The CHANGE Study: A Healthy-Lifestyles Intervention to Improve Rural Children's Diet Quality

BackgroundDespite the high rates of overweight and obesity among rural children, there have been limited interventions reported to improve the diet quality of rural, low-income children in the United States.ObjectiveOur aim was to evaluate students' diet quality at baseline and after implementing the CHANGE (Creating Healthy, Active and Nurturing Growing-Up Environments) study, a 2-year (2007-2009) randomized, controlled, community- and school-based intervention to prevent unhealthy weight gain among rural school-aged children.DesignWe used a school and community-based group randomized, controlled design.Participants/settingData were collected in eight rural communities in California, Kentucky, Mississippi, and South Carolina (one elementary school per community). Children in grades 1 to 6 participated in the study (n=432; mean age=8.65 years±1.6 years). Students' diets were assessed at baseline (spring or early fall 2008) and post intervention (spring 2009) using the Block Food Screener for ages 2 to 17 years.Statistical analysesMixed-model analysis of variance was used to examine the effect of the CHANGE study intervention on students' diets. Results were adjusted for corresponding baseline dietary values, sex, age, grade, race/ethnicity, and state, with school included as a random effect nested within condition.ResultsAt the end of 1 year, students enrolled in the CHANGE study intervention schools consumed significantly more vegetables (0.08 cups/1,000 kcal/day; P=0.03) and combined fruits and vegetables (0.22 cups/1,000 kcal/day; P<0.05) compared with students in control schools. Students in the intervention schools also showed a reduction in the average daily dietary glycemic index (GI=−1.22; P<0.05) and a trend toward more fruit consumption (0.15 cups/1,000 kcal/day; P=0.07). There were no significant differences in students' consumption of whole grains, legumes, dairy, potatoes/potato products, saturated fat, added sugars, or dietary fiber consumption.ConclusionsThe CHANGE study enhanced some aspects of rural students' dietary intake. Implementing similar interventions in rural America can be promising to support vegetable consumption.     

蒙古族7?18岁青少年超重肥胖25年变化趋势分析

目的 了解25(1985-2010)年间蒙古族7～18岁青少年超重肥胖长期变化趋势.方法 采用现况研究方法,应用1985、2000和2010年共计18 366人的蒙古族7～18岁青少年体质健康调研数据,分析比较不同监测年份、性别、城乡间的儿童青少年BMI均数和超重肥胖检出率.结果 25年间蒙古族7～18岁青少年BMI均数总体变化趋势为逐年升高,1985、2000和2010年超重、肥胖检出率分别为2.1％、0.5％,6.3％、2.4％和9.1％、6.6％;1985-2000年的15年间超重、肥胖率分别增长了2倍和4倍,2010年时比1985年增长4倍和12倍.1985、2000和2010年超重、肥胖检出率在城市男性中分别为1.2％、0,7.9％、3.4％和11.0％、11.8％;农村男性分别为0.6％、0.6％,2.8％、2.1％和9.0％、3.4％;城市女性分别为1.8％、0.3％,8.1％、4.3％和9.4％、8.4％;农村女性分别为4.5％、0.9％,8.8％、2.2％和10.2％、4.5％,各组间不同监测年份其超重、肥胖检出率的差异均有统计学意义(P＜0.05),且呈逐年增加趋势.结论 1985-2010年蒙古族青少年的超重、肥胖检出率大幅上升,并有继续升高的趋势,应采取合理有效措施预防和控制肥胖的发生.     

