A composite measure of healthy lifestyle: A study from 38 countries and regions from Europe and North America, from the Health Behavior in School-Aged Children survey

Effectiveness of a nurse-led mHealth approach in preventing obesity in adolescents: an intervention study

Background

Obesity prevention in adolescents is a public health priority given its increasing prevalence and health impact of obesity.

Aim

To evaluate the effectiveness of an educational intervention in overweight and obesity using a mHealth app in improving nutritional and sports knowledge, adherence to the Mediterranean diet, physical activity and anthropometric measurements in adolescents.

Methods

A randomised controlled trial with parallel groups that included 305 adolescents. The app includes the use of effective behavioural strategies to achieve habit change. Primary outcome variables were nutritional and sports knowledge score (GeSNK), adherence to a Mediterranean diet (KidMed) and level of physical activity (PAQ-A).

Results

The study included 154 participants in the mHealth group and 151 in the control group. The level of nutritional and sports knowledge was significantly higher in the mHealth group, 47 points versus 42 points. Adherence to the Mediterranean diet improved in both groups, 9 points in the mHealth group versus 8 points in the control group. Physical activity was statistically higher in the intervention group, 160 minutes/week versus 120 minutes/week.

Conclusions

The mHealth intervention showed a significant improvement in the level of nutritional and sports knowledge, adherence to the Mediterranean diet and time spent on physical activity.

Predictors of visceral and subcutaneous adipose tissue and muscle density: The ShapeUp! Kids study

BACKGROUND AND AIMS

Body fat distribution, i.e., visceral (VAT), subcutaneous adipose tissue (SAT) and intramuscular fat, is important for disease prevention, but sex and ethnic differences are not well understood. Our aim was to identify anthropometric, demographic, and lifestyle predictors for these outcomes.

METHODS AND RESULTS

The cross-sectional ShapeUp!Kids study was conducted among five ethnic groups aged 5-18 years. All participants completed questionnaires, anthropometric measurements, and abdominal MRI scans. VAT and SAT areas at four lumbar levels and muscle density were assessed manually. General linear models were applied to estimate coefficients of determination (R2) and to compare the fit of VAT and SAT prediction models. After exclusions, the study population had 133 male and 170 female participants. Girls had higher BMI-z scores, waist circumference (WC), and SAT than boys but lower VAT/SAT and muscle density. SAT, VAT, and VAT/SAT but not muscle density differed significantly by ethnicity. R2 values were higher for SAT than VAT across groups and improved slightly after adding WC. For SAT, R2 increased from 0.85 to 0.88 (girls) and 0.62 to 0.71 (boys) when WC was added while VAT models improved from 0.62 to 0.65 (girls) and 0.57 to 0.62 (boys). VAT values were significantly lower among Blacks than Whites with little difference for the other groups.

CONCLUSION

This analysis in a multiethnic population identified BMI-z scores and WC as the major predictors of MRI-derived SAT and VAT and highlights the important ethnic differences that need to be considered in diverse populations.

Associations between Self-Objectification and Lifestyle Habits in a Large Sample of Adolescents

The aim of the present study was to test associations between self-objectification and health-related lifestyle habits in a large sample of adolescents. In 2019–2020, a large sample of adolescents (n = 1402, 40.4% boys) participated in the survey and, as a part of a larger study, filled in questionnaires on self-objectification and lifestyle. Self-objectification was assessed using the Self-Objectification Questionnaire (SOQ). The lifestyle questionnaire had three batteries: eating attitudes and behaviors, dietary habits, and questions on harmful behaviors together with time spending patterns: sedentary lifestyle and physical activity. The ages ranged from 15–19 years with a mean age of 16.97 ± 0.46 years. Self-objectification (SO) was associated with a less healthy lifestyle: more frequent dieting and unhealthy eating habits in girls, skipping breakfast, and a lower number of meals per day. Adolescent boys and girls with higher SO demonstrated more frequent smoking and alcohol consumption until they felt dizzy and more frequent consumption of soft drinks, energy drinks, and fast foods. Girls with higher SO demonstrated lower perceived physical activity and longer duration of internet browsing for non-educational purposes. The results of the present study inform healthy lifestyle promotion programs for adolescents, suggesting that including psychoeducation about self-objectification, body functionality, and positive embodiment might be an effective strategy.

