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Rates of obesity continue to rise in the United States and across the globe. Obesity is a risk factor for developing insulin resistance, type 2 diabetes, and cardiovascular disease. For clinicians, other health care providers, and educators, providing patients with accurate and meaningful information about obesity, including lifestyle (diet and exercise) interventions and symptom monitoring, is challenging because of infrequent contact, methods of communication, a lack of effective patient education resources, and inefficient patient feedback methods. Evidence suggests that significantly more patients are now getting their health care information online from general medical websites, disease-specific network communities, and social media. Thus, harnessing the power of technologies, including personal computers and smartphones, with attention to social media may equip health care providers with methods to serve their patients better by addressing challenges, improving indirect patient contact, and enhancing health outcomes. This article aims to provide an overview of technology with a focus on social media use in obesity education and outreach. Practical information is provided related to creating content, delivering content, and managing the social media space for the novice creator.

Early intervention can reduce disability in children diagnosed with autism spectrum disorder. Screening for autism spectrum disorder in young children identifies those at increased likelihood of diagnosis who may need further support. This study assessed in "utero" exposure to maternal obesity and diabetes and offspring performance on the Quantitative Checklist for Autism in Toddlers, an autism spectrum disorder screening questionnaire administered between 18 and 24 months at well-child visits. This retrospective cohort study included 65,433 singletons born in a single healthcare system. Demographic data, maternal obesity, Type 1/Type 2 and gestational diabetes mellitus information, and Quantitative Checklist for Autism in Toddlers score in children 12-30 months old were extracted from electronic medical records. Negative binomial models were used to estimate incidence rate ratios of associations between maternal obesity and diabetes exposure and continuous offspring Quantitative Checklist for Autism in Toddlers scores. Maternal obesity, Type 1/Type 2 diabetes (incidence rate ratio: 1.13, 1.06-1.21) and gestational diabetes mellitus [less than or equal to] 26 weeks (incidence rate ratio: 1.10, 1.05-1.17) were associated with one-unit increases in Quantitative Checklist for Autism in Toddlers scores. Relationships with obesity and gestational diabetes mellitus [less than or equal to] 26 weeks remained after mutual adjustment and excluding children with autism spectrum disorder diagnoses. No associations were reported for gestational diabetes mellitus > 26 weeks. Maternal obesity and diabetes were associated with higher Quantitative Checklist for Autism in Toddlers scores in children 12-30 months old, suggesting these exposures in pregnancy may be associated with a range of early childhood behavior.

I provide novel evidence on the role of imperfect information in shaping childhood obesity. Between 2003 and 2017, 24 states began requiring schools to perform Body Mass Index assessments on students. Using the 1991 to 2017 National and State Youth Risk Behavior Surveys and a stacked difference-in-differences identification strategy, I show that these state-mandated school-based BMI assessments were associated with an increase in the likelihood that teens described themselves as overweight and reported that they were trying to lose weight. The relationship was most pronounced for overweight teens, suggesting that the assessments improved awareness about BMI status among this group, though I also find that non-overweight teen girls were subsequently more likely to incorrectly describe themselves as overweight. While I do not detect meaningful changes in exercise or calorie-limiting behaviors, I do find that these state-mandated school-based BMI assessments were associated with a modest reduction in BMI.

The workplace has been highlighted as a potential setting to deliver health promotion programs to target modifiable health behaviors that contribute to chronic disease. This review evaluated the effectiveness of interventions implemented within the workplace that targeted either smoking, nutrition, alcohol, physical activity, and/or overweight and obesity in men. A review protocol was prospectively registered through PROSPERO (CRD42021293398). Five electronic bibliographic databases were searched for randomized controlled trials conducted in the workplace assessing chronic disease risk factors in men from January 2010 to August 2021. Eleven studies were included, reporting on overweight and obesity n = 8, physical activity n = 7, nutrition n = 4, alcohol n = 3, smoking n = 3, with eight studies assessing multiple outcomes. Results were mixed. Narrative synthesis highlighted studies reporting improvements to snacking frequency, sugar sweetened beverage consumption, and physical activity (METs and Vo2 max). Meta-analysis highlighted pooled mean decrease in body weight of -0.28 kg up to 3 months; -1.38 kg for >3 months, and pooled mean decrease in body mass index 0.06 kg/m2 up to 3 months; -0.27 kg/m2 for >3 months. Despite the encouraging direction of the relationship, results were not statistically significant (p > 0.05). Findings underscore the potential of workplace health promotion programs targeting certain chronic disease risk factors in men; however, future research should consider long-term study designs to assess the efficacy of workplace health programs as a solution to the growing burden of global disease.

School-age children with overweight or obesity continue to be problematic in the United States, and are associated with many health, social, and financial problems. Schools provide an excellent venue in which to promote healthy weight in students, and school nurses are well-positioned to play an essential role in controlling obesity. The number of studies reporting relationships among school health infrastructure and prevalence of elevated Body Mass Index (BMI) is limited. The present study explored associations between three components of school health infrastructure (staff, services, budget) and the proportion overweight or obese 1st, 3rd, and 6th grade students, after controlling for selected factors (race, county education level, county poverty level, rurality). Study results supported an independent association between elevated BMI and school health staff. Additionally, independent associations between elevated BMI and the following covariates were supported: household income, race, and parents' educational level. There is an ultimate need for well-designed studies addressing these associations.

