A Mixed-Method Evaluation of a Rural Elementary School Implementing the Coordinated Approach to Child Health (CATCH) Program.

Despite children living in rural US areas having 26% greater odds of being affected by obesity compared to those living in urban areas, the implementation of evidence-based programs in rural schools is rare. We collected quantitative data (weight and height) from 272 racially and ethnically diverse students at baseline, and qualitative data from students (4 focus groups), parents, and school staff (16 semi-structured interviews and 29 surveys) to evaluate program outcomes and perceptions. At the 2-year follow-up, paired data from 157 students, represented by racial/ethnic groups of 59% non-Hispanic White, 31% non-Hispanic Black, and 10% Hispanic, showed an overall mean change (SD) in BMI z-score of -0.04 (0.59), a decrease of -0.08 (0.69) in boys, and a significant -0.18 (0.33) decrease among Hispanic students. Boys had a mean decrease in obesity prevalence of 3 percentage points (from 17% to 14%), and Hispanic students had the largest mean decrease in BMI percentile. Qualitative data showed positive perceptions of the CATCH program and its implementation. This community-engaged research, with collaboration from an academic institution, a health department, a local wellness coalition, and a rural elementary school, demonstrated successful CATCH program implementation and showed promising outcomes in mean BMI changes.

The Emerging Prevalence of Obesity within Families in Europe and its Associations with Family Socio-Demographic Characteristics and Lifestyle Factors; A Cross-Sectional Analysis of Baseline Data from the Feel4Diabetes Study.

The Feel4Diabetes study is a type 2 diabetes prevention program that recruited 12,193 children [age: 8.20 (±1.01) years] and their parents from six European countries. The current work used pre-intervention data collected from 9576 children-parents pairs, to develop a novel family obesity variable and to examine its associations with family sociodemographic and lifestyle characteristics. Family obesity, defined as the presence of obesity in at least two family members, had a prevalence of 6.6%. Countries under austerity measures (Greece and Spain) displayed higher prevalence (7.6%), compared to low-income (Bulgaria and Hungary: 7%) and high-income countries (Belgium and Finland: 4.5%). Family obesity odds were significantly lower when mothers (OR: 0.42 [95% CI: 0.32, 0.55]) or fathers (0.72 [95% CI: 0.57, 0.92]) had higher education, mothers were fully (0.67 [95% CI: 0.56, 0.81]) or partially employed (0.60 [95% CI: 0.45, 0.81]), families consumed breakfast more often (0.94 [95% CI: 0.91 0.96]), more portions of vegetables (0.90 [95% CI: 0.86, 0.95]), fruits (0.96 [95% CI: 0.92, 0.99]) and wholegrain cereals (0.72 [95% CI: 0.62, 0.83]), and for more physically active families (0.96 [95% CI: 0.93, 0.98]). Family obesity odds increased when mothers were older (1.50 [95% CI: 1.18, 1.91]), with the consumption of savoury snacks (1.11 [95% CI: 1.05, 1.17]), and increased screen time (1.05 [95% CI: 1.01, 1.09]). Clinicians should familiarise themselves with the risk factors for family obesity and choose interventions that target the whole family. Future research should explore the causal basis of the reported associations to facilitate devising tailored family-based interventions for obesity prevention.

The degree of consistency of applying parental dietary and sedentary behavior rules as indicators for overweight in children: a cross-sectional study.

BACKGROUND: Review studies increasingly emphasize the importance of the role of parenting in interventions for preventing overweight in children. The aim of this study was to examine typologies regarding how consistently parents apply energy-balance related behavior rules, and the association between these typologies and socio-demographic characteristics, energy balance-related behaviors among school age children, and the prevalence of being overweight. METHODS: For this cross-sectional study, we had access to a database managed by a Municipal Health Service Department in the Netherlands. In total, 4,865 parents with children 4-12 years of age participated in this survey and completed a standardized questionnaire. Parents classified their consistency of applying rules as "strict", "indulgent", or "no rules". Typologies were identified using latent class analyses. We used regression analyses to examine how the typologies differed with respect to the covariates socio-demographic characteristics, children's energy balance-related behaviors, and weight status. RESULTS: We identified four stable, distinct parental typologies with respect to applying dietary and sedentary behavior rules. Overall, we found that parents who apply "overall strict EBRB rules" had the highest level of education and that their children practiced healthier behaviors compared to the children of parents in the other three classes. In addition, we found that parents who apply "indulgent dietary rules and no sedentary rules" had the lowest level of education and the highest percentage of non-Caucasians; in addition, their children 8-12 years of age had the highest likelihood of being overweight compared to children of parents with "no dietary rules". CONCLUSIONS: Parents' consistency in applying rules regarding dietary and sedentary behaviors was associated with parents' level of education and ethnic background, as well as with children's dietary and sedentary behaviors and their likelihood of becoming overweight. Our results may contribute to helping make healthcare professionals aware that children of parents who do not apply sedentary behavior rules are more likely to become overweight, as well as the importance of encouraging parents to apply strict dietary and sedentary behavior rules. These results can serve as a starting point for developing effective strategies to prevent overweight among children.

