Obesity-related Health Outcomes Research Articles

Community-Wide Efforts to Improve the Consumer Food Environment and Physical Activity Resources in Rural Kentucky.

Community interventions to improve access to food and physical activity resources can reduce obesity rates and improve obesity-related health outcomes. We describe a Kentucky community project that consisted of collaborating with grocery store managers to improve the consumer food environment and partnering with community members to improve walking trails, bicycle racks, and other physical activity resources. We surveyed 2 random samples of community residents in 6 participating rural counties, 741 in 2016 (year 1) and 1,807 in 2017 (year 2). Fruit and vegetable intake significantly increased from year 1 (mean servings fruits, 2.71; vegetables, 2.54) to year 2 (mean servings fruit, 2.94; vegetables, 2.72). Although moderate physical activity did not change from year 1 to year 2, concern among residents about places to be physically active improved (P = .04). Involving community members in promoting obesity prevention programs may improve dietary intake and alleviate community concern about physical activity.

Guided Imagery Council: Feasibility, Acceptability, and Preliminary Effects of a Novel Group-Based Lifestyle Intervention in Predominantly Latino Adolescents.

BackgroundThe combination of higher stress and higher obesity rates suggests that Latino youth in the United States may be a population at particular risk for obesity-related adverse health outcomes. The objective of this article is to describe the feasibility, acceptability, and quantitative stress-related outcomes of a 6-week pilot lifestyle intervention using guided imagery (GI) council in order to reduce risk factors for obesity-related disease.MethodsSeventeen urban, adolescents (12 females/5 males, 16 Latino, age 17 ± 1 years, grades 9–12, body mass index 22 ± 4) participated in the 6-week, after-school pilot intervention. The intervention consisted of three, 75-minute after-school sessions delivered weekly for 6 weeks. The 3 weekly sessions included 1 session each of nutrition education, physical activity education and practice, and GI delivered in council, a facilitated group process based on indigenous practices. Feasibility and acceptability were assessed by attendance and qualitative exit interview. Stress outcomes included salivary cortisol and perceived stress.ResultsThe pilot intervention was found to be feasible to deliver in an after-school setting. The GI and council group format were well liked. A 31% reduction in salivary cortisol was observed following the stress-reduction GI sessions. Diurnal cortisol patterns did not change across the intervention, but change in perceived stress was correlated with change in cortisol awakening response.ConclusionsThe intervention was feasible to deliver and highly acceptable. Acute reduction in salivary cortisol was seen following group GI, while no change was seen in daily cortisol patterns. These results support the development of a full 12-week intervention using GI council to reduce obesity-related disease risk.

Poor Sleep and Obesity: Concurrent Epidemics in Adolescent Youth

Poor sleep and obesity are both extraordinarily common in the US adolescent population and often occur simultaneously. This review explores the links between obesity and sleep, outlining what is known about the relationships between sleep characteristics, obesity, and cardiometabolic risk factors in youth. Sleep duration is less than optimal in teens, and decreases as age increases. This is detrimental to overall well-being and is associated with obesity in children, adolescents, and young adults. Accordingly, inadequate sleep duration is associated with poor diet quality, decreased insulin sensitivity, hyperglycemia, and prevalent cardiometabolic risk factors. Evidence suggests that poor sleep quality and altered circadian timing characterized by a preferred later sleep onset, known as “adolescent chronotype,” contributes to shortened sleep duration. Obstructive sleep apnea (OSA) occurs more frequently among youth with obesity, and is associated with autonomic nervous system activity promoting higher blood pressure, increased markers of cardiovascular disease risk, and insulin resistance. While there is a clear association between OSA and type 2 diabetes in adults, whether or not this association is prevalent in youth is unclear at this time. Interventions to improve both sleep duration and quality, and obesity in adolescents are scarce and more evidence is needed to determine if such interventions can improve obesity-related health outcomes.

