Childhood Obesity Rates Research Articles

Childhood obesity in the first 2000 days: A focus on primary health care in regional and rural Australia.

Rates of childhood obesity have increased in regional and rural areas in Australia over the past two decades. To review the current literature to gain an understanding of (i) ways to improve access to primary health care in the first 2000 days, (ii) models of care for delivering healthy lifestyle advice in the first 2000 days and (iii) the development of partnerships between health and social care services in the first 2000 days in rural and regional settings. Three literature reviews were undertaken. Results were limited to published, peer-reviewed literature from the past 5 years (2017-2022). Access to care could be improved through the expansion of telemedicine, nurse roles and community health worker models. A range of organisational and leadership factors facilitated the integration of health and social care services in the first 2000 days in rural areas with evidence of resultant positive health impacts. Telemedicine, the expansion of nursing roles and the implementation of a formalised community health worker model, may serve to improve access to primary health care for families in the first 2000 days; however, further research on particular models of care for delivering healthy lifestyle advice to rural and regional families is required. Policy-makers should consider the interdependent nature of increasing access to care, establishing best practice models of care and strengthening local partnerships to prevent and manage childhood obesity in the first 2000 days in rural and regional areas.

Navigating Personal, Social, and Environmental Obstacles to Healthy Lifestyle in Jordanian Adolescents

Objective: This study aimed to investigate barriers hindering healthy eating and physical activity among Jordanian adolescents.Methods: A random sample of 1040 adolescents (596 males and 444 females) aged 11–17 from various Jordanian schools participated. A nutritionist‐administered questionnaire assessed barriers.Results: The study unveiled diverse personal, social, and environmental barriers to healthy lifestyles. Notably, inadequate knowledge of nutrition and limited time for healthy food preparation due to homework emerged as key barriers to healthy eating. Conversely, insufficient exercise skills and reduced enjoyment of physical activity were the primary impediments to physical activity. Females perceived homework as a more substantial barrier than males (p = 0.027).Conclusion: These barriers may contribute to increasing childhood obesity rates in Jordan. Future interventions should prioritize creating a supportive environment that respects cultural norms, emphasizing high‐quality parks, nutrition and sports education, healthier food options, student motivation, and park visits. Community engagement is crucial for fostering healthier lifestyles among Jordanian youth.

A comorbidity survey of growth retardation and obesity in Chinese children aged 7-12 years and analysis of influencing factors

To investigate the changing trends and influencing factors for growth retardation-related obesity in Chinese children aged 7-12 years in 2010-2020, providing a basis for formulating physical health interventions for children. The data of body height and body mass index were collected from 16 289 children aged 7-12 years in the China Family Panel Studies (CFPS) in 2010-2020, and the trends of growth retardation, obesity, and growth retardation-related obesity in 2010-2020 were analyzed and compared between different sexes and between urban and rural areas. From 2010 to 2020, the overall rates of growth retardation and growth retardation-related obesity among children aged 7-12 years in China showed a declining trend (P<0.05). By gender and urban-rural classification, the overall obesity rate from 2010 to 2020 showed an increasing trend in all groups except for the rural male and female children groups, the rural children group, and the female children group (P<0.05). The prevalence rates of growth retardation, obesity, and growth retardation-related obesity in male children were significantly higher than those in female children, and similarly, these indicators were also significantly higher in rural children compared to urban children (P<0.05). Urban/rural residence, age, sex, and year were influencing factors for growth retardation and growth retardation-related obesity in children aged 7-12 years (P<0.05). The prevalence of growth retardation, obesity, and growth retardation-related obesity among Chinese children aged 7-12 years shows gender and urban-rural disparities, which highlights the needs for targeted interventions for boys and children in rural areas.

Visceral adiposity index, cardiorespiratory fitness, and fasting plasma glucose associations in adolescents.

