Reduce Childhood Obesity Research Articles

Family-focused obesity prevention program implementation in urban versus rural communities: a case study

PurposeDespite public health efforts to reduce childhood obesity, there remains an unequal distribution of obesity among rural and urban children, with higher rates in rural areas. However, few studies have compared differences in program delivery. This paper aims to describe differences between an urban and rural program delivery of a family-focused, community-based intervention program to prevent and reduce obesity among children.MethodsThis paper uses a case study format to provide a descriptive analysis of similar obesity prevention programs, designed by the same research team, implemented in Minnesota in different settings (i.e., an urban and rural setting) with significant community engagement in the adaptation process. The rural NU-HOME program is compared to HOME-Plus, an urban family-based obesity prevention program for school-aged children.ResultsCommunity engagement in the adaptation process of an urban program to a rural program confirmed some anticipated program content and delivery similarities while identifying key differences that were necessary for adaptation related to engagement with the community, recruitment and data collection, and intervention delivery.DiscussionWhen adapting research-tested programs from urban to rural areas, it is important to identify the modifiable behavioral, social, and environmental factors associated with obesity to ensure the content of effective childhood obesity prevention programs is relevant. Customizing a program to meet the needs of the community may increase reach, engagement, and sustainability. In addition, long-term dissemination of a tailored program may significantly reduce childhood obesity in rural communities and be implemented in other rural settings nationally.

Meals adequacy during weekdays and weekends in an Italian primary school children sample

Abstract Background Between 15 and 50% of European children aged 6-9 are overweight or obese and this number is rising dramatically over time, making it one of the most important public health challenges. Selection of healthy food and a balanced diet are key when addressing this obesity epidemic. At the same time, it is essential to consider schools' role and parents' influence on children's dietary habits. This study aims to assess the adequacy of meals during the weekdays (WD) and weekends (WE), therefore highlighting the critical moments where schools' and parents' involvement needs to be of greater impact. Methods A cross-sectional study was conducted among 428 children aged 6-11 recruited in a primary school of Calderara di Reno (Italy) in 2017. A weekly diary was administered between May and June 2017 to explore the dietary habits of the participants. Every day for each meal (breakfast, morning snack, lunch, dinner) it was required to report what types of food and beverages were consumed, and where (home/school). The adequacy of each meal was determined by using national guidelines. A McNemar test was performed to evaluate the differences in meal adequacy between the WD and WE. Results Our analysis showed that meals consumed at school, i.e. morning snacks and lunches, were more adequate during WD than WE (69.6% vs 22.2%, 53.5% vs 32.5%; P-value <0.001), underlying the positive influence of school. On the other hand, breakfasts and dinners were more adequate during WE than WD (64.5% vs 51.4%, 23.8% vs 15.7%; P-value <0.001); this difference might be partially explained by the different amount of time parents have for food preparation during workdays versus weekends. Conclusions Further preventive interventions should address childrens' and parents' home dietary routine as a tool to improve meal adequacy at home and therefore reduce childhood obesity. Parental school-based interventions could have a key role in changing childrens' dietary habits. Key messages Our study showed a significant difference of healthy dietary habits between meals served at school during weekdays and at home during weekends, highlighting a higher dietary adequacy in the first ones. The results underline the importance of implementing educational programs addressing childrens’ and their parents' home meals routine and dietary habits.

Examining current physical activity interventions in Black school-age children and parents: A systematic review

Obesity is prevalent in Black children and adults; increasing physical activity (PA) can aid in reducing childhood obesity in both age groups. The purpose of this systematic review is to examine current research on PA interventions in school-age Black children. Adhering to PRISMA guidelines, a systematic search was conducted in six databases for PA interventions in Black children. A total of 13 articles met inclusion criteria (n = 7 randomized controlled trial, n = 5 quasi-experimental, n = 1 cross-sectional). The majority of the articles were on a combination of diet and PA programs (n = 9). Four articles targeted PA and parental role modeling of PA as the outcome showing positive intervention effects. Nine additional studies included PA as an outcome variable along with at least one additional obesity-related predictor. PA interventions for Black school-age children typically use a parent-child dyadic approach (n = 13), are guided by theory (n = 11) and are high quality. However, continued investigation is warranted to draw definitive conclusions and determine how to best involve parents within the PA interventions. Theory-driven higher quality trials that clearly describe the structured PA component and outcomes among Black parent-child dyads are needed.

