Parenthood--a contributing factor to childhood obesity

Associations of Longitudinal BMI-Percentile Classification Patterns in Early Childhood with Neighborhood-Level Social Determinants of Health

Background: Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. Methods: We extracted electronic health record data from 2012 to 2019 for a children's health system that includes two hospitals and wide network of outpatient clinics spanning five East Coast states in the United States. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. Results: From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n = 429; 1.16%), overweight most of the time (n = 15,006; 40.65%), increasing BMI percentile (n = 9,060; 24.54%), decreasing BMI percentile (n = 5,058; 13.70%), and always normal weight (n = 7,357; 19.89%). Compared to children in the decreasing BMI percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Conclusions: Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

Associations of longitudinal BMI percentile classification patterns in early childhood with neighborhood-level social determinants of health

Background

Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable.

Methods

We extracted EHR data from 2012-2019 for a children's health system that includes 2 hospitals and wide network of outpatient clinics spanning 5 East Coast states in the US. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately.

Results

From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n=429; 1.16%), overweight most of the time (n=15,006; 40.65%), increasing BMI-percentile (n=9,060; 24.54%), decreasing BMI-percentile (n=5,058; 13.70%), and always normal weight (n=7,357; 19.89%). Compared to children in the decreasing BMI-percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment.

Conclusions

Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

Impact Statement

This study demonstrates the association between longitudinal BMI-percentile patterns and SDOH in early childhood. Five distinct clusters with different BMI-percentile trajectories are found and a strong association between these clusters and SDOH is observed. Our findings highlight the importance of targeted prevention and treatment interventions based on children's SDOH.

Family Structure, Family Transitions, and Child Overweight and Obesity: Comparing Australia, the United Kingdom, and the United States

Growing rates of childhood obesity globally create concern for individuals' health outcomes and demands on health systems. While many policy approaches focus on macro-level interventions, we examine how the type of stability of a family structure might provide opportunities for policy interventions at the micro level. We examine the association between family structure trajectories and childhood overweight and obesity across three Anglophone countries using an expanded set of eight family structure categories that capture biological relationships and instability, along with potential explanatory variables that might vary across family trajectories and provide opportunities for intervention, including access to resources, family stressors, family structure selectivity factors, and obesogenic correlates. We use three datasets that are representative of children born around the year 2000 and aged 11 years old in Australia (n = 3329), the United Kingdom (n = 11,542), and the United States (n = 8837) and nested multivariate multinomial logistic regression models. Our analyses find stronger relationships between child overweight and obesity and family structure trajectories than between child obesity and obesogenic factors. Children in all three countries are sensitive to living with cohabiting parents, although in Australia, this is limited to children whose parents have been cohabiting since before their birth. In the UK and US, parents starting their cohabitation after the child's birth are more likely to have children who experience obesity. Despite a few differences across cross-cultural contexts, most of the relationship between family structures and child overweight or obesity is connected to differences in families' access to resources and by the types of parents who enter into these family structures. These findings suggest policy interventions at the family level that focus on potential parents' education and career prospects and on income support rather than interventions like marriage incentives.

The relationship between modifiable lifestyle behaviours and self-reported health in children and adolescents in the United Kingdom

Obesity, along with its associated health issues, is closely tied to lifestyle habits. While certain elements affecting childhood health, such as genetics and ethnicity, are beyond individuals' control, there exists modifiable lifestyle behaviours that can facilitate healthier living. This study employed multiple regression analysis to investigate the relationship between specific modifiable lifestyle behaviours and self-reported health. The independent variables considered included days of moderate to vigorous physical activity (MVPA), fruit and vegetable consumption, breakfast frequency, school night sleep duration, and non-school night sleep duration. These variables were chosen for their practical modifiability within participants' daily lives. The analysis revealed a highly significant overall model (F(13,11363) = 191.117, p < .001), explaining 17.9% of the variance in self-reported health. Notably, higher MVPA levels were associated with improved self-reported health (B = 0.136 to 0.730, p < .001). Additionally, regular breakfast consumption and increased fruit and vegetable intake exhibited positive associations with self-reported health (B = 0.113 to 0.377, p < .001), while girls reported lower self-reported health (B = -0.079, p < .001). School night sleep duration was positively linked to self-reported health (B = 0.071, p < .001). Furthermore, a dose-response relationship between MVPA, dietary habits, and health was identified. These findings hold substantial potential for public health campaigns to promote healthy behaviours and prevent chronic diseases in young individuals. It is imperative to emphasise that all the variables considered in this study are readily modifiable aspects of individuals' lives, offering a promising avenue for personal health and well-being enhancement.

Patient-Reported Outcomes to Describe Global Health and Family Relationships in Pediatric Weight Management

Background: Patient-reported outcomes (PROs) can assess chronic health. The study aims were to pilot a survey through the PEDSnet Healthy Weight Network (HWN), collecting PROs in tertiary care pediatric weight management programs (PWMP) in the United States, and demonstrate that a 50% enrollment rate was feasible; describe PROs in this population; and explore the relationship between child/family characteristics and PROs. Methods: Participants included 12- to 18-year-old patients and parents of 5- to 18-year-olds receiving care at PWMP in eight HWN sites. Patient-Reported Outcomes Measurement Information System (PROMIS®) measures assessed global health (GH), fatigue, stress, and family relationships (FR). T-score cut points defined poor GH or FR or severe fatigue or stress. Generalized estimating equations explored relationships between patient/family characteristics and PROMIS measures. Results: Overall, 63% of eligible parents and 52% of eligible children enrolled. Seven sites achieved the goal enrollment for parents and four for children. Participants included 1447 children. By self-report, 44.6% reported poor GH, 8.6% poor FR, 9.3% severe fatigue, and 7.6% severe stress. Multiple-parent household was associated with lower odds of poor GH by parent proxy report [adjusted odds ratio (aOR) 0.69, 95% confidence interval (CI) 0.55-0.88] and poor FR by self-report (aOR 0.36, 95% CI 0.17-0.74). Parents were significantly more likely to report that the child had poor GH and poor FR when a child had multiple households. Conclusions: PROs were feasibly assessed across the HWN, although implementation varied by site. Nearly half of the children seeking care in PWMP reported poor GH, and family context may play a role. Future work may build on this pilot to show how PROs can inform clinical care in PWMP.

Effects of a Theory-Based, Multicomponent eHealth Intervention for Obesity Prevention in Young Children from Low-Income Families: A Pilot Randomized Controlled Study

The purpose of this study was to evaluate a theory-based, multicomponent eHealth intervention aimed at improving child health behaviors and parental psychosocial attributes and feeding practices. A pilot randomized controlled trial was conducted among 73 parents with children (1-3 years). Intervention group participants (IG, n = 37) received theory-based educational videos, cooking tutorials, and text messages with key information for a total of 8 weeks. Control group participants (CG, n = 36) received a booklet about general nutrition recommendations for children. A parent-administered questionnaire was used for data collection at baseline and post-intervention. Linear models were performed using R version 4.1.1. for data analysis. Children in the IG significantly increased their daily intake of fruit (ΔΔ = 0.89 servings, p = 0.00057) and vegetables (ΔΔ = 0.60 servings, p = 0.0037) and decreased use of screen time (ΔΔ = -33.87 min, p = 0.026), compared to the CG. Parents in the IG improved significantly more than the CG in self-efficacy (p = 0.0068) and comprehensive feeding practices (p = 0.0069). There were no significant differences between the study groups for changes in child outcomes, such as physical activity and sedentary behaviors, and parental nutrition knowledge and attitudes.