The global rise in the prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents is partly linked to the increasing rates of childhood obesity and physical inactivity. To explore the independent relationships of visceral adiposity index (VAI) and cardiorespiratory fitness (CRF) with fasting plasma glucose (FPG) in adolescents. This descriptive cross-sectional study included 403 adolescents (202 boys and 201 girls) aged 11-19 years. Participants were evaluated for VAI, CRF, and FPG. Regression models, adjusted for age and maturity status, were used to assess the associations between VAI, CRF, and FPG. The prevalence of T2DM risk was 15.3% (girls = 7.4%; boys = 7.9%). In boys, high VAI was positively associated with FPG (β = 0.190, P = 0.009), while low CRF was negatively associated with FPG (β = -0.206, P = 0.010). These associations persisted even after adjusting for CRF and VAI. However, no significant associations between VAI, CRF, and FPG were observed in girls (P > 0.05). Adolescents with high VAI and low fitness levels demonstrated poorer glycemic profiles. Among boys, both VAI and CRF were independently associated with T2DM risk, with CRF showing a stronger association. These associations were not observed in girls. Promoting regular aerobic exercise and healthy diets may serve as essential public health promotion strategies in preventing and managing T2DM risk in adolescents.

Impact of internet addiction and gaming disorder on body weight in children and adolescents: A systematic review.

Internet use and gaming have increased in daily life. Internet addiction has not been recognised in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or 11th Revision of International Classification of Diseases despite gaming addiction having been listed since 2013. Previous studies have shown an association between internet use and weight gain or disordered eating patterns in the general population, however none have addressed this association in a paediatric population. The aim of this study is to investigate the relationship between internet addiction or gaming addiction and weight in children and adolescents under 18 years of age. A systematic search of electronic databases was conducted, and articles were screened for relevance. The Joanna Briggs Institute (JBI) 3critical appraisal tool was used to assess quality of studies. Due to heterogeneity of the studies, a meta-analysis could not be performed, thus a narrative summary was performed with the results summarised and tabulated. Of 8114 initial articles identified, we included 14 studies. The review produced inconsistent results, with three of the 14 studies demonstrating no statistically significant relationship between internet and/or gaming addiction and obesity. The remaining 11 studies showed a statistically significant positive association. One study demonstrated that those who are underweight as well as overweight and obese were more likely to have problematic internet use. Four articles demonstrated increased rates of poor nutritional habits, poor eating patterns and weight control behaviour in children and adolescents with internet addiction or gaming disorder. Another study showed no statistically significant association between internet addiction and disordered eating or eating disorder. Most of the available studies revealed increased rates of obesity in children and adolescents with internet addiction or gaming disorder, with poor patterns of eating. Clearer definitions and consistent use of terminology are required to enable more robust research in this field.

Pharmacological management of pediatric metabolic dysfunction-associated steatotic liver disease.

Pediatric obesity, characterized by a body mass index (BMI) at or above the 95th percentile for age, affects a substantial number of children and adolescents worldwide. Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, represents a prominent hepatic manifestation of obesity and metabolic syndrome, emerging as the most prevalent hepatic disorder among pediatric patients and a significant contributor to liver transplantation in adults. The escalating prevalence of pediatric MASLD mirrors the alarming rise in childhood obesity rates over recent decades. While lifestyle modifications focusing on dietary changes and increased physical activity constitute the cornerstone of MASLD management, achieving and maintaining significant weight reduction remains challenging. Moreover, disease progression often persists despite standard-of-care interventions, warranting exploration into alternative therapeutic strategies. Pharmacological interventions, particularly, glucagon-like peptide-1 receptor agonists (GLP-1RA), have shown promise in addressing pediatric obesity and its associated comorbidities, including MASLD. Recent studies have demonstrated the efficacy of GLP-1RA in inducing weight loss and improving liver enzyme levels, suggesting a potential role in halting disease progression, and reducing the risk of major adverse liver outcomes. This review provides a comprehensive overview of the current pharmacotherapy landscape for pediatric MASLD, with a focus on novel agents such as GLP-1RA. Furthermore, the manuscript proposes a practical algorithm to assist in integrating GLP-1RA into the clinical management of pediatric patients with obesity and MASLD. Despite promising results, further research is warranted to elucidate the long-term efficacy and safety of GLP-1RA in pediatric populations.

