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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]

Introduction: Adolescents' perceptions of eating and culinary behaviours have important implications for their health and nutritional profiles. The purpose of the current investigation is to understand Indian adolescents' perceptions of healthy eating and meal preparation. Methods: Year nine students (n = 1026; 35% males) aged 14–16 years from nine English-speaking private secondary schools in Kolkata, India completed a paper-based, self-reported questionnaire which included questions about facilitators and barriers to healthy eating and meal preparation. Cross-tabulation analyses were performed to examine gender differences on the healthy eating measures. Results: Overall, the adolescents highlighted a number of key facilitators and barriers to healthy eating and meal preparation. The preference for water over sugar-sweetened beverages was cited as the most popular facilitator of healthy eating by adolescents (65.7%). The most commonly perceived barrier to healthy eating was the need for strong motivation to consume a healthy diet (56.1%). The importance of using fresh produce in food preparation (76.5%) emerged as the most prominent component of meal preparation. Conversely, the use of food lists was perceived as the least important aspect of healthy meal preparation (54.2%). In general, girls showed more positive attitudes towards healthy eating and meal preparation compared to boys. Conclusion: This understanding of Indian adolescents' perceptions of healthy eating and meal preparation suggests the development of skills-focussed nutrition education programmes to support young people in preparing and consuming healthy meals. [ABSTRACT FROM AUTHOR]

The article discusses the use of latent class trajectory analysis in child growth and obesity research. Latent class trajectory models (LCTMs) are statistical methods used to identify distinct groups of children with similar growth patterns. However, LCTMs have limitations, including providing a poor fit for longitudinal data and failing to capture individual-level growth curves. The article argues that a growth mixture model (GMM) with fewer constraints is a better alternative. The author recommends following the Guidelines for Reporting on Latent Trajectory Studies (GRoLTS) to ensure the development of a good model and accurate reporting. Overall, the article suggests caution when interpreting research that relies on LCTMs in child growth and obesity studies. [Extracted from the article]

Despite the growing literature on childhood obesity and lifestyle intervention programmes focusing on weight loss, few studies have examined young persons’ experiences of being identified as candidates for such programmes and of participating in them. This paper does so. Juxtaposing insights from phenomenology with an approach inspired by Foucault, the paper shows how teenage girls’ bodily self-perception and bodily self-awareness are shaped in intercorporeal assemblages comprising other people and specific features or elements of the lifestyle programme. Inspired by van Manen’s hermeneutic-phenomenological approach, with its point of departure in lived experience, this paper draws on interviews with Norwegian teenage girls participating in the same lifestyle programme and identifies three core thematic aspects of the girls’ experiences: being identified as a candidate for a lifestyle programme and not wanting this; negotiating the lack of weight loss and the scales; and bodily situated agency - feeling good and being able. Permeating all three themes are two central, interrelated phenomena: agency and resistance. Furthermore, the paper shows how a combination of Foucauldian insights and a phenomenological understanding of intercorporeality can help to shed light on the power, affective, material and temporal dimensions of dys-appearance (i.e., when one’s body appears as bad or wrong), as well as those of eu-appearance (i.e., when one’s body appears as healthy or strong), and thus contribute to the understanding of the girls’ narrated lived experiences. On the basis of these findings, we argue that weight-related treatment goals are not necessarily compatible with the strengthening of adolescents’ body images and self-esteem. However, whilst being obliged to attend to their bodies while in the programme, the girls also encountered unexpected, positive bodily feelings and experiences. Such events, we suggest, offer a means of resisting the more troubling dys-appearing bodily situations our participants described so powerfully. [ABSTRACT FROM AUTHOR]

Objective: Paternal participation and experiences in childhood weight management is an understudied studied area. Given the important role fathers play in childhood obesity prevention and treatment, the aim of this study was to explore Norwegian fathers' experiences of helping to prevent further weight gain in their children with overweight or obesity. Methods: Data were collected through semi-structured interviews with eight fathers of ten children with overweight or obesity and analysed by qualitative content analysis. Results: The analysis resulted in one overall theme: Balancing between assuming and avoiding responsibility for weight management with a desire to preserve the child's dignity, comprising two themes: 1) Alternating between concern, helplessness and responsibility, 2) Needing acknowledgement, and flexible and tailored professional support, both of which have several sub-themes. Conclusion: Fathers need guidance on how to talk to their children to prevent further weight gain, while at the same time emphasizing safeguarding the child's dignity. Healthcare professionals should address parents' own emotional barriers and include fathers to a greater extent as a resource in family-centred counselling and tailor guidance and support to help with childhood weight management. [ABSTRACT FROM AUTHOR]

