Community- and population-level and policy interventions are commonly evaluated using nonrandomized studies (NRS), rather than randomized trials (RCTs). Recent Cochrane reviews of interventions for preventing childhood obesity have been restricted to RCTs, so less is known about the effectiveness of these more upstream interventions. To address this gap, we conducted an overview of reviews of NRS interventions (NRSI), which assessed change in BMI in children and adolescents aged 5-18 years and compared NRSI findings with those from RCTs. We searched five databases up to November 2024. Screening, data extraction, and quality assessment were performed using standardized tools. We included 28 systematic reviews and identified 136 NRSI either based in school (n = 118), community (n = 4) or combined settings (n = 14) and evaluating policy (n = 48), education (n = 11), or a combined intervention (n = 77). Twenty-six reviews included both NRSIs and RCTs; of these, 12 reported meta-analyses. Findings were largely unchanged when we excluded the RCTs and re-ran analyses. Overall, study-level results from the NRSI favored the intervention group; a quarter favored the comparison group. The meta-analysis summary effects from NRSIs were consistent with two recently published Cochrane meta-analyses of RCTs of obesity prevention interventions. The results from this overview of reviews suggest researchers and policy makers can be confident in considering the results of robust nonrandomized study designs (evaluating their impact on BMI) alongside RCTs in their decision making. Although we identified a significant number of NRSIs for review, very few evaluations of upstream interventions were eligible for inclusion.

Childhood obesity remains high in the UK, with a higher prevalence among children from ethnic minority groups. The 'Healthy Madrasa' programme was developed and implemented in Bradford, UK, to support obesity prevention in Muslim children by working with Islamic religious settings such as madrasas. The aim of this study was to explore how the 'Healthy Madrasa' programme could be adapted for delivery in another UK city where the proportion of people from the Muslim faith is lower and the ethnic composition is more diverse. A qualitative study involving a co-production workshop and eight focus groups was conducted utilising topic guides guided by the normalisation process theory (NPT). Data were analysed thematically using NVivo software (V.15) and mapped onto the constructs of the NPT. Bristol City, UK (2024-2025). 34 participants took part, including representatives of Islamic organisations, voluntary sector organisations, public health experts and Muslim parents. Data were collected through one co-production workshop (n=15, 47% female) and eight focus groups (n=19, 100% female) of which two were conducted as individual interviews due to single attendance (n=1). Three constructs of the NPT have been identified. Participants showed positive engagement towards the programme 'cognitive participation, NPT', they highlighted an equity gap in current provision due to issues of inclusivity, safe space and the lack of culturally appropriate opportunities for Muslim girls 'coherence, NPT'. However, barriers to 'coherence, NPT' were noted by Muslim parents, stating that cultural and religious conservatism might hinder female participation in the programme. 'Collective action, NPT', included the practicalities of transferring the programme to Bristol and assigning the roles and responsibilities. Participants emphasised the importance of creating an 'Islamic community-led' steering group, inclusive of diverse communities, building effective partnerships with other relevant organisations and supporting the programme with sufficient resources, such as culturally acceptable funding, space and volunteers. This study generated a co-produced preliminary roadmap for implementation. Further collaboration with stakeholders is required to achieve coherence and collective action before the programme's operationalisation in Bristol.