Systematic Review of Setting-Based Interventions for Preventing Childhood Obesity.

Introduction Child obesity is recognized as one of the major public health problems globally, which demands multicomponent and comprehensive interventions. The objective of this systematic review is to evaluate, synthesize, and combine the existing evidence of various setting-based interventions across developed and developing countries that aim to prevent childhood obesity. Methods An electronic and systematic search was conducted on setting-based interventions related to childhood obesity both in developed and developing countries. A study was considered eligible if it was a randomized controlled trial that focused on home-based, school-based, or community-based intervention for childhood obesity and published in English from 2010 to 2020. A wide range of electronic bibliographic databases, such as PubMed, Medline, Embase, and ERIC were searched. The various studies were carried out among children aged 4-18 years old. A total of 32 studies were identified; out of which 24 were school-based interventions, and the remaining were nonschool-based. Results The studies in this review highlighted important school and nonschool-based interventions to avoid obesity among children and adolescents. School-based interventions that had considered both physical activity (PA) and diet along with home elements showed great effectiveness. These findings reveal that the specific intervention components such as nutrition education curriculum, prolonged time for PA, and upgrading self-efficacy of study participants should be considered to prevent obesity across developed and developing countries. However, the findings from nonschool-based interventions were restricted by the scarcity of the studies. Conclusion Multisetting and multipronged strategies are required to avoid or reduce childhood obesity across the globe. However, additional studies are needed with a large sample size. Further study designs based on theory should be conducted in nonschool settings for the creation of meaningful and detailed guidelines that can support the prevention of obesity in children.

A Mindfulness-Based Pilot Study to Reduce Childhood Obesity Risk in Underserved Hispanic Children: Feasibility, Acceptability, and Preliminary Findings

Describe the feasibility and outcome measures used to evaluate the mindfulness-based intervention.

Effects of aerobic exercise and resistance exercise on physical indexes and cardiovascular risk factors in obese and overweight school-age children: A systematic review and meta-analysis.

Obesity is a serious social and public health problem in the world, especially in children and adolescents. For school-age children with obesity, this stage is in the transition from childhood to adolescence, and both physical, psychological, and external environments will be full of challenges. Studies have showed that school-age children are the largest proportion of people who continue to be obese in adulthood. Physical exercise is considered as an effective way to control weight. Therefore, we focus on this point to study which factors will be improved to reduce childhood obesity. To assess the effects of aerobic and resistance exercise on physical indexes, such as body mass index (BMI) and body fat percentage, and cardiovascular risk factors such as VO2peak, triglycerides (TG) and low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), insulin and insulin resistance in school-age children who are overweight or obese. PubMed, SPORTDiscus, Medline, Cochrane-Library, Scopus, Ovid and Web of Science were searched to locate studies published between 2000 and 2021 in obese and overweight school-age children between 6-12 years old. The articles are all randomized controlled trials (RCTs) and in English. Data were synthesized using a random-effect or a fixed-effect model to analyze the effects of aerobic and resistance exercise on six elements in in school-age children with overweight or obese. The primary outcome measures were set for BMI. A total of 13 RCTs (504 participants) were identified. Analysis of the between-group showed that aerobic and resistance exercise were effective in improving BMI (MD = -0.66; p < 0.00001), body fat percentage (MD = -1.29; p = 0.02), TG (std.MD = -1.14; p = 0.005), LDL (std.MD = -1.38; p = 0.003), TC (std.MD = -0.77; p = 0.002), VO2peak (std.MD = 1.25; p = 0.001). However, aerobic and resistance exercise were not significant in improving HDL (std.MD = 0.13; p = 0.27). Aerobic exercise and resistance exercise are associated with improvement in BMI, body fat percentage, VO2peak, TG, LDL, TC, while not in HDL in school-age children with obesity or overweight. Insulin and insulin resistance were not able to be analyzed in our review. However, there are only two articles related to resistance exercise in children with obesity and overweight at school age, which is far less than the number of 12 articles about aerobic exercise, so we cannot compare the effects of the two types of exercises.

Healthy Schoolhouse 2.0 Health Promotion Intervention to Reduce Childhood Obesity in Washington, DC: A Feasibility Study.

