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Childhood obesity has high societal and economic impact but current treatment approaches are sub-optimal. In the last decade, important studies have been conducted aiming to identify strategies to prevent obesity during critical periods of life. Updated recommendations for childhood obesity prevention are needed. We present data from systematic reviews and meta- analysis, randomised controlled trials (RCTs) and large observational studies, published from 2011 onwards that consider the possible role of the following factors in obesity development: breast-feeding; macronutrient composition and method of complementary feeding; parenting style; dietary patterns; sugar-sweetened beverage consumption; eating behaviour (eg, skipping breakfast, family dinners. etc); meal frequency and composition (fast foods, snacking), portion size; dietary modulators of gut microbiota (including pre-, pro-, and synbiotics); physical activity and sedentary behaviour. We used the Medline database and the Cochrane Library to search for relevant publications. Important research gaps were also identified. This position paper provides recommendations on dietary factors, food habits, and lifestyle to prevent childhood obesity development, based on the available literature and expert opinion. Clinical research and high-quality trials are urgently needed to resolve numerous areas of uncertainty.

Global childhood obesity increased more than 8-fold over 40 years, inducing a very large personal, societal, and economic burden. Effects of available treatments are less than satisfactory; therefore, effective prevention is of high priority. In this narrative review, we explore preventive opportunities. The available evidence indicates large benefits of improving nutrition and lifestyle during early life, such as promoting breast-feeding and improving the quality of infant and early childhood feeding. Promoting healthy eating patterns and limiting sugar-containing beverage consumption from early childhood onwards are of great benefit. Regular physical activity and limited sedentary lifestyle and screen time alone have limited effects but are valuable elements in effective multicomponent strategies. The home environment is important, particularly for young children, and can be improved by educating and empowering families. School- and community-based interventions can be effective, such as installing water fountains, improving cafeteria menus, and facilitating regular physical activity. Reducing obesogenic risk factors through societal standards is essential for effective prevention and limiting socioeconomic disparity; these may comprise food, drink, and physical activity standards for day cares and schools, general food quality standards, front-of-pack food labeling, taxation of unhealthy foods, restriction of food advertisements to children, and others. Effective prevention of childhood obesity is not achieved by single interventions but by integrated multicomponent approaches involving multiple stakeholders that address children, families, and societal standards. Pediatricians and their organizations should be proactive in supporting and empowering families to support their children's health, and in promoting societal measures that protect children.

Background: Health risks associated with the high consumption of sugar-sweetened beverages (SSBs) include overweight or obesity and their complications such as diabetes, as well as oral and dental decay, among others. Aim: The aim of the present statement is to inform health care professionals, parents, care-givers, teachers and school head teachers, stakeholders and governing bodies about the risks associated with drinking SSBs in infants, children and adolescents. Methods: We searched PubMed and the Cochrane databases for English language studies published from 2010 through October 1, 2018, for randomized clinical trials, meta-analyses, systematic reviews and observational studies (search terms are reported in eAppendix in the Supplement). We also manually searched the references of selected articles, reviews, meta-analyses and practice guidelines. Recommendations: Consumption of SSB by children and adolescents should be limited, and the consumption of water and other non-sweetened beverages should be promoted. Educational institutions such as nurseries, pre-schools and schools should offer unlimited access to drinking water, whereas the sale of SSBs should be banned.

Objective: This paper introduces health professionals to the different psychological models thought to influence eating behaviour in the absence of hunger in children who are obese and to propose a method of assessing these behaviours in practice. Methods: Clinical researchers from the European Childhood Obesity Group (ECOG) adopted an evidence-based approach to examine the literature concerning the assessment of eating behaviour in children who are obese. Studies published in English were filtered out of the medical and psychological literature from 1960 to the present, and the resulting bibliography was searched for relevant articles. Key themes from the current evidence were compiled and classified according to the underpinning psychological models. Based on the current evidence and the authors' combined clinical experience, a three-staged approach to assessment was agreed by consensus. Results: Valid and reliable tools for assessing and monitoring each of the three identified models (Dietary Restraint Theory, Emotional Eating and the Diathesis-Stress Model) are suggested for use in clinical practice, and the ECOG three-staged approach to assessing eating behaviours in the absence of hunger is described. Conclusions: This paper presents practical guidance on how to assess eating behaviour in the absence of hunger in children who are clinically obese and suggests a focus for future research.