Assessing adherence to Government's sugar, salt, and calorie reduction targets of the top 20 UK restaurants' menus in 2024: a cross-sectional study

BackgroundTo address high obesity rates in adults and children, the UK government published voluntary targets for industry to reduce the sugar, salt, and calorie content of food products. Initial reports indicate little progress, however there has been limited assessment of the eating out, takeaway, and delivery sector. This study aims to assess the proportion of menu items that meet the government's sugar, salt, and calorie targets, from the 20 highest-grossing chained restaurants in the UK. MethodsWe identified the top 20 UK chained restaurants using data from market research company Euromonitor International. Nutritional information for 4054 products was collected directly from restaurant websites. Each product was assigned an overall category (eg, main meals, sides, etc.), and categories defined by the sugar, salt, and calorie targets. Findings36% (n=207) of products met sugar targets, 60% (n=1411) met salt targets, 72% (n=1592) met calorie targets, and 43% (n=1269) met all applicable targets. Categories with the highest proportion of products meeting the respective target were ‘Breakfast Items’ for sugar (73%, n=138), ‘Burgers’ for salt (100%, n=85), and ‘Salads’ for calories (96%, n=44) and all applicable targets (96%, n=44). Restaurants with the highest proportion of products meeting the respective target were Leon for sugar (63%, n=15), Burger King for salt (97%, n=32), Dominos for calories (95%, n=209), and Subway for all applicable targets (78%, n=62). InterpretationThe calorie targets were reasonably well adhered to whilst a large proportion of products still exceeded the target levels for sugar and salt. Ambiguities in the targets’ food categorisation makes their application somewhat subjective, risking low transparency and hindering a level playing field between companies. These findings can inform which companies and food groups need to be prioritised when implementing similar public health schemes in the future. FundingAOH is funded by the SALIENT project, which is funded by the ESRC (ES/Y00311X/1). RP is funded by a Royal Society and Wellcome Trust Sir Henry Dale fellowship (222566/Z/21/Z). RP is also supported by NIHR Oxford Health Biomedical Research Centre. HF is funded by the COPPER project. The COPPER project is funded by the NIHR Public Health Research programme (NIHR133887). The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care. LB is funded by NIHR Applied Research Collaborations (ARC) Oxford and Thames Valley. The funders had no role in the study design, data collection, analysis or interpretation. The views expressed are those of the author(s) and not necessarily those of the funders.

The association of vitamin D insufficiency with the prevalence of obesity in children: implications for serum calcium levels, alkaline phosphatase activity, and bone maturation.

Vitamin D deficiency has been identified as a potential risk factor for various adverse health outcomes. However, its specific role in metabolic regulation and skeletal development in school-aged children is not fully understood. This study aimed to explore the correlation between vitamin D deficiency and childhood obesity rates, and its impact on serum calcium, alkaline phosphatase, and bone age in children. The study analyzed clinical data from 159 school-aged children who underwent medical examinations. Participants were divided into the 25-hydroxyvitamin D3 (25(OH)D3) deficiency group and the 25(OH)D3 normal group based on their serum levels. We compared body mass index (BMI), total cholesterol (TC), triglycerides (TG), Ca, ALP, bone age, fasting blood glucose (FBG), and hemoglobin A1c (HbA1c) between the two groups. Logistic regression and Spearman correlation analyses were performed to further investigate relationships between 25(OH)D3 levels and metabolic and bone-related markers. This study showed that the 25(OH)D3 deficiency cohort exhibited significantly higher BMI, TC, TG, and ALP levels, with lower Ca levels and delayed bone age compared to the normal group. Logistic regression analysis identified Ca, ALP, and bone age as significant predictors of 25(OH)D3 deficiency. Subgroup analysis showed that in the 25(OH)D3 deficient group, children with higher BMI had elevated TC, ALP levels, and delayed bone age, while Ca levels were lower. Correlation analysis confirmed the predictive value of these markers for 25(OH)D3 deficiency. Our findings demonstrate that 25(OH)D3 deficiency is strongly associated with obesity in school-aged children and may negatively affect normal skeletal development. Regular monitoring of 25(OH)D3 levels in school-aged children is essential for ensuring proper growth and development, especially in those at risk for obesity.