Abstract A57: Validity of self-reported body mass index among African American breast cancer survivors: The Women's Circle of Health Follow-Up Study

Abstract Background: Compared to interviewer-measured, self-reported weight and height are oftentimes less burdensome to participants and less costly in epidemiologic studies. Validity studies of body mass index (BMI) based on self-reported weight and height have shown that individuals commonly underestimate their BMI, but the accuracy varies by participants' characteristics such as weight status and race/ethnicity. However, information is lacking on the validity of self-reported BMI among African American breast cancer survivors, who are known to have a high prevalence of obesity. Objective: The primary objective of this study was to evaluate the validity of BMI, based on self-reported weight and height, among African American breast cancer survivors. The secondary aim was to identify factors associated with BMI misreporting. Methods: The Women's Circle of Health Follow-Up Study is an ongoing population-based longitudinal study of African American breast cancer survivors in New Jersey. Eligible participants at baseline include self-identified African American women aged 20 to 75 years, with histologically confirmed breast cancer diagnosis. Active follow-up visits are ongoing to obtain updated information including self-reported and interviewer-measured anthropometric data. To date, 243 women completed the follow-up 1 visit and their self-reported and interviewer-measured anthropometric data were available for comparison. Pearson correlation and Cohen's kappa coefficients were used to describe the relationship between self-reported and interviewer-measured BMI (at follow-up 1) as continuous and categorical, respectively. Multinomial logistic regressions were used to identify factors associated with reporting accuracy. We also evaluated the associations of self-reported and interviewer-measured BMI with obesity-related health outcomes, using hypertension as an example, to evaluate the impact of potential misreporting. Results: The mean difference (standard deviation) between self-reported and measured BMI was -0.41 (1.49) kg/m2. Self-reported and interviewer-measured BMI values were highly correlated among all participants (r = 0.97) and when stratified by participants' characteristics (e.g., age, smoking, tumor grade; all r >0.90). The agreement between BMI categories (i.e., normal weight, overweight, obese I, II, and III) based on self-reported and interviewer-measured data was good (kappa = 0.75). Women who were older, had higher-grade tumors, and had greater BMI, percent body fat, and waist-to-hip ratio were more likely to under-report their BMI by ≥3%. Women who were current smokers, had higher-grade and ER-negative tumors, and had lower BMI and percent body fat were more likely to over-report by ≥3%. The BMI-hypertension association was similar using self-reported BMI (OR per 5 kg/m2 increase: 1.63; 95% CI: 1.27-2.10) and measured BMI (OR per 5 kg/m2 increase: 1.58; 95% CI: 1.23-2.03). Conclusion: Women who were older, current smokers, had higher-grade and ER-negative tumors, and had higher BMI, percent body fat, and waist-to-hip ratio had higher odds of misreporting their BMI. However, overall, self-reported BMI was reasonably accurate among African American breast cancer survivors in this study. Citation Format: Bo Qin, Adana A.M. Llanos, Elizabeth A. Szamreta, Jesse J. Plascak, Christine Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Validity of self-reported body mass index among African American breast cancer survivors: The Women's Circle of Health Follow-Up Study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A57.

The Potential Cost-Effectiveness and Equity Impacts of Restricting Television Advertising of Unhealthy Food and Beverages to Australian Children

Television (TV) advertising of food and beverages high in fat, sugar and salt (HFSS) influences food preferences and consumption. Children from lower socioeconomic position (SEP) have higher exposure to TV advertising due to more time spent watching TV. This paper sought to estimate the cost-effectiveness of legislation to restrict HFSS TV advertising until 9:30 pm, and to examine how health benefits and healthcare cost-savings differ by SEP. Cost-effectiveness modelling was undertaken (i) at the population level, and (ii) by area-level SEP. A multi-state multiple-cohort lifetable model was used to estimate obesity-related health outcomes and healthcare cost-savings over the lifetime of the 2010 Australian population. Incremental cost-effectiveness ratios (ICERs) were reported, with assumptions tested through sensitivity analyses. An intervention restricting HFSS TV advertising would cost AUD5.9M (95% UI AUD5.8M–AUD7M), resulting in modelled reductions in energy intake (mean 115 kJ/day) and body mass index (BMI) (mean 0.352 kg/m2). The intervention is likely to be cost-saving, with 1.4 times higher total cost-savings and 1.5 times higher health benefits in the most disadvantaged socioeconomic group (17,512 HALYs saved (95% UI 10,372–25,155); total cost-savings AUD126.3M (95% UI AUD58.7M–196.9M) over the lifetime) compared to the least disadvantaged socioeconomic group (11,321 HALYs saved (95% UI 6812–15,679); total cost-savings AUD90.9M (95% UI AUD44.3M–136.3M)). Legislation to restrict HFSS TV advertising is likely to be cost-effective, with greater health benefits and healthcare cost-savings for children with low SEP.