Study Protocol for the Evaluation of "SuperFIT", a Multicomponent Nutrition and Physical Activity Intervention Approach for Preschools and Families.

The promotion of healthy energy balance-related behaviours (EBRB) is already important for children at a young age. Different settings, for example childcare and home, play an important role in the EBRB of young children. Further, factors in different types of environment (e.g., physical, sociocultural and political) influence their behaviours. SuperFIT (Systems of Underprivileged Preschoolers in their home and preschool EnviRonment: Family Intervention Trial) is a comprehensive, integrated intervention approach for 2-4 year old children. This paper describes the development and design of the evaluation of SuperFIT. The SuperFIT intervention approach consists of preschool-based, family-based, and community-based components. Intervention activities aimed at changing the physical, sociocultural and political environments in each setting and establishing an increased alignment between the settings. A quasi-experimental design was adopted with twelve intervention and nine control preschools to evaluate effectiveness. The primary outcomes were Body Mass Index (BMI) z-scores (objectively assessed height and weight), dietary intake (24 h recall), and physical activity (accelerometer) of the children. Further, the effects on the nutrition- and physical activity-related practices of preschool teachers and parents were evaluated (questionnaires). Intervention effectiveness was evaluated using linear mixed models. Process evaluation was performed using mixed methods; both quantitative (questionnaires) and qualitative (observations and in-depth interviews) measures were used. The comprehensive, integrated approach of SuperFIT is expected to support healthy EBRB in young children.

[Intersectoral approach to obesity prevention and control: the Brazilian experience from 2014 to 2018Enfoque intersectorial para la prevención y el control de la obesidad: la experiencia de Brasil en el período 2014-2018]. / Abordagem intersetorial para prevenção e controle da obesidade: a experiência brasileira de 2014 a 2018.

The present article aims to describe and discuss the actions implemented from 2014 to 2018 at the federal level in the context of the Intersectoral Strategy to Prevent and Control Obesity issued by the Brazilian federal government. The goal of the Intersectoral Strategy is to prevent and control obesity based on six action plans: 1) availability and access to adequate and healthy foods; 2) education, communication, and information; 3) promotion of healthy lifestyles in specific environments/territories; 4) food and nutrition surveillance; 5) comprehensive care for individuals presenting obesity in the health care network; and 6) regulation and control of the quality and harmlessness of food. To gather information, semi-structured questionnaires were submitted to representatives from the ministries of Education, Health, Planning, Citizenship, and Agrarian Development. The actions implemented in the period were described in terms of the six action plans. Positive results were achieved through the shared management model adopted, even though many challenges still remain. The agenda for action proposed in the Intersectoral Strategy is attuned to the Brazilian context, and intersectoral management was still in place until the writing of the present article.

El objetivo del presente artículo es describir las actividades realizadas a nivel federal en el período 2014-2018 dentro del marco de la estrategia intersectorial de prevención y control de la Obesidad, publicada por el Gobierno Federal de Brasil, y hacer algunos comentarios pertinentes. La estrategia tiene por objetivo prevenir y controlar la obesidad y se ha organizado en seis grandes ejes de acción: 1) disponibilidad de alimentos adecuados y saludables y acceso a los mismos; 2) educación, comunicación e información; 3) promoción de estilos de vida saludables en entornos y territorios específicos; 4) vigilancia alimentaria y nutricional; 5) atención integral a la salud de las personas con sobrepeso y obesidad en la red asistencial, y 6) regulación y control de la calidad y la inocuidad de los alimentos. Para recopilar información se enviaron cuestionarios semiestructurados a representantes de los Ministerios de Educación, Salud, Planificación, Ciudadanía y Desarrollo Agrario. Las actividades realizadas se presentan según los ejes de acción de la estrategia. Se lograron resultados positivos a partir del modelo de coordinación adoptado, con gestión compartida, aunque fue preciso superar varios desafíos. El programa de trabajo sobre los ejes de acción propuestos en la estrategia está en consonancia con el contexto brasileño y el modelo intersectorial de gestión permaneció vigente hasta el momento de preparación de este artículo.