Planning policies to restrict fast food and inequalities in child weight in England: a quasi-experimental analysis.

England has one of the highest childhood obesity rates in Europe. To promote a healthier food environment in 2015, Gateshead Council in North East England introduced planning guidelines effectively banning any new fast-food outlets. Our aim was to investigate whether this policy led to any reductions in childhood overweight and obesity prevalence and the inequalities in these outcomes. We used data from the National Child Measurement Programme, the Food Standards Agency Food Hygiene Rating Scheme data, and the Office of National Statistics between 2012 and 2020. We estimated a difference-in-differences model employing propensity score matching to identify a control group. We found no significant change in population-level childhood overweight and obesity in Gateshead compared with control areas. In subgroup analysis by area-level deprivation, we found that the quintile of deprivation with the highest proportion of fast-food outlets had a statistically significant reduction of 4.8% in the prevalence of childhood overweight and obesity compared with control areas. Restricting fast-food outlets in areas with a high concentration of such outlets as part of a package of policies to reduce childhood obesity may help to reduce prevalence and inequalities in childhood overweight and obesity.

Spatial variations and predictors of overweight/obesity among under-five children in Ethiopia: A geographically weighted regression analysis of the 2019 Ethiopian Mini Demographic and Health Survey.

Overweight/ obesity among under-five children is an emerging public health issue of the twenty-first century. Due to the quick nutritional and epidemiological change, non-communicable diseases, premature death, disability, and reproductive disorders have grown in low-income countries. Besides, little attention has been given. Therefore, we aimed to explore spatial variations and predictors of overweight/obesity among under-five children in Ethiopia using a geospatial technique. A total weighted sample of 3,609 under-five children was included in the study. A cross-sectional study was conducted using a nationally representative sample of the 2019 Ethiopia Mini Demographic and Health Survey data set. ArcGIS version 10.8 was used to explore the spatial variation of obesity. SaTScan version 9.6 software was used to analyze the spatial cluster detection of overweight/obesity. Ordinary least square and geographically weighted regression analysis were employed to assess the association between an outcome variable and explanatory variables. A p-value of less than 0.05 was used to declare it statistically significant. The spatial distribution of overweight/obesity among under-five children in Ethiopia was clustered (Global Moran's I = 0.27, p-value<0.001). The significant hot spot areas or higher rates of childhood obesity, were found in Southern Amhara, Northwest Somalia, Border of Harari, central Addis Ababa, Eastern SNNPR, and Northwestern Oromia region. In spatial SaT Scan analysis, 79 significant clusters of overweight/obesity were detected. The primary clusters were located in SNNPR, Oromia, and Addis Ababa (RR = 1.48, LLR = 31.40, P-value < 0.001). In the geographically weighted regression analysis, urban residence, cesarean section, rich households, and female children were statistically significant predictors. Overweight or obesity among under-five children show spatial variations across Ethiopian regions. GWR analysis identifies cesarean section, wealth index, urban residence, and child sex as significant predictors. The Ministry of Health and Ethiopian Public Health Institute should target regions with these contributing predictors, promoting localized physical education, health education campaigns, and ongoing community monitoring to encourage active lifestyles and reduce sedentary behaviors among children.

Quantifying the effect of interpregnancy maternal weight and smoking status changes on childhood overweight and obesity in a UK population-based cohort.

