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Breheny K, Adab P, Passmore S, Martin J, Lancashire E, Hemming K, Frew E. A cluster randomised controlled trial evaluating the effectiveness and cost-effectiveness of the daily mile on childhood obesity and wellbeing; the Birmingham daily mile protocol. BMC Public Health 2018; 18:126. [PMID: 29325517 PMCID: PMC5765641 DOI: 10.1186/s12889-017-5019-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 12/21/2017] [Indexed: 02/02/2023] Open
Abstract
Background Childhood obesity prevention is a public health priority. Children spend a large proportion of their waking time in school; therefore this is an appropriate setting to implement obesity prevention initiatives. Anecdotal reports suggest that implementing The Daily Mile in schools has had positive effects on childhood obesity, academic attainment and wellbeing. This trial aims to measure the effectiveness of The Daily Mile for improving health and wellbeing. Methods This protocol describes a cluster randomised controlled trial (RCT) in 40 primary schools located in Birmingham, UK. Eligible participants are children in years 3 (aged 7–8) and 5 (aged 9–10). The study compares The Daily Mile (intervention) to usual practice (control) in relation to health and wellbeing. The Daily Mile intervention involves an additional 15 min of running or walking integrated into the school day, throughout a 12 month study period. The primary clinical outcome is body mass index (BMI) z-scores at 12 months following introduction of the intervention. The cost per Quality Adjusted Life Year (QALY) is the primary outcome of the economic evaluation. Secondary outcomes include wellbeing, physical fitness and teacher reported academic attainment. Discussion This study is the first RCT investigating the clinical and cost-effectiveness of The Daily Mile. A range of outcomes will be measured to evaluate the broader wellbeing and academic benefits in addition to clinical outcomes typically measured in childhood obesity prevention trials. The intervention is simple and low-cost, therefore if the benefits are demonstrated it has enormous potential to influence future policy. Trial registration ISRCTN: 12698269. Date protocol registered 27th October 2016. Electronic supplementary material The online version of this article (10.1186/s12889-017-5019-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katie Breheny
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK.
| | - Sandra Passmore
- Services for Education, Unit 3, Holt Court, Holt Street, Birmingham, B7 4AX, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK
| | - Emma Lancashire
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK
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302
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Kones R, Rumana U. Cultural primer for cardiometabolic health: health disparities, structural factors, community, pathways to improvement, and clinical applications. Postgrad Med 2018; 130:200-221. [PMID: 29291669 DOI: 10.1080/00325481.2018.1421395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The quest to optimize cardiometabolic health has created great interest in nonmedical health variables in the population, community-based research and coordination, and addressing social, ethnic, and cultural barriers. All of these may be of equal or even greater importance than classical health care delivery in achieving individual well-being. One dominant issue is health disparity - causes, methods of reduction, and community versus other levels of solutions. This communication summarizes some major views regarding social structures, followed by amplification and synthesis of central ideas in the literature. The role of community involvement, tools, and partnerships is also presented in this Primer. Recent views of how these approaches could be incorporated into cardiometabolic initiatives and strategies follow, with implications for research. Two examples comparing selected aspects of community leverage and interventions in relation to individual approaches to health care equity are examined in depth: overall performance in reducing cardiovascular risk and mortality, and the recent National Diabetes Prevention Program, both touching upon healthy diets and adherence. Finally, the potential that precision medicine offers, and possible effects on disparities are also discussed.
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Affiliation(s)
- Richard Kones
- a The Cardiometabolic Research Institute , Houston , TX , USA
| | - Umme Rumana
- a The Cardiometabolic Research Institute , Houston , TX , USA.,b University of Texas Health Science Center , Houston , TX , USA
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303
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Döring N, Zethraeus N, Tynelius P, de Munter J, Sonntag D, Rasmussen F. Economic Evaluation of PRIMROSE-A Trial-Based Analysis of an Early Childhood Intervention to Prevent Obesity. Front Endocrinol (Lausanne) 2018; 9:104. [PMID: 29593658 PMCID: PMC5861136 DOI: 10.3389/fendo.2018.00104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/02/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood obesity is a major clinical and economic health concern. Alongside the clinical understanding of obesity, there is a growing interest in designing and implementing interventions that are worth their money given the scarce resources in the health care sector. This study is one of the first efforts to provide evidence by assessing the effects and costs of a population-based primary prevention intervention targeting pre-school children attending child health centers in Sweden. METHODS The economic evaluation is based on the PRIMROSE cluster-randomized controlled trial aiming to establish healthy eating and physical activity among pre-school children (9-48 months of age) through motivational interviewing applied by trained nurses at child health centers. The cost-effectiveness is assessed over the trial period from a societal perspective. The primary outcome was BMI at age 4. Cost data was prospectively collected alongside the trial. Scenario analyses were carried out to identify uncertainty. RESULTS The estimated additional mean total costs of the PRIMROSE intervention were 342 Euro (95% CI: 334; 348) per child. During pre-school years direct costs mainly consist of training costs and costs for the additional time used by nurses to implement the intervention compared to usual care. Early indirect costs mainly consist of parents' absence from work due to their participation in the intervention. The incremental cost-effectiveness ratio in the base case analysis was 3,109 Euro per 1 BMI unit prevented. CONCLUSION We cannot provide evidence that the PRIMROSE intervention is cost-effective, given the uncertainty in the effect measure. Until further evidence is provided, we recommend resources to be spent elsewhere within the field of obesity prevention. Furthermore, to achieve valid and reliable cost-effectiveness results, the economic evaluation of obesity prevention programs in early childhood should incorporate the life time impact to capture all relevant costs and benefits.
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Affiliation(s)
- Nora Döring
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Nora Döring,
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Jeroen de Munter
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Diana Sonntag
- Medical Faculty of Heidelberg University, Mannheim Institute of Public Health, Social Prevention and Medicine (MIPH), Mannheim, Germany
- Department of Health Science, University of York, York, United Kingdom
| | - Finn Rasmussen
- Department of Health Sciences, Lund University, Lund, Sweden
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304
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Imoisili OE, Goodman AB, Dooyema CA, Park S, Harrison M, Lundeen EA, Blanck H. Referrals and Management Strategies for Pediatric Obesity- DocStyles Survey 2017. Front Pediatr 2018; 6:367. [PMID: 30619783 PMCID: PMC6299881 DOI: 10.3389/fped.2018.00367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/12/2018] [Indexed: 01/29/2023] Open
Abstract
Background: Childhood obesity care management options can be delivered in community-, clinic-, and hospital-settings. The referral practices of clinicians to these various settings have not previously been characterized beyond the local level. This study describes the management strategies and referral practices of clinicians caring for pediatric patients with obesity and associated clinician characteristics in a geographically diverse sample. Methods: This cross-sectional study used data from the DocStyles 2017 panel-based survey of 891 clinicians who see pediatric patients. We used multivariable logistic regression to estimate associations between the demographic and practice characteristics of clinicians and types of referrals for the purposes of pediatric weight management. Results: About half of surveyed clinicians (54%) referred <25% of their pediatric patients with obesity for the purposes of weight management. Only 15% referred most (≥75%) of their pediatric patients with obesity for weight management. Referral types included clinical referrals, behavioral referrals, and weight management program (WMP) referrals. Within these categories, the percentage referrals ranged from 19% for behavioral/mental health professionals to 72% for registered dieticians. Among the significant associations, female clinicians had higher odds of referral to community and clinical WMP; practices in the Northeast had higher odds of referral to subspecialists, dieticians, mental health professionals, and clinical WMP; and clinics having ≥15 well child visits per week were associated with higher odds of referral to subspecialists, mental health professionals, and health educators. Not having an affiliation with teaching hospitals and serving low-income patients were associated with lower odds of referral to mental health professionals, and community and clinical WMP. Compared to pediatricians, family practitioners, internists, and nurse practitioners had higher odds of providing referrals to mental health professionals and to health educators. Conclusion: This study helps characterize the current landscape of referral practices and management strategies of clinicians who care for pediatric patients with obesity. Our data provide insight into the clinician, clinical practice, and reported patient characteristics associated with childhood obesity referral types. Understanding referral patterns and management strategies may help improve care for children with obesity and their families.
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Affiliation(s)
- Omoye E Imoisili
- Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Carrie A Dooyema
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Megan Harrison
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Elizabeth A Lundeen
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Heidi Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
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305
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Panter J, Tanggaard Andersen P, Aro AR, Samara A. Obesity Prevention: A Systematic Review of Setting-Based Interventions from Nordic Countries and the Netherlands. J Obes 2018; 2018:7093260. [PMID: 29808116 PMCID: PMC5902009 DOI: 10.1155/2018/7093260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/06/2017] [Accepted: 02/25/2018] [Indexed: 11/29/2022] Open
Abstract
AIM Effective evidence-based interventions have an important role in obesity prevention. Our aim was to present a qualitative synthesis of setting-based health promotion interventions on obesity, from Nordic countries and the Netherlands. METHODS A systematic review of the literature was completed for studies in the community, schools, and worksite, with BMI as an outcome. A descriptive analysis was completed for all full-text articles meeting the inclusion criteria. RESULTS Thirty-three articles were identified: 7 whole of community, 3 worksite, and 23 school-based interventions. The studies were largely quasiexperimental in design (21/33), with follow-up from 4 months to 8 years. The explicit use of theory was not featured in many of the studies (20/33). No consistent direction for BMI change could be identified in the whole of community interventions (2/7 positive, 2/7 negative, and 3/7 no effect) and no effect for worksite (3/3 no effect) or many of the school-based interventions (1/23 negative, 4/23 positive, 15/23 no effect, 1/23 BMI significant increase only for control group and 3/23 no data available). CONCLUSIONS There is a need to prioritise interventions with study designs of high quality, theory, and a participatory approach, for optimal implementation and evaluation of obesity prevention interventions.
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Affiliation(s)
- Jacqueline Panter
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | | | - Arja R. Aro
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | - Anastasia Samara
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
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306
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Lloyd J, Creanor S, Logan S, Green C, Dean SG, Hillsdon M, Abraham C, Tomlinson R, Pearson V, Taylor RS, Ryan E, Price L, Streeter A, Wyatt K. Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:35-45. [PMID: 29302609 PMCID: PMC5738974 DOI: 10.1016/s2352-4642(17)30151-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Although childhood overweight and obesity prevalence has increased substantially worldwide in the past three decades, scarce evidence exists for effective preventive strategies. We aimed to establish whether a school-based intervention for children aged 9-10 years would prevent excessive weight gain after 24 months. Methods This pragmatic cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP), a school-based obesity prevention intervention, was done in 32 schools in southwest England. All state-run primary and junior schools in Devon and Plymouth (UK) with enough pupils for at least one year-5 class were eligible. Schools were assigned (1:1) using a computer-generated sequence to either intervention or control, stratified by the number of year-5 classes (one vs more than one) and the proportion of children eligible for free school meals (<19% [the national average] vs ≥19%). HeLP was delivered to year-5 children (ages 9-10 years) over 1 year, and included dynamic and interactive activities such as physical activity workshops, education sessions delivered by teachers with short homework tasks, drama sessions, and setting goals to modify behaviour (with parental support and one-to-one discussions with HeLP coordinators). The primary outcome was change in body-mass index (BMI) standard deviation score (SDS) between baseline and 24 months, analysed in children with BMI data available for both timepoints. This study is registered with the International Standard Randomised Controlled Trial register, number ISRCTN15811706, and the trial status is complete. Findings Between March 21, 2012, and Sept 30, 2013, 32 eligible schools with 1324 children were recruited, of which 16 schools (676 children) were randomly assigned to the HeLP intervention and 16 schools (648 children) to control. All schools that began the trial completed the intervention, and 1244 children (628 in intervention group and 616 in control group) had BMI data at both baseline and 24 months for the primary outcome analysis. Mean BMI SDS was 0·32 (SD 1·16) at baseline and 0·35 (1·25) at 24 months in the intervention group, and 0·18 (1·14) at baseline and 0·22 (1·22) at 24 months in the control group. With adjustment for school-level clustering, baseline BMI scores, sex, cohort, and number of year-5 classes and socioeconomic status of each school, the mean difference in BMI SDS score (intervention-control) at 24 months was -0·02 (95% CI -0·09 to 0·05), p=0·57. One parent reported an adverse event related to their child's eating and activity behaviours, but agreed for the child to continue trial participation after discussion with the chief investigator. Interpretation Despite a theoretically informed and extensively piloted intervention that achieved high levels of engagement, follow-up, and fidelity of delivery, we found no effect of the intervention on preventing overweight or obesity. Although schools are an ideal setting in which to deliver population-based interventions, school-based interventions might not be sufficiently intense to affect both the school and the family environment, and hence the weight status of children. Future research should focus on more upstream determinants of obesity and use whole-systems approaches. Funding UK National Institute for Health Research, Public Health Research Programme.
