Obesity Prevention Programs in Children: Impact on Weight, Shape and Food Concern.

Childhood overweight and obesity have an estimated prevalence of 10 % globally. High body mass index (BMI) is a known major predictor of body dissatisfaction, problem eating, low self-esteem, bullying and poor social and health outcomes for children. Childhood is also a time when lifelong habits are established, and as such is a time where prevention efforts have a high chance of success if implemented appropriately. Obesity prevention in children also has the potential to create weight, shape and food concerns in children and as such programs should focus on the principle first, do no harm. This paper canvasses existing literature and intervention program data to make the following recommendations for effective childhood obesity prevention: Programs should be educative for both children and their parents, programs should be inclusive of the whole family, there should be a focus on health and growth, not weight, and parents, schools and children should all be involved.

Prevalence of obesity, overweight and thinness in Australian children and adolescents by socioeconomic status and ethnic/cultural group in 2006 and 2012.

OBJECTIVES: To study the prevalence of obesity, overweight and thinness, by sex, SES and ethnic background in 2006 and 2012. METHODS: Large national surveys of school students were conducted. Height/weight was measured. The outcomes were height, weight, BMI, thinness, overweight and obesity (IOTF), SES and ethnicity. RESULTS: Obesity in 2006 and 2012 in boys and girls was 7.5 and 7.1 %, and 5.8 and 5.6 %; being overweight was 17.7 and 18.5 %, and 18.9 and 18.7 %; thinness was 3.8 and 4.6 %, and 5.0 and 6.0 %. Independent predictors of obesity in 2006 and 2012 were being Pacific Islander (OR 5.03, 5.66), Middle Eastern (OR 3.64, 1.50), aboriginal (OR 2.43 in 2012 only), African (OR 1.99 2012 only), Southern European (OR 1.75, 1.72), low SES (OR 2.22, 2.20), middle SES (OR 1.52, 1.60), female (OR 0.77, 0.82) and adolescent (OR 1.08, 2012 only). Predictors of thinness in 2006 and 2012 were ethnicity: Indian (OR 5.29, 1.96), African (OR 2.71, 2006 only), Asian (OR 1.69, 1.57) and female (OR 1.30, 1.27). CONCLUSIONS: The predictors of obesity and thinness were ethnically based, suggesting culturally appropriate interventions in socially and economically disadvantaged communities.

Socioeconomic patterns of overweight, obesity but not thinness persist from childhood to adolescence in a 6-year longitudinal cohort of Australian schoolchildren from 2007 to 2012.

BACKGROUND: The prevalence of childhood overweight and obesity increased during the 1980s to the late 1990s. The prevalence of obesity is higher in socially and economically disadvantaged communities in most Westernised countries. The purpose of this study was to examine how the socioeconomic gradient in weight status, namely thinness, overweight and obesity, changes over time in a longitudinal cohort of Australian schoolchildren, from 2007-2012. METHODS: 939 Australian children in school grades 2-6 from 10 primary schools initially participated in the study in 2007. Height and weight were directly measured by research assistants each year. Obesity/overweight and thinness were defined by using the International Obesity Task Force BMI cut-offs. Chi-square analyses were used to test associations between categorical variables and linear mixed models were used to estimate whether the differences in SES groups were statistically significant over time. RESULTS: Results found both males and females in the low SES group were more likely to be obese (6-7%) than middle (4-5%) and high (2-3%) SES groups and this pattern tended to be similar over the 6 year study period. There appeared to be no particular SES pattern for thinness with all SES groups having 4-5% of participants who were thin. The gender and SES patterns were also similar over 6 years for BMI with low and middle SES participants having significantly greater BMI than their high SES peers. CONCLUSIONS: Patterns of obesity and overweight in children from socially and economically disadvantaged communities in regional NSW are identifiable from a young age and the socioeconomic pattern persists into adolescence. Obesity prevention and intervention programs should be designed, implemented and evaluated with the social determinants of health in mind and in collaboration with community members. Community programs should continue to be based on positive rather than negative messages in order to avoid unintended stigma and other potentially harmful outcomes.

