Prevention of Overweight and Obesity among Children and Youth in Local Government Health Policy Programs in between 2009-2015

Prevention of overweight and obesity undertaken by local government units in Poland

Background: In recent decades, many countries of the WHO European Region experienced an increase in overweight and obesity indicators. In 46 countries of the Region, more than 50% of adults are overweight or obese. In Poland in 2009, over 61% of men and almost 45% of women weighed too much, with over 62% and almost 46%, respectively, at the end of 2014. Objective: The objective of the studies described is to present developed and implemented health policy programmes concerning prevention of overweight and obesity in Poland between 2009 and 2014 financed by local government units. Methods: Data from annual reports submitted to the Minister of Health about health policy programmes implemented by local government units was used in the study. Results: In 2009-2014, local government units of all levels completed 279 programmes. The most programmes were completed by municipalities, followed by counties. The costs incurred by voivodeships to implement programmes were significantly larger than those incurred by municipalities and counties. The most programmes were completed in the Zachodniopomorskie and Mazowieckie voivodeships, whereas the fewest were completed in the Lubuskie and Podlaskie voivodeships. Conclusion: There was only a limited involvement of local government units in fighting overweight and obesity. In some voivodeships the actual health needs of local communities regarding the prevention of overweight and obesity had not been given due consideration. It is necessary for local government units to adopt and maintain measures aimed at fighting overweight and obesity by increasing the number of health policy programmes and including a larger population within the programmes.

Obesity in children and adolescents worldwide: current views and future directions--Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

Recently, overweight and obesity among adolescents have become a growing concern, necessitating a comprehensive understanding of both preventive and effective management strategies. The present study aimed to assess knowledge and practices on the prevention of overweight and obesity among secondary school adolescents in Morogoro Municipality. An institutional‐based cross‐sectional study was conducted from April to May 2023 among 253 randomly selected students studying in Form 1, Form 2, and 3 classes. Data were collected through face‐to‐face interviews using a semi‐structured questionnaire. Statistical Package for Social Science (SPSS) Version 25 was used for descriptive statistics to describe the study variables and logistic regression to identify factors associated with knowledge and practices on prevention of overweight and obesity. Among 253 respondents, 129 (51.0%) were females. Approximately 30% (n = 75) of the students mentioned vegetables and fruits as healthy foods, while 20.6% (n = 57) of the students were not aware of unhealthy foods. Despite the small number of students knowing that fruits and vegetables are healthy, only 20.2% (n = 51) and 43.5% (n = 110) reported consuming them 7 days a week, respectively. Most of the participants (82.2%, n = 208) were aware of the causes of overweight and obesity, and increasing physical activity (51.8%, n = 131) was the most cited preventive measure. Being in a higher level of study, that is, Form 2 (AOR 9.33, 95% CI: 2.71–32.10) and Form 3 (AOR 5.02, 95% CI: 1.38–18.25) were significantly associated with increased knowledge and practices on prevention of overweight and obesity. Conclusively, knowledge and practices regarding the prevention of obesity and overweight among secondary school adolescents vary significantly. While some aspects showed good knowledge and practices, others were less understood and practiced. This suggests a need for implementing a comprehensive community‐based health education program focusing on adolescents as a window of opportunity for current and future prevention of overweight, obesity, and associated comorbidities.

Preventing childhood obesity: establishing healthy lifestyle habits in the preschool years

BackgroundGreater understanding about the prevention and treatment of overweight and obesity in preschool children within public health care is needed. This study assessed the impact of The First Steps module in routine primary health care including mapping of height/weight and diet followed by parental counselling of healthy habits on overweight and obesity in children aged 2 to 7 years. Further, we explored the experiences of public health nurses (PHNs) with the module.MethodsBody weight and height obtained in 2014 and 2016 were extracted retrospectively for 676 children from the health records of children at 2, 4, or 6 years of age in five child health centers in Southern Norway. Sex- and age-adjusted body mass index (BMI) z-scores and weight status classifications were calculated according to the International Obesity Task Force reference values. Impact was assessed as change in mean BMI z-scores for children with under-, normal-, and overweight, respectively, and as proportion of children with overweight and obesity. In focus groups, PHNs described their experiences with the practical application of the module. Focus group transcripts were analyzed using Braun and Clarke’s thematic analysis.ResultsMean BMI z-scores decreased from 2014 to 2016 in overweight children (− 0.26) and increased in children with under- (0.63) and normal weight (0.06), whereas the proportion of children with overweight and obesity was stable. PHNs believed that the module provides them with new tools that are useful for addressing the intricacies of childhood obesity. They described counseling sessions with families as “moving upstream in a river” and that overweight and obesity may be one of many complex challenges for these families.ConclusionsMean BMI z-score decreased in children with overweight during the 2 years after initiation of The First Steps module. PHNs considered the module as useful for addressing children’s overweight and obesity, which was perceived as one of several complex challenges for most of these families. Specialist and evidence-based support is needed to address overweight and obesity in children in primary care. Further research should focus on integrating the issues relating to overweight and obesity within other family problems.

