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Background: The small Atlantic island of St Helena is a United Kingdom Overseas Territory (UKOT) with a high prevalence of childhood obesity (over a quarter of 4–5 and 10–11 year olds) and, anecdotally, adulthood obesity and its associated health detriments. St Helena have taken a whole systems approach to obesity (WSAO) to address the issue. A WSAO recognises the factors that impact obesity as a complex system and requires a 'health in all policies' approach. UK academic and public health technical support was provided to the local St Helena delivery team. This process evaluation sought to explore the early stages of the WSAO implementation and implications for the transferability of the approach to other small island developing states and UKOT. Methods: Data was collected via eight semi-structured interviews, paper based and online surveys, and document analysis. Thematic analysis was used to analyse the data. Results: The analysis identified three factors which aided the first phase of WSAO implementation: (1) senior leaders support for the approach; (2) the academic support provided to establish and develop the approach; and (3) effective adaptation of UK Government resources to suit the local context. Key challenges of early implementation included: maintaining and broadening stakeholder engagement; limited local workforce capacity and baseline knowledge related to obesity and systems thinking; and limited capacity for support from the UK-based academic team due to contract terms and COVID-19 restrictions. Conclusions: Early stages of implementation of a WSAO in a UKOT can be successful when using UK's resources as a guide and adapting them to a small island context. All participants recommended other small islands adopt this approach. Continued senior support, dedicated leadership, and comprehensive community engagement is needed to progress implementation and provide the foundation for long-term impact. Small island developing states considering adopting a WSAO should consider political will, senior level buy-in and support, funding, and local workforce knowledge and capacity to enable the best chances of successful and sustainable implementation. [ABSTRACT FROM AUTHOR]

Aim: Customer discovery, an entrepreneurial and iterative process to understand the context and needs of potential adoption agencies, may be an innovative strategy to improve broader dissemination of evidence-based interventions. This paper describes the customer discovery process for the Building Healthy Families (BHF) Online Training Resources and Program Package (BHF Resource Package) to support rural community adoption of an evidence-based, family healthy weight program. Methods: The customer discovery process was completed as part of a SPeeding Research-tested INTerventions (SPRINT) training supported by the U.S. Centers for Disease Control and Prevention. Customer discovery interviews (n=47) were conducted with people that could be potential resource users, economic buyers, and BHF adoption influencers to capture multiple contextual and needs-based factors related to adopting new evidence-based interventions. Qualitative analyses were completed in an iterative fashion as each interview was completed. Results: The BHF Resource Package was designed to be accessible to a variety of implementation organizations. However, due to different resources being available in different rural communities, customer discovery interviews suggested that focusing on rural health departments may be a consistent setting for intervention adoption. We found that local health departments prioritize childhood obesity but lacked the training and resources necessary to implement effective programming. Several intervention funding approaches were also identified including (1) program grants from local and national foundations, (2) healthcare community benefit initiatives, and (3) regional employer groups. Payment plans recommended in the customer discovery interviews included a mix of licensing and technical support fees for BHF delivery organizations, potential insurance reimbursement, and family fees based on ability to pay. Marketing a range of BHF non-weight related outcomes was also recommended during the customer discovery process to increase the likelihood of BHF scale-up and sustainability. Conclusions: Engaging in customer discovery provided practical directions for the potential adoption, implementation, and sustainability of the BHF Resource Package. However, the inconsistent finding that health departments are both the ideal implementation organization, but also see childhood obesity treatment as a clinical service, is concerning. [ABSTRACT FROM AUTHOR]

Childhood obesity is a complex problem, and its prevalence among school-age children has been found to have a greater impact on their physical well-being compared to their learning difficulties. In some cases, teachers or schools may not pay enough attention to issues that have the potential to affect or delay the psychomotor development of children. Therefore, this study aimed to provide enhanced comprehension regarding the effect of childhood obesity on psychomotor behavior. This study used a systematic review methodology to synthesize information regarding the effect of obesity on children's health and development. The information and data presented in this study were obtained from several scientific sources accessed through online libraries such as PubMed, ScienceDirect, and the Cochrane Library. A comprehensive search was conducted to identify scholarly publications, which resulted in a total of 815 papers published between 2013 and 2022. The selected papers exclusively consisted of original research articles that primarily focused on investigating the relationship between obesity in children aged 5-14 years and their psychomotor abilities and development outcomes. Following the screening process, five studies were found to meet the specified criteria. The findings of the selected studies revealed a substantial resemblance, specifically the correlation between childhood obesity and poor motor skills. Furthermore, the selected studies discovered that an increase in body fat is commonly associated with a rise in total body weight, or the relative body mass index (BMI), in both adults and children. Some studies demonstrated significant differences in the performance of diverse psychomotor variables according to children's BMI. According to the results of the studies, children with a higher BMI showed inferior performance in motor activities as a result of compromised body control and balance that inhibited the children's movement. This systematic review concludes that obesity has an effect on the psychomotor behavior of children. [ABSTRACT FROM AUTHOR]

Background: Per-/polyfluoroalkyl substances (PFASs) are persistent organic pollutants and suspected endocrine disruptors. Objective: The aim of this work was to conduct a systematic review with meta-analysis to summarise the associations between prenatal or childhood exposure to PFASs and childhood overweight/obesity. Methods: The search was performed on the bibliographic databases PubMed and Embase with text strings containing terms related to prenatal, breastfeeding, childhood, overweight, obesity, and PFASs. Only papers describing a biomonitoring study in pregnant women or in children up to 18 years that assessed body mass index (BMI), waist circumference (WC), or fat mass in children were included. When the estimates of the association between a PFAS and an outcome were reported from at least 3 studies, a meta-analysis was conducted; moreover, to correctly compare the studies, we developed a method to convert the different effect estimates and made them comparable each other. Meta-analyses were performed also stratifying by sex and age, and sensitivity analyses were also performed. Results: In total, 484 and 779 articles were retrieved from PubMed and Embase, respectively, resulting in a total of 826 articles after merging duplicates. The papers included in this systematic review were 49: 26 evaluating prenatal exposure to PFASs, 17 childhood exposure, and 6 both. Considering a qualitative evaluation, results were conflicting, with positive, negative, and null associations. 30 papers were included in meta-analyses (19 prenatal, 7 children, and 4 both). Positive associations were evidenced between prenatal PFNA and BMI, between PFOA and BMI in children who were more than 3 years, and between prenatal PFNA and WC. Negative associations were found between prenatal PFOS and BMI in children who were 3 or less years, and between PFHxS and risk of overweight. Relatively more consistent negative associations were evidenced between childhood exposure to three PFASs (PFOA, PFOS, and PFNA) and BMI, in particular PFOS in boys. However, heterogeneity among studies was high. Conclusion: Even though heterogeneous across studies, the pooled evidence suggests possible associations, mostly positive, between prenatal exposure to some PFASs and childhood BMI/WC; and relatively stronger evidence for negative associations between childhood exposure to PFASs and childhood BMI. [ABSTRACT FROM AUTHOR]

The adoption of emerging technologies in healthcare systems plays a crucial part in anti-obesity initiatives. COVID-19 has intensified the Body Mass Index (BMI) discourses in AI (Artificial Intelligence)-powered social media. However, few studies have reported on the influence of digital content on obesity prevention policies. Understanding the nature and forums of obese metaphors in social media is the first step in policy intervention. The purpose of this paper is to understand the mutual influence between obesity and COVID-19 and determine its policy implications. This paper analyzes the public responses to obesity using Twitter data collected during the COVID-19 pandemic. The emotional nature of tweets is analyzed using the NRC lexicon. The results show that COVID-19 significantly influences perceptions of obesity; this indicates that existing public health policies must be revisited. The study findings delineate prerequisites for obese disease control programs. This paper provides policy recommendations for improving social media interventions in health service delivery in order to prevent obesity. [ABSTRACT FROM AUTHOR]

The rising prevalence of mental health conditions among children and young adults accelerated by the COVID-19 pandemic emphasises the urgent need to address this issue effectively. A potential avenue for early diagnosis lies in physical activity patterns as individuals with mental health conditions often move less than the general population. This paper utilises Millennium Cohort Study data to investigate the relationship between childhood physical movement patterns, and mental distress and wellbeing outcomes in late adolescence. By controlling for a range of factors of both cohort members and their parents, the study employs well-adjusted logistic and linear regressions to assess the hypothesis. Objective physical movement data is collected with accelerometers, while mental distress is measured using the Kessler K6 scale and mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. The findings of the study suggest no significant association between raw physical movement and mental distress; however, there is suggestive evidence of a weak positive association with mental wellbeing. In addition, the study found that lower exercise levels at age 7 were associated with an increased likelihood of mental distress at age 17, highlighting the potential impact of exercise habits on mental health in adolescence. Overall, these findings suggest that raw physical activity data may be a better predictor of specific mental health outcomes, such as those assessed by the Strengths and Difficulties Questionnaire in similar studies. The paper offers recommendations for future research -- such as using self-reported questionnaires to contextualise quantitative physical movement data -- and a more comprehensive analysis of the cognitive and mental implications. [ABSTRACT FROM AUTHOR]

