Correlates and suspected causes of obesity in children

School-Level Socioeconomic Status and Nutrient Content of Outdoor Food/Beverage Advertisements

We examined if areas around schools with more students of lower socioeconomic status (SES) have more total food/beverage advertisements and/or more advertisements with poorer nutritional content as compared to areas around schools with fewer students with lower SES. All outdoor food/beverage advertisements within a half-mile radius of 47 middle and high schools in the United States were objectively documented in 2012 and coded for nutritional content. The total number of advertisements and the macronutrient and micronutrient contents (total calories, fat (g), protein (g), carbohydrate (g), sugar (g), and sodium (mg)) of food and beverage items depicted in the advertisements were calculated. In total, 9132 unique advertisements were recorded, with 3153 ads displaying food and beverages that could be coded for nutrient content. Schools located in areas of lower SES (≥60% students receiving free/reduced-price lunch) had significantly more advertisements displaying food and beverages that could be coded for nutrient content (z = 2.01, p = 0.04), as well as advertisements that contained more sodium (z = 2.20, p = 0.03), as compared to schools located in areas of higher SES. There were no differences in calorie, fat, protein, carbohydrate, or sugar content. Policies to reduce the prevalence of outdoor food and beverage advertising are warranted.

Sex differences in the associations between psychological symptoms and tumor necrosis factor-alpha levels among obese and nonobese children aged 6-13 in Taiwan

BACKGROUND

Evidence of associations between psychological symptoms and tumor necrosis factor (TNF)-α level is scant, as is evidence on sex differences in associations for children and adolescents with obesity. This study examined sex differences in associations between psychological symptoms (self-concept, anxiety, depression, anger, and disruptive behavior) and TNF-α level in Taiwanese children and adolescents with healthy weight, overweight, or obesity.

METHODS

In 2010, 564 first, fourth, and seventh graders-comprising 250 children with overweight or obesity (44.3 %), 330 adolescents (58.5 %), and 303 males (53.7 %)-underwent a health examination and blood sampling and completed a questionnaire.

RESULTS

A significantly higher TNF-α level was found in children and adolescents with healthy weight than in those with overweight or obesity (median: 14.5 vs. 4.1 (pg/mL); p < 0.001). In multiple linear regression models, anxiety was significantly positively associated with TNF-α level in female participants with healthy weight (β = 0.11 per 10 increments in anxiety, 95 % confidence interval = 0.01-0.22).

LIMITATIONS

Given the cross-sectional nature of the study, no inferences of causal relationships among TNF-α level, obesity, and psychological symptoms could be made.

CONCLUSIONS

The findings enrich the literature on the TNF-α-psychological symptom association. Sex differences were found in children and adolescents without obesity rather than in those without obesity, and a higher TNF-α level was associated with increased anxiety in girls without obesity. The role of sex differences in the complex associations among psychological symptoms, TNF-α level, and overweight or obesity requires further investigation.

Attachment, Parenting, and Obesogenic Behavior: A Dyadic Perspective

Pediatric obesity is a growing health concern afflicting the United States. The treatment for pediatric obesity, as a health epidemic, costs billions of dollars to our nation, leaving providers and researchers searching for effective and sustainable ways to better manage the biological, psychological, and social health of individuals and families. While many assessments and interventions continue to emerge, researchers have predominately focused on intra-individual concerns among white non-Hispanic populations. This quantitative study was grounded in a relational theory (attachment theory), with a dyadic and primarily Hispanic sample. Evidence from our study supported that child attachment predicted child obesogenic behavior and that this relationship was mediated by child self-regulation. Children with insecure attachments had more obesogenic behaviors and lower self-regulation of eating than those with secure attachments. Family therapists should be on the frontlines of relational research and clinical interventions that interface with biopsychosocial health across diverse cultures and families.

Associations of nitric oxide with obesity and psychological traits among children and adolescents in Taiwan

BACKGROUND

Findings concerning nitric oxide (NO) in children and adolescents with obesity are scant.

OBJECTIVE

This study examined the links of NO with obesity and psychological traits (ie, self-concept, anxiety, depression, anger and disruptive behaviour) in children and adolescents in Taiwan.

METHODS

A total of 564 first, fourth and seventh graders (314 children with overweight/obesity and 250 children with normal weight) completed an in-hospital health examination in 2010. All students received a physical examination, underwent blood sample collection and completed a questionnaire. Multiple linear regression analyses were performed for analyses.