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Affiliation(s)
- Jenny Lloyd
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - Siobhan Creanor
- Peninsula Clinical Trials Unit and Medical Statistics, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Stuart Logan
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Colin Green
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sarah G Dean
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Charles Abraham
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Virginia Pearson
- Public Health Devon, Devon County Council Commissioning Headquarters, Exeter, UK
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Emma Ryan
- ISCA Academy, Earl Richards Road South, Exeter, UK
| | - Lisa Price
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Adam Streeter
- Peninsula Clinical Trials Unit and Medical Statistics, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Katrina Wyatt
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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307
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Wyatt K, Lloyd J, Creanor S, Green C, Dean SG, Hillsdon M, Abraham C, Tomlinson R, Pearson V, Taylor RS, Ryan E, Streeter A, McHugh C, Hurst A, Price L, Crathorne L, Krägeloh C, Siegert R, Logan S. Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundApproximately one-third of children in England leave primary school overweight or obese. There is little evidence of effective obesity prevention programmes for children in this age group.ObjectiveTo determine the effectiveness and cost-effectiveness of a school-based healthy lifestyles programme in preventing obesity in children aged 9–10 years.DesignA cluster randomised controlled trial with an economic and process evaluation.SettingThirty-two primary schools in south-west England.ParticipantsChildren in Year 5 (aged 9–10 years) at recruitment and in Year 7 (aged 11–12 years) at 24 months’ post-baseline follow-up.InterventionThe Healthy Lifestyles Programme (HeLP) ran during the spring and summer terms of Year 5 into the autumn term of Year 6 and included four phases: (1) building a receptive environment, (2) a drama-based healthy lifestyles week, (3) one-to-one goal setting and (4) reinforcement activities.Main outcome measuresThe primary outcome measure was body mass index (BMI) standard deviation score (SDS) at 24 months post baseline measures (12 months post intervention). The secondary outcomes comprised waist circumference SDS, percentage body fat SDS, proportion of children overweight and obese at 18 and 24 months, accelerometer-assessed physical activity and food intake at 18 months, and cost-effectiveness.ResultsWe recruited 32 schools and 1324 children. We had a rate of 94% follow-up for the primary outcome. No difference in BMI SDS was found at 24 months [mean difference –0.02, 95% confidence interval (CI) –0.09 to 0.05] or at 18 months (mean difference –0.02, 95% CI –0.08 to 0.05) between children in the intervention schools and children in the control schools. No difference was found between the intervention and control groups in waist circumference SDS, percentage body fat SDS or physical activity levels. Self-reported dietary behaviours showed that, at 18 months, children in the intervention schools consumed fewer energy-dense snacks and had fewer negative food markers than children in the control schools. The intervention effect on negative food markers was fully mediated by ‘knowledge’ and three composite variables: ‘confidence and motivation’, ‘family approval/behaviours and child attitudes’ and ‘behaviours and strategies’. The intervention effect on energy-dense snacks was partially mediated by ‘knowledge’ and the same composite variables apart from ‘behaviours and strategies’. The cost of implementing the intervention was approximately £210 per child. The intervention was not cost-effective compared with control. The programme was delivered with high fidelity, and it engaged children, schools and families across the socioeconomic spectrum.LimitationsThe rate of response to the parent questionnaire in the process evaluation was low. Although the schools in the HeLP study included a range of levels of socioeconomic deprivation, class sizes and rural and urban settings, the number of children for whom English was an additional language was considerably lower than the national average.ConclusionsHeLP is not effective or cost-effective in preventing overweight or obesity in children aged 9–10 years.Future workOur very high levels of follow-up and fidelity of intervention delivery lead us to conclude that it is unlikely that school-based programmes targeting a single age group can ever be sufficiently intense to affect weight status. New approaches are needed that affect the school, the family and the wider environment to prevent childhood obesity.Trial registrationCurrent Controlled Trials ISRCTN15811706.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katrina Wyatt
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Jenny Lloyd
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Siobhan Creanor
- Peninsula Clinical Trials Unit and Medical Statistics, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, UK
| | - Colin Green
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Sarah G Dean
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Melvyn Hillsdon
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Charles Abraham
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | | | | | - Rod S Taylor
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | | | - Adam Streeter
- Peninsula Clinical Trials Unit and Medical Statistics, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, UK
| | - Camilla McHugh
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Alison Hurst
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Lisa Price
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Louise Crathorne
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Chris Krägeloh
- Health Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Richard Siegert
- Health Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Stuart Logan
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
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308
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Kenney EL, Wintner S, Lee RM, Austin SB. Obesity Prevention Interventions in US Public Schools: Are Schools Using Programs That Promote Weight Stigma? Prev Chronic Dis 2017; 14:E142. [PMID: 29283880 PMCID: PMC5757382 DOI: 10.5888/pcd14.160605] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Despite substantial research on school-based obesity prevention programs, it is unclear how widely they are disseminated. It is also unknown whether schools use obesity programs that inadvertently promote weight stigma or disordered weight-control behaviors. Methods In spring 2016, we distributed an online survey about school wellness programming to a simple random sample of US public school administrators (N = 247 respondents; 10.3% response rate). We analyzed survey responses and conducted immersion/crystallization analysis of written open-ended responses. Results Slightly less than half (n = 117, 47.4%) of schools offered any obesity prevention program. Only 17 (6.9%) reported using a predeveloped program, and 7 (2.8%) reported using a program with evidence for effectiveness. Thirty-seven schools (15.0%) reported developing intervention programs that focused primarily on individual students’ or staff members’ weight rather than nutrition or physical activity; 28 schools (11.3% of overall) used staff weight-loss competitions. School administrators who reported implementing a program were more likely to describe having a program champion and adequate buy-in from staff, families, and students. Lack of funding, training, and time were widely reported as barriers to implementation. Few administrators used educational (n = 12, 10.3%) or scientific (n = 6, 5.1%) literature for wellness program decision making. Conclusion Evidence-based obesity prevention programs appear to be rarely implemented in US schools. Schools may be implementing programs lacking evidence and programs that may unintentionally exacerbate student weight stigma by focusing on student weight rather than healthy habits. Public health practitioners and researchers should focus on improving support for schools to implement evidence-based programs.
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Affiliation(s)
- Erica L Kenney
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115. E-mail:
| | - Suzanne Wintner
- Simmons College School of Social Work, Boston, Massachusetts
| | - Rebekka M Lee
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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309
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Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 2017; 390:2627-2642. [PMID: 29029897 PMCID: PMC5735219 DOI: 10.1016/s0140-6736(17)32129-3] [Citation(s) in RCA: 4144] [Impact Index Per Article: 592.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/12/2017] [Accepted: 07/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. METHODS We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). FINDINGS Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m2 per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese. INTERPRETATION The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. FUNDING Wellcome Trust, AstraZeneca Young Health Programme.
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310
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Training early childcare providers in evidence-based nutrition strategies can help improve nutrition policies and practices of early childcare centres serving racially and ethnically diverse children from low-income families. Public Health Nutr 2017; 21:1212-1221. [PMID: 29233208 DOI: 10.1017/s1368980017003573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We evaluated the extent to which providing training and technical assistance to early childcare centre (ECC) directors, faculty and staff in the implementation of evidence-based nutrition strategies improved the nutrition contexts, policies and practices of ECC serving racially and ethnically diverse, low-income children in Broward County, Florida, USA. The nutrition strategies targeted snack and beverage policies and practices, consistent with Caring for Our Children National Standards. DESIGN We used the nutrition observation and document review portions of the Environment and Policy Assessment and Observation (EPAO) instrument to observe ECC as part of a one-group pre-test/post-test evaluation design. SETTING ECC located within areas of high rates of poverty, diabetes, minority representation and unhealthy food index in Broward County, Florida, USA. SUBJECTS Eighteen ECC enrolled, mean 112·9 (sd 53·4) children aged 2-5 years; 12·3 (sd 7·2) staff members; and 10·2 (sd 4·6) children per staff member at each centre. RESULTS We found significant improvements in centres' overall nutrition contexts, as measured by total EPAO nutrition scores (P=0·01). ECC made specific significant gains within written nutrition policies (P=0·03) and nutrition training and education (P=0·01). CONCLUSIONS Our findings support training ECC directors, faculty and staff in evidence-based nutrition strategies to improve the nutrition policies and practices of ECC serving racially and ethnically diverse children from low-income families. The intervention resulted in improvements in some nutrition policies and practices, but not others. There remains a need to further develop the evaluation base involving the effectiveness of policy and practice interventions within ECC serving children in high-need areas.
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311
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Matvienko-Sikar K, Toomey E, Delaney L, Harrington J, Byrne M, Kearney PM. Effects of healthcare professional delivered early feeding interventions on feeding practices and dietary intake: A systematic review. Appetite 2017; 123:56-71. [PMID: 29225141 DOI: 10.1016/j.appet.2017.12.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/18/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Childhood obesity is a global public health challenge. Parental feeding practices, such as responsive feeding, are implicated in the etiology of childhood obesity. PURPOSE This systematic review aimed to examine of effects of healthcare professional-delivered early feeding interventions, on parental feeding practices, dietary intake, and weight outcomes for children up to 2 years. The role of responsive feeding interventions was also specifically examined. METHODS Databases searched included: CINAHL, the Cochrane Library, EMBASE, Medline, PubMed, PsycINFO, and Maternity and Infant Care. INCLUSION CRITERIA participants are parents of children ≤2 years; intervention includes focus on early child feeding to prevent overweight and obesity; intervention delivered by healthcare professionals. RESULTS Sixteen papers, representing 10 trials, met inclusion criteria for review. Six interventions included responsive feeding components. Interventions demonstrated inconsistent effects on feeding practices, dietary intake, and weight outcomes. Findings suggest some reductions in pressure to eat and infant consumption of non-core beverages. Responsive feeding based interventions demonstrate greater improvements in feeding approaches, and weight outcomes. CONCLUSIONS The findings of this review highlight the importance of incorporating responsive feeding in healthcare professional delivered early feeding interventions to prevent childhood obesity. Observed inconsistencies across trials may be explained by methodological limitations.
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Affiliation(s)
| | - Elaine Toomey
- School of Psychology, National University of Ireland Galway, Ireland
| | - Lisa Delaney
- School of Public Health, University College Cork, Ireland
| | | | - Molly Byrne
- School of Psychology, National University of Ireland Galway, Ireland
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312
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Dupart G, Berry DC, D’Auria J, Sharpe L, McDonough L, Houser M, Flanary S, Koppelberger S. A Nurse-Led and Teacher-Assisted Adolescent Healthy Weight Program to Improve Health Behaviors in the School Setting. J Sch Nurs 2017; 35:178-188. [DOI: 10.1177/1059840517744020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adolescents with overweight and obesity are at risk for future health problems. The purpose of this study was to examine the feasibility and initial efficacy of a weight management intervention to help adolescents develop healthy nutrition and physical activity behaviors and improve their anthropometrics. This study used a single-group repeated measures design in a small school in Durham, North Carolina (NC). The intervention consisted of a nurse-led and teacher-assisted nutrition and physical activity education and exercise classes that met twice each week for 45–60 minutes for 7 weeks. Data were collected at Time 1 (baseline), Time 2 (after intervention completion), and Time 3 (after 3 months on their own). Interview feedback, low cost, and successful completion of all planned activities indicated that all stakeholders found the project beneficial and suitable for their school. This study suggests that a weight management intervention for adolescents was feasible in the school setting.
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Affiliation(s)
- Gary Dupart
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diane C. Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer D’Auria
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leslie Sharpe
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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313
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Hu Y, He JR, Liu FH, Li WD, Lu JH, Xing YF, Lin SF, Liu X, Bartington S, Feng Q, Xia HM, Lam KBH, Cheng KK, Qiu X. Effectiveness of a Kindergarten-Based Intervention for Preventing Childhood Obesity. Pediatrics 2017; 140:peds.2017-1221. [PMID: 29127208 DOI: 10.1542/peds.2017-1221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Interventions to prevent childhood obesity targeting school age children have mostly reported limited effectiveness, suggesting such prevention programs may need to start at an earlier age, but evidence has been scarce. We reported a pilot study aiming to demonstrate the feasibility of a multifaceted intervention for preschool children and to provide a preliminary assessment of the effectiveness. METHODS This nonrandomized controlled trial recruited children aged 3 to 6 years from 6 kindergartens in Guangzhou, China. Based on the preference of the School and Parents Committees, 4 kindergartens (648 children) received a 3-component intervention (training of kindergarten staff, initiating healthy curriculum for children, and close collaboration between families and kindergartens) over 12 months, while the other 2 kindergartens (336 children), serving as controls, received routine health care provision. Outcome measures were the changes in BMI z score between baseline and the end of 12 months, and the prevalence of postintervention children who were overweight or obese. RESULTS By 12 months, children within the intervention group had a smaller BMI z score increase (0.24) compared to the control (0.41), with a difference of -0.31 (95% CI -0.47 to -0.15). The prevalence of overweight or obesity was also lower among the intervention group at the end of the study (OR: 0.43, 95% CI 0.19 to 0.96), adjusted for baseline status. CONCLUSIONS Our results indicated a multicomponent health behavior intervention might be effective in reducing the prevalence of obesity, but the longer term effects will need confirmation from randomized controlled trials.
