Overweight and obese adolescents: what turns them off physical activity?

Youth get a D+ grade in physical activity: How can we change public health messages to help reverse this trend?

The purpose of this paper is to critique how the promotion of physical activity (PA) is communicated and offer evidence-based alternative framings to encourage PA in youth. We argue that PA promotion messaging should not be tied to outcomes that focus on changing physical appearance, preventing or treating diseases, or sport performance or competition. From a public health perspective, we suggest that PA should instead focus on campaigns, policies, and programs that tie PA to enjoyment, wellbeing, and play.

Perceived weight and barriers to physical activity in parent-adolescent dyads

OBJECTIVE

Family-based physical activity interventions have the potential to reduce obesity, but more information is needed regarding physical activity in the family context. This study used an actor-partner interdependence model to estimate the dyadic association between perceived weight status and barriers to physical activity in dyads of adults and their adolescent children. It was hypothesized that greater perceived weight would be associated with greater barriers perceived by both one's self and one's partner.

METHOD

Data from 1,568 dyads in the Family Life, Activity, Sun, Health, and Eating study were used to examine the dyadic association between perceived weight status (i.e., greater perceived weight category) and barriers to physical activity. Models were stratified by actual weight (an overweight or obese dyad member vs. two normal weight dyad members) and adjusted for parent education, parent and adolescent age, gender, and race.

RESULTS

Among dyads with at least 1 overweight/obese member, greater perceived weight status was positively associated with one's own perceived barriers (significant actor effects, βs = 1.17 and 1.03, ps < 0.01) and one's partner's perceived barriers (significant partner effects, βs = 0.38 and 0.62, ps < 0.01). No statistically significant relationships were found for dyads with only normal weight members.

CONCLUSIONS

Among dyads with at least 1 overweight or obese member, significant partner effects for parents and adolescents demonstrate that the weight perception of 1 dyad member correlates with the barriers of the other member. These dyadic associations highlight the potential importance of family-based interventions for physical activity. (PsycINFO Database Record

Incidence of childhood overweight and obesity and its association with weight-related attitudes and behaviors in China: a national longitudinal study

BACKGROUND

Childhood obesity is a major public health challenge. We aimed to investigate the incidence of overweight/obesity among Chinese children; and prospectively examine the associations of weight-change intention with risk of overweight/obesity and behavioral changes in initially normal-weight children.

METHODS

A national sample of 21,796 children aged 6-17 years were investigated in September 2013 and followed up nine months later, of which 19,887 (91%) were normal weight and 1909 (9%) were underweight at baseline. Weight and height were objectively measured. Weight perception, weight-change intention, weight control practices, weight-related behaviors, and demographic information were obtained by questionnaires.

RESULTS

Among children with underweight or normal-weight, the cumulative incidence of overweight/obesity was 2.77% (95% CI 2.55-2.99). Among normal-weight children, those who overestimated their weight had higher baseline BMI z-scores and an increased relative risk (RR) of overweight/obesity (RR 1.51, 95% CI 1.15-1.99). Children who misperceived themselves as underweight or overweight had stronger weight-change intention than their counterparts. However, children with weight-change intention did not develop greater changes in dietary intakes, physical activities, or sedentary behaviors than those without intention. There was no significant association between weight-change intention and incidence after adjusting for BMI z-scores at baseline. Self-reported improving diet, increasing physical activity, and dieting were associated with certain actual behavioral improvements and smaller increase in BMI z-score, but not associated with decreased risk of overweight/obesity.

CONCLUSION

The 9-months cumulative incidence of overweight/obesity was 2.77% among Chinese children. Weight-change intention was not associated with incidence of overweight/obesity in normal-weight children, regardless of their weight perception. More importantly, children's weight-change intention was insufficient in achieving desirable behavioral changes. Future overweight and obesity prevention programs should directly target on promoting children's actual behavioral changes.

Overweight adolescents' views on physical activity - experiences of participants in an internet-based intervention: a qualitative study

BACKGROUND

Overweight and obese adolescents are reported to be less physically active than their peers. Research-based knowledge about their views may contribute to a better understanding of key factors that may foster or undermine motivation for physical activity, and provide knowledge for the future development of interventions. This paper explores experiences of physical activity among overweight adolescents, age 13-14 years, participants in Young & Active, a web-based controlled trial intervention to increase physical activity (ClinicalTrials.gov NCT01700309). The theoretical perspective is based on Self-Determination Theory.

