Childhood Obesity Prevention Research Research Articles

Where is the father? Challenges and solutions to the inclusion of fathers in child feeding and nutrition research

Despite an increasing acknowledgement of fathers’ involvement in and impact on children’s lives, fathers remain underrepresented in child feeding and childhood obesity prevention research, interventions, and actions. Built on our own experiences with conducting research with fathers and recent evidence on this topic, this Research in Practice article has three aims. It will first substantiate the importance of including and studying fathers in the field of child feeding and childhood obesity prevention based on recent study results. Secondly, the article will present and discuss barriers to fathers' inclusion and participation (why isn't it happening?), among other issues, by drawing on sociological and gender ideological insights. Finally, it will provide recommendations and suggestions related to recruitment, focus and methods that can facilitate fathers’ involvement in future research, interventions, and practice. Taken together, this article aims to provide tools for giving fathers a voice in the field of child nutrition and by doing so, to decrease maternal-only “burden” of care. We hope our experiences and theoretical reflections will inspire and support researchers and practitioners to be as successful as possible in the realm of family care.

Tracing coalition changes in knowledge in and engagement with childhood obesity prevention to improve intervention implementation

BackgroundWhile most coalition research focuses on studying the effects of peer relationship structure, this study examines the coevolution of coalition structure and behavior across three communities in the U.S. with the goal of identifying coalition dynamics that impact a childhood obesity prevention intervention. MethodsOver two years (2018–2020), three communities within the U.S. participated in a childhood obesity prevention intervention at different times. This intervention was guided by the Stakeholder-Driven Community Diffusion theory, which describes an empirically testable mechanism for promoting community change. Measures are part of the Stakeholder-driven Community Diffusion (SDCD) survey with demonstrated reliability, which include knowledge of and engagement with childhood obesity prevention and social networks. Data from three coalition-committees and their respective networks were used to build three different stochastic actor-oriented models. These models were used to examine the coevolution of coalition structure with coalition behavior (defined a priori as knowledge of and engagement with obesity prevention) among coalition-committee members and their nominated alters (Network A) and coalition-committee members only (Network B). ResultsOverall, coalitions decrease in size and their structure becomes less dense over time. Both Network A and B show a consistent preference to form and sustain ties with those who have more ties. In Network B, there was a trend for those who have higher knowledge scores to increase their number of ties over time. The same trend appeared in Network A but varied based on their peers’ knowledge in and engagement with childhood obesity prevention. Across models, engagement with childhood obesity prevention research was not a significant driver of changes in either coalition network structure or knowledge.ConclusionsThe trends in coalition Network A and B’s coevolution models may point to context-specific features (e.g., ties among stakeholders) that can be leveraged for better intervention implementation. To that end, examining tie density, average path length, network diameter, and the dynamics of each behavior outcome (i.e., knowledge in and engagement with childhood obesity prevention) may help tailor whole-of-community interventions. Future research should attend to additional behavioral variables (e.g., group efficacy) that can capture other aspects of coalition development and that influence implementation, and to testing the efficacy of network interventions after trends have been identified.

A mixed methods analysis of environmental and household chaos: considerations for early-childhood obesity research

BackgroundChaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. New approaches to studying the environments of young children may help to clarify chaos-obesity relationships.MethodsWe conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to provide preliminary construct validity for our indicators of chaos.ResultsDyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 0 to 7.3 and were on average 2.1 (SD = 1.8). Neighborhood noise scores ranged from 0 to 4 and were on average 1.1 (SD = 1.1). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as lower educational attainment and household income. Qualitative data from households with high and low scores on the two identified factors were aligned in ways that were supportive of construct validity and further contextualized the social and material environments in which chaos occurred.ConclusionsChaos represents a complex construct with implications spanning various disciplines, including childhood obesity research. Previous studies suggest challenges associated with measuring chaos may limit the conclusions that can be drawn about which aspect of chaos (if any) matter most of early childhood weight development. We advance the literature by demonstrating chaos may be comprised of conceptually distinct subdomains. Future childhood obesity prevention research may benefit from more contemporary measure of chaos, such as those relying on direct observations that account for a multifaceted underlying structure.