Childhood obesity is becoming increasingly prolific and problematic. Contributors to childhood obesity include decreased levels of physical activity and increased sedentary behavior. Screen-based entertainment may be an important factor in the development of childhood obesity as children and adolescents prefer to spend time using electronic devices than exercising. While it is difficult to encourage children to cease playing video games, it is possible to change these passive screens to active ones. Information and Communication Technologies (ICTs) have been utilized by academics and researchers to promote levels of physical activity among young people. This paper is part of our continuous research into the use of technology in the facilitation and motivation of children to be more physically active. This paper presents the "MySteps " framework that has been developed to manage youth screen time and exercise performance statistics. By developing technology-based solutions, we intend to increase children and adolescents awareness of their levels of physical activity and screen time. Consequently, self-monitoring and management of screen time and physical activity levels may lead to more active living beginning at an early age and continuing throughout life.

We calculated BMI and the Rohrer index in 5-17 years old children boys and girls with standard weights for height using data from the School Health Statistical Research Report of the Ministry of Education in 2000.The results are also expressed using as growth charts. BMI values for boys 6 to 14 years old and girls 6 to 13 years old with standard weights for height gradually increased as they became taller at the same age. The Rohrer index value of boys with standard weights for height gradually decreased from 5 to 13 years of age. For those over about 13 years of age, the Rohrer index value increased. The Rohrer index value increases as they become shorter at the same age. Furthermore in girls older than 13 years, changes in the Rohrer index value show the same pattern as that in boys. For the reasons mentioned above, it is not suitable for BMI or the Rohrer index to be used as an indicator for defining childhood obesity, especially for observing the course of an individual obese child., 東京女子医科大学東医療センター小児科開局40周年記念論文集

While studies suggest potential influences of childhood adversities on obesity development in adulthood, less is known about the short-term association in children. We examined the association between a wide range of life events experienced in the first ten years of life (including maltreatment and milder adversities) and body composition in 5333 ten-year old Dutch children. In structured interviews, mothers retrospectively reported on their children’s experience of 24 events. BMI was calculated, and fat mass index and fat free mass index were determined by dual-x-ray absorptiometry scanning. Linear regressions showed that, unadjusted, a higher number of life events was associated with higher BMI and body composition. However, associations attenuated to non-significance after adjustment for covariates. Similar findings were observed for maltreatment and milder life events. Thus, the number of experienced life events was not associated with body composition in middle childhood. Rather, other factors, like socioeconomic conditions, accounted for the relationship between life events and weight development in children. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01188-7.

Objective:This article analyses the relationship between socio-economic status and the prevalence of overweight and obesity in the primary school population in Costa Rica.Design:A National School Weight/Height Census was disseminated across Costa Rica in 2016. The percentage of children who were overweight or obese was calculated by sex, age and socio-economic indicators (type of institution: private, public, mix; type of geographic location: rural, urban and the level of development of the district of residence: quartiles). A mixed-effects multinomial logistic regression model and mixed-effects logistic regression model were used to analyse the association between the prevalence of being overweight or obese and district socio-economic status.Setting:The survey was carried out in public and private primary schools across Costa Rica in 2016.Participants:In total, 347 366 students from 6 to 12 years were enrolled in public and private primary schools.Results:The prevalence of overweight and obesity among children was 34·0 %. Children in private schools were more likely to be overweight or obese than students in public schools (OR = 1·10 [1·07, 1·13]). Additionally, children were less likely to be overweight or obese if attending a school in a district of the lowest socio-economic quartile compared with the highest socio-economic quartile (OR = 0·79 [0·75, 0·83]) and in a rural area compared with the urban area (OR = 0·92 [0·87, 0·97]).Conclusions:Childhood obesity in Costa Rica continues to be a public health problem. Prevalence of overweight and obesity in children was associated with indicators of higher socio-economic status.