METHODS

Two qualitative post-intervention research interviews, with a nine-month interval, were conducted with 21 adolescents, 15 girls and 6 boys to study short-term and long-term changes. The informants were recruited from a total of 84 participants from the Young & Active intervention group. Data were analyzed using qualitative content analysis.

RESULTS

The participants associated physical activity with organized sports and physical education classes at school, and as a means of promoting good health and attractive bodies. A majority of the adolescents said that they experienced their health as poorer than other youths, and expressed worries about their fitness and future health. Mastering a physical activity, being together with friends and having fun promoted motivation to perform sports. Not mastering an activity, or not knowing the others made them less motivated. None of the adolescents highlighted the importance of informal active living when asked about their understanding and experiences of physical activity. Consistency was found between the first and second interviews.

CONCLUSION

This study adds to limited research on overweight and obese adolescents' experiences of physical activity. The participants' views reflect opinions in society about physical activity, and its importance for health. Viewing physical activity as conducted within organized sports makes it necessary to look into how these are organized, structured and led, and what can be done to support self-esteem, autonomous motivation and participation. The ability to choose among available, affordable and desirable physical activities, together with friends, may promote participation and maintenance.

The use of bicycle workstations to increase physical activity in secondary classrooms

<b>Background</b><br /> To date, the majority of interventions have implemented classroom-based physical activity (PA) at the elementary level; however, there is both the potential and need to explore student outcomes at high-school level as well, given that very few studies have incorporated classroom-based PA interventions for adolescents. One exception has been the use of bicycle workstations within secondary classrooms. Using bicycle workstations in lieu of traditional chairs in a high school setting shows promise for enhancing adolescents’ physical activity during the school day. <br /> <br /> <b>Participants and procedure</b><br /> The present study explored the effects of integrating bicycle workstations into a secondary classroom setting for four months in a sample of 115 adolescents using an A-B-A-B withdrawal design. The study took place in one Advanced Placement English classroom across five groups of students. Physical activity outcomes included average heart rate, and caloric expenditure. Behavioural outcomes included percentage of on-task/off-task behaviour and number of teacher prompts in redirecting off-task behaviour. Feasibility and acceptability data of using the bicycle workstations were also collected.<br /> <br /> <b>Results</b><br /> Findings showed significant improvements in physical activity as measured by heart rate and caloric expenditure, although heart rate percentage remained in the low intensity range when students were on the bicycle workstations. No effects were found on students’ on-task behaviour when using the bicycle workstations. Overall, students found the bikes acceptable to use but noted disadvantages of them as well.<br /> <br /> <b>Conclusions</b><br /> Using bicycle workstations in high-school settings appears promising for enhancing low-intensity physical activity among adolescents. The limitations of the present study and implications for physical activity interventions in secondary schools are discussed.

School-based physical activity interventions and physical activity enjoyment: A meta-analysis

The purpose of this meta-analysis was to examine the effectiveness of school-based physical activity interventions on increasing students' physical activity enjoyment. An internet search with several databases using the keywords "Adolescents", "Children", "Enjoyment", "Physical Activity", and "Schools" was performed yielding over 200 published studies. Studies were eliminated based on the lack of experimental manipulation (i.e., non-intervention studies), no assessment of physical activity enjoyment as an outcome variable, a lack of a control or comparison group, and no reporting of the effect estimate's variability (i.e., standard deviation, standard error, etc.). This procedure resulted in 10 studies being examined in the meta-analysis. Data were analyzed in the state of Utah, USA in 2017. The Hartung-Knapp-Sidak-Jonkman method for a random effects meta-analysis was employed with studies being weighted by inverse variance. The pooled Standardized Mean Difference=0.38 (95% C.I. [0.10-0.65], p=0.011). Cochran's Q test showed statistical significance (p<0.001) and the I²=76.6%, suggesting large heterogeneity across the 10 studies. Egger's regression model yielded an intercept coefficient that was statistically significant (bias=3.28, 95% C.I. [0.21-6.36], p=0.039), indicating the presence of small-study effects. This meta-analysis provides evidence that school-based physical activity interventions can be effective in increasing physical activity enjoyment in children and adolescents. However, the magnitude of the pooled effect was small-to-moderate and there was evidence for publication bias and large between-study heterogeneity.

