Hot Papers in the Literature

School-day and overall physical activity among youth

Am J Prev Med. 2013 Aug;45(2):150–157. doi: 10.1016/j.amepre.2013.03.011.

Long MW, Sobol AM, Cradock AL, Subramanian SV, Blendon RJ, Gortmaker SL.

Background: Increasing school-day physical activity through policy and programs is commonly suggested to prevent obesity and improve overall child health. However, strategies that focus on school-day physical activity may not increase total physical activity if youth compensate by reducing physical activity outside of school.

Purpose: Objectively measured, nationally representative physical activity data were used to test the hypothesis that higher school-day physical activity is associated with higher overall daily physical activity in youth.

Methods: Accelerometer data from 2003–2004/2005–2006 National Health and Nutrition Examination Surveys were analyzed in 2012 to estimate physical activity levels during the school day (8am–3pm) among youth aged 6–19 years (n=2548). Fixed-effects regressions were used to estimate the impact of changes in school-day minutes of moderate-to-vigorous physical activity (MVPA) on changes in total daily MVPA.

Results: Each additional minute of school-day MVPA was associated with an additional 1.14 minutes (95% CI=1.04, 1.24; p<0.001) of total daily MVPA, or 0.14 additional minutes (95% CI=0.04, 0.24; p=0.008) outside the school day, controlling for total daily accelerometer wear time and age, gender, race/ethnicity, and other non-time varying covariates. There were no differences in the effect of school-day MVPA on total MVPA by age group, gender, race/ethnicity, poverty status, or degree of change in MVPA.

Conclusions: Higher school-day MVPA was associated with higher daily MVPA among U.S. youth with no evidence for same-day “compensation.” Increasing school-based physical activity is a promising approach that can improve total daily physical activity levels of youth.

PMID: 23867021 [PubMed - in process]

Quality of life and BMI changes in youth participating in an integrated pediatric obesity treatment program

Health Qual Life Outcomes. 2013 Jul 10;11(1):116. doi: 10.1186/1477–7525-11-116.

Pratt KJ, Lazorick S, Lamson AL, Ivanescu A, Collier DN.

Background: Changes in Quality of Life (QOL) measures over time with treatment of obesity have not previously been described for youth. We describe the changes from baseline through two follow up visits in youth QOL (assessed by the Pediatric Quality Life Inventory, PedsQL4.0), teen depression (assessed by the Patient Health Questionnaire, PHQ9A), Body Mass Index (BMI) and BMI z-score. We also report caregiver proxy ratings of youth QOL.

Methods: A sample of 267 pairs of youth and caregiver participants were recruited at their first visit to an outpatient weight-treatment clinic that provides care integrated between a physician, dietician, and mental health provider; of the 267, 113 attended a visit two (V2) follow-up appointment, and 48 attended visit three (V3). We investigated multiple factors longitudinally experienced by youth who are overweight and their caregivers across up to three different integrated care visits. We determined relationships at baseline in QOL, PHQ9A, and BMI z-score, as well as changes in variables over time using linear mixed models with time as a covariate.

Results: Overall across three visits the results indicate that youth had slight declines in relative BMI, significant increases in their QOL and improvements in depression.

Conclusions: We encourage clinicians and researchers to track youth longitudinally throughout treatment to investigate not only youth's BMI changes, but also psychosocial changes including QOL.

PMID: 23837620 [PubMed - in process]

PMCID: PMC3710490

Academy of Nutrition and Dietetics benchmarks for nutrition in child care 2011: Are child-care providers across contexts meeting recommendations?

J Acad Nutr Diet. 2013 Aug 2. pii: S2212–2672(13)00649-7. doi: 10.1016/j.jand.2013.05.023. [Epub ahead of print]

Dev DA, McBride BA; The STRONG Kids Research Team.

