Special Issue "Pediatric Obesity Treatment and Prevention"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 January 2019).

Special Issue Editor

Guest Editor
Prof. Dr. Robert M. Siegel Website E-Mail
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Interests: school-based obesity initiatives; behavioral economic change in food selection; cardiovascular risk screening in children

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on the relationship of public health and pediatric obesity treatment and prevention in the International Journal of Environmental Research and Public Health. The venue is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

Pediatric obesity continues to be amongst the most challenging healthcare issues facing the world. As we recognize that environmental issues are critically important, public and population health-based initiatives are playing a more and more prominent role in fighting the obesity epidemic. With this Special Issue, we hope to explore new and innovative ways the obesity problem is being approached on a community, region, national and worldwide scale.

This Special Issue is open to any subject area related to the impacts of public and population health on pediatric obesity. The listed keywords suggest just a few of the many possibilities.

Prof. Dr. Robert M. Siegel
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Pediatric Obesity
  • Built environment
  • Population health
  • Food insecurity
  • Food desert
  • Public health
  • Health geography
  • Community Interventions
  • Food selection
  • Physical activity
  • Walkability
  • Behavioral economics
  • Incentives
  • Food tax

Published Papers (20 papers)

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Open AccessArticle
Adolescents’ and Parents’ Perspectives of a Revised Protein-Sparing Modified Fast (rPSMF) for Severe Obesity
Int. J. Environ. Res. Public Health 2019, 16(18), 3385; https://doi.org/10.3390/ijerph16183385 - 12 Sep 2019
Abstract
The purpose of this pilot study was to assess the acceptability to adolescents (11–18 years old) and their parents using a revised protein-sparing modified fast (rPSMF) for 12 months as an intervention for severe obesity in a tertiary pediatric weight management clinic (PWMC). [...] Read more.
The purpose of this pilot study was to assess the acceptability to adolescents (11–18 years old) and their parents using a revised protein-sparing modified fast (rPSMF) for 12 months as an intervention for severe obesity in a tertiary pediatric weight management clinic (PWMC). To assess acceptability (satisfaction, confidence) with the rPSMF protocol, surveys were completed by adolescents and parents at baseline, 1, 3, 6, and 12 months, with adolescent height and weight measured. Analyses were conducted to assess differences in satisfaction and confidence based on adolescent response (weight loss) and adherence to the rPSMF. Adolescents’ adherence with the rPSMF was close to 50% in the first 3 months, but dropped to 14.7% at 6 months. Adolescents were most confident with choosing low carbohydrate foods at baseline. Over 12 months, adolescents and parents reported weight loss as “the most liked” part of the rPSMF. Adolescents who were adherent were more satisfied with their weight loss than their non-adherent peers. Parents and adolescents reported lack of food variety and difficulty following the protocol as challenges with the rPSMF. Adolescents and their parents were able to follow the rPSMF protocol, with weight loss, but with decreased adherence over time. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessArticle
Using a Revised Protein-Sparing Modified Fast (rPSMF) for Children and Adolescents with Severe Obesity: A Pilot Study
Int. J. Environ. Res. Public Health 2019, 16(17), 3061; https://doi.org/10.3390/ijerph16173061 - 23 Aug 2019
Abstract
Treatment options are limited for children and adolescents with severe obesity. One alternative treatment is the protein-sparing modified fast (PSMF), a low-carbohydrate, high-protein diet that can result in substantial weight loss. The aim of the study is to evaluate the adherence and efficacy [...] Read more.
Treatment options are limited for children and adolescents with severe obesity. One alternative treatment is the protein-sparing modified fast (PSMF), a low-carbohydrate, high-protein diet that can result in substantial weight loss. The aim of the study is to evaluate the adherence and efficacy of a revised PSMF (rPSMF) for severe obesity in a pediatric tertiary care weight-management program. The rPSMF with 1200–1800 calories, 40–60 g of carbohydrate/day and 1.2–1.5 g protein/kg of ideal bodyweight was implemented over 12 months. Twenty-one participants enrolled in the study. Mean age 16.2 ± 1.4 years, females (76.2%) and mean weight at baseline was 119 ± 19.9 kg. Regardless of adherence to the rPSMF, the mean weight change at 1 month was −3.7 ± 3.5 kg, (range −13.5 kg to 0.9 kg); at 3 months was −5.5 ± 5.1 kg, (range −19.3 kg to 1.8 kg) and at 6 months was −4.7 ± 6.6 kg, (range −18.3 kg to 8.6 kg). At 12 months, the mean weight change was −1.3 ± 10.6 kg (range −17.7 kg to 14.8 kg). Parent and child-reported physical and psychosocial quality of life (HRQOL) improved. Despite limited adherence, the rPSMF diet resulted in clinically significant weight loss and improved HRQOL for children and adolescents with severe obesity. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessCommunication
Pilot Testing of a Patient Decision Aid for Adolescents with Severe Obesity in US Pediatric Weight Management Programs within the COMPASS Network
Int. J. Environ. Res. Public Health 2019, 16(10), 1776; https://doi.org/10.3390/ijerph16101776 - 20 May 2019
Abstract
Shared decision-making (SDM) is a best practice for delivering high-quality, patient-centered care when there are multiple options from which to choose. A patient decision aid (PDA) to promote SDM for the treatment of adolescent severe obesity was piloted among 12–17-year-olds (n = [...] Read more.