The home learning environment is a potential correlate of childhood obesity and obesity-related factors. We examined relationships between the home learning environment and weight status and the home learning environment and dietary intake, in a sample of 303 preschool-aged children from Australia. We measured their height and weight, and their parents completed a questionnaire that included questions related to demographics, dietary intake, and the home learning environment. Parents reported their children’s usual consumption of foods from each food group, the frequency of their discretionary food intake, and the frequency of home activities that might support cognitive stimulation. We analysed relationships using regression, adjusting for parents’ education level, and household income. We found no significant associations between the home learning environment and BMI or weight category. We found a significant inverse relationship between the overall home learning environment and discretionary food intake scores, but when stratified by income, this result was significant for children from lower-income families only. Regarding specific elements of the home learning environment, we found significant inverse relationships between discretionary food intake and both reading to children, and teaching them the alphabet. While reading was significant across all income levels, teaching the alphabet was only significant in children from higher-income families. We also found significant inverse relationships between discretionary food intake and: visiting a library, teaching numbers or counting, and teaching songs, poems and nursery rhymes in lower-income families only. There was no association between the home learning environment and meeting individual dietary guidelines. This area requires further research to explore broader home environment factors that may influence these relationships. We also suggest that interventions explore the use of strategies to improve the home learning environment to determine its efficacy in improving healthy eating behaviors.

The transition from childhood to adolescence is a sensitive period, triggering changes in health- and weight-related behaviours including eating habits which likely vary between girls and boys. We aimed to characterise the changes in the frequency of consumption of select sugary foods and drinks ('sweet treats') among 4237 Finnish girls and boys during a 2-year follow-up period. Additionally, we examined four subgroups: children whose weight or waist normalised as well as children whose weight or waist circumference increased during follow-up. An FFQ was completed at 11 center dot 1 (sd 0 center dot 9) and again at 13 center dot 4 (sd 1 center dot 1) years of age. A sum variable sweet treat index (STI, range 0-84) captured the weekly consumption frequencies of sweet treats. From baseline to follow-up, the mean STI decreased among girls from 7 center dot 1 (95 % CI 6 center dot 9, 7 center dot 3) to 6 center dot 0 (95 % CI 5 center dot 9, 6 center dot 2) (P < 0 center dot 001) and boys from 8 center dot 5 (95 % CI 8 center dot 3, 8 center dot 8) to 7 center dot 8 (95 % CI 7 center dot 6, 7 center dot 8) (P < 0 center dot 001), although both sexes increased their chocolate/sweets consumption: girls from 1 center dot 3 (95 % CI 1 center dot 3, 1 center dot 4) to 1 center dot 6 (95 % CI 1 center dot 5, 1 center dot 6) (P < 0 center dot 001) and boys from 1 center dot 4 (95 % CI 1 center dot 3, 1 center dot 4) to 1 center dot 6 (95 % CI 1 center dot 6, 1 center dot 7) (P < 0 center dot 001), and boys increased their soft drink consumption from 1 center dot 4 (95 % CI 1 center dot 3, 1 center dot 4) to 1 center dot 5 (95 % CI 1 center dot 4, 1 center dot 5) (P = 0 center dot 020). We found similar decreases in both the weight and waist subgroups. To conclude, the total frequency of consumption of sweet treats decreased during early adolescence. A similar trend across subgroups suggests that the frequency of consumption of sweet treats is unrelated to becoming overweight.

Considering previously reported discrepant results in the literature, we aimed to investigate the impact of gender and overweight/obesity on cardiometabolic risk (CMR) among Montenegrin urban children. The cross-sectional study included random sample of 201 schoolchildren aged 7-12 years (64% of boys) from Podgorica. Children’s nutritional status was determined according to the International Obesity Task Force criteria. CMR was assessed using a sum of z values of the following five indicators: glucose, total cholesterol, inverted value of high-density lipoprotein cholesterol, triglycerides, and hypertension. Higher CMR was found among both overweight and obese boys compared to normal weight boys (p, Imajući u vidu oprečne podatke iz literature, cilj našega istraživanja je bio ispitati utjecaj spola i pretilosti na kardiometabolički rizik (KMR) kod gradske djece u Crnoj Gori. Studija presjeka je obuhvatila slučajni uzorak od 201 učenika u dobi od 7-12 godina (64% dječaci) iz Podgorice. Nutritivni status djece procijenjen je prema kriterijima International Obesity Task Force. KMR je izračunat kao zbir z vrijednosti dobivenih zbrajanjem 5 parametara: glukoze, ukupnog kolesterola, inverzne koncentracije kolesterola u lipoproteinima visoke gustoće, triglicerida i visokog krvog tlaka. Pretili i debeli dječaci su imali veći KMR u usporedbi s normalno uhranjenim dječacima (p