中国6~17岁儿童青少年超重肥胖流行特征

目的 分析我国6~17岁儿童青少年超重肥胖流行情况,为制定肥胖防治策略提供科学依据。方法 利用"2010-2012年中国居民营养与健康状况监测"中6~17岁儿童青少年调查资料,分析我国儿童青少年超重肥胖现状。6岁儿童采用WHO 2007年推荐的分年龄性别BMI超重肥胖判定标准判定超重肥胖,7~17岁儿童青少年采用《中国学龄儿童青少年超重和肥胖预防与控制指南》中的分年龄、性别的BMI超重肥胖判定标准进行判定。结果 6~17岁儿童青少年超重率和肥胖率分别为9.6%和6.4%,其中城市儿童青少年超重率和肥胖率分别为11.0%（男生：12.8%,女生：9.0%）和7.7%（男生：9.7%,女生：5.5%）,农村儿童青少年超重率和肥胖率分别为8.4%（男生：9.3%,女生：7.4%）和5.2%（男生：6.2%,女生：4.1%）。按家庭经济收入水平分,高、中和低家庭收入儿童青少年的超重率分别为12.3%、10.7%和8.2%,肥胖率分别为8.6%、7.2%和5.7%。结论 2012年,我国6~17岁儿童青少年超重肥胖表现为城市高于农村,男生高于女生;患病率与家庭经济收入水平有关。     

Effect of class-based lifestyle intervention on the management of childhood obesity

ObjectivesChildhood obesity is prevalent in southern Taiwan and lifestyle interventions for the management of childhood obesity are challenging. How to overcome the barriers of implementation programs is crucial. We offered lunchtime education and integrated it into education programs. Finally, we evaluated whether such an intervention could change unhealthy behaviors and reduce obesity tendency among elementary students.MethodsThis was a prospective cohort study, conducted at an elementary school from September 2015 to July 2018. We distributed a lifestyle questionnaire to assess the students’ dietary habits and physical activities before our intervention. We offered class-based interactive nutrition programs and record the behavior and weight change each semester. The body mass index (BMI) of the students were obtained each semester, and they were categorized as underweight, normal, overweight, and obese according to the age-specific BMI.ResultsIn total, 279 students were followed for 3 consecutive years. The most prevalent unhealthy dietary habit was the consumption of sweetened beverages in approximately 76% of the students. At the end of the study, the percentage of normal weight increased and the overall percentage of overweight/obesity decreased in both groups. At the end of the study, the BMI–time curve became flatter than that of Kaohsiung (regional) city and approached the national standard. It indicates that the increase in average BMI was effectively delayed with our intervention.ConclusionsLunchtime education is an innovative way to provide class-based education programs in school that yielded behavior changes and are effective approaches for delaying childhood obesity.     

Effect of a Two-Year Obesity Prevention Intervention on Percentile Changes in Body Mass Index and Academic Performance in Low-Income Elementary School Children

Objectives. We assessed the effects of a school-based obesity prevention intervention that included dietary, curricula, and physical activity components on body mass index (BMI) percentiles and academic performance among low-income elementary school children.Methods. The study had a quasi-experimental design (4 intervention schools and 1 control school; 4588 schoolchildren; 48% Hispanic) and was conducted over a 2-year period. Data are presented for the subset of the cohort who qualified for free or reduced-price school lunches (68% Hispanic; n = 1197). Demographic and anthropometric data were collected in the fall and spring of each year, and academic data were collected at the end of each year.Results. Significantly more intervention than control children stayed within normal BMI percentile ranges both years (P = .02). Although not significantly so, more obese children in the intervention (4.4%) than in the control (2.5%) decreased their BMI percentiles. Overall, intervention schoolchildren had significantly higher math scores both years (P < .001). Hispanic and White intervention schoolchildren were significantly more likely to have higher math scores (P < .001). Although not significantly so, intervention schoolchildren had higher reading scores both years.Conclusions. School-based interventions can improve health and academic performance among low-income schoolchildren.The prevalence of obesity remains high among all age and racial groups in the United States, particularly among African Americans, Hispanic and Mexican Americans, and low-income children.^1,2 Childhood-onset obesity is related to numerous risk factors for cardiometabolic disease that track from childhood into adulthood, including elevated blood pressure and lipids.^3–8 Additionally, studies have documented the mental health consequences of childhood obesity, including low self-esteem and higher rates of anxiety disorders, depression, and other psychopathologies among overweight and obese children.^9–12 How childhood overweight affects academic performance, however, is less well understood.Studies show that in addition to socioeconomic status, obesity, poor nutrition, and food insufficiency affect a child''s school achievement.^13–18 Specifically, students who experience food insufficiency may have lower math scores, social difficulties, and psychological difficulties.^15,16 Children described as normal-weight or overweight (versus obese) who are at nutritional risk have lower math scores, poorer attendance, and more behavior problems.^13,14 Moreover, young children who become overweight between kindergarten and the end of third grade experience reductions in test scores.^17,18 Additionally, severely obese children have been shown to have lower IQs, poorer school performance, and lower test scores than their less-overweight classmates, even after control for behavioral and socioeconomic variables.^19–21Schools play a crucial role in improving the health, and in turn the academic performance, of students. Children generally attend school 5 days per week throughout most of the year, and schools in the United States are located in communities of every socioeconomic and racial/ethnic group. The school environment provides many opportunities to teach children about important health and nutrition practices. The influence of schools on the health of children is strong, especially in low-income communities, where children often receive a significant proportion of their daily nutrition requirements (as much as 51% of daily energy intake)²² via the US Department of Agriculture (USDA) National School Lunch Program (NSLP) and School Breakfast Program.Healthier Options for Public Schoolchildren (HOPS) was an elementary school–based obesity prevention intervention targeting children aged 6 to 13 years that included nutrition and physical activity components. The goal was to improve overall health status and academic achievement by using replicable strategies. We hypothesized that the intervention would improve academic performance and help to maintain a healthy weight in the intervention children versus a control group.     