Relationships between body image, nutritional supplement use, and attitudes towards doping in sport among adolescent boys: implications for prevention programs.

BACKGROUND: Reports of high levels of use of protein powders and nutritional supplements among young men is a concern because these substances may act as a gateway for the use of drugs and illegal substances to enhance appearance or sports performance. The aim of this study was to investigate the relationship between body dissatisfaction, weight change behaviors, supplement use, and attitudes towards doping in sport among an adolescent male sample. METHODS: Participants were 1148 male adolescents (age range 11-21 years) in Australia who completed a self-report questionnaire that measured weight change behaviors, supplement use, body dissatisfaction (Male Body Attitudes Scale; MBAS) and attitudes towards doping in sport (Performance Enhancing Attitudes Survey; PEAS). RESULTS: There was a positive correlation between MBAS total and PEAS scores (r = .19, p < .001), indicating that the young men who were more dissatisfied with their bodies were more likely to support the use of doping in sport. Young men who were currently attempting weight loss or weight gain, and those currently consuming energy drinks (ηp2 = .01, p < .01) and vitamin/mineral supplements (ηp2 = .01, p < .01) were also significantly more supportive of doping in sport. However, those involved in weight lifting, and using protein powders were not (p > .05). CONCLUSIONS: These findings suggest that body dissatisfaction, weight change behaviors, and supplement use are related to more lenient attitudes towards doping in sport among adolescent boys. Future research might examine whether combining educational content for the prevention of body dissatisfaction and the use of drugs in sport may have a greater preventive impact than current programs aimed at young men.

Nutritional quality of breakfast and physical activity independently predict the literacy and numeracy scores of children after adjusting for socioeconomic status.

Health-related behaviors [physical activity (PA), nutritional quality of breakfast and sleep]; personal variables (self-esteem, attitudes to PA and gender) and socioeconomic status (SES) (school SES and parental education), were examined in relation to literacy and numeracy scores of 824 grade 3-7 children. Participants completed a questionnaire, and their national literacy and numeracy test scores were retrieved. Mothers (N = 755) completed a telephone interview. Students of highest school SES, maternal education, nutritional quality of breakfast, more sedentary time and female gender had higher literacy scores. SES, maternal education, male gender and total minutes of daily PA were predictors of numeracy with an interaction between greater total PA in boys and greater numeracy. Even though the socioeconomic factors that have predicted children's academic achievement for many decades are still clearly set in place, there are also other modifiable health influences that affect literacy and numeracy and are independent of SES. The current findings provide evidence for health educators and school administrators who may garner support for both breakfast programs and daily school PA for the dual purposes of health promotion as well as for the improvement of literacy and numeracy in settings in which social class may be acting against the educational interests of disadvantaged children.

Plateau in obesity and overweight in a cross sectional study of low, middle and high socioeconomic status schoolchildren between 2004 and 2009.

OBJECTIVE: To examine cross-sectional trends in obesity and overweight by gender, age and school socioeconomic status (SES) in 1,239 children aged 9-12 years from the same 10 primary schools in 2004 and 2009. METHODS: Self report questionnaire with measured height and weight. BMI and international (IOTF) standards were used to classify overweight and obesity. School SES was determined using a combined government measure of family income and parental education. RESULTS: There was no significant change in obesity, overweight or mean BMI between 2004 and 2009. Obesity decreased slightly but not significantly at 7.0% in 2004 and 4.8% in 2009 (P = 0.42). The significant predictors of obesity were a low school SES (OR = 2.42, P = 0.007) and age ≤10 years (OR = 2.33, P = 0.002). Male gender was a marginally significant predictor (OR = 1.60, P = 0.08). School SES, age and gender were not predictors of overweight. CONCLUSIONS: Obesity and overweight remain high, but the increase of earlier years has abated. Children from low SES schools and in younger age groups remained most at risk of obesity. Preventive measures, physical activity and nutrition interventions are needed.