Background: Adolescents with overweight or obesity are at greater risk of having physical and psychosocial consequences. With increased disparities and inadequate literature on prevalence of adolescent weight status in rural Appalachia, there is potential for further complications. Unfortunately, adolescent obesity treatment options are often limited, especially in medically underserved regions. Methods: This cross-sectional study of adolescents at eight rural Appalachian schools examined weight status among and associations between body mass index percentile (BMIp) categories and health-related perceptions and weight-control intentions. Previously validated instruments were utilized. Analyses included independent samples t-tests, ANOVA tests, and chi-squared tests. Results: Of 814 adolescents (ages 11-13; 55.0% girls), BMIp revealed 20.8% overweight, 22.7% obese, and 10.6% severely obese. Adolescents with higher BMIp categories reported poorer self-rated health, inaccurate weight perceptions, and greater weight loss intentions (all p < 0.05). Conclusions: Findings, including high prevalence of adolescents with overweight and obesity, emphasize the need for more obesity prevention and treatment options. Schools may be an ideal setting to reach at-risk adolescents and provide obesity prevention and treatment options, especially in medically underserved regions such as rural Appalachia. Opportunities and challenges to apply findings, including school-based obesity programs, are discussed.

This study was conducted to evaluate the BMI of the children with intellectual disability and the factors affecting their BMI. This descriptive and cross-sectional study was carried out between March 2016 and April 2016 in Turkey and consisted of 135 children. Children's anthropometric measurements were and their BMI values were calculated. Categorization of children by BMI percentile according to AAP reference values was performed. There was a significant difference between the BMI categories of the children (p < 0.05) and the education level of children's father (x2 = 8.960; p = 0.028), the degree of intellectual disability (x2 = 16.113; p = 0.008), the presence of other disabilities (x2 = 22.013; p = 0.000), type of disability (x2 = 21.359; p = 0.001), the nutrient intake (x2 = 38.935; p = 0.000) and the presence of nutritional problems (x2 = 7.687; p = 0.042). Father's education level, children's degree of disability, child's having presence of other disabilities, child's being dependent in the view of nutrient intake, and child's having nutritional problems were determined as factors affecting BMI.

Researchers are increasingly using web-based technologies to deliver family-based, prevention programming. Few studies have examined the success of such approaches for families with low incomes. The purpose of this study was to describe the level of in-class and online engagement in a childhood obesity prevention program for parents with low incomes, to examine the demographic correlates of parent engagement, and to examine dosage effects on parental feeding outcomes as a function of online exposure. All participants attended in-class nutrition education classes (Eating Smart ? Being Active) as part of the Expanded Food and Nutrition Education Program (EFNEP) in Colorado and Washington State (classes were offered in English and Spanish). Participants in this analysis were 168 parents from a larger cluster randomized controlled trial who had been randomly assigned to also receive a newly developed, mobile-based version of an efficacious, feeding-focused, childhood obesity prevention program. Results showed that despite high levels of in-person attendance (70%), participants only accessed 47% of the videos (online content). Older parents and parents of girls showed higher levels of in-person attendance; currently employed parents showed lower levels. Online engagement varied as a function of ethnicity and acculturation: non-Hispanic parents accessed the most videos, low-acculturated Hispanic parents accessed the second most, and highly acculturated Hispanic parents accessed the least. In contrast, low-acculturated Hispanic parents showed the highest in-person attendance. For all but one outcome, significant online program effects were found only for parents who accessed at least half of the videos. Implications for mobile-based, family-based prevention programs for parents with low incomes are considered.

Background: Internationally 18% of youth are obese. Fitness testing can be used to establish fitness surveillance, which can inform policy and targeted interventions aimed at addressing obesity. The purpose of this study was to estimate the prevalence of overweight, obesity, and low fitness in Idaho school-aged youth through a pilot study. Methods: A convenience sample of 13 teachers from 11 north Idaho rural schools collected FitnessGram fitness data: body composition (body mass index [BMI]), aerobic capacity (Progressive Aerobic Cardiovascular Endurance Run [PACER] test), muscular endurance (curl up), strength (pushup), and flexibility (sit and reach). Results: A total of 761 students (aged 9-18 years) from grades 3&5, 7, and 9 to 12 participated in the study. Approximately 24% of 3&5 and 22% of 7th, and 12% of 9 to 12th-grade students were categorized as Needs Improvement/Health Risk by FitnessGram standards for BMI. Similarly, approximately 25% of 3&5, and 22% of 7 and 9 to 12th-grade students were considered Needs Improvement/Health Risk for PACER. Implications for School Health Policy, Practice, and Equity: Results from fitness testing can provide school and public health representatives with a "needs assessment" of student health that can be used to help develop policies and practices to improve student health and wellbeing. Conclusions: This study provides a model for statewide annual fitness testing surveillance and reporting within K-12 public school physical education classrooms.

The family has a key role in the obesity management of children with autism. This study examines the relationship between the nutrition-physical activity behaviors of autistic children with their families and children's obesity levels during COVID-19 pandemic. The descriptive and cross-sectional study involved 80 parents of autistic children. A positive correlation was found between children's mean BMI values before and during the pandemic (p = 0.000). Family Nutrition and Physical Activity Scale (FNPAS) and Brief Autism Mealtime Behavior Inventory (BAMBI) score were 55.18 ± 7.86 and 31.76 ± 8.79, respectively. In addition, it was found that 32.5% of the children ate more than before the pandemic, 50.0% engaged in less physical activity, and 16.3% didn't do any physical activity. The study results suggesting the risk of obesity.