Childhood obesity prevalence trends involve complex societal and environmental factors as well as individual behaviors. The Healthy Schoolhouse 2.0 program seeks to improve nutrition literacy among elementary school students through an equity-focused intervention that supports the health of students, teachers, and the community. This five-year quasi-experimental study follows a baseline–post-test design. Research activities examine the feasibility and effectiveness of a professional development series in the first program year to improve teachers’ self-efficacy and students’ nutrition literacy. Four elementary schools in Washington, DC (two intervention, two comparison) enrolled in the program (N = 1302 students). Demographic and baseline assessments were similar between schools. Teacher participation in professional development sessions was positively correlated with implementing nutrition lessons (r = 0.6, p < 0.001, n = 55). Post-test student nutrition knowledge scores (W = 39985, p < 0.010, n = 659) and knowledge score changes (W = 17064, p < 0.010, n = 448) were higher among students in the intervention schools. Students who received three nutrition lessons had higher post knowledge scores than students who received fewer lessons (H(2) =22.75, p < 0.001, n = 659). Engaging teachers to implement nutrition curricula may support sustainable obesity prevention efforts in the elementary school environment.

Occupational Therapists Tackling Childhood Obesity with School Wide Programs

ABSTRACT Children in the United States face higher rates of childhood obesity than in other developed countries. A literature review examined eight different articles to discover why these statistics are so high and how occupational therapists can address this issue to reduce rates of childhood obesity. From the age of five, children spend almost 30 hours a week in school systems for 13 years. However, research concluded that United States school systems are lacking in physical activity time and are not being held liable to teach health education to students. Studies also verified that parents must be educated as well as students and staff, in order for children to obtain the most benefits from childhood obesity interventions. These findings attest to the need for occupational therapists to implement school wide programs to intervene with teachers, staff, students, and parents to reduce childhood obesity.

Effect of reducing ultraprocessed food consumption on obesity among US children and adolescents aged 7–18 years: evidence from a simulation model

BackgroundChildren and adolescents in the USA consume large amounts of daily calories from ultraprocessed foods (UPFs). Recent evidence links UPF consumption to increased body fat in youth. We aimed to...

P26 Health 360 Policies: Lessons for Healthy Habits to Reduce Childhood Obesity Risk

<h3>Background</h3> Childhood obesity is the most pressing public health problem in the United States. Prevalence of child obesity has tripled in the past 3 decades, leading to comorbidities. Teaching children healthy habits is vital to reducing obesity. Children need role models to set positive examples and edify consequences of unhealthy habits. The Boys and Girls Club of Charlestown, MA implemented Health360 policies to educate children about healthy habits. <h3>Objective</h3> To examine if the Health360 policies make an impact on children to develop healthy habits in order to reduce risk of obesity. <h3>Study Design, Setting, Participants</h3> Qualitative study focused on the 4 Health360 policies. Eight hands-on lessons were taught weekly for 2 months at The Boys and Girls Club after school program. An assessment survey was given at the start and end of the study. Participants were 8 third and fourth grade Latino girls. <h3>Measurable Outcome/Analysis</h3> Increased participants' knowledge and appreciation of healthy lifestyle benefits. Narrative analysis assessed information from pre- and post-surveys, as well as observations and experiences of participants. <h3>Results</h3> The pre- and post-survey assessment revealed children had higher awareness of the Health360 policies after attending the lessons. All participants believed in the importance of embodying the policies post-lessons, as opposed to 25% pre-instruction. It was observed that the more lessons attended, the more children were engaged in learning about healthy habits. When a health policy was taught a second time it reinforced the lesson and participants retained information. They asked insightful questions, grasped the benefits of healthful lifestyles, and contemplated making changes in their lives. <h3>Conclusion</h3> Childhood obesity is a major health concern, which is exacerbated by a lack of positive examples for healthy habits. When children are exposed to the benefits of healthy lifestyles they are more likely to make changes. This could aid in reducing the risk of chronic disease.

