Obesity Prevention Project Research Articles

Schoolchildren's Lifestyle and Behaviors Relating to Obesity: Collaborative Study in Urban Uganda

Context: Child obesity, one of the major contributors to noncommunicable diseases in developing countries, is rising following drastic economic growth and lifestyle changes. In Uganda, noncommunicable diseases as a cause of death have increased from 15% in 1990 to 35% in 2019.
 Aim: The study aimed to investigate schoolchildren’s obesity status, lifestyle behaviors, and the factors of obesity in urban Uganda.
 Methods: The study was conducted with a cross-sectional, descriptive quantitative design. The survey using the researcher-developed questionnaire and physical measurement tools for 330 children aged 9 to 11 years old in 6 elementary schools in urban Uganda in November 2018. The Japanese Red Cross College of Nursing Institutional Review Board approved this study (Approval Number: 2018-066).
 Results: Obesity status among schoolchildren in urban Uganda was 67.6% normal, 25.2% underweight, 5.4% overweight, and 1.8% obese.
 Conclusion: Obesity and overweight have not been predominant in this population. However, children's growth must be carefully monitored to prevent future overweight and obesity due to the limited availability of school health services and rapid lifestyle changes. Demographic factors associated with obesity status (waist-hip ratio, body fat, and body mass index) were gender, financial access to food, screen time, sleep time, and sleep hours. Based on this study in Uganda, the researchers expect to develop further collaborative child obesity prevention projects.

Community Gardens: A Catalyst for Community Change.

Community gardens are increasing in popularity and are associated with extensive physical and mental health benefits, increased access to fresh produce, and increased social connections. However, evidence is primarily from research in urban and school settings, and little is known about the role of community gardens in rural settings as part of policy, systems, and environmental (PSE) changes to promote health. This study explores the implementation of community gardens as part of an obesity prevention project, titled Healthier Together (HT), in five rural Georgia counties with limited food access and high obesity prevalence (>40%) using a mixed-methods research design that included data from project records, a community survey, interviews, and focus groups with county coalition members. Nineteen community gardens were implemented across five counties, 89% distributed produce direct to consumers, and 50% were integrated into the food system. Few (8.3%) of the survey respondents (n = 265) identified gardens as a food source, but 21.9% reported using an HT garden in the past year. Themes emerging from interviews (n = 39) and five focus groups suggested community gardens were a catalyst for broader community health change by increasing awareness of the value and absence of healthy food and generating excitement for future PSE initiatives to more comprehensively address food and physical activity access. Practitioners should consider placement of rural community gardens to optimize access to and distribution of produce as well as communication and marketing strategies to increase engagement and leverage gardens as gateways for PSE approaches to improve rural health.

Harmonizing Ratings From Different School Environment Assessment Methods: A Simplified Approach.

This study describes a method for harmonizing data collected with different tools to compute a rating of compliance with national recommendations for school physical activity (PA) and nutrition environments. We reviewed questionnaire items from 84 elementary schools that participated in the Childhood Obesity Research Demonstration (CORD) project, which was 3 distinct childhood obesity prevention projects in 7 communities in California, Massachusetts, and Texas. Each project used tools specific to its programs, schools, and communities. While this approach increased the feasibility of data collection, it created a challenge with the need to combine data across projects. We evaluated all questionnaire items and retained only those items that assessed one or more recommendations and constructed several items to indicate compliance or noncompliance with the respective associated recommendations. Ten constructed items covered 11 of the 20 recommendations. Analysis indicated that the scores detected variability in compliance both among communities and among school within communities. The scores captured differences in compliance with the national recommendations at multiple levels. Our method, designed for creating common scores, may be useful in integrated data analysis, systematic reviews, or future studies requiring harmonizing of data collected via different tools.

