Healthy Weight Behaviours Research Articles

Barriers, facilitators, and opportunities to promote healthy weight behaviors among preschool-aged children in two rural U.S communities

BackgroundObesity levels are higher in rural versus urban children. Multi-level community-based interventions can be effective in promoting healthy child weight, but few of such interventions have focused on rural children. This formative study assessed barriers, facilitators, and opportunities to promote healthy child weight in two rural communities.MethodsMultiple data collection methods were used concurrently in two rural communities in Indiana and North Carolina. Focus groups and interviews were conducted with participants, including parents of children aged 2–5 years (n = 41), childcare providers (n = 13), and stakeholders from 23 community organizations. Observational audits were conducted at 19 food outlets (grocery stores) and 50 publicly-accessible physical activity resources. Focus groups/interviews were analyzed thematically. Surveys were analyzed using descriptive statistics, Fisher’s exact test, and t-tests.ResultsFamily level barriers included limited financial resources and competing priorities, whereas parental role-modeling was perceived as a facilitator of healthy weight behaviors. At the organizational level, childcare providers and community stakeholders cited limited funding and poor parental engagement in health promotion programs as barriers. Childcare providers explained that they were required to comply with strict nutrition and physical activity guidelines, but expressed concerns that similar messages were not reinforced at home. Facilitators at the organizational level included healthy meals provided at no cost at childcare programs, and health promotion programs offered through community organizations. At the community level, lack of public transportation, and limited access to healthy food outlets and physical activity-promoting resources posed barriers, whereas existing physical activity resources (e.g., parks) and some ongoing investment to improve physical activity resources in the community were assets. In designing/implementing a potential child obesity prevention intervention, participants discussed the need to garner community trust, emphasize wellness instead of obesity prevention, establish community partnerships, and leverage existing community resources.ConclusionsRural areas experience multiple challenges that make it difficult for children/families to engage in healthy weight behaviors. This study highlights several assets (existing programs/resources, expertise within communities) that can be leveraged as facilitators. Findings will guide the study team in developing a child obesity prevention intervention for the two rural communities.

Family-Based Telehealth Initiative to Improve Nutrition and Physical Activity for Children With Obesity and Its Utility During COVID-19: A Mixed Methods Evaluation.

Guidelines recommend primary care providers refer children with obesity to behavioral interventions, but given limited program availability, access, and parental engagement, referrals remain rare. We developed telehealth coaching interventions for families whose children received care at a health system in Pennsylvania, United States in 2019-2020. Intervention referrals were facilitated by the pediatrician and/or project team for 6–12-year-old children with obesity following well-child visits. Participants chose one of three 26-week interventions focused on healthy eating, physical activity, or a hybrid clinical/nutrition intervention. Interventions engaged parents as change agents, enhancing self-efficacy to model and reinforce behavior and providing resources to help create a healthy home environment. We enrolled 77 of 183 eligible parent/child dyads. We used mixed methods to evaluate the interventions. Repeated measures models among participants showed significant reductions in obesogenic nutrition behaviors post-intervention and at 1-year follow-up, including a reduction in sugar-sweetened beverage intake of 2.14 servings/week (95% confidence interval: −3.45, −0.82). There were also improvements in obesoprotective nutrition behaviors (e.g., frequency of family meals, parental self-efficacy related to meal management). One year post-baseline, we observed no significant differences in changes in body mass index (BMI) z-scores comparing child participants with matched controls. Given potential impacts of COVID-19 community restrictions on study outcomes, we conducted qualitative interviews with 13 participants during restrictions, which exemplified how disrupted routines constrained children’s healthy behaviors but that intervention participation prepared parents by providing cooking and physical activities at home. Findings support the potential of a telehealth-delivered nutrition intervention to support adoption of healthy weight behaviors.

The Relationship Between Adverse Childhood Experiences and Weight-Related Health Behaviors in a National Sample of Children.