Background: Many studies were conducted to evaluate the association between dietary glycemic index, glycemic load and children obesity. The aim of this study was to review these studies. Methods: We searched the ISI and PubMed databases for studies that evaluated the association between dietary glycemic index, glycemic load and obesity in children. At first, the studies containing the words "glycemic index", "glycemic load", "glycaemic index" or "glycaemic load" plus "child", "children", "young", "youth" or "adolescent" were selected. Among 1001 selected studies, articles were accepted if they had considered obesity or related factors as their main dependent variables. Findings: Twenty studies were included. Although the cross-sectional results were inconsistent, stronger studies had found a direct relation between dietary glycemic index, glycemic load and children obesity. Cohort studies had shown positive, neutral and negative associations between these dietary factors and obesity in children. However, although most clinical trials had reported a positive effect of dietary glycemic index on childhood obesity, they had not shown the similar effect for glycemic load. Conclusion: There is not enough evidence for making a certain conclusion. Therefore, further studies in this field are suggested. [ABSTRACT FROM AUTHOR]

The Provincial Health Services Authority (PHSA) of British Columbia suggested that a paradigm shift from weight to well-being could address the unintended consequences of focusing on obesity and improve the outcomes of efforts to address the challenges facing both individuals and our healthcare system. In this paper, we jointly used artificial intelligence (AI) and participatory modeling to examine the possible consequences of this paradigm shift. Specifically, we created a conceptual map with 19 experts to understand how obesity and physical and mental well-being connect to each other and other factors. Three analyses were performed. First, we analyzed the factors that directly connect to obesity and well-being, both in terms of causes and consequences. Second, we created a reduced version of the map and examined the connections between categories of factors (e.g., food production, and physiology). Third, we explored the themes in the interviews when discussing either well-being or obesity. Our results show that obesity was viewed from a medical perspective as a problem, whereas well-being led to broad and diverse solution-oriented themes. In particular, we found that taking a well-being perspective can be more comprehensive without losing the relevance of the physiological aspects that an obesity-centric perspective focuses on. [ABSTRACT FROM AUTHOR]

Background: The burden of childhood obesity and cardiometabolic risk factors affecting newcomer Canadians living in lower socioeconomic circumstances is a concerning public health issue. This paper describes Strengthening Community Roots: Anchoring Newcomers in Wellness and Sustainability (SCORE!), an academic-community research partnership to co-design interventions that nurture and optimize healthy activity living (HAL) among a community of children and families new to Canada in Hamilton, Ontario, Canada. Methods/Design: Our overarching program is informed by a socio-ecological model, and will co-create HAL interventions for children and families new to Canada rooted in outdoor, nature-based physical activity. We will proceed in three phases: Phase 1) synthesis of existing evidence regarding nature based HAL interventions among children and families; Phase 2) program development through four data collection activities including: i) community engagement activities to build trustful relationships and understand barriers and facilitators, including establishing a community advisory and action board, qualitative studies including a photovoice study, and co-design workshops to develop programs; ii) characterizing the demographics of the community through a household survey; iii) characterizing the built environment and HAL programs/services available in the community by developing an accessible real-time systems map; and iv) reviewing municipal policies relevant to HAL and sustainability; leading to Phase 3) implementation and evaluation of the feasibility of co-designed HAL programs. Conclusion: The etiology of childhood obesity and related chronic diseases is complex and multifactorial, as are intervention strategies. The SCORE! program of research brings together partners including community members, service providers, academic researchers, and organizational leaders to build a multi-component intervention that promotes the health and wellness of newcomer children and families. [ABSTRACT FROM AUTHOR]

There has been a major ongoing health impact of the COVID-19 pandemic on children's lives, including lifestyle and overall health. Enforcement of prevention measures, such as school closures and social distancing, has significantly affected children's daily routines and activities. This perspective manuscript aims to explore the rise in childhood obesity and its association with hypertension during pandemics. The COVID-19 pandemic has led to significant disruptions in children's routines, including reduced physical activity, increased sedentary behavior, and changes in dietary patterns. These factors, coupled with the psychological impact of the pandemic, have contributed to an alarming increase in childhood obesity rates. This paper has highlighted the concerning increase in childhood obesity and hypertension during pandemics. The disruptions caused by the COVID-19 pandemic, including reduced physical activity, increased sedentary behaviors, and changes in dietary patterns, have contributed to the rise in these health conditions. It is crucial to recognize the long-term consequences of childhood obesity and hypertension and the urgent need for a comprehensive approach to address them. [ABSTRACT FROM AUTHOR]

A limited number of studies have directly examined the effects of liposomal encapsulated phytochemicals and their anti-obesity effects in adults. This study aimed to summarize the evidence on the effect of liposomal encapsulated phytochemicals and their role in regulating major pathways involved in the anti-obesity mechanism. A systematic search was performed using several search engines like Science Direct, Google Scholar, and other online journals, focusing on laboratory research, systematic reviews, clinical trials, and meta-analysis that focused on liposomal encapsulated phytochemicals with anti-obesity properties, and followed the preferred reporting terms for this systematic review. An initial search provided a result of 1810 articles, and 93 papers were selected after the inclusion and exclusion criteria. Very few studies have been conducted on the liposomal encapsulation of phytochemicals or its synergistic study to combat obesity; hence this review paves the way for future obesity research and is mainly helpful for the pediatric obesity population. Liposomal encapsulation of phytochemicals has improved the efficiency of freely administered phytochemicals. Targeted delivery improved drug utilization and regulated the anti-obesity pathways. PPARƔ is a major therapeutic target for obesity as it inhibits adipocyte differentiation and maintains energy homeostasis. [ABSTRACT FROM AUTHOR]

Background: Calls for the adoption of a systems approach to chronic disease prevention date back at least ten years because of the potential to empower communities to identify and address the complex causes of overnutrition, undernutrition and climate change. Australia, like many countries, has high levels of obesity and extreme climate events. The Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND) trial aims to prevent unhealthy weight gain in children in 10 intervention and two pilot communities in north-east Victoria, Australia using community-based participatory approaches informed by systems science. Intervention activities co-designed in 2019 were disrupted by COVID-19 and bushfires. This paper explores the impacts of these 'shocks' on the local prevention workforce to implement actions within communities. Methods: A case study design involving one-hour online focus groups and an on-line survey (November 2021-February 2022). Purposive sampling was used to achieve diverse representation from RESPOND stakeholders including local council, health services, primary care partnerships and department of health. The focus group interview schedule and survey questions were based on Durlak and DuPre's implementation factors. Results: Twenty-nine participants from seven different communities participated in at least one of nine focus groups to discuss the impacts of COVID-19 and bushfires on localised implementation. Twenty-eight participants (97% of focus group sample) also completed the on-line survey. Implementation of RESPOND stalled or stopped in most communities due to bushfires and/or COVID-19. These shocks resulted in organisational priorities changing, loss of momentum for implementation, redeployment of human resources, culminating in fatigue and exhaustion. Participants reported adaptation of RESPOND, but implementation was slowed due to limited resources. Conclusion: Further research is needed to advance risk management strategies and protect resources within health promotion. System shocks such as bushfires and COVID-19 are inevitable, and despite multiple adaptation opportunities, this intervention approach was not 'shock proof'. [ABSTRACT FROM AUTHOR]

Aim: This paper summarised national data on the prevalence of overweight and obesity among 4‐year‐old children in Sweden in 2020, the first year of the COVID‐19 pandemic. It compares this with data from 2018. Differences between regions and sex were identified. Methods: Comparative data from Swedish Child Health Services were available for 18/21 regions. Chi‐square tests were used to compare data from 2018 and 2020 and to examine differences between the sexes. Sex and year were examined through interaction tests. Results: In 2020, 13.3% of the 100 001 children had overweight or obesity: 15.1% of the girls and 11.6% of the boys (p < 0.001). In 2018, 11.4% of the 105 445 children had overweight or obesity: 13.2% of the girls and 9.4% of the boys. This was an overall increase of 16.6% (p = 0.000) in the national Swedish data from 2018 to 2020. The increase between the years was greater for obesity (31.8%, p = 0.000) than for overweight (13.3%, p = 0.000). Conclusion: The prevalence of overweight and obesity among 4‐year‐olds in Sweden increased during the COVID‐19 pandemic and needs to be addressed. The prevalence needs to be followed as part of prevention programmes and to evaluate health interventions. [ABSTRACT FROM AUTHOR]