Background: In many low- and middle-income countries, the 2019 novel coronavirus (COVID-19) has challenged efforts to ensure access to and availability of quality maternal, newborn, and child health (MCH) services and essential MCH commodities. Objectives: This study evaluated the impact of COVID-19 pandemic on the availability of maternal and child health products and childhood vaccines at selected health facilities in Ethiopia. Methods: We have prospectively assessed 28 maternal–child health products and 14 childhood vaccines and accessories, which are listed in the Ethiopian national essential medicines list. Data were collected from 5 hospitals located in the Jimma zone of Oromia regional state in the southwestern part of Ethiopia. We extracted data on drug availability, and order fill rates for these pharmaceutical products between May 2019 and August 2020. Results: The overall mean availability of selected maternal and child health products was 43.2%. It was 52.9% (range 21.0–63.6%) prior COVID-19 and 42.6% (range 19–56.4) during COVID-19 time. The average monthly orders fill rates of hospitals for the selected products ranged from 39 to 79%. Before COVID-19 the average order fill rate was near 70% of total orders placed by the hospitals. However, immediately after the COVID-19 case notification in Ethiopia, the percentage of order filled correctly in items and quantities began decreasing. Conclusion: This study illustrates that the availability of key essential medicines for maternal and child health in the study area was low. The overall stock-out situation of MCH products has worsened during COVID-19 compared to pre-COVID-19 pandemic. None of the surveyed MCH products met the ideal availability benchmark of 80% in the public hospitals. To allow governments to guarantee these products are constantly available and affordable, a variety of policy frameworks and choices addressing inevitable epidemics should exist. [ABSTRACT FROM AUTHOR]

Every third child in Croatia is classed as overweight or obese. Infant growth can represent early warning signs for obesity. To detect early risk factors for obesity by investigating infant size and early growth trajectories and their association with maternal lifestyle and breastfeeding. Ninety-eight mother–child pairs from the Croatian Islands' Birth Cohort Study (CRIBS) cohort were included in the study. Data were collected from questionnaires and medical records. Growth data were converted to Z-scores using World Health Organisation (WHO) standards and used as the primary outcome. Z-score trajectories in the first year of life were in line with WHO standards. A direct link between infant size and maternal socioeconomic status (SES) or breastfeeding was not detected. However, child weight gain in the first 6 months was associated with maternal body mass index (BMI) before pregnancy (p < 0.01). A positive association was also established between breastfeeding and maternal SES and mothers that report an unhealthy diet have heavier children (p < 0.05, respectively). Infant size and early growth in Croatia is in line with WHO standards and risk factors for obesity development were detectable in the first year of life, but not highly pronounced. However, more effective BMI monitoring and promotion of a healthy diet and lifestyle of women before and during pregnancy is needed. [ABSTRACT FROM AUTHOR]

Separation or monotone-likelihood can be observed in fitting process of a multinomial logistic model using maximum likelihood estimation (MLE) when sample size is small and/or one of the outcome categories is rare and/or there is one or more influential covariates, resulting in infinite or biased estimate of at least one regression coefficient of the model. This study investigated empirically to identify the optimal data condition to define both 'separation' and 'near-to-separation' (partial separation) and explored their consequences in MLE and provided a solution by applying a penalized likelihood approach, which has been proposed in the literature, by adding a Jeffreys prior-based penalty term to the original likelihood function to remove the first-order bias in the MLEs of the multinomial logit model via equivalent Poisson regression. Furthermore, the penalized estimating equation (PMLE) is extended to a weighted estimating equation allowing for survey-weight for analyzing data from a complex survey. The simulation study suggests that the PMLE outperforms the MLE by providing smaller amount of bias and mean squared of error and better coverage. The methods are applied to analyze data on choice of health facility for treatment of childhood diseases. [ABSTRACT FROM AUTHOR]

The family environment is crucial in the prevention and treatment of childhood obesity; however, there is a lack of knowledge concerning paternal perceptions and experiences in childhood weight management. The aim of this study was to explore (i) perceptions of contributing factors to childhood overweight and obesity among fathers of children with overweight or obesity and (ii) the fathers' experiences of their parental role caring for a child with overweight or obesity. A qualitative content analysis was conducted of data from semi-structured in-depth interviews with eight Norwegian fathers of ten children and adolescents with overweight or obesity. The analysis identified one overall theme; Feeling uncertain and struggling to understand their own responsibility for the child's overweight or obesity, which consists of two themes; 1)Trying hard to figure out the child's obesity as a complex interaction of factors and 2)Family functioning—negotiating roles and responsibility in parenthood. Fathers must be met with understanding about their uncertainty and their struggle to understand their individual responsibility for their child's weight excess. It can be necessary to address the significance of family functioning, collaboration, responsibility within the familiy in addition to structural responsibility in clinical dialogues and counselling in order to help with weight management [ABSTRACT FROM AUTHOR]

The global rise in the prevalence of childhood overweight and obesity has necessitated the need for global standards, which is very important for cross-cultural or national comparisons, and to assess the effectiveness of various proposed measures of body composition. In this paper, the body composition of 411 children, consisting of 163 boys and 248 girls, aged 10.49 ± 1.12 years, was analysed based on body mass index (BMI) and two body fat references from Korea (BFK) and the UK (BFUK). BMI was the most sensitive estimate of adiposity (overweight = 15.8%; obesity = 6.6%), when compared with BFUK (overweight = 7.8%; obesity = 3.2%) and the BFK (overweight = 10.2%; obesity = 0.5%). Although, there was significant correlation between BFK and BFUK (r = 0.89, p < 0.0001), BFK and BMI (r = 0.644, p < 0.0001), and BFUK and BMI (r = 0.646, p < 0.0001), they fairly agreed (intraclass correlation coefficient = 0.537), as BMI reliably estimated body fat in normal weight, but overestimated body fat in overweight and obese children. Of all the demographic and physical activity variables, only gender was significantly associated with difference in body fat estimation, as BMI estimation of body fat was higher in girls than in boys. Hence, we must be cautious in using BMI as a surrogate for body fat, especially among overweight and obese children. [ABSTRACT FROM AUTHOR]

