A community-based obesity prevention program for minority children: rationale and study design for Hip-Hop to Health Jr

BACKGROUND; The increasing prevalence of overweight among children in the United States presents a national health priority. Higher rates of overweight/obesity among minority women place their children at increased risk. Although increased rates of overweight are observed in 4- to 5-year-old children, they are not observed in 2- to 3-year-old children. Therefore, early prevention efforts incorporating families are critical. METHODS: The primary aim of Hip-Hop to Health Jr. is to alter the trajectory toward overweight/obesity among preschool African-American and Latino children. This 5-year randomized intervention is conducted in 24 Head Start programs, where each site is randomized to either a 14-week dietary/physical activity intervention or a general health intervention. RESULTS: This paper presents the rationale and design of the study. Efficacy of the intervention will be determined by weight change for the children and parent/caretaker. Secondary measures include reductions in dietary fat and increases in fiber, fruit/vegetable intake, and physical activity. Baseline data will be presented in future papers. CONCLUSIONS: The problem of overweight/obesity is epidemic in the United States. Behaviors related to diet and physical activity are established early in life and modeled by family members. Early intervention efforts addressing the child and family are needed to prevent obesity later in life. This paper describes a comprehensive, family-oriented obesity prevention program for minority preschool children.     

Making tortillas without lard: Latino parents' perspectives on healthy eating, physical activity, and weight-management strategies for overweight Latino children

Latinos are among the most overweight racial/ethnic groups of US children. The study aim was to identify parents' perspectives on healthy eating, physical activity, and weight-management strategies for overweight Latino children. Four focus groups were conducted of Mexican immigrant, Mexican-American, Puerto Rican, and other Latino families with overweight children. Parents were asked 33 questions and sampled four healthy substitutes for traditional Latino foods, including multigrain enchiladas and brown rice. Nineteen parents were interviewed in the focus groups. The children′s median body mass index was 23; 60% had a body mass index ≥95th percentile. Parents identified 22 themes regarding the most important things parents can do to help overweight children lose weight, including encouragement, not making the child feel left out, the whole family eating healthy, and the parent setting a good example. Parents identified 17 themes regarding the most important things overweight children can do to help themselves lose weight, including eating healthier, limiting portion size and second helpings, drinking more water, increased physical activity, decreased screen time, children educating themselves at school, asking parents for help, and participating in interventions that include the whole family. Challenges to getting kids to exercise included expense, time constraints, and neighborhood safety. Parents were open to integrating healthy substitutes into traditional Latino meals/snacks, and found them palatable. One mother stated, “We have to keep our traditional foods, but realize that we can make them more nutritious.” Parents reported their children would accept high-fiber foods and low-fat dairy. In designing effective weight-management interventions for overweight Latino children, the study findings may prove useful in identifying healthy, well-accepted foods and beverages; agreeable physical activities; suitable targets for reducing inactivity; and efficacious strategies for enhancing traditional foods and meals so that there is an increased likelihood of healthy diet and weight loss. Parental input on the most important things that children and parents can do to help children lose weight and on challenges faced in trying to get children to exercise might provide valuable guidance in devising effective, evidence-based interventions that are likely to be adhered to.     

The effects of a 3-year obesity intervention in schoolchildren in Beijing

BACKGROUND: Childhood obesity has become a health problem in urban areas in China. Intervention to reduce childhood obesity should be of high priority. School-based intervention programmes are needed to deal with the growing prevalence of childhood obesity in China. METHODS: Five primary schools were selected randomly for this study in the Beijing urban area in China; two were allocated to the intervention group and three to the control group. A total of 2425 children (1029 children in intervention schools and 1396 children in control schools) took part in the study for 3 years. In the intervention group, children and their parents were involved in a programme of nutrition education and physical activity. Control school students followed their usual health and physical education curriculum with no extra intervention. RESULTS: After the 3-year intervention, the prevalence of overweight and obesity were significantly lower in the intervention schools than in the control schools (overweight: 9.8% vs. 14.4%, P < 0.01; obesity: 7.9% vs. 13.3%, P < 0.01). The prevalence of overweight and obesity decreased by 26.3% and 32.5% in intervention schools respectively after intervention. The prevalence of overweight and obesity increased in control schools. There was also significant difference in body mass index between intervention and control schools (18.2 +/- 2.6 vs. 20.3 +/- 3.4, P < 0.01) after intervention. More non-obese children became obese in the control schools (7.0%) than in the intervention schools (2.4%) at end line (P < 0.01). Among the children who were obese at baseline, 49.2% remained obese at end line in intervention schools while 61.9% remained obese in control schools (P < 0.01). CONCLUSIONS: Our study showed that an intervention programme could be feasible in schools in Beijing, China. The prevalence of overweight and obesity was reduced in schoolchildren in Beijing through an intervention focused on nutrition education and physical activity. Overweight and obesity children as well as normal weight children and their parents should be involved in such an intervention programme.     

