Influence of peers and friends on overweight/obese youths' physical activity

Exercise social support, barriers, and instructions in venous thromboembolism survivors: a descriptive study

Background

Diagnosis of venous thromboembolism (VTE) can be a significant life event that leads to changes in physical activity and exercise. Currently, little is known about the psychosocial experiences of survivors including perceived sources of social support, exercise barriers, and instructions for exercise from medical providers.

Objectives

This study aimed to explore psychosocial characteristics associated with VTE survivors' postdiagnosis exercise. Specifically, 1) what are the main sources of social support utilized by VTE survivors for exercise, 2) what are the most significant exercise barriers (eg, physical, social, and psychological) faced by VTE survivors, and 3) what specific information relative to exercise is provided by medical professionals following diagnosis?

Methods

VTE survivors (n = 472) were recruited through social media groups to participate in open-ended questions about psychosocial characteristics pertaining to postdiagnosis exercise.

Results

VTE survivors reported multiple forms of exercise social support, although almost 1 in 4 participants reported having no support for exercise. Several postdiagnosis exercise barriers were noted, and the data indicated a wide variety of information from their medical providers regarding engaging in exercise following their diagnosis, suggesting that the unique benefits and drawbacks to these instructions should be examined in more detail.

Conclusion

Although VTE survivors identified numerous categories of social support, there also exist numerous barriers, including a lack of standardized instructions for exercise. Further exploration of these characteristics is needed to better serve this population to encourage postdiagnosis exercise.

Significant others and students' leisure-time physical activity intention: A prospective test of the social influence in sport model

This two-wave prospective study applied the Social Influence in Sport Model to investigate whether the social influences of parents, physical education (PE) teachers, and peers were predictive of students' intention to engage in leisure-time physical activity (PA). Participants were 2,484 secondary school students (11-18 years old) who completed a questionnaire assessing positive influence, punishment, and dysfunction from the three social agents (parents, PE teachers, and peers) at baseline, and PA intention at a 1-month follow-up. Structural equation modelling (SEM) yielded excellent goodness-of-fit and consistent pathways between the three social agents. Students' leisure-time PA intention (R² = .103 to 0.112) was positively associated with positive influence (β = .223 to 0.236, p < .001) and punishment (β = .214 to 0.256, p < .01), and negatively associated with dysfunction (β = - 0.281 to -.335, p < .001). Multi-group SEM showed that the predictions were invariant between parents, PE teachers, and peers. Furthermore, no significant differences in students' gender were found between perceived social influence and PA intention. The findings supported the application of the Social Influence in Sport Model in explaining the role of significant others on students' intention to take part in leisure-time PA.

Bayesian spatial modeling of childhood overweight and obesity prevalence in Costa Rica

BACKGROUND

Childhood overweight and obesity levels are rising and becoming a concern globally. In Costa Rica, the prevalence of these conditions has reached alarming values. Spatial analyses can identify risk factors and geographical patterns to develop tailored and effective public health actions in this context.

METHODS

A Bayesian spatial mixed model was built to understand the geographic patterns of childhood overweight and obesity prevalence in Costa Rica and their association with some socioeconomic factors. Data was obtained from the 2016 Weight and Size Census (6 - 12 years old children) and 2011 National Census.

RESULTS

Average years of schooling increase the levels of overweight and obesity until reaching an approximate value of 8 years, then they start to decrease. Moreover, for every 10-point increment in the percentage of homes with difficulties to cover their basic needs and in the percentage of population under 14 years old, there is a decrease of 7.7 and 14.0 points, respectively, in the odds of obesity. Spatial patterns show higher values of prevalence in the center area of the country, touristic destinations, head of province districts and in the borders with Panama.

CONCLUSIONS

Especially for childhood obesity, the average years of schooling is a non-linear factor, describing a U-inverted curve. Lower percentages of households in poverty and population under 14 years old are slightly associated with higher levels of obesity. Districts with high commercial and touristic activity present higher prevalence risk.

Body mass index and obesity-related behaviors in African American church-based networks: A social network analysis

A growing body of research suggests that obesity can be understood as a complex and biobehavioral condition influenced by social relationships ─social networks. Social network analysis allows us to examine how an individual's network characteristics (e.g., popularity) are associated with obesity and obesity-related behaviors. The objectives of the study were to (a) examine whether network members in African American churches are similar in body mass index (BMI) and obesity-related behaviors (physical activity, eating, alcohol consumption) and (b) examine whether an individual's network characteristics, such as popularity (i.e., receiving nominations from peers) and expansiveness (i.e., sending nominations to peers) are associated with BMI and obesity-related behaviors. We used a cross-sectional study design and conducted social network analysis using Exponential random graph models with three African American church-based social networks (network A, B, and C, n = 281). There were no significant network members' similarities on BMI in the three church-based networks. One out of three networks showed similarities in fruit and vegetable consumption (network B), fast food consumption (network C), physical activity, sedentary behaviors, and alcohol consumption (network A). African Americans with a high BMI were more popular, as were individuals with greater fat intake and alcohol consumption. Our findings support the perspective that we need to improve obesity-related behaviors by targeting influential individuals and existing ties and to develop obesity interventions using social networks. The degree to which our findings varied across churches also suggests that the relationship among an individual's obesity-related behaviors and network characteristics should be understood in the unique social context.