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Affiliation(s)
- Yan Hu
- Division of Birth Cohort Study and.,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jian-Rong He
- Division of Birth Cohort Study and.,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | | | - Wei-Dong Li
- Division of Birth Cohort Study and.,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jin-Hua Lu
- Division of Birth Cohort Study and.,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yan-Fei Xing
- Division of Birth Cohort Study and.,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Sui-Fang Lin
- Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xian Liu
- Division of Birth Cohort Study and.,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Suzanne Bartington
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; and
| | - Qiong Feng
- Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | | | - Kin Bong Hubert Lam
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; and
| | - Xiu Qiu
- Division of Birth Cohort Study and .,Department of Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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314
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Li M, Xue H, Wen M, Wang W, Wang Y. Nutrition and physical activity related school environment/policy factors and child obesity in China: a nationally representative study of 8573 students in 110 middle schools. Pediatr Obes 2017; 12:485-493. [PMID: 27384757 DOI: 10.1111/ijpo.12169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/25/2016] [Accepted: 05/30/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Obesity is a serious threat to global health. School is a key setting for obesity intervention. Research on school risk factors for child obesity is limited in developing countries. OBJECTIVES To examine regional variations in obesity and school environments/policies and their associations among students in China. METHODS Analyses were based on the first nationally representative sample of 8573 9th graders in 110 middle schools from 28 regions across China. Multilevel models tested associations between school factors and child self-reported weight outcomes and by school urbanicity setting (urban, rural). RESULTS Overweight/obesity rate is higher among boys and in urban areas. Schools in rural areas, or less developed regions, promote longer on-campus life, as is indicated by the presence of school cafeterias, night study sessions and longer class hours. Multilevel models show that (i) school cafeterias (OR = 2.53, 95% CI = 1.35-4.75) and internet bars close to school (OR = 1.63, 95% CI = 1.15-2.30) are associated with increased overweight/obesity risk in rural areas, especially for boys; (ii) school night study sessions are associated with lower overweight/obesity risk (OR = 0.69, 95% CI = 0.50-0.96) in rural areas. CONCLUSIONS China has large regional disparities in school environment/policies related to nutrition and physical activity. Some school factors are associated with students' weight status, which vary across gender and areas. Future school-based interventions should attend to diverse regional contexts.
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Affiliation(s)
- M Li
- Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - H Xue
- Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - M Wen
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - W Wang
- Department of Sociology, Renmin University of China, Beijing, China
| | - Y Wang
- Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA
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315
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Rajan S, Roberts KJ, Guerra L, Pirsch M, Morrell E. Integrating Health Education in Core Curriculum Classrooms: Successes, Challenges, and Implications for Urban Middle Schools. THE JOURNAL OF SCHOOL HEALTH 2017; 87:949-957. [PMID: 29096407 DOI: 10.1111/josh.12563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 03/24/2017] [Accepted: 04/22/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND School-based health education efforts can positively affect health behaviors and learning outcomes; however, there is limited available time during the school day for separate health education classes. The purpose of this study was to assess the feasibility and sustainability of implementing a classroom-based health education program that integrates skill development with health learning. METHODS A wait-list control study design was conducted among 168 6th graders in 2 urban schools. Data on program implementation, feasibility, and health outcomes were collected from students at 3 time points and from 5 teachers across the implementation of the 10-week program. RESULTS There were barriers to implementation, including time limitations, unexpected school-wide disruptions, and variations in student reading ability and teacher preparedness. However, analyses revealed there were significant increases in self-efficacy regarding fruit and vegetable consumption and outcome expectations following program implementation, which were also sustained post-program implementation. Despite inconsistent implementation in the wait-list control school, small gains were also noted following the completion of the program. CONCLUSIONS Integrating health education efforts within core curricula classes can lead to favorable outcomes. However, implementation barriers must be actively addressed by schools and program developers to improve program fidelity and maximize the sustainability of program gains.
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Affiliation(s)
- Sonali Rajan
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, Box 114, New York, NY 10027
| | - Katherine J Roberts
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, Box 114, New York, NY 10027
| | - Laura Guerra
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, Box 114, New York, NY 10027
| | - Moira Pirsch
- Department of Arts and Humanities and Institute for Urban and Minority Education, Teachers College, Columbia University, New York, NY 10027
| | - Ernest Morrell
- Department of Arts and Humanities and Institute for Urban and Minority Education, Teachers College, Columbia University, New York, NY 10027
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316
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Freedman DS, Butte NF, Taveras EM, Goodman AB, Blanck HM. Longitudinal changes in BMI z-scores among 45 414 2-4-year olds with severe obesity. Ann Hum Biol 2017; 44:687-692. [PMID: 29082754 PMCID: PMC5765752 DOI: 10.1080/03014460.2017.1388845] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/08/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND BMI z-scores (BMIz) based on the Centers for Disease Control and Prevention (CDC) growth charts among children do not accurately characterise BMI levels among children with very high BMIs. These limitations may be particularly relevant in longitudinal and intervention studies, as the large changes in the L (normality) and S (dispersion) parameters with age can influence BMIz. AIM To compare longitudinal changes in BMIz with BMI expressed as a percentage of the 95th percentile (%BMIp95) and a modified z-score calculated as log(BMI/M)/S. SUBJECTS AND METHODS A total of 45 414 2-4-year-olds with severe obesity (%BMIp95 ≥ 120). RESULTS Changes in very high BMIz levels differed from the other metrics. Among severely obese 2-year-old girls, for example, the mean BMIz decreased by 0.6 SD between examinations, but there were only small changes in BMIp95 and modified BMIz. Some 2-year-old girls had BMIz decreases of >1 SD, even though they had large increases in BMI, %BMIp95 and modified BMIz. CONCLUSIONS Among children with severe obesity, BMIz changes may be due to differences in the transformations used to estimate levels of BMIz rather than to changes in body size. The BMIs of these children could be expressed relative to the 95th percentile or as modified z-scores.
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Affiliation(s)
- David S. Freedman
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nancy F. Butte
- Baylor College of Medicine, Children’s Nutrition Research Center, Houston, TX, USA
| | - Elsie M. Taveras
- Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA
| | - Alyson B. Goodman
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heidi M. Blanck
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
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317
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Lloyd J, Dean S, Creanor S, Abraham C, Hillsdon M, Ryan E, Wyatt KM. Intervention fidelity in the definitive cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP) trial: findings from the process evaluation. Int J Behav Nutr Phys Act 2017; 14:163. [PMID: 29179724 PMCID: PMC5704582 DOI: 10.1186/s12966-017-0616-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/09/2017] [Indexed: 11/18/2022] Open
Abstract
Background The Healthy Lifestyles Programme (HeLP) was a novel school-located intervention for 9–10 year olds, designed to prevent obesity by changing patterns of child behaviour through the creation of supportive school and home environments using dynamic and creative delivery methods. This paper reports on both the quantitative and qualitative data regarding the implementation of the HeLP intervention in the definitive cluster randomised controlled trial, which was part of the wider process evaluation. Methods Mixed methods were used to collect data on intervention uptake, fidelity of delivery in terms of content and quality of delivery of the intervention, as well as school and child engagement with the programme. Data were collected using registers of attendance, observations and checklists, field notes, focus groups with children and semi-structured interviews with teachers. Qualitative data were analysed thematically and quantitative data were summarized using descriptive statistics. Results All 16 intervention schools received a complete or near complete programme (94–100%), which was delivered in the spirit in which it had been designed. Of the 676 children in the intervention schools, over 90% of children participated in each phase of HeLP; 92% of children across the socio-economic spectrum were deemed to be engaged with HeLP and qualitative data revealed a high level of enjoyment by all children, particularly to the interactive drama workshops. Further evidence of child engagment with the programme was demonstrated by children’s clear understanding of programme messages around marketing, moderation and food labelling. Thirteen of the intervention schools were deemed to be fully engaged with HeLP and qualitative data revealed a high level of teacher ‘buy in’, due to the programme’s compatability with the National Curriculum, level of teacher support and use of innovative and creative delivery methods by external drama practitioners. Conclusion Our trial shows that it is possible to successfully scale up complex school-based interventions, engage schools and children across the socio-economic spectrum and deliver an intervention as designed. As programme integrity was maintained throughout the HeLP trial, across all intervention schools, we can be confident that the trial findings are a true reflection of the effectiveness of the intervention, enabling policy recommendations to be made. Trial registration ISRCTN15811706. Electronic supplementary material The online version of this article (10.1186/s12966-017-0616-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jenny Lloyd
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), South Cloisters, St Luke's Campus, Exeter, Devon, EX1 2LU, UK.
| | - Sarah Dean
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), South Cloisters, St Luke's Campus, Exeter, Devon, EX1 2LU, UK
| | - Siobhan Creanor
- Peninsula Clinical Trials Unit and Medical Statistics, Plymouth University Peninsula Schools of Medicine & Dentistry (formerly Peninsula College of Medicine and Dentistry), ITTC Building, Plymouth Science Park, Plymouth, Devon, PL6 8BX, UK
| | - Charles Abraham
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), South Cloisters, St Luke's Campus, Exeter, Devon, EX1 2LU, UK
| | - Melvyn Hillsdon
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, Devon, EX1 2LU, UK
| | - Emma Ryan
- Isca Academy, Earl Richards Road, Exeter, Devon, EX2 6AP, UK
| | - Katrina M Wyatt
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), South Cloisters, St Luke's Campus, Exeter, Devon, EX1 2LU, UK
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318
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Okely AD, Hammersley ML. School-home partnerships: the missing piece in obesity prevention? THE LANCET CHILD & ADOLESCENT HEALTH 2017; 2:5-6. [PMID: 30169195 DOI: 10.1016/s2352-4642(17)30154-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Anthony D Okely
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia.
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319
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Avilés-Santa ML, Colón-Ramos U, Lindberg NM, Mattei J, Pasquel FJ, Pérez CM. From Sea to Shining Sea and the Great Plains to Patagonia: A Review on Current Knowledge of Diabetes Mellitus in Hispanics/Latinos in the US and Latin America. Front Endocrinol (Lausanne) 2017; 8:298. [PMID: 29176960 PMCID: PMC5687125 DOI: 10.3389/fendo.2017.00298] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022] Open
Abstract
The past two decades have witnessed many advances in the prevention, treatment, and control of diabetes mellitus (DM) and its complications. Increased screening has led to a greater recognition of type 2 diabetes mellitus (type 2 DM) and prediabetes; however, Hispanics/Latinos, the largest minority group in the US, have not fully benefited from these advances. The Hispanic/Latino population is highly diverse in ancestries, birth places, cultures, languages, and socioeconomic backgrounds, and it populates most of the Western Hemisphere. In the US, the prevalence of DM varies among Hispanic/Latino heritage groups, being higher among Mexicans, Puerto Ricans, and Dominicans, and lower among South Americans. The risk and prevalence of diabetes among Hispanics/Latinos are significantly higher than in non-Hispanic Whites, and nearly 40% of Hispanics/Latinos with diabetes have not been formally diagnosed. Despite these striking facts, the representation of Hispanics/Latinos in pharmacological and non-pharmacological clinical trials has been suboptimal, while the prevalence of diabetes in these populations continues to rise. This review will focus on the epidemiology, etiology and prevention of type 2 DM in populations of Latin American origin. We will set the stage by defining the terms Hispanic, Latino, and Latin American, explaining the challenges identifying Hispanics/Latinos in the scientific literature and databases, describing the epidemiology of diabetes-including type 2 DM and gestational diabetes mellitus (GDM)-and cardiovascular risk factors in Hispanics/Latinos in the US and Latin America, and discussing trends, and commonalities and differences across studies and populations, including methodology to ascertain diabetes. We will discuss studies on mechanisms of disease, and research on prevention of type 2 DM in Hispanics/Latinos, including women with GDM, youth and adults; and finalize with a discussion on lessons learned and opportunities to enhance research, and, consequently, clinical care oriented toward preventing type 2 DM in Hispanics/Latinos in the US and Latin America.
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Affiliation(s)
- M. Larissa Avilés-Santa
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD, United States
| | - Uriyoán Colón-Ramos
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Nangel M. Lindberg
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Francisco J. Pasquel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Cynthia M. Pérez
- University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
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The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111371. [PMID: 29125558 PMCID: PMC5708010 DOI: 10.3390/ijerph14111371] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/18/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
Abstract
The multifactorial causes of obesity require multilevel and multicomponent solutions, but such combined strategies have not been tested to improve the community food environment. We evaluated the impact of a multilevel (operating at different levels of the food environment) multicomponent (interventions occurring at the same level) community intervention. The B’more Healthy Communities for Kids (BHCK) intervention worked at the wholesaler (n = 3), corner store (n = 50), carryout (n = 30), recreation center (n = 28), household (n = 365) levels to improve availability, purchasing, and consumption of healthier foods and beverages (low-sugar, low-fat) in low-income food desert predominantly African American zones in the city of Baltimore (MD, USA), ultimately intending to lead to decreased weight gain in children (not reported in this manuscript). For this paper, we focus on more proximal impacts on the food environment, and measure change in stocking, sales and purchase of promoted foods at the different levels of the food system in 14 intervention neighborhoods, as compared to 14 comparison neighborhoods. Sales of promoted products increased in wholesalers. Stocking of these products improved in corner stores, but not in carryouts, and we did not find any change in total sales. Children more exposed to the intervention increased their frequency of purchase of promoted products, although improvement was not seen for adult caregivers. A multilevel food environment intervention in a low-income urban setting improved aspects of the food system, leading to increased healthy food purchasing behavior in children.