In 2018, 50.9% of all Chilean children, measured by the "Nutritional Map" of the Ministry of Education, were categorized as overweight or obese, which is evidence of rising obesity rates in Latin America. Discussions on the subject revolve around the tension between agency-determining factors, such as eating and exercise habits, and structural ones, pointing to the correlations between high levels of obesity and poverty. However, there is also a territorial dimension that stands out, especially in cases with high levels of residential segregation, as is the case in many Latin American cities. Here there are potential clusters of more or less obesogenic food environments, where the socioeconomic level, the nutritional status of the sector, and the food supply of the place are correlated. In this article, the spatial dimensions of childhood obesity are mapped, arguing that the segregation of nutritional status overlaps with the nature of multidimensional inequalities in Chilean cities. The study was done by organizing and combining public databases and spatial analysis techniques to create diagnostic maps. The results show a trend towards higher obesity rates as the socioeconomic level of the neighborhood decreases, while food environments vary according to the availability of different combinations of supply (street markets, quantity and size of supermarkets, traditional channels) for each socioeconomic level, suggesting the presence of different types of food environments. The paper concludes with reflections on how the nutritional context has changed since the Covid-19 pandemic and opens a discussion on the role of urban planning in creating nutritional (in)equity conditions. [ABSTRACT FROM AUTHOR]

Background: Early parenthood, high parity, and partnership separation are associated with obesity. However, the emergence of non-marital partnerships, serial partnering and childbearing across unions, means that it is important to consider their association to obesity. This paper examined the associations between number of biological children and multi-partner fertility (MPF)—defined as having biological children with more than one partner, with obesity at midlife. Method: The sample consisted of 2940 fathers and 3369 mothers in the 1970 British Cohort Study. The outcome was obesity (BMI 30 or over) at age 46. Fertility and partnership histories ascertained the number of live biological children and MPF status by age 42. The associations were tested using logistic regression adjusting for confounders at birth, age 10 and age 16. Adult factors recorded at age 42 including age at first birth, smoking status, alcohol dependency, educational attainment and housing tenure were considered as mediators. Results: For fathers, obesity odds did not differ according to number of children or MPF. In unadjusted models, mothers with one child (OR 1.24 95%CI 1.01–1.51), mothers who had two children with two partners (OR 1.45 95%CI 1.05–1.99), and mothers who had three or more children with two or more partners (OR 1.51 95%CI 1.18–1.93) had higher odds of obesity. In adjusted models, there remained an association between mothers with one child and odds of obesity (OR 1.30 95%CI 1.05–1.60). All other associations were attenuated when confounders were included. Conclusions: Mothers who had children with multiple partners had higher odds of obesity. However this association was completely attenuated when parental and child confounders were accounted for; suggesting that this association may be explained by confounding. Mothers who had one child only may be at increased odds of obesity, however this could be due to multiple factors including age at first birth. [ABSTRACT FROM AUTHOR]

Idiopathic intracranial hypertension (IIH) affects both children and adults. There are currently no clinical trials in IIH for those who are adolescents or children. The aims of this narrative review were to characterise the differences between pre- and post-pubertal IIH and to highlight the need to be more inclusive in clinical trial planning and recruitment. A detailed search of the scientific literature was performed using the PubMed database, from inception until 30 May 2022 using keywords. This included English language papers only. The abstracts and full texts were reviewed by two independent assessors. The literature revealed that the pre-pubertal group had a more variable presentation. The presenting features in the post-pubertal paediatric group were more akin to adults with headache as the dominant feature. They were also more likely to be female and have an increased body mass index. A clear limitation of the literature was that a number of paediatric studies had variable inclusion criteria, including secondary causes of raised intracranial pressure. Pre-pubertal children do not display the same predilection towards the female sex and obesity as post-pubertal children, who have a similar phenotype to the adult cohort. Inclusion of adolescents in clinical trials should be considered given the similar phenotype to adults. There is a lack of consistency in the definition of puberty, making the IIH literature difficult to compare. Inclusion of secondary causes of raised intracranial pressure has the potential to confound the accuracy of analysis and interpretation of the results. [ABSTRACT FROM AUTHOR]

Objective: Childhood obesity prevention is critical to reducing the health and economic burden currently experienced by the Australian economy. Systems science has emerged as an approach to manage the complexity of childhood obesity and the ever-changing risk factors, resources and priorities of government and funders. Anecdotally, our experience suggests that inflexibility of traditional research methods, and dense academic terminology created issues with those working in prevention practice. Therefore, this paper provides a refined description of research specific terminology of scale-up, fidelity, adaptation, and context, drawing from community-based systems dynamics and our experience in designing, implementing, and evaluating non-linear, community-led systems approaches to childhood obesity prevention.Design: We acknowledge the importance of using a practice lens, rather than purely a research design lens and provide a narrative on our experience and perspectives on scale-up, fidelity, context and adaptation through a practice lens.Setting: Communities.Participants: Practice-based researcher experience and perspectives.Results: Practice-based researchers highlighted the key finding that community should be placed at the centre of the intervention logic. This allowed communities to self-organise with regards to stakeholder involvement, capacity, boundary identification and co-creation of actions implemented to address childhood obesity will ensure scale up, fidelity, context and adaptation are embedded.Conclusions: We need to measure beyond primary anthropometric outcomes and focus on evaluating more about implementation, process, and sustainability. We need to learn more from practitioners on the ground and use an implementation science lens to further understand how actions work. This is where solutions to sustained childhood obesity prevention will be found. [ABSTRACT FROM AUTHOR]

In recent years, due to the continuous improvement of the national economic level and the increasing academic burden of students' main courses, students' physical health problems (e.g., obesity, vision, and lumbar spine) have become more and more serious, which urgently needs the attention of relevant departments of national education and parents. This paper will use digital image technology to create a physical parameter measurement system and use literature, comparative analysis, and other research methods to analyze the impact of volleyball elective courses on students' physical health. Firstly, this paper explains the theory of image processing technology and analyzes the parameters of human body scientifically; secondly, it detects the physical parameters of human body in digital images and also designs an image recognition system; finally, through experimental analysis, the accuracy of identifying key points of images is relatively high. After the system is adopted, the error of the measurement index is small. After the training of human body indexes, the effect of volleyball can be effectively improved. [ABSTRACT FROM AUTHOR]

Melanocortin 3 receptor (MC3R) is a G-protein coupled receptor which has been defined mostly as a regulator of the appetite/hunger balance mechanisms to date. In addition to its function regarding the weight gain and appetite control mechanisms of MC3R, recent studies have shown that MC3R controls growth, puberty, and circadian rhythms as well. Despite the drastic effects of MC3R deficiency in humans and other mammals, its cellular mechanisms are still under investigation. In this review paper, we aimed to point out the importance of MC3R regulations in three main areas: 1) its impact on weight and appetite control, 2) its role in the control of growth, puberty, and the circadian rhythm, and, 3) its protein-protein interactions and cellular mechanisms. [ABSTRACT FROM AUTHOR]

Objective: School nurses are engaging worldwide to promote and protect children's health. Many researchers who examined the effectiveness of the school nurse criticized the inadequate methodology employed in many of the studies. We therefore carried out an evaluation on the effectiveness of school nurses based on a rigorous methodological approach. Methods: In this overview of reviews we performed an electronic databank search and global research results on the effectiveness of school nurses were sought. We identified 1,494 records through database search. Abstracts and full texts were screened and summarized using the dual control principle. We summarized the aspects of quality criteria as well as the significance of the effectiveness of the school nurse. In the first step, k = 16 systematic reviews were summarized and evaluated following the AMSTAR-2 guidelines. In a second step, j = 357 primary studies included in these k = 16 reviews were summarized and assessed following the GRADE guidelines. Results: Research results on the effectiveness of school nurses show that school nurses play a key role in improving the health of children with asthma (j = 6) and diabetes (j = 2), results on combating obesity are less certain (j = 6). The quality of identified reviews is mostly very low with only six studies of medium quality, of which one identified as a meta-analysis. A total of j = 289 primary studies were identified. Approximately 25% (j = 74) of identified primary studies were either randomized controlled trials (RCT) or observational studies, of which roughly 20% (j = 16) had a low risk of bias. Studies with physiological variables such as blood glucose or asthma labeling led to higher quality results. Conclusion: This paper represents an initial contribution and recommends further evaluation of the effectiveness of school nurses, particularly in the areas of mental health or children from low socioeconomic backgrounds. The general lack of quality standards in school nursing research should be integrated into the scientific discourse of school nursing researchers to provide robust evidence for policy planners and researchers. [ABSTRACT FROM AUTHOR]