Overweight and obesity in preschool children in Turkey: A multilevel analysis

Childhood obesity/overweight is a worldwide concern and its prevalence is increasing in many countries. The first aim of this study is to analyse the trends in overweight and obesity among children under the age of five in Turkey based on the new World Health Organization (WHO) standards, using data from the 'five-round of the Turkey Demographic and Health Surveys' (TDHSs). The second aim is to examine whether or not the maternal/household and individual-level factors are associated with overweight/obesity using TDHS 2003, 2008, and 2013 datasets. A total sample of 14,231 children under the age of five were extracted from the TDHS in 1993, 1998, 2003, 2008, and 2013 to determine the prevalence of the trend. Pooled data from 8,812 children were included in the analysis to examine factors associated with overweight/obesity. Taking into account the clustered data structure, multilevel logistic regression models were utilised. In 1993, 1998, 2003, 2008, and 2013 the prevalence of overweight children was 5.3%, 4.9%, 10.0%, 11% and 11.6%, respectively. The factors that were independently associated with overweight/obesity were as follows: living in single-parent households (adjusted odds ratio (aOR) = 2.27, 95%CI = 1.21-4.26), compared to living in dual-parent households; having an obese mother (aOR = 4.25, 95%CI = 1.73-10.44), overweight mother (aOR = 3.15, 95%CI = 1.29-7.69), and a normal-weight mother (aOR = 2.70, 95%CI = 1.11-6.59) compared to having an underweight mother; being aged between 13-24 months (aOR = 1.72, 95%CI = 1.30 to 2.27), compared to being aged 0-12 months; male gender (aOR = 1.30, 95%CI = 1.11 to 1.53); being stunted (aOR = 2.18, 95%CI = 1.74 to 2.73); high birth weight (aOR = 1.55, 95%CI = 1.08 to 2.23) compared to low birth weight. In addition, overweight was higher in children of mothers who had completed primary school (aOR = 1.21, 95%CI = 1.01 to 1.59) than children of mothers who had not completed primary school. These findings reveal that, over the years, there has been a substantial increase in obesity/overweight among children which demonstrates the importance of evaluating the overweight indicators at the maternal/household level.

The role of energy balance related behaviors in socioeconomic inequalities in childhood body mass index: A comparative analysis of Germany, the Netherlands, the United Kingdom, and the United States

Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries-Germany, the Netherlands, the United Kingdom (UK), and the United States (US)-to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors-physical activity, screen time, and breakfast consumption-in explaining these inequalities. Children were aged 5-7 at our first timepoint and were followed up at age 8-11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families.

Struggling with overweight or obesity in children - fathers' perceptions and experiences of contributing factors, role and responsibility

PURPOSE

The family environment is crucial in the prevention and treatment of childhood obesity; however, there is a lack of knowledge concerning paternal perceptions and experiences in childhood weight management. The aim of this study was to explore (i) perceptions of contributing factors to childhood overweight and obesity among fathers of children with overweight or obesity and (ii) the fathers' experiences of their parental role caring for a child with overweight or obesity.

METHOD

A qualitative content analysis was conducted of data from semi-structured in-depth interviews with eight Norwegian fathers of ten children and adolescents with overweight or obesity.

RESULTS

The analysis identified one overall theme; Feeling uncertain and struggling to understand their own responsibility for the child's overweight or obesity, which consists of two themes; 1)Trying hard to figure out the child's obesity as a complex interaction of factors and 2)Family functioning-negotiating roles and responsibility in parenthood.

CONCLUSION

Fathers must be met with understanding about their uncertainty and their struggle to understand their individual responsibility for their child's weight excess. It can be necessary to address the significance of family functioning, collaboration, responsibility within the familiy in addition to structural responsibility in clinical dialogues and counselling in order to help with weight management.

Investigating socioecological obesogenic factors in children with Autism Spectrum Disorder

Obesity-related information in children with Autism Spectrum Disorder (ASD) is limited, and research findings are contradictory. Thus, this study aimed to use a nationwide non-clinical sample to examine the association of sociological factors with overweight status in children with ASD and reveal the degree of differences in the risk factors for overweight in children with and without ASD. The data for this cross-sectional study, based on the modified ecological system theory model, were obtained from the 2019 National Survey of Children's Health. The weighted logistic regressions were performed to determine the factors associated with overweight status in children with ASD, controlling for demographics, physical activity-related behaviors, and family and environmental conditions. A total of 529 children were identified (mean age 13.78 years, 83.21% boys). Two-parent households, less healthy parents and households, households with smokers, poor sleep quality, and greater participation in organized activities were associated with a higher likelihood of overweight in children with ASD (all P < 0.05). The determinants of obesity among children with ASD go beyond the individual level; family and community support are important. Therefore, greater attention should be directed toward the families of children with ASD and community-level administrative policies to improve quality of life by preventing or reducing obesity in children with ASD.

The impact of maternal influences on childhood obesity

There was a lack of detailed information about maternal influences on their children’s body mass index (BMI) in Taiwan. The aim of this study was to find the evidence to describe how mothers’ factors could affect their 2 to 9-year-old children’s BMI, with data collected from May 2021 to June 2021. Anonymous self-administered questionnaires were completed by 1035 participants from Taiwan’s six metropolitan cities and eight counties. After controlling for children’s factors, such as number of children in a family, children’s constitution, children’s age and gender, hierarchical regression models were used to analyze the effects of five maternal factors on their children’s BMI: maternal BMI, age, education level, monthly household income, and marital status (single parent or not). The results were found as follow: maternal BMI [β = .24], maternal educational level [β = −.141], and monthly household income [β = .071], significantly (p < 0.05) influenced their children’s BMI. Higher maternal BMI was associated with a higher children’s BMI. Mothers with lower levels of education background were more likely to have children with a higher BMI. Monthly household income was a positive factor influencing children’s BMI. In conclusion, this study is the first detailed description of maternal influences on their 2–9 years old children’s BMI in Taiwan. Although the study could not cover all of the factors influencing Taiwan’s childhood obesity, we have discovered maternal BMI, education level, and monthly household income were significant factors associated with children’s BMI.

Associations between family structure and adolescents' food habits

OBJECTIVE

To investigate family structure differences in adolescents' consumption of fruit, vegetables, sweets and sugar-added soft drinks with adjustments for socio-demographic and socio-economic variables.

DESIGN

Cross-sectional data from the Health Behaviour in School-aged Children survey.

SETTING

Norwegian primary and secondary schools.

PARTICIPANTS

Adolescents (n 4475) aged 11, 13, 15 and 16 years.

RESULTS

After adjusting for covariates, living in a single-mother family was associated with lower vegetable consumption (OR 0·76, 95 % CI 0·63, 0·91) and higher soft drink consumption (OR 1·29, 95 % CI 1·06, 1·57). Living in a mother and stepfather family was negatively associated with fruit (OR 0·71, 95 % CI 0·54, 0·95) and vegetable (OR 0·72, 95 % CI 0·54, 0·97) consumption. Living in a single-father family was associated with lower sweets consumption (OR 0·48, 95 % CI 0·32, 0·72). No significant interactions were demonstrated between family structure and socio-demographic or socio-economic covariates.

