Theses (Ed.S.)--Marshall University, 2005. / Title from document title page. Includes abstract. Document formatted into pages: contains 21 p. Bibliography: p. 18-21.

Thesis (Ph.D.) - University of Queensland, 2006. / Includes bibliography.

Thesis (M.A.)--University of North Carolina at Chapel Hill, 2005. / Includes bibliographical references (leaves 45-51). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.A.)--University of North Carolina at Chapel Hill, 2005. / Includes bibliographical references (leaves 45-51).

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.

abstract: PURPOSE: Lean hypertension (HTN) is characterized by a mechanistically different HTN when compared to obese HTN. The purpose of this study is to assess whether body phenotype influences blood pressure (BP) responses following both acute and chronic exercise. METHODS: Obese (body mass index (BMI) > 30 kg/m2) and lean (BMI < 25 kg/m2) men with pre-hypertension (PHTN) (systolic BP (SBP) 120 - 139 or diastolic BP (DBP) 80 - 89 mm Hg) were asked to participate in a two-phase trial. Phase 1 assessed differences in post-exercise hypotension between groups in response to an acute exercise bout. Phase 2 consisted of a two-week aerobic exercise intervention at 65-70% of heart rate (HR) max on a cycle ergometer. Primary outcome measures were: brachial BP, central (aortic) BP, cardiac output (CO), and systemic vascular resistance (SVR) measured acutely after one exercise session and following two weeks of training. RESULTS: There were no differences between groups for baseline resting brachial BP, central BP, age, or VO2 peak (all P > 0.05). At rest, obese PHTN had greater CO compared to lean PHTN (6.3 ± 1 vs 4.7 ± 1 L/min-1, P = 0.005) and decreased SVR compared to lean PHTN (1218 ± 263 vs 1606 ± 444 Dyn.s/cm5, P = 0.003). Average 60-minute post-exercise brachial and central SBP reduced by 3 mm Hg in Lean PHTN in response to acute exercise (P < 0.005), while significantly increasing 4 mm Hg for brachial and 3 mm Hg for central SBP (P < 0.05). SVR had a significantly greater reduction following acute exercise in lean PHTN (-223 Dyn·s/cm5) compared to obese PHTN (-75 Dyn·s/cm5, P < 0.001). In lean subjects chronic training reduced brachial BP by 4 mm Hg and central BP by 3 mm Hg but training had no effect on the BP’s in obese subjects. Resting BP reduction in response to training was accompanied by reductions in SVR within lean (-169 Dyn·s/cm5, P < 0.001), while obese experienced increased SVR following training (47 Dyn·s/cm5, P < 0.001). CONCLUSION: Hemodynamic response to both acute and chronic exercise training differ between obese and lean individuals. / Dissertation/Thesis / Doctoral Dissertation Exercise Science 2016

Pediatric obesity is a major public health epidemic with serious physical and psychological consequences. Difficulty engaging families in treatment is a significant obstacle in addressing pediatric obesity, especially among underserved populations. Motivational interviewing (MI) is a collaborative, person-centered communication style that has been shown to reduce attrition, increase attendance, and improve patient treatment adherence; however, little is known about the process of MI and how it improves treatment engagement. This study examined clinician and parent language in a pre-treatment MI session that increased initial engagement in a parent- focused pediatric obesity intervention (N= 81). Results showed that increased parent change talk, and preparatory language in particular, was positively related to the likelihood of initial attendance at baseline. Additionally, certain types of MI consistent clinician strategies were positively associated with parent change talk. Complex positive reflections were correlated with preparatory language and overall change talk, suggesting this might be a particularly important MI skill. Findings have implications for better understanding the process of MI and mechanisms through which MI can improve treatment engagement.

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. / Applied Science, Faculty of / Nursing, School of / Graduate

Cardiovascular disease in populations with obesity is a major concern because of its epidemic proportion. Obesity leads to the development of cardiomyopathy directly via inflammatory mediators and indirectly by obesity-induced hypertension, diabetes and coronary artery diseases. The aim of this review article is to re-visit the available knowledge and the evidence on pathophysiologic mechanisms of obesity-related cardiomyopathy and to propose its placement into a specific category of myocardial disease.