Childhood obesity is a public health concern in the United States. Consequences of childhood obesity include metabolic disease and heart, lung, kidney, and other health-related comorbidities. Therefore, the early determination of obesity risk is needed and predicting the trend of a child's body mass index (BMI) at an early age is crucial. Early identification of obesity can lead to early prevention. Multiple methods have been tested and evaluated to assess obesity trends in children. Available growth charts help determine a child's current obesity level but do not predict future obesity risk. The present methods of predicting obesity include regression analysis and machine learning-based classifications and risk factor (threshold)-based categorizations based on specific criteria. All the present techniques, especially current machine learning-based methods, require longitudinal data and information on a large number of variables related to a child's growth (e.g., socioeconomic, family-related factors) in order to predict future obesity-risk. In this paper, we propose three different techniques for three different scenarios to predict childhood obesity based on machine learning approaches and apply them to real data. Our proposed methods predict obesity for children at five years of age using the following three data sets: (1) a single well-child visit, (2) multiple well-child visits under the age of two, and (3) multiple random well-child visits under the age of five. Our models are especially important for situations where only the current patient information is available rather than having multiple data points from regular spaced well-child visits. Our models predict obesity using basic information such as birth BMI, gestational age, BMI measures from well-child visits, and gender. Our models can predict a child's obesity category (normal, overweight, or obese) at five years of age with an accuracy of 89%, 77%, and 89%, for the three application scenarios, respectively. Therefore, our proposed models can assist healthcare professionals by acting as a decision support tool to aid in predicting childhood obesity early in order to reduce obesity-related complications, and in turn, improve healthcare. [ABSTRACT FROM AUTHOR]

Purpose: Despite public health efforts to reduce childhood obesity, there remains an unequal distribution of obesity among rural and urban children, with higher rates in rural areas. However, few studies have compared differences in program delivery. This paper aims to describe differences between an urban and rural program delivery of a family-focused, community-based intervention program to prevent and reduce obesity among children. Methods: This paper uses a case study format to provide a descriptive analysis of similar obesity prevention programs, designed by the same research team, implemented in Minnesota in different settings (i.e., an urban and rural setting) with significant community engagement in the adaptation process. The rural NU-HOME program is compared to HOME-Plus, an urban family-based obesity prevention program for school-aged children. Results: Community engagement in the adaptation process of an urban program to a rural program confirmed some anticipated program content and delivery similarities while identifying key differences that were necessary for adaptation related to engagement with the community, recruitment and data collection, and intervention delivery. Discussion: When adapting research-tested programs from urban to rural areas, it is important to identify the modifiable behavioral, social, and environmental factors associated with obesity to ensure the content of effective childhood obesity prevention programs is relevant. Customizing a program to meet the needs of the community may increase reach, engagement, and sustainability. In addition, long-term dissemination of a tailored program may significantly reduce childhood obesity in rural communities and be implemented in other rural settings nationally. [ABSTRACT FROM AUTHOR]

Purpose: Despite public health efforts to reduce childhood obesity, there remains an unequal distribution of obesity among rural and urban children, with higher rates in rural areas. However, few studies have compared differences in program delivery. This paper aims to describe differences between an urban and rural program delivery of a family-focused, community-based intervention program to prevent and reduce obesity among children.Methods: This paper uses a case study format to provide a descriptive analysis of similar obesity prevention programs, designed by the same research team, implemented in Minnesota in different settings (i.e., an urban and rural setting) with significant community engagement in the adaptation process. The rural NU-HOME program is compared to HOME-Plus, an urban family-based obesity prevention program for school-aged children.Results: Community engagement in the adaptation process of an urban program to a rural program confirmed some anticipated program content and delivery similarities while identifying key differences that were necessary for adaptation related to engagement with the community, recruitment and data collection, and intervention delivery.Discussion: When adapting research-tested programs from urban to rural areas, it is important to identify the modifiable behavioral, social, and environmental factors associated with obesity to ensure the content of effective childhood obesity prevention programs is relevant. Customizing a program to meet the needs of the community may increase reach, engagement, and sustainability. In addition, long-term dissemination of a tailored program may significantly reduce childhood obesity in rural communities and be implemented in other rural settings nationally. [ABSTRACT FROM AUTHOR]

During the COVID-19 lockdown, especially in the first wave of pandemic (March 2020), sedentary lifestyle and calorie intake increase in children became considerably more prevalent. The aim of the present paper was to evaluate changes in children's weights and nutritional habits during the COVID-19 pandemic in Italy. In this cross-sectional observational study, for 3 years, as part of the corporate wellness program (2019–2021) in Emilia Romagna region of Italy, anthropometric data of Ferrari car company employers' children were collected, analyzed, and compared. Moreover, at the visit of November 2020, performed after the first wave of the pandemic with the most rigorous lockdown rules in Italy, a questionnaire on nutritional and lifestyle habits was administered. We evaluated 307 children (163 M, 10.1 ± 2.3 mean aged in 2019). A significant increase in BMI percentile in 2020 (65.2) compared to 2019 (49.2) was observed; it was confirmed, albeit slightly decreased, in 2021 (64.5). About one-third of participants reported an increase in consumption of fatty condiments and more than half report an increase in consumption of junk food. Levels of physical activity were still high during the COVID-19 lockdown, while sleeping time was significantly reduced. Our findings alert us to the importance of carefully monitoring eating behaviors in young to avoid the adoption of unhealthy food habits and prevent childhood obesity, especially during the period of COVID-19 lockdown. [ABSTRACT FROM AUTHOR]

Online contacts and other activities on the Internet came into focus given the increased use during the COVID-19 pandemic. The online environment is a setting for problematic Internet use, including cyberbullying, and research so far shows that inclusion in cyberbullying depends on the amount of screen time. Increases in screen time during the pandemic could affect the growth of the prevalence rates of children's involvement in cyberbullying. The aim of this paper is to compare the Internet habits, cyberbullying and parental role in children's online activities before and during the COVID-19 pandemic, when the use of the Internet increased due to online classes and implemented measures to prevent the spread of the infection. The Institute of Public Health of Split-Dalmatia County conducted a quantitative online survey of Internet habits and problematic Internet use in two waves in 2017 and 2020 with adolescents from 12–18 (N2017 = 536; N2020 = 284). Research included adherence to ethical standards of research with children. An online activity questionnaire for children, a questionnaire of parental behaviors and the European Cyberbullying Intervention Project Questionnaire—ECIPQ were used. The results of the research point out that cyberbullying rates in the pandemic decreased. The results show that the cumulative effect of parental monitoring is medium with approximately 5% of explained variance for experiencing and 6% for committing violence. The similar set of predictors is statistically significant in both regressions. Parental actions of monitoring applications, informing children and monitoring search history are identified as protective factors for committing or experiencing cyber violence. These findings are important for understanding the effect of the general digitization of society, which leads to an extensive increase in the use of online content and various digital tools, and the role of the parents, especially as protective potential for cyberbullying among children. [ABSTRACT FROM AUTHOR]

Family involvement is important in interventions targeting childhood obesity. However, family-based interventions have limited impact. Being labeled obese or overweight and/or perceiving oneself as overweight is associated with weight gain over time. The links between weight perception, labelling, as well as individual and familial identities need to be studied more closely. This paper examines how dynamics of identity and identification within the family impact how the intervention is implemented into daily practices. The dataset consists of 15 semi-structured family interviews with a total of 15 children and 21 parents. The study showed an intense focus on the children's weight and weight loss. Identification as overweight or obese determined how the members of the enrolled families approached the intervention. Children and other family members who identified themselves as being overweight or obese took more responsibility for their own health behavior, but not necessarily in a positive manner. This often resulted in conflicts within the families. Healthcare professionals working with childhood obesity interventions need to consider how to deal with family identity dynamics to secure support as different identities within the family predicts whether the family members find the intervention relevant and whether the intervention was implemented positively into daily life. [ABSTRACT FROM AUTHOR]

Indigenous leafy vegetables (ILVs) play a pivotal role in sustaining the lives of many people of low socio-economic status who reside in rural areas of most developing countries. Such ILVs contribute to food security since they withstand harsher weather and soil conditions than their commercial counterparts and supply important nutrients such as dietary fibre, vitamins and minerals. Furthermore, ILVs contain bioactive components such as phenolic compounds, flavonoids, dietary fibre, carotene content and vitamin C that confer health benefits on consumers. Several studies have demonstrated that regular and adequate consumption of vegetables reduces risks of chronic conditions such as diabetes, cancer, metabolic disorders such as obesity in children and adults, as well as cardiovascular disease. However, consumption of ILVs is very low globally as they are associated with unbalanced and poor diets, with being food for the poor and with possibly containing toxic heavy metals. Therefore, this paper reviews the role of ILVs as food security crops, the biodiversity of ILVs, the effects of processing on the bioactivity of ILVs, consumer acceptability of food derived from ILVs, potential toxicity of some ILVs and the potential role ILVs play in the future of eating. [ABSTRACT FROM AUTHOR]