Shared decision-making (SDM) is a best practice for delivering high-quality, patient-centered care when there are multiple options from which to choose. A patient decision aid (PDA) to promote SDM for the treatment of adolescent severe obesity was piloted among 12–17-year-olds (n = 31) from six pediatric weight management programs within the Childhood Obesity Multi Program Analysis and Study System (COMPASS). Medical providers used a brochure that described indications, risks, and benefits of intensive lifestyle management alone versus bariatric surgery plus lifestyle. Immediately after, patients/families completed a survey. Patient/family perceptions of provider effort to promote understanding of health issues, to listen to what mattered most to them, and to include what mattered most to them in choosing next steps averaged 8.6, 8.8, and 8.7, respectively (0 = no effort, 9 = every effort). Nearly all (96%) reported knowing the risks/benefits of each treatment option and feeling clear about which risks/benefits mattered most to them. Most (93%) reported having enough support/advice to make a choice, and 89% felt sure about what the best choice was. Providers largely found the PDA to be feasible and acceptable. This pilot will guide a more rigorous study to determine the PDA’s effectiveness to support decision-making for adolescent severe obesity treatment. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessArticle
Weight-Related Teasing of Adolescents Who Are Primarily Obese: Roles of Sociocultural Attitudes Towards Appearance and Physical Activity Self-Efficacy
Int. J. Environ. Res. Public Health 2019, 16(9), 1540; https://doi.org/10.3390/ijerph16091540 - 30 Apr 2019
Abstract
Adolescents who are obese are at risk for being teased about their appearance with the concomitant negative psychological sequelae. Identifying modifiable variables associated with teasing could inform pediatric weight-management interventions. Characterizing society’s role in the victimization of these at-risk individuals could guide anti-bullying [...] Read more.
Adolescents who are obese are at risk for being teased about their appearance with the concomitant negative psychological sequelae. Identifying modifiable variables associated with teasing could inform pediatric weight-management interventions. Characterizing society’s role in the victimization of these at-risk individuals could guide anti-bullying programs for schools and broader public health efforts. This study aims to examine novel societal and cognitive factors associated with weight-related teasing frequency. Participants were adolescents (N = 334) being evaluated for a hospital-affiliated weight-management program. The outcome was perceived weight-related teasing frequency. Predictors were sociocultural awareness and internalization of appearance-related attitudes, physical activity self-efficacy, and psychological functioning. Multivariate regressions controlled for demographics and body mass index (BMI) z-scores with separate regressions testing interactions of BMI z-scores with all predictors. In adjusted analyses, higher physical activity self-efficacy and fewer depressive symptoms related to lower teasing frequency. Interactions indicated that less awareness/internalization of sociocultural attitudes towards appearance, more positive body image, and higher self-esteem related to lower teasing frequency regardless of BMI. Targeted interventions and public health campaigns should be developed and tested for adolescents that improve body image with promotion of diverse views about attractiveness, bolster confidence in overcoming physical activity barriers, and identify and treat mood symptoms. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessArticle
Development and Validation of a Physical Activity Educational Module for Overweight and Obese Adolescents: CERGAS Programme
Int. J. Environ. Res. Public Health 2019, 16(9), 1506; https://doi.org/10.3390/ijerph16091506 - 28 Apr 2019
Abstract
Educational modules can be effective in educating and motivating adolescents to participate in physical activity (PA). This paper describes the development and validation of a PA educational module for use in an obesity intervention programme, CEria Respek Gigih Aktif Sihat (CERGAS). The present [...] Read more.