Twelve-Month Efficacy of an Obesity Prevention Program Targeting Hispanic Families With Preschoolers From Low-Income Backgrounds

ObjectiveAssess effects of an obesity prevention program promoting eating self-regulation and healthy preferences in Hispanic preschool children. DesignRandomized controlled trial with pretest, posttest, 6- and 12-month assessments. Fourteen waves, each lasting 7 weeks. SettingFamilies recruited from Head Start across 2 sites. ParticipantsTwo hundred fifty-five families randomized into prevention (n = 136) or control (n = 119). InterventionPrevention received curriculum; control received no curriculum. Main Outcome Measure(s)Feeding knowledge/practices/styles (parent); body mass index percentile, eating self-regulation, trying new foods, and fruit/vegetable consumption (child). AnalysisMultilevel analyses for nested data (time points within families; families within waves) and multinomial regression. ResultsProgram increased mothers’ repeated presentation of new foods (P < 0.05), measured portion sizes (P < 0.05), child involvement in food preparation (P < 0.001), feeding responsiveness (P < 0.001), knowledge of best feeding practices (P < 0.001), and feeding efficacy (P < 0.05); reduced feeding misconceptions (P < 0.01) and uninvolved feeding (P < 0.01). Effects on child eating behavior were minimal. At 12 months, children in the prevention group were less likely to have overweight (P < 0.05) or obesity (P < 0.05). Conclusions and ImplicationsProgram effects emphasize the importance of feeding approaches in reducing childhood obesity.

The enriched home environment and dietary intake are related to percent overBMI in children.

Longitudinal research suggests that living in a cognitively enriched home environment, in which access to activities including hobbies and books are plentiful, can prevent excess weight gain and obesity in children. In order for the enriched home environment to influence weight it should influence energy and macronutrient intake and/or energy expenditure. To test this hypothesis, we used a cross sectional design to study aspects of the child's enriched home environment along with energy and macronutrient intake. A sample of 158 6-9-year-old children measured between February 2017 - April 2019 in Buffalo, NY were selected from a larger study based on criteria for accurate reporting of energy intake using the Block Kid's Food Frequency Questionnaire. Results showed that the Home Observation for Measurement of the Environment (HOME) subscales enriched environment, parental warmth and an integrated family structure were negatively related to child percent overBMI. Hierarchical regression showed that each of these factors improved variance in child percent overBMI accounted for beyond dietary intake or macronutrients, specifically accounting for a total of 18.2% variance in models controlling for total energy intake. These results provide the first demonstration that characteristics of a child's home environment are associated with lower energy intake and independently associated with percent overBMI beyond knowledge of diet. Enriching a child's home environment by providing alternative activities to eating, improving parental warmth and providing opportunities for parents to interact positively with their children may be novel ways to reduce childhood obesity that should be experimentally tested in future research.

Impact of Mothers Participation in a Nutrition Education Intervention on Their Children Eating Behavior

ObjectivesTo determine whether mother’s participation in a nutrition education program influence obese children’s body weight and improving their health behavior. Additionally, this study evaluates changes in attitude toward food, and beliefs for children-mothers dyad participating in the Healthy Habits (HH) program. MethodsFourteen mothers were willing to participate in the intervention. The mother’s intervention was offered to the mothers of children participating in the Healthy Habits group only. Mothers received “what’s app” text messages and materials related to the nutrition education provided for all children in the Healthy Habits group during the 8-week period. ResultsAfter an 8-week intervention, children with maternal support showed significant (21% VS 100%, P.001), (45% VS 95%, P = 0.012) improvement in eating behavior and attitude compared with the other group in the intervention. Maternal eating behaviors, beliefs and attitudes were also significantly (12% VS 95%, P.001), (21% VS 82%, P.001) changed by their participation. ConclusionsMaternal involvement in the Healthy Habits program showed positive effect on children eating behavior in addition to improvement in maternal behavior. Our findings suggest that actively involving mothers in programs to reduce childhood obesity, will magnify the potential effects of the program on children by changing the family dynamics and creating a supportive environment. Funding SourcesN/A.