Maternal preconception and pregnancy exposures have been linked to offspring adiposity. We aimed to quantify the effect of changes in maternal weight and smoking status between pregnancies on childhood overweight/obesity (≥ 85th centile) and obesity (≥ 95th centile) rates in second children. Records for 5612 women were drawn from a population-based cohort of routinely collected antenatal healthcare records (2003-2014) linked to measured child body mass index (BMI) age 4-5 years. We applied the parametric G-formula to estimate the effect of hypothetical changes between pregnancy-1 and pregnancy-2 compared to the natural course scenario (without change) on child-2 BMI. Observed overweight/obesity and obesity in child-2 at age 4-5 years were 22.2% and 8·5%, respectively. We estimated that if all mothers started pregnancy-2 with BMI 18·5-24·9 kg/m² and all smokers stopped smoking, then child-2 overweight/obesity and obesity natural course estimates of 22.3% (95% CI 21.2-23.5) and 8·3% (7·6-9·1), would be reduced to 18.5% (17.4-19.9) and 6.2% (5.5-7.0), respectively. For mothers who started pregnancy-1 with BMI 18·5-24·9 kg/m², if all smokers stopped smoking, child-2 overweight/obesity and obesity natural course estimates of 17.3% (16.0-18.6) and 5·9% (5·0-6·7) would be reduced to 16.0% (14.6-17.3) and 4·9% (4·1-5·7), respectively. For mothers who started pregnancy-1 with BMI ≥30 kg/m², if BMI was 18·5-24·9 kg/m² prior to pregnancy-2, child-2 overweight/obesity and obesity natural course estimates of 38.6% (34.7-42.3) and 17·7% (15·1-20·9) would be reduced to 31.3% (23.8-40.0) and 12.5 (8.3-17.4), respectively. If BMI was 25.0-29.9 kg/m² prior to pregnancy-2, these estimates would be 34.5% (29.4-40.4) and 14.6% (11.2-17.8), respectively. Interventions supporting women to lose/maintain weight and quit smoking between pregnancies could help reduce rates of overweight/obesity and obesity in second children. The most effective interventions may vary by maternal BMI prior to the first pregnancy.

Adverse Childhood Experiences, Protective Factors, and Childhood Obesity: Comparing the Effectiveness of Three Resilience Frameworks

Abstract While rates of childhood obesity continue to rise in the United States, multiple studies have linked childhood obesity to adverse childhood experiences (ACEs). ACEs researchers have begun to develop frameworks that identify protective factors that build resilience against ACEs. However, these frameworks have a limited evidence base. Utilizing data from the 2018–2020 National Survey of Children’s Health, this study compared the effectiveness of the National Scientific Council on the Developing Child (NSCDC), Health Outcomes from Positive Experiences (HOPE), and cumulative positive childhood experiences (PCEs) frameworks in mitigating the impact of ACEs on childhood obesity. Based on hierarchical logistic regression conducted on data from 46,672 children between the ages of 10 and 17 years old, this study found that both the NSCDC and HOPE frameworks were associated with childhood obesity, with each framework explaining a similar amount of variance in childhood obesity across analyses. The cumulative PCEs framework did not strengthen the association between either framework and childhood obesity. Across analyses, strong self-regulation, mastery/after-school activities, and living in a supportive neighborhood had the strongest association with childhood obesity. The findings suggest that the most salient protective factors may be those most closely associated with the direct causes of childhood obesity, with the need to identify factors across ecological levels. Future research is needed to validate these frameworks further and explore these frameworks with other outcomes. The findings have important implications for future ACEs research and ACEs interventions. Public Relevance By understanding which resilience frameworks and protective factors have the strongest relationship with childhood obesity among children who experienced ACEs, interventions can potentially be developed using these findings to mitigate the harmful impact of ACEs on childhood obesity. Key Findings This study found that the National Scientific Council on the Developing Child (NSCDC) and Health Outcomes from Positive Experiences (HOPE) frameworks were associated with childhood obesity after controlling for adverse childhood experiences (ACEs) in a sample of children between the ages of 10 and 17 years old. The strongest protective factors against childhood obesity were strong self-regulation, mastery/after-school activities, and living in a supportive neighborhood. Given the relationship between these protective factors along with several covariates in the study with childhood obesity, future ACEs interventions should potentially target these protective factors and other social determinants of health to reduce the negative impact of ACEs on childhood obesity.