The role of peer victimization in the physical activity and screen time of adolescents: a cross-sectional study

Background

Negative peer experiences may lead adolescents with overweight and obesity to be less active and engage in more sitting-related behaviors. Our study is among the first to empirically test these associations and hypothesized that 1) peer victimization would mediate the negative association between body weight status and moderate-to-vigorous physical activity (MVPA), and 2) peer victimization would mediate the positive association between body weight status and screen time. Differences by gender were also explored.

Methods

Participants were a part of the Year 1 data (2012–2013) from the COMPASS study, a prospective cohort study of high school students in Ontario and Alberta, Canada. The final sample consisted of 18,147 students in grades 9 to 12 from 43 Ontario secondary schools. The predictor variable was weight status (non-overweight vs. overweight/obese), the mediator was peer victimization, and the outcome variables were screen time and MVPA. Multilevel path analysis was conducted, controlling for clustering within schools and covariates. A few differences were observed between males and females; therefore, the results are stratified by gender.

Results

For both males and females peer victimization partially mediated the association between weight status and screen time. Specifically, females with overweight/obesity reported 34 more minutes/day of screen time than did females who were not overweight and 2 of these minutes could be attributed to experiencing peer victimization. Similarly, males who were overweight/obese reported 13 more minutes/day of screen time than the males who were not overweight and 1 of these minutes could be attributed to experiencing more victimization. Males and females who were overweight/obese also reported less MVPA compared to those who were not overweight; however, peer victimization did not mediate these associations in the hypothesized direction.

Conclusions

We found that higher rates of peer victimization experienced by adolescents with overweight and obesity partially explained why they engaged in more screen time than adolescents who were not overweight. However, the effects were small and may be of limited practical significance. Because this is one of the first studies to investigate these associations, more research is needed before bully prevention or conflict resolution training are explored as intervention strategies.

Lifestyle factors and co-morbidities associated with obesity and overweight in Nkonkobe Municipality of the Eastern Cape, South Africa

BACKGROUND

Obesity is a global epidemic that affects 500 million people worldwide and is predicted to increase to one billion people by 2030. The prevalence of obesity is increasing across populations in South Africa. However, questions still remain surrounding the predisposing factors and obesity-related health problems especially in the rural areas. This study evaluated several lifestyle factors such as dietary habits, physical activity, smoking, alcohol intake, co-morbidities and their association with the prevalence of obesity and overweight in Nkonkobe Municipality of the Eastern Cape.

METHODS

A cross-sectional, population-based survey was conducted among 118 residents in four rural/sub-urban townships of the study area. Measurements including weight, height, body mass index (BMI), physical activity and dietary habits were determined using a validated questionnaire.

RESULTS

The overall prevalence of obesity and overweight was 38 and 19%, respectively. The highest prevalence of obesity (70%) was observed among those who do not undertake any physical activity. Close to half (48.48%) of the respondents who eat fast foods always were obese, and 30.30% were overweight; when combined, the prevalence for obesity is 78.78%. A negative association with obesity was observed among regular smokers (26.92%) and consumers of alcohol (4.00%). Arthritis, hypertension and tuberculosis were co-morbidities significantly (P < 0.05) associated with obesity in the study area.

CONCLUSIONS

The findings of this study reveal that lack of physical activity, overindulgence on fast and fried foods, low fruit and vegetable consumption as well as arthritis, hypertension and tuberculosis were significant risk factors of obesity in Nkonkobe Municipality.

Different consecutive training protocols to design an intervention program for overweight youth: a controlled study

OBJECTIVE

To find the optimal exercise program to be recommended in reducing adiposity and promoting long-term physical activity adherence in a sample of overweight adolescents.

METHODS

Forty-five overweight adolescents were randomly divided into three exercise groups, to perform two phases of physical activity as follows: in the first phase, the first group performed a 16-week moderate-intensity resistance training (RT), the second group performed a 16-week high-intensity RT, and the third group performed a 16-week aerobic training (AT); in the second phase, all groups performed a 6-week AT. Anthropometric body composition and fitness measures were considered as outcome measures.

RESULTS

After the second protocol, both RT groups showed a significant improvement in percentage of fat mass (F_2,76 = 5.843; p = 0.004; h² = 0.133) and free fat mass (F_2,76 = 6.254; p = 0.003; h² = 0.141), and in fitness tests (p < 0.01). The VO₂max values of the RT groups were significantly higher than those of the AT group (F_2,38 = 4.264; p = 0.021; h² = 0.183). The rate of adherence to exercise was an average of 94% in both RT groups, whereas in the AT group, it was 83%. During the 12-week post-intervention follow-up, the number of participants who continued to perform physical activities was significantly higher in both the RT groups than in the AT group (p < 0.05).