Use of the Infant Diet Quality Index Score (DQIS) for the Identification of Targets for Nutritional Intervention Among Infants of 4 to 6 Months at Risk of Childhood Obesity

ObjectivesHealthcare providers have been called to intervene during the first 1000 days of life to reduce childhood obesity. Screening instruments that facilitate the identification of targets for intervention are not currently available. A Diet Quality Index Score (DQIS) was created and measured for its validity in predicting excessive weight gain in a sample of Latino infants. Evidence that infants with BMI percentiles ≥85th at 2 months developed early childhood obesity demands strategies to detect targets for intervention in a systems-based approach. MethodsSecondary database analysis using data sourced from a lifestyle intervention project implemented among WIC participants. Assessments were completed on baseline while the infant was 0–2 months of age and follow up at 4–6 months. Socio-demographic and anthropometric characteristics of infants and their caregivers were evaluated. DQIS was calculated using an infant food frequency questionnaire. Descriptive analysis of the variables of interest was conducted. Correlation analysis between the numeric DQIS and categorical assessment of the scale was performed to determine the degree of association of values or risk category associated with a BMI z score percentile at or above 85th according to the age and gender appropriate WHO growth standards. Results169 dyads were included in this study (Puerto Rico 54.4%), mean caregiver age was 27 y (4.94). 41.4% had achieved an educational level high school or less. In infants: 52% received care in health centers, 82.2% where up to date on vaccinations, 99.4% had an excellent DQIS score at baseline. At follow up 19.5% were found in good and 8.9% needs improvement to poor range. Mean BMI z scores increased from -0.52 (1.35) at birth to 0.9 (1.46) at follow up. ConclusionsThe infant DQIS used between 4 to 6 months of life as a screening tool could assist non nutritional healthcare providers in the identification of intervention targets while a more detailed assessment is completed. Funding SourcesThis study was supported by the National Institute of Minority Health and Health Disparities (NIMHD), of the NIH, award number U54MD008149. Infrastructure support also provided by the National Institute on Minority Health and Health Disparities RCMI Grant: 8G12MD007600. This research was also supported by grant U54MD007584 (RMATRIX) from the NIMHD of the NIH.

California and federal school nutrition policies and obesity among children of Pacific Islander, American Indian/Alaska Native, and Filipino origins: Interrupted time series analysis.

BackgroundObesity prevalence remains high among children of Pacific Islander (PI) origin, Filipino (FI), and American Indian/Alaska Native (AIAN) origins in the United States. While school nutrition policies may help prevent and reduce childhood obesity, their influences specifically among PI, FI, and AIAN children remain understudied. We evaluated the association of the California (CA) state school nutrition policies for competitive food and beverages and the federal policy for school meals (Healthy, Hunger-Free Kids Act of 2010 (HHFKA 2010)) with overweight/obesity among PI, FI, and AIAN students.Methods and findingsWe used an interrupted time series (ITS) design with FitnessGram data from 2002 to 2016 for PI (78,841), FI (328,667), AIAN (97,129), and White (3,309,982) students in fifth and seventh grades who attended CA public schools. Multilevel logistic regression models estimated the associations of the CA school nutrition policies (in effect beginning in academic year 2004 to 2005) and HHFKA 2010 (from academic year 2012 to 2013) with overweight/obesity prevalence (above the 85 percentile of the age- and sex-specific body mass index (BMI) distribution). The models were constructed separately for each grade and sex combination and adjusted for school district-, school-, and student-level characteristics such as percentage of students eligible for free and reduced price meals, neighborhood income and education levels, and age. Across the study period, the crude prevalence of overweight/obesity was higher among PI (39.5% to 52.5%), FI (32.9% to 36.7%), and AIAN (37.7% to 45.6%) children, compared to White (26.8% to 30.2%) students. The results generally showed favorable association of the CA nutrition policies with overweight/obesity prevalence trends, although the magnitudes of associations and strengths of evidence varied among racial/ethnic subgroups. Before the CA policies went into effect (2002 to 2004), overweight/obesity prevalence increased for White, PI, and AIAN students in both grades and sex groups as well as FI girls in seventh grade. After the CA policies took place (2005 to 2012), the overweight/obesity rates decreased for almost all subgroups who experienced increasing trends before the policies, with the largest decrease seen among PI girls in fifth grade (before: log odds ratio = 0.149 (95% CI 0.108 to 0.189; p < 0.001); after: 0.010 (−0.005 to 0.025; 0.178)). When both the CA nutrition policies and HHFKA 2010 were in effect (2013 to 2016), declines in the overweight/obesity prevalence were seen among White girls and FI boys in fifth grade. Despite the evidence of the favorable association of the school nutrition policies with overweight/obesity prevalence trends, disparities between PI and AIAN students and their White peers remained large after the policies took place. As these policies went into effect for all public schools in CA, without a clear comparison group, we cannot conclude that the changes in prevalence trends were solely attributable to these policies.ConclusionsThe current study found evidence of favorable associations of the state and federal school nutrition policies with overweight/obesity prevalence trends. However, the prevalence of overweight/obesity continued to be high among PI and AIAN students and FI boys. There remain wide racial/ethnic disparities between these racial/ethnic minority subgroups and their White peers. Additional strategies are needed to reduce childhood obesity and related disparities among these understudied racial/ethnic populations.