Childhood obesity: concept, feasibility, and interim results of a local group-based, long-term treatment program

ObjectiveThe authors performed a group-based program for obese children and adolescents in Bavaria, Germany to enable them to establish a health-oriented lifestyle and to reduce overweight. The authors compared this program with a control approach based on the patients' own initiative.DesignThis is a controlled clinical trial.SettingA nutrition program for outpatients in a German university hospital.ParticipantsSeventy-three obese patients aged 7 to 15 years (mean 11.2 years) were recruited by pediatricians and local newspaper reports and randomized into intervention and control groups. Children and adolescents in each group were divided into 3 groups according to age–7-8 years, 9-10 years, and 11-13 years. Children were classified overweight (defined as body mass index (BMI) > 90th percentile for age and gender), obese (BMI > 97th percentile), and extremely obese (BMI > 99.5th percentile), according to the European Childhood Obesity Group and the German Working Group on Pediatric Obesity, congruent with adult standards used to assess overweight and obesity.InterventionThirty-seven patients (age 7-13 years, mean 10.9 years) for the 1-year intervention. This intervention consisted of modules for physical activity, nutritional education, and coping strategies. The program was performed twice each week and incorporated parental participation and medical supervision, including laboratory tests. The obese controls (n = 36, age 8-15 years, mean 11.6 years) received written therapeutic advice during a visit at 0 and 6 months in the outpatient clinic.Main Outcome MeasureThe primary outcome variable was the body mass index (BMI) z score.AnalysisAnalysis of variance and t test were used, and a P value < .05 was considered significant.ResultsThere was a reduction of BMI z score in the active treatment group (P < .05), but not for controls. Moreover, the active group showed beneficial effects for body mass index (BMI), fat mass, and systolic blood pressure 12 months after beginning the intervention.Conclusions and ImplicationsGroup-based programs for young, obese patients can be effective tools for establishing a health-oriented lifestyle and reducing the burden of obesity.     

母亲孕前体质指数及孕期增重与学龄前儿童超重肥胖的关系研究

目的 探讨母亲孕前BMI及孕期增重与学龄前儿童超重肥胖的关系。方法 2016年6-11月,以广州市4 303名3~5岁学龄前儿童为研究对象,根据WHO标准和中国成人肥胖标准分别判断儿童和母亲孕前体重状态,参照美国医学研究所孕期增重推荐值判断母亲孕期增重情况。应用多因素二分类非条件logistic回归模型和协方差分析母亲孕前BMI和孕期增重与学龄前儿童超重肥胖的关系。结果 矫正混杂因素后,logistic回归分析显示,母亲孕前超重肥胖的儿童发生超重肥胖的风险是母亲孕前体重正常儿童的1.820倍（OR=1.820,95% CI：1.368~2.422）;与母亲孕期增重适宜的儿童相比,母亲孕期增重过度的儿童超重肥胖发生风险增加（OR=1.296,95% CI：1.007~1.667）。协方差分析结果也显示,母亲孕前体重超重肥胖和母亲孕期增重过度均增加儿童BMI Z值。根据母亲孕前BMI分为3组进行分层分析,结果显示,不同孕期增重组间儿童超重肥胖发生风险差异无统计学意义（P>0.05）。但与母亲孕前BMI适宜且孕期增重适宜组相比,母亲孕前超重肥胖且孕期增重过度组的儿童发生超重肥胖的风险增加（OR=1.574,95% CI：1.029~2.409）。结论 母亲孕前超重和孕期增重过度均增加学龄前儿童超重肥胖的风险,且母亲孕前超重较孕期增重过度对学龄前儿童超重肥胖发生的影响更大。     