Converging Pathways between Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Diabetes in Children.

In the past thirty years, childhood obesity rates have risen significantly worldwide, affecting over 340 million children in affluent nations. This surge is intricately tied to metabolic disorders, notably insulin resistance, type 2 diabetes mellitus (T2DM), and the continually evolving spectrum of metabolic-associated (dysfunction) steatotic liver disease (MASLD). This review underscores the alarming escalation of childhood obesity and delves comprehensively into the evolving and dynamic changes of nomenclature surrounding diverse conditions of hepatic steatosis, from the initial recognition of non-alcoholic fatty liver disease (NAFLD) to the progressive evolution into MASLD. Moreover, it emphasizes the crucial role of pediatric endocrinologists in thoroughly and accurately investigating MASLD onset in children with T2DM, where each condition influences and exacerbates the progression of the other. This review critically highlights the inadequacies of current screening strategies and diagnosis, stressing the need for a paradigm shift. A proposed solution involves the integration of hepatic magnetic resonance imaging assessment into the diagnostic arsenal for children showing insufficient glycemic control and weight loss post-T2DM diagnosis, thereby complementing conventional liver enzyme testing. This holistic approach aims to significantly enhance diagnostic precision, fostering improved outcomes in this vulnerable high-risk pediatric population.

Pathophysiology and Treatment of Prediabetes and Type 2 Diabetes in Youth.

Youth-onset type 2 diabetes is a heterogeneous disease with increasing prevalence in relation to increased rates of obesity in children. It has genetic, epigenetic, social, and environmental determinants. Youth-onset type 2 diabetes is alarming given a rapidly progressive course compared with the course of adult-onset disease, early-onset vascular complications, and long-term exposure to hyperglycemia and associated complications. It is often preceded by prediabetes, a disease phase where defects in β-cell function relative to insulin sensitivity emerge. Herein, we review the current understanding of the pathophysiology of prediabetes and type 2 diabetes in youth. We describe the mechanisms underlying insulin resistance, the precipitous decline of β-cell function, and the role of other hormonal abnormalities in the pathogenesis of the disease. We discuss the critical importance of social determinants of health in the predisposition and progression of these conditions and present current management strategies and the advances in therapeutic approaches. These must adapt to meet the unique needs of the individual patient and family. Significant knowledge gaps remain that need to be addressed in future research.

Sex-specific Effects of Parental Separation on Obesity in Children: Findings from a Nationally Representative Balanced Panel Study

Objectives: Despite the global rise in child obesity and parental divorce rates, the relationship between these 2 phenomena remains largely unexplored, with most previous studies relying on correlational evidence. In this study, we examine the impact of parental separation on child obesity by sex. Methods: Utilizing balanced panel data from the Korea Children and Youth Panel Survey (2011-2016, N=4,288 for each wave), we traced how the weight and BMI of children originally living with both parents changed following parental separation. Results: The transition from living with both parents to a single parent increased weight, BMI, and BMI percentile among boys by 1.11kg (p-value: .03), .44 (p-value: 0.02), and 4.91 percentile points (p-value: .02), respectively, while no significant changes were observed for girls. Conclusion: Whereas restricted to boys, we confirmed that children may experience weight gain following a parental separation. As such, parent education and guidance for their children's health are crucial to prevent childhood obesity, especially in the aftermath of a parental separation.

Risk Factors and 20-Year Time-Trend in Childhood Overweight and Obesity in Switzerland: A Repeated Cross-Sectional Study.

