Chan, Yun Kwan. / Accompanying CD-ROM contains appendix H, I, J, and K. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 161-170). / Abstracts in English and Chinese; three appendixes in Chinese only. / Library's copy: lacks accompanying CD-ROM. / Acknowledgement --- p.i / Abstract --- p.ii / Abstract (Chinese) --- p.iv / List of publications --- p.vi / Table of Contents --- p.viii / List of Figures --- p.xvi / List of Tables --- p.xvii / List of Abbreviations --- p.xxv / Chapter CHAPTER ONE: --- INTRODUCTION --- p.1 / Chapter 1.1 --- Global prevalence of childhood overweight --- p.1 / Chapter 1.2 --- Preschool health situation in HK --- p.2 / Chapter 1.2.1 --- Breastfeeding --- p.2 / Chapter 1.2.2 --- Diet and physical activity patterns --- p.3 / Chapter 1.2.3 --- Prevalence of childhood overweight --- p.5 / Chapter 1.2.3.1 --- Definition of childhood overweight --- p.5 / Chapter 1.2.3.2 --- Local prevalence of childhood overweight --- p.6 / Chapter 1.3 --- Consequences of childhood overweight --- p.7 / Chapter 1.3.1 --- Health consequences of childhood overweight --- p.7 / Chapter 1.3.2 --- Economic consequences of childhood overweight --- p.9 / Chapter 1.4 --- Risk factors of childhood overweight and obesity --- p.11 / Chapter 1.4.1 --- Family Socioeconomic status --- p.11 / Chapter 1.4.2 --- Parental overweight --- p.11 / Chapter 1.4.3 --- Breastfeeding --- p.12 / Chapter 1.4.4 --- Birth order --- p.13 / Chapter 1.4.5 --- Breakfast consumption --- p.13 / Chapter 1.4.6 --- Beverage consumption --- p.14 / Chapter 1.4.7 --- High calcium intake --- p.15 / Chapter 1.4.8 --- Fruit and vegetable consumption --- p.15 / Chapter 1.4.9 --- Physical inactivity --- p.15 / Chapter 1.4.9.1 --- Physical activity recommendations for preschoolers --- p.17 / Chapter 1.4.9.2 --- Screentime recommendations for preschoolers --- p.18 / Chapter 1.5 --- Child development --- p.18 / Chapter 1.5.1 --- Onset of overweight --- p.18 / Chapter 1.5.2 --- Early establishment of lifelong habits at preschool age --- p.19 / Chapter 1.5.3 --- Interaction with parents --- p.20 / Chapter 1.6 --- Justification of preschool multi-component health intervention in Hong Kong --- p.22 / Chapter 1.6.1 --- Local health promotion initiative at preschool --- p.22 / Chapter 1.6.2 --- Justification for DRAGON2006 modifications --- p.23 / Chapter 1.6.2.1 --- Inclusion of family-home component in school- based health intervention --- p.24 / Chapter 1.6.2.2 --- Child BMI monitoring and health report to parents --- p.24 / Chapter 1.7 --- Present school-based preschool health intervention --- p.25 / Chapter 1.8 --- Summary --- p.27 / Chapter 1.9 --- Aims and objectives --- p.27 / Chapter CHAPTER TWO: --- METHODOLOGY --- p.28 / Chapter 2.1 --- Recruitment of preschools and preschoolers --- p.28 / Chapter 2.2 --- Development of DRAGON2006 --- p.33 / Chapter 2.2.1 --- Ethics approval --- p.35 / Chapter 2.2.2 --- Focus groups with parents --- p.35 / Chapter 2.2.3 --- Amendment and pretest of the questionnaires --- p.35 / Chapter 2.2.4 --- Health lessons --- p.36 / Chapter 2.2.4.1 --- Development and adaptation of the health lessons --- p.36 / Chapter 2.2.4.2 --- Improvement of the teaching materials --- p.37 / Chapter 2.2.4.3 --- Lyrics reproduction and CD production --- p.37 / Chapter 2.2.4.4 --- Worksheets --- p.38 / Chapter 2.2.4.5 --- Process evaluation --- p.38 / Chapter 2.2.5 --- Teachers´ة training --- p.38 / Chapter 2.3 --- Intervention Activities and Components --- p.39 / Chapter 2.3.1 --- Opening ceremony --- p.39 / Chapter 2.3.2 --- Health Talks --- p.40 / Chapter 2.3.3 --- Health report --- p.40 / Chapter 2.3.4 --- Parental newsletters --- p.41 / Chapter 2.4 --- Outcome evaluation --- p.42 / Chapter 2.5 --- Data collection --- p.43 / Chapter 2.5.1 --- Recruitment of subjects --- p.43 / Chapter 2.5.2 --- Anthropometric measurements --- p.43 / Chapter 2.5.3 --- Parental baseline and evaluation questionnaire administration --- p.44 / Chapter 2.5.4 --- Teachers´ة pre- and post-intervention evaluation and process evaluation --- p.44 / Chapter 2.6 --- Data management --- p.44 / Chapter 2.6.1 --- Verification of data from the questionnaires --- p.44 / Chapter 2.6.2 --- Data coding --- p.45 / Chapter 2.6.3 --- Data entry and verification --- p.45 / Chapter 2.6.4 --- Data analysis --- p.45 / Chapter 2.5.4.1 --- Descriptive and association analysis --- p.45 / Chapter 2.5.4.2 --- Construction of BMI-for-age percentile and z- score curves --- p.46 / Chapter 2.5.4.3 --- Evaluation of the effectiveness of the program --- p.47 / Chapter CHAPTER THREE: --- RESULTS --- p.48 / Chapter 3.1 --- Organization of the results --- p.48 / Chapter 3.2 --- Baseline comparability between the EG and CG --- p.48 / Chapter 3.2.1 --- General sociodemographic characteristics --- p.48 / Chapter 3.2.2 --- Preschoolers' diet and meal behaviors --- p.54 / Chapter 3.2.3 --- Preschoolers´ة dental health --- p.61 / Chapter 3.2.4 --- Parental child feeding behaviors --- p.62 / Chapter 3.2.5 --- Preschoolers´ة physical activity and sedentary behaviors --- p.66 / Chapter 3.2.6 --- Summary --- p.67 / Chapter 3.3 --- Baseline comparability between the completes and dropouts --- p.69 / Chapter 3.3.1 --- Participant flow in the EG and CG --- p.69 / Chapter 3.3.2 --- General sociodemographic characteristics --- p.70 / Chapter 3.3.3 --- "Preschoolers´ة diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.74 / Chapter 3.3.4 --- Summary --- p.75 / Chapter 3.4. --- Evaluation of the effectiveness of the DRAGON2006 --- p.76 / Chapter 3.4.1 --- General demographic characteristics --- p.76 / Chapter 3.4.2 --- Effects on preschoolers´ة anthropometry and weight status --- p.77 / Chapter 3.4.3 --- Effects on preschoolers' diet and meal behaviors --- p.79 / Chapter 3.4.4 --- Effects on parental child feeding behaviors --- p.89 / Chapter 3.4.5 --- Effects on preschoolers´ة physical and sedentary activities --- p.92 / Chapter 3.4.6 --- Summary --- p.94 / Chapter 3.5 --- "Teaching staff members´ة attitudes, perceptions and practices with respect to addressing childhood overweight" --- p.95 / Chapter 3.5.1 --- General demographic characteristics --- p.95 / Chapter 3.5.2 --- Teachers' attitude toward addressing childhood overweight --- p.98 / Chapter 3.5.3 --- Teachers' behaviors toward addressing childhood overweight --- p.99 / Chapter 3.5.4 --- Teachers' perceived abilities to deal with some childhood overweight topics --- p.100 / Chapter 3.5.5 --- Teachers´ة reported helpful factors to implementing a new preschool health program --- p.101 / Chapter 3.5.6 --- Teachers´ة reported helpful factors for and barriers to parents´ة participation --- p.102 / Chapter 3.5.7 --- Comparisons between staff with and without self-reported weight and height --- p.103 / Chapter 3.5.8 --- Summary --- p.105 / Chapter 3.6 --- EG teachers´ة evaluation of the program --- p.106 / Chapter 3.6.1 --- Teachers' perception of DRAGON2006 program before the intervention --- p.106 / Chapter 3.6.2 --- DRAGON teachers´ة process evaluation of the DRAGON2006 curriculum --- p.113 / Chapter 3.6.3 --- DRAGON teachers´ة evaluation of DRAGON2006 program after the intervention --- p.118 / Chapter CHAPTER FOUR: --- DISCUSSION --- p.127 / Chapter 4.1 --- "Baseline findings about the preschoolers' weight status, diet, meal and physical and sedentary activity situation" --- p.127 / Chapter 4.1.1 --- Preschooler and parental overweight and obesity --- p.127 / Chapter 4.1.2 --- Preschoolers´ة diet and meal behaviors --- p.128 / Chapter 4.1.3 --- Preschoolers´ة physical and sedentary activity behaviors --- p.130 / Chapter 4.2 --- "Gender associations with preschoolers´ة diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.131 / Chapter 4.2.1 --- Gender associations with preschoolers´ة diet and meal behaviors --- p.132 / Chapter 4.2.2 --- Gender associations with parental child feeding behaviors --- p.134 / Chapter 4.2.3 --- Gender associations with preschoolers´ة physical and sedentary activity behaviors --- p.135 / Chapter 4.3 --- "Age associations with preschooler diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.136 / Chapter 4.3.1 --- Preschoolers' age associations with their anthropometry --- p.137 / Chapter 4.3.2 --- Preschoolers´ة age associations with their diet and meal behaviors --- p.137 / Chapter 4.3.3 --- Preschoolers' age associations with their dental health --- p.139 / Chapter 4.3.4 --- Preschoolers´ة age associations with parental child feeding behaviors --- p.139 / Chapter 4.3.5 --- Preschoolers´ة age associations with their physical and sedentary activity behaviors --- p.140 / Chapter 4.4 --- "Family income associations with preschooler diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.141 / Chapter 4.4.1 --- Family income associations with some general demographic characteristics of the sample --- p.143 / Chapter 4.4.2 --- Family income associations with preschoolers´ة diet and meal behaviors --- p.144 / Chapter 4.4.3 --- Family income associations