To examine how adverse childhood experiences (ACEs) relate to healthy weight behaviors in children. We examined data from the 2016 National Survey of Children's Health. ACE scores were calculated from 6 measures of household dysfunction. Outcome measures included 5 healthy weight behaviors. Logistic regression models assessed associations between ACEs and healthy weight behaviors controlling for sociodemographic variables. Children 6 to 17 years of age (n=32,528) with 0 ACEs had increased odds of: watching 2 hours or less of television daily (6-12 years: odds ratio [OR] 1.46; 95% confidence interval [CI], 1.20-1.80, 13-17 years: OR 1.64; 95% CI, 1.39-1.94), using electronics for 2 hours or less daily (6-12 years: OR 1.44; 95% CI, 1.15-1.80, 13-17 years: OR 1.86; 95% CI, 1.60-2.16), sharing 4 or more family meals per week (6-12 years: OR 1.39; 95% CI, 1.17-1.66, 13-17 years: OR 1.68; 95% CI, 1.44-1.95), and getting adequate age-specific sleep (6-12 years: OR 1.50; 95% CI, 1.26-1.79, 13-17 years: OR 1.31; 95% CI, 1.11-1.55) when compared to children with one or more ACEs. Children 13 to 17 years of age with 0 ACEs had increased odds of exercising for 60 minutes daily (OR 1.27; 95% CI, 1.02-1.58) when compared to children with one or more ACEs. There was an overall gradient dose pattern; the odds of engaging in a healthy weight behavior decreased as the number of ACEs increased, with mixed significance levels. In children, ACE exposure is associated with decreased healthy weight behaviors and behavior counseling alone may be insufficient. Trauma-informed care to address intra-familial adversity may be necessary.

Importance of Family Connection for Healthy Weight Behaviors Amid Adverse Family Experiences and Behavioral Difficulties.

Adverse family experiences (AFEs), including parent divorce and domestic violence, negatively affect obesogenic behaviors and engagement in healthy weight behaviors (HWBs). The current study used a moderated mediation model to investigate the role of family connection in the relationship between AFEs and HWBs for children with behavioral difficulties. Youth (6-17 years old; n = 13,921) from the 2016 National Survey of Children's Health data set were included in the study. Family connection mediated the relationship between AFEs and each HWB. The models of physical activity and screen time had significant direct effects. Behavioral difficulties moderated the direct effect of AFEs and screen time and physical activity. Family connection mediated the relationships between each HWB and AFEs. The findings suggest that for children without behavioral difficulties, family connection was a stronger protective factor for adequate physical activity and decreased screen time.

Parents' Efficacy for Child Healthy Weight Behavior in Elementary Schools in Hilla City

Objectives: The study aims to (1) Assess the parents' efficacy for child healthy weight behavior. (2) Identify the difference in parents’ efficacy for child healthy weight behavior between the groups of parent’s gender, family’s socioeconomic status, child’s gender, and child’s birth order, (3) Find out the relationship between parents’ age, child’s age, child’s body mass index, family’s socioeconomic status, the number of children in the family and parents’ efficacy for child healthy weight behavior.Methodology: A descriptive correlational study is conducted for the period from November 11th, 2018 to March 25th, 2019 to assess the parents' efficacy for child healthy weight behavior. The study was carried-out in (30) primary schools that were selected through a simple random sampling of (125) schools from Hilla City. The instruments was composed of two parts , the first part was the demographic data and the second part was the Parent Efficacy for Child Healthy Weight Behavior (PECHWB) Scale, it consists of 41 items based on Australian guidelines for healthy weight behaviors. The validity of the instrument was achieved by eleven experts. Data were collected for the period from January 10th to March 5th, 2019. Data were analyzed using the statistical package for social sciences (SPSS) version 24. Results: The study results revealed that most of pupils eat three or more serves of fruit and vegetables per day, minimize high fats and sugar intake, engaging in one hour of physical activity per day, and being no more than two hours in sedentary behavior per day on holidays/vacations and on weekends. Furthermore, they minimize high fats and sugar intake and eat healthy snacks on their demands/request. Moreover, they do not minimize high fats and sugar intake and eat healthy snacks when they are stressed or in bad mood and when they complain. Recommendations: The researcher recommends establishing health activities that aim to raise the public’s awareness of fostering healthy lifestyle and behaviors for their children