CONCLUSION

The present study provides preliminary evidence that moderate-to-intense RT, followed by AT, can be an effective treatment for overweight adolescents, and the positive effects are maintained even after 12 weeks of follow-up.

Assessment of physical activity levels, fitness and perceived barriers to physical activity practice in adolescents: cross-sectional study

Adolescence is a time of rapid physical, psychological and social changes. Recent studies show that, at this stage, there is a decrease in physical activity (PA) levels, along with high rates of overweight and obesity. The purpose of this study was to assess PA levels and physical condition (PC) related to perceived barriers (PB) and limiting factors for PA practice in a randomised sample of adolescents in Barcelona (Spain) considering overweight status and gender. One hundred and forty-three adolescents (53.8 % boys; median age of 15 years) of Secondary Education in public schools located in a randomly selected district (Sants - Montjuïc) in Barcelona (Spain) participated in a cross-sectional study. Variables assessed were (a) PC (ALPHA-Fitness), (b) PA levels (Physical Activity Questionnaire PAQ-A), and (c) perceived barriers (Self-Reported Barriers to Participation in Physical Activity questionnaire). The different variables were tested by calculating means and standard deviations, with the presence/absence of overweight, and according to the adolescents' gender. Means between groups were compared using Student's t test.

CONCLUSION

Significant differences in most results suggest a correlation between being overweight or obese and having a worse PC. The variables gender (being a girl) and body mass index (overweight or obese) showed a direct correlation to perceive significantly greater barriers to PA practice. What is known: • Epidemiological studies indicate that there is a high prevalence of overweight and obesity linked to an insufficient amount of physical activity (PA) practice in children and adolescents, which is accompanied higher rates of abandonment of the common PA practice as they grow up. • Perceived barriers to regular PA practice had increased in the adolescent population, accompanied with lower levels of PA practice. What is new: • This study shows for the first time the correlation between physical condition, PA levels, and perceived barriers to regular PA, considering overweight and gender. • There is a correlation between being overweight or obese and having a worse physical condition. The variables gender (being a girl) and body mass index (overweight or obese) showed a direct correlation to perceive significantly greater barriers to PA practice.

Adolescents' Perception of the Psychosocial Factors affecting Sustained Engagement in Sports and Physical Activity

The purpose of this study was to explore adolescents' perceptions of psychosocial influences - personal characteristics, environmental factors and behavioural undertakings - influencing their prolonged involvement in sports and physical activity (PA). A qualitative approach was adopted wherein 16 adolescents (8 boys, 8 girls; mean age 15.9 years), who had been physically active for at least the last 8 years, and sixteen adults identified as their 'parents' or 'guardians' participated in semi-structured interviews. Interviews were transcribed verbatim and coded using the HyperRESEARCH software. Data were analysed using thematic analysis procedures. Four main themes pertaining to psychosocial influences were identified: 1) personal characteristics; 2) school and community resources; 3) parental support; and 4) social interaction. Except for social interaction, for which participants did not identify challenges, themes are discussed according to their motivational aspects and the challenges they represent for adolescents' PA involvement. The research has implications for health promotion endeavours directed toward parents of children and adolescents. Given the limitations of a qualitative study, readers are invited to apply the conclusions to their own context.

Prenatal, birth and early life predictors of sedentary behavior in young people: a systematic review

BACKGROUND

Our aim was to systematically summarize the evidence on whether prenatal, birth and early life factors up to 6 years of age predict sedentary behavior in young people (≤18 years).

METHODS

PRISMA guidelines were followed, and searches were conducted in PubMed, SPORTDiscus, EMBASE and Web of Science up to December 1, 2015. We included observational (non-intervention) and longitudinal studies, that reported data on the association between one or more of the potential predictors and objectively or subjectively measured sedentary behavior. Study quality was assessed using a formal checklist and data extraction was performed using standardized forms independently by two researchers.

RESULTS

More than 18,000 articles were screened, and 16 studies, examining 10 different predictors, were included. Study quality was variable (0.36-0.95). Two studies suggest that heritability and BMI in children aged 2-6 years were significant predictors of sedentary behavior later in life, while four and seven studies suggest no evidence for an association between gestational age, birth weight and sedentary behavior respectively. There was insufficient evidence whether other prenatal, birth and early life factors act as predictors of later sedentary behavior in young people.