Current Status and Needs Assessment for Obesity Prevention and Management Project at Public Health Centers

Current Status and Needs Assessment for Obesity Prevention and Management Project at Public Health Centers

Patterns and correlates of objectively measured physical activity in 3-year-old children

BackgroundTo increase the knowledge about physical activity (PA) patterns and correlates among children under the age of 4, there is a need for study’s using objective measurements. The aim of this study was therefore to investigate if objectively measured PA among 3-year-old children differed between day of week and time of day and whether it correlated to child weight status and sex as well as parental weight status and education.MethodsTotally 61 children (51% girls) aged 3, participating in Early Stockholm Obesity Prevention Project were included. PA was measured with a tri-axial accelerometer (ActiGraph GT3X+) worn on the non-dominant wrist for one week. The main outcome was average PA expressed as counts per minute from the vector magnitude. PA and demographics/family-related factors were collected at baseline and at age 3. To analyze the results simple linear regression, ANOVA and paired t-tests were performed.ResultsThe mean number of valid days was 6.7 per child. The children were more active on weekdays than weekends (p < 0.01) and the hourly pattern differed over the day with children being most active midmorning and midafternoon (p = 0.0001). Children to parents with low education were more active (p = 0.01) than those with highly educated parents. No differences in PA by child weight status, sex nor parental weight status were found.ConclusionsPA in 3-year-old children was lower during weekends than weekdays and varied over the day. Boys and girls had similar PA patterns, these patterns were independent of child or parental weight status. Children to parents with low education were more active than their counterparts. The fact that PA differed between weekdays and weekends indicates that PA might be affectable in 3-year-old children.

A Modified Nominal Group Technique (mNGT) - Finding Priorities in Research.

Objectives: The objective of this study was to describe a modified nominal group technique (mNGT) approach to assess community health priorities and its application to a childhood obesity prevention project conducted with the high school population. Methods: This manuscript provides detailed information of a mNGT separately conducted with 3 cohorts, (students, teachers/administration, parents). Participants used a response sheet to brainstorm, document top 5 responses, and rank each response individually. We also used a unique reverse scoring method to quantify the qualitative data and within and between group scores for comparison against other cohorts. Summaries provided additional insight into the participants' perceptions. Results: The mNGT process successfully reduced limitations common to the traditional nominal group technique by providing an in-depth understanding of perceptions and understanding priorities. Conclusions: mNGT can be useful across other disciplines as a method of gathering rich qualitative feedback that can be transformed into a more quantitative form for analysis.

Promoting congregant health in faith-based organizations across Los Angeles County, 2013-2016.

The Los Angeles County Department of Public Health (DPH) launched the Nutrition Education and Obesity Prevention (NEOP) Project in fall 2013. As the local arm of the Supplemental Nutrition Assistance Program Education (SNAP-Ed), this project partnered with faith-based organizations (FBOs) in Los Angeles County to implement policy, systems, and environmental change interventions (PSEs) at selected church sites, alongside the usual delivery of health education.A 2-part programmatic assessment was conducted to better understand how the NEOP Faith Based Project at one of the FBOs was implemented during the 2013–2016 SNAP-Ed funding cycle. A qualitative component (key informant interviews) sought to understand and describe the PSE implementation process at each of the participating church sites, whereas the quantitative component (surveys) focused on assessing congregant perceptions about their awareness of the PSEs, their knowledge and beliefs about health, and their self-reported health behaviors after exposure to onsite changes.Among congregants who participated in the survey, 52% expressed desire for more health education classes. However, only 37% reported being aware of them at church sites that hosted them. When asked to compare their behaviors for “today” versus 6 months ago, more than half reported greater interest in eating more fruits and vegetables (66%), choosing water over soda (69%), and becoming more physically active (59%).Results from the NEOP Project have implications for how local health departments could partner with FBOs to outreach and promote health among congregants, particularly for those who are at high-risk of diet-related diseases due to poor nutrition and obesity.

NP1 Adolescent Obesity Prevention Project Yields Policy, System, and Environmental Changes in Middle Schools

Objective To develop a community-based program targeting overweight and obesity prevention among adolescents in limited resource, minority communities. Description Summary of analyzed data for a tri-state, quasi-experimental project including six communities (one control and one intervention community from each state) who are responsible for creating and implementing one nutrition and one physical activity program addressing overweight and obesity among 6th to 8th grade youth. Evaluation Mixed methods approach used in collecting community food and physical activity environmental data, student health behavior questionnaire data, intervention community focus group data, steering committee annual meeting transcripts and ripple effect mapping (REM) data. Conclusion and Implications This project developed a potential framework for creating community-focused, sustainable and effective adolescent obesity prevention programs. Outcomes reported from REM data support this framework by increased student awareness and importance of positive health behaviors, as well as the willingness to adopt these health behaviors; positive changes in school culture related to collaboration, involvement and commitment to wellness; an increase in school-community partnerships; improvements in the school physical environment; and increased opportunities for physical activity before, during and after school and in the community. This implies community-centered efforts, guided by community stakeholders, educators and youth have led to changes related to policy, system, and environment which promote healthier dietary and physical activity behaviors in youth living in limited-resource communities.