As the optimal source of nutrition for infants, investigations into the human milk lipidome have been quite extensive. Much of the work, however, has been focused on major lipid components such as triglycerides, possibly undermining its actual complexity. This review focuses on two minor but bioactive lipid classes in human milk: fatty acid esters of hydroxy fatty acids (FAHFAs) and alkyl-diacylglycerols (TG(O)s). FAHFAs are known to exhibit anti-diabetic and anti-inflammatory effects, while TG(O)s are important for the prevention of childhood obesity. With the knowledge that early nutrition and metabolic health influence the risk of metabolic dysfunctions later in life, a comprehensive understanding of FAHFAs and TG(O)s, along with reliable characterisations in human milk, would better allow for the development of accurate human milk fat substitutes. This could have future implications as alternative or preventive treatments for infants with early markers of metabolic dysfunction, including diabetes and obesity. The structural characteristics, pathways for biosynthesis and degradation, bioactivity, dietary sources, and characterisations of FAHFAs and TG(O)s in human milk are discussed. Their statuses as emerging lipid classes, however, is reflected in the incomplete understanding of their biochemical pathways. Characterisations of FAHFAs and TG(O)s in human milk are relatively poor, and contradicting results are reported. This review also addresses the challenges involved in the study of minor lipids in complex biological matrices, and the possible reasons underlying the slower evolution of our understanding of FAHFAs and TG(O)s in human milk and their associations with health outcomes.

International targets to address the prevention and treatment of child and adolescent obesity (CAO) remain largely unmet. Engaging frontline healthcare professionals (HCPs) and health service managers (HSMs) to identify barriers and actionable solutions can support appropriate and sufficient health responses. We aimed firstly to explore perspectives, identify barriers, facilitators and priorities in CAO management among HCPs and HSMs in Ireland, using an implementation science lens. Secondly, we aimed to develop recommendations on how to improve health service delivery for CAO management. This study used focus groups alongside a nominal group technique and was an integral part of a comprehensive project exploring CAO management. Data were analysed and interpreted using thematic analysis, and themes were mapped to the Consolidated Framework for Implementation Research (CFIR) to identify strengths and gaps in the health system. We also performed data triangulation to achieve a broader understanding of the complexities involved in health service delivery for CAO management. Twenty-two focus group discussions (FGDs) with 90 HCPs and 16 HSMs were conducted. Five main themes were developed: (i) diverse understanding and perception of CAO, (ii) service-level needs, (iii) partnership and integration, (iv) communication barriers and needs, and (v) policies, and politics. We mapped themes to the CFIR constructs and identified several facilitators and barriers in the current health system. Through nominal group technique, 21 priorities were identified. Five of these focused on improvements that can facilitate practice: (i) availability of clear care pathways, (ii) multidisciplinary team supports, (iii) HCP resources, (iv) training for HCPs, and (v) collaboration with stakeholders. We explored the alignment of priorities data with the themes identified from FGDs and with CFIR constructs. This informed the development of recommendations to strengthen health service delivery for CAO management. The study highlights the need for diverse resources and stakeholder collaboration to enable effective implementation of health services for CAO, while also offering strategic recommendations aimed at strengthening CAO management in health systems.

Social Capital in the Newborn Period and Household Food Insecurity at Child Age Two Years.

The escalating global prevalence of childhood and adolescent overweight and obesity constitutes a pressing public health issue. This network meta-analysis aimed to compare the efficacy and safety of pharmacologic interventions as adjuncts to lifestyle therapy in this population. Randomized controlled trials (RCTs) were sourced from systematic searches of PubMed, Embase (using the OVID platform), the Cochrane Library (CENTRAL), the WHO International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov from database inception to July 28, 2025. A frequentist network meta-analysis was performed using a random-effects model. We used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to evaluate the overall certainty of evidence and categorized the interventions. A total of 41 RCTs (N = 3923) were included. Compared with lifestyle modification alone, semaglutide produced the largest reduction in the 95th BMI percentile (MD -20.40%, 95% CI -24.22 to -16.58), with an additional 500 and 399 patients per 1000 person-years achieving ≥ 5% and ≥ 10% BMI reduction, respectively. Phentermine-topiramate showed the next largest reduction (MD -18.35%, 95% CI -22.26 to -14.45), corresponding to 554 and 734 additional responders per 1000 person-years. Liraglutide and exenatide also significantly reduced the 95th BMI percentile compared with lifestyle modification alone, although the reductions were smaller than those achieved with semaglutide and phentermine-topiramate. Both semaglutide and phentermine-topiramate were closely linked to weight management, and phentermine-topiramate, with its favourable tolerability, may serve as the optimal adjunct to lifestyle interventions.