Objective:To determine whether a previously reported association between the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food package change and reduced child obesity risk among WIC-participating children in Los Angeles County holds across levels of family income and neighbourhood poverty.Design:Analysis of prospectively collected WIC administrative data. The outcome was obesity at age 4 years (BMI-for-age ≥ 95th percentile). Poisson regression was applied to a matched sample (n 79 502) to determine if the association between the WIC food package change and child obesity was modified by family income (100 % but Setting:Los Angeles County, California.Participants:Children who participated in WIC in Los Angeles County between 2003 and 2016; children were grouped as receiving the old WIC food package (2003–2009) or the new WIC food package (2010–2016).Results:Receiving the new WIC food package (i.e., post-2009) was associated with 7–18 % lower obesity risk across all family income categories. Neither family income nor neighbourhood poverty significantly modified the association between the WIC food package and child obesity. However, certain sub-groups seemed to benefit more from the food package change than others. In particular, boys from families with income above poverty but residing in the poorest neighbourhoods experienced the greatest reductions in obesity risk (relative risk = 0·77; 95 % CI 0·66, 0·88).Conclusions:The WIC food package revisions were associated with reduced childhood obesity risk among all WIC-participating families in Los Angeles County, across levels of income eligibility and neighbourhood poverty.

Objective:The objective of the current study was to identify challenges of making and sustaining healthy lifestyle changes for families with children/adolescents affected by obesity, who were referred to a multicomponent healthy lifestyle assessment and intervention programme in Aotearoa/New Zealand (NZ).Design:Secondary qualitative analysis of semi-structured interviews.Setting:Taranaki region of Aotearoa/NZ.Participants:Thirty-eight interviews with parents/caregivers (n 42) of children/adolescents who had previously been referred to a family-focused multidisciplinary programme for childhood obesity intervention, who identified challenges of making healthy lifestyle changes. Participants had varying levels of engagement, including those who declined contact after their referral.Results:Participant-identified challenges included financial cost, impact of the food environment, time pressures, stress, maintaining consistency across households, independence in adolescence, concern for mental health and frustration when not seeing changes in weight status.Conclusions:Participants recognised a range of factors that contributed towards their ability to make and sustain change, including factors at the wider socio-environmental level beyond their immediate control. Even with the support of a multidisciplinary healthy lifestyle programme, participants found it difficult to make sustained changes within an obesogenic environment. Healthy lifestyle intervention programmes and families’ abilities to make and sustain changes require alignment of prevention efforts, focusing on policy changes to improve the food environment and eliminate structural inequities.

Objective:The aim of this cross-sectional study was to examine the association between childhood obesity and modifiable population-level risk factors, after accounting for deprivation.Design:A review of the literature identified population-level risk factors including a healthy childcare setting, the local food environment, accessible open space, community safety and crime. Data for these risk factors were then identified and matched by each of the twenty-two local government areas in Wales to each child that had data on height and weight in the Wales Childhood Measurement Programme (CMP) (2012–2017). Multivariable logistic regression was used to identify associations with childhood obesity.Setting:The current study was undertaken in Wales, UK, where approximately one in eight 4–5-year-olds are classified as obese.Participants:All participants were children aged 4 or 5 years who attend school, measured as part of the CMP, between 2012 and 2017 (n 129 893, mean age 5·0 (sd 0·4) years).Results:After adjusting for deprivation, small but statistically significant associations were found between childhood obesity and percentage of land available as accessible open space OR 0·981 (95 % CI: 0·973, 0·989) P < 0·001) and density of fast food outlets OR 1·002 (95 % CI 1·001, 1·004, P = 0·001). No other population-level risk factors were associated with childhood obesity.Conclusions:The current study indicates that, even after accounting for deprivation, risk factors such as the density of fast food outlets and access to green space should be considered when tackling childhood obesity as a public health issue.