广东省2002-2012年6~17岁儿童青少年超重/肥胖变化趋势分析

目的 分析2002-2012年广东省6～17岁儿童青少年超重/肥胖的流行状况及其变化趋势。方法 2002年营养调查采用多阶段分层与整群随机抽样方法,在全省抽取13个监测点共7 075名6～17岁儿童青少年进行调查。2009-2012年的广东省居民营养调查采用多阶段分层整群随机抽样的方法,在广东省9区/县城乡调查点抽取2 319名6～17岁儿童青少年,进行身高和体重测量。结果 2009-2012年广东省6～17岁儿童青少年平均超重率和肥胖率分别为7.3%和4.5%,男生超重率和肥胖率（8.9%和6.5%）均高于女生（5.3%和2.2%）,城市超重率和肥胖率（9.3%和5.6%）均高于农村（4.7%和3.2%）;以9～11岁组超重率（8.8%）和肥胖率（6.0%）最高。与2002年比较,除城市女生肥胖率下降外,城市男生、农村男生和女生的超重率和肥胖率均明显上升,其中农村超重和肥胖增幅高于城市,男生增幅高于女生。结论 广东省6～17岁儿童青少年超重和肥胖率较2002年有较大上升,其中农村、男生和9～11岁超重/肥胖比例较高,应重点关注。     

Improving weight status in childhood: results from the eat well be active community programs

Objectives

The eat well be active Community Programs (ewba) aimed to prevent obesity among children aged 0–18 years in two Australian communities from 2006 to 2010.

Methods

ewba was a multi-strategy intervention in children’s settings. The evaluation was quasi-experimental, including a before and after survey with intervention (INT) and non-randomised comparison (COMP) communities. Outcome measures included BMI-z score (zBMI) and overweight/obesity prevalence in children aged 4–5 years; and zBMI, waist circumference (WC) z-score and overweight/obesity prevalence in children aged10–12 years.

Results

After 3 years, among the 4–5 years old, mean zBMI was significantly lower in both INT (?0.20, p < 0.05) and COMP (?0.15, p < 0.05), however, changes were not significantly different between INT and COMP. There was a larger reduction in overweight/obesity prevalence in INT (?6.3 %) compared to COMP (?3.7 %) (p < 0.05, χ ² test). In the 10–12 years old, mean zBMI did not change significantly in INT or COMP. There was a significant reduction in WC z-score in INT (?0.17, p < 0.05) but not in COMP (?0.10, p = NS), although not significantly different between INT and COMP (p = 0.092).

Conclusions

These findings suggest that the ewba community intervention had a moderate impact, showing modest improvements in weight status at 3-year follow-up.     

Obesity and Asian Americans in the United States: Systematic Literature Review

ObjectivesObesity is one of the most serious health problems in the world today. Asian Americans are usually less overweight and obese than African Americans and Hispanic Americans, but the rate of obesity in Asian Americans is still increasing, especially in younger generations. This research examines Asian American obesity using existing research, as a means of finding the need for greater emphasis on Asian American obesity intervention research.MethodsIn this research literature review, Asian American obesity using existing research as a means of finding the need for greater emphasis on Asian American obesity intervention research is examined. A systematic review is done in order to find Asian American obesity research, due to the minimal amount of existing studies. In total, there were only nine papers which were not duplicates and which still met the criteria for inclusion, from an initial 106 papers.ResultsThere is very little research on obesity in Asian Americans. Although the rate of obesity among Asian Americans is increasing, there are few related articles, projects, and surveys, and there is little information. There is a need for more specific and in-depth analysis of Asian American obesity. Asian Americans are associated with a lower waist circumference (WC) and BMI, while Hawaiian/Pacific Islanders are associated with a higher WC and BMI. Typically, Asian Americans who were born in the United States (US) tend to be overweight and more obese than those born in foreign countries.ConclusionBased on this literature review, it is concluded that there is a shortage of Asian American obesity research, even though there is an evident need for particular obesity intervention programs that target Asian Americans.     