The integrated role of multiple healthy weight behaviours on overweight and obesity among adolescents: a cross-sectional study

BackgroundThis study contributes to the limited number of studies that have explored the impact of not meeting the recommendations for moderate-to-vigorous physical activity, screen time, fruit and vegetable consumption and sleep on overweight and obesity among adolescents.MethodsA cross-sectional study of data from the 2015 Ontario Student Drug Use and Health Survey (OSDUHS), a provincially representative survey of students in publically funded schools in Ontario, Canada, was conducted. This study included self-reported data from students aged 11–17 years (n = 9866). The main outcome variable was overweight or obesity, classified using WHO BMI cut-points. Four independent variables for healthy weight behaviours were examined: (1) moderate-to-vigorous physical activity (MVPA) (≥ 60 mins vs. < 60 mins everyday over the last seven days); (2) screen time (< 2 h daily vs. ≥ 2 h daily); (3) fruit and vegetable consumption (≥ 5 times/day vs. < 5 times/day); (4) sleep (adequate based on guidelines vs. inadequate). Covariates included sex, age, Subjective Social Status (SSS), parental education and ethnicity. Binomial and multinomial logistic regression models were fitted to determine whether not meeting the recommendations for healthy weight behaviours was associated with overweight or obesity status.ResultsOnly 2% of students in Ontario met the recommendations for all four healthy weight behaviours and 33% of students did not meet any of the four recommendations. In both the binomial and multinomial models, not meeting the recommendations for MVPA was the only significant healthy weight behaviour associated with both overweight and obesity (AOR: 1.29, 95% CI: 1.03–1.62), and solely obesity (AOR: 1.45, 95% CI: 1.05–1.99). Males, students with lower SSS ratings, and students with parents with an education of ‘High School’ or less were also at significantly greater odds of being obese.ConclusionFindings from this study show that inadequate levels of MVPA is a critical behavioural predictor of obesity status in adolescents between the ages of 11–17 years, after controlling for differences in screen time, fruit and vegetable consumption, sleep, and demographics. Findings from this study could have implications toward policies and programs targeted at reducing obesity, and increasing the physical activity rates of adolescents.

Cluster randomised controlled feasibility study of HENRY: a community-based intervention aimed at reducing obesity rates in preschool children

BackgroundIn the UK and beyond, public funding is used to commission interventions delivered in public health early years settings aimed at improving health and well-being and reducing inequalities in order to promote school readiness. This is a key setting for obesity prevention programmes, which are often commissioned despite the limited evidence base. The HENRY (Health, Exercise, Nutrition for the Really Young) programme is an 8-week programme delivered to parents of preschool children, designed to support families to optimise healthy weight behaviours. Early evidence suggests that it may be effective, but a robust evaluation using a randomised controlled design has not been conducted. This study begins this process by evaluating the feasibility of conducting a multi-centre definitive trial to evaluate the effectiveness and cost-effectiveness of HENRY to prevent obesity in the early years.MethodsThis is a multi-centre, open labelled, two group, prospective, cluster randomised, controlled, feasibility study aiming to recruit 120 parents from 12 children’s centres, based in two local authority areas. Within each of the two local authorities, three centres will be randomised to HENRY and three will be randomised to a control arm of standard care (usual provision of services within children’s centres). We will explore HENRY commissioning, provision and delivery and assess the feasibility of local authority, centre and parent recruitment, the processes and time required to train and certify staff to deliver the intervention, the potential sources (and associated risk) of contamination and the feasibility of the trial procedures. Research includes a process evaluation, feasibility of cost-effectiveness evaluation, with progression to the definitive trial judged against pre-defined criteria.DiscussionThis feasibility study will support the decision to proceed to, and the design of, a future definitive trial, providing an evidence base of an approach to prevent childhood obesity, which has been deemed attractive to all stakeholders, including parents. Given the widespread adoption of the intervention, this has the potential to impact on public health in the UK and beyond.Trial registrationClinicalTrials.gov Identifier NCT03333733 registered 6th November 2017Protocol date: 25th October 2017Protocol version: 4.0

Weight-Gain Reduction Among 2-Year College Students: The CHOICES RCT.