CONCLUSIONS

The study suggests that an independent association between family structure and adolescents' food habits exists.

An App about Healthy Habits as an Educational Resource during the Pandemic

Educational institutions and their agents play a fundamental role in improving people’s health literacy and quality of life. We intend here to describe and justify an educational resource embodied in an application for mobile devices developed through a subsidized project by the Ministry of Health (Government of Andalusia); the purpose of this app is to educate young people in healthy habits. The application was designed to be easily used in both smartphones and tablets with the aim of achieving good physical, psychological and social health. The project comprises several phases and the results we have so far show that, from an early age, health institutions and educational settings must work in partnership, increasing health literacy levels. This cooperative work combined with the use of this innovative approach presents an important potential for change in the lifestyles of younger generations. This type of intervention took on a special role in the pandemic context, allowing for the maintenance of the educational stimulus in a safe context.

Social capital or vulnerability: Which has the stronger connection with selected U.S. health outcomes?

We tested associations between social capital or vulnerability and health outcome measures of adult obesity, adult diabetes, and life expectancy at the county level in the United States with data from 2015 to 2018. This ecological cross-sectional study utilized secondary data from four open access databases: The Geography of Social Capital (U.S. Congress, 2018), County Health Rankings (2018), CDC's Behavioral Risk Factor Surveillance System (BRFSS, 2018) and the Kaiser Family Foundation (KFF, 2015). Our dependent variables were adult obesity, adult diabetes, and life expectancy. We identified the highest and lowest states' prevalence for each of three health outcomes in each of the four U.S. regions-Northeast, South, Midwest, and West. Each dependent variable was assessed using a sample of 32 counties (N = 32). Data analysis consisted of bivariate and regression analysis. Our results showed that the most consistent measure of "vulnerability" linked significantly to all three health conditions studied was percent births to unmarried women (Obesity p < .001; Diabetes p = .049; Life Expectancy p = .019). The most consistent measure of "social capital" linked to all three health conditions was recreation establishments per 1,000 inhabitants (Obesity p = .006; Diabetes p = .005; Life Expectancy p = .018). We concluded that measures of vulnerability were strongly associated with obesity, diabetes, and life expectancy when compared with social capital indicators. However, measures of social capital consistently accounted for the second-greatest proportion of the variance. Social and community contexts should be constantly addressed by both public health governmental- and scholarly-research agendas in the United States.

Association of overweight, obesity and insufficient sleep duration and related lifestyle factors among school children and adolescents

OBJECTIVES

To assess the prevalence of overweight, obesity and Insufficient Sleep Duration (ISD) and to investigate their relationship with related lifestyle factors among school-aged students. Obesity in childhood and adolescence is a serious health concern as it may have long term risk for overweight and obesity in adulthood.

METHODS

This is a cross-sectional study of 1,611 students aged between 10 and 18 years from Al Ain city, United Arab Emirates. Data were collected using a multistage stratified random sampling method using a validated questionnaire and the level of significance was set at p<0.05.

RESULTS

The prevalence of overweight and obesity was 42.4%. ISD was 36.6% among students. Higher BMI was significantly related to being a male and inactive (95% CI=0.03-0.23), daily coffee consumption (95% CI=0.03-0.1), older age (95% CI=0.01-0.02), less average sleep duration (95% CI=-0.02 to -0.003) and spending more time on TV/videogames (95% CI=0.01-0.07). The likelihood of ISD was significantly lower among students who consumed breakfast daily (OR=0.58, 95% CI=0.41-0.83), spent less time on smart devices (OR=0.63, 95% CI=0.47-0.84), and never consumed energy drinks or soft drinks (OR=2.64, 95% CI=1.13-6.16, OR=2.02, 95% CI=1.24-3.29, respectively).

CONCLUSIONS

The prevalence of overweight and obesity among school-aged students is high. ISD and related lifestyle factors are significantly associated with overweight and obesity. Study findings emphasize the need to address and implement successful strategies for a healthy lifestyle starting from early childhood to combat the increasing rates of overweight and obesity in adulthood.

Psychosocial Factors and Obesity in Adolescence: A Case-Control Study

INTRODUCTION

The continuously increasing prevalence of childhood obesity is reaching epidemic proportions. Greece is among the countries with the highest childhood obesity prevalence rates. The present study aims to identify psychosocial factors associated with excess body weight of adolescents.

METHODS

This case-control study was conducted in Athens, Greece, and included 414 adolescents aged 11-18 years. Anthropometric measurements were recorded, and an anonymous self-completed questionnaire captured the psychosocial background, family environment, peer relations, and school environment.

RESULTS

Of the total sample of adolescents, 54.6% had normal body weight and 45.4% were overweight or obese. A multivariate logistic regression analysis showed that the factors related to the presence of overweight/obesity were adolescents' age (OR = 0.416, p < 0.001), area of residence, presence of anxiety (OR = 4.661, p = 0.001), presence of melancholia (OR = 2.723, p = 0.016), participation in sports (OR = 0.088, p <0.001), smoking (OR = 0.185, p = 0.005), and mother's occupation (OR = 0.065, p < 0.001).

CONCLUSION

Psychological problems, maternal occupation, the absence of physical activity, and poor school performance were associated with adolescent overweight/obesity. It is important that screening for the presence of psychosocial issues is included in childhood obesity policies and treatment.

Structured, multifactorial randomised controlled intervention to investigate physical activity levels, body composition and diet in obese and overweight adolescents

INTRODUCTION

There has been a steep increase in the prevalence of adolescent overweight and obesity globally and in India, demonstrating that present prevention strategies are insufficient. Available evidence suggests that multifactorial interventions may improve short-term physical activity (PA), nutrition and psychological behaviour of overweight and obese adolescents but long-term follow-ups and strategies are needed. This study will investigate the effects of a structured multifactorial (school-based and family-based) intervention on adolescent obesity, compared with a single or no intervention.

METHODS AND ANALYSIS

A pragmatic, clustered randomised controlled trial with 12 weeks of interventions and 3-month, 6-month and 12-month follow-ups will be conducted at multiple participating schools in Karnataka, India. The participants will be overweight and obese male and female adolescents aged 11-16 years and will be randomly assigned by school into three groups: group A (multifactorial intervention, exercise and dietary advice); group B (exercise only); and group C (controls, no interventions). Primary outcome measures are the level of PA and body composition. Secondary outcomes are dietary change, behaviour change, food behaviours, cardiovascular and muscular fitness, quality of life, parental behaviours (physical and mental) and family functioning. Positive intervention results may reduce obesity in adolescents and promote a healthier lifestyle for students and families. A larger, culturally diverse population can benefit from a similar methodology.

ETHICS AND DISSEMINATION

The study has been approved by the Institutional Research and Ethics Committee (IEC 536-2018), Kasturba Hospital, Manipal, Udupi District, Karnataka, India. A written and verbal informed consent (supplemental material) will be provided to the participants prior to participation. On completion of the trial, the results can be communicated to adolescents and their parents on request, and will be published at national and international conferences and in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

CTRI/2019/04/018834.

