Do parents engage in weight- and health-focused conversations with their emerging adult children and are there cross-sectional associations with weight and well-being outcomes?

BACKGROUND: Research indicates harmful associations between parental weight-focused conversations and markers of pediatric health and well-being. However, little is known about the prevalence and consequences of parent conversations focused on weight or health behaviors (i.e., physical activity or nutrition) with emerging adult children. METHODS: Data are from the 2018 follow-up survey of the population-based EAT 2010-2018 (Eating and Activity over Time) in cohort from Minneapolis-St. Paul, MN. Participants were emerging adults at follow-up with ages 18-26. Regression models adjusted for sociodemographic characteristics were conducted. RESULTS: Over two-thirds (68%) of mothers and 44% of fathers engaged in weight-focused conversations with their emerging adult children; 25% of both parents reported engaging in conversations focused only on health behaviors; and 8% of mothers and 26% of fathers reported not engaging in either type of conversation. Health-focused conversations by both parents were associated with lower body mass index (BMI) and disordered eating behaviors, higher intake of fruit and vegetables, and psychosocial well-being in emerging adult children. Weight-focused conversations with both parents were associated with higher BMI and disordered eating behaviors in emerging adults. There were gender moderated associations of paternal conversations about weight and health with vegetable intake, binge eating, and depressive symptoms. DISCUSSION: The high prevalence and negative health outcomes associated with weight-focused conversations coupled with the low prevalence and positive health outcomes associated with health-focused conversations by parents suggests the need for public health messaging and intervention development aimed at reducing parental weight talk with emerging adult children.

Associations of regular consumption of breakfast, lunch and dinner with Body Mass Index during adolescence: longitudinal findings by weight status among the Eating and Activity over Time 2010-2018 cohort.

OBJECTIVE: To examine how the associations between meal consumption and BMI over 8 years differ by weight status in a sample of adolescents. DESIGN: Longitudinal, population-based study. Breakfast, lunch and dinner consumption and BMI were self-reported. Linear regressions were used to examine how the associations between meal consumption and BMI differed by weight status. SETTING: Adolescents in the Minneapolis/St. Paul metropolitan area. PARTICIPANTS: Adolescents (n 1,471) were surveyed as part of the EAT 2010-2018 in 2009-2010 (Mage = 14·3 years) and 2017-2018 (Mage = 22·0 years). RESULTS: The prevalence of regular breakfast, lunch and dinner consumption (≥ 5 times/week) ranged from 45 to 65 %, 75 to 89 % and 76 to 94 %, respectively, depending on weight status category. Among adolescents with a sex- and age-specific BMI < 15th percentile, regular consumptions of breakfast, lunch and dinner during adolescence were positively associated with BMI in emerging adulthood compared with irregular consumption of breakfast, lunch and dinner (<5 times/week) after adjustment for socio-demographic characteristics (ß = 5·43, ß = 5·39 and ß = 6·46, respectively; all P-values <0·01). Among adolescents in the BMI 15-85th and 85-95th percentiles, regular consumptions of breakfast, lunch and dinner were positively associated with BMI but to a lesser extent (P-values <0·01). For participants with a BMI ≥ 95th percentile, regular consumptions of breakfast, lunch and dinner were positively associated with BMI, but the associations were not statistically significant (P-values > 0·05). CONCLUSIONS: The relationship between meal consumption during adolescence and BMI in emerging adulthood differs by adolescent weight status. Future studies should investigate underlying factors related to meal consumption routines and BMI.

Adolescent sources of stress, stress levels, and associations between stress and changes in weight outcomes at the time of COVID-19 related school closure in March 2020.