Perceived and desired weight, weight related eating and exercising behaviours, and advice received from parents among thin, overweight, obese or normal weight Australian children and adolescents.

BACKGROUND: Thin children are less muscular, weaker, less active, and have lower performance in measures of physical fitness than their normal weight peers. Thin children are also more frequently subjected to teasing and stigmatization. Little is known about thin children's weight perceptions, desired weight and attitudes and behaviours towards food and exercise. The study aimed to compare perceived weight status, desired weight, eating and exercise behaviours and advice received from parents among thin, overweight, obese or normal weight Australian children and adolescents. METHODS: The sample included 8550 school children aged 6 to 18 years selected from every state and territory of Australia. The children were weighed, measured and classified as thin, normal, overweight or obese using international standards. The main outcome measures were perceived and desired weight, weight related eating and exercising behaviours, and advice received from parents. RESULTS: The distribution of weight status was - thin 4.4%; normal weight 70.7%; overweight 18.3%; and obese 6.6%. Thin children were significantly shorter than normal weight, overweight or obese children and they were also more likely to report regularly consuming meals and snacks. 57.4% of thin children, 83.1% of normal weight children, 63.7% of overweight and 38.3% of obese children perceived their weight as "about right". Of the thin children, 53.9% wanted to be heavier, 36.2% wanted to stay the same weight, and 9.8% wanted to weigh less. Thin children were significantly less likely than obese children to respond positively to statements such as "I am trying to get fitter" or "I need to get more exercise." Parents were significantly less likely to recommend exercise for thin children compared with other weight groups. CONCLUSIONS: Thin children, as well as those who are overweight or obese, are less likely than normal weight children to consider their weight "about right'. Thin children differ from children of other weights in that thin children are less likely to desire to get fitter or be encouraged to exercise. Both extremes of the spectrum of weight, from underweight to obese, may have serious health consequences for the individuals, as well as for public health policy. Health and wellness programs that promote positive social experiences and encourage exercise should include children of all sizes.

Increased breakfast frequency and nutritional quality among schoolchildren after a national breakfast promotion campaign in Australia between 2000 and 2006.

This national study examined student breakfast consumption and nutritional quality of breakfast in 2000 and 2006 by gender, school grade, school socioeconomic status (SES) and weight status after the implementation of a national breakfast promotion campaign. Participants were 4237 schoolchildren in grades 2-12 from 32 schools in 2000 and 5645 schoolchildren from the same schools in 2006. Height and weight were measured. Missing breakfast decreased from 2000 to 2006 in primary school females (9.6-6.0%) and males (9.4-6.0%) and in secondary school females (27.7-18.7%) and males (19.9-12.1%). Breakfast skipping was greater and nutritional quality was poorer in students from low SES schools in both study years but significant improvement was seen from 2000 to 2006 among all SES groups. Overweight/obese participants were more likely than normal weight students to miss breakfast in 2000 (20.7% versus 16.0%) and in 2006 (14.3% versus 10.4%) but significant improvement was observed over the 6-year study period. Findings suggest that the consistent, significant and far-reaching improvements in breakfast consumption observed in this study were attributed to the breakfast promotion program conducted in each school community and disseminated nationally via a mass media campaign.

Obesity increase among low SES Australian schoolchildren between 2000 and 2006: time for preventive interventions to target children from low income schools?