Impact of SNAP-Ed Food Safety Intervention in DC Preschoolers (P04-085-19)

ObjectivesAccording to the CDC’s national foodborne illness surveillance system, children are disproportionally affected by foodborne illnesses: those under the age of 15 years account for approximately half of all cases. These diseases can result in short- and long-term health consequences and even death.Children from low-income families face greater food safety risks. This can be a result of poor nutrition, increased exposure to food safety risks, and reduced access to health care. Understanding food safety knowledge and properly practicing food safety behavior is important in preventing foodborne illness.Supplemental Nutrition Assistance Program Education (SNAP-Ed) provides food safety skills to at-risk youth. This study examines the program’s impact on increasing food safety knowledge at the preschool level. MethodsIn October of 2017, the University of the District of Columbia (UDC) SNAP-Ed nutrition educators implemented food safety education in 91 classrooms from 21 different elementary schools and child development centers located in low-income areas in Washington, D.C.During program implementation, 1232 children completed a two-question pre- and post-assessment to measure changes in food safety knowledge:•1: Raise your hand if you agree that we need to wash our hands for at least 20 seconds.•2: Raise your hand if you agree that we should wash our hands every time before we eat. ResultsUDC SNAP-Ed observed a positive change in both questions. Initially, only 307 students (25%) correctly answered question one. After the intervention, 97% answered correctly, resulting in a positive change of 72% or 890 students.Before the intervention, only 341 students (28%) correctly answered the second question. After the intervention, 1191 (97%) answered correctly, resulting in a positive change of 70% or 850 students. ConclusionsSNAP-Ed Nutrition education positively impacted preschool students’ knowledge of food safety practices. Further research is necessary to understand the implementation of food safety techniques following food safety education intervention. Funding SourcesThis project was funded through money appropriated by Congress through the Nutrition Education and Obesity Prevention Grant Program in the Healthy, Hunger-Free Kids Act of 2010 to states for evidence-based nutrition education and obesity prevention interventions and projects. Supporting Tables, Images and/or Graphs▪

Food Safety Knowledge and Eating Behaviors in Low Income Adults Participating in SNAP-Ed Nutrition Education in DC Farmers Markets (P04-084-19)

ObjectivesFarmers Markets are a valuable source of affordable quality foods for Supplemental Nutrition Assistance Program (SNAP) recipients. However, according to a study in the American Journal of Agricultural Economics, farmers markets increase the number of foodborne illnesses. Low-income individuals are at the highest risk of foodborne illnesses and is thought to be related to poor food safety knowledge and limited food preparation skills. Reduced produce consumption has also been indicated in low-income populations. Produce is a major source of foodborne illnesses. Therefore, in addition to increasing access to produce, efforts must be made to ensure that consumers practice proper food safety. The purposes of this study were to 1) assess the food safety knowledge of farmers-market consumers in low-income neighborhoods, 2) their likelihood to use food assistance benefits, 3) consume produce and 4) cook a recipe provided by a SNAP-Ed program. MethodsIn 2018, the University of the District of Columbia (UDC) SNAP-Ed nutrition educators delivered nutrition and food safety education in 17 DC Farmers Markets located in low-income communities. 822 subjects completed a 3 question post-assessment on eating behaviors and of those, 669 participated in an additional 2 question survey on food safety. ResultsThe results show that after the education, 99.0% plan on eating more produce; 95.6% of participants plan to cook the provided recipe; and 92.7% will use SNAP, WIC, Produce Plus or Farmers’ Market Nutrition Program benefits at the Farmers’ Market that day. Additionally, 92.8% think that contamination of food by germs is a serious food safety problem, and 94.3% wash or rinse fresh produce purchased at the Farmers’ Market prior to consumption. ConclusionsMajority of low-income farmers market participants had general food safety knowledge and planned on consuming more produce, use food assistance benefits and try a new recipe. Further research is necessary to assess food safety knowledge of other domains and identify the impact of SNAP-Ed food safety education on behavior change. Funding SourcesThis project was funded through money appropriated by Congress through the Nutrition Education and Obesity Prevention Grant Program in the Healthy, Hunger-Free Kids Act of 2010 to states for evidence-based nutrition education and obesity prevention interventions and projects. Supporting Tables, Images and/or Graphs▪▪▪