Promoting Healthy Eating and Regular Physical Activity in Low-Income Families Through Family-Centered Programs: Implications for Practice

Research concerning children who are overweight has historically focused on providing services to the affected individuals, and limited attention has been paid to their families. Further, childhood obesity prevention and clinical programs continue to be impacted by contextual factors that increase the likelihood of attrition when targeting underserved populations. This paper provides data with relevance for interventions aimed at promoting healthy eating and regular physical activity with low-income families. Participants in a childhood obesity exploratory study provided recommendations to improve programs by reflecting on specific family and contextual issues related to children who are overweight and obese. Following a thematic analysis approach, we conducted semi-structured interviews with 16 low-income, single, female parents. All participants had, at the time of the interview, at least one overweight or obese child between the ages of 3 and 8. We report the critical role of context in the etiology and challenges of childhood obesity among disadvantaged populations. Findings also highlight the need for interventions to be culturally relevant and sensitive and to create opportunities to address and discuss participant experiences of discrimination, cultural factors, and family of origin influences. Interventions that do not address these contextual factors run the risk of being unsuccessful. Our findings are important for mental and public health professionals who are interested in the direct provision of services using a combination of social determinants of systemic perspectives.

Objectively measured waist circumference is most strongly associated in father-boy and mother-girl dyads in a large nationally representative sample of New Zealanders

BACKGROUND

The prevalence of children with elevated weight or obesity is concerning for public health due to associated comorbidities. This study investigates associations between parental adiposity, physical activity (PA), fruit and vegetable consumption, and child adiposity and moderation by both child and parent gender.

METHODS

Cross-sectional nationally representative data from the New Zealand Health Survey were pooled for the years 2013/14-2016/17. Parent and child surveys were matched resulting in 13,039 child (2-14 years) and parent (15-70 years) dyads. Parent and child, height (cm), weight (kg) and waist circumference (WC) were measured objectively. Height and weight were used to calculate BMI. Linear regression, accounting for clustered samples (b [95% CI]) investigated associations between parental characteristics and child BMI z-score and WC. Interactions and stratification were used to investigate effect moderation by parent gender, child gender, and parent adiposity.

RESULTS

Parental PA and fruit and vegetable consumption were unrelated to child adiposity. Overall, higher parent BMI was related to a higher child BMI z-score (b = 0.047 [0.042, 0.052]) and higher parental WC was related to a higher child WC (0.15 [0.12, 0.17]). A three-way interaction revealed no moderation by parent gender, child gender, and parent BMI for child BMI z-score ((b = 0.005 [-0.017, 0.027], p = 0.318). However, a three-way interaction revealed moderation by parent gender, child gender, and parent WC for child WC (b = 0.13 [0.05, 0.22]). The slightly stronger associations were seen between father-son WC (b = 0.20 [0.15, 0.24]) and mother-daughter WC (b = 0.19 [0.15, 0.22]).

CONCLUSIONS

The findings are highly relevant for those wishing to understand the complex relationships between child-parent obesity factors. Findings suggest that family environments should be a key target for obesity intervention efforts and show how future public health interventions should be differentiated to account for both maternal and paternal influences on child adiposity.

The association between family structure and children's BMI over time-the mediating role of income

PURPOSE

Although both family structure and income have previously been indicated as being associated with body mass index (BMI), the extent to which the effect of family structure on BMI is mediated through income is incompletely understood. Taking the case of the United Kingdom, this study aims to investigate the association between family structure, defined in this study as whether children live in a one- or two-adult household, and childhood BMI, and whether this varies by child sex and with increased age. Second, the study aims to examine whether family equivalised income, as a proxy for socioeconomic status, mediates the association between family structure and childhood BMI.

METHODS

This study uses data from the Millennium Cohort Study. Data from 7478 children born between 2000 and 2001 in the UK at the ages of 3, 5, 7, 11, and 14 were used. Mediation analysis was used to consider, at each age, the extent to which the association between living in a one- or two-adult household and BMI was mediated through income overall and stratified by sex. To assess the robustness of the mediation analysis estimates, we used both E-values and multiple confounder adjustment.

RESULTS

At ages 3 and 5, there was no direct or indirect effect of family structure mediated by income on BMI. Between the ages of 7 and 11, the overall proportion of the association mediated vastly increased, from 19.70% at age 7 up to 42.70% at the age of 11. The E-values show that substantial unmeasured confounder associations would be needed to fully explain away the conclusions from the mediation analysis. Results remained significant when models were additionally adjusted for geographic region, the main respondent's (usually the mother's) highest educational attainment, and ethnicity.

CONCLUSIONS

An increasing proportion of the association between family structure and BMI is mediated by income as children grow older. The study focuses on the mediating role of income between family structure and BMI using the available data as an empirical application of the potential impact of income as mediator in the causal pathway.

Family Mealtime Communication in Single- and Dual-Headed Households Among Hispanic Adolescents With Overweight and Obesity

OBJECTIVE

To investigate the association of adolescent self-report of family mealtime communication on obesity-related behaviors in single- and dual-parent households and by sex in a sample of overweight and obese Hispanic adolescents.

DESIGN

Cross-sectional analysis of a randomized control trial SETTING: Eighteen middle schools in Miami-Dade County, Florida.

PARTICIPANTS

Two-hundred and eighty Hispanic seventh- and eighth-grade students MAIN OUTCOME MEASURES: Physical activity, fruit and vegetable intake, and added sugar intake.

ANALYSIS

Structural equation modeling.

RESULTS

The findings indicate that mealtime communication was associated with fruit and vegetable consumption in boys (β = .30; P = .001; 95% confidence interval [CI], 0.52-2.68) and physical activity in girls (β = .26; P = .010; 95% CI, 0.16-1.30). Moreover, a single-parent household was associated with dietary consumption in boys (fruit and vegetable intake [β= .18; P = .039; 95% CI, 0.02-2.60] but had a moderating effect on fruit and vegetable consumption in girls (β = .21; P = .015; 95% CI, 0.14-2.19).

CONCLUSIONS AND IMPLICATIONS

Family mealtime communication may impact dietary and physical activity outcomes in Hispanic adolescents with overweight and obesity, but differentially across gender and household parent makeup. These findings, together with the prevalence of single parents, point to the importance of targeting Hispanic single parents as agents of change to promote healthy lifestyle behaviors in their children via positive mealtime interactions.

Associations between the Neighborhood Social Environment and Obesity Among Adolescents: Do Physical Activity, Screen Time, and Sleep Play a Role?

This study examines: (1) the association between the neighborhood social environment and obesity among adolescents, (2) whether physical activity, screen time, and short sleep mediates this association, and (3) examine sex differences. Participants (n=12,692; age 11-19 years old) came from Waves I and II of the National Longitudinal Study of Adolescent to Adult Health. Neighborhood social disorganization and socioeconomic status (NSES) measures were associated with obesity adjusting for sex, race, age, parental education, and urbanicity. Screen time mediated NSES and obesity. Very short sleep duration (<6 hours) mediated social disorganization and obesity among females only. Findings suggest improving neighborhood social conditions may reduce the risk for obesity.

