Parents' and Children's Experiences with a Coordinating Professional in Integrated Care for Childhood Overweight and Obesity-A Novel Dutch Approach.

BACKGROUND: In the new integrated program of care for childhood overweight and obesity (ICCO), a Youth Health Care (YHC) nurse has the role of a coordinating professional. After a broad assessment of strengths and weaknesses in the family setting, this coordinating professional makes a plan of action with the child and parents and involves other professionals when needed. The aim of this study was to explore the experiences of parents and children with the coordinating professional in the ICCO. MATERIAL & METHODS: Semi-structured interviews were conducted with eight families. Interview data were analyzed using content analysis. In addition, descriptive data on involved professionals and referrals was collected with an online questionnaire in 38 families. RESULTS: In total, eight families (8 mothers, 2 fathers, four boys and three girls aged 10-12 yrs) were interviewed and 38 children and parents filled in (three consecutive) online questionnaires. FINDINGS: The main themes related to the experiences of parents and children with the CP: parents and children felt supported and understood by the coordinating professional. They appreciated the broad perspective and personal approach. Contacts with the coordinating professional were not always frequent. Major points of improvement concerned the intensity of the follow-up and collaboration. Only few parents experienced collaboration between the coordinating professional and other professionals in the ICCO. CONCLUSIONS: Parents and children appreciated the personal approach of the Youth Health Care nurse as a CP. The role of the coordinating professional, however, appears not fully implemented yet. Strengthening the promising role of the coordinating professional in the ICCO is recommended.

La obesidad infantil como prioridad sanitaria. Pautas en la mejora del control de peso / Childhood obesity as a health priority. Guidelines for improving weight control

La obesidad infantil es objeto de preocupación creciente, ya que es un problema que afecta a un elevado porcentaje de niños y es el origen de numerosas enfermedades en el presente y en el futuro, lo que puede condicionar un descenso en la esperanza y en la calidad de vida. Para combatir el problema es necesario analizar los factores que se asocian con el exceso de peso en la infancia para actuar sobre ellos e intentar frenar la tendencia observada en los últimos años. Diversos aspectos sociodemográficos, así como la inactividad y el sedentarismo de los niños, son factores que se asocian con un mayor riesgo de padecer obesidad y adiposidad central.Con gran protagonismo en este tema debe destacarse que el consumo de alimentos es mejorable: disminuir el consumo de azúcar, grasa y sodio, y sobre todo aumentar el de frutas, verduras, cereales integrales, pescado y lácteos, se asocia con menor padecimiento de obesidad y obesidad central en los niños.Pero no hay un único responsable del problema y la interacción entre conductas saludables aumenta las posibilidades de éxito en la lucha contra la obesidad infantil, lo que debe considerarse al planificar campañas de educación nutricional.Deben mejorarse numerosos aspectos de la alimentación y del estilo de vida de la población infantil. Quizá en este momento se hace más hincapié en pautas restrictivas. Aunque es muy conveniente reducir el consumo de dulces y de snacks, resulta muy deseable y quizá prioritario aumentar el consumo de verduras, hortalizas, frutas, cereales integrales y aproximar la dieta al ideal teórico. Las pautas constructivas deberían destacar respecto a las restrictivas. (AU)

Childhood obesity is a growing concern, because the problem affects a high percentage of children and is the source of many diseases in the present and in the future, which can lead to a decrease in life expectancy and quality of life. In order to combat the problem, it is necessary to analyze the factors associated with excess weight in childhood in order to act on them and try to curb the trend observed in recent years.Various socio-demographic aspects, as well as inactivity and sedentary lifestyle in children are factors that are associated with an increased risk of obesity and central adiposity.With great prominence in this issue, we have to highlight that the consumption of food is improvable: decrease the consumption of sugar, fat and sodium, and above all increase the consumption of fruits, vegetables, whole grains, fish, dairy is associated with lower obesity and central obesity in children.There is no single responsible for the problem and the interaction between healthy behaviors increases the chances of success in the fight against childhood obesity, which should be considered when planning nutritional education campaigns. Many aspects of the diet and lifestyle of the child population must be improved, perhaps now more emphasis is being placed on restrictive guidelines. Of course, it is desirable to reduce the consumption of sweets and snacks, but messages aimed at increasing the consumption of vegetables, fruits, whole grains and approximating the diet to the theoretical ideal can be prioritized. Constructive guidelines should stand out from restrictive ones. (AU)

The association between adherence to the Mediterranean diet and childhood obesity; the role of family structure: Results from an epidemiological study in 1728 Greek students.

