School-Aged Overweight and Obese Children in Rural America

School-based obesity prevention programs in rural communities: a scoping review

OBJECTIVE

The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural communities, as well as identify current gaps in the literature.

INTRODUCTION

Pediatric obesity is a significant public health condition worldwide. Rural residency places children at increased risk of obesity. Schools have been identified as an avenue for obesity prevention in rural communities.

INCLUSION CRITERIA

We considered citations focused on children (5 to 18 years of age) enrolled in a rural educational setting. We included obesity prevention programs delivered in rural schools that focused on nutrition or dietary changes, physical activity or exercise, decreasing screen time, or combined nutrition and physical activity that aimed to prevent childhood obesity. We included all quantitative, qualitative, and mixed methods research designs, as well as text and opinion data.

METHODS

A search was conducted of published and unpublished studies in English from 1990 through April 2020 using PubMed, CINAHL Complete, ERIC, Embase, Scopus, Academic Search Premier, Cochrane Register of Controlled Trials, and ClinicalTrials.gov. Gray literature was also searched. After title and abstract review, potentially relevant citations were retrieved in full text. The full texts were assessed in detail against the inclusion criteria by 2 independent reviewers. Included citations were reviewed and data extracted by 2 independent reviewers and captured on a spreadsheet targeting the review objectives.

RESULTS

Of the 105 studies selected for full-text review, 72 (68.6%) were included in the final study. Most of the studies (n = 50) were published between 2010 and 2019 and were conducted in the United States (n = 57). Most studies included children in rural elementary or middle schools (n = 57) and targeted obesity prevention (n = 67). Teachers implemented the programs in half of the studies (n = 36). Most studies included a combination of physical activity and nutrition components (n = 43). Other studies focused solely on nutrition (n = 9) or physical activity (n = 9), targeted obesity prevention policies (n = 9), or other components (n = 8). Programs ranged in length from weeks to years. Overall, weight-related, physical activity-specific, and nutrition-specific outcomes were most commonly examined in the included citations.

CONCLUSIONS

Obesity prevention programs that focused on a combination of physical activity and nutrition were the most common. Multiple outcomes were examined, but most programs included weight-specific and health behavior-specific outcomes. The length and intensity of rural school-based obesity prevention programs varied. More research examining scientific rigor and specific outcomes of rural school-based obesity prevention programs is needed.

Is bodyweight affecting plantar pressure distribution in children?: An observational study

The aim of this study is twofold: firstly, to investigate the plantar pressure distribution differences in children coming from 4 different weight categories and secondly to analyze the presence of sex-related plantar pressure distribution differences.Overall, 416 children, aged 7 to 12 years old were randomly selected from 6 different local schools, and voluntarily participated in the study. Two hundred twenty six of them were men, while 190 were women (mean age: 9.93 ± 1.02 years; height: 1.39 ± 0.8 m; body mass: 37.76 ± 10.34 kg; BMI: 19.24 ± 4.02 kg/m). Based on the body mass index (BMI) the sample was grouped in the following categories: underweight (UW); normal weight (NW); overweight (OW), and obese (OB). Besides, the plantar load distribution parameters (total plantar load distribution and load distribution in forefoot and rearfoot) were assessed employing freeMed Maxi; Sensor Medica device. Shapiro-Wilk test was used to test the data distribution. Between-groups comparisons were conducted using Mann-Whitney U test, or using Kruskal-Wallis test associated with pairwise comparisons.There were significant differences in load distribution between weight categories, with (OW) and (NW) being significantly different with (O), P = .03 and P = .04, respectively. No significant differences were found on load distribution on the rearfoot and forefoot between categories. The sex effect, particularly among boys, revealed a different pattern of load distribution among (O) compared with other categories. This effect was not detected among women. Different profile of load distribution on the rearfoot and forefoot between boys and girls was found, with girls bearing significantly more weight in the right rearfoot compared with boys (P = .001).It can be concluded that the weight status of the children can affect the plantar load distribution, with obese category being different from (NW) and (OW). Additionally, the sex plays a role when it comes to the load distribution in different regions of the foot. Moreover, since the young age, due to growth and development process, is accompanied with anatomical foot changes which might be affected from numerous factors, assessing plantar pressure distribution in young children results to be a quite complicated matter.