Background: In India, the prevalence of overweight among adolescents is on the rise, setting the stage for an increase in metabolic syndrome (MS). This paper presents the national prevalence of MS in adolescents in India. Methods: A nationally representative data of adolescents (10–19 years) from the Comprehensive National Nutrition Survey was used. MS was defined based on the NCEP–ATP III criteria for adolescents. Bivariate analysis was used to report socio-demographic differentials in prevalence and to assess interstate variability. Multivariate logistic regression model was constructed to measure the association between socio-demographic characteristics and prevalence of MS. Census data from 2011 was projected to 2017 to calculate burden. Results: The prevalence of MS was 5.2% among adolescents. 11.9%, 15.4%, 26.0%, 31.9% and 3.7% had central obesity, high blood pressure, hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, respectively. The prevalence was higher among males (5.7% vs. 4.7%, adjusted odds ratio (AOR): 1.3, 95% confidence interval [CI]: 1.0, 1.6), those residing in urban areas (7.9% vs 4.2%, AOR: 1.4, 95% CI: 1.1, 1.8), and from wealthier households as compared to their counterparts (8.3% vs. 2.4%, AOR: 3.4, 95% CI: 2.1, 5.5). There was wide interstate variability in the prevalence of MS (0.5% – 16.5%). In 2017, 14.2 million adolescents had MS in India. Conclusions: The prevalence of MS among adolescents in India is low and clustered in urban areas and richer households. Early prevention interventions promoting a healthy lifestyle, especially in high prevalence areas, are needed to keep MS from becoming a public health issue. [ABSTRACT FROM AUTHOR]

Background: The prevalence of childhood obesity (CHO) has gradually increased in India over the past two decades and has necessitated advanced research to address it. Assessing CHO-related research conducted so far is necessary to guide future research. However, a bibliometric assessment of Indian CHO research is unavailable. Aim: The study aimed to map the CHO research published in India during the last two decades. Materials and Methods: The publication data was retrieved from Elsevier's Scopus database using a predefined search strategy. The quality of publications was assessed using indicators such as citations per paper (CPP), relative citation index (RCI), and Hirsch index (HI). Results: India contributed 705 (1.8%) to a global total of 37,762 publications and is currently ranked 15th in CHO-related research; the top 3 countries are the USA, UK, and Australia with 38.1%, 9.6%, and 6.5% publication share respectively. The annual growth in India's publications was 27.4% compared to the global average of 8.7%. The research quality has declined (average CPP 50.6 during 2002-2011 and 25.4 during 2012-2021). Only 25.2% of publications were internationally collaborative. The most productive organizations were AIIMS, New Delhi, PGIMER, Chandigarh, and St. John's Research Institute, Bengaluru, whereas Amrita Institute of Medical Sciences, Sher-i-Kashmir Institute of Medical Sciences, J&K, and Sitaram Bhartia Institute of Science and Research, New Delhi were the most impactful. CS Yajnik, N Tandon, and V Khadilkar were the most prolific, whereas A Laxmaiah, HPS Sachdev, and V Mohan were the most impactful authors. Seven of the ten top productive journals were Indian, but only three were among the most impactful. Conclusion: India lags in CHO research behind other countries having similar current and future projections for the prevalence of CHO. Its research output, but not impact, has increased over the past two decades. India's international collaboration in CHO research is meager. Our analysis identifies the contributions of various stakeholders in addressing CHO and provides a framework for researchers, policymakers, organizations, and national government for future research to develop interventions for effective prevention and control of CHO. [ABSTRACT FROM AUTHOR]

Background: Rates of childhood obesity have accelerated rapidly over the past decade in low- and middle-income countries and in Latin America in particular. At the same time, Latinx children in high-income countries have been disproportionately affected by obesity. Public health and medical experts have called for greater focus on multi-sector approaches to obesity prevention, including policy, systems, and environmental strategies, but current evidence for effective intervention strategies among Latinx children is lacking. Several systematic reviews have investigated obesity prevention interventions in Latinx children in the United States and in Latin America, including our own review, but these are now a decade old. Thus, an updated review of existing interventions is needed. To address this gap, we will conduct a systematic review and summary of interventions for obesity prevention among Latinx children published over the past 10 years. The objective of this paper is to outline the protocol for conducting the systematic review and possible meta-analysis. Methods: We will conduct a literature search using PubMed, ERIC, PsycINFO, Scopus, Scientific Electronic Library Online, and Google Scholar databases for studies of interventions to prevent obesity in Latinx children ages birth to 18 years of age. To meet our definition of an intervention, we will include study designs that evaluate the either the efficacy or effectiveness of obesity prevention interventions, including randomized controlled trials, quasi-experimental studies, and non-randomized interventions with a control or comparison group. We will exclude interventions that aimed to treat rather than prevent overweight or obesity. Interventions may take place in any country or setting. The primary outcome of interest will be child overweight or obesity, measured as adiposity, body mass, or similar anthropometric measures. We will assess risk of bias of included studies using the Cochrane risk of bias tool for randomized and non-randomized studies, as appropriate. We may conduct meta-analyses if studies with comparable exposure and outcome variables are available. Discussion: This protocol paper establishes a methodology for a future systemic review of obesity prevention interventions in Latinx children. A systematic review of this topic will provide an important update to the literature regarding interventions to prevent obesity in Latinx child populations globally over the past decade. Review results will be relevant to stakeholders across multiple sectors engaged in childhood obesity prevention among Latinx children. Systematic review registration: PROSPERO CRD42020161339 [ABSTRACT FROM AUTHOR]

Background: In the era of new normal life after Coronavirus Disease 2019 (COVID-19), our children are experiencing the double threat of COVID-19 and Childhood Obesity (CO-BESITY). The rate of childhood obesity has been rapidly increasing in developed as well as low middle-income countries during the pandemic. Design and Methods: The current paper aims to identify the probable reasons of increase in childhood obesity during this pandemic and offers suggestions to reduce the burden of it. Literature search was done using PubMed, Google Scholar, and Scopus databases for the key terms “childhood obesity,” “obesity,” “pandemic,” and/or childhood obesity. All the relevant articles were included to support the argument for this viewpoint. Results: Childhood obesity is a complicated disorder having diverse outcomes. The incidence of childhood obesity is analysed from Bronfenbrenner’s model of child development. The model examines an overabundance of bio-psycho-social backgrounds, risks, and probable outcomes on the development of a child. COVID-19 pandemic has disrupted the ecosystem of this dynamic model and has created an economic and social-cultural crisis that has ignited a chain reaction of stressors upon children and their families. In this paper, we have described how this Bronfenbrenner’s model of child development also known as the Bioecological Model can be effective for the estimation and prevention of childhood obesity. Conclusion: We propose that this Bioecological Model will help the children and their families further understand and manage the p [ABSTRACT FROM AUTHOR]

Patients suffering from childhood acute lymphoblastic leukemia (ALL) are at risk of late adverse treatment-related effects. The examination of targeted biomarkers could be used to improve the diagnosis and prediction of life-threatening ALL sequelae. The purpose of this cross-sectional study was to search for treatment-related alterations in apolipoprotein (Apo) levels as potential markers of the occurrence of obesity in subjects treated for ALL, and to assess the relationships between weight, gender, anticancer treatment, and Apo concentrations. Fifty-eight ALL survivors were included in the study. The mean time of follow-up after treatment cessation was 5.41 ± 4.29 years. Serum levels of apolipoproteins were measured using a multiplex assay kit. Among ALL survivors, we observed a significant correlation of Apo-C1, Apo-C3, Apo-H, and Apo-J levels, depending on body mass index (BMI). Marked differences were observed in the area under the curve of Apo-A1, Apo-A2, Apo-C1, Apo-D. In our study, patients with a history of childhood ALL developed alterations in their Apo profile. Furthermore, this is the first study revealing that some apolipoproteins may act as valuable biomarkers useful in the prognosis of metabolic imbalance. We believe that this paper, at least partially, will highlight the importance of long-term prognosis of metabolic complications associated with the anticancer chemotherapy used to treat hematological malignancies in children. [ABSTRACT FROM AUTHOR]

