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This study evaluated the effect on reported readiness for action and attitudes toward obesity prevention among older adolescents (mean age 17) who took part in a youth-led participatory action research European initiative (CO-CREATE Youth Alliances) compared with a comparison group that acted as controls. This was a concurrent before-and-after controlled study across five countries and took place between September 2019 and October 2020. Adolescents (n = 159) recruited from schools and youth organizations came together with researchers and formed 15 Youth Alliances. An online questionnaire measuring their readiness for action and attitudes toward obesity prevention was administered. Alliance members (n = 62) who filled in the questionnaire at both baseline and postinitiative, and adolescents from the comparison group (n = 132) who completed the questionnaire twice were included in the main analysis. Two-level linear mixed models controlling for country-related variance were fitted. Alliance members scored significantly higher than the comparison group on two factors in each of the readiness for action, responsibility, and drivers of behavior concepts. The findings suggest that involving youth in co-creating policies to prevent obesity may increase adolescents' readiness for action and promote a shift in adolescents' conceptualization of obesity from an individual perspective to a societal responsibility and drivers of behavior., (© 2023 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Public health research and practice is increasingly employing systems thinking to help grapple with complex issues, from obesity to HIV treatment. At the same time, there is growing recognition that to address a given problem it is essential collaborate with those most at risk of or affected by it. Group model building (GMB), a process grounded in system dynamics, combines systems thinking and participatory methods to structure and address complex issues. As part of the CO-CREATE project we conducted GMB sessions with young people in six countries to create causal loop diagrams showing the factors that they believe drive obesity. This paper describes the background to GMB and the process we used to construct causal loop diagrams; it discusses how GMB contributed to generating noteworthy and useful findings, and the strengths and limitations of the method. Using GMB, we identified areas of concern to adolescents in relation to obesity that have so far had little attention in obesity research and policy: mental health and online activity. In using GMB, we also helped answer calls for a more participatory approach to youth involvement in research and policy development., (© 2022 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Background and Aims: Body composition in childhood is not only a marker of the prevalence of obesity, but it can also be used to assess associated metabolic complications. Bioelectrical impedance analysis (BIA) shows promise as an easy to use, rapid, and non-invasive tool to evaluate body composition. The objectives of this study were to: (a) develop BIA prediction equations to estimate total body water (TBW) and fat-free mass (FFM) in European children and early adolescents and to validate the analysis with the deuterium dilution as the reference technique and (b) compare our results with previously published paediatric BIA equations., Methods: The cohort included 266 healthy children and adolescents between 7 and 14 years of age, 46% girls, in five European countries: Bosnia and Herzegovina, Latvia, Montenegro, North Macedonia, and Portugal. TBW and FFM were the target variables in the developed regression models. For model development, the dataset was randomly split into training and test sets, in 70:30 ratio, respectively. Model tuning was performed with 10-fold cross-validation that confirmed the unbiased estimate of its performance. The final regression models were retrained on the whole dataset., Results: Cross-validated regression models were developed using resistance index, weight, and sex as the optimal predictors. The new prediction equations explained 87% variability in both TBW and FFM. Limits of agreement between BIA and reference values, were within ±17% of the mean, (-3.4, 3.7) and (-4.5, 4.8) kg for TBW and FFM, respectively. BIA FFM and TBW estimates were within one standard deviation for approximately 83% of the children. BIA prediction equations underestimated TBW and FFM by 0.2 kg and 0.1 kg respectively with no proportional bias and comparable accuracy among different BMI-for-age subgroups. Comparison with predictive equations from published studies revealed varying discrepancy rates with the deuterium dilution measurements, with only two being equivalent to the equations developed in this study., Conclusions: The small difference between deuterium dilution and BIA measurements validated by Bland-Altman analysis, supports the application of BIA for epidemiological studies in European children using the developed equations., Competing Interests: Declaration of competing interest LCW consults to Impedimed Ltd. IAEA provided reimbursement of expenses to attend project planning, training and data finalization meetings., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: To make effective progress towards a global reduction in obesity prevalence, there needs to be a focus on broader structural factors, beyond individual-level drivers of diet and physical activity. This article describes the use of a systems framework to develop obesity prevention policies with adolescents. The aim of this research was to use the group model building (GMB) method to identify young people's perceptions of the drivers of adolescent obesity in five European countries, as part of the EU-funded Co-Create project., Methods: We used GMB with four groups of 16-18-year-olds in schools in each of the five European countries (The Netherlands, Norway, Poland, Portugal and the UK) to create causal loop diagrams (CLDs) representing their perceptions of the drivers of adolescent obesity. The maps were then merged into one, using a new protocol., Results: Two hundred and fifty-seven participants, aged 16-18 years, engaged in 20 separate system mapping groups, each of which generated 1 CLD. The findings were largely congruent between the countries. Three feedback loops in the merged diagram particularly stand out: commercial drivers of unhealthy diets; mental health and unhealthy diets; social media use, body image and motivation to exercise., Conclusions: GMB provides a novel way of eliciting from young people the system-based drivers of obesity that are relevant to them. Mental health issues, social media use and commercial practices were considered by the young people to be key drivers of adolescent obesity, subjects that have thus far had little or no coverage in research and policy., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association.)