School nutritional capacity, resources and practices are associated with availability of food/beverage items in schools.

BACKGROUND: The school food environment is important to target as less healthful food and beverages are widely available at schools. This study examined whether the availability of specific food/beverage items was associated with a number of school environmental factors. METHODS: Principals from elementary (n=369) and middle/high schools (n=118) in British Columbia (BC), Canada completed a survey measuring characteristics of the school environment. Our measurement framework integrated constructs from the Theories of Organizational Change and elements from Stillman's Tobacco Policy Framework adapted for obesity prevention. Our measurement framework included assessment of policy institutionalization of nutritional guidelines at the district and school levels, climate, nutritional capacity and resources (nutritional resources and participation in nutritional programs), nutritional practices, and school community support for enacting stricter nutritional guidelines. We used hierarchical mixed-effects logistic regression analyses to examine associations with the availability of fruit, vegetables, pizza/hamburgers/hot dogs, chocolate candy, sugar-sweetened beverages, and french fried potatoes. RESULTS: In elementary schools, fruit and vegetable availability was more likely among schools that have more nutritional resources (OR=6.74 and 5.23, respectively). In addition, fruit availability in elementary schools was highest in schools that participated in the BC School Fruit and Vegetable Nutritional Program and the BC Milk program (OR=4.54 and OR=3.05, respectively). In middle/high schools, having more nutritional resources was associated with vegetable availability only (OR=5.78). Finally, middle/high schools that have healthier nutritional practices (i.e., which align with upcoming provincial/state guidelines) were less likely to have the following food/beverage items available at school: chocolate candy (OR= .80) and sugar-sweetened beverages (OR= .76). CONCLUSIONS: School nutritional capacity, resources, and practices were associated with the availability of specific food/beverage items in BC public schools. Policies targeting the school environment are increasingly being considered as one of the strategies used to address childhood obesity, as a result it is important to further understand the factors associated with the availability of specific food/beverage items at school.

Sources of validity evidence needed with self-report measures of physical activity.

BACKGROUND: Over the years, self-report measures of physical activity (PA) have been employed in applications for which their use was not supported by the validity evidence. METHODS: To address this concern this paper 1) provided an overview of the sources of validity evidence that can be assessed with self-report measures of PA, 2) discussed the validity evidence needed to support the use of self-report in certain applications, and 3) conducted a case review of the 7-day PA Recall (7-d PAR). RESULTS: This paper discussed 5 sources of validity evidence, those based on: test content; response processes; behavioral stability; relations with other variables; and sensitivity to change. The evidence needed to use self-report measures of PA in epidemiological, surveillance, and intervention studies was presented. These concepts were applied to a case review of the 7-d PAR. The review highlighted the utility of the 7-d PAR to produce valid rankings. Initial support, albeit weaker, for using the 7-d PAR to detect relative change in PA behavior was found. CONCLUSION: Overall, self-report measures can validly rank PA behavior but they cannot adequately quantify PA. There is a need to improve the accuracy of self-report measures of PA to provide unbiased estimates of PA.

Short message service reduces dropout in childhood obesity treatment: a randomized controlled trial.

OBJECTIVE: Lifestyle programs can reduce the level of overweight in children; however, maintenance results and adherence to treatment are difficult to achieve. New technologies, such as the Short Message Service (SMS), might be a promising tool for enhancing interventions. The effect of an SMS approach aimed at improving treatment results and reducing dropout rates in a pediatric lifestyle intervention, is explored. METHOD: Overweight and obese children (N = 141; age 7-12 years) participating in a lifestyle program were randomly assigned to an intervention group receiving an SMS Maintenance Treatment (SMSMT) for 38 weeks (n = 73) or to a control group receiving no SMSMT (n = 68). Children were asked to send weekly self-monitoring data on exercise, eating behavior, and emotional well-being. In return, they received tailored feedback messages. A differential decrease in BMI was analyzed with repeated measures ANOVA and dropout with logistic regression analysis. RESULTS: We found no significant difference in BMI decrease between the two groups after 12 months; however, we showed that the SMSMT group had 3.25 times less probability of dropping out after 1 year (p = .01) than controls. In the first 3 months of SMSMT, the SMSMT completers sent 0.80 SMSs per week, which reduced to 0.50 SMSs in the final 3 months. Younger children sent more SMSs (p = .03). CONCLUSIONS: These results indicate that SMSMT is effective in reducing dropout rates from a pediatric lifestyle intervention. Future research should examine the effectiveness of SMSMT on weight management and related psychosocial variables.