Mothers of children with Autism Spectrum Disorder (ASD) often experience chronic stress and are at risk for adverse health. However, little is known about fathers, especially when their child is in early childhood. Parenting stress, eating behavior and physical health was evaluated in mothers (n = 48) and fathers (n = 43) of young children (3-7 years) with ASD by questionnaires and physical measurements. Mother's prevalence rates of obesity (39.1%), abdominal obesity (59.6%) and metabolic syndrome (21.6%) were higher than the norm. In fathers, the prevalence rate of clinical parenting stress (33%) was higher than the norm. Parenting stress was positively related to disinhibited eating in mothers, not in fathers. It is crucial to monitor stress and health of parents of children with ASD.

The purpose of this study was to explore the validity of evidence for self-efficacy to regulate physical activity scale (SERPA) measurement using an exploratory latent variable approach. The objectives were to explore the dimensionality, temporal invariance, and external validity of scores produced by the SERPA, a modified version of the barriers self-efficacy scale. Data (N[subscript baseline]= 461 and N[subscript 30 days post-baseline] = 427) from the Well-Being and Physical Activity Study (ClinicalTrials.gov, identifier: NCT03194854), which deployed the Fun For Wellness intervention, were analyzed. A two-dimensional factor structure explained responses to the SERPA at baseline. There was evidence for at least partial strict temporal measurement invariance for this two-dimensional structure. There was evidence for external validity of the SERPA measurement as evidenced by group assignment (i.e. the intervention) exerting a direct effect on the proposed two-dimensional structure of latent self-efficacy to regulate physical activity in adults with obesity at 30 days post-baseline.

Objective: The use of social networks has grown substantially over the past few years and especially during COVID-19. This study aims to investigate the possible relationship between social media addiction and obesity which may lead to disturbed body perception in university students. Participants: A total of 250 undergraduates participated. Results: Social media addiction depends on the number of years of social media use, meal skipping, and increased frequency of fast food consumption. There was a significant relationship between fast-food consumption frequency and body perception. No significant relationship was found between BMI and SMAS while there was a significant relationship between SMAS and body perception. Conclusion: The findings support, social media addiction may lead to increased risk factors for obesity and as a consequence impair body perception in young adults.

Background: Feeding behaviors adopted by parents influence children's eating, and parent mental health may affect feeding interactions. Anxiety disorders are the most prevalent mental disorders among adults; thus, there is a need to comprehensively understand the relationship between parent anxiety symptomatology and feeding behaviors. Objective: This systematic review provides the first comprehensive overview that focuses solely on parent anxiety and nonresponsive feeding. Based on PRISMA guidelines, the goal of this review is to elucidate current literature gaps and to inform future interventions that aim to reduce the risk of childhood obesity. Methods: PubMed and APA PsycInfo were searched with an extensive keyword combination to identify empirical studies from peer-reviewed journals that focus on parent anxiety and feeding behaviors that are utilized with typically developing children of ages 6 months or older. After independent and masked screening rounds of 925 articles, 10 studies were included for data extraction. In accordance with the PRISMA guidelines, the independently extracted data included the following: authors, year of publication, sample characteristics, study design, anxiety and feeding measures, study goal, main findings, and methodological limitations. Results: Of the 10 studies included in this systematic review, 70% indicated an association between parent anxiety symptomatology and nonresponsive feeding behaviors of restriction, control, and emotional feeding. Ninety percent of the included studies had a mother-only sample. Conclusions: Parents with anxiety symptomatology tend to use nonresponsive and obesogenic feeding practices. Given this relationship, parent anxiety is a potential area for inclusion in interventions that aim to reduce children's risk for obesity.

This study aimed to examine the moderating effect of student engagement between weight bias internalization and depressive symptoms in Korean adolescent girls with higher weight. Ninety-nine girls with higher weight ([greater than or equal to]85th body mass index percentile) in early adolescence (aged 12-14 years) participated in this cross-sectional study. Weight bias internalization, student engagement, and the interaction between these variables were significantly associated with depressive symptoms. Furthermore, a simple slope analysis indicates that higher student engagement was associated with more significant relief in depressive symptoms. Thus, promoting higher student engagement with family and school support may help reduce depressive symptoms related to weight bias internalization in adolescent girls with higher weight. Therefore, family- and school-based programs are required to enhance student engagement in adolescent girls with higher weight.

Research suggests participating in youth hands-on cooking programs, like those offered by Extension and 4-H, can improve nutrition behaviors and reduce the risk for obesity. We surveyed Georgia Extension professionals (n = 127) to explore factors (e.g., employee characteristics, resources, county demographics) related to offering youth hands-on cooking programs and curricula used. Over 2/3 of participants offer programs and reported creating their own curriculum. More years of experience, having received Extension Specialist training, and increased confidence were positively related to offering these programs. Results suggest training could increase confidence and program implementation and standard curricula may be needed/

A family-skills program for Latino fathers and youth was implemented to prevent youth obesity. Lessons learned focused on practices to address barriers to engagement and retention among fathers and youth within the Latino community. Program development issues included selection of organizations, facilitators, language, and delivery methods. Implementation issues included timing and location. Cultural issues regarding learner needs, and teaching and implementation methods need to be considered. Using the lessons learned, Extension professionals can create impactful programs that engage and retain Latino fathers and youth.

Healthy nutrition is essential in preventing possible diseases and treating existing diseases by controlling their course. Based on this importance, adolescence is one of the periods to be considered. Adolescence is a fundamental determinant of healthy life in adulthood and old age. Healthy nutrition awareness gained in this period will raise awareness of the adolescent individual herself/himself and the people around her/him. This research aimed to determine the nutrition awareness of middle school students in early adolescence. According to the phenomenology, the research was conducted with eight volunteer students in the 8th grade in a public middle school in the Central Anatolia region in Turkey. Data were collected through semi-structured interviews with each student individually using the "Interview Form about Nutrition Awareness in Adolescence Period" prepared by the researchers. The data were analyzed by using content analysis. As a result of the research, it was determined that the nutrition awareness of middle school students in the early adolescence period was low. In this context, increasing middle school students' nutrition awareness was recommended.

