What is a healthy body weight? Perspectives of overweight youth

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.

Convenience Behavior and Being Overweight in Adults: Development and Validation of the Convenience Behavior Questionnaire

The etiology of overweight and obesity is a mixture of genetic determinants, environmental factors, and health behaviors. Especially intra- and interpersonal inactive behaviors, here termed convenience, seems to play an important role. The objective was to develop and validate the Convenience Behavior Questionnaire (CBQ) to assess convenience-related items and their association with overweight and obesity in a large population. A sample of 1233 subjects aged 18–82 years from six population groups took part in a self-administered questionnaire. Test-retest reliability was estimated and the independent association between convenience-related items and overweight and obesity was investigated. Principal component analysis revealed three factors (avoidance behaviors, social interaction behaviors and domestic environmental factors) which explained 43.4% of the variance contributing to the CBQ. Cronbach's α ranged from 0.80–0.89. Test-retest reliability using intra-class correlation was acceptable ≥ 0.70. Forward stepwise logistic regression analysis, including gender, education level, age and TV viewing on weekends showed a positive relation of convenience behavior and overweight (OR: 1.40; 95% CI: 1.01–1.96; P = 0.048), while physical activity status was not significantly associated with overweight (OR: 1.09; 95% CI: 0.77–1.54; P = 0.629). The CBQ seems to be a reliable tool which considers non-traditional behaviors related to overweight development. Interestingly our findings revealed a better relationship between convenience-related behavior with overweight and obesity than the habitual physical activity score.

Perceived barriers to achieving a healthy weight: a qualitative study using focus groups at public and private schools in Guatemala City

BACKGROUND

Overweight prevalence among Guatemalan girls is higher in public than in private schools. Little is known about adolescent girls' perceptions of the right ways to achieve a healthy weight. This study examines public and private school adolescent girls' perceptions of a "healthy weight," and barriers and facilitators to achieving it.

METHODS

We conducted 4 focus groups in public and private schools in Guatemala City with girls from 13 to 15 years old. The discussion guide included open-ended questions and activities aimed at examining perceptions of "healthy weight" and barriers and motivators to achieving it within the school environment. Focus groups were audio-recorded and transcribed. Data analyses followed established methods of content analysis.

RESULTS

Twenty-eight girls (private school, n = 12; public school, n = 16) of ages ranging from 13.1 to 15.9 years (median, 14, IQR, 13.6-14.9) participated in the study. Girls identified images of thin and fit women as healthy. They cited healthy eating and physical activity as ways to achieve a healthy weight. Within the school environment, barriers to maintaining a healthy weight included a lack of healthy food options and the prioritization of sports for boys over girls. In public schools, facilities were less than optimal; in private schools, girls' access to facilities was limited. Public school girls stated that their uniforms were inappropriate for exercising.

CONCLUSION

Our findings support the need to provide more healthy food options in Guatemalan schools. In addition, physical activity for girls should be promoted and facilities made available for their use.

Use of Focus Groups to Inform a Youth Diabetes Prevention Model

OBJECTIVE

To explore minority adolescents' perceptions of their diabetes risk, barriers and facilitators to adopting lifestyle changes, and ideas for adapting a youth diabetes prevention model.

METHODS

The study was conducted at collaborating community sites in East Harlem, NY. Trained moderators facilitated focus groups, which were audio taped and transcribed. Participants were 21 Latino and African American adolescents aged 14-18 years with a family history of diabetes and no reported personal history of diabetes. The phenomenon of interest was youth input in adapting a diabetes prevention model. Two researchers independently coded transcripts, identified major themes, compared findings, and resolved differences through discussion and consensus.

RESULTS

Dominant themes included (1) the impact of diabetes on quality of life within adolescents' personal networks; (2) conflict between changing diet and activity and their current lifestyle; (3) lifestyle choices being dictated by cost, mood, body image, and environment, not health; and (4) family, social, and environmental pressures reinforcing sedentary behaviors and unhealthy diets.

CONCLUSIONS AND IMPLICATIONS

Themes from youth focus groups were framed in the context of an existing youth diabetes prevention conceptual model, with results informing expansion of the model and identification and organization of potential intervention components.