Effects of different movement modes on plantar pressure distribution patterns in obese and non-obese Chinese children

Walking, slow running (jogging) and fast running often occur in daily life, Physical Education Class and Physical Fitness Test for children. However, potential impact of jogging and running on plantar pressure of children is not clear. The purpose of this study was to compare the characteristics of plantar pressure distribution patterns in obese and non-obese children during walking, jogging and running, and evaluate biomechanical effects of three movements on obese children. A 2-m footscan plantar pressure plate (RSscan International, Belgium) was used to collect the gait data of 20 obese children (10.69±2.11years; 1.51±0.11m; 65.15±14.22kg) and 20 non-obese children (11.02±1.01years; 1.48±0.07m; 38.57±6.09kg) during three movements. Paired t-test and independent sample t-test were performed for statistical comparisons and ANOVA was used for comparisons of gait characteristics among three movements. Significance was defined as p <0.05. Propulsion phase during jogging for obese children was the longest among three movements (p=0.02). Peak pressures under metatarsal heads IV, V (M4, M5), midfoot (MF), heel medial (HM) and heel lateral (HL) during jogging for obese children were the highest among three movements (p=0.005, p=0.003, p=0.004, p=0.03, p=0.01). Arch index (AI) of left foot during jogging for obese children was the largest (p=0.04).

CONCLUSIONS

Plantar pressure distribution during three movements changed differently between two groups. The peak pressures under most plantar regions and AI during jogging for obese children were the largest among three movements, indicating that jogging caused more stress to their lower extremities. Obese children perhaps should not consider jogging as regular exercise.

Development and psychometric testing of the childhood obesity perceptions (COP) survey among African American caregivers: A tool for obesity prevention program planning

Currently, public health practitioners are analyzing the role that caregivers play in childhood obesity efforts. Assessing African American caregiver's perceptions of childhood obesity in rural communities is an important prevention effort. This article's objective is to describe the development and psychometric testing of a survey tool to assess childhood obesity perceptions among African American caregivers in a rural setting, which can be used for obesity prevention program development or evaluation. The Childhood Obesity Perceptions (COP) survey was developed to reflect the multidimensional nature of childhood obesity including risk factors, health complications, weight status, built environment, and obesity prevention strategies. A 97-item survey was pretested and piloted with the priority population. After pretesting and piloting, the survey was reduced to 59-items and administered to 135 African American caregivers. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was conducted to test how well the survey items represented the number of Social Cognitive Theory constructs. Twenty items were removed from the original 59-item survey and acceptable internal consistency of the six factors (α=0.70-0.85) was documented for all scales in the final COP instrument. CFA resulted in a less than adequate fit; however, a multivariate Lagrange multiplier test identified modifications to improve the model fit. The COP survey represents a promising approach as a potentially comprehensive assessment for implementation or evaluation of childhood obesity programs.

Mirror, Mirror on the Wall: Children's Preferences and Self-Perceptions of Weight in a Rural Hispanic Community

INTRODUCTION

Although studies have documented parents' misperceptions regarding their children's weight, studies examining preadolescent children's self-perceptions of weight-in particular, Hispanic children's self-perceptions of weight-are limited.

METHOD

A convenience sample of 424 children from a rural community, aged 8 to 11 years and in grades 3 through 5, participated in this cross-sectional, descriptive, nonexperimental study. Using the Children's Body Image Scale, the children were asked to select a figure representing their actual body perception and a figure representing their ideal body perception. The children were weighed and measured, body mass index (BMI) was calculated, and each child was assigned to one of the Centers for Disease Control and Prevention weight categories: underweight, normal or healthy weight, overweight, or obese.

RESULTS

Only BMI category was found to be significantly associated with accurate perception, χ²(3) = 201.4, p < .001, with only 9% of overweight or obese children selecting figures representing their actual BMI category. Actual BMI category, χ²(3) = 8.8, p = .032, and grade level, χ²(2) = 6.7, p = .036, had a significant association with selection of an underweight ideal. Overall, 32% of children selected an underweight figure as ideal.

DISCUSSION

Prepubertal children who are either overweight or obese do not accurately perceive their weight status. Rather than focusing solely on weight reduction programs, emphasis should be placed on promoting healthy lifestyles and choices.