OBJECTIVES: To examine change from 2000 to 2006 in obesity and overweight by gender, school year and school socioeconomic status (SES) in a national sample of students from Australia. METHODS: Survey of students aged 6-18 years from the same 32 schools in 2000 (N = 3,819) and 2006 (N = 5,524) with measured height and weight. All analyses were adjusted for the cluster survey design. Main outcome measures were height, weight, Z-score distribution of BMI, overweight and obesity [International Obesity Task Force (IOTF) cut-offs], school SES. RESULTS: Obesity and overweight were similar to previous Australian findings with 5.2% and 6.1% obese in 2000 and 2006, respectively, and 16.3 and 19.0% overweight. Significant increase in obesity was observed in students from low SES schools which increased from 5.8 to 8.6% (P < 0.05) compared to 5.5 to 6.3% (P = 0.32) in middle SES and 3.3 to 4.2% (P = 0.92) in high SES schools. CONCLUSIONS: Obesity increased significantly among children in low SES schools and preventive efforts should urgently and carefully target preventive efforts to assist schools, families and communities which are socially and economically, disadvantaged using culturally appropriate physical activity and nutrition promotion interventions.

Body image and eating disorders amongst Japanese adolescents. A review of the literature.

This review describes the prevalence of eating disorders and disordered eating behaviors as well as factors influencing body image disturbance amongst Japanese adolescents and compares the prevalence and trends with those of Westernized countries. Although eating disorders have been previously regarded as peculiar to Western society, they are now a more global issue with reports of non-Western countries including Japan having increasing rates of eating disorders. As the aetiology of eating disorders is related to societal norms, culture and ethnicity, their study requires an understanding of body image disturbance within different cultural contexts. Although considered less prevalent than in the West, Japan has an early history of eating disorder research and trends outlined in this review suggest that, as in Western countries the interest in, and study of eating disorders in Japan has increased during the 1980s. The prevalence of eating disorders in Japan based on available reviews, epidemiological studies and clinical reports ranges from 0.025% to 0.2% for AN and from 1.9% to 2.9% for BN. Studies suggest that the prevalence of eating disorders has increased significantly during the past two decades but the prevalence is still quite low compared to those in Western countries. Strategies for culturally appropriate prevention are discussed.

Body image and obesity among Australian adolescents from indigenous and Anglo-European backgrounds: implications for health promotion and obesity prevention among Aboriginal youth.

This study examines the relationship between body image and obesity, among 4367 indigenous and Anglo-European adolescents in Australia in 2006. It shows that indigenous adolescents, male and female, were more likely than their non-indigenous counterparts to desire and pursue weight gain. Indigenous males showed the greatest tendencies to gain weight and to perceive that they should build up their bodies. They also received the strongest parental advice to eat more, lose weight, do more exercise, do less exercise, and heed warnings that they were not eating enough. The percentage distribution of weight, from obese through to underweight, was not significantly different between indigenous and Anglo-European adolescents. Poor body image among obese adolescents was similar in all groups. This article concludes that indigenous Australian adolescents are more likely to desire weight gain and receive more parental and family advice about the desirability of gaining weight. Indigenous adolescents from around the world may have to grapple with conflicting cultural perceptions involving their own self-image, parental coercion and peer group pressure. Therefore, before planning and designing health education programs for indigenous young people, educators and health professionals should consider cultural attitudes lest they inadvertently create weight concerns, confuse or contradict healthy lifestyle messages.

Self perception score from zero to ten correlates well with standardized scales of adolescent self esteem, body dissatisfaction, eating disorders risk, depression, and anxiety.