Everyday life situations in which mothers experience difficulty stimulating healthy energy balance-related behavior in their school-age children: a focus group study.

BACKGROUND: Parental support is an important element in overweight prevention programs for children. The purpose of this study was to examine everyday life situations in which mothers encounter difficulties encouraging healthy energy balance-related behavior in their school-age children. METHODS: We formed four focus groups containing 6-9 participants each. The participants were mothers of Dutch, Turkish, or Moroccan descent with a child 8-13 years of age. All focus group sessions were recorded, transcribed, and coded. Content was analyzed conventionally using ATLAS.ti 6. RESULTS: Twenty-seven difficult everyday life situations were identified in 14 settings. The five most frequently reported situations were a daily struggle regarding eating vegetables, eating breakfast on time before going to school, eating candy and snacks between meals, and spending excessive time watching television and using the computer. A perceived loss of parental control, the inability to establish rules and the failure to consistently enforce those rules were the most commonly cited reasons for why the mothers experience these situations as being difficult. CONCLUSIONS: We identified five difficult everyday life situations related to healthy energy balance-related behavior. These five difficult situations were used as the input for developing a web-based parenting program designed to prevent children from becoming overweight. We reasoned that if we use these situations and the underlying reasons, many parents would recognize these situations and are willing to learn how to deal with them and complete the e-learning.

Associations between family and home-related factors and child's snack consumption in a multi-ethnic population.

BACKGROUND: Energy-dense snacks are considered unhealthy due to their high concentrations of fat and sugar and low concentrations of micronutrients. The present study aimed to evaluate associations between family and home-related factors and children's snack consumption. We explored associations within subgroups based on ethnic background of the child. METHODS: Cross-sectional data of 644 primary school children (mean age: 9.4 years, 53% girls) from the population-based 'Water Campaign' study conducted in the Netherlands were used. Logistic regression analyses were used to evaluate the associations between family and home-related factors and child's snack intake. RESULTS: Of the children, 28.7% consumed more than one snack per day. Children of parents who expressed more restrictive parenting practices towards the child's snack consumption (odds ratio (OR) = 2.5, P < 0.001), and who modelled snack eating less often (OR = 2.2, P < 0.001) had lower snack intake. Restrictive parenting practices and parental modelling of healthy snacking were significant for children with a Dutch or Moroccan/Turkish ethnic background, but not for children with a Surinamese/Antillean ethnic background. CONCLUSIONS: We observed that parenting practices and parental modelling were independently associated with the child's snack intake. Also, the relationships between these factors and the child's snack consumption differed for children with distinct ethnic backgrounds.

The role of fathers in overweight prevention: an analysis of a Caribbean cohort.

BACKGROUND: Family-based strategies to reduce the risk of overweight in childhood are needed in the Caribbean. AIM: To investigate the associations between parental characteristics and risk of overweight and explore possible mechanisms. METHODS: Data from a parenting intervention were analysed. Parental characteristics were obtained by questionnaire at enrolment. At 18 months, 501 infants (82.9% of cohort) had weight and length measured using standardized methods. The association of parents' characteristics with risk of infant overweight was assessed using random-effects logistic regression. Four focus groups among mothers in Jamaica were conducted to explore mechanisms. RESULTS: Overall, 20.6% of infants were 'at risk of overweight'. Fathers were present in 52% of households. Fathers' presence [OR (95% CI) 0.60 (0.37-0.96)] was associated with reduced risk of overweight independent of socioeconomic status. Mothers reported that fathers encouraged healthier practices. CONCLUSION: Fathers may be important agents of change in intervention strategies to prevent childhood overweight.