CONCLUSION

The results suggest that heritability and early childhood BMI may predict sedentary behavior in young people. However, small number of studies included and methodological limitations, including subjective and poorly validated sedentary behavior assessment, limits the conclusions.

TRIAL REGISTRATION

The systematic review is registered in the International Prospective Register of Systematic Reviews, PROSPERO, 17.10.2014 ( CRD42014014156 ).

Childhood Obesity and the Right to Health

Childhood obesity is now a global health epidemic, yet the obligations of states to prevent obesity through fulfillment of the right to health have received limited consideration. This article examines the childhood obesity recommendations of the UN Committee on the Rights of the Child (the committee on the CRC), the Special Rapporteur on the right to health, and the UN High Commissioner on Human Rights. It suggests how their engagement might be strengthened. It concludes that the final report of the World Health Organization's Commission on Ending Childhood Obesity could provide the committee on the CRC with a more systematic basis for advising and assessing preventive measures taken by states. Moreover, while the interim report envisages a central role for states in childhood obesity prevention, it pays inadequate attention to their obligations under international human rights law. It is hoped that this will be remedied in the final report through the adoption of a child-centered approach inspired by the rights to health and play, and the general principles of the Convention on the Rights of the Child (CRC).

Space, body, time and relationship experiences of recess physical activity: a qualitative case study among the least physical active schoolchildren

Background

Increasing recess physical activity has been the aim of several interventions, as this setting can provide numerous physical activity opportunities. However, it is unclear if these interventions are equally effective for all children, or if they only appeal to children who are already physically active. This study was conducted to explore the least physically active children’s “lived experiences” within four existential lifeworlds linked to physical activity during recess: space, body, time, and relations.

Methods

The study builds on ethnographic fieldwork in a public school in Denmark using a combination of participatory photo interviews and participant observation. Thirty-seven grade five children (11–12 years old) were grouped in quartiles based on their objectively measured daily physical activity levels. Eight children in the lowest activity quartile (six girls) were selected to participate in the study. To avoid stigmatising and to make generalisations more reliable we further recruited eight children from the two highest activity quartiles (four girls) to participate.

Results

An analysis of the least physically active children’s “lived experiences” of space, body, time and relations revealed several key factors influencing their recess physical activity: perceived classroom safety, indoor cosiness, lack of attractive outdoor facilities, bodily dissatisfaction, bodily complaints, tiredness, feeling bored, and peer influence.

Conclusion

We found that the four existential lifeworlds provided an in-depth understanding of the least physically active children’s “lived experiences” of recess physical activity. Our findings imply that specific intervention strategies might be needed to increase the least physically active children’s physical activity level. For example, rethinking the classroom as a space for physical activity, designing schoolyards with smaller secluded spaces and varied facilities, improving children’s self-esteem and body image, e.g., during physical education, and creating teacher organised play activities during recess.

Boys, Transitions, and Physical (In)activity: Exploring the Socio-Behavioural Mediators of Participation

PURPOSE

To explore the socio-behavioural mechanisms that motivate or dissuade boys' participation in physical activity (PA) as they transition into adolescence and their implications for physical therapy.

METHODS

This critical qualitative study involved in-depth interviews using active interviewing techniques with 15 adolescent boys. Data generation and analysis were driven by techniques of grounded theory and Bourdieu's sociology of practice.

RESULTS

The analysis identified intersectional relationships among emotions, the inherent pleasures of movement, and a sense of connectedness to PA, each of which acted as a mediating mechanism in motivating participation in PA. Analogously, body dissatisfaction, negative self-perceptions, and repeated instances of explicit and symbolic bullying intersected to dissuade boys from participating and created apathy toward PA.

CONCLUSION

Identifying socio-behavioural mechanisms that motivate or dissuade physically active behaviour contributes new knowledge toward understanding PA attrition among boys transitioning to adolescence. As health advocates and movement experts, physiotherapists have an important role in helping adolescents of all abilities to participate in activities that provide them with meaning, inclusivity, and a sense of connectedness to PA.

