The Impact of Excessive Fructose Intake on Adipose Tissue and the Development of Childhood Obesity.

Worldwide, childhood obesity cases continue to rise, and its prevalence is known to increase the risk of non-communicable diseases typically found in adults, such as cardiovascular disease and type 2 diabetes mellitus. Thus, comprehending its multiple causes to build healthier approaches and revert this scenario is urgent. Obesity development is strongly associated with high fructose intake since the excessive consumption of this highly lipogenic sugar leads to white fat accumulation and causes white adipose tissue (WAT) inflammation, oxidative stress, and dysregulated adipokine release. Unfortunately, the global consumption of fructose has increased dramatically in recent years, which is associated with the fact that fructose is not always evident to consumers, as it is commonly added as a sweetener in food and sugar-sweetened beverages (SSB). Therefore, here, we discuss the impact of excessive fructose intake on adipose tissue biology, its contribution to childhood obesity, and current strategies for reducing high fructose and/or free sugar intake. To achieve such reductions, we conclude that it is important that the population has access to reliable information about food ingredients via food labels. Consumers also need scientific education to understand potential health risks to themselves and their children.

Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study.

BACKGROUND: Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. OBJECTIVE: This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. METHODS: NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children's age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants' experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. RESULTS: Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was "good," "useful," and "helpful" for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. CONCLUSIONS: While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. TRIAL REGISTRATION: ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896.

Development of an action programme tackling obesity-related behaviours in adolescents: a participatory system dynamics approach.

System dynamics approaches are increasingly addressing the complexity of public health problems such as childhood overweight and obesity. These approaches often use system mapping methods, such as the construction of causal loop diagrams, to gain an understanding of the system of interest. However, there is limited practical guidance on how such a system understanding can inform the development of an action programme that can facilitate systems changes. The Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme combines system dynamics and participatory action research to improve obesity-related behaviours, including diet, physical activity, sleep and sedentary behaviour, in 10-14-year-old adolescents in Amsterdam, the Netherlands. This paper illustrates how we used a previously obtained understanding of the system of obesity-related behaviours in adolescents to develop an action programme to facilitate systems changes. A team of evaluation researchers guided interdisciplinary action-groups throughout the process of identifying mechanisms, applying the Intervention Level Framework to identify leverage points and arriving at action ideas with aligning theories of change. The LIKE action programme consisted of 8 mechanisms, 9 leverage points and 14 action ideas which targeted the system's structure and function within multiple subsystems. This illustrates the feasibility of developing actions targeting higher system levels within the confines of a research project timeframe when sufficient and dedicated effort in this process is invested. Furthermore, the system dynamics action programme presented in this study contributes towards the development and implementation of public health programmes that aim to facilitate systems changes in practice.

Healthy lifestyle interventions within the curriculum in school-age children: systematic review and meta-analysis.

Childhood obesity is a major public health challenge. Previous research has identified the impact of school-based interventions for preventing and treating obesity; we hypothesized that when curricular changes are integrated, results could be exponentiated. This study aimed to systematically review and conduct a meta-analysis of the published literature analyzing information about school-based interventions inserted in the curriculum. The Cochrane Handbook methodology was followed. An electronic search was conducted in five databases, with a specific design strategy per database. Randomized controlled trials or quasi-experimental studies of children with nutrition and physical activity (PA) interventions inserted into the school curricula were included. The risk of bias was assessed with the Risk of Bias tool. The mean differences were pooled using a fixed-effects model for the meta-analysis. The certainty of the evidence was evaluated according to the guidelines of the Grading of the Recommendations, Assessment, Development, and Evaluations working group (Protocol ID: CRD42021270557). After the screening and selection process, 12 studies were included. The interventions identified, based on the school curricula, include classroom activities and homework, among others. A meta-analysis with five intervention groups presented an overall mean difference of -0.14 body mass index (BMI) Z-score (95% CI: -0.25, -0.03) after this intervention with high certainty of the evidence. This systematic review and meta-analysis suggest that nutrition and PA lessons inserted into the curricula and supported with additional activities (i.e. homework, workshops, etc.) could increase nutrition knowledge and improve attitudes toward fruit, vegetables, and water consumption, and BMI Z-score reduction.

