Adolescents’ Attitudes About Obesity and What They Want in Obesity Prevention Programs

Riding into Health: A Case Study on an Equine-Assisted Childhood Obesity Intervention

In this article, we present an exploratory case study that describes the initial outcomes of the Equine-Assisted Positively Fit (EAPF) program. Children with obesity and their caregivers were recruited to participate in the eight-session program. Results indicated that treatment completers (n = 2) had a decrease in fat mass and fat mass percentage and an increase in fat-free mass and fat-free mass percentage. Moreover, results from accelerometer measurements of physical activity indicated that participants increased their moderate to vigorous physical activity, as well as reported increased self-efficacy for physical activity. Qualitative data from the post-intervention focus group suggested children perceived the treatment acceptable and enjoyable. Findings from this study provide support for future investigations on the feasibility and potential efficacy of pairing children and their caregivers with horses to accomplish health-related goals.

Attitudes of Jordanian Adolescent Students Toward Overweight and Obesity

Background

Obesity is a serious public health problem especially among adolescents. Understanding adolescents' attitudes toward obesity and healthy lifestyle is a crucial step to develop effective health programs to treat and prevent obesity.

Objectives

To examine the attitudes toward overweight and obesity among Jordanian adolescent students and to identify the components of obesity prevention program that the students perceive as important.

Methods

A sample of 1000 students in 8^th to 10^th grades was randomly selected from 16 schools in Irbid, Jordan. A self-reported questionnaire including attitude related questions was used in a descriptive, cross-sectional study.

Results

Generally, the students expressed positive attitudes toward obesity; which means that their attitudes were consistent with societal norms in terms of health and social functioning (mean= 3.5, SD=0.39). Furthermore, the students expressed positive attitudes toward lifestyle; which means that their attitudes were consistent with healthy behaviors (mean=3.7, SD=0.58). However, boys had significantly more positive attitudes than girls (p=0.04). The prevalence of overweight and obesity was 23.8%, while obese and non-obese students had similar attitudes toward lifestyle and obesity. Finally, around 20% to 30% of students desired a prevention program out of school time shared with their families and friends and involves eating healthy food and getting more exercise.

Conclusion

More efforts are needed to build effective obesity prevention programs that focus on eating healthy diet and getting more exercise considering gender differences.

Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents

AIMS

To examine the effects of physical activity and exercise interventions on body mass index, subsequent physical activity and psychological symptoms for overweight and obese adolescents (12-18 years).

BACKGROUND

Overweight and obesity have increased among adolescents globally and physical activity has decreased. Healthcare systems face challenges promoting physical activity and in treating obesity. Promotion of physical activity must be effective and school nurses should be equipped with the information and resources required to implement counselling for overweight and obese adolescents.

DESIGN

A systematic review of randomized controlled trials was conducted according to procedures by the Centre for Reviews and Dissemination and the Joanna Briggs Institute.

DATA SOURCES

Research studies published between 1950-2013 were identified from the following databases. CINAHL, MEDLINE (Ovid) and PsycINFO.

REVIEW METHODS

Selected studies were reviewed for quality and a risk-of-bias assessment was conducted for the included studies. A narrative synthesis was used to report results, while a fixed-effect meta-analysis was used to analyse the interventions effects on physical activity and body mass index.

RESULTS

Fourteen published studies were included to this review. Supervised exercise interventions most affected adolescents' body mass index. The interventions effect on adolescents' physical activity was small and heterogeneous. Two interventions positively affected psychological symptoms.

CONCLUSION

Interventions were complex, with more than one component and the aspect that effectively promotes physical activity in obese adolescents was not clear. However, it seems that exercise interventions affect the body mass index of overweight or obese adolescents. Interventions that include a component for promoting physical activity with or without supervised exercise can affect subsequent physical activity and body mass index.