UNLABELLED: The ability to quickly and reliably assess mental health status would assist health workers, educators and youth workers to provide appropriate early intervention for adolescents. OBJECTIVE: To investigate the validity of a simple self perception score out of ten by correlating the self perception scores of adolescents from a normal, community sample of adolescents with their scores on standardized mental health measures. Study group was 470 early adolescent students aged 11.0-14.5 years from grades 7 and 8 in two secondary schools. METHODS: Self perception was self reported using a score of zero to ten points, and the scores were then correlated with scores on the Harter Self Perception Profile, Beck Junior Depression, Speilberger State and Trait Anxiety and the Eating Disorders Inventory. A High Risk group (self perception < 5) was assessed to examine how many of these adolescents also had poor self esteem and risk for depression, anxiety, and eating disorders. RESULTS: Self perception scores correlated positively with self esteem and self concept subscales and it was negatively associated with depression, state and trait anxiety, and EDI scores. Of the 15.1% high risk adolescents in the overall sample, 78% scored below the group average on the mean of all Harter Self Concept scores; 70% scored above average for Beck Depression; 64% and 74% scored above average on Speilberger State/Trait Anxiety respectively; 80% scored higher than the average on the group mean EDI. CONCLUSIONS: A self perception score from zero to ten can be a simple and accurate way of gaining an initial insight into the current mental health status of adolescents.

Gender, ethnicity, culture and social class influences on childhood obesity among Australian schoolchildren: implications for treatment, prevention and community education.

The aim of the study was to explore the associations between obesity, weight perceptions and gender, ethnicity, culture and social class in a large national study of Australian school children. Primary and high schools (N = 47) were recruited from every state and territory of Australia and included 7889 children from government, private and Catholic schools (82% response rate) in August-November, 2006. The socioeconomic status (SES) of schools was based on a government survey of total family income. A questionnaire completed by students, measured demographic details of gender, age, weight perceptions and ethnic/cultural background. Height and weight were measured by trained research assistants. Outcome measures included body mass index (BMI), prevalence of obesity, overweight, weight perceptions. Prevalence of obesity was 6.4% of males and 5.6% of females in primary school students (P = 0.34). More high school males were obese than females (7.7% vs. 5.7%, P = 0.001). Obesity was more prevalent among students from Pacific Islander backgrounds. Adolescents who were most likely to be obese were boys and girls of low SES or Pacific Islander or Middle Eastern/Arabic background. The least likely to be obese were Anglo/Caucasian or Asian students and in particular, the girls. Obese female adolescents from Aboriginal, Middle Eastern/Arabic and Pacific Islander backgrounds were less likely than their Caucasian or Asian peers to perceive themselves as 'too fat'.Those working in clinical, community or educational settings with young people and in particular, obese young people, should be aware that obesity is likely to be more prevalent, more culturally acceptable and perhaps more desirable among children and teens from low SES communities and/or Middle Eastern and Pacific Islander backgrounds. Health and social work professionals should be careful not to exaggerate the risks of overweight or obesity or inadvertently create weight concerns among young people. The different body image perceptions identified in this study should be taken into account when planning clinical, community or preventive initiatives among children or adolescents from varying ethnic groups.

Prevention programs for body image and eating disorders on University campuses: a review of large, controlled interventions.

Body dissatisfaction, dieting, eating disorders and exercise disorders are prevalent among male and female university students worldwide. Male students are also increasingly adopting health-damaging, body-image-related behaviors such as excessive weight lifting, body building and steroid abuse. Given the severity and difficulty of treating eating disorders, prevention of these problems is a recognized public health goal. Health promotion and health education programs have been conducted in the university setting since the mid 1980s, but few have achieved significant improvements in target health attitudes and behaviors. In this paper, 27 large, randomized and controlled health promotion and health education programs to improve body dissatisfaction, dieting and disordered eating and exercise behaviors of male and female college students are reviewed. In general, health education programs to improve body image and prevent eating disorders in the university setting have been limited by small sample sizes and the exclusion of male students. The majority of studies were conducted among either female undergraduate psychology students or women that were recruited using on-campus advertising. The latter reduces the ability to generalize results to the whole university population, or the general community. In addition, there has been a paucity of longitudinal studies that are methodologically sound, as only 82% (22/27) of interventions included in the review used random assignment of groups, and only 52% (n = 14) included follow-up testing. Information-based, cognitive behavioral and psycho-educational approaches have been the least effective at improving body image and eating problems among university students. Successful elements for future initiatives are identified as taking a media literacy- and dissonance-based educational approach, incorporating health education activities that build self-esteem, and using computers and the internet as a delivery medium. A newly designed program for Australian university students is described.