The young adult years have been recognized as an influential period for excess weight gain. Non-traditional students and those attending 2-year community colleges are at particularly high risk for a range of adverse weight-related outcomes. Choosing Healthy Options in College Environments and Settings was an RCT with students randomly assigned into a control or intervention condition after baseline assessment. The study was designed to evaluate if a 24-month weight-gain prevention intervention reduces the expected increase in BMI and overweight prevalence in young adults attending 2-year colleges. Two cohorts were recruited, corresponding to the fall and spring semesters. Data collection occurred at four time points for each cohort, with baseline occurring in fall 2011 for Cohort 1 and spring 2012 for Cohort 2. The 24-month follow-up occurred in fall 2013 for Cohort 1 and spring 2014 for Cohort 2. Data analysis occurred in 2015-2016. This research was conducted with 441 students from three community colleges in Minnesota. The 24-month intervention began with a 1-credit college course on healthy weight behaviors. A social networking and social support website was introduced as part of the course and participation encouraged for the duration of the trial. Changes in BMI, weight, body fat percentage, waist circumference, and weight status were assessed. Retention of the cohorts at 24 months was 83.4%. There was not a statistically significant difference in BMI between conditions at the end of the trial. However, there was a statically significant difference in the prevalence of overweight/obesity between treatment conditions at 24 months. Also, participants randomized to the intervention who were overweight or obese at baseline were more than three times as likely to transition to a healthy weight by the end of the trial as compared with control students. The intervention was not successful in achieving BMI differences between treatment groups. However, an 8% reduction in the prevalence of overweight and obesity over time may have population-level significance. This study is registered at www.clinicaltrials.gov NCT01134783.

Workplace social and organizational environments and healthy-weight behaviors.

BackgroundThe workplace is an important setting for health promotion including nutrition and physical activity behaviors to prevent obesity. This paper explores the relationship between workplace social environment and cultural factors and diet and physical activity (PA) behaviors and obesity among employees.MethodsBetween 2012 and 2013, telephone interviews were conducted with participants residing in four Missouri metropolitan areas. Questions included demographic characteristics, workplace socio/organizational factors related to activity and diet, and individual diet and PA behaviors, and obesity. Multivariate logistic regression was used to examine associations between the workplace socio/organizational environment and nutrition, PA, and obesity.ResultsThere were differences in reported health behaviors and socio/organizational environment by gender, race, age, income, and worksite size. For example, agreement with the statement the ‘company values my health’ was highest among Whites, older employees, and higher income workers. As worksite size increased, the frequency of reporting seeing co-workers doing several types of healthy behaviors (eat fruits and vegetables, doing PA, and doing PA on breaks at work) increased. In adjusted analyses, employees agreeing the company values my health were more likely to engage in higher PA levels (aOR=1.54, 95% CI: 1.09-2.16) and less likely to be obese (aOR=0.73, 95% CI: 0.54-0.98). Seeing co-workers eating fruits and vegetables was associated with increased reporting of eating at least one vegetable per day (aOR=1.43, 95% CI: 1.06-1.91) and seeing co-workers being active was associated with higher PA levels (aOR 1.56, 95% CI: 1.19-2.05).ConclusionsThis research suggests that social/organizational characteristics of the workplace environment, particularly feeling the company values the workers’ health and to seeing co-workers engaging in healthy behaviors, may be related to nutrition and PA behaviors and obesity. These findings point to the potential for intervention targets including environment and policy changes.

Do Healthcare Professionals Practice What They Preach in Reality?