Weight status and body image perceptions in adolescents: current perspectives

Adolescence represents a pivotal stage in the development of positive or negative body image. Many influences exist during the teen years including transitions (eg, puberty) that affect one’s body shape, weight status, and appearance. Weight status exists along a spectrum between being obese (ie, where one’s body weight is in the 95th percentile for age and gender) to being underweight. Salient influences on body image include the media, which can target adolescents, and peers who help shape beliefs about the perceived body ideal. Internalization of and pressures to conform to these socially prescribed body ideals help to explain associations between weight status and body image. The concepts of fat talk and weight-related bullying during adolescence greatly contribute to an overemphasis on body weight and appearance as well as the development of negative body perceptions and dissatisfaction surrounding specific body parts. This article provides an overview of the significance of adolescent development in shaping body image, the relationship between body image and adolescent weight status, and the consequences of having a negative body image during adolescence (ie, disordered eating, eating disorders, and dysfunctional exercise). Practical implications for promoting a healthy weight status and positive body image among adolescents will be discussed.

A systematic review and critical appraisal of qualitative metasynthetic practice in public health to develop a taxonomy of operations of reciprocal translation

INTRODUCTION

Reciprocal translation, the understanding of one study's findings in terms of another's, is the foundation of most qualitative metasynthetic methods. In light of the proliferation of metasynthesis methods, the current review sought to create a taxonomy of operations of reciprocal translation using recently published qualitative metasyntheses.

METHODS

On 19 August 2013, MEDLINE, Embase and PsycINFO were searched. Included articles were full reports of metasyntheses of qualitative studies published in 2012 in English-language peer-reviewed journals. Two reviewers, working independently, screened records, assessed full texts for inclusion and extracted data on methods from each included metasynthesis. Systematic review methods used were summarised, and metasynthetic methods were inductively analysed to develop the taxonomy.

RESULTS

Of 61 included metasyntheses, 21 (34%) reported fully replicable search strategies and 51 (84%) critically appraised included studies. Based on methods in these metasyntheses, we developed a taxonomy of reciprocal translation with four overlapping categories: visual representation; key paper integration; data reduction and thematic extraction; and line-by-line coding.

DISCUSSION

This systematic review presents an update on methods and reporting currently used in qualitative metasynthesis. It also goes beyond the proliferation of approaches to offer a parsimonious approach to understanding how reciprocal translations are accomplished across metasynthetis methods.

Pupils' and teachers' experiences of school-based physical education: a qualitative study

OBJECTIVES

To explore pupils' and teachers' experiences of physical education (PE).

STUDY DESIGN

A qualitative investigation employing semistructured interviews. Self Determination Theory was used as a guiding theory and Template Analysis was used to analyse the data.

SETTING

A secondary school in the North East of England.

PARTICIPANTS

14 pupils (aged 13 and 14, boys and girls) with a range of self-perceived competencies regarding PE and four PE teachers of the pupils (3 male, 1 female).

PRIMARY AND SECONDARY OUTCOMES

(1) Attitudes and perceptions of PE pupils regarding their experiences of compulsory school PE lessons. (2) PE teachers' experiences of teaching PE.

RESULTS

Key results from pupils and teachers suggest pupils enjoy participation in PE when they feel competent, in control and supported by others. Feeling competent depended on (1) the activity within PE and (2) the pupils perceived physical capabilities/aptitude. Feeling in control related to (1) having a choice of activities, (2) being able to set exertion levels and (3) control over clothes worn while taking part. Relationships within pupil groups and between pupils and teachers were perceived as important. Teachers could positively influence their pupils' enjoyment by understanding and supporting their personal goals, as opposed to dictating and controlling what they did and for how long, and by promoting a non-threatening atmosphere between pupils.

CONCLUSIONS

Rising obesity levels and concerns over the fitness of children and young people has returned the focus of PE to its potential as a vehicle for promoting health. This study suggests schools and PE teachers in particular can positively influence the PE experience of both boys and girls by providing more choice of activities and letting pupils make their own decisions based on their personal needs.

Parents' obesity-related behavior and confidence to support behavioral change in their obese child: data from the STAR study

OBJECTIVE

Successful childhood obesity interventions frequently focus on behavioral modification and involve parents or family members. Parental confidence in supporting behavior change may be an element of successful family-based prevention efforts. We aimed to determine whether parents' own obesity-related behaviors were related to their confidence in supporting their child's achievement of obesity-related behavioral goals.

METHODS

Cross-sectional analyses of data collected at baseline of a randomized control trial testing a treatment intervention for obese children (n = 787) in primary care settings (n = 14). Five obesity-related behaviors (physical activity, screen time, sugar-sweetened beverage, sleep duration, fast food) were self-reported by parents for themselves and their child. Behaviors were dichotomized on the basis of achievement of behavioral goals. Five confidence questions asked how confident the parent was in helping their child achieve each goal. Logistic regression modeling high confidence was conducted with goal achievement and demographics as independent variables.