The Academy of Nutrition and Dietetics (Academy) recommends feeding practices for child-care providers to establish nutrition habits in early childhood to prevent obesity. With >12 million US children in child care, little is known about child-care providers' feeding practices. The purpose of this study was to examine child-care providers' feeding practices to assess whether providers met the Academy's benchmarks and whether attainment of benchmarks varied across child-care contexts (Head Start, Child and Adult Care Food Program [CACFP], and non-CACFP). Cross-sectional data was collected in 2011 and 2012 from 118 child-care providers who completed self-administered surveys regarding their feeding practices for 2- to 5-year-old children. χ(2) tests and analysis of variance were used to determine variation across contexts. Head Start providers sat more frequently with children during meals (P=0.01), ate the same foods as children (P=0.001), and served meals family style (P<0.0001) more often compared with CACFP and non-CACFP providers. Head Start providers (P=0.002), parents (P=0.001), and children (P=0.01) received more nutrition-education opportunities compared with CACFP and non-CACFP. Head Start providers encouraged more balance and variety of foods (P<0.05), offered healthier foods (P<0.05), modeled healthy eating (P<0.001), and taught children about nutrition (P<0.001) compared with CACFP and non-CACFP providers. Providers across all three contexts used significantly more non-internal than internal mealtime verbal comments (P<0.0001). Head Start providers had greater compliance with the Academy's benchmarks compared with CACFP and non-CACFP providers. Possible reasons for this compliance might be attributed to Head Start nutrition performance standards and increased nutrition-training opportunities for Head Start staff. Head Start programs can serve as a model in implementing the Academy's benchmarks.

PMID: 23916973 [PubMed - as supplied by publisher]

Intervention effects on kindergarten and first-grade teachers' classroom food practices and food-related beliefs in American Indian reservation schools

J Acad Nutr Diet. 2013 Aug;113(8):1076–1083. doi: 10.1016/j.jand.2013.04.019.

Arcan C, Hannan PJ, Himes JH, Fulkerson JA, Rock BH, Smyth M, Story M.

Prevalence of obesity among American Indian children is higher than the general US population. The school environment and teachers play important roles in helping students develop healthy eating habits. The aim of this prospective study was to examine teachers' classroom and school food practices and beliefs and the effect of teacher training on these practices and beliefs. Data were used from the Bright Start study, a group-randomized, school-based trial that took place on the Pine Ridge American Indian reservation (fall 2005 to spring 2008). Kindergarten and first-grade teachers (n=75) from 14 schools completed a survey at the beginning and end of the school year. Thirty-seven survey items were evaluated using mixed-model analysis of variance to examine the intervention effect for each teacher-practice and belief item (adjusting for teacher type and school as random effect). At baseline, some teachers reported classroom and school food practices and beliefs that supported health and some that did not. The intervention was significantly associated with lower classroom use of candy as a treat (P=0.0005) and fast-food rewards (P=0.008); more intervention teachers disagreed that fast food should be offered as school lunch alternatives (P=0.019), that it would be acceptable to sell unhealthy foods as part of school fundraising (P=0.006), and that it would not make sense to limit students' food choices in school (P=0.035). School-based interventions involving teacher training can result in positive changes in teachers' classroom food practices and beliefs about the influence of the school food environment in schools serving American Indian children on reservations.

PMID: 23885704 [PubMed - in process]

Hispanic parents of overweight and obese children and their outcome expectations for children's television viewing: A qualitative study

J Nutr Educ Behav. 2013 Jul 11. pii: S1499–4046(13)00470-3. doi: 10.1016/j.jneb.2013.04.263. [Epub ahead of print]

Del Rio Rodriguez B, Hilmers A, O'Connor TM.

Objective: Explore parental outcome expectations (OE) regarding children's television (TV) viewing among parents of overweight or obese children.

Methods: Qualitative study using semi-structured interviews with 20 parents of 5-to 8-year-old overweight or obese children.

Results: Parent's positive OE for allowing TV viewing were the convenience of using TV for entertainment or as a babysitter. Hispanic parents would limit children's TV viewing to improve their children's health, restrict content, and promote other activities. Negative OE such as children misbehavior and the loss of positive OE for allowing TV emerged as reasons parents may not limit TV.

Conclusions and implications: Although Hispanic parents expected to improve their child's health by limiting TV, the negative OE may prevent them from doing so. Interventions targeting children's TV viewing, as a strategy to fight childhood obesity, may be more effective if they promote parent's positive OE and address parent's negative OE for children's TV viewing.

PMID: 23850016 [PubMed - as supplied by publisher]

Implementation of a school-based internet obesity prevention program for adolescents

J Nutr Educ Behav. 2013 Jul 11. pii: S1499–4046(13)00117-6. doi: 10.1016/j.jneb.2013.03.012. [Epub ahead of print]

Whittemore R, Chao A, Jang M, Jeon S, Liptak T, Popick R, Grey M.

Objective: To evaluate the reach, adoption, and implementation of HEALTH[e]TEEN, a school-based Internet obesity prevention program, and examine differences in student participation and satisfaction by school, gender, age, and race/ethnicity.