Pediatric Preventive Care in Middle-High Resource Countries-The Padova Chart for Health in Children

Importance

The Padova Chart for Health in Children (PCHC) aims to gather the evidence of healthcare promotion and protection for chidren and adolescents (i.e., aged <18 y) into a single document in order to guide families, healthcare providers and social actors on healthy choices. No more than 2% of Europeans and North Americans aged <30 y have a healthy lifestyle. This, together with metabolic and brain plasticity during childhood, creates the ideal opportunity to implement preventive strategies. Guided interventions promoting healthy lifestyle in children and families therefore have a key role in abating the unprecedented pandemic of non-communicable diseases (NCDs) in adulthood.

Observations

The PCHC is divided into four sections: nutrition, cardiovascular health, respiratory health, and mental and social health. Each section is structured in an ALICE approach (assessment, lobbying, intervention, call-for-action, evaluation): assessment of necessity, describing relevance to healthcare; lobbying to identify those who can effect the proposed interventions; interventions involving family, school and peers; a call-for-action to define priorities among the proposed interventions; and objective evaluation measures that can be applied on a population basis.

Conclusions and Relevance

Interventions promoting health in childhood require joint action from multiple institutional, local and family representatives, with the shared goal of promoting health across the entire age group. These lifestyle interventions have the potential to change the lifetime risk trajectory for NCDs.

The Differences in Physical Activity Preferences and Practices among High versus Low Active Adolescents in Secondary Schools

This study aimed to (a) identify the differences in the preferred, practiced, and organized physical activity (PA) between high and low physically active Czech and Polish boys and girls and to (b) identify which types of PA are likely to be recommended by low active boys and girls. The research was carried out between 2010 and 2019 in the Czech Republic and Poland and included 6619 participants aged 15 to 19 years. The preferences and practices of the different types of PA and participation in organized PA were identified using a PA preference questionnaire and weekly PA was identified using the International Physical Activity Questionnaire-long form. Czech and Polish boys and girls who were low active preferred less physically demanding and more health-oriented PA compared with high active individuals. Power exercises and participation in organized PA are the most significant predictors of achieving at least 3 × 20 min of vigorous PA per week among low active individuals in both countries. Monitoring the trends in the preferred and practiced types of PA among boys and girls is crucial for the effective promotion of PA to low active boys and girls and positive changes in physical education and school health policy.

Effects of a novel mobile health intervention compared to a multi-component behaviour changing program on body mass index, physical capacities and stress parameters in adolescents with obesity: a randomized controlled trial

Background

Less than 2% of overweight children and adolescents in Switzerland can participate in multi-component behaviour changing interventions (BCI), due to costs and lack of time. Stress often hinders positive health outcomes in youth with obesity. Digital health interventions, with fewer on-site visits, promise health care access in remote regions; however, evidence for their effectiveness is scarce.

Methods

This randomized controlled not blinded trial (1:1) was conducted in a childhood obesity center in Switzerland. Forty-one youth aged 10–18 years with body mass index (BMI) > P.90 with risk factors or co-morbidities or BMI > P.97 were recruited. During 5.5 months, the PathMate2 group (PM) received daily conversational agent counselling via mobile app, combined with standardized counselling (4 on-site visits). Controls (CON) participated in a BCI (7 on-site visits). We compared the outcomes of both groups after 5.5 (T1) and 12 (T2) months. Primary outcome was reduction in BMI-SDS (BMI standard deviation score: BMI adjusted for age and sex). Secondary outcomes were changes in body fat and muscle mass (bioelectrical impedance analysis), waist-to-height ratio, physical capacities (modified Dordel-Koch-Test), blood pressure and pulse. Additionally, we hypothesized that less stressed children would lose more weight. Thus, children performed biofeedback relaxation exercises while stress parameters (plasma cortisol, stress questionnaires) were evaluated.