RESULTS

Among the fourth and seventh graders (P=.003 and.001, respectively), the students with overweight/obesity displayed significantly higher levels of NO than those with normal weight; however, no difference was observed in males and females. In multiple linear regression models, a high level of anxiety was independently associated with low NO levels (β=-1.33, 95% confidence interval -2.24 to -0.41) in first graders who with overweight/obesity. No association between NO levels and psychological traits was evident among students with normal weight.

CONCLUSIONS

Our results enrich the limited data and suggest that NO may be associated with obesity and psychopathology and should be a concern in the pathophysiology of childhood mental health and obesity.

Psychological and physiological correlates of childhood obesity in Taiwan

Evidence of associations between psychopathology and obesity in childhood remains inconsistent, and most studies have been conducted in Western countries. This study investigated psychological and physiological correlates of obesity in a community sample of children in Taiwan. In total, 302 children (157 overweight/obese and 145 healthy-weight children) were selected from first- and fourth-grade schoolchildren in eight elementary schools in 2009. These children participated in a comprehensive health examination, including a physical examination, blood sample analysis, and questionnaire administration. We found that regarding physiological characteristics, compared with the healthy-weight children, the overweight/obese children had significantly higher values for body fat estimated using the bioelectrical impedance method (p < 0.001), systolic blood pressure (p < 0.001), and diastolic blood pressure (p = 0.001); lower values for high-density lipoprotein (p < 0.001); and worse values for glutamic-pyruvic transaminase (p < 0.001), triglycerides (p < 0.001), and fasting blood glucose (p = 0.049). In logistic models adjusted for parental and child traits and physiological characteristics, children’s overweight/obesity was significantly associated with lower self-concept (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.93–0.99) and less disruptive behavior (OR = 0.96, 95% CI = 0.92–0.99). Less disruptive behavior and the lack of a higher prevalence of anxiety and depression in childhood obesity appear to be a unique pattern in Taiwan that warrants further investigation.

What are the television viewing and eating habits of children in Peru?

While there is already consensus in the scientific community about the deleterious effects of TV exposure, especially through TV advertisements, on children's beliefs, preferences, and food intake, the link between TV and children's eating behaviors is under-studied in Peru, a country experiencing a steady economic growth in recent years and currently with a status of upper-middle-income country. Following research about the effects of media exposure on childhood obesity, we report on a qualitative study of TV viewing and the eating habits of children attending elementary schools in Lima, the capital. Data from eight focus groups with 38 boys and girls between 6 and 11 years old, eight focus groups with 36 female caretakers, and in-depth interviews with two fathers provided consistent information about children's eating habits and media viewing patterns. After dual coding the entire corpus of qualitative data, we found that children watch a great deal of TV during the school season: children watch as early as when they wake up in the morning, then during lunchtime (after returning from school), and then again after completing their homework from 5 pm to 9 pm or 10 pm. Survey data from the parents showed that, on average, children watch about 5 hours of TV on weekdays and more during a weekend-day. This large amount of exposure is concerning, especially because the focus groups revealed that children (1) recall a number of TV advertisements involving food items, (2) request food items seen on TV, and (3) are able to buy food for themselves, which usually involves chocolate, candy, or potato chips. Boys and girls reported different favorite TV shows, suggesting differences in exposure to TV content related to food. In addition, some families reported drinking sodas frequently, underlining a behavior that should be discouraged by public health officials.

Childhood obesity prevention: a review of school nurse perceptions and practices

PURPOSE

The purpose of this review is to examine key school nurse perceptions that may promote or deter school nurse involvement in childhood obesity prevention (COP) practices.

CONCLUSIONS

Ten research articles were identified through a systematic review of the literature. School nurse participation in COP is inconsistent, and this variation is not well understood. Some variations in COP practices may be explained by differences in self-efficacy, perceived benefits, and perceived barriers.

PRACTICE IMPLICATIONS

Efforts are needed to develop and implement interventions and policies to modify those perceptions that may promote school nurse active engagement in COP practices.