Motivations and barriers towards optimal physical activity level: A community-based assessment of 28 EU countries

Regular physical activity (PA) is one of the most important determinants of a healthy lifestyle and improved physical and mental well-being. Despite the health benefits of regular PA, the studies show low levels of PA among European adolescents and adults. An increase in physical inactivity has been associated with different personal and environmental factors. This study aimed to investigate positive motivation and barriers to community-based PA. Face-to-face interviews were conducted to collect data on PA, positive motivation and barriers to PA, demographic, and socioeconomic factors. Moderate and vigorous levels of PA were assessed. Regression analysis was applied to estimate the associations for positive and negative reasons for meeting PA recommendations. Data were available for 28,031 adults with a mean age of 48.3 (SD = 18.8) and 51.8% women. Significant variations in individual characteristics were seen between different types of communities. The percentage of participants who reported achieving recommended levels of PA was the lowest in rural areas (44.3%). Regression models showed that most motivational factors had a strong positive association with meeting PA recommendations. We observed the effects of interactions between making acquaintances, having fun and the type of community on meeting PA recommendations. The effects of interactions between the type of community and barriers to PA such as price, risk of injury, disability / illness, and a lack of motivation on PA recommendations were observed. In conclusion, the motivational factors and barriers to PA are associated with the physical environment, and community-based programs and policies for encouraging PA participation are needed.

Use of Focus Groups to Inform a New Community-Based Youth Diabetes Prevention Program

There have been few youth-led diabetes prevention programs. Our objective was to conduct focus groups to explore peer influences on adolescent lifestyle behaviors and strategies for implementing a youth peer education model for diabetes prevention. We conducted six focus groups with 52 youth (ages 13-22; 62% male, 38% female; 64% Hispanic, 36% non-Hispanic Black) from East Harlem, NYC. We used a Thematic Analysis approach to identify major themes, compared findings, and resolved differences through discussion and consensus. Three dominant themes arose: (1) Adolescents generally encounter more unhealthy peer influences on diet and more healthy peer influences on physical activity; (2) Adolescents endorse youth-led diabetes prevention strategies and describe ideal qualities for peer leaders and methods to support and evaluate leaders; (3) Adolescents prefer text messaging to monitor behaviors, track goals, and receive personalized guidance. Using study findings, our Community Action Board developed a peer-led diabetes prevention program for prediabetic adolescents.

The Association between Stress and Children's Weight Status: A School-Based, Epidemiological Study

Given the evidence on how stress affects weight status in children, this research examined this association among Greek students aged 10−12 years old. Overall, 1452 children and their parents from several urban areas participated in an observational study conducted during the period 2014−2016. Participants completed validated questionnaires. International Obesity Task Force guidelines were used for children’s weight status classification. Descriptive statistics and nested logistic regression models were used. Multivariate correspondence analysis was also used to construct a score to evaluate the children’s stress levels. The overall prevalence of overweight/obesity was 27%. More than 80% of the children appeared to have a medium or high level of stress, mainly due to the school environment. School-related stress increased the odds of obesity in children. The association between stress and overweight/obesity status showed a consistent trend (adjusted odds ratios varied from 1.44 to 1.52, p-values < 0.01). Children’s weight status was associated with several school-related stressors. Although the school environment may play an aggravating role in the weight status of children, family plays a catalyst role in this direction. Therefore, actions have to be promoted in the school community so that children become more health literate on a public health level.

Risk and Protective Factors for Physical Activity Engagement Among Adolescents With Comorbid Asthma and Obesity

OBJECTIVE

The current study identifies levels of physical activity (PA) engagement among adolescents with neither asthma nor overweight/obesity (OW/OB), one, or both conditions. Risk and protective factors are examined across groups.

METHODS

Data from 8th, 9th, and 11th graders were obtained from the 2019 Minnesota Student Survey (N = 125,164). One-way analysis of variance was used to assess PA levels across risk groups. Linear regressions were used to examine patterns of risk and protective factors for adolescent PA engagement across four groups (neither asthma nor OW/OB, asthma only, OW/OB only, and comorbid asthma + OW/OB). Results were stratified by race/ethnicity.