Although genetic susceptibility explains the clustering of multiple sclerosis (MS) cases within families, the changes in MS risk that occur with migration can be explained only by changes in the environment. The strongest known risk factor for MS is infection with Epstein-Barr virus (EBV). Compared with uninfected individuals, the hazard of developing MS is approximately 15-fold higher among individuals infected with EBV in childhood and about 30-fold higher among those infected with EBV in adolescence or later in life. Although the mechanisms underlying this association remain unclear, the data provide strong evidence of a causal relation between EBV infection and MS risk. Relevant aspects of MS epidemiology beyond genetics are not explained by EBV involvement, however, implying the involvement of other factors. Modifiable factors for MS risk include smoking and childhood obesity. Increased risk of MS in individuals with vitamin D insufficiency has been proposed to explain the strong latitude gradient in MS prevalence. Results of case-control studies that relied on prevalent MS cases have been mixed, however, and potentially influenced by selection and recall biases. In a recent case-control study of individuals presenting with a first demyelinating episode, higher levels of vitamin D, sun exposure or actinic damage were found to be associated with reduced MS risk. Two longitudinal studies have thus far been completed. In the first, based on assessment of vitamin D intake from diet and supplements, the risk of MS was found to be 30% lower among women in the highest quintile compared with those in the lowest quintile. In the second study, conducted among young adults in the US military, vitamin D status was assessed by averaging multiple season-adjusted measures of 25-hydroxyvitamin D (25[OH]D). During an average of 5 years' follow-up, MS risk among healthy young adults with serum levels of 25(OH) vitamin D >100 nmol/l was about 60% lower than in individuals of the same age and sex with serum 25(OH) vitamin D levels <100 nmol/l. If confirmed, these findings suggest that a high proportion of MS cases could be effectively prevented by vitamin D supplementation. Furthermore, there is growing evidence that vitamin D insufficiency is a risk factor for conversion from clinically isolated syndrome to MS and for MS progression. Both prevention and treatment trials with vitamin D are needed to confirm these findings and to determine optimal levels of vitamin D. [ABSTRACT FROM AUTHOR]

Background:Malta is an obesogenic country with low levels of daily moderate-to-vigorous physical activity (MVPA) reported amongst Maltese children. Schools play a significant cost-effective role in delivering and encouraging physical activity and thus contributing to population health. So far, there were no specific school-based physical activity interventions in Malta. This creates a public health action gap. The study will assess the feasibility of Maltese children engaging in MVPA in more than 50% of Physical Education lesson time through an evidence-based PE curriculum. Its longitudinal effects on school children's anthropometric factors, cardiorespiratory fitness and biomechanical variables are evaluated.Methods:One-hundred twenty 9-to-10-year-old children, attending state primary schools, participated in a time-series study design over one scholastic year. The intervention group (n = 76) had Sports, Play and Active Recreation for Kids (SPARK) PE curriculum. The control group (n = 44) was taught the national PE curriculum. The functional outcome measures included vertical jump height and posturography. Lesson MVPA levels were measured with the System for Observing Fitness Instruction Time (SOFIT). Other measurements included: BMI z-scores, waist circumference and resting heart rate (RHR).Results:Achievement of >50% of PE lesson time in MVPA intensity is feasible through an evidence-based PE curriculum (60.43% from a baseline of 36.43% in intervention group vs 39.06% from a baseline of 39.89% in control). The intervention group reported improvements in BMI z-scores (p = 0.007; CI = 0.02, 0.15), RHR (p = 0.009; CI = 1.10, 7.46), balance parameters and jump height (p = 0.020; CI = −2.42, −0.23).Conclusions:MVPA levels were successfully increased through the evidence-based physical education curriculum with resultant positive health effects. Force platform analysis allows objective fitness monitoring in schoolchildren. This study recommends the integration of evidence-based PE curricula as a public health initiative against childhood obesity. [ABSTRACT FROM AUTHOR]

Hypertension in children and adolescents has increased over the years and is considered as a major public health issue. The correlation between obesity and hypertension is well established; data show the persistence of elevated blood pressure in children and adolescence into adulthood, which leads to cardiovascular diseases. In the EDDY-Kids 2019 prevention programme, we measured the blood pressure of 123 school children (ages 8–12) over the period of 6 months, starting in January, additionally giving weekly nutrition lessons and sports activities to evaluate the influence of a nutrition-, sports-, and lifestyle intervention on the children's body composition, weight, and blood pressure. At all stages of the project, the number of children with elevated pressure was lower in the normal and below-normal cohorts compared to the overweight and obese group. This demonstrates a positive correlation between obesity and hypertension. In both groups, blood pressure values dropped over the time period of the programme. This could be the result of the intervention programme or the children adapting to the unusual situation. A lot of children were nervous or haven't even experienced a blood pressure measurement before. The results clearly underline the necessity of measuring children's blood pressure on a regular basis (annually or semi-annually) to allow nurses and doctors to facilitate the earliest possible diagnosis of elevated blood pressure in children, thereby helping to prevent a persistence of hypertension into adult age. [ABSTRACT FROM AUTHOR]