Abstract P090: Oculus/PlayStation IV VR Game for Youth to Build Food and Drink Selection Skills

Low-quality food and drink selection by today’s youth is well documented despite their ability to distinguish between low and high-quality foods. In addition, attention spans are short and youth are drawn to screens and gaming technology in our technology-focused culture. We are addressing the need to instill food and drink selection skills using a game-based behavioral intervention utilizing headset virtual reality (VR) technology. As a part of our Obesity Prevention project, we created Food Fight in VR. The virtual reality experience uses current PlayStation VR and Oculus headsets to offer an experience with high ecological validity by presenting high quality and accurate visual and auditory stimuli in a proper social and environmental context. In a realistic virtual world, the game immerses the young player in a believable world with altered game mechanics that control success and failure parameters. VR offers the young player an opportunity to experiment, try out new behaviors, fail, and build confidence. VR success then translates to real-world skills, feelings of empowerment, and improved selection behaviors. In our FoodFight Oculus or Playstation VR game, food cues bombard a young player wearing a virtual reality headset. They inspect each food or drink tossed at them. They quickly decide if the item is unhealthy (based on a diet they have chosen) and thus should be blocked (using a virtual tray), caught and thrown back, discarded, or hit away. Or, if they deem the food to be healthy, they grab it or pull it in with a food magnet and store it in the pantry or fridge for later. Visual cues, points, and active involvement make the process of selecting healthy foods and resisting unhealthy foods easy and fun. The game provides appropriate feedback for saving unhealthy food or rejecting healthy food. Eventually, they have collected enough food to build a healthy meal, win the game level, and proceed to the next level; winning and leveling up are strong motivators for this audience. In the long term, we seek to enhance internal control over the food selection process. Our short-term objectives are for the player to: 1) recognize healthy and unhealthy food, 2) reject unhealthy food/drink, 3) build confidence in rejecting unhealthy foods, and 4) recognize the foods required to build a balanced healthy meal consistent with a dietary guideline. Our future work involves expanding the game to highlight specific dietary requirements beyond the preparation of a single meal and include a wide range of diets such as Dash, Mediterranean, gluten-free, vegan, plant-based whole food, and vegetarian. Initial usability studies show a positive response and innovative use of game mechanics. A more robust evaluation is ongoing.

Higher pricing of fresh produce is more likely in SNAP-Ed eligible neighborhoods when adjacent non-program eligible neighborhoods are mixed income.

This analysis describes the socioeconomic attributes of neighborhoods adjacent to low-income neighborhoods with ≥50% of households that are Supplemental Nutrition Assistance Program Education (SNAP-Ed) eligible. It compares the pricing, availability, and quality of fresh produce between these neighborhoods in Los Angeles County. The Los Angeles County Department of Public Health utilized 2013–2014 community-level data from the Communities of Excellence in Nutrition, Physical Activity and Obesity Prevention (CX3) Project to examine the geographic patterns of fresh produce purchases and accessibility in SNAP-Ed eligible census tracts. Community indicators collected by CX3 included information on pricing, availability, and quality of fruits and vegetables from grocery stores (n = 108) in these eligible neighborhoods (n = 21). Correlation statistics were generated to explore the effects of adjacent neighborhoods' socioeconomic status on fruit and vegetable pricing, availability, and quality in the selected neighborhoods (“CX3 neighborhoods”). Poverty data were obtained from the United States Census' American Community Survey. Residents of CX3 neighborhoods that were surrounded by mixed income neighborhoods paid 43% more for fresh produce than CX3 neighborhoods surrounded by other similarly low-income neighborhoods (median produce price, $1.50 versus $1.05). Study results suggest that while quality of produce remains an issue, it is the higher pricing of fresh produce in CX3 neighborhoods – i.e., in the presence of other surrounding mixed income neighborhoods (those with relatively higher income) – that appeared to potentiate food access barriers. Future SNAP-Ed efforts should take this pricing pattern under consideration when designing, planning, and/or implementing nutrition-related programs in these neighborhoods.