Demographic and Placement Variables Associated with Overweight and Obesity in Children in Long-Term Foster Care

Overweight and obesity is a growing problem for children in foster care. This study describes the prevalence of overweight and obesity in an urban, ethnic minority population of children ages 2–19 in long-term foster care (N = 312) in Los Angeles, California. It also investigates whether demographics or placement settings are related to high body mass index. The estimates of prevalence of overweight/obesity (≥85th percentile) and obesity (≥95th percentile) were presented for gender, age, ethnicity, and placement type. Multiple logistic regression was used to examine potential associations between demographic and placement variables and weight status. The prevalence of overweight/obesity was almost 40 % and obesity was 23 % for the study population. Children placed in a group home had the highest prevalence of overweight/obesity (60 %) and obesity (43 %) compared to other types of placement. Within this study, older children (ages 12–19) were more likely to be overweight/obese than normal weight compared to children between 2 and 5 years old when controlling for gender, ethnicity and placement (OR = 2.10, CI = 1.14–3.87). These findings suggest that older age and long-term foster care in general may be risk factors for obesity. Child welfare agencies and health care providers need to work together to train caregivers with children in long-term foster care in obesity treatment interventions and obesity prevention strategies.     

LA Sprouts: a gardening, nutrition, and cooking intervention for Latino youth improves diet and reduces obesity

Evidence demonstrates that a gardening and nutrition intervention improves dietary intake in children, although no study has evaluated the effect of this type of intervention on obesity measures. The objective of this pilot study was to develop and test the effects of a 12-week, after-school gardening, nutrition, and cooking program (called LA Sprouts) on dietary intake and obesity risk in Latino fourth- and fifth-grade students in Los Angeles, CA. One hundred four primarily Latino children (mean age 9.8±0.7 years), 52% boys and 59% overweight, completed the program (n=70 controls, n=34 LA Sprouts participants). Weight, height, body mass index, waist circumference, body fat (via bioelectrical impendence), blood pressure, and dietary intake (via food frequency screener) were obtained at baseline and postintervention. LA Sprouts participants received weekly 90-minute, culturally tailored, interactive classes for 12 consecutive weeks during spring 2010 at a nearby community garden, whereas control participants received an abbreviated delayed intervention. Compared to subjects in the control group, LA Sprouts participants had increased dietary fiber intake (+22% vs −12%; P=0.04) and decreased diastolic blood pressure (−5% vs −3%; P=0.04). For the overweight subsample, LA Sprouts participants had a significant change in dietary fiber intake (0% vs −29%; P=0.01), reduction in body mass index (−1% vs +1%; P=0.04) and less weight gain (+1% vs +4%; P=0.03) compared to those in the control group. We conclude that a gardening, nutrition, and cooking intervention is a promising approach to improve dietary intake and attenuate weight gain in Latino children, particularly in those who are overweight.     

Prevention and treatment of obesity with lifestyle interventions: review and meta-analysis

Summary Objective: To assess the mid- to long-term effectiveness of lifestyle interventions in the prevention and treatment of obesity. Methods: A systematic literature review with meta-analysis was performed. Electronic databases, reference lists, books and reports covering topic of obesity were searched. The included studies were randomized clinical trials of lifestyle interventions in overweight and obese subjects that had a minimum observation period of one year. Outcomes evaluated were measurements of body weight, body mass index, waist circumference, systolic and diastolic blood pressure, blood lipids: total cholesterol, low density lipoprotein, high density lipoprotein, triglyceride, blood glucose control: two-hour plasma glucose, fasting plasma glucose, and glycosylated haemoglobin. Results: Thirteen studies have been selected in the prevention and seventeen in the treatment of obesity. Compared with standard care, lifestyle intervention reduced significantly body weight, body mass index, waist circumference, blood pressure, blood lipids and blood glucose in overweight and obese people. The favorable effects were maintained up to three years. Conclusions: Lifestyle interventions were efficacious in the mid- to long-term prevention and treatment of obesity leading to a significant reduction in body weight and cardiovascular risk factors. Submitted: 18 October 2006; Revised: 6 June 2007; Accepted: 28 August 2007     