Copyright: © 2014 Mahmood S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Although healthcare professionals (HCPs) are expected to be role models for the general population in term of healthy weight and health behaviours, they do not always set a good example. Evidence suggests that HCPs are gaining weight like the general population [1-3]. A study from the US showed that 40% of the paediatricians were overweight or obese [4] whereas a study conducted among Mexican physicians reported a higher (74%) proportion of physicians as either overweight or obese [5]. Similarly studies conducted among nurses have also highlighted the burden of obesity [6,7]. A study from the UK setting reported 39.8% obesity among nurses [6] whereas a 82.4% prevalence was reported among nurses in Tonga [7].

Reliability and validity of the Parent Efficacy for Child Healthy Weight Behaviour (PECHWB) scale

Interventions for childhood overweight and obesity that target parents as the agents of change by increasing parent self-efficacy for facilitating their child's healthy weight behaviours require a reliable and valid tool to measure parent self-efficacy before and after interventions. Nelson and Davis developed the Parent Efficacy for Child Healthy Weight Behaviour (PECHWB) scale with good preliminary evidence of reliability and validity. The aim of this research was to provide further psychometric evidence from an independent Australian sample. Data were provided by a convenience sample of 261 primary caregivers of children aged 4-17 years via an online survey. PECHWB scores were correlated with scores on other self-report measures of parenting efficacy and 2- to 4-week test-retest reliability of the PECHWB was assessed. The results of the study confirmed the four-factor structure of the PECHWB (Fat and Sugar, Sedentary Behaviours, Physical Activity, and Fruit and Vegetables) and provided strong evidence of internal consistency and test-retest reliability, as well as good evidence of convergent validity. Future research should investigate the properties of the PECHWB in a sample of parents of overweight or obese children, including measures of child weight and actual child healthy weight behaviours to provide evidence of the concurrent and predictive validity of PECHWB scores.

Factors Associated with Weight Resilience in Obesogenic Environments in Female African-American Adolescents

This study used a descriptive, cross-sectional analysis to examine a social ecological model of obesity among African-American female adolescents residing in obesogenic environments. The goal was to identify factors that promote weight resilience, defined as maintaining a healthy body weight despite living in an environment that encourages inactivity and undermines healthy weight behaviors. During 2005 to 2008, weight-resilient (n=32) and obese (n=35) African-American female adolescents (12 to 17 years) living in Detroit, MI, and their caregivers completed measures of individual, family, and extrafamilial weight-resilience factors. Variables related to weight resilience in bivariate analyses were subjected to multivariate analysis using logistic regression to test the hypothesis that these factors independently predicted adolescent membership into the weight-resilient or obese group. As hypothesized, the odds of an adolescent being weight resilient were predicted by lower caregiver body mass index (calculated as kg/m2) (odds ratio [OR]=0.790; 95% confidence interval [CI]: 0.642 to 0.973), lower caregiver distress (OR=0.796; 95% CI: 0.635 to 0.998), higher caregiver monitoring and supervision of exercise (OR=5.746; 95% CI: 1.435 to 23.004), more frequent full-service grocery store shopping (OR=5.147; 95% CI: 1.137 to 23.298), and more peer support for eating (OR=0.656; 95% CI: 0.445 to 0.969). Contrary to prediction, lower eating self-efficacy (OR=0.597; 95% CI: 0.369 to 0.965) also predicted weight resilience. The model correctly classified 92.5% of all cases. Findings suggest that increasing psychosocial weight-resilience factors across multiple systems might be an important intervention strategy for obese African-American female adolescents residing in obesogenic environments.

Development and preliminary validation of the Parent Efficacy for Child Healthy Weight Behaviour Scale

This study developed a new measure of parent self-efficacy for promoting healthy weight behaviours in their children, the Parent Efficacy for Child Healthy Weight Behaviour Scale (PECHWB). In total 601 primary caregivers of children aged 4-17 completed an online survey consisting of the PECHWB, a measure of general parenting self-efficacy, measures of parental depression, anxiety and stress and demographic questions. Factor analysis identified four PECHWB subscales with high levels of internal consistency. The PECHWB showed significant small positive correlations with a measure of global parenting self-efficacy and small negative correlations with measures of parental negative affect. This study provides initial evidence for the reliability and validity of the PECHWB. Future research is required to establish further evidence of the psychometric properties of the PECHWB scale in independent samples before the scale can be used in evaluating intervention outcomes.