BACKGROUND: Childhood obesity is among the leading public health challenges, worldwide. AIM: To examine the association between children's adherence to the Mediterranean diet (MD) and weight status taking into account family structure and related behaviors. METHODS: 1728 primary-school Greek students (46% males), from Athens metropolitan area, island of Crete, and the Peloponnese region, were enroled during school years 2014-2016. Children and their parents completed questionnaires which, among others, recorded family structure (i.e., married/cohabited, divorced, single parent, and widowed), dietary and lifestyle habits. Adherence to the MD was assessed through the KIDMED score (range - 4 to 12). Children's body mass index was calculated and classified as normal, overweight/obese, according to the International Obesity Task Force classification. The working sample was 1142 children (44% males) with a recorded family structure. RESULTS: The prevalence of overweight was 21.7% and obesity was 5.0%; overweight/obesity prevalence was higher among males than females (32.4% vs. 23.3%; p < 0.001). Overweight/obese children had a lower KIDMED score compared to normal weight (median (range): 4 (-2, 11) vs. 5 (-1, 10), p = 0.05). An inverse association between KIDMED score and children's weight status (odds ratio (OR) (95% confidence interval (CI)): 0.95 (0.89-0.99)) was observed. Interaction between family structure and KIDMED was observed (p < 0.001); stratified analysis revealed that in children from nuclear families the KIDMED score was inversely associated with the likelihood of overweight/obesity (OR (95% CI): 0.95 (0.88-1.00)), whereas in children from single-parent families it was not (OR (95% CI): 0.94 (0.79-1.12)). CONCLUSION: Adherence to the MD plays a protective role against childhood overweight/obesity, particularly among children living in nuclear families.

Associations between maternal BMI, breastfeeding practices and infant anthropometric status in Colombia; secondary analysis of ENSIN 2010.

BACKGROUND: Maternal malnutrition and infant feeding mode impact short and long term infant and child morbidity and mortality. The period of lactation may provide an opportunity to modulate the risk of disease later in life. Our aim was to estimate the effect of maternal body mass index (BMI) and infant feeding mode, particularly breastfeeding practices, on the anthropometric status of children under 2 years in Colombia. METHODS: A secondary analysis was performed using the data from ENSIN 2010. Term infants under 2y, singleton, with a mother older than 18y, were included in the analysis. Outcomes were wasting (WLZ < -2SD), overweight (WLZ > +2SD) and stunting (LAZ < -2SD). Predictors were infant feeding (exclusive and predominant BF constructed from 24-h recall, age at introduction of liquids, semisolids and solids) and maternal BMI. Socioeconomic variables, maternal education and age, conditions during pregnancy and birth weight were analyzed as covariates. RESULTS: Mothers of overweight infants had higher BMI (Mean dif = 1.47 kg/m2; 95% CI = 2.1, 0.8) than those with normal weight infants. Stunting and wasting were not predicted by maternal anthropometry or infant feeding mode. Fewer maternal years of education were associated with wasting (OR = 0.90; 95% CI = 0.86, 0.97; p = 0.003) and stunting (OR = 0.92; 95% CI = 0.89, 0.94; p < 0.0001), while more maternal years of education were associated with overweight (OR = 1.06; 95% CI = 1.02, 1.01; p = 0.001); higher birth weight was associated with overweight (OR = 1.001; 95% CI = 1.00, 1.001; p < 0.0001) and lower birth was associated with stunting (OR = 0.99; 95% CI = 0.89; p < 0.0001) in the final regression model. CONCLUSIONS: Maternal BMI is a modifiable target for public health policy to promote healthy infant growth. Infant nutritional status is affected by direct and indirect factors that need to be addressed in further studies.

Are parental dietary patterns associated with children's overweight and obesity in China?