RESULTS

Adolescents with OW/OB only or asthma + OW/OB had significantly lower PA levels than youth with asthma only or neither condition (M = 3.65-3.67 days/week, SD = 2.20 vs M = 4.15-4.19 days/week, SD = 2.16-2.17, p < .001). The following variables were associated with adolescent PA (p < .001): Adult community care across all risk groups (β ranges = .13-.16), depressive symptoms among those with neither and both asthma + OW/OB (β's = -.10), and extracurriculars among those with asthma + OW/OB (β = .10). Extracurriculars and parent connectedness were protective for Hispanic adolescents.

CONCLUSIONS

Adolescents with OW/OB had significantly lower levels of PA compared to those without, regardless of asthma status. Individual and relational factors influenced adolescent PA. Future research investigating factors influencing adolescent PA should consider depressive symptoms, connectedness to adults in the community, non-sport-related extracurricular activity involvement, and address disparities among minoritized youth.

Physical Activity and Exercise Practice to Reduce the Sedentary Behavior in Children and Adolescents Overweight and with Obesity

Childhood obesity remains a serious public health concern all over the world [...]

Weight-Based Victimization and Physical Activity Among Adolescents With Overweight or Obesity: A Scoping Review of Quantitative and Qualitative Evidence

Background

Increased physical activity engagement plays a vital role in preventing and treating overweight or obesity in children and adolescents. Research has found that adolescents who are overweight or obese tend to participate in less physical activity than adolescents of average weight. Weight-based victimization (victimization related to weight or body size) is highly prevalent in adolescence and seems to be a factor that might negatively impact engagement in physical activity. This scoping review's objective was to identify the nature and extent of research evidence on links between weight-based victimization and physical activity among community-based or primary health care samples of adolescents who are overweight or obese.

Methods

Following established scoping review methods, we searched electronic databases PubMed, Web of science, SportDiscuss, and Cinahl from 23 Nov 2020 to 02 Dec 2020. Published studies with community-based or primary health care samples of adolescents who were overweight or obese (aged 13–18 years, Iso-BMI ≥ 25, i.e., age and gender specific percentiles based on specified cut-off value for overweight and obesity) and that were peer-reviewed and published were included in the analysis. Data from the included studies were put into a table and analyzed descriptively and numerically in terms of the extent and nature of the studies.

Results

After full text review, 12 articles were included, equally distributed in the qualitative and quantitative paradigm. There was a homogeneity of the research designs applied. Articles revealed high frequency of weight-based victimization. Among quantitative studies the reported links between weight-based victimization and physical activity were somewhat mixed, with three studies reporting weight-based victimization to negatively impact physical activity, while three studies report no significant impact. Qualitative studies reported experiences of teasing and bullying by peers, humiliation, and feelings of insecurity about appearance as barriers to engagement in physical activity.

Conclusion

The empirical evidence on the links between weight-based victimization and physical activity among community-based or primary-health care samples of adolescents who are overweight or obese is sparse. The results revealed a high presence of weight-based victimization in physical activity which seems to act as barriers for activity engagement. There is a need for more research to advance the understanding of the links between weight-based victimization and physical activity among community-based or primary-health care samples of adolescents who are overweight or obese.

Differences in Physical Activity During Walking and Two Pokémon Go Playing Styles

Objective: Two self-selected playing styles of Pokémon Go (PG) have been observed: intermittent and continuous. However, it is unknown how playing style impacts volume and pattern of physical activity (PA) compared with a traditional walking bout. Materials and Methods: Twenty experienced PG players followed a 1.77 km walking loop during two randomly ordered, 30-minute walking conditions: PG and traditional walking. Objective measurement tools (pedometer, accelerometer, heart rate monitor, GPS watch) were used to measure steps, caloric expenditure, intensity, heart rate, and distance traveled, and direct observation was used to determine number of stops and playing style. Results: Most PG players used the intermittent playing style (60%). Traditional walking resulted in significantly greater PA than PG. There was a significant interaction between the PG playing style (continuous, intermittent) and condition (PG, traditional walking). There was no difference in PA variables between continuous and intermittent PG during traditional walking; however, total steps (3394.3 ± 255.8 vs. 2779.1 ± 317.5), aerobic steps (3314.3 ± 318.9 vs. 2387.5 ± 771.8), caloric expenditure (146.00 [130.0-201.3] vs. 110.0 [89.3-132.3 Kcals]), distance (2.4 [2.3-2.6] vs. 2.0 [1.8-2.1 km]), and moderate minutes (29.7 [27.5-29.8] vs. 25.8 [23.1-27.1]) were significantly greater, while sedentary minutes (0.2 [0-1.0] vs. 2.7 [1.7-4.3]) and number of stops (0 [0-0.8] vs. 4.5 [2.3-7.0]) were less, for continuous compared with intermittent PG. There was a main effect of condition on PA for intermittent PG players, but not continuous PG players. Conclusion: Continuous PG produced similar PA to traditional walking, while intermittent PG reduced PA, nevertheless PG may be a strategy for increasing PA participation.