Objective: Stress is associated with weight changes, yet how level and sources of stress relate to this association is poorly understood. This mixed methods study examined associations between adolescent stress at the COVID-19 pandemic onset and standardized BMI (BMIz) over a three-month period. Methods: Participants (N = 197, mean age 13.66 ± 1.43 years, 85% Hispanic, 56% female) were recruited from a charter school in Texas to participate in a healthy lifestyle intervention during physical education class. We calculated BMIz using height and weight measurements taken December 2019 and the week of COVID-19 school closures in March 2020. We measured stress in March 2020 with the 4-item Perceived Stress Scale. We ran a multiple linear regression model controlling for baseline BMIz (December 2019), age, sex, intervention condition, and assessed the interaction between baseline BMIz and PSS-4 score on BMIz change. Results: Overall, our sample had an average PSS-4 score of seven and mean BMIz decrease of 0.04 over the three-month period. We observed a significant interaction between PSS-4 score and baseline BMIz. At lower baseline BMIz scores, higher PSS-4 scores were associated with decreases in BMIz over time. There was no significant association at higher baseline BMIz scores. COVID-19 pandemic-related concerns and school performance were the two primary stressors reported. Conclusions: The relation between stress and weight changes differed based on starting weight status. Future interventions should consider the influence of external stressors on intervention adherence and outcomes.

More Than Identity: An Intersectional Approach to Understanding Mental-Emotional Well-Being of Emerging Adults by Centering Lived Experiences of Marginalization.

Understanding social determinants that shape pertinent developmental shifts during emerging adulthood (i.e., ages 18-25 years) and their associations with psychological health requires a nuanced approach. In our exploratory study, we investigated how multiple social identities and lived experiences generated by systems of marginalization and power (e.g., racism, classism, sexism) intersect in connection to the mental-emotional well-being of emerging adults (EAs). Eating and Activity Over Time (EAT, 2010-2018) data were collected from 1,568 EAs (mean age = 22.2 (standard deviation, 2.0) years) recruited initially in 2010 from Minneapolis/St. Paul schools. Conditional inference tree analyses were employed to treat "social location" and systems of marginalization and power as interdependent social factors influencing EAs' mental-emotional well-being outcomes: depressive symptoms, stress, self-esteem, and self-compassion. Conditional inference tree analyses identified EAs' subgroups with differing mean levels of mental-emotional well-being outcomes, distinguished primarily by marginalized social experiences (e.g., discrimination, financial difficulties) rather than social identities themselves. The relative positioning of EAs' experiences of social marginalization (e.g., discrimination) to their social identities (e.g., race/ethnicity) suggests that the social experiences generated by systems of privilege and oppression (e.g., racism) are more adjacent social determinants of mental-emotional well-being than the social identities used in public health research to proxy the oppressive systems that give them social meaning.

The Importance of Social Networks for Support and Health Beliefs throughout Pregnancy.

Pregnancy is a unique time when health care providers have more regular contact with women. Using this time to more fully understand the social influences at play can provide physicians an opportunity to leverage networks to improve health and wellbeing while stemming the exposure to health misinformation. Advocating for supportive social networks or exercise groups/programs can provide additional support and behavioral reinforcement which is needed for sustained behavior change. In this manner, fostering these networks is likely more beneficial to supporting healthy exercise behavior during pregnancy than education alone.

Exploratory Decision Trees to Predict Obesity Intervention Response among Hispanic American Youth.

Introduction: Individual variability in weight-related outcomes from obesity intervention is widely acknowledged, yet infrequently addressed. This study takes a first step to address individual variation by determining characteristics that distinguish responsive (improvements in BMI) from unresponsive individuals. Methods: Classification regression tree (CRT) analysis grouped 185 low-income, Hispanic American middle school students who received a school-based obesity intervention. Predictors included baseline age, gender, standardized BMI, health-related quality of life (PedsQL), minutes of moderate-vigorous physical activity (MVPA; accelerometry), energy consumption, and dietary quality (Block Kids 2004 Food Frequency Questionnaire). Response regarding weight-related outcomes to the intervention was defined according to the American Academy of Pediatrics (AAP) guidelines. Six trees were produced, one for 3- and one for 6-month outcomes among all participants, participants with healthy weight status, and participants with overweight/obesity at baseline. Results: The AAP criteria for response were met by 57.3% and 35.1% of participants at 3 and 6 months, respectively. CRT produced six unique trees. Notably, minutes of MVPA appeared twice (the first time at the top of the tree) in most 3-month models. In addition, response at 3 months consistently appeared as the first variable in all the 6-month models. Conclusions: Overall, the number of distinct pathways and the repeated appearance of the same variable within a pathway illustrate the complex, interactive nature of factors predicting an intervention response. Initially unresponsive individuals were unlikely to respond later in the intervention. More complex modeling is needed to better understand how to best predict who will be responsive to interventions.