Effects of parent-adolescent reported family functioning discrepancy on physical activity and diet among Hispanic youth.

Research has shown that family functioning has been positively associated with physical activity and dietary intake, both of which are obesity-related risk factors. The most widely practiced methodological approach to assessing this construct in empirical studies relies on either parent or adolescent report. Yet, discrepancy in parent and adolescent report of family functioning may provide a fuller understanding of the effects of this construct on obesity-related health outcomes. This is especially important among Hispanics, a population that suffers from disproportionately high rates of obesity and its health-related consequences. The purpose of this study was to examine whether, and to what extent, parent-adolescent discrepancies in family functioning are associated with physical activity, and fruit and vegetable and added sugar intake. We estimated discrepancy scores between parents and adolescents (n = 280 dyads) in family functioning. Then, using structural equation modeling, we tested the effect of family functioning discrepancy on adolescent reports of physical activity, fruits and vegetables intake, and added sugar intake. After controlling for adolescent's gender and BMI, family functioning discrepancy was significantly associated with reduced physical activity (β = -.14*, 95% CI ([-.26, -.05]) and fruits and vegetables intake (β = -.22*, 95% CI [-.38, -.09]) such that the larger the discrepancy between parent and youth reported family functioning, the fewer days of adolescent physical activity and the poorer the fruits and vegetables intake. Our findings provide insight for the role of the family in Hispanic adolescent health outcomes and rationale for capturing rich data to better understand that role. (PsycINFO Database Record

Validity of self-reported weight, height, and body mass index among African American breast cancer survivors.

Self-reported weight, height, and body mass index (BMI) are commonly used in cancer epidemiology studies, but information on the validity of self-reports among cancer survivors is lacking. This study aimed to evaluate the validity of these self-reported measures among African American (AA) breast cancer survivors, known to have high obesity prevalence. We compared the self-reported and measured values among 243 participants from the Women's Circle of Health Follow-Up Study (WCHFS), a population-based longitudinal study of AA breast cancer survivors. Multivariable-adjusted linear regressions were used to identify factors associated with reporting errors. We also examined the associations of self-reported and measured BMI with obesity-related health outcomes using multivariable logistic regressions, with hypertension as an example, to evaluate the impact of misreporting. We found that self-reported and measured values were highly correlated among all and when stratified by participants' characteristics (intraclass correlation coefficients ≥ 0.99, 0.84, and 0.96 for weight, height, and BMI, respectively). The agreement between BMI categories (normal, overweight and obese) based on self-reported and measured data was excellent (kappa = 0.81). Women who were older, never smoked, had higher grade tumors, or had greater BMI tended to have overestimated BMI calculated from self-reported weight and height. The BMI-hypertension association was similar using self-reported (OR per 5kg/m2 increase 1.63; 95% CI 1.27-2.10) and measured BMI (1.58; 95% CI 1.23-2.03). Self-reported weight, height, and BMI were reasonably accurate in the WCHFS. Our study supports the use of these self-reported values among cancer survivors when direct measurements are not possible.

Test of an interprofessional collaborative practice model to improve obesity-related health outcomes in Michigan

Abstract The purpose of the study was to test the effectiveness of an interprofessional collaborative practice (IPCP) education program on clinicians' and students' knowledge and attitudes toward IPCP and to determine the effectiveness of an IPCP weight loss program in two nurse-managed centers. The study team used the Midwest Interprofessional Practice, Education, and Research Center (MIPERC) collaborative practice education program that consists of online learning modules followed by daily huddles and collaborative care planning. The obesity intervention program was implemented by faculty and staff practitioners and students in two clinics with very different patient populations (community residents and college students). Staff/faculty practitioners and students demonstrated statistically significant knowledge gains as a result of online learning modules (Introduction to IPE p .05). The study demonstrated the potential of an IPCP program to affect weight loss in two populations.