Universal Free School Meals Policy and Childhood Obesity.

BACKGROUND AND OBJECTIVES: The Community Eligibility Provision (CEP), a universal free school meals policy, increases school meal participation by allowing schools in low-income areas to provide free breakfast and lunch to all students; however, its impact on obesity remains uncertain. The objective of this study is to estimate the association of CEP with child obesity. METHODS: School obesity prevalence was calculated using BMI measurements collected annually between 2013 and 2019 from students in California public schools in grades 5, 7, and 9. To estimate the association of CEP with obesity, we used a difference-in-differences approach for staggered policy adoption with an outcome regression model conditional on covariates, weighted by student population size. RESULTS: The analysis included 3531 CEP-eligible schools using school-level obesity prevalence calculated from 3 546 803 BMI measurements. At baseline, on average, 72% of students identified as Hispanic, 11% identified as white, 7% identified as Black, and 80% were eligible for free or reduced-price meals. Baseline obesity prevalence was 25%. Schools that participated in CEP were associated with a 0.60-percentage-point net decrease in obesity prevalence after policy adoption (95% confidence interval: -1.07 to -0.14 percentage points, P = .01) compared with eligible, nonparticipating schools, corresponding with a 2.4% relative reduction, given baseline prevalence. Meals served increased during this period in CEP-participating schools only. CONCLUSIONS: In a balanced sample of California schools, CEP participation was associated with a modest net decrease in obesity prevalence compared with eligible, nonparticipating schools. These findings add to the growing literature revealing potential benefits of universal free school meals for children's well-being.

Effectiveness and cost-effectiveness of a sustainable obesity prevention programme for preschool children delivered at scale 'HENRY' (Health, Exercise, Nutrition for the Really Young): protocol for the HENRY III cluster randomised controlled trial.

INTRODUCTION: One-fifth of children start school already overweight or living with obesity, with rates disproportionately impacting those living in the most deprived areas. Social, environmental and biological factors contribute to excess weight gain and programmes delivered in early years settings aim to support families to navigate these in order to prevent obesity. One of these programmes (Health, Exercise and Nutrition for the Really Young, HENRY) has been delivered in UK community venues (hereon named 'centres') in high deprivation areas since 2008 and aims to help families to provide a healthy start for their preschool children. We aim to establish the effectiveness and cost-effectiveness of HENRY, including its potential role from a wider systems perspective. METHODS AND ANALYSIS: This is a multicentre, open-labelled, two-group, prospective, cluster randomised controlled trial, with cost-effectiveness analysis, systems-based process evaluation and internal pilot. Primary analysis will compare body mass index (BMI) z-score at 12 months in children (n=984) whose parents have attended HENRY to those who have not attended. Secondary outcomes include parent and staff BMI and waist circumference, parenting efficacy, feeding, eating habits, quality of life, resource use and medium term (3 years) BMI z-scores (child and siblings). 82 centres in ~14 local authority areas will be randomised (1:1) to receive HENRY or continue with standard practice. Intention-to-treat analysis will compare outcomes using mixed effects linear regression. Economic evaluation will estimate a within-trial calculation of cost-per unit change in BMI z-score and longer-term trajectories to determine lifelong cost savings (long-term outcomes). A systems process evaluation will explore whether (and how) implementation of HENRY impacts (and is impacted by) the early years obesity system. An established parent advisory group will support delivery and dissemination. ETHICS AND DISSEMINATION: Ethical approval has been granted by the University of York, Health Sciences' Research Governance Committee (HSRGC/2022/537/E). Dissemination includes policy reports, community resources, social media and academic outputs. TRIAL REGISTRATION NUMBER: ISRCTN16529380.

Satisfaction with a meal kit delivery program and feasibility of a phase I trial in the intervening in food insecurity to reduce and mitigate (InFoRM) childhood obesity study.