Children's sugar-sweetened beverages consumption: associations with family and home-related factors, differences within ethnic groups explored.

BACKGROUND: The consumption of sugar-sweetened beverages (SSB) may contribute to the development of overweight among children. The present study aimed to evaluate associations between family and home-related factors and children's SSB consumption. We explored associations within ethnic background of the child. METHODS: Cross-sectional data from the population-based 'Water Campaign' study were used. Parents (n = 644) of primary school children (6-13 years) completed a questionnaire on socio-demographic characteristics, family and home-related factors and child's SSB intake. The family and home-related factors under study were: cognitive variables (e.g. parental attitude, subjective norm), environmental variables (e.g. availability of SSB, parenting practices), and habitual variables (e.g. habit strength, taste preference). Regression analyses were used to evaluate the associations between family and home-related factors and child's SSB intake (p < 0.05). RESULTS: Mean age of the children was 9.4 years (SD: 1.8) and 54.1% were girls. The child's average SSB intake was 0.9 litres (SD: 0.6) per day. Child's age, parents' subjective norm, parenting practices, and parental modelling were positively associated with the child's SSB intake. The availability of SSB at home and school and parental attitude were negatively associated with the child's SSB intake. The associations under study differed according to the child's ethnic background, with the explained variance of the full models ranging from 8.7% for children from Moroccan or Turkish ethnic background to 44.4% for children with Dutch ethnic background. CONCLUSIONS: Our results provide support for interventions targeting children's SSB intake focussing on the identified family and home-related factors, with active participation of parents. Also, the relationships between these factors and the child's SSB intake differed for children with distinct ethnic backgrounds. Therefore, we would recommend to tailor interventions taking into account the ethnic background of the family. TRIAL REGISTRATION: Number NTR3400 ; date April 4th 2012; retrospectively registered.

Snacking, Satiety, and Weight: A Randomized, Controlled Trial.

PURPOSE: To compare the effects of nut-based snack bars (NBSB) vs. prepackaged 200-kcal portions of typical conventional snack foods, when consumed over a 12-week period by a group of overweight adults. DESIGN: Randomized, single-blind parallel design with two treatment groups. SUBJECTS: Thirty-four overweight participants were enrolled. INTERVENTION: Commercially available NBSB or conventional snack foods as part of an ad libitum diet for 12 weeks. PRIMARY OUTCOME MEASURES: body mass index, body weight, body composition, waist circumference. SECONDARY OUTCOME MEASURES: blood pressure, lipid profile, nutrients intake, hunger/satiety, quality of life. ANALYSIS: Generalized linear models with time as repeated measure were used to analyze these data. RESULTS: Daily consumption of NBSB for 12 weeks, as compared to daily consumption of conventional snacks, significantly reduced percentage body fat (-1.7% ± 10.8% vs. 6.2% ± 9.3%; p = .04) and visceral fat (-1.3 ± 5.9 vs. 2.7 ± 4.0; p = .03). There were no between-group differences (p > .05) for blood pressure, lipid panel, satiety, or quality of life measures. CONCLUSION: Our data suggest that daily consumption of NBSB for 12 weeks reduced body fat and had no adverse effects on weight, blood pressure, lipid profile, satiety, or quality of life in this small sample of overweight adults.

Overweight, obesity, steps, and moderate to vigorous physical activity in children / Excesso de peso, obesidade, passos e atividade física de moderada a vigorosa em crianças