Healthy, Wealthy, and Wise? Exploring Parent Comparative Optimism About Future Child Outcomes

Objectives. Comparative optimism is present in parental predictions of their child’s long-term, obesity-related health outcomes and some of this optimism is unrealistic. An understanding of how comparative optimism relates to parents’ predictions of health versus other child outcomes could contribute to the development of interventions and strategies pediatricians can use to improve risk assessment. Methods. In a nationally representative survey, we asked American parents of 6- to 17-year-old children (n = 410) to estimate the chances that their child and “a typical child in their community” would be affected by overweight, get married, and complete a 4-year college degree by age 30, and the child’s future salary at age 30. We collected data on family demographic and health characteristics. We modeled the difference in parent predictions for their child versus the typical child using multivariate linear regressions. Results. Compared to the typical child, parents were less likely to predict that their child would be affected by overweight (−26.6 percentage points, 95% confidence interval [CI]: −35.6, −17.7) and more likely to predict that their child would complete a 4-year degree (16.7 percentage points, 95% CI: 2.5, 31.0). Parents predicted their child would have a higher income than the typical child at age 30 ($15,266, 95% CI: $7,487, $23,046). Parents did not predict that their child would be more likely than the typical child to be married by age 30 (−2.2 percentage points, 95% CI: −8.1, 3.7). Conclusions. Some parents appear to exhibit comparative optimism around their child’s future weight status, education, and economic outcomes, but not marriage. Future experimental work should assess whether risk communication approaches that consider optimism bias influence parent risk perception and parenting behaviors.

Association between Native American-owned casinos and the prevalence of large-for-gestational-age births.

A small number of studies have used a natural experiment approach to examine the health impacts of increased economic resources stemming from Native American-owned casinos. We build on this work by examining whether casinos are associated with obesity-related health in utero. We examined whether casino openings or expansion (as proxy for increased economic resources) are associated with a decreased likelihood of infants being born large-for-gestational-age (LGA), an important risk factor for childhood overweight/obesity. We used repeated cross-sectional data from California birth records (1987-2011) to assess the prevalence of LGA births among Native Americans (n = 21011). Using zip code fixed-effect regression models, we compared how prevalence of LGA births changed in association with casino openings or expansions, while controlling for secular trends through the inclusion of a comparison group of Native American newborns in zip codes that were eligible to open or expand casinos, but did not do so. In sensitivity analyses, we evaluated whether there was any change in small-for-gestational-age births (SGA). Average prevalence of LGA births over the period was 11%. Every one slot machine per capita increase was associated with a 0.13 percentage point decrease (95% confidence interval: -0.25, -0.01) in the prevalence of LGA births but was not associated with SGA prevalence. Casino expansion in California is associated with a lower prevalence of LGA births. Interpreted in combination with previous work showing that California casino expansions were associated with a lower body mass index (BMI) among schoolchildren, these results suggest that casinos are associated with improvement in a surrogate marker of excess adiposity. Further studies are needed to elucidate the mechanisms by which casinos might be associated with obesity-related health outcomes among Native Americans.

Gelidium elegans Regulates the AMPK-PRDM16-UCP-1 Pathway and Has a Synergistic Effect with Orlistat on Obesity-Associated Features in Mice Fed a High-Fat Diet.

The incidence of obesity is rising at an alarming rate throughout the world and is becoming a major public health concern with incalculable social and economic costs. Gelidium elegans (GENS), also previously known as Gelidium amansii, has been shown to exhibit anti-obesity effects. Nevertheless, the mechanism by which GENS is able to do this remains unclear. In the present study, our results showed that GENS prevents high-fat diet (HFD)-induced weight gain through modulation of the adenosine monophosphate-activated protein kinase (AMPK)-PR domain-containing16 (PRDM16)-uncoupling protein-1 (UCP-1) pathway in a mice model. We also found that GENS decreased hyperglycemia in mice that had been fed a HFD compared to corresponding controls. We also assessed the beneficial effect of the combined treatment with GENS and orlistat (a Food and Drug Administration-approved obesity drug) on obesity characteristics in HFD-fed mice. We found that in HFD-fed mice, the combination of GENS and orlistat is associated with more significant weight loss than orlistat treatment alone. Moreover, our results demonstrated a positive synergistic effect of GENS and orlistat on hyperglycemia and plasma triglyceride level in these animals. Thus, we suggest that a combination therapy of GENS and orlistat may positively influence obesity-related health outcomes in a diet-induced obese population.

Family-centered brief intervention for reducing obesity and cardiovascular disease risk: A randomized controlled trial.

