Association between peer relationship problems and childhood overweight/obesity

Parenting Styles and Psychosocial Factors of Mother-Child Dyads Participating in the ENDORSE Digital Weight Management Program for Children and Adolescents during the COVID-19 Pandemic

Childhood obesity is a complex disease with multiple biological and psychosocial risk factors. Recently, novel digital programs were developed with growing evidence for their effectiveness in pediatric weight management studies. The ENDORSE platform consists of mobile applications, wearables, and serious games for the remote management of childhood obesity. The pilot studies included 50 mothers and their children aged 6-14 years and resulted in a clinically significant BMI z-score reduction over 4 to 5 months. This secondary analysis of the ENDORSE study focuses on parenting styles and psychosocial factors.

METHODOLOGY

Semi-structured clinical interviews were conducted with all participating mothers pre-and post-intervention. The Parenting Styles and Dimensions Questionnaire (PSDQ) evaluated the mothers' parenting styles. The psychosocial functioning of the participating children was assessed with the parental version of the Strengths and Difficulties Questionnaire (SDQ). The relationship between parenting styles, psychosocial parameters, and weight outcomes was investigated using a linear regression analysis.

RESULTS

Weight-related stigma at school (56%), body image concerns (66%), and difficulties in family relationships (48%) were the main concerns documented during the initial psychological interviews. According to the SDQ, there was a significant decrease in children's conduct problems during the study's initial phase (pre-pilot group). A decrease in maternal demandingness (i.e., strict parenting style) was associated with a decrease in BMI z-score (beta coefficient = 0.314, p-value = 0.003).

CONCLUSION

Decreasing parental demandingness was associated with better weight outcomes, highlighting the importance of assessing parenting factors in pediatric weight management programs.

Physical Fitness and Peer Relationships in Spanish Preadolescents

Several studies have linked physical fitness (PF) with improvements in health, at a physiological and psychological level; however, there is little evidence of its relationship with health in the social field. Hence, the main aim of this study was to determine the existing relationship between PF and peer relations, as an indicator of social health in Spanish pre-teens. For that purpose, 642 participants aged 9 to 12 were chosen and given the high-priority Alpha Fitness battery in order to assess the PF, as well as the Classroom Social Experiences Query (CESC) to assess their social status. The results showed that those students with a better cardio-respiratory fitness obtained more nominations from their classmates in pro-sociality and positive status, and fewer in victimisation and negative status. Additionally, although to a lesser extent, muscular fitness was also related to a higher positive status and lower victimisation. The weight condition was also related to social behaviours, although the resulting data were differentiated by sex. While females with a standard weight stood out for their positive status, underweight males obtained worse results in positive status and fewer in negative status. These results all correspond with the aesthetic models imposed by society for females and males, respectively. These results show that PF is related to social health, which makes necessary the promotion of physical activity and the development of PF within the school environment, with attention to its relationship with the social health of the students.

Child behaviour and subsequent changes in body weight, composition and shape

Objective

Studies have found an association between child behavioural problems and overweight, but the existing evidence for this relationship is inconsistent, and results from longitudinal studies are sparse. Thus, we examined the association between behavioural problems and subsequent changes in body mass index (BMI) and anthropometry over a follow-up period of 1.3 years among children aged 2–6 years.

Design

The study was based on a total of 345 children from The Healthy Start Study; all children were healthy weight but predisposed to develop overweight. The Danish version of the Strengths and Difficulties Questionnaire (SDQ), classified as SDQ Total Difficulties (SDQ-TD) and SDQ Prosocial Behaviour (SDQ-PSB), was used to assess child behaviour. Linear regression analyses were used to examine associations between SDQ scores and subsequent change in BMI z-score, body fat percentage, waist circumference and waist-hip ratio, while taking possible confounding factors into account.

Results

We found an association between SDQ-PSB and subsequent change in BMI z-score (β: 0.040 [95% CI: 0.010; 0.071, p = 0.009]). However, there was no evidence of an association between SDQ-PSB and measures of body composition or body shape.

