Childhood Obesity最新文献

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.

Background: Neighborhood environment, which includes multiple social drivers of health, has been associated with a higher incidence of chronic conditions in adult cohorts. We examine if neighborhood environment is associated with glycosylated hemoglobin (HbA1c) and body mass index (BMI) as a percentage of the 95th percentile (BMIp95) for youth with overweight and obesity. Methods: Cohort study using electronic health record data from a large Midwestern Children's Hospital. Youth aged 8-16 years qualified for the study with a documented BMI ≥ 85th percentile and two HbA1c test results between January 1, 2017, and December 31, 2019. Neighborhood environment was measured using area deprivation index (ADI). Results: Of the 1,309 youth that met eligibility, mean age was 14.0 ± 3.2 years, 58% female, 48% Black, and 39% White. At baseline, the average (SD) of BMIp95 was 126.1 (26.14) and HbA1c5.4 (0.46). 670 (51%) lived in a more deprived (MD) area. The median time to follow-up was 15-months. Youth that lived in a MD area had a significantly higher follow-up HbA1c (β = 0.034, p = 0.03, 95% confidence interval [CI]: [0.00, 0.06]) and BMIp95 (β = 1.283, p = 0.03, 95% CI: [0.13, 2.44]). An increase in BMIp95 was associated with worse HbA1c for most youth that lived in a MD area. Conclusions: Youth that lived in an MD area had a small but statistically significant higher level of HbA1c and BMIp95 at follow-up. Public health surveillance systems should include ADI as a risk factor for longitudinal progression of cardiometabolic diseases.

Poor body image is a prominent issue affecting youth. In this nationally representative online survey, we explored parents' concerns about their child's appearance, as well as their perceptions of their child's body image concerns and related behaviors and interactions with others. Among the 1653 respondents, weight was parents' most cited body image concern, while more parents perceived that their child was self-conscious about their weight than there were parents concerned about their child's weight. Parental perceptions related to their child's body image can inform providers' efforts to address poor body image, such as around weight, and improve the health and self-esteem of their pediatric patients.

Background: Childhood obesity disproportionately affects Hispanic families and remains an unresolved public health concern. Interventions to enhance health-related parenting practices may be a promising strategy to lower the risk for childhood obesity. However, there are scarce data on which parenting practices would be culturally relevant and contribute to lower the risk for childhood obesity among Hispanic families in the United States. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. An electronic database search of records was carried out in PubMed, CINAHL, PsycINFO, and Scopus to synthesize studies assessing associations or intervention effects of parenting practices on child BMI or other anthropometric measure among Hispanic parent-child dyads aged ≥18 and 2-12 years, respectively. Results: Of 1055 unique records identified, 17 studies were included. Most of these studies used a cross-sectional design (n = 10) and child BMI z-scores or BMI-for-age-sex percentiles as the outcome variable. Parenting practices to lower the risk for child overweight/obesity among Hispanic families included setting limits and providing routines (e.g., limited screentime), supporting a healthy lifestyle and physical activity (e.g., providing transportation to places for children's physical activities), and parenting feeding or diet-related practices (e.g., control the foods that children eat). Conclusion: Parenting practices that support healthy behaviors may be components of interventions to lower the risk for childhood obesity among Hispanic families.