BACKGROUND: Food and nutrition security interventions have been demonstrated to optimize health, prevent and treat chronic diseases among adult populations. Despite the increasing prevalence and intersection of food insecurity and childhood obesity in the United States, there are few food and nutrition security interventions targeted to children and families. OBJECTIVES: The primary purpose of this phase I randomized, crossover trial was to assess the safety, acceptability and satisfaction of a meal kit delivery program among children with obesity living in households with food insecurity. Secondarily, we assessed the feasibility of our study design, recruitment and retention to inform future larger scale trials. METHODS: We delivered 6 weeks of healthy meal kits, which included fresh pre-portioned ingredients and simple picture-based recipes (two recipes/week) in English or Spanish to prepare one-pot, under 30-min meals (after preparation ~ 10 servings/week). RESULTS: Caregivers received and prepared the meal kits and reported overall satisfaction with the meal kit delivery program. CONCLUSION: A meal kit delivery intervention for children with obesity and food insecurity is acceptable and a phase I randomized, crossover trial is feasible.

Changes in diet and physical activity following a community-wide pilot intervention to tackle childhood obesity in a deprived inner-London ward.

BACKGROUND: Local authorities in England have an important role in shaping healthy local environments contributing to childhood obesity. This study examined changes in diet and physical activity in primary school children following a three-year, complex, community-based intervention in Golborne ward, the second most deprived ward in London. METHODS: The Go-Golborne intervention aimed to shape the local environment across multiple settings with the engagement of a large number of local government and community stakeholders in a joint approach. Activities focused on six co-created themes to make changes to local environments and reduce sugary snacks and beverage consumption, increase fruit and vegetable intake, promote healthy snacks, increase active play and travel, and reduce screen time. We analysed changes in self-reported diet and physical activity, collected annually between 2016 and 2019, from 1,650 children aged 6-11 years through six local schools, who all received the intervention. We used multilevel, linear and logistic random-slope regression models adjusted for time on study, baseline age, gender, ethnicity, deprivation quintile, school, and baseline weight status. RESULTS: After three years of follow-up, there were reductions in sugar-sweetened beverage consumption (adjusted beta -0·43 occasions/day, 95% CI -0·55 to -0·32), fruit and vegetable consumption (adjusted beta -0.22 portions, 95% CI -0.44 to 0.001) and car travel to and from school (adjusted OR 0·19, 95% CI 0·06 to 0·66), while screen time increased (high versus moderate/low: OR 2·30, 95% CI 1·36 to 3·90). For other behavioural outcomes, there was no statistically significant evidence of changes. CONCLUSION: Local authorities have substantial powers to make positive changes to the obesogenic environment but programmes remain under-evaluated. Results from the ambitious Go-Golborne intervention demonstrated mixed results in health behaviours following programme implementation. These results underline the importance of a coordinated and comprehensive policy response to support changes in wider environmental and social conditions as well as appropriate and holistic evaluations of initiatives to inform local actions on obesogenic environments.

Late bedtime combined with more screen time before bed increases the risk of obesity and lowers diet quality in Spanish children.

This cross-sectional study aimed to investigate whether the combination of bedtime and screen time (ST) before bed were associated with obesity and diet quality in toddlers and school-aged children. Parents reported children's bedtimes and ST before bed (0 min, 1-30 min, >30 min). We then defined bed + screen time behavior using bedtime median cut-offs (early [EB] or late [LB]) and ST responses, resulting in four groups: EB-0'ST, EB ≤ 30'ST/LB-0'ST, EB > 30'ST/LB ≤ 30'ST, and LB > 30'ST. For all participants (n = 1133; 5.4 ± 2.7 years, 49.7% girls, 51.9% school-aged) we evaluated body mass index (BMI), diet quality, sleep-related variables, physical activity, and health-related quality of life (HRQoL). Outcome variables were compared across bed + screen time behavior groups, stratified by age group (toddlers and school-aged children) using general linear models for continuous variables, as well as chi-squared tests or logistic regressions for categorical variables. Additionally, we calculated linear p-trends. Analyses were adjusted for sociodemographic variables, BMI, and physical activity (unless the variable was tested). The results showed that toddlers and school-aged children in the LB ≥ 30'ST group were more likely to have overweight/obesity (OR: 3.42 [95%CI:1.41,8.26] and OR: 2.53 [95%CI:1.10,5.03], respectively) than those in the EB-0'ST group. Additionally, toddlers and school-aged children in the EB > 30'ST/LB ≤ 30'ST and LB > 30'ST groups showed significantly lower adherence to the Mediterranean diet compared to the other groups (p < 0.001). Regarding sleep-related outcomes, we observed that the combination of LB and more ST was associated with poorer sleep quality and shorter sleep duration in toddlers and school-aged children (p < 0.001). These findings emphasize the importance of promoting earlier bedtimes and limiting ST before bed as part of obesity prevention strategies for children. Furthermore, such intervention could benefit the quality of children's diet and overall lifestyle.