Development of sleep patterns in children with obese and normal-weight parents.

AimTo study the sleep development and sleep characteristics in children at different obesity risks, based on parental weight, and also to explore their weekday–weekend sleep variations and associated family factors.MethodsA total of 145 children participating in a longitudinal obesity prevention project were included, of which 37 had normal‐weight parents (low obesity risk), and 108 had overweight/obese parents (high obesity risk). Sleep diaries at ages 1 and 2 years were used to study sleep development in children at different obesity risks. Objectively assessed sleep using an accelerometer at 2 years of age was used to analyse weekday–weekend sleep variations.ResultsThere was no difference in sleep development from age 1 to age 2 among children at different obesity risks, but more children in the high‐risk group had prolonged sleep onset latency and low sleep efficiency. At 2 years of age, children in the high‐risk group had more weekday–weekend variation in sleep offset (mean difference 18 min, 95% confidence interval (CI) 4–33 min), midpoint of sleep (mean difference 14 min, 95% CI 3–25 min) and nap onset (mean difference 42 min, 95% CI 10–74 min) than children in the low‐risk group, after adjusting for other family factors. However, no difference could be detected between groups in weekday–weekend variation in sleep duration.ConclusionsUnfavourable sleep characteristics, as well as more variation in sleep schedules, have been observed in children at high obesity risk. While the differences were relatively small, they may reflect the unfavourable sleep hygiene in families at high obesity risk.

NP37 - Wave~Ripples for Change (Year 5 of 5): 2-Y Childhood Obesity Prevention Intervention Preliminary Findings and Project Outputs

Objective: Prevent childhood obesity among high school soccer players (HSSP) ages 14–19 years-old in Oregon. Description: In June 2017 we concluded the 2-y intervention. This 5-year project will conclude in May 2018. Three key program outputs include: A field-tested, 4-lesson, high school sport nutrition curriculum supplemented with three life-skill team-building workshops, and a 3-D animation computer game for experiential learning. The curriculum is being peer-reviewed now; an enhanced cloud-based system named WavePipe field-tested to manage human studies data collection, monitoring, and automated analyses and report generation; and development of a sports mobile game application prototype concept and wireframe. Evaluation: Among 388 HSSP who completed the study (51% attrition rate in 2-y; intervention group n = 278; comparison group n = 110), 58% were females, 38% were Latino, 38% participated in school breakfast program and/or national school lunch program, mean age was 15.3 (1.1 years). Compared to the comparison group, the intervention group significantly decreased in added sugar intake by 12g/d, but had no changes in fruits and vegetable (FV) and saturated fat consumption. Physical activity (PA) was significantly higher in-soccer season than out-of-soccer season for both intervention and comparison groups. Conclusions and Implications: This is the first study to engage HSSP in a 2-y obesity prevention program targeting sport nutrition education, healthy eating behaviors for growth, performance and health, emphasizing the importance of daily PA and life-skills experiential learning. Overall, FV intakes were maintained over the 2-y intervention but were below the dietary recommendations, although higher than those typically reported in the literature for youth and youth athletes. The 2-y intervention significantly decreased added sugar intake, by lowering the frequency of selecting cake/cookies and ice cream foods. PA recommendations were met during soccer season, but below recommendations out-of-season. Thus, it is important to engage active youth yearlong, helping them to make daily PA a priority in their lifestyle. Funding: 2013-67001-2041.