Background: Unhealthy diets are a leading contributor to obesity, disability and death worldwide. One factor cited as contributing to rises in obesity rates is the pervasive and ubiquitous marketing of unhealthy foods and beverages (F&Bs) across a variety of mediums, such as sport sponsorship at both professional and amateur levels. Despite increased academic attention on the detrimental impacts of sport sponsorship within the obesogenic environment, this has not been matched by legislative action. One explanation may be the way that F&B corporations' sport sponsorship is framed within policy debates. Framing is the deliberate ways in which (often contested) issues are presented in communication. This paper examines how sport sponsorship by F&B corporations is framed through media reports.Methods: This study employed a mixed methods content and framing analysis. First, we conducted a quantitative newsprint content analysis (n = 234). This then informed and directed a thematic framing analysis of a sub-set of articles (n = 54) that specifically associated sport sponsorship by F&B corporations with obesity and childhood obesity.Results: The findings suggest that two competing frames are evident within newspaper coverage: 1) public health and 2) industry. The public health frame rejects the sponsorship of sport by High in Fat Sugar and Salt (HFSS) product corporations in particular, calling for such sponsorship to be restricted or banned. The industry frame characterises sponsorship of sport as a form of corporate social responsibility, positioning industry as good moral actors and part of the solution to childhood and adult obesity. These frames are evident across other Unhealthy Commodity Industries (UCIs) policy debates. However, the prominence of industry actors within the sample is potentially indicative of their discursive power within this space, particularly with their emphasis on the financial maintenance of sport as well as encouraging physical activity, contributing to the lack of regulatory development of sport sponsorship by F&B corporations.Conclusions: The findings of this study are particularly useful for public health organisations who seek regulatory change, as it may provide further insight into countering industry framing practices, raising the salience of regulation of sport sponsorship and thus increasing the likelihood of regulatory development that seeks to improve population health. [ABSTRACT FROM AUTHOR]

With the rapid development of my country's economy, the rapid improvement of national living standards, the introduction of western fast food culture, and the modern lifestyle, the detection rate of obese patients in my country has increased year by year. Obesity has gradually become an important issue of social concern, especially among students, obesity is very common, seriously affecting the physical and mental health of students, and laying a hidden danger for the development of society. As an effective method, physical exercise has an important impact on the physical and mental health of obese students and has become an important way to solve the obesity problem. On the basis of a large number of literature research, this paper adopts a variety of research methods such as questionnaire survey, expert consultation, mathematical statistics and comparative analysis, and logical analysis. The current situation of extracurricular physical exercise has been investigated in detail, and after data analysis, it is found that obesity has a great negative impact on all aspects of college freshmen. The results of the study showed that the obese college students in Suzhou had a low level of physical health. The average scores of the "National Student Physical Health Standards" for boys and girls were 58.50 and 60.49, respectively, and the failure rates were 48.24% and 43.55%, respectively. Compared with the average level of college students in the whole country, the height, weight, and vital capacity of obese students in Suzhou are higher than the national level, while the vital capacity index is far lower than the national level, and there are significant differences in physical fitness items (obese girls 800 meters), standing long jump, sit-ups are higher than the national level, and there are significant differences; obese boys 1000 meters, sitting forward flexion are lower than the national level, there is a significant difference, while the standing long jump performance is slightly higher than the national level). In terms of mental health, the detection rate of various mild mental health problems among obese college students in Suzhou is as high as 44.56%, and the detection rate of various moderate mental health problems also reaches 9.69%. Compared with the national youth norm, obese college students are prone to psychological problems such as somatization, obsessive-compulsive symptoms, anxiety, terror, psychosis, hostility, and paranoia. [ABSTRACT FROM AUTHOR]

Background: By 2025, adult obesity prevalence is projected to increase in 44 of 53 of European-region countries. Childhood obesity tracks directly onto adult obesity, and children of low socioeconomic position families are at disproportionately higher risk of being obese compared with their more affluent peers. A previous review of research from developed countries identified factors mediating this relationship. This systematic review updates and extends those findings specifically within the context of Ireland and the United Kingdom.Objective: The aim of this systematic review is to summarise peer-reviewed research completed in Ireland and the United Kingdom between 2011-2021 examining mediators of socioeconomic differentials in adiposity outcomes for youth.Design: An electronic search of four databases, Ovid MEDLINE, Embase, Web of Science and EBSCOhost was conducted. Quantitative studies, published in the English language, examining mediators of socioeconomic differentials in adiposity outcomes in youth, and conducted in Ireland and the United Kingdom between 2011-2021 were included. An appraisal of study quality was completed. The systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results: Following screening, a total of 23 papers were eligible for inclusion. Results indicate socioeconomic differentials for Ireland and the United Kingdom follow similar patterns to other developed countries and have similar mediating factors including early life and parent-level factors. However, this review identified additional factors that mediate the relationship, namely access to green space and favorable neighborhood conditions. Identifying these factors present further opportunities for potential interventions and confirm the requirement for tailored and appropriate research and interventions for Ireland and the United Kingdom.Conclusion: This review identified several modifiable factors that should be considered when planning interventions aimed at reducing socioeconomic differentials in adiposity among youth in Ireland and the United Kingdom. Support was found for interventions to be made as early as possible in an at-risk child's life, with the prenatal and preschool periods considered the most efficacious. Results were equivocal about the role of physical activity in the risk of childhood overweight and obesity. While multi-country analyses provide excellent overviews, country- or area-specific research may produce more nuanced, and potentially more powerful findings, which can help better inform policy responses and interventions. [ABSTRACT FROM AUTHOR]

Background: Childhood overweight and obesity is a global public health issue. Although there is evidence of a reduced prevalence in some countries, there is still much controversy about the efficacy of health interventions that aim to prevent and treat obesity in this specific population. The objective of the present study is to develop an overview of systematic reviews (OSRs) that assesses the effects of school-based, family, and multi-component health interventions for the prevention and treatment of obesity, change in physical activity, dietary, and/or hydration behaviors, and change in metabolic risk factors in school-aged children. Methods: This protocol was developed using the methodology proposed by Cochrane. It outlines a comprehensive search in 12 electronic databases to identify systematic reviews of health interventions, including studies that evaluate and how to prevent and/or treat overweight and/or obesity in children aged 6 to 12 years. The risk of bias of the included Systematic Reviews will be assessed with the ROBIS tool. Discussion: Since the OSRs methodology's purpose is only to harmonize evidence from open access publications, ethical consent is not necessary for the present protocol. In terms of diffusion, a paper will be submitted for publication in a scientific journal to describe the main results obtained through the OSRs. Trial registration: The present overview of the systematic review protocol has been registered in PROSPERO (ID number 218296). [ABSTRACT FROM AUTHOR]

Background: The Early Intervention Program (EIP) was a 10-week, blended, in-person and online lifestyle intervention for families with children who were off the healthy weight trajectory. The engagement pattern and the dose response of EIP have not been examined. Objective: The aims of this paper are to examine families' engagement patterns with the EIP and to evaluate the dose-response relationship between EIP engagement patterns and physical activity and healthy eating--related outcomes at 10 weeks. Methods: Families with children (8-12 years old) who are off the healthy weight trajectory (child BMI ≥85th percentile for age and sex) were recruited. Pre- and postintervention questionnaires assessed child lifestyle behaviors, parental support behaviors, family lifestyle habits, as well as parental physical activity and healthy-eating identity. Hierarchical cluster analysis of both in-person and online components was used to classify engagement patterns. Regression analysis assessed differences in outcomes by engagement groups. Results: Two distinct clusters of engagement groups were identified (N=66), which were in-person (IP; n=40, 61%) and in-person + online (IP+; n=26, 39%) engagement. Relative to the IP group at week 10, IP+ showed a greater child moderate-to-vigorous physical activity level (1.53, SD 0.56; P=.008), child physical activity confidence (1.04, SD 0.37; P=.007), parental support for child physical activity (5.54, SD 2.57; P=.04) and healthy eating (2.43, SD 1.16; P=.04), family habits for physical activity (3.02, SD 1.50; P=.049) and healthy eating (3.95, SD 1.84; P=.04), and parental identity for physical activity (2.82, SD 1.19; P=.02). Conclusions: The online EIP portal complemented the in-person sessions. Additional engagement with the portal was associated with greater improvements in child physical activity and parental support behaviors, habits, and identity for physical activity. [ABSTRACT FROM AUTHOR]

Background: Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness. Methods: A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10–19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score. Results: Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n = 22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n = 26) included strategies such as environment modifications (n = 10), digital interventions (n = 15) and parent involvement (n = 16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (− 0.06 [95% CI -0.10, − 0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated. Conclusions: Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy. [ABSTRACT FROM AUTHOR]

