Obesity-related Behaviors Research Articles

The More and Less Study: a randomized controlled trial testing different approaches to treat obesity in preschoolers.

BackgroundWhile obesity has been shown to be difficult to treat in school aged children and in adolescence, promising results have been detected for children who started treatment in early childhood. Yet knowledge on the effectiveness of structured early childhood obesity treatment programs is limited, preventing the widespread implementation of such programs. The main objective of this study is to evaluate the effectiveness of early treatment of childhood obesity with respect to treatment focus (parenting practices or lifestyle), length and intensity. The study will also examine the influence of gender, age, parental weight status, parenting practices, child behavior as well as parents’ socioeconomic status and child and parental psychosocial health on children’s weight status.Methods/designThis is a parallel open label randomized controlled trial assessing two different behavioral treatment approaches offered in three conditions to families with children aged 4–6 years in Stockholm County, Sweden. Children (n = 180) identified as obese will be referred from primary child health care, school health care, and from outpatient pediatric clinics, and randomized to: 1) a standard treatment with focus on lifestyle, provided within the current healthcare system (n = 90); 2) a 10-session, 1.5 h/week group treatment with focus on parenting (n = 45); or 3) the same group treatment as 2) with additional follow-up sessions (n = 45). The primary study outcome is change in children’s body mass index standard deviation score (BMI SDS) one year post-baseline. Secondary outcomes include changes in children’s waist circumference, metabolic health, lifestyle patterns (Food Frequency Questionnaire), obesity-related child behaviors (Child Eating Behavior Questionnaire and Lifestyle Behavior Checklist, Problem Scale), parents’ general and feeding parenting practices (Communicating with Children and Child Feeding Questionnaire) and lifestyle-specific self-efficacy (Lifestyle Behavior Checklist, Confidence Scale), family functioning (Family Assessment Device), child and parental psychosocial health (Child Behavior Checklist and Beck’s Depression Inventory II).DiscussionThis study will facilitate a close examination of key components of treatment for obesity during early childhood and mechanisms of change. Results from this study will lead to better healthcare options for obesity treatment during early childhood and ultimately to the prevention of obesity later in life.Trial registrationClinicalTrials.gov NCT01792531 Registered February 14, 2013.

Inventory of Determinants of Obesity-Related Behaviors in Adolescents: Development and Psychometric Characteristics.

Background:The rising prevalence of childhood obesity is a major health problem worldwide. Hence, there is a growing need for health professionals to become capable of assessing the factors that determine lifestyle in a culturally relevant manner.Objectives:This study aimed to develop and assess a questionnaire for measuring determinants of obesity-related behaviors in Tehranian adolescents.Patients and Methods:Based on the results of a qualitative study and an extensive literature review, the 44-item “Inventory of determinants of obesity-related behaviors in adolescents (IDOBA)” with eight subscales was developed: 1) unhealthy nutrition and physical inactivity; 2) stress-related eating; 3) perceived inability; 4) perceived lack of threat; 5) perceived priority of educational achievement; 6) perceived acceptability; 7) motivation loss; and 8) lack of support. Validity of IDOBA was assessed, utilizing face, content, and construct validity methods. To confirm face validity, ten overweight/obese adolescents completed the questionnaire. To calculate content validity ratio (CVR) and content validity index (CVI), a different panel of ten experts commented independently on the necessity, relevance, clarity, and simplicity of each item. To assess construct validity using exploratory factor analysis (EFA), a total of 478 adolescents (57.7% male) aged 13 to 18 years, who were recruited from schools, participated in the study. Confirmatory factor analysis (CFA) was used to test whether the data fit the hypothesized measurement model that was derived from EFA. Test-retest and internal consistency methods were used to assess reliability of the IDOBA scale.Results:All items were perceived as relevant and comprehendible by adolescents. Content validity was confirmed by the panel of experts. The internal consistency, as measured by Cronbach’s alpha coefficients, exceeded the minimum reliability standard of 0.60 for eight subscales. No ceiling effects were observed. Detected floor effects ranged from 0.2% for perceived acceptability subscale score to 18.8% for lack of threat subscale score. The EFA suggested an eight-factor construct and the results of the CFA indicated acceptable fit indices for the proposed model. All subscales demonstrated satisfactory test-retest reliability (intra-class correlation coefficient, 0.42 - 0.91) over one month.Conclusions:Results provided initial evidence that the IDOBA is a valid and reliable instrument for measuring determinants of obesity-related behaviors in Iranian adolescents, indicating that the questionnaire can be used in future weight management programs for Tehranian adolescents.