Introduction: The scope and schedule of immunization in Poland is regulated by the Immunization Programme prepared and announced by the State Sanitary Inspector. There are two kinds of vaccines: compulsory vaccines, financed by the state budget at the disposal of the Minister of Health, and vaccines recommended by the central health authorities but financed by local governments within health policy programmes. Compulsory vaccines cover people up to 19 years of age and individuals at higher risk of infections. The public health programmes organized and financed by local governments play an important role in infectious disease control in the country. Objective: The objective of this study is to analyse health policy programmes including immunization programmes, which were developed, implemented and financed by local government units of all levels in Poland between 2016 and 2019. Material and Methods: This analysis covers data compiled by voivodes and submitted to the Minister of Health as annual information on public health tasks carried out by local government units. From the aggregate information, data on all health policy programmes conducted by individual local government units between 2016 and 2019, including immunization, were extracted and analysed. The data were obtained pursuant to the provisions of the act on access to public information. Results: In the analysed period, local government units implemented a total of 1737 health policy programmes that financed the purchase of vaccines, qualification tests for immunization and carrying out immunization by authorized medical entities. Among the vast majority of programmes, promotional activities were also implemented. Conclusions: In Poland, local governments are deeply engaged in the immunization of their citizens by organizing and financing specific health care programmes. These programmes are an essential addition to the state financial resources in infectious disease control. This engagement expresses local government maturity regarding the health needs of the population and public health measures. Communes are the most engaged units among all levels of local governments. It is probably due to close mutual communication between the people and local governments. The growing awareness of the important role of HPV immunization in the prevention of cervical cancer among local government units is reflected in the increase in the number of girls vaccinated against HPV and the increase in financial resources allocated for primary HPV prevention. The decrease in the number of people vaccinated against pneumococci may result from including pneumococcal vaccines in the compulsory immunization schedule.

Overweight and obesity in children is epidemic in North America and internationally. Approximately 22 million children under 5 years of age are overweight across the world. In the United States, the number of overweight children and adolescents has doubled in the last two to three decades, and similar doubling rates are being observed worldwide, including in developing countries and regions where an increase in Westernization of behavioral and dietary lifestyles is evident. Comorbidities associated with obesity and overweight are similar in children as in the adult population. Elevated blood pressure, dyslipidemia, and a higher prevalence of factors associated with insulin resistance and type 2 diabetes appear as frequent comorbidities in the overweight and obese pediatric population. In some populations, type 2 diabetes is now the dominant form of diabetes in children and adolescents. Disturbingly, obesity in childhood, particularly in adolescence, is a key predictor for obesity in adulthood. Moreover, morbidity and mortality in the adult population is increased in individuals who were overweight in adolescence, even if they lose the extra weight during adulthood. Although the cause of obesity in children is similar to that of adults (i.e., more energy in vs. energy utilized), emerging data suggest associations between the influence of maternal and fetal factors during intrauterine growth and growth during the first year of life, on risk of later development of adult obesity and its comorbidities. In addition, recent data suggest that varying biological responses in different racial/ethnic groups differently contribute to overweight, obesity, and their comorbidities. Although differences in gene-nutrient interactions may contribute, the role of varying cultural and socioeconomic variables still needs to be determined to understand these disparities. Novel approaches in the prevention and treatment of childhood overweight and obesity are urgently required. With the strong evidence that a lifecycle perspective is important in obesity development and its consequences, consideration must be focused on prevention of obesity in women of child-bearing age, excessive weight gain during pregnancy, and the role of breast-feeding in reducing later obesity in children and adults. Consideration must be given to family behavior patterns, diet after weaning, and the use of new methods of information dissemination to help reduce the impact of childhood obesity worldwide.