How caregiver infant-feeding practices and infant-feeding environment outcomes are measured in obesity prevention intervention trials is crucial to accurately examine intervention effects. This scoping review identified what and how outcome measurement instruments (OMIs) are used to measure eight infant-feeding practice and two feeding environment outcomes that are included in a core outcome set. Embase, MEDLINE, CINAHL, and PsycINFO databases were searched from inception to 18.09.23, with an updated search conducted 18.09.25. Eligible trials included infants ≤ 1 year old and at least one infant-feeding practice or infant-feeding environment OMI. Article titles, abstracts, and full texts were screened independently in duplicate. Data were narratively synthesized. Twenty-five trials in 26 articles were included. Questionnaires were the most used OMI (n = 18); individual questions (n = 7), ecological momentary assessment (n = 1), vignettes (n = 1), and ratings of videotaped parent-child interactions (n = 2) were also used. OMIs were predominantly researcher-administered and completed in caregivers' homes. Responsive infant-feeding and pressuring the child to eat were the most examined infant-feeding practices outcomes; the feeding environment was only examined in five trials. Reporting of OMIs often lacked clarity/completeness. The findings provide an essential first step to improve the measurement of infant-feeding practices and feeding environment to prevent childhood obesity.

Objective: To explore the prospective associations between rest-activity rhythms (RARs) with obesity and adiposity-related indicators in children. Methods: In April 2023, children in grades 3 to 4 were enrolled from two schools in Chuzhou city, Anhui Province, using cluster random sampling. At baseline, triaxial accelerometers were used to monitor physical activity and sleep continuously for 7 consecutive days. Using R studio software, non-parametric indices(relative amplitude, inter-daily stability, intra-daily variability, average activity during the most active 10 h and least active 5 h, and their midpoints) were calculated. Parametric indices (amplitude, 24 h periodic mean activity, and acrophase) were also derived. At baseline and during the 1.5-year follow-up (October 2024), body fat-related indices, including percent body fat (PBF), fat mass (FM), and visceral fat area (VFA), were measured using a bioelectrical impedance analyzer. Linear mixed-effects models were employed to analyze the associations between RARs and obesity and body fat-related indices. Results: The final analysis included 534 children with a median (Q1, Q3) age of 9.72 (9.17, 10.20) years at baseline; 265 (48.18%) were girls. Relative amplitude and amplitude were associated with reductions in PBF (β=-0.87, 95%CI: -0.53 - -0.20; β=-1.23, 95%CI: -1.89 - -0.56), FM (β=-0.49, 95%CI: -0.89 - -0.08; β=-0.70, 95%CI: -1.10 - -0.30), and VFA (β=-2.70, 95%CI: -4.83 - -0.58; β=-3.66, 95%CI: -5.78 - -1.55) at follow-up (all P values <0.05). Amplitude was associated with reductions in BMI (β=-0.28, 95%CI: -0.51 - -0.05) and waist circumference (β=-0.87, 95%CI: -1.33 - -0.40)(both P<0.05). Conclusions: Robust circadian rhythms, characterized by higher daytime activity and stable nighttime sleep, are protective factors for obesity and adiposity-related indicators in children, suggesting that fostering regular rest-activity patterns helps prevent childhood obesity.

Impact of a home-based obesity prevention intervention on children's eating behaviours: Findings from the Guelph Family Health Study randomised controlled trial.