Changing from primary to secondary school highlights opportunities for school environment interventions aiming to increase physical activity and reduce sedentary behaviour: a longitudinal cohort study.

BackgroundThere is little empirical evidence of the impact of transition from primary to secondary school on obesity-related risk behaviour. The purpose of this study was to examine the effect of a change of school system on physical activity (PA) and sedentary behaviour in pre-early adolescents.MethodsFifteen schools in Victoria, Australia were recruited at random from the bottom two strata of a five level socio-economic scale. In nine schools, students in year 6 primary school transitioned to a different school for year 7 secondary school, while in six schools (combined primary-secondary), students remained in the same school environment from year 6 to year 7. Time 1 (T1) measures were collected from students (N=245) in year 6 (age 11-13). Time 2 (T2) data were collected from 243 (99%) of the original student cohort when in year 7.PA and sedentary behaviour data were collected objectively (via ActiGraph accelerometer) and subjectively (via child self-report recall questionnaire). School environment data were collected via school staff survey. Change of behaviour analyses were conducted longitudinally i) for all students and ii) by change/no change of school. Mixed model regression analysis tested for behavioural interaction effects of changing/not changing school.ResultsSixty-three percent (N=152) changed schools from T1 to T2. Across all students we observed declines in average daily moderate to vigorous physical activity (MVPA) (−4 min) and light PA (−23 min), and increases in average daily sedentary behaviour (16 min), weekday leisure screen time (17 min) and weekday homework screen time (25 min), all P<0.05. Compared to students who remained in the same school environment, students who changed school reported a greater reduction in PA intensity at recess and lunch, less likelihood to cycle to/from school, greater increase in weekday (41 mins) and weekend (45 mins) leisure screen time (P<0.05) and greater encouragement to participate in sport. School staff surveys identified that sport participation encouragement was greater in primary and combined primary-secondary than secondary schools (P<0.05).ConclusionTransitioning from primary to secondary school negatively impacts on children’s PA and sedentary behaviour, and has further compounding effects on behaviour type by changing school environments.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-015-0218-0) contains supplementary material, which is available to authorized users.

Australian Middle Eastern parents' perceptions and practices of children's weight-related behaviours: Talking with Parents' Study.

The home environment is associated with obesity-related behaviours among children, and research in Australia has shown that some of these behaviours are more prevalent among children from particular cultural backgrounds including Middle Eastern. This study presents findings from face-to-face, semi-structured interviews conducted in April 2013 with a convenience sample of Middle Eastern parents of primary school-age children at an Islamic private school in Sydney, Australia. The interviews explored parental perceptions and practices regarding state government health messages addressing children's eating, physical activity and screen time. The purpose of the study was to investigate whether the content of these generic public health messages is relevant and acceptable to Middle Eastern parents of young children, and to identify any enablers and barriers to adopting these healthy practices at home. Thematic analysis identified predominant themes. In total, 21 interviews were conducted (reference children: 12 boys/9 girls, aged 5-12years). The content of current health messages regarding children's weight-related behaviours was familiar to respondents, and accepted as relevant for guiding their parenting practices. Parents perceived that they typically encouraged healthy behaviours, although they also reported making regular exemptions, in response to various circumstances. Overall, the perceptions and reported practices of the parents were consistent with other studies with Australian parents. There were no apparent culturally specific barriers or enablers to children's weight-related behaviours. There is however scope for health promoters to provide more precise information on health recommendations, health risks and benefits, and to provide more specific ideas for ways in which parents can act on these health messages within the home and family environment, to encourage and support healthy behaviours in their children.