Levels of obesity are rising in South Africa, notably among adolescent females. Excessive energy-dense diets and physical inactivity are among the factors contributing to this increase. Given that these factors are largely behavioural, understanding young people's views of obesity can contribute to more targeted behavioural interventions. Yet little is known of how rural South African adolescents view obesity. The aim of this study was to explore rural South African adolescents' views of obesity, including their understanding of its causes, consequences, and solutions. This qualitative study took place within the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) study area, in rural northeast South Africa. Three focus group discussions were held with male (n = 16) and female adolescents (n = 15), aged 14–19 years in 2018. Data were analysed using thematic analysis and the Social Cognitive Theory used to frame the findings. Participants presented conflicting views of obesity, with both positive and negative opinions expressed. Causes of obesity were seen to be multifactorial, including genetics, diet, lack of physical activity, and HIV treatment. Adolescents proposed medication and hospitalisation as ways to address obesity. When discussing interventions to address obesity, adolescents expressed the need for more information, suggesting that providing information to both themselves and their family members as part of interventions would be important. Rural South African adolescents have a complex perspective of obesity, likely driven in part by the current nutrition transition underway and do not inherently see individual behaviour as a driver or mitigator of obesity. Complex interventions including the involvement of other household members are needed to change adolescents' views on the role of the individual, and ultimately, change both individual and household behaviour to prevent obesity. [ABSTRACT FROM AUTHOR]

Introduction: Primary schools have been widely identified as a key site to tackle childhood obesity. While specific school-based interventions have been widely researched, there is an absence of collective analysis of national policies targeting childhood obesity and its determinants in primary schools. Therefore, this narrative review of English policy documentation from 2010 to 2017 examines the extent of alignment across governmental aspirations and implementation approaches towards childhood obesity, physical activity and healthy eating. Methods and analytic framework: Using Arksey and O'Malley's scoping review methodology, 43 relevant policy documents were identified. From these documents, statements of policy aspirations were coded according to the different levels of the socio-ecological model (SEM). Information on policy implementation was coded according to Hood's "NATO" taxonomy of "Nodality", "Authority", "Treasure" and "Organisation" tools which governments can utilise to implement policy. Findings: Common articulations of aspirations to address recognised problems of childhood obesity were identified across policy documents, with the need for multi-level action articulated more clearly for healthy eating than physical activity. The government's signature Childhood Obesity Plan published in 2016 was an isolated example of a policy document that encompassed aspirations across all SEM levels, but still replicated a wider trend in which only aspirations for individual-level behaviours were articulated with precision. Policy documents evidenced uses of information dissemination, funding, organisational direction and, less prominently, governmental authority to drive policy implementation in primary schools. However, the use of these policy tools was often vaguely specified and disjointed both across different tools and between physical activity and healthy eating policies. Conclusion: High-level aspirations in national policy documents align across the dual approach of tackling childhood obesity by enhancing physical activity and healthy eating. However, the effectiveness of policies is likely constrained by limited alignment across different levels of the SEM and across different policy implementation tools. [ABSTRACT FROM AUTHOR]

The time spent in different types of sedentary behaviours has been associated with a poor intake in children, which contributes to childhood obesity. The aims of this study were: to examine the association between sedentary behaviours and the adherence to the total screen time (TST) recommendations, food and beverage consumption and the total diet quality index (DQI), in a sample of Spanish children. The study included a cohort of 420 children (53.6% boys) aged 7 years from Zaragoza (Spain), belonging the Growth and Feeding during Infancy and Early Childhood in Aragon (CALINA) longitudinal study. Data on dietary habits and TST (watching TV/DVD/videos and playing/using personal computers (PC)/video games) were parental-reported. TST was categorized based on the recommendations (≤2 h/day and >2 h/day). The DQI was computed from a validated semi-quantitative food-frequency questionnaire. Generalized linear mixed models, adjusted by maternal education, ethnicity and body mass index of the children, were analysed. Both in boys and girls, using a PC for ≤2 h per day was associated with a lower consumption of sugar and artificially sweetened beverages. In boys, using PC for ≤2 h per day was associated with a lower consumption of sweets, desserts and salty snacks and in girls, were associated with a lower consumption of juices and a higher consumption of fruits and vegetables. Only in boys, a low TST per day was assSociated with a lower consumption of sugar-sweetened beverages, whereas in girls, it was associated with a lower consumption of artificially sweetened beverages. Regarding DQI, both, boys and girls, showed inverse associations between watching TV and total ST and the DQI; boys and girls meeting the TST recommendations (<2 h/day) had a better diet quality. Sedentary behaviours were associated with unhealthy food and beverage consumption and a low total diet quality. [ABSTRACT FROM AUTHOR]

Purpose: Lifestyle interventions can be effective in the management of overweight and obesity in children. However, ineffective guidance towards interventions and high attrition rates affect health impacts and cost effectiveness. The aim of this study was to gain insight into the factors influencing participation, in particular guidance towards, adherence to and completion of an intervention. Methods: A narrative literature review was performed to identify factors related to participation, leading to the development of the "Stages towards Completion Model". Semi-structured interviews (n = 33) and three focus group discussions (n = 25) were performed with children and parents who completed two different group lifestyle interventions, as well as with their coaches. Results: The main barrier to participating in a lifestyle intervention was the complex daily reality of the participants. The main facilitator to overcome these barriers was a personal approach by all professionals involved. Conclusions: Participation in a lifestyle intervention is not influenced by one specific factor, but by the interplay of facilitators and barriers. A promising way to stimulate participation and thereby increase the effectiveness of interventions would be an understanding of and respect for the complex circumstances of participants and to personalize guidance towards and execution of interventions. [ABSTRACT FROM AUTHOR]