Risky behaviors (substance abuse, obesity, suicide, bullying, and others), many of which are indeed preventable, are common among high school students. The most important task in detecting, preventing, and intervening in risky behaviors in schools falls to the school guidance service and school psychological counselor. The main objective of this study is to determine the types and prevalence of risky behaviors observed among high school students and to analyze the practices performed by the school guidance service for such behaviors. This study was organized in accordance with the mixed research design for which qualitative and quantitative approaches were used together. In this context, quantitative (N1=566) and qualitative (N2=21) data collection processes were carried out with psychological counselors working in different types of high schools in 12 provinces. While statistical procedures were included for the quantitative data of the research, content analysis techniques were used for the qualitative data. The results showed smoking, peer bullying, cyberbullying, school dropout, obesity, delinquency, abuse, suicidal tendency and attempt, alcohol use, bonsai use, and other substance use as risky behaviors in high schools. The levels and frequency of these behaviors vary across school types. The preventive activities in the schools were generally based on informative seminars, and practical studies were limited. The research results also indicated that studies of risky behaviors were not sufficiently included in Ministry or school guidance framework programs. Furthermore, it was found that parents, teachers, and administrators gave limited support to the studies carried out within the scope of education and intervention for risky behaviors in schools. These results demonstrate that school psychological counselors encountered several personal, institutional, or legal obstacles in their studies on risky behaviors.

Group model building is a participatory workshop technique used in system dynamics for developing community consensus to address complex problems by consensus building on individual assumptions. This study examines changes in individual mental models of the complex problem of childhood obesity following participation in group model building (GMB), as part of a larger community-based system dynamics project. Data are drawn from GMB participants across six community sites in the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) in rural and regional Victoria, Australia. Each community participated in two GMB sessions resulting in a causal loop diagram (CLD) of drivers of childhood obesity for each community. Presurvey and postsurvey captured participants' perspectives before and after (n = 25) participation in both GMB sessions and a blend of inductive and deductive qualitative content analysis was used to code individual responses. Three calculations were used to determine the number of responses, whether responses were a result of persuasion from others, and comparison of responses to those found in the CLD. Our study found participant mental models shifted during the course of the GMB sessions, with some responses persuaded by others and 75% of new insights identified in CLDs created by communities. The GMB process created a platform for participants to share ideas and learn from each other. In addition, participants listed new insights about childhood obesity in their community through developing CLDs.

This study aims to identify the following factors that affect the physical inactivity of the students in saint joseph college aged 12-16 years old. It aims to understand the impact of this crisis and how to address this pressing issue. A descriptive- survey research design was utilized to document the respondents' behavior, demographics, and experiences correlated to the questions provided. The questionnaire includes 15-item questions that seek to gather information on their basic profile, current experiences, and behavior towards physical activities. The study discovers that teenagers aged 12-16 years old are inactive in physical activities and sports due to some reasons like exposure to too much time to gadgets, whether the activity provides a fun and offers socialization, lack of motivation, occupied schedules for other matters, the COVID-19 pandemic, costly sports equipment on the sports of their interest, the unavailability of playing area, and lastly health concerns. Therefore, physical inactivity only alleviates certain issues, physically, mentally, spiritually, and socially. Physical inactivity is the result of demotivated individuals, physical illiteracy, prolonged screen time, and health issues.

The role of regular physical activity and healthy eating in preventing obesity is well documented. Research has suggested that lifestyle interventions, i.e., programs comprising exercise, nutrition education, and behavior modification, are the preferred, non-invasive strategies to prevent childhood obesity. However, minority groups, e.g., underserved Latinx adolescents, experience high attrition rates and other barriers that limit their participation in obesity prevention programs. The purpose of this study was to examine indicators of the feasibility of the remotely delivered BRAVO! lifestyle intervention in preventing obesity among Latinx youth. This pilot study was a quasi-experimental trial with a sample of 11 pediatrician-referred participants (M[subscript age]=13.73±1.10) assigned to two parallel arms: 1) BRAVO! and 2) as-usual control arms. Researchers designed the BRAVO! lifestyle intervention program comprising 16 hours of remotely instructed (via zoom) exercise training and six hours of family nutrition education. Behavior modification strategies were based on the self-determination theory. The results showed high demand with program adherence being 93.3% and 86.7%, for exercise and nutrition, respectively. There was a statistically significant intervention effect on PA (F[1,8]=7.88, p=0.006, [eta]p2=0.42), integrated (F[1,8]=20.00, p=0.002, [eta]p[superscript 2]=0.71), introjected regulation (F[1,8]=7.94, p=0.008, [eta]p[superscript 2]=0.60), and amotivation (F[1,8]=18.24, p=0.002, [eta]p[superscript 2]=0.69), and psychological well-being (F[1,8]=12.31, p=0.008, [eta]p[superscript 2]=0.61). Finally, interview analyses showed that participants were highly satisfied with the BRAVO! program and they perceived BRAVO! suitable for them. In conclusion, our pilot study findings supported feasibility of the remotely delivered BRAVO! lifestyle intervention.