Educational modules can be effective in educating and motivating adolescents to participate in physical activity (PA). This paper describes the development and validation of a PA educational module for use in an obesity intervention programme, CEria Respek Gigih Aktif Sihat (CERGAS). The present study was conducted in three phases: Phase I was composed of needs assessments with four focus group discussions to elicit adolescents’ opinions regarding module content and design, Phase II was the development of the PA module, while Phase III was content and face validation. A content validity index (CVI) was used to assess content validity quantitatively, with a CVI of more than 0.79 being considered appropriate. The needs assessments indicated that content of interest to adolescents included: the benefits of exercise; exercise techniques; ways to increase PA and how to stay motivated. Attractive graphic design was determined as a way to draw the adolescents’ attention. The module covered five topics: “Let’s Be Active”; “Exercise and Fitness”; “Staying Safe during Exercise and Physical Activity”; “Planning for Success” and “How to Overcome Sedentariness and Get Moving”. The module was found to have good content validity (mean CVI = 0.85). Expert members made suggestions to improve the module. These suggestions were then accepted, and the module was modified accordingly. We concluded that the module has good content validity and can be used to improve PA knowledge amongst CERGAS participants. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessArticle
Food Cravings and Eating: The Role of Experiential Avoidance
Int. J. Environ. Res. Public Health 2019, 16(7), 1181; https://doi.org/10.3390/ijerph16071181 - 02 Apr 2019
Abstract
Food cravings have been associated with problematic eating behaviors, such as emotional eating. Late adolescence is an important developmental period to examine this association, as late adolescents have greater independence in food choices as well as potentially higher demands during a transitional period [...] Read more.
Food cravings have been associated with problematic eating behaviors, such as emotional eating. Late adolescence is an important developmental period to examine this association, as late adolescents have greater independence in food choices as well as potentially higher demands during a transitional period of their lives. Mechanisms underlying the association between food cravings and problematic eating remain unclear. This study examined whether experiential avoidance (EA) may be one possible mechanism mediating the association between higher levels of food cravings and problematic eating behaviors. Late adolescents (n = 174) completed measures assessing EA, food cravings, and three problematic eating behaviors: emotional eating, cognitive restraint, and uncontrolled eating. Height and weight were measured objectively to calculate body mass index (BMI). Food cravings were positively associated with emotional eating and mediated by EA. EA also significantly mediated the association between greater cognitive restraint and greater food cravings. No significant mediation was detected for food cravings and uncontrolled eating. Future research may consider EA as a treatment target in intervention strategies for late adolescents seeking to decrease emotional or restrained eating behaviors. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessArticle
Weight Perception, Weight Control Intentions, and Dietary Intakes among Adolescents Ages 10–15 Years in the United States
Int. J. Environ. Res. Public Health 2019, 16(6), 990; https://doi.org/10.3390/ijerph16060990 - 19 Mar 2019
Abstract
Background: To examine associations of adolescents’ weight status perception and weight control intentions with dietary intakes. Methods: Cross-sectional data from adolescents aged 10–15 in the National Health and Nutrition Examination Surveys, 2005–2014 (n = 4940). Adolescents responded to questions regarding weight perception and [...] Read more.
Background: To examine associations of adolescents’ weight status perception and weight control intentions with dietary intakes. Methods: Cross-sectional data from adolescents aged 10–15 in the National Health and Nutrition Examination Surveys, 2005–2014 (n = 4940). Adolescents responded to questions regarding weight perception and if they were trying to change their weight. Intakes of calories, protein, carbohydrate, fat, saturated fat, sugar, and fiber were assessed using 24-h dietary recalls. Multivariable linear regression estimated associations of intakes with weight perception and weight control intentions. Results: The majority of adolescents perceived their weight as “about right”; however, 45% and 46% of boys and girls, respectively, reported trying to change their weight. Weight perception was not associated with intakes, with the exception of lower sugar (−13.65 g, 95% CI: −23.06, −4.23) and higher percent calories from protein (1.01%, 95% CI: 0.16, 1.87) in boys with overweight/obesity who perceived themselves as overweight, as well as lower percent calories from saturated fat (−1.04%, 95% CI: −2.24, −0.17) among girls with normal weight who perceived themselves as overweight. Weight control intentions were associated with intakes in boys only. Compared to boys who never tried to lose weight, boys who tried to lose weight consumed fewer calories (−188.34 kcal, 95% CI: −357.67, −19.01), a lower percent of calories from fat (−1.41%, 95% CI: −2.80, −0.02), and a greater percent of calories from protein (1.48%, 95% CI: 0.41, 2.55). Conclusions: Despite perceiving weight as “about right”, many adolescents reported trying to change their weight, which was associated with some dietary intakes. Efforts may be necessary to educate adolescents on healthy nutrition and weight management behaviors. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
Open AccessArticle
Case Reports: Multifaceted Experiences Treating Youth with Severe Obesity
Int. J. Environ. Res. Public Health 2019, 16(6), 927; https://doi.org/10.3390/ijerph16060927 - 14 Mar 2019
Abstract
The management of youth with severe obesity is strongly impacted by social determinants of health and family dynamics. We present case studies of three patients seen in our tertiary care obesity treatment clinic as examples of the challenges faced by these patients and [...] Read more.