Looking for evidence of research impact and use: A qualitative study of an Australian research-policy system

Abstract Current assessments of research impact have been criticized for capturing what can be easily counted not what actually counts. To empirically examine this issue, we approached measuring research impact from two directions, tracing forwards from research and backwards from policy, within a defined research-policy system (childhood obesity prevention research and policy in New South Wales, Australia from 2000 to 2015). The forward tracing research impact assessment component traced a sample of 148 local research projects forward to examine their policy impacts. Of the projects considered, 16% had an impact on local policy and for a further 19%, decision-makers were aware of the research, but there was no evidence it influenced policy decisions. The backward tracing component of the study included an analysis of research use across three policy initiatives. It provided a more nuanced understanding of the relative influence of research on policy. Both direct uses of specific research and indirect uses of research incorporated as broader bodies of knowledge were evident. Measuring research impact from both directions captured the diverse ways that research was used in decision-making. Our findings illustrate complexities in the assessment process and in real-life policymaking trajectories. They highlight the role that timing of assessment plays in perception of impacts and difficulties attributing longer-term impacts to specific research. This study supports the use of models where politics and complex system dynamics shape knowledge and its influence on decision-making, rather than research being the primary driver for policy change.

The National Collaborative on Childhood Obesity Research’s Measures Registry and User Guides

There are many types of physical activity and food intake measures. These measures often lack validity and reliability, making it difficult to compare findings across childhood obesity research and evaluation studies. PURPOSE: The National Collaborative on Childhood Obesity Research’s (NCCOR) Measures Registry (nccor.org/mruserguides) promotes consistent use of high-quality, comparable measures and methods across childhood obesity studies. The Registry User Guides extend the reach and usefulness of these resources. Herein we describe the Registry and User Guides and examine their reach to nutrition, physical activity, and obesity researchers and practitioners. METHODS: A search of peer reviewed literature published 1999-2009 was conducted. Measurement experts reviewed and abstracted articles meeting inclusion criteria in four domains: physical activity, diet, physical activity environment, and food environment. The Registry was launched in 2011 and has been updated on an ongoing basis since August 2015. In 2017, subject matter experts authored four User Guides for the measurement domains. The Guides include case studies to help users’ select appropriate measures. The number of web visitors to the Registry and Guides was tracked providing an indicator of reach. RESULTS: The Registry contains 1207 published studies of validation research using measures of physical activity (n=403), diet (n=330), physical activity environment (n=273), and food environment (n=331). Measures include GIS (n=127); 24-hour dietary recall (n=52); food frequency (n=69); electronic monitor (n=121); environmental observation (n=153); questionnaire (n=498); record or log (n=97), and other (n=207). Over 17,100 unique visitors have accessed the Registry since its launch, including visitors from 41 countries. Since their release there have been over 8000 page views of the User Guides from 3633 unique visitors. CONCLUSION: The NCCOR Measures Registry and User Guides can assist researchers and practitioners conducting childhood obesity prevention research and evaluation to select high quality, comparable measures of physical activity, diet, and the environments in which these behaviors occur. Website traffic reflecting access to the materials indicates a large reach. Supported by the JPB Foundation

Motivating systems-oriented research on environmental and policy changes for obesity prevention.

Research on the types of interventions needed for population-level prevention of childhood obesity in complex societal systems can benefit from greater use of systems-science concepts and tools. We report outcomes of a funding programme promoting incorporation of systems-science approaches into studies of imminent policy or environmental changes potentially impacting childhood obesity. Seven funding cycles over 3 years yielded 172 initial submissions from 29 US states and 25 other countries were analyzed. Submissions focused primarily on aspects of school or child-care settings, parks and recreational settings, or access to healthy food; about half reflected attention to systems perspectives. Analysis of initial submissions as well as the 15 funded projects showed some success in motivating use of systems concepts and tools but suggested the need for a more focused effort to educate and prepare the childhood obesity prevention research community for this potentially crucial type of research.