Introduction: Childhood obesity has serious health risks including the development of metabolic syndrome, cardiovascular disease and mortality later in life. The critical growth period from 3 to 7 years provides a window of opportunity for interventions. The goal of this study is to evaluate a one year, multidisciplinary, low-intensity treatment program for young obese children, complemented with web-based modules, called "AanTafel!", on body composition, cardiometabolic risk profile, quality of life (HRQoL), eating behavior and physical activity. Methods: In the pre-post-test design all measures were taken at baseline, 4 months, at the end of treatment and 3 years after baseline. Results: Thirteen boys and 27 girls with median BMI z-score of, respectively, 4.2 and 3.3 aged 3 to 8 started "AanTafel!". Eighty percent (n = 32) completed treatment. BMI z-score decreased with 0.45 (end of treatment) and sustained after 3 years. At the start, 16.7% of the children had all four components of metabolic syndrome which decreased to 0%. HDL cholesterol significantly increased. Concentrations of the markers IL18, e-selectin, and sICAM significantly decreased indicating a reduction of inflammation. Conclusion: "AanTafel!" is effective in improving health of obese young children. The reduction of overweight is clinically relevant and sustained after 3 years. [ABSTRACT FROM AUTHOR]

Objectives: The relation between rapid infancy weight gain (RWG) and childhood obesity has been extensively evaluated but studies examining total food intake and food groups among infants with RWG and normal weight gain (NWG) are limited. Therefore, we aimed to explore: (i) the characteristics of infants with a rapid growth during the second semester of life; (ii) the association between feeding practices (breast-fed vs. formula-fed infants) and RWG and (iii) the association between food intake and food patterns at 9 months of age and RWG. Study design: One-year follow-up study of a cohort of infants from the north of Spain. Methods: 195 infants were measured. Parents recorded all infant´s food consumption for 3 days (grams/day). Mixed-effects logistic regression models were applied. Results: In basic models, breast-feeding practices were associated with a lower risk of RWG (OR = 0.54, 95%CI 0.35–0.84) compared to formula-fed infants. However, this association was no longer significant when additionally adjusting for early-life risk factors and total food intake. Infants with RWG had a higher intake of cereals (OR = 1.03, 95%CI 1.00–1.07), fruit baby food (OR = 1.01, 95%CI 1.00–1.01), and total food intake (OR = 1.02, 95%CI 1.00–1.04) at 9 months of age. Conclusions: Infants with rapid growth during the second semester of life had a higher intake of cereals, fruit baby food, and total food intake compared to the NWG group. Differences in food patterns and intake among infants with rapid weight gain during the second semester might lead to programming towards childhood obesity. [ABSTRACT FROM AUTHOR]

Introduction: This cross-sectional study aims to describe the objectively measured sedentary time (ST) and physical activity (PA) patterns of preschool children during the day, and to compare these patterns between non-overweight and overweight children. Methods: Healthy children aged 3–6 years were recruited from urban preschools in Tianjin, China. Light PA (LPA), moderate-to-vigorous PA (MVPA), and ST of children were measured using ActiGraph accelerometry (at least 3 wearing days, more than 10 hours per day). Multiple adjusted, generally linear mixed models were used for statistical analysis. Results: The time children (n = 134) spent in MVPA was 50.5 ± 17.1 minutes/day, and there were 28% of the children met the PA recommendation of one hour MVPA per day. Children were less active during recess (12:00–14:00) and afternoon (14:00–17:00), and more active during late afternoon (17:00–18:00) and evening (18:00–21:00). Between active and less active children, the difference of MVPA was highest in the evening (4.1 min/hour) and on weekends/holidays (42.7 min/day). Overweight children were more sedentary overall (44.6 minutes/day) compared to non-overweight children. Conclusion: Chinese preschoolers have low levels of PA, especially during school days. Enhancing PA both in school and the home environment should be taken into consideration to prevent childhood obesity. [ABSTRACT FROM AUTHOR]

Background: In addition to health problems or increasing the significant risk of health problems, obesity is also negatively associated with several socioeconomic outcomes. Obesity could negatively influence academic outcomes. The relationship between obesity rates and academic performance deserves attention because obesity rates have been steadily increasing over the last few decades. Purpose: Most of the existing studies assess the effect of student obesity on the student's own educational outcomes. In this study, we examine the relationship in the context of obesity at the student grade level, which allows us to partially examine the influence of stigmatisation. Design & methods: The main variables of interest are obesity rates and academic proficiency rates. We study public school students, grades kindergarten (K) through to 12, in Arkansas. Multilevel methods are employed to account for similar factors at various levels in the school hierarchy, i.e., at the grade-, school- and school district-level. Results: Obesity prevalence is positively associated with the percentage of students performing below proficiency levels in both literacy and maths. Our findings also suggest that stigmatisation experienced by obese children may be one mechanism behind this association. Conclusions: The findings favour the hypothesis that obese students could face greater psychological consequences in school settings with a smaller percentage of obese students and vice versa. [ABSTRACT FROM AUTHOR]