The management of youth with severe obesity is strongly impacted by social determinants of health and family dynamics. We present case studies of three patients seen in our tertiary care obesity treatment clinic as examples of the challenges faced by these patients and their families, as well as by the medical team. We discuss how these cases illustrate potential barriers to care, the role of child protective services, and we reflect upon lessons learned through the care of these patients. These cases highlight the need for comprehensive care in the management of youth with severe obesity, which can include: visits to multiple medical specialists, and mental and behavioral health providers; school accommodations; linkage to community resources; and, potentially, child protective services involvement. Through the care of these youth, our medical team gained more experience with using anti-obesity medications and meal replacements. The care of these youth also heightened our appreciation for the integral role of mental health services and community-based resources in the management of youth with severe obesity. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
Open AccessArticle
Spanish Version of the Family Health Behavior Scale: Adaptation and Validation
Int. J. Environ. Res. Public Health 2019, 16(5), 810; https://doi.org/10.3390/ijerph16050810 - 06 Mar 2019
Abstract
Different studies around the world indicate that the percentages of overweight and obesity in childhood and adolescence are high. In this context, it would be useful to have a common, valid, and reliable instrument to assess health behaviors of families that allows comparisons [...] Read more.
Different studies around the world indicate that the percentages of overweight and obesity in childhood and adolescence are high. In this context, it would be useful to have a common, valid, and reliable instrument to assess health behaviors of families that allows comparisons of data from different countries. The objective is the adaptation of a Spanish version of the Family Health Behavior Scale (FHBS). The questionnaire originally developed by Moreno group was translated and adapted following the International Test Commission protocol. Its psychometric properties were evaluated through analysis of internal consistency, factor analysis and other evidences of validity. The Spanish version of the FHBS demonstrated adequate reliability coefficients, and its factor structure sufficiently replicated that obtained by the original measurement. The results suggested that the adapted version of the questionnaire was an adequate and valid measure for the evaluation of family health behaviors related to the prevention of overweight and obesity. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessArticle
The Intervention Effect of SMS Delivery on Chinese Adolescent’s Physical Activity
Int. J. Environ. Res. Public Health 2019, 16(5), 787; https://doi.org/10.3390/ijerph16050787 - 04 Mar 2019
Cited by 1
Abstract
To examine the effects of short messaging service (SMS) frequency and timing on the efficacy of an SMS-intervention for Hong Kong Chinese adolescents, sixty nine students aged between 12 and 16 (mean age 13.75 ± 0.90) were recruited from five schools in Hong [...] Read more.
To examine the effects of short messaging service (SMS) frequency and timing on the efficacy of an SMS-intervention for Hong Kong Chinese adolescents, sixty nine students aged between 12 and 16 (mean age 13.75 ± 0.90) were recruited from five schools in Hong Kong. Participants were randomly assigned into one of five groups: high-frequency + self-selected timing (HST), low-frequency + self-selected timing (LST), high-frequency + assigned timing (HAT), low-frequency + assigned timing (LAT) and the control group. The total duration of the intervention was four weeks. No significant intervention effects were detected in adolescent’s PA among the five groups (F = 1.14, p = 0.346). No significant differences were observed in the stage movement among the five groups (χ2 = 6.18, p = 0.627). No significant differences appeared in the exercise benefits, barriers and benefits/barriers differential scores. However, a growth trend in the exercise benefits score in the LST and HAT groups was found in contrast to the downswing in the control group. The exercise barriers score in the HST group showed the largest reduction after intervention. The benefits/barriers differential score in all the intervention groups increased, whereas it decreased in the control group. Although an increase is demonstrated in the high dosage SMS frequency and timing, no significant intervention effects were found among the five groups in PA behavior, stage of change and exercise benefits and barriers among Hong Kong Chinese adolescents. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessArticle
Effect of an 8-Week Individualized Training Program on Blood Biomarkers, Adipokines and Endothelial Function in Obese Young Adolescents with and without Metabolic Syndrome
Int. J. Environ. Res. Public Health 2019, 16(5), 751; https://doi.org/10.3390/ijerph16050751 - 01 Mar 2019
Cited by 1
Abstract
Obesity is a chronic condition whose incidence is growing due to lack of exercise and frequent nutrition disorders. Childhood obesity has reached epidemic proportions worldwide. One of the best treatment methods is physical training. However, conflicting results have been reported regarding its clinical [...] Read more.
