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.

Mothers play a vital role in providing healthy food choices for their preschool children. This role has become more complex in the present obesity-producing environment that has contributed to the increasing prevalence of childhood overweight and obesity in Canada. Childhood overweight and obesity is a significant public health issue in Nova Scotia where the percentage is higher than the national average. The purpose of this study was to generate a theoretical understanding of the process in which 18 mothers living within the Cape Breton Regional Municipality engaged while making food choices for their preschool children. Constructivist grounded theory methodology informed by sensitising constructs from symbolic interaction and the socio-environmental health promotion perspective facilitated a multilevel exploration of the factors that affect mothers’ food choice practices for their preschoolers. Data collection took place over 16 months. Thirty-five interviews were completed. Grounded theory methods were used to analyze the data and a substantive theory of how mothers made food choices for their preschool children was co-constructed with the participants. The substantive theory, Persistent Optimizing, consists of three main integrated conceptual categories. In the first conceptual category, Acknowledging Contextual Constraints, mothers acknowledged various individual, interpersonal, and socio-environmental contextual factors that hindered their ability to make intended, healthier food choices for their children. In the second conceptual category, Stretching Boundaries, mothers developed and enacted moderating strategies to lessen the impact of contextual constraints, thereby increasing the number of food choices available to them. In the third conceptual category, Strategic Positioning, mothers developed and enacted a variety of optimizing strategies to get them closer to making the optimal food choice for their children in a given situation. Mothers in this study struggled continuously with varying degrees of success to provide the foods they believed their children needed. The findings suggest that in practice, policy, research, and education, community health nurses must work independently and collaboratively at all levels of influence to facilitate, mediate, and advocate for social, economic, and physical environments that improve mothers’ ability to make food choices that promote their children’s health and reduce their risk of becoming overweight and obese.

Thesis (M.S.)--University of Texas at El Paso, 2008. / Title from title screen. Vita. CD-ROM. Includes bibliographical references. Also available online.

Licentiatavhandling (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 2 uppsatser.

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

This systematic review examined the shifts in undernutrition and overnutrition in Nepal during the past two decades. We searched PubMed for studies and reports published between January 1, 2000, and June 30, 2018. Publications with a sample size greater than or equal to 500 that reported prevalence of nutritional status were included. Six large national reports and 36 studies met study inclusion criteria and were included. Overall, available nationally representative data remained limited. The Nepal Demographic and Health Survey 2001 to 2016 showed that underweight prevalence decreased from 26.7% to 17.2% and prevalence of overweight/obesity increased from 6.5% to 22.1% among women of reproductive age (15-49 years). In preschool children, prevalence of stunting, wasting, and underweight decreased from 57.2% to 35.8%, 11.2% to 9.7%, and 42.7% to 27.0%, respectively. Prevalence of overweight/obesity was low among children and was higher in higher socio-economic status (SES) groups. The overweight-obesity/underweight ratios indicate a shift from undernutrition to overnutrition problem; it was more evident in urban areas and higher SES groups. In conclusion, Nepal is experiencing a nutrition transition. More research is warranted to address this shift, and well-tailored public health efforts need to combat the double burden of overweight/obesity and undernutrition.

Youth obesity prevalence rates in the United States are trending down; however, for Hispanic youth, rates are increasing despite efforts toward a reduction. The purpose of this study was to evaluate the impact of a culturally focused intervention program on weight reduction of Hispanic youth age 2 to 19 through examination of body mass index (BMI) percentile outcomes comparing age, gender, distance to program, time in program, and season of enrollment. Review of literature supports ecological and cultural approaches requiring behavior modification tailored to family and community as successful in decreasing youth obesity. However, researchers have yet to establish how various variables impact intervention outcomes making it difficult to determine what aspects of the cultural approach is effective. The epidemiology triangle and the social cognitive theory approach were used to relate to findings. Use of retrospective clinical archival participant data dating from November 7, 2008 to February 23, 2015 was analyzed through the use of various statistical applications. The analyses of this study indicated that only one age variable had significant results. The category for age 8 to12 had a significantly higher change in BMI than the other groups (p <.05) . This research has the potential to contribute to social change since it reveals that interventions tailored for the 8-12 age group may significantly improve the effectiveness of the program in reducing BMI percentile, thus decreasing obesity rates and associated disease along with morbidity and mortality. This knowledge can benefit educators, community collaborative efforts, practitioners, and other researchers.