This study assessed associations between school nurse workload and student health and academic outcomes. We hypothesized that lower school nurse workload would be associated with better student outcomes, with associations being greater for members of groups who experience health disparities. Our methods entailed secondary analysis of data for New York City school students in kindergarten through 12th grade during 2015-2016 (N = 1,080,923), using multilevel multivariate regression as the analytic approach. Results demonstrated lower school nurse workload was associated with better outcomes for student participation in asthma education but not chronic absenteeism, early dismissals, health office visits, immunization compliance, academic achievement, or overweight/obesity. Our findings suggest school nurses may influence proximal outcomes, such as participation in disease-related education, more easily than downstream outcomes, such as absenteeism or obesity. While contrary to our hypotheses, results align with the fact that school nurses deliver community-based, population health--focused care that is inherently complex, multilevel, and directly impacted by social determinants of health. Future research should explore school nurses' perspectives on what factors influence their workload and how they can best impact student outcomes.

This article aims to show and make explicit the exclusion sometimes experienced by children with disabilities and obesity in physical activity (PA) and physical education (PE). Using empirical data from our previous qualitative work, we have engaged in a process of creative writing to present a tale that exhibits how exclusion is experienced by students in PA and PE, as well as ways in which students' integration and inclusion could be fulfilled. The tale presented in this article draws from data generated in in-depth interviews, focus groups and field notes to recreate the experiences of three composite characters: Will, a student with osteogenesis imperfecta; Ella, a wheelchair user; and Josh, a child with obesity. To conclude, we present some evidence-based pedagogical approaches that may be useful for PE teachers, PA practitioners and other stakeholders to foster inclusion, social justice and equality when working with children with disabilities and obesity.

Background: Associations between school participation in an academic medical center-supported school-based wellness initiative and programmatic components implemented with change in average student body mass index (BMI) over time were examined. Methods: This was an observational study of 103 K-12 South Carolina schools over school years 2014-2018, classified as participating (n = 87 schools, 27,855 students) or non-participating (n = 16 schools; 3608 students). Associations between students' BMI z-score (BMIz) and school participation were evaluated by linear multilevel mixed-effects modeling using data from FitnessGram and the School Wellness Checklist© (SWC), respectively. Results: One-third of the students had a BMI percentile [greater than or equal to]85. Average student BMIz decreased in participating schools (p = 0.026) and increased in non-participating schools (p = 0.004) over time. For schools that participated two or more years, there was an inverse relationship between SWC score and student BMIz (p = 0.002) that did not differ by school type, rural/urban location, Title 1 status, or student sex. Physical activity and stress management interventions for students, as well as employee wellness and establishing a wellness committee at the school level were significantly associated with decreased average student BMIz (all p < 0.05). Conclusion: Implementation of similar comprehensive school-based wellness programs focused on improving physical activity, stress management, and employee engagement may help prevent and reduce pediatric obesity in diverse communities.

Background: Weight stigma and bias are present in education, employment, and health care institutions, and have increased in recent years. College students in pre-health majors have been documented to hold weight biases, and interventions to mitigate these beliefs have had varying results. Objectives: This study's purpose was to assess the impact of a pedagogical intervention regarding weight stigma outcomes among first-year students. Method: Three instructors of lower-division health and social science courses implemented a 3-module lecture series on weight stigma, the environmental sources of weight variability, and body appreciation. Participants (N = 81; 48 from intervention (INT) classrooms, 33 from comparison [COM] classrooms) completed an end-of-semester survey regarding their anti-fat biases, fat phobia, and body appreciation, and a subset (n = 13) participated in a semi-structured interview about their experiences. Results: Results revealed no outcome differences between the treatment versus comparison groups, although self-reported body mass index (BMI) was a significant covariate (p = 0.008). A significant correlation emerged between BMI and fear of fat scores for COM (r = 0.52, p < 0.01) but not for INT students (r = 0.28, p > 0.05), suggesting the intervention may have impacted how students form their anti-fat biases in relation to their BMI. Qualitative findings yielded five themes -- connected course material with personal experiences; learned about weight stigma; shifted perspective on weight stigma; recognised application of weight stigma; material to future career; and valued learning about weight stigma -- that provided insight into how the intervention positively affected students. Conclusion: Informed by the findings from this study, future interventions should take a more immersive pedagogical approach.

Background: Approximately 20% of US children are obese and these rates are expected to increase. The National School Lunch Program (NSLP) provides meals to millions of students and may influence their body mass index (BMI). This study aimed to investigate whether students who participate in the NSLP have a higher BMI when compared to those that do not. Methods: Secondary data from the US Census Bureau were analyzed. Kruskal-Wallis H tests were performed to find associations between NSLP participation and students' BMI. Race and economic stability were included as moderating variables. Results: NSLP participation and respondents that identified as White/Caucasian, African American, and Native American were positively associated with BMI. Lower economic stability was also positively associated with BMI. Conclusion: Participation in the NSLP was significantly associated with participants' BMI, race, and economic stability. While a cause-and-effect relationship cannot be determined, these results are important given their potential influence on students' long-term health.

The aim of this study was to examine the relationship between health life awareness, emotional eating, obesity awareness, and coping with stress in adolescents. Data were collected with the "Personal Information Form," "Healthy Life Awareness Scale," "Obesity Awareness Scale," "Emotional Eating Scale for Children and Adolescents," and "Styles of Coping Stress Inventory." The sample of the study consisted of 382 high school students. The emotional eating scores of the obese adolescents were higher than the thin ones (p < 0.05); obese adolescents had higher submissive approach scores (p < 0.05) in coping with stress compared to adolescents who are overweight. There was a positive relationship between obesity awareness and positive coping approaches (p < 0.05); awareness of healthy living and positive coping approaches (p < 0.05). An one-unit increase in healthy living awareness causes an increase of 0.409 on obesity awareness. Considering these results, education and intervention studies are recommended for adolescents on healthy living, coping with stress, and obesity awareness.