Obesity is a chronic condition whose incidence is growing due to lack of exercise and frequent nutrition disorders. Childhood obesity has reached epidemic proportions worldwide. One of the best treatment methods is physical training. However, conflicting results have been reported regarding its clinical effectiveness. These contrasting findings may be due to the type and intensity of the adopted physical training program. Therefore, the purpose of the current study was to investigate the effect of an 8-week individualized physical training program on endothelial function, blood biomarkers and adipokine levels in obese adolescents with and without metabolic syndrome (MS). One-hundred-and-twenty-two obese adolescents (71 obese without MS and 51 obese with MS) aged 14 ± 2 years were included in this study. The 8-week individualized training program decreased glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol and leptin in obese subjects with and without MS. However, adiponectin and endothelial-dependent vasodilatation increased in the follow-up study in both groups. Taken together, the findings suggest that individualized training program is an effective means for the treatment of obesity and MS in pediatric populations. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessArticle
Psychomotor Limitations of Overweight and Obese Five-Year-Old Children: Influence of Body Mass Indices on Motor, Perceptual, and Social-Emotional Skills
Int. J. Environ. Res. Public Health 2019, 16(3), 427; https://doi.org/10.3390/ijerph16030427 - 01 Feb 2019
Abstract
The present research aimed to study the psycho-motor performance of five-year-old children with different body mass indices (BMI). A total of 694 pre-school children in the province of Albacete-Spain participated. Their performance in motor, perceptual, and social-emotional skills was analyzed using a standardized [...] Read more.
The present research aimed to study the psycho-motor performance of five-year-old children with different body mass indices (BMI). A total of 694 pre-school children in the province of Albacete-Spain participated. Their performance in motor, perceptual, and social-emotional skills was analyzed using a standardized observation sheet (Checklist of Psychomotor Activities—CPA) and then compared according to their BMI using non-parametric statistical methods (Mann-Whitney test). Separate comparisons were made for girls and boys. Results indicated significant differences in performance amongst the groups of girls in all the motor and perceptual activities, and in the social relationships component of the social-emotional factor. These differences seemed to penalize motor activities, perceptual skills, and social relationships in overweight and obese girls compared to normal weight girls. In the case of boys, there were significant differences in laterality and visual-motor coordination (favoring overweight boys). Differences in respiratory control were also found, but in this case, penalizing obese boys compared to normal weight boys. Knowledge of possible psychomotor limitations in obese children could allow psychologists and healthcare professionals to design more focused interventions. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessArticle
Like Father, Like Son. Physical Activity, Dietary Intake, and Media Consumption in Pre-School-Aged Children
Int. J. Environ. Res. Public Health 2019, 16(3), 306; https://doi.org/10.3390/ijerph16030306 - 23 Jan 2019
Cited by 1
Abstract
An imbalance between energy input and energy needs contributes to the growing incidence of overweight children. Pre-schoolers normally like to move, but even at this young age, they are already affected by a lack of physical activity and a high amount of screen [...] Read more.
An imbalance between energy input and energy needs contributes to the growing incidence of overweight children. Pre-schoolers normally like to move, but even at this young age, they are already affected by a lack of physical activity and a high amount of screen time. Media consumption contributes to unhealthy diets and extends the length of time spent sitting. Longer periods of sitting are, independent of the level of activity, seen as a risk factor for the development of obesity. In the present study, 160 pre-schoolers and their parents (128 mothers, 121 fathers) were examined. The results show deviations from actual recommendations regarding physical activity, time spent sitting, dietary intake, and media consumption. Increased screen time was associated with a higher weight status among pre-school-aged children. To provide a healthy upbringing, prevention and intervention measures should be implemented on a behavioral and relational level. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
Open AccessArticle
Increased Health and Wellbeing in Preschools (DAGIS) Study—Differences in Children’s Energy Balance-Related Behaviors (EBRBs) and in Long-Term Stress by Parental Educational Level
Int. J. Environ. Res. Public Health 2018, 15(10), 2313; https://doi.org/10.3390/ijerph15102313 - 21 Oct 2018
Cited by 7
Abstract
This paper describes the Increased Health and Wellbeing in Preschools (DAGIS) survey process and socioeconomic status (SES) differences in children’s energy balance-related behaviors (EBRBs), meaning physical activity, sedentary and dietary behaviors, and long-term stress that serve as the basis for the intervention development. [...] Read more.