Evaluating physical and perceptual responses to exergames in Chinese children

Purpose: The primary objective of this study was to examine whether exergames could help children reach the recommendations for PA and cardiorespiratory fitness regarding exercise intensity. Differences in perceived physical exertion, EE, VO₂, and HR between normal weight (NW) and overweight (OW) children participating in exergames were also examined. Methods: Twenty-one children (age: 10.45 ± 0.88) were assessed for EE, VO₂ and HR during rest, in a maximal treadmill test, and while playing different exergames. Ratings of perceived exertion (RPE) (category range: 0 to 10) were also measured during exergaming. Three types of exergames were examined: running, table tennis, and dancing. These games were either performed on a Chinese game console, I-Dong, or another well-developed Western game console (Sony PlayStation 3 or Nintendo Wii). Results: Exergaming resulted in EE (kcal/min) from 2.05–5.14, VO₂ (mL/kg/min) from 9.98–25.54, and HR (beats per minute) from 98.05–149.66. Children reported RPE ranging from 1.29 to 5.29. The Chinese exergame, I-Dong Running, was the only game in which children reached a moderate intensity and met the recommended minimum VO₂reserve (50%) for cardiorespiratory fitness. Conclusion: Exergames could provide alternative opportunities to enhance children’s physical activity. They could be used as light-to-moderate PA, and with exergames, children can even reach the recommended intensity for developing and maintaining cardiorespiratory fitness.

Aproximación socio-antropológica a la obesidad infantil: estudio de caso en dos colegios de Valencia (España)

OBJETÍVO: El artículo analiza los marcos interpretativos de 82 niños/as (10-12 años) y de 10 madres/1 padre, sobre obesidad y sobrepeso, en dos colegios de Valencia (España). MÉTODOS: Se trata del estudio piloto de un proyecto de investigación cualitativa. Con los niños se usaron cuestionarios de respuesta abierta y elaboración de obras de teatro y cuentos, mientras que con los padres se realizaron grupos de discusión. Se tuvieron en cuenta aspectos como: diferencias de género, atributos negativos y formas de discriminación. En el caso de los padres, se propuso la cuestión de las causas y posibles soluciones del problema en relación a las existentes. RESULTADOS: Entre los niños/as emergieron términos negativos asociados al sobrepeso, presentando una mayor focalización corporal en el abdomen los niños y una notable importancia de la estética las niñas, unida a una percepción más amplia de los efectos del sobrepeso en la sociabilidad. Entre los padres, la preocupación tuvo una preponderancia en los efectos psicológicos del sobrepeso en sus hijos por encima de las consecuencias para la salud (solo en casos graves de obesidad). CONCLUSIÓN: La percepción de los padres sobre las posibles soluciones mostró la clara influencia de los discursos nutricionales, resultado de campañas de concienciación, así como el escaso conocimiento de otras posibles formas de intervención con mayor énfasis social o participativo.

A program for obese youth at-risk for diabetes in Qatar

Background: Obesity is an international public health problem well documented in Qatar among children and adolescents and contributes to diabetes, a disease already highly prevalent in the country. We describe an intervention program developed for obese youth conducted by the Qatar Diabetes Association (QDA). Methods: The QDA conducts a 3-day structured program for obese youth at-risk for developing diabetes which includes physical activities, games and workshops aimed to increase awareness and guide improved diet, activity and related lifestyle choices. Using motivational interviewing techniques, obese youth develop action plans to modify diet and exercise which were shared with parents to promote collaboration and support. Results: In 2011, one girls' camp (n = 15, mean age 12 years) and one boys' camp (n = 17, mean age 13 years) were held. All participants were considered obese: girls mean BMI = 31 kg/m2 (standard deviation (SD) 4.2) and boys mean BMI 35 kg/m2 (SD = 4.7). Youth reported fast food consumption at least twice a week by 6 (40 %) of girls and 10 (59 %) of boys and there was low self-declared frequency of daily physical activity (1 girl and 5 boys). Many stated their weight made their life worse due to fatigue, poor agility, or difficulty finding clothes. When individualized coaching was proposed, 87 % and 100 % of girls and boys felt ready to devise an action plan for improved health. Conclusion: The new national preventative healthcare mandate could facilitate modification and expansion of these QDA educational and behavioural intervention programs as part of the wider strategy to combat obesity in Qatar.

Weight status, gender, and race/ethnicity: are there differences in meeting recommended health behavior guidelines for adolescents?

Healthy behaviors including limited screen time (ST), high physical activity (PA), and adequate fruits and vegetables consumption (FV) are recommended for adolescents, but it is unclear how gender, race/ethnicity, and weight status relate to these public health guidelines in diverse urban adolescents. Participants (N = 384) were recruited from three public high schools in or near New Haven, Connecticut. Descriptive statistics and logistic regression analyses were conducted. Most adolescents exceeded recommended levels of ST (70.5%) and did not meet guidelines for PA (87.2%) and FV (72.6%). Only 3.5% of the sample met all three guidelines. Boys were more likely to meet guidelines for PA (p < .01), while girls were engaged in less ST (p < .001). Black, non-Latinos were less likely to meet PA guidelines (p < .05). There were no significant differences in meeting ST, PA, or FV guidelines by weight status for the overall sample or when stratified by gender or race/ethnicity. We found alarmingly low levels of healthy behaviors in normal weight and overweight/obese adolescents.

