How Can We Better Prevent Obesity in Children?

The Effect of Incorporating an Exergame Application in a Multidisciplinary Weight Management Program on Physical Activity and Fitness Indices in Children with Overweight and Obesity

Children with overweight/obese (OW/OB) have low physical activity (PA) levels and excessive daily screen times. Although access to personal smartphones may complicate restricting sedentary screen time, these devices may be used to promote PA and improve fitness. Therefore, we aim to examine the impact of incorporating an exergame application (APP) into an existing weight management program on BMI, physical activity, fitness levels, and attitude toward PA among OW/OB children. Seventy-nine children (51% girls), median age 10 years, completed an established 5-month weight management program. The intervention included structured PA sessions (2/week), nutritional, and behavioral counseling. An exergame app was installed on the smartphones of the intervention group (APP, n = 32). BMI, physical fitness, PA level, and attitudes toward PA were assessed before and after the intervention. BMI decreased (p < 0.0001) in both groups by 0.67 kg/m2 (Q1, Q3: −1.36–0.12). There were improvements in more fitness components in the APP group than controls, with significantly greater improvements in aerobic fitness (p = 0.038), speed and agility (p = 0.01), and leg strength endurance (p = 0.05) compared to controls. PA levels increased similarly in both groups during the intervention period. The incorporation of an exergame application leads to more significant improvements in fitness components. These findings support the use of exergame apps to improve fitness in OW/OB children.

[Cooccurrence of obesogenic risk factors in Brazilian adolescents: the role of sociodemographic characteristics and parental presence]

The study aimed to estimate the prevalence of cooccurrence of obesogenic risk factors in Brazilian adolescents and associated sociodemographic and family characteristics. This is a cross-sectional study of data from the Brazilian National School Health Survey, 2009 (n = 53,274). The outcome variable (cooccurrence of obesogenic risk factors) varied from zero to five and was obtained as the sum of the risk behaviors: daily consumption of soft drinks; daily consumption of candy; insufficient consumption of fruits; insufficient consumption of vegetables; and insufficient physical activity. The explanatory variables were sex, age, skin color, region of Brazil, household goods and services score, maternal schooling, type of school, family composition, parental monitoring, and main meals shared with parents or guardians. A Venn diagram was used for exploratory analysis, plus ordinal logistic regression with partial proportional odds model for multivariate analysis. The results showed higher odds of simultaneous occurrence of the factors in adolescent girls, in teens with less parental supervision, and teens who shared fewer meals with their parents or guardians. Meanwhile, adolescents living in more developed regions of the country and those whose mothers had more schooling showed lower odds of cooccurrence of obesogenic risk factors. Actions that encourage greater family involvement and supervision in dietary behavior can have a positive impact on the prevention of obesity in Brazilian adolescents, especially in less developed regions and in homes where the mothers have less schooling.

Physical Activity and Changes in Adiposity in the Transition from Elementary to Middle School

OBJECTIVES

This study examined the longitudinal associations of objectively measured physical activity, sedentary behavior, and diet quality with two measures of adiposity and a measure of weight status.

METHODS

A total of 658 children from 21 elementary schools (45.1% boys; 40% white, 33% black, 9% Hispanic, and 18% other race/ethnicity) were assessed at least twice in fifth, sixth, and/or seventh grade. Fat mass index (FMI), percent body fat (PBF), and BMI were calculated from body weight, standing and seated heights, and bioelectrical impedance (BIA) measured each year.

RESULTS

At follow-up, both FMI and PBF decreased among boys and increased among girls, while BMI increased in both boys and girls. After controlling for race/ethnicity, parent education, and maturity offset at baseline, growth curve analyses showed that moderate-to-vigorous physical activity (MVPA) was significantly and negatively associated with FMI, PBF, and BMI for both boys and girls. After forming tertiles of fifth grade MVPA, least-square means for FMI, PBF, and BMI were examined by grade and gender. For both boys and girls, higher MVPA was associated with lower FMI, PBF, and BMI at all three grade levels. The relationships between sedentary behavior and diet quality and FMI, PBF, and BMI were not consistent for boys or girls.