An Exploratory Analysis of Factors Associated with Health-Related Physical Fitness in Adolescents. The ASSO Project

Monitoring physical fitness (fitness) and identifying, since the beginning, possible determinants in youth could be useful to preserve health and avoid morbidities in adulthood. The main objective of this study is to provide details on the fitness levels of a sample of adolescents living in the Southern area of Italy and describe its associations with biological/genetic, socio-cultural/environmental, and lifestyle (physical activity/sedentariness, alcohol/smoking, meal patterns/habits) factors. The study was conducted within the Adolescence Surveillance System for Obesity Prevention (ASSO) project, funded by the Italian Ministry of Health and examining adolescents’ lifestyle in relation to obesity. Fitness measures were collected through the ASSO-fitness tests battery (FTB) and examined in relation to 79 selected possible influencing factors, which were collected through a web-based questionnaire included in the ASSO-NutFit software. Logistic regression analyses were performed to assess associations, with ORs and 95% CIs estimated as crude and adjusted. A total of 919 participants were initially recruited, but fitness data were collected for 544 students aged 13–19 (68% M, 32% F). Fitness level was low for 14.2% of the students, medium for 67.8%, and high for 18.0%. The independent determinants of low physical fitness in our sample of adolescents were included in the biological/genetic and physical activity/sedentariness dimensions: female gender (Adj OR 8.33, CI 2.08–33.33), obesity (Adj OR 1.97, CI 1.10–9.22), practicing sport less than 3 h/week (Adj OR 6.09, CI 1.63–22.72), practicing sport with strength/speed as prevalent biomotor ability (Adj OR 8.97, CI 1.43–56.19), using PC/internet for more than 3 h/day (Adj OR 4.46, CI 1.17–16.98). Drinking alcohol was instead a protective factor. This study confirms that females and obese individuals need more attention in the interventions aimed at increasing fitness levels. It suggests that local actions should be implemented with the aim of increasing sport practices and reducing sedentary time spent in front of PC/internet. The focus should be particularly addressed to sports with strength or speed as dominant biomotor abilities.

Tools for a systematic appraisal of integrated community-based approaches to prevent childhood obesity

BackgroundEvaluation and monitoring methods are often unable to identify crucial elements of success or failure of integrated community-wide approaches aiming to tackle childhood overweight and obesity, yet difficult to determine in complex programmes. Therefore, we aimed to systematically appraise strengths and weaknesses of such programmes and to assess the usefulness of the appraisal tools used.MethodsTo identify strengths and weaknesses of the integrated community-based approaches two tools were used: the Good Practice Appraisal tool for obesity prevention programmes, projects, initiatives and intervention (GPAT), a self-administered questionnaire developed by the WHO; and the OPEN tool, a structured list of questions based on the EPODE theory, to assist face-to-face interviews with the principle programme coordinators. The strengths and weaknesses of these tools were assessed with regard to practicalities, quality of acquired data and the appraisal process, criteria and scoring.ResultsSeveral strengths and weaknesses were identified in all the assessed integrated community-based approaches, different for each of them. The GPAT provided information mostly on intervention elements whereas through the OPEN tool information on both the programme and intervention levels were acquired.ConclusionLarge variability between integrated community-wide approaches preventing childhood obesity in the European region was identified and therefore each of them has different needs. Both tools used in combination seem to facilitate comprehensive assessment of integrated community-wide approaches in a systematic manner, which is rarely conducted. Nonetheless, the tools should be improved in line to their limitations as recommended in this manuscript.

Southern Italian teenagers: the older they get, the unfit they become with girls worse than boys: a cohort epidemiological study: The adolescents surveillance system for the obesity prevention project (ASSO).

Italy comprises a high proportion of people who never exercised. Low physical activity levels in adolescents is a risk factor for several disorders. The aim of this cohort epidemiological study was to compare physical fitness profiles between boys and girls with regard to age and gender and to identify health and fitness-related markers that contribute to the make-up of Southern Italian teenagers.Eight hundred eleven teenagers were assessed for anthropometric measurements and completed the 5 ASSO-fitness tests battery. Data were analyzed with a 2-way analysis of variance (ANOVA) for repeated measures to compare the effect of both age and gender on the fitness components.The boys’ anthropometric measurements were superior than the girls as expected [weight, height, body mass index (BMI), and waist circumference]; the overall BMI was found in the normality range. The overall teenagers’ fitness markers were found to be quite poor with the boys outperforming the girls in all fitness tests. The weak cardiorespiratory performance of the female teenagers was remarkable. The under 16 years old (-16 yrs) girls outperformed the over 16 years old (+16yrs) girls. There were less significant differences when comparing (-16) and (+16) yrs old mixed-gender groups. There were no correlations between the (−16) and (+16) yrs when both genders were considered. The trend analysis showed the younger teenagers might be “catching up” the older ones in both contexts.Gender significantly influenced all variables. Although age did not influence cardiorespiratory fitness, the older the teenagers the worse their health and fitness markers become with the older girls worse than their younger peers.