Conclusions

Among 2 to 6 years old children predisposed to overweight, the association between SDQ-scores and weight gain is either absent or marginal. The SDQ-PSB score may be associated with subsequent increases in BMI z-score, but this association does not seem driven by an increased relative fat accumulation.

Implementation of a School Nurse-led Intervention for Children With Severe Obesity in New York City Schools

PURPOSE

The Healthy Options and Physical Activity Program (HOP) is a school nurse-led intervention for children with severe obesity. HOP was developed by experts at the New York City Department of Health and Mental Hygiene and implemented in New York City schools beginning in 2012. The purpose of this study was to evaluate HOP implementation with the goal of informing HOP refinement and potential future HOP dissemination.

DESIGN AND METHODS

This study entailed a retrospective analysis of secondary data. Analytic methods included descriptive statistics, Wilcoxon rank sum and Chi square tests, and multivariate logistic regression.

RESULTS

During the 2012-2013 school year, 20,518 children were eligible for HOP. Of these, 1054 (5.1%) were enrolled in the program. On average, enrolled children attended one HOP session during the school year. Parent participation was low (3.2% of HOP sessions). Low nurse workload, low school poverty, higher grade level, higher BMI percentile, and chronic illness diagnosis were associated with student enrollment in HOP.

CONCLUSIONS

As currently delivered, HOP is not likely to be efficacious. Lessons learned from this evaluation are applicable to future nurse-led obesity interventions.

PRACTICE IMPLICATIONS

Prior to implementing a school nurse-led obesity intervention, nursing workload and available support must be carefully considered. Interventions should be designed to facilitate (and possibly require) parent involvement. Nurses who deliver obesity interventions may require additional training in obesity treatment. With attention to these lessons learned, evidence-based school nurse-led obesity interventions can be developed.

"No fat friend of mine": Young children's responses to overweight and disability

Two studies investigated 4- to 6-year-old children's weight bias. In Study 1, 126 children read illustrated books where a main character ('Alfie') was healthy weight, in a wheelchair, or overweight. In Study 2, 150 children read the same stories where the character was female ('Alfina'), or stories where her friends were fat. Children rated 'Alfie'/'Alfina' and a comparison character on nine attributes/behaviours, and chose one that best represented each attribute. Fat and wheelchair 'Alfie'/'Alfina' were rated less likely to win a race, and fat 'Alfie'/'Alfina' as having fewer friends. When forced to choose between characters, fat 'Alfie'/'Alfina' was rejected on most constructs. Children's gender, self-perceived shape, and character's friends' size had no effect on judgements. These findings show children's preferences away from fatness rather than outright rejection, and mostly clearly in friendship choices. Understanding young children's weight bias is important given their increasing involvement in obesity surveillance, prevention, and management.

Developmental associations between victimization and body mass index from 3 to 10 years in a population sample

In the current prospective study, we investigated (1) whether high and low BMI in early childhood puts a child at risk of victimization by their peers, and (2) whether being victimized increases BMI over the short- and long-term, independent of the effect of BMI on victimization. We also examined whether gender moderated these prospective associations. Participants were 1,344 children who were assessed yearly from ages 3 to 10 years as part of the Québec Longitudinal Study of Child Development (QLSCD). BMI predicted annual increases in victimization for girls aged 6 years and over; for boys aged 7 and 8 years of age, higher BMI reduced victimization over the school year. Further, victimization predicted annual increases in BMI for girls after age 6 years. When these short-term effects were held constant, victimization was also shown to have a three and 5-year influence on annual BMI changes for girls from age 3 years. These short- and long-term cross-lagged effects were evident when the effects of family adversity were controlled. The findings support those from previous prospective research showing a link between higher BMI and victimization, but only for girls. Further, being victimized increased the likelihood that girls would put on weight over time, which then increased future victimization. The implications of these prospective findings for interventions are considered. Aggr. Behav. 42:109-122, 2015. © 2015 Wiley Periodicals, Inc.