Predictors of participant dropout at various stages of a pediatric lifestyle program.

OBJECTIVE: To evaluate baseline predictors of drop out at various stages in a lifestyle intervention for overweight and obese children. PATIENTS AND METHODS: Children and their families (N = 248) (aged 8-14 years) attended a lifestyle intervention. At baseline, we assessed anthropometric and demographic data, measured competence and behavioral problems, and family functioning. Dropout rates were analyzed at various stages in treatment with logistic regression analyses. RESULTS: Children who had mothers of non-white descent, who had higher BMI SDS, who participated in fewer activities, who did not have breakfast regularly, and who did not live in families with a static adaptability structure were more likely to drop out between 0 and 12 months. Different characteristics predicted dropout at various stages of treatment: (1) having an ethnic minority status and being older predicted dropping out between 0 and 3 months; (2) having a nonwhite mother, participating in fewer activities, having higher delinquency scores, and not presenting the family as extremely positive predicted dropping out between 3 and 9 months; and (3) having a higher BMI SDS, having fewer social problems, and not living in families with a static adaptability structure predicted dropping out between 9 and 12 months of treatment. CONCLUSIONS: The results indicate different characteristics predict dropping out from a pediatric lifestyle program at various stages in treatment. These findings highlight the need for tailored interventions that target different characteristics at various stages of treatment to reduce drop out rates.

Somatic complaints and social competence predict success in childhood overweight treatment.

OBJECTIVE: To determine baseline predictors of treatment success in terms of Body Mass Index-Standard Deviation Scores (BMI-SDS) in a multidisciplinary family-based behavioural lifestyle intervention for overweight and obese children. METHODS: Overweight and obese children (N = 248; age 8-14 years) and their caregivers participated in a prospective study and attended a lifestyle intervention. Baseline data assessment included anthropometrics, demographics, breakfast behaviour, competence and behavioural problems (Child Behaviour Checklist [CBCL]), family functioning (Family Adaptability and Cohesion Evaluation Scales [FACES] III), and personality (Dutch Personality Questionnaire-Youth [NPV-J]). BMI-SDS was measured at start and after 3, 9, and 12 months of treatment. Mixed modelling was used for analysis. RESULTS: Greater BMI-SDS reductions over the course of one year were found in children with Caucasian parents, with lower baseline BMI-SDS, and higher CBCL-social competence scores. Furthermore, children with non-overweight parents, younger children, and children with lower CBCL-somatic scores were more successful in BMI-SDS reduction. No effects on treatment success were found for the number or position of siblings, having divorced parents or a working mother, educational level of the parents, breakfast behaviour, family functioning, and personality. CONCLUSIONS: These results suggest that screening for baseline characteristics in childhood obesity treatment could identify who will benefit most from a paediatric lifestyle intervention. Tailored programs should be developed and the treatment team should focus on children who are less successful in achieving weight reductions. Future research should study by which mechanisms somatic complaints and social competence influence treatment success.

Enhancement of care through self-monitoring and tailored feedback via text messaging and their use in the treatment of childhood overweight.

OBJECTIVE: This paper first illustrates the general potential of the short message service (SMS) for symptom and behavior monitoring and the provision of tailored feedback. Second, an SMS-based maintenance treatment (SMSMT) is introduced aimed at enhancing the treatment of childhood overweight. METHODS: After a 12-week cognitive behavioral group treatment (CBGT), 40 children were assigned to the SMSMT for a period of 36 weeks. Children were asked to send weekly self-monitoring data on eating behavior, exercise behavior, and emotions and received tailored feedback. The adherence to SMSMT and changes in Body Mass Index Standard Deviation Scores (BMI-SDS) during the first and second treatment phase were analysed. RESULTS: Children (mean age=10.05, SD=1.28) submitted 67% of the weekly SMS that they were expected to send in. During CBGT a significant reduction by 0.20 BMI-SDS was observed. The reduction by 0.07 BMI-SDS during the SMSMT did not reach statistical significance. CONCLUSION: The results support the feasibility of SMSMT in the treatment of childhood overweight. The efficacy of the intervention needs to be demonstrated in an RCT. PRACTICE IMPLICATIONS: SMSMT is a promising intervention that may extend the reach of treatment centers for childhood overweight at reasonable cost and effort.