Outcomes From Healthy Eating and Physical Activity Recognition Programs in Early Child Care and Education: A Scoping Review.

OBJECTIVE: Recognition programs are designed to incentivize early care and education (ECE) settings to implement childhood obesity prevention standards, yet little is known regarding their efficacy. This scoping review details characteristics, methodologies, and criteria used to evaluate recognition programs, identifies gaps in evaluation, and synthesizes existing evidence. DATA SOURCE: A public health librarian created the search strategies for six databases: Ovid MEDLINE, AGRICOLA, CAB Abstracts, PAIS Index, ERIC, and Scopus. STUDY INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria include recognition program, ECE setting, nutrition or physical activity, and qualitative or quantitative outcomes. Exclusion criteria include programming without recognition component, no ECE setting, no nutrition or physical activity outcome, case studies, or not written in English. DATA EXTRACTION: Three researchers independently extracted and complied data into an Excel spreadsheet. DATA SYNTHESIS: Tables were created describing location, recognition program criteria, award incentive, study design, study sample, risk of bias, and outcomes (e.g., menu nutrition) evaluated in each study. RESULTS: Three unique recognition programs (described in 7 studies) provided technical assistance, incentives, and training. While outcome measures and study designs varied across programs, it is clear that recognition programs are well accepted and feasible, and one study demonstrated beneficial weight outcomes. CONCLUSION: Although additional evaluation is needed, recognition programs may be a promising strategy to improve obesity prevention practices in ECE.

Helicopter Parenting Among Socio-Economically and Ethnically/Racially Diverse Emerging Adults: Associations with Weight-Related Behaviors.

Helicopter parenting, a parenting style defined by over-involvement, may lead to poor health outcomes. However, research has primarily focused on children and adolescents from White, high socio-economic families, with little research examining weight-related health or with emerging adult children. The current study examined associations with emerging adult diet, physical activity, and body mass index (BMI) among a diverse population-based sample of parent and emerging adult dyads (n = 919). Helicopter parenting was highest among lower socioeconomic households and those identifying as Black, Indigenous, or people of color. Helicopter parenting was associated with both healthy and less healthy dietary behaviors across ethnic/racial groups, but was not associated with physical activity or BMI. Greater consideration of the cultural context related to helicopter parenting is needed before making conclusions about its benefits or harms.

Response to school-based interventions for overweight and obesity: A systematic scoping review.

Heterogeneity of response to paediatric obesity interventions is one of the greatest challenges to obesity care. While evaluating school-based interventions by mean changes compared to control is important, it does not provide an understanding of the individual variability in response to intervention. The objective of this study was to comprehensively review school-based interventions that reported study results in terms of response and identify definitions of response used. A scoping review was conducted using a systematic search of five scientific databases from 2009 to 2021. Inclusion criteria included randomized controlled trial design, school-based setting, weight-based outcomes (e.g., BMI, BMI z-score), weight-based outcomes analysed among youth with overweight/obesity, a study conducted in a developed country and publication in English. A total of 26 reports representing 25 unique studies were included. Overall, 19% (5/26) of articles reported response. Response was defined in three ways: maintenance/decrease in BMI z-score, decrease in BMI z-score ≥0.10, and decrease in BMI z-score ≥0.20. Few school-based interventions identified an a priori intervention goal or identified the proportion of participants who responded to the intervention. Without such evaluation participants who do not benefit are likely to be overlooked.

Sport: A Holistic Approach to Lifestyle Medicine.

Sport represents a holistic health tool that unifies multiple pillars of lifestyle medicine. Sport can mitigate both the ongoing health disparities in communities that were present before COVID-19 and those exacerbated after COVID-19. The significance of this recommendation is highlighted by the impact sport participation has on creating healthy relationships, managing stress, and delivering physical activity among diverse populations. Importantly, sport can offer meaning and value to its participants, particularly when COVID-19 has limited people's ability for purposeful activity and social interaction. Clinicians are urged to consider the broad utility of sport for the prevention and treatment of unhealthy behaviors.