Differences in children's exposure to television advertising of unhealthy foods and beverages in Spain by socio-economic level.

BACKGROUND: The influence of food advertising on food preferences and consumption could also contribute to the socio-economic inequalities among Spanish children in terms of eating habits and childhood obesity. Although the main food advertising channel targeted at children in Spain is television, available studies estimate exposure indirectly by combining content data with audience data. The aim of this study was therefore to describe the frequency of exposure to television advertising of unhealthy foods and drinks, measured directly, among Spanish children and adolescents, and analyse its socio-economic inequalities. METHODS: Observational study of television advertising impacts in a sample of 1590 children aged 4 to 16 years drawn from a consumer panel representative of the Spanish population in this age group, over the course of a full week of broadcasting in February 2022. The sample was obtained through stratified random sampling by Autonomous Region, with quotas being set by reference to socio-demographic variables. Exposure was measured with an audiometer, and the nutrient content of the food and drink advertised was analysed using the nutrient profile of the WHO Regional Office for Europe. We used the Chi-squared test to analyse possible differences in advertising coverage by socio-economic level. RESULTS: The participants saw a weekly mean of 82.4 food and drink commercials, 67.4 of which were for unhealthy products (81.8%), mostly outside the child-protection time slot. On average, low-social class participants received 94.4% more impacts from unhealthy food and drink advertising than did high-class participants (99.9 vs. 51.4 respectively). The mean advertising coverage of unhealthy foods and drinks was 71.6% higher in low-class than in high-class participants (10.9% vs. 18.7%; p = 0.01). CONCLUSION: Spanish children and adolescents received an average of 10 impacts per day from television spots for unhealthy foods and drinks. The exposure of low-class children is double that of high-class children, a finding compatible with the high prevalence of childhood obesity in Spain and the related socio-economic inequalities. To protect Spanish minors from the harmful effects of food advertising and reduce the related social health inequalities would require the implementation of a 24:00 watershed for unhealthy food advertising on television.

Impact of prenatal maternal dietary exclusion on childhood obesity and overweight risk.

BACKGROUND: Child birthweight is a measure of fetal nutrition that is primarily determined by prenatal maternal (PM) diet. Child birthweight and child obesity/overweight risk are well established to be linked. Nevertheless, no studies have investigated the impact of PM dietary exclusion on child obesity/overweight risk or body mass index z-score (BMIz). OBJECTIVES: The study aimed to determine whether PM dietary exclusion affected the child's BMIz, obesity/overweight risk, whether child birthweight serves as a mediator of this, and whether PM use of dietary supplements can protect against this. METHODS: Waves within the years 2004-2019 from the Longitudinal Study of Australian Children, a population-based cohort study, were analyzed. The participants were aged 0 to 15 years during these waves of the study. Analysis was conducted using logistic and linear models. A total of 5,107 participants were involved in the first wave of the study. RESULTS: The PM exclusion of fish was associated with a higher risk of being underweight at age 14 or 15 years and mild-to-moderate obesity at age 6 or 7 years. The PM exclusion of egg was associated with a higher risk of being overweight at age 14 or 15 years. The exclusion of dairy was associated with more mixed effects. Mediation effects did not reach statistical significance. Moderation effects involving PM dietary supplement use, when they did occur, were associated with higher child BMIz and usually a higher risk of obesity/overweight. CONCLUSIONS: Fish and eggs are likely important parts of PM diets for preventing childhood obesity and overweight. Further studies will be needed to determine reasons for this and the apparent adverse effects of dietary supplements on overweight/obesity risk.