RESULTS

Parents achieving physical activity or sleep duration goals were significantly more likely to be highly confident in supporting their child's achievement of those goals (physical activity, odds ratio 1.76; 95% confidence interval 1.19-2.60; sleep, odds ratio 1.74; 95% confidence interval 1.09-2.79) independent of sociodemographic variables and child's current behavior. Parental achievements of TV watching and fast food goals were also associated with confidence, but significance was attenuated after child's behavior was included in models.

CONCLUSIONS

Parents' own obesity-related behaviors are factors that may affect their confidence to support their child's behavior change. Providers seeking to prevent childhood obesity should address parent/family behaviors as part of their obesity prevention strategies.

Perceived difficulty with physical tasks, lifestyle, and physical performance in obese children

We estimated perceived difficulty with physical tasks, lifestyle, and physical performance in 382 children and adolescents (163 obese, 54 overweight, and 165 normal-weight subjects) and the relationship between perceived physical difficulties and sports participation, sedentary behaviors, or physical performance. Perceived difficulty with physical tasks and lifestyle habits was assessed by interview using a structured questionnaire, while physical performance was assessed through the six-minute walking test (6 MWT). Obese children had higher perceived difficulty with several activities of daily living, were less engaged in sports, and had lower physical performance than normal-weight or overweight children; on the contrary, they did not differ with regard to time spent in sedentary behaviors. Perceived difficulty in running and hopping negatively predicted sports participation (P < 0.05 and <0.01, resp.), while perceived difficulty in almost all physical activities negatively predicted the 6 MWT, independently of BMI (P < 0.01). Our results indicate that perception of task's difficulty level may reflect an actual difficulty in obese children. These findings may have practical implications for approaching physical activity in obese children. Exploring both the perception of a task's difficulty level and physical performance may be useful to design exercise programs that allow safe and successful participation.

Lifestyle and treatment adherence among overweight adolescents

This study evaluated the influence of overweight adolescents' lifestyle on the adherence to weight control, and identifies their predictors. Participants were 94 adolescents, aged 12-18 years, attending a Paediatric Obesity Clinic. Lifestyle was assessed using the "Adolescent Lifestyle Profile" and treatment adherence through the "Therapeutic Adherence to Weight Control Questionnaire." Adherence to weight control was associated with various lifestyle domains. Several predictors were identified for lifestyle and adherence to weight control among overweight adolescents. A broad array of inter-correlations and predictors were identified and should be taken into account when designing adolescent weight control interventions.

Physical activity level and its sociodemographic correlates in a peri-urban Nepalese population: a cross-sectional study from the Jhaukhel-Duwakot health demographic surveillance site

BACKGROUND

Physical inactivity is a leading risk factor for cardiovascular and other noncommunicable diseases in high-, low- and middle-income countries. Nepal, a low-income country in South Asia, is undergoing an epidemiological transition. Although the reported national prevalence of physical inactivity is relatively low, studies in urban and peri-urban localities have always shown higher prevalence. Therefore, this study aimed to measure physical activity in three domains-work, travel and leisure-in a peri-urban community and assess its variations across different sociodemographic correlates.

METHODS

Adult participants (n=640) from six randomly selected wards of the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) near Kathmandu responded to the Global Physical Activity Questionnaire. To determine total physical activity, we calculated the metabolic equivalent of task in minutes/week for each domain and combined the results. Respondents were categorized into high, moderate or low physical activity. We also calculated the odds ratio for low physical activity in various sociodemographic variables and self-reported cardiometabolic states.

RESULTS

The urbanizing JD-HDSS community showed a high prevalence of low physical activity (43.3%; 95% CI 39.4-47.1). Work-related activity contributed most to total physical activity. Furthermore, women and housewives and older, more educated and self-or government-employed respondents showed a greater prevalence of physical inactivity. Respondents with hypertension, diabetes or overweight/obesity reported less physical activity than individuals without those conditions. Only 5% of respondents identified physical inactivity as a cardiovascular risk factor.

CONCLUSIONS

Our findings reveal a high burden of physical inactivity in a peri-urban community of Nepal. Improving the level of physical activity involves sensitizing people to its importance through appropriate multi-sector strategies that provide encouragement across all sociodemographic groups.