Different types of parental stress and childhood obesity: A systematic review of observational studies

Different types of parental stress may influence children's health behaviors and weight. The aim of this review was to systematically examine the relationships between parental stress and child obesity. We reviewed 27 studies published through December 2018 and classified parental stress as parents' general stress, parenting role stress, and life event stress. There were positive relationships of parents' general stress and parenting role stress with child obesity among families with younger children and in longitudinal studies. The relationship between life event stress and child obesity differed by measures. We found that parenting role stress may be associated with unhealthy parenting practices. Contextual factors such as children's and parents' sex, race or ethnicity, socioeconomic status, and family structure appeared to play a moderating role in the relationship between parents' stress and child obesity, which warrant cautious interpretation. Our recommendations for future research include clarifying further the types of parental stress that influence child obesity, evaluating long-term relationship between parental stress and child obesity, and identifying possible mediating factors to support the relationship between parents' stress and child obesity. Researchers may also consider developing stress management programs for parents to address child obesity.

Race, Gender, Family Structure, Socioeconomic Status, Dietary Patterns, and Cardiovascular Health in Adolescents

BACKGROUND

Dietary patterns represent a broad picture of food and nutrient consumption and may be more predictive of health outcomes than individual foods and nutrients.

OBJECTIVE

We investigated the relations among race, gender, family structure, parental socioeconomic status (SES), dietary patterns, and cardiovascular disease (CVD) profiles among adolescents in the southeastern region of the United States.

METHODS

A total of 743 adolescents from a cross-sectional study were divided into 4 dietary pattern groups by K-means cluster analysis. Multinomial logistic regression was performed to determine the relations among the parental SES, family structures, and dietary patterns of the adolescents. Associations between dietary patterns and CVD profiles were analyzed by multiple linear regression.

RESULTS

Four dietary patterns were derived: "healthy" (17%), "snacks and sweets" (26%), "processed meat" (20%), and "sugar-sweetened beverage (SSB) and fried food" (37%). Whites and females were more likely to have a "healthy" dietary pattern (Ps < 0.001). There were significant race/ethnicity differences in family structures, SES, and dietary patterns (Ps < 0.05). In whites, higher mother's education and father's education and occupation were associated with greater likelihood of a "healthy" dietary pattern (Ps < 0.05). Stay-at-home mother was associated with less likelihood of an "SSB and fried food" pattern (P = 0.023). In blacks, higher mother's occupation, father's education, and living with both parents were associated with more likelihood of a "healthy" dietary pattern (Ps < 0.05). Stay-at-home father was associated with less likelihood of the "snacks and sweets" (P = 0.025) and "SSB and fried food" dietary patterns (P = 0.044). Overall, adolescents with poor dietary patterns exhibited higher percentage body fat, waist circumference, systolic blood pressure, fasting insulin, homeostasis model assessment of insulin resistance, C-reactive protein, and total triglyceride (Ps < 0.05).

CONCLUSIONS

Our data suggest that family structure, parental working status, and SES are associated with the diet quality in adolescents. Moreover, "snacks and sweets," "processed meat," and "SSB and fried food" dietary patterns are all associated with worse CVD risk profiles.

Association between parents' work hours and nutrient inadequacy in Japanese schoolchildren on weekdays and weekends

OBJECTIVES

Evidence is sparse concerning whether the nutrient intake in schoolchildren differs according to parents' work hours. The aim of this study was to investigate the relationship between parents' work hours and nutrient inadequacy among Japanese primary schoolchildren using dietary reference intakes on days with and without a school lunch.

METHODS

Participants included 10- to 11-y-old children in grade 5 from 19 public primary schools in four prefectures of east Japan. Data for 699 children were analyzed. Participants completed 24-h dietary records with photographs of their meals for 4 d consecutively, which included of 2 d of weekdays and 2 d of weekends. Their mothers' and fathers' work hours were obtained from questionnaires that were completed by the participants' guardians. Logistic regression analyses were used to estimate the odds ratios for whether participants had poor nutrient intake, with adjustment for confounders.

RESULTS

Children whose mothers worked ≥40 h/wk had significantly higher rates of nutrient shortages for vitamins A, E, K, and B₆, pantothenic acid, potassium, magnesium, and iron (P = 0.007, 0.003, 0.007, 0.023, 0.021, 0.045, 0.004, and 0.009, respectively) than those in the 0 h/wk group. These differences were not significant based on fathers' working hours, with the exception of vitamin A (≥40 versus 0-39 h/wk, P = 0.032). Additionally, nutrient shortages for children were more pronounced on weekdays than on weekends.

CONCLUSIONS

This evidence revealed the necessity to improve nutrition intake in children whose mothers work more than statutory working hours, which would enable children to have adequate nutrient intake, especially on weekdays.

Children of single-parent households are at a higher risk of obesity: A systematic review

The goal of this systematic review was to evaluate whether children living in single-parent households have a higher risk of obesity. Of the 539 studies identified using keywords, a total of 10 original studies met the inclusion criteria for this review. The outcome measures included objective assessment of adiposity (weight or body mass index (BMI)), dietary consumption, physical activity, and/or obesogenic behaviors (bedroom television, elevated television viewing time, insufficient physical activity, and infrequent family meals). Overall, the studies found higher BMIs and obesogenic behaviors in children of single-parent households. Characteristics identified with this association is comprised of being most prevalent among girls and Black children. Possible explanations for this association include single-parent households having higher time demands due to the lack of shared household responsibilities. Subsequently, a reduction of homemade meals, shared family meals, and physical activity can occur. Also, lower incomes and higher instability related to living transitions may be other possible challenges experienced in single-parent households. Based on the limited number of studies found, further research of the obesity risk in children from single-parent families is recommended. The findings can help provide clinicians and public health programs with a better understanding of how to effectively target family-based interventions for this population.

Moderation of associations between maternal parenting styles and Australian pre-school children’s dietary intake by family structure and mother’s employment status

Objective

To examine associations between maternal parenting style and pre-school children’s dietary intake and to test whether perceived maternal time pressures, parenting arrangements and employment status influence these relationships.

Design

This cross-sectional study examined mothers’ reports of their child’s frequency of consumption of eight food and drink groups, including sugar-sweetened beverages (SSB), unhealthy snacks, takeaway foods, fruit and vegetables. Parenting styles were classified as authoritative, authoritarian, permissive or disengaged using two parenting dimensions (warmth and control). The moderating roles of parenting arrangements, indexed by number of parents in the home and maternal employment status, were assessed. Associations were examined using multinomial regression.

Setting

Data were from the infant and child cohorts in the Longitudinal Study of Australian Children.

Participants

Children aged 4–5 years from both cohorts (infant:n3607; child:n4661) were included.

Results

Compared with children of disengaged mothers, children of authoritative mothers consumed most unhealthy foods less frequently, and fruit and vegetables more frequently. Results suggested parenting arrangements and mothers’ working status may moderate associations between parenting styles and SSB, takeaway foods, takeaway snacks and fruit consumption.

Conclusions

These findings suggest that authoritative parenting style is associated with a higher consumption of fruit and vegetables and a lower consumption of unhealthy foods among children. However, parenting arrangements and the mothers’ working status may influence these relationships. Further research is required to examine the influence of other potential moderators of parenting style/food consumption relationships such as household time and resource limitations.