The prevalence of childhood overweight and obesity is increasing at dramatic rates in children and adolescents worldwide. Clinical practice guidelines (CPGs) are "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." Their objective is to provide explicit recommendations for clinical practice based on current evidence for best practice in the management of diseases. The aim of this study was to identify and assess the quality of CPGs for the prevention and treatment of obesity and overweight in childhood. We developed a search to identify CPGs published between January 1998 and August 2007. We considered for inclusion documents that provided recommendations for clinical practice referring to children and adolescents. Three independent appraisers assessed the quality of the1 CPGs using the AGREE (Appraisal of Guidelines Research and Evaluation) instrument. We identified 376 references and selected 22 for further assessment. The overall agreement among reviewers using the intraclass correlation coefficient was 0.856 (95% confidence interval [CI] 0.731-0.932). Six of the 22 initial guidelines were recommended and a further eight were recommended with conditions or provisos. We concluded that the number of documents with recommendations on the prevention and treatment of childhood obesity published during the 10-year study period was considerable, but only a few of them could be considered as high quality. CPGs were deficient in areas such as applicability, editorial independence and rigor in development. Due to the increasing burden of obesity among children and the potential for long-term comorbidities, clinicians need to be critical in assessing the rigor of how these are developed and their appropriateness for use in the clinician's own practice. There is a need to improve the methodology and the quality of CPGs on childhood obesity to help clinicians and other decision-makers to tackle this disease.

Childhood obesity is one of the most important problems of public health. Searching was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases, from January 2022 to June 2022, for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Five main topics were defined in a consensus join statement of the Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes and Polish Association for the Study on Obesity: (1) definition, causes, consequences of obesity; (2) treatment of obesity; (3) obesity prevention; (4) the role of primary care in the prevention of obesity; (5) Recommendations for general practitioners, parents, teachers, and regional authorities. The statement outlines the role of diet, physical activity in the prevention and treatment of overweight and obesity, and gives appropriate recommendations for interventions by schools, parents, and primary health care. A multisite approach to weight control in children is recommended, taking into account the age, the severity of obesity, and the presence of obesity-related diseases. Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education are effective in improving metabolic and anthropometric indices. More actions are needed to strengthen the role of primary care in the effective prevention and treatment of obesity because a comprehensive, multi-component intervention appears to yield the best results.

SummaryThe global obesity epidemic is associated with a sedentary lifestyle and diets rich in high-fat, high-energy foods. The potential role of fruit in preventing overweight and obesity is related to their relatively low energy density, high content of dietary fibre, and associated increasing satiety effect. The physical disruption of fruit is of considerable importance for satiety, as shown in studies in which fruit juices were less satisfying compared to sugar-equivalent intakes of purées and whole fruits. The potential role of fruit in the prevention of overweight and obesity may be connected to the dietary pattern of fruit intake, and with the possibility that fruit intake may substitute for other, more energy-dense foods. The majority of human prospective cohort studies in adults suggest a preventive effect of increased fruit intake on body weight gain; whereas a few studies have suggested the opposite, in the case of fruit juices. Prospective studies on children are few and inconclusive, but suggest associations between fruit intake and body weight that are related to the initial nutritional status. In behavioural intervention studies, subjects are often advised to undergo several changes towards a healthy diet and lifestyle, making it impossible to quantify the specific effect of fruit intake on body weight. In the few available intervention studies in adults, the study period was often too short to allow measures of body weight changes, and studies on overweight or obese subjects may not apply to subjects of normal weight. Intervention studies targeted at school children showed that such schemes can be effective in increasing fruit intake, but a convincing role for increased fruit intake in the prevention of overweight and obesity in children still needs to be established. The present evidence suggests that fruit consumption has a potential role in the prevention of overweight and obesity.