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321
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A Multicomponent Schoolyard Intervention Targeting Children's Recess Physical Activity and Sedentary Behavior: Effects After 1 Year. J Phys Act Health 2017; 14:866-875. [PMID: 28682695 DOI: 10.1123/jpah.2016-0656] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of the study was to test the 12-month effects of a multicomponent physical activity (PA) intervention at schoolyards on morning recess PA levels of sixth- and seventh-grade children in primary schools, using accelerometry and additional global positioning system data. METHODS A quasi-experimental study design was used with 20 paired intervention and control schools. Global positioning system confirmatory analyses were applied to validate attendance at schoolyards during recess. Accelerometer data from 376 children from 7 pairs of schools were included in the final analyses. Pooled intervention effectiveness was tested by multilevel linear regression analyses, whereas effectiveness of intervention components was tested by multivariate linear regression analyses. RESULTS Children exposed to the multicomponent intervention increased their time spent in light PA (+5.9%) during recess. No pooled effects on moderate to vigorous PA were found. In-depth analyses of intervention components showed that physical schoolyard interventions particularly predicted a decrease in time spent in sedentary behavior during recess at follow-up. Intervention intensity and the school's commitment to the project strengthened this effect. CONCLUSIONS The multicomponent schoolyard PA intervention was effective in making children spend a larger proportion of recess time in light PA, which was most likely the result of a shift from sedentary behavior to light PA.
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322
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Gene-nutrient interactions and susceptibility to human obesity. GENES AND NUTRITION 2017; 12:29. [PMID: 29093760 PMCID: PMC5663124 DOI: 10.1186/s12263-017-0581-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/04/2017] [Indexed: 12/28/2022]
Abstract
A large number of genome-wide association studies, transferability studies, and candidate gene studies performed in diverse populations around the world have identified gene variants that are associated with common human obesity. The mounting evidence suggests that these obesity gene variants interact with multiple environmental factors and increase susceptibility to this complex metabolic disease. The objective of this review article is to provide concise and updated information on energy balance, heritability of body weight, origins of gene variants, and gene-nutrient interactions in relation to human obesity. It is proposed that knowledge of these related topics will provide valuable insight for future preventative lifestyle intervention using targeted nutritional and medicinal therapies.
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323
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Black AP, D'Onise K, McDermott R, Vally H, O'Dea K. How effective are family-based and institutional nutrition interventions in improving children's diet and health? A systematic review. BMC Public Health 2017; 17:818. [PMID: 29041899 PMCID: PMC5645887 DOI: 10.1186/s12889-017-4795-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/21/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Effective strategies to improve dietary intake in young children are a priority to reduce the high prevalence of chronic non-communicable diseases in adulthood. This study aimed to assess the impact of family-based and school/preschool nutrition programs on the health of children aged 12 or younger, including the sustainability of these impacts and the relevance to socio-economic inequalities. METHODS A systematic review of literature published from 1980 to December 2014 was undertaken. Randomised controlled trials involving families with children aged up to 12 years in high income countries were included. The primary outcomes were dietary intake and health status. Results were presented in a narrative synthesis due to the heterogeneity of the interventions and outcomes. RESULTS The systematic search and assessment identified 39 eligible studies. 82% of these studies were set in school/preschools. Only one school study assessed the impact of involving parents systematically. The family-based programs which provided simple positive dietary advice to parents and regular follow-up reduced fat intake significantly. School and family-based studies, if designed and implemented well, increased F&V intake, particularly fruit. Effective school-based programs have incorporated role-models including peers, teachers and heroic figures, rewards and increased access to healthy foods. School nutrition programs in disadvantaged communities were as effective as programs in other communities. CONCLUSIONS Family and school nutrition programs can improve dietary intake, however evidence of the long-term sustainability of these impacts is limited. The modest overall impact of even these successful programs suggest complementary nutrition interventions are needed to build a supportive environment for healthy eating generally.
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Affiliation(s)
- Andrew P Black
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
- Bulgarr Ngaru Medical Aboriginal Corporation, PO Box 170, South Grafton, NSW, 2460, Australia.
| | - Katina D'Onise
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Robyn McDermott
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
| | - Hassan Vally
- School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Kerin O'Dea
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Händel MN, Larsen SC, Rohde JF, Stougaard M, Olsen NJ, Heitmann BL. Effects of the Healthy Start randomized intervention trial on physical activity among normal weight preschool children predisposed to overweight and obesity. PLoS One 2017; 12:e0185266. [PMID: 28991907 PMCID: PMC5633144 DOI: 10.1371/journal.pone.0185266] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/07/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is limited evidence to support the effectiveness of primary interventions aiming to prevent excess weight gain among young children. Evaluating behavioral changes, such as physical activity (PA), may add to future development of efficient interventions. The objective was to evaluate the effect on PA outcomes of the 15 month Healthy Start intervention that focused on changing diet, PA, sleep and stress management among normal weight but obesity-prone preschool children. Children were defined as obesity-prone if they had a birth weight > 4,000 g, mothers with a pre-pregnancy body mass index of > 28 kg/m2, or mothers with ≤ 10 years of schooling. METHOD From a baseline study population of 635 normal weight 2-6 year old preschool children from the greater Copenhagen area, parents of 307 children had given information on PA at both the baseline and follow-up examinations. PA was obtained from a 7 days recording in the Children's Physical Activity Questionnaire. Time used for sport activities were combined with outdoor playing time to achieve a proxy of total PA level of moderate to vigorous intensity. RESULTS Linear regression analyses revealed that at follow-up the intervention group spent more time on sports and outdoor activities combined per week than the control group (ITT analyses: intervention: 400 min/week; 95% confidence interval (CI): 341, 459 versus control: 321 min/week; 95% CI: 277, 366; p = 0.02), although no significant intervention effects were seen for each of the subcategories, e.g. sports participation, outdoor activities, screen time, or commuting frequency. CONCLUSION Our results suggest that the overall time spent on sports and outdoor activities combined was increased at follow-up among normal weight obesity-prone children, as a result of the Healthy Start intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT01583335.
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Affiliation(s)
- Mina Nicole Händel
- Department of Clinical Research, University of Southern Denmark, Odense Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Research Unit for Dietary Studies, The Parker Institute and the Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- * E-mail:
| | - Sofus Christian Larsen
- Research Unit for Dietary Studies, The Parker Institute and the Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Jeanett Friis Rohde
- Research Unit for Dietary Studies, The Parker Institute and the Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Maria Stougaard
- Research Unit for Dietary Studies, The Parker Institute and the Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Nanna Julie Olsen
- Research Unit for Dietary Studies, The Parker Institute and the Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute and the Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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325
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Wang Z, Xu F, Ye Q, Tse LA, Xue H, Tan Z, Leslie E, Owen N, Wang Y. Childhood obesity prevention through a community-based cluster randomized controlled physical activity intervention among schools in china: the health legacy project of the 2nd world summer youth olympic Games (YOG-Obesity study). Int J Obes (Lond) 2017; 42:625-633. [PMID: 28978975 PMCID: PMC5984083 DOI: 10.1038/ijo.2017.243] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 09/04/2017] [Accepted: 09/17/2017] [Indexed: 01/22/2023]
Abstract
Background: Childhood obesity has been becoming a worldwide public health problem. We conducted a community-based physical activity (PA) intervention program aiming at childhood obesity prevention in general student population in Nanjing of China, the host city of the 2nd World Summer Youth Olympic Games (YOG-Obesity study). Methods: This was a cluster randomized controlled intervention study. Participants were the 4th (mean age±s.e.: 9.0±0.01) and 7th (mean age±s.e.: 12.0±0.01) grade students (mean age±s.e.: 10.5±0.02) from 48 schools and randomly allocated (1:1) to intervention or control groups at school level. Routine health education was provided to all schools, whereas the intervention schools additionally received an 1-year tailored multi-component PA intervention program, including classroom curricula, school environment support, family involvement and fun programs/events. The primary outcome measures were changes in body mass index, obesity occurrence and PA. Results: Overall, 9858 (97.7%) of the 10091 enrolled students completed the follow-up survey. Compared with the baseline, PA level increased by 33.13 min per week (s.e. 10.86) in the intervention group but decreased by 1.76 min per week (s.e. 11.53) in the control group (P=0.028). After adjustment for potential confounders, compared with the control group, the intervention group were more likely to have increased time of PA (adj. Odds ratio=1.15, 95% confidence interval=1.06–1.25), but had a smaller increase in mean body mass index (BMI) (0.22 (s.e. 0.02) vs 0.46 (0.02), P=0.01) and BMI z-score (0.07 (0.01) vs 0.16 (0.01), P=0.01), and were less likely to be obese (adj. Odds ratio=0.7, 95% confidence interval=0.6, 0.9) at study end. The intervention group had fewer new events of obesity/overweight but a larger proportion of formerly overweight/obese students having normal weight by study end. Conclusions: This large community-based PA intervention was feasible and effective in promoting PA and preventing obesity among the general student population in a large city in China. Experiences from this study are the lessons for China to control the childhood obesity epidemic.
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Affiliation(s)
- Z Wang
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - F Xu
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Q Ye
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - L A Tse
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - H Xue
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Z Tan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - E Leslie
- Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, USA
| | - N Owen
- School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Y Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Swinburne University of Technology and the Baker IDI Heart and Diabetes Institute, Melbourne, Victoria Australia
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326
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Kim MJ, Sung E, Choi EY, Ju YS, Park EW, Cheong YS, Yoo S, Park KH, Choi HJ, Kim S. Delphi Survey for Designing a Intervention Research Study on Childhood Obesity Prevention. Korean J Fam Med 2017; 38:284-290. [PMID: 29026489 PMCID: PMC5637220 DOI: 10.4082/kjfm.2017.38.5.284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/29/2016] [Accepted: 08/09/2016] [Indexed: 12/02/2022] Open
Abstract
Background The prevalence of childhood obesity in South Korea has increased owing to economic improvement and the prevailing Westernized dietary pattern. As the incidence of chronic diseases caused by obesity is also expected to increase, effective interventions to prevent childhood obesity are needed. Therefore, we conducted a Delphi study to determine the priorities of a potential intervention research on childhood obesity prevention and its adequacy and feasibility. Methods The two-round Delphi technique was used with a panel of 10 childhood obesity experts. The panelists were asked to rate “priority populations,” “methods of intervention,” “measurement of outcomes,” “future intervention settings,” and “duration of intervention” by using a structured questionnaire. Finally, a portfolio analysis was performed with the adequacy and feasibility indexes as the two axes. Results For priority populations, the panel favored “elementary,” “preschool,” and “middle and high school” students in this order. Regarding intervention settings, the panelists assigned high adequacy and feasibility to “childcare centers” and “home” for preschool children, “school” and “home” for elementary school children, and “school” for adolescents in middle and high school. As the age of the target population increased, the panelists scored increasing numbers of anthropometric, clinical, and intermediate outcomes as highly adequate and feasible for assessing the effectiveness of the intervention. Conclusion According to the results of the Delphi survey, the highest-priority population for the research on childhood obesity prevention was that of elementary school students. Various settings, methods, outcome measures, and durations for the different age groups were also suggested.
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Affiliation(s)
- Min Jeong Kim
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Eunju Sung
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Choi
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Young-Su Ju
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eal-Whan Park
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Yoo-Seock Cheong
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Sunmi Yoo
- Department of Family Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyung Jin Choi
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Seolhye Kim
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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327
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Feng L, Wei DM, Lin ST, Maddison R, Ni Mhurchu C, Jiang Y, Gao Y, Wang HJ. Systematic review and meta-analysis of school-based obesity interventions in mainland China. PLoS One 2017; 12:e0184704. [PMID: 28910362 PMCID: PMC5598996 DOI: 10.1371/journal.pone.0184704] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 08/29/2017] [Indexed: 12/12/2022] Open
Abstract
Background Numerous school-based interventions for childhood obesity have been emerging in mainland China in recent decades, but little is known about the effectiveness of such interventions. This study aims to assess the effectiveness of school-based interventions for childhood obesity conducted in mainland China. Methods A systematic search was undertaken in eight databases to identify both randomized and non-randomized controlled trials from January 1990 to December 2015 examining the effectiveness of school-based obesity interventions. A random effects meta-analysis was conducted assessing the impact of included interventions on (body mass index) BMI. The quality of each included studies were assessed using Effective Public Health Practice Project Quality Assessment Tool. A P value <0.05 (two-sided) was considered statistically significant. Result Of the seventy-six included studies, we found physical activity and health education were the two most common components of interventions. More treatment studies were effective compared with prevention studies (85.0% vs. 58.3%). Comprehensive interventions involving physical activity and health education appeared more effective than the physical activity only interventions in both obesity treatment and prevention studies. The meta-analyses showed comprehensive interventions involving physical activity and health education had larger effect on the change of BMI than physical activity only interventions (treatment studies: -1.80 kg/m2 (95% CI: -2.15,-1.44) vs. -0.91 kg/m2 (95% CI: -1.15,-0.67); prevention studies: -0.19 kg/m2 (95% CI: -0.27, -0.11) vs. +0.05 kg/m2 (95% CI: -0.04, +0.15)). Conclusions Comprehensive school-based interventions may assist in tackling the rising prevalence of childhood obesity in mainland China.