Gender and Ethnic Differences in Health-Promoting Behaviors of Rural Adolescents

Although much is known about health-risk behaviors of adolescents, less is known about their health-promoting behaviors. The purpose of this analysis was to compare health-promoting behaviors in adolescents in Grades 9–12 by gender and ethnicity and explore how these behaviors changed over time. Data were collected from 878 rural adolescents (47.5% Hispanic; mean age at baseline 14.7 years). Males from all ethnic groups scored significantly higher than all females on physical activity; non-Hispanic Black males and females scored significantly higher than other ethnic groups on safety behaviors. Hispanic and non-Hispanic White females scored higher than males in these ethnic groups on stress management. Nutrition, physical activity, and safety behaviors decreased significantly for most participants from Grade 9 to 12 whereas stress management remained relatively stable. Findings are similar to those from nationally representative samples that analyzed cross-sectional data and have implications for school nursing interventions to improve health-promoting behaviors in rural adolescents.

The association between family meals, TV viewing during meals, and fruit, vegetables, soda, and chips intake among Latino children

OBJECTIVE

Examine the relationship of family meals to children's consumption of fruit and vegetables as well as soda and chips. Additionally, to assess the relationship between viewing TV during family meals and children's diet.

DESIGN

Cross-sectional study that used a questionnaire completed by parents.

SETTING

Thirteen schools in San Diego, California.

PARTICIPANTS

Seven hundred ninety-four children and their parents.

ANALYSIS

Ordinal regression assessed associations between children's intake of fruit, vegetables, soda, and chips with family meal frequency and TV viewing during family meals.

RESULTS

Children who consumed breakfast, lunch, or dinner with their family at least 4 days per week ate fruit and vegetables 5 or more times a week 84%, 85%, and 80%, respectively. Of those children who ate breakfast, lunch, or dinner with their family at least 4 days per week, 40%, 44%, and 43% consumed soda and chips 5 or more times a week, respectively. Children who ate breakfast with their families at least 4 times a week were more likely to consume fruit and vegetables, and children whose TV was never or rarely on during family meals were less likely to consume soda and chips (P = .04 and P < .001, respectively).

CONCLUSIONS

Interventions geared at increasing the frequency of eating breakfast as a family and decreasing the amount of TV watched during family meals are needed, especially among acculturating Latino families.

Health promotion and risk behaviors among adolescents in Turkey

Adolescents experience the onset and development of several health-related behaviors. The purpose of this study is to determine health risk and promotion behaviors of adolescents between the ages of 11 and 19 who were attending and to test the reliability and validity analysis of the Turkish version of Adolescent Health Promotion Scale (AHPS). The study was a cross-sectional survey and the sample consisted of 1,351 participants. A questionnaire that included demographic information, health risk behaviors, and AHPS was used to collect data. In the current study, the Cronbach's α coefficient for the AHPS was calculated as .92. Female students had significantly higher mean total scale scores than males (p < .05). The 11-14 age group had a statistically significant higher scale total mean score than the 15-19 age group (p = .001). International directives highlight the important function nurses fulfill in health promotion. Nurses may play a key role in school health services.

Does Behavioral Intention Predict Nutrition Behaviors Related to Adolescent Obesity?

The theory of planned behavior (TPB) proposes that the single best predictor of a person’s behavior is intention to perform that behavior. Successful application of the TPB supports that attitudes, subjective norms, and perceived behavioral control are predictive factors of behavioral intention (BI). The purpose of this study was to examine the extent to which BI predicted nutrition behaviors linked to adolescent obesity. A cross-sectional design obtained a convenience sample of 318 middle school students who completed a 129-item validated instrument. Multiple regression was used to establish predictors for fruit and vegetable (FV) consumption and sweetened beverages (SBs) versus water consumption. The mean BI scores were as follows: FV consumption, M = 12.18, standard deviation [SD] = 5.74, and SB versus water consumption, M = 12.42, SD = 6.07. This denotes a moderate intent to participate in the behavior. Regression showed that BI was predictive for consumption of FV among overweight and obese students and consumption of water versus SB in normal weight students (P < .05). BI was linked to nutrition behaviors related to obesity prevention in adolescents. Differences among those students who were considered normal weight and overweight/obese existed and should be considered when working with these populations and designing future interventions.