A systematic review of the effectiveness of school-based obesity prevention programmes for First Nations, Inuit and Métis youth in Canada.

First Nations, Inuit and Métis (FNIM) youth are disproportionately affected by obesity and represent known a high-risk group in Canada. School-based prevention programmes may have the potential to effectively influence obesity-related health behaviours (i.e. healthy eating and physical activity) among this population. We conducted a systematic review of nine electronic databases (2003-2014) to identify studies that describe school-based programmes that have been developed to improve obesity-related health behaviours and outcomes among FNIM youth in Canada. The objectives of this review were to identify and evaluate the effectiveness of these programmes and assess the strength of the methodologies used to evaluate them. Fifteen studies, representing seven distinct interventions, met our inclusion criteria. The majority of these programmes did not result in significant improvements in outcomes related to obesity, healthy eating, or physical activity among FNIM youth. The studies varied in design rigour and use of evaluation activities. The lack of literature on effective school-based programmes for FNIM youth in Canada that target obesity-related outcomes highlights a priority area for future intervention development, evaluation and dissemination within the peer-reviewed literature. Further research is needed on interventions involving Métis and Inuit youth, secondary school-aged FNIM youth and FNIM youth living in urban settings.

Child behaviors associated with childhood obesity and parents' self-efficacy to handle them: confirmatory factor analysis of the Lifestyle Behavior Checklist.

BackgroundThe development of family-based programs for child weight management requires an understanding of parents’ difficulties in managing children’s eating and physical activity behaviors; however, knowledge about the specific behaviors that parents find most difficult to address is still limited. The Lifestyle Behavior Checklist (LBC) is an Australian instrument that assesses parents’ perceptions of children’s obesity-related behaviors (the Problem scale), and parents’ self-efficacy in dealing with these behaviors (the Confidence scale). Our aims were 1) to examine the psychometric properties (the factor structure, internal reliability, construct and discriminative validity) of the LBC in parents of preschoolers in Sweden, using the Child Feeding Questionnaire (CFQ) as a criterion measure, 2) to study associations between the LBC and socio-demographic factors.MethodsThe LBC and the CFQ (measuring parental feeding practices) were distributed to parents from 25 schools/preschools and to parents starting a childhood obesity intervention. To test the fit of the original four-factor model (misbehavior in relation to food, overeating, emotional correlates of being overweight, physical activity (24 items)) to the data, confirmatory factor analysis (CFA) was performed. Structural equation modelling was used to examine associations between the LBC and the CFQ and socio-demographic factors.ResultsIn a sample of 478 parents, a five-factor structure proved best fit to data, after excluding 6 items and allowing two pairs of error terms to correlate (TLI = 0.899; CFI = 0.918; RMSEA = 0.042; SRMR = 0.055). The Confidence scale indicated unidimensionality, therefore a hierarchical CFA with 5 first order factors and one second order factor was tested showing good fit. The validity of the LBC was proven by relevant associations with the CFQ and child weight status; parental responses differed depending on child weight status. The Confidence scale was not associated with any child or parent variables.ConclusionsIn a large sample of Swedish parents of preschoolers, the LBC showed good psychometric properties, with relevant correlations to similar constructs. A five-factor structure showed best fit to data with moderate to high internal reliability. The LBC was shown to discriminate effectively between parents of normal weight children and parents of overweight/obese children.

A national school-based health lifestyles interventions among Chinese children and adolescents against obesity: rationale, design and methodology of a randomized controlled trial in China.