with parental child feeding behaviors --- p.147 / Chapter 4.4.4 --- Family income associations with preschoolers' physical and sedentary activity behaviors --- p.148 / Chapter 4.5 --- Factors associated with preschool overweight and obesity --- p.148 / Chapter 4.5.1 --- Preschooler overweight and obesity associations with some general demographic characteristics of the baseline participants --- p.149 / Chapter 4.5.2 --- Preschooler overweight and obesity associations with parental overweight and obesity --- p.150 / Chapter 4.5.3 --- Preschooler overweight and obesity associations with preschoolers' meal behaviors --- p.150 / Chapter 4.5.4 --- Preschooler overweight and obesity associations with their physical and sedentary activity behaviors --- p.150 / Chapter 4.6 --- The evaluation of the effectiveness of DRAGON2006 --- p.151 / Chapter 4.6.1 --- Baseline comparison between the education (EG) and control group (CG) --- p.151 / Chapter 4.6.2 --- Baseline comparison between completers and dropouts --- p.151 / Chapter 4.6.3 --- Follow up comparison between the education (EG) and control groups (CG) --- p.152 / Chapter 4.6.3.1 --- The changes in preschooler anthropometry --- p.153 / Chapter 4.6.3.2 --- The changes in preschooler diet and meal behaviors --- p.154 / Chapter 4.6.3.3 --- The changes in preschooler physical and sedentary activity behaviors --- p.155 / Chapter 4.6.3.4 --- Parental child feeding behaviors --- p.156 / Chapter 4.7 --- The teachers´ة evaluation results of DRAGON2006 and of Color Me Healthy --- p.156 / Chapter 4.7 --- Strengths and limitations of the study --- p.157 / Chapter 4.8 --- Suggestions for improvement of DRAGON --- p.159 / Chapter CHAPTER FIVE: --- CONCLUSION --- p.160 / References --- p.161 / Appendices / Chapter AI --- Invitation letter for preschool (English) --- p.171 / Chapter AIII --- Invitation letter for preschool (Chinese) --- p.172 / Chapter AIII --- Invitation letter for CG preschool (Chinese only) --- p.173 / Chapter BI --- Research proposal (English) --- p.174 / Chapter BII --- Research proposal (Chinese) --- p.178 / Chapter CI --- Purpose and structure of DRAGON2006 health lessons (English) --- p.181 / Chapter CII --- Purpose and structure of DRAGON2006 health lessons (Chinese) --- p.185 / Chapter DI --- Teacher evaluation Part A (pre-intervention) (English) --- p.189 / Chapter DII --- Teacher evaluation Part A (pre-intervention) (Chinese) --- p.191 / Chapter EI --- Teacher evaluation Part B (process evaluation) (English) --- p.193 / Chapter EII --- Teacher evaluation Part B (process evaluation) (Chinese) --- p.205 / Chapter FI --- Teacher evaluation Part C (post-intervention) (English) --- p.218 / Chapter FII --- Teacher evaluation Part C (post-intervention) (Chinese) --- p.222 / Chapter GI --- Child health report (English) --- p.224 / Chapter GII --- Child health report (Chinese) --- p.226 / Chapter H --- Teaching kit --- p.228 / Chapter I --- Music sound track --- p.228 / Chapter J --- Curriculum worksheets (Chinese only) --- p.228 / Chapter K --- Parents´ة newsletters (Chinese only) --- p.228 / Chapter LI --- Focus group study questions (English) --- p.229 / Chapter LII --- Focus group study questions (Chinese) --- p.231 / Chapter MI --- Consent form for EG parents (English) --- p.233 / Chapter MII --- Consent form for EG parents (Chinese) --- p.235 / Chapter MII --- Consent form for CG parents (English) --- p.237 / Chapter MI --- Consent form for CG parents (Chinese) --- p.238 / Chapter NI --- Pre-internvetion parental questionnaire (English) --- p.239 / Chapter NII --- Pre-intervention parental questionnaire (Chinese) --- p.245 / Chapter OI --- Post-intervention parental questionnaire (English) --- p.250 / Chapter OII --- Post-internvetion parental questionnaire (Chinese) --- p.256 / Chapter PI --- Post-intervention staff survey (English) --- p.262 / Chapter PII --- Post-intervention staff survey (Chinese) --- p.264 / Chapter Q --- "Gender differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.266 / Chapter R --- "Age differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.296 / Chapter S --- "Income differences in preschoolers' diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.313 / Chapter T --- Factors associated with preschooler weight status --- p.334 / Chapter U --- "Maternal education level differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.352 / Chapter V --- "Maternal birth place differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.374 / Chapter W --- Test-retest reliability of DRAGON2006 questionnaire --- p.394