How adolescent boys perceive their bodies, body parts, and weight: letting adolescent boys' voices be heard

The purpose of this study was to conduct elicitation, semistructured interviews with adolescent boys to document their attitudes, perceived norms, personal agency, intentions, and actions about their weight. The boys indicated that they liked and disliked certain body parts and were in charge of their weight. Almost half of the boys did not want to change their weight. Most of the parents were inaccurate when asked to self-report their sons' heights and weights. A screening procedure that adds adolescents' perceptions of their bodies to BMI classification can aid in the referral and treatment of weight management.

Estado nutricional e autopercepção da imagem corporal de idosas de uma Universidade Aberta da Terceira Idade

O objetivo foi avaliar a associação entre o estado nutricional e a insatisfação da autoimagem corporal de idosas matriculadas no curso Alimentação, Nutrição e Terceira Idade da UnATI/UERJ. Realizou-se estudo seccional, com entrevista semiestruturada com todas as idosas (≥60 anos), obtendo-se informações referentes à percepção da imagem corporal (escala de nove silhuetas de Stunkard), indicadores socioeconômicos, de saúde, demográficos e cálculo do índice de massa corporal (IMC). Os dados foram analisados por meio de teste qui-quadrado e a regressão linear simples (nível de significância=5%). Verificou-se que 50,0% eram eutróficas; 6,0% se encontravam na categoria de baixo-peso e 44,0% apresentavam sobrepeso (p=0,425). Quanto à percepção da imagem corporal, 74,0% (n=37;p=0,0049) estavam insatisfeitas com o corpo, principalmente pelo excesso (89,2%). Das pessoas que manifestaram insatisfação por baixo-peso, a maioria era eutrófica. Já entre as insatisfeitas por excesso, 30,2% não apresentavam excesso de peso. As silhuetas 2 e 3 foram apontadas como ideais por metade das entrevistadas, ainda que a autopercepção de 62,0% das idosas tenham sido as silhuetas 4 e 5. A barriga e membros, principalmente inferiores, foram as partes do corpo que as idosas menos gostavam (78,0%). A classificação na escala das silhuetas da imagem real aumenta conforme aumenta o IMC (p<0,001). Em relação à imagem ideal ocorre o oposto (p<0,001). Indivíduos com IMC elevado tendem a ser mais insatisfeitos com sua imagem corporal e essa insatisfação pode estar relacionada ao excesso de peso. Esse fato merece mais aprofundamento sobre os determinantes e os significados desta insatisfação na complexa relação corpo, beleza, saúde e envelhecimento.

Qualitative studies among obese children and adolescents: a systematic review of the literature

Childhood obesity is a complex condition involving medical, social, moral and cultural issues. Qualitative approaches are of great value in understanding this complexity. This meta-synthesis of 45 qualitative studies deals specifically with the issue of obesity in children and adolescents from different perspectives--those of obese children and adolescents, of parents, and of health professionals providing support to the family. Our aim was to obtain a coherent view of child and adolescent obesity, focused on clinical and personal experience. The themes derived from the synthesis process fall under three main axes: 'Seeing others, seeing oneself', 'Understanding others, understanding oneself', and 'Treating others, treating oneself'. It emerges that participants in all three groups had equal difficulty in perceiving and labelling obesity, mainly because of their lack of any real common ground. The insufficiency of shared representations destabilizes the therapeutic relationship and its construction: an important issue in the doctor-child-parent relationship in this context is the need to exchange their viewpoints of obesity. Health workers may also expand their understanding of obesity by incorporating the personal experiences of obese children and their parents in order to match treatment plans to their needs and expectations.

Overweight and obese adolescents: what turns them off physical activity?