Explorations on risk profiles for overweight and obesity in 9501 preschool-aged children

BackgroundChildhood obesity places a major burden on global public health. We aimed to identify and characterize potential factors, both individually and jointly, in association with overweight and obesity in Chinese preschool-aged children.MethodsWe cross-sectionally recruited 9501 preschool-aged children from 30 kindergartens in Beijing and Tangshan. Overweight and obesity are defined according to the World Health Organization (WHO), International Obesity Task Force (IOTF), and China criteria.ResultsAfter multivariable adjustment, eating speed, sleep duration, birthweight, and paternal body mass index (BMI) were consistently and significantly associated with childhood overweight and obesity under three growth criteria at a significance level of 5%. Additional fast food intake frequency, maternal BMI, gestational weight gain (GWG) and maternal pre-pregnancy BMI were significant factors for overweight (WHO criteria) and obesity (both IOTF and China criteria). Importantly, there were significant interactions between parental obesity and eating speed for childhood obesity. Finally, for practical reasons, risk nomogram models were constructed for childhood overweight and obesity based on significant factors under each criterion, with good prediction accuracy.ConclusionOur findings indicated a synergistic association of lifestyle, fetal and neonatal, and family-related factors with the risk of experiencing overweight and obesity among preschool-aged children.     

Unusually high prevalence rates of obesity in four Mexican rural communities

OBJECTIVE: To establish the nutritional status of previously studied rural populations. DESIGN AND SUBJECTS: A total of 139 households with 245 males and 301 females from four relatively isolated Mexican rural communities were randomly selected to be surveyed in 1996. RESULTS: Underweight was not a problem in either children or adults. In children <5 y only three (4.2%) were stunted but the age- and sex-specific distributions of body mass index (BMI) in children showed 17% of boys and 19% of girls exceeded the proposed International Obesity Task Force limits for classifying the overweight. Triceps skinfold values were similar to NHANESI values for white USA children. Of the adult men 42% were overweight (BMI 25.0-29.9) and 9% obese; 40% of adult women were overweight and a further 33% obese. Adjusting BMI values with corrected total heights by relating them to measured knee height reduced the BMI of women >50 y by 2.0 units; the male data were essentially unchanged. The prevalence of abdominal obesity in women, based on waist measurements and WHO cut-off points was high with 25% of women having elevated values despite a normal BMI; 43% of the overweight women had substantial increases in waist measurements, indicative of high risk, as did 91% of obese women. The men's waist measurements were greater in relation to both BMI and body fat but the prevalence of values in excess of the suggested sex-specific WHO limits was less than half that of women. CONCLUSIONS: The high prevalence of overweight and obesity is now evident in poor and relatively isolated rural communities of Mexico. SPONSORSHIP: The Chronic Disease Office, from the Ministry of Health in Mexico partially financed this study.     