The Experimental Effect of Parent Versus Peer Influence on Children's Physical Activity and Sedentary Behavior

PURPOSE

To assess children's physical activity, sedentary behavior, liking, and motivation during 3 separate simulated recess conditions: playing alone, with their parent participating, and with their peer participating.

METHODS

Children participated in the 3 separate conditions. During each condition, the children had access to an outdoor playground and sedentary activity options for 30 minutes. Accelerometry recorded the physical activity. Time allocated to sedentary options was monitored via a stopwatch. A visual analog scale was used to assess liking, and motivation was assessed as the children's willingness to participate in an additional 10 minutes of each condition.

RESULTS

The children sat 88% less and were 33% more physically active with their peer versus playing alone. The children also sat 65% less during the parent condition than alone. Lastly, the children reported ≥34% liking and were ≥2-fold more likely to participate in the additional 10-minute activity bout during the parent and peer conditions than alone. The differences were significant (P ≤ .05) except for the children's decision to participate in the additional 10 minutes in the parent versus the alone condition (P = .058).

CONCLUSIONS

Relative to the alone condition, the presence of a peer or parent reduced sedentary behavior and increased liking and the motivation to participate in that condition. However, only the presence of a peer increased physical activity versus alone.

Adolescents who are overweight or obese - the relevance of a social network to engaging in physical activity: a qualitative study

Background

Increased level of physical activity (PA) is one of the approaches offered by school health services in Norway for the prevention and treatment of children and adolescents with overweight and obesity. Research has found that young people with overweight and obesity tend to participate in less physical activity than youth of healthier weight. They also tend to perceive several barriers to PA at the environmental, interpersonal, and individual levels. This paper explores how adolescents’, who receive follow-up of weight management in primary health care, experience barriers to and facilitators for engaging in physical activity within their social networks.

Methods

This is a qualitative study with an explorative design inspired by phenomenological ideas based on analysis of semi-structured interviews with 10 adolescents aged 13–18. Interviews were conducted with young people with overweight or obesity in weight-related follow-up in primary health care settings in various regions in Norway.

Results

The results describe the barriers to and facilitators of PA in the adolescents’ social networks. The study reveals a strong emphasis on the importance of a social network for engaging in PA. According to these adolescents’ experiences of PA in their social networks, organizing PA groups that consist of similarly young people with overweight can contribute to an increased level of PA and help modify their negative perceptions of such activity.

Conclusions

This study finds that young people with overweight and obesity place a strong emphasis on a social network where they feel equal to others if they are to engage in PA. The study suggests that School Health Nurses should establish a social network of adolescents in the same situation, in the form of organized activity groups for young people with overweight or obesity, rather than advice on increased participation in ordinary organized sports or individual exercising. This can facilitate an increase in the PA level among this group of young people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10727-7.

The Healthy Kids Initiative: Results from the First 2000 Participants

PURPOSE

The comprehensive and free Healthy Kids Initiative (HKI) was developed with key features including social support, family support, and cognitive behavior education in order to promote program completion and improve health outcomes among youth. The first objective was to determine program completion rates and independent risk indicators for non-completion. The second objective was to determine the 12-week impact of the Healthy Kids Initiative on aerobic fitness, depressed mood and health-related quality of life.

PATIENTS AND METHODS

Obese youth (ages 10-17) were referred to a community-based, multidisciplinary, free program by their doctor or pediatrician. Each participant was requested to attend the program with a "buddy" and complete three social support contracts with family and friends to support their behavioral modifications. The program duration was 12 weeks with physical activity, dietary, and cognitive behavior education sessions. Those who completed the program, and those who did not, were compared across socioeconomic variables, age, gender, depressed mood and aerobic fitness.

RESULTS

Across five cohorts, 1789 of 1995 youth completed the program (89.7% completion rate). Five referred youth never started. Independent risk indicators associated with non-completion included older age (OR 3.07, 95% CI 2.26-4.17; p<0.001), mother with a non-professional occupation (OR 1.84, 95% CI 1.22-2.78; p=0.004), and living in a low-income neighborhood (OR 9.37, 95% CI 5.61-15.65; p<0.001). There were significant improvements from baseline for aerobic fitness (mCAFT score 35.84 to 55.72 mL × kg ^-1 × min^-1; p<0.001), depressed mood (mean CES-D 12 score 21.47 to 17.40; p<0.001), and health-related quality of life (mean SF-12 score 23.4 to 33.8; p<0.001).