Experiences with Public Health Recommendations for COVID-19: A Qualitative Study of Diverse Mothers with Young Children in the United States.

Background: Despite the increased availability of vaccines, masking and social distancing remain important strategies to mitigate COVID-19 transmission. This qualitative study aimed to better understand experiences navigating public health recommendations to slow the spread of COVID-19 among economically and ethnically diverse mothers with young children. Methods: Mothers of preschoolers (n=25) were recruited from Project EAT 2010-2018 (Eating and Activity over Time) longitudinal cohort. Participants completed a virtual semi-structured interview about their experiences during COVID-19. Interview transcripts were coded using deductive and inductive content analysis and analyzed using thematic analysis to identify themes. Results: The first identified theme, "Selective adherence to recommendations" included subthemes highlighting how social distancing was more challenging than mask wearing, family and children were primary reasons for reduced adherence, and concern for the wellbeing of others influenced adherence. The second theme, "Personal experiences and relationships were important determinants of perceived severity of the virus and critical aspects of desired support," included subthemes on feelings of uncertainty, personal experiences with the virus, and desired community supports. Participants felt stressed and confused about what information to trust. Personal experiences with COVID-19 influenced perceptions of its seriousness, and mothers were more confident about following recommendations when they them from trusted medical professionals and desired for communities to work together. Conclusions: How findings among this diverse population of mothers can help inform future public health messaging and policies throughout the remainder of this pandemic, its aftermath, and future public health emergencies, in which masking and social distancing will be needed, are discussed.

Feasibility and Efficacy of the "FUNPALs Playgroup" Intervention to Improve Toddler Dietary and Activity Behaviors: A Pilot Randomized Controlled Trial.

This study evaluated the feasibility and effects of the Families Understanding Nutrition and Physically Active Lifestyles (FUNPALs) Playgroup on toddler (12-36-month-old) diet and activity behaviors. Parent-toddler dyads were recruited from disadvantaged communities and randomly assigned to receive 10-weekly sessions of the FUNPALs Playgroup (n = 24) or dose-matched health education control group (n = 26). FUNPALs Playgroups involved physical and snack activities, delivery of health information, and positive parenting coaching. The control group involved group health education for parents only. Process outcomes (e.g., retention rate, fidelity) and focus groups determined feasibility and perceived effects. To evaluate preliminary effects, validated measures of toddler diet (food frequency questionnaire and a carotenoid biomarker), physical activity (PA; accelerometers), general and feeding parenting (self-report surveys), and home environment (phone interview) were collected pre and post. The sample comprised parents (84% female) who self-identified as Hispanic/Latino (38%) and/or African American (32%). Retention was high (78%). Parents from both groups enjoyed the program and perceived improvements in their children's health behaviors. Objective measures demonstrated improvement with large effects (η2 = 0.29) in toddler diet (p < 0.001) but not PA (p = 0.099). In conclusion, the FUNPALs Playgroup is feasible and may improve toddler eating behaviors.

A staged approach to address youth unresponsive to initial obesity intervention: a randomized clinical trial.