An Observational Study of an Employer Intervention for Children's Healthy Weight Behaviors

This observational study was undertaken to assess whether changes in healthy weight behaviors could be advanced in a short-term intervention involving parents and children at IBM. IBM's Children's Health Rebate offered a cash incentive for parents to complete a 12-week program of self-selected activities in family food planning and meals, family physical activity, and sedentary time related to electronic entertainment ("screen time"). A preprogram/postprogram comparison of self-reported activities was used to assess behavior change. A total of 22,265 (52.3%) employees elected to participate, 11,631 (52.2%) of whom completed all program requirements and earned a $150 cash rebate. Families completing the program reported significant changes in levels of physical activity, amount of entertainment screen time, and proportion of healthy meals. For example, family physical activity >3 times per week increased by 17.1 percentage points (from 23.2% to 40.3%), eating healthy dinners ≥ 5 days/week increased by 11.8 percentage points (from 74.9% to 86.7%), and entertainment screen time <1 hour/day increased by 8.3 percentage points for children (from 22.4% to 30.7%) and by 6.1 percentage points for adults (from 18.1% to 24.2%). The results of this short-term observational study suggest that healthy weight behaviors in children, adolescents, and parents can be improved by using a Web-based intervention linked with a cash incentive. The results also show that employers can activate parents and support a role for employers in community-based strategies for obesity prevention in children. Experimental designs with biometric data would strengthen the suggestion of positive impact.

An Observational Study of an Employer Intervention for Children's Healthy Weight Behaviors

An Observational Study of an Employer Intervention for Children's Healthy Weight Behaviors

School‐wide healthy weight behaviors: Promoting Universal Longevity via School–family Ecologies (PULSE)

AbstractRates of childhood obesity have more than tripled in the last 40 years, resulting in a challenge from the public sector and various governmental institutions for the development of effective prevention/early intervention programming. Based on an extensive review of the literature, an evidence‐based, school‐wide curriculum is proposed. Promoting Universal Longevity via School–family Ecologies (PULSE) is intended to change weight imbalance behaviors via proactive and long‐term interventions directed toward all children and their families (universal prevention model) via the school setting. The authors provide a review of the literature and outline the conceptual model of PULSE. © 2009 Wiley Periodicals, Inc.

Reliability and validity of the Healthy Home Survey: A tool to measure factors within homes hypothesized to relate to overweight in children

BackgroundThe contribution of the environment to the obesity epidemic is well recognized. Parents have control over their home environment and can, therefore, support healthy dietary and activity habits in their children by manipulating factors such as access to energy-dense foods, availability of physical activity equipment, and restricting screen time. This paper describes the development of the Healthy Home Survey and its reliability and validity. The Healthy Home Survey was designed to assess characteristics of the home environment that are hypothesized to influence healthy weight behaviors in children including diet and physical activity.MethodsWe recruited 85 families with at least one child between 3–8 years. The Healthy Home Survey was administered to parents via telephone and repeated in a random sample of 45 families after 7 days. In-home observations were performed within 14 days of the first Healthy Home Survey interview. Percent agreement, Kappa statistics, Intra-class correlation coefficients and sensitivity analyses were used to evaluate reliability and validity evidence.ResultsReliability and validity estimates for the Healthy Home Survey were varied, but generally high (0.22–1.00 and 0.07–0.96 respectively), with lower scores noted for perishable foods and policy items. Lower scores were likely related to actual change in the perishable foods present and the subjective nature or clarity of policy questions and response categories.ConclusionInitial testing demonstrated that the Healthy Home Survey is a feasible, reliable, and valid assessment of the home environment; however, it has also highlighted areas that need improvement. The Healthy Home Survey will be useful in future research exploring the relationship between the home environment and child weight.