Academic procrastination, a common phenomenon among college students, is particularly prominent in the field of higher vocational education in China and has attracted much attention in the field of educational research because of its large influence on student academic achievements. In recent years, an increasing number of studies have held that academic procrastination results from student self-regulation failure, and there is an important internal relationship between self-regulation failure and relative deprivation. To examine the relationship mechanism between relative deprivation and academic procrastination in higher vocational college students, this study investigated 15,998 higher vocational college students in Chongqing, Sichuan, Guizhou and Yunnan by using the "Relative Deprivation Questionnaire," "Adolescent Academic Emotion Questionnaire," "Connor-Davidson Resilience Scale" ("CD-RISC") and "Middle School Student Academic Procrastination Scale." The results show the following. (a) Relative deprivation had a significant negative predictive effect on academic procrastination. (b) Negative academic emotions mediated the relationship between relative deprivation and academic procrastination. (c) Resilience moderated the relationship between negative academic emotions and academic procrastination.

Background: Sleep plays an integral role in a child's physical and neuropsychological development. Children with sleep disorders are at risk of developing inattention, hyperactivity, and learning difficulties, challenges that impact them, their families, their classmates, and their communities. There is a paucity of pediatric sleep medicine providers equipped to partner with families in identifying and addressing sleep disorders. Additional barriers to accessing this specialized care include geographic proximity, parental ability to take time off from work, and hesitance for a child to miss valuable learning time at school. During the SARS-CoV-2 pandemic, our pediatric sleep department transitioned from largely in-person care to a predominantly virtual platform and collected data to monitor the impact of this transition. In this study, we share several key trends that emerged which may have broad implications on how pediatric sleep medicine providers can better support school-aged children with sleep challenges. Methods: We performed a chart review of all scheduled pediatric sleep medicine visits from June 2019 to June 2021, a time frame that included the pandemic-driven overnight transition from in-person to virtual clinic visits. The STEM framework was developed by pediatric telehealth experts to provide a unified approach to assessing the impact of telehealth programs. We applied this framework to the collected data to gauge the impact on the four major domains highlighted in STEM: health outcomes, healthcare delivery, individual experience (patient and provider), and program implementation. Results: The data demonstrated an increased proportion of completed visits and a decreased proportion of canceled/no-show visits when care was provided virtually. Patients accessing virtual care were doing so from greater distances than those who had in-person visits. The school-aged (5-12 years) cohort utilizing telehealth had notable differences in past medical history, with significantly more Attention Deficit-Hyperactivity Disorder. They also presented with significantly more insomnia and behavioral sleep difficulties. Discussion: Sleep disorders are common, and school-aged children have much to gain from sleep optimization. However, pediatric sleep care can be challenging to access. Geographic distance and time away from school and work preclude many families from formal sleep consultations. Telehealth allows high-quality pediatric sleep care to be offered in an easily accessible format to those near and far, resulting in clinics running more efficiently and school-aged children, who need it most, to receive the tools they need to sleep soundly. With a convenient click, families are better able to fit virtual sleep consultations into their day, without the stress of travel or the waiting room. They complete more scheduled visits, allowing pediatric sleep medicine departments to deliver care more efficiently. The low-pressure virtual platform also permits families to seek care for behavioral sleep issues. While our department's transition to predominantly virtual care occurred amidst a pandemic, with many confounding factors limiting the interpretation of the data we collected, the trends seen are very promising.

This study aimed at averting challenges of overweight and obesity among African Americans in rural Alabama. Focus group discussions and surveys were used to design a 12-week nutrition education and physical activity program. Results showed a significant improvement (p<0.05) in participants' knowledge scores. Values for systolic blood pressure significantly reduced (p<0.00). There was an increase in number of participants with normal blood pressure and a reduction in number of participants with stage 2 hypertension. The study highlights that nutrition education and physical activity can lead to improved health outcomes among African Americans in rural Alabama.

The aim of this study was to examine the effects of perception of the close environment on obesity and physical activity levels in university students. Included in this study were 113 students between 18-25 years of age, taking into account that there may be erroneous and missing data according to the 95% confidence level in the pre-sample size calculation table according to the confidence level and acceptable error for the research, 10% more than the recommended sample size was calculated and 113 students participated. Up to 20% of the participants were fitted with a pedometer and heart rate monitor for 1 day to determine their objective physical activity levels. Height measurement, body weight measurement, bioimpedance analysis, International Physical Activity Questionnaire-Short Form (IPAQ-SF), pedometer, heart rate, and Immediate Walkability Perception Questionnaire (IWPQ) were applied to the participants. As a result, a significant relationship was found between the number of steps and the shops, facilities, and other nearby places in the vicinity (P < 0.05; r = -0.353). At the same time, a significant relationship was observed between the stores, facilities, and other nearby places in the vicinity and the level of physical activity (P < 0.13; r = -234). Relationships were found between the body mass index (BMI), Body fat percentage, and abdominal circumference data, which are considered as obesity indicators, and the sub-dimensions of the perception of walkability in the immediate environment, but none of these were statistically significant.

Depending on the developing technology, individuals started to pursue a less active lifestyle. The sedentary lifestyle has brought along many health problems. One of these health problems is obesity. Awareness of obesity is important for individual health. One of the applications that can be implemented to cope with obesity is exercise. This study aims to analyze the relationship between university students' exercise addiction and obesity awareness. Therefore, 249 university students (132 males, 117 females) participated in the study. In the study, the "Exercise Addiction Scale" developed by Tekkursun-Demir, Hazar and Cicioglu (2018) and the "Obesity Awareness" scale developed by Allen (2011) and adapted to Turkish culture by Kafkas and Özen (2014) were used as data collection tools. Data were analyzed with descriptive statistical methods, t-test for independent groups and one-way variance (ANOVA). Correlation test was employed to determine the relationship between exercise addiction and obesity awareness. As a result of the research, it was determined that students' awareness of exercise addiction and obesity was at a moderate level. It was determined that exercise addiction had a significant effect on average the number of steps taken per day. Besides, it was determined that there was a low level of a positive relationship between exercise addiction and obesity awareness.