CONCLUSION

The HKI program had high completion rates and early success in improving outcomes. Knowing the independent risk indicators for non-completion will allow for program revision to help at-risk participants complete the program.

Differences in park characteristic preferences for visitation and physical activity among adolescents: A latent class analysis

In order to optimize environmental interventions, the current study aimed to investigate whether there are subgroups with different preferences regarding park characteristics for park visitation and park-based PA among adolescents (12–16 years). Furthermore, we examined whether the identified subgroups differed in socio-demographics, PA behavior, and park use characteristics (e.g. accompaniment to park, usual activities during park visitation, usual transportation to parks). Adolescents (12–16 years) were recruited via randomly selected secondary schools, located in Flanders (Belgium). Class visits were conducted between September and November 2016 and adolescents were asked to complete an online questionnaire. Latent class analyses using Sawtooth Software were used to identify possible subgroups. A final sample of 972 adolescents (mean age 13.3 ± 1.3 years) remained for analyses. Three subgroups of adolescents with similar preferences for park characteristics could be distinguished for both park visitation and park-based PA. Overall, current results indicate that park upkeep was the most important park characteristic for park visitation as well as park-based PA among at risk subgroups (i.e. adolescents with lower overall PA levels, girls, older adolescents,…) followed by the presence of a playground or outdoor fitness equipment. Among the more active adolescents, especially boys visiting the parks together with friends, the presence of a sport field (soccer and basketball) seems to be the best strategy to increase park visitation as well as park-based PA. Current results provide a starting point to advise policy makers and urban planners when designing or renovating parks that investing in good upkeep and maintenance of parks, and the provision of a playground or outdoor fitness equipment might be the best strategy to increase both park visitation and park-based PA among at risk adolescent subgroups.

Tele-Exercise as a Promising Tool to Promote Exercise in Children With Cystic Fibrosis

Introduction: Cross-infection risk from contact exposure limits exercise opportunities in children with cystic fibrosis (CF). The purpose of this study is to evaluate the feasibility of a new live-streamed platform which delivered supervised and interactive group exercise sessions to CF children via digital devices while avoiding contact exposure. Methods: Ten CF children participated in a 6-week tele-exercise program. The program consisted of three 30-min sessions per week for a total of 18 sessions and included aerobic, resistance, and flexibility exercises. Sessions were streamed via a HIPAA compliant VSee telemedicine platform. Instructors and participants were able to interact in real-time online. Heart rate (HR) monitors were used to evaluate exercise intensity with a goal of moderate-vigorous physical activity ≥10 min, 70% of the sessions. System usability scale (SUS) and qualitative questionnaires were used to gauge participants' satisfaction and feedback. Results: On average participants attended 85% of the sessions. For the overall sessions participants exercise 21.1 ± 6.9 min at moderate-vigorous physical activity. Nine out of 10 participants used the exercise platform without parental guidance. Qualitative questionnaire and System Usability Scale (SUS) indicated that all participants enjoyed the tele-exercise program and highly rated the exercise platform 90.8 out of 100 (passing > 68). Conclusions: Tele-exercise platform is a promising new approach to promote exercise in children with CF. The online platform allows supervised virtual group exercise experience with optimal participation and no risk for cross-infection. This approach might prove to be useful in enhancing the use of exercise as therapy in children with CF.

The Influence of Friends and Psychosocial Factors on Physical Activity and Screen Time in Normal and Overweight Adolescents: A Mixed-Methods Analysis

BACKGROUND

Understanding factors that influence physical activity (PA) and sedentary behavior is crucial to develop interventions to improve adolescents' health-related behaviors.

PURPOSE

To compare the influence of friends and psychosocial factors on moderate-to-vigorous physical activity (MVPA) and screen time (ST) between normal weight (NW) and overweight (OW) adolescents.

METHODS

In all, 21 OW and 21 NW adolescents wore accelerometers and completed questionnaires assessing MVPA, ST, and psychosocial variables. The MVPA and ST were assessed in nominated friends. Adolescents participated in focus groups assessing influence on activity behaviors.

RESULTS

There were no differences in MVPA; however, NW adolescents reported less ST than OW adolescents (8.9 vs 13.1 h/wk, P = .04). For OW adolescents, friends' ST ( P = .002) and psychosocial factors ( P = .05) were associated with ST, while only PA self-efficacy was associated with MVPA. For NW adolescents, only friends' MVPA ( P = .04) was associated with self-reported PA. Exploratory analyses revealed differences among weight status and gender. Focus group discussions revealed that friends influenced both OW and NW adolescents' MVPA; however, this appeared to be more apparent for NW males, while psychosocial factors played a role in both OW and NW females. The OW adolescents reported that friends were more of an influence on their ST levels, while NW adolescents indicated that their ST was not affected by their friends' behaviors.