Dual Versus Single Parental Households and Differences in Maternal Mental Health and Child's Overweight/Obesity

Objectives Mothers report higher levels of psychological stress than fathers. s. Psychological stress is posited to influence parenting practices that could increase children's obesity risk. However, previous studies have not investigated several aspects of maternal mental health and the moderating role of household structure on children's obesity risk. The objective was to investigate associations of maternal mental health with child obesity risk, and whether these associations differed by household structure (single-parent vs. dual parent/multigenerational). Methods Mothers and their 8-12 year old children (N = 175 dyads) completed baseline questionnaires on mothers' mental health and child anthropometrics. Separate logistic regressions assessed associations of standardized maternal mental health indicators with the odds of child overweight/obesity, controlling for child age, and women's BMI, age, education, employment status, and annual income. Household structure was investigated as a moderator of these relationships.Results There were no statistically significant relationships between maternal mental health characteristics and odds of child overweight/obesity. Among single mothers only, greater anxiety was associated with higher risk of child overweight/obesity [OR (95% CI) = 3.67 (1.27-10.62); p = 0.0163]; and greater life satisfaction was marginally associated with lower risk of child overweight/obesity [OR (95% CI) = 0.44 (0.19-1.01); p = 0.0522]. Mothers' life satisfaction may lower risk for their children's overweight/obesity, whereas higher anxiety may increase this risk, particularly among children living in single-mother households. Conclusions for Practice Future interventions could increase resources for single mothers to buffer the effects of stress and lower pediatric obesity risk.

The Association of Grandparent Care with Childhood Overweight and Obesity in Chinese American Families

BACKGROUND

Grandparents are often the caretakers of children in Chinese American families. Studies have shown that Chinese grandparents underestimate the weight of their grandchildren and associate food with increased height and strength. This study examines the association of grandparental care with weight status in Chinese American children and adolescents.

METHODS

This is a cross-sectional study of 12,029 Chinese American pediatric patients ages 2-19 at a community health center in New York City in 2015. Grandparental care was defined as child care provided by at least one grandparent. Multivariable logistic regression was conducted to assess for association between having a grandparent caretaker and weight status in the age groups 2-5, 6-11, and 12-19 while adjusting for sex, place of birth, neighborhood poverty, and two-parent households.

RESULTS

Approximately 12% of Chinese American children in this population had a grandparent caretaker. Children and adolescents with grandparent caretakers are more likely to be overweight than their counterparts with no grandparent caretakers at ages 6-11 (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.23-1.79) and ages 12-19 (OR: 1.54; 95% CI: 1.18-2.02). No association was found between grandparental care and overweight in ages 2-5 nor with obesity in any age group.

CONCLUSIONS

Grandparental care is associated with the weight of school-age children and adolescents. Targeted education on appropriate nutrition for the child's age is needed for grandparents who take care of children.

School-Level Body Mass Index Shapes Children's Weight Trajectories

BACKGROUND

Embedded within children's weight trajectories are complex environmental contexts that influence obesity risk. As such, the normative environment of body mass index (BMI) within schools may influence children's weight trajectories as they age from kindergarten to fifth grade.

METHODS

I use 5 waves of the ECLS-K-Kindergarten Class 1998-1999 data and a series of multilevel growth models to examine whether attending schools with higher overall BMI influences children's weight status over time.

RESULTS

Results show that, net of child, family, and school sociodemographic characteristics, children who attend schools with higher rates of obesity have increased weight compared to children who attend schools with lower rates of obesity, and this effect increases annually.

CONCLUSIONS

Findings indicate that the overall weight status of schools influence child obesity, and further speak to the importance of school-based intervention programs.

The impact of maternal employment on children's weight: Evidence from the UK

Previous research shows that maternal employment is associated with higher children’s body mass index (BMI). Using a large UK longitudinal birth cohort study of almost 20,000 children, we examine the effect of maternal employment during childhood (to age 14) on children’s weight. We address the endogeneity of maternal employment by estimating household fixed effects models. We find that maternal employment has a positive effect on children’s BMI and therefore on excess weight, and this is particularly the case for single mothers. We investigate potential pathways, including children’s sedentary behavior and healthy eating behaviors, and find evidence of more sedentary behavior and poorer eating habits amongst children whose mothers are in employment. This is consistent with higher BMI levels amongst these children.

•

First paper providing causal evidence on the effect of maternal employment on children’s weight in a UK context, for a large contemporaneous cohort of children through childhood and early adolescence, one that has grown up in the midst of the childhood ‘obesity epidemic’.

•

Maternal employment has a positive effect on children’s BMI and therefore on excess weight, and this is particularly the case for single mothers.

•

Consistent with higher levels of excess weight, children of working mothers are more likely to be sedentary and less likely to eat breakfast regularly.

Friday Night Is Pizza Night: A Comparison of Children's Dietary Intake and Maternal Perceptions and Feeding Goals on Weekdays and Weekends

Childhood obesity is a serious issue in the U.S. While obesity is the result of a multitude of factors, a great deal of research has focused on children's dietary intake. While children's eating patterns vary throughout the week, not much else is known about weekday-weekend differences. Therefore, the current study examined differences in the frequency and portion size of school-age children's consumption of common foods and beverages, as well as mothers' perceptions of those items and their child feeding goals, on weekdays and weekends. A total of 192 mothers of children aged 7 to 11 were recruited through Amazon's Mechanical Turk. Results showed a consistent pattern of more frequent consumption and larger portions of unhealthy foods and beverages on weekends. This aligned with mothers' perceptions of those foods and beverages as weekend items, as well as their feeding goals of health and price being less important on weekends. It is quite possible that weekends are viewed as having less structure and facilitate schedules that allow children to consume more meals away from home. These findings shed light on additional risk factors in children's eating patterns and highlight the serious implications that day of the week can have on childhood obesity.

Familial psychosocial risk classes and preschooler body mass index: The moderating effect of caregiver feeding style

BACKGROUND

Early child weight gain predicts adolescent and adult obesity, underscoring the need to determine early risk factors affecting weight status and how risk factors might be mitigated. Socioeconomic status, food insecurity, caregiver depressive symptomology, single parenthood, and dysfunctional parenting each have been linked to early childhood weight status. However, the associations between these risk factors and children's weight status may be moderated by caregiver feeding styles (CFS). Examining modifiable factors buffering risk could provide key information to guide early obesity intervention efforts.

METHODS

This analysis used baseline data from the Growing Healthy project that recruited caregivers/child dyads (N = 626) from Michigan Head Start programs. Caregivers were primarily non-Hispanic white (62%) and African American (30%). After using latent class analysis to identify classes of familial psychosocial risk, CFS was tested as a moderator of the association between familial psychosocial risk class and child body mass index (BMI) z-score.

RESULTS

Latent class analysis identified three familial psychosocial risk classes: (1) poor, food insecure and depressed families; (2) poor, single parent families; and (3) low risk families. Interactive effects for uninvolved feeding styles and risk group indicated that children in poor, food insecure, and depressed families had higher BMI z-scores compared to children in the low risk group. Authoritative feeding styles in low risk and poor, food insecure, and depressed families showed lower child BMI z-scores relative to poor, single parent families with authoritative feeding styles.