Objective:WHO BMI-for-agezscore (BAZ) is widely used in epidemiology, yet it does not distinguish body fat-free mass and fat mass which are better indicators of obesity and related risks. The stable isotope dilution techniques (SIDT) are gold standard methods of assessing body composition. Main objective was to assess significant differences in measurement and validity of WHO BMI-for-age classification for defining childhood obesity by comparing with body fatness using SIDT among schoolchildren.Design:A cross-sectional analytical study. A questionnaire, anthropometry and body composition data were used. SPSS was used to analyse data atP< 0·05 at 95 % CI.Setting:Primary schools in Nairobi City County, KenyaParticipants:One hundred seventy-nine schoolchildren aged 8–11 years were randomly sampled.Results:Prevalence of adiposity by reference SIDT (24·0 %) was significantly higher than that of obesity by BAZ > 2sd(2·8 %) (Wilcoxon test,P< 0·05). Concordance coefficient between SIDT and BAZ > 2sdin diagnosing obesity was poor (κ= 0·167). Only 11·6 % of children with excess body fat were correctly diagnosed as obese by BAZ > 2sd. The use of BAZ > 1sdfor overweight and obesity showed fair concordance coefficient (κ= 0·409,P< 0·001) with 32·5% of children with excess fat positively identified as overweight and obese.Conclusion:WHO BMI-for-age cut-off points severely underestimate the prevalence of overweight and obesity compared with body composition assessment by stable isotope dilution techniques. Evidence-informed interventions should be based on more accurate estimates of overweight and obesity than that can be provided by BAZ.

Convincing evidence suggests that diets laden with added sugar, specifically sugar-sweetened beverages, associate with excess weight in children. The relationships between sugar consumption frequency and BMI remain less well studied. We, therefore, evaluated children's consumption frequency of selected sugary products (n8461; mean age 11 center dot 1 (sd0 center dot 9) years) selected from the Finnish Health in Teens cohort study. Using a sixteen-item FFQ including six sugary products (chocolate/sweets, biscuits/cookies, ice cream, sweet pastry, sugary juice drinks and sugary soft drinks), we calculated a Sweet Treat Index (STI) for the frequency of weekly sugary product consumption and categorised children based on quartiles (Q) into low (Q1, cut-off 10 center dot 5), and as thin, normal and overweight/obese based on the measured BMI. Through multinomial logistic regression analyses, we found that subjects with a high STI exhibited a higher risk of being thin (OR 1 center dot 20, 95 % CI 1 center dot 02, 1 center dot 41) and lower risk of being overweight (OR 0 center dot 79, 95 % CI 0 center dot 67, 0 center dot 92), while subjects with a low STI were at higher risk of being overweight (OR 1 center dot 32, 95 % CI 1 center dot 14, 1 center dot 53). High consumption frequencies of salty snacks, pizza and hamburgers most closely were associated with a high STI. Our findings suggest that consuming sugary products at a high frequency does not associate with being overweight. The relationship between a low consumption frequency and being overweight suggests that overweight children's consumption frequency of sugary products may be controlled, restricted or underreported.

Background: Rapid infant weight gain is a risk factor for childhood obesity. This relationship may depend on whether infant weight gain is preceded by in-utero growth restriction. Aim: Examine whether fetal growth modifies the relationship between infant weight gain and childhood adiposity and blood pressure. Subjects and methods: 786 children in the Southampton Women’s Survey. We related infant weight gain (weight at 2 years-birth weight) to body mass index (BMI), %body fat, trunk fat (kg), systolic (SBP) and diastolic blood pressure (DBP) at age 6–7 years. Mean estimated fetal weight (EFW) between 19–34 weeks and change in EFW (19–34 weeks) were added to models as effect modifiers. Results: Infant weight gain was positively associated with all childhood outcomes. We found no evidence that these effects were modified by fetal growth (p > .1 for all interaction terms). For example, a 1 standard deviation (SD) increase in infant weight gain was associated with an increase in BMI z-score of 0.51 (95% CI 0.37;0.64) when EFW-change was set at -2 SD-scores compared with an increase of 0.41 (95% CI 0.27;0.54, p(interaction)=.48) when set at 2 SD-scores. Conclusion: The documented adverse consequences of rapid infant weight gain may occur regardless of whether growth was constrained in-utero.