BackgroundThe prevalence of obesity among children and adolescents has been rapidly rising in Mainland China in recent decades, both in urban and rural areas. There is an urgent need to develop effective interventions to prevent childhood obesity. Limited rigid data regarding children and adolescent overweight prevention in China are available. A national random controlled school-based obesity intervention program was developed in the mainland of China.Methods/DesignThe study was designed as a national multi-centered cluster randomized controlled trial involving more than 70,000 children and adolescents aged 7–18 years from 7 provinces in China. In each center, about 12–16 primary and secondary schools, with totally at least 10000 participants were randomly selected (Primary: Secondary = 1:1). All of the selected schools were randomly allocated to either intervention or control group (Intervention: Control = 1:1).The multi-components school-based and family-involved scheme was conducted within the intervention group for 9 month, while students in the control group followed their usual health practice. The intervention consisted of four components: a) Create supportive school and family environment, b) Health lifestyles education and related compulsory physical activities, c) Instruct and promote school physical education, d) Self-monitor obesity related behaviors. Four types of outcomes including anthropometric, behavioral, blood chemical and physical fitness were measured to assess the effectiveness of the intervention program.DiscussionThis is the first and largest multi-centered school-based obesity intervention program with the consideration of geographical and social-demographic characteristics of the rapidly increased obesity prevalence of Chinese children and adolescent. The intervention is based on Social Cognitive Theory and Social-Ecological Model of Health, and follows a stepwise approach guided by PRECEDE-PROCEED (P-P) Model and Intervention Map. The results of and lesson learned from this study will help guide future school-based national childhood obesity prevention programs in Mainland China.Trial registrationJanuary 22, 2015; Registration number: NCT02343588

Childhood Obesity Research Demonstration (CORD): the cross-site overview and opportunities for interventions addressing obesity community-wide.

This is the first of a set of articles in this issue on the Childhood Obesity Research Demonstration (CORD) project and provides an overview of the multisite approach and community-wide interventions. Innovative multisetting, multilevel approaches that integrate primary healthcare and public health interventions to improve outcomes for children with obesity need to be evaluated. The CORD project aims to improve BMI and obesity-related behaviors among underserved 2- to 12-year-old children by utilizing these approaches. The CORD consortium, structure, model terminology and key components, and common measures were solidified in year 1 of the CORD project. Demonstration sites applied the CORD model across communities in years 2 and 3. Evaluation plans for year 4 include site-specific analyses as well as cross-site impact, process, and sustainability evaluations. The CORD approach resulted in commonalities and differences in participant, intervention, comparison, and outcome elements across sites. Products are to include analytic results as well as cost assessment, lessons learned, tools, and materials. Foreseen opportunities and challenges arise from the similarities and unique aspects across sites. Communities adapted interventions to fit their local context and build on strengths, but, in turn, this flexibility makes cross-site evaluation challenging. The CORD project represents an evidence-based approach that integrates primary care and public health strategies and evaluates multisetting multilevel interventions, thus adding to the limited research in this field. CORD products will be disseminated to a variety of stakeholders to aid the understanding, prevention, and management of childhood obesity.

The Childhood Obesity Research Demonstration project: linking public health initiatives and primary care interventions community-wide to prevent and reduce childhood obesity.

[Author Affiliation]Heidi M. Blanck. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.Janet L. Collins. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.Address correspondence to: Heidi M. Blanck, PhD, Branch Chief, Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, F77, Atlanta, GA 30341, E-mail: hcb3@cdc.govChildhood obesity is a serious national health problem with 17% of American youth living with obesity.1 In 2010, the Patient Protection and Affordable Care Act (ACA) appropriated $25 million for a 4-year community-based study to determine whether an integrated model of primary care and public health services can improve underserved children's risk factors for obesity. In response, the CDC established the Childhood Obesity Research Demonstration (CORD) to meet the requirements of the ACA and address the call by expert groups for comprehensive, multilevel, multisetting approaches to prevent and reduce childhood obesity.2 This commentary introduces the nine articles in this issue that describe the research collaboration funded by the CDC.Obesity-related health behaviors, such as nutrition and physical activity, are shaped by multiple sources of influence and environments, including the home, early care and education, school, healthcare, and other community settings. Therefore, a host of setting stakeholders who influence these settings, including government, education, the private setting, nonprofit organizations, and families, have a role to play in creating healthier communities. CORD will add to the limited research available on comprehensive, community-wide models for childhood obesity prevention. A recent comparative effectiveness review of the peer-reviewed childhood obesity prevention literature in developed countries found there is a need for more studies that include results from interventions occurring in multiple settings.3 The systematic review found a very limited number of articles with multiple settings and only one community-based, multiple-setting, early childhood obesity prevention study that measured weight and had at least 1 year of follow-up.4 In school-aged youth in the United States, Shape Up Somerville has been novel in its results of reducing BMI over 2 years through a community-based participatory research approach that met the community's interests and strengths and interventions that could be included into existing platforms (schools, afterschool, and community).5The collection of articles in this supplement to Childhood Obesity describes how CORD builds on each community's existing work, uses its stakeholders' perspectives of problems and feasible solutions, and leverages state and local infrastructure in three states: Imperial County, California; Fitchburg and New Bedford, Massachusetts; and Austin and Houston, Texas. Each of the three demonstration sites serves children ages 2-12 years and their families in communities with high childhood obesity rates.While we wait for final evaluation data from each of the demonstration sites, we are learning about novel ways that public health and primary care can work together to embed healthy eating and active living in the daily routines of children and families. CORD is increasing healthy eating and active living opportunities for young children and their families by supporting change at the individual, system, and community levels. Interventions in each setting include those reviewed and described by Foltz and colleagues on population-based research and practice-tested strategies for improving obesity-related behaviors. …