CONCLUSIONS

As boys and girls transitioned from elementary to middle school, children who participated in higher levels of MVPA maintained more favorable levels of two indicators of adiposity and a measure of weight status. These findings support the need for interventions to help children meet current public health guidelines for physical activity.

Unravelling the factors decisive to the implementation of EPODE-derived community approaches targeting childhood obesity: a longitudinal, multiple case study

Background

Implementation of intersectoral community approaches often fails due to a translational gap between the approach as intended and the approach as implemented in practice. Knowledge about the implementation determinants of such approaches is needed to facilitate future implementation processes.

Methods

The implementation of five EPODE-derived intersectoral community approaches was studied longitudinally. Semi-structured interviews were held with 189 community stakeholders from four sectors to elucidate which determinants influenced implementation, and if an to which extent determinants differed across communities, sectors and over time. A framework approach was used to analyze our data.

Results

Twenty-two key determinants of implementation were identified. Facilitators named were mostly proximal (stakeholder level), and barriers were mostly distal (context level). Key determinants varied greatly across sectors and over time, especially between the educational & health care sector and the private, welfare & sports sector. Only ‘perceived importance of IACO goals’ was identified as an universal implementation facilitator.

Conclusions

Striking differences in determinants were found across sectors and over time. Also, stakeholders expressed that possibilities to adapt the approach to the local context were needed to improve implementation. We therefore propose to develop sector- and time specific leads for implementation, which should be approved and amended (over time) by stakeholders. This so-called ‘mutual adaptation’ allows for the use of both scientific insights and practice-based knowledge, enabling program management and community stakeholders to collaboratively improve their implementation efforts.

Intervenções comportamentais de prevenção da obesidade infantil: Estado da arte em portugal

Objetivo

A prevenção do excesso de peso e obesidade infantis em Portugal é prioritária e tem sido alvo de vários programas de intervenção. Este estudo teve como objetivo principal desenvolver um registo nacional, caracterizando as intervenções implementadas.

Método

Incluíram-se programas de promoção de estilos de vida saudáveis implementados em Portugal, identificados através do “Google” e de websites Institucionais, que visavam contribuir direta ou indiretamente para a prevenção e controlo da obesidade infantil. A seleção foi realizada pela leitura dos títulos e informação disponibilizada nos websites, e foram depois extraídas informações sobre cada projeto.

Resultados

Foram incluídos na análise 29 programas de promoção de alimentação saudável (n = 19), atividade física (n = 2) ou ambos (n = 8), realizados entre 2001 e 2015. À exceção de um programa, as atividades realizadas são descritas, mas o racional teórico e as técnicas de mudança comportamental utilizadas não são explicitadas. Apenas 16 programas foram avaliados, disponibilizando online os resultados obtidos.

Conclusão

A maioria dos programas não fornece dados relativamente à sua fundamentação teórica e empírica, nem informação detalhada sobre as atividades realizadas e avaliação. Futuros programas devem fornecer maior detalhe sobre o racional teórico e as técnicas de modificação comportamental utilizadas, e a avaliação da eficácia na mudança do comportamento-alvo.

Obesity Prevention Programs in Children: Impact on Weight, Shape and Food Concern

Childhood overweight and obesity have an estimated prevalence of 10 % globally. High body mass index (BMI) is a known major predictor of body dissatisfaction, problem eating, low self-esteem, bullying and poor social and health outcomes for children. Childhood is also a time when lifelong habits are established, and as such is a time where prevention efforts have a high chance of success if implemented appropriately. Obesity prevention in children also has the potential to create weight, shape and food concerns in children and as such programs should focus on the principle first, do no harm. This paper canvasses existing literature and intervention program data to make the following recommendations for effective childhood obesity prevention: Programs should be educative for both children and their parents, programs should be inclusive of the whole family, there should be a focus on health and growth, not weight, and parents, schools and children should all be involved.