BACKGROUND/OBJECTIVE: Maintenance interventions inherently require BMI improvement to maintain. This overlooks individuals initially unresponsive to obesity interventions. Staged pediatric clinical treatment guidelines were adapted to the school setting to develop an escalated treatment option for individuals initially unresponsive. This staged randomized controlled trial examined differences between escalated treatment (Take CHARGE!) and a maintenance program (PE Planners). Take CHARGE was hypothesized to have greater improvements in BMI as a percentage of the 95th BMI Percentile (%BMIp95) than PE Planners. SUBJECTS/METHODS: From 2018 to 2020, 171 middle and high schoolers (BMI Percentile ≥ 85) were recruited from a Houston school district to participate in a staged obesity intervention in their physical education (PE) class. After receiving a semester-long intensive lifestyle intervention (ILI) with established efficacy, all participants were randomized to Take CHARGE (n = 85) or PE Planners (n = 86). Take CHARGE escalated the behavioral treatment of obesity received in ILI with more frequent individual sessions, additional opportunities for parental and school staff involvement, and increased mentorship from trained college students. PE Planners allowed participants to decide how they wanted to be active in PE class. Mixed linear modeling examined %BMIp95 overtime between groups. This trial was registered at ClinicalTrials.gov (#NCT04362280). RESULTS: Participants were 13.63 ± 1.32 years old; 59% were female, and 85% were Hispanic. Among those initially unresponsive to ILI, Take CHARGE had significantly greater decreases in %BMIp95 than PE Planners (ß = -0.01, p < 0.01). Conversely, among those initially responsive, Take CHARGE had significantly smaller decreases in %BMIp95 than PE Planners (ß = 0.02, p < 0.05). Intention-to-treat analysis had similar results. CONCLUSIONS: Participant outcomes in semester two differed based on initial response. Individuals responsive to initial intervention were most likely to benefit from a maintenance intervention and those initially unresponsive benefited more from escalated treatment. This indicates the need for staged intervention protocols to better address obesity in the school setting.

Do emerging adults know what their friends are doing and does it really matter? Methodologic challenges and associations of perceived and actual friend behaviors with emerging adults' disordered eating and muscle building behaviors.

Disordered eating and muscle building behaviors are common among emerging adults, and friends may be a particularly salient social influence. Epidemiologic research often includes questions about participants' perceptions of their friends. A less common approach, with greater logistical challenges, is to ask for friend nominations and then survey friends about their actual behaviors. The comparability of these different approaches is unknown. This study addresses the following research questions: 1) What is the feasibility of collecting data from emerging adults' friends in epidemiologic research? 2) Do perceptions of friends' weight- and shape-related behaviors align with friends' actual behaviors? and 3) Are perceptions or friends' actual behaviors more strongly and consistently associated with emerging adults' behaviors? Participants (N = 2383) in the EAT (Eating and Activity over Time)-2018 study in Minnesota, USA, were asked to nominate up to three friends and provide data about those friends' weight- and shape-related behaviors (i.e. perceptions); nominated friends were invited to complete an abbreviated survey and report on their own same behaviors (i.e. actual). Among the invited friends, 191 responded and were linked to the 152 EAT 2018 participants who nominated them. Descriptive statistics, Spearman's correlations, and logistic regression were used to address the research questions. The response rate for nominated friends was very low (9.9%), suggesting this approach may have low feasibility for epidemiologic studies of emerging adults. Emerging adults' perceptions of their nominated friends' weight and shape-related behaviors generally did not align well with the behaviors reported by those friends. Furthermore, analytic models found different associations between friends' behavior and EAT 2018 participant behaviors, depending on the measure of friends' behavior used (perceived or actual). Careful consideration of the pros and cons of each study design is essential to build an evidence base and support interventions regarding emerging adults' weight- and shape-related health.

The Health of Health Care Professionals.

Health care professionals represent a population at high risk for poor health. Although this may be counterintuitive given their expertise in health, the high stress and long hours of many medical work environments present challenges for health care professionals to engage in healthy lifestyle behaviors. This is extremely problematic for the health and well-being of both health care professionals and the patients they treat. Medical settings are encouraged to implement interventions that intervene at both the enviornmental and personal level to help faciliate behavior change among health care providers.

Randomized Controlled Trial to Increase Physical Activity Among Hispanic-American Middle School Students.