CONCLUSIONS

Interventions to increase MVPA and/or decrease ST may need to be tailored for NW and OW adolescents.

A systematic review of community-based interventions for the treatment of adolescents with overweight and obesity

Adolescent obesity is a risk factor for obesity and other chronic disease in adulthood. Evidence for the effectiveness of community-based obesity treatment programs for adolescents is required to inform policy and clinical decisions. This systematic review aims to evaluate recent effective and scalable community-based weight management programs for adolescents (13-17 years) who are overweight or obese. Eight databases (Medline, Embase, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Informit, and Scopus) were searched for studies published between January 2011-2 March 2017 which are scalable in a community setting and reported primary outcome measures relating to weight. Following deduplication, 10,074 records were screened by title/abstract with 31 publications describing 21 programs included in this review. Programs were heterogeneous in nature (including length, number and frequency of sessions, parent-involvement and technology involvement). Reduction in adolescent BMIz ranged from 2 to 9% post-program and from 2 to 11% after varied lengths of follow-up. Study quality varied (n = 5 weak; n = 8 moderate; n = 8 high), and findings are limited by the risk of selection and retention bias in the included studies. Factors including the effectiveness and acceptability to the target population must be considered when selecting such community programs.

A systems approach to obesity

Obesity has become a truly global epidemic, affecting all age groups, all populations, and countries of all income levels. To date, existing policies and interventions have not reversed these trends, suggesting that innovative approaches are needed to transform obesity prevention and control. There are a number of indications that the obesity epidemic is a systems problem, as opposed to a simple problem with a linear cause-and-effect relationship. What may be needed to successfully address obesity is an approach that considers the entire system when making any important decision, observation, or change. A systems approach to obesity prevention and control has many benefits, including the potential to further understand indirect effects or to test policies virtually before implementing them in the real world. Discussed here are 5 key efforts to implement a systems approach for obesity prevention: 1) utilize more global approaches; 2) bring new experts from disciplines that do not traditionally work with obesity to share experiences and ideas with obesity experts; 3) utilize systems methods, such as systems mapping and modeling; 4) modify and combine traditional approaches to achieve a stronger systems orientation; and 5) bridge existing gaps between research, education, policy, and action. This article also provides an example of how a systems approach has been used to convene a multidisciplinary team and conduct systems mapping and modeling as part of an obesity prevention program in Baltimore, Maryland.

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

Background

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

Methods

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

Results

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

Conclusions

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

Physical Activity Perceptions in Adolescents: A Qualitative Study Involving Photo Elicitation and Discussion Groups

Adolescence is a key period in life when most of the healthy habits that will affect health during adulthood are established. Numerous interventions based on the acquisition of regular physical activity (PA) in the adolescent population have so far yielded no success, mainly in the long term. Qualitative phenomenological research was used to identify adolescents’ perceived barriers and motivations to regular PA practice, and how they form the concept of PA through thought and action. This study constitutes an explicative design using photo elicitation (PE) and discussion group (DG) techniques to explore different aspects and meanings associated with PA, as well as their perceptions toward PA practice. The study was conducted on adolescents from a randomly selected district in Barcelona (Catalonia), Spain. Through the use of PE, a total of 67 photographs were analyzed. A DG was conducted with a group of 10 teenagers. Input from the DG was examined using interpretative phenomenological analysis. The findings show that social, familial, and environmental factors become motivational elements for the regular practice of PA. The findings observed relevant aspects linked to general barriers and to particular ones associated with young women. This study also considered implications for future interventions.

Effects of an Intensive Lifestyle Intervention to Treat Overweight/Obese Children and Adolescents

Objective

The purpose of the present study is to examine the effects of a multidisciplinary lifestyle intervention to treat overweight/obese children and adolescents. The main outcome was cardiometabolic risk based on the waist-to-height ratio (WHTR) measurement. Secondary outcomes were (1) changes in body composition; (2) adherence to a Mediterranean diet; and (3) physical performance.

Method

The study involved 74 overweight/obese children or adolescents. The intervention was multidisciplinary including nutrition, exercise, and psychological aspects based on a family-based approach; it was delivered for six months for children and three months for adolescents. Before and after the intervention, several anthropometric measures (height, body weight, body mass index or BMI, waist circumference, and body composition), cardiometabolic risk index (waist-to-height ratio or WHTR), and nutrition habits of the participants and their families were evaluated. In addition, a set of functional motor fitness tests was performed to evaluate physical performance measures.