Chan, Po Tai. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 128-150). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes in Chinese.

The purpose of this study was to determine to what extent physical education programs are being implemented in a Southern California school district, in an effort to increase physical activity and decrease obesity among students. This study also identified factors that either contributed to, or detracted from, implementation.

Esta dissertação tem como objetivo compreender o funcionamento das famílias com crianças acometidas pela obesidade na instalação e manutenção da doença, na perspectiva dos pais. Nesta circunstância, foram considerados os sentimentos e dificuldades expressos pelas mães frente à obesidade dos filhos; estratégias utilizadas para enfrentar o problema e indicadores no contexto familiar que pudessem estar contribuindo para a manutenção do quadro de obesidade infantil. O trabalho está dividido em três artigos, sendo um teórico e dois empíricos. O primeiro apresenta um breve histórico da necessidade humana de alimentação que mostrou as mudanças ocorridas que culminaram na proliferação da obesidade e, nesse cenário, as transformações que a família enfrenta para adaptar-se ao meio permeado de tantas ofertas e constantes modificações, em articulação com a Teoria Sistêmica. O segundo artigo identifica no contexto familiar à luz da Teoria Sistêmica, os indicadores da dinâmica familiar que podem estar contribuindo para a instalação e a manutenção da obesidade na infância. O terceiro artigo considera elementos presentes na história familiar das crianças com obesidade, os sentimentos expressos pelas famílias e as consequências físicas e psíquicas da evolução da doença. A pesquisa é de natureza qualitativa levando em consideração a experiência dos participantes em relação ao tema. Foram entrevistadas seis mães e uma avó de crianças, na faixa etária entre 8 a 10 anos incompletos, que se encontravam em atendimento no ambulatório de Obesidade Infantil do Instituto de Medicina Integral Professor Fernando Figueira (IMIP), na cidade do Recife. Utilizamos uma entrevista com roteiro previamente estabelecido e, posteriormente, os resultados foram discutidos com base na análise de conteúdo temática. Os resultados indicaram que todos os membros do sistema estão implicados na instalação da obesidade, através da rejeição materna, compensada por superproteção alimentar, conflitos conjugais, interferência das avós na alimentação dos netos, o que demonstra confusão na hierarquia. As dificuldades de intercâmbio com o meio demonstraram que as famílias consomem alimentos com alto teor de gordura; a falta de coesão acerca das normas alimentares e de limites à criança são elementos que podem estar contribuindo para a manutenção da obesidade na infância / This dissertation aims to understand the functioning of families with children affected by obesity in the installation and maintenance of the disease from the perspective of parents. In this circumstance, we considered the feelings expressed by mothers and difficulties facing the obesity of children, strategies used to address the problem in the family context and indicators that could be contributing to the maintenance of the obese children. The work is divided in three articles, one theoretical and two empirical. The first presents a brief history of the human need to feed that showed the changes that led to the proliferation of obesity and, in this scenario, the changes that the family faces in adapting to the environment permeated with so many offers and constant changes, in conjunction with Systemic Theory. The second article identifies the family context under the light of the Systemic Theory, indicators of family dynamics that may be contributing to the installation and maintenance of obesity in childhood. The third article considers elements in the family history of children with obesity, the sentiments expressed by the families and the physical and psychological consequences of disease progression. The research is qualitative in nature, taking into account the experience of participating in the issue. Six mothers were interviewed and a grandmother of children, aged between 8-10 years old, who were in the outpatient clinic of Childhood Obesity Institute of Medicine Professor Fernando Figueira (IMIP) in the city of Recife. We used an interview with previously established questions, and subsequently the results were discussed based on thematic content analysis. The results indicated that all members of the system are involved in the installation of obesity, through the maternal rejection, overprotection offset by food, marital conflicts, and interference from the grandparents in the feeding of grandchildren, which shows confusion in the hierarchy. The difficulties of exchange with the environment showed that families consume of food with high contents of fat, lack of cohesion about food standards and limits are the child elements that may be contributing to the maintenance of childhood obesity