Objective:We aimed to investigate the associations between school-level characteristics and obesity among Chinese primary school children with consideration of individual-level characteristics.Design:This cross-sectional study was conducted in 2015/2016. School-level characteristics were assessed using an interviewer-administered school questionnaire, and a ‘school-based obesity prevention index’ was further developed. Individual-level characteristics were collected by self-administered questionnaires. Objectively measured height and weight of students were collected, and obesity status was classified according to the International Obesity Task Force criteria for Asian children. Generalised linear mixed models were used to estimate the associations among the school- and individual-level characteristics and obesity of students.Setting:Thirty-seven primary schools from an urban and a rural district of Beijing, China.Participants:School staffs, 2201 students and their parents.Results:The school-based obesity prevention index involved the number of health professionals, availability of students’ health records, monitoring students’ nutrition status, frequency of health education activities, reporting achievements of obesity prevention activities to parents, duration of physical activity during school time and availability of playground equipment. The prevalence of obesity was lower in schools with the higher index value compared with that in schools with the lower index value (OR 0·56; 95 % CI 0·40, 0·79). Some individual-level characteristics were negatively associated with childhood obesity: liking sports, duration of screen time ≤2 h/d, perceived lower eating speed, parental non-overweight/obesity.Conclusions:Irrespective of individual-level characteristics, the specific school-level characteristics had a cumulative effect on obesity among Chinese primary school children. Further school-based obesity intervention should consider these characteristics simultaneously.

Objective:The present study describes the energy content of primary-school children’s lunchboxes and the proportion of lunchbox foods considered discretionary. Subgroup analyses by sex, socio-economic status, age and weight status were undertaken.Design:A cross-sectional study was conducted. Mean kilojoule content, number of items and categorisation of foods and drinks in lunchboxes as ‘everyday’ (healthy) or discretionary (sometimes) foods were assessed via a valid and reliable lunchbox observational audit.Setting:Twelve Catholic primary schools (Kindergarten–Grade 6) located in the Hunter region of New South Wales, Australia.Participants:Kindergarten to Grade 6 primary-school students.Results:In total, 2143 children (57 %) had parental consent to have their lunchboxes observed. School lunchboxes contained a mean of 2748 kJ, of which 61·2 % of energy was from foods consistent with the Australian Dietary Guidelines and 38·8 % of energy was discretionary foods. The proportion of lunchboxes containing only healthy foods was 12 %. Children in Kindergarten–Grade 2 packed more servings of ‘everyday’ foods (3·32 v. 2·98, P < 0·01) compared with children in Grades 3–6. Children in Grades 3–6 had a higher percentage of energy from discretionary foods (39·1 v. 33·8 %, P < 0·01) compared with children in Kindergarten–Grade 2 and children from the most socio-economically disadvantaged areas had significantly higher total kilojoules in the school lunchbox compared with the least disadvantaged students (2842 v. 2544 kJ, P = 0·03).Conclusions:Foods packed within school lunchboxes may contribute to energy imbalance. The development of school policies and population-based strategies to support parents overcome barriers to packing healthy lunchboxes are warranted.

Introduction Childhood obesity is a significant problem nowadays, with breastfeeding being one of many factors responsible for this issue. Breastfeeding as a natural way of feeding infants has many benefits for the child, the mother, and society. Aim The present study aimed to investigate the association between overweight children in preschool age and breastfeeding duration. Methods The current study included 674 preschool children aged 2-5 who attended various municipal kindergartens in South Athens. Questionnaires were given to parents where they recorded the child's personal and body data, parenting, and questions about pregnancy and lactation. The effect of BMI on the duration of breastfeeding in children was examined by the chi-square independence test. Fisher's and Monte Carlo simulations were also used. For data processing, Z scores and percentiles BMI for the first, second until fifth year of the child were found and based on these values the following categorization was performed; for values below -2 as low weight, values from -2 to 1 as normal weight, from 2 to 3 as overweight and over 3 as obese children. The Corresponding categorization was based on the 3rd, 85th, 97th, and 99.9th percentage position. Results The percentage of children at preschool age who have been breastfed for over six months and had normal weight was higher than those who breastfed below six months. Moreover, the proportion of children who were low weight, overweight and obese was lower in children who had been breastfed more than six months compared to those who breastfed for a shorter period. Additionally, a statistically significant difference was found for the effect of breastfeeding on childhood obesity in children aged 2 to 5 years. Conclusion There is a statistical association between breastfeeding duration and body weight in preschool age. Breastfeeding for more than six months has a positive impact on the child's weight.