Results

After the intervention both children and adolescents showed a significant reduction in body weight, BMI, waist circumference, fat mass, and WHTR index and an improvement of fat-free mass, adherence to the Mediterranean diet, and physical fitness performance.

Conclusion

A family-based multidisciplinary approach is effective in the short term in ameliorating the health status, the nutrition habits, and physical performance in children and adolescents.

The social context moderates the relationship between neighborhood safety and adolescents' activities

Studies of neighborhood safety and physical activity have typically neglected to consider the youth's peer context as a modifier of these relationships. This study fills this gap in testing the independent and interactive effects of perceived neighborhood safety and time spent with friends and peers on young adolescents' physical activity and sedentary behavior. Participants (N = 80; ages 13-17) completed the Pedestrian/Traffic Safety and Crime Safety subscales of the adolescent version of the Neighborhood Environment Walkability Scale (NEWS). An experience sampling methodology was used to assess sedentary behaviors/screen time and the social context in which physical activity and sedentary time/behavior occurred. Physical activity was assessed via accelerometry. Multilevel models were used to estimate the relationships between predictors (neighborhood safety and social context) and outcomes (physical activity and sedentary time/behavior). Frequency of peer/friend interactions moderated the relationships between neighborhood safety and adolescents' physical activity and sedentary behavior. Specifically, physical activity was more strongly influenced by neighborhood safety among adolescents who reported spending less time with peers and friends than among those who reported frequent peer interactions. Among youths who perceived that their neighborhoods were safer, spending more time with friends and peers was related to greater engagement in sedentary activities, whereas this was not the case among adolescents who perceived that their neighborhoods were less safe. The peer social context moderates the relationship between perceived neighborhood safety and adolescents' physical activity and sedentary behavior. Improving social interactions at the individual level within neighborhoods may decrease concerns of safety.

Neighborhood, Family and Peer-Level Predictors of Obesity-Related Health Behaviors Among Young Adolescents

Objective

This longitudinal study examines peer social functioning (PSF), familism, and neighborhood socioeconomic status (NSES) on adolescents' obesity risk.

Methods

Participants ( N  = 2,144) were originally sampled from 16 middle schools in Southern California (45% male; 45% Hispanic) as part of an alcohol and other drug use prevention program (CHOICE). Multilevel regression modeling tested main effects and interaction terms of PSF, familism, and NSES assessed at Wave 5 ( M age = 14.15) on body mass index and risk of obesity-related behaviors at Wave 6.

Results

Higher PSF predicted healthier eating habits, less screen time, and more physical activity. Higher familism also predicted more physical activity. The positive effect of PSF on healthy eating was stronger among youth who reported higher familism. PSF also moderated the associations of NSES with healthy eating and physical activity.

Conclusion

Findings emphasize the importance of targeting both peer and family factors, which may be more amenable to change than NSES.

Friends and social contexts as unshared environments: a discordant sibling analysis of obesity- and health-related behaviors in young adolescents

OBJECTIVE

This study examines the contribution of best friends' weight and the peer social context (time spent alone versus with friends) as sources of unshared environment associated with variability in weight and health behaviors among weight-discordant siblings.

METHODS

Pairs of same-sex biologic siblings (N=40 pairs; ages 13-17) were originally recruited as part of a study evaluating putative factors contributing to differences in adiposity among weight-discordant siblings. Siblings were asked to bring their best friends to the laboratory and siblings and friends' height and weight were objectively measured. Siblings also completed multi-pass dietary recalls to assess energy intake and sugar sweetened beverage (SSB) consumption. Siblings' physical activity was measured using accelerometry. Experience sampling methodology was used to assess sedentary behaviors/screen time and the number of occasions siblings spent alone and in the presence of friends. Multilevel models were used to estimate the relationships between predictors (best friends' zBMI, time spent alone or with friends) and outcomes (siblings' zBMI and obesity-related health behaviors).

RESULTS

Best friends' zBMI was the best predictor of participants' zBMI, even when controlling for child's birth weight. Best friends' weight (zBMI) further predicted participants' SSB intake and time engaged in sedentary behaviors. Being active with friends was positively associated with participants' overall physical activity, whereas spending time alone was negatively associated with accelerometer counts regardless of siblings' adiposity.

CONCLUSIONS

A friends' weight and the social context are unshared environmental factors associated with variability in adiposity among biologically-related weight-discordant siblings.

[Settings-based prevention of overweight in childhood and adolescents : Theoretical foundation, determinants and intervention planning]

BACKGROUND

Childhood and adolescent overweight can still be seen as a global public health problem. Based on our socioeconomic understanding, overweight is the result of a complex interplay of a diverse array of factors acting on different levels. Hence, in addition to individual level determinants overweight prevention should also address environmental related factors as part of a holistic and integrated setting approach.