Community social network pattern analysis: Development of a novel methodology using a complex, multi-level health intervention

Community social networks (CSN) include individuals and groups, and those with strong partnerships and relationships are well situated for implementing community-based interventions. However, information on the nature of CSN relationships required for multilevel community-based interventions is not present in the literature. Using data from the multi-level Children’s Healthy Living (CHL) trial to reduce child obesity in nine Pacific communities, this study aimed to develop a methodology based on Social Network Analysis (SNA) to understand how CSN evolved over the course of a two-year trial, as well as the characteristics of CSN most successful in impacting indicators of childhood obesity. &#x0D; The two-year trial was considered in four six-month intervals. Within each interval, implemented activities, as recorded in CHL monthly reports, were coded by activity implementer(s), e.g. government agency, school, or community-based group, as well as for collective efficacy impact of the activity, e.g. to leverage resources from outside the CSN or to facilitate civic engagement. Coded data were used to create CSN maps for the four time intervals, and SNA techniques examined the CSN characteristics. CSN density increased over time, as measured by the number of ties within the network. Schools, community-based groups and large organizations were identified as the primary implementers of the CHL intervention and formed a community implementer backbone. Social leveraging, i.e. linking local groups to people with authority over outside resources, was shown to be a central component in intervention success. It took time to develop strong CSN, and stronger (denser) CSN were more successful in building social cohesion and enacting community change. Findings illustrate a methodology that can be useful for tracking the development and impact of CSN.

Limiting Television to Reduce Childhood Obesity: Cost-Effectiveness of Five Population Strategies.

Objective: To quantify the potential population-wide costs, number of individuals reached, and impact on obesity of five effective interventions to reduce children's television viewing if implemented nationally.Study Design: Utilizing evidence from systematic reviews, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) microsimulation model estimated the cost, population reach, and impact on childhood obesity from 2020 to 2030 of five hypothetical policy strategies to reduce the negative impact of children's TV exposure: (1) eliminating the tax deductibility of food and beverage advertising; (2) targeting TV reduction during home visiting programs; (3) motivational interviewing to reduce home television time at Women, Infants, and Children (WIC) clinic visits; (4) adoption of a television-reduction curriculum in child care; and (5) limiting noneducational television in licensed child care settings.Results: Eliminating the tax deductibility of food advertising could reach the most children [106 million, 95% uncertainty interval (UI): 105–107 million], prevent the most cases of obesity (78,700, 95% UI: 30,200–130,000), and save more in health care costs than it costs to implement. Strategies targeting young children in child care and WIC also cost little to implement (between $0.19 and $32.73 per child reached), and, although reaching fewer children because of the restricted age range, were estimated to prevent between 25,500 (95% UI: 4600–59,300) and 35,400 (95% UI: 13,200–62,100) cases of obesity. Home visiting to reduce television viewing had high costs and a low reach.Conclusions: Interventions to reduce television exposure across a range of settings, if implemented widely, could help prevent childhood obesity in the population at relatively low cost.

Measurement challenges for childhood obesity research within and between Latin America and the United States.

SummaryChildhood obesity is a major public health challenge across Latin America and the United States. Addressing childhood obesity depends on valid, reliable, and culturally sensitive measurements. Such progress within and between countries of the Americas could be enhanced through better measurement across different age groups, different countries, and in sending and receiving communities. Additionally, better and more comparable measurements could accelerate cross‐border collaboration and learning. Here, we present (1) frameworks that influenced our perspectives on childhood obesity and measurement needs across the Americas; (2) a summary of resources and guidance available concerning measurement and adaptation of measures for childhood obesity research; and (3) three major areas that present challenges and opportunities for measurement advances related to childhood obesity, including parental behavior, acculturation, and the potential to incorporate ethnographic methods to identify critical factors related to economics and globalization. Progress to reduce childhood obesity across the Americas could be accelerated by further transnational collaboration aimed at improving measurement for better surveillance, intervention development and evaluation, implementation research, and evaluation of natural experiments. Additionally, there is a need to improve training related to measurement and for improving access to valid and reliable measures in Spanish and other languages common in the Americas.