CONCLUSIONS

Uninvolved feeding styles intensified the risk and an authoritative feeding style muted the risk conferred by living in a poor, food-insecure, and depressed family. Interventions that promote responsive feeding practices could help decrease the associations of familial psychosocial risks with early child weight outcomes.

Utility of a brief index to measure diet quality of Australian preschoolers in the Feeding Healthy Food to Kids Randomised Controlled Trial

AIM

The aim was to evaluate the utility of a brief dietary intake assessment tool in measuring nutritional adequacy of preschoolers and differences in food and nutrient intake between quartiles stratified by overall diet quality.

METHODS

Dietary intakes of preschoolers (n = 146) from the Feeding Healthy Food to Kids trial were reported by parents/caregivers using a 120-item food frequency questionnaire (FFQ). Diet quality was assessed using the Australian Recommended Food Score for Preschoolers. Analyses were performed using Kruskal-Wallis one-way analysis of variance, adjusted for Type 1 error. Participants were grouped into quartiles by total food score for comparison of subscale scores, food groups and nutrient intakes from the FFQ.

RESULTS

Participants who scored less than the median total food score of 36 were more likely to have suboptimal micronutrient intakes. Median fruit (9 vs 5, P < 0.0001) and vegetable (14 vs 7, P < 0.0001) subscale scores for preschoolers in the highest quartile were significantly higher than the lowest quartile, indicating much greater fruit and vegetable variety. Statistically significant differences in diet quality score by quartiles (P < 0.05) were found for total energy and percentage energy from core foods, protein, fibre and 11 micronutrients.

CONCLUSIONS

The Australian Recommended Food Score for Preschoolers is a practical brief diet quality assessment tool to measure food variety and nutritional adequacy in Australian preschoolers. Stratifying children by baseline diet quality in future nutrition interventions is recommended in order to identify those who are likely to benefit or require more targeted approaches to address specific nutritional needs in order to optimise food and nutrient intakes.

Association Between Age and Obesity Over Time

BACKGROUND AND OBJECTIVES

A decline in the prevalence of obesity among 2- to 5-year-olds in the United States was recently reported. This decline may be due to changes in the population composition of children over time or may be a consequence of changes in how strongly individual- or family-level factors are linked to childhood obesity. We applied regression decomposition techniques to identify the sources of the decline.

METHODS

We used data from the 2003-2004 and 2011-2012 NHANES restricted to 2- to 5-year-old children and Blinder-Oaxaca regression decomposition techniques to partition the decline in early childhood obesity into 2 components: changes resulting from (1) how demographic, economic, and health characteristics of children have changed over this period (ie, changes in population composition) and (2) changes in how these demographic, economic, and health factors are associated with obesity (ie, changes in associations).

RESULTS

The obesity rate was lower in 2011-2012 than it was in 2003-2004 mainly because obesity was strongly and positively associated with age in 2003-2004 (ie, older children were more likely to be obese than younger children) but not in 2011-2012 (ie, older children were not more likely to be obese than younger children).

CONCLUSIONS

If the weaker association between age and obesity we observed for this cohort of 2- to 5-year-old children in 2011-2012 persists for subsequent cohorts of young children, the obesity rate for young children will remain at or near the lower rate seen in 2011-2012.

Maternal correlates of body mass index in American Indian/Alaska Native and White adolescents: Differences between mother/son and mother/daughter pairs

INTRODUCTION

Obesity rates for American Indian and Alaska Native (AI/AN) adolescents are among the highest in the US. However, little is known about the influence of maternal correlates on adolescent body mass index (BMI), and the extent to which the size and significance of these correlates vary by adolescent sex and race.

METHODS

We conducted a cross-sectional analysis with a sample of 531 AI/AN and 8896 White mother/adolescent pairs from Wave 1 of the National Longitudinal Study of Adolescent to Adult Health. We used generalized estimating equations to measure the association of maternal educational attainment, marital status, employment status, obesity status, and adolescent BMI of AI/AN and White adolescents, while controlling for adolescents' demographic and behavioral covariates. We sought to determine whether the size and statistical significance of maternal correlates differed by race, and between mother/son and mother/daughter pairs.

RESULTS

The strength and statistical significance of maternal correlates varied between mother/son and mother/daughter pairs in both races. However, we did not find effect modification by race. Maternal obesity showed the strongest effect on adolescent BMI in all mother/adolescent pairs.

CONCLUSION

Our findings suggest that maternal factors are critical in the transmission of obesogenic behaviors from one generation to the next, and their effects vary between mother/son and mother/daughter pairs, and are similar for AI/ANs and Whites. We encourage future work aimed at preventing adolescent obesity to investigate causal pathways between maternal correlates and adolescent BMI.

Características familiares relacionadas con el estado nutricional en escolares de la ciudad de Cartagena

<p>Determinar las características familiares asociadas al estado nutricional de los niños escolarizados de la ciudad de Cartagena. <strong></strong></p><p><strong>Método</strong> Estudio transversal, población 104 384 niños de 6 a 10 años de la ciudad de Cartagena. Nivel de confianza 95 %, prevalencia 5.8 %, error 2 %. La muestra fue de 544 escolares. Se seleccionaron los colegios por afijación proporcional en cada una de las tres localidades de la cuidad, para un total de 21 colegios, posteriormente se seleccionaron, aleatoriamente los salones y de estos los niños hasta completar la muestra. Los instrumentos utilizados fueron la ficha y el APGAR familiar, para valorar las características familiares así como su funcionalidad y para el estado nutricional se tomaron las medidas antropométricas y se evaluaron en el programa WHO Anthro Plus. La información se procesó en el paquete estadístico Epi info 7.<strong></strong></p><p><strong>Resultados </strong>El 53,9 % de los escolares presentó un adecuado estado nutricional mientras que el 46,1 % estaban malnutridos. Las características familiares asociadas a la malnutrición infantil  por exceso fueron el número de integrantes OR 0.65 (IC: 0,4-0,9) y los ingresos familiares OR 0,53 (IC: 0,3-0,7). Por su parte a la malnutrición por déficit se asoció el ingreso familiar OR 2,08 (IC: 1,1-3,9). <strong></strong></p><p><strong>Conclusión </strong>Las variables que mostraron asociación con el estado nutricional fueron: ingresos económicos menores/iguales al salario mínimo y  número de integrantes de la familia.</p>

Family Factors and Body Mass Index Among Korean-American Preschoolers

PURPOSE

The purpose of this study was to examine family factors related to BMI z-scores and overweight/obesity among Korean-American (KA) preschoolers.

METHODS

A cross-sectional study was conducted with 104 KA preschoolers and their mothers in the Chicago metropolitan area. KA mothers completed questionnaires and their preschool-age children's weights and heights were measured. Hierarchical multiple linear regression and multiple logistic regression were performed.

RESULTS

Twenty-two percent of preschoolers were overweight or obese (BMI ≥85th percentile). Family factors explained 30% of the variance in the children's BMI z-scores, with parenting feeding style and family functioning contributing most. In logistic regression, children were more likely to be overweight/obese if: a family had more children, the mother perceived her child as overweight/obese, and the family had regular child routines.

CONCLUSION

Health care providers should consider the family as one unit of care and use that unit to implement culturally appropriate childhood overweight/obesity prevention for Korean-American preschool-aged children. Parental feeding style and parents' attitudes about child weight should be considered when advising Korean-Americans about reducing children's overweight/obesity.