Early childhood development (ECD) is a critical stage in the intergenerational process of human development. Targeted interventions depend on accurate and up-to-date ECD measurements. This paper presents estimates for the nutritional and neurodevelopmental status of socially marginalized children in Mexico. We performed a cross-sectional study based on data collected in 2019–2020 during home visits to 1,176 children aged 0–38 months across 24 highly marginalized locations in Oaxaca. We assessed nutritional status according to the World Health Organization 2006 child-growth standards and ECD status using the Child Development Evaluation Test, 2nd Edition. We stratified results by sex. Prevalence of stunting was 5.3 percentage points (p.p.) higher (p = 0.023) in males (25.3%; 95% CI: 20.2%, 31.1%) compared to females (20.0%; 95% CI: 15.0%, 26.1%). Overall prevalence rates stood at 5.7% (95% CI: 4.0%, 8.1%) for underweight, 1.5% (95% CI: 0.9%, 2.7%) for wasting and 3.6% (95% CI: 2.3%, 5.7%) for overweight/obesity, with no significant differences by sex. Prevalence of normal development was 8.3 p.p. lower (p = 0.001) in males (39.3%; 95% CI: 34.5%, 44.4%) compared to females (47.6%; 95% CI: 41.6%, 53.6%). By development area, the highest prevalence of suboptimal outcomes among children with developmental lag or at risk of delay was observed in their gross motor and language skills: 24.1% (95% CI: 20.0%, 28.8%) and 38.6% (95% CI: 34.0%, 43.3%), respectively. The largest difference between the sexes was found in the language area. Our results show that childhood development strategies have been insufficient thus far in the studied population. Programs specifically designed to prevent ECD lags and bridge inequality gaps are urgently needed. Trial registration: ClinicalTrials.gov ID: NCT04210362. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is a pertinent public health problem in the UK. Consumption of free sugars has been associated with the development of obesity. In 2018, the Change 4Life (C4L) 100 cal snack campaign was launched with the slogan '100 calorie snacks, two a day max', aiming to encourage parents to choose lower sugar, fat and calorie snacks for their children. This study aimed to examine how the campaign has been perceived by parents.Methods: An online survey was developed to explore parent awareness, perceptions and understanding of the C4L 100 cal snack campaign. Respondents were recruited via Leeds City Council, posters displayed at primary schools and children's centres across Leeds and via social media. Paper surveys were also shared with voluntarily led playgroups. Survey data was analysed using descriptive statistics. Thematic analysis was performed on open text responses.Results: Three hundred forty-two 342 respondents completed the survey. Just over half of the respondents had come across the campaign, most seeing the leaflet or a television advert. Over two-thirds of respondents 'agreed' or 'strongly agreed' that the campaign caught their attention. A similar proportion 'agreed' or 'strongly agreed' that the campaign informed them about 100 cal snacks and just over a half thought it was memorable. Most respondents used positive language to describe the campaign, but there was no clear consensus of a perceived positive impact on healthier snack purchasing, nor preparing more 100 cal snacks at home. Respondents provided examples of how the campaign could be improved to positively impact eating behaviours: better publicity and information delivery; healthier snack examples made more visible; improved nutritional labelling and access to healthier products in supermarkets (availability, promotion, display, choice).Conclusions: The C4L 100 cal snack campaign was perceived positively by parents and carers, with many agreeing that the campaign was informative and memorable. However, there was no agreement in terms of the parents reporting an impact of the campaign on behaviour change and healthier snack habits. Future social marketing campaigns could be improved through more formal pilot testing to assess the understanding and acceptance of the campaign amongst the target audience. [ABSTRACT FROM AUTHOR]

Background: This study examines the relationships between childhood food allergy and parental unhealthy food choices for their children across attitudes towards childhood obesity as mediators and parental gender, income and education as potential moderators.Methods: We surveyed parents with at least one child between the ages of 6 and 12 living in Canada and the United States. We received 483 valid responses that were analysed using structural equation modelling approach with bootstrapping to test the hypothetical path model and its invariance across the moderators.Results: The analysis revealed that pressure to eat fully mediated the effects of childhood food allergy and restriction on parental unhealthy food choices for their children. Finally, we found that parental gender moderated the relationship between childhood food allergy and the pressure to eat.Conclusions: The paper contributes to the literature on food allergies among children and the marginalisation of families with allergies. Our explorative model is a first of its kind and offers a fresh perspective on complex relationships between variables under consideration. Although our data collection took place prior to Covid-19 outbreak, this paper bears yet particular significance as it casts light on how families with allergies should be part of the priority groups to have access to food supply during crisis periods. [ABSTRACT FROM AUTHOR]

Introduction. Excess weight has been recognized as a global health issue for many years. It is an established risk factor for several chronic conditions, notably cardiovascular disease and diabetes, and is increasingly present in the pediatric population. The purpose of this paper is to review the existent local data regarding pediatric excess weight (including obesity) and its impact. Method. A review of existent literature from the year 2000 and onwards was performed. Only material referring to a Romanian cohort (or subgroup) was included. Results. Of the initial 455 identified records, 62 full text papers in English and Romanian were considered relevant to the topic and analyzed. A mean prevalence of excess weight of 31.6% (WHO), 18.35% (CDC) and 21.37% (IOTF) with obesity rates of 11.4% (WHO), 7.2% (CDC) and 7.69% (IOTF) was calculated. Several factors that could promote excess weight have been identified in Romanian cohorts and are presented. Possible complications are in line with previous published data and mainly involve the cardiovascular system and metabolic effects. Psychological obesity-associated issues have also been reported. Discussion. To our knowledge, there has not been a local study to assess the prevalence of pediatric excess weight at a country level. The available prevalence data is in line with both previous reports of Romanian data and international figures. There does not appear to be an increase in rates over time in the last few years. Systematic country-level attempts to tackle the excess weight problem are few, however smaller range communitybased intervention programs have been reported, with modest results. Conclusions. A worrying proportion of children are overweight or obese in Romania and this may lead to a variety of physical and psychological issues for the child. Conditions such as arterial hypertension and dyslipidemia, typically encountered in adults, are being noted with increased frequency in the pediatric population and their full impact on quality of life and life expectancy is difficult to grasp. Sustained, community-based interventions could possibly achieve a slow reduction in the rates of pediatric excess weight. [ABSTRACT FROM AUTHOR]

Background: Systems thinking embraces the complexity of public health problems, including childhood overweight and obesity. It aids in understanding how factors are interrelated, and it can be targeted to produce favourable changes in a system. There is a growing call for systems approaches in public health research, yet limited practical guidance is available on how to evaluate public health programmes within complex adaptive systems. The aim of this paper is to present an evaluation framework that supports researchers in designing systems evaluations in a comprehensive and practical way. Methods: We searched the literature for existing public health systems evaluation studies. Key characteristics on how to conduct a systems evaluation were extracted and compared across studies. Next, we overlaid the identified characteristics to the context of the Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme evaluation and analyzed which characteristics were essential to carry out the LIKE evaluation. This resulted in the Evaluation of Programmes in Complex Adaptive Systems (ENCOMPASS) framework. Results: The ENCOMPASS framework includes five iterative stages: (1) adopting a system dynamics perspective on the overall evaluation design; (2) defining the system boundaries; (3) understanding the pre-existing system to inform system changes; (4) monitoring dynamic programme output at different system levels; and (5) measuring programme outcome and impact in terms of system changes. Conclusions: The value of ENCOMPASS lies in the integration of key characteristics from existing systems evaluation studies, as well as in its practical, applied focus. It can be employed in evaluating public health programmes in complex adaptive systems. Furthermore, ENCOMPASS provides guidance for the entire evaluation process, all the way from understanding the system to developing actions to change it and to measuring system changes. By the nature of systems thinking, the ENCOMPASS framework will likely evolve further over time, as the field expands with more completed studies. [ABSTRACT FROM AUTHOR]

Background: It is the investigator's responsibility to communicate the relevant information about a clinical trial to participants before they provide informed consent to take part. Systematic reviews indicate that participants often have a poor understanding of the concepts which are key to ensuring valid informed consent, such as randomisation and risks/discomforts. Paper-based participant information leaflets and informed consent forms (PIL/ICFs) are becoming longer and are often too complex for many participants. Multimedia interventions and enhanced PIL/ICFs have been trialled in an attempt to improve participants' understanding of various aspects of research studies. However, there is insufficient empirical evidence to determine how effective such interventions are. This protocol describes a study to evaluate whether an enhanced PIL/ICF and website help research participants to understand important information about a human immunodeficiency virus (HIV) randomised clinical trial.Methods: This Study Within A Trial (SWAT) is a prospective, multi-centre, randomised, controlled, parallel-group study embedded in a host clinical trial. The host trial (the SWIFT trial; EudraCT: 2019-002314-39) is a prospective, multi-centre, randomised, open-label, controlled trial investigating if semaglutide along with dietary advice assists individuals with HIV and obesity to lose weight, compared to dietary advice alone. For the SWAT, participants will be randomised in a 1:1 ratio to either the control (standard PIL/ICF) or the intervention (an enhanced PIL/ICF and a website which includes animations). The enhanced PIL/ICF and website were developed in line with the guidance from organisations which promote plain English and accessible public-facing materials in conjunction with HIV Ireland, a HIV advocacy organisation, and our previous work on consent documents. The primary outcome of the SWAT is the quality of informed consent, assessed by a validated comprehension test-the modified Deaconess Informed Consent Comprehension Test (DICCT). The DICCT will be administered within 48 h of consent to the host trial. The secondary is recall, measured by the modified DICCT questionnaire scores 2 weeks post-consent to the host trial.Discussion: The results of this SWAT will add to the methodological evidence base on the use of multimedia to improve the quality of informed consent to randomised clinical trials.Trial Registration: ClinicalTrials.gov NCT04174755 . EudraCT 2019-002314-39. SWAT 160, Northern Ireland Hub for Trials Methodology Research SWAT repository (Clarke M, et al., Trials. 16:P209, 2015). [ABSTRACT FROM AUTHOR]