This paper describes the Increased Health and Wellbeing in Preschools (DAGIS) survey process and socioeconomic status (SES) differences in children’s energy balance-related behaviors (EBRBs), meaning physical activity, sedentary and dietary behaviors, and long-term stress that serve as the basis for the intervention development. A cross-sectional survey was conducted during 2015–2016 in 66 Finnish preschools in eight municipalities involving 864 children (3–6 years old). Parents, preschool personnel, and principals assessed environmental factors at home and preschool with questionnaires. Measurement of children’s EBRBs involved three-day food records, food frequency questionnaires (FFQ), seven-day accelerometer data, and seven-day sedentary behavior diaries. Children’s long-term stress was measured by hair cortisol concentration. Parental educational level (PEL) served as an indicator of SES. Children with low PEL had more screen time, more frequent consumption of sugary beverages and lower consumption of vegetables, fruit, and berries (VFB) than those with high PEL. Children with middle PEL had a higher risk of consuming sugary everyday foods than children with high PEL. No PEL differences were found in children’s physical activity, sedentary time, or long-term stress. The DAGIS intervention, aiming to diminish SES differences in preschool children’s EBRBs, needs to have a special focus on screen time and consumption of sugary foods and beverages, and VFB. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessArticle
A Cross-Sectional Pilot Study to Examine the Criterion Validity of the Modified Shuttle Test-Paeds as a Measure of Cardiorespiratory Fitness in Children
Int. J. Environ. Res. Public Health 2018, 15(10), 2290; https://doi.org/10.3390/ijerph15102290 - 18 Oct 2018
Cited by 1
Abstract
With accumulating evidence that exercise capacity decreases all-cause mortality independent of adiposity, benefits may be gained by developing cardiorespiratory fitness measures that are specifically and sensitively designed for use with pediatric populations when cardiorespiratory fitness may be a contributing factor for obesity. This [...] Read more.
With accumulating evidence that exercise capacity decreases all-cause mortality independent of adiposity, benefits may be gained by developing cardiorespiratory fitness measures that are specifically and sensitively designed for use with pediatric populations when cardiorespiratory fitness may be a contributing factor for obesity. This study aimed to examine the criterion validity of the Modified Shuttle Test-Paeds (MSTP) as a measure of cardiorespiratory fitness in children, against the gold-standard reference; VO2peak, compared to the commonly used field-test; 20-m Multi-Stage-Shuttle-Run-Test (20-m MSRT). A cross-sectional pilot study, with 25 school-aged children (age: 6–16 year; male/female: 19/5; BMI: 21 ± 9 kg/m2) was employed. Physical measures included: Bruininks-Oseretsky-Test-of-Motor-Proficiency-2nd Edition (BOT2), VO2peak, 20-m MSRT, MSTP, body composition/anthropometry. The mean cardiorespiratory fitness of participants was: VO2peak: 43.8 ± 11.2 (mL/kg/min); 20-m MSRT: 5.48 ± 2.96 (level); MSTP: 22.10 ± 3.05 (no.). A strong predictive relationship was found between the 20-m MSRT and VO2peak (r2 = 0.486, p < 0.001) whereas a very strong predictive relationship existed between the newly designed MSTP and VO2peak (r2 = 0.749, p < 0.001). Whilst further research with larger study cohorts is needed, this pilot study found the MSTP to have a very high predictive validity for estimating VO2peak in children, suggesting it may be a valid child-specific indicator of cardiorespiratory fitness requiring only a simple equation that is clinically relevant. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Open AccessArticle
Ferroportin-Hepcidin Axis in Prepubertal Obese Children with Sufficient Daily Iron Intake
Int. J. Environ. Res. Public Health 2018, 15(10), 2156; https://doi.org/10.3390/ijerph15102156 - 01 Oct 2018
Cited by 2
Abstract
Iron metabolism may be disrupted in obesity, therefore, the present study assessed the iron status, especially ferroportin and hepcidin concentrations, as well as associations between the ferroportin-hepcidin axis and other iron markers in prepubertal obese children. The following were determined: serum ferroportin, hepcidin, [...] Read more.