Profiles of Cultural Adaptation and Parenting Approach for Childhood Obesity in Lifestyle Interventions for Families With Young Children: A Systematic Review.

BACKGROUND AND OBJECTIVES: Various interventions aim to reduce obesity and promote healthy lifestyles among different cultural groups. METHODS: We have conducted a systematic literature review, following PRISMA guidelines (registered at https://doi.org/10.17605/OSF.IO/HB9AX), to explore profiles of cultural adaptation and parenting approach of lifestyle interventions for families with young children (1-4 years). RESULTS: Our search (in CINAHL, ERIC, PsycINFO, PubMed, Scopus, and SSCI) yielded 41 studies reporting 31 interventions. Drawing on Intervention Mapping, we applied a newly developed framework with various indicators of cultural adaptation and a parenting approach to analyze interventions. Our review shows clear differences in the level of cultural adaptation. A categorical principal component analysis revealed 6 different empirical profiles of cultural adaptation. CONCLUSIONS: Based on our profiles, we discuss how cultural adaptation can be strengthened in the design of future early interventions aimed at promoting a healthy lifestyle.

Early childhood (1-5 years) obesity prevention: A systematic review of family-based multicomponent behavioral interventions.

INTRODUCTION: Globally 38.9 million children under age 5 have overweight or obesity, leading to type 2 diabetes, cardiovascular complications, depression, and poor educational outcomes. Obesity is difficult to reverse and lifestyle behaviors (healthy or unhealthy) can persist from 1.5 years of age. Targeting caregivers to help address modifiable behaviors may offer a viable solution. OBJECTIVE: Evaluate the impact of multicomponent family interventions on weight-based outcomes in early childhood and explore related secondary behavior outcomes. METHODS: Four databases were searched (1/2017-6/2022) for randomized controlled trials (RCTs) of obesity-prevention interventions for children (1-5 years). Eligible studies included an objectively measured weight-based outcome, family interventions targeting the caregiver or family, and interventions including at least two behavioral components of nutrition, physical activity, or sleep. RESULTS: Eleven interventions were identified consisting of four delivery modes: self-guided (n = 3), face-to-face group instruction (n = 3), face-to-face home visits (n = 2), and multiple levels of influence (n = 3). The reviewed studies reported almost no significant effects on child weight-based outcomes. Only two studies (one was an underpowered pilot study) resulted in significant positive child weight-management outcomes. Seven of the interventions significantly improved children's dietary intake. CONCLUSION: Except for one, the reviewed studies reported that family based interventions had no significant effects on child weight-based outcomes. Future studies of this type should include measurements of age and sex-based body mass index (BMI) and trajectories, and also examine other important benefits to the children and families.

FTO genotype and body mass index reduction in childhood obesity interventions: A systematic review and meta-analysis.

Numerous guidelines have called for personalized interventions to address childhood obesity. The role of fat mass and obesity-associated gene (FTO) in the risk of childhood obesity has been summarized. However, it remains unclear whether FTO could influence individual responses to obesity interventions, especially in children. To address this, we systematically reviewed 12,255 records across 10 databases/registers and included 13 lifestyle-based obesity interventions (3980 children with overweight/obesity) reporting changes in body mass index (BMI) Z-score, BMI, waist circumference, waist-to-hip ratio, and body fat percentage after interventions. These obesity-related outcomes were first compared between children carrying different FTO genotypes (rs9939609 or its proxy) and then synthesized by random-effect meta-analysis models. The results from single-group interventions showed no evidence of associations between FTO risk allele and changes in obesity-related outcomes after interventions (e.g., BMI Z-score: -0.01; 95% CI: -0.04, 0.01). The results from controlled trials showed that associations between the FTO risk allele and changes in obesity-related outcomes did not differ by intervention/control group. To conclude, the FTO risk allele might play a minor role in the response to obesity interventions among children. Future studies might pay more attention to the accumulation effect of multiple genes in the intervention process among children.

Effectiveness of Interventions Promoting Dietary Intake, Physical Activity, and Healthy Weight Status of Children in Family Child Care: A Systematic Review.