Background: Increasing numbers of children are facing health problems as a result of physical inactivity. Besides the home, school is a natural place to promote children’s daily physical activity (PA). Knowledge about factors promoting or preventing children’s PA at school, from the perspective of children, is limited. Purpose: The purpose of this study is to learn the factors that eight- and nine-year-old schoolchildren identify from their school environment related to physical activity during their school day. This study was established as a sub-project within a larger, sixteen-country collaboration project by HEPCOM (Promoting Healthy Eating and Physical Activity in Local Communities) and reports on a piloting phase. Sample: Finnish second-graders (age 8-9 years, n = 22) from one primary school participated in the study. Method: A photo-elicitation methodology was used, including photographs taken by children and interviews in groups based on the photographs. The data were analysed qualitatively by inductive content analysis. Results: The children described factors appearing in the physical environment, such as the playground, and those in the nonmaterial, abstract environment, such as the weather. According to the findings, three categories emerged: (1) personal and economic, related to children’s individual preferences and opportunities; (2) sociocultural, related to friends and belonging in a group; and (3) environmental, related to physical and political outdoor and indoor solutions at the school, as well as to policies and rules in the school community. Children emphasised the importance of friends and games, but play areas were also experienced as significant. Based on children’s experiences, rules and laws direct all activities at school, which was not always perceived as a positive thing. Conclusions: Although the findings of this small-scale study cannot be generalised, the children’s perceptions suggest some crucial areas for future research. Playing and exercising during the school day are important in fulfilling the recommendations for daily PA for children, as well as in promoting their mental and social health. To enable equal possibilities for an active lifestyle for all children at school, positive and encouraging adults, as well as age-appropriate and safe infrastructure, are needed. The children’s day should be viewed as a whole, not as single situations, where physical activities are offered. [ABSTRACT FROM AUTHOR]

Over the past 2 decades, the incidence of childhood obesity has risen dramatically. This recent rise in childhood obesity is particularly concerning as adults who were obese during childhood develop type II diabetes that is intractable to current forms of treatment compared with individuals who develop obesity in adulthood. While the mechanisms responsible for the exacerbated diabetic phenotype associated with childhood obesity is not clear, it is well known that childhood is an important time period for the establishment of normal white adipose tissue in humans. This association suggests that exposure to obesogenic stimuli during adipose development may have detrimental effects on adipose function and metabolic homeostasis. In this study, we identify the period of development associated with puberty, postnatal days 18–34, as critical for the establishment of normal adipose mass in mice. Exposure of mice to high fat diet only during this time period results in metabolic dysfunction, increased leptin expression, and increased adipocyte size in adulthood in the absence of sustained increased fat mass or body weight. These findings indicate that exposure to obesogenic stimuli during critical developmental periods have prolonged effects on adipose tissue function that may contribute to the exacerbated metabolic dysfunctions associated with childhood obesity. [ABSTRACT FROM PUBLISHER]

Background: Mexico is a developing country with one of the highest youth obesity rates worldwide; > 34% of children and adolescents between 5 and 19 years of age are overweight or obese. Objectives: The current review seeks to compile, describe, and analyze dietary conditions, physical activity, socioeconomic status, and cultural factors that create and exacerbate an obesogenic environment among Mexican youth. Design: A narrative review was performed using PubMed and the Cochrane Library databases, as well as grey literature data from the Mexican government, academics, and statistical reports from nongovernmental organizations, included in electronic formats. Results: The recent socioeconomic and nutritional transition has resulted in reduced healthy meal options at public schools, high rates of sedentary lifestyles among adolescents, lack of open spaces and playgrounds, socioeconomic deprivation, false or misunderstood sociocultural traditional beliefs, misconceptions about health, a high percentage of overweight or obese adults, and low rates of maternal breastfeeding. Some of the factors identified are exacerbating the obesity problem in this population. Current evidence also shows that more policies and health programs are needed for prevention of childhood and adolescent obesity. Mexico presents alarming obesity levels, which need to be curtailed and urgently reversed. Conclusions: The present narrative review presents an overview of dietary, physical activity, societal and cultural preconceptions that are potentially modifiable obesity-promoting factors in Mexican youth. Measures to control these factors need to be implemented in all similar developing countries by governments, policy makers, stakeholders, and health care professionals to tackle obesity in children and young people. [ABSTRACT FROM AUTHOR]

Objective: The objective was to determine the prevalence of underweight, overweight and obesity in high school learners in the Cape Town area. Design: A cross-sectional study was conducted. Setting: High schools in the Cape Metropole Area of the Western Cape. Subjects: A complex cluster sampling procedure was followed. Thirty-six students per school were selected from each randomly selected school. Thirteen- to 18-year-old pupils were eligible for inclusion. Outcome measures: Height and weight measurements. Results: The sample comprised 689 students. There were considerably more underweight adolescent boys than adolescent girls (17.3% boys to 9.9% girls), and double the frequency of overweight adolescent girls than adolescent boys (7.7% girls to 3.5% boys). The 14-year-old boys had the highest prevalence of underweight (55.2%), and the 17-year-old girls the highest prevalence of overweight (22%). The highest prevalence of obesity was found in 15-year-old boys (11.1%), who also demonstrated a relatively high prevalence of underweight (30.2%). Conclusion: This study reported on a substantial percentage of underweight adolescents (27.1%). Noteworthy levels of overweight and obesity in adolescent girls added to the substantial prevalence of underweight in adolescent boys. Africa has enough to contend with in respect of transmissible diseases, without additional lifestyle-based health burdens. [ABSTRACT FROM AUTHOR]