Background Obesity is a major public health problem globally and in Europe. The prevalence of childhood obesity is also soaring. Several parameters of the living environment are contributing to this increase, such as the density of fast food retailers, and thus, preventive health policies against childhood obesity must focus on the environment to which children are exposed. Currently, there are no systems in place to objectively measure the effect of living environment parameters on obesogenic behaviors and obesity. The H2020 project “BigO: Big Data Against Childhood Obesity” aims to tackle childhood obesity by creating new sources of evidence based on big data. Objective This paper introduces the Obesity Prevention dashboard (OPdashboard), implemented in the context of BigO, which offers an interactive data platform for the exploration of objective obesity-related behaviors and local environments based on the data recorded using the BigO mHealth (mobile health) app. Methods The OPdashboard, which can be accessed on the web, allows for (1) the real-time monitoring of children’s obesogenic behaviors in a city area, (2) the extraction of associations between these behaviors and the local environment, and (3) the evaluation of interventions over time. More than 3700 children from 33 schools and 2 clinics in 5 European cities have been monitored using a custom-made mobile app created to extract behavioral patterns by capturing accelerometer and geolocation data. Online databases were assessed in order to obtain a description of the environment. The dashboard’s functionality was evaluated during a focus group discussion with public health experts. Results The preliminary association outcomes in 2 European cities, namely Thessaloniki, Greece, and Stockholm, Sweden, indicated a correlation between children’s eating and physical activity behaviors and the availability of food-related places or sports facilities close to schools. In addition, the OPdashboard was used to assess changes to children’s physical activity levels as a result of the health policies implemented to decelerate the COVID-19 outbreak. The preliminary outcomes of the analysis revealed that in urban areas the decrease in physical activity was statistically significant, while a slight increase was observed in the suburbs. These findings indicate the importance of the availability of open spaces for behavioral change in children. Discussions with public health experts outlined the dashboard’s potential to aid in a better understanding of the interplay between children’s obesogenic behaviors and the environment, and improvements were suggested. Conclusions Our analyses serve as an initial investigation using the OPdashboard. Additional factors must be incorporated in order to optimize its use and obtain a clearer understanding of the results. The unique big data that are available through the OPdashboard can lead to the implementation of models that are able to predict population behavior. The OPdashboard can be considered as a tool that will increase our understanding of the underlying factors in childhood obesity and inform the design of regional interventions both for prevention and treatment.

Background The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface.

Background There is significant opportunity to improve the nutritional quality of foods packed in children’s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted. Objective This study aimed to assess the effectiveness of a multicomponent, mobile health–based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school. Methods A type I effectiveness–implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children’s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness. Results A total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years; 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (–117.26 kJ; 95% CI –195.59 to –39.83; P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (–88.38 kJ; 95% CI –172.84 to –3.92; P=.04) and consumed (–117.17 kJ; 95% CI –233.72 to –0.62; P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children’s lunchboxes. Conclusions The SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school–aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school–aged children, impacting weight status and associated health care costs. Trial Registration Australian Clinical Trials Registry ACTRN12618001731280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191&isReview=true International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-7725-x

Breastfeeding is related to better overall health in adult life and is one of the commonly described protec-tive factors for childhood obesity. The purpose of this study was to describe the relationship between breastfeeding duration, childhood lifestyle habits, overweight and obesity in a cohort of Croatian second- and third-grade schoolchildren. Randomly selected second- and third-grade children aged 6-11 years (N=5662) were measured for weight and height in order to calculate nutritional status for each child. Also, a self-reported questionnaire was filled in by the parents to gather information on the child including breastfeeding duration, dietary and physical activity habits, and health risk behaviors. Regression analyses were performed to explore associations between breastfeeding duration and the odds of having dietary, physical activity or overall health risk behaviors, or of being overweight or obese. Significant associations were found showing that children who were breastfed for less than 6 months had higher odds for being overweight (ORadj=1.24; 95% CI 1.04-1.47) or obese (ORadj=1.25; 95% CI 1.02-1.53). After adjusting for confounders, breastfeeding for less than 6 months was not found to be predictive of dietary, physical activity or overall health risk behaviors. In conclusion, breastfeeding for longer than 6 months is a protec-tive factor for overweight and obesity in 6-to 11-year-old children in Croatia, but not for healthy lifestyle development., Dojenje je povezano s cjeloživotnim zdravljem te predstavlja jedan od najčešće opisanih zaštitnih čimbenika za debljinu u djetinjstvu. Cilj ovoga rada je prikazati povezanost između duljine dojenja i životnih navika, prekomjer-ne tjelesne mase i debljine u kohorti djece drugih i trećih razreda osnovnih škola Republike Hrvatske. Učenicima slučajno odabranih drugih i trećih razreda osnovnih škola u dobi od 6-11 godina (N=5662) izmjerene su tjelesna visina i masa kako bi im se izračunao status uhranjenosti. Uz to, roditelji su ispunili upitnik u svrhu dobivanja poda-taka o djeci uključujući duljinu dojenja, prehrambene navike i navike tjelesne aktivnosti kao i ponašanja rizična za zdravlje. Provedena je regresijska analiza podataka kako bi se utvrdila povezanost između duljine dojenja i vjeroja-tnosti za rizična ponašanja u području prehrane, tjelesne aktivnosti i zdravlja uopće, kao i vjerojatnosti za prekom-jernu tjelesnu masu i debljinu u djece. Djeca dojena kraće od 6 mjeseci imala su statistički značajno veću vjerojat-nost za prekomjernu tjelesnu masu (prilagođeni omjer izgleda (OIpril)=1,24; 95% interval pouzdanosti (IP) 1,04-1,47) i debljinu (OIpril=1,25; 95% IP 1,02-1,53). Nakon prilagodbe za čimbenike posredne povezanosti, dojenje kraće od 6 mjeseci nije bilo značajno povezano s proučavanim ponašanjima rizičnim za zdravlje. Duljina dojenja veća od 6 mjeseci predstavlja zaštitni čimbenik za prekomjernu tjelesnu masu i debljinu, ali ne i za zdrave navike u djece dru-gih i trećih razreda osnovnih škola Republike Hrvatske.