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Affiliation(s)
- Lin Feng
- School of Public Health, Peking University, Beijing, China
| | - Dong-Mei Wei
- Institute of Child and Adolescent Health, Department of Child, Adolescent and Women’s Health, School of Public Health, Peking University, Beijing, China
| | - Shen-Ting Lin
- Institute of Child and Adolescent Health, Department of Child, Adolescent and Women’s Health, School of Public Health, Peking University, Beijing, China
- Health and Family Planning Bureau of Nanshan District, Shenzhen, China
| | - Ralph Maddison
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Yang Gao
- Department of Physical Education, Hong Kong Baptist University, Hong Kong, China
| | - Hai-Jun Wang
- Institute of Child and Adolescent Health, Department of Child, Adolescent and Women’s Health, School of Public Health, Peking University, Beijing, China
- * E-mail:
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328
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Freedman DS, Butte NF, Taveras EM, Goodman AB, Ogden CL, Blanck HM. The Limitations of Transforming Very High Body Mass Indexes into z-Scores among 8.7 Million 2- to 4-Year-Old Children. J Pediatr 2017; 188:50-56.e1. [PMID: 28433203 PMCID: PMC5572545 DOI: 10.1016/j.jpeds.2017.03.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/10/2017] [Accepted: 03/14/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the associations among several body mass index (BMI) metrics (z-scores, percent of the 95th percentile (%BMIp95) and BMI minus 95th percentile (ΔBMIp95) as calculated in the growth charts from the Centers for Disease Control and Prevention (CDC). It is known that the widely used BMI z-scores (BMIz) and percentiles calculated from the growth charts can differ substantially from those that directly observed in the data for BMIs above the 97th percentile (z = 1.88). STUDY DESIGN Cross-sectional analyses of 8.7 million 2- to 4-year-old children who were examined from 2008 through 2011 in the CDC's Pediatric Nutrition Surveillance System. RESULTS Because of the transformation used to calculate z-scores, the theoretical maximum BMIz varied by >3-fold across ages. This results in the conversion of very high BMIs into a narrow range of z-scores that varied by sex and age. Among children with severe obesity, levels of BMIz were only moderately correlated (r ~ 0.5) with %BMIp95 and ΔBMIp95. Among these children with severe obesity, BMIz levels could differ by more than 1 SD among children who had very similar levels of BMI, %BMIp95 and ΔBMIp95 due to differences in age or sex. CONCLUSIONS The effective upper limit of BMIz values calculated from the CDC growth charts, which varies by sex and age, strongly influences the calculation of z-scores for children with severe obesity. Expressing these very high BMIs relative to the CDC 95th percentile, either as a difference or percentage, would be preferable to using BMI-for-age, particularly when assessing the effectiveness of interventions.
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Affiliation(s)
- David S Freedman
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Nancy F Butte
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Elsie M Taveras
- Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cynthia L Ogden
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Heidi M Blanck
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
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329
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Freedman DS, Berenson GS. Tracking of BMI z Scores for Severe Obesity. Pediatrics 2017; 140:peds.2017-1072. [PMID: 28830920 PMCID: PMC5574726 DOI: 10.1542/peds.2017-1072] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although the Centers for Disease Control (CDC) growth charts are widely used in studies of childhood obesity, BMI z scores are known to be inaccurate at values greater than the 97th percentile. METHODS We used longitudinal data from 6994 children in the Bogalusa Heart Study who were examined multiple times to compare tracking of 3 BMI metrics: BMI-for-sex/age z score (BMIz), BMI expressed as a percentage of the 95th percentile (%BMIp95), and levels of BMI z score that adjust for the compression of very high z scores (adjusted z score [BMIaz]). The later 2 metrics, unlike BMIz, do not have an upper limit. The mean interval between examinations was 2.8 years. We were particularly interested in these metrics among children with obesity or severe obesity (%BMIp95 ≥120%). RESULTS Although there was little difference in the tracking of the 3 metrics in the overall sample, among 247 children with severe obesity, the correlation of BMIz levels between examinations (r = 0.46) was substantially weaker than those for BMIaz and %BMIp95 (r = 0.65 and 0.61). Age-stratified analyses indicated that the weak tracking of BMIz was particularly evident before the age of 10 years (r = 0.36 vs 0.57 and 0.60). Several children with severe obesity showed BMIz decreases between examinations despite having BMI increases of over 5. CONCLUSIONS Among children with severe obesity, the tracking of BMIz is weak. This is because of the constraints in converting very high BMIs into z scores based on the CDC growth charts. Rather than using BMIz, it would be preferable to express very high BMIs relative to the CDC 95th percentile or to use BMIaz.
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Affiliation(s)
- David S. Freedman
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Gerald S. Berenson
- Division of Cardiology, Louisiana State University Health Sciences New Orleans Medical Center, New Orleans, Louisiana
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330
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Lloyd J, McHugh C, Minton J, Eke H, Wyatt K. The impact of active stakeholder involvement on recruitment, retention and engagement of schools, children and their families in the cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP): a school-based intervention to prevent obesity. Trials 2017; 18:378. [PMID: 28807006 PMCID: PMC5557526 DOI: 10.1186/s13063-017-2122-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recruitment and retention of participants is crucial for statistical power and internal and external validity and participant engagement is essential for behaviour change. However, many school-based interventions focus on programme content rather than the building of supportive relationships with all participants and tend to employ specific standalone strategies, such as incentives, to improve retention. We believe that actively involving stakeholders in both intervention and trial design improves recruitment and retention and increases the chances of creating an effective intervention. METHODS The Healthy Lifestyles Programme, HeLP (an obesity prevention programme for children 9-10 years old) was developed using intervention mapping and involved extensive stakeholder involvement in both the design of the trial and the intervention to ensure that: (i) delivery methods were suitably engaging, (ii) deliverers had the necessary skills and qualities to build relationships and (iii) the intervention dovetailed with the National Curriculum. HeLP was a year-long intervention consisting of 4 multi-component phases using a range of delivery methods. We recruited 1324 children from 32 schools from the South West of England to a cluster-randomised controlled trial to determine the effectiveness of HeLP in preventing obesity. The primary outcome was change in body mass index standard deviation score (BMI SDS) at 24 months post randomisation. Secondary outcomes included additional anthropometric and behavioural (physical activity and diet) measures at 18 and 24 months. RESULTS Anthropometric and behavioural measures were taken in 99%, 96% and 94% of children at baseline, 18 and 24 months, respectively, with no differential follow up between the control and intervention groups at each time point. All children participated in the programme and 92% of children and 77% of parents across the socio-economic spectrum were considered to have actively engaged with HeLP. CONCLUSIONS We attribute our excellent retention and engagement results to the high level of stakeholder involvement in both trial and intervention design, the building of relationships using appropriate personnel and creative delivery methods that are accessible to children and their families across the social spectrum. TRIAL REGISTRATION International Standard Randomised Controlled Trials Register, ISRCTN15811706 . Registered on 1 May 2012.
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Affiliation(s)
- J. Lloyd
- University of Exeter Medical School, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2 LU UK
| | - C. McHugh
- University of Exeter Medical School, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2 LU UK
| | - J. Minton
- University of Exeter Medical School, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2 LU UK
| | - H. Eke
- University of Exeter Medical School, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2 LU UK
| | - K. Wyatt
- University of Exeter Medical School, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2 LU UK
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Arenaza L, Medrano M, Amasene M, Rodríguez-Vigil B, Díez I, Graña M, Tobalina I, Maiz E, Arteche E, Larrarte E, Huybrechts I, Davis CL, Ruiz JR, Ortega FB, Margareto J, Labayen I. Prevention of diabetes in overweight/obese children through a family based intervention program including supervised exercise (PREDIKID project): study protocol for a randomized controlled trial. Trials 2017; 18:372. [PMID: 28793919 PMCID: PMC5551009 DOI: 10.1186/s13063-017-2117-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 07/26/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The global pandemic of obesity has led to an increased risk for prediabetes and type-2 diabetes (T2D). The aims of the current project are: (1) to evaluate the effect of a 22-week family based intervention program, including supervised exercise, on insulin resistance syndrome (IRS) risk in children with a high risk of developing T2D and (2) to identify the profile of microRNA in circulating exosomes and in peripheral blood mononuclear cells in children with a high risk of developing T2D and its response to a multidisciplinary intervention program including exercise. METHODS A total of 84 children, aged 8-12 years, with a high risk of T2D will be included and randomly assigned to control (N = 42) or intervention (N = 42) groups. The control group will receive a family based lifestyle education and psycho-educational program (2 days/month), while the intervention group will attend the same lifestyle education and psycho-educational program plus the exercise program (3 days/week, 90 min per session including warm-up, moderate to vigorous aerobic activities, and strength exercises). The following measurements will be evaluated at baseline prior to randomization and after the intervention: fasting insulin, glucose and hemoglobin A1c; body composition (dual-energy X-ray absorptiometry); ectopic fat (magnetic resonance imaging); microRNA expression in circulating exosomes and in peripheral blood mononuclear cells (MiSeq; Illumina); cardiorespiratory fitness (cardiopulmonary exercise testing); dietary habits and physical activity (accelerometry). DISCUSSION Prevention and identification of children with a high risk of developing T2D could help to improve their cardiovascular health and to reduce the comorbidities associated with obesity. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03027726 . Registered on 16 January 2017.
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Affiliation(s)
- Lide Arenaza
- Nutrition, Exercise and Health Research group, Elikadura, Ariketa Fisikoa eta Osasuna, ELIKOS group, Department of Nutrition and Food Science, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - María Medrano
- Nutrition, Exercise and Health Research group, Elikadura, Ariketa Fisikoa eta Osasuna, ELIKOS group, Department of Nutrition and Food Science, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - María Amasene
- Nutrition, Exercise and Health Research group, Elikadura, Ariketa Fisikoa eta Osasuna, ELIKOS group, Department of Nutrition and Food Science, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - Beatriz Rodríguez-Vigil
- Department of Magnetic Resonance Imaging, Osatek, University Hospital of Alava (HUA), Vitoria-Gasteiz, Spain
| | - Ignacio Díez
- Paediatric Endocrinology Unit, University Hospital of Araba (HUA), Vitoria-Gasteiz, Spain
| | - Manuel Graña
- Computational Intelligence Group, University of the Basque Country, UPV/EHU, Donostia, Spain
| | - Ignacio Tobalina
- Department of Nuclear Medicine, University Hospital of Araba (HUA), Vitoria-Gasteiz, Spain
| | - Edurne Maiz
- Department of Personality, Assessment and Psychological Treatment, University of the Basque Country, UPV/EHU, San Sebastián-Donostia, Spain
| | - Edurne Arteche
- Department of Radiology, University Hospital of Araba (HUA), Vitoria-Gasteiz, Spain
| | - Eider Larrarte
- Technological Services Division, Health and quality of life, TECNALIA, Miñano, Spain
| | - Inge Huybrechts
- Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Catherine L. Davis
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Jonatan R. Ruiz
- PROmoting FITness and Health through physical activity research group (PROFITH), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Grenada, Spain
| | - Francisco B. Ortega
- PROmoting FITness and Health through physical activity research group (PROFITH), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Grenada, Spain
| | - Javier Margareto
- Technological Services Division, Health and quality of life, TECNALIA, Miñano, Spain
| | - Idoia Labayen
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain
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Preventing weight-related problems among adolescent girls: A cluster randomized trial comparing the Brazilian 'New Moves' program versus observation. Obes Res Clin Pract 2017; 12:102-115. [PMID: 28797704 DOI: 10.1016/j.orcp.2017.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 07/15/2017] [Accepted: 07/18/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE To conduct a cluster randomized controlled trial comparing the Brazilian version of the New Moves program (NMP) versus observation among Brazilian adolescent girls. METHODS Ten schools were randomly allocated to the Brazilian NMP or the observation arm. Study participants included 12-14-year-old girls. Recruitment occurred between February 2014 and March 2015. The NMP included sports, nutritional support, motivational interviews, collective lunch, and parental information materials. Our main outcome was the Body Shape Questionnaire (BSQ). Secondary outcomes included the Rosenberg Self-Esteem Scale and the Unhealthy Weight-Control Behaviors Index, as well as body mass index. Study results were evaluated through generalized estimating equations. RESULTS A total of 270 adolescents participated in the study. At baseline, mean age was 13.4 years, and average BMI was 21.4. The intervention did not result in any statistically significant differences between the NMP and the observation arm, including BSQ (predicted means of 64.33 - IC 95% 59.2-69.47 vs. 62.02 - IC 95% 56.63-67.4), respectively) and our secondary outcomes. Adherence was low during the intervention (32.9%) and maintenance (19.1%) phases of the program. CONCLUSION The New Moves program did not lead to significant changes in our measured outcomes. Future studies should investigate whether changes might occur when comprehensive behavioral programs are sustained over longer periods while also being customized to local population characteristics.