Migration, acculturation and environment: determinants of obesity among Iranian migrants in Australia.

While migration from low- to high-income countries is typically associated with weight gain, the obesity risks of migration from middle-income countries are less certain. In addition to changes in behaviours and cultural orientation upon migration, analyses of changes in environments are needed to explain post-migration risks for obesity. The present study examines the interaction between obesity-related environmental factors and the pattern of migrant acculturation in a sample of 152 Iranian immigrants in Victoria, Australia. Weight measurements, demographics, physical activity levels and diet habits were also surveyed. The pattern of acculturation (relative integration, assimilation, separation or marginalization) was not related to body mass index, diet, or physical activity behaviours. Three relevant aspects of participants’ perception of the Australian environment (physically active environments, social pressure to be fit, unhealthy food environments) varied considerably by demographic characteristics, but only one (physically active environments) was related to a pattern of acculturation (assimilation). Overall, this research highlighted a number of key relationships between acculturation and obesity-related environments and behaviours for our study sample. Theoretical models on migration, culture and obesity need to include environmental factors.

Modeling social norms and social influence in obesity.

The worldwide increase in obesity has led to changes in what is considered "normal" or desirable weight, especially among populations at higher risk. We show that social norms are key to understanding the obesity epidemic, and that social influence mechanisms provide a necessary linkage between individual obesity-related behaviors and population-level characteristics. Because influence mechanisms cannot be directly observed, we show how three complex systems tools may be used to gain insights into observed epidemiologic patterns: social network analysis, agent-based modeling, and systems dynamics modeling. However, simulation and mathematical modeling approaches raise questions regarding acceptance of findings, especially among policy makers. Nevertheless, we point to modeling successes in obesity and other fields, including the NIH-funded National Collaborative on Childhood Obesity Research (NCCOR) Envison project.

Dietary Improvements Among African American Youth: Results of an Interactive Nutrition Promotion Program

BackgroundThe Junior Doctors of Health© (JDOH) program was developed from a collaboration between a large medical university, school district, and community organization to address obesity-related behaviors in children through education, skill building, and mentoring.PurposeEvaluate the impact of the JDOH program on self-efficacy for and intake of fruits, vegetables, and beverages among a sample of predominantly African American elementary students.MethodsPre- and postintervention surveys were administered to students in grades 4 through 6. A total of 224 students participated (intervention = 133, control = 91) across 5 schools. Independent t tests and mixed-model Poisson regressions were conducted to compare intervention and control groups.ResultsSelf-efficacy was associated with significant differences in reported dietary behaviors, with results varying by gender. For boys, fruit intake increased significantly, and for girls, intake of fruit, green salad, carrots, potatoes, and other vegetables increased significantly.DiscussionThe results indicate that the JDOH program is a useful model for schools to provide nutrition education that may result in positive dietary behavior change among African American youth.