Iron metabolism may be disrupted in obesity, therefore, the present study assessed the iron status, especially ferroportin and hepcidin concentrations, as well as associations between the ferroportin-hepcidin axis and other iron markers in prepubertal obese children. The following were determined: serum ferroportin, hepcidin, ferritin, soluble transferrin receptor (sTfR), iron concentrations and values of hematological parameters as well as the daily dietary intake in 40 obese and 40 normal-weight children. The ferroportin/hepcidin and ferritin/hepcidin ratios were almost two-fold lower in obese children (p = 0.001; p = 0.026, respectively). Similar iron concentrations (13.2 vs. 15.2 µmol/L, p = 0.324), the sTfR/ferritin index (0.033 vs. 0.041, p = 0.384) and values of hematological parameters were found in obese and control groups, respectively. Iron daily intake in the obese children examined was consistent with recommendations. In this group, the ferroportin/hepcidin ratio positively correlated with energy intake (p = 0.012), dietary iron (p = 0.003) and vitamin B12 (p = 0.024). In the multivariate regression model an association between the ferroportin/hepcidin ratio and the sTfR/ferritin index in obese children (β = 0.399, p = 0.017) was found. These associations did not exist in the controls. The results obtained suggest that in obese children with sufficient iron intake, the altered ferroportin-hepcidin axis may occur without signs of iron deficiency or iron deficiency anemia. The role of other micronutrients, besides dietary iron, may also be considered in the iron status of these children. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
Open AccessArticle
“Sacbe”, a Comprehensive Intervention to Decrease Body Mass Index in Children with Adiposity: A Pilot Study
Int. J. Environ. Res. Public Health 2018, 15(9), 2010; https://doi.org/10.3390/ijerph15092010 - 14 Sep 2018
Abstract
Interventions in children with adiposity decrease less than 0.2 the body mass index (BMI) z-score less than 0.2 and only in 21–23% of cases. Experts recommend focusing on the habits of a healthy lifestyle (HLS) but considering the sociocultural context of children and [...] Read more.
Interventions in children with adiposity decrease less than 0.2 the body mass index (BMI) z-score less than 0.2 and only in 21–23% of cases. Experts recommend focusing on the habits of a healthy lifestyle (HLS) but considering the sociocultural context of children and their parents. Our objective was to achieve a higher percentage of success in lowering the BMI z-score in children with adiposity and their parents through a pilot program “Sacbe” based on HLS, sensitive to the sociocultural context previously explored and with the active participation of parents. This is a pilot study in children aged 8 to 18 years with adiposity according to the BMI z-score. The program consisted of two workshops on HLS and nutrition given by the pediatric endocrinologist in group sessions with 3–5 families and reinforcements in each visit by registered dietitians. We recorded lifestyle habits and anthropometric characteristics of children and their parents at the baseline visit and every month for 3–4 months. Forty-nine families, 55 children and 64 parents participated, 60% of the children were female, the average age was 13.95 ± 3.3 years, 72.7% and 86.7% lowered the z score of the BMI due to intention to treat and protocol analysis (p < 0.001), respectively; BMI z-score decreased by 0.22 ± 0.21, from 2.13 ± 0.57 to 1.91 ± 0.58 (p < 0.001). In total, 83% of the parents involved were mothers, the average age was 45.8 ± 9.4 years, 77% lost weight and body fat (p < 0.001), the frequency of unhealthy habits decreased. The results of “Sacbe” exceeded expectations by combining the active participation of parents, sessions in groups, and the education on various components of an HLS inside sociocultural context. The main challenge will be to standardize and reproduce this type of complex interventions, as well as to assure long-term success. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
Open AccessArticle
Profiles of Physical Fitness Risk Behaviours in School Adolescents from the ASSO Project: A Latent Class Analysis
Int. J. Environ. Res. Public Health 2018, 15(9), 1933; https://doi.org/10.3390/ijerph15091933 - 05 Sep 2018
Cited by 3
Abstract
The aim of the present investigation was to describe profiles of adolescents’ fitness level, identify latent classes of fitness-related risk behaviours, and describe their sociodemographic and environmental predictors. In total, 883 adolescents (16.4 ± 1.4 years; 167.3 ± 10.4 cm; 62.8 ± 13.5 [...] Read more.