Made available in DSpace on 2017-06-01T18:08:33Z (GMT). No. of bitstreams: 1 dissertacao_priscila_machado.pdf: 1416795 bytes, checksum: d4a42ab07fac0090b7a9e111146b7e04 (MD5) Previous issue date: 2011-02-15 / This dissertation aims to understand the functioning of families with children affected by obesity in the installation and maintenance of the disease from the perspective of parents. In this circumstance, we considered the feelings expressed by mothers and difficulties facing the obesity of children, strategies used to address the problem in the family context and indicators that could be contributing to the maintenance of the obese children. The work is divided in three articles, one theoretical and two empirical. The first presents a brief history of the human need to feed that showed the changes that led to the proliferation of obesity and, in this scenario, the changes that the family faces in adapting to the environment permeated with so many offers and constant changes, in conjunction with Systemic Theory. The second article identifies the family context under the light of the Systemic Theory, indicators of family dynamics that may be contributing to the installation and maintenance of obesity in childhood. The third article considers elements in the family history of children with obesity, the sentiments expressed by the families and the physical and psychological consequences of disease progression. The research is qualitative in nature, taking into account the experience of participating in the issue. Six mothers were interviewed and a grandmother of children, aged between 8-10 years old, who were in the outpatient clinic of Childhood Obesity Institute of Medicine Professor Fernando Figueira (IMIP) in the city of Recife. We used an interview with previously established questions, and subsequently the results were discussed based on thematic content analysis. The results indicated that all members of the system are involved in the installation of obesity, through the maternal rejection, overprotection offset by food, marital conflicts, and interference from the grandparents in the feeding of grandchildren, which shows confusion in the hierarchy. The difficulties of exchange with the environment showed that families consume of food with high contents of fat, lack of cohesion about food standards and limits are the child elements that may be contributing to the maintenance of childhood obesity / Esta dissertação tem como objetivo compreender o funcionamento das famílias com crianças acometidas pela obesidade na instalação e manutenção da doença, na perspectiva dos pais. Nesta circunstância, foram considerados os sentimentos e dificuldades expressos pelas mães frente à obesidade dos filhos; estratégias utilizadas para enfrentar o problema e indicadores no contexto familiar que pudessem estar contribuindo para a manutenção do quadro de obesidade infantil. O trabalho está dividido em três artigos, sendo um teórico e dois empíricos. O primeiro apresenta um breve histórico da necessidade humana de alimentação que mostrou as mudanças ocorridas que culminaram na proliferação da obesidade e, nesse cenário, as transformações que a família enfrenta para adaptar-se ao meio permeado de tantas ofertas e constantes modificações, em articulação com a Teoria Sistêmica. O segundo artigo identifica no contexto familiar à luz da Teoria Sistêmica, os indicadores da dinâmica familiar que podem estar contribuindo para a instalação e a manutenção da obesidade na infância. O terceiro artigo considera elementos presentes na história familiar das crianças com obesidade, os sentimentos expressos pelas famílias e as consequências físicas e psíquicas da evolução da doença. A pesquisa é de natureza qualitativa levando em consideração a experiência dos participantes em relação ao tema. Foram