ABSTRACT OBJECTIVE The objective of this study is to establish cutoff points for the number of steps/day and minutes/day of moderate to vigorous physical activity in relation to the risk of childhood overweight and obesity and their respective associations. In addition, we aim to identify the amount of steps/day needed to achieve the recommendation of moderate to vigorous physical activity in children from São Caetano do Sul. METHODS In total, 494 children have used an accelerometer to monitor steps/day and the intensity of physical activity (min/day). The moderate to vigorous physical activity has been categorized according to the public health recommendation (≤ 60 versus > 60 min/day). Overweight or obesity is defined as body mass index > +1 SD, based on reference data from the World Health Organization. The data on family income, education of parents, screen time, diet pattern, and sedentary time have been collected by questionnaires. Logistic regression and Receiver Operating Characteristic curves have been constructed. RESULTS On average, boys walked more steps/day (1,850) and performed more min/day of moderate to vigorous physical activity (23.1) than girls. Overall, 51.4% of the children have been classified as eutrophic and 48.6% as overweight or obese. Eutrophic boys walked 1,525 steps/day and performed 18.6 minutes/day more of moderate to vigorous physical activity than those with overweight/obesity (p < 0.05). The same has not been found in girls (p > 0.05). The cutoff points to prevent overweight and obesity in boys and girls were 10,500 and 8,500 steps/day and 66 and 46 min/day of moderate to vigorous physical activity, respectively. The walking of 9,700 steps/day for boys and 9,400 steps/day for girls ensures the scope of the recommendation of moderate to vigorous physical activity. CONCLUSIONS In boys, steps/day and moderate to vigorous physical activity have been negatively associated with body mass index, regardless of race, family income, education of parents, screen time, diet pattern, and sedentary time. We suggest, for steps/day and moderate to vigorous physical activity, studies with different ages and populations, with different designs, so as to inform the cause and effect relationship with various health parameters.

RESUMO OBJETIVO Estabelecer pontos de corte para o número de passos/dia e min/dia de atividade física com intensidade moderada a vigorosa em relação ao risco do excesso de peso e obesidade infantil e suas respectivas associações. Além de identificar a quantidade de passos/dia necessários para atingir a recomendação de atividade física de moderada a vigorosa em crianças de São Caetano do Sul. MÉTODOS No total, 494 crianças usaram acelerômetro para monitorar os passos/dia e a intensidade da atividade física (min/dia). A atividade física de moderada a vigorosa foi categorizada de acordo com a recomendação de saúde pública (≤ 60 versus > 60 min/dia). Excesso de peso ou obesidade foi definido como índice de massa corporal > +1 DP, com base nos dados de referência da Organização Mundial de Saúde. Renda familiar, escolaridade dos pais, tempo de tela, padrão de dieta, e tempo sedentário foram coletados por questionários. Foram construídas curvas Receiver Operating Characteristic e regressão logística. RESULTADOS Em média, os meninos realizaram mais passos/dia (1.850) e min/dia de atividade física de moderada a vigorosa (23,1) do que as meninas. No geral, 51,4% das crianças foram classificadas como eutróficas e 48,6% com excesso de peso ou obesidade. Meninos eutróficos realizavam 1.525 passos/dia e 18,6 min/dia de atividade física de moderada a vigorosa a mais do que aqueles com excesso de peso/obesidade (p < 0,05). O mesmo não foi encontrado nas meninas (p > 0,05). Os pontos de corte para evitar excesso de peso e obesidade nos meninos e meninas foram 10.500 e 8.500 passos/dia e 66 e 46 min/dia de atividade física de moderada a vigorosa, respectivamente. A realização de 9.700 passos/dia (meninos) e 9.400 passos/dia (meninas) garante o alcance da recomendação de atividade física de moderada a vigorosa. CONCLUSÕES Nos meninos, passos/dia e atividade física de moderada a vigorosa foram negativamente associados com o índice de massa corporal, independentemente da raça, renda familiar, escolaridade dos pais, tempo de tela, padrão de dieta e tempo sedentário. Sugere-se para passos/dia e atividade física de moderada a vigorosa, estudos em diversas idades e populações, com diferentes delineamentos, para assim informar a relação causa e efeito com diversos parâmetros de saúde.

One-Year Efficacy Testing of Enabling Mothers to Prevent Pediatric Obesity Through Web-Based Education and Reciprocal Determinism (EMPOWER) Randomized Control Trial.