Problem. The paper offers findings about selected educational aspects of children's academic performance, examined here in terms of sociodemographic variables, BMI percentile values, cognitive test scores, weight bias internalization scale and self-concept scale with an aim to detect whether and to what extent these factors contribute to children's school results. Methods. 557 fifth graders were administered Vana's Intelligence Test, the Piers-Harris 2 self-concept questionnaire and other tools. Children's educational aspects were assessed in terms of school Absence, Grade Point Average, and Czech and Mathematics grades, with data obtained from their most recent report cards under the Informed consent of their legal representatives and in compliance with ethical standards.. Results. Prepubescent children from stronger socio-economic backgrounds suffer from overweight/obesity less often and perform slightly better at school. The present results suggest a link between weight bias internalization and overweight/obesity, and a somewhat weaker link between self-concept and overweight/obesity in the non-clinical population of prepubescent children. In these relationships of overweight/obese children, as in the cases of alarmingly high school absence, gender is an important variable. Multinomial logistic regression modelling the relationship between Czech and Mathematics grades and selected factors discovered that chances for a worse grade were significantly reduced by the results of Vana's Intelligence Test in both the subjects, while the Self-concept total score proved to be an insignificant factor. Conversely, pupils' Czech grades were negatively influenced by increased BMI (quartile), higher Absence rate, male Gender, Presence of only one parent in the family and WBI, while in Mathematics, in addition to the above-discussed, significant regressors only included Absence and Presence of only one parent. Discussions. The results of the Self-concept total score, the level of which is generally lower in girls than in boys in the population of Czech prepubescent children, agree with other authors' experience. The connection between the male sex and poorer performance in Czech can be partly explained by the fact that the development of speech, reading, writing and grammar is generally less complicated for school-age girls than boys. We can ask why a higher BMI quartile increases the chances of a worse grade only in the case of Czech language? So far, we can only speculate about the causes. In our opinion, it is possible that the impact of parents' education on the performance of children of this age is more pronounced in the Czech language (compared to Mathematics). The other possibility of the impact of the BMI quartile on the Czech grade is the significant predominance of boys in the o/o group. On the other hand, it should be noted that this argument would not explain the o/o children's poorer Grade Point Average score. However, we believe that the above reasons answer partially this question. Conclusion. The vulnerability of o/o girls is pronounced in some domains of Self-concept and Weight bias internalization, while in boys it is reflected in the more frequent occurrence of high levels of Absenteeism, with the precise causes of this being still subject to speculation. In this regard, workers in the cooperating professions should pay continuous attention to strengthening the desirable aspects of education and healthy lifestyle among vulnerable groups of children. Educational aspects of overweight/obese children should therefore continue to receive increased attention. [ABSTRACT FROM AUTHOR]

The global prevalence of overweight (including obesity) in children under 5 years of age was 7% in 2012, and it is expected to rise to 11% by the year 2025. The main objective of this study was to fit spatio-temporal quantile interval regression models for childhood overweight (including obesity) in Namibia from 2000 to 2013 using fully Bayesian inference implemented in R-INLA package in R version 3.5.1. All the available Demographic and Health Survey (DHS) datasets for Namibia since 2000 were used in this study. Significant determinants of childhood overweight (including obesity) ranged from socio-demographic factors to child and maternal factors. Child age and preceding birth interval had significant nonlinear effects on childhood overweight (including obesity). Furthermore, we observed significant spatial and temporal effects on childhood overweight (including obesity) in Namibia between 2000 and 2013. To achieve the World Health Organisation (WHO) global nutrition target 2025 in Namibia, the existing scaling-up nutrition programme and childhood malnutrition policy makers in this country may consider interventions based on socio-demographic determinants, and spatio-temporal variations presented in this paper. [ABSTRACT FROM AUTHOR]

Objective: To identify dietary self-monitoring implementation strategies in behavioural weight loss interventions.Design: We conducted a systematic review of eight databases and examined fifty-nine weight loss intervention studies targeting adults with overweight/obesity that used dietary self-monitoring.Setting: NA.Participants: NA.Results: We identified self-monitoring implementation characteristics, effectiveness of interventions in supporting weight loss and examined weight loss outcomes among higher and lower intensity dietary self-monitoring protocols. Included studies utilised diverse self-monitoring formats (paper, website, mobile app, phone) and intensity levels (recording all intake or only certain aspects of diet). We found the majority of studies using high- and low-intensity self-monitoring strategies demonstrated statistically significant weight loss in intervention groups compared with control groups.Conclusions: Based on our findings, lower and higher intensity dietary self-monitoring may support weight loss, but variability in adherence measures and limited analysis of weight loss relative to self-monitoring usage limits our understanding of how these methods compare with each other. [ABSTRACT FROM AUTHOR]

Given the importance of physical activity for the prevention of overweight, this study sought to determine the type and number of physical activity risk behaviours that were associated with overweight in Croatian school children and their association with maternal characteristics - mothers' formal education, employment, and weight status. This paper used data from the Croatian Childhood Obesity Surveillance Initiative study from 2015/2016. During an eight-week period, anthropometric measurements of children were taken. Data on children's physical activity risk behaviours and their mothers' characteristics were provided by the mothers of 4,045 children from the second and third grade (median age 8.6 years) who were included in the analysis. Insufficient active play outdoors, excessive screen time and exhibiting two or three physical activity risk behaviours were significantly associated with childhood overweight. Children of less educated mothers had lower odds for insufficient active play outdoor and higher odds for insufficient frequenting of a sports or dancing club and exhibiting one, two or three physical activity risk behaviours. Children of mothers who were overweight had higher odds for insufficient sleeping, insufficient frequenting of a sports or dancing club and exhibiting two risk behaviours. Children of unemployed mothers had higher odds for insufficient frequenting of a sports or dancing club and for exhibiting two or three risk behaviours. Physical activity risk behaviours in school children were associated with overweight, as well as their mothers' characteristics. This finding should be taken into consideration when planning and implementing health promotion and childhood overweight prevention activities. [ABSTRACT FROM AUTHOR]

Objectives: Parenting is an integral component of obesity treatment in early childhood. However, the link between specific parenting practices and treatment effectiveness remains unclear. This paper introduces and validates a new parenting questionnaire and evaluates mothers' and fathers' parenting practices in relation to child weight status during a 12-month childhood obesity treatment trial. Methods: First, a merged school/clinical sample (n = 558, 82% mothers) was used for the factorial and construct validation of the new parenting questionnaire. Second, changes in parenting were evaluated using clinical data from the More and Less Study, a randomized controlled trial (RCT) with 174 children (mean age = 5 years, mean Body Mass Index Standard Deviation Score (BMI SDS) = 3.0) comparing a parent support program (with and without booster sessions) and standard treatment. Data were collected at four time points over 12 months. We used linear mixed models and mediation models to investigate associations between changes in parenting practices and treatment effects. Findings: The validation of the questionnaire (9 items; responses on a 5-point Likert scale) revealed two dimensions of parenting (Cronbach's alpha ≥0.7): setting limits to the child and regulating one's own emotions when interacting with the child, both of which correlated with feeding practices and parental self-efficacy. We administered the questionnaire to the RCT participants. Fathers in standard treatment increased their emotional regulation compared to fathers in the parenting program (p = 0.03). Mothers increased their limit-setting regardless of treatment allocation (p = 0.01). No treatment effect was found on child weight status through changes in parenting practices. Conclusion: Taken together, the findings demonstrate that the new questionnaire assessing parenting practices proved valid in a 12-month childhood obesity trial. During treatment, paternal and maternal parenting practices followed different trajectories, though they did not mediate treatment effects on child weight status. Future research should address the pathways whereby maternal and paternal parenting practices affect treatment outcomes, such as child eating behaviors and weight status. [ABSTRACT FROM AUTHOR]