INTRODUCTION: This systematic review examines the effectiveness of interventions in family child care (FCC) on (1) children's dietary intake, physical activity levels and weight, and (2) FCC health-promoting environments, policies, and practices. Quasi-experimental studies measuring these outcomes were included. METHODS: All available articles up to July 2023 were searched using MEDLINE, ERIC, CINAHL, Embase, Scopus, and A+ Education, and 15 interventions were included. Methodological quality was assessed with the Effective Public Health Practice Project Assessment tool. RESULTS: Thirteen studies were weak, and 2 strong in quality. Four interventions included children's dietary intake as an outcome measure, 2 included physical activity, and 3 weight status. Twelve interventions assessed nutrition and 7 physical activity environmental outcomes. DISCUSSION: Interventions in FCC improved children's dietary intake, but their impact on physical activity and weight status was inconclusive. Furthermore, positive impacts were observed in environmental outcomes related to nutrition, whereas research on physical activity environmental outcomes was limited. IMPLICATIONS FOR RESEARCH AND PRACTICE: Future research could replicate interventions to validate effectiveness and understand positive outcome mechanisms. Future interventions might use FCC stakeholders' input, incorporate innovative physical activity components, enhance FCC providers' position as role models, involve parents, and target those groups that are at a high risk of being obese.

Using Mobile Technology for Family-Based Prevention in Families with Low Incomes: Lessons from a Randomized Controlled Trial of a Childhood Obesity Prevention Program.

Researchers are increasingly using web-based technologies to deliver family-based, prevention programming. Few studies have examined the success of such approaches for families with low incomes. The purpose of this study was to describe the level of in-class and online engagement in a childhood obesity prevention program for parents with low incomes, to examine the demographic correlates of parent engagement, and to examine dosage effects on parental feeding outcomes as a function of online exposure. All participants attended in-class nutrition education classes (Eating Smart · Being Active) as part of the Expanded Food and Nutrition Education Program (EFNEP) in Colorado and Washington State (classes were offered in English and Spanish). Participants in this analysis were 168 parents from a larger cluster randomized controlled trial who had been randomly assigned to also receive a newly developed, mobile-based version of an efficacious, feeding-focused, childhood obesity prevention program. Results showed that despite high levels of in-person attendance (70%), participants only accessed 47% of the videos (online content). Older parents and parents of girls showed higher levels of in-person attendance; currently employed parents showed lower levels. Online engagement varied as a function of ethnicity and acculturation: non-Hispanic parents accessed the most videos, low-acculturated Hispanic parents accessed the second most, and highly acculturated Hispanic parents accessed the least. In contrast, low-acculturated Hispanic parents showed the highest in-person attendance. For all but one outcome, significant online program effects were found only for parents who accessed at least half of the videos. Implications for mobile-based, family-based prevention programs for parents with low incomes are considered.ClinicalTrials.gov Identifier: NCT03170700; Registration Date: March 08, 2017.

Abordaje de la obesidad infantil. Comparativa entre comunidades autónomas / Approach to Childhood Obesity in Spain. A comparison among autonomies

Fundamentos: la obesidad infantil representa un grave problema de salud pública y, dado su carácter multifactorial y sus consecuencias, resulta necesario llevar a cabo un abordaje eficaz. El sistema de autonomías español, con competencias delegadas, podría acentuar la desigualdad en su abordaje. El objetivo del estudio fue conocer la existencia o no de dichas desigualdades. Métodos: se llevó a cabo un estudio transversal descriptivo, entre los meses de febrero-abril de 2022, en el que se comparó el abordaje de la obesidad infantil entre las diecisiete comunidades y dos ciudades autónomas, mediante el análisis de los siguientes indicadores: personal de pediatría; enfermería pediátrica; personal de nutrición y su reconocimiento legal; existencia de planes integrales; y gasto sanitario para obesidad infantil. La búsqueda de información se realizó mediante revisión bibliográfica y solicitud de acceso a información pública a las correspondientes consejerías autonómicas. Hubo cálculo de ratios de pediatras y enfermeros por 1.000 habitantes y gasto sanitario por habitante. Resultados: se observó que a nivel nacional los pediatras poseen una ratio acorde a las recomendaciones internacionales (1,21), no así enfermería general y pediátrica (con una ratio de 0,65, que equivale a aproximadamente 1.544 habitantes por cada enfermera), ni el personal de nutrición. Entre comunidades autónomas se apreciaron grandes variaciones para las tres categorías. Los planes integrales de abordaje se encontraron desactualizados o, directamente, ausentes, al igual que el análisis periódico del gasto derivado de la obesidad.Conclusiones: el abordaje de la obesidad infantil parece variar de forma considerable entre autonomías según los indicadores analizados. Por ello, sería recomendable encauzar todos los esfuerzos en homogenizarlo, para mejorar la calidad asistencial e igualar las oportunidades de prevención y tratamiento en todo el ámbito nacional.(au)