Design: Concurrent mixed method evaluation.

Setting: Three public high schools in Connecticut.

Participants: Three hundred eighty-four adolescents, 8 teachers.

Intervention(s): HEALTH[e]TEEN vs HEALTH[e]TEEN plus coping skills training.

Main outcome measure(s): Demographic and state-available data, measurements of student satisfaction and participation, interviews with school administrators and teachers.

Analysis: Mixed and logistic models, content analysis.

Results: The sample (n=384) was diverse (35% white), with a mean age of 15.3 years and mean body mass index of 24.7 kg/m(2). Student participation (83% of lessons completed) and satisfaction (mean 3.6 out of 5) was high. Schools implementing the program in class had higher satisfaction and participation compared with schools that implemented the program as homework (P≤.001 and <.001, respectively). Girls had higher satisfaction and participation compared with boys (P=.02 and .03, respectively). Younger students had higher participation compared with older students, but no difference in satisfaction was noted (P=.03).

Conclusions and implications: Two school-based Internet programs to decrease obesity reached diverse adolescents, and were adopted and implemented with high student satisfaction and participation. Implementation of the intervention was influenced by setting (classroom vs homework), teacher characteristics, student age, and gender.

PMID: 23850014 [PubMed - as supplied by publisher]

Mexican-American children have differential elevation of metabolic biomarkers that is proportional to obesity status

J Pediatr Gastroenterol Nutr. 2013 Aug 8. [Epub ahead of print]

McFarlin BK, Johnson CA, Moreno JP, Foreyt JP.

Objectives: There is a health disparity for obesity amongst Mexican-Americans compared to other race/ethnic groups. In particular Mexican-American children who are obese are likely to become obese adults. The purpose of this study was to examine traditional and non-traditional risk factors in a subset of Mexican-American children prior to their participation in a larger clinical weight loss study.

Methods: Venous blood samples were collected from self-identified Mexican-American children (12–14y) who were assigned to one of three weight groups based on their zBMI; normal weight (N=66), overweight (N=23), or obese (N=39). Serum was analyzed for interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), C-peptide, Ghrelin, GIP, GLP-1, Glucagon, Insulin, Leptin, Macrophage Chemoattractant Protein 1 (MCP-1), and Pancreatic Polypeptide (PP) using a Luminex MagPix based assay (EMD Millipore). Total cholesterol, HDL cholesterol, triglycerides, and glucose were analyzed using enzymatic assays. Data were analyzed for significance using separate ANOVA tests, with significance set at P<0.05.

Results: Relative to normal weight and overweight children, obese children had significantly elevated C-peptide (P<0.0001), insulin (P<0.0001), leptin (P<0.0001), MCP-1 (P=0.005), and TNF-α (P=0.006).

Conclusions: We observed that Mexican-American children as a function of body weight had elevated serum concentrations of several biomarkers that have been linked to chronic disease development in adults. More research is needed to understand how these differences effect disease risk in adulthood.

PMID: 23945313 [PubMed - as supplied by publisher]

Impact of Let's Go! 5-2-1-0: A community-based, multisetting childhood obesity prevention program

J Pediatr Psychol. 2013 Aug 11. [Epub ahead of print]

Rogers VW, Hart PH, Motyka E, Rines EN, Vine J, Deatrick DA.

Objective: Document the impact of Let's Go!, a multisetting community-based childhood obesity prevention program on participants in 12 communities in Maine.

Methods: The study used repeated random telephone surveys with 800 parents of children to measure awareness of messages and child behaviors. Surveys were conducted in schools, child care programs, and afterschool programs to track changes in policies and environments.

Results: Findings show improvements from 2007 to 2011: Children consuming fruits and vegetables increased from 18%, 95% CI [15, 21], to 26% [23, 30] (p<.001); children limiting sugary drinks increased from 63% [59, 67] to 69% [65, 73] (p=.011); and parent awareness of the program grew from 10% [7, 12] to 47% [43, 51] (p<.001). Participating sites implemented widespread changes to promote healthy behaviors.

Conclusions: A multisetting, community-based intervention with a consistent message can positively impact behaviors that lead to childhood obesity.

PMID: 23933841 [PubMed - as supplied by publisher]

The role of social cognitive theory in Farm-to-School-related activities: Implications for child nutrition

J Sch Health. 2013 Aug;83(8):589–595. doi: 10.1111/josh.12069.