Can resistance training change the strength, body composition and self-concept of overweight and obese adolescent males? A randomised controlled trial

BACKGROUND/AIM

Resistance training is an exercise modality at which overweight and obese adolescents can excel and which can therefore positively affect their psychological well-being. The aim of this study was to determine the effect of a 6-month resistance training intervention on the self-concept strength and body composition of overweight and obese adolescent males.

METHODS

56 overweight and obese males aged 13-17 years were randomly allocated to an Intervention (n=30) or Control (n=26) group. Primary (psychological) and secondary (strength and body composition) outcomes were assessed at baseline as well as at 3 (halfway through the intervention), 6 (immediately postintervention) and 12 months follow-up. Random effects mixed modelling was used to determine the effects of the intervention.

RESULTS

Statistically significant differences between the Intervention and Control groups were observed at 3-month and 6-month assessments for exercise self-efficacy, resistance training confidence and self-esteem. Large increases in strength for the Intervention group, relative to Controls, were also observed with no substantial changes in body composition shown for either group. Values for all variables returned to baseline following completion of the programme.

CONCLUSIONS

A 6-month resistance training intervention can positively affect the self-concept and strength of overweight and obese adolescent boys.

A multilevel assessment of school climate, bullying victimization, and physical activity

BACKGROUND

This study integrated criminological and public health perspectives to examine the influence of bullying victimization and the school environment on physical activity (PA).

METHODS

We used a weighted sample of 7786 US middle school students surveyed as part of the Health Behavior in School-Aged Children study to conduct a multilevel analysis of bullying victimization as a predictor of self-reported PA and number of days attending physical education (PE) classes. Hierarchical models assessed the contribution of school climate and anti-crime programs.

RESULTS

Results indicated that bullying victimization was associated with fewer days in PE and lower odds of reporting at least 60 minutes of PA more than once a week. Although one of the school crime prevention policies examined was associated with more days in PE, the school-level factors did not account for a large portion of the variance in the 2-level models for either days in PE or PA.

CONCLUSIONS

The results suggest that reduced levels of PA can be added to the growing list of health issues associated with bullying victimization and provide support for the importance of bullying prevention efforts in conjunction with health promotion programs targeted to middle school students.

Top 10 practical lessons learned from physical activity interventions in overweight and obese children and adolescents

Physical activity (PA) interventions targeting overweight and obese children and adolescents have shown only modest success, and dropout is an area of concern. Proper design and implementation of a PA intervention is critical for maximizing adherence and thus increasing the overall health benefits from PA participation. We propose practical advice based on our collective clinical trial experience with support from the literature on best practices related to PA interventions in overweight and obese children and adolescents. The top 10 lessons learned are (i) PA setting–context is important; (ii) choice of fitness trainer matters; (iii) physical activities should be varied and fun; (iv) the role of the parent–guardian should be considered; (v) individual physical and psychosocial characteristics should be accounted for; (vi) realistic goals should be set; (vii) regular reminders should be offered; (viii) a multidisciplinary approach should be taken; (ix) barriers should be identified early and a plan to overcome them developed; and (x) the right message should be communicated: specifically, what's in it for them? The recommendations in this paper can be used in other pediatric PA programs, physical education settings, and public health programs, with the hope of decreasing attrition and increasing the benefits of PA participation to promote health in children and adolescents.

Physical activity, fitness and the energy cost of activities: implications for obesity in children and adolescents in the tropics

The tropics cover a large section of the world in which both developed and developing countries are situated. Rapid socioeconomic development, modernization, urbanization, and globalization have affected both the food market and physical activity (PA), which in turn have propelled the obesity epidemic in the tropics. There is growing concern that overweight and obesity are emerging as major health problems among children and adolescents in the tropics, despite the fact that undernutrition still exists in many of these countries. Physical inactivity, a low metabolic rate, and lack of physical fitness (PF) have been linked to overweight and obesity. Moreover, PF in several tropical countries is declining, and these changes may be a threat to future health, as low PA and PF levels are important risk factors for noncommunicable chronic diseases. Previous studies have reported that the relationships among PA, PF, overweight, and obesity are inconsistent and inconclusive. There is no indication that variances in the energy cost of physical activities lead to obesity. Despite a lack of definite evidence to prove a causal relationship, there is enough certainty that physical inactivity and low fitness levels are linked to overweight and obesity. Hence, people living in tropical countries need to be encouraged to lead a healthier lifestyle by increasing their PA levels and reducing sedentary behaviors to prevent overweight or obesity.