Acculturation, Dietary Practices and Risk for Childhood Obesity in an Ethnically Heterogeneous Population of Latino School Children in the San Francisco Bay Area

Previous studies have found increased acculturation to the US lifestyle increases risk for obesity in Latinos. However, methodologies differ, and results in children are inconsistent. Moreover, previous studies have not evaluated risk factors within the heterogeneous US population. We recruited 144 self-identified Latino school children and their mother or father in grades 4-6 in San Francisco parochial schools and South San Francisco public schools using an information letter distributed to all students. Children and parents had weights, heights, demographic information, dietary patterns and lifestyle variables collected in English or Spanish through an interview format. A high percentage of our children were overweight [≥85th percentile body mass index (BMI)] (62.5%) and obese (≥95th percentile BMI) (45.2%). Correspondingly parents also had a high percentage of overweight (BMI ≥ 25 & <30) (40.8%) and obesity (BMI ≥ 30) (45.3%). Mexico was the country of origin for 62.2% of parents, and 26.6% were from Central or South America. In multivariate logistic analysis, speaking Spanish at home was an independent risk factor for obesity [odds ratio (OR) 2.97, 95% confidence interval (CI) 1.28-6.86]. Eating breakfast daily (OR 0.34, 95% CI 0.15-0.78) and consumption of tortas (a Mexican fast food sandwich) (OR 0.45, 95% CI 0.21-1.00) were associated with decreased risk. In stratified analysis, significant differences in risk factors existed between Mexican origin versus Central/South American Latino children. The processes of acculturation likely impact eating and lifestyle practices differentially among Latino groups. Interventions should focus on ensuring that all children eat a nutritious breakfast and take into consideration ethnicity when working with Latino populations.     

义乌市城区2 069名学龄儿童体格生长水平研究

目的 了解义乌市城区学龄儿童身高、体重状况,探讨当地学龄儿童超重、肥胖和矮小的发病情况,为开展儿童早期干预研究提供线索。方法 抽取义乌市城区学龄儿童共2 069名,测量身高、体重,并计算出体质指数(BMI),以2005年九省市儿童体格发育调查数据的标准,计算超重、肥胖、矮小的检出率,并分析特点。结果 1)男、女生6.0~6.5岁、8.0~11.5岁组身高、体重均高于全国水平。2)超重和肥胖的总检出率为10.68%和14.16%,男生(11.27%和14.77%),女生(9.91%和13.36%)。3)矮小的总检出率为2.80%,男生和女生为2.73%和 2.90%。结论 超重和肥胖的检出率较高,矮小的发病率稍低于全国水平,超重和肥胖问题颇为严重,矮小问题也不容忽视,都需要及时有效干预。     

Ethnic minorities and weight control research priorities: Where are we now and where do we need to be?

Within the overall obesity epidemic, the burden of obesity and related health problems is particularly high among African Americans, Hispanic/Latino Americans, American Indians, and Pacific Islanders—both children and adults. The often asked question of what types of obesity interventions work in these populations reflects uncertainty about how applicable standard interventions are to diverse socio-cultural groups and socio-environmental contexts. A meta-analysis in this issue of Preventive Medicine (Seo and Sa, 2008. A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults) includes selected multi-ethnic and minority-focused studies that in total had 40% minority participants. Although the authors' conclusions were congruent with current general guidance for weight loss programs, insights about how to intervene with minority populations were limited by the small amount and nature of the available evidence. Ethnic minorities in the aggregate are now a third of the U.S. population. We should be purposeful in identifying research needs and quality standards for conducting and reporting studies with these populations and in motivating related research. Improving the relevance to and quality of evidence on obesity prevention and treatment for a more diverse set of populations will also improve the weight control literature as a whole.     