Berlin L, Norris K, Kolodinsky J, Nelson A.

Background: Farm-to-school (FTS) programs are gaining attention for many reasons, one of which is the recognition that they could help stem the increase in childhood overweight and obesity. Most FTS programs that have been evaluated have increased students' selection or intake of fruits and vegetables following the incorporation of FTS components. However, the wide range of activities that are typically part of FTS programs make it difficult to pinpoint which components have the greatest potential to improve students' health behaviors. Within the field of nutrition education, theory-based interventions that target the key underlying factors influencing health behavior offer the most promise.

Methods: We review existing research on dietary health impacts and implications of 3 key FTS-related activities and explore the component activities of FTS in terms of their potential to address the key constructs of social cognitive theory (SCT)-which is a current best practice in the field of nutrition-suggesting that FTS programs incorporating a diverse set of activities appear to be most promising.

Results: We find that components of FTS programs incorporate many of the key theoretical constructs in SCT, and show that FTS programs have great potential to facilitate movement toward desired dietary changes. However, it is unlikely that a set of activities in any one current FTS program addresses multiple constructs of the theory in a systematic manner.

Conclusion: More intentional inclusion of diverse activities would likely be beneficial. Future research can test these assertions.

PMID: 23834611 [PubMed - in process]

The association of screen time, television in the bedroom, and obesity among school-aged youth: 2007 national survey of children's health

J Sch Health. 2013 Aug;83(8):573–581. doi: 10.1111/josh.12067.

Wethington H, Pan L, Sherry B.

Background: Among school-aged youth, we sought to identify characteristics associated with (1) exceeding screen time recommendations (ie, television/videos/video games more than 2 hours/weekday), and (2) exceeding screen time recommendations, the presence of a television in the bedroom, and obesity.

Methods: Using 2007 National Survey of Children's Health data, we used multivariable logistic regression to identify sociodemographic and behavioral characteristics associated with excessive screen time among 6 to 11- and 12 to 17-year-olds on a typical weekday. For 12 to 17-year-olds only, we used logistic regression to examine the odds of obesity using the same variables as above, with the addition of screen time.

Results: Overall, 20.8% of 6 to 11-year-olds and 26.1% of 12 to 17-year-olds had excessive screen time. For both age groups, having a bedroom TV was significantly associated with excessive screen time. For the older age group, the dual scenario of excessive screen time with a bedroom TV had the strongest association with obesity (OR=2.5, 95% CI 1.9, 3.2).

Conclusions: Given the similar risk factors for excess screen time and having a TV in the bedroom, a public health challenge exists to design interventions to reduce screen time among school-aged youth.

Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

PMID: 23834609 [PubMed - in process]

Vital signs: Obesity among low-income, preschool-aged children—United States, 2008–2011

MMWR Morb Mortal Wkly Rep. 2013 Aug 9;62(31):629–634.

Centers for Disease Control and Prevention (CDC).

Background: The prevalence of obesity among U.S. preschoolers has doubled in recent decades. Childhood obesity increases the risk for adult obesity and is associated with negative health consequences. Trends in the state-specific prevalence of obesity among low-income U.S. preschool children have not been examined since 2008. State-specific obesity prevalence surveillance helps determine the need for and impact of state and local obesity prevention strategies.

Methods: Measured weight and height data from approximately 11.6 million low-income children aged 2–4 years from 40 states, the District of Columbia, and two U.S. territories who participated in the Pediatric Nutrition Surveillance System during 2008–2011 were used to estimate state obesity prevalence. Obesity was defined as having an age- and sex-specific body mass index ≥95th percentile, according to the 2000 CDC growth charts. Logistic regression models adjusted for age, sex, and race/ethnicity were used to examine trends in the state-specific obesity prevalence.

Results: During 2008–2011, statistically significant downward trends in obesity prevalence were observed in 18 states and the U.S. Virgin Islands. Florida, Georgia, Missouri, New Jersey, South Dakota, and the U.S. Virgin Islands had the largest absolute decreases in obesity prevalence, each with a decrease of ≥1 percentage point. Twenty states and Puerto Rico experienced no significant change, and obesity prevalence increased significantly in three states.

Conclusions and implications for public health practice: Small but significant declines in obesity among low-income preschoolers were observed in 19 of 43 states/territories examined. Continued prevention efforts are needed to sustain and expand the implementation and evaluation of population-level interventions to prevent childhood obesity.