Relações familiares e comportamento alimentar

Explorou-se a influência das relações familiares no comportamento alimentar das crianças e no desenvolvimento do excesso de peso. Participaram 147 crianças de todas as classes de peso, com idades compreendidas entre os 8 e os 12 anos e respetivas famílias. Às crianças foi aplicada a escala das Relações Familiares do Family Environmemt Scale (FES) e ao principal cuidador o Child Eating Behaviour Questionnaire (CEBQ). Os resultados indicam que o Índice de Massa Corporal (IMC) dos pais é, por si só, um fraco preditor do estatuto de peso dos filhos. Em famílias mais disfuncionais, os filhos têm comportamentos alimentares mais orientados para a atração pela comida, independentemente da classe de peso dos pais

Implementing family-based childhood obesity interventions

Family-based interventions have been effective in managing childhood obesity, and pediatric nurse practitioners (PNPs) are positioned to provide obesity interventions in both patient and family primary care settings. The purpose of this article is to guide the PNP in implementing family-based childhood obesity interventions, including identification, diagnostic evaluation, and management.

An exploration of young women's experiences of living with excess weight

The experiences of eight young women with excess weight were explored using a semi structured interview consisting of open ended questions and also the Child Attachment Interview (CAI). Interpretative Phenomenological Analysis indicated four group themes around participants' experience of having excess weight; emotional regulation, focus on family relationships, lack of control and sense of self. The CAIs indicated that many of the young women had adopted a caring role in their families, which were often characterized by conflict within family relationships. Dismissing their own vulnerability and emotional needs in preference for self reliance was the dominant attachment strategy adopted by participants. It is suggested that obesity is a complex condition and one that requires an understanding of each individual's experiences and relationship with food, in order to offer treatment that is most likely to be effective.

Obesity screening in the pediatric emergency department

OBJECTIVES

The purposes of this study were (1) to examine parental perception of childhood obesity and race with measured body mass index (BMI), (2) to determine if parents are receptive to obesity screening in the pediatric emergency department and if receptivity varies by race or weight status, and (3) to determine eating habits that are predictors of obesity.

METHODS

This study is a cross-sectional study, with a convenience sample of 213 patients (aged 4-16 years accompanied by a parent/legal guardian to a pediatric emergency department). Weight and height were obtained, and parents were asked to complete a survey about perception of their child's weight, nutrition, and exercise habits.

RESULTS

The current study found that parent perception of weight status was fairly accurate, and perception was predictive of BMI. Race, however, was not predictive of BMI. Parents were generally receptive of weight screening in the pediatric emergency department, and this did not vary as a function of weight status; however, receptivity did vary based on ethnicity, with African American parents being more receptive than white parents. Large portion sizes and the number of times a child eats fast food per week were found to be predictive of obesity.

CONCLUSIONS

Greater than half of the children presenting to our pediatric emergency department were overweight or obese. Parents were generally accurate in their perception of their child's weight but were still receptive to obesity prevention and screening in the pediatric emergency department.

Insatisfação com o peso corporal e fatores associados em adolescentes

OBJETIVO: Estimar a ocorrência de insatisfação com peso corporal e os fatores associados em adolescentes. MÉTODOS: Estudo transversal, representativo dos escolares de 15 a 19 anos de escolas públicas de Santa Catarina, no ano de 2002. O desfecho do estudo foi a satisfação com o peso corporal, avaliada pela pergunta: "Você está satisfeito(a) com seu peso corporal?". As variáveis avaliadas foram: sexo, idade, renda familiar, local de residência, estado nutricional, tempo semanal assistindo televisão, tabagismo e autopercepção de saúde. Investigaram-se também os seguintes comportamentos alimentares: tomar remédios para emagrecer, provocar vômitos após as refeições e realizar, no mínimo, três refeições/dia. Empregou-se regressão multinomial nas análises bruta e ajustada. RESULTADOS: Dentre os adolescentes avaliados (n=5.028), 16,7% (IC95%: 15,7-17,7) estavam insatisfeitos com seu peso e gostariam de aumentá-lo, e 36,2% (IC95%: 34,9-37,5) gostariam de diminui-lo. Tomar remédios para emagrecer, provocar vômitos após as refeições e não realizar, no mínimo, três refeições/dia foram mais frequentes entre aqueles que gostariam de reduzir o peso. Após análise ajustada, os fatores associados ao desejo de aumentar o peso foram: sexo masculino, idade >17 anos, residir na zona urbana, não ter excesso de peso e autopercepção de saúde negativa. Já os fatores associados ao desejo de diminuir o peso foram: sexo feminino, residir na zona urbana, ter excesso de peso e uma percepção negativa de saúde. CONCLUSÕES: Encontrou-se alta prevalência de insatisfação com o peso, sendo as variáveis sexo, estado nutricional e autopercepção de saúde os fatores mais fortemente associados a tal comportamento.