Obesity disproportionately affects children from socioeconomically disadvantaged backgrounds. This study assessed the effectiveness of the Feel4Diabetes intervention on weight outcomes among children from low socioeconomic settings. Feel4Diabetes was a randomised pragmatic trial implemented in real-world school and community settings across Europe. Using a two-stage screening procedure, families were recruited and categorised as either 'all families' or 'high-risk families'. The intervention included a 2-year school-based health promotion for all families and additional counselling for high-risk families. Weight improvement was defined as a reduction of ≥ 0.2 BMI z-score units among children with overweight/obesity. Multiple logistic regressions identified predictors of improvement. Data from 2710 children from high-risk families and 7625 children from all families were analysed. After 2 years, a higher proportion of children from high-risk families in the intervention group reduced their BMI z-score compared to the control group (p = 0.002). Children from non-high-risk families showed only a marginal improvement. Multivariate analyses identified predictors of improvement: randomisation in the intervention group (OR = 1.46; 95% CI: 1.14-1.87), baseline obesity (OR = 1.55; 95% CI: 1.16-2.08), residence in LMICs (OR = 2.33; 95% CI: 1.65-3.30) or HICs facing economic crisis (OR = 2.12; 95% CI: 1.54-2.91), and reported financial difficulties (OR = 1.36; 95% CI: 1.06-1.74). Interestingly, maternal obesity was positively associated with BMI z-score improvement (OR = 1.31; 95% CI: 1.03-1.68), while higher maternal education was inversely related (OR = 0.64; 95% CI: 0.41-0.99). These findings underscore the importance of equity-oriented, long-term interventions addressing both behavioural and structural determinants of obesity.

This manuscript describes the design and baseline findings of the POI trial, a school‐based, cluster‐randomized intervention aimed at the prevention of childhood obesity in the Canary Islands, Spain. Childhood obesity prevalence in this region is among the highest in Europe, with 40.6% of children aged 6–9 years classified as overweight or obese. Early, multidisciplinary, school‐based interventions integrating nutrition and physical activity are therefore a public health priority.MethodsThe POI trial is a cluster‐randomized controlled study conducted in primary schools in Gran Canaria, enrolling children aged 6–10 years. The intervention integrates nutrition education, physical activity promotion, and family engagement, supported by both paper‐based and digital educational materials. Teachers played a central role in intervention delivery within the classroom setting. Schools served as the unit of randomization and implementation. Baseline assessments included standardized anthropometric measurements, objectively measured physical activity, and selected metabolic parameters (fasting glucose and lipid profile). Dietary intake outcomes will be reported separately; this manuscript focuses on the nutrition education framework and baseline nutrition‐related metabolic indicators.ResultsA total of 557 children from 13 schools were included (298 intervention participants from 5 schools and 259 controls from 8 schools). Significant differences in overweight and obesity prevalence were observed by school type, with the highest prevalence in public schools (48.6%), followed by partially subsidized (33.2%) and private schools (28.3%) (p = 0.001). Among participants with available blood samples (n = 237), elevated fasting glucose was detected in 21 children and hypercholesterolemia in 24 children.ConclusionsThese baseline findings highlight substantial socioeconomic disparities in childhood overweight and obesity and demonstrate the presence of early metabolic risk in school‐aged children. The POI trial provides a scalable, school‐based model integrating nutrition education and physical activity for obesity prevention, with the potential to inform public health strategies in high‐prevalence settings.Trial Registration: ClinicalTrials.gov identifier: NCT06607159

Gendered perceptions can shape parental beliefs, behaviours and practices relevant to childhood obesity prevention during the critical early life period from pregnancy to infancy. We explored how pregnant women, mothers and healthcare providers in maternal child health in Shanghai, China, perceive the influences of gender within an overweight and obesity prevention context. We conducted a qualitative descriptive study integrated into the intervention arm of an ongoing early childhood obesity prevention trial. Individual interviews and focus group discussions with pregnant women and mothers participating in the intervention and healthcare providers involved in the delivery of the intervention were conducted (n = 59). We documented perceptions on gender in relation to parental beliefs, behaviours and practices in the context of overweight and obesity prevention. Interviews were audio recorded, transcribed and analyzed using thematic analysis. Three main themes were identified. First, participants shared expectations for children's bodies, emphasizing that health was a priority for both boys and girls, but that expectations regarding body figure were generally stricter for girls than for boys. Second, regarding parenting expectations and health behaviours, few gender differences were reported other than boys being expected to engage in more physical activity compared to girls. Third, participants shared their views on gender roles and involvement in parenting, highlighting mothers' central role in overweight and obesity prevention during pregnancy and early childhood, alongside a desire for greater paternal involvement in parenting and in modelling healthy lifestyle behaviours. Findings underscore the importance of integrating gender‑related perceptions into early childhood overweight and obesity prevention efforts, beginning prenatally and extending through early childhood. Increasing awareness of these perceptions early in the life course could contribute to more gender-sensitive care and support childhood obesity prevention from the earliest stages of life. The SCHeLTI protocol was registered on the Chinese registry ChiCTR1800017773 on 2018-08-13 (https://www.chictr.org.cn/hvshowproject.html?id=93827%26v=1.3).