中国0~5岁儿童超重肥胖分布特征

目的 研究中国0~5岁儿童的超重肥胖现况及其分布特点。方法 数据来自"2010-2013年中国居民营养与健康状况监测"数据,2013年儿童调查采用多阶段分层整群抽样的方法,研究对象为全国30个省（自治区、直辖市）55个调查县（区）中0~5岁儿童32 862名。超重肥胖的判定：5岁以下儿童采用WHO 2006年生长发育标准;5岁儿童采用WHO 2007年生长发育参考值。结果采用2010年国家统计局的人口数据进行复杂加权计算。结果 2013年中国0~5岁儿童超重率为8.4%,男童和女童超重率分别为9.4%和7.2%;城、乡儿童超重率均为8.4%。0~、6~、12~、24~、36~、48~和60~71月龄组超重率分别为13.0%、11.1%、8.3%、6.0%、4.8%、3.9%和15.9%;家庭低、中和高收入水平儿童超重率分别为8.0%、8.8%和8.9%。0~5岁儿童肥胖率为3.1%,男童和女童肥胖率分别为3.6%和2.5%;城市和农村儿童肥胖率分别为3.3%和2.9%。0~、6~、12~、24~、36~、48~和60~71月龄组儿童的肥胖率分别为5.8%、3.8%、2.5%、1.6%、1.2%、1.3%和7.8%;低、中和高收入水平儿童肥胖率分别为2.8%、3.3%和3.5%。结论 中国0~5岁儿童的超重和肥胖率正在增高攀升,及时监测0~5岁儿童的超重肥胖状况和实施合理干预十分必要。     

Interleukin-10 as a potential regulator of hepcidin homeostasis in overweight and obese children: A cross-sectional study in Taiwan

ObjectiveA sharp increase in the prevalence of obesity and a decline in iron deficiency in children was observed between the two consecutive Nutrition and Health Surveys in Taiwan. The aim of this study was to evaluate the distribution of hepcidin in relation to nutritional status in children.Methods648 children ages 7 to 13 y living in Taipei and New Taipei City were enrolled in this study. Parameters for obesity, iron status, and inflammatory markers were evaluated.ResultsThere were no differences in the prevalence of iron deficiency and iron depletion between normal and overweight/obese children. A V-sharp hepcidin distribution curve was seen in normal weight children and overweight/obese boys. Serum hepcidin levels remained stable in overweight/obese girls during transition from childhood to teenager. Overweight/obese children had increased serum nitric oxide (NO) and interleukin (IL)-1β but decreased IL-10 concentration compared with normal weight children. A strong inverse relationship was found between IL-10 and body mass index (BMI; odds ratio (OR), 0.86, 95% confidence interval [CI], 0.83–0.89). By contrast, positive correlations were observed between BMI and IL-1β (OR, 1.60; 95% CI, 1.29–1.98); and between BMI and NO (OR, 1.04, 95% CI, 1.02–1.07). Multivariate linear regression analysis showed serum hepcidin was significantly correlated with IL-10 (β = 0.26, P < 0.0001).ConclusionsOur results raise the possibility that IL-10 may play a role in iron homeostasis. Decreased circulating IL-10 concentration may temporary protect young overweight/obese girls against the development of iron deficiency. However, long-term decrease in hepcidin concentration may increase the risk for iron overload in overweight/obese children.     

The role of neighborhood characteristics and the built environment in understanding racial/ethnic disparities in childhood obesity

BackgroundChildhood obesity prevalence remains high and racial/ethnic disparities may be widening. Studies have examined the role of health behavioral differences. Less is known regarding neighborhood and built environment mediators of disparities. The objective of this study was to examine the extent to which racial/ethnic disparities in elevated child body mass index (BMI) are explained by neighborhood socioeconomic status (SES) and built environment.MethodsWe collected and analyzed race/ethnicity, BMI, and geocoded address from electronic health records of 44,810 children 4 to 18 years-old seen at 14 Massachusetts pediatric practices in 2011–2012. Main outcomes were BMI z-score and BMI z-score change over time. We used multivariable linear regression to examine associations between race/ethnicity and BMI z-score outcomes, sequentially adjusting for neighborhood SES and the food and physical activity environment.ResultsAmong 44,810 children, 13.3% were black, 5.7% Hispanic, and 65.2% white. Compared to white children, BMI z-scores were higher among black (0.43 units [95% CI: 0.40–0.45]) and Hispanic (0.38 [0.34–0.42]) children; black (0.06 [0.04–0.08]), but not Hispanic, children also had greater increases in BMI z-score over time. Adjusting for neighborhood SES substantially attenuated BMI z-score differences among black (0.30 [0.27–0.34]) and Hispanic children (0.28 [0.23–0.32]), while adjustment for food and physical activity environments attenuated the differences but to a lesser extent than neighborhood SES.ConclusionsNeighborhood SES and the built environment may be important drivers of childhood obesity disparities. To accelerate progress in reducing obesity disparities, interventions must be tailored to the neighborhood contexts in which families live.     