Gastrointestinal disturbances (GIDs) are relatively common in children diagnosed with autism spectrum disorder (ASD). This study assessed associations between maternal obesity, diabetes, preeclampsia, and asthma and likelihood of ASD with GIDs. This retrospective cohort study included 308,536 mother-child pairs of singletons born between 2001 and 2014 in a single integrated health care system. Social demographics, maternal health conditions during pregnancy, and child's ASD and/or GID diagnosis by age 5 were extracted from electronic medical records. Child's outcome was classified as: no ASD no GIDs; no ASD with GIDs; ASD no GIDs; and ASD with GIDs. Multinomial logistic regression was used to estimate odds ratios of child's outcomes associated with maternal exposures, adjusting for covariates. Compared to children with neither disorder, each maternal condition was associated with higher odds of no ASD with GIDs, ASD no GIDs, and ASD with GIDs. Association was greatest for likelihood of ASD with GIDs (Maternal obesity odds ratio (95% confidence interval): 1.37 (1.22-1.54); Diabetes: 1.50 (1.28-1.76); Preeclampsia: 1.63 (1.36-1.95); Asthma: 1.39 (1.17-1.67); relative to no ASD no GIDs). Associations were robust to mutual adjustment for all maternal exposures. Maternal obesity, diabetes, preeclampsia, and asthma exposure during pregnancy may increase likelihood of both GIDs and ASD with or without co-occurring GIDs in offspring. This association was greatest in children diagnosed with ASD with co-occurring GIDs.

Growth mixture models (GMMs) are applied to intervention studies with repeated measures to explore heterogeneity in the intervention effect. However, traditional GMMs are known to be difficult to estimate, especially at sample sizes common in single-center interventions. Common strategies to coerce GMMs to converge involve post hoc adjustments to the model, particularly constraining covariance parameters to equality across classes. Methodological studies have shown that although convergence is improved with post hoc adjustments, they embed additional tenuous assumptions into the model that can adversely impact key aspects of the model such as number of classes extracted and the estimated growth trajectories in each class. To facilitate convergence without post hoc adjustments, this paper reviews the recent literature on covariance pattern mixture models, which approach GMMs from a marginal modeling tradition rather than the random effect modeling tradition used by traditional GMMs. We discuss how the marginal modeling tradition can avoid complexities in estimation encountered by GMMs that feature random effects, and we use data from a lifestyle intervention for increasing insulin sensitivity (a risk factor for type 2 diabetes) among 90 Latino adolescents with obesity to demonstrate our point. Specifically, GMMs featuring random effects--even with post hoc adjustments--fail to converge due to estimation errors, whereas covariance pattern mixture models following the marginal model tradition encounter no issues with estimation while maintaining the ability to answer all the research questions. [For the corresponding grantee submission, see ED618691.]

Background: This study evaluated the impact of a school-based nutrition program on preventing overweight and obesity in children in Thailand from 2014 to 2019. Methods: We used difference-in-differences with matched comparison group to evaluate program impact. Treatment schools were categorized into those that participated in phase 1 only, and those that participated in phase 1 and 2. We matched 311 treatment schools in phase 1 only with 1504 comparison schools, and 75 treatment schools in both phases with 216 comparison schools. Administrative data from Thailand Office of Basic Education Commission were used from 2014 (baseline), 2016 (first follow-up), and 2019 (second follow-up). Results: Program resulted in a 0.6-1.1 percentage point reduction in the students' probability of overweight by the end of phase 1, and 1.7 percentage points by the end of phase 2. Impact on obesity was found only for schools participating in both phases (0.4 and 0.9 percentage points by the end of phase 1 and 2, respectively). Implications For School Health Policy, Practice, and Equity: Program continuity and intensity are key to achieve a reduction in overweight and obesity in schoolchildren. Conclusions: The program was successful in reducing overweight and/or obesity given appropriate level of continuity and intensity.

Background: To address concerns that healthy weight and lifestyle campaigns (HWLCs) could have unintended psychological or behavioral consequences, this study tested reactions to TV advertisements from two HWLCs--"LiveLighter"® (employs graphic health effects messaging) and "Swap It Don't Stop It" (employs animation and light-hearted messaging). Methods: An online between-subjects experiment tested reactions to one of five advertisements: "Toxic Fat"; "Sugary Drinks" (both from "LiveLighter"); "Become a Swapper"; "How to Swap It" (both from "Swap It"); and "HSBC Bank" (control) among 2,208 adults from Western Australia and Victoria, Australia. Responses assessed were cognitive and emotional reactions, behavioral intentions, internalized weight bias, antifat attitudes, self-esteem and body dissatisfaction. Results: The HWLC advertisements prompted favorable cognitive reactions and weak to neutral positive and negative emotional responses. HWLC advertisements promoted stronger intentions to engage in adaptive lifestyle behaviors compared with the control advertisement. Intention to engage in maladaptive behaviors (e.g., skipping meals) was low overall and did not differ by condition. Compared with the control condition, participants who saw "LiveLighter" "Sugary Drinks" showed weaker disagreement with antifat attitudes; however, mean antifat attitude scores were still at the low end of the scale. HWLC advertisements did not promote internalized weight bias, reduced self-esteem or body dissatisfaction compared with the control advertisement. Conclusions: Overall, HWLC advertisements performed favorably compared with the control advertisement and showed no clear evidence of adverse impacts. Findings suggest HWLC advertisements may not promote negative psychological and behavioral consequences and can continue to be used in obesity prevention efforts.