BackgroundDietary habits are one of the main factors in the prevention of chronic diseases, starting in childhood.AimThe present study investigated the possibility of an association between parents' perception of their children's body weight and their daily macronutrients and energy intakes.MethodsThe study sample consisted of 1073 parent-child pairs in Greece, with a mean age of the latter 11.18 ± 0.818 years. The body mass index of children was calculated using weight and height, and classified using the cut-off criteria established by the World Obesity Federation. Dietary habits were evaluated with the semi-quantitative validated food frequency questionnaire, containing 21 items. Parental body weight perception of children determined by a researcher-made questionnaire. After anthropometric assessment, children were classified into two categories (normal vs. overweight/obesity).ResultsTwo hundred sixty-two children (24.4%) were living with an increased body weight. However, only 52.3% of the parents stated that they were aware of the fact, with the remaining percentage considering the weight as normal. Linear regression analysis showed a statistically significant correlation only between the parents' perception and the children's protein and fat intake (p = 0.021 and 0.015, respectively), an association that remained after the inclusion of confounding factors (p = 0.016 and p = 0.016, respectively).ConclusionParents' perceptions of their child's weight status appear to influence their child's dietary intake. Recognizing the existence of this relationship provides the impetus for reshaping children's diets and preventing childhood obesity.

The rising prevalence of childhood obesity has become a major global public health concern. Dietary intervention remains the cornerstone of pediatric obesity management. However, both conventional all-day energy-restricted diets and time-restricted eating have limitations in school-aged children. Studies indicate that excessive evening caloric intake is closely associated with obesity. This trial aims to evaluate the efficacy of an After-School to Pre-Sleep Energy Restriction (ASER) strategy compared with standard dietary intervention for pediatric obesity management. This study is a prospective, randomized, open-label, parallel-group trial. We plan to enroll 164 obese children from grades 3 to 6, who will be stratified by age, gender, and BMI z-score and randomly assigned in a 1:1 ratio to either the ASER group or the control group. The 24-week intervention consists of an intensive phase (weeks 0-12) followed by a maintenance phase (weeks 13-24). The primary endpoint is the between-group difference in BMI z-score (BMIz) change at week 12. Secondary endpoints include within-group BMIz changes at week 12; between-group and within-group BMIz changes at week 24; between-group and within-group changes in %BMI95, body composition, growth parameters, cardiometabolic markers, and psychobehavioral metrics at both 12 and 24weeks; and between-group differences in the incidence of adverse events at weeks 12 and 24. This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Guangxi Medical University (Approval No.: 2025-K0254). Written informed consent will be obtained from legal guardians, and assent will be obtained from child participants prior to enrollment. Study findings will be published in peer-reviewed journals. The trial was prospectively registered on 3 September 2025, prior to thefirst participant enrollment, with the Chinese Clinical Trial Registry (ChiCTR2500108702).The URL of the specific trial registry record ishttps://www.chictr.org.cn/showproj.html?proj=275435.