US Adults Fall Short of the Dietary Guidelines for Cancer Prevention Regardless of BMI Category

BackgroundCancer risk is determined by specific factors, including body weight and dietary patterns. Accordingly, the World Cancer Research Fund/American Institute for Cancer Research published updated cancer prevention recommendations in 2018 based on comprehensive reviews of modifiable behaviors associated with cancer risk.ObjectiveThe objective of this study was to determine the extent to which US adults meet these evidence-based recommendations and how adherence differs by weight status.DesignThis was a cross-sectional study using nationally representative data from the 2005-2016 National Health and Nutrition Examination Survey (NHANES).Participants/settingDietary intake data for 30,888 adults 18 years and older with normal body mass index (BMI), overweight, or obesity were analyzed.Main outcome measuresDifferences in dietary intakes and the proportion of adults meeting guidelines were compared across BMI categories.Statistical analyses performedLogistic regression and 1-way analysis of covariance were used to analyze differences in adherence to recommendations, controlling for age, sex, race/ethnicity, and family income as a percent of the federal poverty rate.ResultsRegarding fruit and nonstarchy vegetables, 62.8% of adults with normal BMI, 64.5% with overweight, and 70.1% with obesity fell short of recommendations. Regarding whole grains, 67.9% of adults with normal BMI, 70.2% with overweight, and 73.1% with obesity did not meet the recommendation. Regarding red meat, 36.7% of adults with normal BMI, 41.6% with overweight, and 43.5% with obesity consumed >18 oz/week, with a significant difference in mean intakes between adults with normal BMI and obesity (P < .001). Adults with obesity consumed significantly less dietary fiber and more processed meat than adults with normal BMI and overweight (P < 0.001).ConclusionsFew U.S. adults meet cancer prevention recommendations; adults with obesity are significantly less likely to do so. Future research should evaluate compounded risk resulting from obesity and poor dietary patterns inconsistent with current evidence-based guidelines, and inform targeted interventions to address these issues.     

The effects of weight gain over time on gait in children with cerebral palsy: Comparison to a matched healthy weight cerebral palsy control group

BackgroundChildren with cerebral palsy (CP) have demonstrated higher rates of overweight and obesity than their typically developed peers. Limited studies have assessed how being overweight or obese affect lower limb kinematics during gait in these children.Research questionHow are lower limb kinematics during gait affected in children with CP who progress from a healthy weight to being overweight or obese compared to a well-matched healthy weight CP control group?MethodsA retrospective analysis of the movement analysis laboratory database was conducted.Children with CP were included if they were aged between 4 and 17 years at baseline,had a follow-up assessment with a minimum of 12 months between assessments, and had no orthopaedic interventions between assessments. A matched control group of children with CP with the same inclusion criteria, except for a requirement of healthy BMI at follow-up, was included. Temporal-spatial and full 3-dimensional lower limb kinematic data were examined.ResultsNormalized speed and step length reduced from baseline to follow-up for both groups,with no difference in the amount of change between groups. Children with increased BMI demonstrated increased external hip rotation during stance at follow-up not evident in the control group.SignificanceResults demonstrated similar changes over time between groups. Increased external hip rotation in children with increased BMI was considered small and within the threshold of error associated with transverse plane kinematics. Our results suggest that being overweight or obese does not result in a meaningful change in lower limb kinematics in children with CP.     

Trends in Body Mass Index among Ohio's Third-Grade Children: 2004-2005 to 2009-2010