The rapid increase in overweight and obesity in children is a global public health problem. Interventions to reduce the prevalence of obesity before puberty are considered to be the most effective, but the results of trials are not consistent enough. We performed a meta-analysis of the efficacy of interventions to prevent or correct overweight and obesity in pre-pubertal children. Thirty-one Cochrane systematic reviews were analyzed, the results of 10 RCTs and two prospective comparative studies were extracted. All trials had an moderate or high risk of bias. According to the results of meta-analyzes, the prevention of overweight and obesity through recommendations of lifestyle modification is effective, the difference in a BMI decrease is -0.19, 95% CI [-0.35; -0.03], compared with the absence of intervention, in children 78 years old if applied within 24 years, but not within one year or less. The effect of non-drug interventions in children with overweight or obesity was not revealed.

The design, assessment, implementation, monitoring and evaluation of health policy programs Health policy programs (HPP) are since 2004 one of the available paths of implementing public health tasks by local government units (LGUs). The design, assessment, implementation, monitoring and evaluation of HPP is regulated by the Act on the provision of health services financed from public funds. In 2009 an obligation to receive opinions on HPP projects from the Agency for Health Technology Assessment and Tariffs (AOTMiT, agency) has been introduced. Considering the increasing trend of HPP projects numbers sent for opinionizing by the Agency, this form of healthrelated activity is more frequently and willingly chosen by local government units. The experience of both LGUs and the Agency related to previously executed HPP in Poland indicates, that despite statutory changes and attempts to clarify the entries regarding this form of public health tasks in Poland, questions and doubts regarding the design, assessment and implementation of HPP still occur. Another issue discussed by the experts is whether HPP should become a mandatory task of local governments or whether they only supplement the public health system. In addition, an important subject of discussion by public health experts concerns the evaluation of health policy programs. There is an emphasis on the importance of designing HPP in a way that ensures implementation and performing actions that bring long-term health effects in the population. It also seems important to support this form of local governments activity in both substantive and financial terms. The Agency is one of the institutions that has an important role to play in supporting local government units in developing HPP projects of the highest quality, which has a direct impact on their effectiveness, satisfying health needs and improving the health of the population.

Introduction: Adolescent obesity is a major public health challenge and it is a growing epidemic. Change in diet and physical inactivity are the key factors affecting weight among adolescents. Due to this, the prevalence of non communicable diseases and their risk factors are alarmingly high among them. To tackle this issue, early identification and effective health promotion strategies at a young age need to be adopted. Hence, there is a need for understanding the current trend in overweight and obesity among growing adolescents. Aim: To identify the lifestyle practices and to determine knowledge on prevention and control of overweight and obesity among overweight and obese adolescents in selected urban high schools at Mangaluru, Dakshina Kannada (D.K.), India. Materials and Methods: A descriptive cross-sectional study was conducted among adolescents at selected urban high schools of Mangaluru, D K, India. A sample of 360 adolescents were screened to identify the occurrence of overweight and obesity. Body Mass Index (BMI) was computed using the formula, BMI=weight (Kg)/ height (m2). A total of 65 overweight and obese adolescents were assessed for lifestyle practices and level of knowledge on prevention and control of overweight and obesity. Demographic proforma, a structured knowledge questionnaire, and a self-report lifestyle practice rating scale were used to collect data. Results: The occurrence of overweight and obesity among adolescents was 18%. According to their BMI status, 9.7% of adolescents were overweight and 8.3% of them were obese. Self- reported lifestyle practice scores depicted that most (86.2%) of the overweight and obese adolescents follow unhealthy lifestyle practices. Majority (66.1%) of the adolescents had only average knowledge on prevention and control of overweight and obesity. Conclusion: Though a maximum number of adolescents had average knowledge on prevention and control of overweight and obesity, unhealthy lifestyle practices are major risk factors for overweight and obesity among growing adolescents. Overweight and obese adolescents should strictly follow healthy lifestyle practices.

This article reports on a systematic review of articles on food labeling and the prevention of obesity and overweight, in the MEDLINE, EMBASE, Web of Knowledge, Cochrane Library Plus, Food Science and Technology Abstracts, LILACS, and CINAHL databases. The DeCS/MeSH descriptors were obesity and food labeling. 207 articles were retrieved. Using inclusion and exclusion criteria, 14 articles were selected: 11 were on food labeling and its impact on final food product consumption; 2 were on fast food establishments; 1 on sensory attributes as compared to health recommendations; and 2 on follow-up of interventions. Labeling has a positive effect on final food product consumption, in contrast with fast food restaurants. Sensory attributes were more effective than recommendations on the labels. Follow-up of interventions confirmed the long-term effect of the target interventions.