entrevistadas seis mães e uma avó de crianças, na faixa etária entre 8 a 10 anos incompletos, que se encontravam em atendimento no ambulatório de Obesidade Infantil do Instituto de Medicina Integral Professor Fernando Figueira (IMIP), na cidade do Recife. Utilizamos uma entrevista com roteiro previamente estabelecido e, posteriormente, os resultados foram discutidos com base na análise de conteúdo temática. Os resultados indicaram que todos os membros do sistema estão implicados na instalação da obesidade, através da rejeição materna, compensada por superproteção alimentar, conflitos conjugais, interferência das avós na alimentação dos netos, o que demonstra confusão na hierarquia. As dificuldades de intercâmbio com o meio demonstraram que as famílias consomem alimentos com alto teor de gordura; a falta de coesão acerca das normas alimentares e de limites à criança são elementos que podem estar contribuindo para a manutenção da obesidade na infância

The first chapter of this dissertation tests for addiction to food. This is the first empirical study using nationally representative data to do so. Data show that many common foods are addictive, suggesting that prices play a larger role in food consumption than previously thought. The finding of significant addiction also suggests that targeted food taxes may provide effective instruments for reducing the prevalence of overweight and obesity. The second chapter of this dissertation investigates the determinants of childhood obesity. This research improves upon previous economic research on the topic by incorporating controls for biological relationships of mothers and fathers and examining the entire child weight distribution using quantile regression. I find evidence of genetic weight transmission though the behavioral influence of mothers appears to be dominant. Furthermore, I find that the commonly cited influences on childhood weight do little to explain the most extreme weights. The third chapter of this dissertation studies the contract choice effect. Though frequently discussed, the impact of changes in insurance contract on utilization in response to a change in the expected cost of care has not been explicitly studied in an empirical setting. The analysis identifies a significantly negative contract choice effect, implying that individuals choose better insurance plans in response to increases in the expected cost of care. / text

The school environment is often the focus of healthy eating and physical activity policies intended to address childhood obesity. However, students are usually excluded from the development and implementation of such policies. The purpose of this study was to explore grade nine student perspectives regarding: supports and barriers to healthy eating and physical activity at school; strategies for improving the school nutrition and physical activity environments; and potential student contribution to the development, implementation, and evaluation of school-based policies. A qualitative approach utilizing focus groups and photovoice with 30 students from two schools in southern Alberta was used to collect data. Major themes included: access to healthy food choices; teacher influences; peer influences; access to physical activity opportunities; impact of marketing; and conflicting messages. Students can provide valuable insights to policy development, implementation and evaluation. Implications for future research and policy development are reviewed. / xi, 179 leaves : ill. ; 29 cm

Aim: To determine whether the tuck shop purchasing habits of Grade 4 learners were contributing towards the development of childhood overweight and obesity. Objectives: To assess the nutritional quality of the food and beverages available for learners to purchase; items regularly purchased from the tuck shop as well as factors influencing the learner’s decision to purchase these items; the anthropometric and socio-demographic characteristics of grade 4 learners as well as their nutrition knowledge related to the tuck shop items purchased. Method: A survey administered to 11 tuck shop managers, a questionnaire administered to 311 Grade 4 learners and two single-sex focus groups of 5 learners each were conducted. Results: Fifty six percent of the sample were female (n=173) and 44% were male (n=138). Twenty seven percent of the study sample was overweight (n = 83) and 27% were obese (n = 85). Eighty six percent of learners (n = 266) claimed to buy from their school