Results

At intervention start median BMI-SDS of all patients (18 PM, 13 CON) was 2.61 (obesity > + 2SD). BMI-SDS decreased significantly in CON at T1, but not at T2, and did not decrease in PM during the study. Muscle mass, strength and agility improved significantly in both groups at T2; only PM reduced significantly their body fat at T1 and T2. Average daily PM app usage rate was 71.5%. Cortisol serum levels decreased significantly after biofeedback but with no association between stress parameters and BMI-SDS. No side effects were observed.

Conclusions

Equally to BCI, PathMate2 intervention resulted in significant and lasting improvements of physical capacities and body composition, but not in sustained BMI-SDS decrease. This youth-appealing mobile health intervention provides an interesting approach for youth with obesity who have limited access to health care. Biofeedback reduces acute stress and could be an innovative adjunct to usual care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02781-2.

Can Health-Promoting Schools Contribute to Better Health Behaviors? Physical Activity, Sedentary Behavior, and Dietary Habits among Israeli Adolescents

Schools with health-promoting school (HPS) frameworks are actively committed to enhancing healthy lifestyles. This study explored the contribution of school participation in HPS on students' health behaviors, namely, physical activity (PA), sedentary behavior, and dieting. Data from the 2018/2019 Health Behavior in School-aged Children study on Israeli adolescents aged 11-17 years were used. Schools were selected from a sample of HPSs and non-HPSs. Between-group differences and predictions of health behavior were analyzed. No between-group differences were observed in mean number of days/week with at least 60 min of PA (HPS: 3.84 ± 2.19 days/week, 95% confidence interval of the mean = 3.02-3.34; non-HPS: 3.93 ± 2.17 days/week, 95% confidence interval of the mean = 3.13-3.38). Most children engaged in screen time behavior for >2 h/day (HPS: 60.83%; non-HPS: 63.91%). The odds of being on a diet were higher among more active children (odds ratio [OR] = 1.20), higher socio-economic status (OR = 1.23), and female (OR = 2.29). HPS did not predict any health behavior. These findings suggest that HPSs did not contribute to health behaviors more than non-HPSs. Therefore, health-promoting activities in HPSs need to be improved in order to justify their recognition as members of the HPS network and to fulfill their mission.

Prevalence of Physical Activity among Adolescents from 105 Low, Middle, and High-income Countries

Introduction: Physical activity (PA) is a beneficial health behaviour, however most adolescents worldwide are physically inactive. Updated information on the prevalence and trends of PA is important to inform national and international authorities and support countries’ public health policies and actions. This study aimed to present the worldwide, regional, and national prevalence of PA participation according to its frequency in adolescents. Methods: This study is based on cross-sectional surveys of adolescents’ populations from several countries and all regions worldwide. The sample comprised 520,533 adolescents (251,788 boys; 268,745 girls), from 105 countries and regions. Results: Most adolescents engaged in PA up to 3 days/week (57.1%; 95% CI: 56.9; 57.2). The prevalence of engaging in PA every day decreases over the age from 28.2% at age of 11–12 years (95% CI: 27.4; 29.0) to 21.2% at age of 16–17 years (95% CI: 20.3; 22.0) among boys; and from 19.4% (95% CI: 18.5; 20.2) to 11.1% (95% CI: 10.1; 12.0) among girls. For boys and girls who engaged in PA 5-6 days/week, the prevalence increases from countries with the lowest human development index to countries with the highest. Cambodia (7.3%, 95% CI: 3.8; 10.8), Philippines (7.7%, 95% CI: 5.6; 9.7), Sudan (8.8%, 95% CI: 4.7; 12.9), Timor-Leste (8.9%, 95% CI: 5.5; 12.3), and Afghanistan (10.1%, 95% CI: 6.1; 14.1) were the countries with the lowest prevalence of sufficient PA. Conclusions: National, regional, and worldwide data on the prevalence of physical activity in adolescents highlights the importance of improving the global levels of PA, especially in girls. Identifying the factors causing the age-related decrease in physical activity levels will permit public health entities to define priority actions and policies against physical inactivity.