Childhood obesity is a major concern in today's society. Research suggests the inclusion of the views and understandings of a target group facilitates strategies that have better efficacy. The objective of this study was to explore the concepts and themes that make up children's understandings of the causes and consequences of obesity. Participants were selected from Reception (4-5 years old) and Year 6 (10-11 years old), and attended a school in an area of Sunderland, in North East England. Participants were separated according to age and gender, resulting in four focus groups, run across two sessions. A thematic analysis (Braun & Clarke, 2006) identified overarching themes evident across all groups, suggesting the key concepts that contribute to children's understandings of obesity are "Knowledge through Education," "Role Models," "Fat is Bad," and "Mixed Messages." The implications of these findings and considerations of the methodology are discussed in full. [ABSTRACT FROM AUTHOR]

Objective. To investigate the feasibility and impact on BMI and physical fitness of an intervention for obese and inactive children, based on physical activity and carried out in primary health care. Design. A prospective, longitudinal one-year follow-up study. Setting. The community of Kristiansand, Norway (80 000 inhabitants). Intervention. A 40-week structured intervention based on physical training with some lifestyle advice for the obese child and one parent. Subjects. A total of 62 physically inactive children aged 6-14 years with iso-BMI ≥ 30 kg/m2. Main outcome measures. Body mass index (BMI), maximum oxygen uptake, and physical fitness in tests of running, jumping, throwing, and climbing assessed at baseline and after six and 12 months as well as number of dropouts and predicting factors. Results. A total of 49 out of 62 children completed the first six months and 37 children completed 12 months. Dropout rate was higher when parents reported being physically inactive at baseline or avoided physical participation in the intervention. The children's maximum oxygen uptake increased significantly after 12 months from 27.0 to 32.0 ml/kg/min (means), as did physical fitness (endurance, speed, agility, coordination, balance, strength) and BMI was significantly reduced. Conclusion/implications. This one-year activity-based intervention for obese and inactive children performed in primary health care succeeded by increasing cardiovascular capacity and physical fitness combined with reduced BMI in those who completed. Dropout was substantial and depended on the attendance and compliance with physical activity by the parents. [ABSTRACT FROM AUTHOR]

Recent empirical work in the obesity literature has highlighted the role of the built environment and its potential influence in the increasing prevalence of obesity in adults and children. One feature of the built environment that has gained increasing attention is the role of access to chain grocers and their impact on body mass index (BMI). The assessment of the impacts of spatial access to chain grocers on BMI is complicated by two empirical regularities in the data. There is evidence that health outcomes such as BMI are clustered in space and that there is spatial dependence across individuals. In this article, we use an econometric model that takes into account the spatial dependence, and we allow the effect of access to differ for a person depending on whether he or she lives in a low-income community or peer group. We categorize this community using the characteristics of the people who immediately surround the individual rather than using census tracts. Using georeferenced survey data on adults in Marion County, Indiana, we find that the effect of improvements in chain grocer access on BMI varies depending on community characteristics. [ABSTRACT FROM AUTHOR]

By drawing on interviews with administrators, faculty and staff at one school in the northeastern United States, this qualitative work considers the ways in which school leaders negotiate, resist or draw upon discourses associated with health, weight, nutrition and fitness to understand and experience their own bodies and interpret their roles and responsibilities at the school. Analysis of the narratives suggest that school leaders saw themselves as public examples from which students might resist and/or mimic (ill-)health. Further, school leaders believed that it was only through their active engagement in and display of health that they were able to effectively evangelize their commitment to the social project of self. Thus, while schools could provide an important venue for young people to experience diverse notions of health and well-being, without a school leader's knowledge of or commit to exploring these alternatives, this outcome is unlikely. [ABSTRACT FROM AUTHOR]

Objectives: There is a consistent body of evidence to demonstrate that obesity in very early childhood tends to continue into adolescence and through to adulthood. Parental practices in relation to food can have an effect on this trajectory, however existing studies reporting on interventions for treating obesity suggest there is a need to involve populations from demographically diverse backgrounds childhood obesity research. Design/Methods: A qualitative study was carried out using semi-structured interviews with parents in a deprived inner city area. Results: Although parents had good intentions towards providing a health diet for their chidren, a number of barriers emerged. Findings were reported in relation to the following themes: information and education; barriers (having a child with special needs, children's food preferences and using food to promote desirable behaviour) and techniques (household rules & routines, setting limits and parameters, modelling and food preparation). Conclusion: Parents and carers would benefit from targeted interventions based on improving techniques around food parenting practices, with a focus on equipping parents with the skills to overcome barriers encountered not only in early childhood, but as children progress to school age and through to adolescence. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to gain an in-depth understanding of the perspectives and life experiences of adolescents living with obesity. Methods: Five adolescents living with obesity were involved in repeated interviews, and qualitative content analysis was performed. Results: Three themes emerged: obesity as a multi-faceted and difficult to solve condition; obesity as a shameful and vulnerable subject; and bullying and fragile social relationships. Adolescents living with obesity described everyday life challenges as difficult to interpret and solve. Adolescents living with obesity perceived causes for obesity differently, and those who emphasised familial determinants seemed to face greater challenges. Lack of support from parents, trusted friends and health-care providers and bullying, shame, guilt and self-blame represented threats that decreased motivation for help seeking and successful life-style changes. The adolescents were ambivalent regarding disclosing their concerns and seeking help. The adolescents feared that health care providers would demand too much from them, and peers were perceived as a possible source of support. Conclusion: Care providers need to be skilled in assessing each individual's resources and interpretations of their condition, to be able to communicate in a respectful, patient-centred manner and to assist adolescents to explore their ambivalence and set their own realistic goals. More research is needed. [ABSTRACT FROM AUTHOR]