BACKGROUND: Moderate-to-vigorous physical activity (MVPA) declines during adolescence, particularly among girls. In this randomized control trial, we examined MVPA in a physical activity intervention compared to physical education (PE) class as usual (TAU), stratified by sex and weight classification. Standardized BMI (zBMI) overtime was also examined. METHODS: Hispanic-American middle school students (N = 193) were recruited from a school district in Houston, Texas. Participants were randomized to either a circuit-based physical activity intervention or TAU (PE class as usual). MVPA was assessed using accelerometry at baseline and 6 months. Repeated measures ANCOVA were conducted to examine changes in MVPA, overall and stratified by sex and weight classification. This procedure was repeated for zBMI. RESULTS: Participants were 12.10 ± 0.63 years old and 53% were girls. Overall those in intervention increased weekday MVPA more than TAU (F(1,190) = 7.03, p < .01). Intervention girls increased weekday MVPA; whereas TAU girls decreased weekday MVPA (F(1,99) = 7.36, p < .01). Among those with obesity, there was no difference in MVPA between conditions (F(1, 56) = 0.33, p = .57), but Intervention decreased zBMI significantly more than TAU (F(1, 56) = 6.16, p < .05). CONCLUSIONS: Structured PE classes grounded in behavioral theory may be an important strategy to prevent typical decreases in MVPA during adolescence, particularly among girls and for youth with obesity.

Development and Validation of a Questionnaire to Assess Barriers and Facilitators to Physical Activity among Hispanic Youth.

INTRODUCTION: The objective of this study was to develop and validate a questionnaire to better understand barriers and facilitators to physical activity among low-income, Hispanic youth. METHODS: Low-income Hispanic middle and high school students were recruited to participate in this study from a public charter school district in Houston, TX. Questionnaire development and psychometric validation included scale development and question pretesting, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), construct validity, and test-retest reliability of the scales. RESULTS: EFA resulted in three subscales for the Barriers to Youth Physical Activity (BYPA) scale: competing interests, environmental interests, and social barriers. CFA suggested that this three-factor model fit data adequately after removing two items that had high loading on all three factors. The BYPA subscales were internally consistent and stable. All three BYPA subscale scores were negatively correlated with self-reported physical activity. EFA for the facilitators to youth physical activity (FYPA) scale resulted in three subscales: enjoyment, family support, and socialization. CFA suggested that this three-factor model fit data adequately after removing one item that had high loading on all three factors. The FYPA subscales were internally consistent and stable. All three FYPA subscale scores were significantly positively correlated with physical activity. CONCLUSIONS: The development and validation of the BYPA and FYPA scales resulted in a total of six valid subscales for assessing barriers and facilitators to physical activity among low-income, Hispanic youth. The developed subscales have the potential to assist future efforts in designing physical activity interventions to better address disparities in physical activity levels among this population.

Parent Feeding Practices in the Context of Food Insecurity.

The process of feeding is complex and highly dependent on parent, child, social, and environmental factors. Given the rising rates of food insecurity and concomitant poor nutrition and health, the purpose of this article was to outline the important and complex ways in which the context of food insecurity can impact parent feeding practices. Key factors discussed here include the impact of food insecurity on: expectations for motherhood, structural constraints, stress and depression, parents' perceptions of health and child weight, and intergenerational transmission of parent feeding practices. Future research needs are also identified and discussed.

The Role of Early and Later Response on Overall Outcomes in School-Based Obesity Intervention.

OBJECTIVE: Early response to obesity intervention consistently predicts long-term BMI reductions. However, little is known about how changes in weight at other times in an intervention may impact long-term outcomes. This study examined the relationship between weight-related changes that occurred early and later during an intervention and the association between these changes with overall outcomes. METHODS: A secondary analysis of a school-based obesity intervention with replicated efficacy among Hispanic middle school students was conducted (n = 174). Linear regression models were developed in which first and second semester changes in BMI represented as a percentage of the 95th BMI percentile (%BMIp95) were separately used to predict overall %BMIp95 outcomes. First semester changes in %BMIp95 were used to predict subsequent %BMIp95 change (i.e., second semester). RESULTS: Changes in %BMIp95 during both the first and second semesters were independently associated with overall changes from baseline (e.g., at 24 months: first semester, ß = 0.59, P < 0.01; second semester, ß = 1.02, P < 0.001). First semester %BMIp95 change was not associated with second semester change (ß = -0.07, P = 0.32). CONCLUSIONS: Change at any point during the intervention was predictive of overall weight outcomes. Additional research is needed to understand patterns of weight changes throughout interventions to better understand long-term outcomes.