Background: childhood obesity represents a serious public health problem and given its multifactorial nature and its con-sequences; it is necessary to carry out an effective approach. The spanish system of autonomies, with delegated powers, could accentuate inequality in its approach. The objective of the study was to know the existence or not of these inequalities. Methods: a descriptive cross-sectional study was carried out between the months of february-april 2022, in which the approach to childhood obesity was compared among the seventeen communities and two autonomous cities, through the analysis of the following indicators: pediatric staff, pediatric nursing, nutrition personnel and their legal recognition, the existence of comprehensive plans and health expenditure on childhood obesity. The search for information has been carried out through a bibliographic review and a request for access to public information to the corresponding regional councils. It were performed ratios of paediatricians and nurses per 1,000 inhabitants and health expenditure per inhabitant were calculated.results: it was observed that in spain paediatricians have a ratio according to international recommendations (1.21), but not ge-neral and paediatric nursing (with a ratio of 0.65, which is equivalent to approximately 1,544 inhabitants for each nurse), and nutrition professionals. Among autonomies there were large variations for the three categories. Comprehensive plans were outdated or absent altogether, as well as the periodic analysis of obesity expenditure. Conclusions: the approach to childhood obesity seems to vary considerably among autonomies according to the analysed indicators. Thus, it would be advisable to lead all efforts to homogenize it, to improve care quality and prevention and treatment choices in all national regions.(AU)

A systematic review of school-based weight-related interventions in the Gulf Cooperation Council countries.

BACKGROUND: The prevalence of childhood overweight and obesity has increased at alarming levels in the Gulf Cooperation Council (GCC) countries (Saudi Arabia, United Arab Emirates (UAE), Kuwait, Bahrain, Oman, and Qatar). Weight-related interventions are urgently required in these countries to tackle childhood overweight and obesity and their-related consequences. To date, no systematic review has synthesised school-based weight-related interventions in the six GCC countries. This study aims to systematically review school-based, weight-related interventions conducted in the GCC countries, investigating the intervention characteristics, components, and outcomes. METHODS: Medline, Scopus, and ProQuest databases were searched for peer-reviewed literature published in English without date restriction and Google Scholar for grey literature using combined Medical Subject Heading (MeSH) terms and keywords under five relevant concepts including population, setting, interventions, outcomes, and geographical location. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), records were identified, screened for eligibility, and included in this review. Using the Effective Public Health Practice Project tool, the methodological quality of the included studies was assessed independently by two authors. RESULTS: Out of 1303 initially identified records, eight peer-reviewed articles and three doctoral theses were included in this review. The age of the students in the included studies ranged between 5 to 19 years, and the sample sizes between 28 and 3,967 students. The studies included between one and thirty public and private schools. Of the included studies, six were randomised controlled trials, four pre-post studies and one used a post-study design. Only four of the eleven studies were theory based. The included studies reported various improvements in the students' weight or weight-related lifestyle behaviours, such as healthier dietary choices, increased physical activity, and decreased sedentary behaviour. CONCLUSIONS: This review suggests the potential effectiveness of school-based interventions in the GCC countries. However, a thorough evaluation of these studies revealed significant methodological limitations that must be acknowledged in interpreting these results. Future studies in this field should be theory-based and use more rigorous evaluation methods. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42020156535.