Background/Objective: Even though global childhood obesity rates keep increasing, stabilization has been shown over the past decade in several countries, including Switzerland. We aimed to investigate the trends in childhood overweight and obesity over the past 21 years in Switzerland and to identify the associated risk factors. Methods: Using cluster sampling, we recruited a national sample of 6-12-year-old children in Switzerland (n = 1245). We conducted anthropometric measurements and assessed risk factors using a self-administered questionnaire. We investigated the time trend by including data from four comparable previous surveys conducted since 2002. Results: We found a prevalence of overweight, including obesity, of 16.1 (14.1-18.2)%, with a significantly higher proportion in boys (18.6 (15.5-21.6)%) compared to girls (13.7 (11.0-16.4)%). We found a small but significant reduction in the prevalence of overweight including obesity over time (p = 0.005), but not of obesity alone (p = 0.099). The most important risk factors for obesity were parental education, parental origin, media consumption, as well as several dietary factors. Conclusions: Despite a slight decreasing trend in childhood overweight in Switzerland, it remains a public health concern. Prevention programs should focus on migrant families and those with low education and emphasize the risks of sedentary behavior and the importance of a healthy diet.

A systems thinking framework for understanding rising childhood obesity in the Caribbean

ObjectiveThe aim of this study is to develop a systems thinking framework to describe the common complexities of childhood obesity in the Caribbean region and identify potential areas of intervention.MethodsGroup model building (GMB) is a form of systems science. Trained GMB facilitators in Puerto Rico, the US Virgin Islands, Barbados, and Trinidad and Tobago convened a group of multi-disciplinary stakeholders in a series of virtual meetings in 2021 to elaborate a hypothesis of the system driving childhood obesity represented by causal loop diagrams (CLD). Commonalities and differences between the CLDs from each island were identified and reconciled to create a synthesized CLD.ResultsA single explanatory CLD across the islands was developed and includes nine reinforcing loops. These loops addressed the interconnected role of schools, policy, commercial determinants, community and the personal experience of the child in rising childhood obesity rates.ConclusionsDespite differences across settings, there is a core system driving childhood obesity in the Caribbean, as described by stakeholders in GMB workshops. Policy solutions to the problem must be multi-faceted and multi-level to address the interlinked reinforcing loops of the complex system and reduce rates of childhood obesity.

The Interrelation between Obesity Management and Climate Change in Greece

Two major global problems of our era are climate change and obesity. Both are interlinked and interconnected having undesired social, economic, environmental impacts as well as harmful impacts on human health. The rate of obesity and overweight in children and adults in Greece is high compared to other EU countries causing many health, social and economic problems. Climate change is foreseen to have severe and harmful impacts in Greece as well as in other Mediterranean countries altering the climate conditions. Obesity and its treatment mitigate climate change, mainly due to the change in the dietary pattern of the treated patients. The proposed diets for managing obesity, based on Mediterranean dietary patterns, have less GHG emissions and lower climate footprint. Climate change makes more difficult the treatment of obesity, mainly due to the rising temperatures. Climate change has undesired and harmful impacts on obesity treatment in Greece while obesity treatment results in the mitigation of climate change in the country. Future policies for climate change mitigation and managing obesity in Greece should take into account their mutual interconnections and interlinkages in order to maximize their effectiveness in treating these two severe pandemics in the country.

The Prevention of Childhood Obesity Is a Priority: The Preliminary Results of the "EpPOI: Education to Prevent Childhood Obesity" Project.

The increase in childhood obesity rates represents a serious public health problem. The project "EpPOI: Education to prevent childhood obesity" is aimed at a multidisciplinary approach to raise awareness of the importance of preventing childhood obesity through lifestyle education. Two actions by experts were performed: an intervention with children in schools and a meeting for both parents and school staff. Participants completed a questionnaire structured as a Likert scale. The sample size was 96 people, and awareness of the childhood obesity problem as well as the need for obesity prevention was high among respondents. We also found great interest among participants in having more information on pediatric nutrition and physical activity, with a positive correlation with age. Furthermore, the multivariate regression model configured interest in having more information on nutrition and physical activity as an independent and statistically significant predictor of awareness of childhood obesity as a current issue. The results highlight the need to act on childhood obesity through lifestyle prevention strategies early in life.

The relationship between physical education requirements and childhood obesity rates in the United States among high school students

The relationship between physical education requirements and childhood obesity rates in the United States among high school students