The aim of the present investigation was to describe profiles of adolescents’ fitness level, identify latent classes of fitness-related risk behaviours, and describe their sociodemographic and environmental predictors. In total, 883 adolescents (16.4 ± 1.4 years; 167.3 ± 10.4 cm; 62.8 ± 13.5 kg; 62.2% males) were assessed for personal and lifestyle information and for physical fitness components. Eleven possible fitness determinants and seven predictors were included. Latent class analysis (LCA) was used to determine fitness-related risk behaviours. Logistic regressions predicted class membership and assessed associations with fitness levels and fitness components. Five latent classes were recognised: 1—virtuous, 30.7% of respondents; 2—low physical activity/sport, 18.8%; 3—incorrect alcohol/food habits, 25.8%; 4—health risk/overweight, 15.9%; 5—malaise/diseases, 8.8%. Sex, age, parents’ overweightness/obesity and education, and school type predicted most classes significantly. Compared to class 1, class 2 had higher odds of having all poor fitness components except upper body maximal strength; class 4 had higher risk of low muscular endurance; and class 5 was likely to have lower maximal strength, muscular endurance, and speed/agility. Educating adolescents to reach a sufficient practice of PA/sport could help decreasing the risk of low health-related fitness more than discouraging them from using alcohol, addressing proper food behaviours and habits, and helping them understand their psychophysical malaise symptoms. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)

Review

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Open AccessReview
A Systematic Review of Methods, Study Quality, and Results of Economic Evaluation for Childhood and Adolescent Obesity Intervention
Int. J. Environ. Res. Public Health 2019, 16(3), 485; https://doi.org/10.3390/ijerph16030485 - 08 Feb 2019
Cited by 1
Abstract
Many suggested policy interventions for childhood and adolescent obesity have costs and effects that fall outside the health care sector. These cross-sectorial costs and consequences have implications for how economic evaluation is applied and although previous systematic reviews have provided a summary of [...] Read more.
Many suggested policy interventions for childhood and adolescent obesity have costs and effects that fall outside the health care sector. These cross-sectorial costs and consequences have implications for how economic evaluation is applied and although previous systematic reviews have provided a summary of cost-effectiveness, very few have conducted a review of methods applied. We undertook this comprehensive review of economic evaluations, appraising the methods used, assessing the quality of the economic evaluations, and summarising cost-effectiveness. Nine electronic databases were searched for full-economic evaluation studies published between January 2001 and April 2017 with no language or country restrictions. 39 economic evaluation studies were reviewed and quality assessed. Almost all the studies were from Western countries and methods were found to vary by country, setting and type of intervention. The majority, particularly “behavioural and policy” preventive interventions, were cost-effective, even cost-saving. Only four interventions were not cost effective. This systematic review suggests that economic evaluation of obesity interventions is an expanding area of research. However, methodological heterogeneity makes evidence synthesis challenging. Whilst upstream interventions show promise, an expanded and consistent approach to evaluate cost-effectiveness is needed to capture health and non-health costs and consequences. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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Other

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Open AccessProtocol
The Healthy Primary School of the Future: A Contextual Action-Oriented Research Approach
Int. J. Environ. Res. Public Health 2018, 15(10), 2243; https://doi.org/10.3390/ijerph15102243 - 12 Oct 2018
Cited by 4
Abstract
Background: Schools can play an important role in promoting children’s health behaviours. A Dutch initiative, ‘The Healthy Primary School of the Future’, aims to integrate health and well-being into the school system. We use a contextual action-oriented research approach (CARA) to study the [...] Read more.
Background: Schools can play an important role in promoting children’s health behaviours. A Dutch initiative, ‘The Healthy Primary School of the Future’, aims to integrate health and well-being into the school system. We use a contextual action-oriented research approach (CARA) to study the implementation process. Properties of CARA are its focus on contextual differences and the use of monitoring and feedback to support and evaluate the process of change. The aim of this article is to describe the use of the approach. Methods: Four schools (each with 200–300 children, aged 4–12 years) were included; all located in low socio-economic status areas in the south of the Netherlands. Data collection methods include interviews, observations, questionnaires, and health and behavioural measurements. Research contributions include giving feedback and providing schools with a range of possibilities for additional changes. The contextual data we examine include schools’ health promoting elements, practices of teachers and parents, dominating organisational issues, and characteristics of the student population; process data include the presence of potential barriers to changes. Discussion: CARA is an adaptive research approach that generates knowledge and experiences on how to deal with health promotion in complex systems. We think this approach can set an example for research efforts in comparable initiatives. Full article
(This article belongs to the Special Issue Pediatric Obesity Treatment and Prevention)
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