Ethnic minorities and weight control research priorities: where are we now and where do we need to be?

Within the overall obesity epidemic, the burden of obesity and related health problems is particularly high among African Americans, Hispanic/Latino Americans, American Indians, and Pacific Islanders—both children and adults. The often asked question of what types of obesity interventions work in these populations reflects uncertainty about how applicable standard interventions are to diverse socio-cultural groups and socio-environmental contexts. A meta-analysis in this issue of Preventive Medicine (Seo and Sa, 2008. A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults) includes selected multi-ethnic and minority-focused studies that in total had 40% minority participants. Although the authors' conclusions were congruent with current general guidance for weight loss programs, insights about how to intervene with minority populations were limited by the small amount and nature of the available evidence. Ethnic minorities in the aggregate are now a third of the U.S. population. We should be purposeful in identifying research needs and quality standards for conducting and reporting studies with these populations and in motivating related research. Improving the relevance to and quality of evidence on obesity prevention and treatment for a more diverse set of populations will also improve the weight control literature as a whole.     

Overweight and obesity among children who are deaf: Quantitative and qualitative findings

The current study examined rates of overweight and obesity among children attending schools for the deaf, including factors associated with greater prevalence of overweight. Further, interviews were conducted with school staff to assess school perceptions of overweight and weight management. Although prevalence of overweight and obesity was high (approximately 28%), this rate was not greater than that of youth in the general population, and body mass index was higher among females. Several themes regarding factors contributing to overweight among deaf children, barriers for weight management, and possible components for weight management interventions emerged in interviews with school staff.     

Association between overweight or obesity and household income and parental body mass index in Australian youth: analysis of the Australian National Nutrition Survey, 1995

This study is a secondary data analysis based on the 1995 Australian National Nutrition Survey (NNS). A random subsample of 1581 school children aged 7-15 years old from the NNS was studied. The results show the prevalence of overweight, obesity and combined overweight and obesity was 10.6-20.9%, 3.7-7.2% and 15.6-25.7%, respectively. The odds ratio of overweight or obese boys with highest household income was significantly smaller than those with the lowest household income. The proportion of combined overweight and obesity in children whose parents were overweight or obese was significantly greater compared with those whose parents were not. The trend of increasing prevalence of overweight or obesity among children with increasing parental body mass index (BMI) was significant after adjusting for age except the trend of father's BMI for boys. This study provided baseline data on the recent prevalence of overweight or obesity of Australian school children using new international absolute BMI cut-off points. It indicated that young school girls (7-9 years) were more likely to be overweight or obese compared with boys, the prevalence rates of overweight or obesity in older boys (13-15 year) was significantly greater than in other age groups while in girls it was the opposite. The boys with lowest household income ($0-17 500) were more likely to be overweight or obese compared with those with the highest household income (greater than $67 500). Having parents especially mothers who were overweight or obese may increase the risk of children being overweight or obese.     

Relationships between the family environment and school-based obesity prevention efforts: can school programs help adolescents who are most in need?

Identifying factors that contribute to students' behavior and weight improvements during school-based obesity prevention interventions is critical for the development of effective programs. The current study aims to determine whether the support and resources that adolescent girls received from their families were associated with improvements in physical activity (PA), television use, dietary intake, body mass index (BMI) and body composition during participation in New Moves, a school-based intervention to prevent obesity and other weight-related problems. Adolescent girls in the intervention condition of New Moves (n = 135), and one parent of each girl, were included in the current analysis. At baseline, parents completed surveys assessing the family environment. At baseline and follow-up, 9-12 months later, girls' behaviors were self-reported, height and weight were measured by study staff and body fat was assessed using dual-energy X-ray absorptiometry. Results showed few associations between family environment factors and girls' likelihood of improving behavior, BMI or body composition. These findings suggest that in general, school-based interventions offer similar opportunities for adolescent girls to improve their PA, dietary intake, and weight, regardless of family support.     