Socio-cognitive and nutritional factors associated with body mass index in children and adolescents: possibilities for childhood obesity prevention.

A large national study of schoolchildren aged 6-18 years was conducted to assess nutritional and socio-cognitive factors associated with body mass index (BMI). A questionnaire was used to assess nutritional quality of breakfast, importance of physical activity and food variety score, among 4441 students from randomly selected schools in all states and territories of Australia between September and December 2000. Height and weight were measured. Nutritional knowledge, dietary self-efficacy and dietary locus of control were also assessed among adolescents. School socio-economic status (SES) was derived from parental income. The factors were modelled using multiple linear regression to determine significant predictors of BMI. Dietary self-efficacy, nutritional quality of breakfast and SES were found to be the principal predictors of BMI in addition to the expected biological factors of age, gender and height. Furthermore, low SES was found to contribute to high BMI, mediated by the low nutritional quality of breakfast. Food variety was positively associated with high BMI and this was mediated by dietary self-efficacy. Nutrition knowledge and dietary locus of control were not associated with BMI. These results suggest that breakfast programmes for low-income children may be an effective measure in the prevention of childhood obesity.

Self-concept, self-esteem and body weight in adolescent females: a three-year longitudinal study.

Eighty girls aged 12.8 (0.6) years, completed self-concept, depression and anxiety scales over three years and had their height and weight measured. All nine self-concept domains were lower in the Highest BMI group, compared to the Lower BMI group and this trend was stable over three years. Highest BMI girls were substantially lower than population norms on all nine scales. Over three years, the Physical Appearance and Close Friendship scores of Highest BMI girls decreased compared to Lower BMI girls. This pattern was similar for all of the other self-concept domains. Several aspects of early adolescent girls' self-image may be adversely influenced by a heavy weight status.

The role of teachers and other educators in the prevention of eating disorders and child obesity: what are the issues?

This paper examines the important contribution that teachers and other educators (including health educators, school nurses, school counselors, school psychologists, and sports coaches) have to offer in the prevention of eating disorders and child obesity. Our paper notes the important contribution of school educators whilst warning of the current need to specifically examine how teachers and school personnel may be best trained and prepared for such a preventive role, whether they currently feel willing and able to undertake such a role, and whether some groups of teachers may be personally susceptible to body image and eating problems. It is vital to understand the knowledge, behaviors, attitudes, and expectations of educators implementing prevention programs in order to ensure that they are personally and professionally capable of carrying out prevention initiatives in schools. Individuals involved in food and exercise-related careers have been identified as being at environmental and situational risk for body image and eating problems, and it may be possible that they chose their career path due to their own personal experience with eating disorders or weight issues. In such cases, specific training or assistance may be required in order to enable the educators to conduct effective preventive activities. Discussion focuses on what needs to be done in order to enable teachers and other school-based educators to perform most effectively in the implementation of school based eating disorder and child obesity prevention programs.

Evidence for a self-esteem approach in the prevention of body image and eating problems among children and adolescents.

Early suggestions from the 1980s for a self-esteem approach in the prevention of eating problems have been adopted by researchers, and the results of several interventions show support for the efficacy, safety, and suitability of a predominantly self-esteem and self-acceptance approach. Several recent studies utilizing strong self-esteem components as part of their controlled prevention interventions have produced improvements in body dissatisfaction, dietary restraint, internalization of the thin ideal, and attitudes associated with the eating disorders. This article discusses self-esteem as one of the important risk and protective factors in the development of body image concerns and eating disorders and describes the subsequent use of a self-esteem approach for prevention of eating disorders. Interventions containing strong self-esteem components from around the world are discussed in relation to their impact on the body image and eating behaviors of adolescents. Applications of the self-esteem approach for the prevention of child obesity also are discussed.