Considering Mindfulness Training for Obesity-Related Eating Behaviors in Children and Adolescents: A Conceptual Review

Obesity in children and adolescents is a major public health problem in the United States. Obesity-related eating behaviors are an important contributing factor to this issue. Youth in the United Stated tend to have unhealthful dietary intake and poor eating habits, such as consumption of large portion sizes, fruit, vegetable, and dietary fiber intake below dietary recommendations, and sugar intake above dietary recommendations. Emotional eating, external eating, and binge eating, behaviors that are linked with excess weight gain, have also been found to occur in youth. Eating behaviors established during the early years of life tend to persist into adulthood, so forming healthful eating habits and relationships with food early in life are important for the current and future health of children and adolescents. However, numerous factors including parenting practices, the food environment at home and outside of the home, and food advertising impart competing influences on eating behaviors in youth. It is essential to arm children and adolescents with skills that help them make healthful dietary choices and develop healthful eating styles in the face of influences that may impede healthful behaviors. Mindfulness training may be a promising approach. A recent systematic literature review by our research group found that mindfulness training programs can improve obesity-related eating behaviors in adults. Research has also shown that mindfulness training can be successfully implemented in child and adolescent populations with promise for improving stress-related and neurocognitive outcomes. The aim of this brief conceptual review is to provide an overview of obesity-related eating behaviors in children and adolescents and suggest how mindfulness training might hold promise as an intervention approach and a way of being to support healthful eating behaviors in the early years of human development.

The influence of hot and cool executive function on the development of eating styles related to overweight in children

Studies linking executive function (EF) and overweight suggest that a broad range of executive functions might influence weight via obesity-related behaviors, such as particular eating styles. Currently, however, longitudinal studies investigating this assumption in children are rare. We hypothesized that lower hot and cool EF predicts a stronger increase in eating styles related to greater weight gain (food approach) and a weaker increase in eating styles related to less weight gain (food avoidance) over a 1-year period. Hot (delay of gratification, affective decision-making) and cool (attention shifting, inhibition, working memory updating) EF was assessed experimentally in a sample of 1657 elementary-school children (German school classes 1–3) at two time points, approximately one year apart. The children's food-approach and food-avoidance behavior was rated mainly via parent questionnaires at both time points. As expected, lower levels of hot and cool EF predicted a stronger increase in several food-approach eating styles across a 1-year period, mainly in girls. Unexpectedly, poorer performance on the affective decision-making task also predicted an increase in certain food-avoidance styles, namely, slowness in eating and satiety responsiveness, in girls. Results implicate that lower EF is not only seen in eating-disordered or obese individuals but also acts as a risk factor for an increase in particular eating styles that play a role in the development of weight problems in children.