PMID: 23925173 [PubMed - in process]

School lunch debit cards are associated with lower nutrition and higher calories

Obesity (Silver Spring). 2013 Aug 8. doi: 10.1002/oby.20591. [Epub ahead of print]

Just DR, Wansink B.

Objective: Debit card payment systems are known to induce more frivolous purchases in adults, but their impact on children is unknown.

Design and methods: Using a national survey of 2,314 public school students in the United States, we compare food purchases in schools with debit-only systems to those in schools with both debit and cash options.

Results: Students in debit and cash schools purchase more fresh fruit and vegetables and fewer total calories.

Conclusions: Payment systems with cash options have a lower purchase incidence of less healthy foods and higher purchase incidence of more healthy foods.

PMID: 23929600 [PubMed - as supplied by publisher]

Food and beverage advertising on children's web sites

Pediatr Obes. 2013 Jul 2. doi: 10.1111/j.2047–6310.2013.00185.x. [Epub ahead of print]

Ustjanauskas AE, Harris JL, Schwartz MB.

What is already known about this subject: Food and beverage advertising contributes to childhood obesity. Display advertising on children's web sites is a prominent technique used to promote food to children. Industry self-regulation has not substantially improved food marketing to children in other media, such as television and food company web sites.

What this study adds: More than 3 billion display advertisements for food and beverages were viewed on popular children's web sites from July 2009 to June 2010. Three-quarters of these advertisements promoted brands that food companies identified as healthier dietary choices to be included in child-directed food advertising. However, 84% of these ads promoted products high in fat, sugar and/or sodium.

Background: Food marketing contributes to childhood obesity. Food companies commonly place display advertising on children's web sites, but few studies have investigated this form of advertising.

Objectives: Document the number of food and beverage display advertisements viewed on popular children's web sites, nutritional quality of advertised brands and proportion of advertising approved by food companies as healthier dietary choices for child-directed advertising.

Methods: Syndicated Internet exposure data identified popular children's web sites and food advertisements viewed on these web sites from July 2009 through June 2010. Advertisements were classified according to food category and companies' participation in food industry self-regulation. The percent of advertisements meeting government-proposed nutrition standards was calculated.

Results: 3.4 billion food advertisements appeared on popular children's web sites; 83% on just four web sites. Breakfast cereals and fast food were advertised most often (64% of ads). Most ads (74%) promoted brands approved by companies for child-directed advertising, but 84% advertised products that were high in fat, sugar and/or sodium. Ads for foods designated by companies as healthier dietary choices appropriate for child-directed advertising were least likely to meet independent nutrition standards.

Conclusions: Most foods advertised on popular children's web sites do not meet independent nutrition standards. Further improvements to industry self-regulation are required.

PMID: 23818245 [PubMed - as supplied by publisher]

Sugar-sweetened beverages and weight gain in 2- to 5-year-old children

Pediatrics. 2013 Sep;132(3):413–420.

Deboer MD, Scharf RJ, Demmer RT.

Background and objective: Although sugar-sweetened beverage (SSB) consumption has been tightly linked to weight status among older children, the data regarding these relationships in children aged 2 to 5 years have been mixed. Our objective was to evaluate longitudinal and cross-sectional relationships between SSB consumption and weight status among children aged 2 to 5 years.

Methods: We assessed SSB consumption and BMI z scores among 9600 children followed in the Early Childhood Longitudinal Survey-Birth Cohort, using linear and logistic regression and adjusting for race/ethnicity, socioeconomic status, mother's BMI, and television viewing.

Results: Higher rates of SSB consumption were associated with higher BMI z scores among children age 4 (P<.05) and 5 (P<.001) but not yet at 2 years. Children aged 5 years who drank SSB regularly (compared with infrequent/nondrinkers) had a higher odds ratio for being obese (1.43, confidence interval 1.10–1.85, P<.01). In prospective analysis, children drinking SSB at 2 years (compared with infrequent/nondrinkers) had a greater subsequent increase in BMI z score over the ensuing 2 years (P<.05).

Conclusions: Similar to what is seen among older children, children aged 2 to 5 years drinking SSB demonstrate both prospective and cross-sectional correlations with higher BMI z score. Pediatricians and parents should discourage SSB consumption to help avoid potential unhealthy weight gain in young children. From a public health standpoint, strong consideration should be made toward policy changes leading to decreases in SSB consumption among children.

PMID: 23918897 [PubMed - in process]