Primary Prevention Of Obesity Research Articles

Overweight among children and adolescents in a Native Canadian community: prevalence and associated factors

The prevalence of pediatric obesity in North America is increasing. Native American children are at especially high risk. The objective was to evaluate the prevalence of pediatric overweight and associated behavioral factors in a Native Canadian community with high rates of adult obesity and type 2 diabetes mellitus. Height and weight were measured in 445 children and adolescents aged 2-19 y. Fitness level, television viewing, body image concepts, and dietary intake were assessed in 242 subjects aged 10-19 y. Overweight was defined as a body mass index > or =85th percentile value for age- and sex-specific reference data from the third National Health and Nutrition Examination Survey (NHANES III). Multiple logistic regression was used to examine factors associated with overweight, with adjustment for age and sex. The overall prevalence of overweight in subjects aged 2-19 y was significantly higher than NHANES III reference data [boys: 27. 7% (95% CI: 21.8, 34.5); girls: 33.7% (95% CI: 27.9, 40.1)]. In the subset aged 10-19 y, > or =5 h television viewing/d was associated with a significantly higher risk of overweight than was < or =2 h/d [odds ratio (OR) = 2.52; 95% CI: 1.06, 5.98]. Subjects in the third and fourth quartiles of fitness had a substantially lower risk of overweight than did those in the first quartile [third quartile compared with first quartile: OR = 0.24 (95% CI: 0.09, 0.66); fourth quartile compared with first quartile: OR = 0.13 (95% CI: 0.03, 0. 48)]. Fiber consumption on the previous day was associated with a decreased risk of overweight (OR = 0.69; 95% CI: 0.47, 0.99 for each 0.77 g/MJ increase in fiber intake). Pediatric overweight is a harbinger of future diabetes risk and indicates a need for programs targeting primary prevention of obesity in children and adolescents.

Body composition assessment in American Indian children

Although the high prevalence of obesity in American Indian children was documented in several surveys that used body mass index (BMI, in kg/m2) as the measure, there is limited information on more direct measurements of body adiposity in this population. The present study evaluated body composition in 81 boys (aged 11.2+/-0.6 y) and 75 girls (aged 11.0+/-0.4 y) attending public schools in 6 American Indian communities: White Mountain Apache, Pima, and Tohono O'Odham in Arizona; Oglala Lakota and Sicangu Lakota in South Dakota; and Navajo in New Mexico and Arizona. These communities were participating in the feasibility phase of Pathways, a multicenter intervention for the primary prevention of obesity. Body composition was estimated by using a combination of skinfold thickness and bioelectrical impedance measurements, with a prediction equation validated previously in this same population. The mean BMI was 20.4+/-4.2 for boys and 21.1+/-5.0 for girls. The sum of the triceps plus subscapular skinfold thicknesses averaged 28.6+/-7.0 mm in boys and 34.0+/-8.0 mm in girls. Mean percentage body fat was 35.6+/-6.9 in boys and 38.8+/-8.5 in girls. The results from this study confirmed the high prevalence of excess body fatness in school-age American Indian children and permitted the development of procedures, training, and quality control for measurement of the main outcome variable in the full-scale Pathways study.

Design and statistical analysis for the Pathways study

We report the design, rationale, and statistical procedures used in Pathways, a randomized, school-based intervention for the primary prevention of obesity in American Indian children. The intervention, which is now being implemented in 7 American Indian communities around the country, includes a health-promotion curriculum, a physical education program, a school meal program, and a family involvement component. Forty-one schools serving American Indian children were randomly assigned to be either intervention or control groups. The intervention will begin in the third grade and continue through the end of the fifth grade. Efficacy of intervention will be assessed by differences in mean percentage body fat, calculated by a prediction equation, between intervention and control schools at the end of the fifth grade. Power computations indicate that the study has power to detect a mean difference of 2.8% in body fat. Data analysis will use intention-to-treat concepts and the mixed linear model. The study will be completed in 2000.