To assess the effects of a family-centered, physical activity and nutrition "brief" intervention (time-limited contact) on body weight and related health outcomes in primary health care patients with an elevated 5-year cardiovascular disease (CVD) risk. This study implemented a cluster randomized controlled trial design with two treatment conditions: a CVD risk assessment and one-time consultation ("usual care" control) and a CVD risk assessment and up to five home sessions that aimed to reduce obesity by encouraging physical activity and healthy eating (intervention). Three hundred and twenty patients aged 35 to 65 years from 16 primary health care clinics in Auckland, New Zealand, participated in the study. Intervention effects on BMI, waist circumference, blood pressure, blood cholesterol, triglycerides, 5-year CVD risk, physical activity, and dietary patterns were assessed using generalized linear mixed models. When compared with the control group, the intervention resulted in a significant but relatively modest decrease in BMI between baseline and the 12-month follow-up (-0.633 kgm-2 , Padj = 0.048). Significant decreases were also observed for total cholesterol at 4 and 12 months, the total cholesterol to high-density lipoprotein cholesterol ratio at 4 months, 5-year CVD risk at 4 months, and fast food consumption at 12 months. Our findings show that a family-centered brief intervention targeting physical activity and nutrition can generate slightly better obesity-related health outcomes than usual care alone.

Exposure to childhood trauma is associated with increased risk for subclinical hypothyroidism in pregnancy

Growing evidence suggests that exposure to childhood adversity may influence obesity across the life course. High maternal weight complicates pregnancy and increases the risk of child obesity. This study examined the association between maternal childhood adversity and pregnancy-related weight in a large U.S. sample.Data on 6,199 pregnancies from 2,873 women followed from 1979 to 2012 by the National Longitudinal Survey of Youth 1979 were analyzed in 2014. Associations between three adversity exposures before age 18 years (history of physical abuse, alcohol problems, or mental illness in the household) and two maternal weight outcomes (prepregnancy obesity and excessive gestational weight gain) were modeled separately using survey-adjusted log-binomial models.After adjusting for race/ethnicity and early-life socioeconomic factors, childhood physical abuse was associated with a 60% increase in the risk of prepregnancy obesity (adjusted risk ratio=1.6, 95% CI=1.1, 2.2). Household alcohol abuse was associated with a 30% increase in prepregnancy obesity (adjusted risk ratio=1.3, 95% CI=1.0, 1.7), as was household mental illness (adjusted risk ratio=1.3, 95% CI=0.8, 1.9), but the mental illness exposure was not significant. Physical abuse and household alcohol abuse were associated with a significant 20% increase in the risk of excessive gestational weight gain; mental illness was not.Adversity in early life may affect maternal weight before and during pregnancy. Screening and treating women of reproductive age for childhood adversity and its negative effects could significantly reduce obesity-related health outcomes for women and their children.

What can we learn from critical periods of weight gain in military personnel?

What can we learn from critical periods of weight gain in military personnel?

Social change and access to a palatable diet produces differences in reward neurochemistry and appetite in female monkeys

Understanding factors that contribute to the etiology of obesity is critical for minimizing the effects of obesity-related adverse physical health outcomes. Emotional eating or the inability to control intake of calorically dense diets (CDD) under conditions of psychosocial stress exposure is a potential risk factor for the development of obesity in people. Decreases in dopamine 2 receptors (D2R) availability have been documented in substance abuse and obesity in humans, as well as animal models of chronic stressor exposure. Social subordination in macaques is a well-established animal model of a chronic psychogenic stressor that results in stress axis dysregulation, attenuated striatal D2R levels, and stress-induced hyperphagia in complex dietary environment. However, it remains unclear how these phenotypes emerge as the stressor becomes chronic during the formation of new social groups. Thus, the goal of the current study was to assess how the imposition of social subordination over a four-month period would affect food intake, socioemotional behavior, and D2R binding potential (D2R-BP) in female rhesus monkeys maintained on a typical laboratory chow diet (LCD) compared with those having a choice between a LCD and a CDD. Results showed that access to a CDD leads to increased total caloric intake and preference for a CDD over a LCD. For the dietary choice condition, females directing less aggression towards group mates during the four-month period, a characteristic of lower social status, consumed progressively more calories over the four-month period than more aggressive females. This relation between agonistic behavior and appetite was not observed for females in LCD-only condition. Finally, decreased D2R-BP in the orbitofrontal cortex was predictive of increased overall caloric intake in all females regardless of dietary environment, suggesting that reduced availability of D2R within the prefrontal cortex is associated with unrestrained eating. Studies are continuing to determine how newly imposed dominance ranks continue to affect reward neurochemistry and appetite over time, and how this is influenced by the dietary environment.