Over the past 20 years there has been a clear shift in Peru’s mortality profile towards non-communicable diseases. As part of this transition, childhood overweight and obesity (O&O) has become a growing public health concern. In order to address this challenge, context-specific information is needed concerning prevalence, associated factors and culturally appropriate interventions. To this end, I conducted a mixed methods study using a socio-ecological framework to investigate childhood overweight and obesity in Peru. This study found a prevalence of 19.2% overweight and 8.6% obesity among children aged seven to eight in a pro-poor cohort in Peru. Factors associated with being overweight in this cohort included: a high socioeconomic status, living in metropolitan Lima, an O&O mother, being male and being an only child or having only one sibling. The quantitative analysis highlighted the prevalence in O&O in this population and revealed a number of relationships explored in more depth via interviews and focus group discussions. The qualitative component of this research explored these associations amongst a sub-sample of children, parents and teachers in three distinct geographical regions in Peru. My qualitative research showed that parents, teachers and children are aware of the health implications of childhood overweight and obesity and that they have a sophisticated understanding of the many factors that influence its aetiology. Participants also had many suggestions for ways to address this issue in their community. This information was complemented by a systematic review and meta-analysis of the evidence of childhood O&O interventions that took place in Latin America published between 1990 and 2011. A combination of diet, physical activity and pharmaceutical strategies have shown modest effect on BMI reduction in O&O children, but more evidence is needed for effective population-level prevention strategies. The findings highlight the need for comprehensive, multi-level interventions. Notable intervention components include: kiosco reform, junk food taxation, creation of recreational space and enhancement of school-based physical activity programmes. To accomplish this, communities need to be mobilised and work together with school administration, municipal and national government.

Doctor of Philosophy / Department of Horticulture, Forestry, and Recreation Resources / Candice A. Shoemaker / Public health research shows that targeting behavior directly when promoting healthy behaviors is not as effective for sustainability. Instead the recommendation is to integrate a theoretical framework that identifies factors which affect the targeted behavior and develop the intervention aimed at those factors. The objectives of this dissertation were to measure the healthful benefits of gardening for youth. Strategies were developed for creating an after-school garden club curriculum to target healthy eating, physical activity, sedentary behavior, and gardening. Accelerometers were used to determine physical activity intensity during a garden club session following a curriculum developed to promote physical activity through gardening. In a separate experiment, a portable gas analyzer was used to measure energy expenditure of youth while gardening. The constructs of Social Cognitive Theory were used to provide a guide with strategies for developing a curriculum with a theoretical basis for an after-school garden club targeting overweight prevention. Strategies presented include activities for targeting the theoretical constructs as well as for implementing evaluations. Fourth and fifth grade students at four randomly selected elementary schools in Manhattan, Kansas were invited to join the garden club. Students with parental permission attended the club for ten weeks in the fall and twelve weeks in the spring. During the second year of implementation students with parental permission participated in the accelerometer study. For six days students wore an accelerometer and completed a daily activity log detailing their activities during that time. Students in the fourth and fifth grades from eight Manhattan, Kansas elementary schools were invited to participate in the energy expenditure study during the summer of 2010. Students who participated in this study (n=20) wore a portable gas analyzer and heart rate monitor while performing four gardening tasks. Data were used to calculate energy expenditure of youth while gardening. A theoretically-based after-school garden club curriculum was developed to target increasing youth healthy behaviors. Results from the accelerometer study showed that students were significantly more physically active at the moderate and vigorous intensity level and significantly less sedentary at garden club compared to not at garden club. For students who participated in the energy expenditure study, the gardening tasks (transplanting, weeding, cultivating, and raking) were moderate physical activity (3-5.99 METs). Gardening can be a valuable tool for promoting and increasing physical activity in youth.

Children’s risk for overweight and obesity is particularly high in rural areas of the United States. Many health, psychosocial, and economic consequences are associated with childhood overweight and obesity, which concerns health researchers and professionals. But how and why might rural children be more at risk for being overweight and obese? This dissertation investigates childhood overweight and obesity in rural settings through three separate studies. First, a systematic literature review was conducted to identify determinants and mechanisms of childhood obesity-related behaviors that are specific to rural locations. The findings from the review show that lack of health resources and poverty within the rural environment may impact children’s social environment and individual factors. However, results are inconclusive and there continues to be a lack of studies focusing on linking environmental influence with individual factors. Second, a meta-analysis of current research evidence was conducted to assess the efficacy of rural interventions designed to reduce childhood overweight and obesity. Results showed that interventions have been efficacious yet modest, with a mean effect size of 0.18. Moderating variables were also examined. Mean intervention effect size was moderated by children’s age and intervention duration. Last, secondary data were used to examine the association between rural food stores and availability and affordability of fresh fruits and vegetables. A multilevel analytical approach was used to determine if rural location was associated with availability and affordability of fresh fruits and vegetables. After controlling for other variables, results showed that rural location was not associated with fruit and vegetable availability and affordability. The findings from this dissertation suggest that the area of rural childhood overweight and obesity remains understudied. More research is needed in order to understand the mechanisms of social ecological influences on diet, physical activity, and childhood overweight and obesity. This area of research, however, is rife with opportunities for public health education and promotion. Public health educators can help promote and advocate for environmental conditions that support healthy lifestyles.