BACKGROUND: The purpose of this study was to evaluate the efficacy of the Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism (EMPOWER) intervention at 1-year, postintervention follow-up. METHOD: A mixed between-within subjects design was used to evaluate the trial. Independent variables included a two-level, group assignment: EMPOWER (experimental intervention) based on social cognitive theory (SCT) as well as a knowledge-based intervention Healthy Lifestyles (active control intervention). Dependent variables were evaluated across four levels of time: baseline (Week 0), posttest (Week 4), 1-month follow-up (Week 8), and 1-year follow-up (Week 60). Dependent variables included five maternal-facilitated SCT constructs (environment, emotional coping, expectations, self-control, and self-efficacy) as well as four child behaviors (minutes of child physical activity, cups of fruits and vegetables consumed, 8-ounce glasses of sugar-sweetened beverages consumed, and minutes of screen time). Null hypotheses implied no significant group-by-time interactions for the dependent variables under investigation. RESULTS: A significant group-by-time interaction for child fruit and vegetable consumption was found in the experimental group (p = .012) relative to the control group. At 1 year, results suggested an overall increase of 1.847 cups of fruits and vegetables (95% confidence interval = 1.207-2.498) in the experimental group (p < .001). Analysis suggested changes in the maternal-facilitated home environment accounted for 13.3% of the variance in the change in child fruit and vegetable consumption. Improvements in child physical activity, sugar-free beverage intake, and screen time first detected at 1-month follow-up in both groups were no longer significant at 1-year follow-up. CONCLUSIONS: An online family-and-home-based intervention was efficacious for improving child fruit and vegetable consumption. Follow-up booster sessions may assist in maintaining treatment effects.

[With children against obesity]. / S detmi proti obezite.

The project "With Children Against Obesity" (www.sdetmiprotiobezite.cz) is an original and innovative prevention website, which is currently unparalleled in the Czech Republic. It is a rare project that deals not only with the issue of childhood obesity for the general public but also for professionals. The website offers a comprehensive view of the prevention and treatment of overweight and obese children. The project offers original products that can be used in the everyday clinical practice for specific individuals with risks of developing obesity, including their family background. It follows the basic principles of prevention of metabolic diseases.

Associations between the home environment and children's sweet beverage consumption at 2-year follow-up: the 'Be active, eat right' study.

BACKGROUND: This study evaluates the association between home environmental characteristics and sweet beverage consumption (i.e. beverages that contain sugar) of 7-year-old children. METHODS: The population for analysis consisted of n = 2047 parents and their children from the population-based 'Be active, eat right' study. Data on sociodemographic characteristics, parental beliefs, parenting practices and child's sweet beverage consumption were obtained by parental report with questionnaires. We performed linear and multinomial regression analyses evaluating associations between characteristics at age 5 years and (i) consumption at 7 years and (ii) consumption patterns between age 5 and 7 years with reference category 'low consumption'. RESULTS: Based on the report from their parents, 5-year-old children drank on average 3.0 (SD:1.4) sweet beverage per day. Children consumed less sweet beverages at age 7 years (beta -0.16, 95% confidence interval [CI] -0.24 to -0.09) when there were less sweet beverages available at home. The multinomial regression model showed that children with parents who discouraged sweet beverage consumption were more likely to decrease their sweet beverage consumption over the study period (odds ratio: 1.24, 95% CI 1.07 to 1.43). Moreover, when there were less sweet beverages available at home, children were less likely to increase their consumption or have a high consumption over the study period (odds ratio: 0.70, 95% CI 0.59 to 0.83 and 0.61, 95% CI 0.54 to 0.70, respectively). CONCLUSIONS: The results showed that characteristics of the home environment are associated with the consumption of sweet beverages among children. Specifically, the availability of sweet beverages at home is associated with the child's sweet beverage consumption.

Is channel segmentation necessary to reach a multiethnic population with weight-related health promotion? An analysis of use and perception of communication channels.

OBJECTIVE: To explore similarities and differences in the use and perception of communication channels to access weight-related health promotion among women in three ethnic minority groups. The ultimate aim was to determine whether similar channels might reach ethnic minority women in general or whether segmentation to ethnic groups would be required. DESIGN: Eight ethnically homogeneous focus groups were conducted among 48 women of Ghanaian, Antillean/Aruban, or Afro-Surinamese background living in Amsterdam. Our questions concerned which communication channels they usually used to access weight-related health advice or information about programs and whose information they most valued. The content analysis of data was performed. RESULTS: The participants mentioned four channels - regular and traditional health care, general or ethnically specific media, multiethnic and ethnic gatherings, and interpersonal communication with peers in the Netherlands and with people in the home country. Ghanaian women emphasized ethnically specific channels (e.g., traditional health care, Ghanaian churches). They were comfortable with these channels and trusted them. They mentioned fewer general channels - mainly limited to health care - and if discussed, negative perceptions were expressed. Antillean women mentioned the use of ethnically specific channels (e.g., communication with Antilleans in the home country) on balance with general audience-oriented channels (e.g., regular health care). Perceptions were mixed. Surinamese participants discussed, in a positive manner, the use of general audience-oriented channels, while they said they did not use traditional health care or advice from Surinam. Local language proficiency, time resided in the Netherlands, and approaches and messages received seemed to explain channel use and perception. CONCLUSIONS: The predominant differences in channel use and perception among the ethnic groups indicate a need for channel segmentation to reach a multiethnic target group with weight-related health promotion. The study results reveal possible segmentation criteria besides ethnicity, such as local language proficiency and time since migration, worthy of further investigation.