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333
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Evans-Agnew RA, Mayer KA, Miller LLL. Opportunities in the integration of primary care and public health nursing: Two case exemplars on physical activity and nutrition. Nurs Forum 2017; 53:40-45. [PMID: 28776723 DOI: 10.1111/nuf.12218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The integration of primary care and public health nursing may provide new opportunities for transforming nursing practice that addresses population health. Effective programs emphasize multilevel approaches that include both downstream (education) and upstream (policy change) actions. The purpose of this article is to identify downstream and upstream nursing actions that integrate public health and primary care practice through two case exemplars concerning disparities in physical activity and nutrition. METHODS Describe two research case exemplars: (1) a secondary analysis of school physical activity policy for female adolescents in 36 public middle schools and (2) a focus group study of African American adults in a community kitchen program. RESULTS In exemplar 1, school policies lacked population-based standards and presented structural disadvantages to African American girls who were already obese. In exemplar 2, participants found the community kitchen program to be more effective than the federally funded nutrition program. DISCUSSION Integrating primary care and public health nursing could improve the tailoring of physical activity and nutrition programs to local populations by following core principles of community engagement, infrastructural sustainability, aligned leadership, and data sharing for population health improvement.
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Affiliation(s)
- Robin A Evans-Agnew
- University of Washington Tacoma, Nursing and Healthcare Leadership Program, Tacoma, WA
| | - Kala A Mayer
- School of Nursing, University of Portland, Portland, OR
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Larsen KT, Huang T, Møller NC, Andersen LB, Sørensen J. Cost-effectiveness of a day-camp weight-loss intervention programme for children: Results based on a randomised controlled trial with one-year follow-up. Scand J Public Health 2017; 45:666-674. [PMID: 28758542 DOI: 10.1177/1403494816688374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The aim was to analyse the cost-effectiveness of an intensive weight-loss intervention for children compared with a low-intensity intervention. METHODS One hundred and fifteen overweight children (mean age 12.0 ± 0.4) were randomised to either the camp group (CG) ( N=59) or the standard group (SG) ( N=56). Participants in the CG were offered a six-week day-camp weight-loss programme followed by a family-based supportive programme containing four meetings during the succeeding 46 weeks. Participants in the SG were offered a weekly two-hour exercise session for six weeks. Changes in body mass index (BMI) and BMI z-score 12 months after inclusion were used to compare the effects of the two interventions. Incremental cost-effectiveness ratios (ICER) were estimated from the perspective of a Danish municipality. To achieve the required number of participants, an additional intervention was initiated one year later. RESULTS In comparison with the SG, the CG changed their mean BMI by -1.2 (95% CI -1.8 to -0.5). Compared with the SG children, the CG children changed their BMI z-score by -0.20 (95% CI -0.35 to -0.05). The ICER per decreased BMI point in the CG compared with the SG was DDK 24,928. CONCLUSIONS Compared with the SG, the CG showed favourable effects after 12 months. However, the CG was more costly. The results observed in the present study may be helpful in guiding decision makers to take more informed decisions when choosing different types of intervention.
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Affiliation(s)
- Kristian Traberg Larsen
- 1 Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Tao Huang
- 2 Department of Physical Education, Shanghai Jiao Tong University, China
| | - Niels Christian Møller
- 1 Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Lars Bo Andersen
- 3 Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jan Sørensen
- 4 Center for Health Economic Research (COHERE), Department of Public Health, University of Southern Denmark, Denmark
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Vogeltanz-Holm N, Holm J. Changes in Body Mass Index During a 3-Year Elementary School-Based Obesity Prevention Program for American Indian and White Rural Students. HEALTH EDUCATION & BEHAVIOR 2017; 45:277-285. [PMID: 28693339 DOI: 10.1177/1090198117714825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Childhood obesity is a significant but largely modifiable health risk, disproportionately affecting socioeconomically disadvantaged, racial/ethnic minority, and rural children. Elementary school-aged children typically experience the greatest increases in excess weight gain and therefore are important targets for reducing adolescent and adult obesity while improving children's health. Our study evaluated outcomes of a 3-year elementary school-based program for reducing obesity in American Indian and White students attending eight rural schools in the U.S. upper Midwest. METHOD Researchers measured body mass indexes (BMI) and other health indicators and behaviors of 308 beginning third-grade students and then again at the end of students' third, fourth, and fifth grades. The primary focus of this study is a mixed multilevel longitudinal model testing changes in age- and gender-adjusted BMI z scores ( zBMI). RESULTS There was a significant decrease in zBMI across the 3-year study period. Ethnicity analyses showed that White students had overall decreases in zBMI whereas American Indian students' zBMIs remained stable across the program. Comparisons with children from an age- and cohort-matched national sample provided support for the effectiveness of the school program in reducing BMI and obesity during the study period. CONCLUSION An elementary school-based health program that addresses a range of students' obesity-related health behaviors, the school health environment, and that involves educators and parents is an effective intervention for reducing or stabilizing BMI in rural White and American Indian students. School health programs for students living in rural communities may be especially effective due to greater school and community cohesiveness, and valuing of the school's primary role in improving community health.
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Affiliation(s)
| | - Jeffrey Holm
- 1 University of North Dakota, Grand Forks, ND, USA
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Xu F, Wang X, Xiang D, Wang Z, Ye Q, Ware RS. Awareness of knowledge and practice regarding physical activity: A population-based prospective, observational study among students in Nanjing, China. PLoS One 2017. [PMID: 28622354 PMCID: PMC5473587 DOI: 10.1371/journal.pone.0179518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Physical activity (PA) promotion has proven effectiveness in preventing childhood obesity. Increasing children’s health knowledge is the most frequently used approach in PA intervention programs targeting childhood obesity prevention. However, little is known about the specific association between the change in a child’s knowledge awareness and their PA practice. Methods A one-year follow-up study was conducted among primary and junior high school students in Nanjing, China. At baseline students’ knowledge of healthy behavior, and their PA levels, were assessed. Students who were unaware of the association between PA and obesity were followed for one academic year. After nine-months their knowledge and PA levels were re-measured using the same validated questionnaire. Mixed effects regression models were used to estimate the relationship between awareness of knowledge about the link between PA and obesity and PA changes. Results Of the 1899 students who were unaware of the association between PA and obesity at baseline, 1859 (follow-up rate = 97.9%) were successfully followed-up. After nine months 1318 (70.9%) participants had become aware of PA-obesity association. Compared to their counterparts who remained unaware, students who became aware of the PA-obesity association were more likely to increase both the frequency (odds ratio (OR) = 1.34, 95%CI = 1.09, 1.64) and duration (OR = 1.34, 95%CI = 1.09, 1.65) of PA, after adjusting for potentially confounding variables. Conclusion Becoming aware of the known link between PA and obesity led to positive behavior modification regarding PA in this cohort of Chinese students. This is of particular importance that knowledge disimination and health education may be a useful approach for population-based physical activity promotion aiming at childhood obesity prevention in China.
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Affiliation(s)
- Fei Xu
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
- Department of Epidemiology, Nanjing Medical University School of Public Health, Nanjing, China
- * E-mail: (FX); (RSW)
| | - Xiaorong Wang
- Nanjing Children’s Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Dandan Xiang
- Department of Epidemiology, Nanjing Medical University School of Public Health, Nanjing, China
| | - Zhiyong Wang
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Qing Ye
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Robert S. Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- * E-mail: (FX); (RSW)
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337
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Maternal perception of child overweight status and its association with weight-related parenting practices, their children's health behaviours and weight change in China. Public Health Nutr 2017; 20:2096-2103. [PMID: 28583222 DOI: 10.1017/s1368980017001033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Childhood obesity has increased rapidly in China, but understanding is limited on how parents perceive their child's weight status and how this perception affects weight-related parenting practices. We examined maternal perception of her child's weight status and its association with demographics, subsequent weight-related parenting practices, the child's health behaviours and weight change. Design/Setting/Subjects Maternal perception of child's weight status and health behaviours from the China Health and Nutrition Surveys were assessed at baseline and in follow-up surveys for 816 children aged 6-18 years during 2004-2011. Associations were tested using mixed models. RESULTS Overall, maternal and child perceptions of the child's weight status were fairly consistent (κ w=0·56), 63·8 % of mothers had correct perception. While 9·6 % of mothers perceived their child as overweight, 10·9 % of children did so, and 13·6 % of children were indeed overweight. Compared with mothers who viewed their children as normal weight, mothers who thought their children were overweight were more likely to encourage their children to increase their physical activity (OR; 95 % CI: 1·8; 1·0, 3·3) and to diet (4·3; 2·3, 7·8). Children perceived as overweight by their mothers were more likely to have insufficient physical activity (2·8; 1·6, 4·7) and gain more weight during follow-up (BMI Z-score, β (se): 1·0 (0·1); P<0·01) than children perceived by their mothers as normal weight. CONCLUSIONS In China, mothers who perceive their child as overweight are more likely to encourage their child to exercise and modify their diet for weight management, but this encouragement does not seem to improve the child's health behaviours and weight status.
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Abstract
BACKGROUND The present study examined the effects of breastfeeding and its duration on the development of childhood obesity from 24 months through grade 6. METHODS U.S. longitudinal data collected from 1234 children were analyzed using logistic regression models and generalized estimating equation (GEE). Child height and weight were measured six times at ages of 24 months, 36 months, 54 months, grade 1, grade 3, and grade 6. RESULTS During the early 1990s, prevalence of breastfeeding was low in the United States, 60% and 48% at 1 and 6 months, respectively. Nonsmoking, white, married mothers with both parents in the household, and with income above the poverty line, were more likely to breastfeed at 1 month of age of their babies. Obesity rate of the children increased with age from 24 months to grade 6. Logistic regression showed that breastfeeding at month 1 was associated with 53% (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.30-0.73) and 47% (OR: 0.53, 95% CI: 0.36-0.78) decreased risks for childhood obesity at grades 1 and 6, respectively. GEE analysis showed that breastfeeding at 1 month reduced risk for childhood obesity by 36% (95% CI: 0.47-0.88) from ages 24 months through grade 6. Regarding breastfeeding duration, more than 6 months (vs. never) was associated with a decreased risk for childhood obesity by 42% (OR: 0.58, 95% CI: 0.36-0.94). CONCLUSIONS Breastfeeding at 1 month and more than 6 months reduced the risk of childhood obesity. Rate of breastfeeding was low in the United States in the 1990s, which may have had long-term implications on children.
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Affiliation(s)
- Liang Wang
- 1 Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University , Johnson City, TN
| | - Candice Collins
- 1 Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University , Johnson City, TN
| | - Melanie Ratliff
- 1 Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University , Johnson City, TN
| | - Bin Xie
- 2 School of Community and Global Health, Claremont Graduate University , Claremont, CA
| | - Youfa Wang
- 3 Fisher Institute of Health and Well-Being, Systems-Oriented Global Childhood Obesity Intervention Program, Department of Nutrition and Health Sciences, College of Health, Ball State University , Muncie, IN
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339
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Small L, Thacker L, Aldrich H, Bonds-McClain D, Melnyk B. A Pilot Intervention Designed to Address Behavioral Factors That Place Overweight/Obese Young Children at Risk for Later-Life Obesity. West J Nurs Res 2017; 39:1192-1212. [PMID: 28511584 DOI: 10.1177/0193945917708316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this pilot randomized controlled trial (RCT) was to intervene with parents of overweight/obese 4- to 8-year-old children to improve child internalizing and externalizing behaviors. Parent-child dyads ( N = 60) were randomly assigned to treatment or comparison conditions. Parents attended four intervention sessions at their child's primary health care office over 3 months. Child behaviors were assessed at 0, 3, 6, and 12 months post intervention. Parental beliefs in their skills/abilities increased in the experimental group parents, but there was no statistical difference between groups at any time. Child externalizing behaviors significantly decreased from baseline to postintervention for both groups ( F = 3.26, p = .020). Post hoc model testing suggests that this change was more pronounced in the intervention group ( F = 0.56, p = .692). Child somatic symptoms significantly decreased over time ( F = 4.55, p = .004), and there were group differences in child depressive behaviors ( F = 6.19, p = .020). These findings suggest that a parent-focused intervention program demonstrated positive preliminary effects on children's behaviors.