Objectives: In the USA, 18% of school-aged young people are classified as obese, and rural populations appear to be particularly at risk. Achieving high levels of fitness reduces the risk of obesity and underlying health conditions. To better understand youth obesity trends and fitness levels, annual fitness testing ([FT], that is, surveillance) in schools has been recommended. Although many K-12 schools conduct FT, surveillance programmes that compile unified standardised test results are rare. Design: Qualitative design. Setting: Physical education teachers from 11 schools (n = 13; n = 4 men) participated in remote training about conducting FitnessGram FT. Methods: Data included two semi-structured interviews per teacher on experiences with distance fitness training, implementing FitnessGram, and data entry for annual surveillance. Results: Inductive analysis using axial and open coding identified four themes--(1) barriers prior to study, (2) study training, (3) implementation challenges and suggestions and (4) teacher feedback. Teachers had an interest in FT but lacked the recommended training and equipment needed to implement it annually. Conclusion: Teachers believed the training they received (as part of this study) prepared them to collect reliable and valid data, and that FT had benefits for their students and programmes. Every teacher expressed interest in reporting annual surveillance data. Efforts to train teachers for FT through virtual professional development may be a viable means of establishing a unified surveillance system.

Objectives: To (1) determine the weight-reducing effect of the Koa Family Program (KFP), a community-based, telewellness obesity intervention and (2) examine the impact of the KFP on improving weight-related health indicators. Design: Randomised controlled trial. Setting: Community-based in Sacramento, California, USA. Methods: Seventy women with overweight or obesity (25 [less than or equal to] BMI < 40), aged 21-45 years and with low income ([less than or equal to] 185% of the US Federal Poverty Level) were randomly assigned to an intervention (n = 34) or control (n = 36) group. Data were collected by phone-administered questionnaire at weeks 0, 18 and 25. The intervention consisted of three components: (1) weekly, health coach-led, health education meetings on Zoom; (2) social media support through texting and private Facebook groups; and (3) a tree planting and stewardship campaign. The treatment effect on outcome measures (95% confidence intervals) was analysed with adjustment for variables including age, race/ethnicity, education and intake of fruit and vegetables. Results: The overall treatment effect of the KFP was weight loss at both Week 18 (-7.69 pounds [p < 0.000; 95% confidence interval (CI) = -11.97 to -3.41]) and Week 25 (-7.72 pounds [p = 0.002; 95% CI = -13.02 to -2.42]) of the study. KFP-associated improvements in diet, physical activity, stages of change and self-efficacy were also observed. Conclusions: The KFP resulted in weight loss significant at individual and population levels.

Background: Black men and women have the highest rates of obesity in the United States. Behavioral weight loss programs incorporating intimate partners may be effective in combating obesity among this population. Yet, current participation in these programs is low. Identifying motivations and triggers to weight loss may provide insight in designing programs to increase participation. Aim: To determine triggers and motivations for weight loss among Black men and women in committed relationships to inform development of weight loss interventions. Method: Twenty semi-structured interviews, based on an integrated theoretical framework of interdependence and communal coping and the social cognitive theory, were conducted among Black heterosexual couples where one or both individuals intentionally lost [greater than or equal to]5% of their body weight in the last 6 months in a metropolitan region in a southern state. Interviews were transcribed and coded. Themes were identified following multi-rater coding and direct and conventional content analysis. Recommendations were developed from emergent themes. Results: Among individuals with recent weight loss, personal relevancy and awareness (health awareness and self-awareness) were identified as personal triggers for weight loss initiation. Health concerns and appearance were general motivations among the total sample. Conclusion: Emphasizing the impact of weight on daily functioning and quality of life, and increasing awareness of personal weight status and health consequences, may increase weight loss initiation and participation in weight loss programs among Black men and women in committed relationships. Findings also highlight strategies to improve recruitment and retention and guide intervention development and implementation for this population.

We advance the understanding of how student emotions relate to their learning of socioscientific issues (SSI). Studies have tended to examine how students' positive and negative emotions about an issue contribute to their learning. However, this approach overlooks the fact that students may have different emotions about different objects (i.e., stakeholders, phenomena, the status quo, and the future) within an issue. In this study, we examined students' patterns of emotion objects with respect to the extent of their conceptual change from a reductionist view to a systems view of obesity. Using a multiple case study design, we tracked the emotion objects of four purposefully selected university students, who demonstrated either significant change or minimal change in their view of obesity. Data were collected over a 12-week general education course on obesity and 6 months after the course, and included weekly reflective journals and delayed postcourse interviews. We found that students with different extents of conceptual change had distinguishable sets of emotion objects. For example, the emotion objects of students with significant conceptual change included obese people and the food industry. Furthermore, their emotions were more often moral in nature. These findings suggest that moral emotions are an integral part of SSI learning. We make two contributions to the literature. First, we identify the need to attend to and specify emotion objects as key variables in future research on emotions. In practice, teachers should consider strategies that help students attend to the emotion objects that matter for SSI learning. Second, we identify stakeholders as key emotion objects in SSI learning. The expression of moral emotions about stakeholders coincided with conceptual change to a systems view. This implies that future research and the practice of SSI learning should pay attention to students' moral emotions about stakeholders.