Impact evaluation of Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism (EMPOWER) Randomized Control Trial.

BACKGROUND: The family and home environment is an influential antecedent of childhood obesity. The purpose of this study was to pilot test The Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism (EMPOWER) intervention; a newly developed, theory-based, online program for prevention of childhood obesity. METHOD: The two-arm, parallel group, randomized, participant-blinded trial targeted mothers with children between 4 and 6 years of age. Measures were collected at baseline, 4 weeks, and 8 weeks to evaluate programmatic effects on constructs of social cognitive theory (SCT) and obesity-related behaviors. Process evaluation transpired concurrently with each intervention session. RESULTS: Fifty-seven participants were randomly assigned to receive either experimental EMPOWER (n = 29) or active control Healthy Lifestyles (n = 28) intervention. Significant main effects were identified for child physical activity, sugar-free beverage consumption, and screen time, indicating that both groups improved in these behaviors. A significant group-by-time interaction was detected for child fruit and vegetable (FV) consumption as well as the SCT construct of environment in the EMPOWER cohort. An increase of 1.613 cups of FVs (95% confidence interval = [0.698, 2.529]) was found in the experimental group, relative to the active control group. Change score analysis found changes in the home environment accounted for 31.4% of the change in child FV intake for the experimental group. CONCLUSIONS: Child physical activity, sugar-free beverage consumption, and screen time improved in both groups over the course of the trial. Only the theory-based intervention was efficacious in increasing child FV consumption. The EMPOWER program was robust for inducing change in the home environment leading to an increase in child FV intake (Cohen's f = 0.160).

Psychosocial perspectives and the issue of prevention in childhood obesity.

A dramatic increase in childhood overweight/obesity has been recognized globally over the past 50 years. This observed increase may reflect genetic, as well as psychological, environmental, and socio-cultural influences. In the first part of this review, we present an updated summary of the psychosocial factors associated with this change and discuss possible ways in which they operate. Among these factors, lower socio economic status (in both industrialized and non-industrialized countries), being female, belonging to a minority group, and being exposed to adverse life events may all be associated with a greater risk of childhood overweight/obesity. These influences may be mediated via a variety of mechanisms, in particular above-average food intake of low nutritional quality and reduction in physical activity. Other important psychosocial mediators include the influence of the family and peer environment, and exposure to the media. In the second part of the review, we discuss the potential of psychosocial prevention programs to intervene in the processes involved in the rise of childhood overweight/obesity. Two points are emphasized. First, prevention programs should be multidisciplinary, combining the knowledge of experts from different professions, and taking into consideration the important role of the family environment and relevant influential social organizations, particularly school. Second, effective change is unlikely to occur without large-scale programs carried out on a public policy level.

Training program for overweight prevention in the child's first year: compilation and results.

The current local overweight-prevention protocols are not applied as intended by Dutch child healthcare physicians and nurses. The development of a training program for these practitioners, based on the Intervention Mapping framework, with the aim of improving overweight-prevention in a child's first year, is described in this study. The needs assessment showed three program objectives to be relevant, namely improving: (i) awareness of the importance of early overweight-prevention; (ii) the competence to discuss (the risk of) overweight with parents; and (iii) working systematically according to the overweight-prevention protocol. A matrix was then created specifying the program objectives in terms of personal learning objectives and environmental change objectives, and appropriate strategies were identified. The results suggested that a more active tailored and structured change strategy improves knowledge and skills, in particular, which results in a better overall implementation of the overweight-prevention protocol. This training program should help providers understand how the implementation of a protocol, such as the overweight-prevention protocol, can be improved. Using the Intervention Mapping framework for systematic protocol implementation seems a valuable option.