BACKGROUND: It is believed that parents have a great influence on their children's dietary behaviours. However, it is not clear whether parental food patterns are associated with children's nutritional status in China, which includes a vast territory with rich, diverse cultures. The goal of this project is to systematically study the associations between parental food intake and children's overweight and obesity in China, according to children's ages and regional differences. METHODS: Based on individual food consumption data from the China Health and Nutrition Survey (CHNS) package in 2011, cross-sectional studies have previously been conducted to analyse the association between different categories of food intake of parents and children. The current study extends this research by directly. RESULTS: Our analysis results show that parental food intake is highly correlated with children's food intake, with the estimated coefficients of most food intake categories being greater than 0.5. Furthermore, this association between parental food intake and children's overweight and obesity is most significant in young children, but it begins to weaken in relation to children aged between 13 and 18. Additionally, the associations between parental food intake and children's overnutrition are more significant in rural areas than they are in urban areas. CONCLUSIONS: The association between parental food intake and childhood overweight and obesity is significant, although it varies considerably according to food categories, children's ages and area differences. These results show promise for intervening in the overnutrition of children by controlling household dietary patterns according to children's developmental stages and regional differences.

Factors associated with overweight status, obesity, and sedentary behavior in elementary and junior high school students.

BACKGROUND: Sedentary behavior increases the risks of obesity and cardiovascular disease in adults, but these relationships are uncertain in elementary and junior high school students. We investigated whether sedentary behavior is related to overweight status and obesity in high-risk children with lifestyle diseases. METHOD: A cross-sectional study was performed in 115 children and primary caregivers who attended a lecture for preventing child lifestyle diseases in Ibaraki prefecture, Japan. The main outcome measure was excess weight (percent overweight). Factors associated with excess weight in children were evaluated using multiple regression analysis. Basic physical and demographic characteristics, biochemical data (total cholesterol [TC], low and high density lipoprotein cholesterol [LDL-C and HDL-C], alanine aminotransferase [ALT]), blood pressure, child and parental sedentary time, parental BMI, and family environment were evaluated. RESULTS: In total, 107 children were eligible for participation in the study. Excess weight in these children was 28.6 ± 18.4. Sedentary time was 337.2 ± 122.5 min/day in children and 347.0 ± 196.2 min/day in parents. Multiple regression analysis revealed that children's sedentary behavior (ß = 0.02, (95%CI: 0.00 to 0.04)) and HDL-C (ß = -0.59, (95%CI: -0.81 to -0.38)) as independent predictors of children's excess weight. CONCLUSION: Study findings suggest that decreasing children's sedentary behavior in addition to greater physical activity is important for the prevention of overweight status and obesity in high-risk children with lifestyle diseases. Reduction of sedentary time, and engaging in regular exercise are all important for proper weight maintenance in children.

Evaluating of Psychiatric Behavior in Obese Children and Adolescents.

OBJECTIVE: Obesity is a medical condition that may have a harmful effect on health, leading to increased illness and reduced life expectancy. This studyaimed to evaluate the relationship of psychiatry disorders in overweight and obese children and adolescents. MATERIALS & METHODS: In this case-control study, 160 children and adolescent were enrolled refereed to Clinic of Pediatric Endocrinology, Imam Reza hospital, Mashhad, Iran in 2009-2011. The sampling method of this study was non-probability and biased. Study instruments were SDQ, CDI, STAI, Peds QL. All questionnaires were self-administrating completed by subjects or their parents. Differences between groups were examined using t-test and chi-square tests as appropriate. RESULTS: There was no significant difference on scores of anxiety between two groups. However, significant difference was on scores of depression, quality of life, and strength and difficulty between two groups. In addition, there was no significant difference in gender effect on anxiety and depression. However, emotional symptoms were more in girl. In contrast, the conduct problems were more in boys. Anxiety and depression were more in adolescents. CONCLUSION: Obesity has a negative effect on the anxiety, depression, and self-esteem of children and adolescents. It might be a more important risk factor for depression, anxiety, and other psychiatry disorders. This study also emphasizes the importance of prevention of obesity.

Assessment study of the nutritional status, eating habits and physical activity of the schooled population of Centelles, Hostalets de Balenyà and Sant Martí de Centelles (ALIN 2014 Study). / Estudio de la valoración del estado nutricional y los hábitos alimentarios y de actividad física de la población escolarizada de Centelles, Hostalets de Balenyà y Sant Martí de Centelles (Estudio ALIN 2014).