Maternal diet in pregnancy is associated with differences in child body mass index trajectories from birth to adolescence

Nutrition in pregnancy and accelerated childhood growth are important predictors of obesity risk. Yet, it is unknown which dietary patterns in pregnancy are associated with accelerated growth and whether there are specific periods from birth to adolescence that are most sensitive to these associations. To examine the extent to which 3 dietary indices in pregnancy [Dietary Inflammatory Index (DII), Alternate Healthy Eating Index for Pregnancy (AHEI-P), and Mediterranean Diet Score (MDS)] are associated with child BMI z-score (BMI-z) trajectories from birth to adolescence. We examined 1459 mother-child dyads from Project Viva that had FFQ data in pregnancy and ≥3 child BMI-z measurements between birth and adolescence. We used linear spline mixed-effects models to examine whether BMI-z growth rates and BMI z-scores differed by quartile of each dietary index from birth to 1 mo, 1-6 mo, 6 mo to 3 y, 3-10 y, and>10 y. The means±SDs for DII (range, -9 to+8 units), AHEI-P (range, 0-90 points), and MDS (range, 0-9 points) were -2.6±1.4 units, 61±10 points, and 4.6±2.0 points, respectively. In adjusted models, children of women in the highest (vs. lowest) DII quartile had higher BMI-z growth rates between 3-10 y (β, 0.03 SD units/y; 95% CI: 0.00-0.06) and higher BMI z-scores from 7 y through 10 y. Children of women with low adherence to a Mediterranean diet had higher BMI z-scores from 3 y through 15 y. Associations of AHEI-P with growth rates and BMI z-scores from birth through adolescence were null. A higher DII and a lower MDS in pregnancy, but not AHEI-P results, are associated with higher BMI-z trajectories during distinct growth periods from birth through adolescence. Identifying the specific dietary patterns in pregnancy associated with rapid weight gain in children could inform strategies to reduce child obesity.

Better Diet Quality in the Healthy Hunger-Free Kids Act and WIC Package Reduced Childhood Obesity.

* Abbreviations: HEI 2010 — : Healthy Eating Index 2010 HHFKA — : Healthy, Hunger-Free Kids Act WIC — : Special Supplemental Nutrition Program for Women, Infants, and Children The reductions in the prevalence of childhood obesity achieved by the Healthy, Hunger-Free Kids Act (HHFKA) and the changes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package have not been widely recognized. Both the HHFKA and the regulatory updates to the WIC package substantially changed the quality of the foods provided. Both changes improved diets and led to reductions in the prevalence of obesity in the most vulnerable youth served by these programs. The HHFKA was passed by Congress in 2010, and its implementation was required in schools by 2012. In the Act, Congress set age-appropriate caloric ranges, required that at least 51% of grains be whole grains, required students to take at least one-half cup serving of fruits or vegetables with every school breakfast or lunch, and required that schools offer 1 cup of flavored or unflavored fat-free milk or 1% milk. Despite concerns, the changes were not associated with an increase in plate waste.1 In several studies, researchers have confirmed an increase in the quality of school meals and in improved consumption. For example, dietary quality was assessed before and after implementation of the new HHFKA standards by using the Healthy Eating Index 2010 (HEI 2010) and food consumption data from the nationally representative NHANES.2 The HEI 2010 score reflected the degree to which dietary intake was consistent with the 2010 Dietary Guidelines for Americans. The HEI 2010 scores among students aged 5 to 18 years were stratified by low-income, low-middle–income, and middle-high–income students and compared to those among non–school lunch participants in the same income categories. The HEI 2010 scores increased from 42.7 to 54.6 among school lunch participants compared to a decrease from 34.8 to 34.1 among nonparticipants. The differences in comparison with non–school lunch participants were 12.6, … Address correspondence to William H. Dietz, MD, PhD, Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, 214 11th St NE, Washington, DC 20002. E-mail: dietzwcd4{at}gmail.com