Childhood Obesity最新文献

Background: Child care-based interventions have largely neglected sleep as an important health behavior for obesity prevention. Child care sleep environments and caregiver practices likely differ from home sleep environments and parent practices. Methods: We summarize findings of past research examining how child care arrangement, dose, and attendance impact young children's sleep using steps outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analyses methodology. Keywords related to sleep and child care were entered into PubMed, PsycINFO, and CINAHL, yielding a total of 3535 articles. Results: Twenty-three studies were included in the data extraction process. There was evidence indicating that child care arrangement type, dose, and attendance impact various sleep outcomes among children 0-5 years old. Considerable variation across studies with regard to child care comparison groups and sleep outcomes assessed made making comparisons across studies difficult. However, child care outside the home and increased time spent in child care were commonly positively associated with daytime sleep and negatively associated with nighttime sleep. Child care outside the home was also associated with 24-hour sleep, with decreased sleep observed among infants and toddlers but increased sleep observed among preschool-age children receiving outside care, especially in settings with mandatory naptime. Conclusion: The findings of this review demonstrate that child care impacts children's sleep. More research is needed to understand best practices for promoting sleep across child care settings and inform intervention efforts. Integrating sleep into evidence-based child care obesity prevention interventions, such as Nutrition and Physical Activity Self-Assessment for Child Care, would assist in efforts to reduce obesity risk among young children.

Background: Promoting healthy eating and physical activity in early childhood education and care (ECEC) is recommended within guidelines and supported by health promotion programs; however, implementation is suboptimal. Evidence suggests implementation within the sector varies over time; however, this has not been empirically examined in relation to implementation barriers. This study aims to: (1) describe changes in the prevalence of, and barriers to, implementation of priority healthy eating and physical activity practices; and (2) explore the associations between such barriers and implementation. Methods: This was a repeated cross-sectional study over an 8-month period. A cross-section of 150-180 Australian ECEC services were prospectively randomly sampled for each month (April-November 2023), with 1127 ECEC services sampled in total and 20% of services sampled twice. Services reported via survey their implementation of two priority practices: (1) healthy menu standards and (2) educating and engaging parents in child physical activity. They also reported on implementation status, implementation stage, and five core implementation barriers. Results: Overall, 716 services completed 809 surveys. There were no significant differences in the prevalence of implementation or general trends in barriers to implementation of the two priority practices across that time. Services reporting less barriers were significantly more likely to be implementing the priority practices, and services in more advanced implementation stages were significantly less likely to report barriers. Conclusions: To enhance the implementation of priority practices in ECEC services, key barriers to implementation need to be understood and targeted to progress services through to advanced implementation stages.

Background: Few evidence-based obesity interventions have been disseminated in early care and education (ECE) settings. This study describes Go SHAPES: the statewide dissemination of the Study of Health and Activity in Preschool Environments (SHAPES) intervention via online professional development, its classroom implementation, and factors associated with its implementation in ECE. Methods: We recruited ECE teachers through professional conferences to participate in online professional development with ongoing technical assistance support to implement SHAPES in their classrooms. SHAPES integrated physical activity (PA) opportunities into the school day through the following three components-Move Inside (PA in the classroom), Move to Learn (PA in preacademic lessons), and Move Outside (PA during recess). Teachers completed a survey to assess the implementation of the disseminated intervention (Go SHAPES). Multiple logistic regression analyses identified factors associated with meeting implementation goals. Results: SHAPES was disseminated to 935 personnel from 434 ECE programs in South Carolina over 3 years. Eighty-three percent of the participants who began the 6-week online professional development completed all six modules, thereby adopting SHAPES. Implementation of PA opportunities in ECE classrooms was high, and 59% of teachers planned to use SHAPES fully in the future. Teachers perceiving SHAPES as "easy to implement" and experiencing "no barriers" to implementation were associated with meeting weekly goals for providing PA opportunities. Perceiving "administrator support" and "program as worthwhile" was associated with intentions to use SHAPES in the future. Conclusions: Go SHAPES provides a model for statewide dissemination, adoption, and implementation of a PA program in ECE settings, using an online professional development approach.

Introduction: Family child care (FCC) offers a promising setting for obesity prevention, yet interventions have had varied success, potentially due to insufficient stakeholder input. This study aimed to explore barriers, facilitators, and preferences for healthy eating and physical activity interventions among Australian FCC educators and organization staff. Methodology: Semi-structured interviews were conducted with 15 FCC educators and 6 staff members, using the framework method for data analysis. Results: Findings were organized according to the socioecological model. At the public policy level, regulations were seen as prioritizing risk avoidance over health benefits. At the community level, educators cited community programs and facilities as supportive of physical activity, noting that cultural and socioeconomic factors influence healthy eating. At the organizational level, adequate space promoted physical activity, but financial limitations impacted food provision and access to physical activity equipment. Some FCC organizations did not provide support for healthy practices. At the interpersonal level, educators and staff struggled to address unsupportive parental choices. Lastly, at the individual level, nutrition knowledge and education were deemed important for promoting healthy eating, with picky eating as a common obstacle. Conclusion: To enhance healthy eating and physical activity in FCC, recommended strategies include training safety assessors, educators, and parents on risky play; adapting regulations to the FCC context; reimbursing food provision; enhancing opportunities for excursions and outdoor play spaces; improving communication between educators and parents and expanding educators' knowledge of nutrition and physical activity.