Individual,Family, and Community Environmental Correlates of Obesity in Latino Elementary School Children*

BACKGROUND: The prevalence of overweight children has reached epidemic proportions, and affects Latinos youth more than other subgroups in the United States. Given the prevalence of obesity and its economic consequences, community health initiatives have shifted toward primary prevention at younger ages. METHODS: Data representing all levels of the ecological systems theory were collected using diverse methods. Participants were children enrolled in K-2nd grade and their parents. RESULTS: Overweight children were less active compared to normal weight children. The parents of overweight children provided less instrumental support to engage in activity and set fewer limits on their child's activities. Similarly, parents of overweight children were less likely to control, but more likely to set limits on their child's diet compared to parents of normal weight children. Parents who rated their health more positively and were less acculturated were more likely to have children who were overweight. School and community level variables were not significantly correlated with children's weight. Adjusting for the aforementioned variables, parents' weight status was positively associated with children's weight. CONCLUSIONS: Social and structural environments in which Hispanic children are reared may play an important role in determining their risk for obesity and related behaviors. Parents' weight was among the strongest correlate of child weight; however, the extent to which this influence functions primarily through biological or social/structural influences is not entirely clear. The role of school and community factors on child's health practices and body mass index needs to be further examined.     

上海市某社区学龄前儿童超重肥胖状况调查及健康教育

目的］ 了解上海市某社区学龄前儿童的超重肥胖状况及家长、幼托机构工作人员的相关营养知识、态度和行为现状,并进行健康教育以降低学龄前儿童营养过剩的发生率。 ［方法］ 采用分层随机抽样法,选取目的社区各幼托机构儿童及其家长（各360 名）以及幼托机构工作人员（40 名）为研究对象,对样本儿童的家长及幼托机构工作人员进行为期9 个月的健康教育,干预前、后对儿童进行健康体检;对家长及工作人员进行营养知识（knowledge,K）、态度（attitude,A）、行为（practice,P）进行问卷调查。 ［结果］ 健康教育前,目的社区学龄前儿童的平均体质指数（body mass index,BMI）为15.86±1.55,超重儿童34 人,占所有儿童样本的9.4%,肥胖儿童21 人,占所有儿童样本的5.8%;儿童家长及幼托机构工作人员的营养KAP平均得分为84.96 分。健康教育后,该社区学龄前儿童的平均BMI 为15.26±1.50,超重儿童24 人,占所有样本的6.8%;肥胖儿童12 人,占所有样本的3.4%;儿童家长及幼托机构工作人员的营养KAP平均得分为92.27 分。 ［结论］ 通过营养健康教育,改善了目的社区学龄前儿童的超重及肥胖状况（P 〈 0.01）,提高了家长及幼托机构工作人员的营养知识、态度、行为认知水平（P 〈 0.05）。     

Prevalence and socio‐demographic associations of overweight and obesity among children attending child‐care services in rural and regional Australia

Aim: To describe the prevalence and socio‐demographic characteristics associated with body mass index among children attending child‐care services in New South Wales, Australia. Methods: Cross‐sectional study of parent‐reported socio‐demographic characteristics and objectively measured height and weight among children aged two to five years attending 40 randomly selected long day care centres and preschools. Results: Seven hundred and sixty‐four children, 11% of whom were Indigenous, participated in the study (response rate = 66%). Overall, 16.7% of children and 24.6% of Indigenous children were overweight or obese. Overweight and obesity was higher among children whose mothers did not have a university education (OR 1.91: 95% CI 1.15, 3.12) and who were Indigenous (OR 1.74: 95% CI 1.05, 2.90). No differences in prevalence were found between geographic areas. Multivariate analysis indicated that after adjusting for age, child‐care service hours and other demographic covariates, only maternal education remained a significant predictor of weight status (OR 2.06: 95% CI 1.16, 3.66). Conclusion: The high prevalence of overweight and obesity among children attending child‐care services underscores the importance of obesity prevention interventions in early child‐care settings, and particularly those catering for Indigenous children.     