A systematic review of qualitative studies was undertaken to understand the barriers to physical activity experienced by adolescents who were overweight or obese. From a search of electronic databases and 'grey' literature, published between 1950 and 2009, 15 studies met the inclusion criteria. Bronfenbrenner's model of human development provided an ecological lens for identifying and synthesising barriers to physical activity. Two reviewers appraised study quality. Miles and Huberman's cross-case analysis was integrated with thematic networking to synthesize the individual, interpersonal and environmental level barriers for boys and girls of different ethnicities and socioeconomic status, across school settings and generalised context. Thirty-five barriers were identified, 13 of which occurred in physical activity situations in the school setting, 18 were not linked to a specific setting, and the remainder were common across both contexts. The fact that these barriers emerged from studies that focused on topics such as victimisation and mental health is particularly poignant and reflects the potentially pervasive influence of adolescent's excessive weight not only in relation to physical activity situations but other aspects of their lives. Furthermore, socioeconomic status and ethnicity was poorly considered, with only one study linking these participant characteristics to quotations and discussing the potential implications. At present, there are few qualitative studies with sufficiently thick description or interpretive validity that provide insight into this vulnerable group of adolescents, and give them a voice to influence policy and practice.

Food choices in recreation facilities: operators' and patrons' perspectives

PURPOSE

Recreation facilities (RFs) provide physical activity environments; however, unhealthy food choices are abundant there. This needs assessment was conducted to determine patrons' satisfaction with food and purchasing preferences while at RFs, reasons for purchasing certain foods, and inclination for other options. Also assessed were RF operators' receptiveness to and perspectives on the feasibility of providing healthy foods.

METHODS

A previously developed and piloted paper-and-pencil survey was administered to a cross-section of 269 adult patrons of local RFs. Seven operators participated in a previously developed researcher-administered survey.

RESULTS

Among patrons, 52.2% were satisfied with RF food choices, although 59.2% and 68.8% reported not purchasing any RF food or beverages from the snack bar or vending machines, respectively. Patrons who were dissatisfied and did not purchase food and beverages noted the abundance of unhealthy choices, poor food quality and variety, and expense as reasons. All operators were interested in and receptive to healthy food options at their RFs, but expressed concerns about poor sales of existing healthier options. All operators indicated the importance of knowing what patrons would purchase.

CONCLUSIONS

The RF operators and most patrons were interested in and receptive to healthier food options at RFs. Developing, implementing, and evaluating a pilot RF healthy-food intervention are next steps.

It's not just about the french fry: avoidance as an idiom of distress among overweight and obese adolescent boys

The purpose of this article is to explore idiom of distress and its application to overweight and obese adolescent boys. This case study suggests that avoidance, as an idiom of distress, offers self-protection from suffering among this population. Fieldwork included 55 face-to-face contact hours, 25 virtual contact hours (i.e., text messaging, e-mails, phone calls), and 16 person-centered interviews. The daily suffering experienced by this group of boys, and their collective enactment of avoidance as a self-protective strategy, offer an understanding of their lives beyond their obese bodies. Avoidance behaviors, however, can result in negative social consequences such as isolation. Recognizing avoidance as an idiom of distress permits parents, teachers, health professionals, and researchers to interact with overweight and obese adolescent boys in a profoundly different way. Attending to the personhood of these vulnerable boys was an important finding of this qualitative study.

Recommendations to improve physical activity among teenagers--a qualitative study with ethnic minority and European teenagers

BACKGROUND

To understand the key challenges and explore recommendations from teenagers to promote physical activity with a focus on ethnic minority children.

METHODS

Focus groups with teenagers aged 16-18 of Bangladeshi, Somali or Welsh descent attending a participating school in South Wales, UK. There were seventy four participants (18 Somali, 24 Bangladeshi and 32 Welsh children) divided into 12 focus groups.

RESULTS

The boys were more positive about the benefits of exercise than the girls and felt there were not enough facilities or enough opportunity for unsupervised activity. The girls felt there was a lack of support to exercise from their family. All the children felt that attitudes to activity for teenagers needed to change, so that there was more family and community support for girls to be active and for boys to have freedom to do activities they wanted without formal supervision. It was felt that older children from all ethnic backgrounds should be involved more in delivering activities and schools needs to provide more frequent and a wider range of activities.

CONCLUSIONS

This study takes a child-focused approach to explore how interventions should be designed to promote physical activity in youth. Interventions need to improve access to facilities but also counteract attitudes that teenagers should be studying or working and not 'hanging about' playing with friends. Thus, the value of activity for teenagers needs to be promoted not just among the teenagers but with their teachers, parents and members of the community.