial stage of development. The findings of this study have important clinical relevance for physical therapists, who are uniquely qualified to assess these identified impairments and activity limitations that may limit a child’s ability to engage in greater levels of physical activity. This information lends support to the role of the physical therapist in addressing current public health recommendations related to the childhood obesity.

Introduction and Rationale: Childhood obesity is a public health epidemic in the United States. Prevention of childhood obesity is an important health concern, but there is a lack of prevention efforts focused on infancy (Birch, Anzman-Frasca, & Paul, 2012). Many health behaviors are learned in the very early childhood years (Dattilo et al., 2012), so infancy is an opportune time to begin obesity prevention efforts (Grote, Theurich, & Koletko, 2012; Paul et al., 2011). There are very few resources available to educate mothers and caregivers of infants on protective infant feeding practices to reduce obesity risk. Purpose and Objective: The purpose of this DNP project is to develop educational material about infant feeding practices as a significant modifiable risk factor for the development of childhood obesity. The educational material is directed towards pregnant women and caregivers of infants less than 12 months of age. The objective is to educate parents and caregivers about infant feeding practices and the importance of preventing excessive weight gain during the first year of life for the prevention of childhood obesity. Methods: The Information-Motivation-Behavior (IMB) Model of Health Behavior serves as a framework for the content of the educational material. The Toolkit for Making Written Material Clear and Effective serves as a guide for the design of the educational material. Results: A systematic assessment of the educational material was conducted using the Patient Education Materials Assessment Tool (PEMAT), a validated evaluation tool. The educational material was revised based on the PEMAT score. The PEMAT score was calculated for the revised handout and the handout is presented as an educational tool for the prevention of childhood obesity. Conclusions: This DNP Project demonstrated childhood obesity as a current significant health problem and identified infant feeding practices as a significant modifiable risk factor for the development of childhood obesity. Due to a lack of obesity prevention efforts focused on infancy, educational material was created using the IMB model of health behavior and the Toolkit for Making Written Material Clear and Effective. The final PEMAT evaluation yielded educational material that will likely have a positive health influence on the pediatric population.

The prevalence of obesity in the United States is at the highest it has ever been. Adolescent and adult obesity rates have increased greatly over the past three decades, and those individuals who are already obese continue to gain weight. More recently, levels of obesity have stabilized but the number of obese individuals in the country is still very high. Efforts must be made at reducing these levels of obesity, as obesity is associated with the development of chronic diseases, significant reductions in quality of life, and insurmountable costs. The economic impact of obesity expands beyond direct healthcare costs into the workplace, reducing individual productivity levels and increasing the number of workdays missed as the severity of obesity increases. These realities provide incentives for both governmental and private sectors to take an interest in the prevention of obesity. The causes of obesity are many, and an appropriate treatment that will reduce obesity on a population level has not been identified. Current literature suggests the most effective population to target for obesity prevention is youth, especially around the ages of five to seven while lifestyle habits are being formed. This is mostly due to the relatively small changes needed to prevent childhood obesity as compared to the more difficult approach of reducing adult obesity. As opposed to the treatment of adult obesity, the prevention of childhood obesity requires a much smaller correction to daily calorie intake. Furthermore, obese youth tend to maintain their obesity into adulthood. The earlier in age that childhood obesity develops, the more difficult it is to prevent the development of adult obesity. Evidence currently shows that childhood obesity levels are related to the quality of meals and eating habits influenced by parents or caregivers and increased consumption of sugars and high-calorie foods strongly associated with aggressive food and beverage marketing. In addition, decreased levels of physical activity are associated with childhood obesity risk. In these ways, the current social and economic environment in the US strongly promotes childhood obesity. The most effective obesity prevention strategies involve a holistic modification of the surrounding environment. Studies show that addressing the school environment and thoroughly educating parents about the importance of nutritious eating and physical activity are important components of childhood obesity prevention efforts. While school and community interventions are moderately effective, a rise in BMI does tend to occur during summer months when children are typically on a less structured schedule and may not have encouragement from school programs to eat healthy foods and exercise. Schools also provide the opportunity for extracurricular activities, such as sports programs and other such supportive measures, which may prevent the development of childhood obesity. Suggested policy actions may modify the community and environment in such a way that obesity reduction is economically favorable. A tax on sugar-sweetened beverages is estimated to be highly effective in reducing childhood consumption of sugar, and subsequently lowering obesity rates. Other policy interventions that would be effective for reducing childhood obesity include imposing limits on the types of foods sold in school to children, and restricting marketing efforts aimed at children. Implementing a sugared-beverage tax and reducing tax subsidies from advertisements of food and beverage companies would produce positive return-on-investments and raise additional funds for additional adolescent obesity prevention efforts. Policymakers, local governments, parents, schools, and the community will need to invest time and finances into these modifications for obesity prevention to be effective. Policy changes, specifically sugared-beverage taxes, have recently been enacted in Mexico and in Berkeley, California. Evaluation research will provide additional evidence for the efficacy of these policy actions in obesity prevention. Current projects that will contribute to the gaps in preventive community modification research are in progress in California, Massachusetts and Texas. Additionally, research into the prevention of summer-month BMI increases in children may be beneficial for maintaining appropriate lifestyle modifications when school is not in session.