An intervention for improving the lifestyle habits of kindergarten children in Israel: a cluster-randomised controlled trial investigation

OBJECTIVE

To assess the effectiveness of an intervention programme to improve kindergarten children's eating and leisure habits in Israel.

DESIGN

A cluster-randomised controlled trial.

SETTING

Six full-day kindergartens in Israel were randomly divided into three groups. Group A received the full intervention programme, which included lessons on good eating habits and daily physical exercise. Group B received a partial intervention of lessons only. Group C, the reference group, did not receive any intervention.

SUBJECTS

Children aged 4-6 years (n 204) were recruited for the study.

METHODS

Objective data for weight and height were collected to calculate BMI Z-scores. Activity, sedentary time, sleeping hours and daily energy intake were assessed via a parental questionnaire. Nutritional knowledge was assessed by a single dietitian using a questionnaire addressed to the children. Assessments were done at baseline and at the end of the intervention.

RESULTS

After adjustment for baseline levels we observed a significant reduction in daily energy intake for the full intervention group A (P = 0.03). A positive intervention effect was demonstrated on nutritional knowledge in the partial intervention group B (P = 0.03), although no significant change was demonstrated for BMI Z-score.

CONCLUSIONS

The study supports the incorporation of education on healthy lifestyle habits and physical activity into the curricula of kindergartens.

Peer problems are associated with elevated serum leptin levels in children

BACKGROUND

Leptin is thought to act as an important mediator in stress reactions. To date, no study has examined the association between psychological stress and leptin levels in children. This study aimed to assess the association between emotional symptoms and peer problems and serum leptin levels in children aged 10 years of the two population-based GINI-plus and LISA-plus birth cohorts.

METHOD

Cross-sectional data from 2827 children aged 10 years were assessed with regard to leptin concentrations in serum and behavioral problems using the parent-reported Strengths and Difficulties Questionnaire (SDQ). Linear regression modeling was applied to determine the likelihood of elevated leptin levels in children with emotional symptoms and peer problems, controlling for socio-economic status (SES), body mass index (BMI), fasting serum leptin levels, pubertal development and sex hormones.

RESULTS

We found that increases in emotional symptoms (exp β adj = 1.03, s.e. = 0.02, p < 0.04) and peer problems (exp β adj = 1.05, s.e. = 0.01, p = 0.0001) were significantly associated with higher serum leptin levels controlled for BMI and sociodemographic factors. Similar results were found when the fasting serum leptin sample was examined (exp β adj = 1.08, s.e. = 0.04, p = 0.0294). Gender-stratified analyses showed a significant relationship between serum leptin and peer problems in girls (exp β adj = 1.05, s.e. = 0.02, p = 0.03), and a borderline significant association in boys (exp β adj = 1.04, s.e. = 0.02, p = 0.05).

CONCLUSIONS

Children with peer problems have higher stress and eat more, acquire a higher body fat mass and thus, through increased leptin resistance, exhibit higher leptin levels.

A review of the psychological and familial perspectives of childhood obesity

Childhood obesity is on the rise in both industrialized and developing countries. The investigation of the psychosocial aspects of childhood obesity has been the focus of long- standing theoretical and empirical endeavor. Overweight in children and adolescents is associated with a host of psychological and social problems such as reduced school and social performance, less favorable quality of life, societal victimization and peer teasing, lower self-and body-esteem, and neuropsychological dysfunctioning. Whereas community samples of obese youngsters usually do not show elevated psychopathology, clinically-referred overweight children show elevated depression, anxiety, behavior problems, attention deficit hyperactivity disorder and disordered eating. Parents' perceptions of their child's overweight highly influence the well-being of obese children and the way in which they perceive themselves. THE PRESENT REVIEW PAPER AIMS TO BROADEN THE SCOPE OF KNOWLEDGE OF CLINICIANS ABOUT SEVERAL IMPORTANT PSYCHOSOCIAL AND FAMILIAL DIMENSIONS OF CHILDHOOD OBESITY: the psychosocial functioning, self and body esteem and psychopathology of overweight youngsters, the influence of children's perceptions of overweight, including those of the obese children themselves on their well being, and the influence of parental attitudes about weight and eating on the psychological condition of the obese child.