扬州市城区学龄前儿童腰围特征及影响因素分析

目的 研究扬州市城区学龄前儿童腰围特征,并分析其影响因素,为我国学龄前儿童腹型超重/肥胖筛查与防治提供依据。方法 于2015年4-5月分层整群抽取7所幼儿园2 531名儿童,对家长进行问卷调查;采用集中体检的方式,测量儿童体重、身高、腰围等;对其腰围和腰围身高比进行描述性分析,并通过单因素和多因素Logistic回归分析腰围的影响因素。结果 扬州市城区学龄前儿童腰围随年龄增长逐渐增加,各年龄组男童均大于女童;女童腰围身高比随年龄增长逐渐减低,男童则有波动。单因素分析结果显示,父母体重指数(BMI)、母亲学历、儿童每日睡眠时间、户外活动时间、视屏时间等对儿童腰围有影响(P<0.05)。多因素Logistic回归分析结果显示,父母高BMI是学龄前儿童高腹围的危险因素(母亲BMI:OR=1.15,95%CI:1.09~1.18,P＜0.001;父亲BMI:OR=1.12,95%CI:1.07~1.15,P＜0.001)。结论 需逐步建立我国学龄前儿童腰围正常范围与腹型超重/肥胖腰围筛查界值点,为学龄前儿童腹型超重/肥胖筛查与防治提供依据;要控制腹型肥胖需进行以家庭为中心的饮食、生活方式的综合性干预。     

Which factors predict unsuccessful outcome in a weight management intervention for obese children?

Background: Many obese children attending weight management interventions experience positive changes; however, not all are successful and little is known about what factors influence treatment outcome. The present study aimed to assess which baseline characteristics may predict unsuccessful treatment outcome in a weight management intervention for obese children. Methods: WATCH IT is a community weight management intervention for obese children and their families. Data collected during the pilot phase were visited retrospectively and secondary analysis was performed on the dataset. Inclusion criterion prioritised independent variables for the statistical model aiming to detect those that were exerting a significant effect. Logistic regression was used to assess the ability of these independent variables to predict unsuccessful treatment outcome. Results: Seventy‐eight children (mean age 11.9 years) who attended the WATCH IT weight management intervention for at least 6 months were included in the analysis. Multivariable regression analysis showed that children from families where both parents reported having a weight problem were six times more likely to be unsuccessful compared to children from families where neither parent reported weight problems (odds ratio = 6.1; 95% confidence interval = 1.2–32.0; P = 0.032). Age, gender, severity of obesity and duration of previous weight management attempts were not predictive of treatment outcome. Conclusions: To increase the overall success rate of children’s weight management interventions such as WATCH IT, current approaches to behaviour change may need to be adapted or tailored for those families who are less likely to be successful. Supporting overweight parents to make their own successful lifestyle changes may be one way of improving the child’s likelihood of weight management success.     

Predictors of Obesity in Latino Children: Acculturation as a Moderator of the Relationship Between Food Insecurity and Body Mass Index Percentile

As Latino children acculturate to the United States, they are at risk for excess weight gain. Existing literature suggests that higher levels of food insecurity may predict obesity, but the role of acculturation is not well understood. Latino children ages 2–17 of both immigrant and non-immigrant parents (n = 63) were recruited from a primary care clinic serving low income families. Child anthropometric measures, and parent acculturation and food insecurity measures were collected via self-administered questionnaires. Over 63% of the patients were either overweight or obese according to criteria established by the Center for Disease Control and Prevention (CDC). Regression analysis revealed acculturation as a significant moderating variable between food insecurity and BMI percentile, F(5,12) = 4.836, P = .017, R ² = .707 in children of Latino immigrants. The identification of this relationship may serve to facilitate in the development of future weight-gain prevention interventions in primary care settings within Latino immigrant populations.     

Risk Factors for Obesity and High Blood Pressure in Chinese American Children: Maternal Acculturation and Children’s Food Choices

The objective of this study is to explore risk factors associated with overweight and high blood pressure in Chinese American children. Students and their parents were recruited from Chinese language schools in the San Francisco Bay Area. Data were collected on 67 children and their mothers, and included children’s weight, height, waist and hip circumferences, blood pressure, level of physical activity, dietary intake, usual food choice, knowledge about nutrition and physical activity, and self-efficacy regarding diet and physical activity. Mothers completed questionnaires on demographic data and acculturation. About 46% of children had a body mass index exceeding the 85th percentile. Lower level of maternal acculturation is a risk factor for overweight and higher waist to hip ratio. Children’s unhealthy food choices were predictive of high body mass index and high systolic blood pressure, whereas older age and less physical activity in children were predictors of high diastolic blood pressure. Developing culturally sensitive and developmentally appropriate interventions to reduce overweight and high blood pressure is critical to reduce health disparities among minority children.