Obesity prevention opinions of school stakeholders: a qualitative study

BACKGROUND

In general, schools are an important setting to implement current recommendations for obesity prevention in children because the vast majority of children attend school. This study investigated the opinions of different school stakeholders on the feasibility and acceptability of current obesity prevention strategies that could be implemented in Swiss schools.

METHODS

Research methods were comprised of a qualitative study which included school directors, physical education teachers, catering staff, school nurses and health educators, parents of young adolescents, and young adolescents interviewed (N = 40) categorized into 6 focus groups. Open-ended questions were used to determine the participants' opinion regarding current obesity prevention recommendations, and healthy eating and physical activity promotion strategies.

RESULTS

All participants approved the implementation of nutritional standards for food and drinks sold in schools, but thought that increasing the attractiveness of healthy options was the best strategy to improve eating habits. Enjoying participation in physical activity classes or after-school activities was stressed. Participants suggested offering classes for all students with poor physical condition, independent of weight status. Stakeholders called for governmental support and global coordination of interventions balanced with providing schools with enough autonomy to adapt programs relevant to their individual circumstances. They recommended integrating all school stakeholders in obesity prevention initiatives, with special attention to students and local authorities.

CONCLUSIONS

Participants agreed that schools are a crucial setting to implement childhood obesity prevention strategies. They called on school stakeholders to join efforts aiming to encourage healthy behaviors and to support and reinforce parents' efforts by spreading consistent and coherent health messages.

Establishing validity and reliability of an instrument using the theory of planned behavior to predict middle school student obesity-related actions

BACKGROUND

Childhood obesity is of concern to many health professionals, parents, teachers, and school administrators because of the negative impact on the child's physical, psychological, and behavioral health. Lack of structured monitoring and evaluation has hindered the development of an evidence base to disseminate best practices in childhood obesity prevention.

PURPOSE

The purpose of this study was to develop a valid and reliable instrument which affirmed the constructs of the Theory of Planned Behavior in relation to nutrition and physical activity behaviors related to childhood obesity.

METHODS

A convenience sample of 242 students participated in the validation of the 129-item instrument, which was administered during class time, and read to students to increase response rate.

RESULTS

Confirmatory factor analysis established instrument validity, with one factor present for each behavior, and factor loadings greater than 0.32. Reliability and test-retest coefficients achieved apriori criteria of 0.70.

DISCUSSION

Truly learning how to gauge nutrition and physical activity levels in children and adolescents has proved to be difficult, yet it is imperative to understand the relationship of the proposed potentially modifiable behaviors and childhood obesity.

Sixth-grade boys' perceived benefits of and barriers to physical activity and suggestions for increasing physical activity

Interventions are needed to reduce the high overweight prevalence noted among boys in early high school. Because decreased physical activity (PA) is a factor for weight gain and a decline in boys' PA occurs across the middle school years, a need exists to intervene, as soon as boys reach middle school, to help them get adequate PA. The purpose of this study was to explore perceived benefits, barriers, self-efficacy, enjoyment or activity preferences, and situational or environmental influences related to PA among sixth-grade boys (N = 40). Each boy participated in one of seven focus groups. Having an average weight was the most important benefit. The most prominent personal barrier focused on being unmotivated. Environmental barriers included lacking equipment and places for PA. Suggestions for increasing boys' PA were identified. Findings have implications for nurses interested in designing interventions to assist boys of this age in achieving PA recommendations.

Engaging student health organizations in reducing health disparities in underserved communities through volunteerism: developing a student health corps

One underutilized method for reducing health disparities and training culturally competent health care workers is the engagement of undergraduate student health organizations in conducting health screenings, promotion, and health education outreach activities in in underserved racial/ethnic communities. We conducted a needs assessment of 14 predominantly racial/ethnic minority undergraduate student-run health organizations. The 14 organizations annually served approximately 12,425 people (67% Hispanic, 25% African American, 6.33% Asian Pacific Islander), predominantly at health fairs within Los Angeles County (averaging 138 attendees). Student organizations provided screenings on general health conditions and diseases, with less emphasis on behavioral risk factors (e.g., drinking, smoking). Organizations indicated a need for increased and affordable training in preventive health screenings and help in understanding target populations' needs. Universities are in an excellent position to train, supervise, and organize volunteer health corps in order to engage students in reducing health disparities and to train culturally competent health care providers.