Participatory system dynamics (SD) approaches view public health problems as the result of a complex system of interactions. However, most public health research makes a direct leap from system mapping—often through causal loop diagrams (CLDs)—to identifying actions for change, without trying to understand the behaviour of the system as a whole and how actions could intervene. This is possibly because robust methods are lacking. This study aimed to explore whether ‘systems archetypes’ can bridge this gap to (1) better understand system behaviour, (2) identify leverage points (LPs) for change deeper in the system, and (3) provide a more structured and traceable analysis. We developed a novel approach using 11 systems archetypes for a post hoc analysis of the LIKE project—a participatory SD project on childhood obesity prevention in Amsterdam, the Netherlands. For each LIKE mechanism, we compiled a complete archetype profile, including the storyline, CLD, and behaviour over time graph, for which two were cross-checked with empirical data over time. We identified six systems archetypes. The most common was ‘fixes that fail’, in which a ‘fix’ applied to a problem creates unintended consequences that reinforce the problem. This can lead to ‘shifting the burden’ in which resources are siphoned from addressing the root cause of the problem. Compared with the original analysis, we identified LPs deeper in the system and found that systems archetypes structured the process, suggesting that systems archetypes can effectively help public health researchers hypothesize how to change system behaviour.

Meal satisfaction is considered a multidimensional concept that includes sensory enjoyment, cognitive, emotional, and physiological components and relates to contentment with the meal experience as a whole. However, its relevance to eating behavior and body weight remains unclear, especially in children. The present review investigated the potential relationship between meal satisfaction-related constructs and childhood obesity, and whether this relation is shaped by individual factors and the external environment. Seventeen eligible studies from 350 records published between 2008 and 2024 were included. No study directly assessed meal satisfaction; instead, proxy measures were used. Food enjoyment emerged as the proxy most consistently associated with BMI, often clustering with higher food responsiveness, lower satiety responsiveness, and emotional overeating. Parental feeding practices, especially pressure to eat, significantly contributed to variation in children's eating behavior and were associated with lower food enjoyment. Overall, meal satisfaction could be a key aspect to consider in childhood obesity prevention programs. However, to date, the available evidence is heterogeneous and predominantly observational. Future longitudinal and intervention studies are needed, alongside child-appropriate instruments to objectively quantify food satisfaction in children. Research that helps understand the role of contextual eating factors on children's meal satisfaction and eating behavior is also warranted.

the prevalence of childhood overweight and obesity has steadily increased over the past two decades, both in Spain and globally. The COVID-19 pandemic disrupted lifestyles, impacting children's diet and physical activity. we retrospectively analyzed the evolution of weight and BMI (body mass index) in 563 children aged 4 to 14 years, comparing three periods: pre-pandemic (until 2019), pandemic (2021-2022), and post-pandemic (2023-2024). before 2020, a significant weight gain trend was already present: weight Z-scores increased by +0.21 SD (standard deviations) between the ages of 4 and 6. The lockdown drastically accelerated weight gain; weight Z-scores increased by up to +0.41 SD between the ages of 4 and 6 in the immediate post-lockdown phase, nearly doubling the baseline trend. Two years later, in the late post-pandemic phase, a partial reduction in weight was observed (-0.20 SD at age 14), indicating that weight gain has not been fully reversed. The consolidation of excess weight was also found: the combined rates of overweight and obesity (BMI Z-score > +1 SD) had increased: 42.2 % at age 12 and 40.5 % at age 14. a significant weight gain was observed during the pandemic, especially in younger children, with partial persistence. The sustained increase in overweight and obesity rates highlights the urgent need for preventive strategies and monitoring of lifestyle habits in the pediatric population.