Overweight at age two years in a multi-ethnic cohort (ABCD study): the role of prenatal factors, birth outcomes and postnatal factors

BACKGROUND

Childhood overweight/obesity is a major public health problem worldwide which disproportionally affects specific ethnic groups. Little is known about whether such differences already exist at an early age and which factors contribute to these ethnic differences. Therefore, the present study assessed possible ethnic differences in overweight at age 2 years, and the potential explanatory role of prenatal factors, birth outcomes and postnatal factors.

METHODS

Data were derived from a multi-ethnic cohort in the Netherlands (the ABCD study). Weight and height data of 3,156 singleton infants at age 2 years were used. Five ethnic populations were distinguished: Dutch native (n = 1,718), African descent (n = 238), Turkish (n = 162), Moroccan (n = 245) and other non-Dutch (n = 793). Overweight status was defined by the International Obesity Task Force guidelines. The explanatory role of prenatal factors, birth outcomes and postnatal factors in ethnic disparities in overweight (including obesity) was assessed by logistic regression analysis.

RESULTS

Compared to the native Dutch (7.1%), prevalence of overweight was higher in the Turkish (19.8%) and Moroccan (16.7%) group, whereas the prevalence was not increased in the African descent (9.2%) and other non-Dutch (8.8%) group. Although maternal pre-pregnancy body mass index partly explained the ethnic differences, the odds ratio (OR) of being overweight remained higher in the Turkish (OR: 2.66; 95%CI: 1.56-4.53) and Moroccan (OR: 2.11; 95%CI: 1.31-3.38) groups after adjusting for prenatal factors. The remaining differences were largely accounted for by weight gain during the first 6 months of life (postnatal factor). Maternal height, birth weight and gender were independent predictors for overweight at age 2 years, but did not explain the ethnic differences.

CONCLUSION

Turkish and Moroccan children in the Netherlands have 2- to 3-fold higher odds for being overweight at age 2 years, which is largely attributed to maternal pre-pregnancy BMI and weight gain during the first 6 months of life. Further study on the underlying factors of this early weight gain is required to tackle ethnic differences in overweight among these children.

New psycho-pedagogic approach to obesity treatment: a 5-year follow-up

OBJECTIVE

The aim of the present study was to evaluate the body weight evolution in obese patients admitted for a 2-week residential program and followed-up on ambulatory basis, as well as to evaluate factors having impact on weight evolution after 5 years.

METHODS

Thirty-nine obese patients participated in a 2-week structured interdisciplinary weight loss program, involving individual and group therapies, and including physical activity, nutritional education and standard cognitive-behavioral techniques. Patients were then followed-up regularly by their general practitioners for 5 years.

RESULTS

After 5 years, 33 subjects completed the study. Seventy percent of the patients lost weight or maintained their weight loss. Total score for dietary structure, eating behavior disorders, dietary surveillance and weight management strategies, as evaluated by a validated questionnaire, was significantly lower in the weight loss group (22.4+/-4.3) as compared to maintenance group (24.4+/-6.1, p<0.05) and regain group (29.7+/-4.0, p<0.01). Patients who lost weight presented a more important follow-up on long-term weight management (p<0.05), a better dietary results (p<0.01) as well as more physical activity (p<0.05) that the regain group.

CONCLUSION

The present study demonstrated that an initial multidimensional and multidisciplinary in-hospital program with a consecutive long-term ambulatory follow-up may lead to a significant weight loss (55%) and/or weight maintenance (15%).

PRACTICE IMPLICATIONS

A multidisciplinary and well-designed initial treatment and long-term follow-up program is mandatory for obesity management.