Objective:To assess the association between pregestational BMI and offspring’s risk of overweight/obesity after accounting for the most important confounders, especially maternal smoking habit.Design:Prospective cohort study.Setting:The Seguimiento Universidad de Navarra (SUN) study is a prospective cohort of Spanish graduates with more than 22 000 participants nationwide. Recruitment started in 1999, and it is permanently open. Data on diet, lifestyle and clinical diagnoses are collected at baseline and every 2 years.Participants:Women from the SUN cohort who reported at least one pregnancy during follow-up (n 3496) were invited to this study. Among them, 1527 agreed to participate and completed an additional more detailed online questionnaire on their pregnancy history and their offspring’s nutritional status.Results:After excluding 165 children, we analysed data of 2791 participants born to 1485 mothers and observed that each 5 kg/m2 increase in pregestational BMI was associated with a 0·22 (95 % CI 0·15, 0·29) higher z-score in offspring’s BMI and higher risk of overweight/obesity (multivariable-adjusted relative risk (RR) 1·57 (95 % CI 1·39, 1·77)) in childhood or adolescence. Furthermore, we observed stronger association in children born to smoker mothers (RR 1·91; 95 % CI 1·48, 2·46) than from non-smoker mothers (RR 1·51; 95 % CI 1·31, 1·73) (Pfor interaction = 0·02).Conclusions:We found a synergistic interaction between pregestational BMI and maternal smoking habit on offspring’s z-score of the BMI and in their risk of overweight/obesity. Although further research is needed to analyse dose–response relationships, these findings reinforce the importance of promoting healthy lifestyles in pregnant women in order to prevent childhood obesity.

Objective:The National Child Measurement Programme (NCMP) is a mandatory initiative delivered in England to children in Reception and Year 6. To date, no research has explored the methods used to deliver the NCMP by Local Government Authorities (LGA) across England.Design:An online survey was administered between February 2018 and May 2018 to explore the delivery of the NCMP across the 152 LGA in England and disseminated using non-probability convenience sampling.Setting:LGA received an anonymous link to the survey.Participants:A total of 92 LGA participated in the survey.Results:Most LGA who responded provide result feedback (86 %), a proactive follow-up (71 %) and referrals to services (80 %). Additionally, 65 % of the authorities tailor Public Health England specimen result letters to suit their needs, and 84 % provide attachments alongside. Out of 71 % of LGA who provide proactive follow-up, 19 (29 %) provide the proactive follow-up only to upper weight categories and only 4 (6 %) include Healthy Weight category with other categories in proactive follow-up. Regarding the service availability for children, out of 80 % of LGA who indicated that services are available, 32 (43 %) targeted solely upper weight categories, while the other 42 (57 %) offered services across all weight categories. Finally, most LGA (88 %) commission providers to manage various parts of the NCMP.Conclusions:The results show that LGA in England localise the NCMP. Further guidance regarding standards of best practice would help LGA to find the most suitable localisation out of various options that exist across other LGA.