Substantial variation across states in the prevalence and trends in childhood overweight and obesity indicate a need for state-specific surveillance to make state comparisons to national estimates and identify high-risk populations. The purpose of this study was to examine body mass index (BMI) trends among third-grade children in Ohio between the 2004-2005 and 2009-2010 school years and examine changes in prevalence of obesity by specific demographic subgroups. Third-grade children (n=33,672) were directly weighed and measured throughout the school years by trained health care professionals. Trends in overweight/obesity (≥85th percentile of BMI by age/sex), obesity (≥95th percentile), and obesity level 2 (≥97th percentile) over five time periods (2004-2005, 2006-2007, 2007-2008, 2008-2009, 2009-2010) were modeled using logistic regression, accounting for the survey design and adjusting for sex, race/ethnicity, National School Lunch Program (NSLP) participation, and age. Differences in these BMI categories were also examined by these subgroups. BMI estimates did not demonstrate a statistically significant trend over the five time periods for overweight/obesity (34% to 36%), obesity (18% to 20%), or obesity level 2 (12% to 14%). However, increases in overweight/obesity prevalence were found in Hispanic children (37.8% vs 53.1%; P<0.01). Decreases in obesity (16.6% vs 14.1%; P=0.02) and obesity level 2 (11.3% vs 9.3%; P=0.02) were found among children not participating in NSLP and residing in suburban counties (obesity [17.3% vs 14.7%; P=0.03] and obesity level 2 [11.8% vs 9.8%; P=0.05]). Finally, decreases in overweight/obesity and obesity level 2 among boys were observed (15% vs 12.9%; P=0.02). Despite no significant overall trends in overweight/obesity, obesity, or obesity level 2 between 2004 and 2010, prevalence changed among specific subgroups. Obesity prevention efforts should be widespread and include special emphasis on groups experiencing increases or no change in prevalence.     

Eating Competence Among Caregivers of Toddlers: Associations With Caregiver and Child Overweight/Obesity

ObjectiveTo examine the association between caregiver eating competence and child overweight/obesity and caregiver obesity.DesignLongitudinal cohort.SettingA large US children's hospital.ParticipantsCaregiver–child dyads (n = 288 with complete data at 2 time points) were sampled in 2017–2019 from those who received care at Nationwide Children's Hospital.Main Outcome Measure(s)Child overweight/obesity at 24 months of age (body mass index [BMI]) z-score >2 per World Health Organization standards and caregiver weight status (underweight/healthy [BMI < 25 kg/m²], overweight [BMI ≥ 25 and < 30 kg/m²], or obese [BMI ≥ 30 kg/m²]).AnalysisLog-binomial models examined the relationship between caregiver eating competence (ecSatter Inventory) at 18 months and child overweight/obesity at 24 months of age. Proportional odds models investigated the relationship between caregivers’ eating competence and weight status.ResultsEating competent caregivers had more than twice the odds (odds ratio, 2.11; 95% confidence interval, 1.30–3.42) of having a lower BMI category and had lower average BMI than noneating competent caregivers. Child overweight/obesity at 24 months did not differ by caregiver eating competence.Conclusions and ImplicationsAlthough child overweight/obesity did not vary by caregiver eating competence, caregiver eating competence was related to their weight status. Longer-term studies are needed to clarify the role of caregiver eating competence as children develop. Promoting caregivers’ eating competence may translate into healthier behaviors and skills for caregivers and their children long term.     

Creating Healthful Home Food Environments: Results of a Study with Participants in the Expanded Food and Nutrition Education Program

ObjectiveTo evaluate a modified curriculum for the 6-session Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthful home food environments and parenting skills related to obesity prevention.DesignTwo-group randomized control trial; intervention versus usual EFNEP curriculum.SettingTexas EFNEP classes.Participants1,104 EFNEP clients in 100 classes.InterventionSix short videos, with goal setting, problem solving, guided discussion, and handouts, incorporated into existing EFNEP classes.Main Outcome MeasuresBody mass index (BMI), diet, psychosocial variables with baseline measurements, immediately post, and 4 months later.AnalysisMixed-model repeated measures analysis of variance.Results100 classes were randomized (54 intervention/46 comparison), with 1,006 participants at baseline (582 intervention, 424 comparison, 97% women, 89% Hispanic). Significant improvements over time were found for both groups' consumption of most food items and nutrients, and nearly all psychosocial variables, regardless of study group. Only the intervention group had a significant BMI decrease at post. Fidelity to the intervention class session structure was high, and comments from intervention staff and clients were positive.Conclusion and ImplicationsExisting EFNEP programs in local communities could have a significant impact on family dietary behaviors for populations at risk of obesity. Replication with similar populations is warranted.