tuck shop. Twenty two percent of learners purchased from their tuck shop at least three times per week (n =58). Learners who purchased from the tuck shop had a significantly higher BMI than those who did not (p = 0.020). Learners who purchased from the tuck shop spent on average R8,38 per day with a minimum of R1 and a maximum of R40 (standard deviation R5.39). The most popular reasons for visiting the tuck shop included “this is my favourite thing to eat or drink” (66.5%, n = 177) and “I only have enough money to buy this item” (47.0%, n = 125). Savoury pies were the most popular "lunch" item for all learners for both food breaks (45%, n = 5 schools and 27.3%, n = 3 schools) selling the most number of units (43) per day at eight of the eleven schools (72.7%). Iced popsicles were sold at almost every school, ranked as the cheapest beverage and also sold the most number of units (40.7). Healthy beverages sold included canned fruit juice and water, while healthy snacks consisted of dried fruit, fruit salad, bananas, yoghurt and health muffins. The average healthy snack contained almost half the kilojoules of its unhealthy counterpart (465kJ vs 806kJ). Nutritional analyses of the healthy lunch options revealed total fat contents that exceeded the DRI and South African recommended limit. Perceived barriers to stocking healthy items included cost and refrigeration restrictions. The average score for the food groups was only 33% indicating that learners were not familiar with the Food Based Dietary Guidelines (FBDG). Further analyses showed that the total knowledge scores of those learners that reported to buy from the tuck shop frequently, was significantly lower when compared to the total knowledge scores of those learners who bought from the tuck shop less frequently (13.0 ± 3.9 and 11.6 ± 3.1, respectively; p < 0.05). Logistic regression analysis confirmed that the total knowledge of a learner could be used to predict whether he or she is more likely to make purchases from the tuck shop (significance = 0.017). Focus group results revealed that learners are aware of “healthy” and “unhealthy” tuck shop items. Most learners stated that they would continue to purchase items from their tuck shop if all “unhealthy” items were removed. Conclusion: Primary school tuck shops of well resourced schools in Pietermaritzburg are contributing to childhood overweight and obesity through a combination of factors. These include the poor nutritional quality of the items stocked at the tuck shop as well as the poor tuck shop purchasing practices. Much consultation is required amongst dieticians, school principals and privatised tuck shop managers to overcome barriers to stocking healthy items. School management and government have an important role to play in imposing restrictions on the sale of unhealthy items; along with improving the quality of the nutrition education curriculum to ensure that learners are able to translate their knowledge into healthier purchasing practices. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

O excesso de gordura corporal esta associado a diversas doenças de ordem metabólica, psicológica e estrutural. É indicado que a adolescência é o período crítico para o desenvolvimento de hábitos associados ao acúmulo de gordura como a inatividade física, má alimentação e sedentarismo. Desta forma, esta é uma fase crítica para o monitoramento da população visando a redução de casos de obesidade e doenças associadas. A técnica padrão-ouro para avaliação da gordura corporal é a absorciometria de raios-X de dupla-energia. Porém seu caráter laboratorial impede o uso amplo. Desta forma, técnicas mais simples, como a medição de dobras cutâneas devem ser modeladas a partir de técnicas mais exatas para este monitoramento. Os modelos existentes foram desenvolvidos com populações estrangeiras que não se assemelham aos habitantes da Região Metropolitana de Curitiba o que pode levar a erros de avaliação e diagnóstico. Desta forma o objetivo deste estudo é produzir um modelo de análise da gordura corporal apropriado a crianças e adolescentes da Região Metropolitana de Curitiba. Foram selecionadas duas amostras, uma composta por 567 adolescentes hígidos com idade entre 10 e 18 anos; e outra composta por 63 crianças com paralisia cerebral entre 3 e 10 anos. Os dois grupos possuíam indivíduos de ambos os sexos. Foram coletados dados de massa, estatura, idade e espessura de dobras cutâneas, além da avaliação de composição corporal