Background: Malnutrition, both stunting and overweight/obesity, present a public health concern in many countries in the world. Objective: This study aims to examine: (1) longitudinal changes in prevalence of overweight, stunting, and concurrent overweight and stunting among preschool children during 3 years and (2) secular changes in these prevalences of a specific age group of children aged 5.5-6.5 year over a period of 3 years. Methods: A cohort of 2,602 children initially aged 3-6 years old, 1,311 in an urban area and 1,291 in a rural area, was followed for 3 years. Of them, children aged 5.5-6.5 years old were identified to be included in three repeated cross-sectional surveys. The World Health Organization standard was used to classify children with overweight or stunting. Results: Findings from the cohort study indicate that between 2013 and 2016, the estimated prevalence of overweight including obesity (OWOB) increased with age, particularly in the urban setting (14.2%-29.9% in boys and 9.0%-21.6% in girls). The estimated prevalence of stunting decreased from 8.2% to 3.4% in boys and 9.5% to 3.5% in girls with a considerably greater decrease among rural children. There was a similar pattern of an age-related decrease of concurrent OWOB and stunting from 2.4% in 2013 to 1.4% in 2016 in boys and from 2.9% to 1.3% in girls with significant decreases in rural children. Secular trends in the group of children 5.5 to 6.5 show the same pattern as the longitudinal results: decreasing prevalence of stunting as well as concurrent OWOB and stunting. OWOB prevalence increased significantly in urban girls and rural boys. Conclusions: The pattern of increasing overweight, decreasing stunting and concurrent overweight and stunting both with increasing age and over chronological time is observed among Vietnamese preschool children. [ABSTRACT FROM AUTHOR]

Background: The United States (US) is currently facing a public health crisis due to the percentage of obesity in adolescents. The Center for Disease Control (CDC) stated the risks for children due to obesity are many. Adolescents obtain a large portion of their daily caloric intake at school; therefore, what foods/drinks they are consuming is so serious. Objective: To identify and analyze literature on the effects of competitive foods in public schools on adolescent weight, or Body Mass Index (BMI), and possible impacts they may have on adolescent obesity in the United States. Methods: An integrative systematic review of literature was conducted. The literature was collected in CINAHL, MEDLINE and EMBASE databases. Refined keyword search is further detailed in the report. Year restrictions were 2006-2017 from peer-reviewed journals and published in English, including adolescents 13-18 years old in the US. Criteria for inclusion targeted at least one of (1) sugar-sweetened beverages (SSB), (2) competitive foods, (3) commercial foods, (4) vending machines, (5) al a carte venues, and (6) school stores, examining their associations with weight measurements, using either weight or BMI, or caloric intake analysis. Results: A total of 164 articles were detected and assessed, for a final analysis of 34 full text articles. Twenty-six articles met the inclusion criteria. Common aspects of interest involved BMI/Obesity/Weight (73%), (58%) examined Calorie density or consumption, (77%) discussed the Availability of competitive foods in schools, (54%) included Analysis of competitive food, beverage and nutrition policies, and (69%) addressed Other effects. Conclusion: This review discovered substantial evidence that competitive foods are highly available in schools, however, lacking in robust evidence proving causality in increasing BMI or weight. There is strong corroboration in the research revealing that Other effects are factors worthy of studying further. Additional longitudinal and higher-quality research needs to be performed. [ABSTRACT FROM AUTHOR]

Childhood obesity may soon be an equally important health threat as undernutrition and infectious diseases. Accurate information about prevalence and risk factors of obesity in children is important for the design of prevention. The aim of this study was to estimate prevalence of overweight and obesity for preschool children in two Vietnamese areas, one urban and one rural, and to identify risk factors. A cross-sectional study was conducted in urban Dong Da and rural Ba Vi districts, Hanoi, Vietnam. Totally, 2,677 children, 1,364 urban and 1,313 rural, were weighed and measured. Caregivers were interviewed. Background information about children and families was obtained from regular household surveys. The prevalence of overweight and obesity combined were 21.1% (95% CI 18.9–23.3) in the urban area and 7.6% (95% CI 6.2–9.2) in the rural. Multiple logistic regression revealed that at the individual level, in both sites, the risk increased with increased child age. The identified urban risk factors were being a boy, consuming large amounts of food, eating fast, and indoor activity less than 2 hours per day. The rural risk factors were frequent consumption of fatty food. At the family level, significant association was found in rural areas with frequent watching of food advertisements on television. Overweight and obesity are emerging problems in Vietnam, particularly in the urban context. Prevention programs should focus on education about healthy eating habits at early preschool age and need to be tailored separately for urban and rural areas since the risk factors differ. Non-healthy food advertisement needs to be restricted. [ABSTRACT FROM AUTHOR]