Parental Confidence in Changing Child Obesity Behaviors

Research Article| December 01 2014 Parental Confidence in Changing Child Obesity Behaviors AAP Grand Rounds (2014) 32 (6): 70. https://doi.org/10.1542/gr.32-6-70 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Parental Confidence in Changing Child Obesity Behaviors. AAP Grand Rounds December 2014; 32 (6): 70. https://doi.org/10.1542/gr.32-6-70 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: childhood obesity, obesity Source: Arsenault LN, Xu K, Taveras EM, et al. Parents’ obesity-related behavior and confidence to support behavioral change in their obese child: data from the STAR Study. Acad Pediatr. 2014; 14(5): 456– 462; doi: https://doi.org/10.1016/j.acap.2014.03.001Google Scholar Investigators from multiple institutions conducted a study to determine how parents’ obesity-related behaviors influence their confidence in supporting their child to reach obesity behavior goals. The data for the current study were originally collected as baseline data for the Study of Technology to Accelerate Research (STAR) project, a clustered randomized controlled trial. Child participants were 6–12 years old, had a BMI ≥95% for age and gender, and received health supervision at 1 of 14 participating primary care practices in Massachusetts. At enrollment, 1 parent of each child participant completed a survey that included questions regarding demographics, obesity-related behaviors of the child and parent (physical activity [PA], screen time, intake of sugar-sweetened beverages [SSB], sleep duration, and fast food consumption), and parental confidence in supporting their child’s ability to meet obesity behavior goals. For this study, the primary predictor was the parents’ own achievement of obesity-related behavioral targets. Parents were considered to have met their obesity behavior goals if they 1) averaged ≥30 minutes of PA per day, 2) averaged <2 hours of screen time per day, 3) had no SSB servings over the last month, 4) averaged ≥8 hours of sleep per night, and 5) averaged <1 time per week of fast food. The primary outcome was parental confidence in supporting their obese child to reach each of these obesity behavior goals (dichotomized into extremely vs very/somewhat/not confident). The child’s obesity behavior goals were defined similarly to the parents’, except for PA of ≥1 hour per day and sleep of ≥10 hours per night. Data were analyzed on 787 parent/child dyads enrolled. Among parents, 26% were extremely confident in supporting their child to reach the child’s screen time goal, 25% for the fast food goal, 25% for SSB, 19% for PA, and 15% for the child’s sleep goal. Parental confidence in supporting each of the behavioral goals for their child was significantly associated with parents’ achievement of their own obesity-related behavior goals for PA, screen time, sleep, and/or fast food consumption. When adjusting for parent and child demographics, however, the only statistically significant association was between parental confidence and parent achievement of PA and sleep goals. The authors conclude that addressing parental behaviors related to obesity may be an important part of childhood obesity prevention efforts. Dr Schreiber has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. When counseling children about obesity, the tendency is often to focus on the child’s – not the parent’s – health behaviors. Yet, the parent supplies the food, makes decisions about the child participating in physical activity, and acts as a role model. Investigators have looked at family-focused interventions versus child-focused... You do not currently have access to this content.

A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project).

BackgroundThis systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework.MethodsElectronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study’s intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions.ResultsThirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention.ConclusionsAlthough most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-014-0147-3) contains supplementary material, which is available to authorized users.

The Dutch Obesity Intervention in Teenagers (DOiT) cluster controlled implementation trial: intervention effects and mediators and moderators of adiposity and energy balance-related behaviours.

BackgroundThe Dutch Obesity Intervention in Teenagers (DOiT) programme is an evidence-based obesity prevention programme tailored to adolescents attending the first two years of prevocational education in the Netherlands. The initial programme showed promising results during an effectiveness trial. The programme was adapted and prepared for nationwide dissemination. To gain more insight into the process of translating evidence-based approaches into ‘real world’ (i.e., ‘natural’) conditions, our research aims were to evaluate the impact of the DOiT-implementation programme on adolescents’ adiposity and energy balance-related behaviours during natural dissemination and to explore the mediating and moderating factors underlying the DOiT intervention effects.MethodsWe conducted a cluster-controlled implementation trial with 20 voluntary intervention schools (n=1002 adolescents) and 9 comparable control schools (n = 484 adolescents). We measured adolescents’ body height and weight, skinfold thicknesses, and waist circumference. We assessed adolescents’ dietary and physical activity behaviours by means of self-report. Data were collected at baseline and at 20-months follow-up. We used multivariable multilevel linear or logistic regression analyses to evaluate the intervention effects and to test the hypothesised behavioural mediating factors. We checked for potential effect modification by gender, ethnicity and education level. ResultsWe found no significant intervention effects on any of the adiposity measures or behavioural outcomes. Furthermore, we found no mediating effects by any of the hypothesised behavioural mediators. Stratified analyses for gender showed that the intervention was effective in reducing sugar-containing beverage consumption in girls (B = -188.2 ml/day; 95% CI = -344.0; -32.3). In boys, we found a significant positive intervention effect on breakfast frequency (B = 0.29 days/week; 95% CI = 0.01; 0.58). Stratified analyses for education level showed an adverse intervention effect (B = 0.09; 95% CI = 0.02; 0.16) on BMI z-scores for adolescents attending the vocational education track.ConclusionsAlthough not successful in changing adolescents’ adiposity, the DOiT-implementation programme had some beneficial effects on specific obesity-related behaviours in subgroups. This study underlines the difficulty of translating intervention effectiveness in controlled settings to real world contexts. Adaptations to the implementation strategy are needed in order to promote implementation as intended by the teachers.Trial registrationCurrent Controlled Trials ISRCTN92755979.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-014-0158-0) contains supplementary material, which is available to authorized users.