Short Term outcomes of a Faith-based Obesity Attenuation and Prevention Program for Low Income African American Children: CHHIL Feasibility and Efficacy Study

Background: The CHHIL is a faith-based, culturally tailored and multi-level obesity attenuation and prevention program for African American (AA) children and adolescents in low-income church community. The study objective is to test the feasibility and efficacy of 8 weeks CHHIL intervention. Methods: This is a sequential mixed methods study design, examining the feasibility and efficacy of 8 weeks CHHIL intervention conducted at a low income neighborhood AA church. All sessions were conducted at the AA church, after Sunday services. Parents and children separately attended seven weekly group sessions focused on lifestyle modification. Participants: 1) an AA church member; 2) age 8-17 years; 3) Child BMI of 85%-95% or parent with BMI ≥ 25 or family history of type 2 diabetes. Eleven families (child and at least one parent/guardian) were recruited. At the baseline and then every week for 7 weeks children’s nutrition, physical activity (PA) and anthropometric information was obtained. Primary outcomes were changes in dietary intake/patterns and BMI at the end of 8-weeks CHHIL program. Changes in outcome measures were assessed using paired samples t-tests, ANOVA and non-parametric tests. Results: Of the 11 children and adolescents who enrolled, seven (63%) completed the 8-weeks program. Overall there was a trend among the children and adolescents to decrease total calories (kcals), protein, and carbohydrates consumed overtime. Participants consumed significantly lower levels of sodium from baseline to end of the program (P<0.001). At the end of 8 sessions (7 weeks), no significant change in BMI and other anthropometric parameters was seen at the end of the program. Conclusion: The CHHIL program may be a promising option for health behaviors changes and thus changes in weight for church-based ethnic minorities. However trend towards improvements in dietary behaviors were observed, no impact on anthropometric measures were seen requiring further research with longer program duration. With increasing burden of health disparities, childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.

Interventions for preventing obesity in children.

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear. This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?" The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted. The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomized at a cluster level, six clusters were required. Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardized BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings). This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged v 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I2 = 82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15 kg/m2 (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m2 (95% CI -0.53 to 0.00) (0- 5 years), - 0.15 kg/m2 (95% CI -0.23 to -0.08) (6-12 years), and -0.09 kg/m2 (95% C I -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies. We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies: school curriculum that includes healthy eating, physical activity and body image; increased sessions for physical activity and the development of fundamental movement skills throughout the school week; improvements in nutritional quality of the food supply in schools; environments and cultural practices that support children eating healthier foods and being active throughout each day; support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities); parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities. However, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs. Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.

Contextual influences on the development of obesity in children: A case study of UK South Asian communities

ObjectiveAn advocated approach to childhood obesity prevention research is the use of local community knowledge to inform intervention development. This paper demonstrates the value of accessing such local knowledge, and discusses how this information fits with existing conceptual models of childhood obesity. MethodsA series of 9 focus groups were run in 2007 with 68 local community stakeholders (including parents, school staff, community leaders and health and local government representatives) from 8 South Asian communities in Birmingham, UK to explore perceptions of factors contributing to the development of childhood obesity. ResultsPerceptions of causal influences were grouped into several contexts, from the individual to the macro-level, that influence diet and physical activity. Specific cultural contextual data emerged that may explain decisions around physical activity and food intake of children within these communities. Assumptions made about South Asian communities were frequently contested. ConclusionsIn order to truly understand the contextual influences on childhood obesity in target communities, it is necessary to access knowledge from local community members. Existing conceptual models of childhood obesity do not bring the role of cultural factors to the fore, but this context needs to be explicitly considered in the development of childhood obesity interventions.

Interventions for preventing obesity in children

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear. This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?" The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted. The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required. Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded.A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings). This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I(2)=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m(2) (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m(2) (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m(2) (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m(2) (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies. We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:· school curriculum that includes healthy eating,physical activity and body image· increased sessions for physical activity and the development of fundamental movement skillsthroughout the school week· improvements in nutritional quality of the food supply in schools· environments and cultural practicesthat support children eating healthier foods and being active throughout each day· support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)· parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activitiesHowever, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.

Photovoice Engages Rural Youth in Childhood Obesity Prevention

Photovoice is a participatory action research methodology that involves the use of photography and enables people to document, reflect upon, and communicate community needs to policymakers for the purpose of promoting social change. We describe how Photovoice was used to engage rural youth in childhood obesity prevention research and obtain their perspectives of community assets and barriers that influenced children's physical activity and diets in their county. The photographs and stories produced by the youth garnered public interest and were beneficial in raising community awareness of community conditions that may contribute to childhood obesity and the need for environmental change. Utilization of the method also provided a beneficial leadership experience for the youth participants.