OBJECTIVE

This paper aims to discuss the setting approach with regard to overweight prevention in childhood and adolescence. In addition to a summary of environmental factors and their empirical influence on the determinants of overweight, theoretical approaches and planning models of settings-based overweight prevention are discussed.

RESULTS

While settings can be characterized as specific social-spatial subsystems (e. g. kindergarten, schools), living environments relate to complex subject-oriented environments that may include various subsystems. Direct social contexts, educational contexts and community contexts as relevant systems for young people contain different evidence-based influences that need to be taken into account in settings based overweight prevention. To support a theory-driven intervention, numerous planning models exist, which are presented here.

DISCUSSION

Given the strengthening of environments for health within the prevention law, the underlying settings approach also needs further development with regard to overweigth prevention. This includes the improvement of the theoretical foundation by aligning intervention practice of planning models, which also has a positive influence on the ability to measure its success.

Top 10 research questions related to exercise deficit disorder (EDD) in youth

Exercise deficit disorder (EDD) is a pediatric medical condition characterized by reduced levels of moderate-to-vigorous physical activity (MVPA) that are below current recommendations and inconsistent with positive health outcomes. At present, a majority of children and adolescents meet the diagnostic criteria for EDD because they are not accumulating minimum thresholds of daily MVPA. The purpose of this article is to highlight 10 important research questions related to EDD in youth. The critical research needs to better define the clinical spectrum of EDD to include an assessment of physical activity behaviors to determine the age or stage of maturation at which EDD first emerges; an examination of the kinesiogenesis of movement skills and physical abilities; and an evaluation of lifestyle factors that can influence the MVPA trajectory in youth. Research questions about interventions and policies to treat EDD include evaluating the education and training of health care providers on the importance of exercise medicine; determining the effectiveness of strategies to identify and treat youth with EDD in clinical practice; developing sensitive, specific, and cost-effective methods to diagnose youth with EDD; and assessing methods to promote health care reimbursement for the treatment of this condition. Without future research to optimize identification, treatment, and management strategies for youth with EDD, new health care concerns with significant biomedical, psychosocial, economic, and political ramifications will continue to emerge.

Peer mentoring is associated with positive change in physical activity and aerobic fitness of grades 4, 5, and 6 students in the heart healthy kids program

Only 7% of Canadian children achieve activity recommendations, contributing to obesity and preventable disease. The Heart Healthy Kids (H2K) program was designed to test the relationship between peer mentoring, physical activity, and cardiovascular fitness. Participants from 10 schools (5 control, 5 intervention) were enrolled in the program. In control schools, H2K included a physical activity challenge and education sessions. Intervention schools included the addition of a peer-mentoring component. Physical activity was measured through daily pedometer recording. Cardiovascular fitness was evaluated using the PACER (Progressive Aerobic Cardiovascular Endurance Run) protocol to calculate maximal oxygen uptake (VO2 max). Participants included 808 children (average age 9.9 ± 1.0 years). Although control and intervention schools did not differ at baseline, participants with peer mentoring logged significantly more steps per school day, on average, than those in control schools (6,785 ± 3,011 vs. 5,630 ± 2,586; p < .001). Male participants logged significantly more steps per school day than female participants. A significant improvement in VO2 max was also noted in intervention schools, with an average increase of 1.72 ml/mg/min. H2K was associated with positive change in physical activity and cardiovascular fitness, suggesting that peer mentoring shows promise for application in health promotion interventions.

An evolving scientific basis for the prevention and treatment of pediatric obesity

The 2013 Pennington Biomedical Research Center's Scientific Symposium focused on the treatment and management of pediatric obesity and was designed to (i) review recent scientific advances in the prevention, clinical treatment and management of pediatric obesity, (ii) integrate the latest published and unpublished findings and (iii) explore how these advances can be integrated into clinical and public health approaches. The symposium provided an overview of important new advances in the field, which led to several recommendations for incorporating the scientific evidence into practice. The science presented covered a range of topics related to pediatric obesity, including the role of genetic differences, epigenetic events influenced by in utero development, pre-pregnancy maternal obesity status, maternal nutrition and maternal weight gain on developmental programming of adiposity in offspring. Finally, the relative merits of a range of various behavioral approaches targeted at pediatric obesity were covered, together with the specific roles of pharmacotherapy and bariatric surgery in pediatric populations. In summary, pediatric obesity is a very challenging problem that is unprecedented in evolutionary terms; one which has the capacity to negate many of the health benefits that have contributed to the increased longevity observed in the developed world.

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

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