The Influence of Home and School Environments on Children’s Diet and Physical Activity, and Body Mass Index: A Structural Equation Modelling Approach

Introduction The home and school environments play important roles in influencing children's health behaviours. However, their simultaneous influence on childhood obesity has not yet been examined. We explore the relationship of the home and school environments with childhood obesity, to determine whether this relationship is mediated by children's fruit and vegetable intake and physical behaviours. Methods This study uses baseline data from 9 to 11year old children, their parents and school principals (matched data n = 2466) from the Obesity Prevention and Lifestyle Project. Child-reported behaviours, parent-reported home environment and principal-reported school environment data were collected via questionnaires. Trained researchers measured children's height and weight, and Body Mass Index (BMI, kg/m2) was calculated. Structural equation modelling was used to assess the relationship of the home and school environments with children's fruit and vegetable intake, physical activity behaviours, and children's BMI. Result The home diet environment was positively associated with child diet (β = 0.18, p < 0.001). The home physical activity environment had the largest inverse association with BMI (β = - 0.11, p < 0.001), indirectly through child physical activity (β = 0.28 ,p < 0.001). Schools' healthy eating policy implementation was significantly associated with child diet (β = 0.52, p < 0.05), but physical activity policy was not associated with child activity (β = - 0.007, p > 0.05). The school environment was not associated with child BMI. Discussion The home environment had a stronger association with healthier child behaviours, compared to the school environment. These findings suggest that future childhood obesity interventions targeting healthier home environments and supporting parents can promote healthier child eating and physical activity behaviours.

Recommendations for obesity prevention among adolescents from disadvantaged backgrounds: a concept mapping study among scientific and professional experts.

SummaryThe present study aimed to enrich the scientific evidence on obesity prevention programmes for adolescents from socio‐economically disadvantaged backgrounds with practice‐based experiences from both scientific and professional experts in the field of youth obesity prevention. We used the participatory method of concept mapping. Two concept mapping sessions were conducted: one with programme coordinators of national/regional obesity prevention programmes across Europe (n = 8) and one with scientists participating in European obesity prevention projects (n = 5). Five recommendations were extracted from both concept maps: (1) involve adolescents in the design and delivery of the programme, (2) invest in family/parental capacity building, (3) provide and support a healthy school food and physical activity environment, (4) regulate exposure to unhealthy messages/advertising and (5) facilitate safe and active travel. These recommendations can be used as a conceptual framework for programme development for preventing obesity in adolescents.

Positive influences of home food environment on primary-school children's diet and weight status: a structural equation model approach.

The mechanism by which the home food environment (HFE) influences childhood obesity is unclear. The present study aimed to investigate the relationship between HFE and childhood obesity as mediated by diet in primary-school children. Cross-sectional data collected from parents and primary-school children participating in the Obesity Prevention and Lifestyle Evaluation Project. Only children aged 9-11 years participated in the study. Matched parent/child data (n 3323) were analysed. Exploratory factor analysis underlined components of twenty-one HFE items; these were linked to child diet (meeting guidelines for fruit, vegetable and non-core food intakes) and measured child BMI, in structural equation modelling, adjusting for confounders. Twenty geographically bounded metropolitan and regional South Australian communities. School children and their parents from primary schools in selected communities. In the initial exploratory factor analysis, nineteen items remaining extracted eight factors with eigenvalues >1·0 (72·4 % of total variance). A five-factor structure incorporating ten items described HFE. After adjusting for age, gender, socio-economic status and physical activity all associations in the model were significant (P<0·05), explaining 9·3 % and 4·5 % of the variance in child diet and BMI, respectively. A more positive HFE was directly and indirectly associated with a lower BMI in children through child diet. The robust statistical methodology used in the present study provides support for a model of direct and indirect dynamics between the HFE and childhood obesity. The model can be tested in future longitudinal and intervention studies to identify the most effective components of the HFE to target in childhood obesity prevention efforts.