Process evaluation in a multisite, primary obesity-prevention trial in American Indian schoolchildren

We describe the development, implementation, and use of the process evaluation component of a multisite, primary obesity prevention trial for American Indian schoolchildren. We describe the development and pilot testing of the instruments, provide some examples of the criteria for instrument selection, and provide examples of how process evaluation results were used to document and refine intervention components. The theoretical and applied framework of the process evaluation was based on diffusion theory, social learning theory, and the desire for triangulation of multiple modes of data collection. The primary objectives of the process evaluation were to systematically document the training process, content, and implementation of 4 components of the intervention. The process evaluation was developed and implemented collaboratively so that it met the needs of both the evaluators and those who would be implementing the intervention components. Process evaluation results revealed that observation and structured interviews provided the most informative data; however, these methods were the most expensive and time consuming and required the highest level of skill to undertake. Although the literature is full of idealism regarding the uses of process evaluation for formative and summative purposes, in reality, many persons are sensitive to having their work evaluated in such an in-depth, context-based manner as is described. For this reason, use of structured, quantitative, highly objective tools may be more effective than qualitative methods, which appear to be more dependent on the skills and biases of the researcher and the context in which they are used.

Obesity, Levels of Lipids and Glucose, and Smoking among Navajo Adolescents

Although there is a high prevalence of overweight among Navajo children and adolescents, other risk factors for chronic disease in this population have received little attention. We therefore examined the distribution and interrelationships of overweight, cigarette smoking, blood pressure and plasma levels of lipids and glucose among 160 Navajo 12- to 19-y-olds. In agreement with previous reports, participants were ~2 kg/m2 heavier than adolescents in the general U.S. population, and the prevalence of overweight (>85th percentile) was 35–40%. Levels of total cholesterol and blood pressure were similar to those in the general U.S. population, but Navajo adolescents had a 5–10 mg/dL lower median level of HDL cholesterol, and a 30 mg/dL higher median triglyceride level. Eight percent of the adolescents examined had either impaired glucose tolerance or diabetes mellitus as assessed through an oral glucose tolerance test (n = 10) or self-report (n = 1). Relative weight (kg/m2) was associated with adverse levels of lipids, lipoproteins and glucose, with overweight adolescents having a fivefold greater risk for elevated triglyceride levels than other adolescents. Tobacco use was fairly prevalent among boys (24% cigarettes, 23% smokeless tobacco), but not girls (9% cigarettes, 3% smokeless tobacco). Because of its associations with other risk factors and with various chronic diseases in later life, it may be beneficial to focus on the primary prevention of obesity among Navajo children and adolescents.

Changing Diet and Exercise Behaviors in Individuals at Risk for Weight Gain

To date, there have been very few studies on the primary prevention of obesity and/or weight gain. This paper identifies three times periods that might be appropriate for such efforts at weight gain prevention--the 25 to 35 year age window, the perimenopausal period, and the year following successful weight loss. Research is encouraged that compares these three time periods and various intervention strategies. Several different approaches to primary prevention are identified, including group treatment programs with weekly meetings vs. less intensive, community-based interventions; focusing on those who are currently at ideal body weight vs. including those who are overweight as well; and targeting weight gain prevention per se vs. attempting to produce modest weight losses and/or modify cardiovascular risk factors. This paper suggests that primary prevention efforts should include exercise, changes in quality and quantity of food consumed, behavior modification, and some degree of therapist contact, but the manner in which these changes should be implemented to produce long-term habit change remains unclear.

Primary prevention of obesity in American Indian children.

Primary prevention of obesity in American Indian children.

Primary prevention of obesity in Mexican-American children.

Annals of the New York Academy of SciencesVolume 699, Issue 1 p. 137-146 Primary Prevention of Obesity in Mexican-American Childrena JOHN P. FOREYT, Corresponding Author JOHN P. FOREYT Baylor College of Medicine Houston, Texas 77030Send correspondence to John P. Foreyt at the Nutrition Research Clinic, Baylor College of Medicine, 6535 Fannin, Houston, TX 77030.Search for more papers by this authorJENNIFER H. COUSINS, JENNIFER H. COUSINS Baylor College of Medicine Houston, Texas 77030Search for more papers by this author JOHN P. FOREYT, Corresponding Author JOHN P. FOREYT Baylor College of Medicine Houston, Texas 77030Send correspondence to John P. Foreyt at the Nutrition Research Clinic, Baylor College of Medicine, 6535 Fannin, Houston, TX 77030.Search for more papers by this authorJENNIFER H. COUSINS, JENNIFER H. COUSINS Baylor College of Medicine Houston, Texas 77030Search for more papers by this author First published: October 1993 https://doi.org/10.1111/j.1749-6632.1993.tb18845.xCitations: 7 a Preparation of this manuscript was supported in part by Grants HL27341, from the National Heart, Lung, and Blood Institute to both authors, and HD23991, from the National Institute of Child Health and Human Development to the second author. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume699, Issue1Prevention and Treatment of Childhood ObesityOctober 1993Pages 137-146 RelatedInformation