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Affiliation(s)
- Leigh Small
- 1 University of Colorado, College of Nursing, Aurora, CO, USA
| | - Leroy Thacker
- 2 Departments of Family and Community Health Nursing and Biostatistics, Virginia Commonwealth University, Schools of Nursing and Medicine, Richmond, VA, USA
| | - Heather Aldrich
- 1 University of Colorado, College of Nursing, Aurora, CO, USA
| | - Darya Bonds-McClain
- 3 3Center for Improving Health Outcomes in Children, Teens, and Families, Arizona State University, College of Nursing & Health Innovation, Phoenix, AZ, USA
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340
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Fairclough SJ, Dumuid D, Taylor S, Curry W, McGrane B, Stratton G, Maher C, Olds T. Fitness, fatness and the reallocation of time between children's daily movement behaviours: an analysis of compositional data. Int J Behav Nutr Phys Act 2017; 14:64. [PMID: 28486972 PMCID: PMC5424384 DOI: 10.1186/s12966-017-0521-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/27/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Movement behaviours performed over a finite period such as a 24 h day are compositional data. Compositional data exist in a constrained simplex geometry that is incongruent with traditional multivariate analytical techniques. However, the expression of compositional data as log-ratio co-ordinate systems transfers them to the unconstrained real space, where standard multivariate statistics can be used. This study aimed to use a compositional data analysis approach to examine the adiposity and cardiorespiratory fitness predictions of time reallocations between children's daily movement behaviours. METHODS This study used cross-sectional data from the Active Schools: Skelmersdale study, which involved Year 5 children from a low-income community in northwest England (n = 169). Measures included accelerometer-derived 24 h activity (sedentary time [ST], light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], and sleep), cardiorespiratory fitness determined by the 20 m shuttle run test, objectively measured height, weight and waist circumference (from which zBMI and percent waist circumference-to-height ratio (%WHtR) were derived) and sociodemographic covariates. Log-ratio multiple linear regression models were used to predict adiposity and fitness for the mean movement behaviour composition, and for new compositions where fixed durations of time had been reallocated from one behaviour to another, while the remaining behaviours were unchanged. Predictions were also made for reallocations of fixed durations of time using the mean composition of three different weight status categories (underweight, normal-weight, and overweight/obese) as the starting point. RESULTS Replacing MVPA with any other movement behaviour around the mean movement composition predicted higher adiposity and lower CRF. The log-ratio model predictions were asymmetrical: when time was reallocated to MVPA from sleep, ST, or LPA, the estimated detriments to fitness and adiposity were larger in magnitude than the estimated benefits of time reallocation from MVPA to sleep, ST or LPA. The greatest differences in fitness and fatness for reallocation of fixed duration of MVPA were predicted at the mean composition of overweight/obese children. CONCLUSIONS Findings reinforce the key role of MVPA for children's health. Reallocating time from ST and LPA to MVPA in children is advocated in school, home, and community settings.
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Affiliation(s)
- Stuart J Fairclough
- Physical Activity and Health Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire, UK. .,Department of Physical Education and Sports Science, University of Limerick, Limerick, Ireland.
| | - Dorothea Dumuid
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Sansom Institute, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Sarah Taylor
- Physical Activity and Health Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire, UK
| | - Whitney Curry
- Physical Activity and Health Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire, UK
| | - Bronagh McGrane
- School of Arts Education and Movement, Dublin City University, Institute of Education, St Patrick's Campus, Dublin, Ireland
| | - Gareth Stratton
- Research Centre in Applied Sports, Technology Exercise and Medicine, College of Engineering, Swansea University, Swansea, Wales, UK
| | - Carol Maher
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Sansom Institute, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Timothy Olds
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Sansom Institute, School of Health Sciences, University of South Australia, Adelaide, Australia
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Kang Y, Wang Y, Zhang D, Zhou L. The public's opinions on a new school meals policy for childhood obesity prevention in the U.S.: A social media analytics approach. Int J Med Inform 2017; 103:83-88. [PMID: 28551006 DOI: 10.1016/j.ijmedinf.2017.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/10/2017] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study investigates the public's opinions on a new school meals policy for childhood obesity prevention, discovers aspects concerning those opinions, and identifies possible gender and regional differences in the U.S. METHODS We collected 14,317 relevant tweets from 11,715 users since the national policy enactment on Feb 9, 2010 through Dec 31, 2015. We applied opinion mining techniques to classify tweets into positive, negative, and neutral categories, and conducted content analysis to gain insights into aspects of opinions in terms of target, holder, source, and function. RESULTS There were more negative tweets about the school meals policy than positive ones (16.8% vs. 12.9%), in addition to neutral tweets (70.3%). The main targets for negative opinions were campaign and food, and those for positive opinions were policy and health benefits. The opinion holders represent a wide range of policy stakeholders. The first-hand source dominated the opinions. Statement accounted for the function of most opinions. Females (62.5%) were more involved than males (37.5%), and people in the South and the West regions (64.2%) engaged themselves more than people in the Northeast and the Midwest (35.8%) of the U.S. CONCLUSIONS Negative opinions about the school meals policy consistently outnumbered positive ones. The findings discovered the public's opinions for policy improvement, contributed to the evidence base of health benefits for policy promotion and community collaboration, and revealed interesting gender and regional differences in the opinions. The social media analytics offers significant methodological implications for discovering the public opinions on food policies.
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Affiliation(s)
- Yin Kang
- Department of Information Systems, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, United States
| | - Youfa Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, United States
| | - Dongsong Zhang
- Department of Information Systems, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, United States; Software School, North University of China, Shanxi, China
| | - Lina Zhou
- Department of Information Systems, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, United States.
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Lloyd J, Creanor S, Price L, Abraham C, Dean S, Green C, Hillsdon M, Pearson V, Taylor RS, Tomlinson R, Logan S, Hurst A, Ryan E, Daurge W, Wyatt K. Trial baseline characteristics of a cluster randomised controlled trial of a school-located obesity prevention programme; the Healthy Lifestyles Programme (HeLP) trial. BMC Public Health 2017; 17:291. [PMID: 28376846 PMCID: PMC5379664 DOI: 10.1186/s12889-017-4196-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/21/2017] [Indexed: 12/29/2022] Open
Abstract
Background We have developed a healthy lifestyles programme (HeLP) for primary school aged children (9–10 years), currently being evaluated in a definitive cluster randomised controlled trial. This paper descriptively presents the baseline characteristics of trial children (BMI, waist circumference, % body fat, diet and physical activity) by gender, cluster level socio-economic status, school size and time of recruitment into the trial. Methods Schools were recruited from across the South West of England and allocated 1:1 to either intervention (HeLP) or control (usual practice) stratified by the proportion of children eligible for free school meals (FSM, <19%, ≥19%) and school size (one Year 5 class, >1 Year 5 class). The primary outcome is change in body mass index standard deviation score (BMI sds) at 24 months post-randomisation. Secondary outcomes are BMI sds at 18 months, waist circumference and percentage body fat sds at 18 and 24 months, proportion of children classified as underweight, overweight and obese at 18 and 24 months, physical activity (for a sub-sample) and food intake at 18 months. Results At baseline 11.4% and 13.6% of children were categorised as overweight or obese respectively. A higher percentage of girls than boys (25.3% vs 24.8%) and children from schools in FSM category 2 (28.2% vs 23.2%) were overweight or obese. Children were consuming a mean (range) of 4.15 (0–13) energy dense snacks (EDS) and 3.23 (0–9) healthy snacks (HS) per day with children from schools in FSM category 2 consuming more EDS and negative food markers and less HS and positive food markers. Children spent an average 53.6 min per day (11.9 to 124.8) in MVPA and thirteen hours (779.3 min) per day (11 h to 15 h) doing less than ‘light’ intensity activity. Less than 5% of children achieved the Departments of Health’s recommendation of 60 min of MVPA every day. Conclusion We have excellent completeness of baseline data for all measures and have achieved compliance to accelerometry not seen before in other large scale studies. Our anthropometric baseline data is representative of local and national data for children this age and reflects the gender and socio-economic variations expected of children this age in relation to physical activity and weight status. Trial registration ISRCTN15811706 (1/05/2012).
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Affiliation(s)
- Jenny Lloyd
- University of Exeter Medical School, University of Exeter St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Siobhan Creanor
- Peninsula Clinical Trials Unit and Biostatistics, Bioinformatics & Biomarkers Group, Plymouth University Peninsula Schools of Medicine & Dentistry (formerly Peninsula College of Medicine and Dentistry), ITTC Building, Plymouth Science Park, Plymouth, Devon, PL6 8BX, UK
| | - Lisa Price
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Charles Abraham
- University of Exeter Medical School, University of Exeter St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sarah Dean
- University of Exeter Medical School, University of Exeter St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Colin Green
- University of Exeter Medical School, University of Exeter St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Melvyn Hillsdon
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Virginia Pearson
- Public Health Devon, Devon County Council, County Hall, Topsham Road, Exeter, EX2 4QL, UK
| | - Rod S Taylor
- University of Exeter Medical School, University of Exeter St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Richard Tomlinson
- Department of Child Health Barrack Road, Royal Devon and Exeter Hospital, Royal Devon & Exeter NHS Trust, Exeter, EX2 5DW, UK
| | - Stuart Logan
- University of Exeter Medical School, University of Exeter St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Alison Hurst
- University of Exeter Medical School, University of Exeter St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | | | - Wendy Daurge
- St Leonard's Primary School, Exeter, Devon, EX2 4NQ, UK
| | - Katrina Wyatt
- University of Exeter Medical School, University of Exeter St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Freedman DS, Butte NF, Taveras EM, Lundeen EA, Blanck HM, Goodman AB, Ogden CL. BMI z-Scores are a poor indicator of adiposity among 2- to 19-year-olds with very high BMIs, NHANES 1999-2000 to 2013-2014. Obesity (Silver Spring) 2017; 25:739-746. [PMID: 28245098 PMCID: PMC5373980 DOI: 10.1002/oby.21782] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/30/2016] [Accepted: 12/30/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although the Centers for Disease Control and Prevention (CDC) growth charts are widely used, BMI-for-age z-Scores (BMIz) are known to be uninformative above the 97th percentile. This study compared the relations of BMIz and other BMI metrics (%BMIp95 , percent of 95th percentile, and ΔBMIp95 , BMI minus 95th percentile) to circumferences, skinfolds, and fat mass. We were particularly interested in the differences among children with severe obesity (%BMIp95 ≥ 120). METHODS Data was used from 30,003 2- to 19-year-olds who were examined from 1999-2000 through 2013-2014 in the National Health and Nutrition Examination Survey (NHANES). RESULTS The theoretical maximum BMIz based on the growth charts varied by more than threefold across ages. The BMI metrics were strongly intercorrelated, but BMIz was less strongly related to the adiposity measures than were ΔBMIp95 and %BMIp95 . Among children with severe obesity, circumferences and triceps skinfold showed almost no association with BMIz (r ≤ 0.10), whereas associations with %BMIp95 and ΔBMIp95 ranged from r = 0.32 to 0.79. Corresponding associations with fat mass ÷ height2 ranged from r = 0.40 (BMIz) to r =0.82 (%BMIp95 ) among 8- to 19-year-olds. CONCLUSIONS Among children with severe obesity, BMIz is only weakly associated with other measures of body fatness. Very high BMIs should be expressed relative to the CDC 95th percentile, particularly in studies that evaluate obesity interventions.
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Affiliation(s)
- David S Freedman
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nancy F Butte
- Children's Nutrition Research Center, Baylor College of Medicine, Houston TX
| | - Elsie M Taveras
- Department of Pediatrics, MassGeneral Hospital for Children, Boston MA
| | - Elizabeth A Lundeen
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Heidi M Blanck
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cynthia L Ogden
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
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344
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Yang Y, Kang B, Lee EY, Yang HK, Kim HS, Lim SY, Lee JH, Lee SS, Suh BK, Yoon KH. Effect of an obesity prevention program focused on motivating environments in childhood: a school-based prospective study. Int J Obes (Lond) 2017; 41:1027-1034. [PMID: 28216643 DOI: 10.1038/ijo.2017.47] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 12/19/2016] [Accepted: 01/11/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVES There has been an increasing global recognition of the need for effective strategies to prevent and control childhood obesity. In this study, we aimed to identify the effectiveness of an obesity prevention program focused on motivating environments in school. SUBJECTS/METHODS In this school-based, prospective, quasi-experimental study, we enrolled three elementary (fourth graders) and two middle (seventh graders) schools located in Chungju, Korea. We assigned three of the schools to the intervention group and two schools to the control group. The intervention group received 1 year of environmental intervention. Diet- and exercise-related educational video content was provided by internet protocol television services during rest time, and various design materials were painted along the school staircase and hallway to encourage physical activities. Overweight and obese students were recommended to join the summer vacation obesity care program. RESULTS The final number of total participants was 768 (control 350 and intervention 418). After 1 year of follow-up, there was no significant difference in the overweight/obesity incidence rates and remission rates between the two groups. However, the intervention group showed a greater decrease in the body mass index (BMI) z-score (-0.11 (95% confidence interval (CI) -0.16 to -0.06), P<0.001), increase in height (1.1 cm (95% CI 0.8 to 1.4), P<0.001), reduction of body fat, and increase in muscle mass compared with the control group. In addition, blood pressure (BP) was significantly reduced, and significant improvement in physical fitness followed. In subgroup analysis, students of normal weight, boys and younger participants showed the most beneficial results in weight-related outcomes. In addition, the BP reduction was more pronounced in the higher BMI group, boys and older children. CONCLUSIONS A simple environmental intervention could effectively influence children. By adding to previously studied strategies, we can develop a more effective obesity prevention program for children.