BACKGROUND AND OBJECTIVE: Malnourishment can be caused by either a lack of food or an excess of low-nutrient foods. Due to several factors, this predisposes children to academic failure. The objective of this study is to estimate the prevalence of school children with eating problems, study their nutrition level, food quality in the diet, and level of physical activity. MATERIAL AND METHODS: The study involved the school children between 3 months and 16.5 years of age in the municipalities of Centelles, Hostalets de Balenyà and Sant Martí de Centelles. Personal, age, nutrition and physical activity data were collected for the descriptive and bivariate analyses. RESULTS: A total of 1,374 children were included, of which 122 were under 3 years of age (8.9%). Obesity was recorded in 2.5%, while 17.2, 15.6 and 64.8% were overweight, underweight and of normal weight, respectively. The remaining 1,252 children were over 3 years of age (91.1%), and obesity was recorded in 8.1%, while 26.1, 11.0 and 62.9% were overweight, underweight and of normal weight, respectively. Adherence to the Mediterranean diet decreased significantly with increasing age. The maintenance of body weight was significantly correlated to the consumption of carbohydrates for breakfast before going to school, daily fruit consumption, and not having a need for care from the social services. The differences in physical activity and a sedentary lifestyle proved significant between males and females. CONCLUSION: Being underweight and overweight are factors related to eating habits and dependency upon the social services.

Prevalência e fatores associados à desnutrição e ao excesso de peso em menores de cinco anos nos seis maiores municípios do Maranhão / Prevalence and factors associated to malnutrition and excess weight among under five year-olds in the six largest cities of Maranhão

Prevalências de desnutrição e excesso de peso em menores de cinco anos e sua associação com fatores socioeconômicos, sanitários e demográficos foram estimadas nos seis maiores municípios do Maranhão, em 2006/2007. Por meio de inquérito domiciliar por amostragem 1.214 crianças menores de cinco anos foram aleatoriamente selecionadas. Foi utilizada amostragem por conglomerados em dois estágios, representativa dos seis municípios maranhenses com mais de cem mil habitantes. Foram aplicados questionários padronizados para as mães ou responsáveis pelas crianças e aferidos peso e estatura. Para classificação da desnutrição foram utilizados os pontos de corte < - 2 escores z pelos indicadores peso para idade, peso para estatura e estatura para idade. Para a classificação do excesso de peso foram considerados > +2 escores z, de acordo com o indicador peso para estatura, seguindo recomendações da Organização Mundial da Saúde. Pelo índice peso para idade a prevalência de desnutrição foi de 4,5%, pelo índice estatura para idade 8,5% estavam com desnutrição pregressa e pelo índice peso para estatura 3,9% encontravam-se com desnutrição atual, enquanto 6,7% apresentavam excesso de peso. Crianças de famílias chefiadas por mulheres apresentaram menores prevalências de desnutrição (Razão de Prevalências = 0,4). Variáveis socioeconômicas não estiveram associadas à desnutrição ou ao excesso de peso. Recebimento de benefício do programa bolsa família não foi associado à desnutrição ou excesso de peso. A prevalência de desnutrição infantil foi baixa, mas o excesso de peso foi mais prevalente do que a desnutrição. Não foi detectada desigualdade social em relação à desnutrição em crianças menores de cinco anos, sugerindo evolução favorável no sentido de maior equidade.

Prevalences of malnutrition and overweight among children under five years and its association with socioeconomic, demographic and health indicators were estimated for the six largest municipalities of Maranhão, in 2006/2007. By means of a household survey, a sample of 1214 children under five years of age was randomly selected. Two-stage cluster sampling was used, representing the six municipalities of Maranhão with over one hundred thousand inhabitants. Standardized questionnaire was administered to mothers or guardians and trained personnel measured weight and height or length. For classification of malnutrition cutoff points of <-2z scores for weight-for-age, weight-for-length/height and length/height-for-age were used. Overweight was considered when weight for heithg was > +2 z score, following World Health Organization guidelines. By weight-for-age malnutrition prevalence was 4.5, by length/height-for-age 8.5% were stunted and by the weight-for-length/height 3.9% were malnourished (wasting), while 6.7% were overweight. Children of families headed by women had lower prevalence of malnutrition (prevalence ratio=0.4). Socioeconomic variables were not associated with malnutrition or overweight. Participation in money transfer programs from the government was not associated with malnutrition or overweight. The prevalence of malnutrition was low, but being overweight was more prevalent than malnutrition. Social inequality was not detected in relation to malnutrition in children under five years of age, suggesting a favorable trend towards greater equity.