por densitometria radiológica. O percentual de gordura obtido por diferentes equações de dobras cutâneas e demais medidas antropométricas entre os adolescentes foi comparado com o obtido por densitometria indicando associações abaixo do indicado (CCC<0,900). Foi encontrada também uma tendência de subestimação pelas dobras cutâneas, o que resultava em elevados valores de especificidade e baixos de sensibilidade (sendo especificidade á quantidade relativa de verdadeiros negativos entre quem não possui a condição clínica, e a sensibilidade a relação de verdadeiros positivos entre quem possui a condição considerada). Isto indica uma grande quantidade de falsos negativos o que leva muitos adolescentes com excesso de gordura a serem classificados como eutróficos. O modelo classificatório desenvolvido para adolescentes obteve um ajuste de R2 Negelkerke=0,829, sensibilidade de 99,0% e especificidade de 82,7% apresentando indicadores diagnósticos acima do obtido por equações de dobras cutâneas e IMC. Para as crianças com paralisia cerebral foi desenvolvido um modelo estimativo da massa de gordura com ajuste de R2 =0,950 com erro padrão de estimativa de 1,039. As equações utilizadas para converter as dobras cutâneas em medições da gordura corporal demonstraram-se inadequadas para aplicação em adolescentes da região metropolitana de Curitiba. A aplicação de técnicas de regressão logística e linear apresentou resultados positivos, mesmo a partir da modelagem na amostra de crianças com paralisia cerebral. / The overfat is associated with many methabolic, psycological and structural diseases. The adolescence is indicated as the critical period for the development of habits associated with fat accumulation like physical inactivity, poor diet and sedentarism. Thus, this is a important moment to monitorig the population aiming the reduction of obesity and associated disease. The golden standard to evaluate the body fatness is the dual-energy x-ray absorptiometry. However, its laboratorial aspect prevents a wide use. This way, simpler techniques as the skinfold measurement should be model from more exact techniques for this monitoring. The existing models were developed with foreign populations that don't resemble the Curitiba Metropolitan Region habitants. This could lead to evaluation and diagnostic errors. Thus, the aim of this study is to product a model of body fatness analysis appropriate to children and adolescents from the Curitiba Metropolitan Region. Two sample were selected, the first one composed by 567 healthy adolescents aged between 10 and 18 years; the other one composed by 63 children with cerebral palsy between 3 and 10 years. The groups have both genders. The data of weight, height, age and skinfold thickness were collected, beyond the body composition evaluation by radiologic densitometry. The fatness percentage obtained by different skinfold and other anthopometric mesures equations among the adolescents was compared with the obtained by densitometry presenting associations below indicated (CCC<0,900). A tendency of underestimation by the skinfold equations was found, that resulted in higher specificity values and low sensitivity (being specificity the relative quantity of true negatives among those who do not have de clinical condition, and the sensitivity the relations of true positives amons those who have the considered condition). This indicates a major quantitaty of false negatives, that leads many overfat adolescents to be classify as eutrophic. The developed classificatory model for adolescents obtained an adjustment of R2 Negelkerke=0,829, sensitivity of 99,0% and specificity of 82,7% presenting diagnostic's indicators above that obtained by skinfold equations and BMI. For the children with cerebral palsy was developed a fat mass estimation model with adjustment of R2 =0,950 and standard error of estimative of 1,039. The equations used to convert the skinfold in body fatness measures were found to be inadequate for aplication in adolescents from Curitiba Metropolitan Region. The aplication of logistic and linear regression techniques have presented positive results, even from modeling in the children with cerebral palsy sample.

Childhood obesity is a major health problem facing children in the United States. How parents view their children's weight is an important consideration for health care professionals. The purpose of this study was to explore parental perceptions of their children's weight and health.