Prenatal parental separation and body weight, including development of overweight and obesity later in childhood

Background

Early parental separation may be a stress factor causing a long-term alteration in the hypothalamic-pituitary-adrenal-axis activity possibly impacting on the susceptibility to develop overweight and obesity in offspring. We aimed to examine the body mass index (BMI) and the risk of overweight and obesity in children whose parents lived separately before the child was born.

Methods

A follow-up study was conducted using data from the Aarhus Birth Cohort in Denmark and included 2876 children with measurements of height and weight at 9-11-years-of-age, and self-reported information on parental cohabitation status at child birth and at 9-11-years-of-age. Quantile regression was used to estimate the difference in median BMI between children whose parents lived separately (n = 124) or together (n = 2752) before the birth. We used multiple logistic regression to calculate odds ratio (OR) for overweight and obesity, adjusted for gender, parity, breast feeding status, and maternal pre-pregnancy BMI, weight gain during pregnancy, age and educational level at child birth; with and without possible intermediate factors birth weight and maternal smoking during pregnancy. Due to a limited number of obese children, OR for obesity was adjusted for the a priori confounder maternal pre-pregnancy BMI only.

Results

The difference in median BMI was 0.54 kg/m² (95% confidence intervals (CI): 0.10; 0.98) between children whose parents lived separately before birth and children whose parents lived together. The risk of overweight and obesity was statistically significantly increased in children whose parents lived separately before the birth of the child; OR 2.29 (95% CI: 1.18; 4.45) and OR 2.81 (95% CI: 1.05; 7.51), respectively. Additional, adjustment for possible intermediate factors did not substantially change the estimates.

Conclusion

Parental separation before child birth was associated with higher BMI, and increased risk of overweight and obesity in 9-11-year-old children; this may suggest a fetal programming effect or unmeasured difference in psychosocial factors between separated and non-separated parents.

Telephone-based adiposity prevention for families with overweight children (T.A.F.F.-Study): one year outcome of a randomized, controlled trial

The one-year outcome of the randomized controlled T.A.F.F. (Telephone based Adiposity prevention For Families) study is presented. Screening of overweight (BMI-SDS > 90th centile) children 3.5–17.4 years was performed via the German CrescNet database, and candidates were randomized to an intervention group (IG) and control group (CG). The intervention consisted of computer-aided telephone counselling for one year, supported by mailed newsletters. The primary endpoint was change in BMI-SDS; secondary endpoints were eating behavior, physical activity, media consumption, quality of life. Data from 289 families (145 IG (51% females); 144 CG (50% females)) were analyzed (Full Analysis Set: FAS; Per Protocol Set: PPS). Successful intervention was defined as decrease in BMI-SDS ≥ 0.2. In the FAS, 21% of the IG was successful as compared to 16% from the CG (95% CI for this difference: (−4, 14), p = 0.3, mean change in BMI-SDS: −0.02 for IG vs. 0.02 for CG; p = 0.4). According to the PPS, however, the success rate was 35% in the IG compared to 19% in the CG (mean change in BMI-SDS: −0.09 for IG vs. 0.02 for CG; p = 0.03). Scores for eating patterns (p = 0.01), media consumption (p = 0.007), physical activity (p = 9 × 10⁻⁹), quality of life (p = 5 × 10⁻⁸) decreased with age, independent of group or change in BMI-SDS. We conclude that a telephone-based obesity prevention program suffers from well-known high attrition rates so that its effectiveness could only be shown in those who adhered to completion. The connection between lifestyle and weight status is not simple and requires further research to better understand.

Overweight and obesity among low-income women in rural West Virginia and urban Los Angeles County

We described the prevalence of overweight and obesity among low-income women in rural West Virginia (WV) and urban Los Angeles County (LA County). Both communities participated in the national Communities Putting Prevention to Work program during 2010-2012. In each community, we completed health assessments on adult women recruited from public-sector clinics serving low-income populations. All participants answered survey questions regarding socio-demographics and diets. In both jurisdictions, we assessed obesity using objectively measured height and weight (calculated BMI). As part of each community case study, we performed multivariable regression analyses to describe the relationships between overweight and obesity and selected covariates (e.g., dietary behaviors). Overweight and obesity were prevalent among low-income women from WV (73%, combined) and LA County (67%, combined). In both communities, race and ethnicity appeared to predict the two conditions; however, the associations were not robust. In LA County, for example, African American and Hispanic women were 1.4 times (95% CI=1.12, 1.81) more likely than white women to be overweight and obese. Collectively, these subpopulation health data served as an important guide for further planning of obesity prevention efforts in both communities. These efforts became a part of the subsequent Community Transformation Grants portfolio.

Obesity and type 2 diabetes in children: epidemiology and treatment

The incidence of overweight and obesity among children has increased dramatically in recent decades, with about one-third of children in the U.S. currently being either overweight or obese. Being overweight in early childhood increases risk for later obesity. There is evidence for the efficacy of family-based behavioral treatment to control weight and improve health outcomes. Obesity-related health risks have been documented, including metabolic syndrome. There is also increasing incidence of type 2 diabetes (T2D) among youth in recent years, with obesity and family history of T2D generally present. Lower income and ethnic minority status are associated with both obesity and T2D in youth. Most youth with T2D do not achieve optimal glycemic control, and are at high risk for later health complications. Obesity and T2D represent significant public health issues with potentially great personal and societal cost. Research addressing the prevention of obesity and T2D among youth is urgently needed.

Parental marital status and childhood overweight and obesity in Norway: a nationally representative cross-sectional study

OBJECTIVE

Sociodemographic changes in Norway and other western industrialised countries, including family structure and an increasing proportion of cohabiting and divorced parents, might affect the prevalence of childhood overweight and obesity issues. We aimed to examine whether parental marital status was associated with general and abdominal obesity among children. We also sought to explore whether the associations differed by gender.

DESIGN

Cross-sectional.

SETTING

127 primary schools across Norway.

PARTICIPANT

3166 third graders (mean age 8.3 years) participating in the nationally representative Norwegian Child Growth Study in 2010.

MEASUREMENTS

Height, weight and waist circumference were objectively measured. The main outcome measures were general overweight (including obesity; body mass index ≥25 kg/m(2)) using International Obesity Task Force (IOTF) cut-offs and abdominal obesity (waist-to-height ratio ≥0.5) by gender and parental marital status. Prevalence ratios, adjusted for possible confounders, were calculated by log-binomial regression.

RESULTS

General overweight (including obesity) was 1.54 (95% CI 1.21 to 1.95) times more prevalent among children of divorced parents compared with children of married parents, and the corresponding prevalence ratio for abdominal obesity was 1.89 (95% CI 1.35 to 2.65). Formal tests of the interaction term parental marital status by gender were not statistically significant. However, in gender-specific analyses the association between parental marital status and adiposity measures was only statistically significant in boys (p=0.04 for general overweight (including obesity) and p=0.01 for abdominal obesity). The estimates were robust against adjustment for maternal education, family country background and current area of residence.

CONCLUSIONS

General and abdominal obesities were more prevalent among children of divorced parents. This study provides valuable information by focusing on societal changes in order to identify vulnerable groups.