Anxiety and obesity can have negative impacts on the health of children. Understanding the relationship between obesity and mental disorders in children and adolescents will help develop effective prevention and intervention strategies. The main aim is to examine the relationship between anxiety-related emotional disorders, self-esteem, and BMI (obesity) among children, as well as determined the role of anxiety-related emotional disorders and self-esteem in predicting childhood obesity in China. Utilizing a non-experimental, cross-sectional study design, data were from 136 participants collected through standardized instrument measures from Chinese children: the "Chinese screening for overweight and obesity among school-age children and adolescents" in the "Health Industry Standards of the People's Republic of China" as the standard for identifying obesity, the Screen for Anxiety-Related Emotional Disorders (SCARED) for assessing anxiety disorder, and the Children's Self-Esteem Scale (CSES) for evaluating self-esteem. Statistical analysis, including descriptive statistics, Pearson correlation analysis, and multiple regression analyses was performed using SPSS version 26 to determine the predictive relationships between the variables. Specific anxiety-related emotional disorders-particularly panic disorder and separation anxiety disorder-significantly predicted higher BMI in Chinese children, while generalized anxiety disorder and school avoidance were associated with lower BMI. Self-esteem, contrary to expectations, did not significantly predict obesity. This study emphasises the necessity of including early psychological screen in childhood obesity prevention, particularly for anxiety symptoms. The findings have practical consequences for schools, doctors, and public health officials. Further research is needed to better understand the mental-physical health relationship in children.

Childhood obesity is one of the most pressing global public health concerns, associated with an increased risk of chronic diseases later in life. Early and school-based interventions are crucial to promote healthy lifestyles and prevent obesity-related complications. School nurses, due to their proximity to children and families, play a key role in prevention, education, and health promotion within the school setting. To map and synthesize the available evidence on school nurse-led interventions for the prevention and management of childhood obesity, identifying the main strategies, outcomes, and barriers to implementation. Studies published between 2014 and 2025 in English or Italian were included if they described school nurse-led interventions addressing childhood obesity prevention or management in primary or secondary schools. The following databases were searched: PubMed, Cochrane Library, and Scopus. Of 2776 records identified, 22 studies published between 2014 and 2025 were included. Three main themes emerged: multidisciplinary interventions, the role of the care coordinator, and barriers to obesity management. School nurse-led programs were linked to lower BMI, healthier eating habits, increased physical activity, and greater awareness of healthy lifestyles among children, parents, and staff. Childhood obesity is a multifactorial condition. School nurses are integral to its management, promoting healthy habits and supporting relationships among students, families, and school staff. However, despite this role, barriers remain, including difficulties engaging families, lack of specialized training, and limited resources. Integrating school nurses into public health strategies may enhance the effectiveness and sustainability of obesity prevention programs, supporting healthier generations.

Childhood obesity disproportionately affects low-income and racial-ethnic minority communities that tend to also have poor housing quality and obesogenic neighborhood environments. Yet, evidence on "whole-of-community" interventions that simultaneously improve housing, and neighborhood built and social environments, remains limited. This study examines the early impacts of a decade-long redevelopment of Jordan Downs (JD), a low-income public housing community in Watts, Los Angeles. We assessed effects on children's obesity 2years in, when roughly one-third of the site was redeveloped with new housing and built- and social-environment improvements. Using longitudinal data on a cohort of 399 children from JD and a nearby comparison group without redevelopment, we conducted difference-in-differences analyses. Primary outcomes were overweight/obesity, body mass index (BMI) z score, waist circumference, and waist-to-height ratio. Secondary outcomes included self-reported dietary, physical activity, and sedentary behaviors. JD children experienced lesser increase in overweight/obesity prevalence (14.7 percentage points [pp] lesser; 95% CI: 4.4-25.1), BMI z score (0.15 lesser; 95% CI: 0.02-0.32), waist circumference (5% less; 95% CI: 1%-9%) and waist-to-height ratio (3.9% less; 95% CI: 0.1-7.7) than the comparison group. JD children consumed fewer sugar-sweetened beverages (1.13 fewer times per day; 95% CI: 0.09-2.17) and were more likely to be physically active in the neighborhood (18.2 pp more; 95% CI: 0.4-36.9) than the comparison group. JD redevelopment was associated with a significantly lower increase in childhood obesity prevalence within its first 2years.