Economic Origins of Dietary Diseases: Is Obesity becoming a Middle Income Problem?

Obesity resembles a typical negative economic externality to the public health system. Previous literature identifies a positive connection between national income levels and incidence of obesity. Due to changes in globalization of food culture and media, food habits are spreading rapidly over the country borders from high into middle income countries. Due to these developments, association of obesity with high income is questionable. We pursue this research question using cross-country data from 2013 by modeling obesity-related dietary health outcomes in terms of linear and nonlinear income effects. Additional control variables include within-country income inequality and region fixed effects. Departing from the linear trends in the literature, the model results show statistically significant nonlinear effects of income. However, these effects are small in magnitude.

Maternal Childhood Adversity, Prepregnancy Obesity, and Gestational Weight Gain.

Growing evidence suggests that exposure to childhood adversity may influence obesity across the life course. High maternal weight complicates pregnancy and increases the risk of child obesity. This study examined the association between maternal childhood adversity and pregnancy-related weight in a large U.S. Data on 6,199 pregnancies from 2,873 women followed from 1979 to 2012 by the National Longitudinal Survey of Youth 1979 were analyzed in 2014. Associations between three adversity exposures before age 18 years (history of physical abuse, alcohol problems, or mental illness in the household) and two maternal weight outcomes (prepregnancy obesity and excessive gestational weight gain) were modeled separately using survey-adjusted log-binomial models. After adjusting for race/ethnicity and early-life socioeconomic factors, childhood physical abuse was associated with a 60% increase in the risk of prepregnancy obesity (adjusted risk ratio=1.6, 95% CI=1.1, 2.2). Household alcohol abuse was associated with a 30% increase in prepregnancy obesity (adjusted risk ratio=1.3, 95% CI=1.0, 1.7), as was household mental illness (adjusted risk ratio=1.3, 95% CI=0.8, 1.9), but the mental illness exposure was not significant. Physical abuse and household alcohol abuse were associated with a significant 20% increase in the risk of excessive gestational weight gain; mental illness was not. Adversity in early life may affect maternal weight before and during pregnancy. Screening and treating women of reproductive age for childhood adversity and its negative effects could significantly reduce obesity-related health outcomes for women and their children.

Testing an Interprofessional Collaborative Practice Model to Improve Obesity-related Health Outcomes with a Statewide Consortium

s / Journal of Interprofessional Education & Practice 1 (2015) 48e77 66 multiple disciplines to work side-by-side with a patient will be an impediment to adopting inter-professional care models in their own future practices.

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.

Effect of a Park-Based After-School Program on Participant Obesity-Related Health Outcomes

The objective of this study was to examine the effect of a structured after-school program housed in a large county parks system on participant health and wellness outcomes. Longitudinal cohort study over one school year (fall 2011-spring 2012). A total of 23 county parks in Florida. Children ages 5 to 16 (N = 349, 55% non-Hispanic black, 40% Hispanic, mean age 8.9 years). An after-school program called Fit-2-Play that integrates daily standardized physical activity and health and wellness education components. Preintervention (August/September 2011) and postintervention (May/June 2012) anthropometric, systolic/diastolic blood pressure, fitness, and health and wellness knowledge measurements were collected. Comparison of pre-post outcome measure means were assessed via general linear mixed models for normal-weight (body mass index [BMI] <85th percentile for age and sex) and overweight/obese (BMI ≥85th percentile for age and sex) participants. The overweight/obese group significantly decreased their mean (1) BMI z score (2.0 to 1.8, p < .01) and (2) subscapular skinfold measurements (19.4 to 17.5 mm, p < .01) and increased (1) mean laps on the Progressive Aerobic Cardiovascular Endurance Run test (10.8 to 12.5, p = .04) and (2) percentage with normal systolic blood pressure (58.1% to 71.0%, p = .03) from pretest to posttest. On average, participants significantly improved their health and wellness knowledge over the school year (p < .01). Normal-weight participants maintained healthy BMI ranges and significantly increased fitness levels. Findings suggest that the Fit-2-Play after-school programs can be a significant resource for combating childhood obesity and instilling positive physical health in children, particularly among ethnic and socioeconomically diverse communities.