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Affiliation(s)
- Y Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - B Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - E Y Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H K Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H-S Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Institute of Catholic Ubiquitous Health Care, The Catholic University of Korea, Seoul, Korea
| | - S-Y Lim
- Institute of Catholic Ubiquitous Health Care, The Catholic University of Korea, Seoul, Korea
| | - J-H Lee
- Institute of Catholic Ubiquitous Health Care, The Catholic University of Korea, Seoul, Korea
| | - S-S Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Bucheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - B-K Suh
- Department of Pediatrics, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - K-H Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Institute of Catholic Ubiquitous Health Care, The Catholic University of Korea, Seoul, Korea
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Interventions for Preventing Childhood Obesity with Smartphones and Wearable Device: A Protocol for a Non-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020184. [PMID: 28208839 PMCID: PMC5334738 DOI: 10.3390/ijerph14020184] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/11/2017] [Indexed: 12/28/2022]
Abstract
Background: Childhood obesity is a critical health issue, both currently and for the foreseeable future. To prevent obesity, behavior changes are essential. Smartphones can be a good tool, as the number of child smartphone users is rapidly increasing. We have developed a mobile platform system named “HAPPY ME,” which is a smartphone application coupled with a wearable device, designed to improve healthy behaviors to prevent childhood obesity. This study aimed to evaluate the effectiveness of obesity prevention among children 10–12 years of age using HAPPY ME. Methods: A total of 1000 participants, all fifth and sixth graders from four schools, were assigned to either control or intervention groups by school. Students in the intervention group used HAPPY ME. The study comprises a safety test, a 12-week efficacy test, and a six-month follow-up test to determine the long-term effects of preventive intervention via the integrated service platform. The integrated service platform aims to facilitate child-parent-school participation, involving the child-parent mobile application, a child-teacher mobile web, and a school website. Primary outcome measures are behavioral changes, including healthy eating, increased physical activity, and fitness. Secondary outcome measures are changes in anthropometric parameters (body weight, height, body mass index z-score, and waist circumference), body mass index (BMI) percentiles (obesity rate), and psychological perceptions among participants. Conclusions: The results of this study will offer evidence of the effectiveness of a mobile platform service with a multi-component intervention program based on a comprehensive approach.
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346
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Irresponsible and responsible resource management in obstetrics. Best Pract Res Clin Obstet Gynaecol 2017; 43:87-106. [PMID: 28268060 DOI: 10.1016/j.bpobgyn.2016.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 01/02/2023]
Abstract
Low budgets constrain and high budgets stimulate choices. In high-income countries, this economic reality may lead to overuse of healthcare services and pose unnecessary risks for mothers and infants. Options for improvement can be created at different levels of healthcare systems. Pregnancy provides an effective opportunity to profile maternal risks and represents a vulnerable but potentially modifiable period from prenatal life to adulthood. In response to system-inherent false incentives, professional responsibility requires obstetricians to strive to improve the future health of families and their offspring despite disincentives for doing so. This chapter addresses professionally responsible resource management in obstetrics and identifies implications for patients, care givers, communities, policy makers, and academic faculties.
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Polo-Oteyza E, Ancira-Moreno M, Rosel-Pech C, Sánchez-Mendoza MT, Salinas-Martínez V, Vadillo-Ortega F. An intervention to promote physical activity in Mexican elementary school students: building public policy to prevent noncommunicable diseases. Nutr Rev 2017; 75:70-78. [PMID: 28049751 DOI: 10.1093/nutrit/nuw047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Physical activity is an important component of strategies for health promotion and prevention of noncommunicable diseases. It is also associated with decreased risk for cardiovascular disease in overweight and obese adults and children. This article addresses the initial description of a physical activity intervention for children attending public elementary schools in Mexico. The objective was to develop a replicable model based on a strategic public, private, academic, and social partnership that would have a short-term impact on the metabolic health of children and be useful for building effective public policy. Forty-nine schools (20 000 students) participated, and 5 schools were selected for evaluation. The intervention included a 30-minute supervised middle-effort interchangeable routine, 5 days a week for a complete school year, adapted for different school conditions and students of different ages. Evaluation included anthropometric measurements and biochemical markers. Actual prevalence of combined overweight and obesity in these children was 31.9%. The intervention was successfully implemented in all schools. No change in body mass index, waist circumference, or other anthropometric indicators was found. However, changes in biochemical markers showed a significant decrease in blood glucose, total cholesterol, and cholesterol-low-density lipoproteins, reflecting a positive effect on cardiovascular health indicators.
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Affiliation(s)
- Ernestina Polo-Oteyza
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico
| | - Mónica Ancira-Moreno
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico
| | - Cecilia Rosel-Pech
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico
| | - María Teresa Sánchez-Mendoza
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico
| | - Vicente Salinas-Martínez
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico
| | - Felipe Vadillo-Ortega
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico.
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Hardy LL, Mihrshahi S, Gale J, Drayton BA, Bauman A, Mitchell J. 30-year trends in overweight, obesity and waist-to-height ratio by socioeconomic status in Australian children, 1985 to 2015. Int J Obes (Lond) 2017; 41:76-82. [PMID: 27847388 PMCID: PMC5220161 DOI: 10.1038/ijo.2016.204] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/15/2016] [Accepted: 10/23/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND/OBJECTIVE To report 30-year (1985-2015) prevalence trends in overweight, obesity and abdominal obesity among children by school level and socioeconomic status (SES). SUBJECTS/METHODS Five cross-sectional, population child surveys (age 4-18 years; n=27 808) conducted in 1985-1997-2004-2010-2015 in New South Wales, Australia. Outcomes were prevalence of measured overweight, obesity and waist-to-height ratio (WHtR⩾0.5) by sex, school level (children (primary) and adolescents (high)) and SES tertile. RESULTS In 2015, the prevalences of overweight, obesity and WHtR⩾0.5 in children were 16.4%, 7.0% and 14.6%, respectively, and in adolescents 21.9%, 17.2% and 4.6%, respectively. Obesity prevalence has not significantly changed in children or adolescents since 1997, nor since 2010 (children, P=0.681; adolescents, P=0.21). Overweight has not significantly changed in children since 1997, but has in adolescents since 1985, with a relative increase of 16 percentage points (P<0.001) between 2010 and 2015. WHtR⩾0.5 prevalence has significantly changed since 1985, except in adolescent girls between 2010 and 2015. Between 2010 and 2015 the relative increase in WHtR⩾0.5 was 17 and 40 percentage points in children and adolescent boys, respectively. Significant disparities in prevalence rates between children and adolescents from low and high SES backgrounds began in 2010 for overweight, since 1997 for obesity and since 2004 for WHtR⩾0.5. Differences between SES groups have become larger over the past 18 years. CONCLUSIONS Since 1997, obesity has remained stable, and overweight has stabilized in children, not in adolescents. WHtR⩾0.5 significantly increased between 1985 and 2015, with prevalence rates at each survey around twice the obesity prevalence. Compared with high SES children and adolescents, the risk of overweight, obesity and WHtR⩾0.5 was significantly higher for low SES children and adolescents. The findings are highly relevant to policy makers involved in child obesity prevention interventions and highlight the need for better targeted interventions among children and adolescents from low SES backgrounds, and adolescents in particular.
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Affiliation(s)
- L L Hardy
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - S Mihrshahi
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - J Gale
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - B A Drayton
- NSW Ministry of Health, North Sydney, NSW, Australia
| | - A Bauman
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - J Mitchell
- NSW Ministry of Health, North Sydney, NSW, Australia
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Dong H, Yan Y, Liu J, Zhao X, Cheng H, Hou D, Huang G, Li S, Wang Y, Mi J. Alarming trends in ideal cardiovascular health among children and adolescents in Beijing, China, 2004 to 2014. Int J Cardiol 2016; 231:264-270. [PMID: 28063670 DOI: 10.1016/j.ijcard.2016.12.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/28/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The American Heart Association's 2020 Strategic Goals have defined a new concept of cardiovascular health for adults and children, emphasizing the importance of primordial prevention of cardiovascular diseases. However, detailed data on the trends of ideal cardiovascular health in Chinese children and adolescents are sparse. METHODS A total of 5596 children and adolescents (aged 6-18years) were selected from two cross-sectional surveys conducted in 2004 and 2014, respectively. Cardiovascular health behaviors (smoking, body mass index, physical activity, and diet) and factors (total cholesterol, blood pressure, and glucose) were evaluated, and only participants with information on all 7 metrics (n=4309) were included for the cardiovascular score analysis. RESULTS During 2004-2014, ideal levels of almost all the seven metrics decreased, except for a marked increase in physical activity (boys: 23.0% vs 52.8%; girls: 16.2% vs 41.0%). Overall, only 19.5% of boys and 22.0% of girls had ideal cardiovascular health (score≥6) in 2004, which worsened in 2014 (boys: 9.8%; girls: 16.0%). The prevalence of ideal cardiovascular health factors also declined, but the prevalence of ideal cardiovascular health behaviors increased. Being a girl and having a younger age (aged 6-11years) were associated with higher prevalence of ideal cardiovascular health. Higher family income and parental education were associated with a higher prevalence of ideal cardiovascular health behaviors. CONCLUSION Adverse trends in ideal cardiovascular health were observed among Chinese children and adolescents during 2004-2014. Effective intervention programs, in particular targeting children and adolescents, need to be developed to promote cardiovascular health in China.
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Affiliation(s)
- Hongbo Dong
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China
| | - Yinkun Yan
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Junting Liu
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Xiaoyuan Zhao
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Hong Cheng
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Dongqing Hou
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Guimin Huang
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Shengxu Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Youfa Wang
- Systems oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jie Mi
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China.
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Morgan PJ, Jones RA, Collins CE, Hesketh KD, Young MD, Burrows TL, Magarey AM, Brown HL, Hinkley T, Perry RA, Brennan L, Spence AC, Campbell KJ. Practicalities and Research Considerations for Conducting Childhood Obesity Prevention Interventions with Families. CHILDREN (BASEL, SWITZERLAND) 2016; 3:E24. [PMID: 27834820 PMCID: PMC5184799 DOI: 10.3390/children3040024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/19/2016] [Accepted: 10/25/2016] [Indexed: 12/17/2022]
Abstract
Internationally, childhood obesity is a major public health concern. Given the established difficulties in treating obesity, designing and evaluating effective obesity prevention interventions are research priorities. As parents play a crucial role in establishing positive health behaviours in children, they are a key target for child obesity prevention programs. However, recruiting and engaging parents in such interventions can be a considerable challenge for researchers and practitioners. Members of the 'Parenting, Child Behaviour and Well-being' stream of the Australasian Child and Adolescent Obesity Research Network (ACAORN) have considerable and varied expertise in conducting such interventions and can provide insights into addressing these challenges. This paper aims to highlight considerations regarding the design, implementation, and evaluation of obesity prevention interventions with families and provide practical insights and recommendations for researchers and practitioners conducting family-based research in this area. Case studies of three family-based interventions conducted by ACAORN members are highlighted to provide examples and contextualise the recommendations proposed.
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Affiliation(s)
- Philip J Morgan
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan Campus, Newcastle 2308, Australia.
| | - Rachel A Jones
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong 2522, Australia.
| | - Clare E Collins
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan Campus, Newcastle 2308, Australia.
| | - Kylie D Hesketh
- Centre for Physical Activity and Nutrition Research, Deakin University, Geelong 3126, Australia.
| | - Myles D Young
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan Campus, Newcastle 2308, Australia.
| | - Tracy L Burrows
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan Campus, Newcastle 2308, Australia.
| | - Anthea M Magarey
- Discipline of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide 5042, Australia.
| | - Helen L Brown
- Centre for Physical Activity and Nutrition Research, Deakin University, Geelong 3126, Australia.
| | - Trina Hinkley
- Centre for Physical Activity and Nutrition Research, Deakin University, Geelong 3126, Australia.
| | - Rebecca A Perry
- Discipline of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide 5042, Australia.
| | - Leah Brennan
- School of Psychology, Australian Catholic University, Sydney 3065, Australia.
| | - Alison C Spence
- Centre for Physical Activity and Nutrition Research, Deakin University, Geelong 3126, Australia.
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, Deakin University, Geelong 3126, Australia.
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