Children's food store, restaurant, and home food environments and their relationship with body mass index: a pilot study.

This pilot research assessed the feasibility and utility of a study designed to examine the relationship between children's BMI and food store, restaurant, and home food environments. Home visits were conducted with sixth-grade children (N = 12). BMI z-scores were calculated with weight and height measurements. Nutrition Environment Measures Surveys evaluated children's food environments. The study protocol involved a feasible time duration, minimal missing data for primary variables, and participant satisfaction. Potential design problems included the homogeneous store environments and low restaurant exposure of the sample recruited from one school, and the adequacy of a single cross-sectional measure of the home environment.

Children's food choice process in the home environment. A qualitative descriptive study.

This qualitative descriptive study explored children's food choices in the home with particular attention to environmental influences. Semi-structured interviews were conducted with 11- to 14-year-old children (n=47) from one middle school. A data-driven content analysis using selected principles of grounded theory was performed. Children's food choices in the home emerged as a process that involved three interacting components, the child, the parent, and the food, embedded within the context of time. Children's structured activities throughout the day, week, and year provided an overall context for food choices. Parents affected children's food choices through their presence in the home, time pressure and activity prioritization, incorporation of family members' preferences, food preparation effort and skills, and financial and health concerns. Parents created food options through food purchasing and preparation and indirectly affected children's food choices by setting rules, providing information, and modeling behaviors. Children affected parents' decisions by communicating food preferences. For children, important aspects of the food itself included its availability at home and attributes related to taste, preparation, and cost. Children evaluated potential food options based on their hunger level, food preferences, time pressure and activity prioritization, food preparation effort and skills, and expected physical consequences of food.

Adolescent obesity prevention in Botswana: beliefs and recommendations of school personnel.

The study's objectives were to gain school personnel's (1) perceptions on diet, physical activity, body size, and obesity, (2) description of school food and physical activity practices, and (3) recommendations for programs to prevent adolescent obesity. The study took place in six junior secondary schools of varying socioeconomic status in Gaborone, Botswana. Using a qualitative descriptive design, semistructured interviews were conducted with key school personnel. Directed content analysis was used to summarize the findings. School personnel believed that obesity was an important problem. They felt that school food was unhealthy and that physical activity was provided insufficiently. Participants shared enthusiasm for a school-based health-promoting intervention that must be fun and include active engagement and education on healthy lifestyles for all students. Participants supported on-site food shop inventory changes and physical activity programs. Potential barriers listed were schools' financial resources, interest of students, and time limitations of all involved.

Socio-economic status and urbanization are linked to snacks and obesity in adolescents in Botswana.

OBJECTIVE: To describe patterns of food consumption associated with overweight/obesity (OW/OB) and their links to socio-economic status (SES) and urbanization. DESIGN: A nationwide cross-sectional survey. SETTING: Secondary schools in cities, towns and villages in Botswana, Africa. SUBJECTS: A total of 746 adolescent schoolchildren. RESULTS: OW/OB is associated with greater SES, city residence and a snack-food diet pattern. Students belonging to higher SES compared with those from a lower SES background reported significantly (P < 0·01) more daily servings of snack foods (1·55 v. 0·76) and fewer servings of traditional diet foods (0·99 v. 1·68) and also reported that they ate meals outside the home more often (90% v. 72%). Students in cities ate significantly (P < 0·01) more servings of snacks (1·69 v. 1·05 v. 0·51) and fewer servings of traditional foods (0·67 v. 1·52 v. 1·61) compared with those in urban and rural villages. The odds of OW/OB were increased 1·16-fold with a snack-food diet, a result that was diminished when controlled for SES. CONCLUSIONS: These data suggest that nutritional transition occurs at different rates across urbanization and SES levels in Botswana. In cities, increasing the availability of fruit while reducing access to or portion sizes of snack items is important. Emphasis on continued intake of traditional foods may also be helpful as rural areas undergo economic and infrastructural development.

Obesity and the community food environment: a systematic review.

OBJECTIVE: To examine the relationship between obesity and the community and/or consumer food environment. DESIGN: A comprehensive literature search of multiple databases was conducted and seven studies were identified for review. Studies were selected if they measured BMI and environmental variables related to food outlets. Environmental variables included the geographic arrangement of food stores or restaurants in communities and consumer conditions such as food price and availability within each outlet. The study designs, methods, limitations and results related to obesity and the food environment were reviewed, and implications for future research were synthesized. RESULTS: The reviewed studies used cross-sectional designs to examine the community food environment defined as the number per capita, proximity or density of food outlets. Most studies indirectly identified food outlets through large databases. The studies varied substantially in sample populations, outcome variables, units of measurement and data analysis. Two studies did not find any significant association between obesity rates and community food environment variables. Five studies found significant results. Many of the studies were subject to limitations that may have mitigated the validity of the results. CONCLUSION: Research examining obesity and the community or consumer food environment is at an early stage. The most pertinent gaps include primary data at the individual level, direct measures of the environment, studies examining the consumer environment and study designs involving a time sequence. Future research should directly measure multiple levels of the food environment and key confounders at the individual level.