Background: Direct observation (DO) tools developed for preschoolers have been used to describe toddler physical activity (PA). No DO system created to assess PA levels and the childcare environment of toddlers exists. The purpose of this study was to develop the Observational System for Recording Physical Activity in Children-Toddlers (OSRAC-T) and assess the inter- and intra-rater reliability. Methods: This tool is an extension of the Observational System for Recording Physical Activity in Children-Preschool and uses the same focal child, time sampling system (5-second observation and 25-second recording). Tool content was established through identifying similar research, consulting with experts, and conducting informal observations. A sample of toddlers (12-36 months) was observed and video recorded during childcare. In-person observations were compared to video observations from one coder (intrarater reliability). Video observations (39% of intervals) were coded by two raters to determine interrater reliability. Results: The final instrument included nine categories that described PA level and type, social and environmental contexts, and transition support relevant to toddlers. Observers completed 124 observation sessions (n = 31; 25.5 ± 6.0 months) resulting in 7,757 30-second observation intervals. Interval-by-interval agreement was moderate to high (58.90%-95.30%) for all categories, and interrater reliability was low to moderate (k = 0.28-0.69). Conclusion: The OSRAC-T is a reliable observation system to assess several PA-related behaviors of toddlers. It may be used to better inform early childcare center design, future intervention studies, or to assess correlates or relationships between PA behavior and health outcomes in toddlers.

Background: Amblyopia is the most common cause of vision loss in children. Amblyopia has been associated with impaired depth perception but little attention has been paid to the extent to which amblyopia increases the risk of obesity. Methods: Public-use data from the 1999-2008 National Health and Nutrition Examination Survey were used. Analyses were limited to children aged 12-18, who had a visual examination, and a best corrected visual acuity (BCVA) of at least 20/40 in the better-seeing eye. Amblyopia was defined as two or more-line interocular difference in BCVA. Obesity was defined as Body Mass Index (BMI) or body fat percentage (BFP) ≥95th percentile for age and gender. Sedentary lifestyle was defined as cardiovascular fitness level (CFL) rating of "low." We used Mantel-Haenszel odds ratios (ORs) to examine the relative prevalence of obesity in children with/without amblyopia. Results: Adolescents with amblyopia (n = 360) were more likely than those without (n = 7935) to have a high BMI [OR = 1.56; 95% confidence interval (CI): 1.24-1.98; p < 0.001]. The associations with either high BFP (OR = 1.20; 95% CI: 0.86-1.56, p = 0.167) or low CFL (OR = 1.15; 95% CI: 0.83-1.57; p = 0.267) were not statistically significant but in the direction of a priori hypotheses. Conclusions: This analysis of population-based data suggests that adolescents with amblyopia may be at higher risk of having obesity. Given the high prevalence of amblyopia and the range of morbidities associated with childhood obesity, targeted interventions to reduce the risk of obesity among children with amblyopia could be warranted.

Background: The high prevalence of obesity in Latino families with low income necessitates prevention beginning in pregnancy and continuing through infancy. Due to systemic inequities, adverse social determinants of health (SDoH) and mental health symptoms may limit program efficacy by presenting barriers to attendance. We sought to assess: (1) the feasibility of the Starting Early Program (StEP) Prenatal, a 17-session intervention beginning early in pregnancy and continuing to 18 months postpartum; and (2) the effects of adverse SDoH (material hardship, low social support) and mental health symptoms (depression, anxiety, stress) on program attendance. Methods: We conducted a single-arm feasibility trial of StEP Prenatal, enrolling from December 2018 to February 2020 (n = 231). We assessed feasibility (recruitment, retention, fidelity, attendance) and direct and interactive effects of adverse SDoH and mental health symptoms on attendance. We used zero-inflated Poisson regression, adjusting for maternal age, marital status, nativity, education, and pandemic timing. Results: We recruited 57% of eligible participants, with 213 remaining eligible to receive the full program. Retention was 75%. Median fidelity for group format was 64%; median attendance per session was 69%; median number of program sessions attended was 13. Baseline material hardship and high perceived stress predicted approximately one additional session attended. Similar effects were seen for low social support in the absence of anxiety symptoms. Conclusion: Despite pandemic disruptions, StEP Prenatal was feasible to deliver and participants with adverse SDoH at baseline were particularly motivated to attend. Futures studies should tailor programs to baseline SDoH and test flexible implementation models.

Background: School lunch is an important nutritious food source for children. The National School Lunch Program (NSLP) meal patterns guidelines have been established to promote healthier school lunches. This pilot study compared food selection during lunch in a school cafeteria with the NSLP meal pattern guidelines. Food intake and waste were also examined in relation to food selection. Methods: In a cross-sectional design, data were collected from children in the 1st, 6th, and 10th grades from a school in the United States. The digital photography of foods method was used to assess children's food selection, intake, and waste at lunch over 3 weeks. Results were presented as percentage, frequency, and mean ± standard deviation. Results: About 48 children from 1st grade, 47 from 6th grade, and 50 from 10th grade participated each day. Food selection in these grades consistently fell below the NSLP guidelines, with 69%, 79.8%, and 86.9% of children selecting less than the guidelines for energy, respectively. On average, only 10.4% of children selected vegetables at or above the guidelines. About 41% of the selected energy, 43% of fruits, 43% of vegetables, and 56% of milk were discarded as plate waste across all grades. Conclusions: Selection of energy and vegetables was consistently below the NSLP guidelines, yet almost half of the selected fruits, vegetables, and milk were wasted by children. Initiatives to enhance meal quality and variety, along with nutrition education interventions and school policies, are needed to improve food selection and intake and reduce food waste.