Community socioeconomic deprivation and obesity trajectories in children using electronic health records.

ObjectiveLongitudinal studies of the role of community context in childhood obesity are lacking. The objective of this study was to examine associations of community socioeconomic deprivation (CSD) on trajectories of change in body mass index (BMI) in childhood and adolescence.MethodsData come from electronic health records on 163,473 children aged 3-18 residing in 1288 communities in Pennsylvania whose weight and height were measured longitudinally. CSD at the year of birth was measured using 6 census variables and modeled in quartiles. Trajectories of BMI within CSD quartiles were estimated using random effects growth-curve models accounting for differences by age, sex, race/ethnicity as well ascorrecting for non-constant residual variance across age groups.ResultsCSD was associated with higher BMI at average age (10.7 years) and with more rapid growth of BMI over time. Children born in communities with greater CSD had steeper increases of BMI at younger ages. Those born into the poorest communities displayed sustained accelerated BMI growth. CSD remained associated with BMI trajectories after adjustment for a measure of household socioeconomic deprivation.ConclusionsHigher CSD may be associated with more obesogenic growth trajectories in early life. Findings suggest that individual-level interventions that ignore the effect of community context on obesity related behaviors may be less efficient.

Inherited or Behavior? What Causal Beliefs about Obesity Are Associated with Weight Perceptions and Decisions to Lose Weight in a US Sample?

Objectives. To identify the extent to which (1) beliefs about obesity and obesity-related behaviors distinguish individuals based on weight perception (WP) and (2) beliefs about obesity predict perceived health status and WP and how these in turn predict decisions to try to lose weight. Method. 7456 noninstitutionalized US adults (Mage = 54.13, SDage = 16.93; 61.2% female; 75.9% White) completed the 2007 Health Information National Trends Survey. Multinomial logistic regressions and structural equation modeling were used to accomplish study objectives. Results. Age, gender, information-seeking, health status, belief that obesity is inherited, and knowledge of fruits and vegetables recommendations distinguished participants based on WP. Beliefs about obesity predicted health status, WP, and trying to lose weight in the general model. The models varied based on gender, race/ethnicity, education, and weight misperception. Conclusion. This study supports the role of beliefs about obesity, WP, and health perceptions in individuals' decisions and actions regarding weight management. This study increases our understanding of gender, race/ethnicity, education, and weight misperceptions differences in decisions to lose weight. This knowledge may lead to targeted interventions, rather than “one size fits all” interventions, to promote health and prevent obesity.

Impact evaluation of Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism (EMPOWER) Randomized Control Trial.

The family and home environment is an influential antecedent of childhood obesity. The purpose of this study was to pilot test The Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism (EMPOWER) intervention; a newly developed, theory-based, online program for prevention of childhood obesity. The two-arm, parallel group, randomized, participant-blinded trial targeted mothers with children between 4 and 6 years of age. Measures were collected at baseline, 4 weeks, and 8 weeks to evaluate programmatic effects on constructs of social cognitive theory (SCT) and obesity-related behaviors. Process evaluation transpired concurrently with each intervention session. Fifty-seven participants were randomly assigned to receive either experimental EMPOWER (n = 29) or active control Healthy Lifestyles (n = 28) intervention. Significant main effects were identified for child physical activity, sugar-free beverage consumption, and screen time, indicating that both groups improved in these behaviors. A significant group-by-time interaction was detected for child fruit and vegetable (FV) consumption as well as the SCT construct of environment in the EMPOWER cohort. An increase of 1.613 cups of FVs (95% confidence interval = [0.698, 2.529]) was found in the experimental group, relative to the active control group. Change score analysis found changes in the home environment accounted for 31.4% of the change in child FV intake for the experimental group. Child physical activity, sugar-free beverage consumption, and screen time improved in both groups over the course of the trial. Only the theory-based intervention was efficacious in increasing child FV consumption. The EMPOWER program was robust for inducing change in the home environment leading to an increase in child FV intake (Cohen's f = 0.160).